Sandrine Anne Zweifel

Purpose: To report a rare case of bilateral macular serpiginous chorioretinitis associated with Francisella tularensis infection following rabbit exposure. Methods: Observational case report with multimodal retinal imaging and extensive systemic and serologic evaluation. Results: The patient presented with rapidly progressive bilateral central visual loss and placoid macular lesions. Serologic testing confirmed Francisella tularensis infection. Treatment with doxycycline led to regression of inflammatory changes, with residual outer retinal atrophy. Conclusion: This case highlights tularemia as a rare infectious trigger of macular serpiginous chorioretinitis and underscores the importance of considering zoonotic infections in atypical or rapidly progressive chorioretinal inflammatory disease.

Background/Objectives: To assess the acceptance of, attitudes towards, and concerns regarding allogeneic serum eye drops (Allo-SEDs) among patients treated with autologous serum eye drops (ASEDs). Methods: We conducted this investigator-initiated, cross-sectional, single-center survey at the Department of Ophthalmology, University Hospital Zurich, Switzerland. We consecutively recruited all patients using ASEDs during routine visits, who anonymously completed a 9-item questionnaire comprising eight 11-point Likert-scale items and one open numerical item on the daily application frequency. We assessed perceived ASED effectiveness, willingness to switch to Allo-SEDs under different scenarios, and concerns regarding safety, efficacy, and immunological risks. Results: Of 202 eligible patients, 107 returned the questionnaire (53.0%). The full eligible cohort had a median (IQR) age of 63.5 (49.2–75.0) years and a median ASED treatment duration of 4.0 (1.0–8.0) years. They rated ASEDs as highly effective (median 9, IQR 8.2–10.0) and applied them a median of 7 (5–10.5) times daily. Willingness to switch was low without clinical need (median 3, IQR 0–6; p = 1.0), increased when autologous production was no longer feasible (median 7, IQR 5–9; p < 0.001), and was intermediate for general openness (median 5, IQR 2–8; p = 0.7). Concerns regarding infectious disease transmission, immunological reactions, and therapeutic efficacy correlated with lower willingness to switch (all r = −0.29 to −0.46). Daily application frequency did not correlate with acceptance. Conclusions: Patients were highly satisfied with ASEDs but were reluctant to switch to Allo-SEDs unless autologous production was no longer feasible. Among the domains assessed, concerns regarding infection, immunological reactions, and efficacy were the main barriers to acceptance, supporting targeted patient education.

Background: There is limited data available on the efficacy and safety of Transscleral Lutein Iontophoresis (TSLI) in patients with intermediate age-related macular degeneration (iAMD) and reticular pseudodrusen (RPD). Methods: This retrospective multicentre study evaluated the functional and morphological outcomes of TSLI in patients with stage 2 and stage 3 iAMD with RPD. Autofluorescence (AF), Optical Coherence Tomography (OCT), Best Corrected Visual Acuity (BCVA), Intraocular Pressure (IOP), Macular Sensitivity (MS) and adverse events, were recorded at baseline, 1 month and 3 months follow-up after treatment. Results: Thirty eyes from 30 patients, (15 ♂: 15 ♀), mean age (70.3 ± 7.8 years) were included. BCVA improved significantly, from mean baseline 65.6 ± 8.6 ETDRS letters to 66.9 ± 8.0 at 1 month and 69.1 ± 7.8 at 3 months (ANOVA, p < 0.0001, respectively), along with MS, (ANOVA p < 0.001). There was a significant increase of stage 1 RPD ( p = 0.002) and a decrease in stage 3 RPD ( p = 0.020). The Outer Nuclear Layer (ONL) thickness increased significantly (ANOVA, p < 0.0001). No adverse events were recorded. Conclusion: TSLI appears to be an effective, safe technique in patients with iAMD and RPD, leading to structural and functional improvements in short-term follow-up.

Background: Autologous serum eye drops (ASEDs) are produced without preservatives and need to be stored at 2–8 °C while in use. This study aims to analyze the behavior of specific bacteria and fungi in the case of contamination during the usage of single-day use ophtioles containing ASED. Methods: This is a prospective experimental study conducted at the Department of Ophthalmology, University Hospital of Zurich (USZ), and a regulatory-licensed, independent, external laboratory. The laboratory performed microbial testing on the ASEDs with 11 microorganisms in 100% concentration or 50% diluted using the original 2.5 mL ASED ophtioles provided by the Eye Bank of the Department of Ophthalmology, USZ. Storage took place at 2–8 °C and 20–25 °C. The acceptance criterion was the absence of microbial growth between opening (T0), 24 h afterwards (T24), and 48 h afterwards (T48). Results: The acceptance criteria were met for all microorganisms for 2–8 °C. For seven microorganisms, the acceptance criteria were met for 2–8 °C and 20–25 °C. For four microorganisms, the acceptance criteria were only met for 2–8 °C. Conclusions: No relevant growth was observed in any of the test strains from T0 to T24 and T48 at 2–8 °C, demonstrating the microbiological safety of reclosable single-day use ophtioles containing unpreserved ASEDs when stored at 2–8 °C.

