bluuebunny/crossref_metadata_2025 huggingface dataset:
Retinal image quality with myopia control lenses, in the synthetic accommodative wavefront model
Authors: García Maria Mechó , Fernandes Paulo , Faria‐Ribeiro Miguel Ángel
Published: January 2025

Aims/Purpose: Current myopia control contact lenses (CLs) are based on multifocality designs that affect decrease retinal image quality (RIQ). This study aimed to evaluate the changes in RIQ and accommodative response (AR) with two myopia control CLs.

Methods: 100 synthetic eyes were generated using anc accommodative wavefront model to simulate the changes in RIQ with accommodation. The synthetic eyes were “fitted”, using direct wavefront summation, with two myopia control CLs: the MiSight with +2.00D treatment zones and the Mylo with an EDOF design. Peak image quality was calculated for the naked eye and with CLs, in the relaxed state and a target vergence of 40 cm, with an entrance pupil diameter of 4.28 mm. Additionally, the AR that maximizes RIQ was calculated.

Results: The mean RIQ [ranged from 0 to 1] for the relaxed eye was 0.42 ± 0.10 without a CLs. It halved to 0.26 ± 0.05 with the Misight and reduced by threefold to 0.15 ± 0.04 with the Mylo. For 40cm the RIQ was 0.34 ± 0.09 without a CL, 0.24 ± 0.07 with the Misight and 0.19 ± 0.03 with the Mylo.

For target vergences with demands close the effective add power of the CL, the accommodative RIQ through‐focus produced a second peak prior to the maximum peak, correspondent to the focusing power of the treatment zones1, yielding a RIQ of 0.08 ± 0.03 and 0.12 ± 0.04 for the Misight and Mylo, respectively. The AR without CL was 2.33 ± 0.20 D, 1.75 ± 0.22 D and 1.75 ± 0.22 D with the Misight and the Mylo, respectively.

Conclusions: Both myopia control CLs reduced the RIQ in the relaxed and accommodated states. For 40 cm, both CLs induce a secondary peak in the RIQ through‐focus. With Mylo, the secondary peak appeared less than 0.1D from the maximum peak, possibly due to its EDOF design. The AR was reduced with both CLs 0.58 D (lag) compared to the naked eye condition. These results indicate that, both lenses impose significant limitations RIQ and AR.

References: Faria‐Ribeiro M, Amorim‐de‐Sousa A, González‐Méijome JM. Predicted accommodative response from image quality in young eyes fitted with different dual‐focus designs. Ophthalmic Physiol Opt. 2018; 38(3): 309–16.
Repeatability of pentacam AXL in determining axial length and ocular indices in people with irregular cornea
Authors: Yekta Abbas Ali , Irandoust Nilufar , Khabazkhoob Mehdi , Ostadimoghaddam Hadi , Hashemi Hasan , Heravian Javad , Ehsaei Asieh , Yekta Yeganeh , Sardari Sara , Yekta Reihaneh
Published: January 2025

Aims/Purpose: To determine the repeatability of Pentacam AXL in determining ocular axial length and some corneal indices in people with irregular corneas.

Methods: Ocular biometry using Pentacam AXL underwent in this study. The Pentacam AXL measurements were done 3 times 10‐minutes apart. To evaluate the repeatability, the intraclass correlation coefficient (ICC), were calculated.

Results: In this study, 141 eyes of 141 individuals with irregular cornea aged 60 to 91 years (64 ± 15.7) were included. The ICC of axial length, flat keratometry, steep keratometry, anterior chamber depth, central corneal thickness and corneal diameter measurements were 0.957, 0.981, 0.989, 0.980, 0.923 and 0.981 respectively. In cases with long axial length (>24.5mm) the ICC of axial length, flat keratometry, steep keratometry, anterior chamber depth, central corneal thickness and corneal diameter measurements were 0.427, 0.946, 0.993, 0.988, 0.861 and 0.989 respectively.

Conclusions: The results of this study showed that generally Pentacam AXL has a high repeatability in measuring the axial length and some corneal indices of the eye in irregular corneas. However, it should be note that Pentacam AXL has no repeatability in irregular corneas with long axial length.
Personalized approach for laser posterior capsulotomy in patients with open‐angle glaucoma and non‐proliferative diabetic retinopathy
Authors: Gogichaishvili Nino , Rabadanova Madina , Kazantseva Angelina
Published: January 2025

Aims/Purpose: The purpose of this study was to evaluate the results of the Visual Acuity Test, Autorefractometry, Pneumotonometry, Bio‐ophthalmoscopy, B‐scanning after the YAG laser Posterior Capsulotomy in patients with Open‐Angle Glaucoma and Non‐proliferative Diabetic Retinopathy.

Methods: A Retrospective Cohort Study was conducted in 45 patients with OAG and NPDR. After the standard ophthalmological examination, the patients were divided into 2 groups: group 1 included 26 patients (18 women and 8 men) with OAG, average age was 68.4 ± 5 years, group 2 included 19 patients (12 men and 7 women) with NPDP, the average age was 73.8 ± 4 years. Taking into account the international protocol, all patients underwent laser capsulotomy of the posterior capsule using an Ocular Abraham Capsulotomy Lens. In patients of the first group, laser capsulotomy was performed with a power of 2‐3 mJ, laser hole – 2 mm, in patients of the second group – with a power of 1‐1.5 mJ, laser hole – 2 mm.

Results: After the Laser Capsulotomy in patients of the first group there was a significant positive change in Visual Field Test: increased from 0.44 to 0.97 and in patients of the second group increased from 0.33 to 0.62. At the same time, the level of IOP remained stable: in patients of the first group before laser capsulotomy, the IOP was 19.9 ± 2.4 mm Hg, after surgery – 20.3 ± 2.4 mm Hg., in patients of the second group before laser surgery – 17.2 ± 1.4 mm Hg., after laser surgery ‐17.8 ± 2.7 mm Hg.

