Ophthalmic Treatment Research Articles

Hereditary vitreoretinal amyloidosis with transthyretin Gly83Arg variant, a long-term study.

This study evaluated the clinical data on ophthalmic follow-up and treatment efficacy of hereditary vitreoretinal amyloidosis kindred due to transthyretin Gly83Arg variant over a 15-year follow-up period. The clinical data of patients with hereditary ATTRG83R amyloidosis from 2006 to 2021 were analysed retrospectively. Sanger sequencing of the transthyretin gene, detailed medical history, pedigree charting, and systemic and ophthalmic examinations were carried out in all patients. The changes of best-corrected visual acuity (BCVA) after vitrectomy and the associations of amyloidosis recurrence and post-vitrectomy glaucoma were analysed. Fourteen patients with ATTRG83R were included, all experiencing vision loss due to vitreous opacities. The average age of onset was 40.93 ± 6.96 (29 to 52) years. The preoperative BCVA was 2.20 ± 0.69 logMAR, whereas the postoperative BCVA improved to 0.13 ± 0.35 logMAR (P < 0.05). The recurrence time was 58.83 ± 20.85 months after vitrectomy. At 90 months after vitrectomy, the cumulative recurrence rate was 94.7%. Eight eyes developed glaucoma after vitrectomy. None of the 5 eyes without vitrectomy developed glaucoma. Paired chi-square test showed a significant difference in the incidence rate of glaucoma between eyes with or without vitrectomy (P < 0.05). However, retinal amyloid angiopathy and cataract surgery were not associated with glaucoma (P > 0.05). Poor intraocular pressure control in 7 eyes resulted in severe visual impairment. Hereditary ATTRG83R amyloidosis predominantly manifests as vitreous opacity, and vitrectomy can improve the visual acuity in affected patients. However, the recurrence of amyloidosis and related complications significantly impact long-term visual outcomes. Thus, delaying vitrectomy appropriately and maintaining regular follow-up visits is advisable.

FTSNet: Fundus Tumor Segmentation Network on Multiple Scales Guided by Classification Results and Prompts.

The segmentation of fundus tumors is critical for ophthalmic diagnosis and treatment, yet it presents unique challenges due to the variability in lesion size and shape. Our study introduces Fundus Tumor Segmentation Network (FTSNet), a novel segmentation network designed to address these challenges by leveraging classification results and prompt learning. Our key innovation is the multiscale feature extractor and the dynamic prompt head. Multiscale feature extractors are proficient in eliciting a spectrum of feature information from the original image across disparate scales. This proficiency is fundamental for deciphering the subtle details and patterns embedded in the image at multiple levels of granularity. Meanwhile, a dynamic prompt head is engineered to engender bespoke segmentation heads for each image, customizing the segmentation process to align with the distinctive attributes of the image under consideration. We also present the Fundus Tumor Segmentation (FTS) dataset, comprising 254 pairs of fundus images with tumor lesions and reference segmentations. Experiments demonstrate FTSNet's superior performance over existing methods, achieving a mean Intersection over Union (mIoU) of 0.8254 and mean Dice (mDice) of 0.9042. The results highlight the potential of our approach in advancing the accuracy and efficiency of fundus tumor segmentation.

Gellan gum as a promising transplantation carrier for differentiated progenitor cells in ophthalmic therapies

Stem cell-based therapies for various ocular conditions are increasingly gaining traction in ophthalmic treatments, with hydrogel-based polymers playing a pivotal role. Current stem cell delivery methods face challenges such as limited cell retention, immunological rejection, and uneven dispersion. Hence, there is a critical demand for innovative delivery systems to enhance the viability, localization, and integration of transplanted stem cells while minimizing adverse effects. Central to this advancement is the meticulous selection of appropriate materials. Among the promising options, gellan gum, a versatile polysaccharide, is emerging as a potential carrier for differentiated progenitor cells in regenerative medicine, particularly in ophthalmology. This study explores the utilization of gellan gum hydrogels as carriers, focusing on their biocompatibility, customizable gelation properties, and ability to encapsulate, transplant, and biofunctionalize cells. Through a review of literature, the impact of gellan gum hydrogels on cell viability parameters is investigated, revealing their potential for promoting tissue regeneration and functional recovery in ocular diseases. Furthermore, this study compares gellan gum systems utilizing natural and synthetic polymers, discerning differences in efficacy, biocompatibility, and suitability for diverse applications in regenerative ophthalmology. This review highlights the promising role of gellan gum in ophthalmic therapies, providing valuable insights into future directions and hurdles in this evolving field.

