This review aims to highlight the characteristic clinical features, pathophysiology, risk factors, genetics, diagnostic work-up, therapeutic management, and recent advances in the clinical setting and management of juvenile open-angle glaucoma (JOAG). A retrospective literature review of PubMed and Google was judiciously done to provide this update [2000-2025]. A diagnosis of JOAG is established on the basis of history and clinical examination, tonometry, angle evaluation by gonioscopy, central corneal thickness (CCT) evaluation, and slit lamp biomicroscopy for evaluation of optic disc changes and retinal nerve fiber layer (RNFL) loss. Structural [optical coherence tomography (OCT) and OCT angiography] and functional assessment [automated perimetry] is important in diagnosis and monitoring it. Juvenile open-angle glaucoma is a rare type of primary open-angle glaucoma affecting individuals between 3 and 40years of age. Classically described as having an early age of onset, high intraocular pressures, normal-appearing angles on gonioscopy, optic disc cupping, and visual field loss; other forms like juvenile ocular hypertension and juvenile normal tension glaucoma are also observed. Trabeculodysgenesis is the primary pathology hindering the normal egress of aqueous humor from the trabeculum; it is currently classified into four clinical subtypes on the basis of gonioscopic angle appearance. Male gender and myopia are risk factors. The MYOC gene mutations are commonly implicated in its pathogenesis. Medical therapy is the first-line management, but selective laser trabeculoplasty also yields favourable outcomes. Surgical management consensus is based on surgeon expertise and preference and is indicated for inadequate intraocular pressure control with non-invasive procedures. JOAG is a heterogeneous and challenging disease, and a multidisciplinary approach is required in its diagnosis and management. Screening of patients at risk or those with a family history or risk factors may allow for earlier diagnosis and prevent visual disability. Prognosis depends on the stage of diagnosis, patient compliance, and prompt appropriate management. Lifelong follow-up is necessary to prevent visual morbidity from this optic neurodegenerative disorder.

Ocular Hypertension and Glaucoma After Pars Plana Vitrectomy: A Systematic Review and Meta-Analysis.

Mechanotransduction in trabecular meshwork cells: Rho/ROCK-dependent responses to substrate stiffness.

Mechanical and cellular response of lenses to acute ocular hypertension: Implications of AQP1 regulating water transport and lenses opacification.

Oxidative stress in glaucomatous retinal ganglion cell injury: Mechanisms and neuroprotective strategies.

Intraocular inflammation after intravitreal injection of second-generation anti-VEGF agents observed in a tertiary center over 12 months: What are the specific features?

To explore the clinical value of intraocular pressure (IOP) measurements obtained by owners in dogs predisposed to primary angle closure glaucoma (PACG). Owners of 14 dogs with eyes predisposed to developing PACG obtained IOP measurements with a TonoVet Plus from the time of diagnosis of PACG until they developed clinical PACG or were lost to follow up. Owners measured IOP values in 14 dogs. In nine dogs, IOP was measured until they developed overt glaucoma with marked IOP elevations. Four dogs were lost to follow-up, and IOP continues to be monitored in one dog. In seven of the nine dogs that developed overt glaucoma, onset of glaucoma was associated with a sudden rise in IOP > 50 mmHg that was not preceded by an obvious gradual rise in average IOP readings or prior smaller rises in IOP. Dogs that were treated with latanoprost following the onset of overt glaucoma continued to have sporadic rises in IOP. Owner obtained, at home IOP measurements can provide information that may be useful in the management of canine PACG.

Intraocular Pressure after Phacoemulsification with Retained Lens Fragments in the IRIS® Registry (Intelligent Research in Sight).

Measurement of Acute Intraocular Pressure Elevation Immediately After Intravitreal Anti-VEGF Injection and Analysis of Prefilled Syringe Accuracy

In vivo Doppler holography of the optic nerve head in glaucoma: Response to acute IOP decrease.

