Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4030021

Authors: Feliciana Menna Laura De Luca Alessandro Meduri Antonio Baldascino Enzo Maria Vingolo Stefano Lupo

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is an uncommon but likely underrecognized degenerative retinal disorder characterized by peripheral subretinal and sub-retinal pigment epithelium hemorrhagic and exudative lesions, predominantly affecting elderly individuals. The condition frequently mimics choroidal melanoma and other peripheral retinal diseases, often resulting in diagnostic uncertainty and occasionally unnecessary invasive procedures. Recent advances in multimodal imaging have substantially improved the recognition and characterization of PEHCR, suggesting possible associations with polypoidal choroidal vasculopathy and the pachychoroid disease spectrum. A narrative literature review was performed using PubMed/MEDLINE, Scopus, Embase, and Web of Science. Original studies, retrospective case series, multimodal imaging reports, and relevant review articles published in English were included according to their relevance to PEHCR epidemiology, imaging, pathogenesis, differential diagnosis, and treatment. Particular attention was devoted to recent developments in ultra-widefield imaging, optical coherence tomography, indocyanine green angiography, and optical coherence tomography angiography. PEHCR typically presents with peripheral subretinal hemorrhage, exudation, pigment epithelial detachments, and occasionally vitreous hemorrhage. Multimodal imaging, particularly ultra-widefield imaging and ICGA, has substantially improved the diagnosis of PEHCR and supports its relationship with the pachychoroid-PCV spectrum. Although many patients can be managed conservatively, individualized treatment based on lesion activity remains essential, while prospective studies are needed to establish evidence-based management strategies.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4030020

Authors: Margarita Labkovich Randal A. Serafini Andrew J. Warburton Christopher Cheng Oluwafeyikemi O. Okome Vicente N. Navarro Harsha Reddy James G. Chelnis

Background/Aims: This study set out to compare patient experiences and attitudes toward virtual reality (VR) versus in-office ophthalmic functional testing, as well as their eye exam visit preferences. Methods: A total of 64 patients undergoing a comparative clinical trial including VR and in-office versions of 24-2 visual field perimetry, Pelli–Robson contrast sensitivity, ETDRS visual acuity, Ishihara plates, and Amsler Grid tests were given a survey that included Likert-scaled questions regarding overall experience, speed, and comfort of broad VR testing versus in-office tests, as well as binary modality preference, like or dislike of various exam modality aspects, ease of understanding each test, distance traveled to their appointment, visit frequency, and remote care preferences. Results: In terms of overall experience, 59 (93.7%) participants rated VR as “Liked” or “Very Much Liked” compared to 38 (60.3%) for in-office tests (χ2 p < 0.0001). Regarding comfort, 59 (93.7%) and 38 (60.3%) participants at least “Liked” VR and in-office tests, respectively (χ2 p < 0.0001). For speed, 60 (95.2%) and 36 (57.1%) participants at least “Liked” VR and in-office tests, respectively (χ2 p < 0.0001). Accordingly, 11 (17.5%) patients liked all aspects of in-office tests, while 54 (85.7%) patients said the same for VR (χ2 p < 0.0001). Overall, 33 (52.4%) patients disliked something about in-office tests, while 20 (31.7%) said the same for VR (χ2 p < 0.0001). There were no differences in ability to understand tests between the two modalities. We noted a variable distribution of distance traveled and visits per year in our population, yet there was also a strong preference for implementing more remote eye testing options. Conclusions: Development and implementation of virtual reality analogs to in-office, functional ophthalmic exams can improve patient experience and facilitate remote care delivery.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4030019

Authors: Parvin Aghayeva Irwin Leventer Peter Y. Chang Stephen D. Anesi

Background: Potential vision rehabilitation in patients with hypotony and pre-phthisis remains one of the most challenging issues of ophthalmology. Boston type I keratoprosthesis (KPro) combined with pars plana vitrectomy (PPV) and silicone oil injection (SOI) represents a potential approach to this problem in patients believed to have recoverable vision. This study presents a case series of three patients who underwent Boston type I KPro implantation with simultaneous silicone oil tamponade at our center. Methods: We retrospectively reviewed medical records of three patients with prephthisical changes who underwent Boston type I KPro and PPV/SOI. Preoperative and postoperative visual acuity (VA), anatomical stability, and postoperative complications were assessed over a follow-up period. Three eyes of three patients were included. All eyes had severe corneal pathology with sufficient wet surface. Two of three eyes had corneal decompensation secondary to intraocular inflammation, one eye had penetrating trauma-related corneal scarring. All three eyes underwent simultaneous KPro implantation with combined PPV/SOI. Results: Postoperatively, all eyes demonstrated improvement in best-corrected visual acuity (BCVA) from hand motion (HM) to 20/1000, with final BCVA ranging from counting fingers at 2 feet (CF2) to 20/150 and no evidence of progressive phthisical changes over a follow-up period of 23–66 months. Conclusions: Boston type I KPro implantation combined with PPV/SOI can be a viable approach for preserving anatomical integrity and improving visual function in patients with prephthisical eyes and perceived recoverable-vision potential.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4030018

Authors: Timon Ax Fabian N. Fries Tomas L. Bothe Francesc March de Ribot Slade O. Jensen Thomas J. Millar Berthold Seitz

Background: Lateral eye movements are part of natural ocular motility, and their effect on tear film behavior is largely unknown because they are usually not evaluated during tear film examinations, where patients are required to look straight ahead. This study aimed to determine what happens to the tear film during lateral eye movements in the absence of blinking. Methods: Tear film dynamics during a sequence of open-eye lateral gaze maneuvers were recorded using an infrared camera system (TearView). Results: The study included 15 healthy participants (5 female; median age 26) who had no ocular surface-related complaints. It was observed that lateral eye movements exposed new ocular surface areas not previously covered by the tear film. The tear film margins reacted to lateral eye movements by spreading towards the newly uncovered ocular surface areas, thereby recoating them. This response was asymmetrical, with a tear reservoir in the lacus lacrimalis of the medial canthus providing additional tear film spread only during ocular abduction. Conclusions: These findings expand our understanding of tear film physiology beyond static gaze. They might also bear implications for dry eye disease and oculoplastic surgical techniques affecting the medial canthus.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4030017

Authors: Tanya Gupta Benjamin Setters Lama Hanbali Shruti Wadhwa Michael W. Daniels Wei Wang Charles Barr Melis Kabaalioglu Guner SriniVas R. Sadda Aditya Verma

Background: Faricimab is one of the most potent anti-vascular endothelial growth factors used in the management of diabetic macular edema (DME). However, real-world benefits regarding its timing and efficacy are still being explored. Methods: This retrospective non-randomized pilot study aimed to evaluate the efficacy of intravitreal faricimab in the treatment of DME. Eyes initially treatment-naïve for DME with a follow-up of 1 year were grouped as: group 1, where faricimab was introduced within the first six months after the start of treatment; group 2, where it was initiated six or more months after treatment with other drugs. Study parameters included changes in best corrected visual acuity (BCVA) and optical coherence tomography based structural parameters within the 6 × 6 mm optical coherence tomography (OCT) scan regions. Results: Forty-two eyes from 26 patients were analyzed. No statistically significant differences were observed between the groups in cluster-weighted proportions of intra- or sub-retinal fluid, retinal thickness or volume parameters, although group 1 showed modest numerical benefits. SRF showed a trend towards qualitative reduction in group 1, although IRF showed persistence in both groups. Adjusted linear mixed-effects modeling demonstrated no significant impact of early faricimab initiation on functional and anatomical outcomes, which appeared to be influenced by the baseline BCVA, glycemic control, and the number of injections, nullifying the benefits. Conclusions: Faricimab demonstrated modest anatomical improvements with earlier treatment in eyes initially treatment-naïve for DME. Further prospective studies are indicated to assess the treatment strategy and the timing of introduction with faricimab in such eyes.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020016

Authors: Diego Brito Mascarós Priscilla Luppi Ballalai Gabrielle Aredes Leal Vinicius Portela Correia Diego Leite Gava Thais Moura Gascón Samantha Sanches de Carvalho Glaucia Luciano da Veiga Fernando Luiz Affonso Fonseca Vagner Loduca Lima

Introduction: Conjunctival and eyelid lesions encompass a broad spectrum of conditions, ranging from benign entities to malignant neoplasms, and may significantly impact ocular health and quality of life. Their occurrence is influenced by environmental exposure, demographic characteristics, and access to healthcare services. In public health settings, delayed diagnosis and limited access to specialized care may contribute to disease progression. Objective: To characterize the clinical and epidemiological profile of conjunctival and eyelid lesions in patients treated at a referral ophthalmology service within the Brazilian Unified Health System (SUS). Methods: This retrospective observational study reviewed medical records of patients diagnosed with conjunctival and/or eyelid lesions during ophthalmologic screening campaigns. Clinical and demographic variables were analyzed using descriptive statistics to assess prevalence and distribution patterns. Results: A total of 66 patients were included. Conjunctival involvement predominated (78.8%), with the nasal region being the most frequently affected location (62.1%). Pterygium was the most prevalent diagnosis (31.8%), followed by racial melanosis (15.2%) and melanocytic nevus (12.1%). No statistically significant differences were observed according to sex or lesion laterality. However, a significant association was identified between lesion type and anatomical location. Conclusions: Conjunctival and eyelid lesions in this population were predominantly benign and associated with demographic and environmental factors. These findings highlight the importance of structured screening strategies and early diagnosis to improve clinical outcomes and support public health policies aimed at reducing the burden of ocular disease within the SUS.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020015

Authors: Justin S. Yun Ken Kitayama Deyu Pan Fei Yu Victoria L. Tseng

Background: Population-level predictors of intraocular pressure (IOP)-lowering surgery for neovascular glaucoma (NVG) are understudied. This study examines factors associated with IOP-lowering surgery in California (CA) Medicare beneficiaries with NVG. Methods: The study population included all 2019 CA Medicare beneficiaries with NVG. Covariates included age, sex, race/ethnicity, history of treatments for retinal ischemia, dual Medicare/Medicaid eligibility, Social Vulnerability Index score, and Charlson Comorbidity Index (CCI) score. Outcomes included incidence of trabeculectomy, tube shunt, minimally invasive glaucoma surgery, cyclophotocoagulation (CPC), or any IOP-lowering surgery. Results: Of 1843 beneficiaries, 264 (14.3%) had IOP-lowering surgeries. In multivariable logistic regression including all covariates, CCI ≥ 5 versus 0 was associated with lower odds of any IOP-lowering surgery and of each type of surgery except CPC (adjusted odds ratio [aOR] = 0.47, 95% confidence interval [CI] = 0.29, 0.75 for any versus no surgery; aOR = 1.35, CI = 0.51, 3.60 for CPC). Compared to Non-Hispanic White, racial and ethnic minorities had increased odds of trabeculectomy (aOR = 3.77, CI = 1.05, 13.57 for Black; aOR = 2.69, CI = 1.04, 6.92 for Hispanic) and tube shunt (aOR = 2.62, CI = 1.27, 5.41 for Other/Unknown). Beneficiaries 75–79 versus 65–69 years old had decreased odds of trabeculectomy (aOR = 0.21, CI = 0.05, 0.98). Conclusions: Among CA Medicare beneficiaries, higher systemic disease burden was associated with a decreased likelihood of surgery for NVG, while racial and ethnic minorities were more likely to undergo certain procedures. These findings suggest surgical risk stratification and treatment pattern disparities for individuals with NVG.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020014

Authors: Shuan Dai Irina Effendi-Tenang

Purpose: We sought to evaluate the surgical outcomes of unilateral lateral rectus (LR) resection among patients with age-related distance esotropia (ARDE). Methods: We conducted a retrospective review of 39 patients who underwent unilateral LR resection for ARDE between January 2019 and November 2024 performed by a single surgeon at a tertiary eye centre in Brisbane, Queensland. The inclusion criteria included symptomatic horizontal diplopia at distance, comitant esotropia that was at least 25% greater at a distance than nearby, and absence of an abduction deficit or neurologic abnormality. In all but one procedure, an adjustable-suture technique was used. The amount of LR resection was based on a 1 mm per 4 prism dioptre (PD) personal surgical table. Pre- and postoperative measurements of deviation close up at near (33 cm) and at a distance (6 m) were obtained using prism and alternate cover testing. Results: The mean (±SD) patient age was 68.1 ± 9.7 years (range: 44–91). The mean preoperative esotropia measured 14.3 ± 2.7 PD at a distance and 4.7 ± 3.3 PD nearby. The mean LR resection was 3.8 ± 0.7 mm (range: 3.0–6.0 mm), with a mean follow-up of 18 months (range: 9–26). Diplopia was resolved in 97% (38/39) of the patients. At the final follow-up, 85% (33/39) were orthophoric at a distance, and all were orthophoric nearby. Five patients (13%) required postoperative adjustment, four of whom achieved orthophoria. Three patients had minimal residual esotropia (<5 PD). Conclusions: Unilateral LR resection with adjustable sutures provides a safe, effective, and targeted surgical option for ARDE, achieving high rates of distance orthophoria and diplopia resolution without compromising near alignment. Prospective long-term studies are warranted to confirm durability and refine surgical dosing.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020013

Authors: Vinoth Navaratnam Jurgen Baumann Maneli Mozaffarieh

Recreational (“party”) drug use is prevalent in social environments and is increasingly relevant in ophthalmic care. While the neurological and cardiovascular consequences of these subokstances are well documented, their ocular and visual effects may not be fully recognized or consistently reported in clinical practice. This invited narrative review summarizes clinical observations and translational mechanisms underlying ophthalmic manifestations associated with commonly used recreational substances, including sympathomimetic stimulants (cocaine, amphetamines), empathogens (3,4-methylenedioxymethamphetamine (MDMA), inhalants (alkyl nitrites, “poppers”), and cannabinoids (cannabis/Δ9-tetrahydrocannabinol (THC)). Particular focus is placed on vascular dysregulation, altered ocular perfusion pressure, venous outflow impairment, oxidative stress, and neuro-ophthalmic dysfunction. Characteristic presentations, diagnostic pitfalls, and management considerations are discussed. Improved awareness of drug-related ocular effects may facilitate earlier recognition of such conditions and help reduce the risk of visual complications. Other recreational substances, including hallucinogens and emerging psychoactive compounds, may also have ocular effects, although current evidence remains limited.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020012

