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Ji Sang Min,1 Byung Moo Min2 1Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea; 2Woori Eye Clinic, Affiliated Clinical Professor to Department of Ophthalmology, Yonsei University College of Medicine, Daejon, 35229, Republic of KoreaCorrespondence: Byung Moo Min, Woori Eye Clinic, Affiliated Clinical Professor to Department of Ophthalmology, Yonsei University School of Medicine, Daeduk Daero 219 (Dunsan-dong), Seo-gu, Daejon, 35229, Republic of Korea, Tel +82-42-476-1675, Fax +82-42-476-1670, Email bmin8275@naver.comPurpose: This retrospective case control study report includes 4 eyes of 4 patients (aged from 37 to 44 years) with keratoconus suspect (KCS) who underwent laser epithelial keratomileusis linked laser asymmetric keratectomy (L-LAK) as corneal remodeling technique in order to avoid postoperative corneal ectasia.Patients and Methods: Four eyes of 4 patients showed corneal topography findings with abnormal localized steep keratometric curvature greater than 47.0 D and peripheral corneal thickness asymmetry (Total corneal central thickness deviations in four directions on Orbscan map (SUM)≥ 80 μm). L-LAK could be performed both the original ablation of refractive errors (SE from − 1.25 to − 5.50 D) and the customized ablation (selective ablation of the thicker peripheral cornea averaging:64 μm selectively and the central cornea of the myopic shift due to LAK averaging-1.50D. The main outcome measures between preoperative and postoperative 2 year were refraction, visual acuity (UDVA), keratometry, corneal symmetry evaluating SUM.Results: After 2 years, SEs (D, average) were − 0.34, UDVA (LogMAR) was 0.00. keratometry including Kmax was markedly decreased, SUM had diminished markedly. There were no case of postoperative adverse effects.Conclusion: L-LAK resulted in a decreased SUM, increased corneal symmetry, and no postoperative corneal ectasia with good visual outcomes in myopic patients with KCS.Keywords: keratoconus suspect, corneal remodeling, L-LAK, KCS, linked laser asymmetric keratectomy

Malcolm T Wiseman Jr,1 Jared J Ebert,1 James J Augsburger,1 Maura Di Nicola,1,2 Zelia M Correa,1,2 James I Geller,3 Basil K Williams Jr1,2 1Ocular Oncology Service, Department of Ophthalmology, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 2Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; 3Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USACorrespondence: Basil K Williams Jr, Email basilkwilliams@gmail.comIntroduction: A retrospective review of patients treated for retinoblastoma who developed a non-pineoblastoma second primary malignant neoplasm (SPMN) was performed.Methods: The demographics, clinical features and treatments for retinoblastoma, pathologic types of non-pineoblastoma second primary malignant neoplasm (SPMN), intervals between the retinoblastoma diagnosis and treatment and diagnosis of non-pineoblastoma SPMN, treatment provided for the SPMN, and the survival outcomes of the patients were evaluated.Results: Of 550 patients treated initially for retinoblastoma, this series used the 15 (2.7) that developed a non-pineoblastoma SPMN, 14 of which (93.3%) had been treated for bilateral retinoblastoma. All patients had carried a germline mutations in the RB1 gene. The median time from retinoblastoma diagnosis to SPMN diagnosis was 19.0 years (extremes 3.4 and 39.4 years). Six of the fifteen patients died during the follow-up of their SPMN. The median interval between initial retinoblastoma diagnosis and death in the 6 patients who died of their SPMN was 18.8 years (extremes 6.2 and 34.6 years) and between diagnosis of the SPMN and death was 1.2 years (extremes 0.25 and 4 years).Discussion: Of the patients who had been treated with External Beam Radiotherapy (EBRT), 13 developed a SPMN within the previously irradiated field.Keywords: external beam radiotherapy, pediatrics, osteosarcoma, retinoblastoma, family history, second primary malignant neoplasm

Gina Wesley,1 Melissa Morrison Toyos,2 Melinda M DiVito,3 Matthew Zirwas4 1Complete Eye Care, Medina, MN, USA; 2Toyos Clinic, Nashville, TN, USA; 3Medical Affairs, Bausch + Lomb, Bridgewater, NJ, USA; 4Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USACorrespondence: Gina Wesley, Complete Eye Care, 170 Westfalen Trail, Medina, MN, 55340, USA, Tel +1 763 478 3505, Fax +1 763 478 2727, Email drwesley@cecofmedina.comPurpose: Cosmetic products applied to the periocular area can cause skin sensitivity reactions, and manufacturers routinely test the safety and tolerability of products in development. This research was sponsored by Bausch + Lomb to evaluate three Lumify Eye Illuminations products: a lash and brow serum, a hydra-gel eye cream, and a micellar water eye makeup remover.Methods: A cumulative irritation test (CIT) study and a repeated insult patch test (RIPT) study enrolled adult males or females with no known sensitivities to cosmetic products. Three clinical safety studies enrolled adult females with self-reported characteristics targeted by each product, which was applied in a manner consistent with expected use for 8 or 12 weeks.Results: In CIT (n=34) and RIPT (n=201) studies, faint/minimal erythema reactions were observed in 0% to 2.9% of participants; there were no moderate or severe reactions. No safety signals were observed in participants who completed clinical safety studies for lash and brow serum (n=66 enrolled, n=55 completed [83%]), eye cream (n=61 enrolled, n=52 completed [85%]), or eye makeup remover (n=80 enrolled, n=68 completed [85%]). No clinically relevant changes in visual acuity or ophthalmologic slit-lamp examination findings were noted. No participants reported ocular sensations of burning/stinging, foreign-body sensation, or soreness. At the final clinical safety study assessment, mild cutaneous erythema (as graded by the investigator) was reported for one participant (eye cream study); no other prespecified signs of cutaneous irritation (eg, edema, dryness) were observed. A treatment-related adverse event that led to study discontinuation was experienced by one participant in the eye makeup remover study (bilateral periorbital swelling).Conclusion: Findings from rigorously conducted irritation testing and clinical safety studies indicated that these products were safe and well tolerated. Increased availability of data regarding ocular and cutaneous safety of cosmetic products can inform consumer decision-making and eye care provider recommendations.Keywords: cutaneous, cosmetics, irritation, periocular

Parth J Rana,1 Himanshu Deshmukh,2 Urmil Shah,3 Vinod Kumar,4 Sanghamitra Kanungo,5 Deepika Singhal,6 Santosh Kumar Mahapatra,7 Ira Vakharia,8 Mukesh Jaiswal,9 Ajitkumar Gondane,10 Pooja Vaidya,10 Vinayaka Shahavi,9 Harish Shandilya,11 Dattatray Pawar,10 Akhilesh Sharma12 1Department of Retina and Trauma Surgery, Netralaya Superspeciallity Hospital, Ahmedabad, Gujarat, India; 2Department of Retina; ‘Daulat’ Deshmukh Eye Hospital, Khaparde Gardens, Amravati, Maharashtra, India; 3Department of Retina, P.N. Desai Eye Hospital, Ahmedabad, Gujarat, 380052, India; 4Department of Ophthalmology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India; 5Department of Retina, Kar Vision Eye Hospital, Bhubaneswar, Odisha, 751007, India; 6Department of Ophthalmology, GMERS Medical College and Civil Hospital, Ahmedabad, Gujarat, India; 7Department of Retina, JPM Rotary Club of Cuttack Eye Hospital and Research Institute, Cuttak, Odisha, 753014, India; 8Department of Retina, Nirmal Hospital Pvt Ltd, Surat, Gujarat, 395002, India; 9Clinical Research Department, Alkem Laboratories Ltd., Lower Parel, Mumbai, India; 10Medical Affairs Department, Alkem Laboratories Ltd., Lower parel, Mumbai, India; 11Global Product Development, IPM & Regulatory Affairs, Enzene Biosciences Ltd., Pune, India; 12Medical Affairs and Clinical Research Department, Alkem Laboratories Ltd., Lower Parel, Mumbai, IndiaCorrespondence: Ajitkumar Gondane, Medical Affairs, ALKEM Laboratories Ltd., ALKEM HOUSE, “Devashish”, Adjacent to Matulya Centre, Senapati Bapat Marg, Lower Parel, Mumbai, 400 013, India, Tel +8983375722, Email ajitkumar.gondane@alkem.comObjective: This study aimed to compare efficacy, safety, and immunogenicity of the biosimilar ranibizumab in comparison with the Innovator Ranibizumab in treatment-naive patients with neovascular (wet) age-related macular degeneration (nAMD or wAMD).Materials and Methods: This comparative, double blind, multicentre, Phase III clinical study randomized eligible patients in a 3:1 ratio to receive either OPTIMAB® (Alkem Laboratories Ltd./ Enzene Biosciences Ltd.) or Innovator Ranibizumab. Intravitreal injections of Innovator Ranibizumab (0.5 mg in 0.05 mL) and OPTIMAB® (0.5 mg in 0.05 mL) were administered every four weeks for 12 weeks (three doses). Primary efficacy endpoints included loss of < 15 letters from baseline, gain of ≥ 15 letters from baseline in visual acuity, mean change in best corrected visual acuity (BCVA) from baseline, and change in central subfoveal thickness (CSFT) from baseline at week 12. Safety was assessed through monitoring of adverse events (AEs) and serious adverse events (SAEs) throughout the study.Results: Overall, of the 152 patients randomized, 141 (92.8%) patients (mean age, 66.6 ± 9.37 years) completed the study. Percentage of patients who lost < 15 letters in BCVA at week 12 from baseline was comparable in both the groups (100.0%, each). On secondary end point analysis, the two groups had comparable mean changes in BCVA (OPTIMAB®, 11.8 ± 9.18; innovator ranibizumab, 12.9 ± 10.29; P = 0.5509); proportion of patients who gained ≥ 15 letters in visual acuity (OPTIMAB®, 32.18%; innovator ranibizumab, 25.74%; P = 0.4785) and mean change in CSFT (OPTIMAB®, − 76.6 ± 89.03; Innovator ranibizumab, − 73.1 ± 92.23 μm; P = 0.8422) at week 12 as compared to baseline. OPTIMAB® and innovator ranibizumab demonstrated comparable safety over the 12-week treatment period and no patient expressed anti-ranibizumab antibody in either group patient.Conclusion: Biosimilar ranibizumab (OPTIMAB®) was non-inferior to innovator ranibizumab in terms of efficacy, safety, and immunogenicity in the patients of nAMD.Keywords: biosimilar ranibizumab, best corrected visual acuity, central subfoveal thickness, nAMD

Yaqoob Qaseem,1 Kirk Kohwa Hou,1,2 Moritz S Pettenkofer1 1Retina Division, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA; 2Doheny Eye Institute, Los Angeles, CA, USACorrespondence: Moritz S Pettenkofer, Retina Division, Stein Eye Institute, University of California Los Angeles, 200 Stein Plaza Driveway, Los Angeles, CA, 90095, USA, Email mpettenkofer@mednet.ucla.eduPurpose: To examine response to faricimab in neovascular age-related macular degeneration (nARMD) refractory to traditional anti-vascular endothelial growth factor (anti-VEGF) agents.Patients and methods: Retrospective chart review was conducted on eyes with nARMD with persistent subretinal and/or intraretinal fluid despite previously receiving ≥ 15 injections with ≥ 2 different anti-VEGF agents. Best corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters were collected at baseline, initial post-injection visit, and most recent visit with OCT following last faricimab.Results: Nineteen eyes were included. Average logMAR BCVA was 0.47 ± 0.60 at baseline, 0.42 ± 0.47 at initial follow-up (p=0.38), and 0.51 ± 0.63 at final visit (p = 0.50). Average central subfield thickness (CST) was 310 ± 92 μm at baseline, 279 ± 88 μm at initial follow-up (p = 0.001), and 274 ± 100 μm at last visit (p < 0.001). 9 eyes (47%) achieved resolution of fluid at both initial and final follow-up visits.Conclusion: Faricimab mildly decreased CST and reduced fluid in some nARMD eyes refractory to traditional anti-VEGF agents but had minimal effect on BCVA.Keywords: anti-VEGF, choroidal neovascularization, faricimab, neovascular age-related macular degeneration

Karl Aharonian,1 Henry Krasner,1 Jeffrey Martin,1 Kavita Batra,1,2 Meher Yepremyan1 1Department of Medical Education, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USA; 2Office of Research, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, USACorrespondence: Karl Aharonian, Email Aharonia@unlv.nevada.eduPurpose: Does weather affect the rate of developing rhegmatogenous retinal detachment (RRD)? This comprehensive review investigates the findings of the most recent studies on the relationship between RRD and climatic or seasonal factors.Methods: An extensive search across PubMed, Embase, and Google Scholar databases resulted in 112 initial results, from which 18 studies published between 1980 and 2024 were selected. The selection criteria were based on the studies’ relevance to our topic. We analyzed their methodology, geographic scope, and key findings. Data extraction encompassed study design, sample size, sex ratio, incidence rates, results, and identified limitations.Results: Eight studies found no statistically significant relationship between seasonal variations and the incidence of RRD. Conversely, seven studies reported an increased incidence of RRD during the summer months. Additionally, secondary analyses of factors, such as ambient temperature, atmospheric pressure, and daylight hours, showed varied and sometimes conflicting results. A summary of common limitations and biases was synthesized into a table, providing guidelines for future research exploring this topic.Conclusion: This comprehensive review highlights the complex interaction between environmental factors and RRD incidence. The conflicting results across different studies suggest a need for further research in this area. Future studies should address the identified limitations and biases to provide a clearer understanding of the relationship between climate and RRD. By utilizing the guidelines from our review, future research could aim to minimize confounding factors and improve the robustness of their findings. Understanding these interactions can be used to develop preventive strategies and enhance clinical practices to reduce the burden of RRD.Keywords: rhegmatogenous retinal detachment (RRD), climate, seasonality, temperature