Introduction: Laser Iris Depigmentation (LID) is a cosmetic procedure designed to alter eye color by reducing iris pigment using an Nd:YAG laser. While this procedure is increasingly popular, it carries risk of serious, sight-threatening complications. This report highlights two cases that emphasize these potential complications. Case Presentation: Two patients presented after undergoing multiple sessions of LID performed abroad. They exhibited similar symptoms, including blurry vision, nausea, and eye pain. Case 1 had intraocular pressure (IOP) of 34 mmHg in both eyes and later developed herpes simplex keratitis, which resulted in corneal scarring. Case 2 presented with IOP of 60 mmHg in one eye. Both patients were admitted for topical IOP-lowering treatment and received systemic administration of acetazolamide and mannitol, resulting in normalized IOP levels. However, in the first patient, corneal scarring led to a marked decline in visual acuity. Conclusions: LID may be associated with serious, sight-threatening complications, including significant increases in IOP and corneal scarring. It is crucial for both patients and healthcare providers to be fully aware of these potential risks, which may outweigh the potential aesthetic benefits of the procedure, and to actively monitor postoperatively for any signs of these adverse effects.

Background: Secondary glaucoma in children results from congenital or acquired ocular abnormalities, systemic diseases, or syndromes. These conditions impair aqueous humor outflow despite an open iridocorneal angle, causing elevated intraocular pressure (IOP). Micropulse transscleral cyclophotocoagulation (MP-TSCPC) reduces aqueous humor production by targeting the ciliary body and restores the aqueous humor’s circulation balance. The aim of the study was to evaluate the safety and efficacy of MP-TSCPC in pediatric secondary glaucoma. Methods: This retrospective study included 59 children who underwent MP-TSCPC procedures. The mean age was 7.2 years (range 4 months–17 years). Data on IOP, prior glaucoma treatments, medication use, and adverse events were analyzed. The mean follow-up was 10.4 months. Results: The mean preoperative IOP was 34.0 mmHg, which significantly decreased to 25.8 mmHg after MP-TSCPC, representing a mean reduction of 20.8% (p < 0.0001). Satisfactory IOP lowering was achieved in 69.6% of procedures. Eyes without prior glaucoma surgery showed a numerically greater IOP reduction (22%) compared to previously treated eyes (19%), though the difference was not statistically significant (p = 0.628). Among repeated MP-TSCPC treatments, 57.1% were successful, with a mean IOP reduction of 7.3%. The mean number of glaucoma medications decreased significantly from 2.42 to 2.02 (p = 0.0002). A sustained reduction in medication use was observed in 33.3% of cases. Conclusions: MP-TSCPC effectively lowers IOP in pediatric secondary glaucoma and has a favorable safety profile. The option for repeated treatments and reduced medication needs supports its use as a less invasive alternative to conventional surgery.

This study aims to evaluate the post-marketing safety profile of voretigene neparvovec using a large spontaneous reporting database. This is a. retrospective pharmacovigilance disproportionality study. Adverse event (AE) reports for voretigene neparvovec were retrieved from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS), Q1 2019-Q1 2025. Disproportionality was assessed using reporting odds ratio (ROR), proportional reporting ratio (PRR), information component (IC), and empirical Bayesian geometric mean (EBGM). Signals were summarized at the System Organ Class (SOC) and Preferred Term (PT) levels. A total of 128 AE reports were included. The median patient age was 18years, with adolescents and young adults comprising the majority. The primary sources of reports were physicians (44.53%) and consumers (43.75%), with intraocular injection being the most frequently reported route of administration (25.00%). Signal analysis revealed that ocular disorders had the highest number of reports and the most prominent signal strength (e.g., retinal degeneration: ROR = 3742.02, IC025 = 6.93; retinal depigmentation: ROR = 8865.67, IC025 = 8.37). Other significant signals included vitreous floaters (ROR = 1497.43, IC025 = 5.43) and elevated intraocular pressure (ROR = 473.10, IC025 = 4.37). In contrast, systemic events such as headache and ocular pain showed weaker signals that did not exceed the statistical significance threshold. In real-world use, voretigene neparvovec is mainly associated with ocular AEs linked to surgical delivery and local inflammatory responses, notably structural retinal changes and intraocular pressure elevations. These findings support careful preoperative assessment, optimized perioperative technique, and close postoperative monitoring. FAERS-based signals indicate association rather than causality and should be interpreted alongside prospective data. Clinical trial number is not applicable.

