American Journal of Ophthalmology最新文献

{"title":"Comment on: Accuracy of Toric Intraocular Lens Realignment Calculators: A Vector-Based Bivariate Comparison of Current Calculation Methods.","authors":"Dante Luis Buonsanti","doi":"10.1016/j.ajo.2026.07.052","DOIUrl":"10.1016/j.ajo.2026.07.052","url":null,"abstract":"","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148652936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy, Safety, and Durability of Gene Therapy for Inherited Retinal Diseases in the Pediatric Population: A Scoping Review.","authors":"Alessia Amato, Giancarlo Iarossi, Kirk Aj Stephenson","doi":"10.1016/j.ajo.2026.07.039","DOIUrl":"10.1016/j.ajo.2026.07.039","url":null,"abstract":"<p><strong>Purpose: </strong>To map the published interventional gene-based therapies relevant to children with inherited retinal diseases (IRDs), with a focus on efficacy, safety, and durability, including pediatric-vs-adult patterns where available.</p><p><strong>Methods: </strong>This scoping review followed a prospectively registered protocol specifying the search strategy, eligibility criteria, screening process, data-charting framework, and synthesis plan. PubMed and Embase were searched from January 1, 2008, to April 13, 2026. Retrieved records were independently screened by 2 reviewers to identify prospective interventional studies of gene-targeted therapies for molecularly confirmed IRDs enrolling participants younger than 18 years; unresolved disagreements were adjudicated by a third reviewer. Overlapping reports were grouped into trial clusters with a primary anchor record. Records with at least 3 pediatric participants and separately extractable pediatric data were classified as Tier 1 and included in the main synthesis; other eligible records were retained as Tier 2 contextual evidence. Where sufficient individual-level or subgroup-level data were available, review authors extracted descriptive pediatric-vs-adult patterns.</p><p><strong>Results: </strong>Twenty-four records, grouped into 17 trial clusters across 8 genotypes, were included; 14 met Tier 1 criteria. RPE65-associated disease provided the largest pediatric evidence base and the most consistent efficacy and durability signals, although responses varied between trial clusters. AIPL1 gene supplementation showed substantial treated-eye functional gains with relative structural preservation at up to 4 years in 4 very young children, and high-dose GUCY2D gene supplementation improved retinal sensitivity in 3 children within a mixed-age cohort. CEP290-targeted splice modulation and gene editing showed early functional signals, but interpretation was limited by dose-related cataract with sepofarsen and few pediatric participants with EDIT-101. Evidence for RPGR, CNGB3, RS1, and MERTK did not support robust pediatric-specific efficacy conclusions. Serious ocular events were predominantly procedure-related, with no reproducible pediatric-specific toxicity signal. Formal age-stratified analyses were uncommon, and several pediatric-vs-adult patterns required review-author extraction.</p><p><strong>Conclusions: </strong>Pediatric benefit from IRD gene therapy depends on genotype, residual retinal structure, therapeutic platform, dose, surgical strategy, and outcome measure. The major evidence gaps are long-term pediatric durability and inconsistent age-stratified reporting. Future pediatric-inclusive trials should prespecify subgroup analyses, embed prospective long-term follow-up, use developmentally appropriate endpoints, and report individual-level data sufficient to support pediatric inference.