Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

{"title":"Association between intravitreal anti-vascular endothelial growth factor agents and respiratory events: a meta-analysis","authors":"Michael Balas,&nbsp;Aaditeya Jhaveri,&nbsp;Ryan S. Huang,&nbsp;Marko M. Popovic,&nbsp;Peter J. Kertes,&nbsp;Rajeev H. Muni","doi":"10.1016/j.jcjo.2026.03.019","DOIUrl":"10.1016/j.jcjo.2026.03.019","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate associations between intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents and adverse respiratory events.</div></div><div><h3>Methods</h3><div>A comprehensive search was conducted in Ovid Medline, Embase, and the Cochrane Library from January 2005 to February 2024. The search included peer-reviewed randomized controlled trials (RCTs) involving adult patients treated with intravitreal anti-VEGF that reported respiratory adverse events. Meta-analysis employed random-effects modeling to generate risk ratios (RR) and 95% confidence intervals (CI).</div></div><div><h3>Results</h3><div>Of 24,506 studies initially identified, 11 RCTs comprising 9 718 patients were included. Chronic obstructive pulmonary disease (COPD) events were reported at the following rates: 2.2% (bevacizumab), 0.9% (faricimab), 0.8% (brolucizumab), 0.7% (sham), 0.5% (aflibercept), and 0.3% (ranibizumab). There was an increased risk of lower respiratory events with bevacizumab compared with aflibercept (RR = 1.69; 95% CI = 1.18–2.44; <em>p</em> &lt; 0.01), and faricimab compared with aflibercept (RR = 1.50; 95% CI = 1.01–2.23; <em>p</em> &lt; 0.05). These differences were primarily driven by rates of bronchitis: 11.9% (bevacizumab), 3.3% (faricimab), 2.8% (aflibercept), 1.3% (sham), and 0.4% (ranibizumab); however, these estimates were influenced by heterogeneity in reporting and were driven primarily by individual trials. No significant differences were found in COPD, acute respiratory emergencies, upper respiratory events, or patient-reported respiratory symptoms among the anti-VEGF agents.</div></div><div><h3>Conclusions</h3><div>Intravitreal anti-VEGF agents do not appear to significantly increase the risk of COPD compared with sham injections. Differences observed across respiratory events should be interpreted cautiously given heterogeneous reporting across RCTs and highlight the need for further research with standardized safety reporting.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 1006-1017"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Flame-shaped epiretinal membranes: expanding the spectrum beyond neurofibromatosis type 2","authors":"Meira Fogel Levin,&nbsp;Avner Hostovsky,&nbsp;Alessandro Feo,&nbsp;Melissa Yao,&nbsp;Ahmad Santina,&nbsp;Rania Estawro,&nbsp;Joo Yeon Jung,&nbsp;Neda Abraham,&nbsp;Stacy L. Pineles,&nbsp;David Sarraf","doi":"10.1016/j.jcjo.2026.02.004","DOIUrl":"10.1016/j.jcjo.2026.02.004","url":null,"abstract":"<div><h3>Objective</h3><div>To characterize the spectral-domain optical coherence tomography (SD-OCT) features of flame-shaped epiretinal membranes (ERMs) in patients with and without neurofibromatosis type 2 (NF2).</div></div><div><h3>Methods</h3><div>This retrospective study included 9 patients (13 eyes) with flame-shaped ERMs from 3 tertiary centres. Multimodal imaging and clinical data were systematically analyzed.</div></div><div><h3>Results</h3><div>Six of 9 subjects with flame-shaped ERM were confirmed NF2 patients. Among the NF2 cohort of 12 eyes, SD-OCT revealed flame-shaped ERMs in 10 eyes (83%). Flame-shaped ERMs were bilateral in 4 patients (8 eyes) and unilateral in 2 patients (2 eyes). The fellow eyes of these 2 unilateral patients demonstrated combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) and a retinal tuft, respectively. Isolated CHRRPE was noted in 3 eyes (25%) and a retinal tuft in 2 eyes (17%). Multiple retinal findings within the same eye occurred in 3 NF2 patients. By contrast, all 3 non-NF2 patients exhibited unilateral flame-shaped ERMs: 2 with CHRRPE and 1 isolated. OCT angiography performed in 4 patients revealed hyper-reflective foci anterior to the retinal nerve fibre layer in all 3 NF2 patients. During mean follow-up of 6.2 ± 3.4 years, findings remained stable in 78% of patients. One NF2 patient developed intraretinal cysts, while 1 non-NF2 patient underwent vitrectomy.</div></div><div><h3>Conclusions</h3><div>Flame-shaped ERMs are strongly associated with NF2, and bilateral retinal lesions were present in all NF2 patients. However, they can also occur unilaterally with or without CHRRPE in non-NF2 cases. Early recognition of flame-shaped ERMs enables timely and systematic NF2 evaluation.