Abstract: Purpose: We investigated the long-term effects of cataract surgery by the eight-chop technique on intraocular pressure (IOP) in cataract patients.Methods: The patients were classified into three groups (Grade II, III, and IV) according to the lens hardness. The operative time, phaco time, aspiration time, cumulative dissipated energy, and volume of fluid used were measured intraoperatively. The best-corrected visual acuity and corneal endothelial cell density were measured. The IOP was monitored for 5 years. Based on the preoperative IOP, eyes were classified into two groups for analysis: IOP > 15 mmHg and < 15 mmHg.Results: The operative time in Grades II, III, and IV were 4.63 ± 0.88 min, 5.48 ± 1.52 min, and 7.77 ± 1.47 min, respectively. The rate of corneal endothelial cell density loss was 1.9 ± 8.3% at 19 weeks. Postoperatively, the IOPs at 1 year were 12.6 ± 2.4 mmHg, 13.2 ± 2.3 mmHg, and 11.7 ± 2.2 mmHg, and at 5 years were 13.1 ± 2.5 mmHg, 12.0 ± 2.0 mmHg, and 12.0 ± 0.6 mmHg, in Grades II, III, and IV, respectively. In patients with a preoperative IOP < 15 mmHg, the IOP remained significantly lower even after 5 years of surgery.Conclusions: The eight-chop technique can lower the IOP and this effect persists for 5 years. This procedure is short and is associated with a minimal reduction in corneal endothelial cell density. Thus, this technique is very effective in lowering IOP in patients with cataracts.

Abstract: Purpose: To evaluate the safety and efficacy of the eight-chop technique in phacoemulsification for white cataracts.Methods: The lens capsule was stained with brilliant blue G (BBG) and nucleus was cracked using the Eight-chopper. The best-corrected visual acuity (BCVA), corneal endothelial cell density (CECD), and intraocular pressure (IOP) were evaluated. The primary outcome measures were the mean operative time, mean phaco time, aspiration time, cumulative dissipated energy (CDE), and volume of fluid used.Results: The lens capsule visualization was sufficient with BBG. The mean (standard deviation, SD) operative time was 11.40 ± 4.42 minutes. The mean (SD) phaco time was 31.4 ± 15.3 seconds. The corresponding values for aspiration time, CDE, and volume of fluid used were 2.50 ± 0.72 minutes, 12.12 ± 7.07, and 61.9 ± 15.8 mL, respectively. The BCVA improved significantly (p<0.01). The CECD decreased by 5.5% at 7 weeks and 3.7% at 19 weeks postoperatively. The rate of IOP reduction was 7.3% at 7 weeks and 9.5% at 19 weeks postoperatively.Conclusions: The eight-chop technique is safe and effective in phacoemulsification and may reduce postoperative CECD loss and lower IOP in eyes with white cataracts. BBG staining may be safe for corneal endothelial cells.

Abstract:

Vitamin B₁₂ deficiency is increasingly recognized as a contributor in both vascular and neurodegenerative aging-related disorders. Its deficiency disrupts one-carbon metabolism, leading to impaired homocysteine (Hcy) cycling. Elevated Hcy is a well-established risk factor for vascular dysfunction. Previously, we established that elevated Hcy contributes to aging retinal diseases and plays a central role in blood retinal barrier (BRB) dysfunction. Building on this foundation, the present study examines how B-vitamin deficiency disrupts one-carbon metabolism and whether restoring these vitamins can serve as a preventive or therapeutic strategy. Since B-vitamins (B₆, B₉, and B₁₂) are crucial cofactors in the metabolism of Hcy, we investigated how dietary changes in these vitamins affect serum Hcy levels and retinal vascular integrity in mice. C57BL/6- Wild-type (WT) mice were fed specially formulated diets, which contained different levels of B-vitamins (normal, deficient (B-Vit (-)) or enriched (B-Vit (+)). Initially, two groups of mice were placed on either a normal or a deficient diet. After 12-16 weeks, the success of the diet regimes was confirmed by observing serum B₁₂ deficiency in the B-Vit (-) group, along with elevated Hcy levels. Subsequently, a subgroup of the B-Vit (-) mice was switched to an enriched diet. The BRB integrity was evaluated in living mice using fluorescein angiography (FA), optical coherence tomography (OCT), and in the perfused mice retinas with western blot analysis of leaked retinal albumin and tight junction proteins (occludin and ZO-1) levels. The B-vitamins deficiency caused significant drop in serum vitamin B₁₂ and an increase in plasma Hcy, leading to vascular leakage, altered retinal thickness, choroidal neovascular changes, increased retinal albumin leak, and decreased tight junction proteins expression, indicating BRB disruption, which was restored with B-vitamin supplementation. In conclusion, a long-term deficiency of vitamins B₆, B₉, and B₁₂ can lead to disruptions in the BRB. However, supplementation with these B-vitamins has the potential to reverse these effects and help maintain the integrity of BRB. This under-score the significance of one-carbon metabolism for retinal health and suggests that ensuring adequate levels of B-vitamins may aid in preventing aging retinal diseases with BRB disruption such as diabetic retinopathy and age-related macular degeneration.

