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Introduction: A cyclodialysis cleft, separating the ciliary body muscle from the scleral spur, can cause ocular hypotony by creating an abnormal aqueous humor drainage pathway. Though rare, this can occur post-intravitreal injection. Case presentation: A 53-year-old man with diabetic retinopathy presented with persistent hypotony in his right eye after receiving an aflibercept intravitreal injection. On presentation, his visual acuity was 20/200, and intraocular pressure (IOP) was 2 mmHg. Examination revealed a cyclodialysis cleft in the right eye. Despite initial treatment with steroids and atropine, the hypotony persisted, leading to surgical repair via ab-interno cyclopexy. Post-surgery, IOP normalized, and vision slightly improved. At three months post-operation, IOP was stable at 16 mmHg without glaucoma medication, and no signs of hypotony were present, with vision improving to 20/150. Conclusion: Misplaced intravitreal injections can lead to cyclodialysis cleft formation. Ophthalmologists should be aware of this possible complication. Meticulous gonioscopy and the adjunctive use of ocular imaging are crucial for the proper diagnosis of these cases. Ab-interno direct cyclopexy is an effective surgical approach for cyclodialysis clefts non- responsive to medical or laser treatment.

AIM: To analyze and calculate the relative cost of various childhood glaucoma surgical interventions per mm Hg intraocular pressure (IOP) reduction ($/mm Hg). METHODS: Representative index studies were reviewed to quantitate the reduction of mean IOP and glaucoma medications for each surgical intervention in childhood glaucoma. A US perspective was adopted, using Medicare allowable costs to calculate cost/mm Hg IOP reduction ($/mm Hg) at 1y postoperatively. RESULTS: At 1y postoperatively, the cost/mm Hg IOP reduction was $226/mm Hg for microcatheter-assisted circumferential trabeculotomy, $284/mm Hg for cyclophotocoagulation, $288/mm Hg for conventional ab-externo trabeculotomy, $338/mm Hg for Ahmed glaucoma valve, $350/mm Hg for Baerveldt glaucoma implant, $351/mm Hg for goniotomy, and $400/mm Hg for trabeculectomy. CONCLUSION: Microcatheter-assisted circumferential trabeculotomy is the most cost-efficient surgical method to lower IOP in childhood glaucoma, while trabeculectomy is the least cost-efficient surgical method.

Purpose: We report a case of a 10-year-old with Moring glory disc anomaly (MGDA) associated with Moyamoya disease and pituitary stalk duplication. Observations: A 10-year-old Asian child presented with decreased vision in the right eye and bilateral nystagmus. Both dilated fundus exam and magnetic resonance imaging (MRI) of the orbit confirmed MGDA of the right eye. MRI of the brain demonstrated duplication of the pituitary stalk. Magnetic resonance angiography (MRA) of the brain revealed bilateral severe narrowing (greater on the right side) of the distal supraclinoid internal carotid arteries with bilateral reconstitution at the carotid terminus and prominent collaterals, suggestive of Moyamoya disease. Conclusions: Patients with MGDA should undergo neuroimaging due to the associated central nervous system (CNS) anomalies.

Purpose: To report a unique case of metastatic paraganglioma presenting as a junctional scotoma. Observations: A 38-year-old Caucasian man with a history of abdominal paraganglioma presented with minimally blurred vision 20/25 visual acuity in the left eye. The patient was found to have a junctional scotoma upon visual field testing. Cranial MRI revealed a large peri-clival mass compressing the pre-chiasmal optic nerves and other loci of metastatic disease. Intracranial masses, including metastases, can present with a relatively intact central acuity and nonspecific visual symptoms. Conclusions and Importance: To the best of our knowledge, this is the first report of metastatic paraganglioma causing a junctional scotoma. In cases with junctional scotoma, careful neuro-ophthalmic assessment and imaging are of paramount importance, even in patients with excellent visual acuity.

Purpose: The purpose of this study was to develop a deep learning-based fully automated reconstruction and quantification algorithm which automatically delineates the neurites and somas of retinal ganglion cells (RGCs)., Methods: We trained a deep learning-based multi-task image segmentation model, RGC-Net, that automatically segments the neurites and somas in RGC images. A total of 166 RGC scans with manual annotations from human experts were used to develop this model, whereas 132 scans were used for training, and the remaining 34 scans were reserved as testing data. Post-processing techniques removed speckles or dead cells in soma segmentation results to further improve the robustness of the model. Quantification analyses were also conducted to compare five different metrics obtained by our automated algorithm and manual annotations., Results: Quantitatively, our segmentation model achieves average foreground accuracy, background accuracy, overall accuracy, and dice similarity coefficient of 0.692, 0.999, 0.997, and 0.691 for the neurite segmentation task, and 0.865, 0.999, 0.997, and 0.850 for the soma segmentation task, respectively., Conclusions: The experimental results demonstrate that RGC-Net can accurately and reliably reconstruct neurites and somas in RGC images. We also demonstrate our algorithm is comparable to human manually curated annotations in quantification analyses., Translational Relevance: Our deep learning model provides a new tool that can trace and analyze the RGC neurites and somas efficiently and faster than manual analysis.

Purpose of Review: Glaucoma drainage device (GDD) implantation surgery is commonly performed by glaucoma specialists to treat complex and refractory glaucomas. Relative safety and efficacy data from randomized controlled trials conducted in the last two decades have sparked the interest in GDDs as possible surgical options earlier in the course of the disease than has traditionally been practiced. However, until recently, advances in the design and techniques of GDD surgery have fallen short of this increasing interest., Recent Findings: Most recently, new GDDs that possess novel design features have become available to glaucoma specialists. Two of these new devices are the Ahmed ClearPath and the Paul glaucoma implant. These devices have demonstrated promising outcomes that are comparable to those of traditional implants. Additionally, given their unique respective features, these devices may streamline surgical technique due to ease of insertion and afford better safety and efficacy outcomes in certain patients., Summary: The recent introduction of new GDDs has been long awaited by glaucoma surgeons. Although early results are promising, long-term data and comparison of outcomes to those of traditional filtering surgery and commonly implanted devices are needed before these devices can be the new standard of care in glaucoma tube shunt surgery., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)