European Journal of Ophthalmology

This systematic review and meta-analysis aims to compare BT and DT in terms of intraocular pressure (IOP) reduction, safety, and patient preferences.

Following PRISMA and Cochrane guidelines, we searched PubMed, Scopus, Web of Science, CENTRAL, and Embase up to December 30, 2024. Twelve studies (11 randomized controlled trials [RCTs]) involving 1,885 patients were included. Primary outcomes were IOP reduction and adverse events. Statistical analyses were performed using Review Manager 5.4.1, with mean differences (MD) and risk ratios (RR) calculated for continuous and binary outcomes.

BT demonstrated a statistically greater reduction in the morning IOP compared to DT at 12 weeks or more (BT: MD = 0.56 mmHg, P < 0.001; BTFC subgroup: MD = 0.66, P < 0.001), with consistent benefits observed at 8 and 4 weeks. No significant difference was observed in the evening IOP reduction. BT combination was associated with a 49% lower risk of eye irritation (RR = 0.51, P < 0.001) but a threefold higher risk of blurred vision (RR = 3.14, P < 0.001). Patient preference studies favored brinzolamide/timolol fixed combination (BTFC) due to reduced ocular discomfort.

BT showed a statistically greater reduction in morning IOP than DT; however, the absolute difference was modest, and its clinical relevance is uncertain. BT was associated with less ocular irritation but higher blurred vision risk. High heterogeneity for evening IOP and overall adverse events limits interpretation. Considering these findings, the choice of treatment usually depends on the patient's tolerance to higher initial ocular irritation in DT or blurring of vision in BT. Longer-term trials with 24-h IOP and preference are needed to assess these outcomes meaningfully.

This systematic review evaluates the efficacy and safety of different nasal adrenaline concentrations for bleeding control in endoscopic dacryocystorhinostomy (eDCR).

Following PRISMA guidelines, we searched PubMed for studies reporting bleeding and cardiovascular events in adult eDCR. Outcomes were analysed using random-effects models. Statistical analyses employed random-effects models and I² statistic. The protocol was registered with the Open Science Framework (OSF) (DOI: https://doi.org/10.17605/OSF.IO/EZDWG).

Among 103 screened articles, seven studies (comprising 856 patients) were included for meta-analysis. The 1:200,000 infiltrative adrenaline had significantly higher bleeding risk (15.3%, 95% CI: 11.1–20.5%) than 1:100,000 (3.8%, 95% CI: 2.0–6.5%) and 1:80,000 (2.0%, 95% CI: 0.7–4.3%), with an absolute risk difference of +13.3% (95% CI: + 9.8–16.8%, p < 0.0001) between 1:200,000 and 1:80,000. No significant difference existed between 1:100,000 and 1:80,000 (RD=+1.8%, 95% CI: −1.2–4.7%, p = 0.23). Each 100,000-fold dilution increased absolute bleeding risk by 12.1% (p < 0.001), with a number needed to treat (NNT) of 8 favouring 1:80,000 or 1:100,000 over 1:200,000.

The most common infiltrative concentrations (n = 8,648) were 1:100,000 (57%), 1:200,000 (23%), and 1:80,000 (18%). For topical applications (n = 6,343), 1:1,000 (48%) and 1:100,000 (22%) predominated. While no particular topical concentration showed superior haemostasis (p > 0.05), 30-min 1:1,000 adrenaline application reduced bleeding vs. 5-min use (p < 0.05). Rare complications included ocular and cardiovascular events.

1:100,000 or 1:80,000 infiltrative adrenaline is preferred over 1:200,000 for lower bleeding risks, while topical adrenaline benefits from prolonged 30-min application. Surgeons should remain vigilant for rare systemic complications.

The coexistence of heterogeneous tumors, spindle cell hemangioma (SCH) and cavernous hemangioma, is a rare clinical presentation. SCH is an uncommon vascular disease that most often presents as cutaneous or subcutaneous nodules in the distal extremities and only rarely in deep soft tissues.

A 57-year-old woman developed secondary orbital involvement with two tumors 40 years after removal of a cavernous hemangioma in the same orbit. CT and MRI images showed two tumors in the left orbit. Both were removed entirely via a transconjunctival anterior orbital approach combined with a nasal endoscopic transethmoidal approach. Pathology showed SCH and cavernous hemangioma.

Coexistence of SCH and cavernous hemangioma in the same area suggests a continuum and a shared origin. Although SCH is rare and its preoperative diagnosis is challenging, it should be included in the differential diagnosis of cavernous hemangioma.

This meta-analysis aimed to evaluate the studies comparing transepithelial photorefractive keratectomy (TransPRK) to LASIK (Laser-Assisted In Situ Keratomileusis)/SMILE (Small Incision Lenticule Extraction) in terms of visual outcomes for myopia, astigmatism and hyperopia.

Studies from PubMed^® were included based on predefined criteria comparing TransPRK to LASIK/SMILE in terms of efficacy, efficacy index, safety, safety index, predictability, correction index, difference vector or index of success. A random-effects meta-analysis provided standardized mean differences, odds ratios (OR) and 95% confidence intervals (CI).

17 studies with 5686 treated eyes met the inclusion criteria. Compared to LASIK, TransPRK showed a log(OR) of 0.09 (CI: −0.34 to 0.52) for efficacy, −0.85 (CI: −1.40 to −0.31) for safety (favoring LASIK) and 0.08 (CI: −0.28 to 0.44) for predictability. Compared to SMILE, TransPRK had a log(OR) of 0.77 (CI: −0.29 to 1.84) for efficacy, −0.3 (CI: −2.27 to 1.67) for safety and −0.91 (CI: −1.82 to 0) for predictability.

No statistically significant differences were found between TransPRK and LASIK/SMILE in terms of efficacy and predictability. LASIK did show a significant safety advantage compared to TransPRK (negative log[OR], p < 0.05) in the astigmatism and low-to-moderate myopia subgroup but the safety index did not. Procedure choice should be based on patient characteristics, laser availability, complication risk and surgeon experience, and not by performance in efficacy, safety or predictability While LASIK has a lower incidence of haze formation and SMILE offers a better biomechanical stability, TransPRK remains a suitable option especially in the hands of a less experienced surgeon.

Patient information can influence decision-making and engagement with healthcare. This study compares the quality of cataract surgery patient information leaflets (PILs) generated by ChatGPT (an AI model) and two reputable hospitals, assessing AI's potential in producing high-quality patient information.