Abstract: Background/Objectives: To evaluate the accuracy of intraocular lens (IOL) power calculation by ray tracing in eyes with previous radial keratotomy (RK). Methods: A consecutive series of patients with previous RK was retrospectively analyzed. Preoperatively, all eyes underwent optical biometry to measure the axial length (AL) and anterior segment imaging by the MS-39 (CSO), which combines Placido disc corneal topography and anterior segment optical coherence tomography. The ray tracing software of the MS-39 was used to calculate the IOL power. For comparative purposes, the results of the Barrett True-K, EVO, Haigis-Total Keratometry and PEARL-DGS formulas were also investigated. The refractive outcomes were evaluated with Eyetemis. Results: Twenty-four eyes (24 patients) were investigated. The mean AL and keratometry were, respectively, 27.34 ±2.88 mm and 35.53 ±3.66 diopters (D). The mean prediction error (PE) was -0.03 ±0.65 D (range: -1.30 to +1.64 D). The mean and median absolute errors were 0.52 and 0.48 D. The percentage of eyes with a PE within ±0.25 D, ±0.50 D and ±1.00 D were 29.17%, 62.50% and 87.50%, respectively. A comparison to the other formulas was possible in 20 eyes and did not reveal any statistically significant differences, although they achieved a lower percentage of eyes with a PE within ±0.50 D (ranging from 50 to 60%, compared to 65% with ray tracing). Conclusions: Ray tracing is a relatively accurate solution to calculate the IOL power in eyes with previous RK. Paraxial formulas provide similar outcomes and should be considered in these patients.

Abstract:

Background: Active-fluidics phacoemulsification can maintain anterior chamber stability at lower intraoperative intraocular pressure (IOP) levels. However, whether reducing IOP alone—without additional stabilizing technologies such as the Active Sentry handpiece—can decrease surgical invasiveness during Eight-Chop technique phacoemulsification remains unclear. Methods: In this prospective fellow-eye comparative study, 56 non-diabetic patients (112 eyes) underwent Eight-Chop technique phacoemulsification using the Centurion Vision System with active fluidics. One eye was randomly assigned to a standard-IOP setting (55 mmHg; high-IOP group) and the fellow eye to a reduced-IOP setting (28 mmHg; low-IOP group). Intraoperative parameters—including operative time, phaco time, aspiration time, cumulative dissipated energy (CDE), and irrigation volume—were recorded. Postoperative outcomes included aqueous flare (laser flare photometry), corneal endothelial cell density (CECD) and CECD loss, corneal morphology (central corneal thickness [CCT], coefficient of variation [CV], percentage of hexagonal cells [PHC]), and IOP. Linear mixed-effects models with patient ID as a random effect were used for all paired-eye comparisons. Results: Lowering the intraoperative IOP did not reduce surgical invasiveness. Phaco time was significantly longer in the low-IOP group (16.2 ± 5.22 s vs 13.9 ± 4.40 s; p = 0.001), and aspiration time was also longer (75.0 ± 18.3 s vs 69.0 ± 17.9 s; p = 0.033). No significant differences were found in operative time (5.08 ± 1.10 min vs 4.82 ± 1.13 min; p = 0.082), CDE (5.93 ± 1.87 vs 5.56 ± 1.90; p = 0.099), or irrigation volume (26.6 ± 7.71 mL vs 25.2 ± 7.35 mL; p = 0.214). Postoperative outcomes were similarly comparable. Aqueous flare showed no significant differences at any time point (e.g., day 1: 14.8 ± 5.10 vs 14.5 ± 4.76 ph/ms; p = 0.655). Mean CECD loss remained small in both groups and did not differ significantly (7 weeks: -0.82 ± 1.05% vs -0.98 ± 1.16%, p = 0.460; 19 weeks: -0.93 ± 1.38% vs -1.28 ± 1.69%, p = 0.239). Corneal morphological parameters (CCT, CV, PHC) and postoperative IOP also showed no significant differences between settings. Conclusions: When used with the Eight-Chop technique and active fluidics, lowering intraoperative IOP to near-physiologic levels did not decrease surgical invasiveness and did not provide measurable improvements in postoperative inflammation, CECD loss, or structural corneal outcomes. The present results suggest that reducing IOP alone—without supplemental stabilizing technologies—does not enhance tissue protection during phacoemulsification.

