Medicine and Pharmacology

Abstract: Background: The rabbit (Oryctolagus cuniculus) is a currently indispensable pre-clinical model for fundamental discovery and translational research in glaucoma surgery. While not fully representative of the human eye, the rabbit often serves as the first robust assessment of a new chemical entity in an anatomically and physiologically relevant setting. In later stages of development, the rabbit is also a critical model for regulatory-facing Good Laboratory Practice (GLP) graded pre-clinical safety studies. However, while guidelines exist for human glaucoma surgeries in terms of patient profile vs surgery type and success criteria, there is limited collated information available on how rabbit glaucoma filtration surgeries are designed, use and mode of administration of anti-metabolite Mitomycin C (MMC) and post-operative antibiotic and anti-inflammatory dosing regime. These disparities limit cross-comparability in studies and encourage sub-optimal study design and incomplete reporting. Methods: This review investigated and collated current procedural and reporting practices based on 100 peer-reviewed rabbit glaucoma filtration surgery publications from the years 2011-2025. Publications meeting acceptance criteria were segmented into pre-operative design (ethical approval, rabbit characteristics, study duration), intra-operative (surgery type, surgical approach, use of MMC) and post-operative follow up (antibiotics, anti-inflammatories, analysis and adverse events). Results: It was found that there were clear preferences in animal model selection, study design and intra-/post-operative anti-fibrotic/inflammatory treatment regimes. Additionally, there were several areas identified where reporting was ambiguous or omitted. E.g. rabbit age, post-operative treatments, adverse events. The levels of omission were 16-30% and represent areas for improvement and highlight the need for ongoing review in pre-clinical research.

Abstract: Background: Symptomatic vitreous floaters are generally considered benign and self-limiting, especially in young individuals. However, persistent symptoms can sig-nificantly impair vision and quality of life, even when best-corrected visual acuity (BCVA) is preserved. Long-term data on pars plana vitrectomy (PPV) for floaters in young patients remain limited. Methods: This retrospective observational study included patients under 50 years old affected by persistent symptomatic vitreous floaters for at least 24 months who underwent PPV over 10 years at a single tertiary referral center. All eyes had undergone a stand-ardized 25-gauge vitrectomy. If posterior vitreous detachment (PVD) was absent, it was induced. Next, the vitreous base was shaved, the peripheral retina was inspected, and endolaser was applied as indicated. Air tamponade was used at the surgeon’s discretion and was always applied for retinal breaks. Results: Eighty-nine eyes were included. Mean age at surgery was 37.0 ± 7.0 years, with 59.6% of patients under 40 years old. The median duration of symptoms before surgery was 32 months (27–48). Preoperative BCVA was preserved in almost all eyes and re-mained stable postoperatively, with a mean change of +0.03 logMAR. The median fol-low-up was 60 months (58–72). No cases of rhegmatogenous retinal detachment, new-onset glaucoma, or visually significant cataract needing surgery were observed. Postoperative complications included endophthalmitis in one eye, macular hole in one eye, and permanent visual field defects in two eyes due to optic nerve touch during PVD induction. Importantly, no eye required reintervention for recurrent symptomatic floaters. Conclusions: Symptomatic vitreous floaters may persist for years in some young patients. Surgery may be considered when symptoms are significant. In this series, complete PPV with PVD induction provided stable BCVA and anatomical outcomes, with no reinter-vention for recurrent visually disturbing floaters. However, serious complications show that this elective procedure carries real risks.