Exploring the Insights on Exosomes and their Utility in Treating Ophthalmic Disease: Delving into the Clinical Approval and Present Trials.

Ophthalmic diseases include a wide array of conditions, each requiring individualized treatment approaches. In ophthalmic research and as therapeutics against potential pharmacological indications, several subtypes of exosomes (EVs) have been reconnoitered, mainly for their regenerative, neuroprotective, and anti-inflammatory characteristics. EVs are recently gaining wider attention as promising vehicles for therapies because of their natural participation in communication between cells and targeted delivery. These small vesicles, derived from cells, transport numerous molecules between cells, thus contributing advantages like low immunogenicity, stability, and the ability to target cells specifically. These inherent advantages of carrying the therapeutic cargo and enabling intercellular signaling make them a captivating avenue for progressing ophthalmic disease treatment options. While research is ongoing, and clinical applications are still emerging, several EV subtypes have shown promise for possible applications in addressing several ophthalmic diseases, such as glaucoma, age-related macular degenerative disorders, retinal degenerative disorders, and ocular inflammatory conditions.

MobilenetV2-RC: A lightweight network model for retinopathy classification in retinal OCT images

Abstract Retinopathy is an important ophthalmic disease that causes blindness in the elderly population. With the global old peoples increasing, the ophthalmic healthcare system is more and significant to pre-diagnosis. Optical Coherence Tomography (OCT) is considered the gold standard for ophthalmic treatment and diagnosis. OCT technologies and equipment continue to develop towards the intelligence and convenience for requirements of rapid diagnosis in the remote and poverty-stricken areas. We proposed an improved MobilenetV2 lightweight model for retinopathy classification (MobilenetV2-RC), which incorporates Spatial and Channel Reconstruction Convolution (SCConv) and the improved Convolutional Block Attention Module (CBAM) attention mechanism into the framework. Not only can it effectively limit feature redundancy to reduce model parameters, but also enhance the ability of feature representation to improve classification accuracy. The parameters of the proposed model are only 1.96 M with an overall accuracy of 98.96%, which is higher 3.32% than the original MobilenetV2. Compared with ResNet18, InceptionV3, and VGG16_BN, the overall accuracy is increased by 4.6%, 6.3%, and 3.9%, respectively. The test results of UCSD and Duke open-source datasets are more remarkable. Experimental results show that our proposed algorithm has strong reliability and generalization for the accurate classification of retinopathy, and a greater application prospect in the intelligent diagnosis of ophthalmology and mobile detection terminals.&amp;#xD;

Higher prevalence of dupilumab-induced ocular adverse events in atopic dermatitis compared to asthma: A daily practice analysis.

