To quantify serial central subfield thickness (CSFT) changes after slow-coagulation transscleral cyclophotocoagulation (SC-TSCPC) for glaucoma, estimate the incidence of OCT-confirmed cystoid macular edema (CME), and explore baseline factors associated with CME, including diabetes and prior diabetic macular edema. Retrospective cohort of 31 eyes undergoing SC-TSCPC for glaucoma with OCT imaging preoperatively and postoperatively at 1, 3, 6, 9, and 12 months and at last follow-up (range 9-30 months). OCT-confirmed CME was defined as cystoid intraretinal changes on OCT; increased CSFT alone was not classified as CME. Changes over time were assessed with non-parametric repeated-measures testing, and subgroup comparisons were exploratory and univariate because of the small sample size. Mean baseline CSFT was 279 ± 25um and peaked at 355 ± 153um at 1month, then declined to 293 ± 25um at 12months (p < 0.001 across visits). Mean CSFT at last follow-up remained higher than baseline (294 ± 25 vs. 279 ± 25um; p < 0.001). OCT-confirmed CME developed in 8/31 eyes (25.8%), first detected at 1-6months (mean 2.1 ± 1.8). Eyes that developed OCT-confirmed CME had higher preoperative CSFT than eyes without CME (311 ± 21 vs. 267 ± 15um; p < 0.001). In exploratory univariate analyses, OCT-confirmed CME occurred more frequently in eyes with diabetes mellitus (p = 0.031) and prior diabetic macular edema (p < 0.001). Mean intraocular pressure decreased from 36.1 ± 9.0 to 15.2 ± 3.6mmHg at 12months (p < 0.001). Mean corrected distance visual acuity (CDVA) changed from 0.90 ± 0.90 logMAR preoperatively to 1.02 ± 0.85 logMAR at last follow-up (p = 0.004), and CDVA at last follow-up did not differ between eyes with and without OCT-confirmed CME (p = 0.992). SC-TSCPC was associated with a transient postoperative increase in CSFT and a clinically relevant incidence of OCT-confirmed CME. In this small retrospective cohort, higher preoperative CSFT and diabetes-related retinal disease identified a subgroup with greater observed CME frequency, but these findings should be interpreted as exploratory associations rather than independent risk factors. Postoperative OCT surveillance may help identify early anatomic edema, particularly in higher-risk eyes.

Chlorhexidine, a well-established antiseptic in systemic medicine and dentistry, has long been overlooked in ophthalmology outside its role in Acanthamoeba keratitis. However, recent evidence supports its potential as an effective adjunct or alternative agent in multidrug-resistant (MDR) bacterial keratitis, where treatment options remain limited and therapeutic challenges are escalating. This review aims to revisit ocular use of chlorhexidine. A comprehensive search was performed in the PubMed database using combinations of the following keywords: "chlorhexidine", "keratitis", "Acanthamoeba keratitis", "fungal keratitis", "bacterial keratitis", "ocularinfections", and "antimicrobial resistance". Studies relevant to the ophthalmological use of chlorhexidine, particularlyin the context of keratitis and antimicrobial resistance, were utilized. The results revealed chlorhexidine's antimicrobial mechanisms, ocular formulations, and clinical applications, while highlighting emerging evidence from case reports, retrospective analyses, and in vitro studies that suggest potential activity against MDR ocular pathogens, including extended spectrum beta lactamase (ESBL) producing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Pseudomonas spp. As the threat of antimicrobial resistance rises globally, chlorhexidine merits renewed attention and clinical evaluation within ophthalmology, particularly as a viable and accessible therapeutic option in resistant infections. Although current evidence is limited to preclinical studies and case reports, chlorhexidine shows potential efficacy in MDR and may warrant further investigation in well-designed clinical trials.

