AIM: Orbital abscess is a life-threatening emergency due to the possibility of intracranial spread causing cavernous sinus thrombosis, meningitis or brain abscess; as well as primary or secondary sepsis causing organ failure. Our aim is to present a case of orbital cellulitis with a suspected odontogenic origin, highlighting the dental area as a cause of direct or indirect bacterial spread. PATIENTS AND METHODS: CASE REPORT Results: A 72-year-old male with diabetes mellitus type 2 and chronic obstructive pulmonary disease, paraplegic due to spondilodiscitis of septic origin four years prior, presented with rapidly progressive left-sided deterioration of vision, diplopia, periorbital edema and severe pain over two days. On presentation, he had visual acuity RE 0,8 and LE 0,6 Snellen decimal, severe chemosis, ptosis, restricted ocular motility, elevated intraocular pressure (30 mmHg) and choroidal detachment on LE; and multiple peripheral Roth spots on both eyes. Blood work-up showed elevated SR (63 mm/h) and CRP (30 mg/l). CT of the orbit showed a hypodense intraconal lesion under the superior rectus without typical signs of orbital cellulitis. Due to clinical signs of orbital cellulitis with orbital compartment syndrome emergency lateral canthotomy and cantholysis were performed and systemic antibiotic therapy was administered. Haematological origin was suspected due to bilateral Roth spots; however, haemocultures were negative, the chest X-ray was normal and the heart US did not show signs of endocarditis. Poor dental health was noted and on CT scan review periapical granulomas on the upper left side were described. Over the next two days, the clinical picture worsened with increased proptosis and chemosis and an increase of inflammatory markers (SR 62 mm/h and CRP 120 mg/l). Follow-up CT showed inflamed orbital fat and increased size of the hypodense lesion (from 25x10 to 30x13 mm), suggestive of an intraconal absces. Transconjunctival orbitotomy was performed and US assisted abscess localisation and drainage after which the clinical picture dramatically improved. Stomatological exam identified a periapical granuloma at tooth 27 with chronic apical periodontitis as a possible infectious source. Immediate extraction of tooth 27 was performed. Microbial cultures from the orbital abscess isolated Campylobacter rectus, commonly involved in chronic periodontitis with bone loss.

Rhegmatogenous retinal detachment with choroidal detachment (RRDCD) is a challenging situation. This study evaluates the safety and efficacy of preoperative intravitreal viscoelastic injection (PIVOT) in facilitating vitrectomy in RRD-CD. This consecutive series included eight eyes of eight patients with RRD-CD (CD reaching to equator), managed between December 2024 and April 2025. Healon™ PRO (1% sodium hyaluronate) was injected intravitreally, typically one day prior to vitrectomy, along with topical diflupred-nate, cycloplegics, and oral corticosteroids. Outcome measures were intraocular pressure (IOP), cumulative CD height (by ultrasonography), injection-related adverse events, and intraoperative complications. Mean IOP increased from 4.75 ± 2.05 mmHg at baseline to 10.0 ± 3.34 mmHg on day of surgery (P = .001). Cumulative CD reduced from 15.82 ± 4.88 mm to 5.49 ± 6.01 mm (P = .003). No adverse events were noted. Vitrectomy was safely completed, ensuring adequate silicone oil fill in all eyes. PIVOT combined with anti-inflammatory treatment appears safe and effective in optimizing surgical conditions for RRD-CD.

Purpose: To report a case of recurrent hypotony and exudative choroidal detachment in a patient with pseudoexfoliation glaucoma following the use of a topical preservative-free prostaglandin–timolol fixed combination eye drop.Case summary: A 74-year-old diabetic patient with a history of trabeculectomy for pseudoexfoliation glaucoma presented with conjunctival hyperemia, ocular pain, and blurred vision 3 months after using a preservative free prostaglandin-timolol fixed combination. Intraocular pressure (IOP) was markedly reduced to 6 mmHg and fundus examination revealed severe exudative choroidal detachment involving three quadrants. Treatment with oral and topical corticosteroids, cycloplegics, and non-steroidal anti-inflammatory drugs normalized his IOP to 15 mmHg and resolved the detachment within 3 weeks. Two weeks later, the patient inadvertently reused the same medication mistaking it for artificial tears. Symptoms recurred the following day with his IOP dropping to 2 mmHg and choroidal detachment affecting all four quadrants. Re-treatment led to full recovery within 3 weeks.Conclusions: Choroidal detachment following use of combination therapy with a prostaglandin analog and an aqueous suppressant is a rare complication. Patients with pseudoexfoliation syndrome and diabetes may be particularly susceptible. Vigilant monitoring of IOP and fundus status is recommended when prescribing these agents to individuals with multiple risk factors.

