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.

Artificial Intelligence in Glaucoma: Advances in Diagnosis, Progression Forecasting, and Surgical Outcome Prediction

Glaucoma is a leading cause of irreversible blindness, with challenges persisting in early diagnosis, disease progression, and surgical outcome prediction. Recent advances in artificial intelligence have enabled significant progress by extracting clinically relevant patterns from structural, functional, and molecular data. This review outlines the current applications of artificial intelligence in glaucoma care, including early detection using fundus photography and OCT and disease progression prediction using deep learning architectures such as convolutional neural networks, recurrent neural networks, transformer models, generative adversarial networks, and autoencoders. Surgical outcome forecasting has been enhanced through multimodal models that integrate electronic health records and imaging data. We also highlight emerging AI applications in omics analysis, including transcriptomics and metabolomics, for biomarker discovery and individualized risk stratification. Despite these advances, key challenges remain in interpretability, integration of heterogeneous data, and the lack of personalized surgical timing guidance. Future work should focus on transparent, generalizable, and multimodal AI models, supported by large, well-curated datasets, to advance precision medicine in glaucoma.

Contributing factors to short-term intraocular pressure elevation following intravitreal anti-VEGF injections

BACKGROUND

Short-term intraocular pressure (IOP) elevation is a common complication following intravitreal injection (IVI) of anti-VEGF drugs, potentially posing risks to retinal health. This study aimed to identify key factors influencing short-term IOP elevation and provide actionable insights for its prediction and effective management in clinical practice.

METHODS

An observational study was conducted on 64 postoperative measurements from patients who underwent IVI of anti-VEGF drugs at Yidu Central Hospital of Weifang between 2023 and 2024. Data on patient demographics (e.g., age, sex), clinical characteristics (e.g., lens status, diabetes), and pre- and postoperative IOP values were collected. A linear mixed-effects model was applied to evaluate factors associated with IOP elevation 5 min post-injection.

RESULTS

The baseline IOP was 14.64 ± 2.71 mmHg, increasing to 43.33 ± 7.70 mmHg at 5 min post-injection and subsequently decreasing to 19.25 ± 3.80 mmHg at 30 min post-injection. Statistically significant differences were observed between the baseline and postoperative IOP values (p < 0.0001). At 30 min post-injection, 68.8% of the measured IOP values were ≤ 21 mmHg, and all were ≤ 30 mmHg. The linear mixed-effects model revealed that older age (p < 0.001), native crystalline lens (p < 0.001), and diabetes (p = 0.009) were significant predictors of greater IOP elevation at 5 min post-injection.

CONCLUSIONS

Short-term IOP elevation following intravitreal anti-VEGF injections is associated with older age, a native crystalline lens, and diabetes. Individualized preventive strategies may effectively mitigate the risk of postoperative IOP elevation in high-risk patients.

AI-assisted ophthalmic imaging for early detection of neurodegenerative diseases

BACKGROUND

Artificial intelligence (AI) plays a promising role in ophthalmic imaging by providing innovative, non-invasive tools for the early detection of neurodegenerative diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD). Since early diagnosis is crucial for slowing disease progression and improving patient outcomes, leveraging AI-assisted ophthalmic imaging retinal imaging can enhance detection accuracy and clinical decision-making.

METHODS

This review examines clinical applications of AI in identifying retinal biomarkers associated with neurodegenerative diseases. Relevant data was gathered through a comprehensive literature review using PubMed, ScienceDirect, and Google Scholar to evaluate studies utilizing AI algorithms for retinal imaging analysis, focusing on diagnostic performance, sensitivity, specificity, and clinical relevance.

RESULTS

AI-assisted ophthalmic imaging retinal imaging enhances the early identification of neurodegenerative diseases by detecting microscopic structural and vascular changes in the retina. Studies have demonstrated that AI models analyzing Optical Coherence Tomography (OCT) and fundus images achieve high diagnostic accuracy. Studies have reported an area under the curve (AUC) of up to 0.918 in PD detection, with sensitivity ranging from 80 to 100% and specificity up to 85%. Similarly, AI-assisted OCT angiography (OCT-A) analysis has successfully identified retinal vascular alterations in AD patients, correlating with cognitive decline and an AUC of 0.73-0.91. These findings highlight AI's potential to detect preclinical disease stages before significant neurological symptoms manifest.

DISCUSSION

The integration of AI technologies into ophthalmic imaging holds the potential to improve early diagnosis and transform patient outcomes. However, challenges such as model interpretability, dataset biases, and ethical considerations must be addressed to ensure the responsible integration of AI into clinical practice. Future research should focus on refining AI algorithms, integrating multimodal imaging techniques, and developing predictive biomarkers to optimize early intervention strategies for neurodegenerative diseases.

CLINICAL TRIAL NUMBER

Not applicable.

Impact of NSAIDs corticosteroids DMARDs biologics and their comparisons with natural products in C-reactive proteins (CRP) linked cardiovascular disorders

An important part of the pathophysiology of atherosclerosis is the involvement of inflammatory processes, which mediate various stages of the formation of atheroma, from the first leukocyte recruitment to the final rupture of the unstable atherosclerotic plaque. Acute phase reactant C-reactive protein (CRP), which represents varying degrees of inflammation, has been identified as a separate risk factor for several cardiovascular diseases (CVD), particularly unstable coronary syndrome. We hypothesize that CRP is a direct cause of CVD in addition to being an inflammatory marker. Therefore, therapies aimed at lowering CRP should be beneficial for both primary and secondary CVD prevention. It has been demonstrated that the use of many drugs, particularly statins, alters CRP levels while also lowering cardiovascular events. The use of inflammatory biomarkers aids in the discovery of CVDs and tracks the assessment, prognosis, and administration of treatment. An acute-phase protein called C-reactive protein (CRP) is created in response to pro-inflammatory cytokines. CRP is a key modulator of atherosclerosis and a biomarker of the inflammatory response. It is also regarded as a CVD risk factor since it actively promotes the growth of atherosclerotic plaque, instability, and consequent clot. Patients with intermediate risk for cardiovascular diseases have been using the plasma concentration of hsCRP (high sensitivity CRP) as a biomarker for disease prognosis since 2010.

Evolving indications and surgical trends in keratoplasty: a 7-year analysis from a Chinese tertiary referral center

BACKGROUND

The objectives of this study were to investigate the epidemiological characteristics and spectrum of corneal primary diseases among keratoplasty patients in the southern region of Liaoning Province and to study the changing trends in keratoplasty types and corneal graft materials.

METHODS

The medical records of 537 patients who underwent keratoplasty at the Department of Ophthalmology of Dalian Third People's Hospital from 2017 to 2023 were retrospectively analyzed. Patient demographic (age and sex), primary corneal disease type, keratoplasty type and corneal graft material data were statistically analyzed.

RESULTS

A total of 537 patients who underwent keratoplasty during the 7 years study period were included. The average age of the patients was 56.35±15.93 years, ranging from 5 to 90 years. There were 348 male patients (64.8%) and 189 female patients (35.2%), with a ratio of 1.84:1. Among the primary corneal diseases, infectious keratitis was the most common (243, 45.25%), followed by corneal leukoma (73, 13.59%), corneal endothelial decompensation (48, 8.94%), traumatic corneal injury (36, 6.70%), corneal graft rejection (34, 6.33%), immune corneal ulcer (33, 6.15%), keratoconus (32, 5.96%), corneal dystrophy and degeneration (28, 5.21%), and corneal tumor (10, 1.86%). Among infectious keratitis cases, the detailed etiology was as follows: fungal keratitis (154, 63.37%), bacterial keratitis (54, 22.22%), viral keratitis (34, 13.99%), and Acanthamoeba keratitis (1, 0.41%). According to the classification of ker atoplasty types, the most common was PKP (265, 49.35%), followed by DALK (129, 24.02%), ALK (116, 21.60%), and EK (27, 5.03%). PKP is still the main surgical method for corneal transplantation, but the proportions of patients who undergo DALK, ALK, and EK are increasing. The corneal graft materials were classified as fresh human donor corneal grafts (297, 55.31%), dehydrated human donor corneal grafts (166, 30.91%), corneal stromal lenticules (4, 0.74%), and bioengineered corneal grafts (70, 13.04%).

CONCLUSION

Owing to factors such as economic development and industrial distribution, infectious keratitis is the primary cause of keratoplasty in the southern Liaoning region of China, followed by corneal leukoma and corneal endothelial decompensation. Fungal infection is the leading cause of infectious keratitis. The primary keratoplasty type has shifted from PKP to corneal composition transplantation. The range of materials utilized for corneal grafts has expanded significantly and now includes corneal stroma lenticules and bioengineered corneal grafts, in addition to human donor corneal grafts. The present study delineates the evolving surgical patterns and material innovations related to keratoplasty, providing insights for regional ophthalmic policy-making.