To investigate the prevalence of multiple sclerosis (MS) among bilateral Fuchs uveitis syndrome (FUS) cases and compare their clinical characteristics with unilateral cases. Patients with bilateral FUS (Study group) and unilateral FUS (Control group) were reviewed retrospectively. All patients in the study group underwent fluorescein angiography (FA) and magnetic resonance imaging (MRI) and neurological consultation. Whereas in the control group, patients with posterior segment involvement underwent FA. MRI and neurological consultation were performed on patients with neurological symptoms. The relationship between MS diagnosis and data was evaluated. Forty eyes of 20 patients in the study group and 40 eyes of 40 patients in the control group were included. Neurological evaluations revealed that 15% (3/20) of the patients in the study group diagnosed with MS, whereas neurologic symptoms were observed in one patient in the control group; however, MRI findings did not support a diagnosis of MS. Study group showed a higher prevalence of diffuse keratic precipitates (p < 0.001, χ2 test), while iris nodule subtypes differed between groups, with Busacca nodules predominating in study group and Koeppe nodules in control group (p = 0.019, p = 0.008 respectively, χ2 test). There was no significant difference between MS and non-MS eyes with fundus and FA findings (p > 0.05, χ2 test). The frequency of MS disease was found to be higher in bilateral FUS patients than in unilateral FUS cases. MS should be kept in mind in the diagnosis and follow-up of patients with bilateral FUS, and neurological investigations should be carried out when necessary.

To compare the effects of the 45° Kelman phaco tip and the 45° Intrepid Balanced phaco tip used during torsional phacoemulsification in hard cataracts on intraoperative energy use and surgical times, as well as their effects on postoperative anterior segment parameters and the corneal endothelium. In this retrospective comparative study, 180 eyes of 180 patients who met the inclusion criteria were included, comprising 90 patients in the 45° Intrepid Balanced phaco tip group and 90 patients in the 45° Kelman phaco tip group. Clinical findings were obtained preoperatively and on postoperative Day 1 and month 1, corneal endothelial and morphological parameters assessed by specular microscopy, optical biometry measurements were obtained, and intraoperative phacoemulsification device parameters were recorded. The groups were compared in terms of preoperative characteristics, intraoperative parameters, and postoperative corneal findings. There were no significant differences between the groups in terms of preoperative demographic or ocular characteristics. Compared with the Kelman group, the Intrepid Balanced group had significantly lower mean torsional amplitude, torsional ultrasound time, cumulative dissipated energy, aspiration time, and fluid usage (all p ≤ 0.007). However, there was no significant difference in total surgical time (p = 0.115). At postoperative month 1, the endothelial cell density was significantly greater in the Intrepid Balanced group than in the Kelman group (2075.52 ± 346.24 vs. 1929.96 ± 317.29 cells/mm2, p = 0.008). Endothelial cell loss (360.20 ± 207.25 vs. 500.22 ± 271.90 cells/mm2) and the percentage of endothelial cell loss (14.94 ± 8.64% vs. 20.37 ± 10.31%) were significantly lower in the Intrepid Balanced group (both p < 0.001). In torsional phacoemulsification for hard cataracts, the 45° Intrepid Balanced phaco tip was associated with greater intraoperative efficiency and less endothelial damage than the 45° Kelman phaco tip. These findings suggest that the Intrepid Balanced tip may offer advantages in terms of intraoperative efficiency and endothelial preservation under the surgical settings used in this study.

