Shu-Han Chuang

Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is widely used for retinal vascular diseases, but its renal safety remains controversial. This study evaluated the risk of adverse renal outcomes following intravitreal anti-VEGF therapy. Methods: This retrospective cohort study used the TriNetX Global Network. Adults aged over 20 years with retinal vascular disorders who received intravitreal anti-VEGF injections were compared with those who did not. Propensity score matching (1:1) balanced baseline demographics, comorbidities, medication use, laboratory data, and healthcare utilization. The primary outcome was major adverse kidney events (MAKE), defined as end-stage renal disease, dialysis, or all-cause mortality. Risks of progression to chronic kidney disease (CKD) stage 3–5 and dialysis were also analyzed. Cox proportional hazards models estimated hazard ratios (HRs). Results: Among 7194 matched pairs (anti-VEGF cohort: mean age, 55.2±12.9 years, 55.2% male; control cohort: mean age, 55.7±11.6 years, 53.9% male), the anti-VEGF cohort showed a significantly higher risk of MAKE at 1 year (230 [3.20%] vs 146 [2.03%]; HR, 1.53 [1.25–1.89]), with similar findings at 3 and 5 years. The anti-VEGF cohort also showed higher risks of CKD stage 3–5 (769 [10.69%] vs 556 [7.73%]; HR, 1.37 [1.23–1.53]) and dialysis (70 [0.97%] vs 38 [0.53%]; HR, 1.79 [1.20–2.65]). Conclusion: In this real-world cohort, intravitreal anti-VEGF therapy was associated with higher risks of adverse renal outcomes. Given the observational design and small absolute risk differences, these findings warrant cautious interpretation, and renal function monitoring may be considered in these patients.

Purpose: To evaluate the association between thyroid dysfunction and the risk of keratoconus, and to determine whether this association differs according to thyroid disease etiology and hormonal status. Methods: This retrospective cohort study used a large, multicenter electronic health record network in the United States. Patients younger than 60 years who received ophthalmic care between 2015 and 2024 were included. Individuals with thyroid dysfunction were compared with those without thyroid disease after 1:1 propensity score matching to balance demographics, comorbidities, and health care utilization. The primary outcome was incident keratoconus over a 5-year follow-up period. Cox proportional hazards models were used to estimate hazard ratios. Subgroup analyses were conducted according to age, sex, allergic disease, psychiatric comorbidities, thyroid disease etiology, and thyroid functional status. Results: After matching, 66,161 patients with thyroid dysfunction were compared with 66,161 controls. During follow-up, keratoconus occurred more frequently in the thyroid disorders cohort than in controls (hazard ratio, 2.92; 95% confidence interval, 2.24–3.79). This association was consistent across age and sex subgroups and remained significant among patients with allergy or psychiatric comorbidities. Both hyperthyroidism and hypothyroidism were independently associated with increased keratoconus risk. Although both autoimmune and nonautoimmune thyroid disorders were associated with higher risk, no significant difference was observed between these etiologic subtypes. Conclusions: Thyroid dysfunction is associated with a substantially increased risk of keratoconus, independent of demographic factors, comorbidities, and autoimmune status. Comparable risk across autoimmune and nonautoimmune thyroid disorders suggests that thyroid hormone imbalance, rather than immune mechanisms alone, may contribute to keratoconus development.

Background/Objectives: To evaluate the longitudinal association between strabismus and the subsequent risk of developing open-angle glaucoma (OAG), ocular hypertension (OHT), and antiglaucoma agent (AGA) initiation or OAG interventions in patients aged 65 years and older. Methods: We conducted a multicenter retrospective cohort study using the TriNetX US Collaborative Network from 1 January 2003 to 31 December 2022. Patients aged 65 years or older with an ophthalmic encounter and a first recorded diagnosis of paralytic or other strabismus were compared with patients without strabismus. Individuals with prior glaucoma, AGA use, or glaucoma procedures before or on the index date were excluded. One-to-one propensity score matching was performed for demographics, ophthalmic conditions, systemic comorbidities, healthcare utilization, and medication history. Cox models and Kaplan–Meier analyses were used to estimate 3-year risks; 1-year lag-time, follow-up duration, subtype, stratified, and control-outcome analyses were performed. Results: After matching, 20,894 patients were included in each cohort. Strabismus was not associated with a higher 3-year risk of OAG (hazard ratio (HR) = 0.833; 95% confidence interval (CI) = [0.683–1.017]), OHT (HR = 0.923; 95% CI = [0.825–1.031]), or OAG interventions (HR = 0.851; 95% CI = [0.691–1.048]). AGA initiation was lower in the strabismus cohort (HR = 0.629; 95% CI = [0.574–0.690]). Findings were generally consistent across lag-time and subtype analyses. Conclusions: First-recorded strabismus was not associated with an increased recorded risk of OAG, OHT, or OAG interventions among adults aged 65 years or older. Standard glaucoma screening should remain individualized according to established risk factors and examination findings.

