Slit-lamp Research Articles

Visual and anatomical outcomes following vitrectomy with subretinal tPA injection in patients with submacular haemorrhages secondary to wet AMD

Purpose: Submacular haemorrhages (SMHs) are most commonly associated with wet age-related macular degeneration (AMD) and their size and duration are strong prognostic factors for visual outcome. The aim of this audit was to evaluate outcomes of direct injection of submacular tissue plasminogen activator (t-PA) into these lesions during pars plana vitrectomy (PPV). Methods: All patients presenting to the Mater Misericordiae Hospital from January 2017 to December 2019 with large SMHs secondary to wet AMD who underwent this treatment were included for review. All ten patients underwent complete PPV, injection of 0.2ml (50µg) subretinal t-PA and air tamponade. Pre-operative and post-operative evaluations included visual acuity testing (VA), optical coherence tomography (OCT) and slit lamp examination. Results: Eight patients (80%) showed improvement of their VA, with 4 patients achieving a VA of ≤0.4 LogMAR (20/50). Six patients had a total clearing of the macular haemorrhage, with a further 2 having sub-total clearance. One patient subsequently developed a retinal detachment requiring oil tamponade. Conclusions: SMH secondary to wet AMD is a sight threatening event with a varied prognosis but in most cases, vitrectomy with subretinal t-PA injection results in improved anatomical and visual outcomes.

Prevention of Argentinian flag sign in intumescent cataracts using anterior chamber air bubble and cortical fluid release techniques

BackgroundTo investigate the efficiency of a new method for the prevention of argentinian flag sign during the process of continuous, circular, and centered anterior capsulotomy (CCC) on the anterior capsule in cortically liquefied intumescent cataracts. This study was registered in an appropriate registry and the registration number of registration was xyy11[2022]-XJSFX-087; The date of of registration was 2022-04-29.MethodsPreoperative examinations including slit-lamp examination, ocular A-scan ultrasonography, and Ultrasound Biomicroscopy (UBM) UBM were conducted on 61 patients with intumescent cataracts. Cases with cortically liquefied intumescent cataracts were selected and after staining with indocyanine green, the anterior chamber air bubble technique was used to compress the anterior capsule, and liquefied cortex was aspirated using a puncture needle. Corrected Distance Visual Acuity (CDVA) and intraocular pressure were recorded on postoperative days 1, 1 week, 1 month, and 6 months. Intraoperative and postoperative complications were documented and analyzed.ResultsFifty eyes were identified as having cortically liquefied intumescent cataracts. No cases of the Argentinian flag sign occurred, and standard capsulorrhexis was achieved, facilitating smooth phacoemulsification. All patients achieved satisfactory outcomes at follow-ups of 1 day, 1 week, 1 month, and 6 months postoperatively. Mild corneal edema was observed in three cases on the first postoperative day, with no other complications noted.ConclusionsThe anterior chamber air bubble technique combined with cortical fluid release technique can prevent the occurrence of the Argentinian flag sign in cortically liquefied intumescent cataracts, this method is simple, convenient and economic for the clinical promotion.

Performing minor glaucoma interventions on the slit lamp

Background: Complications are frequently encountered after glaucoma surgeries, for which timely intervention is necessary. Many of these interventions, like bleb needling, tube repositioning, anterior chamber (AC) reformation, paracentesis, and hyphema drainage, are fairly simple, but can often be vision saving. However, waiting for operation theater availability for these minor procedures can be a risky decision. Hence, techniques for performing these procedures on a slit lamp should be part of every glaucoma surgeon’s armamentarium. Purpose: This video is meant to introduce the viewers to simple techniques for performing minor procedures, enabling management on a slit lamp. The need to know a simple yet effective way to perform these procedures cannot be overemphasized. Synopsis: This video demonstrates, in the specified order, techniques for AC paracentesis, AC reformation, Ahmed glaucoma valve tube repositioning, iris repositioning, bleb needling and hyphema drainage. Utmost aseptic precautions must be taken before performing these procedures on the slit lamp, especially in cases where the 26G needle enters AC. This includes the use of a sterile air filter, donning sterilized gloves, and using its sterile wrapper to place the 2 ml syringe being used. Use of betadine eye drops before the procedure and a week-long course of topical antibiotics after these procedures is recommended. Highlights: This video demonstrates simple techniques for performing useful procedures on the slit lamp, an effective tool for managing postoperative complications. Video link: https://youtu.be/35sOVm7rxEc