To evaluate the epidemiology of herpetic keratitis over a 15-year period at a tertiary care center in Switzerland, focusing on the relative incidence of herpes simplex virus (HSV)-1, HSV-2, and varicella zoster virus (VZV), gender distribution, and co-infections, we conducted a retrospective single-center analysis of polymerase chain reaction (PCR) assays from corneal and conjunctival scrapings of suspected herpetic keratitis at a tertiary referral hospital. Patient demographics, viral spectra, and microbiological co-infections were assessed. Between 2010 and 2025, we identified 9954 PCR assays from 2892 patients, with 482 samples testing positive for herpesvirus. HSV-1 was the most frequent pathogen (328 of 3358, 9.8%), followed by VZV (143 of 3112, 4.6%), HSV-2 (9 of 3290, 0.27%), and CMV (2 of 194, 1.0%). Triplet testing (simultaneous HSV-1, HSV-2, and VZV-PCR) enabled direct comparisons of relative incidence rates. We found 2913 triplet testing results, with a relative distribution in positive results of 65.4% for HSV-1, 32.5% for VZV, and 2.1% for HSV-2. HSV-1 keratitis had a statistically significant higher incidence in men (58.9%, p = 0.0044), while no sex difference was detected for VZV (47.9%, p = 0.6683), HSV-2 (33.3%, p = 0.5078), or CMV (100%, p = 0.500). Bilateral infections were present in two patients, and co-infections were detected as follows: 8 cases of HSV-1/VZV co-detection, 3 cases of Acanthamoeba, and 15 of fungi. HSV-1 was the overwhelmingly dominant cause of herpetic keratitis at our institution, occurring more than twice as frequently as VZV and vastly outnumbering HSV-2. The statistically significant higher incidence in men in HSV-1 keratitis suggests possible biological or sociodemographic influences, whereas co-infections highlight the complexity of corneal pathology in a referral setting. These findings underscore the importance of multiplex PCR testing for accurate pathogen detection and provide insights into the epidemiologic landscape of herpetic keratitis.

Introduction To evaluate long-term outcomes of neovascular age-related macular degeneration(nAMD) treatment with aflibercept in a treat-and-extend (T&E) regimen and explore correlations between optical coherence tomography (OCT) biomarkers and clinical evolution over 5 years in a real-world setting. Methods This retrospective monocentric study included patients diagnosed with type 1 or type 2 nAMD at the University Magna Graecia of Catanzaro between 2016 and 2024. Inclusion criteria were treatment-naïve status, diagnosis confirmed by OCT and optical coherence tomography angiography (OCT-A), exclusive treatment with intravitreal aflibercept following a T&E regimen, and a minimum 5-year follow-up. Best-correct visual acuity (BCVA) and OCT were assessed at baseline, after the third injection, and yearly up to year 5 (seven time points). Evaluated OCT biomarkers included subretinal and intraretinal fluid (SRF, IRF), hyperreflective spots (HS), drusenoid pigment epithelial detachment (dPED), subretinal hyperreflective material (SHRM), outer retinal tubulations (ORT), onion sign, retinal pigment epithelium (RPE) tears, and subretinal fibrosis. Results Among 59 cases, 57.6% were type 1 macular neovascularization (MNV) and 42.4% type 2. At the baseline, SRF was more common in type 1, SHRM in type 2. Central foveal thickness (CFT) decreased significantly in both groups after loading and remained stable. SRF decreased significantly in type 1 (p = 0.001), but not in type 2. dPED decreased in both groups, significantly in type 1 (p = 0.01). HS decreased in patients with type 1 MNV (p = 0.009). RPE tears were more frequent in type 2 (12%) and linked to BCVA loss. For type 2 MNV, ORT (p = 0.035) and subretinal fibrosis appeared from year 5 (p = 0.006). BCVA improved after loading in both groups, declined after year 2, and was better preserved in those with better visual acuity after the loading dose. Conclusions Baseline SHRM in type 2 MNV may predict more IRF, ORT, and RPE tears over time. Type 1 MNV with baseline SRF often shows reduced HS and dPED but may develop subretinal fibrosis. BCVA gains after loading wane by year 5, and eyes needing ongoing treatment for persistent OCT biomarkers decline gradually in both subtypes (significant in type 1).

