This systematic review and meta-analysis aimed to evaluate the global burden, microbial causes, risk factors, and antibiotic susceptibility patterns of bacterial keratitis (BK) among patients with microbiologically confirmed infectious keratitis.
Methods
We conducted a systematic search of PubMed, Scopus, Cochrane CENTRAL, and PsycINFO through July 1, 2022. Eligible observational studies reported microbiologically confirmed BK cases and bacterial antibiotic susceptibility. Two reviewers independently screened studies and extracted data. Risk of bias was assessed, and a random-effects meta-analysis was performed to estimate the pooled proportion of BK among all infectious keratitis cases. The protocol was registered in PROSPERO (CRD420251088592). Reported risk factors and antibiotic susceptibility were synthesized descriptively.
Results
From 5180 records screened, 58 studies involving over 134,000 patients were included. The pooled global prevalence of BK was 44 % (95 % CI: 39–49 %) with high heterogeneity (I2 ≈ 97 %). Regional variation was notable, ranging from ∼61 % in Oceania to ∼29 % in Africa. Of ∼25,000 bacterial isolates, 72 % were Gram-positive. Dominant species included Staphylococcus epidermidis(15 %), Streptococcus pneumoniae (13 %), Staphylococcus aureus (10 %), and Pseudomonas aeruginosa (17 %). Reported risk factors included trauma (∼44 %) and contact lens wear (∼23 %). Gram-positive isolates showed >95 % susceptibility to vancomycin; Gram-negatives were >90 % susceptible to aminoglycosides and cephalosporins. Fluoroquinolone susceptibility was lower (∼77 % for S. aureus), and ∼20 % of S. aureus were MRSA.
Conclusion
Nearly half of infectious keratitis cases worldwide are bacterial. Findings underscore the need for prevention strategies focused on trauma and contact lens hygiene, and broad empirical therapy targeting MRSA and Pseudomonas.
{"title":"Global burden, risk factors, causative organisms and antibiotic susceptibility patterns in bacterial keratitis","authors":"Rohan Bir Singh , Uday Pratap Singh Parmar , Fasika Woreta , Diyva Srikumaran , Namrata Sharma , Vishal Jhanji","doi":"10.1016/j.jtos.2025.12.003","DOIUrl":"10.1016/j.jtos.2025.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review and meta-analysis aimed to evaluate the global burden, microbial causes, risk factors, and antibiotic susceptibility patterns of bacterial keratitis (BK) among patients with microbiologically confirmed infectious keratitis.</div></div><div><h3>Methods</h3><div>We conducted a systematic search of PubMed, Scopus, Cochrane CENTRAL, and PsycINFO through July 1, 2022. Eligible observational studies reported microbiologically confirmed BK cases and bacterial antibiotic susceptibility. Two reviewers independently screened studies and extracted data. Risk of bias was assessed, and a random-effects meta-analysis was performed to estimate the pooled proportion of BK among all infectious keratitis cases. The protocol was registered in PROSPERO (CRD420251088592). Reported risk factors and antibiotic susceptibility were synthesized descriptively.</div></div><div><h3>Results</h3><div>From 5180 records screened, 58 studies involving over 134,000 patients were included. The pooled global prevalence of BK was 44 % (95 % CI: 39–49 %) with high heterogeneity (I<sup>2</sup> ≈ 97 %). Regional variation was notable, ranging from ∼61 % in Oceania to ∼29 % in Africa. Of ∼25,000 bacterial isolates, 72 % were Gram-positive. Dominant species included <em>Staphylococcus epidermidis</em>(15 %), <em>Streptococcus pneumoniae</em> (13 %), <em>Staphylococcus aureus</em> (10 %), and <em>Pseudomonas aeruginosa</em> (17 %). Reported risk factors included trauma (∼44 %) and contact lens wear (∼23 %). Gram-positive isolates showed >95 % susceptibility to vancomycin; Gram-negatives were >90 % susceptible to aminoglycosides and cephalosporins. Fluoroquinolone susceptibility was lower (∼77 % for <em>S. aureus</em>), and ∼20 % of <em>S. aureus</em> were MRSA.</div></div><div><h3>Conclusion</h3><div>Nearly half of infectious keratitis cases worldwide are bacterial. Findings underscore the need for prevention strategies focused on trauma and contact lens hygiene, and broad empirical therapy targeting MRSA and <em>Pseudomonas</em>.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 49-57"},"PeriodicalIF":5.6,"publicationDate":"2025-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.jtos.2025.08.010
Kaleb S. Abbott , Andrew D. Pucker
{"title":"It's time to retire the terms artificial tears and rewetting drops: A call for accurate terminology and updated clinical usage in eye care","authors":"Kaleb S. Abbott , Andrew D. Pucker","doi":"10.1016/j.jtos.2025.08.010","DOIUrl":"10.1016/j.jtos.2025.08.010","url":null,"abstract":"","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 46-48"},"PeriodicalIF":5.6,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To report the demographic characteristics, clinical spectrum, and outcomes of patients with extra-glandular corneal manifestations of Sjögren's disease (SjD).
