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PRCIS A novel qualitative tomographical classification for bleb following implantation of XEN-Gel-Stent using ab-interno approach is presented. Association of anatomical patterns to IOP and success rates illustrates that AS-OCT can be useful tool in clinical guidance. PURPOSE To present a novel classification of bleb resulting from ab-interno implantation of XEN-Gel-Stent and report association of tomographical patterns with intraocular pressure (IOP) and success rates (SR). MATERIALS AND METHODS A cross-sectional one-armed study of patients receiving XEN-Gel-Stent. Tomographical changes in the bleb area were studied using swept-source optical coherence tomography in an early (day 29 to 90 post-surgery) and late (starting from day 91 post-surgery) phase. Frequency of patterns and their association with IOP and SR (defined as IOP

In glaucoma, macular optical coherence tomography (OCT) typically shows a thinning of the three inner segments and OCT-angiography (OCTA) a reduction of the vascular density (VD). It is still unclear if glaucoma directly affects macular VD. This retrospective study included 31 glaucoma patients of early and moderate stage (GS1, GS2, Mills et al.) and 39 healthy individuals. Macular segments’ thickness and superficial and deep plexus vascular density (VD) were obtained using spectral-domain OCT and OCTA, respectively. One-way analysis of variance (ANOVA) was used to compare healthy controls and glaucoma patients according to their glaucoma stage. Using correlation analyses, the association between glaucoma and either OCT or OCTA parameters was evaluated. A glaucoma stage-stratified linear regression analysis was then performed. Inner macular segment and whole retinal thickness were reduced in GS1 and GS2 patients compared to healthy controls (e.g., ganglion cell layer GCL: controls: 47.9 ± 7.4, GS1: 45.8 ± 5.1, GS2: 30.6 ± 9.4, ANOVA: p &lt, 0.0001). Regarding OCTA-parameters, the VD of both segmentation levels was reduced in glaucoma patients, particularly when comparing GS2 patients with controls (superficial plexus: p = 0.004) and GS2 with GS1 (p = 0.0008). Linear regression revealed an association between these parameters and the presence of glaucoma (for superior plexus: R2 = 0.059, p = 0.043). Finally, a correlation between macular segment thickness and VD was observed, but with a strength increasing with glaucoma severity (GCL and superior plexus VD: controls: R2 = 0.23, GS1 R2 = 0.40, GS2 R2 = 0.76). Despite the glaucoma-independent correlation between macular segment thickness and VD, disease severity strengthens this correlation. This consideration suggests that glaucoma directly influences OCT and OCTA parameters individually.

Purpose Cardiovascular risk factors such as hypertension or dyslipidemia can influence the incidence and progression of diabetic retinopathy (DR) and diabetic macular edema (DME). The aim of this study is to describe the comorbidities in patients with DME. Methods Prospective, monocentric observational study. Patients presenting for the treatment of DME received laboratory and clinical examinations including 24-hour blood pressure measurement. Results Seventy-five consecutive patients were included in the study. The mean age was 61.0 ± 14.5 years, and 83% had type 2 diabetes. The mean body mass index (BMI) was 32.8 ± 6.0 kg/m2. Overweight (BMI ≥ 25 kg/m2) was present in 92% of all patients. HbA1c values were > 7.0% in 57%. Although 87% of the patients already received antihypertensive therapy, the blood pressure (BP) of 82% was still above the recommended target values of systolic < 140 mmHg and diastolic < 80 mmHg. An insufficient nocturnal fall of the systolic BP (< 10%, non-dipping or reverse dipping) was observed in 62%. In 83% of the patients the glomerular filtration rate was ≤ 90 ml/min/1.73m2. Despite 65% of the cohort already receiving lipid-lowering therapy, LDL cholesterol was above the target value of 1.4 mmol/l in 93%. All patients had at least one cardiovascular risk factor in addition to diabetes (overweight, hypertension, insufficient nocturnal BP fall, dyslipidemia, or renal dysfunction) and 86% had ≥ 3 risk factors. Conclusion DME patients are characterized by highly prevalent cardiovascular risk factors that are poorly controlled. These comorbidities reduce the prognosis and negatively influence existing DR and DME. The data reveal an important opportunity for improving patient care by interaction of the ophthalmologist with the general practitioner and internal specialists for the detection and treatment of these conditions.

