A modified Yamane technique with a posterior approach in a case report of intraocular lens dislocation

INTRODUCTION

The Yamane intrascleral fixation technique is a widespread surgical approach used in ophthalmology to secure three-piece intraocular lenses (IOLs) without the use of sutures. This technique is particularly beneficial in cases where the capsular bag is not suitable for IOL implantation. By creating a flange at the tip of each haptic this procedure innovatively eliminates the need for additional securing materials. We report an alternative management of posterior intraocular lens (IOL) dislocation with a modified Yamane technique, performed in vitreous chamber.

CASE PRESENTATION

We describe the surgery of a 56-year-old male with posterior dislocation of the capsular bag and a three-piece IOL with Polymethylmethacrylate (PMMA) loops into the vitreous cavity. His medical history included retinal detachment treated with scleral buckling 40 years earlier and cataract surgery performed 4 years earlier. The patient underwent a 25-gauge pars plana vitrectomy. Scleral tunnels were created to externalize the PMMA loops and securing the IOL in a stable position according to the classic Yamane technique: a bimanual approach with a 30-gauge x 13 mm ultra-thin-walled needle and maxgrip forceps was used.

DISCUSSION

Modified Yamane technique performed in vitreous chamber, especially in selected cases of dislocated IOL with PMMA loops, may allow better handling of the IOL and the loop insertion. This modified technique, by reducing mechanical stress on the PMMA loops, contributes to long-term IOL integrity and lowers the risk of complications during surgery.

CONCLUSION

This technique may offer a reliable alternative for ophthalmic surgeons managing PMMA IOLs dislocations.

Endogenous Endophthalmitis in Children: A 5-Year Retrospective Study in Vietnam

PURPOSE

To describe the findings and outcomes in pediatric endogenous endophthalmitis cases over a 5-year period in Vietnam.

METHODS

All cases of pediatric endogenous endophthalmitis seen at Vietnam National Eye Hospital from 2016 to 2020 (n = 157) were retrospectively studied. Data on epidemiology, microbiology, clinical manifestations, ultrasound findings, and outcomes were collected and analyzed. Success was defined as visual acuity of counting fingers at 1 meter or better if visual acuity testing could be done, and a fully attached retina, controlled intraocular pressure, and no phthisis bulbi.

RESULTS

The mean patient age was 6.0 ± 3.8 years. Gram-positive cocci were the most common causative agents (45.2%), followed by Gram-negative bacilli (10.8%). Among 31 cases in which both vitreous and aqueous specimens were collected, 17 (54.8%) showed discordant microbiological results. The overall treatment success rate was 38.2%. An initial visual acuity better than light perception was associated with a higher success rate (45.8% vs 16.7%, P < .05). Children presenting with ultrasound grade 3 vitreous opacity had a lower success rate compared to those with grades 1 and 2 combined (38.1% vs 69.6%, P < .05).

CONCLUSIONS

Gram-positive cocci were the most frequently identified pathogens in children with endogenous endophthalmitis in Vietnam. The low agreement between smear stain and culture results indicates that using both methods could enhance diagnostic accuracy. Initial visual acuity at admission and the degree of vitreous opacity were recognized as important prognostic factors for treatment outcomes. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].

Prospective evaluation of soluble CD14 as a biomarker following five aflibercept treatments in diabetic macular edema

Using spectral-domain optical coherence tomography (SD-OCT) in patients with diabetic macular edema (DME), we studied the relationships between consecutive aflibercept treatments, soluble CD14 (sCD14) in the aqueous humor (AH), and anatomical features, including hyper-reflective foci (HFs) and other morphologic characteristics. This prospective study included 23 eyes of 23 patients with DME treated with five consecutive monthly intravitreal aflibercept injections. At each visit, sCD14 and VEGF levels in the AH were measured using ELISA. The number of HFs, central macular thickness (CMT), and volume of intraretinal fluid (IRF) and subretinal fluid (SRF) were also assessed. One month after fifth injections, there were significant decreases in CMT, the number of HFs, and the volumes of IRF and SRF. The level of sCD14 also decreased. Although sCD14 levels showed a downward trend, the change was not statistically significant. The group with reduced sCD14 exhibited improvements in all the factors, including visual acuity. In contrast, the group with increased sCD14 only showed significant decreases in CMT. When the data were categorized into two groups based on the final visual outcome, patients with good final visual acuity had consistently lower levels of sCD14 at all visits. This study highlights sCD14 as a potential biomarker for assessing treatment response to aflibercept in DME.

Full-Length Cryptochrome 1 in the Outer Segments of the Retinal Blue Cone Photoreceptors in Humans and Great Apes Suggests a Role Beyond Transcriptional Repression

Mammalian cryptochrome 1 (CRY1) is a central player in the circadian transcription-translation feedback loop, crucial for maintaining a roughly 24-h rhythm. CRY1 was suggested to also function as a blue-light photoreceptor in humans and has been found to be expressed at the mRNA level in various cell types of the inner retina. However, attempts to detect CRY1 at the protein level in the human retina have remained unsuccessful so far. Using various C-terminal specific antibodies recognizing full-length CRY1 protein, we consistently detected selective labeling in the outer segments of short wavelength-sensitive (SWS1, "blue") cone photoreceptor cells across human, bonobo, and gorilla retinae. No other retinal cell types were stained, which is in contrast to what would be expected of a ubiquitous clock protein. Subcellular fractionation experiments in transfected HEK cells using a C-terminal specific antibody located full-length CRY1 in the cytosol and membrane fractions. Our findings indicate that human CRY1 has several different functions including at least one nonclock function. Our results also raise the likely possibility that several different versions of CRY1 exist in humans. We suggest that truncation of the C-terminal tail, maybe to different degrees, may affect the localization and function of human CRY1.

Low-Rank Fine-Tuning Meets Cross-modal Analysis: A Robust Framework for Age-Related Macular Degeneration Categorization

Age-related macular degeneration (AMD) is a prevalent retinal degenerative disease among the elderly and is a major cause of irreversible vision loss worldwide. Although color fundus photography (CFP) and optical coherence tomography (OCT) are widely used for AMD diagnosis, information from a single modal is inadequate to fully capture the complex pathological features of AMD. To address this, this study proposes an innovative multi-modal deep learning framework that fine-tunes pre-trained single-modal retinal models for efficient application in multi-modal AMD categorization tasks. Specifically, two independent vision transformer models are used to extract features from CFP and OCT images, followed by deep canonical correlation analysis (DCCA) to perform nonlinear mapping and fusion of features from both modalities, maximizing cross-modal feature correlation. Moreover, to reduce the computational complexity of multi-modal integration, we introduce the low-rank adaptation (LoRA) technique, which uses low-rank decomposition of parameter matrices, achieving superior performance compared to full fine-tuning with only about 0.49% of the trainable parameters. Experimental results on the public dataset MMC-AMD validate the framework's effectiveness. The proposed model achieves an overall F1-score of 0.948, AUC-ROC of 0.991, and accuracy of 0.949, significantly outperforming existing single-modal and multi-modal baseline models, particularly excelling in recognizing complex pathological categories.

Voluntary running partially prevents photoreceptor cell death in retinitis pigmentosa

Retinitis pigmentosa (RP) is a progressive retinal degenerative disorder characterized by photoreceptor cell death, leading to vision loss. Current treatments are limited, and there is a need for non-invasive interventions. This study evaluates the neuroprotective effects of voluntary exercise in an RP mouse model and explores the role of the adiponectin signaling pathway in mediating these effects. Pregnant Pde6b rd10 (rd10) mice, a transgenic model of RP, and wild-type C57BL/6J mice were divided into sedentary or voluntary running groups (n = 4 per group). Offspring were analyzed at 6 weeks for photoreceptor nuclei counts, outer segment lengths, serum and retinal adiponectin levels, and expression of AMPK and PGC-1α proteins using immunohistochemistry, ELISA, and Western blotting. Voluntary exercise significantly preserved photoreceptor nuclei (97 ± 16 vs. 32 ± 5 in sedentary rd10 mice) and outer segment lengths for rods (13.1 ± 1.2 μ vs. 1.1 ± 0.6 μ) and cones (7 ± 0.9 μ vs. 0.2 ± 0.1 μm) compared to sedentary rd10 mice. Serum adiponectin levels increased significantly in exercised rd10 mice (p < 0.05), while retinal adiponectin levels were elevated in both sedentary and exercised rd10 mice relative to wild-type controls (p < 0.005). No significant changes in AMPK (p = 0.724) and PGC-1α (p = 0.794) protein levels were observed between exercised and sedentary rd10 mice. These findings suggest that voluntary exercise enhances photoreceptor survival in RP by increasing serum adiponectin levels, potentially contributing to neuroprotection. Elevated retinal adiponectin appears linked to RP pathology rather than exercise-induced changes. This study highlights the therapeutic potential of exercise in RP and identifies adiponectin as a promising target for further investigation into neuroprotective mechanisms and treatments.

