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Purpose Methods Results Conclusion To provide a historical overview of the various efforts to change eye colour for purely cosmetic reasons, along with the associated potential risks and harms.Literature and online search.Eye drops containing adrenaline were used during World War II on involuntary inmates of concentration camp Auschwitz‐Birkenau. Prostaglandin drops, used in glaucoma therapy since 1996, can increase iris pigmentation as an undesired side effect. Commercial drops, available since 2011, are not effective and potentially dangerous. Iris implants, commercially available since 2011, led to serious complications like corneal decompensation, uveitis and glaucoma, and for this reason, implants had to be removed, leaving some patients almost blind. Also commercially in use since 2011 are laser treatments to make brown eyes blue. Among the possible complications are anterior uveitis and (pigmentary) glaucoma. Corneal tattooing has existed for almost 2000 years. Complications of modern, intrastromal keratopigmentation include corneal perforation, bacterial infection, allergic or toxic reaction to pigment, migration of pigment, and functional complications like visual field limitation and light sensitivity. Personal identity and self‐esteem are likely contributing factors to undergo this potentially harmful cosmetic eye surgery. In addition to the earlier discussed complications, the artificial layer of colour can obscure ocular pathology of the cornea or iris. As the majority of individuals undergoing these procedures are relatively young, problems may arise in the future when they will need cataract or other eye surgeries.Permanently changing eye colour in healthy eyes for purely cosmetic reasons is a risky procedure. [ABSTRACT FROM AUTHOR]

Topical medications are common initial treatments for Descemet's membrane detachment (DMD). It is crucial to understand the aqueous humour (AH) flow and drug transport to facilitate the DMD treatment. This paper presents a mathematical model to analyse AH flow and drug transport in the anterior of the human eye considering gravity orientation effects. Utilizing the finite element method, the model couples AH flow dynamics, temperature-induced buoyancy, and drug transport by convection-diffusion. COMSOL Multiphysics is used to simulate the spatial-temporal distribution of AH and drugs delivery. The findings indicate that the eye positioning influences the directional flow of AH, due to temperature differences, and impacts the delivery of drug concentrations. It is also discovered that eye drops diffuse faster due to tear turnover in the eye yet more eye ointment is delivered as it has a longer contact time in the cornea. By understanding the AH flow and transport process, this proposed model may offer appropriate guidelines for optimizing DMD treatment under various forms of topical drugs and eye positions. [ABSTRACT FROM AUTHOR]

Glaucoma, a leading cause of blindness due to elevated intraocular pressure (IOP), is managed with medications like latanoprost (LAT), a prostaglandin analogue, to enhance aqueous outflow. Despite the challenge posed by eye anatomy and tear dynamics, effective ocular bioavailability via topical administration remains elusive. This study aims to optimize self-assembled nanomicelles incorporating LAT, an anti-glaucoma drug, belonging to BCS Class II (low solubility and high permeability) via a two-level, two-factor full factorial design, the nanomicelles were formulated via direct dissolution method and validated using design of expert. The optimized nanomicelles exhibited a spherical morphology, with a size of 69 nm and encapsulation efficiency of 77.5%, demonstrating a sustained LAT release over 12 h. In normotensive rabbits, the nanomicelles elicited a substantial reduction in intraocular pressure (IOP) by up to 40% for a duration of three days, that was significantly longer than the IOP-lowering efficacy of XALATAN eye drops (24 h). These findings indicated that self-assembled nanomicelles hold promise for enhancing the ocular bioavailability and extending the therapeutic duration of LAT, while providing the physical stability. [ABSTRACT FROM AUTHOR]

The Coronavirus disease 2019 (COVID-19) pandemic has led to a global health crisis, including ocular symptoms, primarily targeting the Angiotensin-Converting Enzyme 2 (ACE2) receptor. PM2.5 air pollution may increase infection risk by altering ACE2 expression. Silicon Dioxide (SiO2) and carbon black (CB), major components of PM2.5 from sands and vehicle emissions, were studied for their effects on ACE2 and Transmembrane Protease Serine 2 (TMPRSS2) expression in corneal and conjunctival cells, and ocular tissues. Human corneal epithelial cells (HCECs) and conjunctival epithelial cells (HCjECs) were exposed to nanoparticles (NPs) for 24 hours, assessing viability via WST-8 assay. TNF-α, IL-6, and IL-1β levels in the medium were measured. An in vivo rat study administered NPs via eye drops, with Rose Bengal staining to evaluate damage. ACE2, TMPRSS2, and Angiotensin II (AngII) protein expressions were quantified by Western blot. ACE2 expression in HCjECs increased with NP exposure, while it decreased in HCECs. CB exposure increased TNF-α, IL-6, and IL-1β levels in HCECs. In vivo, corneal exposure to CB decreased ACE2 expression, whereas conjunctival exposure to SiO2 increased ACE2 expression. These changes suggest that SiO2 exposure may increase the risk of COVID-19 through the ocular surface, while CB exposure may decrease it. [ABSTRACT FROM AUTHOR]

Background: The estimated number peoples aged 40 to 80 years affected with glaucoma were 76.0 million in 2020 and 111.8 in 2040 globally. The estimated number peoples aged 40 to 80 years affected with glaucoma were 76.0 million in 2020 and 111.8 in 2040. This study identified glaucoma medication non-adherence rates and associated barriers among patients with glaucoma attending Hawassa University Comprehensive Specialized Hospital. Methods: A prospective cross-sectional study was conducted on 340 patients diagnosed with glaucoma who were administered ocular hypotensive medication at least for one week before current visit and those who were diagnosed and prescribed the medication, currently presented to the hospital as new attendant. A systematic random sampling technique was used to select study participants. Data was collected using a validated questionnaire by interviewing patients and reviewing their medical charts from May 01 to November 30, 2022. The collected data checked for completeness, entered to SPSS 22. Descriptive and binary logistic regression analysis were done using the software. The findings were presented using tables and Pie-charts. A p-value ≤ 0.05 was used to indicate statistical significance. Results: About 340 patients participated in this study with response rate of 90%. More than half of them (59.4%) were male. Mean age of the study participants was 60.2 ± 3.17SD years. The majority came from rural areas (186 (54.71%). Approximately 62.4% of them were with bilateral glaucoma while 47.10% were at advanced stage at least in one eye. The glaucoma non-adherence rate was 54.71% (95% CI; 50.90–58.50). Forgetfulness (AOR 28.32 (95% CI;14.80–54.16), difficulty with schedule AOR 2.52 (95% CI;1.009–6.29), believing eye drops were not effective AOR 6.35 (95% CI;1.17–34.49) and poor self-efficacy AOR 10.96 (95% CI;1.26–95.57) were barriers significantly associated with non-adherence. Conclusion and recommendation: The nonadherence rate to glaucoma medication among patients with glaucoma attending Hawassa University comprehensive hospital was high (54.71%). Forgetfulness, difficulty with schedule, belief that the drug was not effective and poor self-efficacy were barriers associated with glaucoma medication non-adherence. Health workers better to properly council and inform the patients about the disease nature, goal of treatment, danger of nonadherence to administered medication and mechanism to increase their adherence such as setting reminder. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ocular and systemic pharmacokinetics of lotilaner ophthalmic solution, 0.25%, following bilateral topical ocular administration of single and repeated doses in rabbits. Methods: Dutch-belted rabbits (n = 34) were administered lotilaner ophthalmic solution, 0.25%, eye drops, either in a single bilateral dose (Group 1) or twice a day bilaterally for 7 days and once on Day 8 (Group 2). The pharmacokinetics and tissue distribution levels of lotilaner were assessed following the single dose in Group 1 and the last dose in Group 2. The drug levels were examined in various ocular tissues and whole blood. The maximal concentration of the drug (Cmax), time to maximal concentration, the terminal phase elimination half-life, the area under the concentration–time curve (AUC), and total clearance of the drug were determined. Results: In the eyelid margins, lotilaner exhibited the highest observed concentrations at 0.25 hour (h), presenting a mean Cmax of 14,600 ng/mL in Group 1 and 20,100 ng/mL in Group 2. The highest AUC was in the eyelid margin at 242,000 h×ng/mL in Group 1 and 535,000 h×ng/mL in Group 2. In the eyelid margin, the observed clearance rate (0.634 mL/h in single dose, 0.288 mL/h in repeat dose) was the slowest among all ocular tissues in both groups, with the longest half-life of 152 h (∼6.3 days) observed in the repeat dose group. Conclusions: Lotilaner ophthalmic solution, 0.25%, demonstrated rapid ocular tissue absorption into the eyelid margin tissue with a long half-life of almost a week. No adverse effects were observed following topical ocular administration in Dutch-belted rabbits. [ABSTRACT FROM AUTHOR]

