VOLUME 89 - ISSUE 6

PURPOSE: To compare obstructive sleep apnea screening classifications, anthropometric characteristics, and mechanical behaviors between participants with keratoconus and controls and to explore their associations with disease severity.
METHODS: This prospective cross-sectional study included 74 participants with keratoconus and 49 controls. The paper-based Berlin and STOP-BANG questionnaires were administered face-to-face by a researcher and scored manually. A study-specific questionnaire assessed eye rubbing and sleep position, whereas a separate structured field recorded self-reported ocular compression during sleep. Both groups underwent corneal tomography. The primary logistic regression model included age, sex, body mass index (BMI), eye rubbing, and ocular compression.
RESULTS: Participants with keratoconus had a higher BMI (29.4±6.4 vs. 26.3±5.1 kg/m²; p=0.005), larger neck circumference (40.1±4.6 vs. 37.6±4.6 cm; p=0.004), more frequent eye rubbing (71.6% vs. 51.0%; p=0.020), and more frequent ocular compression (43.2% vs. 20.4%; p=0.009) than controls. High-risk classifications did not differ significantly between groups according to either the Berlin Questionnaire (p=0.206) or STOP-BANG (p=0.139). In exploratory models adjusted for age and sex, positive associations were observed for the Berlin Questionnaire (OR, 2.58; 95% CI, 0.91-7.28) and STOP-BANG (OR, 3.30; 95% CI, 0.83-13.05). In the primary model, younger age (OR, 0.88; 95% CI, 0.83-0.93), male sex (OR, 2.91; 95% CI, 1.14-7.42), and higher BMI (OR, 1.15; 95% CI, 1.05-1.27) remained associated with keratoconus, whereas the estimates for behavioral factors were attenuated. No association with disease severity was detected.
CONCLUSIONS: Participants with keratoconus had higher anthropometric measurements and more frequent mechanical behaviors; however, the prevalence of high-risk obstructive sleep apnea classifications did not differ significantly between groups. Questionnaire-based and anthropometric findings are not independent because BMI contributes to both screening instruments, whereas neck circumference contributes to the STOP-BANG score. Ocular compression was assessed using a nonvalidated self-report measure rather than objective pressure measurements. Severity analyses were underpowered, and causality cannot be inferred from the study design.

Keywords: Keratoconus; Sleep apnea, obstructive; Risk factors; Body mass index; Sleep; Logistic models; Patient acuity; Tomography; Surveys and questionnaires

PURPOSE: To characterize conjunctiva-scleral thickness over the Ahmed glaucoma valve tube in eyes clinically considered to be at increased risk of tube exposure based on a superficially positioned tube on anterior segment optical coherence tomography, and to explore the association between post-operative follow-up duration and conjunctiva-scleral thickness.
METHODS: This retrospective study included 22 eyes of 21 patients with 23 Ahmed glaucoma valve tubes. One patient contributed both eyes, and another had two Ahmed glaucoma valve tubes in one eye. All eyes had a minimum post-operative follow-up of 6 months and a clinically apparent superficial tube trace on slit-lamp examination. Over-the-tube conjunctiva-scleral thickness and total conjunctiva-scleral thickness were measured at corresponding locations using anterior segment optical coherence tomography. Associations between conjunctiva-scleral thickness measurements and post-operative follow-up duration were evaluated using correlation analysis and generalized estimating equation models to account for clustering.
RESULTS: The mean age was 56 ± 12 years (range, 38–80 years). Best-corrected visual acuity was 1.00 (range, 0.10–3.00) LogMAR, and intraocular pressure was 16 (range, 7–27)mmHg. The median post-operative follow-up duration was 40 months (range, 6–135 months), and the median CST overlying the tube at its most superficial location was 190 μm (range, 54–552 μm). A modest inverse correlation was observed between post-operative follow-up duration and conjunctiva-scleral thickness overlying the tube (ρ=−0.44, p=0.034). generalized estimating equation analysis showed a similar association (p=0.019). However, when eyes were categorized according to post-operative follow-up duration (≤1 year, 1–5 years, and ≥5 years), no statistically significant differences in conjunctiva-scleral thickness measurements were detected were observed among the groups: 273 (79–552), 190 (54–402), and 119 (64–227) μm, respectively (p=0.087).
CONCLUSION: In this preselected high-risk cohort, a modest inverse correlation was observed between post-operative follow-up duration and conjunctiva-scleral thickness overlying the tube; however, this association was not consistently demonstrated across analytical approaches and should therefore be considered exploratory. Anterior segment optical coherence tomography allows objective characterization of tissue coverage over the Ahmed glaucoma valve tube. Further prospective studies with larger cohorts and appropriate control groups are warranted to determine the clinical significance of these findings.

