Optometry and Ophthalmology

Background: Myopic foveoschisis, also termed myopic traction maculopathy (MTM) or myopic macular schisis, is a sight-threatening complication of pathological myopia. Characterized by progressive splitting of retinal layers at the macula, the condition arises from a combination of posterior staphyloma, vitreoretinal interface abnormalities, and axial elongation. First described in 1999 by Takano and Kishi, MTM has gained recognition as a distinct entity with the advent of spectral-domain optical coherence tomography (SD-OCT). Objective: This review synthesizes current knowledge on the etiology, epidemiology, pathophysiology, clinical presentation, evaluation, and management of MTM, with emphasis on the importance of imaging, individualized surgical planning, and interprofessional collaboration. Methods and Findings: MTM occurs in up to one-third of patients with pathological myopia, with a female predominance. The pathophysiology involves differential scleral, choroidal, and retinal stretching, creating tangential and perpendicular tractional forces that progressively split the retina. Clinical manifestations include insidious vision loss, metamorphopsia, and, in advanced cases, macular hole or schisis-detachment. Diagnosis relies on multimodal imaging, with SD-OCT playing a central role. Surgical treatment remains the only effective modality. Pars plana vitrectomy with ILM peeling relieves tangential traction, whereas macular buckling addresses perpendicular traction. In complex cases, combined approaches are required. Prognosis depends heavily on preoperative vision, duration of symptoms, and structural factors such as axial length and choroidal thinning. Conclusion: MTM is a dynamic, multifactorial disorder that poses significant diagnostic and therapeutic challenges. Early recognition, correct identification of tractional forces, and tailored surgical intervention are vital to optimizing outcomes. Patient education, long-term surveillance, and multidisciplinary care are equally critical to preserving vision in this high-risk population.

Background Medical big data analytics has revolutionized the human healthcare system by introducing processes that facilitate rationale clinical decision making, predictive or prognostic modelling of the disease progression and management, disease surveillance, overall impact on public health and research. Although, the electronic medical records (EMR) system is the digital storehouse of rich medical data of a large patient cohort collected over many years, the data lack sufficient structure to be of clinical value for applying deep learning methods and advanced analytics to improve disease management at an individual patient level or for the discipline in general. Ophthatome™ captures data contained in retrospective electronic medical records between September 2012 and January 2018 to facilitate translational vision research through a knowledgebase of ophthalmic diseases. Methods The electronic medical records data from Narayana Nethralaya ophthalmic hospital recorded in the MS-SQL...

O tratamento convencional da hipertrofia papilar na ceratoconjuntivite primaveril pode associar-se a danos importantes, que podem ser suavizado pela homeopatia. Objetivase apresentar os resultados do tratamento homeopático de dois casos desta enfermidade. Avaliaram-se duas crianças masculinas com ceratoconjuntivite primaveril, úlcera em escudo unilateral e hipertrofia papilar gigante. Antes do início do tratamento homeopático foram suspensas todas as medicações convencionais tópicas e sistêmicas. O tratamento foi realizado através de uma única dose por via oral. Os pacientes evoluíram com melhora da úlcera de córnea em escudo e redução importante da hipertrofia papilar. O período de regressão foi de um ano e três meses no primeiro caso e de um ano e oito meses no segundo. Concluiu-se que a homeopatia pode contribuir para o tratamento da ceratoconjuntivite primaveril com úlcera de córnea em escudo e hipertrofia papilar e que novos estudos são necessários para melhor avaliar essa contribuição.

Objetivo: Avaliar as principais indicações de tarsorrafia em Serviço de Córnea, bem como as taxas de sucesso e possíveis complicações do procedimento. Métodos: Foram avaliados, retrospectivamente, todos os pacientes submetidos a tarsorrafia no período de 1 de janeiro de 2002 a 30 de dezembro de 2002 no Hospital São Geraldo, Universidade Federal de Minas Gerais. Avaliou-se idade e sexo do paciente, indicação da tarsorrafia, duração dos sinais e sintomas antes da tarsorrafia, tempo para reepitelização corneana, tipo de tarsorrafia, complicações da tarsorrafia, número de tarsorrafias e duração do acompanhamento. Resultados: Foram encontrados 18 pacientes submetidos a tarsorrafia. As indicações para tarsorrafia foram úlcera de exposição (27,8%), defeito epitelial persistente associado a transplante de córnea (38,8%), úlcera neurotrófica (11,1%), síndrome do olho seco (5,6%), síndrome de Stevens-Johnson (11,1%) e queimadura química (5,6%). Dos 18 pacientes que apresentavam defeito epitelial, 15 pacientes (83,3%) apresentaram epitelização completa com a tarsorrafia. A duração média de sinais e sintomas antes da tarsorrafia foi de 98,7 ± 48,6 dias, e o tempo para epitelização após a cirurgia foi de 53,2 ± 22,8 dias. Do total de 18 tarsorrafias, duas (11,1%) foram temporárias e 16 (88,9%) permanentes. As complicações relacionadas ao procedimento cirúrgico foram abertura precoce da tarsorrafia, triquíase e granuloma piogênico. Conclusão: A tarsorrafia se mostrou procedimento de fácil realização, sendo bastante segura e eficaz no tratamento de defeitos epiteliais, com taxa de sucesso de 83,3% e com poucas complicações.

Objetivo: Apresentar os primeiros resultados do uso da Homeopatia entre os pacientes com conjuntivite primaveril, avaliados no Serviço de Córnea e Doenças Externas do Hospital São Geraldo. Métodos: Foram incluídos no presente estudo 13 pacientes apresentando ceratoconjuntivite primaveril, examinados no período de janeiro de 1998 a dezembro de 1999. A idade média dos pacientes foi de 9,5 anos, sendo nove do sexo masculino e quatro do sexo feminino. Todos os pacientes já haviam feito uso de corticóide tópico antes da sua inclusão no estudo. Antes de iniciar o tratamento homeopático, todos os pacientes foram examinados por um dos autores, sendo acompanhados pelo mesmo médico, mensalmente até os seis meses e depois trimestralmente até completar um ano do tratamento homeopático. O tratamento homeopático foi realizado por meio de uma dose única, via oral, baseando-se na totalidade sintomática do paciente. Resultados: A porcentagem de melhora dos sinais e sintomas, entre os pacientes, foi de: lacrimejamento e dor ocular 100%; secreção ocular 92%; sensação de corpo estranho 86%; prurido e fotofobia 84%; relatavam diminuição ou ausência do desconforto que a ceratoconjuntivite primaveril provocava nas suas atividades diárias 84%; nódulos de Trantas 62,5%; hiperemia conjuntival 61%; erosões epiteliais 58% e hipertrofia da papila tarsal 8%. Conclusão: Este estudo sugere efeito benéfico da medicação homeopática no tratamento da ceratoconjuntivite primaveril, com melhora dos sinais e sintomas da doença. Sugere-se a realização de estudo duplo-cego, com maior número de casos, para a confirmação desses resultados.