Purpose: To compare intraocular pressure (IOP), ocular surface disease (OSD) parameters, and safety in patients with open-angle glaucoma (OAG)/ocular hypertension (OH) and concurrent OSD treated with preservative-free latanoprost 0.005% cationic emulsion (PF-latanoprost-E) or travoprost-Z 0.004% ophthalmical solution containing a soft preservative system. Methods: Patients with OAG/OH and OSD were randomized to treatment with PF-latanoprost-E or travoprost-Z nightly for 3 months. Outcomes included mean diurnal IOP reduction; OSD endpoints, including symptom improvement, tear break-up time (TBUT), and corneal fluorescein staining (CFS) score; and safety after 1 and 3 months. Results: A total of 105 patients were randomized, 51 to PF-latanoprost-E and 54 to travoprost-Z. IOP reductions (LS mean differences) at 3 months were numerically greater in the PF-latanoprost-E than in the travoprost-Z group at 8AM (7.2 versus 6.0 mmHg), 10AM (6.7 versus 5.9 mmHg), and 4PM (6.0 versus 5.4 mmHg). LS mean changes in IOP from baseline in both groups at 1 and 3 months, however, were comparable. Mean ± SD CFS scores on the Ora scale at month 3 showed significantly greater reductions in the PF-latanoprost-E than in the travoprost-Z group (–1.07 ± 1.863 versus –0.16 ± 2.553 P = 0.0461). The mean TBUT at month 3 showed similar improvements in both groups (1.1 versus 1.0 s, P > 0.05). OSD symptoms improved but did not differ significantly in the two groups. Overall safety was comparable in both groups. Conclusion: PF-latanoprost-E effectively and safely lowered IOP and improved OSD parameters in patients with OAG/OH. These findings provide evidence for the beneficial effects of this new formulation of latanoprost in glaucoma patients with OSD. [ABSTRACT FROM AUTHOR]

Clinical relevance: There are many methods to control the progression of myopia. However, it is currently unknown which method could better control myopia progression: 0.02% atropine eye drops, peripheral myopic defocus design spectacle lenses (PMDSL), or orthokeratology (OK). Background: To compare the efficacy of 0.02% atropine, PMDSL, and OK to control axial length (AL) elongation in children with myopia. Methods: This study was analysed based on a previous cohort study (0.02% atropine group) and retrospective data (PMDSL and OK group). Overall, 387 children aged 6–14 years with myopia − 1.00D to − 6.00D in the three groups were divided into four subgroups according to age and spherical equivalent refraction (SER). The primary outcome was changed in AL over 1-year. Results: The mean axial elongation was 0.30 ± 0.21 mm, 0.23 ± 0.16 mm, and 0.17 ± 0.19 mm in the 0.02% atropine, PMDSL, and OK groups, respectively. Multivariate linear regression analyses showed significant differences in axial elongation among the three groups, especially in children aged 6–10, but not in children aged 10.1–14; the corresponding axial elongation was 0.35 ± 0.21 mm, 0.23 ± 0.17 mm, and 0.21 ± 0.20 mm (P < 0.05 between any two groups, except between PMDSL and OK groups at P > 0.05) and 0.22 ± 0.20 mm, 0.21 ± 0.13 mm, and 0.13 ± 0.18 mm (P < 0.05 between any two groups, except between 0.02% atropine and PMDSL groups at P > 0.05) in children with SER from − 1.00D to − 3.00D and from − 3.01D to − 6.00D, respectively. Conclusions: Within the limits of this study design and using only the current brand of PMDSL, OK appeared to be the best method, followed by PMDSL and then 0.02% atropine, for controlling AL elongation over one year. However, different effects were found in the various age and SER subgroups. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. Methods: The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). Results: The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3–18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). Conclusion: This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches. [ABSTRACT FROM AUTHOR]

Purpose: To report the effect of topical application of recombinant human nerve growth factor (rhNGF) eye drops on corneal epithelial regeneration in patients with refractory epitheliopathy. Methods: A retrospective chart review was conducted on patients treated with topical rhNGF for refractory epithelial keratopathy due to stage I neurotrophic keratitis (NK). Data regarding demographics and ocular/systemic past medical history was extracted from patient charts. Visual acuity and corneal staining scores were recorded at baseline and subsequent follow-up visits at 8 weeks and 3 months. Measurements from the worse eye were used to compare before and after treatment values. Results: We identified 14 patients (median age 68 years, 21% male) who received rhNGF treatment for refractory epithelial keratopathy. After an 8-week treatment with topical rhNGF, the median corneal staining score in the worse eye improved from 4 to 1 (p = 0.001). All patients showed at least one-grade improvement in corneal staining at 8 weeks, with sustained effect in seven patients at 3 months. A better response was observed in eyes with post-radiation epithelial keratopathy, LASIK, and Sjogren's disease. Those with chronic use of other topical treatments and uncontrolled diabetes mellitus demonstrated incomplete responses. Eight patients reported mild-to-moderate ocular discomfort from drop application that fully resolved after completion of treatment. Conclusions: Topical rhNGF was effective and safe for refractory epithelial keratopathy in our small cohort, but sustained effects were seen only in certain etiologies for up to 3 months. Further studies are needed for optimal dosing and duration based on underlying causes. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the anti-inflammatory activity of a cell-free supernatant from Lactiplantibacillus plantarum CRL 759, in phosphate buffer modified according to Sorensen called POF-759. Methods: The activity of POF-759 administered by means of eye drops was evaluated on animals subcutaneously injected with the lipopolysaccharide animals in which uveitis was induced by a subcutaneous injection of lipopolysaccharide (EIU). Clinical signs of ocular inflammation, cytokines and proteins were examined in the aqueous humor. Additionally, cellular infiltration was evaluated by histopathological analysis. Results: The new postbiotic administered locally decreases signs of ocular damage, the number of infiltrating cells in the anterior and posterior chambers, the proinflammatory mediators and the proteins in the aqueous humor on mice with EIU. Conclusions: Our results provide an impetus to relieve ocular inflammation and to identify and develop preventive and therapeutic approaches, to avoid deterioration and to maintain healthy eyes on inflammatory processes. [ABSTRACT FROM AUTHOR]

Topical medical therapy is the most common approach to the treatment of many ocular conditions. While effective, topical therapy has numerous important limitations. Eye drops can have unpleasant or even dangerous side effects, are often difficult to self-administer, and the application of multiple drops per day, possibly from multiple different bottles, can be burdensome. Perhaps the most important limitation of topical medical therapy is non-adherence, a complex multifactorial behavior that increases the risk of poor outcomes associated with undertreatment. There is growing interest in a class of therapeutics termed "procedural pharmaceuticals" (PPs), which remove the responsibility of self-dosing from patients. An array of PPs are available for the treatment of a variety of ocular conditions, such as those for glaucoma, retina, and cataract surgery; and many more will emerge in coming years. A paradigm shift away from patient-administered therapy toward provider-administered therapy will have important implications for both providers and patients. This paper explores the impact that PPs have had, and will have, on the clinical practice of ophthalmology. [ABSTRACT FROM AUTHOR]

