BACKGROUND:Interstitial keratitis is a classic manifestation of late congenital syphilis, typically presenting in childhood or adolescence. Adult-onset presentation is rare and poses a diagnostic and therapeutic challenge, particularly in patients without a known history of congenital infection. CASE REPORT:We report a 28-year-old man with an 11-year history of progressive bilateral ocular redness, tearing, and visual decline who was found to have bilateral interstitial keratitis with positive treponemal and negative nontreponemal serologies, consistent with late congenital syphilis. Despite treatment with intravenous penicillin G and adjunctive topical corticosteroids, the clinical course was complicated by refractory inflammation, progressive stromal scarring, corneal thinning, and perforation requiring tectonic patch grafting. Recurrent inflammatory flares persisted despite sustained steroid therapy and negative nontreponemal serologies. Visual rehabilitation required prolonged multidisciplinary management with rigid corneal and scleral contact lenses. CONCLUSION:This case highlights the diagnostic and therapeutic complexity of adult-onset presumed congenital syphilitic interstitial keratitis. In cases where a definitive diagnosis cannot be confirmed, close collaboration among infectious disease, ophthalmology, and optometry is needed to navigate treatment decisions, manage refractory inflammation, and guide visual rehabilitation. This case demonstrates that specialty contact lens fitting and sustained interdisciplinary care are essential in restoring functional vision.
OBJECTIVES:This study aimed to evaluate the short-term effect of a prostaglandin analog-based eyelash serum on the ocular surface. METHODS:A prospective interventional study was conducted on 19 healthy women. Participants applied an eyelash serum containing dechloro dihydroxy difluoro ethylcloprostenolamide once daily to the upper eyelid margin for 6 weeks. Tear film parameters, meibomian glands analysis, and ocular surface inflammation and damage were assessed at baseline and posttreatment using the S390L slit lamp (Firefly WDR, MediWorks, Shanghai, China). RESULTS:A significant reduction in tear film stability was observed, with decreases of 3.92±7.45 sec in first noninvasive break-up time ( P =0.003) and 3.97±6.25 sec in average noninvasive break-up time ( P <0.001). Tear volume was reduced, as shown by decreases of 0.01±0.04 mm in tear meniscus height ( P =0.049) and 0.27±0.66 mm 2 in tear meniscus area ( P =0.019). Ocular hyperemia increased, with temporal ciliary hyperemia rising by 1.68±3.45% ( P =0.006) and temporal conjunctival hyperemia by 2.41±4.14% ( P =0.001). No statistically significant changes were observed in meibomian gland morphology or ocular surface staining. CONCLUSIONS:Daily application of the prostaglandin analog-based eyelash serum induced tear film instability, reduced tear volume, and increased ocular hyperemia. These findings suggest that even short-term use may disrupt ocular surface homeostasis and cause mild inflammation. Further studies with longer follow-up are needed to assess its safety profile on the ocular surface.
ABSTRACT:Zanubrutinib, a second-generation Bruton tyrosine kinase inhibitor used in B-cell malignancies, has a favorable systemic safety profile, whereas its ocular surface effects remain insufficiently defined. We report a 73-year-old woman receiving zanubrutinib for mantle cell lymphoma who presented with acute pain and decreased vision in the right eye. Slitlamp examination revealed a corneal epithelial defect with an associated stromal infiltrate in the right eye and bilateral epithelial surface abnormalities. The patient reported three months of bilateral ocular irritation and conjunctival hyperemia before this acute presentation. Corneal cultures grew Moraxella nonliquefaciens . Topical antimicrobial therapy resulted in resolution of the infiltrate. However, ongoing bilateral epithelial instability with microcystic changes required adjunctive topical corticosteroids, leading to substantial clinical improvement. The prolonged bilateral prodrome preceding the acute infectious episode, together with the absence of prior ocular disease, raises concern for zanubrutinib-associated ocular surface dysfunction predisposing to secondary infection. To the best of our knowledge, this is the first report suggesting an association between zanubrutinib therapy and corneal surface disease. This case raises a potential ocular side effect of zanubrutinib, emphasizing the need for further investigation. As immunotherapy use expands, ophthalmologists should remain vigilant for emerging ocular toxicities and collaborate with oncology specialists for optimal patient care.
