To compare the utility of single-capture ultra-widefield optical coherence tomography angiography (UWF-OCTA) and UWF-OCTA plus UWF colour fundus photography (UWF-CFP) versus UWF fluorescein angiography (UWF-FA) in detecting retinal capillary haemangiomas (RCHs) in von Hippel‒Lindau disease (VHL) and to explore the associations of RCH multimodal imaging features. In this observational cross-sectional study, all enrolled eyes underwent single-capture UWF-OCTA (29 × 24mm). RCHs suspected on UWF-CFP with eye-steering were further checked using regional UWF-OCTA scans. UWF-FA was used for comparison. Independent observers performed the RCH detection and characterisation using different imaging methods. The detection performance was compared, and logistic regression was used to identify the factors associated with leakage. Thirty-nine eyes of 21 patients with VHL were included in this study. At the eye level, UWF-OCTA plus UWF-CFP exhibited a similar performance to UWF-FA in detecting RCH involvement (87.2% vs. 89.7%, P = 0.319) and the median number of RCHs per eye (2 vs. 2, P = 0.252). However, the RCH involvement rate (61.5% vs. 89.7%, P < 0.001) and number of RCHs per eye (1 vs. 2, P = 0.003) were lower with single-capture UWF-OCTA than with UWF-FA. At the RCH level, UWF-OCTA plus UWF-CFP showed slightly lower detection rates than did UWF-FA, albeit without statistical significance (86.8% vs. 93.4%, P = 0.057). Single-capture UWF-OCTA detected significantly fewer RCHs than did UWF-FA (51.7% vs. 93.4%, P < 0.001). RCHs were classified according to OCTA B-scan characteristics. Types 1 (48.8%) and 2 (18.1%) RCHs exhibited a nodular appearance with protrusion into the vitreous cavity and compression of the outer retina, respectively. Type 3 RCHs (28.3%) displayed flat growth patterns, whereas type 4 RCHs (4.7%) breached the inner limiting membrane. Logistic regression revealed that RCH size > 0.5mm was associated with hyperfluorescence with leakage (odds ratio [OR]: 10.987; 95% confidence interval [CI]: 1.747to69.090; P = 0.011), whereas type 3 RCH was associated with lower odds of leakage than type 1 (OR: 0.083; 95% CI: 0.026to0.267; P < 0.001). A screening strategy integrating UWF-OCTA and UWF-CFP, instead of 150° single-capture UWF-OCTA alone, is reliable for non-invasive detection of RCHs in patients with VHL. OCTA-derived features, particularly the morphological subtype, may replace FA in assessing RCH activity and guiding the management of ocular VHL.

To investigate vitreous barrier function by examining ocular distribution patterns of anionic fluorescein dextran molecules with varying molecular weights (MWs) following intravitreal injection and to assess the influence of injection site and plasmin pretreatment on dye distribution. We studied dye distribution across five MWs (3 kDa, 40 kDa, 70 kDa, 500 kDa, and 2 MDa) in an ex vivo pig eye model, with temporal or nasal injections. For experiments involving ex vivo pig eyes pretreated with plasmin, in vivo pig eyes, and ex vivo human eyes, we utilized only 40-kDa and 2-MDa dyes injected temporally. No significant differences were observed between nasal and temporal injections. In ex vivo pig eyes, 3-kDa fluorescein showed near-complete vitreous diffusion within 24 hours. The 40-kDa and 70-kDa dyes continued to spread beyond 24 hours, whereas the 500-kDa and 2-MDa dyes demonstrated restricted distribution with minimal change up to 48 hours. In vivo pig eyes showed limited distribution of 2-MDa fluorescein. Plasmin pretreatment did not affect 2-MDa distribution but enhanced the spread of 40-kDa fluorescein. In ex vivo human eyes, 40-kDa fluorescein distributed widely, whereas 2-MDa fluorescein remained highly localized and delineated a vitreous bursa structure that the dye did not penetrate. We observed a size-dependent relationship between dye molecules and their spread throughout the vitreous cavity, highlighting the role of vitreous as a barrier that can influence the distribution and effectiveness of treatments, including gene therapies. Future research should focus on improving the mobilization of larger substances within the vitreous while recognizing its potential as a natural reservoir for slow drug release when injected into the vitreous bursae.