Comparison of optimized surface ablation and combined customized plus optimized surface ablation in myopic eyes

Background Proscan treats errors of refraction without affecting asphericity, while customized treatment treats correction with high-order aberration (HOA). Recently, Zyoptix HD has been used in the treatment of preoperative HOA and lower-order aberrations without inducing spherical aberrations. Aim To compare the visual outcomes and HOAs after optimized surface ablation versus Zyoptix HD surface ablation for myopia. Patients and methods A prospective comparative clinically controlled study was conducted on patients who have myopia, 40 eyes of 20 patients divided into two groups. Group I: 20 eyes underwent optimized surface ablation. Group II: 20 eyes underwent customized plus optimized surface ablation. The selection of treatment was according to root mean square and spherical aberration corneal topography. All participants were examined by a slit lamp just after the operation, on the first, third, seventh postoperative day, weekly for 1 month, then biweekly for 3 months. The patients had full follow-up by best corrected visual acuity, slit lamp, Orbscan IIZ, and wavefront aberrometry using Zywave after 3 months of procedure. Results The comparison between preoperative uncorrected visual acuity and 3 months postoperative uncorrected visual acuity improved significantly in both groups but better in group II. The comparison between preoperative and 3 months postoperative root mean square in group I increased significantly, and in group II improved significantly, which is better in group II. Conclusion Zyoptix HD is superior to optimized surface ablation in the correction of low-order and high-order eye aberrations, correcting myopia and visual acuity.

Comparison of Efficacy and Safety of Slow Coagulation Transscleral versus Micropulse Cyclophotocoagulation in Refractory Glaucoma

Background Cyclodestructive laser technology has been developed with the aim of achieving a greater reduction in Intraocular Pressure (IOP) with minimal complication. Micropulse transscleral cyclophotocoagulation (MP-TSCPC) and slow-coagulation continuous-wave transscleral cyclophotocoagulation (SC-TSCPC) are considered to have less complications than conventional techniques using continuous-wave transscleral cyclophotocoagulation. Purpose To compare IOP reduction and complications in refractory glaucoma after SC-TSCPC and MP-TSCPC procedures. Methods This study is a prospective interventional study in refractory glaucoma patients. Measurement of IOP using Goldmann applanation tonometry was performed preoperatively, and all patients were monitored at days 1, 7, and 30 in the postoperative period. Success was defined as postoperative IOP reduction of > 20% from baseline with or without glaucoma medication. Complications were identified by evaluating subjective complaints and slit lamp examination. Results The study included a total of 66 eyes, with 33 eyes in each group. Baseline IOP was 50.58 ± 9.937 mmHg and 48.45 ± 12.792 mmHg in SC-TSCPC and MP-TSCPC group, respectively. The mean IOP reduction was 27.44 ± 19.96% vs 14.39 ± 23.52% (p=0.018) in day 1, 46.19 ± 27, 7 3% vs 45.83 ± 24,80% (p=0,956) in day 7 and 46.49 ± 24.63% vs 27.09 ± 23.86% in day 30 (p=0.002), in SC-TSCPC and MP-TSCPC group respectively. Complications between groups were not significantly different. However, hypotonia (IOP < 6 mmHg) was found in the SC-TSCPC group. Conclusion SC-TSCPC showed greater IOP reduction than MP-TSCPC, with no significant differences in complications between the two groups.

