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AbstractPurposeMethodsResultsConclusionsTo evaluate the effect of cyclosporine-A (CsA) 0.05% eye drops for management of acquired punctal stenosis, either alone or in combination with punctoplasty.In this prospective study patients referred to the oculoplastics clinic with acquired punctal stenosis (APS) were divided into three groups. Group A consisted of patients treated with CsA, Group B consisted of patients who underwent punctoplasty, and Group C included patients treated with both CsA and punctoplasty. Munk score, fluorescein dye disappearence test (FDDT), punctal opening grading were evaluated at baseline, and at the 1st and 6th month follow-ups.One hundred-eleven eyes of 80 patients were included in the study. While the punctum grade was significantly higher, the FDDT grade and Munk scores were significantly lower in group C compared to groups A and B at the 1st and 6th month follow-ups. The functional success rate was 69%, 79%, and 88% (p = .01), and the anatomical success rate was 77%, 77%, and 90% (p = .03) in Group A, B, and C, respectively, at the 6th month follow-up.In the treatment of APS, the use of CsA alone and the punctoplasty procedure demonstrated comparable anatomical and functional success rates at the 6th month follow-up. However, combining CsA with punctoplasty enhances both anatomical and functional success rates. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Infantile acute dacryocystitis is due to congenital nasolacrimal duct obstruction (NLDO) in newborns and infants, which involves acute bacterial infection of the lacrimal sac. This report describes a 37-day-old male infant with acute dacryocystitis and lacrimal abscess managed with a modified decompression and nasolacrimal duct probing. Case Report: We report the case of a 37-day-old male infant who presented with acute dacryocystitis complicated by a giant lacrimal abscess. On day 30 of life, his parent brought him to a local clinic due to inferior eyelid edema and hyperemia. He was diagnosed with acute dacryocystitis and was treated with tobramycin eye drops and ointment. However, severe erythema, swelling, and tenderness over the lacrimal sac area persisted. The parent refused a head CT, ultrasound examination, and systemic antibiotics, and brought the infant to our emergency unit for a second opinion on day 37 of life. A modified decompression and probing approach was employed, which involved gentle decompression of the abscess to relieve tension, followed by probing of the nasolacrimal duct to restore proper drainage. After a repeat decompression and probing procedure, the dacryocystitis and giant lacrimal abscess disappeared gradually, with good esthetic results. The infant responded well to the treatment, with resolution of symptoms and no recurrence of the abscess during follow-up. Conclusions: This case demonstrates that our modified decompression and probing approach provides a practical and an alternate option to treat acute dacryocystitis in infants complicated by a giant lacrimal abscess. [ABSTRACT FROM AUTHOR]

Introduction: Corneal damage can happen due to a variety of insults, including environmental factors and iatrogenic issues. For instance, the corneal epithelium is sensitive to oxidative stress caused by reactive oxygen species (ROS) or by ultraviolet B (UVB) radiation. Moreover, the strictly correlated oxidative damage and inflammatory processes impair the corneal reparative wound healing mechanism. Corneal protection after damage remains an unmet medical need that requires urgent management. Sodium hyaluronate is known to protect the cornea against oxidative and inflammatory injury. Additionally, vitamin B12 is a good candidate for counteracting corneal damage, helping preserve visual functions. Methods: The present study aimed to investigate the potential protective effect of an ophthalmic formulation based on 0.01% vitamin B12% and 0.15% sodium hyaluronate (DROPYAL EVO) compared to other ophthalmic formulations containing sodium hyaluronate and trehalose (TRIMIX and THEALOZ DUO). Two different in vitro models of corneal damage were carried out in corneal epithelial cells exposed to hydrogen peroxide (H2O2, 1 mM) or UVB (20 mJ/cm2). Cell viability, cytotoxicity, ROS production, and mRNA expression of pro-inflammatory cytokines (TNF-α and IL-1β) were assessed by MTT, LDH, 2′,7′–dichlorofluorescein diacetate (DCFDA) assays and Real-time PCR, respectively. Additionally, the ability of ophthalmic formulations to affect the wound healing process in corneal epithelial cells was assessed at different time points by scratch wound healing assay. Results: The eye drops containing vitamin B12 were able to significantly counteract oxidative and inflammatory damage in corneal epithelial cells exposed to H2O2 stimulus and UVB radiation, in terms of ROS production and pro-inflammatory cytokines expression. Additionally, the eye drops containing vitamin B12 obtained significantly better outcomes in terms of wound closure at 36 h and 48 h after scratching the corneal epithelial cells, compared to the other two formulations containing trehalose. Discussion: Vitamin B12 potentially enhances the protective effect of sodium hyaluronate, accelerating the wound healing process and modulating oxidative stress and inflammation. Vitamin B12, in combination with sodium hyaluronate, could represent a promising approach to managing corneal epithelial damage. Further clinical investigations are needed to confirm this data. [ABSTRACT FROM AUTHOR]

Neutrophil extracellular traps (NETs) promote neovascularization during the acute phase after ocular chemical injury, while the local inflammatory acidic environment delays post-injury repair. Currently, the mechanism of NETs promoting neovascularization has not been fully elucidated, and there is a lack of therapeutic strategies to effectively improve the local microenvironment for corneal repair. In this study, we validated the NETs-M2-angiogenic pathway after injury. Using transcriptomics sequencing and liquid-phase microarray assays, the intrinsic immune cascade mechanism of NETs inducing macrophage M2 polarization and releasing VEGF via PI3K/AKT was identified. Based on this pathology and the physiological need to improve the local inflammatory acidic environment and promote corneal repair, we organically integrated the alkaline ion-rich bioglass with the highly transmissive and highly adhesive filipin protein, and constructed NETs ablative gel eye drops (DMS) that can release DNase I and alkaline ions in a sustained manner. The eye drops restricted the inflammatory interaction of NETs with macrophages from the source, adhered to the corneal surface and continuously released alkaline ions to improve the local acidic inflammatory environment, providing a favorable immune microenvironment for corneal recovery. We established a cell co-culture system and a corneal alkali burn model to further validate the role of DMS in modulating the intrinsic immune cascade of neovascularization for corneal repair and the related mechanisms. In conclusion, based on the biological mechanism of NETs-M2-VEGF after corneal chemical injury, the present study designed eye drops for dual regulation of intrinsic immunity and the inflammatory acid environment, which not only further supplemented and improved the pathophysiological mechanism of corneal neovascularization after chemical injury, but also provided a new way of thinking about corneal regeneration after injury. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: The intravitreal dexamethasone implant (Dex) is widely used for various ocular conditions, including diabetic macular edema (DME), retinal vein occlusion (RVO), and non-infectious uveitis. Despite its efficacy, concerns remain regarding its safety profile. This study aims to analyze the adverse events (AEs) associated with Dex reported in the FDA Adverse Event Reporting System (FAERS) database from 2010 to 2024. Methods: Data were extracted from FAERS, focusing on cases where Dex was the primary suspect drug. The dataset was processed to eliminate duplicates and incomplete entries. Disproportionality analysis, including Reporting Odds Ratio (ROR) and Proportional Reporting Ratio (PRR), was used to detect safety signals. AEs were categorized by system organ class (SOC) and preferred term (PT). Results: A total of 1,588 adverse event reports (AERs) were analyzed, revealing a significant upward trend. The Eye disorders was the most commonly reported SOC, with strong disproportionality signals (ROR: 45.11; PRR: 23.71). Key AEs identified at the PT level included Corneal decompensation, Choroidal hematoma, and Posterior capsule rupture, which were not listed on the drug label. Considering the reported numbers, the Endophthalmitis was the most common AE. Additionally, a significant proportion of AEs were observed within the first seven days post-administration, emphasizing the need for monitoring. Conclusion: While Dex remains an effective treatment option for ocular conditions, its use is associated with significant risks, particularly regarding unexpected and severe complications such as corneal decompensation. Continuous pharmacovigilance and detailed patient monitoring are essential to mitigate these risks. Future studies should focus on prospective designs and comprehensive clinical data to better understand the safety profile of Dex. [ABSTRACT FROM AUTHOR]

Introduction: Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) agents are a primary management option for retinal diseases. Acute elevation of intraocular pressure (IOP) is a complication associated with these injections that should be considered. This study investigated and compared the prophylactic effects of fixed combination anti-glaucoma medication on IOP spikes following intravitreal anti-VEGF injections. Methods: This randomized double-blind clinical trial included one eye of each participant indicated for treatment with intravitreal injection of anti-VEGF agents (bevacizumab, aflibercept, and ranibizumab) and randomly allocated to one of the three prophylactic anti-glaucoma medications, with each drug further divided into one- and two-drop regimens before intravitreal injection. Participants with allergies or contraindications to medications were excluded from the pretreatment groups and were invited to participate in the control group. Results: The study involved 308 participants: 89 in the dorzolamide/timolol group, 86 in the brimonidine/timolol group, 101 in the brinzolamide/brimonidine group, and 32 in the control group. Baseline characteristics and IOP were comparable across all groups. In the prophylactic premedication groups, mean IOP at 30 min were within 21 mmHg and returned to their baseline at 1 h. Mean IOP measurements between baseline and 30 min in the brimonidine/timolol two-drop regimen were not significantly different: 13.72 ± 4.63 vs 15.11 ± 4.39 mmHg, p = 0.096. In the control group, IOP significantly increased from baseline at 30 min and 1 h post-injection: 14.31 ± 4.10, 22.15 ± 8.64, and 18.36 ± 7.52 mmHg, respectively, p < 0.001. Conclusion: Topical fixed combination anti-glaucoma medication used as a prophylactic treatment before intravitreal anti-VEGF injections significantly prevented IOP spikes post-injection, with a comparable effect among three medications. Prophylactic treatment of IOP spikes should be considered as standard care to prevent further damage in patients with compromised retinal vascular and optic nerve perfusion. Trial Registration: TCTR20241005001, retrospectively registered. Plain Language Summary: Drug injection into the eye is a standard treatment for various eye diseases. However, an increase in eye pressure is often observed post-injection. This study focuses on the effect of prophylactic topical antiglaucoma eye drops on pressure of the eye elevation post-injection of drug into the eye. All medications in the study significantly prevented pressure of the eye spikes compared with no treatment. Prophylactic treatment of pressure of the eye spikes should be considered as standard care to prevent further damage to the eye. [ABSTRACT FROM AUTHOR]

