Introduction Outpatient cataract surgery is one of the most frequently performed surgical procedures worldwide. Reducing its carbon footprint without compromising hygiene and patient safety offers substantial potential for mitigating healthcare-related greenhouse gas emissions. This multicentre study quantified the carbon footprint of outpatient cataract surgery across ten heterogeneous German tertiary centres and examined inter-centre variability in emissions as well as the extent to which current data support transparent, standardised reporting. Methods Between December 2022 and March 2023, standardised on-site assessments collected data on staff and patient travel, electricity consumption, disposable material use, and waste generation. Data were converted into carbon dioxide equivalents (CO₂e) using emission factors from national environmental agencies. Since detailed life cycle and sterilisation data could not be obtained for instrument manufacture and reprocessing, these components were modelled for all centres. Results The centres showed substantial inter-site variation in all major emission categories. Disposable materials (2.53-8.30 kg CO2e) and sterilisation (2.62-7.13 kg CO2e) were the dominant contributors, together accounting for 56.6-84.6% of total emissions. Electricity use contributed 1.0% to 18.5%, whereas waste disposal remained low (≤0.4%). Based on the combination of measured and modelled components, the estimated carbon footprint averaged 14.09 kg CO₂e per cataract procedure (95% CI: 12.08-16.11 kg), with centre-level values ranging from 10.07 to 18.70 kg. Conclusion Substantial emission reductions can be achieved by streamlining material use and improving sterilisation workflow. Transparent reporting that defines system boundaries, specifies uncertainties, and provides access to data collection methods is essential for comparability and for establishing reliable benchmarks in sustainable surgical practice. This study provides a comprehensive multicentre carbon footprint analysis for outpatient cataract surgery in Germany and offers a transparent framework that guides targeted reduction strategies.
PURPOSE:In lack of capsular support, two commonly used secondary intraocular lens (IOL) fixation strategies include retropupillary iris-claw fixation using the hydrophobic Artisan Aphakia and scleral fixation of the hydrophilic Carlevale IOL. Both models may come into direct contact with endotamponades frequently implanted in the same surgical procedure. The purpose of this laboratory study was to compare the interaction of both IOL models with endotamponades, specifically silicone oil adhesion and calcification, which is more prevalent after exposure to gas endotamponades. METHODS:Laboratory study using Artisan Aphakia (Ophtec, Groningen, Netherlands), Carlevale IOL (Soleko IOL Division, Pontecorvo, Italy) and CT Spheris (Carls Zeiss Meditec, Jena, Germany) as a control. Straylight measurements were carried out with C-Quant straylight meter and used to quantify the effects of both, adherent silicone oil and calcifications in the polymer. Siluron 2000 was used to test silicone oil adhesion. Electrophoresis was used to induce IOL calcification. Calcification was quantified using thermogravimetric analysis and plasma optical emission spectroscopy. Light loss was evaluated using a power meter combined with an optical bench system. The reversibility of silicone oil adhesion was evaluated after usage of F4H5 as a cleansing solution. RESULTS:The Artisan Aphakia was more prone to increased silicone oil adhesion causing a clinically relevant increase in straylight (baseline vs. silicone oil adherence: 3.0 vs. 140.7 deg2/sr; p = 0.0001), not fully reversible by using F4H5 as a wash-out (baseline vs. F4H5 washout: 3.0 vs. 15.3 deg2/sr; p = 0.0029). In contrast, the Carlevale IOL demonstrated a higher susceptibility to calcification (baseline vs. calcification: 2.75 vs. 12.59 deg2/sr). CONCLUSION:In addition to clinical aspects, such as iris and ciliary body anatomy, choice of endotamponade in trauma cases can influence the postoperative long-term optical quality of intraocular lenses. Differences between hydrophilic and hydrophobic materials are magnified secondary IOL fixation due to the direct contact to the used endotamponade and may be considered in clinical decision making.
