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Study Type: Multicentre development and validation study (retrospective, cross-sectional imaging biomarker analysis)

Key Question: Can ultra-widefield OCT angiography (UWF-OCTA) peripheral vascular metrics be used to phenotype and grade disease severity in retinitis pigmentosa?

Key Findings:

• Two distinct peripheral vascular phenotypes identified: Terminal Remodeling (56.2%) and Simple Atrophy (43.8%), with Terminal Remodeling showing greater severity at equivalent ages.
• Capillary-nonperfusion zone (CNZ) area strongly correlated with visual function (marginal R² up to 0.77 for kinetic perimetry; 0.64 for full-field stimulus threshold).
• A CNZ-based 4-stage grading system stratified severity effectively (η² up to 0.75 for kinetic perimetry) and retained discriminatory value for BCVA in internal (η²=0.17) and external (η²=0.28) validation cohorts.

Clinical Relevance: Offers UK ophthalmologists an objective, imaging-based staging tool for RP that could standardise severity assessment and patient selection for emerging gene/cell-based therapy trials within NHS retinal genetics services.

Limitations: Retrospective design and reliance on UWF-OCTA image quality/availability may limit generalisability, particularly in patients with poor fixation or peripheral media opacity.

Study Type: Retrospective matched cohort study

Key Question: Do children with perinatal brain injury undergoing strabismus surgery achieve comparable long-term success rates to matched controls without brain injury?

Key Findings:

• Two-year motor success was significantly lower in the brain-injury cohort than controls (43.5% vs 65.7%; OR=0.31, 95% CI 0.16–0.62; P=.0005), with similar reductions in general motor-sensory success (47.2% vs 69.4%); differences at 3–6 months were not significant.
• Failures were predominantly under-corrections with greater postoperative drift, despite comparable normalised surgical dosing (95.9% vs 96.6% of standard).
• Larger preoperative deviation independently predicted lower success (OR=0.963 per prism dioptre, P=.019), particularly in esotropia.

Clinical Relevance: These findings should prompt UK ophthalmologists to counsel families of children with perinatal brain injury about higher likelihood of under-correction and need for secondary strabismus intervention, informing realistic surgical planning within NHS paediatric ophthalmology services.

Limitations: Retrospective design limits causal inference and precludes prospective evaluation of adjusted surgical dosing strategies for this population.

Study Type: Retrospective multicenter cohort study

Key Question: Does presence of immune-mediated disease (with or without corticosteroid exposure) alter clinical course and imaging features of CSCR compared to idiopathic CSCR?

Key Findings:

• Steroid-exposed immune-mediated CSCR had worse baseline vision (0.3±0.4 vs 0.2±0.2 logMAR, p=0.03), greater neurosensory detachment height, larger RPE alteration, and thinner choroid.
• Immune-mediated disease independently predicted less visual improvement (β=0.22, p=0.01) and higher recurrence (OR 2.64, p=0.02); larger RPE alteration predicted worse baseline acuity (β=0.34, p=0.001).
• Older age predicted lower resolution rates (OR 0.11, p=0.03); multifocal lesions predicted greater logMAR change (β=0.23, p=0.007).

Clinical Relevance: Highlights that CSCR in patients with autoimmune comorbidities—commonly seen in UK ophthalmology clinics due to systemic steroid use—follows a more severe, recurrent course, supporting closer monitoring and cautious steroid stewardship.

Limitations: Retrospective design limits causal inference and may introduce selection/confounding bias regarding steroid indication and dosing.

Study Type: Retrospective case series

Key Question: Do prognostic biomarkers (GEP class, PRAME status, NGS mutations) in choroidal melanoma remain stable after initial plaque radiotherapy in eyes requiring secondary treatment (enucleation or repeat brachytherapy)?

Key Findings:

• GEP class concordance between initial and repeat/enucleation sampling was 83.6% (41/49); PRAME concordance was 87.1% (27/31); NGS results were unchanged in all 17 paired cases.
• Greater post-radiotherapy tumour thickness was significantly associated with GEP class change (p=0.027); GEP discriminant scores fell significantly after plaque therapy (p<0.05).
• No biomarker changes occurred in the 15 eyes enucleated for neovascular glaucoma, suggesting class shifts relate to true tumour progression rather than radiation effect alone.

Clinical Relevance: Supports continued confidence in initial GEP/PRAME-based prognostication for UK ocular oncology practice, while flagging that repeat biopsy may be warranted when recurrence or treatment resistance is suspected, as biomarker drift can reflect tumour progression.

Limitations: Small, single-institution retrospective cohort with limited paired NGS/PRAME data, restricting generalisability and statistical power.

