Expert Review of Ophthalmology最新文献

Introduction: Gene therapy is an emerging technology for the treatment of inherited retinal diseases. Whilst the development of delivery vectors and genotyping is progressing at speed, outcome measures used for regulatory approval are slow to change and hinder progress clinical trial stage. Traditional measures of visual function such as best corrected visual acuity (BCVA) and low luminance visual acuity (LLVA) may only be useful across a very short window and in late stages of disease. They are unsuitable measures for early- to mid-stage disease where foveal function, and so letter reading, is primarily unaffected. In such cases, microperimetry is an accurate and repeatable measure of retinal function of the whole of the macular region.

Areas covered: This article provides evidence-based guidance on criteria for microperimetry outcome measures, drawing on experience from long-term clinical trials in RPGR-related retinitis pigmentosa.

Expert opinion: Microperimetry provides a sensitive and repeatable measure of retinal function, with mean sensitivity across the macula or central 16-point region offering a more reliable metric than single-point requirements recommended by the FDA. A 2.5dB gain in mean sensitivity is equivalent to a 13-letter increase in low-luminance ETDRS representing a clinically significant change and aligning closely with regulatory standards.

Introduction: Rates of CMV retinitis (CMVR) resulting from HIV have declined following the advent of highly active antiretroviral therapy (HAART); however, other immunosuppressed populations are becoming increasingly affected by CMVR. More research is required to identify and target differences found in these patients, as they may represent a promising avenue for targeted treatment therapy.

Areas covered: This review includes information from studies on the prevalence, pathophysiology, and clinical manifestations of CMV and CMVR. It also discusses the impact of antiretroviral therapy on CMVR incidence, explores various risk factors, and examines the molecular mechanisms and immune responses associated with CMV infection. Additionally, the article discusses diagnostic considerations, treatment strategies, and the potential for new therapeutic approaches.

Expert opinion: Cytomegalovirus retinitis (CMVR) remains a major cause of vision loss in immunocompromised individuals. CMVR presents differently in HIV-positive and HIV-negative patients, suggesting a possible variation in underlying pathophysiology between the two groups. More research is needed to characterize the potential differences in molecular mechanisms, immunopathology, and genetic markers implicated in the development of CMVR in these populations to develop targeted therapies.

Introduction: Infectious agents have been associated with a variety of conjunctival tumors, including lymphoma, ocular surface squamous neoplasia (OSSN), papilloma, and Kaposi sarcoma.

Areas covered: We discuss the infectious etiologies of certain conjunctival tumors including conjunctival lymphoma (Chlamydia spp. Helicobacter pylori, Epstein-Barr virus, hepatitis C virus), OSSN (human papillomavirus, human immunodeficiency virus), papilloma (human papilloma virus), and Kaposi sarcoma (Kaposi sarcoma herpesvirus). Their respective oncogenic mechanisms, diagnosis, and treatment options are reviewed.

Expert opinion: It is important for the clinician to recognize when tumors of the conjunctiva may be infection-associated. A detailed history and exam are the most important first step in diagnosis; this may be supplemented by tools such as high-resolution optical coherence tomography. For some tumors, the specific causative agent may influence treatment options and outcomes. For others, data suggest the infectious agent does not influence treatment or outcomes, but it is important nonetheless to be aware as further research on these tumors continues. Additionally, there is exciting research investigating novel and minimally invasive diagnostic and treatment options for conjunctival tumors, including treatments that target the infectious agent directly.

Introduction: Keratoconus (KC) is the most prevalent corneal ectasia in the world and its pathogenesis is influenced by both ocular and systemic factors. This review explores the multifaceted associations between keratoconus and systemic health conditions, ocular characteristics, and various other environmental/exogenous factors, aiming to illuminate how these relationships influence the pathophysiology of the disease.

Areas covered: This review will summarize the fundamental attributes of KC, review and discuss the systemic and ocular association of KC including molecular biomarkers, and provide an organized overview of the parallel alterations occurring within various biological pathways in KC.

Expert opinion: Despite the substantial volume of research on keratoconus, the precise etiology of the disease remains elusive. Further studies are necessary to deepen our understanding of this intricate disorder and improve its management.

Objective: High temperatures can trigger cellular oxidative stress and disrupt spermatogenesis, potentially leading to male infertility. We investigated the effects of retinoic acid (RA), chitosan nanoparticles (CHNPs), and retinoic acid loaded with chitosan nanoparticles (RACHNPs) on spermatogenesis in mice induced by scrotal hyperthermia (Hyp).

Methods: Thirty mice (weighing 25 to 30 g) were divided into five experimental groups of six mice each. The groups were as follows: control, Hyp induced by a water bath (43 °C for 30 minutes/day for 5 weeks), Hyp+RA (2 mg/kg/day), Hyp+CHNPs (2 mg/kg/72 hours), and Hyp+RACHNPs (4 mg/kg/72 hours). The mice were treated for 35 days. After the experimental treatments, the animals were euthanized. Sperm samples were collected for analysis of sperm parameters, and blood serum was isolated for testosterone measurement. Testis samples were also collected for histopathology assessment, reactive oxygen species (ROS) evaluation, and RNA extraction, which was done to compare the expression levels of the bax, bcl2, p53, Fas, and FasL genes among groups. Additionally, immunohistochemical staining was performed.

Results: Treatment with RACHNPs significantly increased stereological parameters such as testicular volume, seminiferous tubule length, and testicular cell count. Additionally, it increased testosterone concentration and improved sperm parameters. We observed significant decreases in ROS production and caspase-3 immunostaining in the RACHNP group. Moreover, the expression levels of bax, p53, Fas, and FasL significantly decreased in the groups treated with RACHNPs and RA.

Conclusion: RACHNPs can be considered a potent antioxidative and antiapoptotic agent for therapeutic strategies in reproductive and regenerative medicine.