International Ophthalmology最新文献

Purpose: To evaluate the quantitative changes in subfoveal choroidal thickness (CT), retinal thickness, and choroidal vascularity index (CVI) following upper eyelid blepharoplasty in patients with dermatochalasis, using spectral-domain optical coherence tomography (SD-OCT).

Methods: This retrospective study included 78 eyes of 78 patients (mean age: 57.9 ± 8.7 years) who underwent upper eyelid blepharoplasty between May 2024 and May 2025. Only right eyes with high-quality SD-OCT images obtained both preoperatively and at 3 months postoperatively were included. Retinal thickness was assessed in 9 ETDRS subfields. Subfoveal CT and CVI were measured using horizontal B-scan images. CVI was calculated based on the binarization method described by Agrawal et al., using ImageJ software. Pre- and postoperative values were compared using paired t-tests or Wilcoxon signed-rank tests depending on normality.

Results: Subfoveal CT significantly increased after surgery (287.22 ± 39.67 µm to 294.23 ± 39.74 µm; p = 0.030). A marked increase in CVI was also observed (61.48 ± 9.13% to 63.63 ± 9.13%; p < 0.001). No significant differences were detected in most retinal segments, except for the inferior inner (p = 0.016) and inferior outer (p = 0.002) regions, which showed statistically significant thickening postoperatively.

Conclusions: Upper eyelid blepharoplasty is associated with measurable structural changes in the posterior segment, including increased subfoveal CT and CVI, as well as regional thickening of the inferior retina. These findings suggest that blepharoplasty may influence choroidal hemodynamics and retinal adaptation beyond its functional and cosmetic benefits.

Purpose: To analyze the clinical spectrum of mucus-fishing syndrome (MFS), an often-overlooked cause of dry eye disease, marked by a vicious cycle of self-induced ocular surface irritation and mucus overproduction.

Methods: Retrospective observational case series study.

Results: A total of 29 patients with MFS were included. Most patients were female (89.6%) with a mean age of 54.3 ± 18.5 years. Psychological and psychiatric comorbidities were reported in 31.0% of the patients, with anxiety and depression being the most common. Patients primarily used their fingernails (82.7%) for filament removal, along with other methods including cotton swabs, paper tissues, and needles. Common symptoms included an imminent feeling of mucus removal (100%), foreign body sensation (96.5%), tearing (51.7%), and a red eye (41.3%). Treatment focused on patient education, ocular surface management, and adjuvant therapies, achieving favorable responses in 55.1% of the patients within the first month.

Conclusion: MFS is an insidious cause of dry eye syndrome that may be underdiagnosed because of patient embarrassment and limited clinician awareness. Effective management requires patient education to avoid filament removal and to address the underlying ocular and mental health conditions.

Purpose: To investigate the effects of Mitomycin-C (MMC) use and duration of application on surgical outcomes in patients who underwent 3 snip punctoplasty for epiphora.

Material and methods: Demographic characteristics, follow-up period, nasolacrimal passage patency, degree of punctum stenosis (graded between 0 and 5), presence of epiphora and accompanying diseases of the cases who applied with epiphora complaint between June 2015 and May 2024 were evaluated retrospectively. 3 snip punctoplasty was applied to all cases.The cases were divided into 3 groups. Group 1: 3 snip without MMC, group 2: 3 snip with 0.3% MMC for 1 min, group 3: 3 snip with 0.3% MMC for 2 min.

Results: In this study, 180 eyes of a total of 90 cases were examined. 50 (55.5%) of the cases were female and 40 (44.5%) were male. The average age of the cases was 42.2 ± 3.8 (35-68).The average follow-up period was 6.2 ± 1.5 (6-8) months. In 2 of the cases (2.2%), the postoperative nasolacrimal lavage was closed at the punctum level. Preoperative punctal stenosis grade was 2 in 60 cases (66.6%) and 1 in 30 cases (33.4%). There were no postoperative epiphora complaints in 24 (80%) patients in group 1, 27 (90%) patients in group 2, and 28 (93.3%) patients in group 3. The difference between groups 1 and 2 was statistically significant (p < 0.05).The difference between groups 2 and 3 was not statistically significant (p > 0.05). Postoperative corneal epithelial defect development was observed in 1 of the cases.

Conclusions: 3 snip surgery is a successful method in the treatment of punctal stenosis, and the use of MMC may increase success. Increasing the duration of MMC application did not improve surgical success.

Purpose: To compare the functional and anatomical outcomes of pars plana vitrectomy (PPV) with or without internal limiting membrane (ILM) peeling in patients suffering with non-resolving vitreous hemorrhage and tractional retinal detachment.

Methods: Fifty-seven patients (57 eyes) suffering from PDR were randomly assigned to undergo PPV with ILM peeling (n = 26) or without ILM peeling (n = 31). Outcomes assessed over a 6-month follow-up included best-corrected visual acuity (BCVA), need for additional anti-VEGF injections, frequency of reoperations, central macular thickness (CMT), development of epiretinal membrane (ERM), macular traction, and vascular parameters derived from OCT imaging.