Introduction: This work aimed to evaluate the safety and efficacy of hydroxypropyl guar-hyaluronic acid (HPG-HA) dual-polymer lubricating drops in Indian subjects with dry eye disease (DED). Methods: This prospective, open-label, single-arm, phase IV study was conducted in India. Inclusion criteria: Adults (18–65 years) with an average total ocular surface staining (TOSS) score ≥ 4, best-corrected visual acuity of ≥ 20/40 in each eye, tear break-up time (TBUT) ≤ 10 s, and dry eye questionnaire (DEQ-5) score ≥ 6. Subjects received the first dose of HPG-HA eye drops on day 1 and self-administered 1–2 drops four times daily for 90 ± 5 days. Primary endpoints: Frequency and characteristics of treatment-emergent adverse events (TEAEs) throughout the study and TOSS score at day 90. Secondary/other endpoints: Dry eye symptoms score (through dry eye questionnaire [DEQ-5]) and TBUT. Results: Of 175 subjects, 36 (20.6%) had ≥ 1 TEAE, and 27 (15.4%) of this reported ≥ 1 mild drug-related TEAE (eye irritation [n = 9], eye pruritus [n = 8], blurred vision [n = 6], increased lacrimation [n = 4], ocular hyperemia [n = 3], and ocular discomfort [n = 1]). One subject discontinued due to TEAEs, and none led to drug interruptions. No serious adverse events were reported. The mean TOSS score reduced from day 1 (6.12 ± 1.69, OU [both eyes]) to day 90 (2.40 ± 1.97, OU). The mean DEQ-5 score reduced from day 1 (11.50 ± 2.27) to day 90 (5.50 ± 2.50). TBUT increased from day 1 (right eye [OD], 5.70 ± 1.94; left eye [OS], 5.70 ± 1.96) to day 90 (OD, 9.51 ± 3.08; OS, 9.63 ± 3.01). Conclusions: HPG-HA dual-polymer eye drop was safe and effective in relieving signs and symptoms of DED over 90 days in Indian subjects. Trial Registration: Clinical Trial Registry India, CTRI/2022/03/041175. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of punctal plugs combined with cyclosporine eye drops on dry eye disease (DED) and ocular surface inflammation. Methods: In a clinical trial, 73 patients were randomly allocated into three groups: punctal plug group, combination therapy group, and cyclosporine group. At the baseline and four weeks after treatment, the Schirmer I test score, fluorescein tear film break-up time (FBUT), ocular surface staining score and dry eye symptoms were assessed. Tear samples were collected to detect the level of inflammatory factors (interleukins, matrix metalloproteinase 9 (MMP-9) and tumor necrosis factor alpha (TNF-α)). In an animal experiment, a New Zealand rabbit dry eye model was induced. The rabbits were randomly divided into control group, punctal plug group, and combination therapy group (n = 6). Conjunctival goblet cell density, protein level of MMP-9 in conjunctiva and mRNA levels of inflammatory factors in conjunctiva and cornea were measured before and after treatment. Results: In combination therapy group of the clinical trial, the following results were observed: significant improvement in Schirmer I test scores and FBUT compared to the cyclosporine group and punctal plug group, respectively; a decrease in the tear levels of IL-6, IL-1, and MMP-9 compared to the punctal plug group; and a decrease in the tear levels of IL-1α, IL-6, and IL-17 compared to the baseline (all p < 0.05). In the animal experiment, rabbits in combination therapy group had a higher goblet cell density (p < 0.01) and lower mRNA levels of IL-16 (p < 0.05), IL-17 (p < 0.05), and MMP-9 (p < 0.01) in conjunctiva and that of MMP-9 (p < 0.01) in cornea compared to punctal plug group. Conclusion: Cyclosporine eye drops combined with degradable punctal plugs is a more optimized clinical treatment strategy for DED compared with degradable punctal plugs or cyclosporine eye drops alone, considering the influence of comprehensive clinical efficacy and ocular surface inflammation. [ABSTRACT FROM AUTHOR]

To evaluate the effect of intraocular pressure (IOP) reduction on peripapillary and macular vessel density parameters from optical coherence tomography angiography (OCT-A) in normotensive eyes with optic disc drusen (ODD). Randomized controlled trial, with 6 months of follow-up, including normotensive eyes with ODD divided into two groups: control group (lubricating eye drop) and case group (latanoprost 50mcg/ml). We used OCT-A to evaluate peripapillary and macular vessel density parameters. Data were collected at baseline and at 1, 3, and 6 months following the use of eye drops. This study included a total of 32 eyes (16 cases and 16 controls) from 19 patients. After 6 months, the group using latanoprost IOP reduced IOP to 10.8 ± 0.64 versus 13.5 ± 0.54 mmHg in the control group (p < 0.001). We observed significant changes in OCT-A vessel density peripapillary parameters. The total radial peripapillary capillary (RPC) density (%) at month 6, in the eyes using latanoprost was 55.1 ± 1.05% and control was 57.9 ± 0.88%, p = 0.033. However, no changes were observed in macular vessel density parameters as well as retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness between groups after 6 months of using latanoprost. No sight-threatening events were observed during follow-up in either group. Until now there is no evidence that just lowering IOP can benefit normotensive patients with ODD. In fact, we observed a significant decrease in RPC vessel density after 6 months of IOP reduction using latanoprost, compared to the control group. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the practice patterns related to paediatric myopia among Paediatric Ophthalmologists in India, based on a 2023 survey conducted via Google Forms. Methods: The survey aimed to gather insights into physicians' perceptions and experiences concerning the clinical and treatment aspects of myopia in children. Results: The survey reveals several key insights into current practice patterns among Paediatric Ophthalmologists in India regarding paediatric myopia management. The recommended mean age for a child's first eye checkup is 3 years, underscoring the importance of early detection. Refractive error thresholds for prescribing spectacles are set at 3.0 D for infants, 2.0 D for preschool children, and 1.0 D for school-going children older than 3 years. There is a growing trend in using 0.01% Atropine eye drops for myopia management, with a mean prescription age of 4.83 years. Notably, 80.11% of respondents prioritize documenting myopia progression regardless of the child's age. Orthokeratology and Peripheral Defocus spectacle lenses are gaining recognition, and lifestyle modifications such as increasing outdoor activities and reducing near activities are widely acknowledged as effective. While most respondents do not use progressive lenses for myopia, there is significant emphasis on axial length measurements and considering the lag of accommodation. Additionally, under-correction of myopia is favored by a notable proportion of practitioners. These findings indicate a shift towards early intervention and evidence-based strategies in myopia control. Conclusions: The survey highlights a shift towards early intervention and evidence-based myopia control strategies among practitioners. There is, however, room for improvement in standardizing approaches and considering additional factors like axial length and lag of accommodation. Collaborative efforts among policymakers, health regulatory bodies, and industry stakeholders are essential to enhance the accessibility and affordability of myopia control treatments and address the growing health burden associated with paediatric myopia. [ABSTRACT FROM AUTHOR]

[Display omitted] • A HEMA hydrogel was coated with a chitosan/hyaluronic acid layer and loaded with diclofenac. • It was non-cytotoxic, non-irritant, presented antibacterial properties and low friction coefficient. • Diclofenac was sustainedly released for 24 h with concentrations > IC50 of COX-1 and COX-2. • Its physico-chemical properties were suitable to be used in contact lenses. • Overall, it seems to be a promising material for dry eye therapeutic contact lenses. When placed in the eye, contact lenses (CLs) disturb the tear fluid and affect the natural tribological behaviour of the eye. The disruption in the contact mechanics between the ocular tissues can increase frictional shear stress and ocular dryness, causing discomfort. Ultimately, continuous CLs wear can trigger inflammation which is particularly critical for people suffering from dry eye. In this work, a double strategy was followed to obtain therapeutic daily disposable CLs for dry eye: a hydroxyethyl methacrylate (HEMA) based hydrogel was coated with two natural polysaccharides, chitosan (CHI) and hyaluronic acid (HA) and posteriorly loaded with an anti-inflammatory drug (diclofenac, DCF). Material sterilisation was carried out by high hydrostatic pressure (HHP) combined with moderate temperature. The friction coefficient (μ) was determined in the presence of different tear biomolecules (cholesterol, lysozyme and albumin) using a nanotribometer. Drug release experiments were performed in static and in hydrodynamic conditions. The material was extensively characterised, regarding surface morphology/topography, optical properties, water content and swelling behaviour, wettability, ionic and oxygen permeability and mechanical properties. It was found that the coating did not impair the physico-chemical properties relevant for the material's application in CLs. Besides, it also ensured a sustained release of DCF for 24 h in tests performed in hydrodynamic conditions that simulate those found in the eye, increasing significantly the amount of drug released. It reduced friction, improving the lubrication ability of the hydrogel, and presented antibacterial properties against S. aureus , P. aeruginosa and B. Cereus. The coated samples did not reveal any signs of cytotoxicity or potential eye irritation. Overall, the coating of the hydrogel may be useful to produce daily CLs able to alleviate dry eye symptoms and the discomfort of CLs wearers. [ABSTRACT FROM AUTHOR]

