Fellow Eye Research Articles

Earliest location of glaucomatous retinal nerve fibre layer damage is determined by intact baseline RNFL thickness profile

Background/aimsTo identify whether an intact retinal nerve fibre layer (RNFL) thickness profile could determine the location of the earliest RNFL defect in glaucoma.MethodsRetrospective longitudinal cohort study of patients with initial...

Risk of Zonular Dialysis in Fellow-Eye Cataract Surgeries: A Multicenter Comparative Study.

To evaluate the risk of zonular dialysis (ZD) in fellow eye phacoemulsification cataract surgery and to identify risk factors, including prior first eye ZD. 8 United Kingdom National Health Service clinical centers. Retrospective database study. We calculated the overall risk of ZD in the fellow eye and reported the odds ratio (OR) for the various risk factors, including first eye ZD. The main outcome measures were the risk and the predictors of intraoperative ZD in the fellow eye. There was a total of 66,288 patients. At the time of the first surgery, the mean age of patients was 75.3±10.2 years, and 39.2% were males. Intraoperative ZD occurred during the first eye surgery in 333 patients (0.5%) and the fellow eye in 349 patients (0.5%). The risk of fellow eye developing ZD in patients with first eye ZD was higher than in patients without first eye ZD: 23/333 patients (6.9%) vs. 326/65,955 patients (0.5%) (p<0.001, unadjusted OR=14.9). In the adjusted logistic regression model, first eye ZD was the most significant risk factor (OR=13.3, 95% confidence interval (CI) =8.2-21.7). Other significant covariates of ZD in the fellow eye were pseudoexfoliation (OR=6, CI=3.8-9.7), previous pars-plana vitrectomy (OR=4.5, CI=1.1-18.5), and poor pupillary dilatation (OR=2.2, CI=1.4-3.3). The most important risk factor for the development of ZD in the fellow eye during cataract surgery was the occurrence of ZD in the first eye. Our findings have implications for patient counseling and surgery allocation.

Pharmacokinetic/pharmacodynamic analysis of geographic atrophy lesion area in patients receiving pegcetacoplan treatment or sham.

Pegcetacoplan is a complement C3/C3b inhibitor indicated for the treatment of geographic atrophy (GA). A population pharmacokinetic (PK)/pharmacodynamic (PD) analysis of pegcetacoplan used GA lesion area measurements from three clinical studies to determine the effect of pegcetacoplan exposure on GA progression. A base disease progression model was developed using data from sham-treated eyes and untreated fellow eyes, followed by treatment effect assessment in dose-response and PK/PD models. In total, 1501 patients from FILLY (NCT02503332), OAKS (NCT03525613), and DERBY (NCT03525600) received intravitreal pegcetacoplan 15 mg monthly or every other month (EOM) or sham treatment monthly or EOM and were included in the population analysis of lesion area. Disease progression over time was adequately described as linear-with-time over the 24-month maximal study duration. Disease-specific covariates associated with slower lesion growth were unilateral, unifocal, and subfoveal GA lesions and >20 intermediate or large drusen groups (≥63 μm) at baseline. The dose-response model estimated 0.80-fold (95% CI: 0.75, 0.84) and 0.83-fold (95% CI: 0.78, 0.87) reductions in GA lesion growth rate with pegcetacoplan monthly and EOM, respectively, versus sham. A relationship between vitreous humor concentration and GA lesion growth rate was quantified as 2.6% per unit of log-transformed vitreous pegcetacoplan concentration in the PK/PD model. PK/PD predictions of treatment effect based on exposure (pegcetacoplan monthly: 0.80 [90% CI: 0.77, 0.84]; pegcetacoplan EOM: 0.83 [90% CI: 0.80, 0.86]) were consistent with predictions based on dose response. These results support the benefit of pegcetacoplan administered monthly or EOM in slowing GA lesion growth.

Vision-Related Quality of Life After Fyodorov-Zuev Keratoprosthesis in China.

