Search

Purpose: We report our experience of diagnosing and managing metastatic adenocarcinoma of the lungs with primary manifestation to the iris and the ciliary body with the purpose to raise clinical suspicion for systemic malignancy in the presence of undetected ocular mass along with other ocular manifestations. Observations: An 82‐year‐old male presented with a deterioration of vision and intense pain in the right eye since the day before. With his right eye, he suddenly discerned hand movements only. Intraocular pressure in the right eye was increased. Slit–lamp biomicroscopy revealed a ciliary injection and hemorrhagic mass overlying the temporal half of the iris. The L‐9 ultrasound biomicroscopy (UBM) scan documented the tumor completely infiltrating the iris and the ciliary body. We suspected a metastatic eye lesion. CT chest imaging showed a solid expansive formation of the right lung. At the Oncology Department, a fine needle aspiration biopsy was performed under the control of MSCT, which confirmed lung adenocarcinoma. Conclusions and Importance: Although very rarely, pathological changes in the uvea may indicate a metastatic occurrence that needs to be considered in the differential diagnosis. It is important to undergo a wide ophthalmological examination, which in this case included a standardized A‐scan echography and UBM, which confirmed the suspicion of a tumor lesion, followed by cooperation with other medical professionals in order to discover a primary diagnosis. [ABSTRACT FROM AUTHOR]

PurposeObservationsConclusionsUveal effusion syndrome (UES) is an exudative detachment of ciliary body, retina and choroid. Various underlying causes leads to UES-like drugs (topiramate), inflammation and hypotony. Wnt gene involvement has never been associated with UES. We report a case of bilateral UES being misdiagnosed as Vogt–Koyanagi–Harada syndrome (VKH), with Wnt gene dysfunction as the underlying trigger.A 32-year-old male presented with diminution of vision in his left eye. He was found to have choroidal detachment with retinal detachment in his left eye. Choroidal detachment was noted in the right eye. Various ocular imaging including fundus fluorescein angiography and ocular coherence tomography was done. He was misdiagnosed as a case of VKH syndrome, for which he was treated with systemic immunomodulatory therapy. However, a subclinical response was made to revisit the diagnosis. Ultrasound biomicroscopy showed supraciliary effusion. Systemic and genetic evaluation led to the detection of Wnt10A pathway mutation.UES is an entity of diagnostic challenge. Careful and thorough systemic evaluation is required to clinch the diagnosis. We reported the first case of bilateral UES recalcitrant to corticosteroids, with Wnt10A gene mutation. [ABSTRACT FROM AUTHOR]

Simple Summary: This review serves as a comprehensive summary of how plaque radiotherapy, a specialized treatment for various eye tumors including uveal melanoma, is used to provide effective tumor control while preserving vision. The review discusses the radioisotopes available, explores various plaque designs, and describes clinical outcomes alongside possible complications. The review summarizes ongoing research and advancements that aim to enhance the effectiveness and safety of plaque brachytherapy, which is an important tool for the ocular oncologist. Plaque radiotherapy is an effective treatment modality for medium-sized ocular tumors such as uveal melanoma. The authors review the available literature and concisely summarize the current state of the art of ophthalmic plaque brachytherapy. The choice of radioisotope, which includes Ruthenium-106 and Iodine-125, depends on the intended treatment duration, tumor characteristics, and side effect profiles. Ophthalmic plaques may be customized to allow for the delivery of a precise radiation dose by adjusting seed placement and plaque shape to minimize collateral tissue radiation. High dose rate (HDR) brachytherapy, using beta (e.g., Yttrium-90) and photon-emitting sources (e.g., Ytterbium-169, Selenium-75), allows for rapid radiation dose delivery, which typically lasts minutes, compared to multiple days with low-dose plaque brachytherapy. The efficacy of Ruthenium-106 brachytherapy for uveal melanoma varies widely, with reported local control rates between 59.0% and 98.0%. Factors influencing outcomes include tumor size, thickness, anatomical location, and radiation dose at the tumor apex, with larger and thicker tumors potentially exhibiting poorer response and a higher rate of complications. Plaque brachytherapy is effective for selected tumors, particularly uveal melanoma, providing comparable survival rates to enucleation for medium-sized tumors. The complications of plaque brachytherapy are well described, and many of these are treatable. [ABSTRACT FROM AUTHOR]

Background: The majority of primary, intraocular tumors in cats originate from the uvea and include feline diffuse iris melanoma, lymphoma, and iridociliary epithelial adenoma or adenocarcinoma. In this case report, we describe for the first time the clinical, histological, and immunohistochemical findings of a rare myxoid intraocular neoplasm arising from the ciliary body in a cat. Case presentation: A 14-year-old, female, spayed domestic shorthaired cat was presented for evaluation of discolouration of the right eye. Upon examination, a clear to light whitish-tan, bubble-shaped intraocular mass adherent to the inferior ciliary body and extending into the anterior chamber was noted. Within five weeks, the tumor was significantly larger and the eye had developed secondary glaucoma so was enucleated. Light microscopic examination of the globe revealed a multinodular, hypocellular neoplasm arising from the ciliary body composed of interwoven spindle cells embedded in abundant amounts of a lightly basophilic myxoid matrix. Neoplastic cells exhibited strong immunoreactivity for cytokeratin while also showing moderate to strong immunoreactivity to vimentin. A diagnosis was therefore made of an unusual intraocular myxoid epithelioid sarcoma arising from the ciliary body. Conclusions: Although apparently exceedingly rare, epithelioid myxosarcoma should be included as a differential diagnosis for intraocular tumors in cats and they represent a clinical, histologic, and immunohistochemical diagnostic challenge. Early surgical intervention should be considered to prevent local invasion and ascension to the brain. [ABSTRACT FROM AUTHOR]

Purpose: To describe features of a syphilitic vascularized iris mass on multimodal imaging and its resolution after penicillin treatment. Methods: Observational case report and literature review of syphilitic iris masses. Results: A 43-year-old woman presented with a unilateral vascularized tan iris mass in the setting of bilateral panuveitis that occurred along with bilateral papillitis, cystoid macular edema and retinal vasculitis. Laboratory work-up confirmed a diagnosis of syphilis. Ultrasound biomicroscopy (UBM) of the iris mass showed parapupillary hyperechoic full-thickness iris stromal thickening with small intrinsic circular lumens without cyst or ciliary body extension, while the anterior segment optical coherence tomography (AS-OCT) demonstrated a hyperreflective mass with deep iris extension and partial hyporeflective rim. Following treatment, the mass fully resolved without residual sequela. A review of literature identified 11 additional cases of syphilitic iris masses in the English literature from 1915 to present. Their presentations and clinical courses were reviewed herein. Conclusions: This report characterizes a syphilitic iris mass on slit-lamp photography, iris fluorescein angiography, UBM and AS-OCT; depicts key characteristics of syphilitic iris masses; and highlights the need for close inspection of the iris mass as an uncommon sign of ocular syphilis. [ABSTRACT FROM AUTHOR]

Background: Bilateral malignant glaucoma induced by a capsular tension ring associated with ring-shaped cysts of the ciliary body post-cataract surgery is rare. Herein, we present a case to highlight the possibility of capsular tension ring-induced malignant glaucoma. Case presentation: A 59-year-old woman underwent phacoemulsification combined with capsular tension ring implantation for cataracts and zonular fibre laxity in both eyes. Upon admission, annular ciliary masses were detected in both eyes using ultrasound biomicroscopy. Two months post-surgery, the patient experienced vision deterioration, high intraocular pressure, and an axial shallowing anterior chamber in the right eye, and responded poorly to traditional anti-glaucoma medication. Ten days later, similar symptoms appeared in the left eye. Ultrasound biomicroscopy detected contact between the ciliary body and the capsular tension ring. Subsequently, malignant glaucoma was diagnosed. Anterior and posterior capsulotomies performed peripheral to intraocular lens optics using neodymium: YAG laser restored communication and alleviated the symptoms. A one-year follow-up revealed stable intraocular pressure and anterior chamber in both eyes. Conclusions: This is the first case report of bilateral malignant glaucoma after cataract surgery induced by capsular tension ring, which is associated with bilateral ring-shaped cysts of the ciliary body. Blockage between the ciliary body and capsular tension ring was confirmed using ultrasound biomicroscopy. [ABSTRACT FROM AUTHOR]