Results: Both groups showed statistically significant improvements in BCVA postoperatively (p < 0.001), with no significant difference between them (p = 0.846). The ILM peeling group required fewer repeat anti-VEGF injections (7.7% vs. 35.5%, p = 0.030) and exhibited a significantly lower incidence of secondary ERM (11.5% vs. 51.6%, p = 0.004). ERM formation correlated with iatrogenic retinal tears (p = 0.007) and tractional retinal detachment (TRD) (p < 0.001). Reoperations for ERM removal occurred exclusively in the non-ILM peeling group. No significant intergroup differences were found in CMT, foveal avascular zone (FAZ) area, or vessel density.

Conclusion: ILM peeling during diabetic vitrectomy effectively minimizes the risk of postoperative ERM formation and reduces the need for further Anti-VEGF injections for DME. However, it does not confer a significant advantage in terms of visual acuity improvements.

Glaucoma is a leading cause of irreversible blindness worldwide, characterized by optic nerve damage that is often associated with elevated intraocular pressure. Topical antiglaucoma medications, such as prostaglandin analogues, β-blockers, carbonic anhydrase inhibitors, α-adrenergic agonists, and Rho-kinase inhibitors, represent the mainstay of treatment; however, long-term therapy with these drugs is invariably associated with ADRs, including conjunctival hyperemia, ocular surface inflammation, Meibomian gland dysfunction, and tear film instability. These generally result from drug-induced structural and physiological changes in the conjunctiva, cornea, and tear film. In recent years, compelling evidence has emerged that supplementation with omega-3 fatty acids and hyaluronic acid can prevent and alleviate these ADRs. Omega-3 fatty acids suppress ocular surface inflammation, enhance tear film stability, and improve meibomian gland function, while HA enhances corneal healing, ocular surface lubrication, and epithelial regeneration. In addition, ocular barriers in the eye often impede the poor bioavailability of conventional topical medications, necessitating the development of NDDS. Nanoparticles, nanoemulsions, in-situ gels, and ocular inserts exhibit improved corneal permeability, prolonged retention time, and sustained drug release, thereby offering superior therapeutic outcomes with less local irritation. Combining omega-3 fatty acids and HA with NDDS may thus represent a new strategy to improve ocular drug delivery while minimizing ADRs associated with chronic antiglaucoma medications. This review highlights the mechanism underlying these side effects and discusses new opportunities to improve drug safety and compliance in long-term glaucoma management.

Purpose: Cataracts are associated with oxidative stress-induced damage to lens proteins. This study aims to identify differentially expressed proteins (DEPs) associated with the protective effects of hydrogen-rich saline (HRS) against N-methyl-N-nitrosourea (MNU)-induced cataracts, utilizing the antioxidant properties of hydrogen.

Methods: Sprague-Dawley rats were assigned to control, MNU-only, MNU + normal saline (NS), MNU + pirenoxine(PRX), and MNU + HRS groups. Cataracts were induced with MNU (postnatal day 15), and treatments (postnatal days 8-21) included intraperitoneal injections and eye drops. Cataract severity was assessed using slit-lamp examinations, Pentacam analysis, and spectrophotometry. Proteomic analysis of lens tissues from the MNU + HRS and MNU + NS groups employed tandem mass tag (TMT) labeling and mass spectrometry. DEPs were identified, grouped based on fold changes, and analyzed for Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG),, and domain enrichment. Parallel reaction monitoring (PRM) validated selected DEPs.

Results: HRS reduced MNU-induced cataract incidence to 50% versus 100% in MNU-only and NS groups and preserved lens clarity comparable to normal controls. Proteomic analysis identified 90 upregulated and 303 downregulated proteins in the HRS-treated group versus the NS-treated group. DEPs were enriched in GO terms related to ion transport, homeostasis, and ATP hydrolysis, as well as KEGG pathways like oxidative phosphorylation and arginine biosynthesis. Domain enrichment showed links to ATPase activity and energy metabolism. DEPs were grouped into Q1-Q4, with Q1 showing enrichment in oxidative phosphorylation and metabolic pathways. PRM confirmed the downregulation of 14 stress-response and metabolic proteins in the HRS-treated group.

Conclusion: HRS mitigates MNU-induced cataracts possibly by reducing oxidative stress and downregulating stress-response and metabolic proteins.

Purpose: This review aims to summarize the current understanding of transepithelial corneal cross-linking (TE-CXL) for treating keratoconus (KC). It focuses on how TE-CXL compares with the standard epithelium-off cross-linking (S-CXL) and discusses recent improvements intended to make it more effective.

Methods: Relevant studies were reviewed from PubMed and Google Scholar. The review focused on research about new riboflavin solutions, delivery techniques, ultraviolet-A (UV-A) light settings, oxygen supply methods, and recent new technologies designed to improve the results of TE-CXL.

Results: TE-CXL preserves the corneal epithelium, providing better patient comfort and fewer postoperative complications. However, its corneal stiffening effect is generally lower than S-CXL due to limited riboflavin penetration and UV photoactivation. Recent approaches, including chemical enhancers, iontophoresis-assisted delivery, optimized UV-A protocols, nanotechnology-based or ultrasound-assisted methods have demonstrated potential to improve biomechanical strengthening. In addition, theranostic-guided TE-CXL, which provides real-time monitoring of stromal riboflavin concentration and adaptive UV-A dosing, represents a promising advancement. Nevertheless, differences in treatment protocols and in oxygen and luminance parameters still lead to variability in clinical outcomes.

