To examine trends in retinal detachment (RD) repair surgeries from 2011 to 2021 in the Medicare population that characterizes the types of patients most at risk and in need of surgery. The authors also examined the impact of retinal surgeon demographics and location of practice on RD repair. Retrospective study of RD repair surgeries performed between 2011 and 2021 on Medicare beneficiaries. Patient and surgeon characteristics associated with each claim were extracted and analyzed. In total, 230,802 RD repair surgeries were performed on Medicare beneficiaries from 2011 to 2021. The amount of scleral buckle surgeries steadily declined from 6.38% of all surgeries in 2011 to 1.95% in 2021. The odds of having complex RD repair were associated with non-White race, higher area deprivation index, diabetes, and Charlson Comorbidity Index >0. Most retinal surgeons were male (84%) and practiced in urban areas (95.3%), although the proportion of female retinal surgeons increased over time. Around 20% of patients lived in rural areas, while only 4.7% of retina surgeons practiced in a rural setting. The annual surgical volume was higher for male compared with female surgeons (8.1 vs. 4.9, P < 0.001) and higher in surgeons practicing in rural than urban areas (9.3 vs. 7.5, P < 0.001). Significant racial, geographic, and gender differences are observed within the Medicare patient population receiving RD repair surgeries, as well as significant geographic and gender disparities in the retinal surgery workforce. Further research and initiatives to explore and address these disparities are needed.

To evaluate the feasibility of single-port illuminated endolaser photocoagulation using wide-angle visualization with BIOM as a nonvitrectomy approach for treating peripheral large retinal tears with localized retinal detachment. A 60-year-old patient presented with a peripheral large retinal tear and localized retinal detachment (RD). Owing to media opacity and far peripheral location, barrier laser could not be completed with conventional laser delivery systems. Because of the potential risk of aggravating RD in the setting of a large retinal break with overlying vitreoretinal traction, external cryotherapy was not used. Instead, we used 25g single-port illuminated endolaser probe to complete the barrier laser photocoagulation around the retinal break and localized RD area with the assistance of scleral indentation using a 150° wide-angle BIOM system without vitrectomy. The single-port illuminated endolaser approach provided enhanced visualization including extreme peripheral location of the retina while depressing the sclera, allowing for comprehensive laser coverage of the lesion. This effectively prevented the progression of RD and facilitated fluid absorption, ultimately leading to the resolution of the localized RD. At 4 months postlaser treatment, the patient's retina is stable with well-formed chorioretinal adhesion. When retinal breaks are located in the far periphery with severe VR traction and media opacity is present, completion of conventional laser treatment may be challenging. A 25 g single-port illuminated endolaser photocoagulation without vitrectomy under BIOM may serve as an effective treatment option.

The authors report their long-term outcomes and potential complications after using the sutureless intrascleral fixation (SIS) technique to repair patients after complicated cataract surgery. This is a retrospective cohort study of patients who had SIS surgery due to retained lens fragments from January 2015 to January 2025 at Associated Retinal Consultants. Charts were manually reviewed to ensure consistent SIS technique was used in all participants, were followed for at least 6 months, and to analyze main outcome measures. Hundred and forty nine patients met inclusion criteria with an average follow-up time of 918 days. Most patients had the MA60AC lens (96 patients) or ZA9003 lens (32 patients) placed. Three patients and four patients had the AR40 and CT Lucia secondary intraocular lens (IOL), respectively. Endophthalmitis rate was 2.0%, all cases in the MA60AC group, with an average time of 1,469 days, 11% had IOL dislocations at an average of 442 days, 5% had vitreous hemorrhage at an average of 441 days, and 4% had a retinal detachment at an average of 707 days. No difference among IOL types was found between the anatomical outcomes analyzed. After successful SIS IOL implantation, the authors can see patients develop endophthalmitis, vitreous hemorrhage, retinal detachment, and IOL dislocation.

