Impact of COVID-19 on uveal melanoma in France

PURPOSE

Treatment delays due to the COVID-19 pandemic in uveal melanoma (UM) patients have led to an increased rate of enucleations in Europe. The impact of multiple COVID-19 lockdowns on UM management has not been assessed in France. The goal of this study was to assess whether delayed diagnosis could have led to more advanced stages and thus a higher rate of enucleations.

METHODS

Two datasets were analyzed: patients from two ocular oncology centers (dataset-1), with recording of sizes, prognostic stages (TNM) and treatments, and a national database (dataset-2), obtained by ICD-10 codes and medical procedures for clip placement. After year-by-year comparison, the pre-COVID-19 (2018-2019) and post-COVID-19 (2021-2022) periods were compared for each dataset. Five hundred and thirty-seven patients were diagnosed with UM (dataset-1), including 213 patients in the pre-COVID-19 period and 212 patients in the post-COVID-19 period. Similarly, 2187 patients were diagnosed with UM (dataset-2), of whom 914 patients and 864 patients were diagnosed in the pre-COVID-19 and post-COVID-19 periods, respectively.

RESULTS

A higher number of patients had locally advanced tumors during the post-COVID-19 period compared to the pre-COVID-19 period (cT1=66, cT2=64, cT3=66 and cT4=21 vs. cT1=59, cT2=82, cT3=65 and cT4=7, P=0.03), but without difference in ciliary body involvement, extraocular extension or AJCC stage (dataset-1). Treatments were similar between the pre-COVID-19 and post-COVID-19 periods in dataset-1 (P=0.36) and dataset-2 (P=0.47), with a higher ratio of proton beam therapy to primary enucleation in 2020 than in the pre-COVID-19 and post-COVID-19 periods (21.4 vs. 8.6 and 6.3, P=0.02).

CONCLUSION

The COVID-19 pandemic did not impact the ophthalmological management of UM patients in France, but more locally advanced stages were observed upon initial presentation during the post-COVID-19 period.

Perspectives and Limitations of Mesenchymal Stem Cell-Based Therapy for Corneal Injuries and Retinal Diseases

The eye represents a highly specialized organ, with its main function being to convert light signals into electrical impulses. Any damage or disease of the eye induces a local inflammatory reaction that could be harmful for the specialized ocular cells. Therefore, the eye developed several immunoregulatory mechanisms which protect the ocular structures against deleterious immune reactions. This protection is ensured by the production of a variety of immunosuppressive molecules, which create the immune privilege of the eye. In addition, ocular cells are potent producers of numerous growth and trophic factors which support the survival and regeneration of diseased and damaged cells. If the immune privilege of the eye is interrupted and the regulatory mechanisms are not sufficiently effective, the eye disease can progress and result in worsening of vision or even blindness. In such cases, external immunotherapeutic interventions are needed. One perspective possibility of treatment is represented by mesenchymal stromal/stem cell (MSC) therapy. MSCs, which can be administered intraocularly or locally into diseased site, are potent producers of various immunoregulatory and regenerative molecules. The main advantages of MSC therapy include the safety of the treatment, the possibility to use autologous (patient's own) cells, and observations that the therapeutic properties of MSCs can be intentionally regulated by external factors during their preparation. In this review, we provide a survey of the immunoregulatory and regenerative mechanisms in the eye and describe the therapeutic potential of MSC application for corneal damages and retinal diseases.

Advances and future trends in the detection of beta-amyloid: A comprehensive review

The neurodegenerative condition known as Alzheimer's disease is typified by the build-up of beta-amyloid plaques within the brain. The timely and precise identification of beta-amyloid is essential for understanding disease progression and developing effective therapeutic interventions. This comprehensive review explores the diverse landscape of beta-amyloid detection methods, ranging from traditional immunoassays to cutting-edge technologies. The review critically examines the strengths and limitations of established techniques such as ELISA, PET, and MRI, providing insights into their roles in research and clinical settings. Emerging technologies, including electrochemical methods, nanotechnology, fluorescence techniques, point-of-care devices, and machine learning integration, are thoroughly discussed, emphasizing recent breakthroughs and their potential for revolutionizing beta-amyloid detection. Furthermore, the review delves into the challenges associated with current detection methods, such as sensitivity, specificity, and accessibility. By amalgamating knowledge from multidisciplinary approaches, this review aims to guide researchers, clinicians, and policymakers in navigating the complex landscape of beta-amyloid detection, ultimately contributing to advancements in Alzheimer's disease diagnostics and therapeutics.

Current trends in the allocation of National Institute of Health funding of brain tumor research

Background

The National Institute of Health (NIH) provides a sizable annual budget toward brain tumor research. However, funding allocation for specific pathologies remains poorly described. We aimed to characterize the current landscape of NIH funding toward brain tumors as a function of pathology.

Methods

NIHRePORTER was queried to identify studies focused on glioblastoma, pediatric glioma, oligodendroglioma, brain metastasis, meningioma, pituitary adenoma, and vestibular schwannoma, from 2000 to 2023. Studies with R, U, and P funding mechanisms were included. Data were compiled and assessed according to pathology.

Results

Across these 7 tumors, 3320 unique studies with R, U, or P funding mechanisms were identified from 2000 to 2023. These were conducted across 480 unique institutions. The sum of funds allocated to all studies was $1 607 662 631. Glioblastoma commanded the largest portion of funds, representing 54% of R mechanisms, 55% of R01-funded studies, 48% of U mechanisms, and 49% of P mechanisms, and accounted for 51% ($813 556 423) of total funding. Brain metastasis was the second most-funded tumor, representing 31% of all R mechanisms, 31% of all R01-funded studies, 26% of all U mechanisms, and 28% of all P mechanisms, and accounted for 29% ($472 715 745) of funding. The remaining 14% of R mechanisms, 26% of U mechanisms, and 23% of P mechanisms focused on the remaining pathologies, and accounted for 20% ($321 390 463) of funding.

Conclusions

The current landscape of NIH funding for brain tumor research indicates that awarded mechanisms prioritize malignant intra-axial malignancies. Despite their prevalence, skull base neoplasia is far less represented in NIH-funded studies.

Evaluating Immunotherapy Responses in Neuro-Oncology for Glioblastoma and Brain Metastases: A Brief Review Featuring Three Cases

INTRODUCTION

Recent advancements in immunotherapy have offered new possibilities for treating aggressive glioblastoma (GBM) and brain metastases. However, evaluating treatment responses remains complex, prompting the development of the immunotherapy-specific Response Assessment in Neuro-Oncology (iRANO) criteria. Herein, we present case reports illustrating the intricacies of interpreting imaging changes post-immunotherapy, emphasizing the need for a comprehensive approach to assessing treatment effectiveness.

CASE REPORTS

Case 1 discusses a 41-year-old male with GBM, highlighting the challenges of differentiating tumor progression from treatment-induced pseudoprogression. Case 2 discusses a 45-year-old female with brain metastatic malignant melanoma, presenting radiological evidence of progressive disease while undergoing nivolumab treatment. Case 3 discusses a 37-year-old male with GBM, where radiological evidence indicates progressive disease while receiving pembrolizumab treatment.

MANAGEMENT AND OUTCOMES

In case 1, we discussed the challenges of distinguishing true tumor progression from treatment-induced pseudoprogression, leading to the continuation of the same treatment due to pseudoprogression. In case 2, post-surgery pathology revealed radionecrosis and treatment-related changes, guiding the continuation of nivolumab therapy. Case 3 involved a pathologically confirmed progression, and the patient received best supportive care due to his performance status.

DISCUSSION

Despite aggressive treatment regimens, the prognosis for GBM patients remains poor, underscoring the necessity for innovative therapeutic strategies. Immunotherapy holds promise in reshaping the treatment landscape for GBM and brain metastases, but further research and refinement of assessment criteria are crucial. Throughout our cases, we discuss the iRANO criteria, developed to overcome the limitations of the RANO criteria in capturing immunotherapy responses, particularly pseudoprogression.

Manometric Intraocular Pressure Reduction with Negative Pressure Using Ocular Pressure Adjusting Pump Goggles

OBJECTIVE

The ocular pressure adjusting pump is a novel noninvasive and nonpharmacological intraocular pressure (IOP)-lowering device consisting of goggles attached to a negative pressure (NP) pump. This study aimed to determine the effect of NP in ocular pressure adjusting pump goggles on IOP using continuous direct manometry.

