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Objective: To describe the anterior segment optical coherence tomography (ASOCT) features of nodulo-ulcerative ocular surface squamous neoplasia (nuOSSN) and correlate these findings with histopathology. Methods: Retrospective study of 16 eyes with nuOSSN with clinical images, ASOCT scans, and histopathology. Results: The mean age at presentation was 55 years (median, 58 years; range, 25 to 81 years). Systemic predisposing factors included human immunodeficiency virus infection (n = 2, 13%) patients and xeroderma pigmentosum (n = 1, 6%). Bulbar conjunctiva was the most common epicenter (n = 10, 63%), with limbal and corneal extension seen in 16 (100%) and 14 (88%) eyes. In addition to epithelial thickening, typical of OSSN, scleral thinning, limbal thinning, and corneal thinning were seen in 5 (31%), 10 (63%), and 7 (44%) eyes of nuOSSN, respectively. Corneal stromal opacification with normal overlying epithelium was seen in 10 (63%) cases, corresponding to the 'wedge sign' on ASOCT in all 10 cases. This corresponded to stromal invasion of OSSN on histopathology in all eyes. The wedge sign had a sensitivity of 77%, specificity of 100%, positive predictive value of 100%, negative predictive value of 50%, and an accuracy of 81% for stromal invasion compared with the gold standard of histopathological examination. Conclusion: The ASOCT features of nuOSSN differ from classic OSSN. nuOSSN is associated with adjacent areas of scleral/limbal/corneal thinning. Corneal stromal opacification is seen as a wedge sign on ASOCT and corresponds to corneal stromal tumor invasion on histopathology. Areas of scleral/limbal/corneal thinning, along with the 'wedge sign' on ASOCT, confirmed nuOSSN with stromal invasion in 63% of patients in this retrospective study. [ABSTRACT FROM AUTHOR]

Background: To compare anterior scleral thickness (AST) in Turkish patients with open-angle glaucoma (primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEG)) with healthy controls. Methods: This prospective study involved 41 patients with PEG, 69 patients with POAG, and 46 healthy controls. We obtained spectral domain anterior segment optical coherence tomography (AS-OCT) images from the nasal and temporal quadrants and made AST measurements of 1 mm (AST), 2 mm (AST2), 3 mm (AST3), and 4 mm (AST4) posterior to the scleral spur (SS). Schlemm's canal (SC) diameter and area measurements were performed using the ImageJ software. The results were compared statistically. Results: The average ASTs of the groups did not differ significantly (p > 0.05 for each). The analysis of the nasal SC diameter revealed a significant decrease in the POAG group in comparison with the PEG group, with no difference observed between the POAG and control groups (p = 0.038*). The mean nasal and temporal SC area was significantly smaller in the PEG and POAG groups compared with the control group (p < 0.001** and p < 0.001**, respectively). Conclusions: There was no significant difference in nasal and temporal AST between groups; however, the SC area was found to be smaller in glaucoma groups compared with healthy controls. The present findings should be supported by further studies. [ABSTRACT FROM AUTHOR]

This review seeks to evaluate anterior segment optical coherence tomography (AS-OCT) in the diagnostic procedure and management of Descemet's membrane detachment (DMD) in cataract surgery. DMD may present diagnostic challenges, particularly in pronounced corneal edema where traditional methods such as slit lamp biomicroscopy may be inadequate in evaluating the corneal layers. The role of AS-OCT in providing high-resolution images in the preoperative, intraoperative, and postoperative phases of cataract surgery is analyzed with a focus on its role in the early diagnosis of DMD and in evaluating the extent, morphology, and topographic localization of DMD allowing for immediate intervention during surgery and precise pneumodescemetopexy procedures where conservative treatment has failed. This review explores the integration of AS-OCT into the standard perioperative diagnostic workflow, highlighting its potential role in the prevention, accurate diagnosis, and prompt management of DMD, a complication of cataract surgery that, while low in incidence, can be highly disruptive when it occurs. The emerging role of artificial intelligence (AI) in AS-OCT analysis of anterior segment conditions and surgical procedures is discussed, though refinement of AI algorithms is warranted. [ABSTRACT FROM AUTHOR]

Purpose: To assess the possibility of anterior segment optical coherence tomography (AS-OCT)-based preoperative evaluation of the lens in order to prevent and predict intraoperative complications of posterior subcapsular cataract (PSC) surgery. Methods: This prospective study included 512 eyes diagnosed with PSC. AS-OCT was performed using Line, Cross Line and 3D Cornea scans to visualize the posterior capsule. The posterior capsule and opacities in the subcortical and cortical lens, their relationship and the state of the retrolenticular space were assessed. The study sample was divided into three groups while taking into account the revealed morphological changes in the lens. Groups 1, 2, and 3 comprised 312, 185 and 15 eyes, respectively, with each group characterized by a specific type (1, 2 or 3) of morphological AS-OCT changes in the PSC. Surgery consisted of ultrasound phacoemulsification with intraocular lens implantation. Well-known measures related to cataract surgery stages were performed, if required, to preserve the integrity of the posterior capsule, while taking into account the type of PSC changes. We preoperatively determined the eyes at risk for intraoperative posterior capsular rupture (PCR) and detection of posterior capsular plaque (PCP), and compared this data with the postoperative data on the state of the posterior capsule. Results: The PSC cases with an expected rate of intraoperative complications of 0 to 10% were classified as those with a low risk, whereas the rest, with a high risk of complications. Only eyes with type 2 or type 3 PSC changes were expected to have a high risk of intraoperative PCP, and only eyes with type 3 PSC changes, a high risk of PCR. In groups 1, 2 and 3, the rates of intraoperative PCP were 0%, 100% and 46.7%, respectively, and the rates of intraoperative PCR, 0%, 0% and 53.3%, respectively. There was a significant positive correlation between preoperative OCT-based morphology of the lens and intraoperative complications (r = 0.88, p ≤0.001). Sensitivity and specificity for the method of AS-OCT-based evaluation of risks of intraoperative complications in PSC surgery were 98.8% and 96.5%, respectively. Conclusion: AS-OCT allows evaluating preoperatively posterior lens opacification morphology and posterior capsular changes, determining the risks of complications, and performing surgical planning for PSC. Key messages: What is Known? Complications (posterior capsule (PC) rupture with or without vitreous loss and residual PC plaque) are common in, and affect the expected outcome of, posterior subcapsular cataract (PSC) surgery. What is new? PC plaque is most likely in eyes with preoperative type 2 changes in the PSC, whereas eyes with preoperative type 3 changes are likely to show PC rupture or residual PC plaque. AS-OCT enables an experienced surgeon to predict the risks of intraoperative complications in, and perform surgical planning for, PSC surgery. [ABSTRACT FROM AUTHOR]

Background/Objectives: to report a novel KRT3 Meesmann corneal dystrophy (MECD) mutation and its clinical findings in a Spanish family, thus completing the international database. Case series study. Methods: Two generations of three family members were studied. The clinical ophthalmologic evaluation was made including best-corrected visual acuity (BCVA), biomicroscopy with and without fluorescein, fundoscopy, Schirmer test I, non-invasive break-up time (NiBUT), and esthesiometry. In vivo confocal microscopy (IVCM), anterior segment optical coherence tomography (AS-OCT) with an epithelial map, and genetic analysis were also performed. Results: A novel heterozygous mutation in the KRT3 gene c.1527G>T (p. Glu509Asp) was identified. Biomicroscopy revealed bilateral multiple corneal intraepithelial cysts. IVCM showed numerous and relatively small microcysts (12–32 µm), hyperreflective materials, subepithelial nerve and Bowman's layer alterations. AS-OCT scan revealed diffuse hyperreflectivity and the epithelial map displayed thickening of the corneal epithelium in the interpalpebral zone (proband: 52–68 µm and father's proband: 55–71 µm) with a slightly thinned cornea. Conclusions: We identified a new mutation in the KRT3 gene–c.1527G>T (p. Glu509Asp) in a Spanish family with MECD. A comprehensive characterization of the clinical signs, using different techniques, especially an epithelial map, could be useful to diagnose and monitor epithelial changes by quantitative measures. Epithelial map changes provide better understanding of MECD differential epithelial behavior and its progression changes. Larger studies will be necessary to better understand these specific patterns and clinically evaluate new therapies. [ABSTRACT FROM AUTHOR]

