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

{"title":"Visual, Refractive, and Patient-Reported Outcomes Following Bilateral Implantation of an Enhanced Monofocal IOL: An Exploratory Comparison of Achieved Mini-Monovision and Bilateral Emmetropia.","authors":"Jai G Parekh, Christopher M Spearman, J Morgan Micheletti, Inder Paul Singh, Nisha Kumar, Eric Mann, Karolinne Maia Rocha, Eric Donnenfeld","doi":"10.2147/OPTH.S632198","DOIUrl":"https://doi.org/10.2147/OPTH.S632198","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical and patient-reported outcomes following bilateral implantation of partial-depth-of-field enhanced monofocal IOL in subjects achieving bilateral emmetropia vs mini-monovision.</p><p><strong>Patients and methods: </strong>This prospective, non-interventional, multicenter, cross-sectional study included subjects who had undergone cataract surgery and implantation of enVista Aspire IOL. For the post hoc analysis, patients were classified into bilateral emmetropia (BE) or mini-monovision (MM) based on achieved postoperative manifest refraction. Postoperative assessments included visual outcomes, manifest refraction, defocus curve, contrast sensitivity function, and patient-reported outcomes of questionnaires (AIOLIS and NAVQ).</p><p><strong>Results: </strong>In the BE group (N = 49), the mean MRSE in the first and the second operated eye was -0.18 ± 0.26 D and -0.11 ± 0.26 D, respectively, and the mean UDVA was 0.07 ± 0.11 logMAR and 0.05 ± 0.12 logMAR, respectively. Mean UIVA in the first- and second-operated eyes of the BE group was ~0.23 logMAR, and mean UNVA was ~0.46 logMAR. In the MM group (N = 21), with the mean MRSE of -0.33 ± 0.17 D, the mean UDVA in the distance eye was 0.11 ± 0.12 logMAR. With a mean MRSE of -0.96 ± 0.34 D, mean UIVA and UNVA of the intermediate eye were 0.13 ± 0.09 logMAR and 0.29 ± 0.16 logMAR, respectively. The defocus curve showed 0.2 logMAR or better visual acuity up to a myopic defocus of ~-1.25 D. A higher proportion (~14 to 31%) of subjects in the MM group reported \"no or little difficulty\" with various intermediate- to near-vision-related tasks. The frequency and bothersomeness of visual symptoms were similar between the two groups. A total of 85.7% of subjects in the MM group were \"completely to very satisfied\" with their overall postoperative vision compared to the BE group (77.6%).</p><p><strong>Conclusion: </strong>The MM group demonstrated improved intermediate and near visual performance and favorable patient-reported outcomes.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"632198"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120409","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":"Association of Treatment Decentration with Early Outcomes Following SMILE Pro: A Secondary Analysis.","authors":"Di Wang, Xinyi Gu, Ruoyan Wei, Lin Wang, Meiyan Li","doi":"10.2147/OPTH.S631502","DOIUrl":"https://doi.org/10.2147/OPTH.S631502","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the association of system-recorded treatment decentration with 3-month visual, refractive, and higher-order aberration (HOA) outcomes after SMILE Pro (VisuMax 800 femtosecond laser).</p><p><strong>Patients and methods: </strong>This secondary exploratory analysis of prospectively collected data included 186 eyes of 94 consecutive patients. Treatment decentration-the system-recorded scalar distance between the corneal vertex and the achieved lenticule center-was categorized as <0.10 mm (n = 94), 0.10-0.20 mm (n = 73), or ≥0.20 mm (n = 19). Primary outcomes were 3-month uncorrected distance visual acuity (UDVA), residual spherical equivalent (SE), and anterior corneal wavefront HOA (6-mm pupil) with its change from baseline (ΔHOA). Generalized estimating equations (GEE) clustered by patient constituted the primary analysis; rank-based tests were secondary.</p><p><strong>Results: </strong>Median decentration was 0.098 mm (IQR 0.067-0.150 mm; maximum 0.345 mm). At 3 months, 98.4% of eyes achieved UDVA ≥20/20, 96.2% were within ±0.50 D of target, and no eye lost corrected distance visual acuity. UDVA, residual SE, and postoperative HOA were not significantly associated with decentration group (all GEE Wald P > 0.26). ΔHOA was greater in the 0.10-0.20 mm group than in the <0.10 mm group (GEE β = +0.048 μm, 95% CI 0.013-0.082, P = 0.007), whereas rank-based tests were marginal (Kruskal-Wallis P = 0.065), the ≥0.20 mm group did not differ, and the continuous Spearman correlation was not significant (ρ = 0.116, P = 0.114).</p><p><strong>Conclusion: </strong>Within the narrow decentration range achieved with CentraLign-guided SMILE Pro, decentration magnitude was not associated with 3-month visual or refractive outcomes. Smaller higher-order aberration induction was associated with decentration below 0.10 mm than with decentration of 0.10 to <0.20 mm; this association was not observed in the ≥0.20 mm stratum.