Ophthalmology and Therapy最新文献

The purpose of this manuscript is to report the state-of-the-art advances and consensus proposed by an Italian Dry Eye Consensus Group (IDEC) for the diagnosis of dry eye disease (DED). A targeted review of the literature was carried out, not intended as a meta-analysis or systematic review, but as a selection of authoritative evidence-based guidelines and consensus papers issued by scientific societies or expert panels, which provided the basis for structured group discussion. The diagnostic criteria reported in these publications were organized in tables with a subdivision into levels, from basic to more complex tests, and were discussed in light of both the published data and daily clinical experience. The IDEC consensus highlights a pragmatic, stepwise diagnostic workflow: careful documentation of symptoms (using validated questionnaires where possible), identification of risk factors, slit-lamp assessment with vital stains (fluorescein and lissamine green), and measurement of tear film stability by tear break-up time (TBUT)-or by noninvasive TBUT measurement (NIBUT) where available, and corneal sensitivity-represent the minimum cost-effective core set. A series of second-level targeted tests can then be selectively applied to refine the diagnosis, including corneal sensitivity, osmolarity, meibography, Schirmer I test or meniscometry, and ocular surface imaging. The group also discussed the potential role of all-in-one high-tech devices and digital tools (e.g., smartphone-based applications) as these become more accessible. Grounded in real-life clinical experience, the IDEC consensus offers a pragmatic and cost-effective diagnostic workflow that complements international guidelines and can be readily applied in daily practice.

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: 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.

Introduction: The aim of this work is to predict the implantable Collamer lens (ICL) vault using machine learning (ML) algorithms and a data wrangling approach based on multicenter big data.

Methods: This retrospective cross-sectional study developed ML models using preoperative biometric data and ICL vault from 6715 eyes across five hospitals. Mutual information regression was employed to identify important parameters. A digital vault information system (DVIS) was constructed for data wrangling. ML models integrated with DVIS were used to develop ICL vault prediction and classification models, which were validated in both internal (6552 eyes) and external (163 eyes) validation.

Results: The XGBoost model combined with DVIS exhibited statistically superior performance in ICL vault prediction, with lower mean absolute error (MAE) of 39.15 μm (internal validation) and 149.72 μm (external validation) compared to other ML algorithms. The R² value was 0.86 in the internal validation. For ICL vault classification, the XGBoost algorithm achieved accuracies of 81.4% (internal validation) and 57.27% (external validation), representing accuracy gains of 27.1% and 10.2% respectively, compared to traditional ML algorithms.

Conclusions: The development of DVIS is valuable for ICL vault prediction models, as it provides a data wrangling strategy that improves ML efficiency. Experimental results confirm the applicability of this synergistic method in enhancing existing ML approaches for ICL vault prediction, thereby facilitating more informed clinical decision-making in ICL implantation surgery.

Introduction: This study investigates the anterior chamber (AC) inflammation in the early postoperative period after femtosecond laser-assisted cataract surgery (FLACS) in comparison to conventional phacoemulsification (CPS) by quantifying inflammatory and oxidative stress mediators in aqueous humor and correlating findings with clinical data.

Methods: In this prospective single-center study, 80 patients with cataracts were enrolled. Aqueous humor samples were collected from AC after femtosecond laser pretreatment in the FLACS group (40 patients) and at the beginning of standard cataract surgery before the primary incision was created in the CPS group (40 patients, control group). Mediators of postoperative inflammation including TNF-α, VEGF, IL-2, IL-1 β, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12, GM-CSF, IFN-γ, CXCL5/ENA-78, FGF-basic, G-CSF, IL-1-α, IL-1-ra, IL-17, CCL2/MCP-1, CCL3/MIP-1a, CCL4/MIP-1b, TPO, TGF-β-1, TGF-β-2 and TGF-β-3 were measured using a multiplex array system. The differences between both groups were analyzed using Mann-Whitney U test.

Results: In the FLACS group, significantly higher concentrations of IL (interleukin)-4, FGF-basic (fibroblast growth factor) and TGF-ß2 (Transforming growth factor-beta 2) were detected compared to the CPS group. Conversely, IL-10 levels were significantly higher in the CPS group than in the FLACS group.

