European Journal of Ophthalmology

This study assessed the readability, reliability and accuracy of patient information leaflets on Descemet Membrane Endothelial Keratoplasty (DMEK), generated by seven large language models (LLMs). The aim was to determine which LLM produced the most patient-friendly, comprehensible and evidence-based leaflet, measured against a leaflet written by clinicians from a tertiary centre.

Each LLM was given the prompt, “Make a patient information leaflet on Descemet Membrane Endothelial Keratoplasty (DMEK) surgery.” Readability metrics (FKG, FRE, ARI, Gunning Fog), reliability metrics (DISCERN, PEMAT), misinformation detection and reference analysis were recorded for each response. A weighted scoring system normalised results on a 0–100% scale.

The clinician-generated leaflet scored the highest (92%). Claude 3.7 Sonnet had the top LLM score (77.8%), with strong readability and referencing. ChatGPT-4o followed closely (70.9%) but lacked references. Moderate scores for DeepSeek-V3, Perplexity AI and Google Gemini 2.0 Flash. ChatGPT-4 and Microsoft CoPilot scored the lowest due to limited reliability and misinformation.

LLMs show promise in generating patient education material but vary in reliability and accuracy. Claude 3.7 Sonnet was the best performing LLM, though none matched in quality to the clinician-generated leaflet. LLM-generated leaflets therefore require clinician oversight before safe clinical use.

To analyze and compare the accuracy of different intraocular lens power calculation formulas in patients with cataract after radial keratotomy.

Web of Science, Cochrane Library, EMBASE and PubMed were searched for clinical studies published from the establishment of the database to 10th May 2024. Measurements were taken as percentage of eyes of prediction errors within ±0.5 D and ±1.0 D. A network meta-analysis was utilized to compare the different formulas as a way to identify the most advantageous ones.

Results from 11 studies of 674 eyes after radial keratotomy that used 24 formulas were included. A network meta-analysis indicated that for error within the range of ± 0.5 D, Barrett true-K History and Barrett true-K Partial History were better than Double-K Holladay 1. Intraoperative Aberrometry, Double-K SRK/T, Haigis and Barrett true-K No History performed as well or better than Double-K Holladay 1. Shammas No History and Holladay 1 had poor performance. For error within the range of ±1.0 D, Shammas No History and Barrett Universal II had poor performance. No statistically significant difference was observed between the other formulas.

For cataract patients after radial keratotomy, Barrett true-K History and Barrett true-K Partial History were recommended if the prior medical history were available. Otherwise, no single formula is more advantageous without reference to prior medical history.

To compare the corneal biomechanical characteristics following accelerated cross-linking (A-CXL) and diluted alcohol and iontophoresis-assisted corneal cross-linking (DAI-CXL).

Forty-nine eyes from 41 patients who underwent DAI-CXL or A-CXL for progressive keratoconus were included. Visual acuity, topographic, and biomechanical data were analyzed preoperatively and 12 months postoperatively.

A significant decrease in flat keratometry (K1) and thinnest corneal thickness (TCT) was observed in the A-CXL group between baseline and postoperatively (K1, p = 0.001; TCT: p = 0.007). Both groups showed a significant decrease in steep keratometry (K2) and maximum keratometry (Kmax) compared to baseline (K2: p = 0.03, p < 0.001, respectively; Kmax: p < 0.001 for both groups). Postoperatively, highest concavity time (HCT) was significantly lower (p = 0.007), and highest concavity peak distance (HCPD) was significantly higher (p = 0.034) in the DAI-CXL group compared to the A-CXL group. A significant increase in applanation 1 velocity (A1V), HCPD, and deformation amplitude (DA) (p = 0.03, 0.007, 0.02, respectively) and a decrease in Ambrósio relational thickness to the horizontal profile (ARTh) (p < 0.001) were noted in the A-CXL group at 12 months. The DAI-CXL group showed a significant decrease in HCT, integrated radius (IR), and ARTh (p = 0.006, 0.011, 0.009, respectively) between baseline and postoperative assessments. Corvis Biomechanical Factor (CBiF) and E-stage remained stable in both groups.

