American Journal of Ophthalmology最新文献

{"title":"3D Structural Phenotype of the Optic Nerve Head in Glaucoma and Myopia - A Key to Improving Glaucoma Diagnosis in Myopic Populations.","authors":"Swati Sharma, Fabian A Braeu, Thanadet Chuangsuwanich, Tin A Tun, Quan V Hoang, Rachel Chong, Shamira A Perera, Ching-Lin Ho, Rahat Husain, Martin L Buist, Tin Aung, Michaël J A Girard","doi":"10.1016/j.ajo.2025.09.004","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.004","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the 3D structural phenotypes of the optic nerve head (ONH) in patients with glaucoma, high myopia, and concurrent high myopia and glaucoma, and to evaluate their variations across these conditions.</p><p><strong>Design: </strong>Retrospective cross-sectional study.</p><p><strong>Participants: </strong>A total of 685 optical coherence tomography (OCT) scans from 754 subjects of Singapore-Chinese ethnicity, including 256 healthy (H), 94 highly myopic (HM), 227 glaucomatous (G), and 108 highly myopic with glaucoma (HMG) cases METHODS: We segmented the retinal and connective tissue layers from OCT volumes and their boundary edges were converted into 3D point clouds. To classify the 3D point clouds into four ONH conditions, i.e., H, HM, G, and HMG, a specialized ensemble network was developed, consisting of an encoder to transform high-dimensional input data into a compressed latent vector, a decoder to reconstruct point clouds from the latent vector, and a classifier to categorize the point clouds into the four ONH conditions. Additionally, the network included an extension to reduce the latent vector to two dimensions for enhanced visualization.</p><p><strong>Main outcome measures: </strong>Structural variation in the ONH in H, HM, G, and HMG conditions RESULTS: The classification network achieved high accuracy, distinguishing H, HM, G, and HMG classes with a micro-average AUC of 0.92 ± 0.03 on an independent test set. The decoder effectively reconstructed point clouds, achieving a Chamfer loss of 0.013 ± 0.002. Dimensionality reduction clustered ONHs into four distinct groups, revealing structural variations such as changes in retinal and connective tissue thickness, tilting and stretching of the disc and scleral canal opening, and alterations in optic cup morphology, including shallow or deep excavation, across the four conditions.</p><p><strong>Conclusions: </strong>This study demonstrated that ONHs exhibit distinct structural signatures across H, HM, G, and HMG conditions. The findings further indicate that ONH morphology provides sufficient information for classification into distinct clusters, with principal components capturing unique structural patterns within each group. Future studies should seek to establish a connection between these structural patterns with the functional changes to enhance glaucoma diagnosis in myopic eyes.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022658","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":"Refractive Outcomes Using Simulated Keratometry Versus Keratometry From an Optical Biometer","authors":"David L. Cooke ,&nbsp;Karanpreet S. Multani ,&nbsp;Jascha A. Wendelstein ,&nbsp;Kamran M. Riaz","doi":"10.1016/j.ajo.2025.08.055","DOIUrl":"10.1016/j.ajo.2025.08.055","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare refractive prediction accuracy using simulated keratometry (SimK) measurements obtained from a Scheimpflug tomographer (Pentacam AXL, Oculus) versus keratometry (K) measurements obtained from an optical biometer utilizing telecentric keratometry (IOLMaster 700 (IOLM700), Carl Zeiss Meditec AG) applied to modern IOL power calculation formulas.</div></div><div><h3>Design</h3><div>Retrospective accuracy and validity analysis</div></div><div><h3>Methods and Setting</h3><div>Private practice center</div></div><div><h3>Study Population</h3><div>Five hundred eighty-nine eyes with preoperative SimK and K measurements undergoing phacoemulsification and implantation of monofocal IOL (Clareon SY60WF IOL, Alcon Laboratories, Inc.). Using IOLCon constants and optimized lens constants, nine IOL formulas (Barrett Universal 2.0 (BU2), Cooke K6 (K6), EVO 2.0, Haigis, Hoffer Q, Holladay I, Pearl DGS, SRK/T, and T2) were used to calculate refractive prediction errors across 3 methods: (1) IOLM700 biometry (axial length (AL), anterior chamber depth (ACD), and K), (2) Pentacam AXL biometry (AL, ACD, and Sim K), and (3) combined IOLM700 AL/ACD with Pentacam AXL Sim K</div></div><div><h3>Main Outcome Measures</h3><div>Mean absolute error (MAE) and root mean squared error (RMSE) were used to assess refractive outcomes.