Explore the vast range of titles available.

The refractive accuracy of intraocular lens (IOL) formulas varies in eyes that undergo combined phacovitrectomy for different underlying vitreoretinal pathology. A total of 401 eyes that underwent uncomplicated phacovitrectomy (23–25 g) with implantation of a plate haptic IOL (CT Asphina 409 M) in the capsular bag between April 2020 and December 2022 were included in the study. Inclusion criteria were postoperative best corrected visual acuity of 0.4 LogMAR or better at least 8 weeks after surgery. The Barrett Universal II (BUII), Haigis, Hill-Radial Basis Function (Hill-RBFv3.0), Hoffer Q, Holladay I, Holladay II, Kane, K6, Pearl-DGS and SRK/T formulas were compared for their accuracy in mean absolute error (MAE). Furthermore, all formulas were additionally tested by using the prediction for an IOL power 0,5 or 1D above the IOL used (IOLdown). Wilcox-Holladay-Wang-Koch (WHWK) statistical tests with Holm correction were applied. The Barrett IOLdown formula showed the lowest refractive prediction error (0.03D; together with Hill IOLdown), lowest MAE (0.40D), lowest median absolute error (MedAE; 0.31D), lowest standard deviation of MAE (0.55D) and lowest root mean squared absolute error (RMSAE; 0,54D). Barrett IOLdown had the highest percentage of eyes with predicted error within ± 0.25D (41.6%), Kane IOLdown within ± 0.50D (70.5%) and ± 0.75D (89%) and Hill IOLdown within ± 1D (95.2%). Except for Haigis, Hoffer Q and Pearl-DGS, all other formulas showed a statistically significantly lower MAE after IOLdown modification. The newest formulas with IOLdown modification performed better than old generation formulas, with Barrett IOLdown exhibiting the best results.

BackgroundThis case report describes the course and therapeutic management of a fast-spreading bacterial keratitis caused by multidrug-resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa).Case presentationA 27-year-old male contact lens wearer presented with a multi-resistant, fast spreading P. aeruginosa keratitis. After initial resistance to various antibiotic therapies, testing revealed a MDR P. aeruginosa. The keratitis was treated successfully with specially prepared 50 mg/ml off-label meropenem eye drops for 18 days as well as systemic meropenem for seven days with rapid improvement of the corneal infiltrate.ConclusionThis case report demonstrates the combination of topical and systemic meropenem as a useful treatment option for corneal ulcers caused by MDR P. aeruginosa.

Because rare, but severe adverse effects, i.e. retinal vasculitis or retinal vein occlusion, have been observed after repetitive intravitreal injections of VEGF-A-binding single-chain variable fragment brolucizumab (Beovu), we investigated its possible impact on the barrier formed by immortalized bovine retinal endothelial cells (iBREC) in comparison to that of the VEGF-A-binding Fab fragment ranibizumab (Lucentis). As a measure of stability of the barrier formed by a confluent monolayer of iBREC, we determined the cell index over seven days by continuous electric cell-substrate impedance measurements: Beovu but not Lucentis indeed significantly lowered the cell index, evident about 1.5 days after its addition, pointing to barrier impairment. Early after addition of Beovu, amounts of the integrins α5 and β1—subunits of the fibronectin receptor—had changed in opposite ways, suggesting an effect on cell adhesion due to hindered dimer formation. After exposure for eight days to Beovu, levels of claudin-1—an essential part of the iBREC barrier—were significantly lower, less claudin-1 was located at the plasma membrane after exposure to the VEGF-A antagonist for five days. Beovu did not induce secretion of inflammatory cytokines or VEGF-A. Interestingly, polysorbate-80—component of Beovu—but not polysorbate-20—in Lucentis—slightly, but significantly lowered the cell index, also associated with reduced claudin-1 expression. In summary, our results indicate that Beovu changes the behavior of retinal endothelial cells, thus providing an alternative “non-immunological” explanation for the most relevant of observed side effects.

