PURPOSE: To assess the diagnostic value of tomographic signs on OCT and OCT-A, particularly paracentral acute middle maculopathy (PAMM), in predicting temporal artery biopsy (TAB) positivity in suspected giant cell arter...PURPOSE: To assess the diagnostic value of tomographic signs on OCT and OCT-A, particularly paracentral acute middle maculopathy (PAMM), in predicting temporal artery biopsy (TAB) positivity in suspected giant cell arteritis (GCA), irrespective of ophthalmologic involvement. METHODS: This prospective monocentric study included patients referred for TAB between January and October 2023. All underwent bilateral macular and optic nerve OCT and OCT-A using AngioPlex CIRRUS HD-OCT (Carl Zeiss Meditec). TAB-positive patients were considered biopsy-proven GCA. Primary analysis focused on the association between PAMM and TAB positivity. Secondary analysis explored vascular choroidal index (CVI), radial peripapillary capillaries (RPC), and OCT-A abnormalities. RESULTS: Among 70 patients, 22 (31%) had positive TAB. PAMM was observed exclusively in TAB+ patients (n = 8), with specificity and positive predictive value of 100%. Sensitivity and negative predictive value were 38.1% and 77.6%, respectively. Homolateral anterior ischemic optic neuropathy (AION) was always associated with GCA. CVI and other OCT-A findings did not differ significantly between groups. RPC density was significantly reduced in eyes with ophthalmologic involvement ( P = 0.017). CONCLUSION: PAMM is a highly specific OCT sign of TAB positivity in suspected GCA. This noninvasive marker may support early therapeutic decisions in suspected GCA.
PURPOSE: To characterize the imaging features of choroiditis across different disease stages using the blend function in ultra-widefield imaging (UWFI) and compare its findings with fundus autofluorescence (FAF). METHODS...PURPOSE: To characterize the imaging features of choroiditis across different disease stages using the blend function in ultra-widefield imaging (UWFI) and compare its findings with fundus autofluorescence (FAF). METHODS: This study included 30 patients (25 eyes) with choroiditis, categorized into active, resolving, and healed stages. UWFI images were analyzed using the red and green channels to assess specific imaging characteristics at each disease stage. FAF findings were compared to evaluate disease activity and progression. RESULTS: Active choroiditis lesions were distinctly visualized on the green channel with well-defined inflammatory borders, whereas the red channel showed faintly discernible lesions without clear margins. FAF revealed diffuse hyperautofluorescence but lacked precise border delineation. In the resolving stage, lesion hyperintensity progressively diminished on the green channel, while red channel visibility decreased significantly. FAF changes were subtle, with reduced autofluorescence intensity. Healed lesions exhibited isointense areas on the green channel with well-defined borders, while hyperpigmented regions appeared as hypointense patches on the red channel. FAF showed uniformly dark zones corresponding to healed areas. Retinal vascular abnormalities were more prominently detected on the green channel compared with other imaging modalities. CONCLUSION: The blend function in UWFI offers a novel, stage-wise characterization of choroiditis, with the green channel providing superior delineation of active inflammatory lesions compared with FAF. The red channel serves as an adjunct in assessing disease resolution. This imaging approach enhances diagnostic accuracy and facilitates objective disease monitoring, potentially improving clinical decision-making in inflammatory chorioretinal disorders.
PURPOSE: To compare the characteristics of pediatric patients with pars planitis (PP) who received treatment versus those who were observed without treatment. METHODS: Retrospective chart review of pediatric patients dia...PURPOSE: To compare the characteristics of pediatric patients with pars planitis (PP) who received treatment versus those who were observed without treatment. METHODS: Retrospective chart review of pediatric patients diagnosed with PP at a tertiary referral center from 2000 to 2024. RESULTS: Of 158 eyes from 84 patients with PP, 127 eyes (80.4%) received treatment and 31 eyes (19.6%) were observed. Eyes that were observed presented with less anterior chamber cell ( P < 0.007), vitreous cell ( P = 0.0005), vitreous haze ( P = 0.003), and optic nerve head edema ( P = 0.03). The untreated group had significantly lower total fluorescein angiography scores ( P < 0.0001) than the treated group and specifically scored lower in disc leakage ( P = 0.006) and retinal capillary leakage ( P < 0.0001). In the treated group, 66 eyes (52%) developed ocular hypertension and 24 (18.9%) developed glaucoma, whereas the untreated group had no cases of either. Final visual acuity was similar between treated and untreated groups (20/32 vs. 20/25, P = 0.13), and no untreated eyes developed complications requiring surgery. CONCLUSION: Not all patients with pediatric PP require treatment. Select mild cases may be safely observed without developing sequelae of chronic inflammation. Proper identification of these patients can reduce side effects and medication burden.
