External stimuli-responsive drug delivery to the posterior segment of the eye

Posterior segment eye diseases represent the leading causes of vision impairment and blindness globally. Current therapies still have notable drawbacks, including the need for frequent invasive injections and the associated risks of severe ocular complications. Recently, the utility of external stimuli, such as light, ultrasound, magnetic field, and electric field, has been noted as a promising strategy to enhance drug delivery to the posterior segment of the eye. In this review, we briefly summarize the main physiological barriers against ocular drug delivery, focusing primarily on the recent advancements that utilize external stimuli to improve treatment outcomes for posterior segment eye diseases. The advantages of these external stimuli-responsive drug delivery strategies are discussed, with illustrative examples highlighting improved tissue penetration, enhanced control over drug release, and targeted drug delivery to ocular lesions through minimally invasive routes. Finally, we discuss the challenges and future perspectives in the translational research of external stimuli-responsive drug delivery platforms, aiming to bridge existing gaps toward clinical use.

Ophthalmic formulation of methotrexate: a strategy of using the self-assembled LacAC4A nanoparticles for non-invasive drug delivery to the ocular posterior segment

Drug delivery to ocular posterior segment remains difficult due to the challenges imposed by dynamic and static ocular barriers, lesion point targeting, and off-target effect. In this study, a novel approach is demonstrated for non-invasive drug delivery to the ocular posterior segments using lactose-modified azocalix[4] arene (LacAC4A) as a supramolecular ocular drug delivery platform. LacAC4A contains azo groups and is covalently modified by lactose groups, which confers active targeting to the retina, and induces a hypoxic response. The immunomodulator methotrexate (MTX), which is commonly used in ophthalmology to treat immune system diseases such as uveitis, was also selected as a guest to prepare MTX@LacAC4A. The prepared LacAC4A and MTX@LacAC4A systems were characterized, then the internalization mechanisms and hypoxia response abilities were determined through flow cytometry and fluorescence imaging, respectively. Besides, the delivery route and efficiency were verified, and the safety profile of MTX@LacAC4A was evaluated in multiple dimensions. Importantly, it was found that the prepared MTX@LacAC4A exhibits good biocompatibility, can effectively reach the posterior segment, and demonstrates potential ophthalmic applications. These findings lay the grounds for the future development of non-invasive ocular posterior segment disease treatments based on the advanced use of LacAC4A as a drug delivery platform.

Chitosan nanocarriers: A promising approach for glioblastoma therapy

Glioblastoma is a rapidly growing form of brain tumour originating from the supportive tissues present in the brain or spinal cord. The conventional therapeutic options include the use of alkylating agents, radiation and surgical procedures, that exhibits numerous limitations. The considerably less survival rate, very high incidence of recurrence and lack of effective therapeutic options has made the disease as the most lethal brain cancer. Being widely investigated, nanocarriers assure efficacy in brain targeting. Nano-based systems also hold the edge of higher encapsulation efficiency, ability to encapsulate anticancer therapeutics and effective blood brain barrier (BBB) penetration ability has been proven as one of the most successful means of delivering therapeutic agents in brain interstitial. The extreme biocompatible and biodegradable features of chitosan (CS) have been advantageous in combination with its easy fabrication and modifiable physicochemical behaviour. CS has been extensively investigated in the synthesis of nano-systems for brain targeting of drugs. The mucoadhesive behaviour of CS, cationic nature, and its ability to conjugate with various ligands helps in effective targeting of glioblastoma. This review specifically focuses on the fabrication of various CS-based nanocarriers for glioblastoma therapy, alongside describing its suitability and reflecting the recent research outcomes in glioblastoma therapy.

Seeing the unseen: The low treatment rate of eye emergencies in Africa

BACKGROUND

Emergency medical care is essential in preventing morbidity and mortality, especially when interventions are time-sensitive and require immediate access to supplies and trained personnel.

AIM

To assess the treatment rates of eye emergencies in Africa. Ocular emergencies are particularly delicate due to the eye’s intricate structure and the necessity for its refractive components to remain transparent.

METHODS

This review examines the low treatment rates of eye emergencies in Africa, drawing on 96 records extracted from the PubMed database using predetermined search criteria.

RESULTS

The epidemiology of ocular injuries, as detailed in the studies, reveals significant relationships between the incidence and prevalence of eye injuries and factors such as age, gender, and occupation. The causes of eye emergencies range from accidents to gender-based violence and insect or animal attacks. Management approaches reported in the review include both surgical and non-surgical interventions, from medication to evisceration or enucleation of the eye. Preventive measures emphasize eye health education and the use of protective eyewear and facial protection. However, inadequate healthcare infrastructure and personnel, cultural and geographical barriers, and socioeconomic and behavioral factors hinder the effective prevention, service uptake, and management of eye emergencies.

CONCLUSION

The authors recommend developing eye health policies, enhancing community engagement, improving healthcare personnel training and retention, and increasing funding for eye care programs as solutions to address the low treatment rate of eye emergencies in Africa.

Multidisciplinary management of pituitary macroadenoma

BACKGROUND

Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations. This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas, integrating neurosurgery, endocrinology, radiology, and pathology perspectives.

AIM

To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis, management, and rehabilitation of individuals with pituitary adenomas, to add to already preexisting knowledge, in managing these cases enhancing better ocular and systemic outcomes.

METHODS

A search was conducted on an online publication database (PubMed) using the term “pituitary adenoma” including all results published over twenty years (2004-2024). Results were sorted for relevance, language, and completeness.

RESULTS

A total of 176 records were returned. The guidelines of the PRISMA 2020 statement were followed in this study. A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates. Another 17 records were not available as full-length articles and were also excluded. The references of each included record was further searched for relevant publications. A total of 141 records were therefore used in this minireview.

CONCLUSION

Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact, modern therapeutic strategies offer effective management options. Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life. Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future

HPLC method for detecting prostaglandin F2α analogs in cosmetics: Optimization for chromatographic separation and sample preparation

Some prostaglandin F2α (PGF2α) analogs, including bimatoprost and tafluprost, are pharmaceutical substances known to cause specific abnormal reactions that promote eyelash growth. However, research on the simultaneous analysis of multiple PGF2α analogs using HPLC-UV or DAD techniques is limited. In this study, a high-performance liquid chromatography (HPLC) method was developed for the simultaneous analysis of 11 PGF2α analogs, optimizing both the analytical column and sample preparation method. Five columns with varying particle sizes, lengths, and packing types were compared to select the optimal analytical column. The separation efficiency of the columns was confirmed by comparing their chromatographic parameters, including retention time, resolution, number of theoretical plates, and height equivalent to a theoretical plate. Solid-phase extraction (SPE) was used to pretreat cosmetic samples, and the washing solvent and cartridge type for the SPE process were optimized. The established HPLC method was validated in terms of linearity, limits of detection and quantification, recovery, accuracy, and precision. The verified analytical method was applied to eyelash serums currently available in the market, and norbimatoprost was detected in one product. The HPLC method proposed in this study may help prevent the distribution of cosmetics containing illegal PGF2α analogs.

Long-term follow-up outcomes of intraoperative radiotherapy for breast-conserving treatment in early breast cancer: A retrospective cohort study

Intraoperative radiotherapy (IORT) has been used as a novel therapeutic alternative for breast-conserving surgery (BCS) in patients with breast cancer. However, the long-term outcomes and safety of IORT in patients with breast cancer remain incompletely understood. Therefore, the present study aimed to explore the long-term outcomes of IORT following BCS, focusing on the oncological outcomes and cosmetic consequences compared with postoperative RT (PORT) in patients with breast cancer. Patients with early-stage breast cancer who underwent BCS followed by IORT or PORT between January 2016 and October 2020 at the Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University (Nanjing, China), were retrospectively reviewed. After screening, a total of 59 patients were included in the present study and divided into two groups according RT records as follows: The IORT group (n=21) and the PORT group (n=38). The clinical data of all patients, including surgical and RT complications, cosmetic grading and scoring, and other events, were collected and retrospectively analyzed. No significant difference was observed in terms of the mean follow-up time in the IORT (5.89±1.57 years) and PORT (6.09±1.60 years) groups (P>0.05). Compared with PORT, IORT showed non-inferior therapeutic efficacy, with no significant differences in postoperative complications (surgical site infection and chronic pain; P>0.05). Notably, the IORT group achieved superior cosmetic outcomes, with 95.2% (20/21) of patients achieving a rating of excellent/good vs. 44.7% (17/38 patients) in the PORT group (P<0.001), alongside higher median cosmetic scores at all postoperative intervals (P<0.01). IORT also reduced healthcare utilization, shortening hospitalization by 23.8 days (12.1±5.1 vs. 35.9±3.5 days; P<0.001) and lowering costs significantly (33,117.98±6,281.17 vs. 77,789.55±7,000.90 CNY; P<0.001). These findings suggest that IORT offers comparable safety, improved cosmesis and greater cost-effectiveness than PORT, supporting its integration into clinical practice for eligible patients.

