International Ophthalmology最新文献

Purpose: This review paper is a sightseeing on the molecular pathways of the DED, which culminate in the cascades of inflammatory cytokines, apoptosis, oxidative stress, as well as the breakdown of homeostasis of the ocular surface. The article also discusses complications, and it explains the connection between conjunctivitis, keratitis, corneal ulcers, blepharitis, dysfunction of meibomian glands, recurrent corneal erosion, ocular neuropathic pain, and accentuating the systemic effects of conditions, such as Sjögren syndrome. Within the directions of such molecular pathways, the article analyzes diagnostic biomarkers, as HLA-DR, MMP-9, cytokine profile, and innovations in technologies testing. Associating clinical exercise with the molecular frontier will add a new dimension to how we style, achieve, and eventually treat complications associated with DED.

Methods: Using PubMed, Scopus, Web of Science, and SpringerLink, an extensive appraisal of recent experimental and clinical literature was carried out. To offer mechanistic and translational understanding, studies explaining inflammatory signaling cascades, oxidative and mitochondrial stress, extracellular matrix remodeling, neurosensory changes, and immune-epithelial interaction in DED were assessed.

Results: Pro-inflammatory cytokines (IL-1β, IL-6, TNF-α), dysregulated matrix metalloproteinases (MMP-2/9), oxidative stress-induced epithelial damage, and abnormal neuro-immune signaling mediated by substance P and calcitonin gene-related peptide are all closely linked molecular pathways that contribute to DED complications. Corneal epithelial fragility, poor regeneration, neurotrophic keratopathy, ulceration, secondary infection, and visual impairment are the results of these processes. Refined illness categorization and risk prediction are made possible by developments in molecular diagnostics, such as tear osmolarity, MMP-9, neurosensory biomarkers, and lipidomic and proteomic signatures.

Conclusion: With the passage of research and progress in diagnosis with biomolecular science and technology, biomarkers such as MMP-9, lactoferrin, interleukin, and HLA-DR have brought the possibility of following the evolution, subtyping, and diagnosis of diseases. The recent revelations of the molecular biology of dry eye diseases raise the concern for a specific therapeutic approach that not only brings symptomatic relief but modulates molecular expressions as well. A vibrant combination of ophthalmology, pharmacology, immunology, bioengineering, and material sciences with regard to new therapeutic strategies and more refined delivery platforms. Such leveraging of molecular insight to provide specific interventions is needed clinically.

Purpose: This systematic review explores the relationship between tobacco smoking and the development of primary open-angle glaucoma (POAG). Glaucoma is the leading cause of irreversible blindness worldwide. Prior literature investigating the link between tobacco smoking and glaucoma has reported contradictory findings on the association between tobacco smoking and POAG.

Methods: Systematically EMBASE, MEDLINE, and Web of Science were searched, encompassing articles published up until April 2025. The inclusion criteria comprised observational and randomised controlled studies that provided a statistical analysis exploring the association between tobacco smoking and POAG in adult populations. The ROBINS-E tool was utilised to assess the risk of bias of studies and meta-analyses were completed using RevMan software. The main outcomes were effect estimates that measured the association between tobacco smoking and POAG.

Results: Across 26 eligible studies and 289,930 participants, there was a prevalence of 6,454 cases of POAG. The meta-analyses revealed that current smokers (OR = 1.00, 95%CI 0.76-1.33, p = 0.97, n = 11), past smokers (OR = 0.92, 95%CI 0.75-1.11, p = 0.38, n = 6) as well as both current and past tobacco smoking combined (OR = 1.00, 95%CI 0.84-1.19, p = 1.00, n = 17) exhibited no statistically significant association with POAG when compared to individuals who had never smoked. Heterogeneity ranged from low to substantial across comparisons, and risk of bias was frequently rated as high among included observational studies. The lack of an associative effect was sustained, on exclusion of studies with a high risk of bias.

