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Purpose: This study was performed with the aim of finding a more convenient and less time‐consuming method to diagnose retinal breaks in posterior vitreous detachment (PVD) patients. Methods: A prospective double‐blind observational case study was performed with patients who were admitted to the Eye Emergency Department Sahlgrenska University Hospital with PVD symptoms and approved to participate in the study (n = 128). Standard slit lamp examination was compared with images from a Zeiss Clarus 700 ultra‐wide‐field camera (UWFC). Patients were examined and photographed by an independent operator. Data and image review was performed by three independent reviewers with varying experience. Retinal break detection with the two different methods (detailed eye examination by well‐trained ophthalmologist and UWFC evaluations) was analysed statistically. Results: After excluding diagnoses other than PVD as well as unclear images due to cataracts, vitreous bleeding, etc., a total of 103 eyes with PVD were evaluated. A total of 38 ruptures in 25 patients were detected by routine examination and were subjected to laser treatment. UWFC images were reviewed by three ophthalmology consultants and compared with routine examinations. Sensitivity values in detecting retinal ruptures in UWFC images of the three reviewers were 0.89, 0.87 and 0.79, and specificity values were 0.88, 0.86 and 0.93 (kappa values: 0.742, 0.689 and 0.728) respectively. Conclusion: Although there have been rapid developments in imaging with UWFC in recent years and it is a very promising method for the future, routine clinical examination is still the only valid method for the detection of retinal tears today. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the relationship between subjective (slit lamp examination [SLE]) and objective (densitometry) measurements of corneal haze after accelerated corneal crosslinking (aCXL), assess the relationship between densitometry and corrected distance visual acuity (CDVA), and determine the effect of baseline characteristics on densitometry after aCXL in eyes with progressive keratoconus and other ectasias. Setting: Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada. Design Retrospective analysis of a prospective interventional cohort study. Methods: Scheimpflug‐derived corneal densitometry, CDVA, maximum keratometry (Kmax), and central corneal thickness were measured preoperatively and up to 1 year after aCXL, and post‐operative haze was estimated with SLE (n = 483 eyes). A random effect model was used to examine the relationship between post‐operative subjective haze with SLE and densitometry. Linear mixed models were used to examine the relationship between densitometry, pre‐operative baseline characteristics, and CDVA. Results: There was a significant association between subjective haze with SLE and densitometry (p < 0.001). There was a significant relationship between CDVA and densitometry: for every 10 GSUs of increased densitometry in the 0–2 mm zone, CDVA worsened by approximately half a Snellen line (p < 0.001). Age and pre‐operative Kmax were significant predictors of densitometry. For every 10 years of age, densitometry increased by 0.68 GSUs (95% CI [0.27 to 1.07], p < 0.001). For every 10 D of increased preoperative Kmax, densitometry increased by 0.69 GSUs (95% CI [0.41 to 0.98], p < 0.001). Conclusions: Subjective haze after aCXL estimated with SLE, is significantly associated with densitometry. Increased densitometry after aCXL is associated with a reduction in CDVA. [ABSTRACT FROM AUTHOR]

To describe the diagnostic technique to assess corneal neovascular (CoNV) complexes and identify feeder vessels in ocular surface pathologies. To illustrate the role of corneal angiography in clinical assessment and surgical treatment of patients with complex corneal neovascularization. To compare corneal angiography with non‐invasive diagnostic tests such as OCT angiography and slit lamp camera. A case series of patients with CoNV is presented whose management was guided by indocyanine green (ICG) and fluorescein corneal angiography. Corneal angiography is a useful diagnostic tool to guide medical and surgical management of CoNV by enabling the localization of vessel depth and topography. [ABSTRACT FROM AUTHOR]

Methods for visual or quantitative exploration of the cellular morphology of the cornea based on inherent three‐dimensional features open up completely new diagnostic possibilities. However, previous approaches to confocal microscopy of the cornea using mechanical 3D scanning strategies are slow and thus only partially suitable for in vivo investigations. Addressing these shortcomings, the idea of developing a novel confocal microscopic technique for three‐dimensional in vivo imaging of the cellular morphology of the cornea is aimed. By exploiting induced chromatic aberration using a swept‐source laser in conjunction with a specifically designed high‐dispersion optic, an extremely fast method for focal positioning in the tissue shall be developed. Utilizing a dedicated laser line scanning, will enable the display of sectional images in real time. These are comparable to slit lamp images, but with cellular resolution. Furthermore, with an x–y scanning protocol, corneal volumes can be acquired in less than 1 s. The project thus paves the way for cellular 3D slit‐lamp microscopy and, in perspective, provides ophthalmologists with further methods for dedicated diagnostics of ocular surface diseases. This paper summarizes the concept of this novel approach. [ABSTRACT FROM AUTHOR]

Purpose: Any corneal microsurgeon may have inadvertently transplanted a donor corneal tissue with (subclinical) keratoconus or prior keratorefractive surgery, which typically leads to postoperative refractive surprises and cannot always be detected in the eye bank with only slit lamp. Given the increased number of keratorefractive procedures performed in the last decades, eye banks will soon have to face this problem more intensively. Thus, the efficiency and reliability of anterior segment optical coherence tomography (AS‐OCT) as a non‐invasive and sterile screening method in the eye bank to detect corneal grafts with curvature and/or thickness abnormalities was assessed. Methods: 1315 donor corneal tissues mounted in sterile tissue cultivation flasks were imaged using an AS‐OCT. The corneal tissues were preserved in organ culture medium I and transferred into organ culture medium II (containing dextran T‐500 6%) for deswelling at least 24 h prior to measurement and keratoplasty. Depth raster scans were performed through the posterior surface of the corneal tissues within a 7 mm central zone to create 3D volume data. The volume data set was preprocessed to eliminate flask reflections artefacts and to define the region of interest (ROI). Subsequently, the adaptation of a sphero‐cylindrical surface model was carried out with raytracing. Thus, the radii of curvature for the front and back surfaces can be determined and a corneal thickness map is generated. Results: The mean steep/flat front surface radius was 7.46 ± 0.29 (5.07–9.29)/7.69 ± 0.24 (6.70–9.50) mm, the corresponding values for the back surface being 6.47 ± 0.32 (5.00–8.00)/6.80 ± 0.31 (5.81–8.00) mm and the mean central thickness was 610 ± 84 (379–1457) μm. Abnormalities (beyond ±2 or ± 3 SD) were found in 140 or 34 corneas (10.6% or 2.6%) for anterior surface curvature, 120 or 38 corneas (9.1% or 2.9%) for the posterior surface, and 55 or 16 corneas (4.2% or 1.2%) for thickness. Conclusions: The AS‐OCT provides an objective, sterile and semi‐automated screening method to identify corneal morphological and refractive alterations (e.g. keratoconus, status post PRK/LASIK) and further optimize corneal donor selection in the eye bank. Corneal donors with curvature or thickness abnormalities ±3 SD do not have to be discarded but can be used for posterior lamellar keratoplasty or tectonic keratoplasty. [ABSTRACT FROM AUTHOR]

Introduction: Simulation technology is constantly improving medical education in various fields. In ophthalmology, simulation is already successfully used to teach conservative and surgical skills. In 2022, the Eyesi slit lamp simulator was introduced for the first time, allowing students to learn various examination techniques and ocular pathologies. This study describes medical students' learning experience. Methods: In this exploratory study, 50 medical students without previous experience with slit lamp examination were selected. Each student then had two training sessions, one with the classic slit lamp and one with the Eyesi slit lamp simulator. At the end of the training, students compared their learning experiences in the two sessions using a questionnaire. Results: The simulator course was considered useful for learning slit lamp examinations (p = 0.05). Slit lamp simulator was particularly beneficial for learning ocular pathologies (p = 0.03), as these were constantly available and systemically presented without the need of direct contact with patients. On the other hand, examination of a healthy eye was judged to be better learned (p < 0.001) by reciprocal examination with the real slit lamp. Conclusion: The Eyesi slit lamp simulator provides a structured and promising learning experience. Thanks to the growing library of modelled clinical cases, ocular pathologies can be learned in situations similar to everyday life without the need for patients to be present, allowing students to learn at their own pace and ask questions without being shy in front of patients. [ABSTRACT FROM AUTHOR]

Aims/Purpose: To report a case involving an undifferentiated pleomorphic sarcoma localized in the orbit. Methods: Case report and literature review. Results: Undifferentiated pleomorphic sarcomas (UPS) are one of the least common types within all malignant sarcomas, with their incidence reaching 5–10% of the cases. Within this group of UPS, tumours involving the head and neck have an even lower incidence (approximately 3 to 5%). We report the case of an 86 year old male with a history of cardiovascular disease, presenting with a painless lesion in his right eye. The orbit CT reported a soft tissue lesion in contact with the right ocular globe, lacrimal gland and extraconal fat. At examination the patient registered best corrected visual acuity right eye (OD) no light perception right eye and left eye (OS) 20/50. At slit lamp examination OD is not evaluable due to corneal compromise. OS anterior segment and posterior pole with no alterations. Immunohistochemistry was negative for P40, desmine, CD34, SOX‐10 and cytokeratin cocktail. S100 had weak and patchy staining. These results led to a giant cell pleomorphic sarcoma diagnosis, histological grade 3. The patient underwent urgent orbital exenteration, with an adequate postsurgical evolution and oncology follow up. Conclusions: The diagnosis of an UPS is based on exclusion, due to their heterogeneous nature, with histological characteristics that overlap with other malignant mesenchymal neoplasms, mainly with metastatic sarcomatoid carcinoma and melanoma. These tumours are characterized by their rapid growth and potential for metastasis, especially in the lungs. Treatment includes surgical resection, sometimes combined with adjuvant chemotherapy. Strict periodic checkups are essential, since local recurrence is frequent (between 19 to 31%), with most cases occurring within the first 24 months. [ABSTRACT FROM AUTHOR]