Ana Faria Pereira,1 Ana Gama e Castro,1 Rita Teixeira-Martins,1 Inês Coelho-Costa,1 Sónia Torres-Costa,1 Marta Silva,1 Ana Catarina Pedrosa,1 Joana Araújo,1 Luís Figueira,1– 3 Cláudia Oliveira-Ferreira1,4 1Department of Ophthalmology, Unidade Local de Saúde de São João, Porto, Portugal; 2Unit of Pharmacology and Therapeutics, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, Portugal; 3MedInUP - Center for Drug Discovery and Innovative Medicines, Faculty of Medicine, University of Porto, Porto, Portugal; 4Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Ana Faria Pereira, Department of Ophthalmology, Unidade Local de Saúde de São João, Avenida Prof. Hernâni Monteiro, Porto, 4202 – 451, Portugal, Email acfariapereira@gmail.comPurpose: Syphilis is a re-emerging infectious disease with various systemic manifestations, including ocular involvement, which can lead to significant morbidity if untreated. This study aims to analyze the ocular manifestations of syphilis in patients treated at a Portuguese tertiary center over a 14-year period.Patients and Methods: A retrospective review of patients diagnosed with syphilis who presented with ocular symptoms from 2010 to 2023 was conducted. Data collected included demographic information, clinical presentation, ophthalmologic findings, serologic test results, treatment regimens and outcomes.Results: A total of 47 patients with ocular syphilis were identified. The mean age of the cohort was 45, with a male predominance of 78.7%. The most common ocular manifestations included uveitis (mostly posterior and panuveitis), optic neuritis, acute syphilitic posterior placoid chorioretinitis and vitritis. Best corrected visual acuity (BCVA) at presentation was highly variable, ranging from hand movements to no impairment of visual acuity. At the end of the follow-up period, the majority of the study eyes achieved a BCVA between 0 and 0.1 (p< 0,000). Acute syphilitic posterior placoid chorioretinitis was associated with poorer visual outcomes after treatment, indicating its presence is a poor prognosis factor. HIV status, the presence of vitritis, vasculitis and papillitis at presentation, a positive syphilis serology in cerebrospinal fluid and treatment regimen did not appear to have a significant impact on the final BCVA.Conclusion: Ocular syphilis, though rare, remains a significant cause of visual morbidity. Early recognition and prompt treatment are crucial for preventing permanent vision loss. Regular screening and increased awareness among clinicians are essential to manage this potentially sight-threatening condition effectively. Further research is needed to optimize treatment protocols and improve patient outcomes.Keywords: syphilis, uveitis, optic neuritis, retinal vasculitis, retrospective study, penicillin

Mohanna Aljindan,1 Hanan A Neyaz,1,2 Halah Bin Helayel,3 Nada N Alwohaibi,4 Adel Aziz Rushood5 1Department of Ophthalmology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; 2Department of Ophthalmology, Ohud Hospital, Madinah, Saudi Arabia; 3Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia; 4Anterior Segment Division, Dhahran Eye Specialist Hospital, Dhahran, Eastern Province, Saudi Arabia; 5Anterior Segment Division, Kahhal Medical Centre, Dammam, Saudi ArabiaCorrespondence: Hanan A Neyaz, Imam Abdulrahman bin Faisal University, Ophthalmology Department, Dammam, Saudi Arabia, Tel +966530404999, Email Hanan.Neyaz@gmail.comObjective: To investigate the visual outcomes and patient satisfaction following trifocal intraocular lens (IOL) implantation after radial keratotomy (RK).Methods: This was a retrospective chart review wherein we studied 14 eyes from 7 patients who had undergone cataract surgery and had trifocal intraocular lens (IOL) implanted in the Eastern Province of Saudi Arabia’s King Fahd University Hospital and Kahhal private centre. Data such as demographic characteristics, the time between RK and cataract removal, intraoperative and postoperative complications, preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refraction were evaluated. In addition, visual complaints and satisfaction were assessed through a questionnaire.Results: All eyes included had 8 RK sections. The mean spherical equivalent was +1.81 ± 4.27 D preoperatively and was − 0.41 ± 1.2 D at the last follow-up. The mean uncorrected distance visual acuity (UDVA) increased from 0.32 ± 0.2 prior to surgery to 0.64 ± 0.2 following surgery. The mean efficacy index was 1.01 and a safety index was 1.26. In the last follow-up, 29% reported having 0.5 spherical equivalents, while 86% were within 1D. Improvement in cylindrical correction was noticed in the last follow-up with 36% not more than 0.5 D and 43% within 1D. In total, 80% of patients had a distance-corrected near visual acuity (DCNVA) of better than 20/40. The survey response rate was 100%, and two patients reported a lower degree of satisfaction. Glare and difficulty seeing at night were the most often reported complaints, with a mean of 2.86 ± 1.95 and 22 ± 1.9, respectively.Conclusion: Our results suggest that implantation of a trifocal IOL is safe and effective in patients with previous RK. However, several factors, including the patient’s preoperative expectations, glare testing, refractive error, number of cuts, optical zone size, and visual phenomena related to RK, should be considered before implantation.Keywords: cataract surgery, radial keratotomy, trifocal IOL, refractive surgery

Artur Ma&lstrok;yszczak,1 Joanna Wiktoria Prze&zacute;dziecka-Do&lstrok;yk,2 Urszula Szyde&lstrok;ko-Pa&sacute;ko,1 Marta Misiuk-Hoj&lstrok;o1 1Department and Clinic of Ophthalmology, Wroclaw Medical University, Wroclaw, Dolnoslaskie, Poland; 2Ophthalmology Clinical Center SPEKTRUM, Research and Development Center CREO, Wroclaw, Dolnoslaskie, PolandCorrespondence: Artur Ma&lstrok;yszczak, Department and Clinic of Ophthalmology, Wroclaw Medical University, Borowska 213, Wroc&lstrok;aw, Dolnoslaskie, 50-556, Poland, Tel +71 736 43 00, Email arturm100@gmail.comPurpose: The purpose of this study was to evaluate retinal and choroidal vascularization parameters in patients with type 2 diabetes mellitus (DM), without diabetic retinopathy (DR), and to compare them to healthy controls.Patients and methods: Seventy-four eyes from 74 patients (40 eyes in the DM group and 34 eyes in the control group) were included in the study. Optical coherence tomography angiography RTVue XR Avanti was used to obtain 3× 3mm scans of the macula. The choroidal vascularity index (CVI), superficial and deep capillary plexus vascular densities (SCP and DCP, respectively), and choroidal thickness (CT) were measured.Results: In the diabetic group, SCP was lower in the superior and nasal segments (48.68 vs 50.62, p=0.02; 45.50 vs 48.82, p=0.02, respectively). The DCP did not differ between the groups. CVI was significantly lower in the study group in all measured segments, including central and parafoveal (31.73 vs 48.86 and 50.32 vs 59.58, p< 0.001, respectively). CT was larger in the study group only at the center of the macula (281.89μm vs 268.37μm p< 0.001) and in the inferior segment (337.47μm vs 329.40μm, p< 0.001). In the multivariate regression, clinical and vascularization parameters affecting CVI and CT were analyzed after adjusting for age and sex. Decreased central CVI was associated with the presence of DM, lower central SCP, and bigger foveal avascular zone area (b=− 0.68, b=0.47, b=− 0.21). Parafoveal CVI was also negatively affected by DM (b= − 0.46) and positively by parafoveal SCP (b= 0.44). Increased central CT was found to be positively associated with higher central SCP (b=0.48) and male sex (b=0.20).Conclusion: The results of our study confirmed a reduction of SCP and CVI in diabetic patients without DR. DM and SCP are age and sex independent parameters affecting CVI. Central CT is affected by SCP and sex, rather than the presence of diabetes.Keywords: choroidal vascularity index, choroidal thickness, OCTA, diabetes

Gui-Fu Li, Qin Yu, Chun-Xia Li Shanghai TCM-Integrated Hospital, Shanghai University of TCM, Shanghai, People’s Republic of ChinaCorrespondence: Chun-Xia Li, Shanghai TCM-Integrated Hospital, Shanghai University of TCM, No. 230 Baoding Road, Shanghai, People’s Republic of China, Tel +86-18101915248, Email cx_li1964@outlook.comObjective: To explore the research hotspots in acupuncture treatment for myopia from 2014 to 2023.Methods: A comprehensive search was conducted in the Science Citation Index-Expanded (SCI-E) within the Web of Science Core Collection (WOSCC). We used CiteSpace 6.2.R6 to perform an in-depth analysis of the annual publication trends, prolific authors, institutions, keyword co-occurrences, and citation bursts. The study followed the PICO framework: the population (P) includes studies on patients with myopia, the intervention (I) is acupuncture treatment, no direct comparison (C) is applied, and the primary outcome (O) focuses on the identification of research trends and hotspots. Major outcome assessments included the analysis of publication trends over time, author productivity, influential journals, and the detection of emerging research topics through citation burst analysis. This bibliometric analysis was conducted on November 15, 2023.Results: A total of 281 articles were included in the analysis. The trend line of annual publications over the past decade showed a modest increase, with a significant decline in 2019 and a surge in 2021. China and its affiliated academic institutions led globally in publication volume, with Ma Xiaopeng being the most prolific author and Fudan University the most influential institution. Ophthalmology emerged as the journal with the highest citation frequency. The most frequently occurring keywords were related to adolescent myopia and its complications. The developmental trajectory of the field is distinct, characterized by the integration of a single discipline.Conclusion: Acupuncture shows promise as a complementary and alternative therapy for treating myopia, with growing interest in its clinical efficacy and mechanisms of action. Future research is likely to focus on optimizing treatment protocols and understanding the underlying biological mechanisms of acupuncture in myopia management.Keywords: myopia, acupuncture, bibliometric analysis

Mitsuya Otsuka, Naoki Tojo, Hitoshi Yamazaki, Tomoko Ueda-Consolvo, Atsushi Hayashi Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, JapanCorrespondence: Atsushi Hayashi, Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama City, 930-0194, Japan, Tel +81-76-434-7363, Fax +81-76-434-5037, Email ahayashi@med.u-toyama.ac.jpPurpose: We compared the corneal endothelial cell loss between trabeculectomy (Trab) and Ex-Press® surgery (EXP) for low-intraocular pressure (IOP) glaucoma patients.Patients and Methods: This was a single-facility retrospective study. We analyzed the cases of patients with primary open-angle glaucoma (POAG) and pre-operative IOP ≤ 21 mmHg who had undergone Trab or EXP surgery and were followed for > 3 years. Noncontact specular microscopy was used to determine the corneal endothelial cell density (CED) before and after Trab or EXP surgery. We measured the CED at 12, 24, and 36 months post-surgery. We compared the CED values and CED survival ratio after both surgeries using paired t-tests.Results: We included 39 eyes that underwent Trab and 36 eyes that underwent EXP surgery. In the Trab group, the mean CED value had decreased from 2333 ± 399 at baseline to 2066 ± 587 cells/mm2 after 3 years. In the EXP group, the mean CED value had decreased from 2320 ± 393 at baseline to 2229 ± 460 cells/mm2 after 3 years. The survival ratio of CED at > 3 years was 89.3 ± 14.2% (Trab group) and 95.6 ± 11.1% (EXP group); compared to the Trab surgery, the EXP surgery thus significantly decreased the CED loss (p = 0.037). No case resulted in bullous keratopathy.Conclusion: Compared to trabeculectomy, Ex-Press® surgery appears to be a safer surgical method with regard to the endothelial cell loss risk.Keywords: Ex-Press, glaucoma, corneal endothelial cell, trabeculectomy

Sarah E Guthrie, Doerte Luensmann, Marc-Matthias Schulze, Jill Woods, Lyndon Jones Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, CanadaCorrespondence: Sarah E Guthrie, Centre for Ocular Research & Education (CORE), School of Optometry & Vision Science, University of Waterloo, Waterloo, Ontario, N2L 3G1, Canada, Tel +1 519 888 4567, Fax +1 519 888 4303, Email sarah.guthrie@uwaterloo.caPurpose: This prospective comparative study aimed to assess the effects on contact lens comfort, dryness, and wear time when symptomatic daily disposable (DD) contact lens (CL) wearers were refit with delefilcon A (DT1) lenses.Patients and Methods: Thirty five symptomatic DD CL wearers with dry eye disease as determined according to the TFOS DEWS 2 guidelines, were enrolled and completed the study. Participants wore their habitual DD CLs during an initial assessment and were subsequently refit with DT1 for 1 month. Participants were masked to the study lens type. Subjective ratings of end-of-day comfort and dryness, average wear time, and comfortable wear time were evaluated as primary endpoints.Results: Of the 35 participants, two participants were classified as aqueous deficient dry eye, while the remaining participants exhibited symptoms primarily due to evaporative causes. The median CLDEQ-8 score for dryness significantly improved from 17 (fair) with habitual lenses to 13 (good) with DT1 lenses (p < 0.01). Participants reported significantly better end-of-day comfort (p = 0.01) and less end-of-day dryness (p = 0.01) with DT1 compared to their habitual DD lenses. The comfortable wear time was significantly longer with DT1 (8.5 ± 4.1 hours) compared to habitual DD lenses (6.7 ± 3.2 hours) (p = 0.04). No significant differences were observed in vision ratings (p = 0.07).Conclusion: Refitting symptomatic DD CL wearers with DT1 resulted in improved end-of-day comfort, reduced end-of-day dryness, and extended comfortable wear time compared to their habitual lenses. These findings suggest that DT1 may offer benefits for symptomatic DD wearers with dry eye disease.Keywords: contact lenses, daily disposable, delefilcon A, dry eye symptoms, comfort, wear time

John A Hovanesian,1 Michael Jones,2 Quentin Allen3 1Harvard Eye Associates, Laguna Hills, CA, USA; 2Quantum Vision Centers, Swansea, IL, USA; 3Florida Vision Institute, Stuart, FL, USACorrespondence: John A Hovanesian, Harvard Eye Associates, 23961 Calle De La Magdalena, &num;300, Laguna Hills, CA, 92653, USA, Tel +1 949 951 2020, Fax +1 949 951 9244, Email jhovanesian@harvardeye.comPurpose: To evaluate patient-reported outcomes of cataract surgery using the Clareon Panoptix and Panoptix Toric trifocal lenses and to compare these to the data collected previously for the AcrySof Panoptix and Panoptix Toric.Patients and Methods: Prospective, open-label, multicenter analysis of satisfaction, spectacle independence, presence of unwanted side effects, and best-corrected visual acuity among patients undergoing cataract surgery who had been implanted at least 1 month previously with the Clareon PanOptix or PanOptix Toric trifocal IOL bilaterally. Results were compared to outcomes measured two years ago from a similar study with the AcrySof version of the same lens.Results: No significant differences in patient satisfaction rates were reported between the two cohorts. Spectacle independence was similar with 88% of Clareon Panoptix and 83% of AcrySof Panoptix patients having no need for any corrective lenses. Quality of vision was not statistically different with 7% of Clareon vs 15% of AcrySof patients reporting “very much” or more of glare/halo severity. Significantly more AcrySof (66%) than Clareon (42%) patients achieved a spherical equivalent outcome within 0.25 D of target. Best corrected distance visual acuity differences were not statistically significant, and no safety concerns were reported.Conclusion: The Clareon PanOptix trifocal lens provides similar satisfaction and spectacle independence and has a similar side effect profile and BCVA outcome to the identical lens made of the predecessor AcrySof lens.Plain Language Summary: In this prospective, non-interventional, open-label, multicenter analysis evaluating patient-reported outcomes 1 month after scheduled cataract surgery, patients had similar satisfaction and spectacle independence with the Clareon PanOptix and PanOptix Toric trifocal lenses when results were compared to a previous study of the same lenses made of the predecessor AcrySof lens.Keywords: cataract surgery, spectacle independence, glare, multifocal intraocular lens, lens material

