This Week in Ophthalmology — Nov 1, 2026
Generated Nov 1, 2026 · 11:24
The week's practice-changing Ophthalmology research, summarized for clinicians.
If the audio fails to play, refresh the page to renew the link.
Get next week’s Ophthalmology briefing — free.
In your podcast app, or readable in your inbox with the audio one tap away.
Time Course of Resolution of Diabetic Macular Edema by Sustained Suppression of VEGF-A with the Port Delivery Platform with Ranibizumab.
With continuous ranibizumab delivery, nearly all diabetic macular edema eyes improved, but central intraretinal fluid took a median 68 weeks to clear, suggesting slow rather than absent response.
American Journal of Ophthalmology · 2026 · PubMed
This week’s papers
- 01
Time Course of Resolution of Diabetic Macular Edema by Sustained Suppression of VEGF-A with the Port Delivery Platform with Ranibizumab.
With continuous ranibizumab delivery, nearly all diabetic macular edema eyes improved, but central intraretinal fluid took a median 68 weeks to clear, suggesting slow rather than absent response.
Rustam Z et al. · American Journal of Ophthalmology · 2026
From the briefingIf you only have time for one paper this week, make it the Pagoda analysis by Rustam and colleagues in the American Journal of Ophthalmology [1]. It reopens a question every retina clinic faces, whether persistent diabetic macular edema reflects genuine resistance to VEGF suppression or simply a slower timeline, and it argues that much of what is called non-response is actually slow response.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 02
AI-Based OCT Assessment of Anatomic Response During the Loading Phase of Anti-VEGF Therapy in Neovascular Age-Related Macular Degeneration.
After three loading injections, a dry macula was more frequent with faricimab and aflibercept than bevacizumab in neovascular AMD, though visual acuity did not differ between agents after adjustment.
Nassisi M et al. · Investigative Ophthalmology and Visual Science · 2026
From the briefingA different angle on early response comes from Nassisi and colleagues in Investigative Ophthalmology and Visual Science, who used artificial intelligence to segment OCT fluid after three loading injections in 224 treatment-naive eyes with neovascular age-related macular degeneration [2]. A dry macula at week 12 was seen in about 80 percent of eyes on faricimab, about two thirds on aflibercept 2 milligrams, and about 41 percent on bevacizumab. Visual acuity, however, did not differ between drugs after adjustment, and the study was retrospective and non-randomized, so the anatomic gap may partly reflect who received which drug. Read alongside the Pagoda analysis, it is a reminder that a wet scan at week 12 is not necessarily the end of the story [1, 2].
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 03
Submacular Hemorrhage Requiring Procedural Intervention During Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration in Japan: The JTY Three-Center Real-World Incidence Study.
Submacular hemorrhage needing surgery occurred in about one per thousand anti-VEGF injections in Japan, mostly in polypoidal disease, causing severe vision loss without significant differences between agents.
Inoda S et al. · Retina · 2026
From the briefingRounding out the theme, Inoda and colleagues, writing in Retina, counted submacular hemorrhages that needed gas or vitrectomy across more than 47 thousand anti-VEGF injections at three Japanese centres [3]. These bleeds were rare, about one per thousand injections, but devastating, with median vision falling from roughly 20/60 to 20/200. Polypoidal choroidal vasculopathy accounted for nearly three quarters of the events, and about a fifth of affected eyes had bled before. Faricimab had the lowest crude rate, but after adjustment no drug differed significantly from aflibercept, and with only 54 events the drug comparison is underpowered.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 04
Validation of the TWO-ROP Algorithm in the Shenzhen Prematurity Eye Study.
In over 14,000 Chinese infants, a single 36-week ROP exam caught about 93 percent of treatment-requiring cases under United States criteria but all cases under Chinese criteria.
