bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug‐induced choroidal effusion: Cases review
Authors: Fernandez‐Velasco Diego , Pueyo‐Bestué Ignacio , Mallen Victor , Bermudez Javier , Biescas Andrés , Rius Nuria , Ila Carmen , Monleón Claudia Hernández‐Barahona , Navarro Damián García , Santana Carlos
Published: January 2025

Purpose: Choroidal effusion is a well‐known complication of intraocular surgery, but it can happen as a drug adverse effect.

Methods: We present three clinical cases of choroidal effusion as a result of systemic treatments.

Results: 82‐years‐old woman presents with pain and loss of vision in left eye. She was treated with acenocumarol. She had bilateral phacoemulsification two months ago with normal development. Visual acuity (VA) was 0.8 right eye and 0.3 left eye, intraocular pressure (IOP) was 16/18 mmHg and anterior segment exploration was normal. She had a complete choroidal effusion and a temporal serous retinal detachment in her left eye. After one week of topical steroids and atropine, fundus alterations had disappeared.

65‐years‐old male presents with blurred vision and photopsias in right eye since one week. The patient has a history of type II diabetes and benign prostatic hyperplasia, treated with tamsulosine. First day exploration was: AV 0.3 right eye and 0.5 left eye, he was phakic and IOP was 16 mmHg both eyes. On right eye fundus, there where severe choroidal effusion. Topical and oral steroid treatment was started and cycloplegia. After one month, choroidal effusion had disappeared and VA improved.

86‐years‐old male had bilateral painless loss of VA. He was diagnosed of Parkinson's disease and treated with rotigotine. First day exploration was: VA 0.5 right eye and 0.3 left eye, no alterations in anterior segment and IOP was 12 mmHg both eyes. On fundus examination, bilateral nasal choroidal effusion were found. Topical steroid and cycloplegia were the treatment and rotigotine was suspended. Seven days after rotigotine's interruption, both eyes choroidal effusion had disappeared.

Conclusions: Drug‐induced choroidal effusion must be on the differential diagnosis if there are no antecedents of IOP alterations or recent surgeries. Ophthalmology patients are increasingly older and pluripathologic so drug adverse effects will be more common.
SS‐OCT and SS‐OCT A findings in nascent type 3 neovascularization complicating age‐related macular degeneration
Authors: Sakji Fatma , Aoun Safa Ben , Maamouri Rym , Fendouli Ines , Slim Selmi , Cheour Monia
Published: January 2025

Aims/Purpose: To emphasize the role of Swept‐source optical coherence tomography (SS‐OCT) and SS‐OCT angiography (SS‐OCT A) imaging in identifying and monitoring pre‐exudative type 3 neovascularization.

Methods: Patients diagnosed with nascent type 3 neovascularization associated with age‐related macular degeneration were prospectively followed in the Department of Ophthalmology at Habib Thameur Hospital, Tunis, Tunisia. All enrolled patients had treatment‐naïve eyes in the pre‐exudative stage. All patients underwent SS‐OCT and SS‐OCT A imaging at baseline, one, three, and six months of follow‐up.

Results: Six eyes of 6 patients were assessed in this study. The mean patient age was 65 years. At the baseline, all of them presented, on SS‐OCT, with an intraretinal hyperreflective foci (HRF) visualized above the external limiting membrane associated with retinal pigment epithelium detachment. SS‐OCT A detected a corresponding flow signal of the HRF originating from the outer retina slab without intraretinal exudation. During the follow‐up, only one patient developed an extension of the neovascularization with massive exudation treated by intra‐vitreal injections of Bevacizumab. No progression of the vascular lesions was detected in all the other eyes within 6 months.

Conclusions: With the use of the SS‐OCT and the SS‐OCT A, nascent type 3 neovascularization has been identified as a pre‐exudative stage that warrants closely monitoring and early treatment if lesions progress in order to improve functional outcomes.

References

Miere A, Querques G, Semoun O, Amoroso F, Zambrowski O, Chapron T, Capuano V, Souied EH. Optical coherence tomography angiography changes in early type 3 neovascularization after anti‐vascular endothelial growth factor treatment. Retina. 2017 Oct; 37(10): 1873‐1879.

Sacconi R, Sarraf D, Garrity S, Freund KB, Yannuzzi LA, Gal‐Or O, Souied E, Sieiro A, Corbelli E, Carnevali A, Querques L, Bandello F, Querques G. Nascent Type 3 Neovascularization in Age‐Related Macular Degeneration. Ophthalmol Retina. 2018 Nov; 2(11): 1097‐1106.
AMD: Analysis, evaluation, evolution and prognosis of amd atrophy complication: Study with oct and automatic oct segmentation
Authors: Gonzalez Corinne
Published: January 2025

Aims/Purpose: This study aims to analyze AMD Atrophy Complication using an efficient methodology to maximize the understanding of its characteristics, evolution and prognosis

Methods: 572 eyes from 401 patients with AMD Atrophy Complication were examined using OCT (Spectralis HRA‐OCT, spectral domain OCT) and Automatic OCT segmentation (Ikerian). Every time, Automatic measurements of OCT scans evaluated: width, mean and maximum horizontal loss or extent of change per year, of both inner and outer retinal layers particularly focusing on PR (Photoreceptor), Myoid zone (MZ) and RPE (Retinal Pigment Epithelium) layer. Drusen, pigment epithelial detachment (PED), amorphous material (AM) measurements were also involved. Follow‐up assessments were conducted every 6 months during 4 years. Edge of atrophic areas was also evaluated, particularly focusing on retina layers at the border itself and at distance from it, in intervals of 0.1mm, so basically rings around the lesion