Purpose To evaluate short-term real-world outcomes after switching to faricimab using a modified treat-and-extend (TAE) regimen with a single loading dose in patients with retinal vein occlusion (RVO) refractory to prior anti-VEGF therapy. Methods In this prospective study, 27 eyes of 27 patients with macular edema (ME) secondary to RVO and persistent intraretinal fluid (IRF) and central subfield thickness (CST) ≥ 270 μm despite ≥ 3 prior anti-VEGF injections at treatment intervals ≤ 6 weeks were switched to faricimab. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) parameters, including CST, IRF, and subretinal fluid (SRF), were assessed from baseline (1st faricimab injection) until 3rd faricimab injection (final visit). Outcomes were analyzed for all RVO combined and stratified by central (CRVO) and branch retinal vein occlusion (BRVO). Results In the all RVO combined cohort, median BCVA improved significantly from 0.2 logMAR to 0.1 logMAR ( p  = 0.022), and median CST decreased from 291 μm to 268 μm ( p  < 0.001) over a mean follow-up of 11.7 weeks. The proportion of eyes with IRF was significantly reduced ( p  < 0.001), and a dry macula was achieved in 48.1% of eyes at the final visit. The mean treatment interval increased significantly from 4.6 to 7.3 weeks, with an intended interval extension achieved in 88.9% of eyes. After stratification, both CRVO and BRVO subgroups showed significant CST reduction and significant treatment interval extension, while BCVA improved numerically in both subgroups without reaching statistical significance. No safety-related adverse events were observed. Conclusions In real-world practice, switching to faricimab using a modified TAE regimen with a single loading dose appears to be effective in RVO patients refractory to prior anti-VEGF therapy, yielding significant functional improvement with early interval extension and no safety concerns. Clinical trial number German Clinical Trials Register (DRKS) registration ID: DRKS00036984.

In persons with geographic atrophy due to age-related macular degeneration, a neurostimulation system composed of glasses, a processor, and a subretinal implant restored central vision and significantly improved visual acuity.

Sub-retinal fluid (SRF) has been discussed as a protective factor against macular atrophy in eyes with neovascular age-related macular degeneration (nAMD).To gauge the impact of SRF on macular atrophy, a database of 310 nAMD eyes was screened for eyes manifesting an SRF-only phenotype under treat & extend anti-VEGF treatment, defined as nAMD expressing CNV exudation beyond the three monthly anti-VEGF loading doses by SRF only without any signs of exudative intra-retinal fluid (IRF) for ≥3 years. Incidence of macular atrophy and treatment responses were evaluated on multimodal imaging, including optical coherence tomography (OCT), blue autofluorescence (BAF) and near-infrared (NIR) confocal scanning laser ophthalmoscopy and fluorescence and indocyanine green angiography (FAG/ICGA). In total, 27 eyes (8.7%) of 26 patients with a mean follow-up of 4.2 ± 0.9 (3–5) years met the inclusion criteria. Mean age was 72 ± 6 (range: 61–86) years. The SRF only phenotype was seen from baseline in 14 eyes (52%), and in 13 eyes (48%) after a mean 1.0 ± 1.3 (1–3) injections. In years 1 to 5, mean 7.5, 5.9, 6.1, 6.1 and 7.0 anti-VEGF injections were given (p = 0.33). Cumulative macular atrophy incidence was 11.5% at year 1, 15.4% throughout years 2 to 4, and 22.4% at year 5. In conclusion, eyes manifesting activity by SRF only in treat & extend anti-VEGF regimen for nAMD seem to exhibit rather low rates of macular atrophy during long-term follow-up. SRF might be an indicator of a more benign form of nAMD.

Significant association signals from genome-wide association studies (GWAS) point to genomic regions of interest. However, for most loci the causative genetic variant remains undefined. Determining expression quantitative trait loci (eQTL) in a disease relevant tissue is an excellent approach to zoom in on disease- or trait-associated association signals and hitherto on relevant disease mechanisms. To this end, we explored regulation of gene expression in healthy retina (n = 311) and generated the largest cis-eQTL data set available to date. Genotype- and RNA-Seq data underwent rigorous quality control protocols before FastQTL was applied to assess the influence of genetic markers on local (cis) gene expression. Our analysis identified 403,151 significant eQTL variants (eVariants) that regulate 3,007 genes (eGenes) (Q-Value < 0.05). A conditional analysis revealed 744 independent secondary eQTL signals for 598 of the 3,007 eGenes. Interestingly, 99,165 (24.71%) of all unique eVariants regulate the expression of more than one eGene. Filtering the dataset for eVariants regulating three or more eGenes revealed 96 potential regulatory clusters. Of these, 31 harbour 130 genes which are partially regulated by the same genetic signal. To correlate eQTL and association signals, GWAS data from twelve complex eye diseases or traits were included and resulted in identification of 80 eGenes with potential association. Remarkably, expression of 10 genes is regulated by eVariants associated with multiple eye diseases or traits. In conclusion, we generated a unique catalogue of gene expression regulation in healthy retinal tissue and applied this resource to identify potentially pleiotropic effects in highly prevalent human eye diseases. Our study provides an excellent basis to further explore mechanisms of various retinal disease etiologies.

