Frontiers in ophthalmology最新文献

Purpose: We sought to investigate whether variations in lymphatic morphology are associated with postoperative eyelid edema in patients who underwent upper eyelid blepharoplasty.

Methods: This was a prospective study in which nine upper eyelid skin samples were stained with Podoplanin to immunochemically mark lymphatic vessels. Lymphatic vessel area, density, and perimeter were calculated from averaging 38 slices across 3 cuts of eyelid skin. Corresponding postoperative patient photographs were graded by four physicians with a standardized postoperative edema grading scale that ranged from zero (no edema) to three (severe edema). Patients were classified as having clinically significant eyelid edema (CSEE) if they received an edema grade greater than zero 90 days postoperatively or a grade of three at any time point.

Results: Anti-podoplanin staining demonstrated that there was significantly lower lymphatic vessel density among patients with severe edema (8.00 ± 1.67 vessels/mm²) compared to patients with mild or no edema (12.14 ± 1.93 vessels/mm², p < 0.05). Lymphatic vessel area and perimeter did not reveal any significant associations with postoperative edema grades.

Conclusions: In patients undergoing an upper eyelid blepharoplasty, severe postoperative swelling was significantly associated with lower lymphatic vessel density, but not with lymphatic vessel area or perimeter. These findings suggest that the lymphatic network of the eyelid could play a role in the degree of postoperative swelling.

Lacrimal gland masses represent a diverse group of pathological processes, including inflammatory, lymphoproliferative, and neoplastic lesions. They often present as a palpable mass in the superolateral orbit. There is significant overlap in clinical presentation, and imaging with ultrasound, computed tomography, and magnetic resonance imaging is essential for further characterisation. Key radiological features such as laterality, lobe involvement, lesion composition, margin definition, enhancement pattern, and associated bony changes can significantly narrow the differential diagnosis. This review will describe the radiological features of lacrimal gland masses to guide decision-making.

The state of the art of in-the-bag cataract surgery, though one of the most successful surgeries in ophthalmology, has significant room for improvement as a one-time, lifetime solution for optical clarity. Though optic capture techniques have been known since the 1990's they are underutilized and not adequately explored or understood. This perspective not only explains their history and value but also clarifies the anatomy and suggests a proven improvement and a proposed study for another solution: hyaloid sparing double capture, to once again elevate the outcomes and lessen the complications of our routine surgery. Open your mind: hone your skills with this knowledge and help us move forward.

Consanguineous marriages are common, particularly in Saudi Arabia, where approximately half of all marriages are consanguineous. The likelihood of autosomal recessive (AR) genetic abnormalities, especially rare diseases (RDs) that present long-term health issues, is significantly increased by this trend, making Inherited Ocular Diseases (IODs) a public health concern in Saudi Arabia. The common IODs include Primary Congenital Glaucoma (PCG), Retinitis Pigmentosa (RP), and Leber Congenital Amaurosis (LCA). To date, there are no national initiatives for screening programs to detect, prevent, and manage IOD. This review aims to evaluate the public health landscape of IOD in Saudi Arabia, including epidemiology and genetic factors. It highlights the need for a national framework to facilitate screening, prevention, and early intervention. Cost-effectiveness evaluation, early genetic screening, and counseling can drastically lower the long-term medical expenses related to IOD management. Outreach programs can be used to address issues, including cultural acceptance and equitable access to screening services, which are needed. Further carrier screening for at-risk families accompanied by genetic counseling decreases new IOD cases and provides better family planning for impacted populations. These are among the expected results, which will eventually enhance health outcomes and ensure the long-term viability of Saudi Arabia's healthcare system. In alignment with Vision 2030's futuristic pipeline for screening, introducing telemedicine and AI-driven predictive tools can enhance accessibility and precision in screening programs.

Background: Trigeminal autonomic cephalalgias (TACs) are characterized by unilateral headache with cranial autonomic symptoms. Sudden subtype changes may suggest secondary causes.

Case presentation: A 66-year-old woman presented with a rapid shift from paroxysmal hemicrania to SUNCT. Varicella zoster virus (VZV) reactivation was confirmed by CSF analysis and aqueous humor PCR. Ocular involvement included panuveitis and papillitis. Symptoms resolved after 14 days of intravenous acyclovir.

Conclusion: Rapid TACs subtype transformation should prompt evaluation for secondary causes. Early diagnosis of VZV can lead to favorable outcomes.

Background: Merkel cell carcinoma (MCC) of the eyelid is rare and aggressive. Diagnostic delay and inadequate excision may promote early nodal spread. We assessed the influence of surgical margins and re-excision timing on outcomes, supported by a PRISMA-guided systematic review on metastatic risk.

