PURPOSE: To review the literature on neuro-ophthalmologic complications associated with radiofrequency ablation (RFA) for trigeminal neuralgia (TN) and, in light of current evidence, to present and analyze a case of comb...PURPOSE: To review the literature on neuro-ophthalmologic complications associated with radiofrequency ablation (RFA) for trigeminal neuralgia (TN) and, in light of current evidence, to present and analyze a case of combined autonomic and cranial neuropathy following the procedure. METHODS: A narrative literature review was conducted on neuro-ophthalmologic complications associated with RFA for TN. Published reports were analyzed with attention to involved cranial nerves, mechanisms of injury, clinical presentation, management strategies, and visual outcomes. In addition, a single case was retrospectively reviewed based on medical records, including clinical findings, neuro-ophthalmologic examination data, treatment interventions, and follow-up documentation. Data were synthesized in the context of existing literature. RESULTS: Published literature indicates that neuro-ophthalmologic complications after RFA for TN are rare but may occur due to the proximity of the trigeminal ganglion to adjacent cranial and autonomic structures. Most reported cases involve isolated cranial nerve deficits, whereas simultaneous multiple nerves and sympathetic involvement is uncommon. In the present case, a 66-year-old female developed diplopia, corneal anesthesia, and anisocoria following RFA. Neuro-ophthalmologic evaluation demonstrated right trochlear nerve palsy, ophthalmic nerve (V1) dysfunction, and sympathetic involvement. Conservative management was initiated. During follow-up, ophthalmic nerve dysfunction resolved by week five, while full recovery of trochlear and sympathetic dysfunction occurred by month five. CONCLUSION: Radiofrequency ablation for TN is generally safe but may rarely cause neuro-ophthalmologic complications due to proximity of cranial and autonomic structures. Early recognition and ophthalmologic follow-up are essential. This case highlights rare combined trochlear, ophthalmic, and sympathetic involvement after RFA.
Dry eye disease is a common multifactorial condition that significantly impairs patients' quality of life. In clinical practice, conventional diagnostic tools such as the Schirmer test, tear break-up time (TBUT), and ocu...Dry eye disease is a common multifactorial condition that significantly impairs patients' quality of life. In clinical practice, conventional diagnostic tools such as the Schirmer test, tear break-up time (TBUT), and ocular surface staining show poor correlation between clinical signs and patient-reported symptoms. In this context, point-of-care (POC) biomarkers represent a major advance by enabling objective, reproducible, rapid assessment of ocular surface abnormalities during routine visits. Among these biomarkers, lactoferrin reflects aqueous tear deficiency and can be measured in the clinic using the TearScan Lactoferrin Test® (Advanced Tear Diagnostics [ATD], Birmingham, Alabama, USA) or the Lactoplate® test (Department of Ophthalmology, University of Nijmegen, Nijmegen, The Netherlands). Matrix metalloproteinase-9 (MMP-9) is a pro-inflammatory enzyme overexpressed in moderate to severe dry eye disease and can be detected using the InflammaDry® POC test. Another clinically available test is tear osmolarity measurement, which reflects tear film homeostasis; assessment using the TearLab® system (TearLab Corporation, San Diego, California, USA) or the ScoutPro® Osmolarity System (Trukera Medical, Inc., Southlake, Texas, USA) is valuable for both diagnosis and therapeutic monitoring. Additional biomarkers currently being investigated in research settings include Human Leukocyte Antigen - DR isotype (HLA-DR), Intercellular Adhesion Molecule 1 (ICAM-1), inflammatory cytokines, lipocalin-1, and soluble mucin encoded by the Mucin 5 subtype AC (MUC5AC) gene. Although these markers provide important diagnostic and prognostic insights, their measurement relies on complex laboratory techniques, limiting routine clinical use. Ongoing technological innovations aim to miniaturize diagnostic devices, develop multiplex assays capable of simultaneously analyzing multiple biomarkers, and integrate artificial intelligence to enhance data interpretation. Collectively, these advances contribute to improved phenotyping of dry eye disease and support more personalized management strategies in clinical practice.
