Search Results (213)

Background: Multiple evanescent white dot syndrome (MEWDS) is usually acute and self-limited, whereas multifocal choroiditis (MFC)/punctate inner choroidopathy (PIC) is relapsing; overlap can obscure early diagnosis and requires longitudinal multimodal imaging. Methods: We report a 4-year follow-up of a 31-year-old woman with fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT), plus a systemic/neurologic/rheumatologic work-up. Treatment included intravenous methylprednisolone for presumed optic neuritis, followed by topical, periocular, intravitreal, and systemic corticosteroids, later escalated to adalimumab and an intravitreal dexamethasone implant. Because foveal granularity could not be documented, baseline was termed “MEWDS-like”. Diagnostic labelling was benchmarked against Standardization of Uveitis Nomenclature (SUN) criteria, and choroidal neovascularization (CNV) was assessed at each relapse by OCT and FA. Results: The right eye initially showed a MEWDS-like pattern with wreath-like FA lesions and disc leakage, hyperautofluorescent FAF lesions, focal ellipsoid zone disruption on SD-OCT, and multifocal ICGA hypofluorescent spots. A relapse at 6 months with peripapillary inflammatory foci and recurrent cystoid macular edema supported reclassification to a unilateral MFC/PIC-spectrum phenotype. At 2 years, the fellow eye developed mild vitritis, peripapillary hyperautofluorescence, peripapillary/arcade leakage on FA, delayed peripapillary filling on ICGA, and cystoid macular edema, establishing sequential bilateral MFC; no CNV developed and anti-vascular endothelial growth factor (anti-VEGF) therapy was not required. Complications included steroid-induced ocular hypertension and cataract surgery. Conclusions: The purpose of this report is to highlight longitudinal imaging “red flags” that supported reclassification from a MEWDS-like phenotype to a sequential bilateral MFC/PIC-spectrum disease. Full article

Background: UBE has gained popularity as a minimally invasive alternative to open spinal procedures. However, it raises concerns about potential ocular complications. Despite these concerns, there is a lack of studies evaluating UBE’s impact on retinal microvasculature using objective imaging tools such as OCTA. This study aims to evaluate the effects of UBE on the microvascular structures of the retina and optic nerve using OCTA, and to determine whether UBE poses a risk for perioperative vision loss. Methods: This study included 32 patients who underwent UBE for lumbar stenosis and received ophthalmologic examinations preoperatively, and at postoperative weeks 1 and 4. Patients with systemic or ocular vascular comorbidities were excluded. OCTA parameters including vascular density (VD), foveal avascular zone (FAZ), retinal nerve fiber layer (RNFL), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were evaluated using swept-source OCT. Results: No patients experienced clinical vision loss. A statistically significant change was observed over time in FAZ (p = 0.043), VDd superior (p = 0.018), VDd temporal (p = 0.032), and RNFLts (p = 0.032). However, only VDd superior showed a statistically significant decrease at postoperative week 4 compared to baseline (p = 0.050). All other parameters either returned to baseline or showed no significant change. No clinically relevant visual changes were detected. Conclusions: In this study, UBE spinal surgery was not associated with clinically evident visual loss or sustained OCTA-detected microvascular alterations during short-term follow-up. These findings should be interpreted as reflecting the absence of detectable short-term changes rather than definitive evidence of ocular safety. Full article

Background/Objectives: Steroid-induced glaucoma (SIG) or ocular hypertension is a well-known complication after corticosteroid exposure to the eye, particularly intravitreal dexamethasone implantation. The main mechanism of elevated intraocular pressure (IOP) is trabecular meshwork dysfunction, leading to increased aqueous outflow resistance. Although most SIG cases respond to medical treatment, some patients develop persistent IOP elevation, requiring surgical intervention. Minimally invasive glaucoma surgery (MIGS) has recently emerged as a safer surgical option, but there are a limited number of reports using MIGS for SIG. Methods: A 73-year-old man, who had branch retinal vein occlusion with refractory macular edema despite multiple anti-VEGF injections, received an intravitreal Ozurdex^® (Allergan, Irvine, CA, USA) implant. He developed marked IOP elevation from 17 to 34 mmHg despite maximal topical therapy. Visual field progression and progressive retinal nerve fiber layer thinning were also observed. Given the need for continued ocular steroid use and only having one arm due to trauma making drops difficult, three trabecular micro-bypass stent devices (iStent infinite^®, Glaukos Corp., Aliso Viejo, CA, USA) were implanted for IOP control. Postoperatively, IOP decreased to 13 mmHg and remained stable at 15 mmHg for 12 months. Additionally, macular edema was well-controlled with ongoing Ozurdex treatment and no observed IOP spikes. Conclusions: This is the first reported case of SIG-associated Ozurdex successfully managed with triple trabecular micro-bypass stents. The iStent infinite implantation provided safe and sustained IOP control for SIG, highlighting its potential role in patients requiring continuous intravitreal steroids. Full article

