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Coronavirus disease 2019 (COVID-19) is a form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that has been declared a pandemic by the World Health Organization (WHO). Ocular manifestations related to COVID-19 are uncommon with conjunctivitis being reported in a few cases. We report a unique case of vasculitic retinal vein occlusion (RVO) secondary to COVID-19 in a 52-year-old patient who presented with the diminution of vision in the left eye 10 days after he tested positive for SARS-CoV-2. All investigations for vasculitis were negative. This case supports the mechanism of thrombo-inflammatory state secondary to the \"cytokine-storm\" as the pathogenesis for systemic manifestations of COVID-19.

Anti-vascular endothelial growth factor (anti-VEGF) therapy has transformed the management of macular neovascularization and other retinal vascular disorders; however, treatment burden, variable response, and cost continue to limit real-world outcomes. This Commentary presents an evidence synthesis from a curated collection of articles, focusing on three intersecting priorities: expanding access through biosimilars with comparable efficacy and safety profiles; optimizing treatment through individualized agent selection and faricimab switching paradigms; and leveraging quantitative multimodal imaging biomarkers, including advanced en-face optical coherence tomography fluid metrics, to refine disease monitoring and retreatment decisions. Emerging structural and angiographic biomarkers, including advanced en-face optical coherence tomography metrics, offer opportunities for earlier risk stratification and personalized care. In parallel, patient-centered considerations and pragmatic treatment algorithms remain essential to enhance adherence and durability of response. Together, these themes underscore a shift toward precision-guided, accessible, and evidence-based retinal care. Prospective validation and implementation research will be critical to translate these advances into sustainable clinical practice.

To evaluate visual and anatomical outcomes of pars plana vitrectomy (PPV) with subretinal tissue plasminogen activator (tPA) and gas or air tamponade for large submacular haemorrhage (SMH>4 disc diameters) of varied etiologies and assess postoperative anti-vascular endothelial growth factor (anti-VEGF) requirements in a multicenter real-world cohort. This retrospective, two-center study included 32 eyes undergoing PPV with subretinal tPA (25-50 µg/0.1-0.2 mL) and SF or air tamponade, followed for ≥6 months. The primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included central macular thickness (CMT), SMH dimensions, subretinal/intraretinal fluid (SRF/IRF) status, intraocular pressure (IOP), and anti-VEGF use. Mean patient age was 60.8 ± 19.1 years; etiologies included polypoidal choroidal vasculopathy (PCV; 53.1%), neovascular age-related macular degeneration (nAMD; 28.1%), trauma (12.5%), and retinal artery macroaneurysm (RAM; 6.3%). BCVA improved significantly from 1.13 ± 0.30 to 0.56 ± 0.26 logMAR ( <0.001), with 55.2% gaining ≥3 lines. CMT reduced from 501 ± 219 to 276 ± 70 µm ( <0.001), and SMH size decreased from 5 ± 2 to 0 disc diameters by 6 months. SRF resolved in 65.65% of eyes ( <0.001), while IRF remained stable ( =0.51). IOP normalized after a transient 1-month rise. Mean anti-VEGF use was 1.2 injections/eye (bevacizumab 88.2%, brolucizumab 11.8%). No major complications occurred; one transient vitreous hemorrhage and three cataract progressions were noted. PPV with subretinal tPA achieved rapid hemorrhage clearance, significant visual gain, and durable anatomical restoration with minimal complications and limited anti-VEGF need. It offers an effective, safe option for large SMH across etiologies, enabling timely foveal recovery and improved long-term functional outcomes.

Somnath Chakraborty, Retina Services, Retina Institute of Bengal, C/O Reddy Health Care 3rd Floor Uttarapan Market Complex, Hill Cart Road, Pradhan Nagar, Siliguri, West Bengal, 734003, India, Tel +91-9002508334, Email somnathboom@gmail.com