15 ophthalmologists and 32 patients evaluated three anonymised cataract PILs: one generated by ChatGPT, one from Mount Sinai Hospital (USA) and Manchester Royal Eye Hospital (UK). Doctors used the DISCERN tool (16 questions) for quality assessment. Patients used a shortened version (5 questions). Additional preference and readability questions were added, alongside a readability assessment. PIL ratings and differences between doctor and patient scores were compared.

The ChatGPT PIL scored lowest amongst doctors (mean 42.75 (SD 9.06)/75), followed by Manchester (47.04 (8.56)/75), with Mount Sinai's PIL highest (54.65 (7.09)/75) (p=<0.01). Patients similarly rated ChatGPT lowest (mean total score 4.50 (0.21)/5), with Manchester highest (4.84 (0.06)/5) (p = 0.04). Despite this, doctors were evenly divided on their preferred PIL, while more patients preferred ChatGPT over Mount Sinai. Mount Sinai's PIL had the highest inter-rater reliability(k = 0.38, 95% CI 0.10–0.60), and ChatGPT the lowest (k = 0.13, 95% CI 0.10–0.15). ChatGPT had the lowest Flesch Reading Ease score but doctors rated it most readable.

This study is the first to assess AI-generated cataract PILs using doctor and patient feedback. While ChatGPT received the lowest ratings, some favoured it, particularly for its clarity and readability. Doctors’ highest-rated PIL was the patients’ least favoured. This study highlights AIs potential in PIL development and the importance of doctor and patient feedback in this process.

To evaluate the predictability and uniformity of femtosecond laser-assisted in situ keratomileusis flap created by 3 femtosecond lasers.

In this prospective study, 196 corneal flaps were performed by LDV Z8 (66 eyes), LDV Z2 (70 eyes), VisuMax (60 eyes) laser. The expected flap thickness was 100 μm. Flap thickness was measured one week postoperatively at 28 points using RTVue Fourier-domain optical coherence tomography (OCT).The side-cut angle was measured at three peripheral positions.

The LDV Z8 had a significantly thicker mean central flap thickness (107.0 ± 5.0 μm) and mean flap thickness (110.5 ± 4.0 μm) compared to both the LDV Z2 (mean central 103.1 ± 4.2 μm (P ＜ 0.001), mean 107.5 ± 4.0 μm (P ＜ 0.001)) and the VisuMax (mean central 105.1 ± 5.4 μm (P ＜ 0.027), mean 108.3 ± 3.9 μm(P ＜ 0.002)). The mean overshoot of flap thickness between the actual and planned values was statistically significant (all groups, P < 0.001). The corneal flap thicknesses of the 0-, 45-, 90- and 135-degree meridians showed great uniformity in all groups. The center-peripheral corneal thickness difference in the LDV Z2 (6.1 ± 3.3 μm) was larger compared to the differences in the LDV Z8 (4.0 ± 3.9 μm) (P = 0.003) and the VisuMax (3.4 ± 5.1 μm) (P = 0.002). The mean side-cut angles for the VisuMax, LDV Z8, and LDV Z2 were 62.4 ± 4.5 degrees, 92.3 ± 14.4 degrees, and 147.6 ± 6.7 degrees, respectively.

The corneal flaps generated by three femtosecond lasers exhibit good morphology. The thickness of the flaps in all groups was close to but slightly thicker than the target thickness.

This study aimed to evaluate iris melanin concentration using polarization-sensitive anterior segment optical coherence tomography (PS-AS-OCT) and to explore its correlation with iris color in individuals with brown irides.

Iris cross-sectional images were acquired using PS-AS-OCT. Substructural layers were automatically segmented using a deep learning model. The melanin concentration ratio (MCR) was derived from entropy-based PSAS-OCT images to quantify melanin within the iris layers. Iris surface color was analyzed using CIE L*a*b* values from high-resolution photographs. Correlation analyses were performed between MCR and L*a*b* values. Additionally, a three-grade iris color classification was used, and K-nearest neighbors (KNN) modeling assessed the predictive value of MCR.

Eighty-eight participants (mean age: 39 years) were included. MCR of the iris stroma showed a strong negative correlation with iris color: L* (r = 0.72), a* (r = –0.56), and b* (r = –0.68), all P < 0.001. Stromal MCR significantly differed among color grades (P < 0.001), and the KNN model achieved 85% classification accuracy.

PS-AS-OCT–derived stromal MCR is strongly associated with iris color and offers a noninvasive approach for evaluating iris melanin. This technique may provide new insights into ocular pigmentation.

Evidence for Descemet's membrane endothelial keratoplasty (DMEK) in patients under 30 years old remains limited, although understanding outcomes in this demographic is important given the requirement for decades of graft function and concerns about long-term DMEK survival.

We conducted a retrospective case series at Moorfields Eye Hospital of consecutive patients under 30 years undergoing DMEK between 2015 and 2022. Primary outcome was change in best-corrected visual acuity (BCVA). Secondary outcomes included change in central corneal thickness (CCT), graft failure rates, and post-operative complications.

18 eyes of 17 patients underwent DMEK surgery (mean age 22.7 ± 5.1) over a mean follow-up of 1072.1 ± 869.8 days. Mean BCVA improvement was 0.36 logMAR from pre-operative to final follow-up (p > 0.05), though significant improvements occurred at 1-month and 12-month intervals (p < 0.001 and p < 0.01, respectively). CCT improved significantly from baseline by 111.3 μm (95% CI, 64.3–158.2 μm, p < 0.0001). At final follow-up, 22.2% of eyes achieved BCVA ≤ 0.3 logMAR (n = 4). No patient achieved BCVA ≤ 0.1 logMAR. Rebubbling was performed 9 times (50%) in 8 eyes and was similar between both SF6 and air (p > 0.05). Post-operative complications occurred in 11.1% (n = 2) with no rejection episodes, although secondary graft failure occurred in 22.2% (n = 4), all within 12 months.

DMEK effectively improves visual and anatomical outcomes in patients under 30, though with higher complication rates than older populations. The complex pathology and longer follow-up requirements in this demographic necessitate careful patient selection and realistic expectations. Larger prospective studies are needed to establish definitive guidelines for this population.

To evaluate epithelial thickness (ET) and corneal tomographic parameters in early-stage keratoconus (KC) patients with central cones, comparing eyes with and without a history of corneal collagen cross-linking (CXL).

