British Journal of Ophthalmology最新文献

{"title":"Axial length-related cut-off value for increase in glaucomatous and non-glaucomatous optic neuropathy prevalence.","authors":"Jost B Jonas, Rahul A Jonas, Mukharram M Bikbov, Gyulli M Kazakbaeva, Ellina M Iakupova, Dan Milea, Alain M Bron, Cédric Lamirel, Vinay Nangia, Ya Xing Wang, Songhomitra Panda-Jonas","doi":"10.1136/bjo-2025-329214","DOIUrl":"https://doi.org/10.1136/bjo-2025-329214","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the cut-off value for an axial length-related increase in the prevalence of glaucomatous/glaucoma-like (GON/GLON) and non-glaucomatous (NGON) optic neuropathy.</p><p><strong>Methods: </strong>The project included the population-based Beijing Eye Study (n=3088; age: 40+ years), Ural Eye and Medical Study (n=5199 participants; age: 40+ years), Ural Very Old Study (n=428; age: 85+ years), Ural Children Eye Study (n=4185; school grade: 1+) and Central India Eye and Medical Study (CIEMS; n=4199; age: 30+ years). Using fundus photographs (all studies) and optical coherent tomographic images (all studies except for CIEMS), we assessed the prevalence of GON/GLON and NGON, defined by optic nerve head appearance and absence of neurological perimetric defects.</p><p><strong>Results: </strong>The total study population included 34 864 eyes (17 099 individuals; age: 46.1±23.0 years; range: 6 to 100 years) (axial length: 23.19±1.05 mm; range: 18.22-34.20 mm). Prevalence of GON/GLON and NGON were 438/17 099 (2.6%; 95% CI 2.0 to 3.0) and NGON 57/17 099 (0.3%; 95% CI 0.0 to 0.4) respectively. Higher GON/GLON prevalence was correlated with longer axial length (OR: 1.45; 95% CI 1.35 to 1.56; p<0.001) after adjusting for age and intraocular pressure. The increase in GON/GLON prevalence started at an axial length of 27.0 mm and 26.5 mm for a younger subgroup aged ≤52 years and an older subgroup aged >52 years respectively. Higher NGON prevalence was associated with longer axial length (OR: 4.35; 95% CI 3.58 to 5.29; p<0.001) after adjusting for age. The increase in NGON prevalence started to rise at an axial length of 27.0 mm and 26.5 mm for the younger subgroup and older subgroup, respectively.</p><p><strong>Conclusions: </strong>Prevalence of GON/GLON and NGON started to increase at an axial length of 27.0 mm and 26.5 mm for individuals aged ≤52 years or >52 years, respectively. These cut-off values may be helpful for the differentiation of moderate myopia versus high myopia.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome after cataract surgery with IOL implantation in adolescents and adults with juvenile idiopathic arthritis (JIA) associated or ANA-positive anterior uveitis.","authors":"Johanna Backes, Charlotte Wortmann, Kai Rothaus, Carsten Heinz, Jörg Michael Koch, Thabo Lapp, Charlotte Evers, Maren Kasper, Arnd Heiligenhaus","doi":"10.1136/bjo-2025-328588","DOIUrl":"https://doi.org/10.1136/bjo-2025-328588","url":null,"abstract":"<p><strong>Purpose: </strong>Cataract surgery in patients with chronic anterior uveitis may be associated with increased risk for complications and poor outcomes. This study analyses visual outcome, uveitis course and complications after cataract surgery with intraocular lens (IOL) implantation in adolescents and adults with juvenile idiopathic arthritis (JIA)-associated or antinuclear antibodies (ANA)-positive uveitis.</p><p><strong>Methods: </strong>Data before and at 6 weeks, 1 and 2 years after surgery were retrospectively analysed according to Standardization of Uveitis Nomenclature (SUN) standards. Surgery was performed with small incisions, phacoemulsification and IOL implantation. Surgical technique was adapted to pre-existing uveitis-related morphological abnormalities. Predictors of visual outcome and vision-threatening complications at 2-year follow-up (FU) were analysed.