Search Results (779)

Background/Objectives: Enucleation, evisceration, and exenteration remain essential in ophthalmic practice, despite advances in medical and surgical care. Optimal outcomes rely on meticulous technique, implant selection, and long-term socket rehabilitation. This study reports a single surgeon’s 15-year experience managing anophthalmic sockets at a tertiary referral hospital in Southeast Asia. Methods: A retrospective review was conducted. Clinical records were examined for demographics, indications, type of surgery, implant characteristics, wrapping material, complications, and secondary interventions. Results: A total of 175 anophthalmic sockets were managed (82 primary, 88 secondary). Mean age was 34.1 ± 30.0 years, 54.9% males. The most common indications were ocular/orbital tumors and trauma. Among primary cases, 70 underwent enucleation, 7 evisceration, and 5 exenteration. The most common implant placed was porous polyethylene (Medpor). Donor sclera was the most frequently used wrapping material. Fifteen (18.3%) primary sockets developed postoperative complications, implant exposure being the most common. Among secondarily managed sockets, more than half had severe complications, particularly severe socket contraction and post-enucleation socket syndrome. Conclusions: Anophthalmic sockets remain a complex and challenging condition in ophthalmic practice. Tumors and trauma were the leading indications for globe removal in this cohort. Despite refinements in surgical technique, complications persist, emphasizing the need for multidisciplinary, long-term care to optimize functional and aesthetic outcomes. Full article

Dry eye disease (DED) is increasingly recognized as a condition driven by immune dysregulation at the ocular surface (OS). Chronic inflammation, mediated by aberrant activation of both innate and adaptive immune pathways, underlies disease progression and symptom persistence. Neuroimmune interactions further amplify OS inflammation, contributing to epithelial damage and impaired homeostatic regulation. This review summarizes current literature on the immunopathogenesis of DED, highlighting the complex interplay of molecular mechanisms of innate and adaptive immune activation, neuroimmune-mediated inflammation, and emerging molecular and cellular biomarkers. In addition, we examine existing and emerging therapeutic strategies that target these immune-molecular pathways, including precision immunomodulatory approaches, to inform future management of DED. By integrating mechanistic insights with clinical findings, this review aims to provide a comprehensive overview of the molecular mechanisms underlying the dysregulated immune response associated with DED. Full article

Background: This paper aims to provide an overview of corneal birefringence (CB), systematize the knowledge and current understanding of CB, and identify difficulties associated with introducing CB into mainstream clinical practice. Methods: Literature reviews were conducted, seeking articles focused on CB published between the early 19th century and the present time. Secondary-level searches were made examining relevant publications referred to in primary-level publications, ranging back to the early 17th century. The key search words were “corneal birefringence” and “non-invasive measurements”. Results: CB was first recorded by Brewster in 1815. Orthogonally polarized rays travel at different speeds through the cornea, creating a slow axis and a fast axis. The slow axis aligns with the pattern of most corneal stromal collagen fibrils. In vivo, it is oriented along the superior temporal–inferior nasal direction at an angle of about 25° (with an approximate range of −54° to 90°) from the horizontal. CB has been reported to (i) influence the estimation of retinal nerve fiber layer thickness; (ii) be affected by corneal interventions; (iii) be altered in keratoconus; (iv) vary along the depth of the cornea; and (v) be affected by intra-ocular pressure. Conclusions: Under precisely controlled conditions, capturing the CB pattern is the first step in a non-destructive process used to model the ultra-fine structure of the individual cornea, and changes thereof, in vivo. Full article

Alzheimer’s disease (AD) is a progressive neurodegenerative condition with increasing global prevalence. As early diagnosis becomes critical for timely symptomatic management, noninvasive and easily accessible biomarkers are needed. Given the shared embryologic origins between the eye and the brain, ocular imaging has emerged as a promising diagnostic technique. This review summarizes the associations between AD, ocular imaging and fluid biomarkers in the anterior and posterior segment. We also describe the underlying pathophysiology that explains the connections between each ocular structure and the brain in the context of AD. Optical coherence tomography (OCT), OCT angiography, and fundus photography are the most common imaging modalities utilized in AD research. However, these techniques may or may not be feasible in primary care or neurologic clinical settings. Compared to plasma biomarker analysis, which is minimally invasive and nearing clinical implementation, ocular biomarkers remain primarily valuable in research investigations. Full article

