Search Results (2,536)

Objective: This study aimed to compare time-dependent changes in visual acuity (VA), central corneal thickness (CCT), intraocular pressure (IOP), and the structure and elasticity of ocular tissues, as measured by shear wave elastography (SWE), in the preoperative, postoperative 1st week, and 1st month periods. Methods: This prospective observational study with repeated measurements included 22 individuals aged 44–86 years who underwent trabeculectomy for medically resistant glaucoma. VA, CCT, and IOP were measured preoperatively and at 1 week and 1 month postoperatively for the study. The elastic properties of ocular tissues were evaluated using the SWE method by obtaining quantitative measurements of lens SWE (LSWE), vitreous SWE (VSWE), optic nerve head SWE (OSWE), and retrobulbar fat SWE (RSWE). The changes in the obtained structural and elasticity parameters were compared preoperatively, 1 week postoperatively, and 1 month postoperatively. Results: When anterior segment parameters were evaluated in individuals who underwent trabeculectomy, there were significant differences in VA (p = 0.001, ${\mathrm{ƞ}}_p^2$ = 0.401), CCT (p = 0.001, ${\mathrm{ƞ}}_p^2$ = 0.806), and IOP (p = 0.001, ${\mathrm{ƞ}}_p^2$ = 0.853) values (p < 0.05). There was no statistically significant difference between preoperative and postoperative measurements at 1 week and 1 month for the elasticity parameters of LSWE, VSWE, OSWE, and RSWE (p > 0.05). Conclusions: This study suggests that the biomechanical adaptation of ocular tissues may be incomplete in the early postoperative period. Non-invasive methods such as SWE can be considered a potential tool for postoperative follow-up and predicting surgical success. Full article

Corneal defects are a major cause of vision loss and require rapid, biocompatible, and effective sealing methods to restore ocular integrity and prevent infection. Current clinical adhesives, such as cyanoacrylate and fibrin glue, are limited by problems such as poor biocompatibility and inadequate stability. This study presents the design and evaluation of a fast-curable polymer bioadhesive hydrogel, a corneal glue formulated for efficient sealing of corneal defects. Hydrogels were synthesized from natural and synthetic polymers, including polyvinyl alcohol (PVA), sodium alginate (SA), and carboxymethyl cellulose (CMC), optimized for rapid gelation (~45 s), robust adhesion (~15 kPa), and mechanical strength (tensile strength ~0.35 MPa and storage modulus G′ indicating strong elastic behavior). Physicochemical and rheological properties, including swelling behavior and optical transparency (>90% transmittance across 400–700 nm), were characterized, including gelation time, swelling behavior, and mechanical strength. In vitro biocompatibility was assessed using human corneal epithelial cells to evaluate cytotoxicity and cell adhesion. Ex vivo studies on human cadaveric corneas with full-thickness defects measured adhesive strength and sealing efficacy through burst pressure (~38 mmHg) and leakage tests, with comparisons to commercial fibrin and cyanoacrylate adhesives. The optimized corneal glue exhibited fast curing, robust adhesion, high water retention with minimal swelling, favorable viscoelastic properties, and excellent cytocompatibility effectively sealing corneal defects in ex vivo models. These results highlight its potential as a promising fast-curable bioadhesive for corneal wound repair and ocular surface restoration. Full article

