Abstract Background Conventional topical therapy for glaucoma is limited by poor ocular bioavailability, rapid precorneal drug loss, frequent dosing and systemic absorption through the nasolacrimal pathway, which may reduce therapeutic efficacy and increase the risk of adverse effects. Drug‐eluting hydrogel contact lenses have emerged as a promising strategy to overcome these limitations by enabling sustained ocular drug delivery. Objective This study aimed to evaluate the therapeutic efficacy, ocular biocompatibility and systemic pharmacokinetic profile of an optimized dual‐drug‐loaded HEMA‐based hydrogel contact lens delivering timolol maleate (TM) and brimonidine tartrate (BT) for sustained glaucoma management. Methods Optimized hydrogel contact lenses composed of 2‐hydroxyethyl methacrylate (HEMA), N, N‐dimethylacrylamide (DMA), N‐vinylpyrrolidone (NVP) and ethylene glycol dimethacrylate (EGDMA) were fabricated by UV photopolymerization and loaded with TM and BT (4 mg/mL each). Ocular biocompatibility was assessed using the modified Draize irritation test. Therapeutic efficacy was evaluated in a steroid‐induced ocular hypertension New Zealand White rabbit model by monitoring intraocular pressure (IOP) for 24 h. Systemic drug exposure was determined by validated high‐performance liquid chromatography (HPLC) analysis of plasma samples, while ocular safety was further confirmed through histopathological examination. Results The optimized hydrogel lens exhibited excellent ocular biocompatibility, with a maximum Draize score of 0.33 ± 0.12 that resolved completely within 48 h and no histopathological evidence of ocular tissue damage. In hypertensive rabbits, the dual‐drug hydrogel lens maintained normotensive IOP (16.1 ± 0.8 mmHg) for 24 h, representing a 43.5% reduction from baseline and significantly outperforming conventional eye drops beyond 4 h ( p < 0.01). Plasma concentrations of both TM and BT remained below the limit of quantification (<2.0 ng/mL) throughout the study, whereas conventional eye drops produced measurable systemic exposure (TM: 18.4 ± 2.1 ng/mL; BT: 8.2 ± 1.2 ng/mL), demonstrating effective minimization of systemic drug absorption. Conclusion The optimized dual‐drug‐loaded hydrogel contact lens provided sustained intraocular pressure reduction, excellent ocular biocompatibility and negligible systemic drug exposure compared with conventional topical therapy. These findings highlight its potential as a sustained ocular drug‐delivery platform capable of improving therapeutic efficacy, reducing systemic adverse effects and enhancing long‐term treatment adherence in glaucoma management. Further long‐term preclinical investigations and clinical studies are warranted to support clinical translation.
Abstract Purpose To evaluate the repeatability of interpolated Pentacam HR elevation, densitometry and anterior chamber depth (ACD) map data before and after customized corneal crosslinking (CXL) in keratoconus (KC) and healthy eyes with low‐grade myopia (MY), including effects of KC severity. Methods Participants with progressive KC or stable MY treated with CXL were included from prospective studies. Eyes lacking complete 6‐ and 12‐month follow‐up or acceptable quality Pentacam HR examinations were excluded. Repeatability was assessed descriptively and using linear mixed‐effects models (LMMs) across groups and visits. KC severity analyses used baseline maximum keratometry ( K max ), both continuously and categorically (KC high/low). Results Ninety‐five right eyes (36 KC, 59 MY) were included. Variability was generally low and greater in KC only in central elevation (anterior, p < 0.001; posterior, p = 0.001; LMM). Nevertheless, model‐based limits for absolute differences between measurements, termed repeatability limits (RLs), did not exceed 1.66 μm (maximum visit‐specific descriptive RL: 2.55 μm). Descriptive comparisons indicated greater KC variability overall, mixed 6‐month changes and smaller group differences at 12 months, but LMMs showed no significant post‐CXL repeatability changes. Selected parameters showed 4%–8% greater variability per 1‐D increase in K max , and several elevation parameters and central ACD were more variable in KC high than KC low. Conclusion Interpolated Pentacam HR maps were highly repeatable, with no significant post‐CXL change. Variability appeared more strongly related to KC severity than diagnosis or visit. Subsequent derivation may contribute additional variability to conventional Pentacam parameters, particularly in more advanced KC.