Objetivos: Apresentar 20 casos de ceratite fúngica do Hospital São Geraldo, Belo Horizonte, Minas Gerais, Brasil e analisá-los quanto aos fatores associados, fungos identificados e tratamento instituído. Métodos: Foi realizada uma análise retrospectiva dos prontuários de 20 pacientes (20 olhos) com ceratite fúngica, confirmada pela cultura, durante o período de janeiro de 1994 a dezembro de 1999 no Hospital São Geraldo. Resultados: Quinze pacientes (75%) eram do sexo masculino. A idade variou de 9 a 67 anos (média de 35,7 anos). Um dos fatores associados analisado foi o trauma ocular (60%). O fungo mais freqüentemente isolado foi o Fusarium sp (60%), seguido pelo Aspergillus sp (30%). Natamicina foi o antifúngico tópico mais freqüentemente utilizado. No que diz respeito ao tratamento sistêmico, a droga mais utilizada foi o cetoconazol. Quatorze pacientes (70%) necessitaram de ceratoplastia penetrante durante a fase aguda da infecção. Conclusões: Fusarium sp foi o fungo mais isolado em nosso Serviço e a história de trauma ocular foi freqüente (60%). Nossa experiência mostrou um número maior de indicações de ceratoplastia penetrante terapêutica.

In this prospective comparative study, radiofrequency was applied to 25 eyes of 21 consecutive patients. One group comprised patients with a K-reading between 54.0 diopters (D) and 58.0 D; 8 thermal spots were placed at the 4.0 mm optical zone. The other group comprised patients with a K-reading greater than 58.0 D; 16 spots were applied at the 4.0 mm and 5.0 mm optical zones. The minimum follow-up was 18 months in all patients. Differences between preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), manifest refraction, and K-readings were clinically and statistically evaluated. RESULTS: At end of the 18-month follow-up, the mean BSCVA in the 8-spot group improved from 20/100 (0.71 G 0.25 logMAR) preoperatively to 20/40 (0.32 G 0.11 logMAR) and in the 16-spot group, from 20/200 (1.03 G 0.30 logMAR) to 20/60 (0.62 G 0.22 logMAR). The mean manifest refractive spherical equivalent (MRSE) improved from À7.70 D G 5.20 (SD) preoperatively to À6.82 G 4.41 D after 18 months in the 8-spot group and from À11.33 G 6.70 to À8.38 G 5.12 D, respectively, in the 16-spot group. The mean best contact lens-corrected visual acuity was 20/30 (0.18 G 0.24 logMAR) in the 8-spot group and 20/40 (0.31 G 0.19 logMAR) in the 16-spot group. A dense corneal scar was seen in 1 patient in the 16-spot group at the 6-month follow-up. CONCLUSIONS: Radiofrequency appeared safe for the treatment of advanced keratoconus. Contact lens fitting was stable in all cases.

Introduction: To adapt and replicate deep learning-based methods for the
automated detection of flow signals in OCT imaging, focusing on their
application to the retinas of healthy cynomolgus monkeys.
Methods: From 193 healthy cynomolgus monkeys, an unprecedented
number of 382 coregistered OCT and OCTA stack pairs were obtained for
training, evaluation, and separate testing. An adapted U-Net architecture
with an additional max-pooling layer to account for the large spatial input
format was used. The net was trained with an Adam Optimizer and a Mean
Squared Error loss function until the loss on the validation set reached
a plateau (21,000 steps).The following metrics were calculated for each
OCT and OCTA B-scan pair in the test set: mean-squared error (MSE),
structural similarity index (SSI), and peak signal to noise ratio (PSNR).
Results: The developed deep learning method allowed to automatically
detect the flow signal within the native structural OCT scans in animals.
The average MSE over all test set image pairs was 0.00370368 with a
standard deviation of 0.000825. Average SSI was 0.88339 with a standard
deviation of 0.02167 and the average PSNR was 24.43170 dB with a
standard deviation of 1.08154 dB. No large difference in the distribution
of MSE, SSI, and PSNR were found among eyes and among individual
cynomolgus monkeys.

Background: The purpose of our study was to estimate the variations between TBUT (Tear
f
ilm breakup time)  Schirmers test (ST)value and MGD(Meibomian gland dysfunction)
between a normal eye and an eye with pterygium.
Methods: 50 patients with unilateral pterygium were enrolled in our study.  TBUT,
ST measurements, MGD and conjunctival congestion  were evaluated. The results were
compared between eyes with pterygium (Cases)and normal eyes of the same patient (controls).
Pterygium was graded based on the length of limbal invasion into 3 grades. We have also
evaluated the relationship between grades of pterygium and TBUT and Schirmer I test .
Results: The mean TBUT in cases(eyes with pterygium) was 5.16±1.89 seconds and the mean
TBUT in controls(eyes without pterygium) was 7.00±1.47 seconds . The mean wetting length
of Schirmer’s strip was 10.96±3.51mm in cases and 13.90±4.5 mm in controls. Schirmer’s
test was statistically significant between the eyes with pterygium and eyes without pterygium
with P < 0.0001.
In patients with pterygium 36% had MGD (Meibomian gland dysfunction) of varying
severity whereas 26.5% of eyes without pterygium had MGD. There was no association of
MGD between eyes with pterygium and the eyes without pterygium.
Conclusion: Our study has shown that TBUT and Schirmers test values have an association
with pterygium.

