Search Results (1,316)

Recent evidence links lens epithelial cell (LEC) dysfunction and cellular senescence—an irreversible cell cycle arrest with a pro-inflammatory secretory phenotype—to age-related cataract (ARC) progression. This systematic review synthesizes current knowledge on LEC senescence, its molecular features, and laboratory methods for senescence assessment in the ARC. Following PRISMA guidelines, a comprehensive search of PubMed, Scopus and Cochrane databases retrieved 3417 records from inception to 9 February 2025, with 14 studies ultimately included (821 patients and multiple in vitro LEC models). The following multiple senescence expression pathways were identified: SA-β-gal activity, p53/p21 and p16INK4A pathway activation, mitochondrial dysfunction, oxidative stress, and secretion of senescence-associated secretory phenotype (SASP) factors. Notably, cortical cataract demonstrated direct association with local senescent cell accumulation, while nuclear cataract reflected cumulative oxidative damage from impaired LEC-mediated antioxidant defense. Senescence markers correlated positively with cataract severity across multiple studies. Several potential therapeutic targets emerged, including metformin (AMPK activation/autophagic restoration), circMRE11A silencing, NLRP3 inflammasome inhibition, and modulation of FYCO1/PAK1 and MMP2 pathways. This review establishes LEC senescence as a central process in ARC pathogenesis and highlights promising senotherapeutic approaches. Future research should prioritize human surgical samples, develop standardized senescence detection panels (SA-β-gal + p21/p16 + SASP factors), and conduct longitudinal studies to establish causal relationships between senescence accumulation and cataract progression. Full article

Objective: To develop and validate an artificial intelligence (AI) system for automated lens opacities classification system III (LOCS III)-based grading of all three major cataract subtypes using anterior segment optical coherence tomography (AS-OCT). Methods: This is a single-center cross-sectional study. AS-OCT images were collected and manually graded by ophthalmologists according to LOCS III. The dataset was randomly split into training, validation, and test sets. We propose a novel multi-granularity mask-guided network (MMNet) that jointly performs lens substructure segmentation and severity grading. The model’s performance was assessed on an independent test set for automatic grading of cortical cataract (CC), nuclear cataract (NC), and posterior subcapsular cataract (PSC) and the grading performance of the proposed method against ophthalmologists was also evaluated. The model’s interpretability was assessed via attention heatmaps and feature visualization. Results: The proposed MMNet exhibited high agreement with ground truth conducted through gold standard. The proportions of predictions with an absolute error < 1.0 for three subtypes range from 83.02% to 89.94%. The model’s grading accuracy for cataract subtypes was between 82.20 ± 1.41% and 89.76 ± 1.31% among the three subtypes, the Area Under the Curve (AUC) was between 0.954 (95% CI, 0.952–0.969; p < 0.001) and 0.973 (95% CI, 0.964–0.985; p < 0.001). The MMNet shows a satisfactory mean absolute error (MAE) of 0.14 ± 0.35 in CC, 0.10 ± 0.30 in NC, and 0.17 ± 0.38 in PSC grading. It also achieved a fast grading speed of 0.0178 s/image against manual grading. Conclusions: The proposed AI model presented advanced performance on AS-OCT images in automated LOCS III-based cataract grading for CC and NC, and also showed feasibility in PSC assessment. Full article

