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PurposeMethodsResultsConclusionTo assess the efficacy and safety of preoperative intravitreal triamcinolone acetonide (IVTA) combined with internal limiting membrane (ILM) peeling for idiopathic epiretinal membrane (IMEM).This was a retrospective study. Thirty-six phakic eyes of 35 patients were included in this study. IVTA was administered to 18 patients (18 eyes, Group IVTA) 7 days before vitrectomy, while the other 17 patients (18 eyes, Group no-IVTA) only underwent vitrectomy and ILM peeling. Patients were followed up for at least 6 months. Data on best-corrected visual acuity (BCVA), intraocular pressure (IOP), central macular thickness (CMT), inner retinal thickness (IRT), vascular parameters (measured by optical coherence tomography angiography, OCTA), mean macular sensitivity (MMS), 63% bivariate contour ellipse area (BCEA) and P1 (measured by macular integrity assessment, MAIA) were collected.There were significant differences in BCVA and IRT between the IVTA group and the no-IVTA group at 6 months after surgery (p = .000 and p = .010). The CMT and MMS of the two groups significantly changed from the preoperative values; however, there were no differences between the 2 groups during the entire study period (p = .242 and p = .849). The changes in vascular parameters, including foveal avascular zone (FAZ) area and vessel densities of superficial and deep capillary plexus (SCP VD and DCP VD), in the two groups were not statistically significant. There were no statistically significant differences in 63% BCEA and P1 either.Macular morphology and macular integrity improved after vitrectomy combined with ILM peeling surgery. Compared with the no-IVTA group, preoperative intravitreal triamcinolone acetonide can improve best corrected visual acuity and accelerate the absorption of intraretinal fluid in terms of a significant reduction in IRT. [ABSTRACT FROM AUTHOR]

To elucidate the contributions of M-cone to the negative off-response of rat Electroretinogram (ERG) using specific drugs and spontaneous mutation rat models. The ON/OFF responses of ERG were evoked by long duration flash (200 ms) pre or post the application of 2-amino-4-phosphonobutyric acid (APB), cis-piperidine-2,3-dicarboxylic acid (PDA) or BaCl2 to the Sprague-Dawley (SD) rats. Furthermore, the ON/OFF responses of other two types of mutation rats, the middle-wavelength opsin cone dysfunction (MCD) rats and congenital stationary night blindness (CSNB) rats, were recorded. Typical scotopic and photopic ON/OFF responses were recorded in SD rats. At light offset, the OFF response showed a rapid negative deflection, then the retinal potential slowly returned to baseline from the trough of the negative off-response. The negative off-response was completely eliminated by the intravitreal injection of 400 µM APB. The amplitude of the negative off-response was reduced by the application of 5 mM PDA. However, the off component was not blocked by the application of 50 µM BaCl2. In addition, distinct differences of OFF response were found among MCD, CSNB and SD rats. The scotopic ON/OFF ERG of the MCD and CSNB rats showed no obvious negative off component at light offset, while the negative off component of photopic ON/OFF ERG was found in the CSNB rats, though with lower amplitude. The negative off-response of rat ERGs is not the off component of M-wave: a negative potential change at stimulus onset or offset. M-cone and the depolarizing bipolar cell play a central role in the signal transmission of this negative off-response. [ABSTRACT FROM AUTHOR]

Background: This study aimed to evaluate the efficacy of a simple intravitreal injection of perfluoropropane (C3F8) in treating unclosed idiopathic macular holes (IMHs) in patients who had previously undergone primary pars plana vitrectomy (PPV). Methods: This study was a retrospective, observational clinical study. It included patients diagnosed with unclosed IMHs following primary PPV combined with internal limiting membrane peeling and air tamponade. Optical coherence tomography (OCT) performed 1 week after PPV revealed unclosed IMHs with the presence of the 'cuff' sign and intraretinal cysts. The following day, these patients received a simple intravitreal C3F8 injection. Comprehensive evaluations, including best-corrected visual acuity (BCVA), indirect ophthalmoscopy, fundus photography, and OCT, were performed before PPV, 1 week after surgery, and at follow-up intervals of 1–3 months after the intravitreal gas injection. Results: The minimum linear diameter (MLD) of the macular holes (MHs) 1 week before C3F8 injection was 335.1 ± 74.3 μm. Following C3F8 tamponade, the closure rate of the MHs was 100%. The mean BCVA before C3F8 tamponade was 0.68 ± 0.17 logMAR (20/100) after primary PPV, which improved to 0.48 ± 0.19 logMAR (20/63) after C3F8 tamponade, showing a statistically significant difference (P = 0.01). Conclusions: For patients with unclosed MHs after primary PPV, the presence of the 'cuff' sign on OCT suggests that retreatment can be effectively achieved through a simple intravitreal gas injection. This approach is straightforward, practical, and effective. [ABSTRACT FROM AUTHOR]

• Hollow microneedles (HMNs) enable precise, localized intrascleral drug delivery. • Optimal penetration achieved with 30° bevel angle requiring < 2N force. • 3D-printed adapters enhance injection accuracy and reproducibility. • Ex vivo studies confirm effective drug distribution within the scleral layers. • HMNs present a promising alternative to conventional ocular drug delivery methods. Effective drug delivery to the posterior segment of the eye remains a challenge owing to the limitations of conventional methods such as intravitreal injections, which are associated with significant side effects. This study explored the use of hollow microneedles (HMNs) for localized intrascleral drug delivery as a minimally invasive alternative. Stainless steel HMNs with bevel angles of 30°, 45°, 60°, and 75° were fabricated using wire electron discharge machining. The penetration force of these HMNs in ex vivo porcine sclera was assessed using a texture analyser, revealing that the 60° bevel angle required the lowest force (<2N), making it optimal for scleral penetration. To ensure precision in drug delivery, 3D-printed adapters were developed to control the injection angles and volumes. The distribution of a model dye, rhodamine B, was studied via digital imaging, multiphoton microscopy, and confocal microscopy. The results showed that HMNs with a 60° bevel angle could penetrate the sclera to a depth of approximately 450 µm at a 45° injection angle, providing enhanced distribution within the scleral layers. This study confirmed that the use of HMNs enables effective and controlled intrascleral drug delivery, resulting in the formation of localized depots with minimal tissue damage. This research demonstrates the potential of HMNs as a promising alternative to traditional ocular drug delivery methods, offering improved bioavailability and the potential to reduce patient discomfort. [ABSTRACT FROM AUTHOR]

Introduction: Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study investigated and compared the prophylactic effects of fixed combination anti-glaucoma medication on IOP spikes following intravitreal anti-VEGF injections. Methods: This randomized double-blind clinical trial included one eye of each participant indicated for treatment with intravitreal injection of anti-VEGF agents (bevacizumab, aflibercept, and ranibizumab) and randomly allocated to one of the three prophylactic anti-glaucoma medications, with each drug further divided into one- and two-drop regimens before intravitreal injection. Participants with allergies or contraindications to medications were excluded from the pretreatment groups and were invited to participate in the control group. Results: The study involved 308 participants: 89 in the dorzolamide/timolol group, 86 in the brimonidine/timolol group, 101 in the brinzolamide/brimonidine group, and 32 in the control group. Baseline characteristics and IOP were comparable across all groups. In the prophylactic premedication groups, mean IOP at 30 min were within 21 mmHg and returned to their baseline at 1 h. Mean IOP measurements between baseline and 30 min in the brimonidine/timolol two-drop regimen were not significantly different: 13.72 ± 4.63 vs 15.11 ± 4.39 mmHg, p = 0.096. In the control group, IOP significantly increased from baseline at 30 min and 1 h post-injection: 14.31 ± 4.10, 22.15 ± 8.64, and 18.36 ± 7.52 mmHg, respectively, p < 0.001. Conclusion: Topical fixed combination anti-glaucoma medication used as a prophylactic treatment before intravitreal anti-VEGF injections significantly prevented IOP spikes post-injection, with a comparable effect among three medications. Prophylactic treatment of IOP spikes should be considered as standard care to prevent further damage in patients with compromised retinal vascular and optic nerve perfusion. Trial Registration: TCTR20241005001, retrospectively registered. Plain Language Summary: Drug injection into the eye is a standard treatment for various eye diseases. However, an increase in eye pressure is often observed post-injection. This study focuses on the effect of prophylactic topical antiglaucoma eye drops on pressure of the eye elevation post-injection of drug into the eye. All medications in the study significantly prevented pressure of the eye spikes compared with no treatment. Prophylactic treatment of pressure of the eye spikes should be considered as standard care to prevent further damage to the eye. [ABSTRACT FROM AUTHOR]