</div></div><div><h3>Results</h3><div>Using both nonoptimized (IOLCon) and optimized lens constants, all nine formulas demonstrated the lowest MAE and RMSE with the IOLMaster 700 approach, followed by the combination approach, and then the Pentacam AXL approach. Formula rankings varied among the 3 techniques: the K6 formula had the highest ranking for the IOLM700 technique, while EVO 2.0 had the top ranking for the Pentacam and combination techniques. When applying heteroscedastic testing to compare the 3 methods within each of the nine formulas, the IOLM700 version was significantly better than the combination version (all <em>P</em> &lt; .05), and the combination version was superior to the PC version (all <em>P</em> &lt; .05). Among the top-performing Pentacam formulas, the BU2 and Haigis formulas were statistically similar to the EVO 2.0</div></div><div><h3>Conclusions</h3><div>Biometric values (including standard K) from the IOLM700 provided the most accurate refractive predictions across formulas, outperforming biometric values (including Sim K) from the Pentacam AXL, even after lens constant optimization. Sim K values are not directly interchangeable with SS-OCT biometer-derived K values. The performance of formulas varies based on the source of biometry and optimization.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 10-16"},"PeriodicalIF":4.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017846","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 Ganglion Cell Loss and Patterns of Neuroretinal Rim Thinning at the Onset of Visual Field Defects in Glaucoma","authors":"Aaron Samuel Rabinowitz,&nbsp;Verônica Vilasboas-Campos,&nbsp;Marcus Guerreiro Filho,&nbsp;Felipe A. Medeiros","doi":"10.1016/j.ajo.2025.09.008","DOIUrl":"10.1016/j.ajo.2025.09.008","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare retinal ganglion cell (RGC) loss in glaucoma suspect eyes with diffuse versus localized neuroretinal rim loss at the time of the first confirmed visual field defect.</div></div><div><h3>Design</h3><div>Prospective observational cohort study.</div></div><div><h3>Subjects</h3><div>Fifty-three glaucoma suspect eyes and 124 healthy eyes.</div></div><div><h3>Methods</h3><div>Fifty-three glaucoma suspect eyes were followed until development of repeatable glaucomatous visual field defects. Estimated RGC counts were derived using a validated model combining standard automated perimetry and optical coherence tomography measurements. Conversion was defined as the first confirmed abnormal field, with RGC estimates taken within three months. Neuroretinal rim loss was classified as diffuse or localized through masked grading of optic disc stereophotographs. A normative cohort of 124 healthy eyes provided reference RGC values.</div></div><div><h3>Main Outcome Measures</h3><div>Estimated RGC counts at perimetric conversion.</div></div><div><h3>Results</h3><div>Of the 53 eyes, 36 (68%) showed diffuse and 17 (32%) localized rim loss. Eyes with diffuse loss had significantly lower RGC counts at conversion (613 543 ± 114 886) than those with localized loss (733 614 ± 65 776, <em>P</em> &lt; .001), corresponding to a 32.6% and 19.4% mean reduction relative to healthy controls, respectively. Mean deviation differed modestly between groups (–2.44 ± 1.36 dB vs –1.62 ± 1.13 dB, <em>P</em> = .033) at time of conversion. Multivariable analysis identified diffuse rim loss, older age, and Black race as independent predictors of lower RGC counts.</div></div><div><h3>Conclusions</h3><div>Diffuse rim thinning at the earliest stage of functional loss is associated with substantially greater RGC loss than localized thinning. These findings support incorporating structural features into early glaucoma assessment.