American Journal of Ophthalmology最新文献

{"title":"Surgical Dosing for V-Pattern Exotropia","authors":"Veronika Yehezkeli ,&nbsp;Emanuil Parunakian ,&nbsp;Soh Youn Suh ,&nbsp;Qingyu Meng ,&nbsp;Joseph L. Demer","doi":"10.1016/j.ajo.2025.08.014","DOIUrl":"10.1016/j.ajo.2025.08.014","url":null,"abstract":"<div><h3>PURPOSE</h3><div>Consensus is lacking around optimal surgical strategies to correct V-pattern exotropia (VXT). This study quantitatively examined alternative surgical strategies and dosing .</div></div><div><h3>DESIGN</h3><div>Comparative interventional case series.</div></div><div><h3>METHODS</h3><div>Consecutive patients with VXT undergoing strabismus surgery between 2014 and 2025 were reviewed. Incomitance of at least 15D between sursumversion and deorsumversion was considered V-pattern. Surgeries were performed by 2 surgeons using identical technique<strong>.</strong> The primary outcome was the surgical alignment effect.</div></div><div><h3>RESULTS</h3><div>A total of 55 patients (36 children and 19 adults) underwent horizontal rectus muscle surgery: inferior oblique (IO) recession (n = 12), superior transposition of lateral rectus muscles (n = 20), their combination (n = 10), and no modifications (n = 13). Surgery reduced average primary gaze exotropia in all groups from 29 ± 11Δ to 8 ± 8Δ (SD <em>P</em> &lt; .001), irrespective of pattern collapse. There was 6.0 Δ mean postoperative exodrift after 2.1 ± 2.0 years following surgery. Pattern decreased in all groups from: 22 ± 8Δ to 10 ± 8Δ by IO recession, 22 ± 6Δ to 3 ± 6Δ by horizontal rectus transposition, 30 ± 10Δ to 5 ± 13Δ by the combination, and 16 ± 2Δ to 6 ± 7Δ with no modifications. The combined procedure yielded the greatest pattern reduction. Transpositions of half and three-quarter tendon width yielded similar effects on pattern. Linear regression showed a significant correlation between lateral rectus recession and exotropia reduction (<em>P</em> &lt; .001), accounting for 40% of variance. However, the surgical effect was smaller than that predicted by Parks tables.</div></div><div><h3>CONCLUSIONS</h3><div>IO recession, LR transposition, and their combination reduce pattern in VXT, with the greatest effect when combined. Horizontal rectus recession alone also reduces the pattern, albeit to a lesser extent. Horizontal rectus recession dose need not be adjusted for pattern collapse. Early overcorrection is recommended.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 64-70"},"PeriodicalIF":4.2,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854245","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":"Table of content","authors":"","doi":"10.1016/S0002-9394(25)00395-2","DOIUrl":"10.1016/S0002-9394(25)00395-2","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"277 ","pages":"Pages iv-xiv"},"PeriodicalIF":4.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144809766","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":"CMVFT: A Multiscale Attention-Guided Framework for Enhanced Keratoconus Suspect Classification in Multiview Corneal Topography","authors":"Yifan Lu ,&nbsp;Baojiang Li ,&nbsp;Yunhai Zhang ,&nbsp;Yayu Qi ,&nbsp;Xingbin Shi","doi":"10.1016/j.ajo.2025.08.008","DOIUrl":"10.1016/j.ajo.2025.08.008","url":null,"abstract":"<div><h3>Objective</h3><div>To develop a multiview fusion framework that effectively identifies suspect keratoconus cases and facilitates the possibility of early clinical intervention.</div></div><div><h3>Design</h3><div>Retrospective cross-sectional study.</div></div><div><h3>Subjects</h3><div>A total of 573 corneal topography maps representing eyes classified as normal, suspect, or keratoconus.</div></div><div><h3>Methods</h3><div>We designed the corneal multiview fusion transformer (CMVFT), which integrates features from seven standard corneal topography maps. A pretrained ResNet-50 extracts single-view representations that are further refined by a custom-designed multiscale attention module (MSAM). This integrated design specifically compensates for the representation gap commonly encountered when applying Transformers to small-sample corneal topography datasets by dynamically bridging local convolution-based feature extraction with global self-attention mechanisms. A subsequent fusion Transformer then models long-range dependencies across views for comprehensive multiview feature integration.</div></div><div><h3>Main Outcome Measures</h3><div>The primary measure was the framework’s ability to differentiate suspect cases from normal and keratoconus cases, thereby creating a pathway for early clinical intervention.