Search Results (528)

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publications describing clinical features and management of RA-associated ocular disease were synthesized, and no unpublished data were included.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

Syphilitic panuveitis is a severe and diagnostically highly challenging manifestation of ocular syphilis. Its predominant posterior-segment involvement and its tendency to mimic noninfectious or viral uveitis may delay etiologic recognition and increase the risk of permanent vision loss. Rhegmatogenous retinal detachment (RRD) is a rare but vision-threatening complication that likely reflects advanced, inflammation-induced disruption of the vitreoretinal interface. A narrative literature review was conducted using the PubMed, Scopus, and Web of Science databases (January 2000 to 10 September 2025). Studies addressing the clinical presentation, imaging findings, pathophysiology, and management of syphilitic panuveitis and associated rhegmatogenous retinal detachment were analyzed. Infectious mimickers were also presented, with particular emphasis on West Nile virus (WNV). Evidence was synthesized qualitatively. Posterior uveitis and panuveitis are one of the most common ocular manifestations of syphilis. Posterior segment involvement in ocular syphilis is frequently bilateral, typically presenting with dense vitritis, retinal vasculitis, and optic neuropathy. RRD is a rare presenting complication, most often developing in areas of prior inflammatory retinitis and arising due to retinal necrosis, persistent vitreoretinal traction, and early proliferative vitreoretinopathy, which increases surgical complexity and may limit functional recovery. HIV coinfection often modifies disease severity. In relevant endemic or seasonal settings, WNV-associated ocular inflammation represents an important diagnostic pitfall. Syphilitic panuveitis should be considered early in patients presenting with unexplained posterior uveitis or panuveitis. Routine testing for syphilis and HIV in the uveitic laboratory palette, together with targeted evaluation for infectious mimickers, is essential to reduce diagnostic delay and avoid inappropriate immunosuppression. RRD should be recognized as a marker of advanced, inflammation-induced vitreoretinal interface damage requiring timely antimicrobial therapy and early involvement of vitreoretinal surgery. Full article

Vascular endothelial growth factor (VEGF) is a key regulator of angiogenesis and an established therapeutic target in diseases such as cancer and ocular disorders. However, long-term use of most current anti-VEGF agents is often limited by their associated side effects, including hypertension, bleeding, and gastrointestinal complications. These limitations have stimulated interest in naturally occurring VEGF inhibitors derived from dietary sources, which may offer safer alternatives due to their favorable safety profiles. In this study, we investigated shared structural features of potent VEGFR2 inhibitors, focusing on naturally derived polyphenols. Polyphenols representing multiple structural subclasses were evaluated for their ability to inhibit VEGFR2 kinase activity using an in vitro kinase assay, to suppress VEGF-induced phosphorylation of VEGFR2 and downstream MAPK signaling in endothelial cells by Western blot, and to reduce VEGF-stimulated endothelial cell proliferation. Across all assays, flavonoids with strong VEGFR2 inhibitory activity displayed consistent structural characteristics, including the number and specific positioning of hydroxyl groups on the A- and B-rings, as well as specific structural elements of the C-ring. Our findings provide a strong foundation for further structure–activity relationship (SAR) studies and facilitate identification of key molecular determinants required for VEGFR2 inhibition. Elucidation of these structural patterns may contribute to the development of more effective and safer angiogenesis inhibitors with reduced adverse effects. Full article

