PURPOSE:To evaluate the use of povidone-iodine infusion during pars plana vitrectomy and to assess its clinical outcomes in the treatment of severe endophthalmitis. METHODS:A retrospective case series of 40 patients (41 eyes) with clinically or culture-confirmed endophthalmitis underwent pars plana vitrectomy with 0.025% povidone-iodine in the infusion solution. Outcomes included infection resolution, improvements in visual acuity, the need for additional surgeries, and signs of ocular toxicity. RESULTS:Of the 41 eyes treated, infection resolved in 33 (80.4%) eyes postoperatively. Visual acuity improved postoperatively in 29 eyes (70.7%). Mean uncorrected visual acuity improved from 20/3,337 (2.22 ± 0.70 logMAR) preoperatively to 20/540 (1.43 ± 0.88 logMAR) postoperatively ( P < 0.0001). No ocular toxicity or unexplained vision loss related to povidone-iodine infusion was observed. CONCLUSION:The addition of 0.025% povidone-iodine infusion during pars plana vitrectomy appears safe and led to favorable post-surgical outcomes in a traditionally high-risk cohort.

[This corrects the article DOI: 10.3389/fphar.2025.1660067.].

Intraocular lenses (IOLs) are implanted into the eyes during cataract surgery to improve vision. A rare complication following IOL implantation is the formation of crystallized deposits on the lenses, which significantly impair vision, necessitating subsequent surgical IOL exchange. Preventing these deposits from forming is critical, but this requires definitive molecular assignments of the crystals and knowledge of their mechanism of formation. Determining this information presents a significant analytical challenge due to the low numbers of crystals and curvature of the IOLs that limit use of conventional methods. Here, we report the development of multiple complementary analytical methods to characterize IOLs explanted from human patients and attain insight into the chemical identity and mechanism of the deposits. Initial elemental analyses using energy-dispersive X-ray spectroscopy (EDS) and X-ray photoelectron spectroscopy (XPS) revealed that IOL crystals contained calcium, phosphorus, and sodium and provided quantitative ratios between elements. Subsequent Raman spectroscopy identified carbonate in the crystals as well. An innovative single-crystal X-ray diffraction (XRD) method with integrated Rietveld analysis was then developed, which conclusively determined that IOL crystals were composed of substituted hydroxyapatite. Collectively, the data obtained from EDS, XPS, XRD, and Raman indicate that IOL deposits are composed of crystalline Ca9Na(PO4)5(CO3)(OH)2 layered with amorphous calcium phosphate. This structure is similar to bone, suggesting that a similar ossification mechanism is followed. The robust analytical methods developed herein provide the most comprehensive characterization of IOL crystals to date and signify that the microenvironment of the eye is conducive to bone mineralization pathways that induce crystal formation on IOLs.

PURPOSE:To report two patient cases demonstrating the management of refractory macular holes through the application of temporary thin amniotic membrane grafts, followed by subsequent graft removal on achieving hole closure. METHODS:Comprehensive chart and literature review was conducted using the PubMed database. RESULTS:We describe two patients who underwent repeat pars plana vitrectomy for treatment of refractory macular holes. In both patients, the epiretinal placement of a thin amniotic membrane graft was done to achieve hole closure. After a period of retinal stabilization, the amniotic membranes were removed because of the healthy appearance of the outer retinal layers and the ellipsoid zone, ultimately resulting in an improved final visual acuity in both patients. CONCLUSION:This case series demonstrates a new approach of using a temporary amniotic membrane graft to close refractory macular holes. After graft removal, both patients reported enhanced visual acuity and subjective visual improvement, accompanied by the stable closure of macular holes on serial optical coherence tomography scans.

To described and evaluate a technique in which the fluocinolone acetonide 0.18 mg implant is sutured into the pars plana in cases of noninfectious uveitis. Ocular vitals and slit lamp examination was performed at baseline, 1 month, 3 months, 6 months and 12 months follow up. Optical coherence tomography was obtained at all these visits. Data assessed included visual acuity; intraocular pressure; signs of active inflammation including anterior chamber cell, anterior chamber flare, vitreous cell, macular edema, as well as other forms of ocular inflammation; surgical complications; and need for additional interventions. 6 eyes of 6 patients had scleral fixation of the fluocinolone implant. The mean visual acuity remained stable between the visit prior to refixation and 12 months after scleral fixation (0.03 log MAR change, p = 0.92). The mean macular central subfield thickness decreased from the visit prior to refixation to 12 months after scleral fixation (252.4 μm decrease, p = 0.38). No eyes required additional therapy to control posterior noninfectious uveitis or macular edema. In patients with aphakia, compromised zonules/posterior lens capsule, and anterior or scleral-fixated intraocular lenses, all of which are contraindications to injection of posterior segment implants, scleral fixation of the 0.18 mg fluocinolone acetonide implant may be useful for treatment of noninfectious uveitis.