Transpalpebral measurement of intraocular pressure with the Tono-Pen XL, in a young, healthy, adult population

Identification of increased intraocular pressure has been conventionally limited by direct, corneal applanation, and indentation measurement procedures, conducted by highly trained eye-care specialists e.g. optometrists and ophthalmologists. This practice greatly limits the numbers of individuals which can and need to be screened, for increased intraocular pressures. Increased intraocular pressure is the second leading cause of preventable, irreversible blindness throughout the world and a major modifiable risk factor for the development and progression of glaucoma. Current screening practices are inadequate, leaving many undetected, resulting in high base-rates of unnecessary and preventable blindness worldwide. Three primary research questions are investigated: Can intraocular pressures be measured through the eyelid, using the Tono-Pen XL tonometer? If yes, can the transpalpebral values be transformed to approximate corneal values? If yes, are the transformed values sufficiently precise, accurate, and reliable to substitute for intraocular pressure values measured directly from the cornea, for screening purposes?. Ninety (n = 90), healthy, young, adults completed measurement of intraocular pressures, from each eye (n = 180 eyes), using the Tono-Pen XL tonometer. Intraocular pressures were measured directly from the cornea and then directly from the closed eyelid. Transpalpebral measurements were transformed by simple linear regression to estimate direct corneal measurements. Transformed values were assessed for accuracy, precision, reliability, and agreement with direct corneal measurements. Findings revealed high accuracy, precision, reliability, and agreement between direct corneal and transpalpebral measurements. Transformed transpalpebral measurements correctly classified 95% and 93% of subjects, within 4 mm Hg or less of direct corneal measurements, when intraocular pressures were measured from the right and left eyes, respectively. Intraocular pressures measured directly from the closed eyelid, using the Tono-Pen XL, can be linearly transformed, using simple linear regression, to estimate intraocular pressure values measured directly from the cornea with high agreement, precision, and reliability, in a healthy, young, adult population. Findings have implications for non-eye-care specialists e.g. primary care physicians, choosing to quickly, accurately, and reliably screen individuals for normal intraocular pressures, without the need to anesthetize the eyes or use expensive, office-bound. equipment.

The impact of intraocular pressure fluctuations on the progression of glaucoma and associated factors

Background

In recent years, remarkable advancements in the comprehension of glaucoma pathophysiology have highlighted the necessity of looking beyond the conventional focus on mean intraocular pressure (IOP) levels. IOP fluctuations have been identified as a potential factor that could exert a substantial impact on the progression of glaucoma.

Main text

IOP exhibits dynamic variations throughout a 24-h cycle. Glaucoma patients exhibit substantially more pronounced IOP fluctuations compared to healthy individuals, even when the mean IOP remains within the normal range. This implies that IOP fluctuations may play a role in glaucoma progression through mechanisms independent of elevated mean IOP. In this review, an exhaustive examination of studies spanning the past decade was conducted to analyze the relationship between IOP fluctuations and disease progression in primary open-angle glaucoma (POAG), ocular hypertension (OHT), normal tension glaucoma (NTG), and primary angle-closure glaucoma (PACG). While a few studies present conflicting results, the majority of research supports the notion that elevated IOP fluctuations significantly contribute to disease progression in POAG patients. This association has also been confirmed in PACG patients. However, in NTG or OHT patients, other risk factors may outweigh IOP fluctuations in disease progression or glaucoma conversion. Additionally, we summarized common factors affecting IOP fluctuations to provide a basis for the identification of patients prone to significant daily IOP variations. Finally, the efficacy of various IOP-lowering interventions in modulating IOP fluctuations is concisely summarized, offering insights for the formulation of comprehensive treatment strategies that incorporate IOP fluctuation management.

Conclusions

IOP fluctuations play a significant role in disease progression in POAG and PACG. Individuals with certain systemic or ocular characteristics are more predisposed to pronounced and recurrent IOP fluctuations. Consequently, a comprehensive assessment of IOP fluctuation that transcends mean IOP values, as well as the integration of IOP fluctuations management into glaucoma treatment strategies are of paramount importance.

Association Between Retinopathy and Systemic Sclerosis: A Systematic Review and Meta-Analysis

BACKGROUND AND OBJECTIVES

Studies have indicated a potential link between retinopathy and systemic sclerosis (SSc), but the precise nature of this association remains unclear. This systematic review and meta-analysis aims to synthesize available evidence to evaluate the relationship between SSc and retinopathy.

METHODS

A systematic search was conducted across four major databases and gray literature to collect all relevant studies. The quality of the selected articles was assessed for risk of bias using standardized tools. A meta-analysis was performed using standardized mean difference (Std. Mean Difference) to estimate the association between retinopathy and SSc. Additional analyses for heterogeneity, sensitivity, subgroups, and publication bias were also conducted.

RESULTS

Twelve studies (359 cases, 314 controls) were included in the systematic review. A meta-analysis of eight studies found a nonsignificant and negligible association (pooled Std. Mean Difference = 0.08; 95% CI = -0.31 to 0.48; p = 0.67) between SSc and retinopathy, with no publication bias (p = 0.5362). Differences in Std. Mean Difference were observed in subgroup analyses but did not sufficiently explain the heterogeneity.

CONCLUSIONS

The findings suggest no strong association between retinopathy and SSc. While some subgroup analyses revealed potential variations, they did not fully clarify the observed heterogeneity. Further research with larger, well-designed studies is necessary to determine whether retinopathy could serve as a biomarker for SSc.

SYSTEMATIC REVIEW REGISTRATION NUMBER (PROSPERO)

CRD42024529644 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=529644.

Recent advances in pharmacological treatments of proliferative vitreoretinopathy

PURPOSE OF REVIEW

Proliferative vitreoretinopathy (PVR) is a severe complication of retinal detachment and trauma, posing significant challenges to surgical success and visual prognosis. Despite advancements in vitreoretinal surgery, PVR incidence remains unchanged, this review presents a synthesis of the principal clinical and preclinical research findings from recent years.

RECENT FINDINGS

Recent research has focused on anti-inflammatory, antiproliferative, and antifibrotic agents. Corticosteroids, such as triamcinolone and dexamethasone, show promise in reducing inflammation but have inconsistent results. Methotrexate and mitomycin C demonstrate efficacy in preclinical and select clinical scenarios. Anti-vascular endothelial growth factor agents and immunotherapies, like infliximab, have shown limited clinical benefits despite promising preclinical data. Novel approaches, including CB2 receptor agonists, exosome-based drug delivery, and nuclear factor kappa B pathway inhibitors, are gaining traction. Additionally, RNA-based and multitargeted therapies highlight the importance of addressing inflammation, fibrosis, and proliferation simultaneously.

SUMMARY

Effective management of PVR requires multifaceted therapies targeting its complex pathogenesis. While current treatments are limited, ongoing research in precision drug delivery and combination therapies offers hope for improved outcomes. Future strategies should focus on translating promising preclinical findings into robust clinical applications.

A RARE PRESENTATION OF NOCARDIA CHOROIDAL ABSCESS AFTER GLIOBLASTOMA SURGERY

PURPOSE

The aim of this study was to report the natural history of a rare ocular manifestation of endogenous Nocardia farcinica infection in a patient with compromised immune system, with involvement observed in both the anterior and posterior segments of the eye.

METHODS AND RESULTS

Given the patient's limited mobility, a handheld fundus camera was utilized for bedside anterior segment and ocular fundus examinations. The findings included visual acuity of hand motion, posterior synechiae, vitreal opacity, and a large choroidal abscess. The authors monitored the lesion's progression through a series of follow-ups. Despite not employing intravitreal drug therapy, they noted a significant reduction in the lesion's size until the patient's overall health deteriorated.

CONCLUSION

This case contributes valuable information to our understanding of the natural history of a rare condition like Nocardia endophthalmitis. The authors highlighted the usefulness of a handheld fundus camera in aiding infectious disease specialists in assessing the immediate response to systemic treatment.