Authors: Vita Louisa Sophie Dingerkus Kathleeya Nan Stang-Veldhouse Brian Sloan Keith Raymond Pine

Early eye loss, congenital microphthalmia, and anophthalmia can significantly disrupt facial and psychological development in children. Timely intervention with conformers and ocular prostheses is essential for stimulating orbital growth and supporting healthy psychosocial development. This review presents evidence-based guidelines for ocularists, physicians, and allied professionals on fitting conformers and prostheses in young children, emphasizing the need for individualized treatment based on anatomical severity and age. Recommendations include initial conformer fitting within the first month of life for congenital cases or 4–6 weeks post-surgery in acquired cases, with frequent early replacements. For microphthalmia, moderate-to-severe cases require treatment similar to congenital anophthalmia cases; mild-to-moderate cases treatment within months; and mild cases are usually managed individually without urgency. A cosmetic prosthesis is advised the latest after the first year, as growth slows and self-awareness develops. Regular follow-up and adjustments support functional and psychosocial outcomes. We advocate for standardized care protocols to ensure equitable access and consistent long-term results across healthcare systems.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020011

Authors: Ahmet Turer Tugce Ilayda Turer Levent Akduman

Background: A novel titanium scleral buckle implant (TSBI) was developed for the treatment of posterior pole retinal detachments, analytically modeled and structurally tested as part of preclinical approval studies. The strength and stiffness requirements to apply pressure for retinal reattachment also suggested potential benefits for correcting high myopia greater than 8 diopters. Methods: Laboratory load testing and analytical calculations were complemented by nonlinear finite element modeling (FEM), applied for the first time to capture the interaction between the highly deformed myopic eye and the TSBI. Simulations were used to visualize posterior pole indentation and force distribution across anatomical regions. Seven TSBI units were tested in the transverse direction and six in the longitudinal direction. Results: The simulations confirmed that stable indentation is maintained even in areas distant from the sutures. The TSBI’s minimum midspan bending capacity was 40 N at yield and 60 N at ultimate. These values, together with FEM predictions, demonstrated a very large safety margin and showed that the implant deforms insignificantly under high intraocular pressure changes. Conclusions: The TSBI withstands ocular forces, cushions the sclera safely, and retains its geometry, a behavior that may differ from softer buckle materials, which can exhibit time-dependent deformation under sustained loading. Early controlled clinical applications outside the USA, followed for over three years, further validate its safety and potential effectiveness.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020010

Authors: Alba Chiara Termite Gabriele Bruno Silvana Guerriero Pasquale Viggiano Giacomo Boscia Paola Carluccio Giovanni Alessio Francesco Boscia

Background: Graft-versus-host disease is the most common complication after allogeneic hematopoietic stem cell transplantation. While ocular graft-versus-host disease typically manifests as dry eye syndrome and anterior segment involvement, posterior segment complications are rare. Previously reported posterior segment complications in graft-versus-host disease have been limited to acute presentations with significant functional visual impairment. Methods: A 41-year-old man developed progressive retinal nerve fiber layer and ganglion cell layer loss four years after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. The patient had established chronic graft-versus-host disease with cutaneous involvement and ocular surface disease. Results: Despite preserved visual acuity and visual fields, and only subtle functional involvement on visual evoked potentials, optical coherence tomography revealed significant reduction in retinal nerve fiber layer thickness and ganglion cell layer. Magnetic resonance imaging showed no optic nerve or brain abnormalities. Conclusions: This case describes an uncommon presentation of chronic, subclinical posterior segment involvement in chronic GVHD and suggests that optical coherence tomography may detect progressive structural retinal changes in the absence of clinically evident visual impairment, supporting its potential role in longitudinal monitoring.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4020009

Authors: Ahmad Khatib Haneen Jabaly-Habib Shmuel Raz Ilan Shimshoni

Background: Accurate evaluation of the Near Point of Convergence (NPC) is essential for diagnosing and managing convergence insufficiency (CI). Conventional assessment relies on the patient’s verbal feedback and the examiner’s visual observation, making it subjective and examiner-dependent. The AI-based MobileS platform, previously validated for both diagnosis and home-based therapy of CI, enables smartphone-based measurement and visualisation of NPC through eye tracking, without the need for verbal responses or additional equipment. This study, the third stage of our research programme, examined how ophthalmologists interpret NPC data when presented as videos versus AI-derived graphs. Methods: Twenty-two ophthalmologists completed an online questionnaire with 20 NPC test cases from the validated MobileS database, presented as both silent videos and AI-derived graphs. Accuracy was analysed using mixed-effects logistic regression, and continuous error was assessed using clustered bootstrap. Results: Graph-based interpretation showed higher odds of accurate NPC identification than video-based interpretation at the primary ±5 mm threshold (OR = 19.7, 95% CI: 13.50–28.74; p < 0.0001). Absolute error was lower for graphs than videos (Graphs − Videos: −22.73 mm; 95% CI: −26.88 to −18.59; p < 0.0001). “Uncertain” responses occurred in 28.2% of video-based assessments and 0% of graph-based assessments. Off-target errors decreased from 50.2% (videos) to 3.6% (graphs). Conclusions: AI-derived graphs of eye-movement data were associated with improved NPC estimation, suggesting a potential role in supporting clinical and tele-ophthalmology workflows.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010008

Authors: Margarita Labkovich Andrew J. Warburton Christopher P. Cheng Oluwafeyikemi O. Okome Vicente Navarro Randal A. Serafini Aly A. Valliani Harsha Reddy James Chelnis

Background: Given global population growth and aging, it is imperative to prioritize early eye disease detection and treatment. However, as patient volume increases, providers are facing a shortage of workforce capacity, particularly in areas where eye doctors are already scarce, making it important to consider alternative innovative solutions that could help increase eye screening capabilities. This study compared virtual reality (VR) platform of vision screening exams that are used to evaluate ocular health, such as 24-2 perimetry, Ishihara tiles, and the Amsler grid, against their in-clinic counterparts. Methods: A total of 86 subjects were recruited from Mount Sinai’s ophthalmology clinic (New York, USA) for a comparison trial that was internally controlled across healthy eyes and those with glaucoma and retinal diseases. VR and in-office tests were administered to the patients during their clinical visit, including 24-2 perimetry, Ishihara tiles, and the Amsler grid in a randomized order, and the results were compared for each test. Results: Perimetry results from Humphrey Visual Field Analyzer (HVFA) and VR suprathreshold testing demonstrated a good sensitivity both overall (80% OD, 84% OS) and across control (86% OD, 89% OS), glaucoma (69% OD, 78% OS), and retinal disease (76% OD, 80% OS) groups. A Garway-Heath anatomical map showed an overall 70–80% agreement. Ishihara plate tests did not show a significant difference between the two testing modalities (p = 0.12; Mann–Whitney U test), which remained true across all groups. Amsler grid testing differences were also non-significant within each subgroup (p = 0.81; Mann–Whitney U test). Patient time required to complete VR exams was significantly improved (p < 0.0001; Welch’s t-test) compared to the clinical standard tests. Conclusions: All VR-based exams tested in this study showed high sensitivity and percent agreement when compared to their in-office standards. Given the results of this study, VR has a promising potential in visual function screening, which, in addition to its portable design and easy use, could assist eye doctors in screening for prevalent diseases such as glaucoma and retinal conditions. Translational Relevance: VR-based vision exams that test vision fields, color vision and visual distortions provide comparable results in healthy patients, as well as those with glaucoma and retinal diseases, indicating its potential as a screening technology for different ocular pathologies. Given VR’s portable and low-profile features, it is important to consider leveraging VR to augment delivery of vision care.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010007

Authors: Angela A. Cao Anders D. Westanmo Amy A. Gravely Karen R. Armbrust

Background: Higher intake of omega-3 fatty acids from food sources is associated with a reduced risk of age-related macular degeneration (AMD), but there are no recommended parameters for omega-3 fatty acid supplementation. The purpose of our study was to investigate whether fish oil supplementation protects against development of AMD in the US Veteran Affairs (VA) Corporate Data Warehouse. Methods: Patients ≥ 55 years without an AMD diagnosis at the initial eye examination who also had a 5-year follow up eye examination were included in this retrospective cohort study. Patients receiving fish oil supplementation from the VA pharmacy were categorized into the fish oil exposure group and matched 1:1 to a non-exposure control group. All patients were assessed for AMD development at the 5-year follow up eye examination. Results: AMD developed in 772 of 16,172 patients (4.8%) with fish oil exposure and 635 of 16,093 (3.9%) without fish oil exposure (relative risk (RR) = 1.21, 95% confidence interval (CI) = 1.09–1.34, p = 0.0003). Compared to controls, AMD risk was similar in low-dose (RR = 0.91; 95% CI = 0.65–1.27) and moderate-dose (RR = 0.93; 95% CI = 0.79–1.10) fish oil supplementation but higher in high-dose fish oil supplementation (RR = 1.32; 95% CI = 1.19–1.47). Conclusions: Fish oil supplementation did not protect against AMD in a US veteran population.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010006

Authors: Antonio Martínez-Abad Maria José García-Corral Pilar Yébana-Rubio Ana Siverio-Colomina Lucía Rial-Álvarez Pedro Amat-Peral Maria Luisa Ramón Jorge Alió-del-Barrio Mario Cantó-Cerdán

Background: The impact of cataract surgery on anterior segment structures in subjects affected by primary open-angle glaucoma (POAG) remains incompletely understood. The aim of this study was to characterize changes in anterior segment parameters after cataract surgery in POAG subjects compared with non-glaucoma subjects (control). Methods: A prospective comparative study was conducted, including patients scheduled for cataract surgery who underwent a comprehensive ophthalmic examination before and after surgery using anterior segment optical coherence tomography (OCT). Longitudinal changes and between-group comparisons were analyzed. Results: The results demonstrated a significant enlargement of the anterior chamber and iridocorneal angles after surgery in both groups (p < 0.05), with no significant differences between POAG and control eyes (p > 0.05). Several preoperative parameters, particularly angle-related metrics, were correlated with postoperative anatomical changes, suggesting their potential role as predictors of anterior segment variation (R > 0.50; p < 0.05). Conclusions: In conclusion, this study provides a detailed characterization of anterior segment changes in POAG subjects following cataract surgery, demonstrating anterior chamber enlargement comparable to that observed in non-glaucoma eyes, which may assist clinicians in the management of glaucoma.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010005

Authors: Paras P. Shah Jamie M. Nord Sarangdev Vaidya Daniel Zhu Jules A. Winokur Isha Cheela

Purpose: This study evaluates the association between supervising attending surgeons’ post-residency experience and complication rates during resident-performed phacoemulsification (cataract extraction) surgeries, and to determine whether this relationship changes as the academic year progresses. Methods: A retrospective analysis of 1263 cataract surgeries performed by eight PGY-4 residents under 14 board-certified attendings was conducted at a New York City residency program over two years. Attendings were divided into four groups based on years of post-residency experience. Primary complications included posterior capsule (PC) tears, anterior vitrectomy (AV), capsulorrhexis extensions (CE), and inability to place a one-piece intraocular lens (IOL). Chi-square analyses compared complication rates between attending groups overall, and between the first and second halves of the academic year. Results: A total of 167 primary complications (13.2%) were identified. Attendings with the fewest years of experience (Group 1) supervised significantly more cases with PC tears (χ2 = 8.173, p = 0.004), AV usage (χ2 = 7.748, p = 0.005), and inability to place a one-piece IOL (χ2 = 4.753, p = 0.029), particularly during the first half of the academic year. Notably, supervising attending experience was not correlated with resident complications in the second half of the academic year. Conclusions: Early in the academic year, less experienced attendings supervised cases with higher complication rates, underscoring the critical role of strategic case assignment and targeted mentorship during early surgical training. These findings suggest that aligning resident progression with appropriate supervision can enhance outcomes and support skill development, optimizing both education and patient safety.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010004

Authors: Adam Jacobson Elizabeth M. Bolton Brenda L. Bohnsack

Objective: Assess visual acuity (VA) and strabismus changes in children after Baerveldt 350 (BV350) device placement. Methods and Analysis: Retrospective cohort study of children (<21 years of age) who had superotemporal BV350 placement (2011–2023) and >6-month follow-up. Ocular diagnoses, surgical details, and preoperative and final follow-up exam findings were collected. In bilateral cases, first eye implanted was included in analysis. Results: Ninety-seven patients underwent BV350 surgery with median age of 6.7 (interquartile (IQR) 3.1, 11.2) years and with a median of 4.2 (IQR 1.8, 6.8) years of follow-up. Most common glaucomas were secondary to non-acquired ocular anomaly (n = 31) or primary congenital glaucoma (n = 21). There was no difference in preoperative and final VA (p = 0.6583). Twenty-seven (28%) and twenty-five (26%) patients were orthophoric preoperatively and at final follow-up, respectively. Orthophoria at final follow-up was associated with preoperative (odds ratio (OR)1.8 [1.2, 2.9]) and final VA (OR1.5 [1.1, 2.3]). At final follow-up, 13 patients (13%) and 19 patients (20%) showed worsened or improved horizontal deviation (>10 prism diopter (PD) change), respectively. No patients reported postoperative diplopia. Only four patients, all with esotropia, underwent subsequent strabismus surgery. Conclusions: Children who underwent BV350 placement did not have significant change in VA, and a high percentage of patients had strabismus prior to (72%) and following (74%) glaucoma surgery. Orthophoria was associated with better VA. The majority of patients did not show worsening of strabismus postoperatively, and none reported diplopia.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010003

