Glaucoma is a progressive optic neuropathy that is accompanied by the development of visual functional defects induced by elevated intraocular pressure (IOP). In the clinic, glaucoma is generally treated by pharmacological therapy and surgical intervention. Among the therapeutic techniques, cyclocryotherapy and cyclophotocoagulation can suppress aqueous humor secretion by destroying the ciliary body to lower IOP, but they lack precision in clinical application. In this study, a precise therapeutic ciliary body destruction technique, ciliary body radio frequency ablation (RFA), was used utilizing high-frequency alternating current to generate localized thermal energy to destroy the ciliary body. The effectiveness and feasibility of glaucoma treatment were evaluated and verified using multimodal methods, including optical coherence tomography (OCT), OCT angiography, fundus fluorescein angiography, and electroretinography.

Melatonin and glaucoma: Current insights and clinical prospectives.

Liver surveillance imaging is essential for detecting early asymptomatic metastases in uveal melanoma, which predominantly involves the liver. Early detection may improve treatment opportunities, but variability in imaging protocols and a lack of consensus on surveillance duration present challenges. This study aimed to evaluate our systemic surveillance protocol, optimise pathways, and assess risk factors for metastasis. We retrospectively analysed patients diagnosed with uveal melanoma between 2006 and 2021 who underwent hepatic imaging surveillance at Sheffield Teaching Hospitals NHS Foundation Trust. Demographics, tumour characteristics, treatments, disease status, and survival outcomes were collected. Among 1086 patients (45% female, 79% White; median age 68 years), 315 (29%) developed metastases, with 293 (93%) detected within five years of ocular treatment. The number needed to scan (NNS) increased substantially after five years, indicating reduced detection efficiency. Higher T stage and ciliary body involvement were significantly associated with increased metastatic risk (P < 0.01). Most metastases from uveal melanoma occur within five years of treatment. Personalised, risk-based surveillance strategies considering tumour stage and location may improve efficiency and optimise healthcare resource use.

Nanophthalmos is a rare developmental ocular disorder of congenital origin, manifesting as a notably reduced globe volume, shortened axial length, shallow anterior chamber, thickened sclera, and significant hyperopia. These anatomical features predispose affected individuals to angle-closure glaucoma as a result of anterior segment crowding. Traditional treatments for nanophthalmos-related angle-closure glaucoma often involve complex combined surgeries, which are not only technically demanding but also easily cause postoperative complications, such as malignant glaucoma and choroidal leakage. This case series presents three middle-aged and elderly female patients (a total of four eyes) with nanophthalmos-related angle-closure glaucoma. Common clinical findings included an axial length ≤ 20.5 mm, high intraocular pressure (IOP &amp;gt; 21 mmHg; 1 mmHg = 0.133 kPa), shallow anterior chamber, and diminished visual acuity. Based on the pathogenesis of postoperative malignant glaucoma, we implemented a modified surgical technique termed pars plana filtration (PPF). This procedure involves partial excision of the ciliary body to establish an alternative aqueous drainage route, thereby reducing anterior vitreous and posterior segment pressure. Compared to traditional combined surgeries, the PPF approach offers technical simplicity, minimized tissue invasiveness, and a shorter learning curve for ophthalmic surgeons. Our study describes successful implementation of this surgery without postoperative complications observed. These findings suggest that PPF may represent a safe and effective surgical alternative for managing nanophthalmos-related angle-closure glaucoma. Nevertheless, further larger-scale studies are needed to validate its long-term effectiveness and generalizability.

ABSTRACT Purpose To assess the clinical course of ocular hypotony in a pediatric uveitis cohort. Methods The electronic medical records of children who developed ocular hypotony following uveitis were reviewed retrospectively. Result Forty-one eyes of 30 children were included. There were 17 (56.7%) males and the mean age at presentation was 10.8 ± 4.2 years (aged: 2–16 years). Anterior uveitis was diagnosed in 10 (24.4%) eyes, intermediate in five (12.2%) eyes, posterior in one (2.4%) eye and panuveitis in 25 (61%) eyes. Nine eyes (22%) received intensified topical and/or oral therapy alone, 15 eyes (36.7%) received periocular injections, and nine eyes (22%) received intravitreal steroids with continued systemic and topical treatment. Surgical intervention was performed in 20 eyes (48.8%) to manage hypotony. Among these 20 eyes, silicon oil insertion was done in 10 eyes while in the remaining 10 eyes, pars plana vitrectomy (PPV) with ciliary body membrane removal was done. Following treatment, 16 (39%) eyes showed improvement with restoration of IOP. The visual acuity at baseline and last visit were 2.08 ± 1.31 and 1.82 ± 1.43 log MAR units respectively. The median follow-up duration was 580 days (IQR:191–1610 days). Nine (22%) eyes went into phthisis. Conclusion Ocular hypotony in pediatric uveitis is a serious complication. Despite aggressive medical and surgical management, a significant proportion of eyes showed limited recovery, with nearly one-fourth progressing to phthisis. Early diagnosis, tailored treatment, and close monitoring are essential to improve visual and anatomical outcomes in this vulnerable population.

