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To compare the performance of humans, GPT-4.0 and GPT-3.5 in answering multiple-choice questions from the American Academy of Ophthalmology (AAO) Basic and Clinical Science Course (BCSC) self-assessment program, available at https://www.aao.org/education/self-assessments . In June 2023, text-based multiple-choice questions were submitted to GPT-4.0 and GPT-3.5. The AAO provides the percentage of humans who selected the correct answer, which was analyzed for comparison. All questions were classified by 10 subspecialties and 3 practice areas (diagnostics/clinics, medical treatment, surgery). Out of 1023 questions, GPT-4.0 achieved the best score (82.4%), followed by humans (75.7%) and GPT-3.5 (65.9%), with significant difference in accuracy rates (always P < 0.0001). Both GPT-4.0 and GPT-3.5 showed the worst results in surgery-related questions (74.6% and 57.0% respectively). For difficult questions (answered incorrectly by > 50% of humans), both GPT models favorably compared to humans, without reaching significancy. The word count for answers provided by GPT-4.0 was significantly lower than those produced by GPT-3.5 (160 ± 56 and 206 ± 77 respectively, P < 0.0001); however, incorrect responses were longer (P < 0.02). GPT-4.0 represented a substantial improvement over GPT-3.5, achieving better performance than humans in an AAO BCSC self-assessment test. However, ChatGPT is still limited by inconsistency across different practice areas, especially when it comes to surgery.

To analyze and compare the efficiency of three phaco-emulsifying machines by evaluating parameters related to fluidics and ultrasound time (UST). Pilot, prospective, observational, comparative study conducted at the “Mediterranea” Clinic Ophthalmology Operative Unit, Naples, Italy. A total of 145 consecutive cases of phacoemulsification were included in the study. Patients were randomized into 4 arms and operated using three phaco-emulsifying machines in 4 configurations equipped with three different infusion systems. The phaco machines were: (1) Centurion ® , with and without the Active Sentry ® handpiece (Alcon), (2) Stellaris Elite™ (Bauch & Lomb), and (3) Whitestar Signature ®  Pro (Johnson & Johnson). The primary outcomes were UST and fluid aspiration volume. Centurion, with and without Active Sentry, required less UST compared to other phaco machines ( P  < 0.001). Furthermore, Centurion required lower values of intraocular pressure (IOP) to complete the procedure and aspirated less fluid compared to the Stellaris Elite. No statistical differences in UST, aspirated fluid, and IOP have been found between Centurion and Centurion with Active Sentry. Centurion, with and without Active Sentry required lower UST and IOP for cataract removal compared to Stellaris Elite and Whitestar Signature Pro. Less fluid is necessary to complete the procedure compared to the Stellaris Elite.

AimsThe osteo-odonto-keratoprosthesis (OOKP) is a biological implant indicated for the treatment of eyes affected by corneal blindness, not amenable for keratoplasty. The purpose of the study is to report the long-term outcomes of patients undergone Falcinelli’s modified OOKP (MOOKP).MethodsIn this retrospective study, anatomical and functional survival rates were evaluated using Kaplan-Meier analysis, according to eye coverage (buccal mucosa vs skin). Best-corrected visual acuity (BCVA) was recorded before and after surgery along with intraoperative and postoperative complications.Results310 eyes of 269 patients affected by corneal blindness underwent MOOKP and were followed up for 15.9±12.0 years (up to 45 years). Anatomical survival rates for eyes covered by buccal mucosa were 85.1% at 20 years (number at risk (n)=81) and 82.3% at 45 years (n=10). Functional survival rates were 70.7% at 20 years (n=74) and 56.5% at 45 years (n=7). Anatomical and functional survival rates for eyes covered by skin were 58.9% (n=3) and 37.0% (n=3) at 20 years, respectively. Survival rates were significantly lower for eyes covered by skin (p<0.001). Postoperative BCVA at the last follow-up visit was significantly higher compared with baseline (0.88±1.08 LogMAR vs 2.49±0.38 LogMAR; p<0.001). The most threatening complications were glaucoma (n=70, 22.6%), endophthalmitis (n=24, 7.7%), retinal detachment (n=20, 6.4%), instability/tilting/expulsion of the optical cylinder and expulsion of the prosthesis (n=24, 7.7%).ConclusionsMOOKP showed excellent long-term anatomical and functional survival rates. Visual acuity significantly improved as soon as 3 months postoperatively and remained unchanged in about two-thirds of patients throughout the entire follow-up.

