Background: Keratomycosis, a fungal corneal infection prevalent in tropical regions, frequently leads to visual impairment and blindness. Liposomal amphotericin B (L-AmB) offers improved efficacy and reduced toxicity compared to conventional amphotericin B deoxycholate and represents a promising option for topical ophthalmic use. Objective: To evaluate and compare the therapeutic efficacy of L-AmB eye drops at 0.15% and 0.5% concentrations in experimental Aspergillus keratomycosis in New Zealand White rabbits. Methods: Four rabbits received midstromal corneal inoculation with a mixed suspension of Aspergillus flavus, A. fumigatus, A. niger, and A. terreus (2 x 10⁴ CFU/0.05 mL). L-AmB eye drops were applied hourly from day 8 post-inoculation until corneal cultures became negative. Antifungal susceptibility was assessed by disc diffusion. Clinical response was monitored by slit lamp examination using a modified scoring system. Results: Negative corneal cultures were achieved in all treated eyes within 10 to 18 days (mean 15 days, L-AmB 0.15%) and 11 to 15 days (mean 14 days, L-AmB 0.5%). No toxic effects were observed. Complete corneal transparency without cicatrix was achieved in one eye treated with L-AmB 0.15%. Conclusion: Both concentrations were effective and safe. Liposomal AmB 0.15% appears as efficacious as 0.5% for experimental Aspergillus keratomycosis. Clinical studies in humans are warranted.

BACKGROUND:To evaluate the demographic characteristics, sexual risk behaviours, and ocular manifestations of ocular syphilis, focusing on differences between human immunodeficiency virus (HIV)-positive and HIV-negative individuals. METHODS:This retrospective study included patients diagnosed with ocular syphilis at the Uveitis Clinic, Cipto Mangunkusumo Kirana Eye Hospital, from October 2023 to November 2024. Demographic, behavioural, and clinical manifestations were reviewed. Comparative analyses were performed at initial presentation to our referral centre between HIV-positive and HIV-negative patients with ocular syphilis. RESULTS:Forty-seven patients (81 eyes) were analysed, 78.7% (n = 37) being HIV-positive. Most were male (93.6%) with a median age of 35.3 years. Promiscuous sex without commercial sex workers was significantly associated with HIV positivity (p = 0.029) and was frequent among men who have sex with men (MSM) with HIV-coinfected individuals. Over half (54.1%) of HIV-positive individuals were newly diagnosed during their uveitis workup. Vitritis was common (86.4% of eyes), while anterior chamber inflammation (29.2% vs. 6.3%, p = 0.048) and posterior uveitis with necrotizing retinitis (47.7% vs. 25%, p = 0.085) were more frequent in HIV-positive than HIV-negative patients. CONCLUSION:Ocular syphilis showed marked male predominance (9:1) and high HIV co-infection rates. HIV positivity was linked to high-risk sexual behaviours, particularly among MSM with non-commercial partners. Clinical manifestations were diverse, with certain findings, with several findings-especially anterior chamber and necrotizing posterior inflammation-more frequent in HIV-co-infected individuals.

This study aims to measure oxidative stress levels in cataract patients with varying causes. Total antioxidant capacity (TAC) and malondialdehyde (MDA) levels in the aqueous humor are biomarkers of oxidative stress in the eye, in which ocular comorbidities and systemic conditions will influence preexisting oxidative stress, as will the phacoemulsification surgery performed. Consequently, this study investigates the changes in MDA levels after phacoemulsification and clinical manifestations of the corneal endothelial layer after surgery. Samples from 34 subjects were collected using a consecutive sampling approach. Ethical approval was obtained from the Ethics Committee of Cipto Mangunkusumo National Referral Hospital, Faculty of Medicine, University of Indonesia (Approval No. KET-1156/UN2.F1/ETIK/PPM.00.02/2024). Aqueous humor samples were collected during and after phacoemulsification to measure MDA and TAC levels. Biomarker results were analyzed using SPSS ver. 25. A total of 34 cataract patients with various conditions were analyzed. Prephacoemulsification MDA levels were found to be not significantly different among groups categorized by nuclear density and prior surgery status. Postphacoemulsification MDA level is 58.38 ng/mL, lower insignificantly compared to pre-MDA level. However, in the postoperative analysis, MDA levels were found to have no significant correlation between cumulative dissipated energy and endothelial cell density loss (P = 0.723 and P = 0.676). Biomarker levels can vary widely among cataract cases, reflecting heterogeneous oxidative stress responses. These short-term preliminary findings suggest that surgical parameters or early endothelial outcomes may not directly predict oxidative stress responses in the aqueous humor.

