Search Results (12,366)

Background/Objectives: A macular hole represents a significant surgical condition in an increasingly aging population. Advances in surgical techniques, particularly pars plana vitrectomy with inverted internal limiting membrane (ILM) flap, have established high anatomical closure rates exceeding 90%. The prognostic factors influencing visual recovery remain incompletely understood, and it is unclear which patients can be expected to achieve optimal functional outcomes. Methods: This retrospective longitudinal study included 35 eyes of 32 patients followed for 3–12 months. Preoperative OCT parameters (minimum linear diameter, basal diameter, and hole height) and derived indices were correlated with functional outcomes, including best-corrected visual acuity (BCVA) and microperimetry, stratified as central macular sensitivity (CMS) and sensitivity at 4° and 20°. Postoperative ellipsoid zone (EZ) and external limiting membrane (ELM) integrity were also analyzed. Predictive performance was assessed using root mean square error (RMSE) and coefficient of determination (R²). A linear regression model based on BCVA served as baseline, while Extreme Gradient Boosting (XGBoost) models incorporating OCT features were developed. Feature importance was evaluated using Shapley Additive Explanations (SHAP). Results: Overall closure rate was 100%, including 91.4% Type 1 and 8.6% Type 2 closure. Models incorporating OCT parameters outperformed BCVA-based models (lower RMSE, and higher R²). Minimum linear diameter and hole height were the strongest predictors of postoperative outcomes. Microperimetry detected functional improvement beyond BCVA and correlated with EZ and ELM restoration. Conclusions: Preoperative macular hole morphology represents a key determinant of postoperative functional recovery. These structural parameters provide meaningful prognostic value beyond visual acuity alone, supporting the role of combined OCT and microperimetric assessment in predicting surgical outcomes. Full article

Staphylococcus aureus is a leading cause of bacterial keratitis and antimicrobial resistance-associated death globally. This study aimed to evaluate the efficacy of CaD23, a human-derived hybrid antimicrobial peptide (AMP), in combination with antibiotics in treating S. aureus infections. The efficacy of CaD23 and six medically important antibiotics (amikacin, cefuroxime, chloramphenicol, fosfomycin, vancomycin and levofloxacin) was examined against six strains of methicillin-sensitive and methicillin-resistant S. aureus using a minimum inhibitory concentration (MIC) assay. CaD23–antibiotic interactions were evaluated using checkerboard and time–kill kinetics assays. 3,3′-dipropylthiadicarbocyanine iodide (DiSC_3,5) cytoplasmic membrane depolarisation assay was performed to examine the mechanism of action. Overall, CaD23 exhibited good efficacy against all MSSA and MRSA (MIC = 16–32 μg/mL [6.7–13.3 μM]). Of 20 peptide–antibiotic–organism combinations, 19 (95%) combinations demonstrated positive interactions, with six (31.6%) and 13 (68.4%) exhibiting synergistic (FICI = 0.293–0.412) and additive effects (FICI = 0.521–0.890), respectively. CaD23 was able to achieve complete bacterial eradication significantly faster than cefuroxime and levofloxacin (15 min vs. 8–24 h). When used at a sub-MIC concentration, CaD23 could accelerate the killing of S. aureus of cefuroxime from 8–24 h to within 1 h and enhance the activity of levofloxacin by 90%. CaD23 was shown to rapidly depolarise the inner membrane of S. aureus within seconds of the treatment. In conclusion, CaD23–antibiotic combination therapy serves as a useful strategy for tackling drug-resistant ocular and systemic S. aureus infections. Full article

