Ophthalmology

Long-term unilateral anti-VEGF greatly increases cataract surgery risk versus fellow eyes

In 603 phakic patients receiving ≥12 unilateral intravitreal anti-VEGF injections, injected eyes had much higher cataract surgery incidence than fellow eyes. Ten-year cumulative cataract surgery incidence was 40.7% in injected eyes versus 7.2% in untreated fellow eyes. Injected eyes had an approximately eightfold higher hazard of cataract surgery (HR 8.17; 95% CI 5.77–11.59), and older age further increased risk. At surgery, nuclear, cortical, and especially posterior subcapsular opacities were significantly worse in injected eyes. Long-term intravitreal anti-VEGF should be framed as a strong cataract-accelerating exposure when counseling and planning management in phakic patients. 1

Network meta-analysis favors conbercept for overall ROP efficacy and safety profile

This network meta-analysis pooled 53 studies with 8,787 eyes to compare conbercept, ranibizumab, and laser for ROP. Conbercept ranked best for cumulative efficacy (SUCRA 0.815) versus laser (0.533) and ranibizumab (0.152), with similar initial responses. Ranibizumab had higher recurrence (RR 3.62) and retreatment risk (RR 2.31) than laser, which ranked best for recurrence prevention. Conbercept showed lower ocular adverse events and fewer systemic complications, including NICU admissions, than laser and ranibizumab in available data. A 0.25 mg conbercept dose appeared to balance high inactivity rates with low adverse events, though higher-dose safety data were limited. 2

Metformin exposure associates with lower glaucoma risk in diabetics across multiple analytic approaches

Among 24,206 UK Biobank participants with diabetes, metformin use was associated with a 19% lower glaucoma risk over roughly 12 years. This association was independent of glycemic control, intraocular pressure, diabetes duration, and other measured confounders in European-ancestry participants. Random-effects meta-analysis of cohort studies showed a similar protective estimate for glaucoma incidence among metformin-treated diabetics. Drug-target Mendelian randomization found genetically proxied metformin-target effects associated with substantially lower primary open-angle glaucoma risk. Convergent findings support a possible causal protective effect, though they do not justify metformin prescribing solely for glaucoma prevention. 3

Home-based VR vision therapy modestly improves control in pediatric intermittent exotropia

This randomized trial assigned 177 children with untreated intermittent exotropia to 12 weeks of home-based VR vision therapy or observation. VR therapy led to a modest but statistically significant improvement in distance exotropia control score at 12 weeks versus control. Participants with ≥75% adherence had greater improvement than controls, suggesting a dose–response effect of VR-based training. Children with poorer baseline control (score ≥2) derived more benefit, whereas those with excellent control showed minimal effect. No intervention-related adverse events were reported, supporting VR therapy as a safe non-surgical adjunct for selected patients. 4