Purpose: To report a case of non-arteritic ischemic optic neuropathy (NAION) in an otherwise healthy patient treated with Glucagon-Like Peptide-1 (GLP-1) receptor agonists (RAs) liraglutide and semaglutide. Observations: A 47-year-old Caucasian female with a Body Mass Index (BMI) of 27.92, and no known history of diabetes, hypertension, or ischemic heart disease, developed a progressive decline in visual acuity in the right eye one month after initiating liraglutide therapy for weight loss. Upon symptom presentation, ophthalmic examination performed elsewhere revealed a best-corrected visual acuity (BCVA) of 20/40, optic nerve head (ONH) swelling, and inferior hemifield scotoma on Humphrey Visual Field testing. Oral corticosteroids were prescribed and discontinued because of poor glycemic control. Liraglutide therapy was continued for further three months and then switched to semaglutide owing to poor clinical results. Eight months later, the patient discontinued weight loss therapy because of progressive visual deterioration and presented to our clinic for a second opinion. Upon examination, BCVA was limited to 20/400, ONH edema was evident and confirmed on optical coherence tomography (OCT), and further worsening of the visual field defects was detected. Given the absence of anatomical and/or systemic risk factors, NAION secondary to GLP-1 RAs was diagnosed. Conclusion and Importance: In our patient, liraglutide likely served as the initial trigger for the NAION, with semaglutide acting as an additional contributing factor in the progression of the disease. This case adds to the complex puzzle regarding the association between GLP-1 RAs therapy and NAION. Given the increasing use of these drugs for both obesity and diabetes and the close temporal correlations between GLP-1 RAs use and NAION, healthcare providers should be aware of the possible risk of serious ocular complications. Upon onset of visual symptoms, early ophthalmologic diagnosis and treatment interruption are essential to prevent or limit severe visual morbidities.

Photic retinopathy is an uncommon clinical entity characterized by retinal damage brought on by excessive exposure to light without protection. It encompasses several distinct clinical categories, including solar maculopathy, handheld laser maculopathy, arc welding maculopathy, and iatrogenic macular degeneration. These clinical entities result from exposure to diverse light sources, such as solar radiation, laser pointers, welding arcs, and operating microscopes during ophthalmic procedures. Patients typically present with bilateral but asymmetric symptoms, including reduced visual acuity, central or paracentral scotomas, photophobia, metamorphopsia, and headaches. After exposure, most people can recover on their own in a matter of weeks to six months without the need for special care. However, thanks to their anti-inflammatory properties, several clinical cases reporting the use of steroids for acute photic retinopathy have been documented in the scientific literature, together with the use of antioxidants. The purpose of this review is to provide an update on this phototoxic maculopathy, describing its different clinical entities, diagnosis, and treatment options, and also focusing on the role of optical coherence tomography for its management.

Aim To report real-life data of eyes with neovascular age-related macular degeneration (nAMD) treated with vascular endothelial growth factor (VEGF) inhibitors for an average of 10 years. Methods Anti-VEGF naïve eyes with nAMD and had at least 7-year follow-up at a tertiary center were evaluated. The primary outcome was a change in best-corrected visual acuity (BCVA) at 10 years; secondary outcomes included anatomical outcomes, number of injections, and examinations. Results The study included 102 eyes of 82 patients, with a mean initial age of 69.2 ± 9.7 years. The average follow-up duration was 116.19 ± 24.98 months, and the mean number of injections was 37.42 ± 15.81. Initial mean BCVA was 59.0 ± 18.3 letters, increasing to 70.55 ± 12.72 in the first year, then gradually declining to 60.44 ± 17.55 by the tenth year. Patients had an average of 6.13 ± 1.72 exams in the first year and 4.61 ± 2.60 in the last year, with 6.02 ± 1.70 injections in the first year and 3.18 ± 2.17 in the tenth year. Patients were classified as increasing, decreasing, or stable based on changes in VA by 2 lines or 10 letters. Significant variables among the groups included age (p = 0.018), baseline BCVA (p = 0.001), prior photodynamic therapy (PDT) (p = 0.025), and retinal hemorrhage due to macular neovascularization (MNV) (p = 0.049). Conclusion Eyes with nAMD maintained their initial BCVA after treatment with VEGF inhibitors for 10 years. With regular and prompt treatment, functional vision can be achieved over a long period of time in nAMD.

