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Purpose: This study aimed to assess the effectiveness of monocular and bilateral injections of Dexamethasone-21-acetate (Dex-21-Ac) into the murine fornix twice a week as a glucocorticoid-induced ocular hypertension model and investigated potential systemic side effects., Methods: Dex-21-Ac was administered twice weekly in three groups: bilateral injections, monocular injections, and a control group receiving the vehicle solution bilateral. After 21 days, enucleated eyes were examined using immunocytochemistry (ICC), and organ histology was performed., Results: All groups receiving Dex-21-Ac injections had a significant increase in intraocular pressure (IOP). Monocular injections also resulted in a significant increase in IOP in the fellow eye. The Dex-21-Ac-treated groups showed a bilateral increase in IOP of approximately 8 mmHg, accompanied by elevated expression of alpha smooth muscle actin and fibronectin in the anterior chamber angle. There were no significant changes in weight progression. Hepatic steatosis was observed in all Dex-21-Ac-treated animals, and some suffered from residual neuromuscular blockade under fentanyl anesthesia., Conclusion: Bilateral injections of Dex-21-Ac twice a week lead to a significant increase in daytime IOP and fibrotic changes in the trabecular meshwork. Unilateral application has a significant impact on the fellow eye. Local dexamethasone leads to notable systemic effects independent of changes in animal weight. Considering liver damage and associated influence on metabolization, hepatically eliminated injection anesthetics may lead to overdosing and are not recommended. They should be replaced by inhalation anesthesia.

Purpose: Given the current scenario of increased smartphone use in youth, this study aims to evaluate the proportion of ocular symptoms and binocular dysfunction and their association with smartphone use in adolescents through a hospital-based cross-sectional study., Methods: The participants were asked to fill out questionnaires related to smartphone use and symptoms of eyestrain experienced (Balik et al. and Kucer). They were asked about the following seven symptoms: blurring of vision, redness, visual disturbance, secretion, inflammation, lacrimation, and dryness. Each symptom out of the 7, was scored on a scale of 0-1 and was used to calculate an Ocular Symptom Score (OSS) by summing the scores of each symptom.Depending upon the duration of smartphone usage, the participants were classified into four groups: <2 hours/day, 2-4 hours/day, 4-6 hours/day, and >6 hours/day. Binocular functions were assessed using near point of convergence (NPC), near point of accommodation (NPA), Accommodative convergence/Accommodation (AC/A) ratio, dissociated heterophoria, and binocular accommodative facility (BAF)., Results: A total of 123 smartphone user adolescents, aged 10-19 years were included in this study. The mean age of the study population was 16.58 + 2.8 years, out of which 52.03% were males. Prevalence of ocular symptoms was higher in groups with greater duration of smartphone use (2 to 4, 4 to 6, and >6 hours/day as compared to <2 hours/day: 90.48%, 94.74%, 100% vs. 75% respectively). The mean of NPC was 8.51, it was highest in subjects using smartphones for >6 hours. ( p -value = .001). The mean AC/A ratio was 2.83 + 1.03: 1. A low AC/A ratio was associated with a longer duration of smartphone usage ( p -value = .0001). The mean of BAF was 7.4 + 3.18 cycles/min, only 30 (24.4%) participants had BAF beyond the normal range (<5 cycles/min). The mean of BAF was lowest in the group with >6 hours/day of smartphone use ( p -value < .0001). No significant change was found in NPA and dissociated heterophoria with the duration of smartphone usage., Conclusion: Higher duration of smartphone use (>2 hours/day) is associated with various ocular symptoms and binocular dysfunction. However, additional research is necessary to authenticate the results of the study.

Purpose: To evaluate the repeatability of the Zernike coefficients in healthy eyes when monocular accommodation was stimulated at different vergences demands., Methods: A total of 36 right eyes from healthy volunteers were prospectively and consecutively recruited for this study. Wavefront aberrometry was conducted to objectively characterize the ocular optical quality during accommodation, from the individual's far point to a 5 D accommodation demand in steps of 0.5 D. The repeatability of Zernike coefficients up to the fourth order was assessed by calculating the within-eye repeatability ( Sw ), the coefficient of repeatability ( CR ), the coefficient of variation ( CV ), and the intraclass correlation coefficient ( ICC ) as an indicator of measurement reliability., Results: Correlation among repeated measurements showed high reliability (ICC > 0.513) for all parameters measured except some fourth-order Zernike coefficients, C(4, -4) (ICC < 0.766), C(4, -2) (ICC < 0.875), C(4, 2) (ICC < 0.778) and C(4, 4) (ICC < 0.811). Greater repeatability and less variability were obtained for high-order Zernike coefficients (CR < 0.154), although an increase in CR in the coefficients analyzed was observed with increasing accommodative demand. No clear trend was evident in CV; however, it was observed that the low-order Zernike coefficients exhibit lower CV (CV < 1.93) compared to the high-order Zernike coefficients (CV > 0)., Conclusions: The reliability of Zernike coefficients up to the fourth order in healthy young individuals demonstrated a strong consistency in measuring terms up to the fourth order, with more variability observed for high-order terms. The Zernike coefficients up to the third order exhibited the highest level of repeatability.

Prcis: Central lamina cribrosa thickness (LCT) was found to be higher in eyes with ocular hypertension (OHT) compared with primary open angle glaucoma (POAG) and healthy controls (HCs)., Objective: To evaluate the anatomic features of lamina cribrosa (LC) and the optic disc (OD) using swept-source optical coherence tomography (OCT) in eyes with OHT., Materials and Methods: Treatment naive eyes with OHT and POAG and healthy eyes were included. All eyes underwent a complete ophthalmological examination in addition to swept-source OCT of the OD. Anatomic features of LC, including central LCT, LC depth, prelaminar depth (PLD), and prelaminar tissue thickness, were measured manually using the internal caliper function of the OCT device and compared within groups. OD ovality, disc-foveal angle, and OD torsion were measured on colored photographs, using imageJ software., Results: Seventy-one eyes of 37 patients in the OHT group, 41 eyes of 26 patients in the POAG group, and 30 eyes of 30 patients in the HC group were enrolled in the study. Groups were similar in age and sex distribution. Central LCT was significantly higher in the OHT group, compared with HCs (333.8 ± 50.5 vs 304.5 ± 46.3 µm, P = 0.02) and POAG group (286.7 ± 140.4, P = 0.001). PLD and LC depth were both highest in POAG (282.3 ± 145.5 µm and 471.3 ± 195.2 µm), followed by OHT (244.8 ± 30.2 µm and 440.7 ± 18.7 µm) and HCs (170.1 ± 152.6 µm and 412.8 ± 80 µm), only the difference between POAG and HCs in PLD was statistically significant ( P = 0.03). Prelaminar tissue thickness, OD torsion, disc-foveal angle, and disc ovality showed no significant difference., Conclusion: LC was significantly thicker in eyes with OHT, compared with POAG and HCs. This finding may be relevant to optic nerve protection from high intraocular pressure in patients with OHT., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Importance: This was the first study, to the authors' knowledge, to statistically evaluate the predictive accuracy of Collaborative Ocular Tuberculosis Study (COTS) calculator in guiding initiation of antitubercular therapy (ATT) in patients with clinically suspicious tubercular uveitis (TBU) in an international cohort., Objective: To evaluate the accuracy of a score of 4 or greater on the online COTS calculator in recommending ATT initiation., Design, Setting, and Participants: This study was an evaluation of a diagnostic test or technology. Data input required for the COTS calculator were extracted from the COTS-1 study dataset, which comprised retrospective, observational records of patients with TBU who were monitored for 12 months after treatment. Patients were recruited from international ophthalmic centers. In the absence of a traditional criterion standard, the 12-month treatment response to ATT was used to classify patients as disease positive or negative. The accuracy of clinicians at the ATT decision-making stage in the COTS-1 study was set against COTS calculator scores of 4 or greater. Diagnostic accuracy metrics, including sensitivity, specificity, positive predictive value (PPV), precision, recall, and F1 score, were computed. Data collected from January 2004 to December 2014 were analyzed., Exposures: COTS calculator to guide initiation of ATT in patients with TBU., Main Outcomes and Measures: Comparison of accuracy between clinician judgment and the COTS calculator, analyzed at varying scores and further stratified by tuberculosis endemicity., Results: Of the 492 participants (mean [SD] age, 42.3 [19.0] years; 233 male [47.3%]), application of the COTS calculator identified 225 (45.7%) with high or very high probability to start ATT (score = 4 or 5) and 111 (22.5%) with very high probability alone (score = 5). COTS-5 exhibited the highest specificity (88.7%; 95% CI, 81.4%-93.8%) compared with clinician judgment (29.6%; 95% CI, 21.4%-38.8%), and clinician judgment led in sensitivity (95.5%; 95% CI, 92.9%-97.4%) compared with COTS-5 (26%; 95% CI, 21.6%-30.7%). COTS-4 and COTS-5 balanced specificity (64.3%; 95% CI, 54.9%-73.1%) and sensitivity (48.8%; 95% CI, 43.7%-54%). PPV and sensitivity were consistently higher in the endemic group for all 3 tests., Conclusions and Relevance: Results of this diagnostic study suggest that the COTS calculator (score ≥4) was more specific than clinician judgment for ATT initiation. Although clinician judgment is a good first step to identify all potential true positives (with high sensitivity), a second consultation with COTS-5 (with high PPV) may lead to less false positives. This tool, apt for high-prevalence, low-resource settings, recommends ATT more selectively for genuine TBU cases. Large prospective studies are essential to explore potential improvements in the calculator's sensitivity.

