Barcode lipids for absolute quantitation of liposomes in ocular tissues

Lipid-based drug formulations are promising systems for improving delivery of drugs to ocular tissues, such as retina. To develop lipid-based systems further, an improved understanding of their pharmacokinetics is required, but high-quality in vivo experiments require a large number of animals, raising ethical and economic questions. In order to expedite in vivo kinetic testing of lipid-based systems, we propose a barcode approach that is based on barcoding liposomes with non-endogenous lipids. We developed and evaluated a liquid-chromatography-mass spectrometry method to quantify many liposomes simultaneously in aqueous humor, vitreous, and neural retina at higher than ±20% precision and accuracy. Furthermore, we showed in vivo suitability of the method in pharmacokinetic evaluation of six different liposomes after their simultaneous injection into the rat vitreal cavity. We calculated pharmacokinetic parameters in vitreous and aqueous humor, quantified liposome concentrations in the retina, and quantitated retinal distribution of the liposomes in the rats. Compared to individual injections of the liposome formulations, the barcode-based study design enabled reduction of animal numbers from 72 to 12. We believe that the proposed approach is reliable and will reduce and refine ocular pharmacokinetic experiments with liposomes and other lipid-based systems.

Gaze and attention: mechanisms underlying the therapeutic effect of optokinetic stimulation in spatial neglect

Left smooth pursuit eye movement training in response to large-field visual motion (optokinetic stimulation) has become a promising rehabilitation method in left spatial inattention or neglect. The mechanisms underlying the therapeutic effect, however, remain unknown. During optokinetic stimulation, there is an error in visual localization ahead of the line of sight. This could indicate a change in the brain's estimate of one's own direction of gaze. We hypothesized that optokinetic stimulation changes the brain's estimate of gaze. Because this estimate is critical for coding the locus of attention in the visual space relative to the body and across sensory modalities, its change might underlie the change in spatial attention. Here, we report that in healthy participants optokinetic stimulation causes not only a directional bias in the proprioceptive signal from the extraocular muscles, but also a corresponding shift of the locus of attention. Both changes outlasted the period of stimulation. This result forms a step in investigating a causal link between the adaptation in the sensorimotor gaze signals and the recovery in spatial neglect.

Declining incidence and improving survival of ocular and orbital lymphomas in the US between 1995 and 2018

This epidemiological study examined ocular and orbital lymphomas in the United States from 1995 to 2018, using data from the North American Association of Central Cancer Registries database of 87,543 patients with ocular and adnexal malignancies. We identified 17,878 patients (20.4%) with ocular and orbital lymphomas, with an age-standardized incidence rate (ASIR) of 2.6 persons per million (ppm). The incidence was the highest in the orbit (ASIR = 1.24), followed by the conjunctiva (ASIR = 0.57). Non-Hodgkin B-cell lymphoma was the most prevalent subtype (85.4%), particularly marginal-zone lymphoma (45.7%). Racial disparities were noted, with Asia-Pacific Islanders showing the highest incidence (orbit, 1.3 ppm). The incidence increased significantly from 1995 to 2003 (Average Percent Change, APC = 2.1%) but declined thereafter until 2018 (APC = - 0.7%). 5-year relative survival (RS) rates varied, with the highest rate for conjunctival lymphoma (100%) and the lowest for intraocular lymphoma (70.6%). Survival rates have generally improved, with an annual increase in the 5-year RS of 0.45%. This study highlights the changing epidemiological landscape, pointing to initial increases and subsequent decreases in incidence until 2003, with survival improvements likely due to advancements in treatment. These findings underscore the need for further research to investigate the root causes of these shifts and the declining incidence of ocular lymphoma.

Ocular Mucoadhesive and Biodegradable Sponge-Like Inserts for the Sustained and Controlled Delivery of Voriconazole; Preparation, D-optimal Factorial Optimization and in-vivo Evaluation

The aim of this study was to formulate and optimize by statistical means mucoadhesive and biodegradable sponge-like inserts loaded with voriconazole (VCZ) which increases the contact time of the drug with the eye and sustain its release from the formula in a controlled manner. This avoids the pulsed effect reported for the drug suspension and results in reducing the number of drug instillations in the eye with the result of enhancing the patient compliance. Also, the sponge like nature of the insert reduces the foreign body sensation caused by other ocular solid dosage forms. They were prepared using casting/freeze-drying technique using five polymers namely high molecular weight chitosan (CH), sodium alginate (AL), sodium carboxy methyl cellulose (CMC), gellan gum (GG) and xanthan gum (XG). The prepared inserts were subjected to evaluations of their visual appearance, weight variation, drug content, surface pH, in-vitro release (percent drug released after 1h (Q1 (%)), mean dissolution time (MDT) and dissolution efficiency (DE)) in addition to kinetic analysis of the release data, water uptake, mucoadhesion and rheology of the forming plain polymer solution at the maximum rate of shear. The independent variables of the D-optimal factorial design were the polymer type and concentration while Q1 (%), MDT, DE, % water uptake after 15 minutes and rheology at the maximum rate of shear were chosen as dependant variables. The performed optimization process using design expert software showed an optimum formula consisting of 2 % GG. It showed slow release behavior compared to the drug suspension. FTIR and DSC studies showed that there is no interaction between VCZ and GG. The optimum formula has good in-vitro mucoadhesive properties and pH in the safe ocular range. Moreover, it showed promising in-vivo results of rapid hydration and gelling in addition to good mucoadhesive behavior when instilled in the eye, high ocular safety and biocompatibility, sustained antifungal activity in comparison to the drug suspension and finally biodegradation. So, it may be taken into consideration as an outstanding carrier for the ocular delivery of VCZ.

Ocular lymphoma: overcoming a diagnostic challenge with an endoscopic sinus approach

BACKGROUND

Ocular lymphomas are rare, indolent tumours that pose a diagnostic challenge. Patients may be asymptomatic or present with symptoms of increased orbital mass. An index of suspicion is required alongside an understanding of the diagnostics and staging required to facilitate expedited multi-disciplinary work-up and management.

METHODS

A comprehensive literature review was performed. We present a series of three cases, each presenting their own diagnostic challenge.

RESULTS

Although ocular lymphomas are notoriously difficult to diagnose histologically, our case series show procurement of a diagnostic histological sample using an image-guided endoscopic sinus approach.

CONCLUSIONS

Although not typically involved in the diagnosis or management, the otolaryngologist may encounter ocular lymphoma masquerading as sinus disease or with disseminated disease at other sites in the head and neck. Endoscopic sinus surgery is considered a safe, effective approach for achieving a histological diagnosis in these cases.

The role of long noncoding RNAs in ocular angiogenesis and vascular oculopathy

BACKGROUND

Long noncoding RNAs (lncRNAs) are RNA transcripts over 200 nucleotides in length that do not code for proteins. Initially considered a genomic mystery, an increasing number of lncRNAs have been shown to have vital roles in physiological and pathological conditions by regulating gene expression through diverse mechanisms depending on their subcellular localization. Dysregulated angiogenesis is responsible for various vascular oculopathies, including diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, and corneal neovascularization. While anti-VEGF treatment is available, it is not curative, and long-term outcomes are suboptimal, and some patients are unresponsive. To better understand these diseases, researchers have investigated the role of lncRNAs in regulating angiogenesis and models of vascular oculopathies. This review summarizes recent research on lncRNAs in ocular angiogenesis, including the pro-angiogenic lncRNAs ANRIL, HOTAIR, HOTTIP, H19, IPW, MALAT1, MIAT, NEAT1, and TUG1, the anti-angiogenic lncRNAs MEG3 and PKNY, and the human/primate specific lncRNAs lncEGFL7OS, discussing their functions and mechanisms of action in vascular oculopathies.

In-situ gel: A smart carrier for drug delivery

In-situ gel technology is a promising drug delivery strategy that undergoes a 'sol to gel' transition upon administration, providing controlled and prolonged drug release. These gels are composed of cross-linked 3D networks of polymers, with hydrogels being a specific type of absorbing water while retaining their shape. Gelation can be triggered by various stimuli, such as temperature, pH, ions, and light. They offer several advantages like improved patient compliance, extended drug residence time, localized drug delivery, etc, but also have some disadvantages like drug degradation and limited mechanical strength. In-situ gel falls into three categories: temperature-sensitive, ion-sensitive, and pH-sensitive, but multi-responsive gels that respond to multiple stimuli have better drug release characteristics. The mechanism of in-situ gel formation involves physical and chemical mechanisms. There are various applications of in-situ gel, like ocular drug delivery, nose-to-brain delivery, etc. In this review, we have discussed the types, and mechanisms of in-situ gel & use of in-situ gel in the treatment of different diseases through various routes like buccal, vaginal, ocular, nasal, etc., along with its use in targeted drug delivery.