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 42-51"},"PeriodicalIF":4.2,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017847","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":"Visual Acuity Outcomes After Trans Scleral Cyclophotocoagulation: A Systematic Review and Meta-analysis.","authors":"Chris Zajner,Bhadra Pandya,Michael Balas,David J Mathew","doi":"10.1016/j.ajo.2025.09.009","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.009","url":null,"abstract":"TOPICThe aim of this systematic review and meta-analysis is to evaluate best-corrected visual acuity (VA) outcomes following transscleral cyclophotocoagulation (TSCPC) in patients with refractory glaucoma.CLINICAL RELEVANCETSCPC is typically reserved for cases of refractory glaucoma, due to apprehension of negative affects on VA. Prior studies have reported the VA outcomes from TSCPC, but no comprehensive review of the literature has yet been conducted.METHODSThe full protocol was registered on PROSPERO (42023485891). The electronic databases OVID MEDLINE, and EMBASE were searched using keywords related to TSCPC and visual acuity outcomes (start date to February 7, 2025). Meta-analysis was completed using random effects models and risk ratios to calculate pooled estimates.RESULTSIn total, 90 studies with 6331 eyes were included. Weighted mean patient age was 61.8 (SD 9.8) years, with 53.3% males (n=3374). Follow-up periods of the studies consisted of 19.8% with less than 1 year follow-up, 38.4% with between 1-2 years, and 40.7% with more than 2 year follow-up. Among 19 studies and 1,246 eyes, the weighted mean pre-operative VA was 1.11 LogMAR (SE 0.02)(20/258 Snellen), and 1.12 LogMAR (SE 0.02)(20/264 Snellen) post-procedure. Meta-analysis of 19 studies and 1,246 eyes did not show a statistically significant difference between VA before TSCPC and at last follow-up (Mean Difference: -0.10 LogMAR, 95% confidence interval: -0.22 to 0.01, I2=78.9%, p=0.077). In 59 studies and 3,855 eyes, 50.0% (SE 0.3) of patients maintained their VA at final follow-up, with 6.8% (SE 0.2) showing a 1-line improvement, 9.0% (SE 0.2) improving by 2 or more lines, 17.6% (SE 0.2) decreasing by 1 line, and 16.9% (SE 0.3) decreasing 2 lines or more. In 84 studies and 5,941 eyes, the mean pre-operative IOP was 34.2 (SE 0.09) mmHg, which dropped to 18.3 (SE 0.05) mmHg, with 79.3% of patients achieving an IOP below 22 mmHg. Meta-analysis of 42 studies and 2,393 eyes showed a mean reduction of 1.1 glaucoma medications pre-procedure to last follow-up (95%CI: 0.89-1.31, I2:91.76, p<0.0001). There was a significant negative linear relationship between total energy (Joules) administered with logMAR BCVA outcome (correlation coefficient: -0.008, I2:77.7%, p=0.038). There was no significant correlation between BCVA with duration (milliseconds) of TSCPC application (correlation coefficient: -7.4 × 10-6, I2: 21.5%, p=0.876).CONCLUSIONThis meta-analysis suggests no significant decrease in VA after TSCPC, with a moderate degree of certainty. Larger amounts of total energy during TSCPC was found to be correlated with worse BCVA. However, given the substantial heterogeneity and observational nature of most studies, these findings should be interpreted with caution.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"11 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008703","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 \"OCT and OCTA Features of Optic Disc Melanocytoma: PHOMS, Perfusion Deficits, and Epiretinal Membrane\".","authors":"Ruiheng Zhang,Jiaoyue Dong,Yitong Li,Haotian Wu,Li Dong,Xuhan Shi,Wenda Zhou,Heyan Li,Chuyao Yu,Hanqing Zhao,Yuhang Yang,Shanshan Wang,Huang Yao,Yueming Liu,Wenbin Wei","doi":"10.1016/j.ajo.2025.09.003","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.003","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"14 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008704","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":"Associations Between Visual Impairment and Homebound Status, Home Hazards, and Support Service Utilization: The National Health and Aging Trends Study","authors":"Xindi Chen ,&nbsp;Louay Almidani ,&nbsp;Seema Banerjee ,&nbsp;Jonathan Thomas ,&nbsp;Aleksandra Mihailovic ,&nbsp;Fasika A. Woreta ,&nbsp;Pradeep Y. Ramulu","doi":"10.1016/j.ajo.2025.09.005","DOIUrl":"10.1016/j.ajo.2025.09.005","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the association between visual impairment (VI) and (1) homebound status, (2) presence of home hazards, and (3) utilization of home-based long-term services and supports (LTSS) among older adults. Design: Longitudinal and cross-sectional analyses using National Health and Aging Trends Study (NHATS) data (2021–2023).