George Y. X. Kong, Algis Vingrys, Manisha Ambawat, Md Mahboob, Shakira Bano, Syril Dorairaj, Shibal Bhartiya
The purpose of this study is to evaluate the agreement, repeatability, and testing efficiency of Melbourne Rapid Fields-Web (MRF-Web), a browser-based, device-independent perimeter, compared with the Octopus 600 perimeter in glaucoma patients. This retrospective, cross-sectional, single-center observational study included 113 patients undergoing routine visual field assessment for glaucoma or glaucoma suspicion at Marengo Asia Hospitals, Gurgaon, India. MRF-Web testing was performed on a calibrated 14-inch laptop with Hindi voice guidance. Agreement between MRF-Web and Octopus 600 for Mean Deviation (MD) and pattern-based global indices was assessed using intraclass correlation coefficients (ICCs) and Bland–Altman analysis. Test-retest repeatability was evaluated in 51 patients who underwent repeat MRF-Web testing. MRF-Web showed strong group-level concordance with Octopus 600 for MD, with an ICC of 0.88 (95% CI, 0.81–0.92), Bland–Altman bias of -0.78 dB, and 95% limits of agreement from -4.72 to 3.17 dB. Concordance for the pattern-based indices was moderate, with an ICC of 0.72 (95% CI, 0.58–0.81), bias of -0.59 dB, and 95% limits of agreement from -4.41 to 3.24 dB. MRF-Web demonstrated good test-retest concordance, with an ICC of 0.86 (95% CI, 0.69–0.94). Mean per-eye test duration was significantly shorter with MRF-Web than with Octopus 600 (232.9 ± 49.8 versus 342.4 ± 94.4 seconds). MRF-Web demonstrated strong group-level concordance with Octopus 600 MD measurements and shorter per-eye testing times in this predominantly mild-disease cohort. The limits of agreement indicate that measurements from the two platforms should not be regarded as directly interchangeable, and further study is required in moderate and advanced glaucoma.
Spaceflight-Associated Neuro-Ocular Syndrome (SANS) is a complex and multifactorial condition most commonly observed following long-duration spaceflight. Clinical findings of SANS include optic disc edema, retinal nerve fiber layer swelling, globe flattening, chorioretinal folds, and hyperopic refractive shifts. As human space exploration extends toward prolonged missions such as Artemis and Mars expeditions, SANS represents a significant risk to astronaut health and mission success. Although headward fluid shifts, elevated intracranial pressure, venous outflow congestion, and lymphatic dysfunction have been implicated in SANS pathophysiology, no single unifying mechanism or universally effective countermeasure has been identified. Emerging evidence suggests that oxidative stress from galactic cosmic radiation, endothelial dysfunction, inflammation, mitochondrial injury, altered angiogenesis, and disruptions in one-carbon metabolism contribute meaningfully to SANS development. This review summarizes the clinical manifestations and proposed mechanisms underlying SANS and examines naturally occurring compounds with high therapeutic indices that target these pathways. Specifically, we review bilberry anthocyanins with French maritime pine bark extract, Ginkgo biloba extract, saffron/crocin, curcumin, coenzyme Q10, resveratrol, vitamin E, and B vitamins as potential supplemental approaches, highlighting their mechanisms of action and therapeutic efficacy when targeting terrestrial ocular diseases. While direct studies in spaceflight environments remain limited, these compounds demonstrate antioxidant, anti-inflammatory, neuroprotective, vasoregulatory, and metabolic effects relevant to SANS. Collectively, they represent promising adjunctive candidates within a multimodal preventative strategy aimed at mitigating SANS risk during long-duration spaceflight.
