Describe the clinical features, disease progression, and outcomes of presumed primary lens instability (PLI) in cats, and to assess its association with glaucoma. Thirty-four cats (68 eyes). Medical records were reviewed for signalment, clinical history, ophthalmic findings, and treatment. Eyes were classified as anterior lens luxation (ALL) or subluxated lens (SLL). Clinical monitoring included intraocular pressure (IOP), menace response, absence/presence of blepharospasm, and complications. Surgical eyes underwent intracapsular lens extraction or phacoemulsification, with or without vitrectomy. Cats were 1-13 years old (median 3 years) and predominantly male (82%). At presentation, 68% of eyes had ALL and 32% of eyes had SLL. Blepharospasm was observed in 25% of eyes, mostly in ALL. IOP was elevated (> 25 mmHg) in 38% of eyes overall, comprised of 62% SLL eyes (33 ± 5.7 mmHg) and 25% ALL eyes (54.8 ± 24.1 mmHg). Of SLL eyes followed ≥ 90 days, 73% progressed to ALL within a median of 15 days (5-174 days). Forty-four eyes underwent surgery and, of 42 with follow-up (median 284 days), 95% achieved comfort and 85% retained vision; however, 70% developed postoperative glaucoma within 68 ± 51 days that was still present in 35% of eyes at last recheck. Retinal complications occurred in 14% of operated eyes. Nonsurgical eyes also showed a high risk for IOP elevation. Presumed PLI presents bilaterally in generally young cats, often with limited signs of ocular discomfort, but with a high risk of concurrent or delayed glaucoma. Lens extraction restores comfort and can preserve vision but does not prevent future IOP elevation.
To characterize distinct precursor patterns associated with the development of patchy atrophy (PA) in highly myopic eyes and to describe their structural evolution and clinical outcomes over time. A retrospective multicenter cohort study. Highly myopic patients with documented onset of PAs and at least 3 months of multimodal imaging (MMI) prior to the PA development. Clinical, demographic, and MMI findings were retrospectively collected from 3 tertiary referral centers. Based on MMI findings preceding PA onset, eyes were categorized into 3 patterns: (1) inflammatory PAs in the context of punctate inner choroidopathy; (2) neovascular PAs, associated with extrafoveal macular neovascularization (MNV); and (3) idiopathic PAs, in the absence of identifiable inflammatory or neovascular precursor lesions. Precursor patterns, clinical and MMI characteristics, clinical complication profile, and atrophy growth rate (AGR). The study included 103 eyes (84 patients; 28 [27%] men) with a mean (standard deviation) age of 62 (13.4) years and mean refractive error of -13.2 (5.8) diopters at PA onset. Median observation periods prior to PA onset and post-PA follow-up were 2.1 years (interquartile range 5.20) and 3.44 years (interquartile range 7.23), respectively. Inflammatory PAs were detected in 33 (32%) eyes, neovascular PAs in 9 (9%) eyes, and 61 eyes (59%) had idiopathic PAs. Number of pre-existing PAs at baseline was the highest in inflammatory PAs (6.1 ± 6.4), followed by neovascular PAs (1.6 ± 1.1) and idiopathic PAs (1.5 ± 1.1; P < 0.001). Late-stage complications, including MNV (P < 0.001), subretinal fibrosis (P < 0.001), and macular atrophy (P = 0.01), occurred more frequently in inflammatory and neovascular PA than in idiopathic PA. Exploratory tree-based analysis identified baseline lesion number as a key feature distinguishing inflammatory PAs from idiopathic PAs. Mean AGR in the overall cohort was 0.73 ± 1.06 mm2/year (95% confidence interval, 0.52-0.94), with progression fastest in inflammatory PAs (1.3 ± 1.4 mm2/year), followed by neovascular PAs (0.7 ± 0.7 mm2/year) and slowest in idiopathic PAs (0.4 ± 0.7 mm2/year; P < 0.001). Higher baseline lesion number was associated with faster AGR (P = 0.005). Patchy atrophies in highly myopic eyes develop with 3 precursor patterns (inflammatory, neovascular, and idiopathic) and differ in structural characteristics, atrophy progression, and complication profile. Recognition of PA patterns may improve clinical assessment of highly myopic eyes. The authors have no proprietary or commercial interest in any materials discussed in this article.
