British Journal of Ophthalmology

Purpose:To improve determination of the treatment area for the personalization of subliminal transscleral cyclophotocoagulation (SL-TSCPC) procedures in glaucoma treatment, we designed a biometry based model of the human eye to find the estimated cilary body (CB) arc length (ECBAL) and the calculated CB distance (CCBD). Methods: We developed a rotationally symmetric modified two-sphere eye model based on axial length (AL), mean keratometry (mean K), anterior chamber depth (ACD), lens thickness (LT), and white-to-white (WTW). ECBAL and CCBD were calculated for each eye. Fluence was calculated with standardized parameters. Results: Publicly accessible biometric measurements for 24,001 eyes were pooled for analysis. The mean ECBAL was 23.99+-1.8 mm. The correlations of ECBAL with AL and ACD were 0.723 and 0.754 respectively (p < 0.01). The number of eyes with an ECBAL 21.7-22.0 mm was 131 of 24,001 (0.55%). The mean CCBD was 4.21+-0.8 mm. The number of eyes with a CCBD of 3.8 mm was 1,445 of 24,001 (6.02%). Mean fluence was 120.33+-9.0 J/cm2. A mean difference of -8.18+-6.9%, ranging from -22.66% to +29.07% in fluence was observed with treating only the recommended 22 mm versus the ECBAL. Conclusions: This study demonstrated that use of 22.0 mm as the standard treatment arc length may under or overdose laser treatment in many eyes. Precise estimation or exact localization of the CB treatment area is required to accurately calculate fluence. Translational Relevance:The model proves that CB arc length is a variable while current guidelines consider it a constant

PurposeTo compare the efficacy of Ex-PRESS implantation to trabeculectomy with mitomycin C, for maintaining low target intraocular pressure (IOP) in patients with open angle glaucoma. Materials and MethodsPatients were randomly assigned to receive Ex-PRESS implantation or trabeculectomy. Patients with IOP [&ge;] 15 mmHg were included in this study. Surgical success was defined according to three target mean IOP ranges (5 mmHg [&le;] IOP [&le;]18 mmHg [criterion A], 5 mmHg [&le;] IOP [&le;]15 mmHg [criterion B], and 5 mmHg [&le;] IOP [&le;]12 mmHg [criterion C]) representing reductions of at least 20% below baseline on two consecutive follow-up visits 3 months post surgery. ResultsA total of 73 patients, including 30 in the Ex-PRESS implantation group and 43 in the trabeculectomy group, were included in the study. The baseline IOP was 20.4 {+/-} 4.9 mmHg in the Ex-PRESS implantation group and 21.9 {+/-} 7.9 mmHg in the trabeculectomy group. There were no significant differences in baseline ocular or demographic characteristics between the two groups. There was no statistical difference in IOP every 6 months. After the 3-year follow-up, success rates were A) 60.0% and 60.2%, B) 45.7% and 58.1%, and C) 31.5% and 40.5% for the Ex-PRESS implantation and trabeculectomy groups, respectively. A greater number of glaucoma medications before surgery was associated with a higher failure rate in the trabeculectomy group but not the Ex-PRESS implantation group. ConclusionsBoth procedures resulted in similar IOP reductions and success rates for low target IOP. The number of preoperative glaucoma medications was a risk factor for trabeculectomy failure.

PurposeTo demonstrate that the total loss of astigmatism as a consequence of misalignment or rotation of a toric intraocular lens (tIOL) can occur much earlier than the widely believed and taught 30 degrees. To give a precise surgically useful estimate of that value. To clarify the role of mismatch and misalignment of toric intraocular lenses in cataract surgery beyond what is commonly recognized in the literature and make corresponding surgical recommendations. SettingPrivate Practice and Research Center. The EYE Center. Champaign, IL, USA. DesignFormal Analytical Study MethodsThe astigmatism addition approach is used in its simplest form along with analytical tools to derive new results concerning mismatch, misalignment and rotation of toric intraocular lenses. ResultsThe often stated results of total loss of astigmatic correction by 30-degree rotation and 3.3 % loss per degree represent a usually poor approximation to realistic surgical cases. We show how they constitute a very special case in the context of a more general framework relevant to procedures performed by refractive cataract surgeons dealing with the surgical correction of astigmatism with tIOLs. Total loss of astigmatic correction can occur with as little as 20 degrees of misalignment and less than 10 degrees of tIOL rotation. A practical approximation for that angle of doom, {Delta}, in the surgically relevant range can be expressed by{Delta} {approx} 30 - 15{omega} degrees, where [Formula] is the fractional overcorrection of L, the cylinder of the tIOL, and A, the astigmatism to be corrected. Similarly for undercorrection we show that{Delta} {approx} 30 + 15 u degrees where [Formula] represents the corresponding fractional undercorrection. That is to say the angle of doom is extended beyond the 30 degrees for cases of undercorrection of the astigmatism. We also demonstrate that overcorrection of astigmatism results in a significantly faster decline in astigmatism correction per degree of misalignment/rotation. The significant clinical implications and surgical recommendations, including for optimal degree of overcorrection, are a natural consequence of these novel results. ConclusionsTotal loss of astigmatism correction can occur at a significantly smaller angle than commonly believed and overcorrected astigmatism residual rises with tIOL misalignment or rotation significantly faster than undercorrected astigmatism. We provide the methodology and explicit solution for determining this behavior.

