British Journal of Ophthalmology最新文献

{"title":"Managing refractory herpes simplex keratitis","authors":"Antoine Rousseau,Rafael Boucher,Oscar Haigh,Marc Labetoulle","doi":"10.1136/bjo-2025-329213","DOIUrl":"https://doi.org/10.1136/bjo-2025-329213","url":null,"abstract":"Herpes simplex keratitis (HSK) caused by herpes simplex virus type 1 (HSV-1) is a major cause of infectious corneal blindness in developed countries. The disease reflects a variable combination of viral replication, immune-mediated inflammation and neurotrophic dysfunction, whose respective contributions determine both the clinical presentation and therapeutic strategy. Standard management relies on antiviral agents to suppress viral replication, corticosteroids to control immune stromal involvement and ocular surface optimisation to address chronic inflammation and neurotrophic impairment. Refractory forms, defined by a lack of clinical improvement despite appropriate treatment, require reassessment of adherence, pharmacokinetic exposure and underlying pathophysiology. In such cases, antiviral dose adjustment, the use of steroid-sparing immunomodulators and rigorous control of ocular surface inflammation are essential. Neurotrophic keratopathy may benefit from growth factor-based therapies, autologous serum, recombinant nerve growth factor or scleral lenses. The emergence of acyclovir-resistant HSV-1 strains, particularly in immunocompromised or long-term treated patients, represents an increasing concern. In these situations, alternative agents such as trifluridine, foscarnet or more recently, helicase–primase inhibitors, including amenamevir, have demonstrated clinical efficacy. The new strategies outlined here will all provide benefit in treating the drivers of refractory HSK, to quickly resolve and reduce risk of recurrence, providing new opportunities to prevent vision loss in refractory and antiviral-resistant cases.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"47 1","pages":"bjo-2025-329213"},"PeriodicalIF":4.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020258","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":"Pregnancy-related risk factors for postpartum onset of glaucoma in pre-pregnancy glaucoma suspect: a retrospective cohort study","authors":"Jinyue Dai,Ke Zhang,Qing Sheng,Zhijian Huang,Liyu Shi,Jintao Li,Chaoyang Yao,Ying Wang,Yuan Wei,Jing Hong,Tianchen Wu,Xuran Dong","doi":"10.1136/bjo-2026-330376","DOIUrl":"https://doi.org/10.1136/bjo-2026-330376","url":null,"abstract":"Background/aims To evaluate the risk of postpartum glaucoma development in women with pre-pregnancy glaucoma suspect status and its association with pregnancy-related factors. Methods This retrospective cohort study enrolled patients diagnosed with glaucoma suspect before pregnancy between January 2012 and December 2024. Demographic, obstetric and ophthalmic data were collected. The primary outcome was postpartum glaucoma development. Risk factors were analysed using mixed-effect Cox regression, with Kaplan-Meier and interaction analysis. Results Of 92 patients (184 eyes) 53 patients (57.6%) progressed to glaucoma, with a mean progression time of 2.42±1.97 years. Multivariable Cox regression analysis identified higher mean intraocular pressure (IOP) (HR=1.37, 95% CI 1.26 to 1.49, p<0.001) and pre-eclampsia (HR=4.30, 95% CI 2.33 to 7.93, p<0.001) as independent risk factors, whereas higher pre-pregnancy body mass index (BMI) was protective (HR=0.91, 95% CI 0.83 to 0.99, p=0.037). A significant interaction was observed between pre-eclampsia and mean IOP (HR=1.19, p=0.038). Kaplan-Meier analysis showed an increased cumulative incidence of glaucoma in patients with pre-eclampsia (p=0.022). Conclusion For pre-pregnancy glaucoma suspect, higher mean follow-up IOP and pre-eclampsia increased the risk of postpartum glaucoma development, with a synergistic interaction between the two factors; higher pre-pregnancy BMI appears protective. These findings suggest that enhanced postpartum surveillance with individualised IOP monitoring and risk stratification should be particularly emphasised for glaucoma suspect women with a history of pre-eclampsia.","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":"6 1","pages":"bjo-2026-330376"},"PeriodicalIF":4.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149020259","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":"Intracapsular metformin bioactivity and its role in posterior capsule opacification.","authors":"Christoph Spartalis, Manuel Ruiss, Thomas Dechat, Martin Kronschläger, Oliver Findl","doi":"10.1136/bjo-2025-328949","DOIUrl":"10.1136/bjo-2025-328949","url":null,"abstract":"<p><strong>Background/aims: </strong>Posterior capsule opacification (PCO) is the most frequent long-term complication after cataract surgery, caused by proliferation of residual lens epithelial cells (LECs). Metformin, a common antidiabetic drug with antifibrotic properties, may act as a pharmacological modulator of this process. The purpose was to assess whether systemically administered metformin reaches the human lens capsule and inhibits LEC proliferation at physiologically relevant concentrations.