Pathologic myopia has become a major global cause of blindness, making timely surgical management for myopic traction maculopathy (MTM) increasingly important. This study aimed to identify prognostic factors associated with functional and anatomical outcomes following surgery for MTM and to determine the optimal timing for intervention. This retrospective study included 33 eyes from 28 patients with MTM without full-thickness macular hole who underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Better preoperative best-corrected visual acuity (BCVA) and lower foveal height were associated with better postoperative BCVA, whereas longer axial length, higher MTM, and higher Atrophy–Traction–Neovascularization (ATN) classification grade were correlated with thinner postoperative central foveal thickness. Foveal detachment (FD), ellipsoid zone (EZ) disruption, and advanced MTM grade were associated with poorer functional and anatomical outcomes. Postoperative visual outcomes should be interpreted with caution, as they may have been influenced by lens-related factors, including combined cataract surgery, post-vitrectomy cataract progression, and posterior capsule opacity. Nonetheless, consistent anatomical improvement was observed, supporting early surgical consideration in eyes with MTM showing progressive macular traction or EZ disruption, even in the absence of FD. These findings highlight the importance of serial OCT monitoring and individualized surgical timing based on preoperative assessments. Full article

Background: The implantable miniature telescope is used to provide functional vision for patients with advanced AMD. However, despite the considerable cost of the device, there are strict criteria to be met for this procedure, since the patients require challenging neuroadaptation afterward, which sometimes fails and leads to the necessity of device explantation. Visual outcomes also depend on the stability of the microtelescope; tilts cause unwanted optical aberrations and can lead to device luxation, with sight-threatening complications. Case report: This case presents a novel technique for fixing the ophthalmic telescope device SING-IMT™. A 76-year-old female with pre-operative visual acuity of 15 letters on the ETDRS scale underwent surgery on her left eye. The superior haptic was fixed at the 12 o’clock position with a Prolene 5-0 suture, achieving good postoperative stability. The implant was stable throughout the entire observation period. Conclusions: Implant stability is crucial for maximizing visual potential in patients with advanced AMD selected for the procedure, since visual acuity in the peripheral retina, where the perceived image eventually lands, is much lower than the macula. Therefore, there is a need to standardize surgical approaches and use objective follow-up measures to assess long-term patient satisfaction. Full article

Background and Objectives: To evaluate the occurrence of retinal displacement using blue-fundus autofluorescence (BFAF) imaging in eyes treated for primary rhegmatogenous retinal detachment (RRD) and its associations with clinical factors, including macular status, detachment extent, baseline visual acuity, high myopia, postoperative visual recovery, and metamorphopsia. Materials and Methods: This retrospective observational study included 98 patients who underwent surgery for primary RRD at a single center. Surgical approaches included pars plana vitrectomy (PPV), phacovitrectomy, or scleral buckling, with tamponade agents such as SF₆ gas (20%), silicone oil (≈1300 cSt), or air. Postoperative BFAF imaging assessed retinal displacement. Demographic and clinical data were recorded. Results: Macula-off detachments occurred in 56.1% of cases, while 43.9% were macula-on detachments. Phacovitrectomy was performed in 41.8%, simple vitrectomy in 33.7%, and scleral buckling in 24.5%. SF₆ gas was the most used tamponade, while silicone oil was used in 13.3%. Retinal displacement was detected in 16.3% of cases, predominantly downward (81.25%) and less commonly upward (18.75%). Macula-off detachments were significantly associated with displacement (81.2% vs. 51.2%, p = 0.027). No significant associations were found with other parameters. Metamorphopsia was reported in 12.5% of patients with displacement and 4.9% without, though the difference was not statistically significant. Conclusions: Retinal displacement can occur after primary RRD repair, irrespective of tamponade, though it tended to be less frequent with silicone oil and in macula-on detachments. It is significantly more common in macula-off cases, even with immediate postoperative prone positioning. These findings emphasize the need to refine postoperative positioning protocols to reduce displacement and its sequelae. Further studies should explore the impact of retinal displacement on visual function, particularly metamorphopsia, in patients with preserved best-corrected visual acuity. Full article