Aims/Purpose: The aim of this case series is to present eyes with topographic keratoconus configuration, but in which objectifiable no keratoconus exists and thus a so‐called pseudo‐keratoconus is present. Methods: Inclusion criteria were a topographic classification of the cornea as keratoconus by Scheimpflug imaging using the topographic keratoconus classification TKC and a typical elevation data profile with irregular astigmatism and slope (= Ansteilung) of the cornea. Clinical image by slit lamp examination, best‐corrected visual acuity and Scheimpflug tomography of the anterior segment of the eye (Pentacam®, OCULUS, Wetzlar, Germany) were analysed. Results: In our case series, 33 eyes of 23 patients were included. The mean age was 51 (±16) years and the ratio of females to males was balanced. The mean Kmax was 51.1 (±7.1) dioptres. The mean corneal thickness at the thinnest point was 517 (±80) μm. The best‐corrected decimal visual acuity was 0.47 (±0.27). The study eyes were divided into 3 groups according to the underlying cause of the topographic changes. One group included corneal diseases with inferior slope in topography (corneal scar n = 9, Map‐Dot‐Fingerprint dystrophy n = 6, Fuchs endothelial dystrophy n = 5, vortex keratopathy n = 2). The second group had a superior corneal slope that could be interpreted as a superior keratoconus configuration (Map‐Dot‐Fingerprint dystrophy n = 5, irregular astigmatism without other corneal pathology n = 2, Salzmann corneal degeneration n = 1, corneal scar n = 1). The third group included eyes with postoperative newly occurring keratoconus configuration after phototherapeutic keratectomy (n = 2). Conclusions: This case series shows that different corneal pathologies can imitate a topographic keratoconus configuration. The identification – not least at the slit lamp – and differentiation of these pathologies from keratoconus are important in daily practice with regard to counselling of the patients and further treatment. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Retroillumination observation of the anterior segment is a routine examination method as old as the slit lamp, but capturing good quality images is difficult because of patient glare, the presence of corneal and or lens reflections, and limited resolution. We have modified a slit lamp to overcome these limitations and present the first series of images obtained. Methods: On a Topcon SL‐D7 slit lamp, we replaced the light source with a far‐red LED (Thorlabs, M780L3, 200 mW, 800 mA at 780 nm) and added a monochrome camera with sufficient resolution (Baumer, VCXU‐123 M). Reflection suppression was achieved by modifying the optical path (patent pending). In a clinical trial validated by an ethics committee (IDRCB: 2021‐A01496‐35), we acquired images of 5 different diseases after pupillary dilation: cataract, posterior capsule opacification, hereditary stromal dystrophy, Fuchs' corneal endothelial dystrophy (FECD), Bowman's membrane dystrophy. Results: Our innovative prototype device made it possible to obtain images of 3000 × 4096 pixels for 13.3 × 9.7 mm (×40 magnification). In 100% of the cases, one or more clear images on the area of interest were obtained without glare, and without disturbing reflections in 90% of the cases. Some pseudophakic patients showed minimal to moderate light reflection. The images were sufficiently resolved to allow precise analysis of disease areas, such as each guttae of the FECD. Conclusions: Our retroilluminator prototype provides, for the first time to our knowledge, high‐resolution images of the different structures of the anterior segment, easy to acquire and likely to facilitate the diagnosis and follow‐up of patients. Improvements to the prototype are underway to remove some persistent reflections. One of the first applications will be the classification of the severity of endothelial damage in FECD. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Branch retinal vein occlusion (BRVO) occurs when a branch of the retinal vein becomes obstructed. The aim of this study case was to provide insights into the potential role of Lipoprotein (Lp) (a) in the pathogenesis of BRVO. Methods: Case of a 47‐year‐old woman with no significant ophthalmological or general medical history, except the use of oral contraception and smoking habits. Presented to the emergency care after 5 days of experiencing a sudden vision loss in her right eye. Results: The ophthalmological examination revealed a visual acuity of 10/10 on the left (OS) and VBLM/10 on the right eye (OD). Slit lamp and Fundus examination showed on OD a relative afferent pupillary defect and the classic features of acute retinal branch vein occlusion, including tortuous veins, capillary occlusion, papillary and macular oedema and haemorrhages. While all was normal in OS. A comprehensive ophthalmic examination was conducted, including fluorescein angiography and optical coherent tomography that showed no abnormal vessel growth at this stage. Then, the indication for a dexamethasone intravitreal implant has been made along with panretinal photocoagulation (PRP) in the ischaemic areas. More, discontinuing oral contraception, the serum concentrations of specific antibodies, as anticardiolipin and antiphospholipids, as well as homocysteine and Lp (a) levels. The blood tests yielded negative results except for the abnormal plasma level of lipoprotein (a), which was measured at 900 mg/L. After 2 months of follow‐up. The visual acuity in OD was measured at 9/10. Moreover, the restoration of normal macular thickness after 4 months. However, at 6 months follow‐up, the appearance of a neovascularization adjacent to the previously laser‐treated area. As a result, a series of closely spaced PRP was performed along with an intravitreal anti‐vascular endothelial growth factor. After 1 month, a complete disappearance of the neovascularization was observed. Conclusions: Identification of independent and highly predictive risk factors for BRVO is still a big challenge. The main goals are the preservation of visual acuity and the prevention of relapses. This case report emphasizes the importance of incorporating a systematic Lp (a) testing into clinical practice, even in young individual. [ABSTRACT FROM AUTHOR]

Aims/Purpose: Central retinal artery occlusion (CRAO), which can be likened to a stroke in the eye, is considered a critical condition requiring immediate attention. The aim of this case was to assess whether anterior chamber paracentesis has a notable impact on the ultimate visual acuity in eye experiencing acute CRAO. Methods: We present the case of a 62‐year‐old man with no significant ophthalmological history, only hypertension under treatment. Presented to the emergency care within an hour after experiencing a sudden decrease in visual acuity in his left eye, whose visual prognosis improved after an urgent ocular chamber paracentesis. Results: The ophthalmological examination revealed a visual acuity of 10/10 on the right (OD) and positive light perception/10 on his left eye (OS). The intraocular pressure was normal in both eyes. Slit lamp and fundus examination showed on OS a positive reflex afferent pupillary defect and a whitish appearance of the retina, with narrowed retinal blood vessels and a cherry red spot in the macula while all was normal on OD. In this case an anterior chamber paracentesis was conducted, involving the removal of 0.3 mL of aqueous fluid from the anterior chamber using a small (30 gauge) needle. By decreasing the intraocular pressure through medical means (acetazolamide 250 mg 1cp 3 times a day for 7 days) and performing the anterior chamber paracentesis, the aim is to optimize the conditions for promoting the movement of any potential embolus away from the central retina and along the vessel. After one week, significant improvement was observed. The visual acuity in the OS was measured at 9/10, and the intraocular pressure was 10 mmHg. Ophthalmoscopic examination revealed the disappearance of the previously observed whitish retina, with a granular appearance of the macula. Despite these positive changes, impairment in the visual field has been noted and still persistent even after six months of follow‐up. Conclusions: Paracentesis, by reducing intraocular pressure, can enhance retinal arterial perfusion pressure, vasodilatation and the dislodgement of thrombi or emboli. Despite the prognosis often being poor, it is essential to take quick action and implement appropriate management strategies to prevent permanent vision loss. [ABSTRACT FROM AUTHOR]

Purpose: Develop an algorithm to predict the success of laser peripheral iridotomy (LPI) in primary angle closure suspect (PACS), using pretreatment anterior segment optical coherence tomography (ASOCT) scans. Methods: A total of 69 eyes with PACS underwent LPI and time‐domain ASOCT scans (temporal and nasal cuts) were performed before and after LPI. After LPI, success is defined as one or more angles changed from closed to open. All the pretreatment ASOCT scans were analysed using the Anterior Segment Analysis Program to derive anterior chamber angle (ACA) measurements. The measurements for each angle were ordered along with angle‐independent measurements totalling to 42 measurements which serve as features for the prediction algorithm. Two masked glaucoma fellowship‐trained ophthalmologists graded the pre‐LPI ASOCT scans to determine whether LPI was likely to successful. Results: There were 42 (60.9%) eyes that fulfilled the criteria for success after LPI. Iris concavity, angle recess area (750 μm) and iris concavity ratio showed the highest predictive score and were selected using correlation‐based subset selection method. These features were classified into two ('successful' and 'unsuccessful') categories using a Bayes classifier. The algorithm predicted the success of LPI with 79.28% cross validation accuracy, which was superior to the predictive accuracy of the ophthalmologists (kappa 0.497 and 0.636 respectively). Conclusion: Using pretreatment ASOCT scans, our algorithm was superior to ophthalmologists in predicting the success of LPI for PACS eyes. This novel algorithm could aid decision making in offering LPI as a prophylaxis for PACS. [ABSTRACT FROM AUTHOR]