DAI-CXL and A-CXL demonstrate comparable efficacy in achieving visual, topographic, and biomechanical stabilization in progressive keratoconus over a 12-month period.

The aim of our study was to evaluate the outcome of trabeculectomy with respect to surgeon's experience and to explore additional contributing factors.

This retrospective study was conducted analyzing consecutive single-surgeon cases from October 2019 to June 2022 receiving TE with mitomycin C. Eyes were categorized into five groups based on surgeon experience: E1 for the first 50 TEs, E2 for 51–100, E3 for 101–150, E4 for 151–200, E5 for 201–300. Complete success at one year was defined as an IOP <18 mmHg and 20%-IOP reduction without glaucoma eye drops and revision surgeries.

300 eyes were included (mean age 68.8 ± 13.0 years, 58.3% female). 55.7% had primary open-angle glaucoma. The baseline IOP was 23.4 ± 8.7 mmHg with 3.0 ± 0.9 different antiglaucomatous medication. After 12 months, the complete success for E1 to E5, it was 83.0%, 86.7%, 87.4%, 75.3% and 79.1% (p < 0.0001) with IOP 12.8 ± 6.1, 12.8 ± 6.3, 11.5 ± 4.6, 12.9 ± 6.5, 12.9 ± 4.7 mmHg while there was a higher number of NTG cases in E4 and E5 (p = 0.04).

Even a novice surgeon can achieve a good surgical outcome within the first 50 trabeculectomy under the guidance of an experienced surgeon. When comparing surgical results over time, it is important to incorporate case entity and severity.

To evaluate anterior scleral thickness (AST) in patients with ocular hypertension (OHT) using anterior segment-optical coherence tomography (AS-OCT).

Forty-two eyes of 21 patients with OHT and 40 eyes of 40 healthy participants were included in this cross-sectional study. AST was measured at the level of the scleral spur (SS)(AST-0), 1000 µm posterior of the SS (AST-1), and 2000 µm posterior of the SS (AST-2) in the nasal and temporal quadrants using AS-OCT.

The mean ages were 58.2 ± 12 (27–78) for OHT group; 54.2 ± 9.8 (21–70) years for control group (p > 0.05). The mean nasal AST-0, AST-1 and AST-2 were 647 ± 25.7 (592–689), 490.7 ± 16.4 (453–526), 513.6 ± 19.2 (481–554) µm in OHT group; 701.7 ± 44.9 (605–785), 521.7 ± 33.4 (433–579), 535.5 ± 33.3 (449–599) µm in control group, respectively. The mean temporal AST-0, AST-1 and AST-2 were 667 ± 28.9 (620–723), 495.9 ± 18.7 (459–545), 509.3 ± 24 (430–596) µm in OHT group; 718.1 ± 45.9 (618–796), 525.3 ± 29.8 (456–583), 533.4 ± 41 (450–611) µm in control group, respectively. Mean ASTs measured at all three points in OHT group were significantly thinner than in control group in both nasal and temporal quadrants (p < 0.05).

We found that the scleral thickness was significantly thinner in OHT patients. It is still unknown whether the sclera plays a role in the OHT pathogenesis by affecting the biomechanical response of the globe to IOP elevation. Or conversely, sclera may undergo structural changes secondary to long-term IOP elevation in OHT. Although there are hints about the relationship between sclera and IOP, the mechanisms are still unclear.

To investigate the association between cognitive function and the results and reliability of standard automated perimetry (SAP) in a middle-aged birth cohort.

In this cross-sectional analysis of the prospective birth cohort, the reliability and performance of SAP were evaluated in relation to grade point average (GPA), educational attainment, and scores on the Paired Associates Learning (PAL) test among participants of the Northern Finland Birth Cohort Eye Study.

