American Journal of Ophthalmology最新文献

{"title":"Anti-Acetylcholine Receptor antibodies in Tear for the Diagnosis of Ocular Myasthenia Gravis.","authors":"Cheng Lu,Yuanting Yang,Yuying Dong,Ting Tang,Jian Chen,Yingwei Wang,Zheng Wu,Qing Zhou","doi":"10.1016/j.ajo.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.013","url":null,"abstract":"BACKGROUND AND OBJECTIVEOcular myasthenia gravis (OMG) significantly affects patients' quality of life. However, conventional serum assays often fail to detect anti-acetylcholine receptor (AChR) antibodies in more than half of OMG cases, complicating accurate diagnosis. Given the immunological role of tears in the ocular environment, they may serve as a viable alternative for antibody detection. This study investigates the utility of tear-based anti-AChR antibody detection as a diagnostic tool for OMG and compares its performance with that of serum-based cell-based assays (CBAs).DESIGNProspective diagnostic testing validity evaluation.METHODSA total of 65 participants were enrolled, including 52 patients diagnosed with OMG and 13 healthy controls. Anti-AChR antibodies were assessed in both serum and tear samples using CBAs. Diagnostic performance metrics were compared between the two sample types, and correlations between antibody levels and clinical severity were analyzed.RESULTSTear-based CBA demonstrated significantly superior diagnostic accuracy (AUC = 0.926, P < 0.0001) compared to serum-based CBA (AUC = 0.656, P = 0.0836). The sensitivity of tear CBA was 80.8% (95% CI: 68.1%-89.2%), markedly higher than that of serum CBA at 42.3% (95% CI: 29.9%-55.8%). Among the 42 seronegative OMG patients, 83.3% tested positive using tear CBA, whereas only 40.5% were positive via serum CBA (P < 0.0001). Notably, tear anti-AChR antibody levels did not show a consistent correlation with symptom severity.CONCLUSIONSTear-based detection of anti-AChR antibodies offers a non-invasive, highly sensitive diagnostic approach for OMG, particularly beneficial in cases where serum tests are negative. This method holds promise for improving early diagnosis and clinical decision-making in OMG management.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"78 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Glucagon-like Peptide-1 Receptor Agonists with Optic Nerve and Retinal Adverse Events: A Population-Based Observational Study Across 180 Countries.","authors":"Moiz Lakhani,Angela Th Kwan,Andrew Mihalache,Marko M Popovic,Keean Nanji,Jim S Xie,Alessandro Feo,David Rabinovitch,Reut Shor,SriniVas Sadda,David Sarraf,Bernard Hurley,Edward A Margolin,Peter J Kertes,Varun Chaudhary,Rajeev H Muni","doi":"10.1016/j.ajo.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.007","url":null,"abstract":"PURPOSEGlucagon-like peptide-1 receptor agonists (GLP-1 RAs) are important therapeutic options for type 2 diabetes and obesity; however, concerns about ophthalmic safety persist. This study examined associations between GLP-1 RAs and ocular adverse events (AEs).DESIGNGlobal observational pharmacovigilance study.METHODSWe searched the US FAERS database (via OpenVigil 2.1) and WHO's VigiBase (via VigiAccess) for optic nerve and retinal AEs associated with semaglutide and tirzepatide, covering the period from their respective approval dates-December 2017 for semaglutide and May 2022 for tirzepatide-through September 2024. In FAERS, all other drugs were compared, while in VigiBase, metformin, empagliflozin, dulaglutide, and insulin served as controls. Disproportionality metrics included reporting odds ratios (RORs) with 95% confidence intervals.RESULTSSemaglutide and tirzepatide accounted for 76,444 cases (0.59%) in FAERS (n=12,936,341) and 118,639 cases (0.34%) in VigiBase (n>35,000,000). Semaglutide showed significantly higher odds of ischemic optic neuropathy (ION) (FAERS: ROR=11.12, 