Cataract is the leading ocular disease of blindness and visual impairment globally. Deep neural networks (DNNs) have achieved promising cataracts recognition performance based on anterior segment optical coherence tomography (AS-OCT) images; however, they have poor explanations, limiting their clinical applications. In contrast, visual features extracted from original AS-OCT images and their transform forms (e.g., AS-OCT-based histograms) have good explanations but have not been fully exploited. Motivated by these observations, an explainable machine learning framework to recognize cataracts severity levels automatically using AS-OCT images was proposed, consisting of three stages: visual feature extraction, feature importance explanation and selection, and recognition. First, the intensity histogram and intensity-based statistical methods are applied to extract visual features from original AS-OCT images and AS-OCT-based histograms. Subsequently, the SHapley Additive exPlanations and Pearson correlation coefficient methods are applied to analyze the feature importance and select significant visual features. Finally, an ensemble multi-class ridge regression method is applied to recognize the cataracts severity levels based on the selected visual features. Experiments on a clinical AS-OCT-NC dataset demonstrate that the proposed framework not only achieves competitive performance through comparisons with DNNs, but also has a good explanation ability, meeting the requirements of clinical diagnostic practice. [ABSTRACT FROM AUTHOR]

Objective To observe the early changes of vault after implantation of posterior chamber phakic intraocular lens implantable collamer lens (ICL), and investigate the effect of different implantation axes on the early vault changes. Methods A prospective, parallel cohort study was performed, enrolling a total of 124 eyes of who underwent ICL (V4c) implantation in the refractive clinic. The changes of vault were observed by scheimpflug tomography (Pentacam) and anterior segment optical coherence tomography (CASIA2) at 1 day, 1 week and 1 month after surgery. Results The ICL vault declined significantly by approximately (108.2±82.4)μm 1 week after surgery with the proportion of 16.6%±12.1% compared with the values 1 day after surgery (P<0.001), and then remained stable. Within 1 month after surgery, excluding the difference in vault baseline at 1 day after surgery, the proportion of vault decline in the middle vault group (250-749 μm) and the high vault group (≥750 μm) was similar, and there was no statistically significant difference. We analyzed the relationship between ICL axial directions and vault and found that the vault decline of the horizontal ICL group stabilized quickly at 1 week after surgery, and the vault decline of the vertical ICL group was more significant within 1 month after surgery (P<0.05). Conclusion The vault of the ICL shows a downward trend in the early stage after implantation. The middle vault group and ICL in the horizontal position stabilizes faster, and the downward trend of the high vault group or ICL in the vertical position is more obvious. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the functional and structural daily variations in eyes with a mild form of Fuchs' endothelial corneal dystrophy (FECD). Methods: This prospective study included 30 eyes with the mild form of FECD. Subjects underwent functional and structural testing at 8 AM, 2 PM, and 8 PM. Testing included measurement of uncorrected distance visual acuity (UDVA), best corrected twilight vision (TV), and contrast sensitivity function (CSF) testing (Vista Vision Far-Pola, DMD MedTech charts). Corneal epithelial and stromal parameters were evaluated with anterior segment optical coherence tomography (AngioVue, AvantiRTVue-XR; Optovue, CA, USA). Results: UDVA, TV, and CSF for spatial frequencies B, C, and F showed significant changes during the day, with the lowest values in the morning (P < 0.0001 for UDVA, P = 0.0109 for TV, and P < 0.0001, P = 0.0126, and P = 0.0471 for the three spatial frequencies, respectively). There was no significant change in epithelial parameters between visits. Central corneal thickness showed significant decrease during the day (P < 0.0001), as did the central stromal thickness on the 5- and 7-mm maps (P = 0.0002 and P < 0.0001, respectively), stromal thickness in the superior section of the 5-mm map (P = 0.0107), stromal thickness in the inferior section of the 7-mm map (P = 0.0002), and minimal stromal thickness on both maps (P < 0.0001). Conclusion: A significant negative correlation was found between central stromal thickness and TV, implying that simultaneous evaluation of corneal layers and visual quality may be useful in assessing FECD. [ABSTRACT FROM AUTHOR]

Aims. To present a new method of dynamic Purkinje-metry and to verify it by comparison with a commercially available anterior segment optical coherence tomography CASIA2. Patients and Methods. A dynamic Purkinje-meter with a movable fixation target was assembled. A coaxial circular pattern formed by infrared LEDs was projected onto the eye and evoked Purkinje images (1st, 3rd, 4th = P1, P3, P4). The measurement was performed on 29 eyes with an implanted toric IOL (intraocular lens), under mydriatic conditions, with reference to the visual axis. The IOL tilt was calculated from the position of a fixation target at the moment of P3 and P4 superposition. The IOL decentration was determined based on the relative position of P1 during on-axis fixation and of P3 and P4 superposition during off-axis fixation. A custom-developed software was used for distance measurements. Using CASIA2, the IOL position was fully calculated by the device. Results. The mean absolute difference between CASIA2 and Purkinje-meter values was 0.6° ± 0.4° for the tilt magnitude and 10° ± 10° for the tilt direction, and 0.11 mm ± 0.08 mm for the decentration magnitude and 16° ± 14° for the decentration direction. There was no statistically significant difference between the values determined by the two methods for the tilt and decentration direction. The differences were statistically significant for the tilt and decentration magnitude. Conclusion. The values of IOL tilt and decentration direction are similar for both devices. The values of IOL tilt and decentration magnitude measured by Purkinje-meter are higher than those from CASIA2, but overall, they correspond to the values presented in other published studies.

Abstract Background To compare anterior scleral thickness (AST) in Turkish patients with open-angle glaucoma (primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEG)) with healthy controls. Methods This prospective study involved 41 patients with PEG, 69 patients with POAG, and 46 healthy controls. We obtained spectral domain anterior segment optical coherence tomography (AS-OCT) images from the nasal and temporal quadrants and made AST measurements of 1 mm (AST), 2 mm (AST2), 3 mm (AST3), and 4 mm (AST4) posterior to the scleral spur (SS). Schlemm's canal (SC) diameter and area measurements were performed using the ImageJ software. The results were compared statistically. Results The average ASTs of the groups did not differ significantly (p > 0.05 for each). The analysis of the nasal SC diameter revealed a significant decrease in the POAG group in comparison with the PEG group, with no difference observed between the POAG and control groups (p = 0.038*). The mean nasal and temporal SC area was significantly smaller in the PEG and POAG groups compared with the control group (p

