Background/Objectives: The aim of this study was to review the therapeutic and prognostic factors influencing Acanthamoeba Keratitis (AK) management. Methods: A systematic search was performed across MEDLINE^® (via PubMed), Web of Science^®, and Scopus^®, following the PRISMA 2020 guidelines, and registered in PROSPERO (CRD420251010774). Studies reporting AK treatment regiments and prognostic factors were included. After extracting the data from the included articles, the relevant aspects of the treatment and the prognostic factors were compared and summarized. Results: Sixty-one articles were included: nine were prospective, including 3 randomized controlled trials (RCTs), and fifty-two were retrospective. The findings suggest that therapeutic epithelial debridement (TED), followed by an association with biguanides, diamidines, and an antibacterial agent, is a strong initial treatment option. An adjunctive medical treatment with topical voriconazole 1% or oral miltefosine may also be considered. Surgical approaches were also assessed when the pharmaceutical therapy failed, with Deep Anterior Lamellar Keratoplasty (DALK) playing an important role in the cases without a deep stroma involvement. Early Therapeutic Penetrating Keratoplasty (TPK) should be used as a salvage therapy and Optical Penetrating Keratoplasty (OPK) should be used for rehabilitation purposes. Key prognostic factors include older age, delayed diagnosis, corticosteroid use before prompt diagnosis, poor initial best corrected visual acuity (BCVA), and AK stage at presentation. Conclusions: The initial treatment with TED, biguanides, and diamidines remains the foundation of treatment. Surgical options can be considered in advanced cases. An early diagnosis, age, and initial BCVA are prognosis factors that should be considered. Future research may focus on improvement of protocols and searching for novel agents.

Purpose: To report the 4-year outcomes of transepithelial accelerated corneal collagen crosslinking (TE-ACXL) in the treatment of eyes with progressive keratoconus (KC). Methods: Eyes of patients who underwent TE-ACXL (6mW/cm² for 15 minutes) for progressive KC and presented 48 months of follow-up were included. Corrected distance visual acuity (CDVA), keratometry measurements (Kmax, maximum keratometry, Kmean, mean keratometry and Astg, corneal astigmatism), thinnest corneal thickness (PachyMin), and topographic, and tomographic indices (specifically the posterior radius of curvature from the 3.0 mm centered on the thinnest point of the cornea (PRC), and the D-index) were analysed preoperatively and every 12 months after TE-ACXL, up to 48 months. Progression after TE-ACXL was considered when eyes presented ≥ 1 criteria: (1) increase of ≥ 1D in Kmax or increase of ≥ 0.75D in Kmean or increase of ≥ 1D in Astg; (2) reduction of ≥ 0.085 mm in PRC; (3) decrease ≥ 5% in PachyMin. Results: 41 eyes from 30 patients were included, with a mean age at crosslinking of 20.90± 4.69 years. There was a significant increase in Kmean (+0.64± 1.04 D, p< 0.001; +0.98 ± 1.49 D, p< 0.001; +1.27± 2.01 D, p< 0.001; +1.13± 2.00 D, p=0.006) and a significant decrease in PRC throughout follow-up (− 0.12± 0.22, p=0.002; − 0.15± 0.24, p< 0.001; − 0.17± 0.43, p=0.021; − 0.16± 0.43, p=0.027). PachyMin decreased significantly at 36 and 48 months (− 8.50± 15.93 μm, p=0.004; − 7.82± 18.37, p=0.033). According to our progression criteria, there was a major progression rate throughout follow-up (57.1%, 61.1%, 58.8%, and 67.9%, respectively). Surgery and follow-up were uneventful in all subjects. Eleven eyes (26.8%) required further procedures, ≥ 36 months after the initial TE-ACXL, due to persistent progressive disease. Conclusion: TE-ACXL proved to be a safe therapeutic option for progressive KC. However, its efficacy is deemed unsatisfactory, as a notable proportion of affected eyes may continue to advance within a 4-year timeframe, necessitating additional procedures to halt the disease’s course.