Clinical strategies to prevent recurrence of Herpes simplex and Herpes zoster following ocular surgery: A comprehensive review with practical guidelines

Recurrences of herpetic infections following intraocular surgeries pose a threat to optimal surgical outcomes. The high prevalence of herpetic diseases require ophthalmologists to be familiar with the special measures in the surgery of these patients. A thorough preoperative assessment and meticulous postoperative surveillance should be tailored for each patient, depending on the surgery and the risk of virus reactivation. We compile the relevant evidence in the literature and provide a comprehensive review of the preoperative assessment and postoperative diagnostic clues and management of the herpetic infections following different types of intraocular surgeries, including cataract surgery, keratoplasty, corneal crosslinking, glaucoma, and refractive surgeries.

Evaluating advanced AI reasoning models: ChatGPT-4.0 and DeepSeek-R1 diagnostic performance in otolaryngology: a comparative analysis

PURPOSE

This study aimed to evaluate the diagnostic accuracy, comprehensiveness, and clinical relevance of two advanced artificial intelligence (AI) models, OpenAI's ChatGPT-4.0 and DeepSeek-R1, in the field of otolaryngology.

METHODS

Five common otolaryngology procedures-adenotonsillectomy, tympanoplasty, endoscopic sinus surgery, parotidectomy, and total laryngectomy-were analyzed through standardized queries posed to both AI models. Because the prompts replicate questions that patients typically search online, our evaluation focuses on patient-facing informational adequacy. Responses were independently evaluated by two study members for accuracy, clinical relevance, and comprehensiveness, with discrepancies resolved through consensus. The analysis included comparison with clinical guidelines.

RESULTS

ChatGPT-4.0 generally provided detailed procedural insights, effectively covering indications, methodologies, risks, and recovery processes. However, it occasionally suggested excessive diagnostic imaging and omitted subtle yet significant surgical nuances. DeepSeek-R1 delivered concise, structured responses clearly categorizing indications, treatment alternatives, and procedural risks. Nonetheless, it frequently lacked detailed elaboration, omitting important surgical techniques and minor complications. For instance, DeepSeek-R1 omitted specifics such as hemostatic techniques in adenotonsillectomy and graft stabilization details in tympanoplasty. Neither model adequately addressed critical elements like comprehensive staging, detailed surgical planning, and long-term recovery nuances, especially for complex procedures such as total laryngectomy.

CONCLUSIONS

Both ChatGPT-4.0 and DeepSeek-R1 demonstrated significant diagnostic potential but revealed limitations in precision, comprehensiveness, and nuanced clinical reasoning. Their clinical utility remains restricted, highlighting a continued need for AI refinement to enhance patient-specific decision-making capabilities in otolaryngology.

Enhancing the outcomes of diabetic vitrectomy with pharmacological adjuvants

This editorial offers insights from a minireview by Venkatesh et al, who explored pharmacological adjuvants for diabetic vitrectomy. Specifically, they synthesized current knowledge and evaluated the efficacy of various adjunctive therapies in improving the outcomes of diabetic retinopathy and managing associated complications. Herein, we highlight the key roles of pharmacological adjuvants in optimizing surgical techniques, minimizing intraoperative challenges, and enhancing postoperative recovery. We further discuss the potential implications of this approach for clinical practice and future research directions in this evolving field. Overall, this editorial underscores the importance of incorporating pharmacological adjuvants into standard diabetic vitrectomy care to improve surgical outcomes and thus patients’ quality of life.

Development and validation of a decision algorithm for eyelid reconstruction following oncological resection

BACKGROUND

Eyelid reconstruction is an intricate process, addressing both aesthetic and functional aspects post-trauma or oncological surgery. Aesthetic concerns and oncological radicality guide personalized approaches. The complex anatomy, involving anterior and posterior lamellae, requires tailored reconstruction for optimal functionality.

AIM

To formulate an eyelid reconstruction algorithm through an extensive literature review and to validate it by juxtaposing surgical outcomes from Cattinara Hospital with established findings.

METHODS

The algorithm was formulated by analyzing 1538 articles, which were subsequently refined to 113 according to quality standards, and then implemented in surgical cases at Cattinara Hospital. Complication rates were examined for validity.

RESULTS

The decision algorithm was employed to apply reconstructive techniques customized to the characteristics of the eyelid defect, including its depth and location. The results exhibited a minimal complication rate, consistent with established guidelines. Validation confirmed the algorithm’s efficacy in reducing post-operative problems.

CONCLUSION

This algorithm functions as an essential decision-making instrument for eyelid reconstruction, enhancing outcomes by minimizing complications in clinical practice.

Current concepts and recent trends in endothelial keratoplasty

Endothelial keratoplasty (EK) is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue, which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s) with healthy donor tissue, to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity. Recently, the pathophysiology of corneal decompensation is increasingly being researched upon. Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK. In addition, EK techniques have progressed towards using thinner tissue, optimizing visual outcomes. Improvements have enabled better donor tissue formulation, usage, and attachment, and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection. However, challenges are encountered in various complex clinical scenarios including eyes with prior intraocular surgery, complex anterior chamber anatomy, glaucoma, ocular surface disease etc. These complexities demand tailored surgical strategies, including modifications in graft handling, instrumentation, and postoperative management to ensure success. Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases. The choice of procedure depends on multiple factors, including the surgeon's experience, patient's ocular anatomy, and the specific clinical scenario. This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications, contraindications, surgical techniques, clinical situations, community aspects and future directions pertaining to EK.

Primary open-angle glaucoma: a perspective from plasma metabolomics

INTRODUCTION

Primary open-angle glaucoma (POAG) is an optic neuropathy, characterized by progressive loss of visual field, loss of retinal ganglion cells (RGC) and optic nerve damage. The diagnosis and management of POAG involves tests such as static perimetry, tonometry and optical coherence tomography (OCT) to track progressive structural and functional changes. All these methods have limitations. Advancements in the discovery of metabolomic plasma-derived biomarkers may improve clinical outcomes, through identifying susceptible individuals, predicting disease progression, and assessing treatment efficacy in POAG.

AREAS COVERED

We reviewed the current state of POAG management, identified limitations and need for biomarkers that could potentially fill the gap and current landscape of POAG plasma metabolomics, providing an overview of future potential biomarkers.

EXPERT OPINION

Advances in the identification of metabolomic biomarkers can improve current clinical practices. These biomarkers can complement existing diagnostic tools, allowing for earlier detection and personalized treatment strategies. However, challenges remain, including a lack of standardization in metabolomics protocols, variability in disease progression and finally, recording treatment non-response currently also suffers from a lack of standardization toward depicting treatment outcomes. Future research should focus on standardizing procedures, increasing diversity in study populations, and conducting longitudinal studies to validate biomarkers in clinical settings.

Recent developments in peptide vaccines against Glioblastoma, a review and update

Glioblastoma multiforme (GBM) is the most prevalent invasive CNS tumor, with a high incidence rate and a high likelihood of recurrence in most patients. Despite available treatments, recurrent glioblastoma (rGBM) exhibits growing resistance to chemotherapy and radiotherapy, which necessitates the development of newer methods of treatment. Peptide vaccines, a type of cancer immunotherapy, have recently attracted attention as a potentially practical therapeutic approach because they target tumor-associated or tumor-specific antigens to generate an effective immune response against cancer cells. These vaccines have been included in several clinical trials, demonstrating their safety and effectiveness by eliciting protective immune responses. However, peptide vaccines for glioblastoma face challenges due to the complex nature of intracranial brain tumors that require innovative approaches and in-depth research to increase their efficacy. The main topics covered in this article include immunological inhibitors and immune characteristics of the CNS and GBM, the basis of immunity, and the significant results of clinical trials of peptide vaccine therapy for GBM. Additionally, it examines the potential causes of the low effectiveness of these vaccines and recommends future research to address the specific challenges associated with immunotherapy in GBM. The evaluation of preliminary phase studies and phase III clinical trials will provide insights into potential immunological responses, biosecurity precautions, and clinical outcomes, guiding future vaccination initiatives to promote higher effectiveness.

Psoriasis unveiled: The cellular ballet, molecular symphony, and genetic puzzle

Psoriasis is a chronic autoimmune disease of the skin manifested by keratinocyte hyperproliferation, immune dysregulation, and chronic inflammation that result in scaly plaques. Conventional interventions such as corticosteroids, immunosuppressants, and biologics offer symptomatic relief but are limited by side effects and incomplete remission. Psoriasis pathogenesis is complex and entails numerous immune cells (dendritic cells, Th1, Th17, Th22, Tregs, macrophages, NK cells) and molecular pathways (IL-17, IL-22, IL-23, TNF-α, NF-κB). Gene therapy suppresses cytokine production, modulates immune activation, and normalizes keratinocyte turnover to achieve sustained control of disease. Gene therapy is a promising option by modulating inflammatory circuits at the molecular level. Methods such as CRISPR-Cas9, RNA interference (RNAi), and antisense oligonucleotides (ASOs) target major psoriasis-related cytokines (IL-17, IL-22, IL-23, TNF-α) and transcription factors (NF-κB), inhibiting inflammation and abnormal keratinocyte proliferation. With ongoing research, gene-based therapies in combination with biologics and nanotechnology-based drug delivery provide a personalized and efficient option for the treatment of psoriasis. This review discusses conventional and innovative gene therapies, which have been found to hit specific cellular and molecular targets to combat psoriasis therapy.

