Abstract As there is a lack of reliable structural outcome parameters for posterior uveitis trials, we compared inter-rater reliability (IRR) of chorioretinal lesion area measurement (quantitative analyses) and characterization (qualitative analyses) on color fundus photography (CFP) and multimodal fundus autofluorescence (FAF). In this prospective cohort study, posterior uveitis eyes were imaged with CFP (Eidon, iCare, Vantaa), short- (swBAF, 450 nm; Eidon) and long-wavelength blue-light-autofluorescence (lwBAF, 488 nm), green-light-autofluorescence (GAF, 518 nm), and infrared-autofluorescence (IRAF, 787 nm) (all Spectralis, Heidelberg Engineering, Heidelberg). Lesion area, measured with ImageJ (National Institutes of Health), and image characteristics of lesions were graded on all modalities by two masked raters. A total of 318 lesions from 27 eyes (17 patients) were included. Absolute inter-rater differences in area measurement were 0.57, 0.78, 0.30, 0.36, and 0.55 in standardized 103 pixels for CFP, swBAF, lwBAF, GAF, and IRAF, respectively. IRR was high for all modalities for quantitative (intraclass correlation, 95% confidence interval (CI) [0.997–0.998]) and at least substantial for qualitative measures (unweighted Cohen’s kappa 0.84, 0.91, 0.89, 0.91, and 0.89 for CFP, swBAF, lwBAF, GAF, and IRAF, respectively, all p < 0.0001, CIs [0.79–0.95]). Hence, FAF could be a reliable complementary imaging modality for posterior uveitis clinical trials, especially for lesion quantification.

Provide expert-informed guidance on the integration of aflibercept 8 mg into routine clinical care for patients with neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO), based on clinical trial and real-world evidence. Sixteen retina specialists ('experts') met during the Association for Research in Vision and Ophthalmology (ARVO) annual meeting in May 2025 to discuss the clinical use of aflibercept 8 mg. A post-meeting online platform was used to collect additional independent input. Agreement was captured using binary responses and categorised as: all agreed (100%), majority agreed ( ≥ 75%), most agreed (50-74%), or non-consensus ( ≤ 50%). All experts agreed that aflibercept 8 mg may be considered as a first-line treatment in treatment-naïve patients with nAMD and DMO, and switching to aflibercept 8 mg can be considered for previously treated patients. The majority of experts agreed that switching patients with well-controlled disease on shorter or intermediate dosing intervals may enable further interval extension while maintaining disease control, and switching patients with poorly controlled disease may optimise anatomical outcomes and improve stability. Most experts agreed that three initial monthly loading doses are appropriate in newly diagnosed patients. No consensus was reached on optimal dosing-decision strategies after switching in patients with poorly controlled disease, nor on the timing of initial interval modification during treatment initiation. These expert opinions, informed by available, emerging clinical evidence and real-world clinical experience, support aflibercept 8 mg as a first-line and switch option for nAMD and DMO, using personalised treatment approaches for both treatment-naïve and previously treated patients.

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.

