A recent Ophthalmology digest,
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Study Type: Retrospective multicentre cohort study (propensity-matched, US aggregated EHR data, 70 organisations)

Key Question: Is systemic TNF-α inhibitor use associated with altered 10-year risk of incident primary open-angle glaucoma?

Key Findings:

• Among 11,915 matched pairs (age ≥40, uveitis excluded), 10-year POAG diagnosis was lower in TNF-α inhibitor users: 2.0% vs 3.3% (HR 0.70, 95% CI 0.59–0.82).
• Significant reductions were seen for adalimumab (HR 0.74, 0.57–0.96) and infliximab (HR 0.68, 0.47–0.97); no significant differences between agents on pairwise comparison.
• Etanercept, certolizumab and golimumab results were not reported in the abstract.

Clinical Relevance: Hypothesis-generating support for an inflammatory component in glaucomatous neurodegeneration, but it should not alter UK practice or influence prescribing decisions for rheumatology, gastroenterology or dermatology patients.

Limitations: Reliance on ICD-10 coding for outcomes and retrospective EHR data leaves the study open to detection bias, residual confounding (e.g., steroid exposure, disease severity, ophthalmic screening frequency in biologic users) and misclassification, with no IOP or structural data.

Study Type: Retrospective single-centre cohort study (50 eyes of 50 adults; US tertiary referral centre)

Key Question: What are the presenting features, surgical strategies, complications and visual/IOP outcomes of Morgagnian cataract?

Key Findings:

• Presentation: BCVA hand motions or worse in 86%; lens-induced IOP elevation in 48%, lens-induced glaucoma in 38%, zonular weakness in 42% (18/43).
• Of 40 operated eyes, 75% had phacoemulsification attempted; intraoperative complications 35% (posterior capsule rupture 20%); only 40% received an in-the-bag IOL.
• Mean BCVA improved from 2.39 to 0.68 logMAR (P<0.001), with 50% achieving 20/40 or better; mean IOP fell from 26.0 to 16.7 mmHg at 1 month, but 50% remained on IOP-lowering medication.

Clinical Relevance: Although rare in UK practice, these cases pose high intraoperative risk and warrant senior-led planning, with capsular tension support and alternative IOL fixation options available.

Limitations: Retrospective design with small sample, variable follow-up and tertiary referral selection limits generalisability; no comparison of surgical techniques is possible.

Study Type: Prospective observational cross-sectional validation study (70 patients, 140 eyes).

Key Question: Does the UCI Corneal Cystine Crystal Score, a 0–5 slit-lamp grading tool, reliably reflect objective corneal changes and symptom burden in cystinosis?

Key Findings:

• Inter-rater reliability was excellent (ICC 0.995; 95% CI 0.992–0.996).
• Higher grades correlated with anterior and central Pentacam densitometry (p = 0.0011, p = 0.0016) and with photophobia (τ = 0.397), foreign-body sensation (τ = 0.295) and dryness (τ = 0.405).
• No significant association with BCVA (p = 0.4389) or with topical cysteamine treatment group.

Clinical Relevance: Cystinosis is rare in the UK, with care concentrated in specialist centres. This offers a standardised, reproducible grading tool that could support consistent monitoring across sites without requiring densitometry.

Limitations: The cross-sectional design cannot assess treatment responsiveness or prognostic value, and the lack of cysteamine group differences may reflect uncontrolled confounding rather than true absence of effect.

Study Type: Prospective, randomised, parallel-group clinical trial (60 eyes, ≥12 months follow-up)

Key Question: Does adding an autologous anterior lens capsule spacer to combined phacoemulsification and deep sclerectomy (PE-DS) improve IOP control compared with PE-DS alone?

Key Findings:

• Mean IOP was lower with the spacer at 6 months (11.90 ± 1.82 vs 13.13 ± 2.20 mmHg; P = 0.022) and 12 months (12 ± 2.20 vs 13.29 ± 2.68 mmHg; P = 0.042). Both groups achieved significant reductions from baseline.
• Glaucoma medication use was numerically lower with the spacer (12 months: 0.29 vs 0.68 agents) but not statistically significant (P = 0.063 at 6 months; P = 0.094 at 12 months).
• Under the stringent success definition (IOP ≤12 mmHg), survival was 47.5% vs 15.5% (log-rank P = 0.025).

Clinical Relevance: The spacer is a low-cost autologous option that may improve DS outcomes in cataract-glaucoma patients, though the benefit is a modest IOP difference of ~1.2 mmHg.

Limitations: Small single-population sample with no adjustment for multiple comparisons and unclear power, so the modest, borderline-significant differences need confirmation in larger trials.

