American Journal of Ophthalmology最新文献

{"title":"Fluid Dynamics and Advanced OCT Biomarkers in Optic Disc Pit Maculopathy: Influence on Visual Outcomes","authors":"Matteo Mario Carlà ,&nbsp;Francesco Boselli ,&nbsp;Federico Giannuzzi ,&nbsp;Laura De Luca ,&nbsp;Emanuele Crincoli ,&nbsp;Fiammetta Catania ,&nbsp;Gloria Gambini ,&nbsp;Tomaso Caporossi ,&nbsp;Carlos Mateo ,&nbsp;Stanislao Rizzo","doi":"10.1016/j.ajo.2025.05.050","DOIUrl":"10.1016/j.ajo.2025.05.050","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize sequential pattern of fluid progression in optic disc pit maculopathy (ODP-M), identify threshold values for fluid migration between retinal layers, and determine the prognostic significance of optical coherence tomography (OCT) biomarkers.</div></div><div><h3>Design</h3><div>Multicenter, retrospective interventional case series.</div></div><div><h3>Methods</h3><div>Forty-two eyes with ODP-M underwent surgical treatment with follow-up ≥12 months (mean 38.5 ± 30.6 months). OCT parameters including intraretinal fluid (IRF) height, foveal detachment (FD), intrapapillary proliferation (IPP), ellipsoid zone (EZ) integrity, and retinal pigment epithelium (RPE) disruption were analyzed preoperatively and at 1, 6, 12, and 24 months postoperatively. Visual and anatomical outcomes were evaluated using multivariate regression and Kaplan-Meier survival analysis.</div></div><div><h3>Results</h3><div>IRF followed a distinct progression pattern, sequentially involving the outer nuclear layer (ONL), inner nuclear layer (INL), and nerve fiber layer (NFL). Resolution after surgery occurred in reverse order (NFL→INL→ONL) with median resolution times of 3, 6, and 12 months, respectively. Surgical success rate after first intervention was 66.7%, with complete final fluid resolution in 72.2% of cases. ROC analysis identified threshold values for ONL→INL progression (152 µm, AUC = 0.84) and for INL→NFL progression (178 µm, AUC = 0.79). In multivariate analysis, independent predictors of final visual acuity included preoperative visual acuity (OR: 4.73, <em>p</em> &lt; .001), absence of FD (OR: 0.31, <em>p</em> = .03), EZ visibility (OR: 0.42, <em>p</em> = .04), and absence of IPP (OR: 0.45, <em>p</em> = .05).</div></div><div><h3>Conclusions</h3><div>ODP-M demonstrates a predictable pattern of fluid accumulation and resolution, with specific threshold values for fluid progression between retinal layers that may guide intervention timing and preoperative OCT biomarkers providing valuable prognostic information for visual outcomes.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"278 ","pages":"Pages 1-12"},"PeriodicalIF":4.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245723","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":"Choriocapillaris in Age-Related Macular Degeneration: A Systematic Review of Optical Coherence Tomography Angiography–Based Assessments and Challenges in Standardization","authors":"Alessandro Berni ,&nbsp;Claudio Foti ,&nbsp;Lorena Ulla ,&nbsp;Chinmayi Vyas ,&nbsp;Jay Chhablani ,&nbsp;Varun Chaudhary ,&nbsp;Yousif Subhi ,&nbsp;Giovanni Gregori ,&nbsp;Ruikang K. Wang ,&nbsp;Philip J. Rosenfeld ,&nbsp;SriniVas R. Sadda ,&nbsp;Francesco Bandello ,&nbsp;Michele Reibaldi ,&nbsp;Enrico Borrelli","doi":"10.1016/j.ajo.2025.05.051","DOIUrl":"10.1016/j.ajo.2025.05.051","url":null,"abstract":"<div><h3>Topic</h3><div>This systematic review evaluates the methodologies used for assessing the choriocapillaris (CC) in age-related macular degeneration (AMD) using optical coherence tomography angiography (OCTA). It focuses on identifying methodological heterogeneity in imaging and analysis protocols and its implications for clinical and research applications.</div></div><div><h3>Clinical Relevance</h3><div>AMD is a leading cause of vision loss, and assessing CC perfusion provides critical insights into its pathophysiology. OCTA has emerged as a noninvasive imaging technique offering high-resolution visualization of the CC. However, variability in methodologies has hindered the standardization of CC assessments. Establishing consistent practices is essential for improving clinical and research outcomes in AMD management.</div></div><div><h3>Design</h3><div>Systematic review.