DESIGN

Prospective, single-arm, single center, basic physiological research trial.

SUBJECTS

Adult patients undergoing cataract surgery.

METHODS

Direct manometry was performed via an anterior chamber cannula attached to an IOP sensor. This was placed just prior to each subject's previously scheduled cataract surgery. Intraocular pressure was continuously monitored every 0.5 seconds through the following sequence of 30 seconds each: baseline IOP measurement, NP -10 mmHg, NP off, NP -20 mmHg, and NP off.

MAIN OUTCOME MEASURES

Intraocular pressure response to application of NP.

RESULTS

All 17 subjects had a dose-dependent reduction in IOP, with a mean IOP decrease from 16.9 to 11.3 (33%) with -10 mmHg of NP and from 15.7 to 7.7 (51%) mmHg with -20 mmHg of NP. Intraocular pressure returned to baseline for each cycle when NP was discontinued. There were no patients with increased IOP.

CONCLUSIONS

Negative pressure with the ocular pressure adjusting pump results in a consistent dose-dependent reduction in IOP, with return to baseline IOP when NP is discontinued.

FINANCIAL DISCLOSURE(S)

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Comparative analysis of medical treatments for long-term control of normal tension glaucoma: A systematic review and model-based network meta-analysis

BACKGROUND

To evaluate and compare the long-term efficacy of medical treatments for normal tension glaucoma (NTG) in controlling intraocular pressure (IOP), and establish a hierarchical ranking based on their effectiveness. 'Long-term' is defined as a treatment duration of over 12 weeks in randomised controlled trials (RCTs).

METHODS

This systematic review and model-based network meta-analysis (MBNMA) collected data of 795 patients with 997 eyes from RCTs. Patients with NTG were selected based on strict inclusion/exclusion criteria, with randomsation procedures and masking as reported in the individual trials. Eight different medications were compared, including prostaglandin analogues, beta-blockers, brimonidine, unoprostone isopropyl, brovincamine, and palmitoylethanolamide (PEA). Notably, PEA is an oral medication, while other drugs are topical agents.

RESULTS

Primary outcome is the long-term efficacy of IOP control across medications with different follow-up durations. Among the eight medications, PEA demonstrates the highest efficacy (Surface under the cumulative ranking, SUCRA = 7.46%), followed by two prostaglandin analogues: travoprost (SUCRA = 6.86%) and latanoprost (SUCRA = 6.76%), then two beta-blockers: nipradilol (SUCRA = 4.90%) and timolol (SUCRA = 4.89%). Both brimonidine and unoprostone isopropyl have SUCRA scores below 4.0%, indicating modest but limited efficacy. Brovincamine has the lowest SUCRA score (1.32%), reflecting minimal effectiveness.

CONCLUSIONS

This study revealed PEA as a promising agent for long-term IOP control in NTG patients, suggesting potential use as primary or adjunctive therapy. The outcomes call for PEA's consideration in clinical practice and highlight the need for further research into its long-term efficacy and safety for NTG.

Evaluation of Convolutional Neural Networks (CNNs) in Identifying Retinal Conditions Through Classification of Optical Coherence Tomography (OCT) Images

Introduction Diabetic retinopathy (DR) is a leading cause of blindness globally, emphasizing the urgent need for efficient diagnostic tools. Machine learning, particularly convolutional neural networks (CNNs), has shown promise in automating the diagnosis of retinal conditions with high accuracy. This study evaluates two CNN models, VGG16 and InceptionV3, for classifying retinal optical coherence tomography (OCT) images into four categories: normal, choroidal neovascularization, diabetic macular edema (DME), and drusen. Methods Using 83,000 OCT images across four categories, the CNNs were trained and tested via Python-based libraries, including TensorFlow and Keras. Metrics such as accuracy, sensitivity, and specificity were analyzed with confusion matrices and performance graphs. Comparisons of dataset sizes evaluated the impact on model accuracy with tools deployed on JupyterLab. Results VGG16 and InceptionV3 achieved accuracy between 85% and 95%, with VGG16 peaking at 94% and outperforming InceptionV3 (92%). Larger datasets improved sensitivity by 7% and accuracy across all categories, with the highest performance for normal and drusen classifications. Metrics like sensitivity and specificity positively correlated with dataset size. Conclusions The study confirms CNNs' potential in retinal diagnostics, achieving high classification accuracy. Limitations included reliance on grayscale images and computational intensity, which hindered finer distinctions. Future work should integrate data augmentation, patient-specific variables, and lightweight architectures to optimize performance for clinical use, reducing costs and improving outcomes.

Validation of intraocular pressure measurement using tonometer AVIA across different postures: A Bland Altman analysis

AIMS/OBJECTIVES

Tonometry is a fundamental procedure in the diagnosis and management of glaucoma. Different tonometers have been proposed but none are as accurate as the Goldman applanation tonometry (GAT). Nonetheless, due to the limitations of GAT, mobile tonometry methods became prevalent. This study aims to examine the reliability of the Tono-Pen AVIA® (TPA) in measuring intraocular pressure (IOP) across different postures.

METHODS

A total of 196 eyes were prospectively examined for IOP changes using GAT and TPA. IOP measurements were taken across different postures using the TPA. Reliability of measurements was compared using interclass correlation coefficients (ICC), while agreement was represented using Bland-Altman analysis. Pearson r coefficient was used to measure correlations.

RESULTS

When compared to GAT (14.5 ± 4.4 mmHg), IOP readings were significantly higher for TPA at both seated (16.5 ± 4.5 mmHg; p < 0.001) and supine (16.9 ± 5.7; p < 0.001) positions. The ICC values for GAT and TPA among seated and supine patients were 0.79 (0.54-0.90) and 0.76 (0.48-0.87) indicating good reliability between the readings. There were significantly positive correlations between GAT and TPA at both seated (r = 0.626, p < 0.001) and supine (r = 0.727, p < 0.001) positions. Per Bland-Altman analysis, limits of agreement were -8.57 to 4.37 for GAT and seated TPA and -10.34 and 5.34 for GAT and supine TPA.

CONCLUSION

Good reliability exists between IOP measurements using GAT and TPA. However, the devices are not interchangeable and therefore cannot be used reciprocally in the same patient.

The therapeutic potential of targeting Oncostatin M and the interleukin-6 family in retinal diseases: A comprehensive review

Retinal diseases, which can lead to significant vision loss, are complex conditions involving various cellular and molecular mechanisms. The interleukin-6 (IL-6) family, particularly Oncostatin M (OSM), has garnered attention for their roles in retinal inflammation, angiogenesis, and neuroprotection. This comprehensive review explores the dual nature of OSM and other IL-6 family members in retinal pathophysiology, highlighting their contribution to both degenerative and regenerative processes. The review also examines current research on OSM's interaction with key signaling pathways and discusses the potential of OSM and the IL-6 family as potential therapeutic targets. Understanding these mechanisms could lead to innovative treatments that modulate OSM activity, offering new avenues for managing retinal diseases and contributing to the development of more effective interventions.

Design and in silico analysis of a novel peptide-based multiepitope vaccine against glioblastoma multiforme by targeting tumor-associated macrophage

CD204 is a distinct indicator for tumor-associated macrophages (TAMs) in glioma. Evidence indicates that CD204-positive TAMs are involved in the aggressive behavior of various types of cancers. This study was conducted to develop a new and effective peptide-based vaccine for GBM, specifically targeting CD204. Epitopes of the target protein were identified using NetMHCpan 4.1a, NetMHCIIpan-4.0, and ABCpred tools. Subsequently, the predicted epitopes were evaluated using bioinformatics tools to assess their antigenicity, non-allergenicity, immunogenicity, non-toxicity, and potential to stimulate the production of IL-4 and IFN-γ in HTL epitopes. Selected T-cell epitopes demonstrated a robust binding affinity with the particular HLA alleles. Finally, four HTL epitopes, three CTL epitopes, and two B-cell epitopes, jointed via linkers and adjuvant, were used for the final vaccine construct design. Analysis disclosed that the developed vaccine demonstrated robust antigenic properties while proving soluble, stable, non-toxic, and non-allergenic. Additionally, molecular docking studies and molecular dynamics simulations confirmed a robust correlation between the designed vaccine and TLR-2 and TLR-4 immune receptors. The molecular docking results demonstrated a strong interaction between the newly developed vaccine and TLR2 (-895.1 kcal/mol) and TLR4 (-881.0 kcal/mol) receptors. During the simulation, the vaccine-TLR2 and vaccine-TLR4 complexes exhibited binding energies of -113.41 and -106.61 kcal/mol, respectively. Analysis by different bioinformatic tools indicated the potential of the designed vaccine in immune stimulation and a significant elevation in IgG and IgM antibodies, T-helper cells, T-cytotoxic cells, INF-γ, IL-2, and IL-4. Research findings show that the newly designed multi-epitope vaccine is promising in providing long-term immunity against GBM and offers a promising therapeutic alternative.

