OBJECTIVE:To assess the adherence of glaucoma surgical and laser studies to WGA guidelines for reporting glaucoma surgery studies, analyse trends in adherence over time and explore associations between adherence and study characteristics. METHODS:Systematic review (PROSPERO:CRD42023394477) of glaucoma surgical and laser studies published between 2010 and 2023 in PubMed/MEDLINE and EMBASE. Eligible studies included RCTs, non-randomized comparative and prospective observational designs (>100 eyes). Two reviewers independently extracted data across five domains: Methodology, Definition of success, Ethics, Postoperative complications and Statistical reporting. Temporal trends and associations with study features were analysed using linear regression. RESULTS:Two hundred and fifty-six studies were included, 75% of which were published in Q1-Q3 journals. Mean overall adherence was 47% ± 9.2%. Domain-level adherence was highest in Ethics (61% ± 20%), followed by Postoperative complications (50% ± 22%), Statistical reporting (48% ± 18%), Methodology (44% ± 12%) and Definition of success (30% ± 13%). No significant differences (p > 0.06) were observed in overall adherence for studies from Europe, Asia, Oceania or the Middle East. Studies involving cataract surgery for angle-closure disease (est. = -10% [-19%, -2.2%], p = 0.014) and laser trabeculoplasty (est. = -7.1% [-11%, -3.5%], p < 0.001) had lower adherence compared with trabeculectomy, while MIGS studies showed no difference (p = 0.45). Visual field progression was reported in only 3% of studies, while various anatomical outcomes (e.g. bleb morphology) were reported in 0%-24% of studies. CONCLUSION:Current literature shows poor adherence to WGA guidelines across both traditional and newer glaucoma surgeries, reflecting inadequate reporting and outdated recommendations. Evidence-based updates, broader consensus and stronger implementation are needed to ensure standardized and meaningful reporting.

TOPIC:Fast glaucoma progression is generally defined using numerical cut-offs applied to the rate of progression. However, no consensus guidelines exist for standardized thresholds, and multiple methods are used to estimate progression rates. We systematically review how fast progression is defined in the glaucoma literature and quantify heterogeneity in criteria, analytic methods, and structural or functional parameters used across studies. CLINICAL RELEVANCE:Potential heterogeneity in defining fast glaucoma progression may influence reported prevalence, risk factor associations, and interpretation of outcomes across studies. METHODS:A systematic review (PROSPERO: CRD42024502764) was conducted using MEDLINE and Embase to identify studies assessing fast glaucomatous progression based on visual field (VF) examination, optic disc photography, OCT, confocal scanning laser tomography (CSLT), and OCT angiography (OCT-A). Childhood glaucoma was excluded. Two independent reviewers selected eligible studies and extracted complete definitions of fast progression. RESULTS:Of 31 856 records identified, 122 met the eligibility criteria, yielding 88 definitions of fast progression, including 66 unique criteria and 16 analytic methods. The most frequent definition was mean deviation (MD) rate < -1.0 dB/year calculated using ordinary least squares regression (OLSR) (13 studies, 10.7%). Among structural definitions, the most common was global peripapillary retinal nerve fiber layer thickness decay ≥90th percentile of the study sample using OLSR. When analyzed separately, MD rate < -1.0 dB/year was the most commonly used measure (25 studies, 20.5%) and OLSR the most frequent analytic method (79 studies, 64.8%). Visual field testing was used in 103 studies (84.4%), OCT in 25 (20.5%), and CSLT and OCT-A in 1 study each (0.8%). Seven studies (5.7%) combined VF with a structural device (6 with OCT and 1 with CSLT), and 1 study combined OCT and OCT-A. Among VF-based studies, 3 (2.9%) used central testing (10-2), while among OCT-based studies, 4 (16.0%) focused on macular parameters. Mean deviation was the most frequently adopted index (81 studies, 66.3%), followed by peripapillary retinal nerve fiber layer thickness (21 studies, 17.2%). FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. CONCLUSIONS:Definitions of fast glaucomatous progression in the literature are predominantly VF-based but vary widely in terms of indices, analytic model, and threshold used. Further research should clarify how different definitions influence fast progressor classification.

