PurposeTo present the outcomes of a randomised clinical trial for the treatment of progressive keratoconus using different kinds of riboflavin and the addition of sterile water in thin corneae.MethodsA randomised study using epithelium‐off corneal cross‐linking (CXL) with continuous UVA irradiance 9 mW/cm2 for 10 min (total fluence 5.4 J/cm2) and two kinds of riboflavin solutions: (i) isoosmolar dextran‐based riboflavin (n = 27) and (ii) hypoosmolar dextran‐free riboflavin (n = 27) for the treatment of progressive keratoconus. Visual acuity (corrected and uncorrected), tomographic parameters and endothelial cell count were obtained at baseline and after 1 year. Corneae thinner than 400 μm were also included. A safety limit of 400 μm was used, and sterile water was added if the corneae fell short of this limit during the treatment. Primary outcome: Change in Kmax.ResultsThere were no statistically significant differences in any of the parameters between the isoosmolar and hypoosmolar groups. In the isoosmolar group, 74% of the patients required the addition of sterile water, while only 15% required it in the hypoosmolar group. The measurements of densitometry in the 0–2 mm zone improved less in the group that received sterile water; otherwise, there were no statistically significant differences in any of the parameters between the groups that did and did not receive the addition of sterile water.ConclusionsThe results of this study demonstrate the efficacy and safety in using hypoosmolar riboflavin when performing CXL for progressive keratoconus. The results also demonstrate the efficacy and safety of using sterile water in corneae thinner than 400 μm.

PurposeTo report long‐term outcomes and to search for immunological and genetic risk factors in Terrien marginal degeneration (TMD).MethodsRetrospective, in part prospective, hospital‐based longitudinal follow‐up study of 32 eyes of 16 Finnish patients from 2012 to 2023. Median follow‐up was 7.3 years (range, 0.3–15.2). Symptoms, best corrected visual acuity, pattern in axial power map, astigmatism, corneal thickness, higher order irregularity, cavities, progression and human leukocyte antigen genes were analysed. In 13 blood samples, 483 corneal and inflammatory disease‐related genes were analysed with exome sequencing.ResultsThe median age at first examination was 61 years (range, 13–89). Eleven (69%) patients were male, and 13 (81%) had bilateral disease. The median annual rate of progression of topographic astigmatism and new thinning was 0.03 D (range, −1.50 to 3.60) and 12.9 μm (range, −107.8 to 93.0), respectively; 0.15 D (range −1.50 to 1.17) and 21.6 μm (range, 1.3–93.0) in 6 (38%) patients with fast progression, and 0.02 D (range, −0.06 to 3.60) and 4.1 μm (range, −107.8 to 24.7) in 10 (72%) patients with slow progression. Topographic pattern, unilaterality, cavities, sectoral hyperaemia, poor response to medical treatment and new thinning after surgery were associated with fast progression. Thickness at maximal thinning fell below 450 μm only with fast progression. Five eyes changed the topographic pattern. Coexisting keratitis fugax hereditaria was found in one patient.ConclusionsA subtype of TMD progresses faster. The most sensitive indicators of progression were thinning and topographic astigmatism. No shared genetic cause for TMD was identified.

PurposeAcanthamoeba keratitis (AK) is a severe corneal infection with potential detrimental effects on visual outcome and quality of life, primarily affecting young contact lens wearers. We report Acanthamoeba genotypes, subtypes and clinical outcome from Danish patients with AK.MethodsThirty‐nine PCR‐positive AK cases diagnosed and treated at Aarhus University Hospital, Denmark, from 2002 to 2022 were included. Corneal samples underwent next‐generation sequencing (NGS) for Acanthamoeba genotyping. These data were compared with clinical data and results from PCR.ResultsAcanthamoebaT4 was the most frequent genotype (n = 35), with four subtypes identified (T4A, T4B, T4D and T4G); three cases of the T3 genotype were observed. Three samples showed evidence of two distinct Acanthamoeba sequences. The median patient age was 35 years, genders were equally represented and the median time from symptom onset to diagnosis was 26 days. Ninety per cent had identifiable risk factors in addition to contact lens wear. Corticosteroid treatment prior to AK diagnosis, moderate‐to‐severe pain, male gender, older age, ring infiltration and infiltrate size >3 mm were associated with poor visual outcome. No significant correlation was found between Acanthamoeba genotype or subtype and clinical outcomes.ConclusionWe reveal the genetic diversity of Acanthamoeba involved in AK in Denmark. However, genotype or subtype did not predict clinical outcome. Further research is needed to clarify the role of specific genotypes and subtypes in disease progression and treatment response.