Lattice poses risks to patients with prior detachments. This study evaluates such patients' likelihood of rhegmatogenous retinal detachments (RRD) and retinal breaks (RB) and assesses the efficacy of prophylactic laser retinopexy and cryopexy. Retrospective cohort study using the TriNetX registry. Patients either with or without prior contralateral RRD/RB and also with fellow eye lattice were included. Logistic regression calculated the likelihood of RRD/RB in the fellow eye. The number needed to treat (NNT) was calculated for prophylactic laser retinopexy and cryopexy. Patients with prior unilateral RRD/RB had a higher likelihood of fellow eye RRD/RB than those without prior unilateral RRD/RB (OR: 4.47, 99% CI: 3.47-5.76). Myopia increased this likelihood (OR: 5.67, 99% CI: 3.80-8.48). The NNT to prevent one RRD was lower for patients with prior unilateral RRD (NNT: 4.63; 99% CI: 4.07-5.37) than those without (NNT: 43.29; 99% CI: 38.72-49.08). The NNT to prevent one RB was lower for patients with prior unilateral RB (NNT: 3.83; 99% CI: 3.37-4.44) than those without (NNT: 45.70; 99% CI: 39.99-53.30). Prior contralateral RRD/RB increases the likelihood of RRD/RB in fellow eyes with lattice. Prophylactic laser retinopexy and cryopexy reduce the number of fellow eye RRD/RB.

Modified case-crossover estimators were unbiased in the presence of temporal trends in the exposure of interest: a simulation study.

Anti-vascular endothelial growth factor (anti-VEGF) therapies are standards of care for vision-threatening retinal diseases. This retrospective observational study describes demographics, utilization, best recorded visual acuity (BRVA), and safety among eyes with neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), or retinal vein occlusion (RVO) treated with the biosimilar aflibercept-ayyh (PAVBLU®) in routine clinical practice. Electronic medical records from the Retina Consultants of America database of patients receiving aflibercept-ayyh (12/1/2024-10/31/2025) were analyzed, focusing on eyes with ≥ 84days of follow-up. The index date was defined as the first documented aflibercept-ayyh injection. Post-index data were used to evaluate treatment patterns, changes in BRVA, and adverse events of special interest (AESIs). Within-eye changes in BRVA were assessed using the Wilcoxon signed rank test and summarized as mean change in logarithm of the minimum angle of resolution (ΔlogMAR). A total of 1000 consecutive eyes from 989 patients (55% female, 43% male, 2% unknown) received 3730 injections of aflibercept-ayyh; 91% switched from prior anti-VEGF therapy and 9% were anti-VEGF treatment-naïve. Disease distribution was 58% nAMD, 19% RVO, 16% DME, and 7% DR. Among switchers, median (IQR) number of prior injections was 21 (8,46). Median (IQR) follow-up was 6.0months (4.6,7.1). Median (IQR) number of aflibercept-ayyh injections per eye was 4 (3,5). Among eyes with ≥ 84days of follow-up (n = 889), mean BRVA logMAR remained stable for switchers (0.4to0.4; P = 0.96) and improved from baseline in anti-VEGF-naïve eyes (0.5to0.4; P < 0.01). Confirmed AESIs included iritis (n = 2; 0.05% of injections), with no events of vitreous cells, endophthalmitis, retinal detachment, retinal vasculitis, or vitreous hemorrhage. In this descriptive real-world analysis, aflibercept-ayyh was associated with stable visual acuity in previously treated eyes and vision improvement in treatment-naïve eyes, with no new or unexpected safety findings, consistent with expectations for aflibercept and the established body of evidence supporting biosimilarity between aflibercept-ayyh and reference aflibercept, EYLEA®).

What is the Utility of Point-of-care Ultrasound for Diagnosing Retinal Detachment?