With the rising prevalence of diabetes mellitus globally, vision-threatening diabetic retinopathy (DR) is also rapidly increasing. Due to the advent of newer instrumentation, the indications of pars plana vitrectomy (PPV) in such advanced DR patients have also expanded. Intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections are also increasingly being used in patients with DR, often as an adjunct to PPV. This narrative review was conducted to summarize and critically analyze the role of perioperative anti-VEGF therapy in diabetic vitrectomy. Various indications of diabetic vitrectomy where perioperative anti-VEGF is used have been elucidated. Controversies regarding the optimal timing of preoperative anti-VEGF therapy prior to vitrectomy have been addressed in detail. This review also elaborates the various intraoperative and postoperative benefits of anti-VEGFs with regard to the duration of vitrectomy, intraoperative bleeding, iatrogenic breaks, need for endodiathermy and silicon oil endotamponade, surgical difficulty score, postoperative visual gain, intraocular pressures, postoperative vitreous cavity hemorrhage, and need for second surgery. The current narrative also mentions the potential ocular adverse effects of anti-VEGF, such as progression of tractional retinal detachment, apart from addressing other ocular side effects and a few other uncommon yet serious systemic adverse events.

ABSTRACT Purpose To describe the outcomes of pars plana vitrectomy (PPV) in patients with uveitis, including changes in visual acuity, inflammatory control, and macular edema status, in a sample from Colombia. Methods A retrospective observational study was conducted on 27 eyes from 27 patients with uveitis who underwent PPV at a tertiary referral center. PPV was not performed as primary treatment for active uveitis; instead, it was undertaken only when postponement posed a risk of irreversible visual loss due to structural complications or when diagnostic clarification was urgently required. Aqueous/vitreous sampling was performed with PPV when indicated for etiologic evaluation. Collected data included demographics, uveitis classification, surgical indication, best-corrected visual acuity (BCVA) at 1, 3, 6, and 12 months in LogMAR, inflammatory activity (defined with vitreous haze and anterior chamber cellularity) one month postoperatively, and cystoid macular edema (CME) status six months after PPV. Results PPV was therapeutic in 20 eyes (74.1%), whereas in 7 cases (25.9%), it was performed with vitreous sampling. Mean baseline BCVA was 1.37 ± 1.06 and improved to 0.63 ± 0.70 at final follow-up. A gain of ≥0.3 was achieved in 14 eyes (51.9%) at one month and 17 eyes (63.0%) at 6 months. At one month, 26 eyes (96.2%) had a clear vitreous cavity. CME was present in only 3 eyes (11%) at six months postoperatively. Conclusion In this sample, PPV demonstrated its utility for clarifying uncertain uveitis etiology, no deterioration, and, in some cases, improvement of visual acuity, and enabling adequate visualization for the evaluation and monitoring of CME.

To characterize the structural features and mechanical failure patterns of macular posterior vitreous detachment (PVD) using volume-rendered swept-source optical coherence tomography (OCT) and to analyze the forces governing cortical tearing versus vitreomacular separation. In this retrospective study, eyes with developing or recent macular PVD were imaged with swept-source OCT optimized for vitreous visualization by defocusing into the vitreous cavity. Volumetric datasets were processed and rendered three-dimensionally. Structural findings were analyzed descriptively and interpreted using vector-based mechanical modeling of cortical tensile forces and insertion geometry. Fifty-three eyes of 44 patients were imaged; 48 were evaluable. Circumferential tears of the posterior vitreous cortex were identified in 43 of 48 eyes (89.6%), including partial and complete tears. In a minority of eyes, detachment occurred without cortical rupture. The premacular bursa was preserved in partial tears and absent in complete tears. Measured insertion angles at the vitreomacular interface were shallow (<10°). Vector analysis demonstrated that at small insertion angles, the normal component of cortical tension is markedly attenuated (F⊥ = F sin θ), favoring cortical rupture at the insertion site over adhesive failure at the macula. Volume rendering demonstrated residual full-thickness cortical plaques adherent to the macular surface following tearing. Volume-rendered swept-source OCT demonstrates that macular PVD commonly involves circumferential cortical tearing. Mechanical analysis indicates that shallow insertion geometry favors cortical rupture as an initial failure mode, dissipating traction but leaving a residual cortical plaque that may contribute to subsequent epiretinal membrane formation.

