The expiration of patents for ranibizumab and 2-mg aflibercept has enabled the introduction of several anti–vascular endothelial growth factor (anti-VEGF) biosimilars into ophthalmic practice. Simultaneously, recent changes in the French regulatory framework, particularly those introduced by the 2026 Social Security Financing Act, will expand pharmacist-led substitution of biological medicines as of September 1, 2026. These changes raise important questions for ophthalmologists regarding efficacy, safety, immunogenicity, switching strategies, as well as traceability, liability, and patient information. This review summarizes the scientific principles underlying biosimilar development and regulatory approval, highlighting the analytical, preclinical, and clinical requirements necessary to establish biosimilarity. Current evidence regarding ranibizumab and 2-mg aflibercept biosimilars is reviewed, including pivotal clinical trials, switching studies, and recent meta-analyses, all of which support efficacy, safety, and immunogenicity profiles comparable to those of their reference products over the short and medium term. Nevertheless, several ophthalmology-specific considerations deserve particular attention, including physician-administered intravitreal injections, differences in drug presentation, the long-term management of predominantly elderly patients, and the rarity of intraocular inflammatory events. Furthermore, biosimilars are being introduced into a rapidly evolving therapeutic landscape characterized by the emergence of second-generation anti-VEGF agents designed to reduce treatment burden. Biosimilars therefore represent an important opportunity to enhance the sustainability of healthcare systems. Their integration into routine clinical practice, however, should rely on a gradual, individualized approach supported by robust pharmacovigilance.
Purpose To describe real-world experience after adding preservative-free hydrocortisone 0.335% to manage ocular surface inflammation in patients with dry eye disease (DED) who required combined therapy. Methods This retrospective, multicenter, international case series evaluated 27 patients diagnosed with DED that was poorly controlled on a regimen of ocular lubricants or multimodal treatment and were prescribed topical preservative-free hydrocortisone 0.335% for combination therapy. Similarity and quality of data collection were the main inclusion criteria for inclusion in the study. Data are reported as mean, standard deviation and range for quantitative variables at baseline and the last follow-up visit after initiating low-dose hydrocortisone therapy. Intergroup data were compared using the Kolmogorov–Smirnov test followed by the nonparametric Mann-Whitney test. P < 0.05 was considered statistically significant. Results The severity of DED ranged from mild to severe, with cases that included mixed etiology and DED related to chronic graft versus host disease. Mean intraocular pressure (IOP) was 14.77 ± 2.48 mmHg at baseline and 14.75 ± 2.52 mmHg at 2 weeks after initiating low-dose hydrocortisone therapy. There were no cases of an IOP spike during treatment with the preservative-free low-dose hydrocortisone. The mean ocular surface disease index (OSDI) score decreased statistically significantly from 27.44 ± 15.80 at baseline to 19.10 ± 10.84 at 2 weeks after initiating low-dose hydrocortisone therapy (P < 0.05). There was a clinically significant improvement in these parameters as indicated by Schirmer tests I and II, grading of conjunctival hyperemia and corneal staining. After addition of low-dose preservative-free hydrocortisone, treatment was successful in all cases, with 18 (66.7%) defined as resolved and 9 (33.3%) defined as stable. None of patients were intolerant to the preservative-free low-dose corticosteroid formulation. Conclusion In patients with DED recalcitrant to medical therapy, addition of low-dose, preservative-free hydrocortisone in combination therapy with ocular lubricants improved the signs and symptoms of mild to severe cases without inciting adverse events such as an IOP spike or ocular infections. Treatment was considered successful in all cases.