PURPOSE : To report the efficacy of early versus delayed pegcetacoplan treatment in eyes with geographic atrophy (GA) secondary to age-related macular degeneration as well as the 48-month safety profile of pegcetacoplan. DESIGN : Efficacy and safety data from the phase 3 GALE open-label extension (OLE) of the phase 3 OAKS and DERBY studies, representing up to 48 months of continuous pegcetacoplan treatment, were analyzed. PARTICIPANTS : Eyes with nonsubfoveal or subfoveal GA receiving pegcetacoplan in OAKS and DERBY continued receiving pegcetacoplan at the same dosing regimen in GALE, and sham-observed eyes with nonsubfoveal or subfoveal GA in OAKS and DERBY crossed over to active treatment in GALE at the same dosing interval in those studies. METHODS : The overall population included eyes with nonsubfoveal GA and eyes with subfoveal GA. Subgroup analyses were performed on data from eyes with nonsubfoveal GA and eyes with subfoveal GA. The early treatment group comprised eyes receiving pegcetacoplan for 48 months across the OAKS, DERBY, and GALE studies. The delayed treatment group included sham-observed eyes from OAKS and DERBY which crossed over at 24 months to receive pegcetacoplan treatment for 24 months in the GALE OLE. MAIN OUTCOME MEASURES : GA area growth rate, amount of retinal tissue preserved, risk of progression to absolute scotoma, and safety. RESULTS : In the overall population, 48 continuous months of pegcetacoplan treatment reduced GA area growth rate by up to 24% compared with projected sham, translating to 1.88 mm2 of retinal tissue. Approximately three times more retinal tissue (up to 3.16 mm2 with monthly treatment) was preserved in eyes with nonsubfoveal GA in the early treatment group compared with eyes in the nonsubfoveal GA delayed treatment group (1.11 mm2). Reduced risk of progression to absolute scotoma of all central 4 and 16 loci (32% and 43%, respectively) was observed in the overall population. GALE safety data were consistent with the findings of the OAKS and DERBY studies. CONCLUSIONS : Pegcetacoplan demonstrated effectiveness in slowing GA progression and consistent safety over 48 months. Long-term anatomic and functional outcomes support the importance of early treatment to maximize the preservation of retinal tissue and function.

Epidermal growth factor (EGF) has been suggested to play a role in myopic axial elongation, and EGF receptor blockade may be of potential therapeutic benefit. Here we examined the ocular and systemic toxicity of panitumumab, a clinically used EGF receptor blocker in oncology, when repeatedly administered intravitreally in non-human primates. The experimental study included six non-human cynomolgus primates (3 males) which underwent five (n = 1 animal) or three (n = 5 animals) 4-weekly intravitreal injections of panitumumab (dose: 0.78 mg (78µL)) or of phosphate buffered solution (PBS) (78µL). The study group with panitumumab injections consisted of 7 eyes and the control group with PBS injections of 5 eyes. Two animals of the study group developed on Day 59 (two days after the third injection) signs of a slight intraocular inflammation (cells in anterior chamber and vitreous) and reduction of intraocular pressure, with most of the signs having resolved at study end (Day 86). Panitumumab reached the serum peak concentration at 24 h after the first dose (Cmax 18.3 to 946ng/mL; serum exposure 2120 to 37300 h*ng/mL). Four weeks after the third injection (Day 86), panitumumab concentrations in aqueous humor ranged from 12.8 ng/mL to 65.0 ng/mL, and in the vitreous from 1.74 ng/mL to 531 ng/mL, with a panitumumab accumulation factor between 0.891 and 0.012. TUNEL staining did not reveal pathological results. Except for mild and reversible intraocular inflammation in some eyes, repeated intravitreal application of 0.78 mg panitumumab did not result in ophthalmological or systemic adverse effects in non-human primates.

Teleophthalmologische Untersuchungen können Zugangsbarrieren für Pflegeheimbewohner verringern, jedoch ist unklar, in welchem Maße sich daraus eine tatsächliche augenärztliche Nachsorge ableiten lässt. Sechs Monate nach einer teleophthalmologischen Erstuntersuchung im Rahmen der TOVIS-Pilotstudie werden Akzeptanz des Modells, Nachsorgeteilnahmequote und Gründe für ausbleibende Facharztkontakte untersucht. Bewohner zweier Pflegeheime, die an der TOVIS-Pilotstudie teilgenommen hatten, wurden 6 Monate nach der Erstuntersuchung schriftlich befragt. Erhoben wurden (1) Inanspruchnahme einer empfohlenen augenärztlichen Nachsorge, (2) Gründe für eine Nichtteilnahme einer empfohlenen augenärztlichen Nachsorge, (3) Bewertung der Teleuntersuchung mittels Likert-Skala. Deskriptive Statistiken, Chi2-Tests und t‑Tests wurden zur Analyse genutzt. Von den ursprünglich 86 untersuchten Bewohner:innen nahmen 64 (Teilnahmequote 74

