bluuebunny/crossref_metadata_2025 huggingface dataset:
The face superiority test: A novel method of studying face perception
Authors: Tien Marko , Barton Jason , Albonico Andrea
Published: January 2025

Aims/Purpose: There are several studies that compare written word and face perception. However, many draw conclusions upon different experimental paradigms, complicating direct comparison between these stimuli. We aim to create a novel paradigm studying face recognition that closely resembles the word‐superiority test.

Methods: 40 subjects participated in the study. Each completed both a traditional word‐superiority test and our novel face‐superiority test. In the face‐superiority tests, patients were presented with either a familiar face (real), an unfamiliar face (pseudo‐), or a scrambled face (non‐) initially, then presented with a face feature in isolation and tasked to respond with whether the feature was present in the aforementioned face. Statistical analyses and bivariate correlation analyses were conducted to identify relationships in intra‐ and inter‐stimulus trials.

Results: For both categories of stimuli, there were similar differences between non‐, pseudo‐, and real stimuli. Accuracy was lower for non‐stimuli compared to pseudo‐ and real stimuli, which in turn did not differ between each other. There was greater response latency for non‐stimuli compared to pseudo‐stimuli, which in turn was greater than real stimuli. Bivariate analyses revealed significant correlations between inter‐stimulus trials for reaction times.

Conclusions: Our study was able to replicate a face superiority effect utilizing a similar methodology from the word‐superiority test. Additionally, we provide evidence that response latency follows similar patterns in the recognition of written words and faces.
Management of vertical diplopia due to conjunctival synechiae: A case report and surgical outcome
Authors: Borghi Luca Manuel Bueno , Remacha Carla Sánchez , Simón Cristina Calvo , Clavería Julia Aramburu , Fernández Miguel Castillo , Martínez Marta Suñer , Duarte Javier Ramos , Pascual Ana María Abad , de la Cámara Sahuquillo Edurne , Sánchez Inma Herrero , González Pablo Tejada , García Diana Pérez , Garijo León Remón , Puyuelo Francisco Javier Ascaso
Published: January 2025

Aims/Purpose: To present a case of vertical diplopia following trauma to the inferior orbital region of the left eye, with a duration of 1 year, which caused a limitation of ocular motility secondary to conjunctival synechiae, in an 83‐year‐old female patient.

Methods: Vertical diplopia with restriction of supraduction in the left eye was observed. Examination revealed the presence of synechiae in the tarsal conjunctiva of the left lower eyelid. Initially, an inferior rectus entrapment syndrome secondary to previous orbital trauma was suspected. However, an emergency CT scan ruled out orbital fractures and showed no pathological findings in the inferior rectus muscle. Surgical intervention was performed, starting with a forced duction test, which was positive. Following conjunctival incision, near‐complete normalization of elevation was observed, leading to the decision to release the synechiae and subsequently reconstruct with an autograft from the superior bulbar conjunctiva, accompanied by a 3 mm recession of the left inferior rectus muscle.

Results: One week post‐surgery, the patient showed an improvement in supraduction of 10‐15 degrees, with no diplopia in the primary position of gaze and in downgaze. These results were maintained in the long term.

Conclusions: The management of strabismus secondary to ocular trauma requires a meticulous examination to address the etiological mechanism, aiming to achieve the best postoperative outcomes and optimize long‐term results.

References

1. Kumar S, Artymowicz A, Muscente J, Shinder R, Mostafavi D, Kumar S, et al. Do Not Fall for This; Diagnostic Challenges in Orbital Floor Fractures With Extraocular Muscle Entrapment. Cureus [Internet]. 2023 Feb 21 [cited 2024 May 28];15(2). Available from: https://www.cureus.com/articles/99214‐do‐not‐fall‐for‐this‐diagnostic‐challenges‐in‐orbital‐floor‐fractures‐with‐extraocular‐muscle‐entrapment

2. Shin H, Gronet E, Czerwinski M. Inferior rectus entrapment in a medial orbital wall fracture: A case report. Oral Maxillofac Surg Cases. 2019 Dec 1;5(4):100123.

3. Rogers GL, Simmons RE. Inferior rectus muscle fibrosis following orbital trauma. J Pediatr Ophthalmol Strabismus [Internet]. 1978 [cited 2024 May 28];15(5):318–20. Available from: https://pubmed.ncbi.nlm.nih.gov/24877449/
What if it wasn't normal pressure glaucoma?
Authors: Mabrouk Amira , Lajmi Houda , Zahaf Amine , Hmaied Wassim
Published: January 2025

Purpose: Enlargement of the papillary excavation is a suggestive sign of glaucomatous optic neuropathy. However, it has been reported in other optic neuropathies, particularly compressive ones.Certain clinical elements should raise suspicion of the diagnosis and indicate neuroradiological exploration.We report the case of a patient with a large papillary excavation with a glaucomatous appearance and whose brain MRI revealed an expansive intra‐ and suprasellar lesion compressing the optic pathways.

Methods: A complete ophthalmologic examination was performed, along with automatic perimetry 30‐2 and brain MRI.

Results: We report the case of a 37‐year‐old man who consulted for a progressive decline in visual acuity in the right eye since 2 months. Clinical examination found a visual acuity of 3/10 in the right eye, calm anterior segment, intraocular pressure was normal. Ocular fundus examination showed a large excavation with pallor of the neuroretinal ring, particularly on the right.Automatic 30‐2 perimetry showed relative and absolute scotomas extending from the blind spot, circumventing and widening the fixation point bilaterally.Neuroradiological exploration using brain MRI revealed an expansive, bulky intra‐ and suprasellar lesion compressing the optic pathways and corresponding to a pituitary macroadenoma.

