Search Results (220)

Purpose: To assess whether reducing intraoperative light exposure preserves macular function after cataract surgery in patients with AMD. Methods: A total of 42 eyes of 42 patients with AMD were randomized in a prospective study. The primary outcome was the change in photopic (ERG) b-wave amplitude at one hour after surgery (V2). Secondary outcomes included ERG implicit time, multifocal ERG, visual acuity, and macular thickness, assessed at V2, V3 (day 1), and V4 (1 month). Results: Mean intraoperative light exposure was significantly lower in the 3D group than in the standard group (3938 vs 47,142 lux, p < 0.001). At 1 h after surgery, the decrease in photopic b-wave amplitude did not differ significantly between the two groups (−1.83 µV; 3D group, vs. −1.56 µV; standard group, p = 0.76). In exploratory analyses, ERG implicit time increased significantly in the standard group (p = 0.02) but remained stable in the 3D group (p = 0.24). At 1 month, an increase in macular thickness was observed only in the standard group (V1 265.9 ± 27.7 µm, V4 278.8 ± 34.9 µm; p = 0.003). Conclusions: Digital visualization significantly reduced intraoperative light exposure. However, no significant difference was observed for the primary endpoint of photopic ERG b-wave amplitude at 1 h postoperatively. Secondary findings regarding ERG implicit time and macular thickness should be considered exploratory and require confirmation in larger studies. Full article

Background/Objectives: A macular hole represents a significant surgical condition in an increasingly aging population. Advances in surgical techniques, particularly pars plana vitrectomy with inverted internal limiting membrane (ILM) flap, have established high anatomical closure rates exceeding 90%. The prognostic factors influencing visual recovery remain incompletely understood, and it is unclear which patients can be expected to achieve optimal functional outcomes. Methods: This retrospective longitudinal study included 35 eyes of 32 patients followed for 3–12 months. Preoperative OCT parameters (minimum linear diameter, basal diameter, and hole height) and derived indices were correlated with functional outcomes, including best-corrected visual acuity (BCVA) and microperimetry, stratified as central macular sensitivity (CMS) and sensitivity at 4° and 20°. Postoperative ellipsoid zone (EZ) and external limiting membrane (ELM) integrity were also analyzed. Predictive performance was assessed using root mean square error (RMSE) and coefficient of determination (R²). A linear regression model based on BCVA served as baseline, while Extreme Gradient Boosting (XGBoost) models incorporating OCT features were developed. Feature importance was evaluated using Shapley Additive Explanations (SHAP). Results: Overall closure rate was 100%, including 91.4% Type 1 and 8.6% Type 2 closure. Models incorporating OCT parameters outperformed BCVA-based models (lower RMSE, and higher R²). Minimum linear diameter and hole height were the strongest predictors of postoperative outcomes. Microperimetry detected functional improvement beyond BCVA and correlated with EZ and ELM restoration. Conclusions: Preoperative macular hole morphology represents a key determinant of postoperative functional recovery. These structural parameters provide meaningful prognostic value beyond visual acuity alone, supporting the role of combined OCT and microperimetric assessment in predicting surgical outcomes. Full article

Objectives: We aimed to descriptively evaluate the feasibility and clinical utility of TowardPi BO (4K ultra-HD microscope integrated with a 400 kHz swept-source intraoperative optical coherence tomography (SS-iOCT) system) in managing various ophthalmic surgical conditions in a real-world setting. Methods: We analyzed surgical videos and data from 123 consecutive cases that underwent elective surgery with the assistance of this SS-iOCT system at Beijing Tongren Hospital between 2 September 2025 and 10 February 2026. Cases were included when the iOCT provided critical, real-time information that directly influenced surgical decision-making or technique modification. Cases were excluded if iOCT served only routine confirmatory or educational purposes without altering the surgical plan. Results: A total of 72 surgical cases were included, comprising 7 intraocular lens implantations with ciliary sulcus fixation, 19 macular holes, 3 cases of macular hole retinal detachment (MHRD), 4 cases of macular schisis with or without foveal detachment (MSRD), 12 cases of submacular hemorrhage, 20 cases of rhegmatogenous retinal detachment (RRD), and 7 intraocular mass lesions. The 400 kHz SS-iOCT significantly aided in surgical visualization, guided real-time decision-making, and prompted modifications in surgical techniques. Conclusions: To our knowledge, this is the first real-world study to evaluate the application of a 400 kHz SS-iOCT system across a wide spectrum of ophthalmic conditions, including its novel use in intraocular tumors. From routine to complex surgical cases, SS-iOCT enhances surgical precision and facilitates real-time decision-making, ultimately contributing to improved surgical outcomes. Full article

