We report 18 years of follow-up in a middle-aged Caucasian woman with retinitis pigmentosa (RP) and a non-tractional full-thickness macular hole (FTMH). The case was initially reported after 3 years of observation; this update provides a further 15 years of follow-up and, to our knowledge, represents the longest documented natural history of spontaneous FTMH closure in RP.At presentation, spectral-domain optical coherence tomography (SD-OCT) demonstrated a right-eye FTMH without vitreomacular traction. The patient elected conservative management with serial monitoring. The FTMH subsequently closed spontaneously, leaving a stable lamellar configuration that has remained anatomically unchanged without recurrence for almost two decades. Visual acuity gradually declined, likely due to progressive retinal degeneration and cataract progression, while OCT confirmed long-term foveal stability.This case demonstrates that spontaneous closure of a non-tractional FTMH in RP, although rare, can remain stable in the long term, supporting careful observation in selected patients.

Stickler syndrome, first described by Günnar Stickler in the United States in 1965 as "progressive hereditary arthro-ophthalmopathy", is classified by ophthalmologists as a rare hereditary vitreoretinopathy of connective tissue. Thanks to advances in molecular genetics, different subtypes of the syndrome are now recognized. Its prevalence at birth has been estimated to be between 1 in 7500 and 1 in 10,000. Stickler syndrome is a rare genetic disorder, specifically a multi-system collagenopathy. It is characterized by ocular abnormalities such as severe congenital myopia, cataracts, and retinal detachment, as well as systemic anomalies including craniofacial, auditory, and musculoskeletal (joint) issues. It is primarily caused by mutations in genes encoding various types of collagen and can be inherited in either an autosomal dominant or autosomal recessive pattern. However, this syndrome is both phenotypically and genotypically heterogeneous, which makes recognition and diagnosis challenging. Genetic testing can confirm the diagnosis. Management and regular clinical monitoring of the patient by specialists such as ophthalmologists, ENT (ear, nose, and throat) doctors, physical medicine and rehabilitation specialists, and, if necessary, orthopedic surgeons are essential to prevent secondary complications. Additionally, support from pain management or palliative care teams may be required. However, primary care physicians are often unfamiliar with the symptoms of Stickler syndrome or its potential complications, including blindness and deafness. The goal of consultations is to confirm the diagnosis, rule out other differential diagnoses, identify complications, and optimize care in the ophthalmological, ENT, rheumatological, and physical medicine and rehabilitation fields, as well as in orthopedic surgery, with the possibility of consulting pain management or palliative care specialists as necessary. The objective of this National Protocol for Diagnosis and Management (PNDS) is to present healthcare professionals with the most current and optimal diagnostic and therapeutic management strategies, as well as to standardize and improve patient care across the healthcare system.

Intraocular lens (IOL) implantation is widely performed, but poor adherence to traditional eye drop therapy and low drug bioavailability increase the risk of postoperative inflammation and infection. Although many drug delivery strategies have been proposed, in vivo evidence is limited, and scalability remains a key challenge for clinical use. In this study, we introduce a compact dexamethasone (DXM)-loaded IOL fabricated through a simple, low-cost, one-step process by embedding DXM within a biocompatible polydimethylsiloxane (PDMS)-based polymer matrix. The DXM-loaded IOL was evaluated in in vitro assays and in seven New Zealand-California White rabbits undergoing cataract surgery, with the DXM-loaded IOL implanted in the right eye and a nonloaded IOL used as a control in the left eye. Aqueous humor samples were collected at different time points to assess prostaglandin E2 (PGE2) levels as an inflammatory biomarker, as well as DXM release. Drug release ranged from 31% to 99% (2.1-8.5 μg), and PGE2 levels were lower in eyes implanted with the DXM-loaded IOL than in control eyes, indicating reduced inflammation. In conclusion, we present a preclinical validated prototype of a dual-function IOL that maintains visual performance and reduces postoperative inflammation.

Modeling the three-dimensional geometry of the optical surfaces of the human eye has important applications, including thestudy of myopia and presbyopia, as well as the planning of cataract surgery. In this paper, we present the Eigeneyes, astatistical shape model of the complete three-dimensional geometry of the human eye based on principal component analysis(PCA). The model was constructed from 572 Optical Coherence Tomography eye scans in which the cornea, crystallinelens, and retina were visible. Eigeneyes captures geometric variability across ocular structures using a small number ofcoefficients that represent global modes of variation. Eigeneyes achieved a statistically significantly lower reconstruction errorthan other state-of-the-art methods while using fewer parameters. Furthermore, the Eigeneye coefficients were modeled withina multivariate probabilistic framework, enabling the generation of realistic synthetic eyes conditioned on age and/or axial length.

