Journal of VitreoRetinal Diseases

Purpose: To compare longitudinal retinal and choroidal imaging findings in patients with mild cognitive impairment and cognitively normal control participants. Methods: Eyes of patients with mild cognitive impairment and cognitively normal controls were imaged using Zeiss Cirrus HD-5000 optical coherence tomography (OCT) with AngioPlex OCT angiography (OCTA). Macular vessel density and perfusion density were assessed. The Mini-Mental State Examination was administered at study entry and at least 18 months later. The velocity of change in OCT and OCTA parameters was compared between controls, nonamnestic patients with mild cognitive impairment, and amnestic patients with mild cognitive impairment. Results: Eighty-five eyes of 43 patients with mild cognitive impairment and 85 eyes of 43 control participants were analyzed at baseline, and 45% of those were analyzed at an average follow-up of 28 months. The entire cohort of patients with mild cognitive impairment demonstrated faster rates of decline in perfusion density (/year) in 3-mm circle (P = .02) and ring (P = .01) as well as in vessel density (mm^-1/year) in 3-mm circle (P = .05) and ring (P = .04) vs control participants. Amnestic patients with mild cognitive impairment demonstrated faster decline in perfusion density in 3-mm circle compared with nonamnestic patients with mild cognitive impairment (P = .04) and control participants (P = .007). Amnestic patients had a greater rate of decline in vessel density in 3-mm circle compared with nonamnestic patients (P = .03) and control participants (P = .02). The entire group of patients with mild cognitive impairment and the subgroup of nonamnestic patients had a faster rate of decline in perfusion density compared with control participants (P = .01 and P < .001, respectively). Conclusions: The rate of decline in perfusion and vessel density was faster in the entire cohort of patients with mild cognitive impairment compared with control participants, with no significant change in Mini-Mental State Examination score. Amnestic patients with mild cognitive impairment demonstrated faster rates of decline in perfusion and vessel density compared with nonamnestic patients with mild cognitive impairment.

Purpose: To evaluate the financial impact of monotherapy with intravitreal (IVT) bevacizumab and compare it with a combined approach of panretinal photocoagulation (PRP) and IVT bevacizumab for the treatment of retinopathy of prematurity in the United States. Methods: Data from 122 eyes of 71 infants initially treated with IVT bevacizumab monotherapy (Group 1) or IVT bevacizumab with PRP (Group 2) were collected. The direct cumulative costs of examinations, PRP, IVT bevacizumab, examinations under anesthesia, fundus photography, and fluorescein angiography were reported. The costs for each service or procedure were extrapolated from Centers for Medicare & Medicaid Services. The physician, facility, and total costs of each service were calculated for both groups when using Avastin vials or bottles. Results: Following the ideal American Academy of Pediatrics guidelines, the mean number of inpatient and outpatient examinations for Group 1 infants was 12.10 and 10.74, respectively, and was 9.97 and 2.12 for Group 2 infants, respectively. The average cost billed for all examinations and procedures was $5045.34 in Group 1 and $4349.92 in Group 2 when using Avastin vials. The largest share of total treatment costs in Group 1 was from subsequent inpatient visits, amounting to $1164.04 (23.07%). In contrast, the largest share of costs in Group 2 was for PRP, which totaled $1656.13 (38.07%). Conclusions: This study highlights that, compared with combined treatment of IVT bevacizumab and PRP, the direct cost of treating infants with IVT bevacizumab monotherapy is marginally increased and requires significantly more visits.