PURPOSE:The objective of this study was to present a novel case of exogenous Rahnella aquatilis endophthalmitis following an intravitreal injection. METHODS:This was a case report. RESULTS:A 74-year-old man presented with acute progressive vision loss and pain in the left eye, 5 days after an intravitreal injection for diabetic macular edema. The patient was diagnosed with exogenous endophthalmitis and empirically treated with intravitreal injections of vancomycin and ceftazidime as well as topical and oral ciprofloxacin. At follow-up 2 days later, the patient was treated with preoperative povidone-iodine, followed by prompt vitrectomy with additional vancomycin and ceftazidime due to pharmacy sterile hood issues that delayed antibiotic availability. Microbiological cultures and two mass spectrometry identification tests confirmed the diagnosis of exogenous R. aquatilis endophthalmitis. Despite the presence of scattered retinal hemorrhagic infarcts involving the macula and subsequent full-thickness atrophic macular holes seen in follow-up, the patient achieved a favorable anatomical and functional outcome of best corrected visual acuity 20/80 at 1-year follow-up. CONCLUSION:This case highlights the occurrence of exogenous R. aquatilis endophthalmitis following an intravitreal injection for diabetic macular edema. Prompt diagnosis and treatment produced a favorable outcome relative to other typical gram-negative Enterobacteriaceae organisms.

Purpose:While great progress has been made in screening methods and therapies for proliferative diabetic retinopathy (PDR), it is still a major cause of blindness. Rapidly dividing cells reprogram their metabolism toward hyperglycolysis (the Warburg effect), a process recently implicated in angiogenesis. In this study, we sought to investigate nucleotide metabolism in human retinal endothelial cells (HRECs) under high glucose (HG) and hypoxia (Hyp), both key risk factors in PDR and known to induce the Warburg effect, and to validate these findings in patients with PDR. Methods:HRECs were cultured under normal conditions and then exposed to HG, Hyp, or both. Metabolomic profiling was performed using liquid chromatography-mass spectrometry (LC-MS/MS) to quantify nucleotide-related metabolites. In parallel, proteomic analysis was conducted to assess proteins involved in nucleotide metabolism. To validate the in vitro findings, vitreous samples from patients with PDR and non-PDR controls were analyzed. Receiver operating characteristic (ROC) analysis was then applied to evaluate the diagnostic potential of nucleotide metabolites in PDR. Results:HG and Hyp in HRECs caused selective disruptions in nucleotide metabolism, marked by significant accumulation of D-ribose-5-phosphate, a glycolytic precursor for both purines and pyrimidines, as well as nucleoside mono- and diphosphates (NMPs, NDPs), particularly adenosine mono- and diphosphates (AMP and ADP), without global changes in total nucleotide pools. This accumulation was also observed in vitreous samples from patients with PDR. ROC analysis identified AMP+ADP levels >0.0062 µM as a potential diagnostic biomarker for PDR with 87.5% specificity. Proteomic profiling revealed dysregulation of key enzymes regulating nucleotide homeostasis, including reduced expression of mitochondrial nucleoside diphosphate kinase (NME4), increased levels of cytosolic adenylate kinase (AK1), and upregulation of multiple enzymes involved in de novo and salvage nucleotide biosynthesis. Notably, expression of ribonucleotide reductase catalytic subunit M (RRM2), which converts NDPs to deoxynucleotides (dNDPs) for DNA synthesis, was also elevated. Conclusion:Exposure to HG and Hyp, key risk factors for PDR, disrupts nucleotide homeostasis in HRECs, with enhanced glycolytic flux fueling nucleotide precursor production and altered kinase expression favoring the accumulation of nucleoside mono- and diphosphates over triphosphates. The corresponding increase in AMP and ADP in PDR vitreous highlights their potential as biomarkers and underscores the central role of nucleotide metabolism in PDR pathogenesis.