This retrospective cross-sectional study included patients with early-stage keratoconus (Grade 1–2) and central cone localization diagnosed between 2020 and 2024. Central cones were defined by a maximum keratometry value within the central 3 mm zone, and one eye per patient was randomly selected. Eyes were classified as cross-linked (CXL+) or untreated (CXL−), with all treated eyes demonstrating clinical stability. Corneal tomography and epithelial thickness mapping were performed using Scheimpflug imaging and spectral-domain anterior segment optical coherence tomography.

Group 1 (n = 30 eyes) had a mean age of 24.6 ± 5.7 years, significantly younger than Group 2 (n = 33 eyes, 35.9 ± 9.0 years, p < 0.05). The mean interval since CXL was 4.8 ± 3.2 years. Gender distribution did not differ significantly between groups. Among epithelial parameters, central ET was significantly thinner in CXL-treated eyes (p = 0.014), whereas peripheral ET values showed no significant differences. Tomographic comparison revealed a significant reduction in front apex thickness in Group 1 (p = 0.018), while other indices remained comparable.

In early-stage central keratoconus, CXL-treated eyes demonstrated thinner central epithelial thickness compared to untreated eyes in a cross-sectional comparison. These findings suggest that epithelial remodeling may serve as a long-term biomarker of biomechanical stabilization after CXL, highlighting the clinical utility of epithelial mapping in the follow-up of keratoconus patients.

Following European Medicines Agency (EMA) approval, France implemented a managed access program (MAP) to provide brolucizumab to patients with neovascular age-related macular degeneration (nAMD) who lacked treatment alternatives. The French MAP data analysis evaluated efficacy and safety of brolucizumab in brolucizumab-naïve patients.

Of 599 patients enrolled between February 2022 and January 2024, 360 pretreated with anti-VEGF therapy but brolucizumab-naïve were assessed at baseline for clinical and anatomical benefits of brolucizumab in a close-to-real-world setting.

After 18 months, patients received a median of eight injections, maintaining visual acuity and achieving a mean central subfield macular thickness (CSMT) reduction of −92.0 µm among those with baseline CSMT ≥300 µm. Intraretinal fluid, subretinal fluid, and pigment epithelial detachment occurred in 32.8%, 75.3%, and 61.7% patients at baseline, and 16.5%, 47.0%, and 51.3% patients at 18 months. Patients previously requiring Q4 or Q5–Q7 injections successfully extended their intervals to Q8 or longer. Intraocular inflammation rate was 8.0% (n = 29).

Results demonstrated functional and anatomical benefits of brolucizumab in patients with refractory or suboptimally controlled nAMD, with a manageable safety profile. These findings highlight the potential of brolucizumab to reduce treatment burden in chronic nAMD.

The goal of glaucoma care is to preserve vision and quality of life This study aimed to develop, and rank patient-centered priorities for glaucoma care in Croatia and compare them with the perspectives of ophthalmologists.

A five-phase, Delphi-based national study was conducted involving patients of the Croatian National Glaucoma Referral Center and Croatian ophthalmologists. An initial 20-item questionnaire was completed by 75 patients to identify patient priorities in glaucoma care. The most frequent responses were synthesized into a final 12 patient-centered priority statements, which patients and clinicians ranked independently. Rankings were compared overall and across prespecified patient and clinician subgroups.

The 20-item questionnaire informed a final 12-item survey completed by 130 patients and 97 ophthalmologists. Highest-ranking items across stakeholders were impaired quality of life and fear of losing sight or independence; patient associations ranked lowest. Clinicians emphasized reducing topical therapy burden and side-effects, whereas patients prioritized innovative and curative treatments (including vision restoration), faster, simpler diagnostics, and better communication with clinicians. Subgroup analyses showed stable patterns across clinician groups; among patients, later disease stage shifted focus toward disease control, longer treatment duration increased preference for innovation, and urban–rural differences were minimal.

This study provides a ranked, stakeholder-informed set of glaucoma-care priorities for Croatia. Patient perspectives centered on preventing sight loss, preserving independence, and reducing treatment burden, while highlighting unmet needs in innovation, diagnostics, and communication. These findings complement ongoing European Glaucoma Society initiatives and may inform future Europe-wide strategies in patient-centered glaucoma care.

Normal tension glaucoma (NTG) is a common subtype of glaucoma that progresses silently and can lead to irreversible vision loss if left untreated. Emerging evidence suggests that inflammation and vascular dysfunction may play a role in its pathogenesis. C-reactive protein (CRP), a marker of systemic inflammation and atherosclerosis, has been widely studied as a prognostic indicator in various diseases. However, its potential association with NTG remains unclear. This meta-analysis aims to clarify the relationship between CRP levels in individuals with NTG compared to those without the condition.

We systematically searched PubMed, Embase, and Scopus for observational studies published up to 31 October 2023 investigating CRP levels in NTG patients and controls. Study quality and risk of bias were evaluated using the Newcastle–Ottawa Scale. Eligible studies reporting CRP levels were analyzed using standardized mean differences (SMDs) and 95% confidence intervals (CIs).

A meta-analysis of ten case-control studies involving 766 patients revealed that CRP levels were significantly higher in the NTG group compared to controls (SMD: 0.731, 95% CI: 0.147–1.316 ; z = 2.454; P = 0.014). However, no significant difference in CRP levels was observed between the POAG group and controls (SMD = 0.093; 95% CI: −0.160–0.345; z = 0.719; P = 0.472).

Elevated circulating CRP levels were significantly associated with NTG, suggesting a potential systemic inflammatory contribution to its pathogenesis. Although CRP may serve as an adjunctive marker for identifying high-risk individuals, its clinical value remains provisional and requires confirmation in future prospective studies.

To evaluate whether an algorithm that quantifies changes in hemoglobin (Hb) concentration in the optic nerve head (ONH) can detect progression in glaucomatous eyes with progressive visual field changes.

This retrospective cohort study involved eyes with primary open-angle glaucoma (POAG). Eyes were required to have at least five Standard Automated Perimetry (SAP) tests and three ONH photos during follow-up. ONH photos were processed using the Laguna ONhE software (Retinalyze, Spain). The software estimates Hb concentration at the ONH using automated colorimetric analysis. Visual field progression was defined based on the event-based algorithm provided by the guided progression analysis (GPA) software of the Humphrey perimeter. Changes in Hb levels from fundus photos during follow-up were calculated and receiver operating characteristic curve (ROC) regression models were used to assess the performance of Globin Individual Pointer (GIP) changes as an indicator of glaucomatous visual field progression.

