To investigate the surgical outcomes of 2 different scleral fixation techniques of the new single-piece foldable acrylic Carlevale lens (Soleko) and to compare our results with previous reports of the literature. A retrospective, non-randomized comparative study involving 2 series of patients who underwent 2 different scleral fixation techniques of Carlevale lens was performed. Minimum follow-up of 3 months was requested for inclusion in the study. All the patients underwent a standard ophthalmologic examination including best correct visual acuity, measurement of intraocular pressure, anterior segment, and fundus examination. In the first technique (group 1), plugs were externalized through a 23 gauge sclerotomy and placed within 2 scleral pockets. In the second technique (group 2), plugs were externalized through a 25-gauge sclerotomy and covered by 2 scleral flaps. For an estimation of the refractive prediction error, the postoperative spherical equivalent of objective refraction was calculated (IOL Master 750, Carl Zeiss Meditec AG, Jena, Germany). Spectral domain optical coherence tomography (Spectralis HRA+OCT2, Heidelberg Engineering, Heidelberg, Germany) of anterior segment was used to check plugs positioning postoperatively. Twenty-three eyes in group 1 and 9 eyes in group 2 were included. Preoperative diagnosis was aphakia, dislocated posterior chamber intra ocular lens, dislocated lens, anisometropia, Uveitis-Glaucoma-Hyphema syndrome, perforating trauma with dislocated intra ocular lens, and open globe injury with dislocated intra ocular lens. Respectively, in groups 1 and 2, refractive spherical equivalent prediction error was –0,31 ± 0,74 D and –0,27 ± 0,80 D, and postoperative best-corrected visual acuity was 0,42 ± 0,31 logMAR and 0,47 ± 0,45 logMAR. In group 1, 1 eye developed cystoid macular edema, 1 eye vitreous haemorrhage, and 3 eyes showed plugs located outside the scleral pockets under the conjunctiva. Rupture of 1 of the 2 tips of the plug was observed in 1 patient of group 1 during the externalization. Carlevale lens is a scleral fixated intra ocular lens specifically designed for posterior chamber implantation that could be successfully managed without any significant difference between the 2 surgical techniques, and appears approachable for anterior and posterior segment surgeons. A 25-gauge sclerotomy should be preferred with the aim of a sutureless surgery regardless the technique employed.

Purpose: To evaluate the surgical outcomes and feasibility of a novel approach for scleral-fixation using a single-piece acrylic foldable Carlevale lens (Soleko). Methods: Eighteen eyes of 18 patients with aphakia, dislocated IOL, subluxated lens, anisometropia, perforated trauma, and retinal detachment who underwent IOL implantation with a Carlevale lens were evaluated. All the patients underwent a standard ophthalmologic examination. Anterior segment (AS)-OCT was used postoperatively to check plugs positioning and IOL tilt. Results: Mean patients age was 73 ± 19 years. Mean follow-up was 11.2 ± 4.1 months. Mean axial length was 23.7 ± 1.65 mm, white-to-white distance was 11.74 ± 0.40 mm, and axial length was 23.67 ± 1.65 mm. Refractive spherical equivalent prediction error was −0.31 ± 0.71D. Mean IOL tilt was 2.2° ± 1.6° and plugs were placed within the sclera. Five patients had aphakia, five in-the-bag IOL subluxation, three in-the-bag IOL luxation, one high residual myopia after previous verisyse implant, one Uveitis-Glaucoma-Hyphema syndrome, one perforating trauma with phacodonesis, one intraocular foreign body and retinal detachment, two lens subluxation. One eye developed cystoid macular edema which disappeared with topical steroids and FANS. No other complications were observed throughout the follow-up. Conclusion: Carlevale lens (Soleko) appears to be a viable option for both anterior and posterior segment surgeons in the management of complex cases providing less challenging maneuvers which lead to a good lens self-centration and minimal risk of haptic rupture and/or dislocation. The lens seems to offer a good compartmentalization between the anterior and posterior chamber reducing the risk of an inflammatory response.

Purpose: This study investigated the applicability of a validated AI-algorithm for analyzing different retinal biomarkers in eyes affected by epiretinal membranes (ERMs) before and after surgery. Methods: A retrospective study included 40 patients surgically treated for ERMs removal between November 2022 and January 2024. Pars plana vitrectomy with ERM/ILM peeling was performed by a single experienced surgeon. A validated AI algorithm was used to analyze OCT scans, focusing on intraretinal fluid (IRF) and subretinal fluid (SRF) volumes, external limiting membrane (ELM) and ellipsoid zone (EZ) interruption percentages and hyper-reflective foci (HRF) counts. Results: Postoperative best corrected visual acuity (BCVA) significantly improved ( p < 0.01), and central macular thickness (CMT) decreased from 483.61 ± 96.32 to 386.82 ± 94.86 µm ( p = 0.001). IRF volume reduced from 0.283 ± 0.39 mm ³ to 0.142 ± 0.27 mm ³ ( p = 0.036) particularly in the central 1 mm-circle. SRF, HRF and EZ/ELM interruption percentages exhibited no significant differences ( p > 0.05). Significant correlations ( p < 0.05) were found between preoperative BCVA and postoperative BCVA ( r = 0.45); CMT reduction and postoperative BCVA ( r = 0.42), preoperative IRF and Visual Recovery ( r = −0.48), ELM and EZ interruption and visual recovery ( r = −0.43 and r = −0.47 respectively). Multivariate analysis demonstrated that fluid distribution, especially in the central subfield, correlated with BCVA recovery (R2 = 0.38; p < 0.05; Pillai's Trace = 0.79). Conclusion: The study highlights AI's potential in quantifying OCT biomarkers in ERMs surgery. The findings suggest that improved BCVA is associated with reduced CMT, IRF, and redistribution of IRF towards the periphery. EZ and ELM integrities remain crucial prognostic factors, emphasizing the importance of the preoperative analysis.