Potential applications of mesenchymal stem cells in ocular surface immune-mediated disorders

We explore the interaction between corneal immunity and mesenchymal stem/stromal cells (MSCs) and their potential in treating corneal and ocular surface disorders. We outline the cornea's immune privilege mechanisms and the immunomodulatory substances involved. In this realm, MSCs are characterized by their immunomodulatory properties and regenerative potential, making them promising for therapeutic application. Therefore, we focus on the role of MSCs in immune-mediated corneal diseases such as dry eye disease, corneal transplantation rejection, limbal stem cell deficiency, and ocular graft-versus-host disease. Preclinical and clinical studies demonstrate MSCs' efficacy in promoting corneal healing and reducing inflammation in these conditions. Overall, we emphasize the potential of MSCs as innovative therapies in ophthalmology, offering promising solutions for managing various ocular surface pathologies.

Prediction of Myopia Among Undergraduate Students Using Ensemble Machine Learning Techniques

Background and Aims

Myopia is a prevalent refractive error, particularly among young adults, and is becoming a growing global concern. This study aims to predict myopia among undergraduate students using ensemble machine learning techniques and to identify key risk factors associated with its development.

Methods

A cross-sectional study was conducted in Dinajpur city, collecting 514 samples through a self-structured questionnaire covering demographic information, myopia prevalence and risk factors, knowledge and attitudes, and daily activities. Four feature selection techniques Boruta-based feature selection (BFS), Least Absolute Shrinkage and Selection Operator regression, Forward and Backward Selection and Random Forest (RF) identified 12 key predictive features. Using these features, ensemble methods, including logistic regression artificial neural network, RF, Support Vector Machine, extreme gradient boosting, and light gradient boosting machine were employed for prediction. Model performance was evaluated using accuracy, precision, recall, F1-score, and area under the curve (AUC).

Results

The stacking ensemble model achieved the highest performance, with an accuracy of 95.42%, recall of 93.42%, precision of 98.85%, F1-score of 96.08%, and AUC of 0.979. SHapley Additive exPlanations analysis identified key risk factors, including visual impairment, family history of myopia, excessive screen time, and insufficient outdoor activities.

Conclusion

These findings demonstrate the effectiveness of ensemble machine learning in predicting myopia and highlight the potential for early intervention strategies. By identifying high-risk individuals, targeted awareness programs and lifestyle modifications can help mitigate myopia progression among undergraduate students.

Endoscopic transorbital approach for the management of spheno-orbital meningiomas: A systematic review and meta-analysis

INTRODUCTION

Meningioma is the most common benign tumor in the central nervous system and may arise from the sphenoid wing region. The tumor can involve the cavernous sinus medially, periorbital and orbital apex structures anteriorly, and infratemporal fossa inferiorly. Surgical approaches more currently used include the fronto-temporal approach, the pterional approach, and even the frontotemporal-orbitozygomatic approach. The results of safety and efficacy of Transorbital neuroendoscopic surgery for these cases are still unclear, with scarce literature on the subject.

OBJECTIVE

We assessed the safety and efficacy of Endoscopic Transorbital Approach (TOA) for the Management of Spheno-Orbital Meningiomas (SOMs).

METHODS

We searched Medline, Embase, Web of Science databases following PRISMA guidelines. We used single proportion analysis with 95% confidence intervals under a random-effects model, I2 to assess heterogeneity, and Baujat and sensitivity analysis to address high heterogeneity. Eligible studies included those with ≥4 patients treated with endoscopic transorbital approach for the management of spheno-orbital meningioma.

RESULTS

Of the 3520 studies initially identified, 9 were selected, involving 216 patients, with a median follow-up of 20 months. For subtotal resection, pooled analysis confirmed a rate of 40% (CI: 24% to 57%) and a total resection rate of 46% (CI: 27% to 65%). The analysis also confirmed a rate of visual deficits of 10% (CI: 0% to 24%). The rate of cerebrospinal fluid leak was 2% (CI: 0% to 5%), and diplopia occurred in 8% of cases (CI: 0% to 18%).

CONCLUSION

ETOA is a safe and minimally invasive approach for spheno-orbital meningiomas, with low complication rates and effective cranial nerve preservation. However, its tumor resection efficacy is inferior to non-minimally invasive techniques, potentially affecting long-term outcomes. Further studies are needed to clarify its role and optimize tumor control in selected cases.

Intraocular Pressure Measurements With the Tono-Vera: A New Handheld Rebound Tonometer

PRCIS

In a cross-sectional study comparing the novel Tono-Vera handheld rebound tonometer with the Ocular Response Analyzer, a strong agreement was found between the intraocular pressure measurements of the 2 devices.

PURPOSE

To compare intraocular pressure (IOP) measurements obtained by the new Tono-Vera (Reichert Technologies), a novel handheld rebound tonometer with a proprietary camera-based positioning system, with those from the Ocular Response Analyzer (ORA, Reichert Technologies) non-contact tonometer.

PATIENTS

Fifty-four eyes of normal individuals and open angle glaucoma subjects.

METHODS

All subjects had at least 6 reliable measurements with the Tono-Vera and 3 with the ORA, acquired by the same technician in the same visit. The sample was randomly split into calibration and validation samples. An ordinary least squares linear regression model generated a calibration formula for Tono-Vera readings using ORA's Goldmann-correlated IOP (IOPg) as a target. Bland-Altman plots evaluated the agreement between Tono-Vera calibrated IOP (IOPtv) and ORA IOPg in the validation sample.

MAIN OUTCOME MEASURES

Agreement between IOPtv and IOPg measurements.

RESULTS

Fifty glaucoma and 4 normal eyes were included, mean age 68.3 ± 9.4 years, mean central corneal thickness 535.0 ± 39.6 μm. In the validation sample, mean IOPtv was 14.6 ± 5.2 mmHg (range, 7.4-28.5 mmHg) versus 15.0 ± 5.3 mmHg (range, 6.6-28.6 mmHg) for ORA IOPg ( R ² = 0.782). Bland-Altman plots showed a mean difference of -0.4 ± 2.5 mmHg (95% limits of agreement: -5.4 to 4.5 mmHg). 58.6%, 79.3%, and 96.5% of IOPtv measurements fell within ± 2, ± 3, and ± 5 mmHg of ORA measurements. No fixed or proportional biases were observed ( P = 0.620).

CONCLUSION

There was a strong correlation and agreement in IOP measurements between calibrated Tono-Vera IOP and ORA IOPg.

Adipose derived stem cells - Sources, differentiation capacity and a new target for reconstructive and regenerative medicine

Adipose-derived stem cells (ADSCs) are mesenchymal stem cells (MSCs) derived from adipose tissue with mesenchymal lineage differentiation potential and remarkable potential in regenerative medicine. ADSCs are easily sourced from adipose tissue, share regenerative characteristics akin to other MSCs. Their convenient adherence to plastic culture flasks, coupled with their capacity for in vitro expansion and multi-lineage differentiation, underscores their promise as a robust tool for tissue repair and enhancement. The accessibility of human adipose tissue and the development of minimally invasive isolation protocols have further propelled the autologous use of ADSCs, fueling excitement in both organ repair and regenerative medicine. Consequently, research in ADSCsis experiencing rapid growth. A detailed overview of the current landscape of ADSCs isolation and differentiation capacity including the latest advancements in ADSCs usage, encompassing ongoing clinical investigations are important considerations to understand their potential to shape the landscape of regenerative medicine.

Advancing glioblastoma therapy: Learning from the past and innovations for the future

Marred by a median survival of only around 12-15 months coupled with poor prognosis and effective therapeutic deprived drug armory, treatment/management of glioblastoma has proved to be a daunting task. Surgical resection, flanked by radiotherapy and chemotherapy with temozolomide, stands as the standard of care; however, this trimodal therapy often manifests limited efficacy due to the heterogeneous and highly infiltrative nature of GBM cells. In addition, the existence of the blood-brain barrier, tumor microenvironment, and the immunosuppressive nature of GBM, along with the encountered resistance of GBM cells towards conventional therapy, also hinders the therapeutic applications of chemotherapeutics in GBM. This review presents key insights into the molecular pathology of GBM, including genetic mutations, signaling pathways, and tumor microenvironment characteristics. Recent innovations such as immunotherapy, oncolytic viral therapies, vaccines, nanotechnology, electric field, and cancer neuroscience, as well as their clinical progress, have been covered. In addition, this compilation also encompasses a discussion on the role of personalized medicine in tailoring treatments based on individual tumor profiles, an approach that is gradually shifting the paradigm in GBM management. Endowed with the learnings imbibed from past failures coupled with the zeal to embrace novel/multidisciplinary approaches, researchers appear to be on the right track to pinpoint more effective and durable solutions in the context of GBM treatment.

Agreement and Reliability of Transpalpebral Tonometers with Goldmann Applanation Tonometer: A Systematic Review and Meta-analysis

TOPIC

The systematic review and meta-analysis consolidates the extant body of evidence comparing reliability and agreement between transpalpebral tonometers (TTs) and Goldmann applanation tonometer (GAT).