Minimal change disease (MCD) is the leading cause of idiopathic nephrotic syndrome in children, accounting for >85% of cases in those aged 1-12 years. Although 80%-90% of patients achieve initial remission with glucocorticoids, steroid dependence or frequent relapses occur in 55%-60% of cases, necessitating prolonged immunosuppression. Long-term steroid exposure in children is associated with severe age-specific adverse events, including growth retardation, skeletal dysplasia, cataracts, and impaired vaccine responses from immunosuppression. Steroid resistance and chronic kidney disease may also develop in some patients. Recent clinical evidence and literature (2015-2025) have transformed our understanding of MCD from the traditional "single T cell-driven" hypothesis to a multidimensional interactive regulatory network. This network is based on coordinated T- and B-cell dysregulation, mediated by defined podocyte injury pathways and modulated by genetic and environmental factors. Distinct pediatric traits stem from immature immune system development and pediatric podocyte plasticity. In this review, we synthesize recent advances in these pediatric pathogenic mechanisms, delineate age-dependent differences between childhood and adult MCD, and propose a precision medicine framework for disease subtyping, noninvasive biomarker development, and targeted therapies. This work addresses critical unmet clinical needs in the long-term management of pediatric MCD.

Delayed presentation remains a major contributor to visual impairment and blindness across diverse ophthalmic diseases, particularly in resource-limited settings where barriers to timely eye care remain substantial. Although advanced disease at presentation is widely recognized clinically, the broader biologic, neurodegenerative, developmental, surgical, and health systems consequences of delayed ophthalmic care have received comparatively less integrated attention. We examine delayed ophthalmic presentation as a multidimensional process that may influence inflammatory activity, ischemic injury, fibrosis, neurodegeneration, tissue remodeling, therapeutic responsiveness, and long-term visual outcomes across ophthalmic subspecialties. We further evaluate the clinical implications of delayed presentation in glaucoma, cataract, retinal disease, microbial keratitis, ocular trauma, pediatric ophthalmology, and ocular oncology, while examining the socioeconomic, geographic, behavioral, and health system determinants that contribute to delayed care. Emerging context responsive strategies involving decentralized ophthalmic services, teleophthalmology, integrated referral systems, and earlier disease detection are also discussed. Delayed ophthalmic presentation should therefore be considered not merely as a temporal delay in healthcare seeking behavior, but as a complex biologic and systems level determinant of ophthalmic disease progression and visual prognosis.

Manual Small-Incision Cataract Surgery (SICS) is a prevalent technique in low- and middle-income countries (LMICs). Automated analysis of SICS videos based on artificial intelligence (AI) would benefit self-evaluation, training, monitoring, and ultimately facilitate computer aided surgical assistance. However, this procedure remains understudied in terms of automated surgical analysis due to a lack of publicly available data. To advance this field, we organized the SICS-155 phase recognition challenge at MICCAI 2025. It was based on a dataset with 155 videos recorded at Sankara Eye Hospital in Bengaluru, India with an average duration of 13:05 minutes, annotated with 19 distinct surgical phases. In this work, we first present the results and findings of that challenge in accordance with the BIAS guidelines. Second, we integrated key technical innovations from the participating teams to develop a new, state-of-the-art approach for phase recognition in a post-operative, offline setting. This approach uses a boundary-aware FACT architecture, which we evaluated using videos of both SICS and phacoemulsification. Our approach achieved an accuracy of 87.98% [95%-CI: ±2.06], an edit score of 90.80% [95%-CI: ±1.47], and a segmental F1-score of 89.56% [95%-CI: ±1.92] on the SICS-155 challenge dataset, as well as an accuracy of 97.61%/ 93.36%, a precision of 98.42%/ 95.27%, and a recall of 97.97%/ 93.32% on the Cataract-101 phacoemulsification public dataset (depending on the data split). Building on these promising results, our future work will investigate potential real-time quality assessment and complication recognition in SICS and facilitate the development of clinical training and surgical quality monitoring software for ophthalmologists in LMICs.