PurposeTo compare the clinical outcomes of conventional photorefractive keratectomy (PRK) and transepithelial PRK (TransPRK) for the correction of myopic refractive errors.MethodsThis prospective, paired-eye comparative...PurposeTo compare the clinical outcomes of conventional photorefractive keratectomy (PRK) and transepithelial PRK (TransPRK) for the correction of myopic refractive errors.MethodsThis prospective, paired-eye comparative study included 48 eyes of 24 patients. Each patient underwent conventional PRK in the right eye and TransPRK in the left eye. Both patient and outcome assessors were blinded to treatment allocation. Preoperative and postoperative parameters including uncorrected distance visual acuity (UDVA), spherical equivalent (SE), postoperative pain, epithelial healing time, and complications were evaluated. Paired statistical analyses were used to compare outcomes between the two procedures.ResultsThere were no significant differences in baseline characteristics between the groups. Postoperatively, there were no statistically significant differences in UDVA (p = 0.084) or final SE (p = 0.512). Epithelial healing was faster in the TransPRK group but failed to show statistical significance (p = 0.371). However, postoperative pain was significantly higher in the TransPRK group, with a median pain score of 8 (IQR 8-10) compared to 6 (IQR 6-8) in the PRK group (p = 0.014). Clinically significant postoperative haze was observed in 3 (12.5%) of patients, with an identical pattern in both eyes of every affected patient.ConclusionBoth conventional PRK and TransPRK are safe and effective procedures for myopic correction, providing comparable visual and refractive outcomes. In this cohort, TransPRK was associated with significantly greater early postoperative pain, a finding that contrasts with much of the existing literature and warrants further investigation. The contralateral study design highlights the consistency of other outcomes while isolating this key difference.
ObjectiveGlaucoma and cancer are debilitating diseases with increasing global prevalence and morbidity. However, current literature lacks a systematic consolidation of their relationships and interactions. This systemati...ObjectiveGlaucoma and cancer are debilitating diseases with increasing global prevalence and morbidity. However, current literature lacks a systematic consolidation of their relationships and interactions. This systematic review aims to (A) summarize the association between intraocular/non-ocular cancers and their treatments with the prevalence and etiology of glaucoma, (B) explore glaucoma as a risk factor for complications or poor prognosis for intraocular cancer, and (C) explore the management of glaucoma secondary to cancer therapies.MethodsA systematic search was performed from inception to July 2025 across three databases with variants of 'cancer' and 'glaucoma' as search terms. Findings were narratively synthesized.ResultsOf 8,103 identified studies, 44 were included in this review. Eighteen studies reported increased glaucoma prevalence amongst intraocular and non-ocular cancer patients. Fifteen studies suggested increased risk of regional invasion, metastases, and high-risk histopathologies when intraocular cancers co-occurred with glaucoma. Corticosteroids in cancer therapy have been linked to intraocular pressure (IOP) elevation, while androgen deprivation therapy was associated with lowered glaucoma risk.ConclusionGiven the relationship between glaucoma and intraocular/non-ocular cancers, strategies to monitor and manage glaucoma risk following cancer diagnosis and/or therapy may be considered. Glaucoma may be an early sign of complications in intraocular cancers.
PurposeTo evaluate the impact of perioperative Intense Pulsed Light (IPL) therapy on corneal epithelial remodeling and epithelial refractive stability in patients undergoing femtosecond laser-assisted in situ keratomileu...PurposeTo evaluate the impact of perioperative Intense Pulsed Light (IPL) therapy on corneal epithelial remodeling and epithelial refractive stability in patients undergoing femtosecond laser-assisted in situ keratomileusis (FS-LASIK) or keratorefractive lenticule extraction (KLEx).MethodsThis randomized, controlled, triple-masked clinical trial included 61 patients assigned to either IPL treatment or a placebo prior to and following refractive surgery. Epithelial thickness (ET), epithelial refractive power (Epi-Rx), and Epithelial Wavefront (Epi-WF) were analyzed using anterior segment optical coherence tomography (AS-OCT) and Placido disc-based topography over a six-month follow-up.ResultsBoth groups exhibited significant postoperative epithelial thickening, primarily within the first month. While IPL-treated eyes showed trends toward slightly lower ET and more gradual Epi-Rx changes, including a late hyperopic shift and progressive cylinder adaptation, differences between groups were not statistically significant. Epi-WF values remained <0.5 in both cohorts.ConclusionPerioperative IPL improved ocular surface parameters in prior analyses but did not significantly alter corneal epithelial remodeling or refractive stability in this cohort. Observed trends suggest potential benefits for epithelial adaptation and ocular surface stability, warranting further investigation with larger sample sizes and longer follow-up.