95%CI=8.15-15.16; VigiBase: ROR=68.58, 95%CI=16.75-280.67), diabetic retinopathy (DR) (FAERS: ROR=17.28, 95%CI=13.62-21.91; VigiBase: ROR=7.81, 95%CI=5.60-10.90), as well as retinal/vitreous detachment, retinal/vitreous hemorrhage, and retinal tear (FAERS: ROR=2.44-5.89, 95%CI=1.70-8.97, all p<0.001, IC025=0.49, compared to all other drugs. VigiBase: ROR=5.49-20.91, 95%CI=2.71-90.11, all p≤0.0001, IC025≥0.53, compared to metformin). Unique to VigiBase were macular edema (ROR=3.87, 95%CI=1.89-7.92), macular hole (ROR=20.90, 95%CI=2.65-165.01), and papilledema (ROR=6.97, 95%CI=2.53-19.17) (all p≤0.004, IC025≥0.27, compared to metformin). Sensitivity analyses using empagliflozin and dulaglutide revealed significant associations with ION and DR, while vitreous detachment and hemorrhage were significant when compared to dulaglutide. Additionally, when insulin was used as a comparator, semaglutide showed a higher ROR for ION (ROR=9.84, 95%CI=4.25-22.81, P<0.0001, IC025=0.42). However, tirzepatide was only significantly associated with DR in FAERS.CONCLUSIONSGiven the widespread use of semaglutide, its association with ocular AEs highlight the need for global pharmacovigilance and post-marketing surveillance.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"32 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Terms Retinal Vasculopathy and Retinal Vasculitis Require Clarification.","authors":"James T Rosenbaum,William Rojas-Carabali,Carlos Cifuentes-González,Marc D de Smet,Sapna Gangaputra,Vishali Gupta,Rupesh Agrawal","doi":"10.1016/j.ajo.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.009","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"35 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of 11 intraocular lens power calculation formulas in eyes undergoing simultaneous cataract surgery and Descemet membrane endothelial keratoplasty.","authors":"Eva Sapok,Klemens Paul Kaiser,Thomas Kohnen,Ingo Schmack","doi":"10.1016/j.ajo.2025.04.041","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.04.041","url":null,"abstract":"PURPOSETo evaluate the accuracy of 11 intraocular lens (IOL) calculation formulas in eyes undergoing Descemet membrane endothelial keratoplasty (DMEK) combined with cataract surgery (triple DMEK).DESIGNRetrospective accuracy and validity analysis with a consecutive case series.METHODSWe included 80 eyes of 80 patients (52 females, 28 males) with a mean age of 67.08 ± 7.64 years (range: 45 to 83 years) receiving triple DMEK at the Department of Ophthalmology, Goethe University, Frankfurt, Germany between 2016 and 2023. Preoperative biometry measurements were obtained from IOLMaster 700 (Carl Zeiss Meditec). Statistic evaluation was performed by comparison of the mean prediction error (ME) and the mean and median absolute prediction error (MAE and MedAE). Calculations were performed with and without adjustment by the \"IOLup1D\" method for all formulas.RESULTSAdjusted IOLup1D formulas showed better results than the unadjusted formulas. The MedAE was lowest for Barrett Universal II (IOLup1D) (0.64 diopters [D]) followed by Postoperative spherical Equivalent prediction using Artificial intelligence and Linear algorithms, by Debellemaniére, Gatinel, and Saad (IOLup1D) (0.66 D), Emmetropia Verifying Optical (IOLup1D) (0.67 D), Holladay 2 (IOLup1D) (0.70 D), Hoffer Q Savini/Taroni (IOLup1D) (0.71 D), Kane (IOLup1D) and T2 (IOLup1D) (0.72 D each), Haigis (IOLup1D) and Holladay 1 (IOLup1D) (0.73 D each). The highest MedAE were found with Hill-Radial Basis Function (IOLup1D) and Sanders-Retzlaff-Kraff/theoretical (IOLup1D) (both 0.74 D). Regarding eyes within prediction errors of ±0.50 D, again Barrett Universal II (IOLup1D) (40.0%) performed best. The lowest percentage of eyes within a predicted refraction of ±0.50 D were seen with the Emmetropia Verifying Optical (IOLup1D), Kane (IOLup1D) and Holladay 2 (IOLup1D) (33.8% each).CONCLUSIONPrediction of the postoperative refraction in eyes requiring cataract surgery and DMEK is still challenging and not as accurate, as in healthy eyes without corneal abnormalities. In our case series, the Barrett Universal II formula achieved the overall best results. Although not being statistically significant, this outcome should be taken into account, when calculating IOL power in patients undergoing cataract surgery combined with DMEK.