Iden Amiri

Background: Vitreomacular traction is characterized by incomplete posterior vitreous detachment, wherein persistent adherence of the vitreous to the macula results in tractional distortion and associated visual symptoms. Although spontaneous resolution of vitreomacular traction may occur, surgical intervention is typically pursued when significant visual impairment occurs. The mechanism by which spontaneous release of vitreomacular traction is unclear, as there are numerous intrinsic and extrinsic factors that affect the eye. This case highlights the potential effects of sudden changes in barometric pressure on vitreoretinal dynamics. Case presentation: We report a unique case of a Caucasian 65-year-old patient who was found to have vitreomacular traction in the left eye associated with progressive blurry vision. The patient’s vitreomacular traction unexpectedly resolved following a deep scuba dive to 60 m. The patient experienced an acute onset of floaters followed by a marked improvement in visual acuity. Spectral-domain optical coherence tomography confirmed complete resolution of vitreomacular traction without residual traction or macular damage. Although the effects of barometric pressure changes are well documented in postoperative vitrectomy patients with intraocular gas tamponade, little is known regarding their impact on untreated vitreomacular traction. Conclusions: This case demonstrates a temporal association between extreme pressure fluctuations during deep diving and spontaneous release of vitreomacular traction. Further investigation into the effects of environmental barometric pressure on vitreomacular traction is warranted.

A patient in her 20s with a history of intravenous drug use presented with deteriorating vision due to endogenous endophthalmitis complicated by an iris abscess. Initial management involved systemic antibiotics, intravitreal antibiotic administration and topical anti-inflammatory treatments. Pharmacologic pupil dilation for synechialysis led to anterior lens capsule rupture and cortical material exposure, necessitating careful ophthalmological monitoring and eventual elective cataract extraction following systemic stabilisation. Multidisciplinary collaboration was crucial, involving infectious disease specialists, ophthalmology and cardiology. Postoperatively, the patient showed significant visual improvement and sustained ocular stability, with successful reintegration into daily activities. Regular follow-up and surveillance effectively prevented further complications, highlighting the importance of integrated care in managing complex infectious and ocular conditions.

Background: The Kahook Dual Blade (KDB) is a minimally invasive glaucoma surgery (MIGS) device designed to excise a strip of trabecular meshwork, enhancing aqueous outflow via Schlemm’s canal. While its efficacy is well-documented, there is limited evidence comparing outcomes between anatomical quadrants treated. Objectives: To compare intraocular pressure (IOP) reduction, medication burden, visual acuity improvement, and complication rates between nasal and inferior quadrant sectoral excisional goniotomy with KDB combined with cataract surgery. Design: Retrospective cohort study. Methods: Medical records of patients with primary open-angle glaucoma who underwent combined phacoemulsification and KDB goniotomy between January 2020 and June 2025 at a single tertiary academic center were reviewed. Patients were grouped by treatment location (nasal vs inferior). Primary outcomes were IOP and the number of glaucoma medications; secondary outcomes included best-corrected visual acuity (BCVA) and adverse events. Multivariate linear regression was used to adjust for baseline differences between groups. Results: Sixty-four eyes (nasal: 50; inferior: 14) met the inclusion criteria. Baseline IOP and BCVA were similar between groups, though the inferior group had fewer medications (1.93 vs 2.68; p = 0.045) and milder visual field loss (MD −8.39 vs −15.18; p = 0.04). Mean treatment extent was approximately 90° in both groups. Both groups achieved significant IOP reduction at all follow-up points, with no long-term differences. At postoperative week 1, the inferior group had higher IOP (18.50 vs 13.99 mmHg; p = 0.0433), potentially due to gravity-dependent hyphema. Medication burden decreased in both groups, with a non-significant trend toward fewer drops in the inferior group. BCVA improved similarly, and complication rates were low and comparable, with no serious adverse events. Conclusion: Nasal and inferior quadrant KDB goniotomy combined with cataract surgery yields comparable long-term outcomes in IOP, medication burden, visual acuity, and safety. Quadrant selection may be guided by intraoperative visualization and patient-specific anatomy without compromising efficacy.

This report describes the case of a school-aged male child with T-cell acute lymphoblastic leukemia who developed cytomegalovirus retinitis despite systemic antiviral therapy. The patient had a history of cytomegalovirus viremia that improved with intravenous foscarnet and oral maribavir; however, routine ophthalmic screening revealed new retinal whitening and hemorrhages in the right eye. Anterior chamber paracentesis confirmed intraocular cytomegalovirus DNA. Although systemic viral loads declined, the retinal lesions progressed toward the macula, prompting initiation of intravitreal foscarnet. Treatment was initiated with a 1.2 mg/0.05 mL injection under anesthesia, followed by 2.4 mg/0.1 mL injections administered twice weekly at the clinic. The regimen was well tolerated and resulted in stabilization and regression of retinitis without central involvement, with fundus photography demonstrating fading whitening and vascular sclerosis. This case highlights the importance of close ophthalmic monitoring in immunosuppressed pediatric patients with cytomegalovirus viremia and emphasizes intravitreal foscarnet as an effective adjunct when systemic therapy fails. Furthermore, it demonstrates the feasibility of administering multiple intravitreal injections in the pediatric population, underscoring the role of local antiviral delivery in preserving vision in cases of antiviral-resistant cytomegalovirus retinitis.

