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Considering the limited information on the impact of PM2.5 content on ocular health, a follow-up study was conducted on 50 healthy adults. Samples were collected twice, once before the PM2.5 exposure season and again after exposure. Daily PM2.5 concentration data was gathered from Thung Satok monitoring station. All subjects completed the self-structured ocular symptom questionnaire. The concentrations of 1-OHP were determined using HPLC-FLD. Logistic regression analysis investigated the relationship between PM2.5 toxicity and ocular symptoms. The findings revealed that daily PM2.5 concentrations surpassed the WHO-recommended range by around threefold. Exposure to PM2.5 significantly raised the likelihood of ocular redness (adjusted OR: 12.39, 95% CI), watering (adjusted OR: 2.56, 95% CI), and dryness (adjusted OR: 5.06, 95% CI). Additionally, these symptoms had an exposure-response relationship with increasing 1-OHP levels. Ocular symptoms worsened in frequency and severity during the high PM2.5 season, showing a strong link to elevated PM2.5 levels. Lymphocyte counts were also positively correlated with redness, watering, and dryness during high PM2.5 exposure. In conclusion, our study shows that subjects exposed to higher PM2.5 levels presented more significant ocular surface alterations. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the potency and efficacy of a library of dopamine receptor D2 (D2R) antagonists in the mitigation of fibrotic activation in retinal pigment epithelial (RPE) cells. Methods: ARPE-19 cells were cultured and treated with methotrexate or 27 district D2R antagonists using a fibronectin deposition assay. The most potent compounds were then further assessed in assays measuring cellular proliferation, cellular migration, and profibrotic gene expression. Results: The previously established antifibrotic D2R antagonist loxapine exerted a robust and dose-dependent inhibition of fibronectin deposition, whereas methotrexate exerted minimal inhibition. The most potent D2R antagonist identified, fluphenazine, effectively blocked in vitro models of fibrosis at 300–1,000 nM concentrations. Conclusions: Here we found multiple FDA-approved D2R antagonists that potently block RPE cell fibrogenesis. These findings further support the potential of D2R antagonism as a potential therapeutic for retinal fibrotic disease. [ABSTRACT FROM AUTHOR]

• More than 90 % of both patient groups, oMG and gMG were antibody-positive. • AChR antibody titer above 100 nmol/L seems to predict generalization. • oMG patients responded better to treatment, achieving quicker symptom satisfaction. • 1/3 (350) of all MG patients in Denmark was included in this chart review. • No difference in thymus pathology was found between oMG and gMG patients. The aim of this study was to evaluate clinical and serological differences between the ocular myasthenia gravis (oMG) and generalized MG (gMG). This study is a retrospective chart review, in which data was collected from patients fulfilling 2 of 3 diagnostic MG criteria (positive antibodies, evidence of neuromuscular transmission defect on neurophysiological examination, positive effect of pyridostigmine treatment). 350 patients were included and data concerning demographics and MG medical history were collected. Patients with oMG accounted for 15.7 % of the included patients. The two subgroups differed significantly in oMG having a later age at onset, lower AChR antibody-titers, longer doctor-to-diagnosis delay and less intensive MG treatment. Additionally, patients with oMG were faster at reaching a well-controlled disease state. Thymus pathology, number of antibody-positive (95.9 % of gMG and 94.5 % of oMG), sex, number of other autoimmune diseases and delay before drug stability did not differ between oMG and gMG. In conclusion, oMG is presumably a milder form of gMG characterized by lower AChR antibody-titers, a milder phenotype, and a quicker response to a less aggressive treatment. But otherwise, oMG and gMG show very similar characteristics, including the same frequency of positive AChR antibodies, which seems new compared to previous reports. [ABSTRACT FROM AUTHOR]

The prevalence of ocular disorders is a global issue that affects everyone. If left untreated or undetected, several eye disorders, including cataracts, glaucoma, and diabetic retinopathy, can lead to blindness or impaired vision. Nuinerous studies have revealed that there is a general lack of knowledge about ocular disorders and how seriously they can affect a person's quality of life. Governmental agencies and a few NGOs have stepped up throughout the years to raise awareness of the need to maintain a regular eye care regimen and attend checkups among the general public. However, identifying these disorders takes time and frequently requires manual evaluation by highly qualified ophthalmologists. The goal of this study is to develop a model that can help ophthalmologists quickly detect serious eye conditions such as cataracts, glaucoma, and diabetic retinopathy. The most accurate model among three different machine learning and deep learning models is used to categorise various eye conditions. Metrics including the overall accuracy score, precision, recall score, and fl score are used to evaluate performance. Notably, 52%, 59%, and 61%, respectively, are the Accuracy ratings for the Random Forest classifier, Convolutional Neural Network, and XGBoost. [ABSTRACT FROM AUTHOR]

To review the evidence on the effectiveness and complications of periocular and intraocular corticosteroid therapies for noninfectious uveitic macular edema. A literature search of the PubMed database was conducted last in December 2021 and a post-assessment search was conducted in March 2023. The searches were limited to articles published in English and no date restrictions were imposed. The combined searches yielded 739 citations; 53 articles were selected for inclusion because the studies (1) evaluated periocular corticosteroid injection, intraocular corticosteroid injection or implant, suprachoroidal corticosteroid injection, or a combination thereof for uveitic macular edema; (2) had outcomes that included visual acuity (VA) or macular edema assessed clinically or imaged by OCT or fluorescein angiography; and (3) included more than 20 patients. This assessment reviewed 23 articles that provided level I or level II evidence from 18 studies on the use of periocular, suprachoroidal, and intravitreal triamcinolone acetonide injections and intravitreal dexamethasone and fluocinolone acetonide implants or inserts in noninfectious uveitic macular edema. These reports consistently demonstrated that all investigated periocular and intraocular corticosteroid therapies improved VA, macular structure, or both. One comparative study showed that intravitreal triamcinolone acetonide injection and the dexamethasone intravitreal implant had effectiveness superior to that of periocular triamcinolone acetonide injection for these outcomes. As a group, the studies highlighted the potential for these therapies to elevate intraocular pressure and to accelerate cataract formation. The published literature provides high-quality evidence that periocular and intraocular corticosteroid therapies are effective and safe for the treatment of noninfectious uveitic macular edema. However, information on the relative effectiveness and complication rates across the different therapies is limited. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Approximately 5–15% of all dermatologic malignancies manifest in the upper and lower eyelids. The primary types include basal cell carcinoma, squamous cell carcinoma, and sebaceous cell carcinoma, with Merkel cell carcinoma and melanoma following closely behind. Basal cell carcinoma predominantly affects the lower eyelid, yet various other carcinomas, melanomas, metastases, and neoplasms of diverse origins can arise on both upper and lower eyelids. Risk factors such as advanced age, smoking, and notably, exposure to UV light significantly contribute to the development of these eyelid lesions. Despite the increasing incidence, research on dermatologic eyelid malignancies remains limited. However, such study is imperative given that many systemic oncologic malignancies initially present as metastatic eyelid lesions. This paper provides an in-depth exploration of eyelid anatomy, clinical presentation, diagnosis, and treatment management. Key Points: Eyelid metastases represent less than one percent of all eyelid cancers, yet they often serve as the initial indication of an underlying systemic malignancy. Early detection and treatment is crucial in improving prognosis and quality of life for patients. Treatment options encompass a range of modalities, with Mohs surgery as the gold standard for the removal of ocular tumors. Additional treatment options include local excision as well as non-surgical interventions such as radiotherapy, cryotherapy, immunotherapy, and topical medications. [ABSTRACT FROM AUTHOR]

