Anterior Eye Segment Advances: Diagnosis and Treatment of Corneal Diseases, Cataracts and Glaucoma

Background and Objectives: Open-angle glaucoma subtypes share a structural phenotype but differ in pathophysiology: pseudoexfoliative glaucoma (PXG) involves vascular endothelial dysfunction associated with deposition of exfoliative material, whereas normal-tension glaucoma (NTG) reflects primary vascular dysregulation in the absence of elevated intraocular pressure. We characterized subtype-specific OCT angiography (OCTA) profiles obtained from a 3 × 3 mm macular scan and evaluated their discriminatory power for pairwise subtype classification. Materials and Methods: This was a single-center, cross-sectional study of 304 eyes: 198 glaucomatous eyes—primary open-angle glaucoma (POAG, glaucoma simplex in our clinical nomenclature), n = 102; PXG (glaucoma capsulare), n = 68; NTG (glaucoma sine tensio), n = 28—and 106 healthy controls. The Cirrus HD-OCT 5000 AngioPlex 3 × 3 mm OCTA protocol was used to assess vessel density (VD), perfusion density, foveal avascular zone (FAZ) morphology, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) thickness. Analyses included Kruskal–Wallis tests with Bonferroni post hoc correction, ROC analysis with DeLong comparison of combined versus structural-only models, multivariate regression, and an exploratory XGBoost classifier with SHAP-based interpretation. Results: VD Inner and Perfusion Inner were lower in PXG (16.37 ± 3.33%; 0.31 ± 0.05) than in POAG (18.73 ± 3.41%; 0.34 ± 0.05; both p < 0.001); Perfusion Inner was also lower than in NTG (p < 0.05). FAZ Area was largest in NTG (0.27 ± 0.11 mm²) and greater than in PXG (0.19 ± 0.08; p < 0.01); FAZ Circularity differed across subtypes (p < 0.001). Combined OCTA–structural models outperformed structural-only models for POAG vs. PXG (DeLong p = 0.002) and for PXG vs. NTG (AUC = 0.770; p = 0.010). Sector-resolved Spearman analysis revealed subtype-specific coupling: in NTG, VD Inner and Perfusion Inner correlated with the inferior RNFL (r = 0.53 and r = 0.52; both p < 0.01); in PXG, coupling shifted nasally (r = 0.41 and r = 0.46; both p < 0.001). The exploratory XGBoost classifier separated glaucoma from controls with an internal cross-validated AUC of 0.975 ± 0.008 (5-fold CV; not externally validated); FAZ Circularity (mean |SHAP| = 0.418) and FAZ Area (0.411) were the top inter-subtype features, supported by case-level SHAP. RNFL avg and average GCC independently predicted MD across subtypes; in PXG, Perfusion Inner also predicted MD (β = −32.78; p = 0.032). Conclusions: In this single-center, cross-sectional cohort, OCTA revealed subtype-associated macular microvascular profiles that are complementary to structural OCT. Reduced vessel and perfusion density characterized PXG, whereas FAZ enlargement and reduced circularity distinguished NTG and PXG. Vascular–structural coupling was nasal-predominant in PXG and inferior-predominant in NTG. Combined multimodal models outperformed structural-only approaches. Macular perfusion additionally predicted MD in PXG. The XGBoost/SHAP analysis is exploratory; prospective and externally validated studies are required before clinical deployment. Full article