HSV-induced corneal endotheliitis (HSV endotheliitis) is a sight-threatening ocular disease, with poor underlying its pathogenesis due to the lack of suitable animal models, we therefore aimed to develop a murine HSV endotheliitis model. Herpes simplex virus type 1 (HSV-1) was injected into the anterior chamber (AC) of C57BL/6 mice to establish primary and latent infection. Recurrence was induced at least 5 weeks post-infection via ultraviolet B (UVB) corneal exposure. Clinical manifestations were dynamically monitored. The histopathology and molecular changes were assessed using transmission electron microscopy, immunofluorescence (IF) staining, hematoxylin and eosin (H&E) staining and multiple cytokines and chemokines analysis. HSV-1 load in corneas and trigeminal ganglia (TG) was detected via plaque assay, quantitative real-time PCR and IF staining. Compared with controls, the primary HSV-1-infected mice exhibited characteristic manifestations of viral endotheliitis, including corneal and iris edema, AC inflammation, keratic precipitates (KPs), elevated intraocular pressure, and corneal endothelial cell damage and loss. Early after infection, viral loads were elevated both in corneas and TGs. By day 28, however, a latency-associated transcript (LAT) in TGs increased markedly, while HSV-1 titers became undetectable, indicating viral latency. Following UVB corneal exposure, the recurrent mice showed significant stromal edema, increased KPs, extensive endothelial cell loss, and elevated viral loads, confirming the successful induction of recurrence. We successfully established a murine model of primary infection, latency and recurrence of HSV endotheliitis, providing a reliable platform for investigating pathological mechanisms and potential treatments.

Background/Objectives: Diabetes mellitus (DM) is associated with a doubled prevalence of elevated intraocular pressure (IOP) caused by trabecular meshwork (TM) dysfunction. Chronic hyperglycaemia leads to oxidative stress and fibrotic remodeling of the TM. We previously identified the Sigma-1 receptor (S1R) as a novel anti-fibrotic target by demonstrating that its agonist, fluvoxamine (FLU), is protective in diabetes-related renal fibrosis. Here, we investigate its potential to mitigate ocular fibrosis. Methods: First, we wanted to verify in different in vivo models (high-fat diet/streptozotocin (HFD/STZ) rats, db/db mice) that type 2 DM (T2DM) leads to fibrotic remodeling of the TM. Then, in vitro, we assessed the effect of FLU (15 µM) on hyperglycaemia-induced (HG, 25 µM) fibrosis, oxidative stress and endogenous nitric oxide (NO) production. Results: In T2DM models, excessive accumulation of collagen, α-smooth muscle actin (αSMA), fibronectin (Fn) and F-actin was observed in the eyes. Ocular fibrosis was accompanied by IOP elevation (13.7 vs. 18.7 mmHg) in db/db mice. In human TM cells (HTM5), FLU decreased HG-induced cell proliferation (14% vs. 24%) and upregulated S1R protein expression. Furthermore, FLU suppressed the expressions of key fibrotic elements, including transforming growth factor-β2 (TGF-β2) by 37%, Fn by 49%, collagen type 1 (COL1A1) and type 4 (COL4A1) by 24% and 45%, respectively. FLU also reversed HG-induced F-actin accumulation by 39% and enhanced intracellular NO levels by 34%. Crucially, FLU decreased ROS generation by half, demonstrating its protective effect against HG-induced oxidative stress. Conclusions: These findings highlight the potential of S1R activation as a promising therapeutic target to alleviate hyperglycaemia-induced injury to the TM by modulating multiple molecular pathways.