Conclusions: After the laser capsulotomy, in the patients of the group 1 with OAG (26 patients), visual acuity significantly increased by 53.2%, in the group 2 (19 patients) – by 45.4%. The IOP level and B‐scanning results after the laser capsulotomy practically did not change and remained stable. It has been established that a personalized approach to laser capsulotomy allows one to avoid a number of complications at different stages of the operation and in the postoperative period.
Actual lens position of three intraocular lenses in highly myopic eyes: An ultrasound biomicroscopy‐based study
Authors: Qi Jiao , Zhu Xiangjia
Published: January 2025

Aims/Purpose: To evaluate the actual lens positions (ALPs) of three intraocular lenses (IOLs) in highly myopic eyes and to identify relevant factors using ultrasound biomicroscopy (UBM).

Methods: Ninety‐three highly myopic eyes (93 patients) that underwent uneventful cataract surgery were included: 36 eyes were implanted with Zeiss 409MP IOLs, 27 with Rayner 920H IOLs, and 30 with HumanOptics MCX11 IOLs. The prediction error (PE), ALP determined by UBM, and the factors associated with ALP at 3 months after surgery were evaluated.

Results: The eyes in the MCX11 IOL group had a more hyperopic PE (0.67 ± 0.45 diopters [D]) and greater ALP (4.86 ± 0.39 mm) than those in the 409MP and 920H IOL groups at 3 months after surgery (PE: −0.25 ± 0.54 and −0.16 ± 0.65 D, respectively; ALP: 4.34 ± 0.26 and 4.14 ± 0.32 mm, respectively). The MCX11 IOLs showed more backward bending deformation after surgery than 409MP and 920H IOLs. The radius of curvature of the IOL was negatively correlated with ALP (r = −0.532, p = 0.002) in the MCX11 IOL group, but not in the other two groups. Multivariate analysis showed that MCX11 IOLs were more prone to bending in highly myopic eyes with a smaller anterior capsular opening (β = 0.236, p = 0.023) and lower implanted power (β = 0.542, p = 0.001).

Conclusions: In highly myopic eyes, IOLs with good capsular support show less backward bending, which result in a more stable lens position and refractive status postoperatively. Severe capsular contraction and low implanted power are risk factors for bending of certain IOLs.
The effect of peri‐ and preoperative anxiety on cardio‐vascular parameters and intraocular pressure of patients awaiting cataract surgery
Authors: Dimitrova Galina , Gjorgjiovska Ana , Ljubic Antonela , Jordanovska Sofija Milanovska
Published: January 2025

Aims/Purpose: To evaluate peri‐ and preoperative anxiety in patients scheduled for cataract surgery and its effect and correlation with cardio‐vascular parameters and intraocular pressure (IOP).

Methods: Thirty patients scheduled for cataract surgery were included in the study. Exclusion criteria were any previous ocular surgery on both eyes, glaucoma and any sign of acute or chronic ocular inflammation. In addition to the general ophthalmic examination at the initial evaluation patients were asked to define their level of anxiety using a visual facial anxiety scale (VFAS). Systemic blood pressure (BP) and heart rate (HR) were measured using an automated brachial sphygmomanometer and IOP was measured using an air‐puff tonometer. Mean of three measurements was calculated for both BP, HR and IOP. VFAS, BP, HR and IOP measurements were repeated on the day of surgery. T test was used to compare the peri‐ and preoperative parameters and Pearson's coefficient of correlation was used to study correlation between VFAS, BP, HR and IOP.

Results: The mean level of anxiety according to patients’ self‐evaluation was mild to moderate both at the peri‐ and at the preoperative day. The cardio‐vascular parameters and IOP were not significantly different at the peri‐ and preoperative days. IOP was significantly correlated to HR in the perioperative period (R = 0.62, p < 0.001), whereas in the pre‐operative day it was significantly correlated with systolic BP (R = 0.47, p = 0.009) and with level of anxiety (R = 0.29, p = 0.04). Patients with moderate to high levels of anxiety (grades 3‐5) had significantly higher IOP (17.06 ± 1.69 mmHg) than patients with none to mild/moderate anxiety (grades 0‐2) (14.74 ± 2.41 mmHg; p = 0.006).

Conclusions: Systemic cardio‐vascular parameters are correlated with IOP and the level of anxiety in patients scheduled for cataract surgery. IOP is higher in patients with higher degrees of anxiety.
The importance of adequate preparation of the ocular surface before biometry in reducing refractive errors in patients undergoing cataract surgery
Authors: Biela Katarzyna , Winiarczyk Mateusz , Mackiewicz Jerzy
Published: January 2025

Aims/Purpose: To evaluate the impact of dry eye disease (DED) on refractive errors in patients after cataract surgery.

Methods: Fifty patients undergoing cataract surgery were studied. Two study groups and a control group were distinguished. The first study group (group A, n = 22, 44%) were patients with preoperatively diagnosed DED who received appropriate treatment (eyelid margin hygiene and moisturizing the ocular surface). The second study group (group B, n = 14, 28%) were patients in whom such treatment was also implemented, despite the lack of a diagnosis of DED. The remaining patients (n = 14, 28%) were the control group (Group C). Biometric measurements with calculation of intraocular lens (IOL) power were performed twice in all of them (before and after treatment of DED). Refraction and refractive errors were evaluated one month after surgery.

Results: Significant improvement in best corrected visual acuity (BCVA) was obtained in all groups after surgical treatment. In both study groups, a significant reduction in the mean absolute error (MAE) after the treatment was achieved – in study group A, the MAE was 0.37 ± 0.30 D vs 0.24 ± 0.33 D, p = 0.003. In study group B, MAE was 0.29 ± 0.26 D vs 0.23 ± 0.23 D, p = 0.017. The control group showed no difference in MAE (0.27 ± 0.18D vs 0.33 ± 0.21 D, p = 0.322). In study group A, there was a significant reduction in the percentage of MAE in the ± 0.25 D range (36.36% vs 77.27%, p = 0.016). The results are comparable with previous publications.