INTRODUCTION:This study aimed to evaluate the use of decalin as a short-term endotamponade for the management of severe, persistent retinal detachments. METHODS:This retrospective study analyzed 9 eyes of 9 patients in whom decalin was used as an endotamponade. After 2 weeks, it was removed and replaced with silicone oil. RESULTS:Retinal reattachment was achieved in all patients, despite previous surgical failures. The short-term use of decalin proved safe. No complications related to its use, such as retinal toxicity, subretinal migration, inflammatory reactions, or ocular hypertension, were observed. CONCLUSION:Decalin is a valuable intraoperative tool and effective as a short-term endotamponade.
INTRODUCTION:Branch retinal vein occlusion (BRVO) is the second most common retinal vascular disorder. This study evaluated the real-world visual and anatomical outcomes of intravitreal aflibercept in BRVO, addressing the gap between clinical trials and daily practice, and aimed to identify distinct response phenotypes that predict functional decline. METHODS:This retrospective analysis included 96 BRVO patients receiving aflibercept monotherapy over 12 months. Patients were stratified into three groups based on anatomical response: Resolved (sustained dry macula), Recurrent (fluid recurrence after initial resolution), and Persistent (incomplete resolution). The primary outcome was change in best-corrected visual acuity (BCVA). RESULTS:At 12 months, eyes were Resolved (52%), Recurrent (27%), or Persistent (21%). The Resolved group achieved the best visual outcomes (-0.29 logMAR; 95% CI: -0.38 to -0.20), whereas the Recurrent group showed the least improvement (-0.05 logMAR; 95% CI: -0.22 to 0.12; p = 0.021 vs. Resolved). Despite achieving complete fluid resolution at month 3, this group experienced significant rebound by month 6. Total injections (p = 0.808) and the distribution of treatment strategies did not differ among groups. Baseline BCVA (β = 0.411, 95% CI: 0.202-0.619; p = 0.001) and treat-and-extend (T&E) regimen (β = 0.244, 95% CI: 0.033-0.454; p = 0.025) significantly predicted visual improvement, whereas baseline central macular thickness and systemic factors were not. CONCLUSION:In a real-world setting, nearly half of BRVO patients exhibit unstable phenotypes. Despite comparable treatment intensity, cumulative damage from fluid fluctuations causes irreversible visual loss in the Recurrent group. This supports a stratified intervention strategy: evaluating month-3 response to establish strict T&E intervals or early treatment modifications, mitigating preventable vision loss.
INTRODUCTION:The SHIFT-HB study (SwitcH Faricimab Treatment in High Burden patients) aimed to evaluate the anatomical and functional outcomes -and the short-term stability of extended dosing intervals- after switching to faricimab in high treatment burden (HB) neovascular age-related macular degeneration (nAMD) previously treated with first-generation anti-VEGF agents. The primary aim was to assess treatment interval changes after 6 intravitreal injections (IVI) and the persistence of interval gains between the 5th and 6th faricimab IVI. METHODS:Single-center, retrospective real-world study (November 2023-November 2024; tertiary center Edouard Herriot Hospital, Lyon). Eligible eyes had nAMD requiring ≤8-weeks intervals despite ≥6 prior aflibercept or ranibizumab injections. After the switch, all eyes received ≥6 faricimab IVIs under a proactive Treat-and-Extend regimen. Short-term stability was defined, among eyes with any interval gain, as a prescribed interval at V6 identical to or longer than that at realized at V5. RESULTS:190 eyes from 158 patients (mean age 81 ± 7.5 years; 57.9% female) were included. The mean pre-switch interval was 4.9 ± 1.2 weeks and increased to 6.7 weeks after 6 faricimab IVIs (p=5.85x10-20). Interval increased in 61.6% of eyes; among these, 45% gained ≥ 3 weeks (range +3 to +8). Short-term stability between V5 and V6 occurred in 82.3% of responders. The maximum interval was first achieved at V6 in 52.1% of responder eyes. Among eyes with paired baseline and V6 measurements, best corrected visual acuity remained stable (69.2 vs 71.2 ETDRS letters; p=0.67), while central retinal thickness (CRT) decreased (303.1 µm to 287.2 µm; p=9.98x10-4). Intraocular inflammation occurred in 7 eyes (3.7%; 0.61% of injections) and led to drug discontinuation. CONCLUSION:In real world HB nAMD, switching to faricimab enabled a significant extension of injection intervals in nearly two-thirds of eyes while maintaining vision and improving OCT anatomy, supporting faricimab as a strategy to reduce treatment burden in this difficult to treat population.
