Little is known about compliance with intravitreal anti-vascular endothelial growth factor (VEGF) therapy for the treatment of macular and retinovascular diseases among Nigerians and Africans. The objective of this study is to measure compliance to 3 or more and 6 or more intravitreal anti-VEGF injections for common macular and retinovascular diseases in Nigerian clinics and evaluate the impact on visual outcomes. Retrospective multicenter chart review of 622 eyes/ 528 patients diagnosed with neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), retinal vein occlusions (RVOs), including branch, central, and hemiretinal (BRVO, CRVO, and HRVO), and non-AMD Choroidal Neovascular Membrane (CNVM) from five clinics (urban, semi-urban, and rural), collecting demographics, diagnosis, injection type/number, pre-/post-BCVA (converted to LogMAR), and follow-up. Treatments were intravitreal Bevacizumab (Avastin), Ranibizumab (Patizra), and Aflibercept (Eylea). Definitions of compliance: compliant; ≥3 injections (standard loading), also ≥ 6 injections. For all 622 eyes, presenting BCVA: 1.21 ± 0.84 and the final BCVA: 0.91 ± 0.80 (P = < 0.001). Overall compliance with ≥ 3 injections was 47.5%, and with ≥ 6 injections, 10.1%. Compliance to ≥ 3 injections by diagnosis was as follows: AMD 50.4%, Non-AMD CNVM 58.2%, BRVO 44.8%, CRVO 44.0%, HRVO 46.7%, DME 40.6%. Age (P = 0.264) and sex (P = 0.870) did not affect compliance to ≥ 3 injections. Clinic location significantly influenced compliance with ≥ 3 injections (P = 0.000), but not with 6 injections (P = 0.173). The highest rates of compliance with ≥ 3 injections were observed in urban tertiary centers. Injection type and cost were not significant factors (P = 0.36). Eyes with ≥ 3 injections achieved better vision (≥ 6/18) across all diagnoses; the most notable improvements were in non-AMD CNVM (+ 41.4%) and BRVO (+ 35%). Statistically significant LogMAR improvements were seen in CRVO (p = 0.049) and DME (p = 0.043). Postoperative endophthalmitis occurred in 2/622 eyes (0.0032) (both Avastin); no other serious adverse event was recorded. Real-world compliance is significantly lower than ideal. Urban and tertiary clinics show better adherence. Receiving the recommended loading doses is associated with improved visual outcomes for most diagnoses. Understanding the reasons for non-compliance, using a prospective approach, and addressing them will improve treatment outcomes for more Nigerian and presumably African patients receiving anti-VEGF drugs.

This study aimed to investigate the incidence and timing of unexplained intraocular pressure (IOP) increase over time following the administration of various intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for macular diseases. This retrospective study included 2611 eyes treated multiple times with one or more different anti-VEGF agents between 2016 and 2022. An IOP increase of ≥ 25 mmHg was classified as pathological. We analyzed the incidence rates, the timing of the IOP increase during the administered therapy and the thickness of the retinal nerve fiber and ganglion cell layer over two years in eyes with IOP increase. A total of 50 eyes (1.9%) from 48 patients experienced an increase in IOP during anti-VEGF therapy. In 15 eyes, the increase was attributable to other ocular diseases (such as neovascular glaucoma, uveitis, or endophthalmitis), and these eyes were therefore excluded from further analysis. In contrast, 35 eyes (1.3%) from 33 patients with an average age of 68.4 ± 10,0 years, developed an unexplained increase in IOP up to an average of 27 [25-45] mmHg, typically after 12 [1-35] weeks. 97% of the affected eyes had no history of glaucoma. The baseline IOP was 16 [12-20] mmHg. In 24 eyes (68%), short-term topical therapy led to adequate IOP regulation. For 10 eyes (29%) with persistently elevated IOP, continued topical antiglaucoma therapy was required, while 2 eyes required surgical intervention. The average thickness of the retinal nerve fiber layer and the ganglion cell layer did not change significantly over two years. An increased IOP can occur during the course of anti-VEGF therapy in normotensive eyes. This phenomenon can be conservatively controlled in 94% of cases.

