Glaucoma is one of the leading causes of permanent vision loss worldwide and has a profound impact on patients’ quality of life. Vision impairment is strongly associated with several psychiatric disorders, like depression, anxiety, and sleep problems. These psychiatric issues are often exacerbated by the gradual, irreversible, and typically silent progression of the disease, contributing to increased mental health challenges for affected individuals. A systematic review was conducted following PRISMA guidelines across six different databases (CINAHL, MEDLINE, PsycINFO, Web of Science, Scopus, and the Cochrane Library) and one gray literature source (Google Scholar), covering the period from 2013 to 2024. Twenty-nine studies involving a total of 13,326,845 subjects were included in the synthesis, highlighting a considerable prevalence of psychiatric disorders among glaucoma patients. Depression and anxiety were the most common conditions identified, with depression rates ranging from 6.6% to 57% and anxiety from 12.11% to 49%. Other less frequent but still significant conditions like sleep disorders, psychosis, dementia, and post-traumatic stress disorder were also observed. The findings also indicated that psychiatric severity was influenced by socio-demographic factors, glaucoma severity, and treatment duration. Given the high occurrence of psychiatric pathologies among individuals with glaucoma, it is essential to develop comprehensive care strategies that address both eye and mental health needs. Multidisciplinary collaboration among ophthalmologists, psychiatrists, psychologists, and primary care physicians is crucial for developing personalized treatment plans that effectively manage both the ocular and psychological aspects of the disease.

Introduction Glaucoma, a chronic and progressive optic neuropathy, is a leading cause of irreversible blindness, affecting both visual function and quality of life (QoL). The disease’s progression, alongside the fear of blindness, contributes to anxiety, depression, and reduced life satisfaction. This study aimed to evaluate the impact of glaucoma on mental health and QoL and to examine the relationship between glaucoma severity and psychological and functional factors. Methods A cross-sectional study was conducted involving 102 patients with glaucoma and 82 age-matched controls without significant ocular disease. All participants completed the 12-Item Short-Form Health Survey version 2 (SF-12v2) to assess general health and the Glaucoma QoL Questionnaire (Glau-QoL-17) for disease-specific QoL. Additional demographic and clinical data, such as education level, household composition, driving status, type of glaucoma, best-corrected visual acuity, number of antiglaucoma medications, static automated perimetry results, psychiatric comorbidities, use of psychiatric medications, and disease-related anxiety were also recorded. Results Glaucoma patients had a mean age of 72.3 ± 7.6 years, with 52.0% (n=53) being female, compared to a mean age of 70.1 ± 18.2 years in the control group, with a female population of 51.2% (n=49). Glaucoma patients scored significantly lower in general health compared to controls (Physical component score: 41.3 ± 11.3 vs. 49.7 ± 8.3 (p < 0.001); Mental component score: 41.8 ± 10.8 vs. 51.0 ± 9.2 (p < 0.001), affecting physical functioning, vitality, social functioning, and mental health. Disease-specific QoL was also worse in glaucoma patients (Glau-QoL-17 total score: 44 vs. 58, p < 0.001), particularly in anxiety, self-image, daily life activities, psychological state, constraints, and self-care. Psychiatric comorbidities were more frequent in glaucoma patients (46.1% vs. 22%) (p < 0.001), with 64.7% (n=66) reporting disease-related anxiety. Significant correlations were found between visual field loss severity and both physical (p = 0.028) and emotional (p = 0.035) role functioning, as well as general health perception (p = 0.015). Conclusion Glaucoma significantly impacts both general and disease-specific QoL, with more severe visual field impairment associated with poorer physical health outcomes. The high prevalence of psychiatric comorbidities and increased use of psychiatric medications further illustrate the psychological burden of glaucoma. These findings highlight the need for holistic care approaches that address both the physical and mental health aspects of glaucoma management.