Phacoemulsification is performed within a highly dynamic intraocular environment, in which fluid exchange, pressure regulation, and tissue biomechanics interact continuously. Although modern cataract surgery is considered safe and efficient, disruption of this delicate intraoperative microenvironment remains a major source of complications. Among fluidics-related events, post-occlusion break surge represents one of the most critical destabilizing factors of the anterior chamber. A surge occurs when the sudden release of an occluded aspiration port generates an abrupt pressure–volume imbalance that cannot be immediately compensated by infusion, leading to a transient collapse of the intraocular environment. This narrative review integrates current experimental and clinical evidence on the pathophysiology, quantification, and technological control of surge, framing it as a model of environmentally driven intraoperative stress. The evolution of phacoemulsification fluidics, from gravity-based systems to active, adaptive, and predictive platforms, is analyzed in relation to their ability to preserve a stable and physiologic intraocular environment. Comparative data from contemporary devices are reviewed, highlighting differences in surge volume, recovery time, and pressure restitution. Special emphasis is placed on the impact of surge on the microenvironments of both the anterior and posterior segments, including endothelial stress, capsular instability, vitreoretinal traction, and macular perfusion. Emerging strategies such as handpiece-integrated pressure sensors, predictive fluidics algorithms, intraoperative imaging, and artificial intelligence are reshaping environmental control during surgery. Despite substantial technological progress, the complete elimination of surge remains an unmet need. Continued innovation, standardized biomechanical models, and robust clinical validation will be essential to further protect the intraoperative intraocular environment and improve long-term visual outcomes. Full article

Ocular disorders such as keratitis, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and dry eye disease (DED) are highly prevalent worldwide and remain major causes of visual impairment and blindness. Conventional therapeutic approaches for ocular diseases, such as eye drops, surgery, and laser therapy, are frequently hampered by limited drug bioavailability, rapid clearance, and treatment-related complications, primarily due to the eye’s unique anatomical and physiological barriers. Hydrogels, characterized by their three-dimensional network structure, high water content, excellent biocompatibility, and tunable physicochemical properties, have emerged as promising platforms for ophthalmic drug delivery. This review summarizes the classification, fabrication strategies, and essential properties of hydrogels, and highlights recent advances in their application to ocular diseases, including keratitis management, corneal wound repair, intraocular pressure regulation and neuroprotection in glaucoma, sustained drug delivery for AMD and DR, vitreous substitutes for retinal detachment, and therapies for DED. In particular, we highlight recent advances in stimuli-responsive hydrogels that enable spatiotemporally controlled drug release in response to ocular cues such as temperature, pH, redox state, and enzyme activity, thereby enhancing therapeutic precision and efficacy. Furthermore, this review critically evaluates translational aspects, including long-term ocular safety, clinical feasibility, manufacturing scalability, and regulatory challenges, which are often underrepresented in existing reviews. By integrating material science, ocular pathology, and translational considerations, this review aims to provide a comprehensive framework for the rational design of next-generation hydrogel systems and to facilitate their clinical translation in ophthalmic therapy. Full article

Background and Clinical Significance: Macular holes are rare in pediatric patients and most often result from blunt trauma, commonly from soccer-related injuries. These cases present unique challenges due to delayed presentation, tightly adherent hyaloid layers, and difficulties with postoperative positioning. Larger, chronic macular holes have low spontaneous closure rates and poorer surgical outcomes, necessitating advanced surgical approaches. Herein we report a case of chronic traumatic macular hole in a pediatric patient that closed with an internal limiting membrane (ILM) flap surgical technique with silicone oil tamponade. Case Presentation: A 15-year-old male patient presented with a history of blunt ocular trauma from a soccer ball one year prior, resulting in a large chronic macular hole. The decision was made to perform pars plana vitrectomy with an inverted ILM flap technique and silicone oil tamponade. To stabilize the ILM flap and prevent displacement, a novel technique involving the placement of a single drop of silicone oil on the retinal surface prior to complete silicone oil fill was employed. This “silicone oil drop” technique allowed for smoother propagation of the oil over the flap, effectively securing it without the need for additional manipulation or perfluorocarbon liquid. Postoperatively, the macular hole was closed, and the patient’s vision improved. Conclusions: This case highlights the potential benefits of the ILM flap technique in treating pediatric macular holes with utilization of silicone oil as not only a tamponade but as a method to stabilize the flap. Full article

