Uveal melanoma is predominantly an adult malignancy, with Ireland reporting one of the highest incidence rates at 9.5 cases per million adults annually. Paediatric uveal melanoma is extremely rare, accounting for fewer than 1% to 2% of all uveal melanoma cases in published series. This retrospective study included all patients under 18 years of age diagnosed with uveal melanoma in Ireland between 2010 and 2024. Data were collected from medical records and included demographics, tumour location and dimensions, histopathology or cytology (where available), presence of metastasis, treatment modality, baseline and final visual acuity, intraocular pressure, and survival outcomes. Six Caucasian patients (five male, one female), aged 6 to 17 years, were identified. Tumour locations included five choroidal and one ciliochoroidal melanoma. Treatment modalities included enucleation (n = 2), plaque brachytherapy (two Ruthenium-106, one Iodine-125), and proton beam radiotherapy (n = 1). Histopathological analysis was available in two cases, revealing one mixed cell type and one spindle B melanoma. Fine needle aspiration biopsy was performed in two patients. Mean follow-up was 30 months (median 24; range 12–178). All cases remained metastasis-free at last follow-up. This national case series highlights the rarity and clinical relevance of paediatric uveal melanoma. Outcomes have been favourable, but recent case clustering supports the need for international comparative data collection. Early diagnosis and appropriate treatment help preserve vision and reduce morbidity. Molecular profiling, where possible, may guide metastatic risk assessment. Further studies are needed to confirm international incidence trends.

The early differentiation of benign choroidal naevi from malignant melanoma remains one of the most nuanced challenges in ophthalmic oncology, with profound implications for patient survival. Conventional diagnostic pathways rely on multimodal imaging and expert interpretation, but inter-observer variability and the rarity of melanoma limit timely and consistent detection. Recent advances in artificial intelligence (AI) offer a promising adjunct to conventional ophthalmic practice. This review provides a critical comparative synthesis of the studies to-date which have looked at AI's use in the detection, risk stratification, and longitudinal monitoring of choroidal melanoma. While early results are promising-with some models achieving an accuracy comparable to expert clinicians-significant challenges remain regarding generalisability, dataset bias, interpretability, and real-world deployment. We conclude by outlining practical priorities for future research to ensure that AI becomes a safe, effective, and equitable tool for improving patient outcomes.

Purpose It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments. Methods A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager. Results A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length. Conclusions The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.

We aim to evaluate the impact of the COVID-19 pandemic on ocular oncology in Ireland, comparing uveal melanoma trends in 2019 to 2020. Patients included for analysis were those that presented to the ocular oncology service from January 2019 to December 2020 in the Royal Victoria Eye and Ear Hospital in Dublin, who underwent primary treatment for uveal melanoma—proton beam therapy, brachytherapy or enucleation. Ninety-seven patients presented in 2019 (n = 46) and 2020 (n = 51) who underwent primary treatment for uveal melanoma. Presentation via the eye casualty department was more common in 2020. Dimensions of choroidal melanomas were increased both in basal diameter and thickness compared to those in 2019. More patients had enucleations in 2020 than in 2019 (21.6% vs 9.3%, respectively) and less had proton beam therapy (6.2% vs 12.4%). More patients had evidence of extra-scleral extension at the time of surgery in 2020 compared to 2019 (4.1%, n = 4 versus 0%, respectively). The mean duration of brachytherapy therapy was longer in 2020 (5.3 days ± 35.8) compared to 2019 (4.6 days ± 38.7). Mean time between presentation and primary treatment was 35.6 ± 28.8 days in 2019 and 24.1 ± 20.4 days in 2020. More advanced disease is suggested by the increased mean basal diameter and tumour thickness, extra-scleral extension and longer duration of brachytherapy. Time from diagnosis to treatment was not delayed in 2020.