Birdshot chorioretinopathy (BCR) is a chronic, bilateral posterior uveitis characterized by yellow-white fundus lesions and a strong association with HLA-A29. Visual decline, often due to cystoid macular edema (CME) and retinal atrophy, necessitates early immunomodulatory therapy. This case report describes the clinical course of BCR and highlights the role of intravitreal corticosteroids in managing inflammation and CME. A 54-year-old previously healthy male diagnosed with BCR based on clinical findings and a positive HLA-A29 test presented with refractory CME. Over 20 months, his best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were monitored. Initial treatment included topical corticosteroids, methotrexate, and oral corticosteroids to address anterior chamber reaction, vitritis, diffuse retinal lesions, and vasculitis. Cyclosporine was added for persistent inflammation but discontinued due to a cutaneous reaction. Despite these efforts, CME persisted, necessitating intravitreal corticosteroids. BCVA in the right eye (OD) fluctuated between 20/20 and 20/30, while the left eye (OS) ranged from 20/20 to 20/40, with changes linked to treatment adjustments. Recurrent CME episodes were more pronounced in the OS, where CFT varied from 328 to 637 µm, while OD values ranged from 304 to 576 µm. Intravitreal dexamethasone and fluocinolone implants reduced CFT in both eyes, achieving stabilization at the final assessment (OD 341 µm, OS 347 µm). This case illustrates the challenges of managing BCR with refractory CME. While systemic immunomodulatory therapy is foundational, intravitreal corticosteroids play a vital role in controlling CME and preserving visual function. Combining systemic and local therapies proved essential for disease control. Long-term monitoring and individualized treatment are critical in managing this chronic condition.

Purpose This study aims to investigate whether there is a correlation between intraocular pressure (IOP) elevation after intravitreal triamcinolone acetonide (TA) testing and IOP response following fluocinolone acetonide (FAc) implant injection in the treatment of diabetic macular edema. Methods This study employed a real-world observational cohort retrospective design, enrolling patients who had received at least one intravitreal TA injection prior to a FAc implant injection between December 2018 and July 2022. Demographic data, medical and ophthalmic history were collected at baseline. Mean IOP was assessed before and after both treatments and steroid-response was defined as an IOP greater than 21 mmHg. Statistical analysis was performed to determine correlated IOP changes. Results A total of 28 eyes were included in the study. Six eyes exhibited a steroid response following the initial TA injection, and none of these eyes demonstrated a steroid response following the FAc implant. The FAc implant resulted in steroid response in six additional eyes. The analysis revealed no statistically significant correlation between the occurrence of a steroid response following a TA injection and the subsequent mean IOP progression following an FAc implant injection at any time point. No correlation was observed between the variation in IOP following the two treatments. Conclusion It is crucial to evaluate the necessity of a prior short-acting steroid challenge, which carries the risk of multiple disease relapses, given the potential for a prolonged and stable steroid to provide superior control. The predictive value of the test with TA was not evident in our sample, suggesting some usefulness in delaying treatment with the FAc implant.