The purpose of this study was to assess vision-related quality of life (VR-QoL) and its determinants in patients with implanted Fyodorov-Zuev (MICOF) KPro. Eighty-eight patients with bilateral corneal blindness who underwent unilateral Fyodorov-Zuev (MICOF) KPro implantation were included in this cross-sectional study. VR-QoL was assessed using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Univariate analyses and multivariate linear regression were used to identify VR-QoL determinants. Eighty-eight patients, aged 50.00 ± 13.72 years, with a mean postoperative time of 5.13 ± 3.31 years, were included. The composite NEI-VFQ-25 score improved from 17.04 ± 5.60 to 46.00 ± 19.21 (P < 0.01) after Fyodorov-Zuev (MICOF) KPro implantation. The multivariate linear regression analysis results showed that the postoperative composite score was correlated with postoperative visual acuity (VA) of the operative eye (B = -21.66, P < 0.01). Improvement in NEI-VFQ scores was associated with better postoperative VA of the operative eye (B = -18.67, P < 0.01) and poorer preoperative VA of the fellow eye (B = 7.11, P < 0.05). VR-QoL in patients with bilateral corneal blindness was significantly impaired but improved after Fyodorov-Zuev (MICOF) KPro implantation. Improvement in VR-QoL was inversely associated with postoperative VA of the operative eye but positively correlated with preoperative VA of the fellow eye. This study affirmed that Fyodorov-Zuev (MICOF) KPro was an effective alternative for patients with corneal blindness with respect to VR-QoL.

Early Choriocapillaris Dysfunction in Fellow Eyes of Patients with Unilateral Neovascular Age-Related Macular Degeneration.

To investigate early changes in AMD by evaluating and comparing choriocapillaris (CC) flow in fellow eyes of patients with unilateral neovascular age-related macular degeneration (nAMD) and in healthy controls using swept-source optical coherence tomography angiography (SS-OCTA). Patients with unilateral nAMD and no/early/intermediate AMD (no/e/iAMD) in their fellow eye and normal controls who underwent SS-OCT and OCTA where included. CC perfusion was assessed on MATLAB as percentage of flow deficits (FD%) in the central 4.5 × 4.5 mm macular region, after removing artifacts. 81 eyes/patients (22 eyes with noAMD, 30 with eAMD, 29 with iAMD) with unilateral nAMD and 24 controls were analyzed. Median FD% was 8.97 (IQR 8.58-9.53) in AMD group, 8.92 (IQR 8.64-9.27) in noAMD group, 8.96 (IQR 8.46-9.38) in eAMD group, 9.05 (IQR 8.58-9.8) in iAMD group, and 8.22 (IQR 7.78-8.55) in controls. A statistically significant difference in FD% was observed between controls and AMD group (p < 0.001), as well as between each AMD subgroup and controls (noAMD vs controls p = 0.0037; eAMD vs control p = 0.0012; iAMD vs controls p = 0.0002). This study suggests that CC dysfunction may occur in fellow eyes of patients with unilateral nAMD before visible AMD signs, potentially preceding RPE changes. Further longitudinal studies are needed to confirm these findings and explore the correlation with AMD development/progression.

Visual Acuity and Refractive Status in Congenital Macular Coloboma

Purpose We analysed the refractive state and the factors that influence the best-corrected visual acuity (BCVA) in congenital macular coloboma (CMC) to provide new ideas for improving and predicting the vision of patients with CMC. Methods We reported three patients and reviewed 26 cases of CMC reported in the China National Knowledge Infrastructure (CNKI) database. We measured the BCVA, spherical equivalent refraction (SER), the macular coloboma’s diameter and area, and the distance from the macular coloboma’s nasal edge to the optic disc’s temporal edge (DISTANCE). We analyzed the refractive status of CMC and the factors affecting BCVA. Result The three patients with CMC we reported all had myopia. The study also included 26 patients with CMC reported in the CNKI database (9 unilateral, 17 bilateral) and we analyzed the findings of 26 patients with 43 eyes. The mean age at diagnosis was 22.96 ± 2.32 years. All patients underwent a comprehensive eye examination; 39 eyes (91%) had myopia (44% mild myopia; 28% moderate myopia; 28% high myopia); 23 eyes (53%) had a BCVA ≤6/60 and other 20 eyes (47%)>6/60. No correlation was found between SER or BCVA and the macular coloboma’s diameter or area. BCVA correlated positively with DISTANCE (r = 0.603, p < 0.001). No correlation was found between SER and DISTANCE. The study found a significant difference in SER or BCVA between the affected and fellow eyes in patients with unilateral CMC (n = 9, T=-3.259, p = 0.012; Z=-2.521, p = 0.012, respectively). Conclusion CMC seriously affects visual acuity. The refractive state is mostly myopia. We hypothesize that the DISTANCE is related to the integrity of the papillomacular bundle and affects BCVA.

