To evaluate the anatomical, functional, and aesthetic outcomes of phenylephrine-guided bilateral Müller muscle-conjunctival resection (MMCR) using a standardized resection algorithm designed to optimize eyelid symmetry by preoperatively accounting for Hering's phenomenon in patients with mild-to-moderate ptosis METHODS: This retrospective clinical study included patients with good levator function and a positive phenylephrine test who underwent simultaneous bilateral MMCR planned according to a phenylephrine-based resection algorithm. The protocol aimed to simulate postoperative eyelid position and unmask contralateral ptosis related to Hering's law, thereby enabling individualized bilateral surgical planning in a single session. Preoperative and postoperative best-corrected visual acuity (BCVA), margin reflex distance1 (MRD-1) and upper eyelid symmetry were evaluated at postoperative months 1 and 3 RESULTS: A total of 118 eyes from 59 patients (31 females, 28 males) were included. The mean preoperative MRD-1 was 1.24 ± 0.95 mm in the right eye and 1.32 ± 0.84 mm in the left eye. At postoperative month 3, the mean MRD-1 increased to 2.68 ± 0.91 and 2.61 ± 0.78, respectively. Comparison of preoperative and postoperative MRD-1 values demonstrated demonstrated a statistically significant improvement in both eyes at months 1 and 3 (p < 0.001 for each eye). Postoperative MRD-1 outcomes were not significantly different when stratified by the magnitude of the preoperative phenylephrine response (p = 0.32 for right eye, p = 0.06 for left eye). Excellent eyelid symmetry was achieved in 44 patients (74.6%), satisfactory symmetry in 12 (20.3%), and poor symmetry in 3 patients (5.0%). Revision surgery was required in 5 patients (8.4%) during follow-up CONCLUSION: Phenylephrine-guided bilateral MMCR using a standardized resection algorithm is a safe, effective, and highly predictable surgical approach for achieving optimal eyelid symmetry in patients with mild-to-moderate ptosis. Preoperative simulation of postoperative eyelid position by accounting for Hering's phenomenon allows accurate bilateral surgical planning in a single session and may reduce the need for secondary procedures, making this technique a strong first-line alternative to more invasive ptosis repair methods.
Frontalis sling surgery (FSS) is the standard treatment for congenital blepharoptosis with poor levator function; however, long-term failure and material-related complications are common, particularly with silicone slings. Evidence regarding optimal revision strategies after failed silicone FSS remains limited. This study evaluated the anatomical outcomes, ocular surface safety, and patient satisfaction following maximal levator resection surgery (MLRS) performed after silicone frontalis sling removal. This retrospective study included 20 eyes of 17 patients who underwent MLRS following silicone frontalis sling removal between 2019 and 2023. Preoperative and postoperative assessments included best-corrected visual acuity, margin reflex distance-1 (MRD-1), levator function, lagophthalmos, corneal fluorescein staining, punctate epithelial keratopathy, and patient satisfaction. Postoperative evaluations were performed at 1 week, 1 month, 3 months, and 6 months. Statistical analyses were conducted using paired and repeated-measures tests, with a significance level set at p < 0.05. The mean age at the time of MLRS was 11.05 ± 5.94 years, and the mean preoperative levator function was 4.85 ± 2.49 mm. Revision surgery was indicated for undercorrection in 18 eyes (90%) and conjunctival complications in 2 eyes (10%). Mean MRD-1 increased significantly from 0.25 ± 0.85 mm preoperatively to 2.55 ± 0.60 mm at 6 months postoperatively (p < 0.001), with stable values across follow-up visits. Lagophthalmos increased slightly postoperatively but did not differ significantly from preoperative measurements (p > 0.05). Mild corneal surface changes were observed in the early postoperative period and were successfully managed with medical treatment. Additional revision surgery was required in 2 eyes (10%). Most patients and their parents reported high satisfaction, with dissatisfaction primarily related to insufficient postoperative eyelid elevation. MLRS following silicone frontalis sling removal is associated with significant and stable improvement in eyelid position, with acceptable ocular surface safety and high patient satisfaction in selected patients across a range of levator function values. However, given the retrospective design, small sample size, and lack of a comparative control group, these findings should be interpreted with caution. MLRS may be considered as a potential revision option rather than a definitive or superior approach.