Hemorrhagic Choroidal Detachment Camouflaging Choroidal Melanoma.

A clinical case of exudative retinal detachment after trabeculectomy for secondary glaucoma with Sturge-Weber syndrome is presented. A 50-year-old female patient with Sturge-Weber syndrome sought help for secondary glaucoma with elevated intraocular pressure on maximum drug hypotensive therapy. According to these indications, she was offered trabeculectomy with posterior trepanation of the sclera. Surgical treatment was without intraoperative complications. However, in the early postoperative period flat choroidal detachment and widespread retinal detachment involving the macular region were detected. During observation and prescription of anti-inflammatory and cycloplegic therapy, resolution of the exudative process was noted 1 month after surgery. Conclusion. Despite the peculiarities of the postoperative course, trabeculectomy is one of the effective methods of surgical treatment of secondary glaucoma in Sturge-Weber syndrome.

This retrospective, single-center study aimed to determine the long-term real-world efficacy and safety of the MicroShunt over up to a 6-year period in a heterogeneous glaucoma population of 1001 eyes: including pseudophakic eyes and eyes undergoing combined cataract and MicroShunt surgery. Data were analyzed from 1001 eyes implanted with the MicroShunt between January 2019 and May 2025. The outcomes collected were intraocular pressure (IOP) reduction, complete and qualified surgical success at targets of 6-14, 6-18, and 6-21 mmHg, the medication burden, and the postoperative complications. Subgroup analyses compared all the eyes implanted with pseudophakic eyes or those undergoing combined cataract and MicroShunt surgery. The mean baseline IOP was 24.8 ± 8.4 mmHg across all eyes. IOP decreased to 9.6 ± 4.4 mmHg on postoperative day 1 and remained significantly reduced at 1 year (13.2 ± 3.9 mmHg) and 6 years (13.9 ± 2.3 mmHg). The IOP trajectories were similar in the subgroups. The IOP was slightly lower in eyes that had combined surgery. At 5 years, the complete success was 54%, 36%, and 8% for IOP thresholds of 6-21, 6-18, and 6-14 mmHg, respectively; while the qualified success rates were 62%, 38%, and 15%, respectively. The number of medications decreased significantly after surgery. Early postoperative complications were infrequent and usually transient. The complications were similar across subgroups with choroidal detachment (≤ 12%) and microhyphaema (10-15%) being the most common. Late complications occurred less often, and device-related failure leading to secondary glaucoma surgery rarely occurred (≤ 4%). The MicroShunt provided a sustained reduction in IOP and medication burden with a low incidence of complications over the follow-up period. The outcomes in pseudophakic eyes and those undergoing combined cataract surgery were like the cumulative population. The inclusion of pseudophakic and combined surgery eyes reflects the real-world situation in glaucoma practice. These results build on mid-term evidence to support the reliability and safety of the MicroShunt.

