Background/Objectives: To investigate the role of multimodal imaging, specifically optical coherence tomography angiography (OCTA) and adaptive optics (AO), in the diagnosis and monitoring of diabetic retinopathy. Methods: Our study represents an observational, cross-sectional analysis including sixty-nine patients from four distinct groups: a control group (17 patients), diabetic patients without diabetic retinopathy (no DR) (14 patients), diabetic patients with non-proliferative diabetic retinopathy (NPDR) (18 patients), and diabetic patients with proliferative diabetic retinopathy (PDR patients). A comprehensive ophthalmological evaluation, along with high-resolution imaging using OCTA and AO, was performed. OCTA images of the superficial capillary plexus, acquired with the OCT Angio Topcon, were analyzed using a custom-developed MATLAB algorithm, while AO retinal vascular images were evaluated with the manufacturer’s software of the Adaptive Optics Retinal Camera rtx1™. Results: Our findings demonstrated statistically significant reductions in foveal avascular zone circularity, superficial capillary plexus density, vessel length density, and fractal dimension, correlating with the severity of diabetic retinopathy, particularly in the PDR. Additionally, mean wall thickness and wall-to-lumen ratio were significantly increased in patients with diabetic retinopathy, notably in PDR. Conclusions: In conclusion, our findings demonstrate that the combined use of OCTA and AO imaging offers complementary insights into the microvascular alterations associated with diabetic retinopathy progression and severity. These high-resolution modalities together reveal both perfusion deficits and structural vascular changes, underscoring their utility as essential tools for early detection, staging, monitoring, and informed management of DR.

Diabetic retinopathy (DR), a major diabetes complication, is the fifth leading cause of global blindness and moderate-to-severe visual impairment. DR is categorized into non-proliferative and proliferative forms, with the latter involving neovascularization. Adaptive optics (AO) imaging provides high-resolution, in vivo visualization of retinal microstructures, offering enhanced insight into disease pathology. A comprehensive PubMed search was conducted for studies published before August 1, 2025, using the keywords “diabetic retinopathy” and “adaptive optics”. The review focused on studies assessing cone photoreceptors, retinal vasculature, and clinical signs using AO imaging. Forty-two studies were included. Many examined cone photoreceptor integrity across DR stages, with or without diabetic macular edema (DME). AO imaging revealed microstructural changes, enabling the correlation of cone metrics with other imaging modalities, including optical coherence tomography angiography, electroretinography, microperimetry, and color vision tests. Several studies analyzed capillary-level vascular alterations and their association with DR severity and DME. Some works have integrated AO data with blood flow assessments using techniques such as laser speckle flowgraphy and AO scanning laser ophthalmoscopy. Lastly, several studies have identified clinical signs related to DR and described their features on AO imaging. Adaptive optics imaging reveals early and progressive alterations in photoreceptors, retinal microvasculature, and clinical signs such as microaneurysms and hard exudates in diabetic retinopathy, supporting its role as a valuable tool for understanding disease mechanisms and guiding early diagnosis and monitoring. Adaptive optics is a valuable imaging tool that improves understanding of retinal microarchitecture in diabetic retinopathy. It aids diagnosis, monitoring, and prognosis by enabling detailed evaluation of cellular and vascular alterations.

Background: Glaucoma is a leading cause of irreversible blindness worldwide and is particularly challenging to treat in its refractory forms. The Ahmed valve offers a potential solution for these difficult cases. This research aims to assess the initial clinical experience with Ahmed valve implantation in Romania, evaluating its effectiveness, associated complications, and overall patient outcomes over a five-year period. Methods: We conducted a prospective study on 50 patients who underwent Ahmed valve implantation due to various types of glaucoma. Patients were monitored at several intervals, up to five years post-surgery. Intraocular pressure and visual acuity were the primary measures of success. Results: On average, patients maintained the intraocular pressure within the targeted range, with the mean intraocular pressure being 17 mmHg 5 years post-surgery. Success, defined as maintaining target intraocular pressure without additional surgery, was achieved in 82% at 1 year, 68% at 3 years, and 60% after 5 years postoperative. Conclusion: Ahmed valve implantation is a viable treatment option for refractory glaucoma, demonstrating significant intraocular pressure reduction and manageable complication rates over a five-year follow-up period. Future research should focus on long-term outcomes and optimization of surgical techniques to further reduce complication rates and improve patient quality of life.

