American Journal of Ophthalmology最新文献

{"title":"Organism-Specific Clinical Features and Outcomes of Culture-Positive Endogenous Endophthalmitis: A Multicenter Cohort Study Over 12 Years.","authors":"Elizabeth Ciociola Kelly, Russell Calderon, Peter Weng, Anthony Gonzales, Aunika Zheng, Evan Lau, Justin Bai, Richmond Woodward, Walter Duy, Gabriel Gomide, Ahmed Alshaikhsalama, Krista Thompson, Bita Momenaei, Thomas Jenkins, Peter Fioramonti, Lauren Dimalanta, Joel Epling, Tina Liu, David Hinkle, Alice Yang Zhang, Mark P Breazzano, Sunir Garg, Angeline L Wang, Royce Chen, Margaret Greven, Sharon Fekrat, J Fernando Arevalo","doi":"10.1016/j.ajo.2026.09.035","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.09.035","url":null,"abstract":"<p><strong>Objective: </strong>Evaluate differences in presentation, management, and outcomes of culture-positive endogenous endophthalmitis by microbial pathogen.</p><p><strong>Design: </strong>Retrospective multicenter clinical cohort study PARTICIPANTS: Eyes with a clinical diagnosis of endogenous endophthalmitis that underwent anterior chamber paracentesis, intravitreal aspiration, or pars plana vitrectomy (PPV) and intravitreal injection of antimicrobials with no recent exogenous risk factors.</p><p><strong>Methods: </strong>Clinical presentation, culture characteristics, treatment and outcomes for culture-positive endogenous endophthalmitis from 2012-2024 at nine academic tertiary referral centers stratified by microbial pathogen were reported. Multivariable mixed-effects models were used to determine predictors of final visual acuity (VA).</p><p><strong>Main outcomes and measures: </strong>Final VA, retinal detachment, enucleation.</p><p><strong>Results: </strong>305 eyes from 261 patients were included: Staphylococcus aureus 115 (37.7%), Streptococcus 41 (13.4%), other gram-positive 29 (9.5%), gram-negative 47 (15.4%), fungal 59 (19.3%), and polymicrobial 14 (4.6%) infections. Blood cultures were positive in 202/305 eyes (66.2%), vitreous in 95 (31.1%), and aqueous in 27 (8.9%); concordant organism growth in paired blood and eye cultures occurred in 24/39 cases (62%). Fungal cases had higher rates of immunosuppression and intravenous drug use (p<0.05), while gram-negative cases more often had urinary sources (p<0.001). Presenting and final VA varied across groups (presenting mean logMAR 1.78-2.14 for most bacteria vs 1.30 for fungal, p<0.001; final mean logMAR 1.31-1.75 for bacteria vs 1.13 for fungal, p=0.06). Retinal detachment was most frequent with Staphylococcus aureus and Streptococcus. Enucleation was highest with gram-negative organisms (27.7%), driven by Serratia (85.7%, p=0.05). In adjusted mixed-effects models, worse presenting VA was the most consistent predictor of poorer final VA across groups; in Staphylococcus aureus and Streptococcus infections, systemic infection source, culture positivity, and need for PPV were predictors of final VA.</p><p><strong>Conclusions: </strong>In this multicenter cohort, organism groups were associated with distinct presentations, sources, management, and outcomes. Low intraocular culture yield and imperfect concordance with blood cultures complicate pathogen-directed therapy. Presenting VA is the dominant prognostic factor, but gram-negative infections-particularly Serratia-carry markedly higher risk of globe loss. These findings support organism-informed clinical decision-making and highlight the need for improved intraocular diagnostics and targeted interventions.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056950","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":"Cluster-Based Structural Phenotypes of Chronic Central Serous Chorioretinopathy.","authors":"Alessandro Berni, Giovanni Scalabrin, Giovanni Neri, Ugo Introini, Costanza Barresi, Daniela Bacherini, Chui M G Cheung, Jay Chhablani, Hideki Koizumi, Michele Reibaldi, Francesco Bandello, Enrico Borrelli","doi":"10.1016/j.ajo.2026.09.028","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.09.028","url":null,"abstract":"<p><strong>Purpose: </strong>To identify structural phenotypes of chronic central serous chorioretinopathy (CSC) by unsupervised clustering of baseline optical coherence tomography and functional variables, and to relate them to photoreceptor staging.</p><p><strong>Design: </strong>Multicenter, retrospective, clinical cohort study with an independent comparison cohort.</p><p><strong>Methods: </strong>139 eyes of 126 patients with chronic CSC treated with verteporfin photodynamic therapy at two referral centers. K-means clustering (k = 3) of baseline photoreceptor stage, central subfield thickness, subfoveal choroidal thickness (SCT) and best-corrected visual acuity (BCVA) defined the phenotypes, which were expressed as clinical rules. The primary outcome was change in BCVA after subretinal fluid resolution. Phenotype was compared with six-stage photoreceptor grading, and its distribution with 55 chronic eyes from an independent cohort.