The only proven method to manage glaucoma is the reduction and stabilization of intraocular pressure (IOP). A wide range of daily activities has been demonstrated to affect the IOP behavior, and eye care specialists should be aware of their effects for the prevention and treatment of glaucoma. Indeed, the impact of physical activity on IOP has gained attention in recent years, considering exercise prescription as a promising adjuvant strategy for controlling IOP in glaucoma patients. To integrate all the available information in this regard, we have conducted a clinical review based on a patient-centered approach. Previous studies have demonstrated that the IOP response to physical exercise is dependent on numerous factors such as the exercise type (e.g., endurance or resistance training), exercise intensity, subjects' fitness level, body position (e.g., supine vs. standing) and breathing pattern adopted during exercise, underlying medical conditions, concomitant mental effort, or caffeine intake before exercise. This article summarizes the available scientific evidence on the positive and negative effects of physical exercise on IOP and provides practical recommendations for exercise prescription in glaucoma patients or those at risk. An active collaboration between eye care and sports medicine specialists would permit a better management of this ocular condition. [ABSTRACT FROM AUTHOR]

An ecofriendly, effective, and selective spectrofluorimetric approach for natamycin analysis was developed using fluorescamine as a fluorogenic probe. Natamycin is the only topical ocular antifungal medication that is presently on the market for treating keratitis, conjunctivitis, and blepharitis caused by yeast and other fungi. Owing to its primary aliphatic amino group, natamycin can easily interact with fluorescamine resulting in the formation of the highly fluorescent diaryl pyrrolone derivative. The derivatization reaction was completed within very short time at room temperature in borate buffer solution (pH 7.6). The fluorescence intensity of the reaction product was monitored at 465 nm after exciting at 390 nm. The linearity range of the spectrofluorimetric method was 0.25–4.0 µg/mL of natamycin with limit of detection (LOD) of 0.082 µg/mL. The method was applied for the determination of the cited drug in pharmaceutical eye drops and artificial aqueous humor with high percentage recoveries and low relative standard deviations. In addition, the involved analytical procedure was green based on the results of the ecology scale scores. [ABSTRACT FROM AUTHOR]

Background: To report a case of intraocular inflammation (IOI) after intravitreal injection of aflibercept 8 mg for treatment-refractory neovascular age-related macular degeneration. Case presentation: An 80-year-old man with diabetes mellitus had neovascular age-related macular degeneration refractory to treatment with aflibercept 2 mg. Despite ten injections of faricimab, the exudation remained, and we switched to brolucizumab, which resulted in a mild IOI. The IOI improved with only topical steroids, and we switched back to aflibercept 2 mg for the exudation. However, the exudation remained, and we decided to switch to aflibercept 8 mg after careful discussion with the patient. Two weeks later, he experienced minor ocular pain and photophobia. One month later, although a dry macula was achieved, severe visual impairment occurred due to anterior chamber inflammation, retinal vasculitis, and retinal vascular occlusion. We diagnosed the severe IOI following aflibercept 8 mg and immediately started steroid eye drops and a sub-Tenon injection of triamcinolone acetonide. Although the inflammation resolved, his visual acuity did not improve. Conclusions: This case demonstrated a potential dose-dependent inflammatory response following aflibercept 8 mg, which did not occur with aflibercept 2 mg in patients with a history of intraocular inflammation. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effects of short-acting cycloplegic agents, tropicamide and compound tropicamide, on ocular biological parameters and choroid thickness. Methods: In this study, seventy pediatric subjects aged 6 to 13 years were randomly assigned to two groups: the tropicamide group and compound tropicamide group. Ocular biological parameters and choroidal thickness (CT) and subfoveal choroid thickness (SFCT) were measured in both groups and were retested 40 min after drug administration. The tropicamide eye drops were administered into the conjunctival sac every 5 min with 1 drop, for a total of 4 doses. Compound tropicamide was administered in the same way as tropicamide. Ocular biological parameters included refraction (spherical equivalent, SE), intraocular pressure (IOP), axial length (AL), anterior chamber depth (ACD), lens thickness (LT), central corneal thickness (CCT), and white to white (WTW). The CT is the regional inferior choroidal thickness of nine sectors centered on the macular fovea and automatically generated using an ETDRS grid. And the SFCT is the choroidal thickness at the subfoveal point of the macular region. Results: After application of tropicamide and compound tropicamide to induce the ciliary muscle paralysis, SE, AL, and LT decreased, while ACD, CCT, and WTW increased compared to baseline(all P values < 0.05). There was no significant change in IOP before and after cycloplegia (p > 0.05). The CT in the nasal quadrant before and after ciliary paralysis was significantly thinner than other areas, the CT in the temporal quadrant was significantly thicker than others, and the CT in the inner quadrant was higher than the CT in the outer quadrant. In the tropicamide group: CT was significantly increased in the remaining quadrants except the inner inferior(I) and outer superior(S) quadrants (p < 0.05), and SFCT was also significantly increased (p = 0.005). In the compound tropicamide group: there is a significant increase in CT outer superior(S) quadrant CT (p = 0.043). Increase in the mean values of CT and SFCT in the remaining quadrants was also observed, but the difference was not statistically significant (p > 0.05). Additionally, AL and SFCT were negatively correlated. Conclusions: Some ocular biological parameters were altered after application of short-acting cycloplegic agent tropicamide and compound tropicamide to paralyze the ciliary muscle. Compared with compound tropicamide, tropicamide eye drops can reduce axial length while increasing choroid thickness. [ABSTRACT FROM AUTHOR]

Background: The PreserFlo™ MicroShunt (PFMS) is a bleb-forming device considered to be less invasive than traditional glaucoma surgery such as trabeculectomy. This study evaluates the 1-year success rates as well as safety profile of PFMS in patients having high intraocular pressure (IOP) and/or glaucoma refractory to drop therapy with a history of prior intravitreal dexamethasone therapy. Methods: A total of 16 eyes after PFMS implantation due to elevated IOP after intravitreal dexamethasone implant (DEX-I) administration were included in this retrospective cohort study. Success rates and secondary outcomes were evaluated. Results: Qualified and complete success rates at 12 months, respectively, were 14/16 and 12/16 eyes for criterion A, 13/16 and 11/16 eyes for B, 13/16 and 11/16 eyes for C, and 6/16 and 6/16 eyes for D. The overall mean (range) preoperative IOP decreased from 27 (16–38) mmHg to 13 (10–17) mmHg at 12 months. BCVA was not significantly different up to 12 months (p = 0.63). The preoperative mean (range) number of medications decreased from 3.56 (2–4) to 0.31 (0–3) at 12 months. One eye underwent needling twice, and two eyes were revised surgically. One patient needed replacement of the PFMS. There were no hypotony-related complications. Conclusions: The PFMS is an effective surgical option for patients with steroid-induced IOP elevation. It demonstrates satisfactory short-term success rates, a reduced need for pressure-lowering eye drops, an excellent safety profile with minimal postoperative care, and a low complication rate. Additional interventions such as needling or revisions were infrequently necessary. However, PFMS may not be the ideal choice for cases requiring a low target pressure (≤12 mmHg). [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo examine the recurrence of cytomegalovirus (CMV) iritis in patients using low-dose ganciclovir (GCV) eye drops.We included patients with dormant CMV iritis who were treated using 2% GCV eye drops at the University of Tokyo Hospital between January and June 2023 and whose dosage of GCV eye drops was required to be reduced due to the unstable GCV supply. Patients were excluded if they had active CMV retinitis and underwent corneal transplantation. We examined the recurrence of CMV iritis after the reduction of GCV eye drops.Fifteen eyes of 14 patients (mean age, 62.4 ± 13.0 years) were included. The frequency of GCV eye drops was reduced from four times a day to twice in 13 eyes and three times in two eyes. The mean observation period after the reduction of GCV eye drops was 202.5 ± 155.8 days. Although there were no recurrences in the 6 months prior to the reduction of GCV eye drops, recurrences were observed in five eyes (33.3%) after the reduction. The mean time from GCV reduction to recurrence was 59.2 ± 11.3 days. Patients who survived the first 3 months without recurrence had no recurrence later.Recurrences of CMV iritis were observed in one-third of the eyes within 3 months after dosage reduction of 2% GCV eye drops. [ABSTRACT FROM AUTHOR]

