Giant retinal tear-associated rhegmatogenous retinal detachment (GRT-RRD) presents a significant surgical challenge. Trauma stands out as one of the risk factors. This retrospective case series aims to assess the outcomes of GRT-RRD patients treated with pars plana vitrectomy (PPV), distinguishing between non-trauma and blunt ocular trauma cases. The medical records and relevant retinal imaging of 60 GRT-RRD patients undergoing PPV and followed with a mean (SD) of 21.2 (13.4) months were reviewed (47 were non-trauma-related and 13 were trauma-related). Both the non-trauma and trauma groups exhibited comparable distribution of proliferative vitreoretinopathy grade (P = 0.067). Following the primary operation, there was no statistically significant difference in the proportion of patients achieving single surgery anatomical success between the non-trauma group (27/47 patients, 57.5%) and the trauma-related group (9/13 patients, 69.2%) (P = 0.534). At the final follow-up, 17 patients remained tamponade with silicone oil. Among the remaining 43 patients, 33/34 patients (97.1%) in the non-trauma group and 9/9 patients (100%) in the non-trauma group (P = 0.661) achieved comparable final surgical anatomical success. Additionally the final vision was comparable between the two trauma categories (Snellen equivalent of 20/125 for the non-trauma group and 20/200 for the trauma group, P = 0.331). In multivariable regression, no significant factors related to primary reattachment rate or final vision were identified. Non-penetrating ocular trauma did not emerge as a significant risk factor for recurrent detachment post-surgery. This study supports that PPV outcomes in GRT-RRD patients are unaffected by the ocular trauma association and reports the effectiveness of PPV in managing these patients.

UNASSIGNED: To investigate the difference in the effectiveness and refraction of the foldable capsular buckle (FCB) in rhegmatogenous retinal detachment (RRD).
UNASSIGNED: Six patients with simple RRD were treated for FCB scleral buckling at Xiamen Eye Center of Xiamen University from October 2023 to February 2024. The parameters assessed included demographic data, clinical data such as preoperative ocular axis, corneal endothelial count, macular foveal thickness, operative time, preoperative and final follow-up intro ocular pressure (IOP), retinal attachment status, and postoperative complications. Refractive change before and after surgery, including sphere, cylinder degree, spherical equivalent, and absolute spherical equivalent difference were compared.
UNASSIGNED: All six patients with sound retinal reattachment after FCB scleral buckling, including two men and four women, mean age 41.33 ± 12.40 years old, duration before surgery onset to 7.17 ± 7.16 days, FCB mean operation time 36.67 ± 13.07 min, Preoperative IOP mean 13.35 ± 2.64 mmHg and mean 21.12 ± 8.09 mmHg of final follow-up IOP; there was no significant difference between preoperative IOP and follow-up IOP (p = 0.050). The preoperative sphere range was -6.25 to +2.50 D, and the cylinder range was -2.50 to +1.00 D; the absolute spherical equivalent difference before and after was 1.60 ± 1.69 degrees.
UNASSIGNED: FCB can achieve retinal reattachment and restore visual function in cases of RRD. The shorter duration of external scleral buckle compression with FCB suggests that FCB scleral buckling holds greater promise in the clinical treatment of RRD caused by retinal tears.

Background/Objectives: This retrospective case series analyzed visual outcomes in patients with a prior history of implantable collamer lens (ICL) implantation who underwent cataract extraction (CE). A secondary aim was to investigate the relationship between vault height and the rate of cataract development. Methods: Visual acuity and refraction measurements were collected after CE at one week, one month and six months. Vault height measurements were correlated to the time until symptomatic cataracts were removed. Results: A total of 44 eyes were analyzed at six months after CE with efficacy and safety indexes of 1.20 ± 1.11 and 1.50 ± 1.06, respectively. In addition, 70% of eyes had a post-operative uncorrected distance visual acuity (UDVA) within one line of pre-operative corrected distance visual acuity (CDVA). Refractive predictability at six months demonstrated that 43% and 69% of eyes were within ±0.25 D and ±0.50 D of SEQ target, respectively. Astigmatism measured by refractive cylinder was ≤0.25 D in 17% and ≤0.50 D in 34% of eyes pre-operatively compared to 40% and 60% of eyes, respectively, at six months post-operatively. Vault heights one week after ICL (p < 0.0081) and one week before CE (p < 0.0154) demonstrated a positive linear regression with the time until CE. Conclusions: This sample population achieved favorable visual outcomes six months after CE, similar to six months after ICL implantation. Patients with a history of ICL implantation will similarly have a good visual prognosis after CE.