To report a rare case of intraocular ependymoma in childhood. A case report depicting the clinical timeline, initial diagnosis and management as well as final diagnosis upon description of histological and pathological findings and supportive ancillary testing, performed on the enucleated eye. We present a case report of a 5-year-old boy initially diagnosed with ciliary body medulloepithelioma. Upon failed plaque brachytherapy treatment, resulting in neovascular glaucoma, intraocular hemorrhage and a blind and painful eye, the child underwent secondary enucleation. Histological findings of atypical cells in pseudorosette (uncommon in medulloepithelioma), as well as immunohistochemical positive staining for glial fibrillary acidic protein (GFAP), S100, epithelial membrane antigen (EMA), L1 cell adhesion molecule (L1CAM) and negative for Olig2 with subsequent molecular genetic studies positive for C11orf95-RELA fusion sequence confirmed the rare diagnosis of intraocular ependymoma. Although extremely rare, intraocular ependymoma should be included as part of the differential diagnosis of retinal and ciliary body tumors in childhood.

Background: Iridocyclectomy still remains one of the main treatment options for intraocular anterior tumors. This surgical approach has undergone a century of development. Many famous ocular oncologists have contributed substantially to the advancement of the surgical removal of iridociliary tumors. Summary: Surgical resection of tumors involving the iris and ciliary body is challenging. In this article, we provide a historical overview of the evolution of iridocyclectomy since the beginning of the 20th Century, describing contributions made by the Russian Ophthalmologist, Prof. Leonid F. Linnik (1930-2008) and other eminent surgeons from several countries. Key Messages. Although block excision continues to dominate contemporary practice, a variety of unresolved challenges necessitate further technological innovation.

Minimally Invasive Glaucoma Surgery in the Surgical Landscape of Primary Angle Closure Glaucoma: Current Innovations and Future Trends.

DICER-1 pigmented ciliary body medulloepithelioma diagnosed secondary to cyclitic membrane adherent to intraocular lens.

Uveal tumors represent the most common primary intraocular neoplasms in adults and constitute a significant component of ocular oncology practice. Among these tumors, uveal melanoma is the most frequent malignant intraocular tumor arising from melanocytes located within the iris, ciliary body, and choroid. Despite advances in diagnostic imaging, molecular classification, and treatment modalities, metastatic disease remains the leading cause of mortality in affected patients. The liver is the predominant site of metastasis and accounts for nearly 90% of metastatic cases [1–3]. Recent advances in molecular oncology have significantly improved understanding of the pathogenesis of uveal melanoma, particularly the identification of driver mutations in GNAQ and GNA11 genes and prognostic biomarkers such as BAP1, SF3B1, and EIF1AX [4–7]. Imaging modalities including ultrasonography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCTA) have improved early detection and monitoring of uveal tumors [8– 10]. Current treatment strategies include plaque brachytherapy, proton beam radiotherapy, surgical management, and emerging systemic targeted therapies [11-13]. This review summarizes current knowledge on the epidemiology, molecular genetics, clinical presentation, diagnostic advances, and contemporary management of uveal tumors.

