PurposeThis study assessed retinal non-perfusion areas (RNPAs) and vascular density (VD) in the superficial (SCP) and deep (DCP) capillary plexuses of diabetic patients across three stages of diabetic retinopathy (DR): n...PurposeThis study assessed retinal non-perfusion areas (RNPAs) and vascular density (VD) in the superficial (SCP) and deep (DCP) capillary plexuses of diabetic patients across three stages of diabetic retinopathy (DR): no DR (stage 0), non-proliferative DR (stage 1), and proliferative DR (stage 2).MethodsThirty-nine right eyes of 39 diabetic patients were included and underwent 3 × 3 mm and 15 × 15 mm Optical Coherence Tomography Angiography (OCTA) scans. A semiautomated software was utilized to quantify RNPAs and VD. Correlations with systemic and ocular factors were analyzed.ResultsSix eyes were in stage 0, 25 eyes were in stage 1 and 8 eyes were in stage 2. Mean RNPAs and VD from 15 × 15 mm OCTA scans differed significantly across the three DR stages. A positive correlation was found between DR stage and RNPA in both SCP (CC = 0.42; = 0.04) and DCP (CC = 0.60; = 0.004). Conversely, VD in DCP was negatively correlated with DR severity (CC = -0.51; = 0.0018). Eyes with prior peripheral laser treatment showed significantly larger RNPAs and lower VD in wide-field scans. Macular edema was associated with increased RNPA and reduced VD in the SCP on 3 × 3 mm OCTA ('s < 0.001). No significant associations were observed between OCTA parameters and systemic factors (e.g., hypertension, nephropathy).ConclusionSemiautomated OCTA analysis of retinal ischemia correlates positively with DR stage, peripheral laser treatment, and macular edema. The lack of association with systemic factors highlights the critical role of local ocular changes in DR progression.
PurposeTo evaluate anatomical and visual outcomes and to identify prognostic factors in pediatric patients undergoing pars plana vitrectomy (PPV) following ocular trauma.MethodsThis retrospective study included medical r...PurposeTo evaluate anatomical and visual outcomes and to identify prognostic factors in pediatric patients undergoing pars plana vitrectomy (PPV) following ocular trauma.MethodsThis retrospective study included medical records of pediatric patients who underwent PPV for posterior segment trauma at a tertiary referral center over 13 years. Demographic characteristics, injury patterns, ocular trauma classifications, surgical details, and postoperative outcomes were analysed to identify factors associated with anatomical success and visual prognosis.ResultsAmong 208 pediatric patients who underwent surgery for ocular trauma, 47 patients requiring pars plana vitrectomy (PPV) were included in the present study. The mean age was 9.7 ± 4.2 years, and the median follow-up duration was 28 months (range, 3-118 months). Traumatic retinal detachment was the most frequent indication for PPV, observed in 37 eyes (78.7%). A statistically significant improvement in mean best-corrected visual acuity was observed from baseline to final follow-up ( = 0.003). Final anatomical success was achieved in 24 eyes (52.2%), and final functional success was observed in 11 eyes (23.3%). While the presence of proliferative vitreoretinopathy (PVR) was the only prognostic factor significantly associated with anatomical failure (p = 0.004), corneal injury (p = 0.010) and an increased number of PPV procedures (p = 0.028) were significantly associated with poor functional outcomes.ConclusionPediatric posterior segment trauma requiring surgery remains challenging, with anatomical success achieved in only about half of patients and visual improvement being more limited. PVR, corneal injury, and the need for multiple surgical interventions were associated with less favorable outcomes.