Purpose: To compare the anatomical and visual outcomes in eyes with submacular hemorrhage (SMH) treated with a combination of ranibizumab (RBZ) either innovator or biosimilar (Razumab) and intravitreal perfluoropropane gas (C3F8). Methods: Treatment naïve neovascular age related macular degeneration (n-AMD) patients with SMH were retrospectively analyzed. Patients received either innovator or biosimilar RBZ (3 loading doses followed by pro re nata regimen) and single injection of intravitreal C3F8. Optical coherence tomography (OCT) was performed at baseline, 1, 3 and 6 months. Changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at 6 months. P value ≤ 0.05 was considered statistically significant. Results: A total of 67 eyes (35 and 32 eyes in innovator and biosimilar group respectively) were analyzed. BCVA improved from 1.15 ± 0.19 to 0.51 ± 0.23 logarithm of minimum angle of resolution (logMAR) in innovator RBZ group (p < 0.001) and from 1.17 ± 0.15 to 0.53 ± 0.20 logMAR in biosimilar RBZ group (p < 0.001). Similarly, mean CMT showed significant reduction in both groups at 6 months (innovator RBZ: 609.5 ± 50.1 μm to 254.3 ± 20.3 μm, p < 0.001; biosimilar RBZ: 602.3 ± 58.9 μm to 251.8 ± 22.3 μm, p < 0.001). Intergroup comparisons between innovator and biosimilar RBZ showed no differences in either BCVA or CMT at all time points (all p values > 0.05). Mean number of intravitreal injections was marginally higher in innovator group compared to biosimilar RBZ (4.37 ± 0.49 vs. 4.22 ± 0.42; p = 0.18). Conclusion: Biosimilar RBZ may act as a viable alternative to innovator RBZ to treat SMH with comparable anatomical and visual outcomes at 6 months. [ABSTRACT FROM AUTHOR]

Background: To report a case of intraocular inflammation (IOI) after intravitreal injection of aflibercept 8 mg for treatment-refractory neovascular age-related macular degeneration. Case presentation: An 80-year-old man with diabetes mellitus had neovascular age-related macular degeneration refractory to treatment with aflibercept 2 mg. Despite ten injections of faricimab, the exudation remained, and we switched to brolucizumab, which resulted in a mild IOI. The IOI improved with only topical steroids, and we switched back to aflibercept 2 mg for the exudation. However, the exudation remained, and we decided to switch to aflibercept 8 mg after careful discussion with the patient. Two weeks later, he experienced minor ocular pain and photophobia. One month later, although a dry macula was achieved, severe visual impairment occurred due to anterior chamber inflammation, retinal vasculitis, and retinal vascular occlusion. We diagnosed the severe IOI following aflibercept 8 mg and immediately started steroid eye drops and a sub-Tenon injection of triamcinolone acetonide. Although the inflammation resolved, his visual acuity did not improve. Conclusions: This case demonstrated a potential dose-dependent inflammatory response following aflibercept 8 mg, which did not occur with aflibercept 2 mg in patients with a history of intraocular inflammation. [ABSTRACT FROM AUTHOR]

Background: Ozurdex® (Allergan®, AbbVie Company, North Chicago, Illinois, EUA), is composed of 0.7 mg of dexamethasone, fused in a solid biodegradable PLGA polymer, whose degradation occurs naturally in the vitreous cavity, usually in six months after its application. Methods: In this study, we included patients aged ≥ 18 years with one or two eyes who had an indication for Ozurdex® implants. Eyes submitted to Ozurdex® application were evaluated in the first hour after the injection via transpalpebral contact B-scan ocular ultrasonography (Aviso® or Compact Touch®, Quantel®) and non-mydriatic ultra-widefield fundus photography (California®, Optos®) performed sequentially. The exams were executed using similar parameters and techniques, by the same ophthalmologist, after every 45 days, until the end of 180 days. The programed visits were the initial (tagged D0) and sequential (D45, D90, D135, and D180) visits, with a possible variance of seven days, before or after. The ultrasonographic Ozurdex® findings evaluated were: non-quantitative: structure, height, reflectivity, artifact production, location, and movement; and quantitative: length and thickness. Ultra-widefield fundus photography parameters were: Ozurdex® visualization, location, and structure. Results: The B-scan showed the implant initially, at the D0 visit, as a well-delimited and homogeneously highly reflective linear and continuous structure. On D45, Ozurdex® implants presented with low internal reflectivity and irregularity in the limits. On D90, D135, and D180, reductions in the length and thickness progressively lessened, leading to the final appearance of a small highly reflective clust. Over time, all the implants presented reductions in length and thickness. The mean length at D0 was 7.42 ± 0.39 mm and at the final visit (D180) it was 1.50 ± 0.47 mm. The mean thickness at D0 was 0.77 ± 0.13 mm and at the final visit (D180) it was 0.44 ± 0.18 mm. Conclusions: Considering implant dimensions, the change in length over time was more evident than the change in thickness. In all the cases where visualization was possible, positive correlations with B-scan findings were found despite changes in patient position. These alterations evidenced in the Ozurdex® implant over time may be related to the degradation of the glucose polymer structure. [ABSTRACT FROM AUTHOR]

Background: The PreserFlo™ MicroShunt (PFMS) is a bleb-forming device considered to be less invasive than traditional glaucoma surgery such as trabeculectomy. This study evaluates the 1-year success rates as well as safety profile of PFMS in patients having high intraocular pressure (IOP) and/or glaucoma refractory to drop therapy with a history of prior intravitreal dexamethasone therapy. Methods: A total of 16 eyes after PFMS implantation due to elevated IOP after intravitreal dexamethasone implant (DEX-I) administration were included in this retrospective cohort study. Success rates and secondary outcomes were evaluated. Results: Qualified and complete success rates at 12 months, respectively, were 14/16 and 12/16 eyes for criterion A, 13/16 and 11/16 eyes for B, 13/16 and 11/16 eyes for C, and 6/16 and 6/16 eyes for D. The overall mean (range) preoperative IOP decreased from 27 (16–38) mmHg to 13 (10–17) mmHg at 12 months. BCVA was not significantly different up to 12 months (p = 0.63). The preoperative mean (range) number of medications decreased from 3.56 (2–4) to 0.31 (0–3) at 12 months. One eye underwent needling twice, and two eyes were revised surgically. One patient needed replacement of the PFMS. There were no hypotony-related complications. Conclusions: The PFMS is an effective surgical option for patients with steroid-induced IOP elevation. It demonstrates satisfactory short-term success rates, a reduced need for pressure-lowering eye drops, an excellent safety profile with minimal postoperative care, and a low complication rate. Additional interventions such as needling or revisions were infrequently necessary. However, PFMS may not be the ideal choice for cases requiring a low target pressure (≤12 mmHg). [ABSTRACT FROM AUTHOR]

Background: Age-related macular degeneration (AMD) is a progressive, chronic eye disease with no permanent cure currently available. Symptoms of the disease, including distorted and blurred vision and gradual loss of central vision, significantly aggravate patients' daily functioning. The purpose of this study was to assess the acceptance of the disease among patients diagnosed with neovascular age-related macular degeneration before treatment and after receiving seven intravitreal injections and to determine how it was related to the values of visual parameters. Methods: This survey-based study was carried out using the author's questionnaire and a standardized research tool, the Acceptance of Illness Scale (AIS). It also involved the analysis of the patients' medical records. Results: The study included 121 patients (121 eyes), including 60 women and 61 men. The age range of the participants was 51–90 years. The mean and median age of the participants was 75 years. After undergoing a series of intravitreal injections, statistically significant improvements were observed in the degree of illness acceptance according to the AIS score. Data analysis revealed that the degree of disease acceptance was significantly related to visual acuity and contrast sensitivity. Conclusions: The acceptance of the disease among the study participants from the beginning of the therapy until receiving a series of seven intravitreal injections was at an average level. Acceptance of the disease was better before the beginning of the therapy, due to higher values of corrected visual acuity, and after the therapy, because of higher values of contrast sensitivity and corrected visual acuity. [ABSTRACT FROM AUTHOR]

