VOLUME 88 - ISSUE 6

PURPOSE: To analyze the quality of life and treatment adherence of patients with glaucoma at different disease stages, considering factors such as sex, visual acuity, disease severity, and treatment characteristics.
METHODS: This cross-sectional study included 174 patients (346 glaucomatous eyes) recruited from clinical records and routine follow-ups at a specialized ophthalmology center. Their mean age was 39–90 years, and 60.9% of them were women. Their quality of life and adherence were assessed using the NEI-VFQ25 and MMAS-8 questionnaires, respectively. Complementary tests included 24:2 visual field test, retinography, and optical coherence tomography. Patients diagnosed with glaucoma for at least 6 months were included, whereas pregnant patients and those with ocular diseases were excluded.
RESULTS: Among the participants, 59.2% adhered to the treatment whereas 40.8% showed low adherence. The mean quality of life score was 81.87. Patients with low adherence had slightly higher quality of life scores (mean 83.1) than those with good adherence (mean 81.0), but the difference was not statistically significant. Disease severity was associated with increased optic nerve cupping, reduced thickness of the nerve fiber and ganglion cell layers, and great visual field loss. No significant correlation was observed between adherence and quality of life, indicating the independence of these factors and the influence of psychological or social elements.
CONCLUSION: The absence of a correlation between quality of life and treatment adherence highlights the need for tailored interventions for psychological and social aspects. These findings indicate the importance of a comprehensive approach to managing glaucoma, preserving visual function, strengthening doctor–patient relationships, and considering psychosocial factors to enhance quality of life and treatment adherence.

Keywords: Glaucoma; Quality of life; Patient health questionnaire; Patient acuity; Antiglaucoma agents; Visual acuity; Treatment adherence and compliance; Surveys and questionnaires

PURPOSE: To report the surgical outcomes of patients with primary congenital glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy.
METHODS: This retrospective, noncomparative, interventional study included consecutive patients with primary congenital glaucoma with uncontrolled intraocular pressure undergoing gonioscopy-assisted transluminal trabeculotomy between January 2017 and January 2020. The included participants were followed up for at least 24 months, and only one surgeon performed all the procedures. The number of glaucoma medications, pre- and postoperative intraocular pressure, treatment extension (in quadrants), surgical complications, and any associated events or interventions were documented.
RESULTS: This study included 13 eyes from 10 patients (mean age, 4.5 ± 3.2 years; range, 3 months to 10 years). After a 24-month follow-up, the mean intraocular pressure significantly decreased from 26.1 ± 3.7 to 11.8 ± 2.5 mmHg (p<0.001). The mean number of glaucoma medications was reduced from 3.3 ± 0.5 to 0.85 ± 1.0 (p<0.001). At the end of the follow-up interval, all eyes (13 out of 13) had an intraocular pressure between 7 and 15 mmHg. In 11 of 13 eyes (84.6%), gonioscopy-assisted transluminal trabeculotomy was performed in all quadrants (360º). The most frequent postoperative complication was transitory (self-limited) hyphema (7 out of 13 eyes [53.8%]). No sight-threatening adverse events occurred during the entire follow-up period.
CONCLUSIONS: The 2-year follow-up results indicated gonioscopy-assisted transluminal trabeculotomy as an efficient and safe option for primary congenital glaucoma treatment with minimal postoperative complications.

Keywords: Glaucoma, Open-angle/surgery; Gonioscopy; Trabeculectomy/methods; Intraocular pressure; Antihypertensive agents/therapeutic use.

