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Objective: We describe a patient affected by congenital stationary night blindness (CSNB) secondary to CACNA1F and optic neuropathy associated with an AFG3L2 variant. Methods: We performed comprehensive neuro‐ophthalmologic examinations, retinal imaging, complete ocular electrophysiology, and brain and optic nerve MRI. Genomic DNA was extracted from the peripheral blood. The patient's DNA was then investigated by next‐generation sequencing (NGS) with a panel including 32 genes associated with retinal dystrophy and therefore with a panel including seven genes associated with genetic forms of optic atrophy. Results: The genetic analysis identified a pathogenetic CACNA1F variant causing CSNB and a heterozygous variant in AFG3L2 that alters OPA1 processing and is known to be associated with OPA1‐like optic neuropathy. Conclusion: Optic disc atrophy has been previously described as an atypical feature in the phenotype of CSNB CACNA1F‐related. In this patient, we found a variant of the AFG3L2 gene that presumably explains the presence of optic atrophy in a subject affected by CSNB. Clinical Relevance: The clinical evidence of optic atrophy, which is atypical in CSNB, should raise the suspicion of concomitant hereditary optic neuropathy and emphasize the importance of broad genetic diagnostic testing to better define the genotype–phenotype correlation. [ABSTRACT FROM AUTHOR]

Background and Objective: This study evaluated the efficacy and durability of faricimab in patients with neovascular age-related macular degeneration (nAMD) who were previously treated with anti-vascular endothelial growth factor (anti-VEGF) agents. Patients and Methods: This retrospective case series was conducted at a single tertiary center in the United States. It focused on nAMD patients who transitioned to faricimab after initial anti-VEGF therapy, with a follow-up period of at least 9 months. "Complete dryness" was defined as the absence of intra- and/or subretinal fluid on optical coherence tomography. Durability was gauged by the extension of treatment intervals relative to the injection frequency of the previous agent. Results: Sixty-two eyes from 62 patients were included. Treatment interval ranged from 5 to 10 weeks; 10 (16%) patients were able to be extended by 2 or more weeks compared to their previous regimen. Median (interquartile range [IQR]) central field thickness was 310 μm (254, 376) on initiating faricimab and declined by the ninth month (P values at 3, 6, and 9 months were 0.01, 0.02, and 0.07, respectively). Median (IQR) visual acuity at initiation of faricimab was 0.4 (0.20, 0.50) and did not change by the ninth month. Complete anatomical dryness was present in 10 (16%) eyes before switching; 90% remained dry at 9 months. Of 52 (84%) incompletely dry eyes before switching, 15% achieved complete dryness by 9 months on faricimab. Conclusions: Faricimab modestly improved the treatment intervals for a small proportion of previously treated patients on anti-VEGF therapy. [Ophthalmic Surg Lasers Imaging Retina 2024;55:504–509.] [ABSTRACT FROM AUTHOR]

Objective: To describe the morphological and histopathological features of primary conjunctival basal cell carcinoma (BCC) in a young adult Filipino. Introduction: Malignant conjunctival tumors arise from different cells, the most common of which are squamous cell carcinomas (SCCs), (including ocular surface squamous neoplasia [OSSN]), melanomas, and lymphomas. Primary conjunctival BCC is rare and can mimic the clinical features of OSSN. Only seven reported cases were published. Most cases are in the 6th–8th decades of life, and we report the first case in a young adult male. Case Summary: A 37/M, HIV‐seronegative, presenting with a 3‐year history of enlarging fleshy, pedunculated mass on the right eye measuring 8.5 mm × 8.0 mm at the superonasal limbus encroaching on the cornea, with prominent feeder vessels. Whitish‐to‐grayish plaques were observed on the surface of the lesions. Wide excision of the mass using the no‐touch technique was performed under local anesthesia. Four cycles of mitomycin C (0.02%) were administered as chemoadjuvant therapy. Histopathology showed basaloid cells with peripheral palisading, most consistent with BCC. Immunohistochemistry was positive for Bcl‐2 and CD10 markers and negative for epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), confirming conjunctival BCC. Eight weeks postoperatively, fibrovascular tissue proliferation was noted at the excision site. Anterior segment‐optical coherence tomography (AS‐OCT) revealed a thickened hyperreflective band that was continuous with the epithelium, indicating possible recurrence. Resection with rush frozen section revealed fibrotic tissue that was negative for tumor cells. The bare sclera was covered with conjunctival autograft. There was no recurrence of the lesion after 16 months of follow‐up. Conclusion: Primary BCC of the conjunctiva is rarely encountered, especially in young individuals, mimicking squamous neoplasia both in morphology and histopathology. Therefore, this should be considered in the differential diagnosis of OSSN. Immunostaining is crucial in differentiating between the two conditions and confirming the diagnosis. In most cases, wide surgical excision is sufficient. In addition, adjuvant therapies may be beneficial in preventing tumor recurrence. [ABSTRACT FROM AUTHOR]

ObjectiveTo determine whether, as most modern historians have written, ancient Greco-Roman authors believed the crystalline lens is positioned in the center of the eye.BackgroundHistorians have written that statements about cataract couching by Celsus, or perhaps Galen of Pergamon, suggested a centrally located lens. Celsus specifically wrote that a couching needle placed intermediate between the corneal limbus and the lateral canthus enters an empty space, presumed to represent the posterior chamber.MethodsAncient ophthalmic literature was analyzed to understand where these authors believed the crystalline lens was positioned. In order to estimate where Celsus proposed entering the eye during couching, we prospectively measured the distance from the temporal corneal limbus to the lateral canthus in 30 healthy adults.ResultsRufus of Ephesus and Galen wrote that the lens is anterior enough to contact the iris. Galen wrote that the lens equator joins other ocular structures at the corneoscleral junction. In 30 subjects, half the distance from the temporal corneal limbus to the lateral canthus was a mean of 4.5 mm (range: 3.3-5.3 mm). Descriptions of couching by Celsus and others are consistent with pars plana entry of the couching needle. Anterior angulation of the needle would permit contact of the needle with the lens.ConclusionAncient descriptions of anatomy and couching do not establish the microanatomic relationships of the ciliary region with any modern degree of accuracy. Nonetheless, ancient authors, such as Galen and Rufus, clearly understood that the lens is located anteriorly. There is little reason to believe that Celsus or other ancient authors held a variant understanding of the anatomy of a healthy eye. The notion of the central location of the lens seems to have arisen with Arabic authors in 9th century Mesopotamia, and lasted for over 7 centuries.