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"436-456"},"PeriodicalIF":4.7,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648107","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":"Stem Cell Therapy for Inherited Retinal Disorders: Rebuilding the Retina.","authors":"Anupam K Garg, Ishrat Ahmed","doi":"10.1016/j.ajo.2026.07.033","DOIUrl":"10.1016/j.ajo.2026.07.033","url":null,"abstract":"<p><p>Inherited retinal disorders (IRDs) are a group of ophthalmic conditions that are characterized by progressive degeneration of photoreceptors and/or retinal pigment epithelium (RPE), leading to irreversible vision loss. IRDs are a promising target for stem cell therapies, which have largely aimed to restore vision by either replacement of degenerated photoreceptors or retinal pigment epithelial cells via transplantation of stem cells or preservation of cells through expression of neuroprotective factors. Several therapies have recently moved into early clinical trials, demonstrating that stem cell therapies can be safely administered through different routes of administration including intravitreal, sub-retinal, and suprachoroidal injection. However, further larger-scale studies are needed to demonstrate efficacy of these treatments for the prevention or reversal of vision loss from photoreceptor or RPE degeneration.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"341-351"},"PeriodicalIF":4.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629343","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":"Internal Limiting Membrane Loop Configurations in Epiretinal Membrane: Prevalence, Imaging Associations and Optical Coherence Tomography Morphology.","authors":"Anamika Patel, Alessandro Feo, Néda Abraham, Prashant Tailor, Marjan Afzali, Shahin Faghihi, Hiok Hong Chan, David Sarraf","doi":"10.1016/j.ajo.2026.07.050","DOIUrl":"10.1016/j.ajo.2026.07.050","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize internal limiting membrane (ILM) loop configurations on optical coherence tomography (OCT) in eyes with epiretinal membrane (ERM) and evaluate their association with visual acuity (VA), ILM tear, posterior vitreous detachment (PVD), and ERM grade.</p><p><strong>Design: </strong>Retrospective observational cross-sectional study.</p><p><strong>Subjects: </strong>A total of 138 eyes from 105 patients with nonsurgical ERM at a single academic center.</p><p><strong>Methods: </strong>All eyes underwent spectral-domain OCT. ILM loops were identified on cross-sectional B-scans as loop-like elevations or folds of the ILM at the vitreoretinal interface. Loop number and macular distribution were recorded. PVD was graded using the Engelbert classification and ERM severity using the Govetto classification. Associations between ILM loops and VA, ILM tear, PVD grade, and ERM grade were analyzed using Fisher's exact test and the Mann-Whitney U test.</p><p><strong>Main outcome measures: </strong>Prevalence of ILM loops and their association with Snellen VA, ILM tear status, PVD grade, and ERM grade.</p><p><strong>Results: </strong>ILM loops were identified in 21 of 138 eyes (15.2%). Loop-positive eyes demonstrated a median VA of 0.10 logMAR (IQR, 0.00-0.30; approximately 20/25 Snellen) compared with 0.18 logMAR (IQR, 0.00-0.30; approximately 20/30 Snellen) in loop-negative eyes (P = .683). ILM loops were significantly more prevalent in eyes with ILM tear (16/32 [50.0%] vs 5/106 [4.7%]; odds ratio, 20.2; 95% CI, 6.50-62.80; P < .0001). Multiple loops were present in 15/21 eyes (71.4%) and solitary loops in 6 eyes (28.6%). Complete PVD was present in 19 of 21 loop-positive eyes (90.5%) compared with 83 of 117 loop-negative eyes (70.9%), although this did not reach significance (odds ratio, 3.89; 95% CI, 0.86-17.63; P = .065). Loop-positive eyes demonstrated higher ERM grades than loop-negative eyes (grade 3 in 7/21 [33.3%] vs 10/117 [8.5%]; P = .035).</p><p><strong>Conclusions: </strong>ILM loops are a distinct OCT feature in ERM and are strongly associated with ILM tears. These configurations may represent ILM retraction following ILM tear, although the cross-sectional design precludes determination of a temporal or causal relationship. These interesting lesions are a common OCT finding, and therefore their recognition and understanding will enhance and support evaluation by retinal physicians.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"292-300"},"PeriodicalIF":4.