Unilateral Anterior Scleritis Following the Booster Shot of Inactivated COVID-19 (Sinopharm) Vaccine in a 52-Year-Old Woman: A Case Report

The only way to mitigate the spread of coronavirus disease 2019 (COVID-19) pandemic was vaccines. While effective in decreasing the rate and severity of the disease, there also have been considerable adverse events. Since the birth of vaccines, adverse reactions accompanied the immunity, and COVID-19 vaccines are no exceptions. This is a report about a 52-year-old female patient who presented with bilateral redness of the eyes, with normal bilateral visual acuity, postbooster dose of the Sinopharm COVID-19 vaccine. She had no significant past history of any disease or any similar reactions after previous doses. All her physical examinations were normal. Ophthalmic examination disclosed diffuse erythema, and mild scleral edema consistent with bilateral anterior diffused scleritis with negative phenylephrine test. Thereafter, with a course of tapering doses of prednisolone (30 mg at the onset) combined with azathioprine (100 mg/day), over a 2-week period, the condition completely resolved. Very few vaccination-related adverse events may manifest an unrecognized underlying autoimmune vasculopathy which may also require urgent management. As in this case, ocular adverse events, as highlighted, are highly associated with undiagnosed autoimmune diseases and therefore warrant careful assessment by clinicians.

Development and validation of a radiomics nomogram for preoperative prediction of BRAFV600E mutation status in adult patients with craniopharyngioma

Although craniopharyngiomas are rare benign brain tumors primarily managed by surgery, they are often burdened by a poor prognosis due to tumor recurrence and long-term morbidity. In recent years, BRAFV600E-targeted therapy has been promising, showing potential as an adjuvant or neoadjuvant approach. Therefore, we aim to develop and validate a radiomics nomogram for preoperative prediction of BRAFV600E mutation in craniopharyngiomas. A total of 398 patients with craniopharyngioma (training cohort: n = 278; validation cohort: n = 120) were retrospectively reviewed. We extracted 851 radiomic features from MRI images and adopted a support vector machine (SVM) classifier to develop a radiomic model. Also, a clinical-radiomics nomogram was constructed based on a multivariable logistic regression analysis. The performance of the nomogram was evaluated by its discrimination, calibration, and clinical utility. The radiomic model using the SVM based on three selected features showed good discrimination in the training and validation cohorts (area under the curve [AUC], 0.941 and 0.945, respectively). A higher Rad-score, smaller tumor volume, and homogenous enhancement were demonstrated as independent predictors of BRAFV600E mutation in craniopharyngioma. The nomogram incorporating the Rad-score and clinical-radiological factors exhibited AUCs of 0.958 (95% CI, 0.936-0.980) and 0.956 (95% CI, 0.921-0.991) in the training and validation cohorts, respectively, showing good clinical benefit and calibration. The radiomics nomogram could provide an accurate, non-invasive preoperative prediction of BRAFV600E mutation in craniopharyngioma and may provide potential guidance for the preoperative administration of BRAF V600E mutation inhibitors and promote personalized treatment. Further prospective validation is still needed.

Alkaptonuria: a rare disease with multiorgan manifestation and a long-awaited diagnosis

Alkaptonuria is a rare inherited disease resulting from a genetic variant leading to homogentisic acid accumulation in body tissues, causing a broad spectrum of symptoms. Our case involves a Caucasian male diagnosed in his 70s, who shares a constellation of symptoms and the diagnosis with his monozygotic twin brother. The symptoms include early-onset arthropathy, tendinopathy, osteopenia, discolouration of the auricular regions and fingers, scleral discolouration, secondary glaucoma, proteinuria, calcification of the mitral valve and black urethral and prostate stones. Additionally, the patient suffers from chronic cough, polyneuropathy and corpus cysts in the thoracic spine have been found. This case highlights the importance of holistic assessments, recognition of familial symptom patterns and early identification of key clinical indicators for rare disease diagnosis. It also underscores the challenge of differentiating rare symptomatic manifestations from those unrelated to alkaptonuria.

Practical surgical tips on performing upper blepharoplasty

Upper lid blepharoplasty is a surgical procedure that requires meticulous planning and execution. It is not a standalone procedure but can be combined with ptosis correction surgery. Prior to surgery, thorough lid examinations are essential to determine the appropriate approaches. Skin markings for incision sites should be drawn before anesthesia injection to avoid distortion of lid wrinkles and creases. The design of the lid crease is crucial, with a nasal tapered crease serving as a guide for subsequent parallel crease drawings. Incisions should be made with care to avoid excessive bleeding, particularly from the orbicularis muscles. It is important to control bleeding promptly to prevent secondary ptosis during the early post-operative period. When releasing the orbital septum, care should be taken to avoid injury to surrounding structures, particularly the trochlea nasally and the lacrimal gland laterally. Moist cotton tip applicators can be used to safely separate fat from the underlying aponeurosis.

Meeting Challenges in the Diagnosis and Treatment of Glaucoma

Glaucoma, a progressive and multifactorial optic neurodegenerative disease, still poses significant challenges in both diagnosis and management and remains a perpetual enigma [...].

Revisiting the Visual Acuity Curves. A Proposed Methodology for the Evaluation of Postoperative Visual Acuity in Presbyopia

Purpose

To identify the minimally required number of distances of visual acuity (VA) measurements for the reliable estimation of the visual acuity curve (VAC) and area of the curve (AoC) in presbyopia correction.

Patients and Methods

The study was divided into a validation and a clinical phase with a total recruitment of 120 participants (120 eyes) who underwent uncomplicated pseudophakic presbyopia surgery with bilateral premium intraocular lenses (IOL) implantation. This study was conducted in the Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece. Postoperative VAC and AoC were calculated with VA measurements taken at nine pre-defined distances. A mathematical model based on cubic spline interpolation was developed and assessed comparing the VAC and AoC values obtained using nine distances, with the ones predicted when a subset of VA measurements was inserted into the model.

Results

Less than four measurements resulted in unreliable VAC and AoC assessment. Optimal distances for four to six VA measurements were determined. Mean error in the prediction of VAC and AoC of the clinical group ranged from 2.54 Letters/1.74% (6 measurements) to 2.90 letters/2.9% (4 measurements), respectively.

Conclusion

Mathematical models that use cubic spline interpolation provide reliable VAC and AoC estimation, even with four VA measurements, when obtained at specific distances.

Possible viral agents to consider in the differential diagnosis of blepharoconjunctivitis

BACKGROUND

Blepharoconjunctivitis poses a diagnostic challenge due to its diverse etiology, including viral infections. Blepharoconjunctivits can be acute or chronic, self-limiting, or needing medical therapy.

AIM

To review possible viral agents crucial for accurate differential diagnosis in cases of blepharoconjunctivitis.

METHODS

The PubMed database was searched for records relating to viral blepharoconjunctivitis. The search string generated was "("virally"[All Fields] OR "virals"[All Fields] OR "virology"[MeSH Terms] OR "virology"[All Fields] OR "viral"[All Fields]) AND "Blepharoconjunctivitis"[All Fields]".

RESULTS

A total of 24 publications were generated from the search string. Reference lists from each relevant article were also searched for more information and included in this review. Viral etiologies such as adenovirus, herpes simplex virus (HSV), varicella-zoster virus (VZV), and Epstein-Barr virus (EBV) are frequently implicated. Adenoviral infections manifest with follicular conjunctivitis and preauricular lymphadenopathy, often presenting as epidemic keratoconjunctivitis. HSV and VZV infections can result in herpetic keratitis and may exhibit characteristic dendritic corneal ulcers. EBV, although less common, can cause unilateral or bilateral follicular conjunctivitis, particularly in immunocompromised individuals. Other potential viral agents, such as enteroviruses and molluscum contagiosum virus, should also be considered, especially in pediatric cases.

