The goal of this review is to trace the history of refractive correction, from the earliest optical devices to modern refractive surgical techniques. Following the invention of spectacles in the Middle Ages, the first co...The goal of this review is to trace the history of refractive correction, from the earliest optical devices to modern refractive surgical techniques. Following the invention of spectacles in the Middle Ages, the first corneal procedures, such as Sato's and Fyodorov's keratotomies and Barraquer's keratomileusis, highlighted the limitations of early mechanical approaches. In the 1980s, the advent of the excimer laser revolutionized refractive surgery with the introduction of PRK (photorefractive keratectomy) and subsequently LASIK (Laser-Assisted In Situ Keratomileusis). The development of the femtosecond laser further enhanced precision and safety, while KLEx (keratorefractive lenticule extraction) provided an alternative minimally invasive procedure. In parallel, personalized treatments guided by corneal topography or wavefront analysis have significantly improved visual outcomes. When corneal surgery is not feasible, phakic intraocular lenses or refractive lens exchange offer effective alternatives. Current research is focused on artificial intelligence, new laser platforms, advanced "intelligent" intraocular implants, and ocular bioengineering. The evolution of refractive surgery thus exemplifies continuous progress toward increasingly safe, precise, and patient-tailored techniques.
PURPOSE: To identify systemic, ocular, tomographic, and angiographic predictors of non-response to intravitreal bevacizumab (IVT) injections in patients with diabetic macular edema (DME). METHODS: This was a retrospectiv...PURPOSE: To identify systemic, ocular, tomographic, and angiographic predictors of non-response to intravitreal bevacizumab (IVT) injections in patients with diabetic macular edema (DME). METHODS: This was a retrospective, cross-sectional, analytical study conducted at the Ophthalmology Department of the Internal Security Forces Hospital in La Marsa from January to December 2022. It included 154 patients with DME, divided into responders (54 eyes) and non-responders (100 eyes), all of whom received at least five consecutive IVT injections of bevacizumab. Clinical, laboratory, angiographic, and tomographic parameters were analyzed to assess their impact on treatment response. RESULTS: Among the 154 patients (mean age: 65.3±8.6 years; 63% male), 100 (65%) were classified as non-responders. These patients had a longer duration of diabetes (P=0.012), higher HbA1c levels (9.4 vs. 8.7%, P=0.034), higher body mass index (BMI) (P<0.001), and higher mean arterial pressure (P<0.001) than the responders. OCT revealed significantly greater initial central macular thickness and macular volume (P=0.007; P<0.001), more frequent presence of disorganization of inner retinal layers (DRIL) (P<0.001), and disruption of the IS/OS and ELM lines (P<0.001) in non-responders. Fluorescein angiography showed a higher prevalence of macular ischemia in non-responders (P=0.005). Multivariate analysis identified IS/OS disruption (OR=48.03, P=0.043), increased macular volume (OR=3.77, P=0.006), and macular ischemia (OR=7.15, P=0.006) as independent predictors of non-response. Pseudophakia was independently associated with better response (OR=0.038, P=0.003). CONCLUSION: Non-response to IVT bevacizumab in DME is associated with poor glycemic control, elevated BMI, and several structural (macular volume, DRIL, outer retinal layer disruption) and angiographic biomarkers. Early identification of these predictors may help guide therapeutic decision-making.
PURPOSE: To investigate the effects of refractive amblyopia on neuromotor and cognitive development in children aged 6-11 years. METHODS: Twenty-five children diagnosed with refractive amblyopia at the Ophthalmology Clin...PURPOSE: To investigate the effects of refractive amblyopia on neuromotor and cognitive development in children aged 6-11 years. METHODS: Twenty-five children diagnosed with refractive amblyopia at the Ophthalmology Clinic of Mersin University were retrospectively evaluated. The age distribution was 6 years (n=4), 7 years (n=5), 8 years (n=6), 9 years (n=4), 10 years (n=3) and 11 years (n=3). Spherical equivalent refractive error ranged from -4.00 to +7.50 diopters in the right eye and -1.50 to +7.25 diopters in the left eye. Binocular visual acuity was 1.0 in 23 children, while two children had mildly reduced binocular acuity (0.6 and 0.8). All subjects underwent the Wechsler Intelligence Scale for Children-IV (WISC-IV) test and the Bender-Gestalt Visual Motor Test (BGT) at the time of diagnosis, before initiation of optical treatment. Results were compared with normative values and analyzed according to amblyopia severity. RESULTS: Among the children, 72% had anisometropic, 20% meridional, and 8% isoametropic amblyopia. WISC-IV subtests revealed deficits in verbal comprehension (92%), working memory (48%), and processing speed (48%). The Full-Scale IQ was below normal in 68% of cases. BGT scores were below normal in 96% of children. No significant correlation was found between amblyopia severity and test outcomes (p>0.05). CONCLUSIONS: Refractive amblyopia appears to affect not only visual acuity but also neuromotor and cognitive development. Despite largely preserved binocular visual acuity in most children, subtle neuromotor and cognitive deficits were clearly evident. Early detection and treatment are critical in minimizing developmental disadvantages associated with amblyopia.