PURPOSE:To describe a severe case of crystalline retinopathy secondary to hyperoxaluria from short gut syndrome. METHODS:Case report. RESULTS:A 62-year-old Caucasian woman with short gut syndrome and end-stage renal disease from renal oxalosis presented with chronic bilateral vision loss. She had previously been treated for presumed occlusive vasculitis. Visual acuity on initial examination was 20/400 right eye and 20/100 left eye with an afferent pupillary defect of the right eye. Examination revealed attenuated retinal vasculature and diffuse crystalline infiltration of retinal arterial lumina and throughout the retinas bilaterally. Optical coherence tomography revealed inner retinal atrophy with crystalline deposition in the inner retinal layers. Fluorescein angiography demonstrated delayed vascular filling and dropout consistent with severe ischemic vasculopathy. It was concluded that the short-gut syndrome led to overabsorption of oxalate with subsequent hyperoxaluria leading to retinal atherosclerotic oxalosis. CONCLUSION:Retinal calcium oxalate deposits due to hyperoxaluria have been previously noted; however, this degree of severe retinal vascular infiltration has not been described. Our patient was receiving hemodialysis, which is associated with high rebound increases in systemic oxalate concentrations. It is important to keep hyperoxaluria in mind as a potential cause of retinopathy in patients with end-stage renal disease presenting with vision loss.

Purpose: To evaluate the outcomes of scleral-fixated intraocular lenses (IOLs) implanted using either Yamane technique or Gore-Tex suture fixation, in comparison to intracapsular lens fixation, and to assess the efficacy of various lens formulas in achieving predicted refractive targets. Patients and Methods: This study included 45 eyes from 44 patients with scleral-fixated IOLs, comprising 37 Yamane eyes and 8 Gore-Tex eyes. Preoperative refractive predictions from various formulae were compared with final postoperative refraction. Outcomes assessed included effective lens position (ELP), postoperative predictive error, and changes in visual acuity. The ELP of scleral-fixated IOLs was compared with that of intracapsular IOLs in fellow eyes. Results: Average ELP for Yamane IOLs was 0.62 mm more posterior relative to intracapsular IOLs but was not significantly different for Gore-Tex IOLs. Average postoperative logMAR acuity change was significant at -1.30 (p=4.5x10-11) and -1.65 (p=5x10-4) for Yamane and Gore-Tex eyes, respectively. Mean prediction error for Yamane eyes was +0.29 +/- 1.3 D, -0.53 +/- 0.40 D, +0.80 +/- 1.4 D, and +0.43 +/- 1.4 D using Barrett Universal II, Holladay, Hill-RBF, and Hoffer QST formulas, respectively. Mean prediction error for Gore Tex eyes was -0.37 +/- 1.24 D and +0.53 +/- 1.19 D using Barrett Universal II and Holladay formulas, respectively. Conclusion: Different scleral fixation techniques result in variations in ELP compared to intracapsular IOL placement. In our hands, when using the Yamane technique, surgeons should aim for a myopic refractive target to offset hyperopic errors when employing the Barrett Universal II, Hill-RBF, or Hoffer QST formulas, and a hyperopic target when using the Holladay formula. For Gore-Tex IOLs, a slightly hyperopic target is recommended to counter myopic error when using the Barrett Universal II formula, whereas a slightly myopic target is advised with the Holladay formula to offset hyperopic error. A limitation of our study is the small sample size for patients who underwent Gore-Tex suture fixation.

A 67-year-old woman with history of mild suture hyper-sensitivity presented with localized scleritis after strabismus surgery. After infection was ruled out, the patient was prescribed topical and systemic non-steroidal anti-inflammatory drugs and systemic steroids, which led to full clinical resolution. [ J Pediatr Ophthalmol Strabismus . 2024;61(1):e4–e6.]