BACKGROUND:Persistent full-thickness macular holes (FTMHs) following primary surgery represent a therapeutic challenge. Various surgical treatment approaches have been proposed. This study evaluates anatomical and functional outcomes of a temporary silicone oil tamponade in persistent FTMH in a larger cohort. METHODS:In a retrospective multicentre study, we included consecutive patients with persistent FTMH following vitrectomy with inner limiting membrane peeling and gas tamponade who were treated by a temporary silicone oil tamponade. FTMH morphology in optical coherence tomography, minimum linear diameter (MLD), closure rate and best-corrected visual acuity (BCVA) change were assessed. RESULTS:A total of 102 eyes of 102 consecutive patients were included. Median duration of silicone oil tamponade was 16.6 weeks (interquartile range (IQR) 12.0-22.1). Closure of the macular hole (flat/closed configuration) was achieved in 92.2% of eyes. Median BCVA improved significantly from 1.00 logMAR (IQR 0.70-1.15) to 0.70 logMAR (IQR 0.49-1.00; p<0.0001). Mean preoperative MLD was 460.7 µm (±194.2; range 136-1016), with significantly higher MLD in eyes with unsuccessful (614.4 µm±250.4) compared with successful (446.9 µm±183.9; p=0.019) silicone oil treatment. CONCLUSION:Treatment of persistent FTMH with a temporary conventional silicone oil tamponade without retinal manipulation or postoperative positioning results in a high anatomical success rate and significant mean BCVA improvement. Success rate decreases with higher FTMH size.

Geographic atrophy (GA) is the chronic loss of retinal pigment epithelium, photoreceptors and choriocapillaris, marking the dry late stage of age-related macular degeneration (AMD). GA prevalence is expected to rise in the upcoming decades. Advanced GA leads to central scotomas, reducing visual acuity and quality of life, potentially resulting in profound central vision loss. GA shares features with various retinal diseases and can therefore be complicated to distinguish from mimicking diseases. While no cure exists for GA, therapies like pegcetacoplan and avacincaptad aim to slow atrophy growth, making an accurate diagnosis essential for effective treatment. Misdiagnosis can lead to inappropriate treatment recommendations, impacting patient health and financial burden. This paper outlines the similarities and differences among prevalent diseases such as late-onset Stargardt disease, PRPH2-associated disease and maternally inherited diabetes and deafness (MIDD), resembling GA to aid in accurate diagnosis.

OBJECTIVES:To longitudinally assess ocular involvement in newly diagnosed giant cell arteritis (GCA) patients by evaluating changes in transorbital ultrasonography (TOS) parameters and their association with systemic vascular inflammation and treatment response. METHODS:In this prospective cohort study, newly diagnosed GCA patients underwent serial TOS assessments of the central retinal artery flow velocity [peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI)] and optic nerve diameter (OND) at three-monthly intervals for 12 months. Vascular ultrasonography and calculation of OMERACT Giant Cell Arteritis Ultrasonography (OGUS) Score was conducted. Longitudinal changes and associations were analysed using linear mixed-effects models, accounting for repeated measurements within patients. RESULTS:Thirty-six GCA patients were enrolled. At baseline, 17 (47.2%) patients reported visual symptoms. Compared with baseline, PSV significantly decreased at three (β = -0.81 cm/s, P = 0.046) and nine (β = -0.93 cm/s, P = 0.029) months. OND decreased at three (β = -0.30 mm, P = 0.020) and 12 (β = -0.35 mm, P = 0.008) months, with a consistent trend over follow-up (β = -0.07, P = 0.024). Symptomatic eyes displayed significantly higher PSV (β = 0.96, P = 0.017) and EDV (β = 0.34, P = 0.037) over disease course. Baseline pathological vessel count and OGUS Score were negatively associated with PSV (β = -0.43, P = 0.031; β = -3.15, P = 0.055) and EDV (β = -0.15, P = 0.022; β = -1.45, P = 0.007) and positively associated with OND (β = 0.15, P = 0.006; β = 0.94, P = 0.040). During disease course, significant associations with pathological vessel count and OGUS Score were noted for EDV (β = -0.04, P = 0.024; β = -0.77, P = 0.005) and OND (β = 0.05, P < 0.001; β = 0.72, P < 0.001). CONCLUSIONS:Utilizing TOS, we demonstrated progressive decrease in retinal artery flow and OND, indicating ongoing impairment in retinal vascular supply and potential optic nerve atrophy despite clinical improvement post-treatment. Our findings suggest that intracranial vascular changes in GCA may respond less effectively to treatment than extracranial vessels and support a shared pathophysiological mechanism in GCA.

