Macular Thickness and Microvasculature Loss in Glaucoma Suspect Eyes
Whereas the rate of GCC thinning was faster on average in suspect eyes than in healthy eyes, some suspect eyes showed significant loss of vessel density and faster vessel density loss than GCC thinning.
KEY FINDINGS: Whereas the rate of GCC thinning was faster on average in suspect eyes than in healthy eyes, some suspect eyes showed significant loss of vessel density and faster vessel density loss than GCC thinning. OCT and OCTA are complementary and useful for evaluating eyes with OHT or GON.
BACKGROUND: Objective of this study is to characterize the change of ganglion cell complex (GCC) thickness and macular vessel density in glaucoma suspect eyes with ocular hypertension (OHT) or glaucomatous optic neuropathy (GON).
DETAILS: OCT angiography (OCTA)-based vessel density and OCT-based structural thickness of the 3 x 3-mm1 GCC scan slab were evaluated at each visit. The rates of vessel density and thickness change were compared across diagnostic groups using a linear mixed-effects model. Significant mean rates of both GCC thinning and vessel density loss were detectable in OHT and GON groups. Of the individual suspect eyes, 49.1% showed significant loss (P < 0.05) with either vessel density or GCC thickness. Of the GON eyes, 31.0% showed both significant GCC loss and vessel density loss, 51.7% showed only significant GCC loss, whereas 17.2% showed only significant vessel density loss. Vessel density loss was faster than GCC thinning in half of the suspect eyes based on percent loss analysis. The age and scan quality-adjusted GCC thinning rates of the OHT group (-0.59 µm/year; P = 0.025) and GON group (-0.79 µm/year; P = 0.058) were faster than those of the healthy group (-0.11 µm/year), whereas the rate of vessel density loss was not significantly different among the diagnostic groups (all P > 0.2). Higher mean intraocular pressure during follow-up was associated with faster GCC thinning in the OHT group (P = 0.065) and GON groups (P = 0.015), but was not associated with the rate of vessel density decrease.
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Source: Hou, H., Moghimi, S., Kamalipour, A., et al. (2022). Macular Thickness and Microvasculature Loss in Glaucoma Suspect Eyes. Ophthalmology Glaucoma. 2022; 5(2): 170-178. Published: April, 2022. DOI: 10.1016/j.ogla.2021.07.009.
ILM Flap Technique May Improve Closure Rates for Large High-Myopic Macular Holes
In 499 eyes with large high-myopic macular holes, the 3-month closure rate was 72.4%. Closure declined with increasing hole size after ILM peeling and ILM flap procedures but not after AMT or ART. BCVA improved across all surgical groups, with a mean final gain of approximately 14.5 ETDRS letters.
KEY FINDINGS: In this large global series, ILM flap techniques demonstrated an important role in the management of large HMMHs and appeared more suitable than conventional ILM peeling as hole size increased. For very large defects, particularly those with a minimum diameter of >1000 µm, AMT or ART may offer an advantage because closure rates appeared less dependent on hole size. Meaningful visual improvement was observed across surgical approaches, supporting active surgical management in these complex cases. Interpretation should consider the retrospective design, variation in surgical practices among centers, and the small numbers of patients treated with AMT and ART.
BACKGROUND: Large high-myopic macular holes (HMMHs) are surgically challenging, and closure rates are lower than those reported in non-highly myopic eyes. The relative effectiveness of conventional internal limiting membrane (ILM) peeling, ILM flap techniques, and tissue-based approaches may vary according to macular hole size.