133 eyes of 102 subjects were included in the study, with 26 (20%) eyes demonstrating progression by the SAP GPA over an average follow-up time of 2.4 ± 1.6 years. The median (IQR) change in SAP mean deviation (MD) between the first and last visits was −2.20 (−4.65 to −0.62) dB in progressing and −0.01 (−1.17 to 1.03) dB in non-progressing eyes (P = 0.010). Progressing eyes had a median change of −4.9 (IQR: −10.4 to 3.1) GIP units, compared to −1.6 (IQR: −11.2 to 7.8) units for non-progressing eyes (P = 0.288). A statistically significant negative GIP slope (P < 0.05) was observed in two (7.7%) of the progressing eyes and 14 (13.1%) of the non-progressing eyes. Each 10-unit decrease in GIP during follow-up was associated with a 22% increase in the odds of progressing by GPA (OR: 1.22; 95% CI: 0.98–1.52; P = 0.071), whereas a 10 unit/year faster slope was associated with 6% higher odds of visual field progression (OR: 1.06; 95% CI: 0.90–1.26; P = 0.456). The area under the ROC curve to detect progression based on GIP change was 0.49 (95% CI: 0.39–0.60).

Reductions in Hb concentration estimates from fundus photos were not significantly different between progressing and non-progressing eyes. GIP changes overtime were not associated with visual field progression. We believe that the ability to detect glaucoma progression with this method requires improvement.

To study the outcomes of pars plana placement of Aurolab Aqueous Drainage Implant (AADI) in neovascular glaucoma (NVG).

Study design: retrospective study.

Twenty-eight eyes were evaluated on postoperative days 1, 2 weeks, 6 weeks, 6 and 12 months postoperatively. Baseline and follow-up visits were compared to determine significant differences in intraocular pressure (IOP), the number of antiglaucoma medications (AGM), and best-corrected visual acuity (BCVA), surgical success, complications and interventions.

Mean IOP decreased from preoperative 46.2 ± 8.6 mmHg to 32.07 ± 13.0 mmHg,23.08 ± 12.8 mmHg,21.0 ± 14.4 mmHg, and 22.6 ± 19.5 mmHg at two weeks, six weeks, six months, and one year, respectively. AGM decreased from 3 preoperatively to 2.42, 1.37, 1.37,1.55, and 1.65 at two weeks, six weeks, six and 12 months, respectively. There was no significant difference in BCVA at any time point compared to baseline. Complete success was achieved in 50% and 37.5% of cases (using criteria 1: IOP ≤ 18 mmHg or 30% reduction from baseline without AGM, and criteria 2: IOP ≤ 15 mmHg or 40% reduction) after 12 months. Qualified success was observed in 83.3% and 72.2% of patients (using criteria 1: IOP ≤ 18 mmHg or a 30% reduction from baseline with a single AGM, and criteria 2: IOP ≤ 15 mmHg or a 40% reduction) after 12 months.

This study demonstrates that pars plana placement of AADI in NVG achieves good surgical success regarding IOP control and visual acuity.

To investigate the efficacy of lensectomy (LE) and the role of additional goniosynechialysis (LE-GSL) in eyes with medically uncontrolled synechial angle-closure glaucoma (ACG).

The records of patients who underwent LE or LE-GSL for >180° synechial ACG were reviewed retrospectively. Three groups were formed based on intraoperative gonioscopy (IOG) findings following lensectomy and intraocular lens implantation: Group 1 (n = 39), eyes with total peripheral anterior synechiae (PAS) in which GSL was performed; Group 2 (n = 37), eyes with PAS ≥ 180° and <360° in which GSL was performed; and Group 3 (n = 35), eyes with PAS < 180° in which no GSL was performed.

A total of 111 eyes of 98 patients (M/F: 46/52; mean age: 60.1 ± 11.01 years) were included in the study. Median postoperative follow-up time was 12.0 months. Median PAS extents in the three groups were 12, 6, and 0 clock hours (CH) on IOG, compared to 12, 10, and 7 CH before surgery. GSL was performed in Groups 1 and 2, with a median of 11 and 4 CH. Median IOP at the final visit was 14 mmHg in all three groups. Total success rates were 87%, 81%, and 97% in Groups 1, 2, and 3, respectively (p = 0.102).

The present study identified discrete groups of patients who would benefit from LE alone versus needing further GSL in synechial ACG. When PAS was <180° on IOG, LE alone effectively reduced IOP; in eyes with extensive PAS, performing additional GSL yielded successful results, comparable to eyes undergoing LE alone.

To evaluate the dynamics of retinal fluid in eyes compromised by exudative macular neovascularization beneath the retinal pigment epithelium (MNV type 1) secondary to neovascular age-related macular degeneration (nAMD) and its impact on disease control over time.

In this retrospective single center study, 65 eyes of 65 patients with treatment-naive exudative MNV Type 1 were analyzed for the presence of subretinal fluid (SRF) and intraretinal fluid (IRF) in structural OCT B-scans for three years. All eyes started on three monthly intravitreal anti-VEGF injections followed by a personalized treatment interval. Primary outcome measure was visual acuity score (VAS) change based on fluid dynamics.

29 (45%) eyes with SRF only started with a VAS of 74 ± 9 letters ETDRS, 20 eyes (31%) with SRF in the beginning that developed additional IRF had an initial VAS of 68 ± 11 letters, and 16 eyes (25%) with both, SRF and IRF measured 63 ± 13 letters at presentation. The VAS of all patients declined significantly (p = 0.003) over time, but no significant VAS change was measured between the groups.

IRF was regarded as a negative predictive OCT biomarker towards a lower VAS at the beginning but not necessarily during the course of the disease.

To evaluate the efficacy and durability of faricimab for diabetic macular edema (DME) in a real-world population over 52 weeks using a personalised treatment interval protocol.

Retrospective cohort of centre-involving DME treated with faricimab at St Paul's Eye Unit, Liverpool (September 2022-January 2025). Exclusions: follow-up <12 weeks or anti-vascular endothelial growth factor/steroids within 3 months. Best corrected visual acuity (BCVA) and central subfield thickness (CSFT) compared at baseline, weeks 12 and 52.

167 patients included at baseline; 103 were treatment-naïve. Sixty-five completed 52-week follow-up. Mean BCVA gains were +7.5 letters at week 12 and +7.8 at week 52. Mean CSFT reductions were −134.5 μm at week 12 and −158.0 μm at week 52, with 80% achieving DME resolution. Extended dosing intervals (≥ 8 weeks) were assigned to 53% at week 12 and 72% at week 52. However, 24% did not receive all planned loading doses within 12 weeks. Treatment discontinued in 23% due to death, illness, or off-protocol observation.

