bluuebunny/crossref_metadata_2025_split huggingface dataset:
Six‐month efficacy of red‐light therapy and customised orthokeratology for myopia control in Spanish children
Authors: Velazquez Fernando Fernandez , Fidalgo María Fernández , Ferrel Victoria Ferigo 
Published: January 2025

Aims/Purpose: To evaluate the efficacy and safety of repeated low‐level red‐light (RLRL) therapy with customised orthokeratology (Ortho‐K) for myopia control in Spanish children.Methods: This single‐site, randomised, parallel‐group, non‐blinded trial enrolled 26 children aged 10‐13 years with myopia. A total of 26 children were enrolled, completing the 6‐month follow‐up in May 2024. Children were randomly assigned to either the RLRL combined with the Ortho‐K or the Ortho‐K‐only group. The Ortho‐K group was required to wear Ortho‐K lenses for at least 8 hours per night. In addition to wearing Ortho‐K lenses in the adjunct therapy group, daily RLRL therapy was administered twice a day for 3 minutes per session. The primary outcome was the axial length (AL) change measured at 6 months relative to baseline.Results: Twenty‐six children completed the study (11 in the RLRL + Ortho‐K group and 15 in the Ortho‐K group). After 6 months, the mean AL change was ‐0.06 mm (95% CI, ‐0.12 to 0.01 mm) in the RLRL +Ortho‐K group, significantly lower than in the Ortho‐K group (0.04 mm [‐0.12 to 0.01 mm], p = 0.001). In the RLRL + Ortho‐K group, 5 children (45.5%) achieved significant axial shortening (AL changes < = ‐0.05 mm). The mean change in macular thickness was 0.66 μm (95% CI, 0.05 to 1.28 μm) in the RLRL + Ortho‐K group, significantly greater than in the Ortho‐K group (0.08 μm [0.001 to 0.15 μm], p = 0.022). No severe adverse events were reported, such as vision loss, scotoma, functional visual loss, or structural damage on OCT scans. No significant corneal findings were observed.Conclusions: Combining RLRL therapy with customised Ortho‐K shows promise for controlling myopia progression in Spanish children. This approach may provide clinical benefits in managing myopia without severe adverse effects.
Modified nishida procedure for the treatment of complete cranial nerve palsies: A case series
Authors: Santos Miguel , Ferreira Rui , Fernandes Emanuel , Teixeira Filipa , Gama Rita 
Published: January 2025

Aims/Purpose: To describe the clinical characteristics and outcomes of a series of strabismus patients with horizontal recti palsies treated surgically with a Modified Nishida Procedure (MNP).Methods: A retrospective review of patients who underwent a MNP at Hospital de Santa Maria in Lisbon, Portugal, between November 2023 and February 2024 (n = 5). MNP is a no‐tenotomy, no‐splitting transposition of 1/3 of the muscle body of the vertical recti to the midpoint between itself and the affected horizontal rectus muscle. Inclusion criteria included diplopia due to Grade IV or V palsies of the lateral rectus (LR, n = 4) due to VI nerve palsy or of the medial rectus (MR, n = 1) due to III nerve palsy. A 3‐month post‐operative follow‐up was required. Surgical success was defined as post‐operative horizontal deviation ≤14 prism diopters (PD) and absence of horizontal diplopia in primary gaze.Results: Mean age was 60±13 years. Two patients had bilateral LR palsy with > 85PD esotropia (ET) and received bilateral MNP combined with 6mm MR recession, with additional MR botulinum toxin (BT) injection two weeks later. Two patients had unilateral LR palsy with 45 PD ET with previous 7mm MR recession: these received unilateral MNP. Surgical success was achieved in 3 of these 4 cases. The unsuccessful case had 40PD residual ET and diplopia at 4 months follow‐up. There were two cases of self‐limiting post‐operative ptosis and one case of a surgical complication where the whole vertical rectus body was transposed due to high muscle friability. The MR paralysis patient had 40PD exotropia and MNP was combined with 7mm LR recession. Surgical success was achieved in this case, and no intra‐ or post‐operative complications occurred. No cases of anterior segment ischemia were detected in this series.Conclusions: MNP is an effective surgical option as it greatly reduces the horizontal deviations and diplopia associated with severe cranial nerve palsies and has a reduced risk of complications.
Predictive accuracy of saggital height measurements in optimizing scleral contact lens fitting
Authors: Velazquez Fernando Fernandez , Ferrel Victoria Ferigo 
Published: January 2025

