BMJ Open Ophthalmology最新文献

{"title":"Modified Delphi expert consensus on the optimal intravitreal treatment pathway for centre involving diabetic macular oedema patients within the National Health Service.","authors":"Richard Gale, Clare Bailey, Helen Devonport, Christiana Dinah, Louise Mary Downey, Michael Edward Grinton, Arijit Mitra, Luke Nicholson, Christina Rennie, Maged Habib","doi":"10.1136/bmjophth-2026-002787","DOIUrl":"10.1136/bmjophth-2026-002787","url":null,"abstract":"<p><strong>Aims: </strong>To establish consensus-based guidance on optimising anti-vascular endothelial growth factor (VEGF) and corticosteroid use in centre-involving diabetic macular oedema (CI-DMO).</p><p><strong>Methods: </strong>A two-round modified Delphi study was conducted among medical retina (MR) specialists in the National Health Service in England. In total, 82 statements were developed by a steering group and rated by a wider Delphi panel using a four-point Likert scale. Consensus was predefined as ≥75%.</p><p><strong>Results: </strong>In rounds one and two, 30 and 39 MR specialists responded to the survey, respectively. In total, consensus was achieved for 64/82 statements (78%). Key outcomes were consensus on the value of personalised treatment strategies, consensus of MR specialists to validate a definition of non-response to intravitreal treatment for DMO as a reduction in central retinal thickness (CRT) by ≤10% and a suboptimal response as a reduction in CRT by 10-20% (these thresholds were adapted from those proposed by Downey <i>et al</i>)<i>.</i> Early evaluation of anti-VEGF treatment response should be made at 3-6 months and after trying two different types of anti-VEGF agents. The panel reached moderate consensus that corticosteroid therapy may be considered after 9-12 months in patients with persistent suboptimal response or high treatment burden. The panel also supported consideration of transition to sustained-release corticosteroid therapy in selected patients demonstrating a positive response to short-acting corticosteroids.</p><p><strong>Conclusions: </strong>This Delphi study provides a consensus-based framework to support personalised treatment decisions in CI-DMO, highlighting the importance of timely optimisation of anti-VEGF and corticosteroid therapies in cases of suboptimal response and non-response. However, as these recommendations are derived from expert consensus rather than prospective clinical validation and all panellists were from England, generalisability to other healthcare settings may be limited. Additionally, patient representatives were not included, and the recommendations require validation in clinical practice.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the crystalline lens diameter using swept-source optical coherence tomography.","authors":"Sophia Anna Reifeltshammer, Haidar Khalil, Theresa Höftberger, Peter Laubichler, Leon Pomberger, Klemens Waser, Matthias Bolz, Nino Hirnschall","doi":"10.1136/bmjophth-2026-002819","DOIUrl":"10.1136/bmjophth-2026-002819","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the estimated lens diameter (eLD) of the crystalline lens in a large European cohort.</p><p><strong>Methods and analysis: </strong>Data sets from an Austrian population acquired between 2020 and 2022 were analysed in this study. Measurements included optical biometry (IOLMaster 700, Carl Zeiss Meditec AG, Germany) as well as anterior segment optical coherence tomography (CASIA2, Tomey, Japan). For eLD prediction, three different machine learning approaches were implemented.</p><p><strong>Results: </strong>In total, 2352 eyes of 2352 patients were included in this study. The eLD was normally distributed with a mean value of 10.18±0.56 mm, showing a statistically significant difference (p=0.008) between females and males (10.16±0.54 mm and 10.22±0.57 mm, respectively). There was a low but significant correlation (p<0.01 for all) with age (r=0.246), lens thickness (r=0.265), white-to-white (r=0.122), corneal radii (r=0.090), axial eye length (r=0.092), anterior chamber depth (r=-0.060), decentration (r=-0.087) and tilt (r=-0.159), respectively. Subanalysis of short and long eyes yielded no significant difference in eLD. For eLD prediction, age and lens thickness appeared to be relevant parameters, with all three models demonstrating low predictive accuracy.</p><p><strong>Conclusion: </strong>The crystalline lens diameter followed a normal distribution with no significant differences between short and long eyes. All three models demonstrated low predictive accuracies, suggesting that reliable prediction of eLD is currently not attainable.