Abstract While acanthamoeba keratitis (AK) is a sight‐threatening corneal infection, a thorough comparison of the outcomes of therapeutic penetrating keratoplasty (PK) and therapeutic deep anterior lamellar keratoplasty (DALK) is lacking. We aimed to compare clinical outcomes of PK and DALK in AK. The study was preregistered in the PROSPERO database (CRD420251233705). A comprehensive search of Embase, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted through 11 November 2025. Eligible studies reported outcomes after PK or DALK in patients with AK, specifically graft survival, best spectacle‐corrected visual acuity (BSCVA) and postoperative complications. Of the 1257 studies screened, 28 studies comprising 478 eyes with AK were included in the meta‐analysis. Individual participant data (IPD) were available from 11 studies. The pooled graft survival rate was significantly higher after DALK (0.90, 95% CI 0.48–0.99) than after PK (0.63, 95% CI 0.54–0.71) ( p = 0.025). No significant difference was observed in either BSCVA improvement between PK (−1.00, 95% CI –1.36 to −0.64) and DALK (−1.29, 95% CI –2.30 to −0.28) ( p = 0.314), or in postoperative BSCVA between PK (0.97, 95% CI 0.68 to 1.25) and DALK (0.86, 95% CI –0.02 to 1.74) ( p = 0.739). Postoperative complications did not differ significantly between the two procedures (all p ≥ 0.91). DALK may provide superior graft survival compared with PK in AK, while visual and postoperative outcomes appear comparable between the two procedures. Within the observed follow‐up periods, treatment delay alone was not clearly associated with visual outcomes after PK.
Abstract Purpose To determine the incidence of surgically treated primary rhegmatogenous retinal detachment (RRD) in Southern Sweden between 2011 and 2025, and to examine whether demographic change or risk factor trends account for any change in incidence. Methods This retrospective, population‐based study included all surgically treated primary RRD cases in Southern Sweden between 1 January 2011 and 31 December 2025. Crude and age‐ and sex‐standardised incidence rates were calculated per 100 000 person‐years using population data from Statistics Sweden. Cataract surgery data were obtained from the Swedish National Cataract Registry. Results A total of 6916 surgically treated primary RRD cases were identified. Annual incidence increased from 15.8 to 29.5 cases per 100 000 person‐years between 2011 and 2025, an 86.7% increase. Peak incidence of 30.4 per 100 000 person‐years was seen in both 2019 and 2024. The increase persisted after age‐ and sex‐standardisation. Mean age at surgery was 62 years and 68.3% occurred in men. Cataract surgery rate increased by 56.2% between 2011 and 2024. The proportion of pseudophakic RRD rose from 37.7% during 2011–2013 to 55.4% in 2023–2025. Conclusion The RRD incidence in Southern Sweden nearly doubled over the past 15 years, reaching levels among the highest reported worldwide. The increase persisted after standardisation, indicating that population ageing and sex distribution do not account for it. The concurrent rise in cataract surgery and in the proportion of pseudophakic RRD is notable, but these population‐level observations cannot establish a causal link between the rise in RRD and the cataract surgery rate.
Abstract Purpose Analysing longitudinal trends in recorded diagnosis and medical management of glaucoma in Germany over a 10‐year period. Methods A retrospective cohort study using nationwide outpatient claims and prescription data from the German statutory health insurance system. Patients with documented glaucoma or glaucoma suspect (ICD‐10 H40.*) between 2014 and 2023 were included. Analyses assessed annual diagnosed glaucoma patients, demographic characteristics, proportions of medically treated patients and prescribing patterns of glaucoma medications. Trends in medication classes and number of active ingredients per patient were evaluated. Results In 2014, 2 065 065 glaucoma patients were registered. Documented patient numbers increased until 2019, reaching 2 129 673 and subsequently declined after the pandemic year to 2 025 226 in 2023. Mean patient age increased from 71.0 to 72.4 years. The proportion of medically treated patients increased from 68% to 71.5% across all glaucoma subtypes, except for primary open‐angle glaucoma, where it remained stable (86.2%–86.1%) and primary angle‐closure glaucoma, where it decreased (68.7%–65.6%). Among treated patients, monotherapy declined from 54.8% to 46.8%, while the proportion on two medications increased from 30.7% to 33.7%, three medications from 10.3% to 12.3%, four medications from 3.2% to 4.9% and 5 or more from 1.0% to 1.9%. Among patients receiving multiple agents, fixed‐combinations increased from 75.7% to 80.5%. Prescribing patterns shifted towards greater use of prostaglandin analogues and reduced use of beta‐blockers. Conclusion After increasing until 2019, the number of documented glaucoma patients in Germany declined despite an ageing population. Concurrently, treatment strategies shifted towards intensified medical therapy with greater use of multiple medications and fixed combinations, particularly prostaglandin‐based regimens.
