Purpose: Diabetic retinopathy is marked by hyperglycemia-induced inflammation and chemokine signaling that drive immune cell infiltration and retinal damage. As bevacizumab offers limited benefit in some cases, targeting broader inflammatory pathways with agents like triamcinolone may enhance therapeutic outcomes. Methods: ARPE-19 cells exposed to hyperglycemic conditions (30 mM glucose) for 72 hours were treated with bevacizumab (0.3 mg/ml), triamcinolone (1mg/ml), or their combination. Cell proliferation was assessed using the MTT assay, while ELISA measured VEGF, MCP- 1, and CXCL10 secretion, and qRT-PCR analyzed CCR2 and CXCR3 gene expression. Three independent biological replicates were used in each experiment. Results: Hyperglycemia markedly increased cell proliferation after 24 and 48 hours (P < 0.001). Bevacizumab or triamcinolone alone did not alter cell proliferation under hyperglycemic stress; however, their combined treatment significantly reduced proliferation (P < 0.001). Hyperglycemia markedly elevated VEGF secretion (P < 0.001), whereas bevacizumab, triamcinolone, and especially their combination significantly suppressed it (all P < 0.05). All three treatment conditions significantly reduced MCP-1 levels (P < 0.05), while only the combined therapy lowered CXCL10 secretion (P < 0.01). Regarding chemokine receptors, both drugs individually downregulated CCR2 and CXCR3 expression, with the combination producing an additive inhibitory effect (CCR2: P < 0.001; CXCR3: P < 0.05). Conclusion: These results reveal that triamcinolone may complement bevacizumab by targeting VEGF-independent inflammatory pathways, providing mechanistic insight into combination therapy for diabetic macular edema (DME), particularly in patients with persistent DME despite anti-VEGF monotherapy.
Purpose: Limited knowledge exists about the recurrence and complications of rotational flaps harvested from the inferior bulbar conjunctiva in pterygium surgery. This study aimed to investigate the outcomes and recurrence rate of pterygium surgery using inferior rotational conjunctival flap (IRCF) compared with superior rotational conjunctival flap (SRCF) surgery. Methods: This randomized clinical trial was performed on 82 candidates for pterygium surgery (primary pterygium with horizontal extension >3 mm). The patients had been admitted to Amiralmomenin Hospital (Rasht, Iran) in 2023-2024 and were randomized to “group A” (IRCF surgery) and “group B” (SRCF surgery) using a single-blind method. They were visited on days 1, 3, 7, 30, 90, and 180 post-surgery, and their best corrected visual acuity (BCVA), clinical inflammation, complications, and recurrence were recorded and compared using SPSS version 26. Results: Recurrence was observed in two patients in each group: in group A, one case in the third month and another in the sixth month post-surgery; and in group B, two cases in the third month post-surgery. Frequency of corneal epithelial defect healing, frequency of complications, inflammation severity, BCVA, and recurrence rate did not differ between the two groups at any follow-up visits (P > 0.05). There was no statistically significant difference between the two groups in terms of recurrence rates, categorized by pterygium size and age, at any time point (P > 0.05). Conclusion: Pterygium surgery with IRCF can be a safe and effective method for treating primary pterygium, especially when potential glaucoma filtration surgery is considered or when a proper superior bulbar conjunctiva is not available. Further multicenter prospective trials are needed to confirm the benefits of this technique.
Purpose: To determine the accuracy of the fundus red reflex test using a smartphone and autorefractor to detect refractive errors in children. Methods: This cross-sectional study included 1302 eyes of 651 school-age children aged 6- 13 years with visual acuity worse than 6/9 in at least one eye, examined using the Snellen chart. Study participants were selected using purposive sampling, after which non-cycloplegic refractive measurement was performed using two instruments: a smartphone-based application (MD EyeCare) and an autorefractor. The detection of refractive errors using the online platform was compared with autorefraction as the reference standard. Results: Our study found that 46.10% of participants with abnormal red reflex had significant myopia, 41.20% had nonsignificant refractive errors, and 12.70% had significant hypermetropia. The mean difference between the smartphone-based application and the autorefractor was ≤−3.00 D (range: −2.88 to −2.63), with a sensitivity of 0.89 to 0.90 and a specificity of 0.86 to 0.87 for significant myopia, and the area under the curve was between 0.94 and 0.97. The mean difference between the smartphone-based application and the autorefractor was ≥+1.00 D (range: +0.13 to +0.38), with a sensitivity of 0.76 and a specificity of 0.97 for significant hypermetropia, and the area under the curve was between 0.88 and 0.96. Conclusion: A smartphone-based application could be used as a screening tool for refractive errors in children, especially in resource-limited settings.
