This paper reviews the efficacy and safety of various dosing regimens and treatment cycles of intravitreal faricimab as therapy for Age-related macular degeneration (ARMD). The included studies were randomized controlled...This paper reviews the efficacy and safety of various dosing regimens and treatment cycles of intravitreal faricimab as therapy for Age-related macular degeneration (ARMD). The included studies were randomized controlled trials (RCTs) or post-hoc analyses of RCTs involving a population of ARMD or macular related disorder patients receiving faricimab therapy. Study outcomes were assessed by best-corrected visual acuity (BCVA) or central macular subfield thickness (CST). Data extracted from the journals included characteristics of the patient population, subgroup population, treatment used, therapeutic dose, treatment cycle, BCVA, CVA, number of populations with severe adverse events, and severe ocular adverse events. Study heterogeneity was assessed using the I² statistic, with values ≤ 40% considered homogeneous. A random effects model was applied when effect estimates crossed the line of no effect. Effect sizes were reported as mean differences with 95% confidence intervals. We included eight studies with a total of 8458 study populations. There are several doses that can be given (1.5 mg and 6 mg) and several cycles of administration (every 4, 8, 12, 16 weeks and personalized treatment interval). Faricimab 6 mg every sixteen weeks has shown a better effect than aflibercept and ranibizumab. These findings suggest that faricimab 6 mg administered every sixteen weeks demonstrated superior outcomes in improving best-corrected visual acuity (BCVA) and greater reductions in central subfield thickness (CST) compared to aflibercept 2 mg every eight weeks. However, a more frequent regimens were associated with significantly higher severe adverse events, especially ocular severe adverse events.
This article examines the delineation of professional competencies in visual health care in Spain and the European Union, comparing the continental European model with the British, USA and Canada models. In Spain and mos...This article examines the delineation of professional competencies in visual health care in Spain and the European Union, comparing the continental European model with the British, USA and Canada models. In Spain and most European countries, the diagnosis and treatment of eye diseases is the exclusive responsibility of ophthalmologists, supported by extensive medical training and strict regulation. Optometrists play a complementary role, focused on detecting refractive anomalies and adapting optical aids, without legal authority for medical diagnosis or treatment prescription. The article warns of the risks of expanding optometrists' competencies without appropriate legal and educational reform, as this could compromise patient safety. It emphasizes that Anglo-Saxon models are not directly applicable to the Spanish context due to structural differences. The article advocates for clear interprofessional collaboration, well-defined referral protocols, and regular legal updates, always prioritizing patient safety.
This retrospective case report describes the closure of a large traumatic macular hole following PPV, posterior hyaloid detachment, and air tamponade despite the inability to perform ILM surgery. An 11-year-old male pres...This retrospective case report describes the closure of a large traumatic macular hole following PPV, posterior hyaloid detachment, and air tamponade despite the inability to perform ILM surgery. An 11-year-old male presented with a full-thickness macular hole following blunt trauma and a BCVA of counting fingers. Serial OCT examination precluded spontaneous closure. The surgery consisted of PPV and induction of posterior hyaloid detachment. All attempts to perform a modified ILM flap technique failed. Air tamponade was used at the end of the surgery. The post-operative OCT images showed U-type closure of the hole. The BCVA improved to 6/60. We recommend a modified ILM flap technique in large full-thickness traumatic macular holes to improve the functional and anatomical outcomes. Despite the inability of ILM surgery, the hole closure described in this report is an unusual finding.
BACKGROUND AND OBJECTIVE: Pneumatic retinopexy is a treatment for rhegmatogenous retinal detachment with standard selection criteria. There is growing interest in evaluating its outcomes in broader clinical profiles. Thi...BACKGROUND AND OBJECTIVE: Pneumatic retinopexy is a treatment for rhegmatogenous retinal detachment with standard selection criteria. There is growing interest in evaluating its outcomes in broader clinical profiles. This study aimed to evaluate anatomical outcomes and visual recovery after pneumatic retinopexy in a cohort including non-standard criteria, and to identify independent predictive factors for anatomical failure and reduced visual recovery. MATERIALS AND METHODS: A prospective cohort study of 92 eyes (92 patients), stratified into standard (n = 57) and non-standard (n = 35) criteria. Over 12 months of follow-up, primary reattachment survival was assessed using Kaplan-Meier curves and predictive factors were analyzed with multivariate regression models. RESULTS: The primary anatomical success rate was 82.5% in the standard criteria group and 85.7% in the non-standard group (P = .777), with a cumulative survival at 12 months >95% in both groups (log-rank, P = .754). Final anatomical success exceeded 97%. Final best-corrected visual acuity improved significantly (P < .001) with no differences between groups (P = .343). Greater detachment extent was an independent predictor of anatomical failure in multivariate model (OR = 3.23 per additional quadrant; P = .044). Longer detachment duration (β = 0.021 logMAR/day; P < .001) and older age (β = 0.006 logMAR/year; P < .001) were independent predictors of reduced visual recovery. CONCLUSIONS: Pneumatic retinopexy suggests a high survival rate of primary retinal reattachment and provides significant visual improvement in patients meeting both standard and non-standard criteria. Detachment extent, symptom duration, and age are key independent predictive factors for optimizing candidate selection and anticipating functional outcomes.
