Introduction: Loss to follow-up (LTFU) among patients receiving anti-vascular endothelial growth factor therapy for neovascular age-related macular degeneration (nAMD) remains a critical challenge for maintaining visual outcomes. This systematic review and meta-analysis evaluated the prevalence, risk factors, and impact on visual prognosis of LTFU across real-world studies. Methods: A comprehensive literature search of PubMed, Embase, Cochrane, Scopus, and Google Scholar identified studies published between 2015 and 2025. Eligible studies included observational cohorts and registry-based analyses that reported the LTFU rates, risk factors, and visual outcomes following treatment discontinuation. Random-effects meta-analysis (DerSimonian-Laird) estimated pooled odds ratios (ORs) and 95% confidence intervals (CIs); heterogeneity was assessed via I2 and Cochran’s Q. Continuous predictors were analysed using regression-based ORs or standardized mean differences (SMDs), where appropriate. Results: We included 52 studies. Short-term LTFU was defined as 6–12 months without treatment; long-term LTFU as ≥12 months. LTFU rates ranged from <5% to >75% over up to 10 years. Older age was moderately associated with LTFU (SMD = 0.47, 95% CI: 0.37–0.57; ≈6–7 years older). Greater travel distance increased LTFU risk (OR = 1.35 per 10-km increase, 95% CI: 1.14–1.60). Male sex (OR = 1.20, 95% CI: 1.05–1.37) and caregiver/transport dependence (OR = 2.00, 95% CI: 1.45–2.75) were also associated with a higher likelihood of LTFU. Treat-and-extend (T&E) regimens showed lower LTFU than pro re nata. Patients who were LTFU had worse visual outcomes even after resuming care. Conclusion: LTFU in nAMD treatment is common and driven by demographic (age, sex, and race), socioeconomic (income and insurance), and access (distance and caregiver need) factors. Continuous treatment, early response, and structured regimens (e.g., T&E) mitigate dropout risk. Interventions to improve access and personalize support are essential to reduce LTFU and preserve visual outcomes.

Introduction: The aim of the study was to compare clinical findings, OCT characteristics, and postoperative outcomes in eyes with epiretinal membrane (ERM) with and without associated epiretinal proliferation (EP). Methods: Eyes with ERM with or without associated EP were analyzed for clinical findings and OCT characteristics. The primary outcomes measured were changes in best-corrected visual acuity (BCVA) and OCT features from baseline to the final follow-up visit. Patients with ERM were categorized into two groups based on the presence or absence of EP. Surgical outcomes were also evaluated. Results: Significant changes were reached in each group, particularly for BCVA (p < 0.001 for the ERM group, p = 0.010 for the EP-ERM group). Compared with ERM eyes, EP-ERM had a lower BCVA recovery at 6 months after surgery (p = 0.009). EP-ERM patients demonstrated more frequent microcystic macular edema (MME) (73.3% vs. 37.1%, p = 0.008) and increased central retinal thickness (CRT) (p < 0.001) at 6 months after surgery. No statistically significant differences in terms of external limiting membrane and ellipsoid zone defects were registered at 6 months (p = 0.234, p = 0.446, respectively). Conclusion: EP-ERM showed poorer post-surgical BCVA compared with ERM alone. EP-ERM had a greater chance of MME at 6 months after surgery, with higher CRT. These findings highlight the need for deeper assessment of ERM characteristics to accurately predict surgical outcomes.

Introduction: Sustainability is becoming increasingly important in ophthalmology due to growing environmental, economic, and social responsibilities. Integrating sustainability into clinical practice requires not only advocacy by clinicians but also patients’ collaboration and awareness. This study aimed to understand patients’ perspectives on sustainability and the role attributed to ophthalmologists. Methods: In this multi-item survey, ophthalmologic patients were assessed regarding their views on sustainability in general and in ophthalmology in particular. Levels of agreement were measured using a Likert scale. Results: In total, 105 patients were included. There was high agreement on statements that anthropogenic climate change is an urgent issue, requires action, and is impacting population health (all, ≥85%). Patients supported advocacy of ophthalmologists for more sustainability, and there was broad agreement (74%) that ophthalmology practices should become more environmentally sustainable. No clear trend was observed whether the healthcare sector is taking sufficient measures to become more sustainable and whether the carbon footprint of ophthalmology is smaller compared to other specialties (44% and 33% disagreed; 41% and 63% [strongly] agreed, respectively). Patients aged ≥70 years agreed significantly more than younger patients that healthcare plays an important role in fighting climate change. A similar trend was observed for female compared to male patients. Female and older patients also tended to express greater expectations for ophthalmologists to advocate for sustainability, along with a call for increased advocacy from legislators and ophthalmology societies. Conclusion: Patients showed strong awareness of anthropogenic climate change and the need for ophthalmology to become more sustainable. Especially female and older patients tended to expect more advocacy from ophthalmologists, ophthalmological societies, and the legislators.

