Search Results (140)

Cataracts cause vision loss in rabbits, often either spontaneously or as secondary to uveitis. This study considers the ophthalmic presentation, treatment, and outcome of phacoemulsification in seven pet rabbits: six presenting with lens cloudiness and one presenting with a white mass in the iris. Ophthalmic examinations revealed cataracts. The treatment plan was phacoemulsification. Encephalitozoon cuniculi was identified via an enzyme-linked immunosorbent assay technique performed on all rabbits. Ocular ultrasonography was performed to rule out retinal detachment. Phacoemulsification using the one-handed technique without intraocular lens implantation was performed in 8 of the eyes of the 7 rabbits. After surgery, the corneal wounds healed within 2 weeks. All rabbits were comfortable with opening their eyes and had a positive dazzle reflex and a clear visual axis, with no other severe complications (such as retinal detachment, intraocular hemorrhaging, or uncontrolled glaucoma) throughout the post-operative period. Postoperative complications consisted of corneal edema around the surgical wound (2 eyes; 25%); partial anterior synechiae (1 eye; 12.5%); partial posterior synechiae (5 eyes; 3 eyes before surgery and 2 eyes after surgery; 25%); posterior capsular opacities (3 eyes; 37.5%); and lens fiber overgrowths (2 eyes; 25%). In conclusion, successful phacoemulsification was achieved in the seven pet rabbits. Full article

Background/Objectives: We report the development of a novel intraocular sustained-release implantable pharmaceutical formulation, designed to be placed in the anterior chamber of the eye after cataract surgery. The device is intended to reduce postoperative inflammation, and to prevent opportunistic bacterial infections that may lead to endophthalmitis. Methods: The implants were produced via hot-melt extrusion, using a twin-screw extruder to process a homogeneous mixture of polylactide-co-glycolic acid, moxifloxacin hydrochloride (MOX HCl) and dexamethasone (DEX). Quality control tests included drug content determination, release rate profile evaluation, and several instrumental characterization techniques (scanning electron microscopy (SEM), confocal Raman microscopy, differential scanning calorimetry, and X-ray diffraction). Long-term and accelerated stability tests were also performed, following ICH guidelines. Sterilization was achieved by exposing samples to gamma radiation. In vivo exploratory studies were carried out in healthy rabbits to evaluate the safety and overall performance of the implantable formulation. Results: In terms of quality control, drug content was found to be homogeneously distributed throughout the implants, and it also met the label claim. In vitro release rate was constant for MOX HCl, but non-linear for DEX, increasing over time. In vivo preliminary tests showed that the inserts completely biodegraded within approximately 20 days. No clinical signs of anterior segment toxic syndrome or statistically significant intraocular pressure differences were found between treatment and control groups. Conclusions: The implants developed in this study can act as sustained-release depots for the delivery of both DEX and MOX HCl, and are biocompatible with ocular structures. Full article

Background/Objectives: The objective of this study is to compare the optical and visual quality provided by the advanced monofocal intraocular lens (IOL) ISOPure and the standard monofocal IOL MicroPure in cataract patients, using objective and subjective assessments. Methods: This prospective, single-blind clinical study includes 28 patients with cataracts, bilaterally implanted with either the ISOPure or MicroPure IOL. Eligible eyes had no ocular comorbidities and regular corneal astigmatism ≤ 1.00 D. Three months postoperatively, uncorrected distance and intermediate (UDVA, UIVA) and corrected distance and intermediate (CDVA, DCIVA) visual acuities were measured at 4 m, 80 cm, and 66 cm under photopic (85 cd/m²) and mesopic (3.5 cd/m²) conditions. Photic phenomena, including halo and glare, were evaluated. Objective optical quality was assessed using Objective Scattering Index (OSI), Modulation Transfer Function (MTF), Strehl Ratio (SR), and ocular aberrations. Subjective patient satisfaction was evaluated using Quality of Vision (QoV) and Catquest-9SF questionnaires. Results: Under photopic conditions, logMAR DCIVA at 80 cm, UIVA at 66 cm, and DCIVA at 66 cm were 0.18 ± 0.06, 0.25 ± 0.12, and 0.20 ± 0.13, respectively, for ISOPure, and 0.22 ± 0.06, 0.30 ± 0.09, and 0.25 ± 0.09 for MicroPure (p = 0.05, 0.02, and 0.05, respectively). No significant differences were observed in halo/glare size or intensity, OSI, MTF, or SR. However, statistically significant differences were found in higher-order total aberrations for pupil sizes of 3.0, 4.0 mm, and 5.0 mm. Questionnaires indicated greater satisfaction and functional intermediate vision with ISOPure. Conclusions: The ISOPure IOL offers superior intermediate vision without compromising distance vision, delivering a balanced combination of optical quality, functional performance, and patient satisfaction. Full article