Glaucoma is a group of eye diseases that can lead to damage of the optic nerve. The optic nerve transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. [5] A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). [1] It is associated with old age, a family history of glaucoma, and certain medical conditions or the use of some medications. [6] The word glaucoma comes from the Ancient Greek word γλαυκός (glaukós), meaning 'gleaming, blue-green, gray'. Of the different types of glaucoma, the most common are called open-angle glaucoma and closedangle glaucoma. [7] Inside the eye, a liquid called aqueous humor helps to maintain shape and provides nutrients. The aqueous humor normally drains through the trabecular meshwork. In openangle glaucoma, the drainage is impeded, causing the liquid to accumulate and the pressure inside the eye to increase. This elevated pressure can damage the optic nerve. In closed-angle glaucoma, the drainage of the eye becomes suddenly blocked, leading to a rapid increase in intraocular pressure. This may lead to intense eye pain, blurred vision, and nausea. Closed-angle glaucoma is an emergency requiring immediate attention. [1] If treated early, the progression of glaucoma may be slowed or even stopped. Regular eye examinations, especially if the person is over 40 or has a family history of glaucoma, are essential for early detection. [8] Treatment typically includes prescription of eye drops, medication, laser treatment or surgery. [1][9] The goal of these treatments is to decrease eye pressure. [2] Glaucoma is a leading cause of blindness in African Americans, Hispanic Americans, [10][11] and Asians. [12] Its incidence rises with age, to more than eight percent of Americans over the age of eighty, [1][6] and closed-angle glaucoma is more common in women. [2]

Diabetic Retinopathy (DR) is a microvascular complications caused by increase of insulin in blood, leading to blindness or vision loss because of changes in blood vessels of retina. DR is highly preventable with regular screening and timely intervention of lesions which can help ophthalmologists in detecting at an early stage. The background or non-proliferative DR contains four types of lesions, i.e. microaneurysms, hemorrhages, hard exudates and soft exudates. This paper presents a novel automatic approach for detecting DR in eye fundus images by employing image processing techniques. The proposed system consists of preprocessing, feature extraction using Gray Level Co-Occurrence Matrix (GLCM), and classification is done using Support Vector Machine (SVM) and k Nearest Neighbor (kNN). The proposed system uses genetic algorithm to evaluate and test publicly available retinal image database using performance parameters such as sensitivity, specificity and accuracy. Keywords— Diabeti...

The free-living protozoan Acanthamoeba is recognized as an agent of corneal disease, especially keratitis. Furthermore, this organism is opportunistic in immunosuppressed patients, in whom it causes disseminated fatal diseases like otitis, chronic sinusitis, skin ulcers and a rare form of encephalitis referred to as Granulomatous Amoebic Encephalitis (GAE). Although Acanthamoeba Keratitis may result from accidental eye trauma, most cases are associated with contact lens wearers, with soft contact lenses having the highest risk of infection.In the present communication, four cases of Acanthamoeba keratitis diagnosed out of 110 patients suffering from eye infections from different hospitals and eye clinics are being reported along with a study on the effect of commercial contact lens cleaning solutions on isolated Acanthamoeba polyphaga. Diagnosis in all these patients was based on observation of Acanthamoeba in wet mount of corneal ulcer scrapings and its subsequent culture in agar plate. Thermal disinfection killed all trophozoites of A. castellanii and A. polyphaga. The chlorhexidine solution killed all A. castellanii trophozoites and cysts, but only delayed excystation of A. polyphaga organisms. The reason for the apparent greater effectiveness of this solution over the other chemical disinfection solution is not clear. It is also unclear that whether different strains of Acanthamoeba species would be variably susceptible to this disinfection solution However, results of this study indicate that there may also be strains of Acanthamoeba infecting eyes leading to amoebic Keratitis besides bacteria. Chlorhexidine solution out of all Contact lens cleaning solutions used was more effective overall in killing Acanthamoeba trophozoites and cysts as compared to cold disinfection solutions.

One of the major disadvantages of centrifugal elutriation (CE) is the relatively large volume (150 ml) of the various fractions, especially if small numbers of cells have to be separated and the fractions contain few cells. To reduce the volume of the fractions 2 elutriator rotors were coupled in series. Since the rotor speed of the second rotor was always kept 750 rpm liigher than that of the first rotor, cells elutriated from rotor 1 were collected in rotor 2. After elutriation of a complete fraction from rotor 1, and collection in rotor 2, the cells were harvested from rotor 2, This was achieved by means of a flow distribution unit (FDU), which made it possible to disconnect the flow of both rotors and simultaneously reverse the flow of the second rotor. It is demonstrated that 40-95 X lO 6 mononuclear leukocytes may be fractionated without loss of resolution in fractions of only 9 ml. The lymphocyte ( > 99%) and monocyte subpopulations (88-94%) obtained were as pure as with CE carried out with only 1 rotor. In addition, the cells in rotor 2 could be washed and suspended in culture medium prior to harvesting by means of the FDU. In this way loss of cells by additional centrifugation steps was avoided, Erythrocytes (RBC) present in certain lymphocyte fractions were lysed with N H 4C1 and after lysis of the RBC and elution of ghosts and debris, the cells were washed and harvested. This procedure did not affect cell viability and the PHA response of the lymphocytes. The versatile system described made it possible to apply CE for the separation of small numbers of cells without loss of resolution, and demonstrated that CE is ideally suitable for concentration and washing of cells, and removal of contaminating RBC, not affecting the recovery, viability and function of the cells.

Confocal reflectance microscopy of skin and other tissues in vivo is currently limited to imaging at the cellular, nuclear and general architectural levels due to the lack of microstructure-specific contrast. Morphologic and functional imaging at specific organelle and microstructure levels may require the use of exogenous contrast agents in small (nontoxic) concentrations, from which weakly backscattered light must be detected in real time. We report an analysis based on Mie theory to predict detectability, in terms of signal-tobackground and signal-to-noise ratios, of reflectance contrast agents within skin and microcirculation. The analysis was experimentally verified by detectability of (a) intravenously injected polystyrene microspheres that enhance the contrast of dermal microcirculation in Sprague-Dawley rats, and (b) acetic acid-induced compaction of chromatin that enhances nuclear morphology in normal and cancerous human skin. Such analyses and experiments provide a quantitative basis for developing the opto-biochemical properties and use of contrast agents and for designing confocal instrumentation to enable real-time detectability in vivo.

The Ocular Protection Index (OPI) 2.0 System was developed to evaluate ocular surface protection under a natural blink pattern and normal visual conditions. The OPI 2.0 System implements fully automated software algorithms which provide a real-time measurement of corneal exposure (breakup area) for each interblink interval during a 1-minute video. Utilizing this method, the mean breakup area (MBA) and OPI 2.0 (MBA/interblink interval) were calculated and analyzed. The purpose of this study was to verify and validate the OPI 2.0 System for its ability to distinguish between dry eye and normal subjects, and to accurately identify breakup area. Methods: In order to verify and validate the OPI 2.0 System, a series of artificial images and a series of still image frames captured during an actual clinical session using fluorescein staining videography were analyzed. Finally, a clinical validation process was completed to determine the effectiveness and clinical relevance of the OPI 2.0 System to differentiate between dry eye and normal subjects. Results: Software analysis verification conducted in a set of artificially constructed images and in actual videos both saw minimal error rates. MBA and OPI 2.0 calculations were able to distinguish between the qualifying eyes of dry eye and normal subjects in a statistically significant fashion (P , 0.001 for both outcomes). As expected, dry eye subjects had a higher MBA and OPI 2.0 than normal subjects (0.232, dry eye; 0.040, normal and 0.039, dry eye; 0.006, normal, respectively). Results for the worst eyes and all qualifying analyses based on staining, forced-stare tear film breakup time, and MBA were numerically similar. The OPI 2.0 System accurately identifies the degree of breakup area on the cornea and represents an efficient, clinically relevant measurement of the pathophysiology of the ocular surface.

