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

{"title":"Real-World Outcomes of Intraoperative Intravitreal Triamcinolone at Phacoemulsification Cataract Surgery in Eyes with a History of Diabetic Macular Edema.","authors":"Abigail Sara Affoo, Ronnie Bhola, Vikash Badasee, Vachel Luces, Jeanmarc Sookhoo, Ciara Ramnarine","doi":"10.2147/OPTH.S626796","DOIUrl":"10.2147/OPTH.S626796","url":null,"abstract":"<p><strong>Objective: </strong>Postoperative macular edema is a major cause of suboptimal visual acuity in diabetics who have undergone cataract surgery. Intravitreal Triamcinolone Acetonide (IVTA) may be used at the time of cataract surgery with the aim of limiting postoperative macular edema. This study evaluates the real‑world anatomical, visual and safety outcomes of combined intraoperative IVTA and phacoemulsification cataract surgery in eyes with a history of Diabetic Macular Edema (DME).</p><p><strong>Methods: </strong>This single-centre retrospective observational study analysed the records of 73 eyes, all with a history of DME, which underwent combined phacoemulsification surgery with intraocular lens implantation and IVTA injection between January 2023 and December 2024. Analyses used available paired observations.</p><p><strong>Results: </strong>The mean preoperative central subfield macular thickness (CSMT) was 265.0 ± 98.42 µm and 20/73 eyes (27%) had a baseline CSMT of >300 μm preoperatively. OCT scans were available for 51 eyes at 1 month (mean CSMT 313.2 ± 124.04 µm), 52 eyes at 3 months (299.3 ± 112.34 µm), 42 eyes at 6 months (336.2 ± 119.81µm) and 34 eyes at 1 year (310.5 ± 102.11 µm). A significant increase in CSMT was seen at 6 months and 1 year (p<0.01) but not at 1 month and 3 months (p>0.05). 17 eyes received rescue intravitreal therapy within 12 months (10 IVTA, 7 anti-VEGF). Mean visual acuity was 0.988 ± 0.688 logMAR preoperatively with significant improvement at all postoperative visits to 0.414 ± 0.340, 0.436 ± 0.411, 0.464 ± 0.454 and 0.501 ± 0.571 logMAR at 1 month, 3 months, 6 months and 1 year respectively (p<0.001). The mean IOP was not significantly increased at any of the postoperative visits. 3 eyes required the commencement, and 4 eyes required an increased usage of topical ocular anti-hypertensives within 1-year post-surgery. No patient required surgery for uncontrolled postoperative intraocular pressure. There were no cases of endophthalmitis.</p><p><strong>Conclusion: </strong>In this real-world cohort, the findings suggest that intraoperative IVTA may contribute to maintaining CSMT stability during the first three postoperative months in eyes with a history of DME.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"626796"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019070","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":"Incidence and Clinical Course of Intraocular Inflammation Following Pharmacy-Compounded Intravitreal Aflibercept 8mg for Neovascular AMD: A Real-World Cohort Study.","authors":"Jan Kucharczuk, Hubert Kasprzak, Marlena Tuchowska-Celej, Maciej Gawęcki","doi":"10.2147/OPTH.S643475","DOIUrl":"10.2147/OPTH.S643475","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the incidence and clinical course of intraocular inflammation (IOI) after intravitreal aflibercept 8 mg (Eylea 8 mg - E8) injection in patients with neovascular age-related macular degeneration (nAMD) in Poland.</p><p><strong>Patients and methods: </strong>This retrospective study included 867 eyes of 867 patients (591 female, 276 male) with nAMD treated with E8 at the 10^th Military Hospital in Bydgoszcz between January and December 2025. Of these, 655 patients were switched from other intravitreal agents and 212 were treatment-naïve. A total of 3441 E8 injections were administered before IOI onset, with two full 0.07mL (8mg) doses withdrawn from each single-use vial through pharmacy compounding. IOI severity was graded using the Standardization of Uveitis Nomenclature (SUN) criteria, and clinical course and outcomes were analyzed over 6 months of follow-up.