Higher educational level, higher GPA, and fewer errors on the PAL test were consistently associated with better reliability and performance in SAP. However, the observed correlation coefficients were low, and differences between group comparisons were modest, accounting for only a small proportion of the variance in SAP outcomes.

While greater cognitive ability is positively associated with SAP performance and reliability, its impact is minimal and unlikely to be clinically significant. Further studies are warranted to determine whether higher cognitive function facilitates glaucoma diagnosis and monitoring through more reliable SAP results, or conversely, whether it may obscure glaucomatous damage by enhancing test performance beyond what is typical.

To compare and evaluate the diagnostic performance of OCT-angiography (OCT-A) parameters in diabetic retinopathy (DR) detection compared to fluorescein angiography (FA).

This is a cross-sectional, prospective study including 118 diabetic patients (214 eyes). All patients had a complete clinical examination with FA as well as macular OCT-A imaging (3 × 3 mm, 6 × 6 mm). We compared the detection of fundamental DR lesions using both imaging modalities and assessed the diagnostic value of different OCT-A parameters.

Microaneurysms were more frequently detected by FA than with OCT-A. Intraretinal microvascular anomalies were equally visualized by OCT-A (0.27 ± 0.777) and FA (0.27 ± 0.71). Average of foveal avascular zone (FAZ) surface was less significant at superficial capillary plexus (SCP) (0.353 ± 0.107 mm²) compared to deep capillary plexus (DCP) (0.537 ± 0,135 mm²), (p < 0.001). FAZ remodeling was observed even in DR free eyes and was better identified in DCP (61.1%) than SCP (47.2%). Loss of FAZ circularity was estimated at 0.792 ± 0.081 and 0.741 ± 0.107 respectively in SCP and DCP, (p < 0.001). Average surface area of capillary non-perfusion zones (CNPZ) was 0.487 ± 0.514 mm² in SCP and 0.145 ± 0.223 mm² in DCP, (p < 0.001). The Most reliable OCT-A quantitative parameters for DR screening were: CNPZ surface in DCP (p = 0.0046), total vascular density (VDt) in the DCP (p = 0.003) and CNPZ surface in the SCP (p = 0.0027).

OCT-A enables diabetic microvascular abnormalities detection even at a preclinical stage. Certain OCT-A parameters may provide a valuable quantitative approach for diagnosis and grading of DR severity.

To investigate the effect of nutritional status on pupillary responses in children aged 5 to 18 years.

This cross-sectional study comprised 92 eyes of malnourished children and 80 eyes of age- and gender-matched healthy children based on BMI Z-score. Serum ferritin, hemoglobin, serum 25-hydroxyvitamin D, and vitamin B12 levels were recorded. Pupillary responses were taken using Sirius topography (CSO, Italy) with the automated pupillometry function. Static pupillometry consisted of pupil diameters at scotopic, mesopic, and photopic luminances. In dynamic pupillometry, the mean pupil dilation speed at the 10th second was calculated by dividing the distance by time in each 0.2 s period.

No significant difference was observed between the groups regarding age, gender, visual acuity, and spherical equivalent (p > 0.05). Mean hemoglobin, serum ferritin, serum 25-hydroxyvitamin D, and vitamin B12 levels were lower in malnourished children than healthy children (p < 0.001). The malnutrition group had lower mean pupil diameters under all luminance and higher speed of pupil dilation compared to the control group (p < 0.05). While malnutrition subgroups were similar in terms of pupil diameters under all luminance (p > 0.05), the speed of pupil dilation was significantly different between the groups (p = 0.024). BMI z-score was positively correlated with mesopic and photopic pupil diameter but also negatively correlated with the speed of pupil dilation (p < 0.05).

Malnourished children have smaller pupil diameters and higher speed of pupil dilation than healthy controls, indicating an autonomic impairment.