Human eyes are hypothesized to play a critical role in social cognition, but this hypothesis has yet to be tested concretely in naturalistic settings. This study investigated how direct gaze (i.e., looking someone in their eyes) during live interactions contributes to impression formation and subsequent social cognition processes. Participants were invited to interact with confederates acting as impression targets (e.g., four different people, one at a time), rated each target's personality after the interaction, and then completed a gaze-cuing procedure as a measure of joint attention. Our research questions were (1) whether direct gaze occurrence varies as a function of eyes' visibility, (2) whether such variations meaningfully relate to impression accuracy, and (3) whether they additionally modulate subsequent joint attention. Results show that participants mainly looked at the targets' eyes during the interaction, particularly when their eyes were visible. Additionally, direct gaze showed limited abilities to predict impression accuracy but preliminary links with joint attention. Integrating theories and methods from both social cognitive psychology and personality psychology, this research shows the concrete importance of the social information conveyed by eyes in our everyday lives.
To determine the incidence of postoperative cystoid macular edema (CME) following pars plana vitrectomy (PPV) with epiretinal membrane (ERM) peeling, and to evaluate the anatomical and functional response to intravitreal dexamethasone implant (Ozurdex; AbbVie) in affected eyes. This retrospective, single-center cohort study included 92 consecutive eyes with idiopathic ERM that underwent PPV with ERM peeling by a single surgeon. Eyes were allocated to a control group (n = 84), comprising eyes without postoperative CME, or to a CME group (n = 8), comprising eyes that developed postoperative CME confirmed on swept-source optical coherence tomography (SS-OCT) and subsequently received intravitreal dexamethasone implant (DEX). Best-corrected visual acuity (BCVA, logMAR), central macular thickness (CMT, µm), and intraocular pressure (IOP, mmHg) were assessed preoperatively and postoperatively in both groups, and before and after DEX implantation in the CME group. The incidence of postoperative CME requiring treatment was 8.7%. Most baseline characteristics were comparable between groups, although preoperative IOP was significantly lower in the CME group. CMT decreased significantly after surgery in both the control group (335.1 ± 37.3 to 289.5 ± 22.9 μm; p < 0.001) and the CME group (382.9 ± 74.6 to 310.9 ± 22.9 μm; p = 0.033); however, postoperative CMT remained significantly higher in the CME group than in controls (p = 0.034). DEX implantation produced an additional significant CMT reduction (379.9 ± 67.1 to 302.7 ± 35.3 μm; p = 0.003), reducing the between-group difference to a non-significant level (p = 0.332). BCVA improved significantly after surgery in the control group (0.32 ± 0.26 to 0.04 ± 0.10 logMAR; p < 0.001) but not in the CME group (p = 0.582). Following DEX implantation, BCVA improved significantly in the CME group (0.47 ± 0.35 to 0.22 ± 0.25 logMAR; p = 0.002), approaching values observed in the control group (p = 0.078). IOP remained stable in controls (p = 0.576). A transient but significant IOP increase was observed in the CME group after surgery (11.5 ± 2.7 to 15.3 ± 3.7 mmHg; p = 0.019), with no further change after DEX implantation (p = 0.747). Postoperative CME requiring treatment occurred in approximately 1 in 11 eyes following PPV with ERM peeling and was associated with significant anatomical and functional impairment. The present findings suggest that intravitreal dexamethasone implant was associated with improvement in selected cases of postoperative CME without additional impact on IOP; however, larger prospective studies are required to confirm these results.
To assess and validate rotational stability and visual outcomes data of the CNWTTx (Clareon® PanOptix®) Toric multifocal intraocular lens (IOLs) in routine clinical practice. In this prospective, single-centre, real-world, confirmatory study, CNWTTx was implanted in 40 eyes from 22 patients that underwent bilateral routine phacoemulsification. Manifest refraction, uncorrected vision at distance (UDVA), intermediate (UIVA) and near at 40 cm (N-40) and 33 cm (N-33) were measured at 4-6 weeks and 12-weeks postoperatively. Quality of vision was assessed using the Near Acuity Visual Questionnaire (NAVQ), stereoacuity and contrast sensitivity (CS). Toric alignment was primarily measured using slit lamp examination at 1 hour, 1 week, 4-6 weeks and 12 weeks postoperatively. Rotational stability was assessed by measuring change in toric alignment from target axis at each time point. iTrace was used as an exploratory method of assessing IOL rotation. Mean absolute and actual rotation at 12 weeks was 3.4° and -1.3°, respectively, with 85% of eyes achieving ≤5° of rotation. Monocular uncorrected visual acuity was 0.06 ± 0.09, 0.1 ± 0.14, 0.13 ± 0.11 and 0.14 ± 0.11 LogMAR at 6 m, 60 cm, 40 cm and 33 cm, respectively. Postoperative spherical equivalent at 12 weeks was -0.15 ± 0.28 D. NAVQ score increased significantly following surgery, and contrast sensitivity and stereoacuity were well maintained compared to age-normal values. Accurate visual and refractive outcomes were achieved with CNWTTx in this cohort, and the lens remained stable from 1 week following implantation. This was consistent with the high patient-reported satisfaction despite visual phenomena inherent to diffractive IOLs. However, the percentage of eyes achieving ≤5° of rotation within this cohort was 5% lower than the ANSI Z80.30 standard, which was likely due to the small sample size of this study. Future studies with larger sample size are warranted to fully ascertain the lens' performance against the ANSI Z80.30 benchmark. While offering patients a greater degree of spectacle independence following surgery, multifocal intraocular lenses (IOLs) require precise placement in the eye and to remain stable for optimal outcomes. The CNWTTx IOL is composed of a newer material than that of its predecessor, the TFNT00 toric IOL. It is unclear how this new material affects its stability within the eye. We followed 40 eyes from 22 patients who had received the CNWTTx IOL and measured its position within the eye at 1 hour, 1 week, 4–6 weeks and 3 months. We found that the majority of eyes rotated ≤5°, largely within 1 week of surgery. Additionally, patients achieved good and predictable visual and refractive outcomes. These findings suggest that the stability of the CNWTTx IOL does not appear to be impacted by the new material and is an effective option for patients wanting spectacle independence.