Ocular manifestations of the genetic causes of focal and segmental glomerulosclerosis

Genetic forms of focal and segmental glomerulosclerosis (FSGS) often have extra-renal manifestations. This study examined FSGS-associated genes from the Genomics England Renal proteinuria panel for reported and likely ocular features. Thirty-two of the 55 genes (58%) were associated with ocular abnormalities in human disease, and a further 12 (22%) were expressed in the retina or had an eye phenotype in mouse models. The commonest genes affected in congenital nephrotic syndrome (NPHS1, NPHS2, WT1, LAMB2, PAX2 but not PLCE1) may have ocular manifestations . Many genes affected in childhood-adolescent onset FSGS (NPHS1, NPHS2, WT1, LAMB2, SMARCAL1, NUP107 but not TRPC6 or PLCE1) have ocular features. The commonest genes affected in adult-onset FSGS (COL4A3-COL4A5, GLA ) have ocular abnormalities but not the other frequently affected genes (ACTN4, CD2AP, INF2, TRPC6). Common ocular associations of genetic FSGS include cataract, myopia, strabismus, ptosis and retinal atrophy. Mitochondrial forms of FSGS (MELAS, MIDD, Kearn's Sayre disease) are associated with retinal atrophy and inherited retinal degeneration. Some genetic kidney diseases (CAKUT, ciliopathies, tubulopathies) that result in secondary forms of FSGS also have ocular features. Ocular manifestations suggest a genetic basis for FSGS, often help identify the affected gene, and prompt genetic testing. In general, ocular abnormalities require early evaluation by an ophthalmologist, and sometimes, monitoring or treatment to improve vision or prevent visual loss from complications. In addition, the patient should be examined for other syndromic features and first degree family members assessed.

Pediatric orbital lesions: bony and traumatic lesions

Orbital pathologies can be broadly classified as ocular lesions, extraocular soft-tissue pathologies (non-neoplastic and neoplastic), and bony and traumatic lesions. In this paper, we discuss the key imaging features and differential diagnoses of bony and traumatic lesions of the pediatric orbit and globe, emphasizing the role of CT and MRI as the primary imaging modalities. In addition, we highlight the adjunctive role of ocular sonography in the diagnosis of intraocular foreign bodies and discuss the primary role of sonography in the diagnosis of traumatic retinal detachment.

An Updated Review on Nanoemulsion: Factory for Food and Drug Delivery

BACKGROUND

A nanoemulsion is a colloidal system of small droplets dispersed in another liquid. It has attracted considerable attention due to its unique properties and various applications. Throughout this review, we provide an overview of nanoemulsions and how they can be applied to various applications such as drug delivery, food applications, and pesticide formulations.

OBJECTIVE

This updated review aims to comprehensively overview nanoemulsions and their applications as a versatile platform for drug delivery, food applications, and pesticide formulations.

METHODS

Research relevant scientific literature across various databases, including PubMed, Scopus, and Web of Science. Suitable keywords for this purpose include "nanoemulsion," "drug delivery," and "food applications." Ensure the search criteria include recent publications to ensure current knowledge is included.

RESULTS

Several benefits have been demonstrated in the delivery of drugs using nanoemulsions, including improved solubility, increased bioavailability, and controlled delivery. Nanoemulsions have improved some bioactive compounds in food applications, including vitamins and antioxidants. At the same time, pesticide formulations based on nanoemulsions have also improved solubility, shelf life, and effectiveness.

CONCLUSION

The versatility of nanoemulsions makes them ideal for drug delivery, food, and pesticide formulation applications. These products are highly soluble, bioavailable, and targeted, providing significant advantages. More research and development are required to implement nanoemulsion-based products on a commercial scale.

Systematic review of the ophthalmic complications of robotic-assisted laparoscopic prostatectomy

This study aims to review ophthalmic injuries sustained during of robotic-assisted laparoscopic prostatectomy (RALP). A search of Medline, Embase, Cochrane and grey literature was performed using methods registered a priori. Eligible studies were published 01/01/2010-01/05/2023 in English and reported ophthalmic complications in cohorts of > 100 men undergoing RALP. The primary outcome was injury incidence. Secondary outcomes were type and permanency of ophthalmic complications, treatments, risk factors and preventative measures. Nine eligible studies were identified, representing 100,872 men. Six studies reported rates of corneal abrasion and were adequately homogenous for meta-analysis, with a weighted pooled rate of 5 injuries per 1000 procedures (95% confidence interval 3-7). Three studies each reported different outcomes of xerophthalmia, retinal vascular occlusion, and ophthalmic complications unspecified in 8, 5 and 2 men per 1000 procedures respectively. Amongst identified studies, there were no reports of permanent ophthalmic complications. Injury management was poorly reported. No significant risk factors were reported, while one study found African-American ethnicity protective against corneal abrasion (0.4 vs. 3.9 per 1000). Variables proposed (but not proven) to increase risk for corneal abrasion included steep Trendelenburg position, high pneumoperitoneum pressure, prolonged operative time and surgical inexperience. Compared with standard of care, occlusive eyelid dressings (23 vs. 0 per 1000) and foam goggles (20 vs. 1.3 per 1000) were found to reduce rates of corneal abrasion. RALP carries low rates of ophthalmic injury. Urologists should counsel the patient regarding this potential complication and pro-actively implement preventative strategies.

Overview of processed excipients in ocular drug delivery: Opportunities so far and bottlenecks

Ocular drug delivery presents a unique set of challenges owing to the complex anatomy and physiology of the eye. Processed excipients have emerged as crucial components in overcoming these challenges and improving the efficacy and safety of ocular drug delivery systems. This comprehensive overview examines the opportunities that processed excipients offer in enhancing drug delivery to the eye. By analyzing the current landscape, this review highlights the successful applications of processed excipients, such as micro- and nano-formulations, sustained-release systems, and targeted delivery strategies. Furthermore, this article delves into the bottlenecks that have impeded the widespread adoption of these excipients, including formulation stability, biocompatibility, regulatory constraints, and cost-effectiveness. Through a critical evaluation of existing research and industry practices, this review aims to provide insights into the potential avenues for innovation and development in ocular drug delivery, with a focus on addressing the existing challenges associated with processed excipients. This synthesis contributes to a deeper understanding of the promising role of processed excipients in improving ocular drug delivery systems and encourages further research and development in this rapidly evolving field.

Controlled release, chitosan-tethered luteolin phytocubosomes; Formulation optimization to in-vivo antiglaucoma and anti-inflammatory ocular evaluation

A chitosan-coated luteolin-loaded phytocubosomal system was prepared to improve the pharmacodynamic performance of luteolin in the treatment of glaucoma and ocular inflammation after topical ocular administration. Luteolin, a potent anti-oxidant herbal drug with poor aqueous solubility, was complexed with phospholipid. The prepared phytocubosomes were coated with chitosan, producing homogenously distributed nanosized particles (258 ± 9.05 nm) with a positive charge (+49 ± 6.09 mV), improved EE% (96 %), and increased concentration of encapsulated drug to 288 μg/ml. Polarized light microscopy revealed a cubic phase. Chitosan-coated phytocubosomes showed a sustained drug release profile (38 % over 24 h) and improved anti-oxidant activity (IC50 of 32 μg/ml). Ex vivo transcorneal permeation was higher by 3.60 folds compared to luteolin suspension. Irritancy tests confirmed their safety in ocular tissues after single and multiple administrations. The pharmacodynamic studies on glaucomatous rabbit eyes demonstrated 6.46-, 3.88-, and 1.89-fold reductions in IOP of chitosan-coated phytocubosomes compared to luteolin suspension, cubosomes, and phytocubosomes, respectively. Pharmacodynamic anti-inflammatory studies revealed faster recovery capabilities of chitosan-coated phytocubosomes over other formulations. Thus, chitosan-coated phytocubosomes could be a promising ocular hybrid system for delivering herbal lipophilic drugs such as luteolin.