</div></div><div><h3>Results</h3><div>Experimental evaluation demonstrated that CMVFT effectively distinguishes suspect cases within a feature space characterized by overlapping attributes. Ablation studies confirmed that both the MSAM and the fusion Transformer are essential for robust multiview feature integration, successfully compensating for potential representation shortcomings in small datasets.</div></div><div><h3>Conclusions</h3><div>This study is the first to apply a Transformer-driven multiview fusion approach in corneal topography analysis. By compensating for the representation gap inherent in small-sample settings, CMVFT shows promise in enabling the identification of suspect keratoconus cases and supporting early intervention strategies, with prospective implications for early clinical intervention.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 87-105"},"PeriodicalIF":4.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144843992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Circularity of Neovascular Lesion and Polypoidal Lesion Regression in Polypoidal Choroidal Vasculopathy","authors":"Jaehwan Choi ,&nbsp;Kiyoung Kim ,&nbsp;Junwoo Lee ,&nbsp;Seung-Young Yu","doi":"10.1016/j.ajo.2025.08.007","DOIUrl":"10.1016/j.ajo.2025.08.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the relationship between the circularity of neovascular lesion and the early regression of polypoidal lesions following anti-vascular endothelial growth factor (anti-VEGF) treatment in patients with polypoidal choroidal vasculopathy (PCV).</div></div><div><h3>Design</h3><div>Retrospective, interventional case series.</div></div><div><h3>Methods</h3><div>This retrospective study included treatment-naïve patients with PCV who underwent pre- and post-treatment swept-source optical coherence tomography angiography (SS-OCTA) images. The patients were classified into regressed and persistent groups depending on the regression of polypoidal lesions after 3 consecutive intravitreal anti-VEGF injections. Regression of polypoidal lesions was assessed using en face and B-mode SS-OCTA images. The baseline neovascular lesion circularity was measured using SS-OCTA images. The baseline characteristics, anatomical features, and best-corrected visual acuity (BCVA) were compared between the 2 groups. Receiver Operating Characteristic (ROC) curve analysis was performed to determine the optimal cut off value of neovascular lesion circularity for predicting polypoidal lesion regression. In addition, the association between baseline neovascular lesion circularity and BCVA after 1 year of treatment was assessed.</div></div><div><h3>Results</h3><div>The study included 42 eyes of 42 patients, 11 (24.2%) of whom showed polypoidal lesion regression after treatment. The baseline neovascular lesion circularity was significantly higher in the regressed group (0.50 ± 0.14) compared to the persistent group (0.36 ± 0.11. ROC analysis revealed an optimal neovascular lesion circularity cut-off value of 0.43, with an area under the curve of 0.809, sensitivity of 81.8%, and specificity of 83.3%. In multivariate linear regression analysis, higher baseline neovascular lesion circularity was independently associated with better visual improvement.</div></div><div><h3>Conclusion</h3><div>Neovascular lesion circularity is a promising predictive marker for early regression of polypoidal lesions improves visual outcomes in patients with PCV. Patients with a more circular neovascular lesion morphology were more likely to respond favorably to anti-VEGF treatment. These findings suggest that OCTA-based assessment of neovascular lesion structures could guide personalized treatment strategies for PCV.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 79-86"},"PeriodicalIF":4.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144843991","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":"Peripheral Macular Endothelial Dystrophy: Clinical, Histopathologic, Genetic and Functional Characterization","authors":"Wenlin Zhang ,&nbsp;Huong Duong ,&nbsp;Passara Jongkhajornpong ,&nbsp;Do Thi Thuy Hang ,&nbsp;Huan Pham ,&nbsp;Mai Nguyen ,&nbsp;Charlene Choo ,&nbsp;Dominic Williams ,&nbsp;Xuan Nguyen ,&nbsp;Tien Dat Nguyen ,&nbsp;Brian Aguirre ,&nbsp;Shaukat Khan ,&nbsp;Madhuri Wadehra ,&nbsp;Shunji Tomatsu ,&nbsp;Anthony J. Aldave","doi":"10.1016/j.ajo.2025.08.006","DOIUrl":"10.1016/j.ajo.2025.08.006","url":null,"abstract":"<div><h3>Objective</h3><div>To report a <em>CHST6</em>-associated corneal endothelial dystrophy.