</p><p><strong>Results: </strong>IOI occurred in 20 patients, corresponding to an incidence of 2.31% per eye/patient and 0.58% per injection. Symptoms appeared a mean of 3.3 ± 1.9 days after injection, with decreased visual acuity (BCVA dropped from 0.22 ± 0.10 to 0.58 ± 0.45 logMAR, p=0.0005). All cases were managed with topical corticosteroids, 16/20 additionally received sub-Tenon triamcinolone, and 6 required oral prednisolone; 1 patient required pars plana vitrectomy. Nineteen patients resolved on medical therapy alone, while one patient required surgical intervention (pars plana vitrectomy) to achieve resolution. No retinal vasculitis occurred, and central retinal thickness remained stable during follow-up.</p><p><strong>Conclusion: </strong>In this first Polish cohort study, the incidence of IOI after E8 injection (2.31% per eye/patient) was higher than reported in registration trials, though episodes were generally mild and self-limited, without long-term visual impact. These findings may help inform clinical monitoring for patients receiving E8 for nAMD.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"643475"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592338/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019014","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":"Optimizing Ocular Surface Disease (OSD) Management in Patients with Glaucoma: Expert Strategies from Asia.","authors":"Vilavun Puangsricharern, Jin Rong Low, Manchima Makornwattana, Eng Hui Gan, Chien-Chia Su, Ha Thi Thu Pham, Astrianda Nadya Suryono, Chungkwon Yoo, Joseph Anthony Tumbocon","doi":"10.2147/OPTH.S624778","DOIUrl":"10.2147/OPTH.S624778","url":null,"abstract":"<p><strong>Introduction: </strong>Ocular surface disease (OSD) commonly affects glaucoma patients and can occur due to the disease itself and multiple contributing factors, such as the long-term use of preserved topical medications, thereby impacting adherence and treatment outcomes. In Asia, rising glaucoma burden and variability in regional guidelines underscore the need for a practical synthesis of current literature in the region. This review summarizes the OSD treatment landscape in Asia and proposes a pragmatic approach for identifying and managing concomitant OSD in patients with glaucoma.</p><p><strong>Material and methods: </strong>Eight glaucoma specialists and a cornea expert representing eight Asian countries convened on 8^th March 2025 at an industry‑sponsored expert meeting to discuss the current treatment landscape of concomitant OSD in glaucoma. A practical approach for identifying and managing concomitant OSD in glaucoma patients in daily clinics was subsequently developed based on published literature and expert input.</p><p><strong>Results: </strong>Regional studies estimate high OSD prevalence among glaucoma patients, with country-level estimates ranging 32.1-99.1% based on symptoms or signs. Risk factors for OSD are similar between Asian and global populations, but Asian ethnicity is a recognized risk factor for dry eye disease. Regional and country-level guidelines for OSD are available but vary in terms of diagnostic criteria, and local awareness of OSD remains lacking. The 3-step approach (Step 1: Assess symptoms and risk factors, Step 2: Slit-lamp examination and staining, Step 3: Tailored management by severity) offers a pragmatic pathway for application in daily clinics.</p><p><strong>Conclusion: </strong>The proposed framework serves as a first step towards harmonizing OSD management in glaucoma patients across Asia, with the potential to enhance the quality of glaucoma care. Further validation of the framework, and increased consensus and awareness may help improve the management of OSD in Asia.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"624778"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593577/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027171","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":"Toric versus Standard Implantable Collamer Lens Implantation for Low Myopic Astigmatism: A 12-Month Retrospective Study.","authors":"Haiyan He, Zhanchi Hu, Runhua Peng, Liangqi Feng, Chi Xiao","doi":"10.2147/OPTH.S610499","DOIUrl":"10.2147/OPTH.S610499","url":null,"abstract":"<p><strong>Background: </strong>Implantable collamer lens (ICL) and toric ICL (TICL) have shown effectiveness for myopic and astigmatic patients. This study aims to compare the visual and refractive outcomes of TICL and ICL implantation for low myopic astigmatism.