Search Results (206)

Purpose: The present study aims to evaluate alterations in the peripapillary retinal nerve fiber layer (RNFL) thickness in pediatric patients following surgical resection of childhood-onset craniopharyngioma (CP) and to identify tumor characteristics and other factors influencing these alterations, including changes in the lesion’s location. Design: retrospective clinical cohort study. Methods: A retrospective analysis was conducted on 73 eyes from 38 patients with CP and 64 eyes from 32 age- and sex-matched healthy controls. The mean age of the CP patients was 10.3 ± 4.2 years (range 4–17), while the control group had a mean age of 10.5 ± 3.1 years (range 4–17). Optical coherence tomography (OCT) was used to assess the peripapillary RNFL thickness in the study and control groups. RNFL thickness was analyzed in the superior, inferior, and average sectors, as well as across eight optic nerve sectors. Tumor characteristics were evaluated to determine their correlation with changes in RNFL thickness in individual sectors. Results: Postoperative thickness of peripapillary RNFL in all individual sectors was significantly reduced in the CP group compared to healthy controls. Location, tumor volume, maximum tumor diameter, calcification, ventriculoperitoneal shunt, surgery technique, total resection, presence of Rosenthal fibers, and reoperation due to progression or recurrence correlated with damage to RNFL. Conclusions: CP is associated with significant reductions in RNFL thickness, indicating the tumor’s impact on optic nerve fibers. OCT is a valuable tool for monitoring visual pathway impairment and postoperative outcomes. Correlations between RNFL thickness in individual sectors and clinical parameters may offer valuable insights for diagnosis and monitoring, underlining their potential role in predicting visual outcomes. Regular RNFL evaluation should be integrated into the long-term care of CP patients to optimize visual prognosis and detect progressive or residual damage. Full article

Purpose: The aim of this study was to compare the one-year efficacy of three spectacle lens designs, highly aspherical lenslets (HALs), horizontally asymmetric peripheral defocus (HAPD) lenses, and standard single vision lenses (SVLs) in slowing myopia progression in school-aged children. Methods: In this prospective, non-randomized study, 57 children, aged 8–17 years, were grouped based on the type of lenses worn: HAL (n = 16), HAPD (n = 21), or SVL (n = 20). Comprehensive ophthalmologic examinations were performed at baseline, 6 months, and 12 months. Outcome measures included spherical equivalent refraction (SER), spherical refraction (SR), cylindrical refraction (CR), and axial length (AL). Data were analyzed using non-parametric tests with significance set at p < 0.05. Results: All groups showed some progression in SER and AL over 12 months. The HAL group demonstrated the smallest median SER change (−0.3 D), compared to HAPD (−0.5 D) and SVL (−0.4 D), though group differences were not statistically significant (p = 0.111). Axial elongation was significantly lower in the HAL group (0.1 mm, IQR: 0.0–0.2 mm) compared to HAPD and SVL (both 0.2 mm, p < 0.0001). CR remained stable in all groups, with no clinically meaningful changes. The HAPD groups showed no advantages over SVL in any parameter. Conclusions: Among the three lens types studied, HAL lenses were the most effective in reducing both refractive and axial myopia progression over 12 months. These findings support their use as a reliable intervention in pediatric myopia control. Full article

Purpose: This retrospective study aimed to compare the efficacy of cycloplegic (CR) versus non-cycloplegic refraction (NCR) methods in detecting refractive errors among children and adolescents. Methods: Electronic data from pediatric ophthalmology clinics at the University Hospital “Sveti Duh”; Zagreb, Croatia, from January 2008 to July 2023, were analyzed. Comprehensive eye examinations, including Logarithmic Visual Acuity tests, subjective refraction, cycloplegic retinoscopy, slit lamp, and fundus examinations, were conducted. Results: The dataset included 1075 individuals, with 180 undergoing NCR and 895 undergoing CR. In premyopes, the NCR group had a longer follow-up (5.04 vs. 3.45 years; p < 0.001) with similar SE progression. In low myopia, NCR showed more negative first visit SE (−1.86 D vs. −1.35 D; p < 0.001) and faster progression (p = 0.01). In high myopia, follow-up was longer in NCR (5.08 vs. 2.08 years; p = 0.03) with no other significant differences. SE progression was highest in 4–6-year-olds and significantly faster in NCR (−0.61 vs. −0.40 D/year; p = 0.05). Conclusions: Cycloplegic refraction is essential for accurately assessing refractive status, especially in cases of low myopia, as it prevents misclassification and ensures precise evaluation in children and adolescents, thereby facilitating the appropriate diagnosis and treatment of refractive errors. Full article