</p><p><strong>Results: </strong>93 surgeries of 83 patients (84% female; mean age 24.8±16.2 years) with JIA-associated (84%) or ANA-positive (16%) anterior uveitis were analysed. Preoperative treatment included topical steroids, conventional synthetic disease-modifying antirheumatic drugs (csDMARDs; 72.0%) or biological (b) DMARDs (65.6%). Besides cataract, uveitis-related complications (eg, fibrotic lens membrane, posterior synechiae and pupil contraction) were present in 95.7% before surgery. Best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) improved from 1.57±1.32 preoperatively to 0.42±0.83 at 2 years (p<0.001). Postoperative complications included posterior synechiae formation (30%), giant-cell deposits (35.7%), posterior capsule opacification (51.9%) and macular oedema (12.7%). Significant preoperative predictors of poor visual outcome included poor BCVA and high laser flare (LF) values, and those of postoperative ocular complications also included poor BCVA and a lack of systemic anti-inflammatory drug use (each, p<0.05).</p><p><strong>Conclusions: </strong>Beneficial outcomes can be achieved following cataract surgery with IOL implantation in adolescents and adults with JIA-associated or ANA-positive anterior uveitis. Important prerequisites include preoperative inactivity, appropriate surgical technique and sustained long-term uveitis inactivity with the use of DMARDs.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DeepAdapter: a generalisable algorithm integrating self-supervised learning and unsupervised domain adaptation for robust retinopathy of prematurity screening.","authors":"Jiaman Zhao, Longhui Li, Zhenzhe Lin, Mingjie Luo, Dongyuan Yun, Jingyi Wen, Lixue Liu, Jianqiao Li, Fabao Xu, Suzhen Xie, Meirong Wei, Baohai Liu, Zhenzhen Liu, Duoru Lin, Haotian Lin","doi":"10.1136/bjo-2025-328559","DOIUrl":"10.1136/bjo-2025-328559","url":null,"abstract":"<p><strong>Aims: </strong>To develop and validate DeepAdapter, a novel deep learning algorithm that integrates self-supervised learning (SSL) and unsupervised domain adaptation (UDA) to enhance model generalisability for retinopathy of prematurity (ROP) screening.</p><p><strong>Methods: </strong>DeepAdapter was developed in two stages. First, SSL was applied to 500 000 unlabelled infantile colour fundus photographs (CFPs) retrospectively collected from four Chinese clinical centres to learn general fundus representations. Second, a much smaller labelled dataset of Normal and ROP CFPs was constructed, and a UDA module was incorporated to mitigate domain shift, defined as distribution differences between training and deployment datasets that may impair model performance. Correlation Alignment (CORAL) distance was employed to quantify these domain shifts. External validation was performed using data from an independent clinical centre and two public multiethnic datasets.</p><p><strong>Results: </strong>A total of 500 000 non-overlapping unlabelled CFPs and 39 456 labelled CFPs were included. Compared with the supervised method, DeepAdapter decreased CORAL distance from 0.297 to 3.550×10^-6. Both algorithms achieved high internal accuracy (0.989) in ROP prediction, but DeepAdapter significantly outperformed the supervised method on external testing (accuracy: 0.828 (95% CI 0.823 to 0.833) vs 0.739 (95% CI 0.733 to 0.745), p <0.001) and on the public cross-ethnicity dataset (accuracy: 0.839 (95% CI 0.818 to 0.859) vs 0.813 (95% CI 0.791 to 0.835), p=0.014). A web-based system integrating quality control and ROP diagnosis was developed for large-scale, multicentre clinical screening.</p><p><strong>Conclusions: </strong>DeepAdapter effectively mitigated domain shift and significantly improved model generalisability for ROP screening, providing a valuable reference for developing generalisable models in other medical specialties.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The evolution of globe-preserving management for lacrimal gland carcinoma.","authors":"Kaveh Vahdani, David Harding Verity","doi":"10.1136/bjo-2026-330519","DOIUrl":"10.1136/bjo-2026-330519","url":null,"abstract":"<p><p>The historical evolution of globe-preserving management provides important context for interpreting contemporary outcomes in lacrimal gland carcinoma. Since the early 1990s, evidence has challenged the assumption that orbit-sacrificing surgery, including cranio-orbital resection and orbital exenteration, confers a survival advantage. This was subsequently reinforced by more contemporary long-term comparative outcome data demonstrating no significant survival benefit over globe-preserving surgery with radiotherapy. Recent findings in lacrimal gland adenoid cystic carcinoma are broadly consistent with this established evidence base, although comparisons with exenteration remain susceptible to treatment-selection bias.