PURPOSE: Macular edema is a significant cause of vision loss in uveitis. Effective control of underlying inflammation is essential to treating macular edema in non-infectious uveitis, typically with corticosteroids. In t...PURPOSE: Macular edema is a significant cause of vision loss in uveitis. Effective control of underlying inflammation is essential to treating macular edema in non-infectious uveitis, typically with corticosteroids. In this study, we examine the use of sequential dexamethasone and fluocinolone acetonide steroid intravitreal implants to promote rapid improvement and sustained control in non-infectious uveitic macular edema. METHODS: Sixteen eyes from eleven patients with recurrent uveitic macular edema who received sequential intravitreal dexamethasone and fluocinolone acetonide implants were studied via retrospective chart review in 3-month intervals over a 24-month observation window. All patients had received at least one prior dexamethasone implant, which was used both therapeutically and to assess the intraocular-pressure response to an intravitreal corticosteroid before proceeding to the fluocinolone acetonide implant. The primary outcome was the recurrence rate of clinically significant macular edema after treatment. Chart review was performed to identify recurrences and need for additional anti-inflammatory treatment. We also evaluated change in visual acuity, intraocular pressure, and central subfield thickness throughout the study duration. RESULTS: Twelve eyes (75%) did not experience a recurrence in clinically significant macular edema after treatment with both intravitreal injections. The rate of retreatment (25%) was reduced compared to patients who only received dexamethasone. There was a rapid and sustained improvement in macular edema, though there was no statistically significant improvement in visual acuity. Intraocular pressure initially increased but stabilized after the first 3-month interval. CONCLUSIONS: Sequential administration of dexamethasone and fluocinolone acetonide intravitreal implants reduces the rate of significant macular edema recurrences in non-infectious uveitis. There is a significant quantitative improvement in macular edema, and further studies may demonstrate a noticeable benefit in visual acuity and quality of life with fewer retreatments.
PURPOSE: To evaluate the appropriateness and readability of responses generated by large language model (LLM) chatbots to frequently asked patient questions regarding intravitreal anti-vascular endothelial growth factor...PURPOSE: To evaluate the appropriateness and readability of responses generated by large language model (LLM) chatbots to frequently asked patient questions regarding intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy. METHODS: Forty patient-centered anti-VEGF-related questions were developed by retinal specialists and posed in English to six LLM chatbots (ChatGPT-4.0, ChatGPT-5.2, Google Gemini 3, Microsoft Copilot, Grok 4, and Manus 1.6 Lite) under identical conditions. Responses were recorded verbatim and anonymized. Two ophthalmologists evaluated clinical appropriateness using a three-point Likert scale. Readability was assessed using five validated indices, and text length and time-based parameters were analyzed. RESULTS: None of the responses were classified as inappropriate. Gemini 3 demonstrated the highest rate of appropriate responses (97.5%), followed by ChatGPT-5.2 (90%), ChatGPT-4.0 (87.5%), and Manus 1.6 Lite (87.5%), while Copilot and Grok 4 showed lower appropriateness due to a higher proportion of partially appropriate responses (P=0.033). Significant differences were observed across all readability indices (P<0.001). Gemini 3 achieved the highest Flesch Reading Ease scores, indicating better patient accessibility, whereas Grok 4 produced more complex texts requiring higher educational levels. Manus 1.6 Lite generated the longest and most information-dense responses, while Gemini 3 demonstrated a more balanced profile between informational depth and readability. CONCLUSIONS: While LLM chatbots generally provide clinically appropriate information on intravitreal anti-VEGF therapy, substantial model-dependent differences exist in readability and communication quality. LLMs should therefore be used as physician-supervised tools to support patient education rather than as standalone information sources.
Trabecular MIGS (minimally invasive glaucoma surgery) procedures target the trabecular meshwork and Schlemm's canal in order to restore the physiological outflow of aqueous humor. Some approaches use implants, such as th...Trabecular MIGS (minimally invasive glaucoma surgery) procedures target the trabecular meshwork and Schlemm's canal in order to restore the physiological outflow of aqueous humor. Some approaches use implants, such as the iStent® or Hydrus®, which create a bypass to Schlemm's canal and thus improve drainage. Other techniques rely on incision or ablation of the trabecular meshwork, such as the Trabectome®, Kahook Dual Blade®, or gonioscopy-assisted transluminal trabeculotomy (GATT), to facilitate access to the collector channels. Devices like OMNI® or Visco360® combine canaloplasty and viscodilation to expand Schlemm's canal. Finally, excimer laser trabeculotomy offers a non-implant alternative by selectively perforating the trabecular meshwork. Clinical data show that these procedures, to varying degrees, lower intraocular pressure and reduce the need for topical medications, while presenting a safer profile than traditional filtering surgeries. The iStent® and Hydrus® benefit from the strongest scientific evidence, derived from phase III randomized trials that have confirmed their efficacy and safety. Ablative techniques are also effective but associated with a higher risk of hemorrhage, whereas ELT represents an interesting option free of implants. Overall, trabecular MIGS appears to be a safe and effective alternative for mild to moderate glaucoma, helping to reduce medication dependence and delay the need for more invasive surgeries, although outcomes vary depending on the technique and patient profile.