Purpose To compare refractive measurements, keratometry, pachymetry, and tonometry between two commercially available systems: Visionix VX650 (Luneau Technologies, France) and Nidek TonoRef III (Nidek, France). Methods This is a retrospective cohort study in which 415 valid eye measurements of 206 patients were obtained using both machines. Three groups were created: 1. The refraction group included 206 patients (400 eyes); 2. The keratometry group included 147 patients (293 eyes); 3. The pachymetry and tonometry group included 123 patients (245 eyes). To test agreement, each subject was measured once with each instrument. Results In the first group, there was no statistically significant difference in sphere measurements (p = 0.072), but there was a significant difference in cylinder power (p = 0.014) and axis (p = 0.009) measurements. The second group had a strongly significant difference between keratometry power measurements (p = 2.784 × 10−5), but no statistically significant difference in mean keratometric axis measurements (p = 0.191). The third group found a strongly significant difference for pachymetry (p = 9.632 × 10-10), but none for corrected tonometry (p = 0.064). Discussion The two devices demonstrated variable levels of agreement depending on the parameter analyzed. Nevertheless, both machines have merit in measuring refraction and detecting glaucoma. Conclusion Good agreement between the two instruments was found for sphere power and corrected tonometry. Nevertheless, differences in refractive and keratometric axis measurements, as well as pachymetry, highlight the fact that the same instrument should be used for follow-up.
Introduction Terrien’s marginal degeneration (TMD) is a rare, slowly progressive, non-inflammatory peripheral corneal thinning disorder that may lead to spontaneous perforation in advanced stages. Observation We report the case of a 33-year-old man with bilateral peripheral corneal thinning and a spontaneous inferior perforation in the right eye. Slit-lamp examination revealed 360° peripheral stromal thinning with superficial neovascularization and lipid deposition. Seidel’s test was positive in the right eye. The diagnosis of Terrien’s marginal degeneration was made after exclusion of infectious and autoimmune causes. A tectonic, crescent-shaped, lamellar peripheral keratoplasty was performed to restore globe integrity. Postoperative follow-up showed resolution of leakage, improved corneal stability, and partial visual recovery. Conclusion Corneal perforation in Terrien’s marginal degeneration represents a therapeutic challenge. Peripheral lamellar tectonic grafting is an effective surgical option to preserve ocular integrity while maintaining central transparency and visual potential.
Purpose To evaluate the interobserver reliability of the Smart Eye Camera (SEC) and assess its diagnostic accuracy compared with fundus photography in detecting optic disc abnormalities among patients with optic neuropathies. Design Cross-sectional observational study conducted in two phases (interobserver reliability, diagnostic accuracy) from July 2024 to January 2025. Participants Participants were 68 adults aged 18–60 years with confirmed optic neuropathy. Methods The study was conducted in two phases: Phase I assessed interobserver reliability of SEC recordings by two neuro-ophthalmologists. Phase II compared SEC findings with fundus photography to determine diagnostic accuracy. Statistical analysis included Kappa coefficients for reliability and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy for diagnostic performance. Results Interobserver agreement for optic disc abnormalities assessed via SEC showed moderate to very good agreement (Kappa = 0.649–0.862, p < 0.001). Compared with fundus photography, SEC showed high diagnostic performance for several optic disc abnormalities, with the highest accuracy observed for optic disc edema (94.1%), followed by optic disc pallor/atrophy (80.8%) and disc at risk (88.2%). Reliability and accuracy for peripapillary hemorrhage and optic disc drusen could not be robustly established because of the limited number of cases. Conclusion SEC demonstrated good interobserver reliability and high diagnostic accuracy in assessing optic disc abnormalities in patients with optic neuropathy. Its portability, affordability, and usability suggest potential as a reliable screening tool, particularly in settings with limited access to conventional imaging. Future larger studies should investigate whether diagnostic performance differs across specific etiologies of optic neuropathy.
