Romanian journal of ophthalmology最新文献

{"title":"Optical Coherence Tomography Angiography in Age-Related Macular Degeneration.","authors":"Alexandru-Ionut Duculescu, Ruxandra Pirvulescu, Aida Geamanu, Eylul Firinciogullari, Eduard Toma, Cristina Alexandrescu, Horia Tudor Stanca","doi":"10.22336/rjo.2026.27","DOIUrl":"10.22336/rjo.2026.27","url":null,"abstract":"<p><strong>Objective: </strong>To review and synthesize current evidence regarding the importance of optical coherence tomography angiography (OCTA) in the assessment of choriocapillaris alterations and macular neovascularization (MNV) across the spectrum of age-related macular degeneration (AMD), focusing on disease progression and clinical implications.</p><p><strong>Methods: </strong>Selective review of the specialized literature, concentrating on both qualitative and quantitative OCTA analyses of the retinal and choroidal microvasculature in AMD. We focused on measures related to choriocapillaris flow deficits, the morphology and maturity of MNV, and their associations with structural changes like drusen, geographic atrophy, and exudative conditions. The review included findings from both spectral-domain and swept-source OCTA systems.</p><p><strong>Results: </strong>OCTA enables non-invasive, depth-resolved visualization of choriocapillaris and MNV alterations throughout the progression of AMD. In the early and intermediate stages of AMD, localized choriocapillaris flow deficits are often observed beneath drusen and around lesion areas. In more advanced stages, there is significant choriocapillaris damage, especially near geographic atrophy and macular neovascularization. Quantitative OCTA biomarkers, such as density and flow deficit percentage, show strong correlations with disease stage, progression risk, and treatment response. Additionally, the maturity patterns of MNV identified through OCTA seem to affect the integrity of the surrounding choriocapillaris and the dynamics of atrophy.</p><p><strong>Discussion: </strong>The reviewed studies support a close relationship between choriocapillaris dysfunction, the development of macular neovascularization, and the progression of AMD. These findings reinforce the concept that vascular alterations play a central role throughout the disease spectrum and highlight the potential of OCTA to provide biomarkers that may improve prognostic assessment and treatment monitoring. However, further standardization of imaging protocols and quantitative analysis methods is needed before these biomarkers can be fully integrated into routine clinical practice.</p><p><strong>Conclusions: </strong>OCTA has become a crucial imaging tool for understanding microvascular changes in AMD. The quantitative evaluation of the choriocapillaris and detailed analysis of MNV morphology offer important insights into disease mechanisms, progression risk, and treatment monitoring. Incorporating OCTA-derived biomarkers into routine clinical practice could improve personalized management strategies for patients across the spectrum of AMD.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"191-198"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453101/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703154","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":"Systemic Inflammatory and Microcirculatory Determinants of Long-Term Outcomes in Neovascular Glaucoma: A Multicenter Cohort Study.","authors":"Olga Volodymyrivna Guzun, Oleg Serhiyovich Zadorozhnyy, Camelia Margareta Bogdanici, Volodymyr Viktorovych Vychuzhanin, Natalia Ivanivna Khramenko, Liudmyla Mykolayivna Velichko, Andrii Rostyslavovich Korol, Valeriu Nicon Cușnir, Lilia Gheorghe Dumbrăveanu","doi":"10.22336/rjo.2026.39","DOIUrl":"10.22336/rjo.2026.39","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Neovascular glaucoma (NVG) represents one of the most severe forms of secondary glaucoma and is characterized by an aggressive clinical course, a high risk of irreversible vision loss, and substantial variability in treatment outcomes. At the same time, the roles of systemic inflammation, ocular microcirculation, and neovascularization of the iridocorneal angle (according to the Weiss D. classification, 1978) in determining the long-term prognosis remain insufficiently investigated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To identify clinical, microcirculatory, and systemic inflammatory predictors of long-term treatment effectiveness in secondary NVG and to compare the outcomes of surgical interventions and diode transscleral cyclophotocoagulation depending on the stage of iridocorneal angle neovascularization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A multicenter retrospective cohort study included 87 eyes with ischemic NVG secondary to proliferative diabetic retinopathy or retinal vein occlusion treated between 2018 and 2024 in Ukraine and Moldova. Patients were divided into a surgical group (n=39) and a diode transscleral cyclophotocoagulation group (n=48). Clinical parameters, systemic inflammatory indices (SII, SIRI, AISI), HbA1c, cardiovascular