Acute invasive fungal rhinosinusitis (AIFRS) is a fulminant angioinvasive infection that primarily affects immunocompromised patients and carries substantial morbidity and mortality. Orbital involvement presents particular diagnostic and therapeutic challenges and remains an area of controversy. This review summarizes current concepts in the classification, microbiology, diagnosis, and management of AIFRS, with emphasis on orbital involvement, termed acute invasive fungal rhino-orbital sinusitis (AIFROS). Early recognition, urgent imaging, histopathologic diagnosis, systemic antifungal therapy, debridement of necrotic tissue, and reversal of underlying immunosuppression remain the cornerstones of treating AIFRS. In contrast, management of AIFROS remains less standardized; globe-sparing approaches are increasingly employed in selected patients, as the literature has not demonstrated a clear survival benefit from orbital exenteration.
Purpose:To evaluate the visual and refractive outcomes in patients who underwent bilateral refractive lens exchange (RLE) with the trifocal hydrophobic FineVision HP IOL. Methods:This prospective, single-center, non-comparative study enrolled 70 eyes of 35 patients implanted bilaterally with the FineVision HP IOL (Beaver-Visitec International, Inc. USA). Postoperative outcomes at 3 months included manifest refraction, monocular and binocular logMAR uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected intermediate visual acuity (DCIVA, at 60 cm), and distance-corrected near visual acuity (DCNVA, at 40 cm). The binocular defocus curve was also registered. Results:94.29% of eyes showed a spherical equivalent within ±0.50D and all within ±1.00D. 95.71% of eyes showed a refractive cylinder of ≤0.50D and all ≤1.00D. The mean spherical equivalent and refractive cylinder were 0.16 ± 0.27D and -0.18 ± 0.21D, respectively. Mean binocular CDVA, DCIVA and DCNVA were -0.12 ± 0.06, 0.15 ± 0.07 and 0.03 ± 0.05 logMAR, respectively. 88.57% and 100% of patients achieved a cumulative binocular CDVA of ≥20/16 and ≥20/20, respectively. Furthermore, 51.43% and 91.43% patients achieved a cumulative binocular DCIVA of ≥20/25 and ≥20/32, respectively; and 71.43% and 100% of patients achieved a cumulative binocular DCNVA of ≥20/20 and ≥20/25, respectively. The safety and efficacy indexes were 1.07 and 1.01, respectively. The defocus curve showed a peak of maximum visual acuity, better than 20/16, at distance, with a continuous smooth reduction in visual acuity for intermediate distances, followed by a secondary peak close to 20/20 at near. Conclusions:The FineVision HP IOL demonstrated favorable short-term refractive accuracy and visual performance in this prospective cohort, although larger comparative studies with longer follow-up are warranted.
Purpose:Implantable Collamer Lens (ICL) surgery is mostly performed in patients aged 20-40, with current minimum anterior chamber depth (ACD) eligibility of approximately 2.8-3.0 mm. A shallow chamber carries two distinct long-term risks: corneal endothelial cell loss, determined principally by the endothelium-to-implant distance, and angle closure, determined by progressive anterior segment crowding. This static criterion accounts for neither of the two dynamic factors that reduce effective ACD over decades: age-related crystalline lens thickening, and vault-related anterior displacement of the implant. We propose age-stratified ACD values, anchored to the empirical 2.4 mm threshold for primary angle closure in East Asians, as risk-stratification factors. Methods:We conducted a structured narrative review of ACD and primary angle-closure disease in East Asians including Japanese data; age-related anterior segment biometry; vault dynamics; and long-term ICL outcomes, integrated into a quantitative model presented as a conservative estimate rather than a definitive predictor. Results:The 2.4 mm threshold is confirmed in East Asian populations and consistent with Japanese population-based biometry. ACD shallows at approximately 0.011-0.012 mm/year; vault contributes a further functional reduction of approximately 0.25-0.40 mm. A patient implanted at age 20 with an initial ACD of 2.8 mm may approach 2.0 mm by age 60. Age-stratified minimum values of 3.2, 3.1 and 3.0 mm for the third, fourth and fifth decades preserve a margin above 2.4 mm; sensitivity analysis across lens-extraction ages of 45-60 years yields 3.0-3.2 mm. Independently, ten-year data in eyes with ACD below 2.8 mm show endothelial loss at approximately twice the physiological rate. Conclusion:Current criteria reflect the eye's status at a single time point. We suggest age-stratified ACD values be used as risk-stratification factors alongside gonioscopy and anterior segment imaging, not as standalone exclusion criteria, in parallel with established corneal refractive surgery criteria. Long-term validation is warranted.