PurposeTo investigate the long-term efficacy, safety, and predictability of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the treatment of mixed astigmatism.MethodsThis retrospective study included 72...PurposeTo investigate the long-term efficacy, safety, and predictability of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) for the treatment of mixed astigmatism.MethodsThis retrospective study included 72 eyes of 43 patients who underwent FS-LASIK for mixed astigmatism and completed at least 3 years of follow-up. Uncorrected and corrected distance visual acuity (UDVA, CDVA), manifest refraction, corneal topography, and higher-order aberrations (HOAs) were evaluated preoperatively and at the 1st, 3rd, and 5th years postoperatively.ResultsThe study included 16 females and 27 males with a mean age of 29.44 ± 5.82 years and a mean follow-up of 4.41 ± 0.91 years. The mean preoperative UDVA and CDVA were 0.67 ± 0.34 and 0.07 ± 0.09 logMAR, respectively, and both improved significantly at all postoperative visits (each < 0.001). The mean preoperative manifest spherical (1.66 ± 1.32 D) and cylindrical (-3.77 ± 1.05 D) values showed significant reductions at all postoperative follow-ups (each < 0.001). At final follow-up, all HOAs decreased at a 4 mm, while at 6 mm, spherical aberration decreased and total HOAs increased (each < 0.001).ConclusionLong-term outcomes indicate that FS-LASIK is an effective, safe, and predictable procedure for the correction of mixed astigmatism.
PurposeTo evaluate the long-term outcomes of a simultaneous lenticule rotation and excimer laser ablation for high hyperopic astigmatism, a technique addressing otherwise untreatable refractive errors.MethodsA 41-year-ol...PurposeTo evaluate the long-term outcomes of a simultaneous lenticule rotation and excimer laser ablation for high hyperopic astigmatism, a technique addressing otherwise untreatable refractive errors.MethodsA 41-year-old female patient with a high refractive error (+3.75/-5.50 D) in her left eye underwent femtosecond laser-assisted FLEx, lenticule rotation, and excimer laser ablation. The procedure was performed to correct high astigmatism, which could not be treated with standard laser correction or phakic IOL implantation. Treatment parameters were adjusted to compensate for myopic shift due to centripetal lenticule shrinkage. Postoperative evaluations occurred at 3 months, 1 year, and 2 years.ResultsRefractive astigmatism was reduced by >5.0 D, with corneal astigmatism decreasing by 3.7 D. The lenticule integrated well without distortions. Minor epithelial remodeling occurred, but no structural complications were observed. The patient achieved stable visual acuity and high satisfaction over 2 years.ConclusionThis technique provides a stable, reversible alternative for high hyperopic astigmatism, preserving accommodation and avoiding refractive lens exchange. Corneal lenticule surgery may offer a viable option for patients with extreme hyperopic astigmatism. Further clinical studies are warranted to confirm its long-term efficacy
Glaucoma, a leading cause of irreversible blindness, is primarily managed by lowering intraocular pressure, yet treatment remains limited by poor adherence, ocular surface toxicity, and systemic adverse effects. This rev...Glaucoma, a leading cause of irreversible blindness, is primarily managed by lowering intraocular pressure, yet treatment remains limited by poor adherence, ocular surface toxicity, and systemic adverse effects. This review focuses specifically on treatment simplification strategies in topical glaucoma therapy, exploring the paradigm shift towards a "Less is better" approach in glaucoma care, with particular emphasis on the use of preservative -free formulations, lower active ingredient concentrations, and fixed combinations. These approaches aim to improve treatment tolerability, adherence, and clinical outcomes while minimizing toxicity, complexity, and environmental burden. Although barriers such as higher costs and limited long-term data remain, this new approach represents a patient-centred, sustainable, and clinically effective model for the future of glaucoma management.
