American Journal of Ophthalmology最新文献

{"title":"Immunopathology of the Outer Retina: Crosstalk With the Immune System","authors":"Gerhild Wildner ,&nbsp;Miranda Gehrke ,&nbsp;Olaf Strauß","doi":"10.1016/j.ajo.2025.12.032","DOIUrl":"10.1016/j.ajo.2025.12.032","url":null,"abstract":"<div><h3>Objective</h3><div>The retinal pigment epithelium (RPE) forms the outer blood-retina barrier. This barrier separates the retina from the choriocapillaris, as well as the immune system. The RPE contributes to the immune privilege of the eye by communicating with the local and systemic immune systems via various receptors and soluble factors. We recently described the expression and upregulation of the transcription factor FoxP3 in stressed RPE cells <em>in vivo</em> and <em>in vitro</em>. FoxP3 was initially described as being specific to regulatory T cells. Based on the hypothesis that different FoxP3 variants are expressed in RPE cells, we investigated the subcellular localization of FoxP3 using a panel of nine antibodies raised against different FoxP3 epitopes in ARPE-19 cells.</div></div><div><h3>Design</h3><div>We investigated cytokine secretion and FoxP3 expression in stressed and unstressed ARPE-19 cells.</div></div><div><h3>Methods</h3><div>Culture supernatants from ARPE-19 cells treated with LPS or with mechanical disruption of the cell layer were investigated for cytokine secretion using a multiplex assay. The cells were then stained with immunofluorescent antibodies that target different FoxP3 domains and phosphorylation sites to detect the intracellular localization of FoxP3.</div></div><div><h3>Main outcome measures</h3><div>Detection of FoxP3 at the subcellular level by identifying different epitopes on the protein.</div></div><div><h3>Results</h3><div>Stressed ARPE-19 cells upregulate inflammatory cytokines (IL-6 and MCP-1), which correspond with FoxP3 localization patterns in the cytoplasm and nucleus (phosphorylated FoxP3), depending on the epitope detected by the antibodies.</div></div><div><h3>Conclusions</h3><div>Stressed RPE cells switch from a tolerogenic to an effector phenotype, yet they immediately re-establish immune privilege by upregulating the transcription factor FoxP3, similar to T cells in the immune system. These different FoxP3 detection patterns suggest an RPE-specific role in maintaining the immune barrier, as well as in other non-T cell tissues that express FoxP3.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 56-65"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897374","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":"An Artificial Intelligence-Based Prognostic Model for Prediction of Functional Glaucoma Progression From Clinical and Structural Data","authors":"Vahid Mohammadzadeh ,&nbsp;Sean Wu ,&nbsp;Sajad Besharati ,&nbsp;Mahshad Rafiee ,&nbsp;Yasamin Banaei ,&nbsp;Arthur Martinyan ,&nbsp;Jane Zou ,&nbsp;Evelyn Kung ,&nbsp;Kiumars Edalati ,&nbsp;Esteban Morales ,&nbsp;Fabien Scalzo ,&nbsp;Joseph Caprioli ,&nbsp;Kouros Nouri-Mahdavi","doi":"10.1016/j.ajo.2025.12.026","DOIUrl":"10.1016/j.ajo.2025.12.026","url":null,"abstract":"<div><h3>Purpose</h3><div>Integration of various sources of information for prediction of disease progression is an unmet need in glaucoma diagnostics. We designed a deep learning-based prognostic model incorporating clinical and structural data for forecasting functional glaucoma progression and compared its performance to clinicians.</div></div><div><h3>Design</h3><div>Retrospective, comparative cohort study of prognostic accuracy.</div></div><div><h3>Subjects</h3><div>We included 1599 eyes (908 patients) with definite or suspected glaucoma with ≥5 24-2 visual fields (VF) and 3 or more years of follow-up.