Introduction: High-tech devices for the assessment of dry eye disease (DED) are increasingly available. However, the agreement between high- and low-tech parameters has been poorly explored to date. Trying to fill these gaps, we conducted a post hoc analysis on a recently published retrospective study on patients with DED receiving both low- and high-tech (Keratograph®) assessments, and treatment with different lubricating eyedrops. Methods: Six clinical questions were defined by the authors, considering literature gaps and their clinical experience, namely: (1) are NIKBUT-i and T-BUT interchangeable parameters? (2) What was the correlation between low- and high-tech parameters in untreated and treated patients with DED? (3) What was the correlation between signs and symptoms at baseline and during/after treatment? (4) Which parameters were better associated with symptoms? And with symptoms change over time? (5) What was the performance of NIKBUT-i and T-BUT in detecting clinically relevant changes? (6) What was the clinical advantage of adding other high- and low-tech parameters, respectively, to NIKBUT-i and T-BUT? Results: Low-tech measures were the best descriptors of the Ocular Surface Disease Index (OSDI) at baseline. In contrast, high-tech assessments demonstrate better performance in detecting changes over time. The distribution of NIKBUT-i data was more dispersed than TBUT both at baseline and follow-up. At a fixed specificity of 80%, the sensitivity in detecting clinically relevant ameliorations of symptoms was 42% for NIKBUT-i and 25% for T-BUT. A battery of high-tech tests could detect 90% of clinical amelioration, compared with 45% with low-tech tests (p < 0.001). Correlation between low- and high-tech parameters in both treated and untreated patients is lacking. Conclusions: Low-tech measures are adequate for diagnostic purposes in DED, whereas high-tech showed better performances at follow-up, particularly when different tests are combined. Overall, poor interchangeability among parameters and agreement with symptoms was reported both with high- and low-tech assessments. [ABSTRACT FROM AUTHOR]

One of the most common causes of blindness on a global scale is glaucoma. There is a strong association between glaucoma and increased intraocular pressure (IOP). Because of this, adequate IOP‐lowering is the most important treatment strategy, mostly through topical eyedrops. Well‐functioning meibomian glands are paramount for maintaining a stable tear film, and their dysfunction is the most common cause of dry eye disease. There is a growing concern that both topical glaucoma medications themselves and their added preservatives damage the meibomian glands, and consequently, the ocular surface. Preserved topical glaucoma medications appear to cause dysfunction and atrophy of the meibomian glands. Upon comparison, preserved formulations caused more symptoms of dry eye, tear film instability, inflammatory changes and meibomian gland dropout than the preservative‐free counterpart. However, although seemingly less detrimental, unpreserved alternatives may diminish glandular efficacy, and, depending on the active ingredient, lead to glandular death. This negatively impacts quality of life, adherence to treatment regimens and prognosis. In this review, we explore the available evidence regarding the effects of IOP‐lowering eye drops on the meibomian glands. [ABSTRACT FROM AUTHOR]

Purpose: To compare the effect of the ocular antiseptic treatments 0.05% chlorhexidine, 5% povidone‐iodine (PI) and 5% betadine on cell viability and mucin secretion of primary cultured human goblet cells (GCs). Method: GC viability was analysed using lactate dehydrogenase (LDH) and tetrazolium dye (MTT) colorimetric assays. Expression of mucin was visualised by immunohistochemical MUC5AC staining. Results: PI and betadine significantly reduced GC survival compared to the control (mean cell survival 23 ± 6% and 23 ± 7%, respectively, p < 0.05), whereas chlorhexidine did not significantly affect GC viability (mean cell survival: 78 ± 17%), as measured by the LDH assay. Similar results were obtained from the MTT assay, where PI and betadine caused a significant loss of GCs (mean cell survival: 26 ± 12% and 26 ± 13%, respectively, p < 0.05). Chlorhexidine did not significantly alter GC survival compared to the control (mean cell survival: 79 ± 8%). PI and betadine caused a dispersion of mucin secretion, which chlorhexidine did not. Conclusion: The most used antiseptic treatments, PI and betadine, applied prior to ocular surgery are significantly more cytotoxic to conjunctival GCs than chlorhexidine treatment. [ABSTRACT FROM AUTHOR]

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Pathological neovascularization in retinopathy of prematurity (ROP) can cause visual impairment in preterm infants. Current ROP treatments which are not preventative and only address late neovascular ROP, are costly and can lead to severe complications. We showed that topical 0.1% dexamethasone eye drops administered prior to peak neovessel formation prevented neovascularization in five extremely preterm infants at high risk for ROP and suppressed neovascularization by 30% in mouse oxygen-induced retinopathy (OIR) modeling ROP. In contrast, in OIR, topical dexamethasone treatment before any neovessel formation had limited efficacy in preventing later neovascularization, while treatment after peak neovessel formation had a non-statistically significant trend to exacerbating disease. Optimally timed topical dexamethasone suppression of neovascularization in OIR was associated with increased retinal mitochondrial gene expression and decreased inflammatory marker expression, predominantly found in immune cells. Blocking mitochondrial ATP synthetase reversed the inhibitory effect of dexamethasone on neovascularization in OIR. This study provides new insights into topical steroid effects in retinal neovascularization and into mitochondrial function in phase II ROP, and suggests a simple clinical approach to prevent severe ROP. [ABSTRACT FROM AUTHOR]

The Food and Drug Administration (FDA) has long suffered from a lack of resources limiting their inspection capacity. They have fallen behind on proactive surveillance inspections of foreign manufacturing sites, relying instead on for-cause inspections after a problem has been discovered. Over-the-counter (OTC) products are especially vulnerable because the FDA considers them lower priority. This issue recently made big news after improperly manufactured OTC eye drops harmed users across the country, in some cases causing blindness. To prevent future harm to Americans, it is imperative that the FDA receives enough resources to keep up with their routine inspections. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this case series is to describe the clinical course of patients receiving foscarnet eyedrops for the treatment of refractory herpetic keratitis. Observations: Six patients diagnosed with herpetic keratitis were treated with foscarnet 24 mg/mL (2.4%) eyedrops with resulting improvement in keratitis. Conclusion: Topical foscarnet may be a safe and effective treatment for herpetic keratitis in conjunction with, or as an alternative to, conventional antiviral therapy. This is an off-label use of foscarnet. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma. Methods: We used the Kaplan–Meier method to analyze 29 eyes of 29 patients with exfoliation glaucoma (mean age: 80.7 ± 8.3 years; 16 males; 24 eyes with intraocular lens implants; preoperative intraocular pressure [IOP]: 32.5 ± 9.3 mmHg; preoperative antiglaucoma medications: 3.4 ± 1.0; Asian ethnicity: 100%) who underwent PreserFlo MicroShunt surgery alone at Saneikai Tsukazaki Hospital from November 2022 to November 2023. The criteria for survival were a reduction in IOP of ≥20%, no additional glaucoma surgery, and IOP of 5–21 mmHg (condition 1), 5–18 mmHg (condition 2), and 5–15 mmHg (condition 3). Needling and glaucoma eye drops were considered qualified successes. Results: The mean follow-up period was 27.9 weeks, with a reoperation rate of 31% (9 cases). The complete and qualified success survival rates at 24 weeks were 56%, 52%, and 49%, and 67%, 59%, and 53% for conditions 1–3, respectively. The complete and qualified success survival rates at 48 weeks were 47%, 43%, and 45%, and 52%, 46%, and 48% for conditions 1–3, respectively. Conclusions: The postoperative outcomes of the PreserFlo MicroShunt in Asian patients with exfoliation glaucoma demonstrated an approximate 50% success rate at both 24 and 48 weeks, with a reoperation rate of approximately 30%. Caution is warranted when performing PreserFlo MicroShunt in patients with exfoliation glaucoma. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsWhile 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.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.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.The number of treatments and procedures increased with OCP severity, indicating that advanced OCP often necessitated more intensive OSD management. [ABSTRACT FROM AUTHOR]