AIM: To explore the factors affecting the whole-eye astigmatism after pterygium excision combined with autologous limbal stem cell transplantation.METHODS: A retrospective analysis was conducted on the medical records of 42 patients(42 eyes)with primary pterygium admitted in the ophthalmology department of Xijing Hospital from January 2023 to October 2023. They underwent pterygium excision combined with autologous limbal stem cell transplantation. The maximum invasion depth of pterygium into the cornea was measured with anterior segment optical coherence tomography(AS-OCT)before operation, the length of the pterygium invading cornea, the width of the limbus and the area of the invading cornea were measured during the operation, and three-dimensional values of corneal astigmatism of anterior segment, index of surface variance(ISV), index of vertical asymmetry(IVA), best corrected visual acuity(BCVA)and whole-eye astigmatism were collected before and at 1 mo after surgery. Patients with astigmatism ≤0.50 D or >0.50 D of the whole eye at 1 mo after surgery were assigned to group A and B, respectively. The differences of clinical data before and at 1 mo after surgery between the two groups, and the correlation between pre-operative clinical indicators and whole-eye astigmatism were analyzed. The decision tree algorithm was performed to explore the influencing factors of whole-eye astigmatism at 1 mo postoperatively.RESULTS: The maximum invasion depth of pterygium in the group A was significantly less than that in the group B [80.00(40.00, 180.00)μm vs 175.00(123.00, 190.00)μm, P=0.002]. Preoperative BCVA(LogMAR), whole-eye astigmatism, cornea astigmatism, ISV, IVA and maximum invasion depth of pterygium were positively correlated with whole-eye astigmatism at 1 mo after surgery(rs=0.317, P=0.041; rs=0.545, P0.50 D at 1 mo after operation was higher with maximum invasion depth of pterygium into the cornea >95 μm than that with ≤95 μm. Among the patients with whole-eye astigmatism >2.63 D before operation, the probability of residual whole-eye astigmatism >0.50 D was 88.9%, and the predictive model AUC was 0.804.CONCLUSION: The whole-eye astigmatism after pterygium resection is mainly affected by the maximum invasion depth of pterygium into the cornea and preoperative whole-eye astigmatism. When the maximum invasion depth of pterygium into the corneal is >95 μm and the whole-eye stigmatism is >2.63 D before surgery, the patient should receive surgical treatment as soon as possible in order to obtain good clinical benefits.

Abstract Cataract is the leading ocular disease of blindness and visual impairment globally. Deep neural networks (DNNs) have achieved promising cataracts recognition performance based on anterior segment optical coherence tomography (AS-OCT) images; however, they have poor explanations, limiting their clinical applications. In contrast, visual features extracted from original AS-OCT images and their transform forms (e.g., AS-OCT-based histograms) have good explanations but have not been fully exploited. Motivated by these observations, an explainable machine learning framework to recognize cataracts severity levels automatically using AS-OCT images was proposed, consisting of three stages: visual feature extraction, feature importance explanation and selection, and recognition. First, the intensity histogram and intensity-based statistical methods are applied to extract visual features from original AS-OCT images and AS-OCT-based histograms. Subsequently, the SHapley Additive exPlanations and Pearson correlation coefficient methods are applied to analyze the feature importance and select significant visual features. Finally, an ensemble multi-class ridge regression method is applied to recognize the cataracts severity levels based on the selected visual features. Experiments on a clinical AS-OCT-NC dataset demonstrate that the proposed framework not only achieves competitive performance through comparisons with DNNs, but also has a good explanation ability, meeting the requirements of clinical diagnostic practice.

Conjunctival lymphangiectasia is a low-incidence ocular surface disease that is currently rarely reported in the relevant literature. It may be related to cosmetic eyelid surgery, tumor, radiation or chemotherapy and other factors and often causes a foreign body sensation, lacrimation, eye pain, visual fatigue and other discomfort. These symptoms of constant eye irritation affect the patient's quality of life. At present, anterior segment optical coherence tomography can be used for clinical diagnosis, and the novel monoclonal antibody D2-40, as a marker of lymphatic endothelial cell dilatation, has high specificity in pathological diagnosis. Previous studies have not fully defined the pathogenesis of the disease, and treatment methods vary. Conventional treatment has resulted in varying degrees of damage to the conjunctiva in patients. In recent years, anti-vascular endothelial growth factor drugs have been reported to be effective in treating the disease with few complications. This article reviews the pathogenesis, diagnosis and treatment of this rare disease in order to gain a better understanding of conjunctival lymphangiectasia and provide more support for clinical diagnosis and treatment.

Abstract This retrospective study investigated the degree of intraocular lens (IOL) tilt and decentration after cataract surgery in eyes with varying degrees of myopia using the anterior segment optical coherence tomography (AS-OCT). Eyes of 76 patients were analyzed and divided into three groups: mild myopia (emmetropia to − 1.5 diopter [D], Group 1), moderate myopia (− 1.5 D to − 6.0 D, Group 2), and high myopia (over − 6.0 D, Group 3). Postoperative IOL decentration, tilt, and lens diameter were evaluated using swept-source AS-OCT under mesopic conditions without dilation eyedrop. Postoperative parameters revealed no difference in IOL tilt, but IOL decentration was significantly different among the groups, and the degree of decentration was greater in Group 3 (P = 0.007). Univariable regression analysis indicated that age, sex, preoperative uncorrected distant visual acuity, corrected distant visual acuity, intraocular pressure, spherical equivalent, preoperative anterior chamber depth and lens thickness had no influence on postoperative IOL decentration, but axial length (AL) was significantly related to IOL decentration (P = 0.001). This association was confirmed using multivariable regression analysis, establishing a significant correlation between AL and IOL decentration (P = 0.001) on AS-OCT, showing an increase in IOL decentration associated with increasing AL.

Purpose To compare the corneal epithelial thickness along the flat and steep meridians of corneas with low and high toricity. Methods This was a prospective observational comparative study on healthy subjects with normal corneas seeking preoperative evaluation for refractive surgery at a university-based hospital. Subjects with up to 2 diopters (D) of corneal with-the-rule astigmatism were defined as low corneal toricity (CT), whereas cylinder > two-dimensional was considered as high CT. The anterior segment optical coherence tomography was conducted to measure the epithelial thickness along the principle meridians of CT over a diameter of 9 mm. At the eye level, outcome variables (corneal and epithelial thicknesses in low- and high-astigmatism groups) were assessed using generalized estimating equation models. Results Included were 98 eyes (49 subjects): 46 eyes (23 subjects) with low CT and 52 eyes (26 subjects) with high CT. Two groups were similar with respect to the age (P = 0.82), sex (P = 0.49), and spherical equivalent (P = 0.11). Although the corneal thickness at steep and flat meridians was not different between two groups, high-CT group had significantly thinner epithelium at inferior 2.5–3.5 and 3.5–4.5 mm zones (P = 0.01 and 0.04) as well as superior 2.5–3.5 mm zone (P = 0.03) along the steep meridian. Two groups were similar with respect to epithelial thickness of flat meridian (all P > 0.05). Conclusion The epithelium of steep meridian was thinner in the high-CT group compared to the low-CT group.