Divulging the dust: An examination of particle deposition on soft ocular lens during urban commuting

Air pollution affecting the eye is a relatively new, emerging area of research that has implications for urban commuting and is the key first study. This article emphasizes the importance of understanding the effects of particle deposition on the human eye using soft lenses and their exposure, as well as identifying the chemical, elemental composition, and morphology of particles when commuting over a period of 21-day period. In this study, the focus is on personal sampling with soft contact lenses (42% Hioxifilcon A, 58% H2O) to understand particle deposition on ocular along with cascade to understand cut-off size. Volunteers are used for five different modes, namely bus, open and closed car windows, pedestrian, and two-wheeler. The SEM results show that the morphology in buses, pedestrians and cars are denser, irregular, and nodular, with no or minimal interstitial pores, while the particles in two-wheelers appeared to be fibrous, thin, crystalline, and non-porous ranging from 51.2 nm to 406.3 nm. The ICPMS results show the higher concentration compositions for different commuter types, namely: zinc (0.0562 μg/m3 and 0.1076 μg/m3) for buses and pedestrians, potassium (1.5013 μg/m3) and calcium (2.5892 μg/m3), magnesium (2.978 μg/m3), potassium (4.197 μg/m3), calcium (22.335 μg/m3) and iron (7.526 μg/m3) for two-wheelers. The organic elemental composition from FTIR predominant groups namely carbonyl, carboxylic, OH, N-H, C-H, CC, CO, and C-O. The experiment concludes that travellers in two-wheelers and pedestrians are more susceptible to particle deposits which leads to several ocular effects such as eye-irritation, dryness, and visual impairment.

Carrageenan tethered ion sensitive smart nanogel containing oleophytocubosomes for improved ocular luteolin delivery

Ophthalmic delivery of luteolin (LU) was studied after formulating a carrageenan-based novel ion-sensitive in situ gel (ISG) incorporating oleophytocubosomes for prolonged ocular residence time and improved ocular bioavailability of the poorly absorbed herbal drug luteolin. The prepared oleophytocubosomes and ISG were compared with LU suspension. Optimized oleophytocubosomes possessed small, homogenously distributed negatively charged particles with high entrapment efficiency. Polarized light microscope revealed a cubic phase. Optimized ISG matrix composed of 0.4% kappa carrageenan (KC), and 2% hydroxypropylmethylcellulose (HPMC) demonstrated rapid gelation, high resistance to dilution, increased viscosity after gelation, and strong mucoadhesive properties. oleophytocubosomes exerted improved drug release, while a more sustained release was observed for ISG oleophytocubosomes. The antioxidant activity of both formulations was significantly higher than that of LU suspension. Oleophytocubosome and ISG oleophytocubosome revealed significantly higher apparent permeability coefficients of 3.62 and 2.90 folds, respectively, compared to LU suspension. Irritation tests showed the safety of both formulations for single- and multiple-ocular administration. In-vivo studies demonstrated that the ISG system showed prolonged antiglaucoma effects and a faster anti-inflammatory effect, followed by oleophytocubosomes.

Microneedles for advanced ocular drug delivery

In the field of ocular drug delivery, topical delivery remains the most common treatment option for managing anterior segment diseases, whileintraocular injectionsare the current gold standard treatment option for treating posterior segment diseases. Nonetheless, topical eye drops are associated with low bioavailability (<5%), and theintravitreal administration procedure is highly invasive, yielding poor patient acceptability. In both cases, frequent administration is currently required. As a result, there is a clear unmet need for sustained drug delivery to the eye, particularly in a manner that can be localised. Microneedles, which are patches containing an array of micron-scale needles (<1 mm), have the potential to meet this need. These platforms can enable localised drug delivery to the eye while enhancing penetration of drug molecules through key ocular barriers, thereby improving overall therapeutic outcomes. Moreover, the minimally invasive manner in which microneedles are applied could provide significant advantages over traditional intravitreal injections regarding patient acceptability. Considering the benefitsofthis novel ocular delivery system, this review provides an in-depth overviewofthe microneedle systems for ocular drug delivery, including the types of microneedles used and therapeutics delivered. Notably, we outline and discuss the current challenges associated with the clinical translation of these platforms and offer opinions on factors which should be considered to improve such transition from lab to clinic.

Treatment of pediatric ocular rosacea: A systematic review

BACKGROUND

Ocular rosacea is an underdiagnosed form of rosacea that may occur without typical cutaneous signs of rosacea. Manifestations include blepharitis, lid margin telangiectasias, and scleritis. A systematic comparison of treatment options for ocular rosacea in children is lacking.

METHODS

A systematic review was conducted according to the PRISMA guidelines on treatment for pediatric ocular rosacea.

RESULTS

Eleven articles were included, representing 135 patients with a mean age of 5 years, of whom 69% (n = 75/108) were female. 55% (n = 55/99) exhibited ocular symptoms prior to cutaneous symptoms. Most patients (83%, n = 34/41) experienced a delay in diagnosis (mean 27 months, range 2-120 months). Doxycycline was the most frequently reported treatment (25%, n = 33/135). A complete response was achieved in 33% of patients treated with doxycycline (n = 10/30), while 53% (n = 16/30) achieved a partial response. Erythromycin was used in 20% of cases (n = 26/135), with a complete response in 58% (n = 15/26) and partial response in 42% (n = 11/26). Metronidazole was used in 14% of patients (n = 19/135), with a complete response being reported in 79% (n = 15/19) and partial response in 21% (n = 4/19).

CONCLUSION

Systemic antibiotics, led by doxycycline, were the most commonly reported treatment modalities for pediatric ocular rosacea. Increased awareness of ocular rosacea in this population is crucial for earlier diagnosis.

Ultrasonographic and histopathologic features associated with common ocular diseases in donkeys (Equus asinus)

There is a lack of reports describing ultrasonographic and histopathologic features of ocular diseases in donkeys. The present study aimed to document ultrasonographic and histopathologic changes associated with common ocular diseases in donkeys. The study included 45 donkeys (64 eyes) with ocular diseases that had reached the end of their working lives and requested to be used for educational and research purposes. Complete clinical, ophthalmic, ultrasonographic, gross pathologic and histopathologic examinations were included. Ocular abnormalities were documented, tabulated, and analyzed. Seventy-five ocular abnormalities were diagnosed with multiple involvements within the same eye including anterior uveitis (n = 13; 22.8%), cataract (n = 57; 76%), retinal detachment (n = 3; 4%), lens and phthisis bulbi (n = 2; 2.6%). Descriptive ultrasonographic findings of ocular abnormalities were included. Gross pathologic and histopathology findings confirmed the ultrasonography findings. Ultrasonography provided a clinically useful tool offering insight into detailed intraocular structures especially with opacification of the dioptric structures of the eye.

Acanthamoeba keratitis: Molecular typing of Acanthamoeba species directly from ocular tissue

This report explores the molecular profiling of Acanthamoeba spp. from individuals in the UK suffering from a debilitating, sight-threatening disease of the cornea known as Acanthamoeba keratitis (AK). Seventy ocular samples from individuals undergoing investigations for AK were sent to the Scottish Microbiology Reference Laboratories (SMiRL), Glasgow during 2017-2019, and subjected to DNA extraction followed by in-depth molecular typing using a nested PCR/bi-directional sequencing approach. Of the 70 samples tested, 40 were PCR-positive. Of these, 32 were successfully sequenced and assigned to two of 23 existing genotypes termed T1 to T23. Molecular profiling of the 32 samples highlighted two genotypes, namely T3 (n = 3) and T4 (n = 29). For those 29 samples identified as the T4 genotype, a sub-genotype (T4A-T4H) was recorded: T4A (n = 18); T4B (n = 5); T4C (n = 1); T4E (n = 4); and T4F (n = 1). This study highlights that the T4 genotype and T4A subtype are the predominant molecular variants to cause ocular disease in the UK. Gaining in-depth information on the molecular profiling of Acanthamoeba spp. is essential to increase our understanding of the source(s) of infection, transmission pathways, and potential associations with clinical outcomes for this rare, yet potentially debilitating ocular disease.

Veterinary deworming agent-induced toxic optic neuropathy: a case report

BACKGROUND

Veterinary antiparasitic drugs are widely used in countries and regions in which parasitic diseases are endemic, which leads to the risk of accidental ingestion and poisoning in humans.  CASE PRESENTATION: A 40-year-old male patient with a history of cirrhosis sought medical attention on November 25, 2021, due to progressive vision loss. He had previously taken triclabendazole and bithionol and was diagnosed with toxic optic neuropathy on examination. Steroid, neurotonic, and high-pressure oxygen therapy were ineffective.

