Belantamab Mafodotin (Belamaf) is a BCMA targeted antibody drug conjugate with a multi-modal mechanism of action including direct MMAF induced cellular cytotoxicity as well as immunogenic cell death. Belamaf in combination with bortezomib and dexamethasone (BVd) demonstrated superior progression-free and overall survival for patients with relapsed or refractory multiple myeloma (RRMM) compared to daratumumab, bortezomib and dexamethasone (DREAMM-7 trial) leading to regulatory approvals. However, the mean Belamaf compliance when dosed Q3W in DREAMM-7 was 51%, decreasing as treatment progressed (77% 0-6m, 68% 6-12m, 28% >12m) suggesting that further optimisation of the schedule is possible. Ocular adverse events with Belamaf mean eye examinations are recommended prior to dosing, adding to the treatment burden for patients and placing additional demands on healthcare resources. The Ocular Surface Disease Index (OSDI), a patient questionnaire, was retrospectively evaluated in the DREAMM-2 trial as a potential surrogate for ocular examinations. Notably, a negative questionnaire was able to rule out grade 3-4 keratopathy in 93.5% of examinations (Popat et al., ASH 2021). This questionnaire was adjusted to a 9-item Visual Related Anamnestic Tool (VRAT) to assess eye symptoms and vision related function. This can be used by healthcare professionals to evaluate ocular side-effects associated with Belamaf, potentially streamlining monitoring and improving patient experience. ProMMise is phase I/II muti-centre platform trial investigating Belamaf combinations for patients with RRMM after 1-3 prior lines of therapy. The ProMMise D arm will be conducted in two stages, with a primary objective of determining if BVd can be safely given using the VRAT without the need for mandated eye examinations. Secondary objectives include: to assess the agreement between the VRAT and eye care specialist-led dosing, and to assess treatment compliance and efficacy using a less intensive dosing schedule without eye assessments. In stage 1, 40 patients will have eye assessments prior to the first 3 doses as well as completing the VRAT. Dosing will be interrupted for ≥ grade 3 events or a positive VRAT. A safety assessment for the use of the VRAT will be performed following this by an independent Safety Review Committee. Thereafter, Stage 2 will enrol 60 patients with no mandated on-treatment eye assessments and ocular adverse events assessed using the VRAT alone prior to each Belamaf dose. If the questionnaire is positive, treatment will be interrupted. A multiple outcome Bayesian monitoring strategy will be used to monitor ocular toxicity in the short-term for participant safety and in the longer-term to assess the suitability of this approach. Patients will receive BVd in a less intensive schedule to DREAMM-7 based on the trial post-hoc analysis of actual treatment received to improve Belamaf compliance. A weekly bortezomib schedule is used in line with real world practice to reduce peripheral neuropathy, with home administration permissible for patient convenience. The ProMMise D schedule being evaluated is: Belamaf 2.5mg/kg for cycle 1 then 1.9mg/kg Q8W with bortezomib 1.3mg/m2 s.c. and 40mg dexamethasone weekly for 6 months. Following that, Belamaf monotherapy maintenance will commence Q12W until disease progression or intolerance. ProMMise D gained regulatory approval in December 2024. Enrolment is ongoing with results from Stage 1 expected in the first half of 2026. The ProMMise D trial aims to investigate a patient-centred approach to delivering Belamaf with bortezomib and dexamethasone with less intensive dosing to improve compliance and replacing ocular examinations with a simple questionnaire (VRAT). GSK provided funding and Belamaf supply. This study was also supported by Myeloma UK through the UKMRA-MUK- concept and access research programme. Trial registration number: ISRCTN19869915