To evaluate whether interocular axial length (AL) asymmetry is associated with postoperative refractive error, independent of absolute AL. This retrospective comparative study included 42 patients (84 eyes) who underwent bilateral cataract surgery. Within-patient comparisons were performed between longer-AL and shorter-AL eyes, and longer-AL eyes were also compared with an AL-matched control group. Postoperative spherical equivalent (SE) at 1 month was compared with predicted SE using the Barrett Universal II and SRK/T formulas. Multivariable regression analysis was performed. Mean postoperative refractive error (mean ± SD) was -0.20 ± 0.63 D in the longer-AL group vs 0.02 ± 0.50 D in the shorter-AL group (BU, p = 0.01), and -0.41 ± 0.84 D vs -0.05 ± 0.53 D (SRK/T, p = 0.02). Longer-AL eyes showed a significantly greater myopic shift than shorter-AL and control eyes. Interocular AL difference remained independently associated with postoperative refractive error. Interocular AL asymmetry was associated with postoperative myopic shift, even after adjustment for axial length and other covariates.
This study investigated retinal blood flow alterations in diabetic macular edema (DME) using ultra-widefield optical coherence tomography angiography (OCTA). We enrolled 31 healthy controls (NC, 56 eyes), 40 diabetes patients without diabetic retinopathy (DM, 79 eyes), 25 non-proliferative diabetic retinopathy patients (NPDR, 47 eyes), and 42 DME patients (DME, 54 eyes). OCTA images were analyzed using five-quadrant and concentric zonal divisions to assess vascular density (VD) in the superficial (SVC) and deep vascular complexes (DVC). In the DM group, nasal SVC VD was significantly reduced in the N11, N16, and N21 regions. NPDR patients showed widespread SVC VD reduction compared to controls and DM patients, while DME patients exhibited elevated SVC VD in the peripheral retina (11-21 mm). DVC changes were significant only in the macular area in NPDR group, with DME patients showing increased VD in all regions except I21. Peripheral DVC VD (T11, T16, S16) strongly correlated with DME on ROC analysis. Nasal SVC vascular alterations are among the detectable early intergroup differences in preclinical DR, and peripheral DVC VD is closely correlated with the presence of DME.
We report a case of Bardet-Biedl syndrome (BBS) complicated by bilateral Coats-like exudative vasculopathy with exudative retinal detachment and neovascular glaucoma (NVG). A 10-year-old boy noticed decreased visual acuity and was referred to our clinic. He had a history of retinitis pigmentosa, renal dysfunction, obesity, and a delay in mental development at 4 years of age. Genetic testing confirmed BBS with compound heterozygous variants detected in the BBS2 gene. His visual acuity was light perception in both eyes, and the intraocular pressure (IOP) was 14 mmHg in the right eye and 35 mmHg in the left eye. Fundus examination revealed severe exudative changes in both eyes with vitreous hemorrhage in the left eye. In the right eye, fluorescein angiography showed limited retinal vascular circulation and a nonperfused peripheral area in the equatorial region with multiple sites of neovascularization. Panretinal photocoagulation was performed on the right eye, and vitrectomy was performed on the left eye for the NVG. The left eye had proliferative membranes throughout the periphery. Postoperatively, the IOP of the right eye was elevated accompanied by iris rubeosis. Aflibercept was injected Intravitreally and lens-sparing vitrectomy was performed on the right eye with additional endophotocoagulation. One month later, the visual acuity remained at light perception in both eyes. The IOP was well controlled with topical medication at 18 mmHg for the right eye and 20 mmHg for the left eye. The Coats-like exudative lesions associated with eyes with the BBS2 gene variants and retinal vascular occlusion likely led to the NVG.