An overview of novel formulations for ocular viral infections: focused on nanomedicines

Ocular viral infections are a common cause of blindness globally. Many ocular viral infections are mistakenly identified as bacterial infections. In these situations, treatment is initiated belatedly and fails to address the root cause of the infection, which frequently results in serious ocular complications like corneal infiltrates, conjunctival scarring, and decreased visual acuity. The efficacy of conventional treatments for viral infections suffers from poor bioavailability, which requires the development of novel methods of drug delivery, accurate diagnosis, and efficient treatment choices. As nanotechnology in medicine advances at a rapid pace, multifunctional nanosystems are being prioritized more and more to address the problems brought on by viral infections of the eyes offering targeted delivery, increased bioavailability and decreased systemic toxicity. This study delivers a thorough overview of the use of nanomedicines in the treatment of ocular viral infections, with a particular emphasis on how they may enhance the safety and efficacy of antiviral drugs. We address a range of nanocarrier systems, such as liposomes, nanoparticles, nanosuspension, proniosomes, in-situ gels, dendrimers, and nanogels, emphasizing their distinct characteristics that facilitate the effective transportation of antiviral drugs to ocular tissues. This article also highlighted the regulatory barriers of ocular nanoformulation. The transition of in-vitro studies to in-vivo and clinical models has been discussed. This review also highlights the Preclinical studies of ocular viral treatment, ocular nanotoxicology and advancement of ocular antiviral treatments in the form of patents, ongoing clinical trials and marketed formulations.

Delivery of a novel neuroprotective compound to the retina in rat and rabbit animal models

Posterior segment-related diseases are among the leading causes of irreversible blindness and loss of vision globally. These diseases are extremely difficult to treat due to the drug delivery barriers posed by the eye, among other challenges. One delivery method that bypasses many of these obstacles, albeit not without risk, is ocular injections, and long-acting formulations such as implants can improve patient compliance by allowing for longer intervals between injections. Here, we report our development of a preclinical in situ-forming implant dosage form that provides sustained release of a novel compound, DKR-1677, with a target in the retina. An in situ-forming implant based on polylactic co glycolic acid (PLGA) was chosen in this preclinical stage because it is readily translatable to a preformed implant product. The formulations were tested in vitro, in rat and rabbit animal models for drug release and pharmacokinetics. A two-step in vitro dissolution method with implant formation in a biorelevant gel followed by incubation in release media showed a 30-day three-phase release profile with an initial burst release of 36.04 ± 4.23 %, a plateau, and a controlled release up to 93.75 ± 4.68 % at day 30, typical of PLGA-based implant formulations. Immediate and controlled-release formulations were tested in rat and rabbit animal models and confirmed that DKR-1677 is taken up by the retina after intravitreal administration. Furthermore, the in situ-forming implant was found to prolong drug presence in the retina to 30 days following a single administration, confirming that a PLGA-based implant is a viable approach for this drug candidate.

Sutureless Scleral-Fixated Soleko Fil Carlevale Intraocular Lens and Associated Pars Plana Vitrectomy in Aphakia Management: A National Multicenter Audit

Objective: The aim of this study was to evaluate the clinical outcomes of sutureless scleral-fixated (SSF) Soleko Fil Carlevale intraocular lens (SC-IOL) implants associated with pars plana vitrectomy (PPV) in patients with aphakia secondary to complicated cataract surgery or IOL luxation nationwide. Methods: A multicenter, national, retrospective study of 268 eyes (268 patients) which underwent simultaneous PPV and SC-IOL implantation was conducted. Demographics; ocular data; pre-surgical, surgical and post-surgical details; and refractive results were collected. Intra- and postoperative complications and management details were described. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central retinal thickness (CRT) were collected at 1 week and at 1, 3, 6 and 12 months post-surgery. Kaplan-Meier curves were constructed to assess the cumulative probability of postoperative BCVA, IOP levels, macular edema (ME) and corneal decompensation. Results: The cumulative probability of final VA ≤ 0.3 logMAR was 64.4% at 12 months follow-up. The probability of IOP > 21, ≥25 and ≥30 mmHg was 29.8%, 16.9% and 10.1%, respectively, and the cumulative probability of IOP-lowering treatment was 42.3% at 12 months. Glaucoma surgery was required in 3.7% of the eyes (10/268). The cumulative probability of postoperative ME development was 26.6% at 12 months, managed with topical treatment alone (73.5%) and intravitreal injections (26.5%). Corneal transplantation was required in 3.7% of the eyes (10/268). Conclusions: Sutureless scleral-fixated SC-IOL is an adequate therapeutic alternative in the management of aphakia with good visual results and an acceptable safety profile in routine clinical care. Longer-term studies are needed to evaluate its results and complications compared to other therapeutic alternatives.

Use of semaglutide and risk of non-arteritic anterior ischemic optic neuropathy: A Danish-Norwegian cohort study

AIMS

To investigate the putative association between semaglutide and non-arteritic anterior ischaemic optic neuropathy (NAION).

MATERIALS AND METHODS

Data from national health registries in Denmark (2018-2024) and Norway (2018-2022) were used to compare NAION risk in individuals with type 2 diabetes initiating semaglutide versus sodium-glucose co-transporter 2 inhibitors (SGLT-2is). A supplementary self-controlled analysis examined NAION risk among all semaglutide users. National estimates were pooled using a fixed-effects model.

RESULTS

We identified 44 517 users of semaglutide for the management of type 2 diabetes in Denmark and 16 860 in Norway, with a total of 32 NAION events observed. The unadjusted incidence rate of NAION was 2.19/10 000 person-years among Danish semaglutide initiators, compared to 1.18 among SGLT-2i initiators. In Norway, the corresponding rates were 2.90 and 0.92, respectively. After adjustment, the pooled hazard ratio (HR) was 2.81 (95% confidence interval [CI] 1.67-4.75), and the incidence rate difference (IRD) was +1.41 (95% CI +0.53 to +2.29) per 10 000 person-years. Estimates were consistent across both countries but higher and less precise in Norway (HR 7.25; 95% CI 2.34-22.4) compared to Denmark (HR 2.17; 95% CI 1.20-3.92). Results remained consistent across sensitivity and supplementary analyses, with a stronger association observed in a post hoc per-protocol analysis (HR 6.35; 95% CI 2.88-14.0). In the supplementary self-controlled study, symmetry ratios (SRs) for NAION were 1.14 (95% CI 0.55-2.36) in Denmark and 2.67 (95% CI 0.91-8.99) in Norway.

CONCLUSIONS

The use of semaglutide for managing type 2 diabetes is associated with an increased risk of NAION compared with the use of SGLT-2is. However, the absolute risk remains low.

Nitro-Oleic acid protects from neovascularization, oxidative stress, gliosis and neurodegeneration in oxygen-induced retinopathy

Inflammation and oxidative stress are involved in Proliferative Retinopathies (PR). Müller glial cells (MGCs) and microglia play pivotal roles in pathological neovascularization (NV) and neurodegeneration in PR. Nitro-fatty acids are important electrophilic signaling mediators with anti-inflammatory and antioxidant properties. Herein, our goal was to evaluate the cytoprotective effect of nitro-oleic acid (NO2-OA) on neurons, MGCs and microglia in a mouse model of oxygen-induced retinopathy (OIR). NO2-OA induced vascular regrowth and reduced NV at P17 OIR, although no difference in the proangiogenic/antiangiogenic (VEGF-A/PEDF) balance was found between NO2-OA treatment and vehicle. In addition, Western blot and immunofluorescence assays showed that NO2-OA prevented gliosis at P17 OIR and decreased the number and activation of IBA1+ retinal myeloid cells. However, NO2-OA did not restore the decrease in expression of glutamine synthase (GS). Loss of retinal function in OIR mouse model measured by electroretinography was ameliorated, mainly at P26 OIR, after NO2-OA treatment. Western blot analysis of retinas from OIR mice revealed decreased levels of caspase-3 protein and increased number of TUNEL-positive cells at P26 compared to RA. Notably, these alterations were partially prevented after NO2-OA treatment. Besides, NO2-OA attenuates oxidative stress induced in MGCs exposed to aqueous humor from patients with different stages of PR. These findings highlight NO2-OA as a promising therapeutic strategy targeting both vascular and neuroglial components in PR, suggesting its potential clinical relevance.