Purpose: To evaluate the diagnostic accuracy of GPT-4.o, Claude 3.7 Sonnet, and Gemini 2.5 Pro for real-world retinal cases. Methods: Forty retina cases from the University of Iowa’s EyeRounds repository were assessed under 2 conditions: (1) full clinical context (textual history, examination, and image descriptions); and (2) image-only (raw clinical images). Outputs were evaluated for diagnostic accuracy, symptom/sign recognition, differential diagnosis, and treatment recommendations. Cochran Q, McNemar test, analysis of variance, and Cohen kappa were used to make statistical comparisons. Results: In full-context cases, GPT-4.o achieved the highest diagnostic accuracy (78.4%), followed by Claude (73.0%) and Gemini (29.7%) ( P < .001). In image-only cases, Claude was superior (73.7%), outperforming GPT-4.o (63.2%) and Gemini (31.6%) ( P < .001). GPT-4.o was best at identifying signs/symptoms in full-context cases (64.0%), while Claude excelled in image-only cases (63.3%). GPT-4.o (42.9%) and Claude (37.0%) outperformed Gemini (25.9%) on differential diagnosis ( P ≤ .011). Claude showed superior treatment accuracy in image-only cases (61.1%), while GPT-4.o was superior in full-context cases (57.3%), and both outperformed Gemini (35.8%). GPT-4.o and Claude showed substantial agreement in image-based diagnoses (κ=0.658), while Gemini showed minimal agreement (κ≤0.196). Conclusions: GPT-4.o and Claude demonstrated strong diagnostic and clinical reasoning in retinal cases, with Claude excelling in image-based analysis and GPT-4.o in text-rich contexts. Gemini’s lower performance underscores the importance of careful model selection in clinical applications.

Purpose: Glaucoma, a leading cause of irreversible blindness, lacks a universally accepted diagnostic definition, resulting in significant variability across clinical trials. This systematic review evaluates and categorizes the diagnostic criteria employed for glaucoma in randomized controlled trials (RCTs) over the past decade. Methods: A systematic review of PubMed and ClinicalTrials.gov databases was performed for RCTs published between January 1, 2014, and December 31, 2024, involving adults diagnosed with primary open-angle glaucoma or normal-tension glaucoma. Studies explicitly stating diagnostic criteria were included. Extracted diagnostic criteria were categorized into clinically relevant groups. Results: Of 482 identified articles, 83 met inclusion criteria. Significant variability in glaucoma definitions was observed, encompassing 57 unique definitions. Criteria differed notably in intraocular pressure (45 unique definitions), visual field impairment (40), structural optic nerve parameters (35), and retinal nerve fiber layer assessments (15). Definitions were grouped into Mixed Criteria (37.3%), Combined Comprehensive (31.3%), IOP-Emphasized (27.7%), Visual Field-Emphasized (2.4%), and Imaging-Focused (1.2%). Conclusions: Substantial heterogeneity exists in glaucoma diagnostic criteria across recent RCTs, complicating clinical comparability and risking diagnostic inaccuracies. This highlights the urgent need for universally standardized definitions informed by collaborative international consensus, incorporating structural-functional correlations and advanced imaging technologies.

Purpose: To develop and demonstrate the anatomical feasibility of a human whole-eye transplantation (WET) protocol that eliminates warm ischemia time (WIT) through continuous retrograde arterial perfusion, enabling uninterrupted ocular oxygenation throughout the transplantation process. Design: Experimental cadaveric feasibility study. Subjects: Two fresh human cadaveric specimens used to simulate a complete donor-to-recipient WET sequence. Methods: A modified fronto-temporo-orbito-zygomatic craniotomy with anterior clinoidectomy was performed on each donor to expose the anterior cerebral artery (ACA), middle cerebral artery (MCA), and ophthalmic artery (OA). The ACA was cannulated to permit continuous retrograde perfusion of the ophthalmic circulation while the globe, with preserved optic nerve and extraocular muscles, was harvested en bloc. Recipient preparation involved mobilization of the internal maxillary artery (IMAX) in the infratemporal fossa and removal of the native globe. Orthotopic transplantation was achieved with MCA–IMAX and superior ophthalmic vein (SOV– SOV) microvascular anastomoses and optic nerve coaptation under microscopy, maintaining continuous simulated perfusion through the ACA cannula. Main Outcome Measures: Anatomical feasibility of achieving zero warm ischemia time during the entire transplantation sequence, confirmed by optical coherence tomography (OCT), intraoperative microscopy, and photographic documentation of vascular and neural integration. Results: Continuous retrograde perfusion was maintained throughout donor harvest and transplantation, achieving zero WIT across both specimens. OCT verified luminal patency and vessel continuity after ACA cannulation and MCA–IMAX anastomosis. The IMAX provided a robust, tension-free arterial recipient site with consistent caliber and orientation. Optic nerve coaptation and extraocular muscle reattachment were anatomically aligned, with sequential imaging confirming vascular and neural integration. The technique proved reproducible across both dissections, supporting its feasibility for perfused, anatomically integrated ocular allotransplantation. Conclusions: This study establishes a reproducible human WET protocol achieving zero WIT via continuous retrograde extracorporeal perfusion. The approach provides a foundational anatomical framework for future functional and preclinical studies aiming to preserve retinal viability and enable neurovascularly integrated whole-eye transplantation.