To explore the application effect of a multi-track teaching strategy integrating Outcome-Based Education (OBE) concept with Case-Based Learning (CBL), Problem-Based Learning (PBL), Team-Based Learning (TBL), and multi-station teaching methods in pediatric ophthalmology clinical internship courses. A total of 212 fifth-year pediatric undergraduate students who completed ophthalmology clinical internships from April to May 2025 were selected. They were divided into a research group (107 students, odd-numbered groups) and a control group (105 students, even-numbered groups) according to internship groups (15-16 students per group). The research group adopted a multi-track teaching model based on OBE concept, while the control group followed a traditional clinical internship teaching model. The pre-class, in-class, and post-class teaching evaluations and course satisfaction of the two groups were compared. SPSS 20.0 was used for statistical analysis. Count data were expressed as n (%), analyzed by χ² test; measurement data were expressed as (x̄ ± s), analyzed by independent samples t-test. The post-class case analysis score of the research group was significantly higher than that of the control group (45.10 ± 1.36 vs. 41.50 ± 1.35, P < 0.05). The in-class evaluation scores of the research group in operational skills, case analysis, doctor-patient communication, and teamwork ability were significantly higher than those of the control group (19.34 ± 0.57 vs. 16.97 ± 0.37, 19.53 ± 0.87 vs. 17.95 ± 0.69, 19.26 ± 0.65 vs. 17.92 ± 0.78, 19.42 ± 0.68 vs. 17.58 ± 0.65, P < 0.001). In the teaching feedback, the research group's scores in learning motivation (4.85 ± 0.13 vs. 4.21 ± 0.18), key concept comprehension (4.72 ± 0.21 vs. 4.21 ± 0.18), integration of theory and clinical practice (4.87 ± 0.18 vs. 4.28 ± 0.15), and formation of clinical diagnostic thinking (4.84 ± 0.12 vs. 4.27 ± 0.23) were significantly higher than those of the control group (P < 0.001). The overall evaluation of the internship course by the research group was significantly higher than that of the control group (4.82 ± 0.24 vs. 4.32 ± 0.18, P < 0.001). The OBE concept-based multi-track teaching model was associated with improved clinical reasoning, practical skills, and self-directed learning among pediatric ophthalmology interns, suggesting potential value for clinical teaching quality.
Clinical medicine postgraduates are expected to attain competencies equivalent to senior resident physicians. However, ophthalmology graduate students often struggle to integrate optometry theory with clinical practice during rotations. To address this gap, we developed and evaluated a blended clinical internship model combining Massive Open Online Courses (MOOC) and digital twin-supported high-fidelity surgical simulation (HFS) technology. A randomized controlled trial was conducted with 54 ophthalmology graduate students and 16 trained teachers. Students were randomly assigned to an experimental group (n = 27) receiving the MOOC-HFS blended internship and a control group (n = 27) receiving traditional teaching. Outcomes included an initial assessment after the MOOC phase (henceforth referred to as Test 1), a post-class assessment (Test 2), and a final examination (Test 3) as well as scores on the Course Experience Questionnaire (CEQ), Revised Two-Factor Study Process Questionnaire (R-SPQ-2 F), and a teacher satisfaction questionnaire. Data were analyzed using t-tests and non-parametric tests. The experimental group achieved significantly higher scores in all assessments (P < 0.05), with greater improvements in practical skill-focused Refractive Classroom than memory-based Amblyopia Classroom. They also demonstrated superior CEQ scores, deeper learning approaches in R-SPQ-2 F, and higher teacher satisfaction (all P < 0.001). The MOOC-HFS blended model, structured as "theory → simulation → practice," effectively synergizes MOOC flexibility with HFS realism, significantly enhancing academic performance, deep learning, course experience, and teaching satisfaction. This model redefines teacher roles and establishes a competency-based framework, providing an evidence-based reference for optometry clinical education optimization. Further multi-center and long-term studies are needed to confirm generalizability.