To compare the effects of intranasal (IN) and intramuscular (IM) midazolam–butorphanol–ketamine on intraocular pressure (IOP), tear production (TP) and sedation in rabbits. Prospective, randomized, crossover experimental study. Fourteen male New Zealand White rabbits, aged 1–2 years, body mass 3.1 ± 0.8 kg (mean ± standard deviation). Rabbits were administered midazolam (1 mg kg–1), butorphanol (1.5 mg kg–1) and ketamine (5 mg kg–1) via IN and IM routes. IOP, TP and sedation scores were assessed at 0 (before drug administration), 5, 15, 30, 45 and 60 minutes after drug administration. Heart rate (HR), respiratory rate (f R), rectal temperature (RT), noninvasive mean arterial blood pressure (MAP) and peripheral hemoglobin oxygen saturation (SpO 2) were simultaneously recorded until 45 minutes after drug administration. The onset and duration of sedation and sedation scores were recorded. Drug delivery route had no significant impact on mean IOP (p = 0.271) or TP (p = 0.062), and there were no significant changes over time for IOP (p = 0.711) or TP (p = 0.372). Similarly, delivery route had no significant impact on HR (p = 0.747), f R (p = 0.872), RT (p = 0.379), MAP (p = 0.217) and SpO 2 (p = 0.254). Sedation onset was faster with IN (3.0 ± 1.0 minutes) than with IM administration (4.9 ± 0.7 minutes) (p = 0.011), but sedation duration was significantly longer with IM (52.6 ± 7.2 minutes) than with IN delivery (30.7 ± 6.8 minutes) (p = 0.004). There was no significant difference in sedation scores between the two delivery routes at any of the recorded time points. The combination of midazolam–butorphanol–ketamine had minimal impact on physiological and ocular variables regardless of the route of administration, whereas IN drug administration led to a shorter onset and duration of action than IM administration. [ABSTRACT FROM AUTHOR]

An abnormal head position (AHP) refers to a condition where the head is deviated from the usual, upright posture considered normal. AHPs can manifest as the chin being raised or lowered, the head tilted to the right or left, the face turned to either side, or a combination of these movements. Patients with AHP may present to ophthalmologic clinics; however, there are several etiologies for AHP that may not be commonly recognized by ophthalmologists. Key words from this article were searched in PubMed, Scopus, and Google Scholar search engines from 1975 to December 2023. Various etiologies were identified, evaluated, summarized, and then categorized. The maintenance of a normal head posture during our daily activities relies on the complex interaction of different parts of the brain, with the encoding of related sensory inputs occurring in the vestibular nuclei. Abnormal head posture can stem from a variety of etiologies, including ocular, neurological, orthopedic, otolaryngological, gastroenterological, and other factors. This review provides a comprehensive overview of the different characteristics of AHP based on its etiology. Lack of awareness regarding the wide spectrum of causes may lead to patients undergoing unnecessary extensive workups. Conversely, failure to recognize potentially life-threatening causes may result in adverse outcomes for the patient. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionsTo determine the incidence and clinical characteristics of ocular adnexaltumors in Olmsted County, Minnesota.Retrospective population-based cohort study of all patients residing in Olmsted County, Minnesota diagnosed with any ocular tumor from January 1, 2006, to December 31, 2015. The medical records of all patients with an incident diagnosis of any ocular adnexal tumor were reviewed using the Rochester Epidemiology Project medical record linkage system for patient demographics, tumor type, and histopathologic confirmation. Incidence rates were calculated per 100,000 person-years. Poisson regression analysis was used to analyze changes in incidence over time.There were 717 patients diagnosed with ocular adnexal tumors during the 10-year study period, yielding an age- and sex-adjusted incidence rate of 59.7 per 100,000 (95% CI 55.4 to 64.0, p < 0.05) per year. In total, 764 tumors were diagnosed. Most tumors were eyelid lesions (N = 756, 99.0%), which were mostly benign (N = 512, 67.8%) with epidermal inclusion cysts (N = 275, 36.0%), hidrocystoma (N = 70, 9.2%), and eyelid sebaceous cysts (N = 46, 6.1%) accounting for the majority. Malignant eyelid lesions (N = 244, 31.9%) were relatively common with basal cell carcinoma (N = 184, 24.1%) and squamous cell carcinoma (N = 49, 6.4%) having the highest frequencies. Orbital tumors (N = 8, 1.0%) were infrequent. Of the orbital tumors, the most common was lacrimal gland adenoidcystic carcinoma (N = 2, 25.0%).In a population-based setting, most ocular adnexal tumors were benign eyelid lesions. Understanding the epidemiology of ocular adnexal tumors is important to aid providers in diagnosing and facilitating appropriate referrals of potentially vision- and life-threatening malignancies. [ABSTRACT FROM AUTHOR]

Brachycephaly in cats, characterized by shortened facial and skull length and a rounder head due to inherited defects in skull bone development, can lead to respiratory and ocular problems, particularly in popular breeds like Exotic Shorthair, British Shorthair, Persian and Scottish Fold. Eye diseases in cats and dogs can result from various factors, including infectious agents, metabolic disorders, physical trauma and breed-specific congenital abnormalities, with brachycephalic cats being particularly prone to chronic corneal diseases and glaucoma due to their anatomical features. Despite challenges such as cost, the need for anesthesia and radiation exposure, understanding normal eye measurements and biometrics through imaging techniques like ultrasound, MRI and CT is essential for diagnosing eye diseases in veterinary ophthalmology. This study aimed to utilize computed Tomography (CT) images to measure intraocular structures in healthy cats with varying skull structures and establish the correlation between these measurements and skull morphometric data. In the study, a total of 24 cats from brachycephalic and 27 cats from non-brachycephalic breeds (both sexes) were included. Two- dimensional CT scans of cats were reconstructed into 3D models using the 3D Slicer 5.4.0 program, which was also used for intraocular and skull measurements. Results demonstrated that the anterio-posterior distance of the lens and postorbital breadth measurements were higher, while greatest length of the skull was lower, in brachycephalic than in non-brachycephalic cats (p<0.05). According to the results of Discriminant Function analysis, when considering head types, it was observed that 92.6% of animals with non-brachycephalic head and 79.2% of animals with brachycephalic head types were accurately classified. These findings emphasize the importance of considering anatomical variations in brachycephalic and non-brachycephalic cats for accurate diagnosis of eye health issues in these cats. [ABSTRACT FROM AUTHOR]

Introduction: Ocular rosacea is an underdiagnosed form of rosacea that may occur with or without typical cutaneous signs of rosacea. One of the common manifestations is dry eyes. Although the use of intense pulsed light (IPL) in the treatment of rosacea-related dry eyes has been reported, a recent review is lacking. Methods: A scoping review was performed to summarize the efficacy of IPL in the treatment of ocular rosacea. Results: Five articles were included, representing 108 patients, with a mean age of 58.4 years. Based on available data, 59.2% (n = 58/98) were female. The studies detailed the use of IPL in combination with meibomian gland expression treatment. Overall, 91% (n = 89/98) of patients with ocular rosacea treated with IPL had a partial response and 9% (n = 9/98) had no response. IPL therapy did not lead to complete recovery in any of the included patients. One participant experienced an adverse event across the included studies. Conclusions: IPL is a promising treatment modality for ocular rosacea, as demonstrated by its ability to relieve dry eye symptoms with limited adverse events. Further research into this novel treatment is necessary to ascertain its role in the management of ocular rosacea. [ABSTRACT FROM AUTHOR]

OBJECTIVE To investigate systemic absorption and gastrointestinal (GI) adverse effects of topical ketorolac 0.5% and diclofenac 0.1% ophthalmic solutions. ANIMALS 11 healthy purpose-bred Beagles. METHODS Dogs were randomly assigned to receive either ketorolac (n = 6) or diclofenac (5), 1 drop in both eyes 4 times daily for 28 days. Upper Gl endoscopy was performed on days 0 and 29 with mucosal lesion scores (0 to 7) assigned to each region evaluated. Plasma samples were collected on days 14, 21, and 28 for measurement of diclofenac and ketorolac using high-performance liquid chromatography-mass spectrometry. RESULTS Gl erosions and/or ulcers developed in all ketorolac-treated dogs and 1 of 5 diclofenac-treated dogs. Post-treatment mucosal lesion score for the antrum was higher in the ketorolac group than in the diclofenac group (P = .006) but not significantly different for any other region. Post-treatment antral mucosal lesion scores were significantly related to plasma ketorolac concentrations (P<.001). Ketorolac and diclofenac were detected in the plasma at all time points (median ketorolac day 14, 191 ng/mL; day 21, 173.5 ng/mL; and day 28, 179.5 ng/mL; and median diclofenac day 14, 21.1 ng/mL; day 21, 20.6 ng/mL; day 28, 27.5 ng/mL). Vomiting and decreased appetite events were observed uncommonly and were not significantly different between treatment groups. CLINICAL RELEVANCE Gl ulceration and erosion developed after ophthalmic administration of ketorolac and diclofenac, with higher plasma concentrations and more severe Gl lesions associated with ketorolac. Clients should be alerted to this potential risk with ophthalmic use and informed to watch for systemic clinical signs that would warrant veterinary reevaluation. [ABSTRACT FROM AUTHOR]