The Foldable Capsular Vitreous Body (FCVB) is an implantable vitreous substitute designed to provide internal tamponade in eyes with complex vitreoretinal conditions. This protocol describes a standardized surgical procedure for FCVB implantation via a scleral incision, followed by silicone oil injection. The protocol outlines key preoperative considerations, including patient selection and device sizing, followed by detailed intraoperative steps, including capsule folding, insertion into the vitreous cavity, controlled silicone oil injection, device positioning, and scleral fixation. Postoperative management strategies, including patient positioning, medication regimens, and follow-up evaluation, are also described to support procedural reproducibility. This protocol is intended for adult patients aged 18 to 65 years, with no sex-related restrictions. Eligible subjects must have a best-corrected visual acuity of less than 0.05 in the treated eye, an ocular axial length ranging from 16 to 28 mm, and present with severe retinal detachment that cannot be effectively managed using currently available vitreous substitutes. Previous clinical studies have reported that FCVB implantation can reduce silicone oil-related complications, such as emulsification and secondary glaucoma, by physically isolating silicone oil from intraocular tissues. These reported outcomes provide the clinical rationale for the use of FCVB but are not generated by this protocol itself. By presenting a step-by-step surgical workflow and highlighting critical technical considerations, this protocol serves as an instructional guide for vitreoretinal surgeons seeking to perform FCVB implantation or adapt the technique to their own surgical settings.

Purpose: To analyze the risk of complications attributed to posteriorly dislocated intraocular lenses in the vitreous cavity. Methods: Retrospective cohort study of posteriorly dislocated intraocular lenses from January 2016 to April 2022. Charts were analyzed to determine complication rates and characteristics in eyes with posteriorly dislocated intraocular lenses located in the vitreous cavity (prior to or without ever undergoing repair). Results: A total of 345 eyes met inclusion criteria. The intraocular lens was dislocated for ≥90 days in 72 eyes, ≥180 days in 52 eyes, and ≥1 year in 42 eyes (mean follow-up duration, 244.8 days); 316 of 345 eyes (90.7%) had no complications. Most complications (90.6%) occurred within ≤60 days of dislocation. The total, major, and minor complication rates at any time point were 9.3%, 4.9%, and 4.4%, respectively. Seventeen major complications (7 rhegmatogenous retinal detachment, 5 retinal break, 4 vitreous hemorrhage, 1 pupillary block) and 15 minor complications (7 cystoid macular edema, 1 anterior uveitis, 6 elevated intraocular pressure >35 mm Hg, 1 vitreous plugging of glaucoma drainage implant) were attributed to the dislocated intraocular lens. There was no significant association between complication risk and cataract surgery timing, prior pars plana vitrectomy status, and intraocular lens type. Sixty-four eyes (18.6%) never underwent intraocular lens repair; none of these eyes developed complications. Conclusions: The rate of major complications with posteriorly dislocated intraocular lenses was low. Most complications occurred within 90 days of dislocation. In select patients with medical or ocular comorbidities in whom intraocular lens repair may neither be safe nor significantly improve vision, it may be reasonable to forego or delay surgical intervention, although close monitoring is advisable, especially in the first 2 months after intraocular lens dislocation.

Couching, an ancient technique of cataract management where cataractous lens is manually dislocated from its anatomical position into vitreous cavity. A 85-year-old female was referred complaining of diminished vision, redness and photophobia in both eyes for 2 weeks. A history of similar episodes in the past for which she used topical medication from local doctor. She underwent cataract surgery 25 years back, without intraocular lens implantation and has been using thick spectacles since then. Best-corrected visual acuity in both eyes was hand movements close to face. Bilateral circumcilliary congestion, diffuse corneal edema, anterior chamber reaction, iridodonesis, sluggish pupillary reaction and aphakia were noted. Intraocular pressures were raised. After medical treatment, bilateral cornea cleared. Fundus examination revealed vitritis and vitreous degeneration with optic atrophy in both eyes. B-scan revealed dislocated crystalline lens in the vitreous cavity inferiorly near the posterior pole. Due to the presence of optic atrophy, conservative management was done and inflammation was successfully controlled.