Authors: Yasmine Lahrichi Jean-Marie Rakic Anne-Catherine Chapelle

Background: We report an uncommon presentation of Lyme disease and highlight the importance of a detailed history in a patient with new-onset sixth nerve palsy. Methods: Case report and literature review. Results: A 46-year-old man receiving infliximab presented to the ophthalmology emergency department with horizontal binocular diplopia. History revealed a diffuse headache that had begun three weeks earlier. Ophthalmologic examination demonstrated a left sixth cranial nerve palsy. The workup showed positive Borrelia serum IgG, which was interpreted as a likely false-positive result given the limited specificity of serologic testing. At follow-up, the patient reported left-sided peripheral facial palsy, and worsening headache and diplopia. Further history revealed prior erythema migrans treated with doxycycline four months earlier. Considering these new findings, a lumbar puncture was performed and demonstrated intrathecal production of Borrelia antibodies. Neuroborreliosis, a neurologic involvement secondary to systemic infection by the spirochete Borrelia burgdorferi, was diagnosed. The patient was treated with oral doxycycline for 28 days with complete resolution of symptoms. Conclusions: Lyme disease may present with progressive neuro-ophthalmologic symptoms, underscoring the crucial role of ophthalmologists in its diagnosis. Moreover, immunosuppression may delay diagnosis and allow neurological progression, highlighting the need for careful history taking and close follow-up.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010002

Authors: Emile R. Vieta-Ferrer Adrian Au Jeeyun Ahn Michael B. Gorin

Background: The recently defined pachychoroid disease spectrum (PDS), which includes central serous chorioretinopathy (CSCR), is a group of retinal disorders that share the common characteristic of a thick, dilated, hyperpermeable choroid. This study aimed to evaluate the efficacy of difluprednate and loratadine in the treatment of pachychoroid disease spectrum (PDS). Methods: A retrospective study of 27 eyes from 19 patients with macular edema secondary to chronic PDS were treated with topical difluprednate and oral loratadine at a tertiary medical center. Visual acuity and optical coherence tomography (OCT) images were analyzed at baseline, 1-, 2-, 3-, 6-, 12-month, and final follow-up. Baseline was defined as the initiation of topical difluprednate. Patients with neovascularization or who had other concurrent treatments for PDS were excluded. Subfoveal choroidal thickness was measured at each time point. Response was defined as eyes that showed a reduction in intra- or subretinal fluid. Results: All 27 eyes studied responded to treatment. Of these, 70.4% resolved by 4 months and 81.5% by 6 months, with 52.2% of these patients having recurrences related to cessation or tapering of topical steroids. Visual acuity remained stable (p > 0.05) while subfoveal choroidal thickness decreased compared to baseline (p < 0.001) across all time points. Eleven (40.7%) of the eyes developed increased intraocular pressure, for which seven (25.9%) required incisional surgery. Conclusions: Chronic PDS can be treated with a combination of topical difluprednate and oral antihistamines to reduce retinal edema and subfoveal choroidal thickness. The effectiveness of therapy could be linked to the regulation of mast cell degranulation, necessitating a well-powered prospective randomized clinical trial.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto4010001

Authors: Noreen Shaikh Magdalena Stec Huizi Yin Brenda L. Bohnsack

Objective: The purpose of this study is to investigate the effect of low-dose atropine and dual-focus MiSight contact lenses on myopia control. Methods: This study included a retrospective review of patients (5–13 years old) started on MiSight contacts or 0.05% atropine with a ≥1-year follow-up. Outcomes included cycloplegic refraction, axial length measurement, and side effects. The right eyes were included in analyses. Results: One hundred children were treated with MiSight lenses (n = 55) or 0.05% atropine (n = 45) at an average age of 10.4 ± 2.1 years and 8.4 ± 2.5 years, respectively. At the 1-year follow-up, there was no difference from baseline in spherical equivalent or axial length in the MiSight group (p = 0.61, p = 0.98) or in the atropine group (p = 0.78, p = 0.97). Further, subgroup analysis based on age at treatment initiation (<9.5 years vs. ≥9.5 years) showed no age difference in baseline or final spherical equivalent and axial length in either the MiSight group or the atropine group. Linear regression analysis demonstrated no association between initial age and baseline spherical equivalent, baseline axial length, or the change in spherical equivalent in either the MiSight or atropine group. Conclusions: There was no significant difference in spherical equivalent or axial length after 1 year of treatment with either the MiSight contact lenses or 0.05% atropine eye drops. However, the limited sample size, the difference in age and ethnicity, and baseline refraction prevent a direct comparison between the two treatment groups.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040027

Authors: Sunny Kahlon John Steven Jarstad

Background: Trabeculectomy and minimally invasive glaucoma surgery (MIGS) such as goniotomy aim to reduce intraocular pressure (IOP) and medication burden but are often performed in patients with differing disease severity. Methods: We retrospectively reviewed 100 eyes from 76 adults with glaucoma that underwent either goniotomy (n = 50; Kahook Dual Blade = 42, OMNI = 8) or trabeculectomy ab externo (n = 50) at a tertiary center between May 2022 and June 2023, with at least six months of follow-up. Baseline and six-month IOP, number of medications, and postoperative complications were recorded. Eyes undergoing trabeculectomy had higher preoperative IOP than those undergoing goniotomy (22.6 ± 7.7 vs. 19.1 ± 5.9 mmHg). Results: At six months, trabeculectomy achieved a greater absolute IOP reduction (8.8 ± 0.8 vs. 5.4 ± 0.8 mmHg; p = 0.004), likely reflecting higher baseline IOP, while goniotomy yielded a larger medication reduction (1.47 ± 0.30 vs. 0.72 ± 0.20; p = 0.041). Hyphema occurred more often after trabeculectomy, and the small number of OMNI cases precluded device comparison. Conclusions: In this short-term retrospective series, trabeculectomy achieved larger absolute IOP reduction whereas goniotomy offered greater medication reduction, highlighting the need to individualize surgical choice and confirm these findings in larger prospective studies.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040026

Authors: Jonathan Halim Eleonora Micheletti Maria-Laura Dari Nakul Mandal Sharmina R. Khan

Background: This study evaluates the incidence and outcomes of patients with dropped nucleus/nuclear fragment during phacoemulsification surgery; Methods: Retrospective review of continuous cases with dropped nucleus/nuclear fragment during phacoemulsification cataract surgery from January 2020 to December 2024. Demographic and perioperative data were collected and analysed. A good visual outcome was defined as a postoperative best-distance visual acuity of ≥6/12; Results: A total of 91,883 cases of planned phacoemulsification cataract surgery were identified, of which 175 (0.19%) were complicated by a dropped nucleus/lens fragment. Mean age was 71 years and median number of days from primary procedure to secondary fragmatome was 5 days. Good visual outcomes were achieved in 127 cases (73%). Median final intraocular pressure was 13 mmHg. Most patients required two (63%) or three (29%) operations in total and none developed endophthalmitis. Hypermature cataracts were present in 70 cases (40%) and were significantly associated with poor visual outcomes (p = 0.003). Surgeon grade and other pre-existing ocular co-pathologies known to increase posterior capsular rupture risk were not significantly associated with poor visual outcomes; Conclusions: Overall incidence and outcomes of cases complicated with dropped nucleus/fragment were favourable despite the presence of pre-existing risk factors. Emergent management is paramount to ensure good outcomes in patients.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040025

Authors: Caius Goh Jabez Ng Wei Yung Au Clarence See Alva Lim Jun Wen Zheng Xiuyi Fan Kelvin Li

Background/Purpose: Ophthalmic triage is challenging for non-specialists due to limited training and rising global eye disease burden. This study evaluates a multimodal framework integrating clinical text and ophthalmic imaging with large language models (LLMs). Textual consistency filtering and chain-of-thought (CoT) reasoning were incorporated to improve diagnostic accuracy. Methods: A dataset of 56 ophthalmology cases from a Singapore restructured hospital was pre-processed with acronym expansion, sentence reconstruction, and textual consistency filtering. To address dataset size limitations, 100 synthetic cases were generated via one-shot GPT-4 prompting, validated by semantic checks and ophthalmologist review. Three diagnostic approaches were tested: Text-Only, Image-Assisted, and Image with CoT. Diagnostic performance was quantified using a novel SNOMED-CT-based dissimilarity score, defined as the shortest path distance between predicted and reference diagnoses in the ontology, which was used to quantify semantic alignment. Results: The synthetic dataset included anterior segment (n = 40), posterior segment (n = 35), and extraocular (n = 25) cases. The text-only approach yielded a mean dissimilarity of 6.353 (95% CI: 4.668, 8.038). Incorporation of image assistance reduced this to 5.234 (95% CI: 3.930, 6.540), while CoT prompting provided further gains when imaging cues were ambiguous. Conclusions: The multimodal pipeline showed potential in improving diagnostic alignment in ophthalmology triage. Image inputs enhanced accuracy, and CoT reasoning reduced errors from ambiguous features, supporting its feasibility as a pilot framework for ophthalmology triage.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040024

Authors: Akanksha Malepati Edmund Arthur Maria B. Grant

Diabetes mellitus (DM) is a debilitating chronic disorder that results in ocular microvascular complications, including diabetic retinopathy (DR) and diabetic macular edema (DME). Early detection and timely intervention for DR and DME are crucial for improving visual outcomes in affected patients. Ophthalmic imaging plays a vital role in the screening, diagnosis, and management of DR and DME. In this review, a comprehensive overview of the imaging modalities frequently utilized in the assessment of DR and DME, encompassing both structural and functional imaging techniques are presented. The key imaging findings that are associated with the various stages of DR and DME are underscored and their diagnostic utility in assessing disease progression and visual function are evaluated. Additionally, we discuss emerging imaging biomarkers that are currently under investigation, which hold significant potential for improving the diagnostic and prognostic capabilities of imaging for DR and DME patients. Finally, the advent of new imaging methods, such as ultrawide-field imaging (UWFI) and deep learning models, which have markedly improved the detection of retinal pathologies are considered.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040023

Authors: Josmar Sabage Luís Expedito Sabage João Vitor Mota Lanzarin Leonardo Resende de Sousa Isabela Ussifati Negrine Carolina Poltronieri Chiaroni Ana Claudia Ferreira de Almeida Alessandra Mazzo Ênio Luís Damaso Luiz Fernando Manzoni Lourençone

Smartphone-based fundus cameras and telemedicine are an opportunity for accessing ocular health inequalities in under-resourced areas. The objective of this study is to evaluate the prevalence of retinal findings in a community in the Amazon and propose strategies to enhance ocular health. A retrospective study was conducted in a riverside community. Retinal photos from the posterior pole and optic disc were captured using a portable fundus camera. All photos and data were analyzed remotely by a retina specialist. The final sample was 107 participants, aged 52 ± 17. Retinal findings were detected in 37.4% (95%CI 28.7–46.8) of the sample; the three main retinal findings were epithelial changes (10.3%, 95%CI 5.6–17.1), chorioretinal scars (8.4%, 95%CI 4.2–14.8), and dry age-related macular degeneration (7.5%, 95%CI 3.6–13.6). This study detected retinal alterations in a similar prevalence to that of other under-resourced areas. Telemedicine is an opportunity to address health inequities, especially in ophthalmology, through relatively low-cost portable devices, supporting clinical decisions in areas with low health access; however, maintaining assistance after implementation is a challenge. Enhancing medical education and training local non-specialized health professionals in risk assessment, device handling, and data base use is reasonable to ensure follow-up.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040022

Authors: Wesley Burrow Armand Ceniza Brian Kan Skyler Colwell Jorge Cervantes

Background: Uveitis, although a rare complication of multiple sclerosis (MS), poses a significant challenge in clinical management. Traditional treatments like corticosteroids, immunosuppressants, and surgical interventions often provide limited efficacy. Treatment for MS-associated uveitis involves a combination of traditional and emerging therapies, with a growing emphasis on monoclonal antibodies (mAbs). While there is an increasing use of disease-modifying therapies for MS such as interferon-beta (IFN-β), mAbs are gaining attention for their potential to address both neurological and ophthalmological symptoms. Methods: We conducted a systematic review of the existing literature and analyzed the clinical effect of IFN-β and mAb therapies in the context of MS-associated uveitis, assessing their efficacy in reducing inflammation, maintaining visual acuity (VA), and minimizing steroid dependency. Results: MS-associated uveitis had improved or maintained VA in 95% (35/37) of eyes (21 patients) after an average of 34.7 months (range of 7.9 to 78.7 months) of IFN-β treatment. One hundred percent (10/10) of patients (19/19 eyes) had improved or maintained VA after a mean of 25 months (range 8 to 43 months) of mAb treatment. We also found that IFN-β effect on MS-associated uveitis is comparable to mAbs. Conclusions: We outline the need for further research through human data to strengthen current findings and guide evidence-based clinical practice.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040021

Authors: Enzo Maria Vingolo Simona Mascolo Mattia Calabro Filippo Miccichè Mirko Barresi

Optogenetics is a field that emerged with the goal of studying the physiology of nerve cells by selectively expressing opsins—channel proteins that can be activated by light exposure. Once the methodology was established, several research groups sought to express these proteins in damaged nerve tissue to restore proper signal transmission. Over the years, numerous efforts have been made to restore vision in patients with chronic degenerative diseases, particularly retinitis pigmentosa, with clinical trials yielding encouraging results. However, significant challenges remain, such as the difficulty of delivering the signal to specific retinal cells and the complexity of replicating the physiological activation of the target cells. As research continues, optogenetics remains a promising yet evolving field. This review aims to highlight the therapeutic advantages of optogenetics over currently available strategies and to promote further scientific exploration of this emerging discipline.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040020