Corneal ulcers, whether melting or indolent, are common in humans and companion animals. Treatment involves local administration of antibiotic eye drops and corneal healing drugs. Compared to traditional treatments for ulcerative keratitis, herbal medicines offer unique advantages, such as potent anti-inflammatory effects and inhibition of proinflammatory cytokines. Curcumin, extracted from the Curcuma Longa plant, possesses extensive pharmacological properties, such as anti-inflammatory, anti-cancer, and antioxidant properties, and is used in various medicines. In this study, we developed a novel ophthalmic drop hydrogel using a formulation of Curcumin NPs encapsulated with β-cyclodextrin and hyaluronic acid, to accelerate corneal healing and improve the quality of healed structures. The formation of Curcumin NPs into Hyaluronic acid-based hydrogels was characterized by zeta, FTIR, and scanning electron microscope (SEM) analyses. A total of 25 healthy male New Zealand Albino rabbits were experimentally induced with ulcerative keratitis and treated individually with topical medication. Rabbits were divided into five groups. Fluorescein dye staining, corneal clarity score, Schirmer tear test, proinflammatory cytokine measurement, and pathologic factors assessments were used to evaluate the optimised Curcumin NPs with β-cyclodextrin in Hyaluronic acid hydrogel. Our results demonstrated that the optimized Curcumin NPs with β-cyclodextrin in hyaluronic acid hydrogel significantly reduced the frequency of medication administration compared to conventional therapies, enhancing the quality of healed structures and effectively treating ulcerative keratitis. All findings in this study provide new insight into designing and fabricating novel ophthalmic medicine for ulcerative keratitis for topical usage. [ABSTRACT FROM AUTHOR]

Background: Dry eye disease (DED) is a prevalent condition affecting over 16 million patients in the USA. DED and the symptoms of ocular discomfort are debilitating and a significant burden on patients. If left untreated, DED can progress to cause severe pathology. Treatment is often initiated by patients without consulting a healthcare professional. This study investigated the safety and efficacy of a novel lipid-containing eye drop (BTC), which might better mimic the components of natural tears. Methods: This was a multicenter, randomized, double-masked, active control, two arm, parallel group study of eye drops in adult subjects with self-reported DED. Subjects were randomly assigned to BTC or control (commercially available non-lipid eye drops; NLED) arm and were followed for 30 days. Assessments using visual analog scale and patient-reported outcomes (PRO) questionnaires, non-invasive tear break up time, slit-lamp examination, and subject-reported ocular symptoms were conducted at baseline and at days 7 and 30. The primary endpoint was change in overall ocular comfort score from baseline to day 30. Results: 158 subjects were randomized, of whom 130 completed the study per protocol (PP). Mean (SD) age was 47.8 (14.14) years. The mean (95% CI) change in overall comfort scores at the 30-day follow-up in the PP population was 21.4 (15.1, 27.7) for the test drop and 10.0 (3.9, 16.1) for the comparator. The mean (95% CI) treatment difference was 11.3 (2.6, 20.1); this met the pre-defined requirements for non-inferiority. There was no significant difference in the proportion of eyes with reported ocular symptoms between the groups. At day 7, the OR (95% CI) was 0.967 (0.528, 1.770) and at day 30 was 1.160 (0.610, 2.203). There were no Grade 3 or higher corneal edema, corneal neovascularization, corneal staining, conjunctival injection, tarsal abnormalities or any other biomicroscopy findings, and no corneal infiltrates observed during the study. Conclusions: The investigational lipid eye drop BTC was noninferior to the commercially available non-lipid comparator in all parameters measured and has the potential to provide an effective therapy for subjects with symptoms of dry eye who would benefit from a lipid-based artificial tear. Trial Registration: NCT03995355 (http://www.clinicaltrials.gov), registered June 24, 2019. [ABSTRACT FROM AUTHOR]

Background: Allergic conjunctivitis is increasing with the rise in the levels of allergens. Drug therapy is usually needed in addition to avoidance of general allergens to treat this condition. Both bepotastine besilate and olopatadine hydrochloride ophthalmic solutions are newer additions in the treatment of allergic conjunctivitis having dual properties of second-generation antihistaminics along with mast cell stabilizing activity. Aims and Objectives: The aim of the study was to compare the efficacy and tolerability of bepotastine besilate (1.5%) and olopatadine hydrochloride (0.1%) eye drops in patients presenting with allergic conjunctivitis in a tertiary care hospital of Southern part of India. Materials and Methods: Sixty patients who were clinically diagnosed to be suffering from allergic conjunctivitis were selected as participants for the study. They were randomly distributed into two groups consisting of 30 patients each. One group received eye drop bepotastine (1.5%) and the other group received eye drop olopatadine (0.1%), with each patient receiving the medication twice daily for a duration of 2 weeks. During the first visit, all the patients were assessed for the signs and symptoms and subsequently re-assessed at weekly intervals for a period of 2 weeks. They were also advised to report occurrence of any unwanted drug reaction during the weekly follow-up visits. Results: The above study showed the effectiveness of both bepotastine and olopatadine eye drops in decreasing the signs and symptoms of allergic conjunctivitis. Significant clinical improvement was found in all participants, whereas deterioration was found in none of them. Statistically significant improvement of itching and redness of eyes was observed with use of both the study drugs mentioned beforehand. Both the drugs were well tolerated by the patients. Statistically significant reduction of itching and foreign body sensation was found to be more in patients using bepotastine eye drops compared to those using olopatadine eye drops. Only two patients using bepotastine eye drops complained of having a mild burning sensation in eyes. Conclusion: From this study, bepotastine and olopatadine eye drops have been observed to be safe and efficacious in allergic conjunctivitis. Bepotastine eye drop was found to be more efficacious to relieve itching and foreign body sensation compared to that of olopatadine eye drops. [ABSTRACT FROM AUTHOR]

Ophthalmic pharmaceutical preparation containing antazoline (ANT) and tetryzoline (TET) is prescribed widely as an over the counter medication for allergic conjunctivitis treatment. Development of a selective, simple and environmentally friendly thin-layer chromatographic method established to determine both ANT and TET in their pure forms, pharmaceutical formulation and spiked aqueous humor samples. By using silica gel plates and means of a developing system consists of ethyl acetate:ethanol (5:5, by volume), the studied drugs separation was achieved, and scanning was carried out at 220.0 nm for the separated bands with a 0.2–18.0 μg/band concentration range for each of ANT and TET. Standard addition technique application was carried out to determine the proposed method validity. Statistical comparison was made between the proposed method and the official methods ANT and TET showing no significant difference concerning accuracy and precision. Furthermore, greenness profile assessment was accomplished by means of four metric tools, namely, analytical greenness, green analytical procedure index, analytical eco-scale and national environmental method index. Highlights Green TLC-densitometric determination of antazoline and tetryzoline. Applicability of analysis of studied drugs in eye drops and in rabbit aqueous humor samples. Greenness profile assessment was accomplished via four smart metric tools. [ABSTRACT FROM AUTHOR]

Background/Objectives: This review examines the evolution of lyotropic liquid crystals (LLCs) in ocular drug delivery, focusing on their ability to address the challenges associated with traditional ophthalmic formulations. This study aims to underscore the enhanced bioavailability, prolonged retention, and controlled release properties of LLCs that significantly improve therapeutic outcomes. Methods: This review synthesizes data from various studies on both bulk-forming LLCs and liquid crystal nanoparticles (LCNPs). It also considers advanced analytical techniques, including the use of machine learning and AI-driven predictive modeling, to forecast the phase behavior and molecular structuring of LLC systems. Emerging technologies in biosensing and real-time diagnostics are discussed to illustrate the broader applicability of LLCs in ocular health. Results: LLCs are identified as pivotal in promoting targeted drug delivery across different regions of the eye, with specific emphasis on the tailored optimization of LCNPs. This review highlights principal categories of LLCs used in ocular applications, each facilitating unique interactions with physiological systems to enhance drug efficacy and safety. Additionally, novel applications in biosensing demonstrate LLCs' capacity to improve diagnostic processes. Conclusions: Lyotropic liquid crystals offer transformative potential in ocular drug delivery by overcoming significant limitations of conventional delivery methods. The integration of predictive technologies and biosensing applications further enriches the utility of LLCs, indicating a promising future for their use in clinical settings. This review points to continued advancements and encourages further research in LLC technology to maximize its therapeutic benefits. [ABSTRACT FROM AUTHOR]