Aflibercept and brolucizumab, two anti-VEGF agents used as intravitreal injections in ophthalmology, differ significantly in molecular weight (aflibercept—115 kDa and brolucizumab—26 kDa). Using aqueous humor samples collected after drug administration, we measured and performed a comparative analysis of pharmacokinetics and half-lives of these drugs in the human eye. Since the quantification of monoclonal antibodies (mAbs) using antigen–antibody reactions, such as ELISA, is influenced by endogenous ligands or anti-drug antibodies, we employed nano-surface and molecular-orientation limited proteolysis (nSMOL), combined with liquid chromatography–tandem mass spectrometry (LC-MS/MS), for accurate measurements. Aqueous humor samples were collected from 59 eyes of 59 patients treated with aflibercept and 52 eyes of 52 patients treated with brolucizumab. Samples were obtained with a median post-injection period of 30 (range, 2–49) days for aflibercept and 28 (range, 4–60) days for brolucizumab. A population pharmacokinetic (PPK) analysis revealed that the half-life of aflibercept in human aqueous humor was significantly shorter than that of brolucizumab, 2.88 days versus 9.00 days, respectively (p = 1.16 × 10−7). Using the same mass spectrometry conditions, we calculated the half-lives of the two drugs. These results may be useful for optimizing the efficacy of these drugs in clinical practice. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusionsIntravitreal bevacizumab has been utilized to mitigate radiation retinopathy, yet the potential role of intravitreal melatonin for its prevention remains unexplored. This study aims to evaluate and compare the efficacy of intravitreal melatonin and bevacizumab in preventing radiation retinopathy in an experimental animal model.Twelve healthy male New Zealand white rabbits (n = 24 eyes) received a single 3000 cGy irradiation dose in both eyes. Intravitreal melatonin (100 mcg/kg = 300 mcg/0.05 mL) was administered to the left eyes of six rabbits, and bevacizumab (1.25 mg/0.05 mL) to the left eyes of the remaining six, with sham injections given to the right eyes as controls. Six weeks after irradiation, bilateral enucleation was performed for biochemical and histopathological evaluation.Oxidative stress markers did not differ significantly between the groups (p = .827). Both melatonin and bevacizumab treatments markedly reduced axonal damage compared to the sham control group (p < .001). Melatonin also demonstrated a trend toward superior neuroprotective effects relative to bevacizumab, though this difference was not statistically significant (p = .07).Intravitreal melatonin demonstrated efficacy comparable to bevacizumab in reducing radiation-induced retinopathy, with an encouraging trend toward enhanced neuroprotection. These findings position melatonin as a potential novel therapeutic for radiation retinopathy prophylaxis. Further research with larger, long-term studies is warranted to validate these results and investigate melatonin’s broader applications in retinal protection. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic literature review analyzing visual outcomes of immediate, early, and delayed vitrectomy in the treatment of acute endophthalmitis after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections. Methods: We conducted a literature search using the Ovid Medline, Embase.com, and Web of Science databases, and relevant articles were selected from original English papers published from 2005 to 2021. Inclusion criteria were studies reporting cases of acute post-anti-VEGF endophthalmitis, defined as occurring within 6 weeks of injection treatment. Exclusion criteria were pediatric cases and cases explicitly reported to be caused by injections of contaminated drugs. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool for case reports and case series. The study dataset for descriptive and statistical analysis comprised patient-level data extracted from included studies. The timing of vitrectomy compared were defined as (1) immediate vitrectomy as occurring within 24 h of endophthalmitis diagnosis; (2) early vitrectomy as occurring between 24 and 48 h of endophthalmitis diagnosis; (3) late vitrectomy as occurring after 48 h of endophthalmitis diagnosis. Primary outcome was final visual acuity following treatment with vitrectomy. Results: Twenty-five articles were published that met our inclusion and exclusion criteria for a total of 86 cases. Thirty-seven were immediate vitrectomy, 25 were early, and 24 were late vitrectomy treatment groups, respectively. We observed differences in final visual outcomes and in improvement from diagnosis to final visual acuity, with patients receiving immediate and late vitrectomy to have better final visual outcomes than those patients receiving early vitrectomy (p < 0.005). Conclusion: Our results show that there may be an association between time to vitrectomy and visual outcomes. Immediate and late vitrectomy treatment groups had better visual outcomes than the early group. Our results were limited by the reliance on case reports and series and the paucity of data available specifying the timing of vitrectomy. Additional research is necessary to elucidate the effects of treatment timing in patients with endophthalmitis following anti-VEGF injection. Plain language summary: Timing of vitrectomy for treatment of endophthalmitis after intravitreal anti-VEGF injection: a systematic literature review of case reports and series In this study, we aimed to review existing literature to assess the associations between timing of surgery to treat endophthalmitis following intravitreal anti-VEGF injection and visual outcomes. The timing of vitrectomy compared were defined as (1) immediate vitrectomy as occurring within 24 hours of endophthalmitis diagnosis; (2) early vitrectomy as occurring between 24-48 hours of diagnosis; (3) late vitrectomy as occurring after 48 hours of diagnosis. We found 25 articles with 86 total cases. We observed differences in final visual outcomes and in improvement from diagnosis to final vision, with patients receiving immediate and late vitrectomy to have better final vision than those patients receiving early vitrectomy. [ABSTRACT FROM AUTHOR]

Autophagic dysfunction-induced deterioration of the retinal microenvironment drives the progression of wet age-related macular degeneration (wAMD). The efficacy of single-target anti-VEGF antibodies in treating wAMD has long been suboptimal due to the intricate interplay between autophagy dysfunction, oxidative stress, and angiogenesis. Here, we introduce an intravitreal hydrogel depot, named Rab&Rapa-M@G, consisting of rapamycin-loaded microemulsion (Rapa-M, an mTOR inhibitor), ranibizumab (anti-VEGF antibody), and a thermosensitive hydrogel matrix. A single intravitreal injection of Rab&Rapa-M@G can sustainably deliver Rapa-M and ranibizumab to the retinal pigment epithelium for at least 14 days. This formulation significantly improves retinal autophagic flux homeostasis and reduces oxidative stress injury in wAMD mice by modulating the AMPK/mTOR/HIF-1α/VEGF and AMPK/ROS/HO-1/VEGF pathways. Consequently, it synergistically disrupts the "autophagic dysfunction-oxidative stress-angiogenesis" loop, leading to a remarkable reduction in choroidal neovascularization area and retinal damage compared to ranibizumab alone. Notably, the sequential administration of ranibizumab and Rab&Rapa-M@G further enhances the overall anti-wAMD efficacy, achieved through sequential delivery of Rab and Rapa, allowing for a more precise grasp of the treatment window. In conclusion, this hydrogel depot design, with its sequential and sustained delivery of mTOR inhibitors and anti-VEGF antibodies, offers a promising strategy for multi-target synergistic therapy in wAMD. [Display omitted] • Microemulsion-doped hydrogel enables sustainable co-delivery of Rab and Rapa to retina. • The drug combination disrupts the "autophagy-oxidative stress-angiogenesis" loop. • Sequential release of therapeutics accurately targets the treatment window. [ABSTRACT FROM AUTHOR]

Background: This study evaluates the efficacy of intravitreal Faricimab in reducing pigment epithelium detachment (PED) and fluid volumes in both treatment-naïve eyes and eyes unresponsive to anti-VEGF mono-therapies, all diagnosed with type 1 macular neovascularization (T1 MNV) over a period of 12-month. Methods: A retrospective, single-center cohort study was conducted at the Jules Gonin Eye Hospital, Lausanne, Switzerland. Clinical records of treatment-naïve and non-responder switch patients presenting T1 MNV secondary to neovascular age-related macular degeneration (nAMD) from September 2022 to March 2023 were reviewed. Patients received a loading dose of three monthly Faricimab injections followed by a treat-and-extend (T&E) regimen. Multimodal imaging, including structural OCT and AI-assisted analysis, was used to quantify PED volumes and related fluid biomarkers at baseline, 3-month, 6-month, and 12-month follow-up. Statistical analyses included linear mixed models to evaluate differences and trends in intraretinal (IRF), subretinal fluid (SRF) and PED volumes. Results: 65 eyes of 65 patients were enrolled (female: 70.7%; mean age = 80.7yrs, SD = 6.9yrs). 80% had received anti-VEGF treatment (Switch group) and 20% were treatment-Naïve at baseline. At 12 months, intravitreal treatments were more frequent in the Switch group (mean number = 8.3 vs. 6.0; p = 0.009). BCVA improved at the 12-month follow-up in Naïve eyes (+ 6.9 ETDRS letters from baseline, p = 0.053) and was maintained in Switch eyes. No cases of intraocular inflammation were observed. Significant reduction in SRF and IRF volumes were noted in both groups. A significant reduction in PED volume was observed over the follow-up period in both groups (mean slope = -206 nL, 95%CL = -273/-138; p-value < 0.001). Conclusions: Intravitreal Faricimab significantly reduced PED volumes in both treatment-Naïve and non-responder Switch patients over 12 months. The study highlights Faricimab's potential as an effective treatment option for T1 MNV in nAMD, offering significant improvements in PED volume and related fluid biomarkers. [ABSTRACT FROM AUTHOR]

