Search Results (54)

Background/Objectives: Neovascularization, defined as the sprouting of new blood vessels from pre-existing vasculature, is a critical pathological feature in ocular diseases such as pathological myopia and represents a leading cause of corneal vision loss. Vascular endothelial growth factor A (VEGFA) plays a pivotal role in endothelial cell proliferation, migration, survival by anti-apoptotic signaling, and vascular permeability. Dysregulation of VEGFA is closely linked to pathological neovascularization. Exosomes, nanosized phospholipid bilayer vesicles ranging from 30 to 150 nm, have emerged as promising gene delivery vehicles due to their intrinsic low immunogenicity, superior cellular uptake, and enhanced in vivo stability. This study aimed to investigate whether highly purified mesenchymal stem cell (MSC)-derived exosomes loaded with VEGFA siRNA labeled with FAM can effectively suppress pathological corneal neovascularization (CNV) via targeeted cellular transduction and VEGFA inhibition. Furthermore, we examined whether the therapeutic effect involves the modulation of the PI3K–Akt–Caspase-3 signaling axis. Methods: Exosomes purified by chromatography were characterized by electronmicroscopy, standard marker immunoblotting, and nanoparticle tracking analysis. In vitro, we assessed exosome uptake and cytoplasmic release, suppression of VEGFA mRNA/protein, cell viability, and apoptosis. In a mouse CNV model, we evaluated tissue reach and stromal retention after repeated intrastromal injections; anterior segment angiogenic indices; CD31/VEGFA immunofluorescence/immunoblotting; phosphorylated PI3K and Akt; cleaved caspase-3; histology (H&E); and systemic safety (liver, kidney, and spleen). Results: Exosomes were of high quality and showed peak efficacy at 48 h, with decreased VEGFA mRNA/protein, reduced viability, and increased apoptosis in vitro. In vivo, efficient delivery and stromal retention were observed, with accelerated inhibition of neovascularization after Day 14 and maximal effect on Days 17–19. Treatment reduced CD31 and VEGFA, decreased p-PI3K and p-Akt, and increased cleaved caspase-3. Histologically, concurrent reductions in neovascularization, inflammatory cell infiltration, and inflammatory epithelial thickening were observed, alongside a favorable systemic safety profile. Conclusions:VEGFA siRNA-loaded exosomes effectively reduce pathological CNV via a causal sequence of intracellular uptake, cytoplasmic release, targeted inhibition, and phenotypic suppression. Supported by consistent PI3K–Akt inhibition and caspase-3–mediated apoptosis induction, these exosomes represent a promising local gene therapy that can complement existing antibody-based treatments. Full article

Objectives: Myopia of prematurity (MOP) is a refractive error occurring in individuals born prematurely and is considered a distinct entity from pathologic and school-age myopia. Children affected by MOP are at risk of developing high myopia, with an increased lifelong cumulative risk of related complications. The aim of this study was to evaluate the progression of MOP in children previously affected by retinopathy of prematurity (ROP) who wore spectacles with Highly Aspherical Lenslet Target (HALT) technology compared to conventional single-vision lenses during childhood. Methods: Enrolled subjects were divided into two groups: subjects who used HALT lenses for at least 12 months and children who used standard single-vision lenses for the same period. The temporal evolution of spherical equivalent (SE) and axial length (AL) was evaluated in both groups. Results: Of the 252 preterm children screened, 58 were included in the study: 38 subjects (66%) in the standard lenses group and 20 subjects (34%) in the HALT lenses group. At 12 months SE progression and AL elongation in the HALT group (−0.32 ± 0.20 D and 0.12 ± 0.05 mm) were lower compared to the standard group (−0.93 ± 0.34 D and 0.46 ± 0.09 mm, p < 0.0001). Conclusions: The progression of MOP appears to be reduced in subjects corrected with HALT lenses compared to those wearing conventional lenses. These results suggest further investigation of HALT technology in selected subgroups of patients at high-risk of severe myopia to reduce its progression and the related lifelong cumulative risk of visual impairment. Full article

