Early-onset eyelid basal cell carcinoma (BCC) is uncommon, and it remains unclear whether younger patients exhibit distinct tumor characteristics, risk-factor profiles, or postoperative outcomes compared with older patients. This retrospective cohort included 268 patients with histologically confirmed eyelid BCC. Patients were stratified by age at surgery (< 40 vs. ≥ 40 years). Demographic risk factors, tumor characteristics, surgical margins, reconstruction, and follow-up outcomes were compared. The primary outcome was crude local recurrence during follow-up. Sequential Firth penalized logistic regression evaluated age < 40 years with adjustment for histological subtype and clinical and surgical characteristics. Of 268 patients enrolled in the study, 45 were aged < 40 years and 223 were ≥ 40 years. Younger patients more often were female (64.4
Penetrating keratoplasty has long been the standard treatment for many corneal pathologies, but interest has grown in less invasive, tissue-sparing alternatives. Bowman’s layer (BL) and Descemet’s membrane (DM) transplantation are two anterior approaches that use isolated acellular corneal layers to restore structural support and promote epithelial healing, while avoiding many of the limitations of full-thickness grafting. Although both techniques have been described for ectatic disorders, their theoretically low immunogenicity, minimal long-term steroid requirements, and capacity to support reepithelialization make them appropriate options for a range of nonectatic indications. This narrative review describes the application of BL (11 studies) and DM (3 studies) allografts for nonectatic corneal disease, including their surgical techniques, clinical outcomes, and complications. BL allograft studies consisted of 9 case reports (1−3 cases each) and two cohort studies (22 cases and 30 cases), while DM allograft studies included 2 case reports (1 case each) and one large cohort study (99 cases). Across the reviewed literature, both procedures appeared to be associated with complete reepithelialization for the majority of patients, clinically meaningful improvements in visual acuity in patients without visual comorbidities, and few significant complications. Decellularized BL and DM allograft transplantation represent valuable additions to the growing collection of minimally invasive, tissue-sparing approaches for anterior corneal disease, and continued study is warranted to better define their respective roles for nonectatic indications.
Clinical trials evaluating investigational drugs for dry eye disease (DED) frequently employ vehicle comparators that include excipients (polymers, cyclodextrins, and oil-in-water emulsions) known to have palliative effects. When a saline-based vehicle without any palliative excipient is used as the comparator, the investigational drug only needs to show superiority over a minimally active control to achieve the trial's primary endpoint. Lifitegrast 5
Laser-based repeated low-level red-light (RLRL) therapy may slow myopia progression, but evidence for lower-intensity noncoherent photobiomodulation-based light-emitting diode (PBM-LED) therapy remains limited. We evaluated its short-term efficacy and safety in children with myopia. In this single-center, double-masked, sham-controlled exploratory trial, 40 children aged 8–12 years were randomized 1:1 to PBM-LED or sham treatment twice daily for 3 months. Primary outcomes were axial length (AL) and cycloplegic spherical equivalent (SE). All participants completed follow-up. In eye-specific analyses, the intervention group showed less axial elongation, with significance only in the left eye at 3 months (difference, −0.056 mm; 95
Although the comparative efficacy of interventions for pediatric myopia control has been explored, the trade-off between on-treatment efficacy and post-treatment rebound remains unclear. We evaluated the comparative efficacy and durability of effect of low-dose atropine (LDA, <0.1
Visual fatigue is becoming increasingly prevalent globally, while universally accepted definitions and standardized diagnostic criteria remain lacking. This study aims to develop consensus-based recommendations on the definition, diagnostic criteria, core symptoms, risk factors, and assessment of visual fatigue, using a modified Delphi process to support standardized clinical and epidemiologic practice. A modified Delphi process was conducted with an international panel of experts in optometry, ophthalmology, and related disciplines. Two rounds of questionnaires were used to generate candidate definitions, diagnostic criteria, symptoms, risk factors, assessment methods and management principles. A subsequent hybrid meeting was held to discuss unresolved items and consolidate the final recommendations. Of 20 experts invited, 14 participated in the panel (response rate 70
Postoperative dry eye can impair visual recovery and patients’ perceived benefit after cataract surgery. We compared topical eye-drop regimens across tear-film stability, tear secretion, corneal epithelial damage, and patient-reported symptoms. A PROSPERO-registered review searched nine databases from inception to January 30, 2026, for randomized trials of ocular-surface treatments after cataract surgery. Frequentist random-effects network meta-analyses assessed 1-month tear-film breakup time, Schirmer test, corneal fluorescein staining, and Ocular Surface Disease Index; safety was summarized descriptively. Forty-seven trials (102 arms; 4920 eyes assessed; 4844 arm-level analyzed observations) were included; 38 trials (81 arms; 3898 analysis units) contributed to network meta-analyses within a 19-node framework. Compared with routine postoperative care, moderate-confidence evidence indicated greater tear-film breakup time with diquafosol plus hyaluronic acid (mean difference 4.17 s, 95