The aim of this article is to describe the outcomes of a case series using our own variation of the four-petal evisceration technique which may minimize the rate of orbital implant exposure through a simple approach.

Our new technique consists of incompletely dividing the first two scleral flaps, thus creating four incomplete petals that can be sutured over the orbital implant. A case series with a minimum follow-up of 12 months is reported.

One hundred and twenty-two eyes of 121 patients who underwent evisceration surgery using the described technique are included. No cases of implant exposure or extrusion were observed, and an ocular prosthesis could be adapted in all cases with no complications during a minimum follow-up of 12 months.

The modified “incomplete” four-petal evisceration technique is a safe and accessible technique that may help prevent orbital implant exposure and can be considered a valid alternative in various clinical scenarios.

This study aims to describe the impact on survival of non-exenteration management of orbital disease, supplemented with transcutaneous retrobulbar injection of amphotericin B (TRAMB), in a cohort of patients with COVID-19-associated ROCM, a life-threatening condition for which exenteration is generally the preferred treatment modality.

Method: This retrospective cohort study included 69 COVID-19-associated ROCM patients. All patients were treated with intravenous liposomal amphotericin-B and surgical debridement of paranasal sinuses. All patients with orbital disease were treated with TRAMB (42/69); orbital debridement or extended enucleation was performed when the disease was severe or progressive; debridement of intracranial disease was done when indicated.

Of the 69 patients included, at discharge, 45/69(65.2%) had cured/stable ROCM, 13/69(18.8%) died and 11/69(15.94%) were discharged on request, with progressive disease. The vision was preserved in 45/69(65%), a blind eye with preserved ocular globe in 18/69(26%), and 6/69(9%) underwent extended enucleation. At 18 months follow-up, 6/56 died, 13/56 were lost to follow-up and 37/56 were alive. The cumulative mortality was 27% (19/69). Independent risk factors for mortality were increasing age(p = 0.003), diabetic ketoacidosis(p = 0.006), severe COVID-19 (p = 0.04), and CNS involvement (p = 0.01).

In this study, conservative orbit management sans exenteration augmented with retrobulbar injection of amphotericin B was an effective treatment modality for orbital involvement in ROCM. The mortality in our patients was comparable to reports where exenteration was the first line of treatment, with better vision and cosmetic outcomes. Further studies comparing orbit conservation with TRAMB versus exenteration may be needed to delineate further, whether this approach can be an alternative to exenteration.

Retinopathy of prematurity (ROP) is a blinding disease, however largely preventable by timely detection of severe ROP and treatment when required. Clinical use of the DIGIROP decision support tool (DIGIROP-screen and DIGIROP-birth) can help detecting neonates at high risk of sight-threatening severe ROP needing treatment and to reduce unnecessary screening exams in low-risk infants. External validation is necessary before the tool can be used in clinical decision-making.

Retrospective cohort analysis of all preterm infants who were screened for ROP at the University Hospitals Ghent Belgium from January 1, 2020, to December 31, 2022. Validation of the DIGIROP decision support tools was the primary outcome variable. In a secondary analysis pre-, peri-, and postnatal characteristics were compared in different cohorts.

311 infants were eligible for routine ROP-screening. Infants with a (gestational age) GA beyond 30 weeks (N = 80) and those who died (N = 19) were excluded resulting in 212 infants eligible entered in DIGIROP-birth. 112 infants did not need to be screened according to DIGIROP-birth. This resulted in 94 infants entered in DIGIROP-screen. These infants had a median GA of 27 weeks, a median birth weight (BW) of 892.5 g, and 62.5% were boys. DIGIROP birth showed a sensitivity of 100%. Most important risk factors for ROP across all subgroups are GA, BW.

The DIGIROP decision support tool demonstrated very high performance in our setting. However, multicenter prospective validation studies with large cohorts should confirm our findings before the use of the model can be generalized in Western NICU's with similar levels of care.