PURPOSE: Standard intravitreal medication dosages are based on an assumed vitreous cavity volume of 4.0-4.5 mL. However, individual variations in vitreous cavity volume may influence both the efficacy and safety of these medications. This study proposes dosage adjustments for intravitreal medications and gases according to axial length and the corresponding vitreous cavity volume.
METHODS: This descriptive study employed reference guidelines that use axial length to estimate the Axial Length-based Volume of the Vitrectomized Space and the Vitreous Volume EXact table for determining dose adjustments across varying eye sizes. Small eyes (axial length 19-22 mm) have an average vitreous cavity volume of 3.5 mL at an axial length of 20.5 mm; standard-sized eyes (22-25 mm) have 4.8 mL at 23.5 mm; large eyes (25-28 mm) have 6.4 mL at 26.5 mm; and extra-large eyes (28-32 mm) have 8.4 mL at 29.5 mm. The medications considered included anti-infectives, anti-VEGFs, complement inhibitors, recombinant proteases, chemotherapy agents, corticosteroids, and medical gases.
RESULTS: Analysis of intravitreal drug concentrations relative to vitreous cavity volume demonstrated notable variability when a standard dose was administered. Small eyes received about 135% of the concentration intended for a standard-sized eye; large eyes received around 75%; and extra-large eyes received under 60%. The recommended dose adjustments are as follows: for small eyes, administer 70-80% of the standard dose; for large eyes, 130-140%; and for extra-large eyes, 170-180%.
CONCLUSIONS: Tailoring intravitreal drug and gas dosages according to axial length and vitreous cavity volume may enhance intraocular drug distribution, potentially improving both safety and therapeutic outcomes.

Keywords: Intravitreal injections; Axial length; Vitreous body; Drug dosage calculations; Pharmacokinetics; Anti-infective agents

PURPOSE: To report the ophthalmological signs, symptoms, and clinical management observed during an unprecedented outbreak of chemical ocular injuries related to cosmetic hair ointments in Brazil.
METHODS: This descriptive, cross-sectional study reviewed medical records of patients treated at the emergency center of Fundação Altino Ventura for chemical ocular trauma associated with cosmetic hair ointment use between February 2022 and February 2023. Records with incomplete medical information were excluded.
RESULTS: The study included 168 patients (95.2% [n=160] female), with a mean age of 30.8 ± 9.7 years. The most frequently reported symptoms at presentation were pain (167/168, 99.4%) and photophobia (92/168, 54.8%). Severe pain was reported by 137 patients (80%). Keratitis was present in 280 of 336 eyes (83.3%), conjunctival hyperemia in 256 eyes (76.4%), and corneal abrasions in 174 eyes (51.8%). A decrease in visual acuity (worse than 20/25) was documented in 18.5% (31/168) of cases. Lubricants, antibiotics, and re-epithelialization ointments were prescribed to 64.8% (109/168) of the patients. Topical corticosteroids and oral vitamin C were administered to 34% (57/168) and 1.2% (2/168) of patients, respectively. Followup visits were required in 19% (33/168) of cases.
CONCLUSION: The outbreak of chemical ocular injuries linked to cosmetic ointments used for braiding and hair modeling in Brazil was marked by intense ocular pain, conjunctival hyperemia, keratitis, and corneal abrasions. Most patients were treated with lubricants, antibiotics, and re-epithelialization ointments, although approximately one-fifth required followup care, and one-third received additional treatment with either topical corticosteroids and/or oral vitamin C.

Keywords: Cosmetics; Hair preparations; Eye injuries; Burns, chemical; Eye burns; Keratitis; Cornea; Corneal diseases; Visual low.

PURPOSE: To assess female participation in the Brazilian Congress of Ophthalmology.
METHODS: This retrospective, descriptive-analytical study examined the profiles of individuals involved in the scientific program of the Brazilian Congress of Ophthalmology from 2016 to 2023. Data were provided by the Brazilian Council of Ophthalmology and were categorized by ophthalmology subspecialty, participant role, and geographic region of origin within Brazil. Roles were grouped into three main categories: coordinator, speaker, and moderator/discussant.
RESULTS: Female participation at the congress increased from 33% in 2016 to 42% in 2023, showing an annual upward trend of 1.33 (p<0.001). Around 64% of female participants were from the Southeast region, while 16% were from the Northeast. The coordinator role showed the largest increase in female participation, rising from 22% in 2016 to 40% in 2023 (Slope: 2; p<0.001), followed by the speaker role, which increased from 34% to 44% (Slope: 1.5; p<0.001), and the moderator/discussant role, which rose from 32% to 38% (Slope: 1.24; p=0.0586). Changes in female representation across ophthalmology subspecialties were not statistically significant.
CONCLUSION: From 2016–2023, female participation in the Brazilian Congress of Ophthalmology increased across most subspecialties and conference roles. Although gender disparity has narrowed, continuous efforts are needed to achieve greater gender equity and equality in ophthalmology conferences.

