Search Results (658)

Molecular imaging and precision therapies are transforming ophthalmology, enabling earlier and more accurate diagnosis and targeted treatment of sight-threatening diseases. This review focuses on age-related macular degeneration, diabetic retinopathy, glaucoma, and uveitis, examining high-resolution imaging techniques such as optical coherence tomography (OCT), OCT angiography, MALDI-MSI, and spatial transcriptomics. Artificial intelligence supports these methods by improving image interpretation and enabling personalized analysis. The review also discusses therapeutic advances, including gene therapies (e.g., AAV-mediated RPE65 delivery), stem cell-based regenerative approaches, and biologics targeting inflammatory and neovascular processes. Targeted molecular therapies targeting specific signaling pathways, such as MAPK, are also explored. The combination of single-cell transcriptomics, proteomics, and machine learning facilitates the development of personalized treatment strategies. Although these technologies hold enormous potential, their implementation in routine clinical care requires further validation, regulatory approval, and long-term safety assessment. This review highlights the potential and challenges of integrating molecular imaging and advanced therapies in the future of precision ophthalmic medicine. Full article

Background/Objectives: Epiretinal membrane (ERM) is often associated with macular thickening and foveal intraretinal fluid. The aim of this study was to evaluate the efficacy of early postoperative SMLT (577 nm) in preventing persistent macular oedema and to assess its impact on selected functional and morphometric retinal parameters after ERM peeling. Methods: A total of 68 pseudophakic patients with ERMs were enrolled and randomly assigned (1:1) to a laser group or a nonlaser control group. SMLT was performed one month after PPV. The functional and morphometric retinal parameters were assessed preoperatively and at one and four months postoperatively via optical coherence tomography (OCT), OCT angiography (OCTA), multifocal electroretinography (mfERG), and microperimetry. Results: The reduction in total retinal volume between the first and fourth postoperative months was significantly greater in the SMLT group than in the control group (p = 0.02). No significant differences in functional parameters were found between the groups. A more substantial reduction in total retinal volume post-SMLT was associated with greater baseline macular thickness, a more advanced ERM stage, worse baseline visual acuity, greater fixation stability, lower initial macular sensitivity and lower preoperative p-wave amplitude in ring R1 on mfERG. Conclusions: SMLT may be considered a therapeutic option in patients with advanced ERM stages and low preoperative visual acuity. Full article

Syphilis is a systemic infection with a broad spectrum of ocular involvement that can affect every segment of the eye. Clinical presentations range from interstitial keratitis, conjunctivitis, episcleritis, and scleritis to anterior, intermediate, and posterior uveitis; acute syphilitic posterior placoid chorioretinitis; retinitis; retinal vasculitis; neuroretinitis; optic neuritis; exudative retinal detachment; and optic nerve dysfunction. These manifestations may occur at any stage of infection and are frequently nonspecific, contributing to diagnostic delays. Diagnosis requires a high index of suspicion and is established by combined non-treponemal and treponemal serologic testing, with cerebrospinal fluid analysis when neurosyphilis is suspected. Multimodal imaging, including optical coherence tomography, fluorescein angiography, fundus autofluorescence, and visual field testing, enhances the detection of subclinical and atypical diseases. Management mandates prompt intravenous penicillin G, with adjunctive corticosteroids to mitigate Jarisch–Herxheimer reactions and control inflammation; ceftriaxone or doxycycline serve as alternatives for penicillin-allergic patients. Long-term follow-up with serial serologies and neurologic evaluation is essential to detect relapse or progression to neurosyphilis. Despite effective therapy, diagnostic delays contribute to irreversible visual loss in a significant proportion of cases. This review integrates current knowledge on ocular syphilis, emphasizing its varied presentations and the importance of early recognition to prevent vision-threatening complications, and calls for multidisciplinary, mechanism-based research to optimize outcomes. We conducted a literature search in Pubmed and Embase for articles published between 2000 and 2025, using the terms “ocular syphilis,” “syphilitic uveitis,” and “neurosyphilis,” with a focus on epidemiology, clinical features, diagnostics, therapeutics, and co-infections. Full article