UNASSIGNED: To compare the outcomes of ophthalmic surgical emergencies during shelter-in-place (SIP) order with the corresponding period in 2019.
UNASSIGNED: This retrospective cohort study compared patients presenting to the Bascom Palmer Eye Institute (BPEI) emergency department (ED) who underwent urgent surgery during the SIP period (March 23-May 17, 2020), compared to the same weeks in 2019 (non-SIP). Main outcome measures included symptom-to-ED time, ED-to-surgical decision time, surgical decision-to-operating room (OR) time, ED-to-OR time, and postoperative follow-up time. Secondary outcome measures included travel distance, visual acuity (VA), intraocular pressure (IOP), and number of glaucoma medications.
UNASSIGNED: Seventy-six and 148 patients presented with ophthalmic surgical emergencies in the SIP and non-SIP study periods, respectively. Retinal detachment (RD), acute glaucoma, and open globe injury were the most common diagnoses in both periods. Symptom-to-ED and surgical decision-to-OR times were shorter during the SIP period. SIP patients had comparable preoperative VA but worse postoperative VA compared to non-SIP patients. During the SIP period, RD patients experienced postoperative VA reduction rather than improvement (+0.09 vs. -0.23 logMAR, p = 0.03); glaucoma patients were less likely to reach surgical decision within 24 h (OR 0.16 [95% CI 0.03-0.95]); and globe injuries had longer ED-to-surgical decision time and ED-to-OR time compared to the non-SIP period. Other outcomes were similar between both study periods.
UNASSIGNED: There was reduced volume of ophthalmic surgical emergencies and worse postoperative vision during SIP compared to the non-SIP period, despite shorter symptom-to-ED and surgical decision-to-OR times suggesting minimal delays in seeking or receiving care.

Bacillus cereus endophthalmitis is a severe vision-threatening disease. This study aimed to analyze the clinical characteristics, antibiotic susceptibility, and risk factors for poor final visual acuity (VA) and enucleation or evisceration (ENEV) outcomes of B. cereus endophthalmitis patients. We retrospectively reviewed 52 cases (52 eyes) of culture-proven B. cereus endophthalmitis at Zhongshan Ophthalmic Center from January 2013 to December 2023. The mean age of the patients was 38.1 ± 20.1 years, and males composed the majority (90.4%) of the sample size; laborers (32.7%) and farmers (19.2%) were the primary occupations of the patients. All cases were caused by ocular trauma. Forty-one of 51 eyes (80.4%) had a final VA worse than the ability to count fingers (CFs), and 15 of the 52 total eyes (28.8%) underwent ENEV. Binary logistic forward (LR) regression analysis demonstrated that red eye (odds ratio [OR], 13.13; 95% confidence interval [CI], 1.58-108.80; p = 0.017), eye pain (OR, 22.87; 95% CI, 1.00-522.72; p = 0.050), and corneal edema/ulcer (OR, 13.13; 95% CI, 1.58-108.80; p = 0.017) were significant risk factors for poor VA outcomes. Conjunctival sac purulent discharge (OR, 10.08; 95% CI, 2.11-48.12, p = 0.004) and white blood cell (WBC) count (OR, 1.35; 95% CI, 1.06-1.72, p = 0.016) were significant risk factors for ENEV outcomes. B. cereus showed susceptibility rates of 100.0% to vancomycin and ofloxacin; 98.0% to levofloxacin; 93.3% to ciprofloxacin; 87.5% to imipenem; and 78.9% to tobramycin. The susceptibility to azithromycin and clindamycin was 66.7% and 50.0%, respectively. In contrast, B. cereus was resistant to penicillin (susceptibility at 3.8%), cefuroxime (5.6%), and cefoxitin (37.1%).