To report the proportion and risk factors associated with retinal changes in Chinese pregnant women diagnosed with HELLP syndrome. A retrospective review of medical records was conducted for all pregnant women with HELLP syndrome delivered at the Second Affiliated Hospital of Wenzhou Medical University between September 2010 and August 2023. Retinal changes were identified and were categorized into retinal vascular changes and serous retinal detachment based on the ophthalmology consultation records. The proportion of retinal changes was calculated, and associated risk factors were analyzed. A total of 70 cases with HELLP syndrome were included, with a mean age of 30.1 ± 5.2 years. Forty-nine cases received ophthalmology consultation, presenting a consultation rate of 70.0%. The proportion of retinal changes was 55.1% (27/49) in cases with HELLP syndrome. The proportion of retinal vascular changes and serous retinal detachment were 30.6% (15/49) and 24.5% (12/49), respectively. Patients with retinal vascular change (120.7 ± 8.0 mmHg) and those with serous retinal detachment (116.7 ± 14.5 mmHg) demonstrate significantly elevated diastolic blood pressure at the time of HELLP syndrome diagnosis compared to case without retinal changes (110.1 ± 12.4 mmHg, P = 0.032). HELLP syndrome cases treated with corticosteroids were more likely to develop serous retinal detachment compared to those not receiving corticosteroids (40.0% vs. 13.8%, P = 0.040). The proportion of retinal changes was 55.1% among Chinese pregnant women with HELLP syndrome. Elevated diastolic blood pressure was identified as associated risk factor for developing retinal changes. The use of corticosteroids may have more risk of developing serous retinal detachment.
Cerebrotendinous xanthomatosis (CTX) is a rare yet treatable neurometabolic disorder caused by pathogenic variants in the CYP27A1 gene. Juvenile-onset cataracts may precede systemic signs, allowing for early diagnosis. This study evaluated the prevalence of CYP27A1 variants in patients with bilateral juvenile cataracts and described related clinical findings. This single-center retrospective study was conducted between May 2022 and April 2025 at Başakşehir Çam and Sakura City Hospital, Istanbul. Patients aged 6 months to 21 years with bilateral juvenile cataracts of undetermined etiology were included. Those with congenital, traumatic, or defined metabolic cataracts were excluded. All underwent ophthalmic evaluation and targeted CYP27A1 sequencing (exons 1-9, exon-intron boundaries) with confirmatory Sanger sequencing. Variants were classified per ACMG/AMP guidelines using ClinVar, HGMD, VarSome, and Franklin databases. Among 128 patients (42.2% male, 57.8% female; mean age 10.9 ± 9.4 years), two (1.5%, 95% CI: 0.2-5.4) carried a novel homozygous CYP27A1 c.398G > A (p.W133*) pathogenic variant, and three (2.4%, 95% CI: 0.5-6.9) had a heterozygous c.884 C > T (p.A295V) variant of uncertain significance. Both families had parental consanguinity. Both patients with homozygous pathogenic variants presented with bilateral cerulean cataracts. The absence of systemic symptoms at diagnosis highlights the feasibility of ophthalmology-based genetic screening for CTX. Identifying affected individuals before neurological onset enables timely initiation of oral chenodeoxycholic acid replacement therapy, which may reduce cholestanol and bile alcohol accumulation and help prevent irreversible complications. Incorporating CYP27A1 sequencing into the evaluation of bilateral juvenile cataracts may facilitate earlier detection of CTX and timely referral for appropriate management, especially in high-consanguinity regions.
Effective participant recruitment is crucial for the success of clinical trials, yet little is known about facilitators and barriers to recruitment in pediatric populations with visual impairment. Understanding which methods yield the highest participant engagement can help optimize recruitment efforts and improve study outcomes. Thus, we assessed factors associated with recruitment in the SeeMyLife study, a European multi-center cohort study about quality of life and participation of children and young people with visual impairment. Data on the perceived effectiveness of recruitment strategies were collected from principal investigators, study coordinators, clinical and research staff using an online survey. Additional information on recruitment approaches was obtained through document analysis of study-related communications, including e-mails and meeting minutes. Descriptive statistics were used to summarize recruitment rates and perceived effectiveness scores. Open-ended responses regarding recruitment challenges were analyzed thematically to identify common barriers and facilitators. Seventeen clinical and research staff members from six countries participated in the survey and shared their insights and experience with participant recruitment. In total, study staff reported using twelve distinct recruitment sources to enhance participant enrolment. These sources were grouped into three broad categories: healthcare settings, community engagement and educational settings, and professional and system-level approaches. The recruitment of participants using the hospital information system was perceived as the most effective recruitment strategy, used by 71% of respondents. Other highly ranked sources included pediatric visual rehabilitation centers, patient associations, and affiliated university ophthalmology departments, where staff actively presented the study to their patients and referred eligible participants. Commonly reported recruitment challenges included restrictive inclusion criteria, limited parental responsiveness, concerns about the impact of study participation on children's well-being, and institutional barriers. Successful strategies for enrolling children and young people with visual impairment into clinical research include direct interactions between clinical staff and families, likely due to established trust, easier identification of eligible participants, and clearer communication about the study. In contrast, recruitment approaches outside clinical care settings were perceived as less effective. These findings highlight the importance of integrating recruitment efforts within established healthcare networks when conducting pediatric vision impairment research.