Fellow Eye Risk of Rhegmatogenous Retinal Detachment in the United States: IRIS Registry (Intelligent Research in Sight) Analysis.

This study aimed to investigate the rate of rhegmatogenous retinal detachment (RRD) in the fellow eye of patients after developing an RRD in one eye. This is a retrospective cohort study of patients with a new RRD diagnosis in the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight) from 2016 to 2020. The association between risk factors of RRD and fellow-eye RRD was evaluated using Cox regression. Among the 201,622 patients who developed a new RRD in at least one eye, 6,740 (3.34%) developed an RRD in the fellow eye at a mean time of 406.02 days (SD = 373.74) from the first eye diagnosis. Of those 6,740 eyes, 1,889 (28.03%) had lattice degeneration, 3,938 (58.43%) had PVD, 588 (8.72%) had cataract surgery, and 38 (0.56%) had complex cataract surgery. Adjusted regression modeling showed that male sex (HR 1.73, [95% confidence interval (CI) 1.64 to 1.83]; P < 0.001), younger age at first eye RRD diagnosis (HR 1.02, [95% CI 1.01 to 1.02]; P < 0.001), active smoking (HR 1.13, [95% CI 1.05 to 1.22]; P = 0.002), and cataract surgery (HR 1.33, [95% CI 1.23 to 1.45]; P < 0.001) were associated with increased risk of a fellow eye RRD. On the other hand, fellow eye PVD was associated with a lower risk of RRD (HR 0.80, [95% CI 0.76 to 0.84]; P < 0.001). Among patients with an RRD in one eye, male sex, younger age of first eye RRD diagnosis, active smoking, and cataract surgery were associated with a higher risk of developing a fellow eye RRD, whereas fellow eye PVD was associated with a lower risk of fellow eye RRD. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Clinical Comparison of a Small-Aperture Intraocular Lens Versus a Monofocal Control.

To evaluate range of visual acuity, visual quality, and safety of the IC-8 small-aperture (SA) intraocular lens (IOL) (Apthera; Bausch & Lomb, Inc) in patients with cataract. This was a prospective, multicenter, open-label, parallel-group, non-randomized, examiner-masked, 12-month clinical study conducted at 21 sites in the United States. Included patients (N = 453) received either the SA IOL (targeted to -0.75 diopters) in one eye and a monofocal or monofocal toric IOL (targeted to plano) in the fellow eye (SA IOL group, n = 343) or bilateral monofocal/monofocal toric IOLs (control group, n = 110). At 6 months, the SA IOL group achieved superior binocular uncorrected intermediate and near visual acuity (P < .0001) and equivalent binocular uncorrected distance visual acuity versus the control group. In SA IOL eyes, 99.1% achieved monocular corrected distance visual acuity of 0.3 logarithm of the minimum angle of resolution or better. The SA IOL and control groups had comparable binocular photopic and mesopic contrast sensitivities at 6 months both with and without glare. The SA IOL group reported few visual symptoms overall, although at higher rates than in the control group. The SA IOL group exhibited improved intermediate and near vision, comparable distance vision and binocular contrast sensitivities, and few visual symptoms or adverse events versus the bilateral monofocal/monofocal toric IOL group, suggesting that the SA IOL is an effective option for presbyopia correction at the time of cataract surgery. [J Refract Surg. 2024;40(11):e824-e835.].

Application of Negative Pressure by the Ocular Pressure Adjusting Pump to Provide a Sustained Reduction in IOP.