Results: OCT allowed for a comprehensive analysis of all atrophic areas characteristics, retina layers. Automatic OCT segmentation facilitated enhanced analysis, evaluation, through automation, providing insights into atrophic lesion's characteristics: size, width, evolution, edge. 3317 OCT scans were analyzed. Mean change (mm/year) demonstrated a depletion extent of RPE: 0.16 (0.51); PR: 0.20(0.63); MZ: 0.22(0.69); an extent of PED: 0.07(0.57) and AM: 0.10(0.86). The MZ layer appeared to attenuate first, followed by PR, finally RPE layer over time. At Edge of Atrophic area: similar results concerning MZ, PR and RPE layers, but differences between 0 and 0,4 mm from the border. This approach enabled a closer examination, characterization of atrophy, edge of atrophic area too, as well as area itself, establishing a better understanding of its evolution and physiopathology. Consequently, criteria for risk evolution, biomarkers and predictors of AMD Atrophy complication were determined.

Conclusions: The study of AMD Atrophy Complication with OCT and Automatic OCT segmentation significantly improves the criteria for evaluation, evolution and prognosis of ATROPHY, so better knowledge and understanding of physiopathology process and efficiency in therapeutic evaluations
Intravitreal injection leads to an increased density of vitreous fibrils and macrophage invasion
Authors: Jaramillo Patricia , Pampalona Judit , Carretero Ana , Cunilleras Eduard , Ruberte Jesús
Published: January 2025

Aims/Purpose: The main objective is to describe the inflammatory response produced in the mouse vitreous composition and structure after intravitreal injection (IVI). The mechanism by which a sterile IVI produce inflammation has been previously described; however, no study has analyzed the specific changes occurring at the vitreous fibrils.

Methods: Healthy adult male and female C57/BL6J mice were randomized to receive “in vivo” either physiological serum injection (7μl; one dose; n = 6) or no injection (n = 5). After 1 hour and 24 hours, eyes were enucleated, embedded in paraffin, sectioned (5 μm), and analyzed by scanning confocal microscopy after immunohistochemistry.

Results: The sterile injection of serum in the mouse vitreous chamber produced noninfectious inflammation, characterized by the invasion of Mac‐2 (CD11b) expressing cells, a marker of macrophages. Furthermore, using anti‐fibrillin 1 antibody, the injected eyes showed an increased vitreous fibril density. Interestingly, macrophages expressed intracellularly fibrillin 1 suggesting that vitreous fibrils could be produced from these hyalocyte‐like cells under inflammation.

Conclusions: Understand the composition and spatial arrangement of the vitreous fibrils can be very useful for evaluating pathophysiological conditions during posterior eye diseases. Additionally, determining the role these fibrils play during the post‐IVI inflammatory process provides new insights into the impact of IVI on this part of the eye. These results also establish the mouse as a model suitable for studying the iatrogenic mechanisms associated with therapeutic intravitreal injections.
Non‐clinical safety of PST‐611, non‐viral vectorized human transferrin, for the treatment of geographic atrophy (GA)
Authors: Bigot Karine , Bénard Romain , Gondouin Pauline , Piazza Marie , Orhan Elise , Touchard Elodie , Bordet Thierry , Behar‐Cohen Francine
Published: January 2025

Aims/Purpose: Complement inhibitors slightly reduce geographic atrophy (GA) lesion growth, yet vision loss prevention remains a challenge. Iron overload worsens retinal diseases like age‐related macular degeneration (AMD), and Transferrin (Tf) supplementation mitigates iron‐induced toxicity, offering a promising therapy for GA (Picard 2015). To avoid repeated intravitreal Tf injections, we developed a non‐viral vectorized delivery platform via electrotransfection of the ciliary muscle, acting as a biofactory for sustained therapeutic protein production in the eye (Bigot 2020). We evaluated the safety and biodistribution of PST‐611, a DNA plasmid coding for human Tf.

Methods: New Zealand White rabbits were divided into two treatment groups (45 μg and 150 μg/eye) and one control group. Part 1 animals received a single administration of PST‐611 or vehicle with a 30‐day follow‐up. Part 2 animals received repeated administration at the same doses with a 6‐month interval and were followed for up to 3 months after the second treatment.

Results: No mortality, abnormal clinical signs, changes in body weight, temperature, or food intake were observed. No significant changes in blood chemistry, hematology, or systemic microscopic findings were found in PST‐611‐treated rabbits. PST‐611 caused no adverse ocular effects. The plasmid primarily localized in the ciliary muscle, with dose‐related levels persisting up to at least 30 days and 3 months after single and repeat doses, respectively. Lower levels were detected in nearby ocular tissues. No systemic exposure was observed. Human Tf was not detected in serum but was present in the vitreous of treated animals at almost all time points.

Conclusions: PST‐611, administered via a minimally invasive proprietary delivery system, demonstrated safety. Following single and repeated administration, PST‐611 localized primarily in the ciliary muscle with ocular exposure to human Tf up to at least 3 months after the repeat dose. The favorable safety profile of PST‐611 supports its further clinical development for GA patients.

References

Picard et al. Free Radic Biol Med (2105) 89: 1105‐21; Bigot et al. Pharmaceuticals (2020) 12(9): 836
Anatomical and functional results of injectable plasma rich in growth factors as a treatment for poor prognosis macular holes
Authors: Caminal Marta , Crespí Jaume , Saladrigas Albert , Conversa Santiago , Cobo Maria , Rego Daniela
Published: January 2025

Aims/Purpose: The aim of this study is to analyse de benefits of plasma rich in growth factors (PRGF) as an adjuvant to pars plana vitrectomy (PPV) in por prognosis macular holes (MH).