CONCLUSIONS

Triclabendazole and bithionol have potential risk of optic neurotoxicity and should be considered for enhanced supervision and warning labels.

Normal periocular anthropometric measurements in an Australian population

PURPOSE

To report the normative ocular and periocular anthropometric measurements in an Australian cohort and investigate how these may be affected age, gender, and ethnicity.

METHODS

Prospective study of patients presenting to the Royal Adelaide Hospital. Patient with orbital or eyelid disease, previous surgery, craniofacial abnormalities, pupil abnormalities, strabismus, and poor image quality was excluded. Standardised photographs were taken in a well-illuminated room. A green dot with a diameter of 24 mm was placed on the participant's foreheads for calibration between pixels and millimetres. Ocular and periocular landmarks were segmented to calculate the periorbital measurements. Independent sample t test was used to compare male and female subjects, Pearson's correlation was used to correlate periocular dimensions with age, and ANOVA with Bonferroni was used to compare periocular dimension between ethnic groups.

RESULTS

Seven hundred and sixty eyes from 380 participants (215 female, mean age 58 ± 18 years) were included. The mean marginal reflex distance (MRD) 1 was 3.5 mm and decreased with increasing age (r =  - 0.09, p = 0.01) and MRD 2 was 5.2 mm. Compared to Caucasians, African subjects had a significantly larger interpupillary distance and outer intercanthal distance, whereas East Asians had a significantly larger inner intercanthal distance (p < 0.05). The values of marginal reflex distance 2, palpebral fissure height, horizontal palpebral aperture, inner intercanthal distance, interpupillary distance and outer intercanthal distance were significantly higher in male subjects than female subjects (p < 0.05).

CONCLUSIONS

Normative periocular dimensions may vary according to age, gender, and ethnicity. An understanding of normal periocular dimensions is important in the evaluation of orbital disease across different ethnic groups and may serve as reference points for oculoplastic surgery and industry.

Meandered and muddled: a systematic review on the impact of air pollution on ocular health

From the years 1970-2023, a systematic overview of the diverse consequences of particulate matter on eye health and a disease classification according to acute, chronic, and genetic are presented using the PubMed, Research Gate, Google Scholar, and Science Direct databases. Various studies on medical aspects correlate with the eye and health. However, from an application perspective, there is limited research on the ocular surface and air pollution. The main objective of the study is to uncover the relationship between eye health and air pollution, particularly particulate matter, along with other external factors acting as aggravators. The secondary goal of the work is to examine the existing models for mimicking human eyes. The study is followed by a questionnaire survey in a workshop, in which the exposure-based investigation was tagged based on their activity. This paper establishes a relationship between particulate matter and its influence on human health, leading to numerous eye diseases like dry eyes, conjunctivitis, myopia, glaucoma, and trachoma. The results of the questionnaire survey indicate that about 68% of the people working in the workshop are symptomatic with tears, blurred vision, and mood swings, while 32% of the people were asymptomatic. Although there are approaches for conducting experiments, the evaluation is not well defined; empirical and numerical solutions for particle deposition on the eye are needed. There prevails a broad gap in the arena of ocular deposition modeling.

Association between axial length and HDL in children: a hospital-based cross-sectional study

BACKGROUND

To analyze the relationship between axial length and levels of high-density lipoprotein (HDL) cholesterol in children.

METHODS

A retrospective, hospital-based cross-sectional research with 69 right eyes from 69 children who underwent health examination by Zhejiang Provincial People's Hospital was carried out. The participants were split into three groups: Group A (axial length < = 23 mm), Group B (axial length 23-24 mm), and Group C (axial length > 24 mm). Demographic epidemiological information, blood biochemical parameters and ophthalmic characteristics including refractive status and ocular geometric parameters were obtained and analyzed.

RESULTS

69 right eyes from 69 patients (25 males and 44 females) with a median age of 10.00 years old (IQR: 8.00-11.00 years) were included in the study. Within Group A, there were a total of 17 individuals; Group B consisted of 22 individuals; Group C included 30 individuals. The mean axial length of three groups was 22.148(0.360), 23.503(0.342) and 24.770(0.556) mm, respectively (p < 0.0001). The mean HDL levels were significantly different in three groups are 1.824(0.307), 1.485(0.253) and 1.507 (0.265) mmol/L, respectively. By applying a Pearson Coefficient, we evaluated the association between axial length and HDL and discovered that there was a statistically significant (p = 0.00025) and adverse (R = -0.43) association between axial length and HDL.

CONCLUSIONS

We concluded from our study that there was a significantly inverse relationship between axial length and the levels of HDL in children.

Polymer coated polymeric microneedles for intravitreal delivery of dexamethasone

The polymer coated polymeric (PCP) microneedles (MNs) is a novel approach for controlled delivery of drugs (without allowing release of the excipients) to the target site. PCP MNs was explored as an approach to deliver the drug intravitreally to minimize the risks associated with conventional intravitreal injections. The core MNs was fabricated with polyvinyl pyrrolidone K30 (PVP K30) and coating was with Eudragit E100. Preformulation studies revealed that the films prepared using Eudragit E 100 exhibited excellent integrity in the physiological medium after prolonged exposure. FTIR studies were performed to investigate the possible interaction between the API and the polymer. The PCP MNs fabricated with different drug loads (dexamethasone sodium phosphate) were subjected to in vitro drug release studies. The drug release from uncoated MNs was instantaneous and complete. On the other hand, a controlled release profile was observed in case of PCP MNs. Likewise, even in the ex vivo porcine eye model, the drug release was gradual into the vitreous humor in case of PCP MNs. The uncoated microneedles released all the drug instantaneously where the PCP MNs retarded the release up to 3 h.

Laser microporation facilitates topical drug delivery: a comprehensive review about preclinical development and clinical application

INTRODUCTION

Topical drug delivery is highly attractive and yet faces tissue barrier challenges. Different physical and chemical methods have been explored to facilitate topical drug delivery.

AREAS COVERED

Ablative fractional laser (AFL) has been widely explored by the scientific community and dermatologists to facilitate topical drug delivery since its advent less than two decades ago. This review introduces the major efforts in exploration of AFL to facilitate transdermal, transungual, and transocular drug delivery in preclinical and clinical settings.

EXPERT OPINION

Most of the preclinical and clinical studies find AFL to be safe and highly effective to facilitate topical drug delivery with little restriction on physicochemical properties of drugs. Clinical studies support AFL to enhance drug efficacy, shorten treatment time, reduce pain, improve cosmetic outcomes, reduce systemic drug exposure, and improve safety. Considering most of the clinical trials so far involved a small sample size and were in early phase, future trials will benefit from enrolling a large group of patients for thorough evaluation of the safety and efficacy of AFL-assisted topical drug delivery. The manufacturing of small and less costly AFL devices will also facilitate the translation of AFL-assisted topical drug delivery.

Clinical spectrum of orbital and ocular abnormalities on fetal MRI

BACKGROUND

Fetal magnetic resonance imaging (MRI) may reveal sonographically occult ocular abnormalities. When discovered, acquired causes and genetic associations must be sought.

OBJECTIVE

We aim to evaluate a fetal cohort with orbit and/or globe malformations to determine whether there are imaging patterns that suggest the underlying cause.

MATERIALS AND METHODS

We searched all fetal MRI reports performed at an academic children's hospital over 9 consecutive years for orbit and/or globe abnormalities. Each positive exam and all follow-up MRIs were evaluated for interocular distance, globe size, shape and signal, and brain malformations. Genetic and clinical diagnoses were recorded from the medical record.

RESULTS

Seventy-six of 3,085 fetuses (2.5%) were diagnosed with ocular and/or globe abnormalities; 50% had postnatal follow-up MR exams, all confirming the fetal MRI findings. Ninety-two percent (70/76) had concurrent brain malformations. Sixty-seven percent (51/76) were diagnosed with an underlying disorder and 39% of these were genetically proven. The most common diagnoses with ocular globe abnormalities included CHARGE (coloboma of the eye, heart anomaly, choanal atresia, retardation and genital and ear anomalies) syndrome, trisomy 13 syndrome, dystroglycanopathy, holoprosencephaly and diencephalic-mesencephalic junction dysplasia. Genetic diagnoses were more likely with ocular globe abnormalities than isolated orbital abnormalities (P=0.04). Sixty-seven percent of fetuses with ocular calcifications, hemorrhage and/or lens abnormalities had potential maternal risk factors (P=0.03).