The objectives are to compare axial length (AL) measurements obtained using swept-source optical biometers and contact A-scan ultrasonography (USG) in eyes with mature cataract, and to evaluate inter-device agreement and acquisition success rates. This retrospective cross-sectional study included eyes with clinically defined mature cataract. AL measurements were obtained using two swept-source optical devices (Tomey - OA and Heidelberg Anterion) and contact A-scan USG (Tomey UD-800), all performed on the same day by a single examiner. Inter-device comparisons, Bland-Altman agreement analyses, and intraclass correlation coefficients (ICC) were calculated. Optical measurement failure rates were recorded. AL measurements were successfully obtained with both optical biometers in 50 eyes. AL values showed strong agreement between the Tomey - OA OA-2000 and Anterion, with no significant inter-device difference. In contrast, contact A-scan USG yielded significantly shorter AL measurements compared with both optical devices (mean difference approximately 0.26-0.30 mm). Optical biometry failed to obtain AL measurements in approximately one-third of eyes with mature cataract. Inter-method reliability for AL was high (ICC >0.90). Swept-source optical biometers provide consistent and interchangeable AL measurements in eyes with mature cataract when measurements are obtainable. However, optical acquisition failure remains common in advanced cataracts, highlighting the continued clinical relevance of A-scan USG. The systematic tendency of contact ultrasound to produce shorter AL measurements should be considered during intraocular lens power calculation.
To examine the impact of peripapillary atrophy (PPA) on retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GCL-IPL), and Bruch's membrane opening-minimum rim width (BMO-MRW) in non-glaucomatous myopic eyes. Patients with myopic refractive errors greater than -4.00 dioptres and with normal intraocular pressure (10-21 mmHg) were included in the study. Eyes without PPA were included in group 1, and those with PPA in group 2. RNFL (3.5, 4.1, 4.7 mm) and BMO-MRW were measured with Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany); GCL-IPL with Cirrus HD-OCT 5000 (Carl Zeiss Meditec, Dublin, CA, USA). There were 50 eyes in group 1 and 77 eyes in group 2. Mean age, refractive error, axial length, disc area, rim area, cup-to-disc ratio, mean RNFL and GCL-IPL (mean and minimum) were similar in both groups (p > 0.05 for all). Mean nasal RNFL thickness measured with Cirrus HD-OCT and mean nasal RNFL thicknesses at 3.5 mm and 4.1 mm measured with Spectralis OCT were significantly lower in group 2 (p < 0.05 for all). Nasal RNFL thickness at 4.7 mm and RNFL thicknesses in the other regions at different diameters (3.5 mm, 4.1 mm and 4.7 mm) and BMO-MRW in all regions were similar in both groups (p > 0.05 for all). RNFL thickness at 4.7 mm, BMO-MRW, and GCL-IPL did not significantly differ with PPA. These stable measurements may assist in diagnosing and monitoring glaucoma in myopic eyes with PPA.
This study compares the long-term outcomes and success rates of trabeculectomy and Ahmed glaucoma valve (AGV) implantation in vitrectomized eyes. This study included 58 eyes of 58 patients who had undergone pars plana vitrectomy and subsequently received either trabeculectomy (25 eyes) or AGV implantation (33 eyes) at our hospital between March 01, 2017 and April 01, 2023 and had at least 1-year follow-up. Complete success was defined as maintaining an intraocular pressure (IOP) between 5 and 21 mmHg without medication, whereas overall success was defined as achieving the same IOP range with or without medication. Failure was defined as an IOP exceeding 21 mmHg or falling below 5 mmHg, visual deterioration to light perception due to glaucoma progression or complications from glaucoma surgery, or the need for further glaucoma surgery. The complete success was higher in the trabeculectomy group. Whereas both groups' overall success rates were similar at the last follow-up (p=0.04). Both groups demonstrated a comparable failure rate (p=0.44). The probability of success in the trabeculectomy group was 92.0% at 12 months, 88.0% at 24 months, and 84.0% at 36 months, whereas in the AGV group, it was 87.8% at 12 months, 81.8% at 24 months, and 75.7% at 36 months. There was no difference in terms of post-operative complication rate in both groups. (p=0.36). Both AGV implantation and trabeculectomy yield comparable outcomes in vitrectomized eyes. However, trabeculectomy reduced the requirement for antiglaucoma medications postoperatively. Consequently, trabeculectomy may be a viable option in carefully selected vitrectomized eyes.