INTRODUCTION: Dysfunction of the trabecular meshwork (TM) is implicated in the elevation of intra ocular pressure (IOP) and primary open angle glaucoma (POAG). High-resolution optical coherence tomography (AS-OCT) could...INTRODUCTION: Dysfunction of the trabecular meshwork (TM) is implicated in the elevation of intra ocular pressure (IOP) and primary open angle glaucoma (POAG). High-resolution optical coherence tomography (AS-OCT) could highlight in vivo POAG-related changes of the TM, contributing to better detection and understanding of the disease. METHODS: A prospective, observational, cross-sectional, single center study was conducted. A total of 154 patients (POAG: 81; controls: 73) were included in an open label study. TM length, thickness, area, and reflectivity were compared between POAG eyes and healthy controls using an AS-OCT device (RTVue, Optovue Inc., Fremont, California). Additional analyses were conducted to identify putative correlations between TM changes and the other collected data. Diagnostic performance of the TM imaging by AS-OCT was also studied. RESULTS: TM thickness and TM area were lower in the POAG group than in the healthy group (P<0.001). TM reflectivity was higher in the POAG group (P=0.007). TM length did not statistically differ. A receiver operating characteristic analysis showed an area under the curve of 0.81 [CI95%: 0.74; 0.87] and a maximal Youden index of 0.53 for a TM thickness threshold of 85.13μm (Se: 75%; Sp: 77%). No correlation was found between mean TM thickness and other parameters. CONCLUSION: We observed significant morphological changes in the TM using AS-OCT, which may reflect the TM degeneration in POAG. In addition to the retina/optic nerve analyses, we suggest AS-OCT of the TM could contribute to better screen for and evaluate POAG.
PURPOSE: To evaluate the influence of a relatively low-cost fundoscopy simulator, the Kyoto Kagaku model for direct ophthalmoscopy (DO), on the subjective learning experience and objective knowledge gain of medical stude...PURPOSE: To evaluate the influence of a relatively low-cost fundoscopy simulator, the Kyoto Kagaku model for direct ophthalmoscopy (DO), on the subjective learning experience and objective knowledge gain of medical students at Saarland University Medical Centre, Homburg, Germany. METHODS: Medical students were enrolled in a physical examination course on ophthalmoscopy and ophthalmoscopically visible pathologies. The course consisted of a theoretical part, an introduction to the practical basics of DO using the Kyoto Kagaku fundoscopy simulator, and a mutual examination of real eyes (the classical DO course). They filled out two questionnaires - one on their subjective learning experience immediately after the course and another on objective clinical knowledge in direct ophthalmoscopy (DO), completed before the start of DO training and one week later. RESULTS: The medical students showed a significant gain in knowledge after the course with the Kyoto Kagaku fundoscopy simulator (P<0.001). Specific anatomical structures in the fundus were significantly more often identified during the simulator training compared to the classical DO course (P<0.001). Forty-seven percent of the medical students preferred a simulator-based course only, 23% a classical DO course and 30% a combination of both. CONCLUSION: Simulator-based training is a valuable tool for teaching DO skills to medical students (and aspiring resident physicians). Hands-on courses using the Kyoto Kagaku fundoscopy simulator have been successful in increasing medical students' interest in medical simulation and ophthalmology. This model, known for its relatively low cost, is a good immersive tool for teaching the basics of direct fundoscopic examination and various retinal pathologies.