The aim of this study was to evaluate tear cytokine and chemokine profiles in keratoconus (KC) and to assess their association with long-term tomographic outcomes after corneal collagen cross-linking (CXL). In this cross-sectional observational study, 30 KC eyes and nine healthy controls were enrolled. KC severity was graded using the modified Amsler–Krumeich classification. Tear samples were collected and analyzed using multiplex bead-based immunoassays (LEGENDplex™) for cytokines, chemokines, and TGF-β1. Patients were followed for five years after CXL. Treatment response was categorized according to corneal flattening (<1 D, 1–3 D, >3 D). Individual cytokine levels showed no major differences between the KC and controls, although IL-6 and MCP-1 tended to be higher in the KC group. However, IP 10 and IL-17 were higher in controls (p < 0.05). In contrast, multiple pro-/anti-inflammatory ratios (TNF/TGF-β1, IL-17/IL-10, MCP-1/IL-10, IL-6/IL-10, IL-8/TGF-β1, MCP-1/TGF-β1, IL-6/TGF-β1, and IL-8/IL-10) were significantly elevated in the KC group (p < 0.05), indicating immune imbalance. After five years, all treated eyes remained stable or flattened. Lower baseline MCP-1 and IL-8 levels correlated with greater postoperative corneal flattening (p < 0.05). Keratoconus is characterized by disturbed tear immune homeostasis rather than isolated cytokine elevation. Lower preoperative inflammatory activity may predict a more favorable biomechanical response to CXL, supporting the potential role of tear cytokine profiling in patient stratification and prognostication. Full article

Background/Objectives: The co-occurrence of diabetic peripheral neuropathy and depression increases the symptom burden and risk of long-term complications. Methods: This cross-sectional study enrolled 131 patients with type 1 (age: 58.47 years; duration of diabetes: 35.61 years) and type 2 diabetes (age: 63.60 years; duration of diabetes: 11.49 years). All patients underwent assessment of socioeconomic status and evaluation using the Hospital Anxiety and Depression Scale, the Mental Component Score of the Short Form Healthy Survey Questionnaire, neuropathy disability score, nerve conduction studies, corneal confocal microscopy and intraepidermal nerve fibre density (IENFD) assessment. Results: The prevalence of foot pain (45% vs. 23.9%, p = 0.019), tingling (56.7% vs. 32.9%, p = 0.013), weakness (35% vs. 9.9%, p < 0.001), ataxia (40% vs. 16.9%, p = 0.001), and upper limb symptoms (45% vs. 19.7%, p = 0.001) were statistically significantly higher, while cold perception threshold (22.50 ± 8.47 vs. 26.34 ± 3.08, p = 0.007), corneal nerve fibre density (20.49 ± 7.55 vs. 24.16 ± 5.68, p = 0.002) and length (20.06 ± 6.98 vs. 22.95 ± 6.22, p = 0.014) were statistically significantly lower, but no differences in nerve conduction studies or IENFD were observed in patients with depression compared to patients without depression. Furthermore, patients with depression were from a lower socioeconomic class (51.7% vs. 21.1%, p < 0.001), had lower educational attainment (37.9% vs. 12.9%, p < 0.001), had lower income < £37,000 (29.3% vs. 11.4%, p = 0.010) and lived in areas of high deprivation (62.1% vs. 31.4%, p < 0.001). Conclusions: Comorbid depression in people with diabetes was linked to increased socioeconomic deprivation and a greater prevalence of neuropathic symptoms and small fibre pathology. Full article

Descemet stripping automated endothelial keratoplasty (DSAEK) is a well-established surgical technique for the treatment of endothelial dysfunction, in which intracameral gas tamponade plays a critical role in graft adherence. We report the case of a 67-year-old pseudophakic woman with advanced Fuchs endothelial corneal dystrophy and symptomatic pseudophakic bullous keratopathy in the right eye, who presented with progressive visual deterioration and underwent DSAEK using an 8.25 mm donor graft inserted with a Busin glide and tamponaded with a 25% sulfur hexafluoride (SF6) gas–air mixture. On the first postoperative day, slit-lamp examination suggested an appropriate anterior chamber configuration and satisfactory graft attachment. However, detailed multiplanar anterior segment optical coherence tomography (AS-OCT), defined here as assessment using vertical, horizontal, and rotational scan orientations, revealed subtle posterior migration of the gas bubble beneath the iris plane. This clinically occult finding indicated altered anterior segment anatomy associated with a risk of secondary angle-closure mechanisms and raised concern for malignant glaucoma. Prompt surgical re-intervention was undertaken on postoperative day one, involving decompression of the misdirected gas bubble and reinjection of a centrally positioned tamponade. This resulted in restoration of normal anterior chamber configuration and stable graft adherence. Best-corrected visual acuity (BCVA) improved from 0.1 Snellen (1.0 logMAR) preoperatively to 0.7 Snellen (0.15 logMAR) at 2 weeks following surgery. This case highlights the added value of multiplanar AS-OCT in detecting clinically occult posterior gas migration after DSAEK, particularly when the abnormality is scan-orientation-dependent and not apparent on slit-lamp examination, thereby enabling timely intervention in the presence of a potentially sight-threatening postoperative configuration. Full article