</div></div><div><h3>Design</h3><div>Prospective observational case series.</div></div><div><h3>Participants</h3><div>Thirty-five individuals from seven families, including 13 affected individuals exhibiting corneal epithelial and stromal edema, peripheral posterior corneal macular opacities, and endothelial guttae, as well as 22 unaffected family members.</div></div><div><h3>Methods</h3><div>Whole-exome sequencing was performed in 3 families and Sanger sequencing of <em>CHST6</em> was performed in all individuals. Histological examination of Descemet membrane (DM) excised at the time of endothelial keratoplasty was performed for three probands. Serum keratan sulfate (KS) levels were measured in members of six families. Functional analysis of identified mutations was performed using <em>CHST6</em> promoter containing CHST6 expression vector in human keratocytes (HK) and corneal endothelial cells (HCEnC).</div></div><div><h3>Main Outcome Measures</h3><div>Clinical phenotype; genetic analysis; functional analysis of identified <em>CHST6</em> mutations; serum KS levels; histologic examinations of DM.</div></div><div><h3>Results</h3><div>All affected individuals demonstrated peripheral macular opacities at the level of DM. Visually significant corneal edema in affected individuals was successfully managed by endothelial keratoplasty. Genetic analysis demonstrated a rare <em>CHST6</em> promoter mutation (c.-690G&gt;C) in the homozygous state in affected individuals from three families and in the compound heterozygous state with a <em>CHST6</em> coding mutation (p.R211Q, p.Y268C or p.P280L) in affected individuals from the other four families. In silico analysis predicted c.-690G&gt;C to be a regulatory variant, located at the RNA polymerase II binding site. Functional analysis <em>in vitro</em> demonstrated that c.-690G&gt;C leads to increased KS sulfation in the corneal endothelium and DM, with no change of KS sulfation in keratocytes. Histologic examination of DM from affected individuals revealed elevated levels of sulfated and non-sulfated KS in DM and endothelium, consistent with the functional analysis. Minimum changes in serum sulfated KS levels were observed in affected individuals.</div></div><div><h3>Conclusions</h3><div>We suggest the name Peripheral macular endothelial dystrophy (PMED) to describe this dystrophy that is characterized by peripheral posterior corneal macular opacities and endothelial dysfunction without stromal haze or opacities. Given that both PMED and macular corneal dystrophy are associated with promoter and coding region mutations in <em>CHST6</em>, we propose that they be categorized as <em>CHST6</em>-associated corneal dystrophies.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 154-168"},"PeriodicalIF":4.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144843993","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":"Retinopathy of Prematurity in the Extremely Premature: Disease Burden, Treatment Approaches, and Visual Outcomes in Micro- and Nano-Premature Infants","authors":"Melissa Yuan ,&nbsp;Celine Chaaya ,&nbsp;Francisco Altamirano ,&nbsp;Daniel Hu ,&nbsp;Sandra Hoyek ,&nbsp;Muhammad Abidi ,&nbsp;Hanna De Bruyn ,&nbsp;Anne Fulton ,&nbsp;Iason S Mantagos ,&nbsp;Carolyn Wu ,&nbsp;Efren Gonzalez ,&nbsp;Deborah K VanderVeen ,&nbsp;Nimesh A Patel ,&nbsp;Ryan Gise","doi":"10.1016/j.ajo.2025.08.004","DOIUrl":"10.1016/j.ajo.2025.08.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize the treatment and outcomes of retinopathy of prematurity (ROP) in high-risk extremely premature infants.</div></div><div><h3>Design</h3><div>Retrospective, single-center clinical cohort study.</div></div><div><h3>Methods</h3><div>Infants meeting criteria for micro-prematurity (24-26 weeks gestational age [GA] and/or birth weight [BW] 600-799 grams) or nano-prematurity (&lt;24 weeks GA and/or BW &lt;600 grams) from 2013 to 2023 were included.</div></div><div><h3>Results</h3><div>Total 3239 infants were screened, of which 702 infants were included and 525 infants were selected for analysis after excluding patients lost to follow-up ROP was observed 891 eyes (84.9%)225 eyes (21.4%) developed type 1 disease and required treatment. with laser and/or anti-VEGF. One hundred and thirty two eyes of 74 patients (12.6%) required re-treatment. Lower GA, lower BW, and central nervous system hemorrhagic injury were associated with treatment-warranted ROP on multivariable regression. The nano-premature demonstrated more severe ROP, more posterior disease, higher rates of treatment at earlier ages, increased incidence of treatment by all modalities, higher rates of amblyopia, worse final visual acuity, and more frequent developmental delay.