Background: The pachychoroid disease spectrum comprises a group of chorioretinal disorders characterized by structural and hemodynamic alterations of the choroid that may ultimately lead to dysfunction of the retinal pigment epithelium, choroidal neovascularization, and vision loss. This narrative review aims to summarize the recent advances in the understanding of pachychoroid spectrum diseases, with particular emphasis on pathophysiology, multimodal imaging, and current therapeutic approaches. Methods: Relevant English-language literature on pachychoroid spectrum disorders published up to 31 May 2026 was reviewed through PubMed/MEDLINE, supplemented by Google Scholar to identify additional relevant studies; relevant conference abstracts presented by that date and published subsequently were also included. Focus was on recent developments in disease mechanisms, imaging characteristics, clinical phenotypes, and management strategies. Search terms included “pachychoroid” and individual pachychoroid spectrum entities in combination with terms related to imaging, pathophysiology, diagnosis, and treatment. Relevant Medical Subject Headings (MeSH) terms were also used where applicable. Particular emphasis was placed on recently published studies reflecting current concepts and advances in pachychoroid disease. Earlier landmark studies with substantial scientific and historical relevance were additionally included to provide the original descriptions and foundational evidence underlying the pachychoroid spectrum. Results: The pachychoroid spectrum is increasingly recognized as a continuum of disorders associated with choroidal vascular remodeling, venous congestion, and choriocapillaris attenuation. Characteristic multimodal imaging findings include pachyvessels, choroidal hyperpermeability, intervortex venous anastomoses, and variable inner choroidal thinning, while increased choroidal thickness alone may not reliably define the pachychoroid phenotype. Pachychoroid pigment epitheliopathy may occur as an isolated manifestation or coexist with other pachychoroid entities. Central serous chorioretinopathy represents a pivotal entity within the pachychoroid spectrum and may progress toward neovascular complications, including pachychoroid neovasculopathy and polypoidal choroidal vasculopathy. Advances in multimodal imaging, particularly optical coherence tomography angiography and ultra-widefield indocyanine green angiography, have substantially improved the detection of subclinical vascular alterations and disease progression. Although anti-vascular endothelial growth factor therapy and photodynamic therapy remain central treatment approaches, emerging modalities, including no-dose photodynamic therapy and photobiomodulation, are being investigated as potential therapeutic options, but current evidence does not support their routine clinical use. Conclusions: Pachychoroid spectrum disorders share common choroidal vascular and hemodynamic abnormalities despite considerable phenotypic variability. Ongoing advances in multimodal imaging and evolving therapeutic strategies continue to refine the understanding and management of these disorders.
Background:Dry eye symptoms are common among populations exposed to prolonged stress and adverse living conditions, yet brief patient-reported symptom assessment instruments have rarely been evaluated in conflict-affected settings. This study aimed to conduct a preliminary psychometric evaluation of the Arabic Dry Eye Questionnaire-5 (DEQ-5) among internally displaced adults in the southern Gaza Strip, with an emphasis on internal consistency, internal structure, and exploratory cross-language agreement. Methods:A cross-sectional observational study was conducted in the Al-Mawasi camps among internally displaced adults using snowball sampling. Data were collected through face-to-face interviews using paper-based questionnaires. The Arabic DEQ-5 was administered to the primary study sample, while a bilingual subset completed the Arabic version first and the English version 72 hours later for an exploratory fixed-order bilingual agreement analysis. Internal consistency was evaluated using Cronbach's alpha and McDonald's omega total. Item-level analyses included corrected item-total correlations and Cronbach's alpha if item deleted. Internal structure was examined using eigenvalue decomposition, scree plot inspection, and parallel analysis. Bilingual agreement was assessed using the intraclass correlation coefficient (ICC[2,1]), quadratic weighted kappa, and Bland-Altman analysis. Results:Complete Arabic DEQ-5 responses were obtained from 234 participants. Mean (SD) total DEQ-5 score was 8.52 (3.65). Overall, 181 participants (77.4%) met the prespecified symptom-screening threshold of a DEQ-5 score ≥ 6, including 49 (20.9%) with scores ≥ 12. The Arabic DEQ-5 showed acceptable internal consistency (Cronbach's alpha = 0.73; McDonald's ωt = 0.82) and a dominant one-factor structure supported by eigenvalue decomposition, scree plots, and parallel analysis. In the fixed-order bilingual subset, total scores showed good point-estimate agreement (ICC[2,1] = 0.763), with weighted kappa values ranging from 0.364 to 0.840. Bland-Altman analysis showed minimal mean English-Arabic score bias but relatively wide limits of agreement. Conclusions:The Arabic DEQ-5 demonstrated acceptable internal consistency and supportive evidence of a dominant one-factor structure in this conflict-affected displaced population. In the bilingual subset, total scores showed good point-estimate agreement; however, variable item-level agreement and wide limits of agreement do not support individual-level interchangeability between the Arabic and English versions. These findings suggest that the Arabic DEQ-5 may serve as a practical brief instrument for assessing dry eye symptoms in humanitarian and field research settings. However, because external validation measures, clinical assessments, confirmatory psychometric analyses, and test-retest reliability were beyond the scope of this study, the findings should be interpreted as a preliminary psychometric evaluation rather than a comprehensive validation. Further multicenter psychometric validation in diverse Arabic-speaking populations, including larger bilingual samples, is warranted.