Background and Objectives: Micropulse transscleral cyclophotocoagulation (MP-TSCPC) selectively targets the ciliary body epithelium to reduce intraocular pressure (IOP). This study evaluated 6-month efficacy and safety of MP-TSCPC in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEX) refractory to maximally tolerated topical therapy, and formally tested clinical equivalence between subtypes. Materials and Methods: In this single-arm prospective interventional cohort study with planned subgroup comparison, 58 eyes from 41 patients (POAG, 34; PEX, 24) underwent MP-TSCPC using the Cyclo G6 system with MicroPulse P3 probe at 2.0–2.2 W, 31.3% duty cycle, 90 s per hemisphere. IOP, best-corrected visual acuity (BCVA), antiglaucoma medications, and complications were recorded at baseline and at 30, 90, and 180 days. Six prespecified success criteria were evaluated, including the original ≥20% reduction threshold and the stricter Tekeli composite criteria. Outcomes are reported with 95% confidence intervals (CI) and Cohen’s d. Intra-subject correlation from bilateral inclusion was addressed through a linear mixed-effects model, generalized estimating equations, and a 1000-iteration sensitivity analysis with random one-eye-per-patient subsampling. Equivalence was assessed by two one-sided tests (TOST). Results: Baseline IOP was 26.50 ± 2.93 mmHg (POAG) and 25.92 ± 2.47 mmHg (PEX). At 180 days, mean IOP reduction was 32.1% (95% CI 30.1–34.1) in POAG and 28.8% (95% CI 26.9–30.7) in PEX, both p < 0.001 versus baseline, with very large within-group effect sizes (Cohen’s d 4.24 and 4.81). All eyes achieved ≥20% reduction; under Tekeli criterion A (IOP ≤ 18 mmHg AND ≥20% reduction), success was 67.6% (POAG) and 54.2% (PEX). A 3.2 percentage-point between-group difference at 180 days was statistically detectable unadjusted (p = 0.024) but lost significance after clustering adjustment (mixed-model p = 0.101); equivalence was formally established at the ±7 percentage-point margin (TOST p = 0.004). Medication burden decreased in 41.2% (POAG) and 50.0% (PEX) of eyes. BCVA was preserved in all eyes; no serious adverse events were recorded. Conclusions: MP-TSCPC produces clinically meaningful, progressive IOP reduction over 6 months in both POAG and PEX, with no serious complications and clinically equivalent efficacy between subtypes. Longer-term studies with formal recording of baseline severity descriptors are warranted to confirm durability. Trial registration: ISRCTN registry, ISRCTN62227730. Full article

Background and Objectives: We aimed to describe early real-world visual, refractive, and safety outcomes following implantation of a novel hybrid full range of vision intraocular lens (IOL) in patients undergoing cataract surgery. Materials and Methods: This prospective, single-center, non-randomized clinical study included 50 patients (100 eyes) undergoing bilateral sequential cataract surgery with implantation of the Max Vision™ IOL. Uncorrected and corrected distance visual acuity (UDVA, CDVA) and uncorrected near visual acuity (UNVA) at 32 cm and 40 cm were assessed using logarithmic charts. Spherical equivalent (SE) refraction, intraocular pressure (IOP), and safety outcomes were recorded preoperatively and at postoperative day 1, week 1, and month 1. Preoperative and postoperative values were compared statistically. Results: The mean age was 66.1 ± 7.9 years. At 1 month, mean UDVA improved from 0.58 ± 0.24 to 0.01 ± 0.03 logMAR, and mean CDVA from 0.18 ± 0.20 to −0.001 ± 0.01 logMAR (both p < 0.001). Mean UNVA improved from 0.64 ± 0.18 to 0.19 ± 0.10 logMAR at 32 cm and from 0.61 ± 0.15 to 0.13 ± 0.11 logMAR at 40 cm (both p < 0.001). Mean SE changed from 1.16 ± 1.7 D preoperatively to 0.04 ± 0.4 D at 1 month (p < 0.001). Mean IOP showed a transient increase on postoperative day 1 followed by a reduction at 1 month, without the need for additional hypotensive therapy. No eyes lost two or more lines of CDVA. One posterior capsular rupture occurred without postoperative sequelae. Conclusions: At 1 month after cataract surgery, implantation of the Max Vision™ IOL was associated with improved distance and near visual acuity, early refractive accuracy, and no major short-term safety concerns, under routine clinical conditions. Full article