Purpose: The Preceyes Surgical System (PSS) is a robotic assistive device that may enhance surgical precision. This study assessed pre- and intra-operative times and surgeons’ perceptions of robot-assisted epiretinal membrane peeling (RA-MP). Methods: We analyzed the time requirement of three main tasks: the preparation of the PSS (I), patient preparation (II), and surgery (III). Following surgery, the surgeons were asked questions about their experience. Results: RA-MP was performed in nine eyes of nine patients. Task I required an average time of 12.3 min, initially taking 15 min but decreasing to 6 min in the last surgery. Task II showed a mean time of 47.2 (range of 36–65) min. Task III had a mean time of 72.4 (range of 57–100) min. A mean time of 27.9 (range of 9–46) min was necessary for RA-MP. The responses to the questionnaire revealed a trend towards increasing ease and reduced stress as familiarity with the PSS increased. Conclusions: A substantial reduction in pre- and intra-operative times, decreasing to a total of 115 min, was demonstrated. RA-MP was positively anticipated by the surgeons and led to no hand or arm strain while being more complex than manual MP.

To develop a consensus nomenclature for Optical Coherence Tomography Angiography (OCTA) findings in retinal vascular diseases (RVD). Expert consensus using standardized online surveys with modified Likert scale. RVD imaging experts, OCT biomedical engineers and the members of the International Retinal Imaging Society (IntRIS) METHODS: A PubMed literature review identified quantitative and qualitative terms forming the basis for a consensus-building process using a modified Delphi method. Agreement levels were categorized as "Accepted" (median ≥ 6), "Considerable Consensus" (median 6-7, IQR ≤ 3), "Strong Consensus" (median ≥ 8, IQR ≤ 2), and "Refined Strong Consensus" (median ≥ 8, IQR ≤ 2, with ≥ 70% responses in the 8-10 range). A multidisciplinary expert panel refined the terminology through three survey rounds, leading to a final survey conducted by IntRIS members. Consensus on OCTA nomenclature in RVD RESULTS: The literature review identified 58 relevant papers, yielding 51 quantitative and 108 qualitative terms. A series of three surveys was used to refine the nomenclature framework for describing OCTA findings. The selected framework includes a generic term ("OCTA signal"), adjective terms ("presence/absence", "decreased/increased", "normal/abnormal"), and descriptive/etiologic terms ("of unknown cause", "due to blockage", "due to non-perfusion"). In the final survey among 44 IntRIS members, the framework achieved strong consensus for overall acceptance (median: 8.0, IQR: 7.0-9.0). The term "OCTA signal" met refined strong consensus criteria (median: 8.0, IQR: 8.0-9.0, with ≥ 70% of responses in the 8-10 range). Adjective terms, including "absence/presence" and "increased/decreased," were also rated with strong consensus (median: 8.0, IQR: 7.0-9.0). Similarly, descriptive/etiologic terms achieved strong consensus (median: 8.0, IQR: 7.0-9.0). Adoption of the framework for clinical practice and scientific reporting was rated with strong consensus (clinical: median 8.0, IQR: 7.0-9.0; scientific: median 9.0, IQR: 8.5-10.0). This study establishes a strong consensus framework for reporting OCTA findings in RVD for clinical and scientific contexts.

Background/Objectives: Diabetic macular edema (DME) is a significant cause of visual impairment, often treated with anti-vascular endothelial growth factor (anti-VEGF) agents. However, some patients do not respond adequately to this treatment. This study aims to evaluate the contribution of the intravitreal dexamethasone (DEX) implant as a second-line treatment in DME patients with insufficient response to anti-VEGF therapy or with high treatment burden. Methods: This retrospective multicenter cohort study was conducted across seven clinical sites in Switzerland. The study included eyes with active DME that had been pretreated with anti-VEGF for at least six months before receiving DEX therapy. Data were extracted from electronic patient records, focusing on best-corrected visual acuity (BCVA), central subfield thickness (CST), and injection frequency. Results: A total of 95 eyes from 89 patients (38.8% females, mean age 65.6 ± 9.1 years, follow-up time 80.6 ± 38.5 [13.5–166.7] months) were analyzed. Prior to the first DEX implant, eyes had undergone an average of 16.0 ± 13.3 anti-VEGF injections over 32.5 ± 22.4 months. Post-DEX treatment, 22.1% of eyes received DEX monotherapy, 44.2% received a combination of DEX and anti-VEGF, 25.3% continued with anti-VEGF monotherapy, and 8.4% received no further treatment. The number of anti-VEGF injections decreased significantly from 6.4 ± 3.1 in the year before DEX to 1.6 ± 2.4 in the year after DEX (p < 0.001). BCVA remained stable (0.4 ± 0.3 logMAR at baseline, 0.4 ± 0.5 logMAR at 24 months, p = 0.2), while CST improved from 477.7 ± 141.0 to 320.4 ± 125.5 μm (p < 0.001), and the presence of retinal fluid decreased from 98.0% to 61.1% (p = 0.021). During follow-up, 26.3% of eyes required glaucoma medication, 4.2% underwent glaucoma surgery, and 1.1% needed cataract surgery. Conclusions: In real-world clinical settings, the addition of DEX to anti-VEGF therapy in DME patients significantly reduces treatment burden and retinal fluid while maintaining visual function. Treatment decisions should balance anatomical and functional outcomes, considering individual patient needs.