Objectives: to evaluate the prognostic significance of early postoperative inflammatory response parameters, namely visible aqueous humor opalescence and ciliary body thickness increase, for the effectiveness of transscleral laser cyclothermotherapy (TLCTT) in patients with primary open-angle glaucoma. Patients and methods. A retrospective analysis included 33 patients (22 men, 11 women; mean age 72.4 years) with uncontrolled primary open-angle glaucoma despite maximally tolerated hypotensive therapy. TLCTT was performed under local anesthesia with up to 16 applications delivered in the mode of 0.5 W for 20 s. Optical coherence tomography (CASIA2, Tomey, Japan) was used to assess ciliary body thickness before surgery and on postoperative day 1. Presence of aqueous humor opalescence was also recorded on day 1. Intraocular pressure (IOP) was measured by Maklakov tonometry, and topical regimen was documented preoperatively and at 1, 3, 6, and 12 months. Treatment success was defined as IOP reduction ≥ 20 % starting from 1 month. Results. Mean IOP reduction at 12 months was 8.8 ± 3.9 mmHg, corresponding to 23.8 % ( p &lt; 0.001). Treatment success was achieved in 24 patients (72.7 %). Visible aqueous humor opalescence on day 1 was observed in 24 patients (72.7 %) and correlated positively with greater IOP reduction ( p = 0.008, r = 0.72). Ciliary body thickness increased significantly on day 1 postoperatively ( p &lt; 0.0001). The dynamics of thickness increase showed a strong positive correlation with IOP reduction ( r = 0.86, p &lt; 0.05). Conclusion. Early postoperative signs of intraocular inflammation and ciliary body edema can serve as reliable predictors of TLCTT effectiveness. Visible aqueous humor opalescence and increased ciliary body thickness on day 1 are associated with higher likelihood of achieving a sustained hypotensive effect within 1 month. These parameters may be recommended for early prediction of treatment outcomes in patients undergoing TLCTT for primary open-angle glaucoma.

Objectives: to evaluate the feasibility of reducing exposure time during transscleral laser cyclothermotherapy (TLCTT) by applying a pulsedperiodic laser mode in an experimental setting. Methods. The study was conducted on Chinchilla rabbits of both sexes, weighing 1.5–2.0 kg. Animals were divided into two groups. The control group (20 rabbits, 40 eyes) underwent TLCTT using a continuous laser mode (0.3 W, 16 s). The experimental group (10 rabbits, 20 eyes) received TLCTT with a pulsed-periodic laser mode (duty cycle 50 %, pulse period 1 s), at 0.6 W for 8 s. Biomicroscopy was performed one day after the procedure to evaluate inflammatory response, and macroscopic examination of ciliary body specimens was carried out to assess the characteristics of destruction foci. Results. Biomicroscopy revealed mixed conjunctival injection in all animals, with moderate chemosis in 45 % of eyes in the control group and 50 % in the experimental group. Aqueous humor opalescence of moderate intensity was noted in 75 % and 80 % of eyes, respectively. No precipitates, posterior synechiae, or fibrinous deposits were observed. Macroscopically, destruction foci appeared as pale areas of ciliary processes with comparable diameters (1.35 ± 0.07 mm in the control group and 1.34 ± 0.08 mm in the experimental group, p = 0.3). No rupture-associated mechanical effects were detected in either group. Conclusion. The pulsed-periodic laser mode achieved destruction foci of comparable size to conventional TLCTT, without inducing additional mechanical damage or excessive postoperative inflammation. The shortened exposure time reduces the risk of light guide displacement during the procedure, potentially improving both safety and effectiveness.

ABSTRACT Clinical relevance Anterior segment morphometric parameters, including the iris, ciliary body, ciliary process and anterior sclera, re ect uveal vascular physiology and scleral biomechanics. These structures may help clinicians better understand disorders associated with altered ocular uid dynamics within the pachychoroid spectrum. Background Complex central serous chorioretinopathy is characterised by serous neurosensory retinal detachment and is commonly associated with pachychoroid features, including increased subfoveal choroidal thickness. However, the potential contribution of anterior uveal and scleral structures to its pathophysiology remains insu ciently de ned. Methods This study included 32 eyes with active complex central serous chorioretinopathy and 31 age- and gender-matched controls. Iris, ciliary body, and ciliary process thicknesses were measured using ultrasound biomicroscopy under standardised photo-pic conditions. Anterior scleral thickness was measured at 1, 2 and 3 mm posterior to the scleral spur using anterior segment optical coherence tomography. Subfoveal choroidal and central macular thickness were measured by spectral-domain optical coherence tomography. Correlations were analysed with false discovery rate correction. Results Ciliary body (0.93 ± 0.11 mm vs 0.78 ± 0.10 mm) and anterior scleral thickness (0.57 ± 0.06 mm vs 0.49 ± 0.05 mm) were signi cantly greater in complex disease than in controls (both p < 0.001). Subfoveal choroidal thickness (425.7 ± 83.8 µm vs 290.7 ± 68.5 µm) and central macular thickness (330.7 ± 74.0 µm vs 226.5 ± 18.8 µm) were also higher (p < 0.001). Anterior scleral thickness correlated with ciliary body (r = 0.494), ciliary process (r = 0.498) and subfoveal choroidal thickness (r = 0.509) (all p < 0.001). Temporal iris thickness correlated with temporal anterior scleral thickness (rs = 0.410; p = 0.006). Conclusion Active complex disease is associated with increased anterior uveal and scleral thickness, suggesting anterior segment involvement parallel to posterior pachychoroid changes.