comorbidity, and the rheographic coefficient (RQ), a functional microcirculation marker, were analyzed. Treatment success was defined as intraocular pressure control with stabilization of visual acuity, absence of rubeosis progression, and no need for additional invasive surgery. Multivariable logistic regression and ROC analysis were performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Treatment effectiveness was strongly associated with the stage of iridocorneal angle neovascularization. In the early stages, both approaches showed high success rates, whereas in the advanced stages, surgical outcomes declined markedly. In multivariable analysis, surgery increased the odds of success more than fivefold (OR=5.4; p=0.003), whereas advanced angle stages reduced it nearly sixfold (OR=0.18; p=0.007). Higher systemic inflammation was associated with poorer prognosis (SII OR=0.76; p=0.009), whereas better microcirculation was associated with improved outcomes (RQ OR=1.42; p=0.023). The combined predictive model demonstrated good discrimination (AUC = 0.84; 95% CI, 0.74-0.92).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;In the present study, long-term outcomes of neovascular glaucoma were shown to be determined by the complex interaction between the stage of iridocorneal angle neovascularization, systemic inflammation, and ocular microcirculation. Our findings indicated that the Weiss stage is a key morphological factor that modifies treatment effectiveness. In contrast, systemic inflammatory indices (SII, SIRI, AISI) reflect the underlying biological burden of disease and are associated with poorer prognosis. In contrast, higher values of the microcirculatory parameter (RQ) were significantly associated with m","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 2","pages":"295-304"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13453102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148703268","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":"Neurofibromatosis Type 1 with Plexiform Neurofibroma: A Novel Mutation Uncovered.","authors":"Pragati Garg, Shourriya Garg, Aparajita Shukla, Ruchi Shukla, Shrinkhal","doi":"10.22336/rjo.2026.18","DOIUrl":"10.22336/rjo.2026.18","url":null,"abstract":"<p><strong>Objectives: </strong>The objective of this article is to present a classic case of Neurofibromatosis Type 1 (NF1), a multisystemic genetic disorder, in a 16-year-old female who demonstrated hallmark clinical features, including café-au-lait macules, Lisch nodules, and a plexiform neurofibroma. This case also highlights the diagnostic significance of next-generation sequencing (NGS), which identified a novel pathogenic missense variant in the <i>NF1</i> gene (c.988G>C; p.Ala330Pro).</p><p><strong>Case presentation: </strong>A 16-year-old female presented with a 5-year history of progressive, painless right upper eyelid swelling and ptosis. Examination revealed more than six café-au-lait macules, palmar freckling, and Lisch nodules in the right eye. A soft, ill-defined mass involving the right upper eyelid was consistent with plexiform neurofibroma. She also experienced multiple transient episodes of loss of consciousness (LOC), though no neurological deficits were observed. Whole exome sequencing (WES) revealed a novel heterozygous missense variant (c.988G>C; p.Ala330Pro) in exon 9 of the <i>NF1</i> gene, classified as likely pathogenic. The variant was absent from population databases and supported by high REVEL and CADD scores. Surgical excision and ptosis correction were performed, and genetic counselling was initiated for the family.</p><p><strong>Discussion: </strong>NF1 is a common autosomal dominant disorder with variable phenotypic expression and a wide range of complications. Plexiform neurofibromas are among the more severe manifestations and carry a risk of malignant transformation. The novel <i>NF1</i> variant identified in this case affects a highly conserved residue and expands the spectrum of NF1 mutations. The clinical and molecular findings underscore the importance of early genetic testing to guide diagnosis, management, and familial risk assessment. The episodes of LOC raise the possibility of neurovascular involvement, which, while rare, is a recognized complication of NF1.</p><p><strong>Conclusion: </strong>This case underscored the diagnostic value of combining classical clinical features with molecular analysis in NF1. Early detection of pathogenic mutations, appropriate surgical intervention, and long-term follow-up are essential to reduce complications. Multidisciplinary care and emerging targeted therapies, such as MEK inhibitors, may further improve management and prognosis for patients with complex NF1 manifestations.