CONCLUSION

Prompt recognition of these viral etiologies is essential for appropriate management and prevention of complications. Thus, a thorough understanding of the clinical presentation, epidemiology, and diagnostic modalities is crucial for accurate identification and management of viral blepharoconjunctivitis.

Mesenchymal Stem Cells: What We Have Learned and How to Manage Them

Regenerative medicine is the new frontier of medicine [...].

Daily activities change is linked to acute angle closure occurrence in COVID-19 co-infected patients

OBJECTIVES

To analyze the influence of daily activity-related factors associated with COVID-19 infection on the occurrence of acute angle closure (AAC).

METHODS

A multicenter hospital-based study was conducted at 23 ophthalmic centers in 17 provincial-level regions across China to recruit patients with confirmed AAC during the post-lockdown time of COVID-19 (P-TOC) from Dec 7, 2022, to Jan 17, 2023, and three lockdown time of COVID-19 (TOC) periods, which included the TOC-2022 (Sep 7, 2022 - Dec 6, 2022), TOC-2021(Sep 7, 2021 - Jan 6, 2022) and TOC-2020 (Sep 7, 2020 - Jan 6, 2021). Patient information, including demographic, a questionnaire on daily activity changes during the AAC period, COVID-19 history, and eye examination results, was collected.

RESULTS

The study involved 3216 AAC cases, with 76.2% being female and 78.9% aged over 60 years. AAC occurrences during P-TOC was nearly tripled compared to the corresponding months in TOC-2021 and TOC-2020. Patients with AAC comorbidity and COVID-19 had significantly higher water intake (37.3% vs. 2.2%, p < 0.001) and poorer sleep quality (49.16% vs. 4.07%, p < 0.001) than those without COVID-19 comorbidity, while about 58.4% of these patients received antipyretic analgesic drugs for symptom management. The COVID-19 group showed higher intraocular pressure as well as worse uncorrected distance visual acuity, when compared to non-COVID-19 patients.

CONCLUSIONS

The relationship between AAC occurrence and daily activity factors associated with COVID-19 suggests that patient management should account for changes in daily activities.

Autologous blood in the management of ocular surface disorders

Autologous blood therapy has emerged as a promising modality in managing ocular surface disorders. This review provides a comprehensive overview of the current literature regarding the use of autologous blood in ocular surface disorders, encompassing its physiological basis, clinical applications, techniques, challenges, and future perspectives. The ocular surface, comprising the cornea, conjunctiva, and tear film, plays a critical role in maintaining visual function, and its disruption can lead to various pathological conditions. With its rich composition of growth factors, cytokines, and other bioactive molecules, autologous blood offers therapeutic potential in promoting corneal wound healing, reducing inflammation, and improving tear film stability. Clinical studies have demonstrated the efficacy and safety of autologous blood therapy in diverse ocular surface disorders, including persistent epithelial defects, neurotrophic keratopathy, and dry eye disease. However, challenges such as variability in treatment response, adverse effects, and optimal patient selection remain areas of concern. Further research is needed to elucidate the underlying mechanisms of action, refine treatment protocols, and explore synergistic approaches with other therapeutic modalities. Despite these challenges, autologous blood therapy holds promise as a valuable adjunctive treatment option for ocular surface disorders, offering new avenues for improving patient outcomes and quality of life. This review examines the mechanisms underlying ocular surface disorders while discussing existing autologous blood-based therapies for managing these disorders. Current clinical trials are also summarized, and a comparison between autologous blood therapy and conventional eyedrops is attempted. Finally, safe techniques and protocols for autologous blood medicine are elucidated, and adverse effects and future perspectives of this novel therapy are reviewed.

Cell-Based Glioma Models for Anticancer Drug Screening: From Conventional Adherent Cell Cultures to Tumor-Specific Three-Dimensional Constructs

Gliomas are a group of primary brain tumors characterized by their aggressive nature and resistance to treatment. Infiltration of surrounding normal tissues limits surgical approaches, wide inter- and intratumor heterogeneity hinders the development of universal therapeutics, and the presence of the blood-brain barrier reduces the efficiency of their delivery. As a result, patients diagnosed with gliomas often face a poor prognosis and low survival rates. The spectrum of anti-glioma drugs used in clinical practice is quite narrow. Alkylating agents are often used as first-line therapy, but their effectiveness varies depending on the molecular subtypes of gliomas. This highlights the need for new, more effective therapeutic approaches. Standard drug-screening methods involve the use of two-dimensional cell cultures. However, these models cannot fully replicate the conditions present in real tumors, making it difficult to extrapolate the results to humans. We describe the advantages and disadvantages of existing glioma cell-based models designed to improve the situation and build future prospects to make drug discovery comprehensive and more effective for each patient according to personalized therapy paradigms.

Glaucoma Clinic Monitoring Over 6 Months Using Online Circular Contrast Perimetry in Comparison with Standard Automatic Perimetry: The Developing-World Setting

Purpose

Online circular contrast perimetry provides visual field testing on any computer or tablet without additional hardware. This study compared outcomes of online circular contrast perimetry (OCCP) and standard automated perimetry (SAP) in a developing world setting.

Methods

The longitudinal and observation study was conducted on patients sampled during 2023 at Hanoi Medical University Hospital. Participants were either healthy volunteers as controls or stable glaucoma patients with either primary angle closure or primary open-angle glaucoma. They underwent a comprehensive ocular examination, retinal nerve fiber layer optical coherence tomography scan, and visual field tests performed at baseline and after 3 months and 6 months, using OCCP and SAP in clinic.

Results

The current study was carried out in 168 eyes of 87 patients at baseline, 133 eyes of 69 patients at 3 months, and 121 eyes of 63 patients at 6 months. At baseline, OCCP mean deviation (MD) (R2 = 0.804, p < 0.001) and visual index (VI) (R2 = 0.892, p < 0.001) were strongly correlated with SAP MD and visual field index (VFI) respectively. There was strong agreement and correlation between MD and VI/VFI for SAP and OCCP on repeated testing after 6 months. At 6 months AUC of SAP VFI (0.79) was superior to AUC of OCCP VI (0.67, p = 0.036); otherwise there was no difference in AUC of MD or VI/VFI at baseline, 3 and 6 months, when comparing OCCP and SAP.

Conclusion

OCCP parameters are significantly correlated with those of SAP. OCCP has the potential to provide a complementary role to SAP in glaucoma screening and monitoring.

Evaluation of Sustained Intraocular Pressure Elevations Across Antivascular Endothelial Growth Factor Agents

Purpose: To evaluate the effect of antivascular endothelial growth factor (anti-VEGF) agents on the development of sustained intraocular pressure (IOP) elevations. Methods: This single-center retrospective cohort study included eyes receiving anti-VEGF injections for various indications along with nontreated fellow eyes from 2012 to 2022. Patients were grouped according to treatment with bevacizumab, ranibizumab, or aflibercept. Trends in IOP were recorded after treatment initiation for 1 year. The development of sustained IOP elevations (defined as an increase of 5 mm Hg or greater than baseline for 4 or more weeks) and glaucoma manifestations were recorded. Results: The analysis included 1604 eyes (injection cohort, 907; control cohort, 697). The mean age of the injection cohort was 83.3 years; 56.9% were women and 82.0% were White. Injections were for neovascular age-related macular degeneration (498 [54.9%]), diabetic retinopathy (219 [24.1%]), retinal vein occlusion (161 [17.8%]), and other indications (29 [3.2%)]. Bevacizumab was used in 521 eyes (57.4%), ranibizumab in 129 eyes (14.2%), and aflibercept in 257 eyes (28.3%). The mean age in the control cohort was 81.6 years; 56.1% were women and 84.1% were White. Sustained IOP elevations developed in 97 (6.0%) of 1604 eyes throughout the study. Compared with controls, treated eyes overall did not have an increased rate of sustained IOP elevations (P = .38) or glaucoma progression (P = .51), although patients treated with bevacizumab had a significantly greater incidence of IOP elevation than controls (relative risk, 1.81; 95% CI, 1.18-2.78). The mean number of injections to sustained IOP elevation was 5.4 and did not differ between agents (P > .05). Conclusions: Although not all anti-VEGF agents are associated with IOP-related adverse effects, bevacizumab carries an increased risk for sustained IOP elevation. Further investigation into the long-term effects of bevacizumab on IOP and glaucoma and a comparison with other anti-VEGF agents may be warranted.