PurposeTo report a rare case of Spinocerebellar Ataxia type 29 (SCA29) presenting with cerebral visual impairment (CVI), and to describe the functional visual outcomes following visual stimulation therapy (VST).Case Repo...PurposeTo report a rare case of Spinocerebellar Ataxia type 29 (SCA29) presenting with cerebral visual impairment (CVI), and to describe the functional visual outcomes following visual stimulation therapy (VST).Case ReportA 4-month-old male infant was referred for evaluation of vertical nystagmus and absence of visual fixation. Clinical assessment revealed axial hypotonia and profound visual impairment, confirmed using the VAS CVI-PIMD scale. Neuroimaging was unremarkable, but genetic testing identified a heterozygous c.805C > T (p.Arg269Trp) pathogenic variant in the ITPR1 gene, consistent with SCA29. VST was initiated weekly using high-contrast and brightly colored stimuli. After 20 sessions, the patient showed marked improvement in visual behavior and acuity, progressing from severe CVI to normal classification. Visual gains were objectively tracked with the VAS CVI-PIMD, showing a stepwise functional response to therapy.ConclusionThis case highlights the potential role of early visual rehabilitation in neurogenetic visual dysfunction. VST may offer a valuable intervention for improving visual outcomes in children with rare ataxias and CVI. Structured visual assessment tools can aid in monitoring progress and guiding treatment in similar pediatric presentations.
PurposeTo assess the ocular surface of patients with Helicobacter pylori (HP) infection using conjunctival impression cytology.MethodsThis study included 71 patients, who were divided into two groups. Group I included 41...PurposeTo assess the ocular surface of patients with Helicobacter pylori (HP) infection using conjunctival impression cytology.MethodsThis study included 71 patients, who were divided into two groups. Group I included 41 patients with HP infection and Group II included 30 patients without HP infection. HP infection was diagnosed histopathologically by Giemsa staining of endoscopic gastric biopsy specimens. To evaluate the ocular surface of the patients, tear break-up time (TBUT), the Schirmer I test, and conjunctival impression cytology (CIC) were performed.ResultsThe mean CIC in Groups I and II was 1.12 ± 0.90 and 0.60 ± 0.68, respectively, with CIC grades being higher in Group I. The mean Schirmer I test value was 16.73 ± 7.72 and 20.00 ± 2.94 mm in Groups I and II, respectively. When both groups were compared, Schirmer I test results were significantly lower in Group I ( = 0.031). The mean TBUT value was 11.27 ± 3.30 s in Group I and 13.27 ± 1.64 s in Group II. When the groups were compared, the TBUT values were significantly lower in Group I ( = 0.003). In the correlation analysis, a significant positive correlation was found between CIC and HP density (rho = 0.77, < 0.01).ConclusionThe prevalence of dry eye disease was higher in patients with HP infection, and greater tear film instability was observed in this group. Evaluation of dry eye disease in these patients may be clinically relevant, as HP infection may be associated with alterations in tear film parameters.
To compare the effectiveness of defocus incorporated multiple segments (DIMS) lenses, atropine monotherapies, and their combination for myopia management in children. A systematic review was conducted following the guide...To compare the effectiveness of defocus incorporated multiple segments (DIMS) lenses, atropine monotherapies, and their combination for myopia management in children. A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Multiple electronic databases were searched to identify relevant, comparative studies. The primary outcome was the change in spherical equivalent refraction (SER) in diopters and axial length (AL) in millimeters at the latest patient follow-up, with a minimum follow-up period of 6 months. The secondary outcomes included adverse effects, changes in visual acuity and compliance related to the interventions. A total of 1460 participants from eight studies were included. Three studies compared DIMS lenses and atropine monotherapy; there was no statistically significant difference in SER reduction except with one study that reported significant reduction with atropine. However, two studies reported a significant decrease in AL with DIMS lenses, while one did not. Four studies compared the combination therapy versus DIMS monotherapy; three reported a significant reduction in SER with the combination. Regarding AL, all studies favored combination therapy, with three showing statistically significant results. Three studies compared combination therapy with atropine monotherapy; all demonstrated reductions in SER and AL, with two studies showing statistical significance for each. The evidence suggests that both DIMS lenses and atropine monotherapy are effective in managing myopia, with DIMS lenses being preferred due to fewer adverse effects. However, combining these therapies offers greater effectiveness than either therapy alone.
