In recent years, retinal vascular imaging has attracted growing interest and is experiencing rapid technological advancements in imaging modalities such as swept-source optical coherence tomography angiography (SS OCT-A). OCT-A enables precise, noninvasive, quantitative measurements of retinal vascularization. However, it is also prone to artifacts that are challenging to detect and can significantly limit diagnostic accuracy and biomarker reliability. We present a dataset of en face retinal SS OCT-A images, labeled by artifact type and severity. Each patient's OCT-A scan consists of 14 images that are graded by multiple experts and assigned corresponding artifact labels with an overall quality grade. We also report results for two deep learning binary classification models trained on the dataset: one based on image compression via principal component analysis (PCA) and the other using a six-channel tensor. The dataset comprised 281 OCT-A scans from 115 anonymized patients. The PCA-based model achieved a precision of 87% for image quality classification, while the six-channel model achieved 97%. Using a curated dataset of en face SS OCT-A images with detailed artifact annotations, we trained a deep learning model capable of high-precision image quality classification. These results demonstrate the feasibility of using task-specific artificial intelligence for quality assessment based on artifact detection in retinal imaging.

Tear-deficient dry eye disease (DED), including Sjögren's syndrome and ocular graft-versus-host disease (oGVHD), is often refractory to therapy. We tested whether PDGF isoform imbalance, quantified as a PDGF AB/BB: PDGF AA ratio ("PDGF Ratio"), is associated with innate activation and corneal epitheliopathy. Tear samples from 151 participants were profiled across two independent assay runs: Discovery (n=79) and Replication (n=72). Data were harmonized as within-plate rank percentiles. Plate-adjusted mediation tested whether the PDGF Ratio mediated associations between tear-deficient status and an innate NF-κB composite (IL-18/IL-6/IL-8/TNF-α) and National Eye Institute (NEI) scale graded corneal staining. A parallel model for staining included Schirmer scores to distinguish trophic from aqueous volume deficiency. The PDGF Ratio differed significantly across diagnostic groups (Kruskal-Wallis p < 0.001), driven by concurrent PDGF-AA depletion (median rank 0.69 healthy vs. 0.19 oGVHD) and PDGF-AB/BB enrichment (0.18 vs. 0.62; both p < 0.001). High ratio co-occurred with higher innate cytokine ranks and lower EGF and IFN-γ. In pooled mediation, the ratio accounted for 62.8% of the tear-deficient association with innate inflammation (indirect 0.168; 95% CI 0.118-0.225) and 34.2% of the association with corneal staining (indirect 0.117; 95% CI 0.055-0.190). The staining pathway remained significant after accounting for Schirmer (indirect 0.113; 95% CI 0.050-0.185). Tear-deficient DED exhibits a reproducible PDGF isoform imbalance that statistically accounts for substantial portions of innate activation and corneal staining. These findings support the PDGF Ratio as a coherent candidate biomarker and therapeutic axis for isoform-selective rebalancing.

Introduction There is a paucity of data on microbial keratitis in the Southwestern United States, specifically Southern Arizona. Understanding demographic factors and causative organisms will help design future treatments and preventative measures. Methods A retrospective chart review was conducted on all cases (>17 years old) of microbial keratitis at Banner University Medical Center Tucson, Arizona from September 1, 2017 to August 31, 2022. Reported frequencies of social, demographic, ocular factors, and isolated organisms. We used Fisher's exact tests to compare findings with latest census data. Results We identified 272 eyes in 268 patients. Compared with census data, demographic factors overrepresented in microbial keratitis were: unemployment (50.4%) and homelessness (8.2%). Drug use was identified in 22.4% of patients. Associated factors were contact lens wear (33.1%) and preceding ocular trauma (14.7%). Among eyes associated with contact lens use, 49 (54.4%) were worn overnight. Of 203 eyes with culture results, 152 (74.9%) yielded a positive microbial culture; 96.5% bacterial and 3.4% fungal. Gram-positive bacteria were found in 54.7%, most commonly Staphylococcus epidermidis (16.7%). The most common Gram-negative isolate was Pseudomonas aeruginosa (12.8%). Conclusion In Southern Arizona, microbial keratitis is particularly associated with drug use, unemployment, and homelessness. Contact lens use and overnight wear were common, warranting education on safe practices. Positive fungal cultures were rare. Each factor deserves consideration for societal intervention, to reduce the burden of microbial keratitis in Southern Arizona, and should be evaluated as potential risk factors in other communities. Overall culture results may influence choice of initial therapy.