To evaluate the anatomical and functional outcomes and treatment burden of intravitreal brolucizumab in chronic central serous chorioretinopathy (cCSCR) over 12 months in a real-world setting. In this retrospective, single-center cohort, 29 eyes with cCSCR received pro re nata intravitreal brolucizumab. Baseline OCT angiography excluded macular neovascularization. Patients were seen monthly for three months, then as needed through month 12. At each visit, best-corrected visual acuity (BCVA), central retinal thickness (CRT), and presence of SRF, intraretinal fluid (IRF), and pigment epithelium detachment (PED; including PED height) were recorded. Total injections per eye were tallied. Twenty-nine eyes (mean age 55.2±11.0 years; 72% male) with cCSCR received 1.72 ± 0.62 intravitreal brolucizumab injections over 12 months. Vision improved from BCVA 0.59 ± 0.23 logMAR at baseline to 0.46 ± 0.22 at one month ( =0.002), 0.40 ± 0.20 at three months ( <0.001), and 0.39 ± 0.20 at month 12 ( <0.001). Mean CRT reduced from 340 ± 140 µm to 260 ± 110 µm at one month and stabilized at 230 ± 98 µm by month 12 ( <0.001). Mean PED height decreased from 48 ± 55 µm at baseline to 13 ± 17 µm at month 12 ( <0.001). Fluid resolution was rapid and sustained; SRF cleared in 63% at one month ( <0.001) and 88.9% at 12 months ( <0.001), IRF in 85.7% by month 3 ( =0.016) and 71.4% by month 12 ( =0.063), and PEDs in 43.8% at one month ( =0.021) rising to 68.8% at month 12 ( =0.001). No ocular or systemic adverse events occurred. Intravitreal brolucizumab provided significant and sustained visual and anatomical improvements in cCSCR with a low injection burden over 12 months. Given the off‑label use and absence of a control group, findings should be interpreted cautiously and confirmed in prospective controlled studies.

To compare twelve-month visual, anatomical, safety, and inflammation-biomarker outcomes of intravitreal dexamethasone implant (DEX) in treatment-naïve versus recalcitrant center-involving diabetic macular edema (CI-DME) eyes. In this multicenter, retrospective cohort study (January 2022 to December 2024) at two Indian tertiary centers, adults with type 2 diabetes and CI-DME confirmed by optical coherence tomography (OCT) were stratified into treatment-naïve or recalcitrant cohorts. All eyes received a 0.7 mg dexamethasone implant, with pro-re-nata retreatment for recurrent fluid, ≥5-letter best-corrected visual acuity (BCVA) loss, or ≥50 µm central macular thickness (CMT) increase. Visits at baseline and periodic intervals up to 12 months included BCVA, intraocular pressure (IOP), slit-lamp and fundus exams, and OCT quantification of CMT and presence and/or hyperreflective foci (HRF). Safety and adverse event monitoring included IOP elevations, cataract progression, and other ocular adverse events. Statistical analysis used paired and independent tests with < 0.05. We analyzed 102 eyes (30 naïve, 72 recalcitrant) from 74 patients (mean age 61.7 ± 8.8 years). Mean DEX implants per eye were 1.83 ± 0.73, higher in recalcitrant eyes (1.87 vs 1.73; = 0.02). At 12 months, mean BCVA improved from 0.73 ± 0.26 to 0.62 ± 0.28 logMAR ( = 0.002), with no intergroup differences ( > 0.05). Mean CMT decreased from 520 ± 144 to 462 ± 192 µm ( = 0.03), similarly across cohorts ( > 0.10). HRF declined from 58% to 26% ( < 0.001). Ocular adverse events included cataract progression in 39% of phakic eyes (26% underwent surgery) and transient IOP elevations >21 mmHg in 9.8%, all managed medically; no glaucoma surgery was required. In real-world practice, intravitreal DEX implant delivers sustained visual and anatomical benefits in both treatment-naïve and recalcitrant CI-DME eyes. Although cataract progression and transient IOP rises occur, they are predictably manageable. Its extended durability and acceptable safety profile underscore DEX implant as a practical, valuable option across diverse DME populations.

To evaluate the role of an Indian bevacizumab biosimilar (Bevatas ), for the management of type 1 retinopathy of prematurity (ROP) and aggressive posterior ROP (APROP) over 24-weeks. A retrospective, single-center, interventional study of 144 eyes of type 1 (100 eyes) and APROP (44 eyes). All eyes received a single dose of 0.625mg Bevatas injection, and were advised additional laser therapy for suboptimal response. The study population had a mean gestational age of 28.94 (±2.32) weeks, an average birth weight of 1.2 (±0.34) kg, and modest male predominance (52.05%). Complete regression of ROP was seen in 65.97% of 144 eyes after 24 weeks of bevacizumab monotherapy, and in 97.22% of eyes (140 eyes) after adding laser photocoagulation. The remaining four eyes (all had APROP) developed Stage 4 ROP and needed vitreous surgery. After monotherapy with bevacizumab biosimilar, type 1 ROP eyes had significantly higher rate of complete ROP regression than APROP eyes (87% vs 18.18%; <0.00001). All eyes with type 1 ROP, and 90.91% of eyes with APROP, regressed after receiving additional laser therapy. The study population experienced no ocular or systemic adverse effects. The BIOS-ROP study demonstrates that intravitreal bevacizumab biosimilar monotherapy offers significant benefit for type 1 ROP, but not APROP. Low-cost biosimilars can help sustain healthcare systems in lower-middle income countries (LMICs) with escalating healthcare expenditures. They can also improve healthcare equity by making vision-saving therapies like bevacizumab more affordable and accessible.