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identifying symptom-based subgroups in Sjögren's disease: a latent class analysis of a patient co-designed survey.","authors":"Gráinne Tynan, Deirdre Collins, Eileen Sheehy, Monika Lauder, Valeria Lima Passos, Joan Ní Gabhann-Dromgoole","doi":"10.1136/bmjophth-2026-002998","DOIUrl":"10.1136/bmjophth-2026-002998","url":null,"abstract":"<p><strong>Objective: </strong>To identify symptom-based subgroups in Sjögren's disease using patient-reported data and explore differences in symptom burden, functional impact, psychological distress and healthcare priorities.</p><p><strong>Methods and analysis: </strong>This secondary analysis used cross-sectional data from a patient co-designed online survey conducted between June and September 2022. Individuals self-identifying as living with Sjögren's disease (diagnosed or symptomatic) were eligible to participate. Latent class analysis was applied to 24 patient-reported symptom variables. European Alliance of Associations for Rheumatology (EULAR) Sjögren's Syndrome Patient Reported Index and the Hospital Anxiety and Depression Scale were used in post hoc analyses to characterise and compare classes.</p><p><strong>Results: </strong>A total of 296 respondents were included. Four symptom-based subgroups were identified: a sicca-predominant low-burden group (Class 1), a fatigue-dryness dominant group (Class 2), a musculoskeletal-cognitive group (Class 3) and a multisystem high-severity group (Class 4). Symptom burden, psychological distress and functional impact differed significantly across classes (all p<0.001). Inability to work increased from 3.4% in Class 1 to 33.9% in Class 4 (p<0.001). Higher-burden classes also reported greater unmet healthcare needs. Urgent need for effective treatments increased from 56% in Class 1 to 86% in Class 4 (p=0.0031), while urgent need for diagnostic testing increased from 38% to 68% (p<0.0001). Improved education of doctors and other healthcare professionals was consistently identified as a priority for improving care across all classes.</p><p><strong>Conclusion: </strong>Patient-reported data identified clinically interpretable symptom-based subgroups in Sjögren's disease that differed in symptom burden, psychological distress, functional impact and perceived unmet healthcare need. These findings support multidimensional patient-reported assessment for characterising disease heterogeneity and informing patient-centred care. Limitations include the cross-sectional design and reliance on self-reported data.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148788289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in ocular blood flow and haemodynamic waveform parameters following trabeculectomy.","authors":"Shian Mae, Kazunori Hirasawa, Tomohiko Yanagita, Nobuyuki Shoji","doi":"10.1136/bmjophth-2026-002987","DOIUrl":"10.1136/bmjophth-2026-002987","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate postoperative changes in ocular blood flow velocity and waveform parameters measured by laser speckle flowgraphy (LSFG) following trabeculectomy (TLE) in patients with glaucoma.</p><p><strong>Methods and analysis: </strong>This retrospective study included 80 eyes of 80 patients with glaucoma who underwent TLE and underwent LSFG examinations before and at 1, 3 and 6 months after surgery. LSFG-derived blood flow velocity parameters (mean blur rate (MBR) in MBR of vascular area (MV) and MBR of tissue area (MT), area ratio of blood speed and vascular cloudiness) and waveform parameters (blowout time, blowout score (BOS), skew, acceleration time index, rising rate, falling rate, flow acceleration index (FAI), resistivity index (RI) and fluctuation) were longitudinally evaluated using linear mixed-effects models.</p><p><strong>Results: </strong>Intraocular pressure (IOP) significantly decreased from 18.3 mm Hg preoperatively to 10.1, 10.0 and 9.9 mm Hg at 1, 3 and 6 months after TLE, respectively (all p<0.01). MV significantly decreased at all postoperative time points (all p<0.01), whereas MT showed a mild decrease only at 6 months (p=0.023). Among waveform parameters, BOS significantly increased postoperatively (all p<0.05), whereas FAI, RI and fluctuation significantly decreased at all postoperative time points (all p<0.01). IOP measured at each visit was independently associated with FAI and fluctuation, whereas age, mean deviation (MD) and axial length (AL) were associated with selected blood flow velocity and waveform parameters.</p><p><strong>Conclusion: </strong>These findings suggest that postoperative changes in ocular haemodynamics reflect the combined influence of postoperative IOP, patient age, MD and AL.