Methods: A retrospective descriptive study was performed in patients with MH. Large ( > 400 μm), myopic, persistent and recurrent MH were included. Patients were treated with PPV associated with adjuvant injectable liquid PRGF. Postoperative best corrected visual acuity (BCVA) and the MH closure, by Optical Coherence Tomography (OCT), were evaluated. Other variables were analysed such as: sex, age, type of MH, diameter, base and height of the MH and type of closure by OCT.

Results: A total of 12 eyes were included in the study, 10 female (83.3%) and 2 males (16.66%). The mean age was 64.83 ± 10.4 years. The MH presented diverse etiology: 4 were myopic MH (33.3%), 4 were persistent MH (33.3%) and 4 were idiopathic large MH. One of the myopic holes, was recurrent. 7 patients (58.3%) had large MH ( > 400 microns). All patients underwent vitrectomy, internal limiting membrane (ILM) peeling and adjuvant PRGF. Complete closure of de MH was achieved in 11 patients (91.7%) and BCVA improvement in 9 patients (75%). Reconstitution of the external limiting membrane (ELM) and ellipsoid layer was observed in 5 patients (41.66%). In 5 patients (41.66%) closure type 1A was observed. Follow‐up time was 3 months. No adverse effects were recorded in any case.

Conclusions: The use of PRGF as an adjuvant in PPV and ILM peeling in por prognosis MH may be an effective alternative to achieve anatomical closure of these, as well as reconstitution of the retinal structure and future improvement in final VA.
Imitation game: Ocular tuberculosis camouflaged as acute retinal necrosis
Authors: Chong Xin Yee , Chew Chia Chee , Yew Yih Chian , Ismail Fazliana
Published: January 2025

Aims/Purpose: To report a case of ocular tuberculosis (TB) mimicking acute retinal necrosis (ARN)

Methods: Case report

Results: A 32‐year‐old immigrant, presented with right eye blurring of vision for 2 months and associated with 1 week history of floaters. The left eye was blind since 8 years ago with a history of progressive blurring of vision. He did not seek any medical attention at that time due to financial constraint. Otherwise, he denies any constitutional or autoimmune disease symptoms. On examination, visual acuity of the right eye was 6/36 and left eye was non‐perception to light in all 4 quadrants. There was positive relative afferent pupillary defect on the left eye. Anterior segment examination of the right eye was normal and fundus examination showed presence of vitritis 3+ with multiple foci of retinitis 360 degrees peripherally, oedematous retina with confluent retinitis at superonasal and areas of haemorrhage nasally. Left eye showed white cataract and B‐scan revealed total retinal detachment (RD) posteriorly. He was treated for right eye ARN in view of typical peripheral retinal involvement with haemorrhages and left eye RD. He was started on intravenous Acyclovir 100mg/kg/dose TDS and was given 2 times of intravitreal Ganciclovir.

Unfortunately, the symptoms worsened with deteriorating visual acuity throughout admission, and he was referred to medical retina team and the diagnosis revisited. Mantoux test showed positive result with 24mm with blister. However vitreous TB and viral polymerase chain reaction (PCR) were negative. Fundus fluorescein angiogram showed presence of hot disc and multiple peripheral vessel leakages from all quadrants. The diagnosis was revised to right eye ocular TB. Patient was co‐managed with medical team and anti‐TB medications were commenced. His symptoms improved tremendously with visual acuity of 6/9.

Conclusions: Ocular TB is a great masquerader. High index of suspicion and thorough investigations are required to diagnose an atypical uveitis presentation especially in TB endemic areas such as in this case. Multidisciplinary approach is vital in treating tuberculosis to monitor for multisystem involvement.
Clinical outcomes of silicon oil tamponade in patients with chronic exudative retinal detachments in effective with conservative treatment
Authors: Ha Joonyoung , Han SooYeon , Yang Yunsik
Published: January 2025

Aims/Purpose: To investigate the surgical treatment outcomes and complications of pars plana vitrectomy and silicone oil tamponade in patients with chronic exudative retinal detachment that did not respond to conservative treatment.

Methods: This retrospective study included 81 eyes of 81 patients diagnosed with chronic exudative retinal detachment who underwent pars plana vitrectomy and silicone oil tamponade after failing to respond to conservative treatment with oral steroids and intravitreal or sub‐Tenon's triamcinolone injections between February 2002 and September 2023. The best‐corrected visual acuity (BCVA) before and after surgery, postoperative complications, and recurrence rates were analyzed.

Results: The mean duration of silicone oil tamponade was 17.98 ± 3.16 months. Successful retinal reattachment was achieved in 68 eyes (83.95%) after the initial surgery. Of the 51 eyes that had the silicone oil removed, 14 (27.45%) experienced retinal re‐detachment and required additional silicone oil injection. After final silicone oil removal, 39 eyes (48.15%) maintained stable retinal attachment. The mean BCVA improved significantly from logMAR 1.54 ± 0.134 preoperatively to logMAR 1.155 ± 0.139 after silicone oil removal (p = 0.029). Postoperative complications included cataract (n = 30), secondary glaucoma (n = 20), epiretinal membrane and macular edema (n = 8), and emulsified silicone oil (n = 4).