</div></div><div><h3>Subjects</h3><div>A total of 3022 Medicare beneficiaries aged ≥71 years (mean age 78.8 years, 55.3% female) with complete data on homebound status and visual function.</div></div><div><h3>Methods</h3><div>VI was defined as impairment in distance visual acuity or near visual acuity (&lt;0.3 logMAR), or in contrast sensitivity (&lt;1.55 logCS). Homebound status was classified as homebound, semi-homebound, or non-homebound based on frequency and difficulty leaving home. Home hazards (peeling paint, broken furniture, flooring damage, and tripping hazards) were documented during in-home visits. LTSS utilization encompassed assistive devices, home modifications, transportation services, senior housing, meal delivery, paid care, and high-burden family caregiving. Regression models (logistic and Cox proportional hazards) assessed cross-sectional and longitudinal relationships between VI – its presence, severity, and rate of decline – and outcomes.</div></div><div><h3>Main Outcome Measures</h3><div>Presence or transition to homebound or semi-homebound status, presence of home safety hazards, and utilization of home-based LTSS.</div></div><div><h3>Results</h3><div>Among 3,022 participants (mean age 78.8 years, 55.3% female), 5.7% were homebound, and 14.4% semi-homebound. The presence of any VI was associated with a higher likelihood of both being (OR = 1.52, 95% CI: 1.17-1.98, <em>P</em> = .002) and becoming homebound or semi-homebound (HR = 1.35, 95% CI: 1.04-1.74, <em>P</em> = .02). Participants meeting all three VI criteria had an even higher risk (HR = 1.86, 95% CI: 1.35-2.58, <em>P</em> &lt; .001). Individuals with VI were more likely to have home hazards (OR = 1.88, 95% CI: 1.32-2.69, <em>P</em> = .001) and utilize home-based LTSS (OR = 1.35, 95% CI: 1.10-1.66, <em>p</em> = 0.005).</div></div><div><h3>Conclusions</h3><div>VI is a significant risk factor for being and becoming homebound in older adults, with increasing severity and breadth of VI compounding this risk. Individuals with VI also face greater home hazards and require more home-based LTSS, suggesting challenges maintaining home safety and functionality as they become more confined to the home. Early vision interventions, comprehensive home safety assessments, and targeted LTSS may be important preventive strategies for maintaining independence in visually impaired older adults.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 52-62"},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008709","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":"Real-World Experience With Intravitreal Pegcetacoplan for the Treatment of Geographic Atrophy in Age-Related Macular Degeneration","authors":"Mengxi Shen ,&nbsp;Alessandro Berni ,&nbsp;Jeremy Liu ,&nbsp;Farhan Hiya ,&nbsp;Gissel Herrera ,&nbsp;Omar S. El-Mulki ,&nbsp;Sara Beqiri ,&nbsp;Yuxuan Cheng ,&nbsp;James Kastner ,&nbsp;Omer Trivizki ,&nbsp;Sivathanu Kumar ,&nbsp;Yi Zhang ,&nbsp;Viet Hoan Le ,&nbsp;Robert C. O'Brien ,&nbsp;Maura Di Nicola ,&nbsp;Zohar Yehoshua ,&nbsp;Sander R. Dubovy ,&nbsp;Ruikang K. Wang ,&nbsp;Giovanni Gregori ,&nbsp;Philip J. Rosenfeld","doi":"10.1016/j.ajo.2025.09.006","DOIUrl":"10.1016/j.ajo.2025.09.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To report on the real-world experience of using intravitreal pegcetacoplan for the treatment of geographic atrophy (GA) in age-related macular degeneration (AMD).</div></div><div><h3>Design</h3><div>Retrospective interventional case series.</div></div><div><h3>Methods</h3><div>Eyes with symptomatic GA secondary to AMD were treated with 15 mg of intravitreal pegcetacoplan and participated in an ongoing prospective swept-source optical coherence tomography angiography (SS-OCTA) imaging study. All eyes underwent SS-OCTA imaging before and during pegcetacoplan therapy to assess for GA lesion size, the presence of nonexudative macular neovascularization (MNV), and the onset of exudation. The growth rate of GA and best-corrected visual acuity (BCVA) were assessed for eyes followed for 1 year.