Purpose: Clinical presentation of anterior uveitis affecting the iris is nearly identical in patients with juvenile idiopathic-associated uveitis (JIAU) and patients with antinuclear antibody-positive anterior uveitis (ANA-U). This study investigates whether the iris transcriptomes of patients with JIAU or ANA-U differ or reflect the clinical homogeneity. Methods: Iris biopsies were obtained from patients with JIAU (n = 31) or ANA-U (n = 9) during trabeculectomy, iridectomy, or complex cataract surgery. Frozen iris tissues were homogenized, the RNA was isolated and analyzed using a bulk RNA sequencing approach. Genes with a Benjamini–Hochberg false discovery rate (FDR) p ≤ 0.05 and a log₂ fold change (FC) of >1 or <−1 were defined as significantly differentially expressed genes (DEGs). Pathway enrichment analysis was subsequently performed to characterize these DEGs. Results: The JIAU group included nine male and 22 female patients (median age 10.2 [IQR 7.2, 13.7] years), while the ANA-U group consisted of one male and eight female patients (median age 10.2 years (IQR [6.1, 11.7]) years). No DEGs were identified when comparing the iris transcriptomes of JIAU and ANA-U directly. Subgroup analyses based on disease activity revealed 35 DEGs in ANA-U, one DEG in JIAU. Inter-group comparisons based on uveitis activity status yielded no DEGs. In the merged JIAU/ANA-U cohort, 28 DEGs were upregulated in the active vs. inactive uveitis. Regarding secondary glaucoma, 12 DEGs were identified in JIAU, and 15 DEGs were identified in the corresponding ANA-U subgroup. Inter-group comparisons based on glaucoma status yielded no DEGs. In the merged JIAU/ANA-U cohort, 20 DEGs were identified between patients with and without glaucoma. Conclusions: Our findings reveal only marginal differences in gene expression patterns in iris tissues from JIAU and ANA-U patients. These results suggest a high degree of similarity in the underlying inflammatory processes of both uveitis subsets. Full article

Here, we describe vision health in aging adults living with HIV (PLWH) and comparable people without HIV (PWOH) from the MACS/WIHS Combined Cohort Study (MWCCS). PLWH and PWOH aged 60 years and older were recruited from Baltimore/Washington, DC, from September 2021 to September 2023. Exact matching and sample weights were used to create age-balanced comparisons. Visual impairment (VA worse than 20/40 after refraction or CS worse than 1.50 logCS in the better eye) and the presence of eye pathology were assessed. We studied 74 PLWH (97% virally suppressed) and 65 PWOH, aged 61 to 79 years, 36% Black, and 87% male. For PLWH and PWOH, distance VA impairment was noted in 4% vs. 1%, respectively, and uncorrected refractive error in 15% vs. 5%. More than half had signs of dry eye disease (63% for PLWH and 51% for PWOH). About half of PLWH had developed at least an early stage of cataract, compared to 20% of PWOH. Posterior chamber abnormalities were observed in 4% and 0%, and glaucomatous changes in 19% and 25% of PLWH and PWOH, respectively. The need for eyecare was high among this sample of PLWH with viral suppression and PWOH. Full article

Werner syndrome is a rare autosomal recessive premature aging syndrome characterized by its development after puberty and death in patients in their 50s due to cancer or atherosclerotic disease. Early diagnosis can improve the management of disease, quality of life and prolong the lifespan of patients with Werner syndrome. Ophthalmologists should include Werner syndrome in the general work-up in patients with bilateral early-onset cataracts. We present a case of Werner syndrome with initial signs of juvenile cataracts. The patient had a high-pitched voice, a bird-like face and progeroid hair. We performed routine ophthalmological examinations including slit-lamp examinations, fundus examinations, and optical coherence tomography, and genetic analysis. The patient had plateau iris and pachychoroid-like features in addition to bilateral cataracts. The gene analysis revealed compound heterozygosity of Mut4 and Mut25 in WRN and the patient was diagnosed with Werner syndrome. After cataract surgeries, his visual acuities were improved. Additionally, we performed a thorough literature review to better understand the previously reported ocular manifestations in patients with Werner syndrome. Full article