Background/aimsTo compare the efficacy of the Centrion handpiece anti-surge system (Active Sentry(R)) and main body according to the grade of nucleosclerosis. Methods600 eyes of 415 patients who underwent cataract surgery was retrospectively enrolled. Intraoperative parameters included phacoemulsification time (seconds), cumulative dissipated energy (CDE), and balanced salt solution (BSS) use (ml). Clinical measurements were made preoperatively and at one day, one month, two, and three months postoperatively, including the best corrected visual acuity (BCVA), and the corneal endothelial cell (CEC) count in the handpiece group (N=300) and main body group (N=300). Within the anti-surge group, the number of anti-surge system activated was collected. ResultsAnti-surge (times), phacoemulsification time, CDE, and BSS use significantly increased with increasing nucleosclerosis grades and in zonule weakness, poor mydriasis, and pseudoexfoliation syndrome in handpiece group, respectively (p < 0.05). Phacoemulsification time, CDE, and BSS use of handpiece group were significantly lower than those of main body group (p < 0.05). Phacoemulsification time, CDE, and CEC loss of handpiece group were significantly lower than those of main body group in nucleosclerosis grade 5 and 6 (p < 0.05). BSS uses of handpiece group were significantly lower than those of main body group in all nucleosclerosis grade (p < 0.05). ConclusionBecause of the fast-reacting anti-surge, Intraoperative parameters were saved in handpiece anti-surge system rather than in main body. Therefore, the anti-surge system in the Centrion handpiece helps the surgeon perform safer cataract surgery in higher nucleosclerosis grade, zonule weakness, poor mydriasis, and pseudoexfoliation syndrome. SynopsisAnti-surge system in the Centrion handpiece helps the surgeon perform safer cataract surgery in higher nucleosclerosis grade, zonule weakness, poor mydriasis, and pseudoexfoliation syndrome. WHAT IS ALREADY KNOWN ON THIS TOPICActive Sentry handpiece was reported to be as safe and efficacious as the Ozil handpiece, with the benefit of operating at lower intraocular pressure levels WHAT THIS STUDY ADDSAnti-surge system in the Centrion handpiece helps the surgeon perform safer cataract surgery in higher nucleosclerosis grade, zonule weakness, poor mydriasis, and pseudoexfoliation syndrome. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYWith anti-surge system in the Centrion handpiece, phacoemulsification can be performed effectively and safely in patients with complicated cataract.

PurposeTo evaluate long-term clinical and patient-reported outcomes (PROMs) following the implantation of an enhanced monofocal intraocular lens (IOL). MethodsThis ambispective non-comparative single-centre study involved 41 patients (ages 48-84) who underwent bilateral cataract surgery with the Tecnis Eyhance IOL (model ICB00, Johnson & Johnson Vision). Distance and intermediate visual acuities, refraction, and PROMs were assessed 18 months or more after surgery. Spectacle independence was evaluated using the PRSIQ questionnaire, with patients self-reporting on visual quality, difficulties in performing specific tasks and perception of photic phenomena at distance and intermediate vision. ResultsAt 18 months or later, 100.0%, 73.2%, 100% and 79.5% of patients achieved a binocular uncorrected distance, uncorrected intermediate, corrected distance, and distance-corrected intermediate visual acuity of 0.20 logMAR or better, respectively. Less than 10% of patients reported photic phenomena. Mean visual quality scores were 1.68{+/-}0.72 for distance and 2.05{+/-}0.92 for intermediate vision (1=very good to 6=very poor). The dashboard was clearly visible while driving for 95.1% of patients, while 45.0% could perform screen work without glasses; an additional 40.0% could do so with enlarged fonts. Complete spectacle independence was reported by 87.8% for distance vision, and 53.7% for intermediate vision. At least moderately satisfied were 90.2% with distance vision, 87.8% with intermediate vision, and 51.2% with near vision. ConclusionsThe enhanced monofocal IOL ICB00 provides good long-term distance and intermediate visual quality, leading to considerable spectacle independence and patient satisfaction. Most patients required near vision correction.