Purpose: To evaluate the risk of developing depression, anxiety, and suicidal behavior in older adults newly diagnosed with blindness. Methods: A retrospective cohort study was conducted using the TriNetX Analytics Network, analyzing de-identified electronic health records from 2006 to 2024. Patients ages ≥60 years with a diagnosis of blindness based on International Classification of Diseases, Tenth Revision, Clinical Modification codes were identified. Patients were matched 1:1 to control subjects with normal vision using propensity score matching (PSM), based on demographics and psychiatric comorbidities. Primary outcomes included incident major depressive episodes, persistent depression, anxiety disorders, and suicide attempts at 1-, 3-, and 5-year follow-up intervals. Results: After PSM, 143 668 subjects were included in each cohort. Compared with matched controls, blindness was associated with increased risk of major depression at 1 year (relative risk [RR] 1.69; 95% confidence interval, 1.64–1.72), 3 years (RR 1.47), and 5 years (RR 1.39). Similar trends at 1, 3, and 5 years were observed for risk of persistent depression (RRs of 1.88, 1.43, and 1.29, respectively), anxiety (RRs of 1.92, 1.45, and 1.30, respectively), and suicide attempts (RRs of 8.50, 5.26, and 3.42, respectively). Risks remained elevated in validation and subgroup analyses. Suicide attempts were particularly high among those with preexisting depression (suicide attempt rate at 1 year, 0.24%). Mental health risks were highest within the first year after diagnosis and declined over time but remained significantly elevated. Conclusions: Blindness in older adults is associated with significantly increased risks of depression, anxiety, and suicide, especially within the first year of diagnosis. These findings suggest the need for mental health screening and early psychosocial intervention in newly blind patients to mitigate long-term psychiatric morbidity.

Purpose: To report a rare retinal complication of posterior persistent fetal vasculature (PFV) and describe the surgical outcomes. Methods: A retrospective review was performed of 3 cases undergoing vitrectomy for tent-like posterior PFV. Results: All 3 cases presented with unilateral tent-like posterior PFV; 2 of them were associated with significant lens opacity. One eye underwent lens-sparing vitrectomy, while 2 underwent combined lensectomy and vitrectomy. In all cases, a retinal defect was identified on the tent-like elevated retina at the posterior pole. Macular holes were detected intraoperatively immediately after transection of the fibrovascular stalk. The residual stalk was left positioned over the hole, and 20% sulfur hexafluoride gas tamponade was used. Conclusions: Posterior PFV may be associated with occult macular hole formation due to chronic retinal traction, particularly in cases with delayed diagnosis. Early surgical intervention may be important to prevent progression to total retinal detachment.

Purpose: To report a case of ocular toxocariasis in a child initially suspected to have persistent fetal vasculature (PFV), highlighting the importance of accurate differential diagnosis in cases of retrolental membranes. Methods: A single case was reviewed. Results: A 4-year-old Guatemalan boy presented with a 3-week history of right eye irritation and visual acuity limited to counting fingers. Clinical examination revealed a retrolental membrane extending to the optic nerve, initially suggestive of PFV. Further investigation under anesthesia revealed a visually significant funnel-shaped vitreous cavity devoid of vascularity. Fluorescein angiography showed a peripheral avascular retina with leakage, suggesting a granulomatous lesion. Pars plana vitrectomy and lensectomy revealed a chorioretinal scar in the peripheral inferonasal retina. Serologic testing confirmed the diagnosis of ocular toxocariasis, with the presence of Toxocara immunoglobulin G antibodies and peripheral eosinophilia. Conclusions: Ocular toxocariasis can mimic PFV in pediatric patients presenting with retrolental membranes. Careful clinical evaluation, imaging, surgical exploration, and serologic testing are essential for accurate diagnosis and appropriate management.