Presbyopia-correcting IOLs have revolutionized cataract surgery by enabling functional vision across multiple focal distances, thereby reducing dependence on spectacles. These lenses—ranging from multifocal to extended depth-of-focus (EDOF) and hybrid designs—incorporate advanced optical technologies to address the limitations of traditional monofocal IOLs. Despite their clinical promise, patient satisfaction remains variable, with a substantial subset experiencing postoperative visual discomfort. This review provides a comprehensive overview of presbyopia-correcting IOL technologies, detailing their optical principles, design evolution, and clinical performance. It further analyzes the multifactorial causes of postoperative dissatisfaction, which include optical phenomena such as glare, halos, and reduced contrast sensitivity; ocular comorbidities like dry eye disease, corneal irregular astigmatism, glaucoma, and macular pathology; and surgical variables including IOL centration, pupil size, and biometry accuracy. Additionally, non-physiological factors—such as patient expectations, lifestyle demands, and psychological disposition—play a critical role in perceived outcomes. To address these challenges, the review explores evidence-based strategies for improving satisfaction. These include rigorous preoperative screening for ocular surface disease and aberrations, personalized lens selection based on anatomical and functional criteria, and thorough patient counseling to align expectations with achievable results. Emerging IOL designs that blend multifocal and EDOF features offer promising avenues for minimizing visual disturbances while preserving range of vision. By integrating optical innovation with individualized clinical care, ophthalmologists can enhance postoperative outcomes and optimize real-world satisfaction with presbyopia-correcting IOLs. Full article

Background: The recently defined pachychoroid disease spectrum (PDS), which includes central serous chorioretinopathy (CSCR), is a group of retinal disorders that share the common characteristic of a thick, dilated, hyperpermeable choroid. This study aimed to evaluate the efficacy of difluprednate and loratadine in the treatment of pachychoroid disease spectrum (PDS). Methods: A retrospective study of 27 eyes from 19 patients with macular edema secondary to chronic PDS were treated with topical difluprednate and oral loratadine at a tertiary medical center. Visual acuity and optical coherence tomography (OCT) images were analyzed at baseline, 1-, 2-, 3-, 6-, 12-month, and final follow-up. Baseline was defined as the initiation of topical difluprednate. Patients with neovascularization or who had other concurrent treatments for PDS were excluded. Subfoveal choroidal thickness was measured at each time point. Response was defined as eyes that showed a reduction in intra- or subretinal fluid. Results: All 27 eyes studied responded to treatment. Of these, 70.4% resolved by 4 months and 81.5% by 6 months, with 52.2% of these patients having recurrences related to cessation or tapering of topical steroids. Visual acuity remained stable (p > 0.05) while subfoveal choroidal thickness decreased compared to baseline (p < 0.001) across all time points. Eleven (40.7%) of the eyes developed increased intraocular pressure, for which seven (25.9%) required incisional surgery. Conclusions: Chronic PDS can be treated with a combination of topical difluprednate and oral antihistamines to reduce retinal edema and subfoveal choroidal thickness. The effectiveness of therapy could be linked to the regulation of mast cell degranulation, necessitating a well-powered prospective randomized clinical trial. Full article

Background/Objectives: The aim of the present study was to identify preoperative functional and anatomical parameters that better predict postoperative best corrected visual acuity (BCVA) after full-thickness macular hole (MH) surgery during long-term follow-up. Methodology: Initial visual outcomes, medical history, retinal imaging data, microperimetry and mfERG measurements were collected to characterise functional and morphological macular status. Results: Among the study subjects, 22 presented with a BCVA > 0.5, and 20 presented with a BCVA ≤ 0.5 at the final visit. Multivariate regression analysis revealed that a smaller minimum MH diameter (OR = 0.98; 95% CI = 0.87–0.99; p = 0.004) and a shorter disease duration (OR =0.11; 95% CI = 0.02–0.53; p = 0.005) were predictors of postoperative long-term BCVA > 0.5. Baseline P wave amplitudes in the central ring on mfERG were positively correlated with postoperative BCVA gain (Rs = +0.53, p = 0.001). Conclusions: Our findings corroborate the significance of hole diameter measurements for postoperative visual outcomes and support the rationale of early intervention. Full article

Objectives: To assess retinal microvascular changes in patients with Grade II and III obesity before and after bariatric surgery using Optical Coherence Tomography Angiography (OCTA), and to compare these metrics with age- and sex-matched healthy controls. Methods: Prospective, consecutive, longitudinal cohort study with a 12-month follow-up. Grade II and III obese patients scheduled for bariatric surgery underwent comprehensive ophthalmic examinations, including OCTA imaging, prior to the surgery and postoperatively at 1 month, 6 months, and 12 months post-surgery. Results: A total of 43 eyes from 43 patients with obesity (one eye per patient) were included at baseline. At 12 months post-surgery, there was a significant increase in vessel density (VD) (16.70 vs. 17.68; p < 0.01) and perfusion density (PD) (0.406 vs. 0.433; p < 0.01), reaching values comparable to those of the control group (17.73 and 0.434, respectively). Significant reductions were also observed in body mass index (BMI) (43.74 vs. 29.53; p < 0.01), body weight (122.44 kg vs. 81.90 kg; p < 0.01), and intraocular pressure (IOP) (15.72 mmHg vs. 14.16 mmHg; p < 0.01). Conclusions: This study demonstrates a compelling association between obesity and retinal microvascular impairment, highlighting the efficacy of bariatric surgery not only in achieving substantial weight loss but also in improving the retinal perfusion of these patients, achieving metrics at 12 months comparable to age- and sex-matched healthy controls at baseline. These findings raise the hypothesis of the potential utility of OCTA as a monitoring tool for tracking the microvascular status in patients with obesity undergoing bariatric surgery in a longitudinal manner. Full article