Background/Objectives: Age-related macular degeneration (AMD) is a leading cause of visual impairment in older adults and often coexists with cataracts. The indication of presbyopia-correcting intraocular lenses (IOLs) in these patients remains controversial. This study aimed to evaluate the clinical performance of a non-diffractive extended depth-of-focus (EDOF) IOL (LuxSmart™) compared to a monofocal plus IOL (Tecnis Eyhance™) in cataract patients with early-stage dry AMD. Methods: In this prospective observational study, 41 patients with early-stage AMD underwent bilateral cataract surgery with either LuxSmart™ or Tecnis Eyhance™ IOL implantation, targeting postoperative emmetropia. The eye selected for analysis was the first eye scheduled for surgery. Preoperative and postoperative evaluations included high and low-contrast distance visual acuity, intermediate and near visual acuity, defocus curves, ocular light scatter (halometry), and quality of life assessment (NEI VFQ-25). Postoperative biometric accuracy and refractive outcomes were also analyzed. Results: Both IOLs showed high refractive accuracy, with 100% of eyes within ±0.50 D of target. Postoperative uncorrected distance visual acuity was 0.10 ± 0.06 LogMAR for Eyhance and 0.07 ± 0.02 for LuxSmart (p = 0.06). Low contrast VA at 20% was 0.22 ± 0.11 (Eyhance) and 0.26 ± 0.16 (LuxSmart) (p = 0.49). Depth of focus was approximately 1.75 D for both lenses. Light scatter (LDI) improved postoperatively in both groups with no significant differences (p = 0.54). VFQ-25 scores showed improvement in daily activities, though no changes were observed in driving or mental health domains. Conclusions: Both lenses are safe and effective options for early AMD patients undergoing cataract surgery, providing good functional vision at multiple distances Full article

Background/Objectives: Orbital reconstruction remains one of the most demanding procedures in maxillofacial surgery. It requires not only precise anatomical knowledge but also poses multiple intraoperative challenges. Limited surgical visibility—especially in transconjunctival or transcaruncular approaches—demands exceptional precision from the surgeon. At the same time, the complex anatomical structure of the orbit, its rich vascularization and innervation, and the risk of severe postoperative complications—such as diplopia, sensory deficits, impaired ocular mobility, or in the most serious cases, post-traumatic blindness due to nerve injury or orbital compartment syndrome—necessitate the highest level of surgical accuracy. In this context, patient-specific implants (PSIs), commonly fabricated from zirconium oxide or ultra-high-density polyethylene, have become invaluable. Within CAD-based reconstructive planning, especially for orbital implants, critical factors include the implant’s anatomical fit, passive stabilization on intact bony structures, and non-interference with orbital soft tissues. Above all, precise replication of the orbital dimensions is essential for optimal clinical outcomes. This study compares the morphological accuracy of orbital structures based on anthropometric measurements from 3D models generated from fan-beam computed tomography (FBCT) and cone-beam computed tomography (CBCT). Methods: A cohort group of 500 Caucasian patients aged 8 to 88 years was analyzed. 3D models of the orbits were generated from FBCT and CBCT scans. Anthropometric measurements were taken to evaluate the morphological accuracy of the orbital structures. The assessed parameters included orbital depth, orbital width, the distance from the infraorbital rim to the infraorbital foramen, the distance between the piriform aperture and the infraorbital foramen, and the distance from the zygomatico-orbital foramen to the infraorbital rim. Results: Statistically significant differences were observed between virtual models derived from FBCT and those based on CBCT in several key parameters. Discrepancies were particularly evident in measurements of orbital depth, orbital width, the distance from the infraorbital rim to the infraorbital foramen, the distance between the piriform aperture and the infraorbital foramen, and the distance from the zygomatico-orbital foramen to the infraorbital rim. Conclusions: The statistically significant discrepancies in selected orbital dimensions—particularly in regions of so-called thin bone—demonstrate that FBCT remains the gold standard in the planning and design of CAD/CAM patient-specific orbital implants. Despite its advantages, including greater accessibility and lower radiation dose, CBCT shows limited reliability in the context of orbital and infraorbital reconstruction planning. Full article