PURPOSE: To evaluate the baseline characteristics, intraoperative choices and outcomes of the surgical management of open globe injuries. SETTING: Longitudinal, monocentric, retrospective study, conducted at the University Hospitals of Geneva. METHODS: All cases of adults were included with an open globe injury, with or without an intraocular foreign body (IOFB), at a tertiary university centre and for the period between January 2013 and July 2023. The primary outcome was the eye status at the final follow-up visit (defined as the anatomical final outcome). Secondary outcomes included the final best-corrected visual acuity (BCVA), the number of surgical interventions required to stabilise the eyes and the adverse events (AEs). RESULTS: 37 eyes of 37 patients were included. The main type of penetrating injury was through a scleral wound (51.4%; n = 19), and the main cause of injury was occupational (46.0%; n = 17. Nine patients (n = 24.3%) presented an IOFB, 88.9% (n = 8) into the vitreous cavity and 11.1% (n = 1) into the anterior segment. Primary wound closure alone was performed in 81.1% of cases, while combined wound closure and pars plana vitrectomy was performed in 18.9%. Primary globe closure was successful in 91.9% of eyes. 21 eyes (56.8%) required a subsequent PPV after the first surgery (with success rate of 81.0%). Removal of most of IOFBs was performed during the first surgical intervention (66.7% vs. 33.3% during the second). Mean BCVA improved significantly during the follow-up (0.08 ± 0.20 decimals at baseline vs. 0.3 ± 0.41 decimals at the final follow-up; p < 0.05). The most frequent AE was rhegmatogenous RD, that was found in 54.1% (n = 20) of eyes at any time during the follow-up. One eye presented with exogenous endophthalmitis secondary to the open globe injury. Average follow-up time was 28.6 ± 32.8 months (range 12 - 96 months). CONCLUSIONS: In order to preserve the anatomical outcome, globe closure should be performed rapidly. Retinal detachment seems to be the most common complication and may occur months after the trauma. Good anatomical and functional results can be achieved, with appropriate surgical management, even in challenging cases.

Hyaluronic acid-based in situ injectable crosslinked hydrogels as next-generation vitreous substitutes: A review.

Postoperative Dynamics of Full-Thickness Macular Holes: Insights from High-Resolution OCT Under Gas Tamponade.

Recording electroretinograms (ERGs) in eyes with intraocular gas tamponade is difficult, and the mechanism remains unclear. We evaluated the effect of intraocular gas on ERGs by comparing recordings at different body positions. This study included 31 patients who underwent vitrectomy with sulfur hexafluoride (SF6) or air tamponade at Hirosaki University (between May 2023 and October 2024). The patients included those with retinal detachment (25 patients), macular holes (4 patients), and epiretinal membranes (2 patients). ERGs were recorded using skin electrodes when approximately 50% of the vitreous cavity was filled with the intraocular gas. ERGs were recorded in sitting, supine, and face-down positions. Amplitudes and latencies of the LA 3 b-wave and LA 30Hz were compared using the Wilcoxon signed-rank and Friedman tests. In the gas-filled eyes, amplitudes in the face-down position were smaller, and latencies were longer than those in the other positions (p < 0.05). Median amplitudes in the gas-filled eyes in the sitting, supine, and face-down positions were 20.4, 19.5, and 10.1µV for LA 3 and 14.4, 15.5, and 7.11 for LA 30Hz, respectively; median latencies were 32.5, 33.0, and 34.3ms for LA 3 and 30.8, 30.0, and 34.3 for LA 30Hz, respectively. ERG amplitudes were reduced and latencies were prolonged in the face-down position, which may be attributed to a larger retinal area being covered by intraocular gas. The gas acts as an insulator, and the gas-covered retina may not effectively generate or transmit electrical signals.

Vitreous exosomes and ocular regeneration: Emerging roles in intercellular communication, biomarkers, and therapeutic delivery.

Effect of conbercept combined with dexamethasone implantation on macular thickness, visual function, retinal perfusion, and inflammatory markers in patients with diabetic macular edema: A prospective controlled study.

Relevance. Secondary silicone-induced glaucoma (SIG) is one of the complications of prolonged tamponade of the vitreous cavity with silicone oil. Timely detection of early signs of silicone oil emulsification is a significant diagnostic tool for an ophthalmologist. Methods. This article represents a comparison of instrumental methods of patient’s examination aimed to identify signs of emulsification, reveals the strengths and weaknesses of various methods, formulates and illustrates signs indicating an active emulsification process in the eye, and analyzes the possible relationship between instrumental findings and clinical data. Results. Ultrasound biomicroscopy has become the most universal among instrumental examination Methods. Diagnostic capabilities of optical coherence tomography in the context of detecting a silicone oil emulsion are limited, applicable only to the posterior segment of the eye and only possible in conditions of transparent optical media. The most informative signs indicating a high risk of SIG are hyperechoicity of the structures of the ciliary apparatus (the flat part and its processes) and the angle of the anterior chamber (trabecular apparatus, Schlemm canal), as well as “ghost images”. Hyperoleon is sensitive, but probably a late sign of emulsification. When conducting research, the natural hyperechogenicity of the pigment leaf of the iris should be taken into account. Hyperechoic inclusions in the anterior chamber of the eye are not directly related to the risk of CIG, however, they indicate the emulsification process in general. Conclusion. Further investigation of methods for early detection of silicone oil emulsification will optimize patient management and reduce the incidence of secondary glaucoma.

