Ophthalmology and Therapy最新文献

No current treatments are curative for age-related macular degeneration (AMD), and preventing disease progression is challenging. Dietary factors play a role in the course of macular degeneration, and management of AMD commonly includes nutraceuticals (e.g., supplementation with a combination of antioxidant vitamins and minerals). This commentary summarizes the existing literature, emerging evidence, and upcoming research on the role of B vitamins in both preventing the development of AMD and slowing its progression.

Introduction: This work compares the tolerability of 0.6% povidone-iodine (PI) and 0.5% liposomal ozonated oil (LOZ) as antiseptic prophylaxis in patients undergoing intravitreal injections (IVI), aiming to optimize preventive strategies against injection-related endophthalmitis.

Methods: This multicenter cohort study was conducted at the University Paris Est, Créteil, and the University of Trieste between November 2024 and June 2025. A total of 691 patients with maculopathies (329 in the PI group, 362 in the LOZ group) were enrolled. Patients received either 0.6% PI or 0.5% OZ topical prophylaxis three times daily for 3 days before and after IVI. Clinical tolerability was assessed by slit-lamp examination, grading conjunctival hyperemia, discharge, tarsal papillae, corneal changes, burning, and foreign body sensation (0-4 scale). Patient-reported discomfort was evaluated using a Visual Analogue Scale (VAS), classified into four categories: 0-10 mm (score 0), 11-40 mm (score 1), 41-70 mm (score 2), and 71-100 mm (score 3). Statistical analyses included generalized linear models adjusted for dry eye and prostaglandin therapy.

Results: LOZ treatment was associated with significantly lower mean scores for hyperemia (0.52 vs. 1.51), discharge (0.15 vs. 0.91), tarsal papillae (0.02 vs. 0.57), corneal changes (0.04 vs. 0.58), burning (0.25 vs. 1.69), and foreign body sensation (0.21 vs. 1.58) compared to 0.6% PI (all p < 0.001). VAS scores confirmed superior tolerability in the LOZ group (mean 0.23 vs. 1.58). No cases of endophthalmitis occurred in either group.

Conclusions: LOZ (0.5%) represents an ophthalmic antiseptic that addresses the limitations of traditional povidone-iodine preparations, suggesting it may represent a more patient-friendly prophylactic alternative for IVI.

Subepithelial corneal haze remains a clinical risk after excimer laser-based surface ablation (ELSA), especially with deep ablations, high myopia or retreatments, with downstream effects on vision and quality of life. Mitomycin C (MMC) is widely used intraoperatively for haze prophylaxis and has multi-study support; however, its antiproliferative, anti-fibrotic action does not directly address early inflammation, epithelial barrier restoration or neuroregeneration, and use remains off-label with heterogeneous protocols. This narrative review synthesises preclinical, early clinical (non-randomised/small trials) and established clinical evidence (randomised trials/systematic reviews or guidelines) on amniotic membrane transplantation (AMT) as a complementary adjunct in ELSA. We emphasise modern, sutureless, dehydrated AMT (dAM), including vision-preserving formats suited to peri-operative workflows. Across adjacent ocular-surface indications, AMT demonstrates multi-modal properties: anti-inflammatory/immunomodulatory, antioxidant, anti-proteinase (including matrix metalloproteinase-9 suppression) and support of epithelial and nerve recovery. In ELSA-specific work, preclinical photorefractive keratectomy (PRK) models show reduced haze and faster epithelialisation with patch-AMT; one prospective laser-assisted sub-epithelial keratectomy (LASEK) human study reports faster healing and lower opacity versus standard care. By contrast, small fellow-eye studies using ring-mounted cryopreserved-AMT devices showed no superiority for routine myopic PRK, underscoring the importance of format and protocol. This review outlines a complementary paradigm: MMC targets downstream fibrosis, whilst patch-AMT acts earlier on inflammation, epithelial repair, protease imbalance (including MMP-9) and neurotrophic support. With major international guidelines now recognising sutureless patch-AMT for regeneration and inflammation/oxidative stress control in dry eye, prospective refractive-cohort trials with standardised product/placement protocols, long-term follow-up, patient-reported outcomes and embedded health-economic evaluation are warranted to define AMT's role alongside MMC in routine ELSA.

Introduction: Intact corneal sensation plays a vital role in maintaining ocular surface health. Various ocular surface pathologies can present with differing levels of decreased corneal sensation, while in some cases patients may instead experience heightened sensation. This study compared corneal sensitivity with the new quantitative non-contact esthesiometer (NCE, Brill, USA) and the conventional qualitative cotton wisp (CW) test in patients with ocular surface diseases (OSD).

Methods: A retrospective, cross-sectional study was conducted, including patients with OSDs, who had both CW and NCE test results available. Descriptive analysis of one eye per patient was performed to compare the distribution of patients according to NCE and CW responses.