PURPOSE:To discuss the case of an 82-year-old man with high myopia who developed a full-thickness macular hole (FTMH) following the spontaneous resolution of a central bouquet hemorrhage (CBH) associated with a lacquer crack. METHODS:The patient initially presented with a central scotoma in the right eye, with optical coherence tomography (OCT) showing the presence of CBH. The patient was closely monitored with noninvasive retinal imaging. RESULTS:Over five months, the CBH gradually reabsorbed, yet vertical hyperreflective lines and disruption of the ellipsoid zone persisted in the foveal area on follow-up OCT scans. Approximately three years after the reabsorption of the hemorrhage, the patient developed a FTMH, despite OCT scans showing no significant vitreomacular traction. The FTMH was treated with vitrectomy and gas tamponade injection, resulting in persistent MH after two vitreoretinal surgeries. CONCLUSIONS:We hypothesize that Müller cell dysfunction, induced by the CBH, may have played a crucial role in the central cleavage that led to the FTMH formation. Given the prolonged interval between the CBH and FTMH development, this case underscores the need for further longitudinal studies to investigate the long-term outcomes of CBHs and the possible association with FTMH formation.

AIMS:To evaluate how different methods of managing multiple visits within predefined time windows affect intraocular pressure (IOP)-based success rates in glaucoma surgery studies. METHODS:We applied literature-based high IOP failure criteria to two cohorts of 934 and 1760 eyes undergoing trabeculectomy and deep sclerectomy (DS) with median follow-up of 41.4 months and 45.4 months, respectively. Failure was defined by IOP thresholds, loss of light perception, hypotony requiring revision or additional IOP-lowering surgery. Visits were grouped into guideline-based windows and six visit-managing strategies were applied to all visits, mean, lowest, highest, median and closest IOP to the recommended time point. We calculated Kaplan-Meier success rates for each visit-managing strategy. Visual field (VF) analysis was conducted on patients in the trabeculectomy cohort with ≥4 VFs in ≥2 years post-surgery. RESULTS:For the 21 mm Hg threshold, 5-year success was highest with the lowest IOP (trabeculectomy: 54.8%; DS: 74.5%), followed by closest IOP (trabeculectomy: 46.7%; DS: 67.6%), the median (trabeculectomy: 46.9%; DS: 69.1%) and mean IOP (trabeculectomy: 46.3%; DS: 68.6%). Success rates were lower with peak IOP (trabeculectomy: 39.3%; DS: 60.4%) and all visits IOP (trabeculectomy: 38.8%; DS: 61.0%). In the VF subset, eyes classified as failures demonstrated significantly faster mean deviation (MD) progression than those classified as successes although substantial overlap in the distribution of MD rates persisted between groups under every strategy. CONCLUSIONS:Visit-managing strategies influence reported success rates. None of the evaluated approaches achieved a clear separation in VF progression rates, underscoring the inherent limitations of IOP-threshold-based classifications.

Diabetic retinopathy (DR) is a leading cause of vision loss worldwide and represents a complex neurovascular complication of diabetes mellitus driven by chronic hyperglycemia. Increasing evidence identifies oxidative stress—defined as an imbalance between reactive oxygen species (ROS) production and antioxidant defenses—as a central pathogenic mechanism linking metabolic dysregulation to retinal injury. The retina is particularly vulnerable to oxidative damage due to its high metabolic demand, elevated oxygen consumption, and abundance of polyunsaturated fatty acids. Hyperglycemia activates multiple interconnected biochemical pathways, including the polyol and hexosamine pathways, protein kinase C signaling, advanced glycation end-product formation, and lipid peroxidation, all of which converge on excessive ROS production and mitochondrial dysfunction. Growing attention has focused on oxidative stress biomarkers as tools to characterize DR severity and progression. Elevated systemic markers of lipid, protein, and DNA oxidation, together with impaired antioxidant capacity, correlate with disease stage, while oxidative biomarkers detected in aqueous and vitreous humor reflect localized retinal injury. Importantly, oxidative stress biomarkers are also associated with functional outcomes, including best-corrected visual acuity and diabetic macular edema. Integration of systemic and ocular oxidative biomarkers with clinical staging may improve risk stratification and support personalized therapeutic strategies in DR.