Background: Eye and visual symptoms are becoming increasingly common in young people, along with the emerging conditions text neck and computer vision syndrome, though underlying mechanisms are not fully elucidated. The link between cervical spine structure and the eye remains relatively unexplored. Methods: This paper employs a hypothesis-driven, literature-based evidence approach, aiming to explore the hypothesis that cervical spine structural issues may be an underlying mechanism for visual symptoms and eye diseases. The purpose of exploring this hypothesis is to lay the groundwork for future research, and advance diagnostics and treatment options. No new analysis was performed. Results: This article lays the groundwork for the hypothesis that cervical spine structural dysfunctions, including a forward-displaced atlas (C1), can cause dynamic carotid sheath compression, contributing to neurological and neurovascular mechanisms that affect the eye, primarily by (1) impaired venolymphatic drainage of the eye and brain due to compression of the internal jugular veins, and (2) ocular dysautonomia from a disruption of the parasympathetic/sympathetic system balance, partly due to vagus nerve degeneration. Conclusions: Potential mechanisms, diagnostics, and treatment options for visual disorders initiated by cervical structural dysfunction are discussed, providing a foundation for future research aimed at improving clinical outcomes for some eye conditions which have an otherwise unknown etiology. Full article

Background/Objectives: Ocular drug delivery faces significant challenges due to anatomical and physiological barriers that limit drug bioavailability, particularly with conventional eye drops. Levofloxacin (LEVO), a broad-spectrum antibiotic, is widely used in the treatment of bacterial conjunctivitis, but its therapeutic efficacy is hindered by rapid precorneal clearance and short residence time. Methods: This study introduces a biorelevant 2 mL dissolution model to simulate ocular conditions better and evaluate the release kinetics of LEVO-loaded nanofibrous ophthalmic inserts. Compared to the conventional 40 mL setup, the 2 mL system demonstrated a slower and more sustained drug release profile, with kinetic modeling confirming a more controlled release behavior. Difference and similarity factor analysis further validated the distinct release profiles, highlighting the impact of dissolution volume on release dynamics. Results: Preliminary pharmacokinetic modeling suggested that the nanofiber inserts, particularly when applied twice daily, maintained levofloxacin concentrations above minimum inhibitory and bactericidal levels for extended durations across three bacterial strains (Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus), potentially outperforming traditional eye drops. Conclusions: These findings suggest that small-volume dissolution testing may provide a more realistic method for evaluating ophthalmic insert formulations, though in vivo validation is needed. Moreover, the nanofibrous inserts show potential as a sustained-release alternative that warrants further investigation to improve patient compliance and therapeutic outcomes in ocular disease management. Full article

Background: This study aimed to evaluate the effects of Trimix^® on the microvilli and glycocalyx of ocular conjunctival epithelial cells, assessing drug persistence on the cell surface and its interaction with the glycocalyx. Microvilli, vital indicators of cellular health, are altered in inflammatory or toxic conditions, making their restoration a key therapeutic target. Method: Building upon previous scanning electron microscopy work, this investigation utilized Transmission Electron Microscopy (TEM) to delve into the direct interaction between Trimix and the cell membrane, elucidating its role in cellular mechanisms. The research involved both an in vitro phase, examining the drug’s molecular arrangement, and an in vivo phase, treating three subjects (healthy, moderate inflammation, severe dry eye) for 30 days. Cytological samples were taken via impression cytology for TEM analysis to observe the drug’s long-term action and its influence on microvillar structures, glycocalyx, and vesicular transport. Results: We demonstrated that Trimix stimulated vesicular transport and promoted the formation of a rudimentary glycocalyx, significantly increasing its presence and the number of microvilli in treated patients across all inflammatory grades, even in severe dry eye. Conclusions: In conclusion, Trimix acts as an effective glycocalyx substitute, restoring the second mucosal system (SMS) and enabling distressed cells to resume essential exchange functions, offering a novel therapeutic approach for dry eye disease. Full article

Regulated proteolysis via autophagy is essential for cellular homeostasis, yet the specific role of autophagy-related gene 7 (ATG7) in corneal epithelial maintenance remains unclear. Using a conditional knockout mouse model (Atg7^f/f K14Cre^+/−), we investigated the impact of ATG7 deficiency on corneal epithelial autophagy, morphology, and vascular dynamics. Loss of ATG7 disrupted autophagosome formation, evidenced by increased LC3B expression but reduced LC3B-positive puncta and absence of autophagosomes ultrastructurally. Although gross corneal morphology was preserved, ATG7 deficiency led to thickened epithelium and increased peripheral lymphatic vessel sprouting, indicating a pro-inflammatory and pro-lymphangiogenic microenvironment. Proteomic analysis revealed upregulation of RAB8, TM9S3, and RETR3, suggesting activation of compensatory pathways such as exophagy, reticulophagy, and Golgiphagy. Inflammatory and angiogenic components were downregulated, suggesting a moderate loss of inhibitory capacity based on the lymphatic phenotypes observed. At the same time, while these two compensatory changes occur, other proteins that positively regulate lysosome formation are reduced, resulting in a phenotype linked to deficient autophagy. These findings demonstrate that ATG7-mediated autophagy maintains corneal epithelial homeostasis and immune privilege, with implications for understanding corneal inflammation and lymphangiogenesis in ocular surface diseases. Full article

