Clinical ophthalmology (Auckland, N.Z.)最新文献

{"title":"Comparison of Surgically Induced Astigmatism After Glaucoma Filtering and Implant Procedures.","authors":"Suguru Shiga","doi":"10.2147/OPTH.S633822","DOIUrl":"https://doi.org/10.2147/OPTH.S633822","url":null,"abstract":"<p><strong>Purpose: </strong>To compare keratometric surgically induced astigmatism (SIA) at 3 months after trabeculectomy (LEC), EX-PRESS shunt (EXP), PRESERFLO MicroShunt (PSM), and Ahmed glaucoma valve (AGV) with ciliary-sulcus tube insertion using vector analysis, and to assess the directionality of SIA.</p><p><strong>Study design: </strong>Single-center, nonrandomized, retrospective comparative study.</p><p><strong>Subjects and methods: </strong>We retrospectively analyzed 100 eyes with glaucoma undergoing LEC (n = 20), EXP (n = 30), PSM (n = 30), or AGV (n = 20) at a single center. Best-corrected visual acuity (BCVA), intraocular pressure (IOP), and keratometric astigmatism were evaluated preoperatively and at 3 months postoperatively. SIA was calculated using the Jaffe vector method. Directional non-uniformity of the SIA axis was assessed using the Rayleigh test after double-angle transformation. Associations between SIA magnitude and postoperative IOP and BCVA were assessed using Spearman's rank correlation. In the LEC group, the association between SIA magnitude and the number of residual scleral-flap sutures was also evaluated.</p><p><strong>Results: </strong>Preoperative and postoperative corneal astigmatism magnitudes did not differ significantly among the four groups. Arithmetic mean individual SIA magnitudes were 1.17 ± 0.80 D in the LEC group, 0.66 ± 0.44 D in the EXP group, 0.65 ± 0.57 D in the PSM group, and 0.58 ± 0.28 D in the AGV group (overall P = 0.035). SIA magnitude was significantly greater after LEC than after EXP, PSM, and AGV (Holm-adjusted P = 0.031, 0.031, and 0.015, respectively), whereas no significant differences were detected among EXP, PSM, and AGV. Significant directional non-uniformity of the SIA axis was detected only in the LEC group, with a circular mean axis of 19.9° (mean resultant length, 0.487; Rayleigh Z = 4.740, P = 0.007), consistent with a with-the-rule-oriented astigmatic change. No significant correlations were detected between SIA magnitude and postoperative IOP or BCVA in any surgical group. In the LEC group, SIA magnitude was not significantly correlated with the number of residual scleral-flap sutures.</p><p><strong>Conclusions: </strong>At 3 months, LEC was associated with greater keratometric SIA than EXP, PSM, and AGV. Significant with-the-rule-oriented directional non-uniformity was detected only after LEC.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"633822"},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13664690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198541","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":"Premium Intraocular Lenses and Their Impact on Visual Field Assessment: A Narrative Review.","authors":"Aini Aniz Izzuani Aridan, Norshamsiah Md Din","doi":"10.2147/OPTH.S585090","DOIUrl":"10.2147/OPTH.S585090","url":null,"abstract":"<p><p>Premium intraocular lens (IOL) such as enhanced monofocal, extended depth-of-focus (EDOF) and multifocal IOL has become increasing popular due to its ability to treat pseudophakic presbyopia and it also offers a spectacle-free lifestyle. However, the difference in light focality between these types of lenses may affect post operative outcomes, such as the worsening of visual field defects. From the existing literature, seven articles were selected for inclusion in this review to determine the effect of these presbyopia-correcting lenses on visual field assessment. Inclusion criteria included articles involving healthy individuals without ocular pathologies and patients diagnosed with glaucoma, all whom had undergone cataract surgery, and had a comparison of visual field outcomes between different types of intraocular lenses such as multifocal, EDOF, enhanced monofocal, and standard monofocal. A key limitation in the available evidence is that most of these studies involved healthy individuals without ocular comorbidities. Only two studies recruited patients diagnosed with glaucoma implanted with an enhanced monofocal lens or a standard monofocal lens. There have been no studies on glaucoma patients implanted with either EDOF or multifocal lenses. In conclusion, EDOF and enhanced monofocal may be viable options for patients with glaucoma seeking spectacle independence after cataract surgery. Multifocal and trifocal lenses should be avoided in this group of patients because of their refractive and diffractive aberration effects on the visual field.