Search Results (107)

Background/Objectives: Intramuscular immunization elicits systemic IgG and is the primary route of vaccine administration in humans. However, there is growing interest in utilizing other routes of administration to tailor antibody profiles, increase immunity at primary sites of infection, simplify administration, and eliminate needle waste. Here, we investigated the antibody profiles elicited by immunization with bacteriophage virus-like particle vaccine platforms at various routes of administration. Methods: We chose two model bacteriophage vaccines for investigation: bacteriophage MS2 virus-like particles (VLPs) recombinantly displaying a short, conserved peptide from Chlamydia trachomatis major outer membrane protein (MS2) and bacteriophage Qβ VLPs displaying oxycodone through chemical conjugation (Qβ). We comprehensively characterized the antibodies elicited systemically and at various mucosal sites when the vaccines were administered intramuscularly, intranasally or periocularly with or without an intramuscular prime using various prime/boost schemes. Results: Intranasal and periocular immunization elicited robust mucosal and systemic IgA responses for both MS2 and Qβ. The intramuscular prime followed by intranasal or periocular boosts elicited broad antibody responses, and increased antibodies titers at certain anatomical sites. Conclusions: These findings demonstrate the tractability of bacteriophage VLP-based vaccines in generating specific antibody profiles based on the prime–boost regimen and route of administration. Full article

Purpose: The objective of this study was to evaluate the implementation of a Multidisciplinary Tumor Board (MDTB) strategy in the treatment of patients with uveal melanoma. Methods: A retrospective analysis was conducted on the implementation of MDTB meetings over a 24-month period. During this time, 72 intraocular tumors were discussed, including 59 confirmed cases of uveal melanoma. The MDTB involved a core group of specialists (e.g., ophthalmologists, oncologists, and radiologists), with other experts included when clinically appropriate. To assess patient satisfaction with the MDTB approach, a structured questionnaire was administered, including items on clarity of communication, perceived quality of care, and overall satisfaction, which were ranked on a 5-point scale. Results: A total of 319 patients with ocular, periocular, or orbital tumors were discussed during the study period, of which, 72 had intraocular tumors. A total of 13 (18%) were diagnosed to have choroidal metastases, whereas 59 (82%) had uveal melanomas. The average time between patient care and MDTB discussion was 15.9 days (IQR: 7.5–16.5). The mean time between the case discussion and the implementation of recommendations (diagnostic, therapeutic, or referral decisions) was 14.8 days (IQR: 6.0–23.75). Overall, 4 (7%) patients were classified as Stage I, 16 (27%) as Stage IIa, 18 (31%) as Stage IIb, 7 (12%) as Stage IIIa, 2 (3%) as Stage IIIb, and 12 (20%) as Stage IV. Regarding the satisfaction questionnaire, all patients (100%) agreed to have the clinical case discussed at the TB even though this could result in a delay in diagnostic/therapeutic implementation. However, only 60% of patients perceived they had been directly involved in the decision-making process. Conclusions: In selected cases of uveal melanoma and other types of cancer, MDTBs should be recognized as a gold standard in cancer care, allowing for comprehensive decision-making that draws on a wide range of highly specialized expertise. Full article

Retinoblastoma is a success story in pediatric oncology, evolving from life-saving interventions to approaches that preserve eyes and vision while minimizing complications. Initially managed with enucleation and radiotherapy, treatment now emphasizes eye preservation through chemotherapy as the cornerstone therapy. Various chemotherapy delivery methods—including intravenous (IVC), intraarterial (IAC), intravitreal, intracameral, and periocular—offer flexibility in treatment. Studies show nearly 100% eye salvage rates for groups A–C. For advanced cases (groups D and E), IAC has achieved outcomes that were not possible before. Intravitreal injections, when performed safely, may help avoid enucleation and radiotherapy in advanced cases, preserving vision, even in complex scenarios, with vitreous seeding. Each strategy may be tailored to tumor and patient characteristics that may help optimize outcomes. Recent innovations like liquid biopsy, prenatal diagnosis, prognostic biomarkers, and new surgical methods, such as tylectomy and chemoplaque, are paving the way for more personalized care. While advanced extraocular or metastatic retinoblastoma remains challenging, these advancements underscore a shift towards better outcomes and individualized management. The future holds promise for refining treatment strategies to maximize eye and vision preservation while ensuring patient survival. Full article