PurposeTo identify the ocular biometric parameters associated with refractive outcomes in Chinese Primary angle closure glaucoma (PACG) patients receiving phacoemulsification and intraocular lens (IOL) implantation (PEI) surgery. Methods165 Chinese PACG patients receiving PEI and goniosynechialysis (GSL) and 53 cataract patients as controls only receiving PEI surgery were recruited. The prediction accuracy of IOL power calculation was assessed by the prediction error (PE), mean absolute error (MAE), median absolute error (MedAE), and proportions of eyes with a PE within {+/-} 0.25 diopters (D), {+/-} 0.50 D, {+/-} 0.75 D, and {+/-} 1.00 D. The association of different ocular biometric parameters with the PE of IOL calculation were evaluated. ResultsThe PACG patients had significantly higher absolute of PE as compared to the control subjects, especially the acute PACG patients. The axial length (AL), changes in aqueous depth pre- and post-surgery ({bigtriangleup}AD), and the ratio of {bigtriangleup}AD/AL were significantly associated with the PE in acute PACG patients. The association of {bigtriangleup}AD with the PE of IOL power calculation was found in PACG patients with AL [&ge;] 22 mm. ConclusionsThis study revealed the association of AL and {bigtriangleup}AD with the PE of IOL calculation in Chinese PACG patients. Precisely predict the {bigtriangleup}AD is necessary for acute PACG patients, especially for those with AL [&ge;] 22 mm, to improve the refractive outcomes.

BackgroundThis systematic review and meta-analysis aim to evaluate the efficacy and safety of the PAUL(R) Glaucoma Implant in reducing intraocular pressure and number of anti-glaucoma medication use in both adult and paediatric populations. MethodsA systematic review was conducted following the PRISMA guidelines. The databases PubMed, Ovid-Embase and Scopus were searched to include studies published between January 2017 and September 2025. Studies were stratified by age and risk of bias was assessed using the Newcastle-Ottawa Scale for observational studies and ROBUST-RCT for randomized trials. Primary outcomes were intraocular pressures and number of glaucoma medications at each follow-up visits. Random effects meta-analyses were performed. Secondary outcome was complications. ResultsTwenty-four studies (twenty adults, four paediatric) comprising 836 eyes were included in our review and meta-analysis. Both adult and paediatric patients showed significant IOP reduction post-surgery, with a mean difference of 17.48 mmHg (95% CI: 14.59, 20.37) and 20.31 mmHg (95% CI: 7.80, 32.82) at 1 week, respectively, and sustained reductions at 12 months. The reduction in glaucoma medications was 79.2% for adults and 71.4% for children at 12 months. Subgroup analyses demonstrated greater IOP reduction in studies conducted in the Middle East. The uses of Mitomycin C did not significantly affect outcomes. ConclusionThe PAUL(R) glaucoma implant showed significant and sustained IOP reductions with reduced need for glaucoma medications. The PAUL(R) glaucoma implant is a promising surgical option for glaucoma management in both adults and children. Further long-term prospective comparative studies are needed to assess long-term efficacies and allow direct comparisons with other glaucoma drainage devices.

Purpose: To evaluate the impact of ''not commonly considered risk factors '' on glaucoma surgical outcomes. Methods: This study included 339 eyes that underwent glaucoma surgery. Surgical procedures included microhook ab-interno trabeculotomy (TLO), Preserflo ab-externo microshunt implantation, trabeculectomy (Trab), and Ahmed Glaucoma Valve (AGV) implantation. In addition to conventional background factors, we examined a set of ''not commonly considered risk factors, '' including very elderly age ([&ge;]85 years), avitreous status, aphakia, use of antithrombotic agents, difficulty attending frequent postoperative visits, small palpebral fissure, corneal endothelial dysfunction, poor vision in the fellow eye, dementia, hearing loss, mental illness, atopic dermatitis, pseudophacodonesis, glaucoma eye drop allergy, and conditions contraindicating {beta}-blocker use. Surgical success was defined as intraocular pressure (IOP) [&le;]21 mmHg, [&ge;]20% reduction from baseline, and no additional glaucoma surgery at 1 year. Logistic regression was performed to identify potential risk factors; significant factors were further evaluated using propensity score matching. Results: Of the 339 cases, surgical success rates were 65% for TLO, 82% for Preserflo, 91% for Trab, and 82% for AGV. Multivariate logistic regression identified two independent predictors of surgical failure: small palpebral fissure (odds ratio 2.52, p < 0.01) and hearing loss (odds ratio 3.94, p = 0.04). Propensity score matching of patients with small versus large palpebral fissures (111 per group) confirmed significantly worse postoperative outcomes in the small-palpebral-fissure group despite balanced baseline characteristics. Conclusion: Small palpebral fissure is an independent and previously unnoticed risk factor for glaucoma surgical failure, affecting both minimally invasive and filtration procedures.

