European Journal of Ophthalmology

Purpose This study aimed to describe the results of slow-cooking transscleral cyclophotocoagulation (SC-TSCP) with diode laser in patients with refractory glaucoma. Methods This retrospective study included 289 eyes of 263 patients who underwent the SC-TSCP technique at the glaucoma service of Oculare Ophthalmology Hospital, Brazil, with a minimum of one year of postoperative follow-up. We analyzed intraocular pressure, number of medications, postoperative complications, visual acuity, need for additional glaucoma surgery, need for repeat sessions of SC-TSCP, and the variables influencing success rates. We used three criteria to analyze the technique's success: 1) Final IOP ≤ 21 mmHg, 2) Final IOP between 6 and 21 mmHg, and 3) Reduction of at least 30% in IOP. Results Mean IOP dropped from 37.52 (±12.12) mmHg preoperatively to 14.48 (± 7.56) mmHg at the end of the study ( p = 0.0001). The average reduction in IOP was 23.04 (±14.00) mmHg, representing a reduction of 61.41% in IOP ( p = 0.0001). The mean number of medications dropped from 2.98 (±1.43) to 1.79 (±1.50) ( p = 0.0001). Complete success (without eyedrops) was achieved in 25.61%, 18.69%, and 29.41% for each success criterion, and qualified success (with or without eyedrops) was achieved in 79.58%, 68.86%, and 85.43%, respectively. Visual acuity decreased from 1.99 LogMar (Snellen 20/1954) to 2.11 LogMar (Snellen 20/2576) ( p = 0.0001). Seventy-two eyes (24.91%) needed a second session, 15 eyes (5.19%) needed a third cyclophotocoagulation, and one eye (0.35%) needed a fourth session. The most common complications were persistent hypotony (8.65%), corneal decompensation (6.23%), loss of light perception (5.88%), and phthisis (2.77%). After cyclophotocoagulation, 86.85% of the eyes did not require additional surgical procedures for IOP control. Conclusion The slow-cooking transscleral cyclophotocoagulation technique proved highly effective in the prolonged control of intraocular pressure in severe and refractory glaucoma and demonstrated a favourable safety profile. However, in complex and refractory cases, severe complications such as vision loss or phthisis, although rare, may occur.

Background Platelet parameters have been linked with glaucomatous optic neuropathy but whether they were associated with retinal nerve fiber layer (RNFL) thickness among healthy individuals remains unclear. We aim to determine the relationship between different platelet parameters and RNFL thickness in healthy university students. Methods The Dali University Students Eye Health Study is a university-based, cross-sectional study in southwestern China in 2021. RNFL thickness was measured automatically using an optical coherence tomography scanner. An automated hematology analyzer was used to analyze the platelet parameters including platelet (PLT) count, platelet distribution width (PDW), mean platelet volume (MPV) and plateletcrit (PCT). Linear regression models and generalized additive models were established to examine the associations of platelet parameters with RNFL thickness. Results A total of 1905 participants with valid RNFL thickness and platelet parameters data were included in the current analysis. Per unit increase in the levels of MPV and PDW was associated with a decrease of 0.74 μm ( P = 0.04) and 0.35 μm ( P = 0.04) in RNFL thickness in multivariable-adjusted model. Subgroup analyses indicated that the association between MPV and RNFL thickness was present in male students. A non-linear trend in the association of MPV with RNFL thickness were observed ( P = 0.04). Conclusion Increased levels of MPV and PDW were associated with thinner RNFLs among university students, suggesting that the platelet parameters, a simple, global, and economical markers, have the potentials to be an additional valuable biomarker for predicting the change of RNFL thickness and onset of RNFL-related nerve diseases in late adulthood.