Conclusions: Papillary excavation is a characteristic feature of glaucomatous optic neuropathy.However, in the absence of associated ocular hypertonia, the diagnosis of compression of the anterior optic pathways must be considered in the presence of certain clinical elements, in particular, age less than 50 years, reduced visual acuity and pallor of the neuroretinal ring.
High myopia: Reviews of myopia control strategies and myopia complications
Authors: Shah Rakhee , Evans Bruce , Vlasak Natalia
Published: January 2025

Aims: Most participants in myopia control studies have low and moderate myopia, relatively little is known about myopia control in high myopia. This review aims to evaluate the efficacy of myopia control strategies in high myopia and report on the structural and pathological complications of the eye.

Methods: Comprehensive literature searches were undertaken using keywords in MEDLINE and EMBASE to identify publications in English, evaluating (1) the efficacy of myopia control strategies (environmental, pharmacological and optical) in high myopia (≤‐6.00D) and (2) the complications of high myopia. Outcomes include change in spherical error (SE) and/or axial length (AL) to evaluate progression in high myopia.

Results: Twelve studies evaluating the efficacy of optical and pharmacological (none on environmental) interventions on axial elongation and myopic refractive error for high myopia control were identified. A statistically significant reduction in progression of refractive error in high myopes was reported with 1% and 0.5% atropine. Defocus Incorporated Multiple Segment spectacle lenses had lower efficacy in slowing high myopia progression compared to moderate and low myopia. Ortho‐K lenses were equally effective in reducing myopia progression in low, moderate and high myopia. All myopic patients have an increased risk of myopic macular degeneration, retinal detachment, cataract and glaucoma; with the risk increasing with level of myopia.

Conclusions: High myopia has significant effects on quality of life and risk of pathological complications and vision impairment. Young children, excluding those with some syndromic associations, who are fast progressing moderate and high myopes require early intervention and close monitoring. Further research investigating the efficacy of myopia control strategies in highly myopic patients, both monotherapies and combination treatments, are necessary.
Comparing performance in a general ophthalmology exam: Artificial intelligence versus ophthalmologists, residents and general practitioners
Authors: Aroco Clara Lara , Angulo Cristina García‐Velarde , de Paz Sergio Pérez , Díaz Marta García , Vargas Juan Javier Castro , Celemín Helena Garreta , Guzmán Javier
Published: January 2025

Aims/Purpose: To compare the results on a general ophthalmology exam consisting of 68 questions between two artificial intelligence systems (ChatGPT 3.5 and Google Gemini) against ophthalmologists, residents, and medical graduates

Methods: A total of 8 participants were recruited: 4 ophthalmologists, two first and third‐year residents, and two medical graduates after taking the Spanish medical residency entrance exam. Each subject underwent a standardized general ophthalmology exam, consisting of 68 questions in the form of clinical cases, covering various relevant aspects of the ophthalmological discipline. The scores obtained were recorded and statistically analyzed. The same exam was performed by ChatGPT 3.5 and Google Gemini. A one‐way ANOVA test with Tukey correction was conducted to compare the different groups.

Results: ChatGPT 3.5 and Google Gemini demonstrated acceptable competency, with an average accuracy of 48.8%, but their performance was lower than that of residents (average of 68.4%) and attending ophthalmologists (average of 79.4%). However, their performance was only slightly lower than that of medical graduates without clinical experience in ophthalmology, with an average accuracy of 52.2%. Statistically significant differences were observed between attending ophthalmologists with artificial intelligence and medical graduates (p < 0.05), as well as between residents and artificial intelligence (p < 0.05), while no differences were observed between medical graduates and artificial intelligence, nor between attending ophthalmologists and residents.

Conclusions: These results suggest that the difference lies in the learning acquired during residency and clinical experience. Artificial intelligence can contribute to the evaluation of knowledge in ophthalmology, but its performance is still surpassed by residents and ophthalmologists with deeper training to solve clinical practice problems.

References

Mihalache A, Grad J, Patil NS, Huang RS, Popovic MM, Mallipatna A, Kertes PJ, Muni RH. Google Gemini and Bard artificial intelligence chatbot performance in ophthalmology knowledge assessment. Eye (Lond). 2024 Apr 13. doi: 10.1038/s41433‐024‐03067‐4. Epub ahead of print. PMID: 38615098.
Literature review: Light and colour in myopia control
Authors: Evans Bruce , Shah Rakhee , Vlasak Natalia
Published: January 2025

Aims/Purpose: The mechanism for the benefit from time outdoors at reducing the risk of myopia is not fully understood. The intensity and breadth of spectrum of outdoor light is likely to be relevant. Interventions based on light of different chromaticities to slow myopia progression are of increasing interest. A narrative review is presented that aims to assess the efficacy, effectiveness, and safety of myopia control interventions using violet light (VL); blue light (BL); and repeated low‐level red light (RLRL).

Methods: A comprehensive literature search was undertaken for publications in English, evaluating the efficacy and safety of VL, BL and RLRL in human myopia control. Randomised controlled trials (RCTs) were prioritised but observational (non‐RCT) studies were included enabling evaluation of effectiveness and safety of interventions in real‐world clinics. Outcomes are changes in spherical equivalent refraction (SE) and/or axial length elongation (ALE).

Results: 26 relevant publications were found. The literature is suggestive of a benefit from VL. Studies on RLRL reveal significant treatment effects. In most RLRL studies, control groups did not receive a sham control intervention, hence not controlling for placebo effects. Data concerning long‐term follow‐up are not available. Importantly, safety concerns have recently been raised, indicating that RLRL devices exceed maximum permissible exposure.