Ocular infections are a common cause of visual morbidity worldwide and continue to pose significant diagnostic and therapeutic challenges. Metagenomic next-generation sequencing (mNGS) enables unbiased detection of wide range of pathogens; however, its diagnostic utility in ocular infections warrant further evaluation. We evaluate the diagnostic performance of mNGS, highlighting its advantages, limitations, and future directions for clinical application. Twenty-one studies involving 1219 eyes were included. mNGS positivity rates ranged from 10 % to 94 %. Sensitivity ranged from 15 % to 100 % and specificity from 12 % to 100 %. Viral pathogens were the most frequently detected (15 out of 21 studies), followed by bacteria (14 out of 21), fungi (10 out of 21), and parasites (6 out of 21). A broad spectrum of pathogens at both the genus and species levels was identified. mNGS also helps in assessing AMR-associated genes and mutations linked to therapy susceptibility. mNGS appears to be a valuable tool for pathogen indentification in ocular infections, particularly for organisms undetectable by conventional diagnostic methods, although careful interpretation is required. Overall, mNGS demonstrated promising diagnostic performance across different types of ocular infections. Larger, well-designed studies employing standardized protocols are needed to address current limitations and to enhance the clinical applicability of mNGS in routine clinical practice.

Background Phacoemulsification is one of the most frequent surgeries in the world. However, prolonged use of phacoemulsification machines produces reactive oxygen species which will damage corneal endothelial cells. Ascorbic acid has an antioxidant capacity to neutralize oxidative stress in the anterior chamber. This study will investigate the protective effect of ascorbic acid on corneal endothelial cells in patients with hard nuclear cataracts. Methods This study is a double-blinded randomized controlled trial. Samples will be divided into three groups, and 500 mg vitamin C three times daily (1500 mg/day), or placebo will be received for seven weeks. Clinical characteristics, ascorbic acid, malondialdehyde, and total antioxidant capacity of patients in serum and aqueous humor will be measured before and after intervention and phacoemulsification. Conclusions Data from this study will reveal the protective effect of oral vitamin C supplementation on the corneal endothelial cells in patients with hard nucleus cataracts. This trial has been registered at ClinicalTrials.gov (identifier: NCT06781970; registered on 17 January 2025). The trial record is available at: https://clinicaltrials.gov/ct2/show/NCT06781970

Introduction: HLA-B27 is a genetic marker strongly associated with spondyloarthropathy (SpA) and acute anterior uveitis (AAU). Detection of this allele can support earlier diagnosis and targeted management. However, commercially available HLA-B27 tests are costly and often inaccessible in low- and middle-income countries, including Indonesia. Methods: A cross-sectional study was conducted involving 42 subjects: 14 with SpA, 19 with AAU, and 9 healthy controls. DNA was extracted from peripheral blood samples and analyzed using both conventional PCR (targeting exon 3 of HLA-B27) and a commercial HLA-B27 strip assay. Sensitivity, specificity, and diagnostic accuracy of conventional PCR were calculated against the commercial kit as the reference standard. Results: Conventional PCR showed high sensitivity (100%) and accuracy (85.71%) in SpA patients, indicating its potential as a reliable screening tool in this group. However, its performance in AAU patients was suboptimal, with lower sensitivity (40%) and specificity (55.56%). False positives and false negatives were observed, likely due to limitations in allele coverage by conventional primers. Conclusion: Conventional PCR is a promising, affordable alternative for HLA-B27 detection in SpA patients, particularly in resource-limited settings. However, its lower reliability in AAU cases highlights the need for careful clinical application and further optimization. Larger studies and local allele mapping are recommended to enhance diagnostic precision in diverse populations.

BACKGROUND:Corneal ulcers are a major cause of visual impairment in developing countries. In Indonesia, severe infective ulcers often require keratoplasty (KP) to preserve ocular integrity and improve outcomes. AIM:To determine demographic, clinical and microbiological characteristics, complications, and KP outcomes in patients with moderate to severe infective corneal ulcers. METHODS:A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1, 2018 and December 31, 2020, with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta. Data were extracted from medical records. RESULTS:A total of 99 eyes from 99 patients with a mean age of 41.7 ± 16.2 years were included. Eight-nine eyes of corneal cases were located at the central cornea with > 6 mm lesion size (forty-one eyes). The culture positivity rate was 33%, primarily composed of Staphylococcus epidermidis. Eyeball integrity was maintained in all patients. Mean uncorrected visual acuity (VA) before KP was 2.50 and improved to 2.04 after 3 months of follow-up. Twenty patients with a cornea that was kept transparent achieved a VA of 0.40. Complications after KP appeared in 60 eyes, while secondary glaucoma was the most common complication (28 eyes), followed by graft failure (24 eyes) and graft rejection (14 eyes). CONCLUSION:Corneal ulcers are a common problem in Indonesia following eye trauma. Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases, although complications are common.