PurposeTo explore the long-term anatomical and functional outcomes in naïve patients with Myopic Traction Maculopathy (MTM) treated with either macular buckle (MB) plus pars plana vitrectomy (PPV) or primary MB as unique treatment according to MTM Staging System (MSS). MethodsRetrospective study involving 206 consecutive naïve patients with MTM who underwent either MB plus PPV or primary MB. Postoperative anatomical and functional outcomes, including the MTM stage and its progression, axial length (AL), and best-corrected visual acuity (BCVA) changes, were evaluated at one month (i.e., “early follow-up”), six months (i.e., intermediate follow-up”), 12 months postoperatively (i.e., “late follow-up”) and at last follow-up ranging between 12 and 156 months postoperatively (i.e., “final follow-up”). ResultsRetinal and foveal anatomical results significantly improved in patients who underwent either primary MB plus PPV or MB (p < 0.001), with 100% and 92.1% of patients who underwent complete resolution, respectively. For every MTM stage, the BCVA significantly improved over the follow-up visits. (p < 0.001). At the last visit, 84 (41%) eyes improved to 0.5 decimal or more. In patients treated before 2020, when applying more combined PPV treatments, there was a high rate of early iatrogenic full-thickness macular holes (p = 0.005). The results obtained since 2020, when the customized treatment was employed, led to better results without sight-threatening complications. ConclusionsThe MTM Staging System should be the foundation for treating MTM. It should precisely assess the optimal surgical technique and the ideal time to perform it concerning the various stages to maximize anatomical and functional success.

Purpose: to present a case of active neovascular AMD treated with anti-VEGF drug in the presence of silicone oil. Study design: case report. Results: A 69-year-old male was referred to the surgical retina service due to a sudden loss of peripheral vision in the left eye (LE). Biomicroscopic examination revealed the presence of geographic atrophy in the right eye (RE) and a macula-on retinal detachment in the far periphery with drusen at the posterior pole in LE. Combined OCT-OCTA examination demonstrated the presence of non-active type 1 MNV in the LE. The patient underwent a 25-gauge pars plana vitrectomy (PPV) with silicone oil tamponade in the LE. Post-operative follow-up involved clinical and instrumental monitoring every 7 days for the first 3 months and every 15 days in the fourth month, until the removal of the silicone oil. During the follow-up, we detected the reactivation of type 1 MNV in the LE, and as a result, the patient received three monthly Ranibizumab injections in the LE, in conjunction with the removal of silicone oil from the vitreous cavity at the at the fourth month postoperatively. Conclusions : our case report highlights the clinical response to three injections of intravitreal Ranibizumab therapy in managing active neovascular AMD with SO tamponade. The duration of intravitreal Ranibizumab therapy in SO may not differ significantly compared to an eye with intact vitreous humor.

Purpose This study aimed to validate visual acuity measurements using a cross-platform system in an ophthalmological setting. Methods Visual acuity was assessed at a distance of 5 m using two different modalities: printed and digital optotypes. The devices included Android, LG WebOS and Samsung Tizen smart TVs. Optotypes were presented in the logMAR scale. Two modalities, a single row and a block of symbols, presented SLOAN letters and Tumbling-E symbols. Results Visual acuity measurements of 190 participants aged 12 to 60 years demonstrated good-to-strong test-retest correlation (ICC > 0.75) and minimal bias (−0.03 to 0.02 logMAR). Limits of agreement were comparable to other studies (0.13−0.26 logMAR), with the smallest values for Tumbling-E row presentation in all devices and the highest value for Sloan chart in LG device. ANOVA revealed no statistical differences in visual acuity across devices. Sloan letters showed superior visual acuity compared to Tumbling-E ( p < 0.001), however, this difference corresponded to only 2 letters of visual acuity. Conclusion The digital cross-platform evaluated serves as a versatile substitute for traditional visual acuity assessments in individuals aged 12 years and older. Further research is necessary for patients with visual acuity worse than 0.5 logMAR and for conducting vision screenings in young children.

Background Visual dysfunctions in Parkinson's disease (PD) patients suggest a possible degeneration of dopaminergic retinal layers, This study aimed to investigate macular retinal thickness in PD patients versus healthy controls using Optical Coherence Tomography (OCT), a non-invasive technique for in vivo retinal imaging. The role of the Val66Met polymorphism in the BDNF gene in relation to retinal degeneration and clinical features of PD was also explored. Methods This case-control study included 26 patients with idiopathic PD and 78 age- and sex-matched healthy controls, for a total of 208 eyes. All subjects underwent a 512 × 496-line OCT volumetric scan centred on the macular region. Results Macular thickness was measured in each sector and as an average across 360°. Significant differences were found in the superior sector of the left eye (OS2) (increase of 3 units in PD), the inferior sector of the left eye (OS2) (decrease of 3 units in PD), and the total volume of both eyes (decrease of 0.13 units in PD). An inverse correlation between retinal thickness and age at onset was observed in the temporal and inferior sectors of both eyes. The Val/Met heterozygous polymorphism was identified in 30.7% of PD patients. Conclusions The study confirms that thinning of the inner retinal layers is associated with PD. OCT provides a rapid, non-invasive, repeatable, and cost-effective method for in vivo assessment of retinal layers, supporting its potential as an early biomarker for PD. Further longitudinal studies with larger samples are needed to clarify the role of the BDNF polymorphism in retinal degeneration in PD.