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148719890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White spot lesions in vitreoretinal lymphoma: multimodal imaging features and differential diagnosis.","authors":"Wenwen Chen, Yao Zhou, Wei Liu, Ming Wang, Tingting Jiang, Junxiang Gu, Shixue Liu, Xinyi Zhou, Qing Chang","doi":"10.1136/bjo-2026-329825","DOIUrl":"https://doi.org/10.1136/bjo-2026-329825","url":null,"abstract":"<p><strong>Aims: </strong>To characterise the clinical and multimodal imaging (MMI) features of vitreoretinal lymphoma (VRL) with white spot lesions (WSLs) and differentiate it from multiple evanescent white dot syndrome (MEWDS).</p><p><strong>Methods: </strong>This retrospective observational case-control study consecutively enrolled patients with biopsy-proven VRL between 2018 and 2024 at Fudan University Eye and ENT Hospital. Included patients with VRL with baseline WSLs on fundus photography comprised the WSLs VRL group compared with 34 eyes from 34 patients diagnosed with primary MEWDS in 2024.</p><p><strong>Results: </strong>Totally 35 (35/158, 22%) eyes of 25 (25/89, 28%) patients (53.8 (SD 10.4) years; 80% female) presenting with WSLs were included in the WSLs VRL group. Eyes with WSLs presented with significantly shorter symptom duration and better visual acuity at initial examination than those without WSLs (both p<0.001). Compared with the MEWDS cohort, the WSLs in VRL demonstrated a distinct eccentric, peripheral and limited distribution, involving <50% retina in significantly more eyes than in MEWDS (p<0.001). Involvement of the posterior pole and macula was significantly less frequent in VRL (both p<0.001). The coexistence of multiple fundus autofluorescence patterns was more common in VRL (p<0.001), and a distinctive pattern of hypoautofluorescent spots with hyperautofluorescent rings was observed in 23 of 35 VRL eyes but was absent in MEWDS. Optical coherence tomography revealed more frequent retinal pigment epithelium abnormalities in VRL (p<0.001).</p><p><strong>Conclusions: </strong>WSLs emerged as a potential early sign of VRL, demonstrating distinct MMI features. Recognising these features aids early diagnosis and differentiation from mimickers like MEWDS.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel surgical approach to correct late-hypotony in PreserFlo MicroShunt.","authors":"Bruno Guerreiro Dias, Rafael Whitfield, Inês Leal, Luís Abegão Pinto","doi":"10.1136/bjo-2025-328345","DOIUrl":"https://doi.org/10.1136/bjo-2025-328345","url":null,"abstract":"<p><p>We report a novel surgical approach for managing late hypotony in PreserFlo MicroShunt blebs. Hypotony is a well-known complication of glaucoma filtering surgery, yet treatment options for late-onset cases remain limited. We describe two cases of uveitic glaucoma presenting with hypotony several months after PreserFlo implantation. Both patients were successfully treated with a bleb-modifying procedure. Under local anaesthesia, several interrupted 10-0 nylon sutures were placed in the bleb region to reduce its size and sectorise it, creating an iatrogenic 'ring of steel' that effectively corrected overfiltration. This technique appears to be a feasible and potentially effective option for managing late hypotony.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148688468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating opportunistic ocular diseases screening into general health examination in Chinese: a multicentre study.","authors":"Zhong Lin, Shiyu Wang, Ruirong You, Lei Wang, Mohamed A Abdullahi, Wenjing Du, Xiang Xu, Fan Lu, Shaodan Zhang, Yuanbo Liang","doi":"10.1136/bjo-2025-329267","DOIUrl":"https://doi.org/10.1136/bjo-2025-329267","url":null,"abstract":"<p><strong>Background/aims: </strong>Cost-effective screening models for ocular diseases in large populations remain a critical challenge for blindness prevention. Our preliminary study demonstrated the feasibility of opportunistic glaucoma screening integrated into general health examinations. This study aimed to evaluate the efficacy of this model for fundus disease screening in a multicentre, large-sample Chinese population.