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OBJECTIVE: This study aimed to quantitatively evaluate optic nerve head and retinal vascular parameters in children with hyperopia in relation to age and spherical equivalent refraction (SER) using artificial intelligence (AI)-based analysis of colour fundus photographs (CFP).
METHODS: This cross-sectional study included 324 children with hyperopia aged 3-12 years. Participants were divided into low hyperopia (SER+0.5 D to+2.0 D) and moderate-to-high hyperopia (SER≥+2.0 D) groups. Fundus parameters, such as optic disc area and mean vessel diameter, were automatically and quantitatively detected using AI. Significant variables (p<0.05) in the univariate analysis were included in a stepwise multiple linear regression.
RESULTS: Overall, 324 children were included, 172 with low and 152 with moderate-to-high hyperopia. The median optic disc area and vessel diameter were 1.42 mm2 and 65.09 µm, respectively. Children with high hyperopia had larger superior neuroretinal rim (NRR) width and larger vessel diameter than those with low and moderate hyperopia. In the univariate analysis, axial length was significantly associated with smaller superior NRR width (β=-3.030, p<0.001), smaller temporal NRR width (β=-1.469, p=0.020) and smaller vessel diameter (β=-0.076, p<0.001). A mild inverse correlation was observed between the optic disc area and vertical disc diameter with age.
CONCLUSIONS: AI-based CFP analysis showed that children with high hyperopia had larger mean vessel diameter but smaller vertical cup-to-disc ratio than those with low hyperopia. This suggests that AI can provide quantitative data on fundus parameters in children with hyperopia.

The characteristics of patients with endophthalmitis due to penetrating ocular trauma are still limited. The aim of the study was to fill these gaps among Chinese population. This retrospective study included patients diagnosed as penetrating ocular traumatic endophthalmitis between January 2016 to December 2018. During the past 3-year period, a total of 201 patients with antecedent penetrating eye injuries were evaluated. Of which, 42 (20.9%) patients presented a clinical course compatible with acute infectious endophthalmitis. 39 (92.86%) patients were males, and 15 (35.71%) patients had mechanical injuries from intraocular foreign body (IOFB), the rate of endophthalmitis due to IOFB was 13.43%, higher to the rate among patients without IOFB (7.46%). The duration between injury occurrence and endophthalmitis onset was 1 day in 10 (23,80%) patients; 2 to 7 days in 31 (73.80%) patients, and 7 to 14 days in 1 (2.38%) patient. After 1 year follow-up, best corrected visual acuity (BCVA) better than 20/400 was observed in 15 (35.71%) patients, counting fingers and hand move in 17 (40.48%) patients, light perception in 5 (11.9%) patients and no light perception in 5 (11.9%) patients, respectively. Patients with promising outcomes had better initial BCVA at baseline (P < .001). Endophthalmitis is a severe ocular infectious condition that may lead to irreversible vision loss. A greater attention must be paid to penetrating eye injuries within males, who had poor BCVA at baseline, particularly with obvious IOFB.

OBJECTIVE: To investigate the preoperative choriocapillaris perfusion (CCP) as a biomarker in patients with idiopathic epiretinal membrane (iERM).
METHODS: 28 patients (28 eyes) with unilateral iERM who received pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling were included for retrospective observational study. Optical coherence tomography (OCT) and angiography (OCTA) was performed before and after PPV. Area, perimeter, and circularity of superficial foveal avascular zone (FAZ) were analyzed preoperatively in both eyes using OCTA. Preoperative CCP was also analyzed with binarized en-face OCTA images. Measurements of best-corrected visual acuity (BCVA) and central foveal thickness (CFT) by OCT were conducted at the baseline and 6 months following the surgery. The correlations of preoperative OCT parameters with postoperative BCVA and CFT reduction were analyzed.
RESULTS: CCP was significantly lower (p < 0.001) and FAZ had shrunk (p < 0.001) in eyes with iERM compared to unaffected fellow eyes before surgery. BCVA and CFT became significantly improved after surgery (p = 0.001, p < 0.001). Multiple regression analysis revealed that preoperative CCP was significantly related with BCVA improvement (β = 0.185, p = 0.005), postoperative BCVA (β = 0.108, p = 0.023) and ratio of post- to preoperative CFT (β = 0.106, p = 0.044).
CONCLUSIONS: Preoperative CCP is a biomarker for poor functional and anatomical prognosis after surgery in iERM.