Pradeepa Yoganathan,1– 3 Bernard Hurley,4 Andrew Merkur,5 Chad Andrews,6 Jennifer A Pereira,7 Larissa S Moniz8 1Department of Ophthalmology and Vision Sciences, University of Toronto School of Medicine, Toronto, ON, Canada; 2Department of Ophthalmology, Visual & Anatomical Sciences, Wayne State University School of Medicine, Detroit, MI, USA; 3Windsor Eye Associates, Windsor, ON, Canada; 4University of Ottawa Eye Institute, University of Ottawa, Ottawa, ON, Canada; 5Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, BC, Canada; 6College of Optometrists of Ontario, Toronto, ON, Canada; 7JRL Research & Consulting Inc., Mississauga, ON, Canada; 8Fighting Blindness Canada, Toronto, ON, CanadaCorrespondence: Larissa S Moniz, Fighting Blindness Canada, 12th Floor, 890 Yonge Street, Toronto, Ontario, M4W 3P4, Canada, Tel +1-416-360-4200, Email lmoniz@fightingblindness.caPurpose: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Documentation of the disease’s description and treatment experience of Canadian patients is limited but of interest given the aging population and resultant implications for healthcare systems. A mixed-methods study was conducted to understand the challenges experienced by patients living in Canada with AMD to identify areas of need and for potential reform.Patients and Methods: Canadian residents with wet or dry AMD were eligible for participation in an online survey and one-on-one telephone interview regarding their disease experience. Participants were recruited via a not-for-profit stakeholder organization and an ophthalmology clinic. Surveys were completed from January–June 2020 and interviews were conducted from November–December 2020, with findings reported using descriptive statistics and thematic analysis, respectively.Results: Findings from 303 survey responses and 20 interviews were analyzed. Most participants indicated their vision loss negatively impacts their ability to conduct daily activities (eg, self care, driving) and leads to constant worry, loneliness, and/or isolation. Participants frequently reported requiring caregiver support, often for eye appointment travel or everyday tasks. Regardless of AMD type, participants reported having several appointments each year, and that time spent travelling to/from and waiting at appointments and related costs were considerable. Although participants receiving anti-vascular endothelial growth factor injections valued treatment, the experience added additional burden related to anxiety, fear, pain, and even greater reliance on caregivers. Many participants indicated they felt poorly informed about their disease and treatment options, particularly at diagnosis, which increased their emotional burden.Conclusion: Patients with AMD living in Canada experience a significant and persistent mental, physical, and financial burden as a direct result of their disease. Improvements to provision of disease-related information, support of daily activities and appointment attendance, and the overall treatment experience could substantially enhance outcomes among the growing population of patients with AMD.Keywords: age-related macular degeneration, Canada, burden of illness, disease experience, survey, interview

Damien F Goldberg,1 Claudio Orlich,2 Brian E Flowers,3 Inder P Singh,4 Sydney Tyson,5 Leonard K Seibold,6 Mohammed K ElMallah,7 Elysia M Ison,8 Med Harbin,8 Heather Reynolds,8 Malik Y Kahook9 1Wolstan & Goldberg Eye Associates, Torrance, CA, USA; 2Clinica 20/20, San Jose, Costa Rica; 3Ophthalmology Associates, Fort Worth, TX, USA; 4The Eye Centers of Racine & Kenosha, Racine, WI, USA; 5Eye Associates & SurgiCenter of Vineland, Vineland, NJ, USA; 6Department of Ophthalmology, University of Colorado Eye Center, Aurora, Colorado, USA; 7Ocala Eye, Ocala, FL, USA; 8New World Medical, Rancho Cucamonga, CA, USA; 9Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USACorrespondence: Malik Y Kahook, Department of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA, Tel +1 720 848 2501, Email Malik.Kahook@cuanschutz.eduPurpose: To report interim results of the VENICE study, a multi-center, randomized, controlled trial (RCT) comparing STREAMLINE Surgical System (STREAMLINE) canaloplasty with iStent inject W (iStent W) implantation in patients with mild-to-moderate primary open-angle glaucoma (POAG) undergoing phacoemulsification.Patients and Methods: Safety and efficacy analyses involving the first 72 randomized eyes are included in this report. Following pre- (Screening) and post-medication washout (Eligibility) visits, one eye per subject was randomized 1:1 to STREAMLINE or iStent W after undergoing uncomplicated phacoemulsification. Subjects were evaluated postoperatively at Day 1, Week 1, Month 1, 3, and 6. Intraocular pressure (IOP) measurements, number of IOP-lowering medications, and adverse events (AEs) were assessed at each follow-up visit.Results: Seventy-two eyes were randomized; 35 underwent STREAMLINE canaloplasty and 37 were implanted with the iStent W. Seventy eyes completed their 6-month follow-up. Both the mean morning post-washout Baseline IOP between STREAMLINE 24.86± 3.05 mmHg and iStent W 25.16± 3.41 mmHg and the mean IOP at 6 months between STREAMLINE eyes 16.52± 3.63 mmHg and iStent W eyes 16.08± 3.19 mmHg were not statistically significantly different (p=0.691 and 0.596, respectively). At 6 months, more eyes were on zero glaucoma medications in the STREAMLINE group (81.8%) compared to the iStent W group (78.4%). In medication-free eyes, the mean IOP was reduced from 24.80± 2.79 mmHg to 16.00± 3.40 mmHg and 24.60± 3.18 mmHg to 15.80± 2.21 mmHg in the STREAMLINE and iStent W groups, respectively (p=0.752). Both groups showed reduction in IOP-lowering medications at every visit, compared to pre-washout (Screening), with STREAMLINE resulting in numerically fewer medications 0.20± 0.48 compared to iStent W 0.40± 0.79 at 6 months (P=0.384). AEs were mild and self-limited.Conclusion: To our knowledge, the VENICE trial is the first RCT involving canaloplasty. These interim findings demonstrated comparable IOP and medication reduction between STREAMLINE canaloplasty and iStent W implantation, when combined with phacoemulsification.Keywords: primary open-angle glaucoma, POAG, STREAMLINE, iStent inject W, canaloplasty, microinvasive glaucoma surgery, MIGS

Tanvi Suhas Haldipurkar, Suhas Haldipurkar, Devendra Venkatramani, Ruta Walavalkar, Sarita Deshpande, Maninder Singh Setia Laxmi Eye Institute and Laxmi Charitable Trust, Panvel, IndiaCorrespondence: Maninder Singh Setia, Laxmi Eye Institute and Laxmi Charitable Trust, Panvel, Maharashtra, 410206, India, Email maninder.setia@karanamconsultancy.inPurpose: To assess the visual outcomes in patients bilaterally implanted with novel Clareon® intraocular lens when targeting mini monovision post-operatively.Setting: The study was conducted at Laxmi Eye Institute; it is a tertiary care eye institution in Panvel, India.Design: This is an investigator initiated, prospective, single-centre longitudinal study of 45 patients to assess the visual outcomes in patients who were implanted with Clareon ® IOL bilaterally.Methods: Patients with corneal astigmatism of ≤ 0.75 D who underwent bilateral cataract surgery with pseudophakic mini-monovision and implanted with novel Clareon® intraocular lens were included. Patients having post op manifest refraction >± 0.25 D in the dominant eye and − 0.75 D in the non-dominant eye were excluded. The main study outcomes were assessed at 1 and 3 months; it included uncorrected visual acuities assessment, defocus curve, and patient reported spectacle use.Results: The mean (SD) binocular distance corrected intermediate visual acuity at 3 months was 0.22 (0.09) LogMAR. At 3 months, 54% of patients enjoyed 0.4 LogMAR or better BUCNVA. The defocus curve showed good distance and intermediate visual acuity with > 0.2 LogMAR vision from +0.50 D to − 1.50 D. We found a positive correlation between the Q value of the dominant eye and the BCIVA at 3 months postoperatively, however it was not statistically significant. The Q value was more negative when the intermediate vision was closer to 0 LogMAR. Post operatively, at 3 months, 95% patients did not need glasses for distance and intermediate vision and 73% of patients were comfortable for intermediate vision without glasses all the time.Conclusion: Mini-monovision with Clareon® monofocal IOL implantation can offer overall satisfactory vision for far and intermediate distances with minimal need for use of spectacles for near vision.Keywords: intermediate vision, monofocal IOLs, mini monovision

Abhimanyu S Ahuja,1,&ast; Alfredo A Paredes III,2,&ast; Mallory LS Eisel,3,&ast; Sejal Kodwani,4 Isabella V Wagner,5 Darby D Miller,5 Syril Dorairaj5 1Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA; 3College of Medicine, Florida State University, Tallahassee, FL, USA; 4Windsor University School of Medicine, Cayon, St. Kitts, KN; 5Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, FL, USA&ast;These authors contributed equally to this workCorrespondence: Abhimanyu S Ahuja, Casey Eye Institute, Oregon Health and Science University, 515 SW Campus Drive, Portland, Oregon, 97239, USA, Email ahujaa@ohsu.eduAbstract: Cataract surgery is one of the most performed procedures worldwide, and cataracts are rising in prevalence in our aging population. With the increasing utilization of artificial intelligence (AI) in the medical field, we aimed to understand the extent of present AI applications in ophthalmic microsurgery, specifically cataract surgery. We conducted a literature search on PubMed and Google Scholar using keywords related to the application of AI in cataract surgery and included relevant articles published since 2010 in our review. The literature search yielded information on AI mechanisms such as machine learning (ML), deep learning (DL), and convolutional neural networks (CNN) as they are being incorporated into pre-operative, intraoperative, and post-operative stages of cataract surgery. AI is currently integrated in the pre-operative stage of cataract surgery to calculate intraocular lens (IOL) power and diagnose cataracts with slit-lamp microscopy and retinal imaging. During the intraoperative stage, AI has been applied to risk calculation, tracking surgical workflow, multimodal imaging data analysis, and instrument location via the use of “smart instruments”. AI is also involved in predicting post-operative complications, such as posterior capsular opacification and intraocular lens dislocation, and organizing follow-up patient care. Challenges such as limited imaging dataset availability, unstandardized deep learning analysis metrics, and lack of generalizability to novel datasets currently present obstacles to the enhanced application of AI in cataract surgery. Upon addressing these barriers in upcoming research, AI stands to improve cataract screening accessibility, junior physician training, and identification of surgical complications through future applications of AI in cataract surgery.Plain language summary: Although barriers remain for the generalizability and standardization of artificial intelligence in cataract surgery, there are growing applications improving efficiency, data analysis, safety, training, and patient outcomes in pre-operative, intraoperative, and post-operative stages.Keywords: cataract surgery, artificial intelligence, deep learning, convolutional neural networks

Alan W Kong, Adrian Au, Weilin Song, Angela J Oh, Tara A McCannel Department of Ophthalmology, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USACorrespondence: Tara A McCannel, Department of Ophthalmology, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095, USA, Email TMcCannel@jsei.ucla.eduPurpose: Distinguishing an iris melanoma from an iris nevus can be challenging as few clinical features other than documented growth are helpful in making the diagnosis. In this study, we compared the presenting intraocular pressure (IOP) and cup-to-disc ratio (CDR) between affected and unaffected eyes in patients with iris melanoma and iris nevus.Patients and methods: This was a single-institution retrospective case series of patients treated for iris melanoma and iris nevus from January 2013 to October 2022. Thirty-nine subjects with iris melanoma and forty age-matched patients with iris nevus were included. We analyzed the difference in IOP, CDR, and diagnosis of glaucoma between affected and unaffected eyes in patients with iris melanoma and control iris nevus cohort.Results: The average IOP for eyes with iris melanoma and iris nevus was 18.8± 6.1 mmHg and 14.6± 3.5 mmHg (P< 0.001), respectively. The average CDR was 0.36± 0.27 and 0.24± 0.14 (P=0.02), respectively. The average IOP of the contralateral unaffected eye in iris melanoma patients was 16.3± 3.5 mmHg, significantly less than the affected eye (P=0.03). The average CDR of the contralateral unaffected eye in iris melanoma was 0.25± 0.15, which was trending towards being less than the affected eye (P=0.05). There was no difference in the average IOP (P=0.89) or average CDR (P=0.49) between the affected and unaffected eye in patients with iris nevus.Conclusion: We demonstrate that patients with iris melanoma are more likely to have greater IOP and CDR in the affected eye compared to the unaffected eye, and a diagnosis of unilateral glaucoma than eyes with iris nevus. Patients with iris melanoma had greater IOP asymmetry between the affected and unaffected eye. Therefore, IOP and CDR asymmetry may suggest a diagnosis of iris melanoma.Keywords: iris melanoma, iris nevus, secondary glaucoma, intraocular pressure, cup to disc ratio

Bhim B Rai,1,2 Phuntsho Dorji,2 Ted Maddess1 1John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia; 2Department of Ophthalmology, JDW National Referral Hospital, Thimphu, BhutanCorrespondence: Bhim B Rai, Building 131, Garran Road, John Curtin School of Medical Research, Australian National University, Canberra, ACT, 2601, Tel +61 2 61259253, Email bhim.rai@anu.edu.auPurpose: We conducted this study to determine the pattern and prevalence of retinal vein occlusion (RVO) in Bhutan to inform national health policy as no data has been compiled previously.Methods: A retrospective cross-sectional survey was conducted over 3 years, including all new RVO cases. For patients with bilateral RVO, one eye was chosen randomly. Demographic, clinical, and diagnostic details, including optical coherence tomography, fluorescein angiography, and fundus photography, were collected.Results: Of 141 RVO new patients included, aged 50.5 ± 20.2 years, there were more males (62.4%) than females (37.6%) significantly (p = 0.031), and 59.6% of total patients were from an urban setting. Farmers were the most affected group (44, 31.2%), followed by housewives (34, 24.1%), and the working group (33, 23.4%). Blurry vision (64, 45.5%), sudden loss of vision (17, 12.1%), including unsatisfactory cataract surgery (8, 5.7%) were common presenting complaints. Systemic hypertension (HT) (36, 25.5%), and diabetes mellitus (DM) (17, 12.1%), were associated systemic diseases. The prevalence of RVO was 4.8% (141/2913 all new retinal patients over the survey). Branch RVO (BRVO) was the most common type (77, 54.6%), followed by central RVO (CRVO) 56, (39.7%), and hemi-central RVO (HCRVO) (8, 5.7%). Superotemporal BRVO was the most common subtype (30, 39%) followed by inferotempoal (19, 24.7%). Best correct visual acuity (BCVA) was worse than 6/60 in 38 eyes (25.5%). BCVA was not significantly different between BRVO and CRVO eyes. Intraocular pressure was significantly lower in HCRVO eyes (p = 0.015) compared to BRVO and CRVO eyes.Conclusion: In Bhutan, 8.5% of RVO patients were bilateral. HT was associated significantly as a risk factor. Incidental findings of RVO during routine eye check-up and evaluating for unsatisfactory cataract surgery were common. Therefore, Bhutan needs to control noncommunicable diseases such as diabetes and HT to reduce RVO, and RVO-related blindness and complications.Keywords: anti-VEGF, avoidable blindness, complications of diabetes and hypertension, retinal vein occlusion in Bhutan, risk factors of retinal vein occlusion, vitreoretinal disease in Bhutan