Keywords: Ophthalmology; Gender equity; Ophthalmologists/statistics & numerical data; Physicians, women/statistics & numerical data; Leadership; Congresses as topic/statistics & numerical data.

PURPOSE: This study evaluated macular thickness using spectral-domain optical coherence tomography in healthy participants from a population-based eye survey.
METHODS: The Brazilian Amazon Region Eye Survey was a population-based study assessing the prevalence and causes of visual impairment, blindness, and ocular diseases in adults aged ≥45 years from urban and rural areas of Parintins. A subgroup was selected based on inclusion criteria for both eyes: best-corrected visual acuity ≥20/32, normal eye examination results, and no prior ocular surgery. Scans were performed using the iVue optical coherence tomography device. Measurements were taken from the nine subfields defined by the Early Treatment Diabetic Retinopathy Study, examining the full retina as well as the inner and outer retinal layers. Associations of retinal thickness with age and sex were also analyzed. Statistical significance was set at p≤0.05.
RESULTS: In total, 70 healthy participants (25 males), aged 45–65 years (mean=52 ± 5), were included. Mean central foveal thickness was 248.71 ± 18.73 μm. A significant age-related reduction in macular thickness was observed, particularly in the inner superior parafovea (p=0.036), nasal perifovea (p=0.001), superior perifovea (p=0.028), outer layer of inferior parafovea (p=0.049), and the inferior perifovea of the full retina (p=0.029). Males showed significantly greater thickness in the outer layer, especially in the outer parafovea (p=0.004) and perifovea (p<0.0001).
CONCLUSIONS: This study established normative macular thickness values for healthy older adults in the Brazilian Amazon region using spectral-domain optical coherence tomography. Age and sex were found to significantly influence macular thickness and should be considered when interpreting measurements. These data will support future studies of retinal diseases in this population.

Keywords: Retinal diseases/diagnosis; Macula lutea/pathology; Macular degeneration/diagnosis; Diabetic retinopathy/diagnosis; Vision, low; Vision tests; Tomography, optical coherence/methods; Young adult; Cross-sectional studies; Brazil/epidemiology

PURPOSE: This study aimed to examine factors related to the professionalism of ophthalmology residents.
METHODS: A cross-sectional study was carried out involving 48 ophthalmology residents in Brazil. Professionalism was assessed using the professionalism mini-evaluation exercise, completed by both preceptors and residents, and the Pennsylvania State College of Medicine Professionalism Questionnaire, completed by the residents. The association between the professionalism score assigned by the preceptor through the professionalism mini-evaluation exercise and various sociodemographic and educational variables was assessed. The correlation between the residents’ self-assessment across both instruments and the preceptor’s assessments was measured using Spearman’s Rho.
RESULTS: All 48 residents were included, with equal representation across the 3 years of residency. The majority were female (58.3%) and between 25 and 29 years old (66.7%). The average professionalism score on the professionalism mini-evaluation exercise given by the preceptors was 3.0 (75%). A significant association was found between the year of training and the score in the doctor-patient relationship domain, with first-year residents showing lower scores (p=0.002). Male residents had higher scores in the “Interprofessional” domain (p=0.031). Graduates from private medical schools scored higher in both the “doctor-patient relationship” (p=0.015) and “reflective skills” (p=0.033) domains. Lower interest in professionalism was linked to lower scores in the “Interprofessional relationships” (p=0.033) and “time management” (p=0.003) domains. A strong correlation was observed between preceptor’s professionalism mini-evaluation exercise scores and residents’ self-assessed professionalism mini-evaluation exercise scores (r=0.917). However, the correlation between the self-assessed professionalism mini-evaluation exercise and the Pennsylvania questionnaire scores was weak (r=0.226).
CONCLUSION: Professionalism scores among ophthalmology residents were associated with year of training, gender, type of undergraduate education, and level of interest in the topic.