CLINICAL RELEVANCE

With a global prevalence of 3.54 percent, glaucoma stands as the second leading cause of preventable blindness. Projections indicate a rise to 111 million cases by 2040. Existing literature presents inconsistent findings while comparing TT and GAT. The derivation of summary estimates assessing their agreement holds significance, given TT's multifaceted applicability in clinical, community, and home settings.

METHODS

Systematic review was conducted using PubMed, Cochrane Library, and Google Scholar from January 2000 to December 2022. Two reviewers independently evaluated, enumerated, and extracted studies and data based on eligibility criteria. The Quality Assessment for Diagnostic Accuracy Studies checklist was used to assess study quality. The summary measures were pooled using the random-effects model as mean difference (MD), and 95% limits of agreement (LoA). We assessed heterogeneity using the I2 statistic. The study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42022321693).

RESULTS

A total of 26 methods comparison studies (3577 eyes) were included in the meta-analysis. The overall random-effects MD (TT - GAT) and standard deviation (SD) for intraocular pressure (IOP) were -0.70 ± 4.32 mmHg (95% LoA: -8.74 to 7.33 mmHg). In the subgroup analysis based on index test devices used, Easyton showed the lowest MD, SD, (-0.29 ± 2.35 mmHg), and 95% LoA (-4.90 to 4.32 mmHg). In the univariate meta-regression model, we found that, on average, studies examining normal eyes reported a statistically significant lower MD of 2.67 mmHg (95% confidence interval: 0.27-5.07 mmHg; P = 0.03) between TT and GAT, compared to studies that assessed eyes with mixed ocular condition.

CONCLUSION

In the current meta-analysis, we found a small MD in the measured IOP between the 2 tonometers. However, given the high heterogeneity and a wider LoA, it is not advisable to use TT interchangeably with GAT.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Tackling visual impairment: emerging avenues in ophthalmology

Visual impairment, stemming from genetic, degenerative, and traumatic causes, affects millions globally. Recent advancements in ophthalmology present novel strategies for managing and potentially reversing these conditions. Here, we explore 10 emerging avenues-including gene therapy, stem cell therapy, advanced imaging, novel therapeutics, nanotechnology, artificial intelligence (AI) and machine learning, teleophthalmology, optogenetics, bionics, and neuro-ophthalmology-all making strides to improve diagnosis, treatment, and vision restoration. Among these, gene therapy and stem cell therapy are revolutionizing the treatment of retinal degenerative diseases, while advanced imaging technologies enable early detection and personalized care. Therapeutic advancements like anti-vascular endothelial growth factor therapies and neuroprotective agents, along with nanotechnology, have improved clinical outcomes for multiple ocular conditions. AI, especially machine learning, is enhancing diagnostic accuracy, facilitating early detection, and personalized treatment strategies, particularly when integrated with advanced imaging technologies. Teleophthalmology, further strengthened by AI, is expanding access to care, particularly in underserved regions, whereas emerging technologies like optogenetics, bionics, and neuro-ophthalmology offer new hope for patients with severe vision impairment. In light of ongoing research, we summarize the current clinical landscape and the potential advantages of these innovations to revolutionize the management of visual impairments. Additionally, we address the challenges and limitations associated with these emerging avenues in ophthalmology, providing insights into their future trajectories in clinical practice. Continued advancements in these fields promise to reshape the landscape of ophthalmic care, ultimately improving the quality of life for individuals with visual impairments.

Short-Term Changes in Tear Film Stability and Tear Volume Following the Application of Various DED Management Options in a Healthy Young Population

Background: To determine short-term changes in tear film volume and stability after various treatments for dry eye disease in healthy participants. Methods: 36 healthy participants aged from 18 to 35 years were recruited for a single-session examination and randomly assigned to one of three treatment groups (1:1:1 treatment, 1:1 eye): Group 1 (artificial tears 'Comfort Drops'), Group 2 (eyelid wipes 'Systane Lid Wipes'), and Group 3 (ocular bath 'Acuaiss'). Tear Meniscus Height (TMH) was assessed at baseline, 2, 5, 10, 15, and 20 min, and Non-Invasive Break-Up Time (NIBUT) at baseline, 2, 10, and 20 min, all using the OCULUS Keratograph 5M by one examiner. Results: Of the initially recruited participants, 35 were analyzed; one was excluded for reflex tearing. Group 1 (n = 12) showed a significant TMH increase at 2 min compared to 10 and 20 min (Friedman, p = 0.004; Bonferroni, p ≤ 0.028). Group 3 (n = 12) showed a significant increase at 2 and 5 min compared to baseline and decrease at 10 min against 2 and 5 min (Friedman, p < 0.001; Bonferroni, p ≤ 0.034). Group 2 (n = 11) showed no significant changes over time (Friedman, p = 0.108). NIBUT showed no significant differences at any time-point in any group (Friedman, p ≥ 0.231). Basal TMH differed between groups (ANOVA, p = 0.048), but post hoc analysis found no significance (Bonferroni, all p ≥ 0.088). No significant differences in TMH at other time-points (Kruskal-Wallis/ANOVA, p ≥ 0.265) or in NIBUT between groups (Kruskal-Wallis/ANOVA, p = 0.108) were found. Conclusions: In healthy participants, artificial tears and ocular baths temporarily increase TMH, while eyelid wipes do not. Neither has an immediate impact on NIBUT.

In Vivo Optical Coherence Tomography Outcomes of Hypotony After Trabeculectomy Management with Autologous Blood Injection: A Single-Center Retrospective Study

Background: This study aimed to report the efficacy and safety of peribleb autologous blood injections in patients with hypotony maculopathy following trabeculectomy. Methods: In this retrospective chart-review study, patients with hypotony maculopathy from over-filtering bleb following mitomycin C (MMC)-augmented trabeculectomy treated with ≥1 peribleb autologous blood injections, ≥12 months of follow-up, and macula optical coherence tomography (OCT) imaging were included. Patients with previous laser cyclophotocoagulation were excluded. Hypotony maculopathy was defined as choroidal folds in the macular region, as assessed by OCT. Results: Nine patients met the inclusion criteria (mean age 62.3 ± 17.0). The mean intraocular pressure (IOP) at hypotony maculopathy diagnosis was 3.8 ± 1.5 mmHg. Most (n = 7) patients received a single injection (4 injections n = 1, 5 injections n = 1). Significant improvements in mean overall IOP after blood injection were observed (8.3 ± 2.4 mmHg; p = 0.008). Improvements in visual acuity and the resolution of hypotony maculopathy were observed in patients requiring a single injection only. No intra-operative adverse events were recorded. Successful bleb surgical revision was performed for two patients refractory to blood injections. Conclusions: Peribleb autologous blood injection increased IOP, improved visual acuity, and resolved hypotony maculopathy in 5.3 weeks in 7/9 patients. This procedure is not a contra-indication for further surgical revision.

Current Treatment of Uveal Melanoma

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults worldwide [...].

Recent Optical Coherence Tomography (OCT) Innovations for Increased Accessibility and Remote Surveillance

Optical Coherence Tomography (OCT) has revolutionized the diagnosis and management of retinal diseases, offering high-resolution, cross-sectional imaging that aids in early detection and continuous monitoring. However, traditional OCT devices are limited to clinical settings and require a technician to operate, which poses accessibility challenges such as a lack of appointment availability, patient and family burden of frequent transportation, and heightened healthcare costs, especially when treatable pathology is undetected. With the increasing global burden of retinal conditions such as age-related macular degeneration (AMD) and diabetic retinopathy, there is a critical need for improved accessibility in the detection of retinal diseases. Advances in biomedical engineering have led to innovations such as portable models, community-based systems, and artificial intelligence-enabled image analysis. The SightSync OCT is a community-based, technician-free device designed to enhance accessibility while ensuring secure data transfer and high-quality imaging (6 × 6 mm resolution, 80,000 A-scans/s). With its compact design and potential for remote interpretation, SightSync widens the possibility for community-based screening for vision-threatening retinal diseases. By integrating innovations in OCT imaging, the future of monitoring for retinal disease can be transformed to reduce barriers to care and improve patient outcomes. This article discusses the evolution of OCT technology, its role in the diagnosis and management of retinal diseases, and how novel engineering solutions like SightSync OCT are transforming accessibility in retinal imaging.

