PURPOSE: To evaluate choroidal vasculature in intermediate age-related macular degeneration (AMD) based on drusen phenotypes and to understand the relationship between drusenoid pigment epithelial detachment (PED) distri...PURPOSE: To evaluate choroidal vasculature in intermediate age-related macular degeneration (AMD) based on drusen phenotypes and to understand the relationship between drusenoid pigment epithelial detachment (PED) distribution and the choroidal vascularity index (CVI). METHODS: In this retrospective cross-sectional study, patients with intermediate AMD were included. Eyes were divided into three groups based on drusen phenotype: PED, PED combined with reticular pseudodrusen (RPD), and RPD alone. Plex Elite 9000 device (Carl Zeiss Meditec, Dublin, CA) optical coherence tomography was used to obtain sector-wise measurements of choroidal thickness (CT), choroidal volume (CV), and choroidal vascularity index (CVI) using the Zeiss Advanced Research and Innovation Network ( www.arinetworkhub.com ). Drusenoid PED area and volume were quantified using automated RPE elevation analysis. CVI heat maps were converted to pixel-wise quantitative values and spatially co-registered with drusen maps. Mean CVI was compared between drusen and non-drusen regions. To assess the spatial relationship between drusen distribution and choroidal vascularity, an enrichment ratio (ER) analysis was performed, defined as the proportion of drusen pixels located in high-CVI regions divided by the baseline proportion of high-CVI pixels, using percentile-based CVI thresholds. RESULTS: A total of 47 eyes from 34 patients (21 females) were included. Eyes with RPD alone (5 eyes) exhibited significantly reduced CT across all macular regions compared with PED-only (26 eyes) and PED + RPD eyes (16 eyes) (overall p = 0.005), along with significantly lower central and parafoveal choroidal volume. Mean CVI did not differ significantly among the three groups; however, CVI was positively correlated with both choroidal thickness and choroidal volume (r = 0.37, p ≤ 0.01). Mean CVI was significantly higher in drusen areas compared to non-drusen regions (0.61 ± 0.09 versus 0.5 ± 0.07, p < 0.001). (p < 0.001), with ERs indicating preferential localization of drusen within high-CVI regions. The mean ER at the 75th CVI percentile was 1.74 ± 0.36, suggesting that drusenoid PEDs were 74% more likely to occur in regions with high CVI (top 25%). CONCLUSION: In intermediate AMD, RPDs are associated with marked choroidal thinning and volume reduction, highlighting the primary choroidal involvement in this phenotype. The preferential localization of drusenoid PEDs in regions with higher CVI emphasizes complex, localized choroidal–RPE interactions in AMD pathogenesis.
PURPOSE: To investigate the prevalence and clinical characteristics of Charles Bonnet Syndrome (CBS) in patients referred for bilateral cataract surgery. METHODS: This prospective, cross-sectional clinical trial included...PURPOSE: To investigate the prevalence and clinical characteristics of Charles Bonnet Syndrome (CBS) in patients referred for bilateral cataract surgery. METHODS: This prospective, cross-sectional clinical trial included 391 patients attending cataract assessment at a single-center tertiary cataract clinic. After clinical examination, participants were screened for presence of visual hallucinations (VHs). Participants experiencing complex VHs were further questioned regarding characteristics of their hallucinatory experiences to properly determine if they were attributable to CBS. CBS was defined as complex visual hallucinations with retained insight, no medical history or medication known to cause hallucinations and not limited to hypnagogic or hypnopompic states (hallucinations happening shortly before falling asleep and/or shortly after waking up). RESULTS: Nineteen (4.9%) patients experienced complex VHs. Of these, 11 (2.8%) were diagnosed with CBS while 8 (2.1%) had complex hypnagogic and/or hypnopompic VHs. Multivariable logistic regression analysis identified lower best-corrected visual acuity (BCVA) in the better seeing eye as a significant predictor of CBS. When excluding participants with a BCVA>0.3, prevalence of complex VHs rose to 10.0%. Three of the patients with CBS (27.3%) had ocular comorbidities: two had exudative age-related macular degeneration (AMD), and one had drusenoid AMD. In the overall cohort, twenty-four patients (6.1%) reported prior knowledge of CBS. CONCLUSION: CBS was observed in a clinically relevant minority of cataract patients requiring bilateral surgical intervention. Given the high prevalence of cataract among the elderly, this study highlights the importance of healthcare personnel being aware of CBS and other complex VHs and their potential consequences for cataract patients.