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618114","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":"Challenges to the Access and Utilization of Corneal Cross-Linking in Patients With Keratoconus in the United States.","authors":"Jason J Jo, Yandong Bian, Winston D Chamberlain, Masako Chen, Kathryn Colby, Pauline Dmitriev, Anita Gupta, Jerry Hsu, Scott M Macrae, Ann Ostrovsky, Christina R Prescott, Leejee H Suh, Zeba A Syed, Danielle Trief, Vishal Jhanji, Sonal Tuli, Angie Wen, Fasika A Woreta, Sumayya Ahmad","doi":"10.1016/j.ajo.2026.07.042","DOIUrl":"10.1016/j.ajo.2026.07.042","url":null,"abstract":"<p><strong>Objective or purpose: </strong>To investigate current disparities in access to corneal cross-linking (CXL) for patients with keratoconus in the United States and to anticipate further disparities in the wake of Epioxa approval and planned Photrexa phasing out.</p><p><strong>Design: </strong>Perspective essay.</p><p><strong>Methods, intervention, or testing: </strong>This essay reflects on experiences from all authors in their care for patients with keratoconus, a historical summary of CXL in the United States, and a literature review.</p><p><strong>Results: </strong>CXL has been proven to slow the progression of keratoconus and reduce the need for corneal transplants. Currently, there is only 1 Food and Drug Administration (FDA)-approved epithelium-off CXL protocol in the United States (KXL system using Photrexa or Photrexa Viscous), and its access has been limited by high costs, insurance coverage, and proprietary protocols. The result is that underserved patients have had reduced access to treatment. In 2025, the FDA approved Epioxa, an epithelium-on CXL therapy, under an orphan drug designation. In addition to concerns surrounding affordability, it is uncertain whether Epioxa has comparable short- and long-term effectiveness to Photrexa in terms of visual acuity and maximum keratometry. With Epioxa's recently reported wholesale acquisition cost of $78,500, the authors feel the need to advocate for patients who will be unable to receive these potentially vision-saving therapies. Further concerning is that Photrexa will be phased out in 2026, meaning there will no longer be an FDA-approved epithelium-off CXL therapy available in the United States.</p><p><strong>Conclusions: </strong>With the approval of Epioxa and the planned phasing out of Photrexa, we underscore the risk of exacerbating disparities in access to CXL and propose the formation of an interdisciplinary task force aimed at developing an access framework for CXL therapy for all patients. We believe that the first step is to pause the phasing out of Photrexa until (1) there is a formalized plan in place to combat the issues of CXL access as detailed here and (2) the long-term efficacy of Epioxa can be sufficiently demonstrated.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"58-62"},"PeriodicalIF":4.7,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618063","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":"Systemic Treatment With the ROCK2 Inhibitor Belumosudil in Ocular Chronic Graft-Versus-Host Disease.","authors":"Yibo Wu, Bei Ye, Xiaoyu Lai, Lizhen Liu, Luxin Yang, Xiaolin Yuan, Lin Li, Jimin Shi, Yanmin Zhao, Panpan Zhu, Jian Yu, Chixin Du, He Huang, Jianyong Wang, Yi Luo","doi":"10.1016/j.ajo.2026.07.044","DOIUrl":"10.1016/j.ajo.2026.07.044","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy of oral belumosudil on ocular surface disease in patients with steroid-refractory chronic graft-versus-host disease (SR-cGVHD).</p><p><strong>Design: </strong>Retrospective case series.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed patients with SR-cGVHD and ocular involvement (oGVHD) treated with belumosudil (200 mg daily). Ocular assessments at baseline and 6 months included the International Chronic Ocular GVHD Consensus Group severity score, NIH eye score (0-3), corneal fluorescein staining (CFS, 0-4), tear break-up time (TBUT), Schirmer's I test, and the Ocular Surface Disease Index (OSDI). Treatment response rates were assessed per NIH consensus criteria.