To evaluate the diagnostic performance of a general-purpose vision-language model (GPT-4o) in interpreting gonioscopic images of the anterior chamber angle, with a focus on angle configuration classification and Shaffer grading. A total of 80 slit-lamp goniophotographs representing a range of anterior chamber angle (ACA) configurations were collected from a digital image repository and a specialized textbook. Each image was evaluated by three glaucoma specialists (reference standard), three comprehensive ophthalmologists, and GPT-4o across three trials. GPT-4o was prompted with a standardized diagnostic instruction and shown one example per Shaffer grade prior to evaluation. Performance metrics included accuracy, sensitivity, specificity, Quadratic Weighted Kappa (QWK), and Fleiss’ Kappa. Descriptive analyses and confusion matrices were used to assess misclassification patterns. GPT-4o demonstrated high accuracy in classifying angle configuration (91.3

Purpose:Pseudophakic secondary angle closure is an uncommon event, especially when it manifests itself many years after uneventful cataract surgery. We report a case of a patient who presented with a sudden increase in intraocular pressure (IOP) several years after surgery, highlighting the diagnostic challenges associated. We performed a systematic review of potential etiologies, including spontaneous aqueous misdirection and capsular block syndrome (CBS). Observation:A 91-year-old Caucasian male presented with sudden visual acuity reduction to counting fingers at 30 cm in the left eye (LE), his only seeing eye. Fourteen years earlier, the patient had undergone uncomplicated phacoemulsification with intraocular lens implantation. The slit-lamp examination showed corneal edema and a shallow anterior chamber. IOP measured by Goldmann applanation tonometry was 55 mmHg. Gonioscopy was not feasible, and the anatomical features were at presentation were not univocal for a specific diagnosis, though they were highly suggestive of late-onset CBS with pupillary block or spontaneous aqueous misdirection. The patient underwent laser peripheral iridotomy in the LE, which proved ineffective. Despite the absence of recent surgical interventions and the presence of a markedly elongated axial length of 32 mm, the patient was treated for aqueous misdirection, undergoing pars plana vitrectomy combined with irido-zonulo-hyaloid-vitrectomy. At the last follow-up visit, 4 months postoperatively, the patient's condition significantly improved. Best-corrected visual acuity in the LE improved to 20/40, and the IOP was well-controlled at 10 mmHg. A systematic literature review identified 24 cases of spontaneous aqueous misdirection and 2 cases of late-onset CBS with IOP elevation (5 when early onset was considered). Conclusion and importance:This case underscores the significant challenges in establishing an accurate diagnosis in cases of secondary angle closure in pseudophakic patients, particularly when presentation occurs many years after uncomplicated cataract surgery. The overlap of clinical features among rare entities, such as aqueous misdirection and late-onset CBS, further complicates the diagnostic process. Prompt recognition and timely intervention remain essential to prevent the potentially severe consequences of the condition.

INTRODUCTION:Epiretinal membrane (ERM) is a condition that can lead to visual impairment and metamorphopsia. This study aimed to examine the correlation between metamorphopsia and foveal microstructure before and after macular surgery in a cohort of patients with advanced ERM. METHODS:The severity of metamorphopsia was quantified using M-CHARTS, and foveal microstructure was evaluated via two optical coherence tomography (OCT) measures: central foveal thickness and ectopic inner foveal layer (EIFL). Assessments were performed pre- and post-surgery with an average follow-up of 1 year. Correlations between morphological and functional parameters pre- and post-surgery were explored by means of regression analysis. RESULTS:Sixty eyes of 57 patients diagnosed with advanced ERM and surgically treated were included in the study. Our findings showed a significant correlation between postoperative metamorphopsia and both pre- (R2 = 0.431) and postoperative (R2 = 0.300) EIFL thickness. Disparities were observed in metamorphopsia scores between patients with ERM stages 3 and 4, both pre- (0.46 ± 0.31 and 0.84 ± 0.32, respectively, p < 0.01) and post-surgery (0.18 ± 0.21 and 0.46 ± 0.28, respectively, p < 0.01). Postoperative EIFL thickness was the only variable significantly associated with postoperative metamorphopsia scores according to multiple regression analysis. CONCLUSION:EIFL thickness emerges as a critical determinant of postoperative metamorphopsia severity, underscoring its importance in predicting functional outcomes after ERM surgery. Although surgery improved metamorphopsia across stages, patients with more advanced ERM experienced less favorable outcomes, stressing the importance of a timely surgical intervention.