Background: We evaluated the long‐term biocompatibility and safety of a new modular posterior chamber intraocular lens (IOL) system in rabbit eyes. Methods: Seven New Zealand rabbits underwent bilateral phacoemulsification with placement of the modular IOL in OD and a control IOL (SA60AT) in OS. Slit‐lamp examinations were performed at postoperative weeks 1, 2, 3, 4, 6 and 8 and months 3 and 6. All rabbits were then sacrificed and eyes enucleated. The eyes were examined grossly from the Miyake–Apple view. Selected IOLs were explanted and underwent surface staining for implant cytology. All globes were then sectioned and processed for histopathological examination. Results: The modular IOL remained stable in all seven rabbits through the entire follow‐up period. Biocompatibility was better than the control lens at six months postoperatively, on account of less extensive synechiae formation as assessed by slit‐lamp examination. At the six‐week examination, posterior capsule opacification (PCO) was significantly better in the test group (scored as 1.71 ± 0.8 versus 3.28 ± 0.48 in the control group, p = 0.0008). On gross examination with the Miyake–Apple view, Soemmering's ring formation was significantly better in the test group, (5.14 ± 1.57 versus 10.85 ± 1.95 in the control group, p = 0.002). Conclusion: Previous studies showed that explantation/exchange of the modular system optic was safer and easier than with a standard IOL. The new modular IOL system has demonstrated better long‐term biocompatibility compared to the control lens at six months postoperatively in the rabbit model. [ABSTRACT FROM AUTHOR]

Purpose: In response to anti-VEGF treatment for wet AMD retinal anatomy and visual acuity is often remedied. In our previous study, we showed that visual evoked potentials (VEP) improve following successful anti-VEGF treatment. The aim of the present study was to investigate how visual acuity and retinal thickness changes are reflected in VEP parameters. Moreover, we wanted to assess the feasibility of VEP as a novel monitoring tool for wet AMD patients. Methods: 16 patients and six control subjects were enrolled in this study. Patients received three bevacizumab intravitreal injections. At the beginning of the study and four to six weeks after the last injection, the best corrected visual acuity (BCVA) test, full biomicroscope examination, OCT analysis and VEP were performed. Results: In treated eyes, logMAR visual acuity decreased on average by 0.18 ± 0.32 units, OCT retinal thickness decreased by 170 ± 200 lm and VEP amplitude increased by 1.0 ± 1.4 IV. All changes were significant at p < 0.05. There was a significant correlation between the relative changes of VEP amplitude and retinal thickness r = -0.630 (p < 0.05), and between visual acuity (logMAR) and retinal thickness r = 0.576 (p < 0.05). Conclusion: We showed that both the increase in VEP amplitude and the improvement in visual acuity are associated with the decrease in retinal thickness in treated wet AMD patients. The results do not indicate additional usefulness of VEP in the diagnosis or monitoring of wet AMD. [ABSTRACT FROM AUTHOR]

Age-related macular degeneration ( AMD) is the main cause of visual impairment in developed countries. Several improvements in the visualization of posterior segment of the eye together with the introduction of intravitreal anti- VEGF treatment have revolutionized the prognosis of the wet form of AMD ( wAMD). Increasing incidence of wAMD together with the limited resources of society and of the healthcare system poses challenges for the provision and development of care. In context of these current aspects, we aimed to set evidence-based medical guidelines for diagnosis, treatment and follow-up of patients with wAMD. [ABSTRACT FROM AUTHOR]

Purpose To report the feasibility and long-term safety of lensectomy and iris-claw intraocular lens ( IOL) implantation to treat children with severe ectopia lentis in a paediatric tertiary hospital. Methods Prospective cohort study of 21 eyes from 12 patients with severe ectopia lentis and visual acuity <20/63. All eyes underwent 23-gauge pars plana vitrectomy, lensectomy, iridectomy and Artisan IOL implantation in the anterior chamber with iris-claw enclavation via pars plana. Mean age at surgery was 8.0 ± 5.3 yo (range 3-17 years). A full ophthalmologic examination including best-corrected visual acuity ( BCVA), biomicroscopy, intraocular pressure ( IOP) measurement, fundus evaluation and central endothelial cell count ( cECC) was performed pretreatment, at 3 months' postsurgery, and every 6 months thereafter. Ultrasound biomicroscopy ( UBM) was performed 12 months after surgery. Results Mean follow-up was 39.3 ± 13.0 months. Best-corrected visual acuity (BCVA) (mean ± SD) improved from 0.91 ± 0.29 logMar preoperatively to 0.18 ± 0.23 logMar at final follow-up (p < 0.0001). Mean distance from the endothelium to the anterior IOL surface after surgery was 3.11 ± 0.61 mm. Postsurgically, cECC loss was 5.04% ± 9.58% with an annual cECC loss rate of 3.16% ± 4.46%. One patient developed IOL dislocation and retinal detachment after severe ocular contusion requiring vitrectomy, IOL refixation and gas tamponade. Another patient developed cystoid macular oedema, managed with intravitreal dexamethasone. Conclusion This technique is both feasible and effective to manage severe ectopia lentis in children. Lifetime ophthalmic follow-up including cECC measurement, IOL position monitoring and fundus examination is mandatory in these patients. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to assess the safety of the measurements taken with a new non‐contact esthesiometer ‐Brill Engines esthesiometer (BEE) and to compare the sensitivity obtained with the Cochet‐Bonnet esthesiometer (CBE). Methods: Sixty‐eight eyes of thirty six healthy volunteers were included in the study. Corneal central sensitivity was measured with the new BEE and with the CBE, with a 0.08 mm of diameter nylon monofilament. Measurement was performed according with the manufacturer instructions. BEE was mounted in the slit lamp and CBE measurement was used manually. A sub‐umbral esthesiometry strategy was performed. To assess whether the data followed a normal distribution, the Kolmogorov–Smirnov test was used. Likewise, the data obtained with the BEE were compared with those obtained with the CBE. A 95% confidence level was considered statistically significant. Measurements obtained with the CBE esthesiometer were converted to millibar for their comparison with the obtained with the BEE. Results: Sixty‐eight eyes of thirty six consecutive healthy volunteers, 30.6% males and 69.4% females, underwent and complete the participation in the study. No adverse effected, ocular surface or corneal damage were detected and both test were well tolerated by volunteers. Correlation between both esthesiometers ICC was −0.123. (Table. 1). Bland Altman plots showed the great majority of data were inside the boundaries (2 SD). Conclusions: A new non‐contact air jet corneal esthesiometer was tested in healthy volunteers with good tolerance, no adverse effects. It is not essential to exert so much force on the ocular surface to determine the sensitivity of a healthy cornea and, BEE is more sensitive compared with CBE. To confirm the pressure margins of BEE at each level and know the intervals in subjects with eye conditions, more studies will be conducted in the future with a more diverse population. Brill Engines esthesiometer could be used as easy use, non‐invasive and portable alternative of the Cochet Bonnet esthesiometer. [ABSTRACT FROM AUTHOR]

We evaluated the effect of 2‐year supplementation with a highly concentrated docosahexaenoic acid (DHA) product with antioxidant activity on nonproliferative diabetic retinopathy (NPDR). A prospective, randomized, double‐blind, placebo‐controlled study was performed. A total of 170 patients with diabetes were randomly assigned to the DHA group (n = 83) or the placebo group (n = 87). NPDR was diagnosed by biomicroscopic examination with a non‐contact slit lamp and classified into mild, moderate and severe stages, monitoring the macular status with oct spectral domain. Patients in the DHA group received a nutritional supplement rich in DHA triglycerides (1050 mg/day), and those in the placebo group received olive oil capsules Results: There were improvements in serum HbA1c levels in both groups, and the change to milder stages of the disease was greater in the DHA group, although not statistically significant. Although in our study group, the protective role of nutraceutical supplementation with DHA in mild stages was less evident, the evidence is encouraging and allows us to speculate about the protective role of DHA supplementation in non‐early stages of diabetic retinopathy, in which the most relevant biomarkers of inflammatory stress can act as a more effective therapeutic target for nutraceutical supplementation. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy (DR) and Glaucoma are among the leading causes of irreversible blindness globally. There are over 450 million Diabetics with 1 in 3 developing DR and 70 million affected with glaucoma. With the aging population the numbers are projected to increase exponentially. Early detection of DR with active screening is the key to prevent blindness secondary to advanced disease. Chronic glaucoma is frequently asymptomatic until central vision is impaired in advanced stages, resulting in a high proportion of undetected disease. Current teleophthalmology‐based screening solutions prevent scale up due to several challenges such as expensive equipment, delay in reporting and manual labour‐intensive grading process. The need of the hour for screening programs is a device that is portable, reliable, affordable with integrated AI providing rapid results. Remidio Fundus‐ on‐ phone (FOP) is one such device that has offline artificial intelligence (AI) algorithms that screens for referable diabetic retinopathy (RDR) and Glaucoma without the need for internet and cloud‐based inferencing. It utilizes smartphone technology for capturing non‐mydriatic fundus images which can be operated by minimally trained technicians with an inbuilt patient management software, auto capture and internal fixation features to improve ease‐of‐use. Further, it has the versatility to be used either as a handheld device, mounted on a slit lamp or in a stabilized version with chinrest, thus providing several options for the user. This smartphone‐based fundus camera has proven to be on par with high‐end desktop systems in terms of image quality in multiple published studies. The performance of the RDR AI has been clinically validated in multiple prospective trials. In three published studies conducted at diabetes care centres as well as in the community in India, the sensitivity ranged between 93%–100% with a specificity of 86.7%–92.5% for RDR. Additionally, it was found that the sensitivity to detect sight‐threatening disease which has a high risk of blindness, ranged between 98.7% to 100%. The AI has also been tested in several other populations in Armenia, Poland, Mexico and Caribbean islands with similar results. The novel Referable Glaucoma AI has similarly been prospectively validated against standard of care. Despite being challenged with fundus images alone the sensitivity to pick likely glaucoma was high with minimal overcall of normal subjects. Additionally, activation maps highlight areas of structural abnormality on the optic disc image, thus allowing visualization of key findings and better patient counselling. This device gives an opportunity to make a paradigm shift in the approach for screening as providers could get to the population to screen at‐risk individuals rather than relying on patients to come to clinics to be screened. It is thus an end‐to‐end solution for DR and Glaucoma screening combining two technological advances‐ smartphone technology and AI. With several upcoming algorithms to screen for other retinal conditions, this device is well positioned to be a gamechanger in the efforts aimed at reducing the burden of preventable retinal blindness across the world. [ABSTRACT FROM AUTHOR]