Abdulrahman Kaki, Jumanah Qedair, Nouf Alzendi, Konrad Schargel
After conducting a literature review in July 2026 through PubMed, Google Scholar, Cochrane, and Web of Science databases using the keywords (Bleb needling; Encapsulated bleb; Mitomycin C; PAUL Glaucoma Implant; Primary congenital glaucoma), we did not find any prior similar reports. Therefore, to the best of our knowledge, this is the first report of successful needling of the PAUL Glaucoma Implant in a child with primary congenital glaucoma. To report the clinical outcomes of a minimally invasive, stepwise transconjunctival bleb needling with mitomycin C (MMC) to rescue a failing, encapsulated PAUL Glaucoma Implant (PGI) in a pediatric patient with refractory primary congenital glaucoma (PCG). A case report of a 9-year-old female patient with a complex surgical history, including bilateral deep sclerectomies and PGIs, who presented with uncontrolled left intraocular pressure (IOP) of 27 mmHg despite maximal medical therapy. Baseline B-scan ultrasonography and clinical examination confirmed a +1 encapsulated, loculated fluid collection surrounding the left implant plate. The patient underwent an uneventful, stepwise transconjunctival needle revision using a 27-gauge needle combined with a subconjunctival injection of a 0.3 mL mixture of 0.4 mg/mL MMC and 2% lidocaine to mechanically disrupt the fibrous capsule. On postoperative day 1, the left IOP was 24 mmHg with a deep anterior chamber. At the 9-day follow-up, the left IOP dropped to 14–17 mmHg with the formation of a quiet, diffuse bleb. By 1.5 months postoperatively, excellent stabilization was achieved with a left IOP of 10 mmHg and best-corrected visual acuity maintained at 20/40 (isolated optotypes reaching 20/30). At the final follow-up (2 months and 11 days), the left IOP remained well-controlled at 13 mmHg. A secondary poor ocular surface with superficial punctate keratitis was successfully managed with aggressive topical lubrication. Transconjunctival bleb needling augmented with MMC is an effective, conservative alternative to full surgical revision or implant replacement for managing encapsulated, hypertensive drainage blebs following PGI surgery in pediatric patients.
Celina Wang, Koushani Chakrabarty, Stephen D. Anesi, Peter Y. Chang
Cystoid macular edema (CME) is a vision-threatening complication of retinal vasculitis, a rare inflammatory disease for which large imaging datasets are difficult to obtain. Detection of CME on fluorescein angiography (FA) requires expert interpretation, motivating automated image-based approaches to support clinical decision-making. Deep learning methods, particularly convolutional neural networks (CNNs), have shown strong performance in medical image analysis but are constrained by limited labeled data in rare diseases. Transfer learning may mitigate this limitation by adapting pretrained models to small, task-specific datasets. We analyzed 207 de-identified late-phase 55° FA images from 117 patients with retinal vasculitis. The primary target was concurrent patient-level CME status, established through specialist review of clinical records and optical coherence tomography obtained at the same clinical visit as FA. A patient was classified as CME-positive when CME was present in at least one eye. An ImageNet-pretrained ResNet-18 was evaluated using five-fold nested, patient-level cross-validation. Within each outer-development cohort, 144 candidate configurations were compared by four-fold inner cross-validation and selected according to mean inner-validation AUROC. Each selected configuration was evaluated only on its corresponding untouched outer-test fold. Across 117 pooled patient-level outer-test predictions, the model-selection pipeline achieved an AUROC of 0.708 (95% CI, 0.610–0.802), an AUPRC of 0.626 (95% CI, 0.493–0.755), and an accuracy of 0.726 (95% CI, 0.641–0.803). Sensitivity was 0.694 (95% CI, 0.558–0.822), specificity was 0.750 (95% CI, 0.643–0.853), and the F1 score was 0.680 (95% CI, 0.563–0.780). Exploratory Grad-CAM analysis visualized regions associated with model predictions. The nested model-selection pipeline showed moderate discrimination with a relatively balanced operating profile and slightly higher specificity than sensitivity. Clinically relevant false-positive and false-negative errors, together with the absence of external validation, preclude clinical deployment.
Beatriz Cordón, Beatriz Pardiñas, Mónica Hernández, María Jesús Rodrigo, Elvira Mayordomo, Luis Emilio Pablo, Elena García-Martin
The purpose of this study was to evaluate the different retinal layers of the posterior pole protocol and peripapillary areas in optical coherence tomography (OCT) to identify significant changes attributable to Steinert disease. We analyzed 128 eyes of healthy control subjects and 79 eyes of patients with Steinert disease. We performed the posterior pole and Nsite analytics peripapillary protocols on all subjects and compared thicknesses in the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), retinal pigment epithelium (RPE), and complete retina (RETINA). Patients with Steinert disease showed significant alterations in retinal layer thickness compared with age-matched controls. Overall, a generalized thickening of retinal layers was observed; significant thickening of the RNFL was also found in the temporal area of the optic nerve and in the papillomacular bundle, which comprises the retinal ganglion cell axons connecting the macula with the optic nerve. Steinert disease is associated with retinal structural alterations in retinal layer structure, OCT may provide potential structural markers of retinal involvement in Steinert disease.
