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Objective: To describe the clinical findings and report the incidence of patients developing non-infectious intraocular inflammation (IOI) following intravitreal faricimab injections (IVFs).

Methods: A retrospective review of electronic medical records was conducted for patients receiving faricimab intravitreal injections for neovascular age-related macular degeneration (nAMD) and diabetic macular oedema (DMO) at Moorfields Eye Hospital, London, United Kingdom, over a 24-month period.

Results: 3985 eyes from 3151 patients were included and underwent a total of 28,535 IVFs (20,982 for nAMD, 7553 for DMO). 57 eyes from 46 patients presented at least one episode of IOI. The 2-year estimated incidence of IOI was 0.20% [95% CI 0.15-0.26] per injection, 1.43% [95% CI 1.08-1.85] per eye and 1.46% [95% CI 1.07-1.94] per patient. Mean visual acuity (VA) was significantly different between the day of IVF (0.48 ± 0.43 logMAR, range: 0-1.8) and the day of IOI diagnosis (0.67 ± 0.52, range: 0-2.3) (p < 0.001). VA after IOI resolution showed no significant difference from baseline (p > 0.99). Intravitreal injections were resumed in 42 eyes. IVFs re-challenge was attempted in 9 eyes, with 5 developing another episode of IOI.

Conclusions: This study describes one of the largest reported cohorts of IOI cases following faricimab treatment. It confirms that the incidence of IOI is rare and aligns with the rates of IVF-related adverse effects reported in clinical trials and in recent real-world studies. Overall, faricimab demonstrated a favourable safety profile with good prognosis in cases of IOI.

Background: Assessment and management of dry eye disease (DED) in the UK is increasingly taking place outside of specialist ophthalmology settings. While comprehensive, evidence-based international guidance exists, much of it does not reflect the realities of practice in the UK. A panel of experts was brought together to identify areas of consensus on assessment, management, and appropriate referral of DED in the UK National Health Service (NHS).

Methods: A questionnaire was circulated to a panel consisting of 15 optometrists, ophthalmologists, and corneal specialists with experience and expertise in DED. Based on their responses, consensus statements were developed and underwent two rounds of voting, in which respondents indicated to what extent they agreed with each statement. A core steering panel of seven experts discussed the results and provided further context for the statements.

Results: Strong or very strong consensus was reached for 57/62 statements. Statements with very strong consensus included guidance on the minimum symptoms and signs to be assessed on initial presentation and simple guidance for grading the severity of the disease. Statements regarding initial treatment were divided by setting (primary and secondary care), and a strong or very strong consensus was reached on 17/20 statements relating to treatment options in these settings. Statements specific to referral included approximate target timelines, where possible, as well as guidance on key supporting information to help improve the efficiency of patient care.

Conclusions: This consensus provides a UK-focused resource to support consistent and effective care for patients with DED within the NHS.

Purpose: Open globe injury (OGI) may be associated with corneal wounds that are challenging to close, with a reported wound leakage rate of up to 16%. Management options include conservative and surgical options. No consensus exists on optimal management and studies addressing this have not previously been reviewed.

Methods: We conducted a systematic review to identify all studies including adult patients after OGI involving the cornea and requiring secondary closure after primary repair. All studies reporting secondary closure methods and outcomes were reported. Data were combined in a narrative synthesis and methodological quality assessed using Joanna-Briggs critical appraisal tools.

Results: Fifty-eight eyes from seven retrospective studies and one prospective study were included. Secondary closure included conservative options of stromal hydration, bandage contact lens, cyanoacrylate glue and aqueous suppressants and surgical management including resuturing, lamellar and full-thickness corneal grafting and scleral autograft with amniotic membrane. One study reported successful conservative management in 26 out of 34 cases (76%) attempted. Re-suturing was successful in 17 out of 20 cases (85%) but required subsequent corneal grafting in three cases. Ten corneal grafts and three scleral autografts with amniotic membrane were successful.

Conclusions: Conservative approaches may have a high initial success rate, although these findings were based on a single retrospective study. When conservative approaches were unsuitable or unsuccessful, resuturing leaking wounds was successful in most cases, while lamellar and full-thickness corneal grafting and scleral autograft were additional options.

Background: Limited evidence exists around health inequalities in amblyopia therapy. This cohort study explores amblyopia therapy outcomes and socioeconomic scores by postcode, across two boroughs within Greater Manchester.