Conclusions: Additional studies are needed to determine whether VL plays a key role in myopia progression and whether associated interventions are safe and effective. There is more evidence supporting the efficacy of RLRL in myopia control, but important safety concerns recently raised mean that these devices cannot be endorsed.
AI‐assisted diagnosis of multiple sclerosis via optical coherence tomography
Authors: Plata Carlos Santana , Rufas Ines Munuera , Perez Elisa Funes , Merino Jacobo Yañez , Pinilla María Sopeña , Ciubotaru Olga Ciubotaru , Bestué Ana Pueyo , Bestué Ignacio Leonardo Pueyo , Velasco Diego Fernandez , Gracia Victor Mallen
Published: January 2025

Aims/Purpose: This study aims to evaluate the ability of inter‐eye asymmetry and retinal structure thicknesses, obtained via the Posterior Pole protocol in Optical Coherence Tomography (OCT), to distinguish between healthy controls and patients with recently diagnosed multiple sclerosis (MS). Additionally, it aims to develop a convolutional neural network (CNN) for assisted diagnosis using these measurements.

Methods: Two cohorts, one with relapsing‐remitting MS (RRMS) patients (n = 79) and another with healthy controls (n = 69), were recruited. Structural retinal measurements were obtained using the Spectralis OCT device. The analysis focused on thickness differences in nine retinal layers and their inter‐eye asymmetry. Statistical methods included the Shapiro‐Wilk test, Student's t‐test, χ2 test, and area under the receiver operating characteristic (AUROC) curve. A CNN was trained to classify patients and controls based on the most discriminant retinal measurements.

Results: The study found significant thinning in the ganglion cell layer (GCL) and inner plexiform layer (IPL) of RRMS patients compared to controls, with AUROC values of 0.82 and 0.78, respectively. Inter‐eye asymmetry was also notable in these layers, particularly the GCL (AUROC = 0.75) and IRL (AUROC = 0.74). The CNN, utilizing GCL thickness and IPL inter‐eye difference as inputs, achieved an accuracy of 0.87, sensitivity of 0.82, and specificity of 0.92.

Conclusions: The study demonstrates that neuroretinal thinning and inter‐eye differences in specific retinal layers, measurable by the Posterior Pole protocol in OCT, can effectively discriminate between MS patients and healthy controls. The CNN developed shows high accuracy in MS diagnosis, supporting the potential of OCT and AI integration in clinical settings. Further research is needed to validate these findings across larger and more diverse populations.
Retrospective analysis of refractive errors in pediatric patients in Greece
Authors: Gianni Theodora , Nikolaidou Anna , Tsina Efthymia
Published: January 2025

Aims/Purpose: To investigate the prevalence of refractive errors in Greek children aged 6 months to 16 years old.

Methods: This retrospective study included patients examined at the outpatient clinic of Aghia Sophia Children's Hospital from October 2022 to October 2023. Data collected included gender, age, cycloplegic refractive error, presence of strabismus, and use of spectacles. Patients were grouped by age: preschool (6 months to 6 years), school age (7 to 12 years), and adolescents (13 to 16 years).

Results: Data from 1,132 children were analyzed (mean age: 6 years; 53% males). Hyperopia was the most common refractive error across the sample (82%). The prevalence of hyperopia decreased across age groups: preschool (92%), school age (82%), and adolescents (61%). Myopia showed an increasing trend with age: preschool (7%), school age (18%), and adolescents (40%) and was more prevalent in females (52%). Astigmatism was significantly more common in girls, with boys having a 7% lower probability of astigmatism (p < 0.05). Strabismus was present in 16% of the total sample and was significantly more frequent in the school‐age group (p < 0.001).

Conclusions: The study demonstrated the distribution of refractive errors by age and gender in a large cohort of Greek children. Regular ophthalmological screenings and school‐based eye examinations are recommended for early detection and correction of refractive errors.
Ophthalmologist's musculoskeletal disorders (ergonomic ophthalmology)
Authors: Ettouri Sara , Ghizlane Daghouj , Ennaki Sara , Lamiaa Arab , El Maaloum Loubna , Allali Bouchra , El Kettani Asmaa
Published: January 2025

Aims/Purpose: The concept of ophthalmologists ‘work‐related musculoskeletal disorders and discuss the main risk factors, deduce solutions and basis of their prevention as a primary means of occupational injury for ophthalmological resident.

Methods: A questionnaire established for residents and ophthalmologists looking for the different musculoskeletal disorders that have developed in them through the years of practice, the sites of predilection, repercussions on their course and daily practice with a review of the literature regarding ergonomics in ophthalmology.

Results: Musculoskeletal disorders, or MSDs, are a group of disorders of the muscles, tendons, ligaments, nerves and joints resulting from long‐term, repeated wear and tear on the body. It is a disorder found very frequently in ophthalmologists and ophthalmology residents. Several risk factors come into play. Thus, all ophthalmologists should be taught early in their careers to adjust their work environments properly i order to minimize the load on muscles, tendons and the spine during exams and procedures.