</div></div><div><h3>Conclusion</h3><div>While treatment can stabilize the disease, patients face ongoing challenges, including visual and developmental complications. Lower GA, lower BW, and central nervous system injury emerged as significant risk factors for treatment-warranted ROP. Nano-premature infants showed higher rates of more severe ROP, amblyopia, and poorer visual outcomes compared to micro-premature infants. These findings highlight the importance of screening and follow-up in this population and provide valuable natural history, treatment, and outcome information for ophthalmologists caring for these high-risk infants.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 40-50"},"PeriodicalIF":4.2,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825470","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":"Prevalence and Risk Factors of Open-Angle Glaucoma in an Adult Chinese American Population: The Chinese American Eye Study","authors":"Grace M. Richter ,&nbsp;Benjamin Y. Xu ,&nbsp;Bruce S. Burkemper ,&nbsp;Xuejuan Jiang ,&nbsp;Mina Torres ,&nbsp;Farzana Choudhury ,&nbsp;Roberta McKean-Cowdin ,&nbsp;Nathan Dhablania ,&nbsp;Rohit Varma","doi":"10.1016/j.ajo.2025.08.010","DOIUrl":"10.1016/j.ajo.2025.08.010","url":null,"abstract":"<div><h3>Purpose</h3><div>To estimate the prevalence of and identify risk factors associated with open-angle glaucoma (OAG) among adult Chinese Americans.</div></div><div><h3>Design</h3><div>Population-based, cross-sectional study.</div></div><div><h3>Participants</h3><div>A total of 4582 Chinese Americans aged 50 years and older residing in Monterey Park, California.</div></div><div><h3>Methods</h3><div>Participants from the Chinese American Eye Study underwent a comprehensive interview, eye examination, and ophthalmic testing. OAG was defined by characteristic optic nerve head changes with or without corresponding visual field loss, as determined by a panel of glaucoma specialists, and required at gonioscopic confirmation of least 2 quadrants of visible pigmented trabecular meshwork. Candidate risk factors comprised demographic, clinical, and ocular characteristics. Multivariable logistic regression analysis was used to identify independent risk factors associated with OAG.</div></div><div><h3>Main Outcome Measures</h3><div>Prevalence of and independent risk factors associated with OAG.</div></div><div><h3>Results</h3><div>Of the 4310 participants with complete data, the prevalence of OAG was 4.8% (207/4310), ranging from 2.8% among those aged 50 to 59 years to 14.8% among those 80 years and older. Of those with OAG, 68.5% were previously undiagnosed or untreated, and 88.5% had intraocular pressure (IOP) ≤21 mm Hg. Independent risk factors for OAG, adjusting for sex, were older age (odds ratio [confidence interval] = 1.06 [1.05-1.08], per year); higher IOP (1.12 [1.08-1.17], per mm Hg); longer axial length (1.36 [1.25-1.47], per mm); family history of glaucoma (1.88 [1.19-2.97]); and diabetes mellitus (1.49 [1.05-2.11]).</div></div><div><h3>Conclusions</h3><div>The prevalence of OAG among Chinese Americans may be higher than that reported in US populations of European descent and in Asia-based Chinese populations, but lower than that observed in Latinos in Los Angeles and individuals of African Caribbean descent. More than two-thirds of OAG cases in our study were previously undiagnosed or untreated, with a majority presenting with IOP ≤21 mm Hg. These findings highlight the importance of identifying high-risk individuals based on age, IOP, axial length, family history, and diabetes mellitus. Given the high prevalence of myopia, future research should evaluate whether interventions to prevent myopia could help reduce the risk for developing OAG.