Introduction: This pilot study aimed to test the feasibility of a novel vectorial image analysis method to quantify coronal microvascular displacement in different retinal plexuses in intermediate age-related macular degeneration (iAMD) over 6 months. Material and methods: A retrospective series of iAMD patients with at least 6-month follow-up was included if they had complete medical records, best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCT angiography (OCTA). En-face (coronal) vascular displacement between baseline and 6 months was assessed in the superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) using the Farneback motion tracking algorithm applied to consecutive OCTA scans. Results: Eighteen eyes of 18 iAMD patients met the inclusion criteria. Average coronal vascular displacement (T₀–T₆) was 13.7 ± 7.72 µm for the SCP, 15.11 ± 10.06 µm for the DCP, and 19.02 ± 12.25 µm for the CC slab. Reticular pseudodrusen (RPD) was associated with greater displacement in the DCP (p = 0.047), but not in the SCP (p = 0.980) or CC (p = 0.473). Quantitative analysis confirmed the highest DCP displacement in RPD eyes (66.7%, p = 0.02), while drusenoid pigment epithelial detachment showed the greatest reorganization in the CC (100%, p = 0.02). Discussion: Retinal vessels undergo significant tangential displacement in iAMD, suggesting a structural reorganization of the microvasculature. Such remodeling may constitute a compensatory response to ultrastructural alterations resulting in ischemia. Full article

With the use of Optical Coherence Tomography Angiography (OCTA), the present study is the first study to examine if retinal vascular densities (vessel densities and perfusion densities) could be associated with empathetic levels in young and non-clinical adults. Methods: Fifty-one university students aged from 18 to 25 years (26 males and 24 females) were recruited from a university in Hong Kong. OCTA was conducted to assess their retinal vessel density (VD) and perfusion density (PD) in different scan patterns over the macula (1 mm center subfield, 3 × 3 mm scan, 6 × 6 mm scan). Empathy (cognitive, affective, and somatic) was measured by using the Cognitive, Affective, and Somatic Empathy Scales (CASES). Results: After controlling for age, the multiple linear regression results showed that both the VD and PD in the 1 mm center subfield were significantly and negatively associated with the empathy total score, the affective empathy subscore, and the somatic empathy subscore, respectively (ps < 0.05). Conclusion: The present findings indicate that a lower level of empathy is associated with increased retinal vascular densities in the 1 mm center subfield, specifically involving variations in vascular density (VD) and perfusion density (PD). This suggests the dilation of retinal venules might lead to lower empathy. These results establish a foundation for future studies investigating the underlying mechanism of retinal imaging and empathy in healthy individuals. Full article

Background/Objectives: The aim of this study was to evaluate the relationship between foveal avascular zone (FAZ) enlargement, retinal ganglion cell (RGC) dysfunction, and structural retinal measurements in glaucoma suspects (GS), using pattern electroretinogram (PERG) and optical coherence tomography angiography (OCTA) parameters. Methods: Thirty-one eyes (20 subjects) of GS status underwent comprehensive ophthalmologic evaluation including steady-state PERG, optical coherence tomography (OCT), and OCTA. FAZ area was measured using ImageJ software (version 1.54p), and PERG parameters (Magnitude, MagnitudeD, and MagnitudeD/Magnitude ratio) were analyzed. Partial correlation analyses were performed to assess associations between FAZ area, PERG parameters, and structural metrics including retinal nerve fiber layer (RNFL), ganglion cell layer–inner plexiform layer (GCL + IPL), and macular thickness. Results: After controlling for age, sex, central corneal thickness (CCT), intraocular pressure (IOP), and spherical equivalent, partial correlation analysis showed that FAZ area was significantly associated with both lower Magnitude (r < −0.503, p < 0.05) and MagnitudeD (r < −0.507, p < 0.05) values. PERG parameters were significantly correlated with superior and average RNFL thickness, as well as superior and superior temporal GCL + IPL thickness. FAZ area was significantly associated with multiple GCL + IPL and macular thickness sectors, but not with RNFL thickness. Conclusions: FAZ enlargement is significantly associated with RGC dysfunction and inner retinal layer thinning in GS. Full article