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"631502"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120195","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":"Large Language Model-Generated Patient Education Materials in Pediatric Ophthalmology: A Scoping Review.","authors":"Abdullahi Abdiaziz Mohamed, Thomas Scott/S Armstrong, Ojas Srivastava, Edsel Ing, Travis Pollock, Carlos Solarte","doi":"10.2147/OPTH.S635998","DOIUrl":"https://doi.org/10.2147/OPTH.S635998","url":null,"abstract":"<p><p>Effective management of pediatric ophthalmic conditions such as myopia, amblyopia, and strabismus depend on caregivers understanding patient education materials (PEMs). However, many existing resources exceed recommended grade 8 reading levels. This review maps AI-generated PEMs in pediatric ophthalmology, summarizes reported outcomes across key educational domains, and identifies barriers and opportunities for clinical integration. Following PRISMA-ScR guidelines, a search of Ovid MEDLINE, Embase, and Scopus (January 2015-July 2025) identified studies evaluating LLM-generated PEMs in pediatric ophthalmology. Eligible studies evaluated artificial intelligence for pediatric ophthalmology patient education and reported at least one educational outcome. Data were extracted independently by two reviewers and synthesized descriptively. Twenty studies (2023-2025) evaluated 3286 AI-generated materials across 14 LLMs. Readability was assessed in 17 studies; 59% (37/63) of study-level LLM evaluations exceeded recommended 8th-grade reading levels. ChatGPT-4o evaluations were more often acceptable (52%) than ChatGPT-3.5 evaluations (18%), although these were not head-to-head comparisons. Median understandability (PEMAT-U) exceeded adequacy thresholds (≥70%). Professional society materials were more accurate and higher quality but significantly less readable. No included study explicitly classified outputs as hallucinations under its applied assessment framework; however, incomplete treatment-related content was common. Only two studies assessed patient or caregiver perspectives. LLM-generated PEMs in pediatric ophthalmology are generally understandable and accessible but often exceed readability standards and lack actionable guidance. While professional society materials remain more accurate, LLMs offer scalable tools for generating patient-centered resources. Integrating LLMs into clinician-supervised workflows and emphasizing co-designed, multimodal education strategies may enhance accessibility and clinical safety.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"635998"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120270","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":"A Modified Needle Technique for Enlarging a Small Capsulorhexis Under the Main Incision.","authors":"Xin Liu, Jing Lu, Anpeng Pan, Lingying Ye, He Xie, Fang Yu, Xianhui Gong","doi":"10.2147/OPTH.S621546","DOIUrl":"https://doi.org/10.2147/OPTH.S621546","url":null,"abstract":"<p><strong>Purpose: </strong>To describe and evaluate a modified technique for safely enlarging a small continuous curvilinear capsulorhexis (CCC) during cataract surgery, particularly when the margin of the small CCC lies beneath the main incision, where conventional capsule scissors are difficult or impossible to use.</p><p><strong>Methods: </strong>We describe a bimanual technique in which a manually bent 27-gauge needle is used to create a controlled capsular flap while the capsulorhexis forceps simultaneously stabilize the anterior capsule, facilitating safe and controlled enlargement of a small primary CCC. The technique can be performed at various surgical stages after sufficient viscoelastic has been injected to flatten the anterior capsule. This procedure was applied in eyes requiring CCC enlargement. Clinical outcomes, including capsulorhexis diameters before and after enlargement (measured using image analysis software) and the occurrence of using complications (eg radial tears, zonular damage), were retrospectively analyzed.</p><p><strong>Results: </strong>Between April and November 2025, a total of 1860 cataract surgeries were performed, of which 39 eyes (2.09%) required CCC enlargement. In 20 of these cases, the modified needle technique was employed, primarily for CCCs under the main incision. Enlargement was successful in all 20 cases, with the mean CCC diameter increasing from 4.34 ± 0.44 mm preoperatively to 5.07 ± 0.28 mm post-enlargement. No intraoperative complications such as radial capsular extension or zonular dialysis occurred. During follow-up, no late complications, such as capsular phimosis or intraocular lens decentration, were observed.</p><p><strong>Conclusion: </strong>The described 27‑gauge needle technique appears to be a feasible, safe, and accessible method for enlarging a small CCC in selected cases. It is particularly useful for managing small capsulorhexes situated under the main incision, where conventional instruments have limited access.