Abstract: The study evaluated the resistance of human corneal and scleral tissues to collagenase-mediated degradation after riboflavin/ultraviolet-A collagen crosslinking (CXL), alone or combined with N-acetylcysteine (NAC) and Polygonum cuspidatum dry extract (Polydatin). Twenty-four human donor eyes unsuitable for transplantation provided 12 corneal buttons and 12 scleral strips, which were allocated to untreated controls, CXL alone, NAC/polydatin alone, and combined pre- and/or post-CXL treatment groups. Samples underwent accelerated CXL (9 mW/cm², 5.4 J/cm²) and were subsequently exposed to collagenase solution. Degradation time and protein release were assessed. Untreated corneal and scleral tissues were completely digested after 7 ± 2 and 16 ± 2 days, respectively. CXL significantly increased resistance to enzymatic degradation, extending digestion time to 14 ± 2 days in corneal tissue and 24 ± 2 days in scleral tissue (p < 0.01). The combination of NAC and polydatin administered before and after CXL further enhanced tissue stability, prolonging degradation time to 21 ± 1.8 days for corneas and 30 ± 2 days for sclerae (p < 0.001 vs. controls). These findings suggest that NAC and Polydatin may potentiate the extracellular matrix–stabilizing effects of CXL and warrant further investigation for corneal ectasia and progressive myopia.

Abstract: This study investigated retinal proteomic alterations associated with type-1 diabetes mellitus (T1DM) using two mouse models of diabetic retinopathy (DR): the genetic Ins2akita/+ (Akita) model and streptozotocin (STZ)-induced diabetes. Retinas were collected from Akita (n=4) and STZ-induced diabetic mice (n=6) 15–16 weeks after diabetes onset and compared with age-matched controls. Quantitative mass spectrometry identified 7,933 proteins in Akita retinas and 7,399 proteins in STZ retinas. Differentially expressed proteins were identified using adjusted p-values and log₂ fold-change, ranked by Man-hattan distance, and visualized with volcano plots and heatmaps. The top 20 dysregulat-ed proteins in each model were subjected to canonical pathway analysis. Both models demonstrated upregulation of inflammatory and angiogenesis-associated proteins, in-cluding LRRC58, coronin-2A, S100-A4, and COL4A2, supporting a pro-inflammatory and vascular remodeling microenvironment. However, there were distinctive changes in some proteins between the two models. For example, Crystallins were downregulated in the STZ model but upregulated in the Akita model. Canonical pathway analysis revealed ac-tivation of platelet-related signaling pathways, enrichment of lipid metabolic networks, and significant alterations in extracellular matrix organization. These findings indicate coordinated inflammatory, metabolic, and structural remodeling in DR and identify can-didate molecular pathways for further investigation and therapeutic targeting.

Abstract: Background: Optical coherence tomography (OCT) and OCT angiography (OCTA) retinal imaging in inherited retinal dystrophies (IRD) has been limited to the posterior pole and central midperiphery (up to about 16.5x16.5 mm). Two novel commercially available swept-source (SS) OCT/-OCTA devices provide the possibility of wide-field (WF) evaluation of retinal and choroidal structures including the vasculature in a single examination. Methods: A limited series of 16 IRD patients could be examined with a BMizar (400kHz, 24x20 mm scan width) and a Dream OCT (200 kHz, 26x21 mm scan width) in addition to the normal clinical examination protocol. This series included patients with retinitis pigmentosa, cone-rod dystrophy, macular dystrophy and autosomal recessive bestrophinopathy. Results: WF-SS-OCT/-OCTA enabled the detection of retinal, choroidal and choriocapillaris alterations in the macular and midperiphery in a single examination session. Even small foveal lesions and a small silent macular neovascularization could be detected on WF screening. Regional alterations of choroidal and choriocapillaris flow patterns were identified. These were mostly in correspondence with areas that appeared clinically affected, but unexpected lesions were identified as well. Occlusion of peripheral retinal vessels was seen in retinitis pigmentosa, though flow could be detected in retinal vessel which were difficult to distinguish on fundus images. In one patient with nystagmus WF-SS-OCT/-OCTA could be performed, whereas standard OCT volume scan could not be obtained. Conclusions: Both WF-SS-OCT/-OCTA devices provide detailed insights in structural and vascular retinal and choroidal alterations in a single short examination. Larger series of IRD patients examined with WF-SS-OCT/-OCTA promise to provide novel insights into the pathology of IRDs and will help to understand differences in the development of IRDs between humans and research animals.

