Search Results (239)

Purpose: To investigate the short-term impact of scleral lens wear on intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness. We hypothesized that scleral lens wear would produce a measurable elevation in IOP accompanied by detectable RNFL thinning compared with soft contact lens wear. Methods: This prospective, randomized, contralateral-eye crossover study included 31 healthy participants (mean age: 26 ± 3 years). Each participant wore a 16.5 mm scleral lens over one eye and a soft contact lens over the fellow eye for 8 h, with assignments reversed between visits. IOP was measured using two tonometers: a transpalpebral Diaton tonometer and a non-contact tonometer (NCT), and RNFL thickness was measured by optical coherence tomography at four time points: pre- and post-lens application, and pre- and post-lens removal. Results: Eyes fitted with scleral lenses exhibited a significant IOP increase immediately after lens application (pre-application: 11 ± 3 mmHg vs. post-application: 16 ± 4 mmHg, p < 0.001), sustained throughout 8 h of wear (pre-removal: 16 ± 4 mmHg), and returned to baseline after removal (11 ± 3 mmHg). No significant IOP changes were observed in soft contact lens-wearing eyes (p > 0.05). Scleral lens wear was also associated with small but statistically significant peripapillary RNFL thinning (pre-application: 110 ± 11 µm vs. post-application: 107 ± 11 µm, p < 0.001), which returned to baseline after lens removal. No significant RNFL changes were observed with soft contact lens wear (p > 0.05). Bland–Altman analysis revealed poor agreement between Diaton and NCT measurements, consistent with the published literature on transpalpebral tonometry. Conclusions: Short-term scleral lens wear was associated with transient IOP elevation and peripapillary RNFL thinning, both reversible upon lens removal, in healthy young adults. These findings highlight the need for further longitudinal investigation in at-risk populations such as those with ocular hypertension, keratoconus, or early glaucoma before clinical monitoring recommendations can be established. Full article

Background/Objectives: Type 2 diabetes may impair anterior segment immune regulation. Because transforming growth factor-β2 maintains ocular immune privilege, while nuclear factor-κB is linked to inflammatory activation, we compared their aqueous humor levels in cataract patients with and without diabetes. Methods: In this prospective cross-sectional study, aqueous humor samples were collected from 90 patients (30 diabetic, 60 non-diabetic) via anterior chamber needle aspiration at the commencement of routine phacoemulsification, prior to viscoelastic injection, without additional intervention. Transforming growth factor-β2 and nuclear factor-κB levels were then measured using enzyme-linked immunosorbent assay (ELISA). Between-group comparisons and ROC curve analyses were performed to evaluate differences in biomarker levels and their discriminative ability in distinguishing diabetic status. Covariate-adjusted analysis (ANCOVA) was additionally performed. Results: Transforming growth factor-β2 levels were significantly lower in the diabetic group (p < 0.001), while nuclear factor-κB levels showed no significant difference (p = 0.285). The between-group difference in transforming growth factor-β2 remained significant after adjustment for cataract grade and hypertension duration (F(1,86) = 17.901, p < 0.001, partial η² = 0.172; Cohen’s d = 0.94). Transforming growth factor-β2 demonstrated high specificity (100%) but limited sensitivity (45%) for identifying diabetic status at a cut-off of <449.25 ng/L; however, given the small sample size and exploratory nature of the study, this specificity value should be interpreted with caution and requires validation in larger cohorts. Conclusions: Lower aqueous humor TGF-β2 levels in diabetic cataract patients, independent of cataract severity and hypertension duration, suggest that TGF-β2 suppression may represent an earlier molecular event in anterior segment immune dysregulation preceding overt inflammatory activation. While TGF-β2 shows exploratory biomarker potential, validation in larger, prospective, mechanistic studies is required before clinical application. Full article