Background and Aims: Retinal detachment (RD) is the separation of the neurosensory retina from the retinal pigment epithelium, causing subretinal fluid buildup. Pars plana vitrectomy (PPV) with silicone oil tamponade is commonly used to treat retinal detachment. The aim of the study was to evaluate the anatomical and functional outcomes and to identify the postoperative complications following silicone oil removal in retinal detachment surgery. Study Design: Retrospective cohort study. Place and Duration of Study: Eye department in KCMC hospital in Northern Tanzania, from January 2020 to December 2023. Methodology: A total of 231 eyes with a documented six-month follow-up after silicone oil removal were included. Data were collected using a structured data collection form. Good visual outcome was categorized as visual acuity ≤ 1 LogMAR, and anatomical success was defined as retinal reattachment after oil removal. Statistical analysis was performed using SPSS version 25. Associations between clinical variables and outcomes were assessed using the Chi-square test, univariate and multivariable analysis, with a p-value ≤0.05 considered statistically significant. Results: Anatomical success was achieved in 66.7% and functional success in 42% of eyes. Multivariable analysis showed that retinal re-detachment significantly reduced the likelihood of a good visual outcome (ARR: 0.33, 95% CI: 0.20- 0.54, p< 0.001), whereas good baseline visual acuity (≤1 LogMAR) increased the likelihood (ARR: 1.71, 95% CI: 1.31- 2.23, p<0.001). Preoperative proliferative vitreoretinopathy increased the risk of re-detachment (ARR: 1.57, 95% CI: 0.99- 2.46, p = 0.05), while myopia was associated with a 68% reduced risk (ARR: 0.32, 95% CI: 0.11- 0.94, p = 0.04). The most common postoperative complications comprised of retinal re- detachment (33.3%), cystoid macular edema (14.8%), epiretinal membrane formation (12.1%), ocular hypertension (10.4%), keratopathy (7.5%), and hypotony (7.5%). Conclusion: A good baseline visual acuity and retinal attachment after oil removal were strongly associated with a favorable visual outcome. Proliferative vitreoretinopathy was a major risk factor for postoperative retinal re-detachment, while myopia was linked to a lower risk. The apparent protective effect in myopic eyes may have been attributed to the use of prophylactic panretinal photocoagulation, which could have reduced the risk of retinal re-detachment.

BACKGROUND Acute submacular hemorrhage (SMH) secondary to choroidal neovascularization (CNV), most commonly in neovascular age-related macular degeneration, is a vision-threatening emergency. Thick, fovea-involving SMH can cause rapid photoreceptor injury, and timely intervention aimed at clot lysis and displacement, while continuing CNV suppression with anti-vascular endothelial growth factor (anti-VEGF) therapy, may improve anatomic outcomes. CASE SUMMARY We report a retrospective case series of three eyes with acute, fovea-involving CNV-related SMH treated with pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (tPA), and expansile gas tamponade, with intravitreal anti-VEGF administered at the end of the procedure and continued postoperatively. Two cases had early intraocular pressure-related events (transient hypotony in one patient and transient ocular hypertension in another) requiring close postoperative monitoring and medical management. Follow-up color fundus photography and optical coherence tomography documented postoperative evolution of the hemorrhage compared with baseline, with ongoing anti-VEGF therapy planned to control the underlying CNV. CONCLUSION PPV with subretinal tPA and gas tamponade is a practical surgical strategy for acute, thick, fovea-involving SMH secondary to CNV, particularly when rapid displacement is desired. Careful documentation of operative parameters, strict postoperative monitoring for pressure-related complications, and continued anti-VEGF therapy are essential components of care.