The dynamic visual acuity (DVA) is crucial to assess dynamic visual function in clinical ophthalmology. The impact of objective ocular parameters on DVA remained unknown, which limits the clinical applicability and interpretability of the DVA test. Thus, the present research aims to investigate the impact of objective visual quality and retinal structure on DVA. Healthy young myopic adults aged 18 to 35 years were recruited. Binocular dynamic visual acuity (DVA) was evaluated at a 1-meter distance with habitual spectacles. The test comprised four sequential assessments of horizontal motion DVA at increasing velocities of 20, 40, 60, and 80 degrees per second (dps). Modulation transfer function (MTF) and higher-order aberrations (HOA) were measured to evaluate visual quality. Retinal structure, including retinal thickness and capillary density in the optic disc and macula was measured with optical coherence tomography angiography (OCTA). Thirty participants were enrolled with a mean age of 23.0 ± 3.7 years. DVA differed significantly across velocities (P < 0.001). DVA at 20 dps (r = -0.537, P = 0.002) and 60 dps (r = -0.430, P = 0.018) were negatively correlated with the binocular mean sphere. DVA at 20 and 60 dps was significantly associated with MTF value from 5 to 30 cycle/degree (c/d), and 80 dps DVA was associated with MTF value at spatial frequencies from 10 to 20 c/d (P < 0.05, respectively). The Z9 aberration showed a positive association with DVA at 20 dps (P = 0.047), and the Z7 aberration showed a significant positive association with DVA at 80 dps (P = 0.030). Limited associations were observed between DVA and retinal thickness or capillary density in the optic disc and macula. In healthy myopic adults, better objective visual quality, as measured by MTF, might be associated with better DVA at both low and high speeds, whereas retinal structural parameters had a limited association with DVA. The conclusions are limited by applicating habitual spectacle during the DVA test, which precludes full quantification of optical confounding.
Pterygium progression induces corneal optical distortion, and delayed surgery may limit postoperative recovery of corneal optics. However, quantitative criteria indicating the latest acceptable timing of surgery remain unclear. This study aimed to determine extension-rate thresholds predicting postoperative normalization of corneal asymmetry and higher-order irregularity (HOI). This retrospective observational study included 134 eyes with primary pterygium that underwent surgical excision. The pterygium extension rate was calculated from slit-lamp photographs as the ratio of the apex-to-limbus distance to the horizontal corneal diameter. Corneal asymmetry and HOI within the central 3-mm zone were measured preoperatively and 1 month postoperatively using swept-source anterior segment optical coherence tomography. Receiver operating characteristic (ROC) analyses were used to determine cutoff values predicting postoperative normalization. The pterygium extension rate correlated significantly with preoperative corneal asymmetry (r = 0.5899, p < 0.001) and HOI (r = 0.5462, p < 0.001). ROC analysis showed good predictive ability for postoperative corneal asymmetry (AUC 0.80; cutoff 0.359; sensitivity 58.0%, specificity 89.3%) and moderate predictive ability for HOI (AUC 0.74; cutoff 0.292; sensitivity 72.3%, specificity 64.7%). Postoperative normalization occurred in 62.7% of eyes for asymmetry and 38.1% for HOI. The pterygium extension rate is a simple clinical metric that predicts postoperative optical recovery. These extension-rate thresholds may help support clinical estimation of how long pterygium surgery may be deferred while maintaining the possibility of postoperative optical recovery.