Proprioceptive deficits following anterior cruciate ligament (ACL) injury increase reliance on visual input in athletes after ACL reconstruction (ACLR). Visual disruption may therefore alter movement patterns and increase re-injury risk. However, its influence on lower limb biomechanics during cutting maneuvers in ACLR athletes remains unclear. To investigate the effects of visual disruption on the kinematic and kinetic characteristics of the lower limb during the 90° cutting maneuver in athletes after ACLR. Twenty athletes after ACLR and twenty healthy athletes were recruited to randomly undergo two different visual conditions, eyes-open and visual disruption, and to complete the 90° cutting maneuver in each of the two visual conditions. Visual disruption was performed with strobe glasses. A nine-camera infrared motion capture system (Vicon T40, 200 Hz) was used to collect lower-limb kinematics data during the 90° cutting task, while a three-dimensional force platform (Kistler, 1,000 Hz) recorded kinetic data. Data were processed using Visual 3D software, and statistical analyses were conducted using SPSS (version 25.0). A two-factor repeated measures analysis of variance was used to determine the effects of group and visual conditions on kinematic and kinetic variables. (1) Compared with the eyes-open condition, the peak knee valgus angle (P = 0.025, ES = 0.157) and peak ankle inversion angle (P = 0.005, ES = 0.233) of athletes after ACLR were significantly increased under visual disruption conditions. There was no significant difference between the kinematic variables of the healthy athletes in the two visual conditions (P > 0.05). (2) Compared with the eyes-open condition, the hip extension moment of athletes after ACLR was significantly increased (P = 0.037) and the knee extension moment was significantly reduced (P = 0.039) under visual disruption conditions. There was no significant difference (P > 0.05) in the kinetic variables of the healthy athletes between the two visual conditions. Visual disruption increased knee valgus and ankle inversion angles in athletes after ACLR, which may increase the risk of secondary anterior cruciate ligament injuries and lateral ankle sprains. These results suggest that ACLR athletes have a poorer ability to recalibrate sensory information to visual disruption compared to healthy athletes.
Prefrailty is a reversible transitional stage of frailty and is associated with impaired postural stability and increased fall risk. Tai Chi may improve balance-related performance in older adults, but its effects on postural stability and gait biomechanics in prefrail populations remain insufficiently characterized. In this single-blind randomized controlled trial, 68 prefrail older adults defined by the Fried Frailty Phenotype were allocated to a Tai Chi plus health education group or a health education control group. Sixty-four participants completed the study (mean age 71.1 years; 31 women; 33 men). The intervention group performed 24-form Tai Chi three times weekly for 12 weeks, while both groups received health education. Functional postural stability was assessed using the Timed Up-and-Go Test (TUGT), Berg Balance Scale (BBS), and Short Physical Performance Battery (SPPB). Static balance was evaluated using center-of-pressure (COP) measures, and gait biomechanics were assessed using three-dimensional gait analysis. Continuous outcomes were analyzed using baseline-adjusted ANCOVA, with complementary group × time interaction analyses. Exploratory change-score correlations were conducted within the intervention group, with full-sample sensitivity analyses adjusted for group assignment. After 12 weeks, the intervention group showed better postural stability than controls, including shorter TUGT time (P < 0.001), higher BBS (FDR q < 0.001) and SPPB scores (FDR q = 0.002), lower COP path length and sway velocity under eyes-open conditions (both FDR q = 0.003), and lower COP path length, sway ellipse area, and sway velocity under eyes-closed conditions (FDR q = 0.014-0.018). Gait analysis showed significant improvements in gait speed (FDR q = 0.033), gait profile score (GPS; FDR q < 0.001), gait deviation index (GDI; FDR q < 0.001), and hip rotation deviation (FDR q = 0.007), whereas other joint-specific kinematic variables were only nominally significant. Group × time analyses supported changes in TUGT, BBS, SPPB, gait speed, GPS, and GDI. Exploratory correlation analyses showed that changes in postural stability were mainly associated with changes in hip kinematics, step length, and selected ankle-related features; however, these associations did not remain significant after FDR correction. A 12-week Tai Chi program improved functional performance and static postural control in prefrail older adults and was associated with favorable changes in gait speed and global gait-quality indices. Correlation findings should be interpreted as preliminary mechanistic clues. Larger studies with longer follow-up are needed. Trial registration Chinese Clinical Trial Registry, ChiCTR2300073905, Registered on [2023-07-25]. https://www.chictr.org.cn.