Background:No randomised controlled trial (RCT) has previously evaluated the effect of antitubercular therapy (ATT) in patients with uveitis of undetermined cause who tested positive on interferon-gamma release assays (IGRA), despite the absence of other identifiable causes of uveitis. We aimed to assess the efficacy and safety of treatment involving ATT compared to treatment without ATT in these patients, with respect to uveitis resolution and reduction in the risk of relapse. Methods:We conducted a single-blind, single-centre, phase 2 RCT at the uveitis clinic of Cipto Mangunkusumo Hospital in Jakarta, Indonesia, from August 16, 2021, to February 5, 2024. Seventy-six adults with newly diagnosed, active uveitis of undetermined cause and a positive IGRA were randomised 1:1 using block randomisation (block size 4) into two groups. Participants in the ATT group received an additional full course of ATT in addition to systemic corticosteroids. The control group received systemic corticosteroids without ATT. Investigators were masked to group assignment. The primary endpoint was the complete resolution of uveitis six months after randomisation. The trial is registered at ClinicalTrials.gov (NCT05005637). Findings:Seventy-six participants were randomly assigned to either ATT (n = 37) or control (n = 39) group. At primary end point, more participants assigned to the ATT group achieved the primary outcome of complete uveitis resolution compared to the control group (30/37, 81.1% vs. 20/39 participants; 51.3%, relative risk [RR] 1.58, 95% CI 1.12-2.23, p = 0.0060). Over the subsequent follow-up period, complete uveitis resolution was observed in 34 and 24 participants assigned to the ATT and the control groups, respectively. Additionally, uveitis relapse occurred in fewer participants assigned to the ATT group compared to those assigned to the control group (2/34 participants, 5.9% vs. 7/24 participants, 29.2%; HR 0.20, 95% CI 0.05-0.89, p = 0.0210). The findings regarding uveitis resolution and relapse rates were consistent in the per-protocol analysis. Interpretation:In IGRA-positive patients with uveitis of undetermined cause, initial treatment with ATT resulted in a significant benefit over those not receiving ATT. Funding:This work was supported by RISPRO-LPDP (Riset Inovatif Produktif-Lembaga Pengelola Dana Pendidikan).

Background Phacoemulsification is one of the most frequent surgeries in the world. However, prolonged use of phacoemulsification machines produces reactive oxygen species which will damage corneal endothelial cells. Ascorbic acid has an antioxidant capacity to neutralize oxidative stress in the anterior chamber. This study will investigate the protective effect of ascorbic acid on corneal endothelial cells in patients with hard nuclear cataracts. Methods This study is a double-blinded randomized controlled trial. Samples will be divided into three groups, and 500 mg of vitamin C, tid, or placebo will be received for seven weeks. Clinical characteristics, ascorbic acid, malondialdehyde, and total antioxidant capacity of patients in serum and aqueous humor will be measured before and after intervention and phacoemulsification. Conclusions Data from this study will reveal the protective effect of oral vitamin C supplementation on the corneal endothelial cells in patients with hard nucleus cataracts. This trial has been registered at ClinicalTrials.gov (identifier: NCT06781970; registered on 17 January 2025). The trial record is available at: https://clinicaltrials.gov/ct2/show/NCT06781970