Keywords: Internship and residency; Ophthalmology; Professional competence; Education, professional; Physician-patient relations; Surveys and questionnaires

PURPOSE: The purpose of this study was to assess visual outcomes and patient satisfaction following cataract surgery involving the implantation of quad-loop intraocular lenses, including trifocal, bifocal, and toric variants.
METHODS: Information was obtained from both physical and electronic medical records of patients who underwent phacoemulsification cataract surgery with implantation of different intraocular lenses between January 1, 2022, and December 31, 2023. The study included individuals aged over 18 who received bilateral implantation of bifocal, trifocal, or monofocal toric intraocular lenses. Visual acuity was assessed at various postoperative time points using the logMAR scale. Quantitative variables were analyzed using mean and standard deviation.
RESULTS: A total of 92 eyes received premium intraocular lenses: 4 bifocal, 32 trifocal, 52 toric monofocal, and 4 trifocal toric lenses. The average preoperative corrected visual acuity was logMAR 0.478 ± 0.259. On the first postoperative day, the average uncorrected visual acuity was logMAR 0.301 ± 0.207. By day 30, 67.4% of eyes achieved uncorrected distance visual acuity of logMAR 0.2 or better. Patient satisfaction was high, with few reports of glare or halos.
CONCLUSION: Quad-loop intraocular lenses-including trifocal, bifocal, and toric models-demonstrated effective improvement in visual acuity and high levels of patient satisfaction. These lenses represent a suitable option for enhancing visual outcomes after cataract surgery. Additional studies with larger cohorts are recommended to confirm these results.

Keywords: Cataract extraction; Aberrometry/methods; Lenses, intraocular; Lens implantation, intraocular; Prosthesis design

PURPOSE: This study aimed to evaluate the practices employed by oculoplastic surgeons in the assessment and management of anophthalmic sockets and external ocular prostheses.
METHODS: Oculoplastic surgeons from two countries, who specialized in the management of anophthalmic sockets, participated in a web-based survey. Data collected included demographics, types of surgery, implant use, external ocular prostheses management (including fabrication and cleaning), complications encountered, and follow-up times. The frequencies and distributions of the responses were statistically analyzed.
RESULTS: A total of 177 oculoplastic surgeons participated, 113 (63.8%) from Brazil, the remainder from Spain. Evisceration was the preferred surgical procedure of 149 (84.2%) surgeons. The most commonly reported indication for enucleation was a painful blind eye (n=103, 58.1%; both Brazil and Spain, p<0.001). Brazilian surgeons preferred polymethyl methacrylate implants (n=65, 57.5%), while Spanish surgeons favored porous polyethylene implants (n=53, 82.8%; p<0.001). Discharge was the most frequently observed clinical feature during socket evaluation (n=164, 92.6%; p<0.001). Brazilian surgeons recommended daily (n=53, 46.9%) or weekly (n=41, 36.2%) cleaning of external ocular prostheses, while Spanish surgeons more commonly recommended monthly cleaning (n=31, 48.4%; p<0.001). The majority of Brazilian surgeons (n=83, 73.4%) advised patients to remove their external ocular prostheses at night. Only a small number of Spanish surgeons (n=3, 4.6%) suggested this practice (p<0.001). Overall, the follow-up recommendations varied, with 70 (39.5%) surgeons recommending follow-up based on individual case needs, and 59 (33.3%) suggesting annual visits (p<0.001). The primary indications for external ocular prostheses replacement were edge damage (n=75, 42.3%) and loss of volume (n=68, 38.4%). The replacement intervals given typically ranged from 1 to 5 years (n=92, 51.9%; p<0.001).
CONCLUSION: Oculoplastic surgeons in Brazil and Spain demonstrated similar practices in the management of anophthalmic sockets. However, notable differences were observed in the choice of implant materials, cleaning protocols, and recommendations regarding external ocular prostheses removal during sleep.

Keywords: Anophthalmos; Eye, artificial; Polymethyl methacrylate; Polyethylene; Surgeons; Surveys and questionnaires; Brazil; Spain.