Abstract: Purpose: To establish a geometric framework for scleral fixation planning in secondary intraocular lens (IOL) implantation that accounts for corneal ellipticity and meridional orientation, and to analyze the limitations of fixed limbus-distance marking. Methods: The limbal boundary is modeled as an ellipse defined by horizontal and ver-tical white-to-white (WTW) diameters. A target circumferential scleral locus is defined concentrically relative to an anatomical reference center. Fixation points are determined as a function of meridional orientation θ using an explicit radial model of the elliptical limbus and an orientation-dependent limbal offset. The framework is analyzed for two-, three-, and four-point fixation configurations, including the effect of uniform circumferential displacement. Results: A constant limbus-distance strategy implicitly assumes rotational invariance of limbal geometry. When the cornea is elliptical, this assumption produces predictable meridional deviations from the intended circumferential scleral locus for vertical and oblique fixation. An orientation-dependent limbal offset preserves geometric symmetry across all meridians and maintains fixation points on a consistent target locus independent of angular configuration. Under representative biometric conditions, maximal geometric deviations from the intended scleral locus approached approximately 0.58 mm when a constant limbus-distance strategy was applied. Conclusions: Scleral fixation planning can be formalized as a geometric problem gov-erned by limbal ellipticity and meridional orientation. An explicit orientation-dependent model provides a technique-independent basis for reproducible fixation planning and reduces reliance on fixed-distance heuristics.

Abstract: Background/ Objectives: Meropenem is a broad-spectrum carbapenem antibiotic with demonstrated efficacy against multidrug-resistant Gram-negative pathogens. Alt-hough its use as an ophthalmic formulation is off-label, growing clinical evidence sup-ports its application in severe ocular infections such as keratitis and endophthalmitis. However, the intrinsic instability of meropenem in aqueous solutions and the absence of standardized ophthalmic preparations limit its routine use. Furthermore, no stability studies are currently available for meropenem 50 mg/mL eye drops stored in polypro-pylene (PP) dropper bottles under freezing and subsequent refrigerated conditions. The aim of this study was to evaluate the physicochemical and microbiological stability of a 50 mg/mL meropenem ophthalmic solution prepared in hospital pharmacy and packaged in PP containers. Methods: Eye drops were aseptically prepared and stored at −20 ± 2 °C for up to 42 days, followed by refrigerated storage (5 ± 3 °C) after thawing for up to 7 days. Chemical stability was assessed using a validated stability-indicating HPLC method in accordance with ICH guidelines and was defined as 90–110% recovery of the initial concentration. Physical stability (appearance, pH, particulate matter) and micro-biological stability were also evaluated under simulated in-use conditions. Results: The HPLC method demonstrated excellent linearity, precision, and accuracy. Meropenem concentrations remained within the predefined acceptance limits throughout the 42-day study period under freezing conditions, with no significant changes in pH, color, or par-ticulate formation. After thawing, a progressive decrease in drug concentration was ob-served under refrigerated conditions, falling below 90% of the initial concentration within 24–48 hours. A concomitant color change from colorless to yellow was also detected, consistent with β-lactam ring hydrolysis. Despite this degradation, no significant changes in physical parameters other than color were observed, and microbiological testing con-firmed sterility for up to 7 days under refrigerated conditions. Conclusions: Meropenem drops 50 mg/mL in PP dropper bottles is physicochemically and microbiologically stable for 43 days (42 days under frozen conditions plus 1 day, in-use conditions, after opening and under refrigeration).