</div></div><div><h3>Methods</h3><div>Studies included in this review were selected on the basis of eligibility criteria defined by the Population, Intervention, Comparator, Outcome, Study design framework. Participants included patients with early, intermediate, and late AMD. Interventions involved the use of OCTA for CC assessment, with no restrictions on device type or scan parameters. Comprehensive searches of MEDLINE, Web of Science Core Collection, and the Cochrane Library were conducted up to November 30, 2024. Data extractions and narrative synthesis focused on device types, scan protocols, segmentation techniques, compensation strategies, and quantitative metrics.</div></div><div><h3>Results</h3><div>A total of 102 studies, encompassing 4047 patients with AMD and 4415 eyes, were analyzed. Fifty-two studies used spectral-domain OCTA, and 49 studies used swept-source OCTA, with significant heterogeneity in segmentation boundaries and slab thickness (4.4-30 µm). Only 32 studies used compensation strategies to address signal attenuation under drusen. Quantitative metrics varied widely, with CC flow deficit percentage being the most common. However, inconsistencies in thresholding methods and lack of standardized Phansalkar radius reporting limited comparability. The review highlights gaps in reporting segmentation boundaries and compensation techniques, which impact the ability to assess the reliability of findings.</div></div><div><h3>Conclusions</h3><div>This review underscores substantial variability in methodologies for CC assessment in AMD, highlighting the urgent need for standardized imaging protocols and analytical approaches. Despite advances in OCTA technology, inconsistencies in segmentation, thresholding, and compensation strategies challenge data reliability and reproducibility. Future research should prioritize methodological standardization to enhance comparability and clinical applicability.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 482-496"},"PeriodicalIF":4.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245719","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":"Evidence and Consensus-Based Imaging Guidelines in Acute Posterior Multifocal Placoid Pigment Epitheliopathy (APMPPE) - Multimodal imaging in Uveitis (MUV) Taskforce Report 7","authors":"Ester Carreño ,&nbsp;Panayiotis Maghsoudlou ,&nbsp;Alejandro Fonollosa ,&nbsp;Inês Leal ,&nbsp;Ariel Schlaen ,&nbsp;Alan Roy Abraham ,&nbsp;Andrew D. Dick ,&nbsp;Aniruddha Agarwal ,&nbsp;Sapna Gangaputra ,&nbsp;Alessandro Invernizzi ,&nbsp;Amani Fawzi ,&nbsp;Elisabetta Miserocchi ,&nbsp;Rupesh Agrawal ,&nbsp;Douglas A. Jabs ,&nbsp;David Sarraf ,&nbsp;Vishali Gupta","doi":"10.1016/j.ajo.2025.06.007","DOIUrl":"10.1016/j.ajo.2025.06.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To develop consensus-based guidelines on use and interpretation of multimodal imaging in acute posterior multifocal placoid pigment epitheliopathy (APMPPE).</div></div><div><h3>Design</h3><div>Consensus agreement led by literature, and an expert committee using a nominal group technique (NGT).</div></div><div><h3>Methods</h3><div>The expert committee for APMPPE performed a thorough review of representative cases of APMPPE. The cases were used to develop guidelines for the diagnosis and follow-up of APMPPE using color fundus photography (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), and OCT angiography (OCTA). Structured NGT-based discussions were used to achieve consensus-based recommendations on imaging characteristics, disease activity, and complications, and subsequently were adopted by a vote of the entire taskforce.</div></div><div><h3>Results</h3><div>Diagnosis of active APMPPE is characterized by distinctive imaging findings on CFP, and hyper-reflectivity of the ellipsoid zone (EZ), external limiting membrane (ELM), and outer nuclear layer (ONL) on OCT. Choriocapillaris non-perfusion, detectable via early-phase FFA, ICGA or OCTA, is crucial. In the early stages of APMPPE, OCT findings may be unremarkable, making FFA, ICGA, and/or OCTA relevant for the diagnosis. Based on the imaging findings, APMPPE can be classified into 4 stages of activity: choroidal, chorioretinal, transitional, and resolved. Following diagnosis, OCT and OCTA can be used to monitor lesion activity and identify potential complications.