Aims/Purpose: To evaluate the accuracy of corneal and scleral tomography analysis for determining the initial selection of a 16.5 mm scleral lens to enhance fitting outcomes and patient comfort.Methods: This single‐site, consecutive study fitted scleral lenses in 30 eyes in 16 patients (mean age 39.7 yrs., 11 males)). Patients underwent comprehensive evaluations, including detailed corneal and scleral tomography. Initial fitting used the manufacturer's standard protocol. Lens fitting was assessed with Anterior Segment OCT after 1 hour of wear, focusing on vaulting and overall fit. The required 300‐micron central sagittal vaulting was compared with tomography measurements at 10 mm, the limbal area, and 15 mm.Results: The group included 24 eyes with keratoconus, 2 with high regular astigmatism, and 4 with dry eyes. The mean HVID was 12.05 mm (SD = 0.33 mm, 95% CI: 11.92‐12.18 mm). The mean central corneal astigmatism was 2.91 D (SD = 1.74 D, 95% CI: 2.22‐3.60 D). Mean sagittal heights were 1869.3 microns (SD = 172.4, 95% CI: 1800.7‐1937.9) at 10 mm, 2727.7 microns (SD = 287.6, 95% CI: 2620.4‐2835.0) at the limbus, and 3970.5 microns (SD = 308.5, 95% CI: 3850.0‐4091.0) at 15 mm. The estimated ideal sagittal depth was 4321.8 microns (SD = 258.6, 95% CI: 4233.6‐4410.0). Sagittal height at 15 mm was the strongest predictor for ideal lens fitting (R2 = 0.9367). The multiple regression model, including all three measurements, showed a marginal improvement in accuracy (R2 = 0.947).Conclusions: The sagittal height at 15 mm is a highly effective predictor for initial scleral lens fittings, providing significant accuracy. This measurement can streamline the fitting process, reduce chair time, improve clinical outcomes, and increase patient comfort.
Convolutional neural networks for detection and classification of corneal pathologies on scheimpflug imaging
Authors: Hartmann Lennart , Armin Wolf , Christian Wertheimer 
Published: January 2025

Aims/Purpose: Corneal tomography is a standard imaging modality for the assessment of corneal pathologies, but can sometimes be difficult for non‐specialist ophthalmologists to interpret. Convolutional neural networks as a means of deep learning are used in many clinical areas due to their ability to extract information from multidimensional data sets, especially images. The present retrospective, monocentric study was conducted to assess the use of a convolutional neural network in the detection and classification of corneal pathologies on tomography.Methods: This is a retrospective monocentric study at a tertiary university‐based clinical centre. After a strict quality control, 13567 tomography records (from OCULUS Pentacam) were included. Raw data as well as anterior curvature and elevation data were exported. The raw data was then displayed using a self‐developed non‐linear heat map. Two corneal specialists used a self‐developed labelling tool for annotating the records into the following categories: Normal, regular astigmatism, irregular astigmatism, keratoconus, other ectasia, refractive surgery, pterygium and error. After the labelling process, the dataset was divided into a training set, a validation set and a test set.Results: The training and the validation sets were used to train the network. Accuracy of the detection and classification within the test set was then measured. The accuracy of detection and classification of corneal pathologies by the neural network was 87%. This was accomplished by a combination of a learning rate of 0.001, a batch size of 16 and 500 epochs.Conclusions: Here we show that training a convolutional neural network with images may help clinicians to detect and classify different corneal pathologies.
Ocular pain correlates with substance P levels in tears of healthy subjects
Authors: Palombella Silvia , Suanno Giuseppe , Pederzolli Matteo , Bartolomeo Nicolò , Tilaro Gianluca , Fonteyne Philippe , Massimo De Micheli , Bandello Francesco , Ferrari Giulio 
Published: January 2025