PURPOSE: The need for long-term intravitreal anti-VEGF therapy for neovascular age-related macular degeneration (nAMD) may be challenging for patients and providers, potentially resulting in lapses in care. The global Ba...PURPOSE: The need for long-term intravitreal anti-VEGF therapy for neovascular age-related macular degeneration (nAMD) may be challenging for patients and providers, potentially resulting in lapses in care. The global Barometer survey examined barriers and opportunities for improvement for nAMD management from different perspectives; this article reports findings for Germany. METHODS: Data were gathered from 4 academic tertiary hospitals in Germany. Likert-scale questions captured perspectives from 200 patients with nAMD and 38 ophthalmologists (providers). RESULTS: Communication between patients and providers was positively perceived, with 90% of patients reporting that they felt comfortable asking questions. Most patients reported a general understanding of nAMD and the treatment required. However, 49% did not know how long treatment would be required. Structural barriers such as difficulties in travelling to the clinic and long waiting times were reported by 29% of patients. Individual concerns about being burdensome to family and fear that the treatment might not work were reported by 33% and 31% of patients, respectively. As potential improvements, 72% of patients reported a desire for more individualized discussions regarding treatment challenges, and 57% reported that longer intervals between treatments without vision loss would be beneficial. Overall, responses from patients and providers suggest a need for more structured, ongoing communication to support understanding, engagement, and adherence. CONCLUSION: German results from the Global Barometer Survey identified gaps in patient education, patient expectations and logistical support for nAMD care. Addressing these issues through better communication and longer-acting treatments could improve adherence, satisfaction and outcomes.
PURPOSE: To analyse the genotype and phenotype characteristics of Turkish patients clinically diagnosed with Bietti Crystalline Dystrophy (BCD). METHODS: The clinical findings and the genetic testing results of patients...PURPOSE: To analyse the genotype and phenotype characteristics of Turkish patients clinically diagnosed with Bietti Crystalline Dystrophy (BCD). METHODS: The clinical findings and the genetic testing results of patients diagnosed with BCD were analyzed retrospectively. RESULTS: Thirty-two patients from 26 families were included in the study. Parental consanguinity was reported in 14 patients (43.7%). All patients carried biallelic pathogenic or likely pathogenic variants in CYP4V2. In total, 12 different CYP4V2 variants were identified, three of which were novel: c.802-1G > A, c.802–2 A > C, and c.464 A > C (p.His155Pro). The most common variants were c.1198 C > T (p.Arg400Cys), with an allelic frequency of 23.4% (15/64), and c.802–8_810del17insGC, with an allelic frequency of 18.8% (12/64). Clinical features, including age of onset, visual acuity, disease stage, and optical coherence tomography (OCT) findings, did not differ significantly between genotype groups (p > 0.05). Interocular asymmetry in visual acuity and OCT parameters, as well as variability of clinical findings between siblings and among unrelated patients carrying the same CYP4V2 variants, were observed in the cohort. CONCLUSION: This study, one of the largest European cohorts and the first comprehensive series from Türkiye, broadens the mutational spectrum of CYP4V2 with three novel variants and highlights the marked phenotypic variability of BCD, even within families. The unexpectedly high frequency of c.802–8_810del17insGC in the Turkish population, previously reported mainly in East Asia, provides new insights into the geographic distribution of this variant.