Advantages and limitations of orbital rim resection in transorbital endoscopic approach: an anatomical study

BACKGROUND

Endoscopic transorbital approach (eTOA) has been recently proposed as an alternative skull base approach. However, its feasibility for deeper lesions can be hampered by a reduced surgical maneuverability. Aim of this study is to consider how its extension through orbital rim resection can overcome this limitation, and to compare two different techniques for its removal.

METHODS

Both sides of seven cadaveric fresh frozen head were dissected. Three different surgical approaches were performed consequentially (standard eTOA, its expansion with lateral orbital rim hinge removal, and with its complete resection). Distance to target and angle of attack have been measured for superior orbital fissure (SOF), lateral wall of cavernous sinus (LWCS), anterior clinoid process (ACP), foramen rotudum (FR) and foramen ovale (FO).

RESULTS

The angle of attack to the SOF (p = 0.01), to the LWCS (p = 0.001), to the ACP (p = 0.01), to the FR (p = 0.01) and to FO (p = 0.01) resulted larger in extended approaches with orbital rim resection, as well as the distance to target of LWCS (p = 0.04). Particularly, we observed that hinge lateral orbital rim removal improved the angle of attack to SOF (p = 0.02), APC (p = 0.01), FR (p = 0.01 and FO (p = 0.01) in comparison to the standard eTOA.

CONCLUSION

Our study confirms that the lateral orbital rim resection could significantly expand the surgical room and the instruments maneuverability for the considered target skull base targets. Its hinge removal could balance the clinical outcome with the increase of the angles of attack for the more medial and deeper structures.

Single-step 3D printing aided cranio-orbital reconstruction with patient specific polyetheretherketone implants after resection of benign spheno-orbital tumors

PURPOSE

Computer-aided design (CAD) and computer-aided manufacturing (CAM) techniques have paved the way for single-step resections and cranio-orbital reconstructions with patient specific implants in spheno-orbital tumors. Here, we present our interdisciplinary maxillofacial and neurosurgical workflow and a case series of patients treated with this integrated approach.

METHODS

Patients, who underwent single-step resection of benign spheno-orbital tumors and cranio-orbital reconstruction with polyetheretherketone (PEEK) patient specific implants (PSI) from 2019 to 2024 in our institution were included. Three dimensional models of the tumor, the skull, the implants and the cutting guides were integrated into intraoperative neuronavigation and 3D printed at the point of care (POC) for surgical planning. Clinical data was retrospectively analyzed, pre- and postoperative Exophthalmic index (EI) was radiologically determined.

RESULTS

Eleven patients met inclusion criteria. Meningioma WHO grade 1 was the most common tumor entity (81.8%). In a majority of patients, exophthalmos was the presenting sign (63.6%). Postoperative cranial imaging revealed an optimal position of the PEEK implants with regredient EI in 88.9%. Four (36.4%) patients, of whom two (50%) had undergone prior tumor resections, suffered from surgical complications. The most commonly recorded complication was impaired wound healing (n = 2). Tumor recurrence was observed in one (9.1%) patient at six months follow-up.

CONCLUSIONS

Single-step resection and reconstruction in spheno-orbital tumors with PEEK PSIs is feasible and combines surgical expertise, virtual implant design and 3D printing techniques. Favorable aesthetical, visual and oncological outcomes were achieved in this cohort, despite a significant risk for postoperative complications.

Sociodemographic factors and comorbidities are associated with an elevated risk of herpes simplex keratitis: a population-based study in Taiwan

To investigate the association among comorbidities, sociodemographic factors, and herpes simplex keratitis (HSK). This nationwide, population-based, retrospective, matched case-control study included 27,651 patients with HSK identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 054.42 for dendritic keratitis and 054.43 for herpes simplex disciform keratitis. The age-, sex-, and index date-matched control group included 27,651 non-HSK individuals selected from the Taiwan Longitudinal Health Insurance Database 2000. Associations between HSK, sociodemographic conditions, and comorbidities were examined using univariate logistic regression analyses, and paired t-tests were used for continuous variables. Adjusted logistic regression was used to compare odds ratios (OR) for HSK development. Patients with corneal abrasion were more likely to develop HSK than controls [OR, 402.80; 95% confidence interval (CI), 167.47-968.79; P < 0.0001] even after conditional logistic regression (adjusted OR, 407.36; 95% CI, 169.35-979.89; P < 0.0001). Other conditions that increase the odds of HSK development include systemic diseases such as hyperlipidemia, diabetes mellitus, coronary artery disease, chronic renal disease, and human immunodeficiency virus infection. Regarding sociodemographic factors, >50% of patients with HSK were aged ≥55 years. Moreover, patients living in Northern Taiwan and metropolitan cities had higher odds of developing HSK. HSK is significantly associated with corneal abrasion, hyperlipidemia, diabetes mellitus, coronary artery disease, chronic renal disease, and human immunodeficiency virus infection.

Development of a prediction nomogram for IgG levels among asymptomatic or mild patients with COVID-19

Objective

COVID-19 has evolved into a seasonal coronavirus disease, characterized by prolonged infection duration and repeated infections, significantly increasing the risk of patients developing long COVID. Our research focused on the immune responses in asymptomatic and mild cases, particularly the critical factors influencing serum immunoglobulin G (IgG) levels and their predictive value.

Methods

We conducted a retrospective analysis on data from 1939 asymptomatic or mildly symptomatic COVID-19 patients hospitalized between September 2022 and June 2023. Spearman methods were used to test the correlation between serum IgG and age, immunoglobulin M (IgM), procalcitonin (PCT), interleukin-6 (IL-6), nucleic acid conversion time, and BMI. Univariate and multivariate logistic regression analyses identified independent key factors influencing serum IgG levels, which were integrated and visualized in a nomogram. Finally, receiver operating characteristic (ROC) curves were plotted to predict the model's diagnostic performance by calculating the AUC.

Results

Mild patients showed higher levels of IgG, IgM, and longer nucleic acid conversion times than asymptomatic patients, and a lower proportion of them had received ≥ 3 COVID-19 vaccine doses. Serum IgG was positively correlated with serum IgM and negatively correlated with age, PCT, IL-6, and BMI. Notably, it showed a moderate negative correlation with nucleic acid conversion time (r = -0.578, P < 0.001). Logistic regression results showed that younger age, lower IL-6 levels, ≥ 3 doses of vaccine, and no comorbidities were independent predictors of serum IgG levels ≥ 21.08 g/L. We used age, IL-6 levels, vaccine doses, and comorbidities to create a nomogram for predicting serum IgG levels, with the area under the ROC curve reaching 0.772.

Conclusion

Age, IL-6 levels, vaccination status, and comorbidities were independent predictors of serum IgG levels in asymptomatic or mild COVID-19 patients, facilitating risk stratification and clinical decision-making. Notably, receiving ≥3 doses of the COVID-19 vaccine was the most beneficial factor for elevated serum IgG levels.

Current and emerging strategies for the manufacture, implantation, and clinical management of corneal tissue allografts

Approximately 40,000 Australians have received a donor corneal tissue transplant over the last 40 years, with the primary indications being keratoconus, Fuchs' endothelial dystrophy, bullous keratopathy, and failure of a prior corneal transplant. Although corneal cross-linking and rigid contact lenses have emerged as alternative strategies for the management of keratoconus, the demand for donor corneas is increasing in-line with the ageing population in Australia. Moreover, owing to the lack of tissue banking resources in less-developed countries, the global demand for donor corneas exceeds supply by 70-fold. These supply issues, combined with evolving tissue banking and surgical techniques, have led to the emergence of new strategies for the storage, processing and implantation of corneal cells and tissues. Organ culture techniques have been developed that support the storage of donor corneas for up to 30 days, facilitating improvements in tissue supply and surgery scheduling. Bespoke surgical methods have been developed that are tailored to the requirements of specific conditions, allowing reductions in both the volume of tissue required to be transplanted and the size of the necessary surgical incision. Further efficiencies and improvements in patient care may be achieved via exploitation of cell culture technologies as exemplified through use of cultured corneal epithelial cells for the treatment of limbal stem cell deficiency. Promising progress has also been made in developing a cultured corneal endothelial cell therapy for patients with corneal endothelial dysfunction. These evolving strategies are discussed with respect to their potential impact on the clinical presentation and management of patients who have received an implant of donor corneal tissue or cells.