Most people with obesity who have undergone gastric bypass surgery have dyslipidemia. Because tear film layers play a major role in the pathogenesis of evaporative dry eye, some studies suggest that dry eye syndrome (DES) and dyslipidemia could cooperate in the ocular system. This study aimed to investigate whether tear film conditions are correlated with blood lipid levels. We calculated a sample of 29 patients in this study. We measured the characteristics of the tear film via the Schirmer test and tear break-up time (BUT) test; three measurements were made, and the average value was subsequently recorded. High-density lipoprotein (HDL) correlated positively with BUT (p < 0.05), but cholesterol and triglycerides correlated negatively with Schirmer (p < 0.05 and p < 0.001, respectively). Our findings suggest that HDL levels significantly influence ocular tear film stability and that triglycerides and cholesterol influence the aqueous component of the tear film, which is conducive to the hypothesis that postgastric bypass surgery tear deficiencies could be mainly of evaporative origin and not watery. Bariatric patients may have a high likelihood of suffering dry eye by modifications in the lipid tear layer; however, the development of DES in bariatric patients remains unclear. Thus, high levels of cholesterol and triglycerides could be associated with aqueous-type dry eye (main gland production), and low HDL levels could be associated with evaporative-type dry eye (meibomian gland production). Full article

Recent advances in molecular biology have led to the development of RNA-based therapeutics, offering significant promise for treating various eye diseases. Current RNA therapeutics include RNA aptamers, antisense oligonucleotides (ASOs), small interfering RNA (siRNA), and messenger RNA (mRNA) that can target specific genetic and molecular pathways involved in eye disorders. In addition to their potential in therapy, RNA technologies have also provided tools for mechanistic studies to improve the understanding of eye diseases, expanding the possibilities of RNA-based treatments. Despite the utility of RNA in studying eye disease mechanisms and its potential in disease treatment, only a few RNA-based therapies have been approved for posterior eye diseases. This paper reviews RNA interference and related ocular delivery and posterior eye diseases, focusing on the use of RNA aptamers, siRNA, short hairpin RNA (shRNA), and microRNA (miRNA). Approaches using RNA to advance our understanding of eye diseases and disease treatments, particularly in the posterior segment of the eye, are discussed. It is concluded that RNA therapeutics offer a novel approach to treating a variety of eye diseases by targeting their molecular causes. siRNA, shRNA, miRNA, and ASO can directly silence disease-driving genes, while RNA aptamers bind to specific targets. Although many RNA-based therapies are still in experimental stages, they hold promise for conditions such as age-related macular degeneration (AMD), diabetic macular edema (DME), glaucoma, and inherited retinal disorders. Effective delivery methods and long-term safety are key challenges that need to be addressed for these treatments to become widely available. Full article

Dry eye disease (DED) is a multifactorial ocular surface disorder that significantly affects vision and quality of life. While artificial tears are the standard first-line therapy, their effectiveness is limited by the complex pathophysiology of DED. This study evaluated DayDrop^® Triple Action, a novel formulation combining hyaluronic acid (HA), ectoine, and carboxymethylcellulose (CMC), designed to enhance tear film stability and ocular surface protection. Physicochemical and rheological properties were assessed, including viscosity, pseudoplasticity, and viscoelastic behaviour under dynamic conditions, along with ectoine release over 24 h. An in vitro allergic conjunctivitis model using conjunctival fibroblasts exposed to a pro-allergic cytokine cocktail was employed to examine immunomodulatory effects. DayDrop^® Triple Action demonstrated high viscosity with pronounced pseudoplasticity and stable viscoelasticity, supporting improved mucoadhesion. The formulation provided sustained ectoine release and exhibited a positive immunomodulatory effect, likely linked to ectoine’s preferential hydration mechanism, which stabilizes membranes and reduces inflammatory signalling. These findings suggest that DayDrop^® Triple Action integrates viscoelastic optimization, osmoprotection, and targeted anti-inflammatory action, offering a promising non-pharmacological strategy for managing DED and allergic ocular surface disorders. Full article

P2Y₂ receptors are a subclass of G protein-coupled receptors activated by the extracellular nucleotides ATP and UTP. These receptors are widely expressed in multiple tissues—including the brain, lungs, heart, and kidneys—and play pivotal roles in inflammation, wound healing, and cell migration. Through coupling with various G proteins, P2Y₂ receptors initiate diverse intracellular signaling pathways that mediate calcium mobilization, cytokine release, and cytoskeletal reorganization. Recent studies highlight their dual roles in health and disease. In physiological contexts, P2Y₂ receptors contribute to immune modulation and tissue repair. In pathological conditions, they are implicated in Alzheimer’s disease by promoting non-amyloidogenic processing of amyloid precursor protein and in dry eye disease by enhancing mucin secretion while modulating ocular inflammation. They also influence chloride secretion and mucosal hydration in cystic fibrosis and contribute to inflammatory regulation and epithelial repair in inflammatory bowel disease. Additionally, P2Y₂ receptors modulate breast cancer progression by regulating cell adhesion, migration, and matrix remodeling. Their involvement in blood pressure regulation via epithelial sodium channel modulation and their facilitative role in HIV-1 entry further underscore their clinical significance. These multifaceted functions position P2Y₂ receptors as promising therapeutic targets for diverse diseases, warranting further investigation for translational applications. Full article