Abstract: Background/Objectives: To evaluate the incidence, characteristics, and clinical outcomes of intraocular inflammation (IOI) associated with intravitreal faricimab (IVF) in patients with neovascular age-related macular degeneration (nAMD) and diabetic macular edema (DME). Methods: Following PRISMA guidelines, a comprehensive search of PubMed, Web of Science, Scopus, Embase, and CENTRAL databases was performed from their inception to February 2025. Using the random-effects model, weighted proportions, standardized mean differences, and weighted log odds ratios (OR) were pooled and calculated. A two-tailed p-value of &lt;0.05 was considered statistically significant. The χ2 (z) test and the Higgins I2 test were used to assess studies heterogeneity. Results: We conducted a systematic review and meta-analysis of 24 studies (4,761 patients; 5,652 eyes). The most common diagnoses were nAMD (n = 4,782, 94.6%) and DME (n = 845, 37.1%). The pooled proportion for IOI incidence in eyes receiving IVF was 3.0% (95% CI: 1.0 – 6.0). The odds of developing IOI are significantly lower in the DME group compared to the nAMD group (OR: 0.89, p &lt;0.01). Unspecified IOI was the most common sign (n = 210, 2.9% [95% CI: 1.2 – 7.3]), followed by anterior uveitis (n = 80, 1.9% [95% CI: 0.1 – 34.8]), vitritis (n = 63, 2.9% [95% CI: 0.2 – 32.1]), retinal hemorrhage (n = 27, 0.7% [95% CI: 0.0 – 15.3]), and endophthalmitis (n = 8, 0.5% [95% CI: 0.3 – 1.1]). Conclusions: While IVF demonstrates therapeutic efficacy, our findings highlight a clinically relevant risk of IOI. We, therefore, recommend vigilant monitoring for all patients receiving IVF, especially those with nAMD.

Abstract: Geographic atrophy (GA) is a progressive cause of central vision loss with limited re-habilitation options. This prospective case series aimed to evaluate the effects of bio-feedback fixation training (BFT) on visual function and vision-related quality of life (QoL) in patients with GA. Eighteen patients with total central vision loss in one eye and partial involvement of the fellow eye (study eye) underwent BFT using the Macular Integrity Assessment (MAIA) system, which was used to select a new, previously chosen preferred retinal locus (PRL) on the study eye to stabilize fixation or adopt a new fixation locus. Patients were followed for an average of 13.2 months (range 3-26 months). Functional outcomes included best corrected visual acuity (BCVA, ETDRS), reading performance (Radner test), and contrast sensitivity (CS Spot Checks test). MAIA parameters comprised average retinal sensitivity, fixation distance and stability (P1, P2), and changes in the bivariate contour ellipse area (BCEA). Vision-related quality of life was assessed using the National Eye Institute Visual Functioning Questionnaire-25 (NEI-VFQ-25). Following BFT, BCVA, reading ability and contrast sensitivity improved significantly (p< 0.02), and fixation stability and NEI-VFQ-25 scores showed a positive trend. These findings indicate that BFT is a feasible and promising rehabilitation approach for patients with GA.

