CONCLUSIONS: In this meta-analysis of 6 studies and 5269 patients, deep learning algorithms applied to AS-OCT demonstrated excellent diagnostic performance for closed angle compared with gonioscopy, with a pooled sensitivity and specificity of 94% and 93.6%, respectively.
OBJECTIVE: This study aimed to review the literature and compare the accuracy of deep learning algorithms (DLA) applied to anterior segment optical coherence tomography images (AS-OCT) against gonioscopy in detecting angle closure in patients with glaucoma.
METHODS: We performed a systematic review and meta-analysis evaluating DLA in AS-OCT images for the diagnosis of angle closure compared with gonioscopic evaluation. PubMed, Scopus, Embase, Lilacs, Scielo, and Cochrane Central Register of Controlled Trials were searched. The bivariate model was used to calculate pooled sensitivity and specificity.
RESULTS: The initial search identified 214 studies, of which 6 were included for final analysis. The total study population included 5269 patients. The combined sensitivity of the DLA compared with gonioscopy was 94.0% (95% CI: 83.8%-97.9%), whereas the pooled specificity was 93.6% (95% CI: 85.7%-97.3%). Sensitivity analyses removing each individual study showed a pooled sensitivity in the range of 90.1%-95.1%. Similarly, specificity results ranged from 90.3% to 94.5% with the removal of each individual study and recalculation of pooled specificity.
CONCLUSIONS: DLA applied to AS-OCT has excellent sensitivity and specificity in the identification of angle closure. This technology may be a valuable resource in the screening of populations without access to experienced ophthalmologists who perform gonioscopy.

This article aims to provide a comprehensive review of the biochemical changes observed in the anterior chamber of the eye in diabetic patients. The increased levels of inflammatory markers, alterations in antioxidant defense mechanisms, and elevated levels of advanced glycation end products (AGEs) in the aqueous humor (AH) are explored. Additionally, the impact of these biochemical changes on diabetic retinopathy progression, increased intraocular pressure, and cataract formation is discussed. Furthermore, the diagnostic and therapeutic implications of these findings are presented. This study explores potential biomarkers for detecting diabetic eye disease at an early stage and monitoring its progression. An investigation of the targeting of inflammatory and angiogenic pathways as a potential treatment approach and the role of antioxidant agents in managing these biochemical changes is performed.

OBJECTIVE: To report a challenging Descemet Membrane Endothelial Keratoplasty (DMEK) case, complicated by intraoperative aqueous misdirection and spontaneous anterior chamber fibrin reaction.
METHODS: A 70-year-old female affected by corneal edema due to Fuchs endothelial dystrophy underwent a triple procedure (cataract extraction - IOL implantation - DMEK surgery) in her left eye. This report illustrates the management of the intraoperative complications of aqueous misdirection syndrome and anterior chamber fibrin reaction.
RESULTS: Despite the optimal management of the posterior pressure and the thorough removal of the fibrinous reaction during the case, the DMEK graft was not completely unfolded and centred at the end of the surgical procedure. Nonetheless, the patient showed good long-term anatomical and functional recovery: at the last follow-up (2 years after surgery), central corneal thickness was 526 µm with a best corrected visual acuity of 20/25 and an endothelial cell density of 1112 cell/mm2.
CONCLUSIONS: Early recognition and prompt management of intraoperative aqueous misdirection syndrome and anterior chamber fibrin reaction during DMEK surgery is essential to ensure good functional and anatomical outcomes.

BACKGROUND: Studies on the factors affecting vault after posterior chamber phakic Implantable Collamer Lens (ICL) have been carried out, but most of them are single-centered and subjective selections of parameters. The present study aimed to systematically analyze the factors for vault.
METHODS: A systematic review of case series, case-control, and cohort studies derived from the articles published in PubMed, the Cochrane Library, Embase, Web of Science, CNKI, CBM, Wanfang and VIP, as well as ClinicalTrials, which were conducted to search for studies on factors of vault using four core terms: phakic intraocular lenses, vault, risk factor and observational study, from January 01, 1997, to February 20, 2023. The included studies were meta-analyzed quantitatively and described qualitatively. Subsequently, meta-regression and subgroup analysis were used.
RESULTS: We identified 13 studies (1,607 subjects), and 14 factors were considered. Meta-analysis showed that anterior chamber depth (ACD), horizontal corneal white-to-white (hWTW), ICL-size, and age are dual effects of the abnormal vaults; anterior chamber volume (ACV) and lens thickness (LT) are a one-way effect; while axial length (AL), ICL- spherical equivalent (ICL-SE) and Km are insignificant. In addition, descriptive analysis of anterior chamber angle (ACA), horizontal sulcus to sulcus (hSTS), ciliary processes height (T value), crystalline lens rise (CLR), and gender showed that all factors except gender tend to have significant effects on vault. Sensitivity analysis showed stable combined results. Country and design respectively affect the heterogeneity in ACD and ICL-size at low vault, while design affects the heterogeneity in ACD at high vault. No publication bias exists.
CONCLUSIONS: Vault after ICL is related to multiple factors, especially anterior segmental biologic parameters, and they are weighted differently. We hope to provide a reference for the selection and adjustment of ICL.