Authors: Jeremy Appelbaum Abdullah Virk Deepkumar Patel Karen Allison

Background: Glaucoma is the leading cause of irreversible blindness around the world and is characterized as a group of irreversible optic neuropathies with multiple risk factors such as age, race/ethnicity, sex, and intraocular pressure (IOP), amongst many others that play a role in disease etiology. However, IOP is the only modifiable risk factor, with higher IOP often causing increased damage to the optic nerve, resulting in the vast majority of medical and surgical treatments aiming to reduce IOP. There are a number of interventions available to treat glaucoma including micro-invasive glaucoma surgery (MIGS), whose usage has drastically increased due to its safety and efficacy. Studies also highlight the IOP-reducing effect of cataract surgery, which is the most common procedure performed globally. However, other, more targeted therapies and surgeries have been shown to have a more significant effect on IOP reduction. The objective of this study is to compare the IOP and medication reduction between cataract surgery (CS), MIGS, and MIGS and cataract surgery (MACS) clinical trials. Methods: This analysis consisted of publicly available data on CS, MIGS, and MACS clinical trials from 2005 to 2017 using ClinicalTrials.gov. Data reporting and synthesis adhered to PRISMA guidelines. MIGS interventions studied in this analysis include iStent®, CyPass® Micro-Stent, Ex-PRESS®, Hydrus®, PRESERFLO™ MicroShunt, and XEN® Gel Stent. The main variables of interest are the mean IOP and mean number of glaucoma medications used. The primary outcomes were the baseline, post-procedure, and reduction in IOP and glaucoma medication use. Cohorts were further subdivided by the follow-up period (6, 12, and 24 months), as well as their medicated or unmedicated status for pre-op IOP measurement. PROSPERO CRD42025102892. Results: A total of 21 trials were included in this review, comprising 3330 clinical trial participants: 7 CS trials (N = 570), 13 MIGS trials (N = 1577), and 9 MACS trials (N = 1183). All interventions studied resulted in a decrease in both the IOP and medication usage with varying degrees. At 12 months, the wash-out baseline IOP reduction (mmHg) was 6.9 (27.5%) for CS, 8.8 (34.0%) for MIGS, and 8.2 (32.6%) for MACS. The medication reduction was 0.8 (56.1%) following CS, 1.0 (39.5%) for MIGS, and 1.3 (86.4%) for MACS. At 24 months, the wash-out baseline IOP reduction was 6.3 (25.1%) for CS, 8.4 (33.1%) for MIGS, and 7.6 (30.1%) for MACS. At 24 months, the medication reduction was 0.9 (58.3%) for CS, 1.5 (79.8%) for MIGS, and 1.3 (86.1%) for MACS. Conclusions: The results indicate that CS, MIGS, and MACS all result in a decrease in the IOP and glaucoma medications; however, MIGS and MACS outperform CS in IOP and medication reduction. Adopting MIGS and MACS for patients with ocular hypertension or mild-to-moderate glaucoma will help improve patient outcomes through reducing the IOP and medication burden. Given that glaucoma affects certain populations to a greater degree, future research analyzing racial representation is critical in ensuring the appropriate applicability of clinical trial results toward diverse populations.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3040019

Authors: Priya Agrawal Ami Patel Janet Alexander Ramya Swamy

The prevalence of vision impairment and eye disease is higher among patients with chronic kidney disease (CKD), yet there are no standardized guidelines for this vulnerable population. We hypothesized that there are self-reported unmet ophthalmic care needs among patients receiving hemodialysis. We also hypothesized that limited awareness of the connection between eye health and CKD is a significant barrier to receiving eye care. Methods: From June 2022 to July 2022, patients on dialysis were recruited in-person at two Independent Dialysis Foundation sites in Baltimore, Maryland. Participants completed a survey assessing recent eye exam history, barriers to care, and health literacy. Results: Of 82 participants, 43 (52%) had not received a complete eye exam within the past year. The most common reasons were scheduling conflicts (15 [35%]), not wanting an eye exam (12 [28%]), and costs (6 [14%]). Less than half of respondents (40, 41%) were unaware of a relationship between kidney disease and eye health. Conclusions: Results suggest potential unmet eye care needs and low awareness of CKD-related ocular risks among dialysis patients. Interventions to enhance provider recommendations, improve health literacy, and reduce logistical barriers may help prevent avoidable vision loss in this high-risk population.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030018

Authors: Camille Bosc Sandra Delaunay Anne Barrucand Irene Martínez-Alberquilla

Background: Intraocular lens (IOL) alignment is crucial for optimal performance in presbyopia-correcting designs. The aim was to report a case of a patient with a high angle kappa implanted with the continuous transitional focus (CTF) Precizon Prebyopic NVA IOL. Case presentation: A 51-year-old patient presenting large angle kappa values (0.6/0.8 mm) was implanted with the Precizon Prebyopic NVA IOL and followed-up 1 and 10 months post-surgery. This IOL is designed with a butterfly-shaped central area that allows the orientation of the lens so that the visual axis passes through the wider diameter of the optic zone. Postoperative refraction was −0.25D of cyl at 80° for the right eye and +0.25D −0.50D cyl at 170°. Corrected distance visual acuity (CDVA) at the last visit was −0.1 logMAR monocularly and −0.2 logMAR binocularly. Binocular uncorrected distance (UDVA), intermediate (UIVA) and near visual acuities (UNVA) were −0.1, 0.1 and 0.1 logMAR, respectively. The corrected binocular defocus curve exhibited outstanding vision at the 0.00D defocus level and showed a continuous range of functional vision from distance to near. Overall excellent satisfaction was reported, along with low levels of photopic phenomena. Conclusions: Precizon Presbyopic NVA IOL provided satisfactory vision and low levels of photic phenomena in a high angle kappa patient who would potentially be excluded from presbyopia-correcting IOL implantation.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030017

Authors: Praneetha Thulasi Shae Chambers Soroosh Behshad

This study reports an unusual case of dramatic change in visual acuity, pachymetry, and corneal topography in a patient with a history of Fuchs dystrophy and radial keratotomy following the use of Rho-kinase (ROCK) inhibitor. A patient with a history of 8-cut radial keratotomy (RK), astigmatic keratotomy (AK), and Fuchs dystrophy showed dramatic changes in visual acuity, pachymetry, and corneal topography after using one drop of netarsudil 0.02%. The dramatic effect of netarsudil in our patient may be due to increased penetration of a rho-kinase inhibitor from the corneal incisions, facilitating the effect on corneal endothelium, resulting in a dramatic improvement in corneal pachymetry. This suggests a potential role for corneal incisions to improve the effectiveness of rho-kinase inhibitors in patients with Fuchs dystrophy.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030016

Authors: Amirmohammad Shafiee Taylor Juran Iza Zabaneh Deepkumar Patel Karen Allison

Background/Objective: Age-related macular degeneration (AMD) is a leading cause of irreversible vision loss. Intravitreal anti-vascular endothelial growth factor (VEGF) therapy is the primary treatment for neovascular AMD. This study aimed to assess racial, ethnic, and gender representation in U.S.-based randomized controlled trials (RCTs) of anti-VEGF therapies. Methods: A systematic PubMed search identified 19 eligible RCTs. Titles and abstracts were screened, and demographic data were independently extracted and cross-verified. Chi-squared analysis was used to evaluate disparities in participant representation. Risk of bias was assessed using the ROBIS checklist. Results: Among 8003 participants across 19 trials, 92.3% were Caucasian. Asian, African American, Hispanic/Latino, and American Indian participants collectively comprised just over 5%. This underrepresentation of non-Caucasian groups was statistically significant (p < 0.01, df = 4) and not associated with study sponsorship. Gender analysis showed 59% female and 41% male participation, which was not statistically significant (p = 0.83, df = 1). Conclusions: Non-Caucasian populations remain significantly underrepresented in anti-VEGF RCTs for AMD. This raises concerns about the generalizability of trial findings to diverse populations. Future clinical trials must prioritize inclusive recruitment to ensure equitable, evidence-based care for all patients.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030015

Authors: Chin Sheng Teoh

Refractory full-thickness macular holes (rFTMHs) present a significant challenge in vitreoretinal surgery, with reported incidence rates of 4.2–11.2% following standard vitrectomy with internal limiting membrane (ILM) peeling and gas tamponade. Risk factors include large hole size (>400 µm), chronicity (>6 months), high myopia, incomplete ILM peeling, and post-operative noncompliance. Multiple surgical techniques exist, though comparative evidence remains limited. Current options include the inverted ILM flap technique, autologous ILM transplantation (free flap or plug), lens capsular flap transplantation (autologous or allogenic), preserved human amniotic membrane transplantation, macular subretinal fluid injection, macular fibrin plug with autologous platelet concentrates, and autologous retinal transplantation. Closure rates range from 57.1% to 100%, with selection depending on hole size, residual ILM, patient posturing ability, etc. For non-posturing patients, fibrin plugs are preferred. Residual ILM cases may benefit from extended peeling or flap techniques, while large holes often require scaffold-based (lens capsule, amniotic membrane) or fibrin plug approaches. Pseudophakic patients should avoid posterior capsular flaps due to lower success rates. Despite promising outcomes, the lack of randomized trials necessitates further research to establish evidence-based guidelines. Personalized surgical planning, considering anatomical and functional goals, remains crucial in optimizing visual recovery in rFTMHs.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030014

Authors: Antoine Barloy Florent Boulanger Benjamin Jany Thi Ha Chau Tran

Background: In clinical practice, visual outcomes with anti-VEGF therapy may be worse than those observed in clinical trials. In this study, we aim to investigate the long-term outcomes of neovascularization treated with intravitreal aflibercept injections (IAI) in a teaching hospital setting. Methods: This is a retrospective, single-center study including 81 nAMD patients (116 eyes), those both newly diagnosed and switched from ranibizumab. All patients had a follow-up duration of at least seven years. Treatment involved three monthly injections followed by either a pro re nata (PRN) or treat and extend regimen. Follow-up care was primarily conducted by training physicians. The primary endpoint was the change in best-corrected visual acuity (BCVA) over seven years. Secondary endpoints included central retinal thickness changes, qualitative OCT parameters, macular atrophy progression, injection frequency, and treatment adherence. Results: Among the 116 eyes, 52 (44.8%) completed the seven-year follow-up. Visual acuity improved by +2.1 letters in the overall population (+6.3 letters in treatment-naive eyes) after the loading phase but gradually declined, resulting in a loss of −12.3 letters at seven years. BCVA remained stable (a loss of fewer than 15 letters) in 57.7% of eyes. Central retinal thickness (CRT) decreased significantly during follow-up in both naive and switcher eyes. Macular atrophy occurred in 94.2% of eyes, progressing from 1.42 mm2 to 8.55 mm2 over seven years (p < 0.001). The mean number of injections was 4.1 ± 1.8 during the first year and 3.7 per year thereafter. Advanced age at diagnosis was a risk factor for loss to follow-up, with bilaterality being a protective factor against loss to follow-up (p < 0.05). Conclusions: This study highlights the challenges faced by a retina clinic in a teaching hospital. Suboptimal functional and anatomical outcomes in real life may derive from insufficient patient information and inconsistent monitoring, which contributes to undertreatment and affects long-term visual outcomes. It also raises concerns about supervision in a teaching hospital which needs to be improved.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030013

Authors: Ana Maria Varošanec Leon Marković Zdenko Sonicki

Purpose: This retrospective study aimed to compare the efficacy of cycloplegic (CR) versus non-cycloplegic refraction (NCR) methods in detecting refractive errors among children and adolescents. Methods: Electronic data from pediatric ophthalmology clinics at the University Hospital “Sveti Duh”; Zagreb, Croatia, from January 2008 to July 2023, were analyzed. Comprehensive eye examinations, including Logarithmic Visual Acuity tests, subjective refraction, cycloplegic retinoscopy, slit lamp, and fundus examinations, were conducted. Results: The dataset included 1075 individuals, with 180 undergoing NCR and 895 undergoing CR. In premyopes, the NCR group had a longer follow-up (5.04 vs. 3.45 years; p < 0.001) with similar SE progression. In low myopia, NCR showed more negative first visit SE (−1.86 D vs. −1.35 D; p < 0.001) and faster progression (p = 0.01). In high myopia, follow-up was longer in NCR (5.08 vs. 2.08 years; p = 0.03) with no other significant differences. SE progression was highest in 4–6-year-olds and significantly faster in NCR (−0.61 vs. −0.40 D/year; p = 0.05). Conclusions: Cycloplegic refraction is essential for accurately assessing refractive status, especially in cases of low myopia, as it prevents misclassification and ensures precise evaluation in children and adolescents, thereby facilitating the appropriate diagnosis and treatment of refractive errors.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030012

Authors: Srujana Sahebjada Adam A. Moktar Sara Vogrin Elsie Chan Paul N. Baird Mark Daniell

Background: Rundle’s curve describes the natural progression of disease as gradually worsening before reaching a peak and stabilizing. This study aimed to investigate whether Rundle’s curve could be applied to keratoconus over a five-year follow-up period. Methods: Longitudinal study. Patients with keratoconus who underwent Pentacam tomography imaging from the Australian Study of Keratoconus were included in this study. Patients who received surgical treatment for keratoconus were excluded. Latent class analysis was performed for five parameters: Kmean front, Kmean back, pachymetry pupil, pachymetry minimum and pachymetry apex. A total of 522 patients and 1041 eyes were included for analysis. Most parameters were stable. However, worsening keratoconus in a minority of patients (less than 5% of the population) was observed across the last year of follow-up. The patients that showed progression in the final year were younger in age and had higher baseline parameters. Results: This study suggests keratoconus does not conform to the classic Rundle’s curve of disease progression. Instead, keratoconus exhibits a distinct course characterized by an increased risk of progression among younger individuals and eyes with higher baseline parameter values. Conclusions: These findings underscore the importance of considering treatments that halt disease progression, such as corneal collagen crosslinking, particularly in this specific subgroup of patients.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3030011