Introduction: Treatment-resistant choroidal neovascularization (CNV) remains a major challenge despite anti-VEGF therapy. Faricimab, with dual inhibition of VEGF-A and Ang-2, offers a novel approach. The purpose of this study was to evaluate its effect using advanced OCTA-based vascular analysis and AI-assisted anatomical assessment, providing new insights into therapeutic response in resistant CNV. Methods: This retrospective study analyzed OCTA and OCT biomarkers before and after treatment switch in patients with CNV that was resistant to prior anti-VEGF therapy. Quantitative vascular analysis of CNV lesions was performed using AngioTool 2.0 software. Anatomical response was evaluated by retinal fluid biomarkers, including central retinal thickness (CRT), intraretinal fluid (IRF), subretinal fluid (SRF), and pigment epithelial detachment (PED) volume using the RetinAI software. Results: Following the switch to Faricimab, OCTA analysis revealed reductions in vessel area (p = 0.011), vessel percentage area (p = 0.002), total vessel length (p = 0.011), and total number of junctions (p = 0.006). Lacunarity significantly increased (p = 0.009), indicating notable vascular remodeling. Moreover, AI-assisted imaging analysis showed that the CRT decreased by 9.94% (p = 0.0001), and PED volume decreased by 20.94% (p = 0.011). Total retinal fluid, including IRF and IRF, was reduced by 84.06% (p = 0.007), reflecting substantial anatomical improvement. Additionally, the mean injection interval increased by 3.19 ± 2.47 weeks, indicating enhanced disease stability and a reduced treatment burden. Conclusion: This study highlights the role of OCTA vascular analysis in assessing CNV treatment response. The significant vascular and AI-assisted anatomical improvements observed after switching to faricimab suggest its potential efficacy for treating resistant CNV cases. Given the scarcity of literature on OCTA vascular changes in this context, our findings provide novel insights into treatment response assessment. Further studies with larger cohorts are needed to validate these observations.

Plain Language SummaryThis is the first prospective study comparing how digital heads-up (HUD) systems and traditional analog surgical microscopes (SOMs) influence the learning curves of retina fellows highlighting the importance of optimizing training strategies for the next generation of retina surgeons. Digital group required significantly fewer instructor interventions and reported superior comfort and visualization.

Introduction: This retrospective, single-center, observational cohort study evaluated the 3-year real-world efficacy and safety of intravitreal brolucizumab injections in patients with neovascular age-related macular degeneration (nAMD) who had previously been treated with other anti-vascular endothelial growth factor (VEGF) agents. A total of 97 eyes from 91 patients were included, all of whom completed 3 years of follow-up after switching to brolucizumab. Methods: Patients received intravitreal injections of 6 mg brolucizumab. Data on best-corrected visual acuity (BCVA), central subfield thickness (CST), intraretinal fluid (IRF), subretinal fluid (SRF), subretinal pigment epithelium fluid (sRPEF), treatment intervals, and adverse events were collected over a 3-year follow-up period. Results: The mean age of patients was 78.9 ± 8.2 years, with a mean follow-up of 161.3 weeks. At 3-year follow-up, mean BCVA significantly improved, from 41.1 ± 6.5 at baseline to 50.7 ± 7.5 ETDRS letters (p < 0.001), and mean CST significantly decreased from 371.3 ± 136.7 to 299.1 ± 137.81 (p < 0.001). Significant reductions were observed in IRF (p < 0.001), SRF (p < 0.001), and sRPEF (p = 0.004). Mean injections per year were 4.7 ± 1.9, 3.9 ± 1.7, and 3.6 ± 1.9 in the first, second, and third years, respectively. Adverse events were noted in 4 patients after either the first or second injection, with no further events reported. Conclusion: This study reports that brolucizumab provides favorable anatomical and functional outcomes and can reduce treatment burden in patients with nAMD due to its rapid and sustained efficacy and favorable safety profile.

