Current Opinion in Ophthalmology最新文献

Purpose of review: The role of topical and subconjunctival antibiotics in reducing infection risk in major ocular surgeries remains unclear despite their widespread use. This review discusses the efficacy of both administration routes across various forms of surgery, underscoring evidence-based recommendations for quality practice patterns and limitations in current research.

Recent findings: Although intracameral antibiotics consistently result in low infection rates in phacoemulsification procedures, there may be some role for topical and subconjunctival antibiotic use, also influenced by regional preferences. Topical antibiotics may prove to be more beneficial in cases of pars plana vitrectomy and keratoprosthesis, but subconjunctival may be more beneficial in trabeculotomies.

Summary: Despite substantial data on infection incidence in ocular surgeries, gaps remain in the evaluation of specific antibiotic regimens, particularly for lesser studied procedures, such as minimally invasive glaucoma surgeries (MIGS) and ocular surface surgeries. Further research is needed to address these disparities and explore novel antimicrobial approaches.

Purpose of review: Artificial intelligence (AI) is transforming retina care, with deep learning (DL) models shaping a new era of improved screening accessibility, diagnostic precision, and personalized disease monitoring. This review highlights recent AI-powered clinical applications in diabetic retinopathy (DR), and age-related macular degeneration (AMD) care.

Recent findings: Since the FDA's authorization of the first autonomous AI system for DR screening in 2018, multiple platforms have emerged, expanding access to diabetic eye care. Real-world studies have confirmed a significant improvement in screening adherence and diagnostic accuracy, illustrating AI's tangible impact on public health. Meanwhile, newly certified AI technologies that meet European regulatory standards are increasingly guiding clinical decision-making in the management of AMD and diabetic macular edema through automated analysis of optical coherence tomography (OCT) images. Most recently, FDA-authorized home OCT platforms are transforming AMD monitoring, enabling proactive and remote management of retinal fluid.

Summary: As AI increasingly empowers patients and providers, its widespread success still depends on ongoing work, including thorough validation, outcome-based metrics, and improved workflow integration. The next decade will reveal whether AI in retina care transitions from a promising innovation to an essential and indispensable tool in modern retina.

Purpose of review: This review summarizes the literature regarding vitreous and chorioretinal biopsy, with a focus on surgical techniques and methods to optimize diagnostic yield for the collected samples.

Recent findings: Various novel options for analyzing vitreous samples are being explored such as cell-free DNA analysis, single parameter flow cytometry, and mass spectrometry. These methods show promise in diagnosing primary intraocular lymphoma.

Summary: Vitreous and chorioretinal biopsies may be required in atypical cases of intraocular inflammation that do not respond to treatment or do not respond as anticipated. A thorough differential diagnosis is important, allowing the surgeon to order and prioritize the appropriate testing for an obtained sample. As these samples can be limited or challenging to collect, it is also crucial that vitreoretinal surgeons optimize their diagnostic yield by communicating with various labs that are involved with sample processing.

Purpose of review: Autoimmune retinopathy (AIR) is a rare but vision-threatening disorder characterized by retinal damage through humoral or cellular immune mechanisms. The purpose of this review is to summarize our current understanding on imaging, antibody testing, and immunosuppressive therapies for AIR.

Recent findings: AIR includes paraneoplastic forms - such as cancer-associated retinopathy (CAR) and melanoma-associated retinopathy (MAR) - as well as a nonparaneoplastic (np) variant (npAIR). Definitive diagnosis of AIR is challenging due the similar clinical findings between AIR and inherited retinal dystrophies and the lack of specific laboratory testing. Therefore, a multimodal diagnostic approach including electroretinography, fundus imaging, visual field testing, genetic testing, and serologic assays is necessary to support a diagnosis of AIR. Early diagnosis and treatment with systemic or local immunomodulators may preserve retinal function and lead to better visual outcomes.

Summary: This review highlights current diagnostic approach and treatment strategies in AIR. Advances in biomarkers and precision immunotherapy may improve diagnosis and outcomes.

Purpose of review: This review aims to summarize current knowledge on ocular surface side effects associated with novel systemic therapies for atopic dermatitis (AD) and psoriasis.

Recent findings: Interleukin inhibiting monoclonal antibodies such as dupilumab and tralokinumab, along with small molecule JAK-STAT inhibitors such as upadacitinib and abrocitibib, have revolutionized the treatment of AD and psoriasis. Despite their effectiveness in disease control, these agents have been increasingly associated with ocular adverse events, particularly conjunctivitis. While dupilumab-induced conjunctivitis is the most documented, emerging data highlights variable ocular safety profiles across different agents. Early recognition and grading of ocular inflammation through clinical examination allows for effective management with topical anti-inflammatory treatment. In severe or refractory cases, switching or discontinuing therapy may be necessary.

Summary: With the expanding use of novel systemic dermatologic therapies, ocular surface complications have become an important concern. Multidisciplinary collaboration and increased awareness are vital to prevent vision-threatening outcomes. Ongoing research is needed to elucidate pathophysiology and optimize therapeutic approaches that balance effective skin disease control with ocular health.

Purpose of review: To review the treatment modalities commonly available or under investigation for uveitic macular edema.