Exosomes in Regulating miRNAs for Biomarkers of Neurodegenerative Disorders

Exosomal proteins and miRNAs, including α-synuclein, Aβ, tau, CXCL12, miR-24, and miR-23b-3p, are emerging as valuable biomarkers for Parkinson's disease and prenatal diagnostics, with significant potential for personalized therapies. Advances in MRI and chitosan-based drug delivery systems are creating new opportunities for diagnosing and treating neurodegenerative disorders. Exosomes regulate miRNAs and proteins, presenting theranostic potential for Alzheimer's and Huntington's diseases, yet facing delivery and targeting challenges. Exosomal miRNAs, such as miR-1234, miR-5678, and miR-29a, are crucial for the early detection and monitoring of the progression of neurodegenerative diseases. Additionally, novel biomarkers such as SCA27B and FGF14 gene mutations and serum miR-455-3p offer promising noninvasive diagnostic methods for Alzheimer's disease. The expanding role of exosome-derived miRNAs in targeting oncogenes and regulating the cell cycle enhances therapeutic strategies for neurological disorders, opening doors to more personalized and effective disease management.

Management of ocular hypertension following intravitreal dexamethasone implant (ozurdex)

Purpose

To evaluate the impact of intravitreal dexamethasone implantation (Ozurdex) on ocular hypertension (OHT) development and characterize its management with non-invasive or minimally-invasive modalities.

Results

Chart review was performed for patients who received Ozurdex implantation between September 2016 to September 2023. Patients were excluded if they had ever been diagnosed with neovascular glaucoma or received a different intravitreal corticosteroid prior to Ozurdex injection or 6 months afterwards. The analysis included 171 Ozurdex implants (n = 61 patients, n = 74 eyes) for analysis. Patients were followed for an average of 326 ± 45 days. The rise in IOP was greatest 2- and 3-months post-injection. OHT occurred following 40 (23.3 %) Ozurdex implants. To lower IOP, medical drops were initiated after 17 (10.0 %) implants. Selective laser trabeculoplasty was performed in 2 (1.2 %) cases. Minimally-invasive glaucoma surgeries (MIGS) were utilized in 7 (4.1 %) cases. Patients >60 years old were at increased odds of developing OHT, whereas patients treated for retinal vein occlusion were less likely to develop OHT compared to patients treated for diabetic macular edema.

Conclusion

Patient-specific characteristics, including age and treatment indication, may confer different risk for developing OHT following Ozurdex implantation. Ozurdex-induced OHT can be safely and effectively managed using a combination of medical therapy, laser trabeculoplasty, and angle-based MIGS. This study supports an increasing range of alternative approaches for addressing elevated IOP or postponing surgeries linked with higher risks.

Reliability of Self-Monitoring of Intraocular Pressure With iCare Home2 Rebound Tonometry

PRCIS

Using iCare Home2 (iCare, Finland) rebound tonometry, self-measurement of intraocular pressure has demonstrated good reliability and ease of use.

PURPOSE

To investigate the reliability and repeatability of self-measured intraocular pressure (IOP) with rebound tonometry using iCare Home2.

PATIENTS AND METHODS

One hundred four patients out of 110 consecutive patients were recruited for this observational cross-sectional study. One randomly selected eye from each patient underwent 6 consecutive IOP measurements with Goldmann applanation tonometry (GAT), iCare IC200, and iCare Home2. Every eye was tested twice with each device, in random order, by an ophthalmologist for GAT and IC200, and by the patient itself for Home2. In addition, central corneal thickness (CCT) has been collected. The reliability of Home2 has been tested by calculating limits of agreement (LoA) between self-measured and physician-measured IOP, using the Bland-Altman analysis. The repeatability of each device has been tested by calculating the limits of repeatability (LoR) with the same method. Pearson correlation coefficient was used to determine the correlation between differences in IOP measurements and CCT.

RESULTS

The mean difference between GAT and iCare Home2 was -0.28±1.57 mmHg ( P =0.070), 95%-LoA: (-3.36 to 2.79 mmHg). The mean difference between IC200 and iCare Home2 was 0.92±1.48 mmHg ( P <0.0001), 95%-LoA (-1.98 to 3.82 mmHg). The mean difference between the first and second measurements with GAT, iCare IC200, and iCare Home2 measurements was 0.21±0.98 mmHg ( P =0.03), -0.02±1.11 mmHg ( P =0.88) and -0.23±1.04 mmHg ( P =0.05).

CONCLUSIONS

Self-measured IOP with rebound tonometry showed good reliability and repeatability when compared with physician-measured IOP with both standard GAT and rebound tonometry.

Radiomics-based histological grading of pancreatic ductal adenocarcinoma using 18F-FDG PET/CT: A two-center study

OBJECTIVE

To explore the value of radiomics features derived from 18F-FDG PET/CT images in predicting the histological grade of pancreatic ductal adenocarcinoma (PDAC).

MATERIALS AND METHODS

A retrospective analysis was conducted using data from patients with suspected pancreatic cancer, who histologically confirmed as PDAC within 14 days after 18F-FDG PET/CT scan in one of two hospitals. Tumors were divided into high-grade (undifferentiated or poorly differentiated), and low-grade (moderately or well differentiated). Two researchers independently used uRP to perform layer-by-layer tumor segmentation in both PET and CT images of each patient, and extract features. Model performance was evaluated using 5-fold cross-validation on the entire multi-center cohort, with results averaged across all folds. The least absolute shrinkage and selection was used for feature selection, and support vector machine (SVM), random forest (RF), and logistic regression (LR) were employed to distinguish the grade of PDAC. The performance of the model was evaluated using the receiver operating characteristic curve.

RESULTS

This study comprised 111 patients (72 males and 39 females), comprising 52 patients with high-grade PDAC tumors and 59 patients with low-grade. A series of models were established by SVM, LR, and RF algorithms based on selected features. In the test set, the mean areas under the curve (AUCs) for PET image-based models using SVM, LR, and RF algorithms were 0.773, 0.772, and 0.760. For CT-based models, the mean AUCs were 0.764, 0.770, and 0.576. For PET/CT-based models, the mean AUCs were 0.840, 0.844, and 0.773.

CONCLUSION

Despite the lack of external validation, the PET/CT-derived radiomics model enables accurate preoperative histological grading of PDAC, offering a clinically actionable tool to neoadjuvant therapy stratification and further guide personalized medical decision-making.

Immunological and histopathological changes in alkali burn-induced ocular surface pannus: Implication on success vs. failure of SLET

PURPOSE

This study aimed to investigate the histopathological and immunological characteristics of human alkali burn ocular surface pannus in successful and failed cases of simple limbal epithelial transplantation (SLET).

METHODS

Paraffin embedded pannus sections of limbal stem cell deficiency (LSCD) patients who underwent simple limbal epithelial transplantation were obtained from pathology. Samples included both cases of SLET failure (n = 12) and success (n = 7). Histological features were assessed using Hematoxylin-Eosin and Periodic acid-Schiff staining while infiltrated immune cells were characterised using immunohistochemistry. Data were represented as mean or median with the interquartile range and standard deviation. Multiple comparisons of means by linear mixed effect model with Tukey contrast and Bonferroni method were used.

RESULTS

Conjunctivalization of the cornea that led to fibrous pannus formation was confirmed by the presence of CK19+ and CK3/12- cells. The median percentage of immune cell infiltrates like T-cells (CD3; success (9 %; IQR-9.2) vs. failure (23.5 %; IQR-10.2), (CD5; success (2.2 %; IQR-3) vs. failure (13.4 %; IQR-18.3), B-cells (CD20; success (3.2 %; IQR-3.2) vs. failure (4.1 %; IQR-5.5), antigen presenting cells (co-stimulatory CD40; success (7.8 %; IQR-8.9) vs. failure (16.4 %; IQR-7.1), and plasma cells (CD138; success (1.1 %; IQR-2.1) vs. failure (3.6 %; IQR-3.5) were identified in the pannus.

CONCLUSIONS

This study highlights a significantly higher infiltration of immune cells in the pannus and surrounding ocular tissue in cases of SLET failure compared to successful outcomes. These findings suggest that, strategies to reduce immune infiltration such as immunotherapy, corticosteroids, or amniotic membrane grafting should be considered prior to SLET to improve the success of limbal transplant surgery.

An Engineered Intravitreal Injection Retinal-Pigment-Epithelium-Tropic Adeno-Associated Virus Vector Expressing a Bispecific Antibody Binding VEGF-A and ANG-2 Rescues Neovascular Age-Related Macular Degeneration in Animal Models and Patients

Antiangiogenesis gene therapy based on adeno-associated virus (AAV) vectors represents a promising advancement in the treatment of neovascular age-related macular degeneration (nAMD), providing an alternative to antibody-based therapies. However, the development of a safe and effective AAV vector capable of precisely targeting neovascularization and choroidal leakage remains a critical unmet need. In the present study, we engineered a novel intravitreally administered AAV vector with retinal-pigment-epithelium (RPE)-specific tropism. This vector demonstrated robust and localized gene expression in RPE cells while maintaining a favorable safety profile. The RPE-tropic AAV vector delivered a dual-acting antibody against vascular endothelial growth factor (VEGF) and angiopoietin-2 (ANG-2), exhibiting strong therapeutic efficacy and tolerability in both rodent and nonhuman primate choroidal neovascularization models. Based on the promising preclinical data, a single-center, single-arm, investigator-initiated trial (ChiCTR2400085329) was conducted to assess its safety and efficacy in patients with nAMD. The RPE-tropic AAV vector expressing anti-VEGF-A and anti-ANG-2 effectively alleviated disease progression and was well tolerated in the clinical setting. These findings highlight the potential of this engineered AAV-RPE capsid as a versatile platform for gene therapy, not only for nAMD but also for other ocular diseases involving RPE cells.