Introduction Vitreous cysts are uncommon ocular findings and may be overlooked in patients with chronic floaters, particularly when symptoms are attributed to vitreous degeneration or posterior vitreous detachment. We report a long-standing free-floating vitreous cyst that masqueraded as vitreous degeneration for two decades. Case description A 51-year-old woman presented with persistent floaters in her left eye for more than 20 years, which had become increasingly bothersome in recent months. Best-corrected visual acuity was 20/60 in the affected eye. Fundus examination and multimodal imaging revealed a mobile, free-floating pigmented cyst in the vitreous cavity, with a translucent lumen and no attachment to the optic disc or peripheral retina. There were no signs of intraocular inflammation, and serologic testing for parasitic infection was negative. Because of persistent symptoms, pars plana vitrectomy with cyst removal was performed. Histopathologic examination showed a cyst wall lined by pigmented cuboidal epithelial cells, supporting an origin from the pigmented epithelium of the iris or ciliary body. At 2 weeks after surgery, the patient reported symptom relief, and best-corrected visual acuity improved to 20/25. Discussion This case highlights that vitreous cysts can remain symptomatic for many years and may be mistaken for more common causes of floaters. Careful dilated fundus examination, multimodal imaging, and exclusion of inflammatory or parasitic disease are important in establishing the diagnosis. Vitrectomy may be considered in selected symptomatic cases, particularly when complete removal and histopathologic confirmation are desired. Conclusion A free-floating vitreous cyst should be considered in patients with long-standing floaters, even when symptoms have previously been attributed to vitreous degeneration. Careful examination can prevent delayed recognition, and surgical removal may provide both symptom relief and diagnostic confirmation.
Introduction Angioid streaks are rare, dark red, radiating fundus lesions surrounding the optic nerve head caused by breaks in Bruch's membrane. They predispose to choroidal neovascularization and recurrent hemorrhages requiring proactive management. Case description We report a 44-year-old pseudoxanthoma elasticum patient with bilateral, atypical macular angioid streaks and a 14-year follow-up.In 2011, fundus examination revealed horizontal angioid streaks traversing the macula bilaterally without evidence of choroidal neovascularization; best-corrected visual acuity was 10/10 Parinaud 2 both eyes. The left eye subsequently developed neovascularization complicated by macular hemorrhages. Within two years, bilateral neovascularization with recurrent macular hemorrhages developed, prompting transition from a PRN to a treat-and-extend regimen. After 11 years of intravitreal ranibizumab therapy, the right eye maintained baseline visual acuity, while the left eye progressively declined to 1/10 (Parinaud 16) due to fibrotic sequelae. Discussion This case illustrates an interesting angioid streak pattern, characterized by giant horizontal streaks crossing the fovea, an anatomical configuration associated with particularly high risk of choroidal neovascularization and submacular hemorrhages. The 14-year follow up demonstrates the limitations of a pro re nata regimen in these high-risk presentations, as delayed transition to treat-and-extend failed to prevent subfoveal fibrosis and severe visual loss in the left eye. Conversely, earlier treatment initiation and earlier transition to treat-and-extend protocol was associated with preserved vision in the right eye. This case could suggest that a proactive approach may optimize visual outcomes as in age related macular degeneration. There is a lack of guidelines and studies on this therapeutic strategy. Conclusion Close monitoring, assessment with optical coherence tomography angiography, and preventive education are essential, particularly regarding the risk of neovascularization and hemorrhage in patients with foveal-spanning angioid streaks. A proactive regimen may represent a more suitable and effective option for these patients when complications appear.
Introduction: Ocular trauma is a leading cause of preventable monocular blindness worldwide and imposes significant socioeconomic burdens. This study aims to describe the demographic patterns, trauma profiles, mechanisms of injury, and spectrum of ocular injuries across Malaysia's Ministry of Health (MOH) ophthalmology services. Materials and methods: We prospectively collected data from MOH facilities with ophthalmology services on patient demographics, trauma profiles, mechanisms of injury, baseline eye assessment, use of eye protection, foreign bodies, and details of patients with various ocular injuries. The spectrum of ocular injuries was classified as trivial or severe based on presenting visual acuity, further complications, the need for surgical intervention, frequent follow-up, and ward admission. Results: A total of 2,347 ocular trauma cases were reported across six regions in Malaysia. Ocular trauma predominantly affected males (over 80%), with a mean age of approximately 35 years. Workplace injuries were the most common in trivial cases (36.0%), while domestic injuries were more frequently associated with severe cases (30.3%). Most injuries were accidental, often involving metallic or sharp objects. The use of eye protection was low, at 13.1% in trivial cases and 5.5% in severe cases. Severe injuries were significantly associated with poorer initial visual acuity, relative afferent pupillary defect (RAPD), and higher likelihood of requiring surgery (55.5%). Common presentations included corneal foreign bodies (trivial) and lid lacerations, full-thickness corneal wounds, and orbital fractures (severe). Conclusion: This first nationwide study of ocular trauma in Malaysia identifies key risk groups and injury patterns, highlighting needs for focused public health interventions. These findings support the creation of a national ocular trauma registry and reinforce the importance of public education and occupational eye safety measures for preventable vision loss. However, these findings need to be interpreted cautiously, as private hospital cases were not included, and our findings may not reflect the whole picture.
