Purpose: To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. Setting: Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. Design: Retrospective, consecutive case series. Methods: This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. Results: 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA (P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. Conclusions: A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.

This retrospective single-center case series evaluated the outcomes of direct selective laser trabeculoplasty (DSLT) in patients with primary angle closure glaucoma (PACG). Twelve eyes of 8 phakic patients with PACG and patent laser peripheral iridotomy (LPI) underwent DSLT. The primary outcome was the percentage reduction in intraocular pressure (IOP). Secondary outcomes included treatment success, defined as an IOP reduction of ≥20% from baseline or a reduction in glaucoma medications while maintaining baseline IOP and safety parameters. The mean patient age was 71.0±9.3 years. Baseline IOP was 17.0±2.3 mm Hg and decreased significantly to 13.6±3.0 mm Hg at the 2-month follow-up ( P =0.0024), representing an overall mean IOP reduction of 20.3%±11.6%. Treatment success was achieved in 7 eyes (58.3%), with a mean IOP reduction of 27.6%±7.3%. The mean number of glaucoma medications decreased from 3.17±1.47 to 2.75±1.70 ( P =0.0369), and the medications were completely discontinued in 3 eyes. Corrected distance visual acuity remained stable. The most common transient findings were mild anterior chamber reaction and subconjunctival hemorrhage, and no IOP spikes or other complications occurred. These preliminary results suggest that DSLT is a safe, well-tolerated, and potentially effective noncontact laser therapy for phakic patients with PACG and patent LPI. Larger prospective studies with longer follow-up periods are warranted to confirm these findings.

Introduction: This report describes a challenging case involving the diagnosis and surgical repair of an extensive cyclodialysis cleft (CDC) in a young, phakic patient. Patient and Clinical Findings: A 25-year-old man presented with ocular pain, visual impairment, eyelid hematoma, subconjunctival hemorrhage, and Berlin edema after blunt trauma to the right eye. Initial conservative treatment with medications was converted to surgery due to hypotony-induced maculopathy. Diagnosis, Intervention, and Outcomes: Ultrasound biomicroscopy (UBM) and gonioscopy revealed extensive supraciliary and suprachoroidal fluid and a CDC whose dimensions were inconclusive. However, consequent intraoperative UBM provided precise real-time anatomical evidence of an extensive CDC extending 8 clock hours and mandating closure with a direct cycloplexy approach. Layered scleral dissection and direct suturing of the ciliary body to the sclera were performed with 8-0 nylon sutures, resulting in CDC resolution, supraciliary and suprachoroidal fluid absorption, visual acuity improvement, and intraocular pressure stabilization. Conclusions: This case highlights the innovative use of intraoperative UBM as a critical tool, offering real-time guidance in managing an extensive CDC. The successful closure and improved visual outcomes in this case further validate the efficacy of direct cycloplexy for extensive CDCs.

Objectives: The objective of this study was to evaluate the agreement and clinical interchangeability of intraocular pressure (IOP) measurements obtained with the mechanical Haag-Streit AT900 Goldmann applanation tonometer (mGAT) and the digital Huvitz HT5000 applanation tonometer (dGAT). Methods: This retrospective comparative study included 53 eyes of 28 patients undergoing routine ophthalmologic evaluation. Each eye underwent IOP measurement using both mGAT and dGAT in a randomized sequence. Central corneal thickness (CCT) was also recorded. Pearson’s correlation coefficient was used to determine correlation between paired IOP measurements. Bland–Altman plots were graphed for the analysis of differences for IOP between the instruments. Results: A total of 53 eyes of 28 patients (15 males) were included in the study. The mean age of the patients was 62.6 years. The mean mGAT and dGAT measurements were 16.3 ± 6.6 mmHg (range 9–50) and 16.4 ± 6.2 mmHg (range 8.8–45.9), respectively (p = 0.53). A strong, significant positive correlation was found for paired IOP measurements by the two instruments (r = 0.98; p < 0.0001). Bland–Altman analysis revealed 95% limits of agreement from −2.5 to +2.3 mmHg, with a small but statistically significant proportional bias favoring mGAT at higher IOP levels. Additionally, 91% of paired measurements were within ±2 mmHg. CCT-related differences were statistically and clinically insignificant. Conclusions: IOP measurements obtained with mGAT and dGAT were highly correlated and clinically interchangeable for the range tested. The Huvitz HT5000 may serve as a reliable alternative to the classic Goldmann tonometer in routine clinical settings.