PURPOSE: To evaluate and compare the efficacy, safety, and two-years success rates of XEN® 63 Gel Stent and PRESERFLO™ MicroShunt in uncontrolled glaucoma. METHODS: This retrospective study followed-up patients at day 1,...PURPOSE: To evaluate and compare the efficacy, safety, and two-years success rates of XEN® 63 Gel Stent and PRESERFLO™ MicroShunt in uncontrolled glaucoma. METHODS: This retrospective study followed-up patients at day 1, week 1, and at month 1, 3, 6, 12, 18 and 24, post-operatively, reporting intraocular pressure (IOP), number of IOP lowering medications, success rates, and complications. RESULTS: Ninety-six patients were enrolled, 49 implanted with the Gel Stent (Group A) and 47 with the MicroShunt (Group B). Mitomycin C, at concentration of 0.02% and 0.04%, was applied in Group A and B, respectively. At two years, IOP reduced from 20.7 ± 3.8 to 13.3 ± 3.0 mmHg in Group A and from 21.7 ± 4.3 to 13.4 ± 2.4 mmHg in Group B (p < 0.01). IOP reduction was comparable at all time points except for day 1 and week 1, where MicroShunt was slightly more effective (p < 0.01 and 0.01). The mean number of medications dropped from 2.5 ± 1.0 to 0.8 ± 0.8 and from 2.7 ± 1.0 to 0.7 ± 1.0 in Group A and B, respectively. At two years, complete success was found in 38.7% and 40.4%, while qualified success in 85.7% and 78.7% in Group A and B, respectively. Bleb needling was more frequent in Group A than in Group B (p < 0.01) (16 vs. 1 case), while bleb revisions were two-fold after MicroShunt implantation (10 vs. 5 cases) (p < 0.01). Complications were comparable and self-limiting in both groups. CONCLUSIONS: Over a 2-years follow-up, Gel Stent and MicroShunt presented comparable efficacy and safety in managing medically uncontrolled glaucoma.
PURPOSE: To investigate the effects of autologous platelet-rich plasma (PRP) application on recurrent or refractory full-thickness macular hole (FTMH) in patients who had undergone vitrectomy and internal limiting membra...PURPOSE: To investigate the effects of autologous platelet-rich plasma (PRP) application on recurrent or refractory full-thickness macular hole (FTMH) in patients who had undergone vitrectomy and internal limiting membrane (ILM) peeling. METHODS: Databases including PubMed, EMBASE, and Cochrane Library were searched on April 10, 2025. Studies that investigated the effects of autologous PRP or whole blood application to treat recurrent or refractory FTMH were included. The primary outcome was the closure rate with the procedure, and a meta-analysis of proportions was performed to estimate pooled closure rates. RESULTS: Among preliminary identification of 222 studies, 10 case series using autologous PRP only and three studies using autologous PRP/whole blood and additional flap or graft (retina, lens capsule, amniotic membrane, or residual ILM) were included in the meta-analysis. The overall pooled closure rate with autologous PRP application was 85% (95 confidence interval [CI]: 75-93%), while the additional use of a flap or graft led to an 87% closure rate (95% CI: 64-100%) in cases presenting with recurrent or refractory FTMH. There were no significant differences in closure rate of recurrent or refractory FTMH between groups (p = 0.820). No adverse effects were reported regarding the use of autologous PRP or whole blood application. CONCLUSION: The use of autologous PRP with or without additional flaps was as effective to achieve anatomical closure of recurrent or refractory FTMH, without the need for the concurrent flap or graft techniques.
PURPOSE: To evaluate the incidence and risk factors of steroid-induced ocular hypertension (SIOH) following repeated intravitreal dexamethasone (DEX) implant injections, with particular focus on delayed SIOH, defined as...PURPOSE: To evaluate the incidence and risk factors of steroid-induced ocular hypertension (SIOH) following repeated intravitreal dexamethasone (DEX) implant injections, with particular focus on delayed SIOH, defined as its absence at the first injection and occurrence following subsequent injections. METHODS: This retrospective study included 1,105 eyes treated with DEX implants between 2005 and 2024. Intraocular pressure (IOP) was measured at baseline, 1 week, and 1, 2, 3, 6, and 12 months after each injection. Multivariable logistic regression assessed potential predictors including injection number, and cumulative incidence of SIOH was analyzed using Cox proportional hazards models. Subgroup analyses of multiple-injection SIOH risk factors and IOP trajectories were compared between single-injection and multiple-injection SIOH. RESULTS: Compared to eyes that received only one DEX implant injection, the odds ratios (ORs) for SIOH were: 2.190 (p = 0.004), 2.558 (p = 0.012), 2.560 (p = 0.049), and 4.306 (p = 0.005) for two, three, four, and five injections, respectively. In eyes that experienced SIOH after multiple injections, longer axial length was a significant anatomical predictor (OR = 1.630, p = 0.013). IOP trends differed: multiple-injection SIOH cases showed slower but more sustained elevations. CONCLUSION: Repeated intravitreal DEX implant injections significantly increased the risk of SIOH. Delayed SIOH may occur after subsequent injections even in eyes without SIOH at first injection. Long axial length may contribute to SIOH after multiple injections, with delayed and sustained IOP elevation, underscoring the importance of continued monitoring.