According to the research literature, more than half of all ophthalmologists have experienced at least some signs or symptoms of an MSD (most commonly back pain, neck pain or pain in the shoulder, arm or hand). The major risk factors ophthalmologists face are extreme or awkward postures; excessive force or exertion; and repetitive activities. Nearly, 62% of the ophthalmologists who responded to a national survey in the United Kingdom reported that they suffered from either back or neck pain. A study carried out by Essamlali. I and co found that: 78% reported low back pain, 41% neck pain and these pains are felt the most during examination with the slit lamp followed by surgical operations. Faced with all these musculoskeletal attacks, several proposals for prevention and re‐adaptation have been proposed by experts. In the article of AAO by Linda Roch and CO until the title of ‘Seven risk factors and seven solutions ‘.

Conclusions: As is always – prevention is better than cure. The key is identification of our habits and correcting our posture. A small niggling headache or neck pain can soon transform into a recurrent one and then eventually into a chronic problem. MSDs do not have to be an occupational hazard for ophthalmologists – not if we choose to avoid them!
Visual acuity outcomes by causative mutation in the natural history of leber hereditary optic neuropathy: Analysis of historical data from Case Record Survey‐2 (CRS‐2)
Authors: Yu‐Wai‐Man Patrick , van Everdingen Judith , Leroy Bart , Krawczynski Maciej , Lamperti Costanza , Carelli Valerio , Llòria Xavier , Klopstock Thomas
Published: January 2025

Aims/Purpose: The clinical progression of Leber hereditary optic neuropathy (LHON) is influenced by the causative mitochondrial DNA (mtDNA) mutation. The Case Record Survey‐2 (CRS‐2; NCT02796274) aimed to establish the natural history of LHON in idebenone‐naïve patients. Here, we report the 12‐ and 24‐month clinical outcomes by mutation.

Methods: Data were extracted from case records (20 sites, 7 European countries) meeting the criteria: aged ≥12 y, m.11778G > A, m.3460G > A or m.14484T > C mtDNA mutation, onset of symptoms (OoS) after 1999, ≥2 visual acuity assessments (VAA) within 5y of OoS. Baseline (BL) was the first VAA after OoS; subacute/dynamic (S/D) and chronic eyes were ≤1 or > 1 y from OoS at BL, respectively. Spontaneous clinically relevant recovery, stabilisation and worsening (sCRR, sCRS and sCRW, respectively) were calculated as previously described.1 Eyes eligible for analysis had a VAA 12±3 or 24±3 months from BL.

Results: Eligible eyes included 96 S/D and 11 chronic eyes for the 12‐month analysis and 44 S/D and 2 chronic eyes for the 24‐month analysis.

At 12 months, rates of sCRR, sCRS and sCRW in overall S/D eyes were: 13% (12/96), 26% (11/42) and 66% (50/76), respectively. By mutation, these rates were: m.11778G > A: 9% (6/68), 23% (7/30), 70% (37/53); m.3460G > A: 0% (0/16), 29% (2/7), 82% (9/11); and m.14484T > C: 50% (6/12), 40% (2/5), 33% (4/12), respectively. There were few chronic eyes, with overall rates of 18% (2/11), 100% (2/2) and 67% (4/6), respectively.

At 24 months, rates of sCRR, sCRS and sCRW in overall S/D eyes were: 27% (12/44), 46% (10/22) and 46% (16/35), respectively. By mutation, these rates were: m.11778G > A: 11% (3/27), 33% (5/15), 57% (13/23); m.3460G > A: 50% (7/14), 67% (4/6), 33% (3/9); and m.14484T > C: 67% (2/3), 100% (1/1), 0% (0/3), respectively.

Conclusions: The CRS‐2 study offers important insights into the impact of causative mutation on the natural history of LHON.

References

Yu‐Wai‐Man P et al. Cell Rep Med. 2024;5:101437.
Comparison of blind children's gait pre/post introduction of a wearable assistive safety device
Authors: Ambrose‐Zaken Grace , Bakshi Ishani , Chong Paul , Enzenauer Robert W.
Published: January 2025

Aims/Purpose: Infants with congenital mobility visual impairment or blindness (MVI/B) walking delays are due to exposure and insufficient contact with their environment. Assistive safety devices provide contact and protection. [1,2] Our study measured foot motility/gait in pediatric patients with a MVI/B to quantify the benefits of wearing a Pediatric Belt Cane.

Methods: Videos of fifty pediatric patients (Mean age = 26 mos, SD = 10.8) with a MVI/B Before and After were analyzed using the MediaPipe platform to perform gait analysis. Subsequent analyses included linear regression analysis and data smoothing to calculate metrics for foot mobility, approximate speed, step frequency, and estimated step lengths. T‐test analysis was performed to calculate the significance of differences in gait analyses.

Results: Patients utilizing Pediatric Belt Canes showed significant percent increase in foot mobility (p < .05), percent improvement in approximate speed (p < .05), percent reduction in step frequency (p < .05), and percent increase in step length (p < .05).

Conclusions: Pediatric Belt Canes lead to marked, quantifiable improvements in walking for children with a MVI/B, supporting the conclusion that assistive safety devices are a medical necessity in the care and management of all children with a MVI/B (e.g., lack visual preview). Further work increasing the choice of assistive devices is warranted for sport, blind children with motor impairments, etc.

References: 1. Chong, P., Enzenauer, R., Ambrose‐Zaken, G. Comparative video gait analysis of assistance for cortically visually impaired Children. International Council of Ophthalmology, WOC, August 17, 2024, Vancouver. 2. Chong, P. Comparative video gait analysis of assistance for mobility visually impaired Children. AAPOS, April 8, 2024, Austin, TX.
Corneal epithelial thickness mapping precision in keratoconic eyes with two different optical coherence tomographers
Authors: Venkataraman Abinaya , Vandemoosdijk Stephanie , Samolov Branka , Dominguez‐Vicent Alberto
Published: January 2025

Aims/Purpose: Corneal epithelial thickness measurement precision was evaluated with an anterior segment optical coherence tomography (AS‐OCT) and a posterior segment OCT adapted with an anterior module in subjects with keratoconus and healthy controls.