Background/Objectives Endothelial keratoplasty (EK) is a commonly performed transplant procedure used in the treatment of corneal endothelial dysfunction. The aim of this systematic review and meta-analysis is to evaluate the differences in visual acuity outcomes, endothelial cell density (ECD) and complications between two forms of EK, ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). Methods A literature search of MEDLINE, Embase and Cochrane Library was conducted to identify studies reporting comparative results of UT-DSAEK versus DMEK. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 141 titles, 7 studies met the inclusion criteria; best corrected visual acuity (BCVA) (LogMAR), ECD (cells/mm 2 ), and complications were compared, with all statistical analysis performed using Review Manager. Results A total of 362 eyes were included for analysis. DMEK resulted in significantly better BCVA at 3 months (0.14 vs 0.22, p = 0.003), 6 months (0.08 vs 0.18, p = 0.005) and 1 year post-op (0.07 vs 0.14, p = 0.0005). UT-DSAEK resulted in significantly lower total complications (25.2% vs 57.3%, p = 0.0001) and rates of re-bubbling (11.0% vs 33.7%, p = 0.004). No differences were found in ECD between the two procedures (1541 vs 1605, p = 0.77). Conclusions DMEK results in superior visual acuity rates with quicker recovery. However, UT-DSAEK has a more favourable complication profile, particularly regarding lower rates of re-bubbling. Both are valuable options in the treatment of corneal endothelial disease and choice of procedure may depend on surgical expertise.

Infectious scleritis is a rare disease entity with potentially devastating visual sequelae. Here we present the clinical history, work-up and aetiology of an unusual case of infectious scleritis.

An early adolescent man was referred to the ocular oncology service for evaluation of a pale, raised fundus lesion in the inferotemporal quadrant of his right eye. Unaided visual acuities were 20/20 OD and 20/20 OS. He had no medical, ocular or family history of note. Retinal vasoproliferative tumour with progressive retinal exudation was the working diagnosis. Improvement in tumour features and exudation regression were noted following a combination of argon laser therapy, cryotherapy and intravitreal steroid injection. Paediatric intraocular tumours present a complex list of differential diagnoses and offer significant diagnostic and management challenges. Discussed here are the differential diagnoses and treatment considerations in the setting of an intraocular tumour in childhood.

We report the use of Descemet stripping automated endothelial keratoplasty (DSAEK) for the treatment of sterile corneal perforation after trauma. In an eye with corneal perforation and cataract due to trauma, cataract surgery and DSAEK were performed. Corneal integrity was promptly restored and the patient avoided tectonic anterior lamellar and penetrating keratoplasty. DSAEK may be performed for the management of corneal perforation.

It is known that as people age their tissues become less compliant and the ocular structures are no different. Corneal Hysteresis (CH) is a surrogate marker for ocular compliance. Low hysteresis values are associated with optic nerve damage and visual field loss, the structural and functional components of glaucomatous optic neuropathy. Presently, a range of parameters are measured to monitor and stratify glaucoma, including intraocular pressure (IOP), central corneal thickness (CCT), optical coherence tomography (OCT) scans of the retinal nerve fibre layer (RNFL) and the ganglion cell layer (GCL), and subjective measurement such as visual fields. The purpose of this review is to summarise the current evidence that CH values area risk factor for the development of glaucoma and are a marker for its progression. The authors will explain what precisely CH is, how it can be measured, and the influence that medication and surgery can have on its value. CH is likely to play an integral role in glaucoma care and could potentially be incorporated synergistically with IOP, CCT, and visual field testing to establish risk stratification modelling and progression algorithms in glaucoma management in the future.

AIM:To describe the clinical characteristics and treatments associated with antibody positive optic neuropathies including anti-myelin oligodendrocyte glycoprotein (MOG) and anti-aquaporin 4 (AQP4), alongside diagnostic modalities, investigations, and outcomes. METHODS:A cross-sectional single-centre retrospective case series consisting of 16 patients including 12 anti-MOG positive patients and 4 anti-AQP4 positive patients. Each of these patients had clinical signs and symptoms of optic neuritis and consisted of all patients who had a positive blood antibody result in our centre. Clinical findings including presence of a relative afferent pupillary defect, colour vision and disc assessment were recorded. Structured clinical exam and multimodal imaging was undertaken sequentially on each. Optical coherence tomography (OCT) scanning was preformed to examine the correlation between ganglion cell layer (GCL) thickness and visual acuity (VA) at presentation and as a determinant of final visual outcome in both groups. Initial and long-term treatment is also summarised. RESULTS:A total of 16 patients were included in the study consisting of 12 anti-MOG and 4 anti-AQP4 positive patients. Nine of the 16 patients were female and the average age of onset was 29.2y in the MOG group and 42y in the AQP4 group. There was no statistically significant correlation (Pearson correlation) between GCL thickness and presenting and final VA [r(10)=0.081, P=0.08 and r(10)=0.089, P=0.34 respectively]. The same statistical analysis was performed for the correlation between retinal nerve fibre layer (RNFL) and VA and similar outcomes were observed [r(10)=0.04, P=0.22 and r(10)=0.09, P=0.04]. No correlation was seen for initial RNFL thickness and final visual outcome in this group either [r(2)=0.19, P=0.38]. Visual field testing and radiological findings for each group are described. CONCLUSION:No correlation between initial VA or RNFL and final visual outcome is identified. A broad range of visual field and radiographic findings are identified, a consensus on treatment of neuromyelitis optica spectrum disorders and anti-MOG positive optic neuropathies has yet to be accepted but initial high dose immunosuppression followed by low dose maintenance therapy is favoured.