Diabetic retinopathy (DR) is a progressive, multifactorial complication of diabetes and one of the major global causes of visual impairment. Its pathogenesis involves chronic hyperglycaemia-induced oxidative stress, inflammation, mitochondrial dysfunction, neurodegeneration, and pathological angiogenesis, as well as emerging systemic contributors such as gut microbiota dysregulation. While current treatments, including anti-vascular endothelial growth factor (anti-VEGF) agents, corticosteroids, and laser photocoagulation, have shown clinical efficacy, they are largely limited to advanced stages of DR, require repeated invasive procedures, and do not adequately address early neurovascular and metabolic abnormalities. Resveratrol (RSV), a naturally occurring polyphenol, has emerged as a promising candidate due to its potent antioxidant, anti-inflammatory, neuroprotective, and anti-angiogenic properties. This review provides a comprehensive analysis of the molecular mechanisms by which RSV exerts protective effects in DR, including modulation of oxidative stress pathways, suppression of inflammatory cytokines, enhancement of mitochondrial function, promotion of autophagy, and inhibition of pathological neovascularisation. Despite its promising pharmacological profile, the clinical application of RSV is limited by poor aqueous solubility, rapid systemic metabolism, and low ocular bioavailability. Various routes of administration, including intravitreal injection, topical instillation, and oral and sublingual delivery, have been investigated to enhance its therapeutic potential. Recent advances in drug delivery systems, including nanoformulations, liposomal carriers, and sustained-release intravitreal implants, offer potential strategies to address these challenges. This review also explores RSV’s role in combination therapies, its potential as a disease-modifying agent in early-stage DR, and the relevance of personalised medicine approaches guided by metabolic and genetic factors. Overall, the review highlights the therapeutic potential and the key translational challenges in positioning RSV as a multi-targeted treatment strategy for DR. Full article

Objectives: The aim was to present the complicated diagnostic and therapeutic process of atypical, painless keratitis caused by a cosmopolitan protozoan of the genus Acanthamoeba. Methods: This Case Report describes a medical case involving a 48-year-old woman who occasionally wears soft contact lenses and was referred to our hospital for treatment due to deteriorating visual acuity in her left eye. The diagnostic process included the isolation of amoebae from corneal scrapings and the morphological and molecular identification of the etiological agent of the infection. Results: After examination, painless atypical keratitis was diagnosed, initially considered recurrent herpetic keratitis. However, antiviral treatment did not bring about any improvement. Further observation revealed a dense, central, annular infiltrate on the periphery of the cornea. Despite treatment, the corneal infiltrate did not improve and the patient required therapeutic penetrating keratoplasty. Ultimately, the patient underwent combined surgery: corneal transplantation with cataract phacoemulsification and intraocular lens implantation. The postoperative course was uneventful. Conclusions: Acanthamoeba keratitis should be included in the differential diagnosis of keratitis, even in the absence of its characteristic feature of severe ocular pain, especially in contact lens wearers and patients who have had herpetic keratitis. Infection of the cornea with the Herpes simplex type 1 virus causes nerve degeneration, which probably translates into a painless course of Acanthamoeba castellanii infection. Full article

Microbial biofilms present a formidable challenge in ophthalmology. Their intrinsic resistance to antibiotics and evasion of host immune defenses significantly complicate treatments for ocular infections such as conjunctivitis, keratitis, blepharitis, and endophthalmitis. These infections are often caused by pathogens, including Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans, particularly in patients using contact lenses or intraocular implants—devices that serve as surfaces for biofilm formation. The global rise in antimicrobial resistance has intensified the search for alternative treatment modalities. In this regard, plant-derived antimicrobials have emerged as promising candidates demonstrating broad-spectrum antimicrobial and antibiofilm activity through different mechanisms from those of conventional antibiotics. These mechanisms include inhibiting quorum sensing, disrupting established biofilm matrices, and interfering with microbial adhesion and communication. However, the clinical translation of phytochemicals faces significant barriers, including variability in chemical composition due to environmental and genetic factors, difficulties in standardization and reproducibility, poor water solubility and ocular bioavailability, and a lack of robust clinical trials evaluating their efficacy and safety in ophthalmic settings. Furthermore, regulatory uncertainties and the absence of unified guidelines for approving plant-derived formulations further hinder their integration into evidence-based ophthalmic practice. This review synthesizes the current knowledge on the pathogenesis and treatment of biofilm-associated ocular infections, critically evaluating plant-based antimicrobials as emerging therapeutic agents. Notably, resveratrol, curcumin, abietic acid, and selected essential oils demonstrated notable antibiofilm activity against S. aureus, P. aeruginosa, and C. albicans. These findings support the potential of phytochemicals as adjunctive or alternative agents in managing biofilm-associated ocular infections. By highlighting both their therapeutic promise and translational limitations, this review contributes to the ongoing discourse on sustainable, innovative approaches to managing antibiotic-resistant ocular infections. Full article