</div></div><div><h3>Methods</h3><div>VF mean deviation (MD) rates of change were estimated with linear regression. Sequential MD rates of change were estimated with each series spanning only 5 years of follow-up. VF progression was declared when four sequential statistically significant negative MD slopes were observed, and slope for the entire follow-up was significant. A convolutional neural network pretrained on ImageNet was designed to predict VF progression using baseline clinical and demographic data, disc photographs, and optical coherence tomography-derived global and sectoral retinal nerve fiber layer and macular thickness measurements. In addition, average intraocular pressure and treatment information during follow-up were put into the model. The same data for a subset of patients was provided to two clinicians to independently predict future progression. The model was validated on a separate cohort of eyes in which optical coherence tomography imaging was done with a different device (291 eyes).</div></div><div><h3>Main Outcome Measures</h3><div>Model’s area under receiver operating characteristic curves (AUC), accuracy, and area under the precision and recall curves.</div></div><div><h3>Results</h3><div>Average (SD) baseline MD and number of VF exams were −3.5 (4.9) dB and 10.1 (4.7). 399 eyes (25%) deteriorated. The best-performing model incorporated baseline disc photographs, and retinal nerve fiber layer and macular thickness: AUC, 0.839 (0.771-0.906), accuracy, 76.0% (62.0%-85.0%), and area under the precision and recall curves, 0.558 (0.385-0.733). Deep learning model significantly outperformed clinical graders (AUC : 0.629 [0.531-0738], <em>P</em> &lt; .001 and 0.680 [0.584-0.776], <em>P</em> = .001, for grader one and two, respectively). Model performance was similar on the validation cohort (AUC: 0.754 [0.671-0.837], and accuracy: 77% [71%-82%], respectively, <em>P</em> = .122). The model performed well when predicting fast-progression, defined as MD rate &lt;−1.0 dB/y (AUC: 0.869 [0.792-0.947]).</div></div><div><h3>Conclusions</h3><div>Our newly designed deep learning model can combine baseline demographic and clinical data with widely available structural measurements and provide clinically relevant information for the prediction of glaucoma progression.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 43-55"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893650","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":"Early Peripapillary and Macular Microvascular Changes Following Ruthenium-106 Plaque Brachytherapy For Uveal Melanomas","authors":"Mai A. Abdelkader,&nbsp;Shaymaa H. Salah,&nbsp;Salma F. Al-Etr,&nbsp;Layla El Qadi,&nbsp;Islam Y. Swaify,&nbsp;Tamer A. Macky,&nbsp;Hany Hamza,&nbsp;Abdussalam M. Abdullatif","doi":"10.1016/j.ajo.2026.01.001","DOIUrl":"10.1016/j.ajo.2026.01.001","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate early peripapillary and macular microvascular changes following ruthenium-106 (Ru-106) episcleral plaque brachytherapy for uveal melanoma using optical coherence tomography angiography (OCTA).</div></div><div><h3>Design</h3><div>Prospective case series.</div></div><div><h3>Subjects</h3><div>Twenty-four eyes of 24 patients with extramacular uveal melanoma treated with Ru-106 plaque brachytherapy at Cairo University Ocular Oncology Service.</div></div><div><h3>Methods</h3><div>All patients underwent ophthalmic evaluation and OCTA imaging at baseline, 3 months, and 6 months post-treatment.</div></div><div><h3>Main Outcome Measures</h3><div>Quantitative OCTA parameters included vessel density (VD) in the superficial (SCP), deep (DCP), and radial peripapillary capillary (RPC) plexuses, as well as foveal avascular zone (FAZ) area. Radiation doses to the tumor apex, fovea, and optic nerve were also recorded.