PURPOSE: To evaluate the refractive outcomes of cataract surgery in patients with nanophthalmos. PATIENTS AND METHODS: In this retrospective descriptive case series, the medical records of patients with nanophthalmos (ax...PURPOSE: To evaluate the refractive outcomes of cataract surgery in patients with nanophthalmos. PATIENTS AND METHODS: In this retrospective descriptive case series, the medical records of patients with nanophthalmos (axial length<20mm) who underwent cataract surgery between 2015 and 2024 by the same surgeon (J.-S. R) at the National Vision Hospital of Quinze-Vingts were analyzed. Collected data included clinical and biometric characteristics as well as intraoperative and postoperative complications. The intraocular lens power was used to calculate the predicted postoperative refractive error using seven biometric formulas (Barrett Universal II, SRK/T, Hoffer Q, Holladay I, Haigis, EVO, Hoffer QST). For each formula, both the numerical refractive error and the mean absolute error were calculated. RESULTS: Six eyes of six patients (3 women, 3 men) with a mean age of 63years were included in this study. The mean axial length was 17.2±1.17mm. The Barrett Universal II and Hoffer Q formulas showed better refractive accuracy (mean absolute prediction errors respectively 0.99±0.55 D; 1.38±0.59 D; 1.99±1.13 D). For the Holladay I, Hoffer QST, SRK/T, and Haigis formulas, the mean errors were higher (respectively 3.11±1.11 D; 3.48±1.51 D; 4.19±1.35 D; 6.65±0.95 D) and showed a greater tendency toward myopic shift. One patient experienced a postoperative decrease in visual acuity (from 0.3 to 0.4 logMAR). CONCLUSION: Despite the development of complex automated models, our study suggests that the Barrett Universal II and Hoffer Q formulas, both validated for short eyes, appear to remain reliable for patients with nanophthalmos.
INTRODUCTION: Repeated eye rubbing and ocular microtrauma (F&MOR) have been identified as the main risk factors for the onset and progression of keratoconus. A questionnaire was developed and scientifically validated to...INTRODUCTION: Repeated eye rubbing and ocular microtrauma (F&MOR) have been identified as the main risk factors for the onset and progression of keratoconus. A questionnaire was developed and scientifically validated to provide a tool for screening and managing the behavioral and environmental components of this condition. METHODS: A consortium of experts initially met to define a list of relevant questions aimed at profiling traits of patients coming for the first time to a National Reference Center for Keratoconus (CRNK). This questionnaire was administered twice to a prospective cohort of patients across eight centers. Statistical analyses were performed to retain only the fifteen most relevant questions. A final expert consultation using a nominal group method completed the validation process. RESULTS: The finalized questionnaire includes 15 items designed to assess the risk of F&MOR. Its objective is to support clinical management and serve as a therapeutic tool for the prevention and inhibition of F&MOR in patients with keratoconus. CONCLUSION: This validated questionnaire enables ophthalmologists to standardize and strengthen preventive and therapeutic strategies for keratoconus.
PURPOSE: To study the epidemiological, clinical, and therapeutic aspects of a cohort of French patients with thyroid eye disease (TED). PATIENTS AND METHODS: We conducted a retrospective, single-center study over a 4-yea...PURPOSE: To study the epidemiological, clinical, and therapeutic aspects of a cohort of French patients with thyroid eye disease (TED). PATIENTS AND METHODS: We conducted a retrospective, single-center study over a 4-year period, including all patients referred to our tertiary referral center for TED. Patients without TED or with incomplete data were excluded. RESULTS: A total of 100 patients were included (77% women), with a mean age of 43.5years (range: 25 to 90years). Among them, 47% were smokers, 16% had a personal history of autoimmune diseases, and 24% had a family history of autoimmune conditions. One-third of the patients were euthyroid at the time of consultation, and one-third had undergone radical thyroid treatment. The most common symptoms were upper eyelid retraction (48%) and exophthalmos (42%). In our cohort, 5% of patients had associated myasthenia, most often presenting with ptosis. Among these, 80% had pure ocular myasthenia. An active form (CAS≥3) was found in 15% of the patients, primarily treated with corticosteroid boluses. Six patients had severe forms with optic neuropathy, requiring medical and surgical management in the majority of cases. Approximately half of the patients underwent surgical management (orbital decompression, strabismus surgery, eyelid surgery), either alone or sequentially. CONCLUSION: TED is a condition predominantly affecting women, typically presenting with upper eyelid retraction and/or exophthalmos. Approximately 5% of patients have associated myasthenia and compressive optic neuropathy. An active/inflammatory form is present in 15% of patients.