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Background: The comparative effectiveness of different hyperbaric oxygen (HBO) therapy doses in the acute treatment of central retinal artery occlusion (CRAO) has not been evaluated.

Methods: This retrospective cohort study aimed to compare the efficacy of an initial 2.8_ATA HBO session (HBO18) to the more prevalent 2.0_ATA protocol (HBO10). Excluded were patients with suspected inflammatory arteritis or branch retinal artery occlusion, and when HBO was medically contraindicated. Following the initial session, all patients completed two additional HBO10 sessions within 24 h. The primary outcome was the change in best corrected visual acuity (ΔBCVA) within 24 ± 4 h. Safety outcomes included neurological events suggestive of central oxygen toxicity and barotrauma-related symptoms.

Results: Improvement in ΔBCVA was significantly greater in the HBO18 group (median 0.62 LogMAR, mean -0.81 ± 0.73) compared with the HBO10 group (median 0.22 LogMAR, mean -0.34 ± 0.40, p < 0.001). Adverse events were similar in incidence between the treatment groups, with no severe occurrences necessitating the discontinuation of HBO reported. In multivariate analysis, HBO18 use was associated with a 0.5 LogMAR improvement in BCVA at 24 h (95% CI 0.3-0.7, p < 0.001), with greater initial BCVA impairment and shorter time to HBO further associated with better outcomes (0.20 LogMAR, 95% CI 0.08-0.31, p = 0.001; and 0.04 LogMAR/hour, 95% CI 0.02-0.04, p = 0.01, respectively).

Conclusions: HBO18 as the initial therapy for CRAO seems to be associated with better short-term improvement in BCVA, compared with HBO10.

Objectives: To determine the long-term effect of the administration of topical anti-glaucoma medications on Selective Laser Trabeculoplasty (SLT) efficacy and to identify other potential risk factors for failure of SLT.

Methods: A single-centre, observational cohort study of 264 SLT procedures performed on 127 patients over a 10-year period. Data collected included the absolute number of anti-glaucoma drops administered, intraocular pressure (IOP) and the number of anti-glaucoma medications at each visit. A Cox's proportional hazards regression analysis was performed to analyse various risk factors. A multivariate logistic regression model for failure in the first 12 months was constructed to adjust for potential confounders, including age, pre-SLT IOP, treatment duration, disease duration, total number of pre-SLT drops administered and SLT energy delivered.

Results: A greater number of pre-SLT drop administrations was identified as a risk factor for failure of SLT. At 12 months, the complete success rate of SLT for eyes unexposed to drops was 62%, for those to a moderate number of drops, 36-41% and for those to a high number of drops, only 2%. Other statistically significant risk factors included duration of drop therapy, exposure to drop preservatives, disease duration, age, previous cataract surgery, lower pre-SLT IOP and a lower SLT energy level.

Conclusions: Long-term exposure to topical anti-glaucoma medication (especially if preserved), longer duration of disease and therapy, together with older age and prior cataract surgery, may all have a significant adverse effect on SLT outcome.

Background/objective: Ophthalmologists rely on clinical practice guidelines to inform their practice. Not all guidelines, however, are considered trustworthy. For guidelines to be credible and evidence-based, internationally-accepted standards suggest that they must adhere to certain criteria. We aim to identify strengths and limitations of commonly used ophthalmology guidelines and provide insights to develop trustworthy, fit-for-purpose guidelines in the field.

Methods: We will search MEDLINE, Embase, Trip Database, the Royal College of Ophthalmologists ( https://www.rcophth.ac.uk/ ) and American Academy of Ophthalmology ( https://www.aao.org/clinical-statements ) websites. From these sources, we will include a purposeful sample 100 guidelines published from 2015 onwards addressing diverse areas in ophthalmology (e.g., cornea, glaucoma, retina, paediatrics, etc.) - forty guidelines from major eye care organisations and sixty from diverse ophthalmology subspecialties and regions. We will appraise each guideline according to the modified National Guideline Clearinghouse Extent Adherence to Trustworthy Standards (NEATS) instrument.

Conclusion: By identifying best practices and common pitfalls in existing guidelines, this work will provide a roadmap for creating more robust, transparent, and patient-centred clinical practice guidelines in ophthalmology.