Background/Objectives: A direct link between sensory processing disorder (SPD) and strabismus has not been systematically investigated, though prior studies suggest sensory modulation may influence visual behaviors. Traditional approaches view strabismus through a binary lens—either normal or pathological motor deviation. This report presents a proof-of-concept case suggesting strabismus may represent a neurobehavioral manifestation of sensory processing imbalance, rooted within the broader framework of SPD. Methods: We report a pediatric case marked by episodic monocular eye closure triggered by environmental stimuli, without identifiable ophthalmologic or neurologic pathology. The child’s symptoms were most consistent with sensory over-responsivity (SOR), a subtype of SPD, manifesting as stimulus-bound monocular eye closure and secondary self-regulatory behaviors. Results: We propose the Fusion Dysregulation Hypothesis, suggesting that exotropia and esotropia represent opposing outcomes along a continuum of sensory connectivity: exotropia arising from neural underwiring (hyporesponsivity and fusion instability), and esotropia from overwiring (hyperresponsivity and excessive fusion drive). Our case, marked by sensory hyperresponsivity, showed frequent monocular eye closure that briefly disrupted but did not impair fusion. This suggests an “overwired” binocular system maintaining single vision despite sensory triggers. In early-onset esotropia, such overconnectivity may become maladaptive, leading to sustained convergence. Conversely, autism spectrum disorder, typically associated with hypoconnectivity, may predispose to exotropia through reduced fusion maintenance. Conclusions: These findings highlight the need for interdisciplinary evaluation. We advocate for structured sensory profiling in children presenting with strabismus and, conversely, for ophthalmologic assessment in those diagnosed with SPD. While our findings remain preliminary, they support a bidirectional screening approach and suggest that sensory modulation may play a previously under-recognized role in the spectrum of pediatric strabismus presentations. Full article

Sensenbrenner syndrome, or cranioectodermal dysplasia (CED), is a rare autosomal recessive ciliopathy characterized by craniofacial, skeletal, ectodermal, and renal abnormalities. Ocular involvement, though infrequent, can include retinal dystrophy with early-onset visual impairment. We report a case of a 2-year-old boy with classic clinical features of CED and significant ocular findings. Genetic testing revealed two novel compound heterozygous variants in the WDR19 gene—c.1778G>T and c.3536T>G—expanding the known mutational spectrum associated with this condition. Ophthalmologic evaluation demonstrated bilateral optic nerve hypoplasia, high hyperopia, and severely reduced ERG responses, consistent with global retinal dysfunction. Fundoscopy revealed optic disk pallor, vessel attenuation, and peripheral pigment changes. Multisystem findings included postaxial polydactyly, brachydactyly, short stature, hypotonia, and stage 2 chronic kidney disease. This case highlights the importance of early ophthalmologic screening in suspected CED and underscores the utility of ERG in detecting early retinal involvement. The identification of two previously undescribed WDR19 variants contributes to genotype–phenotype correlation in CED and emphasizes the need for ongoing documentation to guide diagnosis, management, and genetic counseling. Full article

In this paper, we will present the synthesis of coumarins bearing a phosphonate group in the C-3 position of the coumarin skeleton and phosphacoumarin derivatives. The compounds were synthesized by Knoevenagel condensation. Notably, the synthetic difficulties in preparing phosphacoumarins have limited previous studies. Our approach allows us to efficiently produce these derivatives, opening the way to investigate their biological properties. The resulting compounds were fully characterized using spectroscopic techniques and high-resolution mass spectrometry. We then evaluated the cytotoxicity of the compounds against human colon cancer HT-29 tumor and CCD 841 CoTr normal colon epithelial cells. We compared these results with coumarin activity to assess the effect of the introduction of the phosphonate group on their cytotoxicity. In addition, we performed cell cycle analysis by flow cytometry and examined the antioxidant activity of the compounds by the DPPH and FRAP methods. Furthermore, we conducted ADME analysis to gain more insight into the pharmacokinetic properties of the tested coumarins. Our study is in line with current trends in the search for new compounds with potential anticancer properties. Although there are numerous reports in the scientific literature on the anticancer activity of coumarin derivatives, the cytotoxicity of synthetic derivatives with a phosphonate group has not been investigated to date. Full article