Ophthalmic complications of injectable facial fillers

The recently published mini-review article by Miotti et al is an effort to clarify various aspects regarding the choice between fat grafts and fillers in facial aesthetic surgery. One of the complications associated with the administration of fillers is the possibility of vascular injury and spread of the dermal filler into the orbit, causing unexpected effects at a site distant from that of the initial injection, including ophthalmoplegia, ptosis and even visual compromise. Acute vision loss following filler injection is a devastating complication, occurring in up to 0.0008% of cases. The greatest risk of this complication occurs with nasal augmentation, followed by glabellar wrinkle treatment. While injected autologous fat predominantly occludes the proximal portion of the ophthalmic artery, hyaluronic acid fillers obstruct the ophthalmic artery comparatively distally. Treatment interventions include thrombolysis, hyperbaric oxygen therapy, oral aspirin, cobamamide and acetazolamide and administration of corticosteroids. However, most studies show a poor prognosis in the form of partial or no recovery of vision. Hence, prevention is of paramount importance. A high index of suspicion is also warranted on the part of both those administering as well as receiving injections of facial fillers to prevent potentially vision-threatening complications of this seemingly innocuous procedure.

Molecular Biology of Cancer-Interplay of Malignant Cells with Emerging Therapies

Cancer is currently one of the leading causes of death worldwide, and according to data from the World Health Organization reported in 2020, it ranks as the second leading cause of death globally, accounting for 10 million fatalities [...].

Clinical Validation of M-TONX: A Novel Combo Rebound Tonometer and Pachymeter

Purpose

This study aims to perform a clinical investigation of an innovative rebound technology-based device, the M-TONX, to simultaneously measure intraocular pressure (IOP) and central corneal thickness (CCT).

Methods

The IOP and CCT of the patients were first measured by the M-TONX. Then, the measurements were repeated by the Goldman applanation (GAT) and the Pentacam corneal topographer, as the standard devices. For the statistical analysis, the patients were stratified based on their IOPs to group 1 (IOP < = 16 millimeters of mercury [mm Hg]), group 2 (16 mm Hg < IOP < 23 mm Hg), and group 3 (IOP > = 23 mm Hg). The stratification was also performed for the CCTs as: class 1 (CCT < = 475 µm), class 2 (475 < CCT < 574 µm), and class 3 (CCT > = 575 µm).

Results

Of the 374 eyes (225 subjects and 43% women), 262, 66, and 46 eyes belonged to group 1, group 2, and group 3, respectively. Very high IOP (>35 mm Hg) was observed in 12 eyes. The overall confidence interval of the deviation (confidence level = 95%) from the standard devices was estimated to be 0.7 to 1.2 mm Hg for IOP, and -12.7 to -5.4 µm for CCT. The stratified analysis showed substantial agreement with the standard devices with the intraclass correlation > 0.65 and the Pearson Correlation > 0.8 calculated for all the groups and classes.

Conclusions

The M-TONX exhibited a reliable performance concerning the standards for measuring IOP and CCT. Its accuracy remains stable for a broad range of IOP and CCT. The M-TONX successfully incorporates two separate functionalities into a single compact user-friendly device.

Translational Relevance

This study uncovers the conformity of the technology with the standards, linking fundamental research to clinical care.

Modified Method for Nanothin Descemet Stripping Automated Endothelial Keratoplasty

PURPOSE

The purpose of this study was to describe a method to achieve a high success rate for nanothin (NT, ≤50 μm) Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation using anterior chamber pressurizer (ACP) with a modified setting and evaluate its postoperative efficacy.

METHODS

A prospective cohort (study group) of 24 patients with corneal endothelial dysfunction was consecutively enrolled and received DSAEK grafts using the modified ACP method from December 2021 to May 2022. The control group included 24 historical patients who received DSAEK grafts using conventional ACP procedure. Central graft thickness (CGT), graft regularity (3-mm and 5-mm diameter zones), best spectacle-corrected visual acuity, and endothelial cell density (ECD) were compared between 2 groups.

RESULTS

A 100% ultrathin (UT, ≤100 μm) DSAEK rate and 62.5% NT-DSAEK rate was achieved at 3 months postsurgery in the study group, with a 51.3 ± 14.8 μm CGT, while a 70.8% UT-DSAEK rate and 4.2% NT-DSAEK rate was achieved in the control group, with an 89.0 ± 15.4 μm CGT ( P <0.001). At 3-month postoperative follow-up, the regularity of graft thickness was significantly better in the study group (central-to-peripheral thickness difference: P = 0.044 and 0.014 for 3-mm and 5-mm diameter zones, respectively, graft thickness uniformity: P <0.001 and 0.012, respectively). There was no statistical difference in the best spectacle-corrected visual acuity ( P = 0.170) or ECD ( P = 0.833) between 2 groups at 3-month postoperative follow-up.

CONCLUSIONS

DSAEK grafts harvested using modified ACP method were thinner and more regular compared with the conventional ACP method.

Pseudofilariasis, a Presenting Sign of Alkaptonuria

PURPOSE

To report the association of Pseudofilariasis as a presenting sign of Alkaptonuria.

METHOD

Case Report.

RESULTS

A 49-year-old Indian man was referred because of wormlike objects in his left conjunctiva. Ocular and family history was non-contributory. He had not been to India in 15 years. Past medical history revealed hypertension, hypercholesterolemia, arthritis, and a myocardial infarct. He had undergone two stents, bilateral Achilles tendon repairs and bilateral knee replacements. ROS showed longstanding back stiffness and pain. On ocular examination the vision was 20/25 in each eye and positive findings were in the left eye bulbar conjunctival which showed stationary black vermiform (filarial in appearance) foreign bodies along with 2 small corneal limbal pigmented deposits. Conjunctival biopsy showed dilated lymph channels with interstitial proteinaceous material of a light brown color consistent with Ochronotic pigment; hence diagnostic of Alkaptonuria.

CONCLUSIONS

Pseudofilariasis may be a presenting sign of Alkaptonuria and occur years before a clinical diagnosis is made. Filariasis is always involves white worms and never black. Knowing the ophthalmic signs of this rare disease may lead to an accurate diagnosis earlier thusly avoiding unnecessary tests and examinations.

The aryl hydrocarbon receptor: A crucial mediator in ocular disease pathogenesis and therapeutic target

The aryl hydrocarbon receptor (AHR) is a pivotal nuclear receptor involved in mediating cellular responses to a wide range of environmental pollutants and endogenous ligands. AHR plays a central role in regulating essential physiological processes, including xenobiotic metabolism, immune response modulation, cell cycle control, tumorigenesis, and developmental events. Recent studies have identified AHR as a critical mediator and a potential therapeutic target in the pathogenesis of ocular diseases. This review provides a thorough analysis of the various functions of AHR signalling in the ocular environment, with a specific emphasis on its effects on the retina, retinal pigment epithelium (RPE), choroid, and cornea. We provide a detailed discussion on the molecular mechanisms through which AHR integrates environmental and endogenous signals, influencing the development and progression of age-related macular degeneration (AMD), retinitis pigmentosa, uveitis, and other major ocular disorders. Furthermore, we evaluate the therapeutic potential of modulating AHR activity through novel ligands and agonists as a strategy for treating eye diseases. Understanding the molecular mechanisms of AHR in ocular tissues may facilitate the development of AHR-targeted therapies, which is crucial for addressing the pressing clinical demand for novel treatment strategies in ocular diseases.

Gene therapy for glaucoma: Targeting key mechanisms

Glaucoma is a group of optic neuropathies characterised by progressive retinal ganglion cell (RGC) degeneration and is the leading cause of irreversible blindness worldwide. Current treatments for glaucoma focus on reducing intraocular pressure (IOP) with topical medications. However, many patients do not achieve sufficient IOP reductions with such treatments. Patient compliance to dosing schedules also poses a significant challenge, further limiting their effectiveness. While surgical options exist for resistant cases, these are invasive and carry risks of complications. Thus, there is a critical need for better strategies to prevent irreversible vision loss in glaucoma. Gene therapy holds significant promise in this regard, offering potential long-term solutions by targeting the disease's underlying causes at a molecular level. Gene therapy strategies for glaucoma primarily target the two key hallmarks of the disease: elevated IOP and RGC death. This review explores key mechanisms underlying these hallmarks and discusses the current state of gene therapies targeting them. In terms of IOP reduction, this review covers strategies aimed at enhancing extracellular matrix turnover in the conventional outflow pathway, targeting fibrosis, regulating aqueous humor production, and targeting myocilin for gene-specific therapy. Neuroprotective strategies explored include targeting neurotrophic factors and their receptors, reducing oxidative stress and mitochondrial dysfunction, and preventing Wallerian degeneration. This review also briefly highlights key research priorities for advancing gene therapies for glaucoma through the clinical pipeline, such as refining delivery vectors and improving transgene regulation. Addressing these priorities will be essential for translating advancements from preclinical models into effective clinical therapies for glaucoma.