Recent findings: Corticosteroids are a mainstay of treatment and can be administered topically, periocularly, intravitreally, suprachoroidally, and systemically. Advances in drug development aim to target delivery of corticosteroids to the posterior segment while sparing anterior segment structures to avoid intraocular pressure elevation and cataract formation. Nonsteroidal alternatives including intravitreal anti-VEGF, intravitreal methotrexate, intravitreal anti-IL6, systemic acetazolamide, systemic antimetabolites, systemic biologics, and interferons have all been studied as alternatives that would allow for potential reduction or discontinuation of corticosteroid use. Pars plana vitrectomy remains a controversial option for patients with uveitic macular edema refractory to other medical therapies.

Summary: Uveitic macular edema is a common complication of uveitis that can cause significant vision loss and persist even after the resolution of other signs of intraocular inflammation. Treatment modalities aim to reduce macular edema while limiting adverse effects.

Purpose of review: The rising prevalence of contact lens wear is associated with increased contact lens-related complications, with one of the most serious being contact lens (CL)-associated microbial keratitis (MK). We describe updated prevention and management strategies of this sight-threatening condition.

Recent findings: Poor contact lens hygiene and practices remain the most common predisposing factors for CL-associated MK. Management currently relies largely on antimicrobial therapy guided by culture data; however, increasing antimicrobial resistance is a worldwide concern. Recent studies show early promise for novel broad-spectrum therapies including cross-linking and rose Bengal-photodynamic therapy, povidone iodine, and antimicrobial peptides.

Summary: There has been increased investigation in past years into broad-spectrum nonselective treatments for MK. While these investigations show early promise, prevention of CL-associated MK through education on hygiene practices remains an important healthcare intervention.

Purpose of review: Advances in artificial intelligence have integrated into modern medicine decision making and diagnostics. Artificial intelligence in ophthalmology has become more ingrained in refractive surgery because of extensive use of diagnostic modalities including interpretation of anterior segment imaging used in refractive surgery. The role of artificial intelligence has increased to include biometry for the accurate selection of intraocular lenses (IOLs), detection of pathology such as cornea ectasia and keratoconus, sizing of phakic IOLs, as well as surgical decision making for the surgeon and patient. Artificial intelligence will also play a role in education of future medical professionals who will choose refractive surgery as a career.

Recent findings: Research regarding artificial intelligence is on the rise. Interest in artificial intelligence for ophthalmology is international with the largest numbers of studies coming from China and the United States of America. During this review, the most common themes encountered included the role of artificial intelligence in the fields of biometry for IOL selection, detection of keratoconus and cornea ectasia, sizing for phakic IOLs and surgical decision making and education.

Summary: Artificial intelligence will become increasingly important in the field of refractive surgery. With advancements in artificial intelligence, machine learning, and deep learning, the safety and efficacy of refractive surgery will improve due to more accurate detection of pathology and more accurate outcomes in the realm of laser vision correction procedures and (IOL) selection.

Purpose of review: Corneal neurotization, a surgical technique that restores corneal sensation by transferring a healthy sensory nerve to the neurotrophic cornea, has emerged as a treatment of moderate to severe neurotrophic keratopathy. This review provides an overview of the indications, surgical techniques, and outcomes of corneal neurotization.

Recent findings: Corneal neurotization can be performed via direct nerve transfer or indirect nerve grafting, with comparable long-term outcomes. Advances such as minimally invasive and endoscopic techniques, nerve allografts, and alternative donor nerves have expanded its accessibility. Studies show significant improvements in corneal sensation, epithelial integrity, and ocular surface health, with younger patients achieving faster and more complete recovery. The procedure has demonstrated efficacy across diverse neurotrophic keratopathy etiologies and is increasingly considered earlier in disease progression.

Summary: Corneal neurotization offers a promising, long-term solution for neurotrophic keratopathy by addressing the root cause of corneal anesthesia.

Purpose of review: Ocular surface inflammatory disorders (OSIDs), including allergic conjunctivitis, ocular graft-versus-host disease (oGVHD), and cicatrizing conjunctivitis, present significant clinical challenges due to complex immune modulation. Traditional therapies like corticosteroids have limitations, prompting the need for alternative treatments. This review explores novel, steroid-sparing immunomodulatory options.

Recent findings: In recent years, immunomodulatory therapies have evolved from corticosteroids and broad-spectrum T-cell inhibitors such as cyclosporine and tacrolimus to more selective pathway-targeting agents like JAK inhibitors (e.g., ruxolitinib). Biologic agents, including dupilumab and upadacitinib, have demonstrated efficacy in severe allergic conjunctivitis. In oGVHD, JAK inhibitors and combination therapies are emerging as promising strategies. For cicatrizing conjunctivitis, rituximab and IVIg have shown encouraging outcomes. Additionally, novel therapeutic targets such as chemokine receptor blockers (e.g., CCL20 locked dimer), T regulatory cell (Treg) modulation, and transcriptional modification via micro-RNA are shaping the future of ocular surface disease management.

Summary: The future of immunomodulatory therapy for ocular surface diseases lies in refining current treatment approaches and advancing targeted biologic agents that modulate specific immune pathways, offering improved efficacy and safety for patients with these sight-threatening conditions.