We report a rare case of histopathologically confirmed epithelial cell proliferation on the anterior surface of an intraocular lens (IOL) following Descemet stripping automated endothelial keratoplasty (DSAEK). A 61-year-old female with a history of multiple ocular surgeries, including phacoemulsification cataract extraction and DSAEK, was referred for progressive visual deterioration. Clinical examination revealed resistant deposits on the anterior surface of the posterior chamber IOL, confined to the pupillary zone. Despite repeated interventions-including Nd: YAG laser treatment and surgical polishing of the IOL surface-the opacities persisted, ultimately necessitating IOL explantation and histopathological analysis. Light microscopy confirmed epithelial cell proliferation on the IOL surface. Examination of the stained lens revealed a sheath of cellular imprints and ghost cells. Unlike previously reported cases of IOL opacification, von Kossa staining demonstrated no calcium phosphate deposits, suggesting a distinct pathological mechanism originating from epithelial cell proliferation, likely derived from the capsular bag. Epithelial cell proliferation should be considered in the differential diagnosis of unexplained, persistent IOL surface opacities following DSAEK. In this case, definitive diagnosis was established only through histopathological evaluation of the explanted lens.
School-based myopia screening commonly relies on non-cycloplegic refraction because cycloplegic refraction is difficult to implement universally at scale. This study evaluated whether non-cycloplegic spherical equivalent (NC-SE) could serve as a low-burden first-stage triage metric to identify children who warrant cycloplegic assessment for possible hyperopia reserve insufficiency (HRI). This cross-sectional school-based study included 1,650 children aged 6-15 years from Zengcheng District, Guangzhou, China. All participants underwent non-cycloplegic autorefraction, UCVA assessment, and cycloplegic autorefraction. Cycloplegic spherical equivalent (Cyclo-SE) was used as the reference standard for defining HRI, cycloplegic myopia, and pseudomyopia. HRI was operationally defined as preserved UCVA with low cycloplegic hyperopic reserve: Cyclo-SE from 0 to + 1.25 D in children aged 6-8 years and from 0 to + 1.00 D in children aged 9-15 years. Diagnostic performance of NC-SE for identifying HRI was assessed using receiver operating characteristic (ROC) analysis. The prevalence of HRI was 14.1%, 10.5%, and 3.9% in the 6-8, 9-11, and 12-15-year-old groups, respectively. Correlation between NC-SE and Cyclo-SE strengthened with age (Spearman's rho: 0.641, 0.675, and 0.813; all p < 0.001). For detecting HRI, NC-SE achieved an AUC of 0.661 (95% CI: 0.618-0.704). A pragmatic cutoff of -0.50 D yielded a sensitivity of 0.824 (95% CI: 0.765-0.870), specificity of 0.550 (95% CI: 0.524-0.575), PPV of 20.5% (95% CI: 17.9-23.4), and NPV of 95.7% (95% CI: 94.1-96.9). Among children with normal visual acuity, 24.1% had pseudomyopia. NC-SE may serve as a low-burden first-stage triage metric in school-based screening to identify children who warrant cycloplegic assessment for possible HRI. However, its moderate AUC and low PPV indicate that NC-SE should not be interpreted as a stand-alone diagnostic test. Cycloplegic refraction remains necessary for confirming hyperopic reserve status. Further longitudinal studies incorporating axial length, accommodative measurements, and external validation are needed to determine its prognostic value for incident myopia. Not applicable.
This study aimed to evaluate retinal and choroidal microcirculation in transfusion-dependent β-thalassemia (TDβT) patients and to explore associations between systemic iron overload and ocular structural and vascular changes. A total of 66 eyes from 33 TDβT patients and 66 eyes from 33 healthy controls were included in this case-control study. Retinal and choroidal structures were evaluated using Spectral-Domain OCT and OCT-Angiography (OCTA). Systemic iron overload was assessed using serum ferritin and MRI-T2* of the liver and heart. Liver iron load was classified by T2* values into normal, mild, and moderate. Key ocular parameters, including central macular thickness (CMT), subfoveal choroidal thickness (SCT), luminal area (LA), stromal area (SA), total choroidal area (TA), and vessel density (VD) of superficial (SCP), deep (DCP), and choriocapillaris (CC) plexi, were analyzed. Choriocapillaris VD was significantly lower in TDβT patients compared with controls (p < 0.001, p adjusted = 0.004), while ferritin levels showed positive correlations with CMT, SCP VD, and CC VD within the patient group. Patients with moderate liver iron overload showed increased trend toward LA, SA, TA, SCT, and inferior peripapillary VD, but this significance not existed after FDR correction. No significant relationship was found between iron overload and FAZ metrics. Liver iron overload may be associated with changes in choroidal structure and perfusion in TDβT patients, although chronic anemia-related hypoxia and compensatory vascular responses may also contribute to these findings.Choroidal parameters may provide useful non-invasive indicators for monitoring ocular effects of systemic iron burden.