PURPOSE: To evaluate the clinical relevance of hyperreflective choroidal foci (HCF) and characterize their longitudinal alterations after treatment in patients with macular edema (ME) secondary to branched retinal vein o...PURPOSE: To evaluate the clinical relevance of hyperreflective choroidal foci (HCF) and characterize their longitudinal alterations after treatment in patients with macular edema (ME) secondary to branched retinal vein occlusion (BRVO). METHODS: In this retrospective cohort study , the authors evaluated the data of 68 patients diagnosed with treatment-naïve BRVO-ME involving the fovea. HCF were quantified separately in the inner and outer choroidal layers within the central 4,500 µ m region of the fovea. In addition, central macular and subfoveal choroidal thickness and integrity of the external limiting membrane were analyzed. RESULTS: The HCF count decreased notably in the inner and whole choroidal layers after treatment, while outer choroidal HCF remained unchanged. Univariate and multivariate regression analyses revealed that a higher residual HCF count was associated with a greater required annual number of intravitreal injections and a briefer recurrence to ME. Spearman analysis correlated higher baseline HCF counts with disrupted baseline external limiting membrane status. However, no significant correlation was observed between HCF counts and final best-corrected visual acuity. CONCLUSION: HCF may dynamically indicate ongoing choroidal activity in BRVO. Their incomplete resolution after treatment correlates with earlier ME recurrence and greater treatment demand, indicating their potential role in guiding retreatment decisions and assessing disease activity.
PURPOSE: To evaluate the ability of ChatGPT-5 to predict long-term anatomical and functional outcomes after full-thickness macular hole (FTMH) surgery, and to compare its performance with retinal specialists' predictions...PURPOSE: To evaluate the ability of ChatGPT-5 to predict long-term anatomical and functional outcomes after full-thickness macular hole (FTMH) surgery, and to compare its performance with retinal specialists' predictions and real-world results. METHODS: This retrospective study included 50 eyes of 50 patients undergoing pars plana vitrectomy for FTMH (2021-2024). Deidentified clinical summaries with preoperative demographics, ocular history, best-corrected visual acuity (BCVA), optical coherence tomography parameters, foveal B-scan optical coherence tomography images, and surgical details were entered into ChatGPT-5 using a standardized prompt to predict 12-month BCVA and anatomical closure. Predictions were compared with actual results and assessments from two senior retina specialists. RESULTS: At 12 months, closure occurred in 44/50 eyes (88%), and mean BCVA improved from 20/100 (0.7 ± 0.4 logMAR) to 20/63 (0.5 ± 0.5 logMAR) ( P = 0.03). The anatomical prediction accuracy was 72% to 86% (specialists) and 90% (ChatGPT-5). ChatGPT achieved perfect accuracy in closure cases but failed to identify nonclosure, reflecting optimism bias. For functional outcomes, the accuracy was 42% to 44% (specialists) and 66% (ChatGPT-5). ChatGPT-5 performed well when vision improved (60%) but poorly for stable (≤13%) or worsened (0%) cases. The mean BCVA prediction error was 11.4 ± 10.8 letters, with ∼60% within two lines of the true outcome. CONCLUSION: ChatGPT-5 demonstrated apparent accuracy in predicting FTMH surgery outcomes; however, this was largely driven by an optimism bias that overestimated closure and visual recovery. This model still lack clinical judgment. Larger prospective studies are needed before clinical use.