Purpose To evaluate the efficacy of a subthreshold micropulse laser (SML) in patients with central serous chorioretinopathy (CSCR). Methods Retrospective clinical study conducted at the Departments of Ophthalmology at a university and a municipal hospital in Zurich, Switzerland. We enrolled acute and chronic CSCR patients with persistent subretinal fluid (SRF) treated with SML. Two treatment protocols (fluorescein/indocyanine green angiography or optical coherence tomography guided) were evaluated for efficacy after 3 and 6 months. The primary outcomes of the study were reduction and percentage of eyes with complete resolution of SRF 3 and 6 months after SML treatment. Secondary endpoints included changes in central subfield thickness (CST) and visual acuity (VA) after 3 and 6 months. Results The study involved 37 eyes (35 patients, 48.6% chronic). A statistically significant reduction in SRF height and CST could be shown, irrespective of SRF duration, type of CSCR, or chosen guidance after 3 and 6 months: SRF − 40 µm (p < 0.01), CST − 52 µm (p < 0.01). Percentage of eyes with complete resolution of fluid at 3 and 6 months after SML were 24.3 and 21.6%, respectively. No statistically significant functional improvement (VA) could be shown. Multivariable regression and linear mixed regression analyses did not identify statistically significant differences in SRF reduction, CMT change, or VA improvement with respect to the type of CSCR or the treatment plan used (p > 0.05). Conclusion The effectiveness of SML in CSCR is under continuous debate. Our study findings demonstrate structural but only little functional changes with SML. In view of the shortage of verteporfin for photodynamic therapy, SML remains an important therapeutic option for CSCR patients. Zweck Die Effektivität der Subthreshold Micropulse-Lasertherapie (SML) bei Patienten mit Chorioretinopathia centralis serosa (CRCS) zu bewerten. Patienten und Methoden Eine retrospektive klinische Studie, durchgeführt an den Augenkliniken des Universitätsspital Zürich und des Stadtspital Zürich, Schweiz. Akute und chronische CRCS-Patienten mit persistierender subretinaler Flüssigkeit (SRF), die mit SML behandelt wurden, wurden eingeschlossen. Zwei Behandlungsprotokolle (Fluoreszein/Indocyanin-Grün-Angiographie oder optische Kohärenztomographie) wurden auf ihre Wirksamkeit nach 3 und 6 Monaten hin untersucht. Der primäre Endpunkt der Studie war die Reduktion der SRF und der Prozentsatz der Augen mit vollständiger Auflösung der SRF 3 und 6 Monate nach der SML-Behandlung. Sekundäre Endpunkte umfassten Veränderungen der Central Subfield Thickness (CST) und des Visus (VA) nach 3 und 6 Monaten. Ergebnisse Die Studie umfasste 37 Augen (35 Patienten, 48,6% chronisch). Eine statistisch signifikante Reduktion der SRF-Höhe und CST konnte unabhängig von der Dauer der SRF, dem CRCS-Typ oder des Behandlungsprotokoll nach 3 und 6 Monaten gezeigt werden: SRF − 40 µm (p < 0,01), CST − 52 µm (p < 0,01). Der Prozentsatz der Augen mit vollständiger Flüssigkeitsauflösung nach drei und sechs Monaten nach SML betrug 24,3% bzw. 21,6%. Es konnte keine statistisch signifikante funktionelle Verbesserung des Visus (VA) gezeigt werden. Multivariable Regressions- und lineare Mixed-Regressionanalysen identifizierten keine statistisch signifikanten Unterschiede in der SRF-Reduktion, der CMT-Veränderung oder der VA-Verbesserung in Bezug auf den CRCS-Typ oder das verwendete Behandlungsprotokoll (p > 0,05). Konklusion Die Wirksamkeit von SML bei CRCS ist Gegenstand anhaltender Diskussion. Die Ergebnisse unserer Studie zeigen statistisch signifikante strukturelle, aber nur geringfügige funktionelle Veränderungen durch SML. Angesichts des Mangels an Verteporfin für die photodynamische Therapie bleibt SML eine wichtige therapeutische Option für CSCR-Patienten. ^* These authors share the first authorship. ^** These authors share the last authorship. Received: 29 October 2023 Accepted: 12 December 2023 Article published online: 23 April 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

(1) Background: The process of epiretinal membrane peeling (MP) requires precise intraoperative visualization to achieve optimal surgical outcomes. This study investigates the integration of preoperative Optical Coherence Tomography (OCT) images into real-time surgical video feeds, providing a dynamic overlay that enhances the decision-making process during surgery. (2) Methods: Five MP surgeries were analyzed, where preoperative OCT images were first manually aligned with the initial frame of the surgical video by selecting five pairs of corresponding points. A homography transformation was then computed to overlay the OCT onto that first frame. Subsequently, for consecutive frames, feature point extraction (the Shi–Tomasi method) and optical flow computation (the Lucas–Kanade algorithm) were used to calculate frame-by-frame transformations, which were applied to the OCT image to maintain alignment in near real time. (3) Results: The method achieved a 92.7% success rate in optical flow detection and maintained an average processing speed of 7.56 frames per second (FPS), demonstrating the feasibility of near real-time application. (4) Conclusions: The developed approach facilitates enhanced intraoperative visualization, providing surgeons with easier retinal structure identification which results in more comprehensive data-driven decisions. By improving surgical precision while potentially reducing complications, this technique benefits both surgeons and patients. Furthermore, the integration of OCT overlays holds promise for advancing robot-assisted surgery and surgical training protocols. This pilot study establishes the feasibility of real-time OCT integration in MP and opens avenues for broader applications in vitreoretinal procedures.