CONCLUSION

Malformed ocular globes are associated with brain malformations and genetic abnormalities. Ocular calcifications, hemorrhage and/or lens abnormalities may be associated with maternal risk factors. Genetic work-up should be considered when an ocular globe size or shape abnormality is detected.

Relationship between dry eye and expressions of CXCR3 and CCR5 after ocular acid burn

OBJECTIVE

To investigate the manifestation of dry eye and its relationship with CXCR3 and CCR5 expression in patients with ocular acid burns.

METHODS

This is a case-control study. A total of 27 eyes of 22 cases ocular with acid burns of I-V degrees from Jan.2020 to Feb.2021 in Jinshan Hospital of Fudan University were selected as observation group, and 8 eyes of 8 cases of normal people were selected as control group. The follow-up period was 3 months. The visual acuity, intraocular pressure (IOP), corneal fluorescein staining scores (CFS), breakup time of tear film (BUT), Schirmer I test, corneal thickness and tear meniscus height (TMH) were observed at 1 day, 1 and 3 months after injury. The protein expressions of CXCR3 and CCR5 were examined by ELISA and compared among groups at each time point.

RESULTS

BUT and Schirmer I tests value in the observation group were lower than those in the control group 3 months after injury (BUT: Group I ~ IV p = 0.0266, p = 0.0222, p = 0.0003, p = 0.0059, respectively; Schirmer I test: Group I ~ IV p = 0.0027, p = 0.0033, p = 0.0016, p = 0.0032, respectively). CFS scores were higher than those in the control group at 1 day after injury (all p < 0.0001), but decreased gradually at 1 and 3 months after injury (Group I ~ IV p = 0.0042, p = 0.0096, p < 0.0001, p < 0.0001, respectively). The corneal thickness and TMH 1 day after injury were higher than those in the control group (corneal thickness: Group II ~ IV p = 0.0010, p < 0.0001, p < 0.0001, respectively; TMH: Group II ~ IV p = 0.0002, p < 0.0001, p < 0.0001, respectively), and also higher than those at 1 month and 3 months after injury (corneal thickness: Group II ~ IV p = 0.0010, p < 0.0001, p < 0.0001, respectively; TMH: Group II ~ IV p = 0.0345 and p = 0.0045, p = 0.0005 and p < 0.0001, p = 0.0114 and p = 0.0019, respectively). The expression levels of CXCR3 and CCR5 protein were significantly negatively correlated with BUT (all p < 0.0001), and CXCR3 and CCR5 were also significantly negatively correlated with Schirmer I test value (p < 0.0001, p = 0.0004, respectively).

CONCLUSION

Ocular acid burns can cause dry eye, and the expression of CXCR3 and CCR5 protein in tears may be related to the occurrence of dry eye after ocular acid burn.

Biodistribution of progesterone in the eye after topical ocular administration via drops or inserts

Progesterone (PG) has been shown to have a slowing effect on photoreceptor cell death in mouse models of retinitis pigmentosa when administered orally. The aim of this study was to investigate whether ophthalmically administered progesterone was able to reach neuroretina and thus, the distribution through ocular tissues of different PG formulations was studied. The effect of different initial PG concentration was also investigated. Different formulations with PG in their composition (drops, a corneal/scleral-insert and scleral-inserts) were prepared and assayed. Using whole porcine eyes, the different formulations were topically administered to the ocular surface. Frozen eyes were dissected, the PG in each tissue was extracted in acetonitrile and the amount of PG quantified by UHPLC-MS/MS. Our results show that after topical administration, PG diffuses from the ocular surface and distributes throughout all tissues of the eye. Lower levels of PG were found in sclera, choroid and neuroretina when PG was applied as drops compared to inserts. Our results also show that an increase in the initial PG concentrations applied, resulted in a statistically significant increase in the amounts of PG in aqueous humour, sclera, choroid and neuroretina.

A rare case report of pseudomyopia after impacted teeth extraction under general anesthesia

Ophthalmic complications after tooth extraction are rare but discomforting events. This paper reports the rare complications of a 20-year-old male patient who presented with transient blurring of vision after surgical extraction of several teeth under general anesthesia. Additional diagnostic tests were performed to discern the reason for the pseudomyopia. A literature review was carried out by searching for articles published from 1936 to 2019 using the keywords "dental," "ophthalmic," "complication," "blurring of vision," and "accommodation disturbance" in PubMed. Only six patients with detailed ophthalmic symptoms similar to those of our patient have been reported. If blurred vision or a myopic shift in refraction is present, pseudomyopia should be suspected, and cycloplegic refraction is essential for diagnosis. The condition improves spontaneously.

Polymer Coated Polymeric (PCP) Microneedles for Controlled Delivery of Drugs (Dermal and Intravitreal)

Microneedles are used to deliver drugs topically across the skin and mucous membranes. Dissolvable microneedles are made using soluble polymers, which disintegrates in the tissue and release the entire payload instantaneously including the polymer construct. Often, a slow release of drug into the tissue is desirable to overcome the severity of side effects at the site of administration as well as systemic adverse effects. In addition, controlled release of active pharmaceutical ingredient (API) only (not the excipients) is safe and effective particularly when the drug delivery is intended to sensitive organs like the eye. In this project, the feasibility of fabricating polymer coated polymeric (PCP) microneedles to achieve a gradual release of only the active ingredient from the device was investigated. The potential application of such PCP microneedles in the dermal and intravitreal drug delivery was also explored using animal tissue models. The PCP microneedles were found to be intact even after prolonged contact with the release medium. The time at which 50% (T50%) of dextran (10 K) was released in case of microneedles prepared using 20% of core polymer (PVP-K30) was about 15 min versus less than 5 min in the case of uncoated microneedles. Whereas when the core polymer concentration was increased to 50%, the T50% was increased to 90 min. The rate of release depended on the polymer molecular weight grade. The rate of drug release was not influenced by the total amount of concentration of dextran. The PCP microneedles of lidocaine hydrochloride could constantly release the drug for up to 9 h in the skin tissue. Likewise, the PCP microneedles infused voriconazole, intravitreally for 6 h.

Impacts of particulate matter (PM2.5) on the health status of outdoor workers: observational evidence from Malaysia

Ambient air pollution is a significant contributor to disease burden, leading to an estimated 4.2 million premature deaths and 103.1 million disability-adjusted life years (DALYs) annually worldwide. As industrialization and urbanization surge in Asia, air pollution and its corresponding health issues follow suit. Findings on disease burden in developing countries are extremely scanty. This study aimed to determine the concentration of PM_2.5 and its impact on respiratory health of outdoor workers in Malaysia. A 2-cycled 3-month cohort study involving 440 participants was conducted. Workers' health status was assessed via (1) Total Ocular Symptom Score (TOSS), (2) Total Nasal Symptom Score (TNSS), (3) St. George's Respiratory Questionnaire (SGPQ), and (4) Asthma Control Test (ACT). The maximum PM_2.5 concentration was measured at 122.90 ± 2.07 µg/m³ during third week of August 2016. Meanwhile, the minimum concentration was measured at 57.47 ± 3.80 µg/m³ and 57.47 ± 1.64 µg/m³ during fourth week of July 2016 and first week of August 2017 respectively. Findings revealed that TOSS, TNSS, and SGPQ changes were significantly (p < 0.05) associated with the concentration of PM_2.5. Outdoor workers were more significantly (p < 0.05) affected by changes in PM_2.5 compared to indoor workers with a moderate correlation (r value ranged from 0.4 to 0.7). Ironically, no significant association was found between ACT assessment and PM_2.5. Collectively, our findings suggested that changes in the concentration of PM_2.5 threatened the respiratory health of outdoor workers. The existing policy should be strengthened and preventive measures to be enforced safeguarding health status of outdoor workers.

Protein and polypeptide mediated delivery to the eye

Hybrid or recombinant protein-polymers, peptide-based biomaterials, and antibody-targeted therapeutics are widely explored for various ocular conditions and vision correction. They have been noted for their potential biocompatibility, potency, adaptability, and opportunities for sustained drug delivery. Unique to peptide and protein therapeutics, their production by cellular translation allows their precise modification through genetic engineering. To a greater extent than drug delivery to other systems, delivery to the eye can benefit from the combination of locally-targeted administration and protein-based specificity. Consequently, a range of delivery platforms and administration methods have been exploited to address the ocular delivery of peptide and protein biomaterials. This review discusses a sample of preclinical and clinical opportunities for peptide-based drug delivery to the eye.