Lamellar ichthyosis is a rare congenital disorder of keratinization frequently associated with ocular complications, most commonly cicatricial ectropion and exposure keratopathy. We present a case of severe mixed exposure-related and neurotrophic keratopathy with marked corneal thinning in a 61-year-old man with genetically confirmed lamellar ichthyosis. At presentation, the best-corrected visual acuity (BCVA) in the right eye was limited to hand motion (logMAR 2.3). Slit-lamp examination revealed a large central to inferocentral corneal ulcer measuring approximately 3 × 4 mm with severe stromal thinning in the setting of marked lower eyelid ectropion, incomplete eyelid closure, and chronic ocular surface exposure, while anterior segment optical coherence tomography (AS-OCT) demonstrated a minimal corneal thickness of approximately 165 µm. Microbiological swabs obtained from the conjunctival sac were negative, and no purulent discharge, hypopyon, or anterior chamber inflammatory reaction was present, making active infectious keratitis unlikely. Corneal sensitivity measured with Cochet–Bonnet esthesiometry at presentation, centrally and in all four peripheral quadrants of both eyes, was markedly reduced, more severely in the affected right eye, supporting the presence of a severe neurotrophic component contributing to impaired corneal healing. Intensive conservative therapy including preservative-free lubricants, dexpanthenol gel, autologous serum eye drops, topical insulin, prophylactic antibiotics, and systemic doxycycline was initiated. Serial AS-OCT imaging demonstrated progressive structural recovery, with corneal thickness increasing to 438 µm after one month of treatment and complete corneal epithelialization. The BCVA improved to 0.2 Snellen (0.7 logMAR). This case highlights the diagnostic value of multimodal anterior segment imaging in monitoring severe mixed keratopathy with advanced corneal thinning and demonstrates that intensive conservative therapy may stabilize the ocular surface and prevent corneal perforation in patients with lamellar ichthyosis. Full article

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

Ocular tilt reaction (OTR) and trochlear nerve palsy (TNP) can induce cyclotorsion. We aimed to assess the utility of fundus photography in distinguishing between these disorders. The database of a neuro-ophthalmology hospital-based clinic was retrospectively searched for patients referred for new-onset vertical diplopia between 2020 and 2023. Medical data were collected, and the angle between the optic disc and fovea was measured using ImageJ software to quantify torsion. Distinct torsional patterns were identified between the groups. OTR was characterized by variable, often conjugate torsion, whereas TNP demonstrated consistent disconjugate extorsion. Analysis of interocular torsional relationships, rather than magnitude alone, provided useful diagnostic discrimination. Fundus photography may be useful for differentiating OTR from TNP in complicated neurological cases, particularly in patients who are difficult to examine. This study emphasizes the practical clinical value of fundus photography as a simple, accessible, and objective tool for differentiating OTR from TNP, by contributing the torsional component of OTR triad, particularly in emergency or diagnostically challenging settings where standard examination may be limited. Full article

Elevated temperatures are frequently encountered in numerous occupational settings such as iron and steel foundries, non-ferrous metal foundries, brick and ceramic manufacturing plants, glass production facilities, rubber factories, electrical power plants, bakeries, laundries, chemical processing sites, mining operations, smelting plants, and steam tunnels. Employees working in these environments are at risk of developing various health issues and injuries, including ocular complications, due to prolonged exposure to heat and the physical demands of handling heavy materials. This study focuses on examining the pressure within the eye’s anterior chamber, referred to as Intraocular Pressure (IOP), and its association with the cornea’s biomechanical characteristics, with particular attention to corneal temperature. Our methodology is grounded in the principles of the first law of thermodynamics. The findings reveal a link between the temperature of the eye’s anterior chamber and the biomechanical behaviour of the cornea. Specifically, IOP serves as an indicator of the cornea’s elasticity and its optical properties as influenced by temperature variations. We investigated how the cornea’s elastic energy, or the work it performs, varies with temperature changes. The results show that an increase in temperature corresponds to a reduction in the work exerted by the cornea. The corneal temperature is affected by both the ambient environment and the temperature of the aqueous humour within the anterior chamber. This indicates a relationship between the mechanical work done by the cornea and the pressure exerted by the fluid in the eye’s front segment. Furthermore, our study identified a correlation between corneal thickness and IOP, which our modelling approach successfully quantifies. Utilizing the first law of thermodynamics, we calculated the work performed by the anterior chamber against the cornea’s internal surface. Temperature fluctuations influence the secretion, drainage, and flow characteristics of the aqueous humour, thereby impacting IOP and associated ocular conditions. These insights are valuable for devising strategies aimed at preventing eye injuries among workers exposed to high-temperature environments. Full article