</div></div><div><h3>Results</h3><div>Mean best-corrected visual acuity (BCVA) declined from 0.44 ± 0.30 logMAR at baseline to 0.78 ± 0.72 at 6 months (<em>p</em> = .028). Tumor height decreased significantly (<em>p</em> &lt; .001). No clinical signs of radiation maculopathy or optic neuropathy were detected at 6 months. RPC density showed an early significant reduction (49.06 ± 2.77% to 44.95 ± 4.65% at 3 months, <em>p</em> &lt; .001), with no further decline at 6 months; this loss was greater in tumors &lt; 2 disc diameters from the optic disc. SCP showed localized reductions (46.23 ± 3.73% at baseline, 43.96 ± 5.15% at 3 months and 44.64 ± 4.26% at 6 months, <em>p</em> = .083). By contrast, DCP density declined progressively and diffusely (45.17 ± 4.86% to 44.90 ± 4.87% at 3 months and 42.23 ± 3.68% at 6 months, <em>p</em> = .017), accompanied by significant FAZ enlargement (0.25 ± 0.12 to 0.34 ± 0.11 mm², <em>p</em> &lt; .001). Higher optic nerve radiation doses correlated with RPC loss (<em>r</em> = 0.492, <em>p</em> = .014) and poorer BCVA at 3 months (<em>r</em>=-0.454, <em>p</em> = .026) and 6 months (<em>r</em>=-0.412, <em>p</em> = .045), whereas macular doses showed no significant correlation. Tumor location influenced vascular response, with post-equatorial tumors showing greater DCP compromise, and pre-equatorial tumors exhibiting more SCP reduction. Systemic comorbidities did not significantly alter outcomes.</div></div><div><h3>Conclusions</h3><div>Ru-106 brachytherapy induces early, subclinical microvascular injury detecTable by OCTA. RPC changes are early and strongly correlate with optic nerve radiation dose and visual decline, SCP changes are localized, while DCP demonstrates progressive and generalized loss. Tumor location influenced injury patterns, reflecting differential radiation exposure. OCTA may serve as a noninvasive biomarker for early detection and risk stratification of radiation-induced microvascular injury.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 133-143"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145897376","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":"Progression of Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) Occurs Early and Is Unassociated With Modifiable Risk Factors","authors":"ZOË R. WILLIAMS ,&nbsp;RACHELLE MORGENSTERN ,&nbsp;ASALA N. EREKAT ,&nbsp;DAVID SZANTO ,&nbsp;MICHAEL WALL ,&nbsp;NEIL R. MILLER ,&nbsp;LEONARD A. LEVIN ,&nbsp;BRIAN WOODS ,&nbsp;MARK J. KUPERSMITH","doi":"10.1016/j.ajo.2026.01.012","DOIUrl":"10.1016/j.ajo.2026.01.012","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To report the true frequency and risk factors for acute nonarteritic anterior ischemic optic neuropathy (NAION) progression and identify modifiable features to reduce vision worsening.</div></div><div><h3>DESIGN</h3><div>Secondary case-control analysis of the QRK207 multicenter, double-masked, sham-controlled, randomized clinical trial.</div></div><div><h3>SUBJECTS</h3><div>We analyzed 599 study eyes with acute NAION (of 729 individuals prospectively enrolled in the QRK207 trial) with separate screening and Day 1 (mean 2.5-day interval) evaluations for progression. No participants included in this analysis received treatment. The Month 2 analysis included only the 167 sham-injected study eyes.</div></div><div><h3>METHODS</h3><div>Visual outcomes were assessed using best-corrected visual acuity (BCVA) using early treatment diabetic retinopathy study (ETDRS) charts and standardized automated perimetry.</div></div><div><h3>MAIN OUTCOME MEASURES</h3><div>We defined progression as ≥10 ETDRS letter loss (also analyzed ≥15 ETDRS letter loss) or worsening of censored corrected average total deviation (avgTD) using quantile regression to define progression and recovery thresholds. We evaluated systemic and ophthalmic features associated with progression.