The goal of this review is to examine the relationship between pulsatile flow disturbances and region-specific microvascular biomarkers in the disease pathology of glaucoma. We seek to explore the evolution of research on the association between pulsatile flow, vascular resistance, and their effects on the microcirculation at the optic nerve head, leading to mechanical stress. We conducted a review using the PICO framework to identify studies on microvasculature, pulsatile blood flow, and hemodynamic parameters in glaucoma. From 437 initial records, 81 articles were selected for full-text analysis. These studies convey the growing evidence supporting the vascular theory that reducing ocular blood flow, particularly to the optic nerve head, results in ischemic damage. Several methodological approaches have been employed to assess ocular blood flow, including Doppler ultrasound, optical coherence tomography angiography (OCTA), laser Doppler flowmetry, laser speckle flowgraphy, and Doppler optical coherence tomography. OCTA has emerged as particularly valuable, enabling non-invasive visualisation and quantification of retinal and optic nerve head microvasculature and revealing region-specific reductions in vessel density that correlate with visual field loss. Challenges remain in accurately measuring and modelling pulsatile flow in the microcirculation, but future directions involving artificial intelligence and multi-scale modelling approaches show promise. The vascular perspective significantly enhances understanding of glaucoma as a multifactorial disease, with vascular assessment potentially complementing traditional evaluations for earlier detection and more accurate risk stratification, opening new therapeutic possibilities beyond intraocular pressure reduction. Pulsatile flow acts as a vital factor in the disease genesis and progression. OCTA enables non-invasive visualisation and quantification of the microvasculature, which could be further investigated in its role in region-specific examination, leading to targeted treatment options.
Corneal disease continues to be a leading cause of blindness worldwide, yet current treatment with corneal transplantation remains limited by global donor tissue shortage, inconsistent donor tissue quality, and risk of immune complications. Induced pluripotent stem cells (iPSC) have emerged as a promising platform for regenerative corneal therapies due to their broad differentiation potential, scalability, and potential to support allogeneic cell therapy through HLA-matched banking. This review examines recent progress in iPSC-based strategies for regenerating the corneal epithelium, stroma, and endothelium, and evaluates the key barriers to clinical translation. Recent advances in chemically defined and xeno-free differentiation protocols have improved the generation of corneal lineage cells from iPSCs, particularly for epithelial and endothelial applications. iPSC-derived corneal epithelial cell sheets have recently entered the early stages of clinical translation, with first-in-human trials in limbal stem cell deficiency yielding encouraging results for safety and efficacy. Concurrently, iPSC-derived corneal endothelial cells have shown promising preclinical capacity to restore corneal clarity, while stromal applications, exosome-based therapies, and corneal organoid platforms continue to expand the translational landscape. iPSC-based corneal regeneration presents a potential solution to the major limitations posed by conventional corneal transplantation. However, broader clinical application will require improved standardization of differentiation and characterization protocols, reliable safeguards for ensuring functional maturity and tumorigenicity, and scalable GMP-compliant manufacturing guidelines. Continued progress in HLA-typed iPSC banking, quality control, and multidisciplinary translational collaboration will be essential to realize safe and accessible stem cell-based therapies for corneal disease.
This review evaluates the role of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents as peri-operative adjuvants in pars plana vitrectomy (PPV) for proliferative diabetic retinopathy (PDR). We synthesize current evidence on their use before, during, and after PPV, with emphasis on benefits, limitations, risks, and implications for surgical planning. Randomized trials and meta-analyses consistently show that preoperative anti-VEGF improves surgical safety by reducing intraoperative bleeding, shortening operative time, and lowering rates of early postvitrectomy vitreous hemorrhage, whereas long-term visual acuity benefits remain inconsistent. Intraoperative administration shows weaker and less consistent effects, and postoperative treatment is supported only by small studies, although it may reduce recurrent hemorrhage and anterior segment neovascularization in selected high-risk eyes. Bevacizumab remains the most studied and widely used agent. Newer anti-VEGF agents and higher-dose formulations may offer theoretical advantages, but comparative clinical data specifically in the setting of PDR vitrectomy remain limited. Preoperative anti-VEGF is currently the most evidence-based perioperative strategy, improving intraoperative conditions and early postoperative outcomes without clearly demonstrated durable functional gains. Critical gaps remain in optimal timing, agent selection, and real-world applicability, particularly in resource-limited settings. Large, pragmatic comparative trials and better risk-stratification tools are needed to refine perioperative anti-VEGF protocols in PDR surgery
This review explores the evolving role of advanced imaging in the diagnosis and management of recurrent corneal erosion syndrome (RCES), a condition marked by episodic corneal epithelial breakdown. The goal is to evaluate how emerging modalities improve detection, monitoring, and treatment outcomes, and consider the potential future role of artificial intelligence (AI) in this domain. Advances in anterior segment optical coherence tomography(ASOCT), corneal epithelial mapping(CEM), In vivo confocal microscopy(IVCM), and meibography have enhanced visualization of microstructural changes in RCES, including basement membrane irregularities and subclinical epithelial defects. Studies suggest, these tools offer superior sensitivity and reproducibility compared to conventional slit-lamp examination. Advanced imaging significantly enhances diagnostic accuracy and treatment monitoring in RCES. Future integration of AI could further refine risk prediction and enable personalized care. These innovations are poised to reshape clinical practice and inform future research in corneal disease management.
This review aims to provide a comprehensive comparison between acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN), two sight-threatening manifestations of herpetic viral retinopathies emphasizing how immune status shapes presentation, diagnosis, management, and prognosis. Recent studies suggest that ARN and PORN represent a spectrum influenced largely by host immune status rather than distinct diseases. Ultra-widefield imaging improves detection of far-peripheral lesions, while PCR of aqueous or vitreous enables rapid etiologic confirmation. In ARN, high-bioavailability oral antivirals, often with adjunct intravitreal injections, accelerate lesion regression and reduce fellow-eye involvement. In PORN, monotherapy performs poorly; combined intensive intravitreal and systemic therapy improves local control but vision remains limited in advanced immunosuppression. Prompt differentiation based on inflammatory signs, lesion morphology, and host immunity directs therapy. ARN generally responds to systemic agents yet carries substantial detachment risk; PORN progresses quickly with worse outcomes despite aggressive care. Early diagnosis coordinated medical–surgical management, and close surveillance are critical; priorities include optimal dosing and duration of antiviral therapies as well as adjunctive anti-inflammatory strategies.