Purpose: Blenrep® (Belantamab mafodotin) is an antibody‐drug conjugate that targets an overexpressed antigen in myeloma plasma cells. This agent has its indication on adults with triple‐class refractory multiple myeloma (MM). The most frequently reported adverse event is the appearance of microcyst‐like epithelial changes in the cornea (MEC), produced by the apoptosis of epithelial cells. Our purpose is to describe these findings and their evolution. Methods: The evaluation of the MM patients treated with Blenrep® is a coordinated labor between ophthalmology and haematology departments. At the beginning of the treatment, a regulated baseline examination including visual acuity (VA) and slit lamp examination is performed and a cold mask and artificial tears are provided. Subsequently examination is repeated every 3 weeks, prior to the administration of the next cycle. The ophthalmological findings determine if the next dose can be administered or if it has to be postponed due to a VA loss. The evolution of three patients undergoing Blenrep® treatment was analysed, using anterior segment photography and OCT. Results: 31–92% of the patients on Blenrep® develop ocular events. In our case, the three patients studied developed epitheliopathy during the follow up. One of them, after 2 months, presented a VA loss due to MEC affecting visual axis that required next dose administration delay following haematologist's recommendation. After that period, the microcysts disappeared and VA was recovered. The other two patients also developed MEC, but did not need modification of the scheme since VA was not affected. Conclusions: Blenrep® has proved to be effective on the treatment of triple‐class refractory MM. Its principal adverse event is the appearance of MEC, which in some cases may impair the VA. This effect is reversible with the disappearance of the microcysts with the corneal epithelial regeneration cycle by prolonging the interval between the doses. [ABSTRACT FROM AUTHOR]

Purpose: To describe a case of intermediate uveitis and optic neuritis associated with Cogan's syndrome. Methods: A case report. Results: A 29‐year‐old white Caucasian female was referred to our department for decreased vision in her left eye (LE). Previous medical history revealed relapsing intermediate uveitis and optic neuritis in the LE for 5 years and a sensio‐neural hearing loss a year earlier. On presentation, her ophthalmological examination revealed best corrected visual acuity in the LE of 6/60 with a relative afferent pupillary defect. Slit lamp examination revealed a clear cornea, 0.5+ cells in the anterior chamber and 3+ cells in the vitreous. Fundus examination showed an optic disc atrophy. Examination of the right eye was unremarkable. Examination by the internist revealed palmar erythematous lesions. Laboratory work‐up was negative for infectious diseases. Testing for antinuclear antibodies, antineutrophil cytoplasmic antibodies and rheumatoid factor were negative. The diagnosis of atypical Cogan's syndrome was made based on the association of atypical ophthalmological manifestations and typical audio‐vestibular manifestations. The patient was treated with oral prednisone and azathioprine. Conclusions: Optic neuritis may rarely be an ocular manifestation of Cogan's syndrome. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to investigate the endothelial layer and biomechanical properties of the cornea, in a group of low‐moderate myopic children. Methods: This prospective study included only the right eye from myopic patients younger than 18. We performed a complete ophthalmologic examination, including autorefractometry under cycloplegia (to determine the spherical equivalent ‐ SE), slit lamp and fundus examination, visual acuity and ocular tonometry. Furthermore, the patients were examined with the Aladdin biometer (Topcon, Tokyo, Japan) to determine central corneal thickness (CCT) and axial length (AL), with the Specular Microscope (Nidek, Gamagori, Japan) to determine number (Num) and density (CD) of endothelial cells, and with the Ocular Response Analyser (Reichert Ophthalmic Instruments Inc., Depew, NY) to determine corneal hysteresis (CH) and resistance factor (CRF). IBM SPSS Statistics 26 was used for statistical analysis. Results: Our study included 64 right eyes from 64 patients (51.56% male, 48.44% female). The average age was 14.27 years (standard deviation 2.71). The average SE is −2.57 (SD 1.62), AL 24.69 (SD 1.15), CCT 0.565 (SD 0.036), CH 12.32 (SD 1.88), CRF 12.64 (SD 2.24), Num cell 175.17 (SD 38.55), CD 3126.86 (SD 192.74). There are significant correlations between the biomechanical properties of the cornea and the characteristics of the endothelial layer. We found a statistically significant moderate positive correlation between CH and CD in this paediatric myopic population (Pearson's r of 0.353, p 0.004), and also between CRF and CD (Pearson's r of 0.2557, p 0.041). Between AL and the number of cells, there is a significant negative correlation (Pearson's r of −0.287, p 0.025). There are no significant correlations between the number of endothelial cells and CH, CRF, SE or CCT, or between CD and AL, CCT, SE. Conclusions: Our study reveals that in children with myopia, the endothelial cell count is higher in corneas with a higher hysteresis and resistance factor. Moreover, the relationship between the axial length and the number of endothelial cells suggests an impact of myopia on the endothelial layer and warrants further studies, including a larger number of patients and more corneal properties, such as corneal diameter and curvature. [ABSTRACT FROM AUTHOR]

Purpose: CYP1B1 mutations are commonly associated with primary congenital glaucoma (PCG). PCG is due to an isolated trabeculodysgenesis and classically does not involve iris dysgenesis. We describe a cohort of atypical PCG phenotype showing iris atrophy. Methods: In this study, exome sequencing was carried out in five patients with neonatal onset congenital glaucoma who also had features of iris atrophy that were detected once the children were old enough for slit lamp examination. Results: The five patients identified had presented with bilateral neonatal onset glaucoma with iris abnormalities like iris atrophy, corectopia and polycoria detected when they were older. All patients had undergone bilateral trabecutectomy with ab externo trabeculotomy during early childhood. The mean age of these children at the time of this study was 14.4 years (range: 8–25 years). The iris atrophy was characteristically peripheral and circumferential. However, none of these patients had evidence of a posterior embryotoxon or peripheral anterior synechiae in the angle (PAS), typical of Axenfeld Rieger Syndrome (ARS). Whole exome sequencing identified biallelic CYP1B1 mutations in all of these five patients as pathogenic variants. Conclusion: This variant of neonatal onset PCG associated with biallelic CYP1B1 mutations may have associated iridodysgenesis and may resemble the ARS phenotype. [ABSTRACT FROM AUTHOR]

Purpose: To describe clinical, etiological and tomographic features of anterior scleritis. Methods: Retrospective case series study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between the 1st January 2021 and the 1st January 2022. Nine patients (12 eyes) with anterior scleritis were included. All patients underwent complete ophthalmic examination including anterior segment and fundus slit lamp examination. The cases were documented with multimodal imaging including anterior segment optical coherence tomography (AS‐OCT). All patients were referred to the internal medicine department for general examination. Results: The median age of the patients was 37 years. 44% were male and 56% were female. Ophthalmic examination revealed diffuse conjunctival hyperemia and scleral vessel dilation with negative neosynephrine test in all eyes. The scleritis was bilateral in 3 patients, diffuse in 6 eyes, nodular in 5 eyes and necrotizing in 1 eye. One eye was complicated with angle closure glaucoma, 2 eyes had anterior uveitis, 1 eye had retinal vasculitis and 2 eyes were associated with posterior scleritis. AS‐OCT revealed a narrow anterior chamber and a closed angle in 1 eye, dilated scleral vessels in all eyes, thickening of the sclera in 11 eyes, dome‐shaped hyperreflective lesions corresponding to the nodules in 5 eyes and thinning of the sclera in the eye with necrotizing scleritis. Systemic disease was found in 7 patients. Main etiologies were tuberculosis in 3 patients and Behçet disease in 2 patients. The other two diagnosis were granulomatosis with polyangiitis and MacDuffie syndrome. Conclusion: In our case series Behcet disease and tuberculosis were the main diagnosis of anterior scleritis. AS‐OCT could show different features of anterior scleritis depending on the clinical presentation and could consequently help to monitor the inflammation. [ABSTRACT FROM AUTHOR]