Objectives: To review the role of Demodex infestation in blepharitis and summarize available evidence on the efficacy and safety of topical and oral ivermectin. Methods: This narrative review was conducted through collaboration between expert ophthalmologists and infectious diseases specialists with clinical experience in the use of ivermectin. A literature search was performed in PubMed and Embase from inception to November 2025. Results: Evidence from clinical trials, observational studies, and case series was reviewed and synthesized. Ivermectin, administered orally or topically, has been investigated as a potential treatment option for Demodex -associated blepharitis, either as monotherapy or in combination with other therapies. Across different treatment protocols and patient populations, ivermectin use was generally associated with reductions in Demodex mite density, improvement in cylindrical dandruff, ocular surface parameters, and patient-reported symptoms. Reported adverse events were infrequent and predominantly mild. Conclusions: Current evidence suggests that ivermectin may represent an effective and overall safe therapeutic option for Demodex -associated blepharitis. Further studies are needed to establish standardized treatment regimens and to assess long-term outcomes.
OBJECTIVES:To evaluate the efficacy of extended depth-of-focus (EDOF) soft contact lenses with different optical profiles in controlling myopia progression and their effect on visual function in Japanese children. METHODS:In this 12-month multicenter, double-masked, randomized controlled trial, 60 Japanese children aged 6 to 12 years were assigned to wear two types of EDOF soft contact lenses with different depths of focus (Mid-EDOF [+1.50 D] or Low-EDOF [+0.75 D]) or single-vision daily disposable contact lenses (control). Axial length and cycloplegic spherical equivalent (SE) were measured at 6 and 12 months. Visual function, including contrast sensitivity, higher-order aberrations (HOAs), and subjective visual quality, was assessed at baseline and follow-up. RESULTS:Mid-EDOF lenses significantly suppressed axial elongation and SE progression by 49% and 59%, respectively, compared with single-vision lenses (P<0.01). Low-EDOF lenses exerted no significant effect on axial elongation or SE progression. Visual function assessments revealed reduced contrast sensitivity and increased HOAs in the Mid-EDOF group; subjective visual quality remained comparable across groups. No serious adverse events were reported. CONCLUSION:Mid-EDOF lenses significantly suppress myopia progression, with tolerable visual function changes, potentially providing effective myopia control. Low-EDOF lenses showed no significant benefit over single-vision lenses. EDOF lenses' optical profile critically affects treatment efficacy.
ABSTRACT:Ocular neuropathic pain (ONP) can be defined as "pain" or "discomfort" projected to eye because of a lesion or disease or physiological dysfunction of the nervous system. The diagnosis of ONP is a clinical one; history, eye examination, the anesthetic challenge, and in vivo confocal microscopy providing supportive roles in helping to distinguish nociceptive, nociplastic, and neuropathic pain. Multimodal treatment involving local agents and interventions, along with systemic agents, is often required.
PURPOSE:To determine the effects of contact lens-induced full-field and peripheral-field myopic defocus on choroid thickness and variation with time of day in young adults. METHODS:In this prospective, randomized, crossover study, 16 adults (age 28.2±6.3 years) participated in four experimental sessions (two morning and two evening). At each session, optical coherence tomography (OCT) was performed before and 60 min after distance viewing with either full-field or peripheral-field +2.50 D contact lens-induced defocus in the left experimental eye and distance correction in the right eye. Recovery was assessed after 20 min with distance correction in both eyes. Choroidal thickness was analyzed using a custom MATLAB program and two-factor repeated-measures ANOVAs. RESULTS:Mean spherical equivalent refraction was -1.7±1.7 D in right eyes and -1.9±2.0 D in left eyes (P=0.20). Baseline choroidal thickness was greater in the morning (326±71 μm) than evening (316±72 μm, P=0.006). No significant changes occurred after 60 min for either full field or peripheral-field in the morning or evening (P>0.05 for all). CONCLUSION:One-hour exposure to full-field or peripheral myopic defocus did not alter choroidal thickness, irrespective of time of day, in young adults with a range of refractive errors. Studies in children, particularly with longer durations of imposed defocus, are needed to determine whether short-term structural responses may serve as clinically meaningful biomarkers.
