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Open research questions in Retinal and Macular Surgery

78 unresolved questions extracted from the limitations and future-work sections of 271 Retinal and Macular Surgery papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • Abstract Background Vitrectomy with epiretinal membrane (ERM) and internal limiting membrane (ILM) peeling may provide anatomical and functional benefit in selected eyes with refractory diabetic macular edema, but predictors of postoperative outcome remain incompletely defined.

    Preoperative OCT biomarkers and surgical outcomes after vitrectomy with epiretinal membrane and internal limiting membrane peeling for refractory diabetic macular edema: a retrospective cohort study · 2026 · DOI

  • Prior studies have not compared LMH and ERM-FS using multimodal imaging. The pathophysiology of lamellar macular defects is not fully understood.

    Multimodal imaging of photoreceptor and vascular changes in lamellar macular hole and epiretinal membrane-associated foveoschisis · 2026 · DOI

  • Targeted AO analysis of OCT-defined outer retinal disruption areas may provide additional insights in future longitudinal studies, beyond the standardized foveal and parafoveal scan protocol used.

    Multimodal imaging of photoreceptor and vascular changes in lamellar macular hole and epiretinal membrane-associated foveoschisis · 2026 · DOI

  • There is a lack of studies comparing the efficacy of various surgical techniques in the treatment of macular holes with hole-door structures. There is a need to investigate the outcomes of these techniques in the treatment of large-diameter macular holes.

    Inverted internal limiting membrane flap technique versus internal limiting membrane removal in large macular hole with different hole edge configurations: a comparative study · 2026 · DOI

  • PVR is a prevalent cause of unsuccessful RD repair. The pathogenesis of PVR development is complex and not fully understood. There is a need to identify reliable predictive factors for PVR.

    Predictive lipidaemic and clinical factors for PVR formation after RRD surgery in nondiabetic patients · 2026 · DOI

  • The findings regarding predictive risk factors are inconsistent on the occurrence of PVR after RD repair. There is a need to identify serum lipidaemic factors that can predict the formation of PVR in cases after RRD surgery.

    Predictive lipidaemic and clinical factors for PVR formation after RRD surgery in nondiabetic patients · 2026 · DOI

  • Long-term studies are needed to investigate the implications of PPVP on retinal health. Further research should investigate the relationships between PPVP and other ocular pathologies. Advanced OCT techniques should be used to further analyze PPVP morphology and its dynamic relationship with surrounding structures.

    Ultrawidefield OCTA study for the impact of PPVP on the structure and blood flow of the retina and choroid · 2026 · DOI

  • Whether the presence of PPVP contributes to retinal thick- increased blood flow, or whether these retinal ening and characteristics are associated with PPVP detectability, remains to be determined in longitudinal studies.

    Ultrawidefield OCTA study for the impact of PPVP on the structure and blood flow of the retina and choroid · 2026 · DOI

  • The study only included patients with monocular prophylactic peripheral laser retinopexy. The sample size was limited to 98 patients. The follow-up period was only 3 months.

    Changes in pupil size and accommodation following prophylactic peripheral laser retinopexy: a prospective self-controlled study · 2026 · DOI

  • There is a lack of understanding of the effects of prophylactic peripheral laser retinopexy on pupillary and accommodative functions. Prior studies have not fully addressed these effects.

    Changes in pupil size and accommodation following prophylactic peripheral laser retinopexy: a prospective self-controlled study · 2026 · DOI

  • The lack of specialized multimodal datasets with specific imaging conditions is a limitation. The model's performance may be affected by transient data corruption.

    Toward comprehensive real-time scene understanding in ophthalmic surgery through multimodal image fusion · 2026 · DOI

  • The development of more specialized multimodal datasets with specific imaging conditions. The exploration of more advanced network architectures for multimodal image fusion.

    Toward comprehensive real-time scene understanding in ophthalmic surgery through multimodal image fusion · 2026 · DOI

  • The main strength of this study lies in the comprehensive evaluation of multiple baseline OCT biomarkers in nonin- fectious uveitic CME and the analysis of their associations with both baseline and post-treatment BCVA. By simultane- ously assessing both inner and outer retinal integrity, this study provides a more complete understanding of the struc- ture–function relationship in uveitic macular edema. However, the retrospective design and relatively small sample size represent important limitations. Variability in treatment protocols may act as a potential confounding factor. Although manual OCT measurements may carry a risk of observer-related bias, the fact that all measurements were performed by a single examiner enhanced standard- ization and ensured measurement consistency across evalu- ations. HRF number and intraretinal cyst parameters were assessed on OCT B-scans (line scans); HRF were manually counted, whereas intraretinal cyst parameters were obtained by manually delineating the relevant structures, after which the measurements were automatically calculated by the Hei- delberg Spectralis SD-OCT device software. In addition, although recent studies have demonstrated that automated deep learning–based algorithms may provide reliable HRF and intraretinal cyst/fluid quantification with high concor- dance to expert grading in various retinal diseases, HRF and IRC volume assessments in the present study were per- formed using manual/semi-manual methods. Therefore, the findings related to these parameters should be interpreted with appropriate caution. Author contributions MFB, NK, HEO, and YS meet the ICMJE cri- teria for authorship. They contributed to the study conception, de- sign, data acquisition, analysis, and interpretation. MFB drafted the manuscript, and both authors critically revised and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work. Funding Open access funding provided by the Scientific and Techno- logical Research Council of Türkiye (TÜBİTAK). The authors have no relevant financial or non-financial interests to disclose. Data availability The datasets generated during and/or analyzed dur- ing the current study are available from the corresponding author on reasonable request.