To evaluate the sustainability of IOP reduction with continuous negative pressure application over an extended duration with use of the Ocular Pressure Adjusting Pump. Prospective, controlled, open-label, randomized, single site, pilot study. Subjects with primary open-angle glaucoma (OAG) were enrolled. One eye of each subject was randomized to receive negative pressure application; the fellow eye served as a control. The study eye negative pressure setting was programmed for 60% of the baseline IOP. Subjects wore the Ocular Pressure Adjusting Pump for 8 consecutive hours and IOP measurements occurred at 2-hour intervals for a total of 5 IOP measurements (08:00, 10:00, 12:00, 14:00, 16:00). Nine subjects successfully enrolled and completed the study. The mean programmed negative pressure setting was -12.0mmHg. At baseline, the mean IOP in the study eye was 21.4 ± 4.3mmHg. The mean IOP reduction in the study eye at hours 0, 2, 4, 6, and 8 was 8.1 (37%), 6.4 (28%), 6.3 (29%), 7.3 (34%) and 6.7 (31%), respectively. All IOP measurements during negative pressure application were reduced from baseline. There were no serious adverse events. The Ocular Pressure Adjusting Pump provides a sustained reduction in IOP while the device is worn with negative pressure applied with an IOP reduction exceeding 25% across 8hours of continuous wear.

A novel management challenge in age-related macular degeneration: Artificial intelligence and expert prediction of geographic atrophy

PurposeThe progression of geographic atrophy (GA) secondary to age-related macular degeneration (AMD) is highly variable among individuals. Prediction of the progression is critical to identify patients who will benefit most from the first treatments currently approved. The aim of this study was the investigation of the value and difference in predictive power between ophthalmologists and artificial intelligence (AI) to reliably assess individual speed of GA progression. DesignProspective, expert and AI comparison study. ParticipantsEyes with natural progression of GA from a prospective study (NCT02503332). MethodsOphthalmologists predicted yearly growth speed of GA, as well as selecting the potentially faster growing lesions from two eyes based on fundus autofluorescence (FAF), near-infrared reflectance (NIR), and optical coherence tomography (OCT). A deep learning algorithm predicted progression solely on the baseline OCT (Spectralis, Heidelberg Engineering, Germany). Main Outcome MeasuresAccuracy, weighted kappa (κ), and concordance index (c-index) between the prediction made by ophthalmology specialists, ophthalmology residents and the AI. ResultsA total of 134 eyes of 134 patients from a phase II clinical trial were included, among those 53 were from the sham arm and 81 from untreated fellow eyes. 2880 gradings were performed by four ophthalmologists. Human experts reached an accuracy of 0.37, 0.43, 0.41 and a κ of 0.06, 0.16, 0.18 on FAF, NIR+OCT and FAF+NIR+OCT, respectively. On a pairwise comparison task, human experts achieved a c-index of 0.62, 0.59 and 0.60. Automated AI-based analysis reached an accuracy of 0.48 and a κ of 0.23 on the first task, and a c-index of 0.69 on the second task solely utilizing OCT imaging. ConclusionsPrediction of individual progression will become an important task for patient counseling, most importantly with treatments becoming available. Human gradings improved with the availability of OCT. However, automated AI performed better than ophthalmologists in several comparisons. AI-supported decisions improve clinical precision, access to timely care for the community, and socioeconomic feasibility in the management of the leading cause for irreversible vision loss.

Prediction of fellow eye neovascularization in type 3 macular neovascularization (Retinal angiomatous proliferation) using deep learning.