Authors: Rebhi Abuzaitoun Kari Branham Dana Schlegel K. Thiran Jayasundera Abigail T. Fahim

Background: The prevalence of foveal hypoplasia in different inherited retinal diseases (IRDs) has not been compared in a large patient cohort. We aimed to investigate the prevalence and visual significance of foveal hypoplasia in IRDs. Methods: Participants included patients with IRDs and control subjects. All patients had macular optical coherence tomography (OCT). Results: Among our 357 patients, 123 had rod-cone dystrophy (34.5%), 22 had cone/cone-rod dystrophy (6.2%), 30 had macular dystrophy (8.4%), and 182 (51%) were controls. Having a phenotype of rod-cone (OR = 12.9, p < 0.001) or cone/cone-rod dystrophy (OR = 10.2, p < 0.001) was associated with higher odds of having foveal hypoplasia. Males had higher odds of having foveal hypoplasia (OR = 2.4, p = 0.006). The prevalence of foveal hypoplasia in the retinitis pigmentosa GTPase regulator (RPGR) group (8/15 (53.3%)) was significantly higher than in matched controls (0/15, 0.0%) (p = 0.002). Atypical foveal hypoplasia had the highest LogMAR of 0.50 (±0.37), which was higher than grade one 0.16 (±0.17) (p = 0.038). Grade one LogMAR was not different from normal fovea 0.20 (±0.28) (p = 0.572). Conclusions: We report that rod-cone and cone/cone-rod IRDs are associated with foveal hypoplasia. Based on our findings, detection of foveal hypoplasia in a patient with reduced vision should prompt consideration of an IRD.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3020010

Authors: Filomena Palmieri Lorenzo Fabozzi Christopher Leak Vincenzo Maurino

This case report describes a unique ocular finding in a 64-year-old male with a history of central serous chorioretinopathy with choroidal neovascular membrane, treated with intravitreal injections of Aflibercept. The patient was found to have an iatrogenic retro-lenticular non-pigmented cystic formation in the left eye, an anomaly not previously documented in the literature. Comprehensive imaging included ultrasound biomicroscopy and anterior segment optical coherence tomography. This report emphasises a rare ocular finding and the significance of recognising iatrogenic cataracts following intravitreal injections. It also highlights the necessity of individualised patient management and preoperative evaluations to prevent surgical complications.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3020009

Authors: Catherine Johnson Michael Jensen John A. Musser Neil Kelkar Kevin Eid Ryan T. Wallace Cole Swiston Ben J. Brintz Austin Nakatsuka Brian C. Stagg Craig J. Chaya

Background: In this study, we compare the 12-month results of eyes that underwent ab externo, open-conjunctival XEN45 gel stent placement with mitomycin C (MMC) with and without the intraoperative addition of Ologen collagen matrix (XEN45 and XEN45 + Ologen groups, respectively). Methods: Intraocular pressure (IOP) measurements were recorded postoperation at 1 month, 3 months, 6 months, and 9 months, and 12 months, and IOP reduction, reduction in number of IOP-lowering medications, and success rate were compared between XEN45 and XEN45 + Ologen groups. A complete success was defined as a ≥20% drop from baseline IOP at 12 months without the use of medications and without any of the following: an additional procedure (e.g., needling), a recorded IOP ≥ 21 mm Hg at two consecutive visits, or the occurrence of catastrophic events (e.g., no light perception (NLP)). A qualified success was defined as an IOP reduction of ≥20% from baseline with the use of medications. We included 145 eyes with at least 1 month of follow-up data, 46 in the XEN45 group and 99 in the XEN45 + Ologen group. Of these, 113 eyes had 12 months of follow-up data comprising 41 XEN45 eyes and 72 XEN45 + Ologen eyes. Results: There were no significant differences in the IOP change from baseline between XEN45 and XEN45 + Ologen groups except at the 3-month postop timepoint (p < 0.05). At the 12-month follow-up, 41.5% (17/41) of XEN45 eyes and 52.8% (38/72) of XEN45 + Ologen eyes met complete or qualified success criteria. Conclusions: No significant differences in success rate and decrease in the number of IOP-lowering medications from baseline were identified between XEN45 and XEN45 + Ologen groups.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3020008

Authors: Ahmad Khatib Shmuel Raz Haia Nasser Haneen Jabaly-Habib Ilan Shimshoni

Background: This study innovatively combines Artificial Intelligence (AI) algorithms with smartphone technology, automatically detecting the Near Point of Convergence (NPC) and diagnosing Convergence Insufficiency (CI) without the need for extra diagnostic tools and, notably, without having to rely on the subject’s vocal response, marking an unprecedented approach in the field to the best of our knowledge. Methods: This was a prospective study that enrolled 86 participants. The real-time tracking of eye structures and movements was conducted using AI technologies integrated with a mobile application (MobileS). Participants brought the smartphone closer, focusing on a target displayed on the screen. The system calculated pupillary distance (PD) and phone-to-face distance, incorporating a unique feature called the exodeviation episode’s counter (ExoCounter) to determine the NPC. Additionally, participants underwent testing using the RAF Ruler test (RulerT), considering the ground truth. Results: MobileS demonstrated significant correlation with the RulerT, as evidenced by a Pearson correlation coefficient of 0.74 (p < 0.001) and an Intraclass Correlation Coefficient (ICC) of 0.73 (p < 0.001), highlighting its reliability and consistency with conventional ophthalmic testing. Additionally, the system exhibited notable sensitivity and specificity in diagnosing CI. Notably, user feedback indicated a preference for the MobileS, with 71% of participants favouring it for its ease of use and comfort. Conclusions: MobileS is a precise, user-friendly tool for independent NPC measurement, applicable in tele-ophthalmology and home-based care. Its versatility extends beyond CI diagnosis, marking a significant advancement in ophthalmic diagnostics for accessible and efficient eye care.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3020007

Authors: Antonio Salvelli Alba Chiara Termite Pasquale Viggiano Silvana Guerriero Giacomo Boscia Mariapia Laterza Enrico Settimo Francesco Boscia

Objective: To report a case of ocular toxoplasmosis reactivation in a patient with neurosarcoidosis undergoing immunosuppressive therapy. Methods: Case report and literature review. Results: A 34-year-old male with neurosarcoidosis, treated with Infliximab and Mycophenolate Mofetil, presented with sudden visual decline in his left eye. Multimodal imaging revealed active chorioretinitis. Serological tests showed elevated Toxoplasma IgG levels with normal IgM levels. Treatment with oral corticosteroids and antibiotics led to significant improvements in vitreous turbidity and lesion inactivity at follow-up, despite unchanged visual acuity. Conclusions: This case highlights the risk of toxoplasmosis reactivation in immunosuppressed sarcoidosis patients. It emphasizes the importance of considering ocular toxoplasmosis even with normal IgM levels, and demonstrates the value of multimodal imaging in diagnosis and follow-up.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3020006

Authors: Mina Mina Ajay Kumar Goel Fady Mina Doris Goubran Nand Goel

Over 2.2 billion people across the globe face significant barriers to accessing essential ophthalmic care, with elderly, rural, and refugee populations being disproportionately affected, deepening existing disparities in eye care. Three-dimensional printing is a novel technology that has the potential to transform the field and improve access by alleviating many patient-specific barriers. This article delves into the evolution of 3D printing within ophthalmology, highlighting its current applications and future potential. It explores various 3D printing techniques and numerous biomaterials discussing their effectiveness in creating advanced solutions such as bioengineered corneas, ocular prosthetics, and innovative treatments for dry eye syndrome, from punctal plugs to lacrimal gland models. Additionally, 3D printing has revolutionized drug delivery systems for conditions like glaucoma, retinal diseases, and ocular brachytherapy. Whether through 3D printed contact lens-based drug delivery systems or polycaprolactone implants that biodegrade and provide sustained drug release without adverse effects, these systems hold immense potential in the field. Despite its promise, the integration of 3D printing into clinical practice presents challenges, which the article addresses alongside strategies for overcoming them. By mapping out the technological advancements and challenges, this review offers a roadmap for enhancing global eye care accessibility and improving patient outcomes on a global scale.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3010005

Authors: Joshua Ong Ritu Sampige Ryung Lee Hamza Memon Nicholas Panzo Cihan Mehmet Kadipasaoglu Yannie Guo Baltaj S. Sandhur Benjamin Soares Daniela Osteicoechea Ethan Waisberg Alex Suh Tuan Nguyen Mouayad Masalkhi Prithul Sarker Nasif Zaman Alireza Tavakkoli John Berdahl Patricia Chévez-Barrios Andrew G. Lee

In light of the potential effects of spaceflight on the anterior segment of the eye, there is a pressing need for anterior segment imaging to be available and accessible to monitor astronauts’ ocular health, including alterations to the cornea and lens. We aim to highlight the clinical basis and need for anterior segment imaging for astronauts. We explore the impacts of spaceflight-associated hazards, including microgravity and radiation, on astronauts’ risk of developing anterior segment pathology including risk of ocular trauma, infection, dry eye symptoms, cataracts, and possibly additional pathologies from increased radiation exposure. Such risks highlight the potential value that longitudinal assessment of anterior ocular structures would offer in future spaceflight missions. Specifically, anterior segment imaging would enable evaluations of corneal morphology, including longitudinal monitoring for microgravity-induced changes, and evaluation of interventions that aim to preserve anterior segment health during spaceflight. Lastly, non-invasive anterior segment imaging allows for unique insights into astronaut ocular health and can be performed routinely through modalities such as anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM). We discuss these modalities and their implications for astronaut health during future spaceflight.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3010004

Authors: Jie Zhang Jay J Meyer

Wound dehiscence is a rare complication after penetrating keratoplasty (PK) that may occur with or without prior trauma. Multiple factors may influence corneal wound healing, including patient factors, corneal wound characteristics, and other external factors. There is also the possibility that systemic medications could impact corneal wound healing. Possible factors that may predispose a cornea to experience wound dehiscence are discussed. We propose a hypothesis that oral angiotensin-inhibiting medications could play a role in reduced corneal wound healing. A literature review was conducted to investigate the effect of angiotensin inhibitors on corneal wound healing. Five patients on systemic oral angiotensin-inhibiting medications at the time of PK developed dehiscence of the graft–host wound junction following removal of sutures. The dehiscence required resuturing in all cases and resulted in an expulsive choroidal hemorrhage and complete loss of vision in one eye. Age, diabetes, lack of corneal neovascularization, early suture removal, underlying epithelial basement membrane dystrophy, corneal oedema, slower tapering of topical corticosteroid dosage, and glaucoma medication with preservatives were possible predisposing factors for some of these instances of wound dehiscence. However, oral angiotensin-inhibiting medications were taken by all patients in this series, and the literature suggests that ACE inhibitors and ARBs can reduce corneal fibrosis, resulting in inadequate healing. Oral angiotensin-inhibiting medications could have played an anti-fibrotic role in these corneae and predisposed them to wound dehiscence with minimal trauma. Despite limited evidence, these medications warrant further investigation as potential modulators of corneal wound healing.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3010003

Authors: Luigi Caretti Pietro Amistà Cristina Monterosso Martina Formisano

Orbital cavernous venous malformations (CVMs) are the most common primary lesions in the orbit, characterized by slow growth and benign nature. CVMs that become symptomatic require intervention. Surgical management is guided by the expertise of the operating surgeon. Common surgical techniques include anterior orbitotomy (transconjunctival and transcutaneous), lateral and transcranial orbitotomy, and endoscopic transnasal approaches. Liquid agent embolization aids in easier lesion resection with reduced blood loss and potential prevention of recurrence. Our case reports detail the advantages and disadvantages of this approach, showcasing collaboration between neuroradiologists and orbital surgeons.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3010002

Authors: Xiaole Li Michael Balas David J. Mathew

Glaucoma, the second leading cause of irreversible blindness globally, encompasses a heterogeneous group of ocular disorders characterized by the progressive degeneration of retinal ganglion cells. Pharmacotherapy remains the cornerstone of treatment, primarily aimed at reducing intraocular pressure (IOP) by decreasing aqueous humor production or enhancing its outflow. The therapeutic classes employed include carbonic anhydrase inhibitors, β-blockers, α-adrenergic agonists, prostaglandin analogs, parasympathomimetics, Rho kinase inhibitors, and hyperosmotic agents. Despite their efficacy, these medications are associated with a range of ocular and systemic side effects, influenced by their mechanisms of action, formulation, and dosage. Ocular adverse effects, such as irritation, dry eye, allergic reactions, and infections, are common, while systemic absorption may lead to more severe outcomes, including organ dysfunction, exacerbation of comorbid conditions, or life-threatening cardiovascular events. Given these potential risks, it is critical for clinicians to understand and monitor these adverse effects as they significantly affect patient adherence, quality of life, and treatment outcomes. Ongoing research is essential to develop novel therapeutic regimens, agents, or delivery methods that minimize side effects and improve compliance. Incorporating patient-reported outcomes in clinical practice may further enhance the assessment of treatment impact, facilitating more tailored and effective management of glaucoma.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto3010001