Purpose To compare the thicknesses of each retinal layer in patients with clinically unilateral pseudoexfoliation syndrome (XFS) versus unaffected fellow eyes and healthy age-matched controls. Methods In this cross-sectional study, a complete ophthalmologic evaluation, including intraocular pressure (IOP) measurement, was performed in 40 patients with unilateral XFS-affected and 43 healthy controls. After confirming that fellow eyes were clinically unaffected, all eyes underwent the retinal layer segmentation analysis using enhanced depth imaging spectral-domain optical coherence tomography (EDI SD-OCT). The thickness maps were divided into nine subfields (i.e., 1-mm, 3-mm, and 6-mm grids) using the Early Treatment Diabetic Retinopathy Study (ETDRS) and were extracted from the software to compare the groups. Results In the 1-mm central subfield, thicknesses of the ganglion cell layer (GCL), inner plexiform layer (IPL), and inner retinal layer (IRL) were significantly reduced both in XFS-affected and fellow eyes than in controls. Additionally, the thicknesses of the inner nuclear layer (INL) and outer plexiform layer (OPL) were significantly reduced in fellow eyes compared to controls. Comparison of XFS-affected versus fellow eyes in the 1-mm central subfield showed no significant differences in GCL, IPL, IRL, INL, and OPL thicknesses ( p > 0.05, for all; Tukey HSD test). In ETDRS subfields, 3-mm temporal and 3-mm inferior IPL thicknesses of fellow eyes and 6-mm temporal INL thickness in XFS-affected eyes were reduced compared to controls ( p < 0.05, for all). Conclusion In clinically unilateral XFS, the consequential thinning of retinal layers in the fellow eye accompanies the significant thinning of retinal layers in the affected eye.

Background: Retrobulbar block is a popular regional anesthetic technique in modern eye surgery due to its excellent anesthetic properties and the provision of globe akinesia. Severe complications including inadvertent subarachnoidal injection, expulsive retrobulbar hemorrhage, and intoxication with local anesthetic, are very rare. However, most reports date back several decades, mechanisms of action are not fully understood, and in recent years the procedure has changed towards facilitating the retrobulbar injection by a brief analgosedation. We therefore describe a case with inadvertent brainstem anesthesia after retrobulbar block concealed behind an analgosedation and provide cCT (cranial computed tomography) images with characteristic pathological findings. Therapy and outcome: A man in his mid-60´s presenting with retinal detachment was scheduled for surgery. After uneventful retrobulbar injection under brief analgosedation, a severe increase of blood pressure and tachycardia occurred while unconsciousness (originally induced by analgosedation) persisted. Hemodynamic alterations were treated with betablockers and antihypertensive agents, and the patient was intubated and mechanically ventilated. The diagnostic workup revealed a dural fissure with intracranial air in the cCT-scan compatible with a perforation of the dura and accidental injection of local anesthetics into the subarachnoidal space. The patient was kept intubated on ICU throughout the respiratory depression and fully recovered without neurological deficits. The vitreoretinal procedure was performed under general anesthesia 36 h after the event. Conclusion: Albeit rare, inadvertent brainstem anesthesia remains a serious adverse event of retrobulbar block. As an important aspect, analgosedation may mask the typical clinical signs making the diagnostic work-up challenging. Furthermore, for the first time we present radiographic imaging findings providing insightful evidence for a possible mechanism of action. Serious complications, such as prolonged hypoxia with potential neurological damage, can successfully prevented by ensuring the presence of a fully equipped and skilled anesthetic team throughout the regional anesthetic procedure.

