Search Results (492)

Objective: Rho-associated protein kinase (ROCK) inhibitors have recently emerged as promising agents for the treatment of corneal endothelial dysfunction. Because corneal transparency critically depends on endothelial cell function, endothelial failure can lead to persistent visual impairment. However, clinical evidence regarding the use of topical ROCK inhibition in various etiologies of endothelial decompensation remains limited. The aim of this study was to evaluate changes in central corneal thickness (CCT), best-corrected visual acuity (BCVA), and treatment-related adverse events in eyes with corneal edema of different etiologies treated with fixed-combination drops of netarsudil 0.02%/latanoprost 0.005%, Roclanda^®. Methods: In this prospective, uncontrolled, exploratory case series, we investigated the effects of topical ROCK inhibition on corneal endothelial cell function in 13 eyes of 11 patients with persistent, nonhealing corneal edema following intraocular procedures. Patients were treated with topical Roclanda^® once daily for three months. Clinical evaluation included BCVA, CCT, and safety assessment. Changes in CCT and BCVA were assessed before therapy, and after 1 and 3 months of treatment. Results: Mean baseline CCT was 782.8 µm and decreased significantly by 71.0 µm at 1 month and by 120.2 µm at 3 months (p = 0.0074 and 0.0012, respectively). Complete resolution of corneal edema was achieved in 38% of eyes. Mean BCVA improved from 0.744 before treatment to 0.518 logMAR at 3 months (p = 0.0026), with 46.2% of eyes gaining two or more Snellen lines. The analysis including only one eye per patient showed similar results, with statistically significant reductions in CCT at both 1 and 3 months and a significant improvement in BCVA at 3 months after the exclusion of the second eye in bilaterally included patients. Treatment was well tolerated; with mild conjunctival hyperemia as the most common adverse effect, while reticular epithelial corneal edema occurred in one eye and resolved after the completion of the treatment. Conclusions: In this prospective, exploratory case series of patients with nonhealing corneal edema, 3 months of a fixed-dose netarsudil 0.02%/latanoprost 0.005% treatment resulted in significant reduction in CCT, as well as clinically important improvement in BCVA. These exploratory findings cannot explain the mechanism of action, but suggest a potential therapeutic role for ROCK inhibitors in eyes with nonhealing corneal edema and possibly residual endothelial reserve. Larger controlled studies are needed to confirm these observations and further define indications for treatment. Full article

Background/Objectives: Locomotive syndrome (LS) is associated with impaired balance and functional decline in older adults. Although locomotive training (LT) improves mobility, whether central neuromodulation enhances short-term balance adaptation remains unclear. This pilot randomized controlled trial examined the additive effect of anodal transcranial direct current stimulation (tDCS) with LT on balance. Methods: Sixteen community-dwelling adults aged ≥ 65 years with LS were randomized (1:1:1) to anodal tDCS + LT (n = 6), sham tDCS + LT (LT group, n = 6), or anodal tDCS alone (n = 4). Participants underwent five consecutive days of intervention. The primary outcome was eyes-open single-leg stance time, assessed before stimulation and at 10, 20, 50, and 80 min during and after stimulation on days 1–5. Group × time interactions were evaluated using linear mixed-effects models adjusted for baseline and age. Long-term outcomes were assessed on days 1, 5, and 12. Results: In the primary analysis, a significant group × time interaction for right-sided single-leg stance time was observed between the anodal tDCS + LT and the LT groups (F(1,58) = 6.08, p = 0.017; β = 0.966), indicating greater within-day improvement with combined therapy, but not in sensitivity analyses treating time as a categorical variable. No significant interactions were observed on the left side. Secondary outcomes showed time-dependent improvements without consistent group-specific effects or significant group × day interactions over the long term. No serious adverse events occurred. Conclusions: Anodal tDCS with LT improved short-term balance in the primary analysis; however, these effects were model-sensitive and not sustained over 12 days. These findings should be considered preliminary and hypothesis-generating. Larger trials are needed to determine optimal stimulation dosing and long-term efficacy. Full article