PurposeTo evaluate the efficacy and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) for refractory glaucoma.Patients and MethodsThis prospective multicenter study included 62 eyes of 57 refractory glaucoma patients. MP-TSCPC was performed from August 2022 to May 2023. All patients had a complete ophthalmic examination preoperatively, including medical history, slit-lamp examination, best-corrected visual acuity (BCVA) assessment, and pre- and post-operative intraocular pressure (IOP) measurements. The main outcomes included IOP change, antiglaucoma medication use, the cumulative incidence of treatment success, and the postoperative complications over 24 months. Treatment success was defined as an IOP reduction of more than 20% compared with baseline or a decrease in the number of antiglaucoma medications with stable target IOP. Retreatments were classified as failures.ResultsThe glaucoma subtypes included primary glaucoma (n=29) and secondary glaucoma (n=33). Prior glaucoma surgery had been performed in 48 of the 62 eyes (77.4%), with 30 of them having multiple types of surgery. Preoperatively, the mean IOP was 38.2±10.3 mmHg and the median number of antiglaucoma medications used was 3.0 (2.0, 3.0); these values decreased to 20.9±8.8 mmHg (a reduction of 42.7%; P<0.001) and 2.0 (0.0, 3.0) (P<0.001) at month 24, respectively. The treatment success rate was 77.4% at 24 months. Postoperative complications included mydriasis (n=10), conjunctival hemorrhage (n=9), mild anterior chamber inflammation (n=1), hyphema (n=1), mild ciliary body detachment (n=3), and choroidal detachment (n=1), all reversible after treatment.ConclusionMP-TSCPC appears to be a safe and effective treatment option for refractory glaucoma.

Late-onset choroidal detachment after combined surgery for glaucoma and cataract.

Real-life outcomes of the PAUL® Glaucoma Implant with ripcord in refractory glaucoma.

Introduction: Recurrent retinal detachment (re-RD) after primary pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment (RRD) remains a major surgical challenge with often unsatisfactory visual outcomes. This study aims to determine the incidence and identify factors influencing the anatomical and functional outcomes after surgical repair of re-RD. Methods: This retrospective, descriptive analytical study was conducted between October 2024 and December 2024 at RSUPN Cipto Mangunkusumo Hospital, Indonesia. We reviewed 368 RRD cases that underwent primary PPV between January 2022 and December 2023. Of these, 110 developed re-RD, and 72 cases that underwent at least one repair surgery were included. Detailed data on demographics, clinical status (BCVA, high myopia and lens status), and intraoperative details (number and location of tears, extent of RD, macula and proliferative vitreoretinopathy status, tamponade type, presence of choroidal detachment) were analyzed. BCVA was converted to LogMAR. Outcomes were assessed using paired t-test, Chi-square test, and multivariate logistic regression. Result: From this study, the incidence of re-RD was 29.9% (110/368). Following repair, the anatomical success rate (retina attached) was 75% (54/72). Multivariate analysis found that undergoing only one repair surgery (OR, 4.90; CI95%, 1.28–18.79; p=0.020) was the only factor significantly associated with better anatomical success. Functional outcomes improved statistically (median LogMAR 1.7 [0.5−2.3] to 1.7 [0.4−3.0]; p&lt;0.001), but only 11.1% (8/72) of patients achieved BCVA of ≥6/60. Multivariate analysis showed macula-on status at the time of re-RD (OR 9.67; p=0.006) was the only significant predictor for better final functional outcomes. Conclusion: The anatomical and functional outcomes of re-RD management are comparable to reports from other countries. Prognosis is associated with macula status at the time of recurrence and the number of repair surgeries performed.

To evaluate the incidence of postoperative hypotony and early complications in 25-gauge vitrectomy by suturing all sclerotomies. We retrospectively reviewed a consecutive series of 458 eyes of 435 patients who underwent 25G pars plana vitrectomy with suturing all sclerotomies. The primary outcome measure was intraocular pressure (IOP) at postoperative day 1. Secondary outcome measures were clinical signs of hypotony and postoperative complications. Hypotony was defined as an IOP < 5 mmHg. Postoperative hypotony was found in 22 eyes (4.8%). No eyes suffered IOP of 0 nor 1 mmHg. None of the eyes demonstrated any clinical signs of hypotony including endophthalmitis, hypotony maculopathy nor choroidal detachment. The eyes with sulfur hexafluoride (SF6) gas tamponade had a significantly lower rate of hypotony compared to eyes with no tamponade (1.3% (2 eyes/154 eyes) vs 6.3% (18eyes/284 eyes); p = 0.0118). The incidence of hypotony was 11.1% (5 eyes/45 eyes) in reoperation and 4.1% (17 eyes/413 eyes) in primary operations (p = 0.037). Suturing all sclerotomies showed a low incidence of postoperative hypotony. Reoperation increased the risk of hypotony, while SF6 gas tamponade lowered the risk of hypotony.