This retrospective study aimed to compare the efficacy and safety of intravitreal Dexamethasone Implant (DEX) and Brolucizumab Injection in treating Diabetic Macular Edema (DME) with Hyperreflective Intraretinal Dots (HRID). A single-center retrospective study in India included 40 eyes (20 per group) with controlled diabetes and HRID on optical coherence tomography. Patients received either DEX or Brolucizumab, with outcomes assessed at various intervals up to 24 weeks. Primary measures included Best-Corrected Visual Acuity (BCVA), Central Macular Thickness (CMT), and safety parameters. Both treatment groups demonstrated comparable baseline characteristics. Both treatments significantly improved the BCVA at weeks 4, 12, and 24, with the DEX implant showing significantly better results at week 12 than brolucizumab ( =0.04). In treatment-naïve eyes, BCVA improvements were similar across all time points. In recalcitrant DME eyes, DEX showed significant BCVA improvements at all time points, while brolucizumab showed significant improvements only at weeks 4 ( =0.005) and 24 ( =0.04). The CMT also improved with both treatments, with DEX showing superior reduction at weeks 4 ( =0.003), 12 ( =0.003), and 24 ( =0.002) respectively. In treatment-naïve eyes, DEX showed consistently better CMT reductions. In refractory DME eyes, both treatments significantly reduced CMT, with DEX performing better at week 12 ( =0.042). DEX required fewer injections (DEX: 1.5±0.61; brolucizumab: 2.4±0.82; =0.0002) and less supplementary laser treatment (DEX:8/20, 40% eyes; brolucizumab: 16/20, 80%; =0.01) compared to brolucizumab. No adverse events were observed in either group. The study suggests the potential superiority of intravitreal DEX implant over brolucizumab in managing DME with HRID. DEX exhibited sustained positive responses in BCVA and CMT, requiring fewer injections and supplementary interventions. Future research should explore extended follow-up durations, personalized treatment strategies, and refined biomarkers to optimize DME management.

To evaluate the efficacy and safety of Bevatas , an Indian bevacizumab biosimilar, in the management of both Central Retinal Vein Occlusion (CRVO) and Branch Retinal Vein Occlusion (BRVO) (BIOS-RVO). The BIOS-RVO study was a retrospective interventional study conducted at a single tertiary eye care facility in India. 154 treatment-naïve eyes with RVO (CRVO: 62 eyes; BRVO: 92 eyes) received intravitreal bevacizumab biosimilar (IVBb) therapy. Data on best-corrected visual acuity (BCVA), central macular thickness (CMT), and intraocular pressure (IOP) were collected at baseline and at 3, 6, and 12 months post-therapy. The average age of participants was approximately 55.99 (+12.56) years, with a nearly equal gender distribution (M:F = 49.4:50.6). Age differences between BRVO and CRVO groups were not significant ( =0.501), but gender distribution varied significantly ( =0.035), with more males in the CRVO group. Significant improvements in BCVA were observed in both CRVO and BRVO groups at 3 months, 6 months, and 1 year compared to baseline ( <0.001). Both groups showed significant reductions in CMT throughout the follow-up period ( <0.001). The mean number of injections was higher in the CRVO group (5.27[±1.45]) compared to the BRVO group (4.27 [±1.28]) ( <0.001). Significant IOP increases were observed at 1 month ( <0.001) and 6 months ( <0.001) in both BRVO and CRVO groups, although not clinically significant. Safety analysis revealed no additional ocular or systemic adverse events during the study period. The BIOS-RVO study demonstrates that Bevatas is an effective and safe treatment option for both CRVO and BRVO. These findings support the use of Bevatas as a cost-effective alternative to branded anti-VEGF agents, particularly in resource-limited settings.