To evaluate the anatomical and functional outcomes of a simplified superior inverted internal limiting membrane (ILM) flap technique with extended ILM peeling for the surgical treatment of large idiopathic macular holes (iMH). This retrospective, non-randomized, interventional consecutive case series included 42 eyes of 40 patients with iMH. Patients were grouped according to the CLOSE study classification: Group 1: large holes (n=19, minimum linear diameter [MLD] >400 to ≤550 µm), Group 2: extra-large holes (n=18, MLD >550 to ≤800 µm), and Group 3: XXL holes (n=5, MLD >800 to ≤1000 µm). The mean follow-up time was 20.63 ± 18.32 months. The primary endpoint was MH closure rate. Secondary outcomes included closure type, changes in best-corrected visual acuity (BCVA), ellipsoid zone (EZ) defect, flap position, and surgical complications. Anatomical type 1 closure was achieved in all 42 eyes (100%). The proportion of favorable U-shaped closure decreased significantly with increasing hole size (χ2 = 9.26, df = 2, p = 0.010), with rates of 84.2%, 81.3%, and 20.0% in Groups 1, 2, and 3, respectively. BCVA and EZ defect improved significantly over time in all groups. Final BCVA gain was 4.4 ± 3.3, 6.2 ± 2.7, and 7.3 ± 4.7 ETDRS lines in Groups 1, 2, and 3, respectively, without significant inter-group differences (p > 0.05). Final BCVA correlated with preoperative BCVA (r = 0.51, p < 0.001) and final EZ defect (r = 0.39, p = 0.013), but not with iMH size or symptom duration (p > 0.05). No major complications were observed. The described surgical technique, involving the combination of a superior inverted ILM flap with extended ILM peeling and minimal manipulation of the posterior pole is highly effective in achieving anatomical and functional success in large iMHs up to 1000 µm, with a favorable safety profile and consistent structural recovery.
In neovascular age-related macular degeneration (nAMD), persistent disease activity despite anti-VEGF therapy is common. Switching to faricimab may improve outcomes and extend treatment intervals in treatment-resistant patients, but long-term real-world data remain limited. In this retrospective, single-centre study, 43 eyes of 38 patients with treatment-resistant nAMD were switched to faricimab and followed for up to 24 months. Insufficient disease control was defined as inability to extend treatment intervals beyond 8 weeks under a treat-and-extend regimen. Outcomes included best-corrected visual acuity (BCVA), central subfield thickness (CST), pigment epithelial detachment (PED) height, fluid status, and treatment intervals. Longitudinal changes were analysed using mixed-effects models. Exploratory analyses of baseline and early response predictors were performed. Mean BCVA remained stable throughout follow-up, with no significant change from baseline at any time point (p > 0.05). CST decreased significantly at all visits, ranging from - 45.8 μm (95% CI - 65.3 μm to - 26.3 μm) at 1 month to - 52.3 μm (95% CI - 73.7 μm to - 30.8 μm) at 24 months (p < 0.001). PED height decreased at 1 month (- 19.0 μm; 95% CI - 33.6 μm to - 4.4 μm, p = 0.011) and remained reduced from 12 to 24 months, ranging from - 25.9 μm (95% CI - 39.7 μm to - 12.1 μm, p < 0.001) to - 49.1 μm (95% CI - 65.1 μm to - 33.0 μm, p < 0.001). Presence of subretinal fluid decreased significantly at all time points, with odds ratios (OR) ranging from 0.064 (95% CI 0.01 to 0.41, p = 0.004) at 1 month to 0.012 (95% CI 0.01 to 0.10, p < 0.001) at 24 months, whereas intraretinal fluid showed a variable response, with a significant reduction observed at 3 months only (OR 0.204, 95% CI 0.05 to 0.79, p = 0.021). The proportion of eyes with a dry macula increased from 0% at baseline to 23.1% at 12 months and 24.0% at 24 months. Treatment intervals extended from 5.9 ± 1.2 weeks before switch to 8.7 ± 2.6 weeks at 12 months (p < 0.001) and 10.6 ± 3.0 weeks at 24 months (p < 0.001). No adverse events were observed. Switching to faricimab was associated with improved anatomical outcomes and extended treatment intervals while maintaining stable visual acuity, suggesting benefits primarily related to anatomical control and reduced treatment burden.
