Abstract: Aim: This case report presents an unusual instance of bilateral choroidal effusion following oral administration of acetazolamide for the treatment of pseudophakic cystoid macular edema (PCME). Case Presentation: An 87-year-old Caucasian man experienced sudden, painless vision loss in both eyes several days after beginning treatment for PCME in his left eye. He had undergone uncomplicated cataract surgery in both eyes two months earlier. The treatment regimen included oral acetazolamide (250 mg twice daily) and topical pranoprofen, a nonsteroidal anti-inflammatory drug (NSAID). One week after initiation of acetazolamide treatment the patient suffered a marked decline in visual acuity. Bilateral choroidal effusion was diagnosed. Prompt discontinuation of acetazolamide and initiation of topical dexamethasone (1% hourly) and atropine (1% twice daily) resulted in rapid clinical improvement. Conclusion: Carbonic anhydrase inhibitors (CAIs) such as acetazolamide, though commonly used to manage intraocular pressure, can cause choroidal effusion—a rare but potentially sight-threatening complication. Ophthalmologists should exercise caution, particularly in elderly patients, and be alert to early signs of this adverse effect. Early diagnosis and prompt management are essential to prevent permanent visual damage. To our knowledge, this is the first reported case of bilateral choroidal detachment associated with acetazolamide in the context of PCME.

Abstract: BACKGROUND: Textural Interface Opacities (TIO) following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) have become a notable postoperative concern. Several studies have attempted to identify associations between TIO development and intraoperative factors, in-cluding fluid dynamics, irregular stromal surfaces, viscoelastic usage, and recipient immunological responses. Despite these efforts, the precise etiology of TIO remains uncertain. METHODS: Optical Coherence Tomography (OCT) images of DSAEK-processed corneal grafts, prepared using the same microkeratome and technique for transplantation at the Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale. This analysis focused on DSAEK-processed grafts OCT images to evaluate and categorize the occurrence of TIO and assess the final visual acuity of the patients at the 1-year postoperative evaluation. RESULTS: The study included 221 donor corneas transplanted from 2019 to 2023. Greater TIO based on “M-TIO” grading scale was associated with worse recipient logMAR VA (Mean 0.151 [99% CI: 0.077 to 0.225] for corneas with no TIO increased to 0.680 [99% CI: 0.532 to 0.828] for corneas with the greatest TIO grade). CONCLUSION: This study introduces “M-TIO” grading scale for screening TIO in corneal grafts prior to DSAEK transplantation. Our findings demonstrate a significant association between the presence of TIO identified in OCT images of DSAEK-processed corneal grafts and transplantation outcomes.

Abstract: The etiology of blurry vision often remains elusive. In this retrospective study, we assessed objective test findings of 145 patients reporting blurry vision at an outpatient neck clinic in 2022. Patients with previously identified causes were excluded. Viable patients underwent digital motion x-ray (videofluoroscopy) and upright cone beam CT scan of the cervical spine, pupillometry, tonometry, and ultrasound of the carotid sheath and eye. Abnormal ocular test results (bilateral totals) include elevated optic nerve sheath diameter (ONSD >12.2 mm) in 142 (98%), excessive percent light constriction (>60%) in 138 (95%), and increased pupil diameters (>8 mm) in 134 (92%). Abnormal cervical structural findings include forward head posture (C6-atlas interval >10 mm) in 145 (100%), vagus nerve degeneration (< 4.2 mm total) in 138 (95%), decreased internal jugular vein cross-sectional area (IJV CSA) at C1 (total < 180 mm) in 143 (99%), decreased depth of curve (< 7 mm) in 128 (89%), and ligamentous cervical instability (LCI) at C1-C2 (total >4 mm) in 124 (88%). Pupil diameter correlated with intraocular pressure (IOP, r=0.26, p=0.002), and LCI C1-C2 correlated with ONSD (r=0.18, p=0.039). These data indicate that some cases of blurry vision may result from ocular pathology due to LCI and loss of lordosis, causing IJV compression and vagus nerve degeneration.