</div></div><div><h3>RESULTS</h3><div>From screening to Day 1, 7.3% (43/583) of eyes had ≥ 10 ETDRS letter loss, and 4.1% eyes had ≥ 15 ETDRS letter loss. Diabetes mellitus, hypertension, hyperlipidemia (HLD), and cardiovascular risk factors did not increase the risk of progression. Previous fellow-eye (FE) NAION and obstructive sleep apnea (OSA) were significantly associated with ≥10 ETDRS letter loss. Only FE NAION remained a risk factor ≥15 ETDRS letter loss. Of the 167 sham-injected eyes with screening to Month 2 evaluation, 21.6% (36/167) had ≥10 ETDRS letter loss, and 14.4% (24/167) had ≥15 ETDRS letter loss. About 91.6% of eyes (33/36) progressed within 22 days of symptom onset (by Day 8). Of the 139 sham-injected eyes with Day 1 to Month 2 evaluation, 18.7% had ≥10 ETDRS letter loss, and 13.7% had ≥15 ETDRS letter loss. TD progression from screening to Day 1 occurred in 32.1% (192/599) eyes, 66.1% remained stable, and 1.8% improved. FE NAION and HLD were associated with TD progression.</div></div><div><h3>CONCLUSIONS</h3><div>Worsening of vision in NAION occurs acutely. The results do not support cardiovascular risk factors as important hazard features for NAION progression. The only consistent factor associated with progression for both BCVA and VF loss was previous FE NAION.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 181-195"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986497","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 of Sodium-Glucose Cotransporter 2 Inhibitors and Glucagon-Like Peptide-1 Receptor Agonists With Risk of Cataract","authors":"Bing-Hua Lin ,&nbsp;Shu-Han Chuang ,&nbsp;Lien-Chen Wu ,&nbsp;Yu-Pin Chen ,&nbsp;Yi-Jie Kuo ,&nbsp;Cheng-Hsien Chang","doi":"10.1016/j.ajo.2025.12.025","DOIUrl":"10.1016/j.ajo.2025.12.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the risk of age-related cataract (ARC) among patients with type 2 diabetes mellitus (T2DM) using sodium-glucose cotransporter 2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA) as second-line antihyperglycemic agents.</div></div><div><h3>Design</h3><div>Population-based retrospective cohort study.</div></div><div><h3>Participants</h3><div>Adults aged over 40 years with a diagnosis of T2DM between January 2015 and June 2025 were identified from the TriNetX Global Network. The patients were categorized into three cohorts: (1) SGLT2i plus metformin, (2) GLP-1 RA plus metformin, and (3) metformin monotherapy. Patients with aphakia or pseudophakia, orbital injuries, secondary cataracts, or congenital ocular malformations were excluded.</div></div><div><h3>Methods</h3><div>Pairwise comparisons were performed with a 3-year follow-up. Baseline characteristics were balanced using 1:1 propensity score matching for demographics, comorbidities, T2DM severity, and cataract risk factors. Cox proportional hazards models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was the incidence of ARC events, defined as a diagnosis of ARC or cataract surgery, with stratified analyses conducted by demographics, glycemic control, and comorbidities.</div></div><div><h3>Results</h3><div>After matching, three pairwise comparisons included 34,259 (SGLT2i vs metformin; mean age, 62.8 years; 35.1% female), 50,877 (GLP-1 RA vs metformin; mean age, 58.3 years; 54.8% female), and 23,022 (SGLT2i vs GLP-1 RA; mean age, 61.0 years; 40.8% female) patients. Adjunctive SGLT2i or GLP-1 RA was associated with a reduced risk of ARC events (SGLT2i, HR: 0.82, 95% CI: 0.76-0.89; GLP-1 RA, HR: 0.93, 95% CI: 0.87-0.99). The protective effect of SGLT2i was greater than that of GLP-1 RA (HR: 0.84, 95% CI: 0.76-0.92). However, in patients with advanced age, obesity, or diabetic retinopathy, the association attenuated. When analyzed as separate outcomes, adjunctive use of SGLT2i and GLP-1 RA remained associated with a reduced risk of ARC diagnosis, while the risk of cataract surgery did not differ significantly (SGLT2i, HR: 1.14, 95% CI: 0.95-1.34; GLP-1 RA, HR: 1.01, 95% CI: 0.79-1.26).</div></div><div><h3>Conclusions</h3><div>Adjunctive use of SGLT2i or GLP-1 RA was associated with a lower risk of ARC, with a stronger effect for SGLT2i; however, neither agent reduced the risk of cataract surgery. Further studies are needed to clarify the underlying biological pathways and validate our findings.