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"8 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glaucoma Surgery Comparison: SIBS Microshunt vs. Gelatin 45um Microstent vs. Trabeculectomy as Primary Surgical Interventions: Microshunt vs. Gelatin 45um Microstent vs. Trabeculectomy.","authors":"James J Armstrong,Ticiana De Francesco,Henny J Beckers,Ingeborg Stalmans,Antonio M Fea,Chelvin C A Sng,Juan F Batlle,Matthew B Schlenker,Iqbal Ike K Ahmed","doi":"10.1016/j.ajo.2025.05.011","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.011","url":null,"abstract":"PURPOSECompare surgical success, risk factors and post-operative course of the SIBS microshunt, gelatin 45μm microstent, and trabeculectomy with mitomycin C (MMC) as a primary surgical intervention in patients with glaucoma. We present a multicenter,12-month, retrospective, non-randomized, interventional case series.DESIGNMulticenter,12-month, retrospective, non-randomized, interventional case series.METHODSConsecutive patients with glaucoma on maximally tolerated medical therapy received either primary SIBS microshunt, gelatin 45um microstent, or trabeculectomy with MMC as a stand-alone procedure at one of six participating centers (Canada, Italy, Netherlands, Belgium, Singapore, Dominican Republic) from August 2015 to August 2020. Main outcome measures were proportion of eyes at 12-months with (1) no two consecutive IOPs > 17 mmHg or clinical hypotony (IOP < 6 mmHg with a loss of> 2 lines of vision), without (complete) or with (qualified) glaucoma medications; and (2) ≥20%reduction from baseline IOP. Secondary outcomes included IOP thresholds of 14 mmHg and 21 mmHg, median IOP, medications, risk factors, post-operative interventions, complications, and reoperations.RESULTSRecords from 577 eyes from 521 patients with SIBS microshunt (n=235), gelatin 45μm microstent (n=201) or trabeculectomy (n=141) were included. Baseline decision IOP was lower in the SIBS group and baseline number of glaucoma medications was also lower in the SIBS and trabeculectomy groups. After 12-months follow up, complete success occurred in 68.8% of patients with SIBS microshunt, 46.2% with gelatin 45μm microstent and 58.0% with trabeculectomy (p=0.0002). Qualified success occurred in 89.7%, 70.1% and 83.6% of eyes, respectively (p=0.0002). In the multivariate analysis, eyes receiving a gelatin 45μm microstent relative to SIBS microshunt (HR 2.0; 95%CI 1.5 - 2.7), trabeculectomy relative to SIBS microshunt (HR 1.6; 95%CI 1.2 - 2.2), or intra-operative MMC dose less than 0.4mg/ml (HR 1.5; 95%CI 1.1 - 2.0) was significantly associated with failure. Complications occurred in 33.6%, 42.8% and 56% of eyes (p= 0.0001); needling in 12.3%, 29.9% and 22% (p<0.0001); revisions in 10.6%, 8.5% and 8.5% (p=0.68); and reoperations in 5.5%, 13.9% and 7.8% (p<0.001) with SIBS microshunt, gelatin 45μm microstent, or trabeculectomy, respectively.CONCLUSIONOverall, patients with the SIBS microshunt achieved higher success rates compared to both trabeculectomy and the gelatin 45μm microstent group, with fewer postoperative complications, interventions, and reoperations for glaucoma.