Ophthalmology Clinic

Introduction To examine the current landscape of artificial intelligence (AI) applications in vitreoretinal (VR) diseases and surgery, with the aim of identifying knowledge gaps and guiding future directions in this rapidly evolving field.Methods Systematic review including original studies involving the use of AI and focusing on VR pathologies. A comprehensive electronic search of the literature was carried out in multiple databases.Results Thirty-seven studies were included. Most evaluated machine learning or deep learning models for preoperative prognostication using optical coherence tomography with or without clinical variables. Predictive performance for postoperative best-corrected visual acuity (BCVA) was high in several cohorts (R2 up to 0.80; area under the receiver operating characteristic curve [AUROC] > 0.95), with models consistently highlighting outer retinal biomarkers as key determinants of visual recovery after epiretinal membrane and macular hole surgery. For anatomical outcomes, deep learning models frequently achieved > 90% accuracy in predicting macular hole closure and retinal reattachment/reattachment-related endpoints. Intraoperative computer-vision systems demonstrated feasibility for real-time instrument detection and tracking, reporting precision above 90% in experimental or early clinical settings. Large language models showed moderate-to-high agreement with expert surgical planning (80-93%) and potential utility in education and workflow support; however, across domains, most studies were retrospective and single-center, with limited external validation.Conclusions AI may transform vitreoretinal surgery, from outcome prediction to intraoperative guidance and workflow support. Despite strong performance in research settings, broader clinical adoption requires prospective validation to ensure reliability, transparency, and real-world benefit.This study looked at how artificial intelligence (AI) is being used in diseases and surgeries of the back part of the eye, known as the vitreoretinal (VR) area. We reviewed studies that used AI to help predict surgical outcomes, guide surgery, or improve efficiency in eye care, and found that AI models could accurately predict how well patients would see after surgery and whether the retina would heal properly. Some systems could even track surgical tools in real time, helping surgeons during operations. AI chatbots also showed promise in supporting doctors with planning and education. However, most studies were based on past data and small samples, meaning these tools are not yet ready for everyday use. Future research needs to test AI in real-world settings to make sure it is accurate, safe, and truly helpful for both patients and eye surgeons.

BackgroundSelf-management is essential for coping with depressive symptoms, yet little is known about its associations with depressive symptoms and personal recovery.MethodsWe conducted a cross-sectional questionnaire survey of 183 outpatients with major depressive disorder in Japan between October 2024 and June 2025. Participants reported the use and perceived usefulness of 63 self-management strategies. Associations between the number of strategies and symptom severity and recovery were examined using Spearman’s rank correlation coefficients with the Japanese versions of the Quick Inventory of Depressive Symptomatology (QIDS-J) and the Questionnaire about the Process of Recovery (QPR-J).ResultsOf the 183 respondents (mean age 43.6 ± 12.4 years; 54.1% female), the mean QIDS-J score was 9.55 ± 5.25 and 60.7% were in remission. Fourteen of the 63 strategies were used by at least half of the participants. The most frequently used strategies were “ensure enough rest to avoid exhaustion through overexertion” (88.0%), “engage in leisure activities (e.g. reading, watching TV, cooking, traveling, and driving)” (78.9%), and “eat a healthy diet” (65.0%). The strategies rated most useful included “discuss information about depression with a therapist” (86.7%), “meet with friends with whom I can be myself” (83.5%), and “avoid or minimize contact with people who tend to make me stressed or depressed” (83.3%). Participants reported using an average of 20.8 ± 13.5 strategies, of which 13.1 ± 9.16 were rated as useful. The number of strategies rated as useful was weakly negatively correlated with the QIDS-J scores (Spearman’s ρ = −0.207, p = 0.006) and moderately positively correlated with the QPR-J scores (Spearman’s ρ = 0.472, p < 0.001).ConclusionThe number of self-management strategies rated as useful showed a stronger correlation with personal recovery than with depressive symptom severity. The use of a greater number of self-management strategies may be associated with higher levels of personal recovery.