Study Type: Retrospective post hoc analysis of prospective RCT data (Pagoda trial, NCT04108156), with detailed OCT sub-analysis in 56 PDS eyes.

Key Question: How common is true non-response to sustained VEGF-A suppression in DME, and how long does edema resolution take with continuous ranibizumab delivery via the Port Delivery System (PDS)?

Key Findings:

• CST normalised (≤325 µm) by last visit in 87.9% (PDS, n=272) and 85.3% (IVT-PDS, n=238); mean time to normalisation ~21 weeks. All eyes showed CST reduction over time, though some fluctuated or worsened late.
• In the 56-eye OCT sub-analysis, CST normalised in 93% (median 17 weeks); intraretinal fluid cleared from the central 1 mm in 84% (median 68 weeks).
• Only 3/56 eyes had poorly controlled DME at last follow-up.

Clinical Relevance: Supports the concept of "slow responders" rather than "non-responders" to anti-VEGF, which may inform decisions on switching or stopping treatment in UK DME pathways, though PDS availability and use in the NHS remain limited.

Limitations: Post hoc design with detailed OCT analysis restricted to a small subset (56 eyes, 8 sites), and no comparator for non-PDS delivery in the fluid-resolution analysis.

Study Type: Retrospective, multicentre diagnostic accuracy study (three US centres, 2020–2025).

Key Question: Can paracentral acute middle maculopathy (PAMM) on macular OCT help distinguish arteritic from non-arteritic anterior ischaemic optic neuropathy (AAION vs NAION)?

Key Findings:

• 119 patients (27 AAION, 92 NAION); PAMM present in 18.5% of AAION vs 5.4% of NAION (p = 0.032).
• Sensitivity 19% (95% CI 8–37%); specificity 94.6% (88–98%); PPV 50% (24–76%); NPV 79.8% (71–86%).
• Three of five NAION cases with PAMM followed severe systemic hypoperfusion.

Clinical Relevance: PAMM on OCT should heighten suspicion of GCA-related disease but cannot exclude it when absent, so it must not delay urgent GCA pathway assessment or treatment.

Limitations: Small AAION sample with wide confidence intervals and a retrospective design, which limits generalisability and precision of the estimates.

Study Type: Prospective multicentre case series with internal test-set and external validation cohort (98 eyes, 63 patients; 19-eye external cohort).

Key Question: Can a defocus curve derived from a single pyramidal wavefront aberrometry acquisition estimate the subjective through-focus acuity response in eyes with extended-depth-of-focus (EDOF) IOLs?

Key Findings:

• Mapped objective versus ETDRS acuity: RMSE 0.095 logMAR (95% CI 0.078–0.110) in the internal test set and 0.092 logMAR in the external cohort; bias ≤0.02 logMAR; 95% LoA roughly ±0.2 logMAR.
• Depth of field at 0.20 logMAR (objective minus subjective): bias −0.10 D (LoA −1.44 to +1.25 D) internally and −0.15 D (LoA −0.98 to +0.69 D) externally.
• Cohort-mean subjective depth of field was 2.43 D; 88.8% achieved corrected distance acuity of 20/20 or better.

Clinical Relevance: An objective, single-acquisition estimate of through-focus performance could supplement or partly replace time-consuming subjective defocus testing when evaluating EDOF IOLs in NHS and research settings.

Limitations: Individual-level precision is limited (wide LoA), and validation excluded diffractive designs and pupil-specific curves, so results cannot yet guide individual patient decisions.

Study Type: Retrospective, multicentre case series (n=12, Japan)

Key Question: What retinal phenotypes, clinical course and genotypes characterise NPHP1-associated Senior-Løken syndrome?

Key Findings:

• Marked inter- and intrafamilial phenotypic variability: cone/cone-rod dystrophy (4), retinitis pigmentosa (4), sector RP (2), pigmented paravenous retinochoroidal atrophy (1), normal retina (1).
• Retinopathy preceded nephropathy in 9/12 patients, all initially labelled as Leber congenital amaurosis or early-onset retinal dystrophy. FAF showed a "descending tract" in 5 patients.
• 11/12 carried a homozygous whole-NPHP1 deletion; 1 was compound heterozygous for NPHP1 and EYS variants.

Clinical Relevance: Children presenting with LCA/early-onset retinal dystrophy warrant early genetic testing, as NPHP1 diagnosis precedes renal disease and should trigger renal surveillance and multidisciplinary referral.

Limitations: Very small, genetically homogeneous Japanese cohort with variable follow-up (0–44 years), limiting generalisability to UK populations and any genotype–phenotype conclusions.