To report a genetically confirmed case of autosomal recessive bestrophinopathy (ARB) associated with angle-closure glaucoma (ACG) and complicated by central retinal vein occlusion (CRVO). A 28-year-old man with a history of glaucoma and irregular follow-up presented with decreased vision and underwent comprehensive ophthalmic examination, multimodal imaging, and genetic testing. Best-corrected visual acuity was 0.1 in the right eye and counting fingers at 1 meter in the left eye. Both eyes demonstrated shallow anterior chambers, closed angles on gonioscopy, and short axial lengths. Fundus examination disclosed multifocal yellowish subretinal deposits in the right eye and dilated tortuous veins, extensive intraretinal hemorrhages, and macular edema in the left eye, consistent with CRVO. Optical coherence tomography showed mild cystoid change in the right eye and marked cystoid macular edema with subretinal fluid in the left eye. Fluorescein angiography revealed peripheral retinal ischemia. The left eye was treated with intravitreal anti-VEGF therapy, panretinal photocoagulation, and subsequently trabeculectomy for uncontrolled intraocular pressure; the right eye later underwent trabeculectomy. Genetic testing identified a homozygous likely pathogenic variant in BEST1. At 1-year follow-up, intraocular pressure was ≤12 mmHg in both eyes without medication. This case highlights a rare coexistence of genetically confirmed ARB, ACG, and CRVO and underscores the importance of careful anterior and posterior segment evaluation in BEST1-related disease.
To investigate the signs and symptoms of dry eye disease (DED) in patients with hemifacial spasm (HFS) through the evaluation of ocular surface measurements and meibomian gland function, and to assess the effects of botulinum toxin type A (BTX-A) injection on ocular surface health. This prospective study included patients with unilateral HFS who underwent BTX-A injection as treatment. Eyes on the same side as the spasm were defined as the HFS group, whereas the contralateral, unaffected eyes were used as controls. Ocular surface assessments included the ocular surface disease ındex (OSDI) score, Schirmer's I test, tear break-up time (TBUT), corneal surface staining, eyelid margin abnormalities, and meibomian gland function. All evaluations were repeated at 1, 3, and 6 months following BTX-A injection. Compared to the control group, the HFS group demonstrated significantly higher OSDI scores, corneal surface staining, eyelid margin abnormalities, meibomian gland expression scores, meibography scores, and meibomian gland loss, whereas TBUT and Schirmer's I test values were significantly lower (p<0.05). A significant correlation was observed between the severity of HFS and ocular surface dysfunction, including meibomian gland dysfunction (MGD) (p<0.05). Following BTX-A injection, ocular surface parameters showed significant improvement at 1 month (p<0.05) and 3 months (p<0.05) compared to pre-injection values. We found an association between HFS and DED, which was correlated with the severity of HFS. In addition, BTX-A injection led to a temporary improvement in dry eye signs and symptoms, including MGD.
To evaluate the clinical efficacy of probing with or without bicanalicular intubation (BCI) for congenital nasolacrimal duct obstruction (CNLDO) in children at least 3 years of age and to identify factors influencing surgical success. The medical records of children treated between 2014 and 2024 at Health Sciences University Beyoğlu Eye Training and Research Hospital were reviewed retrospectively. All patients underwent probing with or without bicanalicular silicone intubation (BCI) using the square knot technique. Surgical success was defined as resolution of symptoms and a normal fluorescein dye disappearance test. A total of 95 children (116 eyes) were included. Mean patient age was 4.57 ± 1.98 years (range, 3-14). Mean follow-up was 15.5 ± 15.4 months. BCI was performed initially in 102 eyes. Mean tube retention was 66.8 ± 43.0 days. Overall success was 87%, increasing to 95% after reprobing and BCI in failed cases. Age, sex, obstruction type, canalicular stenosis, Rosenmüller's valve hypertrophy, and inferior turbinate infracture were not significantly associated with success (P > 0.05). Tube retention for 45-90 days was significantly associated with higher success compared with retention <45 days (P = 0.013; OR = 12.75; 95% CI, 1.72-94.48). In our study cohort of children undergoing surgery for CNLDO at 3 years of age and older, probing and BCI achieved high success, especially if the tube was successfully retained for at least 45 days. Reintubation in failed cases can improve outcomes.