Purpose To describe cases of infectious and non-infectious intraocular inflammation (NI-IOI) associated with intravitreal injections (IVI) of anti-vascular endothelial growth factor (anti-VEGF) drugs in the largest tertiary center with the highest number of IVI in Portugal. Methods Prospective observational study including all patients diagnosed with infectious endophthalmitis (IE) or NI-IOI after IVI of different anti-VEGF drugs in a total of 83,145 IVI between 2018 and 2023. The most frequent indications for treatment were macular neovascularization or macular edema from different etiologies. Results Twenty-six eyes developed IE (mean incidence 0.031%) after IVI and 24 eyes were diagnosed with NI-IOI (mean incidence 0.028%), including anterior plus intermediate uveitis (n = 18), only vitritis (n = 4) and retinal vasculitis (n = 2). Regarding NI-IOI, eyes were under treatment with aflibercept (n = 12), bevacizumab (n = 11) and faricimab (n = 1). The most common initial presentation was a painless decrease in visual acuity (VA) at a mean of 8 days [1–20] after IVI in patients with NI-IOI versus red eye, pain and blurry vision, at a mean of 3 days [1–9] after IVI in the IE group. There was a significant improvement in VA between the NI-IOI diagnosis and final visits (35 ± 25 vs. 49 ± 24 ETDRS letters) in the NI-IOI group (p = 0.022), an improvement that occurred over a mean of almost 2 months. There were no significant differences between VA at the time of diagnosis and after treatment (25 ± 28 vs. 26 ± 25 ETDRS letters) in the IE group (p = 0.801). Conclusion NI-IOI represents an emergent treatment-related adverse event, that can be reversible when adequately managed, contrasting with the sight-threatening severe cases of IE. We emphasize the importance of maintaining active surveillance in patients under intravitreal therapy.

Purpose: To evaluate the progression of chorioretinal atrophic areas associated with myopic choroidal neovascularization (CNV) in high myopic patients followed by a minimum period of 10 years. Patients and Methods: Patients with myopic CNV lesions that achieved clinical and structural remissions over 10 years of follow-up were included. Medical records were reviewed for CNV characterization and treatment, best-corrected visual acuity at baseline (BCVA0), immediately after the last treatment (BCVA1) and at the latest visit (BCVA2). Fundus autofluorescence (FAF) was used to quantify the amount of atrophic area increase per year associated with the treated myopic CNV lesion. The first FAF performed after treatment suspension (FAF1) was compared with the most recent exam (FAF2). Results: Thirty-six eyes from 36 patients were included. Mean total follow-up was 12.38 ± 2.68 years. Mean number of intravitreal injections (IVI) was 12.50 ± 12.40 and 25% of the eyes had previous treatment with photodynamic therapy (PDT). Mean improvement between BCVA0 and BCVA1 was 5.58 ± 15.98 letters (p < 0.001). However, a drop of 8.03 ± 12.25 letters was noticed between BCVA1 and BCVA2. FAF1 was 6.34 ± 4.92mm² and increased to 9.88 ± 7.56mm² (3.54 ± 3.79mm² variation p < 0.001). The mean growth rate of the atrophic area was 0.89 ± 0.84mm² per year. BCVA2 negatively correlated with FAF2 (k = − 0.498, p = 0.002) being worse in patients with higher atrophic area growth rate (k = − 0.341, p = 0.042). Eyes treated with PDT needed less IVI (5.89 ± 5.21 vs 14.70 ± 13.36, p = 0.008) but had larger FAF1 (9.80 ± 5.33 vs 5.19 ± 4.27, p = 0.013) and FAF2 (16.05 ± 7.10 vs 7.83 ± 6.63, p = 0.003). Hypothyroidism was associated with higher atrophy growth rate (1.55 ± 1.15 vs 0.73 ± 0.67, p = 0.016). Conclusion: This research demonstrates the importance of chorioretinal atrophy progression after myopic CNV lesions regression and its impact on visual prognosis, reporting a mean yearly growth of 0.89 mm² in atrophic areas. Previous treatment with PDT and hypothyroidism were identified as risk factors associated with larger atrophic areas and worse visual outcomes.

Purpose: Behçet’s disease (BD) is a systemic vasculitis which is often accompanied by intraocular inflammation. This study aims to determine the efficacy and safety of systemic immunomodulatory therapy (IMT) in Behçet’s disease and the optimal timing for its discontinuation in patients who are in remission. Patients and Methods: A retrospective single center longitudinal study was performed at the Centro Hospitalar Universitário São João (Porto, Portugal). A total of 38 records of patients with uveitis related to BD and on IMT were analyzed for demographic data, characteristics of their uveitis, treatment period, pattern of relapses, and first and final discontinuation outcomes. The statistical analyses were done with IBM SPSS^® software. Results: The mean follow-up duration was 122.5 ± 62.6 months. Anterior uveitis was the most common manifestation (36.8%), followed by retinal vasculitis (31.6%) and panuveitis (13.2%). Azathioprine (36.8%) and cyclosporine (28.9%) were the most used immunomodulatory agents. The median treatment duration was 63.5 months, significantly reducing relapse rates from 2 ± 2.0 to 1 ± 1.2 per year (p < 0.001). Biologic therapies showed a slight advantage in reducing relapses (p = 0.045). Among 16 patients (42.1%) who discontinued treatment, 30.8% experienced relapse after a median of 13 months. Patients treated for more than 6 years had no relapses. Conclusion: IMT effectively controls ocular inflammation in BD uveitis, significantly reducing relapse frequency. Azathioprine and cyclosporine remain first-line therapies. Discontinuing IMT after 4– 6 years of sustained remission appears to be a safe strategy, particularly after 6 years.