Purpose: To evaluate the effects of topical insulin in patients with persistent corneal epithelial defects that are refractory to the standard treatment. Methods: A retrospective, hospital-based, clinical study was performed on 17 eyes of 16 patients with different types of refractory persistent epithelial defects who were treated with topical insulin. The treatment was continued until the defect either was resolved or persisted after three months. Patients’ demographic information, etiology, comorbidities, and clinical data were reviewed. The rate of epithelial healing was considered as the primary outcome measure. Results: Neurotrophic keratitis was the most common cause of persistent epithelial defects (58.8%), and within this category, herpetic eye disease was the main comorbidity (44.4%). The mean follow-up time was 17.91 months. Eleven out of fifteen eyes (77.3%) had complete improvement and only one patient did not respond to the treatment. The mean time of reepithelization for the eyes with full recovery was 31.27 days (ranging from 6 to 61 days). The best-corrected visual acuity improved significantly after treatment (P < 0.005), and there were no reports of complications or side effects during the study period. Conclusion: Our results suggest that topical insulin, due to its good safety profile, availability, and affordability, could be a good therapeutic alternative for persistent epithelial defects.

A woman in her 40 s presented with recurrent retro-orbital pain over several years, initially attributed to migraine. Later, she was diagnosed with glaucoma in the context of suspected intermittent angle closure. Despite controlled intraocular pressure (IOP) with topical pressure-lowering therapy, progressive visual loss persisted. Optical coherence tomography showed diffuse retinal nerve fibre layer (RNFL) thinning, and visual fields demonstrated severe defects. However, pronounced optic disc pallor, rapid progression despite IOP control and diffuse rather than sectorial RNFL loss raised suspicion of an alternative diagnosis. Visual evoked potentials demonstrated delayed P100 latency, and MRI confirmed inflammatory changes of the optic nerve. High-dose systemic corticosteroids led to marked improvement, with relapse following its withdrawal, confirming steroid dependency. Chronic relapsing inflammatory optic neuropathy was the diagnosis, and immunosuppressive therapy was initiated with subsequent sustained visual recovery. This case highlights the importance of considering alternative diagnoses in atypical glaucoma presentations.

Combined trabeculectomy–phacoemulsification is known to provoke more inflammation and yield a poorer long-term efficacy than trabeculectomy alone. This study evaluates whether a similar trend exists for Ahmed glaucoma valve implantation when performed with or without concurrent phacoemulsification. We retrospectively analyzed 51 eyes from patients who underwent either Ahmed-Alone (n = 25) or PhacoAhmed (n = 26) surgery over a 5-year period. The primary outcomes included intraocular pressure (IOP), the use of IOP-lowering medications, and the need for further surgical intervention. Absolute success was defined as IOP reduction > 20% and IOP < 21 mmHg without medication; relative success allowed for continued pharmacologic therapy. Both groups showed a significant IOP reduction, with similar final mean IOP values (Ahmed-Alone: 14.02 ± 4.76 mmHg; PhacoAhmed: 13.89 ± 4.17 mmHg; p = 0.99) and comparable reductions in medication use (p = 0.52). Reinterventions occurred less frequently and later in the PhacoAhmed group (12% vs. 27.3%; median time: 27.1 vs. 12 months). Absolute success was not achieved in any PhacoAhmed case but occurred in 9.3% of Ahmed-Alone cases; relative success rates were similar (83.3% vs. 81.4%; p = 0.291). These findings suggest that combining phacoemulsification with Ahmed valve implantation does not significantly alter efficacy or safety profiles. Additional prospective studies are warranted to assess long-term outcomes.

A man in his 30s with a prior diagnosis of presumed primary open-angle glaucoma presented with progressive visual deterioration and headaches. Initial optic disc cupping and the established glaucoma diagnosis suggested glaucomatous optic neuropathy; however, visual field defects respecting the vertical meridian and optical coherence tomography changes inconsistent with glaucoma prompted neuroimaging, which revealed a large invasive pituitary macroadenoma compressing the optic chiasm, later confirmed as a mixed prolactin-secreting and growth hormone-secreting tumour. Following medical treatment, visual function improved and serial MRI confirmed tumour shrinkage. Two years later, slowly progressive nasal retinal nerve fibre layer thinning raised concern for recurrence. Repeated neuroimaging instead demonstrated a secondary empty sella with inferior, V-shaped herniation of the optic chiasm rather than regrowth, with traction being the probable cause of the ongoing axonal loss. This case highlights secondary empty sella-related chiasmal herniation as a diagnostic pitfall following pituitary adenoma treatment.

Conjunctival lymphoma classically appears as a painless salmon-pink subepithelial infiltrate, but its indolent forms can closely imitate inflammatory ocular surface disease and delay diagnosis, particularly when an uncommon subtype such as small lymphocytic lymphoma presents bilaterally and in isolation. A woman in her early fifties presented with one month of left ocular discomfort and sectoral redness, and slit-lamp examination revealed two multilobulated hyperaemic bulbar conjunctival nodules, clinically indistinguishable from nodular episcleritis. Topical corticosteroids and a topical non-steroidal anti-inflammatory drug relieved the ocular discomfort and hyperaemia, but the nodules regressed only partially and at no point resolved. This dissociation between symptomatic relief and persistence of the lesions was, in retrospect, the earliest argument against a purely inflammatory process. The initial work-up pointed toward inflammatory and granulomatous causes: elevated serum angiotensin-converting enzyme and lysozyme raised the possibility of sarcoidosis, although thoracic computed tomography, bronchoscopy and a first conjunctival biopsy performed without a lymphoma-directed panel were unrevealing, showing only reactive lymphoid hyperplasia. Approximately one year later, recurrent and now bilateral disease prompted a repeat biopsy with directed immunohistochemistry, which demonstrated a CD20-positive small B-cell infiltrate co-expressing CD5 and CD23 with negative cyclin D1 and CD10, consistent with chronic lymphocytic leukaemia/small lymphocytic lymphoma. Systemic staging with ¹⁸F-FDG PET/CT and bone marrow biopsy revealed no definite extra-conjunctival disease. After multidisciplinary review of observation, local radiotherapy and surgical excision, systemic therapy was preferred given the bilateral, recurrent and symptomatic course, and oral ibrutinib 420 mg once daily achieved complete clinical regression at three months and a sustained ocular response at two years, with indefinite haematological and ophthalmological surveillance planned.