Purpose To study high-resolution ultrasound biomicroscopy ( UBM) findings in anterior scleral inflammatory disease and evaluate the efficacy of high-resolution UBM as an adjunctive diagnostic tool. Methods A cross-sectional study. The medical records of 30 patients (33 eyes) with episcleritis or anterior scleritis were reviewed for clinical features and high-resolution UBM findings. Ultrasound biomicroscopy (UBM) examination was performed using 50 MHz Aviso S ( Quantel Medical, Clermont- Ferrand, France). Results Seventeen eyes had episcleritis [nodular (12), simple (five)], and 16 eyes had anterior scleritis [nodular (14), diffuse (two)] as classified by UBM. The use of high-resolution UBM allowed high-resolution imaging of the sclera and episclera and showed characteristic patterns of episcleritis and anterior scleritis. The clinical classification matched UBM findings in 25 (76%) eyes. In the other eight eyes (24%), UBM analysis led to a change in the final classification: four eyes with suspected episcleritis were classified with scleritis, and four eyes with suspected scleritis were classified with episcleritis. Eleven patients (36.7%) had an associated systemic disease. Conclusion High-resolution UBM enabled visualization of distinct imaging findings of episcleritis and anterior scleritis, indicating its usefulness in the classification of challenging cases of anterior scleral inflammatory disease. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the efficacy and complications of black diaphragm intra-ocular ( BDI) lens implantation in patients with congenital aniridia. Methods Twenty patients underwent BDI lens implantation for the treatment of congenital aniridia from January 1999 to December 2012. Fifteen patients (23 eyes) were enrolled in our study, and the mean follow-up period was 26 months. Patient demographics, clinical evaluations [visual acuity ( VA), best-corrected visual acuity ( BCVA), intra-ocular pressure measurement ( IOP), corneal endothelial cell density ( ECD) and ultrasound biomicroscopy ( UBM)], complications and treatments were analysed for each patient. Results Sixteen eyes (70.1%) had a BCVA better than 20/200 after BDI lens implantation, and photophobia obviously decreased in all patients. Six eyes (26.09%) developed secondary glaucoma after BDI lens implantation, and one eye underwent glaucoma surgery. Corneal decompensation occurred in two eyes (8.70%), one of which was complicated by glaucoma. Two eyes (8.70%) developed visual axis opacity ( VAO) after surgery. One patient (4.35%) had limbal stem cell failure, and another patient (4.35%) had an eccentric BDI lens. Intra-ocular pressure measurement elevation and ECD reduction were found after BDI lens implantation. Conclusions Black diaphragm intra-ocular lens implantation can effectively improve VA, decrease photophobia and resolve cosmetic issues in most congenital aniridia eyes. Glaucoma, corneal decompensation and VAO were the major long-term complications of BDI lens implantation in patients with congenital aniridia. All patients should be managed attentively because of high risk of complications and followed long term to achieve favourable outcomes. [ABSTRACT FROM AUTHOR]

For these eyes characterized by a mean K at 44.17 ± 1.67 D, an anterior astigmatism at 1.03 ± 0.71 D (<0.75D: 40.0%; 0.75D-1.50D: 36.7%; >1.50D: 23.3%), and a mean emmetropic IOL power at 21.48 ± 1.76 D, saline instillation did not statistically modify the mean K (variation of - 0.03 ± 0.08 D for before vs. after, p I i = 0.43), nor for the emmetropic IOL power (0.03 ± 0.09 D, p = 0.51). We evaluated whether instillation of eye drops immediately before performing biometric measurements can modify the planning of intraocular lens (IOL) in cataract candidates. [Extracted from the article]

Prophylactic treatment of retinal breaks has been examined in several studies and reviews, but so far, no studies have successfully applied a systematic approach. In the present systematic review, we examined the need of follow-up after posterior vitreous detachment ( PVD) - diagnosed by slit-lamp biomicroscopy or Goldmann 3-mirror examination - with regard to retinal breaks as well as the indication of prophylactic treatment in asymptomatic and symptomatic breaks. A total of 2941 publications were identified with PubMed and Medline searches. Two manual search strategies were used for papers in English published before 2012. Four levels of screening identified 13 studies suitable for inclusion in this systematic review. No meta-analysis was conducted as no data suitable for statistical analysis were identified. In total, the initial examination after symptomatic PVD identified 85-95% of subsequent retinal breaks. Additional retinal breaks were only revealed at follow-up in patients where a full retinal examination was compromised at presentation by, for example, vitreous haemorrhage. Asymptomatic and symptomatic retinal breaks progressed to rhegmatogenous retinal detachment ( RRD) in 0-13.8% and 35-47% of cases, respectively. The cumulated incidence of RRD despite prophylactic treatment was 2.1-8.8%. The findings in this review suggest that follow-up after symptomatic PVD is only necessary in cases of incomplete retinal examination at presentation. Prophylactic treatment of symptomatic retinal breaks must be considered, whereas no unequivocal conclusion could be reached with regard to prophylactic treatment of asymptomatic retinal breaks. [ABSTRACT FROM AUTHOR]

. Purpose: A peripheral senile retinoschisis is sometimes difficult to distinguish from a retinal detachment by biomicroscopy alone. This study evaluated spectral domain OCT (SD-OCT) scans of the far peripheral retina to improve the differentiation between these diseases. Methods: Patients were included in whom the distinction between retinal detachment and senile retinoschisis was not clear based on biomicroscopy alone, or who had a presumed clinical diagnosis of senile retinoschisis. OCT scans were made with the SLSCAN-1, through a hand-held lens and a 3-mirror contact lens, while the area of interest was simultaneously observed with the slit lamp. The SLSCAN-1 is a SD-OCT integrated into a slit lamp, superluminescent diode light source with a central wavelength of 830 nm, bandwidth 30 nm, scan resolution 8-9 μm in tissue, scan depth 2 mm, scan speed 5000 A-scans per second. Results: In the 11 patients with an uncertain diagnosis, OCT scans showed a senile retinoschisis in four and a retinal detachment in seven patients. Fifteen of the 18 patients with a presumed diagnosis of retinoschisis showed a retinoschisis on OCT. In five of them, the OCT scans revealed a schisis detachment. Interestingly, three of the 18 patients had a retinal detachment. Conclusion: Senile retinoschisis may mimic a peripheral retinal detachment and vice versa. Differentiation is important with respect to therapeutic decisions. OCT scans of the far peripheral retina, which can be made with the SLSCAN-1 through a 3-mirror contact lens, can contribute significantly to this differentiation. The obtained scans of the far peripheral retina clearly visualize the anatomic differences between both diseases. [ABSTRACT FROM AUTHOR]

Purpose Non-invasive measurement of tear meniscus radius ( TMR) is useful in the assessment of tear volume for dry eye diagnosis. This study investigates the agreement between a new, portable, slit-lamp mounted, digital meniscometer ( PDM) and optical coherence tomography ( OCT) in the measurement of human TMR. Methods Images of the tear meniscus at the centre of the lower lid of 30 normal subjects (8M, 22F; mean age 27.5 SD ± 9.6 years) were taken using the PDM and the OCT. On the PDM and OCT images, TMR was measured using imagej 1.46b software. The meniscus on the OCT images was subdivided vertically into three equal sections and the radius calculated for each: bottom ( BTMR), centre ( CTMR) and top ( TTMR). The relationship between PDM and OCT measurements was analysed using Spearman's rank coefficient, and differences between PDM and OCT subsection measurements were evaluated using Bland-Altman plots. Results Tear meniscus radius measured with the PDM (0.25 ± 0.06 mm) and OCT (0.29 ± 0.09 mm) was significantly correlated ( r = 0.675; p < 0.001). The mean differences between TMR using the PDM and the subsections from OCT showed that TMR measured with PDM was greater for BTMR (0.07 mm; CI 0.05-0.10; p < 0.001), similar for CTMR (−0.01 mm; CI −0.04 to 0.02; p = 0.636) and steeper for TTMR (−0.07 mm; CI −0.10 to −0.04; p < 0.001). Conclusions Portable digital meniscometer and OCT measurements of the TMR are significantly correlated, suggesting that the new PDM is a useful surrogate for OCT in this respect. The PDM appears to measure the radius of the central section of the tear meniscus. [ABSTRACT FROM AUTHOR]

. Purpose: To investigate the association between conjunctival ultraviolet autofluorescence (UVAF), a biomarker of ocular ultraviolet radiation (UVR) exposure, and prevalent pterygium. Methods: We conducted a cross-sectional study on Norfolk Island, South Pacific. All permanent residents aged ≥15 were invited to participate. Participants completed a sun exposure questionnaire and underwent autorefraction and slit lamp biomicroscope examination. Area of conjunctival UVAF (sum of temporal/nasal area in right and left eyes) was determined using computerized methods. Multivariate logistic and linear regression models were used to estimate the associations with pterygia and UVAF, respectively. Results: Of 641 participants, 70 people (10.9%) had pterygium in one or both eyes, and prevalence was higher in males (15.0% versus 7.7%, p = 0.003). Significant independent associations with pterygium in any eye were UVAF (per 10 mm2) [odds ratio (OR) 1.16, 95% confidence interval (CI) 1.16-1.28, p = 0.002], tanning skin phenotype (OR 2.17, 1.20-3.92, p = 0.010) and spending more than three-quarters of the day outside (OR 2.22, 1.20-4.09, p = 0.011). Increasing quartile of UVAF was associated with increased risk of pterygium following adjustment of age, sex and time outdoors (pTrend = 0.002). Independent associations with increasing UVAF (per 10 mm2) were decreasing age, time outdoors, skin type and male gender (all p < 0.001). UVAF area correlated well with the duration of outdoor activity (pTrend < 0.001). Conclusion: Pterygium occurs in approximately one-tenth of Norfolk Islanders. Increasing conjunctival UVAF is associated with prevalent pterygia, confirming earlier epidemiological, laboratory and ray-tracing studies that pterygia are associated with UVR. Protection from the sun should be encouraged to reduce the prevalence of pterygium in the community. [ABSTRACT FROM AUTHOR]