</p><p><strong>Methods: </strong>Metformin concentrations were quantified in serum and lens capsule tissue of patients with type 2 diabetes mellitus undergoing cataract surgery using high performance liquid chromatography-tandem mass spectrometry. Patients were stratified into low-dose (≤1000 mg/day) and high-dose (>1000 mg/day) groups. Additionally, anterior lens capsules from non-diabetic donors were cultured with or without metformin (0.75 pg/µL), and LEC proliferation was monitored for 14 days by live-cell imaging.</p><p><strong>Results: </strong>Metformin was detectable in both serum and capsule specimens, with a significant correlation between compartments (r=0.553, p=0.011). Capsule concentrations were similar across dose groups, while serum levels were higher in the low-dose group. In vitro, metformin significantly reduced LEC proliferation compared with controls (p<0.001).</p><p><strong>Conclusion: </strong>Systemically administered metformin reaches the human lens capsule in vivo and suppresses LEC proliferation in vitro at clinically relevant concentrations. These findings provide first clinical and experimental evidence supporting metformin as a potential pharmacological adjunct to current strategies for PCO prevention.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1157-1163"},"PeriodicalIF":4.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147302650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of 0.01% atropine eye drops for myopia control in children of different ethnicities: a systematic review and meta-analysis.","authors":"Xiu Juan Zhang, Mingming Liu, Edison Chak Fung Ho, Marco Yu, Ryan Tak Chun Wong, Weijia Chen, Ebenezer Zaabaar, Philip Yawen Guo, Chen-Wei Pan, Ching-Yu Cheng, Jason C Yam, Dennis Shun-Chiu Lam, Kendrick Shih, Christopher Kai Shun Leung","doi":"10.1136/bjo-2025-328942","DOIUrl":"10.1136/bjo-2025-328942","url":null,"abstract":"<p><strong>Background/aims: </strong>Although 0.01% atropine is widely used for myopia control, its efficacy is debated and its effectiveness across different ethnicities is unknown. We aim to evaluate its efficacy in different ethnic backgrounds.</p><p><strong>Methods: </strong>The randomised clinical trials (RCTs) that compared 0.01% atropine against a placebo in myopic children from five databases through August 2025 were included. The primary outcomes included (1) the ratio of the means (RoM), defined as the RoM of annual changes in spherical equivalent refraction (SER) or ocular axial length (AL) in 0.01% atropine to the placebo groups, for accounting in the natural progression; and (2) the mean differences (MDs) in SER progression and AL elongation.</p><p><strong>Results: </strong>A meta-analysis of 25 RCTs (4374 children aged 4-18) showed that 0.01% atropine reduced the SER progression by 37% annually (RoM: 0.63; 95% CI 0.54 to 0.74), with efficacy being much greater in South Asian populations (66% reduction; RoM: 0.34, 95% CI 0.27 to 0.42), than East Asian populations (35% reduction; RoM: 0.65, 95% CI 0.54 to 0.78) and white populations (28% reduction; RoM: 0.72, 95% CI 0.59 to 0.86) (p<0.0001). Regarding the MD, 0.01% atropine was effective in slowing an overall myopia progression of 0.21D per year (95% CI 0.15D to 0.27D) compared with placebo group. A similar pattern was observed in AL elongation.</p><p><strong>Conclusion: </strong>0.01% atropine effectively slows myopia progression across ethnicities, with the greatest efficacy observed in South Asian populations. Clinical practice should consider this ethnic difference to optimise the treatment effects.</p><p><strong>Prospero registration number: </strong>CRD42025632545.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1108-1117"},"PeriodicalIF":4.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147509809","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":"Trends in 18 years of keratoplasty in Europe: insights from the European Eye Bank Association's data.","authors":"Martin Walter Kuklinski, W John Armitage, Daniel Böhringer, Ilse Claerhout, Iva Dekaris, Andrea Gareiss-Lok, Jesper Hjortdal, Gary Jones, Diego Ponzin, Philip Maier","doi":"10.1136/bjo-2025-329353","DOIUrl":"10.1136/bjo-2025-329353","url":null,"abstract":"<p><strong>Background/aims: </strong>To examine trends in corneal transplantation in Europe over an 18-year period from 2007 to 2024 by using data from the annual reports of the European Eye Bank Association (EEBA) regarding transplantation procedure type and quality control parameters in eye banking.