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"621546"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120207","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":"US Patients' Preferences for Geographic Atrophy Treatment.","authors":"Bennett Levitan, Anthony M Pepio, Seema Garg, Nguyet Tran, Nicolas Krucien, Karl Csaky, Megan Aragon, Ilan Irony, Adrianna Montague, Jennifer A Whitty, Caitlin Thomas","doi":"10.2147/OPTH.S642703","DOIUrl":"https://doi.org/10.2147/OPTH.S642703","url":null,"abstract":"<p><strong>Purpose: </strong>Two complement inhibitors are currently used for treating geographic atrophy (GA) secondary to age-related macular degeneration (AMD) and other treatments are in development. We surveyed people with GA to better understand how efficacy, risks, and intravitreal injection frequency impact their treatment preferences.</p><p><strong>Methods: </strong>We used a mixed-methods approach (including qualitative research, pretesting interviews, and clinical expert and patient input) to design an online preference elicitation survey accessible to people with visual impairment. Preferences of US-based adults with GA were elicited with multi-dimensional thresholding. Participants ranked the included treatment characteristics and completed four sets of trade-off exercises (with two to three questions per exercise) containing two characteristics per question. The relative importance of treatment characteristics and participants' willingness to trade-off between characteristics were evaluated.</p><p><strong>Results: </strong>Participants (N=77; mean age 69.3 years; 32.5% GA treatment-experienced) often preferred treatment over no treatment, ranging from 57% preferring treatment for the \"worst\" assessed treatment to 99% for the \"best\" assessed. Participants' decisions were most influenced by extending the time until they were unable to read (relative importance: 32%) or time to see half as far (27%), followed by injection frequency (16%) and reducing risks of developing wet AMD (14%) and eye inflammation (12%). Most participants (86%) preferred a one-time intravitreal injection (vs every other month or every month). Within an 18-month time treatment timeframe, on average, participants were willing to accept higher risks for increased efficacy (eg a 35% higher risk of eye inflammation or 29% higher risk of wet AMD for a treatment that increases efficacy from 1 to 4 years longer to read and to see half as far). All else equal, participants were willing to accept higher risks for a one-time injection over monthly injections (eg 14% higher risk of eye inflammation or 12% higher risk of wet AMD).</p><p><strong>Conclusions: </strong>Most participants preferred the \"worst\" treatment profile over no treatment, highlighting a potential unmet need for GA treatment. Treatment choices were most influenced by efficacy, particularly prolonging the time until they are unable to read. Participants were willing to tolerate significantly higher risks for their preferred injection frequency. Shared treatment decision-making is encouraged to ensure alignment with patients' individual preferences.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"642703"},"PeriodicalIF":0.0,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13634314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120358","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":"Epidemiology and Associated Ocular Conditions of Visual Impairment in the United States: A Decade of Data from TriNetX US Network.","authors":"Wenwen Gong, Fatma F Shakarchi, Ayorinde Cooley, Marina Zakhary Gad El Sayed, Ibrahim Abboud, Zahra Shakarchi, Christopher L Shelby, Wyche T Coleman Iii, Stephen A LoBue","doi":"10.2147/OPTH.S633951","DOIUrl":"https://doi.org/10.2147/OPTH.S633951","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the demographic profile, within-cohort prevalence of associated ocular conditions, and trends in the incidence and prevalence of visual impairment in the United States using a large, real-world clinical database.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study utilizing the TriNetX US Collaborative Network. Patients with visual impairment and associated ocular conditions potentially contributing to visual impairment were identified using ICD-10 codes between January 1, 2014 and January 1, 2026. Demographic characteristics, within-cohort prevalence of associated ocular conditions, and annual incidence and prevalence within the network were analyzed.