Purpose: This study aims to evaluate the quality of and trends in artificial intelligence (AI) chatbot responses to questions related to age-related macular degeneration (AMD) and to analyze the frequency of incorrect key information. Methods: Three chatbots, ChatGPT 3.5, ChatGPT 4.0, and Gemini, were used in this study. Nine questions were formulated covering general information about: 1) AMD, 2) AMD treatment options, 3) effects and side effects of intraocular injections. Each question was queried three times with each of the three chatbots using two different accounts. Responses to items 1–3 were rated as poor/acceptable/good, and the frequency of incorrect key information was noted. Results: Overall, the majority of the queries received acceptable or good responses. Poor-quality responses were noted in 16.7% of ChatGPT 3.5 responses. Incorrect key information was present in 6.5% of all responses. Conclusions While AI chatbots generally provided acceptable responses to questions regarding AMD, some responses contained incorrect key information, suggesting the need for caution when accessing medical information through AI chatbots.

Purpose: To evaluate the prevalence of intraocular lens rotation (IOL) and related factors during combined vitrectomy and cataract surgery. Methods: A university hospital, non-comparative pilot study. The medical records of patients who underwent combined vitrectomy and cataract surgery were retrospectively investigated. Surgical videos were analyzed to observe the degree and timing of rotation of IOL during vitrectomy. Scleral indentation and peripheral vitrectomy were started from 6 o’clock of the eyeball and proceeded counterclockwise, and the presence of rotation was defined when IOL rotated more than 2 hours (60 degrees). Results: A total of 181 eyes were enrolled in this study, and the rotation of IOL occurred in 13 eyes (7.2%). IOL rotation was observed in 11 out of 117 eyes (9.4%) using 1-piece IOL and 2 out of 64 eyes (3.1%) using 3-piece IOL, and the difference was not significant. The direction of IOL rotation was counterclockwise in 11 eyes (84.6%) and rotated during peripheral vitrectomy and scleral indentation in 12 eyes (92.3%). Conclusions Since the rotation of IOL may occur during combined vitrectomy and cataract surgery, the axis of astigmatism should be checked at the end of the operation when using toric IOL.

Purpose: This study aimed to describe an atypical case of acute retinal necrosis presenting with primary choroidal involvement and early development of rhegmatogenous retinal detachment.Case summary: A 67-year-old immunocompetent woman presented with blurred vision in the right eye. Fundus examination revealed multiple yellowish retinal infiltrations, perivascular sheathing, and hemorrhages in the inferotemporal quadrant. Fluorescein angiography indicated diffuse leakage and obstructive vasculopathy. Moreover, indocyanine green angiography revealed a scattering pattern of hypofluorescence focused in the inferotemporal quadrant. This differed from the results of fundus examination and fluorescein angiography, which were indicative of primary choroidal inflammation. Despite treatment, the patient developed retinal detachment within 4 weeks.Surgical intervention revealed that the area of choroidal infiltration remained attached, whereas the other retinal regions were detached.Postoperative imaging revealed the absence of previously hypofluorescent areas, indicative of choroidal inflammation. Conclusions This case highlights the importance of recognizing primary choroidal involvement in acute retinal necrosis as it can indicate a more severe disease course and lead to earlier complications such as rhegmatogenous retinal detachment. Thus, comprehensive imaging and timely intervention are critical for effective management of these patients.

Purpose: To report short-term efficacy of brolucizumab injection in treatment-naïve large pigment epithelial detachment secondary to neovascular age-related macular degeneration.Case Summary: A 63-year-old male presented with decreased visual acuity in the left eye. He was diagnosed with neovascular age-related macular degeneration accompanied by large pigment epithelial detachment (PED), with central retinal thickness (CRT) of 641 µm and best-corrected visual acuity (BCVA) of 0.3 (decimal). Two months later, without treatment, the PED had worsened, with CRT of 782 µm and BCVA of 0.2. Considering the rapid progression of the PED and the deterioration in visual acuity, intravitreal brolucizumab injection was administered. One month after the injection, significant improvement was observed, with CRT of 246 µm and BCVA of 1.0. The improvement was maintained at the three-month follow-up, with resolution of the PED and subretinal fluid and sustained BCVA of 1.0.No ocular inflammation or occlusive retinal vasculitis was observed during follow-up. Conclusions This case demonstrates the short-term efficacy of brolucizumab injection in a treatment-naïve patient with neovascular age-related macular degeneration, presenting with a rapidly progressing large pigment epithelial detachment and associated visual loss.

Purpose: Intermediate age-related macular degeneration (AMD) is characterized by drusen, alterations in the retinal pigment epithelium, and various features of pigment epithelium detachment (PEDs) without exudation. With the advent of optical coherence tomography angiography (OCTA), non-exudative choroidal neovascularization (CNV) has recently been reported in eyes with intermediate AMD.This study investigated the frequency of subclinical, non-exudative CNV in eyes with intermediate AMD using OCTA. Methods: We retrospectively evaluated the optical coherence tomography (OCT) and OCTA images of 140 eyes (97 patients) with intermediate AMD. PEDs were divided into 4 types based on OCT. En-face OCTA and cross-sectional OCTA were performed to detect the presence of non-exudative CNV in eyes with intermediate AMD. Results: The frequency of subclinical non-exudative CNV was 13.8% (17 eyes) in eyes with intermediate AMD. Drusenoid PEDs accounted for 47% (66 eyes), shallow irregular PEDs for 20% (28 eyes), serous PEDs for 19% (26 eyes), and combined PEDs for 15% (20 eyes). Non-exudative CNV was observed only in eyes with shallow irregular PEDs. The frequency of non-exudative CNV in shallow irregular PEDs was 38.6%. Conclusions Subclinical non-exudative CNV was identified in 13.8% of eyes with intermediate AMD, which does not seem to be low.Therefore, OCTA may be necessary to evaluate patients with intermediate AMD, particularly those with shallow irregular PEDs.