To assess prevalence and associations of epiretinal membranes (ERMs) in a general population. In participants of the population-based Beijing Eye Study, we assessed macular volume optical coherence tomographic (OCT) scans for ERMs. The study included 1351 eyes (914 participants) (age: 64.7±9.8 years; range: 50-91 years). ERMs were detected in 80 eyes (5.9%; 95% CI 4.9% to 6.9%) of 60 participants (6.6%; 95% CI 5.1% to 8.1%), with ERMs without retinal surface wrinkling in 34 (2.5%) eyes, ERMs with retinal surface wrinkling and normal fovea contour in 16 (1.2%) eyes, ERMs with reduced foveal depth in 20 (1.5%) eyes, ERMs with complete foveal flattening in 6 (0.4%) eyes and ERMs with foveal elevation in 4 (0.2%) eyes. Hyper-reflective epiretinal dots (HEDs) were detected in 114 (8.4%) eyes. Higher ERM prevalence was associated (multivariable analysis) with higher stage of posterior vitreous detachment (PVD) (OR: 1.81; 95% CI 1.34 to 2.45; p<0.001), older age (OR: 1.05; 95% CI 1.01 to 1.09; p=0.002), higher prevalence of HEDs (OR: 9.18; 95% CI 4.85 to 17.4; p<0.001) and worse best corrected visual acuity (BCVA) (OR: 2.75; 95% CI 1.04 to 7.30; p=0.04), but not with axial length (p=0.69) or pseudophakia (p=0.98). Out of 746 eyes without PVD, 3 (0.4%) eyes had ERMs (without retinal surface wrinkling) and 9 (1.2%) eyes showed HEDs. Higher ERM stage increased with higher PVD stage (beta: 0.32; p<0.001), older age (beta: 0.11; p=0.006) and worse BCVA (beta: 0.07; p=0.04), but not with axial length (p=0.75) or pseudophakia (p=0.71). As measured by OCT, ERM prevalence was mainly associated with PVD and to a minor degree with older age and worse BCVA, while longer axial length, pseudophakia or ocular diseases such as age-related macular disease and glaucoma were not related to prevalence and stage of ERMs.

Purpose: To evaluate visual acuity and microperimetry correlated with anatomical changes in eyes with macular diseases implanted with the EyeMax Mono intraocular lens (IOL) (SharpView Ophthalmology). Methods: A single-center retrospective, real-world case series set in Knappschaft Eye Hospital, Sulzbach, Germany. Patients with macular disease who underwent EyeMax Mono IOL implantation were included. The outcome measures were corrected distance visual acuity (CDVA) and microperimetry indices: fixation stability and bivariate contour ellipse areas (BCEAs) at 63% and 95%. The geographic atrophy (GA) monitor (RetInSight) was used to analyze changes in retinal integrity. Results: Twenty-one eyes (11 patients; mean age 72.8±8.3 years, mean follow-up 7.4±4.0 months) were included. Preoperative GA measured 4.7±4.0 mm2 (n=14) and EZ loss on SD-OCT was 2433.1±1009.5 µm (n=17). The CDVA improved by 0.2 logMAR (p=0.007, n=21), with 12 eyes gaining ≥1 line and seven eyes gaining ≥3 lines. Fixation stability improved in two eyes, stabilized in nine eyes, and worsened in four eyes. The changes in BCEA were not statistically significant. Higher preoperative BCEA correlated with greater postoperative improvement (p&lt;0.001). In the foveal fixation group (n=4), 75% and 50% of patients showed improved BCEA and CDVA, respectively. In extrafoveal fixation (n=11), BCEA improved in 50% of patients, while 64% showed CDVA improvement. The GA monitor showed worsening in 9/15 eyes, and 4 eyes showed worsening on microperimetry without a CDVA decline. Anatomical changes stabilized in six eyes; of these, two exhibited a decline in microperimetry without a CDVA decline. Conclusions: EyeMax Mono IOL improved CDVA, although no significant changes were observed in the microperimetry indices. Better microperimetry outcomes were observed in extrafoveal fixation cases. While the optical design of the IOL likely contributes to visual improvement, the small sample size limited the statistical power to detect significant microperimetry changes.