Dupilumab has been shown to be an effective treatment in moderate-to-severe atopic dermatitis (AD) and severe asthma (SA). However, comparative real-world analyses of adverse events (AE), particularly dupilumab-associated ocular surface disease (DAOSD), are lacking. This is the first real-world study to provide insight into the prevalence of AEs associated with dupilumab in AD compared with SA. Secondary objectives were to assess the prevalence, onset and therapeutic strategies of DAOSD and evaluate dupilumab discontinuation rates. Data from two daily practice registries including AD and SA patients receiving dupilumab treatment were analyzed. Adverse events, including DAOSD, were evaluated. In total, 322 AD and 148 SA patients were included. Headaches (23.6%), injection site reactions (10.1%), and influenza-like symptoms (13.5%) were more prevalent in SA patients. Interestingly, ocular AEs were significantly more prevalent in AD patients (62.1%, p<0.001), including conjunctivitis (17.1%, p=0.004). 88% AD and 47% SA patients with ocular AEs received one or more ophthalmic treatment(s). Additionally, 20% of AD and 17.6% of SA patients discontinued dupilumab treatment due to ocular AEs, while only 65% of these AD and none of these SA patients were referred to an ophthalmologist. The higher incidence of DAOSD in AD patients compared with SA patients in this real-world study highlights the importance of physician awareness, especially when prescribing dupilumab to AD patients. Conversely, the findings of this study help alleviate potential concerns about ocular AEs in patients with SA who do not have comorbid AD. Furthermore, the effective management of most ocular AEs with ophthalmic treatments suggests favorable tolerability of dupilumab in daily practice, and multidisciplinary collaboration is essential to proactively manage ocular AEs before discontinuing dupilumab.

Knowledge and attitude of medical students towards artificial intelligence in ophthalmology in Riyadh, Saudi Arabia: a cross-sectional study.

The use of artificial intelligence (AI) in ophthalmology represents a transformative leap in healthcare. AI-powered technologies, such as machine learning and computer vision, enhance the accuracy and efficiency of ophthalmic diagnosis and treatment. This study aimed to determine medical students' awareness and attitudes towards the use of artificial intelligence in ophthalmology. This cross-sectional, questionnaire-based study was conducted between November 2022 and January 2023 using online questionnaires. Data collection was carried out using convenience sampling among medical students at the University. IBM SPSS version 23 was used to analyze the data. The current finding shows that most of the participants N=309 (89.6%) had heard of the use of AI in medicine, and N=294 (85.2%) heard of the use of AI in ophthalmology. 98.6% (n=340) of respondents believed AI would be a helpful tool in ophthalmology. Along this line of questioning, a significant majority of respondents, 332 (96.2%) selected screening, 332 (96.2%) selected diagnosis, and 293 (84.9%) selected prevention as a usage of AI ophthalmology. However, the majority, 76.5%) of students had little understanding of the development of AI in ophthalmology. In addition, a significant relationship between sex, academic year, cumulative GPA (cGPA), and awareness of AI in ophthalmology (P<0.001) was found in this study. Overall, medical students in Saudi Arabia appear to have favorable thoughts about AI and positive perceptions towards AI in ophthalmology. However, the findings of this study emphasize the limited understanding and low confidence levels of medical students in Saudi Arabia regarding the use of AI in ophthalmology. As a result, early exposure to AI-related materials in medical curricula is crucial for addressing these challenges through comprehensive AI education and practical exposure to prepare future ophthalmologists.

What's New in Ocular Drug Delivery: Advances in Suprachoroidal Injection since 2023.

Despite significant advancements in ocular drug delivery, challenges persist in treating posterior segment diseases like macular edema (ME) and age-related macular degeneration (AMD). Suprachoroidal (SC) injections are a promising new method for targeted drug delivery to the posterior segment of the eye, providing direct access to the choroid and retina while minimizing systemic exposure and side effects. This review examines the anatomical and physiological foundations of the SC space; evaluates delivery devices such as microcatheters, hypodermic needles, and microneedles; and discusses pharmacokinetic principles. Additionally, advancements in gene delivery through SC injections are explored, emphasizing their potential to transform ocular disease management. This review also highlights clinical applications in treating macular edema, diabetic macular edema, age-related macular degeneration, choroidal melanoma, and glaucoma. Overall, SC injections are emerging as a promising novel route for administering ophthalmic treatments, with high bioavailability, reduced systemic exposure, and favorable safety profiles. Key therapeutic agents such as triamcinolone acetonide, dexamethasone, AAV-based gene therapy, and axitinib have shown promise. The field of suprachoroidal injection is progressing rapidly, and this review article, while attempting to encapsulate most of the published preclinical and clinical studies, mainly focuses on those that are published within 2023 and 2024.