PurposeTo examine the influence of patient demographic characteristics and ophthalmic practice composition on access to cataract surgery in the United States as measured by preoperative best-corrected visual acuity (BCVA). Patient and methodsThis retrospective cohort study analyzed data from the IRIS(R) Registry (Intelligent Research in Sight) for patients age > 50 who had at least one BCVA measurement in the six months preceding cataract surgery performed between January 1, 2016, and December 31, 2020. We used a mixed-effects model to estimate the relationship between individual-level demographic factors and practice-level composition factors and preoperative BCVA. Results2,387,045 individuals met inclusion criteria. The mean BCVA prior to surgery was 0.23 (SD: 0.32) logMAR. The worst pre-operative BCVA was observed in patients with Hispanic race and ethnicity while White patients had the best [0.34 (SD: 0.43), 0.21(SD: 0.30); p<0.001]. Grouping patients in terms of percentage of BCVA worse than 20/50 prior to surgery, Hispanic patients, active smokers, and uninsured patients had higher percentages of worse preoperative vision (33.7%, 23.5%, 34.9%). Analysis of compositional effects of race and ethnicity, smoking and insurance status showed that, regardless of an individual patients demographic, patients treated at practices serving higher proportions of White patients showed better BCVA (b = -.008 per 10 percentage points, P < .001) while patients at practices with higher percentages of actively smoking patients showed worse BCVA (b=-0.016 per 10 percentage points active smoking patients, P < .001). There was no compositional effect of insurance status. Conclusions and RelevanceOverall differences exist with regard to the visual acuity at which cataract surgery is initiated at both the level of the individual patient and the composition of practice in which they are treated. Plain Language SummaryDemographic disparities and geographic variation in access to cataract surgery in the United States have been previously described in large national studies of insurance data. Smaller studies of single institutions expanded upon these studies by showing differences in preoperative visual acuity- an important measure of access to cataract surgery- based on factors such as race and insurance status but were limited by the size and scope of their study patients. The IRIS(R) Registry (Intelligent Research in Sight) is the nations first comprehensive ophthalmic clinical registry with data from both individual patients as well as ophthalmic group practices. Using data from this registry, we show differences in preoperative visual acuity prior to cataract surgery at both the level of the patient and the practice in which they are treated.

BackgroundArtificial intelligence (AI) shows promise in ophthalmology, but its potential on tertiary care settings in Latin America remains understudied. We evaluated a Mexican AI-powered screening tool, against first-year ophthalmology residents in a tertiary care setting in Mexico City. MethodsWe analysed 435 adult patients undergoing their first ophthalmic evaluation. AI and residents assessments were compared against expert annotations for retinal disease, cup-to-disk ratio (CDR) measurements, and glaucoma suspect classification. We also evaluated a synergistic approach combining AI and resident assessments. ResultsFor glaucoma suspect classification, AI outperformed residents in accuracy (88.6% vs 82.9%, p = 0.016), sensitivity (63.0% vs 50.0%, p = 0.116), and specificity (94.5% vs 90.5%, p = 0.062). The synergistic approach deemed a higher sensitivity (80.4%) than ophthalmic residents alone or AI alone (p < 0.001). AIs CDR estimates showed lower mean absolute error (0.056 vs 0.105, p < 0.001) and higher correlation with expert measurements (r = 0.728 vs r = 0.538). In retinal disease assessment, AI demonstrated higher sensitivity (90.1% vs 63.0% for medium/high-risk, p < 0.001) and specificity (95.8% vs 90.4%, p < 0.001). Furthermore, differences between AI and residents were statistically significant across all metrics. The synergistic approach achieved the highest sensitivity for retinal disease (92.6% for medium/high-risk, 100% for high-risk). ConclusionAI outperforms first-year residents in key ophthalmic assessments. The synergistic use of AI and resident assessments shows potential for optimizing diagnostic accuracy, highlighting the value of AI as a supportive tool in ophthalmic practice, especially for early-career clinicians.