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"585090"},"PeriodicalIF":0.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13665671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149198533","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 Clinical and Therapeutic Landscape of Aflibercept Biosimilars (YESAFILI), High-Dose Aflibercept 8 mg (EYLEA HD), and Faricimab (VABYSMO): A Structured Narrative Review.","authors":"Carmen Balian","doi":"10.2147/OPTH.S638646","DOIUrl":"https://doi.org/10.2147/OPTH.S638646","url":null,"abstract":"<p><p>Reference aflibercept 2 mg (EYLEA; Regeneron/Bayer) remains a foundational therapy for neovascular age-related macular degeneration, diabetic macular edema, and macular edema secondary to retinal vein occlusion, supported by high binding affinity for vascular endothelial growth factor (VEGF)-A, VEGF-B, and placental growth factor, along with well-established durability and flexible dosing approaches. The retinal therapeutic landscape is evolving with the introduction of high-dose aflibercept 8 mg (EYLEA HD; Regeneron/Bayer), faricimab (VABYSMO; Roche), and biosimilar aflibercept such as YESAFILI (Biocon Biologics), each representing distinct pharmacologic and clinical strategies. This structured narrative review synthesizes clinical trial and real‑world evidence across these three approaches, with a focus on efficacy, durability, safety, and system-level considerations. A predefined literature search of MEDLINE, Embase, and major ophthalmology conference proceedings was used to identify relevant evidence published from 2015 to 2026. Direct head-to-head evidence among these approaches is limited; therefore, comparisons across separate clinical development programs are descriptive and should be interpreted cautiously. In their respective clinical development programs, high-dose aflibercept and faricimab supported extended dosing intervals with non-inferior visual outcomes relative to standard aflibercept comparators, while biosimilar aflibercept demonstrated clinical equivalence to reference aflibercept with potential economic advantages. Differences remain in long-term real‑world data maturity, safety signal characterization, and implementation considerations. These therapies represent complementary strategies-dose escalation, mechanistic innovation, and molecular equivalence-requiring individualized, evidence-based clinical decision-making in an increasingly complex treatment paradigm.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"638646"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656927/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186902","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":"The Adjunctive Effect of Goniotomy Combined with Phacoemulsification and Goniosynechialysis for Advanced Primary Angle-Closure Glaucoma with 360° Angle Closure: 12-Month Outcomes.","authors":"Yuqiao Zhang, Wenhui Dong, Suwen Zhao, Chunxin Lai, Hongliang Lin, Xiaoyan Liu, Li Zeng, Yuxuan Li, Di Wang, Hongyang Zhang","doi":"10.2147/OPTH.S641105","DOIUrl":"https://doi.org/10.2147/OPTH.S641105","url":null,"abstract":"<p><strong>Purpose: </strong>To compare phacoemulsification with intraocular lens implantation and goniosynechialysis, with or without adjunctive goniotomy, in advanced primary angle-closure glaucoma with complete circumferential angle closure.</p><p><strong>Design: </strong>Retrospective comparative study.</p><p><strong>Methods: </strong>This study included 61 eyes undergoing phacoemulsification and goniosynechialysis without (N=31) or with adjunctive goniotomy (N=30), with at least 12 months of follow-up. A peripheral anterior synechiae of 360° was confirmed by gonioscopy and ultrasound biomicroscopy. The primary outcome was month-12 intraocular pressure (IOP). Longitudinal generalized estimating equations adjusted for baseline IOP, age, sex, and vertical cup-to-disc ratio. Secondary outcomes included medication use, surgical success, postoperative angle status, and complications.