OBJECTIVES:To assess the incidence of ulcerative keratitis (UK) in the United States between 2017 and 2024 and determine the risk of ulcerative keratitis development in patients with and without diabetes mellitus (DM). METHODS:The TriNetX analysis platform was used to retrospectively analyze data from US health care organizations and run analyses to calculate incidence rates of UK. Subsequently, patients with and without DM were identified to determine risk of UK development after propensity score matching for baseline demographic characteristics. RESULTS:The incidence rate of ulcerative keratitis fluctuated between 2017 to 2024, increasing to 30.06 cases per 100,000 person-years in 2024. Patients with DM exhibited increased risk of UK compared with those with no DM within one year of follow-up (RR, 1.601; 95% CI, 1.239-2.069). Among patients diagnosed with DM, those who had recorded hemoglobin A1c values greater than 8% exhibited increased risk of UK development compared with patients with hemoglobin A1c levels below 8% (RR, 1.14; 95% CI, 1.058-1.228). CONCLUSIONS:UK incidence was found to increase to a high of 30.06 cases per 100,000 person-years in 2024. Increased risk of UK was also found with DM, particularly at hemoglobin A1c levels above 8%, underscoring how pathophysiological mechanisms underlying DM can negatively affect corneal health.
ABSTRACT:This study aimed to investigate the longitudinal changes in corneal epithelial and stromal thicknesses in eyes with very asymmetric ectasia that appeared clinically and topographically normal at baseline. Fourteen eyes from 14 patients underwent serial evaluation using corneal topography, corneal tomography, and corneal biomechanical assessment. Based on baseline tomographic and biomechanical parameters, eyes were classified into two groups. Over a mean follow-up of 54 months, eyes with normal baseline parameters showed minimal changes in stromal thickness, whereas a subset of eyes with abnormal baseline indices demonstrated measurable stromal thinning exceeding physiological variability. By contrast, epithelial thickness changes were small and inconsistent across all patients. These findings indicate that eyes with very asymmetric ectasia represent a heterogeneous population and that the longitudinal assessment of corneal layer-specific changes may provide additional insights beyond that derived from cross-sectional evaluation alone.
OBJECTIVES:To assess age-specific effectiveness of dual-focus soft contact lenses (MiSight) and orthokeratology (Ortho-K) in slowing myopia progression over 18 months in pediatric patients, emphasizing axial length (AL) changes. METHODS:Retrospective analysis of 239 eyes from 123 myopic pediatric patients (aged 8-18 years) (MiSight: 137 eyes; Ortho-K: 102 eyes), stratified by age (younger: ≤10 vs. older: >10 years). Primary outcome was AL elongation measured by IOL Master. Secondary outcomes included spherical equivalent (SE), keratometry, and cylinder power (CYL) through autorefraction. Orthokeratology measurements were taken during treatment without washout, limiting direct refractive comparisons. Linear mixed models were used for intragroup changes, and general linear model adjustment was applied for baseline imbalances in AL and CYL. RESULTS:Despite significant baseline imbalances (MiSight group had longer AL and more myopic SE), GLM-adjusted analysis showed modestly lower overall annualized AL elongation with MiSight (0.20 mm/year) compared with Ortho-K (0.24 mm/year). In older children (older than 10 years), MiSight was associated with lower AL progression, particularly between 6 to 12 months (0.07 vs. 0.11 mm/6-months, P =0.012). In younger children (10 years and younger), adjusted AL elongation rates were comparable between groups. MiSight maintained relatively stable refractive parameters, while Ortho-K induced corneal flattening but progressive worsening of CYL. CONCLUSIONS:This age-stratified retrospective comparison demonstrated modestly lower axial elongation with MiSight after adjustment for baseline differences, particularly in older children (older than 10 years). These findings suggest potential age-dependent differences in treatment response between the two modalities and highlight the importance of individualized myopia management strategies.
OBJECTIVE:To investigate the association between treatment zone decentration and axial length elongation in myopic children during 2-year orthokeratology (Ortho-K) treatment. METHOD:This retrospective study analyzed clinical data from myopic children who underwent Ortho-K treatment. The magnitudes and direction of Ortho-K treatment zone decentration were recorded along with axial length measurement at baseline and 2-year follow-up. Right eye data were collected for statistical analysis. RESULTS:Sixty subjects were enrolled and divided into three groups according to the distance of treatment zone decentration: 12 eyes in the mild (<0.5 mm), 30 eyes in the moderate (0.5-1.0 mm), and 18 eyes in the severe decentration group (>1.0 mm). Axial length elongation was significantly slower in both severe (0.28 ± 0.21 mm) and moderate decentration group (0.36 ± 0.20 mm) compared with that of the mild decentration group (0.55 ± 0.24 mm) at 2-year follow-up ( P < 0.05). Multivariate regression analysis showed that magnitudes of Ortho-K treatment zone decentration were associated with the axial length elongation ( P = 0.013). CONCLUSION:Greater treatment zone decentration was associated with less axial length elongation. Moderate Ortho-K treatment zone decentration should be optimal choice for safety and efficiency of myopia control in myopic children.
