Introduction:Merkel cell carcinoma (MCC) is a rare, aggressive cutaneous malignancy with substantial risks of mortality and vision-threatening morbidity when periocular. We aimed to characterize the clinicopathologic features, management strategies, ophthalmic outcomes, and survival of periocular MCC. Methods:We conducted a retrospective cohort study of 18 periocular MCC cases treated at a tertiary center between January12010and February 1 2024. Demographic and tumor characteristics, treatment details, ocular complications, and survival endpoints were extracted from electronic records. Kaplan-Meier curves estimated overall survival (OS) and progression-free survival (PFS). Results:Eighteen patients (61% female; mean age ± SD, 71.6 ± 11.4 years) were included; 67% presented with upper-eyelid disease. Half of tumors were AJCC stage I (50.0%). Initial therapy was excision alone in 33%, excision plus radiation in 28%, and multimodal in the remainder; an average of 1.62 resections was required to achieve negative margins or functional reconstruction. Functional globe preservation was achieved in 78% of patients, with severe ocular complications in 11%. Median OS was 8.5 years (95% CI, 4.6-12.3) and the estimated 2-year OS rate was 88.9%. Median PFS was 6.4 years (95% CI, 0.1-12.8) with a 2-year PFS of 54.7%. Median follow-up was 17 months. Conclusion:Periocular MCC in this single-center cohort was typically detected early and managed with eye-sparing surgery with acceptable morbidity, yielding favorable OS and PFS estimates; these site-specific benchmarks can guide counseling, reconstruction, and future multicenter validation.

PURPOSE:To compare visual performance of the Vivinex Impress enhanced monofocal intraocular lens (IOL) (HOYA Surgical Optics) with the Acrysof IQ monofocal IOL (Alcon Laboratories, Inc). METHODS:In this multicenter, active-controlled trial, participants were randomized 2:1 to bilateral implantation with the enhanced monofocal (test) or standard monofocal (control) IOL and examined through 12 months postoperatively for visual acuities, refractive outcomes, defocus curves, and pupil diameters. RESULTS:Ninety-eight test and 46 control participants completed testing for the first implanted eye. The test arm demonstrated a statistically significant benefit in monocular distance-corrected intermediate visual acuity (DCIVA) (photopic: 1.2 lines, P < .001; mesopic: 0.7 lines, P = .01) and uncorrected intermediate visual acuity (0.8 lines; P < .001) but no significant difference in monocular corrected distance visual acuity (P = .07). Using a stepwise regression analysis for DCIVA, the final model (adjusted R-square, 0.31) identified three significant predictor variables (age, pupil diameter, and treatment arm). Photopic defocus curves showed the test arm produced better monocular visual acuity from -1.00 through -2.50 D than the control arm. The intermediate vision benefit of the test IOL is independent of pupil size and axial length. Cumulative and persistent adverse events for the test IOL did not exceed the Safety and Performance Endpoint rates per International Organization for Standardization 11979-7. CONCLUSIONS:Compared to a standard monofocal IOL, the Vivinex Impress enhanced monofocal IOL offers an extended range of vision, with significant improvements in intermediate vision and a DCIVA benefit unaffected by pupil size and axial length. This IOL is safe and effective for patients seeking improved intermediate vision following cataract surgery. [J Refract Surg. 2025;41(4):e300-e309.].

Merkel cell carcinoma (MCC) is a rare malignancy, with about half of cases affecting the head and neck region. This retrospective study evaluated risk factors and survival outcomes in 89 patients (47 females, 42 males, median age: 77 years) treated with curative surgical therapy ± adjuvant therapy at a single center from 2010 to 2023. Most patients (71.9 %) presented with UICC stage I-II disease, while 28.1 % were diagnosed with stage III disease. Among the 55 patients undergoing surgical neck management, the lymph node metastasis rate was 40.0 %. Adjuvant therapy was completed in 67.5 % of patients. In the 81 patients eligible for survival analysis, the two-year overall survival (OS) was 78.8 %, and disease-free survival (DFS) was 57.2 %. Multivariable Cox regression identified completion of adjuvant therapy as a statistically significant factor of improved OS (HR 0.154; p = 0.00611). UICC stage III was significantly associated with worse DFS (HR 10.507; p = 0.00656). Additionally, a lymph node yield of more than 3 nodes was linked to worse OS (HR 4.337; p = 0.0456) and DFS (HR 3.468; p = 0.0355). This study highlights the high rate of lymph node metastasis in MCC and its detrimental impact on survival, emphasizing the importance of aggressive, guideline-concordant multimodal treatment for improved outcomes.

