bluuebunny/crossref_metadata_2025_split huggingface dataset:
Artificial intelligence, anterior segment and refractive surgery: Which relationship and association?
Authors: Ettouri Sara , Ghizlane Daghouj , Mtalai Naoual , Zamzami Samia , Rami Ali , el Maaloum Loubna , Allali Bouchra , Asmaa El Kettani 
Published: January 2024

Aims/Purpose: The goal of our work is to synthesize the different fields identified by AI in refractive surgery.Methods: Research in the literature of the different manifestations of artificial intelligence related to refractive surgery.Results: Several articles including reviews reported several studies done in this direction. Lops and al introduced the PRFI (Pentacam Random Forest Index) using data from 3 different countries. The PRFI has a sensitivity of 85.2% and specificity of 96.6%. Xie and Co developed PIRSS (Pentacam InceptionResNetV2 Screening) for refractive surgery with a little number of false positive in identifying normal cornea, suspected irregular and keratoconic cornea. AI has also been used in recommending the appropriate refractive surgery and nomograms used, Kamiya and al developed an ML‐based algorithm to predict the postoperative posterior chamber phakic intraocular lens (IOL) vault using preoperative AS‐OCT images of patients undergoing phakic IOL implantation to predict the achieved vault. These examples of studies and discoveries open new horizons in refractive surgery using AI.Conclusions: AI has been successfully used in the prediction of diagnosis of various corneal disorders, including IK, keratoconus, pterygium, endothelial diseases, and corneal graft‐related complications but also in refractive surgery; certainly it has limits but next to telemedicine, 5G/6G networks, Quantum Communication Networks and Internet of Medical Things, AI is likely to form part of the new health care revolution.References1. Artificial intelligence in ophthalmology ‐ Machines think! Indian J Ophthalmol avr 2022.2. Artificial intelligence in ophthalmology: A multidisciplinary approach. 2022.3. Artificial Intelligence for Anterior Segment Diseases: A Review of Potential Developments and Clinical Applications mai 2023.
Novel pathomechanisms of impairment of native tear protein complexes in aqueous deficient dry eye syndrome
Authors: Perumal Natarajan , Hering Janine , Pfeiffer Norbert , Grus Franz , Manicam Caroline 
Published: January 2024

Aims/Purpose: Dry eye syndrome (DES) is a common yet deplorable disease of the ocular surface with high global prevalence. The pathomechanisms underlying the impairment of the native tear protein complexes remain unexplored. This study established a quantitative proteomics approach to characterize the novel protein complexes and unravel their functional roles in tears of DES patients.Methods: Tear samples were collected using Schirmer's strips from aqueous‐deficient DES (DRY, n = 16) and healthy (CTRL, n = 16) subjects following comprehensive DES clinical examinations. The native tear protein complex profiles were elucidated employing a customized blue native gel electrophoretic (BN‐PAGE) combined with mass spectrometry (MS)‐based proteomics strategy. In‐silico bioinformatics tools were employed for gene annotation analysis of the complexes.Results: Five major native protein complexes designated as complex I (cI, 800 kDa), II (cII, 400 kDa), III (cIII, 240 kDa), IV (cIV, 140 kDa) and V (cV, 66 kDa) were characterized for the first time in human tears. Interestingly, a cluster of immune‐related proteins identified in cI (e.g., IGHA1) were annotated to complement pathways and was found to be significantly increased in abundance in DRY vs. CTRL (p = 8.2 × 10−3). Likewise, increased abundance of another cluster of proteins annotated to inflammatory response (e.g. S100A9) in DRY (p = 1.7 × 10−2) was associated to cIII. On the contrary, cII was largely composed of lacrimal‐specific proteins (e.g., LYZ), which was found to be decreased in abundance in DRY (p = 2.4 × 10−2). Similarly, decrement of antimicrobial proteins in cIV (e.g., LACRT) was observed in DRY (p = 1.7 × 10−2). The expression of a cluster of carrier proteins involved in protein–protein interactions (e.g., ALB) was annotated in cV, which was increased in DRY (p = 4.4 × 10−3). Noteworthy, 35 new DES markers were identified with this methodological approach.Conclusions: Collectively, a tear‐customized BN‐PAGE‐MS analysis was instrumental to decipher the multifaceted biological functions of novel native protein complexes in human tears. For the first time, the intricate molecular mechanistic changes underlying these protein complexes in DES were unravelled, which could be instrumental for potential development of therapeutic strategies in ameliorating DES.
Corneal laceration with expulsive iridodialysis and vitreous prolapse following blunt trauma
Authors: Arun Kirupakaran , Danboyi Bitrus 
Published: January 2024

