Search Results (1,210)

Background and Clinical Significance. Steroid-induced central serous chorioretinopathy (CSCR) is a potential complication in patients with uveitis receiving corticosteroid therapy and may be misinterpreted as persistent inflammatory activity. Inflammatory and iatrogenic subretinal fluid may coexist, particularly in primary inflammatory choriocapillaropathies (PICCPs), creating diagnostic and therapeutic challenges. This narrative review discusses the pathophysiological mechanisms underlying steroid-induced CSCR and emphasizes the value of multimodal imaging in distinguishing inflammatory subretinal fluid from steroid-induced serous retinal detachment. Optical coherence tomography, fundus autofluorescence, fluorescein angiography and indocyanine green angiography provide complementary information that may guide accurate diagnosis and avoid inappropriate corticosteroid escalation. Case Presentation. An illustrative case of ampiginous choroiditis, a severe form of PICCP, complicated by bilateral steroid-induced CSCR shortly after initiation of high-dose corticosteroid therapy, is presented to highlight the clinical relevance of this complication and its therapeutic implications. Conclusions. Early recognition through multimodal imaging enabled prompt corticosteroid tapering and introduction of steroid-sparing immunosuppression, with subsequent marked anatomical and functional improvement. Full article

Backgroundand Objectives: Retinal microcirculation may serve as a surrogate marker of systemic vascular status and can be non-invasively assessed using optical coherence tomography angiography (OCTA). Emerging evidence suggests that retinal and choroidal microvascular alterations may occur following coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C), potentially reflecting systemic vascular and inflammatory processes. This review summarizes the current evidence regarding retinal and choroidal microvascular changes detected by OCTA in pediatric patients with COVID-19 and MIS-C. Materials and Methods: A structured literature search of the National Center for Biotechnology Information (NCBI) PubMed database was conducted from inception until April 2026. Original English-language studies evaluating retinal and choroidal microcirculation using OCTA in pediatric patients with COVID-19 or MIS-C were identified and reviewed. Results: Available studies suggest variable retinal and choroidal microvascular alterations following COVID-19 and MIS-C, including changes in vessel density, perfusion, and foveal avascular zone parameters. Several investigations reported reduced vessel density, particularly within the deep capillary plexus, whereas others demonstrated increased peripapillary vascular parameters or no significant differences during the observation period. Differences in patient characteristics, disease severity, timing of imaging, OCTA protocols, and study design likely contribute to the heterogeneity of the reported findings. Conclusions: OCTA represents a promising research tool for investigating retinal and choroidal microvascular alterations associated with pediatric COVID-19 and MIS-C. However, the available evidence remains limited by small observational studies, methodological heterogeneity and inconsistent findings. Larger prospective longitudinal studies using standardized imaging protocols are needed to determine the clinical significance and reproducibility of OCTA-derived parameters and to establish whether they may have potential as biomarkers of ocular or systemic vascular involvement. Full article

Ocular diseases, such as neovascular age-related macular degeneration (nAMD) and proliferative vitreoretinopathy (PVR), have a fibrotic component that negatively impacts vision. Unfortunately, few treatments are available to mitigate fibrosis in the eye. The clearance of inflammatory cells proceeds, at least in part, through the intrinsic cell death pathway in which Bcl-2 family members play integral roles. Here, we assessed the influence of Bcl-2 expression in mononuclear phagocytes (MP) on the engagement and clearance of inflammatory cells, choroidal neovascularization (CNV), and subsequent subretinal fibrosis in a mouse laser-induced CNV model. Lack of Bcl-2 expression in MP (Bcl-2^MP mice) decreased neutrophil (Gr1⁺) and microglia (Iba1⁺) presence without impacting M1 (CD80⁺) and M2 (CD206⁺) macrophage presence, CNV, or fibrosis during the first 2 weeks following laser photocoagulation. Later, after inflammation dampens, decreased later-stage fibrosis and CNV were noted in Bcl-2^MP mice, which were accompanied by increased presence of M2 macrophages (CD206⁺). However, how these increased levels of CD206⁺ M2 macrophages in the absence of Bcl-2 contribute to decreased CNV and fibrosis remains unknown. To address whether Bcl-2 expression affects other forms of ocular fibrosis, we utilized the dispase PVR model. Bcl-2^MP mice, or treatment of wild-type mice with Bcl-2 inhibitors, significantly decreased fibrosis in the PVR model. Furthermore, Bcl-2 inhibitors mitigated CNV and fibrosis (collagen I-defined) in wild-type mice during laser photocoagulation. Thus, inhibition of Bcl-2 activity prevents the late-stage clearance of CD206⁺ M2 macrophages during nAMD and PVR, mitigating ocular neovascularization and fibrosis. Full article