Background: Physician rating websites (PRWs) are increasingly used by patients to assess healthcare providers, yet little is known about the factors influencing patient feedback in ophthalmology across different healthcare systems. Objective: This study aimed to identify variables associated with patient reviews of ophthalmologists, with a particular focus on soft skill-related feedback, and to compare trends between Polish and British healthcare systems. Methods: We analyzed data on 461 verified ophthalmologists—261 from ZnanyLekarz.pl (Poland) and 200 from Doctify.com (UK)—collected between March and July 2024 with the highest number of reviews. Physician characteristics, including sex, academic title, years of experience, practice setting, specialization, and online presence, were examined. Review content was categorized into soft skills, professional abilities, or both. Statistical and multivariate analyses were performed to determine factors influencing (a) soft review frequency and (b) the profile of a top-rated ophthalmologist, defined as one with the highest overall ratings and a minimum of 100 reviews. Results: We analyzed a total of 70,176 patient reviews—55,786 from a Polish physician rating website (PRW) and 14,390 from a British PRW. Polish ophthalmologists received significantly more reviews than their British counterparts, with a median of 141 reviews per physician compared to 44 in the UK (p < 0.001). Feedback focused on soft skills accounted for 74% of Polish reviews and 59% of British reviews. Key predictors of soft skill-focused reviews included female gender, higher average ratings, practice in pediatric ophthalmology, and affiliation with the private sector. In contrast, fewer soft reviews were associated with area of surgical expertise, public sector employment, and practicing in the UK. Academic title also influenced the content of reviews: physicians holding PhDs received more feedback focused on soft skills, while full professors received less and years of experience had no significant effect. In the multivariate model assessing predictors of being a top-rated ophthalmologist for the whole cohort, each additional review containing substantive content or soft skill-related feedback increased the odds by 29% and 14%, respectively (p < 0.001 for both). Conclusions: Patient reviews are largely influenced by perceived interpersonal qualities rather than professional credentials or clinical experience. The active solicitation of patient feedback, as implemented on Polish physician rating platforms, results in over three times the volume of reviews compared to the British approach, which relies on passive voluntary submission without direct prompts. Full article

Background and Objectives: Pediatric Sjögren’s syndrome is a rare autoimmune disease with a heterogeneous clinical expression and limited pediatric-specific diagnostic criteria. Ocular involvement often represents an early manifestation, yet it may go unrecognized in children due to poor symptom reporting and the underuse of objective diagnostic tools. This retrospective study evaluated six pediatric patients with Sjögren’s syndrome, integrating systemic and ocular findings with a focus on early immunological and clinical markers. Materials and Methods: All patients underwent ophthalmological assessments, including tear break-up time, Schirmer’s test, and slit-lamp examination. Results: Tear break-up time values consistently indicated tear film instability (mean RE 7.4 ± 2.5 s; LE 7.7 ± 2.3 s), while Schirmer’s test showed greater variability. Slit-lamp examination revealed inhomogeneous tear films in all patients and blepharitis in 66.7%, consistent with Meibomian gland dysfunction. Systemic features included arthralgia, Raynaud’s phenomenon, fatigue, and frequent seropositivity for ANA and anti-SSA/Ro antibodies. Minor salivary gland biopsy confirmed lymphoepithelial sialadenitis in all cases. Conclusions: These findings highlight the importance of combining laboratory and clinical markers with ophthalmological parameters to support an early diagnosis of Sjögren’s syndrome in pediatric patients. Integrating TBUT and slit-lamp evaluation with serological and histopathological data may enhance diagnostic accuracy and guide timely, targeted intervention to prevent long-term complications. Full article