The study aimed to compare the efficacy and safety of netarsudil (NET), alone or in fixed-dose combinations (FDC), in comparison with prostaglandin analogues (PGAs: bimatoprost [BIM], latanoprost [LAT], travoprost [TRA], and tafluprost [TAF]) for the treatment of primary open-angle glaucoma (POAG) or ocular hypertension. Literature search in PubMed, Embase, Cochrane Library, Web of Science (inception to July 2025). Identified 26 randomized controlled trials (RCTs) (5,390 patients). The primary outcome was the mean difference in intraocular pressure (IOP) reduction at 3months; the secondary outcome was the incidence of conjunctival hyperemia. Pair-wise meta-analysis used Cochrane Review Manager 5.4, Bayesian network meta-analysis via Aggregate Data Drug Information System (ADDIS) with Markov Chain Monte Carlo (MCMC) simulations. Inconsistency assessed via node-splitting, convergence evaluated via Brooks-Gelman-Rubin method. Network meta-analysis showed 3-month IOP -lowering hierarchy: FDC > BIM > TRA > LAT > TAF > NET. Conjunctival hyperemia incidence (highest to lowest): TAF > FDC > NET > BIM > TRA > LAT. Node-splitting confirmed consistency (P ≥ 0.05), convergence was satisfactory. Funnel plots indicated no publication bias for IOP outcomes but potential bias for conjunctival hyperemia. Although NET ranked lower in IOP-lowering efficacy compared to most PGAs and FDC, it demonstrated a favorable safety profile, particularly with a relatively lower incidence of conjunctival hyperemia than TAF and FDC. These findings suggest that NET may serve as a valuable alternative in patients who are intolerant to PGAs or require adjunctive therapy, warranting further investigation in targeted populations.

To evaluate the clinical utility of a pragmatic, off-label multiplex PCR strategy using FilmArray® panels on corneal swabs in suspected infectious keratitis, with emphasis on diagnostic yield, turnaround time, and early therapeutic impact in routine care. This prospective, single-center observational study was conducted over 24 months (January 2024-December 2025) at a tertiary referral center. In episodes of clinically suspected infectious keratitis, corneal swabs were immersed in brain-heart infusion medium. A FilmArray® Meningitis/Encephalitis (ME) panel was used as first-line testing, with selective FilmArray® Blood Culture Identification 2 (BCID2) panel use when clinically indicated. Conventional bacterial and fungal cultures were systematically performed. Outcomes included diagnostic yield of the PCR algorithm, turnaround time (TAT), concordance patterns with culture, and early treatment changes after PCR results. Fifty episodes were included. The multiplex PCR algorithm (ME ± BCID2) detected at least one pathogen in 50% of cases, with viral detections, mainly herpes simplex virus type 1, accounting for a substantial proportion of PCR-positive results. Conventional culture was positive in 32% of cases and identified bacterial and/or fungal pathogens. Median TAT was 6.5h for PCR versus 79h for culture, corresponding to a median reduction of 72.5h. PCR findings were associated with treatment modification within 24h in 32% of cases, with additional changes after 48h in 6%, predominantly antiviral initiation or targeted antimicrobial adjustment. In this real-world exploratory study, the main advantage of the pragmatic FilmArray® strategy was the marked reduction in turnaround time compared with culture, providing microbiological information within hours rather than days. Because PCR and culture differ fundamentally in detectable pathogen classes, particularly due to viral detection by PCR, these findings should not be interpreted as evidence of diagnostic superiority. FilmArray® testing may serve as a complementary approach in selected severe, atypical, pretreated, or culture-negative keratitis cases when rapid therapeutic decisions are needed.

To evaluate early regional corneal epithelial thickness changes following accelerated epithelium-off corneal cross-linking (CXL) in progressive keratoconus using anterior segment optical coherence tomography (AS-OCT), and to explore their relationship with anterior corneal curvature and spherical equivalent. Prospective case series. Ninety eyes of 75 patients with progressive keratoconus underwent accelerated epithelium-off CXL (9 mW/cm2 for 10min). Epithelial thickness profiles were assessed using spectral-domain AS-OCT preoperatively and at 1 and 3months postoperatively. Changes in central and sectoral epithelial thickness were analyzed using repeated-measures ANOVA with post hoc adjustment. Correlations between epithelial parameters, spherical equivalent, and maximum keratometry (Kmax) were evaluated. Baseline central epithelial thickness was 59.7 ± 5.8µm. At 1month, central thickness showed minimal change, while at 3months it increased to 62.9 ± 4.0µm (P < 0.001). Sectoral analysis demonstrated relative thinning in nasal and inferonasal outer regions (1-3µm; P < 0.05) and thickening in selected temporal sectors. The thinnest epithelial point shifted from the inferotemporal to the inferonasal regions. Kmax demonstrated a borderline postoperative change (P = 0.051), and no statistically significant correlations were observed between epithelial thickness changes and Kmax at any time point. Spherical equivalent remained unchanged (P = 0.19). Accelerated epithelium-off CXL was associated with early, region-specific changes in epithelial thickness within three months after surgery. Variability in measurements due to the tear film and the short follow-up period likely influences these results, reflecting early surface remodeling rather than permanent stromal stabilization. Epithelial mapping may provide additional structural information during early postoperative monitoring; however, its ability to predict long-term treatment outcomes requires further research.