Background: Submacular hemorrhage (SMH) is a vision-threatening condition most associated with neovascular age-related macular degeneration (nAMD), although it may also arise from polypoidal choroidal vasculopathy, pathological myopia, retinal vascular diseases, trauma, and systemic factors. Rapid management is essential because subretinal blood induces photoreceptor toxicity, clot organization, and fibroglial scarring, leading to irreversible visual loss. The choice and urgency of treatment depend on hemorrhage size, duration, and underlying pathology, and the patient’s surgical risk category, which can influence the invasiveness of the selected procedure. This review aims to provide an updated synthesis of recent advances in the surgical and pharmacological management of SMH, focusing on evidence from the past five years and comparing outcomes across major interventional approaches. Methods: A narrative review of 27 recent clinical and multicentre studies was conducted. The included literature evaluated pneumatic displacement (PD), pars plana vitrectomy (PPV), subretinal or intravitreal recombinant tissue plasminogen activator (rtPA), anti-VEGF therapy, and hybrid techniques. Studies were analyzed about indications, surgical methods, timing of intervention, anatomical and functional outcomes, and complication and patient risk stratification. Results: Outcomes varied depending on the size and duration of hemorrhage, as well as the activity of underlying macular neovascularization. PD with intravitreal rtPA was reported as effective for small and recent SMH. PPV combined with subretinal rtPA, filtered air, and anti-VEGF therapy demonstrated favorable displacement and visual outcomes in medium to large hemorrhages or those associated with active nAMD. Hybrid techniques further improved clot mobilization in selected cases. Across studies, delayed intervention beyond 14 days correlated with reduced visual recovery due to blood organization and photoreceptor loss. Potential risks, including recurrent bleeding and rtPA-associated toxicity, were reported but varied across studies. Conclusions: Management should be individualized, considering hemorrhage characteristics and surgical risk. Laser therapy, including PDT, may serve as an adjunct in the perioperative or postoperative period, particularly in PCV patients. Early, tailored intervention typically yields the best functional outcomes. Full article

Background/Objectives: Although high myopia primarily affects the eyes, emerging evidence suggests that it is also associated with systemic inflammation and metabolic dysfunction. The liver plays a key role in metabolism and inflammation, and it may share pathological pathways with high myopia. However, no population studies have examined the relationship between high myopia and liver disease progression. This study used UK Biobank data to analyze the relationship between myopia severity and severe liver disease, as well as to determine whether inflammatory markers or metabolites mediate this link. Methods: A prospective cohort of 70,774 UK Biobank participants without severe liver disease at baseline was followed for 14.1 years. Myopia was categorized as emmetropia, low-to-moderate, or high based on refractive error. Cox proportional hazards models, stratified by aspartate aminotransferase (AST) level (≥40 vs. <40 U/L), were used to assess liver disease risk, and mediation analyses were used to evaluate inflammatory markers and metabolites. Results: Among participants with AST levels of at least 40 U/L, high myopia significantly increased liver fibrosis and cirrhosis risk (hazard ratio [HR] = 2.64, 95% confidence interval [CI] = 1.44–4.85, p = 0.002), exhibiting a dose-dependent trend (ptrend = 0.004). No association existed for AST < 40 U/L. C-reactive protein (CRP) partially mediated this link; no metabolites survived correction. Conclusions: High myopia is independently associated with an increased risk of liver fibrosis and cirrhosis in individuals with elevated AST, partially mediated by CRP-related inflammation. Refractive assessment may stratify liver disease risk in subclinical injury, warranting anti-inflammatory intervention research. Full article