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 66-77"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145844794","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 Hospital Employed Ophthalmologist: A Growing Segment of the Profession","authors":"MAC THOMSON,&nbsp;DAVID J. BROWNING","doi":"10.1016/j.ajo.2026.01.013","DOIUrl":"10.1016/j.ajo.2026.01.013","url":null,"abstract":"<div><h3>PURPOSE</h3><div>To describe features of employment of ophthalmologists by hospitals and compare them to correlates in ophthalmologist-owned practices, private equity-owned practices, and public health sectors.</div></div><div><h3>DESIGN</h3><div>Perspective essay.</div></div><div><h3>METHODS</h3><div>Historical summary and relevant literature review.</div></div><div><h3>RESULTS</h3><div>Ophthalmologists with ownership in their practice have declined in the 21st century due to vertical integration by private equity groups and hospitals. Hospital employment and private equity employment share similarities: in both, a third party acquires control of a practice and exchanges revenue from the ophthalmologist for reduced business and administrative tasks. The evolving characteristics of ophthalmologists have created a mobile pool of applicants with enough physicians willing to trade compensation for other pillars of job satisfaction to make hospital employment viable.</div></div><div><h3>CONCLUSIONS</h3><div>The variety of personalities and career stages of ophthalmologists allows for a feasible market of employment by hospitals. Education about market factors and management models can help residents, fellows, and later career ophthalmologists make informed employment choices.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 208-215"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145995266","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":"Seven-Year Clinical Outcomes and Optical Quality of Implantable Collamer Lens Implantation Versus KLEx for Myopia Correction","authors":"Mingrui Cheng ,&nbsp;Mingwei Li ,&nbsp;Guanghan Xu ,&nbsp;Boliang Li ,&nbsp;Yinjie Jiang ,&nbsp;Yadi Lei ,&nbsp;Yanyu Qi ,&nbsp;Xun Chen ,&nbsp;Xiaoying Wang","doi":"10.1016/j.ajo.2025.12.027","DOIUrl":"10.1016/j.ajo.2025.12.027","url":null,"abstract":"<div><h3>Purpose</h3><div>This study aims to compare the seven-year clinical outcomes of Implantable Collamer Lens (ICL) implantation and keratorefractive lenticule extraction (KLEx) for the correction of myopia in patients with anisometropia, with a focus on evaluating long-term refractive stability, visual quality, and patient satisfaction.</div></div><div><h3>Setting</h3><div>Eye and ENT Hospital of Fudan University, Shanghai, China.</div></div><div><h3>Design</h3><div>Retrospective contralateral eye comparative case series</div></div><div><h3>Methods</h3><div>The study encompassed 50 eyes from 25 myopic patients. The eye with the higher degree of myopia underwent ICL implantation, while the contralateral eye underwent KLEx surgery. Comprehensive preoperative evaluations included assessments of visual acuity, refractive error, corneal topography, and endothelial cell density. ICL V4c implantation and KLEx were performed following standardized surgical protocols. Postoperative follow-up evaluations at 1 month and 7 years included measurements of visual acuity, refractive stability, wavefront aberrations, retinal image quality, and patient-reported visual disturbances.