Keywords: Glaucoma; Ahmed glaucoma valve; Intraocular pressure; Anterior segment; Optical coherence tomography; Conjunctiva; Scleral thickness

This narrative review summarizes the pathophysiology, diagnosis, and management of neovascular glaucoma and provides a comprehensive guide for clinical ophthalmologists. An iterative snowballing approach, together with targeted searches of PubMed/MEDLINE, Embase, and the Cochrane Library, identified 81 studies addressing key aspects of neovascular glaucoma, including molecular mechanisms, advanced diagnostic modalities, and surgical strategies. Neovascular glaucoma is an aggressive form of secondary glaucoma driven by ischemia-induced upregulation of vascular endothelial growth factor and angiopoietin-2 through the hypoxia-inducible factor-1α pathway. Diagnosis is primarily based on clinical findings and is increasingly supported by advanced imaging techniques. Management requires a multimodal approach combining panretinal photocoagulation and anti-vascular endothelial growth factor therapy with intraocular pressure-lowering interventions, including glaucoma drainage devices, micropulse transscleral cyclophotocoagulation, and slow-coagulation transscleral cyclophotocoagulation. Glaucoma drainage devices achieve the greatest intraocular pressure reduction, whereas micropulse transscleral cyclophotocoagulation offers the most favorable safety profile. Slow-coagulation transscleral cyclophotocoagulation represents an intermediate option, with a reported success rate of 71.7% and favorable safety outcomes. Emerging therapies aim to provide sustained angiogenic control while targeting fibrosis and neuroprotection.

Keywords: Glaucoma, neovascular/diagnosis; Glaucoma, neovascular/physiopathology; Glaucoma neovascular/drug therapy; Glaucoma drainage implants; Angiogenesis inhibitors/therapeutic use; Vascular endothelial growth factor A; Light coagulation; Neuroprotection; Revie

PURPOSE: To compare standard single-step transepithelial photorefractive keratectomy, planned using a population-derived epithelial thickness profile, with MS-39 epithelial thickness map-guided single-step transepithelial photorefractive keratectomy in eyes with regular corneas, with a focus on early epithelial healing and short-term visual and refractive outcomes.
METHODS: This prospective, randomized, patient-masked, contralateral-eye clinical trial included 15 patients (30 eyes) with stable myopia, with or without regular astigmatism. Each patient underwent standard transepithelial photorefractive keratectomy in one eye and MS-39 epithelial map-guided transepithelial photorefractive keratectomy in the fellow eye using the same excimer laser platform and single-step transepithelial workflow. Early postoperative outcomes included pain scores and epithelial-defect area on postoperative day 2 and complete reepithelialization on day 7. Visual and refractive outcomes included uncorrected distance visual acuity at 30 and 90 days, corrected distance visual acuity at 90 days, residual spherical equivalent, and residual cylinder magnitude at 90 days. Paired analyses were performed.
RESULTS: All patients completed the 90-day follow-up. Early postoperative recovery did not differ significantly between groups. On day 2, the mean pain score was 2.33±0.82 in guided eyes and 2.40±0.63 in standard eyes, whereas the mean epithelial-defect area was 3.75±5.34 and 2.78±2.86 mm², respectively. Complete reepithelialization by ay 7 occurred in all eyes. At 90 days, mean uncorrected distance visual acuity was −0.080±0.056 logMAR in guided eyes and −0.073±0.046 logMAR in standard eyes (p=0.564). Mean residual spherical equivalent was −0.03±0.35 D and 0.00±0.41 D, respectively (p=0.831). A total of 93.3% of guided eyes and 86.7% of standard eyes were within ±0.50 D of plano, and all eyes were within ±1.00 D.
CONCLUSIONS: In this randomized contralateral-eye pilot study, MS-39 epithelial map-guided single-step transepithelial photorefractive keratectomy did not demonstrate a statistically detectable short-term clinical advantage over standard population-based planning in eyes with regular corneas. Because the study was not designed as an equivalence or noninferiority trial, these findings should not be interpreted as evidence of equivalence.