Purpose: To report the rates of rhegmatogenous retinal detachment (RRD), retreatment laser retinopexy, clinical associations, fellow eye laser retinopexy, and outcomes of initial laser retinopexy for symptomatic retinal break(s). Methods: This retrospective, interventional consecutive case series included data on patient demographics, best-corrected visual acuity, and baseline clinical features of retinal breaks. Univariable and multivariable logistic regressions with generalized estimating equations were performed to identify factors associated with subsequent RRD and any additional treatment. Results: Among 600 eyes (572 patients) treated for retinal breaks, an RRD occurred in 43 eyes (7.2%), most commonly as a macula-on RRD (37 eyes [86.0%]). Additional laser retinopexy was performed in 66 eyes (11%), including 53 eyes (80.3%) for original break(s). Risk factors for RRD after initial laser included multiple breaks (odds ratio [OR], 3.94; 95% CI, 1.4-11.2; P = .010), pseudophakia (OR, 3.15; 95% CI, 1.4-6.9; P = .004), and vitreous hemorrhage (OR, 2.31; 95% CI, 1.04-5.14; P = .038). Risk factors for additional laser retinopexy included multiple breaks (OR, 5.9; 95% CI, 2.4-14.2; P = .001), inferotemporal location (OR, 2.34; 95% CI, 1.0-5.4; P = .047), and fellow-eye laser retinopexy (OR, 7.78; 95% CI, 1.63-37.1; P = .01). Outcomes did not differ significantly between eyes treated by residents and attendings (P > .47). Conclusions: RRD occurs in a low, but not trivial, percentage of patients after treatment of a symptomatic retinal break, and additional treatment in the same eye after initial treatment is often performed for the same break or additional breaks. Regular follow-up after initial laser retinopexy is recommended for optimized outcomes.

Purpose: To report an atypical presentation of enhanced S-cone syndrome associated with bilateral foveoschisis and an almost normal fundus appearance. Methods: A single case was reviewed. Results: Enhanced S-cone syndrome is a rare inherited retinal dystrophy caused by mutations in the NR2E3 gene, which plays a critical role in the differentiation of photoreceptor cells. Although characteristic findings include nummular pigmentary alterations around the vascular arcades, our patient presented with unilateral visual impairment and bilateral foveoschisis detected on multimodal imaging despite an almost normal fundus appearance. Genetic analysis revealed a homozygous mutation in the NR2E3 gene. The genetic findings and the electrophysiological test results led to a diagnosis of an atypical form of enhanced S-cone syndrome associated with foveoschisis. Conclusions: This case highlights the phenotypic variability of enhanced S-cone syndrome and that electrophysiologic evaluation and genetic analysis play a crucial role in understanding genotype–phenotype correlations, which are essential for guiding prognosis and treatment strategies.

Purpose: To compare visual, refractive, and surgical outcomes between single-stage (concurrent) and 2-stage (sequential) silicone oil removal with phacoemulsification and intraocular lens implantation in patients previously managed for retinal detachment. Methods:This retrospective case series included patients who underwent silicone oil removal with cataract extraction between January 2018 and October 2024 at Bascom Palmer Eye Institute. Outcomes evaluated included best-corrected visual acuity (BCVA), spherical equivalent, and refractive accuracy based on median prediction error and mean absolute error. Results: A total of 272 eyes were analyzed: 26 in the sequential group (mean ± SD age, 48.7 ± 12.9 years; 54% male) and 246 in the concurrent group (mean ± SD age, 52.9 ± 12.2 years; 61% male). BCVA improved in both groups, with final median BCVAs of 0.53 logMAR in the sequential group and 0.71 logMAR in the concurrent group (P = .064). Spherical equivalent was similar between groups (P = .843), but the sequential group had better refractive predictability with a lower median prediction error compared with the concurrent group (median –0.26 diopters vs 0.21 diopters; P = .008). The mean absolute error was comparable between groups (P = .662). Subgroup analysis and multivariate regression revealed no significant predictors of outcomes. Cystoid macular edema occurred in 6 eyes in the sequential group (23%) and 7 eyes in the concurrent group (3%); glaucoma or elevated intraocular pressure occurred in 6 eyes in the sequential group (23%) and 16 eyes in the concurrent group (7%) (P = .013). Conclusions: Both approaches resulted in improved outcomes, with the sequential method providing superior refractive predictability with less hyperopic error and a trend toward better final visual acuity, suggesting a potential advantage for staged procedures in enhancing surgical precision. However, the sequential method was also associated with higher postoperative complication rates, underscoring the need to balance refractive precision with surgical safety when selecting between staged and combined procedures.