Background/Objectives: Visual recovery after cataract surgery may be affected by lifestyle and environmental factors. This study aimed to investigate the association between daily outdoor activity and patient-reported visual outcomes after cataract surgery under perioperative management using cyclosporine and rebamipide. Methods: This retrospective study included 90 eyes from patients who underwent standardized cataract surgery with implantation of TECNIS Eyhance intraocular lenses. Patients were divided into two groups based on their average daily outdoor activity during the first postoperative month: Group 1 (≤3 h/day) and Group 2 (>3 h/day). Postoperative assessments included Cataract-related Visual Function Questionnaire (CVFQ) scores, uncorrected and corrected distance visual acuity, and ocular surface parameters such as tear breakup time, Oxford score, SICCA score, and OSDI. Results: Group 1 reported significantly higher CVFQ scores for daytime (p = 0.020) and night-time driving (p = 0.037) compared to Group 2, indicating lower levels of visual discomfort in these tasks. No significant differences were observed between the groups for other CVFQ subcategories or ocular surface parameters. Conclusions: Except for driving-related discomfort, no significant differences were found in CVFQ scores between the groups. No difference in ocular surface parameters can be attributed to the perioperative management using cyclosporine and rebamipide. CVFQ may be a useful tool for assessing subjective visual outcomes after cataract surgery. Full article

Purpose: This retrospective observational study evaluates the efficacy and safety of a novel scleral fixation technique of the fluocinolone acetonide (FAc) implant in four consecutive patients with post-surgical macular edema (PSME). Case Presentation: Four patients with PSME underwent intrascleral tunnel clamping (ITC) of the FAc implant due to lens defects. A 25-gauge sclerotomy was made 3.5 mm from the limbus and the implant was inserted into it until its end reached the edge of the sclera. Then, an 8-0 absorbable suture was passed through the sclera without penetrating the implant, thereby clamping the sclera around the FAc. All the patients showed improvements in best-corrected visual acuity (from a mean of 20/100 at baseline to 20/40) and central retinal thickness (from a mean of 534 µm at baseline to 318 µm) and with no recurrence of macular edema in most cases, without the need for further treatment. In addition, no anterior migration of the FAc implant or ocular hypertension was observed. This procedure effectively reduced the therapeutic burden for these patients. Although scleral fixation of the FAc implant has been described in small series of patients with successful results, this approach remains off-label. Conclusions: Although off-label, ITC of the FAc implant may offer a promising treatment option for patients who would otherwise remain untreated. Full article

Objective: The aim of this study was to evaluate the clinical outcomes of sutureless scleral-fixated (SSF) Soleko Fil Carlevale intraocular lens (SC-IOL) implants associated with pars plana vitrectomy (PPV) in patients with aphakia secondary to complicated cataract surgery or IOL luxation nationwide. Methods: A multicenter, national, retrospective study of 268 eyes (268 patients) which underwent simultaneous PPV and SC-IOL implantation was conducted. Demographics; ocular data; pre-surgical, surgical and post-surgical details; and refractive results were collected. Intra- and postoperative complications and management details were described. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) and central retinal thickness (CRT) were collected at 1 week and at 1, 3, 6 and 12 months post-surgery. Kaplan–Meier curves were constructed to assess the cumulative probability of postoperative BCVA, IOP levels, macular edema (ME) and corneal decompensation. Results: The cumulative probability of final VA ≤ 0.3 logMAR was 64.4% at 12 months follow-up. The probability of IOP > 21, ≥25 and ≥30 mmHg was 29.8%, 16.9% and 10.1%, respectively, and the cumulative probability of IOP-lowering treatment was 42.3% at 12 months. Glaucoma surgery was required in 3.7% of the eyes (10/268). The cumulative probability of postoperative ME development was 26.6% at 12 months, managed with topical treatment alone (73.5%) and intravitreal injections (26.5%). Corneal transplantation was required in 3.7% of the eyes (10/268). Conclusions: Sutureless scleral-fixated SC-IOL is an adequate therapeutic alternative in the management of aphakia with good visual results and an acceptable safety profile in routine clinical care. Longer-term studies are needed to evaluate its results and complications compared to other therapeutic alternatives. Full article