To report the deviation type, visual and refractive characteristics of patients with dissociated vertical deviation (DVD) requiring unilateral or bilateral strabismus surgery.

This study included 180 patients with DVD who underwent unilateral or bilateral strabismus surgery at Farabi Eye Hospital.Age, refractive error (RE), Corrected distance visual acuity (CDVA), strabismus angle, presence of amblyopia, and postoperative outcome.

Thirty-eight patients were in unilateral (78.9% bilateral) group. In the unilateral group, CDVA was significantly worse in surgical eyes versus fellow eyes (P < .001). The mean spherical equivalent in surgical eyes was insignificantly hyperopic than fellow eyes (P = 0.354). The mean angle of DVD was greater at distance than near (P < .05). Furthermore, the most prevalent type was “DVD plus horizontal deviation” (47.4%), followed by pure DVD (23.7%), “combined DVD, hypertropia (HT) and horizontal deviation” (13.2%), and “HT plus DVD” (15.8%). CDVA in cases needing bilateral surgery in the right and left eye were 0.91 ± 0.17 and 0.90 ± 110.17, respectively.In the bilateral group, RE components were similar between eyes but lower than surgical eyes in patients with unilateral surgery (P < .05). Moreover, the mean angle of DVD was higher at a distance compared to near.The most prevalent type was “DVD plus horizontal deviation” (64.1%), followed by pure DVD (18.3%), “combined DVD, HT and horizontal deviation” (13.4%), and “HT plus DVD” (4.2%).

The study highlighted significant differences in VA, RE, and prevalence of amblyopia between the two groups.Furthermore, the varying types of coexisting deviations observed in unilateral and bilateral surgery cases emphasize the importance of personalized treatment approaches for patients with DVD.

To report a rare case of acute corneal hydrops and conjunctival ulceration secondary to acquired syphilis.

A male in his late 30's presented with redness, pain, and watering in both eyes and sudden loss of vision in the left eye. Examination revealed bilateral conjunctival ulcers along with well-circumscribed corneal edema with blunt stunted intrinsic vessel in the left eye. Anterior-Segment Optical Coherence Tomography revealed immense corneal edema with stunted vessels suggestive of acute hydrops.

Topical moxifloxacin with oral doxycycline was administered along with oral acetazolamide. The patient's serology (VDRL) was positive with Treponema Pallidum Hemagglutination Assay positivity. Intramuscular benzathine penicillin injections (weekly; 3 injections) were given and subsequently, there was complete resolution with corneal scarring and restoration of vision to 20/60 in the left eye.

This is the first case to illustrate acute hydrops as a presenting sign of ocular syphilis.

Conjunctival involvement in sarcoidosis typically presents as non-scarring granulomatous inflammation; however, cicatricial conjunctivitis represents a rare and poorly characterised manifestation. There are currently no published reports of sarcoid-related conjunctival granulomas with cicatrising features responding to anti-TNF therapy. We present the first case of biopsy-confirmed conjunctival sarcoidosis with progressive scarring successfully treated with adalimumab after failure of conventional immunosuppression.

A 47-year-old male with biopsy-proven systemic sarcoidosis presented with recurrent anterior uveitis and progressive conjunctival granulomas, unresponsive to corticosteroids and mycophenolate. He developed forniceal foreshortening, symblepharon formation, and a dense cataract. Conjunctival biopsy confirmed non-necrotizing granulomatous inflammation. Adalimumab was initiated following disease progression on conventional therapy. Within six months, ocular surface inflammation resolved, enabling successful cataract surgery and visual rehabilitation.

To our knowledge, this is the first documented case of sarcoid-related cicatricial conjunctivitis with histological confirmation responding favourably to anti-TNF therapy. This report suggests adalimumab may be a valuable option in cases of treatment-resistant ocular surface sarcoidosis and may guide future therapeutic decision-making.