In this unselected population, faricimab improved vision and retinal thickness in line with landmark trials. Extended dosing intervals suggest reduced treatment burden in practice. Challenges remain in patient adherence and pathway deviations.

To evaluate the functional and structural outcomes in patients with neovascular age-related macular degeneration (nAMD) switched from ranibizumab or aflibercept to bevacizumab.

This retrospective study included 197 eyes of 192 patients (mean age 83 ± 6 years; 38% male). Patients previously treated with ranibizumab (n = 79) or aflibercept (n = 118) were transitioned to bevacizumab. Best-corrected visual acuity (BCVA) was recorded with ETDRS charts and converted to logMAR. Spectralis SD-OCT was used to evaluate intraretinal and subretinal fluid, presence of retinal pigment epithelium detachment (PED), PED height and central retinal thickness (CRT) at baseline and after 6 months.

Mean BCVA decreased from 0.4 ± 0.3 to 0.5 ± 0.4 logMAR (p = 0.048). The proportion of eyes with intraretinal or subretinal fluid rose from 27% to 69% (p = 0.017). Subgroup analysis indicated greater functional and structural worsening in younger patients and in those switched from aflibercept. Mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091), mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091). In contrast, mean CRT increased substantially from 294 ± 30 µm at baseline to 310 ± 26 at 6 months (p (p < 1 × 10⁻⁷).

Switching from ranibizumab or aflibercept to bevacizumab may lead to reduced visual function and an increase in structural-OCT markers of disease activity, including greater intraretinal/subretinal fluid, CRT and worsening PED features, particularly in younger individuals and in eyes previously treated with aflibercept.

To evaluate the effect of sparing the horizontal meridian during Pan Retinal Photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) on corneal sensation, tear film parameters and to assess the pain in different retinal areas.

Prospective comparative interventional study

Patients were randomized to either Group (A): conventional PRP or Group (B): PRP with sparing of the horizontal meridian.

Comparing the change in central corneal sensation and the precorneal tear film parameters between the 2 groups

50 patients were divided into the two groups at random. The corneal sensation was evaluated by the Cochet Bonnet aesthesiometer & the tear film stability was evaluated by the Schirmer tests (1&2) & the Tear break up time (TBUT). The pain was recorded using a scale of 0–3 in different retinal areas.

The corneal sensation decreased with a nonsignificant difference between the 2 groups through the follow up visits. Regarding the tear film stability, Schirmer test (1), (2) & TBUT decreased with a significant difference in the change from the baseline between the 2 groups (p-value for Schirmer test (1) <0.001, 0.001, 0.001, P-value of Schirmer test (2) 0.007, 0.001, 0.001, P-value of TBUT 0.03, 0.001, 0001 for 1 week, 1and 3 months respectively). Regarding the pain sensation during the PRP, the pain score was the highest in the horizontal meridian and was higher in the peripheral retina than in the central retina and in the lower retina than in the upper retina.

PRP performed with sparing of the horizontal meridian was found to maintain the tear film's stability with less pain increasing patient compliance with therapy.

To measure the Bruch's Membrane Opening (BMO) area and Minimum Rim Width (BMO-MRW) in eyes with high myopia and correlate it with axial length (AL).

A cross-sectional, hospital-based study of 40 participants with high myopia Spherical Equivalent Refraction (SER) ≤ −6D was conducted. Spectral Domain-Optical Coherence Tomography (SD-OCT) of both the eyes (BE) was performed using Glaucoma Module Premiere Edition (GMPE) with Anatomic Positioning System (APS) to measure BMO area and BMO-MRW. The AL in myopic patients was measured using Partial Coherence Interferometry (IOL Master).

This study included 80 eyes of 40 participants aged 18–35 years. The mean BMO area was 2.28 ± 0.48 mm² in the right eye (RE) and 2.15 ± 0.59 mm² in the left eye (LE) and was significantly correlated with (AL). A statistically significant positive correlation was observed between the BMO area and AL in (BE) (RE: r = 0.465, p = 0.003; LE: r = 0.374, p = 0.029). Likewise, the mean BMO-MRW was RE: 325.69 ± 96 μm; LE: 339.20 ± 79.50 μm. In the RE group, there was a significant negative correlation between the inferior temporal (r = - 0.353, p = 0.027) and inferior nasal quadrants (r = - 0.424, p = 0.007) of the BMO-MRW and AL, whereas in the LE group, all the BMO-MRW quadrants were negatively correlated (p < 0.05) with AL. No significant differences were found between the RE and LE when comparing the means of the refractive error (p = 0.314), AL (p = 0.212), BMO area (p = 0.35), and BMO-MRW (p = 0.819).

The findings revealed that BMO area increases and BMO-MRW thickness decreases with increasing AL in high myopic eyes and may contribute to structural vulnerability of the optic nerve head, potentially increasing the risk of glaucomatous damage.

This study investigates global research trends on visually impaired athletes (VIA) from 1960 to 2025, focusing on the evolution, productivity, and influence of scholarly output. By examining contributions from countries, institutions, journals, and authors, the study highlights emerging themes and collaborative networks that shape this specialized field.

A bibliometric analysis was conducted using publications retrieved from the Web of Science (WoS) Core Collection. Quantitative indicators included publication count, citation frequency, average citations per article, and the Hirsch index. VOSviewer (version 1.6.19) was used to map keyword co-occurrence, co-citation, and co-authorship collaboration networks, providing insight into thematic development and international collaboration.

The USA led research output with 112 publications (28.3%), followed by Brazil (53, 13.4%) and the UK (48, 12.2%). Vrije Universiteit Amsterdam (19 publications) and Amsterdam Movement Sciences (15) were the most productive institutions. The Journal of Visual Impairment and Blindness was the most prolific journal, while Mann, DL, was the most productive author, with 19 publications and 381 citations. Research activity increased markedly over time, averaging 11 publications annually between 2010 and 2015 and peaking at 47 publications in 2021.

Research on VIA has increased significantly, especially in the past two decades, reflecting growing recognition of the role of sport in rehabilitation, social inclusion, and psychological well-being. The identification of influential authors, institutions, and collaboration patterns provides a foundation for advancing evidence-based practices and shaping future policy and research directions in support of VIA.