This review aims to synthesize current evidence on the role of melatonin in glaucoma pathophysiology, its relationship with sleep disturbances and circadian dysregulation, and its potential as a therapeutic agent beyond...This review aims to synthesize current evidence on the role of melatonin in glaucoma pathophysiology, its relationship with sleep disturbances and circadian dysregulation, and its potential as a therapeutic agent beyond intraocular pressure (IOP) control. Glaucoma is a chronic neurodegenerative optic neuropathy characterized by progressive retinal ganglion cells (RGCs) loss. While IOP remains the primary modifiable risk factor, disease progression often persists despite adequate pressure control, highlighting the need for adjunctive neuroprotective strategies. Sleep disturbances are highly prevalent in glaucoma and may reflect underlying circadian dysfunction. This review integrates findings from clinical, experimental, and translational studies, including observational cohorts, meta-analyses, and mechanistic investigations of melatonin signaling, receptor distribution, and therapeutic modulation. Melatonin secretion is significantly reduced in glaucoma, particularly in advanced stages, as demonstrated by urinary 6-sulfatoxymelatonin levels. Melatonin receptors 1 and 2 are expressed in multiple ocular tissues, including RGCs, photoreceptors, and the ciliary body, mediating circadian regulation, antioxidant defense, and IOP modulation. Melatonin deficiency contributes to impaired intrinsically photosensitive RGCs (ipRGCs) function, disrupted circadian entrainment, and neurodegeneration. Exogenous melatonin and analogues (e.g., 5-MCA-NAT, agomelatine) show promising IOP-lowering and neuroprotective effects in preclinical and early clinical studies. Novel delivery systems enhance ocular bioavailability and therapeutic efficacy. Melatonin plays a multifaceted role in glaucoma, influencing circadian rhythms, sleep quality, IOP regulation, and retinal neuroprotection. Its therapeutic potential warrants further investigation through controlled trials and optimized delivery strategies. Addressing circadian dysregulation may offer a novel avenue for comprehensive glaucoma management. Therefore, a structured narrative search was conducted in PubMed using the keywords "glaucoma" AND "melatonin", and findings were synthesized qualitatively due to methodological heterogeneity across clinical and preclinical studies.
A 19-year-old male undergoing systemic isotretinoin therapy presented with bilateral corneal nodules resembling Salzmann nodular degeneration (SND). He had no prior ocular comorbidities and reported mild itching. Slitlam...A 19-year-old male undergoing systemic isotretinoin therapy presented with bilateral corneal nodules resembling Salzmann nodular degeneration (SND). He had no prior ocular comorbidities and reported mild itching. Slitlamp examination revealed inflammatory nodules with pannus and blepharitis; optical coherence tomography (OCT) confirmed no stromal involvement. Systemic retinoid therapy was discontinued, and topical antiinflammatory treatment initiated. Despite transient visual decline, the patient improved over six months, with resolution of symptoms and stabilization of the corneal lesions. The temporal relationship between isotretinoin use and lesion onset, in the absence of other risk factors, suggests a possible association between systemic retinoids and SND-like pathology. This case highlights the importance of ophthalmologic monitoring in patients on retinoid therapy and raises awareness of potential corneal complications.
This case report highlights the diagnostic and surgical value of ultrasound biomicroscopy (UBM) in managing phacolytic glaucoma with traumatic lens subluxation, a rare combination requiring differentiation from other len...This case report highlights the diagnostic and surgical value of ultrasound biomicroscopy (UBM) in managing phacolytic glaucoma with traumatic lens subluxation, a rare combination requiring differentiation from other lens-induced glaucomas. UBM precisely identified three pathognomonic features: (1) subluxated lens with reduced thickness yet open angles, (2) cortical liquefaction, and (3) zonular insufficiency, thus overcoming the limitations of conventional imaging modalities. The patient underwent successful phacoemulsification with capsular tension ring implantation, achieving 20/20 vision and normalized intraocular pressure (IOP) at 1-month follow-up.