Conclusions: Silicone oil tamponade is an effective surgical treatment that can improve visual outcomes in patients with chronic exudative retinal detachment refractory to conservative management. Although complications can occur, they are manageable, making this approach a reasonable option when conservative treatments fail.
Restoring vision in acute retinal necrosis: A case report
Authors: de Lázaro Alejandra Antón Guzmán , Lozano Carmen Isabel García , Martín Sergio Pernas , Outeiriño Patricia Roig , Hernández Eduardo Conesa , Carretero Manuel Moriche
Published: January 2025

Aims/Purpose: This case report outlines the management of acute retinal necrosis in a 23‐year‐old patient, highlighting challenges and strategies in restoring vision. Acute retinal necrosis (ARN) is a rare yet severe condition characterized by the rapid destruction of the retina. We present the case of a 23‐year‐old patient with no relevant past medical history who developed ARN due to herpes virus infection.

Methods: A thorough ophthalmologic evaluation, including clinical examination and imaging studies, was conducted to diagnose and treat the patient's condition.

Results: The patient presented with acute visual acuity decline in the right eye, leading to a diagnosis of acute retinal necrosis. Despite the complex complications, including retinal detachment, prompt intervention and multidisciplinary collaboration facilitated successful restoration of vision. The patient's evolution showed a lot of complications that turned out to great improvements.

Conclusions: This case underscores the importance of early diagnosis, prompt intervention, and multidisciplinary collaboration in managing acute retinal necrosis, especially in young patients. Effective management strategies can lead to successful restoration of vision and favourable patient outcomes.
Assessing the retina with pupillometry and silent substitution
Authors: Gibertoni Giovanni , Hromov Anton , Piffaretti Filippo , Geiser Martial
Published: January 2025

Aims/Purpose: This device aims to establish a quantitative method for evaluating photoreceptor function, encompassing intrinsically photosensitive retinal ganglion cells (ipRGCs), through a silent substitution technique. Ultimately, this technology strives to facilitate the early detection of neurological diseases, investigation of the circadian rhythm, and clinical assessment of retinal conditions such as color deficiencies and glaucoma.

Methods: A new ophthalmic device using a Maxwellian layout for independent but simultaneous stimulation of both eyes was created. Each channel uses six LEDs for controlled stimuli. Scheimpflug cameras and near‐infrared light to avoid pupil constriction track the pupil dynamics (25‐35Hz). System calibration allows user‐defined protocols for characterizing pupil responses and comparisons with control groups. The device generates high‐quality stimuli for photoreceptor silencing, featuring a compact design with a 0.9 mm exit pupil, 30 mm vertex distance, and a maximum 60° field. For further control over illumination area, smaller or annulus field stops can be readily inserted.

Results: The spectral uniformity exhibits an excellent spectral uniformity (98‐99%). Notably, the radiant power ratio between stimulus and baseline exhibits good stability, maintaining a variation of less than 1% over a three‐month period.

Preliminary testing confirms the device's performance aligns with expectations. Chromatic pupillometry and melanopsin stimulation experiments conducted on six volunteers using a 3‐second flash yielded results consistent with established literature.

Conclusions: Silent substitution is gaining traction in various research fields, including diagnostics and neurophysiology. Early results indicate the device meets requirements for silent substitution. Certification as a Class‐I CE marked medical device (EU 2017/745) facilitates further clinical research.
Asteroid hyalosis in patients with macular telangiectasia type 2
Authors: Urbancic Mojca , Divjak Darja Dobovsek , Kuncic Ajda , Hudler Petra , Debeljak Natasa
Published: January 2025

Aims/Purpose: Asteroid hyalosis is composed of calcium and phospholipids. The prevalence of this condition is around 1 % and increases with age. Recent reports have indicated an increased occurrence of asteroid hyalosis among younger individuals suffering from retinal dystrophies, implying that degenerative processes may play a role in the onset of condition. Macular telangiectasia type 2 (MacTel) is a neurodegenerative retinal disease. The disease‐associated metabolic profiling indicates distinct alterations, such as reduced serum serine and glycine levels, as well as altered lipid metabolism. We speculated that there might be some common mechanisms in the pathogenesis of asteroid hyalosis and MacTel. Our objective was to determine the prevalence of asteroid hyalosis among MacTel patients and to assess any potential correlation with the progression stages of MacTel disease.

Methods: MacTel patients had a complete ophthalmological exam followed by multimodal imaging. We recorded the presence of asteroid hyalosis and graded MacTel fundus alterations according to MacTel Research Group's classification. The prevalence of asteroid hyalosis was determined, and its correlation with MacTel stages was analyzed in our patients.

Results: Data of 46 patients, 22 (47.8%) males and 24 (52.2%) females, aged 66.76 ± 9.83 years were analyzed. Eight patients had asteroid hyalosis (17.4%), with 3 cases being bilateral. Eyes with asteroid hyalosis (11 eyes) exhibited MacTel changes ranging from stage 0 to stage 6: one eye was at stage 0, two at stage 1, two at stage 2, one at stage 3, two at stage 4, two at stage 5, and one at stage 6. Our findings revealed no correlation between the presence of asteroid hyalosis and the stages of MacTel disease.

Conclusions: We observed higher prevalence of asteroid hyalosis among MacTel patients compared to general population. However, we did not identify any relationship between MacTel fundus alterations and asteroid hyalosis.
The polarity effect of direct current stimulation on the vascular regulation of the inner retina
Authors: Freitag Stefanie , Link Dietmar , Klee Sascha
Published: January 2025

Aims/Purpose: Electrical stimulation is not only a suitable method for researching the human nervous system but also for treating neuronal disorders. In ophthalmology, it is applied to patients suffering from various retinal diseases like retinitis pigmentosa. It is known that in the application of direct current stimulation (DCS), the polarity of the current determines the increase or decrease in neuronal activity and enables different therapeutic approaches. However, the polarisation‐dependent effect of the current on the vascular processes in the retina has not yet been investigated. This study examined the effect of anodal and cathodal DCS on the temporal vessels of the inner retina.

