(1) Background: Ciliary body uveal melanoma is a rare subtype of uveal melanoma which comprises 3–5% of melanomas, an immunogenic cancer, and can present multifaceted initial clinical manifestations, masquerading as various ocular pathologies. Chronic lymphocytic leukemia (CLL) presents immunodeficiency and risk for the development of a secondary malignancy, with Bruton’s tyrosine kinase inhibitor treatment having a mutagenic effect and a secondary anti-platelet aggregation effect. We present the case of a 65-year-old patient undergoing treatment for CLL with ibrutinib who presented with recurrent hyphema that masked an underlying, inferiorly situated, ciliary body uveal melanoma; (2) Methods: Retrospective case review; (3) Results: An ophthalmological examination together with imaging via mode B ultrasound and contrast-enhanced magnetic resonance imaging resulted in the clinical and imagistic diagnosis of a ciliary body uveal melanoma. A pathological examination of the enucleated eye confirmed the diagnosis. Postoperative tumoral reoccurrence was not detected for 1½ years, however, CLL immunosuppression worsened with admission for severe COVID-19 disease. (4) Conclusions: CLL patient screening for melanoma should also include detailed ophthalmological examinations, which could also include ultrasound ophthalmological imaging. The avoidance of uveal melanoma metastatic disease is paramount for patient survival. CLL manifests additional profound immunosuppression.

(1) Background: Laser-assisted refractive surgery is a safe and effective surgical correction of refractive error. For most patients, both the newer Trans-PRK and the established LASIK technique can produce the required surgical correction, sparking the question of which technique should be opted for. (2) Methods: The study prospectively evaluated 121 patients (230 eyes) for at least one month postoperatively; 66 patients (126 eyes) and 45 patients (85 eyes) returned for 6 months and 1 year follow-up. (3) Results: No statistical difference was recorded at 1 week or 1 month post-operation. At 6 months, a difference was found for spherical diopters (Trans-PRK −0.0476 ± 0.7012 versus FS-LASIK +0.425 ± 0.874, p = 0.004) and spherical equivalent (Trans-PRK −0.1994 ± 0.0294 versus FS-LASIK +0.225 ± 0.646, p = 0.025) but not for CYL D (Trans-PRK −0.3036 ± 0.5251 versus FS-LASIK −0.4 ± 0.820, p = 0.499). Uncorrected visual acuity was better for Trans-PRK 6 months post-operation (UCVA logMAR 0.02523 versus 0.0768 logMAR; p = 0.015 logMAR). At 1-year, Trans-PRK was favored for spherical diopters (Trans-PRK −0.0294 ± 0.6493 versus FS-LASIK +0.646 ± 0.909, p < 0.001) and spherical equivalent (Trans-PRK −0.218 ± 0.784 versus FS-LASIK 0.372 ± 1.08, p = 0.007). Overall speed in visual recovery, variance of results and surgically induced astigmatism were in favor of Trans-PRK. (4) Conclusions: The study reported improvements for Trans-PRK patients, with both techniques found to be safe and effective.

Background and Clinical Significance: To our knowledge, there is a lack of electron microscopy studies in hematocornea since 1985, and more so for graft hematocornea after deep anterior lamellar keratoplasty (DALK). This study provides an ultrastructural characterization of hematocornea occurring in a DALK graft. Our study presents several limitations: single-case design and lack of control tissue. Case Presentation: The DALK graft with hematocornea was excised and introduced inside of the operating room in glutaraldehyde solution recipient. The graft was quickly cold-transported to light and transmission electron microscopy. Hematocornea in the DALK transplant graft resulted in features of stromal alteration and dysfunctional cellular clean-up response. The collagen lamellae ultrastructure was affected near electron-dense hem deposits. Two cellular aspects were observed: adaptation and degeneration. Electron-dense granules were found in keratocytes, which may exhibit cellular adaptations, such as vacuoles and phagosomes. Macropinocytosis may mechanistically explain ingestion of electron-dense granules, and dysfunctions in the macropinocytosis process may have led to cell degeneration. Cellular degeneration was marked by loss of organelle contour and loss of cellular membrane integrity (burst-cell aspect). Microscopic corneal alteration corresponded to macroscopic total loss of corneal transparency and elasticity. Conclusions: This study described lamellar ultrastructure alterations and dysfunctional cellular response in hematocornea of a DALK corneal transplant graft.