PURPOSE: To evaluate the frequency, clinical and optical coherence tomography (OCT) predictors, and postoperative anatomical and functional outcomes of bacillary layer detachment (BALAD) in eyes undergoing surgical repai...PURPOSE: To evaluate the frequency, clinical and optical coherence tomography (OCT) predictors, and postoperative anatomical and functional outcomes of bacillary layer detachment (BALAD) in eyes undergoing surgical repair for fovea-off rhegmatogenous retinal detachment (RRD). METHODS: This retrospective, single-center observational study was conducted at a tertiary eye care hospital in India. Primary fovea-off RRD that underwent surgical repair between January 2020 and December 2024 were analyzed. Preoperative spectral-domain OCT images were reviewed for BALAD and other predefined retinal biomarkers. Clinical and imaging parameters were compared between the BALAD and non-BALAD groups. Univariate and multivariable logistic regression analyses identified predictors of BALAD formation. Occurrence rate and preoperative predictors of BALAD were analyzed, and postoperative macular reattachment, external limiting membrane/ellipsoid zone continuity, best-corrected visual acuity, and single-surgery success were assessed over 24 weeks. RESULTS: Two hundred and seventy primary fovea-off RRD eyes were analyzed. BALAD was detected in 51 eyes (18.9%). Younger age ( P = 0.014) and greater subretinal fluid height ( P = 0.002) were independent predictors of BALAD. Anatomical reattachment rates at 24 weeks were 88.5% in BALAD eyes and 77.3% in non-BALAD eyes ( P = 0.286). External limiting membrane/ellipsoid zone restoration occurred in 42.3% and 33.3%, respectively ( P = 0.247). Best-corrected visual acuity improvement trajectories were similar, though slower in BALAD eyes ( P < 0.001). Resurgery rates were comparable between groups ( P > 0.999). CONCLUSION: BALAD is a relatively common OCT feature in fovea-off RRD, predominantly affecting younger, fluid-rich eyes with higher subretinal fluid height. Its presence does not adversely affect anatomical reattachment or single-surgery success.
PURPOSE: To estimate the efficacy of intravitreal injection (IVI) versus subretinal injection (SRI) of tissue plasminogen activator in the treatment of submacular hemorrhage (SMH). METHODS: A comprehensive literature sea...PURPOSE: To estimate the efficacy of intravitreal injection (IVI) versus subretinal injection (SRI) of tissue plasminogen activator in the treatment of submacular hemorrhage (SMH). METHODS: A comprehensive literature search was conducted in six major data sets from inception to 31 October 2025. Random effects meta-analysis was performed to evaluate the final best-corrected visual acuity (BCVA, logMAR) and the changes in central retinal thickness (CRT, μm), and the risk ratio of complete displacement of hemorrhage. RESULTS: A total of seven studies on 353 eyes were finally included. Best-corrected visual acuity was similar between the IVI and SRI groups at 1 month and 6 months postoperation, while better in the IVI group 3 months postoperatively. The final CRT was similar between the two groups. There were no statistical differences between the two groups in the RRs of complete displacement of hemorrhage, total adverse events, recurrent SMH, increased intraocular pressure, postoperative retinal detachment, and vitreous hemorrhages. CONCLUSION: The IVI group showed a better BCVA at 3 months, the two groups showed comparable results in the recovery of BCVA, CRT, and complete hemorrhage displacement at the final visit (within 6 months).
PURPOSE: This study aimed to investigate peripheral retinal angiographic features using ultra-widefield fluorescein angiography (UW-FAG) in eyes with idiopathic epiretinal membrane (iERM), compare them with fellow unaffe...PURPOSE: This study aimed to investigate peripheral retinal angiographic features using ultra-widefield fluorescein angiography (UW-FAG) in eyes with idiopathic epiretinal membrane (iERM), compare them with fellow unaffected eyes, and assess their association with disease severity. METHODS: This retrospective study included 84 patients (168 eyes) with unilateral iERM. UW-FAG images were analyzed in both eyes, and peripheral angiographic findings were categorized as vascular-associated or nonvascular. The frequencies of these features were compared between iERM and fellow unaffected eyes. The iERM eyes were further classified as early (Stages 1-2) or advanced (Stages 3-4) according to optical coherence tomography grading. RESULTS: The mean age of patients was 65.1 ± 7.3 years, and 64.3% were female. Peripheral abnormalities were significantly more frequent in iERM eyes, including granular hyperfluorescence (39.3% vs. 15.5%, P < 0.001), late-phase leakage (89.3% vs. 56.0%, P < 0.001), and microaneurysms (60.7% vs. 31.0%, P < 0.001). Advanced-stage iERM eyes showed higher rates of late-phase leakage (53.8% vs. 23.8%, P < 0.001), microaneurysms (59.0% vs. 31.0%, P = 0.001), and granular hyperfluorescence (26.9% vs. 7.1%, P = 0.005). The iERM severity positively correlated with late-phase leakage (r = 0.32, P = 0.0008) and microaneurysms (r = 0.25, P = 0.007). CONCLUSIONS: Peripheral angiographic abnormalities are more prevalent in iERM eyes and correlate with disease severity. These findings suggest that iERM is not confined to the macula but may reflect broader retinal pathophysiology. UW-FAG serves as a valuable adjunctive tool in comprehensively evaluating eyes with iERM.