Conclusions: Diagnosis and treatment of dry eye syndrome before cataract surgery is an important factor in reducing refractive errors after surgery. The use of lubricating drops and eyelid margin hygiene before biometry can be considered for all patients undergoing cataract surgery.
Clinical impact of intraocular lens tilt and decentration on visual outcome in patients undergoing cataract surgery
Authors: Rodríguez Laura Moreno , Tielas Lourdes Salgueiro , Sánchez‐Lozano Azahara , García‐Onrubia Luis , Velarde‐Rodríguez Gonzalo , Faria‐Ribeiro Miguel Ángel , Alejandre‐Alba Nicolás
Published: January 2025

Aims/Purpose: To study the association between best corrected visual acuity (BCVA) and tilt and decentration of Clareon intraocular lenses (IOL) (CNA0T0). Additionally, to evaluate the best corrected visual acuity for intermediate distance (BCVA‐ID), the kappa angle represented as the distance of the Mu chord (CMu), the white‐to‐white distance (WTW), axial length (AL), and capsulorhexis characteristics.

Methods: A cross‐sectional study was conducted including both eyes of a total of 111 patients. BCVA and BCVA‐ID (60cm) were expressed in LogMAR. Photographs were taken to assess the circularity, area, and principal radii of the capsulorhexis. The tilt and decentration of the IOL, as well as the WTW distance, were measured with anterior segment OCT (CASIA II). AL and CMu were evaluated with the IOL Master 700 biometer.

Results: The median monocular and binocular BCVA were 0.00 [IQR 0.05] and ‐0.02 [0.1], respectively, while the median BCVA‐ID was 0.6 [0.06] and 0.49 [0.06]. The median IOL tilt was 5.30 [1.50], with a decentration of 0.23 [0.17]. The median WTW distance was 11.82 [0.53], the median CMu was 0.35 [0.21], and the capsulorhexis circularity was 93.7 [6] %.

In the correlation analysis, no significant association was observed between IOL tilt and BCVA (r = 0.03 p = 0.63); however, there was a significant association with BCVA‐ID (r = ‐0.16 p = 0.01). None of the other variables showed correlation, except for IOL tilt and CMu (r = 0.20 p < 0.001) and AL (r = ‐0.35 p < 0.001).

Conclusions: IOL tilt is not correlated with best corrected visual acuity for distance, although it is correlated with intermediate distance visual acuity. The measured values of tilt and decentration are low, suggesting good postoperative stability of the intraocular lens.

Study partially supported by an Investigator Initiated Trial Grant from Alcon (#78232309).
Quantifiying epithelial cell viability on whole porcine lenses using triple hoechst‐ethidium‐calcein‐am staining in a chemical toxicity model
Authors: Poinard Sylvain , Coulomb Louise , Chapelon Gabriel , Cortez Oliver Dorado , Thomas Justin , He Zhiguo , Perrache Chantal , Ganeau Alice , Forest Fabien , Mascarelli Frederic , Gain Philippe , Thuret Gilles
Published: January 2025

Aim: Establishing an ex vivo model of the crystalline lens will be a driving force for further research on this tissue. The epithelium plays an essential role in maintaining osmolarity, volume, and lens transparency. Therefore, it is crucial to have a tool to control the lens epithelium ex vivo. We have previously validated a method for quantifying epithelial cell viability on whole lenses ex vivo by triple labeling with Hoechst 33342, ethidium homodimer and calcein‐AM (HEC) using a model of acute frostbite necrosis. We now demonstrate the application of this triple labeling to a model of chemical toxicity by Staurosporine (STS) which induces cell death scattered all over the epithelial surface with a mild severity.

Methods: Ten fresh pairs of 6‐month‐old porcine lens were retrieved. On one lens, a diffuse epithelial lesion was induced by an incubation in STS solution (0.5 μM in CorneaMax, Eurobio) during 24 hours at 37°C. The other was incubated in CorneaMax solution without STS in the same conditions. The day after, both were incubated for 1 hour at 20°C in a HEC mixture. Images were acquired with a macroscope (macro zoom microscope) and analyzed with ImageJ. Calcein‐AM and Ethidium images were used to calculate the area covered by living epithelial cells. Hoescht images allowed to count cell nuclei per unit area. Viable epithelial cell density (vEpCD) was defined as the number of viable cells per unit area. Different strategies were developed to reduce the background noise.

Results: There was no interfering lens auto‐fluorescence for the exposure times used. The median vEpCD was 3804 cells/mm2 [10th‐90th percentiles = 2922 – 4862] for STS treated‐lenses versus 3896 cells/mm2 [3169 ‐4980] for control lenses (p = 0.002).

Conclusion: The assessment of lens epithelial cell viability has been proposed only in cell culture or isolated capsule models. Thanks to a simple sample preparation, triple HEC staining allows fluorescence imaging on large series of whole lens in order to respect the architecture of the epithelium. This STS model induces a subtle change in mortality, confirming the sensitivity of the technique and its use for cytotoxicity studies of new therapeutics targeting the lens.

References

Mechanisms of staurosporine induced apoptosis in a human corneal endothelial cell line. Thuret G & al. Br J Ophthalmol. 2003
Patient demographics and surgical outcomes of dropped nucleus in cataract surgery
Authors: Martins Pedro , Cabanas João , Cardoso Daniel , Sousa‐Neves Filipe
Published: January 2025

Aims/Purpose: To analyse the baseline demographic/clinical characteristics and visual outcomes of patients who experienced nucleus drop during cataract surgery with subsequent need for pars plana vitrectomy (PPV).