We aimed to evaluate long-term graft survival following penetrating keratoplasty (PKP) in eyes with preoperative corneal neovascularization (CorNV), and to assess the impact of the extent of CorNV on graft outcomes. This was a retrospective longitudinal study. Patients with preoperative CorNV who underwent PKP between 2003 and 2024 were included. Demographics, underlying pathology, and CorNV stage (clock-hour extent) and depth were recorded at baseline before PKP. Visual acuity and endothelial cell density (ECD) were assessed during follow-up. Kaplan–Meier survival analysis and Cox proportional hazards models were used to identify risk factors for graft failure. Graft failure was set as primary outcome. A total of 80 eyes were included (mean age 55 ± 16 years; 42 male, 53
This study is a retrospective observational study to evaluate the effects of intravitreal faricimab on choriocapillaris perfusion in diabetic macular edema (DME) using optical coherence tomography angiography (OCTA) and to investigate the relationship between changes in choriocapillaris flow void (CCFV) and visual outcomes. Eyes with center-involved DME that received four consecutive monthly intravitreal faricimab injections were included. OCTA (Solix FullRange®) was obtained within 1 month before the first injection and 1 month after the fourth injection. The choriocapillaris (CC) slab was segmented per device default, and CCFV was quantified after Phansalkar local thresholding. Additional metrics included central retinal thickness (CRT), subfoveal choroidal thickness (sfChT), and choroidal vascularity index in Sattler’s (CVI_S) and Haller’s layers (CVI_H). Pre/post differences were tested with paired t-tests, and Pearson correlation analyses were performed to assess the associations of changes in CCFV with changes in structural optical coherence tomography (OCT) parameters and best-corrected visual acuity (BCVA). Thirty eyes were analyzed. Mean CCFV decreased from 53.35 to 48.89
Thyroid-associated orbitopathy (TAO) often causes restrictive strabismus and diplopia. Large-angle deviations pose particular challenges owing to extraocular muscle fibrosis and unpredictable surgical dose–response. Although combined orbital decompression and strabismus correction has been proposed to reduce the number of procedures, its effectiveness in large-angle TAO remains uncertain. This study aimed to evaluate the outcomes of combined orbital decompression and rectus muscle myectomy in this population. In this retrospective cohort study, 88 patients with TAO-associated strabismus > 25 prism diopters (PD) underwent either staged (step) surgery (n = 42) or combined surgery (n = 46) at a tertiary center between 2018 and 2022. All had stable thyroid function for ≥ 6 months before surgery. The combined procedure involved simultaneous orbital decompression and rectus myectomy. Outcomes included deviation angles, Hertel exophthalmometry, and the field of binocular single vision (BSV). Baseline characteristics were comparable between groups. Postoperatively, the combined-surgery group had smaller residual horizontal and vertical deviations—median 0 (0–3) and 2 (0–3) PD—than the step group, 5 (4–5) and 3 (3–5) PD (all p < 0.001). The BSV field was wider after combined surgery [410 (396–426)° versus 360 (328–386)°, p < 0.001]. Overall success rates (≤ 5 PD deviation in primary and reading positions) were similar (84.8
This study evaluates visual and refractive outcomes of our initial experience using ray-tracing-guided Wavelight Plus (WLP) LASIK and SMILE Pro KLEx carried out by one surgeon at a single center. A retrospective, non-randomized study was conducted at one refractive surgery center. Patients undergoing WLP or SMILE Pro with at least 1 month of postoperative follow-up were included. Outcomes were assessed at 1 and 3 months and included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), safety and efficacy indices, and vector analysis of astigmatism. Additionally, a comparison with wavefront-optimized (WFO) LASIK, an established procedure with a well-refined nomogram at the study center, was provided as an internal benchmark. A total of 160 eyes from 93 patients were analyzed, including 50 eyes treated with WLP, 55 with SMILE Pro, and 55 with WFO. WLP demonstrated significantly better UDVA than SMILE Pro at both 1 month (p < 0.001) and 3 months (p = 0.033) and was more likely to achieve a UDVA of 20/20. Residual astigmatism was significantly lower in the WLP group than in both the WFO and SMILE Pro groups at 1 and 3 months (all p < 0.001). Vector analysis showed a correction index of 1.13 for SMILE Pro, 1.11 for WFO, and 1.08 for WLP at 3 months. In our initial experience with the WLP and SMILE Pro platforms, WLP achieved better UDVA and more precise astigmatic correction compared with SMILE Pro. Additionally, WLP, without the use of a nomogram, had comparable safety and efficacy outcomes to WFO. Based on our initial experience at one center, astigmatic correction appears to be a limiting factor for KLEx platforms in achieving outcomes similar to modern LASIK platforms.