To report on the current evidence of early worsening of diabetic retinopathy (EWDR) in patients treated with new-generation antidiabetic agents, with a focus on glucagon-like peptide-1 receptor agonists (GLP1-RA). A comprehensive analysis of current literature was conducted, with a focus on studies evaluating the impact of glycemic control strategies and GLP1-RA on DR progression. References from landmark studies and recent trials were analyzed. Intensive glycemic control, while effective in reducing long-term microvascular complications including DR, has been associated with EWDR, particularly in cases with rapid HbA1c reductions. Emerging evidence links novel antidiabetic agents, including GLP1-RA, with increased risk of EWDR, though different studies have conflicting results. However, the risk of EWDR seems not to be directly linked to retinal toxicity from specific antidiabetic agents, but more likely to the rapid glycemic improvement. Risk factors for EWDR in these patients include higher baseline HbA1c, rapid and significant reductions in HbA1c levels during the first months of treatment, longer duration of diabetes, and more advanced stages of DR at baseline, while mild or moderate non-proliferative DR seem not be at higher risk of DR progression. While new antidiabetic therapies offer significant benefits for diabetes management, clinicians must be cautious when implementing intensive glycemic control in patients at risk for EWDR. Individualized treatment plans and close monitoring are essential to mitigate risks and optimize outcomes for patients with DR.

PURPOSE:Review high intraocular pressure (IOP) thresholds used as failure criteria in glaucoma surgical outcome studies, evaluate their impact on success rates, and examine the relationship between surgical success criteria and visual field (VF) progression rates. DESIGN:Systematic literature review and application of high IOP failure criteria to 2 retrospective cohorts. PARTICIPANTS:Two cohorts of 934 and 1765 eyes underwent trabeculectomy and deep sclerectomy (DS), respectively, with a median follow-up of 41.4 months for trabeculectomy and 45.4 months for DS. Visual field analysis was conducted on patients in the trabeculectomy cohort with ≥4 VFs in ≥2 years post-surgery. METHODS:We applied literature-based high IOP failure criteria to the patient cohorts, defining failure as exceeding these IOP thresholds, loss of light perception, hypotony revision surgery, or need for additional IOP-lowering surgery. Success rates were estimated with Kaplan-Meier statistics, and Cohen's kappa statistic assessed the agreement among criteria in defining failure at 5 years. Linear mixed models estimated VF mean deviation (MD) progression rates based on success or failure status. MAIN OUTCOME MEASURES:Kaplan-Meier success rates, Cohen's kappa, and MD progression rates. RESULTS:From 2503 initial studies, 277 were included, identifying 144 high IOP failure criteria. The 21-mmHg criterion variations showed success rates at 5 years ranging from 8.7% to 74.0% for trabeculectomy and 22.1% to 89.9% for DS. The median Cohen's kappa for 21-mmHg criteria indicated fair agreement (0.39 for trabeculectomy, 0.42 for DS). A subset of 339 trabeculectomy eyes were eligible for the VF analysis. Overall, the median (interquartile range) postoperative progression rate was -0.36 (-0.09 to -0.74) dB/year. Distributions of progression rates greatly overlapped between failure and success groups as defined by the various criteria. CONCLUSIONS:The criteria for defining high IOP failure in glaucoma surgery are highly heterogeneous in the current literature. Varying high IOP criteria has a large impact on glaucoma surgery success rates, highlighting the need for standardized failure criteria to enable consistent interpretation and comparison across studies. IOP-based classifications are poor surrogates for postoperative VF progression rates. Long-term visual field rates provide a more consistent primary outcome measure and may be incorporated into composite success criteria.