Background: To analyse the effect of suprachoroidal injection (SChI) of triamcinolone acetonide (TA) on macular thickness (CRT), ectopic inner foveal layer thickness (EIFL-T) and best corrected visual acuity (BCVA) in pseudophakic patients undergoing vitrectomy for epiretinal membrane (iERM) compared to intravitreal injection of TA (IVTA). Methods: Prospective matched comparison of patients undergoing vitrectomy for Govetto stage 3 and 4 iERM. 25 eyes receiving IVTA (G-1) were compared to 23 eyes receiving SChI-TA (G-2) during vitrectomy. Primary outcome was change in BCVA, CRT, EIFL-T before surgery and 1, 3 and 6 months after surgery. Secondary outcome was the incidence of cystoid macular edema (CME). Results: Six months after surgery, G2 had a greater mean reduction in CRT (−222 µm vs −131 µm) and EIFL-T (−200 µm vs −104 µm) than G1. BCVA improved more in G2 than in G1 (p = 0.02). Foveal depression reformed in 43% of cases in G-2 and 16% of cases in G-1. Incidence of postoperative CME was 16% in G-1 and 4.3% in G-2. Conclusions: During vitrectomy for iERM, SChI-TA was more effective than IVTA in reducing CRT and EIFL-T and improving BCVA. SChI-TA was effective in preventing postoperative CME. SChI-TA treatment was safe and reproducible and did not affect postoperative IOP. Trial registration NP6289—June 18th, 2024 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: To review hospitalized patients with Acute Retinal Necrosis (ARN) and investigate factors associated with subsequent retinal detachment (RD). Study design: Retrospective. Methods: The study included 40 patients (42 eyes), categorized into non-RD (23 eyes) and RD (19 eyes) groups. Patient demographics, ocular findings, treatment history, and visual outcomes were analyzed. Results: The RD group had higher diabetes prevalence and worse initial and final visual acuity (VA) than the non-RD group (p = 0.035, p = 0.001, p = 0.000). The extent of retinal involvement was greater in the RD group (p = 0.000). The total steroid dose up to RD was significantly lower in the RD group (p = 0.023). Worse initial VA (p = 0.035) and greater retinal involvement (p = 0.036) increased the risk of RD. In the RD group, the time from initial symptoms to RD positively correlated with the duration of oral antivirals, the number of intravitreal antiviral injections, and the duration of oral steroids and immunosuppressants (p = 0.000, p = 0.023, p = 0.018, p = 0.001). The use of oral antivirals, steroids, and immunosuppressants was associated with longer median survival times compared to non-use (p = 0.000, p = 0.000, p = 0.048). The group receiving 9–11 intravitreal antiviral injections had a longer median survival time than the 0–4 and 5–8 injection groups (p = 0.009, p = 0.032). Conclusions: In ARN, reduced steroid use due to diabetes may be associated with RD through inflammatory changes. The worse the initial VA and the greater the extent of retinal lesions, the higher the risk of RD. Oral antivirals, intravitreal antiviral injections, oral steroids, and oral immunosuppressants may be effective in delaying RD. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the first-year real-world anatomical and functional outcomes of intravitreal brolucizumab injection in eyes with refractory neovascular age-related macular degeneration (nAMD). Study design: Retrospective observational study. Methods: nAMD patients who showed poor response to previous anti-vascular endothelial growth factor (VEGF) agents were switched to brolucizumab. Functional and anatomical outcomes were evaluated at initial treatment of nAMD, after treatment with other anti-VEGF agents and after switching and treating with brolucizumab for 1 year. Safety profile was also evaluated after brolucizumab injection. Best-corrected visual acuity (BCVA), central foveal thickness (CFT), subfoveal choroidal thickness (SFCT), and the presence of fluid in different compartments (intraretinal fluid [IRF], subretinal fluid [SRF], pigment epithelial detachment [PED]) were assessed at each time point. Results: A total of 40 eyes of 40 patients were included in the study. BCVA remained unchanged throughout treatment (p > 0.05). CFT did not change after treatment with other anti-VEGF agents (p = 0.588) but decreased after switching to brolucizumab (p < 0.001). SFCT decreased after treatment with other anti-VEGF agents (p = 0.025) but not after switching to brolucizumab (p = 0.236). Presence of SRF (p = 0.001) and PED (p = 0.001) decreased significantly after switching to brolucizumab, despite their persistence with prior treatments using other anti-VEGF agents. However, IRF persisted even after switching to brolucizumab (p = 0.745). Intraocular inflammation (IOI)-related adverse events were reported in 3 eyes (7.14%). Conclusion: Analysis of first-year real-world outcomes after switching to brolucizumab in nAMD patients refractory to other anti-VEGF agents showed improved anatomic outcomes, limited functional improvement and low incidence of IOI-related adverse events. [ABSTRACT FROM AUTHOR]

Purpose: We report three cases of occlusive vasculitis following intravitreal rituximab therapy for biopsy-proven primary vitreoretinal lymphoma (PVRL), one of which was following an injection of the biosimilar Riabni (rituximab-arrx, AmGen) and two of which were following an injection of Rituxan (rituximab, Genentech). Methods: Case series. Results: Three cases of occlusive vasculitis confirmed with fluorescein angiography are reported 5 days, 8 days, and 3.5 weeks following intravitreal injection of rituximab. The initial vision was poor (20/500, 20/150, and light perception), but vision recovered to baseline in two cases, and remained poor in the case of combined artery and vein occlusion. Conclusion: Occlusive vasculitis is a rarely reported but potential complication of intravitreal rituximab therapy in patients who have been previously treated with the agent and may have delayed onset. A low threshold for fluorescein angiography as a diagnostic test for post-injection vision loss and prompt treatment with topical and/or oral steroids should be considered. [ABSTRACT FROM AUTHOR]

Purpose: To present a case of aspergillus-induced endogenous endophthalmitis evolving into delayed lumbosacral osteomyelitis, initially misdiagnosed as ankylosing spondylitis (AS) in an immunocompetent patient. Method: Case Report. Results: A 38-year-old woman, initially treated for pneumonia, experienced sudden loss of vision in her left eye, prompting a thorough examination that revealed a distinct chorioretinal infiltrate. Microbiological analysis of the patient's vitreous samples detected Aspergillus fumigatus, leading to the diagnosis of endogenous endophthalmitis. Treatment involved vitrectomy, intravitreal injections, and intravenous amphotericin B. Two months later, she was referred for lower back pain, misdiagnosed as AS. Lumbosacral biopsy confirmed Aspergillus involvement once more, necessitating antifungal therapy. Conclusion: This case highlights the atypical progression of Aspergillus-induced endogenous endophthalmitis to delayed lumbosacral osteomyelitis in an immunocompetent individual. It highlights the crucial role of a meticulous medical history examination and interdisciplinary collaboration in diagnosing and managing diseases, especially in cases with atypical presentations. [ABSTRACT FROM AUTHOR]