Study Type: Retrospective cohort study

Key Question: What is the long-term incidence of structural glaucoma conversion and which ocular/systemic factors predict it in a health-screened adult population?

Key Findings:

• Over a mean 13-year follow-up (n=17,212), 2.3% converted to glaucoma (incidence rate 180.2/100,000 person-years).
• Independent risk factors: higher IOP (HR 1.158/mmHg), retinal arteriosclerosis (HR 1.459), older age (HR 1.017/year), higher serum uric acid (HR 1.080/mg/dL), and total cholesterol (HR 1.096/10mg/dL).
• Retinal arteriosclerosis on routine fundus photography was independently associated with conversion, alongside established IOP and age effects.

Clinical Relevance: Incorporating fundoscopic microvascular signs and metabolic markers alongside IOP could enhance glaucoma risk stratification in UK screening and community optometry referral pathways.

Limitations: Findings derive from a Korean health-screening population, limiting generalisability to UK/Western populations with different glaucoma phenotypes (e.g., higher normal-tension glaucoma prevalence) and screening infrastructure.

Study Type: Open-label extension analysis of phase 3 RCTs (OAKS, DERBY, GALE)

Key Question: Does earlier initiation of pegcetacoplan (vs delayed treatment after sham crossover) improve long-term anatomic and functional outcomes in geographic atrophy, and is the safety profile sustained over 48 months?

Key Findings:

• 48 months of continuous pegcetacoplan reduced GA growth rate by up to 24% vs projected sham, preserving 1.88 mm² of retinal tissue overall.
• In nonsubfoveal GA, early treatment preserved ~3× more retinal tissue (up to 3.16 mm²) than delayed treatment (1.11 mm²).
• Risk of progression to absolute scotoma was reduced by 32% (central 4 loci) and 43% (central 16 loci); safety was consistent with prior OAKS/DERBY data.

Clinical Relevance: Supports early initiation of pegcetacoplan in eligible NHS patients with GA to maximise structural and functional preservation, informing treatment-timing discussions as pegcetacoplan access pathways develop in the UK.

Limitations: Delayed-treatment comparisons rely on projected sham extrapolation rather than a true concurrent untreated control beyond 24 months, limiting causal certainty.

Study Type: Narrative expert review (non-systematic), incorporating original preclinical data from the authors.

Key Question: What is the current and emerging landscape of biomaterials—tamponades, prostheses, RPE scaffolds, drug delivery platforms, and gene therapy vectors—in retinal surgery?

Key Findings:

• PRIMA subretinal photovoltaic implant improved visual acuity in 81% (26/32) of geographic atrophy patients at 12 months; a 44-channel suprachoroidal prosthesis showed no device-related serious adverse events at 2.7 years.
• Authors' novel oxime-crosslinked hyaluronic acid vitreous substitute showed favourable physical properties (density 1.01 g/mL, refractive index 1.356) with preserved ERG and stable IOP (13.5–25.9 mmHg) in rabbits.
• 2025 saw regulatory approval of a refillable ranibizumab port delivery system and the first encapsulated cell therapy for MacTel type 2; RPE scaffolds and anti-VEGF gene therapies remain in early/Phase 3 trials respectively.

Clinical Relevance: Highlights a pipeline of biomaterial innovations—reduced-burden drug delivery, tissue-replacement scaffolds, and next-generation vitreous substitutes—with direct implications for reducing injection frequency and surgical burden within NHS retinal services.

Limitations: Non-systematic review methodology combined with early-phase/preclinical evidence (including the authors' own unpublished hydrogel data) limits generalisable conclusions.

Study Type: Narrative review (expert experience-based, no primary data or systematic methodology described)

Key Question: How should retinal detachment associated with ocular coloboma (choroidal, optic disc, or lens/zonular) be understood mechanistically and managed clinically?

Key Findings:

• Retinal detachments in choroidal coloboma are categorised as either directly caused by the coloboma or occurring in eyes where coexisting coloboma complicates standard detachment repair.
• Optic disc pit-associated maculopathy/detachment has a distinct pathogenesis and natural history, with specific surgical considerations reviewed.
• Lens and zonular coloboma introduce additional technical challenges (e.g., zonular instability) affecting surgical planning for retinal detachment repair.

Clinical Relevance: Provides UK vitreoretinal surgeons a structured framework for managing a rare but technically challenging group of conditions typically seen only in low-volume, case-report evidence, relevant to tertiary NHS referral centres.

Limitations: Evidence base is derived largely from case reports/series and authors' personal experience rather than controlled studies, limiting generalisability.