The eye, a complex organ essential for visual perception, is composed of diverse cell populations with specialized functions; however, the complex interplay between these cellular components and their underlying molecular mechanisms remains largely elusive. Traditional biotechnologies, such as bulk RNA sequencing and in vitro models, are limited in capturing cellular heterogeneity or accurately mimicking the complexity of human ophthalmic diseases. The advent of single-cell RNA sequencing (scRNA-seq) has revolutionized ocular research by enabling high-resolution analysis at the single-cell level, uncovering cellular heterogeneity, and identifying disease-specific gene profiles. In this review, we provide a review of scRNA-seq application advancement in ocular physiology and pathology, highlighting its role in elucidating the molecular mechanisms of various ocular diseases, including myopia, ocular surface and corneal diseases, glaucoma, uveitis, retinal diseases, and ocular tumors. By providing novel insights into cellular diversity, gene expression dynamics, and cell–cell interactions, scRNA-seq has facilitated the identification of novel biomarkers and therapeutic targets, and the further integration of scRNA-seq with other omics technologies holds promise for deepening our understanding of ocular health and diseases. Full article

Several soluble mediators are activated during myogenesis and progression, and severe neurodegeneration, with related biomarkers, characterizes high myopia-related retinal atrophy. Targets of oxidative stress, epigenetics and neurogenic inflammation have been reported in the prospecting of some bioindicators to mirror retinal insults occurring in high myopia. The aim of the present study was to assess the expression of a few selected biomarkers belonging to the neurotrophin (NGF and BDNF), oxidative (NO, KEAP1/NRF2), and epigenetic (DNMT3 and HD1) pathways. Sixty-five (65; 76.25 ± 9.40 years) specimens—aqueous, anterior capsule (AC), and lens epithelial cells (LEC)—were collected at the time of cataract surgery and used for ELISA (aqueous) and transcripts analysis (AC/LEC). Biosamples were grouped as emmetrope (23; 81.00 ± 6.70 years); myopia (24; 75.96 ± 7.30); and high (pathological) myopia (18; 70.56 ± 11.68 years), depending on axial length (AL) and refractive error (RE). Comparisons and correlations were carried out between myopic and high-myopic subgroups. NGF and BDNF were lowered in myopic samples; NGF and BDNF transcripts were differentially expressed in LEC, and their expression correlated positively with NGF and negatively with BDNF, with the expression of the αSMA phenotype. NGF and BDNF correlated negatively with NO and nitrites. Oxidative stress (iNOS/NOX1/NOX4 and KEAP1/NRF2) and epigenetic (DNMTα3/HD1) transcripts were upregulated in myopic LEC, compared with emmetropic ones. Herein, we prospect the contribution of NGF and BDNF in both neuroinflammation and neuroprotection occurring in this chronic disease. Full article

Background: The World Health Organization defines myopia as a global epidemic. Its growing prevalence and the increasingly early age onset all raise a major concern for public health due to the elevated risk of loss and deterioration of visual function as a result of myopia-related ocular pathological complications. However, it remains unclear whether the vision-related quality of life of patients with myopia is the same as in healthy individuals. The aim of the present study is to assess the quality of life in children and adolescents with myopia between the ages of 8 and 16 years, who underwent observation at USBOBAL-Varna. Methods: This study prospectively included 190 patients with myopia between −1.00 and −5.50 D, corrected with different optical aids. After a thorough physical ocular examination and inquiry into the best visual acuity with and without distance correction, specially designed questionnaires were completed by the patients and their parents/guardians for the purpose of the study. The data from the questionnaires was statistically processed. The mean age of the patients in the study was 11.65 years, 101 were female and 89 were male. Of these, 83 wore monofocal glasses, 50 were monofocal and 47 were multifocal contact lenses, and 10 wore ortho-K lenses. Results: No significant difference in best corrected visual acuity (BCVA) was found among the three types of optical correction (p-value > 0.05). Cronbach’s alpha of the questionnaire for all 10 factors was higher than 0.6, indicating acceptable internal consistency. Significantly higher scores were reported for overall, near, and distance vision, symptoms, appearance, attitude, activities and hobbies, handling, and perception for soft contact lens wearers than for spectacle wearers (p-value < 0.05). Ortho-K wearers performed better than spectacle wearers in all aspects except for pronounced symptoms (p = 0.74). No significant difference was found between ortho-K wearers and soft contact lens wearers for any factor (p > 0.05). Conclusions: Patients wearing spectacles and with myopia above −5.00 D had the highest anxiety scores and lower quality of life among all myopic participants. The research on the quality of life in children with myopia with different refractive errors and optical correction devices is crucial for improving corrective devices and meeting the needs of patients. Full article

