Abstract: Objective: To clarify the pathophysiology of myopic optic neuropathy (MON) and its relationship to glaucomatous optic neuropathy (GON). Background: MON is presumed to be associated with posterior pole ectasia and de-formation of the lamina cribrosa (LC) and parapapillary region. Its dependance on intra-ocular pressure is expected to be weaker than that of GON, however, the characteristics and clinical behavior of MON remain incompletely understood. Methods: A PubMed search using the keywords myopia, glaucoma, retinal nerve fiber, optic disc, and axonal transport identified 233 relevant publications, which were analyzed in this narrative review. Results: In myopic eyes, a large optic disc, thin or defective LC, and parapapillary mi-crovasculature dropout (pMvD) are considered signs of increased vulnerability to glau-comatous injury. Despite these structural risk factors, visual field (VF) progression in myopic patients with glaucoma is often slow. The involvement of MON, which likely de-velops in young adulthood and stabilizes with aging, may explain this discrepancy. MON may substantially contribute to the development of central VF defects in myopic glau-coma, which are associated with elongation of papillomacular bundle, pMvD, and normal tension glaucoma. Experimental studies demonstrating impaired axonal transport at the optic disc margin provide important insights into the pathogenesis of MON. Additionally, optic disc deformations in myopia including disc tilting, rotation, and focal thinning or defects of the LC may contribute to atypical VF defects and altered suscep-tibility to glaucomatous damage. Conclusion: Interaction between MON and GON may explain atypical VF defects and the relatively slow VF progression observed in myopic patients with glaucoma-like VF defects.

Abstract: Background/Objectives: Refractory macular holes (MH) that persist after conventional internal limiting membrane (ILM) peeling pose a significant surgical challenge. This study analyzed the anatomical and functional outcomes of epiretinal human amniotic membrane (hAM) transplantation in these patients. Methods: This retrospective study included 10 eyes of 10 patients with refractory MH. All patients underwent 25-gauge pars plana vitrectomy, epiretinal cryopreserved hAM transplantation, and C3F8 gas tamponade. The large hAM graft was placed over the macula with the chorion side facing the retina. Preoperative and postoperative best-corrected visual acuity (BCVA), optical coherence tomography (OCT) findings, and MH dimensions were recorded. Results: The mean follow-up period was 7 months (range 3–14 months). The mean preoperative minimum linear diameter and base diameter of the MHs were 715 ± 212 μm and 1114 ± 258 μm, respectively. Anatomical closure was achieved in all patients (100%). Postoperative OCT revealed rearrangement of the inner and other retinal layers in 7 out of 10 patients (70%), with partial restoration of the outer retinal layers. The mean logMAR BCVA improved significantly from 1.60 ± 0.37 preoperatively to 1.00 ± 0.45 postoperatively (p < .001). No graft dislocation, rejection, or other significant complications were observed. Conclusions: Epiretinal human amniotic membrane transplantation is an effective and safe surgical technique for achieving anatomical closure and functional improvement in refractory macular holes where conventional ILM peeling has failed.

Abstract: This study quantified the analytical performance of an automated videotopography system for dry eye disease (DED) and evaluated a novel multivariate composite score to improve diagnostic accuracy. In a prospective, repeated-measures study, 35 adults completed three visits involving automated (Keratograph 5M) and manual (fluorescein break-up time; slit-lamp meniscus height) assessments. Data were analysed using linear mixed-effects models and Bland–Altman plots, while a logistic regression-based Objective Symptom Risk Score (Objective-SRS) was derived to predict symptom status. Results showed that automated meniscus height (NIKTMH) had excellent precision (CV 8.8%) and reliability (ICC 0.727), whereas non-invasive break-up times were highly variable (CV &gt; 40%). Automated and manual measures demonstrated wide limits of agreement and systematic bias, precluding interchangeability. While individual objective tests failed to differentiate symptom groups, the composite Objective-SRS achieved good accuracy (AUC 0.768) and superior net clinical benefit. The study concludes that diagnostically useful information is distributed across multiple signals; thus, automated and manual measures should be used complementarily, with multivariate models offering superior discrimination of DED symptom burden.

Abstract: Head-mounted (“virtual reality”) perimeters (HMPs), based on standard consumer electronic hardware, are a cheaper alternative to standard automated perimetry. They have not been validated in patients with inherited retinal disease (IRDs), yet. We evaluated the Iowa-HMP in a first pilot study. It consists of a legacy smartphone, a headset, and freely available, open-source software. We used the 10-2 grid, the ZEST algorithm, and a background of 10 cd/m^2 to measure central visual fields in one normal subject, and in patients with occult macular dystrophy (n = 2), Stargardt’s disease (n=3) and retinitis pigmentosa (n = 6). Results were compared with those from an Octopus 900 perimeter. The typical patterns of visual field loss were clearly discernible, but head-mounted perimeters generally have a limited dynamic range. Within the dynamic range of the Iowa-HMP (14 to 30 dB Octopus sensitivity), the Limits of Agreement (Bland-Altman) were ±7.5 dB. The Iowa-HMP had a diagnostic sensitivity of 0.67 for detecting locations with low perimetric sensitivity (< 14 dB in the Octopus perimetry) with a diagnostic specificity of 0.95. Although the Iowa-HMP cannot be directly compared to standard perimetry in IRDs, open software greatly facilitates research in this area.