</div></div><div><h3>Conclusions</h3><div>MUV imaging criteria enable the identification of key diagnostic features for APMPPE, extending the Standardization of Uveitis Nomenclature (SUN) classification. These consensus-based guidelines provide a framework for evaluating disease activity and complications, enhancing diagnostic accuracy and guiding clinical management.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"278 ","pages":"Pages 38-51"},"PeriodicalIF":4.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245721","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":"Evidence and Consensus Based Guidelines for Imaging in Serpiginous Choroiditis - Multimodal imaging in Uveitis (MUV) Taskforce: Report 4: Imaging guidelines for serpiginous choroiditis.","authors":"Aniruddha Agarwal, Anita Agarwal, Debra A Goldstein, Alessandro Invernizzi, Timothy M Janetos, Luca Cimino, Quan Dong Nguyen, Douglas A Jabs, Rupesh Agrawal, Amani Fawzi, David Sarraf, Vishali Gupta","doi":"10.1016/j.ajo.2025.05.052","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.052","url":null,"abstract":"<p><strong>Purpose: </strong>To develop imaging and consensus-based guidelines for the application of multimodal imaging in serpiginous choroiditis (SC).</p><p><strong>Design: </strong>Consensus agreement guided by literature search, and an expert committee using a nominal group technique (NGT).</p><p><strong>Methods: </strong>An expert committee gathered cases of non-infectious SC based on pre-defined informatics-driven inclusion criteria. These criteria focused primarily on high-quality imaging, including color fundus photographs (CFP), optical coherence tomography (OCT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), and OCT angiography (OCTA). A structured NGT was applied to achieve consensus-based recommendations on imaging use for specific disease characteristics, biomarkers of activity, and complications. These recommendations were further voted upon by members of the full task force.</p><p><strong>Results: </strong>CFP and FAF are key imaging modalities for the diagnosis of SC. SC is characterized by amoeboid/serpentine choroiditis lesions on CFP, with hypo-autofluorescence in older inactive lesions and hyper-autofluorescence along the broad active edges. FAF is the most important tool for assessing disease activity. ICGA findings, particularly at the leading active edge, and OCT further aid in disease characterization. Early hypofluorescence of the active edge with uniform hyperfluorescent staining in the late phase of FFA are key features that help differentiate SC from other placoid chorioretinopathies. FFA, OCT and OCTA are useful in identifying underlying choroidal neovascularization, with OCTA being an important modality.</p><p><strong>Conclusions: </strong>MUV imaging criteria for SC extend the Standardization of Uveitis Nomenclature (SUN) classification, by providing guidelines for the use of multimodal imaging. These criteria also provide a framework for evaluation of disease activity and complications.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245722","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":"Complications and Management of Cosmetic Iris Implants","authors":"SHAFI BALAL ,&nbsp;OMER JAMALL ,&nbsp;IMRAN KARIM JANMOHAMED ,&nbsp;IBTESHAM HOSSAIN ,&nbsp;ROHAN HUSSAIN ,&nbsp;SOYANG ELLA KIM ,&nbsp;GABRIELE GALLO AFFLITTO ,&nbsp;VINCENZO MAURINO","doi":"10.1016/j.ajo.2025.05.049","DOIUrl":"10.1016/j.ajo.2025.05.049","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the complications, management, and outcomes associated with cosmetic iris implants.</div></div><div><h3>Design</h3><div>Single-center retrospective interventional case series.</div></div><div><h3>Subjects</h3><div>30 eyes of 15 patients who presented to Moorfields Eye Hospital, London, UK with complications related to cosmetic iris implants between January 2008 and December 2023. Mean age at implantation was 34.13 ± 9.51 years, with predominantly Asian ethnicity (53%) and male gender (60%).</div></div><div><h3>Methods</h3><div>Medical records were reviewed for patient demographics, pre-explantation parameters, complications, management, and outcomes. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), endothelial cell count (ECC), and central corneal thickness (CCT) were analyzed before and after explantation. Secondary interventions were documented, and statistical analyses were performed using paired t-tests and Pearson correlation coefficients.</div></div><div><h3>Main Outcome Measures</h3><div>BCVA, IOP, ECC, CCT, presence of uveitis, glaucoma, corneal decompensation, cataract formation, and need for secondary surgical interventions.</div></div><div><h3>Results</h3><div>Median time to explantation was 45.5 months (range: 6.0-140.1 months). The most common complications included uveitis (60%), elevated IOP requiring glaucoma surgery (33.3%), corneal decompensation requiring Descemet's Membrane Endothelial Keratoplasty (20%), and cataract formation requiring phacoemulsification (13.3%). A statistically significant positive correlation was found between time to explantation and corneal decompensation (r = 0.392, <em>P = .</em>048). In patients who underwent DMEK (n=6), ECC increased significantly from 778.33 ± 191.53 cells/mm² to 1107.33 ± 17.96 cells/mm² postoperatively (<em>P = .</em>009), and mean CCT decreased from 783.17 ± 293.93 µm to 508.83 ± 48.94 µm (<em>P = .</em>1). Despite these interventions, a considerable proportion of patients experienced persisting symptoms requiring secondary surgery.</div></div><div><h3>Conclusions</h3><div>This case series demonstrates that cosmetic iris implants are associated with serious sight-threatening complications including corneal decompensation, glaucoma, and uveitis. Many patients required multiple surgical interventions after explantation, highlighting the long-term morbidity associated with these devices. The authors recommend that cosmetic iris implantation should be banned worldwide given the substantial risks and lack of therapeutic value, and greater regulatory oversight is needed to prevent further harm to patients.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 433-440"},"PeriodicalIF":4.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245720","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":"Mental Health of US Children With Vision Impairment: An Analysis of the National Health Interview Survey","authors":"Katherine Du ,&nbsp;Preeti Patil ,&nbsp;Michael V. Boland","doi":"10.1016/j.ajo.2025.06.002","DOIUrl":"10.1016/j.ajo.2025.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>While the psychological effects of vision loss in adults has been investigated, few studies focus on the adolescent population. Identifying the mental health burden of vision impairment in children may inform future detection and management of these symptoms. The purpose of this study is to characterize the association between mental health indicators and vision impairment in US children.</div></div><div><h3>Design</h3><div>Cross-sectional study.</div></div><div><h3>Participants</h3><div>Participants were children age 0 to 17 years from the 2022 National Health Interview Survey. Participants completed a household interview survey and Mental Health Assessment from the Strengths and Difficulties Questionnaire. Inclusion criteria is noninstitutionalized US civilians. Exclusion criteria is no fixed household address, active military duty, persons in correctional facilities or long-term care.</div></div><div><h3>Methods</h3><div>A population-based study using multistage complex probability sampling strategy to provide representative national estimates for children nationwide.</div></div><div><h3>Main Outcome Measures</h3><div>Caregiver-reported visual impairment and measures of psychological health including mental health (depression and anxiety), cognition (difficulties learning and remembering), behavior (social and emotional challenges), and access to services (mental health therapy and special education).