ABSTRACT Our study represents the first attempts to describe the ultrastructure features in addition to SEM‐EDX analysis of the pecten oculi of the nocturnal, visually active Eurasian stone‐curlew. The present study was carried out on 10 normal pecten oculi from the migrant Eurasian stone‐curlew (Burhinus oedicnemus) that was captured from the Northern Egyptian coast, Edku Lake, Edku, Behera, Egypt. The intraocular folded quadrilateral fan black pecten oculi was observed on the posteroinferior wall of the eyeball. The pecten oculi had 18–20 pleats, with narrow spaces in‐between. Our SEM findings showed a tortuous, coiled pecteneal surface due to numerous blood capillaries. The apical part was oriented toward the ciliary body, but the basal part was derived from the retina, just behind the optic nerve. The outer pleat surfaces are covered by the vitreopecteneal limiting membrane, which carries numerous hyalocyte cells on the outer pleat surface. The transverse sections revealed numerous blood capillaries surrounded by numerous melanin granules. Each basal part was surrounded by a thin, elevated ridge. Our SEM‐EDX analysis revealed that carbon is the highest (half percent), oxygen represents about one‐third, and nitrogen is one‐fifth percent of all elements. The lowest elements are sulfate at the apical part and phosphorus in the middle and basal parts. In conclusion, our findings reveal that the number of pecteneal pleats is related to the nocturnal active visual pattern and the lifestyle of this migratory bird. [ABSTRACT FROM AUTHOR]

Background: Chemical injuries of the eye may produce extensive damage to the ocular surface epithelium, cornea and anterior segment resulting in permanent unilateral or bilateral visual impairment. In addition to causing ocular surface injury, alkalis readily penetrate into the eye, damaging the corneal stroma and endothelium as well as other anterior segment structuressuch as iris, lens and ciliary body. Objective: To study the epidemiology Of Ocular Chemical Injuries. Methods: This prospective study was conducted among all patients who will presented with ocular chemical injuries to Government Rajaji Hospital between the period October 2012 to November 2013. Result: The mean age of the patient who sustained ocular chemical injuries was 29.05 years. Most of the people who sustained ocular chemical injuries are domestic workers (22.5%) and students (22.5%). Urban people (65%) are prone for chemical eye injuries. Semi urban people (31.7%) and rural people (3.3%) form the minority group in this study. Most literates (76.7%) [College education-36.7%, school education-40%]are prone for chemical injuries. The Right eye was relatively more commonly affected (50%) than the lefteye (30%). In our study, there were 12 cases with bilateral injury (20%). Most of the ocular chemical injuries are accidental (61.7%), work place (21.7%) eye injuries come under second category in our study. Conclusion: Most chemical eye burns are mild injuries with no lasting adverse effects. Immediate irrigation of the eye is the most important part of treatment. Prophylactic efforts should be increased in order to bring down the incidence of burns. Injuries caused by assault were more severe and people proportionately lost more eyes. [ABSTRACT FROM AUTHOR]

To investigate if the interval between diagnosis and treatment of posterior uveal melanoma (UM) is associated with metastatic death. Retrospective, single-center cohort study. A total of 1145 patients consecutively diagnosed with posterior UM at St. Erik Eye Hospital, Stockholm, Sweden, from 2012 to 2022, with recorded dates of diagnosis and primary treatment. This cohort represents 81% of all diagnosed patients in Sweden during this period. Data on the interval between diagnosis and treatment were collected for all patients. Its prognostic importance was examined with univariate and multivariate competing risks regressions, and cumulative incidence analyses. Incidence of metastatic death (UM mortality) for patients with prompt (< 1 month from diagnosis) versus delayed treatment (≥ 1 month) and subdistribution hazard ratios (exp(β j)) for every additional 10-day delay in treatment. The mean interval between diagnosis and treatment was 34 days (SD, 56, range, 0–932). Patients treated promptly had larger tumors at diagnosis, but there were no differences in patient age, tumor distance to the optic disc, rates of ciliary body involvement (CBI) or extraocular extension (EXE), or symptom duration before diagnosis. Those who were treated more than 1 month after diagnosis had greater UM mortality in American Joint Committee on Cancer (AJCC) stage II and III. In stage I, UM mortality for delayed treatment was lower for the first 10 years, followed by a marked spike in the 11th year. In multivariate competing risks regressions of all 1145 patients with tumor diameter, thickness, CBI, and EXE as covariates, the risk for UM mortality increased with 1% for every additional 10-day delay in treatment (exp(β j) 1.01). Among 355 patients treated with enucleation, this delay was associated with UM mortality, independent of AJCC stage, cytomorphology, and level of immunohistochemical BAP-1 expression. Increasing time between diagnosis and treatment of UM is associated with a higher risk of metastatic death. These results challenge a central concept in the understanding of metastatic progression and may indicate the existence of late metastatic seeding. They also underscore the importance of prompt treatment. Validation in independent cohorts is recommended. The author(s) have no proprietary or commercial interest in any materials discussed in this article. [ABSTRACT FROM AUTHOR]

To report a case of disseminated TB presenting as ciliary body and thyroid mass lesions. A 17-year-old male patient presented with a thyroid mass and blurring of vision in the left eye. A diagnosis of ciliary body granuloma was made. Although the Mantoux was negative, the HRCT chest showed evidence of miliary TB, and the fine needle aspiration cytology from the thyroid mass revealed AFB. On initiation of Antitubercular therapy(ATT), a paradoxical worsening of ciliary body granuloma was noted which resolved on starting steroids. Involvement of thyroid gland and ciliary body although rare in tuberculosis, may be the presenting feature of disseminated TB. Paradoxical reactions seen after initiation of ATT in these cases may respond well to oral steroids. [ABSTRACT FROM AUTHOR]

Branched-chain amino acids (BCAAs) play vital roles in metabolic and physiological processes, with their catabolism initiated by two branched-chain aminotransferase isozymes: cytosolic (BCATc) and mitochondrial (BCATm). These enzymes have tissue and cell-specific compartmentalization and are believed to shuttle metabolites between cells and tissues. Although their expression and localization have been established in most tissues, ocular tissues remain unknown. In this study, we used immunohistochemical analyses to investigate the expression and localization of BCAT enzymes in the normal eye tissues. As expected, BCATc was highly expressed in the neuronal cells of the retina, particularly in the ganglion cell layers, inner nuclear layer, and plexiform layer, with little to no expression in Müller cells. BCATc was also present in the cornea, retinal pigment epithelium (RPE), choroid, ciliary body, and iris but not in the lens. In contrast, BCATm was expressed across all ocular tissues, with strong expression in the Muller cells of the retina, the endothelial and epithelial layers of the cornea, the choroid and iris, and the epithelial cells at the lens's front. The extensive expression and distribution of BCAT isozymes in the ocular tissue, suggests that BCAA transamination is widespread in the eye, potentially aiding in metabolite transport between ocular tissues. The findings provide new insights into the physiological role of BCATs in the eye, particularly within the neuronal retina. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to compare the safety and effectiveness of intraocular pressure reduction between micropulse transscleral cyclophotocoagulation and “slow cook” transscleral cyclophotocoagulation in patients with refractory primary open-angle glaucoma. Methods: We included patients with primary open angle glaucoma with at least 12 months of follow-up. We collected and analyzed data on the preoperative characteristics and postoperative outcomes. The primary outcomes were a reduction of ≥20% of the baseline value (criterion A) and/or intraocular pressure between 6 and 21 mmHg (criterion B). Results: We included 128 eyes with primary open-angle glaucoma. The preoperative mean intraocular pressure was 25.53 ± 6.40 and 35.02 ± 12.57 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean intraocular pressure was reduced significantly to 14.33 ± 3.40 and 15.37 ± 5.85 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups at the last follow-up, respectively (p=0.110). The mean intraocular pressure reduction at 12 months was 11.20 ± 11.46 and 19.65 ± 13.22 mmHg in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The median preoperative logMAR visual acuity was 0.52 ± 0.69 and 1.75 ± 1.04 in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p<0.001). The mean visual acuity variation was -0.10 ± 0.35 and -0.074 ± 0.16 in the micropulse- and “slow cook” transscleral cyclophotocoagulation, respectively (p=0.510). Preoperatively, the mean eye drops were 3.44 ± 1.38 and 2.89 ± 0.68 drugs in the micropulse- and “slow cook” transscleral cyclophotocoagulation groups, respectively (p=0.017), but those were 2.06 ± 1.42 and 1.02 ± 1.46 at the end of the study in the slow cook” and micropulse transscleral cyclophotocoagulation groups, respectively (p<0.001). The success of criterion A was not significant between both groups. Compared with 11 eyes (17.74%) in the slow cook” transscleral cyclophotocoagulation group, 19 eyes (28.78%) in the micropulse transscleral cyclophotocoagulation group showed complete success (p=0.171). For criterion B, 28 (42.42%) and 2 eyes (3.22%) showed complete success after micropulse- and slow cook” transscleral cyclophotocoagulation, respectively (p<0.001). Conclusion: Both techniques reduced intraocular pressure effectively. [ABSTRACT FROM AUTHOR]