Purpose To evaluate the efficacy and safety of rebamipide 1% and 2% in the management of dry eye disease (DED) compared to placebo or artificial tears (My Tears, Sodium Hyaluronate, or Diquafosol). Design Systematic review and meta-analysis. Methods This meta-analysis, adhering to PRISMA 2020 guidelines, systematically reviewed randomized controlled trials evaluating the efficacy of rebamipide, a medication known for gastric ulcer treatment, as an treatment for DED. A comprehensive literature search encompassed various databases. Inclusion criteria focused on high-quality evidence, namely RCTs, with a primary focus on outcomes such as tear film break-up time (TBUT), fluorescein staining score (FCS), and lissamine green conjunctival staining (LGCS) score. Results Thirteen studies were included, with diverse outcomes reported at 2, 4, and 8-12 weeks. Rebamipide demonstrated significant improvement compared to the control group in TBUT (MD = 0.47, 95% CI [0.15 to 0.79]), FCS (MD = -1.17, 95% CI [-1.81 to -0.53]), LGCS (MD = -1.73, 95% CI [-2.53 to -0.93]), and Schirmer’s test (MD = 1.05, 95% CI [0.16 to 1.95]). The overall risk ratio for adverse events favored the control group (RR = 1.39, 95% CI [1.10 to 1.77], P = 0.21). Conclusion Rebamipide is emerging as an effective treatment for DED, demonstrating improvements in various outcome measures. This meta-analysis provides valuable insights for all clinicians and researchers supporting informed decision-making and guiding future research endeavors in the management of DED.
Background and purpose: To enable tear meniscus height measurement independently of the clinical setting, we developed an artificial intelligence-based estimation model using a smartphone-mounted slit-lamp microscope (Smart Eye Camera) and anterior segment optical coherence tomography data. Materials and methods: In this prospective study, we analyzed data from 533 eyes of 298 patients who visited Keio University Hospital between March 2021 and January 2025. On the same day, both anterior segment optical coherence tomography and Smart Eye Camera video recordings were obtained. Machine learning was performed using the Light Gradient Boosting Machine to estimate tear meniscus height based on these datasets. Results: After appropriate preprocessing, the artificial intelligence model estimated tear meniscus height with a mean absolute error of 0.113 ± 0.094 mm and a mean squared error of 0.021 ± 0.035 mm, indicating moderate accuracy. Conclusions: We successfully developed an artificial intelligence algorithm capable of estimating tear meniscus height from Smart Eye Camera video and anterior segment optical coherence tomography data by identifying relevant anatomical landmarks. Although the results are promising, the current estimation accuracy remains limited. Future work will focus on improving performance by incorporating additional features such as iris segmentation, increasing the number of training samples, and applying more advanced machine learning techniques. As the present study was conducted in a Japanese cohort, the findings should be interpreted within the context of an Asian population.