To investigate the preventive effect of intravitreal injection on posterior segment magnetic intraocular foreign body (IOFB)-related endophthalmitis, the risk factors for endophthalmitis, and the prognostic factors of posterior segment magnetic IOFBs. Retrospective analysis of patients with posterior segment magnetic IOFBs admitted to Hebei Eye Hospital (2014-2022). Among them, 172 patients (2016-2022) received intravitreal antibiotics at the time of primary repair. Rates of endophthalmitis in this cohort were compared with those in a previous cohort admitted between 2014 and 2016(56 patients). In the previous cohort, patients received only primary repair. The cohort was predominantly male (94%), median age 39 years. the right eye was affected in 105 patients (45%). The incidence of endophthalmitis was 4.7% (8/172) and 13.6 % (8/59) in the recent and previous cohorts, respectively, with significant difference(P=0.043). Lens capsule rupture and IOFB > 2 mm were risk factors for magnetic IOFB-related endophthalmitis (P=0.024 and P=0.031, respectively). Lens capsule rupture (OR=2.872, 95% CI 1.487-5.548, P=0.002); vitreous hemorrhage(OR=2.010, 95%CI 1.064-3.796, P=0.031); retinal detachment (OR=3.745, 95%CI 1.758-7.979, P<0.001); choroidal detachment (OR=5.109, 95%CI 1.465-17.808, P=0.010) and IOFB>2mm(OR=1.914, 95%CI 1.025-3.574, P=0.042) were predictors of poor visual outcome. Prophylactic intravitreal antibiotics can reduce the incidence of endophthalmitis in posterior segment magnetic IOFB injuries. Lens capsular rupture and IOFB > 2 mm are risk factors for endophthalmitis. In addition, lens capsular rupture, vitreous hemorrhage, retinal detachment, choroidal detachment, and IOFB > 2 mm are associated with a poor prognosis. A good initial VA is associated with a good prognosis.

Transscleral Anterior Segment OCT Imaging in Choroidal Detachment Using Swept-Source OCT.

To evaluate the intraocular pressure (IOP)-lowering effect, adverse event profile, and risk factors for failure of an ab externo microshunt combined with phacoemulsification after 1 year of follow-up. A retrospective, single-center, interventional cohort study. One hundred nineteen consecutive glaucomatous eyes of 97 patients with an IOP above target or progressing on maximal medical therapy. All eyes underwent ab externo microshunt surgery with mitomycin C in combination with phacoemulsification from July 2015 to June 2019. Primary outcome was complete success, defined as (1) no 2 consecutive IOP readings >17 mm Hg or IOP <6 mm Hg with >2 lines of vision loss, (2) at least 20% IOP reduction from baseline, and (3) on no medications. Secondary outcomes included upper IOP thresholds of 14 mm Hg and 21 mm Hg, qualified success (with medications), change in IOP, medications, visual outcomes, complications, interventions, and reoperations. At 1-year, complete success was achieved in 67.5% of eyes and qualified success in 79.8%. The median best-corrected vision acuity improved from 0.4 (interquartile range [IQR] 0.2-0.7) at baseline to 0.14 (IQR 0.1-0.3) at 1 year (p < 0.0001), with 93.2% having the same or improved vision. The most common complications were shallow anterior chamber (10.1%), iritis (9.2%), and choroidal detachment (8.4%). Needling was required in 24.4% of the eyes. Reoperation was required in 5.9% of the eyes. The ab externo SIBS microshunt demonstrates reasonable rates of complete and qualified success at 1 year, decreased IOP and medication use, good visual outcomes, and few reoperations when performed in combination with phacoemulsification.

