Achieving optimal treatment outcomes in glaucoma requires patients to adhere to their medication regimens. Possible barriers to patients’ cooperation include the misunderstanding of a treatment’s importance or errors in applying instructions, forgetfulness, financial constraints and others. Due to the fact that glaucoma usually causes no apparent symptoms or pain, on the one hand, and the significant inconvenience that the eye drops used for glaucoma treatment can cause due to local irritation, on the other, patient compliance is a challenge. To address this challenge, we require strategies for improving adherence to glaucoma treatment. The importance of proper eye drop administration techniques cannot be overstated, particularly for vulnerable populations such as the elderly, the sick and the visually handicapped. Studies have shown that failure to comply with glaucoma treatment is a significant factor affecting disease progression, emphasizing the need for interventions that improve patient compliance. Educational interventions, medication reminders and the use of assistive devices such as eye drop aids have been shown to improve adherence to glaucoma treatment. By promoting strategies that can be used to enhance treatment adherence, healthcare providers can ensure that glaucoma patients receive the full benefits of their treatment plans, reducing the risk of disease progression. Many patients struggle with the complexity of their treatment regimens and the challenges of administering eye drops. This entry provides a comprehensive overview of the different barriers to patient adherence to glaucoma eye drop treatment, emphasizing the difficulties associated with eye drop instillation. This entry examines a range of eye drop aids available to patients, evaluating their modes of action, benefits, drawbacks and effectiveness in improving patient compliance. By providing detailed information on the barriers to adherence and the range of eye drop aids available, this entry aims to support healthcare providers in helping glaucoma patients to achieve better treatment adherence and outcomes.

Objectives: This study evaluated the therapeutic potential of topical Ripasudil hydrochloride hydrate in managing various forms of corneal edema. Methods: This retrospective study included 96 patients of 72.20 ± 10.52 years, with 53 females (55.2%) who were treated with Ripasudil for corneal edema, with a mean treatment duration of 5.2 ± 2.3 months, divided into four groups: post-cataract surgery (n = 32), Fuchs endothelial corneal dystrophy (FECD; n = 29), post-Descemet membrane endothelial keratoplasty (DMEK; n = 25), and post-penetrating keratoplasty (PKP; n = 10). All patients were treated with Ripasudil, typically administered three times daily in the first week and twice daily in the following months. Clinical efficacy outcomes were assessed using changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) with specular microscopy, anterior segment optical coherence tomography (OCT), and slit-lamp examination, while intraocular pressure (IOP) was measured using the iCare tonometer. Results: Ripasudil treatment led to a reduction in CCT and improvement in visual acuity across most groups, with minimal changes in ECC. CCT decreased by 30.44 μm (p < 0.001), 25.56 μm (p < 0.001), 8.41 μm (p = 0.05), and 6.80 μm (p > 0.1); visual acuity improved by 0.27 (p = 0.001), 0.18 (p = 0.02), 0.17 (p = 0.025), and 0.07 logMAR units (p > 0.1); and ECC changed by +7.0 (p > 0.1), 15.4 (p > 0.1), −7.6 (p > 0.1), and 2.3 cells/mm² (p > 0.1) in the post-cataract surgery, FECD, post-DMEK, and post-PKP groups, respectively. Conclusions: No adverse events or progression of edema were recorded during the follow-up period. These findings support the role of Ripasudil as a non-invasive pharmacological approach to managing corneal edema and delaying or possibly avoiding surgical interventions, such as corneal transplantation, in selected cases.

Photorefractive keratectomy (PRK) has long been the method of choice for refractive surgery in pilots, and was FDA approved for U.S. Air Force aviators in 2000. We retrospectively reviewed the medical records of 16 male combat pilots (mean age 25.0 ± 5.5 years) who had undergone bilateral laser refractive surgery with surface ablation (alcohol-assisted PRK: 81.25%, transepithelial-PRK: 18.75%), and who had a mean baseline spherical equivalent (SE) of −2.1 ± 0.7 D in the right eye, and −2.0 ± 0.7 D in the left. The mean follow-up was 8.4 ± 6.6 months. On the last visit, the uncorrected visual acuity (UCVA) had improved from 0.75 ± 0.33 logMar to −0.02 ± 0.03 logMar (p < 0.001), and from 0.72 ± 0.36 logMar to −0.02 ± 0.05 logMar (p < 0.001), for the right and left eyes, respectively. The percentages of participants with a right eye UCVA of at least 0.0, −0.08, and −0.18 logMAR (6/6, 6/5, and 6/4 Snellen in meters) were 100%, 37.5%, and 6.2%, respectively, and for the left eye, 93.7%, 43.75%, and 6.2%, respectively. No complications occurred. This is the first study to assess refractive surgery outcomes in a cohort of Israeli combat pilots. Surface refractive surgery effectively improved UCVA and reduced spectacle reliance for the members of this visually demanding profession.