Methods: Retrospective case series of patients who underwent phacoemulsification for non‐traumatic cataract and experienced nucleus drop during surgery, with subsequent need for PPV to extract the dropped fragments. Demographic data, ocular comorbidities (such as ocular hypertension – OHT/glaucoma, pseudoexfoliation – PEX, presence of advanced white or brunescent cataract, shallow anterior chamber or previous intravitreal injections – IVI), timing of nucleus drop, intraoperative complications and post PPV visual outcomes and complications, for the study period (2018 to 2023), were collected.

Results: Over the study period 33 eyes of 33 patients experienced nucleus drop. 17 (52%) were male with a mean age of 74.4 ± 9.4 (45‐92) years. Pre‐operative visual acuity ranged from light perception to 0.22 logmar. Three patients (9.1%) had previously undergone IVI and 7 (21.2%) had glaucoma or OHT; 9 (27.3%) had PEX – all but one had poor pupillary dilation ( < 5 mm). A significant proportion of patients (13, 40.4%) presented with advanced brunescent/white cataracts. Most nucleus drops occurred following a posterior capsular rupture during quadrant removal (18 cases – 54.5%) or hydro‐dissection (8 cases – 24.3%); remaining cases occurred following a radialized capsulorhexis with posterior extension or due capsular bag‐nucleus luxation to the vitreous. PPV was uneventful in most cases – one patient developed an epiretinal membrane 2 years after PPV. Visual acuity improved by an average of ‐0.96 logmar in the post‐operative period.

Conclusions: PPV is the preferred management for nucleus drop after complicated cataract surgery. Current devices and surgeon expertise allow for a low risk of complications and good visual/anatomical outcomes.
Studies in the electroretinogram i‐wave: Evidence for off pathway origin and association with a myopia risk locus
Authors: Vetrivel Krishnika , Tan Jit Kai , Xu Zihe , Jiang Xiaofan , Leo Shaun , Bhatti Taha , Tariq Ambreen , Hammond Christopher , Hysi Pirro , Mahroo Omar
Published: January 2025

Aims/Purpose: A myopia‐risk locus near the GJD2 gene has been associated with cone‐driven electroretinograms (ERGs), specifically cone‐driven OFF pathway signals. In light‐adapted ERGs to a standard flash, conventionally measured components are the a‐wave and b‐wave. A later component, the “i‐wave”, is thought to originate in retinal OFF pathways, as evidenced by pharmacological experiments in primates. We investigated this component in human ERGs, testing the hypothesis that an association would be found with the myopia risk locus.

Methods: ERGs were examined from patients with rare monogenic post‐phototransduction deficits affecting only ON pathways, or both ON and OFF pathways, to explore which gave rise to the i‐wave. ERGs were then analysed from genotyped healthy adults from the TwinsUK cohort. The i‐wave amplitude was measured in the standard flash ERG by two investigators independently. We investigated association with allelic identity, adjusting for age, sex and inter‐individual relatedness. Separately, we adjusted for refractive error where this was available.

Results: Patient recordings showed i‐waves persisted in absence of ON pathway signals, but were abolished when both ON and OFF pathways were impaired. Recordings and genotypes were available in 184 TwinsUK individuals (95% female). Mean (SD) age was 64.1 (9.7) years. Allelic dosage at the risk locus was significantly associated with i‐wave amplitude Refractive error was available for 175 participants. The association in these individuals remained significant both before and after adjusting for refractive error (p = 0.035 and p = 0.043 respectively).

Conclusions: ERGs in patients are consistent with the human i‐wave arising from cone‐driven OFF pathways. i‐wave amplitudes associated significantly with allelic dosage at the myopia risk locus. This supports importance of cone‐driven signalling in myopia development and adds evidence that this locus affects cone‐driven OFF pathway signals.
Characterizing iPSC‐derived organoid models from the most prevalent retinal dystrophies
Authors: Navinés‐Ferrer Arnau , Gaudó Paula , Méndez‐Vendrell Pilar , Ruiz‐Nogales Sheila , Siles Laura , Pomares Esther
Published: January 2025

Aims/Purpose: To establish novel retina cell models to investigate the mechanisms that lead to cell death in IRD.

Methods: We generated induced pluripotent stems cells (iPSC) from a cohort of patients with some of the most prevalent IRDs: Retinitis Pigmentosa (RP), Stargardt Disease, Best Disease and Achromatopsia. We differentiated them into PR precursors, retinal organoids (RO) or retinal pigment epithelium cells (RPE) and analyzed the functional implications of each gene and pathogenic variant.

Results: All cell models generated from 6 iPSC lines allowed for a better understanding of the molecular mechanisms of IRD. Specifically, in the Best Disease model, we determined using RPE cells that a particular dominant mutation in BEST1 is responsible for a defective closure of the bestrophin pentameric channel. The mutation responsible for RP in RHO shows rhodopsin accumulation and mislocalization, along with an increase of autophagy and ER stress. RO models with mutations in the genes PDE6A and PDE6C, causing respectively RP and Achromatopsia, suggest that expression levels of the pathogenic proteins are diminished. Finally, RPE and RO from two distinct Stargardt Disease patient lines show affectations in bisretinoid disposal, phagocytosis reduction and cell death. Interestingly, those results correlate with the severity of the phenotypes.

Conclusions: We show that a wide range of mutations responsible for IRD can be studied using iPSC‐derived retinal models. This opens the door to a deeper understanding of retinal diseases and are key for the development of successful gene and cell therapies.