Enhancing glaucoma care with smart contact lenses: An overview of recent developments

Glaucoma is a leading cause of irreversible blindness worldwide, affecting millions of individuals due to its progressive damage to the optic nerve, often caused by elevated intraocular pressure (IOP). Conventional methods of IOP monitoring, such as tonometry, provide sporadic and often inaccurate readings due to fluctuations throughout the day, leaving significant gaps in diagnosis and treatment. This review explores the transformative potential of smart contact lenses equipped with continuous IOP monitoring and therapeutic capabilities. These lenses integrate advanced materials such as graphene, nanogels, and magnetic oxide nanosheets alongside sophisticated biosensing and wireless communication systems. By offering continuous, real-time data, these lenses can detect subtle IOP fluctuations and provide immediate feedback to patients and clinicians. Moreover, drug-eluting capabilities embedded in these lenses present a groundbreaking approach to glaucoma therapy by improving medication adherence and providing controlled drug release directly to the eye. Beyond IOP management, these innovations also pave the way for monitoring biochemical markers and other ocular diseases. Challenges such as biocompatibility, long-term wearability, and affordability remain, but the integration of cutting-edge technologies in smart contact lenses signifies a paradigm shift in glaucoma care. These developments hold immense promise for advancing personalized medicine, improving patient outcomes, and mitigating the global burden of blindness.

Evolutionary-Driven Convolutional Deep Belief Network for the Classification of Macular Edema in Retinal Fundus Images

Early detection of diabetic retinopathy is critical for preserving vision in diabetic patients. The classification of lesions in Retinal fundus images, particularly macular edema, is an essential diagnostic tool, yet it presents a significant learning curve for both novice and experienced ophthalmologists. To address this challenge, a novel Convolutional Deep Belief Network (CDBN) is proposed to classify image patches into three distinct categories: two types of macular edema-microhemorrhages and hard exudates-and a healthy category. The method leverages high-level feature extraction to mitigate issues arising from the high similarity of low-level features in noisy images. Additionally, a Real-Coded Genetic Algorithm optimizes the parameters of Gabor filters and the network, ensuring optimal feature extraction and classification performance. Experimental results demonstrate that the proposed CDBN outperforms comparative models, achieving an F1 score of 0.9258. These results indicate that the architecture effectively overcomes the challenges of lesion classification in retinal images, offering a robust tool for clinical application and paving the way for advanced clinical decision support systems in diabetic retinopathy management.

Isolated and Syndromic Genetic Optic Neuropathies: A Review of Genetic and Phenotypic Heterogeneity

Nonsyndromic and syndromic hereditary optic neuropathies (HONs) encompass a variety of genetic illnesses that cause progressive optic nerve damage, resulting in considerable vision impairment. These disorders result from pathogenic variants in mitochondrial or nuclear DNA, impacting essential cellular processes like oxidative phosphorylation, mitochondrial dynamics, and neuroprotection. Advances in next-generation sequencing (NGS) have significantly improved the identification of genetic variations, enabling precise diagnoses and genotype-phenotype correlations. This review consolidates current knowledge regarding the classification, molecular pathogenesis, clinical manifestations, diagnostic methodologies, and emerging therapeutic strategies for HONs. The critical role of mitochondrial dysfunction in optic nerve degeneration highlights the necessity for multimodal therapeutic approaches. Recent clinical trials evaluating gene therapy for Leber hereditary optic neuropathy (LHON) and neuroprotective strategies in dominant optic atrophy (DOA) are discussed. Additionally, individualized therapeutic interventions, as demonstrated by recent case studies involving tailored gene therapies, are evaluated. The integration of molecular and imaging biomarkers in future personalized treatment strategies aims to enhance prognosis and therapeutic outcomes.

Diagnosis of early glaucoma likely combined with high myopia by integrating OCT thickness map and standard automated and Pulsar perimetries

Early-stage glaucoma diagnosis is crucial for preventing permanent structural damage and irreversible vision loss. While various machine-learning approaches have been developed for glaucoma diagnosis, only a few specifically address early-stage detection. Moreover, existing early-stage detection methods rely on unimodal information and exclude subjects with high myopia, which contradicts clinical practice and overlooks the adverse effect of high myopia on prediction performance. To develop a clinically practical tool, this study proposes a deep-learning-based, end-to-end early-stage glaucoma detection framework designed for a cohort likely with high myopia. This framework uniquely integrates functional information from visual field (VF) parameters of standard automated perimetry (SAP) and Pulsar perimetry (PP) with structural information derived from optical coherence tomography (OCT) thickness maps. It comprises three key components: 3D OCT ganglion cell complex (GCC) layer segmentation, thickness map generation, and early-stage glaucoma detection. Evaluated on 394 subjects using five-time, 10-fold cross-validation, the proposed system achieved a mean area under the receiver operating characteristic (ROC) curve of 0.887 ± 0.006, outperforming the Asaoka method without transfer learning and nine models based solely on VF parameters. Results further confirmed that incorporating SAP and PP parameters was essential for mitigating the adverse effects of high myopia.

Novel Therapeutic Approaches for Treatment of Diabetic Retinopathy and Age-Related Macular Degeneration

Retina, a light-sensitive layer of tissue of the eye, requires high levels of oxygen for its physiology. Retinal ischemia occurs due to inadequate supply of blood to the retina and choroid. Retinal ischemia is implicated in the development or progression of many ocular diseases, such as diabetic retinopathy (DR) and age-related macular degeneration (AMD). To date, anti-vascular endothelial growth factor (VEGF) treatment has been widely used to manage neovascular diseases associated with retinal ischemia. Nonetheless, a substantial number of patients with DR or AMD still suffer from incomplete response and adverse effects related to its therapy with limitations. Therefore, research scientists have been developing and finding novel treatments to protect against or prevent vision loss in those diseases. In this review article, we summarize the recent novel therapeutic approaches for the treatment of ischemic retinopathy (e.g., cell therapy, advanced molecular targeting, or drug delivery). This summary enables further research to obtain more solid evidence of novel effective drug development in retinal ischemic diseases.

Relationship between stem-bone contact patterns and clinical outcomes of taper-wedged stem designed to fit the bone morphology of the Japanese

INTRODUCTION

Taper-wedged stems have a stable fit and favorable clinical results. However, detailed studies on stem-bone contact patterns and clinical outcomes specific to Japanese patients are limited. This study aimed to describe stem-bone contact patterns and assess clinical outcomes in Japanese patients undergoing primary total hip arthroplasty (THA) with taper-wedged stems designed to fit the bone morphology of the Japanese population.

METHODS

We retrospectively reviewed 125 Japanese patients who underwent THA via a direct anterior approach using taper-wedged stems designed to fit the bone morphology of the Japanese population. Relationships between stem-bone contact patterns and clinical and radiographic outcomes were examined. Preoperative radiographs were evaluated to assess femoral morphology. Postoperative radiographs were evaluated to determine stem-bone contact patterns and the canal filling ratio. We divided the patients into proximal and distal fitting groups according to the stem-bone contact pattern. Osseointegration was assessed on the last follow-up radiograph using the Engh and O-SS scores.

RESULTS

The mean follow-up period was 5.1 years. Proximal femoral stem-bone contact was achieved in 90.4% of the cases. Both groups had good clinical and radiographic outcomes. Except for differences in preoperative bone morphology, there were no differences in demographics or clinical outcomes between the groups. The distal fitting type was more common in cases with champagne flute morphology. No aseptic loosening or revision was observed, and good osseointegration was obtained in either group.

CONCLUSION

THA with taper-wedged stems designed to fit the bone morphology of Japanese patients achieved favorable stem-bone contact patterns and acceptable short- to mid-term clinical and radiographic outcomes. Population-specific implant designs tailored to Japanese bone morphology may improve surgical outcomes and implant longevity.

Using Optical Coherence Tomography in Plant Biology Research: Review and Prospects

Visualizing the microscopic structure of plants in vivo, non-invasively, and in real-time is the Holy Grail of botany. Optical coherence tomography (OCT) has all the characteristics necessary to achieve this feat. Indeed, OCT provides volumetric images of the internal structure of plants without the need for histological preparation. With its micrometric resolution, OCT is commonly used in medicine, primarily in ophthalmology. But it is seldom used in the field of botany. The aim of the present work is thus to review the latest technical development in the field of OCT and to highlight its current use in botany, in order to promote the technique and further advance research in the field of botany.

The Use Of Fundus Photography In The Emergency Room-A Review

PURPOSE OF REVIEW

The ocular fundus reveals a wealth of pathophysiological findings which should change patient management in the emergency room (ER). Traditional fundoscopy has been technically challenging and diagnostically inaccurate, but technological advances in non-mydriatic fundus photography (NMFP) have facilitated clinically meaningful fundoscopy. This review presents an update on the literature regarding NMFP and its application to the ER, illustrating pivotal publications and recent advances within this field.