</div></div><div><h3>Results</h3><div>In a sample of 6429 US children, 5% had visual impairments despite correction with glasses or contacts. Vision-impaired children had higher rates of depression (44%) and anxiety (64%) compared to nonvision-impaired children (33% and 53%, respectively). Adjusted models revealed that vision-impaired children had 1.2 times higher odds of depression (95% CI: 1.03-1.33) and 1.3 times higher odds of anxiety (95% CI: 1.13-1.46). They also had greater odds of learning difficulties (OR: 1.9; 95% CI: 1.29-2.86) and remembering difficulties (OR: 1.4; 95% CI: 0.99-1.82). Vision-impaired children showed higher total Strengths and Difficulties Questionnaire scores (OR = 1.1; 95% CI: 1.05-1.11), indicating more peer relationship issues, hyperactivity/inattention, and emotional symptoms. Additionally, there was a 30% to 50% decrease in the usage of mental health therapy and special education between youth with severe vs moderate depression and anxiety.</div></div><div><h3>Conclusions</h3><div>In this nationally representative 2022 sample, visually impaired children exhibit greater odds of depression, anxiety, cognitive impairments, and behavioral difficulties compared to nonvisually impaired children. Further understanding these relationships may improve the mental health outcomes of children at the population level.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 451-462"},"PeriodicalIF":4.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245737","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 and Prevalence of Syphilitic Uveitis and Associated Ocular Complications in the TriNetX Database","authors":"Lucy R. Zhou BS ,&nbsp;Nila Kirupaharan BS ,&nbsp;Meghan K. Berkenstock MD","doi":"10.1016/j.ajo.2025.05.048","DOIUrl":"10.1016/j.ajo.2025.05.048","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the yearly and cumulative incidences and prevalences of syphilitic uveitis, concurrent sexually transmitted infections, and ocular complications using the United States TriNetX database.</div></div><div><h3>Design</h3><div>Trend study.</div></div><div><h3>Participants</h3><div>Subjects with syphilitic uveitis in the TriNetX database.</div></div><div><h3>Methods</h3><div>Subjects with syphilitic uveitis from 2013 to 2024 were identified with International Classification for Disease (ICD) codes for uveitis with the constraint of a positive treponemal and nontreponemal test for syphilis within 1 month after the diagnosis of uveitis. Incidence and prevalence data were calculated from 2013 to 2024. Additional data collected included demographics, concurrent infection with other sexually transmitted infections (STI- HIV, gonorrhea, chlamydia), and ocular complications (macular edema and low vision).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcomes were the incidence and prevalence of syphilitic uveitis (annual and cumulative). Secondary outcomes were the incidence and prevalence of concurrent sexually transmitted infections and ocular complications (annual and cumulative).</div></div><div><h3>Results</h3><div>From the 81 759 791 total population in TriNetx, 161 317 cases of syphilis and 237 cases of syphilitic uveitis were identified. Of the 237 patients with syphilitic uveitis, 53.58% (N = 127, 95% CI 47.2%-59.9%) were White and 75.10% (N = 178, 95% CI 69.6%-80.6%) were male, with a mean age of 52 years (Range: 20-90, SD = 15). The most common STI co-infection was HIV (32.49%, 95% CI 26.53%-38.45%, N = 77). The most prevalent ocular complication was low vision and blindness (27.85%, 95% CI 22.16%-33.54%, N = 66); of which, the highest rates of low vision and blindness were in the cohorts with pan or posterior uveitis (78.79%, N = 52). The cumulative incidence and prevalence rates of syphilitic uveitis over the 2013 to 2024 period were 0.36 and 0.27 cases per 100 000, respectively.</div></div><div><h3>Conclusions</h3><div>The rising incidence and prevalence of syphilitic uveitis from 2013 to 2024 mirrors the overall syphilis epidemic in the United States. This study highlights the need for serologic testing with treponemal and nontreponemal tests for syphilis in patients with uveitis and timely intervention to prevent irreversible visual complications.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 387-394"},"PeriodicalIF":4.