</p><p><strong>Methods: </strong>Data were extracted from annual EEBA reports, and a longitudinal analysis of the categories-type of transplant, storage methods, issuance and contamination rates was conducted.</p><p><strong>Results: </strong>The analysis included 443 237 corneas issued for transplantation from 116 different eye banks across 25 countries. The total number of keratoplasty procedures grew by 108%. A shift towards lamellar procedures was noted. Penetrating keratoplasties decreased from 85% (2007) to 34% (2017). A significant increase in posterior lamellar grafts was seen, reaching 47% in 2017, which were increasingly produced in eye banks. Issuance rates improved over time, with 59% of procured corneas issued for transplantation in 2024. Contamination rates remained low at 1-2% for bacterial and 0.3 to 0.96% for fungal contamination. Comparison with other international studies confirms the observed trend favouring lamellar procedures, while countries with differing socioeconomic conditions deviate from this trend.</p><p><strong>Conclusion: </strong>This study provides a comprehensive overview of the shifting landscape of corneal transplantation in Europe, reflecting a move towards lamellar procedures and bank-prepared transplants. These findings align with broader international trends, underscoring the importance of continued advancements in surgical techniques and eye banking practices. Low contamination rates are indicative of already successful procedures in eye banking in Europe, and reports of lower rates warrant further investigation and improvement.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1118-1124"},"PeriodicalIF":4.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052813","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":"Three-dimensional topography of Descemet's membrane in Fuchs endothelial corneal dystrophy using laser scanning confocal microscopy and white-light interferometry.","authors":"Corantin Maurin, Sylvain Poinard, Gauthier Travers, Zhiguo He, Fanny Decoeur, Etienne Gontier, Georgia Karpathiou, Philippe Gain, Gilles Thuret","doi":"10.1136/bjo-2026-330189","DOIUrl":"10.1136/bjo-2026-330189","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the potential of a three-dimensional microscope combining laser scanning confocal imaging and white-light interferometry for quantitative topographic characterisation of Descemet's membrane (DM) in Fuchs endothelial corneal dystrophy (FECD).</p><p><strong>Methods: </strong>Descemet's membranes were collected from 38 FECD patients undergoing endothelial keratoplasty and four healthy donors. After flat-mounting on glass slide and drying, specimens were analysed using the VK-X3000 system (KEYENCE). Entire samples were reconstructed by image stitching at low magnification (×10) in white-light interferometry mode (0.01 nm axial resolution). Higher magnifications (×20 to ×150) in confocal mode (12 nm axial resolution) enabled detailed structural analysis. Three-dimensional height maps were generated to calculate standardised surface roughness parameters. Guttae and other DM features were classified according to spatial organisation and elevation profiles.</p><p><strong>Results: </strong>White-light interferometry enabled full-field mapping of whole 8 mm diameter DMs with nanometric vertical resolution (~2 hours/sample). Surface roughness (Sa) was higher in FECD than in controls (median±IQR: 0.571±0.259 µm vs 0.239±0.161 µm; p=0.0018). In FECD, three zones were identified: centre (guttae buried in the posterior fibrillar layer; Sa 0.442±0.112 µm), paracentre (large uncovered guttae; Sa 0.562±0.170 µm; p=0.0423) and outer zone (no confluent guttae; Sa 0.261±0.143 µm; p<0.0001). Confocal three-dimensional (3D) imaging revealed radial striae, embossments and furrows in the DM, confluent central guttae and fused or buried structures.</p><p><strong>Conclusions: </strong>Combining white-light interferometry and confocal microscopy enables label-free, high-resolution surface characterisation of DM in FECD, providing quantitative metrics to compare histological subtypes and supporting the predominance of radial structural organisation.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":"1140-1148"},"PeriodicalIF":4.5,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721564","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":"Analysis of choroidal OCT intensity and profile changes in high myopia: correlation with visual impairment and identification of pathological myopia.","authors":"Ni Wan, Guangqing Lin, Xuewen Ding, Jingsong Wang, Ning Xu, Tong Wang, Xiaotian Wu, Hao Chen, Shuang-Qian Zhu, Yiyi Wang, Meixiao Shen, Fan Lu, Yilei Shao","doi":"10.1136/bjo-2025-327701","DOIUrl":"10.1136/bjo-2025-327701","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the changes in choroidal optical coherence tomography (OCT) radiomic features, their correlations with visual acuity and utility in identifying pathological myopia (PM).