American Journal of Ophthalmology最新文献

{"title":"Cost-Effectiveness of Photobiomodulation for Intermediate Dry Age-Related Macular Degeneration: A Model-Based Analysis Using the LIGHTSITE III 24-Month Trial.","authors":"Arjun Watane, Andre Witkin, Jeffrey Heier, Chirag Shah","doi":"10.1016/j.ajo.2026.07.035","DOIUrl":"10.1016/j.ajo.2026.07.035","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the cost-effectiveness of photobiomodulation (PBM) for intermediate dry age-related macular degeneration (AMD) from the US healthcare payer perspective, using 24-month LIGHTSITE III trial data.</p><p><strong>Design: </strong>Model-based cost-effectiveness analysis using a 5-state Markov model with 6-month cycles over a 10-year horizon, discounting costs and outcomes at 3% annually.</p><p><strong>Participants: </strong>Modeled cohort of adults with bilateral intermediate dry AMD and best-corrected visual acuity (BCVA) 20/32-20/100, consistent with LIGHTSITE III eligibility.</p><p><strong>Methods: </strong>Transition probabilities were derived from LIGHTSITE III 24-month outcomes and AREDS natural history data. Costs were derived from 2025 Medicare Physician Fee Schedule and published claims-based sources. One-way and probabilistic sensitivity analyses, a societal perspective, a 2-year limited treatment scenario, and a 5-year national budget impact analysis were conducted.</p><p><strong>Main outcome measures: </strong>Quality-adjusted life-years (QALYs) derived from published visual acuity-to-utility mapping and VFQ-25-to-EQ-5D conversion of LIGHTSITE III quality-of-life data; incremental cost-effectiveness ratio (ICER) as cost per QALY; 5-year national budget impact.</p><p><strong>Results: </strong>PBM yielded 5.244 discounted QALYs at an incremental cost of $29,556 over 10 years, producing a base-case ICER of $73,910 per QALY, below both the $100,000 and $150,000 US willingness-to-pay thresholds. The ICER ranged from $36,700 ($1,000/course) to $117,694 per QALY (30% geographic atrophy [GA] reduction) across clinically realistic scenarios. Only the $5,000/course scenario exceeded both thresholds. The 5-year cumulative national budget impact was $25.0 billion at 20% uptake.</p><p><strong>Conclusions: </strong>PBM is cost-effective at conventional US willingness-to-pay thresholds, driven primarily by a 71.7% relative reduction in incident GA at 24 months. These findings support coverage consideration of PBM for intermediate dry AMD, pending independent replication of the GA reduction and prospective EQ-5D data collection.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"324-333"},"PeriodicalIF":4.7,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590205","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":"Renal Impairment and Age-related Macular Degeneration: A Comprehensive Systematic Review and Meta-Analysis.","authors":"Anas Alamoudi, Ahmed Alnabihi, Naif Almufarriji, Muhannad Hatem Bin Sawad, Khalid W Helmi, Waleed Batais, Lama Adnan Althagafi, Abdulaziz Aiyidh S Aljiayyd, Hatim Batawi, Mohammed Abdulkarem","doi":"10.1016/j.ajo.2026.07.046","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.07.046","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Topic: &lt;/strong&gt;Chronic kidney disease (CKD) and age-related macular degeneration (AMD) share vascular and inflammatory pathways. Clarifying their association could inform risk stratification across nephrology and ophthalmology.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;In adults with renal impairment, especially those with more advanced kidney dysfunction, closer AMD risk surveillance may be warranted, supporting integrated care between ophthalmology and nephrology even though causality cannot be fully confirmed from observational evidence alone.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We systematically searched MEDLINE, Embase, Scopus, and Web of Science from inception to 11 August 2025. Eligible human observational studies and Mendelian randomization (MR) analyses assessed CKD/renal metrics (eGFR, albuminuria/proteinuria, dialysis) in relation to AMD. Random-effects meta-analyses used REML with Hartung-Knapp adjustments, and pooled evidence using odds ratios (ORs) and 95% confidence intervals (95%CI). Heterogeneity was quantified using I², subgroup analyses explored design, phenotype, and CKD severity, and small-study effects were assessed using funnel plots and Egger's test when appropriate. Certainty of evidence was rated using the GRADE prognostic-factor framework.