We report a novel surgical approach for managing late hypotony in PreserFlo MicroShunt blebs. Hypotony is a well-known complication of glaucoma filtering surgery, yet treatment options for late-onset cases remain limited. We describe two cases of uveitic glaucoma presenting with hypotony several months after PreserFlo implantation. Both patients were successfully treated with a bleb-modifying procedure. Under local anaesthesia, several interrupted 10-0 nylon sutures were placed in the bleb region to reduce its size and sectorise it, creating an iatrogenic 'ring of steel' that effectively corrected overfiltration. This technique appears to be a feasible and potentially effective option for managing late hypotony.

Semaglutide-associated non-arteritic anterior ischaemic optic neuropathy (NAION) mechanisms are unclear. We report a 28-year-old man with type 2 diabetes who developed right NAION 4-5 months after starting semaglutide. Multimodal imaging confirmed NAION and bilateral buried optic disc drusen. The affected eye was short, whereas the fellow eye was highly myopic and longer. Serial bioimpedance showed a 1.9 L decline in total body water over 7 weeks, with preserved fat mass and stable extracellular-to-total-body-water (ECW/TBW) ratio. We propose a hypothesis-generating 'two-hit' model in which anatomical susceptibility and sustained hypohydration together precipitate NAION. Heightened clinical awareness may be warranted and prospective studies are required.

Ophthalmology manages a substantial share of its patients through prolonged observation, spanning nearly every subspecialty, from choroidal nevi and glaucoma suspects to optic disc drusen and diabetic retinopathy. Yet surveillance schedules rarely face the scrutiny of cost, benefit and harm demanded of treatment. This article reframes observation as an intervention in its own right, with direct costs, patient burden, psychological harm and downstream testing cascades that are seldom quantified when monitoring protocols are created. It introduces the concept of surveillance inertia, whereby protocols specify when to start watching but rarely when to stop, and proposes a Surveillance Value Assessment built around six questions: number needed to observe (NNO), incremental cost-effectiveness, patient burden, downstream cascade, stopping rules and actionability and time-sensitivity. NNO is offered as a surveillance analogue of number needed to treat. Drawing on models from oncology and radiology, where structured risk-stratified surveillance with explicit exit criteria is already established, the article contends that ophthalmology should connect its existing risk-prediction tools to explicit surveillance-value metrics and define its own standards before external payers impose them.