Advanced 3D scaffolds for corneal stroma regeneration: a preclinical progress

Corneal stromal defects represent a significant global cause of blindness, necessitating innovative therapeutic strategies to address the limitations of conventional treatments, such as corneal transplantation. Tissue engineering, a cornerstone of regenerative medicine, offers a transformative approach by leveraging biomaterial-based solutions to restore damaged tissues. Among these, three-dimensional (3D) scaffolds fabricated using advanced techniques like 3D printing have emerged as a promising platform for corneal regeneration. These scaffolds replicate the native extracellular matrix (ECM) architecture, providing a biomimetic microenvironment that supports cell proliferation, differentiation, and tissue integration. This review highlights recent advances in the design and fabrication of 3D scaffolds for corneal stroma engineering (CSE), emphasizing the critical interplay between scaffold architecture, mechanical properties, and bioactive signaling in directing cellular behavior and tissue regeneration. Likewise, we emphasize the diverse range of biomaterials utilized in scaffold fabrication, highlighting their influence on cellular interactions and tissue reconstruction. By elucidating the complex relationship between scaffold design and biologics, this review aims to illuminate the evolution of next-generation strategies for engineering functional corneal tissue. Eventually, this review will provide a comprehensive synthesis of the current state-of-the-art in 3D scaffold-based corneal tissue engineering (CTE), offering insights that could advance progress toward effective vision restoration therapies.

Revitalizing upper blepharoplasty: Preserving volume

Blepharoplasty is a frequently performed aesthetic surgery today aimed at enhancing eyelid appearance and correcting age-related changes. The traditional method of subtraction blepharoplasty, which involved removing fat and excess skin, is now considered outdated. This letter explores Gorgy et al's commentary on Miotti et al's study, highlighting a shift in upper eyelid blepharoplasty towards a more conservative, volume-preserving approach. The study systematically reviewed 10 publications, including three retrospective studies, five comparative studies, and two clinical trials. It emphasizes the trend towards preserving the patient's natural anatomy and focusing on enhancement rather than alteration. However, the study's limitations, such as the lack of long-term comparative research, a relatively small sample size, and a single-center design, indicate that further research with extended follow-up is necessary to validate the safety and effectiveness of these techniques. The focus is increasingly on preserving and augmenting volume in upper blepharoplasty rather than removing tissue.

Current and future directions for the use of handheld fundus cameras in telehealth

INTRODUCTION

A shortage of trained retinal specialists has created a growing need for a telehealth retinal screening alternative. Recent developments in handheld fundus cameras, enhanced by artificial intelligence (AI) and machine learning (ML) methods, have created a promising avenue to satisfy the unmet need for efficient retinal disease screening. This paper discusses the state of current handheld fundus cameras as well as promising future directions.

AREAS COVERED

Commercially available handheld fundus cameras and the current and future developments in telehealth retinal screenings using these cameras are discussed. Relevant literature encompassing handheld fundus cameras, diagnostic accuracy, and AI in grading were included. Commercial handheld fundus cameras were targeted in the literature and from their company websites. Additional information was obtained through dialogs with company representatives.

EXPERT OPINION

Handheld fundus cameras utilized for telehealth retinal screening have shown success in multiple small-scale studies. To make their usage more widespread, multiple technical, technological, and methodical barriers must be addressed. This can be accomplished by improving the technology, utilizing AI, and developing telehealth guidelines.

Impact of Multiple Sclerosis on Load Distribution, Plantar Pressures, and Ankle Dorsiflexion Range of Motion in Women

Alterations in static plantar pressure distribution serve as important indicators of gait and balance impairments in individuals with Multiple Sclerosis (MS). In addition, the identification of altered patterns of plantar load distribution, along with restricted ankle dorsiflexion, may serve as early markers of postural instability and gait dysfunction in women with MS. Objectives: To assess differences in static plantar pressure, load distribution, and ankle dorsiflexion range of motion between women diagnosed with MS and women without the condition. Methods: A cross-sectional observational study was conducted between April and December 2024. Women with MS were recruited from patient associations in the provinces of Alicante and Murcia, as well as from the neurology outpatient clinic at the Doctor Balmis University Hospital (Alicante, Spain). Static postural assessment was performed using the Neo-Plate® pressure platform, which measured maximum and mean plantar pressure (kPa), load distribution (%), contact surface area (cm2), and anterior-posterior weight distribution between the forefoot and rearfoot. The ankle dorsiflexion range of motion was assessed with a universal two-arm goniometer. All parameters were compared with those of a group of women without a diagnosis of MS. Results: Compared to women without MS, participants with MS showed a significantly greater load on the right forefoot (25.75% vs. 23.41%, p = 0.021), and reduced load on the right (23.09% vs. 26.01%, p = 0.004) and left rearfoot (26.60% vs. 30.85%, p = 0.033). Total forefoot loading was significantly higher (52.33% vs. 46.40%, p < 0.001), and rearfoot loading was lower (47.64% vs. 52.42%, p = 0.006) in the MS group. Ankle dorsiflexion range of motion was also significantly reduced in women with MS, both with the knee flexed (5.95° ± 4.50 and 6.76° ± 4.69 vs. 15.45° ± 5.04 and 14.90° ± 5.43) and extended (2.69° ± 3.69 and 3.12° ± 3.83 vs. 8.17° ± 3.41 and 8.60° ± 3.31), with all differences reaching statistical significance (p < 0.001). Conclusions: Women with MS present significant alterations in static plantar load distribution, with increased forefoot and decreased rearfoot loading, as well as markedly reduced ankle dorsiflexion, in comparison to women without the disease. These findings suggest the presence of postural imbalances associated with MS, potentially affecting functional stability and mobility.

iPSC-RPE patch restores photoreceptors and regenerates choriocapillaris in a pig retinal degeneration model

Dry age-related macular degeneration (AMD) is a leading cause of untreatable vision loss. In advanced cases, retinal pigment epithelium (RPE) cell loss occurs alongside photoreceptor and choriocapillaris degeneration. We hypothesized that an RPE-patch would mitigate photoreceptor and choriocapillaris degeneration to restore vision. An induced pluripotent stem cell-derived RPE (iRPE) patch was developed using a clinically compatible manufacturing process by maturing iRPE cells on a biodegradable poly(lactic-co-glycolic acid) (PLGA) scaffold. To compare outcomes, we developed a surgical procedure for immediate sequential delivery of PLGA-iRPE and/or PLGA-only patches in the subretinal space of a pig model of laser-induced outer retinal degeneration. Deep learning algorithm-based optical coherence tomography (OCT) image segmentation verified preservation of the photoreceptors over the areas of PLGA-iRPE-transplanted retina and not in laser-injured or PLGA-only-transplanted retina. Adaptive optics imaging of individual cone photoreceptors further supported this finding. OCT-angiography revealed choriocapillaris regeneration in PLGA-iRPE- and not in PLGA-only-transplanted retinas. Our data, obtained using clinically relevant techniques, verified that PLGA-iRPE supports photoreceptor survival and regenerates choriocapillaris in a laser-injured pig retina. Sequential delivery of two 8 mm2 transplants allows for testing of surgical feasibility and safety of the double dose. This work allows one surgery to treat larger and noncontiguous retinal degeneration areas.

Exploring perspectives on skull base chordoma management: a modified Delphi approach to consensus

OBJECTIVE

Current treatment for skull base chordomas utilizes both surgical resection and adjuvant radiation, but recent studies have demonstrated evidence that has brought the use of adjuvant radiotherapy into question. Chordomas differ greatly in molecular makeup and proliferation. These factors have led to significant variation in management across providers. We used a modified Delphi approach to work towards consensus on standardized operative definitions and evidence-based management of chordomas.

METHODS

Our multidisciplinary panel included participants representing the AANS/CNS Tumor Section and North American Skull Base Society (NASBS) with a track record of publishing on chordoma management. Our approach involved a four-step process: one statement-generation round, two voting rounds to establish consensus and refine statements, and a final external validation round by NASBS members. Anonymous voting was completed via Qualtrics surveys.

RESULTS

The statement-generation process produced 65 statements. Through the Delphi process, 36 statements reached consensus during the first round and an additional 17 were refined for further consensus in the second round. Moderate (67-80%) or strong (> 80%) consensus was achieved for 43 final statements. Forty-one items were externally validated. There was consensus that an endoscopic endonasal approach should be utilized whenever possible. They defined the tumor characteristics (molecular and cytogenic) to consider before offering adjuvant radiotherapy.