Aim of the present study is to evaluate the relationship between genetic and phenotypic data in a series of patients affected by grade I and II of foveal hypoplasia with stable fixation and good visual acuity using multimodal imaging techniques. All patients underwent complete clinical and instrumental assessment including structural Optical Coherence Tomography (OCT), OCT Angiography and Adaptive Optics (AO) imaging. Central macular thickness (CMT), inner nuclear layer (INL), vessel density in superficial capillary plexus were the main variables evaluated with OCT technology. Cone density, cone spacing, cone regularity, cone dispersion and angular density were the parameters evaluated with AO. Genetic evaluation and trio exome sequencing were performed in all affected individuals. Eight patients (3 males and 5 females) with a mean age of 12.62 years (range 8-18) were enrolled. The mean best corrected visual acuity (BCVA) was 0.18 ± 0.13 logMAR, mean CMT was 291.9 ± 16.6 µm and INL was 26.2 ± 4.6 µm. The absence of a foveal avascular zone (FAZ) was documented by examination of OCT-A in seven patients in the superficial capillary plexus. However, there was a partial FAZ in the deep plexus in patients P5 and P8. Of note, all the patients presented with major retinal vessels clearly crossing the foveal center. All individuals exhibited a grade I or II of foveal hypoplasia. In 5 patients molecular analyses showed an extremely mild form of albinism caused by compound heterozygosity of a TYR pathogenic variant and the hypomorphic p.[Ser192Tyr;Arg402Gln] haplotype. One patient had Waardenburg syndrome type 2A caused by a de novo variant in MITF. Two patients had inconclusive molecular analyses. All the patients displayed abnormalities on OCT-A. Photoreceptor count did not differ from normal subjects according to the current literature, but qualitative analysis of AO imaging showed distinctive features likely related to an abnormal pigment distribution in this subset of individuals. In patients with foveal hypoplasia, genetic and multimodal imaging data, including AO findings, can help understand the physiopathology of the foveal hypoplasia phenotype. This study confirms that cone density and visual function can both be preserved despite the absence of a pit.

OBJECTIVE: To understand factors affecting visual prognosis and the number of intravitreal antivascular endothelial growth factor (anti-VEGF) injections needed to stabilize wet age-related macular degeneration (AMD).
METHODS: In this retrospective cohort, 119 treatment-naïve wet AMD patients were followed for two years. In patients with bilateral disease, the eye with worse best-corrected visual acuity (BCVA) or that received more intravitreal injections was recruited as the study eye. In all visits, BCVA was recorded, ophthalmological examination was performed including macular optical coherence tomography imaging. Twenty health status/lifestyle questions were asked to the patients via phone as potential risk factors. All patients received 3 loading doses of intravitreal bevacizumab injections and received repeat injections of aflibercept or ranibizumab when the eye had a new, active neovascular lesion.
RESULTS: Patients who took regular micronutrition had similar visual outcome and injection numbers compared to the ones who did not. Patients with bilateral disease needed less intravitreal injections compared to unilateral AMD patients (p = 0.016) and women on hormone replacement therapy (HRT) required less injections compared to the women who were not (p = 0.024). Female patients had a mean gain of 2.7 letters while male patients lost 3.8 letters (p = 0.038). Wet AMD started at an earlier age in smokers (p = 0.002). Patients with a better education level presented earlier with better BCVA (p = 0.037).
CONCLUSIONS: HRT and anti-VEGF injections to the fellow eye improved the prognosis of wet AMD, while male patients had slightly worse prognosis. Estrogen\'s protective effects and potential contribution in wet AMD needs further attention. Retrospectively registered: 2020/0622.