Dry eye disease (DED) incidence is continuously growing, positioning it to become an emergent health issue over the next few years. Several topical treatments are commonly used to treat DED; however, reports indicate that only a minor proportion of drug bioavailability is achieved by the majority of eye drops available on the market. In this context, enhancing drug ability to overcome ocular barriers and prolonging its residence time on the ocular surface represent a new challenge in the field of ocular carrier systems. Therefore, research has focused on the development of multi-functional nanosystems, such as nanoemulsions, liposomes, dendrimers, hydrogels, and other nanosized carriers. These systems are designed to improve topical drug bioavailability and efficacy and, at the same time, require fewer daily administrations, with potentially reduced side effects. This review summarizes the different nanotechnologies developed, their role in DED, and the nanotechnology-based eyedrops currently approved for DED treatment.

Diabetic macular edema (DME) is a common sight-threatening complication of diabetic retinopathy (DR) and the leading cause of severe visual impairment among the working-age population. Several therapeutic options are available for the management of DME, including intravitreal corticosteroids. They have been traditionally used as second-line treatment, due to the risk of intraocular pressure increase and cataract-related adverse events. However, attention has recently been focused on the primary or early use of intravitreal corticosteroids, due to growing evidence of the crucial role of inflammation in the pathogenesis of DME. Furthermore, intravitreal steroid implants offer the additional advantage of a longer duration of action compared to anti-vascular endothelial growth factor agents (anti-VEGF). This review aims to summarize the available evidence on the efficacy and safety profile of dexamethasone (DEX) intravitreal implant, with a specific focus on clinical scenarios in which it might be considered or even preferred as first-line treatment option by adequate selection of patients, considering both advantages and possible adverse events. Patients with contraindications to anti-VEGF, DME with high inflammatory OCT biomarkers, pseudophakic patients and phakic patients' candidates to cataract surgery as well as vitrectomized eyes may all benefit from first-line DEX implant. Additionally, DME not responders to anti-VEGF should be considered for a switch to DEX implant and a combination therapy of DEX implant and anti-VEGF could be a valid option in severe and persistent DME.

To evaluate the agreement of LLMs with the Preferred Practice Patterns ® (PPP) guidelines developed by the American Academy of Ophthalmology (AAO). Open questions based on the AAO PPP were submitted to five LLMs: GPT-o1 and GPT-4o by OpenAI, Claude 3.5 Sonnet by Anthropic, Gemini 1.5 Pro by Google, and DeepSeek-R1-Lite-Preview. Questions were classified as “open” or “confirmatory with positive/negative ground-truth answer”. Three blinded investigators classified responses as “concordant”, “undetermined”, or “discordant” compared to the AAO PPP. Undetermined and discordant answers were analyzed to assess harming potential for patients. Responses referencing peer-reviewed articles were reported. In total, 147 questions were submitted to the LLMs. Concordant answers were 135 (91.8%) for GPT-o1, 133 (90.5%) for GPT-4o, 136 (92.5%) for Claude 3.5 Sonnet, 124 (84.4%) for Gemini 1.5 Pro, and 119 (81.0%) for DeepSeek-R1-Lite-Preview ( P = 0.006). The highest number of harmful answers was reported for Gemini 1.5 Pro ( n = 6, 4.1%), followed by DeepSeek-R1-Lite-Preview ( n = 5, 3.4%). Gemini 1.5 Pro was the most transparent model (86 references, 58.5%). Other LLMs referenced papers in 9.5–15.6% of their responses. LLMs can provide discordant answers compared to ophthalmology guidelines, potentially harming patients by delaying diagnosis or recommending suboptimal treatments.

AimsTo describe a simple surgical technique consisting of opening the vertical graft-host junction (GHJ) to manage high astigmatism following deep anterior lamellar keratoplasty (DALK) and to report postoperative visual and topographic outcomes.MethodsThis is a retrospective interventional case series. Patients affected by high astigmatism after DALK underwent progressive opening of the previous GHJ at the steep meridians, established with preoperative topography and intraoperative keratoscopic guidance. Evaluations were carried out with best corrected visual acuity (BCVA), refractive astigmatism (RA) and keratometric astigmatism (KA) measured with Casia (Tomey, Japan). Visits were conducted preoperatively (T0), 1 week (T1), 6 months (T2) and 1 year after surgery (T3). The Alpins Method was used to evaluate vectorial changes in KA between T0 and T3.ResultsFifteen patients were included in the analysis. BCVA (median (IQR)) increased significantly from 0.70 (0.5–1.1) at T0 to 0.20 (0.1–0.3) logMAR at T3 (p=0.001). RA (mean±SD) at T3 was 2.28±1.59 dioptres (D). KA (mean±SD) varied significantly from 8.04±2.14 D at T0 versus 2.93±1.94 D at T1 versus 3.15±1.79 D at T2, versus 3.23±1.63 D at T3 (p<0.0001). Vectorial analysis showed that target induced astigmatism (mean±SD) was 8.04±2.14 D, while surgically induced astigmatism (mean±SD) was 7.89±4.27 D. Correction index (mean±SD) was 0.92±0.33.ConclusionsHigh astigmatism after DALK can be safely and effectively managed by opening the GHJ down to the cleavage plane achieved with the previous surgery, providing low KA and RA, with an overall low tendency to overcorrection.