To establish a deep learning artificial intelligence model to predict the risk of long-term fellow eye neovascularization in unilateral type 3 macular neovascularization (MNV). This retrospective study included 217 patients (199 in the training/validation of the AI model and 18 in the testing set) with a diagnosis of unilateral type 3 MNV. The purpose of the AI model was to predict fellow eye neovascularization within 24 months after the initial diagnosis. The data used to train the AI model included a baseline fundus image and horizontal/vertical cross-hair scan optical coherence tomography images in the fellow eye. The neural network of this study for AI-learning was based on the visual geometry group with modification. The precision, recall, accuracy, and the area under the curve values of receiver operating characteristics (AUCROC) were calculated for the AI model. The accuracy of an experienced (examiner 1) and less experienced (examiner 2) human examiner was also evaluated. The incidence of fellow eye neovascularization over 24 months was 28.6% in the training/validation set and 38.9% in the testing set (P = 0.361). In the AI model, precision was 0.562, recall was 0.714, accuracy was 0.667, and the AUCROC was 0.675. The sensitivity, specificity, and accuracy were 0.429, 0.727, and 0.611, respectively, for examiner 1, and 0.143, 0.636, and 0.444, respectively, for examiner 2. This is the first AI study focusing on the clinical course of type 3 MNV. While our AI model exhibited accuracy comparable to that of human examiners, overall accuracy was not high. This may partly be a result of the relatively small number of patients used for AI training, suggesting the need for future multi-center studies to improve the accuracy of the model.

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Case Report of Benign Diffuse Anterior Scleritis Associated with SARS-CoV-2

COVID-19 is an emerging infectious disease classified as a zoonotic illness caused by the SARS-CoV-2 strain of coronavirus. This enveloped, positive-sense, non-segmented RNA virus belongs to the order Nidovirales and the family Coronaviridae. Its primary mode of transmission is human-to-human through respiratory droplets. Ophthalmologists worldwide have reported various ocular manifestations associated with the infection. Recent studies have shown that SARS-CoV-2 binds to the cellular receptor for angiotensin-converting enzyme 2 (ACE2) and interacts with the transmembrane serine protease 2 (TMPRSS2), both of which are known to be expressed in the human cornea, retina, and conjunctival epithelium [1, 2]. The aim of this work is to present a case of a patient who developed diffuse viral scleritis related to COVID-19, detailing the diagnostic and therapeutic approaches as well as the patient's progression. We report the case of a 63-year-old man with a history of high triglycerides who developed flu-like symptoms and severe tiredness for over a week. A COVID-19 test came back positive. Ten days later, he had a painful, red right eye but no change in vision. An eye exam showed some redness in the conjunctiva, a clear cornea, and normal pressure in the eye. The fellow eye looked normal as well. He was treated with topical steroids and artificial tears, which helped initially. However, after finishing treatment, his symptoms worsened with more redness and pain, and now both eyes were affected. Further examination of the right eye showed swelling of the eyelid (preseptal cellulitis) and widespread redness in the conjunctiva. The Neosynephrine test was negative, and there was pain when moving the eye. The cornea was clear but had some superficial punctate keratitis, and the anterior chamber looked normal. The left eye also showed redness but was otherwise normal. A full lab workup (including blood tests and serologies for HSV1-2) came back normal. Considering his previous C

Effects of Glaucoma Treatment on Ocular Surface and Tear Functions: Comparison of Trabeculectomy and Antiglaucoma Drops.

To investigate tear function and ocular surface disease (OSD) findings in patients with glaucoma who received antiglaucoma medication in one eye and trabeculectomy surgery in the other eye. The patient group included 38 eyes of 19 patients who had undergone trabeculectomy surgery with mitomycin C (MMC) treatment in one eye at least 6 months prior. These eyes were followed up without medication while the fellow eye continued receiving antiglaucomatous medication. The control group comprised 20 eyes of 20 healthy individuals. Demographic data, follow-up period after trabeculectomy, antiglaucoma medications, number of drops per day, and duration of medication were recorded. Tear break-up time (BUT), corneal and conjunctival fluorescein staining, Schirmer II test, and conjunctival impression cytology were performed. A statistically significant difference was observed in BUT, corneal and conjunctival fluorescein staining, Schirmer II test, and Nelson staging levels in both eyes of patients with glaucoma compared to the control group (p=0.05). Although not statistically significant, BUT, Schirmer II test, punctate staining, and Nelson staging results showed improvement with increasing postoperative time. In our patient group, antiglaucoma medications and trabeculectomy surgery with MMC induced OSD to a similar degree. No superiority was observed between trabeculectomy with MMC and antiglaucoma drops in terms of OSD incidence.

Pseudophakic cystoid macular edema.