Precis: DSLT is a safe and effective modality for IOP reduction in OHT or OAG, performing especially well as first-line therapy in treatment-naive eyes with high baseline IOP. Purpose: To evaluate the safety and efficacy of direct selective laser trabeculoplasty (DSLT) in ocular hypertension (OHT) or open angle glaucoma (OAG), including treatment-naive and medically treated eyes. Methods: A retrospective, single-center study based on electronic medical records of consecutive patients with OHT or OAG who underwent 360-degree DSLT between January 2023 and October 2024 in a tertiary hospital in Jerusalem. Demographic and clinical data were collected. Intraocular pressure (IOP) was measured pretreatment, 30 minutes post-DSLT, and at 2-months. The primary outcome was treatment success, defined as ≥20% or ≥3 mm Hg IOP reduction at 2 months without extra therapy. Secondary outcomes were mean IOP change, adverse events, and best-corrected visual acuity (BCVA) change. Results: The study included 218 eyes from 144 patients. At 2 months, 66.97% of eyes met treatment success criteria. Mean baseline IOP was 19.73±4.52 mm Hg and decreased by 3.42±3.62 mm Hg (15.57%). Treatment-naive eyes showed greater IOP reduction (4.54±2.88 mm Hg, 20.17%) and higher success rates (78.43%) compared with premedicated eyes (3.07±3.11 mm Hg, 14.17%; 63.47% success; P =0.038). Subconjunctival hemorrhages occurred in 54.6% of eyes. IOP spikes were rare (1.8%). BCVA remained stable ( P =0.152). No serious adverse events were observed. Conclusions: DSLT is a safe and effective method for lowering IOP in OHT or OAG patients, particularly in treatment-naive eyes. Its noncontact, rapid, and standardized approach may offer practical advantages over conventional SLT. Further prospective studies with extended follow-up are needed to confirm these findings.

Background/Objectives: To evaluate the short-term effects of direct selective laser trabeculoplasty (DSLT) on retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness in patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG). Methods: This retrospective, single-center study included 45 eyes of 45 patients with OHT or POAG who underwent DSLT at Shaare Zedek Medical Center between February 2024 and February 2025. The primary outcome was the change in RNFL and GCL thickness, as measured by spectral-domain optical coherence tomography (SD-OCT) before and two months after treatment. Secondary outcomes included intraocular pressure (IOP) reduction, corrected distance visual acuity (CDVA), and safety. Only high-quality OCT scans (quality score > 25) were included in the analysis. Results: OCT analysis revealed no statistically significant changes in the inner retinal structure two months post-treatment. The mean RNFL thickness was 77.1 ± 17.2 µm at baseline and 77.4 ± 17.3 µm at follow-up (p = 0.285). The mean GCL thickness remained unchanged (42.4 ± 11.6 µm vs. 42.4 ± 11.3 µm, p = 0.750). CDVA remained stable (0.2 ± 0.4 vs. 0.2 ± 0.4 logMAR; p = 0.351), and no vision-threatening complications were observed. Mean IOP decreased significantly from 19.7 ± 4.0 mmHg at baseline to 16.2 ± 3.5 mmHg at two months (p < 0.001). The mean total laser energy delivered was 196.5 ± 10.2 mJ (range: 176–210 mJ). Conclusions: DSLT was not associated with significant short-term changes in RNFL or GCL thickness, supporting its structural safety in patients with OHT or glaucoma. Further long-term studies are warranted to determine the durability of these findings and the potential neuroprotective effects of DSLT.