In recent, large case series of fungal endophthalmitis (FE) that were published by Asian authors, the most frequent etiologic agents for all types of FE are molds (usually Aspergillus species, while Fusarium is the prevalent etiology in keratitis-related FE). Candida was the organism found in most cases of endogenous FE. However, we must keep in mind that prevalence of fungal species varies with the geographical area. Lately, polymerase chain reaction (PCR) was increasingly used for the diagnosis of FE, allowing for very high diagnostic sensitivity, while the costs become more affordable with time. The most important shortcoming of PCR—the limited number of pathogens that can be simultaneously searched for—may be overcome by newer techniques, such as next-generation sequencing. There are even hopes of searching for genetic sequences that codify resistance to antifungals. We must not forget the potential of simpler tests (such as galactomannan and β-d-glucan) in orienting towards a diagnosis of FE. There are few reports about the use of newer antifungals in FE. Echinocandins have low penetration in the vitreous cavity, and may be of use in cases of fungal chorioretinitis (without vitritis), or injected intravitreally as an off-label, salvage therapy.

Glaucoma is a widespread ophthalmological disease, with a high impact and frequent visual morbidity. While the physiopathology of the two types of primary glaucoma (open angle and angle closure) has been studied, there seems to be little relationship between the two. In this study, we gather clinical and preclinical data to support the idea that the two primary glaucomas are “mirrored” in terms of morphological parameters and disease physiopathology. In short, primary angle closure glaucoma (PACG) is associated with hyperopia and low axial length, and primary open angle glaucoma (POAG) is associated with myopia and high axial length. Moreover, in PACG and in primary angle closure or primary angle closure suspect cases, while there is extensive iridotrabecular contact, the intraocular pressure (IOP) is still maintained in the lower half of the normal range throughout the evolution of the disease, which suggests a baseline trabecular hyperfiltration in PACG. In the opposite case, myopic eyes with open angles and a higher risk of developing POAG often have a baseline IOP in the upper half of the normal range, suggesting a baseline trabecular hypofiltration. As we explore clinical, genetic and animal model data regarding these opposing aspects, we hypothesize the existence of a mirroring relationship between PACG and POAG. Defining the relationship between the two potentially blinding diseases, with a high prevalence worldwide, may aid in understanding the mechanisms better and refining diagnosis and treatment. Thus, our theory has been named the Mirror Theory of Primary Glaucomas.

Clear lens extraction can be considered a therapeutic option in angle closure glaucoma (ACG). Even if it does not represent the first choice of treatment, it can be taken into consideration when the topical treatment does not control the intraocular pressure (IOP) and iridotomy does not have a positive effect on the angle closure, especially in appositional angle closure when biometry or ultrabiomicroscopy (UBM) show lens involvement. In angle closure glaucoma, clear lens extraction represents an etiological treatment that takes into account the role of the lens in the pathogenesis of the disease. If we ignore it and we choose a filtrating surgery as therapeutic option we can end up with complications such as prolonged athalamia, corneal damage and lens opacification that will eventually require cataract surgery, but performed late and with higher risks. Before performing a filtrating surgery in ACG, we should take an UBM. We also need to choose the best moment to perform surgery, after topical treatment and iridotomy have been tested, but before trabecular damage appears.

Background and Objectives: Hyperopia is a refractive error which affects cognitive and social development if uncorrected and raises the risk of primary angle-closure glaucoma (PACG). Materials and Methods: The study included only the right eye—40 hyperopic eyes in the study group (spherical equivalent (SE) under pharmacological cycloplegia over 0.50 D), 34 emmetropic eyes in the control group (SE between −0.50 D and +0.50 D). A complete ophthalmological evaluation was performed, including autorefractometry to measure SE, and additionally we performed Ocular Response Analyser: Corneal Hysteresis (CH), Corneal Resistance Factor (CRF); specular microscopy: Endothelial cell density (CD), Cell variability (CV), Hexagonality (Hex), Aladdin biometry: Anterior Chamber Depth (ACD), Axial Length (AL), Central Corneal Thickness (CCT). IBM SPSS 26 was used for statistical analysis. Results: The mean age of the entire cohort was 22.93 years (SD ± 12.069), 66.22% being female and 33.78% male. The hyperopic eyes had significantly lower AL, ACD, higher SE, CH, CRF. In the hyperopia group, there are significant, negative correlations between CH and AL (r −0.335), CRF and AL (r −0.334), SE–AL (r −0.593), ACD and CV (r −0.528), CV and CRF (r −0.438), CH (r −0.379), and positive correlations between CCT and CH (r 0.393) or CRF (r 0.435), CD and ACD (r 0.509) or CH (0.384). Age is significantly, negatively correlated with ACD (r −0.447), CH (r −0.544), CRF (r −0.539), CD (r −0.546) and positively with CV (r 0.470). Conclusions: Our study suggests a particular biomechanical behavior of the cornea in hyperopia, in relation with morphological and endothelial parameters. Moreover, the negative correlation between age and ACD suggests a shallower anterior chamber as patients age, increasing the risk for PACG.