Introduction: The diagnosis of metastatic iris tumor is made by a fine-needle aspiration biopsy of part of the solid component of the tumor and tumor cells seeded in the anterior chamber; however, sometimes the diagnosis is not made due to insufficient sample volumes. We report a case of metastatic iris tumor in which measurement of tumor marker levels in the aqueous humor together with fine needle aspiration cytology contributed to the diagnosis. Case Report: An 80-year-old Japanese woman was referred to our hospital because of an iris mass. Six months before the initial visit, the patient was diagnosed with adenocarcinoma of the cecum. Slit-lamp microscopy revealed an elevated iris mass. Fine-needle aspiration cytology suggested adenocarcinoma. The carcinoembryonic antigen (CEA) level in the anterior chamber was 5,716.1 ng/mL, and serum CEA level measured on the same day were 678.5 ng/mL. These data indicated CEA levels synchronously elevated in both anterior chamber and serum. Based on aspiration cytology and high CEA levels of anterior chamber, she was diagnosed with metastatic iris tumor derived from adenocarcinoma of the cecum. One month after the initial visit, right eye irradiation was performed for metastatic iris tumor. Conclusions: Measurement of tumor marker levels in the aqueous humor, together with fine needle aspiration cytology of the tumor, contributes to the diagnosis of metastatic iris tumors. [ABSTRACT FROM AUTHOR]

Introduction: Intrableb structures are hallmark features of the filtering bleb. This study aimed to compare the characteristics of functioning blebs using anterior segment optical coherence tomography (AS-OCT) according to amniotic membrane transplantation (AMT). Methods: Forty eyes from 40 patients diagnosed with primary open-angle glaucoma who underwent trabeculectomy, either with AMT (20 eyes) or without AMT (control group, 20 eyes), were included. Parameters including bleb height, bleb wall thickness, striping layer thickness, striping to bleb wall ratio, bleb wall reflectivity, fluid-filled space score/height/area, and presence of microcysts were assessed using AS-OCT. Surgical success was defined at the time of AS-OCT as an intraocular pressure (IOP) ≤18 mm Hg and IOP reduction ≥30% without medication. In these patients, if the bleb had a clinically diffuse and healthy without any signs of an encapsulated bleb, the bleb was then defined as functioning bleb. Results: Except for bleb height (p = 0.352) and microcyst formation (p = 0.266), significant differences were observed between the two groups. The functioning blebs of the AMT group exhibited greater fluid-filled space score, area, and height than those of the control group, following adjustment for AS-OCT time (all p < 0.001). Conversely, the functioning bleb of the control group demonstrated thicker bleb wall and striping layer, higher striping to bleb wall ratio, and lower bleb wall reflectivity than those of the AMT group, following adjustment for AS-OCT time (all p ≤ 0.001). Conclusion: Distinct intrableb structures were identified in functioning blebs according to AMT. The reflectivity and thickness of the bleb wall structures were more pronounced in the functioning bleb after trabeculectomy alone. In contrast, the extent of the fluid-filled space emerged as a more distinctive feature of the intrableb structures in the functioning bleb after trabeculectomy with AMT. [ABSTRACT FROM AUTHOR]

This retrospective study investigated the degree of intraocular lens (IOL) tilt and decentration after cataract surgery in eyes with varying degrees of myopia using the anterior segment optical coherence tomography (AS-OCT). Eyes of 76 patients were analyzed and divided into three groups: mild myopia (emmetropia to − 1.5 diopter [D], Group 1), moderate myopia (− 1.5 D to − 6.0 D, Group 2), and high myopia (over − 6.0 D, Group 3). Postoperative IOL decentration, tilt, and lens diameter were evaluated using swept-source AS-OCT under mesopic conditions without dilation eyedrop. Postoperative parameters revealed no difference in IOL tilt, but IOL decentration was significantly different among the groups, and the degree of decentration was greater in Group 3 (P = 0.007). Univariable regression analysis indicated that age, sex, preoperative uncorrected distant visual acuity, corrected distant visual acuity, intraocular pressure, spherical equivalent, preoperative anterior chamber depth and lens thickness had no influence on postoperative IOL decentration, but axial length (AL) was significantly related to IOL decentration (P = 0.001). This association was confirmed using multivariable regression analysis, establishing a significant correlation between AL and IOL decentration (P = 0.001) on AS-OCT, showing an increase in IOL decentration associated with increasing AL. [ABSTRACT FROM AUTHOR]

Purpose: To compare the results and success rates of patients with epiphora due to punctal stenosis operated with the "canalicular triangular flap punctoplasty" and the "triangular three -snip punctoplasty" using anterior segment optical coherence tomography (AS-OCT). Methods: This study is a retrospective cohort analysis of patients who were diagnosed with punctal stenosis and underwent canalicular triangular flap or triangular three-snip punctoplasty between September 2021 and June 2022. Results: The study included 80 eyes of 43 patients consisting of 15 males and 28 females. Forty eyes underwent canalicular triangular flap punctoplasty (Group A) and 40 eyes underwent triangular three-snip punctoplasty (Group B) technique. The mean age of the patients was 63.9 ± 10.9 years (37–88 years). In Group A, the anatomic success was 100% and functional success was 95% at 6 months. In Group B, 77.5% functional success and 75% anatomic success were achieved at 6 months. Conclusions: The canalicular triangular flap technique was more successful in providing punctal patency both anatomically and functionally than the triangular three-snip punctoplasty. AS-OCT is a method that provides objective, quantitative results in the diagnosis and follow-up of punctal stenosis and may be used more widely in punctum and vertical canaliculi pathologies. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion To test the prognostic role of anterior scleral substantia propria (ASSP) thickness in predicting the 3‐month response after half‐dose photodynamic therapy (PDT) in central serous chorioretinopathy (CSCR) and to assess its clinical relevance of ASSP in different CSCR phenotypes.A prospective, exploratory, multi‐centre cohort study conducted at IRCCS San Martino Hospital (Genoa, Italy) and Jules‐Gonin Eye Hospital (Lausanne, Switzerland). Demographic and clinical data, and optical coherence tomography (OCT) were collected at baseline and 3 months after PDT. Based on OCT images, we categorized CSCR phenotypes and collected clinically relevant imaging metrics. ASSP thickness was obtained from four different measurements using anterior segment (AS) OCT. Multivariable regression models were performed to evaluate the distribution of ASSP thicknesses among different CSCR phenotypes and to test the prognostic role of ASSP thickness in discriminating between PDT responders (complete subretinal fluid reabsorption) and partial responders.The study cohort comprised 109 Caucasian patients (82 males, 75.2%) with a total of 142 eyes: 84 eyes simple (59.1%) versus 58 eyes complex (40.9%) CSCR. A linear normal model confirmed a positive association between complex CSCR and higher ASSP thickness (β = 26.1, 95% CL = 12.1/40.1, p < 0.001), with a low prevalence of ciliochoroidal effusion loculations in AS‐OCT (1/142 eyes, 0.7%). ASSP thickening was positively linked to the presence of posterior cystoid retinal degeneration (PCRD; p = 0.002), indicating a potential role in the pathogenesis of severe CSCR phenotypes. In the subgroup of treated patients (61 eyes), 63.9% had a complete response after PDT. In these patients a logistic binary model highlighted a significantly higher risk of PDT non‐responsiveness (OR = 9.62, 95% CL = 2.44/37.9, p = 0.001) associated with a 60‐unit increase in ASSP thickness levels. By contrast, other anatomical parameters (i.e., body surface area, age, gender, axial length) showed no remarkable prognostic roles.This research highlighted the association of ASSP thickening with complex CSCR phenotype in Caucasian patients and its role in predicting PDT efficacy. These findings enhance our comprehension of the anatomical risk factors in patients affected with CSCR and potentially guide a better understanding of non‐responsive cases to PDT treatment. [ABSTRACT FROM AUTHOR]

We report a rare presentation of limbus-sparing ocular surface squamous neoplasia (OSSN) over post-traumatic adherent leucoma. A 32-year-old healthy male presented with a pedunculated fleshy corneal mass overlying an adherent leucoma secondary to self-healed full-thickness corneal laceration, with an adjacent pinguecula separated by a clear normal limbus. AS-OCT confirmed the separation of corneal epithelial mass from underlying iris tissue by thinned scarred corneal stroma. An excisional biopsy with 2mm conjunctival margins and a limbal conjunctival autograft was performed. A feeder vessel was observed at the base of the corneal lesion. Histopathological evaluation showed moderately differentiated squamous cell carcinoma. Adjuvant Interferon alfa 2b chemotherapy for three months ensured complete clearance with no recurrence at follow-up. This case highlights the traumatic etiology of OSSN development without limbal involvement. Immediate corneal tear repair may have prevented its occurrence and the need for long-term chemotherapy.