Abstract Background The visual performance and the optical quality of a segmental refractive extended depth-of-focus (EDoF) intraocular lens (IOL) were evaluated in a prospective, single-arm, single-center study. Methods A total of 20 patients (40 eyes) after bilateral implantation of the refractive segmental EDoF Acunex Vario AN6V were included. Assessment procedure: refraction outcome, monocular and binocular uncorrected (UCVA) and distance-corrected visual acuity (DCVA), defocus curve, contrast sensitivity (CS), higher-order aberrations (HOAs) and patient satisfaction were evaluated 1 and 3 months after surgery. Results At 3-month follow-up, mean spherical equivalent was − 0.23 ± 0.32 D. Binocular uncorrected distance visual acuity (VA) at distance, intermediate and near was − 0.08 ± 0.06 logMAR at 4 m, -0.03 ± 0.06 logMAR at 66 cm and 0.16 ± 0.06 logMAR at 40 cm, respectively. The binocular defocus curve showed a VA better than 0.20 logMAR over a range from + 1.50 to − 2.45 D. Contrast sensitivity aligned with monofocal lenses, highlighting the lens's clinical value. Aberrometry showed minimal changes in corneal aberrations. NEI-RQL-42-Questionnaire showed a high patient satisfaction for daily activities and revealed reduced dependence on glasses, particularly for near and intermediate vision. The Acunex Vario AN6V demonstrated minimal dysphotopsias, making it a promising option for those seeking spectacle independence. Conclusion This segmental refractive EDoF IOL provides a high degree of spectacle independence for far and intermediate distances with functional near VA. Although inducing residual coma aberrations, it showed subjectively good results with little dysphotopsias. Trial registration This study protocol was reviewed and approved by ethics committee of Charité University, Berlin, Germany, with approval number EA4/126/20.

Zusammenfassung Weil die Erstsymptomatik maligner Neoplasien der Orbita häufig das Auge betrifft (Exophthalmus, Diplopie, Schmerzen), ist der Augenarzt häufig der erste mit der Problematik des jeweiligen Krankheitsbildes konfrontierte Arzt, von dessen Kenntnissen, richtiger Einordnung und richtigen weiteren Entscheidungen die adäquate weitere Therapiesteuerung und die Prognose des Patienten entscheidend abhängen.

Purpose To analyse higher-order aberrations of an enhanced monofocal aspheric intraocular lens (IOL) in relation to the clinical outcome compared to a monofocal aspheric IOL. Setting Department of Ophthalmology, Charité – Universitätsmedizin Berlin, Germany Design Prospective, monocentric, controlled, non-randomized, two-armed study Methods After phacoemulsification, a total of 30 patients (60 eyes) were bilaterally implanted with either TECNIS Eyhance IOL model ICB00 (Johnson & Johnson Surgical Vision, Inc.) or TECNIS Monofocal 1-Piece IOL model ZCB00 (Johnson & Johnson Surgical Vision, Inc.) in 30 eyes each. Assessments were performed 1 and 3 months after surgery including refraction, uncorrected and best-corrected distance, intermediate and near visual acuity, defocus curves, contrast sensitivities under photopic, mesopic and mesopic conditions with glare, higher-order aberrations (HOAs) at pupil sizes of 5, 4, 3 and 2 mm and patient satisfaction. Results At 3-month follow-up, measurements of HOAs revealed significant higher negative internal and ocular primary spherical aberrations in the ICB00 group at pupil sizes of 5, 4, 3 and 2 mm. The ICB00 showed significant better results in intermediate and near visual acuity, but no difference in distance visual acuity. No significant difference was found in contrast sensitivities at any condition or spatial frequency. Spectacle independence was significant better without significant higher rates of dysphotopsia in the ICB00 group. Conclusions Higher negative spherical aberrations in the ICB00 group at all measured pupil sizes appear to lead to a superior clinical outcome in intermediate and near vision compared to the ZCB00 group without compromising contrast sensitivity or distance visual acuity.