PURPOSE: With the growing popularity of badminton worldwide, the incidence of badminton-related ocular injuries is expected to rise. The high velocity of shuttlecocks renders ocular traumas particularly devastating, especially with the possibility of permanent vision loss. This study investigated the mechanism behind ocular complications through simulation analyses of mechanical stresses and pressures upon shuttlecock impact. DESIGN: Computational simulation study. PARTICIPANTS: None. METHODS: A 3-dimensional human eye model was reconstructed based on the physiological and biomechanical properties of various ocular tissues. Finite element analysis simulations involved a frontal collision with a shuttlecock projectile at 128.7 km/hour (80 mph). Intraocular pressure (IOP) changes and tissue stress were mapped and quantified in the following ocular structures: the limbus, ciliary body, zonular fibers, ora serrata, retina, and optic nerve head. MAIN OUTCOME MEASURES: Intraocular pressure and tissue stress. RESULTS: Upon shuttlecock impact, compressive force was transferred to the anterior pole of the cornea, propagating posteriorly to the optic nerve head. Deflection of forces anteriorly contributed to refractory oscillations of compressive and tensile stress of ocular tissue. Initial impact led to a momentary (

Background/aims: Topical agents to lower intraocular pressure (IOP) are the most common initial therapeutic measure in glaucoma prevention. This study aims to assess treatment success duration among patients initiating or intensifying topical glaucoma medication., Methods: Medical records (2013‒2018) for adults initiating/intensifying topical glaucoma medication were extracted from five secondary-care and tertiary-care UK ophthalmology centres. Main study outcomes were time from treatment initiation/intensification to treatment failure (<20% IOP reduction or IOP >21 mm Hg at consecutive clinic visits, or intensification of glaucoma treatment) and time from treatment change to subsequent treatment intensification., Results: Study eyes (n=6587) underwent treatment intensification 0-to-1 glaucoma drop (5358 events), 1-to-2 drops (1469 events) and 2-to-3 drops (857 events) during the observation period. Median time to treatment failure was 1.60 (95% CI 1.57 to 1.65), 1.00 (95% CI 0.94 to 1.07) and 0.92 (95% CI 0.81 to 1.02) years following escalation 0-to-1, 1-to-2 and 2-to-3 drops, respectively. Median time to treatment intensification (non-IOP-based criterion) was 4.68 (95% CI 4.50 to 5.08) years for treatment initiators, 3.83 (95% CI 3.36 to 4.08) years on escalation 1-to-2 drops and 4.35 (95% CI 3.82 to 4.88) years on escalation 2-to-3 drops. On multivariable regression, significant risk factors for both treatment failure and intensification were lower baseline visual field mean deviation, primary open-angle glaucoma and lower eyedrop count in the fellow eye; lower baseline IOP was associated with treatment failure, higher baseline IOP with treatment intensification., Conclusion: Large-scale survival analyses provide the expected duration of treatment success from topical glaucoma medication., Competing Interests: Competing interests: DJF reports consultancy fees/travel expenses from Allergan; AIM reports consultancy fees/travel expenses from Aerie, Allergan, Novartis, Pfizer, Thea and Visufarma UK; APK reports consultancy/lecture fees/travel expenses from Aerie, Allergan, Google Health, Grafton Optical, Novartis, Santen and Thea; EA is an employee of AbbVie Inc.; VS was an employee of AbbVie Inc. at the time of the study., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Selective laser trabeculoplasty (SLT) is becoming the recommended first choice in the treatment of open-angle glaucoma (OAG). However, whether repeat SLT can be recommended regardless of initial response remains controversial., Objective: To assess the potential of OAG and ocular hypertension (OHT) undergoing repeat laser to respond favorably to SLT, termed responsiveness to SLT., Design, Setting, and Participants: This post hoc analysis of the Laser in Glaucoma and Ocular Hypertension Trial in China (LiGHT China) was conducted from March 2015 to April 2023 in Zhongshan Ophthalmic Center. Of 1376 newly diagnosed OAG and OHT eyes of 771 adults in the original trial, 180 eyes of 105 participants were included in the present study, which underwent initial and repeat SLT as primary treatments., Exposures: Standard SLT was the primary treatment. Repeat SLT was the first choice of treatment escalation regardless of initial response. IOP reduction after SLT and the duration of effect were analyzed. The maximum reduction in IOP within 2 years after initial SLT and repeat SLT was used to identify potential nonresponsiveness., Main Outcomes and Measures: IOP reduction 2 months after SLT., Results: A total of 180 eyes from 105 Chinese participants (mean [SD] age, 45.6 [14.5] years; 58 [55.2%] male and 47 [44.8%] female) underwent repeat SLT. Initial SLT and repeat SLT were both associated with a reduction in IOP (mean, 4.5 mm Hg; 95% CI, 3.9 to 5.1; P < .001 and mean, 3.3 mm Hg; 95% CI, 2.7 to 3.8; P < .001, respectively). The mean (SD) IOP after repeat SLT was 15.8 (3.4) mm Hg, similar to 16.0 (4.0) mm Hg after initial SLT (difference, -0.4mm Hg; 95% CI, -1.0 to 0.3; P = .24). Duration of effect after repeat SLT was longer than after initial SLT (1043 days vs 419 days; hazard ratio, 0.38; 95% CI, 0.29 to 0.50; P < .001). IOP reduction after initial SLT was uncorrelated with that after repeat SLT, and 153 eyes (85.0%) responded favorably to SLT at least once. A subset of 27 eyes (15.0%) was identified as potentially nonresponsive and found distinctive with older age (mean [SD], 54.1 [12.5] years vs 44.2 [14.2] years; difference, 10.5 years; 95% CI, 2.9 to 18.1; P = .009), higher proportion of female participants (difference, 27.5%; 95% CI, 3.6 to 51.5; P = .03), and lower baseline IOP (difference, -3.2 mm Hg; 95% CI, -5.2 to -1.3; P = .001)., Conclusions and Relevance: These post hoc analyses showed that most cases of OAG and OHT were highly responsive to SLT and support the consideration of repeat SLT regardless of initial response, while individuals who are nonresponsive to this treatment may have specific features.

Purpose: The purpose of this study was to determine the minimum number of orthonormal basis functions, applying Principal Component Analysis (PCA), to represent the most wavefront aberrations at different accommodation stages. The study also aims to generate synthetic wavefront data using these functions., Methods: Monocular wavefront data from 191 subjects (26.15 ± 5.56 years old) were measured with a Hartmann-Shack aberrometer, simulating accommodation from 0 diopters (D) to 5 D in 1 D steps. The wavefronts for each accommodative demand were rescaled for different pupil sizes: 4.66, 4.76, 4.40, 4.09, 4.07, and 3.68 mm. PCA was applied to 150 wavefront parameters (25 Zernike coefficients × 6 accommodation levels) to obtain eigenvectors for dimensional reduction. A total of 49 eigenvectors were modeled as a sum of 2 multivariate Gaussians, from which 1000 synthetic data sets were generated., Results: The first 49 eigenvectors preserved 99.97% of the original data variability. No significant differences were observed between the mean values and standard deviation of the generated and original 49 eigenvectors (two one-sided test [TOST], P > 0.05/49) and (F-test, P > 0.05/49), both with Bonferroni correction. The mean values of the generated parameters (1000) were statistically equal to those of the original data (TOST, P > 0.05/150). The variability of the generated data was similar to the original data for the most important Zernike coefficients (F-test, P > 0.05/150)., Conclusions: PCA significantly reduces the dimensionality of wavefront aberration data across 6 accommodative demands, reducing the variable space by over 66%. The synthetic data generated by the proposed wavefront model for accommodation closely resemble the original clinical data.