PURPOSE: To compare refractive outcomes following bilateral implantation of three distinct extended depth-of-focus (EDOF) intraocular lens (IOL) technologies. METHOD: Three EDOF IOL technologies implanted in eligible pat...PURPOSE: To compare refractive outcomes following bilateral implantation of three distinct extended depth-of-focus (EDOF) intraocular lens (IOL) technologies. METHOD: Three EDOF IOL technologies implanted in eligible patients were assessed: non-diffractive (NDEDOF) Vivity®, bifocal refractive (REDOF) LENTIS® Comfort, diffractive (DEDOF) AT LARA®. A monofocal IOL (Clareon® Aspheric) was used as a comparator. Corrected and uncorrected distance, intermediate (IVA) and near (NVA) visual acuities were assessed at 1 and 3months. The occurrence of photic phenomena (PP) and spectacle independence were assessed at 1 and 3months using a modified McAlinden questionnaire. RESULTS: Ninety-two patients were analyzed. Binocular corrected distance visual acuity of 10/10 was achieved in 100% of patients in the monofocal, REDOF, and NDEDOF groups, and in 95% of the DEDOF group (P=0.98). Uncorrected intermediate and near visual acuities were better with EDOF IOLs compared to monofocal IOLs, with mean values of -0.1 and -0.2 logMAR, respectively. Photic phenomena were absent or mild (score<4/27) in 75% (NDEDOF), 78% (REDOF), 66% (DEDOF), and 91% (monofocal) of patients. The mean PP score was highest with the DEDOF lens (3.5/27, P<0.05). Spectacle independence was greater in the EDOF groups, with a mean score of 3-4/15 (high independence), compared to>7/15 in the monofocal group. CONCLUSION: Regardless of optical design, the EDOF IOLs provided better intermediate and near vision and greater spectacle independence compared to the monofocal IOL. Photic phenomena were generally mild, although more frequent with the diffractive design.
PURPOSE: To evaluate structural and vascular changes in the retina in adult attention deficit hyperactivity disorder (ADHD) compared to healthy controls. METHODS: Using optical coherence tomography angiography (OCT-A), m...PURPOSE: To evaluate structural and vascular changes in the retina in adult attention deficit hyperactivity disorder (ADHD) compared to healthy controls. METHODS: Using optical coherence tomography angiography (OCT-A), measurements were obtained from the foveal, parafoveal, and perifoveal regions. Parameters measured included superficial capillary plexus density (SCPD), deep capillary plexus density (DCPD), full-thickness retinal thickness, ganglion cell complex (GCC) thickness, and foveal avascular zone (FAZ) area. These metrics were compared between individuals with ADHD and healthy controls. Additionally, subgroup analysis was conducted to compare newly diagnosed patients and established medication users within the ADHD group. RESULTS: A total of 39 eyes of 39 ADHD patients and 49 eyes of 49 healthy subjects were included. DCPD values were significantly reduced in all parafoveal quadrants (temporal P=0.001, superior P<0.001, nasal P=0.021, inferior P=0.005) and all perifoveal quadrants (temporal P=0.006, superior P<0.001, nasal P<0.001, inferior P=0.017) in the ADHD group. Receiver operating characteristic (ROC) analysis showed that the perifoveal DCPD over the 6×6mm area had a sensitivity of 74.4% and specificity of 63.3% for distinguishing ADHD from healthy individuals (P<0.001; AUC=0.717). Parafoveal DCPD showed 61.5% sensitivity and 71.4% specificity (P=0.001; AUC=0.704), while perifoveal DCPD yielded 69.2% sensitivity and 67.3% specificity (P<0.001; AUC=0.717). Foveal SCPD (P=0.026) and DCPD (P=0.024) were significantly lower in established medication users compared to newly diagnosed patients. ROC analysis revealed 87.5% specificity for superficial and deep foveal CPD in distinguishing between newly diagnosed patients and established medication users (P=0.026; AUC=0.714 and P=0.050; AUC=0.689). CONCLUSIONS: Deep capillary plexus density was significantly reduced in adult ADHD patients relative to healthy controls. Moreover, medication use for ADHD treatment was associated with further reduction in foveal SCPD and DCPD. These findings suggest that OCT-A derived vascular density metrics may serve as potential biomarkers for diagnosis, monitoring of treatment response, and disease follow-up in patients with ADHD.
PURPOSE: To determine the effect of trabecular meshwork (TM) peeling on gonioscopy-assisted transluminal trabeculotomy (GATT) surgical outcomes in patients with open-angle glaucoma. METHODS: In this retrospective cross-s...PURPOSE: To determine the effect of trabecular meshwork (TM) peeling on gonioscopy-assisted transluminal trabeculotomy (GATT) surgical outcomes in patients with open-angle glaucoma. METHODS: In this retrospective cross-sectional study, patients who underwent GATT surgery with 5/0 prolene for moderate-to-advanced glaucoma were included. In group 1, the TM was only torn using a prolene suture, and in group 2, the TM was peeled after tearing. A decrease in intraocular pressure (IOP) below 18mmHg after surgery without the need for glaucoma medications or a 30% decrease in IOP from preoperative values were accepted as complete success. Achieving the same outcome with a maximum of two topical medications was defined as a qualified success. The requirement for additional surgery was defined as a failure. Patient demographics, pre- and postoperative IOP, number of glaucoma medications, complete and qualified surgical success, mean retinal nerve fiber layer thickness, and surgical complications were evaluated. RESULTS: Each group contained twenty eyes. Complete trabeculotomy (360°) was performed in 60% of group 1 and 80% of group 2 patients; partial trabeculotomy (200°-270°) was performed in 40% of group 1 and 20% of group 2 patients. Both groups had similar mean IOP levels and number of medications (P>0.05). Surgical success rates were similar between patient groups (P>0.05). Hyphema, which resolved spontaneously, occurred in 75% of group 1 and 70% of group 2. CONCLUSION: In conclusion, adding TM peeling to GATT surgery did not improve early postoperative outcomes. Longitudinal investigations with a larger patient group are needed.