To evaluate retinal nerve fiber layer (RNFL) thickness and visual field (VF) defects in patients with pituitary macroadenomas to assess the utility of these parameters in monitoring visual pathway involvement. A retrospective study was conducted on patients diagnosed with PMA at Beyoglu Eye Hospital between September 2023 and July 2024. Comprehensive ophthalmological examinations were performed, including VF testing and RNFL thickness measurement via optical coherence tomography (OCT), and compared with healthy controls. The study included 62 eyes from 31 PMA patients (19 males, 12 females; mean age 53.50 ± 18.84 years) and 62 eyes from 31 healthy individuals. Among patients, 25 had prior surgery, 4 underwent gamma knife treatment, 2 had scheduled surgery, and 2 were under observation. Visual acuity (VA) in PMA patients was no light perception in 6 eyes, counting fingers at 10 cm in 1 eye, 50 cm in 1 eye, and a mean VA of 0.12 logMAR in 54 eyes. Optic disc exams revealed normal appearance in 33 eyes, temporal pallor in 13, and diffuse pallor in 16. The mean Visual Field Index was 77.34%, and mean deviation was - 7.43 dB (p < 0.05). Mean RNFL thickness was significantly lower in PMA patients, especially in nasal (49.80 ± 22.1 µm) and temporal (54.93 ± 19.4 µm) quadrants compared to superior (78.85 ± 38.58 µm) and inferior (118.08 ± 31 µm) quadrants (p < 0.05). Nasal fibers showed the most pronounced thinning, followed by superior, temporal, and inferior fibers. Visual field testing is the primary method for assessing chiasmal involvement in pituitary macroadenoma. RNFL analysis offers complementary structural information on axonal damage, and evaluating both together improves the clinical assessment and follow-up of visual pathway involvement.
This research investigated the risk factors and multimodal imaging characteristics associated with the onset of central serous chorioretinopathy (CSCR) in the contralateral eye during follow-up of patients initially presenting with unilateral complex CSCR. In this retrospective cohort, patients observed between 2015 and 2023 were classified into two groups: those progressing from unilateral to bilateral CSCR formed the study group, whereas patients who did not develop contralateral disease during follow-up comprised the control group. Demographic characteristics and smoking status were recorded. Multimodal imaging was documented. A total of 126 eyes from 63 patients were evaluated, including 31 with bilateral disease (Group 1) and 32 with unilateral CSCR (Group 2). In Group 1, the mean interval between involvement of the first and second eye was 21.29 ± 18.46 months. At baseline, the mean subfoveal choroidal thickness in affected eyes was 293 ± 67 µm in the study group, significantly lower than the 356 ± 64 µm observed in controls (P < 0.001). Multivariate regression analysis demonstrated that smoking, the presence of CSCR-related changes in the fellow eye on initial fundus fluorescein angiography (FFA), and reduced choroidal thickness in the first affected eye were independent predictors of bilateral disease progression. The findings indicate that smoking, early CSCR-related changes in the contralateral eye on baseline FFA, and reduced choroidal thickness in the initially affected eye represent significant risk factors for bilateral CSCR development.