Aims/Purpose: A full‐thickness corneal laceration can occur following blunt trauma and is an ocular emergency that requires decisive immediate, short and long‐term management. We describe an unusual case of blunt trauma leading to dehiscence of an old cataract wound with traumatic expulsive Iridodialysis associated with vitreous prolapse to create awareness among ophthalmologists on key diagnostic features and patient specific management for this condition.Methods: An 84 year old female presented to the eye emergency department following accidental trauma to her right eye. Ocular examination revealed a 3 mm corneal laceration that was just away from the limbus which was compatible with the incision used for prior cataract surgery over 10 years prior. There was signs of expulsive Iridodialysis as well as vitreous prolapse from this wound with associated ruptured posterior capsule, inferior IOL subluxation and pupil block angle closure.Results: Immediate management included excision of prolapsed vitreous and iris from the corneal laceration, placement of bandage contact lens and an eyeshield, as well as topical and systemic antibiotic therapy, topical steroids and IOP control. Within 3 days, the corneal laceration remained sealed following removal of the bandage contact lens and surgery was performed which included pars plana vitrectomy, IOL repositioning and corneal suturing.Conclusions: We report this case to emphasize the importance of careful anterior segment examination in cases of suspected globe rupture to identify the site of the opening and to always consider old surgical wounds. Once confirmed, no pressure should be placed on the eye to reduce the risk of further extravasation of intraocular contents.
Prevalence of tomographic features associated with subclinical oedema in Fuchs dystrophy across three commercially available corneal tomographers
Authors: Passaro Maria Laura , Ancona Chiara , Airaldi Matteo , cucco rosangela , Semeraro Francesco , Costagliola Ciro , Romano Vito 
Published: January 2024

Aims/Purpose: Specific tomographic alterations suggestive for subclinical oedema have a known impact on FED prognosis. Here, we compare the prevalence of tomographic alterations associated with subclinical oedema in patients affected by Fuchs Endothelial Dystrophy (FED) imaged with corneal tomographers employing three different technologies.Methods: Patients with a clinical diagnosis of FED referred to the cornea service underwent tomography with 3 different devices: the Pentacam Scheimpflung camera (Oculus, Germany), the Casia2 AS‐OCT (Tomey, Japan), and the Precisio 2 blue‐light slit‐scanning tomographer (IVIS, Italy). All patients had confirmed corneal guttae at slit‐lamp examination. Subjects were classified into FED with no oedema, FED with subclinical oedema, and FED with clinical oedema according to a validated classification based on pachymetric and posterior elevation maps appearance on the Scheimpflung camera. The prevalence of these features was compared across the 3 devices, then two experienced ophthalmologists (M.A., M.L.P.) assigned a 0–3 score according to their evidence. A mixed‐effects binomial model estimated Odds Ratios (OR) for the scores of the 3 devices.Results: A total of 30 eyes were included: 7 eyes presented with clinically defined oedema, 18 eyes with no clinical oedema but tomographic features suggestive of subclinical oedema, and 5 eyes with no oedema and no tomographic alterations. The prevalence of Loss of parallel isopachs, Displacement of thinnest point, and Focal posterior depression did not differ between devices. However, identification of Loss of parallel isopachs was most evident on Precisio 2 compared to Pentacam (OR 9.6, p = 0.007), and the Displacement of thinnest point was most evident on Precisio 2 compared to both Pentacam and Casia2 (OR 6.9, p = 0.01 and OR 15.1, p = 0.005). 3 eyes showed alterations only on Precisio 2, one of which was later scheduled for DMEK.Conclusions: Scheimpflung camera, AS‐OCT, and blue‐light slit‐scanning based tomographers were all able to detect tomographic changes in FED. Nevertheless, our results suggest that the blue laser, slit‐scanning tomographer might be able to detect earlier, and delineate better, subclinical changes in FED.
Evaluation of drug release, mucoadhesive and viscoelastic performances of Netildex gel versus an antibiotic‐steroid combination system
Authors: Pepe Veronica , Cuffari Francesco , Curatolo Maria Cristina , Abbate Ilenia 
Published: January 2024