DETAILS: This global, multicenter, retrospective case series included 499 eyes of 463 patients with large HMMHs, defined by a minimum linear diameter of >=400 µm. Surgeries were performed between 2013 and 2023 by 37 surgeons worldwide, with a minimum follow-up of 3 months and a mean follow-up of 18.8 months. Surgical approaches included ILM peeling (n = 127), ILM flap (n = 285), amniotic membrane transplantation (AMT; n = 19), autologous retinal transplantation (ART; n = 36), and other techniques (n = 32). The primary outcome was macular hole closure at postoperative month 3, while secondary outcomes included changes in best-corrected visual acuity (BCVA). Outcomes were stratified according to the CLOSE Study Group size classification. The overall macular hole closure rate at 3 months was 72.4%. Closure rates decreased significantly as hole size increased following ILM peeling and ILM flap procedures. In contrast, closure rates with AMT and ART were not associated with increasing hole size, suggesting that tissue-based techniques may reduce the effect of defect size on surgical success in the largest HMMHs. Despite differences in anatomic closure across procedures, BCVA improved significantly from baseline at all follow-up time points in all surgical groups, with a mean final improvement of approximately 14.5 ETDRS letters.
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Source: Chau, V. Q., Abreu-Arbaje, N. A., Kitahata, S., et al. Surgical Management and Outcomes of Large High Myopic Macular Holes: Global Macular Hole Multicenter Study 3. Ophthalmology Retina. 2026; 46(8): 1345-1362 Published: August, 2026. DOI: 10.1097/IAE.0000000000004871
Fluocinolone Acetonide Implant as Baseline Therapy for Diabetic Macular Edema
This randomized Phase 4 study found that a fluocinolone acetonide implant-based treatment strategy maintained visual and retinal anatomical outcomes comparable with aflibercept monotherapy while significantly reducing overall injection burden. Although the primary endpoint was not met, the findings suggest that sustained corticosteroid therapy may offer a treatment-burden advantage in appropriately selected patients, with careful monitoring for cataract formation and intraocular pressure elevation.
Summary
Results from the Phase 4 NEW DAY Study
[Posted 16/Jul/2026]
AUDIENCE: Ophthalmology, Internal Medicine
KEY FINDINGS: This randomized Phase 4 study demonstrated that baseline treatment with the fluocinolone acetonide implant achieved visual and anatomic outcomes comparable to aflibercept monotherapy while reducing the total number of intravitreal injections by more than half over 18 months. Although steroid-associated cataract and IOP events occurred more frequently, the overall safety profile was consistent with previous studies, supporting the FAc implant as a potential early treatment strategy for selected patients with DME.
BACKGROUND: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy remains the standard treatment for diabetic macular edema (DME), but the need for frequent injections and clinic visits can create a substantial treatment burden. The fluocinolone acetonide (FAc) 0.19-mg intravitreal implant provides sustained corticosteroid delivery and has demonstrated efficacy in persistent DME. The Phase 4 NEW DAY study evaluated whether using the FAc implant as baseline therapy, supplemented with aflibercept only when needed, could reduce injection burden while maintaining visual and anatomic outcomes comparable with aflibercept monotherapy.
DETAILS: NEW DAY was a prospective, randomized, single-masked, active-controlled, multicenter, 18-month Phase 4 trial conducted at 42 sites in the United States. A total of 517 participants were screened, and 306 adults with type 1 or type 2 diabetes and center-involving DME were randomized to receive either a 0.19-mg FAc implant (n = 154) followed by rescue aflibercept injections as needed or aflibercept (n = 152) administered as five loading doses every four weeks followed by rescue treatment when required. The primary endpoint was the mean number of rescue supplemental aflibercept injections during the study. Secondary outcomes included total intravitreal injections, time to first rescue injection, best-corrected visual acuity (BCVA), central subfield thickness (CST), cataract procedures, and intraocular pressure (IOP)-related safety outcomes. The primary endpoint was not met, with a similar mean number of rescue aflibercept injections in the FAc and aflibercept groups (2.4 ± 3.2 vs. 2.5 ± 3.1; P = 0.76). However, the FAc strategy substantially reduced overall treatment burden, requiring fewer total injections than aflibercept monotherapy (3.4 ± 3.2 vs. 7.2 ± 3.4; nominal P < 0.001). Time to first rescue injection was significantly longer with the FAc implant (185.4 ± 97.9 days vs. 132.8 ± 94.0 days; nominal P < 0.001). Approximately one-third of participants in both groups required no rescue injections throughout the study (32.5% vs. 30.3%; nominal P = 0.68). Improvements in visual acuity and retinal anatomy were comparable between groups, with mean BCVA changes of 1.8 letters and 5.5 letters (nominal P = 0.08) and mean CST reductions of -119 ± 112 µm and -114 ± 103 µm (nominal P = 0.71) in the FAc and aflibercept groups, respectively. Cataract procedures occurred more frequently with the FAc implant (27.9% vs. 6.6%), and increased IOP was reported in 15.6% of FAc-treated participants compared with 3.3% receiving aflibercept. Despite these steroid-related adverse events, incisional IOP procedures were uncommon, and no new safety signals were identified.