Aims/Purpose: to quantify the level of the neuropeptide substance P (SP) in the tear fluid and correlate it with measures of ocular pain, corneal sensitivity, and conjunctival hyperemia in healthy subjects.Methods: we enrolled 18 healthy patients (age range: 19–31 y/o) that were randomly divided into two groups: the first received the topical anesthetic oxybuprocaine (A+); the second one did not (A−). Subsequently, mild corneal nerve stimulation was applied with a hypertonic solution to both groups. Before and after the stimulation tear fluid was collected from all volunteers. We then measured SP levels with the ELISA test and correlated those with clinical parameters acquired before and after stimulation. Visual analogue scale (VAS) and ocular surface disease index (OSDI) questionnaires were used to assess ocular pain and discomfort, respectively. Moreover, corneal sensitivity and conjunctival hyperemia were measured with Cochet‐Bonnet esthesiometer and the Efron scale, respectively.Results: in the A+ group, the application of the anesthetic statistically decreased the release of SP in the tear fluid after corneal stimulation (p < 0.01). On the contrary, SP levels in group A‐ tear were not modified by the corneal stimulation. As expected, the A+ group experienced lower ocular pain (p < 0.001), discomfort (p < 0.05), hyperemia (p < 0.01), as well as reduced corneal sensitivity (p < 0.0001) after the corneal stimulation compared to group A−. Remarkably, the SP levels positively correlated with corneal sensitivity (r = 0.6671, p < 0.01) and pain (r = 0.4979, p < 0.05). Moreover, a positive trend was observed between SP and ocular surface inflammation (p = 0.058).Conclusions: our data demonstrated that the inhibition of corneal nerves decreased the SP release in tears together with inflammation and ocular pain. Therefore, SP levels in tears could be used as an objective marker to quantify pain and inflammation of the ocular surface.
In vivo implantation of the grosso shape‐memory implant for corneal shape and strength restoration
Authors: Xeroudaki Maria , Lepore Emiliano , Grosso Edoardo , Moustardas Petros , Mansutti Letizia , González Laura , Del Saz Ana Nolla , Lagali Neil 
Published: January 2025

Aims: The GROSSO® implant is an ophthalmic medical device designed to reshape the ectatic cornea. The primary aim of this study is to assess for the first time the surgical implantation and safety of the device in vivo in a preclinical study done in rabbits.Methods: A 9‐9.5mm diameter circular corneal pocket located at 2/3 of the minimum corneal thickness was created by femtosecond laser in the right eye only. In 8 control eyes the pocket was manually separated while in the GROSSO® group with 12 eyes, the implant was manually inserted through the access cut while being folded with a 6‐0 vicryl suture. After insertion in the intrastromal pocket, the suture was cut and the device was atraumatically unfolded inside the pocket. Intraocular pressure, tomography, biomechanics, in vivo confocal microscopy (IVCM) were evaluated before operation and postoperatively at 1 week and 1,2,3 and 6 months. Haze and neovascularization scoring was used to assess the inflammatory reaction to the implant.Results: All surgeries were successfully completed but with a variable eccentric ablation due to the applanation which is designed in the femtolaser for the human cornea. Haze and neovascularisation did not differ between groups, with haze returning to preoperative levels at 3 months. Neovessels were detected in 5 GROSSO® and 2 control eyes at 1 month and were located outside or in the periphery of the implant and then they were treated with topical steroids resulting in vessel regression. The GROSSO® implantation did not alter the intraocular pressure or central corneal thickness compared to controls. Biomechanical strength of GROSSO® group increased relative to controls and preoperative levels, and IVCM showed minimal inflammation around the implants. The GROSSO® group had lower keratometry values at 1 month that remained stable to 6 months, while controls experienced changing keratometry up to 6 months.Conclusions: The GROSSO® medical device can be safely implanted in the corneal stroma with laser‐assisted surgery. Postoperative inflammation was present in both treatment groups and minimal and could be treated with topical steroids. There were no changes in intraocular pressure or corneal thickness in the GROSSO® group and implanted corneas became flatter and biomechanically stronger thanks to the presence of the GROSSO® medical device.
Can the choice of artificial tears harm patients? A narrative review with learnings from the nordic guidelines
Authors: Mikha Katrine , Rasmussen Christian , Ahrensberg Simone , Freiberg Josefine , Heegaard Steffen , Kolko Miriam 
Published: January 2025