CONCLUSIONS

This modified Delphi study generated consensus on 41 statements regarding skull base chordoma management. These statements aim to shed light on the consensus among providers regarding the use of surgery, neoadjuvant radiation, adjuvant radiation, adjuvant systemic therapies, and treatment of recurrence for chordoma.

Predictive Value of Optical Coherence Tomography Biomarkers in Patients with Persistent Diabetic Macular Edema Undergoing Cataract Surgery Combined with a Dexamethasone Intravitreal Implant

Background: Diabetic macular edema (DME) is the most common cause of vision loss among diabetic patients. The first-line treatments for DME are anti-vascular endothelial growth factor (VEGF)-drugs, while intravitreal steroids are generally reserved for second-line treatment. Limited data exist on the role of optical coherence tomography (OCT) biomarkers as predictors of success in non-responders to anti-VEGF treatment undergoing simultaneous cataract surgery and dexamethasone intravitreal implant (DEX-I). Methods: This study was designed as a retrospective analysis of patients with DME who were refractory to anti-VEGF treatment but underwent cataract surgery and received a DEX-I at the time of surgery. All procedures were performed between May 2021 and February 2024. The best-corrected visual acuity (BCVA) and central subfoveal thickness (CST) were recorded at baseline and at 1 week, 1 month, and 3 months. The following OCT-based biomarkers were also collected: ellipsoid zone (EZ) integrity, disorganization of the retinal inner layers (DRIL), CST, and hyperreflective foci (HRF). Correlations between the baseline biomarkers and the anatomical outcome were analyzed using linear mixed models (LMMs). Results: Eleven patients (eighteen eyes) met the inclusion criteria. The mean CST decreased significantly from 469.4 ± 53.8 µm at baseline, to 373.1 ± 34.7 µm at 1 week (p = 0.002) and 354.4 ± 24.1 µm at 1 month (p = 0.011). The mean BCVA improved significantly from 0.47 LogMAR to 0.33 LogMAR at 1 week (p = 0.001), 0.23 LogMAR at 1 month (p < 0.001), and 0.25 LogMAR at 3 months (p < 0.001). Baseline predictors significantly influencing CST included the presence of DRIL, a disrupted/absent EZ, and a higher CST. Conclusions: The administration of DEX-I for DME refractory to anti-VEGF treatment in patients undergoing cataract surgery promoted functional improvements persisting longer than the anatomical ones. Patients presenting with DRIL, disrupted EZ, and higher CST at baseline may be better candidates for the combination of DEX-I and cataract surgery.

Integrated Single Nanoparticle Analysis for Rapid Quantification of Spatiotemporal Crosstalk between Herpes Simplex Virus-1 and Extracellular Vesicles

Cells secrete extracellular vesicles (EVs) to mediate precise communication during viral infections, yet the spatiotemporal regulation of EV composition by herpes simplex virus 1 (HSV-1) remains poorly understood. Here, we develop an integrated single-nanoparticle analysis platform combining nanoporous membrane-based EV isolation with an on-chip immunoassay to quantitatively probe EV-HSV-1 interplay throughout infection. A dual-membrane filter design significantly enhances nanoparticle recovery, enabling high-sensitivity single-particle detection. We reveal that HSV-1-infected neural stem cells display viral glycoprotein B on EV surfaces at an early stage (<8 hpi), while intact virions are selectively packaged into EVs later (24-48 hpi). Proteomic profiling indicates infected cell-derived EVs facilitate antigen processing and presentation, potentially amplifying antiviral responses. Functional studies further demonstrate EVs promote viral entry at late stages (48 hpi), likely via EV-virion encapsulation. These findings elucidate a dynamic EV-virus interplay, offering insights into HSV-1 pathogenesis and EV-mediated immune modulation. Our platform provides a transformative approach for advancing infection diagnostics and therapeutics.

Sustained intraocular pressure-lowering effect and biocompatibility of a single subconjunctival administration of hydrogel-encapsulated nano-brinzolamide

Brinzolamide is a widely used treatment for glaucoma, but its effectiveness relies on at least twice-daily dosing, which can be challenging for patient adherence. To overcome this limitation, we developed an injectable hydrogel-based delivery system designed to maintain therapeutic drug levels with a single administration. This approach aims to simplify treatment and improve clinical outcomes. Brinzolamide-loaded polyethylene glycol poly (lactic-co-glycolic acid) (PEG-PLGA) nanoparticles were encapsulated within a hydrogel synthesized through the crosslinking of oxidized hyaluronic acid (OHA) and carboxymethyl chitosan (CMC). In vitro studies were conducted to assess the nanoparticles' characterization, release profile, and biocompatibility. In a steroid-induced high intraocular pressure (IOP) mouse model, the efficacy of a single subconjunctival injection in lowering IOP was evaluated. Additionally, both cellular and animal biocompatibility were assessed. The brinzolamide-loaded hydrogel system (Hydrogel@Brz) contained nanoparticles with an average diameter of 40.76 nm, exhibiting a stable size distribution and a spherical morphology. The hydrogel demonstrated excellent injectability, self-healing properties, and a porous structure conducive to nanoparticle encapsulation. In vitro release studies revealed a sustained drug release of 86% over 14 days. No cytotoxicity was observed in human primary trabecular meshwork cells (HTMCs), human Tenon's capsule fibroblasts (HTFs), or the retinal ganglion cell line R28. In vivo, a single injection led to a prolonged IOP reduction lasting up to 21 days. No signs of drug toxicity were detected in ocular tissue sections, transverse optic nerve sections under transmission electron microscopy, or pathology slides of various organs. The brinzolamide-loaded hydrogel has demonstrated promising potential for sustained drug delivery and effective intraocular pressure reduction while maintaining good biocompatibility. However, further studies in larger animal models and long-term evaluations are needed to confirm its clinical applicability.

Feasibility of improving vocal fold pathology image classification with synthetic images generated by DDPM-based GenAI: a pilot study

BACKGROUND

Voice disorders (VD) are often linked to vocal fold structural pathologies (VFSP). Laryngeal imaging plays a vital role in assessing VFSPs and VD in clinical and research settings, but challenges like scarce and imbalanced datasets can limit the generalizability of findings. Denoising Diffusion Probabilistic Models (DDPMs), a subtype of Generative AI, has gained attention for its ability to generate high-quality and realistic synthetic images to address these challenges.

PURPOSE

This study explores the feasibility of improving VFSP image classification by generating synthetic images using DDPMs.

METHODS

404 laryngoscopic images depicting VF without and with VFSP were included. DDPMs were used to generate synthetic images to augment the original dataset. Two convolutional neural network architectures, VGG16 and ResNet50, were applied for model training. The models were initially trained only on the original dataset. Then, they were trained on the augmented datasets. Evaluation metrics were analyzed to assess the performance of the models for both binary classification (with/without VFSPs) and multi-class classification (seven specific VFSPs).

RESULTS

Realistic and high-quality synthetic images were generated for dataset augmentation. The model first failed to converge when trained only on the original dataset, but they successfully converged and achieved low loss and high accuracy when trained on the augmented datasets. The best performance was gained for both binary and multi-class classification when the models were trained on an augmented dataset.

CONCLUSION

Generating realistic images of VFSP using DDPMs is feasible and can enhance the classification of VFSPs by an AI model and may support VD screening and diagnosis.

Melatonin in Glaucoma: Integrative Mechanisms of Intraocular Pressure Control and Neuroprotection

Background: Glaucoma is a leading cause of irreversible visual loss worldwide, characterized by progressive retinal ganglion cell (RGC) degeneration and optic nerve damage. Current therapies mainly focus on lowering intraocular pressure (IOP), yet fail to address pressure-independent neurodegenerative mechanisms. Melatonin, an endogenously produced indoleamine, has gained attention for its potential in modulating both IOP and neurodegeneration through diverse cellular pathways. This review evaluates the therapeutic relevance of melatonin in glaucoma by examining its mechanistic actions and emerging delivery approaches. Methods: A comprehensive literature search was conducted via PubMed and Medline to identify studies published between 2000 and 2025 on melatonin's roles in glaucoma. Included articles discussed its effects on IOP regulation, RGC survival, oxidative stress, mitochondrial integrity, and inflammation. Results: Evidence supports melatonin's involvement in IOP reduction via MT receptor activation and its synergism with adrenergic and enzymatic regulators. Moreover, it protects RGCs by mitigating oxidative stress, preventing mitochondrial dysfunction, and inhibiting apoptotic and inflammatory cascades. Recent advances in ocular drug delivery systems enhance its bioavailability and therapeutic potential. Conclusions: Melatonin represents a multi-target candidate for glaucoma treatment. Further clinical studies are necessary to establish optimal dosing strategies, delivery methods, and long-term safety in patients.

Biomarkers of risk of switching to dexamethasone implant for the treatment of diabetic macular oedema in real clinical practice: a multicentric study

OBJECTIVE

To establish the influence of different optical coherence tomography (OCT) biomarkers at baseline treatment on the potential response to anti-vascular endothelial growth factor (VEGF) treatment for diabetic macular oedema (DME).