</p><p><strong>Methods: </strong>A total of 288 myopic participants aged 18-50 years were included. Choroidal radiomic features were extracted and screened from OCT images via PyRadiomics and machine learning. Selected features were analysed for their associations with axial length, spherical equivalent, age and best corrected visual acuity (BCVA). Classification models were built using these features and their performance to identify PM was evaluated and compared with clinical parameters through five-fold cross-validation using metrics including area under the curve (AUC), accuracy, recall and F1 score.</p><p><strong>Results: </strong>A total of 464 radiomic features were extracted and four choroidal intensity and shape features significantly correlated with axial length (p<0.001) were selected. Smaller maximum diameter, higher coarseness and greater perimeter surface ratio were significantly associated with worse BCVA (p<0.05). Radiomic features showed better performance than clinical features in both the internal test set (AUC=0.970 vs 0.938) and external validation set (AUC=0.858 vs 0.753) in identifying PM. Combining radiomic features with risk factors improved classification performance (AUC=0.990 internally and 0.892 externally). Among the included factors, intensity feature was most predictive for PM.</p><p><strong>Conclusions: </strong>OCT-based choroidal intensity and shape features were significantly correlated with axial elongation and visual impairment and outperformed clinical parameters in identifying PM. These features could serve as reliable biomarkers for monitoring high myopia progression.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147939681","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":"Coexpression of IGF1R and TSHR in extraocular muscles of patients with thyroid-associated orbitopathy.","authors":"Kuan-Ying Chen, Chia-Chen Lin, Wan-Ju Chen, Chun-Chieh Lai","doi":"10.1136/bjo-2025-329199","DOIUrl":"https://doi.org/10.1136/bjo-2025-329199","url":null,"abstract":"<p><strong>Background/aims: </strong>To explore the roles of insulin-like growth factor 1 receptor (IGF1R) and thyroid-stimulating hormone receptor (TSHR) in extraocular muscle pathology.</p><p><strong>Methods: </strong>Extraocular muscle specimens were obtained during rectus muscle myectomy surgeries performed for large-angle strabismus correction in patients with thyroid-associated orbitopathy (TAO) and during rectus muscle resection surgeries performed for congenital strabismus in normal controls. Immunohistochemistry was employed to detect and compare between-group IGF1R and TSHR expression; ImageJ software was used to assess the staining area and H&E staining was used to evaluate morphological differences in tissues. Intergroup comparisons were conducted using the Mann-Whitney U test.</p><p><strong>Results: </strong>Histological examination of the extraocular muscle specimens revealed greater fibrosis in the TAO group (n=12) than in the control group (n=6). Immunohistochemistry (IHC) revealed significantly higher expression of both IGF1R and TSHR in the TAO group, particularly in elongated fibroblast-like cells and some myocytes, than in the control group, which exhibited minimal expression. Semiquantitative analysis confirmed significantly larger mean expression areas for IGF1R and TSHR in the TAO group than in the control group (p<0.05).</p><p><strong>Conclusions: </strong>Our study revealed elevated IGF1R and TSHR expression in the extraocular muscles of patients with TAO, supporting their potential involvement in orbital fibroblast infiltration and muscle remodelling in TAO. These findings provide tissue-based support for the biological relevance of IGF1R in TAO-related extraocular muscle pathology and may help inform future investigations of IGF1R-targeted therapies such as teprotumumab. Further quantitative and mechanistic studies are warranted to better define the therapeutic implications of these findings.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001251","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":"COSMYC: a Core Outcome Set for MYopia clinical trials with Children and young people.","authors":"Annegret Dahlmann-Noor, Megan Jacobson, Lily Islam, Sarah Gorst, Helen Baker, Nick Freemantle, Carol Rivas, Augusto Azuara-Blanco","doi":"10.1136/bjo-2026-330475","DOIUrl":"https://doi.org/10.1136/bjo-2026-330475","url":null,"abstract":"<p><strong>Background/aims: </strong>Childhood myopia is an increasing public health concern, with earlier onset, faster progression and greater severity than in previous generations, increasing the risk of sight-threatening complications in adulthood. Randomised controlled trials (RCTs) of myopia interventions report heterogeneous outcomes and may not address priorities of all stakeholders. We aimed to develop a core outcome set (COS) and recommendations for outcome measurement instruments (OMIs) for myopia intervention trials in children and young people (CYP).