Authors: Mouayad Masalkhi Noura Wahoud Bridget Moran Ezzat Elhassadi

Background: Immunotherapy represents a revolutionary approach in cancer treatment, where it leverages the body’s immune system to target and destroy malignant cells. In ophthalmic oncology, immunotherapeutic agents offer potential for managing traditionally challenging ocular malignancies, such as melanoma and retinoblastoma. In this literature review, we aim to provide a comprehensive and up-to-date review of all current research and trends in this field. Methods: This literature reviews data from recent clinical trials, peer-reviewed articles, and meta-analyses focused on immunotherapeutic interventions for eye-related cancers. Emphasis is placed on the types of immunotherapies being tested, including checkpoint inhibitors, vaccine therapies, and adoptive cell transfer therapies. Results: Recent advancements indicate a growing and significant improvement in survival rates and tumor reduction with minimal adverse effects. Clinical trials focusing on melanoma show significant promise with targeted therapies, while early-stage investigations into retinoblastoma and conjunctival melanoma explore innovative approaches to harness the immune system without harming visual function. Conclusions: Immunotherapy in ophthalmic oncology is evolving rapidly and has demonstrated a remarkable potential as a primary treatment strategy. Although results from various clinical trials are promising, further research is needed to refine these therapies, minimize side effects, and improve overall patient outcomes. The future directions involve more comprehensive clinical trials that integrate immunotherapy with existing treatment modalities to establish more robust treatment protocols.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2040015

Authors: Agustin Peñaranda Oscar Torrado Ana Márquez António M. Baptista Pedro M. Serra

Background: Cycloplegic refraction is crucial in pediatric eye assessments. While spherical refraction changes due to cycloplegia are well-documented, astigmatic alterations remain unclear. This study assessed the agreement between spherical and astigmatic refraction pre- and post-cycloplegia. Methods: We enrolled 96 patients (mean age: 12.5 ± 2.4 years), including 35 myopes, 30 emmetropes, and 31 hyperopes. Pre- and post-cycloplegia autorefraction and keratometry (Myopia Master) were conducted using 1% cyclopentolate. Ocular residual astigmatism (ORA) was calculated as the difference between refractive and keratometric astigmatism. Astigmatism was analyzed using Fourier analysis (J0 and J45). Results: Cycloplegia resulted in a more positive spherical equivalent (SE) (+0.80 D), with myopes showing the smallest (+0.38 D) and hyperopes showing the highest variation (+1.47 D) in SE. With-the-rule (WTR) astigmatism predominated in the refractive and keratometric measurements, while ORA was against-the-rule (ATR). Cycloplegia shifted the refractive J0 (+0.06 D) towards more WTR and decreased ORA J0 (+0.05 D). No effect was observed in the J45 component. About 25% of patients exhibited astigmatism changes above 0.25 D, with refractive J0 variation being positively correlated with accommodation relaxation (0.044 D per D of relaxation). Conclusion: Cycloplegia induces clinically significant changes in the spherical component, but minimal variations in astigmatic components, predominantly in hyperopic eyes, likely reflecting alterations in crystalline lens anatomy.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2040014

Authors: Laura Denisa Stejar Ramona Barac Dana Preoteasa

Background: This study aims to evaluate the visual performance, both quantitative and qualitative, of the novel non-diffractive extended monofocal intraocular lens (Evolux, Sifi) following cataract surgery. This serves as a preliminary study to assess its feasibility and improve the research methodology. Methods: We conducted a single-arm, non-randomized, retrospective study at Onioptic Hospital, Craiova, Romania, involving patients who underwent cataract surgery from November 2022 to August 2023. The following visual parameters were evaluated 3 months postoperatively: monocular uncorrected (UDVA) and corrected (CDVA) distance visual acuity at 4 m; uncorrected (UIVA) and distance-corrected (DCIVA) intermediate visual acuity at 60 cm; uncorrected (UNVA) and distance-corrected (DCNVA) near visual acuity at 40cm; postoperative refraction expressed as spheric equivalent (SE) and Quality of Vision (QoV) questionnaire scores. The contrast sensitivity and defocus curve were evaluated 1 month postoperation in 22 patients who underwent surgery in both eyes. SPSS Statistics 26.0 was used for statistical analysis, employing percentages, standard deviations (SDs), and a 95% confidence interval (95% CI). Results: Among the 103 eyes from 81 patients (mean age of 68.7 ± 1.845), 64% achieved an UDVA of logMAR 0.1 or better, and 91.26% achieved a CDVA of logMAR 0.1 or better at 3 months. Additionally, 83.24% of the eyes exhibited a UIVA of logMAR 0.3 or better, and 60.19% attained an UNVA of logMAR 0.3 or better. The SE was within ±0.50 D in 77.76% of the eyes. The QoV mean scores were as follows: frequency = 30.20 ± 16; severity = 17.19 ± 12.45; bothersome = 15.45 ± 12.94. Conclusions: The Evolux IOL demonstrated very good biometric predictability and excellent distance visual performance and very good intermediate vision, with no photopic side effects or glare in our sample population. This study provides a strong foundation for a larger comparative study with an extended depth-of-focus (EDOF) IOL, incorporating contrast sensitivity and defocus curve assessments to enhance the research quality.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2040013

Authors: Raheel Anwar Gabriel Bellamy Plaice Andrew Geddes Hannah F Botfield Lisa J Hill Imran Masood

Glaucoma is the leading cause of irreversible blindness globally, with the commonest subtype being primary open angle glaucoma (POAG). POAG is characterised by an increase in intraocular pressure (IOP), optic nerve damage and irreversible visual field loss. People of African descent (AD) are significantly more susceptible to POAG when compared to people of European descent (ED), and the reasons for this are complex and multifaceted. The vast level of genetic diversity in AD populations has allowed, through genome-wide association studies (GWAS), for the identification of several single nucleotide polymorphisms (SNPs) as well as differences in mitochondrial haplogroups, which could explain the pathophysiology underlying the increased susceptibility of AD populations to POAG. The altered expression of genes such as MYOC as well as the expression of inflammatory mediators influencing reactive astrocytes have also been implicated. There are also several differences in morphology between AD and ED eyes which must be considered, including differences in central corneal thickness (CCT) and corneal hysteresis (CH) as well as variation in properties of optic discs. The link between all the aforementioned factors and the increased prevalence of POAG in AD populations will be explored in this review.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2040012

Authors: Christian Pompoco Chase Paulson Nora Fino Samuel Taylor Ayesha Patil Matt Conley James Barker Robert Ritch Gregory S. Hageman Karen Curtin Barbara Wirostko

Objective: To investigate any relationships between exfoliation syndrome or exfoliation glaucoma and age-related macular degeneration utilizing the Utah population database. Design: This was a retrospective, case–control cohort study. Subjects, Participants, and/or Controls: We identified 3405 patients diagnosed with exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) during a dilated eye exam within the UHealth system from 1996 to 2021, whose dry or wet age-related macular degeneration (AMD) status was assessed. A population-based control pool of 257,714 UHealth patients with no XFS/XFG diagnosis and a dilated eye exam history from 1996 to 2021 was compiled, with its patients randomly selected and individually matched 3:1 to cases based on sex and age at index diagnosis of their respective case. Methods: A covariate analysis was performed of characteristics and risk factors associated with XFS/XFG, which included race/ethnicity, residence location, partner/marital status, and family history of XFS/XFG, obesity, tobacco use, alcohol use, osteoporosis/vitamin D deficiency, primary/essential hypertension, ocular hypertension, and cataract surgery. Main Outcome Measure: We studied the trends of non-exudative (dry) or exudative (wet) AMD in a large Utah population study of XFS/XFG patients and controls. Results: Of 3396 XFS/XFG patients, as well as 10,179 individually matched 3:1 control patients, 64% were female and the average age of XFS onset was 74.3 yrs. In a univariate model, we observed a very modest increased risk of wet AMD in XFS/XFG patients (odds ratio, OR = 1.14, 95% confidence interval (CI) 0.99–1.32), which did not achieve statistical significance (p = 0.07). After adjusting for the main effects of potential confounders, there was no greater presentation of AMD in XFS/XFG patients when compared with controls (dry AMD: OR = 0.94, 95% CI 0.85–1.05, p = 031; wet AMD: OR = 0.98, 95% CI 0.83–1.14, p = 0.76). In XFS/XFG patients compared to controls, the risk of having cataract surgery was elevated (OR = 2.39, 95% CI 2.18–2.62). However, after accounting for an interaction with AMD, XFS/XFG patients who underwent cataract surgery did not exhibit an increased risk of either dry or wet AMD (dry AMD: OR = 0.91, 95% CI 0.80–1.03; wet AMD: OR = 0.89, 95% CI 0.75–1.07). The risk of AMD in XFS/XFG patients vs. controls showed no association with osteoporosis/vitamin D deficiency for dry (OR 0.78 95% CI 0.66–0.92 p = 0.004) or wet AMD (OR = 0.72 95% CI 0.56–0.92 p = 0.01), while we found a borderline positive association with both dry and wet AMD if they had osteoporosis/vitamin D deficiency. Conclusion: Using the Utah Population Database, we found that a cataract surgery history significantly impacts the association between AMD and XFS, and that vitamin D deficiency/osteoporosis is a significant confounder of the association. However, no direct association between XFS and AMD was found in this study.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2040011

Authors: Arash Maleki Tate Valerio Yasmin Massoudi Maria L. Ruggeri C. Stephen Foster Stephen D. Anesi

Peripheral ulcerative keratitis (PUK) is an inflammatory process causing thinning of the cornea, epithelial defect, and inflammatory infiltrates and is caused by several etiologies. This sight-threatening condition can indicate the presence of potentially fatal underlying systemic conditions, and, accordingly, warrants thorough investigation upon clinical presentation and immediate intervention in order to mitigate disease progression. This review aims to provide an update on the current diagnostic and management landscape for PUK, specifically with immunomodulatory methods in cases of noninfectious etiologies. A literature search was conducted to develop a nuanced, evidence-based perspective in which we present our preferred approaches. There are currently a number of viable options, following which a “stepladder” method is typically employed, where treatment methods are escalated as a result of inadequate clinical response to lower-level interventions. This method balances efficacy with the potential side effects of immunomodulatory medications. Ultimately, carefully monitored treatment regimens are needed to mitigate visual impairment in patients with PUK, and efforts must be made to achieve steroid-free remission to avoid the known side effects of long-term corticosteroid use.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2040010

Authors: Helen Jerratsch Ansgar Beuse Martin S. Spitzer Carsten Grohmann

(1) With persistent symptoms emerging as a possible global consequence of COVID-19, the need to understand, diagnose, and treat them is paramount. This systematic review aims to explore the potential of optical coherence tomography (OCT) and/or optical coherence tomography angiography (OCTA) in effectively diagnosing long COVID. (2) The database PubMed and, to reduce selection bias, the AI research assistant Elicit, were used to find relevant publications in the period between February 2021 and March 2024. Included publications on OCT and OCTA analysis of participants with acute COVID symptoms, those after recovery, and participants with long COVID symptoms were organized in a table. Studies with participants under the age of 18, case reports, and unrelated studies, such as pure slit-lamp examinations and subgroup analyses were excluded. (3) A total of 25 studies involving 1243 participants and 960 controls were reviewed, revealing several changes in the posterior eye. Long COVID participants displayed significant thinning in retinal layers in the OCT, including the macular retinal nerve fiber layer (mRNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL). Divergent findings in recovered cohorts featured mRNFL reduction, GCL increase and decrease, and GCL-IPL decrease. Long COVID OCTA results revealed reduced vessel density (VD) in the superficial capillary plexus (SCP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP). In recovered patients, SCP consistently showed a reduction, and DCP exhibited a decrease in five out of six publications. The foveal avascular zone (FAZ) was enlarged in five out of nine publications in recovered participants. (4) During various stages of COVID-19, retinal changes were observed, but a comparison between long COVID and recovered cohorts was aggravated by diverse inclusion and exclusion criteria as well as small sample sizes. Changes in long COVID were seen in most OCT examinations as thinning or partial thinning of certain retinal layers, while in OCTA a consistently reduced vessel density was revealed. The results suggest retinal alterations after COVID that are variable in OCT and more reliably visible in OCTA. Further research with larger samples is important for advancing long COVID diagnosis and management.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2030009

Authors: Knut Sandok Wigestrand Santosh Gupta Kulbhushan Sharma Goran Petrovski

Background: Pre-clinical studies related to the use of rapamycin (Sirolimus®), a mammalian target of rapamycin (mTOR) inhibitors, for age-related macular degeneration (AMD) have shown improved therapeutic outcomes. However, knowledge of its dose–effect relationship in humans with AMD has been limited and requires further investigation. Objective: The aim of this study is to assess the safety and efficacy of Sirolimus® for treatment of AMD in humans and determine the dose range for its application in the eye. Methods: A systematic literature review was conducted following the PRISMA guidelines. The MEDLINE, Embase, CINAHL, Scopus and Cochrane Central Registry of Controlled Trials databases were searched for original clinical studies examining the effects of Sirolimus® on outcomes linked to AMD in humans. This review has been registered in the PROSPERO database. Results: Only four studies were found to satisfy the inclusion and exclusion criteria and were analyzed in this systematic review in a narrative way. The dose range of rapamycin in the limited number of studies appears to be toxic to the retina. Conclusion: Future studies should focus on establishing the optimal low-dose range of Sirolimus® that effectively induces autophagy without causing retinal toxicity, as current data indicate a potential therapeutic window that remains underexplored. Specifically, longitudinal, controlled studies with larger, heterogeneous patient populations are necessary to determine the precise dosing that balances efficacy and safety in treating AMD.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2030008

Authors: Natalie Brossard-Barbosa Matias Agoglia Maria Elena Vergara Monique Costa Ernesto Cairoli Teresa Freire