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 936-943"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147282434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ocular adverse events associated with aflibercept and faricimab: a population-based pharmacovigilance study","authors":"Sara Kamali Zonouzi,&nbsp;Michael Balas,&nbsp;Parnian Arjmand","doi":"10.1016/j.jcjo.2026.02.010","DOIUrl":"10.1016/j.jcjo.2026.02.010","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the postmarketing ocular adverse events (AEs) reported for intravitreal antivascular endothelial growth factor (anti-VEGF) therapies, aflibercept (2 mg and 8 mg), and faricimab (6 mg).</div></div><div><h3>Design</h3><div>Retrospective pharmacovigilance analysis.</div></div><div><h3>Participants</h3><div>Food and Drug Administration Adverse Event Reporting System (FAERS) database.</div></div><div><h3>Methods</h3><div>We conducted a retrospective pharmacovigilance analysis of the FAERS database from the fourth quarter of 2023 to the first quarter of 2025. Descriptive statistics and reporting odds ratio (ROR) analysis were employed to evaluate and compare AEs between 2 mg aflibercept, 8 mg aflibercept, and faricimab.</div></div><div><h3>Results</h3><div>A total of 462 unique reports of AEs secondary to 2 mg aflibercept, 151 reports for 8 mg aflibercept, and 2 427 reports for faricimab were identified. Ocular AEs that were disproportionately over-reported for all of the 3 agents included intraocular injection complications, increased intraocular pressure, endophthalmitis, reduced visual acuity, eye inflammation, uveitis, visual impairment, and blurred vision.</div></div><div><h3>Conclusions</h3><div>In this study, faricimab generally showed lower point estimates for ROR of ocular AEs compared to 2 mg and 8 mg aflibercept; however, the wider confidence intervals for some outcomes reflect the limited number of reports and highlight the need for continued safety monitoring, particularly given the inherent reporting biases and lack of detailed patient or dosing information in the FAERS database.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 990-998"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147462569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A real-world pharmacovigilance analysis of uveitis from systemic medications","authors":"Fahad Butt,&nbsp;Andrew Mihalache,&nbsp;Salem Abu Al-Burak,&nbsp;Ryan S. Huang,&nbsp;Marko M. Popovic,&nbsp;Rajeev H. Muni","doi":"10.1016/j.jcjo.2026.03.007","DOIUrl":"10.1016/j.jcjo.2026.03.007","url":null,"abstract":"<div><h3>Objective</h3><div>To identify U.S. Food and Drug Administration (FDA)-approved systemic drugs disproportionately associated with reported uveitis events using real-world pharmacovigilance data.</div></div><div><h3>Design</h3><div>A retrospective pharmacovigilance study of a large spontaneous adverse event reporting database.</div></div><div><h3>Participants</h3><div>All uveitis cases reported to the FDA Adverse Event Reporting System (FAERS) between the fourth quarter of 2003 and the third quarter of 2024.</div></div><div><h3>Methods</h3><div>FAERS data were analyzed using OpenVigil 2.1 data-mining software. Reports identifying FDA-approved drugs as primary suspects in uveitis cases were included. Disproportionality analyses were conducted by comparing drug-specific uveitis reports with the background reporting rate across all other drugs in the database. Reporting odds ratios (RORs) with 95% confidence intervals (CIs) were calculated. Bayesian confidence propagation neural network algorithms were applied to reduce false-positive associations and strengthen signal detection.</div></div><div><h3>Results</h3><div>A total of 7 301 uveitis events were identified. The strongest safety signals were observed for cidofovir (ROR = 103.8; 95% CI 53.0–203.2) and rifabutin (ROR = 77.4; 95% CI 50.5–118.7). Additional signals were detected for cobimetinib (ROR = 30.5), foscarnet (ROR = 29.0), infliximab (ROR = 18.1), dabrafenib (ROR = 16.4), vemurafenib (ROR = 16.2), trametinib (ROR = 15.5), brodalumab (ROR = 14.9), binimetinib (ROR = 11.3), encorafenib (ROR = 11.2), ipilimumab (ROR = 11.0), and moxifloxacin (ROR = 10.3). Implicated drug classes included antivirals, antibiotics, biologics, mitogen-activated protein kinase kinase inhibitors, and v-Raf murine sarcoma viral oncogene homolog B1 (or BRAF) inhibitors.