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nineteen studies contributed to the primary meta-analysis. CKD was associated with higher odds of AMD (OR = 1.27, 95% CI 1.07-1.50; I² = 95.1%). Effects were similar by design (P for subgroup difference = 0.84): cohorts OR = 1.29 (0.98-1.69) and cross-sectional studies OR = 1.25 (0.96-1.62). By phenotype, associations were significant for non-exudative AMD (OR = 1.46, 1.06-1.99), while exudative AMD showed an imprecise increase (OR = 1.71, 0.72-4.08), and early AMD was not statistically significant (OR = 1.32, 0.90-1.93). CKD severity analyses suggested significantly higher odds with eGFR &lt;60 mL/min/1.73 m² (OR = 1.40, 1.15-1.72), and a stronger association in dialysis ≥90 days (OR = 1.74, 1.52-2.00). Continuous renal markers aligned with a biological gradient (per SD decrease in eGFR OR = 1.30, 1.11-1.52). Two Mendelian randomization studies supported a causal association between lower eGFR and AMD (pooled OR = 1.65, 1.54-1.76). Overall certainty ranged from moderate (any AMD overall, non-exudative AMD, dialysis exposure, MR) to low/very low for most subgroups due to heterogeneity and imprecision.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Renal impairment, particularly reduced eGFR (&lt;60 mL/min/1.73 m²), elevated serum creatinine, and dialysis exposure, was associated with modestly higher odds of AMD, and the association was most consistent for non-exudative disease. A biological gradient across continuous renal markers and concordant Mendelian randomization evidence support a plausible eye-kidney link, but the very high heterogeneity (I² = 95.1%) means the pooled estimate should be read as a central tendency of a diverse evidence base rather than a ","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590223","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":"Retinal Pigment Epithelium and Microglia Transplantation in Age-related Macular Degeneration.","authors":"Nuntachai Surawatsatien, Rajvir Mukesh Solanky, Robert P van de Werken, Maximilian Kong, Vlad Diaconita, Stephen H Tsang","doi":"10.1016/j.ajo.2026.07.036","DOIUrl":"10.1016/j.ajo.2026.07.036","url":null,"abstract":"<p><p>Age-related macular degeneration (AMD) remains a leading cause of irreversible blindness worldwide, characterized by the progressive breakdown of the outer blood-retinal barrier, accumulation of protein and lipid deposits in the subretinal space, and the consequential degeneration of macular photoreceptors. Geographic atrophy (GA) is one of the blinding end points of AMD. While current pharmaceutical interventions can slow lesion expansion or counter choroidal neovascularization, they fail to address the most significant clinical unmet need: regeneration of damaged retinal tissue to restore vision. Regenerative medicine via stem cell transplantation offers a definitive curative approach by replacing the structural and immune framework of the outer retina. This review synthesizes current advancements in human embryonic and pluripotent stem cells platforms engineered for outer retinal reconstruction. We evaluate the differentiation, culturing, and quality validation required to generate clinical-grade, polarized RPE monolayers and homeostatic microglia-like cells. Structurally, single-cell suspensions are contrasted against bioengineered patches, scaffold-free cell sheets, and advanced cell strips, analyzing how graft configuration dictates post-transplantation integration and visual recovery while balancing procedural adverse events like cell reflux and epiretinal membrane formation. Furthermore, this review addresses the microenvironmental challenges of transplanting allogeneic constructs into an inflamed, senescent host niche. We examine CRISPR-Cas9 genome editing paradigms, including cytosine base and prime editing, designed to rectify cell-intrinsic genetic vulnerabilities such as the complement factor H (CFH) risk variant. We highlight translational applications, such as knocking out the Class II transactivator to eliminate major histocompatibility complex class II (MHC-II) expression, which successfully circumvents host T-cell immune surveillance and prevents graft rejection in non-human primates. Additionally, we analyze how engineering an