Long-acting injectable formulations of dexamethasone with minimal invasiveness are highly desired to manage chronic ocular inflammatory conditions. Here, we applied microcrystals (MCs) of a hydrophobic acetone-based ketal-linked prodrug of dexamethasone (SKD) to treat postoperative ocular inflammation. We compared the efficacy and safety of SKD MCs through subconjunctival (SC) injection with that of Maxidex (a topical suspension of dexamethasone MCs) through SC injection and eye drops in the phacoemulsification combined with intraocular lens implantation (Phaco-IOL) rabbit model. In Phaco-IOL rabbit eyes, a single SC injection of SKD MCs (0.4 mg dexamethasone equiv.) showed anti-inflammatory effects comparable to Maxidex eye drops and completely alleviated the inflammation within 28 days, while an SC injection of Maxidex at the same dose only provided anti-inflammatory effects for 7 days. The study on the dose-dependent anti-inflammatory effects of SKD MCs showed no significant difference in anti-inflammatory effects for the high dosage (0.8 mg dexamethasone equiv.) and the low dosage (0.4 mg dexamethasone equiv.) in 28 days. Nevertheless, systematic drug distribution of SKD MCs and Maxidex in normal rabbits after SC injection demonstrates that the drug concentration in conjunctiva was higher for the high dosage and that a considerable amount of prodrug and dexamethasone could still be detected in the cornea and iris-ciliary body at least 84 days for SKD MCs at high dosage. Furthermore, no persistent elevated intraocular pressure and abnormality in retinal structure and thickness were observed, confirming the excellent safety of long-acting SKD MCs post-SC injection. Our findings provide valuable insights into using prodrug-based MCs for treating ocular postoperative inflammation, and the detailed drug distribution analysis would promote the clinical translation of these MCs in ocular diseases. [Display omitted] • SC injection of SKD MCs effectively controls ocular inflammation in Phaco-IOL rabbits. • SC injection of Maxidex only shows ocular anti-inflammatory effects for a week. • SKD MCs can sustain the in vivo release of Dex more than 84 days after SC injection. • SKD MCs are safe for ocular applications after SC injection. [ABSTRACT FROM AUTHOR]

This case report aims to document a case of bilateral endotheliitis occurring shortly after riboflavin-assisted cross-linking (CXL) in a young male patient with progressive keratoconus. The objective is to identify potential risk factors, treatment strategies, and outcomes while considering relevant literature on similar cases. A male in his late adolescence with bilateral progressive keratoconus underwent bilateral CXL using riboflavin and ultraviolet A light exposure. Postoperatively, the patient received moxifloxacin drops, prednisolone acetate drops, and artificial tears. Seven days later, the patient presented with decreased vision, photophobia, and corneal findings consistent with endotheliitis. Treatment with prednisolone acetate and moxifloxacin eye drops was initiated. Two months later, visual acuity deteriorated, but anterior slit-lamp findings improved, and the intraocular pressure measurement was high. Prednisolone acetate was tapered, whereas loteprednol etabonate gel, brimonidine eye drops, and cyclosporine eye drops were initiated. After 7 months, visual acuity improved, and endotheliitis resolved, although mild residual central haze persisted. This case highlights the occurrence of acute idiopathic endotheliitis following routine CXL and its successful management. Although limited cases have been reported, a standardized treatment protocol is lacking. In our patient, the utilization of loteprednol etabonate gel, cyclosporine eye drops, brimonidine eye drops, and regular follow-up examinations led to improved clinical findings and visual acuity. Further studies are warranted to establish optimal treatment approaches for similar cases of endotheliitis following CXL. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the clinical and pathologic findings of 7 patients with inflamed juvenile conjunctival nevus (IJCN) treated with tacrolimus. Study design: Retrospective study. Subjects and Methods: The medical records of 7 male patients diagnosed with IJCN between February 2007 and October 2022 at the Kansai Medical University Hospital and Ideta Eye Hospital were retrospectively reviewed. The patients' mean age was 11.3 (8–20) years, and the average follow-up period was 18 months. The patients underwent anterior segment optical coherence tomography (AS-OCT) and anterior segment optical coherence tomography angiography (AS-OCTA). All the patients were treated with steroids or immunosuppressant eye drops, or both. Histopathologic examinations were performed on specimens resected from 2 patients. Results: The clinical characteristics of IJCN were as follows: (1) presence of cysts within a pigmented conjunctival mass, (2) tumor accompanied by feeder vessels, and (3) predominantly found in boys with allergic diseases. AS-OCT and AS-OCTA revealed the presence of a cystic structure with poor vascular signals within it and numerous vessels distributed on the sclera underlying the lesion. Immunosuppressant eye drops relieved the congestion, diminished the inflow vessels, and induced shrinkage of the cysts in all the patients. Histopathologic examinations revealed infiltration of inflammatory cells such as lymphocytes and macrophages and low proliferative activity of melanocytes with no division pattern. Conclusions: This study clarified the clinical and histologic characteristics of IJCN. Noninvasive AS-OCT and AS-OCTA might be useful for diagnosing IJCN. The histopathologic findings of this study indicate that immunosuppressive and antiallergic agents can effectively bring about disease remission. [ABSTRACT FROM AUTHOR]

Background/Objectives: This study aimed to evaluate the therapeutic effects of combined 5% lifitegrast (LF) and tocopherol (TCP) eye drops in a murine experimental dry eye (EDE) model. Methods: Female C57BL/6 were divided into seven groups: untreated controls, EDE control, EDE + 0.05% cyclosporin A (CsA), EDE + tocopherol (TCP), EDE + 5% LF, EDE + 5% LF + TCP (once daily), and EDE + 5% LF + TCP (twice daily). Clinical parameters (tear volume, tear break-up time (TBUT), corneal fluorescein staining score (CFSS), tear film lipid layer grade (TFLLG)) were assessed on days 7 and 14. Goblet cell density in the conjunctiva, CD4+ IFN-γ+ T cells, interleukin levels, reactive oxygen species (ROS) levels, and corneal apoptotic cells were analyzed on day 14. Results: Monotherapy with 0.05% CsA and LF showed improvements in all clinical parameters compared to the EDE control (p < 0.05). Combination therapy groups demonstrated superior improvements in clinical parameters compared to the EDE control, 0.05% CsA, and 5% LF groups. CD4+ IFN-γ+ T cell percentages and ROS levels in the cornea and conjunctiva were markedly reduced in the combination groups compared with the 0.05% CsA and 5% LF groups (p < 0.01). Furthermore, corneal apoptotic cells significantly decreased in the combination groups compared to the 0.05% CsA and TCP groups (p < 0.05). Conclusions: Combined 5% LF and TCP eye drops improved tear film parameters and reduced inflammatory and oxidative stress markers. The combination therapy can mitigate ocular surface damage by managing inflammation and oxidative stress in dry eye. [ABSTRACT FROM AUTHOR]

To evaluate the safety and efficacy of 0.75% phentolamine ophthalmic solution (POS), an α-adrenergic antagonist, in reversal of pharmacologically induced mydriasis. Two phase 3, multicenter, placebo-controlled, randomized, double-masked clinical trials in healthy participants. Five hundred fifty-three healthy 12- to 80-year-old participants were randomized 1:1 (MIRA 2) and 2:1 (MIRA 3) to receive either POS or placebo eye drops in both eyes. Participants received POS or placebo administered 1 hour after mydriasis, induced by instillation of either 2.5% phenylephrine, 1% tropicamide, or 1% hydroxyamphetamine / 0.25% tropicamide. Percent of participants returning to within 0.2 mm of baseline pupil diameter in study eye 90 minutes after POS administration. Safety measures included treatment-emergent adverse events and tolerability measures, including conjunctival hyperemia. A total of 553 participants were randomized to treatment with placebo (n = 215) or POS (n = 338). A statistically significant greater percentage of participants treated with POS showed reversal of mydriasis at 90 minutes compared to placebo (MIRA 2: 48.9% vs. 6.6% [ P < 0.0001]; MIRA 3: 58% vs. 6% [ P < 0.0001]) and as early as 60 minutes (MIRA 2: 27.7% vs. 2.2% [ P < 0.0001]; MIRA 3: 42% vs. 2% [ P < 0.0001]). Between 28% and 34% of participants receiving placebo did not returned to baseline PD at 24 hours after pharmacologic dilation compared with 8% to 11% of patients treated with POS (P < 0.0001). Treatment with POS reduced PD within 60 to 90 minutes, with a statistically significant time savings of 5 to 6 hours to return to baseline PD compared with placebo. One or 2 drops of POS rapidly reversed mydriasis in all participants regardless of mydriatic agent or iris color. More participants receiving POS reported a benefit in the resolution of visual symptoms caused by pharmacologically induced mydriasis compared with placebo, with statistically significant differences noted as early as 1 hour. The safety profile was favorable, with the most common adverse effects being mild transient conjunctival hyperemia (11.2%), instillation site discomfort (10.9%), and dysgeusia (3.6%). Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess in-vitro efficacy of a suffusion of autologous serum withcyclosporine 0.05% (CsA) and sodium hyaluronate 0.1% (SH). Methods: The expression of proinflammatory markers interleukin 6 (IL-6) and TNF-Alpha (TNF-α) in limbal epithelial cells was evaluated. Also, assessment of the stability of epithelial growth factor and transforming growth factor-beta (EGF, TGF-β) in the 50% combinations with autologous serum (AS) was done. The characteristics (pH, density, osmolality) of the two combinations were also evaluated. Additionally, cytotoxicity effect of given test compounds was evaluated on human limbal epithelial cells (LEpiC). Results: The percentage of cells expressing IL-6 subjected to AS + SH and AS + CsA were 6.23% and 5.69% respectively. There was no significant difference in percentage of cells expressing TNF-α between the formulations (5.87%, 5.83% respectively). The growth factors; EGF and TGF-β remained stable forone month duration (on 2 and 4 weeks) at 4 °C without significant difference between the time intervals tested. The results of MTT assay suggested that limbal epithelial cells treated with AS + CsA and AS + SH combinations showed minimal toxicity however it was not significant statistically (p ≤ 0.05). Conclusion: Two test combinations (AS + CsA, AS + SH) showed stable growth factors (EGF, TGF-β) and good anti-inflammatory property against pro-inflammatory markers. Also, the 2 combinations were found safe on cultured limbal epithelial cells. The novel combination of autologous serum in CsA may provide added benefit in dry eye disease (DED) through their combined anti-inflammatory and epitheliotropic effects. [ABSTRACT FROM AUTHOR]