To evaluate the impact of age-related ocular anatomical changes on the accuracy of postoperative vault prediction following implantable collamer lens (ICL) surgery and to identify key predictors for vault change (ΔVault). This retrospective study analyzed 2107 eyes that underwent ICL implantation (model V4c). Machine learning algorithms, including Light Gradient Boosting Machine, XGBoost, Support Vector Regression, Random Forest, and Gradient Boosting Decision Tree, were used to construct two prediction models: a full-age cohort model (18–50 years, n = 2107) and a young cohort model (< 40 years, n = 1788). Furthermore, 426 eyes were stratified into three age-based groups for anatomical and dynamic vault analysis: Young group (18–30 years, n = 188), Middle-aged group (31–39 years, n = 134), and Older group (≥ 40 years, n = 104). The preoperative parameters were measured using ultrasound biomicroscopy. Model performance was evaluated using the root mean square error (RMSE), coefficient of determination (R²), mean absolute error, and mean square error. Anatomical parameters and dynamic postoperative vault changes were compared across the age groups. The prediction accuracy of the young cohort model (< 40 years) was significantly superior to that of the full-age cohort model (RMSE: 53.59 μm vs. 64.36 μm; R²: 0.896 vs. 0.881; P < 0.01). Anatomical analysis revealed a significant stepwise increase in lens thickness (LT) from the Young to the Older group (3.5131 ± 0.1962 mm, 3.5860 ± 0.2784 mm, 3.9212 ± 0.2470 mm, P < 0.001), whereas anterior chamber depth (ACD) progressively decreased (3.2662 ± 0.2877 mm, 3.1067 ± 0.1958 mm, 3.0440 ± 0.2317 mm, P < 0.001). The variability of ΔVault, defined as the difference between vault at 6 months postoperatively and vault at 1 day postoperatively, was greatest in the Older group (standard deviation = 122.55 μm), intermediate in the Middle-aged group (111.61 μm), and smallest in the Young group (67.62 μm). Feature importance analysis for ΔVault identified ciliary process length, maximum ciliary body thickness, and LT as the top three predictors. The inclusion of patients aged 40 years and older significantly reduces the performance of a universal vault prediction model. Older patients exhibit distinct ocular anatomical characteristics, including increased LT, altered ciliary body parameters, and poorer postoperative vault stability. These findings suggest the need to develop age-specific prediction models that incorporate dynamic anatomical factors to optimize surgical planning.

Background Iris and ciliary body melanomas are rare but potentially life-threatening tumors that are difficult to distinguish from benign nevi. Earlier diagnosis improves outcomes, but reliable clinical indicators are limited. Glaucoma has been observed in conjunction with iris or ciliary body melanoma, but its prevalence and clinical significance at a population level is not well established. Objective To determine the prevalence of glaucoma in iris and ciliary body melanoma compared with nevus and to assess whether unilateral glaucoma may serve as a diagnostic indicator of melanoma. Methods This retrospective cohort study used the IBM MarketScan Research Database, which contains de-identified longitudinal healthcare claims data from commercially insured patients in the United States. Patients with iris or ciliary body melanoma or nevus were identified by International Classification of Diseases, Tenth Revision (ICD-10) diagnostic codes. Outcomes included the prevalence of glaucoma prior to treatment in melanoma versus nevus, age-stratified prevalence of glaucoma, and rates of glaucoma surgery. Odds ratios (ORs) with 95% CIs were calculated to compare groups. Results A total of 17,978 patients were included (112 with melanoma, 17,866 with nevus). Glaucoma prevalence prior to treatment was significantly higher in the melanoma cohort than nevus cohort (11.6% vs 1.3%; OR, 10.1; 95% CI, 5.1-18.4; P &lt; 0.001). This pattern persisted across all age groups, with the greatest relative difference observed in patients aged 20-39 years (10.9% vs 0.7%; OR, 14.2; 95% CI, 1.5-63.0; P = 0.01). Among patients with glaucoma, surgery was required more frequently in the melanoma cohort (18.9%) than nevus cohort (15.0%). Conclusion Unilateral glaucoma is significantly more common in eyes with iris and ciliary body melanoma than in those with iris and ciliary body nevus in this claims-based cohort, and melanoma patients are more likely to require surgical management. Unilateral glaucoma may serve as an important early clinical indicator of melanoma, although further clinical correlation is necessary. Incorporating glaucoma status into diagnostic criteria could improve recognition, prompt referral and biopsy, and reduce delays in treatment.