Background/Objectives: Optical coherence tomography (OCT) and OCT angiography (OCT-A) provide detailed measurements of retinal structure and vasculature; however, age-related differences in how these parameters correlate with one another remain poorly understood. We hypothesized that vascular–structural integration in the macula is more pronounced in adults than in children. Our aim was to characterize correlation patterns in pediatric and adult populations to inform the development of age-specific clinical interpretation guidelines. Methods: This prospective cross-sectional observational study enrolled 37 healthy children (age 1–17 years) and 28 healthy adults (age 18–65 years). Eyes with ocular or systemic conditions affecting the retina or prior intraocular surgery were excluded. Standardized OCT and OCT-A acquisition protocols provided structural and vascular measures. Univariable correlation analyses applied a stringent threshold (p < 0.001) to identify robust associations. Significant univariable results were entered into multivariable regression models adjusting for age, gender, intraocular pressure, and axial length. A Group-wise Linkage Proportion quantified the percentage of potential significant correlations among eight predefined anatomical parameter groups. Results: Ninety univariable correlations met p < 0.001. Fourteen correlations were shared across age groups, notably foveal avascular zone metrics and vessel density, showing very large negative correlations (r = −0.70 to −0.87). The pediatric cohort displayed 40 unique correlations, primarily linking optic nerve head flow indices to retinal nerve fiber layer thickness. Adults exhibited 36 unique correlations, dominated by macular vascular–thickness coupling concentrated in the parafoveal region. After multivariable adjustment, 52 of 90 associations remained significant. Adult-specific associations lost significance more frequently (58%) than pediatric-specific associations (43%), whereas correlations shared across both groups showed complete stability (100%). The Group-wise Linkage Proportion indicated pronounced macular vascular–structural coupling in adults (48.4%) versus near absence in children (1.2%). Conclusions: Retinal parameter correlation patterns show fundamental differences between pediatric and adult eyes. While optic nerve head-macular thickness relationships remain consistent across ages, adults exhibit mature, localized integration of macular vascular and structural parameters absent in children. These findings suggest that pediatric and adult OCT/OCT-A measurements may benefit from separate reference standards, although prospective validation is required before clinical implementation. Full article

Background/Objectives: The objective of this study was to evaluate macular perfusion changes after intracameral injection (ICI) of cefuroxime at the end of phacoemulsification. Methods: Patients who underwent routine phacoemulsification were enrolled. Subjects in the case group had ICI 1 mg/0.1 mL cefuroxime at the end of surgery. Using optical coherence tomography angiography (OCT-A), macular perfusions were assessed at T0 (before surgery), T1, T10, T30, and T90 (days after surgery). Perfusion parameters were calculated in the superficial capillary plexus (SCP) and the deep capillary plexus (DCP). Independent t-tests were used to compare the changes from baseline in each parameter between groups. Results: A total of 33 eyes in the case group and 27 eyes in the control group were enrolled. After surgery, the case group showed a less pronounced reduction in the foveal avascular zone (FAZ) in the DCP at T10 (−0.06 ± 0.23 vs. −0.18 ± 0.18 mm², p = 0.041) and T30 (−0.04 ± 0.20 vs. −0.16 ± 0.24 mm², p = 0.050). At T90, there was no statistically significant difference in the FAZ change in the DCP between the groups. The postoperative changes in the vessel density, skeleton density, and acircularity index of the FAZ in the SCP and DCP, central retinal thickness, and best-corrected visual acuity were similar between the groups in all 3 months. Conclusions: Our findings indicate that intraoperative ICI low-dose cefuroxime is associated with a temporary deceleration in FAZ reduction in the DCP during the first postoperative month. From a personalized medicine perspective, these layer-specific microanatomic variations suggest that, while prophylactic cefuroxime is globally safe—demonstrating no evidence of inducing capillary dropout, aggravating macular thickening, or compromising visual outcomes within this cohort—preoperative and postoperative OCT-A monitoring can serve as an individualized screening framework to track subclinical perfusion dynamics, especially in patients with compromised retinal baselines. Full article