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245736","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 and Prevalence of Glaucoma, Corticosteroid Response, and Ocular Hypertension in Uveitis and its Anatomical Subtypes","authors":"RAYNA F. MARSHALL ,&nbsp;DANIEL LEE ,&nbsp;JENNIFER E. THORNE ,&nbsp;MONA KALEEM ,&nbsp;MEGHAN K. BERKENSTOCK","doi":"10.1016/j.ajo.2025.05.046","DOIUrl":"10.1016/j.ajo.2025.05.046","url":null,"abstract":"<div><h3>Purpose</h3><div>Uveitic glaucoma represents one of the most serious, sight-threatening complications of ocular inflammatory disorders. In this study, we assessed the cumulative and yearly prevalence and incidence of uveitic glaucoma in the TriNetX United States (US) Collaborative Network, a database composed of over 100 million patient medical records.</div></div><div><h3>Design</h3><div>Incidence, Prevalence, and Trend study.</div></div><div><h3>Participants</h3><div>Subjects with uveitic glaucoma in the TriNetX database.</div></div><div><h3>Methods</h3><div>A retrospective study of a uveitic-glaucoma cohort, identified with patients having both ICD-10 codes of uveitis and glaucoma, ocular hypertension, or corticosteroid response diagnosed on the same day or after the onset of uveitis, was conducted using the TriNetX US database. Demographic information as well as cumulative and yearly incidence and prevalence of uveitic glaucoma were determined.</div></div><div><h3>Main Outcome Measures</h3><div>Cumulative and yearly incidence and prevalence of uveitic glaucoma, between 2013-2022. A sub-analysis of uveitic glaucoma by uveitis anatomic location was also conducted.</div></div><div><h3>Results</h3><div>30,681 patients with uveitic glaucoma were identified. The average age of the cohort at presentation was 67 years (SD = 19, 95% CI 66.8-67.2 years); 55.0% (n = 16 875, 95% CI 54.4-55.9%) were female and 50.7% (n = 15 555, 95% CI 50.1-51.3%) were Caucasian. Among the uveitis population, 15.5% of patients developed glaucoma in the 10-year time period (n = 30 681, 95% CI 15.3-15.6%). The cumulative incidence of uveitic glaucoma was 5 per 100 000 and the cumulative prevalence was 27 per 100,000 between 2013 and 2022. During the study period, the incidence and prevalence of uveitic glaucoma decreased. Patients with both anterior and intermediate uveitis (n = 529; 20.3%, 95% CI 18.8-21.9%) had the highest rates of uveitic glaucoma, followed by anterior (n = 20 849; 16.4%, 95% CI 16.2-16.7%), panuveitis (n = 48; 11.6%, 95% CI 8.5-14.7%), endophthalmitis (n = 273; 11.3%, 95% CI 10.9-11.7%), intermediate (n = 173; 10.0%, 95% CI 8.6-11.5%), and posterior (n = 1579; 8.2%, 95% CI 7.8-8.6%). Anterior and intermediate uveitis patients also had the highest rates of ocular hypertension (n = 465; 17.9%, 95% CI 16.4-19.3%) and corticosteroid response (n = 279; 10.7%, 95% CI 9.5-11.9%).</div></div><div><h3>Conclusions</h3><div>Since 2013, the incidence and prevalence rates of uveitic glaucoma have been decreasing. Patients with both anterior and intermediate uveitis patients had the highest relative rates of glaucoma compared to other uveitis subtypes.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"278 ","pages":"Pages 13-21"},"PeriodicalIF":4.1,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245724","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 of Botulinum Toxin Type A for Acute Acquired Comitant Esotropia: An Age-Stratified 2-Year Follow-Up Study","authors":"Xiaoning Yu ,&nbsp;Weiyi Pan ,&nbsp;Xiajing Tang ,&nbsp;Yidong Zhang ,&nbsp;Lixia Lou ,&nbsp;Yang Ye ,&nbsp;Zhaohui Sun","doi":"10.1016/j.ajo.2025.05.045","DOIUrl":"10.1016/j.ajo.2025.05.045","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess and compare the 2-year follow-up efficacy of botulinum toxin type A (BTXA) in the treatment of acute acquired comitant esotropia (AACE) across five age groups.</div></div><div><h3>Design</h3><div>Retrospective clinical cohort study.</div></div><div><h3>Methods</h3><div>A total of 276 patients with AACE who received BTXA injections were enrolled from a single institution between January 2019 and January 2023 (Notably, surgery was recommended for patients &gt;12 years with large-angle esotropia (&gt;50 prism diopters) to reduce failure or recurrence risk). Patients were stratified into five age groups based on intervention age: ≤6 years, &gt;6 to ≤12 years, &gt;12 to ≤20 years, &gt;20 to ≤30 years, and &gt;30 years. The primary outcomes included the cumulative motor and sensory success rates across different age groups, as well as the hazard ratio (HR) for the risk of AACE relapse.