AIM: To determine the factors related to preoperative ocular characters that are predictive of insufficient vault (

Background: Uveitis, characterized by inflammation of the iris, ciliary body, and choroid, presents a significant global clinical challenge, contributing substantially to visual impairment. Risk factors include autoimmune diseases and immune cell dysfunctions, yet many remain unidentified. Immune cells, notably T cells, B cells, and monocytes, play pivotal roles in uveitis pathogenesis. While biologic agents show promise, comprehensive studies on immune cell types in ocular diseases are lacking. Genome-wide association studies (GWAS) and Mendelian randomization MR) present promising avenues to elucidate genetic susceptibilities and causal relationships between immune cell traits and uveitis risk. Methods: Two-sample MR analysis was used to evaluate the causal relationship between 731 immune cells and uveitis, and genome-wide significance analysis was performed for genetic variation in 731 immune cells traits (P < 5 x 10-8). Immune characteristics include median fluorescence intensity (MFI), relative cell counts (RC), absolute cell counts (AC), and morphological parameters (MP), which were determined by published GWAS, and public data from the IEU Open GWAS database. The main analysis method of MR is inverse variance weighting IVW). Heterogeneity and horizontal pleiotropy were also assessed. Results: 5 immunophenotypes, including CD62L-DC %DC, IgD+ CD38dim %B cell, CD3 on CM CD4+T cell, CD3 on CD45RA-CD4 +T cell, and CD3 on CD39+ CD4+ Treg may increase the risk of uveitis. 5 immunophenotypes, including CD11b on CD33dim HLA DR-Myeloid cell, HLA DR on CD33dim HLA DR+ CD11b-myeloid cell, CD14-CD16 + %monocyte, HLA DR on CD14-CD16 + monocyte and PDL-1 on CD14-CD16 + monocyte was negatively associated with the risk of uveitis. Among them, HLA DR on CD14-CD16 + monocyte (OR=0.921, 95%CI =0.875-0.970, P=0.001) and HLA DR on CD33dim HLA DR+ CD11b- (OR=0.879, 95%CI = 0.833- 0.927, P=0.00) were negatively associated with the risk of uveitis in bi-direction. Conclusion: These results indicate that 10 immune cells traits are significantly associated with the risk of developing uveitis and 2 of them were strongly associated with uveitis bi-directionally, after excluding the effects of confounding factors such as some immune diseases, which provided new ideas and therapeutic targets for the study of immune mechanism of uveitis. [ABSTRACT FROM AUTHOR]

Cisplatin (CP) is a chemotherapeutic agent employed as a therapy for different solid tumors. CP elicits many negative side effects including ocular toxicity. L-arginine able to increase the anti-inflammatory cytokine levels in the bloodstream. This study aimed to evaluate the possible protective impact of L-arginine against ocular toxicity of cisplatin through its anti-inflammatory action. Forty male rats were utilized in this experiment. The treatment protocol duration lasted for one week. The rats were divided randomly into four equal groups, as follows: the normal control group (G1) received a single intraperitoneal injection of normal saline, Cisplatin-administered group (G2) received single intraperitoneal injection of cisplatin in a dose (10 mg/kg body weight), Cisplatin + L-arginine-treated group (G3) received i.p. injection of cisplatin in a dose (10 mg/kg b.wt.) followed immediately by i.p. injection of L-arginine in a dose (10 mg/kg b.wt.), and L-arginine-treated group (G4) received intraperitoneal injection of 10 mg/kg b.wt. L-arginine. The protective effect of L-arginine was assessed through histopathology and immunohistochemical analysis of inducible nitric oxide synthase (iNOS) in ocular tissues. Cisplatin-administered group revealed corneal neovascularization, stromal inflammatory infiltration, corneal epithelial hyperplasia, and endothelial degeneration. Sclera revealed vascular congestion and inflammatory infiltrates. There were congested blood vessels, apoptosis, and a decrease the ganglionic cells number in the retinal tissue. Ciliary body had epithelial necrosis, congestion, and hemorrhage. These pathological changes were attenuated to be mild in the cisplatin + L-arginine-treated group. The intensity of the immunohistochemical expression of iNOS appeared weak and significantly decreased in G3 compared to G2. The obtained data validate that Co-treatment of cisplatin with L-arginine cause a reduction in histopathological ocular damage through its anti-inflammatory effect. [ABSTRACT FROM AUTHOR]

Background/Aim: Intraocular metastases of systemic cancer are most frequently located in the choroid, followed by the iris and ciliary body, while retinal metastases are extremely rare. Here we present a case of retinal metastasis and analyze multimodal imaging. Case Report: A 66-year-old woman with a medical history of breast cancer 5 years earlier was referred to our Department struggling with blurry vision in her right eye. At initial examination, her best-corrected visual acuity (BCVA) was 1.0 oculus dexter (OD). Fundus examination revealed a yellowish elevated lesion with irregular surface, measuring 2 papillary diameters, along with serous retinal detachment (SRD) on the temporal side of the optic disc. Optical coherence tomography showed SRD with an isointense nodule extending across all retinal layers. Fluorescein angiography showed hyper-fluorescence and vigorous fluorescence leakage inside the tumor in the early and late phases, respectively. Indocyanine green angiography depicted feeder and drainage vessels within the mass. Laser speckle flowgraphy (LSFG) showed a cold signal inside the tumor. Based on these clinical findings, the mass was diagnosed as a retinal metastasis. Eight days after the initial visit, the patient underwent external beam radiation to the right eye. One month after the initial diagnosis, her BCVA was 0.7 OD, the tumor was localized, and SRD had decreased. LSFG indicated vascular remodeling with marginally warmer signals in the tumor. Conclusion: LSFG of the retinal metastasis showed a cold signal, suggesting low tumor blood flow velocity and that the tumor may have grown slowly. LSFG findings are likely to play a supportive role in clinical diagnosis and contribute to better understanding of pathogenesis in juxtapapillary tumors. [ABSTRACT FROM AUTHOR]

Serving as the cell's sensory antennae, primary cilia are linked to numerous human genetic diseases when they malfunction. DZIP1L, identified as one of the genetic causes of human autosomal recessive polycystic kidney disease (ARPKD), is an evolutionarily conserved ciliary basal body protein. Although it has been reported that DZIP1L is involved in the ciliary entry of PKD proteins, the underlying mechanism remains elusive. Here, an uncharacterized role of DZIP1L is reported in modulating the architecture and function of transition fibers (TFs), striking ciliary base structures essential for selective cilia gating. Using C. elegans as a model, C01G5.7 (hereafter termed DZIP‐1) is identified as the sole homolog of DZIP1L, which specifically localizes to TFs. While DZIP‐1 or ANKR‐26 (the ortholog of ANKRD26) deficiency shows subtle impact on TFs, co‐depletion of DZIP‐1 and ANKR‐26 disrupts TF assembly and cilia gating for soluble and membrane proteins, including the ortholog of ADPKD protein polycystin‐2. Notably, the synergistic role for DZIP1L and ANKRD26 in the formation and function of TFs is highly conserved in mammalian cilia. Hence, the findings illuminate an evolutionarily conserved role of DZIP1L in TFs architecture and function, highlighting TFs as a vital part of the ciliary gate implicated in ciliopathies ARPKD. [ABSTRACT FROM AUTHOR]

Background: Ocular tuberculosis is a relatively rare extrapulmonary manifestation of tuberculosis. This vision-threatening disease is extremely challenging to diagnose, particularly because it can mimic other diseases. We report a case of tuberculous ciliary body granuloma initially diagnosed as bullous retinal detachment. Case report: A 52-year-old female presented with bullous retinal detachment in her left eye, and ultrasound biomicroscopy (UBM) verified the presence of a lesion with ciliary body granulomatous inflammation. The T-SPOT was positive, and the purified protein derivative (PPD) test was strongly positive (diameter of 20 mm). Following the administration of oral anti-tuberculosis regimen combined with prednisone, the retina gradually became reattached, the ciliary body granuloma became significantly reduced in size, and the visual acuity of the patient noticeably improved. Conclusions: Tuberculous ciliary body granulomas can cause bullous exudative retinal detachment and can be diagnosed with UBM. Early and full-course anti-tuberculosis treatment (ATT) combined with corticosteroid therapy can improve the patient prognosis. [ABSTRACT FROM AUTHOR]