To evaluate real-world efficacy, durability, and safety of faricimab in treatment-naïve Asian patients with neovascular age-related macular degeneration (nAMD). Retrospective study of treatment-naïve nAMD eyes treated with faricimab at a single centre in South Korea. After four monthly loading doses, treatment intervals (Q8W, Q12W, Q16W) were assigned based on disease activity at weeks 20 and 24. Comprehensive assessments included best-corrected visual acuity (BCVA), central subfield thickness (CST), pigment epithelial detachment (PED) height, subfoveal choroidal thickness (SFCT), and intraretinal/subretinal fluid (IRF/SRF) presence. Eighty-eight treatment-naïve eyes were included. Mean age was 72.8 (9.0) years. At week 20, BCVA improved from 62.1 (15.4) to 69.3 (14.6) ETDRS letters (+ 7.1 letters, P < 0.001). CST decreased from 414 (150) to 280 (94) µm (- 134 μm, P < 0.001). PED height decreased from 297 (167) to 171 (116) µm (- 43%, P < 0.001). SFCT decreased from 208 (91) to 184 (83) µm (- 12%, P < 0.001), with PCV eyes showing the greatest reduction (- 32 μm, P < 0.001). IRF presence (1 mm/6 mm) decreased from 33%/34% to 7%/9%, and SRF from 78%/84% to 12%/20% at week 20. At week 60, 52.3% achieved Q16W and 67.0% achieved ≥Q12W intervals. Among 168 eyes in the safety analysis, there was 1 case of mild vitritis and 2 cases of RPE tear, with no cases of endophthalmitis or retinal vasculitis reported. Initiation of faricimab in treatment-naïve nAMD patients resulted in favourable visual and anatomical outcomes with durable treatment intervals and a low incidence of adverse events in a real-world setting.
Keratorefractive lenticule extraction (KLEx) is a widely used refractive procedure, but intraoperative suction loss remains a critical complication. While the faster laser frequency of the VisuMax 800 theoretically reduces this risk, it can still occur, occasionally presenting as sliding suction loss. In this phenomenon, the globe shifts while partial suction is maintained, resulting in a complete but decentered lamellar plane. This creates a surgical dilemma where standard re-docking protocols risk double cuts. In this report, we describe the first case of using the CIRCLE software as a rescue strategy specifically for sliding suction loss. A 30-year-old male with - 4.25 diopter (D) myopia and - 0.25 D astigmatism underwent KLEx surgery using the VisuMax 800. During the peripheral cap cut, a sudden Bell's phenomenon caused the eye to shift, resulting in a sliding suction loss. The cap cut was completed in an inferiorly decentered position, while the subsequent incision was interrupted at 48.5%. To avoid corneal irregularities from standard re-initiation, the procedure was aborted. The following day, a rescue procedure was performed using CIRCLE software. By creating a junction (5.5 mm diameter, with a vertical offset of ± 5 μm) that precisely integrated with the existing decentered cap plane, the surgeon successfully bypassed the irregular incision and extracted the lenticule uneventfully. One month postoperatively, the patient achieved an uncorrected distance visual acuity of -0.04 logMAR, with stable refraction and a well-centered treatment zone confirmed by tomography. Sliding suction loss represents a specific intraoperative challenge that can occur even with high-speed laser systems. This case demonstrates that the CIRCLE software is a highly effective rescue tool for managing such complex interfaces. By enabling safe access to existing lamellar planes, CIRCLE software extends its utility from refractive enhancement to a vital intraoperative rescue strategy, preventing permanent corneal irregularities and ensuring excellent visual outcomes.
This study is aimed to evaluate retinal pigment epithelium (RPE) entropy in eyes with full-thickness macular hole (FTMH) using polarization-sensitive optical coherence tomography (PS-OCT). Patients diagnosed with treatment-naïve FTMH who underwent pars plana vitrectomy with internal limiting membrane peeling were included. Ophthalmologic examinations, including visual acuity (BCVA), swept-source OCT (SS-OCT), and PS-OCT, were performed. Polarimetric entropy (PE) of RPE was assessed using PS-OCT and compared with affected and fellow eyes and before and after surgery. Fourteen eyes of 14 patients were included (64.5 ± 5.84 years). All eyes achieved complete FTMH closure following the surgery. PE value within the central foveal area (< 200 μm from the foveal center) was significantly lower than that in fellow eyes (p = 0.013), whereas PE in the area surrounding FTMH was significantly higher (p = 0.0402). The interocular difference in foveal PE (affected eye minus fellow eye) was significantly and negatively correlated with baseline BCVA (p = 0.0445). Postoperatively, PE in the surrounding area significantly decreased, whereas foveal PE did not change. Eyes without EZ recovery exhibited significantly greater baseline foveal PE reduction than those with EZ recovery (p = 0.0053). These findings suggest two spatially distinct RPE responses in FTMH: decreased entropy in the foveal area and increased entropy in the surrounding region. Foveal RPE-PE quantified by PS-OCT is associated with EZ recovery and may reflect postoperative structural outcomes.