Zhao X et al. · Ophthalmology Retina · 2026
From the briefingIn Ophthalmology Retina, Zhao and colleagues tested the TWO-ROP algorithm, which proposes a single retinopathy of prematurity examination at 36 weeks postmenstrual age for lower-risk infants, in more than 14 thousand infants from 56 Chinese centres [4]. Under United States screening criteria, the 36-week rule caught 275 of 295 treatment-requiring cases, about 93 percent, and 14 of the 20 missed infants had aggressive disease. Moving the exam to 35 weeks lifted sensitivity to nearly 99 percent. Under the narrower Chinese criteria, the 36-week rule caught every one of the 89 treatment-requiring cases, while an exploratory 38-week rule missed three infants, all in local hospitals. The message from this retrospective cohort is that a reduced-screening algorithm performs very differently depending on which population it is applied to and the level of care.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 05
Risk-Stratified Outcomes of Prophylactic Laser Versus Observation for Pediatric Peripheral Retinal Lesions.
In 273 pediatric eyes with peripheral retinal lesions, prophylactic laser was not associated with significantly fewer retinal detachments than observation, even among high-risk eyes, though lasered eyes were sicker.
Meshkin RS et al. · Ophthalmology Retina · 2026
From the briefingAlso in Ophthalmology Retina, Meshkin and colleagues reviewed 273 pediatric eyes with peripheral tears, holes or lattice [5]. Lasered eyes carried more risk features at baseline, such as subretinal fluid, symptoms or trauma. Over a median of about a year and a half, detachment occurred in 5 percent of lasered eyes and about 1 percent of observed eyes, a difference that was not statistically significant, and even among high-risk eyes laser did not significantly reduce detachment. Because sicker eyes were chosen for laser, this cannot show that laser is ineffective, but the authors conclude that many pediatric lesions may be safely observed, and they note the absence of pediatric-specific evidence.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 06
Pediatric Endothelial Keratoplasty: A Modified Delphi Consensus by the EKLG Study Group on Indications, Surgical Techniques, and Postoperative Care.
An international expert consensus endorsed pediatric endothelial keratoplasty for defined indications, favoured DSAEK techniques, timing by amblyopia risk rather than age, and prolonged postoperative steroid therapy.
Gupta N et al. · American Journal of Ophthalmology · 2026
From the briefingOn the surgical side, Gupta and colleagues in the American Journal of Ophthalmology report a modified Delphi consensus on pediatric endothelial keratoplasty [6]. The panel endorsed it for congenital hereditary endothelial dystrophy, aphakic or pseudophakic edema, persistent edema in congenital glaucoma, and trauma or iatrogenic decompensation, but not for severe anterior segment dysgenesis with extensive adhesions. Timing, they agreed, should hinge on amblyopia risk rather than an age cut-off, ultrathin DSAEK and DSAEK remain the predominant techniques, DMEK is reserved for older children with uncomplicated anatomy, and topical steroids are favoured for more than six months. This is expert opinion rather than outcome data, but it offers a benchmark in an area with very little comparative evidence.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 07
Diagnostic Accuracy of Paracentral Acute Middle Maculopathy for Arteritic Anterior Ischemic Optic Neuropathy.
Paracentral acute middle maculopathy on OCT was about 95 percent specific but only about 19 percent sensitive for arteritic ischemic optic neuropathy, so its absence offers little reassurance.
Molleti S et al. · American Journal of Ophthalmology · 2026
From the briefingIn the American Journal of Ophthalmology, Molleti and colleagues examined paracentral acute middle maculopathy on early macular OCT as a clue to arteritic rather than non-arteritic ischemic optic neuropathy, across three United States centres [7]. Among 119 patients, this finding appeared in about a fifth of the 27 arteritic cases and about one in twenty of the non-arteritic cases. That makes it highly specific, around 95 percent, but insensitive, missing more than four in five arteritic cases. Three of the five non-arteritic patients with the sign had severe systemic hypoperfusion. The arteritic group is small, but the finding positions this sign as something that raises suspicion of giant cell arteritis, never as something whose absence offers reassurance.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 08
False-Positive Acanthamoeba Keratitis From Multiplex Polymerase Chain Reaction Diagnostics, a Case Series.
