Seminars in Ophthalmology最新文献

Relationship between sex hormones and ocular surface immunity is controversial. Estrogens, androgens, and progesterone, play pivotal roles in modulating immune responses on the ocular surface. Estrogens exhibit dual roles, acting as both pro-inflammatory and anti-inflammatory agents depending on their concentration and receptor interaction, while androgens generally demonstrate immunosuppressive effects. Progesterone, though less studied, may have immunomodulatory properties. Despite numerous studies, the exact molecular pathways through which sex hormones regulate ocular immunity are not fully understood, and findings often appear inconsistent. To address these gaps, a comprehensive literature search was conducted across PubMed, Scopus, and Web of Science, focusing on keywords related to sex hormones, immunity, and ocular surface health. The aim is to summarize hormone receptor mechanisms, their influence on immune cell function and production of inflammatory mediators at the ocular surface. Overall, this review highlights the intricate interplay between sex hormones and ocular surface immunity, emphasizing that hormonal balance is essential for maintaining ocular health. A deeper understanding of these mechanisms could drive the development of novel, hormone-based therapeutic strategies for inflammatory ocular disorders, such dry eye disease, meeting an urgent clinical need.

Background: Superior limbic keratoconjunctivitis (SLK) is a chronic inflammatory disorder of the ocular surface, primarily affecting the superior bulbar and palpebral conjunctiva. It predominantly occurs in middle-aged women and is associated with conditions, such as dry eye disease, thyroid eye disease, and ocular graft-versus-host disease. Although its exact etiology remains unclear, mechanical microtrauma and tear film instability are key contributing factors. Given its relapsing-remitting nature, early diagnosis and appropriate management are essential to prevent chronic ocular discomfort and visual disturbances.

Purpose: To provide a comprehensive review of the pathophysiology, clinical presentation, diagnosis, and management strategies for SLK, emphasizing the latest advances in medical and surgical treatment.

Methods: A literature review was conducted to analyze current evidence on the mechanisms, diagnosis, and treatment of SLK. The therapeutic approaches were categorized into medical, mechanical, and surgical interventions, highlighting their indications, efficacy, and limitations. Emerging treatments and their potential role in SLK management were also evaluated.

Conclusion: SLK is an often underdiagnosed yet significant ocular surface disorder that requires a customized treatment approach. The management of SLK focuses on minimizing mechanical friction and controlling inflammation. In mild cases, patients typically respond well to ocular lubricants and mast cell stabilizers. For moderate cases, treatment may involve punctal occlusion and immunomodulatory therapy. Severe or refractory cases can benefit from supratarsal corticosteroid injections, scleral lenses, or surgical interventions such as conjunctival resection or thermal cauterization. While the overall prognosis is generally favorable, recurrence is common. Therefore, long-term follow-up is essential to optimize treatment outcomes and reduce the likelihood of relapses.

Purpose: Vernal keratoconjunctivitis (VKC) is a chronic, recurrent, allergic ocular surface disorder affecting children and young adults, particularly in tropical climates. Corneal sequelae such as giant papillae (GP), shield ulcers, limbal stem cell deficiency (LSCD), and keratoconus (KC) often necessitate surgical intervention when medical therapy is inadequate. This review summarizes the current surgical strategies for managing VKC-related corneal complications and their outcomes.

Methods: comprehensive review of published literature was undertaken using PubMed, Scopus, and Google Scholar up to 2025. Studies focusing on the surgical management of GP, shield ulcers, LSCD, and KC in VKC were analyzed. Emphasis was placed on surgical indications, techniques, outcomes, and adjunctive measures.

Results: Surgical excision of refractory GP, combined with adjuvants such as mitomycin-C, amniotic membrane transplantation, or mucous membrane grafting, reduces recurrence and improves ocular surface stability. Shield ulcers benefit from early surgical debridement and amniotic membrane use to prevent scarring and neovascularization. LSCD secondary to VKC can be successfully managed with conjunctival autografts in partial cases, while total LSCD requires allogeneic simple limbal epithelial transplantation with systemic immunosuppression. Keratoconus associated with VKC is often severe and rapidly progressive. Corneal collagen cross-linking is effective when inflammation is controlled, while intrastromal corneal ring segments and keratoplasty (deep anterior lamellar keratoplasty preferred over penetrating keratoplasty) provide visual rehabilitation in advanced cases.

