Association Between Pseudoexfoliation Glaucoma and Central Serous Chorioretinopathy.

There are research findings suggesting that antiglaucoma agents may reduce aqueous humor outflow and decrease the elimination of intravitreally administered anti-vascular endothelial growth factor agents, prolonging their effect. The aim of this study was to evaluate central macular thickness (CMT) after repeated injections, using real-world data, to provide insight into how this phenomenon may affect clinical outcomes. One hundred forty-seven patients with diabetic macular edema (DME) were included in the study;66 patients received topical therapy due to pre-existing glaucoma, either primary open- angle or pseudoexfoliative glaucoma, and 81 patients without glaucoma. CMT values were evaluated before treatment, 1 month after the first three injections, 1 month after the subsequent four injections, and at the end of the first year. No significant differences were detected with respect to HbA1c levels, the presence of SRF, or prior photocoagulation (p = 0.085, p = 0.24, and p = 0.3, respectively). There was no difference between anti-glaucoma agent users and control group in CMT measurements 1 month after the first three injections (p = 0.6, p > 0.05). However, measurements taken 1 month after the subsequent four injections were significantly lower in patients using topical anti-glaucoma agents (p = 0.001, p < 0.05). At the 1-year measurement interval, although the values remained lower, the significant difference had disappeared (p = 0.11, p > 0.05). The presence of hyper reflective dots (HRD) was also greater in this group (p = 0.021, p < 0.05). At the 1-year measurement interval, although the values remained lower, the significant difference had disappeared (p = 0.11, p > 0.05). The presence of HRD and the combined presence of SRF and HRD had a significant effect on the changes in the measurements (F (4.412), p = 0.006, Eta2 = 0.103 and F (4.51), p = 0.001, Eta2 = 0.106, respectively). Although the use of topical anti-glaucoma therapy may have a partial effect on reduction of CMT in DME patients receiving anti-vascular endothelial growth factor (anti-VEGF) treatment.

Uveitis Glaucoma Hyphema (UGH) syndrome results from chafing between an intraocular implant and anterior chamber structures, and it typically presents with anterior chamber inflammation, elevated intraocular pressure and recurrent microhyphema or hyphema. Herein, we report the case of a patient with atypical presentation: iridocorneal angle closure secondary to a clot-induced pupillary block. The same patient developed reverse pupillary block a few weeks after surgery. A 77-year-old Caucasian woman presented with iridocorneal angle closure secondary to a clot induced pupillary block. The bleeding was caused by rubbing between a late in-the-bag dislocated intraocular lens and the iris in pseudoexfoliative syndrome. The diagnosis of UGH was initially delayed due to the unusual presentation. She underwent intraocular lens (IOL) exchange and secondary IOL scleral fixation, and subsequently developed reverse pupillary block. Both pupillary blocks were resolved by laser iridotomy. Uveitis Glaucoma Hyphema syndrome can rarely present with pupillary block, particularly in cases caused by late in-the-bag IOL dislocation in pseudoexfoliation syndrome. This case is unusual due to the occurrence of both pupillary block and subsequent reverse pupillary block in the same patient, highlighting the importance of recognizing these uncommon and atypical mechanisms.