Background: Several recent clinical studies have directly compared TECNIS PureSee with lenses from the Vivity platform; however, direct comparative clinical data specifically involving AcrySof IQ Vivity remain limited. Therefore, we aimed to indirectly compare the visual and patient-reported outcomes of two non-diffractive extended depth of focus (EDOF) intraocular lenses (IOLs), AcrySof IQ Vivity and TECNIS PureSee, using data from their respective FDA premarket approval (PMA) studies. Methods: In this indirect cross-trial comparison, aggregate 6-month outcomes were compared from the FDA Summary of Safety and Effectiveness Data for the Vivity (107 implanted subjects) and PureSee (116 subjects in the intent-to-treat population; 115 in the safety population) PMA studies. The principal binocular visual-acuity threshold comparisons included 106 Vivity subjects from the All-Implanted population and 113 PureSee subjects from the Safety Population with observed 6-month data. Both were prospective, randomized, masked trials of bilateral implantation against a monofocal control from the same manufacturer. Outcomes included binocular visual acuity thresholds at distance, intermediate, and near, depth of focus at the 0.20 logarithm of the minimum angle of resolution (logMAR) threshold, mesopic contrast sensitivity, ISO 11979-7 safety endpoints, visual symptoms, and spectacle independence. Categorical visual acuity outcomes were compared using chi-square or Fisher’s exact tests, with absolute risk differences and 95% confidence intervals (CIs) and Holm adjustment for multiple comparisons. Contrast sensitivity, visual symptoms, spectacle independence, and defocus curves were summarized descriptively. Results: At distance, the PureSee FDA trial reported more subjects reaching 0.00 logMAR or better for uncorrected distance visual acuity (68.1% versus 44.3%; risk difference [RD], -23.8 percentage points [pp]; 95% CI, -35.8 to -10.7; Holm-adjusted P < 0.05) and best-corrected distance visual acuity (92.0% versus 73.6%; RD, -18.5 pp; 95% CI, -28.3 to -8.6; Holm-adjusted P < 0.05). At intermediate distance, the Vivity FDA trial reported more subjects reaching distance-corrected intermediate visual acuity of 0.00 logMAR or better (40.6% versus 10.6%; RD, +29.9 pp; 95% CI, +18.6 to +40.4; Holm-adjusted P < 0.001). No near-vision threshold comparison remained significant after Holm adjustment. Monocular depth of focus was 1.53 D for Vivity and 1.77 D for PureSee, representing gains of +0.54 D and +0.64 D over their respective monofocal controls. Descriptively, more Vivity eyes were unable to detect the mesopic contrast reference pattern at 6 and 12 cpd with and without glare. Visual symptoms and spectacle independence were also reported descriptively because the trials used different questionnaires. Each trial met the safety and performance endpoint limits applicable to its respective ISO 11979-7 edition. Conclusions: At the 0.00 logMAR threshold, PureSee reported higher proportions of subjects reaching corrected and uncorrected distance acuity, while Vivity reported a higher proportion reaching distance-corrected intermediate acuity. No near-vision threshold difference remained significant after multiplicity adjustment. Contrast sensitivity and patient-reported outcomes were interpreted descriptively because of differences in testing and questionnaire methods. Overall, the two FDA trials showed different patterns of visual performance, supporting the need for prospective head-to-head comparison.
Background:Dry eye disease (DED) is one of the most prevalent and distressing ocular conditions worldwide; it primarily results from alterations in the natural tear film that covers the ocular surface and is often due to enhanced evaporation of its aqueous component. This process is frequently associated with dysfunction of the meibomian glands (MGs), which are embedded within the tarsal plate of our eyelids and secrete the meibum, an oily mixture of proteins and lipids. Meibum forms the outermost layer of the tear film, playing a critical role in controlling water evaporation and stabilizing the tear film by lowering surface tension. Meibomian gland dysfunction (MGD) may result from structural abnormalities in the MGs, such as tortuosity, which impair normal delivery of meibum. Increased laxity of the eyelid is also associated with development of MGD and DED, likely due to insufficient mechanical support for the glands, and causing morphological changes. Hypothesis:We designed and initiated the development of a noninvasive method to strengthen and stiffen the tarsal collagen containing the embedded MGs. By reducing tissue laxity, our aim is to halt further morphological deterioration of the glands and promote uniform and smooth delivery of meibum to the ocular surface. Our previous studies showed that both mechanical tensile strength and rigidity (Young's modulus) of tarsal collagen in animal and human eyelids were significantly enhanced by exposure to ultraviolet-A (UV-A) radiation with a wavelength of 365 nm in the presence of riboflavin as a photosensitizer. Conclusions:We propose that performing this procedure at the initial manifestations of MGD and DED may prevent disease progression by restoring and preserving the normal morphology of the glands through reduced laxity, thereby ensuring proper secretion of the meibum into the tear film. The underlying principles and safety of the procedure were discussed in detail, and further pre-clinical evaluation steps were proposed and justified. Based on the proposed concept and the results of previous ex-vivo studies, in-vivo animal experiments and human clinical trials are currently in preparation.
Background:Exposure keratopathy is a common ocular complication in patients admitted to the intensive care unit (ICU) and may progress from superficial epithelial breakdown to corneal perforation, a vision-threatening emergency requiring timely management. Conventional treatments often necessitate urgent surgery, which is challenging in critically ill individuals who are unsuitable for surgical intervention. OmniLenz®, a customized bandage contact lens pre-lined with vacuum-dried Omnigen® amniotic membrane, offers a practical, non-surgical, bedside alternative for managing small corneal perforations. This study evaluates its clinical outcomes in ICU patients with a small corneal perforation secondary to exposure keratitis. Methods:This prospective interventional case series included ICU patients with <1 mm corneal perforations secondary to exposure keratitis, recruited over a two-year interval. All patients underwent corneal scraping with culture and sensitivity testing, followed by targeted antimicrobial therapy. A dehydrated amniotic membrane (Omnigen®) was applied beneath a customized bandage contact lens (OmniLenz®) at the bedside under sterile conditions. Patients were examined daily using a portable slit-lamp and followed for one month. The primary outcome was perforation closure, defined by a negative Seidel test and anterior chamber reformation. Secondary outcomes included improvement in epithelial integrity, corneal infiltration, and ciliary injection. Results:Five ICU patients, aged 18 to 70 years, with < 1 mm corneal perforations secondary to exposure keratitis were included. All eyes demonstrated rapid tectonic recovery following Omnigen®/OmniLenz® device application. Anterior chamber reformation and a negative Seidel test were achieved by day 7 in four patients and by day 10 in one patient. Complete perforation closure occurred in all cases. Marked improvement in keratitis was observed, with full epithelial defect healing and resolution of corneal infiltrates in every patient, followed by stable grade-3 stromal scarring. No neovascularization, device-related adverse events, or treatment complications occurred during the one-month follow-up. Conclusions:Omnigen®/OmniLenz® device provides a safe, effective, and non-invasive bedside treatment for small corneal perforations secondary to exposure keratitis in critically ill ICU patients. Its use enabled consistent tectonic restoration, rapid perforation closure, and resolution of infection-associated corneal pathology without procedure-related complications. This approach offers a practical alternative to urgent surgical intervention in patients unsuitable for operative care and may serve as a valuable addition to corneal perforation management protocols. Further studies with larger cohorts are needed to evaluate its safety and efficacy in larger perforations and to determine long-term outcomes, including corneal scarring and visual acuity.