Purpose: The poor bioavailability and therapeutic response exhibited by conventional antibiotic‐steroid ophthalmic solutions due to rapid precorneal elimination of the drug may be overcome using a gel systems. Netildex gel is a preservative‐free product based on netilmicin and dexamethasone indicated for the treatment of inflammatory ocular conditions of the anterior segment and ocular adnexa including post‐cataract surgery. The current investigation evaluated the in vitro drug release, viscosity and mucoadhesion profile of Netildex gel in comparison to a gel matrix with regard to steroid and antibiotic delivery.Methods: In vitro drug release was assessed using Franz‐type diffusion cells, under sink condition, exploiting a simulated tear solution (STS) as dissolution medium and a regenerated cellulose membrane. Evaluation of mucoadhesive and viscoelastic properties were performed by texture analyzer TA‐XT2 and rheometer.Results: The dexamethasone and netilmicin release curves in Netildex gel exhibited a better sustained and controlled pattern over an extended time period (48 h) with respect to another gel system containing anti‐inflammatory and antibiotic drugs. The results were expressed as cumulative percentage of drug release and the antibiotics‐release kinetics from the polymeric matrix, evaluated by different mathematical models. The determination of detachment force demonstrated a significant mucoadhesive strength of Netildex gel compared to mucin. Moreover, rheological analysis of Netildex gel highlighted a strong pseudo‐plastic behaviour under shear strain due to its formulation features.Conclusions: Overall, Netildex gel exhibits a sustained and controlled drug release of both dexamethasone and netilmicin from polymeric matrix thanks to its viscoelastic and mucoadhesive properties allowing to prolong drug residence time on the ocular surface. These data support the reduced administration frequency while maintaining the same efficacy and simultaneously favouring patients' compliance [1].Reference1. Mencucci R. et al. Adv Ther (2022) 39: 5474–5486.
Bowman's layer transplantation—A new hope for regaining of correct ocular surface
Authors: Wyroslak‐Bednarek Diana , Jurowski Piotr 
Published: January 2024

Aims/Purpose: To present a novel surgical technique of selective Bowman's layer transplantation as well as results of the surgery in patients with neurotrophic corneal ulcers.Methods: 3 eyes from 3 patients with neurotrophic corneal ulcers who underwent corneal grafting with Bowman's layer. Pre‐ and postoperative analyses of the anterior segment of the eye were based on optical coherence tomography and slit lamp assessment.Results: Postoperatively a gradual corneal stroma restoration and fast corneal epithelialisation were noticed.Conclusions: Based on our observations, stiff and firm structure of Bowman's layer is supposed to strengthen corneal surface and maintain its shape. It acts also as an anti‐pathogen and anti‐toxin corneal barrier. Application of this acellular corneal layer transplantation to cover trophic corneal ulcers is an interesting, modern and crucial method of neurotrophic keratitis treatment.Reference1. Hsu HY, Modi D. Etiologies, quantitative hypoesthesia, and clinical outcomes of neurotrophic keratopathy. Eye Contact Lens 2015;41(5):314–7.2. Sacchetti M, Lambiase A. Diagnosis and management of neurotrophic keratitis. Clin Ophthalmol 2014;8:571–9.3. Mantelli F, Mauris J, Argüeso P. The ocular surface epithelial barrier and other mechanisms of mucosal protection: from allergy to infectious diseases. Curr Opin Allergy Clin Immunol. 2013 Oct;13(5): 563–8.4. Wilson SE. Bowman's layer in the cornea‐ structure and function and regeneration. Exp Eye Res 2020 Jun;195:108033.5. Lagali N, Germundsson J, Fagerholm P. The Role of Bowman's Layer in Corneal Regeneration after Phototherapeutic Keratectomy: A Prospective Study Using In Vivo Confocal Microscopy. Invest Ophthalmol Vis Sc. 2009 Sep;50(9):4192–8.
Contribution of TRPM8‐mediated activity to thermally‐evoked reflex blink
Authors: Diaz‐Tahoces Ariadna , Aleixandre‐Carrera Fernando , Velasco Enrique , del Carmen Acosta Maria , Gallar Juana 
Published: January 2024