To evaluate the efficacy and safety of Kahook dual blade (KDB) goniotomy combined with phacoemulsification for open-angle glaucoma in Chinese patients. We retrospectively enrolled 78 Chinese patients (100 eyes) with open-angle glaucoma who underwent KDB goniotomy combined with phacoemulsification at the Third People's Hospital of Dalian, Liaoning Province, China, between September 2021 and December 2024, of whom 63 eyes had primary open-angle glaucoma (POAG) and 37 eyes had pseudoexfoliation glaucoma (PXFG). Intraocular pressure (IOP), the number of glaucoma medications used preoperatively and at 1day, 1 week, 1 month, 3, 6, 12, and 36 months postoperatively, surgical success rates, and surgical complications were recorded. Surgical success was defined as: Criterion A (IOP reduction ≥ 20% with IOP ≤ 21 mmHg), Criterion B (IOP reduction ≥ 20% with IOP ≤ 18 mmHg), and Criterion C (IOP reduction ≥ 20% with IOP ≤ 15 mmHg). The mean IOP reduced from 25.25 ± 6.54 mmHg at baseline to 14.09 ± 3.48 mmHg at 36 months (P < 0.01). The number of medications decreased from 3.0 (2.0, 4.0) to 1.0 (0.0, 2.0) at 36 months (P < 0.01). Surgical success rates at 36 months, defined by Criteria A, B, and C, were 76.32%, 67.11%, and 48.68%. The mean IOP reduced from 24.57 ± 5.71 mmHg at baseline to 14.83 ± 3.35 mmHg at 36 months for POAG (P < 0.01) and from 26.41 ± 7.70 mmHg at baseline to 12.90 ± 3.40 mmHg at 36 months for PXFG (P < 0.01).The number of medications decreased from 3.0 (2.0, 4.0) to 1.0 (0.0, 2.0) for POAG (P < 0.01) and from 3.0 (2.0, 4.0) to 0.0 (0.0, 1.0) for PXFG (P < 0.01) at 36 months. Between the two groups, IOP showed no statistical difference at baseline, 3 months, and 36 months (P > 0.05). At 1day, 1 week, 1 month, 6 months, 12 months, and 24 months, IOP in the PXFG group was significantly lower than that in the POAG group (P < 0.05). From 3 months to 36 months, the number of medications in the PXFG group was significantly lower than that in the POAG group (P < 0.05). Surgical success rates at 36 months according to Criterion A were 72.34% in POAG and 82.76% in PXFG (P = 0.127); according to Criterion B, 59.57% vs. 79.31% (P = 0.087); and according to Criterion C, 42.55% vs. 62.07% (P = 0.036). Twenty-four-hour IOP fluctuations at 12 months were 4.02 ± 2.01 mmHg in POAG and 3.69 ± 1.31 mmHg in PXFG, both significantly decreased compared with baseline (10.02 ± 3.58 mmHg and 10.39 ± 3.32 mmHg, respectively; P < 0.01 for both groups). Common surgical complications included hyphema and IOP spike. KDB goniotomy combined with phacoemulsification was safe and effectively reduced IOP and the medication burden in patients with POAG and PXFG. In the first and second year, significantly lower IOP was noted in PXFG compared with POAG.

ABSTRACT Purpose To evaluate long-term intraocular pressure (IOP), number of antiglaucoma medications (AGMs), and success after phacoemulsification combined with XEN-45 implantation (Phaco+XEN-45), and to compare these outcomes between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). Methods This retrospective study included 30 patients (30 eyes; 17 POAG, 13 PEXG) who underwent Phaco+XEN-45 implantation. IOP, number of AGMs, postoperative interventions, complete or qualified surgical success (IOP of 5–18 mmHg with AGMs or independent of AGMs, respectively), and failure (failure to achieve qualified success) were evaluated at 1, 2, 3, 4, 5 years postoperatively and at the final follow-up. Results The median IOP at baseline was 20.5 (14.8–26.5) mmHg and decreased to 16.0 (14.8–17.3) mmHg at 5 years. The median number of AGMs decreased from 3.0 (2.0–3.3) at baseline to 2.0 (0.0–2.3) at 5-year, presenting a significant reduction at all follow-up time points (p < .001). The median IOP did not differ between POAG and PEXG during follow-up, whereas PEXG required more AGMs at 1 and 2 years (p = .048 and p = .031, respectively). Kaplan-Meier analysis showed complete success rates of 60% and 36% and qualified success rates of 100% and 96%, at 1 and 5 years, respectively; with 70% qualified success rate at 8 years. Long-term success did not differ between the POAG and PEXG groups. Conclusion Phaco+XEN-45 implantation offers a significant reduction in AGMs and a marked decrease in IOP, with an acceptable long-term efficacy and safety profile. The similarity in the success rates of POAG and PEXG suggests that Phaco+XEN-45 is a feasible and safe option for both types of glaucoma with appropriate patient selection and effective postoperative bleb modulation.