PURPOSE: To evaluate feasibility and safety of robot-assisted subretinal injections through attached retina using the comanipulated Mynutia system in patients with submacular hemorrhage. METHODS: This prospective, single...PURPOSE: To evaluate feasibility and safety of robot-assisted subretinal injections through attached retina using the comanipulated Mynutia system in patients with submacular hemorrhage. METHODS: This prospective, single-center case series included 20 eyes undergoing vitrectomy with subretinal recombinant tissue plasminogen activator between June 2024 and August 2025. The EVA Inicio microinjection system with a 38-G needle was mounted on the Mynutia system. Injections were performed through attached retina when feasible. Primary outcomes were successful needle insertion, stable subretinal positioning for ≥3 minutes, safe withdrawal, and absence of device-associated adverse events (DAE). Secondary outcomes included injection parameters, hemorrhage displacement, visual outcomes, and complications. RESULTS: Robot-assisted injection succeeded in all eyes; one required injection into the submacular hemorrhage because of anatomy. Mean injection duration was 178 ± 34 seconds (max 400), but the needle tip was maintained in the subretinal space ≥3 minutes in all cases. No DAE occurred. Retinotomies closed spontaneously without visible reflux. Mean bleb initiation and propagation pressures were 10.3 ± 3.2 and 3.0 [3.0-3.25] PSI, respectively; internal limiting membrane peeling reduced initiation pressure ( P < 0.05). Complete subfoveal displacement was achieved in 95%. Median BCVA improved from LogMAR 1.85 (counting fingers) to 0.66 (20/90) at 6 weeks ( P < 0.001). Adverse events included hyphema (5%), ocular hypertension (5%), vitreous hemorrhage (25%; 80% self-limited), RPE tear (20%), and recurrent submacular hemorrhage (5%). CONCLUSION: Robot-assisted subretinal injection with Mynutia is feasible and safe, enabling stable, prolonged low-pressure delivery through attached retina, and may enhance precision and tissue preservation in subretinal therapies.
PURPOSE: To evaluate the association between retinal vein occlusion and leukemia. METHODS: A comprehensive literature search was conducted across PubMed, Google Scholar, ScienceDirect, Scopus, and Cochrane Library from i...PURPOSE: To evaluate the association between retinal vein occlusion and leukemia. METHODS: A comprehensive literature search was conducted across PubMed, Google Scholar, ScienceDirect, Scopus, and Cochrane Library from inception to October 20, 2025, following PRISMA guidelines and a registered PROSPERO protocol (CRD420251134924). Observational studies reporting ocular findings in leukemia were included. Data extraction and risk of bias assessment were performed independently using the JBI and ROBINS-I tools. Pooled effect sizes were calculated using Comprehensive Meta-Analysis (CMA v4.0), expressed as logit event rates with 95% confidence intervals. Case reports were narratively summarized but excluded from quantitative synthesis. RESULTS: Eight studies encompassing 1,016 participants were included in the meta-analysis. The pooled logit event rate for overall ocular manifestations was -0.3307 (95% CI: -0.456 to -0.206; P < 0.0001), corresponding to a prevalence of 42%. Retinal hemorrhage was the most frequent finding (logit = -1.90; 13%-15%), followed by retinal infiltration (logit = -3.55; 3%) and retinal vein occlusion (logit = -4.41; 1.2%). Heterogeneity was low for infiltration (I 2 = 10.2%) and retinal vein occlusion (I 2 = 0%). CONCLUSION: Ocular involvement occurs in nearly half of patients with leukemia, with retinal hemorrhages and microvascular compromise as dominant manifestations. Although retinal vein occlusion is rare, it signifies advanced hematologic derangement. These findings highlight the importance of routine ophthalmic screening including fundus examination, OCT, and OCTA-as integral components of leukemia management for early detection, systemic correlation, and vision preservation.