References: Inherited retinal dystrophies (IRD) are a group of rare diseases where photoreceptor (PR) cell death leads to partial or total visual impairment. Over 300 genes have been determined to cause these dystrophies, but most of the molecular mechanisms underlying the start and development of the pathology are still waiting to be unraveled.
Retinal neurovascular coupling in long covid patients
Authors: Lindner Theresa , Pai Viktoria , Janku Patrick , Pylypenko Liudmyla , Ehm Astrid , Fritsch‐Stork Ruth , Garhöfer Gerhard , Schmidl Doreen
Published: January 2025

Aims/Purpose: Long COVID is a multi systemic condition that occurs in some patients after acute SARS‐CoV‐2 infection. It has been hypothesized that endothelial dysfunction might be involved in the disease process. Assessment of neurovascular coupling (NVC) in the retina is a non‐invasive method to measure endothelial function. Briefly, stimulation of the retina with flicker light usually leads to a significant increase in retinal blood flow. This mechanism has been found to be disturbed in diseases that are associated with endothelial dysfunction.

In this context, we investigated whether changes in NVC can be found in patients with long COVID compared to healthy subjects.

Methods: We included patients who had a previously confirmed COVID‐19 infection and were diagnosed with long COVID according to WHO guidelines. Healthy subjects had no history of COVID‐19 infection and were negative for SARS‐CoV‐2 seroprevalence. To assess NVC, diffuse flicker light stimulation was performed over 60s using the Dynamic Vessel Analyzer (DVA, Imedos, Germany). We calculated the percentage increase in mean vessel diameter of arteries and veins in response to the flicker light relative to the baseline diameter size.

Results: Fifteen (15) patients with long COVID and 11 healthy subjects were included in the current study. During stimulation with flicker light, the diameters of retinal arteries and veins significantly increased in patients with long COVID (3.1 ± 3.5% for arteries and 4.8 ± 2.9% for veins, p < 0.001 vs. baseline each). The same was found for healthy controls (increase in arteries: 3.4 ± 3.0%, increase in veins: 4.2 ± 1.8%, p < 0.001 vs. baseline each). No difference between the two groups in the flicker response was observed (p = 0.792 for arteries and p = 0.579 for veins).

Conclusions: In our small study, NVC was not altered in patients with long COVID compared to healthy subjects. However, further studies including larger sample sizes are needed to assess vascular issues in long COVID patients to better understand the underlying pathophysiological mechanisms.
Non‐invasive variables to assess acute stress in surgical personnel: A pilot study
Authors: Beyrouti Rubén Cabrera , García Marina López , Guerra Rocío Alfayate , Quesada María Eugenia Torregrosa , Ferré Jorge Francés , Bueno María Victoria González , Aracil‐Marco Adolfo
Published: January 2025

Aims/Purpose: To evaluate the use of non‐invasive markers of acute stress in healthcare workers during surgery.

Methods: Fifteen ophthalmologists (9 men; 6 women) and one interventional radiologist were recruited. They were assessed on two different days: a) at rest, early morning, at home; b) in the hospital, at four different time points: on arrival, before hand‐washing, after completion of surgery and approximately 30 minutes later. The following measurements were taken: a) heart rate (HR) and heart rate variability (HRV, an indicator of parasympathetic activity) using a Polar HR9 monitor and the EliteHRV® app; and b) salivary cortisol using ECLIA (Cobas 411® autoanalyzer, Roche Mannheim). Data were analysed using Sigmaplot® (Pearson correlation coefficient; one‐way repeated measures ANOVA).

Results: The sample consisted of individuals with a mean age of 40.4 ± 10.9 years and a mean professional experience of 10.5 ± 11.6 years. No significant correlations were found between the different variables on any of the days. However, on the day of surgery, both heart rate (HR) and salivary cortisol were significantly lower in the final measurement (HR = 67.9 ± 9.9 beats per minute; cortisol: 0.22 ± 0.10 μg/dL) compared to the preoperative values (HR = 74.6 ± 12.8 beats per minute, p = 0.004; cortisol: 0.47 ± 0.19 μg/dL, p = 0.001). In addition, heart rate variability (HRV) tended to be lower in the pre‐ and post‐intervention measurements.

Conclusions: This pilot study suggests that non‐invasive measurement of variables such as HR, HRV and salivary cortisol concentration may be useful in assessing the level of acute stress experienced by healthcare professionals during surgical activity. However, further studies are needed to identify the most sensitive and specific variables for this purpose.
Actin‐related proteomic changes in age‐related, diabetic and post‐vitrectomy cataract
Authors: Karakosta Christina , Samiotaki Martina , Parayotou George , Papaconstantinou Dimitrios , Moschos Marilita
Published: January 2025

Aims/Purpose: Actin has been implicated in lens opacification; however, the specific actin‐related pathways involved in cataracts remain unclear. In this study, actin‐related signaling pathways involved in the development of different types of cataract were evaluated.

Methods: Two sample types were collected during routine cataract surgery; the anterior capsule (AC) and phacoemulsification cassette contents (PCC). Participants were divided into three groups. Age‐related cataract (ARC) group included 12 patients without a history of DM, and age > 75 years; Diabetic cataract (DC) group included 11 patients with diabetes mellitus (DM) and age < 65 years.; and Post‐vitrectomy cataract (PVC) group included 7 patients without a history of DM, who had vitrectomy surgery in the past 12 months. The sample preparation was based on Sp3 protocol (Single‐Pot, Solid‐Phase‐enhanced, Sample‐Preparation). Liquid chromatography online with tandem mass spectrometry was used for protein recognition and quantification. DIA‐NN software was applied for data analysis. Statistical analysis was performed on Perseus software.

Results: In PCC samples, proteins with significant differential expression in ARC compared to DC and PVC were involved in pathways including actin binding, actin cytoskeleton reorganization, and small GTPase‐mediated signal transduction pathways. In AC samples, proteins with significant differential expression in ARC compared to DC and PVC were involved in actin binding and actin cytoskeleton reorganization pathways.

