Gábor Márk Somfai

Purpose To share first experience from the Swiss RetinAI Consortium in applying artificial intelligence (AI)-based optical coherence tomography (OCT) analysis across multiple centres, to highlight practical barriers encountered during implementation, and to outline practical recommendations for future collaborative multicentre AI-based OCT research. Methods The Swiss RetinAI Consortium, consisting of six ophthalmology centres, implemented the FDA-cleared Discovery platform (RetinAI, Bern, Switzerland) for collaborative OCT analysis. Challenges encountered during protocol development for OCT export, anonymisation, data upload, AI-based analysis, and data sharing were systematically collected from all sites involved. These included regulatory, technical, and methodological aspects. The findings were discussed at expert meetings and consolidated into shared guidance for data acquisition and processing. The aim was to provide practical recommendations to support standardised workflows in future multicentre AI-driven research. Identified Challenges Key regulatory, technical, and methodological challenges were identified during multicentre implementation. These included the legal requirement for Swiss-based server hosting, incomplete anonymisation due to heterogeneous export protocols, and non-standardised OCT protocols treated as being equivalent, despite covering different retinal areas. Additional barriers were inter-device variability, ETDRS grid misalignment without the option for manual correction, major segmentation errors requiring extensive review, and unfiltered data exports that often exceeded one million entries, thereby increasing the risk of readout errors. Moreover, the absence of automated quality screening and the lack of cross-centre reproducibility data were identified as important methodological gaps. Together, these challenges shaped our practical recommendations for reliable multicentre AI-based OCT analysis. Practical Recommendations Based on the identified challenges, we derive practical recommendations focusing on standardised anonymised data export procedures, harmonised OCT acquisition protocols, mandatory quality control steps for grid placement and segmentation, and structured strategies for handling large-scale output data. Our recommendations offer a practical roadmap to support future collaborative multicentre AI-based OCT research.

To determine the incidence of posterior capsule rupture (PCR) and vitreous loss (VL) during cataract surgery in a Swiss tertiary care center. Furthermore, we aimed to evaluate preoperative risk factors associated with PCR/VL, including pseudoexfoliation (PEX), age, type of anesthesia, and the Triemli Cataract Score (TCS), a locally implemented preoperative risk assessment tool for surgical complexity. This retrospective single-center cohort study included all phacoemulsification and refractive lens exchange procedures performed at Stadtspital Zürich between January 2021 and late August 2024. Data were retrieved from the Dendrite clinical database of the TCS and supplemented through manual chart review and surgical reports for identification of intraoperative complications. Univariable and multivariable logistic regression analyses were performed to evaluate associations between preoperative factors and the occurrence of PCR and/or VL. A total of 2’719 eyes were included in the study. PCR and/or VL occurred in 52 eyes (1.9%), including 45 cases of PCR (5 with concomitant VL) and 7 additional cases of isolated VL due to zonulolysis. In univariate analysis, PEX and a TCS ≥3 were significantly associated with an increased risk of PCR and/or VL (OR 2.72; p=0.003 and OR 2.38; p=0.002, respectively), while topical (vs. general) anesthesia was associated with a reduced risk (OR 0.51, p=0.019). In multivariate analysis, only PEX remained an independent risk factor (OR 2.38; p=0.013). The association between TCS ≥3 and PCR/VL just missed statistical significance (OR 1.79; p=0.057). The rate of PCR and/or VL during cataract surgery at a Swiss tertiary care center is comparable to international statistics. PEX is a strong and independent predictor for these complications; although the predictive power of TCS did not reach statistical significance in multivariable analysis, the observed trend suggests that risk-based preoperative scores such as the TCS may support risk-stratification and surgical planning in clinical practice.

Wir präsentieren einen Fallbericht über 2 Patienten mit penetrierender Augenverletzung durch große metallische IOFK, die über einen modifizierten skleralen Zugang mittels 23-G-PPV entfernt wurden. Die Modifikation besteht darin, dass zusätzlich zur limbusparallelen Inzision ein kleinerer, 1,5 mm langer, perpendikulär dazu angeordneter Schnitt zur Vereinfachung der Fremdkörperentfernung gesetzt wird. Received: 02 November 2025 Accepted: 11 January 2026 Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 14, 70469 Stuttgart, Germany

Purpose: To investigate the reproducibility of hand-held full-field electroretinogram (ERG) to determine the minimum change required in longitudinal measurements to reach statistical significance. Methods: The study included 27 healthy volunteers, aged 45–65. Light-adapted (ISCEV standard) full-field ERGs measured with the RETeval device (LKC Technologies, Germantown, MD, USA) were recorded using non-invasive skin electrodes, followed by a second examination 1–14 days later. Intersession variability of the a- and b-waves, the flicker responses (light intensity 85 Td·s, frequency 28.3 Hz) and the photopic negative response (PhNR, 38 Td·s on 380 Td blue) were assessed. Results: The mean standard deviations were 0.86, 0.83, 0.40 and 3.24 ms for a-wave, b-wave, flicker and PhNR peak times, respectively. Coefficient of variations (CV) were 32%, 22%, 18%, and 19.2% for the amplitudes of the a-wave, b-wave, flicker and PhNR, respectively. Conclusion: While flicker ERGs had the smallest variability, ISCEV standard a-wave and b-wave times also had variability less than 1 ms, indicating excellent reproducibility. Amplitudes were more variable, with the a-wave amplitude having the most variability. While it depends on disease, longitudinal studies utilizing ERG timing are expected to be more likely to show statistically significant results due to low inter-session variability.