Background/Objectives: Given the limited evidence on multi-distance visual function assessment in presbyopia, this study aimed to compare dynamic binocular visual function between presbyopic and non-presbyopic (NP) participants at different distances, and to further evaluate the effects of additional power (ADD) on dynamic sharpness discrimination, binocular integration, and dynamic stereopsis in presbyopic participants. Methods: A total of 54 presbyopic and 77 NP participants were tested at 0.4 m, 0.7 m, 1 m, and 3 m using a dichoptic rotating ring system with red-blue anaglyph glasses. Presbyopia was classified as low (LP, ADD < 1.5D) or high (HP, ADD ≥ 1.5D). Tests included dynamic sharpness discrimination, binocular integration, and stereopsis. To account for potential confounders, generalized linear models (GLM) were applied with sex, eye laterality, age, ADD, spherical equivalent (SE), and group as covariates, allowing comparison of visual function outcomes across different viewing distances between NP and ADD-stratified presbyopic groups. Results: There was no statistically significant difference in the passing rates of dynamic sharpness discrimination test between the presbyopic and NP groups (all p > 0.05). At 0.4 m, 0.7 m, and 1 m, the presbyopic group showed significantly lower passing rates in the binocular integration test compared with the NP group (all p < 0.05), while no significant difference was observed at 3 m (p = 0.051). Furthermore, the passing rates for binocular integration test at all distances were significantly lower in the HP group than those in both the NP and LP groups (all p < 0.05). GLM analysis indicated that both SE and age were potential confounders in the comparison of binocular integration between presbyopic and NP groups (both p < 0.05). There were no significant differences in the passing rates of binocular dynamic stereopsis test at any distance between the NP and presbyopic groups, or between the LP and HP groups (all p > 0.05). Conclusions: This novel dynamic testing method revealed ADD-dependent impairment of binocular integration at near-to-intermediate distances in patients with presbyopia. Full article

Background/Objectives: Minipuberty represents the second phase of physiological activation of the reproductive axis and may play a role in postnatal genital development. Its course has been shown to be affected by untreated or inadequately treated maternal hypothyroidism. The aim of the present study was to investigate minipuberty in the sons of women with euthyroid autoimmune thyroiditis during pregnancy. Methods: This prospective matched cohort study included three groups of apparently healthy infant boys. Two groups comprised the male offspring of levothyroxine-naive, euthyroid women with autoimmune thyroiditis: one group was unsupplemented, and the other received vitamin D and selenium supplementation. The control group consisted of boys born to healthy women. Salivary concentrations of testosterone, androstenedione, DHEA-S, estradiol, and progesterone, along with urinary FSH and LH levels, were assessed longitudinally over the first 12 months of life. These hormonal measurements were evaluated in relation to genital development, including testicular volume and penile length, which were recorded at each study visit. Results: Compared with the offspring of healthy mothers, sons of women with autoimmune thyroiditis who did not receive supplementation exhibited lower concentrations of LH and testosterone, without a distinct peak, while the duration of hormone detectability did not differ between the groups. These hormonal alterations were accompanied by reduced penile length, with no differences observed in testicular volume. This group also exhibited lower DHEA-S concentrations, whereas levels of other hormones were comparable. In contrast, in the group receiving vitamin D and selenium supplementation, the dynamics of hormonal changes and genital organ growth did not differ from those observed in the control group. LH concentrations were inversely correlated with thyroid peroxidase antibody titers, which were lower in the supplemented group. Conclusions: The findings indicate an altered course of minipuberty in the sons of women with euthyroid autoimmune thyroiditis during pregnancy and suggest a potential benefit of exogenous vitamin D and selenium supplementation in this population. Full article

Background/Objectives: Although vascular mechanisms are increasingly implicated in the etiology of sudden sensorineural hearing loss (SSNHL), the inability to directly visualize the labyrinthine artery remains a diagnostic obstacle. Sharing embryological and physiological parallels with the inner ear, the eye represents an accessible surrogate organ capable of reflecting systemic microvascular status. This study aimed to evaluate the diagnostic value of ocular hemodynamic and structural parameters in patients with acute unilateral idiopathic SSNHL. Methods: This prospective, comparative, cross-sectional study enrolled 30 patients with acute unilateral idiopathic SSNHL and 25 age and sex matched healthy controls. Three groups were defined: the affected eye, the contralateral eye, and the control eye. Retrobulbar hemodynamics (PSV, EDV, RI, PI) were assessed by color Doppler imaging; peripapillary choroidal thickness, RNFL, GCC+, and macular thickness by swept-source OCT; and macular microvascular perfusion by OCT angiography. Results: End diastolic velocity in the posterior ciliary arteries was significantly reduced in both patient eye groups relative to controls (p < 0.001), while RI and PI were significantly elevated (p = 0.001 and p = 0.004, respectively). Comparable hemodynamic impairment was observed in the ophthalmic artery. Peripapillary choroidal thickness was bilaterally reduced in the inferior and temporal quadrants in both patient groups (p = 0.003 and p = 0.010). No significant difference was detected between affected and contralateral eyes in any parameter. RNFL, GC+, and macular thickness remained comparable across all groups. Conclusions: The bilateral symmetry of hemodynamic impairment and choroidal thinning suggests that SSNHL arises against a background of systemic microvascular disease. The combined use of OCT and color Doppler ultrasonography holds clinical potential as a non-invasive biomarker panel for defining the vascular phenotype of the condition. Full article