</p><p><strong>Results: </strong>A total of 805,428 patients with visual impairment were identified. The mean current age was 55.3 ± 26.0 years, with slightly more females (52.93%). Most patients were White (61.68%), followed by Black or African American (20.92%) and Hispanic or Latino (11.54%). Cataract (18.5%), glaucoma (13.9%), age-related macular degeneration (9.7%), and diabetic retinopathy (6.6%) were the most frequently observed associated ocular conditions in our cohort. Between 2014 and 2025, the annual incidence of visual impairment increased significantly from 124.56 to 212.69 per 100,000 persons (P < 0.001). Prevalence increased from 471.56 to 1433.70 per 100,000 persons (P < 0.001).</p><p><strong>Conclusion: </strong>Visual impairment affected a broad demographic spectrum, with cataract, glaucoma, age-related macular degeneration, and diabetic retinopathy being the leading associated ocular conditions. Network-based incidence and prevalence increased over the decade, reflecting both true epidemiologic trends and network expansion. These findings highlight the importance of targeted screening, early detection, and timely treatment, particularly among high-risk and underserved populations.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"633951"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120230","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 Blooming Effect: A Potential Source of Variability in OCT-Derived Choroidal Vascularity Measurements [Letter].","authors":"Chiara Busillo, Pasquale Alfano","doi":"10.2147/OPTH.S657815","DOIUrl":"https://doi.org/10.2147/OPTH.S657815","url":null,"abstract":"","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"657815"},"PeriodicalIF":0.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120316","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 Spectrum of Neuro-Ophthalmic Disorders at a Thai Tertiary Referral Center: An 11-Year Retrospective Study.","authors":"Worapot Srimanan, Sunita Sawangsribanterng","doi":"10.2147/OPTH.S641990","DOIUrl":"https://doi.org/10.2147/OPTH.S641990","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the diagnostic spectrum of a tertiary neuro-ophthalmology service in Thailand and to describe the etiologic distribution of selected H47-coded optic nerve and optic disc records after chart-based adjudication.</p><p><strong>Patients and methods: </strong>We conducted a retrospective service-based study of outpatient (OPD) and inpatient (IPD) neuro-ophthalmic records from January 2015 through December 2025. Analyses distinguished unique individuals, setting-specific patient-year records, patient-year-category records, and individual diagnostic records. H46-coded optic neuritis records were retained as code-based diagnoses; selected H47-coded records underwent manual chart adjudication by a fellowship-trained neuro-ophthalmologist using prespecified criteria. Annual analyses combined OPD and IPD after same-person/same-year cross-setting deduplication.</p><p><strong>Results: </strong>The dataset contained 1533 OPD and 504 IPD setting-specific patient-year records, representing 1815 unique individuals overall and 1905 cross-setting patient-years. Optic nerve and optic disc disorders occurred in 769/1,533 OPD patient-years (50.2%; 95% CI, 47.7-52.7) and 302/504 IPD patient-years (59.9%; 95% CI, 55.6-64.1). At the diagnostic-record level, 1076 optic nerve/disc records were identified: 344 H46-coded optic neuritis records and 732 selected H47-coded records with chart-based final classification. The most frequent diagnostic records were optic neuritis (344, 32.0%), optic atrophy/optic neuropathy NOS (230, 21.4%), ischemic optic neuropathy (111, 10.3%), optic disc cupping/glaucoma suspect (102, 9.5%), traumatic optic neuropathy (94, 8.7%), and compressive optic neuropathy (76, 7.1%). Optic nerve/disc disorders were the numerically largest category in every study year, accounting for 47.2%-58.3% of annual cross-setting patient-years.</p><p><strong>Conclusion: </strong>In this single-center service-based dataset, optic nerve and optic disc diagnoses were the most frequently recorded neuro-ophthalmic category. Manual chart review of selected H47-coded records enabled more detailed etiologic grouping, while H46-coded optic neuritis remained a code-based subgroup. The findings describe local tertiary referral practice and should be externally validated before generalizing the classification approach across institutions.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"641990"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120140","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":"A Novel Microbubble Air Injection System for Controlled Graft Fixation in DMEK Surgery.","authors":"Tsung-Ying Tsai, Yu-Kai Kuo, Shin-Yi Chen","doi":"10.2147/OPTH.S636029","DOIUrl":"https://doi.org/10.2147/OPTH.S636029","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a novel, low-cost microbubble air injection system using a customized 3-French nasogastric tube for precise volume control and stable graft fixation during Descemet membrane endothelial keratoplasty (DMEK).