Methods: The study was conducted on 24 healthy subjects (14w, 10m, mean age 25.5 ± 3.2yr) who were randomly assigned to either an anodal or a cathodal DCS group (symmetrical design). To test the effect of the DCS (800μA; ring‐shaped electrode placed surrounding the eye, square electrode placed at the occiput) on vascular regulation, the DCS was combined with visual flicker stimulation using the Dynamic Vessel Analyzer (DVA, Imedos Systems GmbH; standard protocol). Exclusion criteria were ocular and systemic diseases. We investigated two primary vessel segments (superior temporal artery (STa) and vein (STv)) located between 0.5 and 2.0 disc diameters from the optic disc. For each subject the DVA was performed two times (first baseline DVA1, followed by a 20‐minute DCS (different polarity depending on the group), and directly afterwards a second DVA2). For statistical analysis, the t‐test for paired samples was used and Bonferroni corrected.

Results: The mean vascular responses (STa/STv) for the anodal DCS group were DVA1: 3.7 ± 1.7%/3.4 ± 1.6%; DVA2: 3.5 ± 1.3%/5.4 ± 3.2% and for the cathodal DCS group DVA1: 3.2 ± 2.0%/4.0 ± 2.6%; DVA2: 3.2 ± 1.4%/2.5 ± 1.3%. For the venous vascular response, we found a significant increase after anodal DCS (p = 0.019) and a significant decrease after cathodal DCS (p = 0.018).

Conclusions: We were able to successfully determine the effect of different DCS polarities on the retinal vascular system. We found significant effects on the veins. The absence of effects on the arteries indicates different regulatory pathways in the retina. This should be investigated by further selective stimulation.
Delayed onset macular hemorrhage following previous intraocular tuberculosis
Authors: Cabo Ana , Garcia‐Bardera Javier , Amor Patricia Robles , Fernández‐Sáez Clara , Caride Sara Garcia
Published: January 2025

Aims/Purpose: Mycobacterium tuberculosis, an acid‐fast‐staining bacterium, thrives in oxygen‐rich environments due to its obligate aerobe nature. Consequently, tuberculous lesions often manifest in highly oxygenated tissues. Among these tissues, the choroid stands out for its exceptionally high blood flow rate, making it a prime site for M. tuberculosis colonization. We will focus on macular hemorrhages as a complication following intraocular tuberculosis, which may have a delayed onset and arise from inactive lesions.

Methods: Presentation of a clinical case.

Results: We present a case involving a 58‐year‐old patient who presented to the Emergency Room with complaints of acute loss of visual acuity in her right eye. She had been immunocompromised in the past, and had a personal history of intraocular tuberculosis, which she reported had been inactive for years. On examination, her visual acuity was measured at 0.1 in the affected eye. Fundus examination revealed a macular hemorrhage surrounding a choroidal scar. There were no signs of anterior ocular involvement, vitreal inflammation, or active choroiditis. The patient was otherwise asymptomatic. Despite the lack of active lesions, a chest radiograph was performed to rule out active tuberculosis in the lungs, yielding negative results. Active tuberculosis disease was hence ruled out, as well as the need for systemic anti‐TB therapy. The patient was started on antiVEGF intravitreal injections. The patient was scheduled for follow‐up visits, and her visual acuity had improved to 0.8 in the right eye after four months.

Conclusions: Choroidal neovascularization and hemorrhages are rare complications of intraocular tuberculosis, and they may arise from both active and inactive lesions. Activity can be determined by fundus examination and fluorescein angiography. Any systemic symptoms should also be recorded on the patient's history. If risen from an inactive choroidal scar, a macular hemorrhage should be treated with anti VEGF injections.
Diagnosis of a case of ocular reactivation in a patient with lymphoplasmacytic lymphoma
Authors: Muñoz Noelia Montaña , de Ulzurrun Gabriel Liaño Diez , Shadvar Samira Ketabi , Moreno Silvia Virseda , de la Torre Marta Vela , Fiz Jesús Pérez , de Andrade Pérez Marina Pardo , González Miguel Herrero , González Olga Martinez
Published: January 2025

Aims/Purpose: Waldenstrom's macroglobulinemia (WM) is a rare hematological neoplasm characterized by lymphoplasmacytic proliferation, monoclonal immunoglobulin M (IgM) production, and bone marrow infiltration. Ocular involvement can be one of the signs of disease activity, and the purpose of this case is to present the ocular manifestations that may occur through a clinical case seen in consultation.

Methods: A review was conducted of a case involving a 64‐year‐old male patient seen in the ophthalmology department of our hospital, with no known drug allergies and a personal history of Waldenstrom's macroglobulinemia diagnosed in 2018, currently in remission. The patient presented with progressive visual acuity loss in the left eye in the context of possible vitritis/chorioretinitis. He was treated with trimethoprim, sulfamethoxazole, and prednisone due to the suspicion of a possible infectious cause. Laboratory tests, serologies, a vitreous biopsy, fluorescein angiography, and ocular ultrasound were performed to determine the etiology. A few weeks later, he presented with clinical symptoms of disorientation and behavioral changes, prompting an emergency visit. A brain MRI was performed, revealing a tumoral lesion in the left frontal lobe, suggestive of cerebral lymphoma.