Aims To investigate the impact of surgeon learning on endothelial keratoplasty (EK) procedure outcomes.Methods A prospective nationwide registry study of EK grafts in patients aged at least 21 years with Fuchs endothelial corneal dystrophy or pseudophakic bullous keratopathy undergoing a first EK procedure in that eye between 2005 and 2020. EK procedures were either Descemet Stripping Endothelial Keratoplasty (DSEK) or Descemet Membrane Endothelial Keratoplasty (DMEK). Primary outcome was transplant survival at 2 years. Secondary outcomes at 1-year post-transplant were (1) best-corrected visual acuity, (2) requirement for repeat air injection procedures to treat graft detachment and (3) iatrogenic primary graft failure.Results Following analysis of 11 516 EK transplants, significant impact of surgeon learning was indicated by (1) the influence of surgeon prior experience in that EK technique, (2) the influence of surgeon prior experience in postoperative management and (3) the time interval from introduction of that EK technique in the United Kingdom to time of surgery. EK grafts reported to have failed within the first 6 months were a significant proportion of all transplant failures.Conclusions Influence of surgeon learning and inexperience in EK of clinical and statistical significance can be quantified and diminishes over time. Equivalent analyses may be feasible for novel procedures in other ophthalmology specialties and surgical training. Training programmes and nationwide advisory networks may be helpful in reducing the duration and impact of surgeon learning curves.

High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome (see page 1193) High-risk factors for intraoperative zonular complications due to pre-existing zonular dehiscence in eyes with pseudoexfoliation syndrome were poor mydriasis, a shallow anterior chamber, and large lens decentration, emphasising the importance of preoperative assessment of these clinical parameters.Ocular inflammatory events following COVID-19 vaccination: reporting of suspected adverse drug reactions to regulatory authorities in the United Kingdom (see page 1200) Ocular inflammatory events following COVID-19 vaccination are rare, the most commonly reported phenotype being anterior uveitis.

Navigation guided transcaruncular orbital optic canal decompression in indirect traumatic optic neuropathy: long term outcomes (see page 779)No therapeutic modality has an established role in traumatic optic neuropathy.Minimally invasive navigation guided transcaruncular orbital optic canal decompression is reported by the authors to be a promising technique for visual recovery in indirect traumatic optic neuropathy.

Normative data and percentile curves for axial length and axial length/corneal curvature in Chinese children and adolescents aged 4 to 18 years (see page 167) A probability model based on age, gender, axial length and axial length/corneal curvature percentiles has significant value in screening for myopia in Chinese children; additionally, the percentile charts constructed using the LMS method provide reference data and aid in monitoring changes over time. Progression of keratoconus in children and adolescents (see page 176)In this longitudinal study, the majority of eyes (77%) of individuals≤18 years old showed progression of keratoconus based on changes in corneal tomography.More advanced keratoconus at presentation was associated with continued progression.

Purpose To compare Kaplan–Meier survival curves and funnel plots for the audit of surgeon-specific corneal transplantation outcomes. Methods We obtained data on all patients with Fuchs endothelial dystrophy (FED) receiving a first corneal transplant in one eye between January 2012 and December 2017. We produced 2-year Kaplan–Meier graft survival curves to compare a simulated individual surgeon’s graft survival rate to national pooled data. We used funnel plots to compare all surgeon outcomes to the national graft survival rate with superimposed 95 and 99.8% confidence limits. We defined an outlier as a surgeon who performed ≥10 transplants and had graft survival below the 99.8% national lower limit. To assess the effect of the surgeon case mix, we also compared unadjusted and risk-adjusted graft survival rates. Results There were 3616 first corneal transplants for FED patients with complete data, performed or overseen by 196 surgeons. The 2-year national graft survival rate was 88%. The median change from the unadjusted to the risk-adjusted graft survival rate for individual surgeons was 0% (IQR: 0%– −2%). Of the 108 surgeons who had performed ≥10 transplants, we identified two outliers based on the unadjusted graft survival funnel plot, compared to four outliers based on the risk-adjusted graft survival funnel plot. Conclusion Funnel plots provide a visually accessible method for comparing individual graft survival rates to the national rate. Risk-adjustment accounts for clinical factors, and this has advantages for audit and clinical governance.