Background: The low prevalence of rare diseases poses a significant challenge in advancing their understanding. This study aims to delineate the clinical and genetic characteristics of patients with rare eye diseases (RED) enrolled in the Spanish Rare Diseases Patient Registry. Methods: A total of 864 patients from the registry database were included. Diseases were categorized into inherited retinal dystrophies (n=688); anterior segment diseases (n=48); congenital malformations (n=27); and syndromic diseases with ocular involvement including muscular (n=46), neurological (n=34), or metabolic (n=13); inflammatory diseases (n=4); and tumors (n=4). Data on visual acuity (VA) and/or visual field (VF), symptoms and signs, concurrent diseases in syndromic cases, age of onset and at diagnosis, affected genes, disability rating, inability to work and dependency grade recognition were collected. Results: A mean diagnostic delay of 7 years from symptom onset was observed. Commonly reported symptoms included photophobia, night blindness, and progressive vision loss (≥57% of patients). Cataract was the most prevalent secondary disease (46%), with pseudophakia being the most common ocular surgery (26%). Hearing loss and cardiovascular diseases were the most prevalent concurrent systemic diseases (≥13%). Certificates of disability, incapacity for work, and dependency were held by 87%, 42%, and 19% of patients, respectively. Among the 719 patients with available VA data, 193 (27%) were blind, and 188 (26%) had moderate to severe visual impairment. Over half of the patients (54%) exhibited VF defects, and 216 (25%) had concentric contraction ≤5° or abolished VF. Most had genetic diseases with autosomal recessive (55%), autosomal dominant (30%), X-linked (9%), and mitochondrial (6%) patterns. One patient had mutations in both recessive USH2A and dominant RHO genes simultaneously. Of the 656 patients (75.7%) who underwent genetic testing, only 461 (70.3%) received a positive result (pathogenic or likely pathogenic mutations explaining the phenotype). We found 62 new gene variants related to RED not previously reported in databases of genetic variants related to specific phenotypes. Conclusions: This study delineates the clinical and genotypic profiles of RED in Spain. Genetic diseases, particularly retinal disorders, predominate, but a significant proportion of affected patients remain genetically undiagnosed, hindering potential gene therapy endeavors. Despite notable improvements in reducing diagnosis delays, it is still remarkable. RED frequently lead to disability and blindness among young populations. [ABSTRACT FROM AUTHOR]

Stereotactic radiosurgery (SRS) is a valuable treatment option for uveal melanoma, offering excellent tumour control rates and eye preservation. Its efficacy relies upon accurate localisation of the tumour, which is challenging in the mobile eye. Various methods of globe immobilisation have been used, including non-invasive devices, such as eye movement tracking and suction cups, but common practice is to use local anaesthetic block with or without transconjunctival suturing of the extraocular muscles. Some studies have suggested that the addition of muscle suturing to local anaesthetic block provides better immobilisation of the globe, when compared to anaesthetic block alone. Controversy exists regarding the clinical relevance of this observation and ocular oncologists differ in their choice of immobilisation technique. In order to establish if the addition of muscle suturing to local anaesthetic block improves clinical outcomes, we performed a retrospective review of all cases that underwent SRS for uveal melanoma over a 10-year period (May 2008 to May 2018). Based on surgeon preference, all patients received either local anaesthetic block plus muscle suturing (Group A) or local anaesthetic block alone (Group B) to induce globe akinesia. Outcomes assessed were primary treatment failure, tumour recurrence, secondary enucleation and death rate. In our cohort of 290 eyes; 118 patients were in group A and 172 patients were in group B. There were no cases of primary treatment failure in either group. With a minimum of 24 months follow-up, only 3 patients experienced tumour recurrence (1 in group A and 2 in group B). There was no significant difference in recurrence, enucleation and all-cause death rates between the two groups. Our retrospective review suggests that although extraocular muscle suturing may be considered by some units to provide superior globe immobilisation for SRS, it does not alter the clinical outcome. [ABSTRACT FROM AUTHOR]

Lipid-based drug formulations are promising systems for improving delivery of drugs to ocular tissues, such as retina. To develop lipid-based systems further, an improved understanding of their pharmacokinetics is required, but high-quality in vivo experiments require a large number of animals, raising ethical and economic questions. In order to expedite in vivo kinetic testing of lipid-based systems, we propose a barcode approach that is based on barcoding liposomes with non-endogenous lipids. We developed and evaluated a liquid-chromatography-mass spectrometry method to quantify many liposomes simultaneously in aqueous humor, vitreous, and neural retina at higher than ±20% precision and accuracy. Furthermore, we showed in vivo suitability of the method in pharmacokinetic evaluation of six different liposomes after their simultaneous injection into the rat vitreal cavity. We calculated pharmacokinetic parameters in vitreous and aqueous humor, quantified liposome concentrations in the retina, and quantitated retinal distribution of the liposomes in the rats. Compared to individual injections of the liposome formulations, the barcode-based study design enabled reduction of animal numbers from 72 to 12. We believe that the proposed approach is reliable and will reduce and refine ocular pharmacokinetic experiments with liposomes and other lipid-based systems. [Display omitted] • A method to quantify many liposome formulations and study their ocular pharmacokinetics within the same animal was developed. • The ocular pharmacokinetics of six barcoded liposomes were successfully evaluated within the same animal. • The barcode lipid method reduced the number of animals required for a pharmacokinetic study from 72 to 12. [ABSTRACT FROM AUTHOR]

Chronic, non-communicable diseases present a major barrier to living a long and healthy life. In many cases, early diagnosis can facilitate prevention, monitoring, and treatment efforts, improving patient outcomes. There is therefore a critical need to make screening techniques as accessible, unintimidating, and cost-effective as possible. The association between ocular biomarkers and systemic health and disease (oculomics) presents an attractive opportunity for detection of systemic diseases, as ophthalmic techniques are often relatively low-cost, fast, and non-invasive. In this review, we highlight the key associations between structural biomarkers in the eye and the four globally leading causes of morbidity and mortality: cardiovascular disease, cancer, neurodegenerative disease, and metabolic disease. We observe that neurodegenerative disease is a particularly promising target for oculomics, with biomarkers detected in multiple ocular structures. Cardiovascular disease biomarkers are present in the choroid, retinal vasculature, and retinal nerve fiber layer, and metabolic disease biomarkers are present in the eyelid, tear fluid, lens, and retinal vasculature. In contrast, only the tear fluid emerged as a promising ocular target for the detection of cancer. The retina is a rich source of oculomics data, the analysis of which has been enhanced by artificial intelligence-based tools. Although not all biomarkers are disease-specific, limiting their current diagnostic utility, future oculomics research will likely benefit from combining data from various structures to improve specificity, as well as active design, development, and optimization of instruments that target specific disease signatures, thus facilitating differential diagnoses. Plain Language Summary: Long-term diseases can stop people living long and healthy lives. In many cases, early diagnosis can help to prevent, monitor, and treat disease, which can improve patients' health. In order to diagnose disease, we need tools that are easy for patients to access, painless, and low-cost. The eye may provide the solution. In this review, we discuss the link between changes in the eye and four types of long-term disease that, together, kill most of the population: (1) Cardiovascular disease (affecting the heart and/or blood). (2) Cancer (abnormal growth of cells). (3) Neurodegenerative disease (affecting the brain and/or nervous system). (4) Metabolic disease (problems storing, accessing, and using the body's fuel). We show that neurodegenerative disease leaves tell-tale signs in lots of different parts of the eye. Signs of cardiovascular and metabolic disease biomarkers are mostly found in the back of the eye, and signs of cancer can be found in the tear fluid. Although signs of disease can be seen in the eye, not all of them will tell us what the disease is. We believe that future research will help us to understand more about long-term disease and how to detect it if we combine information from different structures within the eye and develop new tools to target these specific structures. [ABSTRACT FROM AUTHOR]