Purpose: To provide an overview of artificial tears marketed in the Nordic countries: Denmark, Sweden, Norway and Finland. Furthermore, this review aims to highlight the different preservatives and other constituents found in artificial tears of the Nordic market, focusing on adverse effects.Methods: Artificial tears appearing in the Nordic Guidelines of “Dry Eye Disease” 2022 edition were included and tables listing their components were created. Based on the preservatives and other constituents found in the artificial tears on the Nordic market, a literature search was conducted to investigate differences and potential adverse effects. Included articles were (i) studies performed on humans in vivo or in vitro human models, (ii) published between 2000‐2023 and (iii) studies focusing on effects, preservatives, toxicity, other constituents, and preservative‐free artificial tears.Results: A total of 66 artificial tears were found on the Nordic market based on the Nordic Guidelines. A large proportion (27 out of 66) of the artificial tears contains preservatives. Ten of these are preserved with benzalkonium chloride (BAK) or cetrimide. After a thorough systematic literature search, 87 articles met the inclusion criteria. A substantial amount of evidence has been found for the toxic effects of BAK and phosphate buffer solutions. There is no evidence of toxic effects of lubricants, osmoprotectants and lipids.Conclusions: The findings of this review highlight the paradoxical fact that many treatments for ocular surface diseases contain toxic preservatives contributing to a possible worse condition. In particular, long‐time toxic effects of BAK may contribute to disease progression.
Tear proteomics for the understanding of corneal biomechanical weakness in offspring of keratoconus patients
Authors: López‐López Maite , Alvite‐Piñeiro Tania , Pastoriza Yaiza , Lema Isabel , Regueiro Uxía 
Published: January 2025

Aim: To analyze the tear proteome of offspring of keratoconus patients (O‐KC) to elucidate the molecular mechanisms involved in corneal weakening in high‐risk individuals.Methods: 80 O‐KC young participants matched with 42 control subjects without KC family history were involved in this case‐control study. Corvis® ST and Pentacam® HR were used for the biomechanical and tomographic assessment. O‐KC eyes were classified as low, moderate, and high risk of KC development (O‐KC‐LR, O‐KC‐MR, and O‐KC‐HR) based on the corneal biomechanical behavior. Tear fluid was extracted using Schirmer strips, and the proteomic profile was analyzed using micro–liquid chromatography coupled to tandem mass spectrometry (LC‐MS/MS). SWATH‐MS method was used for protein quantification. Relationship and molecular characteristics of the proteins with differential expression between groups were explored using in silico tools. SPSS was used for statistical analysis.Results: Biomechanical analysis showed that 18% of O‐KC eyes had moderate risk of KC development [O‐KC‐MR], and 11% biomechanical alterations compatible with high‐risk for ectasia development [O‐KC‐HR]. Of the total proteins quantified, 15 were dysregulated (p < 0.005) in the O‐KC samples, even in those cases without detectable alterations in corneal biomechanical properties [O‐KC‐LR]. Bioinformatic analysis linked dysregulated proteins with oxidative stress, cell adhesion, and cytoskeleton organization processes, as well as with major mechanotransduction paths such as RhoA, mTOR, or E‐cadherin/N‐cadherin signaling. LCN‐1, LF, CAPN1 and SOD1 showed high specificity and sensitivity for detecting biomechanical alterations and for discriminating between controls and O‐KC groups.Conclusions: Our findings support the increased risk of the O‐KC with nearly a third of O‐KC eyes showing signs of corneal weakening that could lead to ectasia development and revealed new promising biomarkers for early detection of KC‐risk.
Management of a case of stromal herpetic keratitis
Authors: Cervilla Javier José Bermúdez , Mallen Victor , Biescas Andrés , Rius Nuria , Ila Carmen , Monleón Claudia Hernández‐Barahona , Navarro Damián García , Santana Carlos , Munuera Inés , Funes Elisa 
Published: January 2025

Aims/Purpose: To present a case study of stromal herpetic keratitis (SHK) and emphasize the importance of accurate differential diagnosis and appropriate therapeutic approaches in primary care settings.Methods: A detailed anamnesis and ocular examination were conducted, including fluorescein staining to identify dendritic corneal ulcers indicative of herpetic keratitis (HK). The patient was followed closely with a combination of antiviral and corticosteroid therapy.Results: A 20‐year‐old woman presented with 72 hours of left eye redness, pain, tearing, and vision loss. No traumatic history was reported, but a recent herpetic lesion on the upper lip was noted. Clinical examination revealed significant conjunctival hyperemia and a characteristic dendritic lesion on the cornea. Detailed examination with a slit lamp showed a central dendritic ulcer stained with fluorescein and peripheral infected cells stained with rose Bengal, alongside a focal stromal inflammation. These findings confirmed the diagnosis of SHK. Follow‐up revealed resolution of the stromal inflammation and closure of the dendritic epithelial defect.Conclusions: The case underscores the critical need for accurate diagnosis of HK subtypes, as SHK requires specific treatment with topical corticosteroids in addition to antiviral therapy. Clinical guidelines indicate that the benefits of corticosteroid use in SHK outweigh the risks, though close monitoring is essential to mitigate adverse effects such as increased intraocular pressure and cataract formation. This case highlights the importance of prompt specialist referral when primary care practitioners encounter complex ocular presentations, ensuring timely and appropriate management to prevent irreversible vision loss.References
Guidelines for Ocular Herpes Management.
SECOIR Monography: Update on Corneal Infections. Chapters 7 and 11.
Ocular bee sting with retained stinger
Authors: Iatissam  , Bentouhami Mohamed Reda , Hidan Younes , Mchachi Adil , Benhmidoune Laila , Rachid Rayad 
Published: January 2025