Im Oktober 2021 stellte sich ein 49-jähriger Patient mit einer seit 1 Jahr zunehmenden Protrusio bulbi in unserer Klinik vor. Der Patient klagte über Bewegungsschmerzen beim Rechts-Aufblick und Sehverschlechterung sowie Verschwommensehen.

The aim of this study was to evaluate whether XEN® implantation is a reasonable and safe method to lower the intraocular pressure (IOP) and amount of medication for adult primary open-angle glaucoma (POAG) over a 3-year period. The influence of the type of anesthesia, previous glaucoma surgery, and postoperative interventions on the outcome were examined. In this retrospective study, 96 eyes were included. XEN® implantation was performed as sole procedure under general (n = 86) or local anesthesia (n = 10). IOP and number of glaucoma medication were assessed preoperatively: day 1, week 6, month 3, 6, 12, 24, and 36. Further outcome parameters were Kaplan–Meier success rates, secondary intervention, and complication rates. IOP decreased from 20.7 ± 5.1 to 12.8 ± 2.5 mmHg at the 36-month follow-up (p < 0.001) and glaucoma therapy was reduced from 3.3 ± 0.8 to 1.2 ± 1.6 (36 months, p < 0.001). Transient postoperative hypotony was documented in 26 eyes (27.1

Ein 61-jähriger Patient stellte sich im November 2020 zur „Kontrolle bei Orbitatumor rechts, am ehesten entzündlich“ in unserer Klinik vor. Der Patient beklagte eine Sehverschlechterung am rechten Auge, sowie Schmerzen und eine Schwellung der Augenlider seit 1 Monat. Weitere Symptome waren ein Exophthalmus (.Abb. 1), ein relativ afferenter Pupillendefekt (im Folgenden als RAPD abgekürzt) sowie Doppelbilder. Bei der klinischen Untersuchung bestand ein bestkorrigierter Visus am rechten Auge von 0,4 und am linken Auge von 1,0. Im vorderen Augenabschnitt am rechten Auge sahen wir eine Bindehautchemosis und eine beginnende Katarakt bei sonst regelrechtemBefund und imhinterenAugenabschnitteinePapillenschwellung(. Abb.2).Das linkeAugezeigteeinen regelrechten Befund. Eigenanamnestisch war ein multiples Myelom vom Typ IgG Kappa bereits vorbekannt, welches erstmals im November 2018 extern diagnostiziert und weswegen der Patient chemotherapeutisch behandelt wurde. Im Zuge des Auftretens der aktuellen okulären Symptomatikwurde im Oktober 2020 extern eine Biopsie der orbitalen Raumforderung durchgeführt, wel-

Optic pathway gliomas in children carry significant morbidity and therapeutic challenges. For the subgroup of pre-chiasmatic gliomas, intraorbital and intradural resection is a curative option after blindness. We present a two-center cohort using different surgical approaches. A retrospective analysis was performed, including 10 children. Mean age at surgery was 6.8 years. Interval between diagnosis and surgery was 1–74 (mean 24 ± 5.5, median 10) months. Indications for surgery were exophthalmos, pain, tumor progression, or a combination. Eight patients underwent an extradural trans-orbital-roof approach to resect the intra-orbital tumor, including the optic canal part plus intradural pre-chiasmatic resection. Gross total resection was achieved in 7/8, and none had a recurrence. One residual behind the bulbus showed progression, treated by chemotherapy. In two patients, a combined supra-orbital mini-craniotomy plus orbital frame osteotomy was used for intraorbital tumor resection + intradural pre-chiasmatic dissection. In these two patients, remnants of the optic nerve within the optic canal remained stable. No patient had a chiasmatic functional affection nor permanent oculomotor deficits. In selected patients, a surgical resection from bulb to chiasm ± removal of optic canal tumor was safe without long-term sequela and with an excellent cosmetic result. Surgery normalizes exophthalmos and provides an effective tumor control.