Purpose: To report long-term ocular alignment and sensory outcomes after medial rectus recession for high accommodative convergence/accommodation (AC/A) ratio esotropia., Methods: The medical records of consecutive patients who had undergone unilateral or bilateral medial rectus recession for high AC/A ratio esotropia and were observed postoperatively for a minimum of 5 years were reviewed retrospectively., Results: A total of 34 patients were included. Twenty-three patients (68%) used bifocals preoperatively. The mean age at surgery was 11.5 ± 4.4 years (range: 2.5 to 19.0 years). The mean postoperative follow-up was 7.5 ± 2.3 years (range: 5.0 to 15.25 years). Overall, 21 patients (62%) had surgical success at their last follow-up visit. Age at surgery, preoperative angle of distance and near deviation, distance-near disparity, and preoperative bifocal wear did not predict motor outcome after surgery. Preoperative presence of peripheral binocular single vision was a significant favorable factor for surgical success. At the last follow-up visit, 21% of patients had a recurrence of high AC/A ratio esotropia and 9% each had consecutive exotropia (intermittent [3%] and constant [6%]) and basic esotropia. Peripheral binocular single vision was achieved in 64% of patients and stereopsis in 28%. Bifocal segment was eliminated postoperatively in 70% of patients., Conclusions: Nearly two-thirds of patients with high AC/A ratio esotropia achieved a successful long-term motor outcome and peripheral binocular single vision, and nearly one-fourth achieved stereopsis. Recurrence of high AC/A ratio esotropia occurred in some patients, and consecutive exotropia and basic esotropia in a few. Bifocal segment was eliminated postoperatively in 70% of patients. [ J Pediatr Ophthalmol Strabismus . 2024;61(5):344-350.] .

Purpose: This study evaluated the efficacy, safety, and tolerability of a single-dose, preservative-free (PF) Dorzolamide/Timolol combination (Twinzol-SDU)., Methods: A 3-month single-arm, multicenter, prospective cohort study was conducted in Egypt between January 2021 and October 2022 on previously diagnosed and controlled patients with ocular hypertension and/or glaucoma. Efficacy was assessed using the change in intraocular pressure (IOP) after 6 and 12 weeks. Safety was identified through the change in the incidence of ocular side effects, ocular surface disease index (OSDI) scores and grades, and Time Break-Up time (TBUT)., Results: A total of 382 patients were enrolled in the analysis. After the three-month period of therapy, a significant reduction in IOP was seen (mean change: -1.9, P < 0.001) after switching to PF Dorzolamide/Timolol combination. The rate of ocular abrasion decreased significantly from 30.6% to 1.3% (P < 0.001). The rate of normal aqueous tear production increased from 24.1% to reach 79.4% (P < 0.001). The OSDI scores decreased significantly throughout the study period, with a median score decreased from 41.7 (21.7) to 12.5 (12.5) (P < 0.001). Mild OSDI grades significantly increased from the baseline of 12.6% to reach 24.7%. Moderate OSDI grade decreased at the same rate, from 12.8% to 11.1%. The number of patients with severe OSDI grade substantially decreased from 64.4% to 4.5%, with a P < 0.001. TBUT increased from 9 (3.7) seconds to reach and 12.3 (4) seconds after 12 weeks of treatment (P < 0.001)., Conclusion: Generally, the PF dorzolamide/timolol combination was associated with a significant reduction in IOP and tolerability among glaucoma patients., Competing Interests: Declarations. Conflict of interest: This study and its investigators were fully sponsored and funded by Orchidia Pharmaceutical Industry. Ethical approval: The protocol and its amendments were submitted to independent ethics committees (IECs) of "Genuine Research Center (GRC)" under study code "GRC/ORCDT/EG/37/CT", protocol code number "ORC-001" for review and written approval. It complied with recommendations of the 18th World Health Congress (Helsinki, 1964), laws and regulations, and any applicable guidelines. Consent to participate: All patients signed written informed consent., (© 2025. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To evaluate the long-term efficacy and safety of ripasudil-brimonidine fixed-dose combination (RBFC), a new intraocular pressure (IOP)-lowering medication for glaucoma and ocular hypertension (OHT)., Methods: This prospective, multicentre (23 sites in Japan), open-label study enrolled patients with primary open-angle glaucoma (POAG), OHT or exfoliative glaucoma and assigned them to one of four combination therapy cohorts, based on previous treatment(s) received: prostaglandin (PG) analogue (Cohort 1); PG analogue and beta-adrenoceptor blocker (β-blocker) (Cohort 2); PG analogue, β-blocker and carbonic anhydrase inhibitor (Cohort 3); or other/no treatment (Cohort 4). After a ≥ 4-week screening period, eligible patients received twice-daily RBFC for 52 weeks in addition to the treatments they were already receiving. Efficacy was assessed by change in IOP from baseline through week 52. Adverse events and adverse drug reactions (ADRs) were monitored throughout., Results: In total, 179 patients from Cohort 1 (n = 48), Cohort 2 (n = 44), Cohort 3 (n = 41) and Cohort 4 (n = 46) entered the RBFC treatment period. For all cohorts, mean IOP was significantly reduced at 11:00 (2 h after instillation of RBFC) through week 52 with the changes from baseline at week 52 of - 2.7 to - 4.1 mmHg across cohorts; all p < 0.001. Common ADRs were conjunctival hyperaemia (58%), allergic conjunctivitis (18%) and blepharitis (17%), most of which were mild in severity., Conclusion: These data demonstrated the long-term efficacy and safety of RBFC, both alone and in combination with other anti-glaucoma agents. RBFC may offer a new treatment option for the long-term management of glaucoma and OHT., Trial Registration: Japan Registry of Clinical Trials Identifier: jRCT2080225063., Date of Registration: 17 February 2020., (© 2024. The Author(s).)

There is a great need for the development of mouse models of ocular hypertension. Here, we describe an inducible mouse model of ocular hypertension that produces a homogeneous intraocular pressure (IOP) response and can be induced in any mouse strain of choice without the need for extensive breeding. The procedure utilizes an ocular hypertension and glaucoma-relevant transgene, bioactivated TGFβ2, and an adenovirus 5 virus with select tropism for the trabecular meshwork (TM)., (© 2025. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: To describe and compare clinical features, treatment approaches, and treatment outcomes of ocular tuberculosis (OTB) patients in the Netherlands, a low tuberculosis (TB)-endemic country, and Indonesia, a high TB-endemic country. We also aimed to identify predictors of treatment outcomes., Methods: A medical chart review of 339 OTB patients ( n  = 93 from the Netherlands and n  = 246 from Indonesia) was performed. The primary outcome was response to treatment, whether with or without anti-tubercular treatment, after six months of treatment initiation (good versus poor responders)., Results: Indonesian OTB patients displayed a higher prevalence of chest radiograph findings indicative of TB infection ( p  < 0.001) and concurrent active systemic TB ( p  = 0.011). Indonesian cohort exhibited a more acute and severe disease profile, including uveitis duration ≤ 3 months ( p  < 0.001), blindness ( p  < 0.001), anterior chamber (AC) cells ≥ 2+ ( p  < 0.001), and posterior synechiae ( p  < 0.001). Overall proportions of good responders to treatment were 67.6% in the Netherlands and 71.5% in Indonesia. Presence of AC cell ≥ 2+ (adjusted odds ratio (aOR): 2.12, 95% CI: 1.09-4.14), choroidal lesions other than serpiginous-like choroiditis (SLC) or tuberculoma (aOR: 4.47, 95% CI: 1.18-16.90), and retinal vasculitis (aOR: 2.32, 95% CI: 1.10-4.90) at baseline were predictors for poor response to treatment., Conclusions: Despite a more severe initial clinical presentation in the Indonesian cohort, the overall treatment outcomes of OTB was comparable in both cohorts. Three baseline clinical features were identified as predictors of treatment outcomes.

Glaucoma is a common optic neuropathy characterized by degeneration of retinal ganglion cells (RGCs). Elevated intraocular pressure (IOP), that is, ocular hypertension, is the primary modifiable risk factor for glaucoma and the primary characteristic of most preclinical glaucoma models. Extensive genotype and phenotype diversity at relatively low cost and high accessibility makes laboratory mice an excellent preclinical model for glaucoma. The microbead occlusion model was introduced in 2010 as an inducible model of ocular hypertension in mice and is now one of the most extensively utilized models of rodent glaucoma. Subsequent modifications of the microbead model increased the magnitude and duration of IOP elevation, primarily through modification of injection materials. Despite its popularity, accessibility of the model is hindered by procedural consistency between users. Here we outline an updated and comprehensive protocol for execution of the microbead model that is focused on improving surgical and outcome measure consistency and on enabling single experimenter execution., (© 2025. The Author(s), under exclusive license to Springer Science+Business Media, LLC, part of Springer Nature.)