Waardenburg syndrome is an autosomal dominant disorder often characterised by pigmentary anomalies of skin and hair and various defects of neural crest tissues. It accounts for 1-3% of all cases of congenital deafness. Here we describe two siblings, congenitally mute and deaf with heterochromia irides. Case I; is one and half year old male with complete heterochromia irides and associated Hirschprung's disease. Case II is seven year old female with bilateral partial heterochromia irides.

The anterior chambers of 27 rabbit eyes were perfused at constant pressure with room temperature (25°C) or cooled (11°C) balanced salt solution at constant flow rates of 4 8 ml/min or 8.5 ml/min. Intraocular-temperature changes in the anterior chamber, anterior vitreous, mid vitreous, and posterior vitreous and on the retina surface were monitored with an intraocular thermocouple probe. Perfusion of the anterior chamber of the pigmented rabbit eye with cooled fluid significantly reduced the temperature of the anterior chamber and anterior vitreous and even that of the retina. Both an increase in the rate of perfusion and a lowering of the perfusion temperature enhanced the cooling effect. The observed decrease in temperatures returned to approximately normal 4 minutes following the cessation of perfusion.

Background: Vascular insufficiency has been reported to be a cause of normal tension glaucoma (NTG). The aim of this study was to compare ocular perfusion pressure (OPP) and ophthalmic artery flow (OAF) between patients with NTG and those without glaucoma. Methods: We considered one eye each from 31 NTG and 15 non-glaucoma control patients. Blood pressure and intraocular pressure (IOP) were measured in the sitting position, for calculation of OPP. Humphrey visual field (HVF) assessment was then carried out on NTG patients. All patients then underwent Transcranial Doppler ultrasound measurements of OAF parameters, including mean flow velocity (MFV), end diastolic velocity (EDV), peak systolic velocity (PSV) and resistive index (RI). We looked at differences in OPP and OAF parameters between the two groups, and their correlations in NTG patients. T-tests, χ 2 , ANOVA and Pearson Correlation tests were performed, with p < 0.05 considered statistically significant. Results: There were no statistically significant differences in OPP between the NTG and control groups (60.5+/-8.7 mmHg and 62.9+/-10.2 mmHg respectively, p = 0.393), and also no statistically significant differences in MFV, EDV, PSV and RI (all p > 0.05). In the NTG group, there were positive correlations between OPP and both MFV (r = 0.416, p = 0.020) and EDV (r = 0.369, p = 0.041). There were no statistically significant correlations between HVF mean deviation and OPP or OAF parameters (all p > 0.05). Conclusion: There is no difference in OPP and OAF parameters between patients with NTG and non-glaucoma controls, suggesting that vascular insufficiency or dysregulation by themselves may not account for the pathogenesis of NTG.

Purpose: The purpose of this report was to describe 2 cases of periocular infantile hemangiomas (IHs) that were successfully treated with low-dose oral propranolol alone and in combination with oral prednisolone. Methods: Two infants aged 3 months and 6 weeks, respectively, were referred for management of visionthreatening periocular IHs causing ocular displacement and obscuration of the visual axis. The first infant had a superficial left upper eyelid capillary hemangioma with extraconal extension and the second infant had a deep preseptal capillary hemangioma in the right lower eyelid with intraconal extension. Both cases were started on oral propranolol 0.5 mg/kg/day in divided doses and titrated up to 1.5 mg/kg/day as first-line therapy. The first infant was also given oral prednisolone 2 mg/kg/day during the initial first month of treatment. Results: Rapid regression in sizes of the hemangiomas was seen within the first 3 days of treatment. By 2 months of therapy, both infants had achieved normal ocular alignment. The second infant experienced a transient period of hypotension after the first dose of propranolol was started but recovered spontaneously. Both infants did not experience any adverse effects of propranolol throughout the treatment period. Conclusions: Low-dose oral propranolol is an effective first-line therapy for the management of visionthreatening IH. Dose escalation in combination with oral prednisolone after pediatric assessment might be useful in avoiding adverse effects of propranolol in young infants.

Most general practitioners and physicians are familiar with the risk factors, clinical presentation, and management of retinopathy in patients with diabetes mellitus, commonly termed diabetic retinopathy. Fewer doctors are fully informed about other ocular and systemic causes of retinopathy or the clinical significance of retinopathy in patients without diabetes (referred to as non-diabetic retinopathy in this review). However, retinopathy is fairly common in adults without diabetes, 1-4 and doctors routinely encounter such patients in whom clinical or laboratory evidence of hyperglycaemia is consistently absent. Although some patients with retinopathy will have an obvious aetiology (for example, severe anaemia, systemic lupus erythematosis, or underlying carotid disease), many do not have an easily identifiable cause for their retinal signs. What course of action should the doctor take when faced with retinopathy in a patient without diabetes? What are the common ocular and systemic causes of retinopathy? What is the clinical significance of these retinopathy lesions? These and other matters are discussed in this review. We reviewed studies on ocular and systemic causes of "retinopathy" from Medline and textbooks. We specifically excluded "diabetic retinopathy." Non-diabetic retinopathy has been defined in different studies to include microaneurysms, retinal haemorrhages (dot, blot, and flame shaped), hard exudates, cotton wool spots, retinal venular abnormalities (venous beading and tortuosity), intraretinal microvascular abnormalities, and new vessels. The ocular and systemic causes of retinopathy in people without diabetes are varied (see table on bmj.com). Central retinal vein occlusion and branch retinal vein occlusion can present with non-diabetic retinopathy. The appearance on funduscopy is usually characteristic, with flame shaped haemorrhages present within the distribution of the affected vein (fig ). The patient may complain of a sudden painless unilateral loss of