Abstract: Purpose: To compare the clinical outcomes of Lotrafilcon A and Balafilcon A silicone hydrogel contact lenses used as therapeutic bandage contact lenses (BCL) following transepithelial photorefractive keratectomy (TPRK). Materials and Methods: A randomized, double-blind, contralateral study was conducted on 82 eyes of 41 consecutive TPRK-treated patients, randomly assigned to wear either Lotrafilcon A or Balafilcon A BCL in their right and left eyes (groups A or B). The postoperative assessment included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, ocular pain/irritation, epithelial healing, limbal and conjunctival hyperemia, lens mobility, and the amount of protein deposition accumulated on the BCLs. Results: On the first postoperative day, the pain intensity was scored as 2.80 ± 2.35 for group A and 4.44 ± 2.46 for group B (P< 0.001). The amount of protein deposition on the BCLs was also significantly lower in group A compared to group B. For BCLs removed on day three, the protein deposition was 9.92 ± 9.82 vs. 25.75 ± 9.86 μg for groups A and B (P< 0.001). For BCLs removed on day four, the protein deposition was 9.47 ± 10.06 vs. 32.60 ± 16.71 μg (P=0.005). However, there were no statistically significant differences between the two groups in terms of corneal epithelial defect area, corneal epithelial healing time, UDVA, CDVA, limbal or conjunctival hyperemia, and lens movement. Conclusions: Lotrafilcon A performed better than Balafilcon A in terms of reducing ocular pain, foreign body sensation, and protein deposition, suggesting that Lotrafilcon A may be a more suitable option for therapeutic BCL use following TPRK.

Abstract: Purpose: The aim of this study was to evaluate the different approaches used in the treatment of Meibomian gland dysfunction (MGD).Materials and Methods: The study included 92 cases with MGD who were assigned to treatment groups of conservative management alone or together with Intense Pulsed Light (IPL) therapy, oral azithromycin, oral doxycycline, topical cyclosporine and preservative-free artificial tears containing polyvinyl alcohol and povidone. Ocular surface parameters, including the Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), SPEED score, and Meibomian gland parameters were evaluated.Results: A statistically significant increase was determined in Meibum grade plugging and Marx line scores with treatment of IPL therapy (p &lt;0.05). In the group receiving doxycycline treatment; there was a significant improvement in OSDI and SPEED ​​scores, plugging, TBUT, and meibum grades. In the group receiving cyclosporine treatment, there was a significant improvement in OSDI and SPEED ​​scores, plugging, TBUT, and meibum grades. There was a statistically significant increase in the conservative treatment group in respect of lid margin irregularity, Marx line score, OSDI and SPEED scores. In the group receiving azithromycin treatment, plugging, lid margin irregularity, TBUT, OSDI and SPEED scores increased significantly. Conclusions: Various treatment methods can be used for MGD. All the conservative treatment methods used in this study were seen to be successful.

Abstract: Purpose: To show how various patients of African descent possess principal superior-temporal and inferior-temporal retinal nerve fiber layer (RNFL) bundle peaks that are anatomically shifted relative to the optical coherence tomography (OCT) normative database majority. This anatomical discrepancy may present as false-positive thinning on RNFL deviation maps thereby appearing like early glaucomatous damage. Observations: Three patients of African descent presented with cup-to-disc ratios of 0.6 or higher and were flagged with bilateral retinal nerve fiber layer thinning in superior-temporal and/or inferior-temporal RNFL sectors relative to the Cirrus OCT normative database population. Thinning on RNFL deviation maps in all three patients showed wedge-defects that traveled towards the superior-temporal and inferior-temporal vulnerability zones of the disc. However, all three patients demonstrated bilateral robust macular ganglion cell thicknesses and had automated visual fields inconsistent with glaucoma. Inspection of the RNFL in these patients showed their principal superior-temporal and inferior-temporal nerve bundle peaks were shifted more vertically and less temporally relative to the database population. Conclusion: As OCT becomes more common in early glaucoma detection, it may be important to recognize how the RNFL anatomy of some patients of African descent differs relative to the normative database majority. All three of the patients in our series had high-risk appearing superior-temporal and/or inferior-temporal RNFL ‘thinning’ attributable to anatomical shifting of these bundle peaks. This may result in improper flagging of sectors known to be vulnerable in early glaucoma thereby increasing the likelihood of misdiagnosis, particularly if ganglion cell thickness is not concurrently inspected.