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"147-150"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13242652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148207509","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":"Macular Telangiectasia Type 2 and Unilateral Subfoveal Vitelliform Lesion: A Longitudinal Follow-up By Multimodal Imaging.","authors":"Hamit Ali, Omer Karti, Ziya Ayhan, Ayse Bozkurt Oflaz, Ali Osman Saatci","doi":"10.22336/rjo.2026.24","DOIUrl":"10.22336/rjo.2026.24","url":null,"abstract":"<p><p>Macular telangiectasia type 2 (MacTel type 2) is a bilateral, acquired macular disorder that typically manifests in middle-aged individuals. Circular, yellowish subretinal deposits distinguish a vitelliform lesion (VL) and are very rarely observed in conjunction with MacTel type 2. The presence of VL in cases of MacTel type 2 may further contribute to visual deterioration and lead to misdiagnosis. We report the case of a 54-year-old, otherwise healthy man with MacTel type 2 and unilateral VL, in whom the VL lesion progressed to macular atrophy during a three-year follow-up period.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"176-183"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966428","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":"Innovations in Corneal Transplantation: The Role of Eye Banks, Donor Corneas, and Artificial Alternatives in Combating Worldwide Corneal Blindness.","authors":"Mahesh Chandra, Jitendra Singh, Gaurav Dubey, Govind Gaurav Pandey, Ayush Jha","doi":"10.22336/rjo.2026.03","DOIUrl":"10.22336/rjo.2026.03","url":null,"abstract":"<p><strong>Aim: </strong>Corneal disorders-including degeneration, dystrophy, infection, and inflammation-rank as the fifth leading cause of global visual impairment. In developing regions, conditions such as trachoma and xerophthalmia further increase this burden. This review explores the current landscape, challenges, and advancements in corneal blindness management, with a focus on the role of eye banks and keratoplasty techniques.</p><p><strong>Objectives: </strong>(i) Assess global burden and causes of corneal blindness; (ii) Highlight eye banks' roles in donor tissue management; (iii) Identify challenges in eye banking and transplantation; (iv) Evaluate keratoplasty procedures; (v) Examine surgical innovations and therapies such as corneal collagen cross-linking.</p><p><strong>Methodology: </strong>A comprehensive literature review was conducted, analyzing peer-reviewed publications, health reports, and clinical guidelines. Data from both developed and developing countries were considered to provide a holistic perspective.</p><p><strong>Discussion: </strong>Corneal transplantation remains the most effective treatment for advanced corneal blindness; however, a significant gap persists between the demand for donor corneas and their availability. Advances in preservation techniques and the shift toward lamellar keratoplasty have improved graft survival and visual outcomes. Nevertheless, limited donor awareness and infrastructural constraints continue to affect successful implementation.</p><p><strong>Conclusion: </strong>Advanced keratoplasty methods-Penetrating Keratoplasty, Deep Anterior Lamellar Keratoplasty, and Endothelial Keratoplasty-have improved outcomes by reducing rejection and accelerating recovery. The adoption of femtosecond laser technology has enhanced surgical precision. Corneal collagen cross-linking now offers a minimally invasive option to delay or prevent transplant in ectatic conditions. Despite these advancements, global eye banks face persistent challenges in donor recruitment, tissue preservation, and ethical management. Continued innovation, improved infrastructure, and strengthened public health efforts are crucial to overcoming these barriers and reducing the global burden of corneal blindness.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"9-19"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966390","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":"Three-Year Corneal Biomechanical Outcomes Assessed by CORVIS ST Dynamic Scheimpflug Imaging After Epithelium-Off Conventional Versus Accelerated Cross-Linking in Progressive Keratoconus.","authors":"Radu Nicolae Pop, Cristina Nicula, Patricia Nicula, Dorin Nicula, Bianca Pop","doi":"10.22336/rjo.2026.13","DOIUrl":"10.22336/rjo.2026.13","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare long-term corneal biomechanical and tomographic responses using dynamic Scheimpflug analysis, three years after epithelium-off (epi-off) conventional corneal collagen cross-linking (C-CXL; Dresden protocol) versus epi-off accelerated cross-linking (A-CXL) in patients with progressive keratoconus.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Prospective comparative study. 