A systematic review of toxoplasmosis cases in patients receiving targeted immunotherapy with biologics or small molecules was performed. This systematic review searched for case reports, case series and observational studies in PubMed; last search was on 19 July 2025. The review identified 46 toxoplasmosis cases among patients receiving biologics (including CAR T-Cell Therapies) or small molecules for diverse autoimmune, oncologic and transplant conditions. These cases were reported from 18 countries, including the United States and several European countries. Most patients developed severe disease. Fifty percent (23/46) presented with cerebral toxoplasmosis, 33% (15/46) with ocular toxoplasmosis, 7% (3/46) with lymphadenopathy, 4% (2/46) with disseminated disease, 2% (1/46) with both cerebral and ocular disease, 2% (1/46) with pneumonic toxoplasmosis, and 2% (1/46) with severe fetal congenital toxoplasmosis. Among those were also four cases with fatal outcomes due to toxoplasmosis and eight cases with permanent ocular or neurological deficits. In addition, there was a case of fetal congenital toxoplasmosis that occurred despite maternal discontinuation of adalimumab five months before conception, resulting in elective pregnancy termination due to severe fetal cerebral disease. Overall, 44% (20/46) of cases were due to reactivation of chronic latent Toxoplasma infections and 39% (18/46) due to acute primary infections; 17% did not report this information. One case of disseminated acute toxoplasmosis was also identified after eating wild boar sausages, and two cases of severe acute ocular toxoplasmosis after eating undercooked venison meat, and undercooked unspecified type of meat respectively, while on small molecules or biologics. Details on the clinical presentations, management and clinical outcomes of these cases were reported. Recommendations for the management of toxoplasmosis in patients with targeted immunotherapies were also provided. Health care providers should consider toxoplasmosis in patients on biologics or small molecules who present with compatible clinical syndromes. Prompt diagnosis and treatment can be lifesaving. Full article

Dry eye disease (DED) is a multifactorial condition characterized by insufficient tear film stability and ocular discomfort. Conventional artificial tears offer limited efficacy due to short precorneal residence time. This study aimed to develop and optimize ion-sensitive in situ gelling formulations based on low-acyl gellan gum (GG) and arabinogalactan (AG) to enhance retention and therapeutic efficacy in DED. Various buffer systems were screened to identify optimal gelation conditions upon interaction with artificial tear fluid (ATF). Formulations were characterized by pH, osmolality, wettability, thermal behavior, viscosity, and viscoelastic properties. A Design of Experiments (DoE) approach was employed to understand the influence of GG and AG concentrations on rheological behavior. The selected formulation, GG(0.1%)/AG(0.2%), demonstrated a significant viscosity increase upon ATF dilution, suitable viscoelastic properties, enhanced mucoadhesion compared to hyaluronic acid, improved ferning patterns, no cytotoxic effects, and stability over time. In vivo studies in rabbits confirmed prolonged precorneal retention of the fluorescently labeled formulation. These results suggest that the GG/AG-based hydrogel is a promising strategy for improving the performance of artificial tears in DED treatment. Full article

Can brightness illusions modulate ocular accommodation? Previous studies have shown that brightness illusions can influence pupil size as if caused by actual luminance increases. However, their effects on other ocular responses—such as accommodative or focusing dynamics—remain largely unexplored. This study investigates the influence of brightness illusions, under two ambient lighting conditions, on accommodative and pupillary dynamics (physiological responses), and on perceived brightness and visual comfort (subjective responses). Thirty-two young adults with healthy vision viewed four stimulus types (blue bright and non-bright, yellow bright and non-bright) under low- and high-contrast ambient lighting while ocular responses were recorded using a WAM-5500 open-field autorefractor. Brightness and comfort were rated after each session. The results showed that high ambient contrast (mesopic) and brightness illusions increased accommodative variability, while yellow stimuli elicited a greater lag under photopic condition. Pupil size decreased only under mesopic lighting. Perceived brightness was enhanced by brightness illusions and blue color, whereas visual comfort decreased for bright illusions, especially under low light. These findings suggest that ambient lighting and visual stimulus properties modulate both physiological and subjective responses, highlighting the need for dynamic accommodative assessment and visually ergonomic display design to reduce visual fatigue during digital device use. Full article