Muneeba Iqbal,1 Abdullah Iftikhar21Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan; 2Department of Extra Curriculars, Alpha College, Karachi, Sindh, PakistanCorrespondence: Muneeba Iqbal, Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Sindh, Pakistan, Email muneebaiqbal1@gmail.com
Kenan Calisir,1,2 Mohamed Salad Kadiye11Mogadishu Somalia Turkey Training and Research Hospital, Department of Ophthalmology, Mogadishu, Somalia; 2Antalya Serik State Hospital, Department of Ophthalmology, Antalya, TurkeyCorrespondence: Kenan Calisir, Mogadishu Somalia Turkey Training and Research Hospital, Department of Ophthalmology, Mogadishu, Somalia, Tel +90 544 582 84 42, Email calisirknn@gmail.comPurpose: To describe the patterns and causes of adult blindness in patients attending a tertiary ophthalmic center in Somalia, to examine age- and gender-related associations with major causes of blindness, and to assess the contribution of trauma-related visual loss.Methods: A retrospective cross-sectional study was conducted using medical records of all eligible patients aged 16 years and older evaluated at a tertiary ophthalmic center in Mogadishu, Somalia, between January and December 2025. Demographic characteristics, blindness laterality, and clinical causes were extracted from electronic medical records jointly by the two investigators and recorded in a Microsoft Excel spreadsheet. Descriptive analyses and multivariable logistic regression were performed to evaluate the distribution of blindness and age- and gender-related associations with major causes of blindness.Results: Of 10,000 patient records screened, 9740 met the eligibility criteria and were included in the analysis. Among these, blindness was identified in 1236 patients (12.7%), of whom 77.9% had unilateral blindness and 22.1% had bilateral blindness. Cataract was the leading cause of blindness overall, followed by trauma-related ocular disease, glaucoma, and corneal opacity. Trauma-related conditions predominated among younger adults, whereas cataract and glaucoma were more common in older age groups. Corneal opacity related to microbial keratitis or undetermined corneal scarring remained among the leading causes of unilateral blindness across age groups.Conclusions: Adult blindness in this hospital-based population reflected distinct age-related patterns, with trauma-related visual loss predominating among younger adults and age-related ocular diseases among older individuals. Corneal opacity remained an important cause of unilateral blindness across age groups. These findings have important implications for ophthalmic care in resource-limited settings.Keywords: blindness, age-related cataract, traumatic cataract, corneal opacity, Somalia
Xian Wu,1,2 Hongbo Luo,1 Huanping Chen,1,3 Rui Luo1,31Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China; 2The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, People’s Republic of China; 3Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Provincial People’s Hospital), Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Hongbo Luo, Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, People’s Republic of China, Email luohongbo1213@163.comBackground: Corneal biomechanical measurements influence the interpretation of intraocular pressure and may also capture aspects of ocular-wall susceptibility that are not represented by central corneal thickness alone. Their diagnostic and prognostic relevance in glaucoma has therefore attracted increasing attention.Methods: A structured narrative search of PubMed/MEDLINE was performed from database inception through July 25, 2026, using combinations of terms related to glaucoma, ocular hypertension, corneal biomechanics, corneal hysteresis, the Ocular Response Analyzer, Corvis ST, dynamic Scheimpflug imaging, and emerging elastographic techniques. Reference lists of eligible publications and key reviews were also screened. Peer-reviewed clinical studies, systematic reviews, meta-analyses, authoritative reports, and selected foundational experimental studies were considered.Review Findings: The Ocular Response Analyzer and Corvis ST provide device-specific measurements that are not directly interchangeable. Lower corneal hysteresis is consistently associated with glaucoma and with faster structural or functional progression, whereas the diagnostic performance of Corvis ST-derived parameters is more heterogeneous and varies by glaucoma subtype, intraocular pressure, central corneal thickness, axial length, and treatment exposure. Unlike previous broad overviews, this review explicitly separates diagnostic from prognostic evidence, contrasts findings across glaucoma phenotypes and devices, and examines the effect of major confounders. Brillouin microscopy and optical coherence elastography may eventually provide spatially resolved tissue measurements, but neither has been validated for routine glaucoma management.Conclusion: Corneal biomechanical measurements should currently be regarded as complementary biomarkers rather than stand-alone diagnostic endpoints in glaucoma. Future progress will depend on standardized acquisition and reporting, subtype-specific prospective validation, and multimodal integration with structural and functional glaucoma assessments.Keywords: Corneal biomechanics, corneal hysteresis, ocular response analyzer, Corvis ST, glaucoma progression, ocular hypertension, risk stratification