Purpose: The aim of this study was to develop a concept for adjustment planning of intraocular lens orientation axes after cataract surgery with implantation of toric intraocular lenses (tIOLs) and to predict the spectacle refraction after tIOL re-alignment. Methods: This calculation concept based on paraxial spherocylindrical vergence transformations uses the actual spherocylindrical refraction at the spectacle plane, corneal power, and the labelled power and measured axis of the implanted tIOL to minimise the refractive cylinder by simulating the rotation of the tIOL in the eye. The axial lens position is derived from simple prediction models using anterior chamber depth and lens thickness or axial length from preoperative biometry or the equivalent tIOL power. The new target axis is predicted together with the spherocylindrical refraction after re-alignment of the tIOL. Results: To show the applicability of this calculation model, we provide four clinical working examples: example 1 deals with keratometric power values; example 2 deals with keratometric curvature values, including surgically induced astigmatism and a statistical posterior astigmatism correction for the cornea (both examples with a thin cornea model); example 3 deals with corneal curvature data for the front and back surface; and example 4 deals with keratometric power data and corneal back surface power data, including surgically induced astigmatism (both examples with a thick cornea model). Conclusions: The effect of tIOL axis adjustment after cataract surgery can be predicted based on actual refraction, corneal power, tIOL power and the measured axis, and a simulation of the tIOL axis rotation enables the best orientation with the lowest refractive cylinder at the spectacle plane to be found. Full article

Background and Clinical Significance: Acetazolamide is routinely used post-cataract surgery to prevent intraocular pressure (IOP) spikes. Rare non-cardiogenic pulmonary edema (NCPE) cases highlight its risks in elderly comorbid patients. This report details acetazolamide-induced NCPE and provides a review of current evidence from the literature. Case Presentation: A 74-year-old male with chronic kidney disease, atrial fibrillation, and aortic aneurysm repair received 250 mg oral acetazolamide post-cataract extraction. Clinical, imaging, and lab data were documented during Intensive Care Unit (ICU) stay. PubMed/Google Scholar review identified similar cases. Within 30 min, severe hypoxemia with SpO₂ (peripheral oxygen saturation) of 77%, accompanied by tachypnea and hypertension, necessitated endotracheal intubation. Echocardiography showed preserved left ventricular (LV) function; computed tomography (CT) confirmed bilateral alveolar opacities without cardiomegaly or embolism, indicating permeability-mediated NCPE. Lung-protective mechanical ventilation and vasopressor therapy resulted in hemodynamic and respiratory stabilization. On day 4, ventilator-associated pneumonia (VAP) due to Acinetobacter baumannii resolved with targeted antibiotic therapy. The patient made a full recovery following ICU discharge. To date, nine prior cases have been reported, alongside 31 entries in EudraVigilance reflecting a 19.4% mortality rate. Conclusions: Rapid-onset NCPE from acetazolamide involves endothelial injury, distinct from cardiogenic pulmonary edema. Early recognition, drug cessation, and admission to the intensive care unit (ICU) are vital components of therapeutic intervention. Risk stratification and pharmacovigilance are recommended for perioperative safety. Full article

Background: Exfoliation syndrome (XFS) is a common age-related disorder and a major risk factor for glaucoma and cataract. This study describes the hospital-based frequency and clinical associations of XFS among patients aged 40 years and older attending a regional ophthalmology outpatient clinic in the Northeastern Black Sea coastal region of Turkey. Methods: This cross-sectional observational study included 938 eligible participants aged ≥40 years with registered birth records and continuous residence within the defined catchment area who underwent a comprehensive ophthalmological examination. XFS was defined by characteristic exfoliative material at the pupillary margin and/or on the anterior lens capsule (phakic eyes) or capsular bag/IOL complex (pseudophakic eyes), with pupillary assessment before and after pharmacologic dilation. Systemic comorbidities were extracted from national medical records. Multivariable logistic regression adjusted for age and gender. Results: XFS was diagnosed in 20.8% (195/938; 95% CI: 18.2–23.5%). The XFS-positive (XFS+) group was older than the XFS-negative (XFS−) group (71.76 ± 0.61 vs. 63.25 ± 0.40 years; p < 0.001). Hypertension was more common in XFS+ participants (57.4% vs. 45.6%; p: 0.002) and remained associated after adjustment (OR: 1.49; 95% CI: 1.05–2.11; p: 0.024). Glaucoma was more frequent in XFS+ participants (23.6% vs. 14.9%; p: 0.005); it remained associated after adjustment (OR: 2.00; CI: 1.31–3.05; p: 0.001). Conclusions: In this hospital-based surveillance, approximately one in five clinic attendees aged ≥40 years had XFS. Findings should not be extrapolated to population prevalence; population-based studies are required to estimate regional prevalence accurately. Nonetheless, these data highlight a substantial clinical burden of XFS in a regional care-seeking population and support vigilant glaucoma surveillance in affected patients. Full article

