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Background: Direct selective laser trabeculoplasty (DSLT) is a novel option for intraocular pressure (IOP) control in patients with glaucoma or ocular hypertension. The automated and touchless translimbal delivery of laser energy to 360 degrees of the trabecular meshwork (TM) improves aqueous outflow and lowers IOP. DSLT is faster, simpler, and less invasive than routinely performed SLT. Few studies have compared the two techniques. Objective: To retrospectively compare the safety and efficacy of DSLT and SLT over a 1-year follow-up period. Methods: In total, 16 eyes that underwent DSLT and 16 eyes that underwent SLT were included. The primary outcome measures were mean absolute and percent IOP reduction, number of medications, and BCVA at 1, 3, 6, and 12 months. Survival analysis on 1-year data was performed based on the presence of one or more of the following failure criteria: (1) IOP > 21 mmHg or less than 20% reduction in IOP from baseline at two consecutive visits; (2) increase in the number of IOP-lowering drops from baseline at two consecutive visits; (3) further procedures. Results: The survival rates in the DSLT vs. SLT group were 81% vs. 78%, 44% vs. 62%, and 37% vs. 43% at 3, 6, and 12 months, respectively. No statistically significant differences were reported. DSLT does not seem inferior to conventional SLT in terms of safety and efficacy in reducing IOP. Conclusions: The advantages of an automated, rapid, contactless technique may enlarge the cohort of patients eligible for a drop-free first-line IOP control procedure.

A Correction to this paper has been published: https://doi.org/10.1038/s41433-021-01469-2

Background/ObjectivesTo investigate if the visual and anatomic response to the first dexamethasone implant (DEX) predicts the 12-month clinical outcome after shifting to fluocinolone acetonide (FAc) implant in patients with diabetic macular oedema (DMO).MethodsRetrospective cohort study including pseudophakic patients with previously treated DMO, undergone one or more DEX injections before FAc. Functional and morphologic response to DEX was defined based on the best-corrected visual acuity (BCVA) and central macular thickness (CMT) changes after the first DEX, respectively. Steroid-response was defined as intraocular pressure (IOP) elevation ≥5 mmHg or IOP > 21 mmHg after any previous DEX exposure. Pairwise comparisons for BCVA, CMT, and IOP after FAc were performed with linear mixed models and a repeated-measure design.ResultsForty-four eyes of 33 patients were included. Patients were shifted to FAc after a mean ± standard deviation of 4.6 ± 3.2 DEX injections. Overall, BCVA and CMT improved during the first 12 months after switching to FAc (p = 0.04 and p < 0.001, respectively). Only eyes with a good morphologic response to DEX had a significant CMT reduction after FAc (p < 0.001), while no significant relationship was found between BCVA improvement after DEX and after FAc. IOP elevation occurred in 9 eyes (20%) following DEX implant. These eyes carried a 20-fold increased risk of having an IOP rise after FAc (p < 0.001), with a non-linear relationship between the IOP increase after DEX and the one after FAc.ConclusionThe response to previous DEX may anticipate the morphologic response to subsequent FAc. Eyes with steroid-induced IOP elevation after DEX are at a high risk of IOP increase after FAc. The visual response after FAc was not associated with the visual response to previous steroids, indicating that FAc may have a role also in patients refractory to DEX implant.

Lamellar macular holes (LMHs) may show morphological and functional deterioration over time, yet no definite prognostic factor for progression has been identified. Since neurovascular retinal unit impairment may take part in neurodegeneration, we compare progressive LMHs to stable ones in optical coherence tomography (OCT) angiography parameters. Methods: OCT B scans of eyes with LMH were analyzed to detect the presence of tissue loss (TL) over time, allowing us to identify a TL group and a stable (ST) group (14 patients each). The best corrected visual acuity (BCVA) at each considered imaging time point was collected. Lastly, patients underwent macular OCT angiography. Results: BCVA at last follow up was significantly reduced in the TL group compared to both the ST group and TL group baseline assessment. SCP foveal vessel density (VD), SCP and deep capillary plexus (DCP) perfusion density (PD) and parafoveal PD were lower in the TL group. Linear correlations between quantitative TL over time and parafoveal PD in SCP and between the speed of TL and BCVA variation during follow up were also detected. Conclusions: TL in LMHs is associated with both OCT angiography modifications and BCVA deterioration over time. We suggest these findings to be a manifestation of foveal Muller cell impairment in progressive LMHs.

Purpose To determine the accuracy of a new machine learning-based open-source IOL formula (PEARLS-DGS) in 100 patients who underwent uncomplicated cataract surgery and had a history of laser refractive surgery for myopic defects. Methods The setting for this retrospective study was HUMANITAS Research Hospital, Milan, Italy. Data from 100 patients with a history of photorefractive keratectomy or laser in situ keratomileusis were retrospectively analyzed to assess the accuracy of the formula. The primary outcome measures were absolute refractive prediction error, refractive prediction error, and cumulative distribution of absolute refractive prediction error within multiple thresholds. These parameters were estimated post-hoc using the Shammas, Haigis-L, Barrett True-K without history, ASCRS calculator average, EVO, Hoffer QST, and PEARL-DGS formulas. The cumulative distribution of the absolute refraction prediction error was analyzed and statistically tested. Results EVO 2.0 showed the lowest median absolute error (MedAE) of 0.36 diopters (D), followed by Hoffer QST (0.38 D) and PEARL-DGS (0.41 D). The cumulative distribution of the absolute refractive prediction error at ±0.50 D threshold showed the following ranking: Hoffer QST (0.65), PEARL-DGS (0.61), EVO 2.0 (0.60), Barrett-True-K (0.56), Haigis-L, ASCRS (0.52), and Shammas (0.45). A significant difference was recorded between Shammas and Hoffer QST only at this threshold (P < .05). Statistical differences could not be detected otherwise. Conclusions The new PEARL-DGS IOL formula demonstrated similar accuracy and comparability in median refractive prediction error to the other current formulas in eyes with a history of myopic laser vision correction. The cumulative distribution of refractive prediction error of the PEARLS-DGS performed well even compared to the Hoffer QST results.