Conclusions: Our findings suggested that actin‐binding pathway may be involved in ARC formation by causing abnormal lens fiber cell elongation and differentiation. The results of the present study revealed that small GTPase‐mediated signal transduction pathway exhibit lower expression in ARC than in the DC and PVC groups in PCC, and this may be linked to ARC formation through abnormal fiber cell organization, leading to lens opacification and cataract.
"Tinu‐like syndrome" as a rare adverse effect of nivolumab: A clinical case
Authors: Bestué Ana Pueyo , Pueyo‐Bestué Ignacio , Fernández‐Velasco Diego , Mallén Victor , Bermúdez Javier , Biescas Andrés , Rius Núria , Ila Carmen , Hernández‐Barahona Claudia , García‐Navarro Damian
Published: January 2025

Aims/Purpose: By presenting this clinical case, our main purpose is to raise awareness of the growing incidence of immune‐related adverse effects (irAEs) with patients undergoing treatments such as Nivolumab.

Methods: Presentation of clinical case from our Ophthalmology department

Results: Our clinical case consists of a patient 66‐year‐old male, presenting pain in both eyes since a couple of days. On examination, in addition to reduced visual acuity (VA) of 6/10 in both eyes, bilateral cellular Tyndall grade 2 was noticed, with no other findings in the anterior or posterior segment. When inquiring into his background, he was being treated with oral corticosteroids due to grade 2 Immune‐mediated Nephritis, attributed by the Oncology service of the same center to the use of Nivolumab in the context of stage IV lung carcinoma. Analytical findings highlighted elevated inflammatory markers, as well as positivity for HLADQA1*01. After a month of topical corticosteroid and mydriatic therapy, VA and anterior segment inflammation returned to normal.

Conclusions: TINU syndrome (Tubulointerstitial Nephritis and Uveitis) is a rare entity, of uncertain pathogenesis, characterized by bilateral anterior uveitis that is usually preceded months before by Tubulointerstitial Nephritis. In addition, analytical findings such as elevated beta‐2 microglobulin in urine or certain haplotypes such as the already mentioned HLADQA1*01 stand out. Although it is a condition typical of adolescents or young people, it could, as in this case, debut late as a “TINU‐like” condition, likely as an immune‐related adverse effect of Nivolumab. Therefore, it is important to be alert to ocular symptoms in the context of any immune checkpoint inhibitor treatment such as Nivolumab
Case report of cancer‐associated retinopathy in a patient with neuroendocrine carcinoma of the esophagus
Authors: Monleón Claudia Hernández‐Barahona , Raez Carmen Ila , Navarro Damián García , Plata Carlos Santana , Rufas Inés Munuera , Pérez Elisa Funes , Merino Jacobo Yañez , Sopeña‐Pinilla Maria , Ciubotaru Olga , Barón Nieves Pardiñas , Bestué Ana Pueyo
Published: January 2025

Aims/Purpose: To present the case of a patient with Retinopathy associated with a neuroendocrine carcinoma of the esophagus and to analyze the characteristics of this paraneoplastic syndrome.

Methods: A 55‐year‐old man with glaucoma and no other relevant medical history came to the emergency department with sudden vision of a “star‐shaped figure” and photopsias in his left eye (OS).

Results: Visual acuity was 0.05 in his right eye (OD) and 1 in his OS. Slit‐lamp examination revealed a bilateral positive Tyndall effect. Fundoscopy of his OS showed nummular lesions in the posterior pole and along vascular arcades. Optical coherence tomography of his OS revealed hiperreflective lesions in the outer retinal layers, with some paravascular extension matching with the nummular lesions observed in the fundus. Fluorescein angiography revealed central mottling without clear vasculitis in his OD and central mottling with vasculitis over paravascular areas of the hyperfluorescence nummular lesions of his OS. The 24‐2 visual field test showed an increase in the blind spot and a nasal scotoma of the OS.

Despite a normal body TAC scan and non‐detected antiretinal antibodies, gastroscopy revealed a neuroendocrine carcinoma of the esophagus after the patient reported dysphagia for gaseous liquids. He began treatment with chemotherapy, radiotherapy and steroid boluses, which partially stabilized the lesions until he eventually deceased a year and half after diagnosis.

Conclusions: Cancer‐associated retinopathy should be considered in the differential diagnosis of patients with inflammatory signs and acute vision loss. Early diagnosis is crucial for the prognosis and treatment of the primary tumor.

References

J.Mª Caminal‐Mitjana. Manifestaciones intraoculares del cáncer sistémico. Neurology 2000; vol.; 31 pages: 1259 – 61.
Efficacy and safety of intralesional bleomycin as a treatment in eyelid hydrocystomas
Authors: Arzola Martin , Cárdenas‐Belaunzarán Jorge , Garcia Ariel Ceriotto
Published: January 2025

Aims/Purpose: To evaluate the efficacy and safety of intralesional bleomycin as a treatment for eyelid hydrocystomas.

Methods: A prospective, longitudinal, experimental, descriptive study was carried out; 33 patients with a clinical diagnosis of eyelid hydrocystoma were evaluated. Measurements were made in length, width and depth to obtain the volume of the lesion, clinical photographs were taken and intralesional bleomycin diluted at 1 unit – 1 milliliter was applied. Afterwards, a safety questionnaire was given. Clinical photographs, volume measurement and safety questionnaire were carried out at 3, 6 and 9 weeks post‐treatment. Persistent cysts received an additional injection. A repeated measures ANOVA was performed to analyze volumetric change

Results: 33 patients were evaluated, presenting with 102 hydrocystomas. Cyst mean volume was 21.16 mm3, 62.74% showed involution after 3 weeks of intralesional bleomycin injection.

After the first application of bleomycin, a decrease in the average millimeter volume of hydrocystomas of 92.2% was achieved.

At this point, remaining lesions had a mean volume of 1.66 mm3. At 6 weeks 90.19% showed involution with a mean volume of 0.98 mm3 and at 9 weeks 100% showed involution. This difference was clinically and statistically significant (F = 16.75, p < 0.05).

Conclusions: This study is a milestone to continue the evaluation of the effectiveness and safety of sclerosing treatments for hydrocystomas, the results obtained through intralesional injection of bleomycin are promising.