Purpose To quantify the decentration of the crystalline lens in a large Austrian adult cataractous and non-cataractous cohort and to predict decentration using biometric parameters. Setting Kepler University Clinic, Linz, Austria. Design Retrospective single-center study. Methods Preoperative data sets from a cataractous population acquired between 2020 and 2022 were analyzed in this study. Measurements included optical biometry (IOLMaster 700, Carl Zeiss Meditec AG, Germany) as well as anterior segment optical coherence tomography (CASIA-2, Tomey, Japan). Both individual and bilateral analysis of decentration was performed. For decentration prediction, a machine learning algorithm (random forest) was implemented. Results In total, 4731 eyes of 2531 patients were included in this study. Overall mean decentration was 0.212 mm; 95% CI: 0.208–0.216 mm, with 5.3% of patients exceeding a decentration amount of 0.4 mm. There was a low but significant correlation with tilt (r2 = 0.29; p < 0.01), CW (r2 = 0.28; p < 0.001), lens diameter (r2 = 0.09; p < 0.001) and ACD (r2 = 0.09; p < 0.001). Conclusion A decentration amount <0.3 mm should be considered physiological. The preoperative assessment of physiological decentration and its relationship with other biometric parameters could aid in the improvement of postoperative refractive outcomes and patient satisfaction, especially in selecting premium intraocular lenses.

Purpose To provide a comprehensive synthesis of the available evidence on the effects of smoking on ocular health. Methods Databases (PubMed, SCOPUS, Web of Science) were searched through December 2024 for systematic reviews and meta-analyses on smoking and ocular disease risk. Meta-analysis quality was assessed using the 16-item A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 . Results Sixteen studies were included, with 12 qualifying for meta-meta-analysis. Current smokers are 7 to 12 times more likely to develop AMD than non-smokers (Odds Ratio [OR]: 11.93 [95% CI 4.40 to 32.33]; Risk Ratio [RR]: 7.45 [95% CI 4.09 to 13.57]). Past smokers have a seven-fold increased risk (OR: 7.09 [95% CI 4.79 to10.51]). For POAG, current smokers have three times the risk (OR: 3.07 [95% CI 2.07 to 4.54]), and past smokers have three times the risk (OR: 2.64 [95% CI 2.33 to 3.00]). Current smokers are four times more likely to develop cataracts (OR: 4.15 [95% CI 3.35 to 5.15]), while “ever” smokers face a six-fold risk (OR: 5.96 [95% CI 3.21 to 11.04]). Conclusion Smoking is a modifiable risk factor for numerous ocular diseases. Public health efforts and clinical guidelines should emphasize smoking cessation to reduce smoking-related ocular disease incidence and promote ocular health.

Purpose To report a case of proliferative diabetic retinopathy (DR) complicated by concomitant undiagnosed chronic myeloid leukemia (CML). Methods A known diabetic presented with minimal vitreous hemorrhage in left eye, along with Roth's spots and retinal hemorrhages in both eyes. Fundus fluorescein angiography revealed Proliferative DR with mid peripheral capillary non perfusion and neovascularization. Panretinal photocoagulation was performed, but the patient subsequently developed a vitreous hemorrhage in both eyes, necessitating bilateral vitrectomy. Post operatively both eyes had unexpected massive sub-conjunctival and recurrent vitreous hemorrhage. Results Repeat surgery with vitreous lavage and silicon oil injection stabilized the ocular condition. Initial hematological evaluation at baseline had elevated blood sugar levels with normal cell counts. However, six months later, repeat testing revealed leukocytosis, prompting further investigation and a subsequent diagnosis of CML. After treatment for CML silicone oil was removed with a final visual acuity of 20/40 in both eyes. Conclusion This case reveals the intricate interplay between CML and DR. Subtle ocular findings, including Roth spots, mid-peripheral capillary non-perfusion areas with mid peripheral neovascularization can indicate coexistent CML. Diagnosis of CML may be obscured by normal blood counts, and an interdisciplinary collaboration is required in managing complex cases.

Purpose Retinal vein occlusion (RVO) induces ischemia that triggers the release of inflammatory cytokines, including tumor necrosis factor alpha (TNF- α). We aimed at measuring TNF- α level in vitreous samples of treatment naïve RVO patients. Material and Methods this is a case control study. The study was conducted on 45 eyes (20 eyes with treatment naïve RVO associated with macular edema & 25 eyes of patients undergoing cataract surgery as control). Vitreous samples were collected using 25 gauge needle connected to 1 milliliters (ml) syringe and the level of TNF- α was assessed using Enzyme-linked Immunosorbent Assay (ELISA) Kits . Results The mean age of RVO cases was 51.50 ± 12.86 years while controls was 55.76 ± 6.88 years (P value =0.192). Vitreous level of TNF-α was statistically significant higher in RVO patients [4.92 ± 0.74 picograms (pg)/ ml] than control [3.54 ± 0.60 pg/ml]; p value < 0.001. Vitreous TNF-α level in ischemic and non-ischemic RVO subgroups was 4.94 ± 0.69 pg/ml and 4.89 ± 0.89 pg/ml respectively that wasn’t statistically significant (p value = 0.885) and its level in branch and central RVO subgroups was 5.02 ± 0.79 pg/ml and 4.84 ± 0.73pg/ml respectively not statistically significant (p value = 0.592). Conclusions TNF-α level is increased in vitreous of RVO associated macular edema patients, thus, it may be involved in its pathogenesis and Anti-TNF-α might be used as treatment targets in the future.