Background: With the development of artificial intelligence (A.I.), the optical coherence tomography angiography (OCTA) analysis of progression in hypertensive retinopathy could be improved. Our purpose was to use the OCTA to study the effect of uncontrolled dyslipidemia and hypertensive retinopathy on the retinal microvasculature and to identify a potential software update of the A.I. secondary to the OCTA analysis. By using our most relevant data, the A.I. software can be upgraded by introducing new mathematic formulas between the OCTA parameters and the lipid level. Methods: We performed a prospective cohort study on 154 eyes of participants from Eastern Europe. We used a standardized protocol to collect data on past medical history of dyslipidemia and hypertension and OCTA to measure retinal vascular parameters. Results: The average age of the participants was 56.9 ± 9.1, with a minimum of 34 and a maximum of 82 and with a higher percentage of males: 55.8%. Statistically significant correlations were found for total cholesterol and skeleton total (r = −0.249; p = 0.029), foveal avascular zone (FAZ), circularity and low-density lipoprotein (LDL) (r = 0.313; p = 0.006), non-flow area (NFA) and LDL (r = 0.233; p = 0.042), and vascular flow area (VFA) and LDL (r = −0.354; p = 0.002). Conclusions: Subjects with dyslipidemia and progressive hypertensive retinopathy had a reduction in microvascular density and vascular flow, a focal capillary non-perfusion, and an increased FAZ. Thus, by improving the A.I. system, our research aims to provide better OCTA monitoring, which could help in the early-stage detection of progression and development of A.I. screening programs, leading to increased efficiency in diagnosing patients.

Background: Our study evaluated the correlation between internal carotid artery stenosis (ICAS) and retinal microvascular changes in patients with hypertensive retinopathy, dyslipidemia and ICAS. We analyzed vascular measurements provided by optical coherence tomography angiography (OCTA) and carotid Doppler ultrasonography (US) and linked OCTA parameters with carotid artery US measurements on the same side. Statistical differences in OCTA analysis among three groups (no stenosis, mild stenosis and moderate stenosis) were evaluated and correlated with carotid Doppler parameters. Our study aimed to evaluate whether OCTA can be proposed as a screening method in patients diagnosed with mild and moderate ICAS in order to improve the early detection of carotid changes, thus potentially reducing the rate of cardiovascular and cerebral complications of ICAS. Methods: We conducted a study on hypertensive patients with ICAS using six OCTA parameters in the analysis of the retinal vasculature and carotid Doppler US velocities of three carotid arteries and the vertebral artery (VA). Kruskal–Wallis and Dunn’s post hoc tests were used to determine whether there were statistically significant differences between the normal, mild and moderate stenosis groups. Spearman and Pearson correlation were used to obtain correlations among OCTA parameters such as the foveal avascular zone (FAZ), non-flow area (NFA), vascular flow area (VFA) and blood flow velocity on carotid Doppler US. Results: In the final analysis, 49 patients were included and 3 groups of stenosis were obtained, comprising 21 subjects with no stenosis, 19 with mild stenosis and 9 with moderate stenosis. Right eye and left eye groups were formed. In the right eye group with right ICAS, we found statistically significant results for FAZ circularity when comparing the normal stenosis group to the mild stenosis group (p = 0.025) and the mild stenosis group to the moderate stenosis group (p = 0.006). Statistically significant results were also observed for NFA when comparing the normal stenosis group to the moderate stenosis group (p = 0.004) and the mild stenosis group to the moderate stenosis group (p = 0.011). When comparing the FAZ area (p = 0.016) and VFA (p = 0.037) for the normal and moderate groups, statistically significant values were obtained. When comparing the normal and moderate stenosis groups with regard to the left eye, we found statistically significant results for VFA (p = 0.041), NFA (p = 0.045) and VFA (p = 0.029). When comparing the mild and moderate carotid artery stenosis groups, we obtained statistically significant results for NFA (p = 0.001), FAZ area (p = 0.007) and VFA (p = 0.013). In the right eye group, correlations between internal carotid artery (ICA) peak systolic velocity (PSV) and VFA (rho = −0.286), ICA end-diastolic velocity (EDV) and NFA (r = 0.365), external carotid artery (ECA) PSV and VFA (r = −0.288; rho = −0.317), common carotid artery (CCA) PSV and NFA (rho = −0.345), CCA EDV and NFA (rho = −0.292) and VA PSV and VFA (r = −0.327; rho = −0.379) were found. When analyzing OCTA parameters, we found statistically significant results for NFA and VFA (r = −0.374; rho = −0.288). Correlations were also found in the left eye group between ICA PSV and NFA (r = −0.351; rho = −0.313), ICA EDV and VFA (r = −0.421; rho = −0.314), ECA PSV and NFA (r = −0.412; rho = −0.457), CCA PSV and NFA (p = −0.288; rho = −0.339), and CCA EDV and NFA (r = −0.404; rho = −0.417). Conclusions: Our study found correlations between carotid Doppler velocities and OCTA vascular flow parameters; thus, OCTA may be used as a tool for monitoring the microvascular changes associated with carotid stenosis. OCTA can provide insights concerning the overall vascular condition of the patient, since it provides subjective data on vessel density and flow; therefore, by monitoring hypertensive patients with both OCTA and carotid Doppler US, we may be able to increase efficiency in screening and diagnosing patients with IACS.