</div></div><div><h3>Conclusions</h3><div>Multiple systemic agents demonstrated disproportionate uveitis reporting in FAERS. Although these findings do not establish causality, they highlight potential safety signals that warrant continued pharmacovigilance, heightened clinical awareness, and further population-based studies to clarify absolute risk and underlying mechanisms.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 1018-1024"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipemia retinalis: a case study of a rare finding in pediatric retina secondary to diabetes","authors":"Colin Xu,&nbsp;Anna Le Saint,&nbsp;Anas Abuseif,&nbsp;Alissa Guarneri,&nbsp;Ken K. Nischal,&nbsp;Meghal Gagrani,&nbsp;Matthew S. Pihlblad,&nbsp;Marie-Helene Errera","doi":"10.1016/j.jcjo.2026.03.023","DOIUrl":"10.1016/j.jcjo.2026.03.023","url":null,"abstract":"","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 1057-1060"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ophthalmic manifestations of Chiari malformation: a systematic review","authors":"Alaina Dhawan,&nbsp;Jillian Dhawan,&nbsp;Ajay N. Sharma,&nbsp;Daniel B. Azzam,&nbsp;Michael G. Fehlings,&nbsp;Matthew P. Quinn,&nbsp;Danah Albreiki","doi":"10.1016/j.jcjo.2026.03.026","DOIUrl":"10.1016/j.jcjo.2026.03.026","url":null,"abstract":"<div><h3>Objective</h3><div>Chiari malformation (CM) comprises congenital or acquired hindbrain herniations (&gt;5-mm cerebellar tonsillar descent below the foramen magnum) that disrupt cerebrospinal fluid flow and compress neural structures. While neurological symptoms are well recognized, ophthalmic manifestations, such as papilledema, diplopia, and nystagmus, which are uncommon in the overall CM population but may serve as important diagnostic clues when present, remain undersynthesized. This systematic review summarizes the ophthalmic manifestations of CM to identify symptom patterns, mechanisms, and implications for early diagnosis and interdisciplinary management.</div></div><div><h3>Methods</h3><div>EMBASE and MEDLINE databases were searched in June 2024, following PRISMA guidelines. English-language articles describing ophthalmic findings in patients with CM, presented as case study/series, or literature review were included.</div></div><div><h3>Results</h3><div>Thirty-two articles met the inclusion criteria, representing 41 individual patient cases. The most common ophthalmic symptoms were diplopia (37%), decreased visual acuity (22%), and visual field loss (28%). Diplopia often resulted from esotropia secondary to 6th nerve palsy, whereas visual acuity and field loss were secondary to papilledema. Among reported cases, the most frequently reported ophthalmic signs were papilledema (44%), nystagmus (32%), and esotropia (29%). In pediatric patients (n = 15), the symptoms of diplopia occurred in 53% of the cases and the sign of esotropia occurred in 53%; usually from the 6th nerve palsy. Papilledema was reported in 27% of the pediatric cases but was the predominating finding among adults (n = 26).</div></div><div><h3>Conclusions</h3><div>CM demonstrates distinct age-related ophthalmic patterns. In symptomatic patients, targeted neuro-ophthalmic evaluation may aid earlier diagnosis and guide management. Further prospective studies are needed to clarify pathophysiology and optimize interdisciplinary management.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 918-928"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International validation of a staging system for ciliary body and choroidal melanomas using estimated tumour volume","authors":"Sacha Nahon-Estève,&nbsp;Jean-Pierre Caujolle,&nbsp;Célia Maschi,&nbsp;Jesintha Navaratnam,&nbsp;Jørgen Krohn,&nbsp;Nils A. Eide,&nbsp;Emine Kiliç,&nbsp;Erwin Brosens,&nbsp;Fabiana L. Bassil,&nbsp;Iwona Rospond-Kubiak,&nbsp;Aleksandra Krasińska-Płachta,&nbsp;Svenja R. Sonntag,&nbsp;Ayseguel Tura,&nbsp;Salvatore Grisanti,&nbsp;Gustav Stålhammar","doi":"10.1016/j.jcjo.2026.01.020","DOIUrl":"10.1016/j.jcjo.2026.01.020","url":null,"abstract":"<div><h3>Objective</h3><div>To validate a newly proposed anatomic staging system for choroidal and ciliary body melanoma, based on tumour volume estimated from routine clinical measurements, and compare its prognostic performance with the American Joint Committee on Cancer (AJCC) 8th edition classification.</div></div><div><h3>Design</h3><div>A retrospective, multicentre cohort study<strong>.