Simple Summary: Adenylyl cyclase is an enzyme that plays an important role in cellular signalling in mammals. This review gathers current understanding of the role of adenylyl cyclase in the eye, covering the cornea, lens, retina, lacrimal gland and tear film, and explores their potential as targets for therapeutic innovation. Adenylyl cyclases (ACs) are a group of enzymes that convert adenosine-5′-triphosphate (ATP) to cyclic adenosine 3′,5′ monophosphate (cAMP), a vital and ubiquitous signalling molecule in cellular responses to hormones and neurotransmitters. There are nine transmembrane (tmAC) forms, which have been widely studied; however, the tenth, soluble AC (sAC) is less extensively characterised. The eye is one of the most metabolically active sites in the body, where sAC has been found in abundance, making it a target for novel therapeutics and biomarking. In the cornea, AC plays a role in endothelial cell function, which is vital in maintaining stromal dehydration, and therefore, clarity. In the retina, AC has been implicated in axon cell growth and survival. As these cells are irreversibly damaged in glaucoma and injury, this molecule may provide focus for future therapies. Another potential area for glaucoma management is the source of aqueous humour production, the ciliary body, where AC has also been identified. Furthering the understanding of lacrimal gland function is vital in managing dry eye disease, a common and debilitating condition. sAC has been linked to tear production and could serve as a therapeutic target. Overall, ACs are an exciting area of study in ocular health, offering multiple avenues for future medical therapies and diagnostics. This review paper explores the diverse roles of ACs in the eye and their potential as targets for innovative treatments. [ABSTRACT FROM AUTHOR]

Background Coloboma (plural: colobomata) is derived from the Greek koloboma, meaning mutilated or curtailed. Iris coloboma may be typical or partial. Typical colobomas are caused by a failure of fetal fisure closure at the inferior nasal quadrant and are called as "keyhole" pupils. They may involve the iris, ciliary body, choroid, retina and optic nerve. Atypical colobomas are those found anywhere except at the inferior nasal quadrant and restricted to the iris. Colobomas are part of a continuum that includes microphthalmos and anophlamos. The visual acuity is affected when the coloboma involves the disc and fovea, or complicated by any occurrence of retinal detachment, choroidal neovascular membrane, cataract, ambylopia due to uncorrected refractive errors. Cataract surgery in these eyes can pose many challenges due to microphthalmia and hard cataracts, resulting in increased risk of intraoperative complications. Aim This study was done to evaluate the clinical outcome of cataract surgery in visually significant cataract patients with co-existing iris-coloboma. Methods This is a tertiary hospital-based prospective interventional study of 30 patients conducted over a period of one year. Best corrected visual acuity (BCVA), grade of cataract, intraoperative challenges and postoperative complications, postoperative BCVA at 1 week and 6 weeks were recorded. Results Out of 30 patients, 19 were males and 11 were females. The mean age of patients at surgery was 55 years with a mean BCVA of 6/60. Grade 3-4 nuclear sclerosis noted in 15% of cases and lens subluxation noted in 2% of cases. Manual small incision cataract surgery was done in all the cases. Primary IOL placement was successful in 66.6% of cases. Intraoperative complications noted were zonular dialysis, posterior capsular rent (PCR) and capsulorhexis extension. The mean postoperative BCVA at 1 week and 6 weeks was 6/24 and 6/18 respectively. Postoperative complications were raised intraocular pressure, corneal edema, IOL decentration and posterior capsular opacity. Conclusion Cataract surgery in iris-coloboma patients with visually significant cataract are challenging due to the interplay of various associated anatomical defects. Delayed surgery results in suboptimum outcomes, thus early surgery is advisable. [ABSTRACT FROM AUTHOR]

Purpose: The goal of this study was to compare the settings and effectiveness of the original P3 and revised P3 probes for micropulse transscleral cyclophotocoagulation. Methods: This retrospective cross sectional study includes a total of 56 patients with glaucoma who received micropulse transscleral cyclophotocoagulation. 32 patients received treatment with the original P3 probe and 24 received treatment with the revised P3 probe. Success was defined as a 20% reduction in intraocular pressure. Laser settings, pre-op and post-op intraocular pressures, and pre-op and post-op medications were assessed. Results: A 20% IOP reduction was achieved in 50% of patients in the original probe vs. 58.3% in the revised probe at one month (P = 0.536) and 71.9% vs. 50% at three months (P = 0.094), respectively. The revised P3 probe used higher values of power (2500 mW vs. 2023 mW, P < 0.0001), total duration (217 s vs. 179 s, P < 0.0001), and energy (170 J vs. 113 J, P < 0.001). There was a significant decrease in IOP lowering meds with the original probe at one month (-0.9 +/- 1.5 vs. -0.0 +/- 0.7, P = 0.010), but this was not seen at three months. Conclusions: There is no significant difference in IOP lowering effect between probes despite the revised probe using higher total energy. The original probe may be associated with fewer medications at 1 month, but not at 3 months. Further studies with longer follow up are needed to optimize the treatment parameters in order to maximize effectiveness while limiting side effects. [ABSTRACT FROM AUTHOR]

Introduction: This study investigates the relationship between ciliary muscle dynamics, thickness, and the regulation of intraocular pressure (IOP), focusing on the progression of cataracts and changes post-phacoemulsification. It explores how these factors impact canine ocular health, particularly in the context of cataract development and subsequent surgical intervention. Materials and methods: Data was collected using Ultrasound Biomicroscopy (UBM) from dogs at the Veterinary Medical Teaching Hospital of Chungbuk National University, Korea. The study involved 57 eyes from 35 dogs, categorized into five groups: 13 normal eyes, 14 with incipient cataracts, 12 with immature cataracts, 6 with mature cataracts, and 12 post-phacoemulsification. UBM measurements assessed various ciliary muscle parameters including ciliary body axial length (CBAXL), ciliary process-sclera angle (CPSA), longitudinal fibers of ciliary muscle thickness (Lf-CMT), and longitudinal and radial fibers of ciliary muscle thickness (LRf-CMT). Results: Findings indicated a decrease in CBAXL and an increase in Lf-CMT as cataracts progressed in severity. Post-phacoemulsification, there was a notable increase in CBAXL and a decrease in CPSA, Lf-CMT, and LRf-CMT, compared to both cataractous and normal eyes. Regression analysis revealed a significant positive association between CBAXL and IOP, alongside a negative association between Lf-CMT and IOP. These findings suggest that variations in ciliary muscle dynamics and thickness, as influenced by cataract progression and phacoemulsification, have distinct impacts on intraocular pressure. Discussion: The study proposes that phacoemulsification leads to ciliary muscle contraction, causing an inward and anterior movement of the ciliary muscle. This movement results in the narrowing of the ciliary cleft and constriction of the unconventional outflow pathway, potentially causing an increased risk of glaucoma post-surgery. Our research contributes to understanding the anatomical and physiological changes in the canine eye following cataract surgery and underscores the importance of monitoring IOP and ciliary muscle dynamics in these patients. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this review paper is to summarise surgical options available for repairing iris defects at the iris–lens plane, focusing on suturing techniques, iridodialysis repair, and prosthetic iris devices. Methods: A thorough literature search was conducted using multiple databases, including Medline, PubMed, Web of Science Core Collection, and the Cochrane Library, from inception to February 2024. Relevant studies were screened based on predefined criteria, and primary references cited in selected articles were also reviewed. Results: Various surgical techniques were identified for iris defect repair. Suturing methods such as interrupted full-thickness sutures and the McCannel technique offer solutions for smaller defects, while iridodialysis repair techniques address detachment of the iris from the ciliary body. Prosthetic iris devices, including iris–lens diaphragm devices, endocapsular capsular tension ring-based devices, and customizable artificial iris implants, provide options for larger defects, each with its own advantages and limitations. Conclusions: Successful iris reconstruction requires a personalised approach considering factors like defect size, ocular comorbidities, and patient preference. Surgeons must possess a thorough understanding of available techniques and prosthetic devices to achieve optimal outcomes in terms of both visual function and, nonetheless, cosmetic appearance. [ABSTRACT FROM AUTHOR]

One crucial component of the optical system is the ciliary body (CB). This body secretes the aqueous humour, which is essential to maintain the internal eye pressure as well as the clearness of the lens and cornea. The histological study was designed to provide the morphological differences of CB and iris in the anterior eye chambers of the following vertebrate classes: fish (grass carp), amphibians (Arabian toad), reptiles (semiaquatic turtle, fan‐footed gecko, ocellated skink, Egyptian spiny‐tailed lizard, Arabian horned viper), birds (common pigeon, common quail, common kestrel), and mammals (BALB/c mouse, rabbit, golden hamster, desert hedgehog, lesser Egyptian jerboa, Egyptian fruit bat). The results showed distinct morphological appearances of the CB and iris in each species, ranging from fish to mammals. The present comparative study concluded that the morphological structure of the CB and iris is the adaptation of species to either their lifestyle or survival in specific habitats. [ABSTRACT FROM AUTHOR]