Álvaro J Rallo-López,1 Rafael Martínez-Costa Pérez2 1Department of Ophthalmology, Clínica Baviera, Valencia, Spain; 2Department of Ophthalmology – Retina and Vitreous, Hospital Universitario y Politécnico La Fe, Valencia, SpainCorrespondence: Álvaro J Rallo-López, Email rallo.1c@gmail.comBackground and Objective: To compare the cost and utility of scleral buckle (SB) and pars plana vitrectomy (PPV) techniques for repairing moderately complex rhegmatogenous retinal detachment (RRD).Patients, Materials, and Methods: A cost-utility analysis was conducted using data from the Primary Retinal Detachment Outcomes Study (PRO) and a study conducted by the author. Total costs, patient utility over a lifetime, and cost per quality-adjusted life year (QALY) were calculated for each surgical procedure.Results: The cost of scleral buckle surgery was € 287.93, with an estimated lifetime QALY of 7.49. Costs per QALY were € 38.44. According to the PRO study and Belin et al, total costs were &dollar;5975, with a lifetime QALY of 5.4 and costs per QALY of &dollar;1106. The cost of pars plana vitrectomy (PPV) was € 1468.26, with an estimated lifetime QALY of 6.84 and costs per QALY of € 214.65. Based on the PRO study and Belin et al, total costs were &dollar;8125, with a lifetime QALY of 4.7 and costs per QALY of &dollar;2196.Conclusion: Repairing moderately complex RRD presents a highly cost-effective profile for both SB and PPV techniques, well below recommended QALY thresholds. SB demonstrated a slightly more favorable profile compared to PPV.Keywords: retinal detachment, pars plana vitrectomy, scleral buckle, cost-utility analysis, QALY

Somnath Chakraborty,1 Jay Umed Sheth2 1Department of Vitreoretinal Services, Retina Institute of Bengal, Siliguri, West Bengal, India; 2Department of Vitreoretinal Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, IndiaCorrespondence: Somnath Chakraborty, Senior Consultant, Department of Vitreoretinal Services, Retina Institute of Bengal, Siliguri, West Bengal, India, Email somnathboom@gmail.comPurpose: This retrospective study aimed to compare the efficacy and safety of intravitreal Dexamethasone Implant (DEX) and Brolucizumab Injection in treating Diabetic Macular Edema (DME) with Hyperreflective Intraretinal Dots (HRID).Patients and Methods: A single-center retrospective study in India included 40 eyes (20 per group) with controlled diabetes and HRID on optical coherence tomography. Patients received either DEX or Brolucizumab, with outcomes assessed at various intervals up to 24 weeks. Primary measures included Best-Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT), and safety parameters.Results: Both treatment groups demonstrated comparable baseline characteristics. Both treatments significantly improved the BCVA at weeks 4, 12, and 24, with the DEX implant showing significantly better results at week 12 than brolucizumab (P=0.04). In treatment-naïve eyes, BCVA improvements were similar across all time points. In recalcitrant DME eyes, DEX showed significant BCVA improvements at all time points, while brolucizumab showed significant improvements only at weeks 4 (P=0.005) and 24 (P=0.04). The CMT also improved with both treatments, with DEX showing superior reduction at weeks 4 (P=0.003), 12 (P=0.003), and 24 (P=0.002) respectively. In treatment-naïve eyes, DEX showed consistently better CMT reductions. In refractory DME eyes, both treatments significantly reduced CMT, with DEX performing better at week 12 (P=0.042). DEX required fewer injections (DEX: 1.5± 0.61; brolucizumab: 2.4± 0.82; P=0.0002) and less supplementary laser treatment (DEX:8/20, 40% eyes; brolucizumab: 16/20, 80%; P=0.01) compared to brolucizumab. No adverse events were observed in either group.Conclusion: The study suggests the potential superiority of intravitreal DEX implant over brolucizumab in managing DME with HRID. DEX exhibited sustained positive responses in BCVA and CMT, requiring fewer injections and supplementary interventions. Future research should explore extended follow-up durations, personalized treatment strategies, and refined biomarkers to optimize DME management.Keywords: diabetic macular edema, dexamethasone implant, Ozurdex, brolucizumab, hyperreflective intraretinal dots

Jaime Aramberri,1,2 Gorka Lauzirika,1,3 Igor Illarramendi,1 Javier Mendicute1,4 1Anterior Segment Department, Miranza Begitek, Donostia-San Sebastián, Spain; 2Anterior Segment Department, Miranza Ókular, Vitoria-Gasteiz, Spain; 3R&D Department, Miranza Group, Barcelona, Spain; 4Ophthalmology Service, Hospital Universitario Donostia, Donostia-San Sebastián, SpainCorrespondence: Gorka Lauzirika, Miranza Begitek, Plaza Teresa Calcuta 7, Donostia-San Sebastián, 20012, Spain, Email gorka.lauzirika@miranza.esPurpose: To compare corneal aberrometry, densitometry, and refractive outcomes of single-step Transepithelial Photorefractive Keratectomy (Trans-PRK) with and without epithelial thickness customization.Patients and Methods: This was a prospective, interventional, randomized controlled study. Patients undergoing Trans-PRK using the WaveLight EX500 laser with StreamLight software (Alcon Laboratories, Forth Worth, TX, USA) were randomly assigned to control (55 μm standard epithelial thickness) or customized (thinnest point of epithelial thickness for each patient) groups. MS-39 (CSO, Italy) anterior segment optical coherence tomography was used to measure the epithelial thickness. Inclusion criteria were spherical equivalent < 6 diopters (D), astigmatism < 4D, and CDVA 20/25 or better. The assessments were at baseline and 6 months post-op: visual acuity, refraction, aberrometry, and corneal densitometry.Results: 108 eyes were enrolled, [control group (n=56) and customized group (n=52)]. Mean epithelial ablation thickness in the customized group was 54.81± 3.56μm (p=0.470 vs control group). Both groups experienced significant postoperative increases in higher-order aberrations (HOA) and spherical aberrations, with no significant intergroup differences. Mean HOA RMS (μm) of the frontal cornea and total cornea increased by 0.27, and 0.29, respectively, in the control group, and 0.26 and 0.28, respectively, in the customized group (p< 0.001 for all). Mean change in spherical aberrations in the frontal cornea and total cornea was 0.23μm (p< 0.001) and 0.25μm (p< 0.001), in the control group, and 0.19μm (p< 0.001) and 0.20μm (p< 0.001), in the customized group. Mean corneal densitometry in anterior cornea decreased by 0.63GSU (p=0.021) and 1.18GSU (p< 0.001) in the control and customized groups. In the posterior cornea, it increased by 1.67GSU (p=0.004) and 0.38GSU (p=0.006).Conclusion: No significant differences in refractive and aberrometry outcomes between control and customized Trans-PRK groups, with corneal densitometry changes not affecting visual acuity.Keywords: Trans-PRK, corneal epithelial thickness, corneal aberrometry, corneal densitometry, corneal refractive surgery

Ahmed Hassan Assaf,1,2 Hams Samy,2 Noha Fawky,2 Menna Ahmed Kamel1 1Department of Ophthalmology, Ain Shams University, Cairo, Egypt; 2Watany Eye Hospital, Cairo, EgyptCorrespondence: Ahmed Hassan Assaf, Ain Shams University, Abbassia, Cairo, Egypt, Email assaf.ahmed@gmail.comPurpose: To evaluate the effect of angles kappa and alpha on the visual outcomes after implantation of isofocal intraocular lens (IOL) during cataract surgery.Methods: This prospective study involved 66 eyes undergoing cataract surgery with Isopure IOLs. Exclusion criteria comprised irregular corneal astigmatism exceeding 1.0D, and ocular co-morbidities affecting visual outcomes post-surgery. Evaluation parameters included postoperative refraction, uncorrected and corrected-distance visual acuity (UDVA, CDVA), uncorrected intermediate visual acuity (UIVA), and distance-corrected intermediate visual acuity (DCIVA) at 80 cm. Additionally, postoperative angles alpha, kappa, and wavefront aberrations at a 3-mm pupil using ray tracing were assessed post-surgery at least 60 days later.Results: Patients had a mean age of 64.48 ± 9.92 years. Mean postoperative manifest refraction spherical equivalent (MRSE) was − 0.21 ± 0.27 D. Mean UDVA and CDVA were LogMAR 0.06 ± 0.04 and 0.02 ± 0.06, respectively. Mean UIVA LogMAR 0.32 ± 0.08 while mean DCIVA was LogMAR 0.29 ± 0.08. Postoperative angles kappa and alpha were 0.39 ± 0.14 mm and 0.45 ± 0.15 mm, respectively. Mean postoperative ocular RMS higher-order aberrations (HOAs) 0.23 ± 0.08. Spherical aberration, coma, and trefoil averaged 0.05 ± 0.07, 0.12 ± 0.03, and 0.07 ± 0.03, respectively. No significant correlations were observed between postoperative angle kappa and alpha with UDVA, CDVA, or HOAs. A non-significant weak positive correlation was noted between angle kappa and UIVA/DCIVA, while no correlation was found between angle alpha and UIVA/DCIVA.Conclusion: No substantial correlations were found between various postoperative angles kappa and alpha values and postoperative visual acuity metrics (UDVA, CDVA, UIVA, and DCIVA) or higher order ocular aberrations (including, spherical aberration, coma, and trefoil with a 3.0 mm diameter) in pseudophakic eyes implanted with isofocal intraocular lenses (IOLs).Keywords: intraocular lens, cataract, optical quality, angle alpha, angle kappa

Somnath Chakraborty,1 Jay Umed Sheth2 1Department of Vitreoretinal Services, Retina Institute of Bengal, Siliguri, India; 2Department of Vitreoretinal Services, Shantilal Shanghvi Eye Institute, Mumbai, Maharashtra, IndiaCorrespondence: Somnath Chakraborty, Department of Vitreoretinal Services, Retina Institute of Bengal, Siliguri, West Bengal, India, Email somnathboom@gmail.comPurpose: To evaluate the efficacy and safety of Bevatas®, an Indian bevacizumab biosimilar, in the management of both Central Retinal Vein Occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) (BIOS-RVO).Patients and Methods: The BIOS-RVO study was a retrospective interventional study conducted at a single tertiary eye care facility in India. 154 treatment-naïve eyes with RVO (CRVO: 62 eyes; BRVO: 92 eyes) received intravitreal bevacizumab biosimilar (IVBb) therapy. Data on best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were collected at baseline and at 3, 6, and 12 months post-therapy.Results: The average age of participants was approximately 55.99 (+ 12.56) years, with a nearly equal gender distribution (M:F = 49.4:50.6). Age differences between BRVO and CRVO groups were not significant (P=0.501), but gender distribution varied significantly (P=0.035), with more males in the CRVO group. Significant improvements in BCVA were observed in both CRVO and BRVO groups at 3 months, 6 months, and 1 year compared to baseline (P< 0.001). Both groups showed significant reductions in CMT throughout the follow-up period (P< 0.001). The mean number of injections was higher in the CRVO group (5.27[± 1.45]) compared to the BRVO group (4.27 [± 1.28]) (P< 0.001). Significant IOP increases were observed at 1 month (P< 0.001) and 6 months (P< 0.001) in both BRVO and CRVO groups, although not clinically significant. Safety analysis revealed no additional ocular or systemic adverse events during the study period.Conclusion: The BIOS-RVO study demonstrates that Bevatas is an effective and safe treatment option for both CRVO and BRVO. These findings support the use of Bevatas as a cost-effective alternative to branded anti-VEGF agents, particularly in resource-limited settings.Keywords: retinal vein occlusion, bevacizumab, biosimilar, Bevatas

Amira Elagamy,1,2 Hessa Khaled Alnasser,3 Wafa Saeed Alghamdi,3 Mohamed Berika,4,5 Dara Aldisi6 1Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 2Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 3College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 4Rehabilitation Science Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia; 5Anatomy Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 6Community Health Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi ArabiaCorrespondence: Amira Elagamy, Department of Optometry and Vision Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia, Email aelagamy@ksu.edu.saAim: This study assessed the correlation between corneal biomechanical properties measured with Corvis ST (CST) and retinal nerve fiber layer thickness profile, anterior lamina cribrosa surface depth, and other optic nerve head parameters in healthy Saudi females.Methods: This study included 62 eyes (only right eyes) of 62 healthy Saudi females aged from 20 to 39 yrs. A complete ophthalmologic assessment was performed for all participants. In addition, corneal biomechanical parameters were measured using CST, and optic nerve head parameters were evaluated using spectral domain optical coherence tomography.Results: This study demonstrated a significant weak positive correlation between circumpapillary retinal nerve fiber layer (cpRNFL) peak angle and only second applanation (A2) length (mm) (r = 0.293, P = 0.021). Also, this study reported a significant moderate negative association between the C/D ratio and radius (r = − .513, P = 0.015). However, there was no significant correlation between corneal biomechanics and ALCSD in this study.Conclusion: This study reported a significant positive correlation between cpRNFL peak angle and A2-length. In addition, the current study documented a significant moderate negative association between C/D ratio and radius. However, there was no significant correlation between ALCSD and the corneal biomechanical properties in this study. Further research is needed to verify the impact of corneal biomechanics on optic nerve head parameters and further investigate its role in the pathophysiology of glaucoma.Keywords: corneal biomechanics, circumpapillary retinal nerve fiber layer peak angle, anterior lamina cribrosa surface depth

