To evaluate the longitudinal progression of myopic maculopathy in a European cohort of highly myopic patients, analyzing disease natural history and its impact on visual function. Retrospective, observational monocentric cohort study. The study included 1228 eyes from 781 highly myopic patients with a minimum follow-up time of 5 years. We collected best-corrected visual acuity (BCVA) measurement, axial length (AXL), fundus photography, and spectral-domain optical coherence tomography (SD-OCT), along with data regarding IOP-lowering drugs and glaucoma surgery. Myopic atrophic maculopathy (MAM) was graded according to the ATN classification system. The presence of myopic staphyloma followed Curtin's classification. The development of myopic macular neovascularization (MNM) and myopic tractional maculopathy (MTM) was also assessed, along with the presence of dome-shaped macula (DSM) and lacquer cracks (LCs) at baseline. Rate of MAM progression and visual outcomes. Secondary outcome included the correlation with the presence of staphyloma subtypes and the development of MNM and MTM. Mean AXL was 31.6±2.8 mm. MAM progressed in 57% of eyes over a mean follow-up of 11.4 years. Eyes with patchy atrophy progressed in 81% of cases, and 47% of them developed macular atrophy, while eyes with tessellated fundus progressed in only 19% of cases. The presence of a macular-involving staphyloma was associated with progression, particular for type IX (86% rate of progression). A significant decline in BCVA (≥2 lines) was observed in 35.8% of eyes, and correlated with AXL, glaucoma surgery, patchy atrophy, MNM and MTM development (all p<0.05). Active MNM developed in 190 eyes (15%), significantly associated with baseline LCs (OR 2.56) and DSM (OR 4.95), determined faster progression toward macular atrophy (OR 5.91). MTM complications were observed in 314 eyes (26%) and significantly correlated with the presence of a type I and II staphyloma. More than half of eyes with myopic maculopathy tended to progress, in particular in cases with patchy atrophy at baseline and in eyes developing MNM or MTM, which caused worse vision loss during the study period. While DSM and LCs correlated with neovascular complications, the shape of posterior staphyloma correlated with tractional complications.

Lamellar macular holes (LMHs) may show morphological and functional deterioration over time, yet no definite prognostic factor for progression has been identified. Since neurovascular retinal unit impairment may take part in neurodegeneration, we compare progressive LMHs to stable ones in optical coherence tomography (OCT) angiography parameters. Methods: OCT B scans of eyes with LMH were analyzed to detect the presence of tissue loss (TL) over time, allowing us to identify a TL group and a stable (ST) group (14 patients each). The best corrected visual acuity (BCVA) at each considered imaging time point was collected. Lastly, patients underwent macular OCT angiography. Results: BCVA at last follow up was significantly reduced in the TL group compared to both the ST group and TL group baseline assessment. SCP foveal vessel density (VD), SCP and deep capillary plexus (DCP) perfusion density (PD) and parafoveal PD were lower in the TL group. Linear correlations between quantitative TL over time and parafoveal PD in SCP and between the speed of TL and BCVA variation during follow up were also detected. Conclusions: TL in LMHs is associated with both OCT angiography modifications and BCVA deterioration over time. We suggest these findings to be a manifestation of foveal Muller cell impairment in progressive LMHs.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as cornerstone therapies for type 2 diabetes mellitus and obesity, offering significant cardiovascular and renal protection. However, recent evidence has sparked interest and concern regarding their potential ocular effects. This review critically synthesizes current data on the impact of GLP-1RAs on diabetic retinopathy (DR), nonarteritic anterior ischemic optic neuropathy (NAION), age-related macular degeneration (AMD), and glaucoma or ocular hypertension. While preclinical studies suggest GLP-1RAs exert anti-inflammatory and neuroprotective effects in retinal tissues, clinical data remain mixed. Several large observational studies suggest a protective role against DR and glaucoma, while others raise safety concerns, particularly regarding semaglutide and NAION. Evidence on AMD is conflicting, with signals of both benefit and risk. We also discuss plausible pathophysiological mechanisms and the relevance of metabolic modulation on retinal perfusion. Overall, while GLP-1RAs hold promise for ocular protection in some contexts, vigilance is warranted, especially in patients with pre-existing eye disease. Further ophthalmology-focused prospective trials are essential to clarify long-term safety and guide clinical decision making.

Purpose: To correlate postoperative optical coherence tomography (OCT) thickness changes of each retinal layer with different patterns of visual recovery after idiopathic epiretinal membrane (ERM) surgery in a cohort of patients showing no known risk factors for poor visual recovery at preoperative imaging. Methods: Best corrected visual acuity (BCVA) and OCT images were acquired preoperatively and 1 month, 3 months and 6 months postoperatively. Patients were divided into four groups according to postoperative BCVA improvement: improvement < 15 ETDRS letters (GROUP 1), immediate improvement of BCVA without further improvements at later follow-ups (GROUP 2), immediate improvement of BCVA with further improvements at later follow-ups (GROUP 3) and delayed improvement of BCVA (GROUP 4). Results: Eighty-five patients were included. GROUP1 was the only one characterized by retinal nerve fiber layer (RNFL) thickness increase and ganglion cell layer/central macular thickness (GCL/CMT) ratio decrease at 1 month and outer nuclear layer (ONL) thickness decrease at 3 and 6 months. GROUP 2 was the only one showing a decrease in GCL/inner plexiform layer (GCL/IPL) ratio at 1 month. GROUP 3 and 4 showed higher preoperative RNFL thickness compared to the other, and GROUP 4 manifested a late increase in RNFL thickness at 6 months. Conclusions: Different patterns of VA recovery are associated with specific layer thickness changes. If further confirmed, this would help detect those cases characterized by poor or delayed visual recovery despite the absence of other known imaging risk factors.