BackgroundPediatric Thyroid Eye Disease (TED) is a rare autoimmune condition primarily associated with Graves' disease. Although usually milder than adult TED, it can still cause functional and psychological morbidity. P...BackgroundPediatric Thyroid Eye Disease (TED) is a rare autoimmune condition primarily associated with Graves' disease. Although usually milder than adult TED, it can still cause functional and psychological morbidity. Pediatric management remains unclear due to the absence of specific guidelines and concerns about treatment-related risks such as growth suppression.MethodsWe conducted a systematic review and meta-analysis following PRISMA guidelines, searching MEDLINE, Embase, and Emcare from inception to March 2024. Studies included interventional and observational reports involving patients ≤18 years with TED. Data were synthesized narratively and quantitatively. Meta-analyses were conducted using random-effects models, with heterogeneity assessed via I statistics and meta-regression. Primary outcomes included visual acuity (VA), proptosis, Clinical Activity Score (CAS), and adverse events.ResultsThirty-two studies comprising 810 pediatric patients (mean age 11.7 years, 64.8% female) were included. The most common symptoms were exophthalmos (99.5%), eyelid retraction (73.1%), and dry eye (66.3%). Treatments ranged from antithyroid drugs and corticosteroids, to orbital decompression and biologics. Meta-analysis showed mean exophthalmos reductions of 4.69 mm for decompression, 4.25 mm for steroids, and 1.75 mm for biologics. Substantial heterogeneity and low certainty of evidence limited interpretability. Interventions were performed earlier than recommended, with no significant adverse effects reported.ConclusionsDespite most pediatric TED cases being mild, a subset of patients requires more intensive management. This review, comprising predominantly of case reports and case series with very low certainty evidence, reveals gaps between practice and recommendations, highlighting the need for pediatric-specific guidelines informed by systematic evidence.
IntroductionKeratoconus is a non-inflammatory corneal ectasia that leads to a reduction in visual acuity, often requiring visual rehabilitation with contact lenses.ObjectivesTo assess the impact of SPOT lenses on visual...IntroductionKeratoconus is a non-inflammatory corneal ectasia that leads to a reduction in visual acuity, often requiring visual rehabilitation with contact lenses.ObjectivesTo assess the impact of SPOT lenses on visual acuity improvement in patients with keratoconus, categorized by their stage according to the Amsler-Krumeich classification, and to analyze the correlation between disease stage and visual gain. Secondary objectives include evaluating visual acuity gain in patients who failed to adapt to the lenses, and in those with one or more corneal opacities.MethodsThis monocentric, retrospective, observational study included keratoconus patients treated at the CHU of Clermont-Ferrand. Patients underwent initial adaptation to SPOT lenses between June 2017 and June 2024. Exclusion criteria included ophthalmological conditions that could impair visual acuity.ResultsA total of 257 eyes from 150 patients were analyzed. Of these, 193 eyes fitted with SPOT scleral lenses were included in the primary analysis. The mean best-corrected visual acuity (BCVA) improved from 0.61 ± 0.59 -LogMAR before adaptation to 0.11 ± 0.14 -LogMAR after, with an average gain of 5 lines. Significant differences ( < 0.05) in visual acuity were observed across all stages, except between stages I and II before adaptation, and between stages I and II, and II and III after adaptation. Significant differences ( < 0.05) in visual acuity gain were found between each stage, except between stages I and II.ConclusionThe success of scleral lens adaptation is closely linked to improved visual acuity, particularly in the more advanced stages of the disease.
PurposeTo evaluate the Intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation in pediatric patients with keratoconus.MethodsPatients aged ≤18 years with keratoconus who underwent ICRS implantatio...PurposeTo evaluate the Intrastromal corneal ring segment (ICRS) implantation for visual rehabilitation in pediatric patients with keratoconus.MethodsPatients aged ≤18 years with keratoconus who underwent ICRS implantation were included. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, manifest refraction and keratometry were recorded preoperatively and at 1-5-7- and 10-year postoperatively. Treatment was categorized as success, qualified success or failure based on short-term visual and refractive improvement, the visual and refractive stability and the comparison between the long-term follow-up and the preoperative.ResultsOne hundred seven eyes (85 patients) were included. All eyes were examined 1 year postoperatively, 89 at 5 years, 69 at 7 years and 36 at 10 years. UDVA (logMAR) changed from 0.64 ± 0.38 preoperatively to 0.34 ± 0.24 one year postoperatively ( < 0.0001). CDVA (logMAR) rose from 0.19 ± 0.15 to 0.08 ± 0.08 ( < 0.0001). No eyes lost lines of CDVA 1 year postoperatively compared to preoperative, and 74.8% of the eyes gained lines. Preoperatively, 61.7% of the eyes had a refractive cylinder ≥3.00 D; one year postoperatively, 76.6% had <3.00 D. The treatment was successful in most cases at 5-, 7- and 10-year follow-ups (84.3%, 85.5%, and 88.9%, respectively), qualified success in around 8% of the eyes, and treatment failed in 6 eyes represented a cumulative rate over the 10 years <10%ConclusionICRS implantation induced significant visual and refractive improvements, and in most eyes with available long-term follow-up, visual and refractive improvements were maintained, supporting ICRS as a long-term visual rehabilitation option in pediatric keratoconus.