Background/Objectives: The aim of this study was to quantify the interscan variability of vascular perfusion in patients with diabetic retinopathy (DR) using sequential optical coherence tomography angiography (OCT-A) scans. Methods: Patients with low-grade DR (DRSS score 20) underwent five sequential OCT-A imaging sessions. Vessel perfusion density (VPD) values of the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), deep capillary plexus (DCP), and choriocapillaris (CC) were computed using ImageJ Version 1.54 software via a binarization process. The binarized images were analyzed to compute VPD using vessel density plugins. Inter-session variability was assessed using the coefficient of variation (CV) and intraclass correlation coefficient (ICC). The results were compared with an age-matched group of healthy controls. Results: A total of 16 eyes from 16 patients with DR (6 females, 37.5%) and 16 eyes from healthy controls (6 females, 37.5%) were included. Mean VPD values for SCP, ICP, DCP, and CC in patients with DR were 23.64, 13.64, 15.31, and 36.57, respectively. Corresponding values for the healthy subjects were 37.65, 23.32, 22.05, and 49.00, respectively. No significant differences were found in VPD across consecutive scanning sessions (p > 0.05) in either group. However, significant differences in VPD were observed between patients who were healthy and patients with diabetes. Conclusions: Sequential OCT-A imaging demonstrated no significant inter-session variability in both healthy subjects and subjects with diabetes. The Spectralis OCT-A system showed high reliability for imaging both healthy and diseased conditions.

Background/Objectives: The aim of this study was to evaluate the choroidal vascular response using optical coherence tomography (OCT) in patients with chronic central serous chorioretinopathy (CSCR) during transient increases in blood pressure. Methods: This observational, case–control study enrolled chronic CSCR patients and age-matched healthy controls. OCT scans of the macula were performed at rest and during hand-grip (HG) isometric exercise. Mean ocular perfusion pressure (MOPP) and subfoveal choroidal thickness (SCT) were measured at baseline and during stress. Quantitative OCT assessment included the bright area (BA, stroma), dark area (DA, vascular lumen), and total choroidal area (CA). The choroidal vascularity index (CVI) was calculated as DA/CA to assess vascular response to stress. A comparative analysis between CSCR patients and controls was conducted. Conclusions: MOPP was significantly higher (p = 0.008) at baseline in CSCR patients and further increased under stress compared to controls. SCT and CA were both significantly higher in CSCR patients than in healthy subjects at rest and under stress (p < 0.001), but no change occurred after HG. A significant decrease in CVI (p = 0.005) was noted in controls under stress, but not in CSCR patients. Additionally, a negative correlation between CVI and MOPP was found in healthy subjects (−0.648; p = 0.043). The study demonstrated a choroidal vasoconstrictive response to stress in healthy subjects, as evidenced by a decrease in CVI, but not in CSCR patients. This suggests that CSCR patients may experience impaired choroidal blood flow regulation, resulting in potentially higher perfusion pressures during stress without compensatory vasoconstriction, potentially affecting the choriocapillaris.

Purpose: To evaluate the functional and structural outcomes in patients with neovascular age-related macular degeneration (nAMD) switched from ranibizumab or aflibercept to bevacizumab. Methods: This retrospective study included 197 eyes of 192 patients (mean age 83 ± 6 years; 38% male). Patients previously treated with ranibizumab (n = 79) or aflibercept (n = 118) were transitioned to bevacizumab. Best-corrected visual acuity (BCVA) was recorded with ETDRS charts and converted to logMAR. Spectralis SD-OCT was used to evaluate intraretinal and subretinal fluid, presence of retinal pigment epithelium detachment (PED), PED height and central retinal thickness (CRT) at baseline and after 6 months. Results: Mean BCVA decreased from 0.4 ± 0.3 to 0.5 ± 0.4 logMAR (p = 0.048). The proportion of eyes with intraretinal or subretinal fluid rose from 27% to 69% (p = 0.017). Subgroup analysis indicated greater functional and structural worsening in younger patients and in those switched from aflibercept. Mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091), mean PED height showed a non-significant increase from 163 ± 94 to 166 ± 95 µm (p = 0.091). In contrast, mean CRT increased substantially from 294 ± 30 µm at baseline to 310 ± 26 at 6 months (p (p < 1 × 10 ⁻⁷ ). Conclusions: Switching from ranibizumab or aflibercept to bevacizumab may lead to reduced visual function and an increase in structural-OCT markers of disease activity, including greater intraretinal/subretinal fluid, CRT and worsening PED features, particularly in younger individuals and in eyes previously treated with aflibercept.