PurposeTo examine the association between the presence of dry eye disease (DED) symptoms when using BAK‐preserved artificial tears (AT) compared to preservative‐free AT.MethodsIn this cross‐sectional study, we used data collected as part of Project ‘Finding Ophthalmic Risk and Evaluating the Value of Eye exams and their predictive Reliability’ (FOREVER). To analyse the strength and direction of associations, we used binomial logistic regression models adjusted for age, sex, smoking and eye diseases. The analysis was conducted on responses regarding AT formulations and seven distinct DED symptoms from 67 951 participants in Project FOREVER, including 8039 AT users.ResultsOur analysis showed statistically significant higher odds ratios (ORs) of experiencing itching and blurred vision among users of BAK‐preserved AT compared to preservative‐free AT users, with ORs of 1.26 (95% CI 1.01–1.58) and 1.28 (95% CI 1.02–1.60), respectively. Additionally, a borderline significant trend indicated an increased number of DED symptoms in the BAK‐preserved AT group compared to preservative‐free AT users. Furthermore, our study provided a comprehensive overview of AT usage patterns within the cohort, illustrating the proportion of users for each type of AT.ConclusionOur findings suggest that BAK‐preserved AT may worsen DED symptoms. We found higher ORs for experiencing itching and blurred vision as well as a tendency towards experiencing a higher number of symptoms when using BAK‐preserved AT compared to preservative‐free AT. Further longitudinal studies with additional questions on AT usage and clinical assessments are needed to validate these findings and optimize AT formulations for safer, effective DED management.

PurposeTo identify the treatment characteristics and outcomes that Dutch patients with large or juxtapapillary choroidal melanoma consider important when choosing between enucleation and proton beam therapy (PBT). We further determined to what extent these treatment characteristics and outcomes are discussed with newly diagnosed choroidal melanoma patients.MethodsThrough a literature search, stakeholder interviews and feedback from patients, we identified 15 treatment characteristics and outcomes that patients might consider important for deciding between enucleation and PBT. Using a ranking survey, we selected the seven most important characteristics. Next, we conducted a Swing Weighting (SW) survey among treated and newly diagnosed large or juxtapapillary choroidal melanoma patients to determine the relative weight patients assign to these characteristics for treatment decision‐making. Furthermore, we assessed which characteristics and outcomes are discussed in current practice with newly diagnosed choroidal melanoma patients eligible for both enucleation and PBT using audio recordings of consultations.ResultsOne hundred sixty‐five participants completed the SW survey. The patients found the risk of tumour recurrence and eye loss most important. These were mentioned in 47% and 42% of the 110 audio‐recorded consultations, respectively. The two most‐often mentioned characteristics were treatment course (96%) and decrease in visual acuity (85%).ConclusionTumour local control and eye preservation matter the most to newly diagnosed choroidal melanoma patients when facing a treatment decision. However, ocular oncologists do not routinely provide this information to patients. The results can be used to align counselling of newly diagnosed patients with choroidal melanoma with what matters most to patients.