    Baseline OCT biomarkers associated with visual prognosis in cystoid macular edema secondary to noninfectious uveitis · 2026 · DOI

  • There is a need for comparison of different surgical techniques for macular hole repair. The effects of microvascular remodeling on visual outcomes are not well understood.

    Macular micro vascular changes following macular hole repair: optical coherence tomography angiography study · 2026 · DOI

  • The main limitations of this study are the relatively short follow-up period, which may underestimate late struc- tural and microvascular remodeling that could last up to the first year. Relying on BCVA as the only determinant of functional recovery may overlook other important aspects of visual assessment, such as microperimetry. The absence of a healthy control group or fellow-eye comparison also limits the interpretation of absolute perfusion changes. Lastly, regarding the baseline parameter comparison between both groups, the mean BHD was larger in group B, which may influence the equivalence of the groups.

    Macular micro vascular changes following macular hole repair: optical coherence tomography angiography study · 2026 · DOI

  • The complexity of the vitreous composition. The difficulty of studying the vitreous barrier function in vivo. The need for new methods and tools to investigate the vitreous barrier function.

    Comparative Analysis of Intravitreal Diffusion Patterns Across Ex Vivo Human and In Vivo/Ex Vivo Animal Models · 2026 · DOI

  • The lack of understanding of the vitreous barrier function and its influence on substance distribution. The need for new intraocular drugs and gene therapies that can effectively target the posterior segment of the eye.

    Comparative Analysis of Intravitreal Diffusion Patterns Across Ex Vivo Human and In Vivo/Ex Vivo Animal Models · 2026 · DOI

  • The challenge of preserving the testicular artery and lymphatic vessels in pediatric microsurgical varicocelectomy - The need for a feasible strategy to optimize surgical procedures and enhance safety

    Indocyanine green fluorescence for vascular visualization in pediatric microsurgical varicocelectomy · 2026 · DOI

  • The study faced challenges in terms of the limited sample size of the extreme high myopia group. There may be variability in the measurement of axial length and OCT parameters. The study's retrospective design may be subject to biases and limitations.

    Impact of Axial Length on Visual Outcomes and OCT Findings in Epiretinal Membrane: A Retrospective Study · 2026 · DOI

  • the study was retrospective, - the distribution of BCVA change was not normal, - non-parametric methods were used, - the study did not investigate the cause of limited postoperative visual improvement in eyes with extreme high myopia

    Impact of Axial Length on Visual Outcomes and OCT Findings in Epiretinal Membrane: A Retrospective Study · 2026 · DOI

  • The long-term anatomical impact of NSAIDs after ERM surgery has not been established. There is a need to investigate the effect of early postoperative bromfenac on macular thickness after phacovitrectomy.

    Long-term effects of short-term postoperative bromfenac on macular thickness after phacovitrectomy for idiopathic epiretinal membrane · 2026 · DOI

  • Topical nonsteroidal anti-inflammatory drugs (NSAIDs) inhibit prostaglandin-mediated disruption of the blood-retinal barrier, but their long-term anatomical impact after ERM surgery has not been established.

    Long-term effects of short-term postoperative bromfenac on macular thickness after phacovitrectomy for idiopathic epiretinal membrane · 2026 · DOI

  • A multicenter, double-blind RCT comparing PPV vs observation ± YAG vitreolysis with validated floater-specific PROMs as primary outcomes. Development and international validation of a floater-specific PROM. Long-term registry data on cataract rates, QoL durability, and RD risk across surgical technique subgroups.

    Association of Vitrectomy for Floaters with Patient-Reported Quality of Life and Visual Disturbance : A Systematic Review of Randomized Controlled Trials and Primary Studies · 2026 · DOI

  • The lack of large RCTs for PPV. The need for standardized, floater-specific PROMs.

    Association of Vitrectomy for Floaters with Patient-Reported Quality of Life and Visual Disturbance : A Systematic Review of Randomized Controlled Trials and Primary Studies · 2026 · DOI

  • There is a need for further research on the safety and efficacy of ILM peeling techniques. The strong adhesion between the ILM and the underlying structures can result in complications.

    Modern approaches to ILM peeling in macular hole and epiretinal membrane surgery: benefits, risks, and surgical innovations · 2026 · DOI

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78 open questions have been extracted from the limitations and future-work passages of 271 Retinal and Macular Surgery papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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