ObjectiveTo perform a systematic review and meta-analysis of the clinical evidence of the treatment effect of surgical cyclodialysis in the management of intraocular (IOP) in patients with glaucoma. MethodsA comprehensive literature review was conducted of peer-reviewed interventional studies from the PubMed, Cochrane, Web of Science and EMBASE databases of surgical cyclodialysis treatment for the lowering of intraocular pressure in patients with glaucoma. Key outcome measures of treatment success were long-term IOP control, as well as IOP-lowering medication burden and the incidence of intraoperative and postoperative adverse events. The meta-analysis was registered with Prospero ID CRD42025632759 ResultsA total of 40 studies spanning a publication period of more than 100 years of surgical cyclodialysis treatment encompassing data from over 4,082 eyes were included in the analysis. Clinical evidence comprised observational, non-randomized studies, 75% of which involved an ab-externo approach and 25% comprised an ab-interno cyclodialysis intervention. Given the natural evolution of the clinical paradigm over the years, changes in surgical technique, instrumentation and addressable population, the overall analysis was constructed to account for the significant variability in outcomes reporting. Across the final evaluable dataset, the clinical performance of cyclodialysis surgery was characterized by overall qualified success rates of 72.3% on average (range 33%-97%) over a postoperative follow-up period ranging from 6 to 132 months. Depending on surgical technique and disease severity, reported success rates indicate slightly increased efficacy and lower rate of complications with ab-interno intervention. Durability of the cyclodialysis procedure varied significantly, with higher rates of failure in patients with advanced and refractory glaucoma. Specific complications such as persistent hyphema, hypotony and vision loss were reported infrequently. All outcomes, including IOP reduction, ocular safety, and durability, showed significant improvement with the newer interventional ab-interno surgical techniques. ConclusionCyclodialysis remains an enduring surgical intervention and one of the few available surgical options for uveoscleral outflow enhancement in glaucoma patients. The IOP lowering effect of the procedure can be significant, albeit variable, with better clinical performance in mild and moderate glaucoma and with advanced interventional ab-interno surgical approaches. SynopsisResults of a meta-analysis comprising more than 4,000 glaucoma cases of cyclodialysis surgery for the lowering of intraocular pressure demonstrate significant and sustained efficacy of one of the few surgical interventions for uveoscleral outflow enhancement.

PurposeTo compare the accuracy of 9 intraocular lens (IOL) power calculation formulas (SRK/T, Hoffer Q, Holladay 1, Haigis, Barrett Universal II, Kane, EVO 2.0, Ladas Super formula and Hill-RBF 3.0) using partial coherence interferometry (PCI). MethodsData from patients having uncomplicated cataract surgery with the insertion of 1 of 3 IOL types were included. All preoperative biometric measurements were performed using PCI. Prediction errors (PE) were deduced from refractive outcomes evaluated 3 months after surgery. The mean prediction error (ME), mean absolute prediction error (MAE), median absolute prediction error (MedAE), and standard deviation of prediction error (SD) were calculated, as well as the percentage of eyes with a PE within {+/-}0.25, {+/-}0.50, {+/-}0.75 and {+/-}1.00D for each formula. ResultsIncluded in the study were 126 eyes of 126 patients. Kane achieved the lowest MAE and SD across the entire sample as well as the highest percentage of PE within {+/-}0.50D, and was proven to be more accurate than Haigis and Hoffer Q (P <.001). For an axial length of more than 26.0 mm, EVO 2.0 and Barrett obtained the lowest MAEs, with EVO 2.0 and Kane showing a higher percentage of prediction at {+/-}0.50D compared to old generation formulas except for SRK/T (P =.04). ConclusionAll investigated formulas achieved good results; there was a tendency towards better outcomes with new generation formulas, especially in atypical eyes.

PurposeTo evaluate the three-year efficacy and safety of compound trabeculectomy for uveitic glaucoma (UG). MethodsThis retrospective study enrolled 51 patients (53 eyes) requiring compound trabeculectomy, divided into UG (25 eyes) and non-UG groups (28 eyes). Outcomes including intraocular pressure (IOP), medication use, surgical success rates, and complications were analyzed over 3 years. ResultsBaseline characteristics including age, sex, preoperative IOP and medication use were comparable (all P>0.05). At 36 months, postoperative IOP was showed no significant differences, which was 15.4{+/-}8.4 mmHg and 14.6{+/-}3.3 mmHg (P=0.73) with 54% and 55% reduction (P=0.88) in UG and non-UG groups respectively. The qualified success rate was 76.0% and 85.7% at 36 months in UG and non-UG group, and Kaplan-Meier analysis showed no significant difference. Medication reduction of UG group was significant lower than non-UG group (P=0.0058). Comparable complication rates were observed between groups (all P>0.05), yet bleb scarring and cataract progression showed elevated incidence in both cohort. ConclusionCompound trabeculectomy effectively reduced IOP and medications use in UG and non-UG. There was no significant difference in both qualified and completed success rate between UG and non-UG. Complications of filtering bleb fibrosis and cataract progression should be pay close attention for both groups.