PURPOSE:Corneal ulcer remains a major, ongoing health issue worldwide as it leads to blindness. The study analyzed the epidemiological patterns, microbiological profiles, antimicrobial resistance, and therapeutic outcomes trends across two time periods to assess changes associated with expanded diagnostic capacity. METHODS:A 10-year retrospective research was conducted at Dr. Cipto Mangunkusumo Hospital, Jakarta (2015-2019, 2022- 2024). Clinical, microbiological, and treatment data were analyzed using chi-square tests and multivariable regression with propensity score matching to identify predictors of improvement. RESULTS:A total of 1,100 eyes were examined. About two-thirds of patients were male, and the majority were aged 41 to 60 years, with trauma as the leading risk factor. Diagnostic testing increased markedly after 2022, revealing predominantly bacterial infections, most commonly Pseudomonas aeruginosa and coagulase-negative Staphylococci, with greater culture positivity and organism diversity. Antimicrobial resistance rose substantially, particularly to fluoroquinolones and aminoglycosides, whereas vancomycin (Gram-positive) and ceftazidime (Gram-negative) remained most effective. Clinical outcomes improved significantly in 2022-2024. Chi-square analysis showed ulcer location, size, depth, severity, and anterior chamber reaction were associated with improvement. Multivariable regression identified ulcer size, severity, surgical treatment, and later period as independent predictors of better outcomes, whereas antibiotic class did not independently influence healing. CONCLUSIONS:Infectious corneal ulcer at our center remains predominantly bacterial, with evolving pathogen profiles and resistance patterns. Improved diagnostic access and standardized therapeutic protocols contributed to better outcomes. Routine culture testing and adherence to local resistance data are essential for guiding empiric therapy.

PURPOSE:The purpose of this study was to evaluate the utility of baseline interferon (IFN)-inducible gene expression as a prognostic biomarker for Anti-tubercular therapy (ATT) response in patients with undetermined cause of uveitis who tested positive for QuantiFERON-TB Gold (QFT-positive uveitis). METHODS:This prospective cohort study included 17 QFT-positive uveitis patients at a tertiary uveitis center in Indonesia. Baseline and week 2 peripheral blood transcripts were evaluated through real time-quantitative polymerase chain reaction to assess the expression of 10 IFN-inducible genes (IRF7, IFIT2, STAT1, IL1B, MyD88, TLR8, FCGR1B, GBP1, UBE2L6, and SERPING1). Patients were stratified into clusters based on gene expression patterns. The primary outcome was complete resolution of uveitis at 6 months. RESULTS:Hierarchical clustering revealed two distinct groups. Patients with higher baseline expression of IFN genes (Cluster 2) were more likely to achieve complete uveitis resolution after ATT compared to those with lower expression levels (Cluster 1) (80% vs. 43%). Using a previously established IFN gene signature score (IGSS) cutoff (≥5.61), 82% of high-scoring patients showed complete resolution, compared to only 33% in the low-scoring group (P = 0.046). However, week 2 gene expression changes did not correlate with treatment response, indicating limited utility in monitoring disease activity or predicting long-term outcomes. CONCLUSION:Baseline, but not week 2, peripheral blood IFN-inducible gene expression may serve as a prognostic biomarker for stratifying QFT-positive uveitis patients through prediction of their response to treatment. Patients with higher baseline IGSS are more likely to require ATT to achieve uveitis resolution at 6-month follow-up.

Cytomegalovirus retinitis (CMVR) is a significant cause of blindness in patients with advanced acquired immunodeficiency syndrome (AIDS). There are no established guidelines for its treatment, resulting in varied antiviral approaches. We pooled data from 59 studies (4,501 patients) to evaluate treatment variations and outcomes (CRD42022321088). Overall pooled estimates showed visual acuity improvement at 18% (95% CI: 7-41%), inflammation resolution at 90% (95% CI: 81-95%), retinal detachment at 11% (95% CI: 8-14%), and recurrence at 19% (95% CI: 11-31%). The main antiviral treatment approaches identified were: (1) intravenous antivirals alone in 33 studies, (2) intravitreal antivirals alone in 26 studies, (3) oral antivirals alone in 3 studies, and (4) a combination of systemic (oral or intravenous[IV]) and intravitreal antivirals in 7 studies, with varying schemes and durations. Ganciclovir was the predominant antiviral, with intravenous administration being the most reported (in 23 studies), followed by intravitreal administration (in 20 studies). While visual acuity improvement was comparable, inflammation resolution tended to be higher with intravitreal than with IV antivirals, though not statistically significant (88%, 95% CI: 69-96% vs 75%, 95% CI: 35-94%, p = 0.38). Retinitis progression rate for IV ganciclovir was lower than for those without ganciclovir. Inflammation recurrence was significantly lower in antiretroviral (ART)-treated compared to non-ART-treated HIV/AIDS patients (10% (95% CI: 4-20%) vs 33% (95% CI: 19-50%), p < 0.01). Neutropenia, particularly with ganciclovir, was the most reported adverse effect (up to 50%).