PurposeTo describe examination and imaging characteristics of presumed iris papulosa in a case of ocular syphilis.ObservationsA 60-year-old man who presented with granulomatous anterior uveitis in his left eye was also noted to have an unusual vascularized iris papule associated with posterior synechiae at the nasal pupillary margin. Anterior segment OCT (AS-OCT) of the iris lesion demonstrated a hyperreflective anterior surface with multiple vascular lumen, internal hyperreflectivity, and shadowing. Ultrasound biomicroscopy (UBM) imaging revealed an echodense mass with relative hyperechogenicity in the anterior portion of the lesion. Systemic work-up confirmed a diagnosis of syphilis, and he was treated with topical steroids and parenteral penicillin.Conclusion and importanceWe characterize the rare finding of iris papulosa that may be encountered in syphilitic uveitis and its distinctive features on both UBM and AS-OCT. This report highlights that syphilis should be considered as a possible diagnosis for an undifferentiated vascular iris mass.

Purpose: Autostereoscopic displays have become increasingly common, but their impact on ocular dimensions remains unknown. We sought to identify changes in the crystalline lens dimensions induced by autostereoscopic three‐dimensional (3D) viewing. Methods: Forty young adults (age: 22.6 ± 2.0 years, male/female: 15/25) were consecutively enrolled and randomly divided into two groups (3D and two‐dimensional [2D] viewing groups) to watch a 30‐min movie clip displayed in 3D or 2D mode on a tablet computer. The lens thickness (LT), diameter, curvature, decentration and tilt were measured with anterior segment optical coherence tomography under both non‐accommodating (static) and accommodating conditions. Results: In the static condition, the LT decreased by 0.03 ± 0.03 mm (p < 0.001) and the anterior radius of curvature (ARC) increased by 0.49 ± 0.59 mm (p = 0.001) post‐3D viewing. In contrast, following 2D viewing, the ARC decreased by 0.23 ± 0.25 mm (p = 0.001). Additionally, the increase in the steep ARC post‐3D viewing was greater in high‐myopic eyes than low to moderate myopic eyes (p = 0.04). When comparing the accommodative with the static (non‐accommodative) condition, for 3D viewing the lens decentration decreased (−0.03 ± 0.05 mm, p = 0.02); while for 2D viewing, the posterior curvature radius (−0.14 ± 0.20 mm, p = 0.006) and diameter (−0.13 ± 0.20 mm, p = 0.01) decreased. Conclusions: Viewing with the autostereoscopic 3D tablet could temporally decrease the thickness and curvature of the lens under non‐accommodating conditions. However, its long‐term effect requires further exploration. [ABSTRACT FROM AUTHOR]

Background: The surgical parameters of phacoemulsification can significantly impact the behavior of the anterior hyaloid membrane (AHM). Methods: In this prospective study, anterior segment optical coherence tomography was used to examine the attachment or detachment of the AHM of 82 eyes after uneventful phacoemulsification preoperatively and postoperatively over 1 year. The impacts of the capsulorhexis' size, number of hydrodissections, nuclear sclerosis grade, cumulative dissipated energy (CDE), ultrasonic time, total surgical time, weakness of zonular fibers, presence of lens materials in Berger's space (LM-BS), and fluid usage were investigated in relation to the behavior of the AHM. Results: A significant linear trend regarding anterior vitreous detachment (AVD) was observed in the presence of zonular weakness and high CDE at all postoperative times (p ≤ 0.024 and p ≤ 0.005, respectively). Similarly, AVD was observed at 1-month, 3-month, and 1-year follow-ups in cases of high nuclear sclerosis grades (p ≤ 0.044) and high fluid usage (p ≤ 0.021). A significant correlation was observed in the group of LM-BS as the zonular weakness value increased (OR: 0.085; 95% CI: 0.017 to 0.420; p = 0.002), and the fluid usage was also significantly higher (OR: 1.049; 95% CI: 1.003–1.096; p = 0.037). Conclusions: Zonular weakness, high CDE, a hard nucleus, and high fluid usage are risk factors for postoperative AVD. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the predictive value of anterior segment optical coherence tomography (AS-OCT) for postoperative corneal edema in cataract patients. Methods: A retrospective cohort study of 144 cataract patients from December 2020 to December 2021 was conducted. Patients were divided into edema eyes (84 cases) and observation (60 cases) group based on postoperative corneal edema occurrence. Relevant indicators were compared between groups. Logistic regression identified risk factors for postoperative corneal edema. Receiver operating characteristic curves evaluated the predictive value. Results: The edema eyes group had significantly higher postoperative central corneal thickness (CCT) and lower postoperative endothelial cell density (ECD) than the observation group (P < 0.05). The edema eyes group also had significantly lower preoperative ECD, anterior chamber depth (ACD), anterior chamber angle (ACA), and preoperative lens position (LP) than the observation group (P < 0.05). Logistic regression analysis showed that preoperative ECD, ACD, ACA, and LP were independent risk factors for postoperative corneal edema (P < 0.05), all of which also showed good predictive value for postoperative corneal edema, with areas under the curve (AUCs) of 0.854, 0.812, 0.791, and 0.778, respectively, under the ROC curve analysis. Conclusion: AS-OCT can provide useful information for predicting postoperative corneal edema in cataract patients. Preoperative ECD, preoperative ACD, preoperative ACA, and preoperative LP are important parameters that can be measured by AS-OCT and used as risk factors for postoperative corneal edema. [ABSTRACT FROM AUTHOR]

We report a case of personalized exclusive brachytherapy treatment for the management of a highly recurrent squamous cell conjunctival carcinoma with corneal invasion. This is a case of a Caucasian 81-years-old man who presented 10 years ago to our clinic with a pink-white para-limbal mass with dilated feeder arteries and mild leukoplakia. Excisional biopsy confirmed the presence of conjunctival intraepithelial neoplasia (CIN). Successively, he underwent two 4-weeks cycles of Mytomicin C topical therapy and a second excisional surgery, due to several recurrences of the lesion. At the last relapse, the pink-white peri-limbic mass which invaded the corneal limbus, determining corneal opacification from 5- to 7-clock hours, was confirmed by anterior segment optical coherence tomography (AS-OCT). Due to resistance to MMC therapy and chronic epitheliopathy, an AS-OCT guided exclusive radiotherapy plan was set: a Rhutenium-106 CCD plaque was applied directly over the afflicted corneal surface, the corneal limbus and the neighboring sclera for 24 hours. The remission of both conjunctival and corneal malignancy was complete 2 months after surgery and no signs of recurrence were highlighted at AS-OCT analysis at the 2-year follow up. Brachytherapy treatment showed optimal management of both corneal and conjunctival involvement, with a free-of-disease follow-up of 24-months. This result suggests that, in specific conditions, Ru-106 brachytherapy could be an effective option of treatment even if not associated with surgical excision. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the long-term structural changes of the anterior chamber (AC) angle following gonioscopy-assisted transluminal trabeculotomy (GATT). Methods: The AC angle of 10 eyes that underwent GATT at least 6 years previously was assessed for structural changes. A detailed gonioscopy was performed to determine the state of the cleft and the position of the trabecular flap. An anterior segment optical coherence tomography (AS-OCT) examination was performed on the corresponding areas on gonioscopy. Results: The typical finding of the angle following GATT was an open cleft with a visible trabecular flap. However, the gonioscopy of our patients revealed three different cleft appearances: open, closed, and segmentally open cleft. In the long-term, the trabecular flap re-approximated the incision site in some areas resulting in the appearance of a closed cleft on gonioscopy. On AS-OCT the cleft was identified when the lumen of Schlemm's canal was connected to the AC, while the position of the flap differed. The cleft was observed as open in median 4.0 (IQR: 2.8-6.0) clock hours. The cleft was found open mostly in the superior quadrants of the angle (nine eyes). No correlation was found between the extent of open cleft and the percentage of IOP reduction. Conclusion: AS-OCT, when used in conjunction with gonioscopy, was found helpful to evaluate the structural changes following GATT. As observed in the study, the cleft tended to close in some areas. It was found preserved mostly in the superior half of the angle in the long term. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of a conjunctival blue nevus in a child. Observations: A 10-year-old girl underwent an excisional biopsy for an atypical growing melanocytic conjunctival lesion. The diagnosis of a conjunctival blue nevus was confirmed on histopathology. We describe the histopathology and the anterior segment optical coherence tomography features of a blue nevus in a 10-year-old child along with a review of literature. Conclusion and importance: Conjunctival blue nevus is rare and has rarely been reported in a child. Multimodal imaging may help document lesion progression. This condition should remain in the differential for a growing, pigmented conjunctival lesion.