To explore the relationship between systemic comorbidities and presenting tumor T category in patients with uveal melanoma.

Single-center, retrospective cohort study of patients with posterior uveal melanoma initially diagnosed between January 2000 and December 2016. Univariate and multivariate ordinal logistic regression analyses were performed to identify comorbidities associated with presenting tumor T category, as classified by AJCC criteria.

Initial presenting AJCC T category was T1 in 190 (43%), T2 in 130 (29%), T3 in 89 (20%), and T4 in 38 (9%). The most common comorbidities present were hypertension (250 patients, 56%), hyperlipidemia (211, 47%), obesity (137, 31%), and diabetes mellitus (87, 19%). Of these, obesity (p = 0.034), hypertension (p = 0.017), and diabetes mellitus (p < 0.001) were associated with earlier presenting T category on univariate ordinal logistic regression. After multivariate regression, only diabetes mellitus (p = 0.01) and obesity (p = 0.04) remained significantly associated with earlier T category on initial presentation.

Among patients presenting with uveal melanoma, diabetes mellitus and obesity were associated with earlier presenting T category, which could reflect earlier detection of uveal melanoma in patients undergoing annual diabetic retinopathy screening examinations or having more frequent contact with the healthcare system. Larger studies should further explore this association and examine the utility of increased ocular screening in early detection of uveal melanoma.

To describe the demographic profile and clinical features associated with upper eyelid (UL) hyperlaxity in the Indian subcontinent.

Retrospective chart review of 100 consecutive patients with UL hyperlaxity, presenting at a tertiary eye centre in India, between January 2016 to February 2022. The data collected included the demographics, clinical features including the ophthalmic and systemic manifestations, and management outcomes.

The average age at presentation was 42.71 (±18.73) years. Majority were males (83%). Syndromic associations included Down's syndrome (2%) and Ehler-Danlos syndrome (1%). Of the 45 investigated, obstructive sleep apnea was diagnosed in 24% cases. Adnexal manifestations included concurrent lower eyelid laxity (70%), blepharoptosis (41%) of which 38% were aponeurotic, lower eyelid retraction (37%), chalazia (25%) of which 58% were either recurrent, multiple, or both, lacrimal gland (LG) prolapse (11%), lash ptosis (11%), lower eyelid ectropion (8%), entropion (5%), and recurrent dacryoadenitis (3%). Chronic papillary conjunctivitis (66%) was the most common ocular surface abnormality followed by meibomian gland dysfunction (31%). Seven cases (7%) had eyelid imbrication syndrome (EIS), of which 60% had retinopathy of prematurity. Surgical management was recommended in 25% cases, indications being ptosis (13%), generalized eyelid laxity (11%), and recurrent globe luxation (2%).

UL hyperlaxity can be associated with a myriad of ophthalmic manifestations. One should look for novel findings such as EIS, dacryoadenitis, LG prolapse, and lower eyelid retraction in these cases.

To evaluate the impact of eyelid hygiene on conjunctival microbial species and ocular discharge in patients with ocular prostheses(OP).

A prospective study included patients with unilateral anophthalmic sockets or phthisis bulbi using OP. Two visits were scheduled: baseline and 7 days later. At each visit, three samples were collected: lower tarsal conjunctiva of the affected eye, bulbar conjunctiva of the affected eye, and lower tarsal conjunctiva of the healthy eye. Patients followed one of two hygiene regimens: Ozonest^® group (wipes and liposomal-ozonated-oil drops) or Lephanet^® group (wipes and saline solution). Demographic data, clinically significant discharge(CSD), and eyelid cleaning habits were recorded. Statistical significance was set at P < 0.05.

Sixty-one patients (mean age 63.7 ± 15.5 years, 54.1% male) contributed 366 samples. 31 (50.8%) were in Ozonest and 30(49.2%) in Lephanet. Staphylococcus epidermidis (39%) and Corynebacterium macginleyi (24.6%) were most common. Positive cultures were higher in affected eyes (78.7%) than in healthy eyes (32.8%, P < 0.05). Tarsal conjunctiva cultures decreased with both Ozonest(64.5% to 51.6%) and Lephanet (56.7% to 46.7%). Overall CSD decreased from 47.5% to 16.4%, particularly in Lephanet (60% to 10%, P < 0.05).

Positive cultures were more frequent in prosthetic eyes than in healthy eyes being with S. epidermidis and C. macginleyi being the most frequent microorganisms. Both hygiene regimens reduced positive tarsal conjunctival cultures and improved CSD.

This study aimed to evaluate dynamic thiol/disulfide homeostasis in the tear fluid of patients with type 2 diabetes and to investigate its relationship with the presence of diabetic retinopathy (DR), considering it as a potential biomarker of oxidative stress.

A total of 96 individuals were included in the study. Participants were divided into three groups: 32 patients with diabetic retinopathy (Group 1, DR (+)), 31 patients with diabetes but without retinopathy (Group 2, DR (–)), and 33 healthy volunteers (Group 3). All participants underwent a comprehensive ophthalmological examination, including best-corrected visual acuity, slit-lamp biomicroscopy, and fundus evaluation. Tear samples were collected using Schirmer strips and stored in phosphate-buffered Eppendorf tubes at −80 °C until analysis. Total thiol, native thiol, and disulfide levels were analyzed using a spectrophotometric method. Patients with a history of intraocular surgery, trauma, glaucoma, or systemic diseases other than diabetes were excluded.

There were statistically significant differences between the groups in terms of total thiol, disulfide, disulfide/total thiol, and disulfide/native thiol ratios (p < 0.001). Total thiol levels were significantly lower, while disulfide levels and ratios were significantly higher in the DR (+) group. No significant difference was found in native thiol levels (p = 0.194). HbA1c and fasting blood glucose levels were significantly higher in the DR (+) group compared to the other groups (p < 0.001). Central macular thickness was also significantly greater in the DR (+) group (p < 0.001). Correlation analysis revealed a positive and significant relationship between HbA1c and fasting blood glucose (r = 0.551; p < 0.01), whereas no significant correlation was found between central macular thickness and glycemic parameters.

The increased disulfide levels and disulfide ratios in the tear fluid of patients with diabetic retinopathy suggest a shift in thiol/disulfide homeostasis toward oxidative stress. These tear-based biomarkers may serve as valuable tools for the early diagnosis and monitoring of diabetic retinopathy.