To evaluate the safety and potential efficacy of a dexamethasone implant (Ozurdex) administered prior to proton radiation. in patients with tumor-associated exudative retinal detachments. This was an investigator-initiated pilot study. Patients diagnosed with choroidal melanomas ≤10 mm thick, detachments spanning > 2 clock hours, and visual acuity of 20/100 or better were randomized 1:1 to receive the dexamethasone implant or no treatment prior to proton radiation. Patients, masked to treatment completed during tumor localization surgery, were evaluated at 6, 14, 28 and 54 weeks after surgery. Efficacy endpoints included retinal detachment resolution, visual acuity preservation, and incidence of neovascular complications. Adverse events associated with the implant were monitored to ensure safety. Baseline characteristics were similar between the dexamethasone (n=5) and no treatment (n=5) groups; median retinal detachment size was 4 clock hours at presentation in both groups. Four patients (80%) in each group had baseline visual acuity of 20/40 or better. At 12 months, the proportion of patients with resolution of retinal detachment was 40% in the dexamethasone group and 80% in the no treatment group; 60% in the dexamethasone group and 20% in the untreated group had visual acuity of 20/200 or worse. Known adverse effects of dexamethasone, cataract progression and elevated intraocular pressure, occurred in two patients and one patient, respectively, who received dexamethasone. Improved clinical outcomes were not observed in patients receiving the dexamethasone implant prior to proton radiation. No new safety concerns were identified with the use of dexamethasone in this cohort.

Précis:This is a retrospective observational study investigating the congruity between numerical and clinical hypotony and the risk factors for clinical manifestations of hypotony after trabeculectomy.Purpose:To identify risk factors associated with clinically meaningful hypotony after trabeculectomy.Design:Retrospective cohort study.Methods:Patients who underwent trabeculectomy with mitomycin-C (MMC) were included. Clinical hypotony was defined as the presence (≥ 3 wk after surgery) of choroidal detachment, hypotony keratopathy, hypotony maculopathy, or shallow anterior chamber or the need for trabeculectomy revision to resolve the hypotony at any time after surgery. Numerical hypotony was defined as intraocular pressure (IOP) ≤5 mmHg in 2 or more consecutive visits, at least one of them ≥ 3 weeks after surgery. Baseline, intraoperative, and postoperative characteristics were evaluated as potential risk factors. Univariable and multivariable analyses were conducted to assess the association between each characteristic and the presence of clinical hypotony.Results:Nine hundred ninety-two eyes were included. Two hundred eighty-four eyes (28.6%) met the criteria for numerical hypotony, 222 of which (79.9%) did not show any clinical sequelae of hypotony. 99 eyes (10%) met our criteria for clinical hypotony, whereas 42 of them (42.4%) did not have numerical hypotony. The most frequent manifestation of hypotony was serous choroidal effusion (54 eyes, 5.4%) followed by shallow anterior chamber (28 eyes, 2.8%). Thirty-four eyes (3.4%) underwent trabeculectomy revision to treat the hypotony. Asian ethnicity mitigated against the development of clinical hypotony (OR: 0.29, CI: 0.10–0.72, P=0.015) and the requirement for suture lysis postoperatively was associated with a lower risk of clinical hypotony (OR: 0.49, CI: 0.29–0.81, P=0.006).Conclusions:A minority of eyes (20.1%) with numerical hypotony showed clinical manifestations of low IOP. Asian ethnicity and eyes that required suture lysis postoperatively tended to have less incidence of clinical sequelae of hypotony after trabeculectomy.