Abstract: Background/Objectives: Peripheral retinal degenerations (PRD) are structural anomalies in the outer regions of the retina, typically emerging in adolescence and early adulthood. Early detection is crucial, as some PRDs can lead to sight-threatening complications, such as retinal detachment, if left unmanaged. Due to a paucity of research regarding PRDs and their association with axial length (AL) and refractive error (RE) in young Australian adults, this study aimed to investigate the prevalence of PRDs in this population and establish whether AL and RE could help predict the likelihood of PRD occurrence. Methods: A cross-sectional study was conducted on a mixed population (n=221) of Australian adults aged 18 to 40. Demographic data, RE, AL, and a series of ultra-widefield (UWF) retinal images were obtained from participants' undilated eyes using the Zeiss ClarusTM 500. Results: The overall PRD prevalence was 8.15% (n=442 eyes). Binary logistic regression revealed that a longer AL was a more significant factor in increasing the risk of PRD development across all myopia classifications compared to emmetropia than RE. The likelihood of a PRD was 50% at an AL of 26.9mm and -6.50D of myopia, and 95% at 29.6mm and -11.00D.Conclusions: PRD prevalence was lower than reported in other global studies, perhaps reflecting the diverse ethnic makeup of the cohort. While our study supports the conventional understanding that longer ALs, and high myopia are key risk factors for developing a PRD, it also provides new insights into the likelihood of detecting a PRD at a given AL or RE in a mixed population. This information is crucial for eye care practitioners, enabling early identification of at-risk individuals and screening for PRDs that may increase the risk of retinal detachment.

Abstract: Objectives: To evaluate the effects of orally administered combination of Bromelain 250 mg from Ananas comosus (L.) Merr. Jambs and 250 mg Diosmin mcgSMIN Plus on visual acuity and central macular thickness (CMT) in patients treated for cystoid center-involving diabetic macular edema (DME) with anti-VEGF intravitreal maintenance therapy (IVT). Methods: Forty patients with type 2 diabetes and center-involving DME, treated with a maintenance protocol based on anti-VEGF, were enrolled in this prospective case-control study. Group A (20 eyes) received one pill containing bromelain (250 mg) and diosmin mcgSMIN Plus (250 mg) twice a day for two months. Group B (20 eyes) was monitored without drug administration until the next IVT. After two months and IVT administration, the groups were switched. At the end of the study, the collected data were divided into two groups. The treatment group included data from patients who received the dietary supplement, the control group consisted of data from patients who were only observed during anti-VEGF therapy. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) measurements were assessed at baseline, after two months, and after four months. Results: A statistically significant improvement in CMT was observed in the treatment group compared to the control group during follow-up (p < 0.05). However, the improvement in BCVA was not statistically significant. Conclusion: Orally administered combination of Bromelain 250 mg and 250 mg Diosmin mcgSMIN Plus has positive impact on central macular thickness in patients treated for cystoid center-involving diabetic macular edema (DME) with anti-VEGF intravitreal maintenance therapy.

Abstract: Objectives: Elevated intraocular pressure (IOP) is a well-known risk factor for glaucoma and other optic neuropathies. This study investigated the impact of two distinct types of physical activity—endurance (marathon running) and strength (weightlifting)—on IOP variations. Methods: Forty healthy male athletes (20 marathon runners, 20 weightlifters) aged 18–35 years were recruited and monitored over three months. IOP was measured using Goldmann and Icare IC200 tonometers before and after 1-hour training sessions. Results: Results showed a significant increase in IOP after training among weightlifters (mean post-training IOP: 19.3 mmHg), in contrast to stable or slightly reduced values in marathon runners (mean post-training IOP: 15.1 mmHg). Conclusions: These findings suggest the need for regular ophthalmologic monitoring in strength athletes. Future studies should examine the long-term impact of sport-specific IOP fluctuations on ocular health and glaucoma risk.

Abstract: Adaptive Optics-Transscleral Flood Illumination (AO-TFI) is a novel imaging technique with potential for detecting retinal pigment epithelium (RPE) changes in dry age-related macular degeneration (AMD). This single-center, prospective study evaluated its ability to visualize pathological features in AMD. AO-TFI images were acquired using the prototype Cellularis® camera over six 5×5° macular zones in patients with good fixation and no exudative changes. Conventional imaging modalities, including spectral-domain optical coherence tomography (OCT), color fundus photography, and fundus autofluorescence, were used for comparison. AO-TFI images were correlated with OCT using a custom method (Fiji software). Eleven eyes of nine patients (70 ± 8.3 years) with early (n=5), intermediate (n=1), and atrophic (n=5) AMD were analyzed. AO-TFI identified relevant patterns in dry AMD. RPE cell visibility was impaired in affected eyes, but AO-TFI distinguished cuticular drusen with hyporeflective centers and bright edges, large ill-defined drusen, and stage 3 subretinal drusenoid deposits as prominent hyperreflective spots. It provided superior resolution for small drusen compared to OCT and revealed crystalline structures and hyporeflective dots in atrophic regions. Atrophic borders remained isoreflective unless RPE displacement was absent, allowing precise delineation. These findings highlight AO-TFI’s potential as a sensitive imaging tool for characterizing early AMD and clinical research.