Four patients with positive commercial multiplex PCR for Acanthamoeba had negative cultures and deep sequencing, ultimately had other diagnoses, and recovered fully without sustained antiamoebic therapy.
Arboleda A et al. · Cornea · 2026
From the briefingA cautionary counterpart appears in Cornea, where Arboleda and colleagues describe four patients whose commercial multiplex PCR returned positive for Acanthamoeba [8]. None had classic risk factors, and in every case cultures and metagenomic deep sequencing were negative. The final diagnoses were staphylococcal marginal keratitis, recurrent herpes simplex keratitis, anterior scleritis, and a neurotrophic defect in a corneal graft, and all patients recovered with treatment directed at those conditions. It is only four cases, but it is a clear signal that a positive molecular result can mislead when the clinical picture does not fit.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 09
Corneal Transplantation From Donors With a Documented History of Suspected Sepsis: Infectious Risks and Graft Outcomes.
Corneas from cleared donors with suspected sepsis showed low infectious risk and two-year graft survival comparable to controls, about 83 versus 84 percent, in a single-centre review.
Herskowitz WR et al. · Cornea · 2026
From the briefingAlso in Cornea, Herskowitz and colleagues addressed donor tissue from people with a documented history of suspected sepsis, who made up about 11 percent of more than 1,300 donors at one tertiary centre [9]. Across 2,583 transplants there were 11 positive rim cultures, three from these donors, and a single case of Candida glabrata endophthalmitis that could not be traced to the donor's systemic infection. In a matched clinical cohort of 156 eyes, two-year graft survival was essentially identical, about 83 versus 84 percent, with no differences in vision, thickness or clarity. The single-centre retrospective design limits certainty, but the data support the view that such donors, once cleared, are not a meaningful source of added risk.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
- 10
Autologous Anterior Lens Capsule as an Intrascleral Spacer in Deep Sclerectomy: A Randomized Clinical Trial.
In a 60-eye randomized trial, an autologous anterior capsule spacer during phaco-deep sclerectomy lowered pressure at one year and improved stringent success, while medication reduction was not significant.
Einollahi N et al. · American Journal of Ophthalmology · 2026
From the briefingFinally, in glaucoma surgery, Einollahi and colleagues in the American Journal of Ophthalmology randomized 60 eyes undergoing combined phacoemulsification and deep sclerectomy to an autologous anterior lens capsule spacer or no spacer [10]. Pressure was lower with the spacer at 6 and 12 months, by roughly one millimetre of mercury, landing near 12. Under the strictest success definition of a pressure of 12 or below, about 48 percent of spacer eyes succeeded against about 16 percent of controls. Medication use was lower with the spacer but did not reach statistical significance. It is a small single trial, yet the spacer uses tissue that would otherwise be discarded, which makes it an inexpensive idea that warrants replication.
Written by AI from the published abstract, for healthcare professionals. Not medical advice; check the paper before acting on it.
The full briefing
This AudioScholar briefing is generated by artificial intelligence for healthcare professionals and trainees. It is not medical advice.
Welcome to This Week in Ophthalmology. This week we're covering 10 notable papers spanning anti-VEGF therapy and its limits in the macula, pediatric eye care from screening through surgery, and the reliability of diagnostic signals and donor tissue in cornea, glaucoma and neuro-ophthalmology. Let's dive in.