Design
Retrospective review of electronic medical records.
Participants
Consecutive patients with SjD diagnosed per the 2016 American College of Rheumatology/European League Against Rheumatism criteria at a tertiary ophthalmology center.
Methods
Patients were systematically evaluated, diagnosed, and followed longitudinally. A database was generated by searching electronic records, collecting data on demographics, clinical and laboratory findings, treatments, and outcomes.
Main outcome measures
Prevalence and management of extra-glandular corneal manifestations of SjD.
Results
A total of 415 patients were included, mostly female (92.5 %), with a mean age of 63 years (range: 18–91) and a mean follow-up of 34 months (range: 1–120). Standalone SjD was present in 126 patients (30.28 %), and 289 (69.63 %) had associated autoimmune diseases, most commonly rheumatoid arthritis (n = 221) and systemic lupus erythematosus (n = 26). Diagnosis was based on ACR/EULAR score-based criteria (score ≥4) with positive serology (n = 372, 89.63 %) and positive minor salivary gland biopsy (n = 46, 11.08 %). Corneal complications were observed in 113 patients (27.2 %), including scarring (38/113), epithelial defects (22/113), and perforation. Corneal perforation occurred in 53 patients (12.77 %), most commonly at presentation (47/53, 88.67 %). Perforation rates were 5.56 % (7/126) in standalone SjD and 15.92 % (46/289) in SjD with other autoimmune diseases. At presentation, 56.6 % of patients with perforation (30/53) were not on systemic immunomodulatory treatment (IMT); they were subsequently treated. Six patients (11.32 %) developed perforation during follow-up while already on IMT and required escalation. All six had coexisting autoimmune diseases, primarily rheumatoid arthritis. To manage complications, 75 surgical procedures were performed, including keratoplasty. Five eyes were enucleated or eviscerated due to delayed presentation and infection.
Conclusions
Corneal complications, including perforation, are common in SjD and may occur even in the absence of other autoimmune diseases. Many patients present without systemic treatment. These findings support incorporating corneal manifestations into SjD disease activity indices to enable earlier medical intervention alongside surgical care.