Purpose: To compare the effectivity of vision therapy plus patching versus patching combined with placebo therapy in bilateral refractive amblyopia. Methods: In this randomized controlled trial, children with bilateral refractive amblyopia were enrolled. Monocular best-corrected visual acuity (BCVA) ranged from 0.3 logMAR (20/40) to 0.6 logMAR (20/80) in both eyes, and visual acuity (VA) difference was less than 0.2 logMAR between the eyes. The experimental group received patching plus in-office vision therapy with Vision Therapy System 4 (VTS4), including accommodation, stereopsis, ocular movements, and visual memory skills, while the control group received patching plus in-office placebo therapy. The primary outcome measure was BCVA, and the secondary outcomes were stereo acuity, and accommodative facility measured pre- and post-therapy. Results: Forty children aged 5 to 8 were included. After 4 months of therapy, the mean VA improvement was 0.23 ± 0.08 logMAR [2.3 line] (P < 0.001) in the experimental group and 0.09 ± 0.06 logMAR [0.09 line] (P < 0.001) in the control group. The difference in VA improvement between the two groups was statistically significant (P < 0.001). Post-therapy, the improvements in Randot stereoacuity and in monocular and binocular accommodative facilities were statistically significant between the experimental and the control groups (P = 0 .013, P = 0.005, P = 0.002, respectively). Conclusion: Administering vision therapy in conjunction with patching significantly improved VA, stereo acuity, and accommodation facility in bilateral refractive amblyopia compared to patching alone.
Purpose:This study evaluated the effectiveness of amniotic membrane photochemical-tissue bonding (AMPTB) versus amniotic membrane grafting (AMG) on treating corneal alkali burns in a rabbit model. Methods:Thirty-six albino rabbits with induced corneal alkali burns were divided into three groups: (a) untreated ulcer group (n = 12), (b) AMPTB group (n = 12), where the amniotic membrane (AM) was attached to the cornea using 532-nm light and Rose Bengal dye, and (c) AMG group (n = 12), in which the AM was secured using cyanoacrylate glue. The area, perimeter, and integrated density of the corneal ulcer were assessed using digital photographs analyzed with ImageJ software, alongside histological evaluation. Results:The AMPTB group experienced significant reductions in corneal ulcer area ( - 73.4%, - 79.8%, and - 89.3%), perimeter ( - 48.5%, - 54.0%, and - 67.2%), and integrated density ( - 81.2%, - 85.1%, and - 96.8%) after 1 day, 1 week, and 2 weeks, respectively. In comparison, the AMG group showed reductions in ulcer area ( - 65.2%, - 67.5%, and - 87.7%), perimeter ( - 35.5%, - 40.9%, and - 52.7%), and integrated density ( - 72.4%, - 69.5%, and - 94.7%). Additionally, histological analysis demonstrated earlier re-epithelialization of the cornea in the AMPTB group compared to the AMG group. Conclusion:The findings suggest that AMPTB promotes more rapid healing of the corneal epithelium and significant reductions in ulcer area, perimeter, and integrated density compared to AMG. AMPTB may, therefore, represent a promising alternative to AMG for the management of corneal alkali burns.