INTRODUCTION: To describe cases of intraocular inflammation (IOI) observed after intravitreal injections (IVI) of second-generation anti-VEGF agents in a university hospital over 12months in 2024. MATERIALS AND METHODS:...INTRODUCTION: To describe cases of intraocular inflammation (IOI) observed after intravitreal injections (IVI) of second-generation anti-VEGF agents in a university hospital over 12months in 2024. MATERIALS AND METHODS: This was a case series observed in a retina referral center over a 12-month period. Visual acuity at baseline and at the time of the IOI episode, clinical presentation, time until symptom onset, intraocular pressure, and clinical course were analyzed. The number of injections received, treatment-naïve versus switch status, and therapeutic management were also recorded. RESULTS: Among 23 eyes of 19 patients, IOI occurred on average 17days after injection, following a mean of 4.4 injections. The implicated drug was faricimab in 19 eyes and brolucizumab in 4 eyes. The clinical presentation consisted of acute anterior uveitis with keratic precipitates. Ocular hypertension was more frequent with faricimab-associated IOI (52%). Vitritis was associated in 12 cases, and one case of occlusive vasculitis was observed. Mean best-corrected visual acuity was 64.2 ETDRS letters at baseline, 47.7 letters during the IOI episode, and 63.8 letters after resolution. Four atypical presentations were described. DISCUSSION: IOI following intravitreal injections represents a safety signal, particularly since the introduction of next-generation anti-VEGF agents. Due to the tertiary-referral nature of our center, we cannot determine the prevalence of IOI in this study. Nevertheless, it was estimated at 3.9% of patients in another cohort of our department. Its occurrence may limit the use of these drugs, necessitating close monitoring and enhanced patient counseling regarding warning symptoms. CONCLUSION: Next-generation anti-VEGF agents carry a non-negligible risk of IOI, most often of moderate severity and with good outcomes after topical corticosteroids. Symptoms suggestive of IOI, as well as confirmed IOI, should contraindicate further injections with the same molecule. No current consensus exists to guide the choice of an alternative anti-VEGF agent after IOI, aside from the clear contraindication for brolucizumab.
PURPOSE: To report an extremely rare case of retinitis pigmentosa (RP) associated with astrocytic hamartoma (AH) of the optic nerve head (ONH) in one eye and optic disc drusen (ODD) in the fellow eye, assessed with compr...PURPOSE: To report an extremely rare case of retinitis pigmentosa (RP) associated with astrocytic hamartoma (AH) of the optic nerve head (ONH) in one eye and optic disc drusen (ODD) in the fellow eye, assessed with comprehensive multimodal imaging. METHODS: Observational case report and review of the literature. The patient was assessed with comprehensive multimodal imaging, including fundus autofluorescence, optical coherence tomography (OCT), OCT-Angiography, fluorescein angiography, ocular ultrasound, electroretinogram, visual evoked potentials, and brain magnetic resonance imaging. RESULTS: A 14-year-old girl presented with progressive visual decline in the right eye (RE). She had been suffering from night blindness and difficulty adapting to darkness since childhood. Visual acuity was 2/10 in the RE and 8/10 in the left eye (LE). Fundus examination revealed characteristic signs of RP in both eyes. Moreover, we noted the presence of a semi-translucent creamy-white lesion with a raspberry appearance centered on the optic disc of the RE, most probably related to an AH of the ONH. In the LE, the optic disc showed blurred margins with multiple calcified nodular lesions consistent with ODD. Fundus autofluorescence and OCT highlighted distinct morphological features of AH and ODD. Systemic assessment ruled out an association with any phacomatosis. The patient was regularly monitored with multimodal imaging, given the potential risk of growth and complications associated with AH and ODD. A two-year follow-up revealed a slight increase in AH size in the RE, and an increase in ODD number in the LE. CONCLUSION: This is the first reported case of AH and ODD occurring together in RP. A comprehensive multimodal imaging evaluation is necessary to identify and distinguish these two lesions and can be of great help in diagnosis.