This review provides an overview of possible complications of the most commonly performed refractive surgeries: laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), small incision lenticule extraction (SMILE), and lens-based refractive surgery. While the vast majority of refractive surgeries are safe with successful outcomes, complications can still occur which requires surgeons to have an in-depth understanding of complication prevention and management. Although overall rare, corneal laser refractive procedures and lens-based refractive surgeries are associated with a distinct set of potential complications. The most common complications from LASIK, PRK, and SMILE include flap issues, infectious keratitis, haze, dry eye disease, and corneal ectasia. Implantable collamer lenses (ICLs) come with a possible risk of intraocular pressure elevation and cataract formation. Refractive lens exchange (RLE) introduces younger patients to potential complications typically associated with cataract surgery, such as dysphotopsias, uveitis, and retinal detachment. The elective nature of refractive surgery may raise expectations of patients for successful outcomes. This timely review provides relevant and detailed guidance to refractive surgeons on best practices to mitigate potential complications, and ultimately maximize patient safety and satisfaction.

This study evaluates colour-coded fundus autofluorescence (FAF) in vitreoretinal lymphoma (VRL), which still represents a diagnostic challenge because of the variety of ocular manifestations and difficulties in obtaining a definite diagnosis. Retrospective cross-sectional analysis of consecutive patients with VRL studied with colour-coded FAF. For comparative analysis, the patients also underwent conventional blue and green fundus FAF. Detection and appearance of typical VRL lesions in macular and extramacular locations on colour-coded FAF were studied and compared with other imaging techniques, including optical coherence tomography. We evaluated 20 eyes from 10 patients affected by VRL. The agreement among readers on the presence of VRL lesions using colour-coded FAF was excellent. Lesion-specific comparative analysis showed that retinitis-like lesions were identified in 2/2 eyes using colour-coded FAF versus 0/2 eyes using blue FAF and green FAF, while lymphomatous retinal pigment epithelium (RPE) detachments were detected in 4/4 eyes using colour-coded FAF versus 1/4 eyes using blue FAF and green FAF. The classic granular appearance was similarly detected in 13/13 eyes across all FAF modalities. Comparative analysis revealed that colour-coded FAF appeared to better delineate retinitis-like lesions and lymphomatous RPE detachments than other types of FAF. Conversely, green FAF was more informative within the macula, while colour-coded FAF was also able to detect minor fluorophores and showed RPE atrophic areas, sub-RPE deposits, and perivascular infiltrates. Colour-coded FAF can recognize the classic features of VRL. As a complementary imaging modality, colour-coded FAF may facilitate the recognition of retinitis-like lesions, lymphomatous retinal pigment epithelium detachments, and minor fluorophores compared with other FAF types.

Effect of one or two cycles of dual immunotherapy with nivolumab and ipilimumab in patients with mismatch repair-deficient rectal cancer (RESET-R): interim results from a multicentre, single-arm, phase 2 trial.

To determine if iris manipulation during phacovitrectomy for retinal detachment repair is associated with the development of proliferative vitreoretinopathy (PVR). Single-center, comparative, retrospective cohort study of 536 eyes who underwent phacovitrectomy for cataract extraction and retinal detachment repair between 2013 and 2024. Eligible eyes had at least 3-month follow-up. Iris manipulation was defined as mechanical pupillary expansion or synechiolysis. Patients with a history of uveitis were excluded. The primary outcome was the development of PVR, and secondary outcomes included the development of other postoperative complications. Of the included eyes, 66 were in the iris manipulation group and 470 were in the control group. The average follow-up time was 18.9 ± 16.0 weeks. Among the 34 eyes without baseline PVR in the iris manipulation group, 5 eyes (14.7%) developed PVR. Among the 282 eyes without baseline PVR in the control group, 12 (4.3%) developed PVR. After adjusting for patients who had previous retinal surgery in an additional regression analysis, iris manipulation remained a significant predictor for PVR development (odds ratio 3.64; P = 0.038). There were no significant differences in the odds ratio for the development of the other postoperative complications between the groups. Iris manipulation during phacovitrectomy for retinal detachment repair and cataract extraction was significantly associated with development of PVR in the absence of active inflammation, despite a similar profile of other postoperative complications. These findings highlight the potential role of iris trauma in amplifying intraocular inflammation and contributing to PVR pathogenesis.