inhibitor-resistant colony-stimulating factor 1 receptor (CSF1R) point mutation enables exogenously administered microglia to robustly outcompete and replace maladaptive, pro-inflammatory host microglia under selective small-molecule pressure. Finally, we discuss future directions, emphasizing multi-lineage bilayered co-transplantation models that combine genome-edited RPE patches with homeostatic microglia or retinal organoids to achieve durable synaptic repair, alongside automated artificial intelligence manufacturing pipelines. Together, these combined structural, molecular, and immune-modulating strategies represent the next clinical frontier in restoring clear central vision and achieving permanent neurovascular rescue in advanced macular degeneration.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"382-393"},"PeriodicalIF":4.7,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590134","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":"Impact of Zonular Laxity on the Accuracy of Intraocular Lens Power Calculation Formulas in Cataract Patients With Retinitis Pigmentosa.","authors":"Yujie Tian, Liangjia Zeng, Jiaqing Zhang, Yuke Pan, Wenlu Yu, Jiebin Xing, Siyuan Liu, Haorui Yuan, Xiaofei Hu, Xiaozhang Qiu, Lixia Luo, Xuhua Tan","doi":"10.1016/j.ajo.2026.07.043","DOIUrl":"10.1016/j.ajo.2026.07.043","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the performance of 12 intraocular lens (IOL) calculation formulas and investigate the impact of zonular laxity on refractive accuracy in patients with retinitis pigmentosa (RP).</p><p><strong>Design: </strong>Retrospective study to compare formulas for IOL selection.</p><p><strong>Methods: </strong>The study enrolled patients with RP who underwent phacoemulsification and IOL implantation between December 2018 and November 2025. The prediction accuracy of 12 formulas were evaluated. Preoperative average zonular length (AZL) and the difference between the maximum and minimum of zonular length (AZL_(max-min)) were measured by ultrasound biomicroscopy. Multivariate regression and mediation analysis were conducted to explore the factors associated with prediction error.</p><p><strong>Result: </strong>A total of 127 eyes from 104 patients were included. The Cooke K6, BUII, Kane, and EVO 2.0 formulas showed no systematic bias and had lower mean absolute errors (0.50-0.51 D), whereas the Hoffer Q, Hoffer QST, Holladay 1, LISA, SRK/T, and T2 formulas showed myopic shifts (-0.21 to -0.12 D, P < .05) and Pearl-DGS displayed a hyperopic shift (0.15D, P = .009). AZL was positively correlated with PE (β = 0.328, P = .019), mediated by postoperative deepening of the anterior chamber (P < .05). For eyes with AZL ≥ 1.8 mm or AZL_(max-min) ≥ 1.0 mm, most formulas showed hyperopic shift and reduced refractive prediction accuracy.</p><p><strong>Conclusion: </strong>The Cooke K6, BUII, Kane, and EVO 2.0 formulas showed higher predictive accuracy in patients with RP. As zonular laxity predisposes these eyes to a postoperative hyperopic shift, clinicians should fine-tune the target refraction according to zonular length in these eyes.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"41-50"},"PeriodicalIF":4.7,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590210","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":"Cultured Human Corneal Endothelial Cell Injection Therapy in Phakic Eyes with Bullous Keratopathy.","authors":"Rintaro Ogino, Akira Kobayashi, Mariko Shirane, Yukari Yagi-Yaguchi, Seiichiro Sugita, Natsuko Mori, Takefumi Yamaguchi, Tomomi Higashide, Kazuno Negishi","doi":"10.1016/j.ajo.2026.07.038","DOIUrl":"10.1016/j.ajo.2026.07.038","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the safety and efficacy of cultured human corneal endothelial cell (cHCEC) injection therapy in phakic eyes with bullous keratopathy (BK), for which endothelial keratoplasty may accelerate cataract progression due to intraoperative manipulation and postoperative gas tamponade.</p><p><strong>Design: </strong>Multicenter retrospective interventional case series.</p><p><strong>Participants: </strong>Five consecutive phakic eyes of 5 patients with BK who underwent cHCEC injection therapy and completed 6 months of follow-up.</p><p><strong>Main outcomes and measures: </strong>Best-corrected visual acuity (BCVA), central corneal thickness (CCT), endothelial cell density (ECD), intraocular pressure (IOP) and cataract progression.