</p><p><strong>Results: </strong>At month 12, mean IOP was 16.26 ± 3.03 mmHg in the group without goniotomy and 16.63 ± 3.29 mmHg in the group with goniotomy. The adjusted between-group difference was -0.46 mmHg (95% CI -1.97 to 1.04, P=0.54), below the post hoc exploratory margins of 4, 3, and 2 mmHg. Medication use had no significant difference between groups (P=0.89). Complete and qualified success rates were similar at IOP thresholds of ≤21, ≤18, and ≤15 mmHg combined with at least 20% IOP reduction, with comparable cumulative success rate. Hyphema occurred in 1/31 eyes (3.2%) and 9/30 eyes (30.0%) in groups without and with adjunctive goniotomy (absolute risk difference, 26.8 percentage points, 95% CI, 7.7 to 45.8, P<0.01).</p><p><strong>Conclusions: </strong>In advanced PACG eyes with 360° angle closure, the differences between the 12-month IOP control, surgical success, and medication reduction of the two groups showed no statistically significance. Routine addition of goniotomy may not provide additional benefit.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"641105"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13658439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186850","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":"Long-Term Postoperative Outcomes of Micropulse Transscleral Cyclophotocoagulation (MP-TSCPC) in Patients with Glaucoma.","authors":"Shoichiro Kusuda, Eiki Oshida, Mana Gonmori, Tomoharu Nishimura, Shigeki Machida","doi":"10.2147/OPTH.S635051","DOIUrl":"https://doi.org/10.2147/OPTH.S635051","url":null,"abstract":"<p><strong>Purpose: </strong>To report long-term postoperative outcomes of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in patients with glaucoma.</p><p><strong>Subjects and methods: </strong>This study investigated 50 eyes in 45 patients (mean age: 67.5 ± 13.4 years) who underwent MP-TSCPC and had at least 24 months of postoperative follow-up. Causative diseases were primary open-angle glaucoma (38 eyes), pseudoexfoliation glaucoma (5 eyes), neovascular glaucoma (3 eyes), secondary glaucoma (3 eyes), and ocular hypertension (1 eye). Pre- and postoperative intraocular pressure (IOP), topical and/or oral medication scores, and complications were investigated retrospectively.</p><p><strong>Results: </strong>During the 24-month follow-up, 34 eyes (68%) underwent additional glaucoma intervention because of insufficient IOP control. Kaplan-Meier analysis showed probabilities of remaining free from additional intervention of 58.0% (95% confidence interval [CI], 43.2-70.2%) at 6 months, 48.0% (95% CI, 33.7-60.9%) at 12 months, and 32.0% (95% CI, 19.7-45.0%) at 24 months; the median additional-intervention-free time was 10 months. In the 16 eyes that remained free from additional intervention for 24 months, IOP decreased significantly at 1, 2, and 3 months compared with baseline after Holm correction (P < 0.05 each), but not at 6 months or later. Medication scores did not decrease. Previous glaucoma surgery was more frequent in eyes requiring additional intervention (41.2% vs 12.5%, P = 0.043). Mild or transient mydriasis occurred in 41 eyes (82%) and had resolved in 92% of affected eyes by 6 months.</p><p><strong>Conclusion: </strong>Most eyes required additional glaucoma intervention within 24 months after MP-TSCPC, and the probability of remaining free from additional intervention was 32.0% at 24 months. Among eyes not requiring additional intervention, the early IOP-lowering effect was not sustained beyond 3 months. MP-TSCPC remains a relatively nonincisional treatment option with few serious complications, but patients should be counseled regarding the frequent need for subsequent glaucoma intervention.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"635051"},"PeriodicalIF":0.