To evaluate the efficacy and safety of the Kahook Dual Blade (KDB) excisional goniotomy procedure combined with phacoemulsification in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and primary angle-closure glaucoma (PACG). This retrospective study included 25 eyes of 25 patients (13 males, 12 females) who underwent combined phacoemulsification and KDB excisional goniotomy for early- to moderate-stage glaucoma. Pre- and postoperative intraocular pressure (IOP), number of antiglaucoma medications, and best-corrected visual acuity (BCVA) were evaluated. Postoperative complications and surgical success rates were analyzed during a 6-month follow-up period. Surgical success was defined as a ≥20% reduction in IOP from baseline and IOP <18 mmHg, with or without medication. The patients' mean age was 67.0±11.9 years; 36% had POAG, 36% PEXG, and 28% PACG. The mean preoperative IOP was 22.7±6.0 mmHg, which significantly decreased to 12.8±2.2 mmHg at 6 months (p<0.05). The median number of medications decreased from 2 preoperatively to 0 postoperatively (p<0.05). There were no significant differences in 6-month IOP values (p=0.96) or IOP reduction rates (p=0.61) among glaucoma subtypes. BCVA improved from 0.5±0.4 to 0.1±0.1 logarithm of the minimum angle of resolution (p=0.001). The most common complications were transient hyphema (12%) and corneal edema (20%), all of which resolved with conservative/topical treatment. One patient required trabeculectomy at month 3, and 3 patients demonstrated less than 20% IOP reduction. The surgical success rate at month 6 was 84%. The KDB procedure combined with cataract surgery provided significant reductions in both IOP and the need for IOP-lowering medications at 6 months of follow-up in patients with early and moderate POAG, PACG, and PEXG, while maintaining a very low rate of complications.

To investigate the effects of selective laser trabeculoplasty (SLT) on the iridocorneal angle, anterior chamber, and iris in patients with pseudoexfoliation glaucoma (PEXG) and to evaluate the relationship between these structural changes and intraocular pressure (IOP) reduction. Thirty-two eyes of 32 PEXG patients were included in the study. Anterior segment optical coherence tomography (AS-OCT) images were obtained using the MS-39 combined Placido disk/AS-OCT system (Phoenix version 4.1.1.5) before SLT and at 1 week and 1 month after SLT. Anterior chamber angle (ACA), angle opening distance at 250 μm, 500 μm, and 750 μm (AOD250, AOD500, and AOD750), and trabecular-iris space area at 250 μm, 500 μm, and 750 μm (TISA250, TISA500, and TISA750) were measured from these images. In addition, iris thickness was assessed at 1000 μm, 2000 μm, and 3000 μm from the pupillary margin. The mean IOP decreased significantly from 23.47±3.56 mmHg at baseline to 17.81±2.62 mmHg at 1 week and 16.12±2.57 mmHg at 1 month after SLT (p<0.001). At both 1 week and 1 month after SLT, temporal and nasal ACA values were significantly greater compared to baseline (all p<0.05). At 1 month, significant increases were observed in all temporal AOD and TISA values, as well as in the nasal AOD, TISA500, and TISA750 values (all p<0.05). No significant change in iris thickness was observed (p>0.05). Changes in IOP showed no significant correlation with baseline visual field parameters, baseline peripapillary retinal nerve fiber layer thickness, ACA, AOD, or TISA values (all p>0.05). In patients with PEXG, SLT effectively reduces IOP and leads to widening of iridocorneal angle parameters. However, the absence of a correlation between changes in angle parameters and IOP reduction strengthens the notion that the primary effect of SLT is related to cellular and biochemical mechanisms rather than a purely mechanical widening of the angle.