Prcis: Selective laser trabeculoplasty (SLT) and medical therapy groups displayed comparable intraocular pressure (IOP) at most follow-ups. SLT was associated with significantly decreased rates of glaucoma surgeries, antiglaucomatous medications, and ocular adverse effects., Purpose: To evaluate the efficacy and safety of SLT compared with medical therapy in the treatment of open angle glaucoma (OAG) or ocular hypertension (OHT)., Methods: A systematic search was performed in PubMed, Embase, Cochrane Library and Web of Science databases. Randomized controlled trials (RCTs) comparing SLT with medical therapy were included. We computed mean differences (MDs) or standardized mean differences (STDs) for continuous endpoints and risk ratios (RRs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Software R, version 4.2.1, was used for statistical analyses. Subgroup analyses were performed on treatment-naive patients and on the class of drugs in the medical therapy group., Results: Fourteen RCTs comprising 1706 patients were included, of whom 936 were submitted to SLT. Medical therapy was associated with a significantly improved IOP at 1 month and a higher proportion of patients achieving ≥20% IOP reduction. There were no significant differences between groups in IOP at 2, 3, 6, and 12 months, IOP fluctuation, rate of eyes at target IOP, visual field, and quality of life. The SLT group exhibited significantly decreased rates of glaucoma surgeries, antiglaucoma medications, and ocular adverse effects., Conclusions: SLT demonstrated comparable efficacy to medical therapy in IOP control at most follow-ups, along with favorable impacts on critical treatment-related factors. Our findings support SLT as a safe and effective treatment for OAG or OHT., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Ocular flutter is a neurological disorder characterized by irregular, rapid horizontal eye movements and is often associated with autoimmune diseases, infections, drug intoxication, or paraneoplastic syndromes. The brain regions involved in ocular flutter have not been definitively determined. Sulfatide is an acidic glycolipid crucial for maintaining myelin sheath integrity and neuronal transmission. Antibodies against sulfatide can disrupt neuronal signals, and their formation is linked to autoimmune conditions such as Guillain-Barré syndrome and GALOP syndrome. To our knowledge, no pediatric cases of ocular flutter associated with sulfatide antibody-positive neuropathy have been reported., Case Description: A 15-year-old male with no medical history presented with oscillopsia and blurred vision. His prenatal, natal, and developmental history were unremarkable. Neurological examination revealed rapid, low-amplitude horizontal saccadic oscillations (ocular flutter) with no other neurological abnormalities. Extensive testing, including MRI of the brain and spine; blood tests; lumbar puncture; and screenings for viral, bacterial, and autoimmune conditions, returned normal or negative results. A high titer of anti-sulfatide IgM antibodies was detected. The patient was treated with intravenous immunoglobulin (IVIG), which led to complete resolution of ocular flutter. At the 3-month follow-up, his neurological examination was normal, and he remained asymptomatic with monthly IVIG infusions., Conclusion: This is the first reported case of ocular flutter associated solely with anti-sulfatide antibody positivity. This finding underscores the importance of considering sulfatide antibody testing in atypical or treatment-resistant cases of ocular flutter. The resolution of symptoms following IVIG treatment suggests its potential effectiveness in managing sulfatide antibody-positive conditions. Further research is needed to explore the role of sulfatide antibodies in ocular flutter and the benefits of targeted immunotherapy., Competing Interests: Declarations. Conflict of interest: The authors declare no conflicts of interest in preparing this paper. Consent: Written informed consent was obtained from the legal guardian of the patient (mother) for publication of this case report and any accompanying images. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Competing interests: The authors declare no competing interests., (© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)

Prcis: This systematic review and meta-analysis found that 360-degree selective laser trabeculoplasty (SLT) is significantly more effective than 180-degree SLT at reducing intraocular pressure at 1-month and 1-year follow-ups without increased serious adverse event risk., Purpose: To determine the efficacy of 180- versus 360-degree selective laser trabeculoplasty (SLT) in adults with open angle glaucoma (OAG) and ocular hypertension (OHT)., Methods: A systematic review was performed using PubMed, Embase, and Scopus databases, from 1995 to December 30, 2023, for studies comparing 180 and 360-degree SLT in adults with OAG and OHT (PROSPERO ID: CRD42024497832). Meta-analyses were performed to calculate nominal percent and raw reductions in intraocular pressure (IOP) between treatment groups at 1-month, 1-year, and 2-year follow-ups, as well as success rates, defined as a 20% or greater IOP reduction., Results: Nine studies with 1044 eyes were included; 491 received 180-degree SLT, and 553 received 360-degree SLT. At the 1-month follow-up, 360-degree SLT reduced IOP by 3.45% more (WMD=3.45; 95% CI: 2.02-4.88; P <0.00001) and 0.87 mm Hg more (WMD=0.87; 95% CI: 0.35-1.38; P =0.0010). At the 1-year follow-up, 360-degree SLT reduced IOP by 4.33% more (WMD=4.33; 95% CI: 2.35-6.32; P <0.0001) and 1.15 mm Hg more (WMD=1.15; 95% CI: 0.25-2.04; P =0.01). At 2 years of follow-up, 360-degree SLT reduced IOP by 4.86% more (WMD=4.86; 95% CI: -0.32, 10.0; P =0.07) and 1.25 mm Hg more (WMD=1.25; 95% CI: -0.29, 2.79; P =0.11); however, the difference was not statistically significant. Compared with 360-degree SLT, 180-degree SLT had a significantly lower success rate (OR=0.50; 95% CI: 0.35-0.72; P =0.0002). There was no difference in serious complications between interventions., Conclusions: 360-degree SLT is more effective than 180-degree SLT at lowering IOP at 1-month and 1-year follow-ups as well as achieving successful IOP control without increased risk of serious complications., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

A clinical scale fully dedicated to evaluating ocular motor abnormalities is required for now. We investigated the utility of a recently developed Scale for Ocular motor Disorders in Ataxia (SODA) in patients with multiple system atrophy (MSA). We prospectively assessed SODA in consecutive patients with MSA between August 2021 and August 2023 at the Korea University Medical Center. The results of the clinical exam-based SODA were compared with those measured using video-oculography (VOG-guided SODA). We also compared the findings with other established clinical scales targeting patients with MSA, including the Unified Multiple System Atrophy Rating Scale (UMSARS) I-II, Movement Disorder Society-Unified Parkinson's Disease Rating Scale motor part (UPDRS-III), Scale for Assessment of Rating of Ataxia (SARA), Composite Autonomic Symptom Score-31 (COMPASS-31), and Composite Autonomic Severity Score (CASS). Twenty patients were enrolled in our study (17 with cerebellar-type MSA and three with Parkinson-type MSA). Scores ranged from 1 to 14 (median [interquartile range (IQR)] = 8 [5-10]). Among the subscales, saccades had a median score of 2.5 (IQR = 1-3), followed by ocular pursuit (1 [0-1]), nystagmus (1 [0-2]), saccadic intrusions (1 [0-1]), vestibulo-ocular reflex (VOR) (0.5 [0-1]), ocular alignment (0 [0-1]), and VOR cancellation (1 [0-1]). The clinical-exam-based SODA (p = 0.020) and VOG-guided SODA (p = 0.034) positively correlated with disease duration. No correlation was found between clinical exam-based SODA and other scales. Skew deviation, gaze-evoked nystagmus, VOR cancellation, and smooth pursuit had the highest precision among the items. Ocular misalignment and spontaneous and positional nystagmus were frequently false positive and were poorly detected with clinical exam-based SODA. Six patients with repeated evaluation exhibited higher scores, along with deterioration documented on other clinical scales. The SODA can reliably predict neurodegeneration as an additional clinical surrogate in MSA., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Objective: To document (1) oculomotor (OM) and vestibulo-ocular (VO) function in children with concussion who were symptomatic at the time of assessment and to compare it with that in children with concussion who were clinically recovered (asymptomatic) and in children with no concussive injury, and (2) the extent to which OM and VO function relates to postconcussion symptom severity in injured children., Setting: Participants were recruited from a concussion clinic or the community., Participants: A total of 108 youth with concussion (72 symptomatic; 36 recovered) and 79 healthy youth (aged 9-18 years). Youth with concussion were included if aged 9 to 18 years, had no previous concussion within the last 12 months, less than 90 days since injury, and no known existing visual disorders or learning disabilities., Study Design: A prospective cross-sectional study., Main Measures: All participants were tested for OM and VO function with a commercial virtual reality (VR) eye-tracking system (Neuroflex ® , Montreal,Québec, Canada). Participants in the concussion group who completed the postconcussion symptoms were scored with the Post-Concussion Symptom Inventory., Results: There was a significant group effect for vergence during smooth pursuit ( F2,176 = 10.90; P < .05), mean latency during saccades ( F2,171 = 5.99; P = .003), and mean response delay during antisaccades ( F2,177 = 9.07; P < .05), where children with symptomatic concussion showed poorer performance than clinically recovered and healthy children. Similar results were found in VO for average vestibular ocular reflex gain in the horizontal leftward ( F2,168 = 7; P = .001) and rightward directions ( F2,163 = 13.08; P < .05) and vertical upward ( F2,147 = 7.60; P = .001) and downward directions ( F2,144 = 13.70; P < .05). Mean saccade error was positively correlated to total Post-Concussion Symptom Inventory scores in younger clinically recovered children., Conclusion: VR eye tracking may be an effective tool for identifying OM and VO deficits in the subacute phase (<90 days) postconcussion., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Ocular torsion and vertical divergence reflect the brain's sensorimotor integration of motion through the vestibulo-ocular reflex (VOR) and the optokinetic reflex (OKR) to roll rotations. Torsion and vergence however express different response patterns depending on several motion variables, but research on their temporal dynamics remains limited. This study investigated the onset times of ocular torsion (OT) and vertical vergence (VV) during visual, vestibular, and visuovestibular motion, as well as their relative decay rates following prolonged optokinetic stimulations. Temporal characteristics were retrieved from three separate investigations where the level of visual clutter and acceleration were controlled. Video eye-tracking was used to retrieve the eye-movement parameters from a total of 41 healthy participants across all trials. Ocular torsion consistently initiated earlier than vertical vergence, particularly evident under intensified visual information density, and higher clutter levels were associated with more balanced decay rates. Additionally, stimulation modality and accelerations affected the onsets of both eye movements, with visuovestibular motion triggering earlier responses compared to vestibular motion, and increased accelerations leading to earlier onsets for both movements. The present study showed that joint visuovestibular responses produced more rapid onsets, indicating a synergetic sensorimotor process. It also showed that visual content acted as a fusional force during the decay period, and imposed greater influence over the torsional onset compared to vergence. Acceleration, by contrast, did not affect the temporal relationship between the two eye movements. Altogether, these findings provide insights into the sensorimotor integration of the vestibulo-ocular and optokinetic reflex arcs., (© 2024. The Author(s).)