Background:Artificial intelligence (AI) is becoming increasingly popular in the scientific field, as it allows for the analysis of extensive datasets, summarizes results, and assists in writing academic papers. Objective:This study investigates the role of AI in the process of conducting a systematic literature review (SLR), focusing on its contributions and limitations at three key stages of its development, study selection, data extraction, and study composition, using glaucoma-related SLRs as case studies and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-based SLRs as benchmarks. Methods:Four AI platforms were tested on their ability to reproduce four PRISMA-based, glaucoma-related SLRs. We used Connected Papers and Elicit to perform research of relevant records; then we assessed Elicit and ChatPDF's ability to extract and organize information contained in the retrieved records. Finally, we tested Jenni AI's capacity to compose an SLR. Results:Neither Connected Papers nor Elicit provided the totality of the results found using the PRISMA method. On average, data extracted from Elicit were accurate in 51.40% (SD 31.45%) of cases and imprecise in 13.69% (SD 17.98%); 22.37% (SD 27.54%) of responses were missing, while 12.51% (SD 14.70%) were incorrect. Data extracted from ChatPDF were accurate in 60.33% (SD 30.72%) of cases and imprecise in 7.41% (SD 13.88%); 17.56% (SD 20.02%) of responses were missing, and 14.70% (SD 17.72%) were incorrect. Jenni AI's generated content exhibited satisfactory language fluency and technical proficiency but was insufficient in defining methods, elaborating results, and stating conclusions. Conclusions:The PRISMA method continues to exhibit clear superiority in terms of reproducibility and accuracy during the literature search, data extraction, and study composition phases of the SLR writing process. While AI can save time and assist with repetitive tasks, the active participation of the researcher throughout the entire process is still crucial to maintain control over the quality, accuracy, and objectivity of their work.

Précis: Deep sclerectomy (DS) and canaloplasty provide better intraocular pressure (IOP) control than viscocanalostomy. DS required less glaucoma medications but more interventions to reach target IOP. Purpose: To compare real-world outcomes of three non-penetrating glaucoma surgery (NPGS) techniques. Methods: Retrospective, cohort study of consecutive patients undergoing canaloplasty (CP), deep sclerectomy (DS), and viscocanalostomy (VC), across nine European glaucoma units. Four intraocular pressure (IOP) criteria were used to define success at 2-year follow-up: (A)IOP≤21 mmHg and ≥20% reduction; (B)IOP≤18 mmHg and ≥20% reduction; (C)IOP≤15 mmHg and ≥25% reduction; (D)IOP≤12 mmHg and ≥30% reduction. Secondary outcomes included IOP control, BCVA, number of medications over time, risk factors for failure, complications, and post-operative interventions. Success was distinguished as qualified or complete, if reached with or without antiglaucoma medications, respectively. Results: 600 eyes (545 patients) undergoing standalone CP (201 eyes), DS (200 eyes), and VC (199 eyes) were included. Qualified success rates of CP, DS, and VP at 24 months were, respectively: (Criterion A) 85.1%, 67.6% and 64.6%; (Criterion B) 85.1%, 66.1% and 58.6%; (Criterion C) 76.6%, 55.5% and 39.0%; (Criterion D) 27.7%, 28.5% and 22.1%. Success rates were significantly different across the three techniques (P=0.04 or below), except for complete success according to criterion A (P=0.07). Mean IOP(±SD) reduced from 25.2(±6.9), 20.5(±6.7), and 22.7(±7.2)mmHg pre-operatively to 13.1(±3.1), 12.9(±4.5), and 14.7(±4.6)mmHg at post-operative year 2 in the CP, DS, and VC groups respectively (P<0.001 between pre-operative and post-operative time points for all groups). Conclusions: All three NPGS provide sustained IOP reduction, but DS and CP provide better success rates and IOP control. Success rates were low for the most stringent cut-offs, suggesting that other techniques such as trabeculectomy may be indicated when a very low target IOP is demanded.