ABSTRACT:Mitomycin intravascular chemoembolization (MICE) is a potential treatment for corneal neovascularization (NV) with encouraging early outcomes. We describe a case of focal corneal perforation occurring two years after MICE. A 65-year-old man with a history of penetrating keratoplasty performed 30 years earlier underwent MICE for treatment of corneal NV. Two years later, he presented with acute visual decline in the left eye. At presentation, the visual acuity was 20/200 improving to 20/50 with pinhole in the right eye and counting fingers improving to 20/400 in the left eye. Examination revealed a pinpoint Seidel-positive corneal perforation near the graft-host junction, occurring at the same site previously treated with MICE and adjacent to an area of prior corneal NV and lipid deposition. No trauma, infection, or autoimmune disease was identified. After three attempts of corneal gluing failed, a therapeutic corneal patch graft was performed. Postoperatively, the patient was treated with topical moxifloxacin four times daily and topical prednisolone acetate four times daily. The pinhole visual acuity improved to 20/250 with the pinhole. The anterior chamber remained formed and quiet. Although causality cannot be established, this case raises the possibility of delayed stromal weakening after MICE in a structurally vulnerable cornea and highlights the importance of long-term surveillance following this procedure.
PURPOSE:To determine orthokeratology (ortho-k) lens decentration and its relationships with annual axial length (AL) changes in children treated with ortho-k. METHODS:This retrospective study included children aged 9 to 15 years treated with ortho-k for at least 1 year. Lens decentration was measured using Pentacam based on the relative positions of the corneal thinnest point, pupil center, and visual center. Annual AL change was analyzed using regression models adjusted for age and target power. RESULTS:In total, 71 eyes from 37 patients (mean age, 10.9 years) were included in the final analysis. The mean follow-up time was 35.0 months. The mean annual AL change was 0.11 mm. According to the customized formula based on the pupil or visual center, greater horizontal and vertical vectors and a larger total distance of decentration were associated with less annual AL change. CONCLUSION:Greater temporal and inferior vectors, as well as a larger total distance of decentration, are associated with greater myopia control efficacy. These findings will help to facilitate the prescription and future design of ortho-k lenses to improve myopia control efficacy.
Abstract: To report the second case report in the literature of early-onset endophthalmitis caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) after penetrating keratoplasty (PK). The associated diagnostic and therapeutic challenges are highlighted, and the precautions that can be applied are emphasized. A 69-year-old woman with bullous keratopathy underwent elective PK. Within 24 hr postoperatively, stromal infiltration and partial separation at the superior quadrant of the graft and anterior chamber reaction were observed. Urgent rekeratoplasty was performed, and microbiologic culture of the donor tissue revealed extensively drug-resistant CRKP resistant to multiple antibiotics. Despite rapid surgical revision and intensive antimicrobial therapy (topical, intrastromal, intravitreal, and systemic), the infection progressed to orbital cellulitis and systemic involvement, ultimately requiring evisceration. Carbapenem-resistant Klebsiella pneumoniae was also isolated from the excised globe. Donor-derived contamination was strongly suspected because of the early clinical course but could not be confirmed microbiologically because the donor margin tissue was not preserved. Furthermore, retrospective medical data review of the donor did not reveal any similar microorganism and clinical follow-up of PK from the other corneal partner showed no infection. This case constitutes the second documented instance of CRKP-related endophthalmitis after PK in the literature. It emphasizes the importance of donor screening, continuous monitoring of the storage environment, preservation of donor margin tissue, and vigilant monitoring for systemic dissemination and severe postoperative complications.