</p><p><strong>Methods: </strong>This single-center, retrospective, non-consecutive, and non-randomized study included 124 eyes of 124 patients with low myopic astigmatism who underwent TICL or ICL implantation. Visual acuity, refractive outcomes, visual quality, and ocular parameters were assessed at baseline, 3 months, and 12 months postoperatively. The surgical results were reported using standard graphs and double-angle astigmatism vector analysis.</p><p><strong>Results: </strong>Both groups demonstrated excellent safety (TICL: 1.28±0.18; ICL: 1.19±0.16) and efficacy (TICL: 1.21±0.19; ICL: 1.09±0.16), with high predictability for spherical equivalent refraction (<i>R</i> ² of 0.980 and 0.984, respectively) and stable refractive outcomes at 12 months. UDVA was marginally better in the TICL group (-0.08±0.07 vs -0.03±0.06, p<0.001). Crucially, TICL yielded significantly lower residual astigmatism (-0.16±0.28 D vs -0.33±0.40 D, p < 0.05) and a smaller prediction error on vector analysis. Despite these refractive differences, objective visual quality metrics improved significantly in both groups, with no statistically significant intergroup differences observed.</p><p><strong>Conclusions: </strong>Both TICL and ICL are safe and effective for low myopic astigmatism (0.75-1.0 D). Although TICL yielded significantly lower residual astigmatism and higher uncorrected visual acuity than ICL, the nonrandomized design and selection bias necessitate caution in claiming comparative superiority. Toric correction for such low astigmatism should be individualized, integrating clinical benefits with economic and safety factors.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"610499"},"PeriodicalIF":0.0,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13592337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019100","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":"Visual, Tomographic, and Biomechanical Outcomes of CAIRS with Accelerated Cross-Linking in Moderate to Advanced Keratoconus: A 6-Month Retrospective Case Series.","authors":"Nauman Hashmani, Sharif Hashmani, Javaria Saleem","doi":"10.2147/OPTH.S625200","DOIUrl":"10.2147/OPTH.S625200","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the visual, tomographic, and biomechanical effects of corneal allogenic intrastromal ring segments (CAIRS) combined with accelerated epithelium-off corneal cross-linking (CXL) in patients with moderate to advanced keratoconus.</p><p><strong>Methods: </strong>This retrospective case series included 40 eyes of 40 patients with keratoconus. CAIRS segments were prepared from donor corneal tissue stored in Netisol medium and implanted via femtosecond laser-created intrastromal channels. Accelerated epithelium-off CXL (10 mW/cm² for 9 minutes; total energy 5.4 J/cm²) was performed immediately after CAIRS implantation; an individualized Sub400 protocol was applied in eyes with post-implantation pachymetry below 400 µm. Outcomes at baseline and 6 months included best-corrected visual acuity (BCVA), spherical equivalent, keratometric indices, pachymetry, higher-order aberrations (HOAs), and Corvis ST biomechanical parameters.</p><p><strong>Results: </strong>Median BCVA improved from 0.52 to 0.22 logMAR (p=0.005), and spherical equivalent improved from -9.3 D to -4.1 D (p=0.007). K1, K2, Km, and Kmax showed statistically significant flattening (all p<0.05). HOAs and coma did not significantly change. SP-A1 decreased from 52.7 to 51.2 mmHg/mm (p=0.015), while integrated radius showed no significant difference. One eye (2.5%) developed donor segment opacification within the first postoperative week without functional visual consequence; BCVA improved in this eye. No rejection, extrusion, or other adverse events were recorded.</p><p><strong>Conclusion: </strong>CAIRS combined with accelerated CXL demonstrated significant improvements in visual acuity, refractive error, and keratometric parameters at 6 months. These findings suggest that CAIRS may represent a promising biological alternative to synthetic intracorneal ring segments, warranting further investigation through prospective controlled studies with longer follow-up.