Background: Myopia is a leading cause of visual impairment worldwide, and accumulating evidence suggests that biomechanics may be closely linked to its development. Understanding this relationship may help clarify the underlying mechanisms of myopia and guide treatment strategies. The aim of the study is to investigate the causal relationship between myopia and corneal biomechanics using the UK Biobank (UKB) database. Methods: Data from 11,064 eyes in the UKB, including refraction results and Ocular Response Analyzer (ORA) measurements, were analyzed. Eyes were categorized by spherical equivalent (SE) into emmetropia, mild myopia, moderate myopia, and high myopia. One-way ANOVA assessed differences in corneal biomechanical parameters across the varying myopia groups, while Quantile Regression (QR) explored the relationship between these parameters and myopia severity across the different quantiles. A Mendelian randomization (MR) analysis was employed to explore the causal relationships. Results: Significant differences in corneal biomechanical parameters and intraocular pressure (IOP) were observed across the myopia levels (p < 0.001). High myopia was associated with lower corneal hysteresis (CH), a lower corneal resistance factor (CRF), and increased IOP. The QR analysis demonstrated that lower corneal biomechanics were associated with higher degrees of myopia, with the impact of corneal biomechanics becoming more pronounced as the myopia severity increased. The MR analysis indicated that low CH (OR = 0.9943, p = 0.004) and CRF (OR = 0.9946, p = 0.002) values were risk factors for myopia, while no causal effect was found when the myopia was treated as the exposure and corneal biomechanics as the outcome. Conclusions: This study establishes a causal relationship where reduced corneal biomechanics contribute to myopia, while myopia itself does not directly affect biomechanics. Corneal biomechanics could serve as a biomarker for assessing high myopia risk. These findings offer new insights into high myopia’s pathological mechanisms and targeted prevention. Full article

Background and Objectives: The search for less invasive and more effective methods in the surgical treatment of glaucoma continues. For advanced glaucoma, all surgical options carry a high risk of complications and vision loss. The aim of this study was to evaluate the outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) surgery in advanced glaucoma. Materials and Methods: In this retrospective study, advanced open-angle glaucoma (OAG) patients were followed up on the 1st day, 1st week, and 1st month, then monthly for 6 months and then every 3 months after GATT surgery. Outcomes at 6 and 24 months were analyzed to evaluate early and long-term surgical success. Surgical success was defined as a ≥20% intraocular pressure (IOP) reduction from baseline, final IOP ≤21 mmHg, and no need for additional glaucoma surgery. Pre- and postoperative measurements included IOP, retinal nerve fiber layer (RNFL) thickness by optical coherence tomography (OCT), peripapillary vessel density (VD) via optical coherence tomography angiography, and visual field (VF) tests. Results: Among 44 advanced glaucoma patients (61.4% pseudoexfoliative glaucoma), surgical success was 81.8% at 6 months and 76.5% at 24 months. Mean IOP decreased from 26.9 ± 10.4 mmHg preoperatively to 13.8 ± 8.3 mmHg at 3 months (40.36% reduction, p < 0.001) and 13.9 ± 4.0 mmHg at final follow-up (42.12% reduction, p < 0.001). Disease progression was absent in 66% of patients. BCVA initially declined (0.61 ± 0.36 to 0.41 ± 0.33 logMAR at 3 months, p = 0.011) but returned to baseline (0.59 ± 0.35 logMAR at final follow-up, p = 1.00). Glaucoma medications decreased by 66.2%, and peripapillary VD remained stable (p > 0.05). The most common complication was mild hyphema (34.1%), which resolved without intervention; only one patient (2.3%) experienced vision-threatening complications (wipe-out phenomenon in degenerative myopia). Conclusions: GATT is a safe and effective alternative to trabeculectomy for advanced glaucoma, achieving significant IOP reduction with stable VD and low rates of serious complications. This study provides novel insights by offering long-term (24-month) follow-up data, evaluating peripapillary VD stability, and specifically assessing GATT outcomes in an advanced glaucoma cohort. However, caution is advised in patients with additional ocular pathologies. Full article