METHODS

Multicentric, retrospective, case-series study in patients with DME switched to dexamethasone implant injections (DEX-i) after anti-VEGF in real clinical practice. Biomarkers analysed on OCT images at baseline included intraretinal fluid (IRF), subretinal fluid (SRF), disorganisation of retinal inner layers (DRIL), disorganisation of retinal outer layers (DROL), hyperreflective foci (HRF), hyperreflective cystoid walls (HCW), dense intraretinal cyst (DIR) and vitreomacular interface (VMI) abnormalities. DME was classified according to the European School for Advanced Studies in Ophthalmology classification. Patients who were treated with anti-VEGF injections with an adequate response were selected as the control group.

RESULTS

275 eyes were analysed in this study; 209 eyes (76.0%) switched from anti-VEGF to DEX-i were compared with 66 control eyes (24.0%). Patients who required switching were statistically older, showed worse initial BCVA and higher CRT. Logistic regression analyses showed that female gender, age, central retinal thickness, type of diabetes, SRF, HCW, DIR and VMI increase the likelihood of switching. The OR regarding the need to switch generated by the presence of two of these three factors (SRF, HCW, VMI) was 48.95. Having all three multiplies it by 4.56×1016.

CONCLUSION

If baseline OCT shows two of SRF, HCW and VMI biomarkers at baseline, the risk of failure of anti-VEGF therapy is close to 50%. In the presence at baseline of all three biomarkers, failure of anti-VEGF therapy is almost certain.

What the diabetologist needs to know about the risk of non-arteritic anterior ischaemic optic neuropathy and GLP-1 receptor agonist use in patients with type 2 diabetes

AIM

Recent findings have raised concern about a potential association between semaglutide use and non-arteritic anterior ischaemic optic neuropathy (NAION), a rare form of permanent vision loss. This report provides a critical analysis of the current knowledge of GLP-1 receptor agonist (RA) use and risk of NAION in patients with type 2 diabetes (T2D).

METHODS

A literature search strategy was conducted for all English-language literature with a systematic review of key references up to April 2025.

RESULTS

Across studies including patients with T2D, the relative increase in NAION risk associated with the use of a GLP-1 RA, mainly semaglutide, ranged from nonsignificant to fourfold, while the absolute number of affected patients remained low. Given the retrospective design of the main studies, no causal link could be established between the use of GLP-1RAs and NAION. Some mechanistic hypotheses have been put forward without any being formally demonstrated to date. The profound metabolic and haemodynamic changes induced by GLP-1RAs might be the trigger of NAION in predisposed patients with an optic "disc-at-risk", a potent anatomical risk factor easily detected by ocular examination.

CONCLUSION

Pending studies clarifying this risk, these findings call for cautious use of GLP-1 RAs, particularly in patients with ocular risk factors. Given the widespread use of GLP-1RAs, clinicians should be aware of this potential risk, without overshadowing the remarkable benefit of GLP-1RAs in patients with type 2 diabetes.

Physiotherapy for Sexual Dysfunctions in Multiple Sclerosis Patients: A Review of Clinical Trials

Multiple Sclerosis (MS) is an inflammatory autoimmune disorder that primarily affects the central nervous system, leading to significant disability in young adults, with a higher prevalence observed in women. The heterogeneous clinical presentation of MS poses substantial challenges in diagnosis and treatment. In recent years, considerable emphasis has been placed on improving the quality of life for MS patients, with sexual health being a key component of this assessment. The literature suggests that sexual dysfunctions affect between 42% and 73% of individuals with MS. While the positive effects of physiotherapy interventions on sexual dysfunction have been extensively studied, there remains a significant gap in understanding the prevalence of these disorders within the MS population and the most effective treatment approaches. This review highlights the critical need to integrate pelvic floor physiotherapists into multidisciplinary MS treatment teams. Six randomized controlled trials (RCTs) meeting the inclusion criteria were identified. These studies included patients diagnosed with MS who reported various sexual dysfunctions, such as orgasmic dysfunction, sexual arousal disorders, and dysfunctions associated with overactive bladder. The outcomes were assessed using sexual function and urological symptom questionnaires. Physiotherapeutic interventions, including manual therapy, kinesiotherapy, and physical therapy elements, have demonstrated positive effects on sexual quality of life, specifically in relation to issues such as desire, arousal, and satisfaction. However, the available data are still preliminary and warrant further investigation. By recognizing the importance of pelvic floor therapy, more targeted and holistic interventions can be implemented, ultimately improving patient outcomes and enhancing the overall standard of care.

Tumor heterogeneity and resistance in glioblastoma: the role of stem cells

Glioblastoma multiforme (GBM) is one of the most aggressive and treatment-resistant brain tumor, characterized by its heterogeneity and the presence of glioblastoma stem cells (GSCs). GSCs are a subpopulation of cells within the tumor that possess self-renewal and differentiation capabilities, contributing to tumor initiation, progression, and recurrence. This review explores the unique biological properties of GSCs, including their molecular markers, signalling pathways, and interactions with the tumor microenvironment. We discuss the mechanisms by which GSCs evade conventional therapies, such as enhanced DNA repair and metabolic plasticity, which complicate treatment outcomes. Furthermore, we highlight recent advancements in identifying novel biomarkers and therapeutic targets that may improve the efficacy of treatments aimed at GSCs. The potential of targeted therapies, including immunotherapy and combination strategies, is also examined to overcome the challenges posed by GSCs. Ultimately, a deeper understanding of GSC biology is essential for developing personalized treatment approaches that can enhance patient outcomes in glioblastoma.

Amniotic Membrane Transplantation for Wound Healing, Tissue Regeneration and Immune Modulation

Amniotic membrane transplantation (AMT) has emerged as a versatile therapeutic modality with significant applications in wound healing, tissue regeneration, and ophthalmology. This review comprehensively evaluates AMT's efficacy in acute and chronic wound management, where it has been shown to alleviate pain, reduce infection risk, and facilitate epithelialization. In chronic wounds, AMT enhances healing through mechanisms such as re-epithelialization, angiogenesis, and immune modulation. Additionally, AMT exhibits promise in nerve regeneration, demonstrating potential in the repair of peripheral and central nervous system injuries by fostering neural recovery and minimizing scar formation. In ophthalmology, AMT is instrumental in corneal surface reconstruction, conjunctival repairs, and the management of dry eye syndrome and limbal stem cell deficiency. While the benefits of AMT are well-documented, this review also addresses significant challenges, including variability in success rates across different clinical conditions, ethical concerns regarding donor tissue usage, and regulatory hurdles impacting its broader clinical application. Furthermore, we integrate recent advances in the understanding of AMT's molecular mechanisms - such as its antioxidant effects via Nrf2/HO-1 pathway and immune modulation via P2X7 receptor pathways - and highlight innovative strategies including the incorporation of nanoceria nanoparticles, Vitamin D3 supplementation, and gene therapy approaches to enhance AMT outcomes. By exploring these dimensions, the review highlights not only the current state of AMT but also its potential future role in advancing regenerative medicine, including emerging applications in spinal cord repair, orthopaedics, and tissue engineering. This updated synthesis aims to inform clinicians and researchers about the multifaceted applications of AMT, promoting further investigation and optimization of this promising therapeutic approach.

Recent advances in craniopharyngioma pathophysiology and emerging therapeutic approaches

Craniopharyngiomas are rare intracranial tumors originating from the Rathke's pouch, affecting the sellar and parasellar regions. Despite their benign nature, they cause significant morbidity and mortality due to their proximity to vital structures such as the optic pathways and the hypothalamic-pituitary axis, resulting in endocrine, visual, neurological impairment, and hypothalamic syndrome. Classified into adamantinomatous (ACP) and papillary (PCP), these tumors differ in epidemiology, histology, and pathophysiology. ACP, the most common type, presents a bimodal peak incidence between 5 and 15 years of age and 45 and 60 years of age, while PCP is more restricted to adults. Traditional treatments such as surgery and radiotherapy face significant challenges, including high recurrence rates. Intracystic chemotherapy is used in monocystic ACP but with limited efficacy and adverse effects related to toxicity. Recent advances in molecular biology have introduced targeted therapies, such as BRAF and MEK inhibitors, which show potential benefits in craniopharyngioma patients, particularly in the PCP. For ACP, however, therapeutic outcomes remain limited despite advances in molecular understanding, including mutations in the CTNNB1 gene and growth factors. Increasing investigation into the inflammatory microenvironment and immune response of these tumors presents new therapeutic possibilities and promising alternatives for tumor control, such as the use of anti-IL-6R, anti-VEGF agents and immune checkpoints inhibitors. This review aims to synthesize advancements in the pathophysiology of craniopharyngiomas and explore emerging therapeutic implications, focusing on precision medicine approaches for the management of this challenging disease.