Choroidal vascular and structural alterations are increasingly recognized as relevant to intraocular pressure (IOP) regulation and glaucoma pathophysiology. Surgical IOP reduction induces hemodynamic and biomechanical changes that may affect choroidal thickness and perfusion, particularly in the peripapillary and submacular regions. Although trabeculectomy is known to cause early postoperative choroidal expansion, the additional impact of concomitant phacoemulsification remains unclear. We compared early regional choroidal responses after trabeculectomy (Trab) alone and phaco-trabeculectomy (Phaco-Trab) in eyes with open-angle glaucoma (OAG). This retrospective study included patients with OAG who underwent Trab or combined Phaco-Trab after failure of maximal medical therapy. Preoperative and 1-month postoperative assessments included best-corrected visual acuity, Goldmann applanation tonometry, slit-lamp and fundus examinations, and enhanced depth imaging optical coherence tomography. Submacular and peripapillary choroidal parameters, including choroidal thickness (CT), luminal area (LA), stromal area (SA), total choroidal area (TCA), and choroidal vascularity index (CVI), were quantified using ImageJ software. Eyes with previous intraocular surgery, systemic vascular disease, media opacity, or postoperative complications were excluded. Intra- and intergroup comparisons were performed. Fifty-five eyes were analyzed (30 Trab, 25 Phaco-Trab). Both groups showed significant postoperative IOP reduction (p<0.001). In the Trab group, submacular CT decreased significantly, whereas LA and TCA increased; CVI remained unchanged. In contrast, the Phaco-Trab group demonstrated significant increases in submacular CT, LA, TCA, and CVI at 1 month. In the peripapillary region, the Trab group showed increased temporal CVI, whereas the Phaco-Trab group demonstrated increased temporal LA. No significant correlation was found between IOP reduction and changes in choroidal parameters. Early postoperative choroidal responses differed between procedures. Phaco-Trab induced greater structural and vascular choroidal changes, likely due to the combined effects of IOP reduction and inflammation associated with cataract surgery. These findings highlight the choroid's dynamic role in postoperative recovery and warrant long-term investigation.
To assess the dynamics of Pattern Electroretinogram (PERG) parameters following glaucoma surgery in individuals with glaucomatous optic neuropathy. The is a single center retrospective study. Preoperative PERG were conducted on moderate and advanced glaucoma patients scheduled for glaucoma surgery. Subsequently, the patients underwent an additional PERG a few months after the procedure. Comparative analysis focused on the PERG parameters (Mag, MagD and MagD/Mag ratio) before and after the glaucoma surgery in eyes achieving successful intraocular pressure (IOP) reduction post-operatively. The study enrolled 23 eyes from 21 consecutive patients who underwent successful glaucoma surgery between January 2021 and December 2023, each with both pre and post-operative PERG assessments. Postoperatively, there was a significant improvement of all the PERG parameters (0.97 ± 0.29 to 1.36 ± 0.29 μV, 0.55 ± 0.3 to 0.84 ± 0.42 μV, 0.52 ± 0.2 to 0.68 ± 0.25 for Mag, MagD and MagD/Mag ratio respectively, all p < 0.05). Three patients who had no IOP reduction postoperatively showed no improvement of all PERG parameters following the surgery. Glaucoma surgery, leading to effective IOP reduction, may demonstrate a positive impact on the functional activity of the retinal ganglion cells, as evidenced by the enhancement in PERG parameters post-operatively.
To report medical cure and treatment failure rates of Acanthamoeba keratitis (AK) with respect to type of treatment, disease stage and prognostic factors. Electronic records were reviewed for 45 patients with PCR-positive AK treated at the Department of Ophthalmology, Aarhus University Hospital, Denmark from 2012 to 2025. Patients received standardized treatment with either polyhexamethylene biguanide (PHMB) 0.02% (n = 27) or chlorhexidine 0.02% (n = 18) both in combination with propamidine 0.1%. Evaluated risk factors included disease stage, patient age, time to diagnosis and prior corticosteroid use. All 29 patients (64%) presenting with stage 1 or 2 disease achieved medical resolution of the infection, irrespective of the treatment regimen. Sixteen patients (36%) presented with stage 3 disease. Twelve of these patients underwent therapeutic keratoplasty and were considered treatment failures. The overall proportion of treatment failures was comparable between groups. Among medically cured patients, the average treatment duration was significantly lower in chlorhexidine- than in PHMB-treated patients (118 vs. 233 days); however, this group also presented with a shorter diagnostic delay. All 12 cases of treatment failure occurred in patients who had received corticosteroid treatment prior to diagnosis and were significantly older than patients achieving medical cure. PHMB 0.02% and chlorhexidine 0.02% in combination with propamidine 0.1% demonstrated comparable clinical outcomes in the treatment of AK, although the average treatment duration was shorter in chlorhexidine-treated eyes. Steroid use before diagnosis and older patient age are significantly associated with higher risk of treatment failure.