Background: Hyaluronic acid (HA) has emerged as a favored adjunct to restore volume after blepharoplasty and is very effective in the treatment of postoperative hollowness, sagging, and asymmetry. Its efficacy, rate of complications, and optimal injection technique are different in different clinical studies. Hyaluronidase has been studied by diverse methods in the treatment of HA complications, including chronic edema and surgical distortion. This study critically evaluated the efficacy, safety, and technical aspects of HA in the context of blepharoplasty outcomes. Methods: A systematic review was performed to evaluate the use of HA and hyaluronidase for post-blepharoplasty volume rejuvenation and the treatment of complications. Studies describing HA injection technique, time interval between blepharoplasty and injection, volumetric maintenance, complication rates, esthetic and functional results, and patient satisfaction scores were considered. Risk of bias was estimated with the ROBINS-I tool. Results: Sample sizes across the five included studies ranged from 5 to 109 patients, and follow-up intervals ranged from 1 month to 7 years. The age of patients ranged from 31 to 76 years, and females accounted for 86% of the participants in some studies. Injection of HA successfully restored meaningful volume, with retention persisting for over 12 months in the majority of cases. HA preoperative injection caused significant patient satisfaction in a short duration and was not associated with severe complications; delayed injection caused slight distortions in some revision operations. Lipofilling showed a reduced rate of complications (12%) compared with isolated blepharoplasty (20%), suggesting its utility as an adjuvant procedure of volume restoration. Hyaluronidase successfully treated recalcitrant edema, with improvements ranging from 50% to 100%, while the application of adjuvant RF microneedling caused complete remission (100%) in subjects with multiple treatments. The application of ultrasound imaging made measurements more precise, although methods of clinical assessment were significantly heterogeneous among the studies. Conclusions: HA displayed efficacy in terms of efficient volume restoration after blepharoplasty, especially when technique, time, and filler selection are meticulously optimized. In comparison to lipofilling, HA is seen as somewhat safer because of its reversibility and lower likelihood of adverse vascular events. Nonetheless, considerable variability in filler type, amount, timing of administration, and result evaluation constrains conclusive clinical recommendations. The use of hyaluronidase is an effective remedial approach for overcorrection or ongoing edema. Full article

Background/Objectives: To evaluate the clinical and histological efficacy, safety, and cosmetic outcomes of 5% imiquimod (IMQ) cream, used in monotherapy or in combination, for periocular superficial and nodular basal cell carcinoma (BCC). Methods: A systematic search of MEDLINE, PubMed, and Google Scholar (inception—12 June 2025) identified studies reporting IMQ treatment of eyelid/periocular BCC. Randomized, nonrandomized and observational designs were eligible. Risk of bias was assessed with Cochrane RoB 2 or ROBINS-I, and certainty of evidence graded with GRADE. Results: Seven studies (n = 152 lesions) met the inclusion criteria. The pooled clinical-plus-histological clearance across case series was 82% (95% CI 72–90%). The single RCT (n = 27) reported 100% histological clearance for both IMQ and radiotherapy at 3 months, but IMQ produced superior cosmetic results. Combination immunocryosurgery (IMQ + cryotherapy) achieved 87.5% sustained remission at ≤5 years. Local adverse events—erythema, crusting, or conjunctivitis—occurred in ≥70% (85/122) of treated cases but were mild-to-moderate and self-limiting; systemic reactions were not reported. Forty-seven additional patients in a dedicated safety cohort showed only transient ocular irritation. The certainty of evidence was moderate for short-term clearance and low for long-term control because of small samples and heterogeneous follow-up. Conclusions: IMQ 5% is a useful, tissue-sparing option for selected (superficial and nodular subtypes) periocular BCCs where surgery is contraindicated or cosmesis is paramount. Overall clearance is slightly lower than Mohs surgery but comparable to radiotherapy, and cosmetic outcomes are favorable. Larger, standardized RCTs with ≥3-year follow-up are needed to confirm durability, optimize dosing schedules, and validate patient-reported outcome measures. Full article