People with vision impairment have lower mental wellbeing than those without eye disease. Loneliness is thought to be associated with lower wellbeing in this population, but the confounding effect of mental ill-health and other factors which affect wellbeing has not been addressed. This study explored associations between loneliness and wellbeing in people with inherited macular disease, controlling for mental ill-health, demographic and clinical factors. Thirty-six people with inherited macular disease were recruited. Age, visual acuity, duration of disease and socioeconomic status were extracted from hospital notes. Loneliness, depression, anxiety and mental wellbeing were assessed using self-report questionnaires. Wellbeing was compared to a reference population of adults in the UK. Univariate and stepwise multivariate regression was used to examine the association between loneliness and wellbeing, controlling for demographic, clinical and mental health factors. On average, participants' wellbeing was not significantly different to the reference population (this study: mean: 50.9, sd: 9.68; reference population: mean = 51.4; sd: 9.42; ANOVA, F = 0.10, p = 0.75). Univariate linear regression showed significant associations between wellbeing and loneliness (β = -38.7; 95% CI: -57, -20; p < 0.0001), depression (β = -6.67; 95% CI: -10, -2.9; p < 0.0001) and anxiety (β = -5.37; 95% CI: -8.7, 2.0; p < 0.0001). None of the other demographic and clinical variables were related to wellbeing (all p > 0.05). Stepwise regression revealed loneliness, gender, depression and anxiety to be (together) significantly associated with wellbeing, accounting for 61% of the variance in wellbeing (r2 = 0.61). Loneliness was associated with lower mental wellbeing even after controlling for mental ill-health, demographic and clinical factors. The severity of vision loss cannot be taken as a simple index of likely wellbeing. Interventions which target loneliness may help maximise wellbeing in people with inherited macular disease.

Despite the revolution of artificial intelligence (AI), its integration remains limited in healthcare. A comprehensive understanding of the barriers to implementation is crucial to enhance the utilisation of AI. This study applies a conceptual framework-based analysis, to explore stakeholder perspectives of implementation barriers of AI in digital diagnosis in eye care. Purposive sampling was used to identify key individuals across stakeholder groups, including technology developers, clinicians, patients and healthcare leaders. Semi-structured interviews were conducted with 37 stakeholders. Using the updated Consolidated Framework for Implementation Research (CFIR), responses to the question: 'What is the biggest barrier to digital diagnosis or AI for macular disease in Australia?' were analysed. Barriers identified by stakeholders were mapped to thematic constructs of the updated CFIR, and the prominence of each implementation barrier was measured. Data saturation was not assessed. For clinicians and developers, the 'innovation' domain was most frequently cited. Clinicians were most concerned with the costs involved, whereas for developers, a lack of evidence surrounding real-world application was the main challenge. For leaders and patients, 'individuals' domain was the most frequently cited. Leaders were focused on the innovation deliverers: expressing the potential risk of over-reliance on the innovation and the subsequent consequence of clinician deskilling. Patients were more concerned about innovation recipients: emphasising the perceived lack of human empathy with the implementation of AI. Differences were revealed in the identified barriers to the implementation of AI across stakeholder groups. A co-design approach to address the misalignment in key barriers may be essential to the successful implementation of AI in digital health innovations.

Background: The metamorphopsia questionnaire (MeMoQ) is an established patient-reported outcome measure (PROM) in the context of macular disease. However, its performance has not been proved in those being treated for various macular conditions with intravitreal anti-vascular endothelial growth factor (Anti-VEGF). The objective was to eliminate misfitting items, enhance measurement precision, and ensure optimal response categorisation. Methods: Rasch analysis was performed iteratively on 2286 responses from patients with macular diseases being treated with Anti-VEGF to optimise the MeMoQ. Fit statistics, reliability indices, person and item separation measures, and principal component analysis (PCA) of residuals were assessed to determine the optimal model. This study was conducted in an outpatient clinic specialising in retinal diseases in Hywel Dda University Health Board. Results: Misfitting items were removed in successive iterations, leading to optimised category probability curves and stable fit statistics for the MeMoQ. The resulting model for all responses included two final items, with person separation remaining inadequate reducing from 1.23 to 1.12 and reliability from 0.60 to 0.56. Category probability curves demonstrated good ordering of response variables with Andrich thresholds separated by >1.2 logits. In the subgroups of neovascular age-related macular degeneration and diabetic macular oedema person separation remained below two and reliability remained low. Conclusions: Rasch analysis demonstrated that the MeMoQ was not a valid or reliable PROM in this patient population. Therefore, the MeMoQ may not provide a reliable index of patient's perception and visual experience when undergoing Anti-VEGF treatment.