(1) Background: It is estimated that 10% of dry eye disease (DED) occurs in patients with Sjogren’s syndrome (SS-DED) and represents a challenge when it comes to treatment. Both innate and adaptive immunity participate in the pathogenesis of SS-DED. Previous studies suggest that Th1 and Th17 cell immune responses are the main actors associated with the pathogenesis of this disease. Ocular surface mucins play a fundamental role in ocular surface homeostasis. In particular, the main transmembrane mucins, MUC1, MUC4 and MUC16, are dysregulated in DED and could be involved in the activation of pro-inflammatory cytokines at the ocular interface. Thus, the objective of this work was to analyze mucin and cytokine expression in ocular surface (OS) damage and correlate it with clinical symptoms.; (2) Methods: 18 patients with SS-DED and 15 healthy controls were included in the study. Samples of conjunctival cells were obtained through cytology impression. RNA was extracted from the collected samples and used to determine the expression of MUC1, 4 and 16 by qRT-PCR. Pro-inflammatory cytokines associated with DED pathogenesis (IL17 and IL-22) were also evaluated. The results were contrasted with the clinical findings on examination of the patients. (3) Results: We observed a significant increase in the expression of MUC1 and MUC4 in patients with SS-DED. MUC4 significantly correlated with both lower production and stability of the tear film, as well as greater superficial keratopathy. On the other hand, MUC1 and MUC16 were positively correlated with the presence of more severe DED symptoms. However, we could not reproduce an increase in IL-17 and IL-22 in DED patients as previously reported; (4) Conclusions: This work constitutes an approach to understanding how the gene expression of transmembrane mucins associates with SS-DED symptoms and clinical signs.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2030007

Authors: Ritu Sampige Joshua Ong Ethan Waisberg John Berdahl Andrew G. Lee

With increasing space exploration, there is a rising need to evaluate the impact of spaceflight on astronauts’ health, including the effects of space-associated hazards such as microgravity. Astronauts’ reports of experienced symptoms upon spaceflight include a notable prevalence of dry eye disease (DED). Hence, there is a pressing need to understand the pathogenesis and mechanism behind space-associated DED onset, which will subsequently guide the development of necessary therapies to reduce dry eye symptoms among astronauts. One critical effect of spaceflight includes alterations to the gut microbiome. On Earth, the prior literature has established the presence of an ocular surface–gut axis and the potential role of gut dysbiosis in DED onset. Meanwhile, the literature about astronauts’ health underscores the presence of space-associated gut microbiome composition alterations and the presence of DED separately. Therefore, in this opinion article, we review and present the current literature regarding the ocular surface–gut axis on Earth and regarding potential translations to spaceflight. We present the view that, based on the existing literature, the ocular surface–gut axis may be a critical mechanism for the pathogenesis of DED in space, and this axis needs to be further explored in the context of identifying ways to reduce astronauts’ experiences of DED during spaceflight.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2030006

Authors: Samuel K. Lee Caroline Mura Nicolas J. Abreu Janet C. Rucker Steven L. Galetta Laura J. Balcer Scott N. Grossman

Hereditary optic neuropathies (HONs) are a class of genetic disorders that may lead to vision loss due to either acute or progressive injury to the optic nerve. Although HONs may commonly manifest as isolated optic atrophy, these disorders can also have a variety of characteristic clinical features and time courses that may narrow the differential diagnosis. While the two most prevalent HONs are Leber Hereditary Optic Neuropathy (LHON) and Dominant Optic Atrophy (DOA), the phenotypic spectrum of these conditions, as well as genetic landscape of less common optic neuropathies, have been better characterized through advances in molecular diagnostic testing. Treatment targeting various pathogenic mechanisms has been investigated, although studies of clinical applicability remain nascent. Present management largely remains supportive. In this review, we discuss the clinical features, molecular diagnosis, current treatment, and future directions for HONs.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2020005

Authors: Patrick Xiang Ji Vethushan Ramalingam Michael Balas Lauren Pickel David J. Mathew

Glaucoma refers to a spectrum of progressive optic neuropathies and remains the leading cause of irreversible blindness worldwide. Its insidious onset poses serious challenges to conventional diagnostic methods and clinicians striving to detect early-stage disease for timely and effective intervention. Artificial intelligence (AI) has demonstrated its ability to process and analyze large datasets which can help identify subtle changes in early glaucomatous clinical presentation. This study reviews the current state of AI utilization in glaucoma and elucidates the strengths and limitations of existing approaches. We dissect the role of AI in various domains: enhancing early detection and diagnosis, monitoring disease progression, and refining treatment strategies to optimize patient outcomes. Furthermore, we address the ethical, legal, and social implications, alongside the inherent limitations of AI in the clinical setting. Despite these challenges, AI holds transformative potential for glaucoma management. Future directions emphasize the need for interdisciplinary collaboration, advanced and explainable algorithm development, and equitable healthcare access to fully realize the promise of AI in combating this vision-threatening condition.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2020004

Authors: Vicente Lorenzo O. Cabahug John Paul S. Llido Loraine Kay D. Cabral Tricia L. Maynes Cathlyn Leigh Pinuela Tommee Lynne Tayengco-Tiu Ruben Lim Bon Siong Ma. Luisa D. Enriquez

Aim: The study aims to identify if mutations in the SLC4A11 gene are present in Filipino families affected with congenital hereditary endothelial dystrophy (CHED). Methods: This is a family cohort study that investigated the genetic profile of a selected family in northern Luzon, Philippines, whose members were diagnosed with congenital hereditary endothelial dystrophy (CHED). A patient who was diagnosed with CHED prior to this study served as the proband for this family. A detailed family history was obtained and a complete ophthalmologic examination was performed on each of the family members. A total of six affected members and three unaffected members were included in this study. DNA was isolated from peripheral blood samples of the family members, polymerase chain reaction (PCR) was used to amplify the gene’s entire coding region (19 exons and 2 putative promoter regions), and finally, the amplified regions were analyzed using DNA sequencing. Results: Consanguinity was not present in the family. Corneal haze was reported to have been present since birth or shortly thereafter in all the affected patients. Slit-lamp examination showed edematous corneas. Molecular studies of the SLC4A11 gene revealed four novel homozygous point mutations variably presenting in the six affected members, as well as the three unaffected members. One unaffected family member (I-1) had a novel sense mutation absent in the other family members. All affected siblings showed little phenotypic variability. Conclusions: This is the first report that gives us a genetic profile of a northern Luzon family with members affected by CHED. This study supports earlier findings that mutations in the SLC4A11 gene are not consistently the same among different ethnic groups worldwide, probably due to the disease’s genetic heterogeneity. Our study documented five novel mutations, adding to the growing list of mutations probably responsible for acquiring the CHED phenotype. It is possible that there are more novel mutations waiting to be discovered in this hereditary disease. Screening for these specific mutations in other families may prove useful for genetic counseling, prenatal diagnosis, and the future development of gene therapy.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2020003

Authors: Kenta Ashikaga Teruhiko Hamanaka Mayumi Hosogai Takao Tanaka Shintaro Nakao Toshinari Funaki

Purpose: to investigate secondary glaucoma resulting from uveitis in a patient infected with Human T-cell Leukemia Virus Type 1 (HTLV-1) pathologically and discuss the management of glaucoma with recurrent uveitis. Clinical course: An octogenarian woman diagnosed as a carrier of HTLV-1 experienced recurrent uveitis and a sudden rise in intraocular pressure (IOP) in both eyes. Due to the uncontrolled IOP and severely damaged visual field in her left eye, a combined procedure of trabeculectomy and DGIS (glaucoma drainage implant surgery, Baerveldt 350) was performed. The presence of HTLV-1 provirus was detected in the aqueous humor. Her trabeculectomy sample was processed for light microscopic observation. Following an irregular follow-up, she presented with a sudden decrease in vision and pain in her fellow eye, four years after the glaucoma surgeries. Her right eye exhibited a significant accumulation of mutton-fat-like keratic precipitates. Results: Clinical manifestations revealed the presence of granulomatous uveitis. The combined glaucoma surgery, along with continuous topical corticosteroid medication post-surgery in her left eye, effectively suppressed the high IOP spikes and the recurrence of uveitis for 4 years. The pathological examination of the outflow pathways showed a range of damages in Schlemm’s canal (SC), including SC endothelial loss, narrowing, and occlusion, as well as loss of trabecular meshwork (TM) cells and fused TM beams. Conclusion: Combined GDIS and trabeculectomy represents a promising approach for managing such refractory cases of secondary glaucoma. Continuous topical corticosteroid medication is strongly recommended to prevent irreversible changes in SC and TM associated with granulomatous uveitis.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2010002

Authors: Braden V. Saba Joshua A. Grosser Dominic Prado Brian A. Robusto Javier Nahmias Gillian Treadwell Atalie C. Thompson

The purpose of this study was to determine if worse visual acuity is associated with an increased risk of incident fall or mortality, independent of other relevant cofounders. This was a single-center retrospective cohort study of 428 new cases of anterior ischemic optic neuropathy (AION). Separate Cox proportional hazards models were constructed to evaluate the relationship between either logMAR visual acuity (VA) or legal blindness (20/200 or worse VA) and survival time to (1) encounter for fall, (2) mortality, and (3) a composite adverse outcome. Multivariable models were adjusted for a priori confounders. In adjusted models, a 1-unit increase in logMAR VA was associated with a significantly greater risk of an incident fall (adjusted HR 1.36, 95% CI (1.06–1.73), p = 0.014) and of mortality (adjusted HR 1.44, 95% CI (1.15–1.82), p = 0.002). Meeting criteria for legal blindness was also significantly associated with a higher risk of incident fall (HR 1.80, 95% CI (1.05–3.07), p = 0.032) and mortality (adjusted HR 2.16, 95% CI (1.29–3.63), p = 0.004). Among patients with AION, worse visual acuity or legal blindness conferred a significantly increased risk of falls and mortality, independent of coexistent comorbidities. Future studies should consider fall reduction interventions for patients with poor vision from severe eye disease such as AION.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto2010001

Authors: Ann-Marie Ako-Adounvo Pradeep K. Karla

Glaucoma therapy aims at lowering intra-ocular pressure (IOP). Brinzolamide, a carbonic anhydrase inhibitor, is utilized as a second-line medication for treating ocular hypertension and primary open-angle glaucoma (POAG). The drug lowers the IOP making it a therapeutic agent against glaucoma, and due to its poor water solubility, is commercially available as Azopt®, a 1% ophthalmic suspension. Adverse effects such as blurred vision, ocular irritation, discomfort, and bitter taste are associated with the use of the marketed brinzolamide formulation. This study aims to test the feasibility of formulating and in vitro testing of brinzolamide-PLGA nanoparticles for improved toxicity profile. The nanoparticles were prepared by the oil-in-water (O/W) emulsion-solvent evaporation method. Particle size and zeta potential were determined by dynamic light scattering (DLS). The morphology of the nanoparticles was determined by scanning electron microscopy (SEM). Encapsulation of the drug was verified by high-performance liquid chromatography (HPLC) and the compatibility of the polymer and drug was verified by Fourier transform infrared (FTIR) spectroscopy. The in vitro drug release profile was assessed employing the dialysis method. Intracellular localization of the nanoparticles was assessed by confocal microscopy utilizing Rhodamine 123-loaded nanoparticles. Cytotoxicity of the formulation was assessed on Statens Seruminstitut Rabbit Cornea (SIRC) and transfected Human Corneal Epithelial (SV40 HCEC) cell lines. The particle size of the nanoparticle formulations ranged from 202.3 ± 2.9 nm to 483.1 ± 27.9 nm for blank nanoparticles, and 129.6 ± 1.5 nm to 350.9 ± 8.5 nm for drug-loaded nanoparticles. The polydispersity of the formulations ranged from 0.071 ± 0.032 to 0.247 ± 0.043 for blank nanoparticles, and 0.089 ± 0.028 to 0.158 ± 0.004 for drug-loaded nanoparticles. Drug loading and encapsulation efficiencies ranged from 7.42–15.84% and 38.93–74.18%, respectively. The in vitro drug release profile for the optimized formulation was biphasic, with a ~54% burst release for the initial 3 h, followed by a cumulative 85% and 99% released at 24 and 65 h, respectively. Uptake study showed nanoparticles(NPs) localization in the cytoplasm and around the nuclei of the cells. Brinzolamide-PLGA nanoparticles were successfully developed, characterized, and tested in vitro. Preliminary data show intracellular localization of the nanoparticles in the cytoplasm of SIRC and SV40 HCEC cells. The formulations appeared to be relatively non-cytotoxic to the cells. The research data from the study provided preliminary data for successful development and promising in vitro absorption efficacy for brinzolamide-loaded PLGA nanoparticle formulation.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1040013

Authors: Seyed Omid Mohammadi Megan C. LaRocca Christopher D. Yang Jordan Jessen M. Cristina Kenney Ken Y. Lin

Objective: Pulsed ultrasound has been proposed as a tool to enhance ocular drug delivery, but its effects on drug potency are not well understood. Doxorubicin-HCl and cisplatin are two drugs commonly used to treat ocular melanoma. We report the effects of pulsed ultrasound on the cytotoxicity of doxorubicin-HCl and cisplatin in vitro. Methods: Cultured human retinal pigment epithelium cells (ARPE-19) were treated with doxorubicin-HCl or cisplatin in the presence or absence of ultrasound. MTT and Trypan blue assays were performed at 24 and 48 h post treatment to assess cell metabolism and death. Results: Cells treated with ultrasound plus doxorubicin-HCl demonstrated a significant decrease in metabolism compared with cells treated with doxorubicin-HCl alone. In contrast, cells treated with ultrasound plus cisplatin exhibited a significant increase in metabolism compared with cells treated with cisplatin alone for 48 h. Cells treated with cisplatin and pretreated with ultrasound (US–Cis) exhibited a significant decrease in metabolism. Cell death was similar in doxorubicin- and cisplatin-treated cells with and without ultrasound. Conclusion: Pulsed ultrasound enhances the cytotoxicity of doxorubicin-HCl at 24 and 48 h post treatment but abrogates cisplatin toxicity 48 h post treatment. This suggests ultrasound modulates cell–drug interactions in a drug-specific manner. These findings may influence the future development of ultrasound-assisted ocular drug delivery systems.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1040012