Diabetic retinopathy (DR) often causes a wide range of lesions in the peripheral retina, which can be undetected when using a traditional fundus camera. Widefield (WF) and Ultra-Widefield (UWF) technologies aim to significantly expand the photographable retinal field. We conducted a geometrical analysis to assess the field of view (FOV) of WF and UWF imaging, comparing it to the angular extension of the retina. For this task, we shot WF images using the Zeiss Clarus 500 fundus camera (Carl Zeiss Meditec, Jena, Germany). Approximating the ocular bulb to an ideal sphere, the angular extension of the theoretically photographable retinal surface was 242 degrees. Performing one shot, centered on the macula, it was possible to photograph a retinal surface of ~570 mm2, with a FOV of 133 degrees. Performing four shots with automatic montage, we obtained a retinal surface area of ~1100 mm2 and an FOV of 200 degrees. Finally, performing six shots with semi-automatic montage, we obtained a retinal surface area of ~1400 mm2 and an FOV of 236.27 degrees, which is close to the entire surface of the retina. WF and UWF imaging allow the detailed visualization of the peripheral retina, with significant impact on the diagnosis and management of DR.

Background/Objectives: The management of ocular tumors often necessitates surgery, either alone or in combination with radiotherapy, chemotherapy, or other modalities. While crucial for tumor control, these treatments can significantly impact the ocular surface, leading to both acute and chronic complications. This review examines iatrogenic ocular surface diseases resulting from oncologic interventions, emphasizing their pathophysiology, diagnostic challenges, and management strategies. Methods: A literature review was conducted to identify studies on iatrogenic ocular surface complications associated with ocular tumor treatments. Results: Ocular surface complications include direct damage from surgical manipulation, leading to corneal opacities and persistent epithelial defects, as well as dry eye disease secondary to postoperative chemosis. These disruptions may progress to more severe conditions such as keratopathy, corneal ulcers, limbal stem cell deficiency, and stromal scarring, further impairing visual function. Structural alterations contribute to eyelid malpositions—including ectropion, entropion, round eye, and lagophthalmos—which exacerbate exposure-related damage and ocular surface instability. In cases of uveal melanomas, the exposure of episcleral brachytherapy plaques can induce chronic conjunctival irritation, promoting adhesion formation and symblepharon. Surgical interventions disrupt ocular surface homeostasis, while radiotherapy and chemotherapy exacerbate these effects through cytotoxic and inflammatory mechanisms. Conclusions: Preventing and managing iatrogenic ocular surface complications require a multidisciplinary approach involving early diagnosis, personalized treatment strategies, and targeted postoperative care. Comprehensive pre- and postoperative planning is essential to optimize both visual function and long-term ocular surface integrity, ultimately ensuring a balance between oncologic control with functional and aesthetic preservation.

Dry eye disease (DED) has become increasingly prevalent in the digital era, largely due to prolonged screen exposure. The excessive use of digital devices contributes to inappropriate blink frequency and dynamics, leading to ocular surface dryness and discomfort. Additionally, digital screen use has broader implications for systemic health, including visual strain, headaches, and disrupted circadian rhythms caused by blue light exposure. Previous studies have shown that prolonged screen time correlates with altered blink frequency and increased symptom severity in DED patients, exacerbating the imbalance in tear film production and evaporation. Blinking dynamics, particularly blink rate and completeness, are crucial in maintaining ocular surface moisture. Incomplete blinking impairs meibomian gland function, reducing lipid secretion, which is essential for preventing tear evaporation. Raising patient awareness through educational material, ergonomic adjustments, and blinking exercises has been shown to mitigate these effects. Digital tools that provide targeted educational interventions can be particularly effective in improving blink dynamics and overall ocular comfort. This study evaluates the efficacy of digital applications in optimizing blinking dynamics and enhancing tear film stability. The findings suggest that these innovations improve patient outcomes by encouraging healthier eye care practices. However, further research is needed to assess their long-term impact across diverse populations.