A 10-year-old male neutered British Shorthair cat with diabetes mellitus presented with an acute onset of unilateral swelling, erythema, alopecia and coalescing ulcerations of the face and periocular skin. Initial clinical differential diagnoses were trauma, infections (including feline respiratory viruses), arthropod bites, and eosinophilic dermatoses such as eosinophilic granuloma complex, mosquito-bite hypersensitivity and cutaneous adverse drug reaction. Histopathology revealed fulminant furunculosis with abundant eosinophils and vasculitis. Initial topical glucocorticoid treatment partially improved the clinical signs but severely raised serum glucose levels. As a result, systemic glucocorticoids and ciclosporin were not considered optimal treatments, and the off-label and short-term use of oclacitinib was chosen with the owner’s informed consent. This treatment induced fast remission of clinical signs with no recurrence for 17 months. Secondary fusion of the eyelids caused by cicatrization was surgically reconstructed to restore full function. Full article

Background: Basal cell carcinoma (BCC) of the ocular and periocular region is characterized by a painless progressive extension. An early diagnosis can limit the extent of facial tissue involvement and subsequent resection resulting in better cosmetic and functional results. Objectives: The aim is to provide the largest and most up-to-date overview of ocular and periocular BCCs. We also reported the first case of caruncle BCC investigated by dermoscopy and reflectance confocal microscopy (RCM). Methods: A systematic review and meta-analysis (Prospero ID CRD583032) were carried out by searching PUBMED–MEDLINE, including all articles with a full-text English version and with BCCs in eyelids, medial and lateral canthus, caruncle, conjunctiva, and orbit. The following data were collected: authors, year, title and type of publication, medical specialization, number, sex, age and comorbidities of the patients, anatomic localization of the disease, clinical and dermoscopic aspect, histological examination, and treatment. Results: We identified 731 articles through a database search, of which 236 articles matched our inclusion criteria. A total of 71.730 patients with ocular and periocular BCCs were included in the present study, and all data collected were reported in a dataset. Most of the articles included were described by ophthalmologists (67.5%), dermatologists (11.2%), or plastic surgeons (5.6%). The proportional meta-analysis revealed varying significance and heterogeneity for each type of study included. Conclusions: BCC more frequently affects the lower eyelid. The most common BCC subtype of ocular and periocular area is the nodular form. Limited data are available concerning the application of dermoscopy and RCM in this area. RCM may be particularly useful for early diagnosis, mapping, and treatment monitoring of ocular and periocular BCCs. Surgery still remains the first-choice treatment. Full article

Background: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis’ (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient’s eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock. Full article

Objectives: Visual field (VF) testing is key to assessing functional loss in glaucoma. Despite its clinical value, traditional VF testing has a number of limitations, including its dependency on medical equipment and posturing requirements. The present study examines the acceptance, tolerability, and comfort of home-based VF testing using a virtual reality (VR) headset. Method: Healthy subjects were prospectively enrolled to undergo VF examination in a non-clinical setting using a commercially available stereoscopic VR headset and SORS (sequentially optimized reconstruction strategy) on the VisionOne platform. Subjects were supervised and wore their own spectacles within the headset. After the VR VF test, they were asked about their comfort, side effects, and readiness to repeat the examination at home. Results: Of the 12 subjects enrolled, 7 were female (58.3%) and 5 were male (41.7%). Mean age was 45 years (range: 30–68). While none of the subjects suffered from glaucoma, their medical histories included severe arthritis, refractive surgery, high myopia, amblyopia, and esotropia. The mean self-reported comfort score was 8.75 out of 10 (range: 8–10), with some subjects taking the test in the dorsal decubitus position. Eleven subjects (91.7%) considered the device to be easy to use, and 100% responded that they would be willing to repeat the test at home, of which 41.7% stated they would prefer to be supervised by a clinician. Overall, three subjects reported mild side effects, namely light asthenopia, epiphora, and periocular flushing. All side effects were mild and self-limited. The mean perceived duration of the test (187 s) correlated strongly with the mean actual duration (166 s; Pearson correlation coefficient r = 0.76, p-value = 0.007). In all, 58.3% of perceived durations were shorter than the actual test durations. Mean false negative and false positive responses were 3.75% and 4.7%, respectively. Central fixation recorded by real-time eye tracking was maintained on average 73.23% of the time and showed a strong correlation with false negative responses (r = 0.75; p = 0.026). Conclusions: While the present study did not examine the test algorithm itself, it suggests that home-based VF testing using a VR headset is well tolerated and accepted, with high levels of self-reported comfort and only mild side effects. While all subjects welcomed the opportunity to perform clinical tests from home, over a third expressed a preference for supervision. Real-time eye tracking correlated well with traditional reliability markers, suggesting potential clinical value. Full article