ZusammenfassungICD-10-Code B83 Toxokariasis

Purpose: To evaluate visual performance and optical quality of an extended depth-of-focus intraocular lens (EDoF IOL) compared with a monofocal aspheric IOL. Setting: Department of Ophthalmology, Charit acute accent e-Medical University Berlin, Germany. Design: Prospective case series. Methods: After phacoemulsification, a total of 28 patients (56 eyes) underwent bilateral implantation of either the Mini Well (EDoF IOL) or the Mini 4 (monofocal IOL). Assessments including refraction, distance, intermediate and near visual acuity, defocus curves, contrast sensitivity, glare disability, higher-order aberrations (HOAs), and patient satisfaction were performed at 1 month and 3 months postoperatively. Results: Both study groups comprised 14 patients (28 eyes) each. At 3-month follow-up, the EDoF IOL showed better results in monocular uncorrected intermediate visual acuity (-0.04 vs 0.10 logMAR, P = .000) and in uncorrected near visual acuity (0.13 vs 0.36 logMAR, P = .000), whereas no statistically significant difference was found between groups in monocular uncorrected distance visual acuity (0.04 vs 0.00 logMAR, P = .110). The monocular depth of focus was 0.8 D greater in the Mini Well IOL group. Measurements of internal HOAs revealed a greater negative primary spherical aberration in the EDoF group at pupil sizes of 2.0 to 5.0 mm. At 5.0 mm, total internal HOAs did not differ statistically significantly (0.376 vs 0.340 mm root mean square, P = .068). Conclusions: The Mini Well IOL provided greater depth of focus with superior outcomes at intermediate and near distances and comparable outcomes at far distance. Although inducing higher amounts of spherical aberration, it showed good results under low lighting conditions with little subjective dysphotopsia.

PURPOSE:To compare and evaluate corneal higher-order aberrations (c-HOA) between conventional manual phacoemulsification (Phaco), femtosecond laser-assisted cataract surgery (FLACS), and femtosecond laser-assisted cataract surgery with astigmatic keratotomy (FSAK). METHODS:In this retrospective single center study, 53 healthy individuals with cataract (73 eyes) underwent phacoemulsification with implantation of an intraocular lens. Three groups were formed: group A, Phaco (n = 27 eyes of 21 patients); group B, FLACS (n = 25 eyes of 15 patients); group C, FSAK (n = 21 eyes of 17 patients). An iTrace aberrometer (Tracey Technologies, Houston, TX, USA) was used to perform aberrometry with a pupil scan size of 5.0 mm. We used ANOVA analysis and the paired sample t-test for statistical analysis. RESULTS:There was no difference in total c-HOA between the groups prior to surgery (F(2,66) = 2.2, p = 0.128), but some evidence for a difference between the groups after surgery (F(2,65) = 3.87, p = 0.025). After surgery, total c-HOA increased in all groups, but the greatest increase occurred FSAK. CONCLUSION:Manual phacoemulsification and femtosecond laser-assisted cataract surgery seem to have less impact on corneal higher-order aberrations than the combination of femtosecond laser-assisted cataract surgery with astigmatic keratotomy.