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the link between ocular shape and myopia: a systematic review.","authors":"Kan Xu, Chi Liu, Shiran Zhang, Yu Jiang, Xuanzhang Tang, Nathan Congdon, Xiaotong Han","doi":"10.1136/bmjophth-2025-002676","DOIUrl":"10.1136/bmjophth-2025-002676","url":null,"abstract":"<p><strong>Purpose: </strong>To present an up-to-date summary of the association between ocular shape and myopia.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, CNKI and Wanfang from June 2009 to September 2025 for cross-sectional and cohort studies examining the association between ocular shape and myopia (PROSPERO: CRD42024558271). The Newcastle-Ottawa Scale and the Agency for Healthcare Research and Quality were used to evaluate the quality of included studies.</p><p><strong>Results: </strong>Thirty-four studies were included. Ocular growth appears relatively uniform in non-myopic eyes whereas myopic eyes tend to show non-uniform expansion. Greater myopia is associated with asymmetric changes in both anterior and posterior ocular shape. Highly myopic eyes frequently display spheroid shapes with equatorial pyriform contours and macular staphylomas, with more pronounced posterior deformities linked to a higher risk of myopic complications. Longitudinal evidence suggests that baseline ocular shape may be associated with subsequent ocular morphological changes and myopia progression.</p><p><strong>Conclusions: </strong>Ocular shape is closely associated with myopia and myopic retinopathy. Existing studies remain mostly observational and heterogeneous, with small sample sizes in some studies limiting causal inference and precluding meta-analysis. Future studies are needed to better understand the potential value of ocular shape in myopia control.</p><p><strong>Prospero registration number: </strong>CRD 42024558271.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475359/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimising the patient pathway for macular conditions requiring intravitreal injections.","authors":"Elizabeth Wilkinson, Sasha Beresford, Bushra Mushtaq, Serena Salvatore, Sobha Sivaprasad, Kieran Brown, Jemma S Carter, Jyotika Singh, Timothy Schrire, Thomas John Godwin Chase","doi":"10.1136/bmjophth-2025-002663","DOIUrl":"10.1136/bmjophth-2025-002663","url":null,"abstract":"<p><p>Macular disease is the leading cause of vision loss in the United Kingdom, affecting nearly 1.5 million people. Vascular endothelial growth factor (VEGF) has a major role in the onset and progression of vision-threatening macular conditions such as neovascular age-related macular degeneration, diabetic macular oedema and retinal vein occlusion. Anti-VEGF treatments, given by intravitreal injection, can prevent vision loss and may improve vision but must be started quickly before sight loss is irreversible. Informed by an observational study using Hospital Episode Statistics and the Emergency Care Data Set in England and a Costed Integrated Patient Scenario, we identify issues within the current pathway in England. Our key recommendations to optimise care and improve patient outcomes include: (1) increasing public awareness of macular disease to reduce late presentation; (2) ensuring the right patients are seen in the right place at the right time by improving quality and priority of optometrist referrals and by specialists directing patients with conditions such as diabetes and hypertension to community optometrists in the first instance; (3) planning for current and future demand and capacity using innovative solutions to manage expected increases in medical retina conditions and (4) ensuring patient-centred care. Our evidence should encourage National Health Service organisations at all levels to review macular disease pathways to address immediate issues and plan for the future. A shift in care delivery is needed, embracing scalable sustainable solutions, earlier diagnosis and treatment, improved access to more durable therapies, wider adoption of digital technologies and care closer to home.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13448564/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for diabetic retinopathy with artificial intelligence in a primary care setting: a comparative cost analysis.","authors":"Livio Di Matteo, Noelle Whitestone, Vishaal Bhambhwani","doi":"10.1136/bmjophth-2026-002904","DOIUrl":"10.1136/bmjophth-2026-002904","url":null,"abstract":"<p><strong>Objective: </strong>Cost analysis of autonomous artificial intelligence (AI)-based screening of diabetic retinopathy (DR) for adults with diabetes at a primary care clinic.