The relationship between retinal images and intraocular cytokine profiles remains largely unexplored, and no prior work has systematically compared fundus- and OCT-based deep learning models for cytokine prediction. We aimed to predict intraocular cytokine concentrations using color fundus photographs (CFP) and retinal optical coherence tomography (OCT) with deep learning. Our pipeline consisted of image preprocessing, convolutional neural network–based feature extraction, and regression modeling for each cytokine. Deep learning was implemented using AutoGluon, which automatically explored multiple architectures and converged on ResNet18, reflecting the small dataset size. Four approaches were tested: (1) CFP alone, (2) CFP plus demographic/clinical features, (3) OCT alone, and (4) OCT plus these features. Prediction performance was defined as the mean coefficient of determination (R²) across 34 cytokines, and differences were evaluated using paired two-tailed t-tests. We used data from 139 patients (152 eyes) and 176 aqueous humor samples. The cohort consisted of 85 males (61%) with a mean age of 73 (SD 9.8). Diseases included 64 exudative age-related macular degeneration, 29 brolucizumab-associated endophthalmitis, 19 cataract surgeries, 15 retinal vein occlusion, and 8 diabetic macular edema. Prediction performance was generally poor, with mean R² values below zero across all approaches. The CFP-only model (–0.19) outperformed CFP plus demographics (–24.1; p = 0.0373), and the OCT-only model (–0.18) outperformed OCT plus demographics (–14.7; p = 0.0080). No significant difference was observed between CFP and OCT (p = 0.9281). Notably, VEGF showed low predictability (31st with CFP, 12th with OCT). Full article

Background/Objectives: Posterior vitreous detachment (PVD) is an age-related physiological process, yet the clinical and biometric factors influencing its progression remain incompletely characterized in adults undergoing routine ophthalmic evaluation at a tertiary center. Characterizing expected vitreous patterns is essential for interpreting vitreoretinal interface changes in disease. This study aimed to identify independent clinical and biometric factors associated with more advanced PVD stages in adults without macular pathology. Methods: In this cross-sectional observational study, 340 eyes from 198 consecutive adults undergoing routine ophthalmological evaluation at a tertiary hospital (March 2022–April 2023) were analyzed. Eyes with current or past macular disease were excluded. Demographic variables, systemic comorbidities and ocular history were recorded. Axial length was measured using optical biometry IOLMaster 700 (Carl Zeiss Meditec, Jena, Germany). Vitreous status was assessed with 10-MHz B-scan ultrasonography and classified as no PVD, partial PVD or complete PVD. Analyses were performed at the eye level. Given its cross-sectional design, this study evaluates associations and cannot establish causal relationships. Bivariate comparisons examined associations between clinical variables and PVD grade. Multivariable modeling was conducted using a clustered generalized estimating equations (GEE) ordinal logit model as the primary analysis, and a secondary independent-eye ordinal logistic regression model was used to evaluate the proportional-odds assumption and model robustness. Results: Mean age was 55.6 ± 18.3 years, and 68.5% of eyes were from female participants. No PVD, partial PVD and complete PVD were present in 30.9%, 43.5% and 25.6% of eyes, respectively. In the primary GEE model, axial length (OR 1.35; p < 0.001), systemic hypertension (OR 7.13; p < 0.001), and prior cataract surgery (OR 2.13; p = 0.020) were independently associated with more advanced PVD stages. Age showed a modest but significant association with increasing PVD severity (OR 1.03; p = 0.012). Sex and diabetes mellitus were not associated with PVD grade. The independent-eye ordinal model yielded consistent effect directions. Conclusions: In adults without macular disease, more advanced PVD stages are independently associated with axial elongation, systemic hypertension, and previous cataract surgery, while age shows a mild but significant association. These findings provide clinically useful contextual reference information for interpreting vitreoretinal interface changes in health and disease. These associations should not be interpreted as causal due to the cross-sectional nature of the study. Full article