Abstract: PURPOSE: The purpose of this study was to deeply investigate the iris biomechanics in pseudoexfoliation syndrome (PEX) patients using anterior segment optical coherence tomography (AS-OCT). METHODS: The study included 34 patients (40 eyes) divided into two groups: 14 patients (20 eyes) with the PEX group and 10 participants (20 eyes) as a normal control group. All participants underwent a thorough ophthalmic examination. AS-OCT imaging was performed using an Avanti RTVue-XR platform, and measurements of angle, iris, and pupil diameter were calculated. RESULTS: AS-OCT measurements showed significantly narrower angle parameters in the PEX group, including smaller OCT angle degree (24.1° ± 8.41° vs. 35.3° ± 6.15°, P = 0.000024), reduced TISA 500 (0.118 ± 0.051 mm 2 vs. 0.211 ± 0.043 mm 2 , P &lt; 0.0001), and smaller angle opening distance at 500 μm (324.65 ± 156.79 μm vs. 581.75 ± 122.62 μm, P &lt; 0.0001). Pupil diameter was significantly smaller in the PEX group (2.73 ± 0.65 mm vs. 4.06 ± 0.75 mm, P &lt; 0.0001). Iris parameters in PEX patients showed greater iris vault (218.8 ± 51.09 μm vs. 163.9 ± 48.28 μm, P = 0.0012), increased maximum iris thickness (554.1 ± 82.24 μm vs. 502.6 ± 78.48 μm, P = 0.0498), and shorter iris chord length (4.28 ± 0.61 mm vs. 4.76 ± 0.52 mm, P = 0.0118). CONCLUSION: The study confirms that PEX eyes exhibit significant structural alterations in iris biomechanics that are responsible for secondary glaucoma.

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.

Most glaucoma genetic data derive from European and East Asian cohorts, leaving high-consanguinity Middle Eastern populations under-characterized. This review synthesizes 33 Saudi-specific genetic studies (2014-2024, >9000 participants) to define a population-level glaucoma genetic architecture that diverges substantially from global models and carries direct precision medicine implications. Three findings distinguish the Saudi landscape. First, CYP1B1 functions as the dominant causal gene across both primary congenital glaucoma (PCG) and juvenile-onset open-angle glaucoma (JOAG), accounting for 76-86% of cases, with two founder alleles, p.G61E (penetrance 87.7%) and p.R469W (penetrance 93%), driving severe, early-onset phenotypes. Critically, MYOC and LTBP2, the primary JOAG genes in other populations, carry no pathogenic variants in Saudi cohorts, rendering standard multi-ethnic gene panels inadequate for this population. Second, adult-onset glaucoma follows a distinct polygenic architecture where APOE ε2 confers a near five-fold risk for primary angle-closure glaucoma (OR = 4.82), an effect absent or inconsistent in global datasets, and NOS3 variants associate with primary open-angle glaucoma specifically in men, a sex-stratified signal unreported outside Saudi cohorts. The MTHFR T/T genotype, common in European and Asian POAG patients, is entirely absent locally, indicating population-specific allelic distributions that alter folate-metabolism-related optic nerve susceptibility. Third, ACVR1 rs12997 associates across POAG, PACG, and pseudoexfoliation glaucoma (PXG), positioning BMP/TGF-β signaling as a shared mechanistic pathway spanning multiple subtypes. These findings argue for Saudi-specific genetic panels, CYP1B1-centered cascade testing in consanguineous families, and polygenic risk models incorporating local allele frequencies rather than globally derived weights.

Epiretinal membrane is more frequent in pseudoexfoliation glaucoma than in pseudoexfoliation syndrome or controls, and is independently associated with worse visual field sensitivity, in addition to retinal nerve fiber layer thinning. To investigate the prevalence and clinical implications of vitreomacular interface disease, particularly epiretinal membrane (ERM), in eyes with pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG), and to evaluate the impact of ERM on visual field parameters. This retrospective study included 258 eyes (105 PXS/PXG; 153 matched controls) from 160 participants. All subjects underwent detailed ophthalmologic examination, optical coherence tomography (OCT) imaging, and visual field testing. ERM was graded according to the OCT-based staging system proposed by Govetto et al The visual field index (VFI) and mean deviation (MD) were analyzed concerning ERM presence and retinal nerve fiber layer thickness (RNFLT). Logistic and linear regression analyses were performed using generalized estimating equations to account for inter-eye correlation. ERM was significantly more prevalent in PXG eyes (28.8%) compared to PXS (19.6%) and controls (8.5%) (P<0.001). Complete posterior vitreous detachment was more common in controls, while incomplete posterior vitreous detachment was prevalent in PXS/PXG groups. After age adjustment, PXG was independently associated with ERM, with approximately 3.6-fold higher odds compared with controls (OR=3.58; 95% CI: 1.34-9.57; P=0.011). In PXG patients, eyes with ERM showed significantly reduced VFI and MD compared to eyes without ERM (P=0.011 and P=0.034, respectively). Multivariate regression identified both ERM presence and reduced RNFLT as independent predictors of visual field loss. ERM was more prevalent and showed a more pronounced functional impact in PXG eyes. Routine OCT assessment in PXS/PXG patients may facilitate early detection of ERM and improve visual prognosis.

