Marcos Pereira de Ávila

Précis: In this randomized multicenter trial, both TRAB and CPC lowered IOP at 12 months as primary glaucoma surgeries, with TRAB yielding lower final IOP with fewer medications, while both procedures demonstrated meaningful clinical effectiveness. Purpose: To compare the efficacy and safety of trabeculectomy (TRAB) and slow-burn transscleral cyclophotocoagulation (CPC) as primary surgical treatments for glaucoma. Methods: Prospective, randomized, multicenter trial including one eye per patient from July 2020 to July 2023, with 12-month follow-up. Participants were allocated to TRAB (GI) or CPC (GII). The primary endpoint was surgical success at 12 months, defined by intraocular pressure (IOP) between 6 and 18 mm Hg without non-protocol glaucoma surgery or serious complications. Results: Eighty-six eyes were included; nine were excluded (four in GI; five in GII). Baseline demographics were similar between groups. Both significantly reduced IOP at 12 months (GI: 22.97±8.23 mm Hg to 10.14±2.89 mm Hg; GII: 23.47±6.34 mm Hg to 14.58±3.66 mm Hg; P P P =0.007). Final IOP between 6 and 18 mm Hg was reached by 97.1% of GI and 90.9% of GII ( P =0.708). Qualified success rates were high and comparable (GI: 97.4%; GII: 86.8%; P =0.08), while complications were infrequent (four in GI; one in GII; P =0.3). Quality of life improved after TRAB (EQ-5D: 0.71±0.19 to 0.78±0.14; P =0.031) but remained unchanged after CPC ( P =0.424). Conclusions: Both procedures reduced IOP at 12 months as primary glaucoma surgeries. TRAB achieved lower final IOP, required fewer medications, and was associated with improved quality of life, whereas CPC required more adjunctive medication and retreatment in some eyes.

Background: To systematically review the diagnostic accuracy and inter-test agreement of optical coherence tomography (OCT) for detecting posterior vitreous detachment (PVD) in blinded, within-subject studies that use different reference standards. Methods: This systematic review followed PRISMA guidelines and was registered in PROSPERO (CRD42024580929). PubMed, Scopus, Embase, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Database were searched from inception through March 2025. Eligible studies were English-language diagnostic accuracy studies evaluating PVD using blinded, within-subject designs, in which any OCT modality served as the index test and was compared with either a non-OCT reference standard or an alternative OCT protocol that differed in modality, scan protocol, diagnostic criteria, or grader type. Index and reference tests were performed on the same eyes within 24 h. Results: Five studies (812 patients, 922 eyes) met the inclusion criteria; three evaluated diagnostic performance and two assessed inter-grader agreement. All studies used spectral-domain OCT (SD-OCT). Diagnostic performance varied substantially by imaging protocol and reference standard. High-density imaging protocols that included both the macula and optic nerve head achieved a sensitivity of 96.4%, a specificity of 87.5%, and substantial agreement (κ = 0.84) compared with composite clinical examination. In contrast, sparse macular-only protocols showed poor agreement (κ = 0.14) and markedly lower sensitivity compared with clinical or surgical reference standards. In two inter-grader studies with markedly different designs and populations, high agreement was observed between reader types under the specific imaging conditions evaluated; these findings should not be extrapolated beyond those contexts. Two studies were judged to be at low risk of bias, whereas three were judged to be at high risk of bias due to unclear masking procedures. Conclusion: The diagnostic performance of SD-OCT for PVD is strongly influenced by scan density, field coverage, and the reference standard used for comparison. In the single study using a high-density, wide-field protocol, diagnostic accuracy was excellent, whereas sparse macular-only acquisitions may fail to detect residual vitreoretinal adhesions. Although inter-grader agreement was generally high, the available evidence remains limited and heterogeneous. Further studies using standardized diagnostic criteria and contemporary swept-source OCT platforms are warranted.