A 15‐month‐old, grey, Thoroughbred filly presented for investigation of a 6‐week history of corneal oedema and blepharospasm on the right eye (OD). The filly was otherwise healthy. Following ophthalmic examination, glaucoma on the OD was diagnosed. A space occupying mass within the anterior chamber was documented on transpalpebral ultrasonographic examination. This mass obliterated most of the anterior intraocular structures on the peripheral nasal side (corneal endothelium and drainage angle), leading to secondary glaucoma. After systemic and topical treatment addressing secondary glaucoma, the corneal oedema reduced. The mass was visualised as an irregularly rounded brown structure associated with the iris on the peripheral nasal side of the anterior chamber. Given the filly's signalment, location and appearance of the mass, a tentative diagnosis of intraocular melanoma was made and enucleation was performed. Histopathological evaluation of the globe revealed solid sheets of heavily pigmented melanocytic cells, disrupting the normal ciliary body architecture and extending into the iris and subretinal. The cells were pleomorphic, polyhedral to round with occasional spindle‐shaped cells, and contained moderate to large amounts of granular black‐brown pigment (melanin). The iridal component expanded into the anterior chamber, with cells directly opposed to Descemet's membrane, with loss of the endothelium and expanding and occluding the filtration angle in this area. The lesion infiltrated locally into the edge of the sclera, but did not extend through the sclera, though occasional perivascular clusters of melanophages were observed within the scleral stroma adjacent to the optic nerve. Diagnosis of a uveal melanocytic neoplasm was confirmed, with characteristics similar to only one reported case. This is a unique case of a rapidly growing, invasive, uveal melanoma in a young horse. Intraocular melanoma should be considered as a differential diagnoses for glaucoma in grey horses, regardless of the age and absence of melanocytic skin lesions. [ABSTRACT FROM AUTHOR]

Purpose: We treated two patients with ciliary detachment due to an ab interno trabeculotomy. The ciliary detachment was improved by the use of sulfur hexafluoride (SF6) gas or octafluoro propane (C3F8) tamponade. Patients and Methods: Patient 1 was a 52-year-old Brazilian man with primary open angle glaucoma (POAG). His preoperative intraocular pressure (IOP) was 29 mmHg. Patient 2 was a 57-year-old Japanese woman with POAG. Her preoperative IOP was 35 mmHg. Both patients underwent an ab interno trabeculotomy with a microhook. They caused ciliary detachment as a postoperative complication. We could observe their ciliary detachment with anterior segment optical coherence tomography (AS-OCT). Hypotony persisted for 2 months and the patients' ciliary detachment had not improved. They each underwent a pars plana vitrectomy (PPV) with simultaneous 20% SF6 filling. Results: In Patient 1, the use of the SF6 gas tamponade successfully attached the ciliary body. His IOP was increased to 30 mmHg after this resolution of the ciliary detachment. He underwent additional tube shunt surgery. For Patient 2, the SF6 gas tamponade improved the ciliary detachment but the ciliary body could not be attached. We injected 0.6 cc of 100% C3F8 gas into the vitreous cavity, and this gas tamponade was able to attach the ciliary body. Conclusion: AS-OCT is very useful to evaluate ciliary detachment. PPV+Gas tamponade can be a treatment option for ciliary detachment. [ABSTRACT FROM AUTHOR]

Differentiation of iris and ciliary body lesions as benign or malignant and cystic or solid is important. The aim of this study was to compare anterior segment swept-source optical coherence tomography (AS SS-OCT) and ultrasound biomicroscopy (UBM) findings in iris and ciliary body tumors. Forty-two eyes of 38 cases with iris and ciliary body tumors imaged with UBM and AS SS-OCT between September 2018 and September 2023 were evaluated retrospectively. Of 42 eyes, 14 had melanoma, 14 iris pigment epithelial (IPE) cysts, 7 nevi, 3 Lisch nodules, 2 iris stromal cysts, 1 pars plana cysts, and 1 iris mammillations. An equivalent (100%) visualization of the anterior tumor margin was obtained with both techniques. Compared to AS SS-OCT, UBM was superior for posterior margin visualization in melanocytic tumors and IPE cysts. Bland-Altman plots demonstrated good agreement between UBM and AS SS-OCT for melanocytic tumors < 2.5 mm in base diameter and < 2 mm in thickness. Although, UBM is the gold standard for ciliary body and iridociliary tumors. AS SS-OCT should be considered as an excellent alternative to UBM, especially in minimally elevated iris lesions. [ABSTRACT FROM AUTHOR]

Purpose: To describe a pilot study on the use of single-session, high-dose-rate, Food and Drug Administration–cleared, yttrium-90 (Y90) plaque brachytherapy for iris and iridociliary melanoma. Design: A single-center, clinical case series. Participants: Six consecutive patients were included in this study. Each was diagnosed with an iris or iridociliary melanoma based on clinical examination with or without biopsy. Methods: Each tumor was staged according to the American Joint Committee on Cancer criteria and received Y90 eye plaque brachytherapy. The main variables were tumor size, patient age, sex, and method of diagnosis (clinical or biopsy). Surgical techniques, treatment durations, and ocular side effects were recorded. Local control was defined as a lack of tumor growth or regression determined by clinical examinations, including slit-lamp and gonio photography, as well as high-frequency ultrasound measurements. Toxicity parameters included acute and short-term corneal/scleral change, anterior segment inflammation, and cataract progression. Main Outcome Measures: Local and systemic cancer control, tumor regression, visual acuity, as well as radiation-related normal tissue toxicity. Results: High-dose-rate Y90 plaque brachytherapy was used to treat small (American Joint Committee on Cancer cT1) category melanomas. Single-surgery high-dose-rate irradiations were performed under anesthesia. Because of short treatment durations, high-dose-rate Y90 did not require the additional procedures used for low-dose-rate plaque (e.g., sutures, amniotic membrane epicorneal buffering, Gunderson flaps, and second surgeries for plaque removal). Only conjunctival recession was used to avoid normal tissue irradiation. High-dose-rate Y90 treatment durations averaged 8.8 minutes (median, 7.9; range, 5.8–12.9). High-dose-rate Y90 brachytherapy was associated with no periorbital, corneal (Descemet folds), or conjunctival edema. There was no acute or short-term anterior uveitis, secondary cataract, scleropathy, radiation retinopathy, maculopathy, or optic neuropathy. The follow-up was a mean of 16.0 (range 12–24) months. Evidence of local control included a lack of expansion of tumor borders (n = 6, 100%), darkening with or without atrophy of the tumor surface (n = 5/6, 83%), and a mean 24.5% reduction in ultrasonographically measured tumor thickness. There were no cases of metastatic disease. Conclusions: High-dose-rate Y90 brachytherapy allowed for single-surgery, minimally invasive, outpatient irradiation of iris and iridociliary melanomas. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

This article discusses a rare condition called Bilateral Acute Iris Transillumination (BAIT) syndrome, which is characterized by depigmentation of the iris, photophobia, conjunctival hyperemia, and pain. The majority of patients with BAIT report a previous respiratory illness treated with systemic antibiotics, particularly moxifloxacin. This case report describes a middle-aged woman who developed BAIT after a COVID-19 infection and oral moxifloxacin intake. The exact cause of BAIT is unclear, but it has been associated with viral illnesses, antibiotic use, and autoimmune hypersensitivity. Treatment typically involves corticosteroids and cycloplegic agents, and patients should be monitored for increased intraocular pressure. [Extracted from the article]

Abstract Background Ciliary body tumor is extremely rare and treatment is challenging. The aim of this study is to present our experience in treating this rare entity, especially large tumors with more than 5 clock hours of involvement, and to evaluate the surgical outcomes and complications of local resection via partial lamellar sclerouvectomy in four cases of ciliary body tumors in China. Methods Four patients with ciliary body tumors underwent partial lamellar sclerouvectomy between October 2019 and April 2023 in Shanghai General Hospital, China. Tumor features, histopathologic findings, complications, visual acuity, and surgical outcomes were reviewed at a mean follow-up of 20.8 months. Results Four patients with a mean age of 31.8 years were included in this study. The histopathological diagnosis was adenoma of non-pigmented ciliary epithelium (ANPCE), schwannoma, and multiple ciliary body pigment epithelial cysts. The mean largest tumor base diameter was 6.00 mm (range: 2.00–10.00) and the mean tumor thickness was 3.50 mm (range: 2.00–5.00). Preoperative complications included cataract in 3 (75%) eyes, lens dislocation in 2 (50%), and secondary glaucoma in 1 (25%). Temporary ocular hypotonia was observed in one case and no other postoperative complications were observed. At a mean follow-up of 20.8 months, the best corrected visual acuity increased in 3 eyes and was stable in 1 eye. Tumor recurrence was absent in all eyes. All patients were alive at the end of follow-up. Conclusions Local tumor resection via PLSU is useful in the treatment of ciliary body tumors, including large tumors occupying more than five clock hours of pars plicata. Surgery-related complications were manageable with adequate preoperative assessment and careful operation during surgery.