Results: After studying and biopsying the brain lesion, the diagnosis of cerebral lymphoma was confirmed, with ocular involvement in the form of vitritis and chorioretinitis as a sign of disease reactivation.

Conclusions: Waldenstrom's macroglobulinemia can manifest in various ways, and one of them can be through ocular activity signs such as uveitis (both anterior and posterior), vitritis, retinitis, and chorioretinitis. Therefore, it is necessary to conduct a thorough differential diagnosis through a complete medical history, laboratory tests, serologies, and imaging studies when suspecting a possible disease reactivation.
A novel artificial intelligence‐based classification of highly myopic eyes based on visual function and fundus features
Authors: Meng Jiaqi , Song Yunxiao , He Wenwen , Lu Zhong‐Lin , Chen Yuxi , Wei Ling , Zhang Keke , Qi Jiao , Du Yu , Lu Yi , Zhu Xiangjia
Published: January 2025

Aims/Purpose: To develop a novel classification of highly myopic eyes using artificial intelligence (AI) and investigate its relationship with contrast sensitivity function (CSF) and fundus features.

Methods: 616 highly myopic eyes of 616 patients were enrolled. CSF was measured using the quantitative CSF method. Myopic macular degeneration (MMD) was graded according to the International META‐PM Classification. Thickness of the macula and peripapillary retinal nerve fiber layer (p‐RNFL) were assessed by fundus photography and optical coherence tomography, respectively. Classification was performed by combining CSF and fundus features with principal component analysis and k‐means clustering.

Results: With 83.35% total variance explained, highly myopic eyes were classified into 4 categories. The percentages of categories 1 to 4 were 14.9%, 37.5%, 36.2%, and 11.4%, respectively. CSF of the eyes in category 1 were the highest, followed by those in category 2 and then category 3, while the lowest was seen in category 4. Compared to those in category 1, eyes in category 2 presented higher percentage of MMD2 and thinner temporal p‐RNFL. Eyes in categories 3 and 4 presented significantly higher percentage of MMD ≥ 3, thinner nasal macular thickness and p‐RNFL (p < 0.05). Multivariate regression showed category 4 had higher MMD grades, thinner macular and p‐RNFL thickness compared to category 3.

Conclusions: We proposed an AI‐based classification of highly myopic eyes by integrating features from both visual function and fundus. It might be an important tool to comprehensively evaluate highly myopic eyes.
Long‐term results of unilateral or bilateral injection of lenadogene nolparvovec gene therapy for leber hereditary optic neuropathy
Authors: Biousse Valérie , Yu‐Wai‐Man Patrick , Newman Nancy , Subramanian Prem , Moster Mark , Wang An‐Guor , Donahue Sean , Leroy Bart , Carelli Valerio , Vignal‐Clermont Catherine , Sadun Alfredo , Sergott Robert , Fernández Gema Rebolleda , Chwalisz Bart , Banik Rudrani , Taiel Magali , Sahel José‐Alain
Published: January 2025

Aims/Purpose: To evaluate the efficacy and safety of intravitreal lenadogene nolparvovec gene therapy (LNGT) in patients with Leber hereditary optic neuropathy due to the m.11778G > A MT‐ND4 mutation for up to 5 years after administration.

Methods: REFLECT is a randomized, double‐masked, placebo‐controlled phase 3 study. The first‐affected eye received LNGT; the other eye was randomly injected with LNGT or placebo. RESTORE is the 5‐year follow‐up study of the two phase 3 studies RESCUE and REVERSE, in which patients received an injection of LNGT in one eye and a sham injection in the other eye. REFLECT interim data at 4 years after LNGT and RESTORE final data at 5 years are presented.

Results: In REFLECT, 48 patients were treated bilaterally and 50 unilaterally. The mean (standard deviation [SD ]) improvement in best‐corrected visual acuity (BCVA) from nadir to 4 years was ‐0.40 (0.32) (+20 ETDRS letters) and ‐0.34 (0.31) (+17 letters) LogMAR in the first and second‐affected eyes of bilaterally treated patients, and ‐0.38 (0.41) (+19 letters) and ‐0.27 (0.32) (+14 letters) LogMAR in the first and second‐affected eyes of unilaterally treated patients. Better BCVA improvement and higher responder rates were observed in patients treated bilaterally. In RESTORE, 62 unilaterally treated patients completed the study. At 5 years, mean (SD) change in BCVA from nadir was ‐0.44 (0.46) LogMAR (+22 ETDRS letters) for LNGT‐treated eyes and ‐0.39 (0.36) LogMAR (+20 ETDRS letters) for sham‐treated eyes. Overall, LNGT safety was favorable in REFLECT and RESTORE.

Conclusions: The persistence of the LNGT effect and the favorable safety profile were confirmed 4 years after a unilateral or bilateral injection in REFLECT and 5 years after a unilateral injection in RESTORE. Bilateral LNGT provided additional benefit compared to unilateral LNGT.
The COVID‐19 pandemic and Urology – reflecting on successful initiatives and lessons in Australia
Authors: Xu Jennifer , Alberto Matthew , Woon Dixon , Bolton Damien , Ischia Joseph
Published: January 2025

Objectives

To summarise the impact of the coronavirus disease 2019 (COVID‐19) pandemic on urological practice globally with a focus on Australian initiatives, as the pandemic resulted in radical changes in healthcare infrastructure and policies.