BACKGROUND: Pituitary apoplexy (PA) is characterized by acute hemorrhage or infarction of the pituitary gland. Management can be either conservative or surgical. Evidence favoring either is still limited to observational studies. This meta-analysis evaluates the effectiveness of both approaches on patient outcomes.
METHODS: A systematic search was performed until February 2024. We included cohort studies of patients with PA. Patients were divided into 2 groups: a conservative management group and a surgery group, including early and late surgery. Outcomes of interest were assessed categorically using risk ratio (RR) and Mantel-Haenszel\'s random effects model.
RESULTS: Of the 273 published articles, 15 cohort studies comprising 908 patients were included. There was no statistically significant difference between groups in recovery of ophthalmoplegia (RR=1.09, confidence interval [CI]=1.00-1.18, P=0.05), visual field (RR=1.09, CI=0.91-1.3, P=0.35), visual acuity (RR=1.05, CI=0.87-1.26, P=0.61), hypopituitarism (RR=1.37, CI=0.81-2.32, P=0.25), and tumor recurrence (RR=0.74, CI=0.34-1.61, P=0.45). This was similar for conservative management versus early surgery in recovery of visual field (RR=0.92, CI=0.62-1.37, P=0.68), visual acuity (RR=1.01, CI=0.81-1.26, P=0.93), and ophthalmoplegia (RR=0.92, CI=0.53-1.61, P=0.77).
CONCLUSIONS: Both interventions provide comparable outcomes. These findings, though, are drawn from observational studies, and more severe cases typically undergo surgery. Larger studies are necessary to provide conclusive evidence.

A leading cause of death and disability in infancy is abusive head trauma (AHT) and there are common clinical signs that help to establish this diagnosis. Children diagnosed with AHT can have many ophthalmologic findings, including retinal hemorrhages, retinoschisis, subconjunctival hemorrhages, corneal injury, and globe rupture. If any such injuries are suspected, an ophthalmologic consultation, with indirect ophthalmoscopy, should be completed. In addition to a complete physical exam, a thorough history imaging, and lab work, should be obtained to investigate the etiology of ophthalmic pathology including accidental and systemic causes. In general, studies show that retinal hemorrhages that are multilayered, too numerous to count, and located from the posterior pole to the ora serrata are highly suspicious for abusive head trauma.

OBJECTIVE: Proton beam reirradiation (PBI) remains an effective and globe-preserving alternative to enucleation in the treatment of local recurrence in uveal melanoma. The study aimed to assess visual outcomes and prognostic factors in visual acuity (VA) after proton beam salvage therapy.
METHODS: Retrospective study.
METHODS: A retrospective study evaluated patients with recurrent uveal melanoma treated with PBI from 1984 through 2019 at a single academic tertiary center.
METHODS: Patient and tumor characteristics were collected from the medical record, as well as best visual acuity (BVA) and ocular outcomes after treatment of recurrent uveal melanoma with PBI.
METHODS: The primary outcome of the study was the BVA of patients after PBI for recurrent uveal melanoma. Additional outcome measures included enucleation rate of patients after salvage PBI and analysis of tumor and patient characteristics in the prognostication of VA.
RESULTS: The study comprised 67 patients who received PBI for recurrent uveal melanoma. The median age at recurrence was 67.6 years (range, 31.6-91.0 years), and median follow-up from the time of recurrence to last examination was 4.4 years (range, 0.23-17.1 years). The median final BVA was hand motions (range, 20/20 to no light perception) and 6 (9.1%) patients maintained a Snellen VA 20/40 or better. The 5-year probability of VA retention of 20/200 or better was 19%. In a multivariable Cox model, VA at tumor recurrence of worse than 20/40 was found to be significantly associated with a VA of 20/200 or worse after retreatment with PBI. Twelve (18%) patients underwent enucleation after retreatment with PBI.
CONCLUSIONS: Proton beam irradiation for the treatment of recurrent uveal melanoma allows for ocular preservation and functional vision in select patients.
BACKGROUND: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