Anup Subedi,1,* Roshni Malla,1,* Mario Cantó-Cerdán,2 Santosh Chhetri,3 Samriddhi Lamsal,1 Ravin Kumar Mishra,1 Umesh Belbase1,41Department of Optometry, Himalaya Eye Hospital, Pokhara University, Pokhara, Nepal; 2Department of Optometry, Vissum Grupo Miranza, Alicante, Spain; 3Department of Optometry, Lumbini Eye Institute and Research Center, Bhairahawa, Nepal; 4University of Houston College of Optometry, Houston, TX, USA*These authors contributed equally to this workCorrespondence: Anup Subedi, Department of Optometry, Himalaya Eye Hospital, Pokhara University, Pokhara, Nepal, Email anup.subedi10@gmail.comBackground: Population-specific reference values for Hertel exophthalmometry are limited in South Asian populations, including Nepal. This limits clinical interpretation of ocular protrusion in routine practice. This study aimed to establish hospital-based reference values for exophthalmometry, evaluate intra-session measurement repeatability, and examine demographic and anthropometric associations.Methods: Participants aged 6– 85 years attending the outpatient department were enrolled using systematic sampling, with every fifth eligible attendee selected. Because recruitment was conducted within a tertiary eye hospital rather than through population-based sampling, the study was designed to provide hospital-based reference data rather than nationally representative estimates. Hertel exophthalmometry was performed by a single examiner with three repeated measurements per eye. Intra-session repeatability was assessed using intraclass correlation coefficient (ICC) and coefficient of variation. Group comparisons were performed using non-parametric tests, and multivariable linear regression identified independent correlates of right eye exophthalmometry value (EV).Results: This study provides the first hospital-based reference data for exophthalmometry in a Nepali clinical population with excellent intra-session repeatability. Provisional upper reference limits are 17.42 mm (95th percentile) and 18.31 mm (mean plus 2SD). Inter-eye difference (IED) values exceeding 1.50 mm were uncommon in this sample (one participant, 0.2%). These findings are descriptive only; diagnostic thresholds for clinically significant asymmetry cannot be established from this study and require population-based investigations. Hertel base value (BV), age, ethnolinguistic ancestry, and geographical region were the independent associated with EV.Conclusion: This study provides hospital-based reference values for Hertel exophthalmometry in a Nepali population. Mean EV was approximately 13.5 mm, with a 95th percentile upper limit of 17.42 mm. Measurement repeatability was excellent. EV was independently associated with age, Hertel base value, and demographic grouping variables, although clinical interpretation should consider the methodological limitations of hospital-based sampling. These findings may assist clinicians in interpreting exophthalmometry in Nepal; however, population-based studies are needed to establish definitive normative ranges.Keywords: exophthalmometry, Hertel, reference values, Nepal, ocular protrusion, repeatability
Purpose:To obtain preliminary data on the tolerability and ocular surface outcomes of liposomal ozonated oil compared with standard prophylaxis in cataract surgery. Patients and Methods:This open-label, prospective, contralateral-eye controlled pilot study included 60 eyes from 33 adult patients undergoing bilateral cataract surgery. For each patient, one eye was treated with liposomal ozonated oil (one drop, four times daily) from 3 days before surgery until 21 days postoperatively, while the contralateral eye received standard treatment. The study outcomes included treatment tolerability, postoperative infectious complications, ocular signs and symptoms, Tear Break-Up Time (TBUT), Ocular Surface Disease Index (OSDI), visual acuity, anterior chamber reaction (Tyndall effect), and patient-reported discomfort. Assessments were performed at postoperative day 21, with exploratory follow-up evaluations at month 3. Results:No postoperative infectious complications were observed in either treatment group. No significant between-group differences were observed in most evaluated ocular surface parameters at postoperative day 21 and month 3. At postoperative day 21, fewer patients in the liposomal ozonated oil group reported foreign body sensation and a higher proportion had TBUT > 10 seconds, although these differences were not statistically significant. At month 3, foreign body sensation was reported more frequently in the liposomal ozonated oil group, whereas no other significant between-group differences were observed. The majority of patients showed no anterior chamber reaction at postoperative day 21 (96.67%), and all patients reported good tolerability and no discomfort. Conclusion:Liposomal ozonated oil was well tolerated and showed comparable clinical outcomes to standard prophylaxis following cataract surgery. The findings of this pilot study suggest potential benefits for ocular surface outcomes that warrant confirmation in adequately powered studies with larger sample sizes and longer follow-up. No infectious complications occurred in either treatment group; however, the absence of events and the limited sample size preclude conclusions regarding its potential role in infection prevention. Clinical Trial Registration:The study was registered in the Spanish Registry for Post-Marketing Clinical Investigations with Medical Devices (NEOPS; Spanish Agency of Medicines and Medical Devices, AEMPS) under registration code 22-0061.e (September 6, 2022).