</div></div><div><h3>Results</h3><div>At the 7-year follow-up, both groups demonstrated high levels of safety visually and physiologically at 7 years, with safety indices of 1.23 ± 0.27 in the ICL group vs 1.08 ± 0.12 in the KLEx group, and endothelial cell density of 2654.96 ± 225.98 cells/mm² in the ICL group vs 2576.92 ± 241.78 cells/mm² in the KLEx group. Efficacy also presented high efficacy indices of 1.13 ± 0.22 in the ICL group and 0.95 ± 0.15 in the KLEx group. Refractive stability was maintained in both groups, although axial length increased marginal significantly in the ICL group (0.35 ± 0.33 mm vs. 0.21 ± 0.21 mm, <em>P</em> = 0.002). ICL exhibited superior visual outcomes, as evidenced by lower intraocular scattering (OSI: 1.13 ± 0.42 vs. 1.57 ± 0.62, <em>P</em> = 0.012) and a higher Strehl ratio (0.20 ± 0.03 vs. 0.16 ± 0.03, <em>P</em> = 0.024). KLEx was associated with lower whole-eye higher-order aberrations for a 3 mm pupil diameter (0.10 ± 0.06 µm vs. 0.12 ± 0.14 µm, <em>P</em> = 0.043). No significant differences were observed in disk halo size or pupil dynamics between the two groups.</div></div><div><h3>Conclusions</h3><div>Both ICL and KLEx are effective for long-term myopia correction, with ICL offering superior visual quality and stability, particularly in patients with high myopia. The combination of these techniques in anisometropic patients is feasible and provides a personalized treatment approach, ultimately enhancing overall visual outcomes and patient satisfaction.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 144-152"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145893644","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":"Noncancerous Monogenic Mimics of Noninfectious Posterior Uveitis","authors":"Mohammad Anas ,&nbsp;Andrew C Browning ,&nbsp;Hwei Wuen Chan ,&nbsp;Margaret Reynolds ,&nbsp;Rebecca A Procopio ,&nbsp;Omar A Mahroo ,&nbsp;Jose S Pulido","doi":"10.1016/j.ajo.2026.01.003","DOIUrl":"10.1016/j.ajo.2026.01.003","url":null,"abstract":"<div><h3>Purpose</h3><div>The eye can only respond in certain patterned ways to any insult. Because of this, it is important to have a sufficiently broad differential diagnosis that encompasses all possibilities that appear to have a similar phenotype.</div></div><div><h3>Design</h3><div>A consensus review.</div></div><div><h3>Method</h3><div>A guide to determine when to consider gentic diseases when a patient is referred as a uveitis mimic.</div></div><div><h3>Results</h3><div>It is critical to appreciate that mimics of noninfectious posterior uveitis (NIPU) are not merely academic distinctions but carry real clinical consequences.</div></div><div><h3>Conclusions</h3><div>Misdiagnosing an inherited retinal disease (IRD) as NIPU can lead to prolonged exposure to systemic corticosteroids or immunosuppressive therapies without benefit, potentially causing avoidable adverse effects. Conversely, failing to recognize a treatable inflammatory cause can lead to avoidable vision loss.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 171-180"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956026","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":"Ablation-Guided K Measurements Improve the Accuracy of IOL Power Calculation After Clinically Decentered Myopic LASIK","authors":"Min Zhang ,&nbsp;Peimin Lin ,&nbsp;Tianhui Chen ,&nbsp;Zexu Chen ,&nbsp;Aizhu Miao ,&nbsp;Ruohong Li ,&nbsp;Yongxiang Jiang","doi":"10.1016/j.ajo.2026.01.011","DOIUrl":"10.1016/j.ajo.2026.01.011","url":null,"abstract":"<div><h3>Purposes</h3><div>Define clinical ablation decentration and construct personalized areas for K measurements to improve the accuracy of intraocular lens (IOL) power calculation after myopic laser in situ keratomileusis (LASIK).</div></div><div><h3>Design</h3><div>Retrospective, observational case series.</div></div><div><h3>Methods</h3><div>Ablation areas were delineated on smoothed corneal topographies (Pentacam AXL). Personalized areas for K measurements were constructed as the overlap between the corneal ablation area and a given apex-centered circle. K values were calculated on these personalized areas using the ring or zone method. Ablation decentration was evaluated by (1) index P: the percentage of the personalized area in the corresponding circle, and (2) index D: the distance from its maximum inscribed circle center to the corneal apex. Their absolute predictive errors (AE) were compared with those of IOLMaster-reported K in 60 cataract eyes from 48 patients with prior LASIK.