AbstractDiabetic retinopathy is the most common complication of diabetes and remains the leading cause of vision loss worldwide. The potent glucocorticoid based anti-inflammatory drug dexamethasone (DEX) chosen for the present work is long-acting with half-life of 37–72 h extensively metabolized in to 6-hydroxy-dexamethasone (6-OH-DEX). The present work aimed to develop dexamethasone loaded nanodispersion (DEX-ND) by improving its solubility, half-life, and bioavailability in biological system thereby this formulation may be afforded economically. With the concept that polymeric surfactant improves the solubility of challenging water insoluble drug the present work has been hypothesized to improve its solubility using polyvinyl pyrrolidone (PVP-K30) polymer and polysorbate 80 (Tween 80) hydrophilic non-ionic surfactant, thereby the bioavailability is expected to get enhanced. By varying the PVP K30 and Tween 80 concentrations three different formulations were developed. The developed DEX-ND was further characterized for its compatibility, particle size, zeta potential, morphology, and in vitro release behavior. The results of Fourier transform infrared spectrometric analysis indicate the compatibility nature of DEX-ND along with other excipients/drug used in the formulation. The developed formulations showed spherical morphology, particle size ranging from 550.46 ± 107.82 to 3560 ± 284.29 nm, zeta potential ranging from −29.23 ± 1.09 to −7.793 ± 1.01 mV. The amount of DEX present in the DEX-NDs was found to be 0.95–3.93 mg. The in vitro release studies as performed by dialysis bag method showed a sustained release pattern. The results of ex vivo corneal permeation studies indicates that the developed DEX- NDs has some exposure to the posterior segment of the eye. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to describe clinical and histologic characteristics of eyelid (LMCT) and conjunctival (CMCT) mast cell tumors in dogs and cats presented to a referral clinic in Germany. Animal Studied: Medical records were reviewed to identify dogs and cats diagnosed with LMCTs or CMCTs between 2006 and 2020. Results: LMCT were diagnosed in 31 patients and were cutaneous (n = 28; 20 dogs and 8 cats) or subcutaneous (three dogs). Five cases involved the mucocutaneous junction (four dogs, one cat). CMCTs occurred only in dogs (n = 3). At the time of presentation two of the four canine LMCT cases involving the mucocutaneous junction had metastasized to a mandibular lymph node. When applying the Kiupel system, both these cases were categorized as high grade. 85.7% (18/21) of the canine (19 cutaneous and 2 subcutaneous) LMCT and all CMCT cases were categorized as Kiupel low grade. No local recurrences occurred in all LMCT cases in which clean surgical margins were obtained (n = 18, mean surgical margin width: dogs 9.4 mm, cats 3.8 mm). Two cats (2/4) and four dogs (4/7) with questionable or incomplete surgical margins experienced local recurrences (mean time to recurrence of 180 and 637 days in dogs and cats, respectively). Conclusion: Recurrence of low‐grade LMCTs and CMCTs following excision with clean margins is rare. Tumors involving the mucocutaneous junction may be of higher grade and prone to lymphatic metastasis. [ABSTRACT FROM AUTHOR]

Ocular drug delivery of any molecule is quite complex and challenging due to the ophthalmic anatomy. The current ocular formulations such as drops, gels or ointments cannot deliver the active molecules efficiently, therefore newer dosage forms are being developed. In situ gels which are in the liquid state in room temperature or in certain pH but transform to gels when instilled onto the eye belongs to such innovative dosage forms. Herein, the fabrication of in situ gels for naringin ocular delivery is presented since there are very few studies examining the use of naringin as an active molecule for eye delivery. Naringin which is hydrolyzed in naringenin, is a flavonoid glucoside found on citrus fruits and has been studied as antioxidant and anti-inflammatory agent or potent antimicrobial agent. The naringin loaded in situ gels developed via cold method using Poloxamer 407, sodium alginate and hydroxypropyl methylcellulose E5. The temperature-responsive in situ gels were characterized for clarity, sol-gel transition temperature, gelling capacity, pH and viscosity. All the results were of desirable limits. Furthermore, in vitro drug release demonstrated that the in situ gels showed sustained pattern Antimicrobial studies indicated specific antimicrobial potency against Enterococcus faecalis. Future studies will involve in vivo studies and ocular irritation analysis. [ABSTRACT FROM AUTHOR]

PurposeMaterials and MethodsResultsConclusionTo report a rare case of a toxoplasma chorioretinitis in one eye and peripheral ocular toxocariasis granuloma in the fellow eye of the same patient.Retrospective case report.A 44-year-old male presented with gradual loss of vision over the past weeks. The patient was diagnosed with ocular toxoplasma chorioretinitis recurrence in his right eye and an inactive peripheral granuloma of ocular toxocariasis was found in the left eye. The patient was a farmer who had been involved in animal husbandry throughout his life. The patient was treated with antibiotics for toxoplasma chorioretinitis and kept under follow-up for ocular toxocariasis.Coinfections of zoonoses are related to socioeconomic environment and individual characteristics of the host. Ocular toxoplasmosis and ocular toxocariasis may present with different scenarios. To our knowledge, this is the first case of a coinfection of ocular toxoplasmosis and ocular toxocariasis in the same patient. A thorough ophthalmological examination and detailed anamnesis are important for diagnosis. [ABSTRACT FROM AUTHOR]

Background: A higher prevalence of ophthalmological alterations in systemic inflammatory diseases has been demonstrated. Objectives: Our objectives were to determine anterior segment findings and corneal properties in alopecia areata (AA). Methods: This is a case-control study. Severe AA patients (Severity of Alopecia Tool > 50%) and non-AA subjects underwent a general ophthalmological examination, a Pentacam and Corvis scheimpflug technology examination (Oculus Optikgeräte GmbH, Wetzlar, Germany). Visual acuity, refractive error, corneal aesthesiometry, and biomechanical and topographic variables were registered. Results: In total, 25 AA patients (50 eyes; 50.6 ± 8.1 years) and 29 controls (58 eyes; 49.4 ± 8.6 years) were included. AA patients had decreased corneal sensitivity, more corneal staining, and a more advanced cataract (p ≤ 0.004). The anterior topographic flat meridian, mean anterior keratometry, and maximum keratometric point were increased in AA (p ≤ 0.040), while pachymetry values were thinner (p ≤ 0.001). Keratoconus index and Belin/Ambrosio-enhanced ectasia total deviation display were increased (p ≤ 0.007). Two eyes with a topographic diagnosis of keratoconus and four eyes with subclinical keratoconus were detected in AA. Applanation lengths were smaller in AA (p ≤ 0.029). The Corvis Biomechanical Index was increased in AA (p = 0.022). Conclusions: AA patients have reduced corneal sensitivity and increased corneal staining. Topographic and biomechanical parameters are altered, and there could be a higher risk of keratoconus, thus possibly requiring routine ophthalmological examination. [ABSTRACT FROM AUTHOR]

Melanoma represents a public health issue. One of the biggest goals of current research is to develop new therapeutic options for patients affected by this aggressive tumor. We conducted a retrospective study including 105 patients diagnosed with cutaneous and ocular melanoma, with stages varying from pT1a to pT4b and pT4e, respectively, and we performed immunohistochemistry reactions with the new potential prognostic marker, VISTA (V-domain Ig suppressor of T cell activation). We quantified the expression by applying the H-score adapted for VISTA and divided the patients, based on the median value, into groups that presented high, low, and negative expression. Therefore, we obtained 65 cases with positive expression for cutaneous melanoma and 8 cases with positive expression for ocular melanoma. Forty-one cases presented high expression in cutaneous melanoma and three cases presented high expression in ocular melanoma. In cutaneous melanoma, analytic statistics showed that VISTA expression was associated with a high Breslow index, high mitotic count, high Ki67 expression, and advanced clinicopathological stage. The majority of ocular melanoma cases demonstrating a positive reaction were classified as stage pT3, whereas earlier stages showed a negative reaction. Our findings underscore a significant correlation between VISTA expression and key prognostic factors in melanoma. Looking ahead, the prospect of future randomized studies holds promise in corroborating the clinical relevance of our findings. By further elucidating the intricate relationship between VISTA expression and melanoma progression, new treatment strategies could be found, improving patient outcomes in this challenging neoplasm. [ABSTRACT FROM AUTHOR]

Glaucoma is a group of optic neuropathies and the world's leading cause of irreversible blindness. Normal-tension glaucoma (NTG) is a subtype of glaucoma that is characterized by a typical pattern of peripheral retinal loss, in which the patient's intraocular pressure (IOP) is considered within the normal range (<21 mmHg). Currently, the only targetable risk factor for glaucoma is lowering IOP, and patients with NTG continue to experience visual field loss after IOP-lowering treatments. This demonstrates the need for a better understanding of the pathogenesis of NTG and underlying mechanisms leading to neurodegeneration. Recent studies have found significant connections between NTG and cerebral manifestations, suggesting NTG as a neurodegenerative disease beyond the eye. Gaining a better understanding of NTG can potentially provide new Alzheimer's Disease diagnostics capabilities. This review identifies the epidemiology, current biomarkers, altered fluid dynamics, and cerebral and ocular manifestations to examine connections and discrepancies between the mechanisms of NTG and Alzheimer's Disease. [ABSTRACT FROM AUTHOR]