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 9-19"},"PeriodicalIF":4.2,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825762","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":"Accuracy of New-Generation Intraocular Lens Power Calculation Formulas for Highly Myopic Eyes: A Multicenter Study in Japan.","authors":"Masaki Kinoshita,So Goto,Yosai Mori,Hidemasa Torii,Yumi Hasegawa,Takashi Kojima,Kazutaka Kamiya,Takuya Shiba,Kazunori Miyata","doi":"10.1016/j.ajo.2025.08.013","DOIUrl":"https://doi.org/10.1016/j.ajo.2025.08.013","url":null,"abstract":"PURPOSETo compare the refractive prediction accuracy of 13 intraocular lens (IOL) power calculation formulas, including seven new-generation formulas available on the European Society of Cataract and Refractive Surgeons (ESCRS) calculator, in highly myopic eyes with axial lengths (AL) of 26.0 mm or longer, through a multicenter study in Japan.DESIGNA retrospective case series.SUBJECTSThe study included 326 eyes of 326 patients at four surgical sites in Japan.METHODSAll patients underwent comprehensive preoperative ophthalmic evaluations, including slit-lamp examination and fundoscopy by ophthalmologists. Corrected distance visual acuity and intraocular pressure were assessed by certified orthoptists. Standard phacoemulsification with intraocular lens implantation in the capsular bag was performed under topical anesthesia by experienced cataract surgeons.MAIN OUTCOME MEASURESPostoperative spherical equivalent prediction error (SEQ-PE) was assessed for 13 formulas, including traditional formulas (Haigis, Hoffer Q, Holladay 1, SRK/T, Wang-Koch (WK) adjustment formulas for Holladay 1 [Holladay 1 WK] and SRK/T [SRK/T WK]) and new-generation formulas (Barrett Universal II, EVO 2.0, Hill-RBF, Hoffer QST, Kane, Cooke K6, Pearl-DGS). Predictive performance was evaluated using root-mean-square absolute error (RMSAE) and the Eyetemis online analysis tool.RESULTSThe mean AL was 27.28 ± 0.98 mm. The Hoffer QST, Holladay 1 WK, and SRK/T WK demonstrated myopic shifts, whereas other formulas showed a hyperopic shift in SEQ-PE. The Haigis, Hoffer Q, and Holladay 1 exhibited relatively large hyperopic errors (≥ 0.27 D). RMSAE exceeded 0.7 in the Hoffer Q and Holladay 1, whereas the best performance (RMSAE < 0.53) was observed in the Holladay 1 WK and six new-generation formulas, except for the Pearl-DGS.CONCLUSIONSNew-generation IOL power calculation formulas and the Holladay 1 WK offer superior predictive accuracy in highly myopic eyes compared with traditional formulas.","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"7 1","pages":""},"PeriodicalIF":4.2,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825761","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":"Overcoming Corneal Opacity Challenges: Visualization Assessment of 3D System With Coaxial Illumination in Cataract Surgery","authors":"Yan Wang ,&nbsp;Yingfeng Hu ,&nbsp;Daoguang Wang ,&nbsp;Rong Zhang ,&nbsp;Zheng Wang ,&nbsp;Guangbin Zhang ,&nbsp;Jinling Huang ,&nbsp;Xiangyu Ye","doi":"10.1016/j.ajo.2025.08.009","DOIUrl":"10.1016/j.ajo.2025.08.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the performance of the 3D visualization system with coaxial illumination (3D-C) in treating cataract patients with corneal opacities.</div></div><div><h3>Design</h3><div>Prospective, comparative interventional case series.</div></div><div><h3>Subjects</h3><div>This study included patients with cataract and corneal opacities that underwent phacoemulsification. Inclusion criteria: senile cataract cases with stable corneal opacity of grade 2-3 (Corneal Haze classification). Exclusion criteria: (1) prior intraocular surgical interventions excluding corneal procedures; (2) ocular complications such as active corneal infections, glaucoma, lens dislocation, vitreoretinal diseases, or uveitis.</div></div><div><h3>Methods</h3><div>This two-part assessment for visualization comprised of an objective analysis utilizing surgical video images and a subjective survey collecting feedback from the surgeons. Data of each eye were obtained with 2 approaches: 3D visualization system with coaxial illumination (3D-C) and 3D visualization system with standard illumination (3D-S).</div></div><div><h3>Main outcome measures</h3><div>Objective analysis: red reflex and contrast assessment of images in the followed steps: before the surgery, capsulorhexis, nucleus groove, and cortex aspiration. Subjective survey: scales from five experienced surgeons at eight parameters: red reflex, depth of field, corneoscleral limbus clarity, capsulorhexis, hydrodissection, nucleus groove, cortex removal, and ophthalmic viscosurgical devices removal.