Abstract: Introduction - This study analyzes the ipsilesional hemifields in patients with hemianopia and Biofeedback Training (BT). Methods - Prospectively, BT stimulated the paracentral ipsilesional hemifields. BT was compared to a control group using C 10-2 program 68 points on the MAIA microperimetry (Centervue, Padova, Italy). Five weekly BT sessions of 20 minutes delivered. 34 subjects enrolled, 28 in treatment, 6 into control group. Outcomes: General retinal sensitivity (RS), average of the central two columns, the paracentral column of the blind hemifield, ipsilesional hemifield, and the whole ipsilesional and blind hemifields. Paired t-tests used for statistical analysis. Results - Control and treatment groups were equal demographically. In control group, no difference found pre-and-post BT. Baseline RS on the ipsilesional hemifield was 21.4 ± 4.5, lower than the normal cut-off value of 25 dB (p < 0.001). BT improved RS from 14.0 ± 4.2 (1.6, 20.9) to 15.0 ± 4.8 (3.8, 27.5), p= 0.01, paracentral two columns, 16.3 ± 5.3 (2.2, 24.5) to 17.8 ± 5.6 (3.8, 30.7), p = 0.01, central column in ipsilesional hemifield, 20.7 ± 5.4 (2.2, 29.1) to 21.8 ± 4.8 (7.3, 30.7), p = 0.05, and ipsilesional hemifield, 21.42 ± 4.8 (2.5, 28.5) to 22.39 ± 4.24 (7.5, 29.4), p=0.01.Discussion - Ipsilesional hemifields were abnormal and BT improved RS, benefiting patients with hemianopia.

Abstract: Transforming Growth Factor-beta (TGF-β) promotes lens epithelial-mesenchymal transition (EMT) and fibrosis, contributing to anterior subcapsular cataract (ASC) formation. Transgenic mice overexpressing TGF-β1 in lens have been studied for over three decades, and yet the impact of active TGF-β1-overexpression on the lens epithelial transcriptome is undefined. We have addressed this knowledge gap by examining the gene expression landscape of these unique lens epithelia. High-throughput RNA-sequencing was performed on isolated lens epithelia from three-week-old TGF-β1-overexpression transgenic mice from two independent lines, OVE853 and OVE918, and wild-type mice. Downstream analyses included comparisons with lens datasets (e.g., cataract-surgery model) and investigations using various resources/tools (e.g., Gene Ontology, CompBio, iSyTE). Compared to wild-type murine lens epithelia, 384 differentially expressed genes (DEGs) were commonly identified in lens of both transgenic lines. Candidates involved in EMT, inflammatory response, extracellular matrix organization, and mechano-sensation were elevated, while those involved in lipid metabolism, Wnt-suppression, Bmp- and Notch-activation were reduced. Comparative analyses with temporal transcriptomes on a mouse cataract-surgery model identified overlapping pathological pathways, and some elevated genes, for example endoplasmic reticulum stress genes, were in agreement with human ASC data. A major discovery was the identification of several novel TGF-β1-targets. All our data is made user-friendly accessible through iSyTE.

Abstract: Fundus fluorescein angiography (FFA) is the gold standard for assessing diabetic retinopathy (DR) severity, but whether different contrast diffusion times affect staging remains unclear. Following two clinical DR staging criteria, we established DR staging models on FFA images respectively adopting Swin-Transformer and ConvNeXt architectures and investigated the impact of FFA diffusion time on staging performance. A total of 7,508 FFA images were annotated according to both staging criteria, and divided into venue, recirculation, and late phase. Single-phase and combined-phase images were used for multi-class and binary classification tasks respectively. Model performance was evaluated using accuracy, precision, recall, and F1-score. A generalized linear model with Bonferroni correction was adopted for inter-phase statistical comparisons. Experimental results demonstrated ConvNeXt architecture outperformed Swin-Transformer in overall accuracy. No statistically significant impact of diffusion time images on staging performance was observed for either model (P > 0.05). Although staging accuracy numerically declined across successive phases, the differences were not significant, possibly attributed to reduced contrast and obscured lesions caused by hyperfluorescent leakage in late phase. Our findings verify that different contrast diffusion times have only a marginal, non-significant impact on DR staging accuracy, offering theoretical guidance for intelligent DR diagnosis using FFA images.