In this study, a new technique that does not cause lower eyelid retraction in patients with excessive limitation of movement and vertical strabismus due to inferior rectus (IR) fibrosis in thyroid eye disease was introduced. There were six patients with their six eyes with their mid-term results. According to the deviation amount, a 7-14 mm length bovine pericardium (Tutopatch®) was inserted between the distal end of the tendon and the beginning of the muscle fibers, which are located between the tendon's distal end and the tendon muscle junction to the IR with 6/0 non-absorbable suture. There were six cases with a mean 19.5±5.2 PD (PD: prism diopters) (14-26 PD) vertical deviation and severe up-gaze limitations with a mean -4.1±0.75. The post-operative vertical deviation was a mean of 3.5±1.22 PD, and the limitation of upgaze was a mean of -1.3±0.4. This procedure provides effective results in reducing gaze limitation and vertical deviation in thyroid patients without causing any problems in the eyelids.
To evaluate the indications, patterns of use, complications, and reasons for discontinuation of contact lenses in pediatric patients over a 10-year period in a tertiary eye care center. This retrospective, observational study included patients who use contact lenses before age of 18 years and followed more than 12 months, between 2014 and 2024. Demographic data, lens type, indication, technical parameters, complications, discontinuation reasons, and follow-up duration were recorded. Descriptive statistics were calculated. A total of 923 patients (63.7% female, 36.3% male) with a mean age of 14.6 ± 3.5 years and mean follow-up of 38.1 ± 26.6 months were included. The leading indications were ametropia (65.7%), anisometropia (14.1%), and keratoconus (13.2%). Most patients (94.1%) used soft contact lenses; 3.6% used rigid corneal lenses and 2.3% used silicone elastomer lenses. Contact lens-related complications occurred in 35.0% of soft lens users and 51.5% of rigid corneal lens users. Punctate epithelial keratitis (41.5%) and allergic conjunctivitis (26.9%) were the most common events. Ninety-six patients (10.4%) discontinued lens use, mainly due to poor adherence (53.1%) or discomfort (25.0%). Contact lenses are effective options for visual correction in children and adolescents. However, contact lens use in pediatric patients may be associated with complications and discontinuation. Appropriate follow-up and patient education remain important components of pediatric contact lens care.
To evaluate the surgical outcomes of blepharoptosis in patients with no light perception (NLP) who used prostheses and to assess eyelid symmetry and functional improvement following appropriate surgical management. This retrospective study included 15 patients with prosthesis-related ptosis treated between 2020 and 2024. Demographic characteristics, prosthesis type and duration of use, type of ptosis, preoperative levator function, and surgical technique were recorded. Margin reflex distance 1 (MRD-1) was measured preoperatively and at postoperative 1 week, 1 month, 3 months and 6 months, using standardized digital photographs. Eyelid symmetry, complications, and need for revision surgery were evaluated. Repeated measurements were analyzed using the Friedman test with Wilcoxon signed-rank post hoc comparisons. The mean age was 40.13±17.41 years (range 15-70 years); 10 patients were female and 5 were male. The mean preoperative levator function was 11.80±3.52. Regarding the underlying causes of eye loss/prosthesis use, 9 (60.0%) were due to trauma, 1 (6.7%) was due to infection, 2 (13.3%) were due to glaucoma, and 3 (20.0%) were due to other causes. 12 patients had evisceration, and 3 patients used a prosthesis over a phthisis bulbi eye. 13 patients underwent Müller Muscle-Conjunctival Resection (MMCR) and 2 patients underwent levator surgery. MRD-1 increased significantly from 1.20±0.94 mm preoperatively to 3.27±0.70 mm at 6 months. Further analysis to determine the source of the difference revealed statistically significant differences between preoperative MRD-1 and postoperative MRD1 at 1 week, 1 month, 3 months, and 6 months. The Friedman test showed a significant improvement over time (p<0.001). Technique comparisons were exploratory due to the small levator subgroup. No significant difference was found between the duration of eye prosthesis use and preoperative MRD-1 (p=0.761). MRD-1 improved from 1.20±0.94 mm preoperatively to 3.27±0.70 mm at 6 months, and eyelid symmetry (≤1 mm) was achieved in 86.6% of patients, demonstrating that ptosis of the upper eyelid in ocular prosthesis patients can be effectively corrected with appropriately selected surgical techniques based on levator function.