Abstract Intraocular pressure (IOP) plays a crucial role in glaucoma development, involving the dynamics of aqueous humor (AH). AH flows in from the ciliary body and exits through the trabecular meshwork (TM). IOP follows a circadian rhythm synchronized with the suprachiasmatic nucleus (SCN), the circadian pacemaker. The SCN resets peripheral clocks through sympathetic nerves or adrenal glucocorticoids (GCs). IOP's circadian rhythm is governed by circadian time signals, sympathetic noradrenaline (NE), and GCs, rather than the local clock. The activity of Na+/K+-ATPase in non-pigmented epithelial cells in the ciliary body can influence the nocturnal increase in IOP by enhancing AH inflow. Conversely, NE, not GCs, can regulate the IOP rhythm by suppressing TM macrophage phagocytosis and AH outflow. The activation of the β1-adrenergic receptor (AR)-mediated EPAC-SHIP1 signal through the ablation of phosphatidylinositol triphosphate may govern phagocytic cup formation. These findings could offer insights for better glaucoma management, such as chronotherapy.

ObjectiveTo analyze the genetic features of melanocytomas and melanomas of the anterior uvea and assess the value of molecular testing for diagnosis and prognostication.DesignRetrospective case-control study.SubjectsPatients with melanocytoma (n = 16) and melanoma (n = 19) of the anterior uvea.MethodsTargeted next-generation sequencing was performed on formalin-fixed, paraffin-embedded tumor tissue from anterior uveal melanocytic tumors and correlated with clinicopathologic features.Main outcome measuresPresence or absence of accompanying oncogenic alterations beyond GNAQ/GNA11 and their association with histologic features and local recurrence.ResultsHotspot missense mutations in GNAQ/GNA11 were identified in 91% (32/35) of all cases. None of the melanocytomas with or without atypia demonstrated chromosomal imbalances or additional oncogenic variants beyond GNAQ mutation, and none recurred over a median follow-up of 36 months. Additional alterations identified in a subset of melanomas include mutations in BAP1 (n = 3), EIF1AX (n = 4), SRSF2 (n = 1), PTEN (n = 1), and EP300 (n = 1); monosomy 3p (n = 6); trisomy 6p (n = 3); trisomy 8q (n = 2); and an ultraviolet mutational signature (n = 5). Local recurrences were limited to melanomas, all of which demonstrated oncogenic alterations in addition to GNAQ/GNA11 (n = 5). A single melanoma harboring GNAQ and BAP1 mutations and monosomy 3 was the only tumor that metastasized.ConclusionsIn this study, anterior segment uveal melanocytomas did not display oncogenic alterations beyond GNAQ/GNA11. Therefore, they are genetically similar to uveal nevi rather than uveal melanoma based on their molecular features known from the literature. Molecular testing can be performed on borderline cases to aid risk stratification and clinical management decisions.

Background: Ciliary body tumor is extremely rare and treatment is challenging. The aim of this study is to present our experience in treating this rare entity, especially large tumors with more than 5 clock hours of involvement, and to evaluate the surgical outcomes and complications of local resection via partial lamellar sclerouvectomy in four cases of ciliary body tumors in China. Methods: Four patients with ciliary body tumors underwent partial lamellar sclerouvectomy between October 2019 and April 2023 in Shanghai General Hospital, China. Tumor features, histopathologic findings, complications, visual acuity, and surgical outcomes were reviewed at a mean follow-up of 20.8 months. Results: Four patients with a mean age of 31.8 years were included in this study. The histopathological diagnosis was adenoma of non-pigmented ciliary epithelium (ANPCE), schwannoma, and multiple ciliary body pigment epithelial cysts. The mean largest tumor base diameter was 6.00 mm (range: 2.00–10.00) and the mean tumor thickness was 3.50 mm (range: 2.00–5.00). Preoperative complications included cataract in 3 (75%) eyes, lens dislocation in 2 (50%), and secondary glaucoma in 1 (25%). Temporary ocular hypotonia was observed in one case and no other postoperative complications were observed. At a mean follow-up of 20.8 months, the best corrected visual acuity increased in 3 eyes and was stable in 1 eye. Tumor recurrence was absent in all eyes. All patients were alive at the end of follow-up. Conclusions: Local tumor resection via PLSU is useful in the treatment of ciliary body tumors, including large tumors occupying more than five clock hours of pars plicata. Surgery-related complications were manageable with adequate preoperative assessment and careful operation during surgery. Key messages: What is known 1. Ciliary body tumor is a rare intraocular tumor that is difficult to detect and determine the malignancy, sometimes leading to overdiagnosis and overtreatment such as eyeball enucleation. 2. Partial lamellar sclerouvectomy (PLSU) is used as a local resection method for iridociliary tumors but surgical procedure is challenging and limited by tumor size. What this paper adds 1. PLSU can also be used in the treatment of large iridociliary tumors occupying more than five clock hours of pars plicata. 2. Surgery-related complications were manageable with adequate preoperative assessment and careful operation during surgery. [ABSTRACT FROM AUTHOR]

Background: Ocular foreign bodies (OFBs) are a relatively common occurrence in ocular injuries, and a severe risk factor for vision disorders. They are notoriously challenging to identify and localize precisely to allow surgical removal, even with the most recent technological advancements. Purpose: To compare the efficiency of different imaging methods in detecting and localizing OFBs. Methods: We conducted a retrospective analysis of the medical records of patients with OFBs, detected by ultrasound biomicroscopy (UBM) and confirmed during surgery. Patients who presented to our medical center between January 2016 and January 2022 and also underwent computed tomography (CT), X ray, and/or ocular B‐scan ultrasonography (B‐scans) were selected. Results: This study included 134 patients with a history of ocular trauma and OFBs (mean age: 47.25 years, range: 8–78). The mean time interval from injury to UBM examination was 36.31 months (range: 0.2–120 months). Most OFBs were metallic (51.82%) or plant‐based (25.37%); 22.39% of them were located in the sclera, 26.87% in the anterior chamber, and 23.88% in the ciliary body and iris. OFBs ranged in size from 0.10 to 6.67 mm (mean: 1.15 ± 1.10 mm). B‐scans identified OFBs in 37 of the 119 patients examined (31.09%); CT in 52 of 84 patients (61.90%); and radiography in 29 of 50 patients (58.00%). Univariate and multivariate analyses determined that both CT and radiography showed low detection rates for plant‐based versus non‐plant‐based OFBs (CT: p < 0.001; radiography: p = 0.007), small particles (<1.00 mm vs. >1.00 mm; CT: p = 0.001, radiography: p = 0.024), and with eyeball wall locations (vs. intraocular; CT: p < 0.001, radiography: p = 0.021). Similarly, B‐scans were less efficient for plant‐based and eyeball wall‐located OFBs (both p = 0.001), whereas the difference based on dimensions was not significant (p = 0.118). Conclusions: CT, radiography, and B‐scans showed lower detection rates for plant‐based, small, and eyeball wall‐located OFBs. Our findings strongly suggest that UBM could be a more adequate imaging modality when such OFBs are suspected. [ABSTRACT FROM AUTHOR]

This article provides a guide to repairing traumatic cyclodialysis clefts, which occur when the ciliary muscle fibers detach from the scleral spur. The detachment can lead to complications and vision loss. Diagnosis can be made through careful examination and imaging modalities. Treatment options include medical therapy, laser treatment, and surgical repair. The article discusses different surgical techniques, postoperative outcomes, and potential complications. The document is a list of references for further research on cyclodialysis cleft. [Extracted from the article]

