Starr, Matthew R.

Purpose: The purpose of this study is to characterize the clinical features, management strategies, and outcomes of endophthalmitis cases following pars plana vitrectomy using data from the American Academy of Ophthalmology (Academy) IRIS ® Registry (Intelligent Research in Sight). Methods: This is a retrospective cohort study of eyes that developed endophthalmitis following pars plana vitrectomy between 2013 and 2022. Data was collected from the Academy IRIS Registry. This study analyzed differences in visual acuity, intraocular pressure, rates of evisceration and enucleation, and rates of rhegmatogenous retinal detachment following endophthalmitis diagnosis. Results: A total of 1,223,777 unique eyes underwent a PPV during the study period, with 1,275 eyes meeting the inclusion criteria. The median time from pars plana vitrectomy to endophthalmitis diagnosis was 10 days. The majority of eyes (80.9%) were managed with intravitreal antibiotics alone, without a repeat pars plana vitrectomy. Long-term visual acuity, intraocular pressure, cup-to-disc ratio, and rate of evisceration or enucleation did not differ significantly between treatment groups. However, eyes that underwent the initial pars plana vitrectomy for retinal detachment repair had poorer long-term vision and higher rates of retinal detachment following endophthalmitis. Overall, 16.1% of eyes required evisceration or enucleation in this cohort. Conclusions: Despite its rarity, post-pars plana vitrectomy endophthalmitis can cause significant morbidity and even globe loss. There were no significant differences observed between eyes that were treated with intravitreal tap and inject versus repeat pars plana vitrectomy.

Background and Objective: This study aimed to characterize clinical characteristics and visual outcomes of patients with hemorrhagic choroidal detachments. Patients and Methods: Single-center retrospective case series of patients with hemorrhagic choroidal detachments from January 1, 2003, to December 31, 2020 at Mayo Clinic. Patients were categorized as appositional or non-appositional based on ultra-sonography. Results: Among 39 cases with hemorrhagic choroidal detachments, 15 (38%) were appositional and 24 (62%) were non-appositional. There was a significant difference between the appositional and non-appositional groups in mean initial logMAR visual acuity (VA) (2.8 [ SD = 0.20] vs 2.2 [ SD = 0.78], P < .001). However, no difference was observed in final logMAR VA (1.9 [ SD = 1.2] vs 1.5 [ SD = 1.1], P = .30). Comparison between surgical ( N = 9) versus non-surgical ( N = 5) hemorrhagic appositional choroidal detachments cases revealed no differences in outcomes. Comparison between anticoagulated ( N = 21) versus nonanticoagulated ( N = 18) patients with hemorrhagic choroidal detachments also revealed no differences in outcomes. Conclusion: Patients with appositional and nonappositional hemorrhagic choroidal detachments did not differ significantly with regards to visual outcome. Surgical intervention was not associated with improved final vision in this cohort.

Purpose of review Ophthalmology has emerged as the proving ground for medical artificial intelligence (AI) because of its imaging-centric workflows, standardized data acquisition, and well defined clinical endpoints. Recently, the field has started transitioning from narrowly trained, task-specific algorithms toward multimodal models that are trained on large datasets and can be adapted to many tasks. These models may integrate information from images, text, and clinical data and are increasingly trialed in real-world settings. This review examines recent advances and ongoing controversies in the use of AI as a basic science, translational, and clinical research tool in ophthalmology. Recent findings Recent literature highlights the growing role of self-supervised and foundation models for scalable phenotyping, biomarker discovery, and cross-task generalization, particularly in retinal imaging and optical coherence tomography (OCT). In parallel, large-scale clinical deployments, including cloud-based OCT platforms and autonomous diabetic retinopathy screening, demonstrate clinical impact while revealing persistent challenges related to workflow integration and patient generalizability. Regulatory and ethics-focused studies underscore increasing attention to validation rigor, bias, and postdeployment monitoring, exposing heterogeneity in research standards and physician practices. Summary Ophthalmic AI is maturing toward real-world clinical implementation. Future progress will depend less on performance gains alone and more on clinical alignment, rigorous validation, equity-aware evaluation, and postdeployment surveillance, alongside continued investment in basic science to advance disease understanding and inform robust, generalizable model development.