Is there evidence for changes in antibiotic resistance of microorganisms causing postcataract surgery endophthalmitis: a systematic review

BACKGROUND/AIMS

To review the evidence for changes in antibiotic resistance patterns before and after cataract surgery since the advent of routine use of intracameral (IC) antibiotic prophylaxis and development of newer topical fluoroquinolones pre- and postcataract surgery.

METHODS

Literature searches in the National Library of Medicine PubMed database were conducted between 2019 and 2021 and updated in 2024. There were no date restrictions, and the search was limited to high-quality studies published in English. The initial combined searches yielded 583 articles, and the search update in 2024 yielded 9 articles. Of these 592 articles, 26 presented original research that met specified inclusion criteria. Reviewed studies were rated based on the Oxford Centre for Evidence-Based Medicine grading system. Because results from the various studies are not directly comparable due to the use of different antibiotics, different methods, different study populations and different outcomes, formal analyses for heterogeneity of results and publication bias were not performed.

RESULTS

There were no studies that presented definitive level I evidence for increased bacterial resistance to IC or oral antibiotics prior to or during routine cataract surgery. There were no studies that provided level I evidence for increased bacterial resistance to topical administration of antibiotics. One study showed level III evidence for potential antibiotic resistance when the antibiotic was administered for greater than 1 month, and four level III studies showed a possible trend towards increased moxifloxacin and ciprofloxacin resistance.

CONCLUSIONS

There is little evidence of increased bacterial resistance following the use of newer fluoroquinolone antibiotic prophylaxis prior to cataract surgery or the routine use of IC antibiotic prophylaxis during cataract surgery. Our work is limited by the lack of high-level evidence on antibiotic resistance. Many studies reviewed are not randomised controlled trial (RCTs), introducing biases and confounding factors. Small sample sizes further reduce reliability, and uncontrolled variables, such as regional prescribing patterns, may lead to misleading results. While lower level evidence offers some insights, cautious interpretation is advised until more rigorous RCTs are conducted.

Identification of Key Nucleotide Metabolism Genes in Diabetic Retinopathy Based on Bioinformatics Analysis and Experimental Verification

A dysregulated nucleotide metabolism has been implicated in the pathogenesis of diabetic retinopathy (DR). RNA sequencing datasets, GSE102485, GSE60436, and GSE165784, were downloaded from the GEO database. The differentially expressed genes (DEGs) between the DR and controls overlapped with nucleotide metabolism-related genes (NM-RGs), resulting in the differentially expressed NM-RGs (DE-NMRGs). Next, the core genes were identified by the five algorithms of the CytoHubba plugin. Receiver Operating Characteristic (ROC) curves and gene expression analysis were utilized to confirm the biomarkers. Then, the correlations between biomarker expression and the immune-related module were analyzed. The miRNA and transcription factor (TF) predictions, biomarker-targeting drugs, and molecular docking were implemented separately. The interaction between each subcluster of DR was elucidated through single-cell RNA (scRNA) analysis. Moreover, RT-PCR was applied to verify the expression of the biomarkers. In GSE102485, 48 DE-NMRGs were identified via the intersection of 1359 DEGs and 882 NM-RGs. Using the CytoHubba plugin, HMOX1, TLR4, and ACE were selected as core genes. As per the GSVA result, the interferon alpha response, IL6_JAK_STAT3 signaling, and apoptosis were activated in the DR group. The TF prediction identified TLR4 and HMOX1 as potential target genes of USF2. In conclusion, ACE and HMOX1 were possible diagnostic biomarkers related to nucleotide metabolism in DR.

RPE-specific MCT2 expression promotes cone survival in models of retinitis pigmentosa

Retinitis pigmentosa (RP) is the most common cause of inherited retinal degeneration worldwide. It is characterized by the sequential death of rod and cone photoreceptors, the cells responsible for night and daylight vision, respectively. Although the expression of most RP genes occurs only in rods, there is a secondary degeneration of cones. One possible mechanism of cone death is metabolic dysregulation. Photoreceptors are highly metabolically active, consuming large quantities of glucose and producing substantial amounts of lactate. The retinal pigment epithelium (RPE) mediates the transport of glucose from the blood to photoreceptors and, in turn, removes lactate, which can influence the rate of consumption of glucose by the RPE. One model for metabolic dysregulation in RP suggests that following the death of rods, lactate levels are substantially diminished causing the RPE to withhold glucose, resulting in nutrient deprivation for cones. Here, we present adeno-associated viral vector-mediated delivery of monocarboxylate transporter 2 (MCT2, Slc16a7) into the eye, with expression limited to RPE cells, with the aim of promoting lactate uptake from the blood and encouraging the passage of glucose to cones. We demonstrate prolonged survival and function of cones in rat and mouse RP models, revealing a possible gene-agnostic therapy for preserving vision in RP. We also present the use of fluorescence lifetime imaging-based biosensors for lactate and glucose within the eye. Using this technology, we show changes to lactate and glucose levels within MCT2-expressing RPE, suggesting that cone survival is impacted by changes in RPE metabolism.

Spatial characterization of RPE structure and lipids in the PEX1-p.Gly844Asp mouse model for Zellweger spectrum disorder

Zellweger Spectrum Disorder (ZSD) is caused by defects in PEX genes, whose proteins are required for peroxisome assembly and function. Peroxisome dysfunction in ZSD causes multisystem effects, with progressive retinal degeneration (RD) among the most frequent clinical findings. However, much remains unknown about how peroxisome deficiency causes RD. To study RD pathophysiology in ZSD, we used the PEX1-p.Gly844Asp (G844D) mouse model, which represents the common human PEX1-p.Gly843Asp (G843D) variant. We previously reported diminished retinal function, diminished functional vision, and neural retina structural defects in this model. Here, we investigate the retinal pigment epithelium (RPE) phenotype, examining morphological, inflammatory, and lipid changes at 1, 3, and 6 months of age. We report that RPE cells exhibit evident degeneration by 3 months that worsens with time, starts in the dorsal pole, and is accompanied by subretinal inflammatory cell infiltration. We match these events with imaging mass spectrometry for regional analysis of lipids in the RPE. We identified 47 lipid alterations preceding structural changes, 9 of which localize to the dorsal pole. 29 of these persist to 3 months, with remodeling of the dorsal pole lipid signature. 13 new alterations occur concurrent with histological changes. Abnormalities in peroxisome-dependent lipids detected by LC/MS/MS are exacerbated over time. This study represents the first characterization of RPE in a ZSD model, and the first in situ lipid analysis in peroxisome-deficient tissue. Our findings uncover potential lipid drivers of RD progression in ZSD, and identify candidate biomarkers for retinopathy progression and response to therapy.

Visualization of retinal displacement after macular hole surgery and its correlation with postoperative visual function

PURPOSE

To observe retinal displacement following macular hole surgery using a three-dimensional barycenter localization algorithm and to evaluate its relationship with postoperative visual function.

METHODS

This prospective study included 28 eyes of 27 patients with idiopathic macular holes. A customized algorithm takes a weighted sum to locate the perimacular area (PMA) barycenter based on the magnitude of the distance between the barycenter and the intersection of retinal vessels. Retinal displacement distance, angle, and the rate of change in the PMA were calculated by comparing the barycenters in preoperative and postoperative photographs. Correlations between retinal displacement and various clinical parameters were also analyzed.

MAIN OUTCOME MEASURES

The primary outcomes included retinal displacement characteristics (distance, angle, and rate of change in the PMA). Secondary outcomes were postoperative visual function, including best-corrected visual acuity, mean retinal sensitivity, and fixation stability.

RESULTS

A significant "rebound" phenomenon, characterized by PMA wrinkling and extension, was observed in 11 cases (39.3 %). The PMA was lower at 1 month postoperatively compared to that preoperatively (t = 1.876, p = 0.025). The mean displacement distance at 1 and 3 months postoperatively was 7.725 ± 0.097 and 6.187 ± 0.827, respectively. Mean retinal sensitivity at 3 months postoperatively improved compared to preoperative values (t = -2.171, p = 0.039) and was significantly correlated with the rate of change in PMA at 3 months postoperatively (t = -2.162, p < 0.05).

CONCLUSION

The three-dimensional barycenter localization algorithm effectively visualized retinal displacement. The PMA was shown to be associated with postoperative visual function in this analysis. The change trend of PMA and mean retinal sensitivity is consistent.

