Seminars in Ophthalmology最新文献

Preservatives are commonly used in eye drops to maintain sterility, to prolong shelf life and to enhance penetration into the eye. Cell culture and animal studies have demonstrated that commonly used preservatives have severe toxic effects on meibomian gland epithelial cells, conjunctival epithelial cells and corneal epithelial cells. Some preservatives penetrate into deeper tissues and cause inflammatory damage to the eye. Clinical studies show that symptoms and signs of ocular surface disease are much more common in patients using preserved eye drops. The beneficial effect of switching patients from preserved to preservative free eye drops has also been demonstrated in many studies. Preservative free eye drops are not universally available, especially in multi-dose vials, and may be more expensive than preserved eye drops. Awareness amongst physicians and patients about the potentially severe adverse effects of preserved eye drops is lacking. This article summarizes the laboratory and clinical evidence on this topic, and lists the recommendations of an expert group for various stakeholders.

Purpose:  Various ocular surface inflammatory disorders (OSID) such as allergic eye disease, Sjogren's syndrome, cicatrizing conjunctivitis, and ocular graft versus host disease have a chronic course, leading to visual morbidity and significantly impacting quality of life. They have chronic ocular surface inflammation which needs topical anti-inflammatory therapy to break the vicious cycle of inflammation and prevent worsening of the ocular surface disease. Topical cyclosporine A (CsA) acts by inhibiting T-cell activation and inflammatory cytokine production, thereby reducing inflammation and maintain the health of the tear film and the surface epithelial cells. The aim of this review is to provide an overview of mechanism of action, indications, formulations, concentration and efficacy of topical cyclosporine available for the treatment of ocular surface diseases.

Methods:  After carrying out a literature search on "Cyclosporine A", "Ocular surface disease", "Dry eye", "Vernal keratoconjunctivitis", "Graft versus host disease", "Restasis", "Cequa", "Vevye", "Ikervis", a total of 101 articles were included for this review.

Results:  CsA has been found useful in cases of dry eye disease, vernal keratoconjunctivitis, graft versus host disease, SJS and high-risk corneal transplantation. Multiple clinical trials have demonstrated significant improvement in corneal fluorescein staining, Schirmer's test scores, and tear break-up time with CsA use in patients with dry eye. Topical CsA formulations such as Restasis (0.05%), Cequa (0.09%), and Vevye (0.1%) have been FDA-approved, showing long-term efficacy and safety. Advancements in drug delivery, including cationic emulsions (Ikervis), nanomicellar solutions (Cequa), and water-free technology (Vevye), have enhanced its bioavailability and patient compliance. However, challenges such as delayed onset of action, transient irritation, and high discontinuation rates remain.

Conclusions:  Topical CsA remains a cornerstone therapy in the management of OSID, providing long-term inflammation control, improved ocular surface integrity, and symptomatic relief. Continued research into optimized formulations, combination therapies, and alternative delivery systems may further refine its clinical utility and enhance patient adherence.

Purpose: The Ocular Surface Workshop (OSW) is a sub-specialty meeting focussed on the management of complex ocular surface disorders. This survey aimed to assess the impact of the workshop on the knowledge and practice of attendees over a decade.

Methods: An online survey was circulated to attendees of past editions of the OSW in February 2025. Survey results were compiled and presented using descriptive statistics, charts and tables.

Results: Sixty-seven responses were received within the survey period. Respondents had a median age of 42 years, and included a significant proportion of trainees and young clinicians. Most respondents (64%) attended the workshop multiple times. Attendees improved their knowledge about various complex ocular surface conditions, which positively impacted their practice. Respondents also reported improvements in the availability of good quality care for ocular surface disorders in their practice location.

Conclusions: Attendees of the OSW reported significant improvements in their knowledge and impact on their practice after attending the workshop. The workshop serves as a model than can be emulated by other sub-specialty meetings to enhance clinician knowledge and improve access to high quality care for patients.

Purpose: To provide a comprehensive overview of filamentary keratitis (FK), its pathophysiology, associated conditions, clinical manifestations, and current management strategies.

Methods: A narrative review of the literature describing the etiopathogenesis, clinical features, and therapeutic approaches for FK. Emphasis was placed on conventional treatments, advanced medical therapies, and surgical interventions used in refractory cases.

Results: FK is a chronic ocular surface disorder marked by the presence of mucus-epithelial filaments adhered to the cornea, frequently associated with dry eye disease, autoimmune disorders, and neurotrophic or exposure keratopathies. Its pathogenesis involves tear film instability, excessive mucus production, and mechanical trauma from blinking. Management remains challenging due to high recurrence rates. Standard treatments include lubrication, mechanical debridement, topical corticosteroids, and mucolytics such as N-acetylcysteine. In severe or refractory cases, autologous serum tears, punctal occlusion, bandage contact lenses, and surgical procedures like amniotic membrane transplantation or tarsorrhaphy are effective in stabilizing the ocular surface and reducing symptoms.

Conclusion: FK is a multifactorial and recurrent disease that requires a tailored therapeutic approach. Early recognition and multimodal management are essential for symptom control and prevention of further ocular surface damage. Emerging therapies and surgical options expand the armamentarium for treating refractory cases, improving patient outcomes.

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.