Sinonasal mucosal melanoma (SNMM) accounts for approximately 4–8% of sinonasal malignancies. SNMM frequently originates in the nasal cavity, causing nonspecific nasal symptoms that inevitably delay diagnosis. Left untreated, the tumor may extend into the orbit.

Herein, the authors describe two patients presenting with compressive optic neuropathy and were found to have advanced SNMM involving the orbit. Both patients presented with vision loss, decreased color vision, proptosis, conjunctival chemosis, and restricted extraocular movements. One patient was found to have a relative afferent pupillary defect. Neither patient was a surgical candidate, and both received palliative radiotherapy and immunotherapy.

These cases and literature review demonstrate the potential for the disease to initially manifest with orbital extension and ocular symptoms. Ophthalmologists can play a crucial role in the early detection of SNMM, which may improve outcomes, given the challenges of SNMM treatment.

To report a case of fungal sclerouveitis caused by Alternaria doliconidium, misdiagnosed as autoimmune scleritis and incorrectly treated with immunosuppressive therapy.

A 69-year-old man presented with progressive chronic necrotizing scleritis in his right eye following ocular trauma. Initial treatment with antimicrobial and steroid therapy showed no improvement, and a scleral biopsy yielded inconclusive results. Autoimmune scleritis was suspected, leading to treatment with systemic steroids and immunosuppressants. Upon further examination, nodular necrotizing scleritis with scleral translucency and whitish floccules in the anterior chamber was observed, prompting a suspicion of fungal etiology. Molecular analysis via PCR confirmed the presence of Alternaria doliconidium.

This case underscores the importance of considering fungal pathogens in cases unresponsive to conventional treatment and the critical role of advanced molecular diagnostics. This is the first reported case of sclerouveitis caused by Alternaria doliconidium, expanding the spectrum of ocular infections associated with this genus.

Muscle eye brain disease (MEB) is a rare, multi-systemic autosomal recessively inherited disorder of relevance to ophthalmologists. The aim of this report is to describe a novel ocular phenotype for a genetically confirmed MEB patient using retinal multi-modal imaging.

We report a case of 18-year-old male patient that was referred to our tertiary unit for management of retinal detachment. Fundoscopic examination indicated optic nerve and macula hypoplasia, retinal hypo-pigmentation, and unilateral retinal detachment. There were no retinal breaks found in association with retinal detachment affecting the left eye. A well demarcated temporal pigmentary retinopathy with a ‘ghost’ retinal vessel in fundus autofluorescence image suggested spontaneous retinal reattachment of the retina in the right eye. Fundus autofluorescence and optical coherence tomography images revealed the novel features of internal limiting membrane disruption and sub-retinal opacity in association with neurosensory separation of the left retina, which is consistent with histopathology in the human eye and the mouse models of the disease.

Our case suggests that retinal detachment in MEB disease should be managed conservatively in the absence of retinal breaks as spontaneous reattachment can occur. Extensive areas of non-perfusion should be treated with laser photo-coagulation to avoid the sequelae of retinal neovascularization. The mechanism for the development of retinal detachment without breaks is unknown.

iStent inject^® W is a minimally invasive surgical device aimed at creating an alternative trabecular drainage of aqueous humour, reducing intraocular pressure (IOP). International reports already support efficacy and safety, but evidence is lacking about the early-stage learning curve for this device.

This research was conducted in a teaching tertiary hospital in Lisbon, Portugal.

Retrospective study on the first 6 iStent inject^® W implants performed by 6 certified ophthalmic surgeons.

All procedures were combined with cataract surgery (phaco + iStent inject^® W). Primary outcome was total surgical time. Secondary outcomes were complications and postoperative IOP. Outcome data were collected preoperatively and at postoperative days 1, 7, 30, and 90.