</p><p><strong>Results: </strong>Mean logMAR best-corrected visual acuity (BCVA) improved from 1.06 ± 0.57 preoperatively to 0.22 ± 0.36 at 6 months (mean change, -0.84; 95% CI, -1.32 to - 0.36; p = .008). Mean central corneal thickness (CCT) decreased from 782 ± 104 µm to 578 ± 61 µm (mean change, -204 µm; 95% CI, -306 to - 102 µm; p = .005). Corneal clarity improved in all eyes and remained stable throughout the 6-month follow-up. Endothelial cell density (ECD) was not measurable preoperatively because of severe corneal edema. At 6 months, postoperative ECD ranged from 693 to 1622 cells/mm². Mean intraocular pressure (IOP) changed from 10.1 ± 4.3 mm Hg to 11.7 ± 3.1 mm Hg (mean change, 1.54 mm Hg; 95% CI, -4.39 to 7.47 mm Hg; p = .511). No intraoperative or postoperative complications, including cystoid macular edema, were observed. No clinically significant cataract progression was noted during follow-up.</p><p><strong>Conclusions: </strong>cHCEC injection therapy demonstrated favorable short-term clinical outcomes in phakic eyes with BK and may represent a promising lens-preserving treatment option. Larger controlled studies with longer follow-up are warranted.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"416-421"},"PeriodicalIF":4.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583356","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":"Factors Impacting Ophthalmology Interest and Perception Among U.S. Medical Students.","authors":"Christine Xu, Matthew Ponzini, Melody Y Hou, Glenn Yiu","doi":"10.1016/j.ajo.2026.07.037","DOIUrl":"10.1016/j.ajo.2026.07.037","url":null,"abstract":"<p><strong>Purpose: </strong>In order to better understand medical students' decision-making to pursue ophthalmology, and inform efforts to recruit more diverse and inspired ophthalmologists, we aim to characterize values and experiences of medical students pursuing ophthalmology.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Participants: </strong>U.S. medical students who responded to American Association of Medical Colleges (AAMC) Matriculating Student and Graduation Questionnaires (MSQ & GQ) between 2013 and 2022.</p><p><strong>Methods: </strong>We examined survey responses pertaining to personal values, medical school experiences, and use of resources. Univariate analyses were performed to compare the odds of pursuing ophthalmology versus other specialties.</p><p><strong>Main outcome measure: </strong>Association of values and experiences with odds of pursuing ophthalmology versus another specialty.</p><p><strong>Results: </strong>Among 134,723 matriculating students who completed the MSQ, those interested in ophthalmology (2425 students) were more likely to value high income (OR: 1.46, p < .001) and work-life balance (OR: 1.44, p < .001), and less likely to value social change (OR: 0.76, p < .001), leadership (OR: 0.94, p = .011), OR: creativity (OR: 0.94, p = .025). Of 98,628 graduates who completed the GQ, those pursuing ophthalmology (2150 students) valued salary (OR: 1.73, p < .001), family considerations (OR: 1.31, p < .001), and work-life balance (OR: 2.40, p < .001) more than those pursuing other specialties. Students pursuing ophthalmology rated their clerkships in neurology (OR: 1.22 [1.16-1.29], p < .001), internal medicine (OR: 1.19 [1.12-1.28], p < .001), surgery (OR: 1.18 [1.12-1.25], p < .001), psychiatry (OR: 1.16 [1.09-1.23], p < .001), and emergency medicine (OR: 1.08 [1.01-1.16], p = .02) more highly compared to other core clerkships. Students pursuing ophthalmology were more likely to perform research (OR: 4.75, p < .001) than those pursuing other fields. These students also more frequently relied on web-based resources (OR: 1.58, p < .001), group panels (OR: 1.39, p < .001), and extra electives (OR: 1.30, p < .001) for specialty information compared to other students, but not mentorship, school workshops, or AAMC-provided information.</p><p><strong>Conclusions: </strong>Medical students pursuing ophthalmology valued lifestyle factors rather than leadership, creativity, or social change and were also more likely to perform research. They were more likely to rely on non-mentorship resources for specialty information. Efforts are needed to refine the perception of ophthalmology, increase focus on creativity and innovation, and improve the recruitment of diverse and inspired future ophthalmologists.