Evaluating the safety of botanical extracts for cosmetics has become mandatory, but it is often challenging because of their phytochemical complexity and limited toxicological data. In this study, the safety of aqueous Sophora flavescens root extract (SFRE), widely used in cosmetics, was assessed using an integrated approach combining in vitro, in silico, margin of safety (MoS), threshold of toxicological concern (TTC), and history of safe use (HSU). Chemical characterization was performed by literature review and LC–MS/MS analysis. SFRE was classified as non-irritant in in vitro skin and eye irritation tests conducted according to OECD TG439 and 492. Whole-extract and constituent-level in silico analysis and literature evaluation were conducted to assess genotoxicity and skin sensitization potential. For systemic toxicity, a 13-week oral repeat dose no-observed-adverse-effect level (NOAEL) of 10 mg/kg bw/day for a decocted Sophorae radix extract was employed without compositional adjustment to calculate the acceptable systemic exposure dose of 0.10 mg/kg bw/day, which was slightly lower than the current usage of SFRE in cosmetics (up to 0.13 mg/kg/day). The TTC approach revealed that many bioactive constituents fell outside the applicability domain due to steroid moieties. HSU data from dietary supplements (32–64.67 mg/kg/day) could support the safety of the current use of SFRE in cosmetics. The findings highlight that a combined, case-by-case application of MoS, TTC, and HSU is essential for the robust safety assessment of complex botanical ingredients. Full article

Trans,trans-2,4-decadienal (tt-DDE), the primary aldehyde component found in cooking oil fumes, is a prevalent environmental pollutant. However, its potential adverse effects on ocular development remain largely unexplored. This study evaluated its toxicity on ocular development and angiogenesis in zebrafish larvae, as well as on human retinal vascular endothelial cells (HRECs). Zebrafish (Danio rerio) larvae at 48 h post-fertilization were microinjected intraocularly with various doses of tt-DDE (65.87–521.3 mM) for 24 h. We observed dose-dependent impairments in ocular development following tt-DDE exposure. It significantly reduced eye size and inhibited the intraocular vascular area at concentrations of 128.9 mM and above. Histopathological analysis revealed retinal structural disorganization, eye shrinkage, and a clear dose-dependent increase in acridine orange (AO) fluorescence intensity. Apoptosis assays confirmed a significant escalation in ocular cell death at higher exposure doses. Additionally, our results demonstrated that tt-DDE (5–100 μM) significantly reduced the viability of HRECs in vitro. These findings suggest that early-life exposure to tt-DDE impairs ocular development in zebrafish by inducing histopathological damage, inhibiting angiogenesis, and promoting apoptosis, and also exerts direct cytotoxicity to human retinal cells. This study underscores the potential risk of tt-DDE exposure as an environmental factor contributing to ocular developmental toxicity. Full article

Sturge–Weber Syndrome (SWS) is a rare neurovascular disorder caused by a somatic mosaic missense point mutation in GNAQ, resulting in a facial capillary malformation (port-wine birthmark) and abnormal blood vessels in the eye and brain. Symptoms include seizures, stroke-like episodes, and glaucoma. Acute seizures induced with low-dose kainate in a transgenic GNAQ R183Q mouse model of SWS assessed seizure susceptibility and the impact of seizures on cerebral vasculature. Mice expressing human GNAQ mutation experienced more severe seizures and greater seizure-induced mortality compared to littermate controls. Mutant mice had longer cortical microvessels, with larger diameters; the expression of tight junction proteins was reduced 2 days after seizures. Blood–brain barrier permeability was not different from controls after chronic gene expression, although vascular dilation persisted compared to controls. These data demonstrate increased seizure susceptibility in this somatic mosaic model of SWS, bidirectional interactions between seizure and vascular remodeling, and chronic persistence of vascular malformation. Full article

Background/Objectives: Rho-associated protein kinase inhibitors reduce intraocular pressure (IOP) by enhancing aqueous humor outflow through the trabecular meshwork–Schlemm’s canal pathway. However, it remains unclear whether the fixed-dose combination of ripasudil hydrochloride hydrate and brimonidine tartrate (GLAALPHA) enhances conventional aqueous outflow in vivo. Methods: This single-center randomized clinical trial included healthy adult volunteers who received GLAALPHA, a brimonidine tartrate–brinzolamide fixed-dose combination (Ailamide), or brimonidine tartrate monotherapy (Aiphagan) in a crossover sequence. The aqueous column width in the episcleral veins was assessed at baseline and at 2 h (primary outcome) and 8 h using hemoglobin video imaging. Results: Among 24 participants, analyses included 23 GLAALPHA-treated eyes, 21 Ailamide-treated eyes, and 22 Aiphagan-treated eyes. Two hours after instillation, the aqueous column width significantly increased from baseline only in the GLAALPHA group (p = 0.002). The percent increase in the aqueous column width at 2 h was significantly greater with GLAALPHA than with Ailamide (p = 0.039) and not significantly different between GLAALPHA and Aiphagan (p = 0.114). At 8 h, the aqueous column width did not differ from the baseline in any groups. Conclusions: In healthy adult eyes, GLAALPHA significantly increased the aqueous column width in the episcleral veins 2 h after instillation, indicating enhanced conventional aqueous outflow. These findings provide evidence that GLAALPHA promotes trabecular outflow beyond the effects of brimonidine tartrate-containing comparators and offer mechanistic insights into its action. Full article