Background/Objectives: Posterior vitreous detachment (PVD), which is closely related to epiretinal membrane (ERM) formation, can affect macular microstructure and function through persistent tractional forces. The aim of this study was to evaluate whether PVD status influences preoperative characteristics and long-term functional and morphological retinal outcomes after ERM surgery. Methods: Ninety patients who underwent idiopathic ERM removal were included and divided into two groups on the basis of intraoperative vitreous status: incomplete or complete PVD. Visual function, retinal imaging, microperimetry, and multifocal electroretinography (mfERG) data were assessed preoperatively and at 1, 4, and 12 months postoperatively. Results: At baseline, compared with the incomplete PVD group, the complete PVD group demonstrated greater fixation stability and lower variability, along with smaller foveal avascular zone (FAZ) areas in both superficial and deep vascular complexes. In terms of absolute postoperative values, the complete PVD group exhibited superior functional outcomes, including higher macular sensitivity and improved fixation variability parameters at 12 months. Morphologically, the incomplete PVD group showed consistently larger FAZ areas in both superficial and deep vascular complexes. In terms of changes from baseline, best-corrected visual acuity (BCVA) gain was greater in the complete PVD group at 1 and 4 months, with no difference at 12 months, whereas no significant between-group differences were observed for other functional or morphological parameters at any time point. Conclusions: Complete PVD is associated with faster visual recovery. Incomplete PVD may induce alterations at the retinal microcirculation level that persist postoperatively and influence microperimetric scores. Full article

Background/Objectives: This study analyzed intraoperative parameters, structural safety, and morphofunctional outcomes of vitreoretinal procedures performed using a conventional operating microscope versus a three-dimensional (3D) heads-up digital visualization system. Methods: A retrospective single-surgeon case series included 248 eyes undergoing pars plana vitrectomy for epiretinal membrane (ERM), macular hole (MH), or rhegmatogenous retinal detachment (RRD). Patients were divided into conventional microscope (n = 122) and 3D heads-up (n = 126) groups. Primary outcomes included surgical duration, endoillumination intensity, best-corrected visual acuity (BCVA), anatomical success, and complications over a 6-month follow-up. Results: The 3D cohort showed a significantly shorter global median surgical duration (50.0 vs. 60.0 min, p = 0.001). Multivariate regression confirmed the 3D system as an independent predictor of shorter operative time globally (p = 0.011). After adjusting for baseline disease severity imbalances in the ERM subgroup, the 3D system maintained an independent reduction in surgical duration of 5.5 min (p = 0.044). The 3D system also required significantly lower endoillumination across all procedures (p ≤ 0.002). Anatomical success rates were high and comparable across indications. Both groups achieved similar and significant visual improvement at 6 months (p = 0.120). Structural safety biomarkers (SANFL, DONFL) and complication rates remained comparable. Conclusions: The 3D heads-up visualization system demonstrated comparable functional and anatomical outcomes to conventional microscopy across standard vitreoretinal procedures. It allows for surgery under significantly lower light conditions and demonstrates the potential to optimize operative time, particularly in ERM peeling. Furthermore, it maintains an equivalent structural safety profile to conventional surgery. Full article