Abstract: Objectives: The Eight-chop technique is a mechanically based nuclear segmentation method designed to improve surgical efficiency and reduce intraocular tissue stress during phacoemulsi-fication. Early postoperative aqueous flare serves as an objective indicator of surgical invasive-ness, whereas corneal endothelial cell density (CECD) loss represents a structural measure of en-dothelial injury. Although both parameters are clinically important, their relationship has not been systematically investigated in the context of this newer mechanical fragmentation ap-proach. Methods: This prospective observational study included 118 eyes from 70 non-diabetic patients undergoing uncomplicated Eight-chop phacoemulsification. Aqueous flare was meas-ured preoperatively and at postoperative Day 1, Day 7, Week 7, and Week 19 using laser flare photometry. CECD was evaluated preoperatively and at Weeks 7 and 19. Changes over time were analyzed using paired t-tests. Linear mixed-effects models (random intercept = patient ID) were constructed to assess predictors of CECD loss and postoperative intraocular pressure (IOP) reduction. Explanatory variables included Day 1 flare, age, preoperative CECD, nucleus hard-ness (Emery–Little grade), cumulative dissipated energy (CDE), and irrigation fluid volume. Re-sults: Postoperative flare increased significantly at all time points (all p < 0.001), peaking on Day 7 (16.7 ± 9.21 photon counts/ms). CECD loss was extremely small, averaging 1.38% at Week 7 and 1.46% at Week 19. In mixed-effects models, Day 1 flare was not associated with CECD loss at Week 7 (p = 0.35) or Week 19 (p = 0.85). Significant predictors of CECD loss included Emery–Little grade (p = 0.004 at Week 7; p = 0.025 at Week 19), with borderline contributions from CDE and irrigation volume. IOP decreased significantly at Weeks 7 and 19; however, Day 1 flare did not predict IOP reduction. Conclusions: Eight-chop phacoemulsification produced uniformly low postoperative inflammation and exceptionally small corneal endothelial cell loss. Early postop-erative flare did not predict CECD loss, suggesting that the Eight-chop technique provides a highly standardized, low-invasiveness surgical environment. These findings suggest that the Eight-chop technique lowers ultrasound energy requirements and may help reduce corneal endo-thelial stress relative to standard phacoemulsification.

Abstract: Introduction: Presbyopia is a refractive condition characterized by progressive loss of accommodation resulting in loss of visual acuity and is known to affect quality of life. Mainstay treatment modalities for presbyopia include reading spectacles, contact lenses, and a series of surgical techniques. Until recently, pharmacologic treatments were not available. In this paper, we aim to review the role of pilocarpine eye drops in managing presbyopia. Methods: A comprehensive literature search was performed using Medline, EMBASE, and grey literature databases for articles until 01 May 2023. Search terms included “presbyopia”, “presbyopia correction/treatment”, “pilocarpine”, and “pharmacological presbyopia treatment”. All relevant articles from 01 January 2005 to 01 May 2023 and written in the English language were included in the review. Results: The initial search yielded 497 publications, of which 17 met our inclusion criteria and were included in analysis. Pilocarpine, a parasympathomimetic drug, increases the power of accommodation by increasing the lens thickness via the muscarinic receptors on the iris and ciliary muscles. Clinical trials utilizing pilocarpine eye drops in the management of presbyopia have reported positive outcomes in terms of near visual acuity. Pilocarpine HCL ophthalmic 1.25% formulation (Vuity) is currently the only approved pharmacologic treatment option for presbyopia shown to be effective in managing presbyopia. Conclusion: Overall, pilocarpine eye drops appear to be an effective option in improving near visual acuity in presbyopia patients. Long term follow-up data on the use of pilocarpine-based eye drops is not available. With the increase in the number of users overtime following the approval of Vuity, the long-term effects of its prolonged use may be determined. Further research is needed to optimize the concentrations and combinations of pilocarpine and other substances to maximize efficacy and minimize adverse effects.