Background:Keratorefractive lenticule extraction (KLEx) has become a widely used corneal refractive surgery. Since its approval by the United States Food and Drug Administration (FDA), there are relatively few studies from large US cohorts that have evaluated visual outcomes beyond one year using KLEx for myopia and myopic astigmatism. Studies are often limited by their small sample size and short follow-up duration. Methods:This was a retrospective study of 577 eyes from 314 patients who underwent KLEx between March 2017 and May 2024 at a single refractive surgery center. Inclusion criteria were myopia between 9.25 and 1.00 D, cylinder up to 3.00 D, and preoperative corrected distance visual acuity (CDVA) of 20/20 or better. Uncorrected distance visual acuity (UDVA), CDVA, manifest refraction, and complications were evaluated at 3 and 12 months postoperatively. Clinical outcomes were also compared to FDA premarket trials and large international cohorts. Results:Of 577 treated eyes, data were available at 3 months for 511 eyes (88.6% follow-up) and 12 months for 440 eyes (76.3% follow-up). Mean spherical equivalent (SEQ) improved from 5.35 ± 1.62 D ( 9.63 to 1.38 D) to 0.04 ± 0.44 D ( 1.88 to 1.88 D) (P < 0.001). Mean cylinder improved from 0.66 ± 0.66 D ( 3.00 to 0.00 D) at baseline to 0.40 ± 0.32 D ( 1.75 to 0.00 D) at 12 months (P < 0.001). Additionally, postoperative UDVA was 20/20 or better in 81% of eyes and 20/25 or better in 94% of eyes. Postoperative SEQ was within ± 0.50 D in 85% of eyes and within ± 1.00 D in 97% of eyes at 12 months. The SEQ remained stable across all postoperative visits, with a mean change of 0.03 ± 0.38 D from 3 to 12 months. There was a gain of one line of CDVA in 16% of eyes at 12 months, with no eyes losing two or more CDVA lines. Target-induced and surgically induced astigmatism were strongly correlated at both 3 and 12 months, with a mean undercorrection of 20% by one year (R² = 0.69). Conclusions:KLEx demonstrates predictable and safe correction of myopia and myopic astigmatism over 12 months in a US cohort. Visual outcomes meet or exceed FDA benchmarks and are consistent with published literature, although a potential need for improved cylindrical correction remains.
Background: Glaucoma is a major cause of vision impairment and blindness, characterized by damage to retinal ganglion cells (RGC) at the optic nerve head (ONH). The pathomechanism underlying glaucoma is heterogeneous and theories explaining the pathomechanism can be categorized as mechanical, vascular, or immunological. This mini-review explores the involvement of reactive oxygen species (ROS) and oxidative stress in these established mechanisms of glaucoma. Methods: A review of literature was conducted using PubMed/MEDLINE, with the query including the following keywords: “antioxidants”, “glaucoma”, “glaucoma pathomechanism”, “immunological”, “intraocular pressure”, “mechanical”, “reactive oxygen species”, “ocular hypertension”, “oxidative stress”, and “vascular”. The date filter was set from January 2010 to September 2025. Papers that were relevant to ROS or oxidative stress in the glaucoma pathomechanism were thoroughly reviewed. Their reference lists were also reviewed for relevant papers of any date. Results: Following a comprehensive literature search, 67 journal articles were selected for review. They revealed the role of ROS and oxidative stress in the mechanical, vascular, and immunological pathomechanism theories of glaucoma. In the mechanical theory, oxidative stress mediates RGC apoptosis and trabecular meshwork damage. In vascular processes, retinal ischemia causes oxidative stress and vice versa, thus causing RGC death and ONH damage. With the immunological theory, ROS is implicated in glial cell and inflammasome activity that causes RGC injury. Key players in the generation of oxidative stress include NADP oxidase 2, dynamin-related protein 1, mitofusin 2, nuclear factor (erythroid-derived 2) like 2, and nitric oxide. Conversely, various antioxidant factors are also implicated in glaucoma, yet in oxidative stress conditions their effects are outweighed by those of ROS. Conclusions: ROS and oxidative stress are important mediators in the glaucoma pathomechanism. They contribute to and unify the existing theories of mechanical, vascular, and immunological injury in glaucoma. Investigating specific oxidative stress players in the pathomechanism may reveal new therapeutic targets in the treatment of glaucoma.