The ocular findings related to oral bisphosphonate use

OBJECTIVE

We aimed to investigate ocular involvement findings in female osteoporosis patients using oral bisphosphonate (BP).

METHODS

A total of 51 female osteoporosis patients aged 50-75 years using oral BP for at least one year for the study group and 64 age-matched non-osteoporosis female patients for the control group were included in the study. The BP type and exposure time were noted. The ophthalmic examination findings and measurements of the flare of the patients who received oral BP due to osteoporosis and the controls were evaluated.

RESULTS

The mean duration of BP use was 3.96 years. In the study group, it was detected four of 51 patients were diagnosed with meibomian gland dysfunction (MGD) (7.8%), seven of 102 eyes had erythematous, irregular, thickened lid margin or telangiectasia around the glandular orifices. There were no pathological findings on fundus examination. The mean value of measurements of the flare (ph/ms) was 7.90±7.96 in the study group, and 5.02±0.81 in the control group. When the mean values were compared, there was a significant difference between the two groups (P=.001). A significant difference was found in the mean value of measurements of the flare between the patients using alendronate, and ibandronate with the control group (P=.001; P=.005, respectively).

CONCLUSION

Our study showed that the flare in the anterior chamber associated with chronic ocular inflammation can be seen higher rate in patients using oral alendronate, and ibandronate compared to those who do not. Morever it can be said that oral BPs may cause similar ocular side effects like as intravascular BPs.

Covered or uncovered: A randomized control trial of Tegaderm versus no Tegaderm for ocular ultrasound

BACKGROUND

Studies on ocular point-of-care ultrasound vary on whether gel should be directly applied to the eye or on top of an adhesive membrane (i.e., Tegaderm™). However, there are currently no data regarding which approach has better image quality and the impact of patient preference. In this study, we sought to address this gap by assessing the difference in image quality and patient preference between Tegaderm™ versus no Tegaderm™ for ocular ultrasound in the emergency department.

METHODS

Patients were randomized to have a Tegaderm™ placed on either their right or left eye. The other eye served as a comparator with no Tegaderm™. Ultrasound was performed on the right eye followed by the left eye in all instances. After performing each ultrasound, the sonographer asked the patient to rate their maximal discomfort from the ultrasound of that eye using a Likert scale (0 = no discomfort; 10 = severe discomfort). The sonographer then asked the patient which side (Tegaderm™ vs no Tegaderm™) they preferred. Finally, images were reviewed by an experienced ultrasound fellowship-trained sonographer blinded to allocation and rated from 1 to 5. Continuous data were analyzed using descriptive statistics with mean and standard deviation. A paired samples t-test was performed to assess for differences between groups. Categorical data were presented as frequency and percentage.

RESULTS

The mean image score was significantly worse with Tegaderm™ compared with no Tegaderm™ (mean difference: 0.94/5.00; 95% CI 0.79-1.08; p < 0.001). This was consistent in both the transverse and the sagittal plane subgroups. The percentage of acceptable images was also higher in the no Tegaderm™ group compared with the Tegaderm™ group (97.8% versus 82.8%). There was no statistically significant difference in patient discomfort with the Tegaderm™ versus no Tegaderm™ group. When asked to compare the two approaches, 54.4% of patients preferred Tegaderm™, 30.0% preferred no Tegaderm™, and 15.6% had no preference.

CONCLUSIONS

Tegaderm™ was associated with reduced image quality and no significant difference in patient discomfort when utilized for ocular ultrasound. This study suggests that ocular ultrasound may be better performed without the use of Tegaderm™. Future research should evaluate the impact of Tegaderm™ vs. no Tegaderm™ among more novice users.

The safety of intracameral phenylephrine - A systematic review

Intracameral phenylephrine is commonly used in ophthalmic surgery as an alternative or supplement to mydriatic eye drops; hence, the importance of an evidence-based understanding of its risk-benefit profile is vital. We performed a comprehensive search in the PubMed, Google Scholar and Cochrane databases for published studies and case reports relating to the use of intracameral phenylephrine. Articles from 1958 to 2021 with the following keywords were used: "intracameral phenylephrine", "intracameral mydriatics", "phenylephrine", "pupil dilation", "complications". Intracameral phenylephrine was first used in 2003 as an alternative to topical mydriatics. Since then, it is being increasingly used with a variety of benefits, including rapid onset of mydriasis, and cost-effectiveness. There are various case reports, however, of ocular and systemic complications associated with intracameral phenylephrine such as generation of free radicals, toxic anterior segment syndrome, inconsistent pupillary dilation during surgery, and ventricular fibrillation. Alternatives to intracameral phenylephrine such as iris hooks, a Malyugin ring, intracameral epinephrine, and intracameral tropicamide were compared with intracameral phenylephrine. Intracameral phenylephrine appears to have a good safety profile.

Impact of Perioperative Dry Eye Treatment with Rebamipide Versus Artificial Tears on Visual Outcomes After Cataract Surgery in Japanese Population

Introduction

The present study aimed to compare the effects of rebamipide and artificial tears during the perioperative period of cataract surgery on the postoperative visual outcomes.

Methods

Seventy-two eyes from 36 patients with a cataract were enrolled. Rebamipide (group R) was administered in one eye and Mytear® artificial tear ophthalmic solution (group A) in the other eye from 4 weeks preoperatively to 3 months postoperatively. Tear breakup time (TBUT), high-order aberrations (HOAs), superficial punctate keratopathy in the central part of the cornea (C-SPK), and corrected distance visual acuity (CDVA) were assessed at baseline, 1 week, 1 month, and 3 months after cataract surgery with trifocal intraocular lens (IOL) implantation. Contrast sensitivity and disability glare with visual angle values compatible with spatial frequencies of 1.1, 1.8, 2.9, 4.5, 7.1, and 10.2 cycles/degree (CPD) were evaluated postoperatively. Between-group differences of all variables were analyzed.

Results

At baseline, no significant differences in the variables were noted between the two groups. Mean TBUT was significantly higher, while mean C-SPK and HOAs were significantly lower in group R than in group A at each assessment. Mean CDVA was significantly higher at 1 week and 1 month postoperatively in group R compared with group A; this value was not significant at 3 months. Between-group differences in contrast sensitivity and disability glare were statistically significant at all spatial frequencies, 1 week and 1 month postoperatively. At 3 months postoperatively, there were significant differences in contrast sensitivity and disability glare at most spatial frequencies.

Conclusion

Dry eye management with rebamipide in the perioperative period of cataract surgery with trifocal IOL implantation was significantly more effective than artificial tears in improving ocular surface condition, contrast sensitivity, and disability glare postoperatively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40123-022-00523-w.

Occupational ocular health problems among marble workers at Shaq El Tho'ban industrial area in Egypt

Eye health of the working population is an essential condition for productivity. Marble industry is processed at large scale at Shaq El Tho'ban area where much dust, crushed pieces of stone, and fluctuating temperatures are endangering employees' health generally and eye health specifically. The objectives of this study were assessing the prevalence of the most common ocular health problems associated with marble industry and investigating the impact of the working environment and occupational risk factors on the oculo-visual status of marble workers. A cross-sectional study was conducted among 250 workers, working at Shaq El Tho'ban area in Egypt during the period from August 2020 to September 2021, using a semi-structured questionnaire and eye examination comprised of full ocular history, visual acuity testing (unaided/aided), slit lamp examination, ophthalmoscopy, and Schirmer's type I and tear break up time tests. The current study showed that gritty sensation (65.2%) and eye dryness (51.2%) were the commonest symptoms complained. By examination, conjunctival hyperemia (59.6%) was the most prevalent finding. By performing dry eye tests, dry eye was diagnosed in 60.4% and 51.2% of workers by Schirmer's test and tear break up time test respectively. The study's results indicated that age, working category, smoking, and diabetes had significant impact on development of ocular symptoms, while working duration, diabetes, smoking, ocular symptoms, and ocular foreign body had significant impact on development of dry eye disease. Implementation of engineering control measures, proper designing, and supply of eye PPE together with adequate health education to all workers about occupational health risks and preventive measures are recommended.

Clinicopathologic and Proteomic Analysis of Amyloidomas Involving the Ocular Surface and Adnexa

OBJECTIVES

Ocular amyloidoma is a rare disorder characterized by deposition of insoluble proteinaceous fibrils in the extracellular space of the ocular adnexa. This study details the clinicopathologic features and proteomic characteristics of periocular amyloid deposition.