Correspondence.

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To describe a rapid surgical technique for removal of the intraocular nematode Setaria digitata from the anterior chamber of horses under standing sedation and to report clinical outcomes. Twelve client-owned horses (2021-2026) presented with a motile intracameral worm. All surgeries were performed under field conditions using standing sedation (xylazine 1.1 mg kg-1 and butorphanol 0.1 mg kg-1 IV), regional nerve blocks (lidocaine 2%), and topical anesthesia (proparacaine). A 2.8 mm uniplanar oblique (~45°) corneal incision was created ventrolaterally approximately 2 mm from the limbus using a keratome. The anterior chamber was filled with dispersive hydroxypropyl methylcellulose (HPMC), and controlled viscoelastic egress facilitated atraumatic extrusion of the worm. The incision was left unsutured. Worm removal was successful in 11/12 eyes (91.7%). In one chronically affected eye, the worm was suspected to be adherent to the iris and could not be removed. Median incision-to-extraction time was 2 min (range 1-3 min). Nine eyes (75%) retained or regained vision within 7 days; three remained non-visual due to pre-existing end-stage glaucoma or suspected retinal detachment. Postoperative complications included transient peripheral corneal edema in one horse, which resolved with medical management, and anterior chamber fibrin formation in one eye in which viscoelastic was not used. Although not a substitute for surgery under general anesthesia, viscoelastic-assisted removal of S. digitata through a small self-sealing corneal incision is a rapid, minimally invasive, and field-applicable technique when performed by appropriately trained ophthalmic surgeons.

Foldable Capsular Buckle as a Viable Intervention for Retinal Detachment in Late Pregnancy.

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To evaluate the association between the baseline morphologic stage of rhegmatogenous retinal detachment and postoperative visual acuity and metamorphopsia. This retrospective study included 39 consecutive patients with primary fovea-off rhegmatogenous retinal detachment who underwent scleral buckling at the Eye and ENT Hospital of Fudan University between 2018 and 2023. Optical coherence tomography, best-corrected visual acuity, and M-CHARTS were assessed at baseline and at 1, 3, 6, and 12 months postoperatively. Baseline morphologic Stage was 1 and 2 in 41%, 3 in 21%, 4 in 15%, and 5 in 23% of patients. Advanced morphologic stage was associated with worse best-corrected visual acuity ( P = 0.001, 0.001, 0.008, 0.002, and 0.002) and greater M-CHARTS scores ( P = 0.033, 0.004, 0.001, 0.003, and 0.005) at baseline and at 1, 3, 6, and 12 months postoperatively, respectively. After adjusting for covariates, the partial correlation coefficients between best-corrected visual acuity at baseline and at 1, 3, 6, and 12 months postoperatively were significantly positive ( P = 0.001, 0.001, 0.002, and 0.005, respectively), as were the partial correlation coefficients between preoperative vertical M-CHARTS scores and scores at 1, 3, 6, and 12 months postoperatively ( P < 0.001, 0.001, 0.001, and 0.027, respectively). The M-CHART scores at 3, 6, and 12 months were significantly better in Stages 1, 2, and 3 versus Stage 4 ( P = 0.002, 0.003, and 0.002, respectively). Postoperative best-corrected visual acuity and metamorphopsia deteriorated significantly at all timepoints in patients with more advanced baseline morphologic stages, highlighting the need for earlier intervention in fovea-off rhegmatogenous retinal detachment.