Background: Intra-arterial chemotherapy (IAC) is increasingly useful for treating intraocular retinoblastoma (Rb). It offers targeted delivery of chemotherapy with reduced systemic exposure. In this study, we evaluate management outcomes and identify predictive factors for globe salvage following IAC in children with Rb. Methods: This retrospective study included 20 eyes of 20 melphalan-based IAC-treated patients (67 sessions) between 2015 and 2023 in a tertiary cancer center (King Hussein Cancer Center) in Jordan. Data collection included patients’ demographics, tumor staging, eye salvage, complications, and survival, followed by statistical comparisons between eye salvage rates and clinical factors. Results: The median age of IAC initiation was 38 months (range: 6–78 months). IAC was used as a primary treatment in 35% (7/20) of eyes and as a secondary treatment following systemic chemotherapy in 65% (13/20) of eyes. Nineteen (95%) eyes showed initial tumor regression, 15 (75%) eyes showed short term tumor control, and long-term eye salvage was achieved in 11 (55%) eyes. Poor prognostic factors for eye salvage included advanced tumor stage (Group D/E: 43% salvage rate vs. Group C: 83%; p = 0.047), vitreous seeding at the time of IAC (38% with seeding vs. 75% without; p = 0.046), use of IAC as a secondary rather than a primary treatment (46% vs. 71%; p = 0.047), and the need for >3 IAC cycles (20% success with >3 cycles vs. 67% with ≤3 cycles; p = 0.034). Complications were notable: systemic adverse effects were seen in five (25%) patients, including neutropenia (20%) and bronchospasm (6%). Procedure-related complications were seen with 22% of injections, including failure of the procedure (7%), ophthalmic artery spasm (6%), and intra-procedural stroke (3%). Five (25%) eyes developed ocular complications, including vitreous hemorrhage (15%), retinal detachment (10%), optic atrophy (10%), and retinal or choroidal ischemia (10%). Notably, all infants under 12 months of age (4/4) developed complications, including the two events of stroke. At a median follow-up of 60 months, eye salvage was achieved in 11 (55%) eyes, and none of the 9 (45%) enucleated eyes showed high-risk pathological features. There was no orbital recurrence, and one (5%) child developed CNS metastasis and passed away. Conclusion: IAC achieves long-term globe salvage in 55% of Rb cases; however, outcomes are poorer with Group D/E tumors, vitreous seeds, prior IVC failure, or requiring >3 IAC cycles. While reducing systemic chemotherapy toxicity, IAC carries significant risks of vision- and life-threatening complications. Infants and single-eyed patients require particularly cautious consideration. Though IAC remains crucial for globe preservation, optimal implementation demands improved patient selection criteria, multicenter collaboration, and long-term outcome studies to maximize safety and efficacy. Full article

Dry eye disease (DED) is a common, multifactorial disorder of the ocular surface. Although DED can affect individuals at any age, its prevalence, clinical manifestations, underlying mechanisms, and optimal management strategies differ considerably across the lifespan. In children, symptoms are frequently associated with atopy and allergic disorders and environmental factors, whereas in young adults, digital device usage and contact lens wear are the predominant contributors. In older adults, systemic diseases and polypharmacy significantly elevate the risk of DED. Across all age groups, tear film instability, decreased tear production, and chronic inflammation are central pathogenic features. Key tear biomarkers, such as pro-inflammatory cytokines, have been widely linked to disease development. Cathepsin S and tumor necrosis factor-alpha have recently been implicated in age-related DED. A nuanced understanding of these age-related differences is crucial for improving diagnostic accuracy and tailoring interventions to specific patient populations. This review synthesizes current evidence on DED across age groups, focusing on prevalence, risk factors, pathophysiology, molecular mechanisms, coexisting conditions, biomarkers, and treatment options. Finally, it highlights critical unmet clinical needs in the management of age-related DED. Full article

This comprehensive review focuses on Eleutherococcus senticosus (ES), examining the phytochemical composition, traditional medicinal roles, ecological traits, and pharmacological effects. Native to Northeast Asia, ES is used in traditional Chinese, Korean, and Japanese medicine. The rhizomes and bark are utilized medicinally and valued for their adaptogenic properties that enhance stress resistance, boost mental and physical endurance, and exhibit immunostimulatory effects that strengthen the immune system. Its pharmacological potential stems from a variety of bioactive compounds, including eleutherosides, lignans, saponins, flavonoids, and polysaccharides, which contribute to health benefits such as neuroprotective, antidiabetic, anticancer, and antioxidative activities. Neuroprotective properties may aid in the management of neurodegenerative conditions, such as Alzheimer’s and Parkinson’s disease, while antidiabetic effects support glucose regulation and insulin sensitivity. With increasing demands and conservation concerns, sustainable cultivation practices are essential, as ES is endangered in some areas. Plant biotechnology techniques offer solutions to enhance secondary metabolite yields while ensuring genetic stability and minimizing environmental impacts. ES is a promising natural resource for various industries because of its extensive benefits. Still, its conservation and sustainable production are critical and require ongoing research and innovative cultivation strategies. Full article

