Background/Objectives: This study aimed to evaluate estimated pulse wave velocity (ePWV) in different glaucoma types. Methods: This was observational, cross-sectional, non-interventional study conducted on 127 primary open-angle glaucoma (POAG) patients, 59 primary angle-closure glaucoma (PACG) patients, 34 pseudoexfoliative glaucoma (PEX) patients, and 55 normotensive glaucoma (NTG) patients (total of 275 glaucoma patients). The control group (CG, 92 patients) consisted of patients with cataract. ePWV was calculated by the formula that was recommended by the Reference Values for Arterial Stiffness Collaboration from data on age and mean arterial blood pressure. The obtained results were processed by applying methods of descriptive (arithmetical mean, standard deviation) and analytical statistics, and comparisons of tested variables were performed using ANOVA. A p value less than 0.05 was considered statistically significant. Results: Statistically significant differences were found between patients with POAG and the CG (p value 0.042), and between those with NTG and the CG (p value 0.001). There was a statistically significant difference in ePWV values when comparing all tested patients with glaucoma and the control group (p = 0.001). Conclusions: Estimated pulse wave velocity may be a helpful tool in future risk assessment models for glaucoma.

Introduction: Dry Eye Syndrome (DES) is a multifactorial disorder of the ocular surface, characterized by complex interactions between environmental factors, immune dysregulation, and potential genetic predispositions. Vitamin D deficiency, known for its immunomodulatory properties, has increasingly been implicated in the pathogenesis of DES; however, the underlying mechanisms remain insufficiently elucidated. Of particular interest is the vitamin D receptor (VDR) gene, whose polymorphisms may influence the bioavailability and biological activity of vitamin D. Objective: The aim of this study was to investigate the association between serum 25-hydroxyvitamin D [25(OH)D₃] levels and selected polymorphisms in the VDR gene (Taq, Fok, Apa, and Bsm) in patients with DES and to analyze their potential clinical and genetic interactions. Methods: This prospective observational study included 60 patients with a confirmed diagnosis of DES. Serum 25(OH)D₃ levels were measured, and genotyping of four VDR single-nucleotide polymorphisms (SNPs) was performed using PCR followed by restriction fragment length polymorphism analysis. Genotype distributions were assessed in relation to vitamin D status using appropriate statistical tests and Hardy–Weinberg equilibrium analysis. Results: Over 85% of patients exhibited insufficient or deficient vitamin D levels. Among the analyzed SNPs, only the ApaI polymorphism (rs7975232) showed a statistically significant association with vitamin D status (p = 0.0384), with the homozygous AA genotype being more prevalent among patients with hypovitaminosis. The remaining polymorphisms (TaqI, FokI, BsmI) did not reach statistical significance; however, potential trends were observed that may warrant further investigation in larger cohorts. Conclusion: The findings suggest a potential role for VDR gene variability in the regulation of systemic vitamin D levels in patients with DES. Identification of specific genotypes may contribute to the development of personalized diagnostic and therapeutic strategies, particularly for patients with treatment-resistant forms of the disease. These results support the integration of genetic biomarkers and nutritional parameters into modern ophthalmologic practice.

Background: Penetrating keratoplasty (PK) is a technically demanding corneal transplant procedure frequently performed in elderly patients with substantial systemic comorbidities. In this population, an anesthetic strategy that ensures hemodynamic stability, cooperative sedation, adequate analgesia, and preserved spontaneous ventilation is highly desirable. Dexmedetomidine, a highly selective alpha2-adrenergic agonist, provides “cooperative” sedation with minimal risk of respiratory depression and additional sympatholytic benefits. Methods: This single-center retrospective observational case series included 50 consecutive patients (American Society of Anesthesiologists [ASA] II–III, age 50–90 years) undergoing PK under sub-Tenon block combined with continuous dexmedetomidine infusion. Dexmedetomidine was administered without a loading bolus at 0.7 mcg/kg/h for 10–15 min, then reduced to 0.5 mcg/kg/h, targeting a Ramsay Sedation Scale (RSS) score of 2–3. The sub-Tenon block was performed using a mixture of levobupivacaine 0.5% and lidocaine 2% (3–5 mL). Heart rate (HR), mean arterial pressure (MAP), oxygen saturation (SpO₂) and RSS were recorded in nine predefined perioperative phases. Data were analyzed descriptively. Results: The mean age was 72 ± 9 years; 52% of patients were ASA III. Hypertension was present in all patients; 30% had cardiovascular disease, 28% diabetes mellitus type II, and 30% chronic obstructive pulmonary disease. Progressive, controlled bradycardia was observed (mean HR decreased from 76 to 57 beats/min during graft transplantation), while MAP gradually decreased from hypertensive baseline values (150–160 mmHg) to an optimal intraoperative range of 115–130 mmHg, without episodes of clinically significant hypotension. SpO₂ remained stable at 98–99% throughout all phases, with no episodes of desaturation or need for airway intervention or supplemental oxygen. Target sedation (RSS 2–3) was achieved in all patients (median RSS 3), with preserved spontaneous breathing and cooperation. Sub-Tenon block-related bulging occurred in 6% of cases. No episodes of clinically significant bradycardia, malignant arrhythmia, respiratory compromise, or need to discontinue dexmedetomidine were recorded. No opioids or non-steroidal analgesics were required intraoperatively or in the early postoperative period. Conclusions: The combination of sub-Tenon block and continuous dexmedetomidine sedation without a loading bolus represents a hemodynamically stable and respiratory-safe anesthetic strategy for PK in elderly, high-risk patients. These preliminary, hypothesis-generating findings suggest that the protocol provides stable surgical conditions and a favorable safety profile, justifying future prospective randomized controlled trials to establish its comparative efficacy against general anesthesia or standard sedative regimens.

Introduction: Perioperative management of patients with glaucoma requires a precise balance between maintaining systemic hemodynamic stability and preserving adequate ocular perfusion pressure. The effects of esketamine on intraocular pressure (IOP) during glaucoma surgery remain insufficiently investigated. Case report: We report the case of a 45-year-old female patient diagnosed with cataract and chronic glaucoma, without significant associated comorbidities, who underwent combined phacoemulsification with intraocular lens implantation and trabeculectomy. The surgical procedure was performed under subtenon anestesia, combined with targeted continuous esketamine analgosedation at a subanesthetic dose, administered as a continuous infusion at a rate of 0.25 mg/kg/h. During the perioperative period, hemodynamic parameters, peripheral oxygen saturation, pain intensity, level of sedation, and intraocular pressure were monitored at multiple predefined perioperative time points. The baseline intraocular pressure was 39 mmHg; following stabilization of sedation, it decreased to 26 mmHg, with a further reduction to 11 mmHg observed in the early postoperative period. No hemodynamic instability, respiratory depression, or need for additional supportive analgesia was recorded during surgery. Conclusion: This case report suggests that continuous subanesthetic esketamine analgosedation is a feasible option during combined cataract and glaucoma surgery performed under sub-Tenon's anesthesia, providing stable hemodynamics, preserved spontaneous respiration, good patient cooperation, and a favorable early perioperative intraocular pressure profile in the presented case. Further prospective studies are required to confirm these findings.

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.