Objective: The aim of this study was to evaluate the safety and efficacy of the Paul Glaucoma Implant (PGI) in a multicenter Argentine cohort with 12 months of follow-up. Methods: This ambispective multicenter study included patients who underwent PGI implantation between November 2022 and July 2024 by glaucoma specialists across Argentina, with a minimum follow-up of 12 months. Primary outcomes were intraocular pressure (IOP) reduction and success rates, defined as complete success (≥20% IOP reduction with IOP ≥6 and ≤21 mmHg without medications), qualified success (same criteria with ≥1 medication), and failure based on predefined efficacy and safety criteria, including additional glaucoma surgery, device removal, or clinically significant hypotony. Secondary outcomes included changes in medication use, best-corrected visual acuity (BCVA), and postoperative complications. Results: Sixty-six eyes were included in the overall analysis. Mean IOP decreased from 31.2 ± 9.1 mmHg preoperatively to 12.8 ± 4.7 mmHg at 12 months (p < 0.01). Medications were reduced from 3.5 ± 0.8 to 1.3 ± 1.2 (p < 0.01). Among the 65 eyes with evaluable 12-month follow-up, 50 eyes (76.9%) achieved complete success, 14 (21.5%) qualified success, and 1 (1.5%) failure. Complications were ocular hypertension (25%), tube or plate exposure (10%), choroidal detachment (7%), and hypotony (5%). BCVA remained stable in 28 eyes (43.8%), improved in 15 (23.4%), and worsened in 21 (32.8%). Conclusions: The PGI achieved significant and sustained IOP reduction with marked medication decrease at 12 months. Most complications were mild or moderate. These findings support the PGI as an effective and safe non-valved implant for refractory glaucoma in Latin American populations. Full article

Spaceflight associated neuro-ocular syndrome (SANS) is a significant ophthalmic complication observed in astronauts during and after long-duration missions, characterized by optic disc edema, globe flattening, choroidal folds, and hyperopic shifts. Unlike papilledema in terrestrial idiopathic intracranial hypertension, optic disc edema in SANS is often asymmetric. The mechanisms underlying this asymmetry remain poorly understood. In this narrative review, we synthesize and critically interpret existing clinical observations, anatomical studies, neuroimaging findings, and experimental evidence, and propose that uneven ocular venous congestion, arising from microgravity-induced cephalad fluid shifts, pre-existing transverse sinus asymmetry, and orbital venous overload, leads to asymmetric optic disc edema by differentially disrupting anterograde ocular glymphatic transport between the eyes. This mechanistic framework highlights the interplay between venous hemodynamics and ocular glymphatic flow as a key factor in SANS pathophysiology. Targeted in-flight monitoring and ground-based analog studies will be essential to rigorously test this hypothesis. To this end, we outline a feasible experimental approach that prospectively integrates preflight cerebral magnetic resonance venography, providing data on transverse sinus dominance, with serial in-flight ophthalmic imaging on the International Space Station. This combined strategy could directly determine whether dural venous sinus anatomy predisposes to uneven ocular venous congestion and asymmetric optic disc edema in microgravity. Insights gained from this work may guide the development of effective countermeasures against SANS and broaden our understanding of ocular fluid dynamics under conditions of altered venous physiology on Earth. Full article

Background/Objectives: Long-term outcomes in systemic lupus erythematosus (SLE) are largely driven by irreversible organ damage, yet the relative contribution of comorbid conditions remains insufficiently characterized. We aimed to characterize damage accrual and identify comorbidities associated with damage severity and mortality. Methods: A retrospective study of adult patients with SLE followed at a single-center (2014–2023). The Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), was used to assess damage at last follow-up. Damage was categorized as none (0), mild–moderate (1–2), or severe (≥3). Demographic, clinical, laboratory, treatment, and comorbidity data were extracted from electronic medical records. Multivariable logistic regression and Cox proportional hazards models were applied to identify factors associated with damage severity and mortality. Results: Among 182 patients (84.1% female; mean follow-up 15.6 ± 11.4 years), 59.5% accrued damage, including 30.8% with severe damage. Damage predominantly involved cardiovascular, ocular, neuropsychiatric, and musculoskeletal domains. It was associated with older age, longer disease duration, hematologic and renal involvement, and corticosteroids and immunosuppressive medications. In multivariable analysis, antiphospholipid syndrome (APS) and hypertension emerged as the dominant independent predictors of damage accrual with an odds ratio of 15.70 (95% CI 4.26–57.89, p < 0.001) and 6.46 (95% CI 2.54–16.40, p < 0.001), respectively. Mortality increased with damage severity (16.1% in SDI ≥ 3, 1.9% in SDI 1–2, none in SDI = 0; p < 0.0001). Damage was also associated with increased hospitalizations. Conclusions: Damage accrual is common and strongly predicts mortality. APS and hypertension emerge as dominant, modifiable drivers, supporting integrated cardiovascular and thrombotic risk management in SLE. Full article

