Seminars in Ophthalmology最新文献

Background: Chemical injuries to the eye are a significant cause of vision impairment worldwide. These injuries demand immediate and appropriate intervention due to their potential for causing visual morbidity and long-term sequelae. The severity and managmenet is influenced by factors such as the chemical type, concentration, duration of exposure, and the extent of ocular surface involvement. Chemical injuries to the eye are a significant cause of vision impairment worldwide. These injuries demand immediate and appropriate intervention due to their potential for causing visual morbidity and long-term sequelae. The severity and managmenet is influenced by factors such as the chemical type, concentration, duration of exposure, and the extent of ocular surface involvement.

Purpose: To provide a comprehensive overview of current perspectives in the classification and management of ocular chemical injuries, with emphasis on recent advances in treatment protocols during both the acute and chronic phases.

Methods: After thorough literature search in PubMed and MEDLINE 72 studies with maximum relevance that were published as systematic reviews, as well as randomized and non-randomized comparative studies (cohort or case series) on the topic of chemical injuries classification and management were finally selected for this article.

Results: Early management is centered on immediate irrigation, neutralization of the chemical agent, and prevention of further tissue damage through clinical assessment and medical therapy. In severe cases, surgical intervention may be necessary to restore ocular integrity. In the chronic phase, once the ocular surface is stabilized, visual rehabilitation becomes the focus, involving a multifactorial decision-making approach tailored to individual patient needs.

Conclusion: Effective management of ocular chemical injuries requires a dynamic, phased approach, integrating timely acute intervention with personalized long-term rehabilitation strategies. Recent advancements in therapeutic techniques have improved outcomes, but ongoing research and clinical vigilance remain essential for optimizing care.

Purpose: To review and compare the mechanisms of action, clinical efficacy, and safety profiles of topical immunosuppressive and immunomodulatory agents for the management of chronic ocular surface diseases.

Methods: A comprehensive review of the literature was conducted using PubMed, Scopus, and Web of Science databases. Peer-reviewed clinical trials, observational studies, case series, and meta-analyses from 1960 to 2024 were included. Studies were selected based on their investigation of the efficacy and safety of topical therapies for chronic ocular surface diseases. Systemic therapies and non-ocular conditions were excluded.

Results: Corticosteroids remain effective in controlling acute inflammation but are associated with significant adverse effects, particularly with long-term use, including elevated intraocular pressure, cataract formation, and infection risk. In contrast, targeted immunomodulators such as cyclosporine, tacrolimus, lifitegrast, tofacitinib, and reproxalap provide more selective modulation of the immune response. These agents have demonstrated favorable tolerability and efficacy in chronic ocular surface diseases, including dry eye disease, vernal keratoconjunctivitis, and ocular GVHD. Recent advances include IL-1 receptor antagonists, JAK inhibitors, RASP inhibitors, and mitochondrial-targeted antioxidants.

Conclusions: While corticosteroids are indispensable for acute management, targeted immunomodulatory therapies offer a safer and more sustainable approach for long-term treatment of chronic ocular surface inflammation. The emergence of novel topical agents supports a shift toward precision immunotherapy in ophthalmology.

Purpose: To describe common ocular surface lesions that clinically mimic ocular surface squamous neoplasia (OSSN) and provide practical guidance for their accurate identification using anterior segment optical coherence tomography (AS-OCT).

Methods: We thoroughly reviewed various ocular surface lesions, categorizing them based on etiology. Diagnostic features on clinical examination, histopathology, and characteristic imaging findings on AS-OCT were critically assessed.

Results: Numerous conditions can resemble OSSN, including corneal pannus, pseudopterygium, herpes simplex keratitis, conjunctival papilloma, trachoma, phlyctenulosis, pterygium, Salzmann nodular degeneration, conjunctival pyogenic granuloma, nevus, myxoma, schwannoma, Kaposi sarcoma, melanoma, lymphoma, sarcoidosis, and amyloidosis. Each of these lesions exhibits distinct imaging patterns on AS-OCT. OSSN uniquely demonstrates a hyperreflective thickened epithelium with a sharp transition between healthy and affected tissues, differentiating it clearly from other conditions.

Conclusions: Accurate diagnosis of OSSN versus its clinical masqueraders remains challenging. AS-OCT is an invaluable, non-invasive tool to support clinicians in reliably distinguishing OSSN, guiding informed management decisions, and appropriate use of biopsy.

Purpose: This comprehensive review evaluates the efficacy and safety of autologous serum (AS) tears in managing dry eye disease (DED) by analyzing published prospective randomized controlled trials (RCTs).

Methods: A comprehensive literature search was conducted in PubMed, Scopus, and the Cochrane Library up to February 28, 2025. The primary outcome measures included symptom improvement, Schirmer's test, tear break-up time, ocular surface staining, and visual performance. The Cochrane Risk of Bias Version 2 tool was used to assess study quality.