Purpose: Corneal neurotization (CN) is a novel, potentially curative surgical procedure for the treatment of neurothophic keratopathy (NK). Patients with severe NK can present with corneal opacification requiring optical keratoplasty, which would likely fail without a proper trophic support of corneal nerves in the recipient cornea. Methods: This is a pilot study on 4 patients undergoing keratoplasty after CN. Pre- and postoperative data at 12, 24 months and at the last follow-up were collected for the examination of (i) best corrected visual acuity (BCVA), (ii) slit lamp examination and photograph acquisition with and without fluorescein staining, (iii) corneal aesthesiometry, (iv) in vivo confocal microscopy of the central cornea. Neurophysiological study of the corneal reflex before corneal graft and at last follow up was performed. Results: Four female patients (47.25 ± 5.06 y.o.) underwent keratoplasty after CN (3 penetrating keratoplasty, 1 deep anterior lamellar keratoplasty). The mean interval between CN and keratoplasty was 22 (± 12) months. The mean graft survival time was 42 (± 25) months. Graft follow-up ranged from 72 to 132 months. At the final follow-up, BCVA was improved in 2 out of 4 patients. The mean corneal sensitivity was 11.9 ± 8.3 mm at last follow-up. In vivo confocal microscopy confirmed the presence of functioning nerves at the last follow-up in all patients. NK-related complications occurred in 3 eyes (2 persistent epithelial defect, 1 corneal melting). The former complication was successfully treated by autologous serum eye drops while the latter required repeated keratoplasty. Conclusions: Keratoplasty is a viable strategy to improve visual acuity in patients with corneal opacity who underwent CN for the treatment of NK. Even in the presence of functioning corneal nerves before keratoplasty, surgeons should be aware of the increased rate of NK-related complications that could require the need for repeated procedure. [ABSTRACT FROM AUTHOR]

A platform was developed to accurately detect the content of ofloxacin (OFX) based on molecularly imprinted polypyrrole-MWCNTs-OH/1,3,5-Tris(4-aminophenyl) benzene (TAPB)-2,5-dimethoxybenzene-1,4-dicarboxaldehyde (DMTP)-covalent organic framework (MIP-MWCNTs-OH/COF)–modified glassy carbon electrode (GCE) sensor (MIP-MWCNTs-OH/COF/GCE). The complex of MWCNTs-OH and COF synergistically enhanced the active area and electrochemical signal, based on which a molecularly imprinted membrane was polymerized on its surface to further improve the selectivity. Under optimized conditions, the prepared MIP-MWCNTs-OH/COF/GCE sensor exhibited strong detection performance to OFX in a linear range 1.969 × 10−11–9.619 × 10−9 M with the limit of detection (LOD, 3S/N) of 4.989 × 10−12 M, excellent selectivity, stability, and reproducibility. Furthermore, the MIP-MWCNTs-OH/COF/GCE sensor can be successfully applied to the detection of OFX in lake water and eye drops with a relative standard deviation (RSD) of less than 4.95%, indicating its high potential in practical applications. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy, safety, and tolerability of lifitegrast 5% versus carboxymethylcellulose (CMC) 0.5% in adult patients with dry eye disease (DED). Methods: A total of 370 eligible patients with DED were randomized equally to receive twice-daily doses of a single drop in each eye of either lifitegrast 5% or CMC 0.5% for 12 weeks. Follow-up at weeks 2, 6, and 12 evaluated changes from baseline in primary [eye dryness score (EDS), ocular discomfort score (ODS), ocular surface disease index (OSDI), and tear film break-up time (TFBUT)] and secondary [Schirmer tear test (STT) score and corneal fluorescein staining (CFS) score] endpoints. Global improvement, safety, and tolerability were also assessed. Results: At week 2, values of ocular discomfort score, OSDI, and conjunctival redness were significantly more favorable in patients treated with lifitegrast compared to CMC. At week 6, values of all study variables were better in patients treated with lifitegrast compared to CMC; differences between the groups were statistically significant for all except photophobia. This trend was also maintained at week 12. Global improvement and tolerability were found to be better with lifitegrast than with CMC. No serious safety concerns were reported in any treatment group. Conclusion: To our knowledge, this is the first active-controlled trial informing on the efficacy, safety, and tolerability of lifitegrast 5%. Significantly more favorable values for EDS (except photophobia), ODS, OSDI, TFBUT, STT score, CFS score, and conjunctival redness score were achieved at week 12 with lifitegrast 5% compared to CMC 0.5%. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and “slow cook” transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and “slow cook” transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the slow cook” and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the slow cook” transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and slow cook” transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively. [ABSTRACT FROM AUTHOR]

Background and Objectives: The rising prevalence of myopia is a significant global health concern. Atropine eye drops are commonly used to slow myopia progression in children, but their long-term use raises concern about intraocular pressure (IOP). This study uses SHapley Additive exPlanations (SHAP) to improve the interpretability of machine learning (ML) model predicting end IOP, offering clinicians explainable insights for personalized patient management. Materials and Methods: This retrospective study analyzed data from 1191 individual eyes of 639 boys and 552 girls with myopia treated with atropine. The average age of the whole group was 10.6 ± 2.5 years old. The refractive error of spherical equivalent (SE) in myopia degree was base SE at 2.63D and end SE at 3.12D. Data were collected from clinical records, including demographic information, IOP measurements, and atropine treatment details. The patients were divided into two subgroups based on a baseline IOP of 14 mmHg. ML models, including Lasso, CART, XGB, and RF, were developed to predict the end IOP value. Then, the best-performing model was further interpreted using SHAP values. The SHAP module created a personalized and dynamic graphic to illustrate how various factors (e.g., age, sex, cumulative duration, and dosage of atropine treatment) affect the end IOP. Results: RF showed the best performance, with superior error metrics in both subgroups. The interpretation of RF with SHAP revealed that age and the recruitment duration of atropine consistently influenced IOP across subgroups, while other variables had varying effects. SHAP values also offer insights, helping clinicians understand how different factors contribute to predicted IOP value in individual children. Conclusions: SHAP provides an alternative approach to understand the factors affecting IOP in children with myopia treated with atropine. Its enhanced interpretability helps clinicians make informed decisions, improving the safety and efficacy of myopia management. This study demonstrates the potential of combining SHAP with ML models for personalized care in ophthalmology. [ABSTRACT FROM AUTHOR]

Background/objectives: The aim of the study was to create a nanofiber insert incorporating Timolol (TIM) and Dorzolamide (DOR), targeting the management of glaucoma. This condition encompasses a variety of chronic, advancing ocular disorders typically associated with elevated intraocular pressure (IOP). Methods: The insert was made of Eudragite RL100 (EUD) polymer, a biocompatible material with high bioavailability, using the electrospinning method. The inserts were studied for morphology, drug–polymer interaction, physicochemical properties, and in vitro drug-release study. The pharmacokinetic properties of fibers were examined alongside consideration for irritation using a rabbit model and cell compatibility. Results: The results of the in vitro drug-release test showed retention and controlled release of both DOR/TIM over 80 h. Morphological examination demonstrated uniform nanofibers with mean diameters < 465 nm. The cell compatibility test showed a high percentage of cell survival, and none of the formulations irritated the rabbit's eye. The Area Under the Curve (AUC0-72) for DOR and TIM in EDT formulations was approximately 3216.63 ± 63.25 µg·h/mL and 2598.89 ± 46.65 µg·h/mL, respectively, with Mean Residence Times (MRTs) of approximately 21.6 ± 0.19 h and 16.29 ± 6.44 h. Conclusions: Based on the results, the dual drug-loaded nanofiber preservative-free system can potentially be a suitable alternative to eye drops and can be used to reduce fluctuation and dose frequency. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions To investigate 2‐year changes in macular choroidal thickness (ChT) in children receiving 0.01% atropine eyedrops and its relationship with spherical equivalent refraction (SER) progression and axial length (AL) elongation.A total of 250 myopic children aged 6–16 years (167%–0.01% atropine, 83‐placebo) were enrolled in the MOSAIC (ISRCTN36732601) clinical trial. Participants with complete 2‐year ChT (Topcon Triton Swept‐Source OCT), SER, and AL data were included in this study. Changes in macular ChT at 2 years and associations with changes in SER and AL elongation were analysed using linear mixed models.A total of 187 children (126%–0.01% atropine, 61‐placebo) were included in the analysis. Choroidal thickness over 2 years was stable in the 0.01% atropine compared with placebo group, which exhibited consistent thinning in subfoveal (mean ± SE: 0.49 ± 2.22 μm vs. −9.46 ± 2.69 μm; p = 0.034), parafoveal (1.40 ± 1.73 μm vs. −8.11 ± 2.08 μm; p = 0.002), and perifoveal (0.80 ± 1.25 vs. −6.17 ± 1.69; p = 0.002) macular subfields. Choroidal thickening was observed in participants with slower axial eye growth and myopia progression, regardless of their treatment group. Mediation analysis indicated that atropine 0.01% had a significant effect on ChT, with 68.3% of the effect being direct and 31.7% mediated through axial length changes. For SER, the direct effect on ChT was 80%, with the remaining 20% mediated by SER changes.Myopic participants treated with 0.01% atropine exhibited stable ChT over 2 years, whereas the placebo group showed consistent thinning. The effect of atropine 0.01% on ChT was only partially explained by axial length and SER changes, indicating a direct effect of atropine treatment on the choroid. [ABSTRACT FROM AUTHOR]