PURPOSE: To assess the association among retinal imaging biomarkers on expanded field swept-source optical coherence tomography angiography (EF SS-OCTA) and non-ocular microvascular complications of diabetes mellitus (DM...PURPOSE: To assess the association among retinal imaging biomarkers on expanded field swept-source optical coherence tomography angiography (EF SS-OCTA) and non-ocular microvascular complications of diabetes mellitus (DM). METHODS: This retrospective, cross-sectional study included 146 eyes from 100 adults with diabetes mellitus (DM), across various stages of diabetic retinopathy. Patients were imaged with EF SS-OCTA (6 × 6 mm, Montage 15 × 15 mm). Mixed effect logistic models were used to identify SS-OCTA metrics associated with the occurrence of non-ocular microvascular complications, while controlling for age, DM duration, and types of treatment that patients received prior to their appointment. Patients’ eyes were treated as random effects, while metrics like ischemia index (Ratio ischemia index = pixels of the NPAs (nonperfusion areas) / pixels of the total image area) and neovascularization real area were rescaled for interpretability. NV (neovascular) VD (vessel density) and VSD (vessel skeletonized density) values are the VD and VSD only of the manually outlined areas of neovascularization. VD is the total area of perfused vasculature per unit area in a region of measurement, while VSD is the total length of perfused vasculature per unit area in a region of measurement. RESULTS: 54 patients had diabetic peripheral neuropathy (DPN), 25 had neither DPN nor diabetic kidney disease (DKD) and 17 had DKD. NV VSD and NV VD (OR = 2.45, p = 0.001) were significantly associated with both DPN and DKD combined (OR = 2.45, p = 0.003; OR = 2.45, p = 0.001, respectively) as well as in separate analyses of DPN (OR = 1.68, p = 0.033; OR = 1.73, p = 0.018, respectively) and DKD (OR = 2.19, p = 0.007; OR = 2.23, p = 0.002, respectively) alone. Ratio Ischemia index (OR: 1.75, p = 0.028) was significantly associated only with DPN. CONCLUSION: NV VSD and NV VD were significantly associated with both DPN and DKD while ratio ischemia index was only significantly associated with DPN, underscoring the potential utility of EF SS-OCTA metrics in predicting and monitoring non-ocular microvascular complications in clinical practice.
Bravo-Gonzalez A, Dominguez-Ruiz P, Buitrago-Gonzalez MJ
… +9 more, Bach B, Chen Z, Suarez D, Arruda MP, Lima RV, Del Valle GS, Zinher MT, de Menezes E Souza Filho CE, Salazar PF
BACKGROUND: Uveal melanoma (UM) is the most common primary intraocular malignancy in adults and carries a high risk of metastasis and poor prognosis when diagnosed late. Distinguishing UM from benign choroidal nevi remai...BACKGROUND: Uveal melanoma (UM) is the most common primary intraocular malignancy in adults and carries a high risk of metastasis and poor prognosis when diagnosed late. Distinguishing UM from benign choroidal nevi remains challenging due to overlapping imaging features. Machine learning (ML) and deep learning (DL) models have emerged as tools to improve diagnostic accuracy and prognostic prediction, but their generalizability and clinical readiness remain uncertain. PURPOSE: To systematically review and meta-analyze the performance of published ML/DL algorithms using ocular imaging on detecting and predicting prognosis of UM. METHODS: A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and IEEE Xplore up to June 2025 for English and Spanish publications since 2012. Eligible studies applied ML/DL to ocular imaging and reported diagnostic or prognostic accuracy metrics. Risk of bias was assessed with QUADAS-2, and pooled sensitivity and