Background and Objectives: The objective of this study is to evaluate whether deferoxamine modulates cell biological properties, such as proliferation and wound closure of porcine corneal endothelial cells (CECs) in vitro, and whether the treatment of CECs with deferoxamine results in an enhanced expression of vascular endothelial growth factor (VEGF). Materials and Methods: Corneal endothelial cells were extracted from porcine globes within 24 h postmortem. Immunohistochemistry for the endothelial Na⁺/K⁺-ATPase was performed to confirm the cells’ endothelial origin. To assess CEC viability and proliferation, a water-soluble tetrazolium salt (WST-1) and 5-bromo-2′-deoxyuridine (BrdU) assay were performed. Corneal endothelial wound closure was evaluated using a wound closure assay. VEGF mRNA expression was evaluated using real-time polymerase chain reaction (rt-PCR). Results: The extracted corneal endothelial cells showed a typical hexagonal morphology with Na⁺/K⁺-ATPase staining of the cell membrane. The treatment with 200 µM deferoxamine significantly increased CEC viability to 121 ± 24% compared to the control group (p = 0.0024). Corneal endothelial cell proliferation did not show any significant changes under the treatment with deferoxamine (p > 0.05). Both 100 µM and 200 µM deferoxamine led to a significantly smaller remaining wound area of 82.4 ± 6.7% and 78.7 ± 6.2% (p < 0.0001) in comparison to the control group after 24 h of treatment in the wound closure assay. Treatment with 200 µM deferoxamine significantly induced VEGF mRNA expression to 1.67- ± 0.57-fold from 1.00- ± 0.03-fold in the control group (p = 0.0006). Conclusions: Deferoxamine effectively enhances corneal endothelial cell viability and wound healing associated with an overexpression of VEGF. Thus, deferoxamine is a potent modulator of cell biological properties of corneal endothelial cells and maintains their integrity in vitro. Full article

Rheumatoid arthritis (RA) is a systemic autoimmune disease that can involve the ocular surface and deeper ocular tissues, leading to a spectrum of ophthalmic manifestations ranging from dry eye disease to vision-threatening inflammation, such as scleritis and peripheral ulcerative keratitis (PUK). This paper presents the results of a narrative review conducted using PubMed and Google Scholar from database inception to March 2026. Eligible publications describing clinical features and management of RA-associated ocular disease were synthesized, and no unpublished data were included. According to the literature, dry eye disease (DED) is the most frequent ocular manifestation of RA, and it is primarily managed with lubrication and topical anti-inflammatory therapies, including cyclosporine and lifitegrast. Additional options for refractory disease include neurostimulation and evaporation-targeted therapy. Scleritis and PUK are less common but represent severe inflammatory complications that generally require systemic immunosuppression. Conventional management includes systemic corticosteroids and steroid-sparing agents such as methotrexate (MTX), azathioprine (AZA), cyclophosphamide (CYC), and mycophenolate mofetil (MMF) in aggressive cases. Escalation to biologic disease-modifying antirheumatic drugs (bDMARDs), specifically tumor necrosis factor-alpha (TNF-α) inhibitors and rituximab (RTX), is supported for refractory scleritis and corneal melt, although evidence is largely observational. Among anti-TNF agents, monoclonal antibodies, such as infliximab and adalimumab, appear more effective than etanercept for ocular inflammation. Rituximab is preferred for vasculitis-associated or refractory disease, and Janus Kinase (JAK) inhibitors represent an emerging option requiring careful safety monitoring. Evidence for DED therapies includes randomized controlled trials (RCTs), whereas data for RA-associated scleritis and PUK are largely derived from registries, case series, and case reports. Prospective studies with standardized ocular outcomes are needed to refine treatment algorithms and compare the effectiveness of biologic versus targeted synthetic agents. Full article