Background and Clinical Significance: This paper presents a case of Vogt–Koyanagi–Harada (VKH)-like disease following nivolumab and ipilimumab therapy for squamous cell carcinoma of the lung, complicated by transient type 1 macular neovascularisation (MNV). Case Presentation: A 67-year-old man presented with reduced visual acuity, more pronounced in the left eye, accompanied by headache and neurosensory hearing loss for 10 days. He had been receiving combination therapy with nivolumab and ipilimumab for approximately nine weeks. Slit-lamp examination and multimodal imaging revealed multiple serous retinal detachments, choroidal folds, and bacillary layer detachment. A bilateral VKH-like syndrome was considered the most likely diagnosis, consistent with an immune-related adverse event (irAE). High-dose systemic corticosteroids were initiated, resulting in marked anatomical improvement and recovery of visual acuity. Following multidisciplinary discussion with the patient’s oncologist, ipilimumab was permanently discontinued and nivolumab was rechallenged in combination with chemotherapy after resolution of the ocular adverse events, given the progression of the underlying malignancy. Notably, optical coherence tomography angiography (OCTA) additionally demonstrated a type 1 non-exudative MNV, which resolved spontaneously during follow-up. Conclusions: Nivolumab and ipilimumab, targeting PD-1 and CTLA-4, respectively, are effective anticancer therapies but may induce immune-related adverse events involving the eye. VKH-like disease is a rare but potentially vision-threatening complication. Early recognition and prompt treatment are essential for favourable visual outcomes. In summary, this is a rare case of VKH-like disease associated with nivolumab and ipilimumab therapy, complicated by transient inflammatory type 1 MNV. Clear guidelines are needed regarding management of ocular immune-related adverse events and decisions on continuation or discontinuation of life-prolonging immunotherapy. Full article

Background: Elevated plasma homocysteine (HCY) is a risk factor for Alzheimer’s disease (AD), but its relationship with structural brain changes across the AD continuum remains unclear. The choroid plexus (CP) regulates cerebrospinal fluid homeostasis and may interface with peripheral metabolic signals. Whether HCY relates to CP structural alterations and disease progression remains unknown. Methods: We analyzed 819 Alzheimer’s Disease Neuroimaging Initiative (ADNI) participants (229 cognitively normal (CN), 397 with mild cognitive impairment (MCI), and 193 with AD dementia). Multinomial logistic regression assessed associations between HCY and diagnosis under stepwise covariate adjustment. Phenotype-wide structural magnetic resonance imaging (MRI) mapping identified HCY-associated signals. Cox models evaluated associations of CP volume (CPV) with CN-to-MCI and MCI-to-AD dementia conversion and whether CPV added prognostic discrimination beyond baseline disease-severity markers. Independent human CP single-nucleus and spatial transcriptomic datasets were reanalyzed to characterize epithelial expression states and their spatial organization in a hypothesis-generating analysis. Results: Higher HCY was associated with MCI and AD dementia; however, the AD association attenuated after adjustment for renal function, vitamin B12, and medications, whereas the MCI association remained stable. CPV was among the HCY-associated MRI signals that persisted after progressive covariate adjustment. Right and bilateral CPV showed model-dependent associations with MCI-to-AD dementia conversion. In the disease-severity sensitivity analysis, larger right and bilateral CPV remained associated with a higher risk of progression from MCI to AD dementia. Single-nucleus analysis identified two CP epithelial states with relatively high expression of one-carbon metabolism-related genes, termed one-carbon metabolism-enriched epithelial state A (OCM-Epi-A) and state B (OCM-Epi-B). Donor-level pseudobulk analysis did not identify pathway enrichment after false discovery rate correction, whereas OCM-Epi-A–like spots were located near endothelial spots more often than expected by chance in three of the four spatial samples. Conclusions: Circulating HCY was associated with larger CPV, and larger CPV showed model-dependent associations with MCI-to-AD dementia progression. Independent transcriptomic reanalysis identified one-carbon metabolism-enriched epithelial states and their spatial organization in postmortem CP tissue, providing hypothesis-generating tissue-level context for the ADNI associations. Full article