Purpose: To compare the effectiveness of antivascular endothelial growth factor (VEGF) therapy with or without panretinal photocoagulation (PRP) on retinal neovascularization (NV) in patients with proliferative diabetic retinopathy (PDR) at 24 months. Methods: This retrospective, multicenter, observational case series included 237 patients (307 eyes) with retinal NV secondary to PDR treated with anti-VEGF. Results: Eyes were divided into 2 groups: eyes with prior PRP (group A, 162 eyes) and treatment-naïve eyes (group B, 145 eyes). Group A received a mean of 4.5 anti-VEGF injections per eye (95% CI, 4.1-5.1), and group B a mean of 5.8 (95% CI, 5.3-6.3) during follow-up. Both groups showed significant improvements in best-corrected visual acuity and central macular thickness. Mean visual acuity in group A improved from 20/125 to 20/60 (P < .001), and in group B from 20/100 to 20/60 (P = .002). Mean central macular thickness decreased in group A from 341.8 µm (95% CI, 327.2-358.1) to 285.3 µm (95% CI, 273.2-296.4; P < .001), and in group B from 346.1 µm (95% CI, 322.6-365.5) to 298.1 µm (95% CI, 276.2-319.1; P < .001). In group A, 127 eyes (78.4%) responded to anti-VEGF alone. In group B, only 23 eyes (15.8%) achieved complete or partial regression with anti-VEGF alone, while 122 (84.1%) required additional PRP or vitrectomy. Pars plana vitrectomy was performed in 6.7% of group A eyes and 12.4% of group B eyes. Main indications were vitreous hemorrhage and tractional retinal detachment in both groups. Conclusions: Antiangiogenic therapy resulted in marked regression of retinal NV in patients with PDR and previous PRP. A combined approach of antiangiogenics plus PRP should be studied.

Purpose: To assess the impact on treatment patterns resulting from underfunding of a large patient copay assistance program (Good Days) in 2024 and 2025. Methods: A 34-item electronic survey was sent to 1860 US members of the American Society of Retina Specialists (ASRS) in April 2025 to assess the effects of Good Days underfunding. Responses were then stratified based on the social deprivation index and poverty levels of the physicians’ office locations. Results: A total of 411 responses (22%) were included. Most physicians (94%) reported significant or moderate disruptions in care after Good Days underfunding, and 90% reported patients being unable to receive their preferred drug therapy. Most physicians (93%) switched patients to off-label bevacizumab, with 84% reporting an increase in injection frequency after switching. Approximately 61% of physicians reported that vision loss was observed in patients due to cost-related delays in treatment, and 63% reported patients being lost to follow-up as a result of financial hardship. Most physicians (77%) believed that the underfunded patient copay assistance program disproportionately affected lower income or underserved communities. Physicians working in lower socioeconomic areas were more likely to report that patients requested to delay or miss therapy (50% vs 37%; P = .019), and patients with geographic atrophy were more likely to request treatment interval extensions (56% vs 44%; P = .033). Conclusions: Physicians were concerned about patients losing access to care, increasing treatment frequency with off-label therapies, and possibly losing vision after a large patient copay assistance program was underfunded. Policy makers, insurance companies, and manufacturers should work together to alleviate the financial burden and barriers to care resulting from high patient copays.

Purpose: To characterize demographic, psychiatric, and retinal comorbidities associated with solar retinopathy in the United States from 2012 to 2024 and to evaluate incidence trends in relation to solar eclipse years. Methods: This retrospective, population-based cohort study was conducted using the TriNetX US Collaborative Research Network. Patients with newly diagnosed solar retinopathy (International Classification of Diseases, 10th edition, code H31.02) were identified and included if they had a documented ophthalmology visit and retinal imaging. Annual incidence rates were compared between eclipse and non-eclipse years. Demographic characteristics and the prevalence of psychiatric disorders, substance use disorders, and concurrent retinal conditions were analyzed. Results: Among 1 042 995 patients, 555 were diagnosed with solar retinopathy. The mean annual incidence was 44.5 cases, with a peak observed in 2017 (71 cases). There was no statistically significant difference between eclipse years (51.5 cases/year) and non-eclipse years (37.3 cases/year; P = .062). The median age at diagnosis was 54.1 ± 21.3 years, and 59% of patients were men. Sixty-eight percent of individuals were White, 27% were Black, and 5% were Asian. Psychiatric comorbidities were common, with 32% diagnosed with anxiety disorders, 24% with major depressive episodes, and 10% with psychotic disorders. Substance use disorders were also observed, including nicotine dependence (18%) and cannabis-related disorders (6%). Concurrent retinal conditions included age-related macular degeneration (8%), hereditary retinal dystrophies (7%), and central serous chorioretinopathy (3%). There was no correlation between solar retinopathy incidence and geographic exposure to eclipse totality. Conclusions: The incidence of solar retinopathy remained low over the study period, with no significant increase during eclipse years. However, psychiatric and retinal comorbidities were prevalent among affected individuals. These findings highlight demographic and psychosocial disparities and support the need for targeted, culturally informed preventive education and eye safety initiatives before future eclipses.