We describe the ophthalmic findings in a case of cerebral venous thrombosis in a young patient. Observations: A five-year-old female presents with acute onset irritability, somnolence, diplopia, and headache. Ophthalmic...We describe the ophthalmic findings in a case of cerebral venous thrombosis in a young patient. Observations: A five-year-old female presents with acute onset irritability, somnolence, diplopia, and headache. Ophthalmic exam showed normal vision, large esotropia with a VI nerve palsy and papilledema. MRI demonstrated longitudinal sinus thrombosis associated with Leiden factor V thrombophilia and an asymptomatic pulmonary thrombosis. Anticoagulant therapy was initiated resolving the diplopia and the disc edema, although MRI evidence of the sinus thrombosis persisted. Venous sinus thrombosis should be included in the differential diagnosis of cranial hypertension.
To describe a case of a macular hole (MH) secondary to a submacular hemorrhage caused by a ruptured retinal arterial macroaneursym (RAM). An individual case and its observations were examined. Initial examination reveale...To describe a case of a macular hole (MH) secondary to a submacular hemorrhage caused by a ruptured retinal arterial macroaneursym (RAM). An individual case and its observations were examined. Initial examination revealed no visible MH due to the hemorrhagic clot. Two weeks later, a full-thickness MH measuring 340 μm was detected. Pneumatic displacement with sulfur hexafluoride (SF6) was performed to reduce hemorrhagic toxicity and potentially promote spontaneous closure. However, after three months, the MH persisted with no evidence of closure, and visual acuity remained reduced (20/150). The Foveal mountain peak sign (FMP) was identified as a useful predictive indicator of MH formation. MHs secondary to ruptured RAMs and submacular hemorrhages may be initially obscured by hemorrhagic clots, complicating early diagnosis. The FMP sign can aid in predicting MH development. Given the risk of persistent MH and visual impairment, especially when the RAM rupture is close to the fovea (<1500 μm), early surgical intervention should be considered.
Conjunctival amyloidosis is an uncommon entity, generally primary and localized, that should be considered in the differential diagnosis of conjunctival lesions. We present the case of a 74-year-old man with no relevant...Conjunctival amyloidosis is an uncommon entity, generally primary and localized, that should be considered in the differential diagnosis of conjunctival lesions. We present the case of a 74-year-old man with no relevant medical history who, during follow-up after cataract surgery, developed elevated yellowish-salmon conjunctival plaques. Incisional biopsy revealed subepithelial amyloid deposits, positive for Congo red and immunohistochemistry consistent with AL amyloidosis with kappa light chain restriction. The initial systemic evaluation was normal; however, clinical progression led to the diagnosis of multiple myeloma with multisystemic involvement. Systemic treatment did not reduce the size of the conjunctival lesions, but topical cyclosporine improved ocular discomfort and the sensation of a foreign body. This case highlights the role of the ophthalmologist in the early detection of systemic diseases. Histological confirmation is essential, and although there is no specific treatment, symptomatic management and multidisciplinary follow-up improve the patient's quality of life.
Stickler syndrome is a rare connective tissue disorder with multisystem involvement. We describe the diagnosis and management of Stickler syndrome in a 39-year-old woman with unclassified bone-muscle dysplasia and no pri...Stickler syndrome is a rare connective tissue disorder with multisystem involvement. We describe the diagnosis and management of Stickler syndrome in a 39-year-old woman with unclassified bone-muscle dysplasia and no prior ocular history, presenting with floaters. Fundus examination showed radial lattice degenerations in both eyes and optical coherence tomography revealed bilateral foveal hypoplasia. Despite not having high myopia (only -4 Diopters in each eye), those funduscopic findings made us investigate further disease. A genetic test was made, and she was found to be heterozygous for the likely pathogenic variant c.1069-2A > T in the COL2A1 gene. Therefore, our patient was finally diagnosed with Stickler syndrome type 1. This case emphasizes the need to consider Stickler syndrome in adults with vitreoretinal degeneration and foveal hypoplasia, even in the absence of high myopia.
INTRODUCTION AND OBJECTIVES: The healthcare system is responsible for around 5% off global CO emissions. Glaucoma is one of the most common chronic diseases. The aim of this work is to quantify the ecological impact of a...INTRODUCTION AND OBJECTIVES: The healthcare system is responsible for around 5% off global CO emissions. Glaucoma is one of the most common chronic diseases. The aim of this work is to quantify the ecological impact of anti-glaucoma medical therapy packaging in Spain, assessing its carbon footprint and waste generation. MATERIALS AND METHODS: This cross-sectional study analyzed the ecological impact of glaucoma medical treatment packaging. Packaging materials from 33 drug presentations were classified, and weighed. Their carbon footprint was calculated using emission factors from Ecoinvent v3.10. Drug presentations were classified as multi-dose or single-dose and the Mann-Whitney U test was used to compare the amount of waste and carbon footprint of each type. RESULTS: The total amount of annual waste was more than 5 times higher in single-dose than in multi-dose treatments (median: 713.1; interquartile range [648.1-806.8] g vs. median: 136.5; interquartile range [118.3-153.9] g). The carbon footprint was 9 times higher with single-dose treatment than with multi-dose treatment (median: 2.23; interquartile range [1.77-2.49] kg COe vs. median: 0.24; interquartile range [0.20-0.28] kg COe) in multi-dose treatments. CONCLUSIONS: The use of single-dose containers significantly increases plastic waste. The increase in carbon footprint is even higher due to plastic and aluminium content. Future studies should clarify their benefits to help balance ecological impact and patient safety.
