Manchester Royal Eye Hospital is an ophthalmic hospital in Oxford Road, Manchester, England, managed by the Manchester University NHS Foundation Trust. It is on the same site as Manchester Royal Infirmary and St Mary's Hospital for Women and Children.
The International Society for Clinical Electrophysiology of Vision (ISCEV) Standard for full-field electroretinography (ERG) describes a minimum procedure, but encourages more extensive testing. This ISCEV extended protocol describes an extension to the full-field ERG Standard, namely the ERG responses to silent substitution stimuli that are directed at the response modulation of single photoreceptor types. The method can be used to detect selective defects in distinct photoreceptor types and post-receptoral retinal pathways. This document, based on existing literature, provides protocols for recording and analyzing the responses to a single class of photoreceptor directed stimuli. For each photoreceptor type (rods, L-, M- and S-cones), optimal luminance conditions and temporal frequencies for Ganzfeld recordings are provided. The exact stimulus conditions depend on the spectral properties of the stimulator. An accompanying technical report describes an app that is meant to provide support in calculating stimuli for individual stimulators.
Background: African-derived populations are disproportionately affected by primary open-angle glaucoma (POAG) and face increased risks of surgical failure due to anatomical and genetic factors. This report identifies challenges in glaucoma care and strategies to optimize surgical outcomes in patients from African-derived backgrounds. Methods: Six UK-based consultant ophthalmic glaucoma surgeons with extensive experience in diverse patient populations convened to discuss challenges and key approaches for optimising glaucoma filtration surgery outcomes in African-derived populations. Their opinions were supplemented by published literature to propose tailored recommendations and address some of the known challenges in this important patient group. Results: Surgical treatment of glaucoma among African-derived populations includes challenges such as Tenon's thickness, variable wound healing, and an increased risk of scarring. Preoperatively, outcomes can be improved through patient education, counselling and ocular surface optimisation, including reduction of preservative exposure. Intraoperatively, surgeons may consider the use of general anaesthesia or conscious sedation in younger patients, higher or prolonged mitomycin C exposure tailored to individual risk, and separate closure of Tenon's capsule and conjunctiva to reduce bleb failure. Proactive postoperative care should include intensified steroid regimens and 5-fluorouracil use when indicated. Conclusion: These insights support the delivery of culturally informed, evidence-based glaucoma care tailored to patients from African-derived backgrounds. By adopting a personalised and proactive approach, healthcare professionals may achieve more consistent and favourable surgical outcomes in this high-risk group.
Aim and background:To describe a case of Preserflo MicroShunt implantation in both eyes of a patient with intraocular pressure (IOP) rise after receiving bilateral Descemet's stripping automated endothelial keratoplasty (DSAEK), with poor IOP control by medical treatment alone. Case description:A female patient, previously diagnosed with primary open-angle glaucoma (POAG) and Fuchs' corneal dystrophy in both eyes, developed bilateral bullous keratopathy in late 2021. The patient underwent combined DSAEK and cataract surgery in her right eye (RE) in December 2021 and in April 2022 in her left eye (LE). After the surgical procedures, we observed an IOP rise not controlled by medical treatment. Bilateral Preserflo MicroShunt implantation was chosen as the surgical option to reduce the IOP increase and was performed in June 2022 in the LE and in July 2022 in the RE. The Preserflo MicroShunt implantation was successful in reducing the IOP in both eyes after bilateral DSAEK without the need for any additional hypotonic medical treatment. We observed good positioning of the device and the maintenance of corneal graft transparency and adhesion in both eyes after a 6-month follow-up from the most recent procedure. Conclusion:Preserflo MicroShunt has the potential to be a safe and effective technique in cases of IOP increase after endothelial keratoplasty. Further investigations with larger patient samples are required to validate our findings. Clinical significance:IOP elevation after corneal transplantation can pose a challenge in the postoperative period and may lead to the need for glaucoma surgery. Our report on a case of bilateral Preserflo implantation after DSAEK highlights the potential benefits of this relatively new glaucoma surgical technique in the management of these patients. How to cite this article:Della Lena F, Boni N, Messina M, et al. Bilateral Preserflo MicroShunt Implantation after Descemet's Stripping Automated Endothelial Keratoplasty: A Case Report. J Curr Glaucoma Pract 2026;20(1):34-37.