Authors: Gregorio Lo Giudice Giuseppe Miceli Giuseppe Tumminello Alessandro Trapani Antonino Pioppo

Purpose: To describe the efficacy and safety of surgical treatment in refractory glaucoma using transscleral cyclophotocoagulation with a diode laser (TSCPC). Cyclo-G6 laser with a G-probe delivery system (Iridex, Silicon Valley, CA, USA). Materials and Methods: 134 patients (134 eyes) with refractory glaucoma were included in this study. Patients received transscleral cyclophotocoagulation (TSCPC) using the IRIDEX Cyclo-G6 diode laser equipped with a G-probe delivery system. The eyes were treated with 1250–1500 mW for 3500–4000 ms depending on the iris colour. Intraocular pressure (IOP) and the count of antiglaucoma medications (AGM) were documented at the initial assessment and again at 3, 6, and 12 months following the treatment. Results: A reduction in IOP was observed in 97.73% of eyes at 12 months. At 12 months, 55.97% of the 134 eyes decreased IOP under 21 mmHg. At the 3-month mark, 96.27% of eyes attained an IOP reduction in 30% or more from their initial baseline levels, 85.61% at 6 months, and 82.17% at 12 months. A reduction in AGM was recorded for 86.07% of patients at 6 months and 87.31% at 12 months. There were no instances of severe complications reported, and minor complications were observed in 3% (4 out of 134) of the treated eyes. Conclusions: IRIDEX Cyclo-G6 laser is a surgical method effective in reducing IOP in patients with refractory glaucoma

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1030011

Authors: Elahhe Afkhamnejad Cooper Stevenson Praveena Gupta

This study aimed to find out whether three Texas state policies restricting opioid prescriptions have influenced the prescribing patterns of the oculoplastic department at the University of Texas Medical Branch (UTMB). This is a retrospective chart review of 520 patients at UTMB between 2019 and 2021, reporting the amount of morphine milliequivalents (MMEs) prescribed to patients undergoing one of eight oculoplastic procedures before and after passage of each state policy. Of 520 patients, 218 received opioids. There were no changes in MMEs/month after the first policy (95% CI: −0.1531–0.1256, p = 0.85), second policy (95% CI: −0.000997–0.00093, p = 0.97), or third policy (95% CI: −0.001431–0.00164, p = 0.096). The passage and implementation of three Texas state antiopioid policies were not associated with significant changes in opioid prescribing patterns following oculoplastic and orbital surgeries at UTMB. Average MMEs/month were driven by orbital-floor fractures, which composed most procedures overall. Limitations included the small population and that only a single provider was reviewed. Future studies would be beneficial in further evaluating the role of state legislation on opioid prescribing patterns and usage among patients.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1030010

Authors: Phat Tran Jonathan Kopel Ted W. Reid

On the cornea, daily epithelial resurfacing is a critical process to prevent the loss of normal function, ocular morbidity, corneal structure, and vision loss. There are several components to wound healing, including cellular attachment, migration, and growth. To develop a treatment for corneal epithelial healing, we studied the effect of substance P (SP) on corneal epithelial cell migration using a cell culture system of either transformed human corneal epithelial cells (SV-40), or rabbit corneal epithelial cells (SIRC). We investigated the effect of SP with insulin and insulin-like growth factor-I (IGF-1). We found that SP is synergistic with insulin and IGF-1 on the stimulation of transformed human corneal epithelial migration in a cell culture system, as well as in rabbit SIRC cells. The addition of either SP, insulin, or IGF-1 alone did not greatly affect epithelial migration, while the combination of SP and insulin or SP and IGF-1 markedly stimulated epithelial migration in a dose-dependent manner. The synergistic effects of SP with insulin and SP with IGF-1 were inhibited by the addition of the SP-specific inhibitor (CP96345). However, the effect of insulin and IGF-1 alone were not inhibited by the NK-1-specific inhibitor (CP96345). Our results are consistent with the need for the involvement of the neuropeptide SP in corneal epithelial wound healing of diabetic corneas where nerve-ending dropout occurs. Additionally, almost identical results were obtained with human and rabbit corneal epithelial cells. These results suggest that the maintenance of the normal integrity of the corneal epithelium might be regulated by both humoral and neural factors.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1030009

Authors: Arsalan Akbar Ali Bobby Saenz Taj Nasser

The management of cataracts in keratoconus patients poses a challenge due to the irregular corneal shape and variability in corneal topography, which may lead to errors in determining corneal power. In this report, we present a case of a 48-year-old male with a history of keratoconus and prior Visian Implantable Collamer lenses and Corneal Allogenic Intrastromal Ring Segments procedures, who presented with a nuclear cataract in his right eye. To address this patient’s complex case, he underwent ICL explantation, cataract extraction, and intraocular lens (IOL) implantation, utilizing the Johnson & Johnson Sensar AR40 monofocal 3-piece lens with a power of −9.5. The Barrett True K formula predicted a spherical equivalent of −1.76, and at the post-operative one-month follow-up, the uncorrected distance visual acuity (UDVA) was 20/60, with pinhole improvement to 20/50. The manifest refraction was −2.50–3.25 × 145, and the best corrected visual acuity was 20/25. This case report highlights the unique challenges encountered in managing keratoconus patients with a history of prior ICL and CAIRS procedures, followed by cataract extraction. Our findings underscore the importance of a comprehensive approach in the management of progressive keratoconus and cataracts to ensure optimal outcomes.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1020008

Authors: Parker Webber Brianna C. Landis Amanda E. Brooks

Neuromyelitis optica spectrum disorder (NMOSD), a demyelinating CNS disorder in which inflammatory cells infiltrate the spinal cord and optic nerve, has been identified as an AQP4-IgG-positive disease. Some of its most common clinical characteristics are optic neuritis, acute myelitis, area postrema syndrome, and brainstem syndrome. However, the relationship between aquaporin-4 (AQP4) and NMOSD appears to be involved in pathologies outside of the CNS due to the fact that autoimmune, muscular, and paraneoplastic syndromes are more common in patients with NMOSD. This perspective presents an analysis of the current literature on neuromyelitis optica in an effort to further understand and compile pathologies that arise outside of the CNS secondary to NMOSD. Recontextualizing neuromyelitis optica as a systemic condition will facilitate greater diagnostic ability and improved treatment approaches.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1020007

Authors: Marcos Peñalver-Mellado Fredy Silva-Fuentes Agustín Villar Anna Mula Andrea Zangara

An in vitro study was conducted using a model of reconstituted human corneal epithelial (SkinEthic™ HCE/Human Corneal Epithelium) to test the modulation of cytokines secretion activity of Pomanox® (PMX), a standardized commercial extract of pomegranate fruit characterized by high punicalagin α + β content. Cell viability and inhibition of the release of interleukin-8 (IL-8) was evaluated in four conditions: negative control, positive inflammatory control with lipopolysaccharide (LPS) from Escherichia coli, positive anti-inflammatory control (LPS plus dexamethasone), and LPS plus PMX after 24 h of culture. The mean (±standard error of mean (SEM)) IL-8 level was 48.7 ± 5.1 pg/mL in the PMX condition vs. 172.7 ± 19.3 and 26.6 ± 1.2 in the LPS from E. coli and negative control, respectively (p < 0.05) and 93.8 ± 8.7 pg/mL in LPS plus dexamethasone (p = 0.165). The percentages of inhibition of IL-8 release were 45.7% for LPS plus dexamethasone and 63.8% for LPS plus PMX. The percentage of cell viability (86%) was also higher for the LPS plus PMX condition. The present findings add evidence to the anti-inflammatory effect of a PMX in an in vitro model of reconstituted corneal epithelial cells.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1020006

Authors: Jonathan Kopel Caezaan Keshvani Kelly Mitchell Ted Reid

In 1931, Von Euler and Gaddum isolated substance P (SP), an undecapeptide from the tachykinin family, from equine brain and intestine tissue extracts. Numerous types of cells, including neurons, astrocytes, microglia, epithelial, and endothelial cells, as well as immune cells including T-cells, dendritic cells, and eosinophils, are responsible for its production. The corneal epithelium, immune cells, keratocytes, and neurons all express the two isoforms of NK1R, which has the highest affinity for SP. The most recent research supports SP’s contribution to corneal healing by encouraging epithelial cell migration and proliferation. Additionally, when applied to the eyes, SP has proinflammatory effects that result in miosis, intraocular inflammation, and conjunctival hyperemia. In this review article, we examine the role of substance P within the eye. We focus on the role of SP with regards to maintenance and healing of the corneal epithelium.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1010005

Authors: Carmen López-de-la-Fuente Hermes Barriga-Longás Elvira Orduna-Hospital

Background: Traumatic brain injury (TBI) can cause visual dysfunction affecting binocularity, spatial orientation, posture, and balance. Currently, there are several options for treating manifested visual disturbances; vision therapy is one of the possible treatment options. Methods: A 14-year-old female fainted and sustained trauma to the upper-temporal part of her right eyebrow. The patient presented with eye pain, a decreased visual field, and blurred vision and she exhibited great difficulties when reading. Both neurological tests and exploration of the anterior and posterior ocular segments showed results within normal limits. The patient was diagnosed with fusional vergence dysfunction, associated with accommodative infacility and oculomotor dysfunction. To eliminate her symptoms, a visual rehabilitation program was implemented; it consisted of accommodative, anti-suppressive, vergential, motility, hand–eye coordination, and peripheral vision exercises. Results: The symptoms manifested by the patient gradually dissipated throughout the course of therapy. However, not all optometric parameters reached normal values after visual therapy, which could indicate a traumatic injury that limited the achievement of normal optometric ranges. Conclusions: After a mild traumatic brain injury (mTBI), it is necessary to carry out a complete examination of the patient’s visual function. This visual examination must include an analysis of vergences, ocular motility, and the accommodative system to obtain an accurate diagnosis. The outcomes of the present clinical case imply that visual therapy should be considered as a treatment in cases of mTBIs.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1010004

Authors: Alfonso Anton Marcos Muñoz Marta Castany Alfonso Gil Alberto Martinez Francisco Muñoz-Negrete Jose Urcelay Javier Moreno-Montañes

(1) Background: After filtering surgery, bleb morphology is an indicator of the factors that may determine the final intraocular pressure (IOP). The present study aimed to evaluate and compare filtering bleb characteristics after combined cataract and glaucoma surgery. (2) Methods: We conducted a prospective multi-center randomized trial. Eyes with glaucoma and cataract were randomly assigned to either phacoemulsification and filtration surgery with an EX-PRESS implant (Alcon) or non-penetrating deep sclerectomy (NPDS) with an ESNOPER implant (AJL). The bleb characteristics were assessed with the Moorfields bleb grading system at months 1 and 12 of follow-up, and the relationship with IOP was analyzed. (3) Results: There were significant changes in bleb appearance between the assessments at month 1 and month 12. The changes in bleb appearance were more evident in the EX-PRESS group. The central area in the EX-PRESS group decreased from 2.9 at month 1 to 2.4 at month 12 (p = 0.014). Bleb height in the EX-PRESS group decreased from 2.3 at month 1 to 1.8 at month 12 (p = 0.034). The vascularity of the central area in the NPDS group decreased from 1.8 at month 1 to 1.3 at month 12 (p = 0.02). The maximal bleb area was inversely related (r = −0.39; p = 0.03) to the IOP in the NPDS group at month 1. Vascularity in the central area was directly related (r = 0.39; p = 0.01) to a higher IOP in the EX-PRESS group at month 1. Vascularity in the central area (r = 0.56; p < 0.001) and maximal area (r = 0.37; p = 0.012) at month 1 was directly related to a higher IOP in the EX-PRESS group at month 12. (4) Conclusions: More intense vascularity at month 1 was related to a higher final IOP in the EX-PRESS group. Larger blebs were associated with a lower IOP in the NPDS group.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1010003

Authors: Sagar Patel Hossein Ameri

Here, we present a case of floppy iris leading to positional pupillary capture by a sutureless, scleral-fixated intraocular lens (IOL) causing recurrent uveitis-glaucoma-hyphema (UGH) syndrome. The patient developed recurrent episodes of UGH syndrome after dislocated IOL removal and the placement of sutureless, scleral-fixated IOL. Gravitationally dependent pupillary capture was noted with the superior iris moving in front of and behind the IOL, depending on head positioning. Ultrasonography showed a floppy iris that moved with shifting gaze. The lack of the capsular bag may have contributed to extreme iris movements. This finding may be secondary to a combination of a lack of zonular support and capsular bag support as well as the lack of vitreous support following vitrectomy. When possible, secondary IOL placement behind a peripherally preserved capsular bag may reduce the risk of UGH.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1010002

Authors: Monika Ecsedy Judit Dohán Gergely Peskó Endre Ludwig Behnam Mohammadpour Zoltán Zsolt Nagy Zsuzsa Récsán

Endophthalmitis is a serious ophthalmologic condition involving purulent inflammation of the intraocular spaces. Fungal endophthalmitis is a highly sight-threatening condition that can be complicated by difficulties in diagnosis and therapeutic delay. We report herein a rare case of bilateral endogenous Candida albicans endophthalmitis with favorable outcome. High suspicion of fungal origin is essential since the diagnosis for fungal endophthalmitis is usually based on the ophthalmological exhibition in combination with the presence of fungemia or predisposing factors. Only prompt initiation of systemic, intravitreal and surgical treatment may reduce ocular morbidity or even mortality.

Journal of Clinical & Translational Ophthalmology doi: 10.3390/jcto1010001

Authors: Jack V. Greiner

The primary objective of the Journal of Clinical & Translational Ophthalmology (JCTO) (ISSN: 2813-1053) [...]