Prcis: Gonioscopy-assisted transluminal trabeculotomy (GATT) may be an effective first-line surgery for decreasing intraocular pressure (IOP) and medication burden in patients with uveitis-related ocular hypertension (OHT) or glaucoma., Objective: The purpose of the study is to determine the efficacy of GATT in lowering IOP in uveitis-related OHT or glaucoma., Methods: Retrospective case series that included patients with uveitis-related OHT or glaucoma who underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at 2 Canadian academic centres from July 2018 to May 2022. Primary outcomes were: complete (no medications) and qualified success (with medication), and failure defined as (1) IOP >21 mm Hg with maximal medical therapy, (2) the need for additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, and (4) IOP <6 mm Hg for 3 months., Results: Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2 ± 7.3 mm Hg on 4.3 ± 0.7 classes of glaucoma drops. The average follow-up was 29.2 ± 17.6 months and 76% of eyes (n = 16) had reached at least 12 months of follow-up. At the 12-month follow-up visit, there was a significant decrease in average IOP by 9.9 ± 7.9 mm Hg (38%, P = 0.005) and a decrease of 1.9 in glaucoma medication classes ( P = 0.002). Of eyes, 14% achieved complete success, whereas 80% of eyes achieved qualified success. Six eyes failed (29%) and 5 patients (24%) required additional glaucoma surgery. The most common postoperative complication was hyphema (n = 9; 43%)., Conclusion: This small case series suggests that GATT may be an effective first-line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-ups should be conducted to assess its long-term outcomes., Competing Interests: Disclosure: G.M.D.: Alcon Laboratories Inc.; Allergan Inc.; Avisi Technologies Inc., Bausch and Lomb, Glaukos Corporation; Ivantis Inc.; Johnson and Johnson; Labtician Ophthalmics Inc.; MicroSurgical Technology; Novartis Pharma; Santen Inc.; Sight Sciences Inc. P.H.: Abbvie, Alcon, Bausch and Lomb, Glaukos, Johnson and Johnson, Santen, Labtician, Novartis, Zeiss. L.J.: Abbvie. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Aim: This study aims to profile the ocular biometric parameters in a large group of children of South-Indian ethnicity who visited our outpatient children's department and were diagnosed with myopia., Methods: Children <15 years old diagnosed with myopia (Jan 2022-Oct 2023) and who had ocular biometry readings recorded were included. Their demographics, axial length (AL), anterior chamber depth (ACD), spherical equivalent (SE), corneal radius of curvature (CR), and AL/CR ratio were analyzed., Results: The study included 3728 myopic children; the mean age was 11.85 (4-15) years, and 52.8% were girls. Mean SE was -3.98 D. The mean (SD) AL, ACD, CR, and AL/CR ratio were 24.64 (1.32), 3.73 (0.40), 7.61 (0.27), and 3.24 (0.16), respectively. Female gender was associated with shorter AL, ACD, CR, and AL/CR ratios ( P < 0.001) across all age groups. There was a significant increase in ACD with age in both sexes ( P < 0.001). A 1-unit (mm) increase in AL was associated with an SE increase of -1.65 D (CL: -1.70 to -1.60). AL/CR ratio could explain 71% of the total variance in SE ( P < 0.001). SE showed a mild correlation with age (rho = 0.14, P < 0.001) and ACD (rho = -0.03, P = 0.041) and a stronger correlation with AL (rho = -0.68, P < 0.001) and AL/CR (rho = -0.83, P < 0.001)., Conclusion: In this hospital-based study, AL and AL/CR ratios strongly correlate with SE, and the AL/CR better explains the total variance in SE than AL alone in children with myopia., (Copyright © 2024 Indian Journal of Ophthalmology.)

Objectives: To evaluate the effects of short-acting cycloplegic agents, tropicamide and compound tropicamide, on ocular biological parameters and choroid thickness., Methods: In this study, seventy pediatric subjects aged 6 to 13 years were randomly assigned to two groups: the tropicamide group and compound tropicamide group. Ocular biological parameters and choroidal thickness (CT) and subfoveal choroid thickness (SFCT) were measured in both groups and were retested 40 min after drug administration. The tropicamide eye drops were administered into the conjunctival sac every 5 min with 1 drop, for a total of 4 doses. Compound tropicamide was administered in the same way as tropicamide. Ocular biological parameters included refraction (spherical equivalent, SE), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT), and white to white (WTW). The CT is the regional inferior choroidal thickness of nine sectors centered on the macular fovea and automatically generated using an ETDRS grid. And the SFCT is the choroidal thickness at the subfoveal point of the macular region., Results: After application of tropicamide and compound tropicamide to induce the ciliary muscle paralysis, SE, AL, and LT decreased, while ACD, CCT, and WTW increased compared to baseline(all P values < 0.05). There was no significant change in IOP before and after cycloplegia (p > 0.05). The CT in the nasal quadrant before and after ciliary paralysis was significantly thinner than other areas, the CT in the temporal quadrant was significantly thicker than others, and the CT in the inner quadrant was higher than the CT in the outer quadrant. In the tropicamide group: CT was significantly increased in the remaining quadrants except the inner inferior(I) and outer superior(S) quadrants (p < 0.05), and SFCT was also significantly increased (p = 0.005). In the compound tropicamide group: there is a significant increase in CT outer superior(S) quadrant CT (p = 0.043). Increase in the mean values of CT and SFCT in the remaining quadrants was also observed, but the difference was not statistically significant (p > 0.05). Additionally, AL and SFCT were negatively correlated., Conclusions: Some ocular biological parameters were altered after application of short-acting cycloplegic agent tropicamide and compound tropicamide to paralyze the ciliary muscle. Compared with compound tropicamide, tropicamide eye drops can reduce axial length while increasing choroid thickness., Competing Interests: Declarations. Ethics approval and consent to participate: The research was approved by the Ethics Committee of The First Affiliated Hospital of Bengbu Medical University (ethics approval number: 2024331), complies with the principles of the “Declaration of Helsinki”. Informed consent form to participate was obtained from all participants’ parents or legal guardians. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: This study aims to examine the correlation between specific clinical parameters, such as axial eye length, and the onset of ocular hypertension "OH" following the use of silicone oil filling in patients with high myopia., Method: In this retrospective analysis, we reviewed 214 eyes from 432 patients diagnosed with severe myopia, all of whom underwent vitrectomy and were treated with silicone oil filling. The study aimed to document the incidence and timing of postoperative ocular hypertension "OH" while assessing various factors, including demographic details, medical history, additional surgical interventions, and findings from supplementary examinations (such as axial length, silicone oil emulsification, and anterior chamber penetration). Binary logistic regression was employed as the primary statistical method to identify significant predictors and their relationship with "OH". This approach allowed for a comprehensive analysis of the impact of the duration of silicone oil presence in the eye on "OH" occurrence, providing a detailed understanding of the factors influencing post-surgical outcomes., Result: The study revealed a statistically significant increase in postoperative axial length (29.21 ± 0.85 mm) compared to the preoperative length (28.31 ± 0.82 mm), corresponding to an incidence rate of 37.38% (80 cases) for "OH". Logistic regression analysis identified the following variables as significantly associated with an increased risk of "OH" post-silicone oil filling: scleral buckling, aphakic status, silicone oil emulsification, and silicone oil penetration into the anterior chamber. The odds ratios (OR) for these variables were 1.397, 0.672, 1.859, and 1.364, respectively, indicating their predictive value for "OH" risk., Conclusion: The development of "OH" post-silicone oil filling is strongly correlated with changes in the anterior segment anatomy and the dynamics of aqueous humor flow, particularly in eyes without the natural lens. Recognizing these risk factors highlights the importance of thorough preoperative evaluation and individualized postoperative care to reduce the incidence of OH in patients with high myopia, thereby improving surgical outcomes., Competing Interests: Declarations. Ethics approval and consent to participate: The study was carried out in accordance with the Helsinki Declaration. Informed consent was obtained from all patients. This study protocol was reviewed and approved by the Ethics Committee of Chongqing Bright Eye Hospital, Chongqin, PR. China. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Others: This paper has been uploaded to preprint server on Research Square as a preprint: https://www.researchsquare.com/article/rs-3903761/v1 ., (© 2024. The Author(s).)