Methods

We conducted a literature review of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE) and Web of Science medical databases. The key terms used to conduct our search algorithm comprised of ‘COVID’, ‘wait list or wait time or delay’, ‘urology’, ‘surgery’ and ‘outcomes’, and generated 231 articles. Abstracts were reviewed for relevance and 40 studies selected for full‐text review. Society position statements and government level press release statements were identified through citation tracking and additionally included.

Results/discussion

The halt on elective surgical services during the pandemic was deemed necessary to curb infection rates and conserve healthcare resources. However, it resulted in extended wait times and large surgical backlogs with major downstream effects. Australia fared favourably with regards to infection rates compared to international populations consequent upon strict border control, vaccine mandates, and stringent lockdowns. However, similar trends were noted in both oncological and non‐oncological urology service reduction, resulting in significant concerns regarding the long‐term sequelae of delayed surgery and missed appointments upon patient clinical outcome. Initiatives including collaborative partnerships between public and private hospital sectors, government‐funded programmes and adoption of telehealth were successfully established as part of Australia's efforts to stabilise our healthcare system in response to the pandemic.

Conclusion

Australia's pandemic efforts have highlighted the escalating imbalance between increasing demand from a growing and ageing population on an already over‐burdened system with finite resources. The additional strain of managing post‐COVID‐19 pandemic fallout in this context provides further challenges for clinicians and healthcare administrators alike. Collaboration by all stakeholders must continue in order to seek innovative solutions to maximise efficiency of healthcare service utilisation, so that quality universal healthcare provision may continue in the future.
Variation in the commissioning of specialist weight management services and bariatric surgery across England: Results of a freedom of information‐based mapping exercise across the 42 integrated Care Systems of England
Authors: Elhariry Maiar , Iyer Pranav , Isack Nadya , Sousa Bernado , Singh Pushpa , Abbott Sally , Wiggins Tom , Nirantharakumar Krishnarajah , Bellary Srikanth , Flint Stuart W. , Pournaras Dimitri J. , Hazlehurst Jonathan M.
Published: January 2025

Specialist weight management services including bariatric surgery are commissioned within regions of England called Integrated Care Systems (ICSs) with eligibility and treatment guidelines determined as part of the National Institute for Health and Care Excellence (NICE) guidance. Reported variation in commissioning and bariatric surgery eligibility criteria has not been previously mapped. Freedom of Information (FOI) requests provide a tool, supported by legislation, to ask questions of public authorities including ICSs such that they must respond accurately. FOIs were sent to all 42 ICSs in England asking 4 questions aiming to establish whether there is variation in the commissioning of specialist weight management services and the eligibility criteria for bariatric surgery across England. Responses were presented descriptively and mapped across England. Responses were received from 41 out of 42 ICSs, with 34 reporting that they provide commissioned medical weight management programmes and 38 funding bariatric surgery. Thirteen reported using criteria that were not compliant with NICE guidance. A large area of the country centred around the East of England does not have a bariatric unit reducing access to care. There is significant geographical variation in the availability of both bariatric and specialist medical weight management services across England, with large portions of the country without local access to a service or no service at all. Where services are available, there is significant inconsistency in eligibility for bariatric surgery despite nationally available guidance.
MUSTN1 Interaction With SMPX Regulates Muscle Development and Regeneration
Authors: Fu Yu , Hao Xin , Shang Peng , Nie Jingru , Chamba Yangzom , Zhang Bo , Zhang Hao
Published: January 2025

Pigs are important agricultural animals whose growth rate and meat production performance are related to muscle development. Musculoskeletal embryonic nuclear protein 1 (MUSTN1) participates in various biological processes, including myogenesis and growth in animals, but the physiological functions and mechanisms of porcine MUSTN1 on muscle development are unclear; thus, we aimed to elucidate them. We found that MUSTN1 was highly expressed in the muscles of fast‐growing pigs. Functionally, MUSTN1 promoted myoblast proliferation and differentiation. MUSTN1 knockout mice exhibited reduced muscle mass and fibre cross‐sectional area, decreased exercise endurance, and delayed muscle regeneration. Small muscle protein X‐linked (SMPX) was identified as an interacting protein of MUSTN1, and its promotion of myogenic differentiation depended on MUSTN1. Furthermore, MUSTN1 stabilised SMPX and maintained myofiber morphology. This study suggests that MUSTN1 is a critical regulator in the control of muscle development and regeneration and is a potential target for animal genetic improvement and the treatment of human muscle disease.
Screening instruments to detect problematic alcohol use among adults in hospitals and their diagnostic test accuracy: A systematic review
Authors: Bisschop Jacqueline M. , de Jonge Hendrik J. M. , Brunsveld‐Reinders Anja H. , van de Mheen Dike H. , Mathijssen Jolanda J. P. , Rozema Andrea D.
Published: January 2025

Issues

Alcohol consumption can cause physical, psychological and social problems that can result in hospitalisations. Screening in hospitals helps to determine which patients should be given interventions. In this review, we aimed to summarise the diagnostic test accuracy (DTA) of screening instruments for problematic alcohol use among adults in hospitals.

Approach

We searched three databases for studies that assessed validated screening instruments for problematic alcohol use among hospitalised adults. We used the Quality Assessment of Diagnostic Accuracy Studies 2 tool to evaluate the risk of bias.

Key Findings

We included 20 studies in the review. In 11 studies performed in the emergency departments, 5 instruments had a high DTA: the AUDIT, the AUDIT‐C, the RAPS4‐QF, the 2‐question screener and HOLD 5. In the eight studies with inpatients, three instruments had a high DTA: the AUDIT, CAGE‐C and CAGE +10 items. Finally, only one of the included studies evaluated outpatients; the authors reported a high DTA for the AUDIT‐C.