</p><p><strong>Methods and analysis: </strong>This study provides a comparative cost analysis of actual results using AI-based DR screening with counterfactual results based on all patients going through the physician-based referral system. A cost analysis is conducted using cost data from published sources, provincial billing codes, statistical sources, and patient characteristics from a clinical study to compare autonomous AI-based screening for DR versus physician-based screening. Costs considered include direct costs of operating the AI system, physician fees, and indirect costs to patient time. Along with total cost comparisons, a cost per DR case detected is estimated and a sensitivity analysis based on variations in AI costs is provided.</p><p><strong>Results: </strong>Over the study period, 202 participants were screened for DR using autonomous AI. The majority (93.6%, n=189) of AI-based DR screening exams were completed successfully. The AI-based scenario results in total direct costs of $C7919.04 and indirect costs of $C5728.80, resulting in total costs of $C13 647.84 per 100 patients. The traditional physician-based approach results in total direct costs of $C8240 and indirect costs of $C19 998.09, resulting in total costs of $C28 238.09 for 100 patients. When costs are converted to costs per unit outcome, the total cost per diagnosed DR case is $C620.36 for the AI-based approach and $C1283.55 for the physician-based approach; the AI-based cost per diagnosed case was 52% lower.</p><p><strong>Conclusion: </strong>Given the lower cost per diagnosed case of the AI-based approach, there are advantages to the implementation of AI-based screening for DR.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging policy gaps in clinical trial volunteering: public and healthcare professional perspectives in England.","authors":"Khawaja Muhammad Ammar Ali Javed, Gibran F Butt, Gurpreet Bansal, Maryam Noeman, Philip I Murray, Saaeha Rauz","doi":"10.1136/bmjophth-2026-002903","DOIUrl":"10.1136/bmjophth-2026-002903","url":null,"abstract":"<p><strong>Objective: </strong>To examine organisational leave policies for clinical trial participation in England and compare willingness between the public and healthcare professionals (HPs) under varying leave conditions.</p><p><strong>Methods and analysis: </strong>Freedom of information (FOI) requests were submitted to 378 public-sector organisations to identify policies supporting leave for clinical trial participation. Parallel cross-sectional surveys of the public (n=503; working-age adults) and HPs (n=110) assessed willingness to participate as a healthy volunteer (HV) or patient (P) in scenarios requiring annual leave (AL) or unpaid leave (UL). Free-text responses were analysed thematically. Group comparisons used χ² tests, and multivariable logistic regression examined predictors of willingness, adjusting for demographic and employment characteristics.</p><p><strong>Results: </strong>Five organisations (1.3%) reported an explicit policy addressing clinical trial leave while 336 (88.9%) reported none. Across all scenarios, public respondents were more willing to participate than HPs, particularly for HV participation using AL (78.9% vs 63.6%; p=0.001). In adjusted analyses, HPs had lower odds of willingness than public respondents for HV-AL (aOR 0.52, 95% CI 0.32 to 0.85), P-AL (aOR 0.67, 95% CI 0.44 to 0.98) and P-UL (aOR 0.61, 95% CI 0.38 to 0.96). Willingness declined when UL was required. No association was observed between Index of Multiple Deprivation decile and willingness. Financial concerns were the main barrier among the public, whereas HPs cited limited availability of AL.</p><p><strong>Conclusions: </strong>There is a widespread lack of organisational policies supporting clinical trial participation leave, and willingness is highly sensitive to whether leave is paid. This is particularly relevant in ophthalmology, where trials often involve repeated, time-intensive visits and reliance on working-age carers. Limitations include non-probability sampling, uncalculated survey response rates, self-reported willingness, a small regionally recruited HP sample and restriction to public-sector FOI data. Employment policy represents an under-recognised structural determinant of clinical trial participation, with implications for ophthalmology research.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual acuity degradation under positive lens-induced myopic defocus at nominal chart contrast levels in young adults: a repeated-measures study.","authors":"Shivani Sah, Suraj Chettri, Pragati Gautam, Gauri Shankar Shrestha","doi":"10.1136/bmjophth-2026-002835","DOIUrl":"10.1136/bmjophth-2026-002835","url":null,"abstract":"<p><strong>Objective: </strong>To quantify visual acuity (VA) degradation across nominal chart contrast levels under graded positive lens-induced myopic defocus and to determine whether corrected low myopes differ from emmetropes in their acute response to optical blur.