Abstract: Background: Endophthalmitis associated with intraocular procedures is an infection of the eye that can rapidly result in substantial irreversible loss of vision and may even lead to removal of the eye. Prevention strategies vary globally and often include antibiotic use – often consisting of a broad spectrum mono-therapeutic agent. The purpose of this study is to test the efficacy and value of combinations of cefuroxime (cefu), cefazolin (cefa), azithromycin (azith), and/or tobramycin (tob) as alternatives to the use of moxifloxacin. We looked for synergism since these antimicrobials used different mechanisms of inhibition.Methods: Initially, we examined individual antimicrobials to determine the minimal bactericidal concentrations (MBC) of each individual treatment, against Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, two clinical isolates of MRSA, and Staphylococcus epidermidis, by both the Zone of Inhibition (ZOI) and the Colony Forming Unit (CFU) assays. We then used this data in a combinatorial study. Results: We found combinations that were synergistic against all the bacteria tested, resulting in total killing of all bacteria. We found that the ZOI assay provided less consistent results than the CFU assays.Conclusions: We have found combinations of these antimicrobials that were synergistic in total killing (8 logs) of all bacteria tested. These three combinations were: cefu/azith; azith/tob; and cefu/tob. Moxifloxacin (Vigamox) did not completely kill Staphylococcus epidermidis

Abstract: Purpose: A novel enhanced monofocal intraocular lens (IOL) has been developed to improve functional intermediate vision, maintaining a distance vision comparable to a standard monofocal lens and avoiding the drawbacks of multifocal IOLs. The aim of this study is to perform optical bench analysis and to evaluate refractive and visual outcomes and patient satisfaction. Methods: This prospective comparative single-center study was conducted in Careggi Hospital, University of Florence (Italy). We included 100 eyes from 50 patients, that underwent bilateral cataract surgery. One group was implanted with the standard monofocal IOL Tecnis GCB00 and the other group the novel enhanced monofocal lens Evolux. We evaluated monocular and binocular visual and refractive outcomes at 6 months after surgery. Binocular defocus curves and contrast sensitivity (CS) were also assessed. Optical quality was also analyzed, in terms of higher-order aberrations (HOAs), Modulation Transfer Function (MTF), Objective Scatter Index (OSI), Strehl-ratio, Effective Lens Position (ELP) and halo analysis. A Patient-Reported Spectacle Independence Questionnaire (PRSIQ) was performed to evaluate spectacle independence outcomes. Finally, we analyzed the optical bench of both lenses. Results: All eyes implanted with Evolux achieved excellent distance vision, comparable to those achieved with GCB00. Evolux showed better intermediate and near vision, without any loss of visual quality, contrast sensitivity, or the presence of halos and photic phenomena. The optical bench analysis confirmed the different optical properties of the two lenses and supported the behavior obtained with clinical defocus curve Conclusion: These preliminary results show good refractive accuracy and visual outcomes for the enhanced monofocal IOL Evolux after cataract surgery. Further studies need to confirm our findings in terms of number of patients and period of follow-up.

Abstract: OBJECTIVES: To evaluate the diagnostic performance of Spectralis optical coherence tomography (OCT) parameters for ocular hypertensive (OH) and glaucoma suspect (GS) eyes in an Asian population from Taiwan. METHODS: This retrospective cross-sectional study included 258 OH (mean deviation [MD]: −1.10 ± 1.75 dB), 380 GS (MD: −1.24 ± 2.63 dB), and 742 normal (MD: −1.47 ± 3.29 dB) eyes. The diagnostic performance of Spectralis OCT parameters, including optic nerve head (ONH) and macular parameters, was compared among groups. The area under the receiver operating characteristic curve (AUC) of each parameter signified its power to differentiate between normal and OH or GS eyes. RESULTS: In various scanning protocols, circumpapillary retinal nerve fiber layer (NFL)-temporal (AUC = 0.538), macular NFL-outer temporal (AUC = 0.611), and retinal average thickness (RAT)_1.8 (AUC = 0.578) were the best parameters in distinguishing OH eyes from normal eyes. Moreover, minimum rim width (MRW)-mean global (AUC = 0.737), macular NFL-outer temporal (AUC = 0.558), and RAT_2.8 (AUC = 0.543) were the best parameters in distinguishing GS eyes from normal eyes. After adjusting for age and refraction effects, we determined that the AUCs for OH and GS were 0.694 and 0.646, respectively. CONCLUSIONS: Our real-world data indicate that Spectralis OCT has clinical utility in evaluating OH and GS eyes in glaucoma practice in an Asian population. When managing OH eyes, caution is required in evaluating macular retinal NFL thickness in addition to the ONH. Bruch’s membrane opening-MRW is a potential objective indicator of ONH changes in GS eyes.