PurposeThis study evaluates the effectiveness and safety of multiple PDT sessions for cases of persistent and recurrent subretinal fluid (SRF) in chronic central serous chorioretinopathy (CSC).MethodsThis multicentre, retrospective cohort study included patients aged ≥18 years with chronic CSC who received at least two sessions of PDT at Amsterdam University Medical Center or Leiden University Medical Center between August 2009 and February 2025. Outcomes included the resolution of SRF, changes in visual acuity (VA), subfoveal choroidal thickness (SFCT) and continuity of the external limiting membrane (ELM) and ellipsoid zone (EZ).ResultsThe study included 88 patients with chronic CSC, of whom 88.6% were male. Of the 105 eyes treated, 62.5% had persistent SRF after the first PDT, while 37.5% achieved complete SRF resolution. After the second PDT, SRF resolved completely in 62.8% of eyes overall, with 53.1% in the persistent SRF group and 64.1% in the recurrent SRF group. Following the third PDT, 67.7% of patients showed complete SRF resolution. VA improved by 3 ± 2 letters (p = 0.033) above baseline after the second PDT, with the recurrent SRF group showing greater improvements. SFCT was lower than baseline after PDT treatments in both groups. ELM and EZ continuity also generally showed improvements on optical coherence tomography, particularly in the recurrent SRF group, suggesting retinal integrity restoration rather than atrophic changes.ConclusionRepeated PDT is an effective and safe treatment for both persistent and recurrent chronic CSC, with improvements in SRF, VA, SFCT and retinal layer continuity.

Ellipsoid tumour models are used to approximate the tumour volume of uveal melanomas, as the conventionally used ultrasound does not provide a three-dimensional visualization of the tumour. However, these models are a simplification of the actual tumour geometry. The aim of this study was to determine to what extent several of these frequently used ellipsoid tumour models accurately describe uveal melanoma volume. Tumours were delineated on contrast-enhanced T1-weighted MRI for 70 uveal melanoma patients. The MRI-delineated volume was compared with three ellipsoid models, which used two-dimensional measurements such as thickness and basal diameters as input: half ellipsoids with round (Vroundbase) or oval base (Vovalbase) and a paraboloid consisting of two parts, also incorporating the curvature of the eye wall (Vtwoparts). Statistically significant relative differences between MRI-delineated and model volume of 53 ± 32% (Vroundbase), 26 ± 24% (Vovalbase) and 15 ± 24% (Vtwoparts) were observed (p < 0.001). Tumour volume and shape did not influence the difference between the model volumes and MRI-delineated tumour volume. All tumour models result in considerable systematic overestimations of tumour volume, with large variations in overestimation between patients. Adding the perpendicular basal diameter to the model decreases this variation. Although ellipsoid tumour models have been shown to be valuable on a group level, they should be used with caution for individual patients.

To design a vergence-based lens power formula based on the classical Haigis formula for better outcomes while retaining the original formula architecture. Four new formula variants (A-D) incorporating a sum of segments correction for axial length, harmonic mean of corneal radii instead of arithmetic mean (all variants), and differing combinations of lower keratometer index (C, D) and an additional term (a3) representing the lens thickness in the effective lens position (B, D) were assessed in an analysis based on four datasets of IOLMaster 700 biometric data for eyes treated with the Hoya Vivinex lens (dataset 1), Alcon SA60AT lens (2), Johnson & Johnson ZCB00 lens (3), and the Bausch & Lomb MX60 lens (4). All parameters (formula constants and keratometer index) were calculated by nonlinear iterative optimisation techniques for minimising the root mean squared prediction error (RMSPE). Performance was assessed in terms of the final RMSPE. All four variants showed reductions in RMSPE ranging from 2.8% to 12.6% over the original Haigis formula. For each of the four datasets, variants B and D (with the additional a3 constant) performed better in this respect than variants A and C. In all four cases, variants C and D (with the adjusted keratometer index) performed slightly better than A and B, respectively. Although not amenable to statistical analysis, the % improvements in RMSPE would appear to be clinically relevant. However, the benefit has to be proven in a prospective multicentric study with a large sample size.