PURPOSE: This study investigated the clinical characteristics and prognosis of rhegmatogenous retinal detachment (RRD) in patients with implantable collamer lens (ICL). METHODS: A retrospective review was conducted of me...PURPOSE: This study investigated the clinical characteristics and prognosis of rhegmatogenous retinal detachment (RRD) in patients with implantable collamer lens (ICL). METHODS: A retrospective review was conducted of medical records from patients with ICL who underwent RRD surgery between 2015 and 2024. Data collected included medical history, preoperative and postoperative best-corrected visual acuity (BCVA), fundus features, intraocular tamponade type, and arch height (AH). RESULTS: Fifteen eyes from 13 male patients (mean age: 32.93 ± 4.01 years) were included. The mean interval from ICL implantation to RRD was 4.53 ± 2.46 years. Twelve eyes (80%) were macula-off and three eyes (20%) were macula-on detachments. The primary anatomical success rate was 80% (12/15), and the final anatomical success rate was 93% (14/15). At the final follow up, the mean BCVA significantly improved from 1.21 ± 0.75 logMAR (Snellen equivalent: 6/100) at baseline to 0.63 ± 0.64 logMAR (23/100) ( P = 0.006). The ICL was retained during primary retinal reattachment surgery. There was no significant change in AH before and after intraocular tamponade ( P = 0.216). CONCLUSION: Surgical management is a key to the success of RRD in patients with ICL. Implantable collamer lens removal is not required during vitreoretinal surgery when using wide-angle viewing systems in our series. Intraocular tamponade does not significantly affect AH.
PURPOSE: Inherited retinal diseases (IRDs) are among the most common causes of visual impairment in children and young adults. The aim of this study was to characterize early clinical manifestations, main IRDs, and causa...PURPOSE: Inherited retinal diseases (IRDs) are among the most common causes of visual impairment in children and young adults. The aim of this study was to characterize early clinical manifestations, main IRDs, and causative genes in a pediatric cohort. METHODS: Retrospective study case series of children with a diagnosed IRD. Data extracted from medical charts included IRD type, clinical manifestations, demographic details, and molecular analysis when available. RESULTS: The authors have identified 199 children. The earliest and most common symptom was nystagmus (mean age: 1.78 years), followed by photophobia, strabismus, and high refractive errors. The most common diagnoses were retinitis pigmentosa, achromatopsia, and congenital stationary night blindness; achromatopsia and Leber congenital amaurosis presented significantly earlier than other IRDs. Most common identified genes were CNGA3 , TRPM1 , CNGB3 , and CRB1 . CONCLUSION: Nystagmus was the earliest and most common symptom, particularly if disease manifests during the first year of life. Photophobia, strabismus, and high refractive errors were also common. Main IRDs in their studied population were retinitis pigmentosa, achromatopsia, and congenital stationary night blindness, and the most common genes identified were CNGA3 and TRPM1 , differing from the ones seen later in adulthood. Identification of IRDs' early clinical manifestations can help affected families reach early diagnosis, support, and family planning.
PURPOSE: To evaluate the prognostic significance of baseline subretinal fluid (SRF) optical density ratio (ODR) in first-onset central serous chorioretinopathy. METHODS: This retrospective study included patients with a...PURPOSE: To evaluate the prognostic significance of baseline subretinal fluid (SRF) optical density ratio (ODR) in first-onset central serous chorioretinopathy. METHODS: This retrospective study included patients with a new diagnosis of central serous chorioretinopathy, no prior retinal disease, and at least 3 months of follow-up. Eyes were categorized as resolved or nonresolved based on SRF resolution at 3 months. Optical density ratio was calculated as the ratio between SRF and vitreous optical densities on baseline optical coherence tomography scans. RESULTS: Thirty-nine patients (33 men, 6 women; mean age 41.4 ± 9.1 years) met the inclusion criteria. At 3 months, SRF resolved in 19 eyes and persisted in 20 eyes. Baseline ODR was significantly higher in the nonresolved group compared with the resolved group (1.03 ± 0.32 vs. 0.80 ± 0.27; P = 0.018). Visual acuity at follow-up was significantly better in the resolved group (20/21.4 [logarithm of the minimum angle of resolution 0.03 ± 0.05] vs. 20/26.4 [logarithm of the minimum angle of resolution 0.12 ± 0.16]; P = 0.035). No significant differences were found between groups in age, sex, or choroidal thickness. In multivariate logistic regression, ODR remained the only independent predictor of SRF persistence at 3 months. CONCLUSION: Baseline ODR is associated with both fluid persistence and visual outcomes. As the only independent predictor of persistent SRF in this cohort, ODR shows promise as a potential prognostic biomarker requiring no additional cost to identify patients at higher risk for chronic disease at initial presentation.