Retinal neovascularization (RNV) is a key pathological process in many blinding disorders. This study aims to investigate the potential mechanisms of heme oxygenase-1 (HO-1) on ferroptosis during RNV. Through bioinformatics analysis, differentially expressed ferroptosis-related genes were identified in the oxygen-induced retinopathy (OIR) mouse model. Ferroptosis was assessed in the OIR model and the human retinal microvascular endothelial cells (HRECs) with the treatment of H 2 O 2. The mRNA and protein levels were measured through RT-qPCR and western blot. Lipid peroxidation was assessed through C11-BODIPY staining. HO-1 expression was knocked down by intravitreal injection with a self-complementary adeno-associated virus in the OIR model and small interfering RNA in HRECs. The pathological neovascular area and avascular area were assessed through immunofluorescent staining. The cellular functions of HRECs were evaluated with migration and tube formation assays. Our results demonstrated that HO-1 was significantly upregulated in the OIR model. 4-HNE upregulation and GPX4 downregulation were observed in the OIR model. The H 2 O 2 -induced oxidative stress resulted in lipid peroxidation, GPX4 downregulation, and mitochondrial morphology changes in HRECs. HO-1 knockdown induced GPX4 upregulation, and decreased lipid peroxidation in vitro and in vivo. Furthermore, HO-1 inhibition reduced pathological RNV in the OIR model and attenuated migration and tube formation in HRECs. Treatment with 6-OHDA restored the decrease of VEGFA, migration, and tube formation caused by HO-1 knockdown in HRECs. Overall, HO-1-mediated ferroptosis can regulate RNV through the COX2/VEGFA signal axis. These findings suggest that targeting HO-1 may serve as a promising approach for treating retinal neovascular diseases. [Display omitted] • HO-1 was a significantly upregulated ferroptosis-related gene in the OIR model. • Knockdown of HO-1 suppresses ferroptosis in both the OIR model and HRECs. • HO-1 knockdown reduces retinal neovascularization and inhibits functions of HRECs. • HO-1-mediated ferroptosis regulates pathological RNV via the COX2/VEGFA axis. [ABSTRACT FROM AUTHOR]

We evaluate the pharmacokinetics, safety, and optimal dosages of intravitreal agents in silicone oil (SO)-filled eyes, addressing challenges in administering such therapies. We assessed the pharmacological properties and safety profiles of intravitreal drugs in SO-filled eyes, deriving conclusions and guidance from available literature and expert consensus. Preclinical data suggest comparable half-lives of anti-vascular endothelial growth factoragents in SO-filled eyes, but clinical evidence is mainly from case reports and small series. Available research prioritizes standard dosages, particularly for bevacizumab (1.25 mg), supported by stronger evidence than aflibercept (2 mg) or ranibizumab (0.5 mg). Intravitreal steroids, especially dexamethasone at 0.7 mg, show efficacy and safety, while evidence for fluocinolone acetonide at 0.19 mg is limited. Intravitreal methotrexate has been reported at the dosage of 250–400 μg, with keratitis as the primary expected side effect. Case reports indicate tolerability of standard dosages of antivirals (foscarnet 1.2–2.4 mg/0.1 mL, ganciclovir 4 mg/0.1 mL) and the antibiotic combination piperacillin/tazobactam (250 μg/0.1 mL). We offer guidance based on current, but limited, literature. Standard dosage of intravitreal agents should be carefully considered, along with close monitoring for potential side effects, which should be discussed with patients. [ABSTRACT FROM AUTHOR]

Purpose: To characterize private equity (PE) acquisition of ophthalmology and optometry practices and compare procedural utilization before and after acquisition. Methods: Ophthalmologists and optometrists in practices acquired from 2012 to 2016 were identified and characterized using an internet archive with an additional search in 2017 to characterize doctor turnover. United States Census Bureau and Internal Revenue Service Data were used to determine population health insurance and adjusted gross income (AGI). Healthcare Common Procedure Coding System codes were drawn from the Medicare database. Results: Six platform companies acquired 36 practices between 2012 and 2016, including 518 optometrists and 136 ophthalmologists with a net doctor decrease of 3% and 7%, respectively (years 2016 to 2017). PE firm-owned practices were primarily located in metropolitan core areas with above-average AGI and insurance coverage. Diagnostic procedures, total encounters, cataract surgery, and yttrium aluminum garnet (YAG) capsulotomy volume increased per physician 1-year post-acquisition. In adjusted difference-in-difference comparisons, cataract surgery (13.3% relative increase, P <0.001) and YAG capsulotomy (35.6% relative increase, P <0.001) remained significant. PE practices demonstrated an increase in cataract surgery procedures (28,813/platform pre-acquisition to 33,930/platform post-acquisition, P =0.015). Conclusion: PE acquisitions of ophthalmology and optometry practices were centered in metropolitan core areas with above-average AGI and insurance coverage. PE acquisition led to less optometrists and ophthalmologists employed at the practice. Overall, they exhibited doctor turnover with a net doctor decrease. When compared to non-PE doctors, PE-acquired doctors demonstrated an increase in cataract surgery and YAG capsulotomy volume. Overall, cataract surgery volume increased among PE practices after acquisition. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to compare the efficacy of the treat-and-extend (TAE) regimen versus the pro re nata (PRN) regimen in patients with bevacizumab-resistant diabetic macular edema (DME) treated with aflibercept, with or without adjunctive laser therapy. Methods: Ninety-one eyes from 91 patients who were switched to aflibercept after three consecutive intravitreal bevacizumab injections for the treatment of DME were included in this retrospective real-world study. The patients were categorized into three groups: TAE (n = 30), TAE + laser (n = 31), and PRN (n = 30). Changes in best-corrected visual acuity and central macular subfield thickness (CMST) at 12, 24, and 52 weeks were defined as the primary functional and anatomical outcomes. Results: A total of 91 eyes from 91 patients (49.5% female) with a mean age of 63.9 ± 7.1 years were included in the analysis. At 52 weeks, the mean letter gains were 8.03, 8.90, and 10.23 in the TAE, TAE + laser, and PRN groups, respectively. Anatomical improvements, as measured by CMST reduction, were 55.33 µm, 33.35 µm, and 48.96 µm in the TAE, TAE + laser, and PRN groups, respectively. The average number of injections administered was 7.7, 8.1, and 8.1, respectively. The final extension interval for the TAE group was 8.7 weeks, compared to 9.5 weeks in the TAE + laser group. Conclusions: The PRN group demonstrated the highest functional improvement while the TAE group showed the greatest anatomical improvement. Overall, both anatomical and functional outcomes in the TAE regimen were comparable to the PRN regimen in patients with bevacizumab-resistant diabetic macular edema. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to evaluate the ocular and systemic safety profiles of intravitreal biosimilar ranibizumab Ranieyes (Lupin Pharmaceuticals, Mumbai, India) in real-world clinical settings across multiple chorioretinal vascular diseases, including neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) in adults. Methods: We conducted a retrospective, consecutive, interventional, uncontrolled multicenter study using data from three hospital networks in India. A total of 1401 eyes received 2194 injections of Ranieyes between June 2022 and November 2023. Patients were followed for a minimum of 6 months, and data on ocular and systemic adverse events (AEs) were collected and analyzed. Results: The study population included 636 male patients and 533 female patients, with a mean age of 58.63 ± 11.54 years. The average number of injections per eye was 1.49 ± 0.23, with the highest frequency in the nAMD group (mean of 2.3 ± 0.23 injections per eye) over 6 months. Non-serious adverse events (nsAEs) were observed in 26.83% of injections, with mild ocular pain and transient blurring of vision being the most common. Serious ocular adverse events were rare, occurring in 0.85% of eyes, with retinal pigment epithelial tear (RPE TEAR) being the most frequent. Systemic adverse events were noted in 5.03% of patients, and all but one were non-serious. One patient developed non-fatal myocardial infarction, the causal relationship of which, however, was not established with the intravitreal agent used. No cases of endophthalmitis were observed. Conclusions: This large-scale, real-world study demonstrates that Ranieyes is a safe intravitreal antivascular endothelial growth factor (anti-VEGF) agent across various chorioretinal vascular diseases. The safety profile of Ranieyes is consistent with that of the reference product, making it a viable option in resource-constrained settings. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the outcome and ocular adverse events of bedside bilateral sequential intravitreal anti-vascular endothelial growth factor injections for retinopathy of prematurity (ROP) (BBSIR). Methods: This retrospective interventional study included infants who received BBSIR with a follow-up of at least 1 month. Clinical history, intravitreal injection details, indications, intraoperative and postoperative ocular adverse events, and outcomes were analyzed. Results: The study cohort included 192 babies (384 eyes) spread over 9 years. The mean gestational age was 30.2 ± 2.6 weeks (28.8–34.1), and the birth weight was 1098.11 ± 271.65 g (650–2000). The indications for BBSIR were as follows: 73.4% (n = 141 infants) were too sick to transfer to an ophthalmic unit, 10.9% (n = 21 infants) due to the parents' inconvenience of traveling to the ophthalmic center, and 15. 6% (n = 30 infants) due to both reasons. The injections were given by an ROP specialist/ROP-trained ophthalmologist after due parental consent, considering each eye as a fresh eye with separate scrubbing and draping. Light from the head-worn indirect ophthalmoscope served as the source of illumination. The retinopathy was regressing/regressed in 92.4% of babies until the last follow-up. The major ocular complication was cataract in 2 eyes (0.5%). There was no incidence of endophthalmitis till last follow-up (median 5.7 months). Conclusions: As per this study, BBSIR was observed to be effective and safe if given by those fully trained in the management of ROP. Though the rate of complications like cataract is small, they can pose management challenges and impact vision in a growing child. [ABSTRACT FROM AUTHOR]