Introduction: In this case report, we demonstrate the application of an aspheric macular lens (Grieshaber, Alcon) for conducting posterior segment procedures after a posterior capsular rupture (PCR) occurrence during cataract surgery. Case Presentation: During a cataract surgery on a 70-year-old female patient, a PCR was identified, accompanied by the descent of the lens into the vitreous, and prompted subsequent interventions. This involved performing posterior-assisted levitation, anterior segment phacoemulsification, and anterior segment vitrectomy. Subsequently, due to the absence of a BIOM posterior viewing system in the operating room, an aspheric macular lens (Grieshaber, Alcon) was positioned on the patient’s eye. Subsequently, pars plana vitrectomy was performed, along with the extraction of residual lens cortical remnants. The procedure concluded with gradually inserting a 3-piece intraocular lens into the sulcus. Conclusion: When managing posterior capsular rupture, using an aspheric macular lens, such as the Grieshaber (Alcon), can be beneficial.

Introduction: In this case study, we present the “Ballerina” sign as a potentially valuable clinical indicator for detecting posterior capsular rupture (PCR) during cataract surgery. The purpose of this study is to highlight the significance of PCR in the context of cataract surgery and introduce this novel sign. Case Presentation: During the cataract operation on a 70-year-old patient, we observed a spiraling fragment of the nucleus attached to a vitreous string. Subsequently, an anterior vitrectomy was successfully performed without further intraoperative complications, followed by the insertion of a 3-piece lens into the sulcus. Positive visual outcomes were observed during postoperative follow-up appointments at 1 day, 2 weeks, and 3 months. Conclusion: The documentation of the “Ballerina” sign in the medical literature is innovative, offering ophthalmic surgeons a valuable tool for early PCR detection during cataract surgeries.

This study evaluates the safety and efficacy of a novel triangular suture technique (TST) as an alternative method to scleral-fixated intraocular lens implantation in patients with intraocular lens (IOL) dislocation following cataract surgery. The aim is to assess visual outcomes, intraocular pressure (IOP) control, and complication rates over an extended follow-up period. A retrospective cohort study analyzed 43 patients (48.8% female; mean age 77.9 ± 10.3 years) who underwent scleral-supported IOL implantation using the TST. Preoperative assessments included ocular history, baseline visual acuity, and IOP. Postoperative follow-up was conducted at 6 defined intervals over 26 months. All surgeries were performed using a uniform triangular scleral suture approach with 10-0 polypropylene in a three-point support pattern. Sutures were placed 3.0 mm posterior to the limbus at 11, 7, and 3 o’clock positions (corresponding to the triangular configuration), with subconjunctival passage between designated clock-hour positions to prevent erosion and ensure proper IOL centration. Outcome measures included uncorrected visual acuity, best-corrected visual acuity, IOP, glaucoma medication requirements, and central macular thickness. Uncorrected visual acuity improved significantly from 0.92 ± 0.55 to 0.50 ± 0.40 logarithm of the minimum angle of resolution (logMAR) at 6 months ( P < .01). Best-corrected visual acuity improved significantly from 0.75 ± 0.34 to 0.36 ± 0.42 logMAR at 6 months ( P < .01) and was maintained at 0.37 ± 0.50 logMAR at 26 months ( P < .01). A transient IOP rise was observed on the first postoperative day (mean 18.14 ± 5.65 mm Hg; P < .05), with normalization thereafter. No significant complications were observed over the 24-month follow-up period. The TST provides a safe and effective alternative to conventional scleral-fixated intraocular lens fixation methods, offering significant and sustained visual improvement, minimal complications, excellent IOL stability, and stable anatomical outcomes over extended follow-up.