Diabetic macula edema (DME) is a leading cause of vision loss among people with diabetes and requires long-term management strategies that balance efficacy, safety, and durability. Although antivascular endothelial growth factor (VEGF) therapies have improved outcomes, challenges remain in achieving sustained disease control and reducing intravitreal injection frequency. Faricimab is a dual angiopoietin-2/anti-VEGF-A inhibitor designed for intraocular use, which targets the vascular and inflammatory components of DME. The phase 3 YOSEMITE and RHINE clinical trials demonstrated the efficacy, durability, and safety of faricimab throughout 2 years in treatment-naive and previously treated patients with DME. RHONE-X (NCT04432831) was a phase 3, multicenter, nonrandomized, open-label extension trial of the YOSEMITE/RHINE clinical trials that assessed the long-term safety and efficacy of faricimab treat-and-extend (T E) for an additional 2 years. In this podcast, two retina specialists, Dr. Veeral Sheth (USA) and Dr. Stela Vujosevic (Italy), discuss the outcomes of faricimab after 4 years in DME and the implications on clinical practice. The speakers note that faricimab was well tolerated throughout 2 years of RHONE-X with a safety profile consistent with that observed during 2 years in YOSEMITE/RHINE. Furthermore, vision and anatomical improvements achieved during YOSEMITE/RHINE were maintained through the RHONE-X study, while treatment burden was eased with approximately 80
To report the visual, refractive, astigmatic, and ocular higher-order aberration (HOA) outcomes of keratorefractive lenticule extraction (KLEx) with the SCHWIND ATOS femtosecond laser platform in a large single-surgeon cohort. In this retrospective consecutive series, 2518 eyes of 1292 patients underwent single-surgeon KLEx (SmartSight procedure, SCHWIND ATOS platform) for myopia or myopic astigmatism. Data from two treatment workflows were pooled: the original SmartSight lenticule workflow (1886 eyes) and, from 2025, SmartSight NOVA with CenTrax-assisted centration (632 eyes); workflow-stratified outcomes are reported separately in Table 4. Refraction, uncorrected and corrected distance visual acuity ( (UDVA and CDVA, respectively), and pyramidal-wavefront aberrometry (OSIRIS-T corneal topographer and ocular aberrometer; 4 and 6 mm) were recorded for 12 months of follow-up (primary; 3 months secondary). The target was emmetropia; astigmatism used the Alpins vector method. Denominators were endpoint specific, and inference was clustered by patient. Mean preoperative spherical equivalent (SEQ) was − 3.86 ± 1.93 diopters (D). At 12 months post-procedure, in 830 eyes with a complete acuity record and 930 with paired SEQ, mean SEQ was − 0.04 ± 0.31 D, with 92.9
INTRODUCTION:This study aimed to compare the effects of three dosing frequencies of 0.05% atropine on the ocular surface in children with myopia. METHODS:In this sub-analysis of a randomized controlled trial, children with myopia (aged 6-14 years) were randomized to 0.05% atropine once daily (Qd), twice weekly (Biw), or once weekly (Qw). Objective parameters, including noninvasive tear breakup time (NIBUT), tear meniscus height (TMH), lipid layer thickness (LLT), incomplete blink rate (IBR), and bulbar conjunctival hyperemia index (BCHI), were assessed at baseline, 2 weeks, and 12 months. Subjective symptoms were evaluated using the Ocular Surface Disease Index (OSDI). RESULTS:Among 130 children (260 eyes) completing objective assessments (Qd: n = 43; Biw: n = 49; Qw: n = 38), a representative subset of 78 completed the OSDI questionnaire. Dosing frequency had no differential effect on any outcome (time-by-group interaction: all P > 0.05). Across all groups, first and average NIBUT increased significantly from baseline through 12 months (P < 0.001), with a shift toward less severe dry eye grades (P < 0.001). IBR decreased, indicating improved blink quality (P < 0.001) and BCHI decreased by 12 months (P = 0.001). LLT increased transiently at 2 weeks (P = 0.003), while TMH remained stable (P = 0.712). OSDI scores remained stable, with no significant differences among regimens (P = 0.193). CONCLUSIONS:During the 12-month follow-up period, ocular surface parameters and subjective symptoms remained comparable among the three 0.05% atropine dosing regimens, with no evidence of clinically significant deterioration. TRIAL REGISTRATION:ChiCTR2100043506.