Daniel Laroche,1,2,&ast; Ayobami Adebayo,3,&ast; Chester Ng2,&ast; 1Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA; 2Advanced Eyecare of New York, New York, NY, USA; 3Albert Einstein College of Medicine, Bronx, NY, USA&ast;These authors contributed equally to this workCorrespondence: Daniel Laroche, Advanced Eyecare of New York, 49 West 127th Street, New York, NY, 10027, USA, Email dlarochemd@aol.comBackground: The Hydrus Microstent has been shown to be efficacious in the treatment of Open-angle Glaucoma. We previously reported 1-year results of the Hydrus Microstent in Black and Afro-Latino patients.Objective: Here we report two-year results of the Hydrus Microstent in Black and Afro-Latino patients with mild to moderate open-angle glaucoma.Design: This was a retrospective, nonrandomized study that was carried out at two private practices in Harlem, NY and Queens, NY.Methods: This study consisted of Black and Afro Latino patients who had a Hydrus Microstent implanted for the treatment of glaucoma. The evaluated parameters were intraocular pressure (IOP), reductions in the number of medications, mean deviation on visual field test and visual acuity. We excluded persons with advanced glaucoma and incomplete data. We included those with mild to moderate glaucoma and had complete two-year follow-up data.Results: The study consisted of 86 patients and 86 eyes. The mean age was 69. The mean pre-op IOP was 14.1 on 2.17 medications. At two years the mean IOP was 14 (p = 0.651) on 0.42 medications (p = 0.000003); 88% of patients were medication free (p = 0.651), The MD on the visual field changed little from − 5.73 preoperatively to − 5.21 at two years. There were 3 intraocular pressure spikes and 1 case of hyphema that were treated and had complete resolution. No patients required secondary surgery.Conclusion: Our results show that at two years the Hydrus Microstent can maintain low intraocular pressures, reduce medication burden and, in aggregate, experienced little change in visual field Mean Deviation in Black and Afro Latino patients with mild to moderate glaucoma.Keywords: hydrus, microstent, glaucoma, Afro–Latino, cataract

Yilin Feng,1 Nandini Venkateswaran,1 Amanda Steele,2 Eric D Rosenberg,3 Preeya K Gupta2,4 1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; 2Triangle Eye Consultants, Raleigh, NC, USA; 3Department of Ophthalmology, New York Medical College, Valhalla, NY, USA; 4Department of Ophthalmology, Tulane University, New Orleans, LA, USACorrespondence: Preeya K Gupta, Email preeyakgupta@gmail.comPurpose: To evaluate the impact of TearCare (TC) treatment on clinical, quality of life, and functional visual outcome metrics in patients with dry eye disease (DED) and meibomian gland disease (MGD).Methods: This is a prospective, single-center clinical trial. Adults with MGD and a DED diagnosis and tear break-up time (TBUT) < 10 seconds were included. All subjects had at least 20/40 vision and no surgery or new treatment for DED within 60 days prior to enrollment. All patients had one baseline visit prior to undergoing TC and one follow-up visit 1 month after TC. At each visit, the meibomian gland secretion score (MGSS), TBUT, and corneal fluorescein staining (KFL) were assessed. DED symptoms were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Visual Function Questionnaire 25 (VFQ-25), and the Fatigue Severity Scale. Reading speed was determined through the International Reading Speed Texts (IReST), Minnesota Low Vision Reading Test (MNREAD), and Wilkins Rate of Reading Test (WRRT).Results: Thirty-two subjects were included. The average age was 55.9 years. Sixteen (52%) participants had a clinically significant improvement in reading speed after treatment with TC, defined as > 10 words per minute increase in their IReST score. Improvement on the IReST and the MNREAD reached statistical significance (p = 0.012 and p = 0.028, respectively). OSDI scores significantly decreased and VFQ-25 scores significantly increased after TC treatment (p < 0.001). All of the clinical exam parameters showed statistically significant improvements after treatment (p < 0.001).Conclusion: TC is an effective treatment both clinically and with respect to visual function. Patients who had TC exhibited improvements in quality of life and improved reading speed after a single treatment. This treatment should be frequently considered and utilized to reduce the disease burden of DED related to MGD.Keywords: thermal pulsation, tearcare, meibomian gland dysfunction, dry eye disease, reading speed

Manoj Motwani Cornea Revolution/Motwani LASIK Institute, San Diego, CA, 92121, USACorrespondence: Manoj Motwani, Cornea Revolution/Motwani LASIK Institute, 8710 Scranton Road, Ste 170, San Diego, CA, 92121, USA, Tel +1 (858) 554-0008, Email drmmlj@gmail.comPurpose: To present the outcomes of a retrospective study of treatment of radial keratotomy-induced corneal irregularity with topographic guided ablation and a trans-epithelial approach based on epithelial compensation.Methods: Sixty eyes of 31 patients were treated for radial keratotomy-induced corneal irregularity utilizing a customized trans-epithelial topographic guided ablation photorefractive keratectomy (PRK) for treatment of corneal higher-order aberrations and lower-order astigmatism. Three-month results were analyzed via measurement of vision, refraction, residual higher-order aberrations (HOAs), residual lower-order and higher-order aberrations, as well as for loss or gains of lines of best corrected visual acuity.Results: Higher-order aberrations (HOA) were reduced by 69%, with an 80% reduction of higher-order aberrations grouped with lower-order aberrations (Grouped). Most (95%) of eyes achieved 20/40 vision or better, 50% of eyes gained 1– 9 lines of best corrected vision, and no eyes had loss of best corrected vision.Conclusion: Use of the CREATE protocol to treat RK-induced corneal irregularity resulted in a significant decrease in HOA, as well as a significant improvement in corrected distance visual acuity.Keywords: astigmatism, higher-order aberrations, radial keratotomy, lower-order aberrations, photorefractive keratectomy, corneal irregularity

Danielle Modeste,1 Christopher Stewart,2 Hajani Premanandhan,2 Mahmoud Husseiny Awad,1 Gwyn Samuel Williams1 1Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Swansea, Wales, UK; 2Swansea Bay University, Medical School, Swansea, Wales, UKCorrespondence: Danielle Modeste, Ophthalmology Department, Singleton Hospital Sketty Ln, Sketty, Swansea, UK, SA2 8QA, Email danielle.modeste@wales.nhs.ukPurpose: To evaluate the efficiency and safety of Faricimab on treatment-naive neovascular age related macular degeneration (nAMD) in a real world UK clinic.Patients and Methods: This single centre, retrospective note review was conducted on treatment-naive patients with nAMD. The data collected included demographics, best corrected visual acuity (BCVA), central macular thickness (CMT), total retinal fluid (TRF), the presence of intraretinal fluid (IRF) and subretinal fluid (SRF).Results: A total of 66 eyes from 62 patients were analysed. The average age was 77 years (range 36– 91) and 54% of patients were female. After the first dose of faricimab, the average BCVA improved by 0.05 LogMAR (+2.5 letters), the average CMT decreased by 65.9μm and 41% of patients were found to be inactive. The follow-up intervals after the third loading dose were divided into 2 subsets of 4 and 8 week extensions. The 4 week extension subset saw a smaller improvement in BCVA (+3 letters) than the 8 week extension (+6 letters) while both had an average decrease in CMT by 86.6 μm. The total retinal fluid decreased by 45% and 70.7%, leaving only 30% and 12.2% residual intraretinal fluid (IRF) and 30% and 24.4% residual subretinal fluid (SRF), respectively. Over a ten-month period, the average number of injections received was 6.6, including 3 initial loading doses. There was only one reported case of an adverse event out of 66 eyes (1/66, 1.5%).Conclusion: Three loading doses of Faricimab appear efficacious and safe for the treatment of nAMD.Plain language Summary: What is already known on this topic:Faricimab is recombinant humanised bispecific IgG monoclonal antibody which binds and neutralises both VEGF-A and angiopoietin-2 (VEGFA and ANG2).Clinical trials have reported faricimab dosing intervals of up to Q16W.What this study adds:To offer a glimpse into real-world effectiveness and safety of faricimab beyond the constraints of a randomised controlled study in treatment naïve nAMD patients.Presents results derived from implementing a “Treat and Extend” algorithm with faricimab in nAMD management, showcasing its beneficial impact on the strategic planning and execution of patient care.How this research may affect research, practice or policy:Faricimab should be seen as a viable therapy in treatment-naive patients with nAMD.Employing a shortened loading regimen of three doses presents no discernible detriment to treatment efficacy when compared to the established four-dose schedule.Keywords: treatment-naïve, nAMD, Faricimab, dosing interval

Tanner J Ferguson,1 Kristen Walton,2 John G Goertz,2 Brandon J Baartman2 1Vance Thompson Vision, Sioux Falls, SD, USA; 2Vance Thompson Vision, Omaha, NE, USACorrespondence: Tanner J Ferguson, Vance Thompson Vision, 3101 W. 57 th Street, Sioux Falls, SD, 57108, USA, Email tannerferg@gmail.comPurpose: To evaluate the use of varenicline solution nasal spray 0.03 mg (VNS) as a treatment option for the signs and symptoms of dry eye disease following photorefractive keratectomy (PRK).Patients and methods: Subjects electing to undergo PRK were randomized to VNS (study group) or vehicle (control group) twice daily and started treatment with VNS 28 days prior to surgery with continued use of the treatment for 84 days after PRK. After starting treatment, subjects were seen on the day of the procedure and postoperatively at days 2, 3, 4, 7, 28 and 84. The primary outcome measure was the mean change in NEI-VFQ-25, a dry eye item questionnaire, from baseline to day 84. The second primary outcome measure was the rate of corneal epithelial healing following PRK. Secondary outcome measures included eye dryness score (EDS), tear break up time and visual outcomes. The use of rescue therapy was also evaluated.Results: Twenty-one subjects were enrolled in the study group, and twenty subjects were enrolled in the control group. Results from the NEI-VFQ-25 questionnaire revealed positive results in both groups and the between-group difference was not statistically significant (P > 0.05). There was a trend towards faster re-epithelialization in patients treated with VNS vs placebo, where 100% epithelial closure was observed by Day 3 in the VNS group versus Day 4 in the control group; however, the between-group difference was not statistically significant (P > 0.05). Three subjects had rescue therapy in the control group while a single subject was rescued in the study group. A higher rate of eyes achieved vision of 20/16 or better in the study group (82.5%) versus the control group (72.5%) at 3 months.Conclusion: VNS is a favorable dry eye treatment option for patients following PRK, particularly in patients hoping to avoid additional topical medications or punctal occlusion. The higher percentage of eyes with UCDVA of 20/16 or better in the treatment group may suggest optimization of epithelial recovery after PRK.Keywords: dry eye disease, dry eye syndrome, varenicline, neurostimulation, ocular inflammation, ocular pain

Javier Mendicute,1,2 Gorka Lauzirika,1,3 Igor Illarramendi,1 Itziar Martínez-Soroa1,2 1Miranza Begitek, Donostia - San Sebastián, 20012, Spain; 2Donostia University Hospital, Donostia - San Sebastián, 20014, Spain; 3R&D Department of Miranza Group, Donostia - San Sebastián, SpainCorrespondence: Gorka Lauzirika, Miranza Begitek, Teresa Calcutta Square, No. 7, Donostia - San Sebastián, 20012, Spain, Email gorka.lauzirika@miranza.esPurpose: To describe the visual, refractive, functional, and patient satisfaction outcomes of the Clareon® PanOptix® trifocal intraocular lens (IOL).Patients and Methods: This was a prospective longitudinal descriptive study. Patients who underwent cataract surgery with implantation of Clareon® PanOptix® (Alcon Laboratories, Inc.) were included. Monocular refractive outcomes and visual acuity at distance, intermediate, and near were evaluated 1- and 6-months post-op. Binocular contrast sensitivity (M&S® Technologies), binocular defocus curve, and patient satisfaction with the IOL Satisfaction (IOLSAT) and Questionnaire for Visual Disturbance (QUVID) questionaries were assessed at 6-month post-op.Results: Seventy-six Clareon® PanOptix® were implanted bilaterally in 38 patients. The mean age of the patients was 67.63± 5.18 years. At 1-month post-op, the monocular Corrected Distance Visual Acuity (CDVA), CIVA and CNVA were 0.00± 0.09, 0.02± 0.17, and 0.12± 0.12 LogMAR, respectively, and CDVA and CNVA were stable at 6-month post-op (p> 0.05). No statistical differences were found in post-op spherical equivalent at 1 and 6 months (− 0.08± 0.27 D and − 0.05± 0.24 D; p=0.351). A 100% of eyes were within ± 0.5 D at 1 month and 6-month post-op. Binocular defocus curve shows three peaks of maximum visual acuity (VA) at 0D (− 0.04± 0.08 LogMAR), at − 1.50D, and − 2.50 D (0.01± 0.10 LogMAR and 0.03± 0.07 LogMAR, respectively). Contrast sensitivity decreased at high spatial frequencies. In patient satisfaction, IOLSAT questionary reveals 78.94% patients “Never” or “Rarely” Needing Glasses and according QUVID questionnaire, 100% of patients report no hazy vision.Conclusion: The PanOptix® IOL platform with the new material Clareon® provides good visual outcomes for distance, intermediate, and near vision, with adequate contrast sensitivity and low visual disturbances.Keywords: cataract surgery, multifocal lens, vision restoration, phacoemulsification