Induced Neural Stem Cell Transplantation in Spinal Cord Injury: Present Status and Next Steps

Spinal cord injury (SCI) remains a significant clinical challenge, with no fully effective treatment available despite advancements in various therapeutic approaches. This review examines the emerging role of induced neural stem cells (iNSCs) as promising candidates for SCI treatment, highlighting their potential for direct neural regeneration and integration with host tissue. We explore the biology of iNSCs, their mechanisms of action, and their interactions with host tissue, including modulating inflammatory responses, promoting axonal growth, and reconstructing neural circuits. Additionally, the importance of administration route, optimal timing for transplantation, and potential adverse events are discussed to address key challenges in translating these therapies to clinical applications. The review also emphasizes recent innovations, such as combining iNSC transplantation with rehabilitative training and the integration of biomaterials and growth factors to enhance therapeutic efficacy. Although preclinical studies have demonstrated positive outcomes, larger, controlled trials and standardized protocols are essential for validating the safety and effectiveness of iNSC-based therapies for SCI patients.

Correlation between pupillary size and depth of focus after the implantation of extended depth of focus intraocular lenses

PURPOSE

To evaluate whether depth of focus after the implantation of extended depth of focus (EDoF) intraocular lenses (IOLs) correlates with pupillary size.

METHODS

This retrospective case series study evaluated eyes undergoing cataract surgery with implantation of EDoF IOLs. At least one month postoperatively, the depth of focus (DoF) was measured to determine the correlation with pupillary size, age, anterior chamber depth (ACD), axial length (AXL), and corneal spherical aberrations (SA).

RESULTS

The study evaluated 64 eyes of 49 patients. The mean depth of focus was 2.67 diopters (D). The mean preoperative photopic pupil size was 3.36 mm. A significant negative association was found between preoperative photopic pupil size and depth of focus (r = 0.30, Pearson's correlation coefficient) and between preoperative mesopic pupil size and depth of focus (r = 0.274, Pearson's correlation coefficient).

Surgical management of chondrosarcomas of the skull-base and temporal bone

OBJECTIVES

To analyze the overall long-term outcome of surgically treated skull base and temporal bone chondrosarcomas.

METHODS

The medical records of patients with surgically treated skull base and temporal bone chondrosarcomas between 1983 and 2024 were thoroughly evaluated.

RESULTS

Out of a total of over 5000 skull base surgeries performed at our center, only 29 patients had histopathologically confirmed chondrosarcomas of the skull base and temporal bone. The mean of patients age was 45.6, and the male-to-female ratio was 1.9:1. The most common symptoms included hearing loss (58.6%), tinnitus (41.4%), diplopia (31%), dysphonia (24.1%), dysphagia (20.7%), vertigo (10.3%), and dizziness (10.3%). The most frequent locations of lesions among the 29 patients are as follows: petroclival region (34.5%), jugular foramen (27.6%), petrous apex (17.2%), middle ear (13.8%), others (3.4%). TO, IFTA, IFTB, IFTC, POTS, and combined surgical approaches were commonly used. The rate of gross total removal and recurrence was 82.6% and 13.8% respectively. The follow-up duration of 6 patients was more than five years and less than ten years whereas ten patients had more than ten years of follow-up.

CONCLUSIONS

Chondrosarcoma of the skull base and temporal bone is a very rare pathology. Due to its multiple potential sites of origin and histological specificity, it presents us with significant challenges. Gross total removal is the primary treatment for chondrosarcoma of the skull base and temporal bone. Personalized decision-making should be considered based on the following aspects: tumor, patient, and surgeon's factors. Postoperative radiation therapy is complementary to surgical treatment in grades II and III lesions to achieve long-term survival.

Advanced drug delivery strategies for diabetic retinopathy: current therapeutic advancement, and delivery methods overcoming barriers, and experimental modalities

INTRODUCTION

Diabetic retinopathy, a significant trigger for blindness among working age individuals with diabetes, poses a substantial global health challenge. Understanding its underlying mechanisms is pivotal for developing effective treatments. Current treatment options, such as anti-VEGF agents, corticosteroids, laser photocoagulation, and vitreous surgery, have their limitations, prompting the exploration of innovative approaches like nanocapsules based drug-delivery systems. Nanoparticles provide promising solutions to improve drug delivery in ocular medicine, overcoming the complexities of ocular anatomy and existing treatment constraints.

AREAS COVERED

This review explored advanced therapeutic strategies for diabetic retinopathy, focusing on current medications with their limitations, drug delivery methods, device innovations, and overcoming associated barriers. Through comprehensive review, it aimed to contribute to the discovery of more efficient management strategies for diabetic retinopathy in the future.

EXPERT OPINION

In the next five to ten years, we expect a revolutionary shift in how diabetic retinopathy is treated. As we deepen our understanding of oxidative stress and metabolic dysfunction, antioxidants with specialised delivery matrices are poised to take center stage in prevention and treatment strategies. Our vision is to create a more integrated approach to diabetic retinopathy management that not only improves patient outcomes but also reduces the risks associated to traditional therapies.

Three techniques for 360-degree gonioscopy-assisted transluminal trabeculotomy with iTrack advance

Purpose

360-degree gonioscopy-assisted transluminal trabeculotomy (GATT) is a safe and effective angle-based intervention to lower IOP. Use of the iTrack Advance allows the surgeon to efficiently advance the microcatheter in one continuous motion with a slider, an improvement upon previous techniques in which microcatheters or sutures which had to be manually threaded through Schlemm's canal with microforceps. This report demonstrates three variations in surgical technique for successful 360-degree GATT using the iTrack Advance.

Observations

The first technique requires retrieval of the tip of the microcatheter and requires an assistant to hold the gonioprism. The second method also requires retrieval of the tip of the microcatheter, but does not require an assistant to hold the gonioprism. The third technique requires neither retrieval of the tip of the microcatheter nor an assistant for the gonioprism.

Conclusions and Importance

The three techniques presented here allow for the completion of a 360-degree GATT using the iTrack Advance without having to manually thread a microcatheter or suture through Schlemm's canal.

Insights on the Genetic and Phenotypic Complexities of Optic Neuropathies

Background/Objectives: Optic neuropathies are a category of illnesses that ultimately cause damage to the optic nerve, leading to vision impairment and possible blindness. Disorders such as dominant optic atrophy (DOA), Leber hereditary optic neuropathy (LHON), and glaucoma demonstrate intricate genetic foundations and varied phenotypic manifestations. This narrative review study seeks to consolidate existing knowledge on the genetic and molecular mechanisms underlying ocular neuropathies, examine genotype-phenotype correlations, and assess novel therapeutic options to improve diagnostic and treatment methodologies. Methods: A systematic literature review was performed in October 2024, utilizing PubMed, Medline, the Cochrane Library, and ClinicalTrials.gov. Search terms encompassed "optic neuropathy", "genetic variants", "LHON", "DOA", "glaucoma", and "molecular therapies". Studies were chosen according to established inclusion criteria, concentrating on the genetic and molecular dimensions of optic neuropathies and their therapeutic ramifications. Results: The results indicate that DOA and LHON are mostly associated with the mitochondrial dysfunction resulting from pathogenic variants in nuclear genes, mainly OPA1, and mitochondrial DNA (mtDNA) genes, respectively. Glaucoma, especially its intricate variants, is linked to variants in genes like MYOC, OPTN, and TBK1. Molecular mechanisms, such as oxidative stress and inflammatory modulation, are pivotal in disease progression. Innovative therapeutics, including gene therapy, RNA-based treatments, and antioxidants such as idebenone, exhibit promise for alleviating optic nerve damage and safeguarding vision. Conclusions: Genetic and molecular investigations have markedly enhanced our comprehension of ocular neuropathies. The amalgamation of genetic and phenotypic data is essential for customized medical strategies. Additional research is required to enhance therapeutic strategies and fill the gaps in our understanding of the underlying pathophysiology. This interdisciplinary approach shows potential for enhancing patient outcomes in ocular neuropathies.