Even with recent improvements, the optimal timing of orbital implant placement after evisceration surgery – particularly in infected cases – remains unclear. This study aimed to compare the long-term outcomes of primary silicone orbital implants after evisceration for infectious and non-infectious causes, focusing mainly on implant-related complications such as exposure or extrusion.

A total of 32 eyes that underwent evisceration were analyzed. Patients were divided into two groups: infectious causes (Group A, n = 10) and non-infectious causes (Group B, n = 22). Postoperative follow-up duration, implant size, histopathological results, and complications – including implant exposure or extrusion – were evaluated.

Demographic characteristics were similar between the groups. The mean follow-up duration was 34.0 ± 17.7 months in group A and 28.18 ± 18.1 months in group B (p = 0.403). The mean implant size was 17.8 ± 2.6 mm in group A and 18.3 ± 1.8 mm in group B (p = 0.693). Mild symblepharon occurred in 2 patients (20%) in group A, while upper lid ptosis was noted in 2 patients (9%) in group B. No cases of implant exposure, extrusion, or sympathetic ophthalmia were observed in either group.

Orbital evisceration results in comparable long-term outcomes for both infectious and non-infectious indications, with no observed cases of implant exposure or extrusion. These findings support the safe use of primary silicone implants in both scenarios when appropriate surgical technique is applied and adequate postoperative follow-up is provided.

To evaluate the efficacy and short-term safety of botulinum toxin type A (BTX-A) injection into the inferior oblique muscle for treating inferior oblique overaction (IOOA) in a pediatric cohort.

We conducted a retrospective cohort study at King Khaled Eye Specialist Hospital & Research Center, Riyadh, Saudi Arabia, including children aged 2–15 years with IOOA treated with BTX-A injections between June 2022 and September 2024. Data on demographics, baseline IOOA grade, associated strabismus, and postoperative complications were collected. All included eyes had a baseline IOOA grade of 2+ to 4+ and underwent a 5.00 units injection of BTX-A (Botox, Allergan Inc., Irvine, California, USA) to the inferior oblique muscle in a trans-conjunctival technique. The primary outcome was IOOA resolution, defined as postoperative IOOA grade of 0 or +1 at three months following the injection.

Twenty-three patients (42 eyes) were analyzed. Median age was 6 years (IQR: 5–8), with 56% were female. Bilateral IOOA was present in 83% of included patients, esotropia in 91%, and exotropia in 9%. Three months after injection, 54% of eyes achieved complete or near complete IOOA resolution, and 76% improved by at least one grade. Exotropia decreased from 36% at two weeks to 5% at three months (p < 0.001), while ptosis declined from 29% to 2% (p < 0.001).

BTX-A injection into the IO muscle is effective and safe for primary IOOA, with significant short-term improvement and minimal transient complications. The long-term sustainability of the IOOA improvement post BTX-A injection is unknown.

To compare the surgical outcomes of two different surgical techniques, resection and plication both in combination with recession, in basic intermittent exotropia.

In this prospective randomized trial, a total of 90 patients with basic intermittent exotropia were followed up pre- and post-operatively for at least 1 year in two treatment groups; 44 patients in the plication-recession (PR) group, 46 patients in the resection-recession (RR) group, and surgical outcomes were evaluated.

There were no significant differences in average deviation angles between the PR and RR groups during the first postoperative week and first month. Over time, the PR group showed a more pronounced exo-drift beginning within the first month and continuing until the sixth month before stabilizing, whereas the RR group maintained significantly lower deviation angles at the 3^rd month, 6^th month and the 1-year follow-up. Consequently, the PR group experienced lower success rates at the 1st month, 6th month, and 1-year follow-ups, with final 1-year success rates of 55% for the PR group compared to 80% for the RR group. All 1-year failures in both groups resulted from under-correction.

Although the plication procedure has favorable outcomes in the short-term, significant exo-drift has caused suboptimal long-term outcomes.

Thyroid eye disease (TED) is characterized by inflammation of orbital tissue, proptosis, diplopia, and potential changes in facial appearance. TED has been associated with poor mental health and reduced health-related quality of life (HRQOL) due to the combined impact of impaired visual functioning and changes in facial appearance. The study aims to determine the impact of treatments for TED on patients’ HRQOL as a measure of comprehensive well-being.

Systematic searches of literature in MEDLINE, EMBASE and CINAHL databases and grey literature sources were conducted. After de-duplication and screening, the modified Downs-and-Black criteria were used to assess the risk of bias. Baseline characteristics, HRQOL-questionnaire data, and mean HRQOL measurements were extracted.

Searches yielded 313 studies from databases and 9 grey literature studies. 23 studies (2023 patients total) were included for quality assessment and data synthesis. Strabismus surgery yielded the greatest improvement in total HRQOL score. Surgical interventions improved visual function QOL (VF-QOL) and visual appearance QOL scores (Ap-QOL).

Other medical therapies, including doxycline and selenium were effective for improving Ap-QOL.

Surgical interventions, particularly decompression, eyelid, and strabismus surgery, improved appearance-related QOL. Immunosuppressive therapy and doxyxycline contributed to progressive functional improvements over time. Longer follow-up durations were generally associated with greater patient-reported benefit from treatments.

Wet lab training on animal eye and surgical simulators are being utilized to enhance surgical outcomes and reduce complications. The study aimed to determine the effectiveness of structured surgical simulator training in improving the phacoemulsification surgery skills of ophthalmology residents.

A retrospective study of the resident cataract surgical program from November 2019 to November 2022. The residents during our study period were categorized into two groups: Group A, representing the period without mandatory wet-lab/simulator training, and Group B, representing the period following the introduction of mandatory wet-lab/ simulator training before supervised surgeries in the operating room. Preoperative, intraoperative, and postoperative surgical data was collected and analyzed. The performance of resident cataract surgery in the two groups was compared. Outcome measures were the incidence of complications and mentor takeover rate.

A total of 227 eyes were included in the study, 126 in group A and 101 in group B. Posterior capsule rupture was seen in 11 patients (8.73%) in Group A and 8 patients (5.94%) in Group B (P = 0.82) with a significantly lower need for surgeon takeover (26 cases (18.6%) in Group A and 9 cases (10.8%) in Group B (p = 0.015). Overall intraoperative and postoperative complication rates were lower in Group B (p = 0.18).

These findings emphasize that integrating wet lab/simulator-based training into residency programs increases surgical independence of residents.

To evaluate the impact of oxidative stress and the antioxidant defense system in the pathogenesis of proliferative vitreoretinopathy (PVR).