Svenja Sladek,1 Nicole Unger-Manhart,1 Cornelia Siegl,1 Hanna Dellago,1 Petra U Zieglmayer,2 Patrick Lemell,3 Markus Savli,4 René Zieglmayer,3 Wolfgang Geitzenauer,5 Matthias Längauer,5 Eva Prieschl-Grassauer1 1Marinomed Biotech AG, Korneuburg, Austria; 2Competence Center for Allergology and Immunology, Department of General Health Studies, Karl Landsteiner Private University for Health Sciences, Krems, Austria; 3Power Project GmbH, Vienna Challenge Chamber, Vienna, Austria; 4Biostatistik & Consulting GmbH, Zuerich, Switzerland; 5Krankenhaus der Barmherzigen Brüder, St. John Hospital, Department of Ophthalmology, Vienna, AustriaCorrespondence: Eva Prieschl-Grassauer, Marinomed Biotech AG, Hovengasse 25, Korneuburg, 2100, Austria, Tel +43 226292300, Email office@marinomed.comPurpose: This randomized, placebo-controlled, crossover, double‐blind trial aimed to evaluate the efficacy and safety of Tacrosolv, a novel 0.005% tacrolimus eye-drop solution, in adults with grass pollen–induced allergic conjunctivitis.Methods: A total of 64 adult participants were randomized to receive 2.5 μg or 5 μg tacrolimus/eye/day or placebo treatment for 8 days, with grass pollen exposure on day 1 and day 8. After a 2-week washout period, placebo participants crossed over to Tacrosolv treatment and vice versa, with repeated treatment and exposure. During exposure, participants recorded ocular, nasal, and respiratory allergy symptoms every 15 minutes. The primary endpoint was the mean total ocular symptom score (TOSS) on day 8. Objective ocular safety parameters were assessed before, during, and after exposure. Adverse events were recorded throughout the study.Results: On day 8, high-dose Tacrosolv reduced the TOSS compared to placebo towards the end of exposure (p< 0.05 at time points 3 hours, 45 minutes and 4 hours). A 26% reduction in baseline adjusted TOSS from day 1 to day 8 was observed in participants treated with high-dose Tacrosolv, whereas placebo-treated participants showed no difference in TOSS between day 1 and day 8. Nasal symptoms were reduced on both day 1 and day 8 in participants treated with high-dose Tacrosolv (p< 0.05). No safety concerns were raised. All adverse events were resolved within the study period.Conclusion: High-dose Tacrosolv is safe and effective for alleviating symptoms of allergic rhinoconjunctivitis.Trial Registration: NCT04532710; EudraCT No. 2019‐002847‐62.Keywords: allergic rhinoconjunctivitis, tacrolimus, ocular redness, ocular itching, topical administration, clinical trial

Federico Badalà,1 Elena Bona,1 Giulia Devincenzi,1 Kouros Nouri-Mahdavi2 1Micro Chirurgia Oculare, Eye Clinic, Milan, Italy; 2Glaucoma Division, Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USACorrespondence: Federico Badalà, Email med@microchirurgiaoculare.comPurpose: To determine long-term efficacy and safety of an extended macular vision intraocular lens (IOL) implanted in patients with dry age-related macular degeneration (AMD) and visually insignificant cataracts.Design: Retrospective observational case series.Setting: MicroChirurgia Oculare, Italy.Methods: A retrospective case series of patients with dry AMD and visually insignificant cataracts undergoing phacoemulsification and implantation of an extended macular vision IOL designed to optimize image quality up to 10° from the foveal center (EyeMax Mono, Sharpview Ophthalmology, London, UK). Criteria for implantation were visually insignificant cataract (NC1 according to LOCS III classification) with dry age-related macular degeneration. Hypermetropia was targeted in most eyes to provide magnification when corrected with spectacles. Primary outcome measures were changes in corrected distant and secondary outcome measures included near visual acuity (CDVA and CNVA, respectively) between baseline and latest follow-up and safety outcomes.Results: 113 eyes of 86 patients (mean age 70.3± 7.9 years) were included (mean follow-up: 48.3± 25.1 months). Mean CDVA improved by 0.22 logMAR (11 ETDRS letters), from 0.53± 0.4 to 0.31± 0.3 (n=113, p< 0.001). Similarly, mean CNVA improved by 0.08 logMAR (4 ETDRS letters), from 0.45± 0.2 to 0.37± 0.2 (n=77, p< 0.001). Eleven eyes had AMD with extensive atrophy, and their mean CDVA improved by 0.32 logMAR (16 ETDRS letters). Three eyes (2.7%) experienced loss of more than one line in logMAR CDVA and four eyes (5.2%) experienced loss of more than one line in logMAR CNVA. No complications or instances of IOL exchange were reported.Conclusion: Visual improvement in eyes with visually insignificant cataract and AMD who underwent phacoemulsification and were implanted with EyeMax Mono IOL appears to be influenced by the IOL optical design. Vision enhancement in eyes with visually insignificant cataracts underscores the IOL’s ability to optimize use of healthy retinal areas. Prospective studies with control groups are needed to confirm these findings.Keywords: AMD, Age macular degeneration, extended macular vision IOL, IOL, preferred retinal locus, PRL

Hongyu Duan,1,&ast; Yifan Zhou,2,&ast; Baikai Ma,1,&ast; Rongjun Liu,3 Tingting Yang,4 Hongling Chu,5 Zejun Huo,6 Hong Qi1 1Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Beijing, People’s Republic of China; 2Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China; 3Department of Ophthalmology, Peking University First Hospital, Beijing, People’s Republic of China; 4Department of Ophthalmology, Guangdong Provincial People’s Hospital, Southern Medical University, Guangzhou, People’s Republic of China; 5Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, People’s Republic of China; 6Department of Traditional Chinese Medicine, Peking University Third Hospital, Beijing, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hong Qi, Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, 49 North Garden Road, Haidian District, Beijing, 100191, People’s Republic of China, Email doctorqihong@163.com Zejun Huo, Department of Traditional Chinese Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, People’s Republic of China, Email huozejun@163.comBackground: Ocular pain is a prevalent symptom of dry eye disease (DED), which often accompanies potential psychological issues. The study aimed to explore whether acupuncture could improve ocular pain, mental state, and dry eye parameters in patients with DED.Methods: The non-randomized pilot study included 48 patients divided into two groups: the acupuncture group (n=27) and the 0.3% sodium hyaluronate (SH) group (n=21). Participants in the acupuncture group underwent treatments on six bilateral acupuncture points (BL1, BL2, ST1, LI 20, SI1 and SI3) 3 times per week for 4 weeks. Patients in the SH group received 0.3% SH 4 times per day for 4 weeks. Ocular pain was assessed using the numerical rating scale (NRS), and mental state was evaluated through the self-rating anxiety scale (SAS) and self-rating depression scale (SDS). Ocular surface parameters, concentrations of inflammatory cytokines, and corneal nerve morphological indicators were measured at baseline, the first week, and the fourth week. Randomization procedures were not used in this study, and outcome assessors and statistical analysts were blinded.Results: Compared with baseline, both NRS scores (from 5.91 ± 1.52 to 1.94 ± 1.57) and ocular surface discomfort index (OSDI) scores (from 49.75 ± 14.92 to 29.64 ± 18.79) were decreased after 1 and 4 weeks of treatment in both groups (all p < 0.05). At 4 weeks, the acupuncture group showed significant improvements, including increased tear break-up time (TBUT) and corneal perception, decreased SAS and SDS scores, and reduced concentrations of interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α concentration in tears (all p < 0.05). These changes were not observed in the SH group (all p > 0.05).Conclusion: Acupuncture treatment could improve ocular surface characteristics in patients with DED, and more importantly, it alleviates their ocular pain and depressive state. The anti-inflammatory effect of acupuncture may be involved in this process. Future research with larger, randomized controlled trials (RCTs) is necessary to confirm these findings and clarify the mechanisms involved.Keywords: acupuncture, dry eye disease, ocular pain, depression, inflammatory cytokines

Kepa Balparda,1– 3 Mariana Escobar Giraldo,4 Yeliana M Valencia Gómez,5 Isabela Franco Sánchez,6 Tatiana Herrera Chalarca2 1Department of Cornea and Refractive Surgery, Clínica de Oftalmología Sandiego, Medellín, Colombia; 2Department of Clinical Research, Black Mammoth Surgical, Medellín, Colombia; 3Private Practice, Medellín, Colombia; 4Department of Ophthalmology, Universidad Pontificia Bolivariana, Medellín, Colombia; 5Department of Ophthalmology, Pontificia Universidad Javeriana, Cali, Colombia; 6School of Medicine, Universidad Pontificia Bolivariana, Medellín, ColombiaCorrespondence: Kepa Balparda, Email kb@kepabalparda.comPurpose: To determine clinical and refractive results after the implantation of EyeCryl Phakic Toric intraocular lens in patients with stable keratoconus.Methods: The study included all patients diagnosed with keratoconus who underwent implantation of an EyeCryl Phakic Toric intraocular lens (Biotech Healthcare Holding; Ahmedabad, India) in at least one eye and had a follow-up of at least 12 months. Visual and refractive data were collected for all patients, along with corneal tomography measurements using Pentacam, and vault measurement using optical coherence tomography. This retrospective study was conducted at a high-volume private refractive surgery center in Medellín, Colombia.Results: A total of 83 eyes from 47 patients were included in the study. The majority (71.1%) were female, with a mean age of 31.2 ± 5.1 years. After 12 months of follow-up post-surgery, the spherical equivalent improved significantly from – 8.19 ± 4.04 D to – 0.06 ± 0.48 D (p < 0.001). Furthermore, 77% of eyes had a post-surgical spherical equivalent within ± 0.50 D, while 92% had residual astigmatism ≤ 0.50 D. Twelve months after surgery, mean manifest astigmatism was – 0.28 ± 0.27 D. Uncorrected visual acuity also showed improvement, from 1.11 ± 0.35 LogMAR to 0.14 ± 0.11 LogMAR. Moreover, 52.4% of eyes demonstrated an improvement of at least one line in best-corrected visual acuity. Notably, no intraoperative or postoperative complications were observed in the study population.Conclusion: The implantation of EyeCryl Phakic Toric intraocular lenses represents a highly effective and safe option for correcting refractive errors in patients with a history of keratoconus. Refractive accuracy is excellent, and a significant proportion of patients experienced an improvement in their best-corrected vision by at least one line.Keywords: keratoconus, lens implantation, intraocular, refractive error

Worapot Srimanan Division of Ophthalmology, Phramongkutklao Hospital, Bangkok, ThailandCorrespondence: Worapot Srimanan, Ophthalmology division, Phramongkutklao hospital, 315 Ratchawithi Road, Thung Phayathai Subdistrict, Ratchathewi, Bangkok, Thailand, Tel +66 2-763-9300, Fax +66 2-354-9309, Email drworapotsmn@gmail.com

Samuel A Cohen,1 Nikhita Yadlapalli,2 Jonathan D Tijerina,3 Chrisfouad R Alabiad,3 Jessica R Chang,4 Benyam Kinde,5 Nicholas R Mahoney,6 Kelsey A Roelofs,1 Julie A Woodward,7 Andrea L Kossler5 1Department of Ophthalmology, Stein Eye Institute at University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA; 2Department of Ophthalmology, FIU Herbert Wertheim College of Medicine, Miami, FL, USA; 3Department of Ophthalmology, Bascom Palmer Eye Institute at University of Miami Miller School of Medicine, Miami, FL, USA; 4Department of Ophthalmology, USC Roski Eye Institute at University of Southern California Keck School of Medicine, Los Angeles, CA, USA; 5Department of Ophthalmology, Byers Eye Institute at Stanford University School of Medicine, Palo Alto, CA, USA; 6Department of Ophthalmology, Wilmer Eye Institute at Johns Hopkins University School of Medicine, Baltimore, MD, USA; 7Department of Ophthalmology, Duke Eye Center at Duke University School of Medicine, Durham, NC, USACorrespondence: Andrea L Kossler, Department of Ophthalmology, Byers Eye Institute at Stanford University School of Medicine, 2452 Watson Court, Palo Alto, CA, USA, Email akossler@stanford.eduPurpose: To compare the accuracy and readability of responses to oculoplastics patient questions provided by Google and ChatGPT. Additionally, to assess the ability of ChatGPT to create customized patient education materials.Methods: We executed a Google search to identify the 3 most frequently asked patient questions (FAQs) related to 10 oculoplastics conditions. FAQs were entered into both the Google search engine and the ChatGPT tool and responses were recorded. Responses were graded for readability using five validated readability indices and for accuracy by six oculoplastics surgeons. ChatGPT was instructed to create patient education materials at various reading levels for 8 oculoplastics procedures. The accuracy and readability of ChatGPT-generated procedural explanations were assessed.Results: ChatGPT responses to patient FAQs were written at a significantly higher average grade level than Google responses (grade 15.6 vs 10.0, p < 0.001). ChatGPT responses (93% accuracy) were significantly more accurate (p < 0.001) than Google responses (78% accuracy) and were preferred by expert panelists (79%). ChatGPT accurately explained oculoplastics procedures at an above average reading level. When instructed to rewrite patient education materials at a lower reading level, grade level was reduced by approximately 4 (15.7 vs 11.7, respectively, p < 0.001) without sacrificing accuracy.Conclusion: ChatGPT has the potential to provide patients with accurate information regarding their oculoplastics conditions. ChatGPT may also be utilized by oculoplastic surgeons as an accurate tool to provide customizable patient education for patients with varying health literacy. A better understanding of oculoplastics conditions and procedures amongst patients can lead to informed eye care decisions.Keywords: oculoplastics, google, ChatGPT, readability, accuracy

Worapot Srimanan Ophthalmology Division, Phramongkutklao Hospital, Bangkok, ThailandCorrespondence: Worapot Srimanan, Ophthalmology Division, Phramongkutklao Hospital, 315 Ratchawithi Road, Thung Phayathai Subdistrict, Ratchathewi, Bangkok, Thailand, Tel +66 2-763-9300, Fax +66 2-354-9309, Email drworapotsmn@gmail.comPurpose: This study aims to evaluate the outcomes of surgical intervention for infantile esotropia at a tertiary care hospital.Patients and Methods: Medical records of patients with esotropia who underwent surgical correction at our tertiary hospital between January 2013 and June 2023 were retrospectively analyzed. Patient demographics, preoperative and postoperative ocular alignment, surgical techniques employed, complications or reoperations, and factors related to successful surgery were analyzed.Results: The study included 77 participants with an average age of 9.54 ± 10.87 years at the time of surgery. Postoperatively, 71.4% (55/77) patients achieved successful alignment, which was defined as an ocular deviation of ≤ 10 prism diopters (PD), at the final follow-up. The average follow-up period was 12 months, during which no complications were noted. Reoperation was required in 15.6% (12/77) patients. Multivariate logistic regression revealed that having a smaller preoperative deviation of < 50 PD positively influenced the success of strabismus surgery (adjusted odds ratio, 7.13; 95% CI, 2.04– 24.86).Conclusion: The surgical correction of infantile esotropia in a tertiary care setting yielded favorable alignment outcomes in most cases, with no complications and a low reoperation rate. A preoperative angle of < 50 PD emerged as a prognostic factor for successful surgical outcomes in this population. Further studies with longer follow-up periods are recommended to evaluate the long-term stability of these outcomes and identify additional influencing factors.Plain language summary: This study reviewed the outcomes of surgery for infantile esotropia, a condition where one or both eyes turn inward. We analyzed medical records of patients who underwent surgical correction for esotropia at a tertiary care hospital between January 2013 and June 2023. We collected information about patient demographics, eye alignment before and after surgery, the types of surgeries performed, any complications, and factors related to successful outcomes.The study included 77 patients, who had an average age of ~9.5 years at the time of surgery. After surgery, 71.4% (55 out of 77) of patients achieved successful eye alignment, defined as an eye deviation of 10 prism diopters or less. Patients returned for follow-up after an average of 12 months, and no complications were reported. However, 15.6% (12 out of 77) of patients required reoperation. Our analysis showed that patients with a smaller initial eye deviation (less than 50 prism diopters) were likely to have successful outcomes.In conclusion, surgery for infantile esotropia in our hospital resulted in good alignment in most cases, with no complications and a low rate of repeat surgeries. Having a smaller initial eye deviation strongly predicted the success of the surgery. Further research with longer follow-up periods is needed to determine the long-term outcomes and identify other factors that may influence outcomes.Keywords: esotropia, strabismus, surgery, success, factor