Results: Of 139 eyes (n = 139 patients), 129 (92.8%) were CW+ and 10 eyes were CW- (7.2%). Among these, 111 eyes responded to levels 1-3 when assessed with NCE, with 38 (34.2%) responding to level 1, 45 (40.5%) to level 2, and 28 (25.2%) to level 3. However, of CW+ eyes, 10 (7.8%) responded to level 4 and 6 (4.7%) responded to level 5 of NCE, while 2 (1.6%) had no response to any NCE stimulation (i.e., level 6), indicating varying degrees of hyposensitivity not detected by CW. Of the 10 eyes (7.2%) that did not respond to CW (CW-), 3 responded to level 4, and one to level 5 of NCE, while 4 eyes (40.0%) failed to respond to NCE (level 6). Notably, two CW- patients responded to level 1 NCE, suggesting potential hypersensitivity. Results showed high sensitivity (98.2%, 95% CI 93.8-99.8%) but low specificity (30.8%, 95% CI 14.3-51.8%) of the CW test in patients with OSD when level 4 of NCE (i.e., levels 4, 5, and 6) was used as the cutoff for defining corneal hyposensitivity.

Conclusion: Our results demonstrate that the low specificity of the qualitative CW test, combined with a broad confidence interval, indicates a high likelihood of false-positive results. This suggests that a positive CW test may not reliably rule out hyposensitivity, underscoring the need for further evaluation in the setting of a positive CW test result.

Corneal disorders are among the leading causes of visual impairment worldwide, with corneal transplantation historically serving as the cornerstone of surgical treatment. However, the global shortage of donor tissue, risk of immune rejection, and variable long-term graft survival underscore the urgent need for alternative approaches, particularly in the setting of ocular surface diseases such as inflammation or dry eye that can compromise graft survival. Regenerative medicine has emerged as a transformative paradigm, offering strategies to restore corneal architecture and function through cell-based therapies, tissue engineering, and gene modulation. These strategies are promising, addressing structural repair and modulating wound-healing responses. In the corneal epithelium, cultivated limbal epithelial transplantation, simple limbal epithelial transplantation, and cultivated oral mucosal epithelial transplantation have expanded therapeutic options for limbal stem cell deficiency, with clinical trials demonstrating long-term ocular surface stability. Regulatory approval of commercial products, such as Holoclar and Nepic, confirms the potential of standardized regenerative products. Stromal regeneration with stromal and mesenchymal stem cells has shown promise in preclinical and early phase clinical trials, with intrastromal stem cell injection improving corneal transparency and biomechanics and potentially stabilizing progressive disorders such as keratoconus. For endothelial dysfunction, intracameral injection of cultured corneal endothelial cells supplemented with Rho-associated protein kinase (ROCK) inhibitors has yielded sustained corneal clarity and visual restoration at 5-10 years, marking a paradigm shift from transplantation to minimally invasive, donor-independent therapies. Tissue engineering innovations, including matrices, hydrogels, and three-dimensional bioprinting, are advancing toward translation, while gene therapy approaches using viral vectors and Clustered Regularly Interspaced Short Palindromic Repeats -Cas9 are being explored to modulate angiogenesis, fibrosis, and inherited dystrophies. Overall, regenerative medicine is reshaping corneal therapeutics, offering effective alternatives to conventional transplantation with reduced donor dependence and improved safety. Future work must focus on long-term safety, cost-effectiveness, and equitable global access to realize its full clinical potential.

Introduction: This study evaluates the efficacy and safety of faricimab in a real-world cohort of treatment-naïve patients with neovascular age-related macular degeneration (nAMD). Data were retrospectively collected from 130 eyes of 118 patients across 11 centers of the Swiss Retina Research Network, all treated with faricimab using a treat-and-extend regimen and followed for 12 months between May 2022 and October 2024.

Methods: Demographic data, visual and anatomical outcomes, treatment intervals, and adverse events were extracted from the electronic medical records over a 12-month follow-up period. Main outcomes included change in best corrected visual acuity (BCVA), central retinal thickness (CRT), presence of intra- and subretinal fluid, retinal pigment epithelial detachment (PED), injection intervals, and safety. Data are presented as mean ± standard deviation.

Results: Twelve months after the initiation of faricimab therapy, mean BCVA improved from 64.6 ± 14.1 to 69.2 ± 20.3 ETDRS (Early Treatment of Diabetic Retinopathy Study) letters (p < 0.001), while mean CRT decreased from 386.3 ± 172.3 to 246.6 ± 90.4 μm (p < 0.001). An early anatomical response to faricimab was observed in 34.6% of eyes achieving complete retinal fluid resolution after the first injection and in 55.6% after 12 months. The mean treatment interval was extended to 10.5 ± 4.3 weeks, with 26.2% of eyes achieving intervals of 8-11 weeks and 39.2% achieving intervals of ≥ 12 weeks after 12 months. Intraocular inflammation occurred in 0.77% of eyes (n = 1, anterior uveitis); serious adverse events were not reported.

Conclusion: Faricimab demonstrates favorable anatomical and functional outcomes with extended treatment intervals in a majority of patients with treatment-naïve nAMD, offering the potential of reduced treatment burden and the absence of retinal fluid in more than half of the subjects during the first year, while maintaining safety in a real-world setting.