Background:This study investigated the correlation between quantitative contrast sensitivity function (qCSF) and spherical equivalent (SE) under uncorrected and corrected conditions in children with ametropia. Methods:All participants completed comprehensive ophthalmic evaluations, including manifest refraction and qCSF testing performed under uncorrected and corrected visual acuity conditions. The qCSF parameters included the area under the log contrast sensitivity function (AULCSF), contrast sensitivity function acuity, and contrast sensitivity at spatial frequencies of 1.0-18.0 cycles per degree (cpd). The analysis was stratified by age and SE. Results:A total of 114 eyes from 57 children (29 boys and 28 girls; mean age: 8.56 ± 2.09 years) were included. The mean SE was -0.60 ± 1.04 D (range: -3.125 to +3 D). In children with myopia, the qCSF results were significantly better after refraction correction than those under uncorrected visual acuity and increased linearly with the degree of myopia, whereas in children with hyperopia, the qCSF parameters before and after refraction correction did not differ significantly. Generalized linear modeling identified SE was the strongest independent predictor of uncorrected qCSF performance, whereas age showed minimal influence. The differences in qCSF parameters before and after refractive correction were correlated with the SE. Conclusions:In children without myopia, uncorrected qCSF closely matched the corrected results supporting its use for screening, whereas in children with myopia, the difference between uncorrected and corrected qCSF increased linearly with the degree of myopia. These findings demonstrate the importance of early optical correction and integrating contrast sensitivity assessment into pediatric eye-health evaluations.
Purpose:This study aimed to report the feasibility and short-term clinical outcomes of a novel technique for one-piece intraocular lens (IOL) fixation using double-threaded 30-gauge needles and flanged polypropylene sutures. Patients and Methods:Forty eyes of 38 consecutive patients with subluxated crystalline lenses, dislocated IOLs, or aphakia were included. Two 30-gauge needles pre-threaded with 7-0 polypropylene sutures were inserted 2.4 mm posterior to the limbus horizontally toward the center of the globe. After the suture loops were externalized, a preset one-piece IOL was inserted into the anterior chamber. Both haptics were then externalized, tied with a 2-1-1 knot, and reinserted. The sutures were pulled to center the IOL, cut, cauterized to form flanges, and buried in the sclera. Results:Uncorrected visual acuity improved from 1.25 ± 0.55 logMAR preoperatively to 0.81 ± 0.52 logMAR at 3 months postoperatively. Best-corrected visual acuity changed from 0.72 ± 0.66 to 0.39 ± 0.48 logMAR. The mean refractive difference was 0.25 ± 0.67 D. The mean IOL decentration and tilt were 0.34 ± 0.20 mm and 7.25° ± 3.4°, respectively. Flange erosion was observed in four eyes (10.0%), retinal detachment in one eye (2.5%), and cystoid macular edema in one eye (2.5%). No postoperative IOL dislocation or clinical signs suggestive of iris chafing were seen during follow-up. Conclusion:In this short-term series, the technique allowed fixation of a one-piece IOL with acceptable centration and no postoperative IOL dislocation. The technique may be an option when three-piece IOLs are unavailable or when preservation of an existing one-piece IOL is desirable.