Purpose To provide the long-term outcome of patients with end-stage severe ocular surface disease (OSD) consecutively treated with cultivated oral mucosal epithelial transplantation (COMET) followed by limbal-rigid contact lens (CL)-wear therapy. Design Retrospective cohort. Methods In 23 eyes of 18 patients with severe OSD who underwent COMET surgery between 2002 and 2019 and who were followed with limbal-rigid CL-wear therapy for at least 1 year postoperative, patient demographics, best-corrected visual acuity (BCVA, logMAR), Ocular Surface Grading Scores (OSGS), surgical indication and adverse events were reviewed. Primary and secondary outcomes were BCVA and OSGS changes at baseline and final examination, respectively. Results This study involved 16 patients with Stevens-Johnson syndrome and 2 patients with mucous membrane pemphigoid (mean age: 59±15 years). The indications for COMET were as follows: corneal reconstruction for vision improvement (10 eyes (43.5%)), corneal reconstruction for persistent epithelial defect (4 eyes (17.4%)) and conjunctival (fornix) reconstruction for symblepharon release (9 eyes (39.1%)). The mean duration of CL-wear postsurgery was 6.4±3.9 years (range: 1.4 to 13.3 years). The mean BCVA at baseline and at final follow-up was logMAR 1.9±0.5 and 1.3±0.7, respectively (p<0.05). Compared with those at baseline, the OSGSs for symblepharon and upper and lower fornix shortening showed significant improvement at each follow-up time point post treatment initiation. No serious intraoperative or postoperative adverse events were observed. Conclusion In patients afflicted with severe OSD, COMET combined with limbal-rigid CL-wear therapy postsurgery was found effective for vision improvement and ocular surface stabilisation.

Objective The objective of this study is to determine the validity and reliability of the red filter meibography by smartphone compared with infrared in assessing meibomian gland drop-out.Methods and analysis An analytical cross-sectional study was done with a total of 35 subjects (68 eyes) with suspected MGD based on symptoms and lid morphological abnormalities. Meibomian glands were photographed using two smartphones (Samsung S9 and iPhone XR) on a slit-lamp with added red filter. Images were assessed subjectively using meiboscore by the two raters and drop-out percentages were assessed by ImageJ.Results There was no agreement in meiboscore and a minimal level of agreement in drop-out percentages between red filter meibography and infrared. Inter-rater reliability showed no agreement between two raters. Intra-rater reliability demonstrated weak agreement in rater 1 and no agreement in rater 2.Conclusion Validity of the red filter meibography technique by smartphones is not yet satisfactory in evaluating drop-out. Further improvement on qualities of images must be done and research on subjective assessment was deemed necessary due to poor results of intrarater and inter-rater reliability.

Purpose: To evaluate the correlation between dry eye symptoms and coronavirus disease 2019 (COVID-19) infection and to assess the real-time reverse transcription–polymerase chain reaction (RT‒PCR) of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) from the conjunctival swab. Methods: A prospective observational case series study was conducted of all suspected and confirmed COVID-19 patients from Dr. Cipto Mangunkusumo Hospital (RSCM) and the Universitas Indonesia Hospital (RSUI). On the first day of the visit (day 0), systemic clinical symptoms and naso-oropharyngeal (NO) RT‒PCR results will classify all subjects as non-, suspected, or confirmed (mild, moderate, and severe) COVID-19. In all patients, we determined the dry eye symptoms based on the Ocular Surface Disease Index (OSDI) and followed up 7(day 7) and 14 days (day 14) after the first visit. When it was technically possible, we also examined the objective dry eye measurements: tear meniscus height (TMH), noninvasive Keratograph® break-up time (NIKBUT), and ocular redness. Additionally, we took conjunctival swab samples for SARS-CoV-2 RT-PCR in all patients. Results: The OSDI scores for 157 patients decreased across days 0, 7, and 14 (median (interquartile range): 2.3 (0–8), 0 (0–3), and 0 (0-0), p value < 0.0001 (D0 vs D14). The moderate-severe COVID-19 group had a higher OSDI score than the other groups at median D0 (15.6 vs 0–2.3), p value < 0.0001 and this pattern was consistently seen at follow-up D7 and D14. However, dry eye complaints were not correlated with the three objective dry eye measurements in mild-moderate COVID-19 patients. NO RT‒PCR results were positive in 32 (20.4%) patients, namely, 13 and 19 moderate-severe and mild COVID-19 patients, respectively. Positive RT‒PCR results were observed in 7/157 (4.5%) conjunctival swab samples from 1 in non-COVID-19 group and 6 in mild group. Conclusion: In the early phase of infection, COVID-19 patients experience dry eye symptoms, which have no correlation with objective dry eye measurements. SARS-CoV-2 in conjunctival swab samples can be detected in patients with normal-to-mild COVID-19, which shows the risk of ocular transmission.