Purpose: To describe a case of massive retinal pigment epithelium (RPE) tear following a hypertensive crisis superimposed on chronic central serous chorioretinopathy (CSCR). Methods: A case report with a focused literature review was performed. Results: A 55-year-old man with a history of chronic CSCR presented with acute vision loss in the setting of a hypertensive emergency (blood pressure, 215/130 mm Hg). Multimodal imaging and clinical examination revealed a massive RPE tear in the right eye extending from the temporal periphery through the macula. The left eye demonstrated smaller RPE tears associated with macular scarring and intraretinal fluid. The right eye was managed conservatively and showed progression of the RPE tear over 1 month. The left eye was treated with an intravitreal faricimab injection, resulting in improvement of the intraretinal fluid. Conclusions: This case supports a potential 2-hit mechanism in which chronic CSCR-related RPE vulnerability, combined with acute hypertensive choroidopathy, leads to extensive and progressive RPE tearing. Patients with chronic pachychoroid spectrum disease and systemic hypertension may be at increased risk for severe RPE complications.

Purpose: To identify retinal morphologic changes associated with pregnancy in patients with diabetes and evaluate potential risk factors for disease progression. Methods: A retrospective chart and image review was performed for 35 patients (70 eyes) with type 1 or type 2 diabetes mellitus (DM) who received prenatal care and had a delivery between January 2010 and December 2022 at Duke University Health System. Multimodal retinal imaging (spectral-domain optical coherence tomography, color fundus photography, and fluorescein angiography [FA]) was assessed pre-pregnancy and post-delivery for morphologic changes, including disorganization of the retinal inner layers (DRIL), diabetic retinopathy (DR) severity (based on Early Treatment Diabetic Retinopathy Study letter level), and central subfield thickness. Clinical data were extracted via chart review. Results: DRIL prevalence increased from 75.5% of eyes (37/49) pre-pregnancy to 88.1% (52/59) post-delivery (P < .001). Average DRIL extent nearly doubled (38.0% pre-pregnancy to 76.4% post-delivery; P < .001), and 38.6% of eyes (27/70) showed new or progressive DRIL after pregnancy. DR prevalence increased from 72.7% of eyes (40/55) pre-pregnancy to 92.1% (58/63) post-delivery, with a significant increase in proliferative DR prevalence after pregnancy (P < .001). Overall, the severity of both proliferative and nonproliferative DR significantly increased following pregnancy (both P < .001). DRIL progression from pre-pregnancy to post-delivery correlated with DR progression (P = .039). No significant associations were found between DR progression and baseline age, DM type, smoking, glycosylated hemoglobin level, body mass index, preeclampsia history, or hypertension treatment. New or worsening retinal ischemia (characterized as foveal avascular zone enlargement and/or peripheral nonperfusion) was identified on the longitudinal FA images available from 4 patients. Conclusions: Pregnancy is associated with the progression of DRIL and DR in diabetic women. Early identification of changes is important for timely intervention and optimizing visual outcomes.

