Abstract Purpose To assess treatment response of Polypoidal choroidal vasculopathy (PCV) in a Caucasian population of British ethnicity with intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections alone and with a combination of anti-VEGF injections and photodynamic therapy (PDT). Setting/Venue Department of Ophthalmology, University Hospitals Southampton NHS Foundation Trust, United Kingdom. Methods Retrospective review of 95 Caucasian patients (see Table 1) in a single centre with diagnosis of PCV between 2013 and 2018 were included. Best corrected visual acuity (BCVA), central retinal thickness (CRT), indocyanine green angiography (ICGA) characteristics, numbers and type of treatment were analysed at baseline and at 1 year. Results One hundred and six eyes included from 95 patients received either anti-VEGF injections (n = 72, 71.3%) alone or combination therapy with anti-VEGF and PDT (n = 13, 12.9%). A third untreated group was also observed (n=16, 15.8%). Five eyes were excluded from the study due to structural retinal damage. Mean number of injections was 16.4 in the monotherapy group and 19.9 in the combination group. Both treatment groups showed improvement in BCVA (See Table 2) at 1 year and this was statistically significant in the monotherapy group with a mean gain of 8.3 letters (p<0.001). Mean CRT decreased (see Table 3) in all treatment groups at twelve months and this change was significant (p<0.01). In the observation group, vision and CRT remained stable. Conclusions This study demonstrates significant improvements in BCVA at one year in our Caucasian cohort of British ethnicity with PCV in the treatment group.

Abstract Background: Losartan, a commonly used hypertension medication, is associated with rare neurological side effects. This report presents the first case of losartan-linked bilateral metamorphopsia - a distortion of visual perception. Case Presentation: A 65-year-old woman with hypertension and myopic degeneration developed bilateral metamorphopsia while taking losartan. Despite normal retinal exams and neuroimaging, the symptoms persisted. Discontinuation of losartan led to symptom resolution over one year with no recurrence. Conclusions: This unique case emphasizes the need to evaluate drug-related adverse events in clinical diagnoses. Losartan's potential impact on the midbrain's visual processing regions may explain the observed visual disturbances. Further research is needed to explore this connection.

Introduction: Release of pigments in the anterior chamber is frequently observed in pigment dispersion syndrome, an autosomal dominant disorder marked by bilateral pigment deposition on the anterior and possibly posterior lens capsule, zonules of the lens, trabecular meshwork, and corneal endothelium, in addition to radial, spoke-like transillumination defects in the mid peripheral iris [J Ayub Med Coll Abbottabad. 2017;29(3):412–414 and Optom Vis Sci. 1995;72(10):756–762]. Pigmentation of the anterior lens surface has also been associated with intraocular inflammation, pseudoexfoliation syndrome, siderosis, antipsychotic medication usage, and remnants of the tunica vasculosa lentis [Br J Ophthalmol. 1998;82(11):1344]. Case Presentation: A 23-year-old female presented to our eye clinic with chief complaint of mild blurring of vision in the right eye and inquired about refractive surgery. The patient denied any previous history of ocular inflammation, trauma, surgery, or use of topical or systemic medications. Slit-lamp examination of the right eye anterior segment was within normal limits except for the crystalline lens anterior capsular which showed confluent pigment deposits stellate in shape over the pupillary axis, whereas left eye examination was completely within normal limits. Ophthalmic examination of the posterior segment was normal in both eyes. Based on her previous ophthalmic history and slit-lamp examination of the right eye, a diagnosis of unilateral congenital lenticular pigmentation was made. Conclusion: Congenital lenticular pigmentation is a rare benign entity carrying no surgical indications with a relatively good visual response to optical correction. Recognition of this rare benign condition would add to the ophthalmologist’s differential of ocular pigmentation and avoid unnecessary concern and follow-up in more potentially progressive disorders such as pigmentary glaucoma.