This study aimed to quantify changes in corneal astigmatism, thickness, and corneal higher-order aberrations after instilling a tear-enhancing drop (Systane Hydration Ultra, SHU) or 0.9 Overall, the induced change in TCA exceeded 0.50 D in 18
Geographic atrophy (GA) can place substantial physical and emotional burdens on affected individuals, related to both the disease and its treatment. Here, we provide insights into the perspectives of a patient with GA and retina specialists around GA diagnosis, treatment, communication, and needs. Unstructured qualitative interviews were conducted with a patient author with GA and two retina specialist authors involved in the management of GA. The authors discussed early GA symptoms, its diagnosis and management, treatment experience, support, and education. Several themes emerged. A GA diagnosis can be emotionally distressing and difficult for patients to accept. The reality is that although current treatments delay progression of further visual impairments, these therapies do not restore lost vision. Current GA treatments are associated with frequent clinic visits and intravitreal injections that can lead to discomfort and temporary visual disturbances, which are disruptive to daily life. Physicians also noted a lack of clinical endpoints for guiding optimal dosing. The importance of patient–physician communication in the management of GA was highlighted, focusing on an approach that incorporates the emotional and practical needs of patients. Physicians play a central role in ensuring treatment compliance to minimize further vision loss. Peer support is also invaluable for sharing experiences, treatment expectations, and reassurance. Finally, patient and provider suggestions for improving outcomes for people with GA were discussed, including access to patient-focused educational materials on GA and treatment, development of tangible endpoints in clinical trials, and facilitation of peer support. All authors supported the development of long-acting formulations, systemic medications, or optimally a cure, to reduce treatment burden. GA and its treatment place a substantial burden on patients. Multiple opportunities remain to improve the experiences of people with GA and empower patients to understand their condition and treatment, which ultimately could improve their outcomes. Audio feature available for this article.
Breakdown of the blood–retinal barrier (BRB) is implicated in many blinding retinal diseases, including diabetic macular edema, neovascular age-related macular degeneration, and retinal vein occlusion. Anti-vascular endothelial growth factor (anti-VEGF) therapies or laser photocoagulation are currently the standard of care for retinal diseases that are characterized by breakdown of the vascular barrier function and vascular hyperpermeability. However, inadequate response to anti-VEGF therapy is seen in a substantial proportion of patients and laser photocoagulation does not restore vision loss and can lead to collateral damage of the retina. Thus, new therapeutic targets are needed. The β-catenin-dependent wingless-related integration site (Wnt) signaling pathway plays a critical role in inner BRB development and maintenance. There are several potential therapeutics for retinal vascular diseases targeting the Wnt/β-catenin pathway under investigation, including several in preclinical development and one (MK-3000; also known as Restoret and formerly EYE103) with early clinical trial results advancing to late-stage clinical development. In this narrative review we examine the role of Wnt/β-catenin signaling in inner BRB maintenance and in retinal vascular diseases, as well as the potential for Wnt pathway agonism as a therapeutic approach.
Endophthalmitis is a severe, sight-threatening intraocular infection that may follow ophthalmic procedures or arise endogenously. Since the Endophthalmitis Vitrectomy Study (EVS, 1995), surgical and antimicrobial strategies have evolved. This study aimed to evaluate treatment approaches, microbial spectrum, and outcomes of endophthalmitis cases at the University Eye Clinic Innsbruck over the past decade. A retrospective observational cohort analysis of all patients treated for endophthalmitis between January 2013 and December 2023 was conducted. Cases were categorized as exogenous, endogenous, or keratitis-related. Data on etiology, treatment, time to intervention, microbial isolates, and best-corrected visual acuity (BCVA, logMAR) were assessed. Treatment included tap and inject, pars plana vitrectomy (PPV) within 24 h after presentation, or delayed surgery. Regression analyses identified predictors of visual outcome and re-intervention. A total of 118 eyes from 110 patients (median age 72 years) were included. Exogenous cases accounted for 60.2