To determine baseline risk factors of incident open-angle glaucoma (OAG) in an elderly white population. Prospective-longitudinal population-based study. 12 years following baseline examinations, subjects were re-invited for follow-up examinations using the same methodology undertaken at baseline. 1092 (74%) were re-examined. In multivariable logistic regression analysis, factors with a p value of ≤0.2 in univariate analysis were included in the model. Overall, 826 subjects met final inclusion criteria. In multivariable regression analysis adjusted for potential confounders, baseline factors associated with incident glaucoma were: pseudoexfoliation (PEX) (p=0.002); higher intraocular pressure (IOP) (p<0.001); cup-to-disc ratio (p=0.020); family history of glaucoma (p=0.029); history of heart attack (p=0.002), blood pressure (BP) ≤140/90 without anti-hypertensive treatment (p=0.019) compared with BP >140/90. Increased hours of sleep (p=0.043) and alcohol consumption (p=0.030) were found to be protective factors. Increased IOP, PEX, increased vertical c/d ratio, family history of glaucoma, history of heart attack and BP ≤140/90 increased the risk for incident OAG. Increased hours of sleep and alcohol consumption were inversely associated with the development of incident glaucoma.

Epiretinal membrane prevalence in asymmetrical pseudoexfoliation glaucoma and its impact on glaucoma monitoring parameters including peripapillary vessel density.

PurposeTo determine the incidence of posterior capsule rupture (PCR) and vitreous loss (VL) during cataract surgery in a Swiss tertiary care center. Furthermore, we aimed to evaluate preoperative risk factors associated with PCR/VL, including pseudoexfoliation (PEX), age, type of anesthesia, and the Triemli Cataract Score (TCS), a locally implemented preoperative risk assessment tool for surgical complexity.MethodsThis retrospective single-center cohort study included all phacoemulsification and refractive lens exchange procedures performed at Stadtspital Zürich between January 2021 and late August 2024. Data were retrieved from the Dendrite clinical database of the TCS and supplemented through manual chart review and surgical reports for identification of intraoperative complications. Univariable and multivariable logistic regression analyses were performed to evaluate associations between preoperative factors and the occurrence of PCR and/or VL.ResultsA total of 2’719 eyes were included in the study. PCR and/or VL occurred in 52 eyes (1.9%), including 45 cases of PCR (5 with concomitant VL) and 7 additional cases of isolated VL due to zonulolysis. In univariate analysis, PEX and a TCS ≥3 were significantly associated with an increased risk of PCR and/or VL (OR 2.72; p=0.003 and OR 2.38; p=0.002, respectively), while topical (vs. general) anesthesia was associated with a reduced risk (OR 0.51, p=0.019). In multivariate analysis, only PEX remained an independent risk factor (OR 2.38; p=0.013). The association between TCS ≥3 and PCR/VL just missed statistical significance (OR 1.79; p=0.057).ConclusionThe rate of PCR and/or VL during cataract surgery at a Swiss tertiary care center is comparable to international statistics. PEX is a strong and independent predictor for these complications; although the predictive power of TCS did not reach statistical significance in multivariable analysis, the observed trend suggests that risk-based preoperative scores such as the TCS may support risk-stratification and surgical planning in clinical practice.

