Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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The British journal of ophthalmology
Incidental ocular surface squamous neoplasia in pterygia: a systematic review and meta-analysis
AIMS: Differentiating pterygium from ocular surface squamous neoplasia (OSSN) is important for guiding management. This meta-analysis evaluates the prevalence and risk factors for incidental OSSN in clinically diagnosed pterygia. METHODS: Ovid Embase, MEDLINE, Cochrane Library and Web of Science were systematically searched from January 2000 to February 2025. Included studies analysed ≥100 clinically diagnosed pterygia via histopathology. Random-effects meta-analysis assessed the prevalence of incidental OSSN among pterygia. Risk factors were evaluated using the Mantel-Haenszel and inverse variance methods, and meta-regression analysed the influence of publication year, geographic proximity to the equator, and country-level ultraviolet (UV) radiation exposure. RESULTS: 12 studies, comprising 8688 specimens, identified 202 cases of incidental OSSN (pooled prevalence=1.32%, 95% CI 0.41% to 4.21%, I2=95.3%). Meta-regression revealed that lower OSSN prevalence was associated with greater distance from the equator (OR 0.49, 95% CI 0.28 to 0.83, p<0.01), while higher prevalence was associated with greater UV exposure (OR 2.20, 95% CI 1.17 to 4.14, p=0.01). Publication year had no effect (p=0.98). Age (p=0.18), sex (p=0.45) and lesion location (p=0.60-0.82) did not differ between incidental OSSN cases and benign pterygia. Incidental OSSN prevalence also did not differ between primary and recurrent pterygia (p=0.23). Regional analyses revealed variation in prevalence: Europe (0.29%), Asia (0.76%), North America (1.03%), Oceania (8.57%) and South America (14.97%). CONCLUSIONS: This meta-analysis, based on low- to very low-certainty evidence, identified a 1.32% pooled prevalence of incidental OSSN in clinically diagnosed pterygia, highlighting the potential influence of UV exposure and equatorial proximity. The overlap in demographic and lesion characteristics between benign pterygia and OSSN underscores diagnostic challenges.
25 Apr 2026
Read appraisal →Translational vision science & technology
OptiDON-Guard: An Ensemble Model for Identification of Dysthyroid Optic Neuropathy Using Optical Coherence Tomography Angiography
PURPOSE: To explore the value of machine learning models based on optical coherence tomography angiography (OCTA) in identifying dysthyroid optic neuropathy (DON). METHODS: A retrospective, dual-center, cross-sectional study was conducted involving 346 thyroid eye disease patients (with/without DON) from two institutions. Participants underwent ophthalmic examinations, including OCTA scans centered on the macula and optic nerve head. The OCTA data from Center 1 were split into a training set and an internal validation set, while the data from Center 2 served as an external test set. Features were extracted from OCTA images, and a wrapper-based feature selection strategy identified the optimal subset. A two-tiered stacking modeling framework was used, incorporating baseline model construction, data augmentation using pseudo-labeling, and ensemble integration. Model performance (area under the curve [AUC], accuracy, sensitivity, specificity, precision) was evaluated alongside receiver operating characteristic, calibration, and decision curve analyses. Additionally, the SHapley Additive exPlanation method was used to interpret feature contributions. RESULTS: The ensemble model, OptiDON-Guard, demonstrated superior performance to individual models on both internal validation and external test sets. In the internal validation set, it achieved an AUC of 0.872, accuracy of 0.943, sensitivity of 0.667, specificity of 0.979, and precision of 0.943. In the external test set, it maintained strong performance with an AUC of 0.854, accuracy of 0.816, sensitivity of 0.767, specificity of 0.842, and precision of 0.854. CONCLUSIONS: The OptiDON-Guard is a reliable, interpretable, and clinically applicable tool for identifying DON. TRANSLATIONAL RELEVANCE: The OptiDON-Guard offers a valuable clinical tool to enhance the diagnostic precision of DON.
9 Apr 2026
Read appraisal →PloS one
Safety and efficacy of Vectored thermal pulsation, Intense pulsed light, and Eyelid Warm compress therapies (VIEW) for meibomian gland dysfunction: Study design and baseline characteristics of a randomized controlled trial
BACKGROUND: Meibomian gland dysfunction (MGD) is one of the most prevalent chronic eye diseases, characterized by meibomian gland obstruction and abnormal meibum secretion both in quantity and quality. OBJECTIVE: To assess the efficacy and safety of vectored thermal pulsation (VTP), intense pulsed light plus meibomian gland expression (IPL + MGX), and eyelid warm compress (EW). METHODS: This is a 3-arm, assessor-masked, randomized controlled trial. 360 symptomatic mild to moderate MGD subjects would be recruited and randomized into 3 intervention groups. Subjects from Group-A, Group-B, and Group-C would be treated with one-session VTP (at baseline), four-session IPL + MGX (at baseline, month-1, month-2, and month-3 visits), and twice-daily EW for 15 months, respectively. All subjects would be prescribed topical artificial tears (Hypromellose, 0.3% w/v) to be used as frequently as needed from wash-out (1 month before baseline) to endpoint (month-15 visit). Subjects would be assessed 9 times throughout a total of 16-month study period. Five self-administered questionnaires would be collected each time in random order. Masked observers would conduct examinations using slit-lamp biomicroscopy, LipiView® II, and Keratograph 5M machines. The eye with worse MGD would be selected and analyzed as the study eye. Tear film break-up time (TFBUT) at month-6 and month-15 visits are the primary outcomes. RESULTS: 374 subjects were enrolled and randomized into three groups, and 372 subjects (aged 54.4 ± 14.7 years) were finally analyzed. The mean of TFBUT time at baseline was 3.1 ± 1.7 seconds. CONCLUSION: This is the first head-to-head comparison of three physical treatments for mild to moderate MGD on their therapeutic efficacy, safety, longevity and compliance in a randomized controlled trial setting.
5 Apr 2026
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