Scleral tunnel formation during Yamane double-needle intrascleral haptic fixation (ISHF) depends on proprioceptive estimation, producing variable tunnel lengths that contribute to intraocular lens (IOL) malalignment. The aim of this study was to evaluate a needle bevel-guided technique using the innate 2 mm bevel of a 26-gauge needle as a visual endpoint for standardising intrascleral tunnel length, and to assess postoperative IOL positional stability using a quantitative geometric landmark framework. Retrospective consecutive case series of 24 eyes undergoing ISHF in the horizontal meridian (3- and 9-o'clock positions) by a single surgeon. During scleral needle advancement, the bevel disappearance point was used to standardise tunnel length to approximately 2 mm at each fixation site. IOL centration was quantified by extracting limbus centre (L) and optic centre (O) from intraoperative and 6-month images, and flange coordinates (F1, F2) from intraoperative images only using Fiji/ImageJ (National Institutes of Health, Bethesda, MD, USA; version 2.14.0/1.54f). The primary outcome was longitudinal Euclidean displacement of the optic centre. Mean best-corrected visual acuity improved from 1.28 ± 0.54 to 0.52 ± 0.47 logMAR (p < 0.001). Mean IOL decentration was 0.401 ± 0.240 mm at baseline and 0.397 ± 0.234 mm at 6 months (mean change - 0.004 mm; p = 0.457). Mean Euclidean displacement was 0.029 ± 0.018 mm; no eye demonstrated displacement exceeding 0.06 mm. No haptic extrusion, IOL dislocation, or sight-threatening complications occurred. The needle bevel provides a simple, reproducible, and cost-free visual cue for standardising intrascleral tunnel length during ISHF and was associated with excellent longitudinal positional stability. Initial centration, governed by entry angle and chord length symmetry, remains a separate challenge requiring complementary strategies.
To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. A cross-sectional survey was conducted among 142 eye health workers across all health workers providing cataract surgery or post-operative care in Tanzania. The survey assessed counselling practices, timing recommendations for resuming 23 daily activities, medication prescription patterns, and follow-up protocols. Variation indices (VI) were calculated to quantify the degree of disagreement among providers using the formula: VI = 1 - (modal frequency/total responses). Variation was classified as low (VI < 0.40), moderate (0.40-0.60), high (0.60-0.70), or very high (> 0.70). Survey respondents included ophthalmology residents (28%), consultant ophthalmologists (22%), ophthalmic nursing officers (17%), assistant medical officers (13%), and optometrists (12.0%). Only 30%of providers routinely provide written post-operative instructions to patients. Substantial variations existed across most activities examined: watching television (VI = 0.775), computer use (VI = 0.761), smartphone use (VI = 0.754), bending for prayers (VI = 0.725), and sexual activity (VI = 0.690). Recommendations for activity resumption ranged from Day 1 to 6 weeks post-operatively (a 41-day span) for most activities. Good consensus existed only for phone use (59.2% allow Day 1, VI = 0.323) and eating normal diet (48.6% allow Day 1, VI = 0.434). Provision of written instructions varied significantly by professional designation (χ²=28.85, p = 0.0013), but activity recommendations showed no significant correlation with designation, years of experience, or surgical volume. The modal number of follow-up visits was 4 (32.4%), with the last visit most commonly scheduled at 8 weeks (30.3%). Substantial variations in post-operative cataract surgery instructions reflect the absence of evidence-based guidelines rather than individual provider factors. The critical deficit in written instruction provision (only 30%) and wide variation in activity restrictions have significant implications for patient compliance, quality of life, and economic productivity. Development of standardized, evidence-based, culturally appropriate guidelines is urgently needed for Tanzania and similar settings in sub-Saharan Africa.
