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Purpose: To report the visual and surgical outcomes of mitomycin-C (MMC) augmented non-penetrating deep sclerectomy (NPDS) and phacoemulsification in patients with severe and end-stage glaucoma.

Materials and methods: A retrospective analysis of 349 eyes of 320 patients who underwent combined NPDS with phacoemulsification surgery between January 2018 to December 2020 were included.

Main outcome measures: Best corrected visual acuity (BCVA), status of central visual fields, intra ocular pressure (IOP), number of antiglaucoma medications (AGM) were compared from baseline to post-operative visits, surgical complications and interventions were noted.

Results: Mean logMAR BCVA improved significantly from baseline of 0.54 ± 0.42 to 0.30 ± 0.37 & 0.29 ± 0.40 at 6(p < 0.001) & 12 months (p < 0.001) postoperatively. HFA 10-2 analysis revealed no significant post operative change in mean deviation from baseline at 6 & 12 months (p = 0.072, p = 0.143) respectively. Significant post-operative reduction in mean (SD) IOP was noted from baseline of 17.54(5.43) mmHg to 15.10(5.34) & 16.23(6.87) mmHg at 6 months(p < 0.001) and one year(p < 0.001) respectively. Similarly, the need for AGM also reduced significantly from 2.95(1.01) to 1.93(0.98) & 2.01 (0.99) at 6 (p < 0.001)& 12 months(p < 0.001) postoperatively. Cumulative surgical success was 95% and 93% at 6 months and 1 year respectively. Complications were seen in 17.8% patients and most were related to poor IOP control (8.3%). Two (0.6%) patients underwent tube surgery and 3 (0.9%) had undergone diode laser cyclophotocoagulation for refractory high IOP.

Conclusion: MMC augmented NPDS combined with phacoemulsification surgery is a safe and a viable option in eyes with advanced glaucoma maintaining stable visual acuity and visual fields postoperatively.

Background: Observational studies suggest that gut microbiome (GM) may contribute to acute anterior uveitis (AAU) development, but causality remains unclear. This study was conducted to test whether specific GM taxa were causally associated with AAU.

Methods: The GM data were obtained from the DMP, which included 7738 individuals' faecal samples and an analysis of host genotype-taxa abundance associations. The AAU data were derived from the FinnGen Consortium (8624 cases and 473,095 controls). We primarily employed the inverse-variance weighted method, complemented by supplementary sensitivity analyses.

Results: Higher abundance of Lachnospiraceae noname (OR = 0.86, 95% CI 0.81-0.91, P = 5.7 × 10^-8), Alistipes finegoldii (OR = 0.87, 95% CI 0.78-0.96, P = 0.008), Erysipelotrichaceae (OR = 0.90, 95% CI 0.81-0.99, P = 0.037), Erysipelotrichia (OR = 0.90, 95% CI 0.81-0.99, P = 0.037), Erysipelotrichales (OR = 0.90, 95% CI 0.81-0.99, P = 0.037), and Bacteroides ovatus (OR = 0.93, 95% CI 0.87-1.00, P = 0.039) predicted a lower AAU risk. Conversely, higher abundance of Bifidobacterium catenulatum (OR = 1.06, 95% CI: 1.02-1.10, P = 0.005), Bacteroides coprocola (OR = 1.11, 95% CI: 1.02-1.21, P = 0.014), Parabacteroides unclassified (OR = 1.12, 95% CI 1.03-1.22, P = 0.010), and Prevotella (OR = 1.15, 95% CI: 1.01-1.29, P = 0.029) predicted a higher AAU risk. The results also showed a reverse causation from AAU to Bifidobacterium catenulatum (OR = 1.39, 95% CI: 1.03-1.86, P = 0.005).

Conclusion: This study suggests that specific GM is causally associated with AAU risk, warranting more mechanistic validation and clinical trials.