To investigate the predictability of long-term intraocular pressure (IOP) fluctuations in open-angle glaucoma eyes implanted with a telemetric IOP sensor. A prospective, open-label, single-arm, multicenter study. Twenty-four patients were enrolled, including 20 with primary open-angle glaucoma, 2 with pseudoexfoliative, 1 with pigmentary, and 1 with uveitic glaucoma. Mean age was 65.2 ± 10.2 years. Telemetric IOP measurements were aggregated into nyctohemeral means. The first 90 postoperative days were excluded. A rolling reference framework was applied, in which temporally paired observations were generated by comparing each eligible day with a future time point at fixed prediction horizons. The relationship between short-term (7, 14, or 28 days) and long-term (273 or 364 days) fluctuations was assessed using Pearson correlation. Multivariate regression was applied to predict long-term fluctuations based on short-term data. In addition, supervised machine learning with a Random Forest Classifier was used to predict long-term fluctuations from clinical, demographic, and IOP-derived features. For each horizon (273 or 364 days) and threshold (+2.0, +3.0, and +4.0 mmHg), changes in mean nyctohemeral IOP were calculated. Outcomes were labeled as "1" if the increase met or exceeded the threshold and "0" otherwise. Predictability of long-term IOP fluctuations at 273 and 364 days. Short-term fluctuations correlated only weakly with long-term variability (Pearson r ≤ 0.33) and explained at most 15.2% in regression analysis. Across 1224 Random Forest Classifier models, 47 met inclusion criteria of area under the receiver operating characteristic curve (AUROC) >0.8 and sensitivity and specificity >0.7 (27 for 364 days, 20 for 273 days). On average, 5563 ± 116 valid pairings from 9.2 ± 0.8 patients were used per configuration. Five final configurations were selected for each threshold-horizon combination based on the highest F1 values. Performance metrics included AUROC 0.81 to 0.86, cross-validated AUROC 0.78 to 0.83, accuracy 0.72 to 0.81, sensitivity 0.72 to 0.78, specificity 0.70 to 0.82, precision 0.32 to 0.44, and F1 value 0.44 to 0.56. All models included 7, 14, and 28-day fluctuations, mean nyctohemeral IOP, ocular pulse amplitude, age, body mass index, and central corneal thickness as predictors, with mean nyctohemeral IOP contributing most (38%-55%). Long-term IOP fluctuations can be predicted from baseline clinical and demographic data combined with IOP-related features. Telemetric devices and remote IOP monitoring, combined with predictive modeling, could reduce the burden of time-intensive procedures and health care costs while supporting individualized care in the face of rising demand. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
To evaluate long-term outcomes of non-Descemet stripping automated endothelial keratoplasty (nDSAEK) in low-vision patients with corneal endothelial decompensation (CED), and to develop a machine-learning framework for predicting graft failure. This retrospective study included 114 eyes (Fuchs' and non-Fuchs' etiologies) treated with nDSAEK. Best-corrected visual acuity (BCVA), endothelial cell density (ECD), and complications were assessed over a long-term follow-up. Linear mixed-effects models (LMM) analyzed ECD kinetics. An XGBoost model using 10 clinical features was constructed to predict graft failure, interpreted via SHapley Additive exPlanations (SHAP) analysis. Results were compared against established endothelial keratoplasty benchmarks. The median follow-up was 41.50 months (IQR: 25.65-55.75 months). Mean BCVA improved significantly from 1.80 logMAR baseline to 1.20 logMAR at 6 months, remaining stable thereafter. At 3 years, mean ECD was 1724 ± 279 cells/mm2.,Subgroup stratification demonstrating a 3-year cumulative ECD loss of 37.9% in the Fuchs' group compared to a significantly higher long-term depletion rate of 45.3% in the non-Fuchs' group. LMM analysis showed that femtosecond laser-assisted nDSAEK (FS-nDSAEK) significantly improved long-term ECD maintenance over manual dissection. The predictive framework yielded longitudinal risk-discrimination capability, demonstrating a time-dependent area under the ROC curve (AUC) of 0.917 (95% CI: 0.819-1.000) at 12 months, 0.920 (95% CI: 0.823-1.000) at 24 months, and 0.880 (95% CI: 0.765-0.995) at 36 months, driven by 15 confirmed graft failure events within the 114-eye cohort. SHAP analysis identified FS assistance and preoperative ECD as key protective factors. Compared to literature benchmarks, nDSAEK demonstrated visual and anatomical stability demonstrated visual and anatomical trends that align with historical DSAEK cohorts. nDSAEK offers stable long-term visual and anatomical outcomes for CED. The integration of AI frameworks offers an exploratory framework for individualized prognostic screening, though further external validation is required before direct clinical integration.