Understanding how retinal morphological features are associated with the risk of developing depression and anxiety disorders holds significant implications for public health and early detection strategies. This study aims to investigate the association between optical coherence tomography (OCT)-detected retinal features and the incidence of depression and anxiety. This cohort study was conducted using data from UK Biobank participants aged 40-70 years who underwent retinal OCT imaging at recruitment. Baseline retinal morphological features, including the retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GCIPL), inner nuclear layer (INL), photoreceptor layer (PRL), retinal pigment epithelium (RPE), and macular thickness, were segmented from macular-centered OCT images. Depression and anxiety disorders were identified using International Classification of Diseases (ICD) codes. Cox proportional hazards regression models were used to assess the association of retinal features with incident depression and anxiety, with the full model adjusting for demographic, lifestyle, and comorbid factors. A total of 36,220 participants were included (mean [SD] age, 55.90 [8.22] years, 47.8% male). Over a median follow-up duration of 12.5 years, 1340 new cases of depression and 1373 new cases of anxiety were observed. In fully adjusted Cox hazard regression models, each standard deviation (SD) increase in GCIPL and macular thickness was associated with a lower risk of incident depression (HR [95%CI], 0.92 [0.87, 0.97]; and 0.91 [0.86, 0.96], respectively). The associations of GCIPL and macular thickness with incident depression were more pronounced among females. On the other hand, there was no association between retinal features and incident anxiety disorders in the fully adjusted model. Thinner GCIPL and macular thickness were independently associated with increased risk of depression, especially in females. Our findings highlight a potential role of OCT-detected retinal features as additional biomarkers for at-risk stratification of depression.
To compare the optical qualities of a novel enhanced monofocal intraocular lens (IOL) - Extend (Hanita), against a well-established IOL - Eyhance (ICB00, J&J Vision) - through in vitro benchmarking. Optical benchmarking was conducted using the OptiSpheric IOL PRO2 device in compliance with International Organization for Standardization (ISO) guidelines. Optical quality was assessed using the modulation transfer function (MTF), point spread function (PSF), area under the MTF (MTFa), and 1951 USAF test charts. Measurements were taken at 3.0 mm and 4.5 mm apertures using a model cornea that induced 0.13 μm of spherical aberration to simulate clinical performance. Both IOLs demonstrated comparable optical performance. At a 3 mm aperture, the Extend produced an average MTF at 50 lp/mm of 0.38 ± 0.01, while the ICB00 produced 0.36 ± 0.01. The MTFa and derived logMAR visual acuity (VA) curves showed nearly complete overlap for defocus levels less than - 1.25 D, with both lenses yielding identical VA at far focus (-0.09 logMAR). At higher defocus levels, the observed difference between the models accounted for < 0.02 logMAR, which is small and below the resolution threshold of standard VA testing. Point spread function assessments revealed comparable light distribution for both IOLs. Under laboratory conditions, the Hanita Extend IOL shows comparable results to the Eyhance ICB00 regarding MTF function, USAF-Chart images, and PSF assessment.
To estimate the yearly and 15-year cumulative incidence of scleritis requiring surgical repair in patients with a prior diagnosis of scleritis who received a subconjunctival or subTenon triamcinolone acetonide injection (STAI). A retrospective cohort study was conducted using the TriNetX US Collaborative Network. TriNetX is an electronic health records database with anonymized, deidentified encrypted data from 69 healthcare networks. Subjects with a history of scleritis were identified using ICD-10 (International Classification of Diseases, 10th Revision) code H15.0X and who subsequently underwent a STAI as identified using the CPT (current procedural terminology) code between January 1, 2009 to December 31, 2024. CPT codes were used to identify STAIs include subconjunctival injection (68200) or subTenon injection (67515) and injection of triamcinolone acetonide 10 mg (J3301). Please note that H15.0X codes specifying posterior scleritis were excluded from this cohort in an attempt to localize anterior scleritis. The time relation was set to ensure all patients in the cohort had an existing diagnosis of scleritis prior to any instance of STAI. The primary outcome measure was the annual and 15-year cumulative incidence of required surgical repair within 4 weeks, and 3, 6, 9, and 12 m after the STAI as best estimated by scleral graft reinforcement and repair of scleral staphyloma with graft, CPT 67255 or 66225. Final data collection ran on April 23, 2026. Possible confounding procedures such as cataracts were also excluded within the time period assessed in order to better localize the STAI for use in cases of scleritis. Out of 113,510,724 patients on the TriNetX database, 36,249 had a diagnosis of scleritis. Of those with a history of scleritis, 176 had a subconjunctival or subTenon triamcinolone injection (STAI). Of this cohort, 0 patients needed surgical interventions requiring a patch graft over the 15-year time period of the study giving an annual and cumulative incidence of 0 per 100,000 persons. The subjects were primarily female (112, 63.64%) with a mean age of 61 years (range 14-90, SD 16). Surgical intervention requiring a patch graft was not observed post-injection among patients with prior scleritis who received a STAI. Further studies with larger cohorts are necessary to accurately represent the risk profile of STAI in the greater population.