The management of intermediate and posterior uveitis poses a significant challenge of achieving adequate drug concentrations in the posterior segment over the chronic nature of the disease. Systemic agents seldom reach effective drug levels, and even with low maintenance or tapering doses, it is hard to avoid systemic toxicity. The use of intravitreal and periocular injections is often unable to prevent recurrences due to their short half-life. Since the emergence of intravitreal implants (Vitrasert, Retisert), it has become possible to circumvent these therapeutic challenges. A detailed review in the PubMed index yielded 155 articles, of which 22 were analyzed based on exclusion criteria. A recent shift from surgically sutured to minimally invasive injectable implants mainly indicated for noninfectious uveitis is evident from the literature. This review article also provides insights into dexamethasone (Ozurdex) and recent fluocinolone acetonide (Yutiq, Iluvien) implants with particular emphasis on their improved safety and efficacy. Dexamethasone implants favor the therapeutic goal of prevention of recurrences, whereas the use of fluocinolone implants helps to attain better visual outcomes due to their longer duration of action. Thus, the review provides recent literature supporting the role and indication of sustained release intravitreal implants in the management of noninfectious intermediate and posterior uveitis. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to evaluate the clinical characteristics and identify the prognostic factors affecting visual outcomes, retinal detachment, and recurrence in cytomegalovirus retinitis (CMVR) patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: A retrospective analysis of 54 CMVR patients (84 eyes) who underwent allo-HSCT between 2015 and 2024 was conducted. Ophthalmologic and systemic evaluations were performed. The visual outcomes were classified as improvement, stabilization, and deterioration. Logistic regression and LASSO regression models were used to identify the prognostic factors. Results: Improved or stabilized visual outcomes were found in 22 eyes, while 62 eyes suffered from deterioration. Larger lesion areas were independently associated with poorer visual outcomes (OR 0.989, p = 0.002). Eight (9.5%) eyes had rhegmatogenous retinal detachment and thirteen (15.5%) eyes suffered from recurrence. Retinal detachment was significantly predicted by higher baseline aqueous CMV DNA load (OR 5.087, p = 0.026). Macula involvement (OR 5.322, p = 0.032) and more intravitreal injections (IVs) (OR 1.263, p = 0.008) were independent risk factors for recurrence. No systemic factors were found to be associated with the clinical outcome of eyes with CMVR. Conclusions: Ocular characteristics, rather than systemic factors, were more useful to predict the clinical outcome of eyes with CMVR. Routine ophthalmic screening and early intervention are essential to improving outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the etiology, pathogens, antibiotic susceptibility, treatments, and factors influencing the visual prognosis of pediatric post-traumatic endophthalmitis (PTE) to provide valuable insights for clinical diagnosis and treatment. Results: A total of 301 children were included, with 142 (47.2%) cultures yielding positive results. Gram-positive cocci were the predominant pathogens (71.1%), with high sensitivity to vancomycin (95.4%). Pars plana vitrectomy (PPV) was performed in 216 eyes (71.8%), with emergency or immediate vitrectomy within 24 h of hospitalization performed on 171 eyes (56.8%). The first intravitreal antibiotic injection, consisting of ceftazidime and norvancomycin, was administered to 248 patients (82.4%). The absence of retinal detachment (OR, 0.191; 95% CI, 0.065–0.560; p = 0.002), normal intraocular pressure (OR, 1.894; 95% CI, 1.151–3.117; p = 0.012), and no lens extraction (OR, 0.187; 95% CI, 0.069–0.504; p < 0.001) were found to be independent factors associated with better visual outcomes (BCVA) in pediatric PTE patients. Methods: A retrospective analysis was conducted on pediatric PTE patients treated between January 2012 and June 2022. Data were collected on clinical characteristics, causative pathogens, antibiotic sensitivity, treatments, and visual outcomes. Conclusions: Gram-positive cocci are the most common pathogens in pediatric PTE, with early vitrectomy and intravitreal ceftazidime and norvancomycin being the most effective treatments. Favorable visual outcomes are strongly associated with the absence of retinal detachment, normal intraocular pressure, and no lens extraction. These findings highlight the need for timely surgical and antimicrobial interventions tailored to each patient to improve visual prognosis. [ABSTRACT FROM AUTHOR]

Juan B Yepez,1 Felipe A Murati,2 Michele Petitto,3 Igor Kozak,4 J Fernando Arevalo5 1Vitreoretinal Surgery Department, Clinica de Ojos, Maracaibo, Venezuela; 2Sotero del Rio, Hospital, Santiago, Chile; 3Glaucoma Department, Clinica de Ojos, Maracaibo, Venezuela; 4Department of Ophthalmology and Vision Science, University of Arizona, Tucson, AZ, USA; 5Retina Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: J Fernando Arevalo, Retina Division The Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Maumenee 713, Baltimore, MD, 21287, USA, Tel +1 443 287 9554, Fax +1 443 287 5492, Email arevalojf@jhmi.eduPurpose: To share our early experience with the novel intravitreal plungerless injector device (IPLID) for application in patients with various retinal diseases.Patients and Methods: This study enrolled 300 eyes (300 patients) who had undergone at least 1 previous conventional intravitreal injection, for various indications, such as diabetic macular edema, venous occlusions, active choroidal neovascular membrane, wet AMD and neovascular glaucoma. Patients with systemic conditions that could affect pain tolerance were excluded. All patients underwent intravitreal injection with the IPLID. After the procedure the patients were asked to grade pain compared to conventional injections. Immediately after the procedure, surgeons completed a simple survey on various aspects of the device, including safety of the procedure. Data were also collected on the duration of the procedure.Results: The study sample was comprised of 210 males and 90 females. The mean duration of the injection was 17.51 minutes (range, 15 minutes to 20 minutes). Post-IPLID injection, 155 (51.7%) patients reported less pain compared to previous injections, 128 (42.7) patients reported pain similar to previous injections and 5.7% (17) of patients reported more pain than previous procedures. The physician survey indicated that there was no difference between IPLID and conventional technique in 13.33% (40) of injections, and 86.67% (260) of the injections were comfortable to perform with the IPLID and size was not an issue in 91.67% (275) of injections. In all cases, the surgeons were comfortable with the delivery of medication with IPLID and there were no adverse events during or after IPLID injection.Conclusion: The IPLID is a simple device for delivering intravitreal injection and may offer greater ergonomic advantages and that address the issue of musculoskeletal disorders in healthcare personnel due to repetitive procedures over time.Keywords: intravitreal injections, IPLID, hand ergonomics, musculoskeletal disorders