Calamine in the ophthalmic external treatment prescription in ancient times

Calamine and its related medicines came into China as articles of tribute from other countries in ancient times. It was not recorded in the books of Chinese materia medica before the Song Dynasty but was widely used in ophthalmology, dermatology and traumatology and was, recorded specifically in the Ming and Qing Dynasty. This paper systematically examines the evolution of calamine herb in the archives of traditional Chinese medicine in terms of ophthalmic eternal treatment prescriptions. It was found that a total of 320 ophthalmic treatment formulas or prescriptions involved calamine, mainly finding its expression in 67 books on herbal medicines, formula and prescriptions, clinical syndrome comprehension and ophthalmic monographs. It was also found that calamine, as an important ophthalmic external medicine, had a wide range of clinical applications, covering internal and external obstructive eye diseases. Its flexibility, diverse compatibility and use in various processing are of great value and significance for in-depth exploration of its current application, its further use in ophthalmic treatment formulas or prescriptions and the redevelopment of classic formulas and prescriptions as well.

The evolution of cyclosporine treatments for treatment of ocular surface diseases.

Cyclosporine is a versatile immunomodulatory drug commonly employed in modern medicine. Although cyclosporine was initially used to prevent solid organ transplant rejection, its indications have extended to treat many inflammatory or autoimmune diseases. Cyclosporin is available for use in oral, intravenous, and topical forms, including eye drops to treat corneal and ocular surface conditions. It is naturally advantageous to administer cyclosporin directly into the eye, avoiding potential and dose limiting systemic adverse effects. However, the transition from systemic to topical administration has been a challenging one. This report reviews the evolution of ophthalmic cyclosporine treatment and explores its clinical impacts and future research directions. Latest advancements in formulations - from oil-based solutions to nanomicelle and gel systems and waterless formulations - have improved the therapeutic efficacy and tolerability of topically applied cyclosporine, demonstrating greater effectiveness in treating ocular surface parameters compared to oil-based solution. Cyclosporine continues to be a safe and effective immunomodulatory drug in the field of ophthalmology to treat various chronic inflammatory ocular surface diseases and dry eye. Currently, there are several commercially available topical preparations available for ophthalmic use each with unique formulation and clinical outcomes.

Causes, treatment, and outcome of hyphema, fibrin, and vitreal hemorrhage in horses: 219 cases (2012-2023).

To determine the causes, time to resolution, effect of therapeutics, and ocular sequelae of hyphema, fibrin, and/or vitreal hemorrhage in horses. 225 horses (219 eyes) who were diagnosed with hyphema, fibrin, and/or vitreal hemorrhage. Records were retrospectively reviewed for the horses. Signalment, ophthalmic examination findings, causes, treatments, and outcomes were evaluated. Common causes of intraocular fibrin or hemorrhage were equine recurrent uveitis (42/219 horses), corneal stromal abscess (32/219 horses), corneal stromal ulcer (25/219 horses), and trauma (21/219 horses). Eyes with fibrin that were treated with intracameral tissue plasminogen activator (TPA; n = 18 eyes) had significantly lower days to resolution (8.9 ± 12.6 days) compared to eyes not treated with TPA (28.3 ± 46.7 days). Ocular sequelae in horses with fibrin, such as cataracts (18/120 eyes), synechiae (11/120 eyes), and vision loss (17/120 eyes), were significantly less common in eyes treated with TPA. Sequelae in eyes with hyphema included cataracts (9/36 eyes), synechiae (6/36 eyes), and vision loss (5/36 eyes). Although 41 horses had an enucleation at presentation because of severe disease, 14/144 (< 10%) of horses with follow-up required an enucleation. The presence of blood products in the eyes of horses suggests severe ocular disease, but if the eye is not enucleated at presentation, the prognosis is good for maintaining the eye. Also, the use of intracameral TPA in horses with anterior chamber fibrin but not those with hyphema, results in less adverse ocular sequelae.