Purpose: To assess the performance of the Camellin-Calossi formula in eyes with prior myopic laser vision correction. Methods: This was a retrospective case series. Patients included had a history of uncomplicated myopic laser vision correction and cataract surgery. The primary outcome measures were cumulative distribution of absolute refractive prediction error, absolute refractive prediction error, and refractive prediction error. These parameters were estimated post-hoc using the Camellin-Calossi, Shammas, Haigis-L, Barrett True-K with or without history, Masket, and Modified Masket formulas and their averages starting from biometric data, clinical records, postoperative refraction, and intraocular lens power implanted. Results: Seventy-seven eyes from 77 patients were included. The Camellin-Calossi, Shammas, Haigis-L, Barrett True-K No History, Masket, Modified Masket, and Barrett True-K formulas showed a median absolute refractive error (interquartile range) of 0.25 (0.53), 0.51 (0.56), 0.44 (0.65), 0.45 (0.59), 0.40 (0.61), 0.60 (0.70), and 0.55 (0.76), respectively. The proportion of eyes with an absolute refractive error of ±0.25, 0.50, 0.75, 1.00, 1.50, and 2.00 diopters (D) for the Camellin-Calossi formula was 54.5%, 72.7%, 85.7%, 92.2%, 98.7%, and 100%, respectively. The cumulative distribution of the Camellin-Calossi formula showed the best qualitative performances when compared to the others. A statistically significant difference was identified with all of the others except the Haigis-L using a threshold of 0.25, with the Shammas, Modified Masket, and Barrett True-K at a threshold of 0.50 D and the Barrett True-K and Modified Masket at a threshold of 1.00 D. Conclusions: The Camellin-Calossi formula is a valid option for intraocular lens power calculation in eyes with prior myopic laser vision correction. [J Refract Surg. 2024;40(3):e156–e163.]

Toxic tumour syndrome (TTS) is a particularly aggressive form of secondary vasculopathy occurring after radiation therapy of uveal melanoma due to the persistence of the necrotic tumour mass inside the eye. The development of TTS confers a particularly unfavourable functional and anatomical ocular prognosis, ultimately requiring enucleation in most cases if untreated. Vitreoretinal (VR) surgery has been successfully applied for treatment and prevention of TTS using both resecting and non-resecting techniques. In this systematic review, we aim to define characteristics of uveal melanomas benefiting the most from secondary VR surgery and to outline the optimal type and timing of VR intervention in such cases. Analysis of the literature reveals that endoresection should be performed within 3 months after radiotherapy to tumours thicker than 7 mm and with a largest basal diameter between 8 mm and 15 mm with post-equatorial location, especially after proton beam treatment. Alternatively, endodrainage remains a valid therapeutic option in eyes with macula-off retinal detachment, tumour diameter larger than 15 mm or ciliary body involvement. VR surgery can be successful in the management of TTS following radiotherapy for uveal melanoma when timing and indication are appropriately evaluated.

The retinal pigmented epithelium (RPE) plays a pivotal role in retinal homeostasis. It is therefore an interesting target to fill the unmet medical need of different retinal diseases, including age-related macular degeneration and Stargardt disease. RPE replacement therapy may use different cellular sources: induced pluripotent stem cells or embryonic stem cells. Cells can be transferred as suspension on a patch with different surgical approaches. Results are promising although based on very limited samples. In this review, we summarize the current progress of RPE replacement and provide a comparative assessment of different published approaches which may become standard of care in the future.

ObjectiveTo assess the safety and efficacy of endocyclophotocoagulation with phacoemulsification (phaco-ECP) in surgically naive, primary open-angle glaucoma (POAG).MethodsA retrospective case series of patients undergoing phaco-ECP between 2007 and 2017 at a single centre in London, UK. The primary outcome was intraocular pressure (IOP). Secondary outcomes were visual acuity, visual field global indices, topical medications and surgical complications. Failure criteria were: (1) IOP > 21 mmHg or <20% reduction at two consecutive visits, (2) IOP <5 mmHg and (3) further IOP-lowering surgery.ResultsEighty-three eyes from 83 patients were eligible. Pre-operatively, mean IOP (±SD) was 18.4 ± 5.2 mmHg. The mean number of topical agents (±SD) was 2.7 ± 0.9. Mean IOP (±SD) significantly reduced to 14.3 ± 4.7 at 1 year, 14.1 ± 4.0 at 2 years and 13.6 ± 3.7 at 3 years (p < 0.0001). Topical medications were significantly reduced to 1.3 ± 1.2 at 1 year, 1.7 ± 1.2 at 2 years and 1.8 ± 1.3 at 3 years (p < 0.0001). Annual IOP ‘survival’ was 70%, 54% and 45% at year 1, 2 and 3, respectively. Complications included uveitis (6%), macular oedema (2%), IOP spikes (1%) and corneal decompensation (1%) with no episodes of hypotony or retinal detachment. One patient underwent filtration surgery within 3 years (1%).ConclusionPhaco-ECP facilitates significant IOP lowering and reduction of medication burden in surgically naive POAG requiring cataract extraction. The procedure is relatively safe and without the use of implants and their associated risks.