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Grand RoundsWeekly Evidence Brief

Ophthalmology

Edition

30-Second Takeaway

  • Toric IOLs in selected pediatric cataract cases improve long-term CDVA and reduce amblyopia versus nontoric lenses.
  • Half-dose PDT provides durable control for chronic CSC, while most eplerenone-treated eyes ultimately require PDT rescue.
  • DALK offers endothelial and refractive advantages over mushroom PK in keratoconus with comparable long-term visual acuity.
  • Non-physician intravitreal injection programs safely expand anti-VEGF capacity when training and governance are robust.
  • Ocular POCUS and mNGS have focused roles; they supplement but do not replace specialist assessment and standard diagnostics.

Week ending February 14, 2026

Targeted Procedures, Safer Systems, and Smarter Diagnostics in Everyday Ophthalmic Practice

Toric IOLs improve 3-year vision and amblyopia outcomes in congenital pediatric cataract with significant astigmatism

AMERICAN JOURNAL OF OPHTHALMOLOGYFeb 7, 2026

In this prospective nonrandomized study, 194 children aged 3–8 years with congenital cataract and ≥2.0 D corneal astigmatism received toric or nontoric IOLs. Both groups showed marked UDVA and CDVA gains, but toric lenses achieved significantly better mean CDVA at 3 years. More toric eyes reached nonamblyopic vision (CDVA ≥0.8) and had consistently lower postoperative refractive astigmatism throughout follow-up. In children with >3.0 D preoperative astigmatism, toric IOLs produced superior CDVA from 3 months to 3 years without clinically important rotation events.

Half-dose PDT shows durable superiority over eplerenone for chronic CSC in longer-term SPECTRA follow-up

ACTA OPHTHALMOLOGICAFeb 12, 2026

The SPECTRA randomized trial followed 107 chronic CSC patients treated with half-dose PDT or oral eplerenone for 24 months. By 3 months, 90% of eplerenone eyes and 20% of PDT eyes crossed over to half-dose PDT for persistent subretinal fluid. At 24 months, complete fluid resolution occurred in 80% of primary PDT and 88% of primary eplerenone groups, with similar functional outcomes. Findings indicate that definitive half-dose PDT, rather than prolonged eplerenone, underlies long-term anatomic and visual results in chronic CSC.

OTS and Pediatric OTS correlate with visual outcome but only moderately match actual categories after open-globe injury

OPHTHALMOLOGYFeb 9, 2026

This systematic review and meta-analysis included 47 studies encompassing 12,515 open-globe injuries evaluating OTS and Pediatric OTS performance. Higher OTS/POTS scores correlated moderately to strongly with better final vision in pediatric cohorts, with correlations around 0.60–0.65. Agreement between predicted and observed visual categories was only moderate (Cohen’s κ≈0.48) with substantial heterogeneity. Overall certainty of evidence was graded moderate, suggesting scores are helpful for group-level counseling but not deterministic for individuals.

Non-physician intravitreal injection services maintain safety while substantially increasing anti-VEGF capacity

ACTA OPHTHALMOLOGICAFeb 11, 2026

This systematic review summarized 16 studies reporting 100,150 intravitreal anti-VEGF injections delivered by trained non-physician staff. All injectors underwent structured, supervised training, and endophthalmitis rates (0.015%–0.07%) matched physician-led benchmarks. Task-shifted services increased capacity by roughly 25%–85%, reducing waiting times and costs without compromising efficiency. Patients reported high satisfaction and confidence in non-physician injectors, supporting broader adoption within robust governance frameworks.

References

Numbered in order of appearance. Click any reference to view details.

Additional Reads

Optional additional studies from this edition.

Edition context

Clinical signal

  • Procedural choices in pediatric cataract, macular surgery, keratoplasty, and chronic CSC meaningfully affect long-term structure and function.
  • Service redesign with non-physician injectors can safely address volume pressures, but ED POCUS has limited triage impact.
  • Trauma scoring systems provide only moderate individual-level prognostic accuracy, supporting cautious use in counseling.