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. Full article

Background: The early diagnosis of eye fundus pathologies is crucial, as they may go unnoticed until reaching advanced stages. To offer an improved screening methodology for this purpose, the effectiveness of a conditional variational autoencoder (CVAE) based on multispectral (MS) imaging and operating from the visible to the near-infrared range (416–1213 nm) has been assessed. Methods: A total of 2040 images from 102 patients (66 females, 36 males; aged 19–91 years) were acquired with an MS fundus camera to feed a fine-tuned CVAE for classifying eye fundus as healthy or diseased. The performance of the neural network was assessed for different image resolutions and spectral ranges. Results: The proposed deep generative model showed excellent results, reaching 100% of accuracy, sensitivity and specificity for the set of MS images from 416 nm to 955 nm at maximum resolution (1757 × 1757 pixels). Other instances with different image resolutions and spectral ranges led to good classifications (accuracy between 96% and 98%, sensitivity between 92% and 98%, and specificity between 97% and 100%). The CVAE exhibited robust performance with convergence of the accuracy and loss through the different epochs for training and validation in all instances. Conclusions: This study proves that a CVAE approach based on MS imaging is a highly effective tool for diagnosing eye fundus conditions and could potentially serve as a valuable clinical support tool for screening. The approach performs remarkably well when high spatial resolution MS images ranging from 416 nm to 955 nm are used. This underscores the importance of combining spatial and spectral information, particularly of wavelengths beyond the visible range. Full article

The global prevalence of myopia is increasing, and the combination of myopia and glaucoma is widely expected to become an important clinical and public health issue. Myopic eyes undergo axial elongation and posterior pole remodeling, leading to optic disc tilt, peripapillary deformation, choroidal thinning, and altered spatial relationships between the optic nerve head and its vascular supply. Glaucomatous optic neuropathy is associated with retinal ganglion cell damage, lamina cribrosa deformation, and ocular blood flow impairment. Recent advances in optical coherence tomography angiography and laser speckle flowgraphy have enabled noninvasive assessment of retinal, peripapillary, choroidal, and optic nerve head circulation. These modalities have revealed reduced radial peripapillary capillary density, choroidal microvasculature dropout, and reduced optic nerve head tissue blood-flow signal in glaucomatous eyes. In eyes with myopia and glaucoma, myopia-related structural deformation and glaucoma-associated perfusion abnormalities may coexist and show sectoral correspondence with neural damage, particularly in regions related to the central visual field. This review summarizes the anatomical background of ocular blood flow, myopia-induced structural and vascular changes, glaucoma-associated blood flow impairment, and their interaction in eyes with myopia and glaucoma. Potential therapeutic approaches targeting ocular blood flow are also discussed, although evidence beyond intraocular pressure reduction remains limited. Full article