Conclusion: Surgical management is pivotal in addressing refractory corneal complications of VKC and in preserving long-term vision. Tailoring surgical intervention to disease severity, ensuring adequate control of ocular surface inflammation, and adopting a multidisciplinary approach integrating medical therapy, surgery, and immunomodulation are essential for optimal outcomes.

Purpose: The purpose of this systematic review and meta-analysis is to evaluate the outcomes of continuing versus discontinuing intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment at various follow-up time-points in neovascular age-related macular degeneration (nAMD) patients who developed retinal pigment epithelium (RPE) tears following anti-VEGF therapy.

Methods: Relevant publications were identified through a systematic search in the PubMed and EMBASE databases. The standardized mean differences (SMD), with their 95% confidence intervals (95% CI), were estimated using random effects models (DerSimonian-Laird), as appropriate. Meta-regression analysis was also performed.

Results: Thirty studies (including 479 eyes with RPE tear) were eligible for the systematic review and meta-analysis. These studies examined the outcomes in patients who continued anti-VEGF treatment post-tear and those who discontinued it, with comparisons made separately for different timepoints in each group. In patients who continued anti-VEGF treatment, the pooled best-corrected visual acuity (BCVA) showed no statistically significant difference compared to baseline at any time-point of the follow-up. The pooled central subfield thickness (CST) improved at 12 months, but did not reach a significant level (SMD -0.45; 95% CI: -0.99, 0.10, I² = 49.5%, p = .159). Long-term follow-up indicated a decrease in the presence of subretinal and intraretinal fluid. In patients who discontinued intravitreal anti-VEGF treatment, there was a non-significant improvement in BCVA within the first 3 months; however, BCVA fluctuated or worsened over time, and fibrosis development was observed.

Conclusions: This systematic review and meta-analysis found that intravitreal injections of anti-VEGF do not significantly impact visual acuity in patients with RPE tears at various follow-up timepoints, but may provide anatomical improvement.

Purpose: Ophthalmia nodosa is an inflammatory ocular condition caused by the penetration of arthropod hairs (setae) into the eye. This review aims to systematize current knowledge on the condition, identify knowledge gaps, and propose an updated classification.

Methods: A systematic literature review was conducted in July 2024 in PubMed and Cochrane Central. Articles focusing on non-ophthalmological manifestations, zoological aspects, or cases in animals were excluded. Relevant data were extracted from each study, including demographic information, causal species, clinical manifestations, and disease classification.

Results: A total of 112 articles were included in the review, with 84 addressing caterpillar-related cases and 28 focusing on tarantula-related cases. The condition was most frequently reported in India and Europe. In Europe, the processionary caterpillar is a common cause. Cases involving tarantulas are typically linked to domestic incidents. Most cases result in mild inflammation, but in some instances, intraocular penetration leads to severe complications, including irreversible visual loss. Diagnosis relies primarily on slit-lamp examination, but OCT and confocal microscopy improve setae detection. The review also highlights the limitations of Cadera's classification, as disease progression does not always follow its defined stages.

Conclusions: Ophthalmia nodosa remains an underrecognized cause of ocular inflammation. While advances in corticosteroid therapy and vitrectomy have improved outcomes, knowledge gaps persist, particularly regarding the pathogenesis of seasonal hyperacute panuveitis (SHAPU). A new classification system is proposed to better reflect disease progression and improve clinical management.

Purpose: Osteo-odonto-keratoprosthesis (OOKP), or "tooth-in-eye" surgery, is a pivotal technique developed for the treatment of severe corneal blindness in patients unsuitable for traditional corneal transplantation. This review aims to highlight the evolution, current advancements, and global adoption of OOKP, particularly for individuals with end-stage ocular surface disease.