Background: Intravitreal injections, a relatively recent treatment in ophthalmology, is being adopted rapidly worldwide and becoming one of the most common therapies in the field. Numerous complications are associated with this treatment, ranging from minor inflammatory ailments to endophthalmitis. We analyzed the conjunctival flora of patients treated with intravitreal injections and topical antibiotics. Methods: The study was a longitudinal prospective analysis of cultures and antibiograms collected from patients who underwent intravitreal injections and topical antibiotics afterwards at the retina clinic in ABC's Medical University. Results: A total of 148 swabs obtained from 98 patients were cultured and underwent antibiotic sensitivity testing. All bacteria were sensitive to vancomycin, and with the exception of Escherichia coli samples, they were also sensitive to a third-generation cephalosporin (ceftriaxone—same class and generation as ceftazidime), both of which are important antibiotics for the treatment of endophthalmitis. The bacteria species were specifically coagulase-negative Staphylococcus sp. 92% of which was penicillin-resistant and 56.9% was resistant to ciprofloxacin, a second-generation fluoroquinolone. The culture results were similar to that described in the literature and showed the same higher prevalence of coagulase-negative Staphylococcus sp. and S. epidermidis. Regarding the antibiotic resistance profiles, vancomycin, a third-generation cephalosporin, and penicillin showed almost identical results to those reported previously. Regarding fluoroquinolones, the incidence of resistant coagulase-negative Staphylococcus sp. was lower than the findings worldwide, but the resistance rates found were: S. aureus (26.7%), S. epidermidis (61.3%), and Staphylococcus sp. (coagulase negative, 56.9%). Conclusions: The current results showed that the typical conjunctival bacteria had higher resistance to fluoroquinolones (although they were not tested specifically to ofloxacin), suggesting a possible selection of resistant bacteria that should not be taken for granted in clinic. However, the same bacteria did not exhibit cross-resistance in the analysis of vancomycin and third-generation cephalosporins. This real-world, longitudinal, prospective study on conjunctival flora analyzed bacterial resistance profiles and contemporary antibiotic use, offering deeper insights into this subject. [ABSTRACT FROM AUTHOR]

Introducion and purpose Millions of people use contact lenses every day. Their primary and most common use is correcting refractive errors. Despite their beneficial purpose, contact lens use has many complications. It is estimated that 5 to 50% of patients may develop at least a single complication. The state of knowledge Contact lens-related complications are multifactorial. One of the main reasons for contact lens discontinuation is contact lens discomfort. Patients most often report dryness, burning, and irritated eyes. Other disorders can be briefly divided into conjunctival and corneal complications. The most common conjunctival and allergic complication of contact lens use is giant papillary conjunctivitis. Other significant conditions involving the conjunctiva can also be superior limbic keratoconjunctivitis or allergic or toxic conjunctivitis. Corneal complications, on the other hand, seemed to be much more severe. These include superficial punctate keratitis, peripheral corneal ulceration, and contact lens-related keratitis. Also, abrasion can occur due to improper eye hygiene or mechanical damage during lens replacement. It should also be remembered that prolonged use of lenses can lead to hypoxia and corneal edema. Summary This paper briefly outlines the possible complications of contact lens use. It is important to remember that despite their appropriate use, sometimes significant complications can occur. Noteworthy, corneal, or conjunctival complications require discontinuation of the lenses and appropriate treatment. [ABSTRACT FROM AUTHOR]

Dorzolamide hydrochloride (DRZ) is a carbonic anhydrase inhibitor utilized in managing elevated intraocular pressure (IOP) associated with glaucoma. However, its clinical effectiveness is hindered by a short half-life, low residence time, and the need for frequent dosing, highlighting the necessity for innovative delivery systems. This work reviews recent advancements in DRZ delivery, particularly focusing on cyclodextrin complexation and nanotechnology applications. It explores the potential of cyclodextrin derivatives to enhance DRZ's bioavailability. DRZ cyclodextrin complexes or nanoparticulate systems maintain high drug concentrations in the eye while minimizing irritation and viscosity-related issues. Nanotechnology introduces nanoparticle-based carriers such as polymeric nanoparticles, solid lipid nanoparticles, liposomes, niosomes, and nanoemulsions. These formulations enable sustained drug release, improved corneal permeation, and enhanced patient compliance. Clinical trials have shown that DRZ nanoparticle eye drops and nanoliposome formulations offer efficacy comparable to conventional therapies, with the potential for better tolerability. Overall, this review highlights significant progress in DRZ delivery systems, suggesting their potential to transform glaucoma treatment by addressing current limitations and improving therapeutic outcomes. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical efficacy of modified limbal stem cell transplantation(Modified LSC transplantation) and bandage contact lens(BCL) implantation in pterygium surgery. Methods: A total of 479 patients with primary pterygium who were admitted to our hospital from March 2019 to March 2023 were randomly divided into three groups: the normal group (Group A: 89 patients), the control group (Group B: 195 patients), and the modified group (Group C: 195 patients). Each group received different intervention measures. Group A did not undergo surgical treatment and were required to follow up as outpatients. Group B received LSC transplantation combined with interrupted suturing plus BCL, whereas Group C received modified LSC transplantation combined with BCL. The degree of corneal irritation symptoms, wound healing and graft status under slit lamp, incidence and recurrence rate of complications, tear film rupture time, tear secretion test, intraocular pressure, ocular surface inflammation response(IL-1β, PGE2, TNF-α, VEGF), and visual quality were compared and analyzed at various time points after surgery. Results: Compared with those in the Group B, patients in the Group C experienced faster normalization of corneal epithelium recovery, fewer corneal irritation symptoms, and better wound healing. The break-up time (BUT) of the tear film at 1 week to 1 year postoperatively was significantly greater in the Group C than Group B, with values approaching those of Group A by 3 months (P < 0.05). The Schirmer test results revealed a similar trend to that of the BUT. Further analysis of intraocular pressure (IOP) at different time points revealed no significant differences among the three groups at postoperative Day 1. However, due to the use of corticosteroid eye drops postoperatively, IOP was greater in both the Group B(17.24 ± 2.12 mmHg) and Group C (17.02 ± 2.37 mmHg) than Group A (13.92 ± 1.57 mmHg) at 1 week. By 1 month, Group C had a lower IOP (15.77 ± 1.63 mmHg) than Group B(17.78 ± 2.41 mmHg). There were no significant differences in IOP among the three groups from 3 months to 1 year (P > 0.05). The ELISA results indicated that the expression levels of the ocular surface inflammatory factors IL-1β, TNF-α, PEG2, and VEGF in the Group C were lower than those in Group B from 1 week to 1 year post surgery. Under both natural light and low-light conditions (spatial frequency/6 cd), Group C had better best-corrected visual acuity and contrast sensitivity than Group B at 1 week to 1 year postoperatively. Additionally, Group C had lower corneal higher-order aberrations (including astigmatism, spherical aberrations, and total higher-order aberrations) and superior vision-related quality of life scores at 1 year postoperatively than Group B, with statistically significant differences (P < 0.05). Conclusion: Modified LSC transplantation combined with BCL implantation provided superior treatment outcomes for patients with pterygium, which was worthy of further clinical promotion. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and treatment options for amblyopia, a common visual disorder in children. Standard treatments include wearing corrective glasses and patching the better-seeing eye, but these methods have limitations. Researchers have explored alternative treatments like extended optical treatment (EOT) to improve vision before patching. A recent clinical trial, the EuPatch study, found that starting patching earlier led to better outcomes, indicating the importance of personalized treatment strategies based on a child's age, type of amblyopia, and social background. [Extracted from the article]

Introduction: Our aim in this work was to investigate the macular choroidal thickness (ChT) changes in 6–12-year-old Danish children with myopia during 2 years of low-dose atropine treatment and 1-year wash-out vs. placebo in an investigator-initiated, placebo-controlled, double-blind randomized clinical trial. Methods: Ninety-seven participants were randomized to either 0.01% for 2 years, 0.1% loading dose for 6 months followed by 0.01% for 18 months, or placebo, then a 1-year wash-out. The primary outcome was ChT in the sub-foveal and inner and outer superior, nasal, inferior, and temporal sectors. The secondary outcome was axial length (AL). Outcomes were measured at baseline and 6, 12, 24, and 36 months. One-way analysis of variance was used to detect baseline ChT differences between AL-stratified groups (< 24 mm, 24–25 mm, or > 25 mm). To determine the longitudinal changes in ChT and its effect on AL, all eyes were included in linear mixed modeling with individual eyes nested in the study ID as a random effect. Results: Longer eyes had significantly thinner ChT in all choroidal sectors (adj-P < 0.01) at baseline. There was no statistically significant change in any ChT sector after 3 years in the placebo group. Sub-foveal and nasal ChT in the 0.1% loading dose and 0.01% group were not significantly different from placebo after 2-year treatment. In the placebo group, a 1-mm increase in AL was significantly associated with a 47-µm thinner nasal ChT after 3 years (95% confidence interval (CI): – 55; – 38, adj-P < 0.001). A 10-µm thicker nasal choroid at baseline was associated with 0.13 mm (95% CI: 0.009; 0.017, adj-P < 0.001) less 3-year axial elongation. Conclusions: The ChT in Danish children with myopia remained stable over the 3-year follow-up. A thinner choroid at myopia onset might predispose to increased axial elongation. Treatment with 0.01% atropine did not change the ChT. We speculate that low-dose atropine does not primarily reduce myopia progression via a choroidal mechanism. Trial Registration: ClinicalTrials.gov identifier, NCT03911271. [ABSTRACT FROM AUTHOR]