Inherited retinal disease-associated uveitis

Inherited retinal diseases (IRDs) are genetic disorders characterized by progressive photoreceptor function loss, often leading to significant visual impairment. Uveitis has been increasingly recognized in the clinical course of some IRDs. Despite advances in understanding the genetic causes and pathophysiology of IRDs, gaps remain in understanding the roles of inflammation and autoimmunity in IRD and IRD-associated uveitis. This review discusses IRD-associated uveitis, including anterior, intermediate, posterior, and panuveitis, as well as complications such as cystoid macular edema and retinal vasculitis. In patients with IRD-associated uveitis, mutations affecting protein function in cilia or photoreceptor outer segments suggest a universal autoimmune mechanism triggered by the immunogenicity of shedding photoreceptor discs. Notably, in patients where uveitis is the initial sign, CRB1 mutations are often implicated, likely due to the compromised blood-retina barrier function or alterations in the external limiting membrane. Other mechanisms leading to uveitis preceding IRD diagnosis include ALPK1 mutations, which activate the proinflammatory NF-κB pathway, CAPN5 mutations, which lead to dysfunction of the innate and adaptive immune systems, and VCAN1 mutations, which elicit immunogenicity due to irregularities in vitreous modeling. Understanding these mechanisms could enhance the development of innovative treatments that target personalized inflammation pathways in IRDs.

Human umbilical cord-derived mesenchymal stem cells improve thymus and spleen functions in D-galactose-induced aged mice

As aging progresses, the structures and functions of immune organs such as the thymus and spleen deteriorate, leading to impaired immune function and immune senescence. This study investigated the potential of umbilical cord mesenchymal stem cells (UC-MSCs) to mitigate D-galactose-induced immune senescence by enhancing the structural and functional integrity of aging immune organs and regulating the gut microbiota. The findings show that UC-MSCs treatment significantly delayed thymus and spleen atrophy and reduced the number of senescence-associated β-galactosidase (SA-β-gal) positive cells. At the molecular level, UC-MSCs treatment downregulated the expression of aging-related genes, including p16, p53, p21, and RB. It also boosted antioxidant enzyme activity, increasing the levels of catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px), while decreasing serum malondialdehyde (MDA) levels by activating the Nrf2/HO-1 pathway. Additionally, UC-MSCs treatment restored the balance of the gut microbiota. These results demonstrate that UC-MSCs significantly improve the structural and functional integrity of immune organs and enhance the composition of the gut microbiome, offering a potential strategy for delaying immune senescence.

In vivo and in vitro analyses of surface whitening in hydrophobic trifocal intraocular lenses

Introduction

Transparency loss due to the whitening of trifocal hydrophobic intraocular lenses (IOLs) is a rare but poorly understood phenomenon. This study investigates its characteristics, underlying mechanisms, and clinical impact to determine its relevance for patient care.

Methods

A clinical and laboratory analysis was conducted on affected IOLs. Two patients with bilateral trifocal IOL implantation, where one eye exhibited whitening, underwent visual performance testing, light distortion assessment, optical coherence tomography, Scheimpflug imaging, and patient-reported outcome evaluations. An explanted IOL was examined using microscopic and optical bench methods, and attempts were made to replicate the whitening process in vitro using unused control lenses.

Results

Clinical findings showed that IOL whitening had minimal impact on visual acuity and light distortion, with no significant impairment reported in patient-reported outcomes. Imaging and laboratory analysis suggested that whitening is caused by subsurface nanoglistening (SSNG), a previously unreported phenomenon in this IOL material. The modulation transfer function of the affected IOLs remained comparable to control lenses, and in vitro attempts to induce whitening were unsuccessful.

Discussion

This study provides the first evidence of SSNG in this hydrophobic IOL material, demonstrating that while whitening can occur, its clinical significance is generally low. Given the predominantly subjective nature of symptoms, management should be individualized, with explantation decisions made in close consultation with the patient. These findings contribute to a better understanding of IOL material stability and patient counseling in cases of transparency loss.

Endogenous Fungal Endophthalmitis in a Patient After Fetal Reduction Surgery With a Literature Review: A Case Report

Endogenous fungal endophthalmitis (EFE) is a rare but severe ophthalmic emergency that often results in vision-threatening complications and, in extreme cases, can be life-threatening. This report presents a successfully treated case of fungal endophthalmitis, offering insights into clinical management. A 35-year-old female experienced decreased vision in her right eye following fetal reduction surgery. Her best-corrected visual acuity was limited to 10 cm finger counting in the affected eye. Following systemic antifungal therapy combined with vitrectomy, her vision recovered significantly. Through a detailed case analysis and literature review, this study aims to guide clinical practice. In patients with suspected EFE, obtaining early vitreous samples for pathogen identification and initiating timely treatment is critical. Furthermore, early vitrectomy during disease progression, along with an appropriate dosage and duration of antifungal therapy, is essential for restoring visual function and preventing vision loss.

Artificial Intelligence in Optometry: Current and Future Perspectives

With the global shortage of eye care professionals and the increasing burden of vision impairment, particularly in low- and middle-income countries, there is an urgent need for innovative solutions to bridge gaps in eye care services. Advances in artificial intelligence (AI) over recent decades have significantly impacted healthcare, including the field of optometry. When integrated into optometric workflows, AI has the potential to streamline decision-making processes and enhance system efficiency. To realize this potential, it is essential to develop AI models that can improve each stage of the patient care workflow, including screening, detection, diagnosis, and management. This review explores the application of AI in optometry, focusing on its potential to optimize various aspects of patient care. We examined AI models across key areas in optometry. Our analysis considered crucial parameters, including model selection, sample sizes for training and validation, evaluation metrics, and the explainability of the models. This comprehensive review identified both the strengths and weaknesses of existing AI models. The majority of image-based studies utilized CNN or transfer learning models, while clinical data-based studies primarily employed RF, SVM, and XGBoost. In general, AI models trained on large datasets achieved higher accuracy. However, many optometry-focused models faced limitations due to insufficient sample sizes-28% of studies were trained on fewer than 500 samples, 18% used fewer than 200 samples, and over half validated their models on fewer than 500 samples, with 38% validating on fewer than 200. Additionally, some studies that used the same data for both training and validation experienced overfitting, leading to reduced accuracy. Notably, 20% of the included studies reported accuracy below 80%, limiting their practical applicability in clinical settings. This review provides optometrists with valuable insights into the strengths and weaknesses of AI models in the field, aiding in their informed implementation in clinical settings.

PNEUMATIC DISPLACEMENT AND INTRAVITREAL ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR, WITH OR WITHOUT INTRAVITREAL TISSUE PLASMINOGEN ACTIVATOR, INJECTION FOR SUBMACULAR HEMORRHAGE

PURPOSE

To evaluate the outcomes of intravitreal gas and anti-vascular endothelial growth factor (anti-VEGF), with or without tissue plasminogen activator (tPA), injection for submacular hemorrhage (SMH).

METHODS

The authors retrospectively enrolled patients with SMH treated with intravitreal gas and anti-VEGF, with or without tPA (tPA and non-tPA groups, respectively), injection between 2014 and 2021, and data were collected at the preoperative visit and at 1-, 3-, 6-, and 12-month follow-ups. The primary outcome was the final best-corrected visual acuity, and the secondary outcomes were central subfield thickness, degree of blood displacement, and incidence of vitreous hemorrhage.

RESULTS

Herein, 38 eyes received intravitreal gas, anti-VEGF, and tPA injections, whereas 89 eyes received intravitreal gas and anti-VEGF injections. At 12 months, no significant intergroup difference was detected (P = 0.94), except the slightly greater central subfield thickness change in the non-tPA group (P = 0.03). Complete SMH displacement occurred in 35 (tPA = 92.1%) and 89 (non-tPA = 89.9%) eyes, with higher vitreous hemorrhage incidence in the non-tPA group (odds ratio 7.03, P = 0.004).

CONCLUSION

In pneumatic displacement combined with anti-VEGF therapy in SMH, adjunctive tPA use did not alter the visual and anatomical outcomes, although the vitreous hemorrhage risk in large SMH was reduced.

The therapeutic potential of mesenchymal stromal cell secretome in treating spontaneous chronic corneal epithelial defects in dogs

Corneal ulcers in dogs pose a significant challenge in veterinary ophthalmology, often leading to prolonged visual impairment and discomfort. This study aimed to assess the efficacy of adipose tissue-derived mesenchymal stromal cell (ASCs) secretome as a treatment for complicated corneal ulcers in dogs. Ten dogs with spontaneous chronic corneal epithelial defects, were treated with topical application of ASC secretome eye drops. Our results showed that secretome therapy facilitated complete healing of all corneal ulcers within 4 weeks, with an average healing time of 1.2 weeks. Notably, secretome treatment was effective even in cases that had previously failed to respond to conventional therapies. Clinical signs such as blepharospasm, conjunctival hyperemia, and photophobia were alleviated promptly following secretome administration. Secretome therapy was well-tolerated, with no adverse reactions reported, further supporting its safety profile. The findings suggest that ASC secretome represents a promising cell-free and minimally invasive therapeutic approach for the treatment of complicated corneal ulcers in dogs.