Background: Normal tension glaucoma (NTG) is a common subtype of glaucoma that progresses silently and can lead to irreversible vision loss if left untreated. Emerging evidence suggests that inflammation and vascular dysfunction may play a role in its pathogenesis. C-reactive protein (CRP), a marker of systemic inflammation and atherosclerosis, has been widely studied as a prognostic indicator in various diseases. However, its potential association with NTG remains unclear. This meta-analysis aims to clarify the relationship between CRP levels in individuals with NTG compared to those without the condition. Methods: We systematically searched PubMed, Embase, and Scopus for observational studies published up to 31 October 2023 investigating CRP levels in NTG patients and controls. Study quality and risk of bias were evaluated using the Newcastle–Ottawa Scale. Eligible studies reporting CRP levels were analyzed using standardized mean differences (SMDs) and 95% confidence intervals (CIs). Results: A meta-analysis of ten case-control studies involving 766 patients revealed that CRP levels were significantly higher in the NTG group compared to controls (SMD: 0.731, 95% CI: 0.147–1.316 ; z = 2.454; P = 0.014). However, no significant difference in CRP levels was observed between the POAG group and controls (SMD = 0.093; 95% CI: −0.160–0.345; z = 0.719; P = 0.472). Conclusion: Elevated circulating CRP levels were significantly associated with NTG, suggesting a potential systemic inflammatory contribution to its pathogenesis. Although CRP may serve as an adjunctive marker for identifying high-risk individuals, its clinical value remains provisional and requires confirmation in future prospective studies.

Background/Objectives Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. This systematic review and meta-analysis assess the association between eight serum biomarkers and the presence of ROP in premature neonates. These biomarkers are neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), red cell distribution width (RDW), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), platelet mass index (PMI), systemic immune-inflammation index (SII), and vitamin D. Subjects/Methods A comprehensive literature search was conducted across PubMed, Embase, Scopus, and Cochrane Library for studies published up to February 2025. Eligible studies included quantitative data on serum biomarker levels in premature neonates with and without ROP. A random-effects meta-analysis estimated standardised mean differences (SMDs) and 95% confidence intervals (CIs). Risk of bias was assessed using the Newcastle-Ottawa Scale. Results Twenty-one studies comprising 3965 participants were included. Significant associations were found for NLR (SMD = 0.43, 95% CI: 0.16–0.71, P = 0.002), RDW (SMD = 0.41, 95% CI: 0.15–0.67, P = 0.002), and vitamin D (SMD = −1.18, 95% CI: -1.47–-0.90, P < 0.00001). CRP, LMR, PLR, PMI, and SII did not show significant associations with ROP presence. Conclusions NLR, RDW, and vitamin D levels are potential biomarkers associated with ROP presence in premature neonates, likely reflecting systemic inflammation and vascular pathology. Further large-scale prospective studies are warranted to establish standardised cutoff values for clinical implementation.

Rationale: Panophthalmitis is a severe, vision-threatening condition that may result from endogenous spread of infection, often presenting with systemic symptoms. Klebsiella pneumoniae (Kp) is a known cause of endogenous panophthalmitis, typically associated with underlying conditions such as diabetes and often linked to pyogenic liver abscesses. However, cases presenting solely with ocular symptoms are exceedingly rare. This report presents a unique case of Kp panophthalmitis with a concurrent asymptomatic liver abscess, emphasizing the importance of systemic evaluation in atypical ocular infections. Patient concerns: A 66-year-old woman presented with a 3-day history of progressive vision loss, periorbital pain, swelling, and redness in the left eye. She denied fever, gastrointestinal symptoms, or other systemic complaints. Diagnoses: Imaging revealed panophthalmitis with retrobulbar infiltration. Blood tests showed leukocytosis and mildly elevated liver enzymes. A liver abscess was identified on ultrasound and computed tomography. Cultures from the eyelid abscess and liver aspiration both yielded K. pneumoniae. Interventions: The patient received empirical systemic antibiotics, intravitreal injections, and daily wound care. After 2 weeks without visual improvement, evisceration was performed. The liver abscess was aspirated and treated with antibiotics. Outcomes: Despite aggressive treatment, the left eye was nonviable and required evisceration. However, systemic infection was controlled, and the patient remained free of complications from the liver abscess. Notably, she exhibited no systemic symptoms throughout the disease course. Lessons: This case highlights the need for systemic evaluation in patients with severe ocular infections, even in the absence of systemic symptoms. It also underscores the potential for serious infections such as Kp-related liver abscess to present solely with ocular manifestations. Early suspicion and comprehensive assessment can prevent misdiagnosis and improve outcomes.