Clinical outcomes of conjunctivochalasis treatment with a new ophthalmic radiofrequency device

PurposeTo investigate the safety and efficacy of a new micro-controlled radiofrequency device for treatment of conjunctivochalasis (Cch).MethodsData of 127 patients (230 eyes) who underwent ophthalmic radiofrequency treatment for Cch from January 2020 to June 2023 were analyzed retrospectively. Cch coagulation was performed with a radiofrequency electrode tip (OcuRF®, Ilooda, Korea) and a high-frequency radio-wave electric unit (0.6 ~ 0.8 watts, 2 MHz, Acutron™, Ilooda, Korea). Pre- and postoperative Cch grading, slit-lamp photography, tear film break-up time (TBUT), and bulbar conjunctival hyperemia using Keratograph 5 M (Oculus, Wetzlar, Germany) were evaluated. Cch grade 0 or 1 after surgery was regarded as ‘success’. Complications, recurrence, and additional treatment rates were analyzed.ResultsIn 227 (98.7%) eyes, the radiofrequency treatment led to marked improvement of Cch, with 224 (97.4%) eyes achieving grade 0 or 1 at 2 months postoperatively. Eight eyes (3.5%) received additional treatment. TBUT improved from 3.17 ± 0.82 s to 5.28 ± 1.10 s after surgery (P < 0.001). The total bulbar conjunctival hyperemia value showed an improvement from 1.7 ± 0.6 to 1.4 ± 0.6 postoperatively (P < 0.05). No serious complications were observed.ConclusionThe novel ophthalmic radiofrequency device led to a marked improvement of Cch with no serious adverse events during the entire follow-up period. Our results suggest that the radiofrequency device presents a safe and efficacious treatment option for Cch.

Real‐World Incidence of Incident Noninfectious Uveitis in Patients Treated With BRAF Inhibitors: A Nationwide Clinical Cohort Study

To compare the incidence of noninfectious uveitis in skin melanoma or lung cancer patients who received BRAF inhibitors with that in those who received immune checkpoint inhibitors (ICIs) or conventional cytotoxic chemotherapy. Nationwide population-based retrospective clinical cohort study METHODS: From the Health Insurance Review and Assessment Service database of South Korea, we retrospectively defined 77,323 patients with skin melanoma or lung cancer who received BRAF inhibitor therapy (BRAF inhibitor-exposed group; n = 396), ICIs (ICI-exposed group; n = 22,474), or conventional cytotoxic chemotherapy (unexposed group; n = 54,453). We calculated the 1-year cumulative incidence of noninfectious uveitis in each group from the first day of BRAF inhibitor, ICI, or cytotoxic agent administration. During the first year of treatment initiation, the cumulative incidence of uveitis was 0.33%, 0.35%, and 2.27% in the unexposed, ICI-exposed, and BRAF inhibitor-exposed groups, respectively. Adjusted hazard ratios (aHR) indicated a 7.52-fold and 5.68-fold increased risk of uveitis in the BRAF inhibitor-exposed group compared with that in the unexposed and ICI-exposed groups (95% confidence interval [CI] 3.83-14.75, P < 0.001 and 95% CI 2.81-11.47, P < 0.001, respectively). After 1:4 propensity score matching, aHRs showed a 35.51-fold and 15.80-fold increased risk (95% CI 4.49-280.48, P = 0.001 and 95% CI 1.76-141.00, P = 0.014) of uveitis and severe uveitis, respectively, in the BRAF inhibitor-exposed versus unexposed patients. Crossover analysis within the BRAF inhibitor-exposed group showed a 3.71-fold increase in uveitis risk during 1-year post index date in comparison with 1-year prior to index date (95% CI 1.03-13.40, P = 0.046). In the BRAF inhibitor-exposed group, female sex, chronic kidney disease, and melanoma were associated with a trend of increased, albeit nonsignificant, risk of uveitis. Melanoma or lung cancer patients treated with BRAF inhibitors showed significantly higher risk of noninfectious uveitis than patients treated with conventional cytotoxic drugs or ICIs. These findings emphasize the importance of pretreatment patient education on BRAF-inhibitor-associated uveitis risk to enable prompt ophthalmic evaluation and treatment if symptoms arise during drug administration.

