PurposeTo develop and internally evaluate pretreatment MR-based radiomics models for predicting local recurrence and metastasis after hypofractionated stereotactic radiosurgery (SRS) for uveal melanoma.MethodsThis retrospective study analyzed pretreatment MRI (T1-weighted, T2-weighted, contrast-enhanced T1-weighted) of 88 SRS-treated UM patients. Tumors were segmented on the axial slice with the greatest cross-sectional area, and 854 radiomic features were extracted for each sequence. After inter-observer reproducibility filtering (ICC ≥ 0.80) and elastic-net feature selection, separate Gaussian Naive Bayes models for local recurrence and metastasis were developed using the retained features with a 70:30 train-test split. SMOTE was applied within training folds to address class imbalance. Held-out test set performance was assessed using AUC, F1 score, accuracy, sensitivity, specificity, and predictive values.ResultsThe local-recurrence model achieved an AUC of 0.958, accuracy of 0.889, sensitivity of 1.00 (3/3), and specificity of 0.875 (21/24). The metastasis model showed limited discrimination (AUC, 0.528; accuracy, 0.815; sensitivity, 0.333 [1/3]; specificity, 0.875 [21/24]). Among three-fraction treatments, a total dose >45 Gy was associated with less local recurrence (p = 0.010), whereas no other clinical variable was significantly associated with either outcome.ConclusionMRI radiomics showed promising discrimination for local recurrence but limited discrimination for metastasis. These findings should be interpreted with caution given the small number of events in the test set and warrant external validation in larger cohorts.

The purpose of the article was to determine the pooled prevalence of co-existing ocular surface squamous neoplasia (OSSN) among clinically diagnosed pterygium (PTG) specimens.A systematic review and meta-analysis were conducted using online databases to identify relevant articles up to May 2024. Eligible original studies that reported the prevalence of non-PTG and co-existing OSSN in clinically diagnosed PTG cases that underwent surgical excision and histopathological evaluation were included. Additionally, based on the geographical coordinates (latitude and longitude) of each study and the global skin pigmentation map, skin types were defined and included. A total of 21 cross-sectional studies consisting of 23,165 specimens from 22,921 patients were included. The pooled prevalence of non-PTG and co-existing OSSN diagnoses after excluding outlier results was 3.8% (95% CI: 1.9-5.8) and 3.7% (95% CI: 1.8-5.7), respectively. Studies from countries with predominantly medium skin pigmentation showed a significantly higher prevalence of co-existing OSSN (10.25% [95% CI: 8.1-12.45, P < 0.001]) compared to those from countries with predominantly white (2.45% [95% CI: 0.0-5.2, P = 0.008] or brown (3.1% [95% CI: 0.65-5.5, P = 0.01]) skin types. A positive association was also observed between regional altitude and co-existing OSSN prevalence (regression coefficient = 0.005, P < 0.001). In conclusion, pathological assessment of PTG specimens may be considered to avoid misdiagnosis and ensure appropriate management.

BackgroundDysthyroid optic neuropathy (DON) is a vision-threatening complication of thyroid-associated ophthalmopathy that may require urgent surgical intervention. We describe a microsurgical two-wall orbital decompression technique designed to achieve effective orbital and optic nerve decompression in extremely severe cases as an additional option.MethodsA frontotemporal extradural approach is used to remove the lateral orbital wall and orbital roof, with optional decompression of the optic canal. Neuronavigation guides bone removal and helps avoid violation of the frontal sinus. The surgical technique, anatomical landmarks, and perioperative considerations are described in detail, and key steps are demonstrated in an accompanying video.ResultsTwelve orbits in 7 patients (mean age 60 ± 5 years) underwent microsurgical two-wall orbital decompression for treatment of visual impairment due to DON. The technique allows controlled removal of the lateral orbital wall and orbital roof with excellent visualization of the orbit and optic canal. Adequate orbital volume expansion and optic nerve decompression can be achieved while preserving critical anatomical structures. The procedure is associated with low technical morbidity.ConclusionMicrosurgical two-wall orbital decompression appears to be a clinically applicable and feasible technique for the treatment of visual impairment due to DON. It may be considered in selected patients with severe or refractory disease and persistent visual impairment despite prior decompression.