Survey of the current state of intravitreal therapy in Spain.

Polypoidal choroidal vasculopathy (PCV) is a distinct subtype of neovascular macular disease with variable responses to anti-vascular endothelial growth factor (anti-VEGF) therapy. This systematic review and meta-analysis evaluated the visual, anatomical, and lesion-regression outcomes of intravitreal aflibercept 8 mg, a formulation developed to extend dosing intervals while maintaining efficacy, in patients with PCV. PubMed, Embase, Scopus, Web of Science, and Google Scholar were searched from inception to March 12, 2026 (PROSPERO: CRD420261339679). Eligible studies enrolled adults with indocyanine green angiography (ICGA)-confirmed PCV treated with aflibercept 8 mg and reported at least one co-primary outcome: change in best-corrected visual acuity (BCVA), central retinal or subfield thickness (CRT/CST), or complete polyp regression. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2), Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I), andJoanna Briggs Institute (JBI) appraisal tools. Complete polyp regression was analyzed using a generalized linear mixed model with a logit link; continuous outcomes were pooled using restricted maximum likelihood estimation with the Hartung-Knapp-Sidik-Jonkman correction. Certainty of evidence was evaluated using theGrading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Five studies encompassing 362 eyes (245 treated with aflibercept 8 mg) were included. The pooled complete polyp regression rate was 57% (95% confidence interval (CI), 39%-73%; I2=55.9%; k=3). The pooled mean CRT/CST change was -157.8 µm (95% CI, -176.9 to -138.7 µm; I2=0%; k=2), though the estimate was predominantly driven by a single study contributing 95.5% of the inverse-variance weight. BCVA outcomes were not pooled due to metric incompatibility and clinical heterogeneity; however, individual study results were directionally favorable, withEarly Treatment Diabetic Retinopathy Study (ETDRS) gains of +8.4 to +9.5 letters at 48 weeks in the largest contributing study. Extended dosing intervals were maintained in 80.5% (q12) and 86.5% (q16) of treated eyes at 48 weeks. One study reported intraocular inflammation in 10.8% of the overall neovascular age-related macular degeneration (AMD) cohort in that study, a safety signal not observed in the remaining studies. The certainty of evidence was low for CRT/CST change and very low for polyp regression and BCVA. Available evidence suggests that aflibercept 8 mg may produce clinically relevant polyp regression and substantial anatomical improvement in PCV, with a potential reduction in injection frequency. However, given the low to very low certainty of the current evidence base across all co-primary outcomes, definitive efficacy and safety conclusions cannot yet be drawn. Prospective, PCV-specific trials with standardized outcome reporting are needed.

En Face Optical Coherence Tomography and OCT Angiography in the Pathoanatomy of Inflammatory Macular Disease.

BackgroundDigital self-monitoring applications could provide individuals with macular disease with a convenient, quantitative method for tracking metamorphopsia at home; yet the usability of such tools remains to be fully established.ObjectiveThis study evaluated the usability of a macular quantitative square grid self-examination application, a semiquantitative, touch-based self-monitoring application for macular function.MethodsThis study used a convergent mixed methods design. The application quantifies (1) distortion severity, (2) distortion area, and (3) temporal trends through a 3-step touch interface. A total of 24 adults with neovascular age-related macular degeneration or diabetic macular edema, accompanied by self-reported metamorphopsia, participated in a single supervised test session. A 10-item System Usability Scale (SUS) was used to assess usability, and semistructured interviews were conducted to gather further insights. Quantitative data were summarized descriptively, and qualitative feedback underwent inductive thematic analysis.ResultsA total of 24 participants completed the GridMacuScan application self-assessment, the SUS questionnaire, and 11 participants completed the interview when data saturation was achieved. All eyes that showed distortion on the Amsler grid also produced positive distortion maps on the GridMacuScan application, yielding 100% diagnostic concordance. The mean SUS score was 82.1 (SD 8.7), indicating “good-excellent” usability. The inductive thematic analysis yielded four overarching themes: (1) high usability and positive overall experience, (2) perceived functional advantages, (3) shortcomings and optimization suggestions, and (4) strong willingness for continued use.ConclusionsThe GridMacuScan application demonstrated diagnostic sensitivity comparable to that of the traditional Amsler grid and received high user ratings for usability. Furthermore, it provided quantitative distortion metrics that could facilitate longitudinal disease surveillance. Future research must be conducted to validate performance in unsupervised home environments and investigate whether sustained use improves time-to-disease-progression detection and treatment outcomes.

