Search Results (1,217)

Background/Objectives: To describe the progression of axial and segmental ocular biometric lengths and refractive status in adolescents and study independent associations between these changes and baseline ocular biomechanics. Methods: Prospective cohort of 126 eyes from 63 individuals followed for 2.5 years. Data from general health and lifestyle were collected through a validated questionnaire. Data from ocular biometry (IOL MASTER 700^®), objective refraction, and ocular biomechanics (Corvis ST^®) were collected at baseline and the end of follow-up timepoints. Biomechanical parameters were correlated with the variation in axial length (d_AL), vitreous cavity length (d_VCL), and spherical equivalent (d_SE). Multivariable linear regression models (one eye randomly assigned) adjusted for age, SE, and AL were developed to identify independent associations between baseline biomechanics and d_AL, d_VCL, and d_SE. Results: The cohort of the present work had a mean age of 14.1 ± 2.6 years at baseline. Variations of 0.122 ± 0.17 mm, 0.092 ± 0.17 mm, and −0.32 ± 0.9 D were found in AL, VCL, and SE at follow-up, respectively. Within the multivariable regression models, the biomechanical parameters found to be independently associated with d_AL (model 1), d_VCL (model 2), and d_SE (model 3) were as follows: Model 1—Biomechanically corrected IOP (bIOP), Integrated Radius (IR), and A2 Deflection Area (A2DArea); Model 2—bIOP, IR, and A2DArea; and Model 3—IR and WholeEyeMovementMAxTime (MaxWEMT). Conclusions: The study of ocular biomechanical behavior may play a pivotal role in the risk assessment of ocular elongation and myopic progression. This work found independent associations between ocular biomechanical behavior at baseline and axial and segmental ocular elongation and refractive myopization, mainly including bIOP, IR, and MaxWEMT. Full article

Glaucoma is a complex condition with an unknown exact cause, but it involves progressive damage to the optic nerve. This damage is primarily driven by high eye pressure, poor blood flow, and oxidative stress, a process linked to cell ageing and inflammation that harms the retina. Recent research highlights that these issues stem from structural changes in the eye’s drainage system and visual pathways, which can be analysed through the lens of engineering thermodynamics. This study proposes a thermal explanation for the physiological processes linking ocular behaviour to inflammatory ion flux alterations. We develop a thermal model demonstrating that temperature increases are tied to the mechanical work necessary for maintaining water flux in the anterior ocular chamber. We show that these changes alter the membrane potential and tissue pH, resulting in elevated intraocular pressure. By clarifying the temperature–pressure effect, this research establishes a theoretical framework to study the developments of future glaucoma therapies. Full article

Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness driven by elevated intraocular pressure from compromised aqueous outflow. While genome-wide association studies have identified numerous risk loci, specific candidate proteins and their cellular mechanisms remain elusive. We employed a multi-omics framework integrating UK Biobank plasma proteomics (N = 53,022) and large-scale POAG GWAS summary statistics. We performed a Proteome-Wide Association Study, Mendelian Randomization, and Bayesian colocalization to infer causality. Identified candidates were mapped to human and mouse ocular scRNA-seq atlases to characterize cell-type specificity, followed by druggability assessments. We prioritized five putative causal proteins, with SEL1L and TFPI demonstrating the strongest evidence. Cross-species scRNA-seq revealed that SEL1L and SERPINF1 are robustly expressed in the trabecular meshwork (TM), particularly the juxtacanalicular tissue, implicating them in outflow resistance. Conversely, TFPI and SLC9A3R2 localize to Schlemm’s canal endothelium, suggesting a role in modulating barrier function. Pathway analyses highlighted endoplasmic reticulum protein processing and coagulation cascades. This study maps putative causal POAG proteins to conventional outflow pathway cells, highlighting SEL1L as a novel target for TM homeostasis and TFPI for drug repurposing, thereby providing data-driven hypotheses to facilitate precision glaucoma therapeutics. Full article

Accurate intraocular pressure (IOP) assessment is essential for glaucoma diagnosis and follow-up. Conventional contact tonometry (e.g., Goldmann and rebound devices) remains widely used, but its accuracy is affected by operator dependence, alignment errors, and patient discomfort. We present a non-contact IOP estimation framework based on corneal stress birefringence and full-field fringe inversion. Ex vivo porcine corneas were imaged under controlled pressure loading from 15 to 20 mmHg, and a coupled stress-optic/shell mechanics model was used to generate pressure-indexed synthetic fringe fields for inverse fitting. In the 15–18 mmHg range, more than 75% of the estimates were within plus or minus 1 mmHg of the reference pressure; performance declined at 19–20 mmHg, consistent with a stronger nonlinear biomechanical response and reduced fringe separability. Defect experiments further showed that local stiffness loss caused both near-defect distortion and far-field stress redistribution, supporting the need for full-field rather than point-wise analysis. These results indicate that stress-birefringence imaging is a promising route toward non-contact, region-sensitive IOP assessment. Full article