PurposeTo characterize ocular involvement in pediatric patients with mucopolysaccharidosis (MPS) using multimodal assessment, with emphasis on corneal densitometry and visual electrophysiology.MethodsThis prospective observational study included 22 patients with molecularly confirmed MPS. Ophthalmic assessment comprised best-corrected visual acuity, cycloplegic refraction, intraocular pressure, ultrasound pachymetry, slit-lamp grading of corneal opacity, Scheimpflug densitometry, in vivo corneal confocal microscopy, optical coherence tomography (OCT), and B-scan ultrasonography. Full-field electroretinography (FF-ERG) and flash visual evoked potentials (Flash VEP) were performed in cooperative patients.ResultsMean age was 9.05 ± 3.46 years, and 11 patients (50.0%) had MPS VI. Corneal opacity was present in 20 patients: mild in nine, moderate in eight, and severe in three. Mean corneal densitometry was 30.1 ± 10.9 grayscale units in the right eye and 28.5 ± 9.1 in the left eye. Densitometry values correlated strongly with corneal opacity grade (right: rs = 0.858, p < 0.001; left: rs = 0.696, p = 0.006). Corneal opacity precluded fundus examination in 11 patients; B-scan ultrasonography showed no posterior segment abnormality. OCT was evaluable in 15 patients and showed preserved macular morphology. Elevated intraocular pressure requiring treatment occurred in four patients with MPS VI; one also had bilateral optic atrophy. FF-ERG abnormalities were identified in nine of 14 tested patients, and bilateral flash VEP P2 latency prolongation was reported in four.ConclusionCorneal opacity was the predominant ocular manifestation and frequently limited posterior segment assessment. Multimodal structural and functional testing provided complementary information on corneal, glaucoma-related, optic nerve, and retinal involvement in MPS.

PurposeTo evaluate long-term tomographic findings in a series of neovascular age-related macular degeneration (nAMD) patients with macular fibrosis.MethodsBest corrected visual acuity (BCVA) and foveal 6-mm optical coherence tomography (OCT) of 30 eyes with stablished fibrosis due to nAMD were collected with a follow-up of five years. A reproducibility study was performed. Subfoveal retinal thickness (SRT), subfoveal fibrosis thickness (SFT), fibrosis extension and sectional area of the fibrosis in a single frame were recorded.ResultsMean age was 79.7 years (53% females). Bilateral fibrosis was present at baseline in 16% of patients rising to 63% at the end of study period. BCVA was 32.2 ETDRS letters in study eyes at baseline, decreased the second year and was stable at 22 letters for the following three years. Unaffected eyes remained with stable vision (70 ETDRS letters) at five years. Intraclass correlation coefficients were above 0.9 for all measurements. SFT was reduced the first three years and stabilized the last two years. SRT experienced progressive decrease without a plateau. Fibrosis longitudinal extension and sectional area remained unchanged during the five years.ConclusionsBCVA stabilizes from the third year on. Macular fibrosis experienced a limited compaction process with progressive neurosensory retinal thinning.

BackgroundImmune checkpoint inhibitors (ICIs) are widely used to treat a variety of malignancies. Ocular immune-related adverse events (irAEs) have been increasingly recognized as rare side effects of these medications.MethodsWe performed a retrospective study of ocular irAEs at our institution between 2017 and 2025. Ophthalmic and oncologic data were extracted, and visual acuity was compared before, during, and after events.ResultsNineteen ocular irAEs occurred in 17 patients. Melanoma and pembrolizumab were the most common type of malignancy and ICI, respectively. Most events were low grade (78.9%), with uveitis being the most common (36.8%). Ocular irAEs developed after a mean of 3.6 ± 3.2 cycles (155 ± 191 days) of ICI treatment. Best-corrected visual acuity (BCVA) declined significantly during events from 0.06 ± 0.12 logMAR (20/23) to 0.22 ± 0.30 logMAR (20/33) (p = 0.011). There was no significant difference between BCVA at baseline and after irAE treatment. Resolution of the ocular irAE occurred in 78.9% of patients.ConclusionsOcular events tended to occur soon after ICI initiation; however, time to onset varied. Most patients responded well to treatment and experienced resolution of the ocular event. ICI discontinuation may be necessary for severe ocular adverse events. Close collaboration between ophthalmologists and oncologists is essential when managing ocular irAEs.

PurposeTo identify risk factors for anterior capsular contraction syndrome (ACCS) after in-the-bag intraocular lens (IOL) implantation in patients with Marfan syndrome (MFS) and ectopia lentis (EL).MethodsThis study included patients diagnosed with MFS and EL, who underwent in-the-bag IOL with modified capsular tension ring (MCTR) implantation. The incidence of ACCS demanding Nd:YAG capsulotomy during 2 years of follow-up was the primary outcome. Univariate analysis and generalized estimating equations (GEE) analyses were performed to identify influencing factors.ResultsA total of 177 eyes from 108 patients were included. The median age at surgery was 6.00 (IQR: 5.00-11.00) years old. The incidence of ACCS was 6.21% (11/177), during a median onset time of 3.00 (IQR: 1.00, 5.00) months postoperatively. Multivariate GEE analysis identified more severe EL (OR = 4.411, 95% CI: 1.115-17.447, P = 0.034), the implantation of AcrySof IQ IOL (OR = 25.594, 95% CI: 1.693-387.030, P = 0.019), compared to TECNIS and Rayner IOLs, and greater central corneal thickness (CCT) (OR = 1.024, 95% CI: 1.001-1.048, P = 0.043), were associated with higher ACCS incidence. All patients with ACCS underwent Nd:YAG laser anterior capsulotomy, with no cases of IOL dislocation or ACCS recurrence during follow-up.ConclusionsIn patients with MFS and EL who underwent IOL-MCTR implantation, severe EL, use of AcrySof IQ IOL and greater CCT were associated with ACCS postoperatively. Meticulous preoperative assessment and tailored IOL selection are required in these patients to improve surgical outcomes and reduce the incidence of ACCS, ultimately enhancing long-term visual prognosis.