Purpose: To evaluate visual acuity (VA) outcomes and postoperative complications after pars plana vitrectomy (PPV) for retained lens fragments (RLF) after cataract surgery. Methods: This retrospective cohort study used data from the IRIS (Intelligent Research in Sight) Registry from January 2013 to December 2022. Eyes that underwent PPV for RLF within 8 weeks of cataract surgery were identified using International Classification of Diseases, 9th and 10th editions, and Current Procedural Terminology codes. Eyes with preexisting ocular comorbidities were excluded. Multivariable regression identified predictors of good (VA ≥20/40) and poor (VA ≤20/200) vision at 3 months. Main outcomes included postoperative VA and complications within 3 months of cataract surgery. Results: A total of 5640 eyes from 5509 patients were analyzed. The mean logMAR VA improved from 0.63 ± 0.51 before cataract surgery to 0.46 ± 0.50 after PPV. PPV was performed the same day in 48.3% of eyes, within 1 week in 25.7%, and after 1 week in 26.0%. Common complications included ocular hypertension (17.1%), corneal edema (7.4%), vitreous hemorrhage (6.3%), and rhegmatogenous retinal detachment (RRD [3.5%]). Same-day PPV was associated with significantly lower rates of anterior uveitis, endophthalmitis, corneal edema, intraocular lens (IOL) displacement, and ocular hypertension (all P < .001). IOL implantation before PPV was an independent predictor of good vision (relative risk, 1.38; 95% CI, 1.21-1.56). Poor outcomes were associated with worse preoperative VA, Black race, older age, delayed PPV (>1 week), corneal edema, and RRD (all P < .05). Conclusions: Same-day PPV significantly reduces postoperative complications, and IOL implantation before PPV improves visual recovery. Delayed PPV, poor baseline vision, older age, and postoperative complications are predictive of worse outcomes. Early surgical intervention and individualized planning are critical for optimizing visual results in RLF management.

Purpose: To describe a simple, inexpensive, 3D-printed holder for a high-resolution, wide-angle contact lens compatible with the Resight 700 system. Methods: This study introduces a contact lens system for use in vitreoretinal surgery. Comprising an aspheric pan fundoscopic lens and an adaptive lens holder designed for easy integration with existing surgical setups, the system is compatible with popular noncontact systems, such as Resight 700, offering flexibility between the 2 modalities. Results: The new system allows seamless switching between noncontact and contact modes, providing a wide field of view with enhanced resolution and stereopsis to overcome the optical limitations of noncontact systems. The design ensures minimal interference with surgical instruments and has been successfully used in more than 500 vitreoretinal surgeries, including complex procedures, without any complications. Conclusions: This hybrid system offers a wide field of view and high-resolution imaging of contact systems, mitigating the need for an assistant and reducing the risk of corneal injury.

Purpose: To report an unusual case of retinal dysfunction in a treating ophthalmologist following inadvertent exposure to 577 nm yellow laser backscatter during panretinal photocoagulation. Methods: A single case was reviewed. Results: A 28-year-old physician was inadvertently exposed to 577 nm yellow laser backscatter while using an indirect ophthalmoscope to deliver panretinal laser photocoagulation for ischemic retinal disease. He immediately experienced bilateral after-images that persisted for 72 hours. Longitudinal multimodal retinal imaging revealed no structural abnormalities. Multifocal electroretinography (mfERG) performed soon after exposure demonstrated macular dysfunction in both eyes. At 18 months, mfERG amplitudes had normalized, but implicit times remained prolonged, consistent with persistent mild cone dysfunction. Conclusions: Inadvertent laser backscatter exposure can result in functional retinal changes without detectable structural abnormalities. This case underscores the importance of rigorous laser safety protocols for treating ophthalmologists during ophthalmic laser procedures.