To evaluate the functional and anatomical outcomes of intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy in treatment-naïve diabetic macular edema (DME) eyes exhibiting disorganization of the retinal inner layers (DRIL) at baseline, and to examine associations between DRIL and systemic or imaging biomarkers in a large multicenter real-world cohort. This multicenter retrospective cohort study included 221 eyes with baseline DRIL among 1321 treatment-naïve DME eyes followed at eight tertiary centers in Türkiye. All eyes initially received a bevacizumab loading dose, followed by a pro re nata (PRN) regimen with bevacizumab, aflibercept, or ranibizumab according to clinical response. Best-corrected visual acuity (BCVA), central macular thickness (CMT), and DRIL status were assessed using spectral-domain OCT at baseline and at months 3, 6, and 12. Mean BCVA and CMT improved significantly at 12 months across all treatment groups (p < 0.001). In univariate analyses, eyes switched to aflibercept showed superior functional (0.58 logMAR) and anatomical (370.7 μm) outcomes compared with bevacizumab and ranibizumab (p = 0.039 and p = 0.001, respectively). However, in multivariable regression analyses adjusting for baseline characteristics and treatment intensity, anti-VEGF agent type was not independently associated with outcomes. Baseline DRIL was negatively correlated with BCVA and CMT improvement and positively correlated with systemic lipid parameters (p < 0.01). In this large real-world multicenter study, anti-VEGF therapy provided meaningful anatomical and functional improvements in DRIL-positive DME eyes. Although aflibercept appeared superior in univariate analyses, this difference was not sustained after adjustment, indicating that baseline characteristics rather than treatment selection may be the primary determinants of outcome. Unlike prior studies that focused primarily on corticosteroids, this study provides one of the largest datasets evaluating anti-VEGF efficacy in DRIL-positive eyes. Findings underscore DRIL as a strong prognostic OCT biomarker with potential to guide individualized treatment planning and optimize therapeutic outcomes in DME.
Background/Objectives: To evaluate margin reflex distance-1 (MRD-1), inter-eyelid symmetry, functional visual parameters, and cosmetic outcomes following Müller Muscle-Conjunctival Resection (MMCR) in selected pediatric patients with mild-to-moderate blepharoptosis, good levator function, and a positive 2.5% phenylephrine test. Methods: This retrospective observational study included pediatric patients (<18 years) who underwent MMCR between 2018 and 2023. Surgical indications were based on functional or developmental criteria, including visual axis obstruction, abnormal head posture, significant eyelid asymmetry, or psychosocial concerns, rather than eyelid height alone. Preoperative and postoperative examinations at 1 week, and at 1, 3, and 6 months, included best-corrected visual acuity (BCVA), MRD-1, eyelid symmetry, levator function, lagophthalmos, and ocular surface findings. Outcomes were analyzed separately for unilateral and bilateral cases. Statistical analyses were performed using non parametric tests, with p < 0.05 considered statistically significant. Results: Fifty patients (55 eyes; mean age 13.16 ± 4.04 years) were included. Mean preoperative MRD-1 increased significantly from 1.83 ± 0.89 mm to 2.97 ± 0.83 mm at 6 months (p < 0.001). Postoperative MRD-1 at 6 months showed a significant correlation with the phenylephrine response. In unilateral cases, excellent or satisfactory postoperative symmetry was achieved in 83.6% of eyes. Bilateral cases demonstrated comparable MRD-1 elevation with satisfactory contour and high patient/parent satisfaction. Transient lagophthalmos improved over time. No overcorrection, exposure keratopathy, or significant ocular surface complications were observed. Revision surgery was required in 8.9% of unilateral cases. Conclusions: MMCR is a safe and effective option for appropriately selected pediatric patients, providing predictable eyelid elevation, good symmetry, and low complication rates when functional indications are present.