The aspiration of this review is to discuss the intricate development of Müller glial cells (MGCs) and their indispensable neuroprotective and regenerative roles, as well as novel avenues of treatment for retinal neurodegenerative diseases. MGCs are the principal radial glial cells of the vertebrate retina, extending from what is composed of a characteristic funnel-shaped morphology spanning throughout the retinal thickness. Their cell bodies are in the inner nuclear layer (INL), and their processes span from the outer limiting membrane to the inner limiting membrane, where they strongly associate with neurons, blood vessels, and the extracellular matrix across all layers of retinal structure. These cells preserve ionic and water homeostasis, control neurotransmitter uptake, and participate in constructing the blood retinal barrier (BRB), as well as deliver crucial metabolic help to neurons by means of the glutamate-glutamine cycle, thus excluding excitotoxic injury. First, we analysed the molecular processes underlying MGCs activation: pro-inflammatory molecules, Reactive oxygen species (ROS), and survival pathways. Special notice was made of changes in gene expression upon activation and the recrudescence of embryonic developmental programs that permit cell-cycle re-entry and retinal regeneration. Systematic searches of Google Scholar and PubMed to find relevant literature. Upon activation, Müller's glia, a type of retinal support cell, commence the expression of protective genes, such as Zfp36, Mt1, and Slc14a1. Some creatures could regenerate; however, in mammals, this capacity is limited, which is particularly evident in the retina, where, despite the activation of Müller's glia, full regeneration of damaged photoreceptors is not achieved. MGCs produces retinal progenitors that assist photoreceptors and interneurons while maintaining retinal integrity. MGCs contain progenitor cells that can differentiate into both neurons and other retinal cell types. Molecular targets for retinal therapeutics that utilize MGCs include pathways that regulate inflammation and oxidative stress. Müller glial cells are essential for maintaining retinal health, safeguarding neurons, and facilitating their regeneration. Targeted molecular therapy is addressed as a promising strategy for retinal neurodegenerative diseases, using their regenerative and protective potential.

Accurate segmentation of glaucoma-related anatomical structures from retinal fundus images is crucial for reliable clinical assessment and early disease diagnosis. However, variations in illumination, low contrast, and complex structural patterns make precise boundary delineation of the optic disc (OD) and optic cup (OC) challenging. This study aims to improve the accuracy of OD and OC segmentation for glaucoma assessment. An Enhanced SwinUNet model is proposed, integrating hierarchical transformer-based feature extraction with a Dual-Stage Context-Aware Feature Refinement (DCF-Refine) module embedded in skip connections. A preprocessing stage is applied using CLAHE-based contrast enhancement in LAB color space along with min-max normalization to improve image quality and stabilize training. The model employs Swin Transformer (ST) blocks to capture both local structural details and long-range dependencies. The DCF-Refine module enhances feature fusion through sequential Spatial Context Refinement (SCR) and Channel Context Refinement (CCR). Experimental evaluation on the Drishti-GS and REFUGE datasets demonstrates that the proposed Enhanced SwinUNet achieves superior performance compared to existing segmentation methods, attaining accuracies of 99.3% and 99.1%, respectively. The proposed model provides highly accurate and reliable segmentation of OD and OC structures, effectively addressing challenges in retinal image analysis. Its strong performance supports improved glaucoma-related structural assessment and has potential for clinical application.