Introduction Poststreptococcal uveitis is among the immune complications following strep infections. Case description A patient treated for acute myeloblastic leukemia presented with febrile neutropenia 22 days after consolidation chemotherapy including cytarabine. Diagnosed with Streptococcus mitis bacteremia, she subsequently presented with uveitis in her right eye, linked to the previous infection through positive anti-streptolysin O and negative microbiological test results. Topical treatment resulted in complete recovery. Conclusion This unprecedented presentation of post– S. mitis uveitis reveals the potential for misdiagnosis of ocular manifestations after cytarabine treatment. Furthermore, neutropenia and profound lymphopenia should not prevent both the ophthalmologist and the hematologist from considering poststreptococcal immune complications.

Purpose To evaluate the in vitro and in vivo antimicrobial activity on the microbial flora of the eyelids and conjunctiva of the new medicated wipes LENIVA bio, soaked with an antiseptic solution containing natural extracts from citrus fruits (Biosecur ® ), Aloe vera , and Ruscus aculeatus . Methods The in vitro antimicrobial activity of the LENIVA bio antiseptic solution against bacteria and fungi commonly found in the periocular area, including antibiotic-resistant strains, was measured by agar diffusion and microdilution assays. The in vivo activity was measured on swabs collected from the eyelid rim and conjunctiva of 20 patients (13 males, 7 females; mean age 70.5 years) before and after a 4-day treatment with the product. Contralateral untreated eyes were used as controls. Results The in vitro analysis of inhibition halos in agar diffusion assays demonstrated that LENIVA bio is active against all tested germs, even when diluted. In vivo , the reduction in the total microbial counts obtained from both eyelid rim and conjunctival swabs following treatment with LENIVA bio wipes was statistically significant (respectively, mean reduction = 4530 CFU/ml, p < 0.0001; mean reduction = 893 CFU/ml, p = 0.0384). Conclusion LENIVA bio wipes showed in vitro and in vivo antimicrobial activity against microorganisms that are potential pathogens of the eye and/or commonly found in the periocular area.

Purpose This study aimed to compare and provide data on the outcomes of continuous wave (CWCPC) and micropulse transscleral cyclophotocoagulation (MPCPC). Methods This was a retrospective cohort study of 130 glaucomatous eyes that underwent CWCPC with a minimum 6-month follow-up matched 1:1 with 130 eyes that underwent MPCPC. The main outcome measure was CPC failure, defined as intraocular pressure (IOP) reduction of <20%, therapy advancement, or progression to no light perception. The secondary outcome measure was safety profile and complications. Results The mean age of patients in the CWCPC and MPCPC groups was 64.4 ± 16.4 and 64.0 ± 17.2 years, respectively. Most patients were male (56.5%), and 48.5% were White. Primary open-angle glaucoma was the most common glaucoma diagnosis (40.4%), 58.5% of the patients had severe glaucoma. Mean preoperative IOP and number of medications were 29.8 ± 10.6 mmHg and 3.7 ± 1.3, respectively. The failure rates at 6 months (46.9% vs. 18.5%) and 1 year (61.5% vs. 40.8%) were higher in MPCPC group ( p = 0.001). Mean IOP reduction was slightly greater in the CWCPC group (15.1 ± 13.9 mmHg vs. 14.2 ± 10.4, p = 0.5). Lower laser energy (HR:0.995) and MPCPC (HR:1.698) were associated with higher risk of failure ( p = 0.002). The complication rate was higher in the CWCPC group (13.8% vs. 4.6%, p < 0.001); vision loss occurred more in the CWCPC group (4.6% vs. 2.3%), and the only phthisis bulbi occurred in one of the eyes of CWCPC group. Conclusion CWCPC was more effective in lowering the IOP despite delivering less total energy than MPCPC but had a higher rate of complications.