Background/Objectives: To evaluate the short-term effects of direct selective laser trabeculoplasty (DSLT) on retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) thickness in patients with ocular hypertension (OHT) and primary open-angle glaucoma (POAG). Methods: This retrospective, single-center study included 45 eyes of 45 patients with OHT or POAG who underwent DSLT at Shaare Zedek Medical Center between February 2024 and February 2025. The primary outcome was the change in RNFL and GCL thickness, as measured by spectral-domain optical coherence tomography (SD-OCT) before and two months after treatment. Secondary outcomes included intraocular pressure (IOP) reduction, corrected distance visual acuity (CDVA), and safety. Only high-quality OCT scans (quality score > 25) were included in the analysis. Results: OCT analysis revealed no statistically significant changes in the inner retinal structure two months post-treatment. The mean RNFL thickness was 77.1 ± 17.2 µm at baseline and 77.4 ± 17.3 µm at follow-up (p = 0.285). The mean GCL thickness remained unchanged (42.4 ± 11.6 µm vs. 42.4 ± 11.3 µm, p = 0.750). CDVA remained stable (0.2 ± 0.4 vs. 0.2 ± 0.4 logMAR; p = 0.351), and no vision-threatening complications were observed. Mean IOP decreased significantly from 19.7 ± 4.0 mmHg at baseline to 16.2 ± 3.5 mmHg at two months (p < 0.001). The mean total laser energy delivered was 196.5 ± 10.2 mJ (range: 176–210 mJ). Conclusions: DSLT was not associated with significant short-term changes in RNFL or GCL thickness, supporting its structural safety in patients with OHT or glaucoma. Further long-term studies are warranted to determine the durability of these findings and the potential neuroprotective effects of DSLT. Full article

Purpose: This study aimed to comprehensively map the structural impacts of ROP on all ocular structures, including and extending beyond the inner retina and the associated long-term sequelae that manifest into adulthood. Methods: This scoping review identified studies on animal oxygen-induced retinopathy and clinical retinopathy of prematurity using a multi-database search. Study selection and data extraction were performed independently by multiple reviewers using Covidence software. Results: ROP results in lasting ocular complications. Posterior segment findings include choroidal insufficiency, photoreceptor dysfunction, and retinal detachment. Anterior segment complications involve a higher incidence of angle-closure glaucoma, strabismus, and significant myopia. Conclusions: This scoping review was conducted and reported in accordance with the PRISMA-ScR guidelines, though it is limited by the exclusion of non-English studies. Lifelong ophthalmic monitoring is essential for ROP patients due to persistent anterior and posterior segment complications. This study also identifies key future research priorities, including elucidating mechanisms of foveal development and conducting longitudinal studies. Furthermore, as neonatal intensive care expands in low and middle-income regions, international collaboration is vital to guide screening and treatment and prevent a debilitating surge of ROP. Full article

Background: Diabetic retinopathy (DR) remains one of the most frequent and severe complications in patients with type 2 diabetes (T2DM), with significant implications for vision and quality of life. While classical screening methods are effective, they are not always accessible or systematically used. Sudoscan, a device that evaluates sweat gland function by measuring electrochemical skin conductance (ESC)—an indicator of chloride ion flow through sweat glands and a marker of peripheral autonomic nerve function—has recently attracted attention as a potential adjunct tool for risk assessment of microvascular complications. Objectives: In this cross-sectional study, we investigated its utility in identifying DR among 271 adults with T2DM. DR was diagnosed in 35.8% of patients, and those affected showed lower Sudoscan scores in the lower limbs and higher scores indicating cardiovascular autonomic neuropathy. Methods: Statistical analyses, including ROC curve evaluation and multiple linear regression, revealed moderate diagnostic accuracy and significant correlations between Sudoscan parameters and DR severity. Results: Our results suggest that Sudoscan could serve as a fast, painless, and informative screening tool, particularly valuable in settings with limited access to ophthalmologic services. Conclusions: Although it does not replace fundus examination, it may offer complementary insights and help stratify patients by risk level, guiding more targeted monitoring and intervention strategies. Full article