This epidemiological study examined ocular and orbital lymphomas in the United States from 1995 to 2018, using data from the North American Association of Central Cancer Registries database of 87,543 patients with ocular and adnexal malignancies. We identified 17,878 patients (20.4%) with ocular and orbital lymphomas, with an age-standardized incidence rate (ASIR) of 2.6 persons per million (ppm). The incidence was the highest in the orbit (ASIR = 1.24), followed by the conjunctiva (ASIR = 0.57). Non-Hodgkin B-cell lymphoma was the most prevalent subtype (85.4%), particularly marginal-zone lymphoma (45.7%). Racial disparities were noted, with Asia–Pacific Islanders showing the highest incidence (orbit, 1.3 ppm). The incidence increased significantly from 1995 to 2003 (Average Percent Change, APC = 2.1%) but declined thereafter until 2018 (APC = − 0.7%). 5-year relative survival (RS) rates varied, with the highest rate for conjunctival lymphoma (100%) and the lowest for intraocular lymphoma (70.6%). Survival rates have generally improved, with an annual increase in the 5-year RS of 0.45%. This study highlights the changing epidemiological landscape, pointing to initial increases and subsequent decreases in incidence until 2003, with survival improvements likely due to advancements in treatment. These findings underscore the need for further research to investigate the root causes of these shifts and the declining incidence of ocular lymphoma. [ABSTRACT FROM AUTHOR]

The aim of this study was to formulate and optimize by statistical means mucoadhesive and biodegradable sponge-like inserts loaded with voriconazole (VCZ) which increases the contact time of the drug with the eye and sustain its release from the formula in a controlled manner. This avoids the pulsed effect reported for the drug suspension and results in reducing the number of drug instillations in the eye with the result of enhancing the patient compliance. Also, the sponge like nature of the insert reduces the foreign body sensation caused by other ocular solid dosage forms. They were prepared using casting/freeze-drying technique using five polymers namely high molecular weight chitosan (CH), sodium alginate (AL), sodium carboxy methyl cellulose (CMC), gellan gum (GG) and xanthan gum (XG). The prepared inserts were subjected to evaluations of their visual appearance, weight variation, drug content, surface pH, in-vitro release (percent drug released after 1h (Q1 (%)), mean dissolution time (MDT) and dissolution efficiency (DE)) in addition to kinetic analysis of the release data, water uptake, mucoadhesion and rheology of the forming plain polymer solution at the maximum rate of shear. The independent variables of the D-optimal factorial design were the polymer type and concentration while Q1 (%), MDT, DE, % water uptake after 15 minutes and rheology at the maximum rate of shear were chosen as dependant variables. The performed optimization process using design expert software showed an optimum formula consisting of 2 % GG. It showed slow release behavior compared to the drug suspension. FTIR and DSC studies showed that there is no interaction between VCZ and GG. The optimum formula has good in-vitro mucoadhesive properties and pH in the safe ocular range. Moreover, it showed promising in-vivo results of rapid hydration and gelling in addition to good mucoadhesive behavior when instilled in the eye, high ocular safety and biocompatibility, sustained antifungal activity in comparison to the drug suspension and finally biodegradation. So, it may be taken into consideration as an outstanding carrier for the ocular delivery of VCZ. [Display omitted] [ABSTRACT FROM AUTHOR]

Zoonotic sporotrichosis, a subcutaneous mycosis caused by Sporothrix brasiliensis, has become hyperendemic and a serious public health issue in Brazil and an emerging disease throughout the world. Typical sporotrichosis is defined as fixed or lymphocutaneous lesion development, however, reports of atypical presentations have been described in hyperendemic areas, which may result in a worse prognosis. Thus, considering an increase in atypical cases and in more severe extracutaneous cases and hospitalizations reported in Brazil, we aimed to perform a systematic review to search for hypersensitivity reactions (HRs) and extracutaneous presentations associated with zoonotic sporotrichosis. A systematic review was performed, following the PRISMA guidelines to search for atypical/extracutaneous cases (mucosal, osteoarthritis, HRs, pulmonary, meningeal) of zoonotic sporotrichosis. A total of 791 published cases over 26 years (1998–2023) in eleven Brazilian states were reviewed. Most cases corresponded to a HR (47%; n = 370), followed by mucosal (32%; n = 256), multifocal (8%; n = 60), osteoarthritis (7%; n = 59), meningeal (4%; n = 32), and pulmonary (2%; n = 14) infections. When available (n = 607), the outcome was death in 7% (n = 43) of cases. Here, we show a frequent and worrisome scenario of zoonotic sporotrichosis in Brazil, with a high and dispersed incidence of atypical/extracutaneous cases throughout the Brazilian territory. Therefore, educational measures are necessary to make health professionals and the overall population aware of this fungal pathogen in Brazil as well as in other countries in the Americas. [ABSTRACT FROM AUTHOR]

The urbanization of suburbs has a significant impact on ocular health, however, the effect of this phenomenon on the epidemiology of eye diseases in the sub-urbanization region of China remains unclear. In this context, the population-based Beichen Eye Study (BCES) was conducted in the Beichen District of Tianjin, China. This article aims to summarize the background, design scheme and operation process of the study. The Chinese Clinical Trial Registry number was ChiCTR2000032280. In total, 8218 participants were randomly selected by a multi-stage sampling method. After their qualification was confirmed, participants were mainly invited to a centralized clinic via telephone interviews after promotion of the study in the community. Examinations included a standardized interview, anthropometric assessment, autorefraction, ocular biometry, visual acuity, anterior and posterior segment examinations, dry eye disease (DED), intra-ocular pressure, visual field testing, gonioscopy, and imaging of anterior segment, posterior segment, fundus, and optic disc. A peripheral venous blood sample was also collected for biochemical testing. For observational purposes, a community-based type II diabetes mellitus management mode was created and assessed for its effect in preventing the progression of diabetic retinopathy (DR). Of the 8,218 residents, 7,271 were eligible for inclusion, and 5,840 (80.32%) subjects were enrolled in the BCES. Most of the participants were female (64.38%) with a median age of 63 years, and 98.23% representing Han Chinese descent. Conclusions: This study provides insights into the epidemiological characteristics of major ocular diseases and their moderators in a suburbanized region of China. [ABSTRACT FROM AUTHOR]

Objective A cross-sectional study was established in Iraq Dhi Qar Governorate, which aimed to determine the prevalence of ocular manifestations in psoriasis among Iraqi patients. Methods This study was designed according to the frequency of ocular manifestations in psoriasis in Iraq, where reliance was placed on the statistical analysis program SPSS and the Schirmer test. To semiquantitative test of tear production that measures the physical tendency of a fluid to travel along a strip of porous material by capillary action due to surface tension for the diagnosis of dry eye. The statistical analysis program SPSS was relied on to analyse demographic data and information about patients. Results/Conclusion The statistical analysis program SPSS was relied on to analyse demographic data and information about patients. The mean age of the patients was 45.2±13.5, and results were found with a statistical correlation between ocular diseases in patients, where a high percentage of contract was found for 50 patients and 100 eyes. In addition, other abnormalities in the eye were found, including keratitis and blepharitis. Moreover, the presence of eye diseases affects the degree of disease activity and the cutaneous form of psoriasis. It can affect one or both eyes, as it generally appears with outbreaks of infections that recur over time. About half of uveitis is due to an unknown cause. [ABSTRACT FROM AUTHOR]

Background: Long noncoding RNAs (lncRNAs) are RNA transcripts over 200 nucleotides in length that do not code for proteins. Initially considered a genomic mystery, an increasing number of lncRNAs have been shown to have vital roles in physiological and pathological conditions by regulating gene expression through diverse mechanisms depending on their subcellular localization. Dysregulated angiogenesis is responsible for various vascular oculopathies, including diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, and corneal neovascularization. While anti-VEGF treatment is available, it is not curative, and long-term outcomes are suboptimal, and some patients are unresponsive. Results and summary: To better understand these diseases, researchers have investigated the role of lncRNAs in regulating angiogenesis and models of vascular oculopathies. This review summarizes recent research on lncRNAs in ocular angiogenesis, including the pro-angiogenic lncRNAs ANRIL, HOTAIR, HOTTIP, H19, IPW, MALAT1, MIAT, NEAT1, and TUG1, the anti-angiogenic lncRNAs MEG3 and PKNY, and the human/primate specific lncRNAs lncEGFL7OS, discussing their functions and mechanisms of action in vascular oculopathies. [ABSTRACT FROM AUTHOR]