Background/Objectives: Fungal keratitis remains a vision-threatening infection, and current amphotericin B (AmphB) eye drops suffer from low corneal residence time, poor aqueous solubility, and the need for frequent dosing. This study develops electrospun nanofiber-based ophthalmic inserts combining polyvinyl alcohol (PVA), gamma-cyclodextrin (γ-CD), and sodium taurocholate (STC) to enhance AmphB solubility and provide a non-invasive, rapidly dissolving ophthalmic dosage form. Methods: γ-CD and STC-enhanced AmphB-loaded PVA nanofiber-based ophthalmic inserts with varying γ-CD and STC concentrations were prepared by electrospinning and characterized by scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), and X-ray diffraction (XRD). Drug content, in vitro release (Weibull modeling), antifungal activity against Candida albicans, Fusarium solani, and Aspergillus fumigatus, ocular cytocompatibility using the Hen’s Egg Test on Chorioallantoic Membrane (HET-CAM), and accelerated stability (40 ± 2 °C, 75 ± 5% relative humidity, 4 weeks) were evaluated. Results: Bead-free nanofibers with mean diameters between 216 ± 33 nm and 310 ± 35 nm were obtained, and XRD confirmed complete amorphization of AmphB within the PVA nanofiber matrix, forming an amorphous solid dispersion. All formulations showed rapid and nearly complete AmphB release (≈100% within 60 min), with Weibull β values < 0.75, indicating Fickian diffusion-controlled release. AmphB-loaded PVA nanofiber-based ophthalmic inserts produced inhibition zones and broth susceptibility profiles comparable to AmphB in dimethyl sulfoxide (DMSO), demonstrating preserved antifungal activity. HET-CAM scores (0–0.9) classified the inserts as practically non-irritant, and SEM/FTIR after accelerated storage showed no relevant morphological or physicochemical changes. Conclusions: These γ-CD and STC-enhanced AmphB-loaded PVA nanofiber-based ophthalmic inserts provide a non-invasive, rapidly dissolving ophthalmic dosage form that combines amorphous AmphB, immediate drug availability, and good ocular tolerance, supporting their further development as a patient-friendly treatment option for fungal keratitis. Full article

This retrospective study evaluated real-world outcomes of standalone iDose TR intracameral travoprost implant administration. Sixty-five consecutive standalone iDose TR implantations performed by a single surgeon were analyzed. Patients were pseudophakic, had a diagnosis of open-angle glaucoma (OAG) or ocular hypertension (OHT), and had a history of a prior non-filtering glaucoma procedure (e.g., selective laser trabeculoplasty [SLT] or bimatoprost intracameral implant) performed beyond the preceding 6 months. Intraocular pressure (IOP) and medications were measured for 12 months postoperatively. Subgroup analysis was stratified by history of SLT treatment and glaucoma severity. If target IOP was not attained, secondary minimally invasive glaucoma surgery was performed instead of reinitiating or adding medication, according to the surgeon’s standard practice. The analysis was by intention to treat. At 12 months, mean IOP reduced significantly to 14.0 ± 2.9 mmHg from a baseline of 20.0 ± 4.0 mmHg (−28%, p < 0.001). Eyes with IOPs ≤ 18, ≤15, and ≤12 mmHg increased significantly vs. baseline (36.9% to 92.3%, 10.8% to 73.8%, and 3.1% to 35.4%, respectively; all p < 0.001), and 89.2% of the eyes were medication-free vs. 87.7% preoperatively. Mean 12-month IOP reduction showed nonsignificant differences between eyes with or without prior SLT (−26% and −31%, respectively; p = 0.907) and among mild/OHT, moderate, or severe glaucoma eyes (−28%, −23%, and −34%, respectively; p = 0.085). Postoperatively, one case each of transient corneal edema and retinal edema were observed, which self-resolved without sequelae. Thus, standalone travoprost implant administration significantly reduced IOP over 12 months in OAG and OHT, while maintaining a low medication burden. Similar IOP reductions were observed regardless of prior SLT treatment and glaucoma severity. Full article