Purpose: To develop recommendations on the use of per- and polyfluoroalkyl substances (PFAS)-containing ocular endotamponades (OEs) in vitreoretinal surgery. Methods: We conducted an expert-led consensus using a modified Delphi methodology with panel consisting of fourteen vitreoretinal surgeons and five representatives of companies involved in OEs production and marketing. Based on a literature review and the latest updates on European Union’s PFAS restriction proposal, the facilitator prepared a list of statements on PFAS-containing OEs currently used. Each statement was graded individually using a nine-point scale (from 1 "absolutely disagree" to 9 "absolutely agree") and the consensus was defined as a score between 7 and 9 from ≥80% of members. Results: After two rounds, and related discussion, the recommendations highlighted the crucial role of PFAS-containing OEs in surgical practice and the potential negative impact of their ban on patients’ outcomes. There was a strong agreement on the need of perfluorocarbon liquids as intraoperative tool, although it was also pointed out that their use should be avoided if possible. Fluorinated gases were deemed essential with no agreement on the possibility to replace SF6 and/or C2F6 with C3F8 at different concentrations. Conversely, semifluorinated alkanes as rinsing solution as well as F6H8 were considered extraneous. No consensus was reached about the current role of heavy silicone oils. Finally, the use of air as alternative and environment-friendly OE was judged not supported by sufficient evidence but worth of further investigation. Conclusions: The consensus panel developed recommendations aimed at promoting a more sustainable surgical practice.
BACKGROUND:This scoping review aimed to explore existing clinical trials on the association between semaglutide use and the occurrence of retinal vascular events to detect any potential safety concern. SUMMARY:The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews guidelines. A search was performed across PubMed, Embase via Ovid, ClinicalTrials.gov, and Google Scholar on April 16, 2025, and March 5, 2026. We aimed to detect clinical trials reporting retinal vascular events while investigating the effect of semaglutide in patients with type 2 diabetes or obesity. Reports on optic ischemic neuropathy were included as a reference outcome to evaluate whether the method used in the review might be capable of detecting rare ophthalmic vascular adverse events and thereby a potential safety signal. KEY MESSAGES:Thirteen randomized clinical trials (predominantly double-blind and placebo-controlled) were included, comparing 17,478 individuals treated with semaglutide and 17,334 placebos. A total of 15 retinal vascular events were reported in the semaglutide groups compared with four events in placebo arms. In large, long-term trials (SELECT, SOUL, FLOW), incidence rates were consistently low but numerically higher in semaglutide-treated patients, ranging from 0 to 0.33 events per 1,000 person-years versus 0-0.05 in placebo groups. In trials with active comparators, rates ranged from 0 to 5.99 events per 1,000 person-years in semaglutide groups and 0-3.52 in comparator groups. For ischemic optic neuropathies, six events were reported among 11,757 semaglutide-treated patients versus one event among 11,105 placebo-treated individuals; in trials with active comparators, two versus one event were reported. In conclusion, retinal vascular events, especially retinal arterial occlusions, showed a higher pattern of reporting in the semaglutide arm across clinical trials, the majority of which were randomized placebo-controlled trials. Optic ischemic neuropathies were also found to be higher on the semaglutide arm. These findings support the need for further investigation through large-scale registry studies.