Purpose: To assess the clinical relevance of pathophysiology-based biomarkers, specifically serum C1q and whole blood interferon gene signature score (IGSS), in ocular tuberculosis (OTB) diagnosis by conducting an integrative analysis of clinical presentations and treatment response., Methods: This retrospective cohort study analysed data from 70 patients with suspected OTB at a tertiary care uveitis practice in Indonesia. Serum C1q levels and whole blood IGSS were quantified. Patients were categorized into four quadrants based on their biomarker profiles: quadrant 1 (high C1q & low IGSS), quadrant 2 (high C1q & high IGSS), quadrant 3 (low C1q & high IGSS), and quadrant 4 (low C1q & low IGSS). Characteristics of clinical presentations, work-up results, and treatment outcomes were explored according to the predefined quadrants., Results: We identified that the majority of OTB patients diagnosed with concurrent active pulmonary TB were in quadrant 1, 2, or 3 (20/23, 87.0%). Twenty-seven patients (27/47, 57.4%) with clinically undifferentiated uveitis were in quadrant 4 ( p  < 0.001). Among patients in quadrants 1, 2, and 3, completion of a full course of antitubercular treatment (ATT) was associated with a lower number of patients showing persistence or recurrence of ocular inflammation compared to those who were not fully treated with ATT (14.3% vs 85.7%, p  = 0.001)., Conclusions: Based on the analysis of clinical features and treatment outcomes, patients with elevated levels of either or both serum C1q and whole blood IGSS may reflect active TB disease in the eye, necessitating full ATT management.

Objective: To evaluate in a real-world setting an intravitreal clindamycin treatment protocol for ocular toxoplasmosis., Methods: This was a single-center, retrospective review with a 6-month follow-up. Our protocol proposed an IVT of clindamycin as first-line treatment, and management was chosen according to the patient's status (past medical history of ocular toxoplasmosis or not). We evaluated the gain in best corrected visual acuity (BCVA) at 6months, the therapeutic burden and anatomical outcomes., Results: The study included 38 eyes of 38 patients. The 6-month follow-up was reached for 23 patients. In the whole cohort, 6 patients experienced one recurrence, and one patient had two recurrences (mean time to recurrence 65±36days), for a total number of 46 occurrences. BCVA gain was 0.24±0.49 logMAR (P-value 0.023). Cicatrization of the chorioretinal lesion was obtained with a mean number of 1.3 (62/46) IVT of clindamycin (1 to 4 IVTs per patient per episode) and a mean time between 2 IVT for the same occurrence of 15.9±8.5days. The percentage of occurrences resolved with a single IVT was 67% (31/46). Oral corticosteroid therapy was started in 26 patients (68%). We demonstrated no adverse effects of IVT, except for one patient who developed a retinal detachment., Conclusion: Our study shows the efficacy and tolerance of our intravitreal treatment protocol with clindamycin for ocular toxoplasmosis., Competing Interests: Déclaration de liens d’intérêts Les auteurs déclarent ne pas avoir de liens d’intérêts., (Copyright © 2024 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

Normal perception of visual information relies not only on the quantity and quality of retinal ganglion cells (RGCs), but also on the integrity of the visual pathway, within which RGC central projection predominates. However, the exact changes of RGC central projection under particular pathological conditions remain to be elucidated. Here, we report a whole-brain clearing method modified from iDISCO for 3D visualization of RGC central projection. The CTB-labeled RGC central projection was visualized three-dimensionally with minimized both fluorescence quenching and the time taken. For observation of RGC axonal degeneration pattern under pathological conditions, we took acute ocular hypertension (AOH) as an example. Mice were intracamerally irrigated, and fluorescent signal in brain subregions where RGC axons projected to were quantified. The novel methodology is well-applied for rapid clearing and observation of RGC central projection in C57BL/6J, showing damaged RGC central projection on the AOH side and the most statistically significant degeneration in the superior colliculi (SC). Detailed analysis also revealed a distinct injury pattern among lateral geniculate nuclei (LGN) subregions, with the parvocellular part of the pregeniculate nuclei (PrGPC) being more vulnerable compared with the magnocellular part (PrGMC). The intracranial retrograde labeling of RGC subgroups based on brain damage variation showed PrGPC-projecting RGCs (Plgn RGC) being smaller than PrGMC-projecting RGCs (Mlgn RGC) in size and less in number, yet more vulnerable in terms of degeneration under AOH. Our data revealed the methodology for visualizing selective neuronal vulnerability under AOH, and in the meantime provided novel approach for future mechanisms exploration regarding RGC degeneration., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: To assess the myopic shift in children with unilateral cataract undergoing primary intraocular lens (IOL) implantation and its association with preoperative ocular parameters., Setting: Single center., Design: Retrospective study., Methods: Children who underwent unilateral primary IOL implantation and were followed up for 3 years were included. Myopic shift and preoperative ocular parameters were compared between the treated and fellow eyes. The correlation between myopic shift and ocular parameters was assessed using partial correlation analysis. Potential factors influencing myopic shift were determined using linear regression analysis., Results: A total of 126 patients (252 eyes) were included. Longer preoperative axial length (AL) and steeper average keratometry (AK) in the treated eyes were noted in the whole cohort and patients aged 2 to <4 years (all P < .05). At 3 years postoperatively, mean myopic shift ranged from 3.53 diopters for children aged 1 to <2 years to 1.99 diopters for those aged 6 years and older. A greater myopic shift in the treated eyes was found in all, except children aged 6 years and older ( P > .05). Preoperative interocular AL difference (IALD) was negatively correlated with myopic shift ( r = 0.32, P < .001). Regression analysis revealed that younger age and smaller IALD were associated with greater myopic shift ( P < .001 and P = .001, respectively)., Conclusions: A greater myopic shift was observed in children with younger age at surgery and smaller IALD. To mitigate long-term anisometropia, selecting target refraction for unilateral pediatric cataracts should consider children's age, refractions of the fellow eyes, and preoperative IALD., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Purpose: To describe intraocular pressure changes after injection of sub-Tenon triamcinolone during examination under anesthesia for pediatric patients., Methods: Multicenter, retrospective case series of pediatric patients who received sub-Tenon triamcinolone from three tertiary care ophthalmic services between November 2018 and October 2023., Results: Of 392 patients identified, 59 eyes (10.5%) of 41 patients were included. Laser was administered in 95.1% of the cases. Sub-Tenon triamcinolone dose ranged from 4 to 20 mg. The most common diagnosis was retinopathy of prematurity (43.9%). Two eyes (3.4%) of two patients (4.9%) were mild steroid responders. One eye (1.7%) of 1 patient (2.4%) was a moderate responder. There were no high steroid responders, and all eyes with steroid response showed a return of intraocular pressure to normal range at next visit without needing any intraocular pressure-lowering medications. No patients were diagnosed with glaucoma or required glaucoma surgery. Only 1 eye (1.7%) developed trace posterior subcapsular cataract, whereas no optic disk cupping or inflammation were noted., Conclusion: Sub-Tenon triamcinolone injection is commonly used to prevent inflammation at the time of retinal photocoagulation treatment in pediatric patients. It has a favorable safety profile in relation to intraocular pressure elevation and cataract formation. There was no requirement for intraocular pressure-lowering medications or surgical interventions.