Background/Objectives: Optical coherence tomography (OCT) and OCT angiography (OCT-A) provide detailed measurements of retinal structure and vasculature; however, age-related differences in how these parameters correlate with one another remain poorly understood. We hypothesized that vascular–structural integration in the macula is more pronounced in adults than in children. Our aim was to characterize correlation patterns in pediatric and adult populations to inform the development of age-specific clinical interpretation guidelines. Methods: This prospective cross-sectional observational study enrolled 37 healthy children (age 1–17 years) and 28 healthy adults (age 18–65 years). Eyes with ocular or systemic conditions affecting the retina or prior intraocular surgery were excluded. Standardized OCT and OCT-A acquisition protocols provided structural and vascular measures. Univariable correlation analyses applied a stringent threshold (p < 0.001) to identify robust associations. Significant univariable results were entered into multivariable regression models adjusting for age, gender, intraocular pressure, and axial length. A Group-wise Linkage Proportion quantified the percentage of potential significant correlations among eight predefined anatomical parameter groups. Results: Ninety univariable correlations met p < 0.001. Fourteen correlations were shared across age groups, notably foveal avascular zone metrics and vessel density, showing very large negative correlations (r = −0.70 to −0.87). The pediatric cohort displayed 40 unique correlations, primarily linking optic nerve head flow indices to retinal nerve fiber layer thickness. Adults exhibited 36 unique correlations, dominated by macular vascular–thickness coupling concentrated in the parafoveal region. After multivariable adjustment, 52 of 90 associations remained significant. Adult-specific associations lost significance more frequently (58%) than pediatric-specific associations (43%), whereas correlations shared across both groups showed complete stability (100%). The Group-wise Linkage Proportion indicated pronounced macular vascular–structural coupling in adults (48.4%) versus near absence in children (1.2%). Conclusions: Retinal parameter correlation patterns show fundamental differences between pediatric and adult eyes. While optic nerve head-macular thickness relationships remain consistent across ages, adults exhibit mature, localized integration of macular vascular and structural parameters absent in children. These findings suggest that pediatric and adult OCT/OCT-A measurements may benefit from separate reference standards, although prospective validation is required before clinical implementation. Full article

Background/Objectives: This study aimed to investigate the correlation between macular flow density (FD) as well as foveal avascular zone (FAZ) characteristics and optic disc size, quantified by Bruch’s membrane opening area (BMOA). In addition, potential differences in FD and FAZ parameters among optic disc size cohorts were evaluated. Methods: In this retrospective, single-centre study, 151 eyes from 151 healthy participants examined at the University Hospital Münster, Germany, were included. Each subject underwent macular and optic disc optical coherence tomography angiography (OCT-A). Rank correlation coefficients for clustered data were computed to assess associations between FD values and BMOA. Further analyses compared FD and FAZ parameters among three optic disc size groups based on their quantiles. Results: Statistical analysis revealed a significant negative correlation between FD in several macular subsectors and BMOA. When stratified by optic disc size, FD in the superficial capillary plexus (SCP) was significantly higher in eyes with the smallest discs compared with intermediate ones, and FD in the deep capillary plexus (DCP) was significantly higher in intermediate discs compared with the largest group. Additionally, both SCP and DCP showed higher absolute FD values in eyes with the smallest optic discs compared with those with the largest. No significant group differences were detected for foveal FD, FAZ area, or FAZ perimeter. Conclusions: This study contributes to normative OCT-A data by incorporating optic disc size as a variable. While FAZ parameters appeared independent of BMOA, eyes with smaller optic discs demonstrated higher FD values in both SCP and DCP. Full article

