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Dynamic realignment of extraocular muscles after inferomedial orbital wall decompression in thyroid eye disease: a 3D CT reconstruction study

2026-03-25T03:07:27Z

Title: Dynamic realignment of extraocular muscles after inferomedial orbital wall decompression in thyroid eye disease: a 3D CT reconstruction study Authors: Byeon, Hyeong Ju; Ko, JaeSang; Park, Hyun Young; Yoon, Jin Sook Abstract: Orbital wall decompression carries a risk of new-onset postoperative diplopia in patients with thyroid eye disease (TED). This study aimed to evaluate the occurrence, clinical progression, and underlying mechanisms of newonset diplopia following inferomedial orbital wall decompression over 1 year, including quantitative CT analysis of orbital structures. Inactive TED patients undergoing inferomedial orbital wall decompression were reviewed. Only patients who developed new diplopia at 1 month and completed a 1-year follow-up were included. Diplopia cases were assessed using Gorman scores and HESS tests. Orbital structures and deviated angles of the medial and inferior rectus muscles were quantified on CT images. New-onset diplopia occurred in 35% (78/204) of patients at 1 month postoperatively, with 73.2% recovering fully from diplopia by 1 year. In the recovered-diplopia group, orbital volume decreased significantly from immediate postoperative to 1 year (p = 0.038) but not in the persistent-diplopia group. Additionally, the rectus muscles, deviated immediately after surgery, showed significant straightening at 1 year in the recovered-diplopia group (p < 0.001), while no significant improvement in muscle alignment was observed in the persistent-diplopia group. New-onset diplopia after inferomedial orbital wall decompression is typically transient, resolving within 1 year. The resolution is mediated by muscle realignment driven by orbital remodeling and muscle contraction.

Demography, Clinical Characteristics and Long-Term Outcomes of Central Serous Chorioretinopathy in Women. MICRoN Report Number Fourteen

2026-04-14T07:23:14Z

Title: Demography, Clinical Characteristics and Long-Term Outcomes of Central Serous Chorioretinopathy in Women. MICRoN Report Number Fourteen Authors: Gregori, Giulia; Sahoo, Niroj Kumar; Hasan, Nasiq; Zarnegar, Arman; Lupidi, Marco; Zhang, Micheal; Wu, Lihteh; Cao, Jessica; Piccoli, Gabriele; Vujosevic, Stela; Shah, Priya; Singhanetr, Panisa; Rossin, Elizabeth; Checchin, Lisa; Pili, Lorenzo; Parodi, Maurizio Battaglia; Kim, Min; Desideri, Lorenzo Ferro; Munk, Marion R.; Chotcomwongse, Peranut; Ruamviboonsuk, Paisan; Fung, Adrian; Small, Kent; Khateb, Samer; Wang, Jay C.; Khurana, Rahul N.; Villafeurte, Carol; Yiu, Glenn; Momenaei, Bita; Garg, Sunir; Lai, Timothy; Ashfaq, Yusuf; Kroeger, Zachary; Chhablani, Jay Abstract: center dot PURPOSE: To evaluate the characteristics and longitudinal outcomes of chronic central serous chorioretinopathy (CSCR) in women compared to an age-matched cohort of men with CSCR. center dot DESIGN: Retrospective, multicenter clinical cohort study from the Macula Society CSCR Study Group. center dot PARTICIPANTS: This study included 426 eyes (213 women and 213 age-matched men) with a diagnosis of CSCR. center dot METHODS: Baseline and final best-recorded visual acuity (BRVA) and multimodal imaging parameters such as area of retinal pigment epithelium (RPE) alterations, choroidal macular thickness (CMT), sub-foveal choroidal thickness (SFCT), subretinal fluid (SRF), pigment epithelium detachment (PED), double layer sign (DLS), hyperreflective dots (HRD), as well as the presence of choroidal neovascularization (CNV) and subretinal hyperreflective material (SHRM) were assessed. Regression analysis was used to evaluate baseline predictors of final visual acuity. center dot MAIN OUTCOME MEASURES: Longitudinal changes in BRVA and imaging parameters in men and women stratified for age; factors affecting subretinal fluid (SRF) persistence, and change in BRVA. center dot RESULTS: A total of 426 eyes (213 women and 213 age-matched men) with CSCR were analyzed. Women showed better BRVA at presentation (0.25 +/- 0.24 vs 0.31 +/- 0.35 logMAR; P = .05), and exhibited smaller areas of RPE alterations (2.37 +/- 2.64 vs 1.59 +/- 1.55 disc areas; P = .003), less frequent peripapillary RPE changes (13.6% vs 7.5%; P < .001), shorter DLS (1353.9 +/- 970.2 vs 1071.6 +/- 888.7 & micro;m; P = .039), and smaller PEDs (644.9 +/- 546.4 vs 442.1 +/- 278.9 & micro;m; P = .022). During follow-up, women exhibited higher rates of complete SRF resolution ( P = .001) while persistence and the number of recurrences were significantly more common in men ( P = .006 and P = .02, respectively). Logistic regression analysis revealed that persistent SRF was independently associated with complex CSCR, male gender, baseline PROS irregularities, worse BRVA, SHRM, and CNV, while PDT was protective. center dot CONCLUSION: Women had better visual outcomes and more favorable structural evolution while men tended to present with more complex anatomical alterations and experience higher rates of persistent SRF. (Am J Ophthalmol 2026;286: 140-151. (c) 2026 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/))