81 patients were assessed; treatment was performed in 40, including 23 bilateral keratoconus treatments and 17 unilateral treatments, resulting in 63 eyes included in the final 36-month analysis cohort. Eyes underwent epi-off CXL with either conventional protocol (3 mW/cm&lt;sup&gt;2&lt;/sup&gt; for 30 min; 5.4 J/cm&lt;sup&gt;2&lt;/sup&gt;; n=34) or accelerated protocol (9 mW/cm&lt;sup&gt;2&lt;/sup&gt; for 10 min; 5.4 J/cm&lt;sup&gt;2&lt;/sup&gt;; n=29). Assessments at baseline, 6, 12, 24, and 36 months included Kmax, uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), pachymetry, and Corvis ST dynamic corneal response parameters: deformation amplitude (DA), applanation times (A1T, A2T), peak distance (PD), highest concavity (HC) radius, stiffness parameter at first applanation (SP-A1), and BAD-D. Primary endpoint: between-group differences at 36 months and longitudinal change in key biomechanical parameters-secondary endpoints: Kmax, UCVA, and CDVA at each follow-up. Welch's t-test compared groups at each time point; repeated-measures modeling evaluated time, group, and time × group interaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Both protocols demonstrated significant longitudinal biomechanical remodeling and clinical stabilization over 36 months (time effect p &lt; 0.001 for DA, SP-A1, A1T, A2T, PD, and HC radius). At 36 months, between-group differences were not statistically significant for Kmax, UCVA, CDVA, pachymetry, DA, A1T, A2T, PD, HC radius, SP-A1, or BAD-D (all p &gt; 0.05). Longitudinal modeling demonstrated a significant time × group interaction for SP-A1 (p=0.042), indicating a modest protocol-dependent divergence in stiffness trajectory over time, while DA, A1T/A2T, PD, and HC radius showed parallel improvements without significant interaction. Pachymetry showed early thinning (6 months) followed by remodeling and stability by 36 months. No sight-threatening complications occurred.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussions: &lt;/strong&gt;Both epi-off conventional and accelerated CXL produced sustained biomechanical remodeling and clinical stabilization over 36 months. Although final between-group differences were not statistically significant for Kmax, visual acuity, pachymetry, deformation amplitude, applanation times, peak distance, HC radius, SP-A1, or BAD-D, repeated-measures analysis identified a significant time × group interaction for SP-A1, suggesting a modest protocol-dependent divergence in the trajectory of corneal stiffening. These findings indicate that matching total fluence does not necessarily produce identical biomechanical time courses and that irradiation duration may sti","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"95-110"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966407","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":"Updates on Corneal Collagen Cross-Linking for Keratoconus: A 10-Year Review of Techniques, Clinical Outcomes, and Future Directions.","authors":"Radu Nicolae Pop, Patricia Nicula, Cristina Nicula, Dorin Nicula, Bianca Pop","doi":"10.22336/rjo.2026.06","DOIUrl":"10.22336/rjo.2026.06","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;To synthesize major advances in corneal collagen cross-linking (CXL) for keratoconus over the past decade (2015-2025), with emphasis on protocol evolution, comparative effectiveness (epithelium-off vs. epithelium-on; conventional vs. accelerated), pediatric outcomes, repeat and customized approaches, adjunctive therapies, biomechanical assessment, safety, and emerging strategies, including oxygen supplementation and topography-guided CXL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Structured narrative review.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A systematic literature survey of randomized controlled trials, prospective cohort studies, registry analyses (including the Save Sight Keratoconus Registry), meta-analyses, and long-term follow-up studies published between 2015 and early 2025 was conducted. Extracted outcomes included maximum keratometry (Kmax), mean keratometry (Kmean), corrected distance visual acuity (CDVA), corneal thickness, progression and re-treatment rates, and complication profiles across protocols (standard epithelium-off, accelerated, transepithelial/epithelium-on, repeat CXL, and combination procedures).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Long-term evidence supports standard epithelium-off (Dresden) CXL as the reference protocol for biomechanical stabilization, with durable arrest of progression in most treated eyes and sustained improvements in corneal shape and CDVA through 5-10 years in several large cohorts. Accelerated protocols provide comparable short-term stabilization and reduce operative time, but may show shallower demarcation lines and less consistent long-term flattening in some series, particularly when pulsed delivery or oxygen enhancement is not used. Transepithelial (epithelium-on) techniques reduce postoperative pain and epithelial complications but, in meta-analyses, generally yield less keratometric flattening than epithelium-off CXL; newer riboflavin formulations, iontophoresis, oxygen supplementation, and pulsed UVA delivery have narrowed this efficacy gap. Pediatric keratoconus benefits from early CXL but has higher rates of late progression and retreatment than adult cohorts. Combined strategies (intracorneal ring segments and/or topography-guided surface ablation with CXL) can improve optical quality in selected eyes with adequate stromal reserve. PACK-CXL remains investigational as an adjunctive therapy for infectious keratitis. Overall complication rates are low; transient haze is the most common complication, and serious adverse events are rare when pachymetric safety thresholds are respected.