Bilateral electricity-induced cataract with dissimilar morphology in a young electrician

This report documents a rare case of bilateral electricity-induced cataracts presenting with dissimilar morphology in each eye following an electrocution incident, underscoring the significance of recognizing electrical injury as a causative factor for varied cataract presentations. A 22-year-old electrician experienced decreased vision in his left eye 11 months post electrocution. A comprehensive ophthalmic evaluation, including best-corrected visual acuity (BCVA), slit-lamp examination, and ultrasonography, was conducted to assess the cataracts’ morphological characteristics. Uniquely, the patient presented with a posterior subcapsular cataract in the right eye and a milky white cataract with snowflake-like anterior subcapsular opacifications in the left eye, confirming the diagnosis of bilateral electricity-induced cataracts with dissimilar morphology. This case highlights the critical need for an exhaustive ophthalmological assessment in electrocution victims, facilitating the early detection and management of varied ocular complications, including diverse cataract morphologies.

Role of Anterior Segment Optical Coherence Tomography in Staging and Evaluation of Treatment Response in Infectious Keratitis.

The aim of this study was to evaluate the role of anterior segment optical coherence tomography during follow-up of infectious keratitis and to assess response to treatment. This was a prospective, consecutive, observational clinical series of cases. Twenty-three eyes of 23 patients with clinically proven fungal keratitis were included in the study. The patients received medical treatment according to clinical diagnosis, and follow-up was performed weekly. Slit-lamp examination and photography, and anterior segment optical coherence tomography were performed at initial and follow-up visits until corneal healing occurred. The main outcome measures included infiltrate depth, width, and density; central corneal thickness; minimal corneal thickness; corneal thickness at the site of the lesion; and stromal thickness at the center of the lesion. Twenty-three eyes of 23 patients (17 men and 6 women), mean age 42.5 ± 19 (8-66) years, were clinically diagnosed with fungal keratitis. Localization was central in 14 cases and paracentral/peripheral in 9 cases. Healing time was 6 to 12 weeks. Minimal corneal thickness, corneal thickness at the site of lesion, and stromal thickness at the center of lesion, and also infiltrate width and depth changed significantly from the first visit to the healing stage at the last follow-up (0.009, 0.001, 0.007, 0.001, and <0.001, respectively). In cases of fungal keratitis, anterior segment optical coherence tomography can provide the clinician with a quantitative assessment of a number of corneal parameters that can be used to determine effectiveness of therapy and confirm complete healing of the lesions that cannot be achieved by clinical evaluation.

Correlation between the Ocular Surface Disease Index and dry eye functional parameters measured with the OCULUS Keratograph 5M in a Hispanic population

Abstract Background: The evaluation of dry eye disease (DED) and the ocular surface can be approached from patient-centered questionnaires, clinical scales using the slit-lamp microscope, and more recently innovative ophthalmological devices that allow for noninvasive tests. The OCULUS Keratograph 5M (K5M) is a device that allows for noninvasive measurement of ocular surface parameters. Materials and Methods: The present article is a retrospective and observational study detailing the correlation of the OCULUS K5M surface parameters and the Ocular Surface Disease Index (OSDI) score. Patients of any gender and age attending a cornea and refractive surgery practice in an academic center underwent a full ophthalmological examination and tear meniscus height, tear breakup time, bulbar redness, meibography, and OSDI score measurement through the K5M. Results: One hundred and sixty-four eyes of 82 patients were included. The sample showed a female preponderance (78%) and a mean age of 49.45 years. When comparing the OSDI score with ocular surface parameters, a weak negative correlation was found with the tear meniscus height (Pearson coefficient: [ −0.229, P = 0.003]). There were no other statistically significant correlations between the K5M and the OSDI score. In addition, the meibomian gland dropout was significantly associated with increasing age, whereas conjunctivochalasis was associated with the female gender, increasing age and increasing OSDI score. Conclusions: The subjective symptoms of DED measured with OSDI score correlate only with tear meniscus height measured by the K5M in a Hispanic population. The detection of symptomatic DED patients through the K5M is incomplete in this population.