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"334-340"},"PeriodicalIF":4.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583442","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":"Greater Exposed Neural Canal Elongation of the Myopic Optic Nerve Head Is Associated With Papillomacular Bundle Defects in Glaucoma.","authors":"Eun Jung Lee, Jong Chul Han, Do Young Park","doi":"10.1016/j.ajo.2026.07.040","DOIUrl":"10.1016/j.ajo.2026.07.040","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the association between optical coherence tomography (OCT) parameters of optic nerve head (ONH) neural canal configuration and papillomacular bundle (PMB) defects in myopic eyes with glaucoma.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Subjects: </strong>Patients with myopia and normal-tension glaucoma (NTG).</p><p><strong>Methods: </strong>Enhanced depth imaging OCT of the ONH was performed. Quantitative measurements of the exposed neural canal (ENC) configuration included border tissue lengths and conjugate opening areas defined by the Bruch's membrane opening (BMO), anterior scleral canal opening (ASCO), and scleral flange opening (SFO).</p><p><strong>Main outcome measures: </strong>Associations between the ONH OCT parameters and the presence of PMB defects.</p><p><strong>Results: </strong>In this cohort, the mean axial length was 26.52 ± 1.10 mm (range, 24.30 to 29.25 mm), and PMB defects were observed in 37 of 101 eyes (36.6%). Longer externally oblique border tissue (EOBT) and externally oblique choroidal border tissue (EOCBT) length ratios relative to the BMO diameter, measured along the axis of maximal EOBT length, as well as lower BMO-ASCO and BMO-SFO conjugate area ratios normalized to the BMO area, were significantly associated with the presence of PMB defects after adjusting for age and axial length (all p < .05). Notably, PMB defects were present in 75.0% of eyes with EOBT ratios ≥ 0.5 and in 66.7% of eyes with BMO-SFO conjugate area ratios < 0.5.</p><p><strong>Conclusions: </strong>Greater ENC elongation in the myopic ONH, most pronounced in the temporal and inferotemporal regions corresponding to the PMB trajectory, was associated with PMB defects in glaucoma.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"7-18"},"PeriodicalIF":4.7,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583416","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 Retinal Nonperfusion in Diabetic Macular Edema Treated With Brolucizumab Versus Aflibercept: A KINGFISHER Trial Analysis.","authors":"Mai Alhelaly, Rouzbeh Abbasgholizadeh, Yu-Chien Chung, Abbas Habibi, Alberto Quarta, Ceren Soylu, Shinichiro Chujo, Yen-Chun Huang, Y E He, Muneeswar G Nittala, Srinivas R Sadda, Michael S Ip","doi":"10.1016/j.ajo.2026.07.041","DOIUrl":"10.1016/j.ajo.2026.07.041","url":null,"abstract":"<p><strong>Purpose: </strong>To compare longitudinal changes in retinal nonperfusion in diabetic macular edema (DME) patients treated with brolucizumab versus aflibercept over 52 weeks using ultrawidefield fluorescein angiography (UWF-FA) data from the KINGFISHER clinical trial.</p><p><strong>Design: </strong>Post hoc analysis from the KINGFISHER trial, (ClinicalTrials.gov Identifier: NCT03917472), a multicenter, masked clinical trial.</p><p><strong>Participants: </strong>Out of 517 participants in the KINGFISHER study, 164 had available baseline UWF-FA. Total 43 cases were excluded due to the presence of laser photocoagulation scar, and 30 cases were excluded due to poor image quality leaving a subset of 91 cases for nonperfusion assessment, of which 59 cases were included in the brolucizumab group, and 32 cases were included in the aflibercept group.</p><p><strong>Methods: </strong>Retinal nonperfusion was assessed from UWF-FA images at baseline, 24 weeks, and 52 weeks in patients treated monthly with either brolucizumab or aflibercept therapy. Images were graded by 2 independent graders for nonperfusion areas in 3 retinal regions: the panretina (TAR area), the posterior pole zone (a 15 mm diameter circle centered on the fovea), and the peripheral zone (all areas within the TAR, but outside the 15 mm circle). Nonperfusion index (NPI) was computed in the different retinal regions.</p><p><strong>Main outcomes measures: </strong>Changes in NPI across follow-up visits were analyzed and compared between the brolucizumab and aflibercept treated groups.