The synthetic peptide of lumican C-terminal 13 amino acids with the cysteine replaced by an alanine, hereafter referred to as lumikine (LumC13C-A: YEALRVANEVTLN), binds to TGFβ type I receptor/activin-like kinase5 (TBR1/ALK5) in the activated TGFβ receptor complex to promote corneal epithelial wound healing. The present study aimed to identify the minimum essential amino acid epitope necessary to exert the effects of lumikine via ALK5 and to determine the role of the Y (tyrosine) residue for promoting corneal epithelium wound healing. This study also aimed to determine the signaling pathway(s) triggered by lumican–ALK5 binding. For such, adult Lum knockout (Lum−/−) mice (~8–12 weeks old) were subjected to corneal epithelium debridement using an Agerbrush®. The injured eyes were treated with 10 µL eye drops containing 0.3 µM synthetic peptides designed based on the C-terminal region of lumican for 5–6 h. To unveil the downstream signaling pathways involved, inhibitors of the Alk5 and EGFR signaling pathways were co-administered or not. Corneas isolated from the experimental mice were subjected to whole-mount staining and imaged under a ZEISS Observer to determine the distance of epithelium migration. The expression of EGFR ligands was determined following a scratch assay with HTCE (human telomerase-immortalized cornea epithelial cells) in the presence or not of lumikine. Results indicated that shorter LumC-terminal peptides containing EVTLN and substitution of Y with F in lumikine abolishes its capability to promote epithelium migration indicating that Y and EVTLN are essential but insufficient for Lum activity. Lumikine activity is blocked by inhibitors of Alk5, EGFR, and MAPK signaling pathways, while EGF activity is only suppressed by EGFR and MAPK inhibitors. qRT-PCR of scratched HTCE cells cultures treated with lumikine showed upregulated expression of several EGFR ligands including epiregulin (EREG). Treatment with anti-EREG antibodies abolished the effects of lumikine in corneal epithelium debridement healing. The observations suggest that Lum/lumikine binds Alk5 and promotes the noncanonical Smad-independent TGFβ/TBRs signaling pathways during the healing of corneal epithelium debridement. [ABSTRACT FROM AUTHOR]

Post-operative fibrosis of the filtering bleb limits the success of glaucoma filtration surgery (GFS). To minimise subconjunctival scarring following GFS, treatment with antimetabolites such as Mitomycin C (MMC) has become standard practice; however, their use is associated with considerable side effects. This study aimed to investigate the anti-scarring properties of 3′,4′-dihydroxyflavonol (DiOHF). GFS was performed in New Zealand white rabbits who received eye drops of DiOHF three times daily and vehicle eye drops after surgery (n = 5) or a single intraoperative treatment of MMC (n = 5). Blebs were imaged immediately following surgery and on days 7, 15, 21, and 28 for clinical examination. On day 28, eyes were harvested to assess collagen deposition, expression of α-SMA, oxidative stress, angiogenesis, fibroblast activity, and inflammation in the conjunctiva/Tenon's layer. At 7 and 28 days post-GFS, MMC-treated blebs were more ischaemic than DiOHF- or vehicle-treated blebs. On day 28, DiOHF treatment significantly suppressed collagen accumulation, CD31 expression, Vimentin expression, and CD45 expression compared to the vehicle control. No difference was observed in 3-Nitrotyrosine or αSMA expression between treatment groups. Treatment with DiOHF reduced conjunctival scarring and angiogenesis in rabbits with GFS, which was comparable to MMC. DiOHF may be a safer and more effective wound-modulating agent than conventional antifibrotic therapy in GFS. [ABSTRACT FROM AUTHOR]

Purpose: To report an uncommon, isolated presentation of bilateral choroidal detachments in a patient diagnosed with P-ANCA-associated vasculitis and to highlight the importance of an inflammatory work-up in such cases. Methods: Case report. Results: A 70-year-old male with a past medical history of autoimmune hepatitis presented with a sudden decrease in vision in both eyes. Over the course of the previous decade, he had experienced recurrent attacks of episcleritis, which were successfully managed with topical corticosteroid eye drops. The patient was diagnosed with bilateral detachments without accompanying scleritis or intraocular inflammation. Inflammatory markers revealed high P-ANCA and anti-MPO levels, confirming the diagnosis of P-ANCA-associated vasculitis. Treatment with systemic rituximab and corticosteroids led to the resolution of the choroidal detachment in both eyes. A 40-month follow-up confirmed the sustained resolution of the detachments. Conclusion: Choroidal detachment without other extraocular/intraocular inflammation can be associated with P-ANCA-associated vasculitis, a previously under-reported link. It is important to consider an inflammatory work-up for patients presenting with choroidal detachment to rule out conditions like P-ANCA-associated vasculitis. [ABSTRACT FROM AUTHOR]

Purpose: To document the long-term visual outcomes in patients with Blau syndrome. Methods: A retrospective institutional cohort study was conducted, and 13 patients with genetically confirmed Blau syndrome were included. Demographic and clinical data were collected from standardised medical charts. Baseline was defined as the first detected uveitis and data were recorded onwards at intervals of 1, 3, 5, 10, 15 and 20 years. Results: Anterior uveitis was the most common classification at baseline (57.1%). Among patients with documented uveitis lasting 10 years or more, all of them developed panuveitis. Median logMAR visual acuity at baseline was 0 (range −0.5; 0.7), 0.19 (range 0; 1.5) at year 5, and 0.7 (range 0.1 – no perception of light) at year 20, as recorded in 13, 16, and 10 eyes, respectively. All patients received treatment with topical and oral steroids, and multiple systemic immunosuppressants including biologics. Disease control, defined as having cells <1+ in both eyes and using topical steroid eye drops less than twice daily, was achieved in 14.3% to 37.5% of patients at the different time points. Cataract surgery was performed in 12 eyes of 8 patients, 3 eyes of 3 patients necessitated glaucoma surgery, and 4 eyes of 4 patients required surgery for retinal detachment. Conclusion: Uveitis associated with Blau syndrome commonly leads to severe, chronic panuveitis, requiring long-term systemic immunosuppression. Early diagnosis and timely initiation of biologics may prevent significant visual impairment. [ABSTRACT FROM AUTHOR]

Corneal neovascularization (CNV) is a major cause of blindness worldwide. However, the recent drug treatment is limited by repeated administration and low drug bioavailability. In this work, SU6668 (an inhibitor of receptor tyrosine kinases) and indocyanine green (ICG) are loaded onto poly(lactic- co -glycolic acid) (PLGA) nanoparticles, and then coated with anti-VEGFR2 single chain antibody (AbVr2 scFv) genetically engineered cell membrane vesicles. The nanomedicine is delivered via eye drops, and the hyperthermia induced by laser irradiation could block the blood vessels. Meanwhile, the photothermal effect can also cause the degradation of nanomaterials and release chemotherapeutic drugs in the blocked area, thereby continuously inhibit the neovascularization. Furthermore, SU6668 could inhibit the expression of heat shock protein 70 (HSP70), promoting the cell death induced by photothermal effect. In conclusion, the combination of photothermal and chemotherapy drugs provides a novel, effective and safe approach for the treatment of CNV. [Display omitted] [ABSTRACT FROM AUTHOR]