{"title":"Corneal complications of Sjögren's disease: Insights from a large tertiary ophthalmological care center","authors":"Gustavo Ortiz-Morales , Mauricio Muleiro-Alvarez , Eber A. Medina-Estrada , Guillermo Raúl Vera-Duarte , Nicolás Kahuam-López , Aida Jimenez-Corona , Alejandro Navas , Arturo Ramirez-Miranda , Esen K. Akpek , Enrique O. Graue-Hernandez","doi":"10.1016/j.jtos.2025.11.009","DOIUrl":"10.1016/j.jtos.2025.11.009","url":null,"abstract":"<div><h3>Purpose</h3><div>To report the demographic characteristics, clinical spectrum, and outcomes of patients with extra-glandular corneal manifestations of Sjögren's disease (SjD).</div></div><div><h3>Design</h3><div>Retrospective review of electronic medical records.</div></div><div><h3>Participants</h3><div>Consecutive patients with SjD diagnosed per the 2016 American College of Rheumatology/European League Against Rheumatism criteria at a tertiary ophthalmology center.</div></div><div><h3>Methods</h3><div>Patients were systematically evaluated, diagnosed, and followed longitudinally. A database was generated by searching electronic records, collecting data on demographics, clinical and laboratory findings, treatments, and outcomes.</div></div><div><h3>Main outcome measures</h3><div>Prevalence and management of extra-glandular corneal manifestations of SjD.</div></div><div><h3>Results</h3><div>A total of 415 patients were included, mostly female (92.5 %), with a mean age of 63 years (range: 18–91) and a mean follow-up of 34 months (range: 1–120). Standalone SjD was present in 126 patients (30.28 %), and 289 (69.63 %) had associated autoimmune diseases, most commonly rheumatoid arthritis (n = 221) and systemic lupus erythematosus (n = 26). Diagnosis was based on ACR/EULAR score-based criteria (score ≥4) with positive serology (n = 372, 89.63 %) and positive minor salivary gland biopsy (n = 46, 11.08 %). Corneal complications were observed in 113 patients (27.2 %), including scarring (38/113), epithelial defects (22/113), and perforation. Corneal perforation occurred in 53 patients (12.77 %), most commonly at presentation (47/53, 88.67 %). Perforation rates were 5.56 % (7/126) in standalone SjD and 15.92 % (46/289) in SjD with other autoimmune diseases. At presentation, 56.6 % of patients with perforation (30/53) were not on systemic immunomodulatory treatment (IMT); they were subsequently treated. Six patients (11.32 %) developed perforation during follow-up while already on IMT and required escalation. All six had coexisting autoimmune diseases, primarily rheumatoid arthritis. To manage complications, 75 surgical procedures were performed, including keratoplasty. Five eyes were enucleated or eviscerated due to delayed presentation and infection.</div></div><div><h3>Conclusions</h3><div>Corneal complications, including perforation, are common in SjD and may occur even in the absence of other autoimmune diseases. Many patients present without systemic treatment. These findings support incorporating corneal manifestations into SjD disease activity indices to enable earlier medical intervention alongside surgical care.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 41-45"},"PeriodicalIF":5.6,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jtos.2025.11.011
Mijeong Park , Elvis Pandzic , John Males , Nick Di Girolamo
Purpose
Disease that develops on the ocular surface in animals and humans that have their limbal stem cells erased or their niche severely damaged by physical or chemical trauma, is difficult to visually evaluate in a progressive and long-term manner. When limbal stem cell deficiency (LSCD) develops under such circumstances, intravital clinical microscopy or other techniques cannot be used to accurately detail what transpires on the cornea. Here, we investigated the evolution of LSCD and characterize cellular transformations that arise when the limbal niche is lost.
Methods
We employed the multi-color K14CreERT2-Confetti transgenic reporter mice (n = 51) to monitor LSCD in real-time, combined with proliferation markers and in vitro analyses to identify and characterize conjunctival epithelial transformations using wild-type C57BL/6 mice (n = 31).
Results
Conjunctival epithelia either spawn MUC5AC + goblet cells (GCs) or K12+ cornea-like epithelia. These cells arise from Ki67+ proliferating differentiated conjunctival squames as opposed to DNA label retaining conjunctival stem/progenitor cells. In vitro analyses suggests that GC metaplasia (GCM) and conjunctival transdifferentiation (CjTD) evolve from environmental stress and soluble keratocyte elaborated signals and corneal matrix-associated physical cues.
Conclusions
GCM is a pathological process, as opposed to CjTD, which is the cornea's attempt to self-repair. The co-existence of two fundamentally diverse cellular interchanges establishes a medical conundrum in LSCD which may be resolved via pharmacological or biological intervention in conjunction with surgery to replenish the stem cell pool.
