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Objectives: To estimate the epidemiologic trends of blindness in patients with diabetic retinopathy (DR) and investigate the age-, period-, and cohort-specific effects on blindness.

Methods: A total of 2.5 million patients with DR aged 20 years or older were included from the Korean National Health Claims database from 2005 to 2019. Non-proliferative DR/ proliferative DR (NPDR/PDR) cohorts were constructed separately. Participants were identified as having a blindness in at least one eye. The incidence of blindness were calculated using a log-linear Poisson age-period-cohort (APC) analysis model, each effect on blindness were estimated for each study group.

Results: The incidence of blindness was 1326.62 per 100,000 in the NPDR group and 3397.57 in the PDR group. The blindness rate sharply decreased after 2011, with annual decreases of 5.6% and 4.4% in the NPDR and the PDR groups, respectively. People born between 1920 and 1930 had the highest overall risk of blindness, with the risk decreasing rapidly after that. For those born after 1980, the risk started to increase in both sexes. Among the APC models, the combination model of age, period, and cohort effects showed the highest explanatory power (0.96).

Conclusions: In this nationwide long-term study, blindness in DR was not due to a single epidemiologic cause but rather a combination of biological age, social determinants, and healthcare policies. The increased risk of blindness in individuals in their 20 s and 30 s may even increase in the future and should not be ignored. Therefore, vigilance of younger patients is recommended.

Background: Separation of the posterior hyaloid membrane (PHM) from the retina in posterior vitreous detachment (PVD) is a fundamental, but poorly understood, process underlying vitreoretinal disorders including retinal detachment and macular hole. We performed electron microscopy studies of the PHM after PVD to investigate its ultrastructure, associated cellular structures and relationship to the internal limiting membrane (ILM).

Methods: Post-mortem human eyes were collected from recently deceased patients over 70 years of age. A posterior scleral button was trephined to identify PVD status, and the PHM and vitreous prepared for analysis with transmission and scanning electron microscopy.

Results: Twelve eyes from six patients were collected. Seven eyes had PVD; five eyes had attached vitreous. PHM was isolated from seven of seven eyes with PVD. The PHM in eyes with PVD is a laminar lacy sheet, distinct from the disorganised fibres of vitreous gel. Eyes without PVD had vitreous encased in internal limiting membrane which had separated en bloc from the retina. Cells embedded in the PHM (laminocytes) were identified in five of seven eyes with PVD, with strands stretching into the membrane.

Conclusions: PHM isolated from eyes with PVD is distinct from artefactual separation of the ILM from the retina during dissection. PHM is ultrastructurally distinct from vitreous gel and is a separate entity. The en face appearance of PHM is similar to that of ILM, suggesting that in PVD, PHM forms from separation of an inner layer of ILM. Laminocytes may play a role in the pathogenesis of vitreoretinal disease.

Background: Evisceration surgery is an important part of an ophthalmologist's skillset but is an uncommon procedure. Therefore, it is important for training ophthalmologists to have adequate knowledge and confidence in this procedure to maximise learning opportunities. Mixed reality involves the intertwining of real and virtual environments and has been used successfully in surgical training.

Objectives: To improve participants' knowledge of the relevant anatomy, steps and confidence in performing evisceration surgery using an extended reality online webinar coupled with conventional teaching.

Methods: The teaching session comprised of a short lecture introducing evisceration and explaining mixed reality technology including the Microsoft HoloLens headset. This was followed by a 3D demonstration of the orbit and globe, then the live evisceration procedure on a porcine cadaver, with the surgeon's point of view via the headset. There was expert live running commentary during the procedure with the use of virtual signposts on relevant anatomy. Participants were encouraged to be interactive and given the ability to share their annotations on-screen.

Results: Ten doctors ranging from Foundation year 1 to Ophthalmology specialist training year 3 attended the 90-min session and completed pre- and post- session questionnaires (5-point Likert scales). Results showed statistically significant improvements in the knowledge, steps and confidence in performing the evisceration surgery (paired two-sample T-tests, SPSS version 29).

Conclusions: This study has demonstrated that utilisation of mixed reality with conventional teaching methods can provide a useful initial learning experience which may facilitate effective further learning of the evisceration surgery in a wet-lab or patient setting.