Thirty-six patients were included (58% female). Mean age was 73.28 ± 9.65 years. Mean surgical time of first surgery was 35.16 min (range 20 to 55), with surgical time decreasing by 8.5 min throughout the learning curve. Mean preoperative IOP was 21.81 ± 4.74 mmHg with a mean need of 2 medications. At 1-month, mean IOP was 16.00 ± 3.12 mmHg (−26.64% than baseline) while resorting to less medication (2.00 ± 0.94 to 0.66 ± 0.95; p < 0.01). Trabecular meshwork haemorrhage was the most common intra-operative complication reported, and no surgical complications requiring secondary intervention were recorded.

iStent inject^® W was perceived as a fast-learning procedure, with a significant safety profile in the first cases. The magnitude of IOP reduction of this combined procedure makes it an interesting approach to the glaucoma patient requiring cataract surgery, performed either by a resident under supervision or a glaucoma consultant.

To evaluate the outcome of PPV in PDR patients with a Light Perception (LP) visual acuity at the time of signing up for surgery.

This retrospective study reviewed patient records from Harbor-UCLA and Olive View Medical Centers between March 2018 and March 2022. 32 patients (32 eyes) with LP visual acuity prior to surgery were included. Preoperative, intraoperative, and postoperative data were collected. Visual outcomes were assessed at 3 months (POM3), 6 months (POM6), and final follow-up. Statistical analyses included paired T-tests for visual acuity comparisons, linear regression for outcome predictors, and logistic regression for macular detachment risk factors.

Significant visual improvement at POM3 (BCVA 20/660) and POM6 (BCVA 20/890) were observed compared to baseline, with a final follow-up BCVA of 20/600. At final follow-up, 37.5% of patients showed no improvement, with 12.5% experiencing No Light Perception (NLP). Multivariable analysis identified longer surgical duration as a significant negative predictor of achieving BCVA of 20/100 or better. Preoperative rhegmatogenous retinal detachment and a higher number of prior vitrectomies were associated with lower odds of maintaining retinal attachment at 6 months.

PPV provides a significant improvement in visual acuity for many patients with advanced PDR. However, a substantial portion of patients experience minimal or no improvement. Identified predictors of poorer outcomes can guide preoperative counseling and decision-making. This study highlights the need for careful consideration of surgical risks and benefits in advanced PDR cases.

To determine the value of central choroidal thickness (CCT) as a clinical marker in differentiating peripheral retinoschisis (PRS) and macula-on rhegmatogenous retinal detachments (mac-on RRD).

In this cross-sectional study, eyes with PRS from January 2012 to May 2021 and mac-on RRD from January 2017 to January 2019 were identified. Macular pathology was exclusionary. CCT was classified as thin, normal, or thick for all eyes. Primary outcomes assessed the proportion of eyes within each diagnostic category with thin, normal, and thick CCT.

One-hundred and sixty eyes with PRS and 59 eyes with mac-on RRD were identified. Thick (65.6%) or normal (25.0%) CCT was noted in 90.6% of eyes with PRS, while only 9.4% had thin CCT. Thin (52.5%) or normal (30.5%) CCT was noted in 83.0% of eyes with mac-on RRD, whereas only 17.0% had thick CCT's. Thick CCT was significantly observed in PRS (p < 0.0001), while thin CCT was significantly observed in mac-on RRD (p < 0.0001).

In the absence of known refractive error or axial length, CCT may serve as a useful and readily available diagnostic tool when attempting to distinguish between two often clinically similar retinal pathologies – PRS and mac-on RRD.

Cataract surgery is a fundamental procedure in ophthalmology, yet intraoperative complications such as anterior vitrectomy can compromise surgical outcomes. This systematic review and meta-analysis (CRD42025637001) aim to compare the incidence of anterior vitrectomy in cataract surgeries performed by ophthalmology residents versus experienced surgeons and assess factors contributing to surgical complications.