BACKGROUND:Remote teleophthalmological examinations can reduce access barriers for nursing home residents; however, it is unclear to what extent an actual ophthalmological aftercare can be realized. OBJECTIVE:The acceptance of the model, aftercare participation rate and the reasons for not contacting a medical specialist when indicated were examined 6 months after a remote ophthalmological first examination during the TOVIS pilot study. MATERIAL AND METHODS:Residents in two nursing homes who had participated in the TOVIS pilot study were surveyed in writing 6 months after the first examination. Data were acquired on 1) utilization of a recommended ophthalmological follow-up examination, 2) reasons for not participating in a recommended ophthalmological aftercare, 3) assessment of the remote examination using a Likert scale. Descriptive statistics, χ2-tests and t‑tests were used for the analysis. RESULTS:Of the 86 originally examined residents, 64 (participation rate 74%, mean age 82.6 ± 8.8 years, 60.9 % female) participated in the follow-up survey. The remote ophthalmological examination was broadly accepted, 83.6% assessed it as meaningful (≥ 8 on the 10-point Likert scale), 82.5% would participate again and 76.9% would recommend the offer to others. Although 52 residents received the recommendation of an ophthalmological follow-up examination, after 6 months only 14/52 (26.9%) followed this recommendation. Findings that required treatment were in particular vision-relevant cataract (50%), glaucoma (21%) and subretinal or intraretinal fluid (7%), which were predominantly (68.8%) previously unknown to those affected. The major reasons for the 38 residents who did not participate in the aftercare were no complaints (31.6%), no desire for treatment (23.7%) and problems with transport or accompanying persons (10.5%). DISCUSSION:The remote ophthalmological model study showed a high acceptance among the participants but there was a clear discrepancy between the express recommendation and the actually realized consultation with a medical specialist. Neither the presence of potentially vision-threatening findings nor the urgency of the recommendation significantly increased the compliance for aftercare. Therefore, for the realization of the full benefit of teleophthalmological programs for residents of nursing homes for the aged, supplementary measures are necessary, such as patient-centered clarification, structured appointment management and logistic support for the continuation with a visit to the practice.

Retinal organoids are widely used to model human retinal development and disease, but their utility is limited by the absence of vascular networks and stable axonal projections, which contribute to retinal ganglion cell degeneration and loss of function. To address these challenges, we incorporated stem cell-derived endothelial cells to induce transient vascular-like networks and used microfluidic devices to stabilize axonal growth. The resulting organoids showed reduced hypoxia, increased size, and decreased apoptosis, indicating improved long-term survival and maturation of retinal ganglion cells. Integration with microfluidic-microelectrode arrays enabled stable recordings of spontaneous and optogenetically evoked activity, which persisted beyond the time when control organoids lost function. At later stages, these transiently vascularized organoids displayed photoreceptor-driven ON, OFF, and ON-OFF light responses, indicating circuit-level retinal activity. This bioengineered platform establishes a long-term, functional model of the human retina as a transformative tool for retinal research and therapeutic innovation.

