Seminars in Ophthalmology最新文献

Introduction: Epiretinal membrane (ERM) is a prevalent vitreoretinal interface disorder characterized by fibro-cellular proliferation on the inner retinal surface. The prevalence increases markedly with age, and progressive membrane contraction distorts retinal architecture, producing metamorphopsia and irreversible visual impairment thereby significantly impairing patients' quality of life. This highlights the need for more accurate and efficient diagnostic and therapeutic strategies. Artificial intelligence (AI) has emerged as a promising tool to address such challenges. This review summarizes and evaluates recent studies on the applications of AI in ERM management, identifying current limitations and future research directions.

Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Embase, and Cochrane Library databases, focusing on studies related to AI and ERM published over the past decade.

Results: The findings indicate that while research on treatment and prognosis prediction remains limited, and new technologies are expected in image processing, current AI models demonstrate substantial potential in the ERM management, especially in detection and diagnosis.

Discussions: Nonetheless, current evidence is constrained by challenges such as single-center design, limited external validation across devices or ethnicities, insufficient multimodal imaging, and lack of health-economic or workflow integration data. Future multicenter prospective studies, federated learning platforms, publicly annotated imaging dataset and cost-effectiveness analyses are warranted to develop robust, generalizable models that can be seamlessly integrated into clinical workflows, substantially optimizing ERM management and delivering tangible benefits to both patients and clinical practice.

Aim: This study aimed to provide a comprehensive bibliometric analysis of retinoblastoma treatment, assessing publication trends, influential research, and leading contributors.

Methods: The research was conducted using the Web of Science Core Collection, focusing on retinoblastoma treatment from January 1, 1941, to June 13, 2024. Bibliometric analysis were conducted using Microsoft Excel, VOSviewer, CiteSpace, and the Bibliometrics R package.

Results: The analysis identified 5,674 documents. The United States led in research output and citation impact, followed by China and Europe. The University of Toronto was the most prolific institution (488 articles). International collaborations accounted for 18.54% of publications. David H. Abramson was the most prolific author (139 articles), followed closely by C.L. Shields (100 articles). Keyword analysis revealed three major thematic clusters: (1) molecular mechanisms and oncogenesis, (2) cell cycle regulation and experimental models, and (3) clinical management and therapeutic strategies. Recent hotspots included intraarterial chemotherapy, melphalan, treatment resistance, risk stratification, and tumor biology. Retinoblastoma research centers on molecular mechanisms, cell cycle regulation, and clinical management.

Conclusion: Advances in intraarterial chemotherapy, risk assessment, and molecular insights are improving survival and quality of life. Greater emphasis on real-world, multicenter, and international studies is needed to advance personalized care.

Purpose: To report a case series of recurrent dacryocystitis following long-term lacrimal duct intubation, and to clarify the side effects of long-term lacrimal duct intubation.

Methods: This study retrospectively evaluated 24 adults (27 eyes) who presented to our center between September 2019 and December 2024 with recurrent dacryocystitis following probing and subsequent stent intubation. Data collected included patient demographics, clinical presentation, duration of intubation, stent-related complications, computer tomography image, management strategies, and prognosis. Systematically reviewed randomized controlled trial articles on lacrimal duct intubation.

Results: Several stent-related complications were identified, including: punctal granuloma (11.1%, 3/27), stent fracture (11.1%, 3/27; all three fractured stents were plastic type, with fragments adherent to granulation tissue.), punctal laceration with recurrent extrusion (3.7%, 1/27; gold stent), soft tissue false passages (47.4%, 9/19), and bony false passages (7.4%, 2/27; cases with traumatic lacrimal obstruction). Among patients undergoing dacryocystorhinostomy, functional success was 81.48% (22/27) and anatomical success was 85.19% (23/27). Denominators vary across outcomes due to incomplete data availability for specific variables in the study cohort.

Conclusions: This study emphasizes the importance of standardized operative techniques and appropriate duration of intubation to prevent complications associated with lacrimal stenting.

Purpose: The US Food and Drug Administration (USFDA) granted the miltefosine orphan drug designation in 2016 for treating Acanthamoeba keratitis. This study evaluates miltefosine's in vitro efficacy against clinical isolates of Acanthamoeba from patients with keratitis and its safety profile in human corneal epithelial cell line to rationalize its localized ocular application.

Methods: Acanthamoeba spp. isolated from corneal scrapings of keratitis patients (n = 17) were cultured axenically, genotyped, and tested for miltefosine's minimal cysticidal and trophozoicidal concentrations (MCC and MTC) by microbroth dilution method. Safer concentrations of miltefosine were determined using human corneal epithelial (HCE) cells at four incubation points. Trophozoites and cysts of one of the isolates, A. castellanii, were challenged on confluent monolayers of HCE in the presence and absence of miltefosine for 24 h. Cytopathic effects were evaluated using microscopic analysis.