Purpose: To evaluate and report the short-term anatomical effects of switching from bevacizumab to the ranibizumab biosimilar CKD-701 in patients undergoing treatment for neovascular age-related macular degeneration (AMD). Methods: A retrospective medical record analysis was conducted on patients receiving bevacizumab therapy for neovascular AMD who were subsequently switched to CKD-701. The changes in central macular thickness and frequency of intraretinal/subretinal fluid before and after a single CKD-701 injection were compared with those before and after a single bevacizumab injection. Results: A total of 20 eyes was included in the study. Following bevacizumab injection, the mean central macular thickness decreased by 14.9 ± 57.6 µm, with intraretinal and subretinal fluid observed in 75.0%/55.0% before injection and 60.0%/55.5% after injection, respectively. Following CKD-701 injection, the mean central macular thickness decreased by 34.9 ± 57.4 µm, with intraretinal and subretinal fluid observed in 75.0%/56.0% before injection and 45.0%/40.0% after injection, respectively. There were no significant differences between the two groups in terms of changes in central macular thickness (p = 0.204), frequency of intraretinal fluid (p = 1.000), and subretinal fluid (p = 0.748) observed before injection or in frequency of intraretinal fluid (p = 0.527) and subretinal fluid (p = 0.527) after injection. Conclusions The short-term anatomical outcomes following CKD-701 injection in neovascular age-related macular degeneration showed no significant difference compared to the short-term outcomes following bevacizumab injection previously administered.

Purpose: We sought to report the results of 0.625%/0.1 mL of povidone–iodine (PI) intravitreal injection (0.013% PI vitreous concentration) for treating acute endophthalmitis after cataract surgery.Case summary: Case 1 developed acute endophthalmitis one day after cataract surgery. Prompt intervention with PI injection and vitrectomy led to full resolution of inflammation and a visual acuity of 0.8, and the patient remained stable at 10 months. Case 2, a patient with persistent post-cataract inflammation, was treated with PI injection and vitrectomy, resulting in complete resolution of inflammation and improvement of visual acuity to 0.6 by eight months. Case 3 was a diabetic patient who experienced severe acute endophthalmitis.The patient was treated with the above intervention, resulting in full resolution of endophthalmitis; however, he eventually lost vision due to neovascular glaucoma. Case 4 developed recurrent endophthalmitis caused by Achromobacter xylosoxidans after cataract surgery. This patient required multiple vitrectomies, PI injections, and intraocular lens removal, which led to a resolution of inflammation and restoration of visual acuity to 1.0 after 14 months. Conclusions 0.625%/0.1-mL IPI injection followed by vitrectomy was performed in four acute endophthalmitis patients after cataract surgery and were successfully treated.

Purpose: In the present study, the efficacy and safety of brolucizumab in refractory polypoidal choroidal vasculopathy (PCV) patients treated with aflibercept were investigated. Methods: The medical records of patients with refractory PCV treated with aflibercept were reviewed. All patients had subretinal fluid or intraretinal fluid followed by at least three consecutive injections of aflibercept on a 4–8-week dosing schedule before switching to brolucizumab. Changes in injection intervals, optical coherence tomography (OCT), and OCT angiography parameters including central macular thickness (CMT), subfoveal choroidal thickness (SFCT), polyp height, lesion area, flow density, and polyp regression rate were evaluated before and 6 months after switching to brolucizumab. Results: The study included 32 eyes of 32 patients with PCV who received brolucizumab injections as switch therapy and were followed at 6 months. After switching to brolucizumab, 53% of eyes had dry macula and the injection interval was extended from 5.4 ± 1.7 weeks to 10.8 ± 2.9 weeks. Best-corrected visual acuity remained stable over the 6 months (p = 0.166). CMT and SFCT were reduced at 6 months after switching to brolucizumab (p = 0.042 and p = 0.023, respectively). Polyp regression was complete in 12.5% and partial in 62.5% of eyes. The largest polyp height and lesion size significantly decreased (p = 0.035 and p = 0.010, respectively). However, significant difference was not found regarding flow density after switching to brolucizumab (p = 0.145). Intraocular inflammation-related adverse events were not reported. Conclusions Brolucizumab could provide additional benefits in refractory PCV treated with aflibercept by reducing leakage from polyps, branching vascular networks, and choroid.

Purpose: To report two cases of peripheral pigmentary retinopathy observed in a family with Danon disease, a rare genetic disorder caused by a mutation in lysosomal associated membrane protein 2 (LAMP2).Case Summary: A 48-year-old woman presented with photopsia. The patient had received a heart transplant for dilated cardiomyopathy and was found to have the c.928G>A mutation on LAMP2 gene testing due to a family history. The patient and her two daughters were found to have the same genetic mutation. Those who underwent ophthalmic examination, the patient and one daughter, exhibited diffuse salt and peppered pigmentation bilaterally. Optical coherence tomography revealed drusen and drusenoid retinal pigment epithelial detachment in both eyes of the patient, but no other significant findings. Fluorescein angiography showed mottled hyperfluorescence due to retinal pigment epithelial atrophy and pigment clumping, with no significant changes in the macula. One patient showed no progression of visual impairment in vision or expansion of pigment lesions over four years. Conclusions Patients with Danon disease may show atypical peripheral retinal pigmentary degeneration along with cardiomyopathy, and in this case, ophthalmic findings tended to be stable for the long term.