Uveitis is an inflammatory condition involving the iris, ciliary body, and choroid, and it represents a significant cause of vision loss in both children and adults. The primary goals of uveitis management are to control inflammation, prevent recurrences, and minimize structural damage and subsequent visual impairment. Currently, corticosteroids remain the mainstay of therapy for noninfectious uveitis. In patients with sight-threatening disease, immunosuppressive or steroid-sparing agents are commonly employed. However, for individuals who are intolerant of or refractory to corticosteroids and conventional immunosuppressive therapies, biologic agents have emerged as effective alternative treatments. Among these, anti-tumor necrosis factor alpha (TNF-α) agents have demonstrated efficacy in both uveitis and systemic autoimmune disorders. Adalimumab, an anti-TNF-α agent, was the first biologic approved by the U.S. Food and Drug Administration for the treatment of noninfectious uveitis. Prior to initiating biologic therapy, potential safety concerns, including the risk of infections and demyelinating diseases, must be carefully evaluated. Other biologic agents, such as interferons, interleukin inhibitors, and Janus kinase inhibitors, are emerging as promising therapeutic options for noninfectious uveitis. Further studies are required to better establish the long-term safety and efficacy of biologic therapies. This review highlights the role and effectiveness of biologic agents in the management of noninfectious uveitis.

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.

Intraocular metastases represent the most common type of malignant intraocular tumour in adults. These commonly affect the choroid but can also involve the iris, ciliary body, retina, vitreous, optic disc or lens. Breast and lung cancer are the most common origins of intraocular metastases. The diagnosis of intraocular metastases can be particularly challenging in patients without a prior history of cancer. Furthermore, treatment decisions may be complex, especially in individuals already receiving systemic therapy or in those with previous ocular treatment history. Herein, we present a review of the current knowledge regarding the epidemiology, origins, clinical and imaging characteristics, differential diagnosis and treatment of intraocular metastases.

This study conducts a comprehensive bibliometric analysis regarding the application of ultrasound biomicroscopy in glaucoma research over the past two decades. Bibliometric analysis was performed on relevant literature published between 2005 and 2024. Data pertaining to authorship, affiliations, countries of origin, journals, keywords, and cited references were extracted. Visualization and analysis were executed utilizing VOSviewer and CiteSpace software. Bibliometric analysis of 557 articles revealed a quadratic growth trend in annual publication volume. The most productive authors, institutions, countries, and journals were identified and collaboration network maps were drawn. Keyword co-occurrence analysis identified five primary research clusters: angle-closure glaucoma pathogenesis, cataract surgery & complications, glaucoma surgery, ciliary body & iris, and iridocorneal angle. Burst detection and timeline analysis highlighted emerging research frontiers, including deep learning, 3D reconstruction, vitreous zonule imaging, and minimally invasive glaucoma surgery. These findings signal a shift in research priorities towards computational approaches and novel clinical applications. This bibliometric analysis delineates the dynamic evolution and broadening scope of ultrasound biomicroscopy application in glaucoma research over the past two decades. Collectively, these findings affirm the enduring value of ultrasound biomicroscopy and delineate promising avenues for future investigation.

Fig. 1 Metastatic iris lesion from non-small cell lung cancer primary.Anterior segment photograph of a large actively shedding exophytic right iris lesion with cystic components filling most of the anterior chamber with peripheral corneal touch (A, B) in a 51-year-old female presenting with a one-month history of progressive right vision loss (BCVA HM) and intermittent brow ache (IOP 14 mmHg).B-scan revealed a hypoechoic iris mass (C, arrow) with no ciliary body extension or posterior segment involvement (C).The diagnosis of unilateral iris metastasis from a known, already metastatic, non-small cell lung cancer (EGFR wild type) primary (D) was made.This is a rare manifestation [1, 2], especially in NSCLC.In addition to the radiation and chemotherapy already prescribed, the patient proceeded to receive external beam radiation therapy delivering 20 Gy in 5 fractions to the right eye which provided minimal subjective improvement in vision and symptoms.