Proponuję model Kryterium Zapłonu, w którym jawność doświadczenia pojawia się wtedy, gdy w krótkim oknie ~1-2 s skutecznie współ-czasują cztery elementy tetrady: (N) dynamika nerwowa (forma), (H) rytm sercowo-krwionośny (przepływ), (G) oś brzuszno-łydkowa (pojemność/preload) oraz (W) akt Świadka (Obecność Serca). Do naszej wiedzy nowość polega na: (1) operacjonalizacji Świadka jako aktu (znacznik czasu + mikro-gest), który powinien zwiększać HEP/koherencję EKG-EEG i poprawiać detekcję bodźców time-locked do R-peaku (Park & Tallon-Baudry, 2014; Azzalini, Rebollo, & Tallon-Baudry, 2019); (2) włączeniu osi brzuszno-łydkowej jako czynnego regulatora powrotu żylnego i barorefleksu, którymodulując preload i pobudliwość kory -bramkuje uświadamianie Delis et al., 2000;. Operacjonalizacja obejmuje: HEP, HRV/BRS, koherencję EKG-EEG oraz wskaźniki złożoności EEG (LZC/PCI), dopełnione fenomenologią oznaczonego wejścia w Świadka (Thayer et al., 2012;. Projekt porównuje ekspertów Ruchu Autentycznego z aktywną kontrolą w zadaniach on/off-R oraz w blokach interwencyjnych "miękkiego mostu" (wydech-pivot szyi-kołys miednicy; opcjonalnie puls łydek) . W wariancie relacyjnym testujemy paradygmat "jednego zdania-ruchu": przewidujemy zbieżność HEP i synchronię oddechu u dwojga względem ciszy . Hipotezy: faza serca bramkuje jawność silniej przy HRV/BRS↑; interwencje "od dołu" podnoszą HEP i trafność/pewność detekcji; DRA wykazuje stabilniejsze sprzężenie κ (Azzalini et al., 2019; Park & Tallon-Baudry, 2014). Jeśli potwierdzone, model wniesie krótkie protokoły regulacyjne oraz falsyfikowalny opis komunii relacji jako synchronii dwóch tetrad. Słowa kluczowe: Kryterium Zapłonu (tetrada N-H-G-W), Świadek / Obecność Serca, Oś brzuszno-łydkowa (przepona-łożysko trzewne-pompa łydkowa, HEP -heartbeat-evoked potentials, HRV / BRS (barorefleks), Koherencja EKG-EEG / sprzężenie fazowe, Złożoność EEG (LZC) / PCI, Dyscyplina Ruchu Autentycznego (Świadomość Świadka)

To document the incidence and treatment of patients with severe ocular and ocular adnexal injuries during Operation Iraqi Freedom. Design: Retrospective hospital-based observational analysis of injuries. Participants: All coalition forces, enemy prisoners of war, and civilians with severe ocular and ocular adnexal injuries. Methods: The authors retrospectively examined severe ocular and ocular adnexal injuries that were treated by United States Army ophthalmologists during the war in Iraq from March 2003 through December 2005. Main Outcome Measures: Incidence, causes, and treatment of severe ocular and ocular adnexal injuries. Results: During the time data were gathered, 797 severe eye injuries were treated. The most common cause of the eye injuries was explosions with fragmentation injury. Among those injured, there were 438 open globe injuries, of which 49 were bilateral. A total of 116 eyes were removed (enucleation, evisceration, or exenteration), of which 6 patients required bilateral enucleation. Injuries to other body systems were common. Conclusions: Severe eye injuries represent a significant form of trauma encountered in Operation Iraqi Freedom. These injuries were most commonly caused by explosion trauma.

To report 7 patients with paradoxical use of the frontalis muscle despite postsurgical correction of ptosis with good postoperative eyelid position. Successful treatment with botulinum A toxin facilitated motor relearning and cessation of muscle contraction. Design: Interventional case series. Participants: Seven patients, in 2 eye-plastic clinics, who underwent successful surgical correction of upper eyelid ptosis. Methods: Review of clinical history, clinical photographs, treatment, and follow-up. Main Outcome Measures: Frontalis muscle contraction and upper eyelid position. Results: Patients underwent successful surgical correction of ptosis but continued using the frontalis muscle despite good eyelid position postoperatively. Frontalis contraction ceased spontaneously in 2 patients, but required botulinum A toxin injection in 5. The effects of a single treatment of botulinum A toxin lasted from 3 months to 2 years, longer than the expected effect of the toxin. Patients with long-standing eyelid ptosis may paradoxically continue utilizing the frontalis after successful surgical correction and despite good postoperative eyelid position. Cessation of frontalis contraction can be achieved with a single injection of botulinum A toxin. We hypothesize that chemodenervation, achieved with the toxin, may influence the central nervous system to relearn the set point for muscle contraction and may be associated with permanent motor relearning. Spontaneous resolution of muscle contraction can occur in the first months after surgery.

Purpose-To analyze the retinal structure underlying the hyperautofluorescent ring visible on fundus autofluorescence in patients with retinitis pigmentosa. Methods-Twenty-four eyes of 13 patients with retinitis pigmentosa, aged 13 years to 67 years, were studied. The integrity of the photoreceptor cilia, also known as the inner/outer segment junction of the photoreceptors, the outer nuclear layer, and retinal pigment epithelium, was evaluated outside, across, and inside the ring with spectral-domain optical coherence tomography (OCT). Results-Inside the foveal area, fundus autofluorescence did not detect abnormalities. Outside the ring, fundus autofluorescence revealed hypoautofluorescence compatible with the photoreceptor/ retinal pigment epithelium degeneration. Spectral-domain OCT inside the ring, in the area of normal foveal fundus autofluorescence, revealed an intact retinal structure in all eyes and total retinal thickness values that were within normal limits. Across the ring, inner/outer segment junction disruption was observed and the outer nuclear layer was decreased in thickness in a centrifugal direction in all eyes. Outside the hyperautofluorescent ring, the inner/outer segment junction and the outer nuclear layer appeared to be absent and there were signs of retinal pigment epithelium degeneration. Conclusion-Disruption of the inner/outer segment junction and a decrease in outer retinal thickness were found across the central hyperautofluorescent ring seen in retinitis pigmentosa. Outer segment phagocytosis by retinal pigment epithelium is necessary for the formation of an hyperautofluorescent ring.