An 18-year-old lady presented with progressive cellulitis of her left orbit. Over the course of several weeks, she had noticed increasing swelling of her eyelid, reduced eye opening, and eventual pain on extraocular movements, all of which were present on clinical examination. Visual field tests and visual acuity were both unaffected, and there was no focal neurology. CT (Figure 1-A) revealed multiple ground glass osseous lesions within the left skull suggestive of polyostotic FD with a more aggressive appearing expansile lesion within the roof of the left orbit and frontal bone. MRI (Figure 1-B) demonstrated fluid-fluid levels within this lesion and surrounding enhancement. Tissue analysis eventually confirmed fibrous dysplasia (FD) with a secondary aneurysmal bone cyst (ABC). Follow-up MRI showed stability of these lesions, and the patient is currently being managed conservatively. FDs and ABCs are relatively common, but there are only a handful of cases of craniofacial FD with secondary ABC formation.1 Secondary ABCs may present a diagnostic challenge and can occur in a variety of primary bone lesions such as giant cell tumors, chondroblastomas, or FD.2 While not pathognomonic, a fluid-fluid level on MRI within a primary lesion may suggest the diagnosis.

BACKGROUND:In this systematic review and meta-analysis, we aimed to compare deep learning versus ophthalmologists in glaucoma diagnosis on fundus examinations. METHOD:PubMed, Cochrane, Embase, ClinicalTrials.gov and ScienceDirect databases were searched for studies reporting a comparison between the glaucoma diagnosis performance of deep learning and ophthalmologists on fundus examinations on the same datasets, until 10 December 2020. Studies had to report an area under the receiver operating characteristics (AUC) with SD or enough data to generate one. RESULTS:We included six studies in our meta-analysis. There was no difference in AUC between ophthalmologists (AUC = 82.0, 95% confidence intervals [CI] 65.4-98.6) and deep learning (97.0, 89.4-104.5). There was also no difference using several pessimistic and optimistic variants of our meta-analysis: the best (82.2, 60.0-104.3) or worst (77.7, 53.1-102.3) ophthalmologists versus the best (97.1, 89.5-104.7) or worst (97.1, 88.5-105.6) deep learning of each study. We did not retrieve any factors influencing those results. CONCLUSION:Deep learning had similar performance compared to ophthalmologists in glaucoma diagnosis from fundus examinations. Further studies should evaluate deep learning in clinical situations.

Background: Hydroxychloroquine is a safe and effective treatment for autoimmune disease. It can however result in a blinding retinopathy the prevalence of which may be 7.5% after five years. Ophthalmology departments must screen for this effect. Aims: To review all new referrals to an ophthalmology department for screening for hydroxychloroquine retinopathy and examine their identification of patient risk factors for its development. The utility of tests recommended in national screening programs elsewhere was evaluated. Methods: A retrospective review of referrals for screening for hydroxychloroquine retinopathy over a 30-month period. Results: 172 new referrals for screening were received. 164 were available for analysis. 139 (84.8%) were female. Rheumatology and dermatology departments were responsible for 88.4%. 5.7% of patients were taking the medication for greater than five years prior to their primary referral. 47.9% were taking hydroxychloroquine doses of >5 mg/kg/day. 22.1% had an eGFR of 5 mg/kg/day with an eGFR of Conclusions: Patients taking hydroxychloroquine should be referred for ophthalmology assessment within oneyear of commencing the drug. Referrals should elaborate patient risk factors for the development of the associated retinopathy. Increased awareness amongst prescribing physicians of the importance of early referral is crucial.