Purpose:To evaluate surgeon performance and intraoperative complication rates of cataract surgery after resumption of elective surgeries following the operating room (OR) shutdown from the coronavirus disease 2019 (COVID-19) pandemic. Subjective surgical experience is also evaluated.Methods:This is a retrospective comparative study which analyzes cataract surgeries performed at an inner city, tertiary academic center. Cataract surgeries were categorized into Pre-Shutdown (January 1-March 18, 2020), and Post-Shutdown, for all cases which occurred after surgeries resumed (May 11-July 31, 2020). No cases were performed between March 19 and May 10, 2020. Patients undergoing combined cataract and minimally invasive glaucoma surgery (MIGS) were included, but MIGS complications were not counted as cataract complications. No other combined cataract-other ophthalmic surgeries were included. A survey was used to gather subjective surgeon experience.Results:A total of 480 cases (n=306 Pre-Shutdown and n=174 Post-Shutdown) were analyzed. Although there was a higher frequency of complex cataract surgeries performed Post-Shutdown (5.2% vs 21.3%; p<0.00001), complication rates before versus after the shutdown were not statistically significant (9.2% vs 10.3%; p=0.75). Phacoemulsification was the step of cataract surgery in which residents were most concerned about when returning to the OR.Conclusion:After the surgical hiatus due to COVID-19, significantly more complex cataract surgeries were reported and surgeons reported higher general anxiety level when first returning to the OR. Increased anxiety did not lead to higher surgical complications. This study provides a framework to understand surgical expectations and outcomes for patients whose surgeons faced a prolonged two-month hiatus from cataract surgery.

Purpose: To analyze visual outcomes and accuracy of intraocular lens (IOL) calculation formulas in predicting postoperative outcomes in patients undergoing flanged intrascleral IOL fixation.Design: Case Series.Subjects: Twenty-three patients who had undergone secondary IOL placement using flanged intrascleral fixation technique.Methods: Retrospective chart review.Main Outcome Measures: Corrected distance visual acuity (CDVA) and postoperative spherical equivalent based on manifest refraction.Results: Visual acuity improved from 20/577 to 20/58. Overall, the actual refraction was 0.06 D more myopic than predicted. Holladay 2, Sanders Retzlaff Kraff/Theoretical (SRK/T) and Barrett Universal II resulted in mild myopic surprise (-0.55, -0.18 and -0.20 D). Haigis and Hill-RBF (Radial Basis Function) resulted in mild hyperopic surprise (+0.28 and +0.28 D). Hoffer Q and Holladay 1 were the most accurate (-0.02D and -0.08 D).Conclusion: Flanged intrascleral IOL fixation improved vision even in patients with other posterior segment pathologies. The effective lens positioning is likely similar to in-the-bag positioning. Hoffer Q and Holladay 1 formulas with in-the-bag calculations were the most accurate.

Purpose: To report two cases of symptomatic posterior pole arterial occlusions in patients with hemoglobin SS disease. Observations: Two teenage patients with hemoglobin SS disease presented with visual distortions, and on dilated fundus examination and testing, they were found to have arterial occlusions involving the posterior pole. The patients were evaluated for stroke with head imaging and received exchange transfusion by hematology. Conclusions and Importance: This case series reports the unusual findings of arterial occlusions in the posterior pole resulting in areas of retinal whitening and ischemia in patients with HbSS. While sickle cell retinopathy is typically considered a peripheral retinal disease, these findings underscore the importance of vigilance when examining patients with sickle cell disease.

Purpose: This case report aims to describe a new method for increasing intraocular pressure (IOP) in patients with acute hypotony resulting from uveitis flare-ups and preexisting glaucoma drainage devices. The temporary glaucoma tube plug method described is effective and safe. Methods: This case report presents a 47-year-old female patient with a history of chronic panuveitis and secondary glaucoma, who had 2 previously implanted Ahmed glaucoma valves. The patient developed panuveitis flare-up and persistent hypotony. A novel method of ab interno plugging of the glaucoma tubes using 2-0 prolene suture plugs was performed. Following treatment, the IOP increased successfully and remained within the normal range. Conclusion: The temporary ab interno glaucoma tube plug method effectively increased IOP in a patient with 2 preimplanted Ahmed glaucoma valves with persistent low IOP due to uveitis.

PURPOSE:To show the feasibility while comparing functional and anatomical outcomes of vitrectomy combined with intralesional injection of voriconazole and povidone iodine for recalcitrant fusarium fungal endophthalmitis.METHODS:In a noncomparative interventional case, vitrectomy combined with intralesional injection of voriconazole and povidone iodine was performed in a single patient.RESULTS:Following vitrectomy and intralesional injection, our patient's fungal endophthalmitis stabilized and vision improved to 20/25. He did not require further intravitreal injections or vitrectomy.CONCLUSIONS:Vitrectomy and intralesional injection for the treatment of refractory filamentary fungal endophthalmitis proved to be safe and effective for this case.