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"625200"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019039","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":"Pilot Community Health Worker-Based Intervention to Address Social Determinants of Health Among Patients with Diabetes in Ophthalmology.","authors":"Bethel Joy DeGracia, Zainab Rustam, Jose Amezcua Moreno, Sophia E Yu, Diep Tran, Kenya Ferguson, James Wilson, Randi Woods, Cindy X Cai","doi":"10.2147/OPTH.S632778","DOIUrl":"10.2147/OPTH.S632778","url":null,"abstract":"<p><strong>Purpose: </strong>Community Health Workers (CHWs) represent a potential strategy in ophthalmology to address adverse social determinants of health (SDoH) and improve vision outcomes. In this study, we explored the feasibility, acceptability, and impact of a structured CHW intervention among patients with diabetes.</p><p><strong>Materials and methods: </strong>This was a prospective single-center pilot study conducted at the Johns Hopkins Wilmer Eye Institute. Adult participants (≥ 18 years) with diabetes and at least one adverse SDoH participated in the study. The CHW worked with the participant for on average 6 months to address the social barriers identified at screening. At the conclusion of the study, participants completed a follow-up SDoH survey and a semi-structured exit interview.</p><p><strong>Results: </strong>Out of 45 enrolled participants, 23 completed the study (mean age 56 years, 52% female, and 83% non-Hispanic Black). Many participants (83%) were satisfied with the frequency of the meetings, 87% had a positive experience with the CHW and felt respected and supported (74%) throughout the program. The experience with the broader program was more mixed with 17% reporting it was negative, 22% neutral, and 57% positive. Participants found the program helpful for resource education (65%), emotional support (43%), access to medical services (43%), and self-confidence (57%). Challenges included limited resources available to address certain social needs and language barriers among the Spanish speaking participants. Participants reported high trust in CHW, but there were no significant changes in pre- and post-intervention SDoH surveys (p>0.05).</p><p><strong>Conclusion: </strong>Integration of CHWs into ophthalmology is feasible and acceptable among patients with diabetes who remained actively engaged over time. High trust in CHW and improvement in resource navigation, health knowledge, and confidence were reported. Our findings support development of CHW integration in ophthalmology as a potential intervention to address barriers to care and improve vision outcomes.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"632778"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013242","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":"Correlation of Mitochondrial Flavoprotein Fluorescence and Sectoral OCT in Patients with Glaucoma, Suspects, and Ocular Hypertension.","authors":"Tiffany Heaster-Ford, Rafaella Nascimento E Silva, Justin Elstrott, Dolly S Chang, Julia A Kim, Joyce Kang, Yan Zhao, Yihao Li, Chen Chen, Sofia De Arrigunaga, Sandra E Freeman, Kanza Aziz, Collin A Rich, Michael M Lin, David S Friedman","doi":"10.2147/OPTH.S613398","DOIUrl":"10.2147/OPTH.S613398","url":null,"abstract":"<p><strong>Purpose: </strong>Flavoprotein fluorescence (FPF) can be measured using a noninvasive investigational device, the OcuMet Beacon (OcuSciences). The Beacon uses blue light to stimulate oxidized mitochondrial flavoproteins, which subsequently emit green autofluorescence. As mitochondrial metabolic stress may reflect axonal damage in glaucomatous eyes, this cross-sectional, exploratory study investigated relationships between optical coherence tomography (OCT) structural parameters and FPF values in patients with glaucoma, ocular hypertension, and glaucoma suspects.</p><p><strong>Patients and methods: </strong>Individuals with mild/moderate glaucoma, suspected glaucoma, or ocular hypertension receiving treatment. FPF images were obtained at the optic nerve head (ONH), peripapillary, and macula regions. FPF intensities in the peripapillary and macula regions were divided into 4 and 6 sectors, respectively, corresponding to Cirrus OCT retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer thickness (mGCIPL). FPF values adjusted for lens autofluorescence and signal attenuation were averaged within each sector and applied for regression modeling with OCT measures.