MAF encodes a transcription factor involved in T-helper-2 (Th2) cell differentiation. Heterozygous pathogenic variants in MAF have been observed in both isolated and syndromic congenital cataract cases; genotype–phenotype correlations are based on the location of the variant within the gene. Variants in the N-terminus domain of MAF are associated with cataracts as part of Aymé-Gripp syndrome. The purpose of this report is to expand the ocular phenotypic spectrum of Aymé-Gripp syndrome by describing a patient with MAF variant c.185C>G, p.Thr62Arg, and the traditional systemic findings and congenital cataracts as well as an unusual feature of pigmentary retinopathy, which has not been previously reported in Aymé-Gripp syndrome. Additionally, a comprehensive review of the literature was completed to report ocular genotype–phenotype data on previously reported patients with MAF-associated Aymé-Gripp syndrome. Full article

Background/Objectives: This study aimed to characterize eyelid speculum-induced intraocular pressure (IOP) elevation during cataract surgery and identify ocular biometric factors that stratify susceptibility to this pressure response. This study was conducted at Zengyo Suzuki Eye Clinic, Kanagawa, Japan. Methods: In this retrospective observational study, we analyzed 100 eyes that underwent routine cataract surgery. IOP was measured immediately before and within 10 s of speculum opening in the seated position using a rebound tonometer. The eyelid speculum was opened to a maximal opening position, and the opening width was recorded. Biometric parameters included axial length (AL), central corneal thickness, white-to-white distance, anterior chamber depth, and temporal angle-opening distance. Associations between IOP elevation and biometric factors were analyzed. IOP elevation rate was quantified as the percentage increase from baseline. The discriminatory performance of axial length was evaluated using receiver operating characteristic (ROC) analysis. Results: Overall, 100 patients (100 eyes) were included in the analysis. Mean IOP increased significantly from 15.75 ± 2.77 mmHg before speculum placement to 21.42 ± 5.54 mmHg after placement. The mean IOP elevation rate was 36.0 ± 27.4%. Shorter AL was consistently associated with a greater proportional IOP elevation. ROC analysis demonstrated consistent stratification of IOP elevation susceptibility by AL (area under the curve [AUC] = 0.645), with eyes shorter than 23.84 mm showing greater pressure elevation (sensitivity, 73.1%; specificity, 56.0%). Eyes in the upper quartile of the IOP elevation rate exhibited relatively greater pressure elevation. Conclusions: Eyelid speculum placement imposes a clinically meaningful IOP load during cataract surgery, with shorter ALs making eyes more biomechanically susceptible to IOP elevation. Full article

