The prognosis of uveal melanoma is significantly influenced by the risk of metastasis, which varies according to clinical and genetic features. Driver mutations can predict the likelihood of disease progression and survival, although the data in the literature are inconsistent. This meta-analysis aimed to evaluate the prognostic significance of driver mutations, including GNAQ, GNA11, BAP1, and SF3B1, in the advancement of uveal melanoma. A comprehensive search of databases yielded relevant studies, and data from 13 studies (848 eyes) were synthesized to assess the impact of these mutations on metastasis-free survival. The BAP1 mutation and negative immunohistochemistry were associated with a higher risk of metastasis (logHR = 1.44, 95% CI 1.05–1.83). GNAQ, GNA11, and SF3B1 mutations did not show a significant increase in risk. In summary, BAP1 has proven to reliably predict the likelihood of disease progression in uveal melanoma, while further studies are needed to establish the significance of other driver mutations.

Objectives: The aim of this study was to investigate endogenous endophthalmitis (EE) in Spain and Mexico, focusing on microbial patterns, antibiotic resistance, infection sources, risk factors, and patient outcomes. Methods: Over 20 years, 705 endophthalmitis cases were reviewed, and we identified 78 cases of EE in Santiago de Compostela, Spain, and Mexico City, Mexico. Microbial etiology, infection sources, antibiotic resistance, and treatment outcomes were compared between patients from Spain and Mexico. Results: Among the 78 EE cases, 47 (60.25%) were from Spain and primarily had bacterial infections (57.1%, mainly Staphylococcus and Streptococcus). In contrast, 31 cases (39.74%) were from Mexico and had a higher prevalence of fungal infections, particularly Candida (47.1%). Diabetes mellitus was a significant risk factor, and was more common in Mexico (61.3%) than in Spain (37.0%). The Spanish cohort exhibited notable antibiotic resistance, especially in Staphylococcus. Treatment typically involved systemic and intraocular antibiotics, with vitrectomy performed in 61.5% cases. Post-treatment, bacterial infections had higher success rates (approximately 50%) compared with fungal infections (approximately 30%). Evisceration was necessary in 9% cases, and the overall mortality rate was approximately 4.4%; it was slightly higher in Mexico than in Spain. Conclusions: The study highlights significant regional differences in EE between Spain and Mexico, particularly regarding microbial etiology and antibiotic resistance. The findings emphasize the need to adapt healthcare practices to specific regions to improve EE treatment outcomes, underscoring the importance of ongoing research and interregional collaboration to better understand and manage this complex condition.

We report on a case of HSV-1 necrotizing stromal keratitis arising from femtosecond laser arcuate keratotomy wounds after femtosecond laser–assisted cataract surgery (FLACS) in a patient without known prior ocular herpes. An 80-year-old woman underwent uncomplicated FLACS with paired arcuate keratotomies and was discharged on topical dexamethasone and ofloxacin. Fifteen days later, examination showed dendritic lesions aligned with the keratotomy incisions, stromal infiltrates/necrosis, diffuse endotheliitis, and mild anterior uveitis. Oral valacyclovir and topical antiviral therapy were started with corticosteroids, but rapid progression occurred with hypopyon, worsening stromal necrosis, and hemorrhagic hyphema. Anterior chamber tap PCR confirmed HSV-1. Treatment escalated to fortified antibiotics during workup, intravitreal ganciclovir (with intravitreal antibiotics), anterior chamber washout, hospitalization for intravenous acyclovir, and later surgical management of secondary inflammation (pupillary membrane with iris bombé) with membrane removal and peripheral iridectomies. Inflammation gradually resolved and final best-corrected visual acuity improved to 0.4 logMAR. HSV reactivation may present as severe necrotizing stromal keratitis originating at femtosecond arcuate keratotomy sites even without a known herpetic history; early recognition and aggressive antiviral therapy with careful steroid use are crucial after FLACS.