Background: Uveal melanoma (UM) is an aggressive intraocular malignancy with high metastatic potential to the liver and poor prognosis. The nuclear factor kappa B (NF-kB) pathway, comprising the canonical and noncanonical branches, has been involved in UM development, tumor-microenvironment communication, and drug resistance. This review consolidates the evidence for NF-kB involvement in UM pathogenesis and therapeutic target value. Methods: A comprehensive search of PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane CENTRAL database was performed from inception to June 2025. Studies investigating NF-kB activation, functional dependencies, genetic or microenvironmental modulators, or therapeutic interventions in UM were eligible. Included designs comprised original observational or experimental research, including mechanistic in vitro studies, animal models, and human tissue–based prognostic or correlative studies. English-language articles and relevant review studies addressing the research question were considered. Exclusion criteria included editorials, commentaries, conference abstracts with insufficient data, case reports lacking mechanistic insights, non-UM cancers without validated UM models, studies mentioning inflammation or NF-kB targets without direct NF-kB readouts, and those using pleiotropic inhibitors without genetic validation or pathway-specific evidence. Appropriate design-specific tools were applied to assess risk of bias. Results: Canonical NF-kB signaling is mechanistically related to UM cell survival, proliferation, and migration, as shown by pharmacologic inhibition like BAY11-7082, and niclosamide and genetic modulation like microRNA-9. Noncanonical signaling is associated with invasive, immune-replenished tumors and liver metastasis yet has limited direct functional data. Deficiency in BRCA1-associated protein-1 (BAP1) and tumor necrosis factor alpha-enriched microenvironments control NF-kB activity, but there is conflicting data on the function of BAP1. Therapeutic targeting of NF-kB consistently suppresses UM phenotypes in vitro and in vivo, but pleiotropic inhibitor effects require confirmation. Conclusions: NF-kB signaling, particularly the canonical branch, is required for UM malignancy, while noncanonical signaling is linked with high-risk features. Branch-specific genetic manipulations and clinically relevant models should be employed in future research to maximize therapeutic strategies.
Background: Glaucoma suspects (GS) exhibit risk factors such as elevated intraocular pressure (IOP), suspicious optic disc or retinal nerve fiber layer (RNFL) findings, or a positive family history, yet their risk of progression varies widely. Optical coherence tomography angiography (OCTA) and central corneal thickness (CCT) have emerged as important markers for detecting early structural and microvascular changes in GS patients. We aimed to estimate the predictive value of OCTA-derived metrics and CCT, and to assess their correlations in GS individuals. Methods: This comparative cross-sectional study included eyes from GS patients and eyes from age- and sex-matched healthy individuals as a comparison group. All participants underwent a detailed medical history and comprehensive ophthalmologic examination. Investigations included visual field perimetry; optical coherence tomography (OCT) to assess structural optic nerve head parameters, RNFL thickness, and ganglion cell layer (GCL) thickness; OCTA to measure papillary vascular density (PVD) and radial peripapillary capillary density (RPC); and non-contact specular microscopy to determine CCT. Results: The GS group had a mean age of 36.9 years, with 52.4% male (n = 11). GS eyes showed significantly larger CDR values, reduced rim area, thinner RNFL and GCL, and lower CCT compared with healthy eyes (all P < 0.05). Mean RPC, quadrant-specific RPC values, and mean PVD were significantly reduced in GS individuals (all P < 0.05). CCT showed significant correlations with all vascular metrics and structural parameters (all P < 0.05), except disc area (P > 0.05). In univariate logistic regression all variables were associated with GS status. After multivariate adjustment, only CCT less than or equal to 506 µm remained an independent predictor. Receiver operating characteristic curve analysis showed good diagnostic performance for CCT (area under the curve [AUC] = 0.757) and mean RPC (AUC = 0.820) in identifying GS eyes. Conclusions: Patients with GS revealed significantly lower structural parameters and vascular metrics compared with the healthy group, and only thin CCT remained an independent predictor of GS status. Both CCT and mean RPC demonstrated good diagnostic performance for identifying GS eyes.
Background:Scleral lenses (SLs) and prosthetic replacement of the ocular surface environment (PROSE) are the same device, designed to enhance the optical quality of irregular surfaces or ectatic corneas. They also improve the corneal surface epithelium and the ocular surface microenvironment for patients with severe ocular surface diseases, including dry eye. This review aims to provide a comprehensive overview of the indications for SL/PROSE, as well as an exhaustive analysis of the corresponding complications, their possible remedies, and future challenges in this rapidly evolving field of ophthalmology. Methods:We conducted a review of the English language literature on the indications and complications of SL/PROSE devices using the following website search engines: National Library of Medicine's PubMed, Google Scholar, EMBASE, Web of Science, and Scopus for articles in English published from inception up to July 2025. The following scientific reports were considered for analysis: systematic reviews and meta-analyses, randomized controlled trials, cohort studies, case-control series, case reports, editorials, and short communications. Results:Research and development in SL/PROSE have made significant strides, broadening its applications, improving structural materials and designs, and adapting it to benefit a diverse range of patients facing numerous pathologies. These include keratoconus, post-refractive surgery ectasia, corneal transplantation, severe dry eye, and chronic cicatrizing ocular surface disorders, among many others. For patients suffering from these emerging pathologies, apart from medical therapy and surgical procedures there are limited treatment options. Currently, SL/PROSE offer a less invasive potential solution for many of these challenging conditions, raising hope and motivation within the field of corneal and ocular surface disease. However, they are not without potential complications, which differ significantly from those associated with soft contact lenses and rigid gas-permeable contact lenses. The most frequently reported SL/PROSE complications relate to improper lens adaptation and patients' handling. Conclusions:While much of the existing literature has focused on the benefits and applications of SL/PROSE devices, the potential complications associated with their use have received less attention and aren't as widely explored.
