Archivos de la Sociedad Espanola de Oftalmologia最新文献

{"title":"Vitamins and Supplementation in Dry Eye Disease: Current Evidence and Clinical Implications according to the TFOS Lifestyle Report: Nutrition: Vitaminas y suplementación en la enfermedad del ojo seco: evidencia actual e implicaciones clínicas según el informe TFOS Lifestyle: Nutrición.","authors":"M S Gasparini, M C C Marini, A E Grau, B Liviero, F L Saá, G Kohn, I Ormazábal, M Alves","doi":"10.1016/j.oftale.2026.502678","DOIUrl":"https://doi.org/10.1016/j.oftale.2026.502678","url":null,"abstract":"<p><p>Dry eye disease (DED) is a chronic, multifactorial inflammatory disorder characterized by tear film instability, epithelial damage, and neurosensory abnormalities that compromise ocular surface (OS) homeostasis. Oxidative stress, immune dysregulation and metabolic imbalance contribute to epithelial damage and inflammation. Emerging evidence highlights nutrition as a modifiable adjunctive factor in DED management. This review examines the biological rationale and clinical evidence supporting the role of vitamins A, B12, C, D, and E, as well as polyunsaturated fatty acids, in OS health. Mainly, vitamin A maintains epithelial differentiation and mucin expression; vitamin B12 supports corneal nerve integrity; vitamins C and E mitigate oxidative stress; vitamin D and omega-3 fatty acids modulate inflammatory pathways. Although supplementation may benefit selected patients, clinical findings remain heterogeneous. Nutritional strategies should therefore be considered complementary, rather than primary, interventions in comprehensive DED management.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502678"},"PeriodicalIF":0.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conjunctival involvement with corneal extension in pediatric mycosis fungoides. Surgical and immunomodulatory management.","authors":"Alicia Cárceles Montoya, Claudia P Tarazona Jaimes, Daniel Romero Valero","doi":"10.1016/j.oftale.2026.502668","DOIUrl":"https://doi.org/10.1016/j.oftale.2026.502668","url":null,"abstract":"<p><p>A 13-year-old boy with mycosis fungoides (MF) presented with uncommon ophthalmic involvement. Clinical examination revealed a vascularized conjunctival nodule with corneal extension involving the visual axis and causing severe visual impairment. Initial treatment with topical corticosteroids and tacrolimus showed poor response. Complete surgical excision was performed for diagnostic and therapeutic purposes. Histopathological analysis confirmed progression to T-cell lymphoma. Adjuvant treatment with topical interferon alfa-2b was initiated. After two years of follow-up, no recurrence was observed, with partial visual improvement. This case highlights a rare pediatric presentation and central corneal involvement, both infrequently described. Combined surgical and immunomodulatory treatment achieved adequate local control, although residual sequelae limiting visual acuity persisted.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502668"},"PeriodicalIF":0.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dysfunctional Lens Syndrome: Molecular, Biomechanical, Optical and Clinical Aspects of Crystalline Lens Aging.","authors":"I Janicijevic, D Teren, J L Alió","doi":"10.1016/j.oftale.2026.502679","DOIUrl":"https://doi.org/10.1016/j.oftale.2026.502679","url":null,"abstract":"<p><strong>Introduction: </strong>Dysfunctional Lens Syndrome (DLS) represents a progressive age-related decline in the optical and functional performance of the crystalline lens. Although cataract remains the most clinically recognizable endpoint of lens aging, important visual changes often occur much earlier, including presbyopia, increased higher-order aberrations (HOAs), intraocular scatter, reduced contrast sensitivity and deterioration of retinal image quality. These changes reflect progressive molecular, biomechanical and optical alterations within the aging crystalline lens in different stages.</p><p><strong>Materials and methods: </strong>This narrative review was based on a literature search on PubMed and reference list of relevant review articles, clinical studies and book chapters published during the last 25 years, using terms related to DLS, crystalline lens, lens aging, lens biomechanics, presbyopia, HOAs, dysfunctional lens index and refractive lens exchange. Articles were selected according to their relevance and provided evidence to the molecular, biomechanical, optical, clinical and therapeutic aspects of lens aging.