Abstract: Background/Aims: To develop an image linearization process and a program capable of quantifying vertical and left-right asymmetries observed in macular scans. We then sought to verify its applicability in clinical settings. Methods: In this single-center cross-sectional study, we examined 37 consecutive patients diagnosed with open-angle glaucoma in one eye, with the other eye being normal. Spectral-domain OCT images were automatically processed by a program we developed to straighten the disc-macula and macula-temporal raphe lines. The following parameters were then analyzed: 1) Mean inner retinal thickness difference between the superior and inferior segments, 2) Vertical Asymmetry Score, and 3) Quadrantal Asymmetry Score. These parameters were automatically measured, and their values were compared between the two eyes.. Results: We analyzed 37 healthy eyes and 37 POAG eyes. After linearization, the mean inner retinal thickness for the normal and POAG groups was 93.4 µm (interquartile range [IQR]: 90.1-98.5) and 80.3 µm (IQR: 77.3-85.0), respectively. The Vertical Asymmetry Score was 6.80 (IQR: 6.15-7.25) for healthy eyes and 9.69 (IQR: 9.16-11.58) for POAG eyes. The Quadrantal Asymmetry Score was 6.35 (IQR: 5.94-7.19) for healthy eyes and 8.47 (IQR: 8.11-9.63) for POAG eyes. Significant differences were found between groups for all parameters (p< 0.001). The Vertical Asymmetry Score (AUC = 0.967, p< 0.001) and Quadrantal Asymmetry Score (AUC = 0.946, p< 0.001) demonstrated significantly greater accuracy in detecting glaucoma compared to the mean inner retinal thickness (AUC = 0.743). Conclusion: The developed linearization program and asymmetry scores have shown promise as parameters for detecting glaucomatous changes in macular scans using spectral-domain OCT.

Abstract: Background/Objectives: Visual sensations from ocular structures are entoptic. They may include retinal vascular shadows, perifoveal leukocyte migration, and phosphenes during eye movement causing retinal deformation. Abnormal neural activity in the visual cortex and retina have been linked to migraine aura. This study described monosymptomatic episodes of an endogenous transparent flicker overlaid on an otherwise intact visual field in medical retina patients. Methods: Retrospective evaluation of four patients' records with comparable descriptions of seeing a flickering overlay in part of their visual field and individual descriptions of their experience with reference to an animated flicker simula-tion. Results: Four patients reported seeing a dim rhythmic flicker over their normal bin-ocular vision. The effect was strongest in low ambient light and faded in bright light and when one or both eyes were covered. Duration was seconds to minutes. Some flicker crossed the vertical midline and appeared to be from one eye. All four patients noticed a simulation flickering at 7 Hz similar to their flicker, however the frequency ranged from 5 to 10 Hz and varied in position, prominence, and frequency. Flicker occurred in three pa-tients during aerobic exercise and in two patients during nighttime awakenings without room lighting. Flicker was unrelated to ocular or systemic conditions. The flickering had no association to the migraine patients' visual auras. Conclusions: Dim flicker is a rhyth-mic translucent overlay on an otherwise normal visual field. Unlike a migraine aura, it does not spread or cause a headache. Associated ocular conditions were retinal venous congestion, central serous chorioretinopathy, and migraine with aura.

Abstract: Background/Objectives: Pigment migration is a key biomarker of progression in age-related macular degeneration (AMD). This study assessed the diagnostic performance of ring aperture Retro mode (RAR) imaging for detecting pigment migration and compared its performance with established multimodal imaging techniques. Methods: This retrospective study included 80 eyes from 61 consecutive patients with AMD who underwent multimodal imaging with color fundus images (CFI), fundus autofluorescence (FAF), RAR imaging (Mirante, NIDEK), and en face optical coherence tomography (OCT) with B-scans (Cirrus HD-OCT 5000, Zeiss). Two independent retina specialists graded AMD stage and the presence of pigment migration across modalities. Sensitivity and positive predictive value (PPV) of RAR were calculated using en face OCT as the reference standard. Results: RAR demonstrated high diagnostic performance, with a sensitivity of 94.7% and a PPV of 93.4% relative to en face OCT. RAR frequently identified pigment migration that was not visible on CFI or FAF, particularly in early AMD and in eyes with media opacity. Distinct morphologic patterns—including hyperreflective foci, thickened retinal pigment epithelium, refractile drusen, and cuticular drusen—were consistently identifiable on RAR. In four eyes with geographic atrophy, RAR detected perifoveal pigment redistribution at least six months before foveal involvement was confirmed by OCT and FAF. Conclusions: RAR imaging is a rapid, sensitive, and clinically practical technique for detecting pigment migration in AMD. By complementing en face OCT and enhancing visualization in cases where standard imaging is limited, RAR may strengthen early disease surveillance, support prognostic assessment, and improve multimodal diagnostic workflows in routine practice.