</p><p><strong>Results: </strong>138 eyes were phenotyped as pachychoroid-dominant (36 [26%]), transitional (79 [57%]) or degenerative (23 [17%]). Out-of-bag accuracy was 0.87 (95% CI, 0.74-0.96). Without access to the staging system, clustering placed 22 of the cohort's 24 eyes at stage 4 or 5 into the degenerative group, which gained 0.33 logMAR less than pachychoroid-dominant eyes after adjusting for baseline BCVA (95% CI, 0.23-0.44; P < .001). Complete SRF resolution occurred in 83%, 76% and 57% (HR for degenerative, 0.39; 95% CI, 0.20-0.77; log-rank P = .013). Phenotype added nothing to photoreceptor stage for visual recovery (marginal R², 0.575 to 0.590; P = .23) or for resolution (P = .45). Pachychoroid-dominant and transitional eyes, 83% of the cohort, were indistinguishable on photoreceptor grading (P = .68) yet differed in SCT (583 versus 397 µm) and in age (45.5 versus 52.0 years; P = .01), a variable outside the clustering. In the independent chronic cohort the phenotype proportions and the age gradient were both reproduced (51, 54 and 65 years; P = .41 and P = .01), whereas the choroidal separation was attenuated (50 versus 186 µm).</p><p><strong>Conclusions: </strong>Chronic CSC has a two-dimensional structure. Unsupervised clustering recovered the photoreceptor threshold that governs visual recovery and resolved a second, choroidal dimension that staging cannot represent, separating eyes staging treats as equivalent by choroidal thickness and age. Visual prognosis follows the photoreceptor axis alone. The 520-µm threshold is calibrated to pachychoroid-confirmed disease.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149056925","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":"Hess Screen Test Distinguishes Decompensated Esophoria From Esotropia Due to Sagging Eye Syndrome.","authors":"Veronika Yehezkeli, Emanuil Parunakian, Eli Neimark, Joseph L Demer","doi":"10.1016/j.ajo.2026.09.027","DOIUrl":"10.1016/j.ajo.2026.09.027","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether comparison of Hess screen test (HST) measure of esodeviation with the prism cover test (PCT) can distinguish decompensated esophoria (DE) from sagging eye syndrome (SES).</p><p><strong>Design: </strong>Retrospective, comparative cross-sectional, and clinical cohort study.</p><p><strong>Methods: </strong>Patients with acquired esotropia due to DE or SES were included. Primary outcome was the difference in central gaze esotropia measured with the HST vs the PCT at distance and near. The diagnostic value of the HST-PCT discrepancy was evaluated by Bayesian posterior probability for distinguishing DE from SES, and postoperative HST-PCT discrepancy was evaluated as a predictor of necessity of reoperation.</p><p><strong>Results: </strong>A total of 140 patients were included, 54 with DE, 86 with SES. Esotropia by HST at 24.6 ± 11.8Δ (standard deviation) in DE significantly exceeded that by PCT at distance of 18.4 ± 9.9Δ Δ (P < .0001), whereas HST and PCT measurements of esotropia were nearly identical in SES 12.2 vs 11.9Δ, respectively (P = .61). An HST-PCT discrepancy of at least 10Δ yielded a posterior probability of DE of 91%. Patients operated for DE who continued to exhibit HST-PCT discrepancy of at least 10Δ had 80% rate of reoperation, compared with 14% in patients with less discrepancy (P = .008).</p><p><strong>Conclusions: </strong>The HST unmasks a systematically larger esodeviation than the PCT in DE but not SES, consistent with their differing pathophysiologic mechanisms: DE is a central vergence disorder, distinct from connective tissue degeneration in SES.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"727-732"},"PeriodicalIF":4.7,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149029707","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":"Incidence, Prevalence, and Clinical Associations of Noninfectious Pediatric Uveitis in the United States: A TriNetX Database Study.","authors":"Wasef Nijim, Nathan Vu Pham, Regina Liu, Khadija Agsalud, Emery Dutta, Arthi G Venkat, Sruthi Arepalli","doi":"10.1016/j.ajo.2026.09.025","DOIUrl":"10.1016/j.ajo.2026.09.025","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the incidence, prevalence, demographics, anatomic subtypes, ocular complications, associated systemic diseases, and immunosuppressive treatment patterns of noninfectious pediatric uveitis in the United States using the TriNetX database.</p><p><strong>Design: </strong>Retrospective incidence and prevalence study.</p><p><strong>Subjects: </strong>Patients aged 17 years or younger with uveitis in the TriNetX US Collaborative Network between 2016 and 2025, stratified into anterior, intermediate, posterior, and panuveitis subtypes according to the Standardization of Uveitis Nomenclature classification.