The prevalence of incidental intraocular malignancy in eye removal cases due to phthisis bulbi remains poorly understood. This retrospective study evaluates the prevalence of unsuspected intraocular malignancies in eye removal specimens. Retrospective study of 1897 evisceration and enucleation specimens submitted for histopathological examination in the UK between 2014 and 2023 submitted to Department of Eye Pathology (DEP), a laboratory within the National Specialist Ophthalmic Pathology Service (NSOPS). Among 664 cases meeting inclusion criteria, the incidence of unsuspected malignancy was 0.75
Purpose:To assess the impact of cigarette smoking on corneal endothelial cell density (ECD), central corneal thickness (CCT), and endothelial morphology following cataract surgery in older adults, and to determine whether smoking independently predicts postoperative endothelial cell loss. Methods:Prospective, observational cohort study conducted at the Institute of Ophthalmology, University of Modena and Reggio Emilia. Patients over 40 years of age undergoing cataract surgery were enrolled and classified as smokers or non-smokers. ECD, CCT, polymegathism, and pleomorphism were assessed preoperatively and at 1 and 3 months postoperatively using specular microscopy. Smoking exposure was quantified in Pack-Years. Statistical analyses included Student's t-tests, multivariate linear regression, and Cohen's d for effect size estimation. Results:A total of 80 eyes from 80 patients were analyzed. Smokers had significantly lower baseline ECD (2294.8 vs 2523.9 cells/mm2; p = 0.0005) and greater CCT (556.2 vs 538.4 µm; p = 0.004) compared to non-smokers. Postoperative ECD loss was significantly greater in smokers at 1 and 3 months (p < 0.001), with increased CCT and more severe morphological changes. Multivariate analysis confirmed smoking as an independent predictor of endothelial loss (β = -0.48; p < 0.001). The effect size for ECD reduction was large (Cohen's d = 1.2). Conclusion:Cigarette smoking is associated with accelerated endothelial cell loss and impaired corneal recovery after cataract surgery. Smoking history should be systematically incorporated into preoperative risk assessments and patient counseling, with consideration for enhanced perioperative monitoring in smokers.
Telemedicine is rapidly expanding in eye care, yet evidence on patient satisfaction and perceived quality is limited, restricting wider clinical adoption and integration. This study aimed to: i) compare satisfaction rates in tele-ophthalmology versus in-person eye care; ii) assess overall patient satisfaction within tele-ophthalmology services. This systematic review was prospectively registered in PROSPERO (International Prospective Register of Systematic Reviews ID: CRD420251218938). We used random-effects meta-analyses to pool comparative satisfaction odds ratios (tele-ophthalmology vs. in-person care) and to calculate overall tele-ophthalmology satisfaction proportions. Heterogeneity was quantified using the I2 statistic. We included 41 studies encompassing 24,595 participants. Five studies reporting patient satisfaction in telemedicine vs in-person revealed comparable satisfaction rates (OR = 0.98; 95% CI = 0.36; 2.65, p = 0.95). Across all telemedicine studies (n = 36), the pooled satisfaction rate was high 93.5% (95% CI = 90.8, 95.5) with comparable rates across different tele-ophthalmology models [( χ 2 = 0.99 , d f = 2 , p = 0.61 ), asynchronous (94.6%), synchronous (92.1%) and hybrid (93.8%)]. While general acceptability for telemedicine was high 92.0%, participants were more likely to recommend telemedicine service (94.9%) than to reuse it in the future (84.0%). No publication bias was found (p > 0.05). Patient satisfaction in tele-ophthalmology is high and appears to be comparable to standard in-person care. However, considerable variability between studies highlights the need for validated and standardised measures for patient satisfaction. Furthermore, lower intention rates for future use underscore the need to address potential systemic gaps, such as digital illiteracy, to sustain long-term adoption.
Artificial intelligence holds the potential to transform ophthalmic assessment, yet its translation into clinical practice remains hindered by its limited ability to perform complex reasoning, utilize specialized tools, or provide transparent justifications. We introduce OphAgent, a multi-agent framework powered by large language models that mimics clinical workflows through dynamic diagnostic planning, knowledge base consultation, and multimodal image interpretation via structured inter-agent debate. Validated across four imaging modalities, 30+ conditions, and 11 diverse real-world datasets, OphAgent achieved 85% average accuracy in retinal diagnosis, surpassing current state-of-the-art multimodal large language models. In a large-scale global reader study with 311 ophthalmologists from 86 centres across 22 countries, spanning seven languages and settings from tertiary hospitals to resource-limited clinics, OphAgent improved diagnostic accuracy by up to 20% across 14 clinically significant tasks. Critically, these gains remained stable across geographic regions, experience levels, and languages, demonstrating robustness, fairness, and generalisability. OphAgent exemplifies an emerging paradigm where medical AI evolves from isolated prediction to collaborative clinical reasoning. By integrating reasoned clinical consultation with state-of-the-art diagnostic performance, the framework offers a scalable pathway toward more equitable, transparent, and trustworthy AI-enabled clinical decision support, with the potential to extend expert-level ophthalmic assessment across diverse healthcare settings.
We present a case of masquerade syndrome secondary to choroidal melanoma, which is a rare presentation of this condition. A 73-year-old patient presented to the emergency department with a history of unilateral red, painful eye, and severe reduction in visual acuity. A Masquerade syndrome was diagnosed after slit lamp examination, and ultrasonography revealed findings suggestive of choroidal melanoma. Metastasis were ruled out, Enucleation was performed, and Histopathological results were consistent with choroidal melanoma without scleral invasion or extraocular extension. This case illustrates an unusual form of presentation for an uncommon pathology, consideration of this syndrome is of utmost importance due to a delayed diagnosis may have significant repercussions on patient mortality.