Abstract: Background: To assess the need of intraocular pressure (IOP)-lowering procedures following Descemet membrane endothelial keratoplasty (DMEK). Methods: We reviewed postoperative outcomes of consecutive patients, who underwent DMEK between May and December 2024 at the University Medical Center in Mainz, Germany. All surgeries included a surgical iridectomy at the 6 o’clock position, a tamponade with 10% sulfur hexafluoride (SF6) and IOP of about 15 mmHg at the end of surgery. Postoperative outcomes included IOP, per cent gas fill in the anterior chamber, and the need for IOP-lowering interventions, as determined by the on-call resident, at 3-, 24-, and 48-hours post-surgery. Complications, such as re-bubbling and re-keratoplasties, were also collected. Results: A total of 116 eyes from 98 patients (62 female, mean age 73.0±9.8 years) were analysed. DMEK was combined with cataract surgery in 41 eyes, and 4 eyes underwent phakic DMEK. The most common indication for DMEK was Fuchs' endothelial corneal dystrophy in 102 eyes. Postoperatively, all iridectomies remained patent, and no cases of pupillary block occurred. Mean IOP and gas fill at 3, 24, and 48 hours were 16.6±6.8 mmHg / 63±12%; 14.3±4.5 mmHg / 59±15%; and 13.0±3.5 mmHg / 55±15%, respectively. IOP-lowering procedures were performed in 11 eyes (9.5%) included venting (n=3), acetazolamide (n=7), and both (n=1). There was no difference between DMEK and triple-DMEK in terms of postoperative gas fill, IOP, or the need for IOP-lowering interventions. IOP-lowering interventions were more frequent in glaucoma vs. non-glaucoma patients. Conclusions: A standardized surgical approach incorporating a surgical iridectomy at the 6 o’clock position, 10% SF₆ tamponade and maintaining a mid-normal IOP at the end of surgery effectively prevented pupillary block and significant postoperative IOP elevations.

Abstract: Objective: To characterize the findings on the ocular surface of patients with cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFB) and to correlate them with the degree of inflammation and systemic severity. Methods: This work is an observational, cross-sectional study of patients with CF and NCFB. A complete pulmonary evaluation (demographic and clinical data, spirometry, blood sample, computed tomography) and ophthalmological evaluation (visual acuity, biomicroscopy, OSDI test, TBUT test, Schirmer test, and InflammaDry test) were performed. Results: A total of 87 patients were recruited (CF=45, NCFB=42). Both the TBUT test (r=–0.373, p=0.001) and the Schirmer test (r=–0.280, p=0.010) correlated with the degree of systemic inflammation in our sample. Conclusion: Both CF and NCFB can cause a systemic inflammatory state related to altered ocular surface homeostasis, leading to evaporative and hyposecretory dry eye. However, in neither disease does this subclinical alteration translate into severe symptoms or serious ophthalmologic complications for these patients.