Introduction: Dry eye disease (DED) is a frequently observed condition characterized by ocular discomfort and visual disturbance. It is highly prevalent and impairs patients' quality of life (QoL). This study assessed the benefit of a preservative-free bioprotectant eye drop formulation containing sodium hyaluronate and trehalose (SH-trehalose) with regards to DED, as well as patient satisfaction, through a large-scale real-life survey. Methods: In a multi-center, international, prospective observational study, subjects with DED received SH-trehalose for 84 days. Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire-5 items (DEQ-5), and patient satisfaction were assessed at baseline, day 28, and day 84, and clinical evaluations included ocular surface staining, Schirmer test, tear film break-up time (TBUT), and conjunctival hyperemia at baseline and day 84. Results: A total of 312 patients were evaluated, of whom 82.4% were women. The mean age was 57.9 ± 15.2 years. The mean OSDI score at baseline was 41.7 ± 20.6. After 84 days, the mean OSDI score was 27.3 ± 19.8 (p < 0.001). The percentage of patients with a severe OSDI score decreased from 60.3 to 34.5%. The DEQ-5 score significantly (p < 0.001) improved after 28 and 84 days, as did patient satisfaction. Ocular surface staining, Schirmer test, TBUT, and conjunctival hyperemia scores improved significantly (all p < 0.001) for both eyes with SH-trehalose between baseline and day 84. Tolerance of SH-trehalose was good. Conclusions: SH-trehalose significantly improved the clinical signs and symptoms of DED after 84 days. Moreover, it significantly increased patient satisfaction and was well tolerated. Trial Registration: NCT04803240. [ABSTRACT FROM AUTHOR]

The application of ketoconazole (KET) in ocular drug delivery is restricted by its poor aqueous solubility though its broad-spectrum antifungal activity. The aim of this study is to develop an ion-sensitive in situ gel (ISG) of KET to promote its ocular bioavailability in topical application. The solubility of KET in water was increased by complexation with hydroxypropyl-β-cyclodextrin (HPβCD), then KET-HPβCD inclusion complex (KET-IC) was fabricated into an ion-sensitive ISG triggered by sodium alginate (SA). The in vitro drug release and antifungal activities investigations demonstrated that the KET-IC-ISG formulation increased drug release and anti-fungal activities compared to pure KET. The ex vivo rabbit corneal permeation studied demonstrated higher permeability of KET-IC-ISG formulation (Papp of (6.34 ± 0.21) × 10−4 cm/h) than pure KET (Papp of (3.09 ± 0.09) × 10−4 cm/h). The cytotoxicity assay and the ocular irritation study in rabbits confirmed the KET-IC-ISG safety and well tolerance. The ocular pharmacokinetics of KET in rabbits was investigated and the results showed that the KET-IC-ISG increased its bioavailability in cornea by 47-fold. In conclusion, the KET-IC-ISG system promoted the precorneal retention, the ocular drug bioavailability and the developed formulation is a potential strategy to treat mycotic keratitis. [ABSTRACT FROM AUTHOR]

Introduction: Diode laser cyclophotocoagulation constitutes a treatment alternative to increase the quality of life in patients with blind and painful eyes with absolute glaucoma. Materials and Methods: A retrospective comparative study was carried out in patients with absolute glaucoma of any etiology with the aim of comparing the effectiveness and safety of MicroPulse transscleral laser therapy (MP-TLT) versus continuous wave transscleral cyclophotocoagulation in eyes of patients with absolute glaucoma. A total of 104 eyes were studied and two groups were formed: 52 treated with CW and 52 eyes treated with MP. Baseline characteristics (number, proportions, mean, and standard deviation) were summarized and compared between the two groups using the Chi-square test. Results: Mean pain was 4.5 out of 10 for the group treated with CW and 5.75 for the group treated with MP. In the CW group, the success rate was 75.0% (P = 0.001); for MP, it was 70.8% (P = 0.002). A decrease in the number of topical antiglaucomatous drugs used was found for the CW group, from a mean of 2.9 eye drops ± 1 at the beginning of the study to 1.9 ± 1.2 at two years of investigation and MP from 3.1 ± 0.5 to 2.1 ± 0.5) and with acetazolamide (P = 0.001 and 0.002), respectively. Significant complications were in the CW group (hypotony in 3, 5.7% eyes, bulbar phthisis in 1, 1.9% eye, and corneal perforation 2, 3.8% eyes; P = 0.03). Conclusions: Both techniques reduced the painful component, being more stable over time with the use of continuous wave transscleral cyclophotocoagulation (CW-TSCP), which showed greater long-term intraocular pressure control, and a higher success rate, but with a significantly lower safety profile due to the number of complications presented. The number of topical antiglaucomatous drugs and acetazolamide was decreased with both procedures. [ABSTRACT FROM AUTHOR]

Purpose: To report the design of FLuorometholone as Adjunctive MEdical therapy for TT surgery (FLAME) trial. Design: Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eye drops twice daily or placebo twice daily for 4 weeks in eyes undergoing trachomatous trichiasis (TT) surgery for assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.1% in preventing recurrent postoperative trichiasis (PTT). Methods: Up to 2500 eligible persons with trachomatous trichiasis undergoing lid rotation surgery were enrolled in the Jimma zone, Ethiopia. Participants, surgeons, study field staff, and study supervisors leading operational aspects of the trial are masked to treatment assignment. Randomization is stratified by the surgeon and is simultaneously stratified by the district. Study visits (in addition to programmatic follow-ups) are at the baseline/enrollment, at four-week post-enrollment, and after 6 months and 1 year. The primary outcome is cumulative one-year PTT incidence, defined as: ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Secondary postoperative outcomes include the number of trichiatic lashes, location (touching the cornea or not), evidence of post-operative epilation, entropion, changes in corneal opacity, IOP elevation, need for cataract surgery, visual acuity change from the baseline, eyelid contour abnormality, granuloma, eyelid closure defect, and the occurrence of adverse events. Health economic analyses center on calculating the incremental cost per case of PTT avoided by fluorometholone treatment. Conclusion: The FLAME Trial is designed to provide evidence of the efficacy, safety, and cost-effectiveness of adjunctive topical peri-/postoperative fluorometholone 0.1% therapy with trichiasis surgery, which is hypothesized to reduce the risk of recurrent trichiasis while being acceptably safe. Clinical Trial Registration: . [ABSTRACT FROM AUTHOR]

Purpose: While substantial research has focused on systemic immunomodulatory therapy for ocular cicatricial pemphigoid (OCP), limited data exist on managing associated ocular surface disease (OSD). This study evaluates treatments for OCP-related OSD at our institution. Methods: We conducted a retrospective analysis of patients diagnosed with cicatrizing conjunctivitis at the University of Colorado Hospital from January 1, 2013, to October 31, 2023. Patients with cicatrizing conjunctivitis due to non-OCP conditions were excluded, and disease severity was classified using the Foster Staging System. Results: Our review included 30 patients with OCP, all with at least six months of follow-up. The mean age of symptom onset (n = 19) was 62.2 years (SD = 16.4), while the mean age at diagnosis (n = 28) was 65.1 years (SD = 12.7). The most common OSD treatments at the last visit were preservative-free artificial tears (87%), topical corticosteroids (43%), autologous serum eye drops (40%), topical antibiotics (30%), and topical immunomodulators (23%). All patients used at least one treatment, with 83.3% on prescription therapies. Patients averaged 3.33 (SD: 1.4) treatments, with 1.7 (SD: 1.2) being prescriptions. Topical immunomodulators had the highest discontinuation rate at 73.1% (n = 19/26). Autologous serum eye drops and topical corticosteroids were the least discontinued treatments. Number of total treatments, prescriptions, and procedures sharply increased at stage three OCP. Conclusions: The number of treatments and procedures increased with OCP severity, indicating that advanced OCP often necessitated more intensive OSD management. [ABSTRACT FROM AUTHOR]

Purpose: To report a rare case of fungal keratitis caused by Cryptococcus neoformans, highlighting its unique morphological features using in vivo confocal microscopy (IVCM). Methods: This was a retrospective case report. A 66-year-old man presented with foreign body sensation and blurred vision in his left eye for over 10 months. Results: His best-corrected visual acuity was 20/20. Slit-lamp examination revealed a gray-white lesion approximately 4–5 mm in the superficial layer of the central cornea without epithelial defects. The IVCM images revealed numerous round or round-like pathogens, each with a central highly reflective body surrounded by a dark ring, ranging in size from 5 to 30 µm, and to a maximum of 85 µm, observed in the corneal epithelium and superficial stroma. No obvious inflammatory cell infiltration was observed in the lesions or endothelium. C. neoformans infection was confirmed. The round pathogens completely disappeared after 8 weeks of treatment with topical amphotericin B and voriconazole eye drops. Conclusion: Fungal keratitis caused by C. neoformans is rare and easily overlooked due to atypical clinical signs and symptoms. This case reports the unique morphological features of C. neoformans in the cornea using IVCM for the first time, facilitating rapid, noninvasive auxiliary diagnosis of C. neoformans keratitis and treatment follow-up. [ABSTRACT FROM AUTHOR]

