Purpose: Cyclodialysis can occur after ocular trauma or intraocular surgery and can lead to persistent hypotony and vision loss if not treated appropriately. In eyes with prior trabeculectomy, conventional cyclopexy requires a conjunctival incision, which may compromise a functioning filtering bleb. We present a case in which a capsular tension ring (CTR) was inserted into the ciliary sulcus to repair cyclodialysis without conjunctival incision, preserving the filtering bleb.Case summary: A 65-year-old man developed hypotony, a shallow anterior chamber, and cataract progression after trabeculectomy. Swept-source anterior segment optical coherence tomography revealed approximately 200° of cyclodialysis involving the nasal and temporal quadrants. The patient had already lost vision in the left eye, and the right eye represented the only eye with preserved visual potential. As preservation of the filtering bleb in the right eye was essential, phacoemulsification with intraocular lens implantation was performed, and a CTR was inserted into the ciliary sulcus without conjunctival incision. One day after surgery, anterior segment optical coherence tomography confirmed complete reattachment of the ciliary body. At the 1-year follow-up, the ciliary body remained well attached with no recurrence of cyclodialysis. The filtering bleb appeared clinically diffuse and healthy, and both visual function and intraocular pressure remained stable throughout the follow-up period. Conclusions Insertion of a CTR into the ciliary sulcus without conjunctival incision enabled successful closure of the cyclodialysis cleft while preserving filtering bleb function, offering a practical treatment option for eyes with prior trabeculectomy.

Purpose: Limited treatment options exist for patients with metastatic castration-resistant prostate cancer (mCRPC) after the failure of taxane-based chemotherapy and novel hormonal therapy. Here, we report the safety and efficacy of ifosfamide and mesna in patients with mCRPC after the failure of taxane-based chemotherapy and novel hormonal therapy (NCT06236789). Materials and Methods: Patients with histologically confirmed prostate cancer who had failed taxane-based chemotherapy and novel hormonal therapy received ifosfamide 2,500 mg/m2 and mesna 1,500 mg/m2 on days 1–3, repeated every 21 days. Safety, objective response rate, disease control rate, reduction in serum prostate-specific antigen (PSA) concentration by >50% (PSA50) or >90% (PSA90), radiographic progression-free survival (rPFS), and overall survival (OS) were analyzed. Results: A total of 47 patients with mCRPC were included in the study. The median number of lines of treatment was 5 (range, 3 to 7). All patients were previously administered docetaxel and novel hormonal therapies including abiraterone (51.1%) and/or enzalutamide (61.7%). Thirty-eight patients (80.9%) were administered cabazitaxel. The objective response and disease control rates were 21.3% and 80.9%, respectively. PSA50 and PSA90 were achieved in 31.9% and 10.6%, respectively. During a median follow-up duration of 54.3 months, rPFS and OS were 5.0 and 9.0 months, respectively. All the patients experienced treatment-related adverse events of any grades; however, no new safety signs were detected. Genomic biomarker analysis revealed that alterations in the TP53 pathway were associated with inferior rPFS and OS. Conclusion Ifosfamide and mesna showed appreciable efficacy and manageable safety profiles in heavily treated patients with mCRPC.

Purpose: This study aimed to investigate the impact of physical activity on dementia risk among cancer survivors in South Korea. Materials and Methods: This retrospective, population-based cohort study included 344,152 cancer survivors identified from the National Health Insurance Service database in South Korea. The mean follow-up time was 5.81 years. Different levels of physical activity post-cancer diagnosis, ranging from inactive to highly active, were assessed. The primary outcome was the incidence of overall dementia, Alzheimer’s disease, and vascular dementia. Secondary outcomes included dementia risk stratified by cancer type and treatment (chemotherapy and radiation). Results: Of the total participants, 24,363 (7.08%) developed dementia. The risk of overall dementia decreased sequentially across the exercise groups compared to the inactive group: insufficiently active (adjusted hazard ratio [HR], 0.89; 95% confidence interval [CI], 0.86 to 0.92), active (adjusted HR, 0.85; 95% CI, 0.83 to 0.88), and highly active (adjusted HR, 0.79; 95% CI, 0.76 to 0.82). This inverse relationship between exercise and dementia risk was statistically significant across various cancer types and was consistent regardless of age, comorbidities, and whether or not excluding the first 1, 2 years. Conclusion Among cancer survivors in South Korea, increased physical activity post-diagnosis was associated with a significantly lower risk of dementia. These findings underscore the importance of promoting physical activity in cancer survivors for cognitive health.