OBJECTIVE: To establish the effects of anterior chamber inflammation (ACI) on the corneal endothelium parameters and central corneal thickness (CCT).
METHODS: We conducted a comprehensive literature review using medical databases (PubMed, EMBASE, VHL, and medRxiv) on March 8, 2023, for studies that included patients with ACI who had undergone specular microscopy or pachymetry. Case series with >10 patients, cross-sectional, case-control, and cohort studies were included. The risk of bias was assessed using CLARITY tools and validated scales such as those by Hassan Murad et al. and Hoy et al. A narrative synthesis and a quantitative standardized mean difference meta-analysis, I2 heterogeneity assessment, and publication bias tests were conducted. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethical committee (DVO005 2277- CV1712).
RESULTS: Thirty-four studies, encompassing 1,388 eyes with ACI, were included. Compared with healthy controls, overall, ACI eyes show significant mean differences in endothelial parameters (endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX)) (P < 0.05). In the subgroup analysis compared with healthy controls, both active and chronic-recurrent ACI demonstrated a reduced ECD. An increased CV was observed in active, inactive, and chronic-recurrent ACI. Lower HEX was evident in inactive, acute, and chronic-recurrent ACI, while both active and acute ACI exhibited high CCT.
CONCLUSIONS: ACI leads to significant alterations in endothelial parameters and CCT. The primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Further studies are needed to explore the impact of ACI etiology on the endothelium, potential biases in IOP measurements during acute ACI episodes, and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI.

Assessing anterior chamber inflammation is highly subjective and challenging. Although various grading systems attempt to offer objectivity and standardization, the clinical assessment has high interobserver variability. Traditional techniques, such as laser flare meter and fluorophotometry, are not widely used since they are time-consuming. With the development of optical coherence tomography with high sensitivity, direct imaging offers an excellent alternative to assess objectively inflammation with the potential for automated analysis. We describe various anterior chamber inflammation grading methods and discuss their utility, advantages, and disadvantages.

BACKGROUND: Generally, there is no lipoprotein in aqueous humor, and chyle usually exists transiently in the body. Therefore, persistent chylous aqueous humor is rare.
METHODS: We report a case of a 39-year-old man with persistent milky white appearance over the right eye.
METHODS: The patient had a history of poorly controlled diabetes for the past 2 years and central retinal vein occlusion of the same eye for the past 2 weeks. The patient\'s right eye had a uniform milky appearance in the anterior chamber, transparent cornea, and no keratic precipitate in the posterior cornea. Color Doppler ultrasound of the affected eye showed no obvious inflammation in the vitreous cavity. Laboratory tests revealed severe chylemia. The patient was finally diagnosed as chylous aqueous humor.
RESULTS: After conventional hypolipidemia and hypoglycemia treatment and locally glucocorticoid treatment. The milky white changes in the anterior chamber improved considerably and finally disappeared.
CONCLUSIONS: Although the impact of hyperlipidemia on the cardiovascular system and digestive system is well known, its impact on the eyes is often overlooked. We report a rare case of unilateral chylous aqueous humor caused by hyperlipidemia. Through the analysis of this special case, we recommend that ophthalmologists should pay attention to the impact of blood lipid change on eyes.

Purpose: Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant. Methods: Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated. Results: A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied. Conclusions: A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the \"Trendelenburg position, external pressure with head positioning\" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).

*Correspondence, Ahmad Shakeel: drshakeel333@gmail.com PURPOSE: To evaluate the clinical results of postureless (no intraoperative or postoperative posturing) Descemet\'s membrane endothelial keratoplasty (DMEK) with the first postoperative review conducted at one week.
METHODS: Retrospective, noncomparative, interventional case series.
METHODS: 17 consecutive eyes of 17 patients requiring DMEK with PI for any cause of endothelial failure.
METHODS: DMEK was performed with an intraoperative inferior PI and a near total fill of SF6 (20% concentration). After filling the anterior chamber with gas there was no intraoperative tamponade time; at the conclusion of surgery the patient was sat up in theatre and an external eye examination was performed to confirm the gas meniscus was above the PI. The patient was allowed home immediately with no instructions to posture at home and the next scheduled review occurred at day 7.
METHODS: Rate of any postoperative complications, including any unplanned visits or intervention between day 0-7, graft detachment, rebubbling and primary failure rates.
RESULTS: There were zero additional or unplanned visits or interventions. No pupil block or Urrets-Zavalia syndrome occurred. No complications occurred other than partial (<1/3 DMEK surface area) detachment in the first month in 3/17 (17.6%) of which a rebubbling was performed in 2 (11.8%). Each of those required one rebubbling, after which total graft attachment was achieved. There were no cases of primary graft failure.
CONCLUSIONS: This small series highlights that DMEK surgery can be safely performed with less demands of patients in the postoperative period for hospital reviews or of posturing.

*Correspondence, Ahmad Shakeel: drshakeel333@gmail.com PURPOSE: To evaluate the clinical results of postureless (no intraoperative or postoperative posturing) Descemet\'s membrane endothelial keratoplasty (DMEK) with the first postoperative review conducted at one week.
METHODS: Retrospective, noncomparative, interventional case series.
METHODS: 17 consecutive eyes of 17 patients requiring DMEK with PI for any cause of endothelial failure.
METHODS: DMEK was performed with an intraoperative inferior PI and a near total fill of SF6 (20% concentration). After filling the anterior chamber with gas there was no intraoperative tamponade time; at the conclusion of surgery the patient was sat up in theatre and an external eye examination was performed to confirm the gas meniscus was above the PI. The patient was allowed home immediately with no instructions to posture at home and the next scheduled review occurred at day 7.
METHODS: Rate of any postoperative complications, including any unplanned visits or intervention between day 0-7, graft detachment, rebubbling and primary failure rates.
RESULTS: There were zero additional or unplanned visits or interventions. No pupil block or Urrets-Zavalia syndrome occurred. No complications occurred other than partial (<1/3 DMEK surface area) detachment in the first month in 3/17 (17.6%) of which a rebubbling was performed in 2 (11.8%). Each of those required one rebubbling, after which total graft attachment was achieved. There were no cases of primary graft failure.
CONCLUSIONS: This small series highlights that DMEK surgery can be safely performed with less demands of patients in the postoperative period for hospital reviews or of posturing.