</p><p><strong>Results: </strong>Among 78 treated patients, 40 had oGVHD; 28 completed both assessments. The cohort (median baseline NIH eye score: 2; oGVHD severity score: 9) had high-risk cGVHD features: 50.0% had severe systemic cGVHD and 82.1% had conjunctival fibrosis. At 6 months, 53.6% of patients showed improvement in the oGVHD severity score and 64.8% reported symptomatic improvement (OSDI). Objective signs significantly improved: median CFS decreased from 4 to 3, TBUT increased from 1.00 to 2.00 seconds, and Schirmer's test improved from 1.0 to 2.0 mm. A greater ocular benefit was observed in 43.6% of patients who achieved systemic overall response, with 66.7% showing improved oGVHD severity scores and 80.0% reporting better OSDI. Visual acuity remained stable, and 42.9% of patients achieved corticosteroid dose reduction. Treatment was well-tolerated.</p><p><strong>Conclusions: </strong>Systemic belumosudil was associated with improvements in ocular surface parameters and symptoms in steroid-refractory oGVHD, with favorable tolerability. Ocular improvement was closely linked to systemic response, warranting prospective validation.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"51-57"},"PeriodicalIF":4.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597343","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":"Metabolomic and Lipidomic Profiling Reveals Dysregulated Glycerophospholipid Metabolism in New-Onset Acute Vogt-Koyanagi-Harada Disease.","authors":"Yang Deng, Ziqian Huang, Xiaoran Jiang, Yinan Zhang, Wanyun Zhang, Qian Zhou, Xiang Luo, Guannan Su, Yujie Lai, Changwei Huang, Qingfeng Cao, Peizeng Yang","doi":"10.1016/j.ajo.2026.07.049","DOIUrl":"10.1016/j.ajo.2026.07.049","url":null,"abstract":"<p><strong>Purpose: </strong>Vogt-Koyanagi-Harada (VKH) disease is a sight-threatening autoimmune disorder whose early systemic metabolic alterations remain poorly defined. We aimed to characterize plasma metabolomic and lipidomic signatures in new-onset acute VKH disease and to explore their clinical relevance.</p><p><strong>Design: </strong>Retrospective case-control study.</p><p><strong>Participants: </strong>Of 26 patients with new-onset acute VKH disease and 39 healthy controls were included.</p><p><strong>Methods: </strong>Untargeted metabolomics and quantitative lipidomics were performed in plasma from treatment-naïve VKH patients and healthy controls. An elastic net model was applied to identify a discriminative glycerophospholipid signature.</p><p><strong>Main outcome measures: </strong>Differential metabolites and lipids and their correlations with cerebrospinal fluid (CSF) white blood cell (WBC) count and subfoveal choroidal thickness (SFCT) were analyzed.</p><p><strong>Results: </strong>Metabolomics identified 74 significantly altered metabolites, with lipids as the predominate class and glycerophospholipid metabolism as a core perturbed pathway. Lipidomics further revealed 262 significantly altered lipids, with 254 downregulated in the VKH group. Glycerophospholipids predominated among the altered lipids (67.2%), representing a marked enrichment compared with their proportion in the overall lipidome (43.9%, P < .0001). Nine glycerophospholipids correlated negatively with CSF WBC count (all P < .05), with PE (16:0_22:4) showing the strongest association (r = -0.59, P = .003). Three phosphatidylcholine species correlated negatively with SFCT (all P < .05). An elastic net model identified a 25-glycerophospholipid signature that achieved an area under the curve of 0.953 in discriminating VKH patients from healthy controls.</p><p><strong>Conclusions: </strong>These findings highlight dysregulated glycerophospholipid metabolism as a key metabolic feature of new-onset acute VKH disease and provide additional insights into disease pathogenesis.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"422-435"},"PeriodicalIF":4.7,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597663","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":"Ocular Response Analyzer Versus Goldmann Applanation Tonometry in a Population-Based Sample: The Thessaloniki Eye Study.","authors":"Rodanthi Christina Bartzoulianou, Anne L Coleman, M Roy Wilson, Alon Harris, Dimitrios A Giannoulis, Georgios Bontzos, Anna-Bettina Haidich, Fei Yu, Vassileios Kilintzis, Iordanis Vagiakis, Eleftherios Anastasopoulos, Dimitrios Mikropoulos, Anastasia Raptou, Grigoria Tzoanou, Fotis Topouzis","doi":"10.1016/j.ajo.2026.07.048","DOIUrl":"10.1016/j.ajo.2026.07.048","url":null,"abstract":"<p><strong>Purpose: </strong>To compare corneal-compensated intraocular pressure (IOPcc) with Goldmann applanation tonometry (GAT-IOP) in an elderly cohort and assess effects of substituting GAT-IOP with IOPcc on IOP distribution, ocular hypertension prevalence, glaucoma screening, and risk modeling.