The article presents a cases series of retinoprotective therapy (RPT) using the water-soluble retinal polypeptide fractions (RPF). The 1st case: the nonproliferative diabetic retinopathy (DR) and cystoid macular edema patient after the 1st year of anti-VEGF therapy and retinal laser coagulation (RLС), which resulted in foveal retinal edema relief, a decrease in its intensity in the paraand perifovea, an increase of the best-corrected visual acuity (BCVA) from 0.03 up to 0.2, and the perimetric indices deviations (MD -12.86 dB; PSD 7.99 dB) relative to normal values. Three courses of RPT were administrated during the 2nd year of anti-VEGF therapy. BCVA increase (up to 0.3), MD normalization (-1.65 dB) and PSD decrease (4.96 dB) were noted 1month after the 3rd course of RPT. The 2nd case: the proliferative DR patient after subtotal 25-G vitrectomy, endo-RLC and silicone oil (SO) tamponade. MD (-8.04 dB) and PSD (4.61 dB) deviations were recorded 1-month after surgery. BCVA stabilization (0.3), MD improvement (-5.43 dB), PSD stabilization (4.61 dB) were noted 1-month after RPT. The 3rd case: the patient with low BCVA (0.08), MD (-14.15 dB) and PSD (7.86 dB) deviations 1-month after vitreous cavity revision with perfluorocarbon (PF) tamponade, endo-RLC and PF replacement with SO due to recurrent retinal detachment after the indirect non-open glob blunt injury. BCVA improved (0.2), MD decreased (-9.38 dB), and PSD stabilized (7.54 dB) one month after RPT. All patients noted improved quality of vision after RPT. The presented clinical cases, as well as many years of experience with the effective and safe use of RPF in patients with retinal pathology, provide grounds for recommending RPT after RLC and vitrectomy in patients with DR and retinal detachment.

The relationship between lifestyle, ocular biomechanical behavior, and myopia is not well established in the literature. The present study aims to describe changes in ocular biomechanics during adolescence and to explore their relationship with lifestyle factors and myopic progression. Prospective cohort study including 63 adolescents (126 eyes) with a mean age of 14.1 ± 2.6 years old examined twice over a 30 ± 0.9-month period. The data from biomechanics, biometry, corneal tomography, and lifestyle was addressed. The relationships between biomechanical changes, biometric and refractive variation, and lifestyle variables were analyzed using parametric and non-parametric statistics with a significance level of p < 0.05. A biomechanical stiffening trend was found. Axial elongation was 0.12 ± 0.17 mm, and refractive shift was -0.32 ± 0.87 D. The history of allergies was associated with greater axial growth (p = 0.032) and smaller increase in stress-strain-index (SSI) (p = 0.01). Myopization was higher in eyes with ocular surface symptoms (p = 0.049) and those with reported eye-rubbing habits (p = 0.04), with a lower gain in stiffness (p < 0.05). Outdoor activities were associated with higher gain in corneo-scleral stiffness (p < 0.05). Reduced myopization correlated directly with the increase in the SSI (p < 0.05) and inversely with the Integrated Radius (p < 0.05). Greater increases in axial length (AL), vitreous cavity length (VCL), and the ratio between VCL and AL (R_VCL/AL) correlated negatively with the increase in the SSI (p < 0.05). The increase in the R_VCL/AL correlated positively with the time spent on digital devices and negatively with the amount of outdoor activity (p < 0.05). Biomechanics may represent the physiological bridge between the environmental exposure and myopization, as lower gain in corneo-scleral stiffness was consistently associated with greater axial elongation and refractive myopization, with outdoor activity appearing to be protective.