</strong></div></div><div><h3>Participants</h3><div>A total of 5 410 consecutive patients diagnosed with choroidal and/or ciliary body melanoma at 6 European ocular oncology centres.</div></div><div><h3>Methods</h3><div>Tumours were staged according to both classifications. Prognostic performance was evaluated using competing risk regression, Cox regression, Kaplan–Meier survival analyses, and net reclassification improvement.</div></div><div><h3>Results</h3><div>The new classification showed better prognostic discrimination than the AJCC system, with a net reclassification improvement of 23%. In competing risk regression, it produced a higher Wald statistic (761 vs 628) and a subdistribution hazard ratio of 1.42 versus 1.22. Cox regression for melanoma-related mortality demonstrated higher hazard ratios, peaking at 24 for the new model compared with 13 for the AJCC classification. Cumulative incidence analyses revealed 15-year metastatic death rates ranging from 7% to 76% with the new system versus 11% to 69% with AJCC, widening the absolute range by 11 percentage points.</div></div><div><h3>Conclusions</h3><div>This large international validation study demonstrates that the new volume-based classification provides more accurate prognostic stratification for choroidal and ciliary body melanoma. Its improved risk discrimination, using readily available clinical measurements, supports its applicability in clinical practice and potential utility for guiding follow-up and resource allocation.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 955-966"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical predictors of disease severity in nasal versus temporal retinopathy of prematurity","authors":"Nicole T. Nudelman,&nbsp;Zena Ibrahim,&nbsp;Sonia Scallon,&nbsp;Samhita Bheemireddy,&nbsp;Paul J. Feustel,&nbsp;Joshua Salandy,&nbsp;Nicole A. Storey,&nbsp;Gerard P. Barry","doi":"10.1016/j.jcjo.2026.02.008","DOIUrl":"10.1016/j.jcjo.2026.02.008","url":null,"abstract":"<div><h3>Objective</h3><div>Recognition of factors associated with a greater need for treatment may be useful in managing retinopathy of prematurity (ROP). We aim to assess the relationship between nasal and temporal ROP on initial presentation and an infant’s eventual need for treatment.</div></div><div><h3>Methods</h3><div>All patients screened for ROP between January 2018 and December 2020 were retrospectively reviewed. Data were collected on all patients (n = 286) with stage 1 or higher ROP. Eyes were classified as either nasal ROP or temporal-only ROP at initial presentation of ROP. Data from all ROP screening exams until treatment or completion of screening were reviewed. The primary outcome was treatment-required ROP. Additional data collected included birth weight, patient age, and laterality. Outcomes were compared using univariable and multivariable logistic regression analyses.</div></div><div><h3>Results</h3><div>Five hundred forty-two eyes were included for analysis. Eyes with nasal ROP on initial presentation were more likely to ultimately require treatment (63/197 [32%]) than eyes with temporal-only ROP on initial presentation (13/345 [4%]; odds ratio [OR]: 12.0, 95% CI: 6.40–22.54) using a univariable logistic regression analysis. A separate multivariable regression analysis demonstrated that eyes with nasal ROP remain more likely to require treatment (OR: 3.28, 95% CI: 1.54–6.99), even when also accounting for birth weight (OR: 0.40/100 g, 95% CI: 0.32–0.51), patient sex, and laterality.</div></div><div><h3>Conclusions</h3><div>Eyes with nasal ROP at initial presentation are more likely to eventually require treatment than those with temporal-only ROP at initial presentation, even when accounting for other risk factors. Nasal ROP at initial presentation should prompt particular attention when monitoring for progression of ROP.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 978-981"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact lens-associated microbial keratitis following keratoplasty: rates and predisposing factors","authors":"Anddre Osmar Valdivia,&nbsp;Dylan Stevens,&nbsp;Victoria Sattarova,&nbsp;Vania Rashidi,&nbsp;Joshua H. Hou,&nbsp;Wassef Chanbour","doi":"10.1016/j.jcjo.2026.03.001","DOIUrl":"10.1016/j.jcjo.2026.03.001","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this study is to investigate the rates of infectious keratitis in patients using contact lenses (CL) post-keratoplasty and to determine associated risk factors that contribute to postoperative infection in contact lens users.