Background: The photopic negative response (PhNR) of the full-field electroretinogram is a retinal ganglion cell-weighted functional signal increasingly proposed as a clinical biomarker. Despite extensive study across ocular and systemic diseases, its precise clinical role and incremental value remain incompletely established. Methods: This narrative review synthesizes key human studies of the photopic negative response, with emphasis on physiological basis, recording methodology, and clinical contexts in which PhNR may provide added functional insight. Results: In glaucoma, PhNR provides an objective measure of retinal ganglion cell dysfunction that correlates moderately with optical coherence tomography (OCT)-derived structural loss and visual field indices, but with substantial inter-individual variability. Its greatest clinical utility lies in early disease detection, cross-sectional functional assessment, and documenting short-term functional changes following intraocular pressure reduction, rather than longitudinal progression monitoring. Beyond glaucoma, PhNR reveals inner retinal dysfunction in systemic and genetic conditions, particularly idiopathic intracranial hypertension and diabetes, where retinal ganglion cells may reflect broader neurological or metabolic stress. Conclusions: PhNR is best viewed not as a standalone diagnostic or progression tool, but as a complementary functional biomarker that adds objective insight when structural imaging or psychophysical testing is limited or discordant. Its role aligns closely with the retina’s emerging function as a mirror of systemic and genetic disease, provided recordings are standardized and results interpreted cautiously. Full article

Cataracts represent the leading cause of blindness worldwide, particularly in older adults, and constitute a significant public health challenge. Although cataract surgery is generally associated with a high safety profile, both patients and healthcare providers often face significant challenges due to age-related physiological changes and the high prevalence of comorbidities, which are directly linked to cataractogenesis and other systemic diseases that can complicate both the surgical procedure and postoperative recovery. This narrative review aimed to assess the epidemiological characteristics of age-related physiological and pathological comorbidities in older adults with cataracts, evaluating their impact on preoperative assessment, surgical outcomes, and public health planning. Articles were identified through non-systematic searches of PubMed, EMBASE, and Scopus using a combination of medical subject headings (MeSH) terms and free-text keywords. Among the multiple non-ocular comorbidities, carotid artery disease (CAD) and hypertension (HTN) are among the cardiovascular diseases (CVDs) with the highest correlations with cataract. Diabetes, dyslipidemia, and metabolic syndrome are also highly prevalent and significantly influence surgical outcomes, as poor glycemic control increases intraoperative risks and postoperative complications. Additionally, neurological conditions such as stroke, Parkinson’s disease, and epilepsy often complicate anesthesia administration, contribute to postoperative delirium, and affect adherence to treatment protocols. Given these complexities, a multidisciplinary approach and targeted preoperative screening may offer personalized care to improve safety and outcomes. Despite advances in clinical care, disparities in access to cataract surgery, especially in underserved populations, continue to exist. Thus, a coordinated public health strategy that promotes early detection, equitable access, and the integration of innovations such as teleophthalmology and artificial intelligence is essential to optimize care for older adults with cataracts worldwide. Full article

Somatostatin is a potent endocrine regulator and neurotransmitter, exerting predominantly inhibitory effects in different tissues of the body, via G-protein coupled receptors. Five such specific receptors have been identified, with different effects and tissue distribution. The multifaceted actions and effects of somatostatin make it useful as a potential therapeutical means in various pathologies; however, in clinical practice, somatostatin analogues, namely octreotide, lanreotide and pasireotide, are commonly used instead, due to their increased half-life and increased receptor selectivity, with pasireotide showing a more extensive receptor binding profile and high affinity for somatotastin receptor (SSTR) 5, which may prove effective in cases of resistance to first-generation analogues. Apart from their many uses in neoplastic pathologies, somatostatin analogues represent viable treatment choices in some ocular pathologies, congenital hyperinsulinism, gastrointestinal bleedings and portal hypertension, acute pancreatitis, and dumping syndrome. They have also been used in some cases, with varying degrees of success, in patients with post-surgical gastrointestinal and lymphatic fistulas, refractory chronic diarrhoea and polycystic kidney disease; many applications in paediatric patients have also been documented. The aim of this review is to present the applications of somatostatin and its analogues as alternative or second-line therapies, along with insights into their effectiveness and future potential. Full article