Diabetic retinopathy (DR) is a leading cause of vision loss worldwide and represents a complex neurovascular complication of diabetes mellitus driven by chronic hyperglycemia. Increasing evidence identifies oxidative stress—defined as an imbalance between reactive oxygen species (ROS) production and antioxidant defenses—as a central pathogenic mechanism linking metabolic dysregulation to retinal injury. The retina is particularly vulnerable to oxidative damage due to its high metabolic demand, elevated oxygen consumption, and abundance of polyunsaturated fatty acids. Hyperglycemia activates multiple interconnected biochemical pathways, including the polyol and hexosamine pathways, protein kinase C signaling, advanced glycation end-product formation, and lipid peroxidation, all of which converge on excessive ROS production and mitochondrial dysfunction. Growing attention has focused on oxidative stress biomarkers as tools to characterize DR severity and progression. Elevated systemic markers of lipid, protein, and DNA oxidation, together with impaired antioxidant capacity, correlate with disease stage, while oxidative biomarkers detected in aqueous and vitreous humor reflect localized retinal injury. Importantly, oxidative stress biomarkers are also associated with functional outcomes, including best-corrected visual acuity and diabetic macular edema. Integration of systemic and ocular oxidative biomarkers with clinical staging may improve risk stratification and support personalized therapeutic strategies in DR. Full article

Background/Objectives: To evaluate margin reflex distance-1 (MRD-1), inter-eyelid symmetry, functional visual parameters, and cosmetic outcomes following Müller Muscle–Conjunctival Resection (MMCR) in selected pediatric patients with mild-to-moderate blepharoptosis, good levator function, and a positive 2.5% phenylephrine test. Methods: This retrospective observational study included pediatric patients (<18 years) who underwent MMCR between 2018 and 2023. Surgical indications were based on functional or developmental criteria, including visual axis obstruction, abnormal head posture, significant eyelid asymmetry, or psychosocial concerns, rather than eyelid height alone. Preoperative and postoperative examinations at 1 week, and at 1, 3, and 6 months, included best-corrected visual acuity (BCVA), MRD-1, eyelid symmetry, levator function, lagophthalmos, and ocular surface findings. Outcomes were analyzed separately for unilateral and bilateral cases. Statistical analyses were performed using non parametric tests, with p < 0.05 considered statistically significant. Results: Fifty patients (55 eyes; mean age 13.16 ± 4.04 years) were included. Mean preoperative MRD-1 increased significantly from 1.83 ± 0.89 mm to 2.97 ± 0.83 mm at 6 months (p < 0.001). Postoperative MRD-1 at 6 months showed a significant correlation with the phenylephrine response. In unilateral cases, excellent or satisfactory postoperative symmetry was achieved in 83.6% of eyes. Bilateral cases demonstrated comparable MRD-1 elevation with satisfactory contour and high patient/parent satisfaction. Transient lagophthalmos improved over time. No overcorrection, exposure keratopathy, or significant ocular surface complications were observed. Revision surgery was required in 8.9% of unilateral cases. Conclusions: MMCR is a safe and effective option for appropriately selected pediatric patients, providing predictable eyelid elevation, good symmetry, and low complication rates when functional indications are present. Full article

Background and Objectives: Orbital exenteration performed for advanced malignancies often results in complex defects that are difficult to reconstruct, particularly in patients treated with adjuvant radiotherapy who subsequently develop osteoradionecrosis. This study describes the preliminary results of a surgical technique for secondary orbital reconstruction using a combined scalp flap and temporalis muscle flap (TMF), referred to as the “Pacman flap with tongue,” performed prior to prosthetic rehabilitation. Materials and Methods: Five elderly patients with multiple comorbidities and osteoradionecrosis following orbital exenteration and radiotherapy underwent secondary orbital reconstruction using the “Pacman flap with tongue” technique. The clinical outcomes, flap viability, complications, and feasibility of subsequent prosthetic rehabilitation were assessed. After stabilization of healing, digitally planned ocular epitheses were fabricated using cone-beam computed tomography (CBCT), computer-aided design, and three-dimensional printing. Results: Healing was uneventful in all patients. No flap necrosis, wound dehiscence, or recurrent bone exposure was observed. The reconstructed orbital sockets provided a stable, well-vascularized prosthetic bed, enabling satisfactory prosthetic rehabilitation. Conclusions: The “Pacman flap with tongue” may be considered a feasible option for secondary orbital reconstruction in selected high-risk patients, particularly in the setting of osteoradionecrosis. Full article