(1) Background: Intralenticular tumors are an entity akin to Schrodinger’s cat since, although the human crystalline cells themselves are not known to malignly proliferate, various entities can take the appearance and clinical presentation of a tumor originating in the lens. We present the peculiar case of an 11-year-old male patient of African descent, HLA B27+, with a previous history of minor ocular trauma and unilateral anterior uveitis a year before which was admitted to our department with total opacification of the crystalline lens in the right eye and lens neovascularization. During surgery, a vascular, white fibrotic mass measuring 0.1–0.2 cm was discovered inside the lens bag and was excised. (2) Methods: Retrospective case review. (3) Results: The histopathological exam of the excised mass revealed an abundant infiltrate consisting of CD68+ foamy macrophages and lymphoplasmacytic elements. CD68 is a pan-macrophage marker associated with an active inflammatory mechanism soliciting macrophages, and tissue activated macrophages are correlated to increased stromal and serum levels of vascular endothelial growth factor, providing an explanation for lens angiogenesis. (4) Conclusions: The diagnosis is of a “masquerade tumor” resulted from an abnormal inflammatory process in connection with previous ocular trauma and possibly the patient’s HLA B27+ status.

Purpose: Our retrospective study on 27 patients with a large mean macular hole diameter (MH-D) of 480.08 +/- 78.62 mu m evaluates the usefulness of combining the current internal limiting membrane (ILM) inverted-flap surgical technique with silicone oil tamponade, which has been associated with the classical technique of ILM peeling. Results: Functional results: mean visual acuity (VA) improved to 0.89 +/- 0.11 logMar (logarithm of the minimum angle of resolution, at one month), 0.67 +/- 0.03 logMar (at three months), 0.52 +/- 0.04 logMar (at six months), 0.42 +/- 0.15 logMar (at one year) postoperative (final VA), with statistical linkage between preoperative VA and final VA (two-sample t-test, p=0.007), mean MH-D and final VA (regression analysis, p=0.003). We compared the results by MH size (Group A <= 400 mu m - eight eyes and Group B >400 mu m - 19 eyes), finding statistical variance (Bonett & Levene methods). Group A presented a final VA of 0.21 +/- 0.12 logMar, while Group B had 0.51 +/- 0.17 logMar. Successful closure was noted in 25 (92.59%) cases, with Group A having complete closure and external limiting membrane (ELM) restoration with ellipsoid zone (EZ) regeneration in six cases. Group B had successful closure in 17 (89.47%) cases with ELM restoration in 16 cases and EZ regeneration in seven (38.88%) cases, with reintervention in two cases. Restoration of the ELM was correlated [Pearson's correlation coefficient (PCC) of 0.999, p=0.022] with successful closure, with overall restoration obtained in 24 (88.88%) cases and EZ regeneration in 13 (48.14%) cases. Conclusions: ILM inverted-flap technique with silicone oil tamponade had favorable functional and anatomical outcomes. ELM restoration was associated with successful MH closure.

Background/Objectives: Toric intraocular lens (IOL) implantation is the standard approach for correcting corneal astigmatism during cataract surgery and refractive lens exchange (RLE). Evidence on outcomes in eyes with high corneal astigmatism (≥2.00 diopters, D), particularly in heterogeneous real-world settings, remains limited. This study evaluated visual, refractive, and astigmatic vector outcomes of toric IOL implantation in a consecutive high-astigmatism cohort and investigated predictors of residual astigmatic error. Methods: This single-center, single-surgeon retrospective analysis of prospectively collected data included 161 eyes (118 patients) with preoperative corneal astigmatism ≥ 2.00 D undergoing cataract surgery or RLE with toric IOL implantation (June 2023–December 2025). Primary outcomes at one month included visual acuity, manifest refraction, and Alpins vector analysis at the corneal plane. Secondary analyses comprised refractive stability assessment (n = 75 eyes, median seven months), comparison of astigmatic outcomes between emmetropia-targeted and intentional myopia-targeted eyes, and multivariate regression of predictors of residual astigmatic error. Results: Mean postoperative UDVA and CDVA were 0.19 ± 0.24 and 0.09 ± 0.15 logMAR, respectively. Spherical equivalent prediction error was −0.19 ± 0.42 D (69.6% within ±0.50 D of target). Mean residual cylinder was 0.52 ± 0.49 D; 62% and 88.8% of eyes achieved ≤0.50 D and ≤1.00 D, respectively. Vector analysis demonstrated a mean difference vector of 0.53 ± 0.44 D, a correction index of 1.04 ± 0.20, and near-zero centroid deviation (0.03 D @ 43°), indicating the absence of systematic directional prediction error. Refractive outcomes were stable at medium-term follow-up. Astigmatic correction accuracy was equivalent between emmetropia-targeted and intentional myopia-targeted eyes (p > 0.05 for all primary metrics). Multivariate regression identified IOL cylinder power (β = 0.051, p = 0.031) and oblique astigmatism orientation (β = 0.299 vs. WTR, p = 0.032) as independent predictors of greater residual astigmatic error. No sight-threatening complications occurred. Conclusions: Toric IOL implantation provides safe, predictable, and stable correction of high corneal astigmatism in a real-world mixed cohort. Astigmatic accuracy is maintained regardless of intended spherical refractive strategy, supporting the use of toric IOLs in highly myopic patients targeted for residual myopia. Oblique astigmatism orientation is an independent predictor of reduced correction accuracy, consistent with known limitations of current toric calculators for this meridian.