</p><p><strong>Results: </strong>A small cohort of 73 eyes from 54 patients was assessed from the initial study population (141 eyes, 83 early/mild/moderate glaucoma patients undergoing treatment) following image quality exclusion. Older age, thinner RNFL, and phakic status were significantly associated with higher FPF intensity at the ONH (age, P=0.009; RNFL, P<0.001; lens status, P=0.04) and peripapillary region (age, P<0.001; RNFL, P=0.01). Inferior peripapillary correlation between RNFL thickness and FPF was significant (P=0.003), while nasal peripapillary correlation was significant only after adjusting for age and lens status (adjusted P=0.04; unadjusted P=0.08). Global macular FPF intensity was not associated with age (P=0.25), lens status (P=0.14) or mGCIPL thickness (P=0.79), nor were there any sectoral mGCIPL-FPF associations potentially given limited disease severity.</p><p><strong>Conclusion: </strong>Age, lens status and RNFL thinning were the main correlates of ONH and peripapillary FPF values. After accounting for age and lens status covariates, higher FPF intensity values mainly correlated with inferior peripapillary RNFL thinning.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"613398"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149013188","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":"Preoperative Corneal Astigmatic Direction is Associated with Stromal Mechanical Anisotropy in SMILE-Derived Lenticules.","authors":"Pengfei Han, Peng Chen, Xiaolong Fang, Hongwei Qin, Yuan Wu, Shuangshuang Chen, Yan Li, Jie Zhang, Qizhi Zhou","doi":"10.2147/OPTH.S641270","DOIUrl":"10.2147/OPTH.S641270","url":null,"abstract":"<p><strong>Purpose: </strong>Direction-dependent mechanical behavior exists in the human corneal stroma, but fixed-axis biomechanical testing may be influenced by preoperative astigmatic direction. This study evaluated whether corneal astigmatic direction, a routinely measurable clinical phenotype, corresponds to superior-inferior (SI) vs nasal-temporal (NT) mechanical anisotropy in human stromal lenticules obtained during small-incision lenticule extraction (SMILE).</p><p><strong>Patients and methods: </strong>Fifty-three spherical stromal lenticules with a programmed cylinder correction of 0 diopters were prospectively collected. Preoperative anterior corneal astigmatism was classified as with-the-rule (WTR) or against-the-rule (ATR), and the steep-axis information was decomposed into a vertical-horizontal component matched to the SI-NT mechanical testing coordinates. Equibiaxial testing was performed along the SI and NT axes, and tangent moduli were calculated at 0.03 MPa. The signed meridional difference index (MDI) was defined as E_SI - E_NT.</p><p><strong>Results: </strong>WTR lenticules predominantly showed higher SI modulus, whereas ATR lenticules predominantly showed higher NT modulus. The vertical-horizontal astigmatic component was strongly correlated with signed MDI (Spearman rho = 0.875, P < 0.001), and this association remained significant after multivariable adjustment (β = 0.673 MPa/diopter, 95% CI 0.537-0.809, P < 0.001). Corneal astigmatism magnitude was also associated with direction-independent anisotropy magnitude.</p><p><strong>Conclusion: </strong>Preoperative corneal astigmatic direction may be a clinically measurable stratification variable for interpreting fixed-axis stromal mechanical anisotropy measurements in SMILE-derived lenticules. These findings support incorporating directional clinical phenotypes into corneal biomechanical research and patient-specific modeling, while requiring validation in larger independent samples.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"641270"},"PeriodicalIF":0.0,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149018946","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":"Optimizing Cataract Surgery Workflows Across a Multi-Satellite Tertiary Care Center.","authors":"Ahmed El Ashry, Mahmoud El Ashry, Sujin Kang, Sotiria Palioura, Allister Gibbons, Jose Miguel Mora Correa, Zubair A Ansari, Despoina Theotoka, Sonia H Yoo, Tamarra R Biekman, Stephen G Schwartz, Guillermo Amescua, Jaime D Martinez","doi":"10.2147/OPTH.S631136","DOIUrl":"10.2147/OPTH.S631136","url":null,"abstract":"<p><p>Cataract surgery requires precise coordination of multimodal processes delivered across