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"30 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144083305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of biologics in pediatric non-infectious retinal vasculitis.","authors":"Irmak Karaca,Zheng Xian Thng,Albert Bromeo,Azadeh Mobasserian,Jia-Horung Hung,Amir Akhavanrezayat,Ngoc Trong Tuong Than,Cigdem Yasar,Negin Yavari,Dalia El Feky,Osama Elaraby,Anh Ngoc Tram Tran,Xiaoyan Zhang,Aim-On Saengsirinavin,Frances Andrea Anover,Yue Bai,Jingli Guo,Chi Mong Christopher Or,Diana V Do,Quan Dong Nguyen","doi":"10.1016/j.ajo.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.002","url":null,"abstract":"PURPOSETo assess the efficacy and safety of adalimumab (ADA) injections (Group 1), infliximab (IFX) (Group 2), and tocilizumab (TCZ) (Group 3) infusions in pediatric non-infectious retinal vasculitis (RV).DESIGNRetrospective interventional case series.METHODSPediatric patients who were diagnosed with non-infectious RV and treated with biologics (ADA, IFX, TCZ) for ≥6 months were included. Chart review of 11 patients (18 eyes), 17 patients (30 eyes), and 7 patients (11 eyes) in Group 1, 2 and 3, respectively, was performed to assess clinical characteristics, central subfield thickness (CST), and fluorescein angiography (FA) score using the Angiographic Scoring for the Uveitis Working Group (ASUWOG) system.RESULTSMean age was 13.5±4.3 years in Group 1, 11.8±2.5 years in Group 2, and 13.9±4.1 years in Group 3 (p=0.332). Eight patients (72.7%, 13 eyes) in Group 1, and 14 patients (82.4%, 24 eyes) in Group 2 were biologic-naïve, whereas in Group 3 all patients were treated with ADA and/or IFX prior to TCZ. Mean FA scores were significantly reduced from 6.8±2.6, 13.4±4.8, and 12.8±4.0 at baseline to 0.9±2.3, 3.6±4.6, and 4.4±3.9 at final visit in Group 1, 2, and 3, respectively (p<0.05). Complete RV resolution was observed in 12 (66.7%), 13 (43.3%), and 1 (9.1%) eyes; mean time to complete resolution was 11.0±5.0, 13.3±5.8, and 23 months in Group 1, 2, and 3, respectively. No significant adverse events were observed in any group, except hair loss in one patient which led to discontinuation of IFX infusions after 20 cycles of therapy.CONCLUSIONADA, IFZ, and TCZ are effective and safe treatment options for pediatric non-infectious RV as objectively shown by FA scoring. TCZ appears as an effective therapy for patients with JIA-associated RV or those who failed TNF-α inhibitors.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"121 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OPHTHALMOLOGICAL AND GENETIC PROFILE IN KNOBLOCH SYNDROME: Ocular and Genetic Features of Knobloch Syndrome.","authors":"Sengul Ozdek,Ece Ozdemir Zeydanli,Gulsum Kayhan,Ebru Yalcin,H Baran Ozdemir,M Ali Ergun,Kenan Sonmez,Arif O Khan,Nicola G Ghazi","doi":"10.1016/j.ajo.2025.05.003","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.003","url":null,"abstract":"PURPOSETo analyze the clinical and genetic characteristics of Knobloch syndrome in a large cohort, with a focus on retinal detachment (RD) characteristics, surgical outcomes, and variants in the COL18A1 gene.DESIGNRetrospective, multicenter interventional/observational case series.SUBJECTSThirty-four patients (68 eyes) with clinically and genetically confirmed Knobloch syndrome were included.METHODS, INTERVENTION, OR TESTINGData were collected from three institutions, including demographics, clinical findings, surgical techniques and outcomes, and genetic testing results. Surgical success was defined as retinal reattachment after silicone oil removal. Genetic testing was performed for the COL18A1 gene to identify pathogenic variants.MAIN OUTCOME MEASURESThe primary outcomes included the prevalence and characteristics of RD, surgical success rates, and the identification of pathogenic variants in COL18A1.RESULTSThe median age at diagnosis was 24 months, with consanguinity noted in 76% of cases. RD occurred in 50% of eyes, with a median onset of 2.5 years. Macular hole (MH)-related RD accounted for 57% of cases and presented early (median