</p><p><strong>Results: </strong>Available evidence indicates that lens aging begins before clinically significant cataract becomes evident. Molecular changes in long lived crystallins, impaired redox homeostasis, altered ion-water balance and membrane remodeling contribute to increased lens density, reduced transparency and protein aggregation. These changes are accompanied by progressive lens growth, nuclear stiffening, loss of accommodation, alteration of the gradient refractive index, HOAs, intraocular scatter and reduced contrast sensitivity.</p><p><strong>Conclusion: </strong>Recognition of DLS may improve the assessment of patients with preserved visual acuity but impaired quality of vision. A broader evaluation of crystalline lens function may support more individualized decision-making in presbyopia management, cataract surgery and lens-based refractive procedures. An integrated perspective for the management of DLS in its different stages is proposed as a guidance for the practical ophthalmologist.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502679"},"PeriodicalIF":0.0,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WEBINO Syndrome Secondary to Multiple Sclerosis Treated Surgically.","authors":"Nuria Cintas, Estel la Rojas-Pineda, Idoia Rodríguez-Maiztegui","doi":"10.1016/j.oftale.2026.502611","DOIUrl":"https://doi.org/10.1016/j.oftale.2026.502611","url":null,"abstract":"<p><p>WEBINO syndrome (wall-eyed bilateral internuclear ophthalmoplegia) is a rare neuro-ophthalmological disorder characterized by bilateral adduction deficit, abducting nystagmus, large-angle exotropia in the primary gaze position, and impaired convergence, secondary to bilateral lesion of the medial longitudinal fasciculus. We report the case of a 35-year-old woman with multiple sclerosis who consulted for persistent horizontal binocular diplopia. Examination revealed alternating exotropia of 50 prism diopters with bilateral adduction limitation, abducting nystagmus, and absence of convergence, consistent with WEBINO syndrome. After one year of clinical stability without improvement in deviation, strabismus surgery was performed, consisting of bilateral lateral rectus recession and bilateral medial rectus resection. Postoperatively, functional orthotropia was achieved, with resolution of diplopia and improvement in both adduction and convergence. Strabismus surgery represents an effective therapeutic option in selected patients with stable deviation and disabling diplopia.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502611"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optic disc drusen as a diagnostic confounder in a child with Alice in Wonderland syndrome.","authors":"Marta Moro-Muñiz, Antonio Rodríguez-Ballesteros, David Salom Alonso","doi":"10.1016/j.oftale.2026.502656","DOIUrl":"https://doi.org/10.1016/j.oftale.2026.502656","url":null,"abstract":"<p><p>We report the case of a 10-year-old boy referred for transient visual episodes compatible with Alice in Wonderland syndrome, described as a sensation that objects were moving away. Ophthalmic examination showed preserved visual acuity and an unremarkable anterior segment, but revealed elevation of the left optic disc, prompting evaluation for true papilledema. Macular OCT was normal, whereas optic nerve head OCT demonstrated structural asymmetry consistent with pseudopapilledema. Brain and orbital MRI showed isolated enlargement of both optic nerve sheaths and mild elevation of the left optic disc, without additional findings suggestive of intracranial hypertension. Orbital ultrasonography identified a hyperechogenic focus suggestive of optic disc drusen. The stable clinical and structural course supported the diagnosis of unilateral pseudopapilledema due to optic disc drusen, probably unrelated to the perceptual symptoms.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502656"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Orbital Apex Syndrome Associated with Peripheral T-Cell Lymphoma and Uterine Leiomyosarcoma: A Report of Synchronous Primary Tumors.","authors":"A Ortiz, J Alvarez, V Gavín","doi":"10.1016/j.oftale.2026.502658","DOIUrl":"https://doi.org/10.1016/j.oftale.2026.502658","url":null,"abstract":"<p><p>Orbital apex syndrome is an uncommon neuro-ophthalmologic entity caused by lesions affecting the orbital apex and associated with inflammatory, infectious, vascular, and neoplastic processes. Synchronous tumors represent an exceptional condition defined by the simultaneous coexistence of neoplasms with different histological origins. We present the case of a 45-year-old woman with progressive visual acuity loss, painful