</div></div><div><h3>Results</h3><div>From April 12, 2023, to November 11, 2024, 154 eyes were injected with pegcetacoplan, and 103 eyes had 1-year follow-up. At baseline, 11 eyes had been previously treated with anti-VEGF therapy, and 9 eyes were diagnosed with treatment-naïve nonexudative MNV by SS-OCTA. Each eye received an average of 10 ± 2 injections, with an average interval of 1.2 months between injections. For the 97 eyes with 1 year of follow-up and measurable GA, the square-root (sqrt) GA growth rate after pegcetacoplan treatment was 0.24 ± 0.15 mm/year. Of these 97 eyes, 63 eyes had prior annual visits before pegcetacoplan treatment was started. In these eyes, the annual sqrt GA growth rate was 0.33 ± 0.22 mm/year before pegcetacoplan and 0.21 ± 0.12 mm/year after pegcetacoplan, resulting in a 37% decrease in the growth rate (<em>P</em> &lt; .001). There were no significant differences in GA growth rate between foveal and nonfoveal GA, either before or after the use of pegcetacoplan (all <em>P</em> ≥ .80). The mean BCVA declined from 63 ± 14 to 59 ± 15 letters over 1 year (<em>P</em> = .001), with no significant difference between foveal and nonfoveal GA (<em>P</em> = .36). Among the 29 eyes developing exudation during pegcetacoplan treatment, 19 (66%) had no evidence of any detectable MNV at baseline and during treatment on SS-OCTA.</div></div><div><h3>Conclusions</h3><div>Eyes treated with pegcetacoplan after 1 year had a 37% reduction in GA growth rate compared with their prior annual growth rate. Pegcetacoplan slowed the growth for foveal and nonfoveal GA at a similar rate. Most of the pegcetacoplan-associated exudation was not due to detectable MNV.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 31-41"},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008706","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 Risk of Retinal Detachment Following Boston Keratoprosthesis Type 1 Implantation: Insights From a Retrospective Case Review","authors":"Simon Elsliger ,&nbsp;Maya Sebag ,&nbsp;Wissam B Nassrallah ,&nbsp;Moncef Berkache ,&nbsp;Allison Bernstein ,&nbsp;Dominique Geoffrion ,&nbsp;Rayan Tolba ,&nbsp;Amir Abd Elkader ,&nbsp;Mona Harissi-Dagher","doi":"10.1016/j.ajo.2025.09.007","DOIUrl":"10.1016/j.ajo.2025.09.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the incidence, risk factors, management strategies, and visual outcomes of retinal detachment (RD) following Boston Keratoprosthesis Type 1 (KPro) implantation.</div></div><div><h3>Design</h3><div>Single-center, retrospective observational case series.</div></div><div><h3>Methods</h3><div>Medical records of 157 eyes from 122 adult patients who underwent Boston Type 1 KPro implantation at a tertiary care center between 2008 and 2022 were reviewed. Inclusion criteria included age ≥18 years and postoperative follow-up of at least 1 year. Demographic data, preoperative characteristics, postoperative complications, and visual outcomes were collected. Univariate and multivariate statistical analyses were conducted to identify significant risk factors for RD. Cox regression and Kaplan–Meier survival analysis were used to evaluate time-to-event data.</div></div><div><h3>Results</h3><div>Of the 157 eyes that underwent Boston Type 1 KPro implantation, 27 eyes (17.2%) developed retinal detachment (RD), all within 8 years postoperatively (2 RD per 100 eye years). Aniridia was significantly associated with increased RD risk (OR: 2.79; 95% CI: 1.23-6.70), while other preoperative diagnoses were not. Eyes with RD were more likely to experience hypotony (OR: 7.63; <em>P</em> &lt; .0001), choroidal detachment (OR: 7.67; <em>P</em> &lt; .0001), phthisis (OR: 7.69; <em>P</em> &lt; .0001), and other serious complications. Surgical intervention was possible in 16 of the 27 RD cases, with pneumatic retinopexy being the most common approach.</div></div><div><h3>Conclusions</h3><div>Retinal detachment is a significant complication following KPro implantation, particularly in patients with aniridia. Postoperative hypotony and other inflammatory complications may contribute to increased RD risk and challenge surgical repair. Close monitoring of high-risk patients may help mitigate long-term visual morbidity.