IntroductionEpithelial inclusion cysts of the iris are a rare complication following ocular surgery or trauma and typically exhibit a more aggressive course than other types of iris cysts. Their management remains challe...IntroductionEpithelial inclusion cysts of the iris are a rare complication following ocular surgery or trauma and typically exhibit a more aggressive course than other types of iris cysts. Their management remains challenging due to their tendency for rapid growth, which can lead to obscuration of the visual axis, elevated intraocular pressure, corneal decompensation, and secondary glaucoma or uveitis. Particularly in pediatric and young adult patients, the high proliferative capacity of epithelial cells increases the risk of recurrence. Current treatment modalities, including Nd:YAG laser cyst disruption, sclerosing agent irrigation, and complete surgical excision, are associated with high recurrence rates.MethodsIn this retrospective case series we describe two patients with a recurrent iris cyst resulting from a trauma in childhood, and successfully managed with glaucoma drainage devices (Baerveldt tube and PAUL tube) to provide continuous cyst fluid drainage.ResultsIn both cases, implantation of the drainage device effectively controlled the progression of the cyst and maintained its position outside the visual axis. The pediatric patient developed a scleral perforation at the surgical site one year postoperatively, following additional mechanical trauma from ocular rubbing; this complication was successfully managed with surgical repair, resulting in a favorable outcome. In the second case, the patient experienced a transient postoperative diplopia, which resolved spontaneously without further intervention.ConclusionThese cases illustrate the potentially promising role of glaucoma drainage devices as a new treatment strategy for recurrent iris cysts, particularly after multiple prior resections or when conventional therapies have failed.
PurposeTo evaluate the diagnostic performance of final-year ophthalmology residents in classifying keratoconus using standard Scheimpflug corneal tomography and to compare their accuracy to that of experienced corneal sp...PurposeTo evaluate the diagnostic performance of final-year ophthalmology residents in classifying keratoconus using standard Scheimpflug corneal tomography and to compare their accuracy to that of experienced corneal specialists.DesignProspective, investigator-initiated, multicenter observational study.MethodsFive final-year residents assessed 1,239 anonymized Pentacam HR (Oculus GmbH, Germany) quad-map outputs, categorized as normal, suspect keratoconus, or keratoconus, previously obtained from 620 pediatric patients in a prior population-based imaging study. Two corneal experts independently established the reference standard. Residents rated their diagnostic confidence using Likert scales. Agreement was quantified using Cohen's kappa (κ) and Fleiss's κ.ResultsResident-to-expert agreement ranged from Cohen's κ = 0.031 to 0.324 (slight to fair). Overall inter-rater reliability across all raters was slight, Fleiss's κ = 0.088. Four residents rated their diagnostic skill as neutral; one rated it as poor. Self-assessed competence relative to peers was rated as neutral by three residents and good by two.ConclusionsFinal-year ophthalmology residents showed limited agreement with expert graders when interpreting Scheimpflug images. The alignment between self-assessed confidence and measured diagnostic performance highlights a potential educational gap in image-based diagnosis of ectatic corneal disease. These findings support the need for competency-based curricular enhancements, including image interpretation benchmarks, expert-guided calibration sessions, and simulation-based learning modules, aiming to improve diagnostic accuracy and support earlier detection of keratoconus. Further multicenter studies are needed to validate these results and guide national and international training strategies.
Ocular ultrasonography is a key imaging modality when the posterior segment cannot be directly visualised by ophthalmoscopy. Image quality and interpretation are operator-dependent. Thus, good technique and understanding...Ocular ultrasonography is a key imaging modality when the posterior segment cannot be directly visualised by ophthalmoscopy. Image quality and interpretation are operator-dependent. Thus, good technique and understanding of the strengths and limitations of the different ultrasonography modalities e.g. A-scan (time-amplitude), B-scan (brightness), doppler and ultrasound biomicroscopy are valuable, especially in complex cases with diagnostic uncertainty. This article discusses the practical applications of ultrasonography in the diagnosis and management of common vitreoretinal emergencies (vitreous haemorrhage, retinal detachment and endophthalmitis) and complications of anterior segment surgery (choroidal effusion, suprachoroidal haemorrhage, malpositioned or dislocated lens).