IntroductionPersisting macular holes (PMH) after surgical release of any epiretinal traction of the vitreous and adjacent membrane may rely on secondary firm adhesions between the retracted retina and adjacent retinal pigment epithelium. Secondary application of subretinal (SR)-fluid may release these adhesions followed by an anatomical closure.MethodsTwelve surgeons applied in a consecutive case series SR-fluid in 41 eyes with PMH and reported retrospectively their initial surgical, anatomical and functional experience with this approach.ResultsThe mean duration of the MH prior to SR-fluid application was 17 months (6–96 months). The mean age of the patients at the time of surgery was 72 years (54–88). The mean preoperative aperture diameter of the opening was 1212 μm (239–4344 μm), base diameter 649 μm (SD 320 μm). The mean preoperative BCVA prior to surgery was 0.1 (0.01–0.3). All patients (41/41) complained about reduced BCVA and a significant central scotoma (negative scotoma) in their central field of vision. The secondary closure rate for our PMH was 85.36% (35 out of 41 eyes) at 6 weeks after surgery. The postoperative BCVA improved to 0.22 (0.02–0.5). The application of SR-fluid was not associated with major intraoperative adverse effects.ConclusionRemaining SR-adhesions may inhibit PMH closure. Their release by application of SR-fluid will lead to a fast and immediate anatomical closure in many cases without serious adverse events.

Purpose To minimize the variability of surgical outcomes in strabismus surgery we evaluated machine learning models that predict the dosage for surgical correction of horizontal non-paretic strabismus, based on preoperative features and tried to determine feature importance with explainable artificial intelligence. Methods First, a structured retrospective analysis of patients who had strabismus surgery between 2003 and 2022 at the university clinic of Ulm was performed. A final streamlined dataset of 767 patients was included in the second step. We built a multilayer perceptron using the functional class from torch neural network to evaluate the data and build model 0. The features were analyzed with approaches from explainable artificial intelligence to check the attributions for plausibility. Results The highest number of predictions in the acceptable range was achieved with the Broyden-Fletcher-Goldfarb-Shanno algorithm. For model 0 the root mean square error for both labels were: L1 = 0.54 mm and L2 = 0.71 mm. For L1 and L2, 69% and 55% of the data was predicted within the acceptable range respectively. The preoperative angle of deviation as the most important feature for dosages was confirmed by feature permutation as well as integrated gradients, followed by near angle of deviation, use of simultaneous cover test, Hirschberg test angle and refraction of own glasses used. Conclusion The developed neural network seems to offer a way to predict dosage in strabismus surgery and could assist surgeons in their decision making. A significant improvement of prediction accuracy is expected after increasing the data basis.

Purpose To evaluate the long-term benefit of early targeted panretinal photocoagulation (PRP) combined with anti-VEGF therapy (IVL group) versus anti-VEGF monotherapy (IV group) in treatment-naïve eyes with macular edema (ME) secondary to ischemic RVO. Methods A retrospective analysis of 143 patients (85 IVL, 58 IV) with ischemic RVO. Baseline ischemic index (IsI), central retinal thickness (CRT), best-corrected visual acuity (BCVA), and age were adjusted. Results Over 48 months, the IVL group showed a reduction in mean CRT from 475.6 ± 117.3 μm to 282.0 ± 69.5 μm and improved BCVA from 0.61 ± 0.34 LogMAR to 0.44 ± 0.34 LogMAR. The IV group demonstrated CRT reduction from 479.4 ± 135.5 μm to 340.9 ± 127.3 μm and BCVA improvement from 0.58 ± 0.32 LogMAR to 0.50 ± 0.43 LogMAR. The IVL group received 26.0 ± 8.6 intravitreal anti-VEGF treatments (IVT), compared to 25.5 ± 6.2 IVT in the IV group. Conclusions The IVL group exhibited a trend toward better treatment response, particularly in patients with severe retinal ischemia, though findings were not statistically significant. Baseline IsI quantification is recommended for optimal RVO management. Key messages What is known : The benefit of adjuvant targeted panretinal photocoagulation (PRP) combined with intravitreal anti-VEGF treatment for macular edema (ME) secondary to ischemic retinal vein occlusion (RVO) remains controversial. Limited evidence suggests that early, targeted PRP of the ischemic peripheral retina may improve visual acuity (VA) and ME response to anti-VEGF treatment. What is new : This is the first study to report long-term outcomes of combined early targeted PRP and anti-VEGF therapy versus anti-VEGF monotherapy in 143 eyes with ischemic RVO. Combined therapy showed a trend toward improved anatomical outcomes, particularly in patients with baseline ischemic index (IsI) ≥ 15%. Early PRP did not reduce the treatment burden, including the number of anti-VEGF injections. Quantifying IsI at baseline is crucial for assessing retinal ischemia severity in RVO.