Background During the COVID-19 crisis, a new nurse and doctor-led telephone triage model of care was evaluated as a method of prioritising essential visits to the ophthalmic accident and emergency department in the Royal Victoria Eye and Ear Hospital. This new method of service is known as “Telehealth” or “E-Health”. Aims To assess the safety and efficacy of a Telehealth model of care ultilised during the COVID-19 pandemic. Methods A prospective study was undertaken in the Royal Victoria Eye and Ear Hospital where the telephone triage records were examined over a 28-day period during the COVID-19 pandemic from 19 March 2020 to 16 April 2020 inclusive. Results During this period, 1120 telephone calls were received by the call centre. A total of 739 patients attended the emergency department over the 28-day period compared to 2247 during the same period in 2019. Conclusion To reduce risk of transmission, the COVID-19 pandemic has necessitated novel ways of interacting with patients and sharing healthcare information. Our new mode of service provision in the RVEEH portrays the effectiveness of Telehealth. This study gives us further scope to improve this model of care into the future.

Purpose: Lens adapted smartphones are being used regularly instead of ophthalmo-scopes. The most common causes of preventable blindness in the world, which are glaucoma and diabetic retinopathy, can develop asymptomatic changes to the optic nerve head (ONH) especially in the developing world where there is a dire shortage of ophthalmologists but ubiquitous mobile phones. We developed a proof-of-concept ONH biometric (application [APP]) to use as a routine biometric on a mobile phone. The unique blood vessel pattern is verified if it maps on to a previously enrolled image. Methods: The iKey APP platform comprises three deep neural networks (DNNs) developed from anonymous ONH images: the graticule blood vessel (GBV) and the blood vessel specific feature (BVSF) DNNs were trained on unique blood vessel vectors. A non-feature specific (NFS) baseline ResNet50 DNN was trained for comparison. Results: Verification reached an accuracy of 97.06% with BVSF, 87.24% with GBV and 79.8% using NFS. Conclusions: A new ONH biometric was developed with a hybrid platform of ONH algorithms for use as a verification biometric on a smartphone. Failure to verify will alert the user to possible changes to the image, so that silent changes may be observed before sight threatening disease progresses. The APP retains a history of all ONH images. Future longitudinal analysis will explore the impact of ONH changes to the iKey biometric platform. Translational Relevance: Phones with iKey will host ONH images for biometric protection of both health and financial data. The ONH may be used for automatic screening by new disease detection DNNs.

A 41-year-old White woman was referred to our service for evaluation of an elevated fundus lesion in the superonasal quadrant of her left eye. The patient had low myopia with pale ocular fundi. Her best-corrected visual acuity was 20/20 in each eye. She was in good health with no relevant ocular or medical history. Figure A depicts a bilobed dark area of retinal elevation in the superonasal quadrant that demonstrated emptying/partial resolution when gentle digital pressure was applied to the globe through the eyelid (Fig B).

To describe rhegmatogenous retinal detachment surgery in a Dublin tertiary referral centre over a 4-year period and to examine factors predictive of surgical and anatomical success. A retrospective study was performed by reviewing the surgical log and the charts of patients who underwent a primary retinal detachment repair in a specialist centre over a 4-year period between 2012 and 2015. We excluded exudative and tractional cases. Multiple parameters were recorded including macular status, visual acuity, type of procedure, complications and visual and anatomical outcomes at 6 months post operation. Primary reattachment rate was calculated alongside change in visual acuity. Chi-square testing and analysis of variance were utilized to determine the effect which lens status, macular status, extent of breaks and type of procedure had on outcome and visual success. A total of 613 primary rhegmatogenous retinal detachment repairs were performed over the 4-year period. Our primary reattachment rate was calculated to be 88.58% (annual range 85.25–91.30%) with a perioperative complication rate of 2.94%. We noted a statistical significant improvement in VA with a median logMAR VA of 1.0 at presentation to 0.5 at 6 months post procedure. Macular status (chi-square test p = 0.15, X2 = 2.072) and lens status (chi-square test p = 0.2974, X2 = 1.086) had no statistical effect on the final anatomical outcome. However, eyes with giant retinal tears were more likely to redetach than those without (chi-square test p = 0.0069, X2 = 7.3). There was no statistical significant difference in the proportion of eyes achieving visual success by surgery category (one-way ANOVA analysis p = 0.501). This is the first study of its kind in Ireland and will help surgeons benchmark their results against international standards in the future. Accurate recording of logMAR acuity and intraoperative complications is imperative to assist with prospective studies.