Conclusion: Although the results suggest no significant statistical association between tobacco smoking and POAG, given the substantial morbidity and mortality associated with tobacco smoking and the detrimental impact on systemic and ocular health, tobacco smoking cessation should remain at the forefront of health promotion. PROSPERO registration ID: CRD42023409440.

Purpose: This study aimed to investigate the potential link between age-related macular degeneration (AMD) and systemic lupus erythematosus (SLE), exploring whether AMD may share underlying autoimmune mechanisms with SLE. The objective was to identify shared core genes and potential diagnostic biomarkers for both diseases.

Methods: We utilized GEO datasets to develop diagnostic models and performed differential gene expression analysis, weighted gene co-expression network analysis (WGCNA), and three machine learning techniques-LASSO regression, random forest (RF), and support vector machine recursive feature elimination (SVM-RFE)-to identify common key genes between AMD and SLE. Mendelian randomization analysis was conducted to validate the potential causal relationship between AMD and the identified essential genes. Single-cell RNA sequencing data were analyzed to explore the expression patterns of shared biomarkers at the cellular level. The expression level of the identified biomarker was validated using reverse transcription quantitative polymerase chain reaction and Western blotting.

Results: Several shared core genes were identified as associated with both AMD and SLE. The Mendelian randomization study confirmed a potential correlation between AMD and these essential genes. Single-cell transcriptomic analysis revealed distinct expression profiles of these markers across relevant cell types, supporting their role in disease pathology.

Conclusion: Our findings suggest that AMD and SLE share key genetic features, supporting the hypothesis that AMD may have an autoimmune component. These shared genes hold promise as potential therapeutic targets and diagnostic biomarkers for both diseases.

Purpose: To analyze environmental sustainability in vitreoretinal surgery and evaluate evidence-based strategies for reducing carbon footprint while maintaining optimal patient outcomes.

Methods: Literature review using PubMed and Google Scholar databases focusing on vitreoretinal surgery's environmental impact and sustainable practices.

Results: Vitreoretinal surgery generates significant carbon emissions through disposable equipment, building energy consumption, and tamponade gas utilization. Fluorinated gases represent the most environmentally damaging component, with SF₆ demonstrating 22,800 times greater global warming potential than CO₂. Despite being used in only 38.6% of procedures, SF₆ was responsible for 68.8% of total emissions in vitreoretinal surgery, demonstrating a 4.4-fold greater environmental impact compared to C₂F₆. Air tamponade offers up to 47% emission reductions for appropriate cases, while alternative gas selection achieves 50% reductions when longer-acting tamponades are necessary. Energy optimization protocols, waste segregation improvements, and packaging modifications provide additional reduction opportunities.

Conclusion: Sustainable vitreoretinal surgery is feasible through evidence-based strategies that significantly reduce environmental impact without compromising patient safety. Key interventions include implementing air tamponade for appropriate cases and selecting alternative fluorinated gases with lower environmental impact. Implementation requires addressing regulatory barriers and cultural resistance through education programs and policy reform. The specialty should adopt the "5 R" framework for sustainable practice.

Background: Global childhood myopia is rising, with longer axial length increasing ocular risks. Orthokeratology corrects vision and may slow axial elongation via peripheral defocus, but the efficacy of newer OK lens designs and long-term persistence of effect remain to be comprehensively evaluated.

Methods: Adhering to PROSPERO and PRISMA 2020, PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched through 18 April 2025. Included studies prospectively compared axial-length changes in children (6-18 years) with OK versus single-vision spectacles, soft contact lenses, or conventional OK. Hartung-Knapp-adjusted random-effects meta-analyses were performed, with subgroup, sensitivity, and leave-one-out analyses addressing heterogeneity.