Genetic forms of focal and segmental glomerulosclerosis (FSGS) often have extra-renal manifestations. This study examined FSGS-associated genes from the Genomics England Renal proteinuria panel for reported and likely ocular features. Thirty-two of the 55 genes (58%) were associated with ocular abnormalities in human disease, and a further 12 (22%) were expressed in the retina or had an eye phenotype in mouse models. The commonest genes affected in congenital nephrotic syndrome (NPHS1, NPHS2, WT1, LAMB2, PAX2 but not PLCE1) may have ocular manifestations. Many genes affected in childhood–adolescent onset FSGS (NPHS1, NPHS2, WT1, LAMB2, SMARCAL1, NUP107 but not TRPC6 or PLCE1) have ocular features. The commonest genes affected in adult-onset FSGS (COL4A3–COL4A5,GLA) have ocular abnormalities but not the other frequently affected genes (ACTN4, CD2AP, INF2, TRPC6). Common ocular associations of genetic FSGS include cataract, myopia, strabismus, ptosis and retinal atrophy. Mitochondrial forms of FSGS (MELAS, MIDD, Kearn's Sayre disease) are associated with retinal atrophy and inherited retinal degeneration. Some genetic kidney diseases (CAKUT, ciliopathies, tubulopathies) that result in secondary forms of FSGS also have ocular features. Ocular manifestations suggest a genetic basis for FSGS, often help identify the affected gene, and prompt genetic testing. In general, ocular abnormalities require early evaluation by an ophthalmologist, and sometimes, monitoring or treatment to improve vision or prevent visual loss from complications. In addition, the patient should be examined for other syndromic features and first degree family members assessed. [ABSTRACT FROM AUTHOR]

Normal ophthalmic parameters of the blue-tongued skink (Tiliqua scincoides), one of the largest members of the skink family of lizards, have yet to be evaluated. The objective of this study was to establish baseline ophthalmic parameters for a captive population of 12 healthy, 1-yr-old blue-tongued skinks. Ophthalmic examination, corneal touch threshold, tear production including phenol red thread test (PRTT) and modified Schirmer tear test-2 (mSTT-2), horizontal palpebral fissure length (HPFL), rebound tonometry (TONOVET and TONOVET Plus), and bacterial and fungal cultures were performed. The blue-tongued skinks were all amenable to ocular diagnostic testing. Corneal touch threshold (mean ± SD) was 5.48 ± 0.81 cm. PRTT (mean ± SD) was 9.17 ± 6.62 mm/15 sec. mSTT-2 (mean ± SD) was 2.54 ± 2.72 mm/60 sec. HPFL (mean ± SD) was 6.96 ± 0.62 mm and was positively correlated with body weight. Intraocular pressure (IOP) assessed using TONOVET (mean ± SD) was 8.43± 1.51 mmHg, whereas IOP assessed using TONOVET Plus (mean ± SD) was 12.39± 1.54 mmHg. Differences in TONOVET and TONOVET Plus tonometry values were statistically significant (P < 0.0001), and TONOVET values were positively correlated with body weight. The most common bacterial species identified were Staphylococcus xylosus (10/12) and Staphylococcus sciuri (8/12). Fungal cultures were all negative. One animal had superficial corneal ulceration that resolved with treatment. Ophthalmic examination and testing is readily performed in blue-tongued skinks. These parameters may be useful for ocular assessment of this species in a clinical setting. [ABSTRACT FROM AUTHOR]

Background: The most significant medications in dentistry are local anesthetics, and intraoral local anesthesia is arguably the most used dental procedure. However, complications have also been reported. Aim: Evaluation of ocular complications in intraoral anesthesia. Materials and Methods: It was a prospective study involving 2,400 patients undergoing different dental procedures that were performed under intraoral local anesthesia over a 12‑month period. There was a thorough ocular evaluation of all patients by ophthalmologist before and after the administration of intraoral local anesthesia. Results: There were different types of ocular complications reported including accommodation disturbance, amaurosis, diplopia, enophthalmos, miosis, mydriasis, ophthalmoplegia, and ptosis. The most common ocular complication was diplopia contributing 40.1% of all ocular complications. It was followed by ptosis (16.9%), mydriasis (14.9%), and amaourosis (13.2%). Conclusion: The most common ocular complication in intraoral local anesthesia was diplopia. [ABSTRACT FROM AUTHOR]

This study aimed to compare the effect of intranasal (IN) and intramuscular (IM) administration of butorphanol and zolazepam‐tiletamine (ZT) combination on intraocular pressure (IOP) and tear secretion (TS) in rabbits. Fourteen healthy male New Zealand White rabbits weighing 3.05 ± 0.72 kg, aged between 1 and 2 years old, were included in the study. Animals randomly received 0.5 mg/kg butorphanol and 15 mg/kg ZT combination either with IN or IM administration. IOP and TS were measured at baseline (T0), and followed by 5, 15, 30, 45, and 60 min after drug administration. The sedation variables, the time to onset of sedation, duration of sedation, and sedation scores were also recorded. The route of administration for the butorphanol and ZT combination had no significant effect on the mean IOP (p = .301) and TS (p = .445). Furthermore, there were no significant changes observed in the IOP (p = .472) and TS (p = .348) over time. The time to onset of sedation was earlier in the IN group (4.57 ± 0.79 min) than in the IM group (5.86 ± 0.9 min; p = .0004). The duration of sedation was significantly longer for IM (57.43 ± 3.41 min) compared with IN (45.0 ± 1.91 min; p < .0001). No significant difference in the sedation score was observed between groups at all time points. In conclusion, both IN and IM administration of the butorphanol and ZT combination in rabbits had similar effects on IOP and TS. [ABSTRACT FROM AUTHOR]

Purpose Animals Procedures Results Conclusion and Clinical Relevance To evaluate the frequency of ophthalmic disorders in Shih Tzus.Five hundred client‐owned Shih Tzu dogs (1000 eyes).Medical records of 500 Shih Tzu dogs were reviewed and ophthalmic examination data were collected and analyzed.In total, out of 1000 eyes, 964 (96.4%; OD: 480 eyes, OS: 484 eyes) had at least one ophthalmic abnormality, and only 36 eyes (3.6%; OD: 20 eyes, OS: 16 eyes) were diagnosed as normal. A total of 1375 individual ophthalmic abnormalities were observed in 964 diseased eyes. Fifty‐nine different unique diagnoses were made in the study population, and only three conditions [medial canthal entropion (10.4% of eyes; bilateral in 10.2% of dogs), caruncular trichiasis (21.1% of eyes; bilateral in 20.2% of dogs), and reduced tear film breakup time (17.6% of eyes; bilateral in 17.4% of dogs)] affected 49.1% of the eyes.Findings suggested that the most prevalent disorders for the Shih Tzus were hairy caruncle, reduced TBUT, medial canthal entropion, keratoconjunctivitis sicca, pigmentary keratitis, lagophthalmos, and mature cataract. [ABSTRACT FROM AUTHOR]

Objective: To describe the successful restoration of superior eyelid function in a horse following traumatic avulsion using an advancement flap blepharoplasty and subdermal hyaluronic acid filler. Animal Studied: A 21‐year‐old American Paint Horse stallion who was attacked by a fellow stallion resulting in numerous traumatic injuries including avulsion of approximately 75% of the left superior eyelid. Procedures: With standing sedation and locoregional anesthesia, the superior eyelid wound was debrided and an advancement flap blepharoplasty (H‐plasty) and temporary tarsorrhaphy were performed. Routine healing of the surgical site occurred over the subsequent weeks, though lagophthalmos persisted. At 2 and 4 weeks post‐operatively, 2.4% cross‐linked hyaluronic acid was injected subdermally into the superior eyelid to attempt to improve corneal coverage. At 8 weeks post‐operatively, a complete blink was restored and the cosmetic outcome was good. Conclusions: Injection of subdermal hyaluronic acid filler following eyelid injuries or blepharoplastic procedures that result in lagophthalmos can improve corneal coverage by the eyelids and allow for maintenance of a comfortable and visual eye. [ABSTRACT FROM AUTHOR]