PURPOSE:To investigate 6-month changes in accommodation and vergence in juvenile myopes wearing multifocal soft contact lenses (MFSCLs) versus single-vision spectacles (SVLs). METHODS:A prospective, matched cohort study was conducted involving 49 myopic children aged 8 to 14 years. Participants were divided into two groups: those fitted with MFSCLs (n=26) and those with SVLs (n=23). Measurements of accommodation (e.g., lag, microfluctuations, facility, relative accommodation) and vergence (e.g., phoria, vergence range, accommodative convergence/accommodation [AC/A] ratio) were taken at baseline, 1, and 6 month. RESULTS:Multifocal soft contact lenses significantly reduced accommodative lag (F=13.75) and increased microfluctuations (F=30.93; both P <0.001) compared with SVLs throughout the study. Initial exophoric shift and decreased AC/A ratio at baseline (both P <0.001) were transient and not sustained at 1- or 6-month follow-ups. Over 6 months, the MFSCLs showed significant changes in accommodative lag, amplitude, facility, phoria, and AC/A ratio (all P <0.05). Notably, accommodative lag, phoria, and AC/A ratio changed from baseline to 1 month, then stabilized with continued wear. CONCLUSIONS:These findings demonstrate rapid binocular adaptation to MFSCL in juvenile myopes, with key parameters stabilizing within the first month despite sustained effects on accommodative lag and microfluctuations over 6 months. TRIAL REGISTRATION:Chinese Clinical Trial Registry: ChiCTR-OOC-17012103. Registered July 23, 2017, http://www.chictr.org.cn/showproj.aspx?proj=20622 .
ABSTRACT:We report a case highlighting the potential of topical ascorbic acid (AA) as an adjunctive strategy for supporting corneal endothelial stability in Fuchs endothelial corneal dystrophy (FECD) after complicated cataract surgery. A 74-year-old man with bilateral FECD presented with progressive vision loss. Baseline endothelial cell density (ECD) was 1,996 cells/mm2 in the right eye and 1,988 cells/mm2 in the left eye. After 15 months of AA treatment, ECD increased to 3,079 and 3,008 cells/mm2, respectively. The left eye underwent uncomplicated cataract surgery with minimal ECD loss (9.61%). The right eye suffered posterior capsule rupture requiring vitrectomy, causing a 67.08% ECD loss (to 1,036 cells/mm2) and corneal edema. With continued AA treatment for 64 months, the ECD in the right eye improved to 2,080 cells/mm2. Corneal clarity and stability were also clinically improved. This case suggests that topical AA may improve endothelial stability in FECD eyes, even after complicated surgeries. The intrapatient comparison provides observational support for a potential association between topical AA use and endothelial stability.
OBJECTIVE:This study aimed to develop supervised machine learning (ML) models to predict ocular sagittal height (OC-SAG), using anterior eye data derived from topography and tomography. METHOD:ology: A retrospective cohort of 100 eyes provided data such as keratometry, eccentricity, white-to-white distance, and corneoscleral junction (CSJ) metrics through anterior segment optical coherence tomography (CASIA 2). Four supervised ML models were developed to predict OC-SAG at 10 mm and 14 mm chord lengths, using either topographical data alone or both topographical and tomographical data. RESULTS:The model with the strongest predictive accuracy for the validation sample was the Random Forest, both for the 10-mm chord (r=0.88; MAE=28.16±26.81 μm) and the 14-mm chord (r=0.77; MAE=73.56±61.31 μm; flat corneal meridian, topography-based model). The inclusion of tomographic data, such as measurements related to the CSJ, did not significantly improve the performance of the models compared with using topographic data alone. CONCLUSIONS:Adding tomographic predictors did not significantly improve model performance. Despite reduced performance for longer chords, the observed error could be considered clinically acceptable for soft contact lens fitting. The study demonstrated the potential of ML in predicting OC-SAG, providing an accessible estimation method for all clinicians to support decision-making.
OBJECTIVE:The purpose of this study was to report the efficacy of prism-incorporated impression-based scleral lenses (pibSL) in the management of binocular diplopia. METHODS:This case series includes seven patients with various etiologies of binocular diplopia, including congenital and acquired conditions, that were managed with pibSLs. Of the seven patients, two had corneal irregularity. Visual acuity (VA), diplopia resolution, and subjective patient reports on comfort and cosmetics were assessed. Wavefront-guided (wfg) optics were incorporated in select cases where poor visual quality was reported. RESULTS:All patients experienced resolution of diplopia with VA improving to 20/20 or better with pibSLs. Wfg optics reduced residual higher-order aberrations, resulting in subjective improvement in vision quality and balanced VA. Patients reported high levels of satisfaction with pibSL. CONCLUSIONS:PibSLs are an effective, well-tolerated alternative to traditional prism spectacles for managing binocular diplopia and can address multiple comorbidities. The addition of wfg optics further improved visual quality in patients with complex visual needs.