Background: Uveal melanoma (UM) is a relatively rare malignancy, yet it remains the most common primary intraocular cancer in adults. Several risk factors have been identified, including light iris color, fair skin tone, and cutaneous freckles. Methods: The aim of this article was an overview of the treatment methods for uveal melanoma, with a particular focus on emerging therapies such as tebentafusp and da-rovasertib. The research method was a review of the latest literature. Results: Genetic studies have uncovered key mutations in GNAQ and GNA11, which significantly contribute to UM pathogenesis. Treatment selection depends on tumor location and disease stage. In localized disease, radiotherapy—especially brachytherapy—is commonly used and generally effective. However, the prognosis worsens significantly once distant metastases, most often to the liver, develop, as no standard systemic therapy has demonstrated high efficacy in this setting. Recent years have seen the emergence of promising therapies, including tebentafusp, which stimulates immune responses against gp100-expressing melanoma cells, and darovasertib, a potent PKC inhibitor that targets MAPK pathway activation driven by GNAQ/GNA11 mutations. Both agents have shown encouraging tolerability; tebentafusp has demonstrated clinical benefit in Phase II and III trials, while darovasertib is still under investigation. Additionally, melphalan-based liver-directed therapy, particularly via hepatic arterial infusion (approved by the FDA), has shown potential in controlling liver-dominant disease in metastatic UM. This localized approach may provide significant benefit for patients with limited extrahepatic spread. Conclusions: Future research should focus on optimizing these novel strategies—tebentafusp, darovasertib, melphalan, and combination therapies—and on expanding our understanding of UM’s molecular drivers to enable the development of more effective, personalized treatments. Full article

Background: The aim of this study was to evaluate the outcome of pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling in patients with diabetic macular edema (DME) refractory to intravitreal injections (IVIs) and without vitreomacular traction. Methods: In this retrospective consecutive case series, we included patients that underwent PPV with ILM peeling for refractory DME. Examination was performed at baseline, and at the 1- and 6-month follow-up. Primary endpoints were best-corrected distance visual acuity (BCVA) and central macular thickness (CMT). Results: A total of 15 eyes were included, and BCVA improved from 0.69 ± 0.27 logMAR preoperatively to 0.48 ± 0.28 logMAR at the 1-month (p = 0.013) follow-up and 0.42 ± 0.29 logMAR at the 6-month (p < 0.001) follow-up. At the 6-month follow-up, 10 eyes (66.6%) gained at least two lines of vision. The BCVA of pseudophakic eyes (nine eyes) improved from 0.64 ± 0.21 logMAR at baseline to 0.40 ± 0.26 logMAR at the 6-month follow-up (p = 0.02). CMT decreased from 457 ± 114 µm preoperatively to 336 ± 112 µm at the 1-month (p = 0.035) follow-up and 302 ± 68 µm at the 6-month (p = 0.001) follow-up. During follow-up, only two eyes received IVIs: one following vitreous hemorrhage and one for persistent DME. Conclusion: PPV with ILM peeling improves BCVA and reduces CMT in eyes with DME refractory to IVIs up to the 6-month follow-up. Full article

The cornea, a highly innervated and avascular ocular tissue, relies on intricate neuro-immune interactions to maintain homeostasis. Among key neuromediators, substance P (SP)—a neuropeptide belonging to the tachykinin family—plays a dual role in corneal physiology and pathology. This review synthesizes current knowledge on SP’s involvement in corneal innervation, epithelial homeostasis, immune regulation, neovascularization, and wound healing, while highlighting its dichotomous effects in both promoting tissue repair and exacerbating inflammation. SP, primarily signaling through the neurokinin-1 receptor (NK1R), influences corneal epithelial proliferation, barrier function, and wound healing by modulating cytokines, chemokines, and growth factors. However, its overexpression is linked to pain sensitization, inflammatory keratitis, and corneal neovascularization, driven by interactions with immune cells (e.g., mast cells, neutrophils) and pro-angiogenic factors (e.g., VEGF). Clinical studies demonstrate altered SP levels in dry eye disease, neurotrophic keratitis, and post-refractive surgery, correlating with nerve damage and ocular surface dysfunction. Emerging therapies targeting SP pathways- such as NK1R antagonists (e.g., fosaprepitant) and SP-IGF-1 combinations-show promise for treating neurotrophic ulcers but face challenges due to SP’s context-dependent actions. Future research should clarify the roles of NK2R/NK3R receptors and optimize SP-based interventions to balance its reparative and inflammatory effects. Understanding SP’s multifaceted mechanisms could advance the development of therapies for corneal diseases, particularly those involving sensory neuropathy and immune dysregulation. Full article