ophthalmoplegia, facial hypoesthesia, and a right relative afferent pupillary defect, associated with an oropharyngeal lesion, nasal obstruction, dysphagia, and dysphonia. Histopathological analysis confirmed peripheral T-cell lymphoma. Concurrently, the patient developed persistent metrorrhagia, hypogastric pain, and mucopurulent vaginal discharge; cervical biopsy demonstrated a mesenchymal neoplasm compatible with leiomyosarcoma. Following multidisciplinary management, the patient showed favorable clinical evolution with partial visual recovery. This case highlights the importance of early recognition of orbital apex syndrome as a manifestation of aggressive neoplasms and underscores the value of a comprehensive multidisciplinary approach in complex oncologic scenarios.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502658"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advances in precision medicine for the anterior segment: therapeutic applications using CRISPR-Cas9.","authors":"J A León Agudelo, D F León Agudelo, M C Martínez Morales, V V Vásquez Villamil, J D Pacheco Ricardo, M P Enríquez Medina","doi":"10.1016/j.oftale.2026.502657","DOIUrl":"10.1016/j.oftale.2026.502657","url":null,"abstract":"<p><p>CRISPR-Cas9 gene editing has emerged as one of the most promising strategies in precision medicine applied to ophthalmology. Although its initial development focused on inherited retinal diseases, recent advances have increasingly targeted anterior segment disorders, including herpetic keratitis, hereditary corneal dystrophies, and genetically associated glaucoma. The ability to modify specific DNA or RNA sequences enables direct intervention in molecular pathways involved in inflammatory, degenerative, and infectious disease progression. This review summarizes the biological basis of CRISPR-Cas systems and discusses the main preclinical and translational findings related to corneal and glaucomatous diseases. Current limitations, including off-target effects, immunogenicity, and challenges associated with molecular delivery into ocular tissues, are also addressed. Available evidence suggests that CRISPR-Cas9 may significantly transform the future management of multiple anterior segment diseases.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502657"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimized intraocular lens power calculation in refractive lens exchange.","authors":"D Romero, J L Alió","doi":"10.1016/j.oftale.2026.502644","DOIUrl":"10.1016/j.oftale.2026.502644","url":null,"abstract":"<p><p>This review aims to evaluate the factors affecting the accuracy of intraocular lens (IOL) power calculation and the strategies to optimize refractive predictability in eyes with atypical anatomy, prior refractive surgery, or phakic intraocular lenses. A narrative review of studies was conducted using PubMed, Scopus, and Web of Science up to March 2026, following PRISMA methodology. Articles were independently screened and reviewed by two authors. Studies on IOL calculation in normal and non-standard eyes, post-corneal refractive surgery, phakic IOLs, and refractive lens exchange were included. In axial myopia, new-generation formulas or third-generation formulas with Wang-Koch adjustment can compensate for the historical tendency toward hyperopic errors in these eyes. In short eyes, new-generation formulas outperform third-generation formulas, particularly in cases with shallow anterior chambers. The use of toric IOL calculators that adjust implant toricity at the corneal plane based on the effective lens position and account for posterior corneal astigmatism appears to improve outcomes. In eyes with high or non-vertical posterior corneal astigmatism, it may be beneficial to use IOL calculation methods that consider the effect of implant position. After myopic refractive surgery, the ASCRS calculator average or post-refractive versions of modern formulas may be valid options. In patients with phakic IOLs, it is recommended to ensure correct crystalline lens identification or to use formulas that do not rely on anterior chamber depth if measurement errors are significant. In conclusion, refractive predictability depends on ocular anatomy, prior surgery, and IOL characteristics. New-generation formulas generally outperform third-generation formulas in non-standard eyes, although the optimal choice varies by cohort. Selecting an appropriate calculation formula and carefully verifying biometric data are essential to improving refractive accuracy in refractive lens exchange.