INTRODUCTION:The aims of this study were to clarify how relative afferent pupillary defect (RAPD) relates to interocular visual acuity asymmetry in Leber hereditary optic neuropathy (LHON), and to derive clinically interpretable thresholds of absolute interocular best-corrected visual acuity difference (|ΔBCVA|) for RAPD interpretation. METHODS:This retrospective study included patients with genetically confirmed LHON (one of the three primary mitochondrial DNA mutations: m.11778G>A, m.14484T>C, or m.3460G>A) who presented within 6 months of symptom onset and underwent RAPD assessment at the initial visit. The absolute |ΔBCVA| (logarithm of the minimum angle of resolution [logMAR]) was analyzed using multivariable logistic regression. Discrimination was assessed by receiver operating characteristic (ROC) analysis. In unilateral-onset cases, time to fellow-eye involvement was compared by the Kaplan-Meier analysis. RESULTS:Ninety-two patients were included; 23 (25%) were RAPD-positive. In multivariable logistic regression, |ΔBCVA| was independently associated with RAPD (adjusted odds ratio 1.20 per 0.1 logMAR, 95% confidence interval [CI] 1.08-1.35; p < 0.001). ROC analysis showed good discrimination (area under the curve 0.791, 95% CI 0.672-0.910). The Youden-optimal cutoff was 0.88 logMAR (sensitivity 56.5%, specificity 92.8%); additional thresholds were 0.47 logMAR for higher sensitivity (87.0%, 58.0%) and 1.14 logMAR for higher specificity (52.2%, 97.1%). In the Kaplan-Meier analysis, fellow-eye involvement occurred earlier in RAPD-negative than RAPD-positive cases (log-rank p = 0.020), with an estimated median time to involvement of 2 months and 4 months, respectively. CONCLUSION:In LHON, RAPD is largely driven by interocular acuity asymmetry. Quantitative |ΔBCVA| thresholds can support interpretation of RAPD without prematurely excluding LHON and may help plan diagnostic work-up and follow-up while confirmatory testing is pending.
Introduction: The aim of the study was to compare functional and anatomical results after 1- vs. 3-month heavy silicone oil (HSO) tamponade to repair complex inferior recurrent rhegmatogenous retinal detachment (Re-RRD). Methods: A retrospective, comparative, cohort study was conducted involving 46 eyes from 46 patients who were affected by complex inferior Re-RRD and had previously undergone tamponade with either gas or silicone oil. All the eyes were treated using HSO (Densiron® 68), which was removed after 1 (group A) or 3 months (group B). The outcomes included the attachment rate, best-corrected visual acuity (BCVA), and intraocular pressure (IOP), comparing these results at 3, 6, and 12 months after HSO removal. Results: Out of 46 eyes that experienced a complex inferior Re-RRD after initial surgery and received HSO, 24 were in group A and 22 in group B, with HSO removal after 1 and 3 months, respectively. The reattachment rates were similar: 91.6% for group A and 81.8% for group B (p = 0.4). In group A, a significant visual gain occurred during all follow-up (p < 0.001); in group B, the significant improvement (p ≤ 0.03) was lost at 12 months. Mean BCVA was better in group A than B at 6 and 12 months (p ≤ 0.02). Group B exhibited a significant increase in mean IOP after 3 months (p < 0.001), consistently exceeding the values observed in group A throughout the follow-up (p ≤ 0.002). Macular edema occurred in 7 eyes, with no notable differences between the groups. Conclusion: A 1-month HSO endotamponade has a similar reattachment rate but provides better visual recovery and controlled IOP than a 3-month endotamponade in complex Re-RRD with inferior involvement.
INTRODUCTION:Silicone oil (SO) has been used in ophthalmic surgery for many years as a long-acting endotamponade. However, its use remains a subject of ongoing debate due to potential complications, including emulsification and retinal toxicity. A further concern described by surgeons is the unexplained functional deterioration associated with SO removal. Recent analyses suggest that this SO-associated impairment in visual acuity is an underrecognized problem and may have been insufficiently investigated to date. The present study aims to evaluate visual outcomes after SO removal in eyes that had previously undergone SO tamponade for rhegmatogenous retinal detachment and to identify factors associated with postoperative visual deterioration. METHODS:This was a retrospective single-center longitudinal study conducted at the Department of Ophthalmology, University of Bonn, Germany. Patients who underwent SO (Siluron®; Fluoron, Ulm, Germany) removal in our department within a period of 1.5 years (July 2022-December 2023) with a follow-up of at least 6 months were included. Demographic data, clinical course, and visual acuity development of these patients were analyzed. In addition, intraocular pressure (IOP), type of SO, optical coherence tomography, and surgical parameters including duration of the SO tamponade were recorded. The analysis was conducted using a logistic regression model with a binomial link function to estimate the risk of visual loss after SO removal, complemented by predictive modeling and visualization of key predictors' effects on outcome probabilities. RESULTS:A total of 255 SO removals were performed during the review period. The most common reason for SO removal was retinal detachment surgery, accounting for 160 cases (62.7%). Of these, 88 eyes met the inclusion criteria and were included in the analysis, and 63 (71.59%) patients were male. The median age at SO removal was 64 years (20-91 years). Macular involvement was present in 40 (45.5%) patients of retinal detachments. Logistic regression analysis indicated that a greater macular volume of the foveal area >0.23 mm3 during SO endotamponade was significantly associated with a lower risk of visual loss. Furthermore, a higher IOP reduction following surgery was also a significant factor associated with a lower risk of visual deterioration. CONCLUSION:Visual loss following SO removal remains an underrecognized and insufficiently studied complication. In this cohort, lower foveal macular volume during SO tamponade and a smaller postoperative decrease in IOP were the only variables significantly associated with visual deterioration after SO removal.