Background/Objectives: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for type 2 diabetes in addition to other conditions such as obesity. As their use expands, understanding potential ocular safety signals is important, particularly in populations already at risk for diabetic eye disease. The aim of this study is to identify potential pharmacovigilance safety signals for ocular adverse events (AEs) related to GLP-1 RA medications to better inform future clinical practice. Methods: This study utilized the publicly available FDA Adverse Event Reporting System (FAERS) to obtain AE reports related to exenatide, tirzepatide, dulaglutide, liraglutide, and semaglutide from 2005 to 2024. Reports were categorized by demographic and geographic variables. Disproportionality analysis using reporting odds ratios (RORs) was performed to detect potential safety signals. Year-over-year trends in the proportional representation of each drug were also assessed through linear regression and time series plots. Results: Ocular AEs represented 3.61% of all GLP-1 RA related reports. Median age was 63 years, and 62.6% of reports involved female patients. Exenatide accounted for 33.61% of ocular AEs but showed a significant annual decline in reporting (–5.15% per year, p < 0.001). Semaglutide (31.37%) and tirzepatide (12.19%) demonstrated significant year-over-year increases in proportional reporting (2.23% and 0.79% per year, respectively; both p < 0.05), consistent with rapid uptake in clinical practice. Semaglutide demonstrated a modestly elevated ROR (1.46), while tirzepatide showed a low ROR (0.42), though this likely reflects shorter post-marketing exposure rather than lower clinical risk. The most frequently reported events were visual impairment, followed by vision blurred, cataract, and blindness. Conclusions: This pharmacovigilance analysis identifies potential ocular AE signals associated with GLP-1 RAs, particularly semaglutide. While semaglutide showed a statistically significant disproportional reporting signal for ocular AEs, the absence of exposure denominators, comparator groups, and the susceptibility of FAERS to reporting bias means these findings are hypothesis-generating rather than causal. Clinicians should remain vigilant and consider eye care referrals when indicated. Further research is needed to validate these associations and clarify underlying mechanisms. Full article

Background/Objectives: Paediatric cataract is among the most common treatable causes of childhood blindness, caused by a genetically diverse disorder with variable clinical features. Although genetic factors significantly contribute to the development of paediatric cataracts, recent data on their genetic makeup and genotype–phenotype relationships in Saudi Arabia is limited. This study aims to investigate the genetic spectrum, inheritance patterns, and genotype–phenotype correlations of paediatric cataract in a Saudi population over twenty years. Methods: We conducted a retrospective cohort study of children diagnosed with congenital or juvenile cataracts between 2000 and 2019 at two major referral centres in Riyadh. Clinical, ocular, and systemic data were collected through multidisciplinary evaluations. Genetic analysis involved whole-exome and whole-genome sequencing performed at College of American Pathologists (CAP)-accredited laboratories. Variant interpretation was supported by bioinformatic and Artificial Intelligence (AI) prediction tools. Genotype–phenotype relationships were systematically analysed. Results: The study included 28 cases of genetically confirmed paediatric cataracts. Variants classified as pathogenic or likely pathogenic were identified in 13 genes. Autosomal recessive inheritance was predominant, with many patients exhibiting homozygous variants, often due to consanguinity. Two novel variants were identified in the Collagen Type XVIII Alpha 1 Chain (COL18A1) and the RAB3 GTPase-activating protein catalytic subunit 2 (RAB3GAP2) genes. Considerable phenotypic variability was observed, even among patients with the same mutation, particularly those with the recurrent CRYBB1 c.171del (p.Asn58fs) mutation. Syndromic cataracts were more frequently associated with loss-of-function variants and multisystem features. Conclusions: This study offers updated insights into the genetics and clinical presentation of paediatric cataract in Saudi Arabia. It highlights high genetic diversity, unique inheritance patterns, and notable genotype–phenotype variability, emphasising the importance of early genetic testing and multidisciplinary assessment for improved diagnosis, management, and counselling. Full article

Cataract diagnosis requires a comprehensive dilated examination by an ophthalmologist using a slit lamp; there is currently no effective means to objectively screen for cataracts in the community using portable devices without dilation. We hypothesized that it would be possible to predict cataract severity using deep learning on images taken using a portable smartphone-based slit lamp prototype, with and without dilation. In this prospective cross-sectional pilot study, slit lamp images were captured from eligible patients with cataracts in a tertiary clinic using a portable slit lamp prototype attached to a smartphone. The Pentacam nuclear staging score (PNS, Pentacam^®, Oculus, Inc., Arlington, WA, USA) was taken from the dilated pupils and served as ground truth. A transformer prototypical network with the Swin transformer on the images was trained to assign the class label corresponding to the highest predicted probability. Heat maps were generated based on attribution masks to identify the anatomical areas of concern. A total of 1900 images from 198 eyes of 99 patients were captured. The average age was 65.3 ± 10.4 years (range, 41.0 to 88.0 years) and the average PNS score was 1.57 ± 0.81 (range, 0 to 4). The model achieved an average accuracy of 81.25% and 74.38% for undilated and dilated eyes, respectively. Heat map visualization using the integrated gradient method successfully identified the anatomical area of interest in certain images. This study suggests the possibility of estimating cataract density using a portable smartphone slit lamp device without dilation. Further work is under way to validate this technique in a larger and more diverse group of eyes with cataracts. Full article