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Source: Singer, M. A., Wykoff, C. C., Riemann, C. D., et al. Fluocinolone Acetonide Implant as a Baseline Therapy for Diabetic Macular Edema. American Academy of Ophthalmology. 2026; 133(7): 837-851. Published: June 22, 2026. DOI: 10.1016/j.ophtha.2026.03.019.
Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks
Findings suggest intensive chemoprophylaxis of 70% or more of residents in response to influenza outbreaks in NHs within the first 2 days is associated with a lower 14-day risk of hospitalization among residents, with additional evidence to support a benefit when 60% or more or 80% or more of residents receive chemoprophylaxis. These findings could strengthen evidence-based recommendations to inform best practices in managing influenza outbreaks in NHs.
KEY FINDINGS: Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.
BACKGROUND: Influenza outbreaks in nursing homes (NHs) pose a substantial threat to older adults, often resulting in morbidity and mortality. The Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) recommend prompt postexposure prophylaxis, also termed chemoprophylaxis or prophylaxis with oseltamivir, for all residents who are not ill to limit influenza spread in NHs. Purpose of the study is to examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days.
DETAILS: Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018-May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026.
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Exposures: Intensive antiviral chemoprophylaxis with oseltamivir (>=70% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to <70% of eligible residents).
Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs).
Among 404 outbreaks in 318 NHs, 35,086 resident-trial observations (29,683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17,155 observations; 17,931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of -0.06% (95% CI, -0.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of -0.96% (95% CI, -1.78% to -0.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death.
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Source: Silva, J. B. B., Hsieh, H. T., Howe, C. J., et al. Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks. JAMA Internal Medicine.. 2026; 186(6): 714-722. Published: June, 2026. DOI: 10.1001/jamainternmed.2026.0401
The Association between Socioeconomic Status and Structural or Functional Baseline Measurements for Patients Receiving a Trabeculectomy
Lower SES is associated with worse optic nerve damage and VF performance at presentation for eyes that eventually undergo trabeculectomy surgery.
KEY FINDINGS: Lower SES is associated with worse optic nerve damage and VF performance at presentation for eyes that eventually undergo trabeculectomy surgery.
BACKGROUND: Objective of this study is to evaluate the association between socioeconomic status (SES; represented by a patient's neighborhood area deprivation index) and structural and functional measurements of the eye at initial presentation for those who eventually underwent trabeculectomy. Authors identify patients who underwent a trabeculectomy and had at least 1 OCT scan and 1 visual field (VF) test before undergoing surgery. Patients of any age with either progressing glaucoma or uncontrolled intraocular pressure, or both, who underwent a trabeculectomy and were a part of the DOMAIN cohort study were included.