Background/Objectives: Ocular surface inflammation has been identified as a key causative factor for dry eye. The current study investigates the feasibility, safety, and efficacy of fenofibric acid (FFA) as a topical eye drops in controlling ocular surface inflammation. Methods: FFA was tested for its dissolution profile and its cytotoxicity in vitro, and its permeability through ocular surface tissues was tested ex vivo. A safe dose was tested on the Sprague–Dawley (SD) rat eye as an eyedrop for ocular safety and ocular pharmacokinetics. The efficacy was tested on a benzalkonium chloride (BAC)-induced dry eye model in the SD rats. The outcome measurements were analyzed against the untouched contralateral eyes of the animals. Results: The study found that FFA had a similar dissolution profile in PBS (phosphate-buffered saline) as is in saline; however, the saturated concentration in PBS was 81 times higher. FFA had an IC50 (half maximal inhibitory concentration) of 282.4 µM on HCECs (human corneal epithelium cells). The FFA permeation rate for the cornea was 1.77 × 10⁻⁶ µg/cm²/min, 4.95 × 10⁻⁶ µg/cm²/min for the conjunctiva, and 11.32 × 10⁻⁶ µg/cm²/min for the complex of the sclera/choroid. A regimen of twice-a-day eyedrops (500 µg/mL) demonstrated good ocular safety and therapeutic efficacy on the BAC-induced dry eye model in SD rats, with significant effects on the reduction in corneal edema and on preventing the loss of goblet cells from dry eye pathology. Conclusions: These findings strongly suggest that FFA eye drops at a concentration of 500 µg/mL may effectively control ocular surface inflammation and relieve dry-eye discomfort. Full article

Background and Objectives: Arterial hypertension is a major cause of systemic microvascular damage involving target organs such as the kidneys and retina. Because the retinal and renal microcirculations share common pathogenic mechanisms, retinal imaging may provide non-invasive biomarkers of hypertensive microvascular injury. This study investigated the association between the renal resistive index (RRI), systemic oxidative stress biomarkers, and retinal abnormalities in patients with essential hypertension. Retinal structural and microvascular parameters were evaluated using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Materials and Methods: In this cross-sectional exploratory study, 32 patients with essential hypertension (64 eyes) underwent comprehensive ophthalmic examination, OCT/OCTA imaging, renal Doppler ultrasonography for RRI assessment, and evaluation of systemic oxidative stress biomarkers. Associations between renal, ocular, and biochemical parameters were analyzed. Results: No significant differences were observed in most global OCT/OCTA parameters. However, higher RRI values were associated with localized macular thinning and reduced optic nerve head perfusion metrics. Patients with RRI values ≥ the 75th percentile showed significantly increased hydrogen peroxide levels (p = 0.004) and reduced nitric oxide bioavailability (p = 0.033), together with thinning of selected inner macular sectors. A trend toward reduced optic nerve head flow index was also observed, suggesting early microvascular impairment that may not be detected by conventional global OCT measurements. Conclusions: These exploratory findings suggest a possible association among increased renal vascular resistance, oxidative stress, and localized retinal structural alterations in patients with essential hypertension. The coexistence of systemic redox imbalance and sectorial retinal changes supports the hypothesis of an eye–kidney–redox interplay and indicates that advanced retinal imaging, particularly detailed sectorial OCT analysis, may represent a complementary non-invasive tool for the early detection of subclinical microvascular damage. Larger prospective studies are warranted to validate these findings. Full article