Background/Objectives: To comprehensively evaluate longitudinal retinal and choroidal vascular changes after phacoemulsification using automated optical coherence tomography angiography (OCTA) analysis and to investigate clinical factors influencing these changes. Methods: This retrospective study included 26 subjects (31 eyes) who underwent uncomplicated phacoemulsification. OCTA was performed at baseline and at 1 day, 1 week, 1 month, and 2 months postoperatively. Automated quantitative analysis was applied to assess vessel density- and structure-related parameters in the superficial capillary plexus (SCP), deep capillary plexus (DCP), choriocapillaris, and Haller layer. Longitudinal changes were analyzed using repeated-measures analysis of variance, with time × clinical factor interactions evaluated for diabetes mellitus, anesthesia method, and sex. Inter-layer associations were assessed using Spearman correlation analysis. Results: Significant longitudinal changes were observed in retinal layers. In the SCP, vessel density increased from 42.59 ± 1.46 at baseline to 44.10 ± 1.44 at 2 months (p = 0.002), accompanied by increases in vessel length and node counts (all p < 0.001). In the DCP, vessel density increased from 34.66 ± 5.98 to 38.65 ± 4.83 (p < 0.001). In contrast, choriocapillaris-related parameters showed no significant overall time effect. In the Haller layer, mean vessel diameter decreased significantly over time (p < 0.001), while density-related metrics remained unchanged. ΔVAD demonstrated positive correlations between adjacent layers (SCP–DCP and DCP–choriocapillaris) and a negative correlation between choriocapillaris and Haller layers. Diabetes mellitus showed no significant longitudinal effect, whereas retrobulbar anesthesia and sex significantly modified selected choroidal trajectories. Conclusions: Automated and integrated OCTA analysis revealed layer-dependent retinal and choroidal vascular responses after phacoemulsification, with coordinated changes confined mainly to anatomically adjacent layers and selective modulation by clinical factors. Full article

Background/Objectives: Early diagnosis of eye diseases is critically important for enhancing individuals’ quality of life and reducing the risk of vision loss. In this study, a deep learning-based hybrid model called MidFusionEfficientV2 has been proposed to classify eye diseases, including uveitis, conjunctivitis, cataract, eyelid drooping, and normal conditions. Methods: The model presents a dual-branch architecture that combines an RGB image branch with an EfficientNetV2-S architecture and a specialized texture branch based on Local Binary Pattern (LBP) transformation at an intermediate level. Thanks to the Squeeze-and-Excitation (SE) blocks integrated into the LBP branch, channel-based attention mechanisms have been activated, enhancing the prominence of textural features. The features obtained from the RGB and LBP branches were combined at an intermediate level and transferred to the classification stage. Results: Experimental studies on the five-class eye disease dataset from the Mendeley Data platform have shown that the proposed model outperformed six strong models (ResNetV2, ConvNeXt, DenseNet-121, EfficientNet-B1, MobileNetV3 Large, and EfficientNetV2-S) with an accuracy of 98%. Especially in the difficult-to-diagnose uveitis class, recall and F1 scores of 97% and 94%, respectively, were achieved. Conclusions: The results show that a moderate combination of color and texture features significantly improves classification performance, and that MidFusionEfficientV2 offers a reliable and effective solution for the automatic diagnosis of eye diseases. Full article