. Purpose: To identify causes of reduced visual acuity after Descemet stripping (automated) endothelial keratoplasty (DSEK/DSAEK) and to determine whether such eyes can be successfully 'repaired' with a secondary Descemet membrane endothelial keratoplasty (DMEK). Methods: Twelve eyes of 12 patients, who underwent secondary DMEK to manage poor visual outcome after initial DSEK/DSAEK, were evaluated with biomicroscopy, Pentacam imaging, and specular and confocal microscopy, before and at 1, 3 and 6 months after DMEK. Results: Four causes of reduced optical quality of the transplanted host cornea could be identified in DSEK/DSAEK: five eyes (42%) showed large host-Descemet remnants within the visual axis during surgery; six eyes (50%) irregular graft thickness; six eyes subtle 'stromal waves'; and nine eyes (75%) high reflectivity at the donor-to-host interface. After DMEK graft replacement, all corneas cleared and achieved a best corrected visual acuity of ≥20/25 (≥0.8), except for one with a partial Descemet graft detachment. Pachymetry values decreased from 670 (±112) μm before to 517 (±57) μm after secondary DMEK. Higher-order aberrations (Coma and Trefoil) at the posterior surface tended to be lower (p = 0.07) in DMEK grafts than in DSEK/DSAEK grafts. Conclusion: Host-Descemet remnants at the donor-to-host interface, interface reflectivity, graft thickness irregularity and donor stromal contraction may contribute to poor visual outcome after DSEK/DSAEK, without causing permanent host corneal damage, as in most cases, complete visual recovery could be achieved by performing a secondary DMEK. [ABSTRACT FROM AUTHOR]

. Purpose: To find the most reliable and efficient noninvasive technique to clinically detect a posterior vitreous detachment. Methods: In a prospective study of 30 eyes in 30 patients with macular pucker or macular hole formation, the posterior vitreous cortex was examined 1 day prior to a scheduled vitrectomy. Three independent investigators classified the posterior vitreous cortex of each eye as 'attached' or 'detached' via slit-lamp biomicroscopy (BM), 10-MHz B-scan ultrasonography (I³ Innovative Imaging Inc.), and optical coherence tomography [OCT III Stratus® (Carl Zeiss Meditec Inc.) and RTVue-100 OCT (Optovue Corp.)]. These preoperative findings were then compared during a triamcinolone acetonide-assisted vitrectomy 1 day later. Results: Triamcinolone acetonide-assisted vitrectomy showed in 60% a posterior vitreous detachment and in 40% an attached posterior vitreous cortex. Preoperatively conducted B-scan ultrasonography and BM revealed the highest, correct evaluation of the posterior vitreous status. The prediction of the OCT was confirmed intraoperatively in 12.5%. In all other cases, the evaluation by OCT was not possible or was inadequate. Conclusion: The prognostic most reliable but investigator-dependent methods to clinically detect whether the posterior vitreous cortex is detached are B-scan ultrasonography and BM. The objective technique of the high-resolution, two-dimensional time-domain OCT allows only in a few cases a clear differentiation of preretinal structures. [ABSTRACT FROM AUTHOR]

. Purpose: To evaluate outcome of surgical resection of iris and irido-ciliary melanomas. Method: Retrospective analysis of all cases treated in Denmark 1975-1999 with clinical follow-up in 2002 and death certificate analysis in 2008. A quality of life questionnaire was completed at follow-up. Results: A total of 53 patients were identified. Of these, 47 were examined at follow-up. Median observation time was 7.15 years (range 0.3-27.4 years). Five patients had died of nonmelanoma causes, and one could not be reached because of immigration. None of the patient had melanoma metastases, and none had died of melanoma-related causes. Only one patient had a local recurrence, which was successfully treated by cryotherapy. The quality of life-related questions demonstrated that most patients (40) suffered from photophobia, and eight patients had changed their driving habits, not driving at night time. However, none had changed job as a consequence of the surgical treatment. Only two patients were emotionally affected by the diagnosis of iris melanoma. Conclusion: Resection of small iris and irido-ciliary melanomas is a safe and efficient procedure, provided that strict diagnostic and surgical procedures are followed and the preoperative intraocular pressure is normal. [ABSTRACT FROM AUTHOR]

. Purpose: To assess the postoperative stability of three-piece intraocular lens (IOL) implants using ultrasound biomicroscopy (UBM). Methods: This is a prospective observational cohort case series. Best-corrected visual acuity (BCVA) assessment, slit lamp examination, refraction and UBM evaluation were performed preoperatively and at 1, 6, 12, 18 and 24 months postoperatively. The anterior chamber depth (ACD) and IOL tilt angles at the 12, 6, 3 and 9 o'clock meridians were assessed. Results: Twenty-one consecutive adult patients (21 study eyes) were recruited, but two dropped out from the study. The average age during cataract surgery was 71.7 years (60-83, SD 6.0). There were very slight changes in the refraction and IOL stability characteristics at all the postoperative follow-up time points. These were not found to be statistically significant, apart from the increase in ACD from months one (3.85 ± SD 0.29) to six (3.91 ± SD 0.26) (p = 0.01, paired t-test). Conclusion: There was a small but statistically significant increase in ACD between the first and sixth postoperative month, but ACD remained stable thereafter. This was not associated with any significant changes in refraction or BCVA. In contrast, IOL optic tilt remained statistically unchanged throughout the 24-month study duration. [ABSTRACT FROM AUTHOR]