Az elmúlt évtizedek során a szemészeti mikrosebészet figyelemre méltó átalakuláson ment keresztül. A sebészeti pontosság növekszik, az anatómiai és funkcionális eredmények javulnak. A robotizált rendszerek integrálása a mikrosebészeti innováció határait feszegeti, fokozott stabilitást, remegéscsökkentést és szubmilliméteres irányíthatóságot kínálva a szemészeti beavatkozások során. Összefoglaló tanulmányunkban a robotasszisztált sebészeti technikák jelenlegi helyzetét tekintjük át a szemészetben, különös tekintettel a legfrissebb fejlesztésekre, a klinikai alkalmazásra és a fejlesztés jövőbeli lehetőségeire. A robotizált rendszereket három fő típusba soroljuk és elemezzük: kézi segédeszközök, közös manipulációs rendszerek, valamint telemanipulációs platformok. Megvizsgáljuk és bemutatjuk ezek technikai jellemzőit és alkalmazási területeit. Bár több ígéretes prototípus már eljutott a korai klinikai vizsgálatok szakaszába, e technológiák széles körű elterjedését korlátozzák a szigorú engedélyeztetési szabályok, a magas költségek és a nagy esetszámú tanulmányok hiánya. Különösen hiányoznak a prospektív klinikai tanulmányok, amelyek a robotasszisztált beavatkozásoknak a hagyományos sebészeti beavatkozásokhoz viszonyított, ún. „non-inferiority” voltát igazolnák. E korlátok ellenére a szemészeti robotasszisztált sebészet az utóbbi időben gyorsan fejlődik, köszönhetően az interdiszciplináris innovációnak, a növekvő befektetéseknek és az automatizált sebészet iránti fokozódó érdeklődésnek. A képalkotás integrációjával, a mesterséges intelligencia és a precíziós vezérlés folyamatos fejlődésével a robotizált asszisztencia jelentős potenciállal bír a szemészeti mikrosebészet területén is. A további kutatás és együttműködés kulcsfontosságú lesz a technológia teljes klinikai hasznosításához – egy biztonságosabb, reprodukálhatóbb és rendkívül precíz szemsebészeti korszak kezdetét hozva el. Orv Hetil. 2025; 166(36): 1403–1411.

Background Our study aims to compare the efficacy of half-dose photodynamic therapy with verteporfin (PDT) and subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR) with regards to subretinal fluid (SRF) resorption, visual acuity (VA), and central subfield thickness (CST). Patients and Methods We conducted a retrospective multicentre clinical study at the Departments of Ophthalmology at the University Hospital Zurich and Stadtspital Zürich, Switzerland. The study included patients with acute and chronic CSCR who underwent PDT, SML, or both sequentially between June 1, 2020 and December 31, 2023. The primary outcome was the reduction in SRF at three and six months post-treatment. The secondary outcomes included change in CST VA at the same intervals. Results A total of eighty-one eyes were analysed (33 PDT, 35 SML, thirteen combined). SRF reduction was statistically significant at both three and six months in the PDT (p < 0.001) and SML groups (p < 0.001). The combined treatment group showed a significant reduction in SRF only at six months (p = 0.001). At three months, PDT resulted in a significantly greater SRF reduction than the combined group. Conclusions Both PDT and SML demonstrated improvements in SRF, CST and VA, with SML presenting as a comparable alternative, particularly in cases where access to verteporfin is limited. Zweck Ziel unserer Studie ist der Vergleich der Wirksamkeit der halbdosierten photodynamischen Therapie mit Verteporfin (PDT) und der Subthreshold-Micropulse-Lasertherapie (SML) bei Patienten mit Chorioretinitis centralis serosa (CSCR) hinsichtlich der Resorption subretinaler Flüssigkeit (SRF), des Visus (VA) und der zentralen Subfelddicke (CST). Patienten und Methoden Eine retrospektive multizentrische klinische Studie wurde an den Augenkliniken des Universitätsspitals Zürich und des Stadtspitals Zürich, Schweiz, durchgeführt. Die Studie umfasste Patienten mit akuter und chronischer CSCR, die sich zwischen dem 1. Juni 2020 und dem 31. Dezember 2020 einer PDT, SML oder beiden Therapien unterzogen haben. Der primäre Endunkt war die Reduktion der SRF 3 und 6 Monate nach der Behandlung. Zu den sekundären Ergebnissen gehörte die Veränderung der CST und der VA zu denselben Zeitpunkten. Ergebnisse Insgesamt wurden 81 Augen analysiert (33 PDT, 35 SML, 13 mit beidem). Die SRF war sowohl nach 3 als auch nach 6 Monaten in der PDT- (p < 0,001) und in der SML-Gruppe (p < 0,001) statistisch signifikant reduziert. Die kombinierte Behandlungsgruppe zeigte eine signifikante Verringerung der SRF nur nach 6 Monaten (p = 0.001). Nach 3 Monaten führte die PDT zu einer signifikant stärkeren Verringerung der SRF als die kombinierte Gruppe. Konklusion Sowohl PDT als auch SML zeigten Verbesserungen der SRF, der CST und der VA, wobei SML insbesondere in Fällen mit begrenztem Zugang zu Verteporfin eine vergleichbare Alternative darstellt. ^* Shared first authorship. ^** Shared last authorship. Received: 27 October 2024 Accepted: 24 December 2024 Article published online: 16 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Artificial intelligence (AI) is gaining widespread traction in ophthalmology, with multiple screening and diagnostic tools already being approved by U. S. and EU authorities. However, the adoption of these tools among medical professionals and their acceptance among patients is still questionable. This narrative review analyses the current literature on stakeholder perspectives on the integration of AI in ophthalmology, with a focus on comparing views across different global healthcare contexts. A PubMed search was conducted for original research articles published between January 1, 2015 and August 31, 2024. The analysis revealed different levels of acceptance for different AI applications among different stakeholder groups. Ophthalmologists and optometrists generally showed positive attitudes toward AI as an adjunct tool, while patients expressed mixed views, appreciating potential benefits while expressing concerns about a lack of transparency in the integration of AI into healthcare. This review reveals a complex landscape of stakeholder perspectives on AI in ophthalmology, highlighting the need for tailored approaches to AI implementation that address specific concerns and consider different healthcare contexts. The findings underscore the importance of collaborative efforts to develop context-specific, effective AI solutions in ophthalmology.