Introduction: This study compared the efficacy of hydroxypropyl guar (HPG)/hyaluronic acid (HA) and carboxymethylcellulose (CMC)/HA lubricant eye drops for post-cataract surgery dry eye disease (DED). Methods: This was a prospective, open-label, assessor-masked, parallel, randomized controlled study. Seventy patients with DED who underwent cataract surgery were randomized in a 1:1 ratio to receive 1–2 drops of HPG/HA or CMC/HA lubricant four times daily for 3 weeks. Efficacy assessments included changes from baseline in corneal fluorescein staining (CFS) score, Ocular Surface Disease Index score, Schirmer's test score (without anesthesia), tear break-up time, and central corneal sensitivity at weeks 1 and 3. Results: There were 35 patients in each group. The HPG/HA group demonstrated superior improvements in CFS scores (expressed as means and standard deviations) to the CMC/HA group at week 1 (– 1.0 [1.7] vs. – 0.1 [1.7], p = 0.039) and demonstrated comparable results at week 3 (– 1.6 [1.8] vs. – 1.3 [1.9], p = 0.552). No statistical differences were observed in other secondary outcomes between groups at weeks 1 and 3 (p > 0.05). Only one adverse event was reported in this study, which occurred in the HPG/HA group. The AE of ocular hypertension was mild, deemed unrelated to the study treatment, and resolved within a week. Conclusions: The HPG/HA lubricant eye drops resulted in greater CFS scores at 1 week after treatment compared with CMC/HA drops. The HPG/HA and CMC/HA drops were safe and well tolerated. ClinicalTrials.gov identifier: NCT06221345. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study is to assess the real-life efficacy and tolerance of a new preservative-free, surfactant-free latanoprost (PFSF-LAT) formulation. Methods: Retrospective, multicentre, non-comparative, observational study in patients with ocular hypertension or open angle glaucoma, naïve or non-naïve to previous intraocular pressure (IOP)-lowering treatment, and treated for at least 3 months with the study eye drop. IOP for worse eye, ocular signs and symptoms, and concomitant use of artificial tears were collected at study drug initiation and at last visit under treatment. Reasons for discontinuing the study eye drop (if relevant) and investigators' satisfaction were also assessed. Results: In the per protocol population (103 eyes; 63 naïve, 39 switched, 1 not classified because of missing data), IOP decreased significantly (p < 0.001) from 21.6 ± 5.0 mmHg at baseline to 16.1 ± 3.5 mmHg at the end of the study (mean reduction of − 5.5 ± 4.6 mmHg; − 25.5%). IOP in naïve patients was significantly improved, with a mean reduction of 7.1 mmHg (− 30.7%), which was within expected latanoprost IOP-lowering effect. Interestingly, in previously treated patients, switching to PFSF-LAT also allowed for a further 2.9 mmHg decrease in IOP (p < 0.001). The incidence of ocular side effects at study initiation was significantly (p < 0.001) reduced from 31.1% to 11.3% in the overall population, and from 65.0% to 7.5% in switched patients. This included conjunctival hyperaemia and superficial punctate keratitis (from 42.5% to 2.5% and from 37.5% to 2.5% in switched patients, respectively). According to investigators, tolerance and efficacy of the study eye drop were satisfactory or very satisfactory in 98.1% and 83.2% of patients, respectively. Conclusion: PFSF-LAT is an efficient treatment for patients with glaucoma with an improved tolerance profile. It can be considered as initial therapy in naïve patients or in patients with poor ocular tolerance to previous IOP-lowering eye drops. [ABSTRACT FROM AUTHOR]

Background: Allergic conjunctivitis, causing eye inflammation and redness, requires effective treatment with alcaftadine 0.25% and olopatadine 0.2% eye drops. Aims and Objectives: The aim of the study was to compare the efficacy and safety of alcaftadine and olopatadine ophthalmic medications in mild-to-moderate allergic conjunctivitis. Materials and Methods: A prospective, open-label, comparative study of 60 patients randomized into two study groups of 30 patients each. Each group was assigned to receive either olopatadine or alcaftadine ophthalmic solutions. Patients were followed through at regular intervals with a reduction of signs and symptoms documented using total ocular symptom scoring (TOSS) and hyperemia scale systems. Results: Baseline (1st visit) mean TOSS scores for the alcaftadine group and olopatadine groups were (6.12±1.92) and (6.32±1.80), respectively, as compared to the corresponding TOSS scores on 14th Day (4th visit) which were (0.5±0.11) and (0.9±0.40), respectively. The resolution of conjunctival symptoms in the alcaftadine group was significantly profoundly as comparison to olopatadine group (P = 0.004). Baseline (1st visit) mean hyperemia scores for alcaftadine group and olopatadine groups were (2.1±1.71) and (2.2±1.52), respectively, as comparison to the corresponding hyperemia scores on 14th day (4th visit) which were (0.08±0.01) and (0.6±0.32), respectively. The resolution of hyperemia symptoms in the alcaftadine group was significantly profound as compared to the olopatadine group (P = 0.002). Conclusion: Two topical medications utilized in the study were effective and safe for the therapy of allergic conjunctivitis. However, alcaftadine appears to surpass olopatadine in alleviating the symptoms of allergic conjunctivitis while having a lower side effect pro [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess and compare the effectiveness and side effects of various concentrations of pilocarpine eye drops (1.5%, 1.25%, and 1%), with and without 0.1% brimonidine, in treating presbyopia, specifically in a Thai population. Materials and Methods: A prospective, randomized, double-blinded, and crossover trial was conducted at Siriraj Hospital from August 2022 to April 2023. The study included emmetropic individuals aged 40 to 60 with presbyopia (near visual acuity not exceeding J1+) and refractive errors within +/- 0.5D. Ten subjects were randomly assigned to six groups for the different concentrations and type of eye drops using a computer-generated systematic randomization to receive 1.5%, 1.25%, and 1% pilocarpine with and without 0.1% brimonidine. And visual outcomes including visual acuity at distance and near were measured at 2, 4, and 6 hours post-application, with adverse effects monitored. Primary outcome was visual acuity at near after applied topical eye drops. Results: Among the 10 participants (30% male, median age 46.5 years old), 1.25% pilocarpine and combined 1.25% pilocarpine + 0.1% brimonidine significantly improved near visual acuity at all time points (statistically significant with Bonferroni correction). Adverse effects, such as dry eye and irritation, were more common with 1.5% pilocarpine + 0.1% brimonidine. Conclusion: In this preliminary study, 1.25% pilocarpine and 1.25% pilocarpine + 0.1% brimonidine showed promise in effectively treating presbyopia in the Thai study population, with acceptable side effect rates. Further research with larger sample sizes is needed to confirm these findings and provide more robust insights into presbyopia management in the Asian demographic. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the effectiveness and safety of intense pulsed light (IPL) therapy plus topical 0.05% cyclosporine A (CsA) eye drops to treat Sjögren's Syndrome-related dry eyes (SS-DE). Research design and methods: In this prospective, randomized trial included, 60 individuals with SS-DE symptoms were randomized to receive topical eye drops containing either 0.1% sodium hyaluronate (Group S) or 0.05% CsA (Group C) plus IPL therapy. Before the first treatment (baseline), and at 12, 16, and 20 weeks after treatment commencement, we assessed the best corrected visual acuity (BCVA), the Ocular Surface Disease Index (OSDI) score, the Schirmer I test (SIT), noninvasive tear breakup time (NBUT), corneal fluorescein staining (CFS), meibomian gland (MG) dropout, lid margin abnormality, MG expressibility, and meibum quality. Results: Both groups showed significant improvements in the OSDI, NBUT, CFS, MG expressibility, and meibum quality (all p < 0.05). Group C showed a greater increase in OSDI, NBUT, MG expressibility, and meibum quality (all p < 0.05). Moreover, SIT and lid margin abnormalities significantly improved in Group C (both p < 0.05), but not in Group S. Conclusion: Treatment with 0.05% CsA eyedrops plus IPL therapy could significantly reduce the issues and physical discomfort of patients with SS-DE. Clinical Trial: Registered on 20 July 2021, with the registration number ChiCTR2100049059. [ABSTRACT FROM AUTHOR]