Abstract: To the best of our knowledge, population-based studies about the prevalence of dry eye in Germany are rare. The aim of our study was to reintroduce the topic of dry eye in the conversation about ophthalmological diseases and to identify relevant risk factors by assessing the usage of artificial tears as a proxy for treated dry eye in an older German population. For this, data was gathered from the medication plan of the first cohort of participants of the Hamburg City Health Study (n= 10 000, aged 46 – 78 years old). The calculated prevalence of self-reported artificial tears’ usage in Hamburg was 4.7% (CI – 95% [4.2%; 5.1%]), with women being four times more likely to use them than men. Since artificial tears are a fundamental part of the dry eye therapy, in this study we defined dry eye as the consistent use of artificial tears. Based on this definition, the prevalence of self-reported dry eye was 7.5% among women and 1.7% among men. A significant in-crease in the dry eye prevalence above the age of 58 was noticed as well. Lifestyle choices, pre-existing conditions and other medication were tested as possible risk factors. In conclusion, this study provides empirical evidence of the dry eye’s distribution and its risk factors.

Abstract: Combined intrastromal corneal ring segment implantation with corneal collagen cross-linking (CXL) aims to improve optical regularity and biomechanical stability in keratoconus. In this retrospective single-center longitudinal case series based on cases treated at OCULENS Ophthalmology Clinic between 2019 and 2022, 58 eyes of 40 patients with complete baseline and 6-, 12-, 24-, and 36-month follow-up after combined KeraRing implantation and conventional epithelium-off CXL were analyzed. Outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), thinnest pachymetry, maximum keratometry (Kmax), the Belin/Ambrosio enhanced ectasia total deviation index (BAD-D), the C and D components of the ABCD classification, and Corvis ST parameters. Longitudinal continuous outcomes were analyzed with repeated-measures analysis of variance and Holm-adjusted paired comparisons, and stage distributions with the Friedman test. At 36 months, UDVA improved from 0.560 ± 0.151 to 0.469 ± 0.136 logMAR and CDVA from 0.350 ± 0.109 to 0.287 ± 0.092 (both p < 0.001); Kmax decreased from 56.11 ± 3.17 D to 54.87 ± 2.86 D; BAD-D improved from 5.62 ± 1.89 to 4.70 ± 1.75; and thinnest pachymetry measured 440.7 ± 21.9 µm at 36 months, corresponding to 97.0% of baseline thickness. Corvis ST findings were consistent with greater postoperative stiffness, including lower deformation amplitude and higher SP-A1 at 36 months (both p < 0.001). Two clinically significant complications were recorded (2/58 eyes, 3.4%): one eye developed a sterile corneal infiltrate requiring ring explantation, and one eye developed corneal melting requiring ring explantation and referral for keratoplasty. Overall, the findings suggest that combined KeraRing implantation and CXL can provide sustained functional, tomographic, and biomechanical benefit, although interpretation is limited by the retrospective design, eye-level analysis, absence of a control group, and the relatively small number of adverse events.