TOPIC:Compare different methods to deliver mitomycin C (MMC) in trabeculectomy surgery. CLINICAL RELEVANCE:Knowing the best way to apply MMC may provide guidance to glaucoma surgeons and improve outcomes. METHODS:Systematic review and meta-analysis (PROSPERO CRD42023394371) for studies comparing ≥ 2 methods to apply MMC in trabeculectomy published until February 22, 2023, from Medline, EMBASE, and CENTRAL. Randomized clinical trials (RCTs), quasi-randomized, and prospective nonrandomized controlled studies published in English and conducted on human subjects were included. The primary outcome was surgical failure at 1 year. Secondary outcomes included intraocular pressure (IOP), number of glaucoma medications, postoperative complications, and interventions. A random-effects meta-analysis was conducted for ≥ 3 studies, whereas a fixed-effect model was used for 2 studies. The certainty of evidence was assessed with Grading Recommendations Assessment, Development and Evaluation (GRADE) score. RESULTS:From 7899 records, 8 articles from 7 RCTs compared intraoperative sub-Tenon MMC injection (315 participants) and intraoperative MMC-soaked sponges (327 participants). One RCT and 1 quasi-randomized study compared postoperative (60 participants) and intraoperative (60 participants) MMC-soaked sponge application. In the injection vs. sponges comparison, no significant difference in surgical failure (relative risk [RR]: 0.78, 95% confidence interval [CI]: 0.48-1.28; P = 0.33, GRADE score moderate) or IOP (mean difference [MD]: -0.85 mmHg, 95% CI: -2.19 to 0.49; P = 0.21, GRADE score moderate) was found at 1 year. Sub-Tenon injection resulted in fewer postoperative medications (MD: -0.40, 95% CI: -0.63 to -0.18; P < 0.001; GRADE score moderate) and better bleb morphology (GRADE score high) in terms of height (MD: -0.39, 95% CI: -0.61 to -0.18; P < 0.001), extension (MD: 0.28, 95% CI: 0.11-0.45; P = 0.001), and vascularity (MD: -0.52, 95% CI: -0.72, -0.31; P < 0.001) than sponges. Serious complication and reintervention rates were low and comparable between groups. We did not perform a meta-analysis comparing postoperative and intraoperative sponge application because of heterogeneity in the study designs of the included studies. CONCLUSIONS:Intraoperative sub-Tenon MMC injection is noninferior to intraoperative MMC-soaked sponges in trabeculectomy surgery in terms of surgical failure and IOP control, with a reduced number of medications, improved bleb morphology, and similar safety profile. Further research with a long-term follow-up is necessary to confirm their long-term equivalence. FINANCIAL DISCLOSURE(S):Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

BACKGROUND:To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small idiopathic macular hole. METHODS:Retrospective, multicentre cohort study including consecutive eyes with a ≤250 μm idiopathic macular hole treated with primary vitrectomy. The primary outcome was best-corrected visual acuity (BCVA) change and macular hole closure rate. Closure patterns on optical coherence tomography (OCT) and rates of external limiting membrane (ELM) and ellipsoid zone (EZ) recovery were considered as secondary outcomes. RESULTS:A total of 389 and 250 eyes were included in the conventional ILM peeling group and in the inverted flap group, respectively. Hole closure rate was comparable between the two groups (98.5% in the ILM peeling group and 97.6% in the inverted flap group). Mean BCVA was comparable between the two groups at baseline (p = 0.331). At 12 months, mean BCVA was 0.14 ± 0.19 logMAR in the conventional ILM peeling group and 0.17 ± 0.18 logMAR in the inverted flap group (p = 0.08). At 12 months, 73% of eyes had a U-shape closure morphology in the conventional ILM peeling group versus 55% in the inverted flap group. At 12 months, ELM recovery rate was 96% and 86% in the conventional ILM peeling group and in the inverted flap group, respectively (p < 0.001); EZ recovery rate was 78% and 69%, respectively (p = 0.04). CONCLUSIONS:The inverted flap technique provides no advantages in terms of visual outcome and closure rate in small idiopathic macular hole surgery. Additionally, this technique seems to impair postoperative restoration of external retinal layers compared with conventional peeling.