{"title":"Mechanistic insights into conjunctivalization in limbal stem cell deficiency using a lineage tracing approach","authors":"Mijeong Park , Elvis Pandzic , John Males , Nick Di Girolamo","doi":"10.1016/j.jtos.2025.11.011","DOIUrl":"10.1016/j.jtos.2025.11.011","url":null,"abstract":"<div><h3>Purpose</h3><div>Disease that develops on the ocular surface in animals and humans that have their limbal stem cells erased or their niche severely damaged by physical or chemical trauma, is difficult to visually evaluate in a progressive and long-term manner. When limbal stem cell deficiency (LSCD) develops under such circumstances, intravital clinical microscopy or other techniques cannot be used to accurately detail what transpires on the cornea. Here, we investigated the evolution of LSCD and characterize cellular transformations that arise when the limbal niche is lost.</div></div><div><h3>Methods</h3><div>We employed the multi-color K14CreER<sup>T2</sup>-Confetti transgenic reporter mice (<em>n = 51</em>) to monitor LSCD in real-time, combined with proliferation markers and <em>in vitro</em> analyses to identify and characterize conjunctival epithelial transformations using wild-type C57BL/6 mice (<em>n = 31</em>).</div></div><div><h3>Results</h3><div>Conjunctival epithelia either spawn MUC5AC <sup>+</sup> goblet cells (GCs) or K12<sup>+</sup> cornea-like epithelia. These cells arise from Ki67<sup>+</sup> proliferating differentiated conjunctival squames as opposed to DNA label retaining conjunctival stem/progenitor cells. <em>In vitro</em> analyses suggests that GC metaplasia (GCM) and conjunctival transdifferentiation (CjTD) evolve from environmental stress and soluble keratocyte elaborated signals and corneal matrix-associated physical cues.</div></div><div><h3>Conclusions</h3><div>GCM is a pathological process, as opposed to CjTD, which is the cornea's attempt to self-repair. The co-existence of two fundamentally diverse cellular interchanges establishes a medical conundrum in LSCD which may be resolved via pharmacological or biological intervention in conjunction with surgery to replenish the stem cell pool.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 21-33"},"PeriodicalIF":5.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-27DOI: 10.1016/j.jtos.2025.11.010
Esen Akpek , Lyndon Jones , Kelly K. Nichols , Lisa M. Nijm , Stephen Pflugfelder
Purpose
Chronic tear deficiency, through reduced production and/or increased evaporation, is regarded as a root cause of dry eye disease (DED). The goal of treating DED is restoration of the tear film ultimately resulting in ocular surface homeostasis. Multiple therapeutic prescription drugs to manage DED exist with varying speed of onset, overall magnitude of efficacy, and tolerability. Neuromodulation is an emerging treatment modality offering direct stimulation of natural tear production. A modified Delphi study was conducted to explore the role of neuromodulation as a treatment for DED.
Methods
Twenty DED experts participated in three rounds of structured electronic Delphi questionnaires. Consensus, defined as ≥ 80 %, was sought on 18 statements across three key DED topics: unmet treatment needs, the importance of natural tears in ocular surface homeostasis, and neuromodulation as a treatment approach. Statements were refined iteratively based on qualitative feedback and quantitative agreement from the panel.
Results
Consensus was reached on all 18 statements. Panelists affirmed that significant unmet needs persist in managing DED. Panelists agreed that stimulating patients’ natural tear production can help maintain and restore ocular surface homeostasis and that neuromodulation, through the ability to rapidly increase natural tear production, has the potential to effectively fill existing treatment gaps.
Conclusion
This Delphi panel reached consensus on the importance of restoring natural tear production as a primary goal in treating DED. Neuromodulation represents a promising treatment option for DED, offering a rapid and restorative therapeutic approach for natural tear production.