Objective To quantify retinal pigment epithelium (RPE) layer thicknesses and reflectivity in healthy subjects across different age groups using improved axial, high-resolution optical coherence tomography (High-Res OCT). Design Cross-sectional observational study. Subjects A total of 110 eyes from 110 healthy participants were included. Subjects were categorized into three age groups: Group 1 (<40 years), 2 (40-65y), and 3 (>65y). Methods High-Res OCT imaging was performed followed up by the segmentation of three RPE layers. The inner layer corresponds to RPE layer 1 (High-Res OCT nomenclature) and outer segment interdigitation zone 2, the middle RPE layer to RPE layers 2, 3 and the outer to RPE layer 4,5 and Bruch’s membrane. A convolutional neural network (CNN) was trained for automated RPE layer recognition. Volumetric thickness maps and reflectivity values were generated to assess age-related differences across the ETDRS grid and analyzed using Kruskal-Wallis / Mann-Whitney U tests. Main Outcome Measures RPE thicknesses and vitreous normalized reflectivity of the three RPE layers across the three age groups. Secondary outcome measure was segmentation accuracy (Dice) of the CNN automated segmentation. Results The CNN achieved high segmentation accuracy with a mean Dice of 0.85. Hypo-reflective RPE layer 1 was absent at the fovea but increased in thickness with eccentricity. Significant age-related increases were observed in the reflectivity throughout the middle hyperreflective RPE layer, at the fovea (H = 13.8, p = 0.001), the inner ETDRS ring (H = 19.8, p = 0.00004) and the outer ETDRS ring (H = 16.2, p = 0.0003). For the outer hyperreflective RPE layer, an increase in thickness with age was noted in the outer (H = 8.63, p = 0.013), along with an increased reflectivity at the fovea (H = 14.8, p = 0.0006) and the inner ETDRS ring (H = 14.35, p = 0.0008). Conclusions OCT imaging with improved resolution enables detailed segmentation of RPE layers, revealing moderate but significant age-related changes in reflectivity and thickness. These findings provide normative data essential for identifying early retinal alterations and developing structural biomarkers for age-related retinal diseases. The high segmentation accuracy supports the potential for automated RPE layer analysis.

To examine sociodemographic and health-related factors associated with the utilization of preventive ophthalmologic examinations in Germany and to explore determinants of out-of-pocket payment, with attention to equity gaps among different socioeconomically groups. Data were derived from a population-based, demographically representative self-reported online survey of 1,008 adults conducted in Germany. All data were analysed descriptively, followed by binary logistic regression analyses. Sociodemographic and health-related factors were assessed. The primary outcome was the utilization of preventive eye examinations within the past 12 months; out-of-pocket payment served as the secondary outcome. Overall, 35.8

PURPOSE:To highlight the role of en face OCT in the measurement of choroidal hypertransmission defects (hyperTDs) in complete retinal pigment epithelial and outer retinal atrophy (cRORA), and to refine the definition of retinal pigment epithelium (RPE)-related alterations associated with cRORA. DESIGN:Consensus meeting. PARTICIPANTS:Panel of retina specialists, including retinal imaging experts, reading center leaders, and retinal histologists. METHODS:As part of the Classification of Atrophy Meeting (CAM) program, an international group of experts analyzed and discussed the role of en face OCT in the assessment of cRORA. A structured study was conducted, consisting of an exercise to assess en face OCT cases, reviewed jointly during the eighth CAM meeting, and to explore the utility of this advanced tool for disease staging and progression. Additionally, definitions previously applied to RPE abnormalities were discussed and refined leading to modifications. The current report summarizes the methods used during the consensus meeting and the outcomes achieved as pertains to the application of en face OCT for cRORA grading and simplification of the RPE assessment criteria. MAIN OUTCOME MEASURES:Defining the role of en face OCT in the detection and quantification of hyperTDs, improving classification of cRORA, and refining the terminology related to RPE alterations to enhance grading consistency. RESULTS:During the consensus case discussions, high levels of agreement were achieved for hyperTD detection using en face OCT. The CAM group affirmed the role of en face OCT as a critical adjunct to traditional B-scan analysis, for more precise measurement of the area of cRORA lesions and for distinguishing threshold cRORA from smaller incomplete retinal pigment epithelial and outer retinal atrophy lesions. Additionally, merger of RPE attenuation and RPE disruption into a unified category termed "abnormal RPE band" significantly reduced interreader variability, leading to greater consistency among graders. CONCLUSIONS:The integration of en face OCT with cross sectional B-scan imaging enhances the accurate classification and area measurement of early atrophic alterations in age-related macular degeneration, improving diagnostic consistency and lesion assessment. The consensus panel's adoption of the abnormal RPE band term as a unified category for RPE abnormalities may reduce confusion regarding the definition of RPE degeneration and has the potential to improve interreader variability. FINANCIAL DISCLOSURE(S):The authors have no proprietary or commercial interest in any materials discussed in this article.