Background: Multiple evanescent white dot syndrome (MEWDS) is usually acute and self-limited, whereas multifocal choroiditis (MFC)/punctate inner choroidopathy (PIC) is relapsing; overlap can obscure early diagnosis and requires longitudinal multimodal imaging. Methods: We report a 4-year follow-up of a 31-year-old woman with fundus autofluorescence (FAF), fluorescein angiography (FA), indocyanine green angiography (ICGA), and spectral-domain optical coherence tomography (SD-OCT), plus a systemic/neurologic/rheumatologic work-up. Treatment included intravenous methylprednisolone for presumed optic neuritis, followed by topical, periocular, intravitreal, and systemic corticosteroids, later escalated to adalimumab and an intravitreal dexamethasone implant. Because foveal granularity could not be documented, baseline was termed “MEWDS-like”. Diagnostic labelling was benchmarked against Standardization of Uveitis Nomenclature (SUN) criteria, and choroidal neovascularization (CNV) was assessed at each relapse by OCT and FA. Results: The right eye initially showed a MEWDS-like pattern with wreath-like FA lesions and disc leakage, hyperautofluorescent FAF lesions, focal ellipsoid zone disruption on SD-OCT, and multifocal ICGA hypofluorescent spots. A relapse at 6 months with peripapillary inflammatory foci and recurrent cystoid macular edema supported reclassification to a unilateral MFC/PIC-spectrum phenotype. At 2 years, the fellow eye developed mild vitritis, peripapillary hyperautofluorescence, peripapillary/arcade leakage on FA, delayed peripapillary filling on ICGA, and cystoid macular edema, establishing sequential bilateral MFC; no CNV developed and anti-vascular endothelial growth factor (anti-VEGF) therapy was not required. Complications included steroid-induced ocular hypertension and cataract surgery. Conclusions: The purpose of this report is to highlight longitudinal imaging “red flags” that supported reclassification from a MEWDS-like phenotype to a sequential bilateral MFC/PIC-spectrum disease. Full article

Background: UBE has gained popularity as a minimally invasive alternative to open spinal procedures. However, it raises concerns about potential ocular complications. Despite these concerns, there is a lack of studies evaluating UBE’s impact on retinal microvasculature using objective imaging tools such as OCTA. This study aims to evaluate the effects of UBE on the microvascular structures of the retina and optic nerve using OCTA, and to determine whether UBE poses a risk for perioperative vision loss. Methods: This study included 32 patients who underwent UBE for lumbar stenosis and received ophthalmologic examinations preoperatively, and at postoperative weeks 1 and 4. Patients with systemic or ocular vascular comorbidities were excluded. OCTA parameters including vascular density (VD), foveal avascular zone (FAZ), retinal nerve fiber layer (RNFL), central macular thickness (CMT), and subfoveal choroidal thickness (SFCT) were evaluated using swept-source OCT. Results: No patients experienced clinical vision loss. A statistically significant change was observed over time in FAZ (p = 0.043), VDd superior (p = 0.018), VDd temporal (p = 0.032), and RNFLts (p = 0.032). However, only VDd superior showed a statistically significant decrease at postoperative week 4 compared to baseline (p = 0.050). All other parameters either returned to baseline or showed no significant change. No clinically relevant visual changes were detected. Conclusions: In this study, UBE spinal surgery was not associated with clinically evident visual loss or sustained OCTA-detected microvascular alterations during short-term follow-up. These findings should be interpreted as reflecting the absence of detectable short-term changes rather than definitive evidence of ocular safety. Full article

Background/Objectives: Steroid-induced glaucoma (SIG) or ocular hypertension is a well-known complication after corticosteroid exposure to the eye, particularly intravitreal dexamethasone implantation. The main mechanism of elevated intraocular pressure (IOP) is trabecular meshwork dysfunction, leading to increased aqueous outflow resistance. Although most SIG cases respond to medical treatment, some patients develop persistent IOP elevation, requiring surgical intervention. Minimally invasive glaucoma surgery (MIGS) has recently emerged as a safer surgical option, but there are a limited number of reports using MIGS for SIG. Methods: A 73-year-old man, who had branch retinal vein occlusion with refractory macular edema despite multiple anti-VEGF injections, received an intravitreal Ozurdex^® (Allergan, Irvine, CA, USA) implant. He developed marked IOP elevation from 17 to 34 mmHg despite maximal topical therapy. Visual field progression and progressive retinal nerve fiber layer thinning were also observed. Given the need for continued ocular steroid use and only having one arm due to trauma making drops difficult, three trabecular micro-bypass stent devices (iStent infinite^®, Glaukos Corp., Aliso Viejo, CA, USA) were implanted for IOP control. Postoperatively, IOP decreased to 13 mmHg and remained stable at 15 mmHg for 12 months. Additionally, macular edema was well-controlled with ongoing Ozurdex treatment and no observed IOP spikes. Conclusions: This is the first reported case of SIG-associated Ozurdex successfully managed with triple trabecular micro-bypass stents. The iStent infinite implantation provided safe and sustained IOP control for SIG, highlighting its potential role in patients requiring continuous intravitreal steroids. Full article