Results: Fifteen trials (1,065 participants) met inclusion criteria. At 12 ± 2 months, OK slowed axial elongation by a pooled mean difference (MD) of - 0.15 mm (95% CI - 0.20 to - 0.10; I2 = 90.8%). Five studies with ≥ 24-month follow-up showed a sustained benefit (MD - 0.19 mm, - 0.32 to - 0.06; I2 = 79%). Four head-to-head trials suggested modified OK designs (e.g., smaller optical zones, higher compression factors) provided an additional - 0.12 mm (- 0.23 to - 0.01) at one year, after excluding one discordant soft-lens study. Funnel plots and Egger's tests indicated no small-study bias. Most studies had low risk of bias; limitations included lack of masking and predominantly East-Asian samples.

Conclusions: Axial elongation in myopic children is reduced by approximately 0.15 mm in the first year with OK, and this effect persists for up to three years. Modified lens designs may offer additional benefit. Larger, multi-ethnic trials with long-term follow-up and standardised safety reporting are needed.

Purpose: To present an overview of emerging pharmacological strategies for the prevention and treatment of proliferative vitreoretinopathy (PVR).

Methods: This review critically examines recent experimental and clinical evidence on pharmacological agents targeting key pathogenic mechanisms of PVR, including epithelial-mesenchymal transition, profibrotic cytokine signaling (TGF-β, PDGF, VEGF), and inflammation-driven tissue remodeling. Investigated compounds include clinically tested substances such as daunorubicin, 5-fluorouracil, corticosteroids, anti-VEGF agents, methotrexate, isotretinoin, decorin and infliximab, as well as newer experimental approaches including Topotecan, Melphalan, ROCK-Inhibitors and gene-regulated therapies. Mechanistic insights into receptor crosstalk, intracellular signaling cascades, and cell survival pathways are integrated with findings from preclinical models and clinical studies.

Results: Several agents have shown anti-proliferative and anti-inflammatory effects in vitro and in vivo, with methotrexate and infliximab emerging as particularly promising candidates. However, clinical data remain heterogeneous, and no pharmacological agent has yet received regulatory approval for PVR treatment. Risk stratification based on preoperative PVR, vitreous hemorrhage, or ocular trauma may help optimize patient selection in future trials.

Conclusion: Pharmacological modulation of PVR is conceptually well supported by preclinical data, but clinical translation remains limited. Well-designed randomized trials in clearly defined high-risk populations are needed to validate efficacy, determine optimal treatment windows, and develop standardized protocols for both prophylaxis and therapy.

Glaucoma is a common eye disease affecting several people worldwide. Blindness can be avoided with proper treatment and regular examination. Delayed diagnosis of eye disease causes serious damage to the optic nerve, resulting in loss of vision and blindness. As a result, early disease detection is crucial, and the current research has employed time-consuming machine-learning techniques. It is also difficult to detect eye diseases using computer-aided diagnostic systems because they rely on manually designed features to assess the disease. In order to detect glaucoma, the proposed work presented a novel hybrid deep learning-based GD Pooled Attention assisted Transformer model. The initial step in the proposed detection method is to remove noise and enhance the contrast of the fundus image from the databases using a cross-guided bilateral filter (Cr-GBF). The glaucoma-affected images are collected from ORIGA and RIMONE datasets. Glaucoma is primarily identified by structural deformation in the optic disc region. Thus, significant features are extracted from the images using improved channel spatial attention with AlterNet-K (Im-ChspAN), and disease detection is performed using the proposed Optimized hybrid GD pooled attention former (OpHGpoTr) model. The proposed model's performance is evaluated using the following metrics: accuracy of 98.68%, precision of 97.06%, sensitivity of 97.07%, specificity of 98.57%, and f-score of 98.31%. The classifier showed better performance than the existing studies.

Purpose: This study aimed to determine the efficacy of various types of topical anesthesia prior intravitreal injection in an effort to lessen adverse effects such as pain and subconjunctival bleeding.