Abstract Purpose: To evaluate the impact of home quarantine on myopia progression in Indonesian children during COVID-19 pandemic. Methods: This multicenter retrospective cohort study included children aged 8-17 years old from 20 hospitals across 9 provinces in Indonesia. Medical records of children diagnosed with myopia and/or astigmatism were obtained and grouped to pre-pandemic (September 2019-March 2020) and pandemic periods (September 2021-May 2022). Patient demographics and spherical equivalents of refraction (SER) were collected. Direct or phone interviews were conducted with questions regarding the child’s screen time, outdoor activity time, break time in between gadget use, and sleep duration. Results: In total, 607 children were enrolled. There was a significant increase in SER progression (-0.97 ± 1.04 D, p<0.001). SER progression in Java-Bali was higher compared to others (-1.3± 1.18 D vs 0.57± 0.67 D, p<0.001). A total of 262 patients were interviewed. Younger age (OR: 2.52, 95% CI:[1.42-5.03], p = 0.004), female gender (OR: 2.16, 95% CI:[1.18-3.83], p = 0.011), screen time of ≥4 hours daily for leisure activities (OR: 1.95, 95% CI:[1.07-3.54], p = 0.028), ≤1 hour of time spent outdoor daily (OR: 1.89, 95% CI:[1.03-3.47], p = 0.047, and sleep duration of >8 hours (OR: 2.7, 95% CI:[1.46-4.99], p = 0.002) were significantly associated with fast myopia progression. Conclusion: Myopia progression was accelerated during COVID-19 home quarantine, especially in more urban area. Collaborative efforts should be made to address this current issue.

This study systematically reviewed the performance of bandage contact lenses (BCL) such as lotrafilcon A, lotrafilcon B, senofilcon A, balafilcon A, and comfilcon A as postoperative treatment in different ocular surgeries. A systematic search of English and Chinese databases (from inception to December 2021) was conducted for studies reporting the efficacy of BCLs after ocular surgeries. Postoperative symptoms, corneal healing, and visual outcomes were studied. Overall, 38 studies were identified. Bandage contact lens was applied as a postoperative aid in corneal refractive, cataract, and vitrectomy surgeries. Most studies were on photorefractive keratectomy. Reduced postoperative symptoms were observed within 4 hr to 3 days, whereas re-epithelization of the cornea and healing was complete within 3 to 7 days after ocular surgeries except for vitrectomy. In a vitrectomy, greater comfort and improved corneal epithelium were observed on the seventh day after surgery. An improvement in dry eye symptoms was observed at 7 days with considerable benefits observed after 1 month of cataract surgery. These findings indicate that BCLs are effective for improving postoperative symptoms and facilitation of early visual rehabilitation with a wear time of 8 hr to 7 days depending on the type of ocular surgery.

Purpose: to evaluate the incision width and implantation time of different IOL models using three preloaded and one manual injector. Patients and methods. 146 patients (160 eyes) including 94 females and 52 males were included in a prospective study. Group I — Isert® (28 patients, 32 eyes); Group II — Multisert® (27 patients, 30 eyes); Group III — Autonome® (45 patients, 50 eyes) and Group IV — Monarch® (46 patients, 48 eyes). mean age of patients was 71.8 ± 11.7 years, follow-up period — 3.0 ± 0.2 months. Results. There were no significant differences (p > 0.05) between the groups when comparing the incision width before IOL implantation. After lens implantation, the incision width in group I was significantly higher than in groups II (p = 0.04), III (p = 0.037) and IV (p = 0.029). There were no significant differences in incision width after IOL implantation between groups II, III, and IV (p > 0.05). The average increase in corneal incision width in group I was 0.6 mm, and for groups II, III, and IV it ranged from 0.2 to 0.3 mm. Groups II, III, and IV showed lower values of surgically induced astigmatism compared with group I (0.47 ± 0.06 D, 0.41 ± 0.06 D, and 0.44 ± 0.07 D compared with 1.12 ± 0.17 D, respectively; p < 0.05 for all groups). No significant differences were found between groups II, III, and IV. Minimum implantation time was observed for groups II and III, maximum for groups I and IV, with a mean difference of about 30 seconds. Differences when comparing the mean IOL implantation time were not statistically significant (p > 0.05). Conclusion. This paper presents the first worldwide comparative analysis of four IOL implantation systems, including Isert®, Multisert®, Autonome®, and Monarch®. The new Multisert® IOL implantation system has similar advantages to the known monofocal IOL injectors with respect to corneal incision width, surgically induced astigmatism magnitude, and time required for IOL implantation. IOL implantation time did not depend on the type of implantation (hydro- or viscous) and the type of injector.

To assess factors that impact the risk of relapse in patients with noninfectious uveitis (NIU) who undergo adalimumab tapering after achieving remission. Retrospective study. In this multicenter study, patients with NIU were treated with adalimumab and subsequently tapered. Patient demographics, type of NIU, onset and duration of disease, the period of inactivity before tapering adalimumab, and the tapering schedule were collected. The primary outcome measures were independent predictors of the rate of uveitis recurrence after adalimumab tapering. Three hundred twenty-eight patients were included (54.6% female) with a mean age of 34.3 years. The mean time between disease onset and initiation of adalimumab therapy was 35.2 ± 70.1 weeks. Adalimumab tapering was commenced after a mean of 100.8 ± 69.7 weeks of inactivity. Recurrence was observed in 39.6% of patients at a mean of 44.7 ± 61.7 weeks. Patients who experienced recurrence were significantly younger than those without recurrence (mean 29.4 years vs 37.5 years, P=.0005), and the rate of recurrence was significantly higher in younger subjects (hazard ratio [HR]=0.88 per decade of increasing age, P=.01). The lowest rate of recurrence was among Asian subjects. A faster adalimumab taper was associated with an increased recurrence rate (HR=1.23 per unit increase in speed, P < .0005). Conversely, a more extended period of remission before tapering was associated with a lower rate of recurrence (HR=0.97 per 10-weeks longer period of inactivity, P=.04). When tapering adalimumab, factors that should be considered include patient age, race, and duration of disease remission on adalimumab. A slow tapering schedule is advisable.