</div></div><div><h3>Design</h3><div>A retrospective cohort study.</div></div><div><h3>Participants</h3><div>Patients examined at the University of Minnesota Eye Clinic, a tertiary care referral center, between November 2012 and January 2023.</div></div><div><h3>Methods</h3><div>Parameters included demographic data, contact lens use, and ocular history. Statistical analyses comprised univariate and multivariate assessments. Only parameters that demonstrated significance in all analyses were considered significant.</div></div><div><h3>Results</h3><div>Seventy-six patients post-keratoplasty (74 penetrating keratoplasty and 2 deep anterior lamellar keratoplasty), who subsequently used CL, were included. Infectious keratitis occurred in 11.8% (n = 9) of cases, and all underwent penetrating keratoplasty. No statistically significant differences were found in age at CL fitting or duration of CL use between the infected and noninfected groups. Univariate analysis revealed higher rates of infection in patients with a history of limbal stem cell transplant (<em>p</em> = 0.003), prior infections (<em>p</em> = 0.02), persistent epithelial defects (<em>p</em> = 0.02), and redo keratoplasty (<em>p</em> = 0.03). Multivariate analysis confirmed these findings, with specific factors, including limbal stem cell transplant history, persistent epithelial defects, and redo keratoplasty history being significant contributors to infection risk.</div></div><div><h3>Conclusions</h3><div>Caution is advised regarding CL use postkeratoplasty, particularly in patients with epithelial defects, a history of redo keratoplasty, or limbal stem cell transplant, as they exhibit increased susceptibility to infectious keratitis. These findings highlight the importance of postoperative management and personalized risk assessment to mitigate the risk of complications associated with CL use following keratoplasty.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 833-839"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147572230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating and reducing environmental waste in oculofacial plastic procedures","authors":"Sruti Rachapudi,&nbsp;Lucy I. Mudie,&nbsp;Patrick J. Hunt,&nbsp;Michael T. Yen","doi":"10.1016/j.jcjo.2026.03.009","DOIUrl":"10.1016/j.jcjo.2026.03.009","url":null,"abstract":"<div><h3>Objective</h3><div>To identify, develop, and implement interventions that reduce the environmental impact of oculoplastic procedures.</div></div><div><h3>Methods</h3><div>Oculoplastic procedures performed in either office-based surgery suites or ambulatory surgery centers at 2 sites were observed by an independent observer. Waste audits were performed to quantify the number of used and unused discarded items. Targeted interventions were developed from meetings with surgeons and staff, and procedure setups were adjusted accordingly.</div></div><div><h3>Results</h3><div>The study included 59 clinic procedures and 44 operating room procedures across 2 sites. Most waste was from textiles, plastics, and medications. The most commonly performed procedures were blepharoplasty, eyelid lesion excisions, and botulinum toxin injections. The most commonly opened yet discarded surgical supplies were cotton-tip applicators (12.8 ± 6) and gauze (9.5 ± 7). Our intervention consisted of reducing the preemptive opening of excess disposable items during oculoplastic procedures, with the option to open more as needed. We reduced preprocedure setups of cotton-tip applicators from 20 to 8 and 4 × 4 gauze squares from 10 to 8 for the office-based procedure, and reduced cotton-tip applicators from 20 to 10 and gauze from 20 to 10 for operating room procedures. These measures reduced wasted cotton tips from 12 to 3 per procedure and gauze squares from 10 to 3.</div></div><div><h3>Conclusions</h3><div>Environmental waste in oculoplastic surgery can be significantly reduced with targeted interventions. We strongly recommend against the preemptive opening of excess cotton-tip applicators and gauze squares for procedures. Other potential interventions include multiuse of topical medications between cases, minimal surface area draping, and optimizing surgical supply packaging and instructions for use.</div></div>","PeriodicalId":9606,"journal":{"name":"Canadian journal of ophthalmology. Journal canadien d'ophtalmologie","volume":"61 4","pages":"Pages 973-977"},"PeriodicalIF":2.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}