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussions: &lt;/strong&gt;Over the past decade, CXL has evolved from a single Dresden protocol to a spectrum of approaches that balance efficacy, safety, comfort, and practicality. Long-term cohort evidence continues to support epithelium-off Dresden CXL as the reference standard for robust biomechanical stabilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;CXL has evolved from a sin","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"42-49"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966355","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":"Inflammatory Stability Index Correlates with Retinal Nerve Fiber Layer Reduction in Glaucoma.","authors":"Raluca Neacșa, Daniela Manasia, Cristiana Tănase, Mădălina-Elena Tobă, Adina-Diana Moldovan","doi":"10.22336/rjo.2026.12","DOIUrl":"10.22336/rjo.2026.12","url":null,"abstract":"<p><strong>Background: </strong>While neuroinflammation is recognized as a driver of glaucomatous neurodegeneration, the prognostic value of inflammatory markers remains unclear. Previous studies have focused on absolute cytokine levels, potentially overlooking other factors.</p><p><strong>Objective: </strong>To determine whether inflammatory stability over time, quantified by a proposed Inflammatory Stability Index (ISI), associates with retinal nerve fiber layer (RNFL) reduction in POAG.</p><p><strong>Methods: </strong>Prospective longitudinal cohort study of 57 participants (19 controls, 38 glaucoma patients) with serum cytokine profiling (IL-1β, TNF-α, IL-6) and RNFL measurements over 24 months. We developed the ISI=Median[cytokines]/{1+IQR[cytokines]} to quantify temporal inflammatory patterns, where higher values indicate stable-high inflammation and lower values indicate volatile-low inflammation.</p><p><strong>Results: </strong>ISI correlated significantly with RNFL progression (r = -0.491, p = 0.002). Stable-high inflammation patients (ISI > 3.5) progressed 74% faster than volatile-low patients (ISI < 1.6). ISI showed acceptable accuracy for identifying rapid progressors (AUC = 0.76). Associations persisted after multivariable adjustment. Treatment benefit was comparable across inflammatory phenotypes.</p><p><strong>Discussion: </strong>In this 24-month prospective cohort of 57 participants (19 controls, 38 POAG patients), ISI correlated significantly with RNFL progression rate (r = -0.491, p = 0.002). Patients with stable-high inflammation (ISI > 3.5) showed 74% faster RNFL progression than those with volatile-low inflammation (ISI < 1.6). Moreover, ISI demonstrated acceptable discriminative accuracy for identifying rapid progressors, with an area under the ROC curve of 0.76 (95% CI: 0.56-0.96). These associations remained significant after multivariable adjustment for age, sex, and treatment status (R² = 0.426, p < 0.001), confirming that inflammatory stability patterns may be more informative than cytokine magnitude alone for predicting glaucomatous neurodegeneration.</p><p><strong>Conclusions: </strong>Inflammatory stability patterns may be more important than magnitude alone in glaucoma progression. The ISI identifies high-risk phenotypes and may predict treatment response, informing personalized management and patient stratification for intensive monitoring.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"85-94"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966395","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":"Neural Network - Supported Prognostic Assessment of Apoptotic and Inflammatory Markers in Neovascular Glaucoma.","authors":"Olga Volodymyrivna Guzun, Oleg Serhiyovich Zadorozhnyy, Camelia Margareta Bogdanici, Volodymyr Viktorovych Vychuzhanin, Liudmyla Mykolayivna Velichko, Andrii Rostyslavovich Korol, Valeriu Nicon Cușnir, Lilia Gheorghe Dumbrăveanu","doi":"10.22336/rjo.2026.14","DOIUrl":"10.22336/rjo.2026.14","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To assess the prognostic value of apoptotic (CD95), endothelial (CD54), and systemic inflammatory biomarkers (SII, SIRI, AISI) for predicting the effectiveness of modified selective diode transscleral cyclophotocoagulation (TSCPC) in patients with neovascular glaucoma using regression and neural network-based models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This prospective cohort study included 258 eyes: 224 eyes with NVG (155 treatment successes and 69 failures) and 34 age-matched healthy controls. Baseline assessments comprised intraocular pressure (IOP), best-corrected visual acuity (BCVA, logMAR), and serum levels of CD95 (Fas), CD54 (ICAM-1), HbA1c, and systemic inflammatory indices (SII, SIRI, AISI). Treatment success was defined as IOP between 10 and 21 mmHg, stabilization or improvement of BCVA, and absence of additional glaucoma surgery. Between-group comparisons were performed using the Mann-Whitney U test and Dunn-Bonferroni post hoc analysis. Predictors of treatment failure were assessed using univariable and multivariable logistic regression. Discriminative performance was evaluated by receiver operating characteristic (ROC) analysis. A gradient-boosting machine-learning model with SHAP-based interpretability was applied to an independent validation set.