PurposeTo compare the outcomes of surface ablation (SA) in patients who have previously undergone Deep Anterior Lamellar Keratoplasty (DALK) and Penetrating keratoplasty (PKP).MethodsThis retrospective study evaluated the outcomes of SA in Keratoconus (KCN) patients who had previously undergone DALK or PKP and at least 6 months has passed after complete suture removal. Participants required a follow-up of at least four years. A total of 36 eyes (20 post-DALK, 16 post-PKP) were included. Collected data comprised demographics (age, gender, affected eye) and clinical characteristics (refractive error, corrected and uncorrected distance visual acuity [CDVA, UDVA], central corneal thickness, keratometry, surgical details, ablation depth, mitomycin duration, and complications). Primary outcomes included final refractive error, CDVA, and UDVA.ResultsDemographic and clinical characteristics were similar between groups. Comparing SA outcomes, no significant differences were found in safety index (1.14 vs. 1.12, P = 0.69), efficacy index (0.94 vs. 0.84, P = 0.27), logMAR CDVA (0.23 vs. 0.18, P = 0.34), logMAR UDVA (0.34 vs. 0.30, P = 0.52), or postoperative spherical equivalent (SEQ) (-2.18 vs. -1.36, P = 0.19). Complications and corneal haziness were minimal in both groups. However, SEQ showed notably greater stability over 48 months in the DALK group.ConclusionSA surgery after corneal transplantation effectively manages refractive errors with minimal complications. While outcomes were generally comparable, DALK patients exhibited greater long-term SEQ stability.

Ocular trauma is a common cause of visual morbidity and can lead to various anterior and posterior segment complications. Traumatic dislocation of the crystalline lens in toto into the anterior chamber without open globe injury is a rare entity. We report a 27-year-old male who presented after blunt trauma from a wooden door with sudden visual loss in the right eye. Best-corrected visual acuity was counting fingers at 1 metre. Slit-lamp examination revealed a clear crystalline lens completely dislocated into the anterior chamber with a clear cornea, well-formed anterior chamber, round pupil and no vitreous prolapse (Figure 1(A)). B-scan ultrasonography showed no posterior segment abnormalities. The patient underwent lens extraction, pars plana vitrectomy and scleral-fixated intraocular lens implantation (Figure 1(B)). Postoperative course was uneventful and his BCVA improved to 6/12. This case highlights the importance of meticulous anterior segment examination in post-traumatic eyes and timely surgical management to prevent complications and achieve favourable outcome.

PurposeTo determine the incidence of cystoid macular edema (CME) within the first 6 months after endothelial keratoplasty (EK) in eyes that had previously undergone vitrectomy versus those without prior vitrectomy.DesignRetrospective cohort study.MethodsA retrospective cohort analysis of the TriNetX database was performed by querying all patients who underwent EK (Descemet stripping automated endothelial keratoplasty or Descemet membrane endothelial keratoplasty) with ≥ 6 months of follow-up between January 1, 2004, and August 30, 2024. Patients with a previous history of diabetic macular edema, uveitis, or retinal vascular occlusion were excluded. Cohorts were stratified based on a history of prior vitrectomy. Propensity score matching (PSM) between cohorts was conducted for age at index, sex, race, ethnicity, and diagnosis of Fuchs endothelial dystrophy. The outcome assessed was the incidence of postoperative CME within 6 months after EK in both groups. Odds ratios were calculated between cohorts.ResultsThe final analysis included 1044 patients, divided into those with (n = 522) and without (n = 522) prior vitrectomy before EK. Patients who had undergone vitrectomy prior to EK were found to develop postoperative CME within 6 months at a significantly higher rate (32 of 522) compared to those who had not undergone vitrectomy (17 of 522) (P = 0.0282; OR 1.94, 95% CI 1.063-3.539).ConclusionPrior vitrectomy appears to be associated with a greater incidence of postoperative CME after EK.

A case of acute Vogt-Koyanagi-Harada disease was evaluated using Ultra-widefield Optical Coherence Tomography Angiography (UWF-OCTA). UWF-OCTA enabled the detection of choroidal granulomas, providing widefield perfusion mapping that closely mirrors Indocyanine Green Angiography findings and supporting its role as a valuable adjunct imaging modality for the assessment of stromal inflammation.