Introduction: In instances where peribulbar anaesthesia (PBA) cannot be used, Descemet membrane endothelial keratoplasty (DMEK) surgery can be performed under topical anaesthesia (TA). We evaluated subjective pain and post-operative outcomes of DMEK surgeries performed under PBA and TA. Methods: Sixty pseudophakic patients without history of ocular comorbidities underwent DMEK surgery under either PBA or TA. PBA was performed with a single injection of 6 mL Prilocaine Hydrochloride 2% in combination with 1500 I.U. hyaluronidase. For TA, patients were given 0.4% Oxybuprocaine eye drops followed by a 2% Lidocain Hydrochloride-Gel and an intraoperative injection of a 2% Lidocaine Hydrochloride solution into the anterior chamber. All surgeries were performed by the same surgeon. Subjective pain was measured using a visual analog scale (VAS). Secondary outcomes (BCVA, duration of surgery, endothelial density, rebubbling rate) were recorded during a follow-up period of 3 months. Results: The mean subjective pain of patients in the PBA group was 1.27 (95% CI 0.87-1.68) and 1.64 (95% CI 1.15-2.21) in the TA group. The mean duration of surgery was 402 s (95% CI 356-448) in the PBA group and 427 s (95% CI 371-483) in the TA group,p = 0.477. No major differences were observed in BCVA, endothelium density and rebubbling rate between the two groups. Anaesthesia-related side effects were more frequent in the PAB group than in the TA group. Conclusion: Although levels of subjective pain are lower under PBA than under TA, in selected patients without ocular comorbidities TA can achieve levels of pain acceptable for DMEK surgery.

To evaluate the long-term effect on intraocular pressure (IOP) and glaucoma medication of selective laser trabeculoplasty (SLT) compared to minimally invasive glaucoma surgery (MIGS) in primary open-angle glaucoma (POAG) and its potential in clinical practice. A total of 342 consecutive patients (stand-alone procedures) were included. One hundred and five patients underwent SLT treatment (360° SLT, 95–105 spots, Trabeculas SLT ARCLaser, Nürnberg, DE), 107 patients had an ab interno-derived trabeculotomy (Trabectome®, NeoMedix, Tustin, USA), and 130 patients received iStent inject® implantation (2 implants-Glaukos, CA, USA). IOP and glaucoma therapy were evaluated preoperatively, 1 day, 6 weeks, 3 months, 6 months, and 1, 2, and 3 years postoperatively. Statistical analysis was performed using a regression model and propensity matching score (reduced cohort number) using SPSS v20.0. Kaplan–Meier analysis was included using the following six criteria: criterion A (IOP ≤ 21 mmHg with or without medication, qualified success), criterion B (IOP ≤ 18 mmHg with or without medication, qualified success), criterion C (IOP ≤ 21 mmHg without medication, complete success), criterion D (IOP ≤ 18 mmHg without medication, complete success), criterion E (IOP ≤ 21 mmHg and IOP reduction > 20% after therapy), and criterion F (IOP ≤ 18 mmHg and IOP reduction > 20% after therapy). In the matched cohort, the SLT cohort showed an IOP reduction of 31.2% from 19.9 ± 2.3 to 13.7 ± 2.7 mmHg (p < 0.001) 3 years postoperatively; in Trabectome® IOP decreased by 31.4% from 20.5 ± 1.3 to 13.8 ± 2.0 mmHg (p < 0.001) and in iStent inject® by 29.9% from 19.5 ± 2.0 to 13.8 ± 2.7 mmHg (p < 0.001). Trabectome® and iStent inject® could not demonstrate a significant reduction in glaucoma therapy (Trabectome® p = 0.138, iStent inject® p = 0.612); a significant drop was noted in SLT (2.2 ± 1.2 to 1.7 ± 1.2, p = 0.046). SLT and MIGS achieved good to moderate survival rates using criterion A (93.3% SLT, 79.7% Trabectome®, 77.6% iStent inject®) and criterion B (74.5% SLT, 48.0% Trabectome®, 56.2% iStent inject®). As expected, low survival rates were obtained with non-filtering procedures: criterion C 11.1% in SLT, 6.5% in Trabectome®, 7.0% in iStent inject® and criterion D 3.0% in SLT, 4.3% in Trabectome®, 3.7% in iStent inject® in 3-year follow-up. The SLT is a low-complication and effective method for reducing pressure in mild to moderate POAG. SLT is suitable as an initial procedure when setting up a step scheme; MIGS is the treatment of choice as a follow-up for mild to moderate forms of glaucoma and accepted topical therapy. Ethic approval had been given by the Ethikkommission Charité – Universitätsmedizin Berlin, EA4/047/20—retrospectively registered.