decentralized multi-site tertiary healthcare systems. Investigating the logistical orchestration required for geographically distributed healthcare networks, this review describes an operational framework from a multi-satellite tertiary academic referral center operating a hub-and-spoke model across South Florida handling approximately 21,000 annual surgeries. To address multi-site care fragmentation, the institute introduced the \"digital spine\" framework, which integrates cloud-based diagnostic platforms, coordinated scheduling, and centralized surgical planning. This cloud-integrated system asynchronously bridges diagnostic hubs up to 116 miles apart, sending centralized surgical plans directly to operating room microscopes and feeding post-operative refractive data back into predictive algorithms. Within this network, cataract surgery accounts for approximately 8000 cases annually. Providers, imaging technicians, surgical coordinators, and nurses seamlessly establish collaborative care pathways. This system plays a critical role in maintaining efficiency, while a tiered referral protocol routes high-risk and complex cases to the central hub where multidisciplinary support is available. The present review fills the literature gap by providing a scalable blueprint for multi-site ophthalmic networks seeking to integrate decentralized diagnostics with centralized surgical execution. However, further quantitative studies are needed to evaluate clinical and cost-effectiveness outcomes.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"631136"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009672","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":"Evidence-Based Clinical Practice Guideline for Diagnosis, Treatment, and Follow-Up of Keratoconus Patients.","authors":"Andres Bustamante-Arias, Andres Rosas-Apraez, Carlos Alberto Restrepo, Martha Isabel Lizarazo, Douglas Tawse-Smith, Nestor I Carreño, Luis Daniel Holguin, Damien Gatinel, Martin Romero, Luis Gabriel Rocha, Andrea Diaz-Cely","doi":"10.2147/OPTH.S612713","DOIUrl":"10.2147/OPTH.S612713","url":null,"abstract":"<p><p>Keratoconus is a progressive corneal ectatic disorder characterized by focal stromal thinning and conical protrusion, typically involving the central or paracentral cornea. Disease progression may lead to significant visual impairment and reduced quality of life. Reported global prevalence ranges from 0.17 to 40 cases per 1000 persons, reflecting differences in diagnostic criteria, imaging technologies, and study populations. Early detection, timely intervention, and risk-based follow-up are essential to limit progression and reduce visual morbidity. A systematic literature search did not identify existing clinical practice guidelines for keratoconus diagnosis and management with sufficient methodological quality to support adoption or adaptation. Therefore, a de novo evidence-based clinical practice guideline was developed. The objective was to provide recommendations for timely diagnosis, risk stratification, interventional treatment, and follow-up of pediatric and adult patients with keratoconus, aiming to standardize clinical criteria and support decision-making among healthcare professionals. The guideline was developed through systematic evidence synthesis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess certainty of evidence and strength of recommendations. The evidence base included systematic reviews, diagnostic accuracy studies, randomized clinical trials, and observational studies, according to each clinical question. Recommendations addressed risk factors, diagnostic and staging criteria, progression assessment, corneal cross-linking protocols, intrastromal corneal ring segments, keratoplasty techniques, and individualized follow-up. Most recommendations were conditional, reflecting low or very low certainty of evidence in several domains. This guideline provides a practical framework for standardized keratoconus care while explicitly identifying areas where evidence remains limited and further research is needed.</p>","PeriodicalId":93945,"journal":{"name":"Clinical ophthalmology (Auckland, N.Z.)","volume":"20 ","pages":"612713"},"PeriodicalIF":0.0,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009643","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}