Purpose: To report a rare case of globe rupture with broken calcified senile scleral plaque (SSP). Observations: A 94-year-old male patient presented with left eye pain and severely decreased left vision immediately after the injury while farming. Examination of the left eye revealed edematous cornea, diffuse subconjunctival hemorrhage, total hyphema and iris prolapse. Preoperative computed tomography (CT) scan revealed calcified SSP in both eyes, and the calcified SSP was found to be broken during surgery. Although it was impossible to thread the broken calcified SSP, threading and suturing with long bites outside of the broken calcified SSP was effective for wound closure. Postoperatively, we were able to observe the broken calcified SSP and the wound closure using anterior segment optical coherence tomography (AS-OCT). Conclusions and importance: In a case of globe rupture with calcified SSP on preoperative CT, the possibility that the SSP has also ruptured should be considered. AS-OCT is also useful to observe the wound in a case of globe rupture with broken SSP during follow-up.

PurposeTo evaluate the effects of clear corneal incision (CCI) location and morphology on corneal surgically induced astigmatism (SIA) and higher-order aberrations (HOAs) in patients receiving implantable collamer lens (ICL V4c) implantation.MethodsThis retrospective study classified right eyes that underwent ICL implantation into two groups based on temporal or superior CCI. The Pentacam HR analyzer was used to measure the corneal astigmatism and HOAs. Analysis of the clear corneal incision (CCI) morphology, including incision width (Angle-W), incision length (IL), incision angles (Angle-En/Ex), and distance from the incision to corneal apex (Dis-En/Ex), was conducted using anterior segment optical coherence tomography (AS-OCT).ResultsThere were 75 eyes in the temporal CCI group and 47 eyes in the superior CCI group. Both groups showed satisfactory safety and efficacy postoperatively. In the temporal CCI group, Dis-En and Dis-Ex were considerably longer, whereas the superior CCI group displayed a significantly wider Angle-W. The anterior and posterior corneal SIA were comparable in both groups. Anterior corneal SIA was significantly correlated to Dis-En and Dis-Ex in the superior CCI group. Superior CCI caused a notable rise in corneal Z (3, 3), while temporal CCI led to increased Z (3, 1). CCI morphology was correlated to corneal Z (4, −4) and Z (4, 4) in the superior CCI group.ConclusionCCI locations caused slight variations in postoperative corneal SIA and HOAs following ICL implantation. Optimal postoperative visual outcomes may be better achieved with a CCI design featuring an increased distance from the corneal centroid and a decreased Angle-W.

AimsTo evaluate the clinical and visual outcomes of fluid-filled scleral lens devices (SL) wear in patients with limbal stem cell deficiency (LSCD).DesignRetrospective consecutive case series.Methods27 eyes with LSCD confirmed by in vivo confocal microscopy at the Stein Eye Institute and fitted with SL were included. Correlations between corrected distance visual acuity (CDVA) and LSCD stage determined by clinical grading were performed between baseline (after the SL fit) and the last follow-up (the time of discontinuation of SL wear or the last visit in eyes in which SL were continued). In a subset of patients that had worsened LSCD while using SL, anterior segment optical coherence tomography (AS-OCT) and anterior segment fluorescein angiogram (AS-FA) were performed.ResultsBaseline LSCD grading was stage I in 12 eyes (44.4%), stage 2 in 12 eyes (44.4%), and stage III in 3 eyes (11.1%). At the last follow-up, CDVA was improved in 7 eyes (25.9%), remained stable in 13 eyes (48.1%) and decreased in 7 eyes (25.9%, P = 0.16). The LSCD stage was improved in 7 eyes (25.9%), remained stable in 8 eyes (29.6%) and worsened in 12 eyes (44.4%, P = 0.10). AS-OCT and AS-FA, performed in 5 eyes, showed limbal compression and delayed fluorescein filling.ConclusionSL can improve visual acuity and maintain the ocular surface in the majority of eyes. Worsening of the ocular surface might be a result of limbal hypoxia. Close monitoring of SL fit is necessary in these compromised eyes.

Abstract Background Paraproteinemic keratopathy is a rare disorder characterized by the bilateral accumulation of polychromatic deposits diffusely in all corneal layers together or not with diffuse or patchy pseudo lipid deposits. We present an atypical case of paraproteinemic keratopathy which lead to an initial misdiagnosis of infectious crystalline keratopathy. Case presentation a 69-year-old woman with an asymptomatic keratopathy detected during a cataract intervention. Slit-lamp examination revealed several hyper refringent subepithelial foci with fern-shaped branches, resembling crystalline keratopathy, in her left eye. Anterior segment optical coherence tomography revealed exclusively subepithelial hyperreflective lesions limited to the anterior stroma. The progressive bilateralization and progression of the condition prompted us to include other entities with crystalline corneal deposits in our differential diagnosis. Hematological analysis showed a high number of free Kappa light chains. Despite the typical clinical appearance of crystalline keratopathy, the atypical evolution and test results led us to consider that monoclonal gammopathy could be the cause of this entity. Conclusions Paraproteinemic keratopathy may present in its early stages as a unilateral subepithelial crystalline keratopathy. Thus, it must always be taken into account in the differential diagnosis of any crystalline keratopathy, particularly when there are no predisposing factors for an infectious crystalline keratopathy. Early recognition of this rare entity is important to address the associated potentially serious systemic disease.

Abstract Purpose: This study aimed to investigate the results of combined phacoemulsification and viscocanalostomy (phaco-VC) in a six-month follow-up and its relationship with intrascleral lake (IL) using anterior segment optical coherence tomography (AS-OCT) in patients with primary open-angle glaucoma (POAG). Methods: In total, 36 eyes with POAG eligible for phaco-VC were enrolled in this prospective observational study. All patients underwent AS-OCT evaluation and ophthalmologic examination including Goldman tonometry, cup–disc ratio assessment, best corrected visual acuity (BCVA) measurement, and antiglaucoma medication(s) prior to surgery and one, three, and six months after the surgery. The width, length, area, and circumference of the ILs were evaluated using AS-OCT at each follow-up. Results: A total of 36 eyes of 34 patients with POAG were investigated in this study. According to the results, the mean age of the patients was 70.09 ± 8.73 years, and the majority of the cases were male (n = 23; 63.9%). The mean preoperative intraocular pressure (IOP) was 20.11 ± 7.22 mmHg on 2.47 ± 1.1 medications, and the mean postoperative IOP reduced to 11.11 ± 2.58 mmHg on 0.11 medications, which was statistically significant (P < 0.001). ILs were detectable in all cases which resulted in a 100% qualified success rate. The reduction in the width, area, and circumference of the IL was significant during the six-month follow-up. The relationship between IOP changes and IL parameters on AS-OCT was not significant. Conclusion: This study evaluated the associations between IL changes and IOP reduction after phaco-VC. A six-month follow-up showed a notable reduction in the IL, but unexpectedly, IOP control did not decline. A reduction in IL diameter, when there is sufficient IOP control, indicates that there may be various IOP lowering mechanisms through VC other than the IL diameters. Further evaluation of VC focusing on long-term changes in IL and Schlemm's canal diameter is necessary to explain the precise mechanisms of lowering the IOP.