Background: In 2016, Charles McMonnies advanced a theory positing that the use of scleral lenses might result in an elevation of intraocular pressure (IOP) due to the compression of the episcleral veins, consequently diminishing the eye's capacity for draining aqueous humor. Alternative drainage pathways are capable of compensating only for 10-30% of the aqueous humor that requires drainage. Then it remains a quantity of fluid trapped in the anterior chamber. Recent data has demonstrated that the scleral lenses wear results indeed in an augmentation of the anterior chamber volume and a reduction of the iridocorneal angle, concomitant with a compression of Schlemm's canal. Assuming that aqueous humor production remains constant, this imbalance between inflow and outflow can only lead to an increase in intraocular pressure. Methods: Several studies have attempted to answer this question over the past 10 years. Most authors have encountered the inherent difficulty of measuring IOP while the lens is still in place. Others were performed without waiting for the required time (>4 h of wear) for the lens to exert its maximum compression, thus minimizing their impact. Some attempted to assess IOP via the sclera (pneumotonometry), a technique known to give variable results and hard to reproduce. Ultimately, there are few reliable ways to assess IOP. One of them is by directly observing changes in the optic nerve structure over time. Results: These works indicate that there is indeed a moderate increase (<5 mmHg) in IOP. Could this be causing neuropathy and long-term negative impacts for patients who may be at risk? Based on the clinical experience of those involved in the field for many years, it is unlikely that IOP variations may have an impact on a healthy optic nerve. However, glaucoma patients or those at risk could be adversely affected in the long term. Conclusions: It is still too early to determine, without a doubt, the actual impact of the likely increase in IOP resulting from the structural changes caused by wearing scleral lenses Further work is therefore urgently needed to document these longitudinal changes.

To report a case of large central Descemet's membrane detachment (DMD) following cataract surgery and discuss the potential for spontaneous resolution as an alternative to surgical intervention. A 79-year-old male with a history of macular degeneration and ocular hypertension developed a large central DMD following cataract surgery complicated by posterior capsular rupture. The patient initially presented with severe corneal edema and an uncorrected visual acuity (UCVA) of 20/200. Despite medical treatment, the DMD persisted, and surgical intervention was considered at week 4 post-op. However, the patient was lost to follow-up, and the surgery could not be performed. At a six-week follow-up, the DMD had resolved spontaneously, with the patient's UCVA improving to 20/30 and best-corrected visual acuity (BCVA) to 20/20. This case demonstrates that large central DMDs (Descemet's membrane detachments) can occasionally resolve spontaneously.

Glaucoma represents a group of diseases where the unifying theme is the progressive degeneration of retinal ganglion cells (RGC), causing irreversible vision loss. Mutations in the myocilin (MYOC) gene represent one of the most common genetic factors associated with primary open-angle glaucoma (POAG). However, the mechanism underlying MYOC mutation-associated POAG is poorly understood. Here, using human disease modeling of MYOC mutation (A445V)-dependent POAG, which is usually without ocular hypertension, we have tested a hypothesis that human RGCs (hRGCs) are the target of the mutant protein, making them vulnerable to degenerative changes. Examination of hRGCs generated from MYOCA445V POAG patient-specific induced pluripotent stem cells (iPSCs) revealed that their differentiation is adversely affected, compared to those generated from isogenic control iPSCs. RGC regulatory and axon growth and guidance gene expression is decreased in patient-specific hRGCs versus isogenic controls. Consequently, the former display immature neurites and their ability to form synapses with the target cells and regenerate are compromised. Furthermore, they display immature networking physiology compared to isogenic controls. The pathological burden of the mutant protein is reflected in their preferential retention in the ER of patient-specific hRGCs, activating the unfolded protein response (UPR) toward mutation-associated developmental phenotype. Furthermore, we demonstrate that REDD1, a stress induced factor, is a mechanistic link between the MYOCA445V -activated UPR axis and inhibited mTOR signaling, a critical regulator of RGC development and function. Ours is the first demonstration of MYOC mutation dependent hRGC phenotype and posits a mechanism for hRGC susceptibility toward degeneration independent of ocular hypertension.