PurposeTo investigate retinal vascular alterations in unilateral and bilateral pseudoexfoliation by assessing macular and peripapillary vascular density, as well as foveal avascular zone parameters.Patients and MethodsThis prospective study included 77 eyes from 39 patients with unilateral pseudoexfoliation, 54 eyes from 27 patients with bilateral pseudoexfoliation, and 50 eyes from 25 healthy controls. All participants underwent OCT‐A imaging with the Topcon ImageNet 6 system. Only scans with signal quality ≥ 6/10 were analyzed. Superficial and deep retinal capillary plexus densities were quantified within a 6 × 6‐mm macular area, and foveal avascular zone dimensions were manually measured at the superficial plexus. Peripapillary vascular density was also evaluated. Statistical significance was set at p < 0.05.ResultsAge and gender were comparable across groups (p > 0.05). Both unilateral and bilateral pseudoexfoliation eyes demonstrated significantly reduced macular superficial and deep capillary plexus densities in all quadrants except nasal (p < 0.05). Foveal avascular zone area and diameter were significantly enlarged in pseudoexfoliation groups compared with controls (p < 0.05). Peripapillary vascular density was decreased in all quadrants except nasal in both pseudoexfoliation groups (p < 0.05). No vascular differences were observed between unilateral and bilateral pseudoexfoliation eyes.ConclusionPseudoexfoliation is associated with widespread macular and peripapillary microvascular compromise, supporting its bilateral nature even in clinically asymmetric cases.

Development of Perimetric Glaucoma and Outcomes of Interventions in Pseudoexfoliation Syndrome With and Without Ocular Hypertension.

Bent ab interno needle goniectomy (BANG) is an excisional trabecular minimally invasive glaucoma surgery (MIGS) technique that employs a modified hypodermic needle to remove a strip of trabecular meshwork via an ab interno approach, thereby enhancing aqueous outflow while preserving the conjunctiva. This article describes the surgical technique and perioperative considerations of BANG performed in a patient with a visually significant cataract, pseudoexfoliation, a poorly dilating pupil (4 mm), advanced primary open-angle glaucoma with a cup–disc ratio of 0.8:1, and uncontrolled intraocular pressure (36 mm Hg in both eyes), who could not afford conventional glaucoma surgery or implant-based MIGS. BANG was combined with temporal manual small incision cataract surgery in the right eye. Cataract extraction and posterior chamber intraocular lens implantation were followed by ab interno goniectomy using a bent 26-gauge needle under direct gonioscopic visualization to excise approximately 90° of nasal trabecular meshwork. On postoperative day 1, intraocular pressure in the operated eye reduced to 15 mm Hg on fewer topical medications. This conjunctiva-sparing, low-cost combined approach may be particularly useful in resource-limited settings and in patients with advanced glaucoma who are unlikely to adhere to intensive postoperative follow-up.

A BSTRACT Introduction: Cataract surgery in patients with small pupils presents significant challenges and potential complications. This study aimed to evaluate visual outcomes and effectiveness of various management strategies for small pupils during manual small incision cataract surgery (MSICS). Methods: This interventional study, conducted at a tertiary care center in Maharashtra, included 95 patients with pupils less than 5 mm in diameter undergoing MSICS between March 2023 and March 2025. Various management strategies were employed including pharmacological methods (intracameral phenocaine and adrenaline), mechanical dilation (stretch pupilloplasty and sphincterotomy), and expansion devices (iris hooks, BHEX ring). All surgeries were performed by a single surgeon. Patients were followed up on postoperative days 1, 3, 7, 21, and 6 weeks. Visual outcomes and complications were documented and analyzed. Results: The majority of patients (71.6%) were aged 61–80 years with nearly equal gender distribution. Diabetes mellitus (31.6%), pseudoexfoliation syndrome (18.9%), and posterior synechiae (7.4%) were the main causes of small pupils. Intracameral phenocaine was the most frequently used management strategy (38.9%). Posterior capsule rent was the most common intraoperative complication (5.3%), while 24.2% of surgeries had no complications. By 6 weeks postoperatively, 89.4% of patients achieved vision of 6/24 or better. There was no statistically significant difference in visual outcomes among different management techniques ( P &gt; 0.05). Conclusion: Small pupils in cataract surgery require a tailored approach based on the underlying etiology. With appropriate preoperative assessment and management strategy selection, good visual outcomes can be achieved regardless of the specific technique used. These findings have significant implications for resource-limited settings, suggesting that simpler techniques can achieve results comparable to more complex devices in appropriately selected cases.