Magnetically Controlled Intraocular Delivery of Dexamethasone Using Silica-Coated Magnetic Nanoparticles.

Although the number of patients with eye diseases is increasing, efficient drug delivery to the posterior segment of the eyeball remains challenging. The reasons include the unique anatomy of the eyeball, the blood-aqueous barrier, the blood-retina barrier, and drug elimination via the anterior chamber and uveoscleral routes. Solutions to these obstacles for therapeutic delivery to the posterior segment will increase the efficacy, efficiency, and safety of ophthalmic treatment. Micro/nanorobots are promising tools to deliver therapeutics to the retina under the direction of an external magnetic field. Although many groups have evaluated potential uses of micro/nanorobots in retinal treatment, most experiments have been performed under idealized in vitro laboratory conditions and thus do not fully demonstrate the clinical feasibility of this approach. This study examined the use of magnetic nanoparticles (MNPs) to deliver dexamethasone, a drug widely used in retinal disease treatment. The MNPs allowed sustainable drug release and successful magnetic manipulation inside bovine vitreous humor and the vitreous humor of living rabbits. Therefore, controlled drug distribution via magnetic manipulation of MNPs is a promising strategy for targeted drug delivery to the retina.

Analysis of the Effect of Superselective Ophthalmic Artery Thrombolysis for Central Retinal Artery Occlusion

Introduction: The aim of the study was to investigate the clinical efficacy of superselective ophthalmic artery thrombolysis for central retinal artery occlusion (CRAO). Methods: Retrospective study of CRAO patients who attended the Department of Ophthalmology of Affiliated Hospital of Weifang Medical University from January 2022 to July 2023, 138 CRAO patients with onset time of 1–3 days were selected for the study. Among them, 86 patients refused thrombolytic treatment and chose to adopt traditional treatment, which was categorized as the control group; 52 patients adopted superselective ophthalmic artery thrombolytic treatment, which was categorized as the observation group. The visual acuity of the patients treated with traditional modality on the 4th day after the onset of the disease and the visual acuity of the patients treated with superselective ophthalmic artery thrombolysis on the 1st postoperative day were recorded, and the visual acuity improvement after different modalities of treatment was compared between the two groups. Results: In the control group, 77 (89.5%) of the treated patients had no improvement in visual acuity, 9 (10.5%) had improvement, 0 (0.0%) had significant improvement, and the total improvement was 9 (10.5%); in the observation group, 18 (34.6%) of the treated patients had no improvement in visual acuity, 21 (40.4%) had improvement, 13 (25.0%) had significant improvement, and the total improvement was 34 (65.4%). The total improvement rate of treatment in the observation group was 65.4%, which was significantly higher than the 10.5% in the control group, and the difference was statistically significant (p < 0.05). Conclusion: Superselective ophthalmic artery thrombolysis for patients with CRAO is clinically effective, promotes improvement in patient vision, and has a high safety profile.

Ophthalmic Complications, Diagnosis, and Treatment of Congenital Human Cytomegalovirus Infection.

Background: Human cytomegalovirus (hCMV) is the most common etiological agent of congenital infections seen in newborns. Among the most commonly observed complications in children with congenital human cytomegalovirus infection are those affecting the visual system. Ocular complications of congenital CMV (cCMV) are a topic rarely addressed in the literature, which prompted the authors to update the available knowledge with the latest data. Methodology: English-language literature published between April 2000 and November 2023 (PubMed, NIH, Google Scholar) was analyzed for ocular complications of cCMV. The data obtained were categorized according to the ocular area involved and the incidence. A compilation of criteria for the symptomatic form of cCMV was also created. Results: The cCMV complications described in the literature affect all parts of the visual system: the anterior segment, the posterior segment, the posterior visual pathways, and the visual cortex. The most commonly described ocular complication of cCMV is choroidal and retinal scarring. Conclusions: Ophthalmic complications of cCMV can cause severe visual disturbances. Ophthalmic diagnosis in newborns should include hCMV PCR testing, which has the highest sensitivity and specificity. In the symptomatic form of cCMV, treatment should be instituted according to recommendations. A consensus should be established for screening of primary hCMV infection in pregnant women, the way in which to define the symptomatic form of cCMV, and the appropriateness and standards of treatment for primary hCMV infection in pregnant women.