Clinical Characteristics and Outcomes in Subretinal Hyper-Reflective Material: MICRoN Report 6

2026-04-14T07:23:13Z

Title: Clinical Characteristics and Outcomes in Subretinal Hyper-Reflective Material: MICRoN Report 6 Authors: Sahoo, Niroj Kumar; Hasan, Nasiq; Jacob, Ninan; Cao, Jessica; Wykoff, Charles C.; Shah, Priya; Singhanetr, Panisa; Rossin, Elizabeth J.; Desideri, Lorenzo Ferro; Hertkorn, Felicia; Munk, Marion R.; Khateb, Samer; Wang, Jay; Khurana, Rahul N.; Ashfaq, Yusuf; Kroeger, Zachary; Zhang, Michael; Parodi, Maurizio Battaglia; Piccoli, Gabriele; Vujosevic, Stela; Kim, Min; Rodriguez-Fernandez, Carmen Antia; Barquet, Luis Arias; Small, Kent; Ruamviboonsuk, Paisan; Chotcomwongse, Peranut; Lima, Luiz H.; Fung, Adrian T.; Wu, Lihteh; Chhablani, Jay Abstract: center dot PURPOSE: To evaluate the clinical features and longitudinal outcomes of chronic central serous chorioretinopa thy (CSCR) presenting with subretinal hyperreflective material (SHRM). center dot DESIGN: Retrospective, multicenter clinical cohort study from the Macula Society CSCR Study Group. center dot PARTICIPANTS: This study included consecutive patients with a diagnosis of CSCR, with and without SHRM. center dot METHODS: Baseline and final best-recorded visual acuity (BRVA) and multimodal imaging parameters were compared between SHRM and non-SHRM groups. center dot MAIN OUTCOME MEASURES: Longitudinal changes in BRVA and imaging parameters in both groups; factors affecting subretinal fluid (SRF) persistence, and change in BRVA. center dot RESULTS: A total of 503 eyes (103 with SHRM and 400 eyes without SHRM) were analyzed. The SHRM group showed poorer baseline BRVA (0.4 +/- 0.3 logMAR; 20/50) compared to the non-SHRM group (0.2 +/- 0.3 logMAR; 20/30) (p = .006). SHRM eyes demonstrated greater RPE alteration (p = .04), higher neurosensory retinal detachment ( p < .001), more photoreceptor irregularities (p = .004), hyperreflective foci (p < .001), and double-layer sign (p < .001). The incidence of concurrent macular neovascularization (p = .01) and persistent subretinal fluid (p < .001) was higher in the SHRM group. Despite visual improvement in both groups, final height of neuro-sensory detachment (p < .001) remained higher in SHRM eyes. Eyes with a history of steroid exposure and ellipsoid zone (EZ) loss (post-resolution) were greater in higher SHRM grades. Logistic regression revealed non-SHRM status, and combination therapy had lower odds of SRF persistence. center dot CONCLUSION: CSCR with SHRM presented with worse initial vision. Although vision improved after treatment, persistent SRF and EZ loss (in resolved cases) remain more frequent in SHRM eyes. (c) 2026 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/))

Success and failure of human-AI collaboration in clinical reasoning: An experimental study on challenging real-world cases

2026-03-25T03:11:59Z

Title: Success and failure of human-AI collaboration in clinical reasoning: An experimental study on challenging real-world cases Authors: Ong, Kai Tzu-iunn; Seo, Junwon; Kim, Hyojun; Kim, Jiwoo; Kim, Jihoon; Kim, Sunghwan; Yeo, Jinyoung; Choi, Eun Young; 최은영 Abstract: Background: While conversational human-AI collaboration (HAC) using large language models (LLM) has shown potential to enhance clinical reasoning, its effectiveness in highly specialized and challenging clinical scenarios remains unclear. This study aimed to evaluate the effectiveness of HAC and analyzed the causes of its success and failure. Methods: A crossover experimental study was conducted using 30 challenging cases from JAMA Ophthalmology. Thirty participants (10 board-certified ophthalmologist, 10 ophthalmology resident, and 10 senior medical students) completed the cases under two conditions: independent work (human-only) and collaboration through free-text conversation with Claude-3.5-Sonnet (HAC). Performance accuracy, along with self-rated confidence and cognitive burden, were assessed. HAC interaction logs were analyzed to evaluate the appropriateness of the LLM's accepting and arguing behaviors, which were categorized into six patterns. Sliding paired t-tests across incremental thresholds were used to assess how accuracy gains from HAC varied by task difficulty. Results: HAC significantly improved mean accuracy compared to the human-only condition (from 0.45 to 0.60, P < 0.001), although 20% of participants showed a decline in performance and the mean remained below the LLMonly accuracy (0.70). HAC significantly increased confidence and reduced cognitive burden (both P < 0.001) in both successful and failed HAC. The appropriateness of LLM behaviors was substantially higher in successful HAC than in failed HAC (F1 score = 0.92 vs. 0.29, P < 0.001). In successful HAC, 92.6% followed the pattern LLM presents correct insight/human accepts, while 58.6% of failures involved LLM presents incorrect insight/human accepts. HAC improved accuracy significantly in tasks where the human-only correct response rate exceeded 47% (P < 0.05), but not below 30% (P >= 0.188). Conclusions: These findings suggest that HAC benefits complex clinical decisions in ophthalmology but remains limited by human, model, and task-level factors requiring further improvement.