Methods: The MS‐39 (spectral domain AS‐OCT) and the HS‐100 (posterior segment OCT with ASA‐1 adaptor) were used to measure the corneal epithelium. On each participant, three consecutive measurements were taken. The metrics used to describe the repeatability of each OCT were the within‐subject standard deviation (Sw) and repeatability limit (Rlim).

Results: 81 controls (81 eyes) and 52 keratoconus subjects (80 eyes) were measured. The best repeatability was obtained in the central sector for both control and keratoconus groups with both MS‐39 and HS‐100. The Rlim never exceeded 5μm in any of the sectors for both groups with MS‐39. With the HS‐100, the Rlim never exceeded 7μm in any of the sectors for the control group and in all but one sector in the keratoconus group. In the keratoconus group, there was a weak negative correlation (p < 0.05) between the thinnest corneal thickness and their respective Sw for both instruments. For the control group, the correlations between the three different metrics (the thinnest epithelial thickness measured with the MS‐39, the thinnest corneal thickness measured with the MS‐39, and the thinnest corneal thickness measured with the Canon OCT) and their respective Sws were not statistically significant (p > 0.05).

Conclusions: Both OCTs showed good repeatability to measure corneal epithelial thickness in both healthy and keratoconus eyes, independent on the history of corneal crosslinking or contact lens use.
Cosmetic keratopigmentation of anterior corneal stroma with modified micropuncture technique
Authors: Cyrino Laura Goldfarb , Garotti Giovanni , Vigga Paulo , Santo Ruth
Published: January 2025

Aims/Purpose: Describe an innovative technique of ocular cosmetic conjunctival pigmentation and represent the cosmetic results, satisfaction, and improvement of the patients' quality of life and the safety indices of the anterior stromal keratopigmentation procedure with modified micropuncture technique.

Methods: In this prospective cohort study with a single measurement at post‐intervention time, we perform superficial anterior keratopigmentation with stromal micropuncture in eyes with poor visual prognosis as an alternative method to contact lenses and ocular prostheses in fifty patients with leukomas at the Cornea Department of the University of São Paulo. Through an appropriate questionnaire, we will also evaluate the perception of the patients participating in this research on the effectiveness of tattooing in cosmetic improvement and social well‐being.

Results: Among our 50 participants, 25 were men and 25 women. The average age was 53 (ranging from 7 to 85). 49 of them had no visual acuity with some degree of light perception, and the most common causes of leukoma were retinal detachment (34%) and glaucoma (32%). 37 participants reported high satisfaction with the procedure (74.0%; 95% CI = (60.4% ‐ 84.1%)), 45 participants reported increased social and professional well‐being (90.0%; 95%CI = (78.6% ‐ 95.7%)) and 100% of participants reported increased self‐esteem.

Conclusions: The innovative technique of modified micropuncture for ocular cosmetic pigmentation of anterior corneal stromal proved to be safe, fast, and efficient, especially in economics as well in terms of cosmetics, and has the potential to impact the lives of patients and bring this alternative to this problem to countries and centers with limited resources and public health systems.

References

Hasani H, Es’haghi A, Rafatnia S, Alilou S, Abolmaali M. Keratopigmentation: a comprehensive review. Eye (Lond). 2020 Jun;34(6):1039–46.
Stuve‐wiedemann syndrome and cornea consequences: A rare case report
Authors: Cyrino Laura Goldfarb , Miranda Bruna , Pina Luciana
Published: January 2025

Aims/Purpose: Stuve‐Wiedemann Syndrome (STWS) is a rare genetic disorder inherited in an autosomal recessive manner. The condition leads to respiratory and feeding difficulties, as well as episodes of hyperthermia, typically resulting in death within the first two years of life. It is characterized by bone dysplasia, hypotonia, and dysautonomia, accompanied by ocular and neuropathic features. The absence of corneal reflexes, decreased blink reflexes, and corneal opacities are recognized markers. Here, we report a case of STWS with corneal hypoesthesia and opacity, highlighting the current challenges in management and treatment.

Methods: A 16‐year‐old male was admitted to the Ophthalmology Department of the University of São Paulo in 2010 due to a history of multiple corneal ulcer episodes. At the slip lamp examination, he presented leukoma formation and corneal hypoesthesia. The patient also presented several orthopedic alterations. After a multidisciplinary investigation, the diagnosis of STWS was made, and follow‐up was conducted. He has been treated with lubricating eye drops and ointment for the last few years. Since 2014, he has not experienced corneal ulcers. At his last appointment in 2024, he kept corneal exposure due to decreased blink reflexes, leukomas in both eyes, mild superficial punctate keratitis and complained of dry eye and eye itching despite the treatment. Therefore, a tarsoconjunctival flap was indicated as a surgical method, having been employed due to persistent corneal involvement.

Results: The case's challenges relate to the management and treatment of corneal involvement in patients with STWS, as most often, they are children who don’t express discomfort or show symptoms due to the characteristic neuropathy of their lesions. Additionally, it's essential to reduce corneal exposure and its consequences.

Conclusions: Although rare, ophthalmologists must be aware of this ocular involvement in STWS for early diagnosis and appropriate management.