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13656907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186886","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":"Femtosecond Laser-Assisted Keratoplasty: A Narrative Review of Technological Evolution, Clinical Evidence, Implementation and Future Directions.","authors":"Yifan Du, Shuang Zhang, Ting Yu, Shuo Yang, Cheng Ge, Yong Tao","doi":"10.2147/OPTH.S631668","DOIUrl":"https://doi.org/10.2147/OPTH.S631668","url":null,"abstract":"<p><p>Femtosecond laser-assisted keratoplasty (FLAK) enables programmable photodisruption, customized graft-host configurations, and image-guided corneal reconstruction. This narrative review synthesizes 107 scholarly publications spanning 2003-2026, identified through PubMed/MEDLINE and reference lists, alongside regulatory documentation. It examines mechanisms, technological development, clinical evidence, emerging approaches, and implementation. Evidence is interpreted primarily through final best-corrected visual acuity, graft survival, and reintervention, with incision precision treated as a surrogate. In penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK), femtosecond laser (FSL) assistance may improve wound architecture and selected early outcomes, but durable patient-relevant superiority remains unproven. Randomized endothelial keratoplasty evidence identified poorer visual acuity and greater endothelial loss with early FSL-assisted donor preparation, despite reduced astigmatism. Selected Descemet membrane endothelial keratoplasty (DMEK) and reconstructive applications remain promising but insufficiently validated. Emerging approaches include stromal lenticule repair, additive reconstruction, limbal transplantation, and scaffold preparation. Their evaluation must separate procedural feasibility from comparative effectiveness. Postoperative healing, suture management, complications, and surgical experience can outweigh initial geometric precision. Historical economic evidence disfavors FSL-assisted endothelial graft preparation; contemporary cost-effectiveness remains uncertain. Selective implementation should consider clinical need, local expertise, shared infrastructure, and equitable access. Future evaluation should prioritize long-term patient outcomes, direct economic comparisons, and multicenter validation of lower-energy platforms, real-time imaging, artificial intelligence-assisted planning, and biomechanically informed incision design.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"631668"},"PeriodicalIF":0.0,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149186852","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":"Primary Response to β-Blocker Therapy in Periocular Infantile Hemangioma - A Proposal for Ophthalmological Indicators.","authors":"Hannakaisa Eloranta, Eeva Castrén, Päivi Salminen, Kristiina Kyrklund, Anna Majander","doi":"10.2147/OPTH.S628449","DOIUrl":"https://doi.org/10.2147/OPTH.S628449","url":null,"abstract":"<p><strong>Purpose: </strong>To determine primary ocular response to β-blocker therapy in periocular infantile hemangioma (IH) and to apply defined ophthalmological indicators for the response assessment.</p><p><strong>Patients and methods: </strong>A retrospective study of 85 infants treated for periocular IH with β-blocker between June 2008 and December 2020. IH characteristics, associated ocular features, and implementation of β-blocker therapy were recorded. Ophthalmological treatment indications were reevaluated, and response to treatment was defined as the resolution of indications according to the following categories: 1) anisoastigmatism ≥ 1.0 diopter, 2) progressive eyelid closure, 3) exophthalmos, 4) other ocular defect, 5) prophylaxis, and 6) non-ocular indication.</p><p><strong>Results: </strong>β-blocker therapy was initiated at a median age of 3.0 months (IQR 2.0-5.0) and continued for a median of 9.0 months (IQR 7.0-16.5). Primary ocular response was achieved in 89% (95% CI: 79-95) of the patients. Seven patients were left with ≥ 1.0 diopter residual anisoastigmatism and mean cylinder power 1.50 D (range 1.25-3.00 D), one patient had partial eyelid closure, and three patients inadequate cosmesis despite complete ocular response. In isolated cases, astigmatism enhanced during β-blocker therapy. Repeated treatment periods were administered to 13 (15%) patients. No factors predictive of incomplete response or retreatment could be identified.