The space of visual signals is high-dimensional and natural visual images have a highly complex statistical structure. While many studies suggest that only a limited number of image statistics are used for perceptual judgments, a full understanding of visual function requires analysis not only of the impact of individual image statistics, but also, how they interact. In natural images, these statistical elements (luminance distributions, correlations of low and high order, edges, occlusions, etc.) are intermixed, and their effects are difficult to disentangle. Thus, there is a need for construction of stimuli in which one or more statistical elements are introduced in a controlled fashion, so that their individual and joint contributions can be analyzed. With this as motivation, we present algorithms to construct synthetic images in which local image statistics-including luminance distributions, pair-wise correlations, and higher-order correlations-are explicitly specified and all other statistics are determined implicitly by maximum-entropy. We then apply this approach to measure the sensitivity of the human visual system to local image statistics and to sample their interactions.

To examine ocular outcomes and survival after proton irradiation in patients with peripapillary and parapapillary melanomas ineligible for the Collaborative Ocular Melanoma Study. Methods: A total of 573 patients who received proton irradiation from January 4, 1985, through December 24, 1997, for tumors located within 1 disc diameter of the optic nerve, and therefore ineligible for the Collaborative Ocular Melanoma Study, were evaluated. Cumulative rates of vision loss in the treated eye, eye loss, melanoma-related mortality, and tumor recurrence were estimated using the Kaplan-Meier method. Results: Most (53.4%) tumors abutted the optic disc; median distance from the tumor to the macula was 0.5 disc diameters. By 5 years after proton therapy, radiation papillopathy had developed in 56.8% and maculopathy in 60.4% of patients. Of 450 patients with a base-line visual acuity of 20/200 or better in the treated eye, vision was retained in 54.9% at 2 years after irradiation. This decreased to 20.3% by 5 years after treatment, although 56.2% had visual acuity of counting fingers or better. Five-and 10-year rates of local recurrence were 3.3% and 6.0%, respectively. Enucleation rates were 13.3% at 5 years and 17.1% at 10 years after treatment. Melanoma-related mortality rates were similar to those in our larger cohort of patients (24.0% at 15 years).

Purpose Previous studies have reported increased audiometric thresholds in patients with pseudoexfoliation syndrome (XFS), compared with normative data. This study examines mean audiometric thresholds and tympanometric peak values in patients with XFS and in a control group. Methods This is a prospective, nonrandomized control case study. Patients with XFS in one or both eyes constituted the study group (SG). Patients without XFS in either eye constituted the control group (CG). Patients with a history of conditions affecting hearing function were excluded. The SG and the CG included 54 and 48 patients, respectively. Pure tone hearing thresholds levels were measured at 0.25, 1, 2, 3, and 8 kHz. Tympanometric peak values were also recorded. Differences in audiometric mean threshold values and tympanometric peak values between SG and CG, as well as between glaucomatous and nonglaucomatous eyes, were examined. Results Bone and air audiometric thresholds were significantly increased in ...

This case report describes a 36-year-old woman who presented with a giant sebaceous nevus affecting her right periauricular area, right facial region, and neck. Excision of all lesions was performed. The remaining defect was reconstructed using local tissue flaps and full-thickness skin grafting, resulting in a favorable aesthetic outcome.

Aim-Evaluation of potential side eVects of photon radiotherapy on the transparency of the lens. Methods-The anterior segments of 14 phakic eyes from patients suVering from subfoveal neovascularisation as a result of age related macular degeneration (AMD) were documented by Scheimpflug photography (Topcon SL-45, Kodak Tmax 400) before the start of radiotherapy as well as 6 and 12 months afterwards. All negatives were evaluated by microdensitometry, and peak heights for distinct layers of the lens were used for statistical comparison. External beam radiotherapy (6 MeV photons) consisted of a total dose of 20 Gy, delivered as 10 fractions of 2 Gy. Results-Six and 12 months following irradiation statistical comparison of the ratios in density change of lenses from irradiated versus non-irradiated fellow eyes revealed statistically significant (p<0.05) loss of transparency of layers 5 and 7 of the nuclear region. In layer 1 (capsuloepithelial complex) the changes were close to significance. At the 12 month examination, however, all of these significant changes had disappeared. Conclusion-Six months following radiotherapy for AMD, both the anterior capsuloepithelial region and the nuclear layers showed precataractous changes. As most of these significant diVerences had disappeared after 12 months, it is obvious that these findings reflect acute radiation damage to the lens epithelial cells and an ionising eVect on the proteins of the lens nucleus. Long term studies will have to be carried out to demonstrate whether or not this acute radiation damage, which is expressed as a transient increase in light scattering of some layers of the lens, actually does lead to permanent transparency changes, thus reflecting radiation cataractogenesis, and if so, after what time interval and to what extent cataract occurs.

In a previous study, we investigated physical methods to reduce whole-body, diet-related autofluorescence interference in several mouse strains through changes in animal diet. Measurements of mice with an in vivo multispectral imaging system over a 21-day period allowed for the quantification of concentration changes in multiple in vivo fluorophores. To be an effective instrument, a multispectral imaging system requires a priori spectral knowledge, the form and importance of which is not necessarily intuitive, particularly when noninvasive in vivo longitudinal imaging studies are performed. Using an optimized spectral library from a previous autofluorescencereduction study as a model, we investigated two additional spectral definition techniques to illustrate the results of poor spectral definition in a longitudinal fluorescence imaging study. Here we systematically evaluate these results and show how poor spectral definition can lead to physiologically irrelevant results. This study concludes that the proper selection of robust spectra corresponding to each specific fluorescent molecular label of interest is of integral importance to enable effective use of multispectral imaging techniques in longitudinal fluorescence studies.

ment-epithelial-derived macrophages, leading to eventual desmosomal adhesion between MUller cells in the neuro retina and the pigment epithelium. In view of these find ings it is perhaps surprising that the sort of macroscopic retinal necrosis we describe has not been reported before. The factors responsible for the unusual response in this case may include an inherent structural weakness in the retina. The scleral thinness and splits as well as the pre vious adverse reactions in the fellow eye to surgical inter vention may support this. It is probable that cryotherapy further alters the structure of the extracellular matrix pro teins leading to a critical loss of structural integrity. How ever, scleral thinness is a common finding in patients with retinal detachment and one would expect such necrosis to occur more often if this were a significant factor. The scleral thinness may also have contributed to inad vertently heavy cryotherapy, which was suggested as the cause of the cases reported by Okubo and Uemura.' Elec tron microscopy has shown that extension of cellular nec rosis into the inner retinal layers does increase with strength of application as judged by clinical retinal whitening, traversing the whole retina including the nerve fibre layer in the heaviest lesions.6 Overtreatment is thought to be unlikely as a factor in this case since the cryotherapy was applied by a very experienced retinal sur geon (J.D.S.) who is scrupulous in avoiding retreatment of any area of retina. Furthermore if retinal necrosis were simply the result of excess cryotherapy it would be expected to be more commonly reported, especially in the hands of trainees. The exact reasons for the development of retinal nec rosis in this case are unknown. We felt it important to report this unusual and dramatic complication of cryotherapy.

