Background/Objectives: The aim of this study was to investigate quantitative differences in optical coherence tomography angiography (OCTA) between diabetic patients and healthy controls and to identify the early OCTA biomarkers for diabetic macular changes. Methods: Ophthalmological examination and OCTA were performed on two groups of diabetic patients (with and without mild diabetic retinopathy) and healthy controls. Macular, foveal, perifoveal, and parafoveal vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), foveal avascular zone (FAZ), and flow area in the choriocapillaris were calculated. Results: A total of 431 eyes of 233 participants were analyzed. The VD in the SCP in the whole macula was the lowest in the DM + DR group and lower than in the DMnoDR group; however, in the fovea, it was the highest in the DM + DR group and higher than in the DMnoDR group. The VD in the SCP in the parafovea was lower in the DM + DR group than in the DMnoDR group, and in the perifovea, it was lower in the DMnoDR group than in the control group. The VD in the DCP in the macula, parafovea, and perifovea was lower in the DM + DR group than in the DMnoDR and control groups. The FAZ and flow areas in the choriocapillaris were smaller in the DM + DR group than in both the DMnoDR and control groups. Conclusions: VD reduction in the SCP and the DCP of the macular and parafoveal regions, as well as in the DCP of the perifoveal region, may indicate progression of diabetic retinopathy from subclinical to clinical stages; however, an increase in the foveal region in the SCP can be a compensatory mechanism. VD reduction in the perifovea and whole macula in the SCP can be a screening factor for subclinical macular changes. FAZ reduction before clinical signs of retinopathy may be an early compensatory vascular mechanism.

Reported tetracaine allergy, particularly in the absence of supporting medical documentation or a confirmed allergy diagnosis, represents a common challenge during the preoperative assessment of patients undergoing cataract surgery. In such cases, clinical decisions often rely primarily on patient history, which may be incomplete, inaccurate, or unreliable, resulting in considerable diagnostic uncertainty. A narrative review of the literature was conducted to examine the clinical relevance of reported tetracaine allergy in perioperative management of cataract surgery. Based on critical appraisal and synthesis of the available evidence, a phenotype-based framework comprising three clinical presentation phenotypes was developed, accompanied by a structured algorithm to support preoperative decision-making. The proposed framework classifies patients into three clinically relevant phenotypes: the irritative phenotype, the suspected hypersensitivity phenotype, and the clinical uncertainty phenotype. This classification provides a structured approach to interpreting reported tetracaine allergy and forms the basis of a practical algorithm for phenotype-guided preoperative management. The phenotype-based framework is intended to support, rather than replace, clinical judgment in the preoperative evaluation of patients with reported tetracaine allergy. By providing a structured approach to decision-making when diagnostic information is limited or uncertain, the framework may improve the consistency and transparency of perioperative management. Although conceptual, the proposed framework highlights the importance of obtaining reliable clinical information in patients reporting tetracaine allergy. Further methodological studies, including prospective validation, are required before the framework can be recommended for routine clinical practice.

The aim of this study was to evaluate tear cytokine and chemokine profiles in keratoconus (KC) and to assess their association with long-term tomographic outcomes after corneal collagen cross-linking (CXL). In this cross-sectional observational study, 30 KC eyes and nine healthy controls were enrolled. KC severity was graded using the modified Amsler–Krumeich classification. Tear samples were collected and analyzed using multiplex bead-based immunoassays (LEGENDplex™) for cytokines, chemokines, and TGF-β1. Patients were followed for five years after CXL. Treatment response was categorized according to corneal flattening (3 D). Individual cytokine levels showed no major differences between the KC and controls, although IL-6 and MCP-1 tended to be higher in the KC group. However, IP 10 and IL-17 were higher in controls (p < 0.05). In contrast, multiple pro-/anti-inflammatory ratios (TNF/TGF-β1, IL-17/IL-10, MCP-1/IL-10, IL-6/IL-10, IL-8/TGF-β1, MCP-1/TGF-β1, IL-6/TGF-β1, and IL-8/IL-10) were significantly elevated in the KC group (p < 0.05), indicating immune imbalance. After five years, all treated eyes remained stable or flattened. Lower baseline MCP-1 and IL-8 levels correlated with greater postoperative corneal flattening (p < 0.05). Keratoconus is characterized by disturbed tear immune homeostasis rather than isolated cytokine elevation. Lower preoperative inflammatory activity may predict a more favorable biomechanical response to CXL, supporting the potential role of tear cytokine profiling in patient stratification and prognostication.