Continuous intraocular pressure (IOP) monitoring is crucial for glaucoma management. Currently, traditional static IOP measurements often fail to detect circadian fluctuations, leading to a clinical dilemma where “normal IOP” is observed despite persistent visual field deterioration. This study presents a wireless, passive localized surface plasmon resonance (LSPR) sensing platform integrated into flexible silicone hydrogel contact lenses. Gold nanoparticles (AuNPs), synthesized via the sodium citrate reduction method, were incorporated into the lens periphery using a “swelling-induced nano-doping” technique to transduce IOP-induced corneal strain into detectable spectral shifts. Ex vivo porcine eye investigations established a physical mapping model, confirming significant LSPR peak wavelength response trends in correlation with IOP variations (10–50 mmHg) and corneal curvature changes. Subsequent 21-day in vivo rabbit studies demonstrated excellent ocular surface biocompatibility; quantitative histopathological analysis (HE, PAS, and Ki67 staining) revealed no significant adverse alterations in corneal endothelial cell density or conjunctival goblet cell function compared to control groups (p > 0.05). Furthermore, the platform maintained high structural integrity and anterior segment tolerance under transient high-IOP conditions. While currently a proof-of-concept, these results indicate that the LSPR-active hybrid system effectively captures dynamic IOP fluctuation patterns as an optical response to acute interventions, providing a foundational engineering path for next-generation, battery-free wearable diagnostics in personalized glaucoma care without the need for built-in electronics. Full article

Purpose: To evaluate the clinical efficacy and safety of eye drops containing lyophilized amniotic membrane (AM) in the treatment of dry eye disease (DED), with a focus on tear film stabilization and epithelial–immune balance. Methods: In this prospective cohort study, 40 patients (80 eyes) with DED were followed over six visits. The primary outcome was tear break-up time (TBUT). Secondary outcomes included corneal and conjunctival staining graded by the Oxford scale, meibomian gland parameters, corneal sensitivity (Cochet–Bonnet esthesiometry), best-corrected visual acuity, intraocular pressure (IOP), and Schirmer I test. Continuous variables were analyzed using repeated-measures ANOVA with Greenhouse–Geisser correction and Bonferroni post hoc testing; ordinal outcomes were analyzed using the Friedman test with Dunn–Bonferroni correction. Results: TBUT increased significantly in both eyes (OD: +5.3 s; OS: +4.9 s; both p < 0.001; ηp² ≈ 0.33). Corneal and conjunctival staining scores decreased (p < 0.001), meibomian gland quality and expressibility improved (p < 0.001), and corneal sensitivity increased (p < 0.001), while visual acuity and IOP remained stable. Schirmer I values showed no significant change. The combined pattern of changes (TBUT ↑, staining ↓, meibum/expressibility ↑, sensitivity ↑) indicates tear film stabilization and ocular surface improvement with a preserved safety profile. Conclusions: Lyophilized AM eye drops significantly prolong TBUT and improve clinical signs of DED, presumably by restoring the extracellular matrix (ECM) niche and the heavy-chain hyaluronan/pentraxin 3 (HC-HA/PTX3) complex, reducing proteolytic burden, and promoting a pro-resolving immune balance, with potential neurotrophic effects. These findings support the adjunctive use of AM-derived eye drops within contemporary TFOS DEWS II-based management algorithms for dry eye disease. Full article