References

Hernández‐García S et al. Neuroparalytic keratopathy in Stüve‐Wiedemann syndrome treated with tarsoconjunctival flap. Indian J Ophthalmol. 2023
Effect of postoperative subconjunctival corticosteroid injections in a multimodal approach for the treatment of severe symblepharon
Authors: Artemiev Dmitri
Published: January 2025

Aims/Purpose: To report on the impact of additional subconjunctival corticosteroid injections in a subsequent multimodal treatment of a challenging case of symblepharon following a Roper Hall Grade III chemical burn.

History and signs: A 42‐year‐old male patient was referred due to multiple failed treatment attempts for his corneal disease and severe symblepharon formation. The initial cause of the accident was a chemical burn on the right eye (OD) caused by potassium hydroxide. At the time of referral, extensive ocular surface damage was present with corneal vascularization, fibrovascular pannus, persistent central corneal ulcer, distichiasis, upper eyelid nasal entropion, and limbal stem cell deficiency (LSCD), with visual acuity reduced to finger counting.

Results: To treat this patient's condition, we adopted a multimodal three‐step approach. The first step was to reconstruct the fornix, with additional preoperatively intensive topical therapy with autologous serum drops and antibiotic eye drops to reepithelialize the corneal ulcer. In the crucial postoperative period, we administered a subconjunctival injection of 0.5ml betamethasone and a week later 1ml triamcinolone to prevent recurrence of symblepharon. The healing process went well and there were no further signs of symblepharon recurrence three months later. To improve tissue modulation, we administered a subconjunctival injection of triamcinolone again to achieve a more lasting effect and planned step two, which included a limbal stem cell transplant and lastly a penetrating keratoplasty as the final step.

Conclusions: There are numerous therapeutic approaches to treat symblepharon, which are primarily based on surgical procedures and these remain an important cornerstone for the chances of recovery. In addition to surgical treatment, postoperative adjustment is also crucial for success. With our new approach we took action in the fibrosis formation process by administering early postoperative subconjunctival injections, this to achieve better bioavailability.
Identification and quantification of CD3+ and HLA‐DR+ cells in pellets from low volume samples of human tears through an automated image‐based cell counter
Authors: Ciavarella Carmen , Versura Piera
Published: January 2025

Aims/Purpose: Tears are a novel fluid source for biomarker analysis in several human diseases, becoming attractive for the rapid and less invasive collection method. The low sampling volume and the lack of standardized anlytical procedures are significant challenges. Here, we tested the performance of an automated image‐based cell counter for analysis and counting of CD3+ T lymphocytes and HLA‐DR+ cells in tear pellets.

Methods: Tears aspirated from 10 healthy volunteers were centrifuged and pellets were fixed in 4% paraformaldehyde. Pellets were then resuspended in Bovine Serum Albumin (BSA) buffer and divided in two samples for parallel evaluation by Countess FL Automated Cell Counter and the flow cytometer Attune Cytpick (Thermo Fisher Scientific). Pellets were stained with Human Leukocyte Antigen‐ DR as marker of inflammation and CD3 as marker of T cells.

Results: The total cell counting between flow cytometry and automated cell counter showed a significant correlation (R2 = 0.9587, p value = 0.0209). HLA‐DR and CD3 fluorescence percentages were comparable between the two methods, without significant differences (HLA‐DR positive cells: Countess 49%, Attune 48.6%; CD3 positive cells <5% in both estimations).

Conclusions: The Automated Cell Counter is a promising approach to strengthen the application of tear fluids in the diagnosis of ocular surface diseases. The combination of cell counting with cell imaging into a bench instrument may overcome the limitations of flow cytometry due to the scant number of events in tear volumes. Further studies are aimed at optimizing the whole analytical workflow to bring the method in the daily practice.
Investigating dexpanthenol transfer to the anterior segment from coated contact lenses and aqueous solution
Authors: Santer Verena , El Guamra Adyl‐Michaёl , Kawaguchi Tohru , Kalia Yogeshvar N. , Lamrani Mouad
Published: January 2025

Aims/Purpose: Dexpanthenol (Dxp) is a common excipient in topical formulations used in dermatology and ophthalmology. However, little is known about the absorption of Dxp into biological tissues. In this study we investigated the transfer of Dxp into the anterior segment – i.e. cornea and aqueous humor – first, from contact lenses (CL) following treatment with SOLOCARE AQUA® care solution and second, after administration of Bepanthen® and Siccaprotect® eye drops. All products contained approximately equivalent amounts of Dxp (2–3%).

Methods: A bioanalytical method for the quantification of Dxp by UHPLC MS/MS was validated. The initial experiments evaluated the ad/absorption of Dxp from the SOLOCARE AQUA® care solution onto FDA class representative CL. Then, ex vivo porcine eye globes were mounted in an eye globe holder developed inhouse, with simulated tear flow, and Dxp uptake into the anterior segment from SOLOCARE AQUA® treated CL and eye drops was investigated.

Results: Dxp ad/absorption in CL was correlated to exposure time and CL material. Following exposure to Dxp‐soaked CL and eye drops, transport of Dxp through porcine cornea to the aqueous humor was found in all experimental conditions. However, there was a statistically significant difference in the concentrations measured after CL application and eye drop instillation. Direct application of Dxp containing eye drops resulted in higher Dxp deposition in the anterior segment than the SOLOCARE AQUA® treated CL.