Acute retinal necrosis is a progressive intraocular inflammatory syndrome characterized by diffuse necrotizing retinitis that can lead to a poor visual outcome, mainly from retinal detachment. The antiviral treatment approach for acute retinal necrosis varies as there are no established guidelines. We summarize the outcomes of acute retinal necrosis with available antiviral treatments. Electronic searches were conducted in PubMed/MEDLINE, EMBASE, Scopus, and Google Scholar for interventional and observational studies. Metaanalysis was performed to evaluate the pooled proportion of the predefined selected outcomes. This study was registered in PROSPERO (CRD42022320987). Thirty-four studies with a total of 963 participants and 1,090 eyes were included in the final analysis. The estimated varicella-zoster virus and herpes simplex virus polymerase chain reaction -positive cases were 63% (95% CI: 55-71%) and 35% (95% CI: 28-42%), respectively. The 3 main antiviral treatment approaches identified were oral antivirals alone, intravenous antivirals alone, and a combination of systemic (oral or intravenous) and intravitreal antivirals. The overall pooled estimated proportions of visual acuity improvement, recurrence, and retinal detachment were 37% (95% CI: 27-47%), 14% (95% CI: 8-21%), and 43% (95% CI: 38-50%), respectively. Patients treated with systemic and intravitreal antivirals showed a trend towards better visual outcomes than those treated with systemic antivirals (oral or intravenous) alone, even though this analysis was not statistically significant (test for subgroup differences P = 0.83). (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Purpose: To assess the clinical relevance of pathophysiology-based biomarkers, specifically serum C1q and whole blood interferon gene signature score (IGSS), in ocular tuberculosis (OTB) diagnosis by conducting an integrative analysis of clinical presentations and treatment response. Methods: This retrospective cohort study analysed data from 70 patients with suspected OTB at a tertiary care uveitis practice in Indonesia. Serum C1q levels and whole blood IGSS were quantified. Patients were categorized into four quadrants based on their biomarker profiles: quadrant 1 (high C1q & low IGSS), quadrant 2 (high C1q & high IGSS), quadrant 3 (low C1q & high IGSS), and quadrant 4 (low C1q & low IGSS). Characteristics of clinical presentations, work-up results, and treatment outcomes were explored according to the predefined quadrants. Results: We identified that the majority of OTB patients diagnosed with concurrent active pulmonary TB were in quadrant 1, 2, or 3 (20/23, 87.0%). Twenty-seven patients (27/47, 57.4%) with clinically undifferentiated uveitis were in quadrant 4 (p < 0.001). Among patients in quadrants 1, 2, and 3, completion of a full course of antitubercular treatment (ATT) was associated with a lower number of patients showing persistence or recurrence of ocular inflammation compared to those who were not fully treated with ATT (14.3% vs 85.7%, p = 0.001). Conclusions: Based on the analysis of clinical features and treatment outcomes, patients with elevated levels of either or both serum C1q and whole blood IGSS may reflect active TB disease in the eye, necessitating full ATT management.

Introduction & Objectives : Essential blepharospasm is a neurological condition that is defined by uncontrolled and abnormal eyelid closure from a central cerebral disorder. Between 40%-85% of blepharospasm occurs in conjunction with dry eye symptoms. Botulinum neurotoxin (BoNT) injections are commonly used treatment for reducing spasms in blepharospasm. Furthermore, it is often suggested for dry eye therapy due to their ability to reduce lacrimal drainage. The purpose of this review is to assess the effectiveness of BoNT treatment for blepharospasm with dry eye symptoms. Methods : A literature research was conducted on online databases such as PubMed, Cochrane library and Google scholar. All studies of BoNT and dry eye with full-text journals published in English within the last 10 years were included. We assessed Tear Breakup Time (TBUT), Schirmer Test, and Blepharospasm Disability Index (BSDI). Results : 204 patients from 6 publications were analyzed. In five trials, the BoNT treatment statistically significant increased TBUT (p<0,5), with mean final TBUT 5,7 ±1.1 s. Furthermore, the Schirmer test also increased with the mean final score 6,29 ± 4,6 mm. The mean BSDI score dropped by 6,05 ± 3,7 in two studies. Conclusion : It is confirmed that BoNT injection is an effective treatment for essential blepharospasm with dry eye symptoms. Clinicians should be screened for dry eye in all blepharospasm patients prior to BoNT treatment.