PURPOSE: This clinical study aimed to assess the effectiveness of microemulsion artificial tears containing povidone and propylene glycol in the management of dry eye disease. Secondary objectives included evaluating improvements in tear-film stability, measured by tear break-up time and corneal staining scores, along with the tolerability and safety of the formulation.
METHODS: This was a prospective, single-arm interventional study involving 30 participants (52 eyes) diagnosed with dry eye disease. Participants self-administered the investigational eye drops twice daily for 28 consecutive days. Primary and secondary outcomes included changes in the Ocular Surface Disease Index, tear break-up time, and corneal staining scores. Adverse events were documented throughout the study period.
RESULTS: Significant improvements in Ocular Surface Disease Index scores were observed, reflecting a reduction in dry eye disease symptoms. Tear break-up time increased notably between baseline and follow-up assessments, with the proportion of eyes exhibiting tear break-up time ≥10 srising from 25.0% to 63.5%. Additionally, the percentage of eyes with a corneal staining score of zero improved from 23.1% to 69.2%. Conjunctival staining also decreased, with the proportion of eyes with scores of 2 and 3 dropping from 11.5% to 3.8% and 5.8% to 0%, respectively.
CONCLUSIONS: The findings suggest that povidone and propylene glycol-based artificial tears significantly enhance tear-film stability and alleviate symptoms in patients with mild to moderate dry eye disease, with minimal adverse effects. This formulation represents a safe and effective short-term treatment option for dry eye disease management.

Keywords: Artificial tears; Dry eye disease; Tear-film stability; Propylene glycol; Povidone; Visual acuity; Surveys and questionnaires

PURPOSE: This pilot study evaluated the diagnostic accuracy of a deep learning model for detecting pterygium in anterior segment photographs taken using smartphones in the Brazilian Amazon. The model’s performance was benchmarked against assessments made by experienced ophthalmologists, considered the clinical gold standard.
METHODS: In this cross-sectional study, 38 participants (76 eyes) from Barcelos, Brazil, were enrolled. Trained nonmedical health workers captured high-resolution anterior segment images using smartphones. These images were analyzed using a deep learning model based on the MobileNet-V2 convolutional neural network. Diagnostic metrics–including sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve–were calculated and compared with the ophthalmologists’ evaluations.
RESULTS: The deep learning model achieved a sensitivity of 91.43%, specificity of 90.24%, positive predictive value of 88.46%, negative predictive value of 92.79%, and an area under the curve of 0.91. Logistic regression revealed no statistically significant association between pterygium and demographic variables such as age or gender.
CONCLUSIONS: The deep learning model demonstrated high diagnostic performance in identifying pterygium in a remote Amazonian population. These preliminary findings support the potential use of artificial intelligence–based tools to facilitate early detection and screening in underserved regions, thereby enhancing access to ophthalmic care.

Keywords: Pterygium/diagnostic imaging; Smartphone; Diagnostic techniques, ophthalmological; Deep learning; Telemedicine; Artificial intelligence; Cross-sectional studies; Brazil/epidemiology

PURPOSE: This study aimed to report the surgical outcomes and success predictors of micropulse transscleral cyclophotocoagulation in eyes with refractory glaucoma.
METHODS: This was a noncomparative, interventional case series. Patients with refractory glaucomas, defined as eyes with prior incisional glaucoma surgery failure and uncontrolled intraocular pressure, who underwent micropulse transscleral cyclophotocoagulation between March 2017 and June 2021 were enrolled. A minimum follow-up period of 6 months was required. Preoperative and postoperative intraocular pressure, number of hypotensive medications, surgical complications, and any subsequent related events were recorded. Success criteria were as follows: 1) intraocular pressure reduction ≥20% and intraocular pressure ≤18 mmHg; 2) intraocular pressure reduction ≥30% and intraocular pressure ≤15 mmHg. The need for topical hypotensive medications was not considered a failure.
RESULTS: Seventy-nine (79) eyes (79 patients; mean age, 57.5 ± 20.6 years) were included. Overall, the median follow-up duration was 12.0 (interquartile interval, 6–24) months, and the mean intraocular pressure was reduced from 22.8 ± 6.8 mmHg to 15.5 ± 5.6 mmHg at the last follow-up visit (p<0.001). The mean number of medications was reduced from 2.8 ± 0.7 to 2.0 ± 1.0 (p<0.01). At 12 months postoperatively, the success rates for criteria 1 and 2 were 54.9% and 49.7%, respectively. Aside from one case of corneal ulcer, which fully resolved with clinical treatment, and two cases of persistent hypotony (with no visual acuity loss during follow-up), no other vision-threatening complications were observed during the postoperative period. The magnitude of intraocular pressure reduction at 1 month (adjusted to preoperative intraocular pressure; HR=1.01; p=0.002).
CONCLUSION: Our findings suggest that micropulse transscleral cyclophotocoagulation is a relatively effective alternative for managing refractory glaucomas, with minor postoperative complications. In addition, the initial intraocular pressure reduction was a statistically significant predictor of 1-year success in patients undergoing micropulse transscleral cyclophotocoagulation.