Purpose: To study the characteristics of reflex blink evoked by cold and heat stimulation of the ocular surface (OS), and to define the contribution of TRPM8 to the process.Methods: The orbicularis oculi muscle electromyography signal (OOemg) and the ocular surface temperature (OST; measured with a small thermoprobe placed on the cornea) were recorded in anaesthetised rats. OS temperature changes (ΔT) were induced by topical instillation of 20 μL drops of saline solution at different temperatures (15–50°C). ΔT and the area under the curve (AUC) and duration of the evoked OOemg signals were analysed before (control) and after topical treatment with the TRPM8 antagonist N‐(3‐aminopropyl)‐2‐[(3‐methylphenyl) methoxy] ‐N‐(2‐thienylmethyl) benzamide hydrochloride (AMTB; 1 mM).Results: Mild (−ΔT 0.1–5°C) and intense (−ΔT 5–15°C) cooling always evoked a reflex OOemg signal (probability = 1). AMTB significantly reduced the probability of cooling to evoke blink (probability = 0.26 and 0.57 for mild and intense cold stimuli, respectively; p < 0.001). OOemg AUC and duration were also significantly reduced by AMTB (p < 0.01). Probability of evoking OOemg signal by mild (ΔT 0.1–5°C) and intense (ΔT 5–15°C) OS heating was low (0.30 and 0.59 respectively), and their duration and AUC were significantly smaller than those evoked by cooling (p < 0.001). Although AMTB did not modify the probability of heating stimuli to evoke OOemg signals (0.17 and 0.57 for mild and intense heating, respectively), the duration of signals evoked by mild heating stimuli was significantly increased (p < 0.001).Conclusions: Cold stimuli applied to the ocular surface always evoked reflex EMG activity of the lid muscle. This ability of cooling stimuli to evoke reflex blink is mediated by TRPM8 channels, whose pharmacological blockade reduces both the probability to evoke the reflex blink and its amplitude.Support: PID2020‐115934RB‐I00 from DOI: MCIN/AEI/10.13039/50110001103; CIPROM/2021/48 from Generalitat Valenciana, Spain.
Repeatability of ANTERION in subjects with keratoconus
Authors: Larraz Marta Sancho , Blasco‐Martinez Alejandro 
Published: January 2024

Aims/Purpose: The aim of this study was to study the repeatability of ANTERION in subjects diagnosed with keratoconus.Methods: The subjects selected had a previous diagnosis of keratoconus. These subjects were divided into three groups, according to the keratoconus treatment: subjects without treatment, intrastromal ring implantation and crosslinking. Subjects with pathologies with ophthalmological repercussion or previous surgeries were excluded.Three measures were performed with ANTERION in patients with keratoconus to evaluate the repeatability. These exams were performed with Cataract and Metricts module; therefore, six measurements were performed per patient and eye.Results: The parameters that showed values of coefficient of variation (CV) >5% in all the evaluated groups were: the vertical coma value, the difference between the thickness of the inferior–superior stroma and the eccentricity of the anterior and posterior corneal surface. In the groups with intrastromal ring segments and crosslinking, a CV >5% was obtained in the measurements of the minimum epithelial thickness and in the difference between the inferior–superior epithelial thickness. In the crosslinking and untreated groups, a CV >5% was obtained in the horizontal coma value. In the groups with intrastromal ring segments and without treatment, a CV >5% was obtained in the corneal RMS value and in the Score, which gives a value of the degree of keratoconus.The subjects implanted with intrastromal rings segments, a CV >5% was obtained in the measurements of the epithelial thickness at the point of greatest thickness.Conclusions: A parameter was considered to show low repeatability when its CV was >5%. The topographic measurements of K corneal and elevation values show good repeatability in subjects diagnosed with keratoconus. However, ANTERION shows a low repeatability in aberrometric values, and in measurements related to the stage and progression of the keratokonus.
May a post‐radiation ocular surface disorder compromise penetrating keratoplasty surgery? A case report
Authors: Gjukaj Driton , Todorova Margarita 
Published: January 2024