In this prospective study, three groups of patients undergoing pars plana vitrectomy (PPV) were included: Group 1 included patients with rhegmatogenous retinal detachment (RRD) complicated by grade C PVR; Group 2 included patients with RRD without PVR; and Group 3 (control group) consisted of patients undergoing PPV for macular hole or vitreomacular traction. At the initiation of PPV, approximately 0.2 ml of a vitreous sample was obtained. Samples were analyzed for total oxidant status (TOS, µmol H₂O₂ equivalent/L), total antioxidant status (TAS, mmol Trolox equivalent/L), and oxidative stress index (OSI, TOS/TAS).

A total of 60 eyes from 60 patients were included (n = 20 per group). The mean TAS levels were 1.23 ± 0.62 in Group 1, 1.41 ± 0.64 in Group 2, and 1.84 ± 0.52 in Group 3 (p = 0.008). The mean TOS levels were 18.62 ± 8.56, 14.32 ± 6.57, and 10.42 ± 5.82 in Groups 1, 2, and 3, respectively (p = 0.005). There was a statistically significant difference in OSI values between the groups (Group 1: 24.4 ± 31.51; Group 2: 13.31 ± 13.79; Group 3: 6.88 ± 6.26) (p = 0.001).

Elevated TOS and OSI levels, along with reduced TAS levels in the vitreous samples of patients with PVR, suggest that oxidative stress and impaired antioxidant defense may play a critical role in the pathogenesis of PVR.

This study compares the anatomical and functional outcomes of two treatments for acute submacular haemorrhage (SMH): pars plana vitrectomy with subretinal recombinant tissue plasminogen activator (tPA) and gas tamponade versus intravitreal tPA and gas injection.

A retrospective single-centre study was conducted of patients treated for acute SMH at Buckinghamshire Healthcare NHS Trust between January 2016 and December 2022. Patients received either intravitreal tPA and gas ± anti-VEGF (Group A) or pars plana vitrectomy with subretinal tPA and gas tamponade ± anti-VEGF (Group B). The primary outcome was anatomical success, defined as displacement of haemorrhage from the fovea. Secondary outcomes were visual acuity (VA) improvement, central foveal thickness (CFT) reduction, and complication rates.

Eighty eyes from 73 patients (mean age: 79.8 ± 11.5 years; 57.5% female) were analysed, with 53 eyes in Group A and 27 in Group B. Anatomical success was achieved in 71.6% of Group A and 77.8% of Group B. VA improved in 66% of Group A and 63% of Group B. CFT decreased by over 50% in both groups. No statistically significant differences were found between the two treatment groups and in anatomical or functional improvement.

In this real-world study, both approaches effectively displaced SMH and improved vision with comparable outcomes, suggesting that treatment selection may be best determined by patient-specific and logistical factors.

To evaluate the incidence of postoperative retinal displacement (RD) following three surgical techniques—pars plana vitrectomy (PPV), scleral buckling (SB), and pneumatic retinopexy (PR)—for macula-off rhegmatogenous retinal detachment (RRD).

In this retrospective observational study, 183 eyes with primary macula-off RRD were treated between June 2021 and June 2023 at a tertiary care retina center. Patients underwent one of three surgical techniques: PPV, SB, or PR. RD was assessed using fundus autofluorescence imaging and correlated with early face-down positioning (EFP) and other clinical variables.

RD incidence varied by technique: 36.3% after PPV, 21.2% after SB, and 8.1% after PR. In PPV cases, gas tamponade was associated with higher RD rates than silicone oil (68.4% vs. 29.8%, p = 0.010), and perfluorocarbon liquid (PFCL) use was associated with increased RD (44.1% vs. 0%, p = 0.009). Adherence to EFP had no significant protective effect (p = 0.985). Metamorphopsia was more frequent in patients with RD (p = 0.040); final visual acuity was similar across groups.

RD is most common after PPV and least frequent after PR. Surgical choices, particularly tamponade type and PFCL use, significantly influence RD risk and should guide surgical planning.

To describe the characteristics and outcomes of endoresection in patients with uveal melanoma previously treated with ruthenium brachytherapy or proton beam therapy.

In this retrospective study, data on the indication to perform endoresection, best-corrected visual acuity, tumor characteristics, surgery details, and characteristics of ruthenium brachytherapy or proton beam therapy were obtained.

A total of 27 patients (12 men and 15 women) were included, with a median age of 63.5 (range 50.5) years. The indication for endoresection was exudative retinal detachment in 20 patients, glaucoma induced by tumor bleeding in 6 patients, and persistent inflammation in 1 patient. Ruthenium brachytherapy was performed in 6 patients, while 21 patients received proton beam therapy. In the ruthenium group, mean visual acuity before endoresection in Snellen was 0.099 ± 0.197, which increased to 0.285 ± 0.302 after endoresection (p = 0.043). In the proton beam group, mean visual acuity before endoresection was 0.030 ± 0.044, which decreased to 0.020 ± 0.036 after endoresection (p = 0.546). Mean change in visual acuity before and after endoresection was +0.186 ± 0.249 in the ruthenium group and −0.009 ± 0.053 in the proton beam group. Enucleation had to be performed in 1 eye in the ruthenium group and 8 eyes in the proton beam group. No surgery-related vascular events were observed.

Patients previously treated with ruthenium brachytherapy have favorable post-endoresection outcomes, opposed to those treated with proton beam therapy. Patient-specific counselling is important before endoresection, as there is a wide variety in expected outcomes.

To present our results using a novel “flapless” trocar-assisted intrascleral fixation technique for Carlevale intraocular lens (IOL) Implantation without conjunctival opening.

Retrospective, non-comparative study of consecutive patients undergoing this technique. Patients older than 18 years who had at least two years post-operative follow-up were included.

61 eyes of 61 consecutive patients were included in the analysis. The study sample included 55.74% males with a median age of 76 years (interquartile range (IQR): 67–82 years). The mean follow-up period was 48.9 months (SD ± 14.38) and the range was between 26 and 76 months. A statistically significant difference was observed between the median pre-operative visual acuity value (1.8LogMAR, IQR: 1.0–1.8) and the median postoperative value visual acuity (0.05 LogMAR, IQR: 0.0–0.1). No intraoperative complications occurred and, the Carlevale IOL was well centered in all cases. No haptic exposure was observed during the follow-up period.

The results of our study demonstrate that the proposed technique is a simplified, safe and effective surgical approach for placement of the Carlevale IOL. Further studies are needed to validate our data and explore the results of a longer follow-up.