Methods: A single-center retrospective series (2012-2024) included 9 histologically confirmed eyelid MCCs, analyzing presentation, treatment, and outcomes. Surgical strategies were classified as one-step wide local excision (1WLE, ≥5 mm), two-step wide local excision (2WLE) with early (E2WLE, ≤2 months) or late (L2WLE, 6 months) re-excision, and insufficient margin excision (IME, <2 mm without re-excision). A systematic review identified periocular MCC cases with individual-level data on margins and outcomes.

Results: Patients (median age 71.8 years, range 42-92; 89% female) all presented with solitary nodules on the upper eyelid, and were node-negative and metastasis-free at diagnosis, consistent with AJCC 8th clinical stage I-IIA.Median follow-up was 48 months (IQR 12-120). Treatments included 1WLE (n=4), 2WLE (n=3; 2 E2WLE, 1 L2WLE), and IME (n=2). Three patients (33%) developed cervical lymph node metastases within 1-3 months: one after L2WLE (fatal at 12 months) and two after IME. Both IME patients showed marked responses to Avelumab. Of the remaining six, four (67%) remained disease-free and two (33%) died of unrelated causes. Metastatic risk was significantly higher after IME versus sufficient margins (p=0.0119). In the PRISMA-guided review (76 eyelid MCC), insufficient margins correlated with adverse outcomes; in a subset without baseline metastasis (n=39), insufficient margins increased risk of recurrence/metastasis (OR 10.56; 95% CI 1.84-77.24; Fisher's exact p=0.002).

Conclusion: In eyelid MCC, adequate margins at first surgery or early re-excision are crucial to prevent early nodal spread. Our findings emphasize the prognostic value of surgical adequacy and support incorporating wide excision into initial management. Further multicenter studies are warranted to define evidence-based management pathways, improve long-term outcomes, and clarify the role of checkpoint inhibition in periocular MCC.

The vitreous fluid, situated in the posterior chamber of the eye, holds a close relationship with the inner retina. Within this milieu, retinal cells secrete a diverse array of biomolecules, potentially harboring vital biomarkers. Among these, short, non-coding micro-RNAs (miRNAs) emerge as promising candidates. Their dynamic regulation by various gene signaling mechanisms, enhanced resistance to degradation, and secretion via separate exocytotic pathways make them particularly significant. Alterations in vitreal miRNA profiles may reflect pathological states and offer insights into disease etiology and progression. Here, we conducted a comprehensive survey of 22 peer-reviewed studies to assess the potential of vitreous miRNAs as biomarkers for retinal diseases. Our analysis demonstrates the utility of miRNAs as biomarkers in specific retinal pathologies. We show that miR-142, miR-9, and miR-21 are robust biomarker candidates, displaying consistent and significant alterations correlating with proliferative vitreoretinal diseases. We also address the methodological challenges encountered in characterizing vitreous miRNA content, including the absence of standardized purification, amplification, and analysis protocols, as well as the scarcity of true control samples. Moreover, we recommend the adoption of specific housekeeping genes and data normalization techniques to standardize miRNA analysis in the vitreous and explore potential methodologies for obtaining vitreous samples from healthy individuals. We conclude that vitreous miRNAs hold promise as potential biomarkers for various retinal diseases, with miR-142, miR-9, and miR-21 emerging as promising candidates. Enhancing methodologies for vitreous sampling and miRNA analysis presents an opportunity to expand the repertoire and utility of miRNA biomarkers in retinal disease diagnosis and prognosis.

Eye movement abnormalities are increasingly recognized as early and sensitive markers of neurodegenerative dementias, particularly Alzheimer's disease (AD). Disruptions in saccadic, antisaccadic, smooth pursuit, fixation, and naturalistic eye movement tasks reflect dysfunction in frontal, parietal, subcortical, and cerebellar circuits that are vulnerable to neurodegeneration. Studies have consistently demonstrated that AD patients show prolonged saccadic latencies, increased antisaccade error rates, reduced smooth pursuit gain, and fixation instability. Such deficits correlate with cognitive impairment, disease severity, and neuroimaging biomarkers of cortical atrophy. Comparisons with frontotemporal dementia (FTD), dementia with Lewy bodies (DLB), and posterior cortical atrophy (PCA) highlight overlapping yet distinct oculomotor profiles, suggesting diagnostic and prognostic value. Eye-tracking methodologies offer non-invasive, cost-effective tools that could complement neuropsychological and imaging assessments. However, methodological variability remains a barrier to clinical implementation. This review integrates evidence from foundational and recent studies to provide a comprehensive account of oculomotor dysfunction in AD and other dementias, emphasizing the translational potential of eye movement biomarkers in clinical practice and research.