BackgroundDry eye disease (DED) is a multifactorial disease in ocular surface, and inflammation plays an etiological role. Berberine (BBR) has shown efficacy in treating inflammatory diseases. Yet, there was no adequate information related to the therapeutic effects of BBR for DED. PurposeTo detect the effects and explore the potential mechanisms of BBR on DED. Study DesignIn vitro, in vivo study and network pharmacology analysis were involved. MethodThe human corneal epithelium cells viability was evaluated with different concentrations of BBR. Dry eye murine model was established by exposing to the desiccating stress, and Ciclosporin (CSA), BBR eye drops or vehicle were topical administration for 7 days. The phenol red cotton tests, Oregon-green-dextran staining and Periodic acid-Schiff staining were performed and evaluated the dry eye after treatment. Inflammation and apoptosis levels of ocular surface were quantified. The potential targets related to berberine and dry eye were collected from databases. The Protein-Protein interaction network analysis and GO & KEGG enrichment analysis were realized by STRING database, Metascape platform and Cytoscape software to find core targets and signaling pathways. The SchrÖdinger software was used to molecular docking and PyMOL software to visualization. Finally, the levels of PI3K/AKT/NFκB and MAPK pathways were detected. ResultThe data revealed BBR could rescue impaired HCE under hyperosmotic conditions. In addition, BBR eye drops could ameliorate dry eye. And BBR eye drops suppressed the inflammatory factors and CD4+T cells infiltration in conjunctiva. Besides, BBR eye drops protected ocular surface by avoiding the severe apoptosis and decreasing the level of MMP-3 and MMP-9. 148 common targets intersection between BBR and dry eye were found via network pharmacology analysis. Core proteins and core pathways were identified through PPI and GO&KEGG enrichment analysis. Molecular docking displayed excellent binding between BBR and those core targets. Finally, in vivo study verified that BBR eye drops had a therapeutic effect in dry eye by inhibiting PI3K/AKT/NFκB and MAPK pathways. ConclusionThe research provided convincing evidence that BBR could be a candidate drug for dry eye.

Abstract Purpose Measurement of corneal endothelial cells is critical for postoperative evaluation of phakic intraocular lens (pIOL) surgery. However, inter-instrument differences in corneal endothelial cell density (ECD) after pIOL implantation have not yet been reported. This study aimed to compare automated corneal endothelial cell analysis between CellChek-20 (Konan Medical, Hyogo, Japan) and EM-4000 (Tomey, Nagoya, Japan) in healthy and postoperative eyes with pIOL. Methods We retrospectively analyzed 154 healthy and 236 postoperative eyes after pIOL surgery. Endothelial cell measurements were performed using CellChek-20 and EM-4000 with autofocusing and automated image analysis. ECD, percentage of hexagonal cells (HEX), coefficient of variation in cell size (CoV), and central corneal thickness (CCT) were compared between the two devices. Results The ECDs of the two devices were highly correlated in both healthy (Spearman’s correlation coefficient [r] = 0.805; p &lt; 0.001) and postoperative (r = 0.901; p &lt; 0.001) groups. ECD from CellChek-20 was higher than EM-4000 in both healthy (mean difference = 228.9 cells/mm2; p &lt; 0.001) and postoperative (mean difference = 115.6 cells/mm2; p &lt; 0.001) groups. The CCT values also showed a strong correlation in healthy eyes (r = 0.974; p &lt; 0.001) and in postoperative eyes (r = 0.936; p &lt; 0.001); however, significant inter-instrument differences were observed. HEX and CV showed relatively weak correlations (r &lt; 0.7) between the two devices in both healthy and postoperative groups. Conclusion The ECD values between the two instruments were correlated, but that of the CellChek-20 was significantly higher than that of the EM-4000 in both healthy and postoperative eyes after pIOL surgery. The possibility of measurement bias should be considered when replacing equipment used for corneal endothelial cell measurements.