Substance P- and Insulin-like Growth Factor 1-derived Tetrapeptides for Neurotrophic Keratopathy Related to Leprosy: A Clinical Trial

PurposeNeurotrophic keratopathy is part of the leprosy sequelae and causes progressive deterioration of visual acuity. Although leprosy is bacteriologically curable, there is currently no efficient treatment. Eye drops containing tetrapeptides, Phenylalanine-Glycine-Leucine-Methionine-amide (FGLM-NH2) and Serine-Serine-Serine-Arginine (SSSR), derived from substance P and insulin-like growth factor 1 (IGF-1), are clinically efficacious in the treatment of corneal epithelial disorders caused by neurotrophic keratopathy. To further investigate the effect of this treatment on leprosy sequalae, we evaluated the clinical efficacy of FGLM-NH2+SSSR eye drops for treating neurotrophic keratopathy. DesignClinical trial: Interventional, multicenter, exploratory, single-arm, before and after comparison. ParticipantsThe eyes (12) of 11 patients, aged >60 years, were studied from two leprosy sanatoriums in Japan. MethodsPatients with neurotrophic keratopathy in leprosy sanatorium, specifically those with corneal perception of <40 mm, assessed by the Cochet-Bonnet corneal esthesiometer, and persistent corneal epithelial defects (PEDs) and/or corneal stromal thinning were included in this study. Those treated for infection in the acute phase were excluded from the study. Eye drops containing FGLM-NH2 0.05% and SSSR 5x10-6% were administered four times daily for up to 3 months. Fluorescein staining and optical corneal sections were photographed using a slit-lamp microscope at protocol-set intervals. Where possible, anterior segment optical coherence tomography was performed before and after the intervention. Main outcome measuresThe primary outcome measured was improvement in neurotrophic keratopathy. The patient was judged to have improved when one or more of the following criteria were met: 1) healing epithelial defects or 2) increased thickness in the thin area of the cornea. Secondary endpoints were visual acuity, subjective findings, and time to complete healing for a PED. ResultsNeurotrophic keratopathy on epithelial defects or stromal thickness improved in 83.3% of the patients (90% confidence interval 56.2%–97.0%, P<0.00001). The mean value of corrected visual acuity increased -0.16 by logarithm of the minimum angle of resolution. There were no adverse events reported in association with the treatment. ConclusionsWe confirmed that FGLM-NH2+SSSR eye drops are effective for neurotrophic keratopathy without any adverse reaction in leprosy. These results should be disseminated to any parties who could need this information.

Evaluation of the different methods of optic disc examination in glaucomatous patients

Background Glaucoma is a leading cause of blindness worldwide. Many patients discover glaucoma accidentally during regular checkups. Purpose To evaluate the agreement using slit lamp biomicroscopy, stereoscopic fundus photography, and optical coherence tomography (OCT) in the evaluation of the optic disc area, the cup area, and the vertical cup disc ratio (VCDR) in glaucomatous patients. Patients and methods This cross-sectional observational study includes 28 eyes of glaucomatous patients. All patients underwent slit lamp biomicroscopy using a +90 D lens, stereoscopic fundus photography using a computerized program to measure the optic disc parameters, and OCT for optic disc evaluation. Three examiners did the analysis. Results Comparing results obtained on stereoscopic fundus photography and OCT, examiner one reported moderate reliability regarding disc area, cup area, and the VCDR with an intraclass coefficient (ICC) of 0.67, 0.67, and 0.50 and P values of 0.68, 0.61, and 0.01, respectively. Examiner two reported moderate reliability regarding disc area, cup area, and VCDR with an ICC of 0.66, 0.63, and 0.54 and P values of 0.16, 0.69, and 0.03, respectively. Examiner three reported moderate reliability regarding disc area and VCDR with an ICC of 0.65, 0.71, and P values of 0.69 and 0.07, respectively. A good reliability for the cup area was reported with an ICC of 0.82 and a P value of 0.02. The slit lamp and stereoscopic fundus photos showed moderate reliability compared with fundus photography values. Conclusion There is an agreement between values obtained by slit lamp biomicroscopy, stereoscopic fundus photography, and OCT.