Updates on medical and surgical managements of diabetic retinopathy and maculopathy

Diabetic retinopathy (DR) and diabetic macular edema (DME) are leading causes of vision loss globally. This is a comprehensive review focused on both medical and surgical management strategies for DR and DME. This review highlights the epidemiology of DR and DME, with a particular emphasis on the Asia-Pacific region, urban-rural disparities, ethnic variations, and grading methodologies. We examine various risk factors for DR, including glycemic control, hypertension, hyperlipidemia, obesity, chronic kidney disease, sex, myopia, pregnancy, and cataract surgery. Furthermore, we explore potential biomarkers in serum, proteomics, metabolomics, vitreous, microRNA, and genetics that may aid in the detection and management of DR. In addition to medical management, we review the evidence supporting systemic and ocular treatments for DR/DME, including anti-vascular endothelial growth factor (anti-VEGF) agents, anti-inflammatory agents, biosimilars, and integrin inhibitors. Despite advancements in treatment options such as pan-retinal photocoagulation and anti-VEGF agents, a subset of cases still progresses, necessitating vitrectomy. Challenging diabetic vitrectomies pose difficulties due to complex fibrovascular proliferations, incomplete posterior vitreous detachment, and fragile, ischemic retinas, making membrane dissection risky and potentially damaging to the retina. In this review, we address the question of challenging diabetic vitrectomies, providing insights and strategies to minimize complications. Additionally, we briefly explore newer modalities such as 3-dimensional vitrectomy and intra-operative optical coherence tomography as potential tools in diabetic vitrectomy. In conclusion, this review provides a comprehensive overview of both medical and surgical management options for DR and DME. It underscores the importance of a multidisciplinary approach, tailored to the needs of each patient, to optimize visual outcomes and improve the quality of life for those affected by these sight-threatening conditions.

Mesenchymal stem cells and mesenchymal stem cell-derived exosomes: a promising strategy for treating retinal degenerative diseases

Mesenchymal stem cells (MSCs) have emerged as a promising therapeutic strategy in regenerative medicine, demonstrating significant potential for clinical applications. Evidence suggests that MSCs not only exhibit multipotent differentiation potential but also exert critical therapeutic effects in retinal degenerative diseases via robust paracrine mechanisms. MSCs protect retinal cells from degenerative damage by modulating inflammation, inhibiting apoptosis, alleviating oxidative stress, and suppressing cell death pathways. Furthermore, MSCs contribute to retinal structural and functional stability by facilitating vascular remodeling and donating mitochondria to retinal cells. Of particular interest, MSC-derived exosomes have gained widespread attention as a compelling cell-free therapy. Owing to their potent anti-inflammatory, anti-apoptotic, and vascular-stabilizing properties, exosomes show significant promise for the treatment of retinal degenerative diseases.

High-Accuracy Intermittent Strabismus Screening via Wearable Eye-Tracking and AI-Enhanced Ocular Feature Analysis

An effective and highly accurate strabismus screening method is expected to identify potential patients and provide timely treatment to prevent further deterioration, such as amblyopia and even permanent vision loss. To satisfy this need, this work showcases a novel strabismus screening method based on a wearable eye-tracking device combined with an artificial intelligence (AI) algorithm. To identify the minor and occasional inconsistencies in strabismus patients during the binocular coordination process, which are usually seen in early-stage patients and rarely recognized in current studies, the system captures temporally and spatially continuous high-definition infrared images of the eye during wide-angle continuous motion, and is effective in inducing intermittent strabismus. Based on the collected eye motion information, 16 features of the oculomotor process with strong physiological interpretations, which help biomedical staff understand and evaluate results generated later, are calculated through the introduction of pupil-canthus vectors. These features can be normalized, and reflect individual differences. After these features are processed by the random forest (RF) algorithm, this method experimentally yields 97.1% accuracy in strabismus detection in 70 people under diverse indoor testing conditions, validating the high accuracy and robustness of the method, and implying that the method has strong potential to support widespread and highly accurate strabismus screening.

Ablating VHL in rod photoreceptors modulates RPE glycolysis and improves preclinical model of retinitis pigmentosa

Neuroretinal degenerations including retinitis pigmentosa (RP) comprise a heterogeneous collection of pathogenic mutations that ultimately result in blindness. Despite recent advances in precision medicine, therapies for rarer mutations are hindered by burdensome developmental costs. To this end, Von Hippel-Lindau (VHL) is an attractive therapeutic target to treat RP. By ablating VHL in rod photoreceptors and elevating hypoxia-inducible factor (HIF) levels, we demonstrate a path to therapeutically enhancing glycolysis independent of the underlying genetic variant that slows degeneration of both rod and cone photoreceptors in a preclinical model of retinitis pigmentosa. This rod-specific intervention also resulted in reciprocal, decreased glycolytic activity within the retinal pigment epithelium (RPE) cells despite no direct genetic modifications to the RPE. Suppressing glycolysis in the RPE provided notable, noncell-autonomous therapeutic benefits to the photoreceptors, indicative of metabolically sensitive crosstalk between different cellular compartments of the retina. Surprisingly, targeting HIF2A in RPE cells did not impact RPE glycolysis, potentially implicating HIF1A as a major regulator in mouse RPE and providing a rationale for future therapeutic efforts aimed at modulating RPE metabolism.

Mussel-Inspired In Situ Photodynamic Antibacterial Coating for Postoperative Management of Artificial Corneas

Artificial corneal (AC) implants offer hope to millions with corneal blindness, including 5 million in China. Titanium is one of the materials commonly used in the fabrication of artificial corneal scaffolders because of its light texture, high mechanical properties, and high biosafety. However, postoperative bacterial infections, especially from Pseudomonas aeruginosa and Staphylococcus aureus (S. aureus), remain a significant challenge due to the bioinert nature of titanium materials, leading to high infection rates. In this study, we introduce an innovative in situ photodynamic coating technology designed to manage postoperative infections in artificial corneas. Inspired by mussel adhesive proteins, this coating employs a composite of APTES-TA formed by Schiff base and Michael addition reactions between 3-aminopropyltriethoxysilane (APTES) and tannic acid (TA), integrated with the bacterial targeting capabilities of 4-carboxyphenylboronic acid (CPBA) and the photo-Fenton activity of FeOOH (iron(III) hydroxide). The design of the AC@APTES-TA-CPBA-FeOOH coating leverages the dynamic boronate ester bonds, which interact specifically with bacteria in tears, effectively capturing them on the surface of the artificial cornea. The coating exhibits a photocatalytic Fenton-like effect, which confers it with an exceptional bactericidal efficiency of over 99% in vitro. Furthermore, it demonstrates excellent protective functionality for mouse corneas in vivo experiments.

Selective inhibitors of the TrkC.T1 receptor reduce retinal inflammation and delay neuronal death in a model of retinitis pigmentosa

The heterogeneity of receptor isoforms can cause an apparent paradox where each isoform can promote different or even opposite biological pathways. One example is the neurotrophin receptor TrkC. The trkC mRNA translates a full-length receptor tyrosine kinase (TrkC-FL) whose activation by the growth factor NT3 promotes neuronal survival. In some diseases, the trkC mRNA is spliced to a kinase-truncated isoform (TrkC.T1) whose activation by NT3 up-regulates tumor necrosis factor alpha (TNF-α) causing neurotoxicity. Since TrkC.T1 expression is significantly increased at the onset of neurodegeneration, we hypothesized that in disease TrkC.T1-mediated toxicity prevails over TrkC-FL-mediated survival. To study this, we developed small molecules that selectively antagonize NT3-driven TrkC.T1 neurotoxicity without compromising TrkC-FL survival. In a genetic mouse model of retinitis pigmentosa, therapeutic administration of TrkC.T1 antagonists prevents elevation of TNF-α and reduces photoreceptor neuronal death. This work demonstrates the importance of accounting for functional and structural heterogeneity in receptor-ligand interactions, illustrates chemical biology strategies to develop isoform-selective agents, validates TrkC.T1 as a druggable target, and expands the therapeutic concept of reducing neurotoxicity as a strategy to achieve neuroprotection.

The role of metal nanocarriers, liposomes and chitosan-based nanoparticles in diabetic retinopathy treatment: A review study

Diabetic Retinopathy (DR) is a significant and progressive eye complication associated with diabetes mellitus, leading to potential vision loss. The pathophysiology of DR involves complex neurovascular changes due to prolonged hyperglycemia, resulting in microangiopathy and neurodegeneration. Current treatment modalities come with limitations such as low bioavailability of therapeutic agents, risk of side effects, and surgical complications. Consequently, the prevention and management of DR, particularly in its advanced stages, present ongoing challenges. This review investigates recent advancements in nanotechnology as a novel approach to enhance the treatment of DR. A comprehensive literature review of recent studies focusing on nanocarriers for drug delivery in DR treatment and an analysis of their efficacy compared to traditional methods was conducted for this study. The findings indicate that nanotechnology can significantly enhance the bioavailability of therapeutic agents while minimizing systemic exposure and associated side effects. The novelty of this study lies in its focus on the intersection of nanotechnology and ophthalmology, exploring innovative solutions that extend beyond existing literature on DR treatments. By highlighting recent advancements in this field, the study paves the way for future research aimed at developing more effective therapeutic strategies for managing DR.