Abstract: BACKGROUND: to evaluate the anatomical and functional outcomes associated with temporal arcuate relaxing retinotomy technique for persistent full-thickness macular hole (FTMH) repair. METHODS: a retrospective, single-center, interventional study of temporal relaxing retinotomy in eyes with persistent FTMHs following one or more standard repair procedures with pars plana vitrectomy and internal limiting membrane peeling. Patients received an additional pars plana vitrectomy and temporal arcuate relaxing retinotomy, followed by fluid-air and air-gas exchange. Key postoperative outcomes included the achievement of FTMH closure and changes in visual acuity from baseline. RESULTS: nine patients with persistent FTMHs were included, with a median age of 70 years (range, 58-76 years). The diameter of the 9 FTMHs ranged from 412 to 1037 µm (median, 613 µm). Vitrectomy and temporal relaxing retinotomy were performed in all 9 eyes. Successful FTMH closure was achieved in 7 of 9 eyes (closure rate, 78%), with an average postoperative follow up of 10.4 months (range: 2 to 20 months). 8 of 9 eyes (89%) achieved BCVA improvement during postoperative follow-up, including the long-standing FTMHs. Overall, mean BCVA (± SD) improved significantly from 1.26 ± 0.51 logMAR at baseline to 0.56 ± 0.27 logMAR during postoperative follow-up (P = 0,002). CONCLUSIONS: Temporal arcuate relaxing retinotomy may be an effective method to promote anatomical closure and to improve vision outcomes in patients with persistent FTMHs.

Abstract: Background: Acquired brain injury (ABI) often disrupts binocular vision, causing deviations on cover test and reduced stereopsis that impair functional visual performance. This study investigated the effects of a dichoptic vision therapy protocol—based on an immersive virtual reality (VR) system—on visual field parameters, oculomotor reaction times, and self-reported visual symptoms in adults with ABI. Methods: In a controlled parallel-group design, adult ABI patients (median age 51 years) were assigned to an experimental group (dichoptic VR therapy) or a control group. Six sessions of visual therapy were performed. Primary outcomes included perimetric visual field indices and oculomotor reaction times; the secondary outcome was the Brain Injury Vision Symptom Survey (BIVSS) score. Etiology (stroke vs. traumatic brain injury) was recorded. Results: No statistically significant improvements were found in perimetric visual field indices (p &gt; 0.05), except for a slight gain in the top-right quadrant in the experimental group. Reaction times did not differ significantly between groups. However, the experimental group reported a greater reduction in visual symptoms as measured by the BIVSS. Patients with traumatic brain injury exhibited better functional improvement, particularly in the top-left quadrant (p = 0.04). Conclusions: Dichoptic VR-based therapy did not restore perimetric field losses in ABI patients but reduced visual symptoms and may enhance functional adaptation of residual vision rather than structural recovery. The therapeutic response varied by etiology, favoring traumatic brain injury. Larger, longer trials integrating objective and subjective measures, including neuroimaging, are warranted.

Abstract: Purpose: To present the clinical outcomes of a combined pharmacological and gas-assisted treatment approach for sub-macular haemorrhage secondary to neovascular age-related macular degeneration (nAMD). Methods: A retrospective analysis was conducted on ten patients with sub-macular haemorrhage secondary to nAMD treated between 2024 and 2025. Each patient received a single intravitreal injection of tissue plasminogen activator (tPA; alteplase, Actylise 10, Boehringer Ingelheim, Int.) and perfluoropropane (C₃F₈, Micromed) gas. This treatment was administered within 3 weeks of symptom onset (range 7-60 days). Subsequently, all patients received anti-VEGF injections of aflibercept (Eylea 2mg, or Eylea 8 mg, Bayer) using a treat-and-extend (T&Ex) regimen, started 7–14 days after the tPA + gas injection. Clinical evaluation included best-corrected visual acuity (BCVA), fundus photography, optical coherence tomography (OCT), and OCT- angiography angio-OCT at baseline and at 7 -14 days, 1 month, 3 months, and 6 months after the initial tPA + gas injection. Results: All patients showed rapid anatomical improvement of the haemorrhage. Visual acuity improved in the majority of cases, with an average gain of three ETDRS lines at four weeks, an additional three lines at three months, and over four lines at six months. No major adverse events were reported. One patient developed a transient intraocular-pressure rise, which was easily controlled with medication. Conclusion: Prompt combined therapy using intravitreal alteplase with C₃F₈ gas, followed by anti-VEGF treatment, may offer a safe and minimally invasive alternative to surgery for sub-macular haemorrhage due to nAMD, providing promising visual and anatomical outcomes.