Methods: This randomized controlled study included 239 patients. All patients were randomly assigned to either receive: (1) Lidocaine gel 3% (Anaesthetic BL 3% gel), (2) Lidocaine gel 10% (Anaesthetic BL 10% gel), (3) Oxybuprocaine 0.4% eye drops (Localin), (4) Tetracaine HCl 1%, eye drops (Tetracaine) (5) A combined Oxybuprocaine 0.4% eye drops (Localin) and an ice patch. Patients' discomfort, itching, burning and pain (using Visual Analog Scale), and bleeding size (using images) were measured one and ten minutes post-injection. Tolerability was calculated by averaging patients' pain, discomfort, itching, and burning scores.

Results: In the one- and ten-minute post-injection analyses, the groups receiving Tetracaine (0.60 ± 0.63, 0.50 ± 0.61) and the combined Oxybuprocaine and ice patch anesthesia (0.55 ± 0.66, 0.38 ± 0.58) had the lowest mean tolerability scores. In most parameters (discomfort burning, and pain scores) the Tetracaine and the combined Oxybuprocaine and ice patch anesthesia demonstrated the lowest mean scores. All subjective criteria assessed by the surgeon immediately following the injection were not found to be significantly different at any group, such as movements during injection (p = 0.19), complaints during injection (p = 0.56), complaints following injection (p = 0.21). Bleeding size (area or circumference) was not statistical different between groups.

Conclusion: This study demonstrated a considerable reduction in pain and overall tolerability with Tetracaine or a combination of ice patch and Oxybuprocaine anesthesia. These findings may lessen patients' discomfort and improve their tolerance.

Purpose: Prospective randomized single-blinded study of 261 cataract patients to investigate the influence of different instruments and techniques in continuous curvilinear capsulorhexis (CCC) on the stability of the anterior chamber using intraoperative rebound tonometry.

Methods: The study included 261 eyes allocated to six groups according to three ophthalmic viscoelastic device (OVD) conditions-hyaluronic acid (HA), hydroxypropylmethylcellulose (HPMC), and their combination via the soft-shell technique (SST)-and two instruments (Utrata forceps UF and a 26-G cystotome RN). Intraocular pressure (IOP) was measured before and after CCC using rebound tonometry with sterilized probes.

Results: IOP reached 78.6 mmHg in the RN group and 76.5 mmHg in the UF group after OVD instillation and after the creation of the CCC. The mean IOP drop during capsulorhexis was significantly greater with UF (67.1 ± 12.3 mmHg; n = 117) compared to RN (56.5 ± 11.6 mmHg; n = 144) (P < 0.001).

Conclusion: The results of this study showed a statistically significant difference in the stability of the anterior chamber depending on the instrument used. The use of different OVDs had no statistically significant influence on anterior chamber stability. Maintaining a more stable IOP with a 26-gauge cystotome may be advantageous in complex cases, such as increased posterior vitreous pressure, zonular weakness or heightened intracapsular pressure.

Purpose: To evaluate the visual outcomes with scleral lens (SL) wear in patients who have undergone surgical repair for open globe injuries (OGI).

Methods: The medical records of patients with a history of OGI at the Department of Ophthalmology, Marmara University School of Medicine, between 2017 and 2023 were retrospectively reviewed. Eleven patients (8 male, 3 female) with corneal scar and/or irregular corneal astigmatism, and intolerance to corneal rigid lenses (CRLs) were included in the study. Demographics, type and extent of injury were assessed. Best corrected visual acuity (BCVA) before SL trial and with SLs wear were measured.

Results: The median age of the patients was 40.0 years (IQR, 24-42). The patients were followed up for a median duration of 22.0 months (IQR, 17-59) months. Central scarring was observed in 45.5% of cases, and paracentral scarring in 54.5% of cases. Aphakic correction was performed in one patient. The median BCVA improved from 0.50 (logMAR) to 0.10 (logMAR) after SL wear (p = 0.003).

Conclusions: The significant improvement in BCVA observed after SL wear indicates that SLs are an effective option for visual rehabilitation in patients with corneal scarring and irregular astigmatism following OGI repair.