{"title":"Delphi panel on neuromodulation as a treatment strategy for dry eye disease: Unlocking the potential of natural tear production","authors":"Esen Akpek , Lyndon Jones , Kelly K. Nichols , Lisa M. Nijm , Stephen Pflugfelder","doi":"10.1016/j.jtos.2025.11.010","DOIUrl":"10.1016/j.jtos.2025.11.010","url":null,"abstract":"<div><h3>Purpose</h3><div>Chronic tear deficiency, through reduced production and/or increased evaporation, is regarded as a root cause of dry eye disease (DED). The goal of treating DED is restoration of the tear film ultimately resulting in ocular surface homeostasis. Multiple therapeutic prescription drugs to manage DED exist with varying speed of onset, overall magnitude of efficacy, and tolerability. Neuromodulation is an emerging treatment modality offering direct stimulation of natural tear production. A modified Delphi study was conducted to explore the role of neuromodulation as a treatment for DED.</div></div><div><h3>Methods</h3><div>Twenty DED experts participated in three rounds of structured electronic Delphi questionnaires. Consensus, defined as ≥ 80 %, was sought on 18 statements across three key DED topics: unmet treatment needs, the importance of natural tears in ocular surface homeostasis, and neuromodulation as a treatment approach. Statements were refined iteratively based on qualitative feedback and quantitative agreement from the panel.</div></div><div><h3>Results</h3><div>Consensus was reached on all 18 statements. Panelists affirmed that significant unmet needs persist in managing DED. Panelists agreed that stimulating patients’ natural tear production can help maintain and restore ocular surface homeostasis and that neuromodulation, through the ability to rapidly increase natural tear production, has the potential to effectively fill existing treatment gaps.</div></div><div><h3>Conclusion</h3><div>This Delphi panel reached consensus on the importance of restoring natural tear production as a primary goal in treating DED. Neuromodulation represents a promising treatment option for DED, offering a rapid and restorative therapeutic approach for natural tear production.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 34-40"},"PeriodicalIF":5.6,"publicationDate":"2025-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-24DOI: 10.1016/j.jtos.2025.11.006
Pier Luigi Surico , Chun-Bing Chen , Chuang-Wei Wang , Tai Ping Lee , Martin Sieber , Wen-Hung Chung , Kevin Sheng-Kai Ma , Yueh-Ju Tsai , Chi-Chin Sun , David Hui-Kang Ma
{"title":"Umbilical cord-derived mesenchymal stem cell therapy for acute Stevens Johnson syndrome/Toxic Epidermal Necrolysis with severe ocular involvement","authors":"Pier Luigi Surico , Chun-Bing Chen , Chuang-Wei Wang , Tai Ping Lee , Martin Sieber , Wen-Hung Chung , Kevin Sheng-Kai Ma , Yueh-Ju Tsai , Chi-Chin Sun , David Hui-Kang Ma","doi":"10.1016/j.jtos.2025.11.006","DOIUrl":"10.1016/j.jtos.2025.11.006","url":null,"abstract":"","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 17-20"},"PeriodicalIF":5.6,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145592818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1016/j.jtos.2025.11.005
Emanuele Käser , Estelle Reymond , Daniela S. Nosch
Background
Dry eye disease (DED) is a worldwide prevalent condition; however, its pathophysiology is not well understood. Corneal nerves play a primary role in DED, and a better understanding of the changes to their morphology and function is required. This systematic review investigated changes to the function of corneal nerves.
Methods
Relevant literature from inception to September 10, 2025 was searched for in PubMed, Web of Science and Scopus, following the PRISMA statement. Studies measuring corneal sensitivity in patients with DED and in healthy controls were included. Publication selection and analysis were conducted independently by two authors.
Results
Twenty-five studies involving 1580 participants (1001 with DED and 579 healthy controls) were included. Nineteen studies used the Cochet-Bonnet aesthesiometer and found a consistently reduced corneal sensitivity in patients with DED. No consistent correlation was found between corneal sensitivity and DED severity, possibly due to heterogeneity of study design and methodology. Six studies used a variant of the Belmonte air jet aesthesiometer, reporting inconsistent results for mechanical corneal sensitivity. Increased sensitivity in DED patients was reported, using a stimulus at ambient temperature. One study used the Brill aesthesiometer and found reduced corneal sensitivity in DED patients.