Methods: A comprehensive and systematic literature search was conducted across Embase, PubMed, Scopus, and Web of Science for articles published between 2014 and 2024, using the keyword search terms: "osteo-odontokeratoprosthesis" OR osteoodontokeratoprosthesis OR "osteo-odonto-keratoprosthesis" OR OOKP OR MOOKP.

Results: OOKP remains uniquely effective for cases of severe ocular surface damage, including Stevens-Johnson syndrome and chemical or thermal burns. Long-term data demonstrate consistent visual rehabilitation and prosthesis retention across diverse populations in Europe, Asia, and South America. Advancements have improved tissue integration and reduced complications like graft resorption and secondary glaucoma. Innovations in surgical precision have further minimized tissue trauma and improved postoperative stability.

Conclusions: Despite its complexity, OOKP continues to evolve through surgical and material innovations, reflecting a sustained global commitment to improving visual outcomes in patients with otherwise untreatable corneal blindness. The continuous refinement of this technique holds promise for expanding its accessibility and success worldwide, paving the way for future advancements in keratoprosthesis surgery.

Background: Intraocular biopsy is a diagnostic procedure used to obtain tissue samples to identify intraocular lesions, including tumors, infections, and inflammatory conditions. Inconclusive clinical and imaging findings necessitate intraocular biopsy.

Methods: This retrospective review reviewed the relevant literature, including relevant reviews, original articles, case reports, and case series published up to July 2024.

Results: Depending on the location and suspected nature of the lesion, intraocular biopsy is performed using various techniques, such as fine-needle aspiration biopsy (FNAB), vitreous biopsy, and chorioretinal biopsy. Despite its challenges, such as small sample size and potential complications like retinal detachment and hemorrhage, intraocular biopsy plays a vital role in guiding management decisions, including treatment planning. Recent advancements in molecular pathology and imaging-guided biopsy techniques have enhanced tissue yield and safety, making biopsy an invaluable diagnostic tool. In ocular oncology, prognostic biopsy for uveal melanoma has become the standard of care.

Conclusion: Intraocular biopsy remains a crucial diagnostic tool for treatment decision-making and improving patient outcomes. Technological advancements continue to refine its efficacy and safety, reinforcing its role in modern ophthalmic practice.

Background: A symblepharon is an adhesion between the bulbar and the palpebral conjunctiva and is a manifestation of the loss of conjunctival redundancy. It occurs due to conjunctival scarring, most commonly resulting from trauma or chronic inflammation. Vision can be affected either if the symblepharon is present along with primary keratopathy and limbal stem cell deficiency, or if it is extensive leading to secondary corneal involvement. There is currently no medical treatment for symblepharon, nor can its occurrence be fully prevented. Surgical management is often necessary in cases associated with chronic cicatrizing conjunctivitis.

Purpose: This review aims to summarize the etiology, clinical presentation, and management strategies for ocular symblephara. Methods: A comprehensive literature search was conducted using PubMed database, identifying published studies addressing ocular symblephara and their management. Mechanisms of symblephara formation and emerging treatment modalities for prevention of symblephara were also evaluated.

Conclusion: Surgical approaches to symblephara management involve excision of the fibrotic tissue and placement of mechanical barriers or biological tissue substitutes such as amniotic membranes, conjunctival autografts, and oral mucous membrane grafts. Surgical intervention is recommended for symblepharon in cases where cosmesis is a concern, the visual axis is affected, or in extensive cases before procedures such as cataract surgery, limbal stem cell transplantation, or keratoprosthesis surgery, as well as to facilitate scleral contact lens fitting. Management also involves addressing the underlying disease that led to symblepharon formation. The recurrence rate of symblepharon following surgical treatment is higher in eyes with Stevens-Johnson syndrome or mucous membrane pemphigoid compared to those with ocular chemical burns. Further research is needed to explore preventive strategies such as anti-fibrotic agents and potential medical treatment for symblepharon.