Purpose: Ocular trauma represents a considerable etiological factor for unilateral blindness, especially in developing countries. This research was conducted to examine the determinants influencing visual acuity after surgical intervention for traumatic cataracts. Methods: This retrospective study investigated individuals diagnosed with traumatic cataract who were referred and subsequently underwent surgical intervention in a tertiary hospital in Ahvaz, Iran, from June 2013 to October 2023. All patients were contacted, and a thorough ophthalmological evaluation was performed for each person. Visual acuity was assessed utilizing a range of techniques, including central, steady, maintained (CSM) fixation, LEA symbols, Teller acuity cards, and the Snellen chart. Data were analyzed using SPSS version 25.0, and a P-value <0.05 was considered statistically significant. Results: A total of 64 eyes from 64 patients were included. The mean age was 25.5 ± 22.0 years, and 71.9% were male. Open globe injuries accounted for 75% of cases, most (38%) of which were caused by sharp metal objects. Seventeen patients (26.6%) were under 7 years of age. Significant factors associated with final visual acuity included age (P = 0.021), injury type (P = 0.025), vitreous prolapse (P = 0.012), and size of rupture (r = 0.327, P = 0.024). Younger patients and those without vitreous prolapse had better visual outcomes. Conclusion: Age, injury type, vitreous involvement, and wound size were the main predictors of final visual acuity after traumatic cataract surgery. Comprehensive evaluation and timely surgical management may improve visual prognosis.
Purpose: To report a case of unexplained perivascular chorioretinal atrophy temporally associated with ranolazine use. Case Report: A 64-year-old man with chronic stable angina pectoris was referred to our retina clinic with a complaint of an inferior visual field defect in the right eye over the last 1 month. The symptom onset coincided with the prescription of ranolazine extended-release 500 mg daily and slowly progressed over this period. Central and color vision were normal, and relative afferent pupillary defect was negative. Fundus exam showed chorioretinal atrophy in both eyes along the main vascular arcades, which was more prominent in the right eye and along the superior temporal arcade. Visual field assessment disclosed a double arcuate scotoma in both eyes. Swept-source optical coherence tomography showed outer retina, retinal pigment epithelium, and choriocapillaris atrophy in the extrafoveal area. Fundus autofluorescence showed hypo-autofluorescence, and fluorescein angiography revealed staining along the vascular arcades. Electroretinogram disclosed abnormal photopic and scotopic responses. All findings were more prominent in the right eye and along the superior temporal arcade. Ranolazine intake was stopped. Three months after drug cessation, the patient’s visual field and electroretinogram improved. Conclusion: This is the first case report on ranolazine-associated chorioretinal toxicity, highlighting the necessity of further studies on potential side effects of even short-term exposure to this drug.
Purpose:To compare thevisual outcomes of small-incision lenticule extraction (SMILE) versus femtosecond laser in-situ keratomileusis (FS-LASIK) in eyes with myopia and high astigmatism. Methods:This retrospective study was conducted at a tertiary eye hospital between January 2021 and December 2022. Data were collected from individuals with myopia up to - 10.00 diopters (D) and cylinder ≥ 2.50 D who underwent SMILE (VisuMax 500) or FS-LASIK (MEL 90) and completed a 3-month postoperative follow-up. Results:A total of 170 eyes of 123 patients were included: 83 eyes (60 patients) underwent SMILE, and 87 eyes (63 patients) underwent FS-LASIK. The preoperative cylindrical refractive error was - 3.01 ± 0.61 D in the SMILE group and - 3.09 ± 0.66 D in the FS-LASIK group. At 3 months, there was no statistically significant difference in uncorrected visual acuity (UCVA) or manifest refraction spherical equivalent (SEQ) between the two groups (P = 0.26 and P = 0.88, respectively). In the SMILE group, 90.4% of eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 or better compared to 98.77% with a preoperative corrected distance visual acuity (CDVA) of 20/20 or better. In the FS-LASIK group, 80.46% of eyes achieved a UDVA of 20/20 or better compared to 94.25% with a preoperative CDVA of 20/20 or better. Moreover, 95.1% of eyes in the SMILE group and 94.3% in the FS-LASIK group were within ± 0.50 D. Vector analysis showed comparable results between the two groups in terms of target-induced astigmatism (P = 0.559), difference vector (P = 0.155), index of success (P = 0.091), and angle of error (P = 0.89). The surgically induced astigmatism and correction index were significantly lower in the SMILE group (P < 0.01), whereas the absolute magnitude of error was higher in the SMILE group (P = 0.02). Conclusion:SMILE and FS-LASIK have comparable efficacy, predictability, and safety in correcting myopia associated with high astigmatism ( ≥ 2.50 D).