Background:Retinal diseases, including neovascular age-related macular degeneration, diabetic retinopathy, and retinal vein occlusion, are leading causes of vision loss worldwide. The introduction of anti-vascular endothelial growth factor (anti-VEGF) therapies has dramatically changed the management of these conditions, offering targeted treatment that can preserve and even improve vision. We aimed to provide a comprehensive review of the development, clinical applications, and emerging indications of anti-VEGF therapies in ophthalmology, including biosimilar agents. Methods:A comprehensive literature search was conducted in PubMed/MEDLINE for English-language articles published up to 31 July 2025. Additional sources were identified through manual screening of reference lists. Included studies spanned various designs: clinical trials, meta-analyses, observational studies, and preclinical research. Keywords used in the search strategy included terms such as "anti-VEGF therapy", "biosimilar pharmaceuticals", "intravitreal and intrastromal anti-VEGF injections", "retinal diseases" including "macular degeneration" and "retinal neovascularization", "ranibizumab", and "bevacizumab", as well as relevant MeSH terms where applicable. Results:Anti-VEGF agents have transformed the management of retinal diseases such as neovascular age-related macular degeneration, diabetic macular edema, proliferative diabetic retinopathy, retinal vein occlusion, and retinopathy of prematurity. Newer agents such as brolucizumab and faricimab offer prolonged durability and enhanced anatomic outcomes, while biosimilars provide cost-effective alternatives. Anti-VEGF therapy has also shown promise in off-label or emerging indications such as neovascular glaucoma, corneal neovascularization, and other retinal or choroidal disorders including secondary macular edema and/or macular neovascularization associated with various forms of uveitis, diffuse choroidal hemangioma in Sturge-Weber Syndrome, hereditary retinal disorders such as fundus flavimaculatus, Coats-Like retinitis pigmentosa, Peripherin-2-associated retinopathy, immune checkpoint inhibitor use, radiation retinopathy, retinitis pigmentosa, Bietti crystalline dystrophy, autosomal recessive bestrophinopathy, melanocytoma-associated macular neovascular membrane, Best disease, Wyburn-Mason syndrome, choroidal osteoma, peripheral exudative hemorrhagic chorioretinopathy, traumatic choroidal rupture, torpedo maculopathy, optic disc melanocytoma, type 2 proliferative macular telangiectasia, and Coats disease. High-dose formulations and innovative delivery systems are under active investigation to reduce the treatment burden and extend dosing intervals. Conclusions:Anti-VEGF therapies have revolutionized the field of ophthalmology, providing sight-saving treatment for a range of retinal diseases that were once considered untreatable or inevitably blinding. Today, anti-VEGF drugs are the go-to option for managing neovascular retinal disorders, thanks to their proven efficacy, favorable safety profile, and transformative impact on modern eye care.
Background:Acanthamoeba keratitis represents a devastating corneal infection caused by free-living protozoan organisms. This condition has evolved from an extraordinarily rare disease to a significant public health concern, with increasing global incidence. The infection predominantly affects contact lens wearers and poses substantial diagnostic and therapeutic challenges. This narrative review aims to provide analysis of current knowledge regarding Acanthamoeba keratitis, including epidemiology, pathogenesis, diagnostic approaches, treatment strategies, and prevention methods, to guide clinicians in optimal patient management. Methods:This review was conducted through a literature search of PubMed-indexed journals from January 2000 to August 2025, incorporating current information on pathophysiology, clinical features, diagnosis, therapy, and outcomes of Acanthamoeba keratitis. Keywords included "Acanthamoeba keratitis", "contact lens-related keratitis", "Acanthamoeba diagnosis", and "Acanthamoeba treatment". English-language publications including original articles, reviews, case reports, and clinical studies were included based on relevance to current diagnostic and therapeutic practices, with an emphasis on recent advances in the field. Results:Contact lens wearers comprised the vast majority of cases, with soft contact lens users representing the predominant affected population. Peak occurrence involves young adults aged 20-40 years, with water-based transmission through contaminated domestic supplies representing a significant risk pathway. Clinical manifestations commonly include epithelial abnormalities, stromal infiltration, and ring infiltrates in advanced cases. Traditional culture methods evidence limited sensitivity (33-67%), while advanced diagnostic approaches include polymerase chain reaction (PCR) and in vivo confocal microscopy (IVCM) achieving superior accuracy (sensitivity 77-100%, specificity 84-100%). First-line therapy employs biguanides and diamidines with prolonged administration. Advanced treatment options include oral miltefosine for refractory cases, azole antifungals, and surgical interventions ranging from epithelial debridement to corneal transplantation. Early diagnostic recognition represents the strongest predictor of visual recovery, with diagnostic delays associated with poor prognosis. Conclusions:Acanthamoeba keratitis management requires high clinical suspicion, rapid diagnosis using advanced techniques such as IVCM and PCR, and prolonged antimicrobial therapy. Early diagnosis remains the most important predictor of visual recovery. Prevention through proper contact lens hygiene and water exposure avoidance is paramount. Future research priorities include development of novel antimicrobial agents and enhanced prevention strategies.
Background:The cornea and ocular surface serve as a vital barrier and the eye's primary refractive medium, requiring precise coordination to maintain transparency, structural integrity, and immune protection. Constantly exposed to environmental stressors, this interface relies on the stability of the tear film, epithelial architecture, mucin layers, and limbal stem cells to preserve function. Disruption in any component can impair vision and increase vulnerability to disease. Advances in imaging and molecular diagnostics have deepened our understanding of these structures, offering new avenues for early detection and personalized treatment strategies. A comprehensive review is needed to integrate recent findings and assess their clinical relevance. Methods:A targeted literature search was conducted using PubMed/MEDLINE and Google Scholar to identify English-language publications from 1 January 2000 to 30 May 2025. Keywords included "anatomy," "histology," "cornea," "ocular surface," "epithelium," "Bowman's layer," "stroma," "Descemet's membrane," "endothelium," "conjunctiva," "lacrimal functional unit," and "eyelids." Studies were selected irrespective of design, and reference lists of included articles were manually screened for additional relevant sources. Results:Eighty-six publications were reviewed. Findings highlight that the cornea and ocular surface constitute an integrated anatomical and physiological continuum essential for optical clarity, visual acuity, and ocular health. This dynamic unit comprises the cornea, conjunctiva, tear film (mucin, aqueous, and lipid layers), meibomian glands, goblet cells, and the limbal stem cell niche. Collectively, these elements provide lubrication, immune defense, epithelial homeostasis, and structural integrity. Disruption in any component-such as in dry eye disease, limbal stem cell deficiency, or meibomian gland dysfunction-can precipitate epithelial breakdown, neovascularization, or stromal scarring, ultimately compromising vision. Recognizing this interdependence has reframed ocular surface disease as a multifactorial condition rather than an isolated disorder. A comprehensive understanding of the structural and immunological dynamics of this system is therefore critical for refining surgical strategies and developing targeted therapies. Conclusions:The cornea and ocular surface components function synergistically to maintain a transparent, stable refractive surface essential for vision. Their coordinated roles in protection, lubrication, immune defense, and tissue repair reveal the importance of anatomical understanding for developing targeted therapies and improving clinical outcomes. A comprehensive understanding of this anatomy is essential for clinicians and researchers aiming to develop more precise therapeutic strategies and surgical techniques to enhance patient outcomes and preserve visual function. Future research should focus on advancing regenerative strategies and personalized treatments to address complex ocular surface disorders more effectively.