Joana Santos-Oliveira,1 Rita Teixeira-Martins,1 Ana Margarida Ferreira,1 João Paulo Macedo,1 Cláudia Oliveira-Ferreira1,2 1Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal; 2Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, PortugalCorrespondence: Joana Santos-Oliveira, Department of Ophthalmology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email joana.santos.oliveira@ulssjoao.min-saude.ptPurpose: Ozurdex® is a dexamethasone intravitreal implant approved for the treatment of macular edema secondary to branch or central retinal vein occlusion, non-infectious uveitis affecting the posterior segment of the eye, and diabetic macular edema.Patients and Methods: We report a case of an accidental injection of the implant into the crystalline lens, successfully managed by surgery afterwards. The case description is supported by Anterior Segment Optical Coherence Tomography (AS-OCT) images.Results: A 69-year-old male was observed for bilateral diabetic macular edema. He had previously been treated with bevacizumab and aflibercept, with an incomplete anatomical response (< 20% reduction in central macular thickness). The patient consented to undergo a bilateral intravitreal dexamethasone injection (dexamethasone intravitreal implant (0.7 mg)). The procedures were uneventful, except for an extensive conjunctival hemorrhage in the right eye. An appointment was scheduled for fifteen days later, however the patient missed it. Four months later, he referred OD vision loss, which occurred a few days after the injection, and the implant was found within the right crystalline lens. An AS-OCT was done to better understand the implant’s location and entry point. Due to decreased visual acuity, the patient was scheduled for surgery. A phacoemulsification surgery with a three-piece hydrophobic intraocular lens implantation in the sulcus associated with anterior vitrectomy was done.Conclusion: The injection of a dexamethasone implant is becoming increasingly common. Nonetheless, it must always be carried out carefully, to avoid complications. If the implant is accidentally injected into the crystalline lens, the AS-OCT can help determine its exact location, which is important for preparing the surgical plan and determining the appropriate timing.Keywords: crystalline, intravitreal injections, lens, macular edema

Aim: We report a unique finding of iris nodules in a woman with endogenous endophthalmitis due to Acinetobacter baumannii with no history of ocular surgery or trauma and good visual outcome. Materials & Methods: Retrospective case report. Results: A 39-year-old woman with a history of type 2 diabetes mellitus presented with a decrease in vision in the right eye of 1-month duration. On examination, her BCVA was CF2m (OD) and 6/6 (OS). Right eye examination showed medium-to-large-sized keratic precipitates, iris nodules, and vitritis. PCR on the aqueous showed faint positivity for Propionibacterium acne and was negative to panfungal genome. Despite two intravitreal injections of vancomycin (1 mg/0.1 ml) and intravenous cefazolin 1 g bd for 5 days, there was progression to hypopyon. Vitrectomy with lensectomy was done. The vitreous culture grew Acinetobacter baumannii. She was given multiple intravitreal ceftazidime (2.25 mg/0.1 ml) with dexamethasone (0.4 mg/0.1 ml) injections. She was also put on tab bactrim DS twice a day for 3 months along with tab doxycycline 100 mg twice a day for 3 months by the infectious disease specialist. As the inflammation improved, the iris nodules were the last to resolve completely in 6 weeks. At 15-month follow-up, her eye was quiet, and vision was 6/9 (OD) with aphakic correction. Conclusion: We report a rare finding of iris nodules in a patient with culture proven Acinetobacter baumannii endogenous endophthalmitis. [ABSTRACT FROM AUTHOR]

The article discusses cystoid macular edema (CME) in peripheral exudative hemorrhagic chorioretinopathy (PEHCR), a peripheral disease primarily affecting the elderly. The study analyzed 72 PEHCR cases and found that 10 eyes developed CME without vascular network or polypoidal lesions in the macular region. Intravitreal antiVEGF injections were used for treatment, resulting in improved visual acuity and reduced central macular thickness. The study highlights the importance of thorough peripheral retinal examinations in elderly patients with CME to ensure accurate diagnosis and appropriate management. [Extracted from the article]

Purpose: Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development.This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye.The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001).The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure.Methods: Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development.This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye.The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001).The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure.Results: Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development.This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye.The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001).The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure.Conclusion: Intravitreal injections are essential for treating retinal diseases. This study aims to assess the impact of repeated intravitreal anti-VEGF injections using an eyelid speculum on the risk of ptosis development.This single-center, retrospective chart review included 114 patients (228 eyes) who received at least three unilateral intravitreal anti-VEGF injections. Patient demographics, clinical characteristics, and MRD1 and MRD2 of the injected and the fellow eyes were analyzed. A multivariate linear regression model was constructed to identify predictors of MRD1 in the injected eye.The study cohort had a mean age of 75.18 ± 0.98 years, with 57% female patients. On average, patients received 16.92 ± 1.18 injections. At the final follow-up, no significant difference was observed in mean MRD1 between injected and fellow eyes (2.85 ± 0.11 mm vs. 2.90 ± 0.11 mm, p = 0.445). Multivariate regression analysis identified MRD1 of the fellow eye as the only significant predictor of MRD1 in the injected eye (β = 0.769, p < 0.001).The repeated use of an eyelid speculum during intravitreal anti-VEGF injections does not significantly contribute to ptosis development. MRD1 tends to be similar between the injected and non-injected eye, suggesting that intrinsic factors may play a more crucial role in determining eyelid position than the mechanical effects of the procedure. [ABSTRACT FROM AUTHOR]

Purpose: Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels.20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6 mg/0.05 ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50 μm.CMT decreased from 384.8 ± 108.8 μm prior to intravitreal injection (IVI) to 286.1 ± 63 μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size.The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory.What is knownBispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.What is newThe knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.Methods: Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels.20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6 mg/0.05 ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50 μm.CMT decreased from 384.8 ± 108.8 μm prior to intravitreal injection (IVI) to 286.1 ± 63 μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size.The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory.What is knownBispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.What is newThe knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.Results: Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels.20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6 mg/0.05 ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50 μm.CMT decreased from 384.8 ± 108.8 μm prior to intravitreal injection (IVI) to 286.1 ± 63 μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size.The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory.What is knownBispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.What is newThe knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.Conclusion: Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels.20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6 mg/0.05 ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50 μm.CMT decreased from 384.8 ± 108.8 μm prior to intravitreal injection (IVI) to 286.1 ± 63 μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size.The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory.What is knownBispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.What is newThe knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.Key Messages: Recently, a systemic counterregulatory response of angiopoietin-2 after intravitreal application of the anti vascular endothelial growth factor (anti-VEGF) drug aflibercept in neovascular age-related macular degeneration (nAMD) has been described. The aim of the study was to find out wether faricimab, a combined anti-VEGF/angiopoietin-2 drug, had an effect on systemic cytokine levels.20 women and 11 men (mean age 79.5 ± 7.3 years) were included into this cohort study. Plama levels of VEGF-A and angiopoietin-2 were determined before and after intravitreal application of faricimab (6 mg/0.05 ml/eye) using ELISA-technique. These results were correlated with central macular thickness (CMT). Responders were defined as having had CMT thinning ≥ 50 μm.CMT decreased from 384.8 ± 108.8 μm prior to intravitreal injection (IVI) to 286.1 ± 63 μm one month after IVI (p < 0.0001). Angiopoietin-2 levels increased from 526.9 ± 129 pg/ml to 597.2 ± 174.8 pg/ml (p = 0.0087) one week after IVI and dropped to 547.4 ± 165 pg/ml (ns) four weeks after IVI. Responders revealed higher angiopoietin-2 (p = 0.0035) as well as higher VEGF-A (p = 0.0248) levels throughout the study period compared to non-responders. Initial CMT revealed to be the only independent factor influencing CMT 4 weeks after IVI in linear regression models with a positive correlation between initial thickness and effect size.The trending increase in systemic angiopoietin-2 levels, may be interpreted as an escape mechanism of the concomitant anti-VEGF component of therapy. Angiopoietin-2 levels could serve as a positive predictive factor of therapy response in the future. Further research regarding this effect as well as differences between responders and non-responders is mandatory.What is knownBispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.Bispecific antibodies may be more beneficial compared to monospecific antibodies in neovascular age related macular degeneration (nAMD).For monospecific antibodies, there are systemic effects on systemic vascular endothelial growth factor (VEGF) levels.What is newThe knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies.The knew bispecific antibody faricimab entails an increase in systemic angiopoietin-2 levels, as well as a decrease in VEGF levels.The increase in systemic angiopoietin-2 may be interpreted as a counterregulatory effect.The decrease in systemic VEGF levels resembles the effects of monospecific antibodies. [ABSTRACT FROM AUTHOR]