</p><p><strong>Design: </strong>Retrospective, single-surgeon observational study.</p><p><strong>Methods: </strong>A total of 80 eyes of 80 patients who underwent DMEK surgery between 2021 and 2025 were included. All procedures were performed by a single corneal specialist with more than 15 years of corneal surgical experience and approximately 5 years of DMEK experience. The system consisted of a standard 27-gauge anterior-chamber cannula connected to a short segment of 3-French nasogastric tubing. Technical success was defined as generation and intracameral delivery of a microbubble sufficient to complete the intended graft-positioning/fixation maneuver without conversion to conventional syringe-based air injection. Device-related intraoperative complications, conversion, rebubbling, elevated intraocular pressure (IOP), primary graft failure, graft rejection, best-corrected visual acuity (BCVA), central corneal thickness (CCT), and postoperative endothelial cell density (ECD) were reviewed.</p><p><strong>Results: </strong>Mean age was 65.8 ± 12.3 years. Fuchs endothelial corneal dystrophy accounted for 49 eyes (61.3%); 60 eyes (75.0%) underwent triple DMEK. Technical success was achieved in 80/80 eyes, with no conversion to a conventional syringe and no documented device-related intraoperative complication. Mean BCVA improved from 1.05 ± 0.61 to 0.43 ± 0.42 logMAR and mean CCT decreased from 630 ± 86.3 to 533.9 ± 55.8 µm. At 1 year, postoperative ECD was 1609 ± 563 cells/mm²; estimated ECL was 35.6 ± 22.5%. Rebubbling was performed in 27 eyes (33.8%); elevated IOP occurred in 7 (8.8%), primary graft failure in 3 (3.8%), and graft rejection in 2 (2.5%).</p><p><strong>Conclusion: </strong>The novel microbubble air injection system is a feasible modification for DMEK surgery. Ergonomic customization based on the surgeon's hand size is critical for achieving optimal mechanical control, leading to successful graft fixation across diverse endothelial pathologies.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"636029"},"PeriodicalIF":0.0,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120156","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":"Efficacy and Safety of Reproxalap 0.25% Ophthalmic Solution in Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Mustafa H Khazali, Hamzah M Alghzawi, Mohammed W Ainer, Menna R Abdelghaffar, Ali M Elghareab, Mayer H Ghaly, Noora Noureldin, Abdelrhman W Mohamed, Mohamed Ahmed Elshafie","doi":"10.2147/OPTH.S640064","DOIUrl":"https://doi.org/10.2147/OPTH.S640064","url":null,"abstract":"<p><strong>Purpose: </strong>Dry eye disease (DED) is an ocular surface disorder characterized by tear-film instability, inflammation, and symptoms that can impair visual function and quality of life. Reproxalap is a topical reactive aldehyde species (RASP) inhibitor. This systematic review and meta-analysis assessed the efficacy and safety of reproxalap 0.25% ophthalmic solution vs vehicle in adults with DED.</p><p><strong>Methods: </strong>MEDLINE/PubMed, Embase, Cochrane CENTRAL/Cochrane Library, and ClinicalTrials.gov were searched through June 20, 2026. The PROSPERO-registered review (CRD420261425460) included randomized trials and public trial-registry results records with extractable 0.25% reproxalap-versus-vehicle data. Outcomes included Schirmer test change and response (at least 10 mm improvement), instillation-site irritation, treatment-emergent adverse events (TEAEs), and discontinuation. Risk of bias and certainty were assessed using RoB 2 and GRADE.</p><p><strong>Results: </strong>Six eligible sources involving 2230 randomized participants were included. Reproxalap improved Schirmer test score (mean difference [MD], 2.34 mm; 95% confidence interval [CI], 1.45 to 3.22; P < 0.0001; I² = 0%) and Schirmer response (risk ratio [RR], 2.04; 95% CI, 1.68 to 2.46; P < 0.0001; I² = 0%). Instillation-site irritation was more frequent (RR, 27.27; 95% CI, 12.20 to 60.99; P < 0.0001) but was generally mild and transient in published reports. Any TEAE was uncertain (RR, 2.02; 95% CI, 0.92 to 4.44; P = 0.082). Adverse event-related discontinuation was more frequent (RR, 4.88; 95% CI, 2.36 to 10.10), whereas all-cause discontinuation did not differ (RR, 0.99; 95% CI, 0.50 to 1.99).</p><p><strong>Conclusions: </strong>Reproxalap 0.25% demonstrated rapid objective tear-production improvements vs vehicle, though routine clinical recommendation must be weighed against frequent, transient instillation-site irritation. No treatment-related serious ocular adverse events were reported. Certainty ranged from low to very low due to reliance on registry-only data, trial program endpoint restructuring, eye-level denominators, and small study numbers.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"640064"},"PeriodicalIF":0.0,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120160","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}