Big data study using health insurance claims to predict multidisciplinary low vision service uptake.

There is a lack of research from high-income countries with various health care and funding systems regarding barriers and facilitators in low vision services (LVS) access. Furthermore, very few studies on LVS provision have used claims data. This study aimed to investigate which patient characteristics predict receiving multidisciplinary LVS (MLVS) in the Netherlands, a high-income country, based on health care claims data. Data from a Dutch national health insurance claims database (2015 to 2018) of patients with eye diseases causing potentially severe visual impairment were retrieved. Patients received MLVS (n = 8766) and/or ophthalmic treatment in 2018 (reference, n = 565,496). MLVS is provided by professionals from various clinical backgrounds, including nonprofit low vision optometry. Patient characteristics (sociodemographic, clinical, contextual, general health care utilization) were assessed as potential predictors using a multivariable logistic regression model, which was internally validated with bootstrapping. Predictors for receiving MLVS included prescription of low vision aids (odds ratio [OR], 8.76; 95% confidence interval [CI], 7.99 to 9.61), having multiple ophthalmic diagnoses (OR, 3.49; 95% CI, 3.30 to 3.70), receiving occupational therapy (OR, 2.32; 95% CI, 2.15 to 2.51), mental comorbidity (OR, 1.17; 95% CI, 1.10 to 1.23), comorbid hearing disorder (OR, 1.98; 95% CI, 1.86 to 2.11), and receiving treatment in both a general hospital and a specialized ophthalmic center (OR, 1.23; 95% CI, 1.10 to 1.37), or by a general practitioner (OR, 1.23; 95% CI, 1.18 to 1.29). Characteristics associated with lower odds included older age (OR, 0.30; 95% CI, 0.28 to 0.32), having a low social economic status (OR, 0.91; 95% CI, 0.86 to 0.97), physical comorbidity (OR, 0.87; 95% CI, 0.82 to 0.92), and greater distance to an MLVS (OR, 0.95; 95% CI, 0.92 to 0.98). The area under the curve of the model was 0.75 (95% CI, 0.75 to 0.76; optimism = 0.0008). Various sociodemographic, clinical, and contextual patient characteristics, as well as factors related to patients' general health care utilization, were found to influence MLVS receipt as barriers or facilitators. Eye care practitioners should have attention for socioeconomically disadvantaged older patients when considering MLVS referral.

Concise Review on Integral Structure of Egg Shell Membrane

The article outlines various valuable applications for eggshell waste, including its use as a catalyst in biodiesel production to minimize pollutants, as an absorbent for heavy metals in wastewater, as a biomaterial for bone tissue replacement, and as a fertilizer and calcium supplement in various domains. It highlights the increasing research interest in exploring these applications for eggshell waste. This highlights the potential of the eggshell membrane (ESM) as a biomaterial for wound dressing due to its abundant availability and favourable properties. The study developed an extraction protocol for ESM and evaluated its physical, chemical, mechanical, and biological properties for wound dressing applications. Results showed that ESM retained its structure and composition after extraction, with promising characteristics such as optical transparency, porosity, fluid absorption, thermal stability, and mechanical strength. Biological studies confirmed its excellent biocompatibility with corneal cells, suggesting its potential for ophthalmic wound treatment and other biomedical applications, contributing to sustainable biomaterial development. The article discusses the formation and mineralization of calcareous eggs, primarily focusing on studies of chicken eggshells. It highlights areas of uncertainty such as the role of amorphous calcium carbonate and the molecules involved in eggshell formation. Additionally, it mentions the recent advancements in avian genomics and proteomics, which will aid in comparative studies of egg shell constituents across different bird species.