INTRODUCTION:This study compared the reoperation rate of vitrectomy between weekend/holiday and weekday surgeries. METHODS:This nationwide, population-based retrospective cohort study used the Korean Health Insurance Review and Assessment Service database to identify 387,544 adults (≥18 years) who underwent initial vitrectomy between January 2011 and March 2024. Weekend/holiday and weekday surgeries were compared. The risk of reoperation within 90 days was assessed using Cox proportional hazards regression, with sensitivity analyses extending the outcome to 180 days and subgroup analyses of the five most common diagnoses. Logistic regression was performed as a secondary analysis. RESULTS:A total of 45,074 patients underwent vitrectomy on weekends/holidays and 342,470 on weekdays. Reoperation rates per 100 person-months were 2.83 in the weekend/holiday group and 2.87 in the weekday group. Weekend/holiday surgery was not associated with reoperation within 90 days (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI]: 0.97-1.04; p = 0.860) or 180 days (aHR, 1.02; 95% CI: 0.99-1.04; p = 0.274). Logistic regression showed consistent results for both 90 days (adjusted odds ratio [aOR], 1.00; 95% CI: 0.97-1.04; p = 0.849) and 180 days (aOR, 1.02; 95% CI: 0.99-1.05; p = 0.283). Subgroup analyses revealed no association between weekend/holiday surgery and reoperation across diagnostic categories, except for vitreous hemorrhage, in which a higher risk of reoperation was observed within 180 days (aHR, 1.09; 95% CI: 1.02-1.16; p = 0.011; aOR, 1.10; 95% CI: 1.02-1.18; p = 0.009). CONCLUSION:Our analysis of nationwide claims data from Korea demonstrated that vitrectomy surgery is not subject to a weekend effect, either overall or within major diagnostic subgroups.
INTRODUCTION:This study aimed to evaluate visual acuity and microperimetry correlated with anatomical changes in eyes with macular diseases implanted with the EyeMax Mono intraocular lens (IOL) (SharpView Ophthalmology). METHODS:A single-center retrospective, real-world case series was set in Knappschaft Eye Hospital, Sulzbach, Germany. Patients with macular disease who underwent EyeMax Mono IOL implantation were included. The outcome measures were corrected distance visual acuity (CDVA) and microperimetry indices: fixation stability and bivariate contour ellipse areas (BCEAs) at 63% and 95%. The geographic atrophy (GA) monitor (RetInSight) was used to analyze changes in retinal integrity. RESULTS:Twenty-one eyes (11 patients; mean age 72.8 ± 8.3 years, mean follow-up 7.4 ± 4.0 months) were included. Preoperative GA measured 4.7 ± 4.0 mm2 (n = 14), and EZ loss on SD-OCT was 2,433.1 ± 1,009.5 µm (n = 17). The CDVA improved by 0.2 logMAR (p = 0.007, n = 21), with 12 eyes gaining ≥1 line and seven eyes gaining ≥3 lines. Fixation stability improved in two eyes, stabilized in nine eyes, and worsened in four eyes. The changes in BCEA were not statistically significant. Higher preoperative BCEA correlated with greater postoperative improvement (p < 0.001). In the foveal fixation group (n = 4), 75% and 50% of patients showed improved BCEA and CDVA, respectively. In extrafoveal fixation (n = 11), BCEA improved in 50% of patients, while 64% showed CDVA improvement. The GA monitor showed worsening in 9/15 eyes, and 4 eyes showed worsening on microperimetry without a CDVA decline. Anatomical changes stabilized in six eyes; of these, two exhibited a decline in microperimetry without a CDVA decline. CONCLUSIONS:EyeMax Mono IOL improved CDVA, although no significant changes were observed in the microperimetry indices. Better microperimetry outcomes were observed in extrafoveal fixation cases. While the optical design of the IOL likely contributes to visual improvement, the small sample size limited the statistical power to detect significant microperimetry changes.