Ocular and Adnexal Diseases in Human Immunodeficiency Virus-Infected Pregnant Women Attending HIV Clinics in Ibadan, Nigeria

Abstract Background: Human immunodeficiency virus (HIV) is a lentivirus. It is transmitted through sexual intercourse, shared intravenous drugs, contaminated needle use, blood transfusion, and mother-to-child transmission. Of the patients with HIV, 50%–75% have ocular manifestations and this may be the primary presentation. This study was carried out in two prevention of mother-to-child transmission (PMTCT)/HIV clinics. The aim was to determine the incidence, patterns of presentation, and determinants of ocular and adnexal diseases in HIV-positive pregnant women attending HIV clinics to develop an eye care protocol for them. Materials and Methods: The study was a cross-sectional study of HIV-positive pregnant women attending the PMTCT/HIV Clinics at University College Hospital and Adeoyo Maternity Teaching Hospital, Ibadan. Patients were interviewed using a structured questionnaire. Blood samples were taken for CD4+ count and viral load. The stage of the disease, type of antiretroviral therapy (ART), and the interval between HIV diagnosis and commencement of ART were recorded. Comprehensive ocular examination, which included visual acuity check unaided and with pinhole, lid, anterior segment examination with slit lamp and posterior segment examination with dilated binocular indirect ophthalmoscopy, was conducted. Statistical Package for Social Sciences version 23 was used to analyse the data. Results: A total of 153 pregnant women aged 23–42 years (mean, 33.5; standard deviation, ±5.6) were recruited. One hundred and fifteen (75.2%) of them were married in a monogamous setting. Multiple sexual partners (48.4%; n = 74—some women married in monogamous settings at the time of recruitment for this study had multiple sexual partners in the past) and the use of unsterilised objects (46.4%; n = 71) were major high-risk behaviours. Ocular and adnexal diseases were found in 81 (53%) participants. HIV-related ocular and adnexal diseases were found in 16 (10%) participants. Of the 16 HIV-related diseases, optic atrophy was found in seven (43.8%), presumed toxoplasmosis in three (18.7%), presumed cytomegalovirus retinitis in three (18.7%) lid warts in two (12.5%), and conjunctival microangiopathy in one (6.3%) participant. The association between HIV- related ocular and adnexal diseases and gestational age, CD4+ count, viral load and type of ART was not statistically significant. Conclusion: The few HIV-related findings in this study could be a result of the improved CD+ count/low viral load of most of the recruited participants. Ensuring that patients attending PMTCT/HIV clinic have at least one ocular examination during pregnancy by collaborating with eyecare professionals could ensure prompt detection and treatment of eye diseases, to improve the quality of life of HIV-positive pregnant women.

Fluid accumulation in Berger’s space in a patient with phacolytic glaucoma: A case report

Leakage of the cortical fluid behind the lens through the posterior capsule into the space between the capsule and anterior hyaloid, called as hyaloido-capsular space or Berger’s space, is a rare phenomenon that can occur in phacolytic glaucoma. It is difficult to note the retrolental fluid preoperatively due to anterior chamber flare and white hard cataract and is often first seen intraoperatively. The visual outcome in such patients is suboptimal in immediate postoperative period despite uneventful cataract surgery. We present a case of retrolental fluid accumulation in a patient of phacolytic glaucoma and Morgagnian cataract with good visual gain at 1-month post-cataract extraction with intense steroid therapy. We would like to highlight the importance of conservative management in such cases with no intraoperative intervention for the retrolental fluid.

BNT162b2 vaccine booster dose did not influence the activity of the exudative form of age-related macular degeneration during anti-vascular endothelial growth factor therapy.