Conclusion
Cochet-Bonnet measurements suggest a decreased mechanical corneal sensitivity in DED patients. Air jet aesthesiometry results were inconsistent, indicating variable responses from functionally different corneal nerve endings. Future research should employ reliable corneal sensitivity measurement methods with a wide stimulus range and standardised study designs to improve understanding of changes in corneal sensitivity in dry eye disease.
干眼病（DED）是一种世界性的常见病；然而，其病理生理机制尚不清楚。角膜神经在DED中起主要作用，需要更好地了解其形态和功能的变化。本系统综述研究了角膜神经功能的变化。方法按照PRISMA的声明，在PubMed、Web of Science和Scopus中检索成立至2025年9月10日的相关文献。研究测量了DED患者和健康对照的角膜敏感性。出版物选择和分析由两位作者独立进行。结果共纳入25项研究，共1580名受试者（1001名DED患者和579名健康对照）。19项研究使用Cochet-Bonnet美感计，发现DED患者的角膜敏感性持续降低。角膜敏感性和DED严重程度之间没有一致的相关性，可能是由于研究设计和方法的异质性。六项研究使用了贝尔蒙特喷气美感计的一种变体，报告了机械角膜敏感度不一致的结果。据报道，在环境温度下使用刺激会增加DED患者的敏感性。一项使用Brill美感计的研究发现，DED患者的角膜敏感度降低。结论cochet - bonnet测量提示DED患者角膜机械敏感性降低。喷气美感测量结果不一致，表明不同功能的角膜神经末梢的不同反应。未来的研究应采用可靠的角膜敏感性测量方法、广泛的刺激范围和标准化的研究设计，以提高对干眼病角膜敏感性变化的认识。
{"title":"Corneal sensitivity in dry eye disease: A systematic review","authors":"Emanuele Käser , Estelle Reymond , Daniela S. Nosch","doi":"10.1016/j.jtos.2025.11.005","DOIUrl":"10.1016/j.jtos.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Dry eye disease (DED) is a worldwide prevalent condition; however, its pathophysiology is not well understood. Corneal nerves play a primary role in DED, and a better understanding of the changes to their morphology and function is required. This systematic review investigated changes to the function of corneal nerves.</div></div><div><h3>Methods</h3><div>Relevant literature from inception to September 10, 2025 was searched for in PubMed, Web of Science and Scopus, following the PRISMA statement. Studies measuring corneal sensitivity in patients with DED and in healthy controls were included. Publication selection and analysis were conducted independently by two authors.</div></div><div><h3>Results</h3><div>Twenty-five studies involving 1580 participants (1001 with DED and 579 healthy controls) were included. Nineteen studies used the Cochet-Bonnet aesthesiometer and found a consistently reduced corneal sensitivity in patients with DED. No consistent correlation was found between corneal sensitivity and DED severity, possibly due to heterogeneity of study design and methodology. Six studies used a variant of the Belmonte air jet aesthesiometer, reporting inconsistent results for mechanical corneal sensitivity. Increased sensitivity in DED patients was reported, using a stimulus at ambient temperature. One study used the Brill aesthesiometer and found reduced corneal sensitivity in DED patients.</div></div><div><h3>Conclusion</h3><div>Cochet-Bonnet measurements suggest a decreased mechanical corneal sensitivity in DED patients. Air jet aesthesiometry results were inconsistent, indicating variable responses from functionally different corneal nerve endings. Future research should employ reliable corneal sensitivity measurement methods with a wide stimulus range and standardised study designs to improve understanding of changes in corneal sensitivity in dry eye disease.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"39 ","pages":"Pages 1-16"},"PeriodicalIF":5.6,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145509652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jtos.2025.10.004
Haozhe Yu, Wenyu Wu, Jinji Cui, Yun Feng
Aims
To develop and validate a label-free analytical platform using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy on Schirmer strips for tear biomarker profiling, and assess its diagnostic utility in differentiating aqueous-deficient dry eye disease (DED) subtypes.
