Purpose: To evaluate the efficacy of intravitreal chemotherapy for vitreous seeding in patients with retinoblastoma (Rb). Design: Retrospective, single-arm cohort study. Methods: This study was conducted at a tertiary eye center. Between 2013 and 2021, 27 patients (27 eyes) with vitreous Rb receiving adjuvant intravitreal melphalan (IVM) as secondary/salvage treatment in one eye were included. Patients who were unable to follow-up or treated elsewhere were excluded. Survival analysis was performed to assess the incidence of enucleation in the melphalan-treated group, as well as in bilateral cases with eyes receiving melphalan and those receiving standard treatment, consisting of chemotherapy, thermotherapy, and enucleation according to the disease stage. Results: The median (interquartile range) follow-up time was 65 months (range, 34– 83 months). Seventeen patients (63%) had bilateral disease. Sixteen eyes (59%) were saved. The Kaplan–Meier survival estimates for eyes receiving melphalan were 100% at 1 year (95% confidence interval [CI]:11.2– 14.3), 75% (95% CI:14.2– 48.9) at 3 years, and 50% at 5 years. Melphalan-treated patients with bilateral disease showed a significantly higher number of saved eyes than the standard treatment group (P=0.002). Tumor recurrence was the primary cause of enucleation, accounting for 36% of the cases. In the vitreous hemorrhage group, the odds of enucleation were 13 times higher (95% CI:1.04– 165.28) than in the group without this condition. Conclusion: IVM is an effective treatment option for vitreous seeds. After 3 years of follow-up, the estimated survival rate for saved eyes decreased, and vitreous hemorrhage significantly increased the likelihood of enucleation. Further studies are required to determine the precise effects of IVM. Graphical Abstract:

Purpose: To compare the outcomes of non-penetrating deep sclerectomy (NPDS) for primary congenital glaucoma (PCG) performed by experienced vs trainee surgeons. Patients and Methods: This retrospective cohort study was conducted in 2022 in Saudi Arabia. Consultants (Gr-1) and trainee pediatric ophthalmologists (Gr-2) performed NPDS on pediatric patients with PCG. Success was defined as an intraocular pressure (IOP) less than 21 mmHg at 6 months after surgery. Complications, glaucoma medications, and additional procedures were also observed in the two groups. Results: Gr-1 and Gr-2 operated on 14 and 39 eyes with PCG, respectively. The absolute success rates were 90.9% (95% confidence interval [CI]: 73.9, 100) in Gr-1 and 96.7% (95% CI: 90.2, 100) in Gr-2 (odds Ratio=1.1; 95% CI: 0.87, 1.3; P=0.54). Survival analysis suggested that the failure rate in the first 6 months after NPDS was not significantly different between the two groups (hazard ratio=1.45; 95% CI: 0.13, 16.0; P=0.767). The complications included hypotony (2 cases), vitreous hemorrhage (1 case), and total flap penetration (1 case). Only one eye in Gr-2 needed glaucoma medication after surgery. There was no significant difference in the success rates of one surgeon before and after training (P=0.43). The age (P=0.59) and sex (P=0.77) of patients, type of surgeon (P=0.94), and preoperative IOP (P=0.59) were not significant predictors of a stable IOP at 6 months after NPDS. Conclusion: At 6 months after NPDS surgery performed by experienced and trainee pediatric ophthalmologists, the outcomes (stabilization of IOP) were similar between the two groups. Graphical Abstract:

Introduction and importance: Polyglactin 910 sutures are commonly used in strabismus surgery due to their favorable handling and absorption qualities. However, their potential to cause allergic reactions is poorly documented in medical literature. This case report emphasizes this rare complication, stressing the importance of promptly recognizing and managing such reactions to ensure optimal patient outcomes. Case presentation: An 11-year-old girl with a history of left congenital partial third nerve palsy was treated with 8-0, polyglactin 910 sutures during a strabismus surgery. However, two days postoperatively, she experienced persistent redness, swelling, and pain in her left eye despite antibiotic therapy. After six days, the sutures were removed, resulting in an immediate reduction in symptoms. By the two-month follow-up, the patient fully recovered, with no signs of inflammation or complications. Clinical discussion: This case highlights a rare but crucial allergic reaction to polyglactin 910 sutures used in strabismus surgery. The patient's persistent inflammation, pain, and resistance to antibiotics indicated a localized allergic reaction, rather than an infection. The prompt resolution of symptoms after suture removal supports the diagnosis of suture-related allergic reaction. This case emphasizes the need to consider suture material as a potential cause of postoperative complications, especially when standard treatment fails. Conclusion: Healthcare providers should be alert to potential allergic reactions to sutures after strabismus surgery. Timely identification and removal are vital for resolving the symptoms and achieving optimal patient outcomes. This case emphasizes the importance of postoperative care protocols that consider allergies to suture material. Highlights:

Introduction: Sturge-Weber syndrome (SWS) is a rare congenital disorder characterized by leptomeningeal angiomas, port-wine stains, and glaucoma, affecting up to 70 % of pediatric cases. Elevated episcleral venous pressure disrupts aqueous outflow, leading to a persistently high intraocular pressure (IOP). Conventional treatments, such as trabeculectomy and Ahmed valve implantation, often fail because of fibrosis, hypotony, and vascular anomalies. The PreserFlo MicroShunt, a minimally invasive glaucoma surgery device, offers controlled IOP reduction with fewer complications; however, its use in pediatric SWS remains unexplored. Case presentation: A 32-week-old female infant with SWS presented with tearing, photophobia, and elevated IOP (40 mmHg) in the right eye. Initial management included seizure control with levetiracetam. Examination under anesthesia revealed corneal edema, horizontal corneal enlargement, and significant axial length asymmetry. Given the risk of irreversible vision loss, an urgent PreserFlo implantation was performed. Discussion: Postoperative outcomes demonstrated a 42 % reduction in IOP, improved corneal clarity, and a stabilized axial length. Revision surgery successfully addressed iris obstruction of the device and restored aqueous flow. The device's minimally invasive nature and predictable outflow make it a promising alternative to traditional surgeries. However, pediatric ocular growth necessitates close monitoring to prevent complications, such as tube migration or obstruction. Conclusion: This case highlights the first successful off-label use of PreserFlo in infants with SWS-associated glaucoma. Early intervention and careful postoperative management can help achieve sustained IOP control. However, further studies are needed to optimize its long-term efficacy in pediatric patients. Highlights:

To report the incidence and outcomes of microbial keratitis (MK) following cyclophotocoagulation (CPC) for treatment of refractory childhood glaucoma (CG) at a single center over a period of 6 years. In this cohort study, the medical records of children with CG who underwent CPC and subsequently presented with MK from 2014 to 2020 were reviewed retrospectively. Data were collected on age, type of glaucoma, surgeries before MK, CPC parameters, interval between CPC and MK, presenting symptoms of MK, infiltrate location, bacterial isolates, MK treatment, and outcomes. Among the 312 children who underwent CPC during the study period, 37 eyes of 33 children had MK, with an incidence of 1.8% (95% CI, 0.3-3.2). The median interval between CPC and MK was 4 years (IQR, 2.7-7.4). CPC was repeated once in 20 eyes (54%) and twice in 4 (11%). In 20 eyes, there was no pain at MK onset. The primary isolates were Streptococcus pneumoniae (12/27 [22%]) and Staphylococcus epidermis (8/27 [30%]). MK resolved in 17 eyes (46%) after treatment; 8 eyes (22%) underwent evisceration or had phthisis, and keratoplasty failed in 6 eyes (16%). The absence of pain at presentation with MK was negatively associated with resolution (OR = 5.0 [95% CI, 1.1-23.8]; P = 0.04). The absence of pain at MK onset may be a proxy for neurotrophic keratitis after CPC and is linked to poor response to management.

Introduction Persistent fetal vasculature (PFV) is a congenital anomaly associated with significant surgical challenges, including a high risk of postoperative retinal detachment (RD). This study aimed to evaluate the impact of surgical approach and axial length (AL) on RD risk and visual outcomes in pediatric PFV management. Methods A retrospective cohort study was conducted involving 76 eyes of 74 patients who underwent cataract surgery for PFV between 2014 and 2022. Patients were categorized by RD status postoperatively (14 with RD, 62 without RD). Key predictors, including surgical approach (corneal vs. pars plicata), AL, and age at surgery, were analyzed. The primary outcomes were RD incidence and final best-corrected visual acuity (BCVA). Results Compared to the pars plicata approach, the corneal approach was associated with a significantly lower risk of RD, as indicated by a multivariate odds ratio of 0.08 (95% CI 0.01–0.6, P = 0.011). A shorter AL increased the risk of RD (median 17 vs. 20 mm, P = 0.002). The RD group showed poorer visual outcomes (P < 0.001), with a 71% loss of light perception. Surgery before 3 months improved outcomes, regardless of RD. Visible ciliary processes were strongly correlated with RD (P < 0.001). Conclusions Corneal surgical approach and longer AL are associated with a lower RD risk in PFV cataract surgery. Early intervention and thorough preoperative assessment of the AL and ciliary processes are crucial for optimal outcomes.