Introduction: Submacular hemorrhage (SMH) is a severe complication of neovascular age-related macular degeneration (nAMD), often causing profound vision loss. The aim of this study was to assess the long-term outcomes of SMH patients managed with anti-VEGF monotherapy (MT) versus surgical displacement (SD) and to identify prognostic factors for visual acuity. Methods: This multicenter retrospective study included patients with SMH secondary to nAMD treated in three hospitals in Lyon between 2018 and 2023. Patients were treated with MT or underwent pneumatic displacement (PD) or SD. The best-corrected visual acuity (BCVA) and clinical parameters were assessed at baseline (time of SMH onset), months 1, 3, 9, and 12. Results: Sixty-six eyes were included: 33 received MT, 6 underwent PD, and 27 underwent SD. The baseline VA was strongly reduced (mean BCVA: 0.14). The VA improved to 0.21 at M1, 0.29 at M3, and 0.33 at M6 but was stabilized at 0.28 at M12. At M12, VA did not significantly differ between MT and SD groups (0.27 vs. 0.32, p = 0.624). However, multivariate analysis revealed a significantly greater VA gain in the SD group (p = 0.025), despite more severe baseline characteristics. SMH thickness was significantly associated with a poorer VA (p = 0.02). Conclusion: SD may offer greater visual improvement in cases of large and thick SMH. Maximum SMH thickness appears to be a key prognostic factor. Treatment decisions should consider initial hemorrhage severity.

Introduction: In this study, we wanted to evaluate the effect of intraoperative early positioning on anatomical success in patients with large macular holes undergoing the inverted flap (IF) technique. Methods: This retrospective, comparative study included 43 patients diagnosed with a macular hole ≥400 μm in minimum linear diameter who underwent pars plana vitrectomy using the IF technique. Patients were allocated chronologically into two groups: those operated on prior to February 2020 formed the standard positioning group (n = 23), and those treated thereafter composed the early positioning group (n = 20). In the early intraoperative positioning group, the patient’s head was turned nasally immediately after the air-fluid exchange to stabilize the IF. In contrast, the standard group followed conventional postoperative prone positioning. The primary outcome was complete macular hole closure, assessed using optical coherence tomography. Secondary outcomes included IF stability, retinal layer integrity, and the need for additional postoperative surgical interventions. Results: At postoperative month 3, anatomical closure was achieved in all patients (100%) in the early positioning group, compared to 85% in the standard group (p = 0.05). Flap dislocation occurred in 15% of patients in the standard group, while none was observed in the early group (p = 0.05). Preoperative BCVA was 0.67 ± 0.28 logMAR in the early group and 0.65 ± 0.28 logMAR in the standard group (p = 0.74). Postoperative BCVA improved to 0.07 ± 0.08 logMAR and 0.16 ± 0.22 logMAR, respectively (p = 0.09). Conclusion: Intraoperative early positioning significantly improves anatomical outcomes in large macular hole surgery by enhancing flap stability and promoting successful closure.

Introduction: We investigated the effects of internal limiting membrane (ILM) peeling on treating posterior segment complications other than macular edema in patients with proliferative diabetic retinopathy (PDR) treated with vitrectomy. Methods: Databases including PubMed, EMBASE, and Cochrane Library were searched on October 2, 2023. Studies comparing patients with PDR who were treated with ILM peeling to those who did not undergo ILM peeling were included. The primary outcome was the final best-corrected visual acuity (BCVA). Secondary outcomes were final central retinal thickness (CRT) and formation of the postoperative epiretinal membrane (ERM). Results: Eleven comparative studies were included in this meta-analysis. The postoperative BCVA at 6 months was better in those who underwent ILM peeling (95% confidence interval [CI]: −0.51 to −0.15) than in those did not, whereas the final BCVA was not significantly different between the groups (95% CI: −0.30 to 0.00). The final CRT was significantly thin (95% CI: −61.82 to −35.63), with a low occurrence of postoperative ERM in the ILM peeling group (95% CI: 0.12–0.26). Conclusion: ILM peeling effectively prevented postoperative ERM formation in patients with PDR complications; however, the benefit for postoperative vision was not evident after 6 months.