Conclusions: FLACS triggers a distinct cytokine and growth factor profile in the aqueous humor, including elevated levels of IL-4, IL-12, FGF-basic, and TGF-β2 and a reduction in anti-inflammatory IL-10, indicating a shift toward proinflammatory and fibrotic signaling. These molecular changes may underlie immune activation and tissue remodeling not apparent in clinical examination and highlight the need for further studies to evaluate their long-term clinical relevance.

Myopia, particularly high myopia, poses a significant global public health burden. While low-concentration atropine is effective in controlling myopia progression, its conventional eye drop formulation is hampered by low bioavailability, poor patient compliance, and side effects, driving the need for advanced delivery systems. This review explores the contact lens-based drug delivery platform as a promising strategy to overcome these limitations. It synthesizes current evidence on the global myopia prevalence, atropine's pharmacology, and clinical efficacy, with a detailed analysis of the design principles for atropine-eluting lenses-encompassing material selection, drug-loading techniques, release mechanisms, and performance evaluation. The review systematically argues the superiority of this sustained-release system over traditional eye drops and discusses the remaining technical challenges, safety considerations, and future directions. We infer that integrating sustained drug delivery into a vision-correction device represents a transformative frontier in myopia management and has the potential to enhance efficacy, improve adherence, and reshape treatment paradigms.

Introduction: Pediatric patients with noninfectious uveitis refractory to standard therapies have limited options. Efficacy and safety of systemic tacrolimus, a calcineurin inhibitor used successfully in adult noninfectious uveitis as an adjuvant immunomodulatory treatment, was investigated in the pediatric population at our institution.

Methods: This was a retrospective chart review of patients ≤ 18 years old diagnosed with noninfectious uveitis who were intolerant to or failed conventional systemic immunosuppressants between January 2014 and June 2025 at a tertiary referral center. The primary outcome was treatment success, defined as two or more of the following: ≤ 0.5+ anterior chamber cell, ≤ 2 drops of topical steroids per day per eye, improvement or resolution of vitritis, macular edema, papillitis, and angiographic leakage without addition of systemic therapy at 6 and 12 months after tacrolimus initiation. Secondary outcomes included need for dose reduction or discontinuation owing to adverse effects. Descriptive statistics were used to analyze the data.

Results: Data from 11 patients, with median age of 10 years, were analyzed. Treatment success was achieved in 88.9% and 63.6% of patients at 6 and 12 months, respectively. Although seven patients experienced laboratory abnormalities, tacrolimus was not discontinued. An average tacrolimus dose of 0.16 mg/kg/day divided every 12 h achieved therapeutic tacrolimus levels. Median duration (range) of tacrolimus therapy was 24 months (4-93 months).

Conclusions: Tacrolimus may potentially be a well-tolerated, safe, and effective option for refractory cases of pediatric noninfectious uveitis.

Introduction: The purpose of this study is to evaluate the anatomical and functional outcomes of photobiomodulation (PBM) in patients with chronic central serous chorioretinopathy (cCSC).

Methods: In this retrospective study, ten eyes from nine patients with cCSC were treated with PBM. All patients had persistent subretinal fluid (SRF) for ≥ 6 months and no history of prior laser therapy. PBM was delivered once a week for 4 weeks, then monthly for two additional months using a dual-wavelength (590 and 625 nm) protocol delivered through the eye-light® device. Anatomical and functional outcomes were assessed at baseline and 6 months through multimodal imaging and best-corrected visual acuity (BCVA).

Results: Mean patient age was 45.37 years. At 6 months, mean BCVA improved significantly from 67.12 (±4.96) to 77.87 (±7.77) ETDRS letters (p = 0.0053). SRF completely resolved in 70% of eyes, partially improved in 10%, and remained unchanged in 20%. Among five eyes with serous avascular pigment epithelial detachment (PED), two PEDs resolved, one partially regressed, and two were unchanged. No adverse events were reported.

Conclusions: PBM may be beneficial in improving retinal anatomy and visual function in cCSC, with an excellent safety profile. These findings support PBM as a promising noninvasive treatment modality in patients with cCSC. Prospective controlled trials are warranted to validate its efficacy and durability.