Objectives: To characterize the one-year functional, anatomical, and molecular responses to intravitreal Ranibizumab in treatment-naïve patients with neovascular age-related macular degeneration (nAMD), and to identify systemic immune and miRNA signatures associated with treatment response. Methods: This prospective longitudinal observational study included 44 treatment-naïve patients with nAMD. Patients received up to four monthly intravitreal Ranibizumab injections, followed by a treat-and-extend regimen. Best-corrected visual acuity using ETDRS letters, central retinal thickness by optical coherence tomography, fluorescein angiography, and OCT angiography were assessed at baseline and 12 months. Peripheral blood samples were collected at both time points to quantify seven circulating cytokines using an IMMULITE chemiluminescent immunoassay and to profile 37 candidate miRNAs by TaqMan OpenArray RT-qPCR from leukocyte-derived RNA. Treatment response was classified using composite anatomical and functional criteria, including intraretinal/subretinal fluid resolution, ≥25% central retinal thickness reduction, and a ≥5 ETDRS letter gain. Results: At one year, patients showed significant central retinal thickness reduction and overall visual stabilization, although good and poor responders differed according to composite response criteria. Statin use was numerically more frequent among poor responders, although this difference was not statistically significant. Soluble IL-2R increased significantly over time in the overall cohort, mainly driven by good responders who showed higher median levels at both visits. IL-8 also increased globally, without significant between-group differences. Among differentially expressed miRNAs, miR-3121 was the only candidate reaching statistical significance and was downregulated in good responders. ROC analysis showed moderate discriminative performance for miR-3121, with an AUC of 0.76. Conclusions: One-year response to Ranibizumab in nAMD may involve systemic immune activation and miRNA regulation. miR-3121 emerges as a candidate biomarker of treatment response, supporting further validation in larger independent cohorts. Full article

Diabetes mellitus represents a major global health challenge with rapidly increasing prevalence and substantial morbidity driven by metabolic and vascular complications. Extracellular vesicles (EVs) have emerged as critical mediators of intercellular communication and are increasingly implicated in the pathogenesis and progression of diabetes. This review summarizes current knowledge on EV biology, including their classification, cellular sources, biogenesis, uptake mechanisms, and molecular cargo. We discuss the contribution of EV-associated microRNAs to immune dysregulation and β-cell damage in type 1 diabetes mellitus (T1DM), as well as the role of EVs in insulin resistance, metabolic signaling, and vascular dysfunction in type 2 diabetes mellitus (T2DM). Particular emphasis is placed on EV-mediated modulation of endothelial function, angiogenesis, and tissue repair, alongside their involvement in the impairment of insulin receptor integrity. We further explore how lifestyle factors may influence EV composition and function, highlighting their potential integration into preventive strategies. Finally, we evaluate the emerging therapeutic potential of EVs as biomarkers and delivery systems, while addressing current limitations and future directions. Collectively, EVs represent a promising frontier in understanding diabetes pathophysiology and developing innovative diagnostic and therapeutic approaches. Unlike previous reviews that examine EVs separately as biomarkers or therapeutic vehicles, this review integrates emerging evidence supporting EVs as mediators of systemic communication linking pancreatic islets, adipose tissue, immune cells, vascular endothelium, kidney, heart, and retina throughout diabetes progression. We further critically evaluate translational barriers that currently limit clinical implementation of EV-based diagnostics and therapeutics. Full article

Arthropathies are a major global health challenge because of their high prevalence, chronic progression, and significant impact on quality of life and health systems. Therefore, prompt and accurate diagnosis is critical for slowing disease progression and improving outcomes. Traditional imaging modalities, such as ultrasound and magnetic resonance imaging, suffer from significant limitations, including operator dependence, limited accessibility, high cost, and limited reproducibility. Infrared thermography has become a promising non-invasive imaging technique for identifying thermal variations linked to inflammatory and metabolic processes. Advances in quantitative thermography, automated segmentation, and artificial intelligence have greatly enhanced its clinical applicability. This review summarizes recent advances in thermography-based biomarkers, including region-of-interest-derived metrics, asymmetry indices, hotspot burden, spatial and texture descriptors, and composite thermographic scores. It discusses the role of machine learning and deep learning in prediction, phenotyping, and multimodal integration with clinical, laboratory, and imaging data. Heterogeneity of protocols, variability in measurements, domain shift, validation design, overfitting, and reporting quality are also addressed. Overall, thermography combined with AI is highly promising as an adjunct to early diagnosis, assessment of disease activity, and follow-up in arthropathies. However, clinical application at a large scale requires strict standardization, external validation, transparent reporting, and well-elucidated, reproducible analytical processes. Full article

