Editorial: Updates in Ocular Therapeutics and Surgery – Volume IV

Georgios D Panos^1,2*Horace MASSA³

• ¹Department of Ophthalmology (School of Medicine), Aristotle University of Thessaloniki, Thessaloniki, Greece
• ²Department of Ophthalmology & Visual Sciences (School of Medicine), University of Nottingham, Nottingham, United Kingdom
• ³Department of Ophthalmology, Hopitaux Universitaires Geneve, Geneva, Switzerland

The fourth volume of Updates in Ocular Therapeutics and Surgery showcases how our field is advancing along three converging fronts: (i) surgical technique and visualisation, (ii) biomaterials and drug delivery, and (iii) pharmacotherapy informed by real-world evidence and data-driven discovery. Together, the nine articles in this Research Topic—spanning cornea, lens and retina, and including one surgical Methods paper—highlight pragmatic solutions to persistent clinical bottlenecks while pointing to platforms that may generalise across diseases. A Corrigendum in this collection also underscores the value of transparent correction without altering scientific conclusions. 1. Surgery & visualisation Refining corneal endothelial surgery. Cheong et al. directly compare Descemet membrane endothelial keratoplasty (DMEK) insertion techniques in an Asian cohort—"injector" (endothelium-out) versus "pull-through" (endothelium-in). Adjusted analyses show comparable clinical outcomes overall, with surgical indication (not technique) chiefly driving graft failure, and pseudophakic bullous keratopathy faring worse than Fuchs dystrophy. A linked Corrigendum corrects panel order in a figure and does not change conclusions. These data help surgeons choose instruments and manoeuvres based on ocular context rather than fashion, and they set expectations for case selection and training. Stabilising the capsular bag after trauma. Li et al. report long-term outcomes using heat-shaped polypropylene "capsular hooks" to secure zonular-deficient capsular bags in traumatic crystalline lens subluxation. Visual acuity improved markedly with well-centred IOLs and no device dislodgement over a mean ~10-month follow-up. In settings without commercial fixation devices, this customisable, low-cost approach is both elegant and scalable. Retrieving posteriorly dislocated IOLs—simple, safe, reproducible. Gu et al. (Methods) describe levitating posteriorly dislocated IOLs by coupling a 22-gauge IV catheter to the vitreotome aspiration line, allowing controlled vacuum to lift the optic off the retina before grasping. In four consecutive cases the IOL never fell back, and no intraoperative complications occurred. This technique avoids PFCL-related risks and illustrates how incremental engineering can de-risk delicate steps in vitreoretinal surgery. A safer way to see: lutein-based vital dye. Rossi et al. pilot a lutein-based vitreous dye for idiopathic epiretinal membrane surgery. The dye selectively stains vitreous/posterior hyaloid, facilitates key manoeuvres, and is associated with improved visual acuity and reduced central retinal thickness at 4–6 months without IOP penalty. As visualisation increasingly relies on adjuncts with favourable safety profiles, lutein-based dyes may offer a thoughtful alternative to triamcinolone or indocyanine green. 2. Biomaterials & delivery Nanoparticles that can be seen—and deliver. Raîche-Marcoux et al. synthesise fluorescent gold nanoparticles with properties comparable to their non-fluorescent counterparts and track their localisation across ocular tissues after topical application in ex vivo rabbit eyes. The work is a step toward non-invasive delivery systems that can be imaged end-to-end—from corneal surface to posterior segment—supporting rational formulation and pharmacokinetic studies. Harnessing amniotic membrane proteins via smart hydrogels. Basasoro et al. test two hydrogel platforms loaded with amniotic membrane protein extract in a rabbit model of severe alkali burn. Treated corneas showed more frequent wound closure at day 14 and histologic signals of modulated inflammation. The take-home message is pragmatic: biocompatible, muco-adhesive hydrogels can turn a proven biological milieu (AM proteins) into a controllable, residence-time-enhancing therapy. 3. Pharmacotherapy & data-driven discovery Real-world anti-VEGF: structure–function matters. Zhang et al. evaluate aflibercept for diabetic macular oedema with both OCT/OCTA and microperimetry. Short-term treatment reduced central retinal thickness and improved best-corrected visual acuity and fixation stability, while FAZ area/density metrics were unchanged— reminding us that functional endpoints can move even when angiographic surrogates do not, and supporting microperimetry as a sensitive complement in routine care. Brolucizumab in practice. Rossi et al. provide 1-year, real-world results for brolucizumab in neovascular AMD, reporting improved visual acuity and central retinal thickness with relatively few injections and only one intraocular drug-related adverse event. Such pragmatic data help clinicians balance potency, durability and safety when individualising anti-VEGF regimens. Data-driven discovery meets traditional medicine. Zhang et al. construct an integrated bioinformatics–network pharmacology–machine-learning framework to interrogate a triplet of traditional Chinese medicines in diabetic retinopathy, nominating stigmasterol and PPARG as a plausible axis and validating in vivo. Beyond the specific candidate, the blueprint is noteworthy: AI-assisted target/component prioritisation funnelled into experimental confirmation can accelerate hypothesis generation for complex polypharmacy systems. Where do we go from here? Three priorities emerge. First, standardise technique-sensitive procedures (e.g., DMEK) with indications-aware pathways and training metrics. Second, translate biomaterials with imageable, muco-adhesive, and tissue-specific properties from bench to clinic via pharmacokinetics and manufacturability studies. Third, enrich routine outcomes with function (microperimetry, fixation stability), not just structure, and continue to weave data-science pipelines that triage candidates before costly trials. The articles assembled here exemplify clinically grounded innovation—small changes that make surgery safer, smarter matrices that keep drugs where they matter, and pragmatic evidence that helps us treat the right patient with the right tool at the right time.