Relationship between platelet distribution width and non-dipping pattern in children with essential hypertension

BACKGROUND

Hypertension has shown a trend of prevalence at younger ages, and the non-dipping pattern is associated with target organ damage in hypertension. However, few studies have yet investigated the clinical characteristics and risk factors of non-dipper status in essential hypertension children. This study aimed to explore the clinical characteristics and possible indicators associated with non-dipper status in children with essential hypertension.

METHODS

A total of 125 children (99 boys, 26 girls) with untreated essential hypertension were retrospectively included in this study. Non-dipping was defined as a nocturnal drop in systolic or diastolic BP (SBP, DBP) < 10%. Clinical data, ambulatory blood pressure monitoring (ABPM), laboratory and echocardiography parameters were recorded from the hospital database.

RESULTS

Non-dipping pattern was found in 74 (59.2%) children and the dipping pattern in 51(40.8%) children, and the nocturnal SBP drop was 8.43 ± 0.71 (%), and the DBP drop was 14.44 ± 0.86 (%). The proportion of children with left ventricular hypertrophy was higher in the non-dipping group than in the dipping group. The platelet distribution width, high-sensitivity C-reactive protein (hs-CRP) and triglycerides (TG) levels were higher in the non-dipping group compared with the dipping group. In multivariate logistic regression analysis, PDW, TG and hs-CRP were found to be associated with the non-dipping pattern.

CONCLUSION

Non-dipping pattern in children hypertension is common, and the proportion of left ventricular hypertrophy is higher in non-dipping hypertension children. Moreover, higher PDW, hs-CRP and TG levels are the risk factors for non-dipping status in essential hypertension children.

Recent trends and outcomes in immediate and delayed sequential bilateral cataract surgeries: a nationwide cohort study in South Korea

PURPOSE

To analyze the latest annual trends in immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) among patients with bilateral cataracts in Korea, and to identify the factors influencing the choice of surgery and the outcomes associated with ISBCS and DSBCS.

METHODS

This retrospective, nationwide cohort study included all patients aged 65 and older who were covered by the Korean National Health Insurance and underwent ISBCS or DSBCS from 2016 to 2021. The study recorded yearly numbers of ISBCS and DSBCS procedures, the interval between surgeries in DSBCS cases, patient demographics, types of implanted intraocular lenses (IOLs), and the incidence of cystoid macular edema and endophthalmitis following ISBCS or DSBCS.

RESULTS

A total of 50 878 (7.2%) patients underwent ISBCS, and 658 609 (92.8%) patients underwent DSBCS. ISBCS cases more than doubled in 2020 (7902) from 2019 (3703) before increasing even more significantly in number in 2021 (33 645). Age, hospital size, ocular and systemic comorbidities, type of IOL, and calendar year were associated with receiving ISBCS. In 2020 alone, the incidence of postoperative endophthalmitis among ISBCS patients was significantly higher (1.39 per 1000 procedures) than among DSBCS patients (0.40 per 1000 procedures; P = 0.001).

CONCLUSION

The number of patients undergoing ISBCS for bilateral cataracts increased annually, particularly after the onset of the COVID-19 pandemic in Korea in 2020. However, this significant rise in ISBCS also led to a surge in the incidence of postoperative endophthalmitis in 2020.

High dose aflibercept treatment in naive neovascular age-related macular degeneration

BACKGROUND

To evaluate the efficacy and safety of intravitreal injections of 4 mg (high dose) of aflibercept in treatment-naive patients with neovascular AMD(nAMD) with treat and extend(TREX) dosing regimens, and to determine the frequency of injections.

METHODS

In this interventional, retrospective study a total of 15 eyes of 14 patients (eight female and 9 male) with nAMD were included. All patients were examined and OCT imaging was performed at the time of initial presentation, on the day of each injection and at subsequent follow-up visits. Each eye received intravitreal injections of 4 mg/0.1 mL aflibercept at the dose of every 4 weeks for three months (loading phase) after that 4 mg high dose of aflibercept was applied as the TREX regime. The eyes with a minimum follow-up time of 12 months are included.

RESULTS

The mean age of the patients was 74.9 ± 7.3(61-85) years and the mean follow-up time was 20.33 ± 8.7(12-34) months. Total number of injections were 9.3 ± 3.0 (5-14) during the follow-up period. A statistically significant increase was found in terms of best-corrected visual acuity and central macular thickness between mean baseline values and at 1, 3, 6, 12 months, and the final examination(p < 0.05 for each comparison). No complication was observed during follow-up.

CONCLUSIONS

High-dose Aflibercept of 4 mg/0.1 mL application with the TREX regimen was found to be efficient and safe. High-dose may also help to reduce the frequency of injections and visits in the follow-up period in eyes with nAMD. Prospective studies with large series are warranted.

Does Nocturnal Blood Pressure Matter in Retinal Small Vessels? A Systematic Review and Meta-Analysis of the Literature

PURPOSE OF THE REVIEW

Τhe association between nocturnal blood pressure (BP) and alterations in the retinal microvasculature remains understudied, with few available studies to provide conflicting results. Therefore, we conducted a systematic review and meta-analysis to determine whether an association exists between retinal microvascular alterations and nocturnal BP patterns, determined by 24h ambulatory BP measurement.

RECENT FINDINGS

Our search concluded to 1002 patients (6 studies). A total of 3 studies (411 patients) were enrolled in the meta-analysis. Central retinal arteriolar equivalent found to be not different between patients with and without dipping status (mean differences [MD]: -0.01; 95% CI: -0.23 to 0.20; I²=0%; P < 0.610). Regarding central retinal venular equivalent, dippers showed significantly lower values compared to non-dippers (MD: -0.25; 95% CI: -0.47 to -0.03; I²=0%; P < 0.024). For the comparison between nighttime and daytime BP regarding the damage in small retinal vessels, we identified only 5 studies. Due to different evaluated outcomes as well as due to the heterogeneity of outcomes and different grouping of patients based on different BP cut-off values, these results couldn't be analyzed quantitatively. In summary, this is the first effort to summarize evidence on the effects of day-to-night variation of BP on the retinal small vessels. According to the findings of the present systematic review and meta-analysis, non-dipping status may be associated with retinal venular dilatation, and elevated nighttime BP with retinal arteriolar narrowing. Further studies are warranted to elucidate the impact of nocturnal BP patterns in the retinal microvasculature.

Biomedical Application of MSCs in Corneal Regeneration and Repair

The World Health Organization estimates that approximately 285 million people suffer from visual impairments, around 5% of which are caused by corneal pathologies. Currently, the most common clinical treatment consists of a corneal transplant (keratoplasty) from a human donor. However, worldwide demand for donor corneas amply exceeds the available supply. Lamellar keratoplasty (transplantation replacement of only one of the three layers of the cornea) is partially solving the problem of cornea undersupply. Obviously, cell therapy applied to every one of these layers will expand current therapeutic options, reducing the cost of ophthalmological interventions and increasing the effectiveness of surgery. Mesenchymal stem cells (MSCs) are adult stem cells with the capacity for self-renewal and differentiation into different cell lineages. They can be obtained from many human tissues, such as bone marrow, umbilical cord, adipose tissue, dental pulp, skin, and cornea. Their ease of collection and advantages over embryonic stem cells or induced pluripotent stem cells make them a very practical source for experimental and potential clinical applications. In this review, we focus on recent advances using MSCs from different sources to replace the damaged cells of the three corneal layers, at both the preclinical and clinical levels for specific corneal diseases.