Pathologic myopia has become a major global cause of blindness, making timely surgical management for myopic traction maculopathy (MTM) increasingly important. This study aimed to identify prognostic factors associated with functional and anatomical outcomes following surgery for MTM and to determine the optimal timing for intervention. This retrospective study included 33 eyes from 28 patients with MTM without full-thickness macular hole who underwent pars plana vitrectomy with internal limiting membrane peeling and gas tamponade. Better preoperative best-corrected visual acuity (BCVA) and lower foveal height were associated with better postoperative BCVA, whereas longer axial length, higher MTM, and higher Atrophy–Traction–Neovascularization (ATN) classification grade were correlated with thinner postoperative central foveal thickness. Foveal detachment (FD), ellipsoid zone (EZ) disruption, and advanced MTM grade were associated with poorer functional and anatomical outcomes. Postoperative visual outcomes should be interpreted with caution, as they may have been influenced by lens-related factors, including combined cataract surgery, post-vitrectomy cataract progression, and posterior capsule opacity. Nonetheless, consistent anatomical improvement was observed, supporting early surgical consideration in eyes with MTM showing progressive macular traction or EZ disruption, even in the absence of FD. These findings highlight the importance of serial OCT monitoring and individualized surgical timing based on preoperative assessments. Full article

Background: The implantable miniature telescope is used to provide functional vision for patients with advanced AMD. However, despite the considerable cost of the device, there are strict criteria to be met for this procedure, since the patients require challenging neuroadaptation afterward, which sometimes fails and leads to the necessity of device explantation. Visual outcomes also depend on the stability of the microtelescope; tilts cause unwanted optical aberrations and can lead to device luxation, with sight-threatening complications. Case report: This case presents a novel technique for fixing the ophthalmic telescope device SING-IMT™. A 76-year-old female with pre-operative visual acuity of 15 letters on the ETDRS scale underwent surgery on her left eye. The superior haptic was fixed at the 12 o’clock position with a Prolene 5-0 suture, achieving good postoperative stability. The implant was stable throughout the entire observation period. Conclusions: Implant stability is crucial for maximizing visual potential in patients with advanced AMD selected for the procedure, since visual acuity in the peripheral retina, where the perceived image eventually lands, is much lower than the macula. Therefore, there is a need to standardize surgical approaches and use objective follow-up measures to assess long-term patient satisfaction. Full article