This study developed an automated deep learning-based system to quantify retinoschisis and detachment volume (RDV) in pathological myopia (PM) patients undergoing posterior scleral contraction (PSC). A prospective study included 51 PM patients (36 PSC-treated and 15 controls). Based on the myopic traction maculopathy staging system classification, PSC-treated patients were divided into retinoschisis (RS, Stage 2, n=21) and retinal detachment (RD, Stages 3-4, n=15), while controls were classified as Stage 1 (n=15). Swept-source optical coherence tomography (OCT) and angiography imaging was used to acquire retinal data, and a Mask R-CNN model was trained to segment and calculate RDV. The primary outcome measures were regional macular recovery rate, defined as the percentage reduction in RDV at 12 months postoperatively. Clinical parameters such as axial length (AL) and best-corrected visual acuity (BCVA) were analysed. The model achieved an Intersection over Union of 80.9%. RDV increased with more advanced stages of myopic traction maculopathy (MTM). As MTM stage advanced, RDV distribution shifted from predominantly parafoveal/perifoveal involvement to foveal involvement. Macular RDV increased progressively with MTM stage (control: 0.94 mm3, RS: 5.24 mm3, RD: 9.50 mm3; p<0.001). Postoperative AL decreased significantly and BCVA improved significantly (all p<0.001). Postoperative RDV decreased significantly, achieving macular and foveal recovery rates as 80.90% and 99.50%, respectively. AL reduction demonstrated the strongest correlation with foveal RDV changes (r=0.479, p=0.003). The Mask R-CNN-based RDV measurement provides a sensitive 3D biomarker for assessing PSC efficacy and monitoring MTM progression. The system offers objective, high-precision quantification of retinal structural changes, addressing limitations of manual OCT analysis. ChiCTR2200065561.

Reports on RRD surgery in pregnant women remain limited, highlighting the need for a safe, effective technique that does not compromise pregnancy or fetal health. This report presents a 36-year-old, 28-week pregnant myopic female with macular-involved RRD in the left eye (best-corrected visual acuity [BCVA] 20/40). Due to the risks of prolonged supine positioning and anesthesia with traditional scleral buckling (SB), we performed foldable capsular buckle (FCB) scleral buckling under subconjunctival anesthesia. The retina was reattached, and BCVA recovered to 20/20. Intraocular pressure and refractive status remained stable throughout follow-up. The patient delivered a healthy female via Cesarean section at 38 weeks. FCB scleral buckling may represent a promising alternative in selected pregnant patients with uncomplicated RRD; however, larger studies are needed to establish safety and efficacy.

Background/Objectives: Cytomegalovirus (CMV) retinitis remains a significant opportunistic infection in patients with advanced human immunodeficiency virus (HIV) infection, particularly with late HIV diagnoses. This three-case series aimed to describe HIV-associated CMV retinitis in newly diagnosed advanced HIV infection with documented concurrent and/or prior infectious conditions, and to highlight the importance of bord systemic screening and multidisciplinary management. Methods: We retrospectively reviewed three male patients diagnosed with HIV-associated CMV retinitis at a tertiary ophthalmology referral center. Clinical findings, CD4-positive T-cell counts, HIV-RNA levels, aqueous humor CMV-DNA results, systemic infectious conditions, treatment and ocular outcomes were summarized. Results: All patients had marked cellular immunodeficiency, with CD4-positive T-cell counts ranging from 46 to 141 cells/µL, and CMV-DNA was detected in aqueous humor in all cases. The infectious burden was substantial: all three patients had syphilis and hepatitis B virus infection, two had oral candidiasis, and individual patients had chlamydia infection, tuberculosis, amebic colitis, or a history of herpes zoster. One patient was initially suspected of having syphilitic uveitis, which illustrates how coinfections may obscure the diagnosis of CMV retinitis. Retinal detachment occurred in two cases and was surgically repaired with anatomical recovery. Conclusions: These cases emphasize that CMV retinitis in newly diagnosed advanced HIV infection should prompt broad infection screening and multidisciplinary evaluation, particularly in the setting of delayed HIV diagnosis and severe immunosuppression. Comprehensive screening for opportunistic and sexually transmitted infections, prompt ocular virological confirmation, and multidisciplinary management are essential in patients with HIV-associated CMV retinitis.