Purpose The purpose of this systematic review and meta-analysis was to assess the influence of active smoking, secondhand smoke, and the use of electronic cigarettes (e-cigarettes) on tear film stability and the health of the ocular surface with a goal of determining their role in Dry Eye Disease (DED). Methods A thorough literature search was conducted in prominent databases to yield clinical studies that have documented tear film parameters (Tear Break-Up Time, Schirmer test, tear osmolarity) and ocular surface changes in smokers, individuals exposed to secondhand smoke, and electronic cigarette users. Pooled using random-effects meta-analysis, eligible studies were identified, and heterogeneity was analyzed using the I² statistic. Results The aggregated data revealed that active and passive smokers exhibited significantly lower TBUT (SMD = −2.87) and Schirmer values (SMD = −2.79) and higher tear osmolarity (SMD = +12.55), reflective of severe tear film instability. Structural changes, such as greater central corneal staining, central corneal thinning, and lower corneal sensitivity, were also commonly observed. Similar but inhomogeneous patterns of ocular surface damage were found in e-cigarette users. Comparisons were made with other studies, such as those of Putri (2024), Harjanti and Indrawati (2024), Miglio et al. (2021), Dabas et al. (2025), and Zaib et al. (2023)—broadly consistent with these results, although variations in methodology and groups were responsible for some variation. Conclusion Tobacco exposure, in the form of conventional smoking, secondhand smoke, or e- cigarette use, has been linked to severe tear film dysfunction and ocular surface injury. These observations underscore the importance of early ophthalmic examination and smoking cessation counseling, particularly in high-risk individuals.
Retinal tumors emerging from the intrinsic cell types of the neurosensory retina are a rare entity. They are subdivided in benign retinal astrocytoma or -astrocytic hamartoma and malignant retinoblastoma, the latter of which requires immediate intervention. Recently, a fourth type of retinal tumor named Benign Lobular Inner Nuclear Layer Proliferations (BLIP) was described by Sanfilippo et al. based on its characteristic findings on optical coherence tomography (OCT) [1]. Only very few cases have been reported and its pathophysiology remains unclear to date. We report the clinical findings and multimodal imaging of a rare case of unilateral BLIP associated with a Congenital Hypertrophy of the Retinal Pigment Epithelium (CHRPE) lesion.
Purpose Glaucoma, an optic neuropathy and major cause of avoidable irreversible blindness worldwide, has public health implications for the quality of life of affected individuals. Surgery is usually indicated when medical treatments fail or as primary treatment in severe disease. Anecdotally, willingness to accept glaucoma surgery among patients at the Lions International Eye Centre (LIEC), Korle Bu Teaching Hospital (KBTH) is low. This study thus sought to determine the predictors of willingness to accept glaucoma surgery among glaucoma patients at the LIEC, KBTH. Materials and methods This was a cross-sectional, hospital-based study among adult patients with glaucoma at the LIEC, KBTH from July 2022 to February 2024. Data were analyzed using SPSS version 26. Descriptive and inferential statistics were performed on the data. P-values <0.05 were considered statistically significant. Results We included 240 participants, consisting of 122 (50.8%) females and 118 (49.2%) males.The majority (180, 75.0%) were aged ≥ 48 years. Ninety-eight (40.8%) had lived with glaucoma for ≥ 5 years. Most participants (149, 62.1%) were willing to accept surgery as a treatment option. Fear of surgery (53, 22.1%) and blindness (50, 20.8%) were reasons provided for non-acceptance of surgery. Educational level, residential area, and family history of glaucoma were associated with knowledge about glaucoma (p < 0.05). Male gender (AOR = 2.0; CI = 1.0−3.3; p = 0.036) and presence of comorbidities (AOR = 0.4; CI = 0.2−0.7; p = 0.002) were predictors of willingness to accept glaucoma surgery. Conclusions Most glaucoma patients at the Korle Bu Teaching Hospital were willing to accept glaucoma surgery. Male gender and presence of comorbidities predicted willingness to accept glaucoma surgery. Consequently, there is a need for increased education on the necessity of glaucoma surgery.
Purpose The purpose of this study is to describe a technique using near-infrared (NIR) video for the diagnosis and documentation of symptomatic floaters. Methods Subjects with symptomatic floaters were identified through electronic case notes review, in which there was a primary diagnosis of floaters, secondary to PVD or syneresis.The presence of vitreous floaters was evaluated with both 30° NIR or fundus autofluorescence images and short, dynamic 30° NIR videos, in which subject is asked to briefly look away and refixate on the target. Three retinal specialists assessed both unseen still images and videos to determine the presence or absence of vitreous floaters. Group descriptive statistics and inter/interobserver percentage agreement were calculated using SPSS. Results Ninety-three eyes from 51 subjects (30 males and 21 females, mean age (±SD) 54 ± 14.7 years and baseline visual acuity 0.13 ± 0.49) were analysed. An underling diagnosis of PVD was noted in 31 eyes and syneresis in 62 eyes.Floaters were observed in 43% of the still images versus 96% of videos. Interrater agreement was 0.75 for still images and 0.96 for videos. Intraobserver agreement was 0.84–0.96 for still images and 1.0 for videos. Conclusions Dynamic NIR video is an objective imaging test for the detection and recording of floaters in symptomatic patients, demonstrating both superior interobserver and intraobserver test-retest reliability to static fundal imaging.This technique helps visualize and assess symptomatic vitreous floaters, offering objective documentation of their presence or absence. It aids in pre-operative decisions, patient education, and post-operative comparisons.