Developing a quantitative method of mangiferin in rabbit lacrimal fluid as a tool for investigating pre-cornea drug residence

Mangiferin (MGF) has been evidenced to effectively treat infectious diseases caused by Herpes simplex virus, especially on the acyclovir-resistant strains. For ophthalmic disease treatment, prolonging drug retention in the eyes plays an essential role in effectively delivering drugs, which are prone to elimination by eye blinking and tear fluid secretion. The objective of this study was to develop a method for analysis of MGF in tear fluid that can be further utilised to evaluate the kinetics of precornea drug concentration. For sample collection, lacrimal tear fluid was absorbed into pre-weighed absorbing paper strips, which were then immediately weighed again right after sampling to calculate the sample mass. Subsequently, MGF was extracted from the paper strips using a mixture of methanol : acetic acid 0.6% (35:65, v/v). The extracted solution was finally injected into an HPLC system for MGF analysis (RP-column C18 - 4.6 x 250 mm, 5 μm was stabilised at 40oC; moblie phase methanol : acetic acid 0.6%; 35 : 65 (v/v) at a flow rate of 1.0 mL/min; autosampler, injection volume 10 µL; detection wavelength: 258 nm). The developed methodology was validated following the U.S. FDA and ICH M10 guidances for bioanalytical method validation, with respect to system suitability, linearity, recovery, accuracy and precision, dilution integrity and stability. The method was also successfully employed to determine MGF concentration in the tear fluid collected from rabbit eyes at one hour after instilling with MGF suspension. The methodology herein provides a practical tool to investigate kinetics of MGF in tear fluid that can be applied in ophthalmic drug development as well as drug quality evaluation activities.

Investigation of the reasons for delayed presentation in proliferative diabetic retinopathy patients.

To investigate reasons for delayed presentation in patients with proliferative diabetic retinopathy (PDR). A questionnaire was designed to investigate consecutive PDR patients with delayed presentation who visited our center between January 2021 and December 2021. The questionnaire was divided into four sections: knowledge regarding diabetic retinopathy (DR), attitude toward DR treatment, difficulties adhering to follow-up plans, and medical care. The systemic disease status and severity of DR were recorded. Logistic analysis was undertaken to investigate DR treatment refusal and delay factors. A total of 157 patients were included in this study, with an average age of 50.0 ± 11.6 years. The median glycated hemoglobin level (HbA1c) was 7.8% (IQR 2.5%). Among the 157 eyes, most required vitrectomy intervention (144, 91.7%); 17 developed neovascular glaucoma (NVG), while only 13 required additional photocoagulation. Among the 36 patients with undiagnosed DM, the reason for delayed DR presentation was a lack of awareness of DM status among these patients (36 cases, 100.0%). Most of the patients with a known history of DM exhibited inadequate DR knowledge (29, 24.0%), believed their good visual acuity did not require DR screening (98, 81.0%), and had poorly controlled diabetes (113, 93.3%). Factors related to refusing DR treatment were patients with an inability to receive regular diabetes treatment in internal medicine clinics (OR 6.78, 95% CI 1.73-26.59, p = 0.006), patients who could not tolerate discomfort during ophthalmic examination and treatment (OR 15.15, 95% CI 2.70-83.33, p<0.001), and patients who did not have any retinal abnormalities detected and were not informed about the need for regular screening (OR 2.05, 95% CI 1.36-3.09, p<0.001). This study investigated the factors contributing to delayed presentation among patients with PDR. Many individuals in the delayed population were found to have undiagnosed DM. Among patients already aware of their DM status, reasons for delay included insufficient knowledge about DR, negative attitudes toward screening and treatment, and difficulties seeking medical care in real-life situations. Furthermore, there needed to be more improvements in the detection, treatment, and follow-up of DR by internal medicine practitioners and ophthalmologists.