Methods
Tear samples were collected using Schirmer strips from individuals undergoing routine ophthalmic examinations and from patients with aqueous-deficient DED, with or without primary Sjögren's syndrome. The wetted regions of the strips were analyzed using ATR-FTIR spectroscopy. Stepwise linear regression was employed to model the spectral contributions of individual proteins to the simulated tear spectrum. Spectral differences were quantified using Euclidean distances and correlated with biomarker concentrations and clinical parameters using Spearman correlation. Sparse partial least squares discriminant analysis (sPLS-DA) was then applied to classify DED subtypes.
Results
Prominent spectral features were observed in the 800-1700 cm−1 and ∼3000 cm−1 regions. Model fit for the simulated tear spectrum progressively improved with the sequential addition of protein spectra. Spectral Euclidean distance effectively captured the biomarker concentration gradient, as exemplified by lactoferrin. It demonstrated stronger correlations with tear film breakup time and lipid layer thickness than Schirmer wetting length and remained stable after elution. sPLS-DA accurately classified DED subtypes with an AUC of 0.963, driven primarily by protein-related spectral features.
Conclusions
The integrated tear analysis platform based on ATR-FTIR spectroscopy of Schirmer strips enables accurate, cost-effective differentiation of DED subtypes by capturing tear molecular fingerprints, laying the foundation for integrating tear-based precision medicine into routine clinical workflows.
{"title":"Repurposing schirmer strips for tear biomarker profiling using infrared spectroscopy","authors":"Haozhe Yu, Wenyu Wu, Jinji Cui, Yun Feng","doi":"10.1016/j.jtos.2025.10.004","DOIUrl":"10.1016/j.jtos.2025.10.004","url":null,"abstract":"<div><h3>Aims</h3><div>To develop and validate a label-free analytical platform using attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy on Schirmer strips for tear biomarker profiling, and assess its diagnostic utility in differentiating aqueous-deficient dry eye disease (DED) subtypes.</div></div><div><h3>Methods</h3><div>Tear samples were collected using Schirmer strips from individuals undergoing routine ophthalmic examinations and from patients with aqueous-deficient DED, with or without primary Sjögren's syndrome. The wetted regions of the strips were analyzed using ATR-FTIR spectroscopy. Stepwise linear regression was employed to model the spectral contributions of individual proteins to the simulated tear spectrum. Spectral differences were quantified using Euclidean distances and correlated with biomarker concentrations and clinical parameters using Spearman correlation. Sparse partial least squares discriminant analysis (sPLS-DA) was then applied to classify DED subtypes.</div></div><div><h3>Results</h3><div>Prominent spectral features were observed in the 800-1700 cm<sup>−1</sup> and ∼3000 cm<sup>−1</sup> regions. Model fit for the simulated tear spectrum progressively improved with the sequential addition of protein spectra. Spectral Euclidean distance effectively captured the biomarker concentration gradient, as exemplified by lactoferrin. It demonstrated stronger correlations with tear film breakup time and lipid layer thickness than Schirmer wetting length and remained stable after elution. sPLS-DA accurately classified DED subtypes with an AUC of 0.963, driven primarily by protein-related spectral features.</div></div><div><h3>Conclusions</h3><div>The integrated tear analysis platform based on ATR-FTIR spectroscopy of Schirmer strips enables accurate, cost-effective differentiation of DED subtypes by capturing tear molecular fingerprints, laying the foundation for integrating tear-based precision medicine into routine clinical workflows.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"38 ","pages":"Pages 330-336"},"PeriodicalIF":5.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145310447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-01DOI: 10.1016/j.jtos.2025.09.003
Mattan Arazi , Aya Wattad , Hila Magen , Abraham Avigdor , Nirit Agay , Yoav Berger , Irina S. Barequet
Purpose
Belantamab mafodotin (BLENREP), an antibody–drug conjugate for relapsed/refractory multiple myeloma (RRMM), is associated with corneal toxicity driven by limbal stem cell dysfunction and corneal epithelial damage. We examined how keratopathy severity relates to hematologic management decisions in clinical practice.