Purpose: The aim of this study is to describe a slit-modified 23-gauge infusion trocar designed to enable early postoperative hypotony-free sclerotomy closure by allowing scleral suturing prior to complete trocar removal, and to report initial clinical outcomes in eyes with proliferative diabetic retinopathy with or without vitreous hemorrhage (PDR + H and PDR). Methods: A standard 23-gauge metallic (titanium) trocar was modified by creating a longitudinal slit that permitted passage of a suture needle while the trocar remained partially engaged within the scleral tunnel. At the end of pars plana vitrectomy, a transscleral suture was placed through the slit with the knot prepared prior to trocar removal, followed by simultaneous trocar extraction and suture tightening. Eighteen consecutive patients undergoing vitrectomy for PDR (fourteen with vitreous hemorrhage [PDR + H]; four without) were included. Intraocular pressure (IOP) was recorded preoperatively, immediately after sclerotomy closure (postoperative baseline), and at 8 and 24 h postoperatively. The study was designed as an exploratory pilot feasibility and safety evaluation of a slit-modified infusion trocar in 23-gauge vitrectomy. The primary outcomes were postoperative IOP stability and wound leakage. Secondary outcomes included early hypotony, postoperative hemorrhage, choroidal effusion, and the need for additional suturing. Results: All procedures were completed without intraoperative complications. The mean IOP was 14.83 ± 2.50 mmHg preoperatively, 13.33 ± 1.53 mmHg immediately after closure, 14.17 ± 3.01 mmHg at 8 h, and 15.17 ± 1.79 mmHg at 24 h. No cases of wound leakage or early postoperative hypotony were observed in either subgroup. One eye exhibited a transient IOP increase at 8 h; no choroidal effusion, postoperative hemorrhage, or need for secondary suturing occurred. Endotamponade consisted of balanced salt solution (BSS) in eight eyes, SF6 in seven eyes, silicone oil in two eyes, and air in one eye. Conclusions: The slit-modified infusion trocar enables secure, hypotony-free closure of the infusion sclerotomy by eliminating the open-wound interval during trocar removal. This simple biomedical device modification provides stable early postoperative IOP across different tamponade agents and appears safe and feasible in high-risk eyes with PDR. Full article

Background/Objectives: To investigate the scleral inferior rectus–optic nerve distance (SIROND) and its association with intraocular pressure (IOP) elevation during upward gaze in patients with thyroid eye disease (TED), based on magnetic resonance imaging (MRI) examinations. Methods: This prospective study included 20 eyes (13 patients) diagnosed with active TED. All patients underwent orbital MRI in both primary and upward gaze positions before and 6 months after steroid pulse therapy. The SIROND was measured on MRI. IOP was recorded in both gazes. Changes in SIROND, inferior rectus (IR) muscle volume, proptosis, optic disc and scleral morphology, and IOP were analyzed pre- and post-treatment. Results: SIROND significantly decreased from primary gaze to upward gaze both before and after treatment (p < 0.001). Following steroid pulse therapy, there were significant reductions in IR muscle volume and proptosis (p < 0.05). Correspondingly, SIROND significantly increased in both primary and more in upward gaze post-treatment (p < 0.05). Although IOP during upward gaze was significantly higher than that in primary gaze both before and after treatment (p < 0.001), the gaze-related difference in IOP (p = 0.059), as well as SIROND, tended to be smaller after treatment (p < 0.001). A larger reduction in gaze-related pre-treatment SIROND was associated with greater IOP elevation in upward gaze (p = 0.038). MRI showed no evidence of globe compression by the IR muscle, and optic disc morphology remained unchanged following treatment. Conclusions: SIROND may serve as supportive radiological evidence for IOP elevation induced by upward gaze in patients with TED. Full article

Glaucoma is a collection of disorders that result in permanent vision loss and is characterized by a gradual decline in retinal ganglion cells. While it may not always be high, intraocular pressure (IOP) is the sole risk factor that can be modified according to extensive clinical research. Glaucoma remains the leading cause of irreversible blindness, yet early treatment lowering intraocular pressure is effective in slowing the rate of visual deterioration. Issues like poor absorption, low bioavailability, and short drug resistance time have thus made the management of glaucoma challenging when using conventional ophthalmic drugs. Thus, extensive research has been conducted to explore specific nanodrug delivery systems from various nanocarriers such as nanoparticles, micelles, liposomes and nanofibers, with a focus on systems that have achieved drug release for more than 12 h. These carriers have demonstrated substantial improvements in a lot of the evaluated aspects: enhancing ocular barrier-crossing capabilities, improving bioavailability, prolonging drug release, targeting active tissues of interest, and reducing IOP. This review covers recent developments in nanocarrier ocular delivery systems regarding the management of glaucoma. In this study, the advantages and disadvantages of each system were evaluated and their potential for advancing translation from research to clinic were assessed. Full article