Abstract: The advancement of generative artificial intelligence (AI) has resulted in its use permeating many areas of life. Amidst this eruption of scientific output, a wide range of research regarding the usage of LLMs in ophthalmology has emerged. In this study, we aim to map out the landscape of LLM applications in ophthalmology and by consolidating the work done, we aim to produce a point of reference to guide the conduct of future works. 8 databases were searched for articles from 2019 - 2024. 976 studies were screened, and a final 49 were included. The study designs and outcomes of these studies were analysed. The performance of LLMs was further analysed in the areas of exam taking and patient education, diagnostic capability, management capability, administration, inaccuracies, and harm. LLMs performed acceptably in most studies, even surpassing humans in some. Despite the relatively good performance, issues pertaining to study design, grading protocols, hallucinations, inaccuracies, and harm were found to be pervasive. LLMs have received considerable attention through their introduction to the public and have found potential applications in the field of medicine, and in particular, ophthalmology. However, using standardised evaluation frameworks and addressing gaps in current literature when applying LLMs in ophthalmology is recommended through this review.

Abstract: Since its introduction, optical coherence tomography (OCT) has significantly progressed in addressing its limitations. By integrating artificial intelligence and multimodal imaging, OCT enhances both speed and image quality while reducing its size. OCT continues to advance, offering new possibilities beyond the in-office setting, including intraoperative applications. This review will explore the different types of home OCT and intraoperative OCT, as well as the uses of each device and their future potential in ophthalmology.

Abstract: Neurotrophic keratopathy (NK) is a rare degenerative disease caused by trigeminal nerve impairment, leading to corneal anesthesia, epithelial breakdown, and progressive vision loss. NK produces damage through the lack of pain. Conventional treatments focus on symptom management and preventing complications but do not address the underlying nerve dysfunction. Corneal neurotization (NT) has emerged as a promising surgical intervention aimed at restoring corneal sensation and improving ocular surface homeostasis. This review examines the outcomes of corneal neurotization in NK patients, while also comparing the effectiveness of direct (DNT) and indirect (INT) techniques. Studies report significant improvement in corneal sensitivity, with success rates ranging from 60.7% to 100% (average ~90%). Most patients showed corneal sensation recovery, as measured by the Cochet–Bonnet aesthesiometer. No significant differences were found between DNT and INT outcomes. Indirect neurotization with a sural nerve graft was the most performed procedure (63% of cases), with acellular allografts demonstrating comparable efficacy while simplifying the technique. Postoperative corneal sensitivity improved significantly from a preoperative average of 2.717 mm to 36.01 mm, with reinnervation occurring within 4–6 months and peaking at 12 months. In vivo confocal microscopy confirmed nerve regeneration. Neurotization was safe, with minimal donor-site complications, typically resolving within one year. While corneal neurotization enhances corneal sensation and tear film stability, visual acuity outcomes remain variable, influenced by pre-existing corneal damage. Early intervention is recommended to prevent irreversible scarring. Further studies with larger sample sizes are needed to refine surgical techniques and optimize patient selection, ensuring the best possible outcomes for NK patients.

Abstract:

Objectives: To investigate corneal endothelial changes and intraocular pressure (IOP) after phacoemulsification using the eight-chop technique and intraoperative parameters in patients with diabetes. Methods: Eyes of patients with cataracts who underwent phacoemulsification were included in this study. Cataract surgery was performed using the eight-chop technique. The operative time, phaco time, aspiration time, cumulative dissipated energy, and volume of fluid used were measured. The best-corrected visual acuity, IOP, corneal endothelial cell density (CECD), central corneal thickness (CCT), coefficient of variation (CV), and percentage of hexagonal cells (PHC) were measured pre- and post-operatively. Results: Overall, 181 eyes of 138 patients with cataracts were evaluated. In the diabetes group, the CECD loss rates were 5.1%, 3.9%, and 2.1% at 7 weeks, 19 weeks, and 1 year post-operatively, respectively. In the control group, the CECD loss rates were 2.8%, 2.6%, and 1.2% at 7 weeks, 19 weeks, and 1 year postoperatively, respectively. Significant differences in the CV and PHC were observed preoperatively and postoperatively between the diabetes and control groups (p < 0.01 or p = 0.01, 0.02). Significant differences were also observed between CV and PHC preoperatively, 19 weeks, and 1 year postoperatively in the diabetes and control groups (p < 0.01). At 1 year postoperatively, IOP reduction rates were 8.0% and 11.2% in the diabetes and control groups, respectively. Conclusions: CECD loss in the eight-chop technique was minimal. The repair and healing mechanisms of the endothelium may have increased by phacoemulsification using the eight-chop technique postoperatively. The IOP reduction was maintained in both groups postoperatively.