Purpose: This retrospective case-control study from 2008 to 2022 aimed to determine the effect of adjunctive sodium bicarbonate (NaHCO₃) on treatment outcomes of and side effects of acetazolamide (ACZ) for the treatment of idiopathic intracranial hypertension (IIH).

Subjects/methods: Retrospective data was collected via chart review. 288 eyes of 144 patients with IIH, including those taking ACZ alone (control group, n = 89) vs. ACZ and NaHCO₃ (treatment group, n = 56). The primary outcome measure was time to IIH resolution. Secondary outcomes included retinal nerve fibre layer thickness (RNFL), visual field mean deviation (VFMD), visual acuity (VA), discontinuation ACZ, and patient-reported side effects of ACZ.

Results: Cox proportional hazards model for the primary outcome yielded a hazard ratio of 0.800, which was statistically insignificant (95% CI, 0.57-1.13; p = 0.200). There was no significant difference between groups when comparing RNFL, VFMD, VA, surgical intervention, or discontinuation of ACZ. The treatment group was more likely to experience side effects from ACZ prior to starting sodium bicarbonate therapy (p < 0.001). Among the treatment group, 92.7% remained on NaHCO₃ until IIH resolution, and 9 of 12 (75%) subjects reported significant improvement in ACZ-related side effects.

Conclusion: Sodium bicarbonate does not appear to impact treatment outcomes in patients taking acetazolamide for IIH. Sodium bicarbonate may represent a reasonable adjunctive medication to help mitigate acetazolamide-related side effects in this group of patients.

Objectives: This study was performed to evaluate the safety and effectiveness of a lyophilised amniotic membrane (LAM) as a patch for the treatment of retinal breaks and to describe the structural changes at the implantation site.

Design: Prospective, interventional case series study. Patients with diabetic retinopathy and combined tractional and rhegmatogenous retinal detachment.

Methods: Patients were organised into 3 groups according to the number of rhegmatogenous lesions: those in group A had a single break, those in group B had two breaks, and those in group C had three or more breaks. The location of the break was also evaluated as either superior or inferior. Structural outcomes were assessed using SD-OCT during a 3-month follow-up period.

Results: Of a total of 23 eyes of 23 patients, 22 (95.6%) achieved retinal repair without associated complications. Patients with 2 or fewer rhegmatogenous lesions located in the superior sector had a better anatomical result as they achieved 100% surgical success. The structural changes observed by SD-OCT over the follow-up period showed adequate adaptation of the lyophilised patch and complete closure of the rhegmatogenous lesion with no alterations in the adjacent tissue.

Conclusions: The LAM patch seems to be safe and effective, as it promotes therapeutic closure of rhegmatogenous lesions without damaging the retinal architecture adjacent to the implantation site.

Objectives: To analyse the incidence of persistence and recurrence after the peeling of idiopathic epiretinal membrane (ERM) and to describe its clinical features.

Methods: This retrospective study included 666 eyes (645 patients) that underwent macular surgery for ERM removal. Optical coherence tomographic (OCT) images taken within three months after surgery and at the following visits, clinical parameters and surgery related factors were analysed to investigate the incidence and associated factors of ERM persistence and recurrence. Postoperative ERM types were categorised depending on the size ( < 100 µm, ≥100 µm) and the location (foveal, parafoveal, outside the parafovea) RESULTS: The mean follow-up time was 29.4 months. ERM persistence (examination within 3 months) was found in 29.6% of all eyes. Only 1.9% of the eyes presented foveal ERM persistence. Foveal recurrence, defined as reappearance or growth of persistent ERM covering the fovea, was found in 8.2%. In 84.4% of eyes with foveal ERM recurrence, postoperative persistence of ERM of varying severity were identified. None of the pre-operative or surgery related factors were found significantly associated with ERM recurrence. Persistent ERM within the parafovea was the most significant risk factor for foveal ERM recurrence.

Conclusion: Recurrence of ERM is generally preceded by the persistence of ERM fragments found in the early postoperative period. Growth of ERM persistence from the parafoveal region was often the origin of foveal ERM recurrence. Insufficient peeling seems to be the most significant predisposing factor for foveal ERM recurrence.