Acute lymphoblastic leukemia (ALL) is a malignant neoplasm of the blood and bone marrow characterized by the uncontrolled proliferation of precursor cells of B- or T-lymphocyte lineage. Usually, the disease arises because of spontaneous mutations in bone marrow cells. Risk factors include genetic predisposition, exposure to ionizing radiation, prior chemotherapy or radiotherapy, and certain environmental factors. Clinical manifestations may include recurrent infections, anemia, and an increased tendency toward bleeding and stroke. A 12-year-old boy presented to the emergency department with a sudden decrease in visual acuity in the right eye. Best-corrected visual acuity (BCVA) in the right eye was 0.02, and intraocular pressure (IOP) was 16 mmHg. Ophthalmologic examination revealed a macular hemorrhage in the right eye. Blood samples were obtained for laboratory analysis. Complete blood count demonstrated leukocytosis with a white blood cell (WBC) count of 362.58 × 10³/µL, thrombocytopenia with a platelet (PLT) count of 87 × 10³/µL, hemoglobin (Hgb) level of 8.7 g/dL, and a red blood cell (RBC) count of 3.46 × 10⁶/µL. The patient was subsequently referred to the Department of Pediatric Hematology, where the diagnosis of acute lymphoblastic leukemia of B-cell precursor origin was confirmed. Appropriate systemic therapy targeting the underlying disease was initiated. Full article

Background: The T-hook is a recently introduced device for ab interno trabeculotomy, first reported in 2022. This study compared the one-year surgical outcomes of Kahook Dual Blade (K group)- and T-hook (T group)-assisted trabeculotomy combined with phacoemulsification in patients with primary open-angle glaucoma (POAG). Methods: This retrospective study included patients with POAG who underwent 180° ab interno trabeculotomy combined with phacoemulsification at our institution between June 2018 and September 2024 and were followed for at least 12 months. Changes in intraocular pressure (IOP), mean IOP reduction rate, number of antiglaucoma medications, postoperative complications (hyphema and transient IOP spikes), and cumulative surgical success rates were evaluated. Results: A total of 45 patients (61 eyes) were included, comprising 29 patients (42 eyes) in the K group and 16 patients (19 eyes) in the T group. A transient increase in IOP at one week postoperatively observed in the K group (p < 0.0001); however, both groups demonstrated significant IOP reduction from baseline after 1 month (p < 0.05). The mean IOP reduction rate at 12 months did not differ significantly between groups (p = 0.0720, ANCOVA). The number of antiglaucoma medications significantly decreased at all postoperative time points in both groups compared with baseline (p < 0.05). Kaplan–Meier survival analysis revealed no significant difference in cumulative surgical success rates between groups (p = 0.6217). The incidence of hyphema was comparable between groups (p = 1.00), whereas transient IOP spikes occurred significantly more frequently in the K group (p = 0.0057). Conclusions: While both procedures demonstrated comparable intraocular pressure-lowering efficacy, T-hook-assisted trabeculotomy was associated with fewer transient postoperative IOP spikes during the early postoperative period in this cohort. Full article

Background/Objectives: The aim of this study was to investigate the effects of intraocular pressure (IOP)-lowering drops on the sublayers of the human tear film as assessed by a novel nanometer-resolution Tear Film Imager (TFI, AdOM, Israel). Methods: In a prospective, cross-sectional study, 98 eyes from 56 adult human subjects were imaged using the TFI. The dataset included data from 18 eyes from 12 subjects treated with preserved IOP-lowering drops and 80 eyes from 44 control subjects not under ocular hypotensive therapy. Subjects in the IOP treatment group used a variety of IOP-lowering medications, including prostaglandin analogs, beta-blockers, carbonic anhydrase inhibitors, alpha agonists, and combination drops. A linear mixed effects model was used to assess the association between IOP-lowering therapy and tear film (TF) metrics, controlling for age and intra-individual correlation. The following parameters were measured: muco-aqueous layer thickness (MALT), muco-aqueous layer thinning rate (MALTR), lipid layer thickness (LLT), lipid map uniformity (LMU), inter-blink intervals (IBI), and lipid break-up time (LBUT). Results: Average ages significantly differed (p = 0.013) between the treatment group (66.5 years) and control group (average age 51.5 years), and thus results were adjusted for age accordingly. IOP was 17.1 mmHg in the treatment group and 16.1 mmHg in the control group. When analyzing the sublayers of the TF, MALTR had a significant association with IOP-lowering therapy after adjusting for age, with a difference of −52.68 nm/s; 95% confidence interval [−96.87, −8.48]; p-value = 0.020. Additionally, IBI was significantly associated with IOP-lowering therapy after log transformation (p = 0.049), with shorter IBI in the treatment group. All other metrics (MALT, LLT, LMU, and LBUT) were statistically insignificant (p > 0.05). Conclusions: These pilot results suggest that IOP-lowering drops may accelerate thinning of the TF, specifically the muco-aqueous layer. Longitudinal studies with significantly larger samples are needed to specify the differential impact of various ocular hypotensive therapies on the human TF and the clinical implications of these findings. Full article