This study aims to characterize diurnal changes in corneal geometry of the anterior and posterior cornea in healthy eyes using global and sector-based metrics, and to explore their associations with lifestyle-related factors. A prospective observational study of 109 eyes was conducted, measuring intraocular pressure (IOP), corneal thickness, volume, and global/sector-based keratometry at five time points over a 10 h period, alongside a lifestyle questionnaire. Results revealed significant diurnal decreases in IOP, central and minimum corneal thickness, and corneal volume (p ≤ 0.031). While posterior keratometry remained stable, anterior keratometry showed statistically significant but clinically negligible changes (amplitude of change ≤ 0.29 D), primarily within the central 4 mm and inferotemporal regions. Weak to moderate positive correlations were found between water and coffee intake, smoking, and changes in corneal thickness and volume, with no relevant effects on keratometric parameters. Overall, corneal thickness and volume exhibit significant diurnal reductions, whereas anterior keratometric changes are minimal and clinically irrelevant globally. These findings underscore the importance of considering the time of day when interpreting corneal measurements, as lifestyle factors appear to modulate corneal thickness but not curvature in healthy eyes. Full article

Background: Eyelid reconstruction is particularly challenging because of the delicate anatomy and its critical functional and aesthetic roles. Although various methods have been described for anterior and posterior lamellar repairs, no standardized approach has been established. We developed a single-stage technique integrating reconstruction of both lamellae. Methods: This retrospective case series included seven consecutive patients who underwent full-thickness eyelid reconstruction between 2012 and 2024. Patients were included if they had full-thickness defects requiring reconstruction of both lamellae, underwent reconstruction using a nasal septal chondromucosal graft combined with a large local flap, and had at least 12 months of follow-up. The posterior lamella was reconstructed using nasal septal chondromucosal grafts, and the anterior lamella using large local flaps. Donor sites were managed using various methods. Results: All patients (7/7) achieved complete graft survival without partial or total graft loss. All patients achieved complete eyelid closure without lagophthalmos, and no cases of ectropion, corneal complications, or graft failure were observed. Buccal mucosal grafting demonstrated the most favorable donor-site outcomes, with uneventful healing and no septal perforation or airway-related complications. Conclusions: This single-stage approach combining chondromucosal grafts and local flaps is a feasible and reproducible option for selected patients, providing reliable structural support and satisfactory functional outcomes. Full article

Background/Objectives: As scleral lens (SL) use continues to expand, particularly for medically necessary management of corneal irregularity and ocular surface disease, it is important to determine if wear of these lenses is associated with eyelid disease. This study evaluated habitual SL wearers for meibomian gland obstruction, meibum quality, and signs of lid margin inflammation. Methods: Eligible participants wore scleral lenses in one or both eyes for any indication and had been wearing their current lens design(s) for at least six months, with habitual wear of ≥5 h per day, six days per week. Eyelid inflammation metrics were specifically assessed. Results: Forty-nine scleral lens wearers (32 females) were enrolled. Upper lid wiper epitheliopathy (LWE) was present in 21 eyes (43%), and lower LWE was present in 15 eyes (31%). Thirty-nine eyes (80%) had expressible meibomian glands. Eyes with no expressible meibum were significantly higher in ocular surface disease (39%, 7/18) than corneal irregularity (11%, 3/27) (p = 0.03). Lid margin telangiectasia was present in wearers with ocular surface disease (61%, 11/18) and corneal irregularity (19%, 5/26) (p = 0.005). Conclusions: Eyelid disease was common among habitual scleral wearers regardless of indication for lens use. Eyes with ocular surface disease demonstrated a higher prevalence of meibomian gland obstruction and lid margin telangiectasia compared to those with corneal irregularity. Full article