Purpose: To investigate changes in astigmatism with age. Are changes from with‐the‐rule (WTR) in younger ages to against‐the‐rule (ATR) in older patients mediated through oblique astigmatic axes or spherical prescriptions, and at what ages do these changes occur? Methods: Prescription data were gathered retrospectively from one optical practice belonging to a large multiple group in the UK. Longitudinal assessments were made of the changes in astigmatism for 326 patients (mean age at first prescription 46 years, range 28–69 years) and 640 eyes through their recorded prescription history (median 20 years of prescription data per participant, IQR 19–22 years, range 18–29 years). Results: Changes in small degrees of astigmatism (0.25 or 0.50 DC) from WTR to ATR were more than three times more likely to pass through an oblique cylinder axis as through a spherical prescription (56 vs. 16, χ12 = 22.2, p < 0.0001). For patients aged 28–40 years at their first recorded eye examination, 55% (92/167) of eyes had an onset of astigmatic changes at a mean of 44 years (SD 6.2) and 41% (68/167) of eyes had no change until after a mean of 54 years (SD 4.6). Compared with a measured prevalence of oblique astigmatism in the literature of 11%–19%, 36% (232/640) of the eyes in this study had an oblique cylinder prescribed at least once in their refraction history and of these oblique cylinders, 78% were transient in nature. Conclusions: The change in ocular astigmatism with age, from WTR to ATR, was more than three times more likely (56 vs. 16) to pass through oblique cylinder axes as through a spherical prescription. Changes in oblique astigmatism have been implicated in complaints with new spectacles, so given this prevalence of oblique cylinder axes (232/640, 36%), continuing professional development is needed regarding reconciling these oblique changes with previous prescriptions. [ABSTRACT FROM AUTHOR]

Introduction: Penetrating Intraorbital Foreign Body (IOFB) injuries are a rare form of traumatic injury. Recognized as a surgical emergency, meticulous history-taking and a thorough examination are essential for determining the trauma's mechanism and cause, facilitating accurate diagnosis and effective disease management. Case Illustration: In the emergency room, a 5-year-old female patient was presented with a craniofacial injury resulting from an IOFB. An evacuation procedure, conducted through a subsidiary incision, was performed to extract the foreign body. Interestingly, the object removed from the orbital cavity was a plastic foreign body, initially suspected to be a fractured orbital bone. Discussion: The clinical presentation, management, and outcomes of orbital foreign body injuries can differ based on the material composition of the foreign body. In cases of intraorbital foreign body trauma, the primary treatment goal is foreign body removal. Conclusion: Precise and accurate initial management in the emergency department is crucial. Early diagnosis, aided by a 3D head CT scan, is instrumental in locating the IOFB and identifying the involved anatomical structures. This, in turn, enables timely treatment decisions to minimize the risk of complications. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the focus of pediatricians’ gaze during the heel prick of neonates. Methods: Prospective study in which pediatricians wearing eye tracker glasses evaluated neonatal pain before/after a heel prtick. Pediatricians scored the pain they perceived in the neonate in a verbal analogue numerical scale (0=no pain; 10=maximum pain). The outcomes measured were number and time of visual fixations in upper face, lower face, and hands, in two 10-second periods, before (pre) and after the puncture (post). These outcomes were compared between the periods, and according to pediatricians’ pain perception: absent/mild (score: 0–5) and moderate/intense (score: 6–10). Results: 24 pediatricians (31 years old, 92% female) evaluated 24 neonates. The median score attributed to neonatal pain during the heel prick was 7.0 (Interquartile range: 5–8). Compared to pre-, in the post-periods, more pediatricians fixed their gaze on the lower face (63 vs. 92%; p=0.036) and the number of visual fixations was greater on the lower face (2.0 vs. 5.0; p=0.018). There was no difference in the number and time of visual fixations according to the intensity of pain. Conclusions: At bedside, pediatricians change their focus of attention on the neonatal face after a painful procedure, focusing mainly on the lower part of the face. [ABSTRACT FROM AUTHOR]

At present, the drugs used to treat dry eye are mainly ocular topical drugs, with only 5 % of the drugs are absorbed, which on the market have adverse reactions, such as eye pain, eye burns, conjunctival hyperemia and poor patient compliance. In order to reduce irritation and improve bioavailability, a new type of ocular drug delivery system, mixed micelles modified with cationic hyaluronic acid was studied by rotary evaporation method. Vitamin E tocopheryl polyethylene glycol succinate and polyoxyethylene hydrogenated castor oil, two non-ionic surfactants are used for the preparation of cyclosporin micelles. Finally, the micelles were modified with cationic hyaluronic acid to form the final formulation named cationic hyaluronic acid modified cyclosporin A nanomicelle, which was designed with particle size of 17.21 nm, polydispersity index of 0.221, zeta potential of -23.4 mV and osmotic pressure of 299 mOsmol/kg. The release rate of cyclosporin A nanomicelle in vitro reached 88 %, and the preparation showed reduced surface tension (34.46 mN/m) and contact angle (22.8°), which indicated that cyclosporin A nanomicelle had better wetting and spreading properties. Transmission electron microscope showed that the preparation was spherical, homogeneous and no aggregates. After modification with cationic hyaluronic acid, the corneal permeability and apparent permeability increased by about 1.4 times and 1.3 times respectively, indicating that cyclosporin A nanomicelle can improve corneal penetration and improve bioavailability. Draize test of rabbit eye surface showed that cyclosporin A nanomicelle has no ocular irritation. In conclusion, Cationic hyaluronic acid modified cyclosporin A nanomicelle might be a promising ocular drug delivery system for the treatment of dry eye. [ABSTRACT FROM AUTHOR]

Objective: Diabetes mellitus is a chronic metabolic disorder which is preventable if appropriate measures are taken. The present study aimed to study the ocular manifestations in controlled and uncontrolled Type 2 Diabetes Mellitus Material & Method: This is a Prospective observational study on 150 Type 2 Diabetes mellitus patients attending MNR Medical College & Hospital. Patients fulfilling inclusion criteria were taken for the study during the study period. The data was collected for each patient including detailed diabetes history, ocular complaints and complete ophthalmological examination was done. Data was compiled and tabulated using MS Excel spread sheet and statistical analysis done for relevant tables. Results: The present study included total of 150 patients fulfilling inclusion criteria with majority of patients in the age group of 51-60yrs (47.3%) followed by 61-70yrs (25.34%). Among the gender 69 were male and 81 were female patients with marginal female preponderance in the study. Cataract was the most common complication found in 100 cases (66.66%), followed by retinopathy in 51 instances (34%). Dry eye was observed in 30 instances (20%), and lid involvement was observed in 17 cases (11.33%). Conclusion: Diabetes is linked to a wide range of eye diseases. Diabetes affects the entire eye, from the lids to the retina and the cranial nerves. Cataract was discovered to be the most prevalent ocular symptom of diabetes mellitus. The periodic eye examinations remain the primary approach for reducing the impact of diabetes-related vision loss. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to study the ocular manifestations in human immunodeficiency virus (HIV)-infected patients and the correlation of posterior segment lesions with CD4+ counts. Methods: This hospital-based, cross-sectional study enrolled HIV-positive patients attending the ophthalmology department of a tertiary care hospital in Eastern India. Complete demographic information was obtained for each patient. Comprehensive ophthalmic evaluation was done in each case. Results: A total of 184 HIV-positive patients were enrolled in the study. Ocular manifestations were detected in 62 cases. The prevalence of ocular manifestations in the present study was 33.69%. Mean age of patients included in the study was 34.8 ± 10.77 years. Prevalence of ocular manifestations was highest in the age group of 30–39 years (41.93%). Highest prevalence of ocular manifestations was noted in patients with low level of education and poor socioeconomic status. Sexual transmission was the major route of HIV transmission (in 92% of cases). Posterior segment lesions were seen in 69.35% of cases. HIV retinopathy was the most common posterior segment manifestation noted in 25 eyes. Significant positive correlation was noted between severities of posterior segment findings and CD4+ counts, which we found to increase with decrease in CD4+ counts (P < 0.001). Conclusion: Detailed ophthalmic evaluation including fundus examination is must in all cases of HIV/acquired immunodeficiency syndrome (AIDS) patients as it may help in early diagnosis, treatment, and prevention of sight-threatening complications due to opportunistic infections. [ABSTRACT FROM AUTHOR]