Abstract: Objective: To test the ability of ChatGPT-4 (GPT-4) to effectively triage patient messages sent to the general eye clinic at our institution. Methods: Patient messages sent to the general eye clinic via MyChart were de-identified and then triaged by an ophthalmologist-in-training as well as GPT-4 with two main objectives. Both ophthalmologists and GPT-4 were asked to direct patients to either general or specialty eye clinics, urgently or non- urgently, depending on the severity of the condition. Main Outcomes: GPT-4’s ability to accurately direct patient messages to 1.) a general or speciality eye clinic and 2) determine the time frame within which the patient needed to be seen (triage acuity). Accuracy was determined by comparing percent agreement with recommendations given by GPT-4 with those given by Ophthalmologist. Results: The study included 139 patients (and messages). Percent agreement between the ophthalmologist and GPT-4 was 64.7% for general/specialty clinic recommendation and 60.4% for triage acuity. GPT-4 recommended a triage acuity equal to or sooner than ophthalmologist-in-training for 93.5% of cases and recommended a less urgent triage acuity in 6.5% of cases. Conclusions: Our study indicates an AI system, such as GPT-4 should complement rather than replace physician judgment in triaging ophthalmic complaints. These systems may assist providers and reduce the workload of ophthalmologists and ophthalmic technicians as GPT-4 becomes more adept in triaging ophthalmic issues.

Abstract: The management of ocular conditions, including cancer, is hindered by anatomical and physiological ocular barriers. Chemotherapy is limited by sub-optimal drug delivery, and similarly to other conventional treatments such photothermal therapies and radiotherapy, can often cause collateral damage to healthy tissues. Nanomedicine-based approaches have transformed the field of ophthalmology, and their application can be potentially extended to ocular oncology. A comprehensive literature review was conducted to analyze advancements in nanoparticle-based therapies for ocular cancers, mainly retinoblastoma and uveal melanoma. A series of preclinical and clinical studies are presented, where organic and inorganic nanoparticles have been used to enhance traditional therapies through improved drug bioavailability, targeted delivery, and multimodal applications. Nanomedicine-based approaches have emerged as a transformative solution for ocular cancer management.

Abstract:

Purpose: To calculate the impact of the refractive power associated with the epithelial thickness in transepithelial refractive corrections Setting: Aurelios Augenzentrum Recklinghausen, Germany Methods: We analyzed the impact of the epithelium in a consecutive retrospective group of hiperopic eyes treated with TransPRK with the AMARIS 1050 RS laser platform (Schwind Eye-Tech Solutions, Kleinhostheim, Germany) with a minimal follow-up of 4 months. The group of 95 treated eyes had an average age of 36 years. The preoperative mean sphere was +1.6 dioptres (D) with a range till +5D, and the mean cylinder was -2.16 D with a range till -5.75D. For the epithelium measurements, we used the anterior segment optical coherence tomography MS-39 (CSO, Florence, Italy). Results: The refractive outcome showed a mean sphere of -0.03 D (range -0.5 to 1 D) and a mean cylinder of -0.33 (range -1.75 to 0 D). 93% and 98% of the cases had 0.5D, 1D, respectively, or less of spherical equivalent refractive error. The epithelium showed preoperative toricity, correlating to the preoperative manifest astigmatism. Preoperatively, at 6 mm, the epithelium showed compensational effect of ~15% of the refractive astigmatism (12% for cardinal and 18% for oblique astigmatism); whereas for 3mm the compensation accounted for ~25% of the refractive astigmatism (21% for cardinal and 31% for oblique astigmatism). No correlation was found postoperatively. Conclusions: The preoperative toricity of the epithelium is correlated with the amount of preoperative refractive astigmatism. No systematic correlation was found between preoperative epithelium and refractive deviations after hyperopia transepithelial treatments.