Background/Objectives: To evaluate ocular disease and eye care utilization among adults with vitamin A deficiency (VAD) in a high-resource healthcare setting, with particular emphasis on nutritional etiologies, clinical nutrition oversight, and outcomes associated with severity of deficiency. Methods: A retrospective chart review was conducted at Dartmouth Hitchcock Medical Center (DHMC) from 1 January 2019 through 31 December 2022. Adults (>18 years) with measured serum retinol concentrations were identified, and data were extracted on retinol concentration, diagnosis, referring service, and vital status. Patients with VAD (serum retinol <32.5 µg/dL per our laboratory threshold) underwent detailed chart review, including social determinants of health and documented nutritional risk factors. For patients with VAD who received an ophthalmologic evaluation, slit lamp findings, ocular symptoms, duration of deficiency, and vitamin A treatment were assessed. Results: VAD was identified in 752 of 2725 patients (27.7%) tested for VAD, and 330 patients had concentrations below the World Health Organization (WHO) threshold for VAD (<20 µg/dL). Hepatic, nutritional, and malabsorptive conditions were prominent contributors, including cirrhosis related to alcohol use or hepatitis C virus (30%), malnutrition or malabsorption following bariatric surgery (24%), and pancreatic insufficiency (20.1%). Food insecurity data were incomplete but showed no significant association with vitamin A concentration. Despite biochemical evidence of deficiency, only 72 patients with VAD (9.6%) underwent ophthalmologic evaluation, and only three were referred specifically due to VAD. Clinical signs or symptoms consistent with xerophthalmia were observed in 21% of those evaluated, and 18% demonstrated corneal findings. Vitamin A supplementation was documented in just over half of symptomatic patients, with objective or symptomatic improvement noted in three cases. VAD was explicitly acknowledged in only 9.7% of ophthalmology notes. Increasing severity of VAD was strongly associated with mortality (p < 0.001), independent of food insecurity, which showed no association with serum retinol concentrations. Conclusions: In this high-resource clinical setting, VAD is common in an at-risk population and largely driven by nutrition-related disease states affecting absorption, metabolism, and hepatic storage. Despite clear biochemical deficiency and associated mortality risk, VAD is underrecognized, undertreated, and infrequently linked to ocular evaluation, highlighting a critical gap in nutrition-focused screening, interdisciplinary communication, and proactive vitamin A assessment in medically complex adults. Full article

Corneal alkali burn induces severe inflammation and tissue damage, leading to loss of corneal transparency and vision impairment. In this study, we evaluated the therapeutic potential of rapamycin (RAPA) compared with cyclosporine A (CsA) in a mouse model of corneal alkali burn, focusing on nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)–mediated inflammatory signaling and its impact on corneal wound healing and repair. Notably, RAPA robustly suppressed NF-κB activation, reduced infiltration of F4/80 macrophages and MPO neutrophils, and downregulated pro-inflammatory cytokines, including TNF-α, IL-1β, and IL-6. RAPA also markedly inhibited corneal neovascularization, as evidenced by decreased VEGF expression, reduced CD31 vessel formation, and suppression of Ang-2. RAPA substantially inhibited pathological fibrotic remodeling by reducing TGF-β1 expression, attenuating myofibroblast activation (α-SMA), decreasing collagen III deposition, and modulating matrix remodeling through suppression of MMP-9. Crucially, RAPA preserved epithelial barrier integrity by maintaining occludin expression, supported proper epithelial differentiation through sustained expression of CK12, and enhanced mucin layer stability by increasing MUC1 expression. It also restored tear production, reduced apoptotic cell death (TUNEL), and decreased dysregulated epithelial proliferation (Ki67). In conclusion, RAPA showed superior efficacy compared with CsA, primarily by enhancing corneal wound healing and facilitating structural and functional outcomes in the burned cornea. These findings underscore RAPA as a promising therapeutic candidate for ocular surface repair and vision restoration in extensive corneal injury. Full article