RECENT FINDINGS

NMFP's application in the ER is demonstrably feasible and seamlessly integrates into emergency physicians' (EP) diagnostic workflows in a clinically meaningful and time efficient manner. The images of the ocular fundus (OF) generated by NMFP are consistently high quality, allowing a greater diagnostic accuracy to EP and ophthalmology interpreters alike. Digital NMFP images facilitate effective ophthalmology input via telemedicine to review the images in the ER. NMFP has been shown to change management decisions in the ER, improving patient and departmental outcomes. Interpretation of fundus images remains a medical education challenge, and early research highlights the potential for artificial intelligence (AI) image systems of NMFP to augment image interpretation in the ER. NMFP can change the ER approach to OF assessment, however the factors limiting its routine implementation need further consideration. There is potential for AI to contribute to NMFP image screening systems to augment EPs diagnostic accuracy.

Current Research Trends in Glioblastoma: Focus on Receptor Tyrosine Kinases

Glioblastoma (GBM) is an aggressive brain tumor characterized by molecular complexity and resistance to conventional treatments, including surgery, radiation, and chemotherapy. Despite these challenges, advancements in receptor tyrosine kinase (RTK) research, combined with multi-omics approaches, hold promise for improving patient outcomes and survivability. RTKs are central to GBM progression, influencing cell proliferation, survival, and angiogenesis. However, the complexity of RTK signaling necessitates a broader, integrative perspective, which has been enabled by the emergence of -omics sciences. Multi-omics technologies-including genomics, transcriptomics, proteomics, and metabolomics-offer unprecedented insights into the molecular landscape of GBM and its RTK-driven pathways. Genomic studies have revealed mutations and amplifications in RTK-related genes, while transcriptomics has uncovered alterations in gene expression patterns, providing a clearer picture of how these aberrations drive tumor behavior. Proteomics has further delineated changes in protein expression and post-translational modifications linked to RTK signaling, highlighting novel therapeutic targets. Metabolomics complements these findings by identifying RTK-associated metabolic reprogramming, such as shifts in glycolysis and lipid metabolism, which sustain tumor growth and therapy resistance. The integration of these multi-omics layers enables a comprehensive understanding of RTK biology in GBM. For example, studies have linked metabolic alterations with RTK activity, offering new biomarkers for tumor classification and therapeutic targeting. Additionally, single-cell transcriptomics has unveiled intratumoral heterogeneity, a critical factor in therapy resistance. This article highlights the transformative potential of multi-omics in unraveling the complexity of RTK signaling in GBM. By combining these approaches, researchers are paving the way for precision medicine strategies that may significantly enhance diagnostic accuracy and treatment efficacy, providing new hope for patients facing this devastating disease.

Success of Myocutaneous Flaps Without Posterior Lamellar Reconstruction for Large Full-Thickness Eyelid Mohs Defects

BACKGROUND

For full-thickness Mohs eyelid defects, closure involves reconstruction of the posterior lamella (conjunctiva and tarsus) and anterior lamella (skin and orbicularis muscle).

OBJECTIVE

This study examines the necessity of dedicated posterior lamellar reconstruction in the repair of large, full-thickness eyelid defects based on functional and histologic analysis of the posterior margin without dedicated reconstruction of the posterior mucosa.

METHODS

A case series of consecutive large Mohs eyelid defects (>50% loss of palpebral conjunctiva) repaired with myocutaneous flaps without dedicated posterior mucosal reconstruction were reviewed. Postoperative complaints were recorded. Biopsies of the posterior eyelid were reviewed from 4 patients during scheduled 4- to 6-week secondary separation of interpolated flaps or debulking.

RESULTS

Twenty-six cases were identified, of which 16 (62%) lost >90% of the involved eyelid. A variety of flaps were employed (paramedian/glabellar, Fricke, nasolabial rotation, Mustarde) with good outcomes. Complications were uncommon and infrequent. All 4 biopsy specimens showed "squamous epithelium," "conjunctival epithelium," or "mucosa" without evidence of keratinization.

CONCLUSION

This series suggests that posterior mucosa reconstruction may not be necessary in cases of full-thickness eyelid defect repair as large myocutaneous flaps may act as a matrix for de novo regeneration, or extension, of conjunctival-like squamous epithelium on the posterior eyelid.

Intrastromal Suturing Technique Compared With Interrupted Corneal Suturing Technique, Loose Suture and Knot Exposure: A Comparative Rabbit Study

PurposeThis study aimed to assess the effectiveness of an innovative intrastromal suturing technique in an experimental rabbit model, comparing it to standard interrupted suturing, loose suture, and suturing with knot exposure.MethodsFourteen adult male New Zealand White rabbits were included in this study. Each rabbit underwent suturing in both eyes, divided into four groups based on suturing techniques. The novel intrastromal suturing technique involved burying the entire suture material within the corneal stroma. Corneal neovascularisation (CoNV) areas were evaluated by image analysis and immune cell densities by in vivo confocal microscopy (IVCM).ResultsThe intrastromal suturing group demonstrated significantly smaller CoNV areas at both 1 week and 1 month post-suturing compared to other interventional groups, indicating effective mitigation of CoNV development and progression. Moreover, this group exhibited lower immune cell densities in the superficial stromal layer and endothelial layer, suggesting a reduced inflammatory response. Both the loose suture and the knot exposure groups exhibited significant levels of CoNV and heightened immune cell densities.ConclusionThis experimental study demonstrated effectiveness of intrastromal suturing technique in limiting CoNV and immune cell infiltration, common contributors to graft rejection and complications. Furthermore, the study revealed that loose sutures and those with exposed knots are likely to cause more severe CoNV and inflammation, compared to the traditional interrupted suturing technique and intrastromal suturing.

Integrative analysis of mitochondrial-related gene profiling identifies prognostic clusters and drug resistance mechanisms in low-grade glioma

Mitochondrial dysfunction has emerged as a critical factor in the progression and prognosis of low-grade glioma (LGG). In this study, we explored the role of mitochondrial-related genes through consensus clustering analysis using multi-omics data from the TCGA, CGGA, and other independent datasets. Patients were categorized into three clusters (Cluster A, B, and C), with Cluster B consistently associated with poorer prognosis. Mutation landscape analysis revealed distinct genetic alterations and copy number variations among clusters, particularly in Cluster B, which exhibited unique genetic signatures. Immune infiltration analysis showed that Cluster B had higher expression levels of immune checkpoint genes, stronger immune evasion activity, and greater immune cell infiltration, suggesting an immunosuppressive tumor microenvironment. Furthermore, we identified mitochondrial-related prognostic markers and developed a MITscore based on gene expression patterns, which stratified patients into high- and low-risk groups. High MITscore groups displayed stronger stemness characteristics, poorer survival outcomes, and differential responses to chemotherapy and immunotherapy. Cross-validation with drug sensitivity and immunotherapy cohorts indicated that high MITscore patients were more sensitive to certain chemotherapeutic agents and responded better to immunotherapy. Finally, using the SRGA method, we identified novel biomarkers (KDR, LRRK2, SQSTM1) closely associated with mitochondrial function, which may serve as potential targets for therapeutic intervention. These findings highlight the critical role of mitochondrial dysfunction in LGG prognosis, tumor microenvironment regulation, and treatment response, providing new avenues for precision oncology.

Retinal OCT image segmentation with deep learning: A review of advances, datasets, and evaluation metrics

Optical coherence tomography (OCT) is a widely used imaging technology in ophthalmic clinical practice, providing non-invasive access to high-resolution retinal images. Segmentation of anatomical structures and pathological lesions in retinal OCT images, directly impacts clinical decisions. While commercial OCT devices segment multiple retinal layers in healthy eyes, their performance degrades severely under pathological conditions. In recent years, the rapid advancements in deep learning have significantly driven research in OCT image segmentation. This review provides a comprehensive overview of the latest developments in deep learning-based segmentation methods for retinal OCT images. Additionally, it summarizes the medical significance, publicly available datasets, and commonly used evaluation metrics in this field. The review also discusses the current challenges faced by the research community and highlights potential future directions.