Results: Six RCTs (102 participants, 169 eyes) were included. Significant symptom improvement was recorded with AS tears 20%. The most consistent improvement in clinical signs was observed with AS tears 50%. The risk of bias assessment identified only one study as high risk due to lack of blinding.

Conclusion: AS tears show promise for moderate-to-severe DED, but variability in study design and small sample sizes necessitate standardized protocols and larger RCTs.

Purpose: The dry eye disease(DED) is caused by many possible factors, manifesting classical symptoms such as irritation, pain, and visual disturbance, which can severely impact the quality of life.  This review aims to critically evaluate currently available point‑of‑care (POC) diagnostic kits for DED, focusing on osmolarity‑based and biomarker‑based assays, while exploring emerging technologies that promise better precision and personalized management.

Methods: A comprehensive literature survey (2010-2025) was undertaken using PubMed, Scopus, and Google Scholar to identify studies assessing DED pathophysiology, tear film biomarkers, and commercially available diagnostic systems. Particular emphasis was placed on kits measuring tear osmolarity (TearLab, I-PEN, ScoutPro) and inflammatory or protective biomarkers (MMP‑9, lactoferrin, IL‑6).

Results: Osmolarity‑based kits provide rapid, reproducible insights into tear hyperosmolarity, a recognized hallmark of DED, but also has limitations due to environmental variability, reflex tearing, and cost. Biomarker‑based kits, particularly MMP‑9 (InflammaDry) and lactoferrin assays, enhance diagnostic specificity by targeting ocular surface inflammation and lacrimal gland dysfunction, respectively. Emerging multiplex immunoassays, nanobiosensors, and paper‑based microfluidic platforms offer quick, low‑volume demand, and multi‑analyte detection with precise disease stratification potential.

Conclusion: Current diagnostic kits have improved early detection and management of DED but are still limited by single parameter constraints, moderate reproducibility, and high costs. The combination of multiplex biomarker panels, biosensor technologies, and patient-specific organ-on-chip models is a promising deal toward precision diagnostics.

Purpose: To describe the clinical course and management challenges of chronic ocular complications in Stevens-Johnson syndrome (SJS) patients with co-existing autoimmune diseases, emphasizing the role of systemic immunomodulatory therapy (IMT) in controlling inflammation and preventing disease progression.

Method: Two cases of chronic ocular SJS with underlying autoimmune diseases are described. Both patients experienced recurrent ocular inflammation, conjunctival scarring, and progressive limbal stem cell deficiency. They were managed with systemic IMT, including corticosteroids, mycophenolate mofetil (MMF), azathioprine, intravenous immunoglobulin (IVIG), cyclophosphamide, and rituximab. Disease progression, treatment response, and outcomes were assessed over a year follow-up.

Result: Both patients had recurrent ocular inflammation despite initial management with corticosteroids and conventional immunosuppressives. The introduction of MMF combined with rituximab successfully stabilized inflammation and ocular surface integrity in both cases. Long-term IMT was necessary to maintain ocular stability and prevent progressive ocular surface failure.

Conclusion: Chronic ocular complications of SJS require tailored immunosuppressive strategies, particularly in patients with preexisting autoimmune diseases. Early identification of disease patterns and co-management with rheumatologists are crucial. Rituximab and MMF may provide long-term disease control, but discontinuation of IMT should be approached cautiously to prevent recurrence. Further research is needed to optimize treatment protocols and determine the ideal duration of systemic therapy in chronic ocular SJS.

Background: Ocular surface disorders (OSD) and glaucoma often co exist. Intraocular pressure lowering medications and preservatives used with them may lead to ocular surface toxicity and drug induced cicatrizing conjunctivitis (DICC). Surgical management of glaucoma helps in reducing the requirement of topical anti glaucoma drugs but, at the same time, may also disrupt the ocular surface. On the other hand, medical therapies and surgeries required for management of OSD often lead to secondary glaucoma, thereby inducing a vicious cycle.

Methods: Relevant articles (English only) up to January, 2025 were searched from PubMed and summarized.

Results: Our review discusses the epidemiology, various diagnostic, therapeutic and surgical aspects of this interlinked scenario in a comprehensive manner. Medical therapies (steroids) utilized for controlling inflammation in OSD and related steroid induced glaucoma, anti glaucoma medications (and their preservatives) causing OSD and their respective available alternatives have been discussed in individual sections. Similarly, glaucoma surgeries causing OSD, surgeries for OSD leading to secondary glaucoma and the surgical considerations with possible alternatives, including the novel therapies, have been reviewed. The future directions, along with the role of gut microbiome in ocular diseases and the various therapeutic agents/interventions under clinical investigations, are also explored.

Conclusion: A deeper understanding of the interplay of different factors in these co-morbid conditions will help in breaking the vicious cycle induced and therefore, in offering more effective treatment. Recommendations for clinicians have been suggested to help optimize the treatment provided to this specific patient cohort of 'OSD and glaucoma'.