This article systematically review and compare the efficacy and safety of femtosecond laserassisted cataract surgery (FLACS) and traditional phacoemulsification (PE) in patients with diabetes. A systematic search was conducted in Scopus, PubMed, Cochrane Library, and Google Scholar from inception to December 2024. Studies comparing FLACS with PE in patients with diabetes were included. The primary outcomes were central corneal thickness (CCT) and endothelial cell density (ECD), while the secondary outcomes included effective phaco time (EPT), surgical complications, and visual outcomes. The Cochrane Risk of Bias Tool 2.0 was used to assess quality in randomized controlled trials (RCTs), ROBINS-I for cohort studies, and the Newcastle-Ottawa scale for retrospective studies. Six studies involving 345 eyes met the inclusion criteria: one RCT, two cohort studies, one prospective study, and two retrospective studies. In the RCT, FLACS demonstrated significantly higher postoperative ECD compared to PE (mean difference: 423.55 cells/mm²; 95% CI: 199.89 to 647.21; P < 0.001). One cohort study reported EPT values of 6.52 ± 4.93 seconds for FLACS and 5.63 ± 4.31 seconds for PE. No significant differences in CCT were observed between groups at 3 months postoperatively across multiple studies. One study reported a lower incidence of postoperative complications, including fibrin exudation, corneal edema, posterior synechiae, and pigment dispersion, in the FLACS group, although specific rates were not provided. Overall, FLACS demonstrated superior endothelial cell preservation and a favorable safety profile in patients with diabetes; however, the available evidence is limited by study heterogeneity and risk of bias. Large-scale randomized controlled trials with standardized outcome reporting are needed.
Purpose: The endocannabinoid system can suppress inflammatory environment by regulating inflammatory mechanisms in immune and glial cells. Astrocytes secrete soluble inflammatory mediators. Prolonged activation of astrocytes is associated with accelerated aging in the central nervous system. MicroRNAs are increasingly shown to be critical gene regulators during inflammation and gliosis. In this study, we investigated the microRNA changes affected by anandamide (AEA), a dominant endocannabinoid in normal human astrocytes, following exposure to the HIV-1 Tat (Trans-activator of transcription) protein. Methods: We performed global human microRNA profiling in Tat-activated astrocytes on exposure to AEA. To delineate the mechanism of action, we utilized the bioinformatic tools miRWalk, KEGG, and Cytoscape to assess the global microarray data for significantly impacted miRNAs and their gene targets at the mRNA level. Results: Tat-induced activation significantly upregulated 122 miRNAs (P < 0.05) in astrocytes. Conversely, the addition of AEA in activated astrocytes significantly downregulated the expression of 57 miRNAs. Out of 122 miRNAs upregulated by Tat treatment, 37 miRNAs that were common to Tat and Tat+AEA cells showed reversed expression, suggesting these might be the critical miRNAs with a key role in the AEA-induced mitigation of neuroinflammation. Conclusion: Reversed expression of a selected group of miRNAs identifies antagonistic pathways that promote an anti-inflammatory environment. Pathway analysis of these 37 key miRNAs showed gene targets that regulate inflammation and senescence.
Purpose: To describe the clinical presentation, diagnostic challenges, management, and visual outcome of acute posterior vitreous detachment (PVD) in patients with Fuchs uveitis syndrome (FUS) Methods: This retrospective case series included consecutive patients with FUS who presented with acute PVD at a referral center from 2020 to 2024. The diagnosis of PVD was established based on fundus examination and dynamic B-scan ultrasonography findings. Results: Sixteen eyes of 16 patients (11 females, 5 males) with a mean age of 43 ± 9.8 years were studied. All patients reported sudden blurred vision in a white, painless eye, with 43.8% noting a new onset or an increased floater. The mean best-corrected visual acuity (BCVA) ranged from 20/25 to 20/200 at presentation, with an average of 0.43 logMAR. B-scan imaging revealed that following PVD, the majority of echogenic vitreous opacities were confined to the detached, shrunken vitreous body, and in some instances, accumulated within the peripheral vitreous cortex. The liquefied vitreous humor between the retina and the posterior hyaloid remained relatively echo-free. Within 3 months, spontaneous visual improvement occurred in 62.5% of patients, with mean BCVA improving from 0.310 to 0.127 logMAR. In three patients with persistent symptoms, pars plana vitrectomy (PPV) resulted in significant visual improvement, with the mean logMAR changing from 0.740 to 0.133. Conclusion: Acute PVD in patients with FUS can lead to sudden blurred vision, likely due to the increased density of inflammatory cells, opacities, and condensed vitreous strands within a detached, shrunken vitreous gel. In some cases, inflammatory deposits were layering over the peripheral vitreous body, contributing further to visual disturbance. Although most eyes showed spontaneous improvement, PPV was an effective intervention for patients with persistent, intolerable symptoms.