Our first theme asks how quickly, and how completely, the macula responds to VEGF suppression. In the American Journal of Ophthalmology, Rustam and colleagues went back to the Pagoda trial of the Port Delivery Platform with ranibizumab in diabetic macular edema, using continuous drug release as a way to test whether so-called non-responders really exist. Across the trial population, close to nine in ten eyes reached a normal central subfield thickness, typically within about five months. In a detailed OCT review of 56 eyes, thickness normalized in 93 percent, but clearing intraretinal fluid from the central millimetre took a median of about 68 weeks, and only 3 of those 56 eyes had poorly controlled edema at last follow up. The authors argue that the label unresponsive should be replaced by slowly responsive. This is a retrospective look at trial data, and the detailed subset came from just eight sites, but it challenges the common practice of declaring an agent failed after a few injections [1]. A different angle on early response comes from Nassisi and colleagues in Investigative Ophthalmology and Visual Science, who used artificial intelligence to segment OCT fluid after three loading injections in 224 treatment-naive eyes with neovascular age-related macular degeneration [2]. A dry macula at week 12 was seen in about 80 percent of eyes on faricimab, about two thirds on aflibercept 2 milligrams, and about 41 percent on bevacizumab. Visual acuity, however, did not differ between drugs after adjustment, and the study was retrospective and non-randomized, so the anatomic gap may partly reflect who received which drug. Read alongside the Pagoda analysis, it is a reminder that a wet scan at week 12 is not necessarily the end of the story [1, 2]. Rounding out the theme, Inoda and colleagues, writing in Retina, counted submacular hemorrhages that needed gas or vitrectomy across more than 47 thousand anti-VEGF injections at three Japanese centres [3]. These bleeds were rare, about one per thousand injections, but devastating, with median vision falling from roughly 20/60 to 20/200. Polypoidal choroidal vasculopathy accounted for nearly three quarters of the events, and about a fifth of affected eyes had bled before. Faricimab had the lowest crude rate, but after adjustment no drug differed significantly from aflibercept, and with only 54 events the drug comparison is underpowered.
Our second theme is pediatric, and it spans screening, prophylaxis and surgical consensus. In Ophthalmology Retina, Zhao and colleagues tested the TWO-ROP algorithm, which proposes a single retinopathy of prematurity examination at 36 weeks postmenstrual age for lower-risk infants, in more than 14 thousand infants from 56 Chinese centres [4]. Under United States screening criteria, the 36-week rule caught 275 of 295 treatment-requiring cases, about 93 percent, and 14 of the 20 missed infants had aggressive disease. Moving the exam to 35 weeks lifted sensitivity to nearly 99 percent. Under the narrower Chinese criteria, the 36-week rule caught every one of the 89 treatment-requiring cases, while an exploratory 38-week rule missed three infants, all in local hospitals. The message from this retrospective cohort is that a reduced-screening algorithm performs very differently depending on which population it is applied to and the level of care. Also in Ophthalmology Retina, Meshkin and colleagues reviewed 273 pediatric eyes with peripheral tears, holes or lattice [5]. Lasered eyes carried more risk features at baseline, such as subretinal fluid, symptoms or trauma. Over a median of about a year and a half, detachment occurred in 5 percent of lasered eyes and about 1 percent of observed eyes, a difference that was not statistically significant, and even among high-risk eyes laser did not significantly reduce detachment. Because sicker eyes were chosen for laser, this cannot show that laser is ineffective, but the authors conclude that many pediatric lesions may be safely observed, and they note the absence of pediatric-specific evidence. On the surgical side, Gupta and colleagues in the American Journal of Ophthalmology report a modified Delphi consensus on pediatric endothelial keratoplasty [6]. The panel endorsed it for congenital hereditary endothelial dystrophy, aphakic or pseudophakic edema, persistent edema in congenital glaucoma, and trauma or iatrogenic decompensation, but not for severe anterior segment dysgenesis with extensive adhesions. Timing, they agreed, should hinge on amblyopia risk rather than an age cut-off, ultrathin DSAEK and DSAEK remain the predominant techniques, DMEK is reserved for older children with uncomplicated anatomy, and topical steroids are favoured for more than six months. This is expert opinion rather than outcome data, but it offers a benchmark in an area with very little comparative evidence.