Background: Robot-assisted laparoscopic radical prostatectomy (RALP) requires prolonged steep Trendelenburg positioning, which increases intraocular and intracranial pressure. Although transient visual field defects have been documented after RALP using objective perimetric testing, data on patient-reported visual outcomes remain limited. We hypothesized that intraoperative optic nerve sheath diameter (ONSD) measurements and hemodynamic variables would be associated with postoperative patient-reported visual symptoms. Methods: This prospective, single-center observational cohort study enrolled consecutive adult patients undergoing RALP between March and September 2023 at Ospedale Santo Stefano, Prato, Italy. Patients with pre-existing glaucoma, ocular disease, or intracranial hypertension were excluded. Intraoperative ONSD was measured by transorbital ultrasound at three time points: before Trendelenburg (t1), 30 min after Trendelenburg (t2), and at end of Trendelenburg (t3). Postoperative visual symptoms were assessed at ≥1 month follow-up using the validated Catquest-9SF questionnaire. Rasch analysis converted ordinal responses to interval-level measures. Logistic regression explored associations between visual complaints and intraoperative predictors (Rasch scores, lowest mean arterial pressure [MAP], maximum ONSD). Results: Fifty-five patients were enrolled. Six patients (10.9%) reported new subjective visual symptoms at follow-up. Rasch-transformed scores were associated with the presence of these symptoms (coefficient 1.38; p < 0.05). Lowest intraoperative MAP (p = 0.081) and maximum ONSD (p = 0.811) did not reach statistical significance as independent factors. Conclusions: Patient-reported visual symptoms occurred in approximately 11% of patients after RALP. Postoperative Rasch-transformed visual function scores correlated with these complaints. While intraoperative ONSD was not associated with visual outcomes, the potential role of intraoperative hypotension requires further investigation in larger, powered cohorts. 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

This retrospective study evaluated real-world outcomes of standalone iDose TR intracameral travoprost implant administration. Sixty-five consecutive standalone iDose TR implantations performed by a single surgeon were analyzed. Patients were pseudophakic, had a diagnosis of open-angle glaucoma (OAG) or ocular hypertension (OHT), and had a history of a prior non-filtering glaucoma procedure (e.g., selective laser trabeculoplasty [SLT] or bimatoprost intracameral implant) performed beyond the preceding 6 months. Intraocular pressure (IOP) and medications were measured for 12 months postoperatively. Subgroup analysis was stratified by history of SLT treatment and glaucoma severity. If target IOP was not attained, secondary minimally invasive glaucoma surgery was performed instead of reinitiating or adding medication, according to the surgeon’s standard practice. The analysis was by intention to treat. At 12 months, mean IOP reduced significantly to 14.0 ± 2.9 mmHg from a baseline of 20.0 ± 4.0 mmHg (−28%, p < 0.001). Eyes with IOPs ≤ 18, ≤15, and ≤12 mmHg increased significantly vs. baseline (36.9% to 92.3%, 10.8% to 73.8%, and 3.1% to 35.4%, respectively; all p < 0.001), and 89.2% of the eyes were medication-free vs. 87.7% preoperatively. Mean 12-month IOP reduction showed nonsignificant differences between eyes with or without prior SLT (−26% and −31%, respectively; p = 0.907) and among mild/OHT, moderate, or severe glaucoma eyes (−28%, −23%, and −34%, respectively; p = 0.085). Postoperatively, one case each of transient corneal edema and retinal edema were observed, which self-resolved without sequelae. Thus, standalone travoprost implant administration significantly reduced IOP over 12 months in OAG and OHT, while maintaining a low medication burden. Similar IOP reductions were observed regardless of prior SLT treatment and glaucoma severity. 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