Oliver Hassel,1 Mustafa Kamal Hallak,2 Maximilian K Köppe,1 Ramin Khoramnia,3 Gerd U Auffarth11Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany; 2Department of Ophthalmology, University Medical Centre Mannheim, Mannheim, Germany; 3Department of Ophthalmology, University Hospital Carl Gustav Carus, Dresden, GermanyCorrespondence: Oliver Hassel, International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, Ruprecht-Karls-University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg, 69120, Germany, Email Oliver.Hassel@med.uni-heidelberg.dePurpose: To evaluate 12-month visual and clinical outcomes after implantation of a monofocal aspheric hydrophobic acrylic intraocular lens (IOL) delivered with a preloaded system.Methods: This investigator-initiated, prospective, single-center, uncontrolled feasibility study enrolled 30 patients undergoing unilateral or bilateral cataract surgery with implantation of the OPTIFLEX GENESIS COMFORT NY IOL. Twenty patients contributed 22 operative eyes to the per-treatment evaluable analysis at 12 months. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), manifest refraction, contrast sensitivity, and intraocular pressure (IOP) were assessed postoperatively. Posterior capsule opacification (PCO), clinically detectable IOL tilt, decentration, discoloration, and higher-order aberrations were evaluated during follow-up.Results: Mean preoperative UDVA and CDVA were 0.64 ± 0.33 and 0.30 ± 0.23 logMAR, respectively. Mean UDVA improved to 0.12 ± 0.16 logMAR at 3 months and 0.19 ± 0.16 logMAR at 12 months. Mean CDVA improved to − 0.01 ± 0.10 logMAR at 3 months and 0.01 ± 0.09 logMAR at 12 months. IOP remained stable, and no statistically significant change in spherical equivalent refraction was observed, although a numerical hyperopic trend was noted. At 12 months, PCO was absent in 15 eyes and minimal in 7 eyes. No clinically detectable IOL tilt, decentration, or discoloration was recorded. Contrast sensitivity was generally within or close to age-matched reference ranges.Conclusion: In this uncontrolled prospective feasibility cohort, implantation of the investigated monofocal aspheric hydrophobic acrylic IOL was associated with improved distance visual acuity and stable IOP through 12 months. The findings provide preliminary device-specific clinical data and should be confirmed in larger controlled studies with longer follow-up.Keywords: intraocular lens, hydrophobic, aspheric, preloaded delivery system
P Dee Stephenson,1 Cynthia Matossian21Stephenson Eye Associates, Venice, FL, USA; 2CM Associates, LLC, New Hope, PA, USACorrespondence: P Dee Stephenson, Stephenson Eye Associates, 200 Palermo Place, Venice, FL, 34285, USA, Tel +1 9414851121, Email Eyedoctordee@gmail.comPurpose: To evaluate the effect of varenicline nasal spray (VNS) 0.03 mg on the signs and symptoms of dry eye disease (DED) and tear film stability.Patients and Methods: In this prospective, placebo-controlled study, 50 DED subjects were randomized to receive either VNS 0.03 mg nasal spray or its vehicle twice daily for 28 days. Study parameters included dry eye questionnaire score (DEQS), eye dryness score (EDS), corneal (CFS) and conjunctival fluorescein staining, non-invasive tear break-up time (TBUT), surface asymmetry index (SAI), and surface regularity index (SRI).Results: Post treatment, the improvement in mean symptom scores, including DEQS (23% vs 12%, p=0.022) and EDS (44% vs 27%, p = 0.012), was significantly higher in the VNS group compared to the vehicle group. The mean CFS and conjunctival staining scores also showed significantly higher improvement (~50% vs ~20%, p< 0.001) in the VNS group compared to the vehicle. The mean change in non-invasive TBUT was higher in the VNS group (70% vs 30%, p = 0.680). The mean improvement in SAI and SRI were comparable between the two groups. There were no serious adverse events in either group.Conclusion: There was a statistically significant improvement in the symptoms and signs of DED in the VNS group. These results indicate that improving natural tear production using VNS nasal spray can help foster tear film stability and ocular homeostasis over time.ClinicalTrials.Gov Identifier: NCT05514041.Keywords: dry eye disease, varenicline nasal spray, tear film stability, VNS