METHODS

Specimens (1991-2020) were retrieved and reviewed. All available H&E slides and special stains were reviewed. Proteomic analysis was performed using immunohistochemistry (IHC) for IgG, IgG4, IgA, IgD, IgM, CD20, CD3, CD138, and κ/λ, as well as chromatography-electrospray tandem mass spectrometry on formalin-fixed, paraffin-embedded tissue.

RESULTS

There were 14 patients (7 men, 7 women). The depositions involved eyelid (n = 3), conjunctiva (n = 8), and orbit (n = 3). All patients were adults with a median age at diagnosis of 56 (range, 39-88) years. The deposits were predominantly λ light chain restricted (n = 6) and mixed light chains (n = 2), and one case was κ predominant. Two of the cases with a mixture of κ and λ light chains had an excess of transthyretin by mass spectrometry. Four of the cases did not have adequate material for proteomic subtyping.

CONCLUSIONS

Amyloidomas involving ocular adnexa contain a variety of amyloid-related and immunoglobulin-associated peptides. The λ light chain predominates as in other body sites, but mixed patterns and rarely κ light chain restriction may be encountered.

The dose-dependent effect of a stabilized cannabidiol nanoemulsion on ocular surface inflammation and intraocular pressure

Cannabidiol (CBD) is a phytocannabinoid that has a great clinical therapeutic potential. Few studies have been published on its efficacy in ocular inflammations while its impact on intraocular pressure (IOP), a major risk factor for glaucoma, remains unclear. Moreover, due to its lability and high lipophilicity, its formulation within a prolonged stable topical ophthalmic solution or emulsion able to penetrate the highly selective corneal barrier is challenging. Therefore, various CBD nanoemulsions (NEs) were designed and evaluated for stability in accelerated conditions. Further, the optimal formulation was tested on a murine LPS-induced keratitis inflammation model. Lastly, increasing CBD concentrations were topically applied, for two weeks, on mice eyes, for IOP measurement. CBD NEs exhibited optimal physicochemical characteristics for ocular delivery. A specific antioxidant was required to obtain the stable, final, formulation. In vivo, 0.4 to 1.6% CBD w/v reduced the levels of key inflammatory cytokines, depending on the concentration applied. These concentrations decreased or did not affect the IOP. Our results showed that a well-designed CBD ocular dosage form can be stabilized for an extended shelf life. Furthermore, the significant decrease in inflammatory cytokines levels could be exploited, provided that an adequate therapeutic dosage regimen is identified in humans.

A Systematic Review of Multi-decade Antibiotic Resistance Data for Ocular Bacterial Pathogens in the United States

INTRODUCTION

Since 2009, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study has been assessing in vitro antibiotic resistance for bacterial isolates sourced from ocular infections in the US. The main goal of this systematic review was to compare in vitro resistance data for ocular pathogens from published US studies with the most recently published data from the ARMOR study (2009-2018) and, where possible, to evaluate trends in bacterial resistance over time over all studies.

METHODS

A literature search was conducted using MEDLINE®, BIOSIS Previews®, and EMBASE^® databases (1/1/1995-6/30/2021). Data were extracted from relevant studies and antibiotic susceptibility rates for common ocular pathogens (Staphylococcus aureus, coagulase-negative staphylococci [CoNS], Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae), longitudinal changes in susceptibility, and multidrug resistance (MDR) were compared descriptively.

RESULTS

Thirty-two relevant studies were identified. High in vitro resistance was found among S. aureus and CoNS to fluoroquinolones, macrolides, and methicillin/oxacillin across studies, with high rates of MDR noted, specifically among methicillin-resistant staphylococci. Data from studies pre-dating or overlapping the early years of ARMOR reflected increasing rates of S. aureus resistance to fluoroquinolones, macrolides, methicillin/oxacillin, and aminoglycosides, while the ARMOR data suggested slight decreases in resistance to these classes between 2009 and 2018. Overall, methicillin-resistant S. aureus (MRSA) prevalence peaked from 2005 to 2015 with a possible decreasing trend in more recent years.

DISCUSSION AND CONCLUSIONS

Data from local and regional US datasets were generally consistent with data from the national ARMOR surveillance study. Continued surveillance of ocular bacterial pathogens is needed to track trends such as methicillin resistance and MDR prevalence and any new emerging antibiotic resistance phenotypes. Susceptibility data from ARMOR can inform initial choice of therapy, especially in practice areas where local antibiograms are unavailable.

Recent progress in polymeric non-invasive insulin delivery

The design of carriers for insulin delivery has recently attracted major research attentions in the biomedical field. In general, the release of drug from polymers is driven via a variety of polymers. Several mechanisms such as matrix release, leaching of drug, swelling, and diffusion are usually adopted for the release of drug through polymers. Insulin is one of the most predominant therapeutic drugs for the treatment of both diabetes mellitus; type-I (insulin-dependent) and type II (insulin-independent). Currently, insulin is administered subcutaneously, which makes the patient feel discomfort, pain, hyperinsulinemia, allergic responses, lipodystrophy surrounding the injection area, and occurrence of miscarried glycemic control. Therefore, significant research interest has been focused on designing and developing new insulin delivery technologies to control blood glucose levels and time, which can enhance the patient compliance simultaneously through alternative routes as non-invasive insulin delivery. The aim of this review is to emphasize various non-invasive insulin delivery mechanisms including oral, transdermal, rectal, vaginal, ocular, and nasal. In addition, this review highlights different smart stimuli-responsive insulin delivery systems including glucose, pH, enzymes, near-infrared, ultrasound, magnetic and electric fields, and the application of various polymers as insulin carriers. Finally, the advantages, limitations, and the effect of each non-invasive route on insulin delivery are discussed in detail.

Concomitant uveal melanoma and papillary thyroid carcinoma: a case report

Background

Melanoma develops in the cells that produce melanin; ocular melanoma accounts for 3–4% of all malignant melanomas. Thyroid tumors are the most common endocrine neoplasms, with more than 95% of cases arising from follicular cell origin. Previous studies have reported associations between malignant melanoma and a wide variety of malignancies.

Case presentation

We report a 54-year-old Iranian woman who was diagnosed with ocular melanoma based on a mushroom-shaped filling defect with homogeneous echo pattern arising from the anterior third of the temporal side of the globe detected on ocular sonography during routine ophthalmological examination. She underwent right globe enucleation and implant replacement. During tumor surveillance, fluorodeoxyglucose positron emission tomography/computed tomography scan showed low-grade metabolically active tumoral involvement in the anterolateral aspect of the right lobe of thyroid. The patient subsequently underwent thyroidectomy and submandibular lymphadenectomy. Pathologic report demonstrated micropapillary carcinoma (9 × 8 mm²), tall cell variant without lymphovascular or perineural invasion in the base of lymphocytic thyroiditis.

Conclusion

This case illustrates the importance of precise active surveillance in case of papillary carcinoma of thyroid or malignant melanoma to avoid missing other associated pathologies and emphasizes the simultaneous treatment of two tumors.

Itraconazole loaded nano-structured lipid carrier for topical ocular delivery: Optimization and evaluation

Background & Objectives

Low penetration efficiency and retention time are the main therapeutic concerns that make it difficult for most of the drugs to be delivered to the intraocular tissues. These challenging issues are often related to those drugs, which have low or poor solubility and low permeability. The goal of this study was designed to develop nanostructured lipid carriers (NLCs) loaded with itraconazole (ITZ) with the objective of enhancing topical ocular permeation and thereby improving clinical efficacy.

Materials and Methods

ITZ-loaded NLCs were fabricated by a high-speed homogenization technique using surfactant (Poloxamer 407), and lipids (stearic acid and oleic acid). Optimization of formulations was performed by 3 level factorial design and the selected formulation (F6) was evaluated by differential scanning calorimetry and transmission electron microscopy. Antifungal activity was assessed by measuring the zone of inhibition and irritation potential using the HET-CAM test.

Results

The independent variables (lipid ratio-X₁ and percentage of emulsifier-X₂) have a positive impact on percentage entrapment efficiency (Y₂) and percentage release (Y₃) but have a negative impact on particle size (Y₁). Based on the better entrapment efficiency (94.65%), optimum particle size (150.67 nm), and percentage cumulative drug release (68.67%), batch F6 was selected for further evaluation. Electron microscopic images revealed that the prepared particles are spherical and have nano size. Antifungal studies demonstrated enhancement in the zone of inhibition by formulation F6 as compared to a commercial eye drop. The non-irritancy of optimized formulation (F6) was confirmed with a zero score.