</p><p><strong>Methods: </strong>This study was conducted in five health examination centres from four provinces of China. Chinese participants aged ≥18 years undergoing routine health examinations were invited to complete bilateral presenting visual acuity and non-mydriatic fundus photography. Fundus photography was assessed by two experienced graders. Proportion of fundus diseases/changes were calculated. Costs for the screening were also assessed.</p><p><strong>Results: </strong>A total of 63 935 eligible participants (age 45.4±14.0 years, 51.3% men) were enrolled. The top five diseases/changes were non-macular drusen (8.80%), macular degeneration (6.30%), glaucoma suspect (5.54%), epiretinal membrane (3.92%) and diabetic retinopathy (3.89%). The proportion of low vision and blindness in the total population was 5.85% and 0.15%, respectively. The top five diseases/changes with vision impairment were retinitis pigmentosa (18.18%), myopic retinopathy (16.52%), macular hole (11.76%), non-glaucomatous optic neuropathy (7.25%) and glaucomatous optic neuropathy (6.37%). The unit cost of screening a single case and an ocular disease suspect was US$22.2 (US$15.7 to US$26.7) and US$83.2 (US$58.7 to US$99.9), respectively.</p><p><strong>Conclusions: </strong>This health examination centre-based screening model is feasible, effective and affordable for detecting multiple fundus diseases in large populations. As the model is promoted and its coverage expands, screening costs may be further reduced.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148677411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic nerve compression predicts acuity loss while orbital crowding predicts field defects in patients with early-to-moderate intraorbital cavernous haemangiomas.","authors":"Boyue Xu, Haodi Cheng, Xiaohui Jiang, Jichen Du, Nanxin Wu, Jinli Xiang, Yunhai Tu, Wencan Wu, Ende Wu","doi":"10.1136/bjo-2026-329540","DOIUrl":"https://doi.org/10.1136/bjo-2026-329540","url":null,"abstract":"<p><strong>Background: </strong>Intraorbital space-occupying lesions impair visual function, yet whether this stems primarily from optic nerve compression, elongation or orbital apex crowding remains unclear. This study investigated the differential impact of these mechanical factors on visual acuity (VA) and visual field (VF) in patients with intraorbital cavernous haemangiomas.</p><p><strong>Methods: </strong>This retrospective cohort study analysed 130 patients with unilateral intraorbital cavernous haemangiomas. Key imaging parameters were measured from CT/MRI and categorised into optic nerve elongation, compression (eg, optic-nerve aspect ratio (ONAR)) and orbital crowding (eg, tumour-to-orbit (TO) ratio, tumour mid-position (TMP)). Univariate and multivariate linear regression models were used to correlate these metrics with visual outcomes.</p><p><strong>Results: </strong>Regression analysis revealed two distinct injury mechanisms. Direct compression, best quantified by ONAR, was the strongest predictor for VA decline (R²=0.15, p<0.0001) but correlated weakly with VF loss (R²=0.09, p=0.0015). Conversely, orbital apex crowding (TO-ratio and TMP) correlated more strongly with VF defects (R²=0.19 and R²=0.20, p<0.0001) than with VA. Optic nerve elongation showed no significant correlation with visual dysfunction. The final multivariate model explained 17.68% of the variance in VA and 36.48% in VF.</p><p><strong>Conclusions: </strong>Visual loss from orbital tumours involves two mechanical pathways: direct compression preferentially impairs central vision (VA), while orbital apex crowding predominantly affects peripheral vision (VF). Imaging metrics like ONAR and TO-ratio can effectively quantify these mechanisms. They may serve as supplementary reference indicators for evaluating visual risk and informing clinical follow-up and surgical consultation, with ONAR indicating risk to central vision and TO-ratio signalling impending field loss.