Aims/Purpose: Ocular surface disorder after ocular radiation therapy, even commonly reported, remains overlooked. Any delay in diagnosis may lead to vision threatening complications. The presented case highlights the clinical outcome of a severe post‐radiation ocular surface disorder, the importance of intense therapy and the limitations of further surgical interventions.Methods: Case report.Results: A 34‐year‐old woman was referred with complains of painful and reddish right eye since years. Her medical history revealed an iris melanoma excision at the age of 29 years. Due to recurrence, a proton beam treatment has been performed thereafter. Consequently, the patient developed post‐radiation retinopathy with macula edema, secondary glaucoma, cataract, as well as a severe ocular surface disorder with corneal decompensation and band keratopathy. Several surgical treatments have been attempted among which: phacoemulsification with IOL implantation, trabeculectomy with mitomycin C. Due to refractory glaucoma a Baerveldt glaucoma drainage was necessitated, thereafter. Despite these various therapeutic approaches, there was no improvement of the ocular surface problem. With increasing deterioration of the corneal situation, a penetrating keratoplasty, has been discussed.Conclusions: The continuous worsening of clinical symptomatology of the proton beam radiotherapy ocular surface disorder can be the result of a post‐radiation syndrome. An ischaemic retinopathy and anterior segment disorder lead to engorgement of posterior and anterior segment tissues. Gradual expansion of ischemia, vasculitis and inflammatory mediators compresses the retinal tissue leading to recurrent macular oedema; as well as to secondary glaucoma and corneal decompensation. Due to the worsening of the clinical presentation of ocular surface disorder a penetrated keratoplastic surgery has been discussed. It remains however still questionable whether such patients would make profit from penetrated keratoplastic surgery, as the resulting corneal stromal lymphangiogenesis and hemangiogenesis, in the presence of post‐radiation keratopathy, are essential conditions for allograft rejection.
New non‐toxic fluorescent marker for quantifying the viability of corneal endothelial cells
Authors: Maurin Corantin , Mentek Marielle , Vaitinadapoule Hanielle , Ulrich Gilles , De Nicola Antoinette , Maret Corentin , Zhiguo He , Thuret Gilles , Gain Philippe 
Published: January 2024

Aims/Purpose: Viability markers are essential for cellular research and tissue transplantation. However, existing options such as Trypan Blue lack specificity, and some clinically used markers are cytotoxic. Therefore, we synthesized the compound F4267, a non‐fluorescent marker that releases fluorescein upon hydrolysis. The aim of this study was to evaluate the quality of F4267 labelling of endothelial cells and its cytotoxicity in immortalized cells and organ‐cultured endothelium.Methods: We compared the marking capability of F4267 and Calcein‐AM using immortalized cells and endothelium from corneal pairs. The quality of fluorescent labelling was assessed using F4267 at 4 μM and Calcein‐AM at 4 μM. Cytotoxicity of F4267 was evaluated at varying concentrations of 40 and 1000 μM on cells, and at 40 μM on corneal endothelium, with single, repeated, or prolonged exposures. The final density and viability of corneal endothelium were measured using HEC1 staining.Results: F4267 (40 μM) exhibited fluorescent labelling quality equivalent to Calcein‐AM (4 μM), allowing clear differentiation between living, dying, and acellular areas. In HCE‐2 cells, cytotoxicity was reduced by 19% with F4267 (40 μM) compared to Calcein‐AM (4 μM). Prolonged exposure (24 h) to HCEC‐B4G12 cells showed no cytotoxicity with F4267 (40 and 100 μM), but resulted in destruction of the cell layer with Calcein‐AM (4 μM). F4267 (40 μM) also demonstrated significantly lower cytotoxicity, reducing mortality by 10% (single exposure) and 17% (repeated exposure) in organ‐cultured corneas.Conclusions: F4267 shows promise as a marker for assessing viable endothelial cells in organ culture, providing a safe alternative to existing markers. Its release of fluorescein with excellent cell tolerance supports its clinical potential. The integration of viable endothelial cell density assessment would enhance the value of corneal banks. Further validation is required, as well as exploration of broader applications.Reference1. Pipparelli et al., IOVS 2011.