Branch retinal vein occlusion (BRVO) can cause persistent visual impairment, and predicting long-term best-corrected visual acuity (BCVA) after anti-vascular endothelial growth factor treatment remains clinically challenging. This retrospective proof-of-concept study developed multimodal neural networks to predict 12-month BCVA classes using retinal images and clinical metadata from treatment-naive BRVO eyes. The best internal model used OCT-horizontal scans, OCTA images, baseline BCVA, central subfield thickness, age, and sex. We evaluated performance using adjacent accuracy, exact accuracy, and mean absolute error under five-fold cross-validation, and we analyzed attribution localization using Pathway Attribution. We additionally performed a supplementary exploratory cross-disease feasibility analysis using an available diabetic macular edema (DME) OCT cohort with 24-month visual acuity outcomes. This analysis was interpreted only as supplementary exploratory feasibility evidence and not as disease-matched BRVO external validation. Overall, the results suggest that multimodal imaging and clinical metadata may provide complementary prognostic information after BRVO, but the modest predictive performance, retrospective single-center design, lack of disease-matched external validation, and limited attribution reliability require cautious interpretation and further prospective validation.
Primary open-angle glaucoma (POAG) is a progressive optic neuropathy; elevated intraocular pressure (IOP) is the only broadly modifiable risk factor. Some elderly patients remain uncontrolled on multi-drug regimens and are not immediate candidates for laser or filtering surgery. This CARE-compliant case report describes an integrative approach in such a patient. This case describes a 76-year-old woman with drug-refractory POAG and fluctuating IOP despite quadruple topical therapy. Adjunct electroacupuncture (EA, twice weekly) was initiated on March 28, 2025. IOP decreased from 12 mmHg in the right eye (OD) / 29 mmHg in the left eye (OS) to within target after the first two sessions and remained stable; best-corrected visual acuity (BCVA) improved from 0.4 (OD) / 0.25 (OS) to 0.5 in both eyes (OU). No major adverse events were observed. The observed clinical course was consistent with previously reported short-term IOP-lowering and ocular-perfusion effects of acupuncture in POAG. EA layered on top of standard care may be a feasible adjunct for short-term IOP stabilization and symptomatic improvement in drug-refractory POAG. However, given that topical antiglaucoma therapy was continued throughout the intervention and the inherent limitations of a single-case design, causal attribution cannot be established, and confirmation in randomized sham-controlled trials with longer follow-up is needed.
Dry eye disease (DED) is a global health burden with limited effective and safe treatments. Quercetin (Qu) possesses potent anti-inflammatory and antioxidant activities, but its poor solubility and short half-life restrict ophthalmic use. Qu‑loaded PEGylated liposomes (Qu‑PL) were prepared by thin‑film hydration and incorporated into gellan gum to form an ion‑responsive in situ gel (Qu‑PL‑ISG). The formulation was characterized for particle size (PS), zeta potential (ZP), polydispersity index (PDI), encapsulation efficiency (EE), short-stability, in vitro release, cytotoxicity, ocular irritation, mucoadhesion, ocular surface retention, pharmacokinetics, and therapeutic efficacy in a BAC‑induced DED mouse model. Network pharmacology and molecular docking were used to generate testable hypotheses on possible mechanisms of Qu in DED. Qu‑PL‑ISG had a PS of 173.33 ± 1.27 nm, a ZP of -46.87 ± 0.95 mV, and an EE of 88.85 ± 1.41%. It released 46% of Qu over 72 h and remained stable for 21 days at 4 °C, with no cytotoxicity or irritation. Compared with Qu‑PL, Qu‑PL‑ISG exhibited higher mucoadhesive force (3783.5 ± 125.2 vs. 1986.2 ± 145.7 dyne/cm2) and longer ocular surface retention (45 vs. 20 min). Ocular bioavailability (AUC0‑1 80) in cornea, conjunctiva, and tears increased 2.79-, 1.47- and 1.44-fold, respectively. In DED mice, 0.2% Qu‑PL-ISG restored tear secretion, reduced corneal staining, repaired epithelial thickness, increased goblet cell density, and lowered corneal IL-1β and TNF-α levels, with efficacy comparable to 0.05% cyclosporine A. Network pharmacology and molecular docking were used as computational tools to predict that Qu may act on DED through multi‑target interactions (TNF, NF‑κB, STAT3, IL-1β, AKT1, IL-6, Src) and pathways (IL-17, PI3K-Akt, TNF signaling), though these findings require experimental validation. Qu‑PL‑ISG is a safe, ion‑activated in situ gel that significantly enhances Qu bioavailability and anti‑inflammatory efficacy, showing promise for DED treatment.