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraocular foreign bodies: a systematic review and meta-analysis of clinical manifestations, diagnostic challenges and management strategies.","authors":"Priyanshi Priya, Nibha Mishra, Niraj Kumar Yadav, Priyanka Sharma, Apjit Kaur Chhabra","doi":"10.1136/bjo-2026-329418","DOIUrl":"https://doi.org/10.1136/bjo-2026-329418","url":null,"abstract":"<p><strong>Background/aims: </strong>Retained intraocular foreign bodies (IOFBs) are important causes of vision-threatening ocular trauma and preventable visual impairment. This systematic review and meta-analysis evaluated the clinical manifestations, diagnostic approaches, surgical management and visual outcomes associated with IOFBs.</p><p><strong>Methods: </strong>A systematic search of PubMed, Embase, Scopus and Web of Science identified studies published between 1 January 2000 and 30 November 2025. Eligible studies reporting clinical presentation, imaging findings, management strategies or outcomes of retained IOFBs were included. Data were synthesised using a random-effects meta-analysis model.</p><p><strong>Results: </strong>A total of 59 studies involving 4289 patients were included of which 42 were eligible for quantitative meta-analysis. Reduced visual acuity (78%), ocular pain (42%) and intraocular inflammation (36%) were the most common clinical manifestations. Endophthalmitis occurred in 12.4% and retinal detachment in 9.8% of cases. Favourable visual outcomes (Best Corrected Visual Acuity-BCVA≥20/40) were achieved in 65.7% of patients. CT demonstrated the highest diagnostic accuracy (91.2%), while ultrasonography showed 83.6% sensitivity particularly in media opacity. Pars plana vitrectomy was the predominant surgical approach, with an overall surgical success rate of 96.5%. Early IOFB removal (≤24 hours) was associated with improved visual recovery and reduced complications.</p><p><strong>Conclusions: </strong>Early diagnosis and timely surgical intervention are critical for optimising outcomes in retained IOFBs. CT and pars plana vitrectomy remain central to management, while delayed intervention increases the risk of severe complications. Standardised protocols and prospective multicentre studies are needed to strengthen evidence and improve patient care.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of glaucoma among patients using tadalafil for lower urinary tract symptoms: a multinational cohort study.","authors":"Yun Hsia, Chien-Yun Tsai, Sheng-Chun Hung, Jun-Peng Chen, Ssu-Yu Pan, Hui-Ju Lin, I-Jong Wang, Chien-Hsiang Weng, Mi-Hyun Nam, Chien-Chih Chou","doi":"10.1136/bjo-2026-329957","DOIUrl":"https://doi.org/10.1136/bjo-2026-329957","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the association between tadalafil use for lower urinary tract symptoms (LUTS) and the risk of developing glaucoma.</p><p><strong>Methods: </strong>This multinational, retrospective cohort study was conducted using the TriNetX database. Men aged ≥40 years with a history of LUTS were enrolled between 2012 and 2022. Individuals with a history of glaucoma prior to cohort entry were excluded. Participants were categorised into the tadalafil group and the non-phosphodiesterase type 5 inhibitor (non-PDE5i) group. Propensity score matching (1:1) was conducted to balance age, race, comorbidities, renal function and concomitant medications. Hazard ratios (HRs) were estimated for incident glaucoma of different subtypes and initiation of glaucoma treatment.</p><p><strong>Results: </strong>The cohort included 36 927 tadalafil users and 36 927 matched non-PDE5i users. Up to 5 years, tadalafil use was associated with an increased risk of glaucoma compared with non-PDE5i use (HR 1.22; 95% CI 1.12 to 1.33). Elevated risks were observed for ocular hypertension (HR 1.32; 95% CI 1.06 to 1.65), primary open-angle glaucoma (HR 1.33; 95% CI 1.05 to 1.67) and initiation of glaucoma treatment (HR 1.33; 95% CI 1.20 to 1.47). No significant associations were found for low-tension or primary angle-closure glaucoma. Tadalafil users had a higher 5-year cumulative incidence than non-users (3.93% vs 3.16%; p<0.001), with consistent risk in men >50 years, white population and across comorbidities, remaining robust to 1-, 3- and 6-month lag times.</p><p><strong>Conclusions: </strong>Tadalafil was associated with increased risk of glaucoma compared with non-PDE5i in males with LUTS. Ophthalmic evaluation and follow-up may be considered, particularly in patients with risk factors for glaucoma.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}