Introduction This study reports the 1-year efficacy of aflibercept 8 mg (afl8) in a real-world cohort of treatment-naïve patients with neovascular age-related macular degeneration (nAMD).Methods An observational, retrospective case series from nine centers of the Swiss Retina Research Network including treatment-naïve eyes with nAMD started on intravitreal afl8. Changes in visual acuity (VA), macular thickness, pigment epithelial detachment (PED) height, and retinal fluids were evaluated over 12 months and compared with baseline. Treatment intervals and safety data were recorded along with subgroup analyses based on macular neovascularization type, loading-phase completion, and treatment regimen.Results A total of 91 eyes met the inclusion criteria. After 1 year of treatment, VA changed by + 1.0 ± 13.2 letters (p = 0.018), mean CST changed by -110.0 ± 130.9 µm (p &lt; 0.001), and mean PED height changed by -71.2 ± 104.8 µm (p &lt; 0.001). After 12 months, 66.2% of eyes demonstrated a complete absence of macular fluids. Mean treatment interval was 13.9 ± 7.9 weeks, with 56.1% of eyes being extended to ≥ 12 weeks with an anatomy-driven approach. No functional or anatomical differences were observed between eyes receiving a clean loading phase and in terms of different macular neovascularization (MNV) subtypes. Two adverse events were observed.Conclusions The first 1-year real-world experience with afl8 in patients with nAMD revealed a robust anatomical response but only a variable and limited visual gain over 12 months due to a ceiling effect. Our findings confirm the fast and sustained macular drying reported from clinical trials, allowing for extended treatment intervals without compromising safety and efficacy.

The corneal epithelium, a stratified squamous non-keratinized layer of 50-60μm thickness, forms the outermost barrier of the cornea and provides both optical clarity and protection against trauma, infection, and fluid imbalance. It plays a vital role in protecting the eye and maintaining visual clarity. A range of conditions, including trauma, metabolic disorders, microbial infection, and limbal stem cell deficiency, can lead to chronic corneal epithelial defects and subsequent visual impairment. Epithelial renewal is a continuous process, primarily sustained by stem cells located at the limbus. These stem cells give rise to transient amplifying cells, which migrate centripetally and superficially to maintain epithelial integrity. Wound healing follows a highly regulated sequence, superficial cells slide to cover the defect, basal cells proliferate, and corneal nerves realign to support epithelial stratification. This process is orchestrated by cytoskeletal remodeling, integrin-matrix interactions, and growth factor signaling. The epithelium relies on glucose from the corneal stroma, primarily metabolized through glycolysis, while mitochondrial oxidative phosphorylation generates the ATP required for repair. Thus, epithelial regeneration is closely tied to cellular energy availability. Enhancing this process involves supporting mitochondrial function, metabolic signaling pathways, and stem cell activity. Emerging strategies in regenerative ophthalmology include NAD+ replenishment, activation of AMP-activated protein kinase (AMPK), application of growth factors, targeted nanotherapies, and photobiomodulation. This chapter explores these cutting-edge approaches aimed at promoting energy-driven regeneration of the corneal surface.

Hypophosphatemic osteomalacia is a rare metabolic bone disease in adults, most commonly caused by acquired conditions. Clinically, it may present with widespread musculoskeletal pain, proximal muscle weakness, and gait disturbance, often mimicking rheumatologic disorders. Tenofovir disoproxil fumarate, a widely used nucleotide reverse transcriptase inhibitor in the treatment of human immunodeficiency virus infection, may rarely cause hypophosphatemia and osteomalacia due to proximal renal tubular dysfunction.We report a 33-year-old male patient who presented with progressively worsening diffuse bone and muscle pain, proximal muscle weakness, and difficulty walking over one year and was diagnosed with tenofovir-associated hypophosphatemic osteomalacia. Laboratory evaluation revealed marked hypophosphatemia, phosphaturia, and elevated alkaline phosphatase and parathyroid hormone levels. After discontinuation of tenofovir and initiation of phosphate and active vitamin D supplementation, both clinical symptoms and laboratory abnormalities improved significantly.This case highlights hypophosphatemic osteomalacia as a potentially overlooked complication of tenofovir therapy.