Abstract Purpose Secondary glaucoma encompasses a broad spectrum of disease entities arising from diverse ocular pathologies and is often refractory to conventional treatment. Glaucoma drainage devices (GDDs) have therefore become an important surgical option. This study evaluates the efficacy and safety of the PAUL® Glaucoma Implant (PGI) across a broad spectrum of secondary glaucoma types. Methods This retrospective observational cohort study included 96 eyes from 92 patients who underwent PGI implantation for secondary glaucoma between April 2021 and September 2024, with a minimum follow‐up of 12 months. Secondary glaucomas were categorized into neovascular, uveitic, post‐vitrectomy, traumatic and other types. Surgical success was defined according to World Glaucoma Association intraocular pressure (IOP) thresholds (≤21, ≤18, ≤15, and ≤12 mmHg), with failure defined by IOP above threshold, hypotony‐related complications, need for further glaucoma surgery, or device explantation. Results At one year, 83% of eyes achieved an IOP ≤21 mmHg, with 42% maintaining this level without topical medication. Success rates declined with stricter IOP targets but did not differ significantly among secondary glaucoma subtypes. Mean IOP decreased significantly from 28.0 mmHg preoperatively to 13.6 mmHg at 12 months, corresponding to an average reduction of approximately 51%, and remained stable during long‐term follow‐up. Visual acuity and visual field parameters remained largely stable. Postoperative complications occurred in 26% of eyes and were predominantly transient; no intraoperative complications were observed. Removal of the intraluminal Prolene stent was associated with further IOP reduction without subtype‐specific differences. Conclusion The PGI was associated with effective and sustained IOP reduction across a heterogeneous population of secondary glaucoma, with an acceptable complication profile in this retrospective cohort. These findings support the PGI as a useful surgical option for complex secondary glaucoma, although controlled comparative studies are needed to define its relative role among established GDDs.

PURPOSE:To analyze the frequency of misdiagnoses in macular telangiectasia type 2 (MacTel) and to investigate factors influencing the probability of receiving an incorrect diagnosis. METHODS:A retrospective analysis of 288 patients with confirmed diagnosis of MacTel from the Natural History Observation Registry at the University Eye Hospital Bonn was performed. Patients were grouped as follows: correct diagnosis of MacTel, misdiagnosis, and incidental finding. Clinical and demographic data, including best-corrected visual acuity, symptoms, and prior treatments, were recorded. Misdiagnoses were categorized, and predictors were analyzed using mixed effect models. RESULTS:Of 288 patients, 174 (60.4%) were correctly diagnosed, 103 (35.8%) were misdiagnosed, and 11 (3.8%) diagnosed incidentally. Misdiagnoses included macular hole (17.3%), maculopathy (12.5%), and AMD (12.5%). Mean age at symptom onset was 54.7 (±9.8) years; mean time to correct diagnosis was 38.5 ± 50.3 months, decreasing from 115 months (2000-2005) to 5.9 months (after 2020). Younger age at symptom onset reduced the probability of misdiagnosis (odds ratio 0.96, 95% CI: 0.94-0.98), subjective glare sensitivity increased misdiagnosis probability (odds ratio 2.01, 95% CI: 1.14-3.55). CONCLUSION:Misdiagnoses of MacTel are common and may delay care. Improved awareness and imaging have shortened these delays. Early multimodal imaging and clinician education remain key to timely diagnosis and better management.

BACKGROUND:Nutrition has an influence on the condition of our retina and appears to play a role in the complex, multifactorial pathogenesis of age-related macular degeneration (AMD). OBJECTIVES:This article summarizes the current epidemiological evidence on nutrition and AMD and discusses the intake of specific nutrients as well as nutritional supplements and their potential role in prevention and disease modification. MATERIAL AND METHODS:A narrative literature review of epidemiological studies, clinical trials and experimental work on the role of individual micronutrients, supplements and dietary patterns in AMD was carried out. RESULTS:There is evidence of a protective effect for individual nutrients such as lutein, zeaxanthin, zinc and omega‑3 fatty acids. The AREDS studies in particular show a reduction in the progression of intermediate AMD to late stages through defined supplements. In addition, a Mediterranean diet correlates with a reduced risk of AMD. Nevertheless, the study results remain contradictory in some cases, which is due to methodological limitations and the complex pathogenesis of AMD. DISCUSSION:Nutrition can potentially influence and reduce the risk for and progression of AMD. The existing literature underlines the potential of nutrition-based approaches, which must be further investigated in the future.