Purpose This study aimed to assess the complication rate of porous polyethylene (PP) implants in patients who underwent enucleation for uveal melanoma and to explore the link between complications and surgical factors. Methods A retrospective cohort study was conducted on consecutive cases treated at the Ocular Oncology Unit, University Clinical Hospital of Valladolid, from 1995 to 2023. Complications were classified as mild (managed conservatively) or severe (requiring implant removal or replacement). Kaplan-Meier curves analyzed complication timing. Results The study included 193 patients, with an average age of 63.6 years and a mean follow-up of 65.9 months. Results showed that 54 complications (28%) were recorded, with 13 (6.7%) classified as severe, and 55.6% of complications occurred within the first three years. Implant wrapping varied: 50.3% with sclera, 11.9% with bovine pericardium, and 33.2% not wrapped. The study found no significant difference in implant survival between wrapped and unwrapped implants or between different sizes ( p > .05). Conclusion The findings suggest that PP implants have a low rate of severe complications in uveal melanoma patients and that complication risk is not significantly impacted by wrapping or implant size.

Purpose To evaluate the role of external limiting membrane aperture (ELMA) as a prognostic factor for the anatomical and functional outcomes of full thickness macular hole (FTMH) surgery. Design Retrospective. Methods 120 eyes of 120 patients who underwent surgery for idiopathic FTMH were enrolled. Best corrected visual acuity (BCVA) and spectral-domain optical coherence tomography (SD-OCT) scans were evaluated preoperatively and postoperatively at 3 and 12 months. Statistical analysis was performed to correlate the following preoperative parameters with 12-months postoperative BCVA and anatomical results: ELMA, apical hole diameter (AD), base hole diameter (BD), macular hole index (MHI), tractional hole index (THI), height (H), diameter hole index (DHI), hole form factor (HFF) and preoperative BCVA. Results Primary successful MH closure was achieved in all the eyes. Postoperative BCVA showed a statistically significant increase from a preoperative logMAR median (IQR) value of 0.70 (0.52–1.00) to 0.18 (0.10–0.34) at 3 months and 0.16 (0.05–0.30) at 12 months. As demonstrated by ROC curves analysis, ELMA revealed to be a good predictor for 1B and 1C types of MH closure when its value was greater than 369 µm. Moreover, ELMA sizes above 369 µm were strongly associated with a postoperative BCVA less than 20/40. Conclusions ELMA appears to be a reliable prognostic factor for postoperative anatomical and functional outcome in FTMH surgery.

Purpose To report the clinical outcomes with three-dimensional (3D)-printed custom orbital implants, designed using contralateral orbit mirroring techniques. Methods Case series of 3D-printed custom orbital implants used for complex orbital reconstructions at University of Michigan Kellogg Eye Center is presented in this study. Data from 2020 to 2023 was collected. Results In this case series of 8 patients, the surgical indications include diplopia, enophthalmos, hypoglobus either post-trauma or tumor removal. One patient had bilateral defects; others had unilateral defects. The mean follow-up time was 27.88 ± 9.66 months (Range: 7–38 months). Postoperative improvement was seen for enophthalmos in 7 of 8 cases, hypoglobus in 3 of 5 cases, and diplopia in 3 of 4 cases, and the average exophthalmometry asymmetry improved from 3.1 mm to 0.5 mm. Conclusions 3D-printed orbital implants demonstrated effectiveness and safety in this diverse series of orbital reconstruction cases, yielding significant clinical improvements. Our findings support the use of these implants in a variety of complex orbital reconstructions.