With advancements in hardware, high-quality head-mounted display (HMD) devices are being developed by numerous companies, driving increased consumer interest in AR, VR, and MR applications. This proliferation of HMD devices opens up possibilities for a wide range of applications beyond entertainment. Most commercially available HMD devices are equipped with internal inward-facing cameras to record the periocular areas. Given the nature of these devices and captured data, many applications such as biometric authentication and gaze analysis become feasible. To effectively explore the potential of HMDs for these diverse use-cases and to enhance the corresponding techniques, it is essential to have an HMD dataset that captures realistic scenarios. In this work, we present a new dataset of periocular videos acquired using a virtual reality headset called VRBiom. The VRBiom, targeted at biometric applications, consists of 900 short videos acquired from 25 individuals recorded in the NIR spectrum. These 10 s long videos have been captured using the internal tracking cameras of Meta Quest Pro at 72 FPS. To encompass real-world variations, the dataset includes recordings under three gaze conditions: steady, moving, and partially closed eyes. We have also ensured an equal split of recordings without and with glasses to facilitate the analysis of eye-wear. These videos, characterized by non-frontal views of the eye and relatively low spatial resolutions ($400\times 400$), can be instrumental in advancing state-of-the-art research across various biometric applications. The VRBiom dataset can be utilized to evaluate, train, or adapt models for biometric use-cases such as iris and/or periocular recognition and associated sub-tasks such as detection and semantic segmentation. In addition to data from real individuals, we have included around 1100 presentation attacks constructed from 92 PA instruments. These PAIs fall into six categories constructed through combinations of print attacks (real and synthetic identities), fake 3D eyeballs, plastic eyes, and various types of masks and mannequins. These PA videos, combined with genuine (bona fide) data, can be utilized to address concerns related to spoofing, which is a significant threat if these devices are to be used for authentication. The VRBiom dataset is publicly available for research purposes related to biometric applications only. Full article

(1) Background: Controlled skin perforations, such as ear tags, piercings, and microdermal implants, induce inflammation and stress in individuals undergoing these procedures. This localized trauma requires care to optimize healing, reduce inflammation, and prevent infections. (2) Methods: Two formulations were developed: an FB-suspension and an FB-gel. Their in vivo efficacy was evaluated, along with drug retention in porcine and human skin after 30 min of administration, chemical stability at different temperatures, cytotoxicity, histological changes induced via transdermal application, and irritative potential, assessed using the HET-CAM assay. (3) Results: Both formulations reduced inflammation when applied 30 min before perforation compared to the positive control. The FB-suspension demonstrated no cytotoxicity and exhibited greater efficacy than the free flurbiprofen solution, highlighting the advantages of using nanoparticle-mediated drug delivery. Moreover, the FB-gel maintained chemical stability for up to 3 months across a temperature range of 4 to 40 °C. Histologically, no significant changes in skin composition were observed. (4) Conclusions: The FB-suspension is viable for both pre- and post-perforation application, as it is a sterile formulation. In contrast, the FB-gel is a convenient and easy application, making it a practical alternative for use in both clinical and veterinary settings. Full article

Background/Objectives: Cystoid macular edema (CMO) is a common complication that follows cataract surgery, presenting management challenges due to the lack of standardized treatment guidelines and the potential for spontaneous resolution. This study aimed to evaluate various treatment modalities for post-operative CMO, including topical non-steroidal anti-inflammatory drugs (NSAIDs), periocular steroids, and intravitreal injections. Methods: A systematic review of the literature was conducted to assess the efficacy of different treatment approaches for post-operative CMO. Studies evaluating topical NSAIDs, periocular steroids, intravitreal triamcinolone acetonide (TCA), dexamethasone implants (Ozurdex), and intravitreal bevacizumab were included. The main outcomes assessed included improvements in vision, resolution of CMO, recurrence rates, and safety profile. Results: Topical NSAIDs, particularly ketorolac and diclofenac, showed effectiveness in acute CMO, while their efficacy in chronic cases was variable. Periocular steroids, including retrobulbar TCA and sub-Tenon injections, demonstrated significant improvements in vision and the resolution of CMO, especially in cases resistant to topical therapy. Intravitreal TCA and dexamethasone implants exhibited variable effects on CMO resolution and recurrence rates, with some studies reporting sustained improvements over 12 months. The role of intravitreal bevacizumab as initial therapy remains unclear, although it may be considered in cases unresponsive to steroids. Conclusions: Topical NSAIDs, often combined with periocular steroids, serve as first-line therapy, with periocular steroids offering additional efficacy in resistant cases. Further research is needed to establish optimal treatment algorithms and improve outcomes for patients with post-operative CMO Full article