</p><p><strong>Design: </strong>Prospective diagnostic sensitivity and specificity analysis using population-based data.</p><p><strong>Participants: </strong>One eye from 854 participants in the 12-year incidence phase of the Thessaloniki Eye Study.</p><p><strong>Methods: </strong>Participants underwent measurements of GAT-IOP and IOPcc. Agreement and screening performance (sensitivity, specificity, area under the receiver operating characteristic curve) were assessed. Two multivariable logistic regression models were constructed, 1 with GAT-IOP and 1 with IOPcc.</p><p><strong>Main outcome measures: </strong>GAT-IOP and IOPcc.</p><p><strong>Results: </strong>The mean age was 79.2 (SD 3.9) years; 42.4% were female. GAT-IOP was 14.3 (SD 3.3) mm Hg and IOPcc was 17.1 (SD 4.3) mm Hg. IOPcc exceeded GAT-IOP by 2.75 mm Hg (limits of agreement, -3.2 to 8.7). The prevalence of ocular hypertension (>21 mm Hg) increased from 1.3% to 10.7% when IOPcc was used instead. GAT-IOP was associated with central corneal thickness (95% CI, 0.009-0.022; P = .02), whereas IOPcc was not (95% CI, -0.001 to 0.016; P = .08). In untreated participants, GAT-IOP > 21 mm Hg had 98.6% specificity and 34.2% sensitivity; IOPcc increased sensitivity to 44.7% but reduced specificity to 88.3%. Area under the receiver operating characteristic curve values were similar (0.818 vs 0.780; P = .31). In multivariable models, IOP measures were independently associated with glaucoma, with a stronger effect size for GAT-IOP (odds ratio = 1.264, 95% CI: 1.182-1.359) than for IOPcc (odds ratio = 1.176, 95% CI: 1.116-1.241); pseudoexfoliation, family history, and body mass index were significant in both models, whereas central corneal thickness and axial length were significant only in the GAT-IOP model.</p><p><strong>Conclusions: </strong>Substituting GAT-IOP with IOPcc changed the risk estimates; the 2 measures are not interchangeable and standard IOPcc thresholds may overestimate ocular hypertension.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"28-40"},"PeriodicalIF":4.7,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597676","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":"Ipsilateral Eyelid Disorders Following Ocular Brachytherapy.","authors":"Shiran Madgar-Golfor, Yael Lustig, Ella Nissan, Guy J Ben-Simon, Ofira Zloto, Vicktoria Vishnevskia-Dai, Ido Didi Fabian, Daphna Landau-Prat","doi":"10.1016/j.ajo.2026.07.045","DOIUrl":"10.1016/j.ajo.2026.07.045","url":null,"abstract":"<p><strong>Background: </strong>While episcleral brachytherapy is an effective treatment for uveal melanoma, its long-term complications have primarily focused on intraocular structures. Eyelid disorders following brachytherapy are rarely reported despite potential complications related to the plaque surgery. This retrospective study aimed to assess the prevalence, characteristics, and risk factors for acquired ipsilateral eyelid disorders (IEDs) after ocular brachytherapy.</p><p><strong>Design: </strong>A retrospective clinical cohort study was conducted on patients who underwent episcleral brachytherapy at a single tertiary center between 2009 and 2023.</p><p><strong>Methods: </strong>Medical records were reviewed. Data collected included demographic variables, tumor characteristics, plaque type, surgical details, and presence of postoperative IEDs. The primary outcome was the association between brachytherapy and acquired IEDs.