This study describes a novel technique for removing the internal limiting membrane (ILM) using a 25-G vitrectomy probe during the epiretinal membrane (ERM)/ILM double peeling procedure. After standard 3-port 25-gauge pars plana vitrectomy, ERM is removed using membrane forceps and appropriate staining. An incidental ILM flap may occur while washing out the ILM-specific dye with the vitrectomy probe. To prevent this, we suggest not withdrawing the vitrectomy probe, but instead applying proximal and tangential aspiration force over the ILM flap, which may be extended and peeled off by gentle probe maneuvers along the retinal surface. The technique is described in three cases, with details, and shown in a video. This approach has several advantages. It may reduce the number of entries into the posterior segment during pars plana vitrectomy, preventing inadvertent retinal breaks. Furthermore, in cases with fragile ILMs that are hard to elongate with forceps, the active aspiration force of the vitrectomy probe might rapidly extend and form large flaps. We suggest applying this technique in scenarios involving ERM/ILM double peeling and double staining, where an incidental ILM flap is found after washing out the ILM-specific dye.
Purpose: To report two cases of macular holes (MHs) that spontaneously formed and closed following pars plana vitrectomy (PPV) and summarize the literature. Case Report: A 72-year-old man and a 67-year-old woman underwent PPV for repair of rhegmatogenous retinal detachment. Both patients developed MHs following PPV. In both cases, the holes closed without further surgical intervention. A retrospective chart review and literature review were conducted to supplement this study. Conclusion: Spontaneous MH closure is possible in post-vitrectomized eyes. Small- or mediumsized MHs (<400 μm) may be more likely to close spontaneously. Large MHs (>400 μm) that form in the setting of vitreomacular traction (VMT) from residual posterior vitreous cortex remnants were found to close after spontaneous VMT release, often within the first month following surgery. Overall, among eyes with spontaneous closure, about two-thirds of MHs in the literature closed spontaneously within the first month following diagnosis, and 4 in 5 holes closed within 3 months. Over one-third of MHs that close spontaneously reopen later, some requiring additional surgery to achieve closure. Sustained closure was seen in this report up to 7 years following closure.
Anterior segment eye diseases significantly affect patients’ quality of life (QoL) by impairing physical health, psychological well-being, social interactions, and economic stability. Conditions such as dry eye disease, blepharitis, conjunctivitis, keratoconus, keratitis, and corneal dystrophies cause chronic discomfort, visual disturbance, and emotional distress, leading to reduced daily functioning and work productivity. Other disorders like chalazion, trichiasis, ptosis, strabismus, and thyroid eye disease entail a psychological burden by affecting appearance and social confidence. This narrative review comprehensively examines the multidimensional impact of anterior segment diseases on QoL. A systematic literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language articles published between December 1997 and February 2025. Using relevant keywords and Boolean operators, we initially identified 854 articles. Following duplicate removal and screening based on inclusion and exclusion criteria focused on QoL-related outcomes in anterior segment diseases, we selected 72 high-quality studies for the review. This methodology ensured a thorough and focused analysis of the available evidence. Findings highlight the importance of addressing both clinical symptoms and psychosocial effects in management strategies. Future research should emphasize interventions that improve ocular function alongside overall well-being.