PurposeTo investigate the efficacy of lensectomy (LE) and the role of additional goniosynechialysis (LE-GSL) in eyes with medically uncontrolled synechial angle-closure glaucoma (ACG).MethodsThe records of patients who underwent LE or LE-GSL for >180° synechial ACG were reviewed retrospectively. Three groups were formed based on intraoperative gonioscopy (IOG) findings following lensectomy and intraocular lens implantation: Group 1 (n = 39), eyes with total peripheral anterior synechiae (PAS) in which GSL was performed; Group 2 (n = 37), eyes with PAS ≥ 180° and <360° in which GSL was performed; and Group 3 (n = 35), eyes with PAS < 180° in which no GSL was performed.ResultsA total of 111 eyes of 98 patients (M/F: 46/52; mean age: 60.1 ± 11.01 years) were included in the study. Median postoperative follow-up time was 12.0 months. Median PAS extents in the three groups were 12, 6, and 0 clock hours (CH) on IOG, compared to 12, 10, and 7 CH before surgery. GSL was performed in Groups 1 and 2, with a median of 11 and 4 CH. Median IOP at the final visit was 14 mmHg in all three groups. Total success rates were 87%, 81%, and 97% in Groups 1, 2, and 3, respectively (p = 0.102).ConclusionThe present study identified discrete groups of patients who would benefit from LE alone versus needing further GSL in synechial ACG. When PAS was <180° on IOG, LE alone effectively reduced IOP; in eyes with extensive PAS, performing additional GSL yielded successful results, comparable to eyes undergoing LE alone.
This study aimed to evaluate the surgical outcomes and prognosis of patients who underwent Descemet membrane endothelial keratoplasty (DMEK) or penetrating keratoplasty (PK) following Ahmed glaucoma valve (AGV) implantation. Patients who underwent keratoplasty at the cornea department of our hospital between April 2016 and April 2024 were retrospectively reviewed. Patients with a history of prior AGV implantation were included. Surgical success was defined as maintaining graft clarity for a minimum of 6 months post-keratoplasty. A total of 13 eyes of 13 patients (four women, nine men) with a mean age of 62.0±16.0 years were included. Five patients had a history of multiple glaucoma surgeries prior to AGV implantation. Among the included patients, six had no history of corneal transplantation before AGV implantation, whereas four had previously undergone PK, and two had undergone DMEK. One patient had received two DMEK procedures followed by PK. No tube-related complications, including endothelial touch, were observed. Corneal decompensation developed at a mean of 12.7±10.5 months after AGV implantation, prompting PK in four patients, repeat PK in five patients, and DMEK in four patients. The mean follow-up period after keratoplasty was 21.3±17.3 months. Although the best-corrected visual acuity (BCVA) achieved postoperatively was 1.5 (0.4-2.3) LogMAR at a mean of 13.9±12.3 months, there was no statistically significant difference between pre-operative BCVA (2.3 [1.0-2.3] LogMAR) and final post-operative BCVA (2.3 [0.4-2.7] LogMAR) (p=0.735). Similarly, no significant change was observed in intraocular pressure before and after keratoplasty (p=0.283). A second keratoplasty was recommended in five cases after the initial keratoplasty. At the final follow-up, graft rejection was observed in eight patients, two of whom developed keratitis. The overall surgical success rate was calculated as 23.1%. In patients undergoing keratoplasty for corneal decompensation following AGV implantation, both graft survival and overall surgical outcomes were found to be unfavorable.
To assess the rate of retinal thinning as a biomarker for incident late-stage age-related macular degeneration (AMD). This retrospective cohort study included patients (aged ≥50 years) with ≥3 optical coherence tomography (OCT) macular scans ≥6 months apart. Eyes that developed ≥250 μm of complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) with associated hypertransmission through Bruch's membrane on OCT were considered to have developed geographic atrophy (GA). The spatial pattern of macular thinning was assessed using the ETDRS rings centered on the foveola, calculated as a percentage change relative to its baseline value by eye. A total of 201 eyes met inclusion criteria. At last follow-up, 17 eyes developed GA (8.5%) at a median observation of 5.2 (2.4) years. The central subfield (1-mm) and inner ring (3-mm ETDRS subfield) thinned faster in eyes that developed incipient GA (central subfield thickness [CST]: -1.59% vs. -0.47% per year, p=0.007; inner ring: -1.48% vs. -0.65% per year, p<0.001), while the outer ring (6-mm ETDRS subfield) thinned less rapidly (-0.75% vs. -0.30% per year, p=0.003). Linear regression identified the rate of inner ring thinning as the most significant predictor of GA, with a receiver operating characteristic curve demonstrating a high predictive accuracy (area under the curve [AUC], 0.821; 95% CI, 0.746-0.896; p<0.001). Rapid thinning of the inner ETDRS ring is associated with incipient GA. Identifying eyes at risk of late AMD using serial OCT scans would permit personalized monitoring and treatment strategies critical for safeguarding vision.