</div></div><div><h3>Results</h3><div>The red reflex values of the 3D-C group were 207.7 ± 26.2, 195.7 ± 24.6, 154.3 ± 18.6, and 179.7 ± 21.6 in the steps of surgery beginning, capsulorhexis, nucleus groove, and cortex aspiration, which were markedly greater than those of the 3D-S group (<em>P</em> ≤ .001). Contrast values of the aforementioned steps were higher in the 3D-C group than in the 3D-S group (<em>P</em> ≤ .01). All surgeons emphasized that the intraocular tissue below corneal opacity was more clearly identified during various stages of the surgery by intensifying intraoperative visualization through the 3D-C approach.</div></div><div><h3>Conclusions</h3><div>The 3D-C approach significantly enhanced red reflex and contrast within the pupillary area during phacoemulsification. The utilization of the 3D-C approach is beneficial for performing surgical maneuvers in cataract patients with corneal opacities.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 71-78"},"PeriodicalIF":4.2,"publicationDate":"2025-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144825764","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":"Delphi-Based Global Consensus on Fuchs Endothelial Corneal Dystrophy. An Endothelial Keratoplasty Learners Group Initiative","authors":"Sanjay V. Patel ,&nbsp;Nidhi Gupta ,&nbsp;Maninder Bhogal ,&nbsp;Ula V. Jurkunas ,&nbsp;Naoki Okumura ,&nbsp;Vito Romano ,&nbsp;Bruce D. Allan ,&nbsp;Keith H. Baratz ,&nbsp;Samar K. Basak ,&nbsp;Lamis Baydoun ,&nbsp;Winston Chamberlain ,&nbsp;Sunita Chaurasia ,&nbsp;Kathryn Colby ,&nbsp;Claus Cursiefen ,&nbsp;Ticiano Giobellina ,&nbsp;Mark A. Greiner ,&nbsp;Jesper Hjortdal ,&nbsp;Akira Kobayashi ,&nbsp;Viridiana Kocaba ,&nbsp;Ellen H. Koo ,&nbsp;Roberto Pineda II","doi":"10.1016/j.ajo.2025.08.012","DOIUrl":"10.1016/j.ajo.2025.08.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify areas of consensus among global experts for the management of Fuchs endothelial corneal dystrophy (FECD) in clinical practice, including its diagnosis, evaluation, decision-making principles with respect to intervention, and recommendations for performing cataract surgery in patients with FECD, including when to combine with keratoplasty.</div></div><div><h3>Design</h3><div>Modified Delphi-based global consensus.</div></div><div><h3>Participants</h3><div>Thirty-seven ophthalmologists from around the world with significant expertise in the management and mechanisms of FECD.</div></div><div><h3>Methods</h3><div>A series of consensus statements about FECD were developed from three iterative rounds of structured questions and statements posed to the panel of experts. Two rounds were asynchronous electronic questionnaires, and the third round was a live virtual meeting. Experts responded anonymously to statements assessing consensus and to open-ended questions that invited diverse input.</div></div><div><h3>Main Outcome Measures</h3><div>Consensus was defined as 70% agreement among experts.</div></div><div><h3>Results</h3><div>Consensus was reached for 90 of 91 statements after three rounds. Experts agreed that FECD is defined by the presence of central or paracentral scattered or confluent guttae with or without edema. There was strong consensus that a chronic state of subclinical edema precedes the onset of clinically detectable edema that may or may not cause symptoms. With near-unanimous consensus, disease evaluation recommendations included assessing for findings that implicate the cornea as a source of decreased vision to separate it from the effect of comorbid conditions, as this would inform whether corneal intervention is appropriate. These findings include diurnal variation in vision, clinical or subclinical (tomographic) edema, and changes or differences in central corneal thickness. Based on current evidence, experts agreed that there are no effective medical therapies for FECD, and that Descemet membrane endothelial keratoplasty is the surgical treatment of choice when indicated.</div></div><div><h3>Conclusions</h3><div>The consensus statements provide current globally endorsed recommendations for the diagnosis and management of FECD. The guidelines are important and relevant for general ophthalmologists, who typically first diagnose and evaluate FECD, and for cornea specialists, by allowing them to benchmark their current practice patterns against expert recommendations. This could help improve patient outcomes and establish a framework adaptable to future advances and evolving technologies in the management of FECD.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"280 ","pages":"Pages 130-143"},"PeriodicalIF":4.2,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144819727","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}