To determine which donor characteristics, like previous diseases and surgeries, influence the graft preparation difficulty of the Descemet membrane (DM)/endothelial lamella in DMEK-surgery and to analyze the impact on the one-year clinical outcome. 1051 eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany were included in this single-center and retrospective study. Information regarding the donors' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, that contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively and postoperative clinical follow-up. Three preparation groups (easy, difficult and very difficult) were correlated to the donors' previous disease and surgeries. Also, outcome parameters, like visual acuity, endothelial cell density and graft survival were correlated to the graft preparation group. Donor diabetes was found as significant predictor for central adhesions (p<0.001). Diabetes patients are 2-times more likely to have central adhesions complicating preparation than non-diabetes patients (OR =2.2). Previous cataract surgery was significantly associated with difficult stripping and preparation (p <0.001), with an estimated 1.07 fold increase in stripping difficulty (95% CI 0.80-1.34) and overall 1.99 fold increase in preparation difficulty (95% CI 1.71-2.29). Chronic kidney disease (p=0.012) and previous cataract-surgery (p=0.005) show significant associations to tissue loss. Donor diagnosis such as Diabetes Mellitus type 2, chronic ischemic heart disease and respiratory insufficiency have a significant association with the preparation group (p=0.001; p=.004 and p=0.032, respectively). No interactions were found between preparation difficulties and visual acuity (p=0.122), rebubbling rate (p=0.780) or endothelial cell density (p=0.886) nor graft survival (p value=0.157) one year postoperatively. Donor diabetes mellitus, heart failure, hypertension, respiratory insufficiency, kidney disease and previous cataract surgery are associated with difficult DMEK graft preparation, the latter two also with tissue loss. No impact of donor factors on clinical outcome was found.

Background Meibomian gland dysfunction (MGD) is a chronic and widespread abnormality of the meibomian glands that often results in symptoms such as eye irritation and blurred vision, significantly affecting patients' daily activities. While conventional treatments like warm compresses and meibomian gland expression remain widely used, their limitations have driven the development of novel therapeutic technologies. Summary This review synthesizes evidence from 71 clinical and experimental studies in Medline databases on both established and emerging therapeutic strategies for MGD, including physical interventions (warm compresses, eyelid cleansing, probing and expression, thermal pulsation systems such as LipiFlow®, and intense pulsed light (IPL)) and pharmacological approaches. Across these modalities, most interventions improve symptoms, tear film stability, and meibum quality primarily by enhancing glandular outflow and modulating ocular surface inflammation. Device-based physical therapies typically offer greater and more long-lasting improvements than conventional methods but are limited by cost, access, and a lack of long-term safety data. Key Messages Though the current range of MGD treatments cannot regenerate affected glands, their secreting functions can be greatly improved. Clinicians should therefore individualize treatment options according to disease stage, meibography findings, comorbid ocular surface conditions, and patient-specific factors such as tolerance, adherence, and cost.