Purpose: To assess the rate of retinal thinning as a biomarker for incident late-stage age-related macular degeneration (AMD). Methods: This retrospective cohort study included patients (aged ≥ 50 years) with ≥ 3 optical coherence tomography (OCT) macular scans ≥ 6 months apart. Eyes that developed ≥ 250 μm of complete retinal pigment epithelium (RPE) and outer retinal atrophy (cRORA) with associated hypertransmission through Bruch’s membrane on OCT were considered to have developed geographic atrophy (GA). The spatial pattern of macular thinning was assessed using the ETDRS rings centered on the foveola, calculated as a percentage change relative to its baseline value by eye. Results: A total of 201 eyes met inclusion criteria. At last follow-up, 17 eyes developed GA (8.5%) at a median observation of 5.2 (2.4) years. The central subfield (1-mm) and inner ring (3-mm ETDRS subfield) thinned faster in eyes that developed incipient GA (central subfield thickness [CST]: − 1.59% vs. − 0.47% per year, p=0.007; inner ring: − 1.48% vs. − 0.65% per year, p< 0.001), while the outer ring (6-mm ETDRS subfield) thinned less rapidly (− 0.75% vs. − 0.30% per year, p=0.003). Linear regression identified the rate of inner ring thinning as the most significant predictor of GA, with a receiver operating characteristic curve demonstrating a high predictive accuracy (area under the curve [AUC], 0.821; 95% CI, 0.746– 0.896; p< 0.001). Conclusion: Rapid thinning of the inner ETDRS ring is associated with incipient GA. Identifying eyes at risk of late AMD using serial OCT scans would permit personalized monitoring and treatment strategies critical for safeguarding vision.

Aims: To evaluate long-term clinical outcomes and factors associated with recurrence after nasolacrimal drainage procedures with bicanalicular silicone intubation. Methods: This retrospective cohort included 1576 patients (2094 eyes) treated between 2008 and 2025 at a tertiary referral center. All tubes underwent square-knot fixation without additional intranasal fixation; no comparator group was available. Success required a Munk score of 0–1 and patent irrigation at final follow-up, coinciding with tube removal for eyes followed for only three months. Generalized estimating equation (GEE) logistic regression accounted for bilateral eye correlation. Sensitivity analyses compared pediatric and adult patients, repeated multivariable GEE in adults, and stratified follow-up (3–12, 13–24, and >24 months). Results: Recurrence occurred in 5.9% of eyes (123/2094), ranging from 5.5% after external dacryocystorhinostomy to 13.2% after probing with intubation (p=0.016). External dacryocystorhinostomy comprised over 90% of procedures, limiting comparisons. Epiphora, postoperative complications, and tube exposure occurred in 6.7%, 11.0%, and 5.3%, respectively; exposure was not significantly associated with recurrence. Multivariable GEE identified associatio with probing [odds ratio (OR) 2.79, 95% confidence interval (CI) 1.22–6.37; p=0.015], increasing age (OR 1.01, 95% CI 1.00–1.03; p=0.048), and attending-surgeon procedures (OR 1.69, 95% CI 1.07–2.69; p=0.026). Recurrence was higher with longer documented follow-up. Conclusion: Standardized square-knot fixation was accompanied by 5.9% recurrence and 11.0% postoperative complications. Associations are descriptive and hypothesis-generating given subgroup imbalance, incomplete covariate information, variable follow-up, and residual confounding. The attending-surgeon association may reflect case selection or other unmeasured factors. These findings do not establish causality, fixation superiority, comparative effectiveness, or surgeon performance.