Background:A-pattern esotropia is defined as an increase of more than 10 prism diopters (PD) divergence in down-gaze than in up-gaze. The long-term outcomes of bilateral superior oblique tendon suture extension (SOSE), a hardware-free technique, were evaluated in pediatric A-pattern esotropia with bilateral superior oblique overaction (bi-SOOA), addressing complications associated with traditional silicone spacers and tenotomy. Methods:In this retrospective cohort study, all participants with A-pattern esotropia and bi-SOOA underwent bilateral SOSE using nonabsorbable polypropylene sutures combined with medial rectus recession. Preoperative and postoperative assessments included prism cover testing in nine gazes, fundus photography for objective torsion quantification, and grading of superior oblique overaction (SOOA). Results:This study included 64 eyes from 32 children with a mean (SD) age of 7.0 (3.1) years and a mean (SD) postoperative follow-up of 35.2 (15.6) months (range: 8-55). The mean (SD) A-pattern esodeviation collapsed from 23.4 (7.7) PD preoperatively to 2.4 (2.3) PD postoperatively (P < 0.001), representing an 88.3% reduction. The mean (SD) horizontal esodeviation improved from 37.5 (10.9) PD to 1.7 (1.8) PD in primary gaze (P < 0.001). The mean (SD) objective fundus torsion decreased from 10.9 (2.5) degrees to 1.1 (1.4) degrees (P < 0.001), with no cases of torsional diplopia or vertical deviation. SOOA grades normalized from 2.8 (0.7) to 0.2 (0.4) (P < 0.001). No suture-related complications were observed, and alignment stability was maintained through to the final follow-up visit. Conclusions:In pediatric A-pattern esodeviation surgery, SOSE provided biomechanical precision, anatomical preservation, and elimination of hardware-related risks. Its effectiveness in collapsing A-pattern esotropia, normalizing torsion, and achieving durable outcomes establishes it as a first-line surgical intervention for bi-SOOA. This study addresses a significant gap in pediatric ophthalmology, offering extended follow-up data and highlighting the value of minimally invasive, growth-compatible techniques in protecting visual development. Larger randomized trials with extended follow-up are needed to confirm the efficacy and safety of this procedure for A-pattern esotropia.
Background:Reactive oxygen species and oxidative stress are increasingly recognized as central drivers in the development of major ocular diseases, including cataracts, age-related macular degeneration, glaucoma, and diabetic retinopathy. The eye's unique environment-continuous light exposure, high oxygen tension, and abundant photosensitizers-renders it particularly vulnerable to ROS-mediated damage. This narrative review aims to synthesize current evidence on the molecular mechanisms of oxidative stress in ocular disease and highlight emerging therapeutic approaches. Methods:Targeted searches of PubMed, Scopus, and Google Scholar for literature published between 2000 and June 2025 were conducted. Keywords included "oxidative stress", "reactive oxygen species", "ocular disease", "cataract", "age-related macular degeneration", "glaucoma", and "diabetic retinopathy". Only English-language, peer-reviewed articles were considered. Relevant primary studies, clinical trials, reviews, and experimental reports were selectively incorporated, with an emphasis on recent publications and high-impact contributions to the field. Results:Evidence consistently demonstrates that ROS induce lipid peroxidation, protein oxidation, DNA damage, mitochondrial dysfunction, and disruption of redox-sensitive cellular signaling pathways across ocular tissues. In cataracts, oxidation of crystalline proteins and glutathione depletion are primary drivers of lens opacification. In age-related macular degeneration, mitochondrial dysfunction and lipofuscin accumulation promote retinal pigment epithelium degeneration and neovascularization. Glaucoma involves both trabecular meshwork oxidative injury, contributing to elevated intraocular pressure, and mitochondrial-driven retinal ganglion cell apoptosis. In diabetic retinopathy, hyperglycemia-induced ROS overload activates pathogenic pathways, leading to microvascular damage and neuronal dysfunction. Clinical and experimental studies support antioxidant therapies as adjunctive strategies, with the strongest evidence for Age-Related Eye Disease Study-based formulations in age-related macular degeneration and promising results for agents such as Coenzyme Q10 in glaucoma and sulforaphane in diabetic retinopathy. For cataracts, supplementation trials have yielded mixed outcomes and surgery remains the definitive treatment. Conclusions:Oxidative stress represents a unifying mechanism in the pathogenesis of vision-threatening ocular diseases. Antioxidant-based interventions show potential, particularly when integrated with existing treatment regimens, but their translation into routine practice remains limited by heterogeneous trial results and the absence of robust biomarkers for patient selection. Future research should focus on precision antioxidant therapy, leveraging stage-specific interventions, novel delivery systems, and pathway-targeted compounds, to transform ocular care from reactive management toward prevention.