age: 11 months). Surgical success after the first procedure was 54%, improving to 69% after reoperation. The use of Tenon's capsule or amniotic membrane grafts in 69% of MH-RD cases doubles the reattachment rate (82% vs. 40%). Genetic testing identified 14 COL18A1 variants, including nine novel variants.CONCLUSIONSKnobloch syndrome presents significant diagnostic and surgical challenges: early-onset RD, small flap-shaped MHs that are easily overlooked, and an abnormally adherent vitreoretinal interface. Early recognition of MH-RD and the use of grafts during surgery can improve anatomical outcomes. While the ocular phenotype is often pathognomonic, genetic testing aids in confirming the diagnosis and guiding counseling. Understanding these clinical and surgical challenges may improve outcomes in patients with this rare disorder.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"24 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators of Implementing a Community and Faith-Based Intervention to Increase Eye Care Utilization in Black Americans.","authors":"Dominique A Alexis,Olivia L Johnson,Charles E Williams,Paula Anne Newman-Casey,Gretchen A Piatt,Angela R Elam","doi":"10.1016/j.ajo.2025.05.006","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.006","url":null,"abstract":"Purpose To identify the determinants to successfully implement a community-based intervention to increase eye care utilization in individuals at high-risk for glaucoma. Design Qualitative study with semi-structured interviews Methods Semi-structured qualitative interviews were conducted with community members in Detroit, Michigan at a trusted community site. Participants were Black Americans at least 40 years of age. A codebook of themes was developed through an iterative process and analyzed using Dedoose. Results Narrative themes emerged under two overarching categories: barriers and facilitators. The number of themes identified were 15 and 14 for barriers and facilitators, respectively. All perceived barriers and facilitators fell into one or more domains of the social determinants of health model. Conclusion Identifying facilitators and eliminating barriers to eye care in Black and low-income communities is essential to successful implementation of interventions to increase eye care utilization. Understanding how these determinants align with social determinants of health may be helpful in designing community-based interventions. Community-based participatory research methods are critical to achieving equity in eye care.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"53 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fern-Like Retinal Vasculopathy in Intermediate Uveitis: Pathogenesis, Natural History, and Clinical Implications.","authors":"Maria Vittoria Cicinelli,Costanza Barresi,Makan Ziafati,Lorenzo Bianco,Prithvi Ramtohul,Francesco Bandello,Elisabetta Miserocchi","doi":"10.1016/j.ajo.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.008","url":null,"abstract":"PURPOSETo investigate peripheral vascular changes and their progression in intermediate uveitis characterized by a fern-like leakage pattern and examine their relationship with macular vascular changes to elucidate their pathogenesis, natural history, and clinical implications.DESIGNRetrospective, observational case series with healthy-eyes comparison.PARTICIPANTS43 eyes (28 patients) with intermediate uveitis (mean age 31±16 years, 58% female) followed for an average of 18 months, compared with 41 healthy control eyes.METHODSUltra-widefield fluorescein angiography (UWF-FA) images were analyzed. Vessel Length Density (VLD), Fractal Dimension (FD), and Branchpoints Density (BPD) were compared across different leakage extents (posterior pole/diffuse[Zone 1], mid-periphery[Zone 2], and far periphery[Zone 3]) and control eyes using linear