Ten-Year Results After Canaloplasty and Phacocanaloplasty

Background/Objectives: To evaluate the long-term efficacy and safety of canaloplasty and phacocanaloplasty in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG). Methods: This retrospective observational study included 85 patients with POAG and PEXG who underwent canaloplasty (group 1) or phacocanaloplasty (group 2). Every patient had complete medical records over a 10-year follow-up period. The primary endpoints were the pressure-lowering and drug-sparing effects. The secondary endpoints were intra- and postoperative complications as well as the need for additional surgical interventions. Results: In group 1, the mean baseline intraocular pressure (IOP) of 22.1 ± 0.9 mmHg was reduced to 15.3 ± 0.5 mmHg, 15.7 ± 0.5 mmHg, and 15.9 ± 0.7 mmHg at 1, 5, and 10 years, respectively. The mean medication use decreased from 2.4 ± 1.0 before surgery to 0.1 ± 0.5, 0.8 ± 1.1, and 1.4 ± 1.3 at 1,5, and 10 years, respectively. In group 2, IOP was reduced from 20.4 ± 1.5 to 15.6 ± 1.0, 14.3 ± 0.8, and 14.2 ± 1.2 at 1, 5, and 10 years, respectively. The mean medication use dropped from 2.4 ± 1 to 0.3 ± 0.9, 0.9 ± 1.4, and 0.8 ± 1.1 at 1,5, and 10 years, respectively. Goniopuncture was performed postoperatively in nine cases (13.9%) within the initial 3 months due to IOP spikes (POAG n = 6, PEXG n = 3). Patients with PEXG had a significantly higher likelihood of requiring re-operation (HR = 5.11, HR = 5.11, 95% CI 1.05-24.74, p = 0.043). No serious complications were observed. Conclusions: Canaloplasty is a safe and effective procedure for lowering IOP in eyes with POAG and PEXG, achieving approximately a 30% reduction in IOP. PEXG patients are likelier to have IOP spikes in the late postoperative period therefore careful monitoring and management is required.

Editorial to the Special Issue "Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments, and Reliable Follow-Up"

The Special Issue "Retinopathies: A Challenge for Early Diagnosis, Innovative Treatments, and Reliable Follow-Up" brings together a diverse yet interconnected collection of research papers that collectively address the multifaceted challenges of retinal diseases [...].

Diagnostic Value of PET Tracers in Differentiating Glioma Tumor Recurrence from Treatment-Related Changes: A Systematic Review and Meta-Analysis

BACKGROUND

It is often difficult to identify treatment-related changes (TRC) from tumor progression (TP) in patients with glioma, and the current application of PET scanning is expected to improve the diagnosis.

PURPOSE

We used a systematic review and meta-analysis to reveal diagnostically more promising tracers by comparing the diagnostic accuracy of different PET tracers in identifying TRC and TP in patients with glioma.

DATA SOURCES

We searched PubMed, Web of Science, and EMBASE databases, and we selected studies that used PET scans to identify TP and TRC in patients with glioma.

STUDY SELECTION

Twenty-eight studies were identified based on the set criteria. The studies involved a total of 10 different tracers and 1405 patients. TP occurred in 67.4% (947) of patients, while TRC occurred in 32.6% (458) of patients.

DATA ANALYSIS

The sensitivity, specificity, diagnostic odds ratio, positive likelihood ratio, and negative likelihood ratio of various PET tracers were calculated and summarized. Moreover, the diagnostic value of various tracers was compared.

DATA SYNTHESIS

This systematic review included 28 studies comparing 10 different PET tracers, including 18F-fluoro-deoxy-glucose FDG (18F-FDG), 11C methionine (11C -MET), 18F-fuoroethyl-L-tyrosine (18F-FET), 3,4-dihydroxy-6-18F-fluoro-L-phenylalanine (18F-FDOPA), 18F-fluorothymidine (18F-FLT), 18F-PSMA-1007, 68Ga-PSMA-11, 18F-choline (18F-CHO), 18F-fluciclovine, and [11]C-Alpha-Methyl-Tryptophan(11C-AMT). The results revealed that 11C-MET exhibited the highest diagnostic value, with an overall sensitivity and specificity of 0.89 [0.85, 0.93] and 0.91 [0.84, 0.99], respectively. Although the number of 18F-FDOPA studies is limited, it exhibited high diagnostic value, with an overall sensitivity and specificity of 1.00 [0.91, 1.00] and 0.92 [0.75, 0.99], respectively.

LIMITATIONS

Most studies consisted of small sample sizes; however, the included studies differed to some extent regarding the reference standard for the final diagnosis and the standard of care. Additionally, most selected studies were retrospective.

CONCLUSIONS

Amino acid-based tracers exhibited the highest diagnostic value in identifying TRC and TP in gliomas, with 11C-MET and 18F-FDOPA having the most notable advantages. Research on other new tracers is limited, therefore, further studies are needed to prove their diagnostic value.

Paracentral Acute Middle Maculopathy in a Pregnant Woman on Supplemental Hormones for Invitro-Fertilization

This case study examines the rare occurrence of paracentral acute middle maculopathy (PAMM) in a first-trimester pregnant patient, highlighting the importance of promptly addressing acute neurological symptoms in expectant mothers. PAMM, a retinal vascular disorder causing ischemic damage to the middle retinal layers, is sparsely documented in literature. The patient, a 31-year-old primigravida with migraines and elevated anti-nucleic acid titer, presented with sudden painless monocular vision loss. Initially suspected as a migraine aura, persistent symptoms led to a comprehensive evaluation. Imaging and consultations confirmed PAMM, likely due to retinal microvascular occlusion exacerbated by her hypercoagulable state and inflammation. This case underscores the need for thorough differential diagnosis and interdisciplinary collaboration in managing pregnant patients with acute neurological symptoms, ensuring optimal outcomes for mother and fetus.

Harnessing the Underutilized Potential of Lens Capsule Transplantation in Ophthalmology: A Narrative Review of Current Applications and Future Directions

The human lens capsule is a transparent and durable basement membrane routinely discarded during cataract surgery, exhibiting unique biochemical, biomechanical, and immunologic properties. This narrative review discusses validated ophthalmic applications across corneal, retinal, and glaucoma filtration surgeries. It emphasizes the capsule's emerging role as a tissue-engineering scaffold for cultivating corneal endothelial cells, limbal epithelial stem cells, and retinal pigment epithelial cells, demonstrating significant promise in regenerative ophthalmology. However, variability in harvesting techniques, small graft sizes, and limited long-term clinical data currently hinder its broader clinical implementation. Future directions highlight the necessity of standardizing capsule harvesting and preservation protocols, potentially in collaboration with eye banks, to enhance accessibility and utility. Additionally, this review explores speculative applications, including encapsulation devices for drug and cell delivery, ultraviolet cross-linking for keratoconus management, and novel scaffolds for optic nerve regeneration and retinal transplantation. While preliminary evidence strongly supports the capsule's versatility, rigorous clinical trials and comparative analyses remain essential to establish long-term safety, efficacy, and optimal surgical integration. Ultimately, harnessing this naturally available biomaterial represents a meaningful advancement in ophthalmology, opening new horizons for future research.

Cellular senescence and glaucoma

Cellular senescence, a characteristic feature of the aging process, is induced by diverse stressors. In recent years, glaucoma has emerged as a blinding ocular disease intricately linked to cellular senescence. The principal pathways implicated are oxidative stress, mitochondrial dysfunction, DNA damage, autophagy impairment, and the secretion of various senescence- associated secretory phenotype factors. Research on glaucoma-associated cellular senescence predominantly centers around the increased resistance of the aqueous humor outflow pathway, which is attributed to the senescence of the trabecular meshwork and Schlemm's canal. Additionally, it focuses on the mechanisms underlying retinal ganglion cell senescence in glaucoma and the corresponding intervention measures. Given that cell senescence represents an irreversible phase preceding cell death, an in-depth investigation into its mechanisms in the pathogenesis and progression of glaucoma, particularly by specifically blocking the signal transduction of cell senescence, holds the potential to decrease the outflow resistance of aqueous humor. This, in turn, could provide a novel avenue for safeguarding the optic nerve in glaucoma.

Assessment of Corneal Biomechanics and Intraocular Pressure With Scleral Lenses of Different Diameters

PURPOSE

To evaluate the short-term influence of scleral lenses (SL) with different diameters on intraocular pressure (IOP) and corneal biomechanics. A secondary objective was to investigate the relationship between fluid reservoir (FR) thickness and IOP and biomechanical parameters.

METHODS

Thirty healthy subjects were randomly fitted with L1 (diameter of 15.80 mm) and L2 (diameter of 16.80 mm) on the right eye and worn for 2 hr. On IOP and corneal biomechanical parameters were measured with the CORVIS ST before and after SL removal. Fluid reservoir thickness at 0 and 2 hr of wear was measured using anterior segment optical coherence tomography.