The current, 8th edition of the American Joint Committee on Cancer (AJCC) anatomic classification and staging model for uveal melanoma does not fully separate survival estimates for patients with advanced stages of the disease (e.g., IIIB and IIIC). Furthermore, some tumors in higher size categories have a smaller volume than tumors in lower categories. Therefore, we developed a novel model for prognostication of metastatic mortality based on estimations of tumor volume. Retrospective, multicenter case series of patients with uveal melanoma involving the choroid, ciliary body, or both. Six thousand five hundred twenty-eight consecutively registered patients treated at 3 tertiary ocular oncology centers on 2 continents between 1981 and 2022. Data on survival, tumor size, and extent were collected for all 6528 patients. Tumor volume was estimated using a simple equation based on largest basal diameter and thickness. Volume-based size categories and stages were developed and validated in independent patient cohorts using competing risk analyses, and correlations with cytogenetic and cytomorphologic features were examined. Cumulative incidence of metastatic death. The 6528 patients were distributed over 7 stages based on estimated tumor volume and anatomic extent (V stages IA, IB, IIA, IIB, IIIA, IIIB, and IIIC), with a 15-year incidence of metastatic death ranging from 7% to 77%. A new category, V1 min , and corresponding stage IA, were introduced, indicating an excellent prognosis. Metastatic mortality in V stage IIIC was significantly higher than that in V stage IIIB (P = 0.03), whereas incidence curves crossed for patients in AJCC stages IIIC vs. IIIB (P = 0.53). Univariable and multivariable competing risk regressions demonstrated higher Wald statistics for V stages compared with AJCC stages (1152 vs. 1038 and 71 vs. 17, respectively). The frequency of monosomy 3, gain of chromosome 8q, and epithelioid cytomorphologic features increased with tumor volume (R 2 = 0.70, R 2 = 0.50, and R 2 = 0.71, respectively; P < 0.001) and showed similar correlations with both AJCC and V stages. Anatomic classification and staging of ciliary body and choroidal melanomas based on estimation of tumor volume improves prognostication of metastatic mortality. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. [ABSTRACT FROM AUTHOR]

Uveal melanoma (UM) is a neuroectodermal tumor that results from malignant transformation of melanocytes in the eye uvea, including the iris, the ciliary body, and the choroid. UM accounts for 5% of all melanoma cases and is extremely aggressive with half of the UM patients developing metastases within the first 1‒2 years after tumor development. Molecular mechanisms of UM carcinogenesis are poorly understood, but are known to differ from those of skin melanoma. Activating mutations of the GNAQ and GNA11 genes, which code for the large G protein subunits Gq and G11, respectively, are found in 90% of UM patients. The Gaq/PKC/MAPK signaling pathway is a main signaling cascade that leads to the transformation of melanocytes of the uveal tract, and major regulators of the cascade provide targets for the development of drugs. Metastatic UM (MUM) is most often associated with mutations of BAP1, EIF1AX, GNA11, GNAQ, and SF3B1. A combination of a commercial expression test panel of 15 genes and a mutation panel of 7 genes, supplemented with data on the size of the primary tumor, is highly efficient in predicting the risk of metastasis. The risk of metastasis determines the choice of therapy and the patient follow-up regimen. However, no systemic therapy for MUM has been developed to date. New drugs undergoing clinical trials are mostly targeted drugs designed to inhibit the protein products of mutant genes or immunotherapeutic agents designed to stimulate the immune response against specific antigens. In addition to these approaches, potential therapeutic targets of epigenetic regulation of UM development are considered in the review. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the anterior segment structures using ultrasound biomicroscopy (UBM) in primary congenital glaucoma (PCG) and explore their correlation with disease severity and surgical outcomes. Methods: Clinical information of PCG patients who underwent UBM prior to their first glaucoma surgeries from September 2014 to March 2021 were reviewed. The study included 214 UBM images of 154 PCG eyes and 60 fellow unaffected eyes. Anterior segment characteristics were analyzed. UBM parameters, including the iris thickness (IT) at variant distances from the pupil edge and iris root, anterior chamber depth (ACD), and pupil diameter (PD), were compared between two groups and their relationship with clinical factors and surgical outcomes were analyzed in PCG eyes. Results: PCG eyes had unclear scleral spur, thin iris, wide anterior chamber angle, deep anterior chamber, rarefied ciliary body, elongated ciliary processes, and abnormal anterior iris insertion. ITs were thinner, ACD was deeper, and PD was larger in PCG eyes than fellow unaffected eyes (all P < 0.001). In PCG eyes, thinner ITs correlated with bilateral involvement and earlier age at presentation, and larger PD correlated with earlier age at presentation (P = 0.030) and higher intraocular pressure (P < 0.001). Thinner IT2 (P = 0.046) and larger PD (P = 0.049) were identified as risk factors for surgical failure. Conclusion: UBM is a powerful technique to exam anterior segment structures in PCG. The anatomical features are associated with disease severity and surgical outcomes, providing essential clinical insights. [ABSTRACT FROM AUTHOR]

The escalating global prevalence of diabetes mellitus (DM) over the past two decades has led to a persistent high incidence of diabetic retinopathy (DR), necessitating screening for early symptoms and proper treatment. Effective management of DR aims to decrease vision impairment by controlling modifiable risk factors including hypertension, obesity, and dyslipidemia. Moreover, systemic medications and plant-based therapy show promise in advancing DR treatment. One of the key mechanisms related to DR pathogenesis is the polyol pathway, through which aldose reductase (AR) catalyzes the conversion of glucose to sorbitol within various tissues, including the retina, lens, ciliary body and iris. Elevated glucose levels activate AR, leading to osmotic stress, advanced glycation end-product formation, and oxidative damage. This further implies chronic inflammation, vascular permeability, and angiogenesis. Our comprehensive narrative review describes the therapeutic potential of aldose reductase inhibitors in treating DR, where both synthetic and natural inhibitors have been studied in recent decades. Our synthesis aims to guide future research and clinical interventions in DR management. [ABSTRACT FROM AUTHOR]

Recent advancements in the field of endothelial markers of lymphatic vessels and lymphangiogenic factors have shed light on the association between several ocular diseases and ocular nascent lymphatic vessels. The immune privilege of corneal tissue typically limits the formation of lymphatic vessels in a healthy eye. However, vessels in the eyes can potentially undergo lymphangiogenesis and be conditionally activated. It is evident that nascent lymphatic vessels in the eyes contribute to various ocular pathologies. Conversely, lymphatic vessels are present in the corneal limbus, ciliary body, lacrimal glands, optic nerve sheaths, and extraocular muscles, while a lymphatic vasculature-like systemexists in the choroid, that can potentially cause several ocular pathologies. Moreover, numerous studies indicate that many ocular diseases can influence or activate nascent lymphatic vessels, ultimately affecting patient prognosis. By understanding the mechanisms underlying the onset, development, and regression of ocular nascent lymphatic vessels, as well as exploring related research on ocular diseases, this article aims to offer novel perspectives for the treatment of such conditions. [ABSTRACT FROM AUTHOR]

Purpose: To examine the risk factors for haptic malposition in eyes with implantable collamer lens (ICL). Setting: Eye and ENT Hospital, Fudan University, Shanghai, China. Design: Prospective nonrandomized observational study. Methods: This study included 134 (77.9%) of 172 initially enrolled patients who underwent ICL implantation and completed a 1-year follow-up. The extent of haptics present in the ciliary sulcus (ICS) was measured. Patients were categorized based on ICS count (0 to 4). The position of the haptics was quantified as the distance between the iris root and the terminal tip of ICL haptics (iris root to haptic tip, IRH). The related factors to the ICS count and its correlation with the central vault were analyzed. Results: ICS distribution was 0 ICS in 19 eyes (14.2%), 1 in 22 eyes (16.4%), 2 in 32 eyes (23.9%), 3 in 29 eyes (21.6%), and 4 in 32 eyes (23.9%). Parameters like maximum ciliary body thickness (CBTmax, P = .008), iris--ciliary process distance (ICPD, P < .001), and ciliary process length (P = .034) varied significantly across ICS groups. A multiple linear regression analysis revealed that the iris--ciliary angle (P = .006), CBTmax (P = .007), the distance between the sulcus-to-sulcus plane and the anterior crystalline lens surface (STSL, P = .035), and ICL size (P = .015) were significantly associated with IRH. Spherical equivalents (P = .042), STSL (P = .001), and ICS count (P = .020) significantly correlated with the central vault. Conclusions: Shortened ciliary process is a primary risk for haptic malposition. The ICS count significantly relates to the central vault. [ABSTRACT FROM AUTHOR]