INTRODUCTION:Hyaluronic acid (HA)-based hydrogels are promising vitreous substitutes, but clinical translation requires more than biocompatibility alone. Key determinants such as intraocular swelling, enzymatic stability, and cellular interactions must be precisely controlled. This study investigated strategies to further refine an advanced HA hydrogel toward these requirements. METHODS:UV-crosslinked HA hydrogels were tested as chunks and injectable extrudates under varying osmolarities. Swelling behavior was analyzed in physiological media, including a dehydration-rehydration protocol. Enzymatic degradation assays with hyaluronidase, trypsin, and collagenase were performed, and fibroblast adhesion/proliferation was evaluated in the context of proliferative vitreoretinopathy. RESULTS:Swelling was formulation- and format-dependent, with pre-dehydrated extrudates reaching up to 1.8-fold baseline weight. Only hyaluronidase induced degradation, while proteases had no effect. Fibroblasts showed reduced proliferation on the hydrogel surface. CONCLUSION:Systematic tuning of swelling, enzymatic stability, and antifibrotic properties advances HA hydrogels toward clinical application as customizable vitreous substitutes.
Introduction: The prospective, observational IDEAL study evaluated the effectiveness and safety of the long-acting fluocinolone acetonide (FAc) implant in patients with chronic diabetic macular edema (DME) and examined the influence of various baseline factors on treatment success. Methods: Patients with persistent DME despite prior treatment with available therapies who received FAc implant were included from 35 ophthalmological centers in Germany and monitored for up to 24 months. Demographic and clinical data, including disease duration, previous treatment, best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), and adverse events were recorded at routine visits and analyzed descriptively, also in predefined groups. Results: Overall, 214 eyes from 185 patients (57% male) with a mean (SD) age of 66.2 (9.7) years were followed up for a mean (SD) of 21.53 (6.49) months. Functional and anatomical improvements occurred rapidly within 1 week after FAc injection and were sustained over 24 months in these previously intensively treated eyes (72.9% laser treatment, 79.9% intravitreal therapy with dexamethasone and/or anti-VEGF inhibitors, 28.9% vitrectomy). Mean BCVA increased from 55.8 (18.4) letters at baseline to 60.9 (19.0) letters at 24 months, with comparable results across subgroups defined by baseline characteristics. Eyes with fewer than two prior dexamethasone injections showed a more pronounced CMT reduction. In a subset with early follow-up, greater CMT reduction at week 1 was strongly associated with greater CMT reduction at month 1. Mean IOP in the total cohort increased from 15.3 ± 3.3 mm Hg to 17.4 ± 4.8 mm Hg within 9 months and returned to 16.7 ± 5.0 by month 24. IOP lowering was required in 35.5% of eyes (topical medication), and 4.6% underwent IOP-lowering surgery. Conclusion: The IDEAL observational study demonstrated a rapid onset of effect and reaffirmed the long-term efficacy and safety of the FAc implant in a large cohort of patients with persistent DME despite extensive prior treatment, thus underlining the high medical need of this treatment option for DME patients insufficiently responding to other therapies.