Background/Aims: Biliary tract cancer (BTC) is a rare malignancy with poor prognosis. We investigated genomic determinants of clinical benefit from gemcitabine, cisplatin, and nab-paclitaxel (GAP) versus gemcitabine and cisplatin (GC) in advanced BTC. Methods: Clinical and genomic data using TruSight Oncology 500 were analyzed from patients treated with GAP (N=198) or GC (N=89) as first-line therapy. Results: With a median follow-up of 33.0 months, GAP modestly improved progression-free survival (PFS) (hazard ratio [HR] 0.764; 95% confidence interval [CI] 0.591–0.989) without significant overall survival (OS) difference compared to GC. Genomic profiling revealed frequent alterations in TP53 (35.2%), KRAS (16.4%), SMAD4 (10.5%), and TNFRSF14 (10.5%), involving RTK/RAS (44.3%), TP53 (41.8%), and PI3K (20.2%) pathways. Single-gene mutations did not predict treatment benefit. However, pathway-level analysis identified PI3K pathway activation as significantly associated with inferior PFS (HR 2.148; 95% CI 1.478–3.124) and OS (HR 2.096; 95% CI 1.413–3.109) in patients receiving GAP, an effect not observed with GC. Importantly, GAP conferred clinical benefit only in patients without PI3K pathway activation, while no survival advantage was seen in those with such alterations (Pinteraction=0.023 for PFS, Pinteraction=0.003 for OS). Similar results were obtained in the independent validation cohort treated with GAP (N=103) or GC (N=64) for BTC. Conclusions Genomic profiling using next-generation sequencing identified PI3K pathway activation as key molecular determinant that differentiates patient outcomes between GAP and GC treatments in advanced BTC.

Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.

Purpose: To report a case of angle-closure glaucoma caused by pupillary block in a patient with familial exudative vitreoretinopathy (FEVR).Case summary: A 20-year-old man with FEVR presented with sudden-onset pain in his left eye. The best-corrected visual acuity (BCVA) was 0.04, and the intraocular pressure (IOP) was 76 mmHg. The central anterior chamber depth was reduced to twice the corneal thickness. Gonioscopy revealed 360° angle closure. Anterior segment optical coherence tomography and ultrasound biomicroscopy demonstrated a closed angle and anteriorly convex peripheral iris due to forward displacement of the lens–iris diaphragm and contact between the iris and lens. Trabeculectomy and cataract surgery were performed because the IOP was not controlled despite maximal medical therapy. At 9 months postoperatively, the IOP was 13 mmHg without the use of glaucoma medications, and the BCVA was 0.1. Conclusions In patients with FEVR, angle-closure glaucoma due to pupillary block can occur even at a young age. FEVR should be considered in young patients with acute angle-closure glaucoma.

Purpose: Conjunctival incisional surgery is a known risk factor for trabeculectomy failure. The occurrence of avascular bleb following failed ab interno XEN stent implantation has been documented in patients undergoing trabeculectomy with mitomycin C (MMC). However, reports on same quadrant trabeculectomy with MMC after failed ab externo open conjunctiva XEN stent implantation are scarce. This study sought to document the 1-year clinical outcomes and bleb morphology following this procedure.Case summary: This retrospective study reviewed the medical records of 4 eyes from 4 patients who received trabeculectomy with MMC in the same quadrant following ab externo open conjunctiva XEN stent implantation failure. At 1 year after trabeculectomy, the intraocular pressure was successfully controlled without glaucoma medication, and no visual field progression was observed. Anterior segment tomography indicated that the blebs were elevated and broad, with a suprascleral fluid-filled space evident in all eyes. There were no instances of prolonged hypotony or bleb leakage one year after the trabeculectomy, although an avascular bleb was observed in one eye. Conclusions Performing trabeculectomy with MMC in the same quadrant appears to be an effective method for reducing IOP after the failure of ab externo open conjunctiva XEN stent implantation.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye.Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.

Purpose: To report a case of angle-closure glaucoma caused by pupillary block in a patient with familial exudative vitreoretinopathy (FEVR).Case summary: A 20-year-old man with FEVR presented with sudden-onset pain in his left eye. The best-corrected visual acuity (BCVA) was 0.04, and the intraocular pressure (IOP) was 76 mmHg. The central anterior chamber depth was reduced to twice the corneal thickness. Gonioscopy revealed 360° angle closure. Anterior segment optical coherence tomography and ultrasound biomicroscopy demonstrated a closed angle and anteriorly convex peripheral iris due to forward displacement of the lens–iris diaphragm and contact between the iris and lens. Trabeculectomy and cataract surgery were performed because the IOP was not controlled despite maximal medical therapy. At 9 months postoperatively, the IOP was 13 mmHg without the use of glaucoma medications, and the BCVA was 0.1. Conclusions In patients with FEVR, angle-closure glaucoma due to pupillary block can occur even at a young age. FEVR should be considered in young patients with acute angle-closure glaucoma.