Purpose To evaluate changes in intraocular pressure (IOP), central corneal thickness (CCT) and corneal biomechanics before and after exposure to hypobaric hypoxia, accounting also for Time of Useful Consciousness (TUC) as a parameter of short time exposure to systemic hypoxia. Methods This prospective, observational study recruited 45 healthy individuals training in Hypobaric Chamber. IOP, CCT and corneal biomechanics were evaluated before and immediately after the end using the Corvis ST. Comparisons of score values before and after hypoxia were performed with paired t-test for normally distributed differences. Difference between the IOP measurements was correlated with differences in CCT, corneal biomechanics and TUC with multivariate mixed effect linear regression models. Results Biomechanically corrected IOP (bIOP-Corvis) and pneumotonometry IOP as produced by Corvis ST (NCT) showed statistically significant higher values before hypoxia ( p = 0.048 and p = 0.047 respectively). We observed a strong negative correlation of the difference between bIOP-Corvis before and after hypoxia with the difference in Deformation amplitude ratio (DARatio) ( p < 0.001) and a significant positive correlation with the difference in Integrated Inverse Radius(IntegrRadius) ( p = 0.01), Stiffness parameter at the first applanation (SPA1) ( p < 0.001) and TUC ( p = 0.023). We observed a strong negative correlation of the difference between NCT before and after hypoxia with the difference in DARatio ( p < 0.001) and a significant positive correlation with the difference in IntegrRadius ( p = 0.023), SPA1 ( p < 0.001) and TUC ( p = 0.025). The R-squared values of the regression models were 0.6420 and 0.6626 for the bIOP and NCT respectively. Conclusion We demonstrated reduction in IOP after hypoxia exposure. A combination of alterations in corneal biomechanics explain a degree of this IOP reduction, whereas CCT did not have a significant role in IOP changes.TUC was found to significantly correlate with IOP changes.

Objective To investigate the causes of corneal epithelial defects (CEDs) due to mechanical trauma and analyze the risk factors for progression to persistent epithelial defects (PEDs). Method A retrospective analyze 241 patients (241 eyes) with CEDs caused by mechanical ocular trauma. All patients received initial treatment as outpatients at our hospital. Data collected included patients’ basic information, injury causes, use of adjunctive treatments, improvement in symptoms and adverse reactions before and after treatment. Logistic regression analysis was used to explore the relationship between the causes of injury, the use of adjunctive treatments, and the occurrence of persistent corneal epithelial defects. Results The study involved 241 patients: 164 males (68.1%) and 77 females (31.9%), averaging 38.06 ± 17.88 years old. The most common age groups were 31–40 years (24.1%), 41–50 years (19.9%), and 51–60 years (18.2%). The top five causes of injury were finger pokes (20.4%), impacts from plastic objects (14.6%), branch strikes (13.3%), paper cuts (8.8%), and metal scratches (8.3%). 164 patients used recombinant human growth factor (rhEGF) eye drops with an average healing time of 3.2 ± 1.3 days, while 77 did not use these drops, averaging 7.4 ± 2.2 days. Continuous use of bandage lenses was a risk factor for persistent epithelial defects ( P < 0.001). Conclusion Treatment of CEDs caused by mechanical trauma should focus on managing ocular surface inflammation. The use of rhEGF eye drops can be an effective supplement treatment for CEDs. However, caution is needed regarding the use of bandage lenses.

Refractive error is among the leading causes of visual impairment globally. The diagnosis and management of refractive error has traditionally relied on comprehensive eye examinations by eye care professionals, but access to these specialized services has remained limited in many areas of the world. Given this, artificial intelligence (AI) has shown immense potential in transforming the diagnosis and management of refractive error. We review AI applications across various aspects of refractive error care – from axial length prediction using fundus images to risk stratification for myopia progression. AI algorithms can be trained to analyze clinical data to detect refractive error as well as predict associated risks of myopia progression. For treatments such as implantable collamer and orthokeratology lenses, AI models facilitate vault size prediction and optimal lens fitting with high accuracy. Furthermore, AI has demonstrated promise in optimizing surgical planning and outcomes for refractive procedures. Emerging digital technologies such as telehealth, smartphone applications, and virtual reality integrated with AI present novel avenues for refractive error screening. We discuss key challenges, including limited validation datasets, lack of data standardization, image quality issues, population heterogeneity, practical deployment, and ethical considerations regarding patient privacy that need to be addressed before widespread clinical implementation.

Introduction The glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as Semaglutide, have revolutionized the treatment of type 2 diabetes mellitus and obesity. Case desciption The aim of the present study was to report a case of Non-Arteritic Anterior Ischemic Optic Neuropathy (NAION) occurring in a diabetic patient taking Semaglutide and to review the literature in order to find a possible relation between the ophthalmological event and the drug intake. Discussion Although the clinical trials of Semaglutide did not report any significant increase in the risk of NAION, a recent retrospective cohort study suggested a possible association between NAION and GLP-1 RAs. After this publication, the association between NAION and Semaglutide became an hot topic and several studies were published, presenting conflicting results. Conclusion and Importance Albeit the association between the use of GLP-1 RAs and NAION, to date, remain controversial, clinicians and ophthalmologists should be aware of such possible association to analyze for each patient the risk-benefit ratio.

