Ophthalmology

Five-year outcomes support standard epi-off CXL across pediatric to adult keratoconus

In 243 eyes with progressive keratoconus, standard epithelium-off CXL produced significant CDVA improvement maintained through 60 months. Kmax flattening was greatest in the first two years and remained stable through 48 months, indicating durable biomechanical effect. Central corneal thickness decreased initially but showed gradual re-thickening after 24 months while remaining below baseline, suggesting stromal remodeling. Wavefront aberrations were stable and adverse events were minimal across pediatric, adolescent, and adult subgroups. These data support timely referral and intervention for progressive keratoconus with standard epi-off CXL in a diverse U.S. population. 1

DIMS lenses modestly slow pediatric myopia progression over 12 months

This meta-analysis of six studies including 1,224 myopic children compared DIMS spectacle lenses with single-vision lenses over 12 months. DIMS lenses reduced spherical equivalent progression by a pooled mean difference of 0.37 D versus single-vision lenses. They also reduced axial elongation by 0.16 mm, indicating structural impact on eye growth during the first treatment year. Most participants were from China, and heterogeneity was moderate to high, limiting global generalizability. Durability of effect beyond one year and performance versus other defocus spectacle designs remain uncertain. 2

Preoperative brimonidine linked to higher trabeculectomy failure from high IOP

This retrospective cohort of 501 eyes undergoing primary trabeculectomy evaluated the impact of preoperative glaucoma medications on surgical success. Preoperative brimonidine use was associated with an increased hazard of high IOP failure (HR 2.87; p = 0.002). Higher baseline IOP also increased failure risk, whereas beta-blockers, prostaglandins, and carbonic anhydrase inhibitors showed no significant effect. At three years, probability of success from high-IOP failure was 81.9% with brimonidine versus 93.36% without brimonidine. These findings support critically reviewing and potentially modifying brimonidine use before trabeculectomy. 3

Aflibercept 8 mg allows interval extension in DME with maintained vision

In this multicenter real-world cohort, 156 DME eyes received aflibercept 8 mg for 12 months, including treatment-naïve and pretreated patients. Treatment-naïve eyes gained vision, improving from 72.9 to 77.7 ETDRS letters, while pretreated eyes maintained vision without significant loss. Central subfield thickness decreased significantly in both groups, and up to 38.1% of naïve and 27.2% of pretreated eyes became fluid-free centrally. Treatment intervals extended to about 15 weeks in naïve eyes and from 7.6 to 13.0 weeks in pretreated eyes. Noninfectious intraocular inflammation and acute IOP rises occurred only in pretreated eyes, but overall adverse events were infrequent. 4