</p><p><strong>Results: </strong>A total of 191 patients were included, 101 females (52.9%) mean age 63.4±14.2 years. All tumors were malignant melanoma: choroidal (n = 156, 81.7%), ciliary body (n = 27, 14.1%), iris (n = 7, 3.7%), and anterior segment (n = 1, 0.5%). Isotopes used included Iodine-125 (n = 150, 78.5%) and Ruthenium-106 (n = 41, 21.5%). IEDs developed in 40 cases (20.9%), predominantly affecting the upper eyelid. Ptosis was the most common finding (n = 35, 87.5%), followed by trichiasis (n = 1, 2.5%), ectropion (n = 1, 2.5%), and benign eyelid lesions (n = 3, 7.5%). Ptosis was significantly associated with anterior tumor location (p = 0.03), iodine isotope (p = 0.01), and female gender (p = 0.04). On multivariate logistic regression analysis, iodine-125 use (OR 5.38, 95% CI 1.21-23.88; p = 0.027) and anterior tumor location (OR 2.40, 95% CI 1.01-5.71; p = 0.048) remained independently associated with postoperative ptosis, whereas female gender did not retain statistical significance. No association was found with age, plaque diameter, radiation dose, laterality, muscle manipulation, or tarsorrhaphy.</p><p><strong>Conclusion: </strong>Acquired eyelid disorders, particularly upper eyelid ptosis, are a relatively common and underrecognized complication following episcleral brachytherapy. Increased awareness of these potential sequelae and timely referral to oculoplastic specialists are advised.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"63-68"},"PeriodicalIF":4.7,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597631","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":"Longitudinal Change in Keratoconjunctivitis Sicca By Sjögren's Disease Status.","authors":"Sally E Peterson, Vinayak N Prathikanti, Fanxiu Xiong, Robert D Nguyen, Caroline H Shiboski, Thomas M Lietman, Vatinee Y Bunya, Esen K Akpek, Nancy A McNamara, John A Gonzales","doi":"10.1016/j.ajo.2026.07.034","DOIUrl":"10.1016/j.ajo.2026.07.034","url":null,"abstract":"<p><strong>Objective: </strong>To longitudinally compare changes in ocular surface signs and symptoms over 2 to 3 years in patients with isolated KCS (KCS-only) and those with concomitant SjD (KCS + SjD).</p><p><strong>Design: </strong>Prospective cohort study using data from the Sjögren's International Collaborative Clinical Alliance (SICCA) registry. Participants were enrolled from 2003 to 2012 and invited for 2- to 3-year follow-up.</p><p><strong>Participants: </strong>Participants with KCS (defined as ocular staining score [OSS] ≥ 5) who presented at both baseline and follow-up visits were included.</p><p><strong>Methods: </strong>Participants underwent standardized ocular surface testing, including OSS, Schirmer I, tear break-up time (TBUT), and Ocular Surface Disease Index-6 (OSDI-6), at baseline and follow-up visits. Multivariable linear regression models evaluated differences in longitudinal change in ocular metrics between KCS-only and KCS + SjD participants.</p><p><strong>Main outcome measures: </strong>Changes in ocular metrics, including OSS, Schirmer I, TBUT, and OSDI-6, from baseline to follow-up.</p><p><strong>Results: </strong>This analysis included data from 427 participants (mean age: 54.4 ± 12.8 years, 94.8% female), including 305 with KCS + SjD and 122 with KCS-only. Participants with KCS + SjD exhibited significantly more severe dry eye signs than those with KCS-only at both time points. After adjusting for covariates, the change score for OSS was 1.51 points higher (95% confidence interval [CI], 0.99-2.04; p < .001) in the KCS + SjD groups compared to the KCS-only group. Similarly, participants with KCS + SjD demonstrated greater longitudinal decline in TBUT (-1.10 sec, 95% CI: -1.56 to -0.65; p < .001) and in Schirmer I (-2.16 mm, 95% CI: -3.31 to -1.01; p < .001). The difference in OSDI-6 scores was not statistically significant (0.36, 95% CI, -0.60 to 1.33; p = .46).</p><p><strong>Conclusions: </strong>Participants with KCS + SjD exhibited more severe baseline signs and greater longitudinal worsening of objective ocular findings compared to KCS-only participants. These findings support the hypothesis that KCS associated with SjD and isolated KCS may represent distinct clinical forms of dry eye disease and may help differentiate these dry eye subtypes.</p>","PeriodicalId":7568,"journal":{"name":"American Journal of Ophthalmology","volume":" ","pages":"372-381"},"PeriodicalIF":4.7,"publicationDate":"2026-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590142","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}