</p><p><strong>Results: </strong>Over 52 weeks, both brolucizumab and aflibercept demonstrated no statistically significant change in retinal nonperfusion indices across posterior, peripheral, and pan-retinal zones. The mean NPI showed slight numerical increases from baseline at week 52, but differences were not statistically significant (P > .05). Additionally, linear mixed-effects modeling indicated no statistically significant difference in longitudinal NPI changes between both treatment groups (P > .05).</p><p><strong>Conclusion: </strong>In this treated cohort, NPI did not show a statistically significant change over 52 weeks in eyes receiving monthly brolucizumab or aflibercept, with no statistically significant difference detected between agents. The absence of significant reperfusion despite intensive VEGF inhibition may suggest non-VEGF-mediated mechanisms.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"19-27"},"PeriodicalIF":4.7,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148576631","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":"Demographic Disparities in the Likelihood of Surgical Repair Following Diagnosis of Rhegmatogenous Retinal Detachment.","authors":"Ashvin Babu,Sonia B Kim,David C Kaelber,Rishi P Singh,Aleksandra V Rachitskaya,Katherine E Talcott","doi":"10.1016/j.ajo.2026.07.005","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.07.005","url":null,"abstract":"PURPOSEThis US-based large-scale retrospective study explores whether demographic differences influence likelihood to surgical intervention after a diagnosis of rhegmatogenous retinal detachment (RRD).DESIGNRetrospective Cohort Study SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Patients with ICD-10 encounter diagnosis codes for RRD METHODS, INTERVENTION, OR TESTING: Through a de-identified electronic health record platform, RRD patients were separated into sex, race, ethnicity, and socioeconomic/psychosocial (SES) cohorts. Pair-wise comparisons were made after 1:1 propensity score matching (PSM) on age, ocular conditions, socioeconomic/psychosocial conditions, and systemic and lifestyle comorbidities. Patients likelihood of CPT code for RRD repair surgery at 4 timepoints (within 1 day, 1 week, 1 month, 3 months) following RRD was assessed.MAIN OUTCOME MEASURESRisk ratios (RR) and 95% confidence intervals (CI) were reported with a significance threshold <0.9 or >1.1.RESULTSFollowing PSM, there were 21756 patients in the male versus female analysis, 5071 in the White versus Black, 1903 in the White versus Asian, 3279 in the Hispanic versus non-Hispanic, and 2194 in the socioeconomic/psychosocial analysis. Males were more likely to receive surgery within 1 day (RR 1.20, 95% CI: 1.15, 1.24) up to 3 months after RRD (RR 1.19, 95% CI 1.15, 1.23). Compared to Black patients, White patients were more likely to receive surgery within 1 day (RR 1.47, 95% CI 1.35, 1.61) up to 3 months (RR 1.36, 95% CI 1.26, 1.46) after RRD. Both White versus Asian patients and Non-Hispanic/Latinos versus Hispanic/Latinos did not have significant differences in time to surgery. Patients without socioeconomic/psychosocial (SES) conditions were more likely to receive surgery at 1 day (RR 3.35, 95% CI 2.73, 4.10) up to 3 months (RR 2.83, 95% CI 2.41, 3.34) after RRD. A sensitivity analysis performed between female patients ± SES as well as black patients ± SES yielded increased differences. Comparison between patients with reported and unreported race and ethnicity also demonstrated differences up to 3 months.CONCLUSIONMales are more likely to receive surgical intervention for RRD. Significant racial disparities exist in timely RRD repair for Black patients and patients with SES conditions. This study highlights continued disparities that exist in RRD management.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"3 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148539259","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":"Comment on \"Intraocular Pressure Changes Following Intraluminal Stent Removal From the Paul Glaucoma Implant: A Systematic Review and Meta-Analysis\".","authors":"Yuting Wu, Liqin Luo, Guanghui Liu","doi":"10.1016/j.ajo.2026.06.057","DOIUrl":"10.1016/j.ajo.2026.06.057","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535158","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}