</p><p><strong>Methods: </strong>Demographic characteristics, ocular complications, associated systemic inflammatory diseases, and systemic immunosuppressive medications were identified using International Classification of Diseases, Tenth Revision, Clinical Modification, RxNorm, and Healthcare Common Procedure Coding System codes. Incidence and prevalence were calculated per 100 000 persons, annually and cumulatively, overall and by subtype. Proportions are reported with 95% confidence intervals (CIs) constructed using Wilson score intervals.</p><p><strong>Main outcome measures: </strong>Annual and cumulative incidence and prevalence of pediatric uveitis and its subtypes, demographic distribution, rates of ocular complications, associated systemic diseases, and immunosuppressive medication use.</p><p><strong>Results: </strong>Of 30 729 490 children, 30 533 (0.10%) had uveitis. Median age was 11 years (interquartile range, 8 years); 16 671 (54.6%; 95% CI, 54.0-55.2) were male. Anterior uveitis was the most common subtype (22 481; 73.6%). From 2016 to 2025, annual incidence rose from 22 to 33 per 100 000 persons and prevalence from 106 to 226 per 100 000 persons. Glaucoma (2509; 8.8%; 95% CI, 8.5-9.1) and cataract (1962; 6.9%; 95% CI, 6.6-7.2) were the most common ocular complications; posterior uveitis had the highest rate of blindness and low vision (397; 13.4%; 95% CI, 12.2-14.6). Prednisone (3979; 13.6%) and methotrexate (3854; 13.1%) were most frequently prescribed, and antimetabolites were the most common class (4568; 15.6%). Juvenile idiopathic arthritis (3038; 10.4%) and tubulointerstitial nephritis and uveitis (450; 1.5%) were the most frequent discrete systemic associations.</p><p><strong>Conclusions: </strong>The incidence and prevalence of pediatric uveitis increased over the past decade. Anterior uveitis predominated, whereas ocular morbidity and treatment intensity concentrated in intermediate uveitis and vision loss in posterior uveitis. Juvenile idiopathic arthritis and tubulointerstitial nephritis and uveitis were frequent associations. Prospective studies should determine whether rising rates reflect a true increase in disease or improved detection.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"718-726"},"PeriodicalIF":4.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149007758","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 Outcomes of Nasal Vertical Rectus Belly Transposition and Lateral Rectus Recession for Large Exotropia After Medial Rectus Transection.","authors":"Emine Tınkır Kayıtmazbatır","doi":"10.1016/j.ajo.2026.09.018","DOIUrl":"10.1016/j.ajo.2026.09.018","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987747","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":"Reply to Comment on \"Outcomes of Nasal Vertical Rectus Belly Transposition and Lateral Rectus Recession for Large Exotropia After Medial Rectus Transection\".","authors":"Weiyi Xia, Chao Jiang, Ling Ling, Jing Yao, Chen Zhao","doi":"10.1016/j.ajo.2026.09.017","DOIUrl":"10.1016/j.ajo.2026.09.017","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975489","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":"Reply to Comment on: \"Glucagon-like peptide-1 receptor agonists and risk of systemic and ocular vascular complications in patients with type 2 diabetes and diabetic retinopathy\".","authors":"David J Ramsey","doi":"10.1016/j.ajo.2026.08.025","DOIUrl":"10.1016/j.ajo.2026.08.025","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148811740","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":"Corrigendum to \"Three-Year Outcomes of Toric vs Non-toric Monofocal Intraocular Lens Implantation in Children Aged 3-8 Years With Congenital Cataract\". Am J Ophthalmol. 2026;285:152-160.","authors":"Lei Cai, Runhan Shi, Xuanqiao Lin, Xiaohuan Zhao, Yanhong Hou, Xiaoyan Han, Zhixiang Hua, Wenqian Shen, Xiaodi Qiu, Jiaxu Hong, Jin Yang","doi":"10.1016/j.ajo.2026.08.036","DOIUrl":"https://doi.org/10.1016/j.ajo.2026.08.036","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944084","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: Temporal Patterns of Posterior Segment Imaging Findings and Laboratory Correlates in Ocular Syphilis.","authors":"Parag J Ratnakar, Hima Bindu Mantravadi, Sachin Kumar, Hariharan Srinivasan","doi":"10.1016/j.ajo.2026.08.050","DOIUrl":"10.1016/j.ajo.2026.08.050","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910573","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, \"Glaucoma and Neurodegenerative Disease Risk: A 10-Year Assessment of Real-World Global Data\".","authors":"Daniyal Matin Ansari, D I Zou, Zakariya Jarrar, Abdus Samad Ansari","doi":"10.1016/j.ajo.2026.08.048","DOIUrl":"10.1016/j.ajo.2026.08.048","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900079","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}