Molecular Epidemiological Characteristics of Staphylococcus pseudintermedius, Staphylococcus coagulans, and Coagulase-Negative Staphylococci Cultured from Clinical Canine Skin and Ear Samples in Queensland

Background/Objectives: Infections in dogs caused by methicillin-resistant staphylococci (MRS) present limited treatment options. This study's objective was to investigate the molecular epidemiology of Staphylococcus spp. cultured exclusively from clinical canine skin and ear samples in Queensland, Australia, using whole-genome sequencing (WGS). Methods: Forty-two Staphylococcus spp. isolated from clinical canine skin and ear samples, from an unknown number of dogs, were sourced from two veterinary diagnostic laboratories between January 2022 and May 2023. These isolates underwent matrix-assisted laser desorption ionisation- time of flight bacterial identification, minimum inhibitory concentration testing using SensititreTM plates and WGS. Phylogenetic trees and core genome multilocus sequence typing (cgMLST) minimum spanning trees (MSTs) were constructed. Results: The isolates included methicillin-resistant and -sensitive S. pseudintermedius (MRSP: 57.1%, 24/42; and MSSP: 19.1%, 8/42), methicillin-resistant and -sensitive S. coagulans (MRSC: 14.3%, 6/42; and MSSC: 2.4%, 1/42) and methicillin-resistant coagulase-negative staphylococci (MR-CoNS: 7.1%, 3/42). Thirty-nine isolates were included after WGS, where all MRS harboured the mecA gene. Eighteen sequence types (STs) were identified, including three novel MRSP and six novel MSSP STs. MRSP ST496-V-VII (23%; 9/39) and MRSP ST749-IV-(IVg) (12.8%; 5/39) were commonly isolated. Phylogenetic analysis of single nucleotide polymorphisms showed that MRSP, MRSC and MSSC were similar to globally isolated staphylococci from canine skin and ear infections. Using cgMLST MSTs, MRSP isolates were not closely related to global strains. Conclusions: Our findings revealed a genotypically diverse geographical distribution and phylogenetic relatedness of staphylococci cultured from clinical canine skin and ear samples across Queensland. This highlights the importance of ongoing surveillance to aid in evidence-based treatment decisions and antimicrobial stewardship.

Whole-exome sequencing uncovers the genetic basis of hereditary concomitant exotropia in ten Chinese pedigrees

PURPOSE

To explore possible pathogenic genes for concomitant exotropia using whole-exome sequencing.

METHODS

In this study, 47 individuals from 10 concomitant exotropia (including intermittent exotropia and constant exotropia) pedigrees were enrolled. Whole-exome sequencing was used to screen mutational profiles in 25 affected individuals and 10 unaffected individuals. Sanger sequencing and in silico analysis were performed for all participants. Two target genes were used to capture the sequences of 220 sporadic samples.

RESULTS

All 10 concomitant exotropia pedigrees presented autosomal dominant inheritance with childhood onset (3.35 ± 1.51 years old). Eleven different missense variants were identified among seven potential pathogenic genes (COL4A2, SYNE1, LOXHD1, AUTS2, GTDC2, HERC2 and CDH3) that cosegregated with pedigree members. All variants were predicted to be deleterious and had low frequencies in the general population. Distinct variants of COL4A2 were present in three pedigrees, and distinct variants of SYNE1 were present in two pedigrees. Fifteen variants in AUTS2 and four variants in GTDC2 were identified in 220 patients with sporadic concomitant exotropia using a target-capture sequencing approach.

CONCLUSION

This is the first study to explore the genetic mechanism of concomitant exotropia and identify seven associated genes (COL4A2, SYNE1, LOXHD1, AUTS2, GTDC2, HERC2 and CDH3) that may be candidate genes causing concomitant exotropia. More samples and in-depth studies are needed to verify these findings.

Mechanisms of Rhodopsin-Related Inherited Retinal Degeneration and Pharmacological Treatment Strategies

Retinitis pigmentosa (RP) is a hereditary disease characterized by progressive vision loss ultimately leading to blindness. This condition is initiated by mutations in genes expressed in retinal cells, resulting in the degeneration of rod photoreceptors, which is subsequently followed by the loss of cone photoreceptors. Mutations in various genes expressed in the retina are associated with RP. Among them, mutations in the rhodopsin gene (RHO) are the most common cause of this condition. Due to the involvement of numerous genes and multiple mutations in a single gene, RP is a highly heterogeneous disease making the development of effective treatments particularly challenging. The progression of this disease involves complex cellular responses to restore cellular homeostasis, including the unfolded protein response (UPR) signaling, autophagy, and various cell death pathways. These mechanisms, however, often fail to prevent photoreceptor cell degradation and instead contribute to cell death under certain conditions. Current research focuses on the pharmacological modulation of the components of these pathways and the direct stabilization of mutated receptors as potential treatment strategies. Despite these efforts, the intricate interplay between these mechanisms and the diverse causative mutations involved has hindered the development of effective treatments. Advancing our understanding of the interactions between photoreceptor cell death mechanisms and the specific genetic mutations driving RP is critical to accelerate the discovery and development of therapeutic strategies for this currently incurable disease.

Clinical Characteristics, Pathogen Distribution, and Factors Affecting Visual Outcomes of Pediatric Post-Traumatic Endophthalmitis

Objective: This study aimed to investigate the etiology, pathogens, antibiotic susceptibility, treatments, and factors influencing the visual prognosis of pediatric post-traumatic endophthalmitis (PTE) to provide valuable insights for clinical diagnosis and treatment. Results: A total of 301 children were included, with 142 (47.2%) cultures yielding positive results. Gram-positive cocci were the predominant pathogens (71.1%), with high sensitivity to vancomycin (95.4%). Pars plana vitrectomy (PPV) was performed in 216 eyes (71.8%), with emergency or immediate vitrectomy within 24 h of hospitalization performed on 171 eyes (56.8%). The first intravitreal antibiotic injection, consisting of ceftazidime and norvancomycin, was administered to 248 patients (82.4%). The absence of retinal detachment (OR, 0.191; 95% CI, 0.065-0.560; p = 0.002), normal intraocular pressure (OR, 1.894; 95% CI, 1.151-3.117; p = 0.012), and no lens extraction (OR, 0.187; 95% CI, 0.069-0.504; p < 0.001) were found to be independent factors associated with better visual outcomes (BCVA) in pediatric PTE patients. Methods: A retrospective analysis was conducted on pediatric PTE patients treated between January 2012 and June 2022. Data were collected on clinical characteristics, causative pathogens, antibiotic sensitivity, treatments, and visual outcomes. Conclusions: Gram-positive cocci are the most common pathogens in pediatric PTE, with early vitrectomy and intravitreal ceftazidime and norvancomycin being the most effective treatments. Favorable visual outcomes are strongly associated with the absence of retinal detachment, normal intraocular pressure, and no lens extraction. These findings highlight the need for timely surgical and antimicrobial interventions tailored to each patient to improve visual prognosis.

The Importance of Differentiated RPE Cultures for studying Cell Biological Processes

The retinal pigment epithelium (RPE) is a polarized monolayer of cells that provides essential functions to the light-sensitive photoreceptors in the retina. Many of the cell biological processes involving the RPE, including those underlying disease mechanisms, can be studied using in vitro culture systems. For such models to be informative, the RPE cultures must be well-differentiated and fully mature, exhibiting the key characteristics of their native counterparts. In this mini review, we emphasize this requirement to use fully differentiated RPE cultures by discussing structural, functional, and metabolic aspects of the RPE.

Genetically Encoded Metabolic Sensors to Study Retina Metabolism

Dysfunctional retinal metabolism has been shown to contribute to retinal diseases such as age-related macular degeneration (AMD), diabetic retinopathy (DR) and inherited retinal degeneration (IRD). Data indicates that metabolism in the retina is complex and involves intricate interactions between cell types, including the exchange of metabolites between photoreceptors and retinal pigment epithelium (RPE) cells. To understand these interactions on a single cell level, cell-type specific expression of genetically encoded metabolic sensors can be used to reach a spatial and temporal resolution that is superior to other techniques. These sensors comprise a metabolite binding site and a fluorescent reporter protein. The binding of the metabolite leads to changes in the emission of the fluorophore which can be detected by specialized microscopy. The usage of such sensors together with other techniques in the normal and diseased retina will not only help to resolve metabolic interactions between cells and fluxes of metabolites but also enhance our understanding of pathophysiological changes in the retina.

Comparative Efficacy of Brolucizumab and Aflibercept in Polypoidal Choroidal Vasculopathy: A Systematic Review and Meta-Analysis

Polypoidal choroidal vasculopathy (PCV) represents a distinct subtype of neovascular age-related macular degeneration (nAMD). PCV is currently managed using intravitreal anti-vascular endothelial growth factor (VEGF) agents such as brolucizumab and aflibercept. This meta-analysis compares the effectiveness of brolucizumab and aflibercept in PCV patients. We systematically searched four electronic databases to identify eligible studies. Data extraction and pooling were performed utilizing the mean difference (MD) or rate ratio (RR) through the generic inverse variance method, with significance determined by a p-value < 0.05 between intervention subgroups. The generic inverse variance analysis method was applied with the employment of the random-effect model when data were heterogeneous. We retrieved 44 studies, 35 were included in the meta-analysis. The analysis compared the efficacy of aflibercept and brolucizumab in patients with nAMD over 3-6 months and 12 months. For best-corrected visual acuity (BCVA), the MD between aflibercept and brolucizumab were -0.11 versus -0.06 at 3-6 months and -0.11 versus -0.04 at 12 months, with no substantial differences (p = 0.58 and p = 0.08, respectively). Regarding polypoidal regression, RR after aflibercept use was 53% versus 70% for brolucizumab at 3-6 months and 47% versus 61% at 12 months, with no significant differences (p = 0.19 and p = 0.31, respectively). In terms of central retinal thickness (CRT), the MDs for aflibercept versus brolucizumab were -129.03 versus -143.93 at 3-6 months and -129.72 versus -145.32 at 12 months, without significant differences (p = 0.62 for both). For central choroidal thickness (CCT) and central foveal thickness (CFT), no significant differences were found between the two interventions at either time point. However, for central macular thickness, brolucizumab demonstrated superiority over aflibercept at 12 months (MD = -119.29 versus -215.00, p < 0.0001). In conclusion, our meta-analysis comparing aflibercept and brolucizumab in PCV revealed no significant differences in BCVA, polypoidal regression, CRT, CCT, and CFT at 6 or 12 months. Overall, both drugs demonstrated comparable efficacy in managing PCV.