OBJECTIVE: This study evaluates the effectiveness of implantation of extended depth of focus (EDOF) intraocular lenses (IOL) in patients with cataract and glaucoma.
METHODS: The study included 13 patients (16 eyes) who underwent implantation of the Lentis Comfort EDOF IOL (Teleon Surgical BV, Netherlands). Standard phacoemulsification cataract surgery with IOL implantation was performed in a planned manner after the hypotensive surgery stage in two eyes; a combined procedure was performed in 14 cases. Uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), near visual acuity, and intraocular pressure (IOP) measured with a Maklakov tonometer were assessed preoperatively, on the first day, and 3-6 months after surgery. Computer perimetry using the 30-2 program and spatial contrast sensitivity (SCS) assessment were also performed preoperatively and at the same follow-up time points.
RESULTS: On the first day after surgery, UCVA was 0.53±0.65, BCVA was 0.85±0.45. Near UCVA (at 40 cm) was 0.5±0.14 on the first day after surgery and 0.56±0.18 at 3-6 months. According to computer perimetry data, retinal light sensitivity values increased in all patients in the long-term (-3.1±2.9 dB). SCS values increased for objects of all sizes compared to preoperative values.
CONCLUSIONS: Implantation of EDOF IOL contributes to improved vision without reducing contrast sensitivity and retinal light sensitivity in patients with concomitant cataract and glaucoma.
UNASSIGNED: Оценить эффективность имплантации интраокулярных линз (ИОЛ) с увеличенной глубиной фокуса у пациентов с катарактой и глаукомой.
UNASSIGNED: В исследование включено 13 пациентов (16 глаз), которым была имплантирована ИОЛ с увеличенной глубиной фокуса Lentis Comfort (Teleon Surgical BV, Нидерланды). В двух глазах была выполнена стандартная факоэмульсификация катаракты с имплантацией ИОЛ в плановом порядке после этапа гипотензивной операции; в 14 случаях было выполнено комбинированное вмешательство. Некорригированная острота зрения (НКОЗ), максимально корригированная острота зрения (МКОЗ), острота зрения вблизи и внутриглазное давление, определяемое с помощью тонометра Маклакова, измерялись до операции, в первый день и через 3—6 мес после оперативного вмешательства. Также до операции и в те же сроки после нее выполнялись компьютерная периметрия по стратегии 30-2 и оценка пространственной контрастной чувствительности (ПКЧ).
UNASSIGNED: На следующий день после операции НКОЗ составляла 0,53±0,65, МКОЗ — 0,85±0,45. НКОЗ вблизи (на расстоянии 40 см) составила 0,5±0,14 на следующий день после операции и 0,56±0,18 через 3—6 мес. По данным компьютерной периметрии значения светочувствительности сетчатки в отдаленном послеоперационном периоде увеличились у всех пациентов (-3,1±2,9 дБ). Значения ПКЧ увеличились для всех размеров объектов по сравнению с дооперационными значениями.
UNASSIGNED: Имплантация ИОЛ с увеличенной глубиной фокуса способствует улучшению зрения, не снижая контрастную чувствительность и светочувствительность сетчатки у пациентов с катарактой и сопутствующей глаукомой.