Background:Recent innovations in intraocular lens (IOL) design have introduced extended depth of focus lenses, which has shown promise in improving visual acuity at multiple distances while preserving the distance vision provided by a standard monofocal IOL. This study aimed to evaluate the visual outcomes of TECNIS Eyhance, a monofocal IOL with enhanced intermediate function, and a standard TECNIS monofocal 1-piece IOL, and to review published studies comparing the clinical performance between the TECNIS Eyhance and standard IOLs. Methods:A retrospective analysis was conducted on patients who underwent cataract extraction with bilateral implantation of either TECNIS Eyhance IOLs or TECNIS Monofocal 1-Piece IOLs. Primary outcomes included monocular and binocular uncorrected distance visual acuity (UDVA), uncorrected near visual acuity (UNVA), and corrected distance visual acuity (CDVA), and manifest refraction. Outcomes such as glare, halos, and dry eye were also assessed. A literature review was performed to identify studies evaluating the clinical outcomes of TECNIS Eyhance and standard TECNIS monofocal IOLs. Results:In total 108 patients (216 eyes) underwent bilateral implantation with either TECNIS Eyhance (104 eyes) or TECNIS Monofocal 1-Piece (112 eyes) IOLs. The mean (standard deviation [SD]) binocular UNVA was better in the Eyhance group at 1 month (0.18 [0.13] logMAR) compared to the standard monofocal group (0.24 [0.14] logMAR; P < 0.05). A greater proportion of Eyhance patients achieved binocular UNVA of 20/25 or better (46.9% vs 21.8%; P < 0.01), and 20/32 or better (65.3% vs 45.5%; P < 0.05). However, there was no significant difference for 20/20 visual acuity (20.4% vs 18.2%; P > 0.05). No significant differences were observed in postoperative UDVA or CDVA between groups (both P > 0.05). The mean (SD) monocular UNVA showed a slight, but non-significant, advantage in the Eyhance group (0.26 [0.15] logMAR vs 0.29 [0.15] logMAR; P > 0.05). Eyhance eyes demonstrated less residual refractive cylinder at 1 month (P < 0.01), which may be attributed to a higher rate of toric IOL use (P < 0.01). Patient-reported visual symptoms did not differ between groups. Thirteen studies were identified that compared the Eyhance and standard monofocal IOLs. Across the studies analyzed, the Eyhance group showed better monocular and binocular UNVA with mean (SD) differences of - 0.10 (0.20) logMAR and - 0.10 (0.21) logMAR, respectively (both P < 0.01), as well as improved binocular uncorrected intermediate visual acuity (UIVA) (mean difference [SD]: -0.10 [0.18] logMAR; P < 0.01). These studies also showed low rates of glare and halos for both IOLs. Conclusions:Patients receiving the TECNIS Eyhance IOL had better binocular UNVA compared to those with a standard monofocal IOL, consistent with published literature. The Eyhance IOL also showed better binocular UIVA and monocular UNVA across the studies reviewed. Both enhanced and standard monofocal IOLs demonstrate excellent distance vision and have similar levels of photic phenomena. Nevertheless, the Eyhance IOL shows promising potential for improving intermediate and near vision.
Background: Resistant fungal keratitis is a major cause of corneal blindness, particularly in resource-limited regions where donor tissue is scarce. Amniotic membrane transplantation (AMT) offers potential benefits through its anti-inflammatory, anti-proteolytic, and epithelialization-promoting effects. This study evaluated the efficacy and safety of AMT for treatment-resistant fungal corneal ulcers. Methods: This prospective, single-arm study enrolled consecutive patients with microbiologically confirmed, treatment-resistant fungal corneal ulcers at Al-Azhar University Hospital, Damietta, between January 2022 and October 2023. All patients underwent standardized single- or double-layer AMT. Baseline and follow-up assessments included best-corrected distance visual acuity (BCDVA, logarithm of the minimum angle of resolution [logMAR]), ulcer size, anterior chamber reaction and depth, and presence of blepharospasm or pain (visual analog scale). Clinical evaluations were performed at baseline, 1 day, and 1, 3, and 6 months postoperatively. Treatment success was defined as complete resolution or significant improvement over 6 months. Results: A total of 24 patients (mean [standard deviation] age, 59 [7.5] years; 3:1 male-to-female ratio) with resistant fungal corneal ulcers were studied. Most were rural residents (n = 17, 70.8%), and nearly half were farmers (n = 11, 45.8%). Common comorbidities included hypertension and diabetes mellitus. The median baseline ulcer area was 3 mm²; most ulcers were central (n = 10, 41.7%) or paracentral (n = 8, 33.3%), and 12.5% (n = 3) had perforations. At 6 months, significant improvements were observed: median BCDVA improved from 3.0 logMAR to 2.0 logMAR (P = 0.001), ulcers completely closed (P = 0.001), and the pain score dropped from 2 to 0 (P = 0.001). Anterior chamber reaction and blepharospasm also improved significantly (both P = 0.001). Overall, 91.7% (n = 22) achieved complete resolution or marked improvement, and two patients required further surgery. The results showed progressive benefits throughout the follow-up period. Conclusions: AMT is a safe and effective adjunctive treatment for resistant fungal keratitis, particularly when corneal donors are scarce. The procedure promotes ulcer healing, relieves pain, and improves visual outcomes. Controlled trials are required to confirm these findings and refine patient selection.
Background:Systematic reviews and meta-analyses (SRMAs) are central to evidence-based ophthalmology, influencing clinical guidelines and treatment decisions. However, the rapid increase in SRMA publications has exposed serious ethical concerns, including selective reporting, duplicate publication, plagiarism, authorship misconduct, and undeclared conflicts of interest. Despite established frameworks such as Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), International Prospective Register of Systematic Reviews (PROSPERO), and International Committee of Medical Journal Editors (ICMJE), ethical compliance remains inconsistent, undermining the credibility of synthesized evidence. We aimed to examine the ethical landscape of SRMAs with a particular focus on ophthalmology, highlighting common pitfalls, evaluating current guidelines, and providing practical recommendations to ensure that these reviews are conducted and reported with the highest ethical standards-ultimately safeguarding the integrity of the evidence base that underpins clinical eye care. Methods:A structured literature search was conducted in PubMed, Scopus, Web of Science, and Google Scholar through May 2025 using combinations of the terms "systematic review," "meta-analysis," "ethics," "research integrity," and "ophthalmology." Relevant guidelines, peer-reviewed studies, and editorials were synthesized to identify ethical pitfalls and propose best practice solutions. Results:We illustrate these challenges with ophthalmology-specific examples and highlight the downstream impact of unethical SRMAs on clinical practice and public trust. We also propose actionable recommendations for researchers, editors, and institutions to enhance the ethical quality of SRMAs, including improved training in research integrity, stricter enforcement of reporting guidelines, and increased editorial oversight. By addressing these ethical dimensions, the ophthalmic community can ensure that SRMAs not only meet methodological benchmarks but also reflect the core values of scientific honesty, accountability, and patient-centeredness. Approximately one-third of ophthalmology SRMAs fail to assess bias or comply with PRISMA guidelines. Industry-sponsored reviews have shown a tendency to favor commercially linked interventions, raising objectivity concerns. Key ethical concerns include: lack of protocol registration, selective inclusion of studies, inclusion of retracted or flawed trials, duplicate or plagiarized data, and authorship and disclosure misconduct. Conclusions:To protect the integrity of ophthalmic evidence synthesis, SRMAs must adhere to the highest ethical standards. Researchers should commit to transparent, methodologically rigorous, and ethically sound practices. Journals and institutions must enforce compliance, provide oversight, and support education in research integrity. Field-specific adaptations of reporting standards may further support ethical clarity. Ultimately, ethical SRMAs are critical to preserving trust, guiding responsible care, and fulfill their intended role as trustworthy instruments in advancing evidence-based ophthalmology.