Introduction: This study aimed to investigate the relationship between spectral domain optical coherence tomography (SD-OCT) structural findings and visual acuity in patients with retinitis pigmentosa (RP), with and without cystoid macular edema (CME), at baseline and 1-year follow-up. Methods: This retrospective chart review included 30 patients with RP treated at the University of Florida Health Eye Center from 2014 to 2020. Patient records were analyzed for SD-OCT structural features and visual acuity outcomes. Statistical analyses included descriptive statistics, χ2 tests, independent t tests, and Pearson’s correlation tests. Main outcome measures were best corrected visual acuity (BCVA), presence of the ellipsoid zone (EZ) in the fovea and macula, central retinal thickness (CRT), total macular volume (TMV), and presence of an epiretinal membrane (ERM). Results: The study included 30 patients (21 female, 9 male) with an average age of 46.83 ± 18.86 years (range, 10–80 years). The average follow-up period between visits was 11.9 ± 1.6 months (range, 9–15 months). Among the 60 eyes analyzed, 50% had CME. Eyes with CME had a greater CRT at the follow-up visit (p = 0.029). No significant differences were found in BCVA or TMV between RP patients with and without CME. Correlation analyses revealed a significant relationship between CRT and BCVA at both visits (p = 0.001, p = 0.004) in RP patients without CME, but not in RP patients with CME. EZ foveal sparing consistently predicted BCVA outcomes (p < 0.001) and CRT (p ≤ 0.001) at both visits in RP patients with and without CME. Greater TMV at both visits (p = 0.009, p = 0.012) and the presence of an ERM at the follow-up visit (p = 0.046) were significantly associated with a decline in BCVA between visits in RP patients without CME. Conclusions: EZ foveal sparing is a significant predictor of visual acuity in RP patients regardless of the presence of CME. While CRT correlates with visual acuity in patients without CME, it does not predict outcomes in those with CME. TMV may serve as a marker for preclinical CME, and both increased TMV and ERM presence may predict visual decline in RP patients with undetectable CME on SD-OCT.

Introduction: The aim of the study was to evaluate functional and anatomical changes at the 44-week follow-up in patients with naïve neovascular age-related macular degeneration (nAMD) treated with faricimab intravitreal injections (IVIs). Methods: Fifty-four eyes of 54 patients with naïve active macular neovascularization and nAMD were enrolled at the Ophthalmology Clinic of University “G. d’Annunzio,” Chieti-Pescara, Italy. All patients were scheduled for faricimab IVI. Each patient underwent complete ophthalmic examination including best-corrected visual acuity (BCVA) using the Early Treatment Diabetic Retinopathy Study (ETDRS) charts and optical coherence tomography. All measurements were evaluated at baseline, at week 20 and then according to fixed retreatment interval up to week 44. Fluorescein angiography and indocyanine green angiography were also performed at baseline. Main outcome measures were changes in BCVA, central macular thickness (CMT), subfoveal choroidal thickness (SFCT), intraretinal fluid presence, subfoveal subretinal fluid presence and thickness, the presence of pigment epithelial detachments (PEDs), and its maximum height (PED-MH). Results: BCVA improved and CMT reduced significantly from baseline to week 44 (p = 0.002 and p = 0.020, respectively) in the overall sample with a higher significant improvement from baseline to week 20 (p < 0.001 for both parameters) and no additional significant improvement from week 20 to week 44 in the overall sample (p = 0.348 and p = 0.146, respectively). At week 20, 72.3% of patients were in the Q12/Q16 interval. Patients in the Q8 interval showed significant improvement in BCVA (p < 0.001) and significant reduction of CMT (p = 0.008) from baseline to week 44, respectively. PED-MH as well showed a significant reduction from baseline to week 44 (p < 0.001). Patients in the Q12 interval showed significant improvement in BCVA (p = 0.030) and significant reduction of CMT, SFCT, and PED-MH from baseline to week 36 (p < 0.001). Patients in the Q16 interval showed significant reduction of BCVA during follow-up (p = 0.026). CMT, SFCT, and PED-MH were significantly reduced from baseline to week 44 (p < 0.001). Conclusion: Faricimab showed efficacy in the treatment of naïve nAMD patients with an improvement of many anatomical and functional parameters at 44 weeks, allowing the maintenance of a treatment regimen for most patients equal to or greater than 12 weeks.