Pseudophakic cystoid macular edema (PCME) is the most common postoperative complication of cataract surgery, resulting in visual decline. In this review, we discuss its pathophysiology, epidemiology, clinical presentation, and the current available evidence on therapeutic management. Patients with diabetes mellitus have twice the risk of developing PCME as compared to nondiabetic individuals. Recent large database studies have revealed an increased risk among young, male, and black patients. A previous history of PCME is perhaps the strongest risk factor for fellow eye involvement. PCME generally occurs around 6 weeks postoperatively and is likely a consequence of postoperative inflammation with disruption of the blood-queous and blood-retina barriers. Optical coherence tomography of the macula servers as a key diagnostic tool. There is a lack of large controlled clinical trials to guide treatment approaches. We recommend a stepwise approach for PCME that includes observation if not visually significant versus treatment with topical nonsteroidal anti-inflammatory drugs and steroids if symptomatic. Refractory cases can be treated with a periocular steroid injection, followed by intravitreal steroids if still nonresponsive.

Continuous Wireless Telemetric Measurement of Intraocular Pressure (IOP), Ocular Perfusion Pressure (OPP), and Cerebrospinal Fluid Pressure (CSFP) in Nonhuman Primates (NHPs).

Intraocular pressure (IOP) and cerebrospinal fluid pressure (CSFP) telemetry in large animal models can be used to determine the exact IOP, CSFP, translaminar pressure, and translaminar pressure gradient exposure that each normal and treated eye is subjected to relative to its fellow eye. In this way, it is possible to determine the independent contributions of each of these parameters (mean and/or transient fluctuations) to the risk of both the onset and rate of progression of glaucoma. Importantly, we have shown that IOP and CSFP fluctuate continuously by up to 100% over the course of the day, so snapshot cage-side IOP measurements are unable to adequately capture the pressure in the eye; CSFP is not measurable noninvasively at all. Implementation of IOP and CSFP telemetry will allow us to precisely determine the pressure insult in each eye of each animal and thereby unravel the true mechanisms underlying pressure-induced damage to the retinal ganglion cells in glaucoma.

Analysis of Choroidal Thickness Changes in Recurrent Rhegmatogenous Retinal Detachment.

To analyze changes in choroidal thickness in patients with recurrent rhegmatogenous retinal detachment (RRD) before and after surgical intervention and to identify factors that influence changes in choroidal thickness. A retrospective observational study was conducted on patients who underwent surgery for recurrent RRD from November 2019 to March 2023. Choroidal thickness was measured using optical coherence tomography (OCT) at baseline, and then at 2 and 6 months postoperatively. The study analyzed the impact of various factors on choroidal thickness changes. The study included 33 patients, demonstrating a significant decrease in choroidal thickness in the surgical eye compared to the fellow eye over a 6-month period. In the univariate analysis, changes in choroidal thickness were significantly correlated with changes in central retinal thickness (p=0.048) between 0-2 months, and with proliferative vitreoretinopathy (PVR) grade between 2-6 months (p=0.009) and 0-6 months(p=0.02). In the multivariate analysis, an association was found between changes in choroidal thickness from 2 to 6 months and PVR grade(p=0.030). The findings indicate that surgical reattachment in eyes with recurrent RRD leads to a significant reduction in choroidal thickness. The extent of this reduction is influenced by the severity of PVR, highlighting the importance of considering PVR severity when evaluating surgical outcomes in patients with recurrent RRD.

Understanding contrast perception in amblyopia: a psychophysical analysis of the ON and OFF visual pathways.

The study aimed to explore potential discrepancies in contrast sensitivity in the ON and OFF visual pathways among individuals with amblyopia compared to controls. Eleven adult amblyopes (26.2 ± 4.4 [SD] years old) and 10 controls (24.6 ± 0.8 years old) with normal or corrected to normal visual acuity (logMAR VA ≤ 0) participated in this study. Using the quick contrast sensitivity function (qCSF) algorithm, we measured balanced CSF which would stimulate the ON and OFF pathways unselectively, and CSFs for increments and decrements that would selectively stimulate the ON and OFF visual pathways. Contrast sensitivity and area under log contrast sensitivity function were extracted for statistical analysis. For the balanced CSF, we found significant interocular differences in sensitivity and area under log contrast sensitivity function in both amblyopes [F(1,10) = 74.992, p < 0.001] and controls [F(1,9) = 35.6, p < 0.001], while such differences were more pronounced in amblyopes than in controls. For increment and decrement CSFs, we found that the increment sensitivity (p = 0.038) and area under log contrast sensitivity function (p = 0.001) were significantly lower than the decrement in the amblyopic eye. Such differences between increment and decrement CSFs were not observed in the fellow eye of the amblyopes or in the controls. There is a subtle difference in the contrast sensitivity of the amblyopic eye when exposed to stimulation in the ON and OFF pathways.

