Purpose: To report recently described type 4 macular neovascularization (T4MNV) in eyes with diabetic retinopathy (DR). Methods: A retrospective analysis including nine eyes with DR (and without any features of age related macular degeneration or AMD) that displayed T4MNV with optical coherence tomography (OCT) and OCT angiography (OCTA). Results: The mean age of the patients was 64 years, and the mean duration of diabetes mellitus was 20 years. All patients displayed unilateral T4MNV with an average visual acuity of 20/500 in the affected eye. Seven of the nine patients (77.8%) were diagnosed with proliferative DR, and the remaining exhibited severe non-proliferative DR. Central posterior hyaloid fibrosis was detected in 7/9 eyes (77.8%) and showed flow on OCTA in 4/9 eyes (44.4%). All 9 eyes showed subretinal hyperreflective material (SHRM) on OCT corresponding to Type 2 (and Type 1) MNV on OCT and OCTA. Drusen were not detected in any of the 9 affected or fellow eyes. Conclusion: T4MNV can occur in eyes with long-standing DR without signs of AMD. It is possible that early identification of T2MNV and timely anti-VEGF intervention may potentially mitigate progression to T4MNV, but this requires validation with prospective analysis. Early recognition of T4MNV imaging features is important in counseling patients about the poor visual prognosis.
The hepatotherapeutic agents from plants have become more predominant around the world. Evening primrose oil (EPO) is a popular alternative treatment that contains several phytoconstituents with strong anti-inflammatory and anti-oxidant properties. The current work inspected the potential protective effect of EPO against carbon tetrachloride (CCl4)-induced hepatotoxicity in rats. Twenty-four adult male albino Wistar rats were divided into 4 equal groups: group I received the vehicle only (control rats), group II was treated with EPO at 300 mg/kg/day, group III was treated with CCl4 at 1 mL/kg, twice a week, and group IV was treated with EPO at 300 mg/kg/day, followed 60 min later by CCl4 1 mL/kg, twice a week. All regimens were oral and for 4 weeks. At the end of the work, we assessed body-weight gain, liver functional markers, hepatic histological examination, quantitative histochemistry, and immunohistochemical profiling of tumor necrosis factor alpha (TNF-α). Gas chromatography coupled with triple quadrupole mass spectrometry (GC-MS) analysis was used to detect the fatty acid composition of EPO. CCl4 administration revealed a significant increase in serum liver functions, a disrupted oxidant/antioxidant status, hepatic histological changes, and an increase in H-score of TNF-α immunoexpression. Inversely, EPO pretreatment attenuated all toxic insults of CCl4. GC-MS showed that linoleic acid and its ethyl ester are the most prevalent components in EPO. Our findings showed that EPO could be a potential hepatoprotective agent that can be used in the future to prevent liver injury. Furthermore, the dominant compounds identified in this sample that may have the potential protective effects are fatty acids and their ethyl esters, such as linoleic acid and its ethyl ester.
Purpose: To assess and compare the short-term effects of repeated intravitreal injection of ranibizumab vs bevacizumab on macular microvasculature in cases with diabetic macular edema (DME) applying optical coherence tomography angiography (OCTA). Methods: Prospective comparative study included 75 eyes of 56 cases with DME. Eyes were assigned to receive 3 consecutive monthly intravitreal injections of either ranibizumab (0.5 milligram) or bevacizumab (1.25 milligram). OCTA imaging was done at baseline and 1 month after the 3rd injection evaluating vessel density in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), as well as foveal avascular zone (FAZ). We also assessed Best-corrected visual acuity (BCVA)and central macular thickness (CMT). Results: BCVA and CMT improved significantly in both groups following injection. However, OCTA analysis showed a decline in SCP vessel density and a mild rise in FAZ area in both groups. In the ranibizumab group, DCP vessel density showed a slight increase, whereas a reduction was observed in the bevacizumab group. A statistically insignificant difference was detected among ranibizumab and bevacizumab groups in post-injection BCVA, CMT, SCP, DCP, or FAZ measurements (p > 0.05). Also, BCVA showed significant correlations with OCTA parameters and CMT. Conclusion: Both ranibizumab and bevacizumab groups showed comparable short-term anatomical and functional enhancements in DME. Our study showed that OCTA remains a valuable non-invasive tool for assessing microvascular changes after anti-vascular endothelial growth factor (VEGF) treatment of DME.
Infectious keratitis can lead to significant ocular morbidity and threaten vision if not treated promptly with antimicrobial therapy. Adjuvant treatment with corneal cross-linking (CXL) can improve visual outcomes in cases of infectious keratitis. Anterior segment optical coherence tomography (AS-OCT) can provide additional qualitative and quantitative information on healing. This was a prospective, comparative control study of 40 eyes of 40 patients with infectious keratitis. The effectiveness of a customised epi-off CXL protocol was evaluated as adjuvant therapy. Clinical and AS-OCT parameters on days 7 and 14 of treatment, date of first report of healing and 1 month following reported healing were recorded. Forty patients were randomly allocated to group A (medical treatment) and group B (medical treatment and CXL). The mean healing duration in days was 27.3 ± 9.27 in group A and 30.75 ± 7.39 in group B. The AS-OCT parameters corneal thickness (CT), infiltrate thickness (IT) and infiltrate width (IW) showed significant reduction compared to preoperative state with no clinically significant change between the groups (p > 0.05). The scar thickness (SC) was measured following reported complete healing and showed a statistically significant difference between the two groups (p < 0.03). The addition of CXL to the treatment of infectious keratitis is associated with reduced scar thickness in the healing phase. Clinically, CXL as an adjuvant therapy to the medical treatment for infectious keratitis did not improve the healing duration or the final visual outcome. NCT06967376 on ClinicalTrials.gov retrospectively registered on 13 May 2025.
Background: Ocular and periocular infections are a significant public health concern because they can affect several anatomical elements of the eye and ocular adnexa, resulting in corneal opacity, conjunctival scarring, decreased vision, or permanent vision loss. These infections can be caused by bacterial, viral, fungal, parasitic, or chlamydial pathogens and can result from direct contamination, trauma, eye surgery, contact lens wear, or transmission from diseased tissues. The purpose of this study is to cover the etiology, epidemiology, risk factors, pathogenesis, virulence mechanisms, and antimicrobial susceptibility patterns of ocular and periocular infections, as well as provide a brief anatomical background when relevant to infection development and host defense. Ocular infections include conjunctivitis, keratitis, blepharitis, dacryocystitis, uveitis, and endophthalmitis, with conjunctivitis and keratitis being the most common. The distribution of pathogenic organisms differs depending on geographical region, climate, socioeconomic background, cleanliness, immunological status, contact lens use, ocular trauma, previous surgery, and antibiotic or steroid exposure. Conclusion: Bacterial pathogens, including Staphylococcus aureus, Coagulase-Negative Staphylococci, Streptococcus pneumoniae, Haemophilus influenzae, and Pseudomonas aeruginosa, are frequently involved in eye infections. Fungal pathogens, notably Aspergillus and Fusarium species, are common causes of keratitis, especially in tropical and underdeveloped countries. The increase of antibiotic resistance among eye pathogens emphasizes the importance of good microbiological diagnosis, culture-based identification, and antimicrobial susceptibility testing for effective therapy. To summarize, understanding the morphological, microbiological, epidemiological, and risk-related features of ocular and periocular infections is critical for early detection, proper practical therapy, and the prevention of vision-threatening consequences.