Congenital subluxation of the lens as a complication of Marfan syndrome, Weill-Marchesani syndrome, microspherophakia, etc. leads to the development of amblyopia and requires timely surgical treatment with removal of the subluxated lens and implantation of an artificial intraocular lens (IOL). IOL implantation in children with pathology of the ligamentous apparatus of the lens remains an urgent problem of ophthalmic surgery due to the lack of a consensus regarding the IOL fixation method among practitioners.
OBJECTIVE: This study evaluated the effectiveness and safety of IOL implantation with transscleral fixation using the knotless Z-suture technique in pediatric patients with congenital lens subluxation.
METHODS: The study included 24 children (36 eyes) with grade III congenital subluxation of the lens who underwent phacoaspiration of the subluxated lens with IOL implantation with transscleral fixation using the knotless Z-suture performed in the Kazakh Research Institute of Eye Diseases in Almaty in the period from 2017 to 2021. The average observation period was 31.7±11.3 months (2.0 to 4.5 years). The stability of the IOL position, the state of the intrascleral sutures, visual acuity after surgery, the presence and severity of complications in the long-term period were evaluated.
RESULTS: All patients (100%) had a significant improvement in visual acuity after surgery. No intraoperative complications were registered in any of the cases. Postoperative complications were noted in 8.3% of cases (n=3). The final functional outcome of surgical treatment depended on the presence of concomitant pathology, the main cause of low vision was the development of refractive amblyopia due to refractive errors.
CONCLUSIONS: The presented technique of transscleral fixation of IOL has proven to be reliable, which is especially important for pediatric patients considering their high physical activity and expected lifespan.
Врожденная сублюксация хрусталика в детском возрасте при таких состояниях, как синдромы Марфана, Вейля—Марчезани, микросферофакия и др., приводит к развитию амблиопии и требует своевременного хирургического лечения с удалением сублюксированного хрусталика и имплантацией интраокулярной линзы (ИОЛ). Имплантация ИОЛ у детей с патологией связочного аппарата хрусталика остается актуальной проблемой офтальмохирургии ввиду отсутствия на сегодняшний день единого подхода к методу фиксации ИОЛ в мировой практике.
UNASSIGNED: Оценка эффективности и безопасности имплантации ИОЛ с транссклеральной фиксацией с использованием метода безузлового Z-образного шва у пациентов детского возраста с врожденной сублюксацией хрусталика.
UNASSIGNED: В исследование включено 24 ребенка (36 глаз) с врожденной сублюксацией хрусталика III степени, которым была проведена факоаспирация сублюксированного хрусталика с имплантацией ИОЛ с транссклеральной фиксацией безузловым Z-образным швом на базе КазНИИ глазных болезней (Алматы, Казахстан) в период с 2017 по 2021 г. Средний срок наблюдения составил 31,7±11,3 мес (от 2,0 до 4,5 года). Оценивали стабильность положения ИОЛ, состоятельность интрасклеральных швов, остроту зрения после операции, наличие и степень тяжести осложнений в отдаленном периоде.
UNASSIGNED: У всех пациентов (100%) отмечалось достоверное улучшение остроты зрения после операции. Интраоперационных осложнений не было зарегистрировано ни в одном случае. Послеоперационные осложнения отмечены в 8,3% случаев (n=3). Окончательный функциональный результат хирургического лечения зависел от наличия сопутствующей патологии, основной причиной низкого зрения являлось развитие рефракционной амблиопии вследствие аномалий рефракции.
UNASSIGNED: Представленная методика транссклеральной фиксации ИОЛ обеспечивает надежную фиксацию, что особенно актуально для пациентов детского возраста, учитывая их высокую физическую активность и предполагаемую продолжительность жизни.

The Boston Keratoprosthesis type I (KPro-I) has been shown to be successful in restoring vision after severe ocular burns; however, its long-term outcomes in phthisical eyes have rarely been reported. A monocular woman with a history of severe alkali chemical injury necessitating facial transplantation presented with a light perception left eye after a complicated course, including failed KPro-I, therapeutic penetrating keratoplasty, endophthalmitis, hypotony, total retinal detachment, and structural changes, including a shrunken 18 mm axial length and eye wall thickening. The patient underwent a combined vitrectomy with silicone oil and KPro-I implantation, resulting in her regaining ambulatory visual acuity (20/250) at 3 years\' follow-up.

A healthy 4-year-old boy referred for evaluation of an abnormal red reflex in the left eye was noted, on fundus examination, to have extensive white, striated lesions surrounding the optic nerve that involved the superior and inferior macular arcades. On further examination, he was found to have ipsilateral high myopia and amblyopia. The triad of unilateral myelinated retinal nerve fibers, myopia, and amblyopia led to a diagnosis of Straatsma syndrome, which requires early treatment to prevent permanent vision loss. Treatment comprised a contact lens for refractive correction of the left eye, patching of the right eye, and full-time polycarbonate protective lenses. With 2 years\' follow-up, the left eye failed to improve appreciably.