We can conclude that the use of bleomycin is safe and effective as a treatment modality for hydrocystomas.

References

Koumaki, D. et al (2021). Apocrine and eccrine hidrocystomas: a clinicopathological study. Acta Dermatovenerologica Alpina, Panonica, et Adriatica, 30(2), 53–56.

Trischman, T., & Scott, J. F. (2020). Comparative efficacy of hidrocystoma treatments: A systematic review. Journal of Cutaneous Medicine and Surgery, 24(5), 474–480.

Froudarakis, M., et al (2013). Revisiting bleomycin from pathophysiology to safe clinical use. Critical Reviews in Oncology/Hematology, 87(1), 90–100

Dailey, R. A., et al. (2005). Treatment of multiple apocrine hidrocystomas with trichloroacetic acid. Ophthalmic Plastic and Reconstructive Surgery, 21(2), 148–150.
Evaluating brolucizumab in neovascular AMD: Clinical outcomes from a tertiary care eye hospital
Authors: López‐Cuenca Inés , Fabozzi Lorenzo , Younis Saad , Sen Sagnik , Palmieri Filomena
Published: January 2025

Aims/Purpose: To present real‐world clinical data on the effectiveness of brolucizumab in managing neovascular age‐related macular degeneration (nAMD), either as primary therapy or as switch therapy, in a tertiary care eye hospital in London.

Methods: This research involved 37 eyes diagnosed with nAMD, all of which received intravitreal injections of brolucizumab. The main metrics assessed were changes in best corrected visual acuity (BCVA) and central retinal thickness (CRT) by optical coherence tomography (OCT), as well as the incidence of serious ocular adverse events. Additional evaluations included intraretinal fluid (IRF), subretinal fluid (SRF), subretinal hyperreflective material (SHRM), pigment epithelial detachments (PEDs), hyperreflective foci (HF), macular atrophy, and retinal pigment epithelial tears.

The patients are classified into: patients not previously treated (Naïve) and patients treated with other anti‐VEGF agents.

Results: The average BCVA for all patients after treatment was 0.47 ± 0.33 LogMAR, compared to a baseline of 0.50 ± 0.28 LogMAR (p = 0.372). Treatment‐naïve patients showed a non‐significant improvement in BCVA (p = 0.116). Both treatment‐naïve patients and the entire cohort exhibited a statistically significant reduction in mean CRT following the injections. Most patients showed enhancements in OCT findings, notably in the resolution of IRF, SRF, SHRM, and PEDs. Four eyes developed ocular adverse events, specifically intraocular inflammation.

Conclusions: While brolucizumab did not lead to a significant improvement in BCVA, it effectively reduced CRT in both the overall study group and in treatment‐naïve nAMD patients. The study identified intraocular inflammation as a noteworthy adverse event related to brolucizumab. Therefore, careful patient selection, education, and diligent monitoring of inflammation are essential for those receiving this therapy.
Myopia‐related risks and benefits in the two‐continent population‐based studies project
Authors: Panda‐Jonas Songhomitra , Mukharram Bikbov , Gyulli M. , Wang Yaxing , Xu Jie , Nangia Vinay , Nangia Prabhat , Jonas Jost
Published: January 2025

Aims/Purpose: Prevalence of myopia and vision impairment due to myopic macular degeneration and myopia‐related optic neuropathies have markedly increased worldwide. We evaluated for which ocular diseases myopia is a risk factor or protective factor.

Methods: The Russian Ural Eye and Medical Study (UEMS) and the Beijing Eye Study (BES) included 5899 individuals and 4439 individuals (all aged 40+ years), respectively, and the Central India Eye and Medical Study (CIEMS) consisted of 4711 individuals, aged 30+ years.

Results: In the UEMS, DR prevalence (OR: 0.73; 95% CI: 0.56, 0.96), AMD prevalence (OR: 0.85; 95% CI: 0.74, 0.98) and ACG prevalence (OR: 0.61; 95% CI: 0.39, 0.94) decreased, and OAG prevalence (OR: 1.36; 95% CI: 1.17, 1.58) increased with longer axial length in multivariable analyses. In the CIEMS, lower AMD prevalence (OR: 0.81; 95% CI: 0.69, 0.95) and lower ACG prevalence (OR: 0.55; 95% CI: 0.36, 0.83), and higher OAG prevalence (OR: 1.45; 95% CI: 1.15, 1.83) correlated with longer axial length. DR prevalence (0.33%; 95% CI: 0.16, 0.50) was too low for statistical analysis in the CIEMS. In the BES, prevalence (OR: 0.64; 95% CI: 0.50, 0.81) and 10‐year incidence of DR (OR: 0.48; 95% CI: 0.33, 0.71) and prevalence (OR: 0.83; 95% CI: 0.77, 0.89) and 5‐year incidence of AMD (OR: 0.996; 95% CI: 0.993, 0.999) decreased, and prevalence (OR: 1.35; 95% CI: 1.17, 1.56) and 10‐year incidence of OAG (OR: 1.40; 95% CI: 1.22, 1.61) increased with longer axial length. In all three studies, the correlation between higher OAG prevalence and longer axial length was nonlinear with a linear slight increase for the moderate myopia range, and a steep increase in the highly myopic range.

Conclusions: Myopia is protective against DR, AMD and ACG, while high myopia more than moderate myopia is a risk factor for OAG. Future studies may assess whether in myopia, in particular in moderate myopia, the myopia‐related advantages of a lower risk for DR, AMD and ACG may outweigh the increased risks for OAG and other myopia‐related disorders.
Association of ABO and Rh blood groups with retinal structural indices
Authors: Rafati Shokoofeh , Shanbezadeh Effat , Vasaghi‐Gharamaleki Behnoosh , Nabovati Payam , Koochakzadeh Leili , Khabazkhoob Mehdi
Published: January 2025

Purpose: To determine the association between ABO and Rh blood groups with retinal structural indices including macular thickness and peripapillary retinal nerve fiber layer thickness.