PURPOSE: To evaluate risk factors for failure of Microshunt in glaucoma patients. DESIGN: Multicenter retrospective cohort study. METHODS: The study included 220 eyes from 220 consecutive glaucoma patients undergoing Microshunt implantation at six glaucoma units. Four intraocular pressure (IOP) success criteria were defined: (A) IOP <= 21 mm Hg with >= 20% IOP reduction; (B) IOP <= 18 mm Hg with >= 20% IOP reduction; (C) IOP <= 15 mm Hg with >= 25% IOP reduction; and (D) IOP <= 12 mm Hg with >= 30% IOP reduction from baseline. Kaplan-Meier analysis was used to estimate success rates according to the criteria above, and multivariable Cox models were used to identified risk factors for failure according to criterion A. RESULTS: Success rates varied based on different criteria, ranging from 43.3% to 62.5% (overall success for criteria D and A, respectively) and from 35.3% to 44.4% (complete success for criteria D and A, respectively) at 1-year follow-up. Higher intraoperative MMC concentration was associated with reduced risk of failure to maintain complete (0.4 vs 0.2 mg/mL: hazard ratio [HR] = 0.441, P < .001) and overall (0.4 vs 0.2 mg/mL: HR = 0.360, P = .004) success. For complete success, other risk factors for failure were pseudoexfoliation glaucoma/pigmentary glaucoma (HR = 1.641, P = .004), primary angle closure glaucoma (HR = 1.611, P < .001), and previous non-glaucomatous ocular surgeries (HR = 2.301, P = .002). For overall success, other risk factors for failure were lower preoperative IOP (for 1-mm Hg increase, HR = 0.934, P = .005), higher number of preoperative antiglaucoma agents (HR = 1.626, P < .001), and Microshunt combined with cataract surgery (HR = 1.526, P = .033). CONCLUSIONS: This study identified risk factors for Microshunt failure, highlighting the importance of high intraoperative MMC dose and careful patient selection to optimize surgical success.

To test the hypothesis that optical coherence tomography (OCT) choroidal hypertransmission width (CHW) is a prognostic biomarker in idiopathic macular hole (MH) surgery Retrospective cohort study of consecutive patients undergoing successful pars plana vitrectomy for idiopathic MH. We collected demographic, clinical, and OCT variables at the preoperative and last available visits. Two investigators assessed the following OCT parameters: MH minimum diameter, base diameter, CHW, ellipsoid zone, and external limiting membrane status (absent vs. present). Delta CHW was calculated as the difference between CHW and MH minimum diameter. Linear models were used to investigate factors associated with postoperative best-corrected visual acuity (BCVA) and BCVA change. Thirty-six eyes (36 patients) with a median (interquartile range (IQR)) follow-up of 9 (8–11) months were included. The median BCVA (IQR) improved from 0.75 (1–0.6) logMAR preoperatively to 0.2 (0.6–0.1) logMAR at the last visit (p < 0.001). Preoperative MH minimum diameter (for a 10-μm increase, estimate (standard error (SE)): 0.009 (0.003) logMAR, p = 0.003), base diameter (for a 10-μm increase, 0.003 (0.001) logMAR, p = 0.032), CHW (for a 10-μm increase, 0.008 (0.002) logMAR, p < 0.001), and delta CHW (for a 10-μm increase, 0.013 (0.005) logMAR, p = 0.009) were significantly associated with postoperative BCVA. The proportion of variance explained was the highest for MH CHW (R2 0.35), followed by minimum MH diameter (R2 0.24), delta CHW (R2 0.19), and MH base diameter (R2 0.14). None of the study variables was associated with delta BCVA. Preoperative CHW is associated with postoperative visual acuity in patients undergoing successful idiopathic MH surgery and may be a useful OCT prognostic biomarker.