Background and Objectives: To evaluate the occurrence of retinal displacement using blue-fundus autofluorescence (BFAF) imaging in eyes treated for primary rhegmatogenous retinal detachment (RRD) and its associations with clinical factors, including macular status, detachment extent, baseline visual acuity, high myopia, postoperative visual recovery, and metamorphopsia. Materials and Methods: This retrospective observational study included 98 patients who underwent surgery for primary RRD at a single center. Surgical approaches included pars plana vitrectomy (PPV), phacovitrectomy, or scleral buckling, with tamponade agents such as SF₆ gas (20%), silicone oil (≈1300 cSt), or air. Postoperative BFAF imaging assessed retinal displacement. Demographic and clinical data were recorded. Results: Macula-off detachments occurred in 56.1% of cases, while 43.9% were macula-on detachments. Phacovitrectomy was performed in 41.8%, simple vitrectomy in 33.7%, and scleral buckling in 24.5%. SF₆ gas was the most used tamponade, while silicone oil was used in 13.3%. Retinal displacement was detected in 16.3% of cases, predominantly downward (81.25%) and less commonly upward (18.75%). Macula-off detachments were significantly associated with displacement (81.2% vs. 51.2%, p = 0.027). No significant associations were found with other parameters. Metamorphopsia was reported in 12.5% of patients with displacement and 4.9% without, though the difference was not statistically significant. Conclusions: Retinal displacement can occur after primary RRD repair, irrespective of tamponade, though it tended to be less frequent with silicone oil and in macula-on detachments. It is significantly more common in macula-off cases, even with immediate postoperative prone positioning. These findings emphasize the need to refine postoperative positioning protocols to reduce displacement and its sequelae. Further studies should explore the impact of retinal displacement on visual function, particularly metamorphopsia, in patients with preserved best-corrected visual acuity. Full article

Phacoemulsification is performed within a highly dynamic intraocular environment, in which fluid exchange, pressure regulation, and tissue biomechanics interact continuously. Although modern cataract surgery is considered safe and efficient, disruption of this delicate intraoperative microenvironment remains a major source of complications. Among fluidics-related events, post-occlusion break surge represents one of the most critical destabilizing factors of the anterior chamber. A surge occurs when the sudden release of an occluded aspiration port generates an abrupt pressure–volume imbalance that cannot be immediately compensated by infusion, leading to a transient collapse of the intraocular environment. This narrative review integrates current experimental and clinical evidence on the pathophysiology, quantification, and technological control of surge, framing it as a model of environmentally driven intraoperative stress. The evolution of phacoemulsification fluidics, from gravity-based systems to active, adaptive, and predictive platforms, is analyzed in relation to their ability to preserve a stable and physiologic intraocular environment. Comparative data from contemporary devices are reviewed, highlighting differences in surge volume, recovery time, and pressure restitution. Special emphasis is placed on the impact of surge on the microenvironments of both the anterior and posterior segments, including endothelial stress, capsular instability, vitreoretinal traction, and macular perfusion. Emerging strategies such as handpiece-integrated pressure sensors, predictive fluidics algorithms, intraoperative imaging, and artificial intelligence are reshaping environmental control during surgery. Despite substantial technological progress, the complete elimination of surge remains an unmet need. Continued innovation, standardized biomechanical models, and robust clinical validation will be essential to further protect the intraoperative intraocular environment and improve long-term visual outcomes. Full article

Ocular disorders such as keratitis, glaucoma, age-related macular degeneration (AMD), diabetic retinopathy (DR), and dry eye disease (DED) are highly prevalent worldwide and remain major causes of visual impairment and blindness. Conventional therapeutic approaches for ocular diseases, such as eye drops, surgery, and laser therapy, are frequently hampered by limited drug bioavailability, rapid clearance, and treatment-related complications, primarily due to the eye’s unique anatomical and physiological barriers. Hydrogels, characterized by their three-dimensional network structure, high water content, excellent biocompatibility, and tunable physicochemical properties, have emerged as promising platforms for ophthalmic drug delivery. This review summarizes the classification, fabrication strategies, and essential properties of hydrogels, and highlights recent advances in their application to ocular diseases, including keratitis management, corneal wound repair, intraocular pressure regulation and neuroprotection in glaucoma, sustained drug delivery for AMD and DR, vitreous substitutes for retinal detachment, and therapies for DED. In particular, we highlight recent advances in stimuli-responsive hydrogels that enable spatiotemporally controlled drug release in response to ocular cues such as temperature, pH, redox state, and enzyme activity, thereby enhancing therapeutic precision and efficacy. Furthermore, this review critically evaluates translational aspects, including long-term ocular safety, clinical feasibility, manufacturing scalability, and regulatory challenges, which are often underrepresented in existing reviews. By integrating material science, ocular pathology, and translational considerations, this review aims to provide a comprehensive framework for the rational design of next-generation hydrogel systems and to facilitate their clinical translation in ophthalmic therapy. Full article