Down's syndrome (DS) is the most common chromosomal anomaly. Numerous ophthalmic features have been reported. The aim of our study was to investigate the incidence of refractive errors in children and young adults with DS in Macedonia. Fifty-six children and young adults with DS, aged 2-28 years, from Macedonia, underwent slit-lamp examination, ocular motility and refraction. The overall incidence of refractive errors in the Macedonian children and young adults with DS was 96.4%. A total of 17.8% of the subjects had myopia, 23.2% had hypermetropia and 55.3% had astigmatism. Strabismus was seen in 13 (23.2%) of the subjects (nine had esotropia, three had exotropia, one had hypertropia). The incidence of refractive errors in Macedonian children and young adults with DS was similar to that in Asian children. Compared with White (Caucasian) and Asian children with DS, Macedonian children and young adults exhibited lower incidences of hypermetropia and myopia, and a higher incidence of astigmatism, in which oblique astigmatism represented the predominant type. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects on near visual acuity, reading speed, central visual field and related quality of life of ranibizumab treatment of wet age-related macular degeneration (AMD). Methods: The study was a prospective, non-comparative consecutive case series, followed for 3 months and investigator-driven. Thirty eyes of 30 patients with wet AMD were included, mean age 75 years (range 69–95 years). In addition to a full ophthalmological examination – including best-corrected visual acuity (BCVA; Early Treatment Diabetic Research Study chart), fundus biomicroscopy, fundus photography, fluorescein angiography, indocyanine green angiography (occult cases) and ocular coherence tomography – near visual acuity, reading speed, central visual field and quality of life for related activities were also investigated at baseline and at 3 months after ranibizumab treatment. Results: Mean BCVA increased from 62 ± 11 to 66 ± 14 letters at 3 months (7%; p = 0.018). Near vision improved from 9 ± 5 to 6 ± 3 points (33%; p = 0.0006) and reading speed increased from 59 ± 40 to 85 ± 50 words/min (44%; p < 0.0001). The mean deviation from normal of the visual field improved from −9 ± 7 to −6 ± 5 dB (33%; p < 0.0001). Quality of life improved for distance activities from 54 ± 28 to 63 ± 28 points (17%; p < 0.0001) but significantly (p = 0.024) more for near activities, from 49 ± 26 to 63 ± 26 points (29%; p < 0.0001). Reading newspaper text in the group in which the better eye was treated showed the highest increase in quality of life score of all: 116%. Conclusion: The increase in BCVA after ranibizumab treatment is well established. The present study also showed significant improvements in other important visual qualities, such as near visual acuity, reading speed, central visual field and several activities influencing quality of life. The improvement was greater for near activities than for distance activities. Therefore, the beneficial effects of ranibizumab treatment shown here are more extensive than those reported previously. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to describe the morphology, corneal topography and sensitivity in individuals with Dystrophia Helsinglandica. This autosomal dominant corneal disease is characterized by recurrent corneal erosive episodes and progressive subepithelial fibrosis not significantly affecting visual acuity. Methods: The corneas of nine affected and nine unaffected individuals were examined using slit-lamp biomicroscopy, in vivo confocal microscopy (IVCM) and videokeratography. Corneal mechanical sensitivity was also measured using a non-contact esthesiometer. Results: Slit-lamp biomicroscopy revealed that the affected individuals represented different stages of corneal changes, from a nearly normal cornea to subepithelial fibrosis of the central cornea. Corneal changes in affected individuals did not significantly decrease the best spectacle-corrected visual acuity. In vivo confocal microscopy detected morphological changes in the epithelium and stroma. Subepithelial opacity formation including altered keratocytes could be found in the anterior stroma in all affected eyes. With the exception of two eyes (one affected and one unaffected), all videokeratographies showed irregular astigmatism. Corneal sensitivity was significantly lower in affected individuals (p = 0.01). Age and corneal sensitivity showed no correlation. Conclusion: The main morphological findings in affected individuals were discrete and progressive subepithelial fibrosis, in the in vivo confocal microscope corresponding to optically dense extracellular matrix and activated keratocytes. Subbasal nerve morphology was changed in the affected family members who also showed a decreased corneal sensitivity. The findings are per se not specific to the disease. The changes probably reflect a healing response to erosive events on the corneal surface influenced by the genotype. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate prospectively the frequency with which exfoliation syndrome (XFS) occurs in patients with central retinal vein occlusion (CRVO) by clinical examination and ultrastructural examination of conjunctival biopsy specimens. Methods: Prospective observational case series. Thirty-six eyes of 36 consecutive patients with CRVO were investigated for XFS by slit-lamp examination and conjunctival biopsy when XFS was not clinically visible on examination. Results: A clinical diagnosis of XFS or a positive biopsy result for exfoliation material (XFM) was present in 22 of the 36 patients (61%; 95% confidence interval 45–75%). Twelve of these 22 patients (54%) had a clinical diagnosis of XFS. Aggregates of XFM were identified ultrastructurally in the biopsy specimens in 10 of 24 patients with no clinical signs of XFS (42%). Patients with and without XFS had similar distribution of age, gender, race and prevalence of systemic disorders. Twelve of the 22 (54%) XFS patients had neither glaucoma nor ocular hypertension prior to the CRVO. Conclusion: In accordance with previous retrospective and histological studies, this prospective, in vivo study suggests that CRVO is commonly associated with XFS. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare and study potential factors that affect the accuracy of corneal flap thickness created in laser-assisted in situ keratomileusis (LASIK) using the Moria model 2 (M2™) head 130 microkeratome with the Med-Logics calibrated LASIK blades Minus 20 (ML –20) and Minus 30 (ML –30). Methods: Corneal thickness in 200 (164 myopic and 36 hyperopic) eyes (100 patients) was measured by ultrasonic pachymetry preoperatively and intraoperatively after flap cutting. A total of 100 eyes were treated with the ML –20 and 100 with the ML –30. The right eye was operated before the left eye in each patient, using the same blade. In an additional group of 40 eyes, the left eye was operated first. Results: Mean corneal flap thickness using the ML –20 blade for an intended flap thickness of 140 μm was 129.1 μm (standard deviation [SD] 15.6, range 104–165 μm) in right eyes and 111.5 μm (SD 14.5, range 78–144 μm) in left eyes. Mean corneal flap thickness using the ML –30 blade for an intended flap thickness of 130 μm was 127.1 μm (SD 16.6, range 90–168 μm) in right eyes and 109.9 μm (SD 16.8, range 72–149 μm) in left eyes. Conclusions: Both microkeratome blade types cut thinner flaps than were intended. There was substantial variation in flap thickness. The first flap to be cut with a particular blade was considerably thicker than the second flap cut with the same blade. Based on these data, we recommend the use of disposable single-use microkeratomes rather than these ML blades. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate dynamic changes in the anterior segment in patients with acute anterior uveitis (AAU) using ultrasound biomicroscopy (UBM). Methods: Acute anterior uveitis was diagnosed in 18 patients according to history and ocular examinations. Ultrasound biomicroscopy was performed and the results at three time-points (within 2 weeks of the uveitis attack, and at 2−4 weeks and 6 weeks after it) were analysed. The relationships between clinical manifestations and UBM findings were also evaluated. Results: All investigated AAU patients showed severe ciliary injection, numerous dust keratic precipitates (KPs), aqueous flare and inflammatory cells, and were treated predominantly with corticosteroid and cycloplegic eyedrops. Ultrasound biomicroscopy showed a large number of cells in the anterior and posterior chamber, marked oedema and exudates in and around the iris and ciliary body within 2 weeks of AAU onset. These abnormalities were dramatically improved at 2−4 weeks and almost resolved at 6 weeks and thereafter. Conclusions: Ultrasound biomicroscopy reveals severe inflammatory changes in and around the ciliary body in patients with AAU. These signs rapidly resolve upon treatment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the possibility of including the presence of choroidal abnormalities detected by infrared reflectance as a new diagnostic criterion for neurofibromatosis type 1 (NF1). Methods: A cross‐sectional study was carried out in 24 eyes of 12 patients diagnosed with NF1 using the criteria of the National Institutes of Health (NIH). A group of 12 healthy individuals of equivalent age and sex served as control. The presence and number of visualized choroidal abnormalities were evaluated by Heidelberg optical coherence tomography (OCT) with infrared reflectance (NIR) as well as the presence of iridian Lisch nodules by slit lamp examination. Results: NIR by OCT shows the presence of choroidal hyperreflective nodules in all the patients diagnosed with NF1, while these choroidal abnormalities are not observed in any control. This finding is more frequent than the presence of iridian Lisch nodules. Conclusions: Hyperreflective nodules detected by NIR appear more frequently than Lisch nodules in NF1. The study suggests that it could be considered as a new diagnostic criterion for NF1. [ABSTRACT FROM AUTHOR]

Purpose: To describe the features of a choroidal macrovessel (CM) in multimodal imaging and underline the importance of non‐invasive imaging techniques. Methods: A 78‐year‐old man presented to our department for alteration of central vision of the right eye after uneventful cataract surgery. The patient had a complete ophthalmic examination with best corrected visual acuity (BCVA) measurement and slit lamp examination. Multimodal imaging was performed including fundus autofluorescence (FAF), Swept‐Source Optical Coherence Tomography (SS‐OCT), en‐face OCT, OCT‐angiography, Fluorescein Angiography (FA) and Indocyanine Angiography (ICG‐A). Results: BCVA was 20/50 in the right eye and 20/80 in the left eye. Anterior segment examination was unremarkable except for a nuclear cataract in the left eye. Funduscopic examination showed a subretinal tortuous lesion starting in the fovea and extending toward the temporal periphery in the right eye and was normal in the left eye. FAF of the right eye showed increased autofluorescence of the lesion retracing its serpiginous shape. SS‐OCT revealed a choroidal hollowness. This lesion had a pattern corresponding to a choroidal macrovessel on en‐face OCT scans with a similar signal to the physiological choroidal vessels. OCT‐A showed a low signal within the choroidal vessel. FA of the right eye showed an early serpentine‐shaped hyperfluorescence and ICG‐A revealed early prominent filling with late hypofluorescence and persisting laminar flow. A choroidal macrovessel (CM) was diagnosed. Conclusions: CM is a rare entity that is not always easy to recognize. ICGA is the most valuable tool for its diagnosis when the presentation is not typical. In cases of CM with a well delineated pattern, non‐invasive imaging modalities and particularly SS‐OCT and en‐face OCT can be very helpful for the diagnosis while avoiding dye injection. [ABSTRACT FROM AUTHOR]

Purpose: To report a case of a very late onset atypical sympathetic ophthalmia presented as a leopard spot retinopathy. Methods: An observational case report of a 64‐year‐old patient with a history of penetrating ocular trauma of the right eye (RE) at the age of 3‐year‐old who presented with visual blurring of the left eye (LE). The patient underwent complete ophthalmic examination, autofluorescence imaging, fluorescein angiography, Indocyanine Green (ICG) angiography, swept‐source optical coherence tomography (SS‐OCT). Results: Examination of the RE showed a phthisis bulbi. Visual acuity of the LE was limited to hand motion. Slit lamp examination revealed +1 cells anterior chamber inflammation, granulomatous keratic precipitates, posterior synechiae, with a mild cataract and +2 vitreous cells. Fundoscopy showed multiple yellowish patchy subretinal lesions. Fluorescein angiography revealed hyperfluorescent nummular areas at early frames without late leakage surrounded by zones of hypofluorescences. Fundus autofluorescence imaging showed a leopard spot pattern with areas of hypoautofluorescence surrounded by hyperautofluorescence. ICG angiography showed no hypofluorescent dark dots. SS‐OCT demonstrated retinal thickening, multiple areas of flat subretinal fluid, irregular hyperreflective spots at the photoreceptor outer segment layer and irregularities of the retinal pigment epithelium. The diagnosis of unilateral diffuse uveal melanocytic proliferation (DUMP) was first made. The patient underwent a systemic workup with full‐body computed tomography scans, cerebral and ocular magnetic resonance imaging and blood tests including tumor markers. All tests were normal. The patient was put on oral prednisone (1 mg/kg/day) during 6 months with a gradual tapering and good initial outcome. Visual acuity increased to 40/200. Two weeks after stopping steroids, he presented with acute granulomatous anterior uveitis and the diagnosis of very late onset sympathetic ophthalmia was made. Conclusions: Leopard retinopathy can be an uncommon clinical presentation of a variety of disorders especially sympathetic ophthalmia. The diagnosis could be challenging in case of atypical presentation and very late onset. Treatment outcome and close follow‐up should be considered for a correct diagnosis. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study is to explore the relationship between biomechanical corneal parameters and axial length in a pediatric population. Methods: We conducted a prospective study that included 82 eyes from 41 pediatric patients. All patients were submitted to a complete ophthalmologic examination that included autorefractometry (before and after pharmacological cycloplegia), slit lamp and fundus examination, ocular tonometry. Additionally, the patients underwent examination with Ocular Response Analyzer (Reichert Ophthalmic Instruments Inc., Depew, NY) to determine corneal hysteresis (CH), corneal resistance factor (CRF) and with Aladdin biometer (Topcon, Tokyo, Japan) to determine axial length (AL) and central corneal thickness (CCT). Statistical analysis was performed using IBM SPSS Statistics 26. Results: Our study included 82 eyes, from 41 patients (63.41% female, 36.59% male). The average age was 13.29 years old (12.92 in females, 13.93 in males). Average CH, CRF, and spherical power, respectively, were similar between sexes: 12.30 mmHg, 12.47 mmHg, −0.70 D respectively in females, 12.89 mmHg, 13.31 mmHg and −1.27 D respectively in males. Mean AL and CCT are larger in males than in females, in a statistically significant manner. Average AL is 23.69 mm in females, 24.52 mm in males (p = 0.007) and average CCT is 0.558 mm in females and 0.583 mm in males (p = 0.003). We also found a statistically significant moderate negative correlation between CH and AL in the pediatric population (Pearson's r of −0.350, p = 0.001), and also in both sexes (Pearson's r of −0.419, p = 0.002 in females and −0.437, p = 0.016 in males). Conclusions: Our study reveals that in the pediatric population, at similar age, males have a thicker central cornea and longer axial length. Furthermore, in these patients, a high axial length is correlated to a low corneal hysteresis. Further studies are needed to explore these data and to confirm these findings in adults. [ABSTRACT FROM AUTHOR]