Kenneth Kenyon,1 Eugene B McLaurin,2 Steven M Silverstein,3 John C Meyer,4 Erik Anderson,5 Ravi H Patel,6 Paul J Gomes,7 Erin Reilly,8 Srilatha Vantipalli,8 Matthew W Cheung,8 Michael H Goldstein8 1Andover Eye Associates, Andover, MA, USA; 2Total Eye Care, P.A., Memphis, TN, USA; 3Silverstein Eye Centers, Kansas City, MO, USA; 4The Eye Care Institute, Louisville, KY, USA; 5Vision Institute, Colorado Springs, CO, USA; 6Eye Associates of Texas, Round Rock, TX, USA; 7Ora, Inc., Andover, MA, USA; 8Ocular Therapeutix, Inc., Bedford, MA, USACorrespondence: Matthew W Cheung, Ocular Therapeutix, Inc., 15 Crosby Drive, Bedford, MA, 01730, USA, Tel +1 516-287-7678, Email mcheung@ocutx.comPurpose: To evaluate the efficacy and safety of a dexamethasone intracanalicular insert (DEX) for treatment of allergic conjunctivitis (AC).Patients and Methods: In this multicenter, randomized, double-masked, placebo-controlled phase 3 study, adults (≥ 18 years) with AC were randomized 1:1 to DEX or placebo insert (PBO) placed bilaterally. Subjects underwent repetitive conjunctival allergen challenges (CAC) across 30 days and were assessed for changes in AC signs and symptoms. The primary endpoint was ocular itching score at 3, 5, and 7 minutes post-CAC at Day 8 (7 days post-insertion). This trial is registered on ClinicalTrials.gov (NCT04050865).Results: Ninety-six subjects were randomized (n=48 DEX, n=48 PBO). Compared to PBO, there were statistically significant treatment differences favoring DEX for the primary endpoint of mean ocular itching score at Day 8 (− 0.86, − 0.98, − 0.96 at 3, 5, and 7 minutes post-CAC respectively; P< 0.0001 for all). Treatment differences favored DEX for all 24 time points across 6 visits and were statistically significant (P< 0.05) except for the first post-insertion (Day 7, 3 minutes). For the 18 time points at which conjunctival redness was assessed, DEX had lower scores than PBO (P< 0.05 for all). The most common ocular adverse events (AEs) in DEX subjects were eye discharge and irritation. No serious AEs, elevated intraocular pressure, dacryocanaliculitis, or use of rescue medications were reported.Conclusion: Results of this study support the potential use of dexamethasone insert as a physician-administered, preservative-free treatment for AC, with significant improvements in ocular itching and conjunctival redness compared with placebo. The dexamethasone insert was generally safe with a favorable safety profile.Keywords: allergy, conjunctivitis, dexamethasone, insert, intracanalicular

Rosario Tourino-Peralba,1,2,&ast; David Lamas-Francis,1,&ast; Laura Freijeiro-Gonzalez,3 Laura Martínez-Pérez,1 Teresa Rodríguez-Ares1 1Department of Ophthalmology, University Hospital of Santiago de Compostela, Santiago, Spain; 2Department of Surgery and Medical-Surgical Specialities, Faculty of Medicine, University of Santiago de Compostela, Santiago, Spain; 3Department of Statistics, Faculty of Mathematics, University of Santiago de Compostela, Santiago, Spain&ast;These authors contributed equally to this workCorrespondence: Rosario Tourino-Peralba, Department of Ophthalmology, University Hospital of Santiago de Compostela, Ramón Baltar s/n, 15706, Santiago de Compostela, Spain, Tel +34 981 951 749, Email rtourinop2@gmail.com; david.lamas@outlook.esPurpose: This study aims to analyze the incidence of pseudophakic macular edema (PME) and the role of contributing risk factors following prepupillary or retropupillary implantation of iris-claw lenses.Methods: This retrospective cohort study included patients who underwent iris-claw intraocular lens implantation over a 16-year period at the University Hospital of Santiago de Compostela, Spain. The presence of risk factors for PME was recorded, and surgical outcomes included visual acuity, macular OCT scans, and description of complications.Results: A total of 148 eyes from 147 patients were included. Seventy-nine eyes (54.4%) underwent prepupillary iris-claw lens implantation and 69 eyes (46.6%) underwent retropupillary implantation. The mean age of the patients was 68.9 ± 17.2 years. The incidence of PME post-surgery was 23.0% (26.6% prepupillary and 18.8% retropupillary), and the mean time between surgery and diagnosis was similar for both locations (4.8 and 4.7 months, respectively). PME recurred in 33% of the patients, reaching a high rate of 72.7% when the lens location was prepupillary. The mean best-corrected visual acuity was 0.66± 0.55 logMAR preoperatively and 0.38± 0.50 logMAR postoperatively. Postoperative complications occurred in 29 patients (19.6%).Conclusion: PME following iris-claw lens implantation tends to be more frequent and recurrent when the location is prepupillary. Planning for iris-claw lens surgery should consider the risk factors for the development of PME.Keywords: macular edema, aphakia, pseudophakia, iris-anchored intraocular lenses

Ali S Alsudais,1,2 Waleed Mohammed Alshehri,3 Ahmed M Alrehaili,4 Reyadh Khalid Albeladi,5 Mohammed Khoshhal,4,6 Ahmed Albelowi,4 Raghad Saleh Alzahrani,1,2 Ahmed Alnabihi,1,2 Bader Bashrahil,1,2 Omar Alabbasi3 1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia; 2King Abdullah International Medical Research Center, Jeddah, Saudi Arabia; 3Department of Ophthalmology, King Salman Bin Abdulaziz Medical City, Madinah, Saudi Arabia; 4College of Medicine, Taibah University, Madinah, Saudi Arabia; 5College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 6Ohud Hospital, Madinah, Saudi ArabiaCorrespondence: Ahmed Alnabihi, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, 21423, Saudi Arabia, Tel +966569493360, Email Alnabihi.ahmed@gmail.comObjective: This meta-analysis evaluated the efficacy and safety of DEXTENZA, an intracanalicular dexamethasone insert, for the treatment of seasonal/perennial allergic conjunctivitis.Methods: Multiple databases, including PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, the Directory of Open Access Journals, and Scopus, were searched for randomized controlled trials (RCTs) comparing the efficacy of DEXTENZA with a placebo. The primary efficacy endpoint was the change in the conjunctival allergen challenge (CAC) model. The GRADE approach was used to assess the certainty of evidence, and the revised Cochrane risk of bias tool for randomized trials was employed to assess bias.Results: Four RCTs involving 323 participants met the eligibility criteria, and all had a low risk of bias. A meta-analysis revealed a statistically significant increase in the mean CAC change for conjunctival itching, with low heterogeneity among measurements at 3 minutes (P

Muhammad B Qureshi,1 Jose O Garcia,1 Jaxon Quillen,2 Carolyn Mead-Harvey,2 Christina Wentz,3 Cherie B Nau,4 Muriel Schornack,4 Keith Baratz,4 Sanjay V Patel,4 Joanne Shen5 1Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA; 2Department of Quantitative Health Sciences, Mayo Clinic, Scottsdale, AZ, USA; 3Illinois College of Optometry, Chicago, IL, USA; 4Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA; 5Department of Ophthalmology, Mayo Clinic, Scottsdale, AZ, USACorrespondence: Joanne Shen, Department of Ophthalmology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, USA, 85259, Tel +1 480-301-8085, Fax +1 480-301-7326, Email shen.joanne@mayo.eduPurpose: To compare baseline characteristics and treatment of chronic ocular graft-versus-host disease (oGVHD) patients in two treatment locations.Patients and Methods: Patients diagnosed with definite chronic oGVHD between September 1, 2014 and September 20, 2021 at two locations were identified. IRB-approved retrospective chart review was conducted for the following data: demographic information, ocular surface disease index (OSDI), corneal fluorescein staining (CFS), and treatment(s) used. Differences by site were assessed using Pearson’s Chi-Square tests and two-sample t-tests; differences by time were assessed using paired t-tests.Results: At baseline, Clinic 1 (C1) patients had a worse mean OSDI score (47.8 vs 36.3, p = 0.011) and CFS in both OD (1.3 vs 0.8, p = 0.005) and OS (1.3 vs 0.6, p < 0.001) compared to Clinic 2 (C2). Comparing baseline to endpoint, C1 patients experienced an improvement in OSDI (− 17.26, p < 0.001), CFS OD (− 0.50, p < 0.001), and CFS OS (− 0.51, p < 0.001) at C1. Change in OSDI, CFS OD, or CFS OS was not statistically significant at C2. Despite similar follow-up length, C1 demonstrated more clinic visits (10.4 vs 3.4, p < 0.001) and more treatment trials (4.9 vs 2.4, p < 0.001) compared to C2. Punctal plugs (85.5% vs 61.2%, p = 0.002), punctal cautery (69.7% vs 28.6%, p < 0.001), topical steroids (72.4% vs 22.4%, p < 0.001), and autologous serum tears (AST) (52.6% vs 8.2%, p < 0.001) were used more frequently at C1 than at C2.Conclusion: oGVHD patients at C1 experienced significant improvement in OSDI and corneal fluorescein staining and compared to patients at C2, had more frequent follow-up and use of punctal plugs, punctal cautery, topical steroids, and AST.Keywords: graft-versus-host disease, GVHD, chronic GVHD, dry eye disease, ocular GVHD, keratoconjunctivitis sicca, KCS

Nawaf Almarzouki Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi ArabiaCorrespondence: Nawaf Almarzouki, Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia, Email nawaf.almarzouki@gmail.comBackground: Glaucoma, a leading cause of irreversible vision loss, is characterized by progressive degeneration of retinal ganglion cells. Intraocular pressure (IOP) remains a well-established risk factor, but recent research suggests environmental and lifestyle factors may also play a role.Objective: This review aimed to evaluate the current evidence on the impact of environmental factors on glaucoma progression.Methods: We conducted a systematic review following PRISMA guidelines, searching various databases for studies on environmental factors and glaucoma progression.Results: Our review identified several key findings. IOP remains the most crucial modifiable risk factor. Aerobic exercise and mindfulness practices may lower IOP and provide neuroprotection. Lifestyle modifications like smoking cessation and balanced diets were also emphasized. Studies suggest air pollution exposure, particularly PM2.5, may be associated with an increased risk of glaucoma. However, the studies were primarily observational, and more research is needed to establish causality and elucidate underlying mechanisms.Conclusion: This review highlights the multifaceted nature of glaucoma, emphasizing the interplay between established risk factors (IOP) and emerging environmental influences (air pollution). Environmental factors hold promise as potential targets for glaucoma prevention and management strategies. Future research should focus on well-designed studies to investigate causal relationships and biological mechanisms.Keywords: glaucoma, intraocular pressure, IOP, environmental factors, air pollution, lifestyle modifications, aerobic exercise, diet, public health

Peiyu Xing,1,&ast; Yucheng Zhang,2,&ast; Yong Zhang,1 Shaowei Wang,2 Xiaojia Hu,1 Meihua Wang,1 Fan Xia,1 Yang Zhao,1 Wei Qu,2 Bo Meng2 1Department of Ophthalmology, China Medical University the Fourth People’s Hospital of Shenyang, Shenyang, People’s Republic of China; 2Department of Ophthalmology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Bo Meng, Department of Ophthalmology, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, People’s Republic of China, Email m18204507737@163.comPurpose: The objective of this research was to assess the effectiveness and safety of using Conbercept injection and dexamethasone implant (DEX I) in sequence for treating refractory macular edema (ME) caused by central retinal vein occlusion (CRVO) in patients.Methods: A study was conducted on 34 patients with persistent macular edema caused by central retinal vein occlusion, reviewing their medical history and interventions performed. Sequential implantation of DEX I was performed 1 week after the Conbercept injection. OCTA images were used to measure central retinal thickness (CRT), best-corrected visual acuity (BCVA), intraocular pressure (IOP), and pre- and post-treatment vessel density of the superficial capillary plexus (SCP) and deep capillary plexus (DCP), with a 1-year follow-up period.Results: At the 12-month follow-up, participants demonstrated notable improvements in central retinal thickness and intraocular pressure (p < 0.05). Throughout the monitoring period, no significant differences were found in BCVA improvement or vessel density reduction (p > 0.05). Two patients required topical treatment to lower their intraocular pressure during the study period.Conclusion: In conclusion, patients experiencing persistent ME due to secondary CRVO may benefit from transitioning to a treatment regimen involving Conbercept and DEX I, potentially resulting in a reduction in CRT. However, no significant improvement was observed in BCVA or deep and superficial capillary plexus vessel density.Keywords: macular edema, sequential, central retinal thickness, best corrected visual acuity