specificity were estimated using a random-effects meta-analysis, with subgroup analyses by imaging modality (fundus-only vs. ultrasound-based imaging, with or without an additional modality). For diagnostic studies, we additionally synthesized positive and negative likelihood ratios along with diagnostic odds ratios (DOR) and conducted hierarchical summary receiver operating characteristic curve (ROC) (Reitsma) analyses stratified by modality. RESULTS: Thirteen diagnostic studies met inclusion criteria. Most were retrospective, single-center cohorts using fundus photography, while others employed ultrasound (US), ultra-widefield (UWF), OCT, or autofluorescence. Ten studies used DL architectures, mainly convolutional neural networks or transformers. Pooled sensitivity was 78.21% and specificity 94.28%. Fundus-based models showed lower specificity (87.70%) than US-based models (98.16%). AUC values were consistently high; HSROC AUC was 0.912 (fundus) vs. 0.984 (US; Δ0.073, bootstrap 95% CI − 0.101 to 0.143). The largest modality separation was for LR+ (39.48 vs. 6.16; p < 0.0001), with higher DOR for US (225.25 vs. 27.89; p = 0.0102), while LR − was similar. Six prognostic studies (up to 4,600 patients) reported AUCs between 0.71 and 0.92 for predicting metastasis, survival, or enucleation, though all lacked external validation. CONCLUSIONS: ML and DL models show strong diagnostic performance and emerging prognostic value in UM. However, reproducibility and real-world validation remain limited. New foundation models such as RETFound and VisionFM, trained on large multimodal eye datasets, could improve standardization, explainability, and cross-center generalization. As these models evolve, they have the potential to become essential tools in clinical practice, accelerating the translation of AI into reliable, routine implementation in ocular oncology. (PROSPERO ID: CRD42025643874).
PURPOSE: To determine whether adding pars plana vitrectomy (PPV) to phacoemulsification and intraocular lens implantation (PEI) promotes long-term macular stability in eyes with subclinical diabetic macular edema (DME),...PURPOSE: To determine whether adding pars plana vitrectomy (PPV) to phacoemulsification and intraocular lens implantation (PEI) promotes long-term macular stability in eyes with subclinical diabetic macular edema (DME), defined as fluorescein angiography–positive macular leakage without optical coherence tomography (OCT)–evident center-involving macular edema (CI-ME). METHODS: We conducted a retrospective study including 79 eyes with subclinical DME; 35 eyes underwent PPV with PEI (PPV-PEI), and 44 eyes underwent PEI alone. Outcomes were assessed at baseline, 1 year, and the final follow-up visit (mean follow-up > 6 years), including best-corrected visual acuity (BCVA), central macular thickness (CMT), CI-ME, and epiretinal membrane (ERM) formation. RESULTS: Baseline CMT was higher in PPV-PEI than in PEI (p = 0.028), whereas baseline BCVA was comparable. BCVA improved at 1 year in both treatments (both p < 0.001) and remained similar at the final visit. In PPV-PEI, CMT increased transiently at 1 year (p < 0.001 vs. baseline) and then decreased toward baseline by the final visit (p = 0.005 vs. 1 year), whereas PEI showed persistently elevated CMT (p < 0.001 at 1 year; p = 0.017 at final). Final OCT-evident CI-ME tended to be less frequent in PPV-PEI (11.4%) than in PEI (29.5%). Within PPV-PEI, internal limiting membrane peeling was associated with fewer ERMs (p = 0.012) and independently associated with lower final CMT (p = 0.039). CONCLUSION: Adding PPV to PEI was associated with preserved BCVA and improved long-term macular stability in eyes with subclinical DME.