Dania Mohammed Jamal,1 Doaa Sofyan Milibari,1,2 Muhammad Ali Ahad11Anterior Segment Division, King Khaled Eye Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; 2Eye Center, King Abdullah Medical City, Makkah, Saudi ArabiaCorrespondence: Muhammad Ali Ahad, Anterior Segment Division, King Khaled Eye Specialist Hospital & Research Centre, Riyadh, 11462, Saudi Arabia, Tel +966532349429, Email mahad@kkesh.med.saBackground: Delayed epithelialization is a common complication after keratoplasty that can compromise graft survival and increase the economic burden.Purpose: To identify donor and recipient factors linked to extended epithelial healing time in eyes with delayed epithelialization after routine penetrating and lamellar keratoplasty.Methods: This retrospective cohort study included eyes undergoing penetrating or lamellar keratoplasty that developed delayed epithelialization, defined as complete epithelial closure occurring ≥ 8 days postoperatively. Recipient, donor, surgical, and postoperative variables were analyzed. Multivariable linear regression was used to quantify the effect of predictors on epithelial healing time (days). Time to epithelial closure was additionally analyzed using Kaplan–Meier estimates and Cox proportional hazards regression. A cumulative risk-factor burden model was constructed based on independent predictors.Results: A total of 146 eyes were included. In multivariable analysis, three independent predictors of prolonged epithelial healing were identified: recipient vernal keratoconjunctivitis (VKC) (β = +9.51 days, p < 0.001), female donor sex (β = +2.13 days, p = 0.030), and donor history of chemotherapy or radiotherapy (β = +3.28 days, p = 0.013). Cox regression confirmed slower epithelial healing associated with VKC (HR 0.38), female donor sex (HR 0.65), and donor chemotherapy/radiotherapy exposure (HR 0.64). Kaplan–Meier analysis demonstrated progressively delayed epithelial closure with increasing risk-factor burden (log-rank p < 0.001), with median healing times of approximately 10, 12, and 16 days for patients with 0, 1, and ≥ 2 risk factors, respectively.Conclusion: VKC, female donor sex, and donor history of chemotherapy or radiotherapy were independently associated with prolonged epithelial healing time in this single-center cohort of eyes that already exhibited delayed epithelialization after routine keratoplasty. The cumulative risk-factor burden model showed a stepwise association with slower epithelial closure; however, these findings are exploratory and require prospective external validation before integration into donor allocation strategies or routine clinical protocols.Keywords: keratoplasty, corneal transplantation, epithelialization, persistent epithelial defect, vernal keratoconjunctivitis, donor factors
Ocular neuropathic pain is typically treated with local anti-inflammatory and neuroregenerative agents, and psychological approaches such as cognitive behavioral treatment, as well as systemic pharmacological medications and nerve blocks. In recalcitrant cases, neurostimulation or neuromodulation may be considered. In this review, we evaluate the existing literature for the use of non-invasive forms of neurostimulation: home-based extra nasal neurostimulation (iTear100), extracranial direct current stimulation (tDCs), transcutaneous electrical nerve stimulation (TENs) and transcranial magnetic stimulation therapy (TMS). We compared the mechanism of action of these therapies and clinical studies of their effectiveness. Although most of the published literature is based on general neuropathic pain and often combinatorial treatment, we compared the pros and cons of using such modalities for ocular neuropathic pain, including effectiveness, potential side effects, convenience and other factors.
Purpose:To investigate changes in contrast sensitivity (CS) and their association with Lenticule surface regularity after keratorefractive lenticule extraction (KLEx) performed with the VisuMax 800. Patients and Methods:In total, 92 patients (184 eyes) with myopia were recruited between November and December 2024. CS was measured using the quantitative contrast sensitivity function at 1, 3 and 6 months postoperatively. The lenticules were examined using scanning electron microscopy (SEM), and the SEM images were scored using the large language model Doubao-vision-pro 32k. Correlation analysis between Lenticule surface regularity and CS was performed based on the Generalized Estimating Equations model. Results:At 6 months postoperatively, the uncorrected distance visual acuity of all operated eyes was 20/25 or better; none of the eyes lost 1-2 lines of corrected distance visual acuity. Area under the log CS function, cutoff spatial frequency acuity and CS (3.0-18.0 cpd) significantly improved from 1 to 6 months and correlated with visual acuity and refraction (P < 0.05). Lenticule surface regularity, mainly influenced by age (β=0.204, P < 0.001) and cap thickness (β=-0.325, P < 0.001), was significantly associated with CS (3.0 cpd) at 1 and 3 months postoperatively (β=0.027, P=0.005; β=0.028, P=0.006), and with CS (6.0 cpd) at 6 months postoperatively (β=0.035, P=0.001). Conclusion:KLEx performed with the VisuMax 800 yields excellent and stable visual outcomes at six months postoperatively and postoperative CS improved over time. Lenticule surface regularity could contribute to postoperative visual quality to a certain extent.