Methods
Retrospective cohort at a tertiary referral center, including RRMM patients treated with belantamab mafodotin (2019–2022). Ophthalmic examinations were performed at baseline and before each cycle; keratopathy was graded using the Keratopathy and Visual Acuity (KVA) scale. The primary outcome was the association between KVA severity (modeled as a time-dependent covariate) and management (dose reduction, treatment holiday, or discontinuation). Secondary outcomes included predictors of severe KVA, impact of management on immediate KVA change, and timing of the first management change.
Results
Among 41 patients (mean age 67.10 ± 11.78 years; 23/41 [56.1 %] female), 38/41 (92.68 %) developed KVA keratopathy. The median time to first KVA occurrence was 4.14 weeks, and to first management change was 7.29 weeks. Higher KVA grade was associated with earlier management change (HR 1.514; 95 % CI 1.048–2.187; p = 0.0270). At the first assessment after the initial intervention, KVA worsened after treatment holidays (+0.70 ± 0.114 grades) and improved after dose reductions (−0.20 ± 0.084; p = 0.0165). Overall, during follow-up, the most common intervention was a treatment holiday (23/37, 56.1 %), followed by dose reduction (16/37, 39.0 %) and discontinuation (6/37, 16.2 %).
Conclusion
KVA keratopathy occurred more frequently than in clinical trials, and nearly all patients required treatment modification. Given the strong relationship between KVA severity and management decisions, close ophthalmic monitoring from Grade 1 is warranted to mitigate progression and reduce vision-related morbidity.
{"title":"Interdisciplinary management of belantamab mafodotin-associated ocular toxicity in clinical practice","authors":"Mattan Arazi , Aya Wattad , Hila Magen , Abraham Avigdor , Nirit Agay , Yoav Berger , Irina S. Barequet","doi":"10.1016/j.jtos.2025.09.003","DOIUrl":"10.1016/j.jtos.2025.09.003","url":null,"abstract":"<div><h3>Purpose</h3><div>Belantamab mafodotin (BLENREP), an antibody–drug conjugate for relapsed/refractory multiple myeloma (RRMM), is associated with corneal toxicity driven by limbal stem cell dysfunction and corneal epithelial damage. We examined how keratopathy severity relates to hematologic management decisions in clinical practice.</div></div><div><h3>Methods</h3><div>Retrospective cohort at a tertiary referral center, including RRMM patients treated with belantamab mafodotin (2019–2022). Ophthalmic examinations were performed at baseline and before each cycle; keratopathy was graded using the Keratopathy and Visual Acuity (KVA) scale. The primary outcome was the association between KVA severity (modeled as a time-dependent covariate) and management (dose reduction, treatment holiday, or discontinuation). Secondary outcomes included predictors of severe KVA, impact of management on immediate KVA change, and timing of the first management change.</div></div><div><h3>Results</h3><div>Among 41 patients (mean age 67.10 ± 11.78 years; 23/41 [56.1 %] female), 38/41 (92.68 %) developed KVA keratopathy. The median time to first KVA occurrence was 4.14 weeks, and to first management change was 7.29 weeks. Higher KVA grade was associated with earlier management change (HR 1.514; 95 % CI 1.048–2.187; p = 0.0270). At the first assessment after the initial intervention, KVA worsened after treatment holidays (+0.70 ± 0.114 grades) and improved after dose reductions (−0.20 ± 0.084; p = 0.0165). Overall, during follow-up, the most common intervention was a treatment holiday (23/37, 56.1 %), followed by dose reduction (16/37, 39.0 %) and discontinuation (6/37, 16.2 %).</div></div><div><h3>Conclusion</h3><div>KVA keratopathy occurred more frequently than in clinical trials, and nearly all patients required treatment modification. Given the strong relationship between KVA severity and management decisions, close ophthalmic monitoring from Grade 1 is warranted to mitigate progression and reduce vision-related morbidity.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"38 ","pages":"Pages 324-329"},"PeriodicalIF":5.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号