PreserFlo® MicroShunt implantation alone may be well tolerated for the corneal endothelium across glaucoma subtypes over 12 months, whereas combination with cataract extraction may increase the risk of endothelial compromise, with a tendency toward a more pronounced reduction in pseudoexfoliation glaucoma. To evaluate the impact of PreserFlo® MicroShunt (PMS) implantation on corneal endothelial cell density (ECD) over 12 months, stratified by glaucoma subtype and surgical procedure. This retrospective cohort study included 103 eyes with primary open-angle glaucoma, pseudoexfoliation glaucoma (PEXG), and secondary open-angle glaucoma without PEXG, all undergoing PMS implantation (either alone or combined with cataract extraction [PMS-CE]) between August 2022 and December 2023. Changes in ECD, coefficient of variation (CV), and hexagonal cell percentage (HEX) were assessed. Firth logistic regression was employed to evaluate risk factors for >10% ECD loss. Subgroup analyses were performed by surgical procedure. No significant within-group ECD, CV, or HEX changes were observed at 12 months in any glaucoma subtype. Thirteen eyes (12.6%) exhibited >10% ECD loss, predominantly in the PMS-CE group. Multivariate analysis identified PMS-CE as a significant risk factor (odds ratio [OR]: 12.1; 95% confidence interval [CI]: 2.69-75.0; P <0.001). In the PMS-CE subgroup, PEXG was associated with greater risk of ECD loss (OR: 9.39; CI: 1.19-125.0; P=0.033). PMS-alone demonstrated a favorable safety profile for the corneal endothelium across glaucoma subtypes. However, PMS-CE may pose an elevated risk of endothelial compromise, with a tendency toward a more pronounced reduction in PEXG eyes.

Background: Exfoliation syndrome (XFS) is a common age-related disorder and a major risk factor for glaucoma and cataract. This study describes the hospital-based frequency and clinical associations of XFS among patients aged 40 years and older attending a regional ophthalmology outpatient clinic in the Northeastern Black Sea coastal region of Turkey. Methods: This cross-sectional observational study included 938 eligible participants aged ≥40 years with registered birth records and continuous residence within the defined catchment area who underwent a comprehensive ophthalmological examination. XFS was defined by characteristic exfoliative material at the pupillary margin and/or on the anterior lens capsule (phakic eyes) or capsular bag/IOL complex (pseudophakic eyes), with pupillary assessment before and after pharmacologic dilation. Systemic comorbidities were extracted from national medical records. Multivariable logistic regression adjusted for age and gender. Results: XFS was diagnosed in 20.8% (195/938; 95% CI: 18.2-23.5%). The XFS-positive (XFS+) group was older than the XFS-negative (XFS-) group (71.76 ± 0.61 vs. 63.25 ± 0.40 years; p < 0.001). Hypertension was more common in XFS+ participants (57.4% vs. 45.6%; p: 0.002) and remained associated after adjustment (OR: 1.49; 95% CI: 1.05-2.11; p: 0.024). Glaucoma was more frequent in XFS+ participants (23.6% vs. 14.9%; p: 0.005); it remained associated after adjustment (OR: 2.00; CI: 1.31-3.05; p: 0.001). Conclusions: In this hospital-based surveillance, approximately one in five clinic attendees aged ≥40 years had XFS. Findings should not be extrapolated to population prevalence; population-based studies are required to estimate regional prevalence accurately. Nonetheless, these data highlight a substantial clinical burden of XFS in a regional care-seeking population and support vigilant glaucoma surveillance in affected patients.