PurposeTo investigate the clinical features, treatments, and outcomes of patients with secondary orbital lymphoma.Major FindingsIn this cohort of 31 patients, 15 (48.4%) were female and 27 (87.1%) were white. Follicular...PurposeTo investigate the clinical features, treatments, and outcomes of patients with secondary orbital lymphoma.Major FindingsIn this cohort of 31 patients, 15 (48.4%) were female and 27 (87.1%) were white. Follicular lymphoma was the most common subtype (n = 13, 41.9%) and was more associated with unilateral disease compared to other subtypes (p = 0.01). Common presenting symptoms included a palpable mass (n = 17, 54.8%), eyelid swelling (n = 16, 51.6%), and ptosis (n = 12, 38.7%). Patients were most often diagnosed with Ann Arbor Stage IV lymphoma (n = 17, 54.8%) via incisional biopsy (n = 13, 41.9%). Radiation therapy (n = 9, 29.0%) was the most common initial treatment, and most patients received radiation (n = 19, 61.3%) and/or chemotherapy (n = 21, 67.7%). A majority of patients had final best corrected visual acuity (BCVA) within 1 line of initial BCVA (n = 19, 82.6%) and had no local recurrences (n = 21, 67.7%). However, complete remission was rare (n = 3, 9.7%), and systemic recurrence occurred in over half of patients (n = 18, 58.1%).ConclusionsFollicular lymphoma was the predominant subtype of secondary orbital lymphoma in this cohort. Most patients with secondary orbital lymphoma presented with advanced disease where few achieved complete remission and more than half of the patients developed systemic recurrence despite majority retaining visual acuity.
PurposeTo study the surgical outcomes of inferior oblique (IO) myectomy in patients with unilateral superior oblique (SO) palsy and mild to moderate hypertropia (≤15 PD) in the primary position.MethodsThis retrospective...PurposeTo study the surgical outcomes of inferior oblique (IO) myectomy in patients with unilateral superior oblique (SO) palsy and mild to moderate hypertropia (≤15 PD) in the primary position.MethodsThis retrospective study included 36 eyes of 36 patients who underwent IO myectomy for unilateral SO palsy between 2017 and 2023. Patients with bilateral SO palsy, primary position hypertropia >15 PD, prior strabismus surgery, or SO tendon laxity on Guyton's exaggerated traction test were excluded. Hypertropia in different gaze positions, oblique muscle action, and other parameters were evaluated preoperatively and at the final follow-up.ResultsThe mean age was 25.1 ± 13.1 years (range: 8-58), and 58% were male. Mean follow-up was 18.1 ± 9.8 months (range: 6-42). Hypertropia decreased significantly in primary and reading positions, from 10.2 ± 3.7 PD (range: 4-15) and 11.0 ± 3.8 PD (range: 5-15) preoperatively to 1.9 ± 2.3 PD (range: 0-8) and 2.2 ± 2.7 PD (range: 0-8) postoperatively ( < 0.001). IO overaction decreased from 2.4 ± 0.9 (range: 1-4) to 0.4 ± 0.6 (range: 0-2), and SO underaction improved from -2.1 ± 0.7 (range: -3 to -1) to -0.3 ± 0.4 (range: -1 to 0) (both < 0.001). Excyclotorsion was present in 72% preoperatively and decreased from 4.0° ± 2.8° (range: 0-8) to 1.7° ± 1.6° (range: 0-4) ( < 0.001). Abnormal head position (AHP) was present in 26/36 patients (72%) and resolved in 81%, while diplopia was reported in 22/36 patients (61%) and resolved in 77%.ConclusionIO myectomy is a simple, effective, and safe procedure for mild to moderate hyperdeviation secondary to unilateral SO palsy; however, these findings should be interpreted in light of the study's retrospective design and modest sample size.