Impact of stereotactic radiotherapy for craniopharyngioma: a large, academic hospital cohort

PURPOSE

Adjuvant radiotherapy has been a standard of care for craniopharyngioma. Nevertheless, it is a rare disease with multiple presentations, and results with conservative surgery followed by radiotherapy (RT) can vary. We compared treatment results for both adult and pediatric patients.

METHODS

This is a retrospective cohort of patients treated between 2010 and 2023 in a single university hospital.

RESULTS

Seventy-nine patients' clinical data was assessed. Median follow-up was 75.5 months (7.1-210.2 months). Median age was 24.4 years, and 40 (50.6%) were considered pediatric patients. Median lesion size after surgery was 3.4 cm (range 0.4 to 10.4 cm). Ten patients (16.9%) were submitted to Ommaya reservoir placement surgery, and most (70%) have lesion reductions that impact radiotherapy planning. Timing of radiotherapy whether adjuvant or salvage did not impact progression-free survival (PFS) (p = 0.39). Median PFS was not reached, and mean PFS was 65.7 months. Disease control was obtained in 67 (84.1%) patients.

CONCLUSION

We achieved great results with consisting institutional protocol in both adult and childhood craniopharyngioma. Timing of RT did not translate into loss of disease control in our study, with good results for salvage radiotherapy. Ommaya reservoirs can impact RT planning, but not outcomes.

Candidate SNP Markers Significantly Altering the Affinity of the TATA-Binding Protein for the Promoters of Human Genes Associated with Primary Open-Angle Glaucoma

Primary open-angle glaucoma (POAG) is the most common form of glaucoma. This condition leads to optic nerve degeneration and eventually to blindness. Tobacco smoking, alcohol consumption, fast-food diets, obesity, heavy weight lifting, high-intensity physical exercises, and many other bad habits are lifestyle-related risk factors for POAG. By contrast, moderate-intensity aerobic exercise and the Mediterranean diet can alleviate POAG. In this work, we for the first time estimated the phylostratigraphic age indices (PAIs) of all 153 POAG-related human genes in the NCBI Gene Database. This allowed us to separate them into two groups: POAG-related genes that appeared before and after the phylum Chordata, that is, ophthalmologically speaking, before and after the camera-type eye evolved. Next, in the POAG-related genes' promoters, we in silico predicted all 3835 candidate SNP markers that significantly change the TATA-binding protein (TBP) affinity for these promoters and, through this molecular mechanism, the expression levels of these genes. Finally, we verified our results against five independent web services-PANTHER, DAVID, STRING, MetaScape, and GeneMANIA-as well as the ClinVar database. It was concluded that POAG is likely to be a symptom of the human self-domestication syndrome, a downside of being civilized.

Temporoparietal Fascia Flap (TPFF) in Extended Endoscopic Transnasal Skull Base Surgery: Clinical Experience and Systematic Literature Review

Background and Objectives: The temporoparietal fascia flap (TPFF) has recently emerged as an option for skull base reconstruction in endoscopic transnasal surgery when vascularized nasal flaps are not available. This study provides a systematic literature review of its use in skull base surgery and describes a novel cohort of patients. Methods: PRISMA guidelines were used for the review. Patients undergoing skull base reconstruction with TPFF in our center from May 2022 to April 2024 were retrospectively included. Data were collected on pre- and post-operative clinical and radiological features, histology, surgical procedures, and complications. Results: Sixteen articles were selected, comprising 42 patients who underwent TPFF reconstruction for treatment of complex skull base pathologies. In total, 5 of 358 patients (0.9%) who underwent tumor resection via endoscopic transanal surgery in the study period in our institution required TPFF. All had been previously treated with surgery and radiation therapy for different pathologies (three chordomas, one giant pituitary neuroendocrine tumor (PitNET), and one sarcoma). Post-operative complications included CSF leak, which resolved after flap revision, and an internal carotid artery pseudoaneurysm requiring endovascular embolization. Conclusions: TPFF is an effective option for skull base reconstruction in complex cases and should be part of the armamentarium of the skull base surgeon.

Cardiovascular and nonalcoholic fatty liver disease: Sharing common ground through SIRT1 pathways

As a non-communicable disease, cardiovascular disorders have become the leading cause of death for men and women. Of additional concern is that cardiovascular disease is linked to chronic comorbidity disorders that include nonalcoholic fatty liver disease (NAFLD). NAFLD, also termed metabolic-dysfunction-associated steatotic liver disease, is the greatest cause of liver disease throughout the world, increasing in prevalence concurrently with diabetes mellitus (DM), and can progress to nonalcoholic steatohepatitis that leads to cirrhosis and liver fibrosis. Individuals with metabolic disorders, such as DM, are more than two times likely to experience cardiac disease, stroke, and liver disease that includes NAFLD when compared individuals without metabolic disorders. Interestingly, cardiovascular disorders and NAFLD share a common underlying cellular mechanism for disease pathology, namely the silent mating type information regulation 2 homolog 1 (SIRT1; Saccharomyces cerevisiae). SIRT1, a histone deacetylase, is linked to metabolic pathways through nicotinamide adenine dinucleotide and can offer cellular protection though multiple avenues, including trophic factors such as erythropoietin, stem cells, and AMP-activated protein kinase. Translating SIRT1 pathways into clinical care for cardiovascular and hepatic disease can offer significant hope for patients, but further insights into the complexity of SIRT1 pathways are necessary for effective treatment regimens.

Epidemiological survey of anterior segment diseases in Japanese isolated island using a portable slit-lamp device in home-based cases in Miyako Island

The ophthalmic diseases often affect the elderly and require proper diagnosis, treatments, and follow ups. However, many cases lack adequate eye care due to limited resources and decreased daily living activities among individuals. Despite the importance of ophthalmic home care, epidemiological research in this area has been lacking. This study utilized portable ophthalmological equipment to conduct an epidemiological research of anterior segment diseases in patients receiving home-based medical care in Japanese isolated island "Miyako island". A retrospective examination was conducted on home visit cases from a single facility in Miyako island (Dr. Gon Clinic). Data from 147 cases were collected and analyzed which the data are all recorded by the home care doctors and send the data to the cloud in order to make a diagnosis by the ophthalmologists. Findings included various anterior segment eye diseases such as Ptosis, meibomian gland dysfunction, conjunctival chalasis, corneal opacity, conjunctival hyperemia, pterygium, and cataract. Notably, over half of the cases (51.67%) had not undergone cataract surgery although the average age are notably high (85.69 ± 12.11 age of years). Among those without surgery, all showed signs of moderate to severe cataracts, with severity increasing with age. Additionally, a shallow anterior chamber depth was observed in one-third of these cases (33.63%) which considerable to receive a surgery to prevent the acute glaucoma attack. From our study, to ensure that patients in remote islands as Miyako island do not miss opportunities for eye care, there is an urgent need for the establishment of a supportive medical system.

Detection of Disease Features on Retinal OCT Scans Using RETFound

Eye diseases such as age-related macular degeneration (AMD) are major causes of irreversible vision loss. Early and accurate detection of these diseases is essential for effective management. Optical coherence tomography (OCT) imaging provides clinicians with in vivo, cross-sectional views of the retina, enabling the identification of key pathological features. However, manual interpretation of OCT scans is labor-intensive and prone to variability, often leading to diagnostic inconsistencies. To address this, we leveraged the RETFound model, a foundation model pretrained on 1.6 million unlabeled retinal OCT images, to automate the classification of key disease signatures on OCT. We finetuned RETFound and compared its performance with the widely used ResNet-50 model, using single-task and multitask modes. The dataset included 1770 labeled B-scans with various disease features, including subretinal fluid (SRF), intraretinal fluid (IRF), drusen, and pigment epithelial detachment (PED). The performance was evaluated using accuracy and AUC-ROC values, which ranged across models from 0.75 to 0.77 and 0.75 to 0.80, respectively. RETFound models display comparable specificity and sensitivity to ResNet-50 models overall, making it also a promising tool for retinal disease diagnosis. These findings suggest that RETFound may offer improved diagnostic accuracy and interpretability for specific tasks, potentially aiding clinicians in more efficient and reliable OCT image analysis.