In recent years, there has been increasing recognition of the importance of diversity in pivotal randomised clinical trials (RCTs). This is vital to ensure the validity and applicability of the results in the clinical setting. In this review, we aim to assess the inclusion of females and minoritized groups in recent RCTs in age-related macular degeneration (AMD) and diabetic macular oedema (DMO) and explore any potential barriers to their enrolment. Overall, a female predominance was observed among the AMD RCTs while less than half of the study population in DMO trials were females. White participants made up the majority of the study population in both AMD and DMO trials. Gender distribution within minoritized groups has only been reported in a few trials but appears lower than in the white population. This disparity may be attributable to the difference in the prevalence of diseases between these subgroups, as well as social and/ or cultural reasons. Nonetheless, there has been an overall increase in representation of minoritized groups over the past two decades. These observations provide important perspectives to consider when applying clinical trial learnings to clinical settings.

Purpose: To report on five-year results with the PreserFlo MicroShunt (MicroShunt) for the surgical treatment of open-angle glaucoma.

Patients and methods: Retrospective case series of consecutive patients who underwent a stand-alone MicroShunt implantation at the University Eye Clinic of Maastricht. If a patient underwent the procedure in both eyes, only the first eye was included in the analysis. MicroShunt implantation was augmented with 0.2 mg/ml mitomycin-C. The primary outcome was intraocular pressure (IOP) during follow-up. Furthermore, information on IOP-lowering medication use, success rates, reoperation rates, and postoperative complications was collected.

Results: Sixty-six eyes were included for analyses. Diagnoses included primary open-angle glaucoma (88%) and pigmentary glaucoma (12%). The majority of patients had moderate or advanced glaucoma, based on the mean deviation of the visual field examination. Mean (95% - confidence interval) IOP dropped from 21.8 (20.8-22.8) at baseline to 13.2 (11.8-14.6) mmHg after 5 years (p < 0.001). Mean number of IOP-lowering medications was reduced from 2.5 (2.2-2.9) at baseline to 0.9 (0.5-1.2), 1.0 (0.7-1.4), and 1.1 (0.7-1.5) after three, four, and five years (all p < 0.001). Needling or surgical revision was performed in twelve eyes (18%). Nineteen eyes (29%) required further IOP-lowering surgery. Postoperative complications were usually mild and self-limiting and included early hypotony, shallow anterior chamber, and hyphaema.

Conclusions: After five years, the MicroShunt was found to be a safe procedure, leading to a sustained reduction in mean IOP and number of IOP-lowering medications. However, almost one third of the eyes required further IOP-lowering interventions.

Objectives: Characterise the international variation in ophthalmic trauma and determine risk factors associated with visual and anatomical outcomes for low-, middle- and high-income countries.

Subjects/methods: Observational multi-centre cohort study using data from the International Globe and Adnexal Trauma Epidemiological Eye Study (IGATES) from April 2014 to August 2023. Data on acute presentations of ophthalmic injury including open/closed globe injury, and/or Adnexal/orbital involvement, and/or intraocular/ intraorbital foreign body were collected and Ocular Trauma Score (OTS) was calculated. A total of 5350 patients (5557 eyes) from 31 centres in 12 countries were included. The main outcome measures included demographics, mechanism and setting of injury, and presenting and final visual outcomes. Descriptive statistics, Kruskal-Wallis tests and multinomial logistic regression (MLR) analysis are presented, with correction performed using the Hochberg method. P values less than 0.005 were significant.

Results: Age, gender, presenting and final best-corrected visual acuity were all strongly associated with country (p < 0.005). Poor final visual outcomes were strongly associated with OTS predictions, type of injury (p < 0.005) and delayed presentation as well as firework injuries. High-income countries (HIC) showing reduced duration to presentation (HIC 5 h) and increased improvement in visual acuity (HIC -0.40) compared to low to middle-income countries (LMICs) (28 h) (-0.19). MLR analysis identified a significant association between countries' income classification and BCVA worse than 6/60, presence of scleral, iris, limbus injury and surgery being undertaken (p < 0.005).

Conclusion: Data from 31 centres internationally identified differences in demographic trends for each country. Age was identified as a risk factor for eye injuries. Low- and middle-income countries were associated with longer delays to presentation, smaller gains in BCVA and poorer visual outcomes. IGATES provides an opportunity to collect global data on ophthalmic trauma to facilitate improved management and prevention strategies.