Purpose: To determine the influence of strabismus and its surgical correction on the preoperative and postoperative functional and psychosocial aspects of patients being treated at the CEROF/UFG Strabismus Outpatient Clinic. Methods: This prospective cross-sectional study included 27 patients, aged >7 years that were divided into two groups (18 years). The AS 20 questionnaire is composed of two domains (psychosocial and functional). Each domain includes 10 questions, which should be answered using a 5-point Likert scale. The questionnaire was administered preoperatively and 3 months postoperatively. In patients aged <18 years, the questionnaire was concurrently administered to their parents and/or guardians. Results: Preoperatively, the average psychosocial and functional scores were 55 (p=0.01) and 57.5 (p=0.025), respectively, in adults, 70 (p=0.03) and 78.7 (p=0.16), respectively, in children and adolescents, and 46.2 (p=0.002) and 57.5 (p=0.003), respectively, in the parents and/or guardians. Postoperatively, the average psychosocial and functional scores were 80 (p=0.01) and 82.5 (p=0.025), respectively, in adults, 81.2 (p=0.03) and 85 (p=0.16), respectively, in children and adolescents, and 83.7 (p=0.002) and 86.2 (p=0.003), respectively, in parents and/or guardians. Conclusion: The postoperative scores in the psychosocial (p=0.001), functional (p=0.001) and general (p<0.001) domains had increased in all the patients, demonstrating an improvement in the quality of life following strabismus correction surgery.

Purpose: Compare 12-month (12 M) safety and efficacy of endoscopic cyclophotocoagulation (ECP) + cataract surgery (Group 1) versus ECP + cataract surgery + iStent inject trabecular micro-bypass implantation (Group 2) in Brazilian patients with open-angle glaucoma (OAG). Methods: This prospective, multicenter, comparative case series included patients with OAG and cataract who were randomized to receive treatment in Group 1 or Group 2. Outcomes included mean and percent reduction versus preoperative in intraocular pressure (IOP) and number of glaucoma medications; visual acuity; occurrence of adverse events; and rate of secondary surgeries. Results: Preoperatively, Groups 1 and 2 had similar mean IOP (mean ± standard deviation 22.1 ± 3.6 and 22.0 ± 2.5 mmHg, respectively) and mean number of medications (3.3 ± 0.6 and 3.4 ± 0.6 medications, respectively). At all follow-up timepoints through 12 M, both groups achieved significant IOP and medication reductions versus preoperative (IOP p < 0.001 and number of medications p < 0.001 for both groups). At 12 M, IOP reductions were 24.2% (Group 1) and 43.6% (Group 2) (p < 0.001); mean medication reductions were 50.2% and 71.5%, respectively. Mean postoperative IOP and number of medications were higher in Group 1 than Group 2 (IOP p < 0.01 all visits, medication p < 0.01 at 6 M and 12 M). Adverse events were generally mild and infrequent in both groups. Conclusion: Both treatment groups (ECP + phacoemulsification, with/without iStent inject implantation) achieved significant and safe reductions in IOP and medications versus preoperative in Brazilian OAG patients. Percent reductions were significantly greater, and mean IOP and medications were significantly lower, in the group receiving iStent inject. Clinical trial registration (CTR): CAAE project identification #20053019.5.0000.5078. Protocol #3.587.147. Clinical Trial Database of the Federal University of Goiás, Brazil. Registration Date: September 19, 2019.

Purpose: We report a case of paracentral acute middle maculopathy secondary to cholesterol embolization syndrome after an endovascular aortic aneurism repair (EVAR). Methods: Functional and anatomical damage was assessed by Snellen visual acuity, fundoscopy, and optical coherence tomography. Results: A 67-year-old man presented with sudden vision loss in the right eye for one day with concomitant livedo reticularis in both feet. His medical history included an abdominal EVAR repair three days before the symptoms. The best-corrected visual acuity was 20/40 in the right eye and 20/20 in the left eye. Fundoscopy showed intraarteriolar cholesterol plaques (Hollenhorst) bilaterally, and a localized retinal whitening in the right eye. Optical coherence tomography at the lesion site revealed a hyperreflective band on the level of inner nuclear layer. The patient was referred for imaging and complete systemic evaluation. He was then closely followed up by a vascular team, without additional intervention. Retinal stigma partially regressed at six months with visual improvement. Conclusion: This case describes paracentral acute middle maculopathy as a rare ocular sign of cholesterol embolization in postoperative intraaortic operations. The diagnosis of this complication led to prompt clinical care with a multidisciplinary approach.