Abstract: Background and Objectives: Pediatric keratoconus often progresses rapidly and may require early intervention. This study evaluated 24-month visual, tomographic, pachymetric, and biomechanical outcomes after conventional epithelium-off (Dresden protocol) corneal collagen cross-linking (CXL) in pediatric keratoconus using Pentacam tomography and Corvis ST dynamic Scheimpflug analysis. Materials and Methods: This single-center longitudinal cohort included 28 eyes of 23 patients aged 13–18 years treated at the OCULENS Clinic, Cluj-Napoca, Romania, between 2019 and 2023. Baseline, 6-, 12-, and 24-month values were analyzed for UCVA, BCVA, Kmax, thinnest pachymetry, SP-A1, deformation amplitude (DA), first and second applanation times (A1T and A2T), highest concavity (HC) radius, and BAD-D. Repeated-measures ANOVA assessed longitudinal change, and Pearson correlation tested the association between Kmax and SP-A1. Results: UCVA improved from 0.53 ± 0.16 to 0.44 ± 0.16 logMAR and BCVA from 0.31 ± 0.11 to 0.25 ± 0.11 logMAR (both p < 0.001). Mean Kmax decreased from 54.36 ± 3.11 D to 53.41 ± 2.79 D, while SP-A1 increased from 84.69 ± 4.75 to 97.39 ± 5.11 (both p < 0.001). Thinnest pachymetry showed early postoperative thinning with partial recovery by 24 months. DA decreased, A1T increased, A2T decreased, HC radius increased, and BAD-D decreased significantly (all p < 0.001). Kmax and SP-A1 were strongly inversely correlated at all visits (r = -0.714 to -0.773; all p < 0.001). Outside the formal 24-month analytic window, later clinical follow-up identified three eyes that required retreatment at approximately 3 years and one patient who subsequently developed an indication for keratoplasty. Conclusion: Conventional epithelium-off CXL in pediatric keratoconus was associated with improved visual acuity, modest tomographic flattening, sustained biomechanical stiffening, and overall structural stabilization over 24 months; however, a small subset showed late progression, supporting the need for continued long-term surveillance. Keywords: pediatric keratoconus; corneal collagen cross-linking; Pentacam; Corvis ST; corneal tomography; corneal biomechanics; adolescents Abbreviations: BCVA, best-corrected visual acuity; CXL, corneal collagen cross-linking; KC, keratoconus; Kmax, maximum keratometry; logMAR, logarithm of the minimum angle of resolution; SP-A1, stiffness parameter at first applanation; UCVA, uncorrected visual acuity; UVA, ultraviolet A.

Abstract: Background: The conventional Hess-Lancaster test is widely used to assess ocular mis-alignment across diagnostic gaze positions, but it relies on subjective responses and manual recording. Virtual reality may provide a more standardized framework for oc-ular motility assessment. Objectives: To evaluate the agreement and within-method repeatability of point-by-point deviation measurements obtained with the convention-al Hess-Lancaster test and a VR-based Hess-Lancaster assessment implemented in Di-copt Pro. Methods: This cross-sectional observational study included 52 adults with suspected or diagnosed ocular motility disorders. Participants underwent both assess-ments using the same predefined gaze positions. Agreement was assessed using Bland–Altman analysis, concordance correlation coefficients, mean absolute differences, and mixed-effects modeling. Repeatability was evaluated in a subset with repeated meas-urements using session-to-session differences and intraclass correlation coefficients. Results: The VR-based assessment showed moderate agreement with the conventional test, with a mean concordance correlation coefficient of 0.57 for both eyes. Mean bias was 1.22 prism diopters for the right eye and 0.10 prism diopters for the left eye. Re-peatability was moderate-to-good, with ICC values ranging from 0.62 to 0.83. Conclu-sions: The VR-based Hess-Lancaster assessment showed small mean differences and moderate agreement with the conventional test, although both methods should be in-terpreted within the context of the complete clinical examination.