This case report aims to present the findings of in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) in three patients with iridocorneal endothelial (ICE) syndrome. Three female patients 37, 50, and 57 years of age presented with complaints of unilateral visual impairment and elevated intraocular pressure (IOP). Biomicroscopy revealed unilateral pupil irregularities and anterior synechiae, and gonioscopy demonstrated synechiae in the iridocorneal angle. IOP was within normal limits with medical treatment in two patients, while one patient had an IOP of 44 mmHg despite maximal antiglaucomatous treatment. IVCM revealed large, polymorphic, and hyperreflective cells in the corneal endothelial layer of the affected eyes and normal corneal epithelium, stroma, and endothelium in the fellow eyes. AS-OCT findings were normal in healthy eyes, while the affected eye showed synechiae in the iridocorneal angle and a hyperreflective, thickened endothelial layer. The patient with refractory glaucoma underwent trabeculectomy surgery with 5-fluorouracil. In conclusion, IVCM and AS-OCT allow a detailed examination of endothelial cell abnormalities and iridocorneal membranes in ICE syndrome, which is characterized by unilateral pupil and iris irregularities and anterior synechiae mainly in women.

Context Pharmacological mydriasis possibly is associated with intraocular pressure (IOP) rise and anterior chamber angle changes. Hence, this study is focused on pressure analysis with anterior segment optical coherence tomography measurements of angle parameters during various dilation phases. Aims Purpose is to investigate IOP variations during dilation phases and to discover association of anterior segment optical coherence tomography measurements. Settings and design Observational study. Patients and methods Thirty-two participants were recruited and IOP measured by rebound tonometer in pre, mid, and full pupillary dilation phases. Lens vault (LV at horizontal and vertical), angle opening distance (AOD at 500 and 750 μm) and trabecular iris space area (TISA at 500 and 750 μm) in temporal and nasal scans were quantified. Paired t test performed to establish a statistical significance P value less than or equal to 0.05. Statistical analysis used MS Excel. Results A total of 32 participants with mean age of 47.5±10.94 years consisting of 17 (53.13%) males and 15 (46.87%) females with 20 (62.5%) right and 12 (37.5%) left eyes were investigated. Mean IOP in pre, mid, and full-dilation phases were 14.86±2.87, 15.94±2.72, and 15.63±2.69 mmHg. Predilation IOP with IOP in mid and full dilation showed statistical significance (P=0.0001, 95% confidence interval 0.56–1.56) and 0.88 and 0.85 Pearson’s coefficients, respectively. IOP analysis with LV, AOD, and TISA in pre, mid, and full-dilation phases exhibited a significant difference (P

Purpose: To assess the relationship between graft–host junction (GHJ) profile and corneal astigmatism and higher-order aberrations (HOAs) in postpenetrating keratoplasty (post-PKP) eyes. Methods: A retrospective observational cross-sectional study was carried out at the Corneal Department of the Farabi Eye Hospital from April 2019 to March 2020. The objective of the study was to review the clinical records of 32 eyes belonging to 25 patients who had undergone PKP. The classification of the eyes was based on the most frequent alignment pattern observed in the eight GHJ sections using anterior segment optical coherence tomography (AS-OCT). The three classifications included the well-apposed junction, mal-apposed junction, and equally apposed junction. Results: A total of 256 GHJ sections were analyzed in 32 AS-OCT images, comprising 24 keratoconus and 8 nonkeratoconus eyes. Among them, 10 eyes (31.25%) exhibited well-apposed junctions, 15 eyes (46.8%) had mal-apposed junctions, and 7 eyes (21.8%) displayed equally apposed junctions. The most prevalent type of mal-apposition observed was protrusion, accounting for 67 sections (25.3%). The mal-apposed group displayed a significantly higher mean spherical equivalent (SE) (P = 0.01) and postoperative astigmatism (P < 0.001), whereas there was no significant difference in total HOAs between the mal-apposed group and the other groups (P = 0.58). Conclusions: Significant associations were observed between the alignment pattern of GHJ after PKP and both SE and keratometric astigmatism. Conversely, no significant association was found between the alignment pattern of GHJ and HOAs.

Background: Paraproteinemic keratopathy is a rare disorder characterized by the bilateral accumulation of polychromatic deposits diffusely in all corneal layers together or not with diffuse or patchy pseudo lipid deposits. We present an atypical case of paraproteinemic keratopathy which lead to an initial misdiagnosis of infectious crystalline keratopathy. Case presentation: a 69-year-old woman with an asymptomatic keratopathy detected during a cataract intervention. Slit-lamp examination revealed several hyper refringent subepithelial foci with fern-shaped branches, resembling crystalline keratopathy, in her left eye. Anterior segment optical coherence tomography revealed exclusively subepithelial hyperreflective lesions limited to the anterior stroma. The progressive bilateralization and progression of the condition prompted us to include other entities with crystalline corneal deposits in our differential diagnosis. Hematological analysis showed a high number of free Kappa light chains. Despite the typical clinical appearance of crystalline keratopathy, the atypical evolution and test results led us to consider that monoclonal gammopathy could be the cause of this entity. Conclusions: Paraproteinemic keratopathy may present in its early stages as a unilateral subepithelial crystalline keratopathy. Thus, it must always be taken into account in the differential diagnosis of any crystalline keratopathy, particularly when there are no predisposing factors for an infectious crystalline keratopathy. Early recognition of this rare entity is important to address the associated potentially serious systemic disease. [ABSTRACT FROM AUTHOR]

Ocular burns can have three origins: chemical (by acid or alkaline agents), luminous (by ultraviolet radiation) or thermal. We report the cases of eight patients with ocular burns (3 thermal and 5 chemical). Of these, one patient had a grade 2 burn according to the Dua classification, two had grade 3 damage and one had grade 4. One patient had grade 3 damage in the right eye and grade 4 in the left eye. Anterior segment optical coherence tomography (AS-OCT) was performed in two patients, showing corneal de-epithelialization, corneal thickening and a hyper-reflective line in the posterior stroma. All patients received medical treatment with topical antibiotics, topical corticosteroids, cycloplegics and wetting agents. Five patients had outpatient treatment with clinical improvement. Three patients were hospitalized, one of whom received an amniotic membrane graft (AMG), one had an AMG followed by a transfixing keratoplasty (TK), and the other is scheduled for a TK. Ocular burns are associated with significant functional risk, warranting prompt and effective management. [ABSTRACT FROM AUTHOR]