Purpose: To provide updated survival data for patients with proliferative diabetic retinopathy (PDR) undergoing pars plana vitrectomy (PPV) and identify associated prognostic factors. Methods: An aggregated electronic health records research network was used to identify patients with a diagnosis of PDR who underwent PPV between 2009 and 2019 and a control group of patients with PDR without a history of PPV. Groups were propensity score matched for age, sex, race, ethnicity, and HbA1c. Main outcomes included survival rates at 3, 5, and 10 years using the Kaplan-Meier life table method. Additional analyses were performed to assess if survival rates differed in patients with PDR by PPV indication (vitreous hemorrhage [VH] or tractional retinal detachment [TRD]). Results: A total of 8637 patients were included. The 3-, 5-, and 10-year survival rates in patients with PDR after PPV were 89.2%, 80.9%, and 52.8%, respectively. Survival rates in patients with PDR with a history of PPV vs without a history of PPV were lower at 3 (88.7% vs 89.9%; P = .03), 5 (80.2% vs 82.6%; P < .01), and 10 years (51.4% vs 55.8%; P < .01). Survival rates were similar between patients who underwent PPV for VH or TRD at 3 (90.4% vs 88.7%; P = .05), 5 (82.7% vs 81.0%; P = .10), and 10 years (53.0% vs 53.4%; P = .75). Conclusions: Despite major advances in diabetes care, the long-term survival rates in patients with PDR after PPV have remained stable the last 2 decades, emphasizing the need for multidisciplinary evaluation and prompt cardiovascular and renal optimization.

Purpose: To evaluate the outcomes of intravitreal povidone–iodine as an alternative treatment for exogenous endophthalmitis in patients with antibiotic allergies. Methods: This retrospective case series included patients with antibiotic allergies who developed exogenous endophthalmitis and received monotherapy with intravitreal 1.25% povidone–iodine (0.1 mL). Primary outcomes were best-corrected visual acuity (VA) at 3 and 6 months and treatment-related complications. Results: A total of 7 eyes from 7 patients were included. The mean patient age was 72 years, and the mean follow-up duration was 10.5 months. The mean presenting VA was counting fingers at 4 feet (1.83 ± 0.97 logMAR), which improved to 20/160 (0.91 ± 0.99 logMAR, P = .03) at 3 months and to 20/150 (0.89 ± 1.00 logMAR, P = .03) at 6 months. Five patients (71%) regained baseline VA or better. No adverse events occurred, and no patients needed further interventions. Conclusions: Intravitreal injection of 1.25% povidone–iodine (0.1 mL) was well tolerated and was associated with visual improvement in patients with exogenous endophthalmitis.

Purpose: To evaluate the safety and efficacy of supraorbital vibration anesthesia in combination with topical anesthesia during intravitreal therapy. The primary objective is to assess the effectiveness of vibrational anesthesia in reducing pain and stress associated with the procedure. Methods: A retrospective chart review of 842 patients undergoing intravitreal therapy was conducted, with 834 patients opting for vibrational anesthesia. Additionally, a survey of 50 patients was conducted to evaluate the effects of vibrational anesthesia on patient experiences. Results: No adverse events were observed following intravitreal therapy in conjunction with vibrational anesthesia. Additionally, a survey of 50 patients revealed that 94% preferred vibrational anesthesia, and 84% would request it in future treatments. The majority of patients surveyed reported a reduction in pain (82%) and stress (72%) with the use of vibrations. Conclusions: The results suggest that supraorbital vibration anesthesia is safe and effective in reducing pain and stress during intravitreal therapy. Further studies are warranted to validate these findings and determine optimal device placement.

Purpose: To describe a previously unreported association between sclerochoroidal calcification and hepatocyte nuclear factor-1β deficiency syndrome. Methods: A single case was reviewed. Results: A 66-year-old man with a history of diabetes mellitus, chronic kidney disease, renal cysts, and prior prostate cancer was found to have bilateral superotemporal placoid sclerochoroidal lesions during routine follow-up. Fundus autofluorescence demonstrated corresponding hyperautofluorescent foci, and optical coherence tomography revealed hyperreflective scleral elevations with posterior shadowing and focal ellipsoid zone disruption. Previous genetic testing identified a pathogenic hepatocyte nuclear factor-1β stop codon variant. The lesions remained stable over 2 years, without evidence of choroidal neovascularization. Conclusions: This case broadens the spectrum of systemic associations with bilateral sclerochoroidal calcification and suggests hepatocyte nuclear factor-1β deficiency syndrome as a potential underlying etiology in patients presenting with bilateral sclerochoroidal calcification and concurrent renal or metabolic abnormalities.