Simple Summary Optical coherence tomography (OCT) is an established ophthalmologic diagnostic tool to visualise vital retinal structures. In glaucoma, it is used to quantify the thickness decrease in the peripapillary retinal nerve fibre layer (pRNFL) and in the macula. While glaucoma management in adults incorporates traditional clinical parameters as well as instrumental methods such as OCT, guidelines for paediatric glaucoma focus on conventional methods. Even though some reports encouraging a broader use of OCT in children are present, its diagnostic potential in this particular population has still not been sufficiently analysed. To address this, the present study compares the glaucoma discriminative ability of OCT measurements of the pRNFL and macular layers in a paediatric population. The results indicate a reduction of the pRNFL and of inner macular layer thickness in glaucoma eyes, as well as a high correlation with the presence of glaucoma. The glaucoma discriminative ability can be maximised combining either all pRNFL sectors or the thickness results of the three innermost macular layers, even though sensitivity remains moderate. In conclusion, the OCT measurements of the pRNFL and macular thickness have a strong ability to diagnose paediatric glaucoma. However, OCT should be used in addition to conventional diagnostic tools rather than as a standalone method. Abstract Paediatric glaucoma leads to a decreased thickness of the peripapillary retinal nerve fibre layer (pRNFL) and of the macula. These changes can be precisely quantified using spectral domain-optical coherence tomography (SD-OCT). Despite abundant reports in adults, studies on the diagnostic capacity of macular SD-OCT in paediatric glaucoma are rare. The aim of this study was to compare the glaucoma discriminative ability of pRNFL and macular segment thickness in paediatric glaucoma patients and healthy children. Data of 72 children aged 5–17 years (glaucoma: 19 (26.4%), healthy: 53 (73.6%)) examined with SD-OCT (SPECTRALIS®, Heidelberg Engineering) were analysed retrospectively. The thickness of pRNFL sectors and of macular segment subfields were compared between diseased and healthy participants. Areas under the receiver-operating characteristic curves (AUC), sensitivity, and specificity from logistic regression were used to evaluate the glaucoma discriminative capacity of single and combined pRNFL and macular segments’ thickness. The results revealed a reduced thickness of the pRNFL and of the three inner macular layers in glaucoma patients, which correlates highly with the presence of glaucoma. The highest glaucoma discriminative ability was observed for the combination of pRNFL sectors or inner macular segments (AUC: 0.83 and 0.85, respectively), although sensitivity remained moderate (both 63% at 95% specificity). In conclusion, while confirmation from investigations in larger cohorts is required, SD-OCT-derived pRNFL and macular thickness measurements seem highly valuable for the diagnosis of paediatric glaucoma.

BACKGROUND To describe cases of retinal vascular events shortly after administration of mRNA or adenoviral-vectored COVID-19 vaccines. DESIGN Retrospective, multicenter case series. METHODS Six cases of retinal vascular events shortly after receiving COVID-19 vaccines. RESULTS A 38-year-old, otherwise healthy male patient presented with branch retinal arterial occlusion four days after receiving his second dose of SARS-CoV-2 vaccination with Comirnaty�� (BioNTech��, Mainz, Germany; Pfizer��, New York City, NY, USA). An 81-year-old female patient developed visual symptoms twelve days after the second dose of SARS-CoV-2 vaccination with Comirnaty�� and was diagnosed with a combined arterial and venous occlusion in her right eye. A 40-year-old male patient noticed blurry vision five days after his first dose of SARS-CoV-2 vaccination with Comirnaty�� and was diagnosed with venous stasis retinopathy in his left eye. A 67-year-old male was diagnosed with non-arteritic anterior ischemic optic neuropathy in his right eye four days after receiving the first dose of Vaxzevria�� (AstraZeneca��, Cambridge, UK). A 32-year-old man presented with a sudden onset of a scotoma two days after receiving the second dose of SARS-CoV-2 vaccination with Spikevax�� (Moderna, Cambridge, UK) and was diagnosed with a circumscribed nerve fiber infarction. A 21-year-old female patient developed an acute bilateral acute macular neuroretinopathy three days after receiving the first dose of SARS-CoV2-vaccine Vaxzevria�� (AstraZeneca��, Cambridge, UK). CONCLUSION This case series describes six cases of retinal vascular events shortly after receiving mRNA or adenoviral-vectored COVID-19 vaccines. The short time span between received vaccination and occurrence of the observed retinal vascular events raises the question of a direct correlation. Our case series adds to further reports of possible side effects with potential serious post-immunization complications of COVID-19 vaccinations.

Mael Lever,1 Jan Darius Unterlauft,2 Christian Halfwassen,1 Nikolaos E Bechrakis,1 Anke Manthey,1 Michael RR Böhm1 1Department of Ophthalmology, University Hospital Essen, Essen, Germany; 2Department of Ophthalmology, University Hospital Leipzig, Leipzig, GermanyCorrespondence: Mael LeverDepartment of Ophthalmology, University Hospital Essen, Hufelandstr. 55, Essen 45147, GermanyTel +49 201 723 2900Fax +49 201 723 5917Email mael.lever@uk-essen.dePurpose: Diagnostic 24-hour intraocular pressure curves(IPC) are well established in the management of glaucoma. However, objective criteria for the IPC indication are lacking. The aim of this study was to evaluate the impact of individual patient characteristics and glaucoma-related parameters on therapy decisions after IPC and thus examine their relevance for glaucoma management.Patients and Methods: Retrospective analysis of adult primary open-angle glaucoma (POAG) patients who underwent an IPC (≥ 6 IOP measurements in 24 hours). The main exclusion criterion was previous IOP-lowering surgery. IPC-dependent (eg, mean and peak IOP) and IPC-independent parameters (eg, perimetry, RNFL thickness) were analyzed in relation to the therapeutic decision after IPC. Further, these parameters were compared in patient subgroups based on age, glaucoma stage, or therapy intensity.Results: A total of 101 eyes of 101 patients were included. In general, mean and peak IOP were elevated in patients with a therapeutic change after IPC. These subjects presented differences of IPC-independent parameters (eg, IOP at admission, RNFL thickness, glaucoma stage). Regression analysis results suggested a predictive role of IPC-independent parameters for IPC therapeutic decisions. In subgroups of patients of older age or advanced glaucoma, IPC-independent parameters did not correlate with therapeutic decisions after IPC.Conclusion: These results support the relevance of IPC in the therapeutic management of POAG. Moreover, the study promotes a personalized classification of patients using selected glaucoma characteristics to objectivize their individual benefit from IPC. Further prospective studies are needed to verify the utility of these parameters and IPC in the management of glaucoma.Keywords: glaucoma management, IOP phasing, diagnostic, antiglaucomatous therapy