Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.

We report a case of alpelisib-induced uveitis. A 68-year-old female who had recently been given alpelisib for metastatic breast cancer presented with a 2-week history of bilateral worsening vision with a corresponding acute hypermetropic shift. Her unaided visual acuity was 6/60 in both eyes, with bilateral anterior uveitis, non-granulomatous keratic precipitates, posterior synechiae, and limited fundal view. There was also a mild iris bombe configuration, although the intraocular pressures were normal. Ocular ultrasound revealed bilateral uveal effusion, ciliary body congestion, dense vitreous cells, and exudative retinal detachments. These findings were also confirmed on multimodal imaging with widefield fundus photography (Optos) and optical coherence tomography. Based on the clinical features above, a diagnosis of alpelisib-induced panuveitis was diagnosed. She was then admitted and treated with a 3-day course of intravenous methylprednisolone and intensive topical steroids. Her clinical signs and symptoms started to improve, and she was discharged 4 days later. At 1 week of follow-up, her best-corrected visual acuity was 6/12 in both eyes, with broken posterior synechiae and resolution of exudative retinal detachments. This case highlights the importance of early ophthalmology involvement by the oncology team as oncology therapy can have potential unexpected ocular manifestations.

Objectives To assess and describe current utilisation, characteristics and perspectives on virtual glaucoma clinics (VGCs) amongst European glaucoma specialists. Methods Cross-sectional, anonymized, online questionnaire distributed to all European Glaucoma Society-registered specialists. Questions were stratified into five domains: Demographics, Questions about VGC use, Questions for non-VGC users, COVID-19 effects, and VGC advantages/disadvantages. Results 30% of 169 participants currently use VGCs, with 53% based in the United Kingdom. Of those using VGCs, 85% reported higher patient acceptance compared to traditional care. The commonest virtual model was asynchronous remote monitoring (54%). Nurses (49%) and ophthalmic technicians (46%) were mostly responsible for data collection, with two-thirds using a mixture of professionals. Consultant ophthalmologists were the main decision-makers in 51% of VGCs. Preferred cohorts were: ocular hypertension (85%), glaucoma suspects (80%), early/moderate glaucoma in worse eye (68%), stable glaucoma irrespective of treatment (59%) and stable glaucoma on monotherapy (51%). Commonest investigations were: IOP (90%), BCVA (88%), visual field testing (85%) and OCT (78%), with 33 different combinations. Reasons for face-to-face referral included: visual field progression (80%), ‘above-target’ IOP (63%), and OCT progression (51%). Reasons for not using VGCs included: lack of experience (47%), adequate systems in place (42%), no appropriate staff (34%) and insufficient time/money (34%). 55% of non-VGC users are interested in their use with 38% currently considering future implementation. 83% stated VGC consultations have increased during the COVID-19 pandemic; 86% of all participants felt that the pandemic has highlighted the importance of VGCs. Conclusions A significant proportion of European glaucoma units are currently using VGCs, while others are considering implementation. Financial reimbursement and consensus guidelines are potentially crucial steps in VGC uptake.

Non-infectious uveitis represents a heterogenous group of immune-mediated ocular diseases, which can be associated with underlying systemic disease. While the initial choice of treatment of non-infectious uveitis depends on a number of factors such as anatomical location and degree of inflammation, topical therapies often remain the initial choice of non-invasive therapy. In this narrative review, we aim to describe the literature on non-infectious uveitis, with specific focus on the current perspective on topical anti-inflammatory therapy.

Recently, Abdelrahman et al. described a novel technique modifying deep sclerectomy (DS) surgery through placement of a non-absorbable mattress suture beneath the superficial scleral flap. 1 The authors reported superior IOP reduction with no complications, highlighting an effective and inexpensive way of replacing a spacer device.Our standard DS technique has been described extensively in previous publications. 2 The main differences from Abdelrahman et al. are the 5 × 4 mm 2 trapezoid, rather than 4 × 3 mm 2 rectangular, superficial scleral flap (Figure 1) and our use of a hydroxyethyl methacrylate spacer (EsnoperV2000 ® ). We similarly place the superficial flap back loosely with a single 10-0 nylon suture or none at all. We modified our standard technique by performing the proposed 10-0 nylon suture instead of the spacer device, without modifying the rest of our standard DS technique, in three consecutive cases. All surgeries were performed by the same experienced surgeon and patients had a minimum of 6 months follow-up.The first patient had a slow anterior leak day one postoperatively. This resolved without intervention within two weeks. IOP was 12 mmHg at week 2, and 17 mmHg at 6 months post-surgery. In the second case, a Seidel's test was performed intra-operatively and was positive. An additional conjunctival mattress suture was used to ensure a watertight bleb. IOP remained constant at 6-8 mmHg over the following 6 months. The third patient was Seidel's negative intraoperatively. However, a large subconjunctival bleb, hypotony (IOP 2 mmHg) and choroidal detachments with macular folds were found day one postoperatively. All hypotonous sequelae resolved within two weeks following cycloplegia and reduction in topical steroids. IOP was 10-12 mmHg in subsequent reviews.For all patients, VA post-operatively was stable when compared to pre-op, with a range of LogMAR 0.05-0.34 at 6 months post-op. None of our patients required laser goniopuncture (LGP) during the post-operative follow-up