Abstract: Background/Objectives: To evaluate the relationship between lens thickness (LT) and postoperative outcomes following cataract surgery versus combined cataract and glaucoma procedures in a predominantly Black and Caribbean population, and to assess the utility of LT and the Laroche Glaucoma Risk Calculator in predicting intraocular pressure (IOP) reduction. Methods: This retrospective cohort study included 187 eyes from patients aged ≥50 years who underwent cataract surgery alone or combined cataract and glaucoma surgery (goniotomy or Ahmed retrobulbar/intraconal tube at a single-center practice in Queens, New York. Preoperative and postoperative data at ≥3 months included IOP, visual acuity (logMAR), medication burden, visual field mean deviation, and anterior segment biometry measured with optical imaging. Patients were stratified by surgical type, diagnosis, and glaucoma risk. Associations between LT and postoperative IOP reduction were analyzed. Results: Mean LT across the cohort was 4.53 mm. Greater LT was consistently associated with increased postoperative IOP reduction across all surgical groups. Eyes with LT ≥4.5 mm demonstrated greater IOP reduction compared to those with LT ≤4.2 mm (2.63 ± 4.59 mmHg vs 1.19 ± 4.10 mmHg). Those with LT between 4.2-4.5 saw an average IOP reduction of -2.04 ± 3.80 mmHg. Combined procedures yielded greater IOP reduction than cataract surgery alone, with the largest decrease observed in the Ahmed group (−4.56 mmHg, 25%). Cataract surgery alone produced significant but smaller IOP reductions (−1.58 mmHg, 11%) and the greatest improvement in visual acuity. Medication burden decreased substantially in combined groups (80% in goniotomy, 47% in Ahmed). Patients with angle-closure glaucoma exhibited the highest LT. Stratification using the Laroche Glaucoma Risk Calculator showed that high-risk patients experienced greater IOP reduction following cataract surgery compared to low-risk patients (2.4 mmHg vs 1.09 mmHg, both statistically significant). Conclusions: Increased lens thickness may be associated with greater postoperative IOP reduction following both cataract and combined cataract–glaucoma surgery, showing its potential as a predictive biomarker. Combined procedures provide superior IOP and medication burden reduction, while cataract surgery alone offers meaningful benefit, particularly in high-risk patients. Incorporating LT analysis and the Laroche Glaucoma Calculator into preoperative assessment may improve surgical planning and outcome prediction, especially in underserved populations disproportionately affected by glaucoma.

Abstract: Tear film instability and dry eye disease (DED) are among the most common postoper-ative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all alter ocular surface homeostasis through mechanisms including corneal denervation, inflammation, loss of goblet cells, and meibomian gland dysfunction. However, the severity and duration of postoperative dry eye vary significantly depending on the procedure performed. This comprehensive review of the literature summarises current evidence on pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Proce-dure-specific recovery trajectories are compared, distinguishing transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy are also reviewed. Understanding these distinct re-covery patterns allows for better surgical planning, improved patient counselling, and earlier intervention to reduce chronic postoperative dry eye and improve visual outcomes and patient satisfaction.

Abstract: Background: Epiretinal membrane (ERM) is a fibrocellular preretinal proliferation composed of fibroblasts, glial cells, and hyalocytes overlying the internal limiting membrane. Pars plana vitrectomy (PPV) with membrane peeling is the standard surgical treatment, but postoperative cystoid macular edema (CME) can limit visual recovery. Inflammation plays a key role in CME pathogenesis, and corticosteroids may help reduce the inflammatory response associated with both ERM-related traction and surgical trauma. Therefore sustained-release dexamethasone (DEX) intravitreal implants have been investigated as an adjunct to surgery. Methods: A narrative review of the literature was conducted using PubMed and Embase databases up to January 2025. Studies evaluating DEX implants in conjunction with PPV and ERM peeling were included. Both prospective and retrospective clinical studies were considered, in accordance with SANRA recommendations. Results: DEX implantation appears to promote faster resolution of postoperative inflammation and CME, with consistent improvements in anatomical parameters such as central macular thickness. However, the impact on visual acuity remains variable, with some studies reporting earlier functional recovery and others showing no significant long-term benefit. Reported adverse events mainly include intraocular pressure elevation manageable with medical therapy and cataract progression. Conclusions: DEX implant appears to be a safe and potentially effective adjunct to PPV with membrane peeling for ERM, particularly in high-risk eyes, although further large, prospective randomized studies are needed to better define its role.

Abstract: Background and Objective: Treat-and-extend(TREX) dosing is widely used for anti-VEGF therapy in macular disease but no principled basis exists for choosing interval-change rules. We frame TREX as a threshold-search problem and compare rules in terms of search efficiency and overshoot.Patients and Methods: A deterministic model represented TREX as a threshold search for the true maximum dry interval(T_max) on a 1-week grid(4–16 weeks). Four rules were evaluated:+2/−2,+4/−2,+4/−4 with midpoint refinement, and a midpoint binary-like rule. Visits to maintenance interval and overshoot metrics were calculated for each rule and T_max.Results: No single rule was optimal. The +2/−2 rule minimised overshoot (maximum 2 weeks) but required most visits. The +4/−2 rule was fastest. In long-durability eyes, midpoint search matched +4/−2 in speed with overshoot comparable to +2/−2.Conclusion: Framing TREX as a threshold search makes the speed-overshoot trade-off explicit and provides a principled basis for choosing and justifying interval-change rules.