mixed-effects models. The foveal avascular zone (FAZ) was manually traced.MEAN OUTCOME MEASURESQualitative retinal changes and quantitative measures of VLD, FD, and BPD across three concentric temporal retina sectors.RESULTSEarly-phase UWF-FA revealed substantial alterations in study eyes, including dilated capillary channels, reduced capillary branching, delayed venous filling, and telangiectatic post-capillary dilations, primarily in non-perfused regions. Eyes with intermediate uveitis showed significantly lower VLD, FD, and BPD than controls, particularly in the far peripheral retina, with the most pronounced reductions in eyes with diffuse leakage [Zone 1](interaction p-values: 0.04 for VLD, 0.007 for FD, and 0.045 for BPD). Negative correlations were observed between these vascular metrics and enlarged FAZ areas, suggesting a potential association between peripheral and macular perfusion (all p < 0.05). Fern-like leakage persisted with reduced intensity despite immunosuppression; some vascular changes progressed, while others, such as non-perfusion and neovascularization, showed possible reversibility.CONCLUSIONThis study identifies \"Fern-Like Retinal Vasculopathy\" as a distinctive vascular pattern observed in at least some forms of intermediate uveitis, characterized by chronic vascular remodeling. Recognizing these peripheral vascular changes is clinically important, as emphasizing such patterns in practice may refine treatment strategies, reduce unnecessary long-term immunosuppression, and improve the management of young adults affected by this condition.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"42 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IOL power calculation project: accuracy of 36 formulas.","authors":"Oleksiy V Voytsekhivskyy,Kenneth J Hoffer,David L Cooke,Giacomo Savini","doi":"10.1016/j.ajo.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.004","url":null,"abstract":"PURPOSETo ascertain the refractive accuracy of 36 intraocular lens (IOL) power calculation formulas in unoperated eyes.DESIGNRetrospective accuracy and validity analysis.PARTICIPANTSSix hundred fifty-five patients undergoing phacoemulsification and implantation of the Tecnis 1 ZCB00 IOL (Johnson & Johnson Vision, Jacksonville, FL, USA).METHODSThirty-six formulas were evaluated including some that have never been tested, such as 3C 2.0, Eom, Hoffer H, Hoffer H-5, Fam adjusted methods, Norrby Regression Formula (Norrby RF), Norrby thin lens paraxial Ray-Tracing (Norrby RT), and VRF Cooke modified axial length (VRF CMAL). Optical biometry with the IOLMaster 700 (Carl Zeiss Meditec AG) was performed preoperatively. All descriptive statistics and the percentage of eyes within prediction error thresholds were evaluated with optimized lens constants.MAIN OUTCOME MEASURESThe Formula Performance Index (FPI) and Formula Performance Index for subgroup (FPI sub) were used as the primary formula outcomes.RESULTSThe highest FPI indexes were yielded by the VRF-G (0.590), Hoffer QST (0.575), VRF CMAL (0.574), Eom (0.572), EVO 2.0 (0.569), and Kane (0.568) formulas. The heteroscedastic test revealed statistically significant differences (P < 0.05) among formulas. The standard deviation (SD) of VRF-G (0.353 D), EVO 2.0 (0.362 D), Kane (0.366 D), Hoffer QST (0.371 D), and Eom (0.372 D) were lower than other methods (P < 0.05). The highest percentage of eyes with a PE within ±0.50 D was achieved by VRF-G (87.48%), Kane (86.41%), Hoffer QST (86.26%), and PEARL-DGS (86.26%).CONCLUSIONContemporary IOL power calculation formulas (Eom, EVO 2.0, Hoffer QST, VRF CMAL, and VRF-G) improved accuracy in all axial length ranges compared to traditional and updated methods. The CMAL method raised the accuracy of the VRF formula.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"148 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}