Persistent central serous chorioretinopathy (CSC) is acomplex macular disease that if left untreated can lead to deterioration of visual acuity and impairment of the quality of life. A treatment of choice is photodynamic therapy (PDT), which in studies has been shown to achieve stable functional and morphological results with ashort follow-up period. As there are only few studies on the long-term evolution after PDT, this study aims to evaluate the long-term functional and morphological outcomes after PDT. In this multicenter retrospective cohort analysis, patients with persistent CSC treated with PDT during 2004-2020 were analyzed over afollow-up period of at least 4 years after PDT. In addition to the clinical examination, the results of multimodal imaging techniques such as optical coherence tomography (OCT), OCT angiography, fundus autofluorescence and fluorescein angiography were analyzed. Atotal of 33eyes of 31patients were analyzed over amean follow-up period of 7.3 ± 3.6years (4-19years) after PDT. During the observation period astable mean visual acuity of 0.41 ± 0.29 logMAR before PDT and 0.39 ± 0.38 logMAR at the last follow-up was observed. The subfoveal subretinal fluid (SRF) decreased significantly from amean of 153 ± 90 µm (median 137 µm) before PDT to 24 ± 61 µm (median 0 µm) at the last follow-up. Of the 33eyes 23showed no evidence of SRF at the last OCT examination. Five eyes developed new choroidal neovascularization during the course of the study, which was treated with intravitreal injections. In atotal of nine eyes newly occurring atrophy of the retinal pigment epithelium was detected at the last follow-up. In the present study apredominantly stable functional and improved anatomical outcome after PDT was observed over along observation period of more than 7 years. Further prospective long-term studies with ahigh level of evidence are required for a better assessment of the safety and functionality of PDT.

Background:Aberrant anterior tibial artery (AATA) is an uncommon variation of the anterior tibial artery. It is an important vascular variation that increases the risk of vascular complications in some knee surgeries (high tibial osteotomy, posterior cruciate ligament reconstruction, etc).Hypothesis:The anatomic and morphometric features of AATA remain unclear. The authors hypothesize that the posterior femoral morphology and popliteus muscle-related features may be associated with the presence of AATA.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Between December 2022 and December 2024, knee magnetic resonance imaging (MRIs) were analyzed to detect AATA. Images in which image analysis was not optimal due to artifacts, images of patients with previous surgery around the knee, and patients with vascular malformations in the lower extremity were excluded. A control group was formed through computer-assisted randomization, comprising an equal number of men and women with AATA as patients. The condylar twist angle, posterior condylar angle (PCA), posterior tibiofemoral angle, popliteus sulcus depth (PSD), and PSD/lateral condylar width (LCW) parameters were measured on the MRIs of all patients and recorded for each patient. Patients with AATA variation were scanned for the presence of MRI of the opposite knee outside the time interval determined for the study, and it was analyzed whether patients with opposite knee MRIs had bilateral AATA.Results:After applying the inclusion and exclusion criteria, 4075 knee MRIs were analyzed. A total of 78 AATA variations were detected, with a prevalence of 1.91%. The prevalence of AATA was 2.04% in women and 1.78% in men. The PCA was statistically higher in patients with AATA compared with the control group (P < .005). PSD and PSD/LCW were found to be lower in patients with AATA compared with the control group (P = .012, P = .05). The prevalence of bilateral AATA in patients with AATA variation was 48.5%.Conclusion:The prevalence of AATA was found to be 1.91%. High PCA, low PSD, and PSD/LCW are radiologic parameters associated with AATA variation. Both the popliteus musculature and posterior femoral morphometry are related to the occurrence of AATA variation.