This study aimed to investigate the role of neural adaptation in the perception of Haidinger's brushes, an entoptic phenomenon enabling the perception of polarization by the human visual system. The objective was to consider the rotational speed of the pattern in combination with the polarization level of the input light, to identify normal values in a cohort of healthy individuals. An experimental setup was designed and assembled using two LED sources, one of which was filtered by a rotating linear polarizer with adjustable speed. The relative intensity of the LEDs could be changed to tune the polarization level. A cohort of 37 healthy individuals underwent monocular testing at seven polarization levels. For each value, descending and ascending limit tests were conducted to determine the rotational speed thresholds. The rotational speed threshold decreases linearly with the logarithm of the polarization level. All participants could perceive the pattern down to at least 20% polarization, with a dramatic drop in the number of subjects at 10% and 5% polarization levels. The estimated average polarization threshold was 9.7 ± 1.2%. Lower initial rotational thresholds at maximum contrast corresponded with lower polarization thresholds. The study confirms the crucial role of rotational speed in the perception of Haidinger's brushes, especially at low polarization levels. As a normal pattern perception correlates with macular pigment distribution and density, those findings are essential for the development and calibration of screening devices based on Haidinger's brush perception for the early detection of maculopathy and other macular diseases.

Efficacy and safety of intravitreal Ziv-Aflibercept for the treatment of macular edema: A systematic review and meta-analysis.

Occult macular dystrophy (OMD) is a hereditary macular disease characterized by no visible macular abnormalities. It is an autosomal dominant disease associated with retinitis pigmentosa 1 like 1 (RP1L1) gene mutation. c.133C>T mutation in the RP1L1 gene is the primary cause of severe visual impairment in OMD patients. The induced pluripotent stem cell (iPSC) line was generated using the integration-free Sendai virus method from peripheral blood mononuclear cells (PBMCs) of a vision-impaired patient harboring heterozygous RP1L1 c.133C>T mutation. This cell line may serve as a cellular model for studying the pathogenic mechanisms of OMD caused by RP1L1 mutation.

Telemedicine is booming in France, particularly in disciplines dealing with chronic pathologies such as ophthalmology. Odysight© is the first French mobile application for functional self-monitoring of patients with chronic macular disease. The objective of this study was to assess French ophthalmologists' perceptions of this tool. An online questionnaire was emailed to 807 French ophthalmologists between February and July 2025, with three follow-ups spaced one month apart. Fifty-five usable responses were collected. The questionnaire included closed-ended and open-ended items regarding practical experience with the application, perceived utility, impact on daily practice, and prospects for integration into the healthcare system. Perceptions of the clinical utility of the data were mixed; 18.2% of respondents considered the data "very useful", 29.1% "somewhat useful", 38.2% "not very useful", and 14.5% "useless". Hospital staff were the most critical (69.3% negative); private practitioners were more nuanced (53.1% negative); while mixed-practice practitioners were more favorable (70% positive). Open-ended comments highlighted the frequency of false positives (10 practitioners), the perceived lack of reliability of the data (5 practitioners), and difficulties with consistent patient compliance (5 practitioners). Odysight© is seen as a promising tool but is limited in particular by the high false positive rate of alerts sent to practitioners. This obstacle must be addressed to enable wider adoption and sustainable integration into the healthcare system.