We describe a case of the recently described MEWDS like retinopathy in a patient with active PEHCR and history of bilateral non-arteritic ischaemic optic neuropathy (NAION). This patient was an 83-year-old man with a known history of PEHCR not requiring treatment and sequential NAION. He presented to the emergency eye services complaining of left eye (LE) reduced vision. Cystoid macular oedema (EMC) was noted. There were multiple hyper-autofluorescent dots within the macula which corresponded to subretinal hyper-reflective deposits on optical coherence tomography (OCT). The patient was observed with partial resolution of deposits and complete resolution of EMC noted 4 months following his initial presentation.
Importance:There is an increasing amount of literature evaluating the clinical knowledge and reasoning performance of large language models (LLMs) in ophthalmology, but to date, investigations into its multimodal abilities clinically-such as interpreting images and tables-have been limited. Objective:To evaluate the multimodal performance of the following 7 foundation models (FMs): GPT-4o (OpenAI), Gemini 1.5 Pro (Google), Claude 3.5 Sonnet (Anthropic), Llama-3.2-11B (Meta), DeepSeek V3 (High-Flyer), Qwen2.5-Max (Alibaba Cloud), and Qwen2.5-VL-72B (Alibaba Cloud) in answering offline Fellowship of the Royal College of Ophthalmologists part 2 written multiple-choice textual and multimodal questions, with head-to-head comparisons with physicians. Design, Setting, and Participants:This cross-sectional study was conducted between September 2024 and March 2025 using questions sourced from a textbook used as an examination preparation resource for the Fellowship of the Royal College of Ophthalmologists part 2 written examination. Exposure:FM performance. Main Outcomes and Measures:The primary outcome measure was FM accuracy, defined as the proportion of answers generated by the model matching the textbook's labeled letter answer. Results:For textual questions, Claude 3.5 Sonnet (accuracy, 77.7%) outperformed all other FMs (followed by GPT-4o [accuracy, 69.9%], Qwen2.5-Max [accuracy, 69.3%], DeepSeek V3 [accuracy, 63.2%], Gemini Advanced [accuracy, 62.6%], Qwen2.5-VL-72B [accuracy, 58.3%], and Llama-3.2-11B [accuracy, 50.7%]), ophthalmology trainees (difference, 9.0%; 95% CI, 2.4%-15.6%; P = .01) and junior physicians (difference, 35.2%; 95% CI, 28.3%-41.9%; P < .001), with comparable performance with expert ophthalmologists (difference, 1.3%; 95% CI, -5.1% to 7.4%; P = .72). GPT-4o (accuracy, 69.9%) outperformed GPT-4 (OpenAI; difference, 8.5%; 95% CI, 1.1%-15.8%; P = .02) and GPT-3.5 (OpenAI; difference, 21.8%; 95% CI, 14.3%-29.2%; P < .001). For multimodal questions, GPT-4o (accuracy, 57.5%) outperformed all other FMs (Claude 3.5 Sonnet [accuracy, 47.5%], Qwen2.5-VL-72B [accuracy, 45%], Gemini Advanced [accuracy, 35%], and Llama-3.2-11B [accuracy, 25%]) and the junior physician (difference, 15%; 95% CI, -6.7% to 36.7%; P = .18) but was weaker than expert ophthalmologists (accuracy range, 70.0%-85.0%; P = .16) and trainees (accuracy range, 62.5%-80%; P = .35). Conclusions and Relevance:Results of this cross-sectional study suggest that for textual questions, current FMs exhibited notable improvements in ophthalmological knowledge reasoning when compared with older LLMs and ophthalmology trainees, with performance comparable with that of expert ophthalmologists. These models demonstrated potential for medical assistance for answering ophthalmological textual queries, but their multimodal abilities remain limited. Further research or fine-tuning models with diverse ophthalmic multimodal data may lead to more capable applications with multimodal functionalities.