Corneal scarring is a result of unregulated fibrotic processes in wound healing, which causes visual impairment. Bioactive sphingolipids (SPLs) are known to modulate physiological processes that are central to wound healing. Of these bioactive SPLs, sphingosine-1-phosphate (S1P) is perhaps the most studied. Previous research has shown that knocking out sphingosine kinase 1 (Sphk1), which produces S1P, alters SPL species metabolism and improves wound healing in mice corneas. However, it is unknown how SphK1 knockout (SphK1^-/-) affects SPL metabolism during stages of corneal wound healing. Following an alkali burn procedure on wild-type (WT) and SphK1^-/- mice, corneal lipidomic profiles in unburned corneas at 1, 7, 14, and 28 days post-injury (DPI) were measured. Significant differences in SPL species between genotypes, both in uninjured mouse corneas and during distinct stages of corneal burn healing, were observed. WT mice expressed burn healing stage-dependent modulation of SPL species, with decreased expression of most SPL species observed at 1 and 14 DPI. Interestingly, this wild-type SPL modulation was absent in most measured SPL species in the SphK1^-/- corneas. These findings provide evidence for a previously unknown modulatory role of SphK1 and S1P on the expression of SPLs during corneal wound healing. Full article

Background: Keratoconus is a progressive corneal condition that leads to visual impairment and is primarily managed with corneal cross-linking (CXL), a procedure designed to halt its progression. However, while the clinical outcomes of CXL are well-documented, its impact on patient well-being, including postoperative pain and recovery, remains underexplored. This study aimed to evaluate postoperative pain, functional limitations, visual recovery, and patient-reported outcomes following corneal cross-linking (CXL) for keratoconus. Methods: A structured survey was conducted among 31 patients who underwent CXL for keratoconus. The survey assessed postoperative pain using a Numeric Rating Scale (NRS) and collected information on visual recovery, functional limitations, and the socioeconomic effects of the procedure. Clinical data, including best-corrected visual acuity (BCVA) and keratometry, were also recorded before and after CXL to evaluate the procedure’s efficacy. Results: The study found that postoperative pain was moderate, with a mean pain score of 6.06 ± 1.82, typically lasting 1–3 days. Nearly 54.8% of patients reported significant disruption to daily activities, including missing work or studies, and 77.4% experienced some degree of functional limitation. A statistically significant correlation was observed between postoperative pain intensity and quality-of-life impairment (Spearman’s ρ = 0.503, p = 0.004). Despite these challenges, 93.5% of participants reported improvement in vision, with most recovering within a week. Objective clinical data supported the effectiveness of the procedure. Conclusions: Corneal cross-linking is associated with favorable clinical outcomes; however, the early postoperative period is characterized by moderate pain and functional limitations, highlighting the importance of patient-centered care. Full article

Background: Corneal sensitivity is a key indicator of ocular surface health. This prospective, cross-sectional study evaluated agreement between corneal sensitivity thresholds obtained from equivalent stimulus settings on a contemporary, enhanced dual-temperature non-contact corneal aesthesiometer (NCCA) and a previously validated (standard) device. Methods: Central corneal sensitivity thresholds were measured in the right eyes of healthy participants using both devices. Participants with previous ocular surgery, laser treatment, trauma, contact lens wear, diabetes, or peripheral neuropathy were excluded. Sensitivity thresholds were determined using a forced-response, double-staircase protocol. Inter-device agreement was assessed using Bland–Altman analysis, and consistency was assessed using intraclass correlation coefficients. Results: Median corneal sensitivity thresholds in 51 healthy participants (32 female, 19 male; mean age: 33 ± 14 years) did not differ between enhanced (0.23 [0.18 to 0.38]) and standard (0.25 [0.15 to 0.35]) NCCA instruments (p = 0.73). Bland–Altman analysis demonstrated moderate inter-device agreement, with a mean difference of −0.01 mbar (95% limits of agreement: −0.41 to 0.39 mbar). Linear regression analysis identified greater measurement discrepancies at higher thresholds (p < 0.05), indicating greater variability in individuals with reduced corneal sensitivity. Conclusions: The enhanced NCCA yields reliable corneal sensitivity measures for a room-temperature stimulus and acceptable agreement with the existing (standard) model. Full article