Slit-lamp specular reflection is a valuable technique for in vivo visualization of the corneal endothelium; however, many clinicians find it difficult, largely due to an incomplete understanding of the underlying optics. This educational guide presents an explanatory optical framework based on geometric analysis to clarify the principles governing successful image acquisition. This guide presents the imaging principles and optical path diagrams of specular reflection to clarify how the endothelial mosaic is visualized. The endothelial-aqueous interface serves as the primary reflecting surface, with the aqueous humor providing the low-refractive-index medium necessary for reflection. Successful imaging requires a narrow slit beam combined with a large external angle of incidence to ensure that the endothelial reflection is not obscured by the stronger reflections from the anterior corneal surface. Additionally, corneal curvature imposes geometric constraints on beam positioning and limits the observable area, particularly in the periphery. A firm understanding of these optical fundamentals enables clinicians and trainees to master this technique more effectively.
Background:Intracranial aneurysms affect 2-3% of the population. Ophthalmological symptoms, such as ophthalmoplegia and visual field defects, can be symptoms of unruptured intracranial aneurysms. In this study, we reported the frequency of ophthalmological abnormalities and the relationship between these abnormalities and treatment and life prognosis. Methods:One hundred forty-two patients who were referred from the Kyoto University Hospital Neurosurgery Department to the Ophthalmology Department between January 2011 and October 2022 were enrolled in this study. Age, sex, aneurysm location, visual field defects, ophthalmoplegia, presence of subarachnoid hemorrhage, treatment, and death during follow-up were retrospectively investigated. Results:Of the 142 patients, internal carotid artery aneurysms were the most frequent (93 cases), followed by internal carotid-posterior communicating artery (IC-PC) aneurysms (20 cases). Cranial nerve III palsy was observed in 50% of cases with IC-PC aneurysms, and this frequency was higher compared to cases with other aneurysms (p=0.0095). Post-chiasmal visual field defects were present not only in patients with anterior circulation aneurysms (anterior communicating artery, 25%; internal carotid artery, 19%; and middle cerebral artery, 33%), but also in patients with posterior circulation aneurysms (basilar artery, 21%). Conclusions:Cranial aneurysm not only causes III palsies but also causes visual field defects. Our findings support careful ophthalmologic assessment, including visual field testing when clinically feasible, especially when aneurysms are large or near the visual pathway, regardless of the anatomical position of the originating artery.
Purpose:Shelf-stable, cryopreserved amniotic membrane (AM) has anti-inflammatory and anti-scarring properties and clinically has been shown to promote corneal epithelialization with benefits reported up to 3 months. Herein, we assessed the long-term outcomes after treatment with AM in patients with recalcitrant keratopathy. Patients and Methods:A single-center, retrospective review was performed of consecutive recalcitrant keratopathy patients that received treatment with shelf-stable cryopreserved AM and had at least 6-month outcomes. Corneal staining, corneal sensitivity, tear osmolarity, symptoms, concomitant treatments, and complications were assessed before treatment and up to last follow-up visit. Results:A total of 33 eyes of 17 subjects that had recalcitrant keratopathy despite use of prior treatment were included in the analysis. After treatment with shelf-stable AM, corneal staining score significantly improved by a mean of 1.34 ± 0.9 at 1 week (p<0.001), 1.04 ± 0.8 at 1 month (p<0.001), 1.13 ± 0.7 at 6 months (p<0.001), 1.17 ± 0.7 at 12 months (p<0.001) and 1.10 ± 0.7 at 15 months (p<0.001). The proportion of subjects with improved corneal staining compared to baseline was 81.8% at 1 week, 72.0% at 1 month, 81.5% at 6 months, 86.2% at 12 months and 90.0% at 15 months. Improvements in corneal sensitivity were also observed, while tear osmolarity remained relatively unchanged. Despite initial improvement, symptoms gradually returned over time, coinciding with increased use of concomitant topical therapies. No complications related to the AM were observed. Conclusion:Recalcitrant keratopathy patients had significantly improved corneal epithelialization within 1 week of treatment with shelf-stable cryopreserved AM, which persisted in the majority of patients for up to 15 months with concomitant topical treatment.