OBJECTIVE: To characterize anti-VEGF intravitreal therapy (IVT) patterns and long-term visual outcomes among patients with diabetic macular edema (DME) in routine clinical practice in the United States.
METHODS: Retrospective analysis of the American Academy of Ophthalmology\'s IRIS® (Intelligent Research in Sight) Registry.
METHODS: Treatment-naïve patients with DME (no previous IVT in the past 12 months) initiating anti-VEGF IVT from January 1, 2015, to March 31, 2021.
METHODS: Baseline characteristics, treatment patterns, and long-term visual acuity (VA) outcomes were reported for up to 6 years of follow-up.
METHODS: Outcomes included the annualized number of injections, change in VA, and anti-VEGF agents.
RESULTS: A total of 190 345 eyes met the inclusion criteria. After 1 year of anti-VEGF IVT initiation, eyes received a mean of 3.9 (±2.8) injections and gained +3.2 (±16.4) letters of vision. Of the 1236 eyes with year 6 data, eyes received a mean of 2.9 (±2.1) injections in year 6 and gained +0.5 (±19.7) letters from baseline. The number of injections decreased, and injection intervals increased year over year up to 6 years regardless of baseline VA initiation. The average injection interval was 10 weeks in year 1 and increased to 13.2 weeks in year 2 before plateauing in years 3 to 6 (12.6, 12.3, 12.2, and 12.3 weeks, respectively). Improvements in VA from baseline were greatest in eyes that received 5 or more injections each year. At the end of follow-up, eyes with good baseline vision (>20/25) lost vision, whereas those with worse baseline vision (<20/25) gained vision. Although 51.7% of patients with DME discontinued IVT after a mean of 6 months, 32.8% reinitiated anti-VEGF IVT. Worse VA outcomes were associated with patients of Hispanic ethnicity (-1.08; 95% confidence interval: -1.34, -0.83] compared with non-Hispanic), Medicaid insurance (-1.15; 95% confidence interval: -1.48, -0.81 compared with commercial), and older age (-0.06; 95% confidence interval: -0.07, -0.05] each additional year).
CONCLUSIONS: Patients with DME in routine clinical settings receive fewer injections than those in clinical trials and fewer than recommended per the label of US Food and Drug Administration-approved anti-VEGF IVT.
BACKGROUND: Proprietary or commercial disclosure may be found after the references in the Footnotes and Disclosures at the end of this article.

UNASSIGNED: To report our experience of performing immediate sequential bilateral cataract surgery (ISBCS) in patients with visually significant cataracts and reduced preoperative corrected distance visual acuity (CDVA).
UNASSIGNED: Data of patients who underwent ISBCS for visually significant cataracts and had preoperative CDVA ≤20/32 (≤0.2 logMAR) in each eye were retrospectively reviewed. Refractive and visual outcomes were evaluated for the last available postoperative visit. Intraoperative and serious postoperative adverse events occurring within the first three months of surgery were reviewed.
UNASSIGNED: A total of 1335 patients (2670 eyes) were included in the analysis, with a mean age of 71.9 ± 9.5 years. On the last visit, 50.2% and 89.1% of eyes achieved uncorrected distance visual acuity (UDVA) ≥20/20 (0.0 logMAR) and ≥20/32 (0.2 logMAR), respectively. Of all eyes, 83.8% were within ±0.50D, and 96.4% were within ±1.00 D of emmetropia. Ten patients had postoperative bilateral ametropia of more than 1.00D in each eye, but eight of them still achieved binocular UDVA ≥20/40. Intraoperative events occurred in 14 eyes of 13 patients (per-eye incidence: 0.524% or 1 in 191 eyes). A total of 86 postoperative adverse events occurred in 80 eyes of 53 patients (per-eye incidence 2.996% or 1 in 33 eyes), of which cystoid macular edema was the most common. Only three eyes had CDVA reduced by more than two Snellen lines compared to preoperative CDVA, two of which were not related to cataract surgery. There was no patient with bilateral CDVA loss.
UNASSIGNED: In our cohort of patients with visually significant cataracts, ISBCS resulted in good refractive predictability and a low incidence of serious adverse events.