Purpose: This study aims to assess the reliability and agreement of fundus autofluorescence, near-infrared reflectance (NIR), and a combination of NIR and dense structural optical coherence tomography (OCT) scans (OCT + NIR) in delineating the areas of reticular pseudodrusen (RPD) in eyes affected by age-related macular degeneration. Methods: This was a single-center, cross-sectional study. Patients with nonadvanced age-related macular degeneration exhibiting signs of RPD on multimodal imaging were enrolled. Two independent masked graders manually delineated the margins of the area occupied by RPD using the three distinct imaging techniques. Results: The study included 60 eyes from 51 patients, with a mean age of 81.5 (±7.1) years. The intraclass correlation coefficient between the two graders across all imaging modalities was 0.96 for fundus autofluorescence, 0.92 for NIR, and 0.98 for OCT + NIR. The narrowest limits of agreement were observed with OCT + NIR (−4.38 + 5.17 mm²). Foveal involvement and age were significantly correlated with larger RPD area (P = 0.036 and P = 0.019, respectively). Pairwise comparisons of square root-transformed RPD areas indicated that fundus autofluorescence detected a significantly larger RPD area compared with other methods (P < 0.001). Conclusion: These findings validate OCT + NIR as a reliable approach for measuring RPD areas, potentially serving as a critical biomarker for age-related macular degeneration in future clinical trials.

Despite rising global reports of Acanthamoeba keratitis (AK), the incidence of AK in Switzerland remains unknown. This investigator-initiated, retrospective, multicenter study assessed the nationwide incidence of PCR- and/or culture-positive Acanthamoeba results from January 2010 to December 2023. Data were collected from all tertiary care and large ophthalmological facilities in Switzerland, fully anonymized, and aggregated by month and year. We considered all corneal scraping results, whereby the detection method was specific to local standards. We identified 271 PCR- or culture-positive Acanthamoeba cases over 14 years. Applying the population data from the Federal Statistical Office in Switzerland, this corresponds to a mean incidence of 2.29 cases per million people annually. Infections were most common in summer (87 cases, 32.1%), followed by autumn (74 cases, 27.3%), spring (60 cases, 22.1%), and winter (50 cases, 18.5%). We found no significant change in incidence across the investigated period, p = 0.47. This nationwide study reveals a low but stable incidence of AK in Switzerland, in line with other industrialized countries but well below levels reported in tropical or densely populated regions such as India or Egypt. Seasonal variation supports the influence of environmental exposure and underscores the importance of preventive measures during warmer months.

This study aims to evaluate the real-world efficacy and safety of aflibercept 8 mg intravitreal injections (IVTs) in pretreated patients with neovascular age-related macular degeneration (nAMD) throughout the first three IVTs. Background: Established anti-vascular-endothelial-growth-factor (anti-VEGF) therapies positively impact the progression of nAMD but require frequent administration, thus burdening patients and the healthcare system. Pivotal trials of the recently approved aflibercept 8 mg have demonstrated extended dosing intervals with comparable safety to standard treatments. However, real-world data is still scarce. Methods: A retrospective, single-center single-arm analysis was conducted on 22 eyes from 18 pretreated nAMD patients. Eyes were switched from other anti-VEGF agents to aflibercept 8 mg injections continuing a treat-and-extend regimen (no loading dose after switching). Treatment intervals and structural (central subfield thickness (CST); disease activity) and functional (best corrected visual acuity (BCVA)) outcomes were assessed at baseline (date of first aflibercept 8 mg injection) and at follow-up examinations until follow-up 3. Safety data, including intraocular pressure changes, were recorded. Results: Over a median follow-up of 16.6 weeks (IQR 15.1–27.0), patients switched to aflibercept 8 mg showed prolonged intervals between injections (5.5 weeks vs. 7 weeks, p < 0.001, Wilcoxon signed-rank test), reduced disease activity, stable CST, and stable BCVA. One patient experienced transient intraocular pressure elevation, which resolved without intervention. No other adverse events were observed. Conclusions: Treatment with aflibercept 8 mg appears to provide effective disease control with prolonged treatment intervals in switched nAMD patients in routine clinical practice. These findings further indicate the potential for reducing treatment burden.