Spheno-Orbital Meningiomas: Advances in Reconstruction Workflow and Cosmetic/Functional Outcomes in the Digital Era

Spheno-orbital (SOM) meningioma is a rare subtype of skull base tumor characterized by the proliferation of arachnoid cap cells with intradural expansion, hyperostosis of calvarial and spheno-orbital bone, and consecutive infiltration of critical surrounding neurovascular structures of the frontotemporal base of the skull. Surgical resection is often challenging due to the infiltrative growth and the anatomically complex localization. In most cases, a microsurgical transcranial approach is performed, resulting in the need to reconstruct the orbit with or without a cranioplasty. This review highlights the evolution and current state-of-the-art reconstructive strategies used in SOM surgery.

Exploring the Gut Microbiota-Retina Axis: Implications for Health and Disease

The gut microbiota represents a rich and adaptive microbial network inhabiting the gastrointestinal tract, performing key functions in nutrient processing, immune response modulation, intestinal wall protection, and microbial defense. Its composition remains highly personalized and responsive to external influences, including lifestyle patterns, physical activity, body composition, and nutritional intake. The interactions of the gut microbiota with bodily systems are conventionally interpreted as broad systemic impacts on organ balance. Yet, emerging research-exemplified by the gut microbiota-brain axis-suggests the potential existence of more targeted and direct communication mechanisms. Dysbiosis, characterized by microbial ecosystem disturbance, generates multiple metabolic compounds capable of entering systemic circulation and reaching distant tissues, notably including ocular structures. This microbial imbalance has been associated with both systemic and localized conditions linked to eye disorders. Accumulating scientific evidence now supports the concept of a gut-retina axis, underscoring the significant role of microbiota disruption in generating various retinal pathologies. This review comprehensively investigates gut microbiota composition, functional dynamics, and dysbiosis-induced alterations, with specific focus on retinal interactions in age-related macular degeneration, diabetic retinopathy, glaucoma, and retinal artery occlusion. Moreover, the review explores microbiota-targeted therapeutic strategies, including precision nutritional interventions and microbial transplantation, as potential modulators of retinal disease progression.

Modern treatment of craniopharyngioma to improve outcomes: evidence of a change of paradigm

BACKGROUND

Craniopharyngiomas, rare primary brain tumors of the pituitary-hypothalamic axis, frequently result in sicubstantial morbidity, including compromised quality of life, vision impairment, hypothalamic and endocrine dysfunction, and neuroendocrine disturbances. Of particular importance is the development of hypothalamic obesity, which affects up to 25% of patients at diagnosis and increases to 50% after treatment. Genotyping has revealed that over 90% of papillary craniopharyngiomas (PCP) harbor BRAF V600E mutations. Recent studies have demonstrated a significant reduction in tumor size with the use of BRAF-MEK inhibitors in PCP.

METHODS

We conducted a systematic review of recent literature on pretreatment or neo-adjuvant medical therapies, analyzing their effectiveness, safety, and sequelae following surgical treatment with this new approach.

RESULTS

At the time of this review, 15 studies involving more than 50 patients have been published, with a response rate of up to 90%.

CONCLUSION

Based on this evidence, we propose a new treatment paradigm aimed at improving outcomes by maximizing relief from compressive symptoms while minimizing hypothalamic dysfunction.

Curcumin-Induced Molecular Mechanisms in U-87 MG Glioblastoma Cells: Insights from Global Gene Expression Profiling

Curcumin, a major phytochemical derived from Curcuma longa, has been shown to enhance the efficacy of chemotherapeutic agents such as doxorubicin, 5-fluorouracil, and cisplatin by overcoming drug resistance, making it a promising adjunct in the treatment of glioblastoma. However, the global gene-expression changes triggered by curcumin in glioblastoma remain underexplored. In this study, we investigated the effects of curcumin on human glioblastoma (U87 MG) cells, where it significantly reduced cell viability and proliferation in a dose- and time-dependent manner and induced apoptosis without affecting senescence. Transcriptomic analysis revealed 5036 differentially expressed genes, with pathway enrichment identifying 13 dysregulated cancer-associated pathways. Notably, curcumin modulated several key regulators involved in MAPK, Ras, TGF-β, Wnt, Cytokine, and TNF signaling pathways. Several apoptosis and cell cycle-associated genes, including PRKCG, GDF7, GDF9, GDF15, GDF5, FZD1, FZD2, FZD8, AIFM3, TP53AIP1, CRD14, NIBAN3, BOK, BCL2L10, BCL2L14, BNIPL, FASLG, GZMM, TNFSF10, TNFSF11, and TNFSF4, were significantly altered. Several pro-apoptotic and anti-BCL, cell-cycle-regulated genes were modulated following curcumin treatment, emphasizing its potential role in curcumin-mediated anti-tumor effects. This study provides insight into the molecular mechanisms underlying curcumin's action against glioblastoma.

Assessment of retinal microvascular changes in patients with systemic lupus erythematosus using optical coherence tomography angiography

BACKGROUND

It is evident that the physiopathological pathways of ocular and renal microvascular tissues in patients with systemic lupus are similar. Previously, this was confirmed by employing traditional fundus examination, optical coherence tomography, and high-resolution color electroretinography. Recent years have seen the development of Optical Coherence Tomography Angiography (OCTA) as a non-intrusive procedure that can be employed to image the microvasculature of the retina and choroid.

OBJECTIVE

The aim of this study is to assess the correlation between renal functional and histologic features with the retinal microvasculature alterations in systemic lupus patients through OCTA analysis.

PATIENTS AND METHODS

This case-control study enrolled thirty-six eyes from 18 lupus nephritis (LN) patients, thirty-six eyes from 18 systemic lupus erythematosus (SLE) patients, and thirty eyes from 15 healthy controls. An ophthalmological evaluation, including history, examination, and investigations, was conducted using OCTA for all participants. Prior to ocular examination and investigation, all SLE patients underwent a rheumatological evaluation, encompassing disease-related clinical and laboratory assessments. Specimen retrieval and renal biopsy examinations were also performed, categorizing them into lupus and lupus nephritis patients.

RESULTS

Regarding central foveal thickness (CFT) and parafoveal thickness (PFT), there were no significant differences compared to healthy subjects. A comparison of the foveal avascular zone area (FAZ-A) among the three groups revealed a significant increase in both patient groups compared to healthy controls. Whole superficial capillary plexus (SCP) vascular density (VD) in the parafoveal and foveal regions showed a significant reduction in both SLE patient groups compared to healthy controls (HC). Specifically, SCP values were 42.65 ± 2.23% in the SLE with nephritis group, 44.88 ± 2.09% in the SLE without nephritis group, and 49.10 ± 3.12% in the healthy control group. SCP parafoveal VD values were 40.77 ± 3.27% in SLE with nephritis, 47.19 ± 2.63% in SLE without nephritis, and 50.98 ± 4.80% in healthy controls. SCP foveal VD was 18.96 ± 3.43% in SLE with nephritis, 21.61 ± 4.00% in SLE without nephritis, and 24.16 ± 2.69% in healthy controls. The whole deep capillary plexus (DCP), parafoveal, and foveal VD were significantly reduced in the SLE with nephritis group but showed only marginal differences in the SLE without nephritis group compared to healthy controls, as DCP values were 48.04 ± 3.93% in SLE with nephritis, 53.63 ± 2.19% in SLE without nephritis, and 54.88 ± 3.57% in healthy controls. DCP parafoveal VD was 54.56 ± 2.37% in SLE with nephritis, 56.93 ± 1.90% in SLE without nephritis, and 57.39 ± 5.99% in healthy controls. DCP foveal VD was 34.42 ± 3.12% in SLE with nephritis, 41.96 ± 3.19% in SLE without nephritis, and 42.55 ± 7.74% in healthy controls.

CONCLUSION

OCT angiography has a considerable role in the detection of the early changes of the retinal vascular plexus in patients with SLE, especially those with lupus nephritis, even before the development of retinopathy.

Three-year outcomes of cystotomy and fibrinogen clot removal for diabetic macular edema with subfoveal cystoid macular edema

Several new surgical techniques for managing refractory diabetic macular edema (DME) have demonstrated favorable short-term outcomes. However, no studies have reported the long-term outcomes of these treatments. This study aimed to evaluate the long-term outcomes of cystotomy for DME retrospectively. Twenty-seven patients (31 eyes; 16 male, 11 female) who underwent cystotomy for DME between January 2015 and April 2019, with a follow-up period of 3 years were included. Statistical analyses involved variables including age, sex, best-corrected visual acuity (BCVA), central macular thickness (CMT), number of treatments (anti-vascular endothelial growth factor, sub-Tenon injection of triamcinolone acetonide, direct photocoagulation for microaneurysms, vitrectomy with internal limiting membrane peeling), number of clinic visits, and DME recurrence. The mean age was 67.2 ± 9.3 years. BCVA (logMAR) and CMT(µm) significantly improved from preoperatively to 3 years postoperatively (P < 0.001). Total treatments significantly decreased from the year before surgery to the third year after surgery (P < 0.001). The mean number of clinic visits significantly decreased from the year before surgery to the third year after surgery (P < 0.001). Fibrinogen clot removal was performed in 14 eyes. and DME recurrence occurred in 12 eyes. Cystotomy may be a viable treatment option for DME.