Sri Ganesh, Sheetal Brar, Supriya Sriganesh, Hemali D Bhavsar Department of Phaco-Refractive Surgery, Nethradhama Super Speciality Eye Hospital, Bengaluru, Karnataka, IndiaCorrespondence: Sheetal Brar, Department of Phaco-Refractive surgery, Nethradhama Superspeciality Eye Hospital, Jayanagar, Bengaluru, Karnataka, India, Tel +919591002092, Email brar_sheetal@yahoo.co.inPurpose: To compare the intra-operative surgical performance of Quatera 700 with Centurion and Signature Pro phacoemulsification systems.Setting: Nethradhama Superspeciality Eye Hospital, Bangalore, India.Study Design: Prospective, interventional, 3-arm, randomized comparison study.Methods: A total of 180 non-consecutive eyes satisfying the eligibility criteria were recruited. N = 60 eyes were operated using each of the above systems, of which n = 30 eyes had LOCS III grade 1– 2, and n = 30 eyes had grade 3– 4 nuclear density. Phacoemulsification with foldable IOL implantation was performed by a single experienced surgeon. Chamber stability scores (1– 4, 4 being the worst), fluid turnover per case, surge incidence and intra-operative complications were assessed.Results: Intra-operatively, the mean chamber stability score was significantly better for the Quatera 700 in both the soft and dense cataract groups compared to the other two machines (p < 0.001). Total Phaco Time (TPT) with Quatera 700 was significantly lower compared to Signature Pro, while it was comparable with Centurion for both the soft and dense cataract groups. The mean fluid turnover was significantly lower for the Quatera 700 in the dense cataract group (p = 0.04) and so was the combined phaco and I/A time (p = 0.01) when compared with Signature Pro. One eye operated with Signature Pro and 2 eyes operated with Centurion had PCR due to surge. The mean corneal clarity scores on POD-1 and specular counts at 2 weeks and 6 months were comparable.Conclusion: The new Quatera 700 system resulted in lesser TPT, fluid turnover and phaco + I/A time than Signature Pro, while its performance was comparable to Centurion for these parameters. Moreover, the surgeon graded intra-operative chamber stability scoring was highest, when compared to the other two systems.Ctri Registration Number: CTRI/2022/01/039296.Keywords: Quatera 700, Quattro pump, phacoemulsification

Guo-Hong Zhao,1 Jin-Da Wang,1 Mei-Rui Liu,2,3 Li-Jun Zhang,4 Yan Sun,5 Kai Cao6 1Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Pulmonary Rehabilitation, Emergency General Hospital, Beijing, People’s Republic of China; 3School of Public Health, North China University of Science and Technology, Tangshan, Hebei, People’s Republic of China; 4Department of Obstetrics and Gynecology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China; 5Department of Ophthalmology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, People’s Republic of China; 6Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Kai Cao, Email crcteam@163.comObjective: To explore the distribution and influence factors of non-invasive tear film break-up time (NIBUT) in children.Methods: This is a hospital-based cross-sectional study. Spherical equivalent error (SER) was measured with cycloplegia. NIBUT was measured by an ocular surface integrated analyzer.Results: A total of 1269 children (1269 eyes) were included in this study. Participants’ median age was 11 (range 6– 18) years. 47.1% (598/1269) of participants were boys. The median NIBUT of myopic children and non-myopic children were 9.9 seconds (s) (Inter-quartile range, IQR: 6.4 to 16.1) and 10.9 s (IQR: 8.8 to 17.9), respectively, which was statistically significant (p = 0.004). In myopic children, 49.9% (573/1148) were able to achieve NIBUT of 10 s or more, compared to 67.8% (82/121) in non-myopic children, which was statistically significant (p < 0.001). There were 41 (3.57%) children in the myopic group and none (0%) in the non-myopic group with dry eye disease (p = 0.028). There was a positive correlation between NIBUT and age: NIBUT = 9.256 + 0.352&ast;Age. 71.8% (824/1148) of myopic children used electronic products almost every day, compared to 37.2% (45/121) of non-myopic children, which was statistically significant (p < 0.001).Conclusion: The NIBUT of myopic children was significantly shorter than that of non-myopic children. Children with myopia are more likely to have dry eyes. NIBUT increases with age. High frequency of electronic product use may be an important cause to NIBUT shortening in children.Keywords: Tear film break-up time, dry eye, Myopia, ocular surface, children

Ana Marta,1,2 André Ferreira,1,3,4 Inês Couto,1 Miguel Mesquita Neves,1 Miguel Gomes,1 Luis Oliveira,1 Celia Azevedo Soares,5– 8 Maria João Menéres,1,2 Carolina Lemos,2,8 João Melo Beirão1,2 1Department of Ophthalmology, Centro Hospitalar Universitário de Santo António, Unidade Local de Saúde de Santo António, Porto, Portugal; 2Instituto Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal; 3Department of Biomedicine - Unit of Anatomy, Faculty of Medicine of University of Porto, Porto, Portugal; 4Centre for Health Technology and Services Research, Health Research Network (CINTESIS@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal; 5Medical Genetics Department, Centro Hospitalar Universitário de Santo António, Unidade Local de Saúde de Santo António, Porto, Portugal; 6Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; 7Medical Science Department, Universidade de Aveiro, Aveiro, Portugal; 8i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, PortugalCorrespondence: Ana Marta, Centro Hospitalar Universitário de Santo António, Unidade Saúde Local de Santo António, EPE (ULSSA), Largo do Prof. Abel Salazar, Porto, 4099-001, Portugal, Email analuisamarta2@gmail.comPurpose: Inherited retinal diseases (IRDs) are a group of degenerative disorders of the retina, that can be potentially associated with changes in the anterior segment, but their prevalence and impact are not known. Exploring these concomitant ophthalmologic changes with biomechanical assessment may help identify other non-retina causes of vision loss in these patients, such as corneal ectasia or susceptibility to glaucoma. This study aimed to measure and compare corneal biomechanics in patients with and without IRDs.Methods: A total of 77 patients (154 eyes) with IRD were recruited as the study group. The control group consisted of 77 healthy adults (154 eyes) with matched age and sphere equivalents. All participants underwent a comprehensive assessment including corneal tomography (Pentacam®) and biomechanical assessment (Corvis ST®). A total of 4 second-generation biomechanical parameters and 3 indexes were collected: Ambrosio Relational Thickness (ARTh), Deflection Amplitude Ratio Max (DARM), Integrated Radius (IR) and Stiffness Parameter at Applanation (SP-A1), the final deviation value D of the Belin/Ambrosio Enhanced Ectasia Display (BAD-D), Corvis Biomechanical Index (CBI) and Tomographic Biomechanical Index (TBI).Results: For IRD patients, there was a higher DARM (p < 0.001), lower ARTh (p < 0.001), higher CBI (p < 0.001), higher TBI (p< 0.001), and higher BAD-D (p < 0.001) compared to the control group. Regarding discrimination of healthy subjects and IRD patients, ARTh was the most sensitive parameter.Conclusion: The results showed that IRD patients tend to have softer corneal behaviour, compared to eyes without pathology, which may predispose patients to corneal ectasia or glaucoma development. ARTh could be used to screen IRD patients if a non-retina cause of vision loss is suspected.Keywords: IRD, corneal biomechanics, corneal tomography

Alex D Meyer,1 Delcora Huggins,2 Imani Nwokeji,3 Lorraine M Provencher1,2,4 1Cincinnati Eye Institute, Cincinnati, OH, USA; 2University of Cincinnati, College of Medicine, Cincinnati, OH, USA; 3City College of New York (CUNY), School of Medicine, New York, NY, USA; 4Vance Thompson Vision, Omaha, NE, USACorrespondence: Lorraine M Provencher, Vance Thompson Vision, 4909 S 118th St, Omaha, NE, USA, 68137, Tel +1 402 506-9970, Fax +1 402 315-9753, Email lorraine.provencher@vancethompsonvision.comPurpose: To assess the efficacy and safety of goniotomy using a uniquely shaped trapezoidal, serrated dual blade (TDB), designed to accommodate variability in patient anatomy, in reducing intraocular pressure (IOP) or anti-glaucoma medications (AGM) in adult glaucoma patients when combined with cataract surgery.Patients and Methods: Retrospective consecutive case series of patients with glaucoma who underwent phacoemulsification with TDB-goniotomy were included. Preoperative, intraoperative, and postoperative data were collected over 6 months. The primary outcome measure was surgical success, defined as IOP reduction ≥ 20% from baseline at 6 months, and/or reduction of at least 1 AGM. Postoperative adverse events were collected as a secondary outcome measure.Results: Sixty-five eyes of 46 patients were included with data available on 53 eyes at 6 months. Primary open-angle (38%), primary angle-closure (37%), and mixed-mechanism glaucoma (11%) were the most common diagnoses. Most cases were severe (48%) or moderate (32%) stage. At the 6-month mark, surgical success was achieved in 92% of eyes by either or both criteria. Mean preoperative IOP decreased from 18.4 mmHg (SE 0.83) to 13.0 mmHg (SE 0.37) (p< 0.001) at postoperative month 6. Mean AGM decreased from 2.46 (SE 0.19) preoperatively to 1.45 (SE 0.17) (p< 0.001). The most common postoperative complication was an IOP spike at postoperative week 1 (11%). No serious adverse events occurred related to the goniotomy.Conclusion: TDB-goniotomy in combination with cataract surgery safely and effectively lowered IOP and reduced AGM burden in adults with various types and severities of glaucoma over 6-months of follow-up.Plain Language Summary: There are many tools available to perform goniotomy, a popular minimally invasive glaucoma surgery, but data is lacking on many of these devices. This study sought to determine the safety and efficacy of excisional goniotomy using a uniquely shaped trapezoidal dual blade (TDB) in combination with cataract surgery for adult glaucoma patients. At 6 months, the primary outcome measure of intraocular pressure (IOP) reduction ≥ 20% from baseline and/or reduction of at least 1 anti-glaucoma medication was met by 92% of eyes. Six months postoperatively, there was a statistically significant decrease in mean IOP from 18.4 mmHg to 13.0 mmHg and mean antiglaucoma medications from 2.5 to 1.5. Therefore, TDB-goniotomy in combination with cataract surgery can safely decrease IOP and/or antiglaucoma medications in a mixed population of various glaucoma types and severities.Keywords: minimally invasive glaucoma surgery, MIGS, goniotomy, glaucoma, phacoemulsification

Eric Jennings,1 Brad Hall2 1Woolfson Eye Institute, Atlanta, GA, USA; 2Sengi, Penniac, NB, CanadaCorrespondence: Eric Jennings, Woolfson Eye Institute 800 Mount Vernon Hwy NE Suite 130, Atlanta, GA, 30501, USA, Tel +1-404-256-1125, Email ejennings@woolfsoneye.comPurpose: To evaluate the efficacy of a cloud-based surgical planning platform with regards to refractive target accuracy.Methods: This was a retrospective chart review of consecutive cases from January 2022 through December 2023. Surgical planning was performed using the SMARTCataract platform, eyes were implanted with Clareon monofocal IOLs, and power calculations were done using the Barrett Universal II formula. Data were collected for the percentage of eyes within ± 0.5 D of target refraction, mean absolute error (MAE), and postoperative visual acuity.Results: A total of 148 eyes were identified that met the inclusion/exclusion criteria. The percentage of eyes within ± 0.5 D of the planned target was 94%. The MAE was 0.25 ± 0.17 D. In addition, 57%, 93%, 98%, and 100% of eyes had MAE ≤ 0.25 D, ≤ 0.5 D, ≤ 0.75 D, and ≤ 1.0 D, respectively.Conclusion: The results of this study suggest high refractive accuracy when using the SMARTCataract planning platform with the Barrett Universal II formula and excellent distance visual acuity.Plain Language Summary: When the natural lens inside the eye develops a cataract (becomes opaque) it can be replaced with a clear artificial intraocular lens (IOL). Good visual outcomes after surgery are heavily reliant on implanting the optimal lens power. A new cloud-based surgical planning tool (SMARTCataract) aims to automatically use patient data, surgeon preferences, favored IOL power calculation formulas, and desired IOL type to guide surgical planning. However, to date there are no data on the refractive outcomes when using the SMARTCataract platform. The purpose of this study was to evaluate the efficacy of the SMARTCataract platform with regards to refractive target accuracy. The results of this study suggest high refractive accuracy when using the SMARTCataract platform with the Barrett Universal II formula and excellent distance visual acuity.Keywords: SMARTCataract, biometry, accuracy, intraocular lens

Nithya Boopathiraj,1 Isabella V Wagner,1 Paul Connor Lentz,2 Christian Draper,3 Chelsey Krambeer,1 Yazan S Abubaker,1 Bryan Chin Hou Ang,1,4,5 Darby D Miller,1 Syril Dorairaj1 1Department of Ophthalmology, Mayo Clinic, Jacksonville, FL, USA; 2Department of Ophthalmology, Mayo Clinic Alix School of Medicine, Jacksonville, FL, USA; 3Department of Ophthalmology, Eye Consultants, Spokane, WA, USA; 4Department of Ophthalmology, Tan Tock Seng Hospital, National Healthcare Group Eye Institute, Singapore; 5Department of Ophthalmology, Woodlands Health, National Healthcare Group Eye Institute, SingaporeCorrespondence: Syril Dorairaj, Department of Ophthalmology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA, Tel +1-904-953-2377, Fax +1-904-953-7040, Email dorairaj.syril@mayo.eduPurpose: To compare the safety and effectiveness of standalone Kahook Dual Blade (KDB) excisional goniotomy to standalone ab-interno Xen gel stent implantation in eyes with moderate-to-severe open-angle glaucoma (OAG).Methods: A single-center, retrospective study including eyes with moderate-to-severe OAG undergoing standalone KDB goniotomy or Xen gel stent implantation was conducted. Intraocular pressure (IOP), the number of antiglaucoma medications taken daily, and best-corrected visual acuity (BCVA) were recorded at baseline and for up to 36-months. Primary outcomes assessed included changes from baseline in IOP and the number of antiglaucoma medications taken. Intergroup comparisons were conducted using independent-samples Student’s t-tests. The incidence of intraoperative and postoperative adverse events and the need for glaucoma surgical re-interventions were also recorded.Results: Eyes receiving standalone KDB (n=26) or Xen gel stent (n=45) surgery were analyzed. The baseline mean IOP and number of antiglaucoma medications in both groups were as follows: KDB: 23.2 ± 6.0 mmHg, 2.2 ± 1.4 medications; Xen: 22.7 ± 8.8 mmHg, 3.0 ± 1.0 medications. At 36 months, IOP was reduced to 16.6 ± 5.4 mmHg in KDB eyes (n=23, − 23.5%; p=0.0004) and 15.3 ± 5.6 mmHg in Xen gel stent eyes (n=15, − 22.1%; p=0.006), while number of antiglaucoma medications was reduced to 1.1 ± 0.7 (− 30.8%; p=0.0005) and 2.2 ± 1.4 (− 25.6%; p=0.01), respectively. Three eyes (11.5%) in the KDB group and 19 eyes (42.2%) in the Xen gel stent group required additional surgery before month 36 due to refractory high IOP.Conclusion: Both KDB goniotomy and Xen gel stent implantation significantly lowered the IOP and antiglaucoma medication burden in patients with moderate-to-severe OAG. While the Xen gel stent is frequently used to treat moderate-to-severe OAG patients with uncontrolled IOP, standalone KDB goniotomy may be equally effective as a long-term intervention, reducing the need for subsequent glaucoma surgery.Keywords: kahook dual blade, micro-invasive glaucoma surgery, open angle glaucoma, xen gel stent