Background/Objectives: XTEND is the largest global, prospective, observational study of treatment-naïve patients with neovascular age-related macular degeneration (nAMD) receiving 2 mg of intravitreal aflibercept (IVT-AFL) in routine clinical practice designed to examine the real-world effectiveness of IVT-AFL proactive treatment regimens. The outcomes from the Switzerland cohort are reported here. Methods: Patients aged ≥50 years were eligible if they planned to receive IVT-AFL 2 mg. After three initial monthly IVT-AFL injections, treatment intervals could be extended (4-week minimum treatment interval). Visual and anatomic outcomes, treatment exposure, and safety were assessed. Statistics were descriptive. Results: Fifty-one patients were treated. At baseline, the mean ± standard deviation (SD) best-corrected visual acuity (BCVA) was 64.9 ± 17.9 letters, and central subfield thickness (CST) was 402 ± 106 µm. At month (M) 12 and M24, the mean (95% confidence interval [CI]) change from baseline in BCVA was +5.7 (1.9, 9.4) and +5.6 (1.3, 9.8) letters, respectively. In patients with a high baseline BCVA (≥70 letters [n = 28; mean ± SD: 77.5 ± 4.8 letters]), BCVA was maintained at ≥70 letters at M12 and M24 (mean change from baseline [range] +1.0 [−15.0, 11.0] and +1.1 [–10.0, 14.0], respectively). At M12 and M24, the mean (95% CI) change in CST was −125 (−161, −90) µm and −127 (−162, −93) µm, respectively. Patients received a mean ± SD of 9.5 ± 3.2 and 13.7 ± 6.0 injections by M12 and M24, respectively. No safety concerns were identified. Conclusions: In Swiss routine clinical practice, functional and anatomic improvements were achieved with IVT-AFL 2 mg proactive treatment in patients with nAMD over 24 months despite a relatively high baseline BCVA.

(1) Background: The process of epiretinal membrane peeling (MP) requires precise intraoperative visualization to achieve optimal surgical outcomes. This study investigates the integration of preoperative Optical Coherence Tomography (OCT) images into real-time surgical video feeds, providing a dynamic overlay that enhances the decision-making process during surgery. (2) Methods: Five MP surgeries were analyzed, where preoperative OCT images were first manually aligned with the initial frame of the surgical video by selecting five pairs of corresponding points. A homography transformation was then computed to overlay the OCT onto that first frame. Subsequently, for consecutive frames, feature point extraction (the Shi–Tomasi method) and optical flow computation (the Lucas–Kanade algorithm) were used to calculate frame-by-frame transformations, which were applied to the OCT image to maintain alignment in near real time. (3) Results: The method achieved a 92.7% success rate in optical flow detection and maintained an average processing speed of 7.56 frames per second (FPS), demonstrating the feasibility of near real-time application. (4) Conclusions: The developed approach facilitates enhanced intraoperative visualization, providing surgeons with easier retinal structure identification which results in more comprehensive data-driven decisions. By improving surgical precision while potentially reducing complications, this technique benefits both surgeons and patients. Furthermore, the integration of OCT overlays holds promise for advancing robot-assisted surgery and surgical training protocols. This pilot study establishes the feasibility of real-time OCT integration in MP and opens avenues for broader applications in vitreoretinal procedures.