ImportancePharmacologic dilation is vital for eye disease screening but is often avoided due to concerns about triggering acute angle closure (AAC), a sight-threatening ophthalmic emergency. ObjectiveTo assess AAC incidence after dilation and validate the use of International Classification of Diseases (ICD) codes for identifying AAC cases. DesignRetrospective cohort study SettingPrimary care-based teleretinal diabetic retinopathy screening (TDRS) program ParticipantsEligible participants were Los Angeles County (LAC) Department of Health Services (DHS) patients who underwent teleretinal screening by dilated fundus photography between August 23, 2013, and March 1, 2024. Potential AAC cases were identified using ICD codes for angle closure, including acute angle closure glaucoma (AACG), primary angle closure glaucoma (PACG), and anatomical narrow angle (ANA), within three months of dilation. All urgent care, emergency department, and eye clinic encounters within the next calendar day after TDRS and encounters with Current Procedural Terminology (CPT) codes for iridectomy/iridotomy or lens extraction within 14 calendar days of TDRS were also identified. Manual chart review was conducted to verify AAC cases and extract clinical information. ExposuresDilation with 1.0% or 0.5% tropicamide. Main Outcomes and MeasuresCumulative incidence of AAC after dilation. Results84,008 patients received 168,796 dilations with a mean of 2.01 {+/-} 1.50 (mean {+/-} standard deviation) dilations per patient. 55.1% were female. Mean age was 55.4 {+/-} 10.7 (mean {+/-} standard deviation) years. The cohort was 67.7% Hispanic, 8.2% Black, 6.3% Asian, 4.1% White, and 2.4% Other. Manual chart review confirmed four AAC cases after dilation: 3 coded as AACG and 1 as ANA. The AAC risk was 2.4 (95% CI 0.05-4.69) per 100,000 dilations (0.0024%) or 4.8 (95% CI 0.10-9.43) per 100,000 patients (0.0048%). All four cases were female, had narrow angles in the non-presenting eye on gonioscopy, and presented within one day with AAC symptoms, including eye pain and blurry vision. Conclusions and RelevanceAAC risk was less than 1 in 40,000 per dilation in a high-volume TDRS program serving a diverse, safety net population, supporting the overall safety of dilation in this setting. Further discussion about AAC risk as a contraindication to dilation is warranted.

PurposeTo analyze the anatomic and functional outcomes of lamellar macular hole (LMH) surgery. Patients and methodsThis is a retrospective interventional cohort study of ninety patients with unilateral idiopathic LMH who underwent pars plana vitrectomy (PPV) with membrane peeling for LMH between 2014 and 2021. We evaluated the anatomic and functional success of PPV with membrane peeling for treating LMH, compared surgical outcomes between the two LMH subtypes ("true" LMH and epiretinal foveoschisis (ERMF)), and identified predictive factors for anatomical and functional success. Primary outcomes included final postoperative best-corrected visual acuity (BCVA) and LMH closure. Variables associated with final BCVA were assessed using a multiple linear regression model. Results51 subjects presented with ERMF, while 39 presented with "true" LMH. LMH closure occurred in 80 cases. "True" LMH cases had a lower rate of closure ("true" LMH closure rate: 76.9%, vs. ERMF closure rate: 94.2%, p=0.005) and were more at risk of developing a postoperative macular hole (p=0.008). A significant difference was observed between median [Q1, Q3] preoperative BCVA (0.42 [0.26, 0.61]) and final BCVA (0.31 [0.14, 0.48], p=0.024). "True" LMH without epiretinal proliferation ({beta}=0.194, p=0.040) was associated with worse final BCVA in multivariate analysis. ConclusionResults support the effectiveness of PPV as a treatment for LMH. "True" LMHs had worse anatomic outcomes than ERMFs.