Delivery of drugs to special locations of ocular lesions, while minimizing systemic and local toxic effects, is recognized as a critical challenge in the ophthalmic practice. The special anatomy and physiology barriers within the eyeball entail effective drug delivery systems. Emerging attempts in drug delivery has led to developments in ocular iontophoresis, which acts as a noninvasive technology to enhance drug penetration using a small electric current. This technique offers greater flexibility to deliver desired drug dose in a controlled and tolerable manner. In previous studies, this technique has been testified to deliver antibiotics, corticoid, proteins and other gene drugs into the eye with the potency of treating or alleviating diverse ophthalmological diseases including uveitis, cataract, retinoblastoma, herpes simplex and cytomegalovirus retinitis (CMVR), etc. In this review, we will introduce the recent developments in iontophoresis device. We also summarize the latest progress in coulomb controlled iontophoresis (CCI), hydrogel ionic circuit (HIC) and EyeGate II delivery system (EGDS), as well as overview the potential toxicity of iontophoresis. We will discuss these factors that affect the efficacy of iontophoresis experiments, and focus on the latest progress in its clinical application in the treatment of eye diseases. [ABSTRACT FROM AUTHOR]

Objective: (1) To compare patient- and clinician-administered measurements of near point of convergence (NPC) distance including the percentage of patients exceeding clinical cutoffs among concussed adolescents and (2) to assess the reliability of patient- and clinician-measured NPC distances. Methods: A total of 762 patients (mean = 15.51, SD = 3.09 y) within 30 days of concussion participated. The NPC distance was measured consecutively with the patient and clinician controlling the fixation target. The differences between patient (PT) and clinician (CLIN) measurements and cases exceeding cutoffs (ie, ≥5 cm) were examined with a series of t tests and chi-square tests, respectively. Intraclass correlation coefficients and unbiased estimate of reliability were performed. Results: The NPC measurements were similar, t(761) = −.26, P =.79, between the PT (mean = 3.52, SD = 3.77 cm) and CLIN (mean = 3.54, SD = 3.97 cm) conditions. The number of measurements that exceeded cutoffs was similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P =.10), and the number of measurements classified as abnormal/invalid was also similar among the PT (2.5%; 19/762) and CLIN conditions (3%; 23/762) (P =.10). There was excellent reliability between the methods (intraclass correlation coefficients =.85, unbiased estimate of reliability =.92). Conclusion: The findings support the application of this assessment in clinical settings where the clinician may not have direct contact with their patient and rely on the patient (eg, telehealth). [ABSTRACT FROM AUTHOR]

Ocular complications of Ebola virus disease are well-documented and long-term sequelae in survivors are common and lead to considerable morbidity. However, little is currently known regarding EBOV's tropism and replication kinetics within the eye. To date, limited studies have utilized in vitro infections of ocular cell lines and analyses of archived pathology samples to investigate these issues. Here, we employed ex vivo cultures of cynomolgus macaque eyes to determine the tropism of EBOV in 7 different ocular tissues: cornea, anterior sclera with bulbar conjunctiva, ciliary body, iris, lens, neural retina, and retina pigment epithelium. We report that, except for neural retina, all tissues supported EBOV replication. Retina pigment epithelium produced the fastest growth and highest viral RNA loads, although the differences were not statistically significant. Immunohistochemical staining confirmed and further characterized infection. This study demonstrates that EBOV has a broad tropism within the eye. [ABSTRACT FROM AUTHOR]

Introduction: IgG4-associated ocular inflammatory pseudotumor is a rare, non-neoplastic inflammatory process with an incidence of 0.28-1.08 per 100,000 people. The diagnosis of this pathology is one of exclusion, having to meet histopathological criteria, enlargement of a specific organ, and serious concentrations of IgG4. Treatment aims to avoid secondary complications. Clinical case: A 54-year-old woman with no previous reported pathologies, reports that for the past 6 months she has itching at the level of the eyeball and the left eyelid, suddenly and without apparent cause, in addition to decreased visual acuity and retro-ocular pain; this is why she asked for the evaluation. The physical examination revealed normal eye movements, left proptosis, pain on palpation, subconjunctival hyperemia, corneal opacity, absence of red reflex, and the left eye being more resistant to pressure in relation to the contralateral eye. The cranio-thoraco-abdominal tomography reported images at the left ocular level that were suggestive of choroidal melanoma without findings of metastatic activity. Enucleation of the left eye was performed. The specimen was sent to pathology which reported diffuse lymphoplasmacytic infiltrate positive for IgG4. Conclusion: Ocular IgG4 disease is a very rare pathology with non-specific symptoms and complex diagnosis. However, a quick and correct approach is essential to avoid complications. [ABSTRACT FROM AUTHOR]

Eyelids may be affected in systemic, ocular adnexal and primary cutaneous lymphomas (PCLs). The frequency of eyelid involvement in PCLs is still not well known and it is not a predilection site for any type. While primary cutaneous T‐cell lymphomas (CTCLs) are more commonly seen than primary cutaneous B‐cell lymphomas (CBCLs), especially mycosis fungoides (MF) as by far the most frequent type, B cell lymphomas are reported to be the commonest type in eyelid localization on the contrary. PCLs may be located on the eyelids, as the sole manifestation or in association with the involvement of other parts of the eye and elsewhere of the body. MF may present with a rich spectrum of clinical features on the eyelids mostly seen in folliculotropic subtype and advanced‐stage disease. Erythematous scaly patches or plaques representing the most commonly encountered eyelid MF lesions may mimic many other dermatological conditions. Diffuse thickening, oedema, poikilodermic changes, atrophy and wrinkling are other suggestive findings of eyelid MF. Milia‐like papules, madarosis and ectropion are also seen in the folliculotropic variant of MF, as ectropion is more typical for Sezary syndrome. Eyelids are also a typical location for tumoural MF which has been suggested as a poor prognostic indicator in MF. Papulonodular lesions, large tumours, ulceration, diffuse infiltration, oedema and subcutaneous atrophy on the eyelids may also be seen in other types of PCLs. Keep in mind, the rich clinical spectrum of PCLs on the eyelids may be crucial in early diagnosis in this special localization. [ABSTRACT FROM AUTHOR]

Purpose: To discuss the characteristics, etiological factors, and visual outcomes of open globe injuries (OGIs) in children at a tertiary eye hospital in Riyadh, Central Saudi Arabia.Methods: This was a hospital-based cohort study conducted in 2021. Children aged ≤ 16 years with OGI based on the Birmingham Eye Trauma Terminology classification were included. The age, gender, type, cause of OGI, and vision were recorded, as well as uncorrected and best corrected visual acuity (UCVA and BCVA, respectively). There was a change in the UCVA and BCVA one year after management. BCVA following management was linked to a variety of factors.Results: There were 664 eyes with OGI. [median age 5.1, 461 (69.6%) boys]. UCVA at presentation was < 20/400 in 525 (79%) of eyes with OGI. Injuries were mainly due to metallic objects in 195 (29.4%), glass in 102 (15.4%), and fireworks in 62 (9.4%). The Change in visual impairment grade in UCVA and BCVA after management compared to the initial presentation was significant (p < 0.001). Improvement of two lines of BCVA was noted in 345 (52%), no change in (<± 2 lines) 299 (45%) and deteriorated in 10 (1.5%).Conclusion: OGI was identified as a leading cause of unilateral blindness. Children with OGIs who receive standard treatment have better outcomes. Many children could not achieve normal, functional vision despite the intervention of skilled care providers. [ABSTRACT FROM AUTHOR]

There are an estimated 2–3 million emergency department (ED) visits in the United States for eye complaints. Although most patients who present to the ED have nontraumatic eye complaints, many seek treatment for eye trauma, which is a leading cause of unilateral blindness and vison impairment. Given the prevalence of eye-related emergencies, it is imperative that emergency care providers understand how to recognize and treat eye complaints to prevent permanent vision loss and disability. This article covers basic eye anatomy and physiology, discusses a systematic approach to the eye examination, and presents the evidence-based treatment of selected, common nonemergent and emergent eye complaints. For each complaint, essential history questions, examination techniques, differentials, and emergency management have been presented [ABSTRACT FROM AUTHOR]