Purpose: The study compares refractive outcomes of secondary intraocular lens (SIOL) surgery performed by vitreoretinal, anterior segment, and both surgeons. Methods: Eyes included in this study underwent SIOL surgery from 2012 to 2024 and had a final postoperative visual acuity of 20/50 or better. Regression analysis compared refractive outcomes, and chi-squared analysis compared complications between subspecialty of SIOL surgeons. Results: A total of 94, 104, and 80 eyes were included in the retina surgeon, anterior segment surgeon, and combo surgeon cohorts, respectively. There was no significant difference in error between target and final postoperative spherical equivalence between retina and combo ( P = 0.079), retina and anterior segment ( P = 0.135), or anterior segment and combo cohorts ( P = 0.567). There was no significant difference in number of eyes with final spherical equivalence within 1 diopter of target spherical equivalence between retina and combo ( P = 0.136), retina and anterior segment ( P = 0.061), or anterior segment and combo cohorts ( P = 0.783). The retina cohort had higher postoperative corneal edema than the combo ( P = 0.017) and the anterior segment cohorts ( P = 0.035). The combo cohort had more postoperative retinal detachment than the anterior segment cohort ( P = 0.046). Conclusion: In eyes with good final vision, retina and anterior segment surgeons have similar refractive outcomes after SIOL surgery.

Purpose: To present a case of a dislocated posterior lamellar graft into the vitreous cavity in an eye that was post pars plana vitrectomy. Methods: Retrospective case report Results: A middle-aged man underwent pars plana vitrectomy (PPV), pars plana lensectomy (PPL), and SSIOL fixation following a traumatic eye injury. The patient required subsequent Descemet stripping automated endothelial keratoplasty (DSAEK) for corneal edema, and the posterior lamellar graft was lost intraoperatively into the posterior segment. The graft was surgically retrieved one week later, followed by a successful placement of a new posterior lamellar graft. Histopathological examination of the retrieved graft after one week in the vitreous cavity revealed viable endothelial cells, a novel finding in a posteriorly dislocated DSAEK graft. The newly placed graft remained attached and healed well, with the patient achieving a visual acuity (VA) of 20/80 at three months post-operatively. Discussion: Posteriorly dislocated grafts may be suitable for transplantation to the corneal stroma following prompt retrieval from the vitreous cavity. Prompt retrieval and appropriate surgical techniques are critical for optimizing outcomes in such clinical scenarios.

When encountering diseases of the anterior vitreous and peripheral retina (ie, the “middle segment” of the eye), vitreoretinal (VR) surgeons are specifically trained in surgical techniques for managing the vitreous and visualizing the peripheral retina during anterior vitrectomy, and therefore, they are well equipped to address the complications of surgery involving the anterior vitreous space. This clinical update reviews and compares the current literature discussing techniques and patient outcomes related to complete pars plana vitrectomy versus incomplete, subtotal pars plana vitrectomy, and addresses the proposition of developing an abridged training curriculum for non-VR surgeons to acquire the knowledge and skills required to perform these procedures. Recent studies confirmed that operating in the anterior vitreous carries potential risk of retinal tear, retinal detachment, and other adverse events that may cause vision loss. To mitigate these risks, studies suggest that the use of dedicated visualization equipment and illumination instruments is necessary for surgeons to safely perform anterior vitrectomy and recognize complications, should any occur. Performing VR surgery in the absence of wide-angle viewing systems, endoillumination, careful peripheral examinations, modern vitrectomy platforms, and appropriate training may lead to outcomes that are detrimental to patient safety.

Background and Objective: Scleral-fixated intraocular lens (SFIOL), scleral-sutured IOL (SSIOL), anterior chamber IOL (ACIOL) are used to manage aphakia or lens subluxation. This study compared trends in surgical techniques and outcomes of secondary IOL implantation based on surgeon type. Patients and Methods: This retrospective study included patients from United States (US) retinal centers who underwent surgery by vitreoretinal (VR cohort) or VR and anterior segment (AS) (combined cohort) surgeons from 2015 to 2024. Complications assessed included retinal detachment, endophthalmitis, suture erosion, haptic erosion, repeat pas plana vitrectomy, and corneal edema. Results: VR surgeons performed 4,143 secondary IOL surgeries (1,977 ACIOL, 1,327 SFIOL, 839 SSIOL) while VR and AS surgeons performed 511 (342 ACIOL, 125 SFIOL, 44 SSIOL). SFIOL and SSIOL surgeries by VR surgeons increased, whereas ACIOL surgeries decreased. VR and AS surgeons maintained a steady but lower volume of SFIOL and SSIOL cases, with increasing ACIOL surgeries. Postoperative visual acuity for the VR and combination cohorts was 54.3 ± 27.8 and 51.5 ± 27.2 (≈ 20/100 Snellen) ( P value = 0.102), respectively. Complication rates were similar between cohorts, except for postoperative retinal detachment (VR: 144, 3.5%; combined: 26, 5.1%; P value < 0.001). Conclusion: ACIOLs were the most commonly performed secondary IOL surgery. However, a shift toward SFIOL and SSIOL techniques among vitreo-retinal surgeons emerged. Outcomes were comparable between approaches.