PurposeTo describe a novel tissue-sparing surgical technique-the Qidwai Quilt Pull-Over Patch-graft (Q-POP) technique-for the management of impending or established glaucoma drainage implant (GDI, ACP) tube exposure in h...PurposeTo describe a novel tissue-sparing surgical technique-the Qidwai Quilt Pull-Over Patch-graft (Q-POP) technique-for the management of impending or established glaucoma drainage implant (GDI, ACP) tube exposure in high-risk eyes with conjunctival scarring and mechanical stress.MethodsThis report presents a single-case description of a monocular patient with severe nystagmus, extensive conjunctival fibrosis, and prior multiple ocular surgeries who developed progressive conjunctival thinning over a GDI (ACP) tube. A minimally invasive subconjunctival tunneling approach was used to deliver and position a scleral patch graft over the tube without a limbal-based peritomy.ResultsThe Q-POP technique provided stable tube coverage with minimal conjunctival manipulation. Postoperatively, the graft remained flat and well-positioned with no evidence of re-exposure, conjunctival dehiscence, inflammation, or intraocular pressure instability during follow-up.ConclusionsThe Q-POP technique offers a safe, reproducible, and cost-neutral alternative for managing tube exposure in eyes with compromised conjunctiva where conventional peritomy-based repairs carry high risk. This method may be particularly valuable in eyes subjected to mechanical stress like nystagmus. Larger case series are warranted to assess long-term outcomes and broader applicability.
PurposePregnancy induces hormonal changes that can affect various organ systems, including ocular structures. This study aimed to evaluate changes in anterior segment (AS) parameters, higher-order aberrations (HOAs), and...PurposePregnancy induces hormonal changes that can affect various organ systems, including ocular structures. This study aimed to evaluate changes in anterior segment (AS) parameters, higher-order aberrations (HOAs), and aqueous humour (AH) optical density (OD) in pregnant women compared to healthy controls.MethodsThis prospective case-control study included 45 healthy pregnant women and 47 age-matched non-pregnant controls. Comprehensive ophthalmological examinations were performed, including best-corrected visual acuity (BCVA), intraocular pressure, spherical equivalent, axial length, central corneal thickness, corneal volume, corneal curvature (K1, K2, Km), AS parameters, and endothelial cell metrics. HOAs (coma, trefoil, spherical aberration) and AH OD were also assessed. Ocular surface evaluations included the OSDI questionnaire, Schirmer test and tear break-up time. Pregnant participants were assessed in each trimester and three months postpartum, with comparisons conducted both cross-sectionally against healthy controls and longitudinally within the pregnancy cohort across trimesters and postpartum.ResultsRMS-HOA was higher in the third trimester (0.41 ± 0.19 µm, = 0.003) and postpartum (0.39 ± 0.31 µm, = 0.041). RMS-total increased in the second (1.64 ± 0.21 µm, = 0.031) and third trimesters (1.63 ± 0.46 µm, = 0.022). Coma was higher in the second (1.64 ± 0.34 µm, = 0.045) and third trimesters (1.61 ± 0.29 µm, = 0.040), and trefoil increased in the third trimester (1.50 ± 0.35 µm, = 0.027). AH OD was higher than in controls at every time point, measuring 4.74 ± 0.41% in the first trimester ( = 0.007), 4.81 ± 0.50% in the second ( = 0.001), 4.96 ± 0.42% in the third ( = 0.001), and 4.79 ± 0.46% postpartum ( = 0.020). BCVA was unchanged.ConclusionIn pregnancy, small increases in HOAs and AH OD are typically subclinical and reflect physiological change rather than pathology.