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 1-9"},"PeriodicalIF":4.2,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008701","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":"Innovative Non-Inverted ILM Free Flap Covering Technique for Unclosed Macular Hole Repair.","authors":"Xuerui Zhang,Yu Xu,Wenting Zhang,Yuan Yang,Jiawei Yin,Huanyu Liu,Victoria Y Gu,Haodong Xiao,Shipeng Guo,Jie Peng,Peiquan Zhao","doi":"10.1016/j.ajo.2025.09.002","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.09.002","url":null,"abstract":"OBJECTIVETo examine the safety and effectiveness of non-inverted ILM Free Flap combined with the SPOT technique (Sub-Perfluorocarbon liquid (PFCL) injection of Ocular viscoelastic device (OVD) Technique) in the treatment of unclosed macular holes (MHs).DESIGNRetrospective interventional case series.PARTICIPANTSEight patients (8 eyes) with persistent unclosed MHs were treated at a tertiary eye hospital in China from September 2023 to February 2025. All procedures were performed by the same vitreoretinal surgeon(P.Q.Z.).METHODSEnhanced ILM peeling and a limited ILM flap harvested outside the peeling margin to cover the MH. A combination of PFCL and OVD (SPOT technique) was applied to stabilize the ILM flap.MAIN OUTCOMES AND MEASURESPrimary outcome was anatomical closure of the MH within one month postoperatively. Secondary outcomes included best-corrected visual acuity (BCVA) and structural restoration of the external limiting membrane (ELM), outer nuclear layer (ONL), and ellipsoid zone (EZ) on optical coherence tomography (OCT).RESULTSAll MHs achieved anatomical closure within one month. U-shaped closure was noted in six eyes (75%) and V-shaped in two eyes (25%). BCVA improved in all eyes at final follow-up. OCT showed reconstitution of the ELM, ONL, and EZ bands in all cases.CONCLUSIONSThese findings demonstrate that the innovative combination of the non-inverted, single-layered ILM-free flap with the SPOT technique is effective in treating unclosed MH and improving VA. This approach offers a new solution for unclosed MH and its effectiveness needs to be validated by more well-designed research.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"128 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145007088","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":"Scorpion Venom Peptides in Ophthalmology: Insights from the Babylonian Talmud","authors":"David Maskill ,&nbsp;Robert Morgan Blizzard","doi":"10.1016/j.ajo.2025.08.054","DOIUrl":"10.1016/j.ajo.2025.08.054","url":null,"abstract":"<div><div>Historical medical texts can reveal overlooked therapeutic approaches relevant to modern ophthalmology. This perspective revisits a remedy from the Babylonian Talmud prescribing a mixture of scorpion and kohl for an eye condition called <em>buruqti</em> (also transliterated as <em>beroketi</em>), traditionally translated as cataract. Through philologic, zoologic, and pathologic analysis, we argue that <em>buruqti</em> likely refers to a corneal or conjunctival lesion rather than a true lens opacity. The description within the remedy of the scorpion’s “seven-beaded tail” is interpreted symbolically within the cultural and mystical framework of Late Antiquity. This ancient preparation, although not adopted in later medical texts, raises intriguing possibilities for the use of arachnid venom peptides in ocular disease. These peptides possess antimicrobial, immunomodulatory, and antiangiogenic properties with emerging potential for treating inflammatory and degenerative eye disorders. This article highlights the intersection of historical scholarship and modern biomedical research, suggesting that ancient remedies can inspire novel pharmacologic strategies. We thereby aim to expand the conceptual horizons of ophthalmic drug discovery and encourage exploration of venom-derived peptides as next-generation therapeutics.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"281 ","pages":"Pages 25-30"},"PeriodicalIF":4.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995919","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}