RESULTS

Biomechanical parameters decreased after removal of L1 (-1.04±1.47 mm Hg) ( P <0.01) and L2 (-0.80±1.74 mm Hg) ( P =0.02). The biomechanical parameters A1T (-0.11±0.18 ms) ( P =0.01) and SP-A1 (-4.29±9.97 mm Hg/mm) ( P =0.02) decreased after L1 removal, whereas a decrease in highest concavity time (-0.21±0.50 m/s) ( P =0.03) and an increase in highest concavity radius (+0.17±0.43 mm) ( P =0.04) were observed after L2 removal. A significant, negative, and moderate correlation was found between highest concavity deformation amplitude and FR thickness with L1 (r=-0.42, P =0.02).

CONCLUSIONS

The small changes in corneal biomechanical parameters and IOP values induced by short-term SL wear have no significant clinical impact and were not influenced by the diameter of the SL.

Using Facial Recognition Software to Quantify Perceived Age Reduction in Patients Undergoing Blepharoplasty

INTRODUCTION

Changes to periorbital morphology, including decreased skin elasticity and ptosis, contribute to the appearance of an aging face. Consequently, many patients seek blepharoplasty surgery to address these changes. However, objective measures of surgical success remain sparse. Therefore, we investigated the ability of convolutional neural networks (CNNs) to assess differences in perceived age before and after blepharoplasty and examined correlations between CNN-generated results and human evaluations.

METHODS

Pre- and postoperative patient blepharoplasty images from inception through December 2023 were extracted from the American Society of Plastic Surgeons website. Patient age, follow-up time, gender, and type of procedure were recorded. Two CNN-based platforms, FacePlusPlus (Beijing, China) and Amazon Rekognition (Seattle, WA), were used to estimate patients' pre- and postoperative ages. Two trained volunteers rated patients' aesthetic changes using the Global Aesthetic Improvement Scale (GAIS). Statistical analyses to compare patients' pre- and postoperative CNN-estimated ages and factors associated with perceived age reduction included paired t tests, linear regressions, and ANOVA tests.

RESULTS

Ninety-four patients were included in the analysis (mean age, 52.4 ± 10.5 years; 84.0% female). Preoperatively, the CNNs estimated patients to be 2.4 years younger than their true ages (estimated age, 50.0 years; true age, 52.4 years; P < 0.05). Postoperatively, the CNNs perceived an average of 3.2 years of age reduction (estimated preoperative age, 50.0 years; estimated postoperative age, 46.8 years; P < 0.01). Perceived age reduction was not associated with gender, true preoperative age, or procedure type (P > 0.05). GAIS scores positively correlated with perceived age reduction (r = 0.33, P < 0.05). Patients estimated as older than their true preoperative age had greater CNN-perceived age reductions compared to those estimated as younger (5.0-year reduction vs. 2.3-year reduction, P < 0.05). The discrepancy between preoperative estimated age and true age correlated with postoperative age reduction (r = 0.31, P < 0.05).

CONCLUSIONS

Convolutional neural networks quantified reductions in perceived age following blepharoplasty, with results aligning with human evaluations. CNN-perceived age reduction was greatest in patients who appeared older than their true age, particularly for those with larger discrepancies. These findings support the potential utility of CNNs as objective tools for assessing aesthetic outcomes and may help preoperatively guide patient expectations for postoperative age reduction.

Assessing the quality of ChatGPT's responses to commonly asked questions about trigger finger treatment

BACKGROUND

This study aims to evaluate the accuracy and reliability of Generative Pre-trained Transformer (ChatGPT; OpenAI, San Francisco, California) in answering patient-related questions about trigger finger. This evaluation has the potential to enhance patient education prior to treatment and provides insight into the role of artificial intelligence (AI)-based systems in the patient educa-tion process.

METHODS

The ten most frequently asked questions regarding trigger finger were compiled from patient education websites and a literature review, then posed to ChatGPT. Two orthopedic specialists evaluated the responses using the Journal of the American Medical Association (JAMA) Benchmark criteria and the DISCERN instrument (A Tool for Judging the Quality of Written Consumer Health Information on Treatment Choices). Additionally, the readability of the responses was assessed using the Flesch-Kincaid Grade Level.

RESULTS

The DISCERN scores for ChatGPT's responses to trigger finger questions ranged from 35 to 47, with an average of 42, indicating "moderate" quality. While 60% of the responses were satisfactory, 40% contained deficiencies. According to the JAMA Benchmark criteria, the absence of scientific references was a significant drawback. The average readability level corresponded to the university level, making the information difficult to understand for patients with low health literacy. Improvements are needed to enhance the accessibility and comprehensibility of the content for a broader patient population.

CONCLUSION

To the best of our knowledge, this is the first study to investigate the use of ChatGPT in the context of trigger finger. While ChatGPT shows reasonable effectiveness in providing general information on trigger finger, expert oversight is necessary before it can be relied upon as a primary source for patient education.

Noninvasive ocular delivery of adalimumab-loaded nanostructured lipid carriers for targeted retinitis pigmentosa therapy

Retinitis pigmentosa is a genetically heterogeneous retinal degeneration process. There is hardly any treatment available. It is associated with extensive chronic inflammation and the release of proinflammatory cytokines such as TNFα. The blockade of TNFα through systemic or intraocular routes slows retinal degeneration. They are invasive routes with possible side effects. Herein, we propose a noninvasive approach to address the inflammatory component of retinitis pigmentosa. This approach is based on the development of eye drops of nanostructured lipid carriers (NLCs) loaded with the monoclonal antibody against TNFα, adalimumab (ADA). We physicochemically characterized NLC-ADA. We evaluated retinal and corneal toxicity; corneal permeation; diffusion to the retina; and effects on retinal dysfunction, degeneration and inflammation. These results prove that NLC-ADA eye drops exhibit excellent corneal permeation, no toxicity and high retinal distribution in mice. These compounds improve retinal function, reduce retinal degeneration and ameliorate the inflammatory process. In particular, NLC-ADA eye drops reduce M1 microglial activation, macrophage infiltration and the levels of some components of the NLRP3 inflammasome in rd10 mice, a model of retinitis pigmentosa. This strategy offers a noninvasive route that circumvents the bloodretinal barrier in a safe and efficient manner. Hence, this approach could offer a promising therapeutic option for treating retinitis pigmentosa regardless of genetic defects. This approach could be useful for other inflammation-related retinal diseases.

Delayed Onset Spontaneous Hyphema After an OMNI Surgical Procedure

Minimally invasive glaucoma surgery (MIGS) offers options for glaucoma treatment that have generally improved safety profiles compared with filtering surgery. MIGS vary in design and procedure, but all angle-based MIGS function by bypassing or removing aqueous humor outflow resistance at the level of the trabecular meshwork. This can lower intraocular pressure but also remove the blood-aqueous barrier. Most studies of MIGS report on relatively short-term safety, but awareness of potential long-term complications is critical for optimal patient management. This case report describes a patient with recurrent and refractory delayed onset spontaneous hyphema after an OMNI procedure. To the best of our knowledge, this is the first case report describing this complication of the OMNI surgical system.

Enhanced Bioprinting of 3D Corneal Stroma Patches with Reliability, Assessing Product Consistency and Quality through Optimized Electron Beam Sterilization

This study focuses on the optimization of sterilization methods for bioprinted three-dimensional (3D) corneal stroma patches prepared using cornea-derived decellularized extracellular matrix (Co-dECM) hydrogels and human keratocytes, with the aim of enhancing clinical applications in corneal tissue engineering. An essential aspect of this study is to refine the sterilization processes, particularly focusing on electron beam (EB) sterilization, to maintain the structural and functional integrity of the Co-dECM hydrogels while ensuring sterility. The study reveals that EB sterilization outperformed traditional methods like ethylene oxide (EtO) gas and autoclaving, which tend to degrade the biochemical properties of hydrogels. By optimizing the EB-sterilization process, the essential mechanical and biochemical characteristics needed for successful 3D bioprinting are retained, reducing batch variability in bioprinted 3D corneal stroma patches. Consistency in production is vital for meeting regulatory standards and ensuring patient safety. Moreover, the study investigates the immunomodulatory properties of sterilized hydrogels, emphasizing their potential to minimize inflammatory responses, which is crucial for maintaining keratocyte phenotype. These findings significantly advance biomedical engineering by providing a sterilization method that preserves material integrity, minimizes immunogenicity, and supports the clinical translation of bioprinted corneal stroma patches, offering a promising alternative to donor transplants and synthetic substitutes.