Keywords: Photorefractive keratectomy/methods; Cornea/physiopathology; Corneal epithelium/surgery; Myopia/surgery; Astigmatism/surgery; Corneal topography; Refraction, ocular/physiology

PURPOSE: This study aimed to compare retinal, choroidal, and optic disc vascular density parameters before infection and at 6 months and 5 years after infection in individuals with a history of coronavirus disease 2019 (COVID-19) using optical coherence tomography angiography.
METHODS: A total of 17 eyes from 17 healthcare workers were included in this study. Retinal, choroidal, and optic disc vascular parameters were evaluated using optical coherence tomography angiography before infection and at 6 months and 5 years after infection. The Friedman test and Wilcoxon signed-rank test with Bonferroni correction were used for statistical analysis.
RESULTS: The foveal avascular zone area was significantly larger at 5 years after infection than at 6 months after infection (p=0.002). Inner retinal parafoveal (p=0.022) and perifoveal (p=0.012) thicknesses were significantly lower at 5 years after infection than before infection. Total optic disc vascular density was significantly lower at 5 years after infection than at 6 months after infection (p=0.005). Furthermore, intraoptic disc vascular density was significantly lower at 5 years after infection than before infection (p=0.009).
CONCLUSION: Microvascular impairment following COVID-19 may persist over the long term. COVID-19 may also have lasting effects on retinal and optic nerve head microcirculation beyond the acute phase of infection. Larger prospective studies with longer follow-up periods are warranted to clarify the clinical significance of these alterations and their potential impact on visual function.

Keywords: COVID-19; Coronavirus disease; Microcirculation; Microvascular density; Optic disk; Tomography, optical coherence;  Angiography; Health personnel

PURPOSE: To compare surgical outcomes and patient tolerability between conventional knotted fixation and a novel technique using cyanoacrylate gel glue to secure the silicone stent during external dacryocystorhinostomy.
METHODS: This retrospective study included 70 patients who underwent external dacryocystorhinostomy, of whom 40 received cyanoacrylate glue fixation (study group) and 30 underwent conventional knotted fixation (control group). Patients with congenital or acquired lacrimal obstruction and a minimum follow-up period of 6 months were included. All procedures were performed by the same surgeon at a single institution. Patient tolerability, including foreign body sensation, sneezing, and nasal secretion, and surgical complications, including glue-induced toxicity, infection, stent extrusion, mobilization, release, and pyogenic granuloma, were assessed. Data were analyzed using descriptive statistics and nonparametric tests.
RESULTS: The median patient age was 69.0 years (range, 3–90 years), and most patients were women (81.4%, n=57). There were no significant differences between the groups in age (p=0.264) or sex (p=0.213). Symptoms were reported by 34.3% of patients and were significantly more frequent in the control group than in the study group (33.3% vs. 10.0%, p<0.001). Foreign body sensation (p=0.002), sneezing (p=0.012), and nasal secretion (p<0.001) were all significantly more common in the control group. Overall, complications were infrequent, with no significant between-group differences in stent release (17.5% vs. 20.0%, p=0.790), mobilization (5.0% vs. 16.7%, p=0.130), or infection (2.9% vs. 0%, p=0.503). No cases of glue-induced toxicity were observed. Follow-up duration did not differ significantly between the groups.
CONCLUSIONS: Cyanoacrylate fixation was associated with favorable patient tolerability and no increase in complication rates compared with conventional knotted fixation. These findings suggest that cyanoacrylate glue may be a safe and well-tolerated alternative for silicone stent fixation during external dacryocystorhinostomy.

Keywords: Dacryocystorhinostomy/methods; Lacrimal duct obstruction; Nasolacrimal duct/surgery; Intubation; Cyanoacrylates; Adhesives; Stent; Silicones; Comparative study