PURPOSE: The efficacy and safety of Aflibercept (AFL) 2 mg versus Brolucizumab (BRZ) 6 mg in diabetic macular edema (DME) were evaluated in this retrospective comparative research. PATIENTS AND METHODS: Thirty-eight eyes...PURPOSE: The efficacy and safety of Aflibercept (AFL) 2 mg versus Brolucizumab (BRZ) 6 mg in diabetic macular edema (DME) were evaluated in this retrospective comparative research. PATIENTS AND METHODS: Thirty-eight eyes with DME for > 18 months were retrospectively reviewed and divided equally. Group A received three loading doses of intravitreal BRZ (6 mg) and Group B received five loading doses of intravitreal AFL (2 mg), followed by pro re nata (PRN) dosing per OCT-detected persistent macular edema. The central macular thickness (CMT) change from baseline was the main outcome measure. Injection count, complication rate, and best-corrected visual acuity (BCVA) were the secondary objectives. RESULTS: Thirty-eight eyes were analyzed (19 per group). At six months, BCVA and CMT improvements were comparable (p > 0.05). At 12 and 18 months, BRZ achieved significantly greater BCVA gain (0.17 ± 0.08 vs. 0.34 ± 0.11 logMAR, p < 0.001) and greater CMT reduction (239.5 ± 12.5 μm vs. 263.2 ± 19.8 μm, p < 0.001) compared with AFL. The BRZ group had a considerably lower mean total number of injections (5 ± 1.2 vs. 9 ± 1.3, p < 0.001), representing a 44% reduction in injection burden. A mild, non-vision-threatening retinal vasculitis occurred in one BRZ patient (5.3%, p = 0.4866). CONCLUSION: BRZ provided superior visual and anatomical outcomes compared with AFL at 12 and 18 months, with significantly fewer injections. Both agents demonstrated acceptable safety profiles. With a lower treatment burden and long-lasting effectiveness in practical situations, our results validate BRZ as a viable and long-lasting therapy option for DME.
PURPOSE: To evaluate the correlation between objective bench assessment of halos and subjective clinical experience in patients receiving monofocal and presbyopia-correcting intraocular lenses (IOLs). METHODS: Data from...PURPOSE: To evaluate the correlation between objective bench assessment of halos and subjective clinical experience in patients receiving monofocal and presbyopia-correcting intraocular lenses (IOLs). METHODS: Data from four clinical studies included patients with cataracts who received bilateral monofocal (SN60AT, SN60WF), extended depth-of-focus (EDOF; ZXR00, DFT015, 829MP), or multifocal (ZFR00V, TFNT00) IOLs. Subjective halo severity was assessed 6 months after implantation using the Questionnaire for Visual Disturbance (QUVID). Bench assessments were measured using a simulation of a 100-mm headlight at 31 m (20,000 cd/m2 intensity) and an IOL mounted in a model eye with a 4.5-mm pupil. The area under the curve (AUC) of intensity plot was calculated for each IOL and compared with the QUVID-based assessment using a statistical regression analysis. Correlation was assessed using linear regression analysis. RESULTS: In clinical studies, moderate to severe halos were reported by 29% to 48% of patients with diffractive (TFNT00, ZXR00, 829MP, ZFR00V), 11% with nondiffractive EDOF (DFT015), and 4% to 7% with monofocal (SN60WF and SN60AT) IOLs. Diffractive IOLs produced larger halos (AUC, 1448–1896) compared with nondiffractive EDOF (997) and monofocal (1002–1008) IOLs. Correlations were reported between bench halo AUC and patient-reported severity (no halo, r = − 0.92; little to mild halo, r = 0.43; moderate to severe halo, r = 0.93). CONCLUSIONS: A greater proportion of patients with diffractive versus nondiffractive IOLs reported severe halos. Bench halos correlated with subjective clinical experience, particularly for moderate and severe halos.
PURPOSE: To investigate, whether postoperative cystoid macular edema (CME) after combined XEN45 Gel Stent implantation with phacoemulsification has a predictive potential for the occurrence of bleb failure and subsequent...PURPOSE: To investigate, whether postoperative cystoid macular edema (CME) after combined XEN45 Gel Stent implantation with phacoemulsification has a predictive potential for the occurrence of bleb failure and subsequent conjunctival revision surgery. METHODS: This retrospective study involved 45 eyes of 45 participants being treated via combined XEN45 Gel Stent implantation with phacoemulsification and who received optical coherence tomography- (OCT) scans after surgery. In 15 eyes OCT detected a postoperative CME (CME group), the remaining 30 eyes did not show a postoperative CME (Control group). The occurrence of bleb failure and subsequent conjunctival revision surgery was compared among the two groups via a Kaplan-Meier survival analysis. A predictive potential was assessed via a Cox proportional hazards regression model. Postoperative intraocular pressure (IOP), medication scores, success and revision rates were compared. RESULTS: Bleb failure requiring conjunctival revision surgery occurred significantly more frequently in the CME group than in the Control group (87% vs. 50%, p = 0.039). The detection of CME went along with a 2.149-fold increased risk for bleb failure (p = 0.045). IOP decreased by 56% in the CME group, and by 42% in the Control group after an average follow-up of 32.9 ± 20.1 months and 24.8 ± 19.0 months, respectively. There was no significant difference in terms of postoperative IOP, medication scores and success rate observed. CONCLUSIONS: Our results suggest that postoperative CME goes along with a considerably increased risk for bleb failure after combined XEN45 Gel Stent implantation with phacoemulsification. Therefore, when CME is detected postoperatively, close follow-up is advised.