</p><p><strong>Methods and analysis: </strong>In this repeated-measures study, 300 adults aged 18-35 years (150 low myopes and 150 emmetropes) underwent monocular logMAR VA assessment at 6 m. Positive spherical lenses (+0.50 to +2.00 D) were added over best correction to induce myopic defocus. VA was measured at five nominal chart contrast levels (100%, 70%, 50%, 25% and 13%) under natural pupil conditions. A repeated-measures general linear model evaluated the effects of defocus and contrast on VA, with refractive group and gender as between-subject factors and age as a covariate.</p><p><strong>Results: </strong>Defocus produced a significant decline in VA (p<0.001, partial η²=0.471), with progressive degradation as defocus increased. Progressively lower nominal chart contrast levels also significantly worsened VA (p<0.001, partial η²=0.237). A small but significant Defocus×Contrast interaction was observed (p<0.001, partial η²=0.015), indicating slightly greater blur-related degradation at lower nominal contrasts. No clinically meaningful interactions involving refractive group were observed. Although myopes demonstrated slightly poorer overall VA than emmetropes (mean difference 0.041 logMAR; p<0.001, partial η²=0.056), refractive status had little influence on the overall pattern of acuity decline across defocus or contrast levels.</p><p><strong>Conclusions: </strong>VA degradation under positive lens-induced myopic defocus is primarily determined by the magnitude of optical blur, with reduced contrast exerting an additional but smaller effect. Corrected low myopes and emmetropes show broadly comparable functional responses to acute defocus under natural viewing conditions, although subtle subgroup differences cannot be excluded.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy of different treatment modalities in the management of macular oedema in retinitis pigmentosa: a systematic review and network meta-analysis.","authors":"Hsi-An Yang, Wun-Long Jheng, Yih-Shiou Hwang, Wei-Chi Wu, Chi-Chun Lai, Hung-Da Chou, Eugene Yu-Chuan Kang, Laura Liu, An-Ning Chao, Yen-Ting Chen, Kuan-Jen Chen, Yi-Hsing Chen","doi":"10.1136/bmjophth-2026-002896","DOIUrl":"10.1136/bmjophth-2026-002896","url":null,"abstract":"<p><strong>Objective: </strong>To compare the efficacy of current treatments for retinitis pigmentosa (RP)-associated macular oedema using network meta-analysis (NMA).</p><p><strong>Methods and analysis: </strong>Electronic databases were searched for studies reporting changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). A frequentist NMA was performed and treatment hierarchies were estimated using the surface under the cumulative ranking curve.</p><p><strong>Results: </strong>12 studies were included to compare the following: oral acetazolamide 500 mg/day, oral methazolamide 50-100 mg/day, topical dorzolamide 2% three times daily, topical ketorolac 0.5% four times daily, intravenous umbilical cord mesenchymal stem cells (UCMSCs; single administration of 3×10⁶ cells), intravitreal dexamethasone implant (DEXi) 0.7 mg, intravitreal triamcinolone acetonide (IVTA) 4 mg, sub-Tenon TA (STTA) 20 mg, intravitreal bevacizumab 1.25 mg and intravitreal ranibizumab 0.5 mg. Regarding changes in BCVA at 3-4 months, oral carbonic anhydrase inhibitors (CAIs) showed greater BCVA improvement compared with anti-vascular endothelial growth factor (anti-VEGF) therapies; however, no intervention demonstrated statistically significant superiority in BCVA at 12 months. At 3-4 months, DEXi, acetazolamide, methazolamide and dorzolamide demonstrated comparable CMT reduction and outperformed anti-VEGF therapies, IVTA, STTA, intravenous UCMSC and control. By 12 months, dorzolamide (vs acetazolamide: -169.50 µm (95% CI -331.83 to -7.17) and vs methazolamide: -185.49 µm (95% CI -354.35 to -16.63)) and DEXi (vs acetazolamide: -147.00 µm (95% CI -206.58 to -87.42) and vs methazolamide: -162.99 µm (95% CI -238.56 to -87.42)) provided significantly greater CMT reduction than acetazolamide and methazolamide.</p><p><strong>Conclusions: </strong>CAIs and DEXi demonstrated the greatest long-term anatomical benefit for RP-associated macular oedema, whereas durable BCVA gains remained limited across available therapies. While oral and topical CAIs showed comparable short-term efficacy, topical dorzolamide and DEXi provided greater long-term CMT reduction than oral CAIs. Given the limited number of studies and small sample sizes, these findings should be interpreted cautiously and validated in larger randomised controlled trials.</p>","PeriodicalId":9286,"journal":{"name":"BMJ Open Ophthalmology","volume":"11 3","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}