Introduction: Diabetes mellitus (DM) is frequently associated with microvascular complications, including diabetic peripheral neuropathy (DPN). The cornea, one of the most densely innervated tissues in the body, has been proposed as a surrogate marker for small fiber neuropathy. Patients with DM often present with ocular surface disease (OSD) and corneal sensitivity impairment, but the relationship between DPN, ocular surface alterations, and inflammatory biomarkers remains unclear. This study aimed to evaluate ocular surface parameters between patients with type 2 DM with and without DPN and to explore the associations among corneal sensitivity, ocular surface inflammation (matrix metalloproteinase-9 [MMP-9]), and dry eye-related parameters. Methods: In this cross-sectional observational study, 158 eyes of 79 patients with type 2 DM were categorized based on the presence or absence of DPN, diagnosed via electromyography. Corneal sensitivity was evaluated using the Brill esthesiometer, and tear MMP-9 levels were assessed with the InflammaDry test. Additional assessments included the Ocular Surface Disease Index (OSDI), tear osmolarity, Schirmer test, noninvasive tear break-up time, and meibography. Corneal impairment was defined as esthesiometry levels 4–6 or pressure thresholds ≥8 mbar in either eye. Results: Patients with DPN exhibited significantly reduced corneal sensitivity (6.98 ± 2.25 mbar vs. 5.62 ± 2.53 mbar; p = 0.014) and higher OSDI scores (median 26 vs. 10; p < 0.001). MMP-9 positivity was more common in patients with corneal sensory impairment (81.8% vs. 54.3%; p = 0.0215). A significant negative correlation was observed between tear osmolarity and corneal sensitivity (r = −0.182, p = 0.022). Multivariable regression showed that both DPN (β = 1.20) and MMP-9 positivity (β = 1.24) were independently associated with reduced sensitivity. Conclusions: Reduced corneal sensitivity was significantly associated with the presence of DPN and with MMP-9 positivity and showed a negative correlation with tear osmolarity. Corneal sensitivity testing combined with tear MMP-9 assessment may provide complementary information on ocular surface changes in diabetic patients, although current variability and limited reproducibility prevent their use as standalone screening tools for neuropathy.

Introduction: Neovascular age-related macular degeneration (nAMD) is a leading cause of vision loss and requires long-term anti-vascular endothelial growth factor therapy. This study aimed to evaluate the efficacy and safety of faricimab in patients with nAMD. Methods: This systematic review and meta-analysis were performed according to the PRISMA guidelines to identify studies assessing faricimab in nAMD. Primary outcomes included visual acuity, central macular thickness (CMT), and dry macula rate. Secondary outcomes included macular status, central choroidal thickness (CCT), and complications. A random-effects model was used to calculate pooled mean with 95% confidence intervals. Results: Out of the 365 studies identified, 21 studies were included, comprising a total sample size of 1,864 eyes of 1,791 patients. Post-operatively, there was a statistically significant improvement in corrected distance visual acuity (standardized mean difference [SMD]: −0.122, 95% p = 0.039) and CMT (SMD: −3.672, p = 0.010). Similarly, there was a significant improvement in the rate of dry macula at the final follow-up visit (event rate: 0.529; p < 0.05). For the secondary outcomes, there was a statistically significant improvement in CCT (SMD: −0.199, p = 0.026) and in the rate of macular exudates (0.452, p < 0.05), specifically intraretinal fluid (0.140, p < 0.05) and subretinal fluid (0.271, p < 0.05). Complications secondary to faricimab injections included hemorrhagic pigment epithelial detachment with a rate of 0.120 (p < 0.05) and retinal pigment epithelium tear with a rate of 0.025 (p < 0.05). Conclusions: The use of faricimab injection in patients with nAMD is safe and effective, resulting in significant improvements in a myriad of visual measures and OCT parameters.