Due to safety concerns, patients were hesitant to receive a booster dose of COVID-19 vaccine. In this study, we investigated whether neovascular age-related macular degeneration activity deteriorated after receiving the booster dose of the BNT162b2 vaccine. Optical coherence tomography (OCT) of the macula, best-corrected visual acuity (BCVA), and slit-lamp examination data were collected from 89 patients. All these individuals were diagnosed with neovascular age-related macular degeneration (AMD) and treated with intravitreal injections of aflibercept or ranibizumab. During the process of treatment, patients received a booster dose of the BNT162b2 vaccine. Time points included two visits before (marked as "-2", "-1") and two visits after (marked as "1", "2") the uptake of the booster dose. There were significant differences in the average thickness and total volume of the macula during follow-up. Moreover, a decreased average thickness, total volume, total thickness of the macula, subretinal fluid thickness, and subretinal complex thickness was observed between the time points "-2" and "2", but only in the aflibercept group. There were no significant differences in the frequency of occurring intraretinal cysts, subretinal fluid, serous retinal pigment epithelial detachments retinal hemorrhage, subretinal hyperreflective material, complete RPE and outer retinal atrophy, and BCVA before and after the booster dose. These results demonstrate that the BNT162b2 vaccine booster dose did not deteriorate the course of neovascular AMD.

Use of Plasma Rich in Growth Factors for Ocular Surface Disorders: A Systematic Review.

Ocular surface disorders (OSDs) can severely affect vision and quality of life. Autologous blood products, such as plasma rich in growth factors (PRGF), are recently available to treat OSDs refractory to traditional therapies. This review aims to summarize the efficacy and safety of PRGF in OSDs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was established a priori and published on PROSPERO (CRD42024522119). MEDLINE, Embase, and Cochrane Library were searched for primary articles until February 6, 2024. Primary outcomes included slit-lamp examination findings and patient-reported outcomes. Secondary outcomes included visual outcomes and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias and ROBINS-I tools. Twenty-two studies involving 1158 eyes were included. PRGF showed notable improvement in objective and subjective outcomes in OSDs. Comparative studies did not show PRGF to be superior to a standard steroid taper for dry eye disease. However, the use of PRGF was also reported in persistent epithelial defects and corneal ulcerations. In these conditions, there were high rates of complete healing and reduced corneal staining. PRGF has also been reported to improve ocular surface healing and stability when used as an adjunct to refractive and pterygium surgeries. No serious adverse events were reported. PRGF has potential as an effective treatment of OSDs resistant to traditional therapies with minimal safety concerns. Large randomized controlled trials are needed to better evaluate the role of PRGF within the treatment armamentarium for corneal pathologies.

Evaluation of bone-conducted oVEMPs using frontal medial and mastoid stimulations

AimsTo determine the optimal stimulation intensity for frontal stimulation with a modified slit lamp holder and to compare the reliability and symmetry of bone-conducted ocular vestibular evoked myogenic potentials (oVEMPs) using two stimulation sites: frontal medial and mastoid. MethodsThis observational study included 33 healthy volunteers (15 women, 18 men; mean age 24.5years) at the University Hospital of Lausanne. Participants underwent otoneurological assessments, and those with normal results were included. Bone-conducted oVEMPs were recorded using a Brüel and Kjaer mini-shaker type 4810. A modified slit lamp holder was used for frontal stimulation to ensure consistent application pressure, freeing the examiner's hands. Mastoid stimulation was performed manually. ResultsThe best reproducibility of oVEMP recordings was observed at 70dB nHL. Frontal stimulation demonstrated lower dispersion of data and lower asymmetry ratios of latencies (up to 7%) and amplitudes (up to 50%) compared to mastoid stimulation (up to 40% for latencies). Single stimulations at both frontal and mastoid sites were sufficient to obtain reliable measurements of both utricles. ConclusionFrontal stimulation at 70dB nHL using a modified slit lamp holder is recommended for bone-conducted oVEMP recordings due to its superior reproducibility, comfort, and reliability. This study establishes a new standard for optimal stimulation intensity and supports the use of frontal stimulation in clinical practice.