Background: Orbital floor blowout fractures (OFBF) can have serious consequences for the patient. Selecting the right treatment method and materials is essential. Krenkel’s maxillary sinus implant has been used successfully for more than 40 years in clinical practice. The aim of this study was to evaluate the long-term outcome of this implant compared to polydioxanone (PDS) sheets. Material and methods: This retrospective study examined a cohort of 82 OFBF patients over a seven-year period. Clinical and geometric data were collected. Defect size, location, and the volume of the herniated tissue were measured from conventional computer tomography (CT) or cone beam computer tomography (CBCT) scans. The relationship between ophthalmologic rehabilitation and treatment modality was analyzed using logistic regression. Results: The study included 82 patients, 28% female and 72% male, with a median age of 45.2 years. Defect size and hernia volume correlated with preoperative ophthalmological symptoms. At follow-up, 14.8% in the implant group and 28.6% in the PDS group showed mild visual impairment, with no severe diplopia. Conclusions: Our results suggest this method is a reliable and effective solution for repairing OFBFs and ophthalmologic rehabilitation. However, further research in a clinical controlled trial is needed. Full article

Background/Objectives: The aim of the study was to investigate the difference in operative times for iStent inject^® W (iStent) implantation based on variations in the gonio lens and with use of a surgical microscope or the NGENUITY^® 1.5 (Alcon Laboratories, Inc. Fort Worth, TX, USA) which is a digitally assisted surgery system). Methods: This retrospective study included patients who underwent iStent implantation performed by the same surgeon at Juntendo University Urayasu Hospital between January 2021 and December 2022. Participants were divided into Group M, which utilized a disposable gonio lens (Ocular Instruments, Washington, DC, USA) and the surgical microscope; Group A, which used Ahmed’s DVX Surgical Gonio lens^® (Ocular Instruments) and the surgical microscope; and Group D, which employed the disposable gonio lens and the NGENUITY^® system. The preparation and recovery times were retrospectively compared as the primary outcome across the three groups. Results: Preparation and recovery times were significantly shorter in Group A than those in the other two groups (both p < 0.01). There were no significant differences in preparation (p = 0.968) and recovery times (p = 0.841) between groups M and D. Conclusions: In iStent surgery, preparation and recovery times for angle observation were shorter with the Ahmed gonio lens than with the disposable gonio lens. No difference was observed between the surgical microscope and digitally assisted surgery methods. The Ahmed gonio lens is useful for surgeons who perform cataract surgery through an upper incision. Full article

Complex anatomical and physiological barriers make the eye a challenging organ to treat from a drug delivery perspective. Currently available treatment methods (topical eyedrops) for anterior segment diseases pose several limitations in terms of bioavailability and patient compliance. Conventional drug delivery methods to treat posterior segment ocular diseases are primarily intravitreal injection (IVT) of solutions. IVT is highly invasive and leads to retinal toxicity, endophthalmitis, and intraocular inflammation, frequently requiring professional administration and frequent clinical visits. Advanced drug delivery treatment strategies could improve patient compliance and convenience. Long-acting drug delivery platforms (biodegradable or nonbiodegradable) provide sustained/controlled release of drugs for at least four to six months. Smart drug delivery alternatives, for instance, in situ forming implants, are injectable formulations that form semisolid-to-solid implants in response to the various stimuli of pH, light, osmolarity, and temperature. Additionally, nanoparticulate drug delivery systems, contact lenses, electrospun patches, and microneedle-based drug delivery systems provide minimally invasive treatment options for ocular disorders. This comprehensive review focuses on advanced drug delivery options for the management of ocular disorders. Full article

Background/Objectives: This study aimed to compare the visual outcomes of two diffractive trifocal intraocular lenses (IOLs): the Bi-Flex Liberty 677MY (Medicontur; Zsámbék, Hungary) and the FineVision POD F (BVI Medical; Waltham, MA, USA). Methods: A prospective study with a 3-month follow-up was conducted. A total of 62 patients were divided into two groups according to the type of lens implanted: 31 patients with the Liberty lens (61.1 ± 6.4 years) and 31 patients with the Finevision lens (61.9 ± 6.8 years). Three measurement sessions were conducted (baseline, 1 month, and 3 months). These sessions included measurements of the subjective refraction, visual acuity, and defocus curve. Both eyes of each patient were operated on and included in the statistical analysis. Results: Three months after surgery, monocular visual acuity with the Liberty lens was statistically greater than with the Finevision lens at defocus values of −2.00 D (50 cm) and −2.50 D (40 cm) (p < 0.01). In this regard, the near visual acuity results (40–50 cm) with the Liberty lens showed greater variability compared to those of the Finevision lens. Binocularly, however, the Finevision lens demonstrated a statistically significant improvement in visual acuity than the Liberty lens at a defocus of −1.50 D (67 cm) (p = 0.01). Both IOLs provided visual acuities better than 0.20 logMAR for a defocus range from distance (0.00 D) to near (−3.50 D). Conclusions: Future studies are needed to investigate which patient ocular parameters could predict improved near vision with the Liberty lens or intermediate vision with the Finevision lens. Full article