PURPOSE: To evaluate differences in choroidal thickness (CT) throughout the fundus using ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) and to assess its association with age, sex and axial length...PURPOSE: To evaluate differences in choroidal thickness (CT) throughout the fundus using ultra-widefield swept-source optical coherence tomography (UWF SS-OCT) and to assess its association with age, sex and axial length (AL). METHODS: Seventy-two eyes of 36 healthy subjects were imaged with an UWF SS-OCT using a 26 mm x 21 mm volume scan protocol. Mean CT by quadrant was computed within concentric rings centered on the optic nerve head (ONH). CT values were then plotted in 4 quadrants as a function of distance from ONH. Mean CT of each quadrant was correlated with age, sex and AL. RESULTS: All 4 quadrants demonstrated a rapid initial rise in CT with the superior, inferior, and nasal quadrants reaching peak values at 3.75 mm from the ONH center. The temporal quadrant peaked at 5.25 mm with the highest CT overall (341.41 ± 69 µm). The inferior quadrant had the lowest CT at 8.25 mm (177.62 ± 36.5 µm). In the temporal quadrant, CT was negatively associated with age and AL (both p < 0.05) and was thinner in females (p = 0.036). Superior CT was negatively associated with AL (p = 0.007). Inferior CT was associated with age and AL (both p < 0.05), with no impact of sex. CONCLUSION: CT exhibited regional variation throughout the retina with the temporal quadrant demonstrating the greatest thickness and the inferior quadrant showing the lowest CT. Axial length was the most consistent determinant of CT across multiple quadrants while age and sex demonstrated quadrant-specific effects.
Garcia MD, Ding X, Shan M
… +14 more, Romano F, Gan J, Overbey KM, Zhu Y, Ploumi I, Garg I, Vingopoulos F, Wu DM, Patel NA, Kim LA, Husain D, Miller JW, Vavvas DG, Miller JB
PURPOSE: To evaluate the predictive value of optical coherence tomography angiography (OCTA)-derived parameters for visual acuity (VA) decline in non-proliferative diabetic retinopathy (NPDR). METHODS: In this retrospect...PURPOSE: To evaluate the predictive value of optical coherence tomography angiography (OCTA)-derived parameters for visual acuity (VA) decline in non-proliferative diabetic retinopathy (NPDR). METHODS: In this retrospective longitudinal study, 102 eyes from 69 patients with NPDR were followed for a median of 30 months. All eyes underwent expanded field 6 × 6-mm and 12 × 12-mm swept-source OCTA centered on the fovea. Quantitative OCTA parameters including ischemia index (ISI), vessel density (VD), and perfusion density (PD) of the superficial (SCP), deep capillary plexus (DCP), and full retina were measured once at baseline. The primary outcomes were ≥ 5-letter and ≥ 10-letter loss in VA from baseline to final follow-up. Multilevel mixed-effects Cox regression models, adjusted for clinical covariates, were used to identify predictors of VA decline. Predictive performance was evaluated using time-dependent receiver operating characteristic (ROC) analysis. Kaplan-Meier survival and Cox regression analyses across ISI-based risk strata further evaluated time-to-visual-decline relationships. RESULTS: Baseline ISI was a significant predictor of both ≥ 5-letter (HR: 1.84, 95% CI: 1.25–2.70, p = 0.002) and ≥ 10-letter (HR: 1.89, 95% CI: 1.15–3.10, p = 0.01) VA loss. Other OCTA-derived parameters, including VD and PD in SCP, DCP, and full retina, were not significantly associated with visual outcomes. ISI demonstrated the highest area under the ROC curve for both endpoints (AUC = 0.68), with time-dependent ROC analyses showing improved accuracy over longer follow-up. Kaplan–Meier and ISI-stratified Cox analysis confirmed significantly earlier and more frequent ≥ 5-letter decline in eyes with medium–high baseline ISI. CONCLUSIONS: ISI is a promising, non-invasive biomarker predictive of visual decline in NPDR, outperforming other OCTA metrics. ISI demonstrated robust and time-increasing discriminative ability and showed a clear dose–response relationship with the risk of vision loss, particularly for ≥ 5-letter decline. These findings highlight the prognostic value of widefield OCTA in NPDR management and support its integration into clinical risk stratification.