Regulated cell death pathways are vital for proper developmental and homeostatic processes. Dysregulation of these pathways contributes to the pathogenesis of many diseases, including ocular inflammatory and neurodegenerative diseases such as glaucoma, diabetic retinopathy, age-related macular degeneration, retinitis pigmentosa, and ocular surface diseases. Our knowledge of the regulated cell death pathways, including apoptosis, necroptosis, pyroptosis, and ferroptosis, has been extensively expanded in the recent years. The targeting of these pathways as a potential therapy for various ocular diseases is now widely recognized. In recent years, it has also become clear that in many circumstances, the engagement of multiple regulated cell death pathways could be coordinated through specific cross talks to drive a stress-specific cell death and disease pathogenesis. This knowledge is extended to the recognition that targeting multiple regulated cell death pathways could be more effective for the treatment of various pathologies. However, the identity of upstream regulatory pathways and the engagement hierarchy of individual pathways and their coordinated interactions require further investigation. Here, I will briefly introduce these regulated cell death processes, discuss the key regulatory pathways involved in determining cell death or survival, as well as upstream modulators. I will also highlight studies targeting these pathways as potential treatment strategies for various eye diseases.
Posterior segment eye diseases pose a significant threat to vision-related quality of life, affecting functional independence, psychological health, and social well-being. Conditions such as diabetic retinopathy and age-related macular degeneration are leading causes of blindness, often resulting in severe emotional distress and reduced mobility. Optic neuritis and optic neuropathy can lead to vision loss and increase the risk of depression, particularly in patients with multiple sclerosis. Retinal disorders like central serous chorioretinopathy and retinitis pigmentosa disrupt daily tasks such as reading and driving, thus leading to social isolation and economic burden. Hypertensive retinopathy and retinal detachment further contribute to vision impairment, with long-term implications for functional ability and mental health. Inherited retinal diseases such as Stargardt disease and Leber congenital amaurosis significantly reduce quality of life from an early age and negatively affect education, employment opportunities, and psychological wellbeing. Additionally, the economic impact of these diseases is substantial, with high treatment costs and productivity loss. On the other hand, vision rehabilitation, psychological support, and advancements in gene and pharmacological therapy can largely mitigate the adverse effects on quality of life associated with posterior segment diseases. Therefore, a comprehensive approach that integrates medical, psychological, and social interventions is essential for improving patient outcomes. Future research should focus on developing innovative treatments and patientcentered care strategies to improve the quality of life for individuals affected by this condition.
Optical coherence tomography (OCT) diagnostic technology is increasingly being integrated into clinical practice and is evolving rapidly. Performing a meta-analysis of these advancements can provide valuable insights to clinicians and healthcare decision-makers and help identify gaps that need further research and development. We conducted a systematic review and network meta-analysis (NMA) comparing the diagnostic accuracy of three key OCT-derived parameters in identifying early glaucoma: peripapillary retinal nerve fiber layer (RNFL) thickness, macular metrics, and optic nerve head (ONH) characteristics. We systematically searched PubMed, Embase, Web of Science, and Scopus for studies published from January 2004 through March 2024, and identified 47 eligible studies. These studies comprised 12,723 eyes from 8177 participants, including patients with mild primary open-angle glaucoma, pre-perimetric glaucoma (PPG), and ocular hypertension, as well as healthy controls. Our NMA summarized the existing evidence on the diagnostic performance of these parameters. The highest diagnostic accuracies for glaucoma detection were observed for average and inferior RNFL parameters, both achieving an accuracy of 0.77 and macular GLV parameter with an accuracy of 0.76. These were followed by inferotemporal GCIPL and two ONH parameters—rim area and cup-to-disc ratio—each with an accuracy of 0.75. In conclusion, the overall diagnostic accuracy was comparable across all three categories of OCT parameters. The results also suggest the potential benefits of combining two or three of these parameters in a single report, along with the application of artificial intelligence. This approach could significantly enhance the diagnostic accuracy of OCT in detecting glaucoma at its earliest stages, ultimately improving patient outcomes through earlier intervention.