Background/Objectives: The aim of the present study was to assess the influence of physical activity on retinal microvascularization in patients with uveal melanoma (UM) and nevus. In addition, vascular differences between tumor and nevus patients as well as the interaction effect of physical activity (PA) and group on retinal microvascular density (MVD) were analyzed. Methods: This cross-sectional, observational clinical study was conducted at the outpatient ophthalmic oncology department at the Center for Integrated Oncology of the University Hospital Cologne (between April 2024 and July 2025). Patients with confirmed uveal melanoma or choroidal nevus were enrolled. Physical activity and retinal MVD via optical coherence tomography angiography were assessed. In addition, regression analyses were performed. Results: A total of 42 participants were enrolled with a mean age of 56.14 (±13.48) years (nevus) and 63.45 (±13.76) years (UM). UM eyes (N = 20) demonstrated significantly reduced MVD in both the superficial and deep layer compared to Nevus (N = 22, all p < 0.001, η² = 0.155–0.190), while UM eyes showed greater mean vessel length (B = 5.54, p = 0.009, η² = 0.104). Physical activity was positively associated with MVD in the superficial layer, including vessel area density (B = 1.07, p = 0.022, η² = 0.133) and vessel length density (B = 0.28, p = 0.028, η² = 0.119), independent of group. No significant associations were found in the deep layer and no interaction effects between group and PA were detected. Conclusions: Our findings suggest that habitual PA is positively associated with retinal MVD in the superficial layer, independent of diagnostic group, and may partially counteract tumor-induced as well as treatment-related microvascular disruption. As a low-risk and accessible intervention, PA holds promise as a supportive strategy in the oncological management of UM. Full article

Background/Objectives: Multiple sclerosis (MS) is frequently accompanied by cognitive impairment, yet the neurobiological mechanisms underlying cognitive heterogeneity remain incompletely understood. The choroid plexus (CP), a blood–CSF barrier structure involved in cerebrospinal fluid production and neuroimmune signaling, has recently emerged as a potential MRI marker of inflammatory and neurodegenerative activity in MS. This scoping review mapped evidence on associations between CP features and cognitive functions in adults with MS. Methods: A broad search of PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library identified 1163 records; after deduplication, screening, and full-text assessment, seven studies were included. Results: CP volume or normalized CP volume was assessed in all seven studies, and one study additionally examined the CP T1/T2 ratio. The Symbol Digit Modalities Test was used in six studies, while five applied multidomain cognitive assessment. Larger CP volume was associated in several studies with poorer baseline information-processing speed, visuospatial memory, or multidomain cognition, but longitudinal findings did not show consistent predictive value for CP volume. One study reported that a higher CP T1/T2 ratio predicted faster visuospatial-memory decline. Conclusions: CP-related measures may reflect broader neuroinflammatory and neurodegenerative processes relevant to cognition in MS, but the evidence remains limited and methodologically heterogeneous. Standardized acquisition and segmentation, harmonized cognitive assessment, and adequately powered longitudinal studies are needed to establish their independent and predictive value. Full article

Epilepsy is a challenging brain disease that requires significant clinical findings. (1) Background: The aim of this study is to improve the success rate of epilepsy detection using a newly developed method by optimizing the high-dimensional dataset obtained from brain MRI images. Standard machine learning models fall short of achieving the desired success in high-dimensional datasets. To achieve this, we aimed to develop an optimized hybrid model by combining the local classification power of the k-Nearest Neighbor classifier and the anomaly detection success of the negative selection algorithm. (2) Methods: Cortical and subcortical brain regions were analyzed to examine volumetric differences. A dataset was created by identifying regions statistically significant for epilepsy. This dataset was then optimized using the Scatter Search Snake Optimization algorithm. The performances of six different machine learning models trained on this optimized dataset were compared. (3) Results: The standard and popular models, SVM (82.70%), kNN (78.70%), RF (69.30%), MLP (73.30%), and NSA (95.89%), demonstrated a detection success rate. In contrast, the proposed hybrid model, kNN-NSA (98.65%), demonstrated a detection success rate. (4) Conclusions: The optimized hybrid kNN-NSA approach, which considers local density in such high-dimensional datasets and tolerates outliers within the self-data, appears to outperform traditional methods. Furthermore, this study has demonstrated that volumetric differences in regions not previously reported in the literature, such as WM-hypointensities, ventral DC, and choroid plexus, may be effective in the decision-making process for diagnosing epilepsy, as they are also found to be significant. Full article