Keywords: Intraocular pressure/physiology; Glaucoma, open-angle/surgery; Trabeculectomy; Laser coagulation/methods; Tonometry, ocular/methods; Postoperative complications; Antihypertensive agents/therapeutic use.

PURPOSE: In Brazil, it has traditionally been standard practice to teach a wide range of surgical techniques to all ophthalmology residents, with the aim of equipping them to manage most ocular conditions. However, with modern developments, access to subspecialists has expanded to nearly the entire country. This raises the question of whether it is still necessary to teach numerous surgical techniques to every resident. This study evaluates the effectiveness of surgical training in Brazilian ophthalmology residency programs to determine if comprehensive surgical training for all residents is truly effective, thereby providing evidence to inform educational policy decisions.
METHODS: A cross-sectional study using a questionnaire distributed to physicians engaged in eye care.
RESULTS: A total of 137 physicians responded to the survey, with 104 (76.0%) having already completed their specialization. The findings indicate that most practicing ophthalmologists received surgical training during residency in cataract, glaucoma, oculoplastic, and strabismus surgeries. Nonetheless, many of these specialists no longer perform most of these surgeries in practice, except for cataract surgery. While 53.8% of those who completed residency reported satisfaction with their training, 35.6% indicated that they wished they had received better surgical preparation.
CONCLUSION: The training of ophthalmology specialists must be made more efficient. Training efficiency is reduced when time and resources are devoted to surgical procedures that many specialists will not perform in their careers.

Keywords: Opthalmologists; Teaching; Education, medical; Ophthalmological surgical procedures; Simulation training; Wet lab; Surveys and questionnaires

PURPOSE: To examine how ophthalmological features, screen exposure duration, and break habits among office employees affect ocular surface parameters.
METHODS: This single-center cross-sectional study involved two assessments on the same day: one before and one after a visual display terminal task. During the initial assessment, information on screen use was gathered, and refractive error, anterior segment examination, tear breakup time, and Schirmer test measurements were conducted. Participants tracked their screen usage and break durations throughout the day. At the end of the workday, tear breakup time and Schirmer I tests were repeated. Baseline and follow-up results were compared, and regression analysis was performed to identify factors linked to tear breakup time reduction.
RESULTS: The study enrolled 60 female office employees. Their mean screen time was 269.26 ± 70.21 min, with an average break duration of 151.93 ± 46.24 min. Tear breakup time at the second assessment (6.38 ± 2.70) was significantly lower than at baseline (8.62 ± 2.73) (p<0.001), whereas Schirmer test scores showed no significant change (p>0.05). Tear breakup time reduction was noted in 54 participants (90.0%), with a significant association between tear breakup time decrease percentage and screen exposure (p=0.001, r=0.463). Regression analysis showed that uncorrected or undercorrected refractive error was an independent risk factor for a ≥30% tear breakup time reduction, while taking more frequent short breaks (<15 min) acted as a protective factor.
CONCLUSIONS: Taking more frequent short breaks (<15 min) and correcting refractive errors help prevent intra-day tear breakup time decline during visual display terminal use. Structuring breaks to support tear film stability is advisable for occupations that require regular visual display terminal tasks.

Keywords: Tear film; Screen time; Tear breakup time; Office workers; Protective factors; Lacerations;  Refractive errors; Risk factors.