Purpose: To investigate the relationship between deviation control and accommodative load in patients with intermittent exotropia (IXT). Methods: A total of 35 patients with IXT aged 5-21 years (average, 10.46 ± 4.42 years) with a best-corrected visual acuity of 20/20 or better were included in this study. All examinations, including binocular and monocular refraction, deviation angle, near stereoacuity, and deviation control, were done in patients with the best optical correction. Results: Of the 35 patients, 16 (45.7%) were male and 19 (54.3%) were female. The results indicated a statistically significant difference in the average distance and near deviation angles between good, relatively good, and poor deviation control levels (P = 0.012). The results also showed that the likelihood of deterioration in deviation control increased significantly with deviation angle (P = 0.012). The accommodative load of the right and left eyes at distance and near fixation did not differ significantly across the three levels of deviation control. Based on the results of univariate logistic regression, no statistically significant relationship was observed between accommodative load (both the right and left eyes at distance and near) and deviation control level. However, there was a significant difference between the accommodative loads of the left and right eyes at near and distance (P < 0.001). Conclusion: In patients with IXT, deviation control decreased with deviation angle, and accommodative load increased in near fixation compared to distance fixation, but differences were not significant across the three deviation control groups (good, relatively good, and poor).
Purpose: To evaluate the 1-year effectiveness of selective laser trabeculoplasty (SLT) in patients with pseudoexfoliative glaucoma (PEXG). Methods: This prospective, single-arm, non-randomized interventional study involved 40 eyes from 40 patients with PEXG with no history of glaucoma surgery and laser trabeculoplasty. All participants underwent a single session of 360º SLT. Follow-up visits were conducted at 2 hours, 1 day, 1 week, and at 1, 2, 3, 4, 5, 6, and 12 months after the procedure. The intraocular pressure (IOP), the number of anti-glaucoma medications (NOM), and the 1-year success rate were investigated as primary outcome measures; while the incidence of adverse effects was considered the secondary outcome. Treatment success was defined as a ≥20% decrease in IOP compared to baseline. Results: The baseline IOP was 22.19 ± 2.08 mmHg, and the mean NOM was 3.12 ± 0.55 before the SLT procedure. The mean IOP was significantly lower at all follow-up visits than at baseline, whereas the mean NOM remained unchanged throughout the follow-up period. The mean IOP values at 1, 3, 6, and 12 months after SLT were 18.02, 16.92, 16.47, and 15.31 mmHg, respectively. The overall 1-year success rate was 85%, with an average IOP reduction of 31.0% relative to baseline. The most common adverse event following SLT was mild anterior chamber inflammation, which occurred in 32.5% of eyes. Conclusion: The SLT procedure could significantly reduce IOP in patients with PEXG with minimal adverse effects. The 1-year outcomes were favorable, suggesting that SLT may serve as an effective primary or complementary treatment for PEXG.
Purpose: To compare the outcomes of combined phacoemulsification and viscocanalostomy with versus without intrascleral implantation of Ahmed glaucoma valve (AGV) tube remnants in patients with primary open-angle glaucoma (POAG) and cataract. Methods: A randomized clinical trial involving 60 patients with cataract and POAG was carried out. The case group underwent phacoemulsification and viscocanalostomy together with intrascleral implantation of AGV tube remnants, while the control group underwent the same procedures without any implant. The two groups were compared in terms of best-corrected visual acuity (BCVA), intraocular pressure (IOP), cup-to-disc ratio, number of ocular hypotensive medications, surgical success rate, and scleral lake size. Results: Sixty patients were enrolled and equally divided into two groups. Postoperative IOP, BCVA, and cup-to-disc ratio did not differ significantly between the groups (P = 0.196, P = 0.724, and P = 0.443, respectively). Despite comparable IOP outcomes, the case group required a significantly higher number of ocular hypotensive medications at the final follow-up (P = 0.043). Anterior segment optical coherence tomography (AS-OCT) revealed significantly larger scleral lake dimensions in the case group in terms of length, height, surface area, and perimeter (all P ≤ 0.001). Conclusion: Our study found no significant difference in success rates or postoperative IOP control between combined phacoemulsification and viscocanalostomy with or without silicone implants. Although the case group demonstrated larger scleral lake dimensions on AS-OCT, this anatomical difference did not translate into superior IOP outcomes and was associated with a higher requirement for postoperative ocular hypotensive medications. The clinical significance of increased scleral lake size in the presence of an implant remains uncertain, and longer-term follow-up is warranted.