Conclusions: In this benchmark study we investigated the deposition of Dxp in the anterior segment of excised porcine eyes from CL treated with a care solution and commercially available eye drops. Despite the excipient Dxp being classified as Generally Recognized as Safe (GRAS), the inferior absorption of the substance from SOLOCARE AQUA® washed CL compared to approved Dxp containing eye drops is considered preferable with regard to medical device safety.
Marginal keratitis after intravitreal injection of bevacizumab
Authors: Aroco Clara Lara , de los Ángeles Ibáñez Ruiz María , Martín Silvia Beatriz De Miguel , Escribano Rosa María Jiménez
Published: January 2025

Aims/Purpose: To report a case of marginal keratitis that developed after intravitreal bevacizumab (Avastin) injection.

Methods: A 88‐year‐old woman with Age‐related macular degeneration (AMD) and macular edema in both eyes received four intravitreal injection of bevacizumab (Avastin) in left eye and five in right eye. No previous history of herpes.

Results: Two days following the fifth injection of Avastin in the patient's right eye, she experienced sensations akin to having a foreign body, accompanied by redness and a decrease in visual acuity in that eye. Examination with a slit lamp revealed peripheral infiltrates beneath the corneal epithelium, delineated from the limbus by a clear zone. Additionally, there was corneal edema with folds in the endothelium and a mild anterior chamber reaction. No presence of hypopyon was noted. The patient's symptoms showed favorable response to topical steroid and topic and oral antibiotic medications

Conclusions: The intravitreal administration of bevacizumab carries a risk of inducing hypersensitivity reactions like marginal keratitis. To our knowledge, this is the first documented account of marginal keratitis after intravitreal bevacizumab injection.

References

Farrell DA, Deacon S, Mauger T. "Marginal keratitis following COVID 19 vaccination". IDCases. 2022 Jun 15; 29: e01536. doi: 10.1016/j.idcr.2022.e01536. PMID: 35756698; PMCID: PMC9212909

Aslan Bayhan S, Bayhan HA, Adam M, Gürdal C. Marginal keratitis after intravitreal injection of ranibizumab. Cornea. 2014 Nov; 33(11): 1238‐9. doi: 10.1097/ICO.0000000000000255. PMID: 25222003
Anti‐pseudomonal effect of nephrite‐impregnated contact lenses
Authors: Lee Jieun , Kim Sangyoon
Published: January 2025

Aims/Purpose: This study investigates the efficacy of nephrite‐impregnated contact lenses (NICLs) against Pseudomonas aeruginosa.

Methods: After inoculating the lenses with a standardized Pseudomonas aeruginosa strain, three types of contact lenses were assessed: nephrite‐impregnated, conventional, and cosmetic. We performed a quantitative assessment of bacterial adhesion using viable cell count techniques. The lens surface characterization involved atomic force microscopy (AFM) and scanning electron microscopy (SEM) for detailed topographical analysis and bacterial attachment patterns. The safety evaluation in rabbits examined parameters such as corneal clarity, thickness, and endothelial cell count over time, providing a thorough assessment of biocompatibility and safety.

Results: Both conventional and cosmetic CLs (n = 258 ± 2.9 × 104, 368 ± 2.2 × 104) showed significantly decreased number of attached bacteria when compared with those without nephrite impregnation (n = 134 ± 0.8 × 104, 238 ± 2.5 × 104, p < 0.0001, respectively). AFM and SEM revealed that P. aeruginosa was less attached to the nephrite‐impregnated CLs than to the conventional and cosmetic CLs, although those with nephrite impregnation had rougher surface. In the safety test, there were no significant differences in the findings between four groups, and the clarity and stability of all corneas were preserved.

Conclusions: Nephrite, used in traditional medicine, is shown to reduce Pseudomonas aeruginosa adhesion on CLs, potentially preventing infections. Employing the Flusier method, the study embeds nephrite in CLs, reducing bacterial attachment despite a rougher surface. Safety evaluations in rabbits reveal no significant complications, suggesting its safety. The study, however, has limitations like the short testing duration and unclear anti‐pseudomonal mechanisms. Further research is needed to validate nephrite‐impregnated CLs for human use, but this study lays a promising groundwork for developing safe, anti‐microbial CLs.
Comparison of mice from two different vendors for dry eye disease mouse model
Authors: Thapa Rubina , Lappeteläinen Birgitta , Kolehmainen Anni , Koponen Anna Mari , Partanen Päivi , Lappalainen Eerik , Härkönen Kirsti , Pakarinen Oona , Varis Sanni , Haapaniemi Anne Mari , Pietikäinen Piia , Vähätupa Maria
Published: January 2025

Aims/Purpose: The purpose of the study was to compare corneal surface damage at baseline and 20 days after induction of dry eye disease (DED) in mice from two different vendors: Janvier Labs, France, and The Jackson Laboratory, USA.

Methods: 120 C57BL/6JRj female mice (Janvier Labs, Saint‐Berthevin, France) and 120 C57BL/6J female mice (The Jackson Laboratory, Bar Harbor, ME USA) were received at our facility and corneal fluorescein staining (CFS) was performed to evaluate corneal surface damage at baseline. 40 mice with CFS score ranging from 0‐2 were selected for DED study. DED was induced in 8‐week‐old mice by administering scopolamine (500 μg/mouse/dose) subcutaneously three times per day for 20 days. Mice were housed in the dry eye inducing chamber (DEIC, 12l/min airflow and 13 % humidity on average). Mice were treated topically with Ikervis® or phosphate‐buffered saline (PBS) twice daily (5 μl/eye). Corneal surface damage was assessed using CFS on day 13 and day 20, and with rose bengal staining (RBS) on day 21.