Background/Objective: Poor vision can lead to low academic performance and negatively affect the quality of life. In Moldova, there are few guidelines for vision and eye care in children. Further, the prevalence of refractive errors, visual impairment, or eye disease in Moldovan children is unknown. The study aimed to explore the prevalence of refractive errors and eye disease among children examined in ophthalmological practice in Moldova. Methods: The study had a cross-sectional design, including consecutive patients, aged <18 years, examined in an ophthalmological practice in Chișinău, Moldova, during two time periods, from July to September 2018 and from May to June 2023. Results: Data of 299 children (157 female) aged 0–18 years were collected. In all, 177 (59.2%) children had cycloplegic refraction and assessment of refractive error: 47 in the age group 0–2 years, 64 in the age group 3–6 years, and 66 in the age group 7–18 years. In children under 3 years, 8 (17%) were emmetropic (−0.50 D < SER < +0.50 D), 4 (9%) were myopic (SER ≤ −0.50 D), 34 (72%) had mild hyperopia (0.5 ≤ SE < 3.0), and 1 (2%) had high hyperopia (SER > 3.0). Among children aged 3–6 years, 11 (17%) were emmetropic (−0.50 D < SER < +0.50 D), 5 (8%) were myopic (SER ≤ −0.50 D), 46 (72%) had mild hyperopia (0.5 ≤ SER < 3.0), and 2 (3%) had high hyperopia (SER > 3.0). In children over 6 years, 33 (50%) were myopic (SER ≤ −0.50 D), 2 (3%) were emmetropic (−0.50 D < SER < +0.50 D), 27 (41%) had mild hyperopia (0.5 ≤ SER < 3.0), and 4 (6%) had high hyperopia (SER > 3.0). A total of 4 children (2.3%) had amblyopia and 19 children (6.4%) had ocular pathologies. Twelve children (6.8%) were visually impaired with their habitual correction. Conclusions: Half of the school children had myopia and a little less than half had hyperopia. Among toddlers and pre-school children, one in four had myopia or were at risk of developing myopia. Full article

Myopia is one of the dominant causes of visual impairment in the world. Pathological myopia could even lead to other serious eye diseases. Researchers have reached a consensus that myopia could be caused by both environmental and genetic risk factors. Exploring the pathological mechanism of myopia can provide a scientific basis for developing measures to delay the progression of myopia or even treat it. Recent advances highlight that scleral hypoxia could be an important factor in promoting myopia. In this review, we summarized the role of scleral hypoxia in the pathology of myopia and also provided interventions for myopia that target scleral hypoxia directly or indirectly. We hope this review will aid in the development of novel therapeutic strategies and drugs for myopia. Full article

The abnormal growth of irregular new blood vessels into the subretinal or intraretinal space is known as macular neovascularization (MNV). People over 50 are often affected by this disorder, which is typically brought on by age-related macular degeneration. In addition, MNV can be found in people under 50 years of age, who may present primary ophthalmic diseases such as pathological myopia, angioid streaks, traumatic choroidal rupture, or suspected ocular histoplasmosis syndrome. However, it is important to consider a specific set of young individuals who may develop MNV even in the absence of pathological myopia or other identifiable inflammatory, peripapillary, post-traumatic, or degenerative fundus abnormalities. This latter condition is classified as idiopathic MNV. After a literature review focused on young patients affected by one of these two clinical entities, we report the case of a Caucasian young woman suffering for four years from an idiopathic and quiescent MNV that started exuding after childbirth, probably due to the induction with oxytocin, and was treated with intravitreal Aflibercept 2 mg injections. Full article