Proliferative diabetic retinopathy (PDR) remains a leading cause of blindness despite progress in screening and treatment. Recently, the Warburg effect, a metabolic alteration affecting amino acid (AA) metabolism in proliferating cells, has drawn attention regarding its role in PDR. This study aimed to investigate the impact of the Warburg effect on AA metabolism in human retinal endothelial cells (HRECs) subjected to PDR-associated risk factors and validate the findings in patients with PDR. In vitro experiments exposed HRECs to high glucose (HG) and/or hypoxia (Hyp), known inducers of the Warburg effect. The HG + Hyp group of HRECs exhibited significant differences in non-essential AAs with aliphatic non-polar side chains, mainly driven by elevated glycine concentrations. Pathway enrichment analysis revealed several glycine metabolism-related pathways significantly altered due to the Warburg effect induced by HG + Hyp. Crucially, vitreous humor samples from PDR patients displayed higher glycine levels compared to non-diabetic and diabetic patients without PDR. The odds ratio for PDR patients with glycine levels above the cut-off of 0.0836 µM was 28 ( p = 0.03) compared to non-PDR controls. In conclusion, this study provides mechanistic insights into how a specific Warburg effect subtype contributes to glycine accumulation in PDR and supports glycine's potential as a biomarker for PDR pathogenesis.

Abstract Background To evaluate the accuracy of intravitreal injection volume of the pre-filled syringe (PFS) in which aflibercept is packaged compared to the BD Luer-Lok 1-mL syringe. Methods Ophthalmologists injected their typical intravitreal volume for aflibercept using either the PFS or BD Luer-Lok 1-mL syringe for 5 times each. The injected fluid was weighed using a micro-scale and converted to volume. The volume of fluid injected was also evaluated when the 0.05 mL line on the PFS was lined up to the tip or base of the dome-shaped plunger. Results Injection volume was measured for 12 physicians. The average injected fluid volume was 74.22 ± 15.87 µL for PFS and 53.42 ± 4.61 µL for the BD Luer-Lok 1-mL syringe (p < 0.0001). The average deviation in volume injected for the PFS was higher compared to the BD Luer-Lok 1-mL syringe (11.36 µL vs. 3.35 µL, p < 0.0001). When the PFS was lined up with the tip of the dome-shaped plunger at the 0.05-mL line, the average injected volume was 71.03% higher. Conclusions The intravitreal injection volume and variability using the new PFS were significantly higher than the volume injected using the BD Luer-Lok 1-mL syringe previously used, potentially leading to higher rates of visually significant elevation of intraocular pressures.

Purpose: We describe a case and our experience with using plasmapheresis as a treatment for scleritis. Observations: Treating relapsing autoimmune scleritis can be challenging when it inadequately responds to traditional therapy. Our patient could not receive non-steroidal anti-inflammatory therapy for her scleritis due to recent gastrointestinal surgery and previously failed multiple steroid sparing treatments due to intolerance. There was good initial control with high dose oral prednisone, however, the steroid could not be tapered to a safe dosage (<10 mg per day) without relapse. Therefore, we opted to treat our patient with plasmapheresis. Conclusions and Importance: After undergoing plasmapheresis, our patient experienced total resolution of symptoms with corresponding clinical resolution of scleritis. Plasmapheresis derives great benefit by filtering circulating immune complexes. Although rarely used, plasmapheresis can be effective in treating non-infectious scleritis.

Abstract BACKGROUND: To evaluate Deep Learning (DL) Artificial Intelligence (AI) application to optical coherence tomography scans of non-infectious pan-uveitis patients. METHODS: Consecutive patients with non-infectious pan-uveitis were included in the study if they had an OCT scan (Zeiss, Germany) of the macula. Inflammation was graded on the Nussenblatt scoring system by a uveitis specialist. A DL AI system developed using Python 3.9 and open source TensorFlow software was then trained to classify inflammation as high, low, or none. Performance was assessed by AUC scores. Training to cross-validation used an 80:20 split with 2000 iterations in all evaluations.RESULTS: 154 scans of 52 patients were analyzed. 38 (70.4%) of patients were female and the mean age of participants was 50.3 ± 15.5 years. 58 (37.7%) of OCT scans were graded as no inflammation, 61 (39.6%) scans as mild inflammation, and 35 (22.7%) scans as high inflammation. The AUC for OCT images was 0.830 (CI95: 0.784 to 0.876).CONCLUSION: Deep Learning AI can be applied in the grading of non-infectious pan-uveitis OCT scans in a precise manner.