OBJECTIVE: To evaluate visual function in children with cerebral visual impairment (CVI) from various causes, examine its relationship with the severity of cerebral involvement using a semi-quantitative MRI scoring syste...OBJECTIVE: To evaluate visual function in children with cerebral visual impairment (CVI) from various causes, examine its relationship with the severity of cerebral involvement using a semi-quantitative MRI scoring system (sqMRI), and compare the results with strabismic controls without visual impairment. METHODS: This retrospective study included children diagnosed with CVI and controls without CVI who were followed for strabismus. MRI data were compared using a modified 24-point sqMRI scale. Inter-rater agreement was excellent (ICC = 0.91; 95% CI: 0.79-0.96). Partial correlations controlling for gestational age were computed for primary MRI-BCVA relationships. RESULTS: Forty-two children with CVI and 40 strabismic controls were included. Hypoxic-ischemic encephalopathy was the most common cause (26.1%). Children with CVI had significantly lower gestational ages, birth weights, and best-corrected visual acuity (BCVA) (mean 0.28 ± 0.17 logMAR) compared to controls (0.05 ± 0.05 logMAR) (p < 0.001). The sqMRI scores showed significant correlation with BCVA, especially in the basal ganglia, thalamus, hemispheric, subcortical, and total MRI scores ( < 0.05). The total MRI-BCVA correlation remained strong after adjusting for gestational age (partial = 0.78, < 0.001). CONCLUSION: A strong, prematurity-independent correlation was observed between sqMRI scores and visual impairment in a clinically diverse CVI population. These findings suggest that sqMRI scoring could be a useful additional tool for visual prognosis and early rehabilitation planning.
PurposeTo analyze trends in the clinical use of the iStent device, characterize the evolving baseline profile of treated patients, and assess surgical outcomes over time.MethodsThis retrospective longitudinal study inclu...PurposeTo analyze trends in the clinical use of the iStent device, characterize the evolving baseline profile of treated patients, and assess surgical outcomes over time.MethodsThis retrospective longitudinal study included 145 eyes undergoing iStent implantation between 2010 and 2022. Data included intraocular pressure (IOP), medications, and functional and structural parameters. Surgical success was defined using three criteria: (1) IOP <21 mmHg with medication reduction, (2) IOP <18 mmHg with medication reduction, and (3) IOP <21 mmHg with a ≥ 20% reduction from baseline.ResultsiStent use increased from 3.4% to 9.4% of glaucoma surgeries (p = 0.0125). Combined phaco-iStent surgery was performed in 95.9% of eyes. At 12-month, mean IOP decreased from 19.2 ± 4.5 mmHg to 16.4 ± 2.5 mmHg, with medications reduced from 1.9 ± 0.8 to 0.6 ± 0.8. Surgical success was achieved in 81.0% of eyes according to Criterion 1, 64.9% according to Criterion 2, and 49.6% according to Criterion 3. Over time, surgical success progressively improved, reaching 89.8% (Criterion 1), 78.0% (Criterion 2), and 57.6% (Criterion 3) between 2020 and 2022, while surgeries were increasingly performed in patients with lower baseline IOP and less advanced visual field loss.ConclusionOver the past decade, the iStent has become increasingly integrated into routine clinical practice. Compared with its early use, indications have expanded toward earlier stages of glaucoma, accompanied by improved surgical success and reduced medication burden. These results support the idea that the surgical treatment of glaucoma is gradually evolving towards earlier and more individualized surgical intervention.
Optic neuropathy is an underrecognised but vision-threatening complication following rhegmatogenous retinal detachment (RRD) repair, even when anatomical success is achieved. Several mechanisms have been implicated, incl...Optic neuropathy is an underrecognised but vision-threatening complication following rhegmatogenous retinal detachment (RRD) repair, even when anatomical success is achieved. Several mechanisms have been implicated, including intraoperative light toxicity, mechanical stress on the optic nerve, postoperative elevation of intraocular pressure (IOP), and reduced ocular perfusion pressure (OPP). Tamponade agents such as silicone oil and expansile gases may further contribute to IOP spikes and ischaemic optic nerve injury. Systemic factors, including diabetes, hypertension, and hypercoagulability, can impair vascular autoregulation, increasing susceptibility to ischaemia. Although optical coherence tomography (OCT) and magnetic resonance imaging (MRI) can detect early structural or functional injury, standardised diagnostic and preventive approaches remain limited. In this narrative review, we evaluated evidence from case reports, small case series, retrospective cohort, and case-control studies to outline the incidence, risk factors, and proposed pathophysiological mechanisms of post-RRD optic neuropathy. We also highlight areas of controversy, including the relative contribution of pars plana vitrectomy versus scleral buckle and the potential neurotoxicity of silicone oil, and we discuss the strength of evidence supporting each risk factor. Defining high-risk patients, optimising perioperative IOP control, and evaluating neuroprotective and monitoring strategies represent key priorities for future research.