Interpretation & Conclusion

In summary, the optimized NLCs seem to be a potent carrier for the effective delivery of itraconazole in ocular therapy.

Ocular Tuberculosis: More than 'Of Mice and Men'

Tuberculosis (TB), caused by infection with members of the Mycobacterium tuberculosis-complex, is one of the oldest known infectious disease entities, resulting in the death of millions of humans each year. It also results in a substantial degree of morbidity and mortality in animal species. Extrapulmonary TB is well recognized in humans, and the eye is one site that can be affected. Studies seeking to understand ocular TB have often relied on animal models; however, these have their limitations and may not truly reflect what happens in humans. We wish to raise awareness among ophthalmologists and vision scientists of naturally occurring cases of ocular TB in animals, namely cattle and domestic cats, and the possibilities of gaining further understanding of this presentation of TB by adopting a collaborative approach. This will hopefully improve outcomes for both human and animal patients.

Besifloxacin-loaded ocular nanoemulsions: design, formulation and efficacy evaluation

The purpose of this study was to develop and evaluate nanoemulsions (NEs) containing besifloxacin for ocular drug delivery. Pseudo ternary phase diagrams were constructed using Triacetin (oil), Cremophor® RH 40 (surfactant), and Transcutol®P (co-surfactant) to identify NE regions. Six formulations were developed by low-energy emulsification method and then evaluated for size, refractive index, pH, osmolality, viscosity, and drug release. After accelerated physical stability and bovine conrneal permeation studies, NE2 was chosen as optimized formulation forantimicrobial efficacy, and hen's egg test-chorioallantoic membrane (HET-CAM) tests. The particle size of optimum NE was 14 nm with a narrow size distribution. Moreover, other physicochemical characterizations were in the acceptable range for ocular administration. Besifloxacin-loaded NEs demonstrated sustained release pattern and 1.7-fold higher permeation compared with the control suspension in the ex vivo transcorneal permeation study. HET-CAM test indicated no irritation, and HL% revealed no damage to the tissue, so the optimum NE is well tolerated by the eye. In vitro antimicrobial evaluation, showed comparative efficacy of lower drug-loaded NE (0.2%) versus 0.6% besifloxacin suspension (equal concentration to commercial besifloxacin eye drop). In conclusion, besifloxacin-loaded NEs could be considered as a suitable alternative to the marketed suspension for treating bacterial eyeinfections.

Non-dermal applications of microneedle drug delivery systems

Microneedles (MNs) are micron-scaled needles measuring 100 to 1000 μm that were initially explored for delivery of therapeutic agents across the skin. Considering the success in transcutaneous drug delivery, the application of microneedles has been extended to different tissues and organs. The review captures the application of microneedles to the oral mucosa, the eye, vagina, gastric mucosa, nail, scalp, and vascular tissues for delivery of vaccines, biologics, drugs, and diagnostic agents. The technology has created easy access to the poorly accessible segments of eye to facilitate delivery of monoclonal antibodies and therapeutic agents in management of neovascular disease. Microporation has been reported to drastically improve the drug delivery through the poorly permeable nail plate. Curved microneedles and spatially designed microneedle cuffs have been found to be capable of delivering stem cells and therapeutic macromolecules directly to the cardiac tissue and the vascular smooth muscle cells, respectively. Besides being minimally invasive and patient compliant, the technology has the potential to offer viable solutions to deliver drugs through impermeable barriers owing to the ability to penetrate several biological barriers. The technology has been successful to overcome the delivery hurdles and enable direct delivery of drug to the target sites, thus maximizing the efficacy thereby reducing the required dose. This review is an attempt to capture the non-dermatological applications of microneedles being explored and provides an insight on the future trends in the field of microneedle technology. Pictorial representation of different microneedle application.

The persistence of remote visual semantic memory following ocular blindness

Subjects with complete ocular blindness in both eyes provide a unique opportunity to study the long-term durability of visual semantic memory. In this cross-sectional study we recruited eleven subjects who had acquired blindness for between 1 and 36 years. For comparison, we studied four subjects with congenital blindness and seventeen age- and sex-matched sighted control subjects. We administered ten forced-choice questionnaires that probed one auditory category and four visual categories, namely object shape and size; object hue and lightness; word and letter shape; and the shape and features of famous faces. Subjects with congenital blindness performed worse than controls on all visual categories, but nevertheless performed better than chance on object structure or colour, suggesting that the answers to some questions about visual properties can be derived from haptic or non-visual semantic information. Subjects with acquired blindness performed similarly to controls on all categories except for facial memory, particularly for facial features. We conclude that there is a substantial "permastore" of visual semantic memory but that facial memories are less durable, perhaps indicating that they are either less over-learned or more dependent on visual representations than other forms of visual object information.

The application of clinical registries in ophthalmic trauma-the International Globe and Adnexal Trauma Epidemiology Study (IGATES)

Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The prevalence of ophthalmic trauma varies considerably based on geographic location, socio-economic status, age groups, occupation, and cultural practices such as firework celebrations. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. However, there is currently a lack of a centralized international data repository for ophthalmic trauma. We draw lessons from past and existing clinical registries related to ophthalmology and propose a new suitable international multicenter clinical registry for ophthalmic trauma: the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES is hosted on a secure web-based platform which exhibits user-friendly smart features, an integrated Ocular Trauma Score (OTS) prognosis calculator, efficient data collection points, and schematic graphical software. IGATES currently has 37 participating centers globally. The data collected through IGATES will be primarily used to develop a more robust and improved ophthalmic trauma prognostic classification system, the Ocular Trauma Score-2 (OTS-2), which builds on previous systems such as the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Furthermore, IGATES will act as a springboard for further research into the epidemiology, diagnosis, and management of ophthalmic trauma. Ultimately, IGATES serves to advance the field of ophthalmic trauma and improve the care that patients with ophthalmic trauma receive.

Fatal transorbital-intracranial penetrating injury- A case report

Transorbital injuries are rare and may lead to fatal craniocerebral damage. Ocular penetrating injuries account for 24% of all penetrating head injuries in adults, while this percentage goes up to 45% in children. Any penetrating injury through the eyes may enter the intracranial cavity and might prove fatal to the victim owing to cerebral tissue damage and complex management. The dead bodies of three victims were found by the side of the river with multiple injuries to their eyes. Further examination revealed that they had sustained multiple transorbital-intracranial injuries. In such cases, identifying injury patterns is vital so that cause and manner of death can be determined precisely. A thorough postmortem examination can help identify the alleged weapon involved in the act and may clear the doubts concerned with the manner of death.

Comparison of the effects of the McGRATH MAC, C-MAC, and Macintosh laryngoscopes on the intraocular pressures of non-ophthalmic patients: A prospective, randomised, clinical trial

INTRODUCTION

In this prospective, randomised study, we compared the effects of the Macintosh, McGRATH MAC, and C-MAC laryngoscopes on intraocular pressure (IOP) and haemodynamics of non-ophthalmic patients during endotracheal intubation.

METHODS

One hundred and twenty adult patients undergoing non-ophthalmic surgeries performed in the supine position under general anaesthesia requiring orotracheal intubation were included in this study. The patients were separated randomly and prospectively into 3 groups: Macintosh group (n = 40), McGRATH MAC group (n = 40), and C-MAC group (n = 40). Mean arterial pressure (MAP), heart rate (HR) and IOP of left and right eye were measured at specified times.

RESULTS

There were no significant differences with regard to patients characteristics. After intubation, the HR increased significantly in the Macintosh group when compared to the other groups (p = 0.001) and the MAP increased significantly in the Macintosh group when compared to the McGRATH MAC group (p = 0.001) and the C-MAC group (p < 0.001). The IOP values increased in the Macintosh group when compared to the McGRATH MAC group (p < 0.001) and the C-MAC group (p < 0.001) after intubation. Additionally, there was a significant difference between the McGRATH MAC group and C-MAC group in the IOP values of the eyes after intubation (p < 0.001). According to the evaluation within the groups, there were significant differences in all of the groups at all times when compared with the baseline values (p < 0.001).

CONCLUSIONS

In this study, we concluded that the C-MAC VL may be preferable when compared to the Macintosh and McGRATH MAC laryngoscopes for use in ophthalmic patients in whom a rise in the IOP is undesirable.