Objectives: A vestibulo-ocular reflex called the ocular counter-roll can be used to assess how well the otolith organs are functioning. The video ocular counter-roll (vOCR) test is a recent addition to the videonystagmography test battery that allows for video recording and quantitative ocular counter-roll analysis. The purpose of this study is to investigate potential discrepancies in vOCR measurements obtained from a 30° lateral head tilt in the roll plane versus measurements obtained from a 30° tilt of the head and body., Design: Thirty otologically, and neurologically healthy subjects aged 18 to 30 (M = 23.32 years, SD = 2.66 years; 8 men, 22 women) participated in this study. Pure-tone audiometry, oculomotor tests, and vOCR evaluation were performed for all participants. The vOCR assessment was performed in 2 positions, 30° lateral head tilt, and 30° body tilt position. The degree of static vOCR eye position and vOCR asymmetry in both positions were calculated and compared., Results: There was no statistically significant difference between the vOCR findings obtained in the right and left 30° lateral head tilt ( p = 0.546) and body tilt ( p = 0.114). vOCR asymmetry was determined as median (interquartile range) 0.08 (0.07) in lateral head tilt position and 0.09 (0.06) in body tilt position. The degree of static vOCR (8.75° [1.91]) detected during body tilt was statistically greater than the static vOCR (6.62 [1.69]) detected during head tilt ( p < 0.001). There was no statistically significant difference in terms of ocular counter-roll asymmetry detected between head tilt and body tilt ( p = 0.918)., Conclusions: Our study shows a significant difference in the vOCR responses during head tilt and body tilt, a finding that should be considered during clinical evaluation of vestibular function. There was no significant asymmetry between the responses with either head or body tilt., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Evidence from human studies of ocular accommodation and studies of animals reared in monochromatic conditions suggest that chromatic signals can guide ocular growth. We hypothesized that ocular biometric response in humans can be manipulated by simulating the chromatic contrast differences associated with imposition of optical defocus. The red, green, and blue (RGB) channels of an RGB movie of the natural world were individually incorporated with computational defocus to create two different movie stimuli. The magnitude of defocus incorporated in the red and blue layers was chosen such that, in one case, it simulated +3 D defocus, referred to as color-signed myopic (CSM) defocus, and in another case it simulated -3 D defocus, referred to as color-signed hyperopic (CSH) defocus. Seventeen subjects viewed the reference stimulus (unaltered movie) and at least one of the two color-signed defocus stimuli for ∼1 hour. Axial length (AL) and choroidal thickness (ChT) were measured immediately before and after each session. AL and subfoveal ChT showed no significant change under any of the three conditions. A significant increase in vitreous chamber depth (VCD) was observed following viewing of the CSH stimulus compared with the reference stimulus (0.034 ± 0.03 mm and 0 ± 0.02 mm, respectively; p = 0.018). A significant thinning of the crystalline lens was observed following viewing of the CSH stimulus relative to the CSM stimulus (-0.033 ± 0.03 mm and 0.001 ± 0.03 mm, respectively; p = 0.015). Differences in the effects of CSM and CSH conditions on VCD and lens thickness suggest a directional, modulatory influence of chromatic defocus. On the other hand, ChT responses showed large variability, rendering it an unreliable biomarker for chromatic defocus-driven responses, at least for the conditions of this study.

This study aims to assess fixational eye movements (FEMs) obtained under binocular and monocular viewing in normal individuals across different age groups. We recruited 68 healthy participants divided into Group 1 (children, 3-9 years, n = 20), Group 2 (adolescents, 10-19 years, n = 26), and Group 3 (adults, 20-73 years, n = 22). FEMs were collected using a high-resolution video-based tracker under 3 viewing conditions: binocular viewing (BV), monocular viewing right eye (MV&#95;RE), and monocular viewing left eye (MV&#95;LE). We quantified fixation stability, the frequency, amplitude, and disconjugacy of fixational saccades, and inter-saccadic drift velocity in BV, MV&#95;RE, and MV&#95;LE. We also computed inter-ocular fixation stability under binocular viewing and monocular viewing in the 3 groups. Fixation instability (FI) and fixational saccade amplitudes were higher in Group 1 than in Group 3 whereas inter-saccadic drifts were increased in Group 3. Vergence stability was greater in binocular viewing than in monocular viewing likely due to binocular summation in all groups. However, the fixational saccade amplitude and drift velocity of the right and left eye did not significantly differ across different viewing conditions within each group. Interestingly, the inter-ocular fixation stability ratio and vergence stability showed no significant differences between the groups. In conclusion, FEMs differ across age groups but inter-ocular FEMs are immune to the effects of age and can be a valuable parameter while evaluating FEM abnormalities in diseases like amblyopia., Competing Interests: Declarations Ethics approval and consent for publication Experiment protocols were approved by the Cleveland Clinic institutional review board and complied with the tenets of the Declaration of Helsinki, and informed consent was obtained for all participants. Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

BACKGROUND: The resident astrocyte-retinal ganglion cell (RGC) lipoxin circuit is impaired during retinal stress, which includes ocular hypertension-induced neuropathy. Lipoxin B4 produced by homeostatic astrocytes directly acts on RGCs to increase survival and function in ocular hypertension-induced neuropathy. RGC death in the retina and axonal degeneration in the optic nerve are driven by the complex interactions between microglia and macroglia. Whether LXB4 neuroprotective actions include regulation of other cell types in the retina and/or optic nerve is an important knowledge gap. METHODS: Cellular targets and signaling of LXB4 in the retina were defined by single-cell RNA sequencing. Retinal neurodegeneration was induced by injecting silicone oil into the anterior chamber of mouse eyes, which induced sustained and stable ocular hypertension. Morphological characterization of microglia populations in the retina and optic nerve was established by MorphOMICs and pseudotime trajectory analyses. The pathways and mechanisms of action of LXB4 in the optic nerve were investigated using bulk RNA sequencing. Transcriptomics data was validated by qPCR and immunohistochemistry. Differences between experimental groups were assessed by Students t-test and one-way ANOVA. RESULTS: Single-cell transcriptomics identified microglia as a primary target for LXB4 in the healthy retina. LXB4 downregulated genes that drive microglia environmental sensing and reactivity responses. Analysis of microglial function revealed that ocular hypertension induced distinct, temporally defined, and dynamic phenotypes in the retina and, unexpectedly, in the distal myelinated optic nerve. Microglial expression of CD74, a marker of disease-associated microglia in the brain, was only induced in a unique population of optic nerve microglia, but not in the retina. Genetic deletion of lipoxin formation correlated with the presence of a CD74 optic nerve microglia population in normotensive eyes, while LXB4 treatment during ocular hypertension shifted optic nerve microglia toward a homeostatic morphology and non-reactive state and downregulated the expression of CD74. Furthermore, we identified a correlation between CD74 and phospho-phosphoinositide 3-kinases (p-PI3K) expression levels in the optic nerve, which was reduced by LXB4 treatment. CONCLUSION: We identified early and dynamic changes in the microglia functional phenotype, reactivity, and induction of a unique CD74 microglia population in the distal optic nerve as key features of ocular hypertension-induced neurodegeneration. Our findings establish microglia regulation as a novel LXB4 target in the retina and optic nerve. LXB4 maintenance of a homeostatic optic nerve microglia phenotype and inhibition of a disease-associated phenotype are potential neuroprotective mechanisms for the resident LXB4 pathway.