This study characterized fibrosis-associated pigment changes in neovascular age-related macular degeneration (nAMD) using fluorescence lifetime imaging microscopy (FLIM). Retinal cross sections from human donor eyes with nAMD (n = 5; mean age 91.0 ± 2.8 years) and control eyes without maculopathy (n = 5; 83.0 ± 1.9 years) were analyzed at λexc 488 nm and λexc 780 nm. In total, 116 regions of interest (50 μm width each) were assessed across the fovea, parafovea, and areas of subretinal fibrosis in nAMD eyes and compared with corresponding locations in controls. Fluorescence lifetimes (FLTs) were evaluated using a linear mixed-effects model across pigment in unremarkable retinal pigment epithelium (RPE), pigment in RPE above fibrosis, pigment within fibrosis, and pigment in the choroid. At λexc 488 nm, FLTs were significantly prolonged in RPE above fibrosis (0.54 ± 0.04 ns) compared with unremarkable RPE (0.49 ± 0.04 ns, linear mixed-effect model: p = 0.04). Pigment within fibrosis (0.51 ± 0.03 ns) showed similar lifetimes to unremarkable RPE (p = 0.58), while choroidal pigment exhibited markedly shorter lifetimes (0.23 ± 0.04 ns; p < 0.001). At λexc 780 nm, pigment within fibrosis displayed shorter lifetimes (0.27 ± 0.03 ns) than unremarkable RPE (0.34 ± 0.04 ns, p = 0.04), and choroidal pigment again showed the shortest values (0.11 ± 0.01 ns; p < 0.001). Dual-wavelength FLIM reveals distinct lifetime patterns at fibrotic locations consistent with an RPE origin of fibrosis-associated pigment in nAMD.

OBJECTIVE:To describe the histological findings 7 weeks and 18 months after subretinal implantation of the PRIMA photovoltaic array in eyes with geographic atrophy. DESIGN:Comparative case series SUBJECTS: and controls: Four globes of two deceased study participants from the prospective PRIMAvera study were analyzed. METHODS:The subretinal implant was removed after horizontal sectioning of the globe. Serial sections were performed and stained with hematoxylin-eosin, Masson trichrome as well as periodic acid Schiff for histopathologic analysis. Selected sections were immunohistochemically stained for CD68, CD163, GFAP, CD31, CK18, ARR3, RPBMS, and TRPM1. Both study and fellow eyes were analyzed. MAIN OUTCOME MEASURES:The histopathological analysis focused on the anatomical implant localization, wound healing processes, potential inflammatory reactions adjacent to the implant and at the retinotomy site, the development of retinal gliosis and retinal atrophy as well as a potential encapsulation. RESULTS:Both implants could be removed in toto without obvious retinal trauma. Histologically, the implants were located at the level of the outer plexiform layer, as intended, close to the inner nuclear layer. A tissue layer was identified beneath the implant, consisting of a basement membrane deposit and cellular components. A small rupture of Bruch's membrane was detected (in the globe with an 18 months follow-up) associated with localized subretinal fibrosis. At the implant-retina interface, there was only a minimal tissue response without pseudocapsule formation. Furthermore, no significant inflammatory response was detected. The retina overlying the implant was comparable to the fellow eyes in most areas, with limited focal atrophy of the inner retina 18 months after PRIMA implantation. At the retinotomy site, a full thickness scar was noted with mild atrophic changes in the implant insertion area. CONCLUSIONS:The wireless subretinal PRIMA implant demonstrated good biocompatibility with no significant encapsulation or surrounding inflammatory response. At seven weeks and eighteen months after implantation, retina overlying the implant was viable and layered as in control areas. Histopathologic analysis following innovative surgical techniques can provide important information in addition to in vivo findings.