Our third theme concerns how much weight a single sign, test or donor history can bear. In the American Journal of Ophthalmology, Molleti and colleagues examined paracentral acute middle maculopathy on early macular OCT as a clue to arteritic rather than non-arteritic ischemic optic neuropathy, across three United States centres [7]. Among 119 patients, this finding appeared in about a fifth of the 27 arteritic cases and about one in twenty of the non-arteritic cases. That makes it highly specific, around 95 percent, but insensitive, missing more than four in five arteritic cases. Three of the five non-arteritic patients with the sign had severe systemic hypoperfusion. The arteritic group is small, but the finding positions this sign as something that raises suspicion of giant cell arteritis, never as something whose absence offers reassurance. A cautionary counterpart appears in Cornea, where Arboleda and colleagues describe four patients whose commercial multiplex PCR returned positive for Acanthamoeba [8]. None had classic risk factors, and in every case cultures and metagenomic deep sequencing were negative. The final diagnoses were staphylococcal marginal keratitis, recurrent herpes simplex keratitis, anterior scleritis, and a neurotrophic defect in a corneal graft, and all patients recovered with treatment directed at those conditions. It is only four cases, but it is a clear signal that a positive molecular result can mislead when the clinical picture does not fit. Also in Cornea, Herskowitz and colleagues addressed donor tissue from people with a documented history of suspected sepsis, who made up about 11 percent of more than 1,300 donors at one tertiary centre [9]. Across 2,583 transplants there were 11 positive rim cultures, three from these donors, and a single case of Candida glabrata endophthalmitis that could not be traced to the donor's systemic infection. In a matched clinical cohort of 156 eyes, two-year graft survival was essentially identical, about 83 versus 84 percent, with no differences in vision, thickness or clarity. The single-centre retrospective design limits certainty, but the data support the view that such donors, once cleared, are not a meaningful source of added risk. Finally, in glaucoma surgery, Einollahi and colleagues in the American Journal of Ophthalmology randomized 60 eyes undergoing combined phacoemulsification and deep sclerectomy to an autologous anterior lens capsule spacer or no spacer [10]. Pressure was lower with the spacer at 6 and 12 months, by roughly one millimetre of mercury, landing near 12. Under the strictest success definition of a pressure of 12 or below, about 48 percent of spacer eyes succeeded against about 16 percent of controls. Medication use was lower with the spacer but did not reach statistical significance. It is a small single trial, yet the spacer uses tissue that would otherwise be discarded, which makes it an inexpensive idea that warrants replication.
If you only have time for one paper this week, make it the Pagoda analysis by Rustam and colleagues in the American Journal of Ophthalmology [1]. It reopens a question every retina clinic faces, whether persistent diabetic macular edema reflects genuine resistance to VEGF suppression or simply a slower timeline, and it argues that much of what is called non-response is actually slow response.
Here is what this week's evidence adds up to in Ophthalmology. First, in diabetic macular edema, sustained VEGF suppression appears to resolve edema in the large majority of eyes, though intraretinal fluid can take more than a year to clear; this rests on retrospective analysis of trial data and has not been tested as a switching strategy [1]. Second, newer anti-VEGF agents dried the macula more often than bevacizumab after loading, without a measurable vision difference at 12 weeks, and no agent clearly altered the rare but severe risk of submacular hemorrhage, which concentrates in polypoidal disease [2, 3]. Third, reduced-intensity retinopathy of prematurity screening performs differently depending on local criteria and level of care, and in a retrospective cohort prophylactic laser for pediatric peripheral lesions did not show a significant reduction in detachment, though selection bias leaves that question open [4, 5]. Fourth, several single signals need clinical context: maculopathy on OCT is specific but insensitive for arteritic ischemic optic neuropathy, and multiplex PCR can return false-positive Acanthamoeba results, both supported by small retrospective series [7, 8]. Fifth, single-centre data suggest that corneas from donors with suspected sepsis perform like any other tissue, and one small randomized trial suggests that a capsule spacer may improve pressure control in deep sclerectomy, with replication still needed [9, 10].
That's your roundup for This Week in Ophthalmology. The full transcript and references are available on the episode page. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.
If this weekly briefing is useful, follow the show in your podcast app so new episodes arrive automatically. And if it saves you time, a quick rating in your podcast app helps other physicians find the show.
This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.
Spot something worth flagging?
Get this every week in your podcast app — free.
New ophthalmology episodes land in your feed automatically — listen on your commute.