Mitochondrial dysfunction and oxidative stress are increasingly recognized as key contributors to the development and progression of retinal degenerative diseases, including age-related macular degeneration and inherited retinal dystrophies. Growing evidence suggests that alterations in mitochondrial function, excessive production of reactive oxygen species, defective mitophagy, and chronic inflammatory responses are closely interconnected processes that contribute to retinal cell damage and degeneration. This review provides an overview of the current understanding of the molecular mechanisms linking mitochondrial dysfunction to retinal degeneration, with particular emphasis on the impact of oxidative stress, mitochondrial quality-control pathways, and inflammatory signaling. Available evidence indicates that mitochondrial DNA damage, impaired bioenergetics, and dysregulated mitochondrial dynamics play a crucial role in the degeneration of photoreceptors and retinal pigment epithelium cells. In turn, oxidative stress further exacerbates mitochondrial impairment, creating a self-sustaining cycle that promotes disease progression. Recent advances have also highlighted the therapeutic potential of targeting mitochondrial pathways. Although several mitochondria-directed strategies have shown encouraging results in experimental models, their translation into clinical practice remains at an early stage. Overall, the available data identify mitochondria as a promising therapeutic target and support the development of precision medicine approaches aimed at preserving retinal function and slowing disease progression in patients with retinal degenerative disorders.

Background: Scleral fixation of intraocular lenses (IOLs) is a valuable option in cases of aphakia or inadequate capsular support, yet conventional sutured and sutureless approaches can pose technical challenges and complication risks. The needle-guided scleral fixation technique offers a simplified, single-suture solution that enhances safety and reproducibility. Methods: In this retrospective interventional case series, 30 eyes with insufficient capsular support underwent IOL implantation using Meduri’s needle-guided single-suture technique at the G. Martino University Hospital, Messina. The surgical method employs a 24-gauge needle to guide a double-armed 10-0 polypropylene suture through the sclera for precise IOL anchorage, minimizing vitreous manipulation. Outcomes were assessed over 24 months, including best-corrected visual acuity (BCVA), IOL centration, intraocular pressure (IOP), and postoperative complications. Results: Mean BCVA improved from X to Y LogMAR at two years (p < 0.05). All IOLs remained well-centered without tilt or decentration. Mild conjunctival hyperemia occurred in 70% of cases, resolving spontaneously. No suture erosion, vitreous hemorrhage, or retinal detachment was observed. Conclusions: The needle-guided single-suture technique provides a stable, efficient, and reproducible method for posterior chamber IOL fixation in aphakic eyes lacking capsular support. Its minimal learning curve and reduced surgical complexity make it an attractive alternative to both traditional sutured and modern sutureless methods, particularly in centers without vitreoretinal expertise.

Age-related macular degeneration (AMD) is referred to as the leading cause of irreversible visual loss in developed countries, with a profound effect on the quality of life

Neovascular age-related macular degeneration (nAMD) remains a major cause of visual morbidity worldwide, although its contribution to blindness in developed healthcare systems has declined in the era of anti-VEGF therapy. Although randomized clinical trials have consistently demonstrated meaningful visual gains under structured retreatment protocols, real-world outcomes frequently decline over time due to undertreatment, limited durability, and persistent disease activity. Recent therapeutic advances have shifted the focus from maximizing short-term efficacy to engineering sustained disease control. Faricimab, a bispecific antibody targeting both VEGF-A and angiopoietin-2, introduces dual-pathway vascular modulation, while high-dose aflibercept (8 mg) enhances VEGF suppression through pharmacokinetic intensification. This perspective critically examines the biological rationale, clinical evidence, real-world implications, and strategic positioning of these agents, proposing a durability-centered framework for next-generation management of nAMD.

The ocular surface microbiome plays a critical role in maintaining ocular health, preventing infections, and regulating immune responses. Contact lens (CL) wear has been linked to alterations in microbial composition, potentially leading to dysbiosis and increased susceptibility to ocular infections. This review aims to summarize current evidence on the effects of CL use on the ocular microbiome and to discuss strategies to preserve microbial homeostasis. A literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar for English-language human studies published between January 2005 and January 2025. We included original studies and systematic reviews evaluating the ocular surface bacterial community in contact lens (CL) wearers using either sequencing-based approaches (microbiome; e.g., 16S rRNA gene sequencing/metagenomics) or culture-based methods (microbiota). Two authors screened titles/abstracts and full texts. Overall, 12 studies met the inclusion criteria and were qualitatively synthesized. Across included studies, CL wear was associated with reproducible changes in the ocular surface bacterial community, most commonly a shift toward a skin-like profile and increased detection/relative abundance of opportunistic taxa (e.g., Pseudomonas, Acinetobacter, and Staphylococcus aureus) together with reduced representation of typical ocular commensals in several sequencing-based datasets. Culture-based studies reported increased recovery of opportunistic bacteria from lenses and storage cases, supporting contamination/biofilm-related mechanisms. Lens care solutions and preservatives were reported to modulate bacterial profiles and may contribute to dysbiosis, although evidence remains heterogeneous across study designs and analytic pipelines. CL use is associated with significant alterations in the ocular microbiome, increasing the risk of microbial keratitis and corneal inflammatory events. Strategies to maintain microbial balance, including careful selection of lens care products and development of antimicrobial lenses, may improve ocular surface health in CL wearers. Future longitudinal studies with standardized sampling and analytic workflows are needed to clarify causal links between CL-associated microbial changes and clinical outcomes.

The choriocapillaris is the terminal capillary bed that sustains the retinal pigment epithelium (RPE) and the outer retina, and its integrity is inseparable from that of the RPE–Bruch’s membrane complex it supplies. Histopathological work established decades ago that choriocapillaris density declines with age and falls further in disease, but for most of that period, the layer could not be assessed reliably in living eyes. Optical coherence tomography angiography (OCTA), particularly with swept-source instrumentation, signal compensation and validated thresholding, has changed this: choriocapillaris flow deficits can now be quantified reproducibly and followed over time. A flow deficit is, however, a signal-level measurement that does not by itself establish anatomical capillary loss, and this distinction is maintained throughout. This review examines what that capability has revealed. We first summarize choriocapillaris anatomy, its functional coupling to the RPE through polarized vascular endothelial growth factor secretion, and the mechanisms implicated in its failure, including complement-mediated endothelial injury, Bruch’s membrane thickening, oxidative stress and venous overload. We then address the methodology in detail—slab definition, shadow compensation, binarization, averaging and the artefacts that inflate or mask flow deficits—because the comparability of published values depends almost entirely on these choices. The clinical sections review choriocapillaris involvement in age-related macular degeneration, where baseline flow impairment has been associated with subsequent drusen formation and with the rate of geographic atrophy enlargement, an association that is temporal rather than proven causal and that rests on a small number of cohorts; in the pachychoroid spectrum, where the layer is thought to be compressed rather than primarily diseased; and in diabetic retinopathy, myopia, inherited retinal dystrophies, inflammatory chorioretinopathies and systemic vascular disease. We conclude by considering structure–function relationships with outer retinal integrity and visual sensitivity, the relevance of choriocapillaris metrics as trial endpoints and stratification variables in the complement inhibitor era, and the standardization, validation and automation required before these biomarkers can be used in individual patients.