Background/Objectives: While intravitreal administration allows for increased ocular exposure to anti-TNF-α monoclonal antibodies, there is still a need for developing delivery systems able to prolong ocular drug exposure and alleviate patient compliance and safety concerns because of repeated injections. Therefore, the objective of this work was to guide the design of sustained-release formulations of anti-TNF-α monoclonal antibodies for intravitreal administration through a model-based strategy in non-infectious uveitis in the preclinical setting. Methods: Using an in-house-developed anterior uveitis disease model in rats, an intravenous reference dose reducing free TNF-α by 90% at the biophase was established. Intravitreal administrations of sustained-release formulations every 24 weeks were then simulated for adalimumab, golimumab and infliximab to evaluate TNF-α kinetics in the anterior chamber of the eye at different release rates. The selected sustained-release formulation was further evaluated for possible formulation issues causing device emptying before the next administration. Results: Intravitreal administration of sustained-release formulations releasing adalimumab, golimumab or infliximab at 1.802, 0.979 and 1.442 μg/week, respectively, met the predefined criteria of ≥90% reduction in free TNF-α at the biophase. TNF-α levels in aqueous humour were anticipated to be the most sensitive to detect possible formulation issues. Formulation emptying 10, 4 or 8 weeks for adalimumab, golimumab and infliximab, respectively, before next administration triggered TNF-α reaching pathological levels at week 24 post-dose. Conclusions: This work underscores the potential of new approach methodologies in the preclinical drug development of sustained-release formulations for intravitreal administration in ocular inflammatory disorders with less animal testing and without compromising the accuracy of model-informed predictions for human translation. Full article

Ocular toxoplasmosis is a relapsing infectious eye disease that carries an increasing risk of vision loss with each reactivation episode. Antimicrobial drug prophylaxis has been used to reduce the rate of recurrence. This review aims to summarize the current literature regarding expert clinician preferences, as well as the effectiveness and safety of prophylaxis. A literature search was conducted using the PubMed platform of the National Library of Medicine of the National Center for Biotechnology Information and relevant pre-specified search terms. Four professional surveys indicated that approximately three-quarters of experts gave antimicrobial drug prophylaxis for recurrent ocular toxoplasmosis, and that trimethoprim-sulfamethoxazole was the most popular approach. Clinical studies of prophylaxis varied in multiple parameters, including drug, dosing and duration, plus time of follow-up. Considering the four studies with at least 50 participants, the rate of recurrence of ocular toxoplasmosis within 5 years was up to 9.1% of patients taking prophylaxis, and treatment-limiting side effects occurred in up to 7.9% of patients. The available literature demonstrates that antimicrobial drug prophylaxis can reduce the recurrence rate of ocular toxoplasmosis; however, further research on drug dosing and duration of treatment is required to assist decision-making in clinical practice. Full article

This pharmacovigilance study drew upon the U.S. Food and Drug Administration’s Adverse Event Reporting System (FAERS) database to compare the reporting patterns of ocular and systemic adverse events (AEs) for the 2 mg (standard-dose [SD]) and 8 mg (high-dose [HD]) formulations of aflibercept given for any ocular indication. Disproportionality analysis, including reporting odds ratios (ROR), was used to compare each dose individually to the background reporting rate for the AE. Statistical significance of the RORs was evaluated using Bonferroni correction, alongside signal detection based on Evans criteria, and Bayesian information components. The Breslow–Day test was used to conduct a head-to-head comparison of RORs between each dose. We identified 953 SD and 314 HD AE reports within the 750-day period after the approval of HD by the U.S. Food and Drug Administration (FDA; 8/18/2023). Compared to SD, HD had a higher ROR for endophthalmitis (HD: ROR 767.56 [95% CI, 466.11–1263.95]; SD: ROR 331.64 [95% CI, 216.71–507.51]), eye inflammation (HD: ROR 118.45 [95% CI, 55.85–251.20]; SD: 43.98 [95% CI, 21.87–88.44]), retinal vasculitis (HD: ROR 769.87 [95% CI, 337.13–1758.04]; SD: ROR 124.80 [95% CI, 39.67–392.63]), and systemic vasculitis (HD: ROR 28.40 [95% CI, 14.63–55.14]; SD: ROR 4.05 [1.52–10.82]). These results, based on FAERS, indicate associations rather than causal relationships. Further studies are needed to quantify the absolute risks and elucidate the mechanisms underlying differences in safety signals, if any. Full article