DETAILS: Authors use a subject's first recorded OCT scan and VF test to obtain baseline structural and functional measurements. We next use patient addresses to determine their census block, which is then matched to the corresponding proxy for SES. Univariate and multivariate regressions controlling for race, age, and gender were used to analyze the associations between SES and structural and functional measurements at baseline. Among the 154 eyes in the study, we find that living in an area with greater deprivation is associated with worse structural (larger cup volumes [CVs], thinner retinal nerve fiber layer, and ganglion cell-inner plexiform layer) and functional (lower visual field index [VFI] and mean deviation [MD]) measures at baseline. However, these associations only remained statistically significant in the multivariate analysis for CV, VFI, and MD after controlling for a patient's race, gender, and age. In addition, when comparing those living in the best and worst neighborhoods, we find that living in the area with the highest decile level of deprivation is associated with a 6.63 dB lower MD at presentation compared to those living in areas with the least deprivation.
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Source: Chen, J. L., Lavinsky, F., Lee, T., et al. The Association between Socioeconomic Status and Structural or Functional Baseline Measurements for Patients Receiving a Trabeculectomy. Ophthalmology Glaucoma. 2026; 9(3): 302-308. Published: May-Jun, 2026. DOI: 10.1016/j.ogla.2025.12.007.
Efficacy of Low-Dose Oral Isotretinoin Combined with Fractional Microneedle Radiofrequency Versus Low-Dose Oral Isotretinoin Monotherapy in the Treatment of Moderate-To-Severe Acne Vulgaris
Early active treatment with isotretinoin and FMRF is safe and better than isotretinoin monotherapy over 44 weeks regarding severity, reduced erythema, and improved surface roughness in moderate-to-severe acne vulgaris. This encourages early and effective treatment of acne to mitigate acne scarring and improve patients' quality of life.
Summary
A Randomized Controlled Comparative Study
[Posted 19/May/2026]
AUDIENCE: General Surgery, Family Medicine
KEY FINDINGS: Early active treatment with isotretinoin and FMRF is safe and better than isotretinoin monotherapy over 44 weeks regarding severity, reduced erythema, and improved surface roughness in moderate-to-severe acne vulgaris. This encourages early and effective treatment of acne to mitigate acne scarring and improve patients' quality of life.
BACKGROUND: Oral isotretinoin is the standard therapy for severe acne. However, scarring may persist. Fractional microneedling radiofrequency (FMRF) improves both inflammatory lesions and scars with minimal downtime. In this study, we compare isotretinoin monotherapy and concurrent isotretinoin and FMRF for active acne regarding clinical outcomes. The GAGS scores of isotretinoin and FMRF were significantly lower than those of isotretinoin monotherapy from weeks 12-44 (-79.69% vs. -60.34% at week 44, respectively; p < 0.001). Isotretinoin and FMRF showed significantly greater lesion count reductions than isotretinoin monotherapy at follow-up visits from weeks 12-44. Isotretinoin and FMRF showed significantly lower hemoglobin levels than isotretinoin monotherapy at weeks 32 and 44 (p = 0.029 and p < 0.001, respectively). Skin surface roughness improved substantially and persistently from week 12-44.
DETAILS: In this parallel two-group comparative study, patients received either low-dose isotretinoin monotherapy for 20 weeks (n = 34) or low-dose isotretinoin concurrently with 5 monthly FMRF sessions (n = 36). Outcomes were assessed at baseline and weeks 12, 20, 24, 32, and 44. The primary endpoints were Global Acne Grading System (GAGS) scores and inflammatory/non-inflammatory lesion counts. Secondary endpoints were hemoglobin indices and skin roughness.
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Source: Disphanurat, W., Leeyangyuen, P,, and Srisantithum, B. Efficacy of Low-Dose Oral Isotretinoin Combined With Fractional Microneedle Radiofrequency Versus Low-Dose Oral Isotretinoin Monotherapy in the Treatment of Moderate-To-Severe Acne Vulgaris: A Randomized Controlled Comparative Study. Lasers in Surgery and Medicine. 2026; 58(4): 321-330. Published: April, 2026. DOI: 10.1002/lsm.70120.
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