Cytomegalovirus (CMV) infection of the anterior segment is increasingly recognized as an important cause of corneal endotheliitis and secondary glaucoma, even in immunocompetent individuals. CMV corneal endotheliitis typically presents with coin-shaped or linear keratic precipitates (KPs), corneal edema, mild anterior chamber inflammation, and recurrent intraocular pressure (IOP) elevation; persistent or episodic ocular hypertension may progress to glaucomatous optic neuropathy if inadequately treated. Definitive diagnosis relies on aqueous humor polymerase chain reaction (PCR) testing for CMV DNA, supported by adjunctive imaging including specular microscopy, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM). Management requires a comprehensive strategy integrating antiviral therapy, anti-inflammatory treatment, and appropriate IOP control. Topical or systemic ganciclovir remains the cornerstone, while refractory disease may necessitate surgical intervention. Older age and male sex, host immune status, prolonged or recurrent CMV infection, and pre-existing ocular conditions are major risk factors for progression and poor outcomes. The pathogenesis of secondary glaucoma is thought to involve both direct viral cytopathic effects and inflammation-mediated damage to the trabecular meshwork (TM), resulting in impaired aqueous outflow. Therefore, early recognition, accurate diagnosis, and effective treatment are essential to prevent corneal decompensation and permanent vision loss. Full article

Background/Objectives: Optical coherence tomography-angiography (OCT-A) is a non-invasive method of visualizing the capillary system. As vascular dysregulation impacts glaucoma pathogenesis, the aim of this study was to evaluate APSified-BMO-based-peripapillary vessel density (VD) in patients with ocular hypertension (OHT), pre-perimetric-open-angle glaucoma, as well as primary (POAG) and secondary (SOAG) open-angle glaucoma in comparison to healthy controls using OCT-A. Methods: The present study included 180 eyes from 115 patients of the Erlangen Glaucoma Registry, divided into 35 eyes with OHT, 16 pre-perimetric-OAG eyes, 64 OAG eyes—which were subdivided into 37 POAG and 27 SOAG eyes—and 65 healthy controls. All subjects underwent measurements of the retinal nerve fiber layer (RNFL), inner nuclear layer (INL), retinal ganglion cell (RGC) layer, and Bruch membrane opening–minimum rim width (BMO-MRW). APSified-BMO-based-peripapillary vessel density (VD) was visualized by using OCT-A and quantified using the Erlangen Angio Tool. Results: Mean APSified-BMO-based peripapillary VD showed a significant correlation with age (p < 0.0001). Considering the age effect, mean APSified-BMO-based peripapillary VD of OAG was significantly lower compared to healthy eyes (p < 0.0001) and OHT (p = 0.016). Subgroup analysis yielded a significant difference in mean APSified-BMO-based peripapillary VD between controls and POAG (p = 0.001) and SOAG (p = 0.018), respectively. In addition, a significant difference was observed between OHT and POAG patients (p = 0.036). No significant differences were observed between the OHT, pre-perimetric-OAG, and healthy eyes, respectively. Conclusions: As peripapillary VD was significantly decreased in glaucoma patients compared to controls, the data might suggest that peripapillary VD might be useful for monitoring glaucoma progress. Full article

Background/Objectives: To investigate the incidence and risk factors for postoperative hyphema following Baerveldt glaucoma implant (BGI) surgery. Methods: This retrospective study included Japanese patients who underwent BGI surgery at Fukui University Hospital between 1 April 2012 and 31 March 2025. Hyphema was defined as any clinically detectable blood in the anterior chamber. Baseline demographic, ocular, and surgical variables were compared between eyes with and without hyphema. Independent risk factors for hyphema were determined using multivariable logistic regression analysis. Results: Of 273 eyes, 77 (28.2%) developed postoperative hyphema. On multivariable analysis, tube insertion site and intraocular pressure (IOP) on postoperative day 1 were identified as independent predictors. Although the overall effect of tube insertion site was borderline (p = 0.074), anterior chamber (odds ratio [OR], 2.83; p = 0.036) and ciliary sulcus insertion (OR, 2.88; p = 0.031) were associated with significantly higher risk of hyphema compared with vitreous cavity insertion. Lower postoperative day 1 IOP was also a significant predictor (p < 0.01). Patient-related factors, including age, diabetes mellitus, hypertension, antithrombotic therapy, neovascular glaucoma (NVG), combined surgery, number of previous intraocular surgeries, and preoperative IOP, were not independently associated with hyphema. In a sensitivity analysis excluding NVG eyes (n = 191), vitreous cavity insertion remained protective, and postoperative day 1 IOP remained an independent predictor. Conclusions: Postoperative hyphema following BGI surgery is primarily determined by surgical factors and early postoperative IOP. Vitreous cavity tube insertion is associated with a markedly lower hyphema risk than anterior chamber or ciliary sulcus insertion. Full article