Genome or prime editing has become a promising tool for the treatment of hereditary disorders affecting the inner retina, such as dominant optic neuropathies. In vivo delivery of gene editors, such as Cas9, is typically achieved using recombinant adeno-associated virus (rAAV) vectors, which have a broad range of cellular tropisms and are well tolerated following intravitreal administration. Owing to the large size of gene editing constructs and the limited carrying capacity of rAAV (<5.1 kb) it is unfortunately usually necessary to split therapeutic transgene cassettes across multiple co-administered vector genomes. While the efficiency with which multiple vector genomes recombine following cellular entry has been studied extensively, another potentially limiting factor is the likelihood of target cells (e.g. retinal ganglion cells) receiving two or more vectors containing genomes that correspond to the full-length expression cassette when recombined. In this study we examine the efficiency with which two or more vector genomes transduce various retinal cell types following intravitreal administration. rAAV2/2[MAX] vectors expressing individual fluorescent reporters (GFP, BFP or mCherry) were co-injected intravitreally singly or in combination (dual or triple), allowing the extent of co-transduction to be assessed through multimodal in vivo imaging, electroretinography, flow cytometry and post-mortem histology. We find that intravitreal co-administration of vectors containing multiple genomes is well tolerated – with no observed alterations in retinal thickness or ERG amplitudes – but that co-transduction efficiency decreases significantly with increasing genome number. As such co-transduction of multiple vectors may be a major bottleneck limiting gene editing of inherited disorders affecting the inner retina. • Co-transduction of multiple rAAV remains inefficient in inner retinal neurons. • Müller glia are the most susceptible to rAAV co-transduction via IVT injection. • Low co-transduction efficiency represents a major bottle neck for gene editing. [ABSTRACT FROM AUTHOR]

We aimed to explore the protective effects and underlying mechanisms of taurine on retinal cells during acute ocular hypertension (AOH)-induced damage. Retinal morphology, apoptosis, mitochondrial structure, electroretinography, expression of GTP binding protein 3 (GTPBP3), and molecules in the unfolded protein response (UPR) were examined in an AOH mouse model and wild-type (WT) mice with or without intravitreal injection of taurine. For in vitro experiments, the GTPBP3 expression and endoplasmic reticulum (ER) stress were examined in R28 cell line under hydrogen peroxide (H 2 O 2)-induced damage or hypoxia/reoxygenation (H/R)-induced damage, with or without taurine pretreatment. Taurine pretreatment alleviated retinal damage caused by AOH modeling. The GTPBP3 expression level decreased after AOH injury, and taurine pretreatment reversed this reduction. Retinas with decreased GTPBP3 expression showed reduced retinal ganglion cell (RGC) function, which could be reversed by intravitreal taurine injection. In H 2 O 2- , H/R-, and AOH-induced damage, UPR were activated and alleviated by taurine pretreatment. GTPBP3 knockdown in R28 cells also activated the UPR, which was alleviated by taurine. A UPR activator downregulated GTPBP3 levels in normal R28 cells, whereas a UPR inhibitor upregulated GTPBP3 levels in GTPBP3 knockdown R28 cells. In conclusion, this study provides important evidence that taurine prevents retinal cell damage in mice exposed to AOH and modulates GTPBP3 expression via the UPR pathway. Interventions targeting this mechanism can be used as potential therapeutic targets for AOH damage. • Taurine protects against AOH-induced retinal damage and modulates expression of retinal GTPBP3 in AOH-induced damage. • Activation of the PERK pathway under AOH damage downregulates GTPBP3. • Decreased GTPBP3 activates the PERK pathway to promote cell damage. • Supplemented taurine can serve as a substrate for mt-tRNA modification to directly improve the function of mitochondria. • Taurine treatment inhibits the PERK pathway to relieve UPR damage and upregulates GTPBP3 to promote mitochondrial function. [ABSTRACT FROM AUTHOR]

[Display omitted] Diabetic retinopathy (DR) and age-related macular degeneration (AMD) are the primary causes of vision impairment and blindness worldwide. The current treatment for these diseases is an intravitreal injection of anti-VEGF agents, which are costly and require frequent injections. Implants can be used to sustain the release of drugs and minimize side effects. Axitinib (AX) is a potent VEGF receptor inhibitor and a promising candidate for treating posterior ocular diseases, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). A sustained release of AX was successfully achieved from 3D-printed AX-loaded implants fabricated using the well-known 3D printing technique, semi-solid extrusion (SSE). AX at concentrations of 10% w/w and 20% w/w was incorporated within the polycaprolactone (PCL) and Precirol®-based matrix. The fabricated implants were characterized via FTIR spectroscopy, SEM imaging, and thermal analysis. The implants were also evaluated for their drug release and biocompatibility. The AX-loaded implants exhibited thermal stability, and no chemical interactions were found between AX and the matrix components. The release mechanism study of AX revealed that the concentration of drug loading influenced AX release from the implant, with a 10% w/w and 20 %w/w of AX showing first-order and Korsmeyer-Peppas mechanism, respectively. A biocompatibility study using ARPE-19 cells confirmed that AX-loaded implants are nontoxic and safe for ocular use. [ABSTRACT FROM AUTHOR]

Purpose: Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2–10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections.Methods: Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2–10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections.Results: Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2–10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections.Conclusions: Intravitreal injections of anti-VEGF agents are considered as safe, with a very low rate of intraocular inflammations (IOI). Faricimab is a novel intravitreal bispecific antibody targeting both VEGF-A and angiopoietin-Tie2 independently. Despite a safe profile in randomized clinical trials, several real-life studies have reported cases of IOI. The aim of this monocentric study was to report the incidence and clinical course of intraocular inflammation following intravitreal faricimab injections.A retrospective analysis was performed in our tertiary care center, based on the observation of cases between December 1, 2023 and April 30, 2024. The incidence of intraocular inflammation occurring following faricimab injections compared to other anti-VEGF agents and dexamethasone implants was assessed over the study period.Intraocular inflammation was observed in 11 eyes of seven patients, and presented as isolated, painless anterior uveitis with retrocorneal precipitates in three cases and vitritis associated with anterior uveitis in eight cases. The pattern of vitritis appeared distinctive, characterized by dense, grayish vitreous bands observed mainly in the peripheral fundus. The inflammatory phase persisted for 2–10 weeks, and regressed with steroid treatment. The overall incidence of IOI with faricimab was 0.87% (11 out of 1,271 injections), with vitritis specifically observed in 0.63% of cases (8 out of 1,271 injections). In contrast, of the 3,728 injections of other anti-VEGF agents administered (including 1,765 injections of aflibercept, 1,952 injections of ranibizumab) and 43 injections of dexamethasone implants, no cases of intraocular inflammation were reported.Our initial experience with faricimab indicates a potentially higher risk of intraocular inflammation, including a distinctive pattern of vitritis, compared to aflibercept and ranibizumab. The benefit/risk ratio should be carefully assessed, particularly in patients with monocular vision or who require simultaneous bilateral injections. [ABSTRACT FROM AUTHOR]

A correction notice in the Indian Journal of Ophthalmology addresses errors in the article "Bedside Bilateral Sequential Intravitreal Anti-VEGF Injections for Retinopathy of Prematurity." The names of the second and eighth authors were omitted, and the affiliation of the last author was incorrect. The correct author names and affiliations have been provided in the correction notice for accurate reference. [Extracted from the article]

• Retinopathy of prematurity (ROP) is a blinding disease in preterm infants. • Retinal laser, intravitreal injections, and surgery treat the complications of ROP. • We describe a possible role for Ringer's lactate to prevent ROP complications. • Topical Ringer's lactate may cause normal vascularisation of the retinal periphery. Retinopathy of Prematurity (ROP) is a disorder affecting the developing retinal vasculature in preterm infants and is one of the major preventable causes of childhood blindness worldwide. The pathogenesis of ROP is characterized by two distinct phases: Phase 1 occurs when preterm infants are exposed to relative hyperoxia compared to in-utero conditions, either from atmospheric oxygen or supplemental therapy. This exposure causes vaso-obliteration and disrupts peripheral retinal vascularization. In Phase 2, the resulting peripheral avascular retina becomes hypoxic, triggering the release of pro-angiogenic factors like VEGF. This leads to proliferative retinopathy, potentially causing complications such as retinal detachment and permanent blindness in affected neonates. Current management strategies in ROP include intravitreal anti-VEGF injections and laser photocoagulation. Lactate is a well-known pro-angiogenic molecule. We hypothesize that topical administration of lactate in the form of Ringer's lactate solution in the eye in Phase 1 of ROP would allow normal retinal vascularisation, potentially preventing the progression of ROP to Phase 2. This approach warrants investigation as a potential therapy to reduce the incidence of phase 2 ROP and its complications. [ABSTRACT FROM AUTHOR]