INTRODUCTION:Surgical treatment of rhegmatogenous retinal detachment is evolving. The purpose of this paper is to describe the clinical results of retrospective consecutive case series of suprachoroidal viscobuckling, without gas tamponade, for the treatment of rhegmatogenous retinal detachment. Nine patients with retinal detachment due to a single retinal break or few breaks within 1 clock hour were included. METHODS:Patients were treated with pars plana vitrectomy, trans-scleral suprachoroidal injection of sodium hyaluronate under the break to create a temporary indent, laser retinopexy, and no gas tamponade, under local anaesthesia. The main outcome measure was retinal reattachment at 12 weeks and adverse events. RESULTS:All patients had closure of the causative break, but in 1 patient there was a small area of peripheral retinal detachment due to a missed break. This was walled off with laser barrage and was non-progressive. Eight cases had successful primary reattachment, and all had final reattachment. There was 1 case of raised intraocular pressure that responded to topical therapy but no clinically significant complications. CONCLUSIONS:Vitrectomy and viscobuckle for simple retinal detachment appears to be safe and effective. This has the potential to reduce the burden of recovery and complications associated with gas tamponade and permanent buckling. Further study appears warranted.
INTRODUCTION:The aim of this multicenter study was to assess the efficacy and safety of injecting a fluocinolone acetonide implant (FACi) 1 month after the last dexamethasone implant (DEXi) intravitreal injection (IVI) in chronic diabetic macular edema (DME) patients. METHODS:This retrospective study evaluated a standardized care protocol implemented across 5 centers. Inclusion criteria were as follows: pseudophakic, chronic DME treated with DEXi every <6 months, FACi injected 1 month after the last DEXi. Best corrected visual acuity (BCVA), intraocular pressure (IOP), and additional treatment were assessed on the day of FACi injection (M0), 1 (M1), and 3 months (M3) later and then every 3 months until month 36 (M36). RESULTS:Thirty-seven eyes (30 patients) were included: the median age was 73 (interquartile range [IQR]: 66, 78) years and the median DME duration was 72 [59, 84] months. The mean BCVA was 62.8 ± 17.7 letters at M0 and remained stable throughout the follow-up. The cumulative incidence of additional IVI was 35.1% [95% CI: 20.2; 50.5] at M12 and 70.1% [51.3; 82.8] at M36. Among the 25 eyes with additional IVI, the median reinjection interval increased by a factor of 4.3 [2.2; 8.4]. The mean IOP was 15.8 ± 4.1 mm Hg at M0 and remained stable during the follow-up. The cumulative incidence of the "IOP >30 mm Hg" event was 2.7% [0.0; 12.2] at M12 and 18.8% [7.2; 34.4] at M36. One patient underwent incisional surgery (Xen stent implantation). CONCLUSION:Injecting FACi 1 month after the last DEXi in patients requiring DEXi IVI every <6 months allowed maintaining the BCVA while spacing out or even discontinuing IVI with limited IOP concerns.
INTRODUCTION:Silicone oil (SO) is widely used as a long-term intraocular tamponade following pars plana vitrectomy (PPV) for complex retinal conditions. However, its emulsification is associated with serious complications, including intraocular inflammation and glaucoma. While various factors influencing this process have been explored, the role of time in SO emulsification remains unclear. This study investigates the movement time effect on SO emulsification using a physiologically realistic model, with a focus on changes in droplet size distribution and emulsion density. METHODS:A 3D-printed, anatomically accurate model of the human vitreous chamber was filled with SO and an albumin-containing aqueous phase, maintained at 35°C. Experiments were conducted with varying albumin concentrations and saccadic eye movements of different amplitudes. Emulsions were sampled and analyzed after 6 h, 12 h, 24 h, and 6 days. RESULTS:Emulsification was observed under all conditions. Over time, the number of smaller droplets increased, and emulsion density rose sharply within the first 12 h, followed by a slower progression. Higher albumin levels and larger saccadic amplitudes promoted more extensive emulsification. CONCLUSION:These findings identify the early postoperative period, particularly the first 12 h, as critical for SO emulsification.