To evaluate the diagnostic utility of fundus autofluorescence (FAF) imaging in identifying and characterizing phenotypically classified inherited macular dystrophies. In this way, we aim to provide methods by which eye care practitioners can link FAF imaging and other clinical results or imaging modalities to aid their clinical decision-making. Phenotypically identified inherited macular dystrophies, including Stargardt disease and related ABCA4 mutations, Best vitelliform dystrophy, pattern dystrophies, and cone and cone-rod dystrophies, are discussed. We provide evidence that the use of FAF alone and in combination with other clinical results and imaging modalities can assist in the diagnosis of a range of inherited macular dystrophies.

A deep learning (DL) model capable of analyzing optical coherence tomography (OCT) 3-dimensional (3D) scans from various vendors is essential for robust disease detection. To develop a vendor-agnostic model for multidisease classification using 3D scans from different vendors. This multicenter retrospective cohort study included OCT scans from tertiary eye hospitals, a private eye center, an open online database, and retrospective and prospective research cohorts in Hong Kong and Vietnam. The model was trained exclusively on 3D scans from vendor 1 (Spectralis [Heidelberg Engineering]). Nine external datasets, including 3D scans from vendor 1, 3D scans from vendor 2 (Cirrus [Zeiss]), and 2-dimensional (2D) scans from vendor 1, were used for testing. A category labeled uncertain was introduced to handle previously unseen macular conditions. A triage module was incorporated into the model. 3D scans from vendor 1 were retrospectively collected from the period January 2010 through September 2022, and external data sets (from vendors 1 and 2) were retrospectively collected from January 2008 through September 2022. Model development and data analysis were conducted between July 2022 and September 2024. A Residual Neural Network (ResNet) 3D model was trained using 2 different architectures for comparison. An unsupervised test time domain adaptation method, Test Entropy, was used to address vendor-to-vendor domain discrepancies. The primary outcomes were area under the receiver operating characteristic curve (AUROC), micro-average positive predictive value (PPV), micro-average negative predictive value (NPV), and clinically important miss rate. A total of 6756 OCT scans from 1669 patients were used for model development (mean [SD] age, 70.6 [16.5] years; 742 female patients [44.5%]), and 12 236 OCT scans from 4336 patients were used for external testing (mean [SD] age, 63.9 [10.4] years; 2099 female [51.2%]). AUROC ranged from 0.779 (95% CI, 0.752-0.806) to 0.999 (95% CI, 0.995-1.000) for vendor 1, from 0.754 (95% CI, 0.615-0.872) to 0.991 (95% CI, 0.980-0.999) for vendor 2, and from 0.801 (95% CI, 0.781-0.821) to 0.950 (95% CI, 0.943-0.956) for 2D scans. Micro-average PPVs ranged from 56.7% (95% CI, 54.5%-58.7%) to 72.0% (95% CI, 68.9%-74.9%) for vendor 1 and from 46.0% (95% CI, 43.6%-48.4%) to 60.4% (95% CI, 58.3%-62.4%) for vendor 2. All micro-average NPVs exceeded 97.5% (95% CI, 97.1%-97.8%). The uncertain category demonstrated high specificity (>95.0%; 95% CI, 93.4%-96.2%) and accuracy (>92.7%; 95% CI, 90.9%-94.1%) but varied sensitivity (from 14.3%; 95% CI, 2.6%-51.3%; to 83.3%; 95% CI, 60.8%-94.2%). The clinically important miss rates were 6.16% (45 of 731) and 6.70% (13 of 194) for urgent cases and 4.41% (47 of 1066) and 8.67% (50 of 577) for semi-urgent cases for vendors 1 and 2, respectively. The results of this multicenter cohort study highlight the potential of this vendor-agnostic DL model for broad deployment across diverse eye care settings, streamlining detection and triage in modern ophthalmic practices.