Retinal detachment in Type IX collagen recessive Stickler syndrome.

Stickler Syndrome (SS) is associated with eye, joint and orofacial abnormalities. Most cases are dominantly inherited through COL2A1/COL11A1 variants encoding type-II/XI collagen, with patients having up to 78% retinal detachment (RD) risk. Rarer cases of recessive SS have also been identified, associated with pathogenic variants of genes including COL9A1, COL9A2 & COL9A3 encoding type-IX collagen, but there is limited published data on patients' phenotype or RD risk. Our study aimed to investigate RD risk in type-IX recessive SS, determining whether patients would benefit from prophylactic retinopexy. A secondary objective was to explore patient phenotypes, identifying key features which clinicians should identify, leading to earlier diagnosis. We report 13 cases from 11 families with Type-IX recessive SS, identified from the cohort attending the NHS England Highly Specialised Stickler Syndrome Service (1/1/15-31/12/22). Patients underwent multidisciplinary assessment by ophthalmology, rheumatology and audiology. 6/11 families exhibited previously undescribed genetic variants, and 7 had consanguineous parents. Clinical findings included abnormal vitreous architecture and high myopia. 15.4% of patients developed RD secondary to horseshoe retinal tears, with no cases of bilateral RD or giant retinal tears (GRTs). No patients had cleft palate, and 30.8% had midfacial hypoplasia. Hearing loss was more prevalent (91.7%) than in dominant SS. Arthropathy was uncommon but variable in manifestation. Ours results do not point to high RD nor GRT incidence in recessive SS, although given the rarity, our numbers are small. Prophylactic retinopexy should only be offered case-by-case for fellow eyes of patients presenting with GRT detachments in their first eye.

Serial intravitreal injections in age-related macular degeneration patients from the dry eye disease perspective: a cross-sectional study

BackgroundTo evaluate the effects of serial intravitreal injections (IVI) on the ocular surface and meibomian glands in patients with neovascular age-related macular degeneration (nAMD).MethodsPatients receiving anti-vascular endothelial growth factor (anti-VEGF) agent injections for unilateral nAMD were included. Untreated fellow eyes served as the control group. All participants followed a pre-IVI asepsis protocol with povidone-iodine (PI). Ocular surface diseases index (OSDI) questionnaire scores, first and average non-invasive tear break-up time (fNITBUT and avgNITBUT), Schirmer-1 test results, corneal staining score (according to Oxford scale), meibomian gland (MG) loss rates of lower and upper eyelids were recorded four weeks after the last IVI.ResultsForty-two nAMD patients with a mean age of 63.3 ± 19.4 were included in the study. The mean OSDI score was 20.3 and the median of IVI number was 9 (6–22). There were no statistically significant difference between treated and untreated fellow eyes regarding fNITBUT (5.6 vs. 4.5, p = 0.872), avgNITBUT (6.2 vs. 7.2, p = 0.968), Shirmer-1 results (7 vs. 7, p = 0.854), corneal staining (0.3 vs. 0.2, p = 0.341), lower and upper MG loss rate (29.3 vs. 28.4, p = 0.162, and 27.1 vs. 26.9, p = 0.476, respectively). Only significant correlation was observed between age with lower and upper MG loss rate (r:0.396, p = 0.042, and r:0.365, p = 0.047).ConclusionThe results of the present study demonstrated that serial IVI of anti-VEGF agents with PI asepsis is well tolerated by nAMD patients in terms of ocular surface, MG loss and DED measurements.