Aims/Purpose: Ocular bee stings are a rare but can lead to severe inflammatory complications. Some cases have been described, but stinger retention is exceptional. We report the case of a young patient with a limbal bee sting, with stinger retention.Methods: A male 19‐year‐old, presented a painful red eye following an accidental bee sting. Examination found a visual acuity of 20/20, conjunctival hyperaemia, a clear cornea, calm anterior chamber, and a perilimbal foreign body, which corresponded to the bee stinger.We performed a conjunctival peritomy and removed the stinger using McPherson forceps under topical anesthesia. The sclera being intact, we sutured the conjunctiva and prescribed antibiotiotics and steroid drops. Evolution was marked with improvement and disappearance of symptoms.Results: Bee sting wounds can penetrate tissues like a harpoon, complicating the stinger's removal, along with possible sequelae: mechanical like corneal abrasion or intrastromal retention, and toxic effects. The venom contains phospholipase A2 and mellitin, leading to membrane lysis and pain, as well as apamin, which causes mast cells degranulation and histamine release. It can cause conjunctivitis, corneal infiltrates, cataract, uveitis, hyphema, lens subluxation, retinal lesions, optic neuropathy or choroidal detachment.Conclusions: Ocular bee stings are rare and can induce severe inflammation. Extraction of the stinger and topical antibiotic associated with steroids are the treatment of choice, in addition to close monitoring of possible complications.References
Gudiseva H, Uddaraju M, Pradhan S, Das M, Mascarenhas J, Srinivasan M, Prajna NV. Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes. Indian J Ophthalmol. 2018 Feb; 66(2): 262‐268.
Chilibeck, C., Wang, N., & Murphy, C. (2021). Making a bee‐line for the eye: a limbal sting and retained honey bee. Clinical and Experimental Optometry, 104(4), 538–540.
New deep AI‐based algorithm to assess quality of primary corneal endothelial cell cultures
Authors: Maurin Corantin , Guillaume Bonnet , Yann Gavet , Inès Aouimeur , Louise Parveau , He Zhiguo , Philippe Gain , Thuret Gilles 
Published: January 2025

Aims/Purpose: The development of cell therapies to treat corneal endothelial pathologies requires characterizing the cells during the cell culture process. The endothelial cell density (ECD) and morphometry are essential parameters for identifying cultures with sufficient phenotype and yield. However, they are difficult to measure on cells in culture using conventional image analysis tools. Aims: (1) To develop an AI‐based automatic cell segmentation method for reliable ECD and morphology measurement. (2) To select new morphometry parameters. (3) To classify endothelial cell cultures by quality.Methods: Experiments were conducted on primary cultures of human corneal endothelial cells (hCECs) after immunofluorescent labeling against NCAM revealing lateral membranes. Cultures from donors < 30 years old (high ECD and regular mosaic) were compared with cultures form older donors comprising senescent cells and cells in endothelial‐mesenchymal transition. Images were acquired with an epifluorescence microscope. We compared two AI segmentation models, a custom model and the published Cellpose model1,2. Models were trained with manually labeled images and tested on separate images. Standard image analysis methods in Python measured cell number, morphology, comparing reference and AI‐generated images3. Additional metrics were developed to qualify endothelial cell culture and correlated with known metrics. K‐Means and other classifications were tested to classify cell culture quality.Results: Cellpose outperformed the custom model in segmentation accuracy (mean relative error ± SD respectively: 0.054 ± 0.020 vs 0.0499 ± 0.0136). New reliable morphological measurements were defined, enabling classification of endothelial cell culture clusters based on quality. Coronal CV (coefficient of variation) was developed to complement classical CV used to characterize clinical endothelial cell.Conclusions: AI segmentation of hCEC in culture significantly improves quality measurement during bioengineering, facilitating rapid analysis and classification of cell batches, thereby enhancing quality assessment and success rates for cell‐based endothelial therapy.References
Stringer et al (2020).
Pachitariu et al (2022).
Gavet et al (2012).