Abstract:

Objectives: White cataracts present substantial technical challenges during phacoemulsification because nuclear hardness cannot be assessed preoperatively and the risk of intraoperative complications is increased. This study aimed to evaluate the surgical efficiency, safety, and postoperative outcomes of the eight-chop technique in eyes with white cataracts across different levels of intraoperative nuclear hardness. Methods: This retrospective, single-center, single-surgeon observational study included eyes with white cataracts that underwent phacoemulsification using the eight-chop technique between January 4, 2010, and March 25, 2025. White cataract was defined as a completely white and opaque lens with absent red reflex on slit-lamp examination. Nuclear hardness was classified intraoperatively according to the Emery classification. Intraoperative parameters, corneal endothelial cell density (CECD), corneal endothelial morphology, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were evaluated preoperatively and postoperatively. Outcomes were compared among nuclear hardness groups. Results: Among 12,642 cataract surgeries performed during the study period, 126 eyes were diagnosed with white cataracts. After exclusions, 105 eyes were included in the final analysis. Operative time, phacoemulsification time, and cumulative dissipated energy increased significantly with nuclear hardness (all p < 0.01), whereas aspiration time and irrigation fluid volume did not differ significantly among groups. CECD loss at 7 and 19 weeks postoperatively was minimal, with no significant differences among hardness groups. Transient changes in corneal endothelial morphology were observed postoperatively but resolved by 19 weeks. Postoperative IOP decreased significantly in eyes with higher nuclear hardness. BCVA improved markedly in all groups, and differences observed in the early postoperative period disappeared over time. Posterior capsule rupture occurred in 2 of 105 eyes, and no cases of dropped nucleus were observed. Conclusions: The eight-chop technique enables safe and efficient phacoemulsification in eyes with white cataracts across a wide range of nuclear hardness. This technique minimizes ultrasound energy and corneal endothelial damage while providing favorable visual outcomes and acceptable complication rates, even in advanced cases.

Abstract:

Carbon monoxide (CO) therapy involves the controlled administration of low doses of CO to harness its cytoprotective properties, including anti-inflammatory, anti-apoptotic, and vasodilatory effects. Originally studied for its role in cardiovascular and pulmonary conditions, CO therapy is now being explored for its potential in treating ocular diseases. Traditionally recognized for its toxic effects, carbon monoxide is gaining attention as a promising therapeutic agent in ocular medicine. Controlled, low-dose CO therapy has demonstrated anti-inflammatory and anti-apoptotic benefits in various models of retinal disease, including retinal ischemia-reperfusion injury, optic nerve crush, ocular hypertension, and autoimmune uveitis. This review summarizes key findings from clinical and preclinical studies, highlighting the therapeutic potential of CO. We also explore current and emerging methods of CO delivery, evaluating their safety, efficacy, and applicability in treating retinal disorders.

Abstract:

Retinitis pigmentosa (RP) is a genetically heterogeneous group of inherited retinal degenerations with primary degeneration of rod photoreceptors followed by secondary cone loss. We investigated whether downregulating Nrl (neural retina leucine zipper), a key transcription factor specifying rod fate, can reprogram rods into a more resilient state. In a transgenic Nrl^N/N mouse in which Nrl was markedly downregulated, rod phenotype became more like rod-precursor, particularly in the inferior retina. Crossing Nrl^N/N mice with two rod-degeneration models, rd1 (Pde6b^rd1/rd1) and rhodopsin P23H knock-in (Rho^P23H/P23H) mice, resulted in significantly improved photoreceptor survival in double mutant mice. In addition, AAV-mediated delivery of shRNA targeting Nrl mRNA substantially enhanced photoreceptor survival in rd10 (Pde6b^rd10/rd10) mice. These findings demonstrate that downregulation of Nrl reprograms rods and confers broad resistance to degeneration across multiple RP models. AAV-mediated Nrl knockdown represents a promising mutation-independent therapeutic strategy for autosomal recessive and dominant forms of RP.