Methods: All available orthoptic records for school vision screening referrals from the academic year 2017-2018 were reviewed by one Research Orthoptist, to identify children diagnosed with unilateral amblyopia. Clinical data were extracted and the proportion amblyopia deficit corrected and appointment attendance rates over 1 year of therapy were calculated. Home postcodes were used to identify socioeconomic situation for each patient, by Index of Multiple Deprivation (IMD) 2019 and Townsend Deprivation Index 2011.

Results: From 730 school screening referrals, 512 orthoptic records were accessible and 42 cases of unilateral amblyopia were identified. The median proportion amblyopia deficit corrected in 1 year was 51.0% (IQR 22.6-72.9). The median attendance rate was 87.5% (IQR 67.9-100.0); 47.6% of patients attended every appointment. No statistically significant relationships were found between socioeconomic score and the proportion amblyopia deficit corrected in a year (IMD: unstandardised beta coefficient 1.782, 95% CI -1.877 to 5.441, p = 0.331) or orthoptic clinic attendance rates (IMD: unstandardised beta coefficient -0.479, 95% CI -2.492 to 1.534, p = 0.633). A positive relationship was found between attendance rate and proportion amblyopia deficit corrected (unstandardised beta coefficient 0.743, 95% CI 0.213 to 1.274, p = 0.007).

Conclusion: In two Greater Manchester community orthoptic services, amblyopia therapy outcome and clinic attendance rate were not related to individual socioeconomic scores by postcode. A positive relationship between orthoptic clinic attendance rate and amblyopia therapy outcome was found.

Background: Conventional occlusion is an effective treatment for amblyopia; however, adherence remains a significant barrier. This is the first randomised controlled trial (RCT) investigating whether objective, electronically monitored adherence "feedback" improves amblyopia treatment adherence.

Methods: This unmasked, parallel two-armed multicentre RCT included 102 children aged 3-8 yrs with monocular amblyopia (≥0.3 logMAR interocular difference). Participants could have up to 18 months of previous patching and were prescribed 10 h/6days of patching. Participants were randomised to a Feedback Group (n = 51), receiving feedback from treatment monitors, or Controls (n = 51). Change in adherence (CA) was measured from the first to last available monitor for patching and glasses over 12 weeks. Regression models explored factors influencing visual outcome and adherence.

Results: Of 102 participants, 74 were analysed for patching and 78 for glasses. Mean patching CA was -0.39 ± 2.01 h/day (control) versus -0.32 ± 2.20 h/day (feedback), with no significant group difference (P = 0.89). Median glasses-wearing CA was -0.55 IQR:2.55 h/day (control) vs. -0.05 IQR:1.73 h/day (feedback), also non-significant (P = 0.38). Overall average adherence to glasses was 10.3 h/day and 7.9 h/day for patching. Younger age, less previous patching, and higher adherence to treatment significantly predicted better visual outcome. Females had significantly lower glasses-wearing adherence.

Conclusion: This study shows for the first time that patching and glasses adherence can be monitored and fed back to patients and their carers. While we found no additional influence of feedback on adherence, we observed that when children and their guardians were aware of active monitoring and frequently seen, we observed high and sustained levels of adherence. The significant correlations to visual outcomes further highlight the importance of early treatment in amblyopia.

Purpose: To characterise geographic atrophy (GA) associated with age-related macular degeneration (AMD) and its progression rates in an Asian cohort.

Methods: Retrospective study of 170 eyes characterising GA lesions using near infrared (NIR) and spectral domain optical coherence tomography (SD-OCT).

Results: The majority of patients were Chinese (88.2%), followed by Malay (4.7%), Indian (3.5%) and Others (3.5%). Mean age at baseline was 78.4 (SD 8.2) years, with 42.9% males. Mean baseline GA area was 4.25mm² (SD 4.25), best-corrected visual acuity 0.71logMAR units (SD 0.52) and subfoveal choroidal thickness (SFCT) 168.3  μm (SD 77.4). Multifocal GA was present in 97 (57.1%) of eyes, foveal involvement in 114 (67%) and bilateral in 42 (24.7%). Macular neovascularisation was present in the fellow eye of 48 (28.2%) patients. Mean follow-up was 4.12 (SD 2.95) years, with a mean GA progression rate of 0.98 (SD 1.26)mm²/yr (SQRT 0.22 mm/yr SQRT, SD 0.21). Bilateral disease (p = 0.005), reticular pseudodrusen (p = 0.02), larger baseline GA area (p < 0.001) and multifocal disease (p = 0.01) were independently associated with greater odds of rapid GA progression.

Conclusion: We evaluated AMD-associated GA in Asian patients, predominantly of Chinese descent, using NIR and SD-OCT. These findings are valuable to identify high-risk patients and guide future GA therapies in Asian populations.