Abstract: Background/Objectives: Rhegmatogenous retinal detachment (RRD) is a vi-sion-threatening condition characterized by the separation of the neurosensory retina from the retinal pigment epithelium due to retinal breaks, leading to subretinal fluid accumulation. This review aims to provide a comprehensive overview of the epidemi-ology, risk factors, and historical evolution of RRD from a global perspective, highlighting trends, regional variations, and key advancements to inform clinical practice and future research. Methods: A systematic literature search was conducted using databases such as PubMed, Google Scholar, and Web of Science for studies published from 1970 to 2025 on RRD epidemiology, risk factors, incidence rates and temporal trends. Inclusion criteria focused on population-based studies, meta-analyses, and reviews. Data were synthesized qualitatively and quantitatively where possible. Results: The global annual incidence of RRD is estimated at 12.17 per 100,000 population, with significant regional variations: highest in Europe (14.52 per 100,000) and lower in the Americas (8.95 per 100,000). The incidence of rhegmatogenous retinal detachment has risen by 5.4 cases per 100,000 population per decade, with projections suggesting it could double over the next 20 years. Key risk factors include myopia (3-39-fold increased risk depending on severity), age (peak in 60-70s), male sex, cataract surgery, and trauma. Conclusions: RRD incidence is rising globally, driven by aging populations and increasing myopia prevalence, with myopia as the strongest potentially modifiable risk factor. Historical advancements underscore the importance of early detection and surgical intervention. Future efforts should focus on preventive strategies in high-risk groups and addressing regional disparities in access to care.

Abstract: The retina is a highly specialized structure consisting of neurons, glial cells, and pigment epithelial cells. Glaucoma, the leading cause of irreversible blindness, is characterized by increased intraocular pressure (IOP), retinal ganglion cell (RGC) loss, and retinal nerve fibre layer thinning. This study aimed to validate an experimental glaucoma model and examine retinal structural changes during disease development. Female DBA/2 mice, genetically predisposed to glaucoma, were used as the experimental group, while pre-glaucomatous DBA/2 and non-glaucomatous C57Bl/6 mice served as controls. IOP was measured biweekly. Retinal sections were analysed histologically for retinal thickness, individual layer thickness, and the number of cells within the ganglion cell layer. Glaucomatous DBA/2 mice exhibited significantly higher IOP and significant retinal thinning. Structural changes were observed as reduced outer plexiform layer and inner nuclear layer thickness and increased inner plexiform layer thickness. Ganglion cell layer cell counts decreased in glaucomatous mice in both central and peripheral regions. In conclusion, DBA/2 mice develop hallmark glaucoma features while retinal thinning is layer-specific. Understanding the sequence of retinal damage, including RGC axonal dysfunction and cell death, is critical for designing advanced preclinical research strategies and, in the future, developing targeted therapies.

Abstract: Norrin-Wnt signaling is essential for retinal vascular development and generation of the inner blood retinal barrier. Norrin itself is a potential therapeutic for retinal vascular repair. We explored the feasibility of producing a recombinant protein therapeutic based on human Norrin for intravitreal injection. NorrinK86P production was testing using MBP-fusion and non-tagged versions. FZD4 binding was evaluated by ELISA and the activation of AXIN-2 gene expression in primary human retinal microvascular endothelial cells was measured by qPCR. Intravitreal injection was tested in the rat eye, evaluated by fluoresceine angiography, OCT, and ERG. MBP-tagged Norrin was resistant to HRV3C-protease cleavage unless linker polypeptides were also incorporated. MBP-Norrin or cleaved MBP-Norrin also required refolding with disulfide reshuffling to generate FZD4-binding activity and to affect AXIN-2 gene expression. A production strategy based upon untagged NorrinK86P refolded from bacterial inclusion bodies was selected. Intravitreal injection of NorrinK86P did not affect retinal thickness nor retinal function, the later monitored by the ERG A-wave and B-wave amplitudes. We concluded that MBP-Norrin, cleaved Norrin, and untagged-Norrin from inclusion bodies, display Norrin-like biological activity after refolding with disulfide-reshuffling. The untagged, bacterial inclusion body process was selected for future large-scale bacterial fermentation. NorrinK86P could be produced with Norrin-like biochemical and biological activities and was tolerated after intravitreal injection into the rat eye.