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502644"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual deep anterior lamellar keratoplasty alone or combined with lens surgery in patients with radial keratotomy.","authors":"B Alfonso-Bartolozzi, L Fernández-Vega-Cueto, I A Fernández-Vega, N Besteiro-Suárez, R Alvarado-Villacorta, D Madrid-Costa, J F Alfonso","doi":"10.1016/j.oftale.2026.502698","DOIUrl":"10.1016/j.oftale.2026.502698","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>This study aims to report the clinical outcomes of the manual deep anterior lamellar keratoplasty (M-DALK) performed alone or combined with lens surgery in post-radial keratotomy (post-RK) patients.</p><p><strong>Patients and methods: </strong>This retrospective study included post-RK eyes that underwent M-DALK alone or combined with lens surgery. Corrected visual acuity (AVCC), manifest refraction, and intra- and postoperative complications were recorded.</p><p><strong>Results: </strong>The study included 20 eyes, twelve eyes underwent M-DALK alone, and eight eyes combined with lens surgery. In two eyes in each group, a micro-perforation of the Descemet Membrane occurred during dissection, which did not prevent DALK completion and was successfully managed. 7 in the M-DALK alone and 4 in the M-DALK combined with lens surgery experienced RK incision dehiscence during the host corneal trephination or donor graft suturing, uneventfully solved by additional sutures. No cases required conversion to PKP. No postoperative complications were recorded during the follow-up. The mean postoperative AVCC was 0.23 ± 0.12 logMAR in the M-DALK alone group and 0.26 ± 0.9 logMAR in the M-DALK combined with lens surgery group (P = 0.3). The mean refractive sphere in the M-DALK alone group was -5.02 ± 3.52 D and -0.06 ± 1.18 D in the M-DALK combined with lens surgery (P < 0.0001). The postoperative refractive cylinder was -4.71 ± 2.54 D in the M-DALK alone group and -3.84 ± 1.67 D in the M-DALK combined with lens surgery group (P = 0.2).</p><p><strong>Conclusion: </strong>Our results suggest that M-DALK surgery alone or combined with lens surgery provides a good balance between visual rehabilitation and safety, minimizing potential surgical-related complications in post-RK patients.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502698"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications of refractive lens exchange.","authors":"R S Medalle, A Salmoral Lorenzo-Arroyo, J L Alió Del Barrio","doi":"10.1016/j.oftale.2026.502690","DOIUrl":"10.1016/j.oftale.2026.502690","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Refractive lens exchange (RLE) has become an established option for the correction of refractive errors and presbyopia in appropriately selected patients. However, because the procedure involves removal of a clear crystalline lens, its potential complications and the appropriate limits of its indication require careful consideration. The objective of this review was to summarize the principal complications associated with RLE, with emphasis on their incidence, risk factors, prevention, and management.</p><p><strong>Materials and methods: </strong>Narrative review of the current literature on complications associated with refractive lens exchange.</p><p><strong>Results: </strong>RLE is generally safe and predictable in appropriately selected patients, but complications remain clinically relevant. Principal adverse outcomes include refractive surprise, multifocal IOL-related dysphotopsias and neuroadaptation failure, retinal detachment, cystoid macular edema, posterior capsule opacification, and other IOL-related complications. Their incidence varies according to patient characteristics, IOL type, and duration of follow-up. Retinal detachment represents the most serious vision-threatening complication, particularly in younger and highly myopic patients. Careful preoperative assessment, individualized IOL selection, and systematic evaluation of postoperative complaints are essential to minimize complications and improve patient satisfaction.</p><p><strong>Conclusions: </strong>Safe application of RLE depends on individualized patient selection, comprehensive preoperative assessment, appropriate IOL selection, and realistic patient counselling. Because RLE involves the irreversible removal of a clear crystalline lens, its risks, benefits, alternatives, and ethical boundaries should be carefully considered before surgery.</p>","PeriodicalId":93886,"journal":{"name":"Archivos de la Sociedad Espanola de Oftalmologia","volume":" ","pages":"502690"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}