PURPOSE: Using advanced imaging techniques, this study aimed to evaluate corneal stability, epithelial remodeling, and tear film changes over a one-year period in first-time soft-contact lens wearers.
METHODS: A retrospective study was conducted on 100 eyes of 50 first-time daily soft-contact lens users aged 21–65 years with no prior rigid gas-permeable lens wear. The Sirius Scheimpflug imaging system was used to assess corneal topography, epithelial thickness, and non-invasive tear break-up time at baseline, 3, 6, and 12 months. Corneal warpage was evaluated using symmetry indices and Baiocchi Calossi Versaci indices. We performed statistical analysis using repeated-measures analyses of variance with Greenhouse-Geisser correction.
RESULTS: The mean baseline central corneal thickness was 537.83 (±7.92) µm, with no significant thinning after one year. The average simulated keratometry values remained stable, indicating no progressive corneal steepening or flattening. There were no significant changes in warpage indices over time, suggesting corneal shape preservation. Higher-order aberrations (coma, trefoil, and spherical aberrations) and non-invasive tear break-up time remained unchanged throughout the study period.
CONCLUSIONS: Modern silicone hydrogel soft-contact lenses do not induce significant corneal warpage, epithelial remodeling, or optical aberrations over a one-year period. We found that corneal morphology and tear film stability were preserved, supporting the safety of soft-contact lens use. These findings provide clinically relevant insights into the long-term impact of contact lens wear. They may facilitate improved lens fitting strategies and preoperative refractive surgery assessments.

Keywords: Contact lenses, hydrophilic; Cornea/surgery; Corneal diseases; Corneal topography; Adaptation, ocular/physiology; Endothelium, corneal/pathology; Refractive errors; Tears/metabolism.

PURPOSE: To describe the technique and outcomes of intrastromal autologous blood injection in patients with severe corneal hydrops.
METHODS: Nineteen patients with corneal hydrops underwent intrastromal autologous blood injection. Postoperative assessments included best-corrected visual acuity and time to resolution of corneal edema
RESULTS: Corneal edema resolved within 1 week in 5 patients, within 1 month in 11, and within 3 months in 3. The mean duration of edema persistence was 37.94 ± 33.05 days (range, 6–124). Corneal thickness decreased from 2.06 ± 0.71-mm preoperatively to 1.34 ± 0.65-mm at day 7, 0.85 ± 0.56-mm at day 30, and 0.57 ± 0.13-mm at day 90 (p<0.001). Descemet’s membrane (DM) detachment decreased from 1.01 ± 0.75-mm to 0.44 ± 0.57-mm, 0.24 ± 0.36-mm, and 0.08 ± 0.11-mm on postoperative days 7, 30, and 90, respectively (p<0.001). DM break size decreased from 1.12 ± 1.19-mm to 0.62 ± 0.84-mm at 3 months (p<0.005). Three patients developed hematocornea; no other major complications were observed. At 3 months, mean best-corrected visual acuity improved from 2.37 ± 0.66 to 0.41 ± 0.17 logMAR with hard contact lenses (p<0.001).
CONCLUSIONS: Intrastromal autologous blood injection is an effective treatment for severe corneal hydrops, promoting faster edema resolution and visual improvement with minimal complications.

Keywords: Corneal edema; Corneal diseases; Edema; Visual acuity; keratoconus.

The advantages and disadvantages of using perioperative subconjunctival steroid injections in dropless cataract surgery continue to be debated. A systematic review of PubMed, EMBASE, and the Cochrane Central database identified five studies—two randomized controlled trials and three non-randomized studies—encompassing 70,751 eyes. Among these, 12,319 eyes (17.4%) received subconjunctival steroid injections, while 58,432 eyes (82.6%) were managed with topical steroids. The Cochrane Collaboration’s RoB 2 tool was applied for bias assessments in randomized controlled trials, and heterogeneity was assessed using the I² statistics. No statistically significant differences were found between the two groups regarding macular edema (p=0.249), visual acuity (p=0.73), or laser flare count (p=0.45). Both subconjunctival injections and topical steroids demonstrated comparable efficacy and safety in controlling postoperative inflammation after cataract surgery. Additional research is warranted to validate these conclusions.

Keywords: Cataract extraction; Phacoemulsification; Lens implantation, intraocular; Postoperative care; Intravitreal injections; Anti-inflammatory agents, non-steroidal/administration & dosage; Glucocorticoids; Triamcinolone acetonide; Research design; Randomiz