A rare case of hyperlipropoteinemia in a 35-day-old infant who presented not only high blood levels of cholesterol and triglycerides but also an ocular manifestation described as lipemia retinalis. The fundoscopic abnormality cleared as the levels of chilomicrons in plasma dropped. Lipemia retinalis is an important and reliable parameter of high levels of chilomicrons and triglycerides and should be considered as a significant clue while diagnosing.

Purpose: To evaluate the retinal toxicity of varying doses of bevacizumab when injected intravitreally in rabbits. Bevacizumab has been approved by the US Food and Drug Administration for the treatment of metastatic colorectal cancer. Materials and Methods: Twelve New Zealand albino rabbits were used for this study and divided into four groups. Four concentrations of bevacizumab were prepared: 500 g/0.1 mL, 1.0 mg/0.1 mL, 2.5 mg/0.1 mL, and 5.0 mg/0.2 mL. Each concentration was injected intravitreally in one eye of each of three rabbits; 0.1 mL volume of sterile balanced saline solution was injected into the contralateral eyes. Slit-lamp and funduscopic examinations were performed and the animals were observed for 2 weeks for signs of infection, inflammation, or toxicity. A baseline electroretinogram (ERG) was performed before the drug treatment and at day 14 before the animals were killed. The enucleated eyes were prepared for histologic evaluation of retinal toxicity. Results: Histologic and ERG results in all groups showed no retinal toxicity. However, some inflammatory cells were found in the vitreous at the 5-mg dose. Conclusions: Intravitreal bevacizumab did not appear toxic to the retina in albino rabbits at a concentration of 2.5 mg. Intravitreally injected bevacizumab should be evaluated for efficacy in choroidal neovascularization and macular edema.

Purpose: To evaluate retinal toxicity of varying doses of rapamycin when injected intravitreally in rabbits. Rapamycin is a potent immunosuppressive agent with significant antitumor and antiangiogenic properties, clinically approved for prevention of organ transplant rejection. Methods: Twelve New Zealand albino rabbits were divided into four groups. Four different doses of rapamycin were prepared in 0.1 ml: 20 μg, 50 μg, 200 μg, and 1000 μg. Each concentration was injected in one eye of three rabbits, and 0.1 ml volume of sterile BSS was injected into the contralateral eye of the three rabbits. Slit-lamp and fundoscopic examinations were performed and the animals were observed for 2 weeks for signs of infection, inflammation, and toxicity. A baseline ERG was performed before drug treatment and at day 14, after which the rabbits were euthanized. Histology of the enucleated eyes was studied to look for retinal toxicity. Results: ERG results showed some decrease in scotopic response; however this was not dose related. ERG results were normal at 20 μg. Histological results showed no retinal toxicity in all groups. Conclusion: Although ERG changes were identified at dosages between 50-1000 μg, the histology of all groups up to 1000 μg did not show any discernable abnormalities.

A rare case of hyperlipropoteinemia in a 35-day-old infant who presented not only high blood levels of cholesterol and triglycerides but also an ocular manifestation described as lipemia retinalis. The fundoscopic abnormality cleared as the levels of chilomicrons in plasma dropped. Lipemia retinalis is an important and reliable parameter of high levels of chilomicrons and triglycerides and should be considered as a significant clue while diagnosing.

A successful application of self-interference digital holographic microscopy in combination with a sample-rotation-based tomography module for three-dimensional (3-D) label-free quantitative live cell imaging with subcellular resolution is demonstrated. By means of implementation of a hollow optical fiber as the sample cuvette, the observation of living cells in different 3-D matrices is enabled. The fiber delivers a stable and accurate rotation of a cell or cell cluster, providing quantitative phase data for tomographic reconstruction of the 3-D refractive index distribution with an isotropic spatial resolution. We demonstrate that it is possible to clearly distinguish and quantitatively analyze several cells grouped in a "3-D cluster" as well as subcellular organelles like the nucleoli and local internal refractive index changes.

Aim: To evaluate the performance of a new Extended Depth Of Focus (EDOF) Evolux Intraocular Lenses (IOLs), an extended monofocal IOL with a non-diffractive profile designed to improve intermediate vision while providing distance vision comparable to monofocal IOLs, in terms of Visual Acuity (VA) at various distances and contrast sensitivity. Materials and methods: Twenty five patients (50 eyes) were included in this retrospective case series. Every patient underwent bilateral implantation of Evolux IOLs after cataract surgery. Preoperative and postoperative parameters evaluated included axial length, IOL power, refractive error in terms of spherical equivalent (SE) and VA for various distances. Patients were reviewed periodically after surgery. At 1 month after surgery, Contrast Sensitivity (CS) was assessed. Results: The study included 14 (56%) male and 11 (44%) female patients. Significant improvement in VA was observed at all distances. When assessing uniocular VA, near VA > N8 was seen in 80% of eyes, intermediate VA > 6/9 was seen in 54% eyes and distance VA > 6/6 was seen in 96% eyes. Binocular VA at 1 month showed 92% of patients with near vision comparable to N8 or better and 96% with distance vision of 6/6 or better. The mean CS was 0.07 ± 0.02. At 1 month, the mean SE was-0.33 ± 0.46 Conclusion: This study shows that extended mono focal Evolux iols with non-diffractive optical profile safe, effective and stable providing excellent distance vision, intermediate vision and better near vision compared to standard monofocal IOLs.

Background: Dry eye disease is a prevalent condition affecting the ocular surface, leading to discomfort, inflammation and potential vision loss. Among its various causes, Meibomian Gland Dysfunction (MGD) and the presence of Demodex mites are notable contributors. Objective: This study aims to investigate the relationship between Demodex infestation and the severity of MGD. Methods: A total of 30 patients (60 eyes) treated at Thammasat Hospital were enrolled. Comprehensive eye examinations, including best-corrected visual acuity, slit-lamp biomicroscopy and meibomian gland assessment using the Keratograph 5 M, were performed. Eyelash samples were collected to detect Demodex presence under microscopy. Statistical analyses were conducted to explore correlations between Demodex detection, MGD severity, age and gender. Results: The mean age of participants was 59.83 ± 15.27 years. Demodex was detected in 21.7% of eyes, with a significant association found between age over 60 and Demodex presence (p = 0.028). No correlation was observed between Demodex detection and the severity of MGD, nor between Demodex presence and gender. Conclusions: This study indicates that while Demodex infestation is more prevalent in older patients, it does not correlate with the severity of meibomian gland dysfunction. Further research with larger sample sizes and advanced methodologies is warranted to better understand the interplay between Demodex and dry eye disease.