A 32-year-old man of Maghrebi origin consulted for visual loss in both eyes (OU) with recurrent oral ulcers and erythematous lesions. The examination revealed panuveitis in the right eye, posterior uveitis in the left ey...A 32-year-old man of Maghrebi origin consulted for visual loss in both eyes (OU) with recurrent oral ulcers and erythematous lesions. The examination revealed panuveitis in the right eye, posterior uveitis in the left eye and cystic macular edema (CME) in OU. Along with mucocutaneous lesions and the presence of HLA B51 positive suggested a diagnosis of Behçet's disease. He was initially treated with pulses of Methylprednisolone followed by oral Prednisone and Azathioprine (AZA). Given the insufficient control, Adalimumab (ADA) was added. Due to the lack of visual improvement and worsening of the CME, it was decided to switch from ADA to Tocilizumab (TCZ) at a dose of 8 mg/kg/month. After three years of follow-up, he remained stable at the systemic and ocular levels with AZA and TCZ, and oral corticosteroids were discontinued. In cases where signs of ocular activity persist, a change in biological therapeutic target should be considered, with Tocilizumab being a beneficial option.
Intrastromal rings have a high safety profile, with late complications being rare. A clinical case is presented of a patient who attended the emergency department due to photophobia and redness in the right eye with a tw...Intrastromal rings have a high safety profile, with late complications being rare. A clinical case is presented of a patient who attended the emergency department due to photophobia and redness in the right eye with a two-day onset. A relevant medical history includes the implantation of an intrastromal corneal ring segment for keratoconus 11 years earlier. Examination revealed a deep whitish stromal infiltration around the ring. After several weeks of antibiotic treatment, the decision was made to explant the ring. Preoperative OCT demonstrated endothelial perforation at the site of the infiltration. Aqueous humour leakage was observed upon removal of the ring segment. The patient reported notable symptomatic improvement following surgery. We present a rare complication following the implantation of an intrastromal ring, initially suspected to be a stromal infiltration, which turned out to be an unusually late endothelial perforation.
BACKGROUND AND OBJECTIVE: The refractive outcome is one of the factors that determine the success of cataract surgery. This result depends largely on the calculation of the intraocular lens. Technological advances have e...BACKGROUND AND OBJECTIVE: The refractive outcome is one of the factors that determine the success of cataract surgery. This result depends largely on the calculation of the intraocular lens. Technological advances have enhanced the accuracy of this calculation using high-precision biometers and new biometric formulas. The aim of this study is to evaluate the refractive predictive accuracy of the Barrett TK Universal II formula using IOLMaster 700 technology under real-world clinical conditions in a public university hospital setting. MATERIALS AND METHODS: This is a retrospective study performed between October 2021 and February 2023. Biometric variables were recorded using the IOLMaster 700, applying the Barrett TK Universal II formula for the calculation of intraocular lens power. The mean absolute (MAE) and relative (ME) prediction error at three months post-surgery were analyzed, as well as the influence of preoperative variables on the achieved refractive outcome. RESULTS: One hundred ninety-three patients have been studied, with a mean age of 73.58 ± 9.09 years. The ME was -0.09 ± 0.5diopters (D), and the MAE was 0.39 ± 0.32D. 67.88% of the patients ended up within ±0.5D of the target refraction, and 95.85% within ±1D. No significant correlation was found between the MAE and any of the studied variables. CONCLUSIONS: The findings support the importance of having precise technology for performing biometrics such as the IOLMaster 700 and the use of last-generation formulas such as the Barrett TK Universal II.
Toxicity secondary to checkpoint inhibitors (ICP) can affect numerous parts of the body, with varying frequency. We present a case of bilateral optic neuritis secondary to the use of pembrolizumab (an anti-PD-1), which h...Toxicity secondary to checkpoint inhibitors (ICP) can affect numerous parts of the body, with varying frequency. We present a case of bilateral optic neuritis secondary to the use of pembrolizumab (an anti-PD-1), which has been described in the literature in less than 1% of cases associated with the use of anti-PD-1/PD-L1 and anti-CTLA4 (ICP).