To evaluate the real-world 3-year safety and efficacy of the Preserflo MicroShunt with mitomycin-C(MMC) in reducing intraocular pressure(IOP) and medications in patients with inadequately controlled glaucoma. This retrospective, multicentre, open-label study included consecutive patients who received the Preserflo MicroShunt implantation with MMC. We included patients with glaucoma (primary open-angle glaucoma (POAG), pseudoexfoliative glaucoma (PXF), pigmentary dispersion glaucoma (PDG), normal-tension glaucoma (NTG), ocular hypertension (OHT), primary angle-closure glaucoma (PACG), uveitic glaucoma and other) inadequately controlled by medical therapy. The primary endpoints were the mean change in IOP and the number of IOP-lowering medications from baseline. Treatment success was defined as achieving IOP ≤ 18mmHg and a 20% reduction from baseline with (qualified success) or without (complete success) the need for hypotensive medications. A total of 242 patients had a mean baseline IOP of 25.3 ± 7.2mmHg, reduced to 13.6 ± 4.7mmHg at 1year, 13.5 ± 5.1mmHg at 2years, and 13.1 ± 4.6mmHg at 3years (p < 0.0001). Medication burden decreased from 3.0 ± 1.0 at baseline to 0.55 ± 0.7 at 1year, 0.72 ± 0.9 at 2years, and 0.72 ± 0.9 at 3years (p < 0.0001). Overall success rates at 1,2 and 3years were 76.1%, 71.7% and 68.7% respectively. Common adverse events included hyphema (9 eyes), hypotony (5), and choroidal detachment (4). Over three years, the most common interventions included needling (22), surgical revision (29), and tube surgery (8). In a real-world, multicentre setting, the Preserflo MicroShunt showed sustained IOP reduction and decreased medication use over 3years, supporting its long-term safety and efficacy.

We reported the clinical course of refractory childhood glaucoma associated with Sturge–Weber syndrome (SWS) treated with Baerveldt glaucoma implant (BGI). The patient was a 14‐year‐old male diagnosed with SWS after birth. He had previously undergone four trabeculotomies for glaucoma and vitrectomy for submacular hemorrhage from a diffuse choroidal hemangioma in his left eye. Before the BGI surgery, his intraocular pressure was 30 mmHg under full medications. The patient experienced extensive serous retinal and choroidal detachments on Postoperative Day 9. The cause may have been the increased leakage of serous fluid from the choroidal hemangioma and the high venous pressure in the episclera due to SWS. Retinal and choroidal detachments subsided within 8 days with conservative therapy. It is important to avoid postoperative hypotony for the treatment of secondary childhood glaucoma due to SWS.

To describe the clinical course and treatment outcomes of Vogt-Koyanagi-Harada (VKH) disease presenting with bullous exudative retinal detachment (bullous ERD). This retrospective study included all patients diagnosed with VKH presenting with bullous ERD in one or both eyes between 2016 and 2024. Their best-corrected visual acuity (BCVA), clinical presentations, and treatment outcomes were analyzed. Among 646 patients with VKH, 12 (22 eyes) presented with bullous ERD in the early stage of the disease. The mean age at presentation was 38.67 years (range: 22-58 years). Bilateral bullous ERD was noted in 10/12 patients, while two had unilateral involvement. The mean BCVA at presentation and the final follow-up was 1.74 logMAR (SD 0.67, range 0.2-2.3 logMAR) and 0.84 logMAR (SD - 0.57, range 0-2.2), respectively. Anterior segment inflammation was noted in 15 eyes (68.1%), disc edema in 16 (72.7%), and vitritis and choroidal detachment in four eyes each (18.2%). The average choroidal thickness on B-scan ultrasonography was 1.79 mm (range: 1.04-3.57 mm). Six eyes (27%) experienced acute exacerbations, and five eyes (22.7%) had recurrences. The mean follow-up was 17 months (range: 6-61). At final follow-up, sunset glow fundus developed in 17 eyes (72%), secondary glaucoma in eight eyes (36.3%), and subretinal fibrosis in nine eyes (41%). Bullous ERD is a rare manifestation of VKH. Although initial visual recovery is promising, these patients are at higher risk for disease exacerbation, recurrences, and complications. Initial aggressive therapy and prolonged follow-up with sustained immunosuppression are essential for optimal outcomes.

We present a rare case of non-arteritic anterior ischemic optic neuropathy (NAION) following flanged-scleral-fixated intraocular lens (SFIOL) implantation in a middle-aged patient with traumatic cataract and no systemic risk factors. Postoperative complications included hypotony, choroidal detachment (CD), and persistent optic disc edema. Visual field analysis revealed an inferior altitudinal defect, confirming the diagnosis of NAION. Systemic and neuroimaging evaluations were unremarkable. This case highlights a possible association between postoperative hypotony and optic nerve ischemia following complex intraocular surgery. It emphasizes the importance of close postoperative monitoring of optic nerve health, especially in trauma-related cases requiring secondary IOL fixation.