</div></div><div><h3>Results</h3><div>The median age of the 276 participants was 18 years (interquartile range: 9-30 years), with 125 (45.29%) being female. The overall 2-year motor success rate of BTXA for AACE treatment was 69.03% (95% confidence interval [CI]: 62.30%-74.81%). Notably, the motor success rate exhibited a tendency to decline with age, and patients older than 30 years showed significantly lower motor success rate compared to other age groups (≤6 years: 86.53%, &gt;6-≤12 years: 79.96%, &gt;12-≤20 years: 74.08%, &gt;20-≤30 years: 67.45%, &gt;30 years: 44.29%, Bonferroni-corrected posthoc test: <em>P</em> &lt; .05/4). Similarly, patients aged &gt;30 years demonstrated significantly lower rates of stereopsis recovery post-treatment compared to younger cohorts (Bonferroni-corrected posthoc test: <em>P</em> &lt; .05/4). Furthermore, hours of near-work per day (HR: 1.09, 95% CI: 1.01-1.17) and age (HR: 1.04, 95% CI: 1.02-1.06) were identified as significant risk factors for AACE relapse following BTXA injection.</div></div><div><h3>Conclusions</h3><div>In this retrospective cohort study, our findings demonstrated that younger AACE patients (≤30 years) exhibited significantly greater treatment stability and success rates following BTXA injection therapy. Postoperative preservation or achievement of normal stereopsis can serve as a reliable predictor of reduced recurrence risk.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages 463-470"},"PeriodicalIF":4.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232942","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":"TFOS DEWS III Digest Report.","authors":"Fiona Stapleton, Pablo Argüeso, Penny Asbell, Dimitri Azar, Charles Bosworth, Wei Chen, Joseph Ciolino, Jennifer P Craig, Juana Gallar, Anat Galor, José A P Gomes, Isabelle Jalbert, Ying Jie, Lyndon Jones, Kenji Konomi, Yang Liu, Jesus Merayo-Lloves, Fabiola R Oliveira, Victor A Perez Quinones, Eduardo M Rocha, Benjamin D Sullivan, David A Sullivan, Jelle Vehof, Susan Vitale, Mark Willcox, James Wolffsohn, Murat Dogru","doi":"10.1016/j.ajo.2025.05.040","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.05.040","url":null,"abstract":"<p><p>This digest summarises the interdisciplinary research in dry eye disease (DED) published since the 2017 TFOS DEWS II reports. It comprises seven topics including Sex, Gender, and Hormones, Epidemiology, Pathophysiology, Tear Film, Pain and Sensation, Iatrogenic and Clinical Trial Design and explores how each of these inform diagnostic methodology, disease subtype and management of DED. Sex- and gender-related differences significantly influence the ocular surface due to hormones, sex chromosomes, sex-specific autosomal factors, epigenetics, care-seeking behaviors, and service utilization. Epidemiological data reveal that DED prevalence varies by age and sex, influenced by diagnostic criteria and the multifactorial nature of the disease. New risk factors for DED include environmental, iatrogenic, systemic diseases and lifestyle domains. Pathophysiological distinctions between Aqueous Deficient Dry Eye (ADDE) and Evaporative Dry Eye (EDE) have been clarified. EDE is characterized by a muted inflammatory response at the ocular surface, meibomian gland dysfunction and conceivably phenotypic changes in corneal epithelial cells. There is an expanding role for metabolic, hormonal, physical, neural and cellular stresses, including hyperosmolarity, mitochondrial stress, and neurogenic inflammation. Advancements in tear film research recommend new approaches to understanding DED pathogenesis and identifying biomarkers, such as microRNAs. Ocular pain perception is linked to structural integrity of corneal nerves, functional capacities of neurons, and activity of the central and peripheral nervous systems. Iatrogenic DED can result from medications, contact lenses, and surgical procedures. Clinical trials now emphasize aligning design and endpoints with DED subtypes and therapeutic mechanisms, with new therapeutics and trial designs under consideration.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144232943","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}