Purpose: To describe the importance of applying an urgent protocol in cases of lens subluxation into the anterior chamber (AC) in order to diminish the risk of corneal decompensation. Methods: A 60‐year‐old man with a history of ocular trauma in his youth and pseudoexfoliation syndrome, presented pupillary block in the right eye 2 months after an accidental fall without ocular involvement. Visual acuity was 0.05 (decimal) and intraocular pressure was 55 mmHg. Slit lamp examination and anterior segment Optical Coherence Tomography showed a lens subluxation towards AC (lower portion) with endothelial contact and corneal edema. In funduscopy, an inferior giant tear with associated retinal detachment was observed. Results: After treating ocular hypertension with hypotensive agents, Pars Plana Vitrectomy 25 Gauge + Lensectomy + Endolaser + SF6 Tamponading gas were performed, leaving the patient in aphakia for subsequent intraocular lens implantation surgery. Two months later, a substantial loss of endothelial cell count was observed (777 cells right eye VS 2223 cells left eye). Conclusions: In this type of pathology, it is imperative to take immediate pharmacological, postural and surgical measures to reduce contact between the lens and the cornea, in order to minimize endothelial damage and improve the visual prognosis of these patients. Bibliography: Ke G, Zhou E, Zhu K, Wei Y, Wang Z, Jia Y, Wang S, Gu Y. Retinal break associated with traumatic lens dislocation or subluxation requiring vitrectomy. Graefes Arch Clin Exp Ophthalmol. 2020 Mar;258(3):693–697. doi: 10.1007/s00417‐019‐04530‐9. Epub 2019 Nov 28. PMID: 31781882. Salehi‐Had H, Turalba A. Management of traumatic crystalline lens subluxation and dislocation. Int Ophthalmol Clin. 2010 Winter;50(1):167–79. doi: 10.1097/IIO.0b013e3181c567de. PMID: 20057305. [ABSTRACT FROM AUTHOR]

Purpose: The tonographic effect has been observed in several studies in occulopression, repeated tonometry or ophthalmodynamometry. It describes an intraocular pressure (IOP) decrease caused by an artifical IOP increase. In healthy eyes, an IOP drop of 2–3 mmHg/min was reported. However, there are studies that show a reduced decrease of the IOP drop for instance in glaucoma patients. In this work, we present a proof of principle to determine the tonographic effect in healthy eyes by utilizing a novel pneumatic pressure modulator. Methods: The study was conducted on 8 healthy subjects (4 m, 4 f, 1 eye each, mean age 27.4 ± 7.1 yr). All subjects passed an ophthalmic examination procedure, including visual acuity determination, tonometry, objective refraction, slit lamp examination. Exclusion criteria were myopia < ‐8 dpt, anamnestic surgeries, corneal scars, eye diseases, ocular hypertension, and ongoing ocular local therapy. No anaesthetics were used. A pressure modulator (IOPstim, Imedos Systems GmbH, Jena, Germany) was used to increase the IOP to initially pathologic IOP values of about 35 mmHg (36.6 ± 2.5 mmHg). The applied pressure was kept constant for 2 minutes. The IOP was measured 4 times (at 0s, 40s, 80s, and 120s) using a rebound tonometer (Icare PRO, Icare Finland Oy, Helsinki, Finland). Linear regression was performed to calculate the average IOP decrease within the 2‐minutes interval. Results: For all 8 subjects, a typical decrease of the IOP was observed during a 2 min constant pressure stimulation. The mean decrease of the pressure profiles was 2.77 mmHg/min (R2 = 0.94). Conclusions: We successfully applied a pneumatic pressure modulator to determine the tonographic effect in the human eye. For 2 min we measured the mean decrease of the IOP drop with similar values known by the literature. Application of the pneumatic pressure modulator allows the investigation of pathological reduced IOP drops that differ from normal values as shown in this study. [ABSTRACT FROM AUTHOR]

Purpose: To describe corneal changes after birth trauma from forceps delivery, using anterior segment optical coherence tomography (AS‐OCT), in order to reduce the risk of potential anisometropic amblyopia. Methods: A 73‐year‐old female patient came to the ocular surface section consulting for dry eye disease symptoms. At the slit lamp examination, a vertical endothelial stria was observed in the right eye. After an exhaustive anamnesis, the patient referred having a traumatic birth in which forceps had been used. Results: An AS‐OCT was performed, showing a vertical rupture in the Descemet membrane secondary to traumatic birth with forceps. Conclusions: Descemet's membrane rupture can cause corneal oedema which usually clears over time, but those ruptures often persist. The residual corneal changes can result in anisometropia and the main cause of vision loss after such injury is anisometropic amblyopia. The AS‐OCT is a useful diagnostic tool to detect these alterations at early stages. Bibliography: Sarma P, Borgohain M, Tayab S, Sangma CA. Descemet's membrane rupture secondary to forceps‐induced birth injury. Indian J Ophthalmol. 2020;68(10):2253. https://doi.org/10.4103/ijo.IJO%5f149%5f20 Alobaidy R, Srinivasan S. Forceps‐induced birth injury to the cornea. BMJ Case Rep. 2014;2014:bcr2013201786. Published 2014 Apr 9. https://doi.org/10.1136/bcr‐2013‐201786 [ABSTRACT FROM AUTHOR]

Purpose: Remogen® Omega is the first omega‐3 containing drop indicated in the treatment of dry eye syndrome (DES). It contributes to the maintenance of the physicochemical balance of the tear film and facilitates eye recovery. The aim of this study was to compare the efficacy and safety of Remogen® Omega and Cationorm® in patients with moderate to severe DES. Methods: This was a randomised controlled, masked‐observer multicentre trial. Patients used 4 drops of Remogen® Omega or Cationorm® per day for 3 months. The primary efficacy endpoint was the change from baseline at D28 in the score of ocular surface staining with fluorescein (OSSF) using Oxford scale. Other efficacy parameters included the score of ocular surface staining with lissamine green, Schirmer I test, tear film break‐up time, ocular surface disease index score, symptoms intensity and frequency, treatment comfort and overall efficacy at D28 and D84. Safety was evaluated based on intraocular pressure, best‐corrected visual acuity, general external examination, slit lamp examination and occurrence of adverse events. Results: In total, analysed intent‐to‐treat population consisted on 23 patients who were randomly assigned to Remogen® Omega (n = 10) or Cationorm® (n = 13) arms. Patients were in average 67.1 years old and 91.3% were women. Demographics were balanced between the two arms. Mean (standard deviation) reductions of ‐1.0 (1.1) and ‐0.7 (1.7) were observed for OSSF scores in Remogen® Omega (p = 0.01) and Cationorm® (p = 0.05) arms at D28 versus baseline, respectively. Similarly, improvements were observed in both treatment groups for other efficacy criteria. The only between‐arm difference detected was the duration of blur vision which was longer after administration of Remogen® Omega compared with Cationorm® at D28 and D84 (p < 0.01). Both treatments were considered as comfortable and satisfying by patients and investigators. No statistically significant between‐arm differences were observed for safety parameters and no safety issues were raised. Conclusions: Observed results suggest that both treatments have a beneficial effect on DES symptoms alleviation. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ability of ultrasound biomicroscopy (UBM) to detect abnormalities in the zonular apparatus in unaffected eyes of patients with clinically unilateral exfoliation syndrome (XFS) using a standardized grading system. Methods: The affected and unaffected eyes of 17 patients with clinically unilateral XFS and 17 eyes of 17 control subjects underwent UBM. Radial sections detailing the lens and zonules at 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00 and 10:30 clock hours were obtained. The images were graded by a masked, experienced UBM observer using a standardized scoring system based on the zonular appearance (0, none; 1 and 2, uneven or disrupted zonules with or without patchy deposits; 3, diffuse granulation, thick zonules or both; 4, total zonular disruption). Affected meridians were compared by the Friedman test, while distributions of unaffected and affected eyes were compared using the Student t-test. Results: In the control group, 15/17 eyes showed normal zonules; the remaining two eyes showed grade 1 changes in some meridians. The mean grade score was 0.33 [standard deviation (SD) 0.84]. Eyes with XFS had a higher score than control eyes, with a mean score of 14.35 (SD 7.14, P < 0.001, Student t-test). In clinically unaffected fellow eyes, the mean score was 10.53 (SD 7.44), and was less than that of XFS eyes ( P = 0.008, Student t-test). Twelve XFS eyes (71%) and six unaffected fellow eyes (35%) had grade 3 or 4 in at least one meridian ( P = 0.07, Friedman test). Conclusion: Bilateral zonular involvement is present in subjects with clinically unilateral XFS. These zonular changes may be extensive in fellow eyes without clinically evident exfoliation material. UBM assessment of zonular status in fellow eyes prior to cataract extraction may aid in surgical planning. [ABSTRACT FROM AUTHOR]