Implication and Conclusions

The results indicate that the AUDIT is an appropriate screening instrument for both inpatients and patients in the emergency department. Moreover, for patients in the emergency department, the AUDIT‐C and the RAPS4‐QF can be used. More research is needed on outpatients, and several screening instruments have only been validated with one study (i.e., the 2‐question screener, DSM‐IV‐2, HOLD 5, CAGE‐C and CAGE +10 questions).
Beyond glycated haemoglobin: Modelling contemporary management of type 2 diabetes with the updated Cardiff model
Authors: McEwan Phil , Foos Volker , Roberts Geraint , Jenkins Robert H. , Evans Marc , Wheeler David C. , Chen Jieling
Published: January 2025

Aims

Recommendations on the use of newer type 2 diabetes (T2D) treatments (e.g., SGLT2 inhibitors and GLP‐1 receptor agonists [RA]) in contemporary clinical guidelines necessitate a change in how T2D models approach therapy selection and escalation. Dynamic, person‐centric clinical decision‐making considers factors beyond a patient's HbA1c and glycaemic targets, including cardiovascular (CV) risk, comorbidities and bodyweight. This study aimed to update the existing Cardiff T2D health economic model to reflect modern T2D management and to remain fit‐for‐purpose in supporting decision‐making.

Materials and Methods

The Cardiff T2D model's therapy selection/escalation module was updated from a conventional, glucose‐centric to a holistic approach. Risk factor progression equations were updated based on UKPDS90; the cardio‐kidney‐metabolic benefits of SGLT2i and GLP‐1 RA were captured via novel risk equations derived from relevant outcomes trial data. The significance of the updates was illustrated by comparing predicted outcomes and costs for a newly diagnosed T2D population between conventional and holistic approaches to disease management, where the latter represents recent treatment guidelines.

Results

A holistic approach to therapy selection/escalation enables early introduction of SGLT2i and GLP‐1 RA in modelled pathways in a manner aligned to guidelines and primarily due to elevated CV risk. Compared with a conventional approach, only considering HbA1c, patients experience fewer clinical events and gain additional health benefits.

Conclusions

Predictions based on a glucose‐centric approach to therapy are likely to deviate from real‐world observations. A holistic approach is more able to capture the nuances of contemporary clinical practice. T2D modelling must evolve to remain robust and relevant.
Adherence to 6‐Mercaptopurine (6‐MP) and Habit Strength in Pediatric Acute Lymphoblastic Leukemia (ALL)
Authors: Yang Mira Muxi , Singh Revika , Haugen Maureen , Duff Ashley , Shoop Jenny , Morgan Elaine R. , Rossoff Jenna E. , Weinstein Joanna L. , Heneghan Mallorie B. , Badawy Sherif M.
Published: January 2025

Background

Low 6‐mercaptopurine (6‐MP) adherence (< 95%) is associated with increased relapse in pediatric acute lymphoblastic leukemia (ALL). Stronger habit has been associated with higher adherence. We examined the relationship of 6‐MP adherence to habit strength and health‐related quality of life in pediatric ALL.

Methods

A single‐center, cross‐sectional study of 52 participants: 11 patients (mean age 16 ± 4) and 41 parents/caregivers (age 37 ± 5). Participants completed Visual Analogue Scale (VASdose), Patient Reported Outcomes Measurement Information System Medication Adherence Scale, and the Self‐Regulated Habit Index (SRHI). Twelve semi‐structured participant interviews were analyzed using thematic analysis.

Results

81% (42/52) of participants reported high 6‐MP adherence (VASdose ≥ 95%): patients 91% (10/11), parents 78% (32/41). No significant correlation was found between adherence and habit strength. Reported adherence facilitators included reminders, care team communications, personalized tools, administration experience, self‐efficacy, and social support. Conversely, financial burden, scheduling conflicts, and medication access were cited as barriers.

Conclusions

One‐fifth of participants reported low 6‐MP adherence, with habit strength not associated with adherence. Variability of 6‐MP routines may prohibit automaticity. While 6‐MP adherence may not correlate with habit strength, interventions promoting and strengthening habit formation may overcome barriers to 6‐MP adherence and improve outcomes.
Weaker Plant‐Frugivore Trait Matching Towards the Tropics and on Islands
Authors: Huang Xiao , Dalsgaard Bo , Chen Si‐Chong
Published: January 2025

Biotic interactions play an important role in species diversification and maintenance and, thus, are regarded as the architecture of biodiversity. Since Darwin and Wallace, biologists have debated whether biotic interactions are stronger towards the tropics and on continents, when compared to temperate regions and islands. Here, based on 354 avian frugivory networks accounting for 22,199 interactions between 1247 bird species and 2126 plant species, we quantified trait matching strength, which reflects interaction strength and specificity, across gradients of latitude and insularity globally. We found that matching between beak size and fruit size was significantly stronger towards the poles and on continents, when compared with the tropics and on islands. As underlining ecological factors, trait matching was stronger with a larger proportion of frugivory (measured as the mean proportion of fruits in bird diets) and network‐level mean beak size, and with a smaller proportion of fleshy‐fruited species (measured as the proportion of fleshy‐fruited plant species in the botanical country where the network was located). These findings suggest that the latitudinal and insular patterns in trait matching are driven by biotic factors that may relate to trait co‐evolution between interacting species and optimal foraging for bird species.