Results: The majority of Acanthamoeba isolates tested were T4 genotypes (94.11%). MTC₉₀ and MCC₉₀ of miltefosine were 0.125 and 4 mg/mL, respectively. Miltefosine was found safe on HCE at 0.0625 and 0.125 mg/mL for 4 and 0.25 h, respectively. Microscopical findings showed that A. castellanii trophozoites destroyed the cellular structures of HCE within 24 h without miltefosine. Drug pre-treatment prevented the initiation of infection at both the tested concentrations (0.0625 and 0.125 mg/mL) upto 24 h.

Conclusion: Miltefosine was effective against Acanthamoeba trophozoites and cysts in vitro with >30-fold higher cidal concentration for cysts compared to trophozoites. An effective trophozoicidal concentration of miltefosine (0.125 mg/mL), found to be safe for HCEs, suggests its potential utility as an adjunct treatment for Acanthamoeba keratitis.

Background: Susac syndrome is a rare autoimmune microangiopathy that affects the small vessels of the retina, brain, and inner ear, leading to a characteristic triad of encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss. The syndrome often presents diagnostic challenges due to its overlapping symptoms with other conditions. Immunosuppressive therapies remain the cornerstone of treatment.

Methods: A retrospective review of the literature from PubMed (1998-2024).

Results: Special emphasis is placed on the role of ophthalmologists, who play a pivotal role in the diagnostic process. This article provides a comprehensive overview of the disease, focusing on the pathogenesis, clinical presentation, diagnostic process, and treatment approaches.

Conclusion: By highlighting the role of ophthalmologists in recognizing and managing Susac Syndrome, this review underscores the importance of a multidisciplinary approach to improve outcomes in this complex, multisystem disease.

Purpose: To assess the clinical features of ocular adverse events in patients receiving BRAF/MEK inhibitor therapy.

Methods: In this retrospective study, 65 patients were treated with BRAF/MEK inhibitors (dabrafenib/trametinib or encorafenib/binimetinib).

Results: Of the 65 patients, 28 had malignant melanoma and 37 had non-melanoma malignancies. Bilateral MEK-associated retinopathy was observed in nine cases; none experienced vision loss due to MEK-associated retinopathy. Uveitis was diagnosed in four patients (6.1%), three of whom presented with Vogt-Koyanagi-Harada (VKH)-like uveitis. All VKH-like uveitis cases were observed in patients with melanoma and their incidences were significantly higher in these patients than in those without melanoma (p = .04). Treatment with corticosteroids resulted in either resolution or control of symptoms in all cases of VKH-like uveitis, enabling continuation of BRAF/MEK inhibitor therapy.

Conclusion: VKH-like uveitis was found to be significantly more frequent in patients with melanoma than in those with other malignancies.

Background: The anterior segment of the eye plays a crucial role in maintaining the normal intraocular pressure and vision. Developmental defects in the anterior segment structures lead to anterior segment dysgenesis (ASD) and primary congenital glaucoma (PCG), which share overlapping clinical features. Several genes have been mapped and characterized in ASD, some of which are also involved in other glaucoma phenotypes. PCG exhibits genetic heterogeneity like ASD, but the known genes do not account for the entire genetic basis of the disease. Considering the significant phenotypic and genotypic overlap between ASD and PCG, this article explores the possible involvements of ASD-associated genes in PCG pathogenesis.

Methods: A nonsystematic search in PubMed was performed using various combinations of keywords related to ASD, glaucoma, genetics, and molecular mechanisms, and articles published up until March 2024 were considered. Specifically, information pertaining to ASD-associated genes (FBN1, FOXE3, HMX1, LMX1B, MAF, OTX2, PAX6, PITX2, PITX3, PRDM5, PRSS56, RAX, SLC4A11, SOX2, TRIM44, VAX1, and WT1) was extracted, and their expressions were determined from the GTEx and EMBL-EBI Expression Atlas. Interactions of these genes were determined through the Ingenuity Pathway Analysis software.

Results: Most of the ASD-associated genes were found to be highly expressed in the early embryonic stages. Interactome analysis revealed that TRIM44, PAX6, WT1, SOX2, OTX2, PRDM5, and FBN1 interacted through the NFκB and Akt/PI3K pathways, either directly, or through interactions with other partners. FOXC1, PITX2, and HMX1 interacted through Wnt and Hedgehog signaling pathways. Both ASD and PCG present similar clinical features and harbor mutations in genes that are implicated in both these conditions. Collectively, we constructed a hypothetical model and proposed two parallel mechanisms comprising the defects in the anterior chamber angle and cell death in PCG pathogenesis.

Conclusions: Our findings suggest that complex interplay of these ASD-associated genes and their interactions could potentially result in defects in the anterior chamber angle and trabecular meshwork and induce cell death, resulting in PCG pathogenesis.