Rhegmatogenous retinal detachment (RRD) is a potentially blinding condition that affects ~ 1 in 10,000 adults per year. Retinal detachment surgery usually involves internal reapposition of the retina using the injection of a gas tamponade into the vitreous cavity. However, this has downsides including delayed visual recovery, the need to posture postoperatively, limiting fundal view during postoperative monitoring, and the risk of raised intraocular pressure. We examine a novel surgical variation, using a temporary suprachoroidal viscobuckle (SCVB) instead of gas. SCVB involves the controlled injection of high viscosity viscoelastic through an external scleral incision into the suprachoroidal space to create an indent under a causative retinal break. The sodium hyaluronate viscoelastic is resorbed over 2-3 weeks, long enough for intraoperative laser retinopexy to cause chorioretinal adhesion. The primary objective of this study is to establish if it is feasible to recruit, retain, and evaluate patients with RRD into a larger randomised controlled trial of SCVB. Secondary objectives are to make a preliminary assessment of safety and efficacy. This multicentre, randomised, controlled, two-group, unmasked feasibility trial recruits participants with primary RRD and a break or breaks within 1 clock hour. The CE-marked sodium hyaluronate viscobuckle is created during otherwise standard pars plana vitrectomy RRD surgery. Feasibility outcomes include screen failure rate, rate of recruitment, protocol compliance, and participant retention. The main efficacy outcome is retinal attachment with no intravitreal tamponade present and no subretinal fluid which could spread, without the need for further surgery, at week 12. The key secondary efficacy outcome is Early Treatment of Diabetic Retinopathy Study best-corrected visual acuity at week 24. Safety is recorded through adverse events and serious adverse events. SCVB has multiple potential advantages for patients. This study will help determine if a definitive study of SCVB is justified and deliverable and inform its design. ClinicalTrials.gov Identifier: NCT04557527, registered 09 September 2020.

To describe a novel technique for the levitation of intraocular foreign bodies (IOFBs) embedded in the vitreous cavity or resting on the surface of the retina. Our novel technique was used on one patient with a metallic IOFB embedded in the vitreous cavity of the left eye following a penetrating injury to that eye. The technique revolves around using the nitinol wire of the Finesse loop® to levitate the IOFB from the vitreous cavity instead of the usual instruments used for that purpose such as External electromagnets (EEM), forceps, rare earth intraocular magnets (IOM). The Patient was followed up for 6 months with routine ophthalmic examinations including dilated fundus examination and fundus imaging. 6 months follow-up of the patient showed stable surgical outcomes with no adverse events related to the used technique. The novel technique for IOFB levitation using the nitinol wire of the Finesse loop® is promising as an easy-to-perform, minimally traumatic alternative to the available techniques especially in cases where magnets cannot be used (eg. Non-metallic IOFBs). Larger samples and longer follow-ups are required to confirm the outcomes of this technique.

Background/Objectives: To investigate the incidence and risk factors for postoperative hyphema following Baerveldt glaucoma implant (BGI) surgery. Methods: This retrospective study included Japanese patients who underwent BGI surgery at Fukui University Hospital between 1 April 2012 and 31 March 2025. Hyphema was defined as any clinically detectable blood in the anterior chamber. Baseline demographic, ocular, and surgical variables were compared between eyes with and without hyphema. Independent risk factors for hyphema were determined using multivariable logistic regression analysis. Results: Of 273 eyes, 77 (28.2%) developed postoperative hyphema. On multivariable analysis, tube insertion site and intraocular pressure (IOP) on postoperative day 1 were identified as independent predictors. Although the overall effect of tube insertion site was borderline (p = 0.074), anterior chamber (odds ratio [OR], 2.83; p = 0.036) and ciliary sulcus insertion (OR, 2.88; p = 0.031) were associated with significantly higher risk of hyphema compared with vitreous cavity insertion. Lower postoperative day 1 IOP was also a significant predictor (p < 0.01). Patient-related factors, including age, diabetes mellitus, hypertension, antithrombotic therapy, neovascular glaucoma (NVG), combined surgery, number of previous intraocular surgeries, and preoperative IOP, were not independently associated with hyphema. In a sensitivity analysis excluding NVG eyes (n = 191), vitreous cavity insertion remained protective, and postoperative day 1 IOP remained an independent predictor. Conclusions: Postoperative hyphema following BGI surgery is primarily determined by surgical factors and early postoperative IOP. Vitreous cavity tube insertion is associated with a markedly lower hyphema risk than anterior chamber or ciliary sulcus insertion.