Background/Objectives: Conjunctival hyperemia is a common clinical finding in clinical practice; however there are significant differences between graders. Vessel detection using deep-learning approaches could enable more objective measures. We aimed to evaluate vascular metrics derived from automated vessel detection and compare these metrics with manual severity gradings. Methods: Slit lamp images from 139 glaucoma patients were included. Images from 103 participants were used as the primary development dataset and the remaining as a validation subset. The images were independently graded by two graders for conjunctival hyperemia using the Efron Grading Scheme. Conjunctival vessels were detected using an automated vessel detection pipeline based on semi-supervised learning. Vessel density, fractal dimension and tortuosity were calculated and compared with the manual Efron grades. Results: Grading of conjunctival hyperemia between the two graders were consistent (Spearman’s rho: 0.79; ICC: 0.79 [95%CI: 0.72–0.84]) but showed significant differences with a higher proportion of differences in the moderate grades. Of the vascular metrics, vessel density showed significant associations with the individual Efron grading and against the mean Efron grading (0.78, p < 0.001). Fractal dimension was significantly associated with the mean Efron grading (0.55, p < 0.001). Agreements were similar in the subset (vessel density, 0.80, p < 0.001; fractal dimension 0.62, p < 0.001). Vessel tortuosity showed lower agreements (<0.23). Conclusions: Vessel density and fractal dimension showed significant associations with manual Efron gradings. These metrics could be potentially used to enable more objective and interpretable measures of conjunctival hyperemia severity.

Background/Objectives: Optical coherence tomography angiography (OCTA) enables noninvasive quantitative assessment of the retinal microvasculature and is widely used in diabetic retinopathy (DR). However, OCTA-derived metrics are highly dependent on post-processing techniques, particularly vessel binarization. This study aimed to compare local and global binarization methods applied after Frangi filtering for vessel enhancement in parafoveal vessel density analysis. Methods: This cross-sectional study included 69 participants: 17 healthy controls and 52 diabetic patients, classified as the following: no DR (n = 14), non-proliferative DR (NPDR, n = 18), or proliferative DR (PDR, n = 20). All subjects underwent comprehensive ophthalmological examination and OCTA imaging of the superficial capillary plexus using a Topcon OCTA system. Images were processed using a custom MATLAB protocol. Following Frangi filtering, five binarization methods were applied: three local (Phansalkar, local Otsu, adaptive mean) and two global (global mean and global Otsu). Parafoveal vessel density was quantified within the four inner quadrants of the ETDRS grid. Results: Statistically significant differences in vessel density were consistently observed between PDR group and both the control and no DR groups across all local binarization methods. Among global methods, only global Otsu thresholding detected a significant difference between PDR and control. The most robust differences were predominantly identified in the nasal and inferior quadrants. Conclusions: Local adaptive binarization methods demonstrated superior sensitivity and structural preservation for parafoveal vessel density analysis in DR. Global methods showed limited discriminative capability. These findings support the preferential use of local adaptive techniques for reliable OCTA-based vascular assessment in diabetic retinopathy.

Background: Macular telangiectasia (MacTel), also known as idiopathic juxtafoveolar telangiectasis (IJFTs), involves telangiectatic changes in the macular capillary network. The most common variant, MacTel type 2, has distinct clinical features and management strategies. Methods: This study offers a comprehensive review of MacTel and focuses on a series of three patients diagnosed with MacTel type 2 in our clinic. A meticulous ophthalmological evaluation, augmented by high-resolution imaging techniques like optical coherence tomography (OCT), OCT angiography (OCT-A), fundus autofluorescence (FAF), fluorescein angiography (FA), and adaptive optics (AOs) imaging, was conducted. Results: The findings revealed normal anterior segment features and a grayish discoloration in the temporal perifoveal area on fundus examination. OCT exhibited hyporeflective cavities in the inner and outer neurosensory retina, along with other changes, while OCT-A identified retinal telangiectatic vessels in the deep capillary plexus. FAF demonstrated increased foveal autofluorescence, while FA initially detected telangiectatic capillaries followed by diffuse perilesional leakage in the later phase. Adaptive optics images showed the cone mosaic pattern. Notably, one patient developed a macular hole as a complication, which was successfully managed surgically. Conclusion: This study underscores the challenges in diagnosing and managing MacTel, emphasizing the importance of a multidisciplinary approach and regular follow-ups for optimal outcomes.