Current Opinion in Ophthalmology最新文献

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.

Purpose of review: This review compares two refractive surgery modalities, femtosecond laser-assisted in situ keratomileusis (FS-LASIK) and small-incision lenticule extraction (SMILE), focusing on their efficacy, safety, postoperative recovery, and patient-reported outcomes. The aim is to provide an updated review of recent findings and identify areas for additional research to further optimize surgical outcomes and patient selection.

Recent findings: FS-LASIK and SMILE show excellent, comparable visual outcomes for the correction of myopia and astigmatism. SMILE may have a lower risk of dry eye and has no flap-related complications, while FS-LASIK provides quicker visual recovery. SMILE may offer superior long-term visual outcomes, particularly for high myopia. However, customized FS-LASIK (wavefront- and topography-guided) outperform SMILE in some visual metrics, including uncorrected visual acuity and reduction in higher-order aberrations.

Summary: FS-LASIK remains the gold standard refractive procedure due to its rapid recovery and predictable results, but SMILE offers advantages in preserving corneal biomechanical stability and potentially minimizing dry eye symptoms. SMILE may also offer improved long-term stability for patients at risk of myopic regression. However, a growing body of evidence suggests that wavefront- and topography-guided LASIK yield superior visual outcomes compared to SMILE. Additional long-term comparative studies are needed for different refractive treatment requirements.

Purpose of review: To summarize and evaluate the current literature concerning corneal complications associated with common vaccinations, particularly keratitis and corneal graft rejection following vaccination against SARS-CoV-2, Varicella-Zoster, and Influenza.

Recent findings: Small case series and reports have documented keratitis/herpesvirus reactivation and corneal graft rejection following vaccination, prompting concern from ophthalmologists regarding vaccination timing and management of patients. Recent population-based studies have reported higher risks of herpesvirus keratitis and herpes zoster ophthalmicus recurrence associated with the COVID-19 and varicella zoster vaccinations in rare cases, often in patients with identified risk factors. Similarly, corneal graft rejection rates appear to be stable following vaccination when compared with unvaccinated individuals, with the bulk of vaccine-associated rejection noted to occur with penetrating keratoplasties and in patients at a higher risk for rejection.

Summary: While the benefits of vaccination continue to outweigh the risks, clinicians must identify and balance patient-specific risk factors for corneal complications to inform individual management and counseling, potentially with heightened steroid use in the postvaccination period and more stringent follow up for signs of keratitis or graft rejection.

Purpose of review: The integration of artificial intelligence (AI) in the diagnosis and management of anterior segment diseases has rapidly expanded, demonstrating significant potential to revolutionize clinical practice.

Recent findings: AI technologies, including machine learning and deep learning models, are increasingly applied in the detection and management of a variety of conditions, such as corneal diseases, refractive surgery, cataract, conjunctival disorders (e.g., pterygium), trachoma, and dry eye disease. By analyzing large-scale imaging data and clinical information, AI enhances diagnostic accuracy, predicts treatment outcomes, and supports personalized patient care.

Summary: As AI models continue to evolve, particularly with the use of large models and generative AI techniques, they will further refine diagnosis and treatment planning. While challenges remain, including issues related to data diversity and model interpretability, AI's integration into ophthalmology promises to improve healthcare outcomes, making it a cornerstone of data-driven medical practice. The continued development and application of AI will undoubtedly transform the future of anterior segment ophthalmology, leading to more efficient, accurate, and individualized care.

Purpose of review: Keratoconus is one of the leading indications for corneal transplantation surgery. Although the surgical success rate is high, the long-term outcomes do not match other solid organ transplantation procedures. The availability of minimally invasive techniques has led to a reduction in the number of corneal transplantations in addition to improved visual outcomes in patients with keratoconus.

Recent findings: Collagen crosslinking slows down or stops disease progression in keratoconus. Customized contact lenses provide patient comfort and excellent visual outcomes. Bowman's layer onlay grafts have demonstrated promising outcomes in keratoconus patients. Corneal regeneration approaches provide hope as the next generation treatment option.

Summary: Minimally invasive treatments for keratoconus patients enable alternatives to corneal transplantation. This review summarizes some of the commonly used management approaches with a view into the future.

Purpose of review: In this review, we will address advances and limitations in the field of scleral lenses pertaining to the correction of irregular astigmatism.

Recent findings: There are reports on the benefits of scleral lenses for eyes with irregular astigmatism, particularly regarding improvement of visual acuity and the reduction of higher-order aberrations. Innovations such as wavefront-optimized and wavefront-guided optics can improve vision in keratoconus. Customized haptics, topographic and profilometric-based fitting, and impression-based design can achieve fit in problematic eyes with ectasia, after penetrating keratoplasty, and with corneal scarring. Challenges persist, including resource requirements for practitioners, patient difficulty with insertion and removal, and limitations to lens wear, including midday fogging and corneal edema. Risks such as graft failure persist.

Summary: Scleral lenses have emerged as a useful tool in the management of irregular astigmatism, reducing the need for penetrating keratoplasty. By vaulting the cornea and resting on the sclera, scleral lenses neutralize corneal astigmatism, while providing a stable and comfortable surface for advanced optics. Over the past two decades, the use of scleral lenses has increased, reflecting advances in fitting systems, expanded access, greater adoption by clinicians, broader patient eligibility, and improved clinical outcomes.

Purpose of review: This review aims to provide a comprehensive overview of the epidemiology and clinical features of pediatric blepharokeratoconjunctivitis (BKC), with a focus on elucidating the underlying pathophysiology and evaluating new therapeutic strategies.

Recent findings: Ongoing research continues to refine the management of pediatric BKC. Recent evidence suggests that disease remission can be achieved in approximately 95% of cases through an integrated approach involving topical or systemic antibiotics, corticosteroids, topical immunosuppressants, and lid hygiene. Notably, a significant advancement in the treatment of Demodex blepharitis is the FDA approval of 0.25% lotilaner ophthalmic solution, which has demonstrated safety and efficacy with twice-daily application over six weeks.

Summary: Pediatric blepharokeratoconjunctivitis is a chronic inflammatory condition affecting the eyelids, conjunctiva, and cornea. It is underdiagnosed and associated with significant vision-threatening complications. While there is no established consensus on the most effective therapeutic strategy, management currently includes lid hygiene, topical/systemic antibiotics, corticosteroids, immunosuppressants, lubricants, and dietary supplements. Challenges arise from its chronicity, recurrence, and lack of standardized treatment protocols. This underscores the importance of early diagnosis, education, and continued research on treatment methods to prevent severe outcomes.