Ultrasound biomicroscopy (UBM) is an invaluable investigation for imaging anterior segment structures. Although it is operator‐dependent and time consuming, unlike optical‐based imaging techniques, it is able to image structures posterior to the iris, such as the zonules, ciliary body and part of the pars plana. It is especially useful in advanced cataracts, traumatic cataracts, subluxed lenses, posterior polar cataracts, and congenital and developmental anomalies affecting the anterior segment. It provides diagnostic information in eyes with complex cataracts or intraocular lens (IOL)‐related pathology, and aids in surgical planning in order to minimise complications. In this review, we describe the UBM features of various lenticular pathologies and demonstrate its application in the diagnosis and surgical management of lens and IOL‐related pathologies. [ABSTRACT FROM AUTHOR]

Adult stem cells, present in various parts of the human body, are undifferentiated cells that can proliferate and differentiate to replace dying cells within tissues. Stem cells have specifically been identified in the cornea, trabecular meshwork, crystalline lens, iris, ciliary body, retina, choroid, sclera, conjunctiva, eyelid, lacrimal gland, and orbital fat. The identification of ocular stem cells broadens the potential therapeutic strategies for untreatable eye diseases. Currently, stem cell transplantation for corneal and conjunctival diseases remains the most common stem cell‐based therapy in ocular clinical management. Lens epithelial stem cells have been applied in the treatment of paediatric cataracts. Several early‐phase clinical trials for corneal and retinal regeneration using ocular stem cells are also underway. Extensive preclinical studies using ocular stem cells have been conducted, showing encouraging outcomes. Ocular stem cells currently demonstrate great promise in potential treatments of eye diseases. In this review, we focus on the identification, characterisation, and therapeutic application of adult stem cells in the eye. [ABSTRACT FROM AUTHOR]

Parasitic nematodes are globally important and place a heavy disease burden on infected humans, crops, and livestock, while commonly administered anthelmintics used for treatment are being rendered ineffective by increasing levels of resistance. It has recently been shown in the model nematode Caenorhabditis elegans that the sensory cilia of the amphid neurons play an important role in resistance toward macrocyclic lactones such as ivermectin (an avermectin) and moxidectin (a milbemycin) either through reduced uptake or intertissue signaling pathways. This study interrogated the extent to which ciliary defects relate to macrocyclic lactone resistance and dye-filling defects using a combination of forward genetics and targeted resistance screening approaches and confirmed the importance of intraflagellar transport in this process. This approach also identified the protein trafficking pathways used by the downstream effectors and the components of the ciliary basal body that are required for effector entry into these nonmotile structures. In total, 24 novel C. elegans anthelmintic survival-associated genes were identified in this study. When combined with previously known resistance genes, there are now 46 resistance-associated genes that are directly involved in amphid, cilia, and intraflagellar transport function. [ABSTRACT FROM AUTHOR]

Introduction: Melanoma is a dangerous malignancy primarily involving the choroid, ciliary body, or iris. The most frequent primary intraocular malignant tumor is choroidal melanoma. The tumor most often affects Caucasians of Northern Europe ranging between the ages of 50 and 80. Most choroidal melanomas are pigmented, however, non-pigmented or mixed pigmented and non-pigmented forms can also happen. Compared with other amelanotic choroidal lesions, amelanotic choroidal melanoma showed markedly greater basal diameter, thickness, frequent connection with subretinal fluid, and ultrasonic hollowness. Extrascleral extension is currently detected in 10% to 28% of choroidal melanoma patients, and the mortality rate is much greater than in those without the extension. Case Presentation: We reported a rare case of extraocular extension in a 51-year-old female patient with amelanotic melanoma. The primary complaint was a painful and bleeding mass on her left eye that had developed two months prior to admission. On the conjunctiva of the left eye, there was a solid, palpable mass measuring 4 x 3.5 x 1 cm. It was red, well-defined, and had a hard, solid consistency. It was fixed at the base, had minimal bleeding, and pressed on her eyeball from the inferolateral direction. The cornea appears clear, and there is no light perception in visual acuity. The orbital focus computed tomography scan revealed an Enhancing solid mass containing a fat component. The mass was in the left intraocular, extending from intraconal to extraconal. Conclusions: Amelanotic melanoma with extraocular extension is a rare condition that can be difficult to detect due to its unclear clinical symptoms and wide range of possible causes. Patients and their families must be educated to receive the appropriate first therapy and prevent the illness from worsening. Melanoma management depends on several factors: tumor size, location, related characteristics, opposite eye status, systemic status, and patient preference. Orbital exenteration is one of the management options for choroidal melanoma with significant extraocular extension. By the time ocular treatment begins, the patient's survival may already be predetermined, and this realization could impact how uveal melanoma is treated in the years to come. [ABSTRACT FROM AUTHOR]

Intraocular pressure (IOP) plays a crucial role in glaucoma development, involving the dynamics of aqueous humor (AH). AH flows in from the ciliary body and exits through the trabecular meshwork (TM). IOP follows a circadian rhythm synchronized with the suprachiasmatic nucleus (SCN), the circadian pacemaker. The SCN resets peripheral clocks through sympathetic nerves or adrenal glucocorticoids (GCs). IOP's circadian rhythm is governed by circadian time signals, sympathetic noradrenaline (NE), and GCs, rather than the local clock. The activity of Na+/K+-ATPase in non-pigmented epithelial cells in the ciliary body can influence the nocturnal increase in IOP by enhancing AH inflow. Conversely, NE, not GCs, can regulate the IOP rhythm by suppressing TM macrophage phagocytosis and AH outflow. The activation of the β1-adrenergic receptor (AR)-mediated EPAC-SHIP1 signal through the ablation of phosphatidylinositol triphosphate may govern phagocytic cup formation. These findings could offer insights for better glaucoma management, such as chronotherapy. [ABSTRACT FROM AUTHOR]

Background: To assess the characteristics and outcomes of uveal melanoma management at a tertiary center in the Middle East. Methods: A study on 164 patients with uveal melanoma was conducted by reviewing the available medical records, ultrasound, and pathology report results. Age at diagnosis, tumor location and size, treatment mode, visual outcome, metastasis, mortality, and survival were studied. Results: The mean age of patients was 52.0 ± 15.0 years, and 52.5% were male. Choroidal melanoma was the most common uveal melanoma, followed by the ciliary body and iris melanoma. The mean thickness of tumors was 8.29 ± 3.29. The majority of patients (n = 111, 67.9%) were managed by brachytherapy with ruthenium-106 plaques. Enucleation was performed primarily in 46 (28%) patients and secondarily in nine (5.5%) patients. The sexual disparity was detected as the proximity of uveal melanoma to the fovea in males. For a 61-month mean follow-up period, mortality occurred in eight of our cases, six of which were due to metastasis. The most common site for distance metastasis was the liver (5/6), followed by the lung (1/6). The five-year and eight-year overall survival (OS) rate was 0.947%± 0.019. The 5-year survival rate reached zero in metastatic patients. OS was not statistically different depending on the age, tumor diameters, the primary treatment received, or the histopathologic findings (p > 0.50 for all). Conclusion: In this study, individuals diagnosed with UM exhibited an OS rate of around 94% at the five-year mark, which remained consistent up to eight years. Notably, the presence of distance metastasis emerged as the sole statistically significant factor influencing overall survival. [ABSTRACT FROM AUTHOR]

Background: Micropulse transscleral cyclophotocoagulation is a non-invasive, widely employed procedure that uses diode laser to target the ciliary body to lower the intraocular pressure. Despite its acknowledged efficacy, certain complications are recognized, with neurotrophic keratopathy being a rare yet serious consequence. This report seeks to shed light on a potential high-risk subgroup susceptible to neurotrophic keratopathy, exemplified by our patient with Marfan syndrome, a condition characterized by thin sclera. Case Report: Our patient, who was confirmed to have Marfan syndrome with pseudophakic glaucoma, underwent micropulse transscleral cyclophotocoagulation due to high intraocular pressure bilaterally and subsequently quickly manifested neurotrophic keratopathy in both eyes postoperatively. Swift initiation of management involved a comprehensive approach, including topical antibiotics, preservative-free lubrication, medroxyprogesterone acetate 1%, serum balanced salt solution (BSS) 50%, and the application of bandage contact lenses to expedite healing. Fortunately, the left eye demonstrated resolution within 10 days, while the right eye exhibited delayed healing, leading to subsequent scarring. Conclusions: This report highlights the critical importance of recognizing populations predisposed to neurotrophic keratopathy before subjecting them to micropulse transscleral cyclophotocoagulation. Such awareness allows for the fine-tuning of procedural parameters, offering a strategic approach to mitigate the risk of neurotrophic keratopathy development. By further exploring and recognizing potential risk factors, clinicians can enhance patient outcomes and refine the safety profile of micropulse transscleral cyclophotocoagulation. [ABSTRACT FROM AUTHOR]