Purpose: To report an atypical presentation of severe toxicity, anterior chamber (AC) inflammation, and transient parafoveal formation of subretinal fluid induced by the subconjunctival injection of 5-fluorouracil (5-FU). Methods: Case presentation. Results: Seven weeks after trabeculectomy, a 40-year-old white male had a subconjunctival injection of 5-FU. Within minutes after the injection, the lens turned grey and then total white. Initially, AC was clear, and 20 min later, a severe AC reaction was detected. The patient was prescribed hourly dexamethasone eye drops and tropicamide eye drops twice daily. Two days post-injection, vision improved, AC reaction was minimal, and there was whitish fibrinous material on the anterior surface of the lens, extending up to the pupillary margin. Minimal posterior synechiae were observed, and upon dilation, the remainder of the anterior surface of the lens appeared completely clear, indicating that only the portion of the lens not covered by the iris exhibited fibrinous material and deposits. One week post-injection, vision worsened due to severe corneal toxicity. The dimensions of the whitish fibrinous material on the anterior lens capsule decreased, and macular scans revealed parafoveal subretinal fluid. Two weeks later, vision significantly improved, and the dimensions of the whitish fibrinous material on the anterior lens capsule were further decreased. The subretinal fluid had completely resolved. Conclusion: We describe a rare case of severe toxicity, AC inflammation, and transient parafoveal subretinal fluid formation caused by the 5-FU. This was treated with topical steroid treatment, and eventually some level of lens opacification persisted despite significant clearance of the AC inflammation. [ABSTRACT FROM AUTHOR]

Background: Internal ocular diseases, such as macular edema, uveitis, and diabetic macular edema require precise delivery of therapeutic agents to specific regions within the eye. However, the eye's complex anatomical structure and physiological barriers present significant challenges to drug penetration and distribution. Traditional eye drops suffer from low bioavailability primarily due to rapid clearance mechanisms. Methods: The novel ocular drug delivery system developed in this study utilizes poly(lactic-co-glycolic acid) (PLGA) nanoparticles modified with cell-penetrating peptides (CPPs). In vitro drug release studies were conducted to evaluate the sustained-release properties of the nanoparticles. Ex vivo experiments using MDCK cells assessed corneal permeability and uptake efficiency. Additionally, in vivo studies were performed in rabbit eyes to determine the nanoparticles' resistance to elimination by tears and their retention time in the aqueous humor. Results: In vitro drug release studies demonstrated superior sustained-release properties of the nanoparticles. Ex vivo experiments revealed enhanced corneal permeability and increased uptake efficiency by MDCK cells. In vivo studies in rabbit eyes confirmed the nanoparticles' resistance to elimination by lacrimal fluid and their ability to extend retention time in the aqueous humor. CPP modification significantly improved ocular retention, corneal penetration, and cellular endocytosis efficiency. Conclusions: The CPP-modified PLGA nanoparticles provide an effective and innovative solution for ocular drug delivery, offering improved bioavailability, prolonged retention, and enhanced drug penetration, thereby overcoming the challenges of traditional intraocular drug administration methods. [ABSTRACT FROM AUTHOR]

Background/Objectives: Early stages of diabetic retinopathy are currently considered an unmet medical need due to the lack of effective treatments beyond proper monitoring and control of glycemia and blood pressure. Sitagliptin eye drops have emerged as a new therapeutic approach against early stages of the disease, as they can prevent its main hallmarks, including both neurodegeneration and microvascular impairment. Interestingly, all of these effects occur without any glycemic systemic improvement. In the present study, we aimed to investigate the pharmacokinetics and distribution of the drug within the eye and plasma. Methods: A total of 48 male New Zealand rabbits were treated with topical administration (eye drops) of sitagliptin at two concentrations: 5 mg/mL and 10 mg/mL. Blood, iris/ciliary body, retina/choroid, aqueous humor, and vitreous humor samples were collected at specific intervals post-administration (10 and 30 min and 1, 3, 6, 15, and 24 h), processed, and analyzed using an LC-MS/MS method. The pharmacokinetics of sitagliptin were then calculated, and statistical comparisons were performed. Results: Our findings indicate that sitagliptin reaches the retina prior to the aqueous and vitreous humors, suggesting that its absorption follows the transscleral route. Additionally, systemic absorption was minimal and below pharmacologically active concentrations. Conclusions: These results support the use of an eye drop formulation for the treatment of diabetic retinopathy and other retinal diseases. [ABSTRACT FROM AUTHOR]

The Laser in Glaucoma and Ocular Hypertension Trial demonstrated the efficacy and safety of selective laser trabeculoplasty (SLT) compared with topical hypotensive medication as first-line therapy for ocular hypertension and open-angle glaucoma. This substudy explored the impact of pretreatment (baseline) intraocular pressure (IOP) on treatment response. Post hoc analysis of randomized control trial data. A total of 1146 eyes from 662 patients were included in this analysis: 559 eyes in the SLT group and 587 in the medication group. Intraocular pressure reduction at 8 weeks after treatment with either SLT or prostaglandin analog (PGA) eye drops was assessed at different levels of baseline IOP, and the groups were compared. Differences in absolute and percentage IOP lowering between SLT and PGA groups were tested with a linear mixed-effects model. Differences in the probability of achieving ≥ 20% IOP lowering between SLT and PGA groups, at different levels of baseline IOP, were estimated using a logistic mixed-effects model. Intraocular pressure-lowering response to SLT versus PGA eye drops. Mean IOP was not significantly different between the groups at baseline or 8 weeks after treatment initiation. Both treatments showed greater IOP lowering at higher baseline IOP and less IOP lowering at lower baseline IOP. Selective laser trabeculoplasty tended to achieve more IOP lowering than PGA drops at higher baseline IOP. Prostaglandin analog drops performed better at lower baseline IOP, and the difference compared with SLT, in terms of percentage IOP reduction, was significant at baseline IOP of ≤ 17 mmHg. A significant difference was found in the relationship between baseline IOP and probability of ≥ 20% IOP lowering between the two treatments (P = 0.01), with SLT being more successful than PGA at baseline IOP of more than 22.5 mmHg. We confirm previous reports of greater IOP lowering with higher baseline IOP for both SLT and PGA drops. In treatment-naïve eyes, at higher baseline IOP, SLT was more successful at achieving ≥ 20% IOP lowering than PGA drops. At lower baseline IOP, a statistically greater percentage, but not absolute, IOP lowering was seen with PGA drops compared with SLT, although the clinical significance of this is uncertain. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Background and Purpose: Retinal ganglion cells (RGCs) are the output stage of retinal information processing, via their axons forming the optic nerve (ON). ON damage leads to axonal degeneration and death of RGCs, and results in vision impairment. Nerve growth factor (NGF) signalling is crucial for RGC operations and visual functions. Here, we investigate a new neuroprotective mechanism of a novel therapeutic candidate, a p75‐less, TrkA‐biased NGF agonist (hNGFp) in rat RGC degeneration, in comparison with wild type human NGF (hNGFwt). Experimental Approach: Both neonate and adult rats, whether subjected or not to ON lesion, were treated with intravitreal injections or eye drops containing either hNGFp or hNGFwt. Different doses of the drugs were administered at days 1, 4 or 7 after injury for a maximum of 10 days, when immunofluorescence, electrophysiology, cellular morphology, cytokine array and behaviour studies were carried out. Pharmacokinetic evaluation was performed on rabbits treated with hNGFp ocular drops. Results: hNGFp exerted a potent RGC neuroprotection by acting on microglia cells, and outperformed hNGFwt in rescuing RGC degeneration and reducing inflammatory molecules. Delayed use of hNGFp after ON lesion resulted in better outcomes compared with treatment with hNGFwt. Moreover, hNGFp‐based ocular drops were less algogenic than hNGFwt. Pharmacokinetic measurements revealed that biologically relevant quantities of hNGFp were found in the rabbit retina. Conclusions and Implications: Our data point to microglia as a new cell target through which NGF‐induced TrkA signalling exerts neuroprotection of the RGC, emphasizing hNGFp as a powerful treatment to tackle retinal degeneration. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo report the clinical presentation, management, and outcomes of nodulo-ulcerative ocular surface squamous neoplasia (nuOSSN).Retrospective interventional clinical cohort study of 27 patients from a quaternary ocular oncology center.Twenty-seven patients were diagnosed with nuOSSN during the six-year study period. The mean age at presentation was 53 years (median, 51 years; range, 25 to 81 years). Misdiagnosis was noted in 7 (26%) patients, and the mean lag time from symptom onset to presentation at our center was 14 months (median, 6 months; range, 1 to 96 months). The bulbar conjunctiva was the commonest epicenter (n = 19, 70%), and the temporal quadrant was most commonly involved (n = 13, 48%). The mean tumor diameter and thickness were 18 mm (median, 16 mm; range, 8 to 60 mm) and 3 mm (median, 2 mm; range, 1 to 5 mm), respectively. Corneal, limbal, and scleral thinning were seen in 15 (56%), 18 (67%), and 10 (37%) patients, respectively. Peripheral corneal opacification was seen in 18 (67%), and thickening around the area of scleral thinning was seen in 12 (44%) patients. Tumors belonged to the American Joint Committee for Cancer classification T2 (n = 2, 7%), T3 (n = 19, 70%), and T4 (n = 6, 22%) categories. Primary treatment (n = 19) included topical 1% 5-fluorouracil (5FU) eye drops (n = 1, 4%), excisional biopsy (n = 4, 14%), extended enucleation (n = 11, 41%), and orbital exenteration (n = 3, 11%). At a mean follow-up of 9 months (median, 3 months; range 1 to 46 months) in 19 patients who received treatment, the outcomes included local tumor recurrence in 2 patients (11%), tumor control in 16 (84%), globe salvage in 3 (16%), and lymph node metastasis in 2 patients (11%).nuOSSN is an aggressive form of the disease that is frequently misdiagnosed due to the presence of corneoscleral thinning. Globe salvage rates are poor owing to the advanced stage of presentation. [ABSTRACT FROM AUTHOR]