To investigate the changes in the neurovascular unit (NVU) of the retina in rats following optic nerve (ON) injury, and to explore the translational implications for traumatic optic neuropathy (TON). The ON transverse quantitative traction (ONTQT) was performed to establish the model of ON and retinal injury. The rats were divided into the sham operation group (SG) and the model group (MG). At 14th day post-modeling, flash visual evoked potential (FVEP) test was performed to evaluate the visual function. Transmission electron microscopy (TEM) was used to observe the microstructure of retinal NVU. RNA binding protein with multiple splicing (RBPMS) immunofluorescence was applied to detect the survival retinal ganglion cell (RGC). The activity of astrocytes and Müller cells in retina was detected by glial fibrillary acidic protein (GFAP) immunofluorescence. The expression of tight junction proteins (Claudin-1, Claudin-5) and glial end feet markers aquaporin-4 (AQP4) and inwardly rectifying potassium channel subtype 4.1 (Kir4.1) in retinal tissue were test by western blot and Quantitative Real-Time Polymerase Chain Reaction (qRT-PCR). At 14th day following ONTQT, the FVEP results exhibited the prolonged peak latency of P2 and the reduced amplitudes of N1-P1 and N2-P2. TEM showed structural changes of the basement membranes in NVU and ultrastructural abnormalities of tight junctions (TJs) after ONTQT. Besides, the expression of RBPMS in ganglion cell layer (GCL) was down-regulated and GFAP was over-expression in the injured retinal sections. The relative expressions of claudin-1and claudin-5 declined and the mRNA levels of AQP4 increased in the retina at 14 days following ONTQT. The mRNA levels of Kir4.1 was downregulated in the retina of MG. ONTQT can be applied in the model of ON and retina injury. The dysfunction of retinal NVU may promotes the optic degeneration in rats following ONTQT, contributing to the RGC loss and impaired visual function. These findings provide a mechanistic basis for NVU-targeted neuroprotection and identify potential clinical biomarkers for the diagnosis and treatment of TON.
Customized corneal cross-linking (CXL) has primarily been performed using the epithelium-off technique. Evidence on epithelium-preserving (transepithelial or epi-on) customized procedures remains limited, particularly with high oxygen concentrations (> 90%) beyond 1 year. We evaluated the 3-year clinical outcome and safety of customized transepithelial CXL (custom TE-CXL) with oxygen supplementation in patients with progressive keratoconus. This retrospective study included 74 individuals (90 eyes) with progressive keratoconus who underwent custom TE-CXL with oxygen supplementation and were followed for at least 3 years. Outcomes included visual acuity, keratometric parameters, corneal thickness, and total corneal higher-order aberrations (HOAs). Examinations were performed at baseline and at 1, 2, and 3 years postoperatively. Longitudinal changes were analyzed using a linear mixed-effects model adjusted for baseline values. From 1 year onward, uncorrected visual acuity (UCVA) and maximum keratometry (Kmax) showed significant improvement compared with preoperative values. Least squares mean (LSMean) Kmax values decreased from 56.2 D at baseline to 54.9 D, 54.4 D, and 54.2 D at 1, 2, and 3 years, respectively (all P < 0.01). UCVA improved at 1 year and remained stable thereafter, whereas corrected distance visual acuity (CDVA) showed no significant changes. Total HOAs, including coma and spherical aberration, decreased progressively over time. Apical corneal thickness decreased gradually, and thinnest corneal thickness showed significant reductions from 1 year onward. No adverse events, such as infection or corneal haze, were observed during follow-up. This descriptive, non-comparative analysis showed that custom TE-CXL with oxygen supplementation may be associated with stabilization of keratoconus over a 3-year period without observed adverse events. Further randomized controlled studies are warranted to evaluate its comparative effectiveness.