Background: Swept-source anterior segment optical coherence tomography (SS-AS-OCT) is a suitable examination for the vitreolenticular interface. Methods: In a prospective study using Anterion (Heidelberg Engineering, Heidelberg, Germany), 102 eyes of 102 patients were examined in pupil dilation, preoperatively and 6 times over 1-year follow-up. Preoperatively anterior hyaloid membrane (AHM) visibility was determined with Imaging App with high reliability. Postoperatively capsular bag–AHM distance was measured on six points by using Metrics App. Results: The AHM was visible in 18.6% preoperatively and postoperatively as well (Group 1), 49% of the preoperatively adherent AHMs became visible (Group 2A), 32.4% remained attached (Group 2B). Group 1: the average deepest point on the first day was 782.5 ± 324.1 microns, and it significantly differed from the later follow-up values. Group 2A: the average deepest value was 184.1 ± 220.1 microns, and there was no statistically significant difference between the postoperative visit values. The difference between the groups was statistically significant at every location and at each time point. Conclusions: AS-SS-OCT can be used to check BS both preoperatively (with limitations) and postoperatively. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the changes in thickness of tissues, specifically the pericardium patch graft (PPG) covering the silicone tube in Ahmed Glaucoma Valve (AGV) surgery. Study design: Prospective observational study. Methods: This study included cases with refractory glaucoma that underwent AGV implantation with PPG coverage. Conjunctival epithelium, stroma and PPG thickness covering the tube were measured using anterior segment optical coherence tomography (AS-OCT) at 1, 6 and 12 months. Additionally, the same measurements were taken 1500 µm away from the tube as a control for the central measurements. Results: Twenty-seven eyes of 27 patients were evaluated in the study. Although PPG thickness decreased significantly in both regions, the amount of reduction was more pronounced centrally. Centrally, the reduction rate was 21.2% and 34.8% during the 1-6 months period and 6-12 months period, while peripherally it was 3.5% and 5.1%, respectively. No change was observed in the thickness of the epithelium during the follow-up period. There was a significant thinning of the stroma in the central and peripheral regions during the 1-6 months period (30.5% and 17%, respectively). No cases of exposure were observed during the follow-up period. Conclusion: Although the most evident thinning of the layers covering the tube was observed in the early postoperative period, PPG showed a stable decrease even in the late period. The progressive reduction in the PPG thickness observed also in the peripheral region indicates that factors beyond mechanical forces contribute to this degenerative process. AS-OCT could be a valuable non-invasive tool in clarifying this process. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo report the clinical presentation, anterior segment optical coherence tomography features, treatment, and outcomes of ocular surface squamous neoplasia (OSSN) associated with pterygium.Retrospective interventional series of 14 cases in a 28-month study period.OSSN was coexistent with pterygium (n = 14) in < 1% of all pterygia (n = 7384). The mean age at the presentation of OSSN with pterygium was 49 years (median, 49 years; range, 36 to 71 years). Referral diagnosis included pterygium sans OSSN (n = 7, 50%), granuloma (n = 1, 7%), actinic keratosis (n = 1, 7%), and conjunctivitis (n = 1, 7%). All OSSNs were unilateral, and six patients (43%) had bilateral pterygia. Tumors arose from the nasal (n = 8, 57%), or temporal (n = 6, 43%) quadrants. The mean tumor diameter was 4 mm (median, 4 mm; range, 2 to 6 mm), and the mean thickness was 2 mm (median, 1 mm; range, 1 to 3 mm). The delineation between OSSN and pterygium could be identified on anterior segment optical coherence tomography (AS-OCT) in all (100%) cases. All patients received 1% topical 5-fluorouracil (5-FU), and complete tumor regression was achieved in 13 (93%) cases with a mean number of 2 cycles (median, two cycles; range, 1 to 4 cycles). There were no significant adverse effects. No tumor recurrence was noted over a mean follow-up period of 11 months (median 12 months; range, 1 to 4 months)AS-OCT allows accurate detection and mapping of tumor extent in OSSN with coexistent pterygium, and topical 5-FU yields excellent tumor control. [ABSTRACT FROM AUTHOR]

Differentiation of iris and ciliary body lesions as benign or malignant and cystic or solid is important. The aim of this study was to compare anterior segment swept-source optical coherence tomography (AS SS-OCT) and ultrasound biomicroscopy (UBM) findings in iris and ciliary body tumors. Forty-two eyes of 38 cases with iris and ciliary body tumors imaged with UBM and AS SS-OCT between September 2018 and September 2023 were evaluated retrospectively. Of 42 eyes, 14 had melanoma, 14 iris pigment epithelial (IPE) cysts, 7 nevi, 3 Lisch nodules, 2 iris stromal cysts, 1 pars plana cysts, and 1 iris mammillations. An equivalent (100%) visualization of the anterior tumor margin was obtained with both techniques. Compared to AS SS-OCT, UBM was superior for posterior margin visualization in melanocytic tumors and IPE cysts. Bland-Altman plots demonstrated good agreement between UBM and AS SS-OCT for melanocytic tumors < 2.5 mm in base diameter and < 2 mm in thickness. Although, UBM is the gold standard for ciliary body and iridociliary tumors. AS SS-OCT should be considered as an excellent alternative to UBM, especially in minimally elevated iris lesions. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to present the characteristics of deeply embedded metallic corneal foreign bodies using anterior segment optical coherence tomography (AS-OCT). Materials and Methods: The study included one eye of 163 patients who presented with a deeply embedded, metallic corneal foreign body to an ophthalmological emergency clinic. All patients were assessed using anterior segment photographs and AS-OCT to determine the characteristics of the foreign bodies and wound features. All foreign bodies were removed, and wound debridement was performed. Results: The study population included 160 men and 3 women with a mean age of 32.1±8.4 years. The mean diameter of the foreign body and burn halo were 776.8±21.1 μm and 1299.6±54.2 μm, respectively. The mean areas of the foreign body and burn halo were 0.41±0.14 mm2 and 0.81±0.32 mm2 . The mean foreign body penetration depth was 141.0±26.0 μm. During follow-up, there was no corneal foreign bodies-related keratitis in any patients. A decrease in visual acuity was observed in all patients with central cornea involvement. In these cases, the mean final visual acuity was 20/25 (20/20 to 20/32). Conclusion: This study showed that AS-OCT can define characteristics of corneal wounds associated with metallic foreign bodies. By detecting the diameter and depth of the foreign body in AS-OCT images, the size of the corneal scar that will occur after the injury can be predicted. Being able to make this estimation is critical, especially in centrally located foreign bodies, as it will reduce visual acuity. [ABSTRACT FROM AUTHOR]

Context Pharmacological mydriasis possibly is associated with intraocular pressure (IOP) rise and anterior chamber angle changes. Hence, this study is focused on pressure analysis with anterior segment optical coherence tomography measurements of angle parameters during various dilation phases. Aims Purpose is to investigate IOP variations during dilation phases and to discover association of anterior segment optical coherence tomography measurements. Settings and design Observational study. Patients and methods Thirty-two participants were recruited and IOP measured by rebound tonometer in pre, mid, and full pupillary dilation phases. Lens vault (LV at horizontal and vertical), angle opening distance (AOD at 500 and 750 μm) and trabecular iris space area (TISA at 500 and 750 μm) in temporal and nasal scans were quantified. Paired t test performed to establish a statistical significance P value less than or equal to 0.05. Statistical analysis used MS Excel. Results A total of 32 participants with mean age of 47.5±10.94 years consisting of 17 (53.13%) males and 15 (46.87%) females with 20 (62.5%) right and 12 (37.5%) left eyes were investigated. Mean IOP in pre, mid, and full-dilation phases were 14.86 ±2.87, 15.94±2.72, and 15.63±2.69 mmHg. Predilation IOP with IOP in mid and full dilation showed statistical significance (P=0.0001, 95% confidence interval 0.56–1.56) and 0.88 and 0.85 Pearson’s coefficients, respectively. IOP analysis with LV, AOD, and TISA in pre, mid, and full-dilation phases exhibited a significant difference (P<0.0001). Conclusion This research highlights an increase in IOP alongside a noteworthy decrease in the average LV by 30.94 μm during mid-dilation compared to the predilation phase. Likewise, the AOD at 750 μm demonstrated a significant reduction by 0.40 and 0.45 μm in temporal scans during mid and full dilation, respectively, while TISA remained unchanged. [ABSTRACT FROM AUTHOR]