Background: Although optical coherence tomography (OCT) has become essential in pediatric ophthalmology, normative data for children are lacking in most device databases. Due to ongoing ocular growth and developmental changes that occur during childhood and adolescence, adult reference values are not appropriate for pediatric use. Additionally, OCT measurements vary across devices, indicating the need for device-specific norms. In this study, we aimed to establish normative values for total macular retinal thickness, macular ganglion cell layer (GCL+) thickness, and circumpapillary retinal nerve fiber layer (cpRNFL) thickness in children aged 5–17 years relevant to the Topcon DRI Triton Plus swept-source OCT device. Methods: We recruited children aged 5–17 years with normal ocular health, adequate visual acuity, and refractive errors within ±3.00 diopters (D) spherical and –1.00 D or less cylindrical under cycloplegia. Each child underwent comprehensive eye examinations and four OCT scans (two macular and two optic disc scans) using the Topcon DRI Triton Plus. Retinal thickness measurements were obtained from the eye with better visual acuity, or from a randomly selected eye in cases where both eyes had similar acuity. Scans were included if image quality was 40 and were free from artifacts or segmentation errors. Measurements were compared between age groups (5–7 and 8–17 years). Intra-visit repeatability was assessed using test–retest correlations based on repeated measurements obtained by the same examiner during a single visit. Results: Sixty-nine children (n = 33, 48% girls), with a median age of 7 years (5–7-year age group) and 13 years (8–17-year age group), were included. The total macular thickness was 287.5 µm (11.1) and 290.5 µm (13.8), GCL+ thickness was 75.7 µm (4.2) and 74.9 µm (5.2), and cpRNFL thickness was 111.5 µm (10.2) and 108.3 µm (7.9) for the 5–7-year and 8–17-year age groups, respectively (mean [standard deviation]). Mean retinal thickness measures did not differ significantly by age or sex (all P > 0.05). Correlation between repeated measurements showed excellent repeatability: 0.991 for both total macular and GCL+ thickness, and 0.954 for cpRNFL (all P < 0.001). Spherical equivalent did not correlate significantly with retinal thickness measures (all P > 0.05). Conclusions: This study provided normative values for macular total retinal thickness, macular GCL+ thickness, and cpRNFL thickness in children aged 5–17 years, measured using the Topcon DRI Triton Plus OCT device. We observed no significant age- or sex-based differences in these values, and measurement repeatability was excellent. Given the variability in retinal thickness across populations and devices, region- and device-specific pediatric norms are essential. These findings fill a critical gap in pediatric OCT normative databases and contribute to the development of reliable pediatric reference standards for swept-source OCT imaging. This may enhance diagnostic accuracy and clinical decision-making in pediatric ophthalmology.
Background:Diabetic retinopathy (DR) is a major microvascular complication of diabetes mellitus (DM) and a leading cause of preventable visual impairment (VI) and blindness worldwide. The rising global prevalence of DM, particularly in low- and middle-income regions such as the Middle East, necessitates the collection of localized data on DR-related VI. Despite growing public health concerns, limited research has been conducted in the Gulf region, including Oman. This study aimed to assess the prevalence and severity of VI associated with DR and identify its key risk factors among patients with types I and II DM in Al Buraimi, Sultanate of Oman. Methods:A retrospective cross-sectional study was conducted at Buraimi Hospital and Polyclinic in Oman between June 2023 and January 2024. Medical records of patients with type I or II DM and a confirmed diagnosis of DR were reviewed. Best-corrected distance visual acuity was assessed using a Snellen chart, and fundus examinations were performed using both direct and indirect ophthalmoscopy for DR detection and staging. VI was classified according to the WHO criteria. Relevant demographic and clinical data, including age, duration of DM, and duration of DR, were extracted. Coexisting ocular conditions were also documented. Results:A total of 218 participants were included, with a mean age of 57.5 years; 52.3% (n = 114) were male and 47.7% (n = 104) female. Most participants had no VI (n = 131, 60.1%), whereas mild VI (n = 58, 26.6%) was the most frequent type of VI. A significant association was detected between DR severity and VI levels (P < 0.01); blindness occurred only in patients with severe nonproliferative DR (n = 1) and proliferative DR (n = 8). Age and DR duration were significantly associated with increasing VI severity (both P < 0.05), with each additional year increasing the odds by 4% and 12%, respectively. No significant association was observed between DM duration and VI severity (P > 0.05). Cataract (n = 131) was the most common coexisting ocular condition. Conclusions:The frequency of VI among patients with DR was relatively high, and its severity was significantly associated with older age and longer DR duration. Blindness occurred only in more severe DR stages, reinforcing the value of early screening and immediate care in mitigating disease severity. These findings indicate the need to optimize resources for early DR management and to promote screening, even in diabetic individuals with normal vision, to prevent disease progression and reduce visual disability. Further community-based research is needed to achieve a robust, practical understanding of the preventable causes of VI, guide national eye health policies, and enhance long-term patient outcomes.