</p><p><strong>Methods: </strong>Using Core Outcome Measures in Effectiveness Trials (COMET) methodology, we undertook a three-phase consensus process. Phase 1 comprised a systematic literature review, workshops with CYP and parents/caregivers, and interviews with eye care professionals (ECPs) and myopia researchers to identify candidate outcomes and OMIs. Phase 2 used a two-round Delphi process and consensus meeting involving CYP, parents/caregivers, ECPs and researchers to agree on core outcomes. Phase 3 involved literature review, content-validity assessment and stakeholder consensus to develop OMI recommendations.</p><p><strong>Results: </strong>Phase 1 identified 308 verbatim outcomes from randomised trials and qualitative work, from which 21 outcomes were retained for consensus. In Phase 2, stakeholders reached consensus on 10 core outcomes: axial length, spectacle prescription, visual acuity, eye health, eye comfort/discomfort, quality of life, adherence, treatment satisfaction, ocular adverse effects and systemic adverse effects. Phase 3 produced stakeholder-informed recommendations for OMIs for each core outcome.</p><p><strong>Conclusion: </strong>Core Outcome Set for MYopia clinical trials with Children and young people (COSMYC) provides the first stakeholder-informed COS and OMI recommendations for paediatric myopia intervention trials. Adoption and international ratification of COSMYC may improve consistency, comparability and relevance of future myopia research.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001269","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":"Incidence patterns and genetic validation of primary glaucoma subtypes among 1 million adults in China and the UK.","authors":"Charles Li, Baihan Wang, Robin G Walters, Kelsey V Stuart, Robert N Luben, Benjamin Y Xu, Catherine Q Sun, Flora Lum, Zilun Shao, Xiangyang Zheng, Daniel Avery, Dianjianyi Sun, Canqing Yu, Pei Pei, Jun Lv, Yiping Chen, Ling Yang, Liming Li, Anthony P Khawaja, Zhengming Chen, Derrick A Bennett, Iona Y Millwood, Huaidong Du","doi":"10.1136/bjo-2026-330795","DOIUrl":"https://doi.org/10.1136/bjo-2026-330795","url":null,"abstract":"<p><strong>Background/aims: </strong>Primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) are distinct diseases, yet many glaucoma cases in population-based datasets lack subtype specification. We assessed incidence patterns of glaucoma subtypes in China and the UK and used genetic evidence to infer the likely subtype composition of cases recorded as unspecified glaucoma.</p><p><strong>Methods: </strong>Incident primary glaucoma was identified from linked inpatient records in the prospective China Kadoorie Biobank (CKB; n=512 504) and UK Biobank (UKB; n=492 329) studies. Cohort-specific phenotyping algorithms defined POAG, PACG and unspecified glaucoma. Adjusted incidence rates were estimated by direct standardisation. To support subtype inference, polygenic risk scores (PRSs) were constructed using ancestry-specific genome-wide association studies, including a new East Asian PACG meta-analysis, and tested for association with glaucoma phenotypes using multivariable logistic regression.</p><p><strong>Results: </strong>Over 12 years of follow-up, 1658 primary glaucoma cases were identified in CKB and 7643 in UKB. Most (>68%) cases lacked subtype specification. Incidence increased with age and was twofold higher among women for PACG in both cohorts and for unspecified glaucoma in CKB. In UKB, POAG incidence was fivefold higher among Black than White participants, with a similar but attenuated pattern for unspecified glaucoma. PRS analyses indicated that unspecified glaucoma closely aligned with PACG in CKB but was more heterogeneous in UKB.</p><p><strong>Conclusion: </strong>Healthcare-recorded incidence patterns for POAG and PACG were consistent with established demographic risk factors, whereas unspecified glaucoma showed differences in subtype composition between populations. Integrating epidemiological and genetic evidence improves interpretation of glaucoma phenotypes when detailed clinical information is unavailable.</p>","PeriodicalId":9313,"journal":{"name":"British Journal of Ophthalmology","volume":" ","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148987877","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}