Introduction: Concentration mix errors of fluorinated gases commonly used in vitreoretinal surgery can lead to catastrophic elevations in intraocular pressure (IOP). The timing and optimal management of this complication is poorly understood. This study aimed to evaluate the impact of controlled venting on IOP elevation following simulated gas mix errors. Methods: A validated mass transfer model of intraocular gas dynamics was used to simulate the properties of “isovolumetric” gas concentrations of 20% SF6, 16% C2F6, and 12% C3F8, along with the most common concentration mix errors: double concentration, 10/3 (3.33×) concentration, and 100% gas. Simulations were performed on eyes with vitreous cavity volumes of 4.0 mL, 7.2 mL, and 10.0 mL (representing hyperopic to highly myopic eyes). The model calculated gas volume and IOP over time, both before and after controlled venting events to normalise IOP. Results: All gas concentration errors produced complete gas fill and rapid IOP elevations. Only double concentration errors generated IOPs potentially manageable with medical therapy (peak 60 mm Hg for 40% SF6, 75 mm Hg for 32% C2F6, 61 mm Hg for 24% C3F8). Simulated 10/3 (3.33×) and 100% concentrations resulted in extreme IOP elevations incompatible with ocular perfusion. Controlled gas venting on day 1 normalised IOP for SF6 but repeated venting procedures were required for C2F6 and C3F8 due to continued gas re-expansion. Eyes with larger vitreous cavities experienced prolonged IOP elevation and delayed equilibration after venting. Conclusion: Gas concentration mix errors produce rapid and often unsalvageable IOP rises. While limited SF6 over-concentrations may be temporarily stabilised with medical therapy and controlled venting, most scenarios, especially involving C2F6 or C3F8, require urgent surgical complete gas exchange.
Retinal artery occlusions (RAOs) constitute a rare but serious ophthalmological emergency with a poor prognosis for visual recovery, for which there is currently no adequate therapeutic strategy. However, there is substantial evidence highlighting the importance of systemic (non-ophthalmological) management of patients with RAO. Since RAOs are the ocular analogous of a cerebral stroke, they require a similar urgent, multidisciplinary approach involving laboratory tests and imaging studies that go beyond the typical scope of ophthalmologists. This calls for cooperation and understanding from all stakeholders, including neurologists, radiologists, interventional neuroradiologists, emergency and primary care physicians, as well as patients and the wider community. Therefore, while there are presently no proven therapies to restore vision following RAOs, the ophthalmologist's primary responsibility lies in prompt systemic referral. It is imperative to exclude underlying vascular pathology to rule out concurrent cerebrovascular disease and to minimize the risk of subsequent cerebrovascular and cardiovascular events. These guidelines have been developed by a panel of retina specialists in Spain, representing the Spanish Retina and Vitreous Society (SERV). The recommendations provided are derived from an evidence-based expert consensus methodology and not from a formal systematic review. The aim was to inform ophthalmologists and other healthcare professionals who care for these patients about the significance and seriousness of the condition, support decision-making regarding appropriate ophthalmological and systemic management, and provide a foundation for creating protocols.
INTRODUCTION:Non-exudative macular neovascularization (neMNV) in age-related macular degeneration (AMD) may remain stable or progress to exudation with vision loss, but its natural history is not well established. This study aimed to assess the prevalence of neMNV, the conversion rate to exudation, and to discern differences between neMNVs that exhibited exudation versus those that remained non-exudative. METHODS:In this retrospective, multicentric, longitudinal study, consecutive patients treated with anti-VEGF between august 2008 and June 2023, presenting exudative AMD in one eye and intermediate AMD in the fellow eye, were analyzed. The presence of neMNVs in the fellow eyes and their conversion rate to exudation were assessed. Clinical and anatomical features were compared between eyes that developed exudation versus those that did not. The correlation between lesion major diameters and areas was examined to evaluate their equivalence as parameters for assessing neMNV growth rate. RESULTS:A total of 61 eyes out of 840 (7.3%) exhibited neMNV. Of these, 21 neMNV (34.42%) converted to exudation in a mean time of 24.14 months (min. 7 - max. 113). The remaining 40 eyes did not develop exudation during a mean follow-up of 32.5 months (min. 12 - max. 101). No significant differences were found regarding visual acuity, OCT angiography features, or baseline lesion diameters. NeMNV that developed exudation exhibited a higher lesion growth rate (p value <0.001). The growth rate evaluated using lesion major diameters was consistent with that obtained through lesion area measurements. CONCLUSION:The results highlight lesion growth rate as a marker of conversion risk. Lesion diameter was identified as a reliable parameter for monitoring neMNV progression. Even considering a long-term follow-up, many lesions did not develop exudation. These results support the idea that neMNV may represent a spectrum of neovascularizations with different characteristics and clinical courses.