Results: The baseline CFS score (median of 2) did not differ in mice from Janvier and Jackson. DED was successfully induced in mice from both vendors. However, Janvier mice developed more severe corneal damage on day 13 (median score 3 vs 2, respectively; p < 0.05). CFS score in Jackson mice did not reach statistical difference on day 20 as compared to baseline (median score 1 vs 2, respectively; p = 0.21). Mice treated with Ikervis® did not differ from PBS‐treated mice in corneal surface damage as assessed using CFS on Day 13 and 20 and RBS on Day 21. RBS staining results from PBS‐treated mice were similar in Janvier and Jackson mice.

Conclusions: The corneal damage at the baseline was similar in both vendors’ mice. The successful induction of dry eye disease was evident in both vendors’ mice based on day 13 CFS data. However, the phenotype persisted only with Janvier mice. This dosing regimen of Ikervis® failed to show any therapeutic effect as assessed from CFS and RBS scoring in mice from either of the vendors.
Vitamin D supplementation modifies clinical and biological markers of keratoconus progression
Authors: Ferrari Giulio , Palombella Silvia , Bartolomeo Nicolò , Tilaro Gianluca , Pederzolli Matteo , Vitar Romina Mayra Lasagni , Fonteyne Philippe , Massimo De Micheli , Bandello Francesco
Published: January 2025

Aims/Purpose: evaluation of vitamin D (Vit D) supplementation on clinical progression and systemic biomarkers in adolescent patients affected by keratoconus (KC) and Vit D insufficiency.

Methods: forty adolescent patients (age range: 12–19) meeting the criteria of KC diagnosis and Vit D insufficiency ( < 30 ng/mL) were enrolled and followed for 12 months. Vit D supplementation was prescribed for the first 6 months and patients were then followed up for additional 6 months. Clinical parameters, including best spectacle‐corrected visual acuity, maximal keratometry, and corneal thickness were measured at month 0, 2, 4, 6, 9, 12 after enrollment to monitor the KC progression. Moreover, at month 0 and 6 after enrollment we evaluated serum biomarkers, including Vit D levels and metabolism, collagen degradation, and inflammation by ELISA and RT‐PCR.

Results: after 6 months of Vit D supplementation, serum Vit D levels were significantly increased and remained clinically stable up to month 12. Two‐thirds of patients responded to treatment and showed KC stabilization 12 months after enrollment. Interestingly, Vit D receptor was upregulated only in stable patients (p < 0.01) at month 6. Serum markers indicated that type I collagen degradation product, procollagen type I carboxyl‐terminal propeptide, and the ratio between matrix metalloproteinase 9 and tissue inhibitor of matrix metalloproteinase 1 were statistically decreased (p < 0.05) only in stable patients. Vit D supplementation was associated with increased expression of CD 14 (p < 0.0001) and decreased levels of lactoferrin (p < 0.0001).

Conclusions: these data demonstrated that Vit D treatment stabilized KC progression in the majority of patients. These stable patients showed reduced systemic inflammation and collagen catabolism, thus suggesting that KC could be considered a systemic disease.
Performance and safety of a new preservative‐free eye drops in contact lens wearers with dry eye
Authors: Christina Grupcheva
Published: January 2025

Aims/Purpose: One of the most common reason for contact lens discomfort and drop out is dry eye. The aim of this study was to assess the performance of new preservative‐free eye drops Thealoz®Total containing sodium hyaluronate (SH) 0.15%, trehalose 3%, NAAGA (N‐Acetyl‐Aspartyl‐Glutamic Acid) 2.45% (Laboratoires Théa, Clermont‐Ferrand, France), in patients with subjective appreciation of ocular surface problems due to contact lenses (CL)wear.

Methods: A prospective, single‐arm, multicenter, 5‐week study included three visits: Day 1 (D1), D15 and D36 in 34 patients wearing CL daily, applying Thealoz®Total 3 to 6 times daily. The Ocular Surface Disease Index (OSDI) and the Contact Lens Dry Eye Questionnaire‐8 (CLDEQ‐8) were used to evaluate symptoms and quantify discomfort. Standardized clinical tests were performed to assess dry eye.

Results: The results for 34 participants were analyzed (FAS). The mean (SD) of the CLDEQ‐8 total score was 22.6 (4.6) at baseline, 13.5 (5.2) at D15 and 10.0 (4.7) with a mean Change From Baseline (CFB) of ‐12.6 (5.0) at D36 (p < 0.001). The mean (SD) OSDI score was 36.85 (16.29) at baseline, 19.37 (14.41) at D15, 12.71 (10.34) at D36 with a mean CFB of ‐24.14 (12.57) at D36 (p < 0.001). The mean CFB in the ocular discomfort score was ‐22.1 ± 18.3 mm at D15 and ‐32.6 ± 19.0 mm at D36 (p < 0.001). The mean CFB in total symptom score was ‐4.4 ± 2.4 at D15 and ‐6.3 ± 3.2 at D36 (p < 0.001). Most patients experienced an improvement of each symptom at D15 (50.0% for itching and 82.4% for dryness) and D36 (67.6% for itching and tearing, and 91.2% for dryness). A soothing sensation upon instillation was judged “important” by 47.1% of patients at D15, and increased to 79.4% at D36. Only two Treatment‐Emergent Adverse Event (TEAE) were experienced by 1 patient, and were non‐serious and of mild intensity (photophobia and instillation site discomfort).

Conclusions: This new eye drops containing SH 0.15%, trehalose 3%, NAAGA 2.45% has been shown to be efficacious on dry eye symptoms and ocular discomfort in CL wearers as soon as 15 days, with sustainable improvement in 36 days. This makes the drops safe and efficient, not only for CL users but for variety of therapeutic and postsurgical applications with utilization of CL.