Long-acting diquafosol ophthalmic solution (DQS-LX) has significant advantages regarding patient adherence owing to the reduced frequency of required eye drops; however, some patients prefer conventional diquafosol ophthalmic solution (DQS) over DQS-LX. Herein, to clarify the characteristics of patients according to their preference for ophthalmic solutions, dry eye (DE) and meibomian gland (MG) findings were retrospectively investigated. This study enrolled 341 patients with DE (mean age, 62.1 ± 11.7 years) treated at the Itoh Clinic between November 8, 2022, and July 31, 2023, who switched from DQS to DQS-LX. Patients were divided into two groups: those who continued DQS-LX administration (DQS-LX group) and those who wished to revert to conventional DQS (DQS group). Data regarding subjective symptoms assessed using the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire, tear film breakup time (BUT), tear meniscus height (TMH), corneal and conjunctival fluorescein staining (CFS), conjunctival hyperemia/papilla, meiboscore, plugging, vascularity, meibum grade, and Schirmer's score at the time of DQS-LX switch were evaluated. Of the 341 patients, 31 (9.1%) wished to revert to conventional DQS. In total, 16 eyes of 16 patients in the DQS group and 32 eyes of 32 patients in the DQS-LX group—for whom complete data were available—were included in the analysis. The DQS-LX group had higher SPEED scores, lower TMHs (P < 0.001, respectively), shorter FBUTs, greater CFS findings, larger meibum grades, lower Schirmer scores, and more pluggings compared with the DQS group (P = 0.005, 0.001, 0.001, 0.046, 0.003, respectively). Meiboscores and vascularity did not differ significantly between the two groups (P = 0.73 and 0.39, respectively). In conclusion, patients with low tear film volume and DE complicated by moderate or severe meibomian gland dysfunction (MGD) preferred DQS-LX, while those with allergic findings preferred conventional DQS. [ABSTRACT FROM AUTHOR]

Topical eyedrop administration is identified as an ideal non‐invasive strategy for ocular drug delivery. However, multiple complex ocular barriers greatly restrict their effectiveness in the treatment of posterior ocular disease. Herein, a liposome‐based permeable eyedrops (pDrops) capable of overcoming multiple ocular barriers and achieving efficient posterior drug delivery is presented. pDrops have a core‐shell structure in which drugs are encapsulated inside the liposome core with a chitosan shell. This chitosan coating significantly enhances the pDrops' binding to mucin in tears and facilitates the temporary opening of tight junctions in cornea/conjunctive epithelial cells, thereby achieving prolonged preocular retention and enhanced posterior segment drug delivery. In this study, hydrophilic ganciclovir (GCV) and hydrophobic curcumin (CUR) are employed as model drugs. Upon topical instillation, pDrops effectively overcome ocular barriers and delivered GCV to the posterior segment in both rat and rabbit eyes. Notably, CUR delivery by pDrops demonstrates significantly enhanced therapeutic efficacy in light‐damaged retina of mice. Considering that pDrops can deliver both hydrophobic and hydrophilic drugs to the posterior segment of the eye, it can potentially become a feasible platform for the non‐invasive delivery of various drug molecules and improve the treatment efficiency of posterior ocular diseases. [ABSTRACT FROM AUTHOR]

Purpose: An innovative eyedrop formulation based on a combination of 0.2% hyaluronic acid and 0.001% hydrocortisone sodium phosphate (Idroflog®, Alfa Intes, Italy; HAC eyedrops) was granted a European Patent in 2016 and has been available on the market since 2019 in Europe and in other countries around the world. HAC eyedrops aim to synergize the moisturizing effects of hyaluronic acid with the mild anti-inflammatory properties of low-dose hydrocortisone, offering a more effective and safer alternative for treating dry eye disease (DED), targeting both tear film instability and dysfunctional para-inflammation. The activity of HAC eyedrops has been explored in different post-marketing clinical trials, in addition to preclinical studies. In this narrative review, we explored the available evidence on the use of HAC eyedrops for the management of para-inflammation in DED patients to provide a comprehensive overview of efficacy and safety data related to the use of this medical device in routine clinical practice. Methods: A literature search for preclinical and clinical data involving treatment with HAC eyedrops was conducted using PubMed/MEDLINE, considering only original research articles published in English, without time restrictions. Results: One preclinical and four clinical papers were retrieved. Preclinical evidence suggests that 0.001% hydrocortisone is able to control the expression of inflammatory markers, and this, together with the hydrating and lubricating properties of hyaluronic acid, leads to improvements in DED clinical signs, such as tear volume and the stability of the tear film. The results of clinical trials demonstrate that HAC eyedrops are able to improve the signs and symptoms of DED and that 0.001% low-dosage hydrocortisone can be helpful in preventing the progression to chronic stages of DED. Conclusions: HAC eyedrops represent a promising therapeutic strategy for the management of dysfunctional para-inflammation and offer a valuable addition to the armamentarium of treatments for DED. [ABSTRACT FROM AUTHOR]

Background: Mooren's ulcer (MU) is a rare and debilitating form of peripheral ulcerative keratitis (PUK), characterized by a crescent-shaped ulcer with a distinctive overhanging edge at the corneal periphery. If left untreated, MU can lead to severe complications such as corneal perforation and blindness. Despite various treatment approaches, including anti-inflammatory and cytotoxic drugs, as well as surgical interventions, there is no clear evidence of the most effective treatment due to the lack of randomized controlled trials. AS-OCT is a non-invasive imaging technique that provides high-resolution cross-sectional images of the anterior segment, allowing for accurate evaluation of corneal ulcer characteristics, including depth, extent, and disease progression. Methods: We present the case of a 20-year-old male patient with MU managed using a stepladder approach, which included local and systemic corticosteroids, limbal conjunctival resection, and Cyclosporine A 1% eye drops. The patient underwent consecutive AS-OCT examinations and strict follow-up to tailor systemic and topical therapy. Results: Complete healing of the corneal ulcer with resolution of the inflammatory process was achieved. There was no recurrence of the disease at the 7-month follow-up. AS-OCT demonstrated progressive reorganization and thickening of the stromal tissue until the complete recovery of stromal thickness. Conclusions: The AS-OCT imaging modality allowed for the accurate evaluation of corneal ulcer characteristics, facilitating informed decision-making regarding the use of systemic immunosuppression, surgical interventions, and local immunomodulation and providing detailed and precise assessment of disease progression. This approach enabled a tailored and effective treatment strategy for the patient and played a critical role in guiding the therapeutic approach. [ABSTRACT FROM AUTHOR]

Ophthalmic tacrolimus compounded formulations are usually made from the commercial intravenous presentation, which contains ethanol as a solubilizer due to the low solubility of tacrolimus. The use of cyclodextrins is presented as an alternative to ethanol, an ocular irritant excipient, to avoid its long-term irritant effects. Open-label, sequential, prospective study to compare effectiveness, safety, and adherence of a new formulation of 0.015% tacrolimus with cyclodextrins (TCD) versus 0.03% tacrolimus with ethanol (TE). The ocular evaluation was assessed by ocular signs, corneal staining, subjective questionnaires as Visual Function Questionnaire (VFQ-25) and Visual Analogue Scale (VAS) of symptoms, lacrimal stability, ocular redness, and intraocular pressure. Compliance was assessed by VAS of adherence and empirically (difference between theoretical and actual consumption). Clinical ocular signs and corneal staining score remained stable for most patients 3 months after switching formulations. The TCD formulation did not modify the tear stability and intraocular pressure of the treated patients compared to the TE formulation. TCD eye drops significantly decreased the subjective pain values on VFQ-25 scale and burning sensation on the VAS symptom scale in comparison to TE formulation after 3 months after the change to TCD formulation. The novel tacrolimus in cyclodextrins formulation is a promising alternative for treating inflammatory ocular pathologies refractory to first-line treatments. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusionsCorneal 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.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.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.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]

Background: To compare and evaluate objective and subjective clinical parameters between 0.05% cyclosporine nanoemulsion (CsN) and 0.15% hyaluronic acid (HA) administration in patients with mild-to-moderate dry eyes. Methods: In this prospective, randomized, double-masked, single-center, and placebo-controlled parallel study, patients with mild-to-moderate dry eyes were randomly allocated to be treated with 0.05% CsN or 0.15% HA twice daily. Patients were followed-up at 4, 8, and 12 weeks. Objective and subjective parameters were evaluated during each visit. Results: A total of 35 patients were enrolled in this study. Compared with baseline, tear film break-up time and fluorescein staining scores at 4, 8, and 12 weeks significantly improved in the CsN group. However, the Schirmer I test showed no statistically significant change until week 12. Using the Symptom Assessment in Dry Eye (SANDE) score, both groups gradually showed significant improvement compared with baseline values. However, the Dry Eye-Related Quality-of-life Score Questionnaire (DEQS) showed no statistically significant change during the treatment period. Conclusions: Both 0.05% CsN and 0.15% HA administration twice a day effectively improved the objective signs and subjective symptoms of patients with mild-to-moderate dry eyes. However, patients treated with 0.05% CsN experienced greater and faster improvement. [ABSTRACT FROM AUTHOR]