Purpose: To systematically review the evidence regarding the characteristics of Optical Coherence Tomography Angiography (OCTA) in acute retinal arterial occlusion (RAO), with a particular focus on vascular alterations across the superficial and deep capillary plexuses, choroid, and peripapillary regions. Methods: A comprehensive literature search was performed across PubMed, Web of Science, Scopus, EMBASE, Google Scholar, and the Cochrane Database up to April 2025. The search terms included “Optical coherence tomography angiography,” “OCTA,” “Retinal arterial occlusion,” “Central retinal artery occlusion,” and “Branch retinal artery occlusion.” Studies were included if they evaluated the role of OCTA in diagnosing or assessing acute RAO. Case reports, conference abstracts, and non-English articles were excluded. Two reviewers independently conducted the study selection and data extraction. The methodological quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Results: The initial search yielded 457 articles, from which 10 studies were ultimately included in the final analysis after a rigorous screening process excluding duplicates, non-English publications, and ineligible articles based on title, abstract, or full-text review. The included studies consistently demonstrated that OCTA is a valuable, noninvasive modality for evaluating microvascular changes in RAO. Key OCTA findings in acute RAO include significant perfusion deficits and reduced vessel density in both the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Several studies noted more pronounced involvement of the SCP compared to the DCP. OCTA parameters, such as vessel density in the macular region, have been found to correlate with visual acuity, suggesting a prognostic value. While findings regarding the foveal avascular zone (FAZ) were mixed, the peripapillary area frequently showed reduced vessel density. Conclusion: Acute RAO is an ocular emergency that causes microvascular ischemic changes detectable by OCTA. This review establishes OCTA as a significant noninvasive tool for diagnosing, monitoring, and prognosticating RAO. It effectively visualizes perfusion deficits that correlate with clinical outcomes. However, limitations such as susceptibility to motion artifacts, segmentation errors, and the lack of standardized normative data must be considered. Future standardization of OCTA protocols and analysis is essential to enhance its clinical application in managing RAO. Full article

Background and Clinical Significance: Ischemic optic neuropathies (IONs) are significant causes of vision loss resulting from compromised blood flow to the optic nerve. Diabetes mellitus (DM) exacerbates the risk of IONs through chronic hyperglycemia and associated vascular dysfunction. Recently, semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has been linked to ocular complications, including non-arteritic anterior ischemic optic neuropathy (NAION), potentially due to the rapid glycemic changes or vascular effects. Case Presentation: A 55-year-old female with type 2 DM, hypertension, and hyperlipidemia presented with blurred vision and optic disc edema after four months of semaglutide therapy (Ozempic^®, Sydney, Australia). Initially diagnosed with diabetic papillopathy (DP), her condition progressed to NAION, leading to partial visual recovery with corticosteroid treatment and improved glycemic management. Diagnostic evaluations, including visual field testing, optical coherence tomography, and fluorescein angiography, supported the diagnosis. Conclusions: This case report describes the clinical course of a diabetic patient treated with a semaglutide who developed an ischemic optic event. The timing of symptom onset in relation to the initiation of semaglutide therapy raises the possibility of a causal association between the drug and this rare ocular complication. Close monitoring of ocular health is crucial for patients on GLP-1 receptor agonists, particularly those with pre-existing vascular risk factors. Further research is needed to elucidate the underlying mechanisms and guide clinical practice. Full article

Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize atherosclerotic plaques was demonstrated in an in vitro study, and the following year marked the acquisition of the first in vivo OCT image of a human coronary artery. A major milestone followed in 2000, with the first intracoronary imaging in a living patient using time-domain OCT. However, the real inflection point came in 2006 with the advent of frequency-domain OCT, which dramatically improved acquisition speed and image quality, enabling safe and routine imaging in the catheterization lab. With the advent of high-resolution, second-generation frequency-domain systems, OCT has become clinically practical and widely adopted in catheterization laboratories. OCT progressively entered interventional cardiology, first proving its safety and feasibility, then demonstrating superiority over angiography alone in guiding percutaneous coronary interventions and improving outcomes. Today, it plays a central role not only in clinical practice but also in cardiovascular research, enabling precise assessment of plaque biology and response to therapy. With the advent of artificial intelligence and hybrid imaging systems, OCT is now evolving into a true precision-medicine tool—one that not only guides today’s therapies but also opens new frontiers for discovery, with vast potential still waiting to be explored. Tracing its historical evolution from ophthalmology to cardiology, this narrative review highlights the key technological milestones, clinical insights, and future perspectives that position OCT as an indispensable modality in contemporary interventional cardiology. As a guiding thread, the myth of Prometheus is used to symbolize the evolution of OCT—from its illuminating beginnings in ophthalmology to its transformative role in cardiology—as a metaphor for how light, innovation, and knowledge can reveal what was once hidden and redefine clinical practice. Full article