IntroductionAnti-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(R)) in routine clinical practice. MethodsElectronic 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 [&ge;]84 days of follow-up. The index date was the first documented aflibercept-ayyh injection. Postindex data were used to assess treatment patterns, BRVA (Wilcoxon signed rank test), and adverse events of special interest (AESIs). ResultsA total of 1,000 consecutive eyes from 989 patients received 3,730 injections of aflibercept-ayyh; most (91%) switched from prior anti-VEGF therapy and 9% were anti-VEGF treatment-naive. 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 6.0 months (4.6-7.1). Median (IQR) number of aflibercept-ayyh injections per eye was 4 (3-5). Among eyes with [&ge;]84 days of follow-up (n=889), mean BRVA expressed as logarithm of minimum angle of resolution (logMAR) remained stable for switchers (0.4 to 0.4; P=0.96) and improved from baseline in anti-VEGF-naive eyes (0.5 to 0.4; 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. ConclusionIn this descriptive real-world analysis, aflibercept-ayyh was associated with stable visual acuity in previously treated eyes and vision improvement in treatment-naive eyes, with no new or unexpected safety findings, consistent with expectations for aflibercept. These findings add real-world experience to preexisting evidence demonstrating no clinically meaningful differences between aflibercept-ayyh (PAVBLU(R)) and reference aflibercept (EYLEA(R)). KEY SUMMARY POINTSO_ST_ABSWhy carry out this study?C_ST_ABSO_LIThe anti-vascular endothelial growth factor (VEGF) drug aflibercept, approved in 2011 and marketed in the United States as EYLEA(R),* has demonstrated efficacy in treating retinal diseases such as neovascular age-related macular degeneration (nAMD), diabetic retinopathy (DR), diabetic macular edema (DME), or retinal vein occlusion (RVO) and is a standard of care for these disorders. C_LIO_LIAflibercept-ayyh is a biosimilar to aflibercept that has demonstrated comparable efficacy and safety in the treatment of nAMD in a randomized controlled clinical trial. C_LIO_LIThis study describes the real-world use patterns, vision outcomes, and safety of aflibercept-ayyh in clinical settings in the United States for the treatment of nAMD, DR, DME, and RVO. C_LI What was learned from the study?O_LIIn this real-world study of 1,000 consecutive eyes treated with the biosimilar aflibercept-ayyh in patients with retinal diseases, we observed no new safety concerns and that aflibercept-ayyh maintained visual acuity in eyes switching anti-VEGF agents and improved vision in anti-VEGF-naive eyes, consistent with expected responses to aflibercept. C_LIO_LIThese findings support aflibercept-ayyh as a suitable treatment option when anti-VEGF therapy is indicated. *EYLEA(R) is a registered trademark of Regeneron Pharmaceuticals, Inc. PAVBLU(R) is a registered trademark of Amgen Inc. C_LI

BackgroundAchieving precise postoperative refractive outcomes remains a significant challenge in cataract surgery. While advanced intraocular lens (IOL) power calculation formulas exist, they are constrained by their singular algorithmic structures. This study investigated whether a stacking ensemble machine learning approach could overcome these limitations. MethodsA dataset of 1,710 eyes from patients who underwent cataract surgery with monofocal IOL implantation (Vivinex or SA60AT) was utilized. Following rigorous preprocessing and feature engineering, a stacking ensemble architecture was developed comprising three diverse base learners (Multi-Layer Perceptron, Support Vector Regressor with RBF kernel, and SplineTransformer with Linear Regression) and a Ridge Regressor meta-learner. The model was trained on 80% of the data using 5-fold cross-validation and evaluated on an independent 20% test set (n=341). Performance was compared against six standard IOL formulas. ResultsThe stacking ensemble model demonstrated excellent predictive accuracy, achieving a Mean Absolute Error (MAE) of 0.272 D on the independent test set (n=341). The model achieved lower MAE compared to all six standard IOL formulas, including Kane (MAE 0.295 D) and Barrett Universal II (MAE 0.318 D). Clinically, 85.1% of eyes achieved predictions within {+/-}0.50 D, compared to 82.5% for Kane formula and 81.8% for Barrett Universal II. ConclusionThe stacking ensemble machine learning model significantly enhances postoperative refraction prediction accuracy compared to established IOL calculation formulas. By leveraging algorithmic diversity and data-driven learning, this approach represents a promising advancement toward reducing refractive surprises and improving patient satisfaction in cataract surgery. External validation on independent datasets is required to confirm generalizability.

Background/AimsInvestigate the role of language barriers in cataract surgery outcomes at a county hospital. MethodsRetrospective chart review of patients who underwent cataract surgery March 2018-February 2019 at Lyndon B. Johnson Hospital. Patients who underwent cataract surgery combined with another procedure or had severe glaucoma or proliferative diabetic retinopathy were excluded. Patients were classified into limited English proficient (LEP) or English proficient (non-LEP) groups based on language preferences. Demographics, baseline ocular characteristics, intraoperative complications, postoperative BCVA (best-corrected visual acuity), complications, and compliance were recorded. The primary outcome was incidence of poor visual outcomes (BCVA<20/40) at the postoperative 1-month visit. Results354 patients (199 [56%] LEP and 155 [44%] non-LEP) with 125 (35%) males and a mean age 66.1 ({+/-}10.9) years were included. LEP patients were about 5 years older than non-LEP patients (P<0.001) and were mostly Hispanic (172 [86%] LEP vs. 36 [26%] non-LEP, P<0.001). The baseline ocular characteristics were similar (P >0.05), except severity of cataract (125 [63%] NSC grade >2+ for LEP vs 70 [51%] for non-LEP, P =0.03). No significant differences in intraoperative complications (P =0.18), incidence of poor vision (P =0.59), postoperative cystoid macular edema (P =0.32), and compliance with the postoperative drop regimen (P =0.11) were noted. ConclusionThere were no statistically significant differences in incidence of poor vision, complications, or compliance. However, there was a trend toward significance, showing that language barriers may lead to more advanced disease and compliance issues with postoperative medications. SYNOPSISLanguage barriers may lead to compliance issues with postoperative medication regimens, as shown by the difference in postoperative care adherence rates between limited English proficient and English proficient patients.