Background Primary angle closure suspect (PACS) is characterized by an anatomically narrow anterior chamber angle, predisposing individuals to angle closure and subsequent glaucomatous damage. Prophylactic interventions including laser peripheral iridotomy (LPI) and lens extraction (LE) can be employed to mitigate this risk, especially in high-risk patients. While both procedures aim to widen the iridocorneal angle, their comparative efficacy in improving anterior segment parameters remains a subject of ongoing investigation. Purpose This meta-analysis aimed to evaluate the comparative effects of lens extraction (LE) and laser peripheral iridotomy (LPI) on anterior segment parameters in primary angle closure suspects (PACS). The analysis encompassed a range of metrics, including angle opening distance (AOD), trabecular iris space area (TISA), trabecular iris angle (TIA), iris curvature (I-CURV), trabecular-ciliary process distance (TCPD), lens vault (LV), and mean Shaffer gonioscopy grading. Method A comprehensive search was conducted across PubMed, Scopus, Web of Science (WOS), and Cochrane Library to identify studies comparing the effects of laser peripheral iridotomy (LPI) and lens extraction (LE) on anterior segment morphology. Studies of all original design were included except case reports and case series. Effect estimates for continuous outcomes were expressed as mean differences (MD) with 95% confidence intervals (CIs). Meta-analysis was performed using Review Manager (version 5.4). The methodological quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS) tool. Results Four studies met the inclusion criteria for the meta-analysis. LE demonstrated consistently greater improvements compared to LPI in both short-term (1 month) and long-term (2 years) follow-up across all evaluated metrics. At one month, LE resulted in significantly larger anterior chamber angle metrics, including AOD500 and AOD750 (mean differences: −0.19 mm and −0.26 mm, respectively; both p < 0.00001), with these effects persisting at two years. Similarly, TISA500 and TISA750 were notably larger after LE (mean differences: −0.07 mm² and −0.21 mm²; both p < 0.00001). LE also achieved a greater reduction in TIA (−21.85 °; p < 0.00001), while I-CURV and TCPD improvements significantly favored LE (both p < 0.00001). Additionally, LV increased more substantially following LE (0.86 mm; p < 0.00001). Mean Shaffer gonioscopy grading also showed superior outcomes with LE (Standardized mean difference (SMD): −2.49; p < 0.00001). Conclusion LE consistently enhances anterior chamber dimensions, including AOD, TISA, and TIA, with benefits sustained for up to two years in patients with PACS. These anatomical improvements suggest a more effective long-term approach to reducing intraocular pressure and preventing disease progression. Clinicians should consider early LE in appropriate patients to optimize angle widening and minimize the need for additional interventions.
For patients with eye injuries, especially corneal foreign bodies, care pathways may vary depending on many circumstances. Mild cases can progress rapidly within hours and threaten the functional prognosis. Various clinical practitioners may be consulted for urgent care in this context. Each provider will propose specific care according to their resources and level of specialization. A well-codified management strategy and adequate training of healthcare providers might ensure improved standards of care for patients. Several classification tools for corneal foreign bodies are available. Removal is the mainstay of treatment, and several techniques are described, particularly in cases of metallic foreign bodies. The use of slit-lamp magnification should be considered in most cases. Various clinical simulation models have already been tested. We present herein an original model that takes advantage of affordability and realistic visual and tactile feedback, as well as innovative early recognition of iatrogenic corneal perforation and realistic interference from the upper eyelid.