A systematic search was conducted across EMBASE, MEDLINE, CINAHL Plus, Web of Science, ClinicalTrials.gov, PQDT Global, ARVO and AAO for studies published after 2000 that reported on anterior vitrectomy incidence in cataract surgery. Eligible studies included randomized controlled trials and observational studies. Meta-analysis was performed using STATA v. 18.0.

Out of 1,190 screened studies, five studies (four retrospective cohort, one prospective cohort) involving phacoemulsification, extracapsular cataract extraction (ECCE), and femtosecond laser-assisted cataract surgery (FLACS) were included, encompassing a total of 4,918 cataract surgeries, and 208 anterior vitrectomy (AV) cases. The random-effects meta-analysis demonstrated a significant AV incidence for residents (ES = 0.04, 95% CI: [0.01, 0.06]), while the incidence for experienced surgeons was not statistically significant (ES = 0.03, 95% CI: [−0.03, 0.09]). High heterogeneity was observed among the included studies (I² = 92.1% for residents and I² = 96.7% for surgeons).

Residents may have a higher incidence of AV, highlighting the potential benefits of structured surgical training, early exposure, and mentorship in reducing intraoperative complications. Future research should explore simulation-based training and technology-assisted surgery to improve resident proficiency and patient outcomes.

Local anesthesia represents an alternative to general anesthesia in selected patients undergoing repair for open globe injuries. This study aimed to evaluate and compare visual acuity and clinical outcomes in such patients.

A systematic literature search was conducted across PubMed, Embase, Scopus, Cochrane Library, and Google Scholar. Adults (≥18 years) hospitalized with open globe injuries were included. Out of 551 articles screened, four observational studies met the inclusion criteria. Standardized Mean Differences (SMD) for continuous and Risk Ratios (RR) for dichotomous outcomes were pooled using the Inverse Variance method with a Random Effects model. Outcomes included visual acuity, wound location, wound length, and operative time.

Four retrospective case series comprising 1,690 patients were included. All studies had low risk of bias per the Newcastle-Ottawa Scale. No significant difference was observed in best corrected visual acuity between groups (MD = −0.18; 95% CI: −0.45 to 0.08; p = 0.17; I² = 55%). Patients in the local anesthesia group had more anterior wound locations (MD = 1.33; 95% CI: 1.06–1.66; p = 0.01; I² = 65%). Wound length (MD = −4.97; 95% CI: −5.95 to −3.98; p < 0.00001; I² = 0%) and operative time (MD = -33.32; 95% CI: −40.82 to −25.82; p < 0.00001; I² = 0%) were significantly shorter.

Local anesthesia was associated with more anterior wounds, shorter wound length, and reduced operative time without compromising visual outcomes. It may be a safe and effective alternative to general anesthesia in selected open globe injuries.

To explore a new suprachoroidal space (SCS) injection technique using an ingenious, handmade, and precise suprachoroidal injector based on the resistance feedback theory to treat recurrent macular edema.

We designed a suprachoroidal injector on the basis of the resistance feedback theory and fabricated it with readily available commercial materials. Nine patients with recurrent macular edema secondary to diabetic retinopathy or retinal vein occlusion who could not afford repeated anti-vascular endothelial growth factor treatment received suprachoroidal injection of triamcinolone acetonide using this injector. Changes in SCS, macular edema and visual acuity before and after injection were evaluated.

In all patients, anterior-segment optical coherence tomography revealed SCS expansion immediately after injection. At 1 month after injection, spectral-domain optical coherence tomography revealed a reduction in macular edema with average central subfield thickness decreasing from 574.56 ± 151.53 μm to 338.78 ± 61.26 μm, and best-corrected visual acuity improved from 0.87 ± 0.29 logMAR to 0.55 ± 0.24 logMAR. Complications such as increased intraocular pressure, cataract, retinal damage and fluid injection into the vitreous cavity were not observed.

This new injector is expected to provide an economical, safe, and precise SCS injection and may have potential for widely clinical application.