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients with TSCPC failure exhibited significantly higher biomarker levels than those who had successful outcomes: CD95 (+41%), CD54 (+71%), and AISI (+164%) (all &lt;i&gt;p&lt;/i&gt; &lt; 0.001). In univariable analysis, CD95 (OR = 1.80; 95% CI: 1.55-2.15), AISI (OR = 1.60), and CD54 (OR = 1.50) showed the strongest associations with treatment failure. In the multivariable model, CD95 (OR = 1.65), CD54 (OR = 1.30), and AISI (OR = 1.40) remained independently significant, with robust explanatory power (Nagelkerke R&lt;sup&gt;2&lt;/sup&gt; = 0.60). The combined apoptosis-endothelial model (CD95 + CD54 + AISI) demonstrated superior discriminatory performance (AUC = 0.87; sensitivity 82%; specificity 76%). SHAP analysis confirmed that these three biomarkers accounted for approximately 75% of total predictive importance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;The findings of this study indicate that the effectiveness of modified selective TSCPC in neovascular glaucoma is determined not merely by baseline IOP, but predominantly by the patient's integrated biological profile, particularly apoptotic (CD95), endothelial (CD54), and systemic inflammatory markers (SII, SIRI, AISI). The observed convergence of endothelial activation, systemic inflammation, and Fas-mediated apoptosis supports the concept of NVG as a multifactorial ischemic-inflammatory disorder and provides a mechanistic basis for treatment resistance. The combined biomarker model demonstrated high predictive performance (AUC = 0.87), outperforming individual parameters and underscoring the value of a multimarker approach. These findings support biomarker-guided risk stratification and reinfo","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"111-120"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966371","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 Improvement and Optical Quality Changes After Keratoplasty in Macular Corneal Dystrophy in Romania.","authors":"Ana Maria Arghirescu, Alina Gabriela Gheorghe, Maria Cristina Marinescu, Liliana Mary Voinea, Radu Ciuluvică","doi":"10.22336/rjo.2026.07","DOIUrl":"10.22336/rjo.2026.07","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate visual and optical outcomes after penetrating keratoplasty in eyes with macular corneal dystrophy in Romania.</p><p><strong>Methods: </strong>This observational study included 11 eyes from 6 patients with macular corneal dystrophy who underwent penetrating keratoplasty. Preoperative and 6-month postoperative assessments included best-corrected visual acuity, central corneal thickness, and anterior segment optical coherence tomography parameters obtained with the CSO MS-39, including higher-order aberrations at 3 mm, mean pupil power, cylinder, and point spread function expressed as the Strehl ratio. Continuous variables were summarized as mean ± standard deviation. Preoperative and postoperative values were compared using the Wilcoxon signed-rank test. Associations between preoperative central corneal thickness and other baseline variables were assessed using Spearman correlation.</p><p><strong>Results: </strong>Mean best-corrected visual acuity improved from 0.123 ± 0.090 preoperatively to 0.755 ± 0.082 at 6 months (p = 0.0010), corresponding approximately to an improvement from 0.91 to 0.12 logMAR. High-order aberrations at 3 mm increased from 0.269 ± 0.106 to 0.777 ± 0.523 (p = 0.0010), and cylinder magnitude increased from -1.42 ± 0.44 diopters to -8.15 ± 4.10 diopters (p = 0.0010). The Strehl ratio decreased from 0.214 ± 0.039 to 0.080 ± 0.024 (p = 0.0010). Mean pupil power increased from 42.60 ± 0.88 to 44.58 ± 2.55 without statistical significance (p = 0.0537). Preoperative central corneal thickness was positively correlated with age (rho = 0.699, p = 0.0167).</p><p><strong>Discussion: </strong>Our study underscores that even if visual quality metrics, such as higher-order aberrations and the point spread function, have decreased after keratoplasty, alongside a significant increase in astigmatism, penetrating keratoplasty still plays a very important role in restoring visual independence in patients with advanced macular dystrophy.</p><p><strong>Conclusions: </strong>Penetrating keratoplasty in macular corneal dystrophy was associated with substantial improvement in visual acuity at 6 months, despite worsening in several optical quality metrics derived from anterior segment optical coherence tomography. These findings suggest that functional visual gain after keratoplasty may occur even when postoperative optical regularity does not improve.</p>","PeriodicalId":94355,"journal":{"name":"Romanian journal of ophthalmology","volume":"70 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966401","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}