Glaucoma remains a primary cause of blindness, yet its pathogenesis often extends beyond intraocular pressure (IOP). This review integrates four converging lines of metabolic evidence—aqueous humor (AH) metabolomics, kynurenine pathway (KP) activity, tetrahydrobiopterin (H4BIP) biology, and NAD/one-carbon dysfunction—into a testable framework for retinal ganglion cell vulnerability. By utilizing a systematic AH metabolomics atlas covering glaucoma, pseudoexfoliation, and diabetes on a standardized HILIC-LC-HRMS platform, we demonstrate that, while aromatic amino acid elevations are non-specific markers, kynurenine monooxygenase (KMO) upregulation is a condition-specific glaucoma signature. These local findings are corroborated by systemic evidence: POAG patients exhibit significant folic acid deficiency (p = 0.007) and elevated alpha-1-antitrypsin (AAT). Critically, AAT correlates inversely with both serum folate (r_s = −0.485, p < 0.001) and retinal nerve fiber layer thickness (r_s = −0.386, p = 0.017), providing the first in-patient evidence linking systemic inflammation to structural optic nerve damage. We conclude that KMO serves as a critical enzymatic node linking tryptophan metabolism, H4BIP availability, and NAD synthesis. These results characterize glaucoma as a disease of progressive cofactor failure and define a research agenda for multimodal metabolic neuroprotection. Full article

Background and Objectives: Open-angle glaucoma subtypes share a structural phenotype but differ in pathophysiology: pseudoexfoliative glaucoma (PXG) involves vascular endothelial dysfunction associated with deposition of exfoliative material, whereas normal-tension glaucoma (NTG) reflects primary vascular dysregulation in the absence of elevated intraocular pressure. We characterized subtype-specific OCT angiography (OCTA) profiles obtained from a 3 × 3 mm macular scan and evaluated their discriminatory power for pairwise subtype classification. Materials and Methods: This was a single-center, cross-sectional study of 304 eyes: 198 glaucomatous eyes—primary open-angle glaucoma (POAG, glaucoma simplex in our clinical nomenclature), n = 102; PXG (glaucoma capsulare), n = 68; NTG (glaucoma sine tensio), n = 28—and 106 healthy controls. The Cirrus HD-OCT 5000 AngioPlex 3 × 3 mm OCTA protocol was used to assess vessel density (VD), perfusion density, foveal avascular zone (FAZ) morphology, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) thickness. Analyses included Kruskal–Wallis tests with Bonferroni post hoc correction, ROC analysis with DeLong comparison of combined versus structural-only models, multivariate regression, and an exploratory XGBoost classifier with SHAP-based interpretation. Results: VD Inner and Perfusion Inner were lower in PXG (16.37 ± 3.33%; 0.31 ± 0.05) than in POAG (18.73 ± 3.41%; 0.34 ± 0.05; both p < 0.001); Perfusion Inner was also lower than in NTG (p < 0.05). FAZ Area was largest in NTG (0.27 ± 0.11 mm²) and greater than in PXG (0.19 ± 0.08; p < 0.01); FAZ Circularity differed across subtypes (p < 0.001). Combined OCTA–structural models outperformed structural-only models for POAG vs. PXG (DeLong p = 0.002) and for PXG vs. NTG (AUC = 0.770; p = 0.010). Sector-resolved Spearman analysis revealed subtype-specific coupling: in NTG, VD Inner and Perfusion Inner correlated with the inferior RNFL (r = 0.53 and r = 0.52; both p < 0.01); in PXG, coupling shifted nasally (r = 0.41 and r = 0.46; both p < 0.001). The exploratory XGBoost classifier separated glaucoma from controls with an internal cross-validated AUC of 0.975 ± 0.008 (5-fold CV; not externally validated); FAZ Circularity (mean |SHAP| = 0.418) and FAZ Area (0.411) were the top inter-subtype features, supported by case-level SHAP. RNFL avg and average GCC independently predicted MD across subtypes; in PXG, Perfusion Inner also predicted MD (β = −32.78; p = 0.032). Conclusions: In this single-center, cross-sectional cohort, OCTA revealed subtype-associated macular microvascular profiles that are complementary to structural OCT. Reduced vessel and perfusion density characterized PXG, whereas FAZ enlargement and reduced circularity distinguished NTG and PXG. Vascular–structural coupling was nasal-predominant in PXG and inferior-predominant in NTG. Combined multimodal models outperformed structural-only approaches. Macular perfusion additionally predicted MD in PXG. The XGBoost/SHAP analysis is exploratory; prospective and externally validated studies are required before clinical deployment. Full article

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. Full article