Background: Despite advances in coronary artery disease (CAD) treatment, challenges persist, particularly in complex lesions. While percutaneous coronary intervention (PCI) is widely used, its outcomes can be affected by complications like restenosis. Optical coherence tomography (OCT), offering higher-resolution imaging than angiography, shows promise in guiding PCI. However, meta-analytical comparisons between OCT-guided and angiography-guided PCI remain limited. Methods: Databases, including PubMed, Scopus, Cochrane Library, and ClinicalTrials.gov, were queried through May 2025 to identify randomized controlled trials (RCTs) comparing OCT-guided PCI with angiography-guided PCI. Data were pooled using risk ratios (RRs) and mean difference (MD) with 95% confidence intervals (CIs) in a random-effects model. Results: Five RCTs involving 5737 patients (OCT: 2738 and angiography: 2999) were included. On pooled analysis, OCT-guided PCI was associated with a notable reduction in major adverse cardiovascular event (MACE) (RR: 0.71, p = 0.0001), cardiac mortality (RR: 0.43, p = 0.003), target lesion revascularization (TLR) (RR: 0.53, p = 0.007), and stroke (RR: 0.17, p = 0.02), compared to angiography-guided PCI. No significant differences were noted for all-cause mortality and myocardial infarction. Conclusions: In patients with complex coronary lesions, OCT-guided PCI reduces the risk of MACE, cardiac mortality, TLR, and stroke, compared to angiography-guided PCI only. This study supports incorporating advanced imaging techniques like OCT to improve clinical outcomes, especially in complex PCIs. Full article

Background/Objectives: Diabetic macular edema (DME) is the primary cause of vision loss in people with diabetes, and if untreated, it can result in irreversible macular damage. Both fluorescein angiography (FA), the gold standard, and optical coherence tomography angiography (OCTA) are used for evaluation of this disease. The objective of this study was to compare the diagnostic value of both. Methods: We conducted a comparative analysis of 98 patients aged 18–80 years with significant DME and best-corrected visual acuity ≥0.1 according to the Snellen chart. Participants underwent glycated hemoglobin blood test (HbA1c) and ophthalmological examinations, including OCTA and FA. OCTA 3 × 3 mm scans of superficial (SCP) and deep capillary plexus (DCP) along with FA scans were exported to the Gimp computer program. Size of the foveal avascular zone (FAZ), the number of visible microaneurysms (MAs), and ETDRS report number 11 classification of the images were assessed. Results: FAZ size differed significantly in superficial plexus (0.41 mm²), deep plexus (0.43 mm²) OCTA, and FA (0.38 mm²) (p < 0.001). FAZ size in DCP OCTA closely correlated with that of FA (τ = 0.79, p < 0.001). The total number of MAs visualized in the OCTA was significantly lower than in FA (p < 0.001). ETDRS classification of scans revealed that the level of consistency between the examinations was moderate to very strong. Conclusions: OCTA may be useful in evaluating macular ischemia. It is less sensitive in detecting MAs in DME eyes. FAZ has sharper boundaries and is larger when measured in OCTA. Poor glycemic control results in higher incidence of MAs in macula. Full article

Background/Objectives: This study aimed to prospectively assess the incidence of retinal embolization and to evaluate the vascular and structural changes in the retina and choroid in 52 patients with asymptomatic severe carotid artery disease who underwent carotid artery revascularization. Methods: In our study, 35 patients underwent carotid endarterectomy (CEA) and 17 underwent carotid artery stenting (CAS). Biomicroscopy, fundoscopy, optical coherence tomography (OCT), and OCT-angiography (OCTA) were performed at baseline and 1 month after revascularization. Results: The subfoveal choroidal thickness (SFCT), peripapillary choroidal thickness inferior to the optic nerve head (ppCTi), total overall average retinal vascular density (rVDtot), and total overall average choriocapillaris vascular density (ccVDtot) of the eyes ipsilateral to the operated carotid artery increased significantly after revascularization, whereas a statistically significant increase was also found in the SFCT, rVDtot, and ccVDtot of the contralateral eyes in the overall cohort. Comparing the two study groups, we found that the SFCT, superior and inferior peripapillary choroidal thicknesses (ppCTs, ppCTi), rVDtot, and ccVDtot increased in both groups after revascularization, but significantly only in the CEA group. Furthermore, the temporal choriocapillaris vascular density (ccVDt) increased significantly after revascularization in both groups to a similar degree. Conclusions: Carotid artery revascularization led to a statistically significant increase in retinal and choroidal vascular densities, which indicates significantly improved ocular perfusion. The analysis of the findings of the two study groups suggests the superiority of CEA in terms of improving ocular perfusion in asymptomatic severe carotid artery disease. The rate of retinal embolization was similar in both surgical groups. Full article