Background: To compare retinal microvascular parameters assessed by optical coherence tomography angiography (OCTA) among patients with axial spondyloarthritis (axSpA) receiving different biologic and targeted synthetic therapies and to evaluate the association between smoking status and OCTA-derived retinal microvascular parameters. Methods: This cross-sectional study included 159 eyes of 82 patients with radiographic or non-radiographic axSpA receiving tumor necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), or Janus kinase inhibitors (JAKi) for at least one year. At the time of examination, all patients had BASDAI scores below the established threshold for active disease (BASDAI < 4). Comprehensive ophthalmic evaluation and swept-source OCTA imaging were performed. Superficial capillary plexus vessel density and foveal avascular zone (FAZ) areas in both the superficial (SCP) and deep capillary plexus (DCP) were assessed. Statistical analyses were adjusted for age, sex, smoking status, history of uveitis, treatment duration, and ocular variables. Results: Significant differences were observed among treatment groups in the deep foveal avascular zone (DCP-FAZ) area (p = 0.0060). Post hoc analyses demonstrated larger DCP-FAZ values in patients receiving TNFi than in those receiving IL-17i (p = 0.0010), and larger values in the IL-17i group than in the JAKi group (p = 0.0151). No significant differences were observed in superficial FAZ area or superficial capillary plexus vessel density between treatment groups. Patients receiving JAKi were older and had a shorter treatment duration than those in the other groups. Smoking status was associated with a significantly smaller deep FAZ area (p = 0.0019), whereas no significant association was observed for superficial FAZ measurements. A weak positive correlation was found between intraocular pressure and deep FAZ area (r = 0.18, p = 0.0237), and treatment duration was weakly positively correlated with deep FAZ area (rho = 0.16, p = 0.0454). Conclusions: Retinal microvascular parameters differed among patients with axSpA receiving different classes of biologic and targeted synthetic therapies. Differences were observed primarily in the deep FAZ area, while smoking status was also associated with deep retinal microvascular parameters. Because of the cross-sectional design, these findings should be interpreted as associations rather than evidence of treatment effects. OCTA may provide a useful non-invasive method for assessing retinal microvascular characteristics in patients with axSpA. Further longitudinal studies are warranted to clarify the relationship between systemic therapies, smoking status, and retinal microvascular changes. Full article

Background: Optical coherence tomography (OCT) and OCT angiography (OCTA) retinal imaging in inherited retinal dystrophies (IRD) has been limited to the posterior pole and central midperiphery (up to about 16.5 × 16.5 mm). Two novel commercially available swept-source (SS) OCT/-OCTA devices provide the possibility of wide-field (WF) evaluation of retinal and choroidal structures, including the vasculature, in a single examination. Methods: A limited consecutive series of 16 IRD patients were examined with a BMizar (400 kHz, 24 × 20 mm scan width) and a Dream OCT (200 kHz, 26 × 21 mm scan width) in addition to the normal clinical examination protocol. This series included patients with retinitis pigmentosa, cone-rod dystrophy, macular dystrophy and autosomal recessive bestrophinopathy. In addition, 12 healthy probands were examined. Results: WF-SS-OCT/-OCTA enabled the detection of retinal, choroidal and choriocapillaris alterations in the macular and midperiphery in a short, single examination session of up to 15 s. Even small foveal lesions and a small silent macular neovascularization were detected on WF screening. Regional alterations of choroidal and choriocapillaris flow patterns were identified. These were mostly in correspondence with areas that appeared clinically affected, but unexpected lesions were identified as well. Occlusion of peripheral retinal vessels was seen in retinitis pigmentosa, though flow was detected in retinal vessels, which were difficult to distinguish on fundus images. In one patient with nystagmus, WF-SS-OCT/-OCTA was performed, whereas standard OCT volume scan could not be obtained. The most frequent artifact were horizontal lines of misalignment, which did not interfere with the detection of pathologies. Conclusions: Both WF-SS-OCT/-OCTA devices provide detailed insights in structural and vascular retinal and choroidal alterations in a single, short examination. Larger series of IRD patients examined with WF-SS-OCT/-OCTA promise to provide novel insights into the pathology of IRDs. Full article