Methods: This cross‐sectional study was conducted using convenience sampling in a tertiary referral eye hospital in Tehran, Iran. Study participants were referred to the hospital laboratory to test their blood group. Ocular examinations were performed including measurement of visual acuity, auto‐refraction, subjective refraction, and slit‐lamp biomicroscopes. Retinal imaging was carried out using Spectral‐domain optical coherence tomography under dilated papillary conditions.

Results: According to the multiple linear regression model, the global retinal nerve fiber layer thickness [coefficient: ‐3.05 (95% confidence interval: ‐5.30 to ‐0.74); p = 0.010] and retinal nerve fiber layer thickness in the superior [coefficient: ‐4.65 (95% confidence interval: ‐8.40 to ‐0.89), p < 0.001] and inferior [coefficient: ‐4.00 (95% confidence interval: ‐7.81 to ‐0.19); p = 0.040] quadrants were significantly thinner in individuals with blood type B compared to those with other ABO blood groups. The average [coefficient: 12.69 (95% confidence interval: 4.12‐21.64); p = 0.004) and central [coefficient: 16.21 (95% confidence interval: 6.44‐25.97); p = 0.001) macular thicknesses were significantly thicker in AB group compared to other blood groups. The average macular thickness was significantly thinner in Rh+ compared to the Rh‐ group [coefficient: ‐8.33 (95% confidence interval: ‐15.4 to ‐1.25); p = 0.021].

Conclusions: Retinal structural indices are related to blood groups implying a genetic linkage. Clinicians should consider blood groups in the clinical evaluation of retinal structural indices to avoid misdiagnoses. It is also recommended that the optical coherence tomography devices include the blood group in their databases.
Texture analysis of optical coherence tomography retinal images: Its potential use for the early diagnosis of diabetic retinopathy
Authors: Ambrósio António Francisco , Oliveira Sara , Guimarães Pedro , Campos Elisa Julião , Fernandes Rosa , Serranho Pedro , Matafome Paulo , Bernardes Rui
Published: January 2025

Aims/Purpose: Diabetic retinopathy (DR) is usually diagnosed many years after diabetes onset. The early diagnosis of DR remains challenging, and identifying novel biomarkers is crucial. We aim to identify novel early biomarkers for DR, based on texture analysis of optical coherence tomography (OCT) retinal images.

Methods: A type 1 diabetes (T1D) rat (Wistar) model (streptozotocin‐induced) was used. Volume OCT scans (N = 40‐44) and electroretinograms (N = 25) were acquired before and after 1, 2 and 4 weeks of diabetes. Automated OCT image segmentation was performed, followed by retinal thickness and texture analysis. Changes in blood‐retinal barrier (tight junctions and permeability), glial reactivity and nitrosative stress were assessed.

Results: Early T1D induced significant changes in retinal texture. Several texture metrics, autocorrelation, correlation, homogeneity, information measure of correlation II (IMCII), inverse difference moment normalized (IDMN), inverse difference normalized (IDN), and sum average, decreased in all retinal layers at week 4. Correlation, homogeneity, IMCII, IDMN, and IDN decreased at week 2. T1D induced a progressive weekly reduction in the texture metrics. T1D also induced significant thinning of the inner plexiform and inner nuclear layers, inner/outer photoreceptor segments, and total retina, at weeks 1, 2 and 4. Impaired retinal function was also observed (increased latencies in a‐wave and oscillatory potentials at weeks 1, 2 and 4), as well as decreased tight junction proteins immunoreactivity and increased microglial cell number and nitrosative stress, but vascular permeability was unchanged.

Conclusions: Early T1D impacts retinal texture, concomitant with molecular, cellular and physiological retinal changes, thus unlocking the potential of texture analysis for DR early diagnosis, but this needs further proof in clinical studies.

Support: FCT, Portugal: 2020.07432.BD, PEst UIDB/04539/Base/2020 and UIDP/04539/Programatico/2020, and PEst UIDB/04950/Base/2020 and UIDP/04950/Programatico/2020.
Medium‐term post‐covid outcomes in patients with neovascular age‐related macular degeneration
Authors: Burgić Sanela Sanja , Mavija MIlka , Markić Bojana , Skočić Saša Smoljanović
Published: January 2025

Aims/Purpose: To evaluate medium‐term post‐COVID visual and anatomical outcomes in patients with neovascular age‐related macular degeneration (nAMD) due to delayed intravitreal anti‐VEGF treatment during pandemics.

Methods: Single‐center retrospective study evaluating all patients with previous delayed anti‐VEGF tretment in the Eye Clinic of University Clinical Center of Republic of Srpska during COVID‐19 pandemic with 1‐year follow‐up period. The best‐corrected visual acuity (BCVA) and anatomical findings (central macular thickness (CMT)) were evaluated before the pandemic, and at 6‐, 12‐months post‐pandemic.

Results: We included 60 patients (92 eyes) with a mean age 75.64 ± 7.63 years (range 58‐90 years ). Compared to pre‐COVID BCVA, visual outcomes were significantly worse at 6‐month (0.22 ± 0.25 vs 0.16 ± 0.34 Snellen, p < 0.05) vs 12‐month follow up (0.22 ± 0.25 vs 0.16 ± 0.24 Snellen, p > 0.05). There was significant CMT reduction at 12‐month follow up in comparison to pre‐COVID CMT (281.88 ± 123.02 μm vs 238.03 ± 90.64 μm, p < 0.05).

Linear regression analysis showed positive correlation between pre‐COVID CMT and post‐COVID CMT at 12‐month follow up (p < 0.05), while there was no correlation in BCVA change (p > 0.05).

Conclusions: Delayed anti‐VEGF treatment has negative impact on treatment and disease progression and is assosiciated with significantly worse outcomes in patients with nAMD.