Modifying the Silt Lamp by Using a White Laser in Place of the Halogen Light

This paper explores the modification of the slit lamp, a vital ophthalmic instrument, by replacing the traditional halogen light source with a white laser. This modification aims to enhance the diagnostic capabilities and efficiency of the slit lamp. White laser technology offers superior brightness, intensity, and color accuracy, which improves the visibility and differentiation of ocular tissues. Additionally, white lasers are more energy-efficient, provide consistent light output, and require less maintenance. The redesign process includes adjustments to the optical system, incorporating specialized filters and lenses, and ensuring proper thermal management. The integration of a high-resolution digital camera system with white laser illumination further improves image quality and diagnostic precision. The study outlines the benefits, potential challenges, and implementation steps, concluding that the use of white lasers in slit lamps can significantly enhance the effectiveness of ocular diagnostics, benefiting both ophthalmologists and patients.

Dysfunctional lens syndrome: a literature review

Introduction. The term “Dysfunctional Lens Syndrome” (DLS) refers to age-related changes in the lens, including early cataracts and presbyopia, that do not significantly reduce visual acuity. This syndrome is characterized by a decrease in accommodative amplitude, an increase in light scattering, and a reduction in contrast sensitivity. With rising life expectancy, the prevalence of DLS is increasing, necessitating a more in-depth study of the pathogenic mechanisms underlying the syndrome and the refinement of its diagnostic criteria to establish standards for treatment correction. Aim: to summarize information on the pathogenesis of DLS, the potential for staging the syndrome using objective examination methods, and to provide treatment recommendations. Materials and methods. A bibliographic study of scientific publications was conducted using the Pubmed, ScienceDirect, and Cyberleninka databases. Literature sources were searched using the following keywords: dysfunctional lens syndrome (DLS), presbyopia correction, cataract, age-related lens changes. A total of 32 publications, primarily from the last 10 years, were included in the study from more than 100 viewed sources. Results. The DLS encompasses a wide range of conditions, from early stages characterized by a loss of accommodative amplitude and minor refractive anomalies to later stages involving a decrease in visual acuity and quality due to increased light scattering and aberrations. Currently, the evaluation of age-related lens changes involves assessing visual acuity and determining the degree of lens opacification using slit-lamp examination. Additionally, objective instrumental methods, such as optical coherence tomography and Scheimpflug imaging, can be used to assess the degree of lens opacification. Various methods are employed for the correction and treatment of DLS, ranging from glasses and contact lenses to surgical interventions, such as lens extraction and intraocular lens implantation. Research is also ongoing into drugs aimed at slowing the progression of lens changes. Conclusion. The term “Dysfunctional Lens Syndrome” is currently used to describe early cataracts and presbyopia, where the reduction in visual acuity is still minor, but patients experience visual complaints due to age-related lens changes. Further research is necessary to develop and standardize diagnostic criteria and to evaluate the effectiveness of new treatment methods and interventions in order to create the most effective and adequate approach to correcting DLS and alleviating the associated visual complaints.

IL-37 Inhibits Inflammation of Lacrimal Gland in Dry Eye Mice via the IL-37-PTEN-NFκB Signaling Pathway

ABSTRACT Purpose This study aims to investigate the role of Interleukin-37 (IL-37) in mouse models of dry eye. Methods Two murine models of dry eye were employed in this investigation. The evaluation of the anti-inflammatory impact of IL-37 (200 μl, 10 μg/ml) on dry eye mice involved intraperitoneal injections administered once daily for 7 days. Additionally, intraperitoneal injection of VO-Ohpic trihydrate (VO, 0.25 mg/kg) in dry eye mice was performed to investigate the role of PTEN in the IL-37 anti-inflammatory signaling pathway. Tear production was assessed using phenol red cotton thread, while corneal damage was examined through sodium fluorescein staining using a slit lamp. Histological alterations in the lacrimal gland were observed through H&E staining. PAS staining was used to assess conjunctival goblet cells. The levels of NFκB-P65, p-NFκB-P65, IL-1β, IL-6, TNF-α, CD3, AQP5, α-SMA and PTEN proteins were determined via Western blotting or immunofluorescence. Results Following IL-37 treatment, both dry eye models exhibited reduced corneal fluorescence staining scores and enhanced tear production. In lacrimal gland, the expression of p-NFκB-P65, IL-1β, IL-6, CD3 and TNF-α was diminished, while PTEN, AQP5, α-SMA expression increased after IL-37 treatment in both dry eye mice. However, the intraperitoneal injection of VO significantly attenuated the anti-inflammatory effect of IL-37 on dry eye mice. Conclusion IL-37 emerges as an anti-inflammatory mediator within the lacrimal gland of dry eye mice, exerting its effects through the IL-37-PTEN-NFκB signaling pathway.