Conclusions: TE-CXL is a promising and less invasive treatment for KC, offering better comfort and faster recovery. However, its long-term stability and biomechanical effect remain inferior to S-CXL. Future progress will depend on optimizing riboflavin and oxygen delivery, refining UV-A irradiation protocols, and validating newer technologies such as theranostic-guided CXL through large-scale clinical studies.

Purpose: To investigate wavefront aberrations, as well as corneal optical densitometry (COD), in eyes with epithelial basement membrane dystrophy (EBMD) and the influence on visual acuity.

Methods: In this cross-sectional study, 70 eyes of 70 patients (mean age 55.9 ± 14.0 years) with the central cornea involving EBMD were compared to 50 healthy eyes of 50 patients (mean age 58.8 ± 14.1 years) serving as controls. Wavefront aberrations of the anterior corneal surface and the total cornea were measured with the Pentacam AXL (Oculus Optikgeräte GmbH, Wetzlar, Germany), and calculated for the 6 mm central corneal zone. In addition, the COD (corneal light backscatter measured in grey scale units) of the anterior 120 µm of the central 0-2 mm, 2-6 mm, and 6-10 mm of the cornea was evaluated. Corrected distance visual acuity (CDVA) was correlated with wavefront aberrations and COD using Spearman correlation analysis.

Results: EBMD resulted in significant higher peak-to-valley (PTV; median: 15.0 [interquartile range: 9] µm), square root of the sum of the squared higher-order aberrations (RMS-HOA; 0.77 [0.52] µm), astigmatism (1.06 [1.04] µm), coma (0.41 [0.44] µm), and trefoil (0.28 [0.40] µm) (all p ≤ 0.01). A moderate correlation was found especially between CDVA and PTV as well as RMS-HOA. EBMD led to a statistically significant higher COD (p < 0.01) in the central corneal 6-mm and correlated moderately with CDVA outcomes.

Conclusions: Our study revealed a significant correlation between elevated wavefront aberrations and backscattering in eyes affected by epithelial basement membrane dystrophy. While COD demonstrates potential for diagnostic purposes, additional studies are necessary to ascertain its specificity and distinguish EBMD from other ocular surface disorders.

Background: Keratoconus (KCN) is a progressive degenerative corneal disorder characterized by corneal thinning and cone-shaped protrusion, leading to significant visual impairment if not detected early. Accurate staging of KCN using corneal topographic maps is critical for timely diagnosis and effective treatment planning.

Methods: This study proposes an enhanced deep learning framework for KCN stage classification based on corneal topographic images. The model employs a Dual Vision Transformer (DViT) to effectively capture both local and global spatial features. To optimize model performance, the Electric Eel Foraging Optimizer (EEFO) is utilized for tuning attention weights and hyperparameters of the DViT architecture. Additionally, model interpretability is enhanced through Local Interpretable Model-Agnostic Explanations (LIME) and SHapley Additive exPlanations (SHAP), enabling visualization of corneal regions influencing classification decisions.

Results: Experimental evaluations conducted on a keratoconus dataset demonstrate that the proposed DViT-EEFO model outperforms existing approaches, achieving an accuracy of 99.2%, recall of 99.3%, and precision of 99.5%. Interpretability analyses confirm that the model focuses on clinically relevant corneal regions during decision-making.

Conclusion: The proposed DViT-EEFO framework delivers high classification performance and improved interpretability, highlighting its strong potential as a reliable clinical decision support tool for early keratoconus diagnosis and treatment planning.

Purpose: To evaluate subclinical retinal microvascular changes in long-term hydroxychloroquine (HCQ) users (≥ 5 years) using optical coherence tomography angiography (OCTA), comparing retinal parameters with a healthy control group.

Method: This single-center, case-control study involved 118 participants (comprising of 59 HCQ users and 59 controls) who underwent comprehensive ophthalmic evaluations, including OCTA to assess the foveal avascular zone (FAZ), macular vessel density (VD) in superficial and deep capillary plexus (SCP and DCP), and retinal thickness. Statistical tests included independent t, Mann-Whitney U, and Spearman's rank correlation tests, with significance set at p < 0.05.

Results: Most HCQ users were female (88.14%) with a median age of 47 years, primarily treated for systemic lupus erythematosus (SLE), receiving a mean HCQ dose of 5.14 mg/kg/day. FAZ area and central foveal thickness (CFT) did not differ significantly between groups. However, parafoveal and perifoveal retinal thickness was significantly reduced in the HCQ group (p < 0.001). Macular VD was significantly higher in the foveal and parafoveal DCP among HCQ users (p < 0.001).

Conclusion: Long-term HCQ use is associated with significant parafoveal and perifoveal retinal thinning, with variable OCTA microvascular changes. These findings highlight the potential role of OCTA in early detection of HCQ-induced retinal alterations.