Efficient strabismus diagnosis from small samples: Harnessing spatial features for improved accuracy

Strabismus is a common ophthalmological condition, and early diagnosis is crucial to preventing visual impairment and loss of stereopsis. However, traditional methods for diagnosing strabismus often rely on specialized ophthalmic equipment and trained personnel, limiting the widespread accessibility of strabismus diagnosis. Computer-aided strabismus diagnosis is an effective and widely used technology that assists clinicians in making clinical diagnoses and improving efficiency. To address this, we designed an efficient strabismus diagnosis model, RIS-MLP, based on a small number of samples derived from frontal facial images captured under natural lighting conditions via the Hirschberg test. The RIS-MLP combines light reflex point detection and iris detection modules to accurately extract key spatial features even under noisy and occluded conditions. The optimized spatial feature strategies further enhances the performance of the classification module. To validate the superiority of RIS-MLP, we conducted both direct and indirect comparative experiments. Indirect comparisons demonstrate that the RIS-MLP has advantages in terms of sample efficiency. While direct comparisons show that the RIS-MLP can mitigate overfitting to a certain extent, and the RIS-MLP along with its variants (e.g., RIS-SVM) have outperformed state-of-the-art models on our noisy and imbalanced dataset.

One-Year Outcomes of Aflibercept in Treat-and-Extend Versus Pro Re Nata Regimens for Bevacizumab-Resistant Diabetic Macular Edema: A Real-World Study

INTRODUCTION

The aim of this study was to compare the efficacy of the treat-and-extend (TAE) regimen versus the pro re nata (PRN) regimen in patients with bevacizumab-resistant diabetic macular edema (DME) treated with aflibercept, with or without adjunctive laser therapy.

METHODS

Ninety-one eyes from 91 patients who were switched to aflibercept after three consecutive intravitreal bevacizumab injections for the treatment of DME were included in this retrospective real-world study. The patients were categorized into three groups: TAE (n = 30), TAE + laser (n = 31), and PRN (n = 30). Changes in best-corrected visual acuity and central macular subfield thickness (CMST) at 12, 24, and 52 weeks were defined as the primary functional and anatomical outcomes.

RESULTS

A total of 91 eyes from 91 patients (49.5% female) with a mean age of 63.9 ± 7.1 years were included in the analysis. At 52 weeks, the mean letter gains were 8.03, 8.90, and 10.23 in the TAE, TAE + laser, and PRN groups, respectively. Anatomical improvements, as measured by CMST reduction, were 55.33 µm, 33.35 µm, and 48.96 µm in the TAE, TAE + laser, and PRN groups, respectively. The average number of injections administered was 7.7, 8.1, and 8.1, respectively. The final extension interval for the TAE group was 8.7 weeks, compared to 9.5 weeks in the TAE + laser group.

CONCLUSIONS

The PRN group demonstrated the highest functional improvement while the TAE group showed the greatest anatomical improvement. Overall, both anatomical and functional outcomes in the TAE regimen were comparable to the PRN regimen in patients with bevacizumab-resistant diabetic macular edema.

Eye on the horizon: The metabolic landscape of the RPE in aging and disease

To meet the prodigious bioenergetic demands of the photoreceptors, glucose and other nutrients must traverse the retinal pigment epithelium (RPE), a polarised monolayer of cells that lie at the interface between the outer retina and the choroid, the principal vascular layer of the eye. Recent investigations have revealed a metabolic ecosystem in the outer retina where the photoreceptors and RPE engage in a complex exchange of sugars, amino acids, and other metabolites. Perturbation of this delicate metabolic balance has been identified in the aging retina, as well as in age-related macular degeneration (AMD), the leading cause of blindness in the Western world. Also common in the aging and diseased retina are elevated levels of cytokines, oxidative stress, advanced glycation end-products, increased growth factor signalling, and biomechanical stress - all of which have been associated with metabolic dysregulation in non-retinal cell types and tissues. Herein, we outline the role of these factors in retinal homeostasis, aging, and disease. We discuss their effects on glucose, mitochondrial, lipid, and amino acid metabolism in tissues and cell types outside the retina, highlighting the signalling pathways through which they induce these changes. Lastly, we discuss promising avenues for future research investigating the roles of these pathological conditions on retinal metabolism, potentially offering novel therapeutic approaches to combat age-related retinal disease.

Role of RPE Phagocytosis in the Retina Metabolic Ecosystem

Photoreceptors are the most glycolytically active cells in the body. Vital to glucose homeostasis is the metabolic relationship between the photoreceptors and the retinal pigment epithelium (RPE). The photoreceptors and RPE are in metabolic symbiosis, wherein the RPE takes up glucose from circulation and passes it on to the photoreceptors to fuel glycolysis. In turn, the photoreceptors produce energy substrates that are taken up by the RPE to support their metabolism. One of the main roles of the RPE is to phagocytose "used" photoreceptor outer segments (POS), a process that occurs to mitigate damage accrued by light. This mini-review explores the role that POS phagocytosis has in supporting the metabolic ecosystem linking photoreceptors and the RPE.

The pathogenicity and virulence of the opportunistic pathogen Staphylococcus epidermidis

The pervasive presence of Staphylococcus epidermidis and other coagulase-negative staphylococci on the skin and mucous membranes has long underpinned a casual disregard for the infection risk that these organisms pose to vulnerable patients in healthcare settings. Prior to the recognition of biofilm as an important virulence determinant in S. epidermidis, isolation of this microorganism in diagnostic specimens was often overlooked as clinically insignificant with potential delays in diagnosis and onset of appropriate treatment, contributing to the establishment of chronic infection and increased morbidity or mortality. While impressive progress has been made in our understanding of biofilm mechanisms in this important opportunistic pathogen, research into other virulence determinants has lagged S. aureus. In this review, the broader virulence potential of S. epidermidis including biofilm, toxins, proteases, immune evasion strategies and antibiotic resistance mechanisms is surveyed, together with current and future approaches for improved therapeutic interventions.

Unburied polytetrafluoroethylene scleral suture erosions and failure of pericardial graft revision

Purpose

The purpose of this case series is to report three cases of exposed, unburied polytetrafluoroethylene (Gore-tex) sutures used for scleral fixated intraocular lenses and their management, including failure of pericardial patch and success of irradiated corneal patch. This series aims to inform management options for this uncommon adverse event.

Observations

A retrospective case series was conducted of three patients who presented at a tertiary care center with exposure of unburied Gore-tex sutures used for fixation of intraocular lens. All three patients underwent initial suture revision with pericardial graft patching. Chart review was conducted to assess past ocular history, operative technique for lens fixation surgery, time from this surgery to suture exposure, time to pericardial patch failure, and long-term outcome.Results showed that pericardial patch grafting failed within several months in all three cases. One patient subsequently had an irradiated corneal graft placed and still had a successful outcome after 36 months of follow-up. Possible risk factors for suture erosion were identified as a surgical history of pterygium excision and loose or unburied suture knots.

Conclusions and importance

Pericardial patch grafting may not work well for unburied Gore-tex suture exposure. Eyes with prior complex histories are at risk for erosion of unburied Gore-tex sutures with surgical repair required.

Integrating artificial intelligence in strabismus management: current research landscape and future directions

Advancements in artificial intelligence (AI) are transforming strabismus management through improved screening, diagnosis, and surgical planning. Deep learning has notably enhanced diagnostic accuracy and optimized surgical outcomes. Despite these advancements, challenges such as the underrepresentation of diverse strabismus types and reliance on single-source data remain prevalent. Emphasizing the need for inclusive AI systems, future research should focus on expanding AI capabilities with large model technologies, integrating multimodal data to bridge existing gaps, and developing integrated management platforms to better accommodate diverse patient demographics and clinical scenarios.