Purpose: To evaluate the incidence and baseline predictors of intraocular pressure (IOP)-lowering treatment following detection of referable glaucoma by teleretinal screening. Design: Retrospective cohort study. Methods: Participants were derived from a safety-net teleretinal diabetic retinopathy screening program (2013-2024). Participants included individuals who screened positive for referable glaucoma (cup-to-disc ratio [CDR] [&ge;]0.6 or CDR asymmetry [&ge;]0.2) and completed in-office diagnostic evaluation. The primary outcome was initiation of IOP-lowering treatment (medication, laser, or surgery) and the secondary outcome was intervention with surgery. Cumulative incidence functions were estimated, accounting for loss to follow-up. Fine-Gray models were used to identify baseline screening predictors to risk stratify each outcome. Glaucoma diagnosis was approximated using diagnostic codes and chart review. Results: 2,367 participants were included. The cumulative incidence of treatment was 19.6% (95% CI: 18.0-21.2) at Year 1 and 45.1% (42.1-48.1) at Year 8. Early treatment occurred primarily in glaucoma cases, whereas treatment accumulated longitudinally in glaucoma suspects, reaching 36.5% (31.6-41.5) by Year 8. Surgery was less common (8-year incidence: 5.3%). Baseline screening data predicted treatment and surgery, enabling risk stratification. At Year 8, cumulative incidence differed substantially between high- and low-risk groups (treatment: 59.9% vs. 31.2%; surgery: 9.7% vs. 1.0%). Older age (sub-distribution hazard ratio [SHR] 1.03 per year, p<0.001), Black race (SHR 1.50, p<0.001), and personal history of glaucoma (SHR 1.90, p<0.001) were associated with treatment; Asian race was protective (0.71, p=0.03). Older age (SHR 1.06, p<0.001), worse visual acuity (SHR 5.11 per logMAR unit, p<0.001), and screening at a hospital-based site (SHR 2.46, p=0.003) were associated with surgical treatment. Conclusion: Nearly half of safety-net diabetic patients screening positive for referable glaucoma initiated IOP-lowering treatment over 8 years, while few received surgery. Baseline screening characteristics enabled risk stratification of treatment and surgery. These findings address an evidence gap about longitudinal consequences of screening and suggest that its impact extends beyond detection of prevalent glaucoma to include identification of high-risk glaucoma suspects who warrant ongoing surveillance.

PurposeThis study aimed to evaluate the novelty and potential value of therapeutic suggestions made by an artificial intelligence large language model for treating various ophthalmic diseases. MethodsChatGPT-3.5 was used to suggest novel ophthalmic indications for available medications. The generation of therapeutic suggestions was performed by inputting standardized queries about treatments for common ophthalmic conditions and then categorizing the responses by drug type. Data tables were organized by ophthalmic condition, with consistent quality checks to ensure accuracy. Literature searches were conducted to determine the FDA-approval status of each therapy, and whether the suggested application was novel in the context of the condition. Therapies were categorized according to current use and level of evidence for use. ResultsChatGPT proposed 180 medications and treatment options for 36 eye conditions. Of the 180 medications, 143 (79.4%) were FDA-approved for general medical use and 32 out of 180 (17.7%) were specifically approved for the recommended ophthalmological conditions. The majority of suggested treatments were for corneal and anterior segment disease (82/180 or 46%), with other categories being retina (23%), glaucoma (8.9%), pediatrics and strabismus (12%), neuro-ophthalmology (0.55%), and uveitis (10%). The proposed treatments were then evaluated by the degree to which the literature supported additional investigation. The majority, 86/180 (48%), were already being used in the clinic, while 27/180 (15%) represented a novel ophthalmic use that appeared to be a reasonable hypothesis to test, and 20/180 (11%) were novel, but appeared unlikely to succeed, based on their mechanism of action. The level of novelty for each treatment was also evaluated, with categories spanning from pre-existing testing in animal models to repurposed for novel ophthalmic use. ConclusionThese findings suggest that ChatGPT is capable of formulating novel treatment options for a range of ophthalmic diseases. Of the suggestions, 27/180 (15%) appeared novel, and reasonable suggestions, based on their mechanism of action. ChatGPT can potentially suggest novel ophthalmic applications for existing medications, which could be evaluated with further laboratory and clinical research.