The main purpose of the study was to describe the surgical success rate and visual results of penetrating keratoplasty in children. This retrospective study included children that underwent corneal transplantation at the Department of Ophthalmology, General Hospital "Sveti Duh", in the period 1994-1999. Patients' age ranged from 6 to 16 years. Twenty-five corneal transplants were performed in 24 eyes. Corneal pathologies were corneal leucoma, congenital dystrophy, corneal combustion, corneal scar after perforating injury, keratoconus, corneal melting, hematocornea and rekeratoplasty. The follow-up period was at least 6 months. The rate of graft survival was 1 year in 75% of eyes with congenital dystrophy and keratoconus. Hematocornea and rekeratoplasty ended with graft failure. Postoperative visual acuity improvement was recorded in 14 out of 25 eyes. Penetrating keratoplasty in children showed very good surgical success. The final visual outcome was affected by irreversible amblyopia.

In this paper, we investigate the crossing statistics of speckle patterns formed in Fresnel diffraction region by a laser beam scattering through a nanofluid. We extend zerocrossing statistics to assess dynamical properties of nanofluid. According to joint probability density function of laser beam fluctuation and its time derivative, theoretical framework for Gaussian and non-Gaussian regimes are revisited. We count number of crossings not only at zero level but also for all available thresholds to determine the average speed of moving particles. Using probabilistic framework in determining crossing statistics, a priori Gaussianity is not essentially considered, therefore even in presence of deviation from Gaussian fluctuation, this modified approach is capable to compute relevant quantities such as mean value of speed more precisely. Generalized total crossing which represents the weighted summation of crossings for all thresholds to quantify small deviation from Gaussian statistics is introduced. This criterion can also manipulate the contribution of noises and trends to infer reliable physical quantities. The characteristic time scale for having successive crossings at a given threshold is defined. In our experimental setup, we find that increasing sample temperature leads to more consistency between Gaussian and perturbative non-Gaussian predictions. The maximum number of crossing does not necessarily occur at mean level indicating that we should take into account other levels in addition to zero level to achieve more accurate assessments.

To evaluate once-daily nepafenac 0.3% to prevent and treat ocular pain and inflammation after cataract surgery. SETTING: Sixty-five centers in the United States and Europe. DESIGN: Randomized double-masked vehicle-and active-controlled phase 3 study. Patients received nepafenac 0.3% once daily, nepafenac 0.1% 3 times daily, or their respective vehicles from day À1 to day 14 after cataract extraction. An additional drop of study drug was administered 30 to 120 minutes preoperatively. The primary endpoint was the percentage of patients with a cure for inflammation (score of 0 for both aqueous cells and flare) at day 14. Of randomized patients, 817 received nepafenac 0.3%, 819 received nepafenac 0.1%, and 200 and 206 received the respective vehicles. Significantly more nepafenac 0.3% patients had no inflammation (68.4% versus 34.0%) and were pain free (91.0% versus 49.7%) at day 14 than vehicle patients (both P<.0001). Nepafenac 0.3% was noninferior to nepafenac 0.1% for inflammation (95% confidence interval [CI], À5.73% to 3.17%) and pain-free rates (95% CI, À3.08% to 2.70%). At all postoperative visits, fewer treatment failures (P%.0012) and more clinical successes (P%.0264) were observed with nepafenac 0.3% versus vehicle. Nepafenac 0.3% was well tolerated and had a safety profile comparable to that of nepafenac 0.1%. Once-daily nepafenac 0.3% was noninferior to nepafenac 0.1% 3 times daily for prevention and treatment of ocular inflammation and pain following cataract surgery. The safety of nepafenac 0.3% was comparable to that of nepafenac 0.1%, with the added convenience of once-daily dosing.

for the iStent inject Study Group* Purpose: Evaluate the safety and effectiveness of an ab interno implanted (iStent inject) Trabecular Micro-Bypass System (Glaukos Corporation, San Clemente, CA) in combination with cataract surgery in subjects with mild to moderate primary open-angle glaucoma (POAG). Design: Prospective, randomized, single-masked, concurrently controlled, multicenter clinical trial. Participants: Eyes with mild to moderate POAG and preoperative intraocular pressure (IOP) 24 mmHg on 1 to 3 medications, unmedicated diurnal IOP (DIOP) 21 to 36 mmHg, and cataract requiring surgery. Methods: After uncomplicated cataract surgery, eyes were randomized 3:1 intraoperatively to ab interno implantation of iStent inject (Model G2-M-IS; treatment group, n ¼ 387) or no stent implantation (control group, n ¼ 118). Subjects were followed through 2 years postoperatively. Annual washout of ocular hypotensive medication was performed. Main Outcome Measures: Effectiveness end points were !20% reduction from baseline in month 24 unmedicated DIOP and change in unmedicated month 24 DIOP from baseline. Safety measures included best spectacle-corrected visual acuity (BSCVA), slit-lamp and fundus examinations, gonioscopy, pachymetry, specular microscopy, visual fields, complications, and adverse events. Results: The groups were well balanced preoperatively, including medicated IOP (17.5 mmHg in both groups) and unmedicated DIOP (24.8AE3.3 mmHg vs. 24.5AE3.1 mmHg in the treatment and control groups, respectively, P ¼ 0.33). At 24 months, 75.8% of treatment eyes versus 61.9% of control eyes experienced !20% reduction from baseline in unmedicated DIOP (P ¼ 0.005), and mean reduction in unmedicated DIOP from baseline was greater in treatment eyes (7.0AE4.0 mmHg) than in control eyes (5.4AE3.7 mmHg; P < 0.001). Of the responders, 84% of treatment eyes and 67% of control eyes were not receiving ocular hypotensive medication at 23 months. Furthermore, 63.2% of treatment eyes versus 50.0% of control eyes had month 24 medication-free DIOP 18 mmHg (difference 13.2%; 95% confidence interval, 2.9e23.4). The overall safety profile of the treatment group was favorable and similar to that in the control group throughout the 2-year follow-up. Conclusions: Clinically and statistically greater reductions in IOP without medication were achieved after iStent inject implantation with cataract surgery versus cataract surgery alone, with excellent safety through 2 years.