Background/Objectives: The neonatal Fc receptor (FcRn) plays a crucial role in extending the systemic half-life of monoclonal antibodies (mAbs), but its influence on ocular distribution remains incompletely understood. This study investigated the impact of FcRn on the ocular disposition of mAbs following systemic administration in rabbits. Methods: New Zealand White rabbits received a single intravenous dose (1 mg/kg) of either wild-type trastuzumab (TS-WT) or its FcRn non-binding variant (IHH). Plasma and ocular tissues (retina, iris–ciliary body, vitreous humor, aqueous humor, cornea, conjunctiva, and tears) were collected at terminal time points up to 336 h for TS-WT and 168 h for IHH. Antibody concentrations were quantified using a validated sandwich ELISA. Pharmacokinetic parameters and antibody biodistribution coefficients (ABC) were calculated to assess the FcRn-mediated effects on ocular distribution. Results: TS-WT demonstrated 2-fold higher systemic exposure compared to IHH. The iris–ciliary body exhibited the highest absolute exposure for both antibodies, with TS-WT showing significantly higher accumulation (ABC_0–168h: 14.95% vs. 8.89%). Retinal distribution remained comparable between antibodies (5.96% vs. 5.51%). Both antibodies were detectable in tears, with ABC value of ~4% reported for TS-WT. TS-WT also demonstrated markedly increased distribution in vitreous humor and tear fluid (3.5- and 5.5-fold higher ABC values, respectively) compared to IHH. The cornea (5.76% vs. 5.57%) and conjunctiva (7.71% vs. 7.21%) showed comparable relative distribution between TS-WT and IHH, while aqueous humor showed minimal differences (0.44% vs. 0.52%). Conclusions: This investigation reveals distinct tissue-specific patterns of FcRn-mediated mAb distribution within the eye. FcRn binding significantly enhanced antibody distribution in ocular tissues, such as the iris–ciliary body, and tears, with less pronounced effects on the retina, cornea, conjunctiva and aqueous humor. These findings provide mechanistic insights for optimizing mAb-based therapeutics for ocular disease and understanding the ocular toxicity of mAb-based therapeutics, such as antibody–drug conjugates. Full article

Aesthetic patients in East Asia are commonly concerned about small apparent eye size. Simultaneous treatment of the glabellar and lateral canthal areas with botulinum neurotoxin has potential to provide improvements. This case series evaluated changes in eye size following treatment of these two areas using standard on-label doses of onabotulinumtoxinA in patients from Japan or China. Outcomes were assessed based on standardised frontal photographs taken before and after treatment (at rest, maximum smile, and maximum frowning). Changes in eye size were examined using a 4-point Likert scale, as evaluated by three independent groups: six injectors; six non-injecting observers; and treated patients. Furthermore, improvements in overall facial impression were analysed using two established tools: ‘emotional attributes’ and ‘social attributes’. Twenty East Asian subjects were included (n = 17 women; mean age: 37.5 ± 6.4 years). The majority of evaluators in all three groups rated patients’ eye size as ‘significantly’ or ‘mildly’ improved post-treatment, whether assessed at rest, when smiling, or during frowning. Furthermore, almost all evaluators noted improvements in one or more emotional and social attributes. This approach has significant potential as a culturally adapted aesthetic technique for improving eye size in East Asian patients. Larger multicentre studies are warranted. Full article