PurposeTo assess the influence of epithelium-off (epi-off) crosslinking (CXL) on overall flattening of the cone & pachymetry and in different cone locations (central, paracentral, and peripheral) at 5-year and to analyse...PurposeTo assess the influence of epithelium-off (epi-off) crosslinking (CXL) on overall flattening of the cone & pachymetry and in different cone locations (central, paracentral, and peripheral) at 5-year and to analyse preoperative factors influencing cone flattening at 5-year in keratoconus.MethodsAll patients with at least 5-year follow-up were included. Data was collected on age, sex, and cone location. Cone location (Central (3 mm centrally), paracentral (3-5 mm) and peripheral (beyond 5 mm)) were classified based on maximum keratometry (Kmax). Data was collected for preoperative, 1-, and 5-year visits. Anterior Kmax and thinnest pachymetry changes were also analysed for various cone locations. Stepwise backward multiple regression analysis was performed to look at the preoperative factors (sex, age, cone location, preoperative Kmax, and thinnest pachymetry) influencing cone flattening at 5-year.Results53 eyes (53 patients) (M:F = 36:17) were included. There was a significant change between preoperative Vs. 5-year Kmax (P < 0.01) and they were significantly correlated (r = 0.86, p < 0.01). Peripheral and paracentral cones flattened more at 5-year. Whereas there was a significant thinning between preoperative and at 1-year only (P = 0.01) and they were significantly correlated too (r = 0.83, p < 0.01). Central cones thinned more over 5-year. Only preoperative Kmax was significantly correlated to postoperative cone flattening at 5-year.ConclusionThere is a significant flattening at 5-year and peripheral and paracentral cones flattened more. Whereas significant thinning of the cones were only observed until 1-year and central cones thinned more. Flattening of cone at 5-year was only related to preoperative Kmax.
ImportanceOcular manifestations of polycystic ovarian syndrome (PCOS), particularly related to elevated testosterone, are understudied.ObjectiveTo evaluate prevalence and odds of ocular diseases in PCOS patients using la...ImportanceOcular manifestations of polycystic ovarian syndrome (PCOS), particularly related to elevated testosterone, are understudied.ObjectiveTo evaluate prevalence and odds of ocular diseases in PCOS patients using large-scale electronic health records (EHRs).DesignCross-sectional study comparing females aged 15-50 with PCOS (n = 494,557) to two controls: total female population (n = 32,162,331) and BMI ≥30 (n = 4,895,226), based on ICD-10 ocular diagnoses. Prevalence odds ratios (PORs) with 95% confidence intervals were calculated and used to determine statistical significance.SettingTriNetX US Collaborative Network, comprising EHRs from 70 healthcare organizations.Main OutcomesPrevalence and PORs of 17 ocular conditions in PCOS versus controls.ResultsPCOS patients had higher ocular disease prevalence than both total female (11/17) and high BMI (12/17) groups, and higher PORs. Dry eye (245.63 vs. 129.99 and 105.99 per 10,000) and glaucoma (117.86 vs. 80.39 and 56.44 per 10,000) were significantly more prevalent (p < 0.001). Idiopathic intracranial hypertension, papilledema, diabetic retinopathy (p < 0.001), and several posterior segment diseases also had increased prevalence rates among PCOS patients (p < 0.05).ConclusionPCOS is associated with an increased odds of ocular disease independent of BMI. Hormonal and metabolic factors may underlie this relationship and should be further explored.