Purpose To present a case of orbital fracture arising from a pickleball related injury. Methods Retrospective case report Results Pickleball is a fast-growing sport combining elements of tennis, badminton, and table tennis and injuries to the eye and adnexa from blunt trauma associated with pickleball are increasing. To date, no cases of orbital fractures arising from pickleball-associated trauma have been documented. We report the case of a 54-year-old male who sustained orbital trauma when his teammate's paddle struck his face. Examination revealed lid hematoma, a lower eyelid laceration, subconjunctival haemorrhage and periorbital edema. Imaging demonstrated a minimally displaced medial orbital wall fracture without muscle entrapment or bony impingement. The laceration was repaired, and the fracture was managed conservatively given the absence of diplopia or enophthalmos. Conclusions and importance While on its own, an orbital fracture is a commonly encountered entity, the mode of injury and the nature of the trauma that led to the injury are extremely rare. This case highlights the potential for serious orbital injuries in pickleball, emphasizing the need for protective measures and increased awareness among players and healthcare providers. In this communication, we describe our case in detail and review the reported cases of pickleball related ophthalmic trauma.

Purpose To report a case of extensive macular atrophy with pseudodrusen (EMAP) complicated by a non-exudative quiescent type 1 macular neovascularization (MNV). Case description A 65-years-old male patient complained of bilateral progressive visual loss and nyctalopia over the last ten years. Fundus examination showed in both eyes central foveal sparing geographic atrophy partially extending outside vascular arcades, reticular pseudodrusen (RPD), and mid-periphery pavingstone degenerations. On optical coherence tomography (OCT), RPD, basal laminar deposits, retinal pigmented epithelium and outer retinal atrophy were detected bilaterally. In left eye (LE), a perifoveal mid-reflective pigment epithelium detachment (PED) with no neovascular activity signs (e.g., macular hemorrhage, intraretinal/subretinal fluid, subretinal hyperreflective material) was found. Fluorescein angiography revealed in LE a hyperfluorescence coincident with PED without leakage on late phase. OCT-angiography displayed a pathological neovascular network consistent with a non-exudative type 1 neovascularization. No treatment was performed and the patient was closely followed. On last consultation six months later, MNV was stable with no identifiable activation signs. Based on these findings, a diagnosis of EMAP complicated by non-exudative quiescent type 1 neovascularization was hypothesized. Discussion Similarly to age-related macular degeneration, EMAP could be associated to non-exudative neovascularization. Choriocapillaris loss could be the trigger for the development of vascular sprouts, representing the precursor of non-exudative type 1 MNV. Conclusion This case-report supported the importance of at least six-months follow-up for NE-MNV in EMAP. Further studies are needed to confirm our result and to consolidate therapeutic management of MNV in this rare macular disorder.

Purpose To provide more basis for further diagnosis and differentiation for Endocrine Mucin-Producing Sweat Gland Carcinoma (EMPSGC), we offer a case report and a comprehensive review of the epidemiology, immunohistochemical findings, and molecular mechanisms underlying EMPSGC. Case description We herein present a case of a 70-year-old Chinese male patient who presented with a painless, progressively enlarging skin mass at his right lateral canthus. Histopathological examination revealed solid papillary growth patterns with intracellular mucin, and immunohistochemical staining was positive for Ki-67, P53, EMA, CK7, GATA3, CgA, Syn, INSM1, and AR, confirming the diagnosis of EMPSGC. Literature revealed that EMPSGC is a rare, low-grade malignant tumor with neuroendocrine differentiation. Key immunohistochemical markers include CK7, GATA-3, and INSM1, which aid in diagnosis. Hormone receptors such as ER, PgR, and AR are frequently expressed. The recurrence risk ranges from 7.11% to 14.3%, with rare cases of metastasis to the parotid gland, lungs, and skeletal system. Following surgical resection and subsequent pathological examination, the lesion was diagnosed as EMPSGC. In this report, we delineate the clinical presentation, Hematoxylin and eosin (H&E) staining features, and immunohistochemical characteristics of this case. We also conduct a literature review to enhance the understanding of EMPSGC. Conclusion EMPSGC is a relatively rare type of eyelid tumor in ophthalmic diagnosis and treatment. However, it poses a significant risk of misdiagnosis with other ocular tumors. Any eyelid mass demands attention, and necessitates prompt resection followed by intraoperative and/or postoperative pathological examination to avoid misdiagnose and poor prognosis.