</p><p><strong>Conclusions: </strong>Ocular complications of periocular IH resolved in most patients during β-blocker therapy. The application of the defined ophthalmological response indicators allowed for simple and consistent outcome assessment. Careful monitoring is essential during and after therapy.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"628449"},"PeriodicalIF":0.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653527/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170348","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":"Safety and Efficacy of the Ahmed ClearPath versus Ahmed ClearPath Small Tube at Six Months: A Retrospective Comparative Cohort Study.","authors":"Kelvin S Y Shi, Emily Aashna Dorairaj, Shibal Bhartiya, Kody Oyama, Weiwei Wang, Ryan Y Thé, Kevin Bryce Moreno, Melanie Wang, Caleb Towne, Ibrahim M Qozat, Raphael G Banoub, Syril K Dorairaj","doi":"10.2147/OPTH.S634975","DOIUrl":"https://doi.org/10.2147/OPTH.S634975","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the safety and efficacy of the Ahmed ClearPath® (ACP) and Ahmed ClearPath® Small Tube (ACP-ST) in the management of glaucoma.</p><p><strong>Methods: </strong>This retrospective comparative study included 15 ACP eyes and 15 ACP-ST eyes. Outcomes compared through 6 months included intraoperative pressure (IOP), medication burden, surgical success, BCVA, and complications. Complete surgical success was definied as a ≥ 20% reduction in IOP from baseline with postoperative IOP > 5 mmHg and no additional glaucoma surgery or medication.</p><p><strong>Results: </strong>Baseline IOP and medication were similar between cohorts. At 6 months, mean IOP decreased from 28.13 ± 7.68 to 10.73 ± 3.63 mmHg in the ACP cohort (p < 0.0001) and from 27.15 ± 6.72 to 12.00 ± 5.32 mmHg in the ACP-ST cohort (p = 0.0001), with no significant difference between groups (p = 0.4535). Mean medication use decreased from 2.93 ± 0.80 to 0.73 ± 1.03 in the ACP cohort (p = 0.0005) and from 3.47 ± 1.46 to 1.00 ± 1.00 in the ACP-ST cohort (p < 0.0001), with no significant difference between groups (p = 0.4785). No intraoperative complications, postoperative hypotony, or IOP spikes occurred in either cohort.</p><p><strong>Conclusions: </strong>Preliminary findings suggest that the ACP-ST may achieve IOP and medication reductions comparable to the ACP through 6 months. No postoperative hypotony was observed in the ACP-ST cohort despite the absence of tube ligation. However, given the sample size and differences in surgical technique, larger prospective controlled studies are needed to determine whether the smaller lumen independently contributes to flow control.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"634975"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169212","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":"Clinical Outcomes of Orbital Fat Decompression in Pediatric Thyroid Eye Disease: A Two-Center Retrospective Study.","authors":"Ayaka Kizaki, Tomoyuki Kashima","doi":"10.2147/OPTH.S637025","DOIUrl":"https://doi.org/10.2147/OPTH.S637025","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the clinical outcomes and safety of orbital fat decompression in pediatric patients with thyroid eye disease (TED).</p><p><strong>Patients and methods: </strong>This retrospective two-center study included pediatric patients (≤17 years; achieved age range 12-17 years) with inactive, non-sight-threatening TED (Clinical Activity Score 0-1) who underwent orbital fat decompression between June 2017 and February 2025 at two centers in Japan. Patients with follow-up <3 months, prior orbital decompression, or additional eyelid surgery within 3 months were excluded. Outcomes assessed included Hertel exophthalmometry, lower scleral show, diplopia, and postoperative complications.