Coronary plaque vulnerability, more than luminal stenosis, drives acute coronary syndromes. Optical coherence tomography (OCT), intravascular ultrasound (IVUS), and coronary computed tomography angiography (CCTA) visualize plaque morphology in vivo, but manual interpretation is time-consuming and operator-dependent. We performed a narrative literature survey of artificial intelligence (AI) applications—focusing on machine learning (ML) architectures—for automated coronary plaque segmentation and risk characterization across OCT, IVUS, and CCTA. Recent ML models achieve expert-level lumen and plaque segmentation, reliably detecting features linked to vulnerability such as a lipid-rich necrotic core, calcification, positive remodelling, and a napkin-ring sign. Integrative radiomic and multimodal frameworks further improve prognostic stratification for major adverse cardiac events. Nonetheless, progress is constrained by small, single-centre datasets, heterogeneous validation metrics, and limited model interpretability. AI-enhanced plaque assessment offers rapid, reproducible, and comprehensive coronary imaging analysis. Future work should prioritize large multicentre repositories, explainable architectures, and prospective outcome-oriented validation to enable routine clinical adoption. Full article

Background: Early neurovascular unit (NVU) impairment plays a critical role in the pathogenesis of diabetic retinopathy (DR), often preceding clinically detectable changes. Butyrate, a short-chain fatty acid (SCFA) derived from gut microbiota, has shown promising metabolic and anti-inflammatory effects. Methods: This study investigated the protective potential of oral butyrate supplementation in a mouse model of early type 2 diabetes mellitus (T2DM) induced by a high-fat diet and streptozotocin. Mice (C57BL/6J) received sodium butyrate (5 g/L in drinking water) for 12 weeks. Retinal NVU integrity was assessed using widefield swept-source optical coherence tomography angiography (WF SS-OCTA), alongside evaluations of systemic glucose and lipid metabolism, hepatic steatosis, visual function, and gut microbiota composition via 16S rRNA sequencing. Results: Butyrate supplementation significantly reduced body weight, fasting glucose, serum cholesterol, and hepatic lipid accumulation. Microbiome analysis demonstrated a partial reversal of gut dysbiosis, characterized by increased SCFA-producing taxa (Ruminococcaceae, Oscillibacter, Lachnospiraceae) and decreased pro-inflammatory, lipid-metabolism-related genera (Rikenella, Ileibacterium). KEGG pathway analysis further revealed enrichment in microbial lipid metabolism functions (fabG, ABC.CD.A, and transketolase). Retinal vascular and neurodegenerative alterations—including reduced vessel density and retinal thinning—were markedly attenuated by butyrate, as revealed by WF SS-OCTA. OKN testing indicated partial improvement in visual function, despite unchanged ERG amplitudes. Conclusions: Butyrate supplementation mitigates early NVU damage in the diabetic retina by improving glucose and lipid metabolism and partially restoring gut microbial balance. This study also underscores the utility of WF SS-OCTA as a powerful noninvasive tool for detecting early neurovascular changes in DR. Full article

Diabetic retinopathy (DR), a leading cause of blindness in working-age adults, arises from chronic hyperglycemia-induced oxidative stress, inflammation, and vascular dysfunction. Current therapies such as laser photocoagulation, intravitreal anti-vascular endothelial growth factor (VEGF) agents, and steroids target advanced stages but fail to prevent early neuronal and microvascular damage. Emerging evidence highlights oxidative stress as a key driver of DR pathogenesis, disrupting the blood-retinal barrier (BRB), promoting neurodegeneration and angiogenesis. Advances in imaging, particularly optical coherence tomography angiography (OCTA), enable earlier detection of neurodegeneration and microvascular changes, underscoring DR as a neurovascular disorder. Polyphenols, such as resveratrol, curcumin, and pterostilbene, exhibit multitarget antioxidant, anti-inflammatory, and anti-angiogenic effects, showing promise in preclinical and limited clinical studies. However, their low bioavailability limits therapeutic efficacy. Nanotechnology-based delivery systems enhance drug stability, tissue targeting, and sustained release, offering potential for early intervention. Future strategies should integrate antioxidant therapies and precision diagnostics to prevent early irreversible retinal damage in diabetic patients. Full article