Abstract: Purpose: To review the conceptual evolution, mechanical principles, and clinical outcomes of the Eight-chop nuclear fragmentation technique, and to clarify its position within modern cataract surgery. Methods: A narrative review was conducted focusing on the historical development of nuclear fragmentation strategies, including sculpting-based techniques, divide-and-conquer, chop-based methods, femtosecond laser–assisted cataract surgery, and prechop techniques. Particular attention was given to the wedge-induced fracture mechanism, geometric optimization through eightfold division, and integration with modern fluidics systems. Published clinical studies and the authors’ clinical data were analyzed across a wide range of cataract subtypes. Results: Across standard cataracts and challenging conditions—including dense nuclear cataracts, white cataracts, small pupils, shallow anterior chamber, microcornea, diabetic eyes, and pseudoexfoliation syndrome—the Eight-chop technique consistently demonstrated reduced phaco time, cumulative dissipated energy, and irrigation volume compared with conventional techniques. Corneal endothelial cell density loss was generally limited to approximately 1–3%, even in high-risk subgroups. Postoperative intraocular pressure showed a sustained reduction over mid- to long-term follow-up. These subtype-specific outcomes are integrated in Table 1, highlighting the reproducibility and low invasiveness of the technique regardless of nuclear hardness or anterior segment anatomy. Conclusions: Eight-chop is a segmentation-first nuclear fragmentation strategy based on complete in-the-bag prefragmentation using a wedge-induced fracture mechanism. Its compatibility with modern fluidics systems, including AFS, enhances anterior chamber stability and reinforces its minimally invasive profile. By reducing energy use, fluid load, and zonular stress, Eight-chop represents a rational and versatile option for contemporary cataract surgery, particularly in high-risk eyes.

Abstract:

Ocular hypotony is an uncommon but vision-threatening cause of optic disc oedema. We present a case of a young woman with a complex ophthalmic history, including juvenile idiopathic arthritis (JIA), JIA-associated uveitis, secondary glaucoma, and suspected idiopathic intracranial hypertension, who developed significant hypotony-related optic disc oedema on a background of mild bilateral disc swelling. The case emphasises the importance of recognising hypotony maculopathy as a differential diagnosis for disc swelling, particularly in patients with fluctuating intraocular pressure and coexisting inflammatory eye disease. We discuss the concepts of the translaminar pressure gradient and its role in the development of optic disc oedema in the presence of both ocular hypotony and probable raised intracranial pressure.

Abstract: Background/Objective: Experimental autoimmune uveitis (EAU) in rats is a model of human uveitis that is pivotal for understanding the immunological mechanisms of the disease and developing therapies. In humans, optical coherence tomography (OCT) enables in vivo detection of characteristic findings in active uveitis, as well as sequelae of inflammation. This study aimed to correlate OCT findings in uveitis patients with retinal histologies from two rat models of experimental autoimmune uveitis caused by T cells with different autoantigen specificities and gene expression patterns, as well as well-known underlying immunological pathomechanisms. Methods: Patients with various noninfectious uveitis subtypes were imaged using ultrawidefield swept-source or conventional OCT. Histological cryosections from rat eyes with experimental autoimmune uveitis were stained for T cell and/or macrophage markers. Results: Typical human OCT findings were reproduced in the experimental animal model. Hyperreflective signals observed on OCT corresponded to lymphocyte infiltration in histological sections, which was typically found in perivascular regions (vasculitis), the posterior hyaloid (snowballs), and retinal infiltrations by lymphocytes and macrophages through the retinal pigment epithelium. Conclusion: Comparing in vivo OCT imaging of human uveitis with corresponding histologies from rat models improves our understanding of the type of inflammation, the extent of tissue destruction, and the immunopathogenesis.

Abstract: Purpose: To investigate the long-term effects of phacoemulsification by the eight-chop technique on intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG). Methods: This study comprised the eyes of patients with cataracts who had undergone phacoemulsification and posterior chamber intraocular lens implantation. Patients with corneal disease or opacity, uveitis, pupillary dilation problem, and previous trauma or surgery were excluded. Cataract surgeries were performed using the eight-chop technique. The operative time, phaco time, aspiration time, cumulative dissipated energy, and volume of fluid used were measured intraoperatively. Best-corrected visual acuity and corneal endothelial cell density (CECD) were measured postoperatively at 7 and 19 weeks.Results: In total, 150 eyes of 98 patients were followed up. The POAG group had a CECD loss rate of 1.5% and 1.2% at 7 and 19 weeks postoperatively, respectively. The control group had a CECD loss rate of 0.8% and 1.4% at 7 and 19 weeks postoperatively, respectively. The IOP reduction rate at 1 year postoperatively was 12.7% and 12.5% in the POAG and control groups, respectively. In the subgroups with preoperative IOP below 15 mmHg, IOP decreased significantly (p<.01, paired t-test) at 7 weeks and remained significantly lower at 1 year postoperatively.Conclusions: The eight-chop technique remained effective in lowering IOP after 1 year in the POAG and control groups. This effect did not diminish in patients preoperative IOP below 15 mm Hg. Phacoemulsification using the eight-chop technique may be effective for patients with glaucoma.

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:

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.