</p><p><strong>Results: </strong>Twenty patients (39 eyes) were included. Mean proptosis was significantly reduced after surgery (p < 0.001), with a combined mean reduction of 2.36 mm (95% CI 1.97-2.75 mm; right eye 2.30 mm, left eye 2.39 mm). Lower scleral show improved in 84.2% of patients, with complete resolution in 63.2%; outcomes were similar after excluding three patients who underwent concomitant lower eyelid fat grafting. Subjectively perceived diplopia was documented in 5 patients (25%) on postoperative day 1 and persisted at 1 month in 2 patients (10%); all cases resolved by final follow-up with no persistent or de novo symptomatic diplopia. Mydriasis occurred in 4 patients (20%), resolving completely in 3, with mild asymptomatic residual pupillary asymmetry in 1 patient at final follow-up. No vision-threatening complications, visual acuity loss, infections, or wound-related complications occurred.</p><p><strong>Conclusion: </strong>Orbital fat decompression via a sutureless transconjunctival approach achieved clinically meaningful and statistically significant improvement in proptosis and lower eyelid position in pediatric TED, with generally self-limiting complications and no vision-threatening adverse events, although mild asymptomatic pupillary asymmetry persisted in one patient at final follow-up. These findings support orbital fat decompression as a viable surgical option in pediatric patients, although they should be confirmed in larger, prospective, multicenter studies with longer follow-up.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"637025"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168812","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":"Development and Clinical Evaluation of an Anterior Chamber Angle-Based Lens Sizing Method for Implantable Collamer Lens Surgery.","authors":"Tomoya Nishida, Yukihito Kato, Yukihiro Sakai, Rie Horai, Satoshi Gotoda, Sho Ichikawa, Kei Ichikawa, Kazuo Ichikawa","doi":"10.2147/OPTH.S646865","DOIUrl":"https://doi.org/10.2147/OPTH.S646865","url":null,"abstract":"<p><strong>Purpose: </strong>To derive a regression formula estimating an individualized postoperative vault threshold associated with narrow-angle status from preoperative angle measurements and to evaluate an implantable collamer lens (ICL) sizing approach incorporating this formula.</p><p><strong>Patients and methods: </strong>This retrospective study included a formula-derivation cohort of 97 eyes treated from April 2024 to March 2025 and a CEC-implementation cohort of 162 eyes treated from April 2025 to March 2026. The 360° angle opening distance at 500 μm (AOD500) was measured by anterior segment optical coherence tomography (AS-OCT; CASIA2, TOMEY). Postoperative angle status was classified by the device's Narrow Angle Index (NAI) software. Eyes open in all 32 radial directions formed the open group; those narrow or closed in at least one direction formed the narrow group. A threshold formula was derived from the relationship between preoperative AOD500 and postoperative vault among the 29 narrow-group eyes of the derivation cohort. In the CEC-implementation cohort, the formula's discrimination of postoperative angle status was assessed, and its association with postoperative narrow-angle classification was examined using multivariable logistic regression with generalized estimating equations. The threshold formula was used alongside the KS and NK formulas and a previously reported equation for predicting postoperative trabecular-iris angle (post-TIA) to select a lens size with a predicted vault below the calculated threshold.</p><p><strong>Results: </strong>The derived formula was as follows: threshold (mm) = 0.9091 × preoperative AOD500 (mm) - 0.0493. In the CEC-implementation cohort, the formula yielded a sensitivity of 73.7% (14/19 eyes), specificity of 94.4% (135/143 eyes), and area under the receiver operating characteristic curve of 0.922 (95% confidence interval, 0.857-0.972; P < 0.001). In the multivariable analysis, use of the threshold formula was associated with lower odds of postoperative narrow-angle classification (odds ratio, 0.311; 95% confidence interval, 0.138-0.704; P = 0.005).</p><p><strong>Conclusion: </strong>An ICL sizing approach incorporating a preoperative angle-based threshold formula (the CEC method) was associated with a lower frequency of postoperative narrow-angle classification and warrants further prospective validation.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"646865"},"PeriodicalIF":0.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13653528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171752","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}