Background/Objectives: Childhood-onset Sjögren disease (cSjD) is a rare autoimmune disorder with heterogeneous manifestations and ongoing diagnostic challenges, as there are no validated paediatric criteria. Our study aims to characterise the clinical, laboratory, and imaging features of children diagnosed with cSjD at a single Romanian paediatric rheumatology centre between 2015 and 2025 and contextualise these findings within the most recent literature. Methods: A retrospective review of 15 consecutive cSjD patients was conducted, including clinical features, autoantibodies, imaging, biopsy findings, treatment, and outcomes. Results: Our cohort showed a significant female predominance (80%) and a broad age range at disease onset (3–15 years). Extraglandular manifestations were more common at presentation than glandular phenotypes (53.3% vs. 40%). Lupus-like extraglandular presentations frequently led to initial misdiagnosis as childhood-onset systemic lupus erythematosus (SLE) in our cohort. Sicca symptoms were present at diagnosis in only 3 of 15 patients (20%) and developed later during follow-up in an additional 4 patients (26.7%). Notably, the cohort included novel findings, such as an unprecedented presentation with acute exudative pericarditis complicated by cardiac tamponade. Anti-SSA antibodies and salivary gland ultrasound abnormalities were highly prevalent (86.7% and 100%, respectively). Anti-SSB antibodies were detected in seven patients (46.7%), with titres showing more variability than those of anti-SSA, ranging from just above the positivity threshold to mildly elevated levels. The association with macro-creatine kinase type I was another distinctive feature of this series. Chronic musculoskeletal pain and dryness were our patients’ most frequently reported symptoms at the last assessment, affecting up to 5/15 (33.3%) in each domain. One patient showed irreversible ocular damage during our study. Conclusions: Extraglandular presentations of cSjD are highly heterogeneous and diagnostically challenging, often occurring without glandular symptoms. Lupus-like systemic features—including facial vasculitic purpura, with or without arthralgia, and occasional pericarditis, as observed in our cohort—may contribute to frequent initial diagnostic misattribution to SLE. Early salivary gland ultrasonography, targeted autoantibody testing, and selective biopsy are essential for timely diagnosis, underscoring the urgent need for paediatric-specific validated classification criteria. Full article

Background: The aim of this study was to evaluate the influence of demographic, clinical and physical factors on the occurrence of ocular complications after ruthenium-106 (Ru-106) brachytherapy, iodine-125 (I-125) brachytherapy and proton therapy of uveal melanoma. Methods: A retrospective analysis of 300 patients’ electronic and paper medical records treated for uveal melanoma at the Department of Ophthalmology and Ocular Oncology, University Hospital in Krakow, Poland, from May 2014 to December 2016 was performed. The created database, which includes numerous parameters characterizing patients, tumors, applied treatments and their effects, with particular emphasis on the occurrence of ocular complications, was subjected to detailed analysis. The influence of selected factors on the occurrence of identified complications was checked by performing a univariable Cox proportional hazards regression analysis, and then the factors that were statistically significant were included in a multivariable Cox proportional hazards regression analysis which gave the final results. Results: Of the 300 patients, 125 (41.67%) were treated with Ru-106 brachytherapy (87 (29%) with CCB plaque and 38 (12.67%) with COB plaque), 102 (34%) with I-125 brachytherapy and 73 (24.33%) with proton therapy. Mean follow-up was 88.63 months (median 89, range: 20–127). The occurrence of cataract was associated with the older age of patients. Maculopathy was associated with female sex, younger age, use of I-125 brachytherapy, tumor location involving the macula and/or optic disc and moderate tumor pigmentation. Diagnosis of systemic hypertension was associated with a lower risk of maculopathy. Retinopathy was associated with younger age, tumor location involving the macula and/or optic disc and the use of I-125 brachytherapy. Optic neuropathy was associated with younger age, greater tumor largest base diameter, tumor location involving the macula and/or optic disc and the use of I-125 brachytherapy. Secondary glaucoma was associated with baseline best corrected visual acuity (BCVA) weaker than 0.5, greater tumor thickness, involvement of the left eye and the use of I-125 brachytherapy. Vitreous hemorrhage was associated with greater tumor thickness, tumor location including the macula and/or optic disc and mushroom-shaped tumor. Conclusions: Our study demonstrated an association between demographic, clinical, and physical factors and the occurrence of ocular complications after radiotherapy for uveal melanoma. Full article