Background/Objectives: The PHOTON trial established the efficacy of aflibercept 8 mg using fixed-interval dosing in treatment-naïve patients; however, real-world evidence regarding pro re nata (PRN) regimens in switch cases remains limited. This pilot study evaluated the short-term efficacy and safety of switching to aflibercept 8 mg with PRN dosing in eyes with DME. Methods: This retrospective study included 20 eyes from 12 patients with DME who switched to aflibercept 8 mg and were followed for 6 months. Patients received initial induction doses (1–3 injections based on predetermined anatomical and functional criteria) followed by PRN dosing based on clinical findings. Primary outcomes were changes in best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Treatment intervals and injection frequency were also analyzed. Results: Mean logMAR BCVA was maintained from baseline (0.242 ± 0.252) throughout the follow-up period: 0.164 ± 0.218 at 1 month, 0.138 ± 0.241 at 2 months, 0.145 ± 0.204 at 3 months, 0.143 ± 0.181 at 4 months, 0.149 ± 0.166 at 5 months, and 0.180 ± 0.224 at 6 months. No statistically significant changes in BCVA from baseline were observed at any time point. Mean CRT decreased from baseline (369.6 ± 138.3 μm) at all follow-up time points: 251.5 ± 82.1 μm at 1 month, 269.1 ± 104.5 μm at 2 months, 255.8 ± 67.8 μm at 3 months, 275.2 ± 76.6 μm at 4 months, 301.4 ± 81.2 μm at 5 months, and 302.7 ± 86.8 μm at 6 months. Statistically significant reductions in CRT were observed at 1 through 4 months (1 month: p = 0.000010; 2 months: p = 0.000243; 3 months: p = 0.000035; 4 months: p = 0.000597), whereas the reductions at 5 months (p = 0.0317) and 6 months (p = 0.0424) were not statistically significant. The mean number of injections over 6 months was 1.45 ± 1.05 (median 1; range 1–4), with 70% of eyes achieving treatment intervals ≥ 4 months. Five eyes (25%) required only the switching dose with no additional treatment during follow-up. No intraocular inflammation or retinal vasculitis was observed. Conclusions: Switching to aflibercept 8 mg with PRN dosing provided sustained anatomical improvement and maintained visual acuity in DME, with one quarter of the cases maintaining these outcomes with only a single additional injection. These real-world findings from a pilot study suggest that the PRN approach appears feasible and effective in real-world practice, offering a practical treatment option that may help reduce treatment burden while maintaining disease control. Full article

Background: Pachychoroid pigment epitheliopathy (PPE) is a non-exudative entity within the pachychoroid disease spectrum characterized by increased choroidal thickness and isolated serous pigment epithelial detachment (PED) without subretinal fluid. Although photodynamic therapy (PDT) is established for chronic central serous chorioretinopathy (CSC), its efficacy in isolated pachychoroid-related PED remains insufficiently defined, with available evidence limited to small case series. Purpose: This study aims to characterize symptomatic pachychoroid-related PED and evaluate anatomical and functional outcomes following half-dose PDT (hd-PDT), with additional analysis according to lesion localization and CSC history. Methods: This retrospective study included 34 eyes of 27 patients treated with hd-PDT between June 2022 and December 2024. PEDs were categorized as central (fovea-involving) or paramacular. Best-corrected visual acuity (BCVA) and spectral-domain optical coherence tomography parameters—central subfield thickness (CST), mean subfield thickness (MST), macular volume (MV), subfoveal choroidal thickness (SFCT), and PED height—were assessed at baseline, 1 month, and 6 months. Treatment planning was based on indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT) findings. Statistical analyses employed non-parametric tests and generalized estimating equations. Results: Central lesions were associated with longer disease duration, worse baseline BCVA, and greater retinal thickness and PED height (p < 0.05). Complete PED resorption occurred in 79.4% of eyes at 1 month and 73.5% at 6 months (central: 86.3% and 81.8%; paramacular: 66.6% and 58.3%). Mean BCVA improved significantly from 0.22 ± 0.24 to 0.10 ± 0.16 logMAR at 6 months (p < 0.0001), with greater functional gain in central lesions. Significant reductions were observed in CST, MST, MV, and PED height, whereas SFCT remained stable. Better final BCVA correlated with younger age, shorter disease duration, smaller baseline retinal volume, smaller PDT spot size, and absence of CSC history. Non-responders had worse baseline BCVA, higher PED height, and larger treatment areas. No treatment-related complications were detected. Conclusions: Half-dose PDT was associated with favorable anatomical and functional outcomes in symptomatic pachychoroid-related PED, particularly in centrally located lesions. Baseline disease severity appeared to influence treatment response. Prospective studies with longer follow-up are warranted to confirm long-term efficacy and safety. Full article