Petr Bulir,1,2 Pavel Studeny21Department of Ophthalmology, Regional Hospital Liberec, Liberec, Czech Republic; 2Department of Ophthalmology, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czech RepublicCorrespondence: Petr Bulir, Department of Ophthalmology, Regional Hospital Liberec, Husova 357/10, Liberec, 460 01, Czech Republic, Email bulir.peter@gmail.comPurpose: To quantify the extent of clinically non-significant Descemet membrane detachment (DMD) at the clear corneal incision (CCI) during phacoemulsification and to compare its extent between longitudinal and torsional ultrasound modulation as a morphological marker of local tissue–instrument interaction.Methods: In this prospective contralateral-eye comparative randomized study, 14 patients (28 eyes) undergoing bilateral cataract surgery were included. One eye received longitudinal and the fellow eye torsional ultrasound (Constellation system, Alcon). DMD was assessed intraoperatively using microscope video recordings under red reflex illumination. Still images were analyzed, and DMD area (mm2) at the internal wound was measured. Correlations with cumulative dissipated energy (CDE) was evaluated.Results: Incision-site DMD was detected in all analyzed cases (100%) using intraoperative red reflex–based visualization. Mean DMD area was 1.33 ± 0.43 mm2 (longitudinal) and 2.37 ± 0.67 mm2 (torsional), with a mean difference of 1.04 mm2 ± 0.74 mm2 (95% CI, 0.60– 1.48). The paired analysis demonstrated a highly significant difference (p < 0.001). No correlation was found between DMD extent and CDE.Conclusions: Clinically non-significant incision-site DMD appears to be a frequent intraoperative morphological phenomenon during phacoemulsification when assessed using sensitive visualization techniques. Torsional ultrasound was associated with a significantly greater DMD extent than longitudinal modulation. Rather than indicating greater clinical damage, DMD area may serve as a sensitive quantitative morphological marker of local tissue–instrument interaction at the corneal incision. Its potential value therefore lies primarily in the comparative evaluation and future refinement of phacoemulsification technologies, while the clinical significance of these subtle morphological differences remains to be established.Keywords: phacoemulsification, descemet membrane detachment, clear corneal incision, ultrasound modulation, torsional ultrasound, longitudinal ultrasound, corneal wound, intraoperative imaging, cataract surgery
Ziqing Ding,1– 3,* Yulian Zhou,1– 3,* Jingrong Liu,1– 3,* Zhi Chen,1– 3 Chen Zhao,1– 3 Wen Wen1– 41Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, People’s Republic of China; 2Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences, Fudan University, Shanghai, 200031, People’s Republic of China; 3Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, 200031, People’s Republic of China; 4Shanghai Key Laboratory of Gene Editing and Cell Therapy for Rare Diseases, Fudan University, Shanghai, 200031, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chen Zhao, Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, People’s Republic of China, Email dr_zhaochen@163.com; Wen Wen, Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, 200031, People’s Republic of China, Email wenweneye@126.comObjective: To evaluate the association between 6-month home-based antisuppression with binocular integration training with binocular sensory outcomes and the 2-year surgical rate in patients with intermittent exotropia (IXT).Methods: In this retrospective cohort study, patients diagnosed with IXT were included and classified into training and control groups according to their treatment history. The primary outcome was improvement in fine stereopsis (FS) at 6 months. Secondary outcomes included improvements in coarse stereopsis (CS), dynamic stereopsis (DS), peripheral suppression (PS), foveal suppression (FoS) at 6 months, and surgical rate within 2 years. Propensity score matching and inverse probability of treatment weighting were applied to balance baseline characteristics. Relative risks were estimated using univariable and multivariable log-binomial regression. Subgroup analyses were performed for the primary outcome.Results: A total of 252 patients were included. At 6 months, the training group showed significantly higher improvement rates than the control group in FS (61.54% vs 32.11%, P=0.0001), DS (49.65% vs 31.19%, P=0.0050), and CS (41.96% vs 22.94%, P=0.0025). The training group also had a significantly lower surgical rate within 2 years (8.39% vs 18.35%, P=0.0118). No significant differences were observed in PS or FoS. Subgroup analysis identified no significant interactions of FS improvements.Conclusion: Home-based antisuppression with binocular integration training was associated with improved binocular sensory outcomes and a lower 2-year surgical rate in patients with IXT. These findings suggest that this intervention may represent a potential adjunctive non-surgical treatment option.Keywords: intermittent exotropia, antisuppression training, home-based visual training, non-surgical treatment