Abstract: Introduction: Transepithelial photorefractive keratectomy (Trans-PRK) offers superior re-epithelialization and visual recovery. This study evaluates the impact of preoperative refractive status on clinical outcomes and identifies prognostic factors across varying myopic severities. Methods: This retrospective observational study included 125 eyes [64 patients; age > 20 years; best-corrected visual acuity (BCVA) ≥ 20/25] that underwent Trans-PRK between March and December 2022. Patients were stratified into low myopia (LM: > -5.0 D), moderate-to-high myopia (MHM: ≤ -5.0 D to > -8.0 D) extremely high myopia (EHM: ≤ -8.0 D) groups. Analysis focused on preoperative refraction, intraoperative parameters, postoperative uncorrected visual acuity (UCVA) and corneal conditions of superficial punctate keratitis (SPKs) and haze. Results: The mean age was 30.20 ± 6.34 years, with a mean initial manifest sphere (MS) of -6.42 ± 2.27 Diopter (D) overall and -3.73 ± 0.15 D, -6.28 ± 0.13 D and -9.17 ± 0.15 D in the LM, MHM and EHM groups, respectively. At a mean follow-up of 6.69 ± 3.73 months, the overall mean final manifest spherical equivalent (MSE) was -0.12 ± 0.73 D and mean final UCVA was 0.01 [Snellen equivalent (SE), 205/200] ± 0.08 logMAR. Predictability was 94.4%, 88.88% and 94.3% for the final MS ≤ -1.0 D, final MSE ≤ -1.0 D and UCVA ≥ 0.8, respectively. In the LM and MHM groups, cycloplegic and subjective refractions showed the highest concordance with emmetropia, whereas initial manifest refractions were most accurate for the EHM group. Corneal SPK incidence declined from 32.2% (1 month) to 1.6% (6 months), primarily localized to EHM eyes. Corneal haze peaked at 28.2% at three months before receding to 9.4% by 6 months. Conclusions: Refractive and visual stability were achieved by the third month for the LM and MHM groups, whereas the EHM group required six months to reach both refractive and visual plateaus. Despite transiently higher rates of corneal SPKs and haze in EHM eyes, final visual outcomes remained excellent (UCVA 18/20).

Abstract: Photoreceptor (PR) degeneration is a shared pathological feature of multiple blinding retinal diseases. This review examines the mechanisms underlying PR vulnerability to lipid-peroxidation-driven injury, with emphasis on three interconnected features: the marked enrichment of docosahexaenoic acid (DHA) and other polyunsaturated fatty acids (PUFAs) in PR outer-segment disc membranes; the chronically high metabolic demand of PRs and the specialized spatial organization of their mitochondria; and retinal pigment epithelium (RPE)–PR metabolic coupling, including outer-segment renewal and phagocytic turnover, glucose transport and lactate shuttling, and the visual cycle. We also summarize antioxidant defense systems centered on the cystine/glutamate antiporter (xCT)–glutathione (GSH)–glutathione peroxidase 4 (GPX4) axis and mitochondrial GPX4 (mtGPX4), which restrict iron-dependent lipid peroxidation in PRs. We propose that highly oxidizable membrane lipid substrates, mitochondrial homeostatic imbalance, and impaired RPE–PR metabolic coupling may collectively shape PR susceptibility to ferroptosis-associated injury. From a therapeutic perspective, this framework supports multitarget strategies designed to interrupt lipid-peroxidation propagation, stabilize mitochondrial redox homeostasis and quality-control mechanisms, and restore RPE–PR metabolic support and local iron-buffering capacity.