We report a surgically challenging case, in the context of a diagnosis of juvenile glaucoma refractory to drug therapy, multi-operated, known patient with congenital ichthyosis, part of Dorfman–Chanarin Syndrome (DCS), with a single functional eye. She is a young patient (54) and housewife in an urban environment known to have DCS and BE (both eyes), strong myopia, and congenital nystagmus. She initially underwent cataract surgery in 2015 and again in 2017. As of 2015, she was known to have juvenile glaucoma under maximal therapy. The important increases in pressure started in 2020 when the dermatological condition worsened (exacerbation of skin changes in the context of ichthyosis), the patient is in menopause, and presbyopia has set in. The glaucoma could no longer be controlled with medication and required serial surgery in both eyes (initially in the right eye in 2020 and in the left eye in 2023). The right eye showed a favorable evolution until 2024, when a second trabeculectomy became necessary, with a favorable evolution. Conclusions: To our knowledge, such a case has not been documented in the medical literature. Frequent monitoring of intraocular pressures and prompt treatment are required. It is a rare association, a very complicated case of managing a patient with refractory glaucoma and multiple associated ophthalmic and systemic pathologies. We are also dealing with a single functional eye, difficult to manage due to a thin sclera that has caused intraoperative difficulties, and the association of congenital nystagmus and strabismus. Full article

Background: The purpose of this study is to evaluate the effectiveness of Defocus Incorporated Multiple Segments (DIMSs) in slowing myopia progression in pediatric patients as a function of age. Methods: This was a non-randomized experimenter-masked retrospective controlled observational study of European individuals aged 6–16 years with progressive myopia but no ocular pathology. We retrospectively reviewed the charts of the participants allocated to receive DIMS spectacles (Hoya^® MiyoSmart^®) or single-vision spectacle lenses (control group). Cycloplegic spherical equivalent (SE) and axial length (AL) were measured at baseline and at 12-, 24-, and 36-month follow-ups. The results were stratified by age into four groups: patients wearing DIMS spectacles older or younger than 10 years of age (group A, 20 patients mean age 13.6 ± 2.2, and group C, 20 patients mean age 9.0 ± 1.2) and age-matched control groups (group B, 18 patients mean age 13.2 ± 2.5, and group D, 22 patients mean age 8.5 ± 0.9). Results: At 36 months, SE and AL increase were significantly reduced in groups A and C, respectively, compared to groups B and D (p < 0.05). Linear regression analysis showed a significant correlation (p < 0.05) between patient age and myopia progression for SE in groups A and C, but only in group A for AL. Groups B and D did not show any significant correlation (p > 0.05). Conclusions: DIMS spectacles seem to slow myopia progression in pediatric patients; however, their effectiveness shows the greatest results in children older than 10 years of age. Moreover, our findings suggest that AL may be the more reliable parameter for evaluating myopia progression. Full article

Background/Objectives: Posterior staphyloma (PS) is a hallmark of pathological myopia, corresponding to a circumscribed outpouching of the eyeball with choroidal thinning and inward scleral deformation at its edges. Its pathogenesis is still unclear, thus constituting a research priority as the prevalence of myopia is increasing worldwide. Recently, it has been suggested that the optic nerve sheaths or oblique muscles are potential promoters of PS through the traction or compression effect that they apply to the eye wall. The inferior oblique muscle (IOM) inserts 1–2 mm from the macula. The projection of its insertion is accessible using Optical Coherence Tomography (OCT). Before launching prospective studies, we sought to detect any choroidal thinning (ChT) in the temporal vicinity of the macula and to measure the distance between it and the fovea (FT-distance). Methods: This retrospective cross-sectional pilot study included 120 eyes. Using Spectralis^®-OCT, the area centered by the Bruch’s membrane opening–fovea axis was analyzed for ChT and FT-distance. Results: Of the 112 defined eyes, 70% (78 eyes) had ChT. Pachymetry was significantly thinner (p = 0.018) in eyes with than without ChT. The mean FT-distance was 3601.9 ± 93.6 µm. Conclusions: The location of ChT coincided with the insertion distance of the IOM, suggesting a link between them. The association between the presence of ChT and a thinner pachymetry suggests a reduced scleral resistance, as a thinner pachymetry is related to a thinner sclera. Our results suggest a link between ocular deformation and the IOM, which may be relevant for the pathogenesis of PS, warranting further investigation. Full article