PURPOSE: To compare clinical outcomes, complications, and long-term graft survival following penetrating keratoplasty (PK) versus deep anterior lamellar keratoplasty (DALK) in keratoconus, with 10 years of follow-up. MET...PURPOSE: To compare clinical outcomes, complications, and long-term graft survival following penetrating keratoplasty (PK) versus deep anterior lamellar keratoplasty (DALK) in keratoconus, with 10 years of follow-up. METHODS: This retrospective, comparative cohort study included 224 consecutive primary grafts performed for keratoconus, each with a minimum follow-up of 10 years. Of these, 116 eyes underwent PK and 108 eyes underwent DALK. Outcome measures included postoperative visual acuity, refractive error, and postoperative complications. Graft survival at 10 and 15 years was also evaluated. RESULTS: The mean follow-up was 11.7 ± 1.4 years in the PK group and 11.4 ± 1.6 years in the DALK group (P = 0.10). Final visual acuity and refractive error were similar between groups; however, PK resulted in faster visual recovery and a higher proportion of eyes achieving corrected distance visual acuity (CDVA) ≥ 20/25. Episodes of graft rejection were more frequent after PK, with 10-year rejection-free survival rates of 66.4% for PK versus 77.8% for DALK. Rates of ocular hypertension, cataract formation, traumatic wound dehiscence, and keratoconus recurrence were comparable between groups. Graft survival was excellent in both groups: 100% (10 years) and 99.0% (15 years) for PK, compared with 97.2% (10 and 15 years) for DALK (P = 0.26). CONCLUSION: PK and DALK provide comparable long-term visual, refractive, and graft survival outcomes in keratoconus. PK offers faster visual rehabilitation and a greater likelihood of achieving CDVA ≥ 20/25, but carries a higher risk of graft rejection.
PURPOSE: The aim of the study was to compare two Descemet membrane endothelial keratoplasty (DMEK) graft preparation techniques, the liquid bubble technique and the Melles technique. METHODS: In this prospective study, a...PURPOSE: The aim of the study was to compare two Descemet membrane endothelial keratoplasty (DMEK) graft preparation techniques, the liquid bubble technique and the Melles technique. METHODS: In this prospective study, a total of 20 corneas from 10 donors were included. For each donor, one cornea was prepared using the liquid bubble technique, and the contralateral cornea using the Melles technique. Outcome measures included endothelial cell count, the occurrence of tears and defects in the graft, preparation time, and histological findings. RESULTS: Mean endothelial cell density (ECD) before preparation was 2330 ± 210 cells/mm² in the liquid bubble group (LB) and 2380 ± 157 cells/mm² in the Melles group (M). Mean ECD after preparation was 2170 ± 264 cells/mm² (LB) and 2287 ± 237 cells/mm² (M). This corresponds to an average cell loss during the preparation process of 160 ± 316,1 cells/mm² (6.87%, LB), and of 93 ± 147,1 cells/mm² (3,92%, M), which was not statistically significantly different (p = 0.05). Preparation time was statistically significantly different (p = 0.002) with a mean of 5.74 ± 2.43 min (LB) and 23.60 ± 1.81 min (M). In the liquid bubble group, collagen fibrils on the Descemet membrane after preparation were observed in 4 cases (40%), whereas in the Melles group, this was seen in only one case (10%). CONCLUSION: DMEK grafts prepared via the liquid bubble technique and via the Melles technique exhibit comparable ECD, graft quality, and surgical suitability. The liquid bubble technique offers a significant advantage in preparation time for donors without previous cataract surgery.