Introduction Diabetic macular edema (DME) imposes a substantial clinical and psychosocial burden on patients and caregivers due to frequent visits and intravitreal treatments. The fluocinolone acetonide intravitreal implant (Iluvien^®) offers sustained drug delivery for up to 3 years. We assessed its real-world impact on vision, macular anatomy, intraocular pressure (IOP), quality of life (QoL), and treatment burden, including caregiver impact. Methods Prospective, real-world observational study of 41 patients with previously treated DME. Assessments occurred at baseline and at 6, 12, 18, 24, and 30 months. Outcomes included best-corrected visual acuity (BCVA), central macular thickness (CMT), IOP, and National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) composite scores. Burden metrics included clinic visits per year and caregiver accompaniment/absenteeism. Results At baseline, mean BCVA was 0.42 ± 0.30 logMAR, CMT 415.8 ± 106.5 µm, IOP 16.6 ± 4.1 mmHg, and NEI VFQ-25 67.6 ± 16.4; 46.3% of patients required caregiver accompaniment, and 61% reported pre-injection anxiety (median duration 2 days). At last follow-up, mean BCVA improved to 0.29 ± 0.26 logMAR (≈+6–7 ETDRS letters; p < 0.001), CMT decreased to 368.1 ± 79.6 µm (p = 0.002), and IOP remained stable at 16.7 ± 4.1 mmHg. The NEI VFQ-25 increased to 77.0 ± 18.0, with a significant main effect of time (repeated-measures analysis of variance (ANOVA), p = 0.001; partial η² = 0.675); improvements were evident by 6 months and sustained through 30 months (all comparisons p < 0.05). Clinic visits declined from 5.8 ± 1.6 to 3.7 ± 1.5 per year (p < 0.001). Conclusions In a prospective real-world setting, Iluvien was associated with durable improvements in vision, macular anatomy, and QoL, with stable IOP. Treatment reduced the frequency of clinic visits and procedures, alleviating patient burden and caregiver absenteeism. These findings support Iluvien as a patient-centered, long-acting therapy for chronic DME and motivate multicenter validation and health-economic studies that incorporate caregiver outcomes.

Objective: Pseudoexfoliation syndrome (PEX) is an age-related systemic disorder characterised by the deposition of extracellular fibrillar material in ocular tissues, particularly the lens capsule, pupillary margin, and trabecular meshwork. PEX is a major risk factor for glaucoma and elevated intraocular pressure (IOP), but its independent effect on corneal endothelial morphology remains uncertain. Previous studies have reported inconsistent findings regarding endothelial cell density (ECD), morphology, and central corneal thickness (CCT). This study aimed to evaluate the impact of PEX on endothelial morphology and CCT using non-contact specular microscopy in a Portuguese cohort. Material and methods: We conducted a retrospective cross-sectional study including 450 eyes: 250 with PEX and 200 age-matched controls without PEX. Eyes with pre-existing corneal disease, prior intraocular surgery, or contact lens wear were excluded. PEX was diagnosed by slit-lamp biomicroscopy, and IOP was measured by Goldmann applanation tonometry. Endothelial parameters were assessed with the EM-3000 specular microscope, including cell count, ECD, mean cell area, coefficient of variation (CV), hexagonality, and CCT. Group differences were analysed using parametric and non-parametric tests, with ANCOVA adjusting for age, sex, and IOP. Results: Baseline characteristics were comparable for age (PEX: 76.2 ± 6.9 years; controls: 75.9 ± 6.1 years; p = 0.289) and sex (female: 56.4% vs. 55.5%; p = 0.521). Glaucoma and ocular hypertension were more frequent in PEX (35.5% and 5.2%, respectively) compared with controls (3.9% and 0%; p < 0.001). On unadjusted analysis, ECD was lower in PEX eyes (2389.2 ± 305.7 vs. 2461.8 ± 274.1 cells/mm²; p = 0.042), though the difference attenuated after adjustment (p = 0.055). Mean cell area was larger in PEX (417.0 µm² [IQR 386.0–452.0] vs. 410.5 µm² [381.0–439.0]) and reached significance after adjustment (p = 0.036). CV was slightly lower in PEX (37.8% [35.0–42.5] vs. 40.9% [36.5–45.0]; p = 0.029), persisting after adjustment (p = 0.031). Hexagonality did not differ between groups. CCT was significantly greater in PEX (541.0 ± 35.9 vs. 530.2 ± 36.8 µm; p = 0.029), remaining significant after adjustment (p = 0.041). Conclusion: PEX was associated with subtle but clinically relevant corneal endothelial changes, including a trend toward reduced ECD, larger cell area, lower CV, and increased CCT. These alterations persisted for CCT, CV, and cell area after adjustment for age, sex, and IOP. The higher prevalence of glaucoma and ocular hypertension in PEX further reinforces the need for careful preoperative assessment. Specular microscopy should be considered routine in PEX patients to anticipate surgical risks and guide management.