</div></div><div><h3>Results</h3><div>Ablation-guided K values derived from the 3.5 mm-diameter circle and the ring methods, namely K_3.5ring, had the best predictive accuracy (Mean AE = 0.64D, Median AE = 0.47D). This method had better performance with smaller index P (ρ = -0.473, <em>P</em> = .006) and larger index D (ρ = 0.432, <em>P</em> = .014). Personalized areas with index P &lt; 95.02% (<em>P</em> = .013) or index D ≥ 1.0975 mm (<em>P</em> = .007) showed greater accuracy improvements, and were defined as clinical ablation decentration.</div></div><div><h3>Conclusions</h3><div>This study developed a novel ablation-guided K measurement method for IOL calculation in eyes with clinically decentered myopic ablation. We also provide a ready-to-use tool (<span><span>https://boluo-baba-ablation-guided-k-measurements.share.connect.posit.cloud</span><svg><path></path></svg></span>) based on this method for clinical convenience.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 161-170"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956202","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":"Exploring the Association Between Autoimmune and Inflammatory Diseases and Uveitis","authors":"Nitesh Mohan ,&nbsp;Sunil K. Srivastava ,&nbsp;Matthew J. Schulgit ,&nbsp;Rula A. Hajj-Ali ,&nbsp;David C. Kaelber ,&nbsp;Sumit Sharma","doi":"10.1016/j.ajo.2026.01.004","DOIUrl":"10.1016/j.ajo.2026.01.004","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To evaluate the association between immune-mediated inflammatory diseases (IMIDs) and uveitis.</div></div><div><h3>DESIGN</h3><div>Retrospective cohort and case-control study using electronic health record data.</div></div><div><h3>METHODS</h3><div>The study included patients diagnosed with uveitis and/or one of the following 12 IMIDs: rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), sarcoidosis, scleroderma, inflammatory bowel disease (IBD), multiple sclerosis (MS), ankylosing spondylitis, psoriasis, juvenile idiopathic arthritis (JIA), and giant cell arteritis (GCA), anti-neutrophil cytoplasmic antibody (ANCA)–associated vasculitis, and other systemic vasculitis. Controls were patients without prior uveitis diagnosis or any IMIDs. The risk of developing uveitis in patients with each IMID, the odds of prior IMID diagnoses among patients with uveitis, and the risk of developing an IMID following a uveitis diagnosis were calculated. The main outcome measures were the risk ratio (RR) and odds ratio (OR) estimates with 95% confidence intervals for associations between IMIDs and uveitis.</div></div><div><h3>RESULTS</h3><div>Patients with all 12 IMIDs had a significantly increased risk of developing uveitis. The highest risks were observed in ankylosing spondylitis (RR = 7.71, 95% CI = 5.84-10.19), JIA (RR = 5.13, 95% CI = 3.51-7.49), and systemic vasculitis (RR = 4.61, 95% CI = 3.73-5.69). Increased risk was also found in sarcoidosis (RR = 3.67, 95% CI = 3.02-4.47), GCA (RR = 3.24, 95% CI = 2.58-4.07), and ANCA vasculitis (RR = 3.18, 95% CI = 1.84-5.48). In addition, in patients with uveitis, both the odds of a prior IMID diagnosis and the risk of a future IMID diagnosis were significantly increased for all 12 IMIDs.</div></div><div><h3>CONCLUSIONS</h3><div>IMIDs are strongly associated with uveitis, with significant bidirectional risk. Patients with uveitis should be monitored for potential IMID development, and those with IMIDs should undergo ophthalmologic evaluation when appropriate.</div></div>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":"284 ","pages":"Pages 101-109"},"PeriodicalIF":4.2,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956036","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}