This study aimed to explore the impact of yogic eye exercises on reducing eye fatigue among computer users. Employing a pre-post experimental design, 30 participants aged 20-40 were selected using convenience sampling, with 15 individuals assigned to both the exercise and control groups. The yogic eye exercise regimen involved 60-minute sessions twice daily for 120 days (4 weeks), encompassing 10 specific steps including palming, blinking, sideways viewing, rotational viewing, and guided relaxation techniques. Eye fatigue was assessed using a validated questionnaire designed to evaluate ocular fatigue. This study contributes to understanding the potential benefits of yogic eye exercises in alleviating eye fatigue among computer users. Result: The measurements from the exercise group demonstrated a notable reduction in eye fatigue scores compared to the control group. Conclusion: These results suggest that the implementation of yogic eye exercises has the potential to diminish eye fatigue scores in undergraduate nursing students [ABSTRACT FROM AUTHOR]

AIM: The aim of this study was to compare the sedative and analgesic effects of ketorolac and diclofenac eye drops among patients with cataract surgery (CS) who received tetracaine. METHODS: This double-blind randomized clinical trial was conducted in 2022. Participants were the candidates for CS consecutively selected from Amirkabir hospital, Arak, Iran, and were assigned to an artificial tear group, a ketorolac group, and a diclofenac group through block randomization. Pain, sedation status, heart rate, blood pressure, and arterial oxygen saturation were assessed during and after surgery. Complications prevalence and intraoperative propofol use were also documented. Data were analyzed using the SPSS software (v. 20.0) at a significance level of <0.05. RESULTS: There were no significant differences among the study groups respecting participants' age, gender, body mass index, blood pressure, heart rate, arterial oxygen saturation, CS duration, and Aldrete score (P > 0.05). From 5 min after CS onward, the mean score of pain in the ketorolac group was significantly less than the other groups (P < 0.05). The mean score of sedation from recovery to 1 h after surgery in the artificial tear group was significantly more than the other groups, whereas the mean score of sedation 2 and 4 h after CS in the ketorolac group was significantly more than the other groups (P < 0.05). Propofol use in the artificial tear group was significantly more than in other groups (P = 0.001) and patient and surgeon satisfaction in this group was significantly less than in other groups (P < 0.05). The ketorolac and the diclofenac groups did not significantly differ from each other respecting surgeon and patient satisfaction and the prevalence of complications (P > 0.05). CONCLUSION: Ketorolac eye drops are more effective than diclofenac eye drops in significantly reducing intraoperative pain among the candidates for CS with topical anesthesia. Therefore, ketorolac eye drops can be used with tetracaine eye drops in CS with topical anesthesia to produce greater perioperative analgesia and sedation. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To probe into clinical efficacy and safety of different doses of tacrolimus eye drops in the treatment of patients with keratoconjunctivitis. METHODS: A randomized, open cohort study was adopted. Totally 89 patients with keratoconjunctivitis admitted into Hubei Third People’s Hospital Affiliated to Jianghan University from Mar. 2021 to Mar. 2023 were extracted to be divided into low-dose group (n = 44) and conventional dose group (n =45) by random number table method. Tacrolimus eye drops were used once a day in the low-dose group and twice a day in the conventional dose group. All patients were treated continuously for 6 months. The scores of ocular symptoms and signs were compared between two groups before treatment, after treatment of 1 month, 3 months and 6 months. The inflammation levels [C-reactive protein (CRP), interleukin (IL)-2, IL-6], best corrected vision and intraocular pressure (IOP) were compared between two groups before treatment and after treatment of 6 months. The clinical efficacy and adverse events were compared between two groups. RESULTS: After treatment of 1 month and 3 months, the scores of ocular symptoms and signs in the conventional dose group were significantly lower than those in the low-dose group, with statistically significant differences (P <0. 05). After treatment of 6 months, there was no statistically significant difference between two groups in the scores of ocular symptoms and signs (P >0. 05). After treatment of 6 months, there was no statistically significant difference in serum CRP, IL-2, IL-6, IOP and best corrected vision between two groups (P>0. 05). The total effective rate of conventional dose group and low-dose group was respectively 91. 11% (41/45) and 88. 64% (39/44), with no statistically significant difference (P>0. 05). The incidence of adverse events in the low-dose group was 4. 55% ( 2/44), lower than 11. 11% ( 5/45) in the conventional dose group, the difference was not statistically significant (P>0. 05). CONCLUSIONS: The effects of low-dose tacrolimus in improving the clinical symptoms and signs of keratoconjunctivitis in the short term is less than that of conventional dose regimen, yet the long-term clinical efficacy is not affected, and the incidence of adverse events is lower when using low-dose tacrolimus, which has certain clinical application prospects. [ABSTRACT FROM AUTHOR]

Glaucoma stands as a primary cause of irreversible blindness globally, characterized by the progressive dysfunction and loss of retinal ganglion cells (RGCs). While current treatments primarily focus on controlling intraocular pressure (IOP), many patients continue to experience vision loss. Therefore, the research focus has shifted to therapeutic targets aimed at preventing or delaying RGC death and optic nerve degeneration to slow or halt disease progression. Traditional ocular drug administration, such as eye drops or oral medications, face significant challenges due to the eye's unique structural and physiological barriers, which limit effective drug delivery. Invasive methods like intravitreal injections can cause side effects such as bleeding, inflammation, and infection, making non-invasive delivery methods with high bioavailability very desirable. Nanotechnology presents a promising approach to addressing these limitations in glaucoma treatment. This review summarizes current approaches involving neuroprotective drugs combined with nanocarriers, and their impact for future use. [ABSTRACT FROM AUTHOR]

Glaucoma is one of the world's leading causes of blindness, and its management is challenging. The main objective is to lower intraocular pressure through medical, para-surgical, and surgical therapy. Medical therapy often represents the first line of treatment. Although effective in many cases, the eye drops are accompanied by significant problems. They require high patient compliance and can be associated with various side effects, limiting their efficacy. Consequently, the research for new drug delivery systems trying to overcome these limitations is ongoing: numerous devices are developing and gradually entering clinical practice. These new therapeutic options may offer better control of the intraocular pressure, with fewer side effects, and are less dependent on patients' compliance. Hence, the research in this field continues to flourish. This review summarizes the most recent findings in the scientific literature, underlines the role and possible limitations of the new glaucoma drug delivery systems in clinical practice, and recognizes their new horizons and perspectives. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety and efficacy of ripasudil for retinopathy of prematurity (ROP). Study design: Phase 1/2, multicenter, open-label, single-arm, 12-week clinical trial. Methods: Infants born with gestational age (GA) of ≤ 32 weeks or weight of ≤ 1500 g with zone I or II, ≥ stage 1, ROP in both eyes were enrolled. Ripasudil eye drops were administered to patients in both eyes. Phase 1 was a dose-escalation study (once daily for 1 week, then twice daily for 2 weeks); an additional dosing up to 9 weeks was allowed if no safety issues occurred. In phase 2, ripasudil was administered twice daily for up to 12 weeks. Adverse events were assessed. The proportion of patients with type 1 ROP progression, number of days for type 1 ROP progression, and progression to the most advanced ROP stage were estimated. Results: Twenty-four infants were enrolled (phase 1, n = 3; phase 2, n = 21). Nineteen and four patients experienced systemic and ocular adverse events, respectively. Efficacy endpoints were not different between the ripasudil and historical control groups. However, in the GA ≤ 27 weeks subgroup, fewer patients progressed to type 1 ROP in the ripasudil than in the historical control group (P = 0.09). In the GA ≤ 27 weeks subgroups, the 25th percentile for the number of days for type 1 ROP progression was 22 days in the historical control group and 44 days in the ripasudil group. Conclusion: Ripasudil was safe and inhibited/delayed type 1 ROP progression, especially in infants with short GA. [ABSTRACT FROM AUTHOR]