The aim of this study was to identify the clinical factors associated with postoperative visual acuity following Descemet's membrane endothelial keratoplasty (DMEK), with emphasis on the impact of macular diseases. This retrospective multicenter study included consecutive eyes that underwent DMEK between March 1, 2011, and June 30, 2022, and had available optical coherence tomography findings. Eyes with other ocular diseases causing visual loss were excluded. Overall, 77 eyes of 66 patients were included in the study. Univariable and multivariable regression analyses were performed to identify the predictors of best-corrected visual acuity (BCVA) at the final follow-up. Worse preoperative visual acuity and macular comorbidity were identified as independent predictors of poorer postoperative BCVA. Among macular pathologies, cystoid macular edema was most strongly correlated with reduced vision in the univariable analysis (β = 0.195; p = 0.016). In the subgroup analysis, worse preoperative visual acuity and macular comorbidity remained significant predictors (p < 0.001 and p = 0.023, respectively). Other comorbidities such as epiretinal membrane and wet age-related macular degeneration were not significant predictors. Worse preoperative visual acuity and macular comorbidity are independent risk factors for suboptimal visual recovery after DMEK. These findings highlight the importance of comprehensive preoperative retinal assessment and individualized postoperative management to optimize visual outcomes.

Erratum in: Histological Assessment of Foveal Mechanical Instability and Potential Implications for Macular Diseases.

Abstract This study aimed to investigate factors affecting visual outcomes after phacoemulsification in highly myopic patients with cataracts, based on the detection of nanobacteria (NB) in aqueous humor. Fifty highly myopic patients with cataracts who underwent phacoemulsification surgery at The First People’s Hospital of Ziyang from December 2022 to June 2023 were enrolled. Aqueous humor samples were gathered from patients before surgery, and NB were isolated and cultured from the aqueous humor. They were identified using scanning electron microscopy and transmission electron microscopy. The calcium-phosphorus ratios in NB cultures (NB group) and nanohydroxyapatite (nHA) cultures (nHA group) were determined by energy-dispersive X-ray spectroscopy. Cell inhibition was compared using a CCK-8 assay. The expressions of calcification-related proteins, bone morphogenetic protein 2, osteopontin, apoptosis-related proteins, B-cell lymphoma 2 (Bcl-2), and Bcl-2–associated X protein in cells were examined by western blot. Based on the best-corrected visual acuity (VA) 3 months after surgery, patients were classified into a normal vision (NV) group (best-corrected VA ≥0.3) and an abnormal vision (AV) group (best-corrected VA &amp;lt;0.3). The factors influencing postoperative VA and efficacy were analyzed. Results revealed that the characteristics of the aqueous humor cultures were consistent with the features of NB described in the literature, with NB measuring approximately 90 to 340 nm in transmission electron microscopy. Energy-dispersive X-ray results indicated no remarkable difference in calcium-phosphorus ratios between the NB and nHA groups (p &amp;gt; 0.05), but the NB group exhibited remarkably stronger cell inhibition relative to the nHA group (p &amp;lt; 0.05). Western blot results revealed obviously higher levels of bone morphogenetic protein 2, osteopontin, and Bcl-2–associated X proteins in the NB group compared to the nHA group (p &amp;lt; 0.05), while Bcl-2 expression was sharply lower, with a great difference in the NB group (p &amp;gt; 0.05). The gap in best-corrected VA 1 month after surgery between the NV group (68%) and the AV group (32%) was obvious (p &amp;lt; 0.05). With increasing recovery time, the number of patients with best-corrected VA ≥0.3 at 6 months postoperatively substantially increased (86%). The NB-positive rate in the aqueous humor samples was observably lower in the NV group than the rate in the AV group (p &amp;lt; 0.05). Univariate logistic regression analysis revealed great differences in age, duration of high myopia, axial length (AXL), corneal astigmatism, incidence of macular disease, and NB-positive rate (p &amp;lt; 0.05). Multivariate logistic regression analysis indicated that AXL and the presence of NB in the aqueous humor were independent factors influencing the postoperative visual prognosis of highly myopic patients with cataracts (p &amp;lt; 0.05). The experimental results signified that NB cultures suppressed cells and, at the cellular level, influenced the visual recovery after surgery by regulating the expression of calcification-related proteins and mitochondrial apoptosis-related proteins. Multivariate logistic regression analysis further confirmed that AXL and the presence of NB in the aqueous humor were independent factors affecting the postoperative visual prognosis. This finding offered strong support for the future development of relevant treatment modalities.