The progression of myopia in the pediatric population is currently highly prevalent. Thus, there is a need to look for new, effective methods that might suppress this pathological process. It not only affects visual comfort but also increases the risk of developing further ocular complications. The aim of the study is to review the literature and summarize contemporary methods for preventing the progression of myopia in children. The review is based on publications available on PubMed from the past 17 years, supplemented by the current literature on advanced digital technologies in ophthalmology. This article highlights that among other treatments such as orthokeratology, low-dose atropine or specialized lenses, there are also further beneficial options, including increased outdoor time, reduced screen time or the implementation of the latest medical innovations. The results indicate that defocus spectacle lenses may reduce myopia progression by approximately 50–67%, while orthokeratology has been associated with about a 46% reduction in axial elongation. Although there is a broad spectrum of therapeutic strategies, it is essential to develop novel approaches to myopia prevention in children to improve their quality of life from childhood into adulthood. Full article

Background/Objectives: Discharge letters are essential for continuity of care but are often time-consuming to prepare and variable in quality. Large language models (LLMs) may help standardize and support this process, yet evidence in ophthalmology remains limited. This study compared the quality of resident-written and GPT-5.2-generated ophthalmology discharge letters derived from the same de-identified clinical data. Methods: This retrospective blinded study was conducted at a tertiary hospital in Croatia. For 146 consecutive inpatient discharges, original resident-written letters were paired with GPT-5.2-generated letters created using a standardized prompt; 142 complete pairs were available for the primary analysis. Three board-certified ophthalmologists evaluated anonymized letters using a structured assessment of accuracy, completeness, clarity/structure, tone/professional phrasing, conciseness, global quality, errors, omissions, and key content elements. Results: In the primary paired analysis, GPT-5.2-generated letters performed similarly to resident-written letters across accuracy, completeness, clarity/structure, errors, omissions, and overall quality. GPT-5.2-generated letters received higher ratings for tone/professional phrasing, whereas resident-written letters were rated as more concise, although inter-rater agreement was poor on these stylistic domains (at or below chance for conciseness) and these findings should therefore be interpreted as exploratory. Resident-written letters more often documented operations, while GPT-5.2-generated letters more consistently included findings. Reviewer-adjusted sensitivity analyses were less favorable to GPT-5.2 for several domains. Conclusions: GPT-5.2-generated ophthalmology discharge letters showed similar performance to resident-written letters in several evaluated domains in the primary paired analysis, but differences in specific content elements and less favorable sensitivity analyses indicate that clinician oversight remains necessary to ensure accuracy, procedural completeness, and clinical usability. Full article

Intraocular foreign bodies penetrating the eye can lead to serious complications, including endophthalmitis, and therefore require urgent removal. We present the case of a 9-year-old boy with an intraocular foreign body lodged in the lens with a corneal flap wound. The injury occurred while hammering a bicycle frame. The patient presented with sudden pain, tearing, and decreased visual acuity in the left eye. On admission, the left eye distance best-corrected visual acuity (BCVA) was 0.4 and intraocular pressure (IOP) was 17 mmHg. Slit-lamp examination of the left eye revealed a full-thickness corneal flap wound, a traumatic cataract, and a foreign body located centrally within the lens. B-scan ultrasonography demonstrated an echogenic focus within the lens consistent with an intralenticular metallic foreign body, with a normal posterior segment, a regular appearance of the optic disc, and an attached retina. The patient underwent phacoaspiration of the traumatic cataract with intraocular lens implantation and simultaneous removal of the foreign body. Given the corneal flap wound located in the visual axis and the absence of ocular hypotony, the decision was made not to place a corneal suture. At discharge, BCVA improved to 1.0, with IOP of 17 mmHg and normal fundus appearance. Full article

The corneal endothelium is essential for maintaining corneal transparency through active fluid transport and barrier function. Corneal cell loss from disease, ageing or surgical trauma underlies a significant proportion of corneal blindness worldwide, with Fuchs’ endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) representing the dominant clinical indications for corneal transplantation. While Descemet’s membrane endothelial keratoplasty (DMEK) has substantially improved surgical outcomes, the procedure remains constrained by global donor tissue shortage. Regenerative medicine offers a compelling alternative by exploiting the latent proliferative and reparative potential of corneal endothelial progenitor populations. This review synthesises current knowledge on the foundational biology of corneal endothelial progenitor populations and the optimisation of expansion platforms to emerging preclinical and clinical evidence for both cell-based and pharmacological regenerative strategies. We also consider the outstanding translational challenges of potency standardisation, GMP-compliant manufacturing and regulatory navigation, as well as the longer-term potential of biomaterial-cell platforms and personalised iPSC-based medicine. The cumulative evidence positions progenitor-based approaches as viable and increasingly well-characterised alternatives to conventional donor transplantation, although their routine clinical use awaits the optimisation of manufacturing and regulatory platforms. Full article