Non-Descemet stripping endothelial keratoplasty for bullous keratopathy in patients with atopic dermatitis: A long-term case report.

Patients with atopic dermatitis undergoing penetrating keratoplasty (PKP) face a high risk of postoperative complications. Endothelial keratoplasty may be a safer alternative for such patients, including those with abnormal anterior chamber anatomy. 3 male patients, aged 33 to 44, presented with blurred vision at Keio University Hospital. Bullous keratopathy was diagnosed through slit-lamp examination and specular microscopy. Two patients had well-controlled systemic atopic dermatitis, while 1 had blepharitis associated with atopic dermatitis. Two patients had peripheral anterior synechia, and 2 had undergone glaucoma surgery before keratoplasty. Non-Descemet stripping endothelial keratoplasty (nDSAEK) was performed by a single surgeon. The best-corrected visual acuity ranged from 0.7 to 1.5 logMAR before surgery and from 0.2 to 2.3 logMAR after surgery. One year post-surgery, the graft remained clear in 2 cases; however, in the case of repeated glaucoma surgeries after nDSAEK, the graft became edematous. Corneal endothelial cell density was 1586 and 1988 cells/mm² in 2 cases and undetectable in the failed case. The follow-up period ranged from 2.5 to 9 years. Despite the presence of peripheral anterior synechia or prior glaucoma surgery, some patients experienced a favorable long-term postoperative course following nDSAEK. This procedure may offer a safer alternative for treating patients with atopic dermatitis who have ocular complications that present a high risk for PKP.

Targeting PYK2, entrectinib allays anterior subcapsular cataracts in mice by regulating TGFβ2 signaling pathway

BackgroundFibrosis cataract occurs in patients receiving cataract extraction. Still, no medication that can cure the disease exists in clinical. This study aims to investigate the effects and mechanisms of Entrectinib on fibrotic cataract in vitro and in vivo.MethodsThe human lens cells line SRA 01/04 and C57BL/6J mice were applied in the study. Entrectinib was used in animals and cells. Cataract severity was assessed by slit lamp and Hematoxylin and Eosin staining. Expression of alpha-smooth muscle actin, fibronectin, and collagen I were examined by real-time quantitative PCR, western blotting, and immunofluorescence. Cell proliferation was evaluated by Cell Counting Kit-8. Cell migration was measured by wound healing and transwell assays. Molecular docking, Drug Affinity Responsive Target Stability, and Cellular Thermal Shift Assay were applied to seek and certify the target of Entrectinib treating fibrosis cataract.ResultsEntrectinib can ameliorate fibrotic cataract in vitro and in vivo. At the RNA and the protein levels, the expression of alpha-smooth muscle actin, collagen I, and fibronectin can be downgraded by Entrectinib, while E-cadherin can be upregulated. The migration and proliferation of cells were inhibited by Entrectinib. Mechanistically, Entrectinib obstructs TGFβ2/Smad and TGFβ2/non-Smad signaling pathways to hinder the fibrosis cataract by targeting PYK2 protein.ConclusionsTargeting with PYK2, Entrectinib can block TGF-β2/Smad and TGF-β2/non-Smad signaling pathways, lessen the activation of EMT, and alleviate fibrosis cataract. Entrectinib may be a potential treatment for fibrosis cataract in clinic.