This article describes the surgical treatment of superior semicircular canal dehiscence syndrome (SCDS) by isolating the dehiscence using transmastoid two-point canal plugging while preserving the high-frequency vestibulo-ocular reflex (VOR) of the affected semicircular canal. The superior semicircular canal is opened via a transmastoid approach anterior (as far from the ampulla as possible) and posterior to the dehiscence and then plugged with connective tissue and bone dust. In two clinical exemplary cases, vestibular testing showed that the VOR measured by video head impulse (vHIT) test was preserved (patient 1: gain preoperative 0.7, long-term postoperative 0.75; patient 2: gain preoperative 0.64, long-term postoperative 0.79; reduction of corrective saccades in each case) with a simultaneous reduction in pathologically increased amplitudes of vestibular evoked myogenic potentials (VEMPs) and a significant improvement in clinical symptoms with almost complete freedom from symptoms. One possible explanation for preservation of the high-frequency VOR of the superior semicircular canal would be the deformability of the endolymphatic space described at high stimulation frequencies, which can lead to endolymph movements in the area of the ampulla with deflection of the cupula despite blockage of the semicircular canal., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: F. Schmäl und S. Kösling geben an, dass kein Interessenkonflikt besteht. Die Institution der Autoren I. Seiwerth, T. Rahne und S.K. Plontke erhält Forschungsunterstützung von Cochlear Ltd. Sydney, Australien, MED-EL, Innsbruck, Österreich, und AudioCure Pharma GmbH, Berlin, Deutschland. S.K. Plontke erhielt Reisekostenunterstützung von Cochlear Ltd. Sydney, Australien, und Honorare für Referententätigkeit auf Weiter- und Fortbildungsveranstaltungen von MedKom Akademie GmbH, München; Merck Healthcare Germany, GmbH, Weiterstadt und Biologische Heilmittel Heel GmbH, Baden-Baden (Deutschland), sowie Vortragshonorare von verschiedenen Universitäten und internationalen wissenschaftlichen HNO-Fachgesellschaften. J. Dlugaiczyk erhielt Vortragshonorare von Forum für medizinische Fortbildung (FomF), Diatec, Schwabe Pharma AG und Hennig Arzneimittel sowie Unterstützung bei Reise- und Übernachtungskosten von Diatec, Schwabe Pharma AG und Hennig Arzneimittel. Für diesen Beitrag wurden von den Autor/-innen außer der Erhebung von Routinemessdaten keine Studien an Menschen oder Tieren durchgeführt., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Ocular toxoplasmosis, caused by Toxoplasma gondii , is a significant cause of posterior uveitis and vision impairment globally. Accurate diagnosis is essential to prevent retinal damage and optimise treatment. This study aimed to compare three diagnostic methods funduscopy, serology (ELISA), and PCR in detecting ocular toxoplasmosis in patients at ECWA Eye Hospital, Kano, Nigeria., Methods and Analysis: A total of 264 patients suspected of having ocular toxoplasmosis were enrolled. Funduscopy was performed to identify retinal lesions typical of T. gondii . Serological analysis was conducted using ELISA to detect anti- Toxoplasma IgG antibodies. Additionally, PCR was used to confirm the presence of T. gondii DNA in blood samples. The results from these methods were compared with assess their sensitivity, specificity and diagnostic value., Results: Funduscopy detected T. gondii in 25.4% (67/264) of the patients, while ELISA showed a higher detection rate of 36.7% (97/264). PCR, the most specific method, confirmed infection in only 3.8% (10/264) of cases, with 60% (6/10) of these being male and 40% (4/10) female. T. gondii detected had 196 base pairs. The study found that ELISA had the highest sensitivity (90.0%) but lower specificity (64.9%), whereas funduscopy showed high specificity (74.4%) but low sensitivity (20.0%). PCR had the highest specificity but a low detection rate, emphasising its role in confirming diagnosis., Conclusion: Although ELISA and funduscopy detected more positive cases, PCR remains the gold standard for confirming T. gondii infection due to its high specificity. In resource-limited settings like ECWA Eye Hospital, combining serology and PCR offers a practical approach for improving diagnostic accuracy and ensuring timely treatment of ocular toxoplasmosis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Purpose: Descemet membrane endothelial keratoplasty (DMEK) has emerged as a novel approach in corneal transplantation over the past two decades. This study aims to identify predisposing risk factors for post-DMEK ocular hypertension (OHT) and develop a preoperative predictive model for post-DMEK OHT., Methods: Patients who underwent DMEK at Gangnam Severance Hospital between 2017 and 2024 were included in the study. Four machine learning models-XGBoost, random forest, CatBoost, and logistic regression-were trained to assess feature importance and develop a predictive classifier. An ensemble of these four models was used as the final predictive model. The ensemble model identified clinically significant patients for prediction or exclusion., Results: A total of 106 eyes from patients who underwent DMEK were analyzed, with 31 eyes (29.2%) experiencing post-DMEK OHT. The final ensemble model achieved clinically significant classification for 61 eyes (57.5%) in the total patient population. Significant risk factors identified in all four models included angle recess area (ARA), best-corrected visual acuity, donor graft size, angle-to-angle distance, crystalline lens rise, and central corneal thickness. The average accuracy, precision, recall, area under the receiver operating characteristic curve, and area under the precision-recall curve values of the ensemble model obtained by a 5-fold cross-validation were 80.2%, 60.0%, 59.7%, 82.3%, and 68.0%, respectively., Conclusions: This study identified significant risk factors for post-DMEK OHT and highlighted the importance of ocular topographic measures in risk assessment. The development of a final machine learning model to differentiate between clinically predictable patient groups demonstrates the clinical utility of the proposed model for predicting post-DMEK OHT.

Objective: The ocular pressure adjusting pump is a novel noninvasive and nonpharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump. This study aimed to determine the effect of NP in ocular pressure adjusting pump goggles on IOP using continuous direct manometry., Design: Prospective, single-arm, single center, basic physiological research trial., Subjects: Adult patients undergoing cataract surgery., Methods: Direct manometry was performed via an anterior chamber cannula attached to an IOP sensor. This was placed just prior to each subject's previously scheduled cataract surgery. Intraocular pressure was continuously monitored every 0.5 seconds through the following sequence of 30 seconds each: baseline IOP measurement, NP -10 mmHg, NP off, NP -20 mmHg, and NP off., Main Outcome Measures: Intraocular pressure response to application of NP., Results: All 17 subjects had a dose-dependent reduction in IOP, with a mean IOP decrease from 16.9 to 11.3 (33%) with -10 mmHg of NP and from 15.7 to 7.7 (51%) mmHg with -20 mmHg of NP. Intraocular pressure returned to baseline for each cycle when NP was discontinued. There were no patients with increased IOP., Conclusions: Negative pressure with the ocular pressure adjusting pump results in a consistent dose-dependent reduction in IOP, with return to baseline IOP when NP is discontinued., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Ocular toxoplasmosis is the leading cause of infectious retinochoroiditis in both adults and children. It is caused by the obligate intracellular parasite, Toxoplasma gondii. It is a common cause of posterior uveitis and focal retinitis, typically seen in immunocompetent individuals as a primary infection or in immunocompromised individuals as reactivation of latent infection. Here, we report a rare case of a 29-year-old immunocompetent female presenting with gradual, painless diminution of vision in the left eye associated with headache for over one month. She had a history of hypertension but no other significant medical history. On ocular examination anterior segment was unremarkable and fundus examination of left eye showed "Headlight in fog appearance" suggestive of vitritis. Serological evaluation revealed positive for Toxoplasma IgG antibodies. The patient was treated with cotrimoxazole, oral prednisolone, and topical steroids for 4-6 weeks. Following treatment, her visual acuity improved to 6/6 in left eye. This case highlights the importance of considering ocular toxoplasmosis in the differential diagnosis of unilateral vitritis, even in immunocompetent patients.

Background and Purpose: The dorsolateral portion of the caudal pons contains the vestibular nucleus (VN) and inferior cerebellar peduncle (ICP) that play important roles in conveying and processing vestibular and ocular motor signals. This study aimed to characterize ocular motor abnormalities along with their anatomical correlations in dorsolateral pons (DLP) lesions., Methods: We analyzed clinical features, and results of neuro-otological evaluations and neuroimaging of 18 patients with unilateral DLP lesions (17 with DLP infarction and 1 with cavernous malformation) from among 506 patients with pontine infarction in a stroke registry., Results: Most of the patients (n = 16) presented with isolated acute vestibular syndrome (AVS). The involved structures within the DLP were the ICP in four patients and the VN in the remaining 14. The unilateral ICP lesions were associated with consistent abnormalities in vestibular and ocular motor tests, including ipsilesional nystagmus without gaze-evoked nystagmus (GEN), and normal head impulse tests (HITs) and caloric response. In contrast, lesions of the VN were associated with a broader range of eye-movement abnormalities, including ipsi- or contralesional nystagmus with GEN, positive HITs, normal or abnormal caloric responses, and fixation nystagmus. Initial diffusion-weighted magnetic resonance imaging (within 48 h) was falsely negative in 41% (n = 7) of the DLP infarction cases., Conclusions: This study demonstrates that unilateral DLP lesions frequently present with isolated AVS and diverse ocular motor abnormalities. These characteristics may be due to the complex involvement of afferent or efferent fibers to and from the VN., (© 2024 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)