Whole genome sequencing-based characterization and determination of quinolone resistance among methicillin-resistant and methicillin-susceptible S. Aureus isolates from patients attending regional referral hospitals in Tanzania

BACKGROUND

The emergence of multidrug-resistant termed Methicillin-resistant Staphylococcus aureus (MRSA) strain, driven by the acquisition of resistance gene mecA imposes a substantial challenge in the treatment and control of their related infections. Although quinolones have historically been effective against both MRSA and methicillin-susceptible S. aureus (MSSA) strains, the rising resistance to quinolones among S. aureus isolates, particularly in MRSA, has severely curtailed their potency and further narrowed down the therapeutic options. This study aimed to determine the burden of MRSA among isolates, as well as their resistance profile, genotypic characterization, and molecular relatedness through the construction of a phylogenetic tree.

MATERIALS AND METHODS

Archived clinical S. aureus isolates from a descriptive, cross-sectional study involving six regional referral hospitals in Dodoma, Songea, Kigoma, Kitete, and Morogoro in the mainland Tanzania and Mnazi Mmoja in Zanzibar were analyzed. Bacterial identification was performed using both classical microbiology and whole genome sequencing on Illumina Nextseq 550 Sequencer. Species identification was done using KmerFinder 3.2, Multilocus Sequence Typing using MLST 2.0, SCCmec typing using SCCmecFinder 1.2, resistance genes using ResFinder 4.1, and phylogenetic relatedness using CSI Phylogeny 1.4.

RESULTS

Out of the 140 isolates analyzed, 69 (49.3%) were identified as MRSA, with 57 (82.6%) exhibiting quinolone resistance. Conversely, 71 isolates were identified as MSSA, and none of them exhibited resistance to quinolones. Spa-typing revealed six spa types, with t355, t1476, and t498 being the most common. Moreover, all (69) MRSA were found to carry SCCmec type IV. The isolates exhibited 14 different sequence types (STs). Notably, ST152 was prevalent among MSSA (50 isolates, 70%), while ST8 was the predominant sequence type among MRSA (58 isolates, 84%). The antimicrobial resistance profile revealed at least three horizontally acquired resistance genes, with blaZ, dfrG, tet(K), and aac (6')-aph (2'') genes being highly prevalent.

CONCLUSION

There is a high genetic diversity among the S. aureus isolates existing in Tanzania regional hospitals, with a concerning burden of quinolone resistance among MRSA isolates. The diversity in resistance genes among MRSA lineages emphasizes the necessity for the development of sustainable antimicrobial stewardship and surveillance to support evidence-based guidelines for managing and controlling MRSA infections in both community and hospital settings.

Strabismus Detection in Monocular Eye Images for Telemedicine Applications

This study presents a novel method for the early detection of strabismus, a common eye misalignment disorder, with an emphasis on its application in telemedicine. The technique leverages synchronized eye movements to estimate the pupil location of one eye based on the other, achieving close alignment in non-strabismic cases. Regression models for each eye are developed using advanced machine learning algorithms, and significant discrepancies between estimated and actual pupil positions indicate the presence of strabismus. This approach provides a non-invasive, efficient solution for early detection and bridges the gap between basic research and clinical care by offering an accessible, machine learning-based tool that facilitates timely intervention and improved outcomes in diverse healthcare settings. The potential for pediatric screening is discussed as a possible direction for future research.

Post-Cataract Surgery Fungal Endophthalmitis: 6-Year Experience in Management and Outcomes at a Tertiary Eye Care Center

Purpose

This study aimed to describe the functional and anatomical outcomes of post-cataract surgery fungal endophthalmitis at King Khaled Eye Specialist Hospital (KKESH).

Patients and Methods

A retrospective analysis of clinical data from a single institution was performed. This study included 29 patients with post-cataract surgery endophthalmitis with suspected or confirmed fungal etiology who presented between January 1, 2017, and December 31, 2022. We evaluated demographics, clinical features, microbiological assessments, and treatment strategies. The effects of various treatments on outcomes were analyzed. The need for additional treatment and functional and anatomical outcomes was also investigated.

Results

The mean time from surgery to the onset of ocular symptoms was 52.1 (SD ± 59.9; range, 3-210) days, and the mean time from surgery to the first visit to KKESH was 81.4 (SD ± 103.5; range, 2-510) days. Low culture positivity was noted in four samples, with two revealing Aspergillus sp. and two revealing Cladosporium sp. Of the 29 patients, 6 underwent pars plana vitrectomy (PPV) and received intravitreal antimicrobial/antibiotic injections. Two of the six patients also underwent simultaneous intraocular lens removal. The average number of additional treatments, regardless of visual acuity, was lower in the PPV group than in the conservative group (0.5 [SD ± 1.1; range, 0-3] and 1.48 [SD ± 1.47; range, 0-6], respectively). In the PPV group, 50% (n=3) of the eyes achieved functional success and 83.3% (n=5) of the eyes achieved anatomical success. In contrast, in the conservative group, 43.5% (n=10) of the eyes achieved functional success and 69.6% (n=16) of the eyes achieved anatomical success.

Conclusion

For post-cataract surgery fungal endophthalmitis, a high index of suspicion and prompt PPV with empirical administration of intravitreal antifungal agents are required to achieve a favorable prognosis.

An artificial intelligence platform for the screening and managing of strabismus

OBJECTIVES

Considering the escalating incidence of strabismus and its consequential jeopardy to binocular vision, there is an imperative demand for expeditious and precise screening methods. This study was to develop an artificial intelligence (AI) platform in the form of an applet that facilitates the screening and management of strabismus on any mobile device.

METHODS

The Visual Transformer (VIT_16_224) was developed using primary gaze photos from two datasets covering different ages. The AI model was evaluated by 5-fold cross-validation set and tested on an independent test set. The diagnostic performance of the AI model was assessed by calculating the Accuracy, Precision, Specificity, Sensitivity, F1-Score and Area Under the Curve (AUC).

RESULTS

A total of 6194 photos with corneal light-reflection (with 2938 Exotropia, 1415 Esotropia, 739 Vertical Deviation and 1562 Orthotropy) were included. In the internal validation set, the AI model achieved an Accuracy of 0.980, Precision of 0.941, Specificity of 0.979, Sensitivity of 0.958, F1-Score of 0.951 and AUC of 0.994. In the independent test set, the AI model achieved an Accuracy of 0.967, Precision of 0.980, Specificity of 0.970, Sensitivity of 0.960, F1-Score of 0.975 and AUC of 0.993.

CONCLUSIONS

Our study presents an advanced AI model for strabismus screening which integrates electronic archives for comprehensive patient histories. Additionally, it includes a patient-physician interaction module for streamlined communication. This innovative platform offers a complete solution for strabismus care, from screening to long-term follow-up, advancing ophthalmology through AI technology for improved patient outcomes and eye care quality.

Genomics of Staphylococcus aureus and Enterococcus faecalis isolated from the ocular surface of dry eye disease sufferers

Ocular surface inflammatory disorders, such as dry eye, are becoming increasingly prevalent. Developing new treatment strategies targeting harmful bacteria could provide significant therapeutic benefits. The purpose of this study was to characterize the common ocular pathogen Staphylococcus aureus and the rarer endophthalmitis-associated species Enterococcus faecalis isolated from the ocular surface of dry eye disease patients in Norway. Together the 7 isolates (5 S. aureus and 2 E. faecalis) comprise the complete set of members of each species isolated in our previous study of the ocular microbiome of 61 dry eye sufferers. We aimed to investigate the pathogenic potential of these isolates in relation to ocular surface health. To this end, we used whole genome sequencing, multiplex PCR directed at virulence genes and antibiotic susceptibility tests encompassing clinically relevant agents. The E. faecalis isolates showed resistance to only gentamicin. S. aureus isolates displayed susceptibility to most of the tested antibiotics, except for two isolates which showed resistance to trimethoprim/sulfamethoxazole and three isolates which were resistant to ampicillin. Susceptibilities included sensitivity to several first-line antibiotics for treatment of ocular infections by these species. Thus, treatment options would be available if required. However, spontaneous resistance development to gentamicin and rifampicin occurred in some S. aureus which could be a cause for concern. Whole genome sequencing of the isolates showed genome sizes ranging from 2.74 to 2.83 Mbp for S. aureus and 2.86 Mbp for E. faecalis, which is typical for these species. Multilocus sequence typing and phylogenetic comparisons with previously published genomes, did not suggest the presence of eye-specific clusters for either species. Genomic analysis indicated a high probability of pathogenicity among all isolates included in the study. Resistome analysis revealed the presence of the beta-lactamase blaZ gene in all S. aureus isolates and the dfrG gene in two of them; while E. faecalis isolates carried the lsa(A) gene which confers intrinsic resistance to lincosamides and streptogramin A in this species. Screening for virulence factors revealed the presence of various pathogenicity associated genes in both S. aureus and E. faecalis isolates. These included genes coding for toxin production and factors associated with evading the host immune system. Some of the identified genes (tst, hylA & hylB) are suggested to be linked to the pathophysiology of dry eye disease. Lastly, the presence of specific S. aureus virulence genes was confirmed through multiplex PCR analysis.