Skin aging is a complex and multifactorial process influenced by both intrinsic and extrinsic factors. The periorbital area of the face is particularly susceptible to premature aging signs due to its delicate skin structure, and is a major concern for many individuals. While hyaluronic acid (HA)-based dermal filler products are commonly used for periorbital rejuvenation, novel approaches to effectively locally address the visible signs of aging are available. This study aimed to investigate Innovyal Regenerative Action (IRA), an injectable polynucleotide–HA (PN-HA) regenerative complex designed for periocular prejuvenation. Firstly, PN-HA was compared to other commercially available HA-based dermbooster products (Profhilo^®, Suisselle Cellbooster^® Glow, and NCTF^® 135 HA) in terms of rheological properties, in vitro antioxidant capacity, and total collagen production stimulation in human fibroblasts. Secondly, the clinical effects of the IRA PN-HA complex were evaluated in two case reports (monotherapy for periorbital prejuvenation). It was shown that the PN-HA complex outperformed its comparators in terms of relative rheological behavior (biophysical attributes normalized to polymer contents), intrinsic antioxidant activity (CUPRAC, FRAP, and ORAC assays), as well as total collagen level induction (72-h in vitro dermal fibroblast induction model). Generally, the results of this study provided mechanistic and preliminary clinical insights into the potential benefits of the IRA PN-HA complex for periocular cutaneous treatment. Overall, it was underscored that combining the structural support and regenerative properties of PN with the hydrating and volumizing effects of HA bares tangible potential for multifactorial skin quality enhancement and for periocular prejuvenation in particular. Full article

Background: Adult xanthogranulomatous disease (AXD) is a rare histiocytic disorder with systemic potential, while xanthelasma palpebrarum (XP) is a common xanthoma often linked to lipid disorders. Differentiating these conditions is challenging due to overlapping features. Reflectance confocal microscopy (RCM), a non-invasive imaging tool, offers high-resolution visualization of skin structures and may aid diagnosis. Methods: We present a 71-year-old woman with periocular lesions. RCM was used to evaluate the lesions, identifying cellular and structural features. The findings were confirmed through histopathology, followed by surgical excision. Postoperative monitoring utilized RCM and LC-OCT. Results: RCM identified Touton giant cells, foamy histiocytes, and fibrosis, helping to distinguish xanthogranuloma from xanthelasma. Histopathology confirmed the diagnosis, and the patient underwent successful lesion excision without complications. Conclusions: This case underscores RCM’s utility as a diagnostic adjunct for differentiating AXD from XP in sensitive regions like the periocular area. The combined use of RCM and LC-OCT enhances monitoring for recurrence. While histopathology remains the diagnostic gold standard, RCM shows promise as a non-invasive tool, warranting further research to validate its role and develop standardized clinical protocols. Full article

Background/Objectives: The management of periocular skin malignancies presents a unique challenge. Proton beam therapy, due to its sharp dose fall-off, allows for the delivery of a tumoricidal dose to the tumor while sparing adjacent normal tissues. Methods: Thirteen patients with a median age of 76.5 years received protons at our institution to a median dose of 66.6 Gy (RBE). Sixty-four percent of the lesions were basal cell carcinoma, and 22% were squamous cell carcinoma. Eighty-six percent of patients underwent biopsy only or partial resection. Fifty-seven percent of the lesions were located in the medial or lateral canthus. There was orbital invasion in 93% of the cases. Locoregional control probability and overall survival were estimated with the Kaplan–Meier method. Treatment toxicity was scored using the CTCAE 4.0. Results: At a median follow-up of 96 months, there was no local recurrence. The rate of orbital preservation was 100%. Functional vision was maintained in all the patients. There was no acute or late grade 3 or higher toxicity. Conclusions: Protons allow for long-term tumor control with eye preservation in patients with locally advanced periocular skin cancers. Larger prospective multi-institutional trials with standardized ophthalmological assessments are needed to confirm our findings. Full article