To evaluate the clinical characteristics, microbiological profiles, and visual and anatomical outcomes of delayed-onset endophthalmitis following trabeculectomy or glaucoma drainage device (GDD) implantation managed with early pars plana vitrectomy (PPV). This retrospective case series included patients diagnosed with delayed-onset endophthalmitis (≥6 weeks after glaucoma surgery) at a tertiary referral center between 2013 and 2023. Demographics, clinical presentation, microbiological findings, surgical management, and outcomes were reviewed. All eyes underwent PPV within 24 hours of diagnosis, with adjunctive procedures such as bleb excision or GDD explantation performed when indicated. Primary outcomes were best-corrected visual acuity (BCVA) and anatomical success (defined as maintenance of globe integrity without phthisis bulbi or enucleation) at 6 months. Fifteen eyes of fifteen patients were included (mean age, 50.6 ± 24.0 years). The median interval from glaucoma surgery to infection was 5.2 years (range, 3 months-15 years). Mean presenting BCVA was 3.01 ± 0.34 logMAR, and 93.3% of eyes presented with hand-motion vision. Cultures were positive in 8 cases (53.3%). At 6 months, median BCVA improved to 1.70 logMAR (p < 0.01), and 66.7% of eyes achieved ≥ 1.0 logMAR improvement. No eye progressed to no-light-perception vision or required enucleation. Postoperative complications included transient hypotony (13.3%), elevated intraocular pressure (13.3%), and retinal detachment (6.7%) treated with repeat PPV. Silicone oil tamponade was used in all eyes and was retained long-term in one case (6.7%). Early PPV combined with appropriate source-control procedures was associated with visual improvement and anatomical success in delayed-onset endophthalmitis after glaucoma surgery.
To quantify anterior-segment remodelling and pupillary behaviour in unilateral Fuchs uveitis syndrome (FUS) and to evaluate the diagnostic utility of anterior-segment metrics. Single-centre, retrospective, paired-eye study of 42 patients with unilateral FUS was conducted. Each patient's FUS eye was compared with the contralateral clinically healthy eye. Anterior-segment parameters (K1, K2, Kmax, central corneal thickness, anterior chamber depth (ACD), anterior chamber volume, iridocorneal angle (ICA)) were obtained with a Scheimpflug system. Static pupillometry recorded pupil diameter under scotopic (0.04 lx), mesopic (4 lx), and photopic (40 lx) conditions. The discriminative performance of parameters was assessed by receiver-operating characteristic (ROC) analysis. FUS eyes showed a wider ICA and deeper ACD (p < 0.001, for each). K2 and Kmax were steeper in FUS (both p < 0.001). On pupillometry, the photopic pupil was larger in FUS (p = 0.001), whereas scotopic and mesopic diameters were comparable (p = 0.78 and 0.64, respectively). The mesopic to photopic constriction amplitude was reduced in FUS (p = 0.002); the scotopic to photopic amplitude was borderline (p = 0.061), and scotopic to mesopic was not different (p = 0.739) between eyes. In ROC analysis, ACD discriminated FUS from fellow eyes with an AUC of 0.747 (95% CI, 0.638-0.846); the cutoff was 3.05 mm, with a sensitivity of 0.67 and a specificity of 0.79. Unilateral FUS exhibits a coherent structural-functional signature: wider angles and deeper ACD, axis-selective anterior steepening, and attenuated photopic constriction with a larger photopic pupil. Combining Scheimpflug anterior-segment metrics with standardized pupillometry provides practical, adjunctive markers that may strengthen diagnostic confidence and sharpen hypotheses on FUS pathophysiology.