Search Results (273)

Traumatic optic neuropathy (TON) causes vision loss through compression and contusion, yet there is no consensus on the most effective treatment. Polyunsaturated fatty acid (PUFA)-derived bioactive lipids metabolized by lipoxygenase (LOX), cytochrome P450 (CYP), and cyclooxygenase (COX) enzymes are known mediators of inflammation and neurodegeneration. However, their role in TON-related retinal pathology remains unclear. Controlled orbital impact (COI) was used to induce unilateral TON in mice with controlled velocity (2–3 m/s), with the fellow eye serving as an internal control. Retina tissues were collected three days post-injury and analyzed by LC/MS to quantify bioactive lipid metabolites from ω−6 and ω−3 PUFAs. Statistical analysis was performed using paired, nonparametric Wilcoxon signed-rank tests with Benjamini–Hochberg false discovery rate (FDR) correction. Results showed that among 38 reliably detected metabolites, no individual lipid showed a statistically significant difference between TON and control eyes after FDR correction (q < 0.05). However, both individual and pathway-level analysis revealed consistent trends toward increased expression of LOX- and CYP-derived metabolites across FDA PUFA substrates, including arachidonic acid (AA), linoleic acid (LA), and docosahexaenoic acid (DHA). These findings support further investigation into lipid-mediated inflammation in TON and its potential as a therapeutic target, particularly through expanding both the sample size and the post-TON time periods. Full article

Background/Objectives: Diabetic retinopathy (DR) develops from the interplay of vascular, inflammatory, and neurodegenerative processes. Citicoline, a natural compound essential for cell membranes, enhances neurotransmitter levels, has a neuroprotective effect, reduces oxidative stress by increasing glutathione, and decreases glutamate toxicity. Studies suggest that a citicoline liposomal formulation (eye drops) may prevent diabetes-induced retinal neurodegeneration. This study aimed to evaluate the impact of citicoline eye drops on the clinical signs of DR in clinical settings. Methods: More than 100 patients with nonproliferative DR (NPDR) were selected consecutively from the DR screening program and included in this real-life prospective observational clinical study. Each patient underwent color-fundus photography of two fields (macular field and disk/nasal field) in both eyes using a standard 45° fundus camera. Patients were prescribed citicoline eye drops and followed for a period of one year or longer. Results: In 4 patients with NPDR and macular hard exudates, the application of citicoline (Omk1^®) eye drops three times a day for at least six months to a year resulted in a reduction or complete disappearance of hard exudates. Conclusions: Our study, to the best of our knowledge, is the first one that establishes a clinically positive effect of citicoline eye drops on hard exudates in DR. However, to support the potential value of citicoline in the treatment of DR, the conclusions of this study still need to be confirmed by statistical analysis of a larger sample size and prospective studies with longer follow-up periods. Full article

Background: Rhegmatogenous retinal detachment (RRD), the most common type of retinal detachment, requires prompt surgery to reattach the retina and avoid permanent vision loss. While surgical treatment is adapted to each individual case, one frequent option is pars plana vitrectomy (PPV) with silicone oil (SO) tamponade. Despite achieving anatomical success (complete retinal attachment), concerns persist regarding potential microvascular alterations in the retina and choroid, with a negative impact on visual function. Optical coherence tomography angiography (OCTA) allows detailed, in-depth imaging of retinal and choroidal circulation, whereas microperimetry makes it possible to accurately assess macular function. This review aims to strengthen the existing evidence on vascular and functional alterations at the macular level after SO tamponade in cases of RRD. Methods: A narrative review was conducted using a structured approach, utilizing a PubMed search from January 2000 up to April 2025. Twenty-three studies on OCTA and microperimetry after SO tamponade for RRD were included. Data on vessel densities, choroidal vascular index (CVI), foveal avascular zone (FAZ) size, and retinal sensitivity were extracted and qualitatively analyzed. Results: Studies consistently reported a reduction in the vessel density within the superficial capillary plexus (SCP) under SO tamponade, with partial but incomplete reperfusion post-removal. Choroidal perfusion and CVI were also decreased, exhibiting a negative correlation with the duration of SO tamponade. Microperimetry demonstrated significant reductions in retinal sensitivity (~5–10 dB) during SO tamponade, which modestly improved (~1–2 dB) following removal but generally remaining below normal levels. Conclusions: SO tamponade causes substantial retinal and choroidal vascular impairment and measurable macular dysfunction, even after anatomical reattachment of the retina. It is recommended to perform early SO removal (~3–4 months) and implement routine monitoring by OCTA and microperimetry with the aim of optimizing patient outcomes. Future research should focus on investigating protective strategies and enhancing visual rehabilitation following RRD repair. Full article

Age-related macular degeneration (AMD) represents a leading cause of irreversible blindness in the elderly, primarily by choroidal neovascularization (CNV) leakage. While intravitreal injections of anti-angiogenic antibodies (e.g., aflibercept) provide clinical benefits, their short half-life necessitates frequent administrations, potentially causing ocular infections or retinal detachment. There is an urgent need for effective antibody delivery systems. Mesoporous silica nanoparticles (MSN) have emerged as promising nanocarriers due to their tunable porosity, surface modifiability, and biocompatibility, though their application in ophthalmology for antibody delivery remains underexplored. We developed two MSN carries: spiky mesoporous silica nanospheres (S-MSN) without amino groups and amine-functionalized hollow dendritic mesoporous silica nanospheres (A-HDMSN). Characterization revealed that A-HDMSN exhibited superior properties, including a larger surface area (550.32 vs. 257.72 m²/g), larger mesoporous pore size (17 vs. <10 nm), and 5.28 times higher drug loading capacity (286.31 ± 8.14 vs. 54.26 ± 3.61 μg/mg) compared to S-MSN (n = 3, p < 0.001), attributable to pore size effects and hydrogen bonding. FITC-labeled A-HDMSN demonstrated efficient uptake by retinal pigment epithelial cells (ARPE-19). Notably, A-HDMSN loaded with Aflibercept (A-HDMSN@Afl) showed significant inhibitory effect on VEGF-induced cell migration even 10 days after drug release in vitro, indicating a favorable sustained-release effect of the drug. These findings highlight A-HDMSN as a promising antibody delivery platform that could extend clinical dosing intervals, offering potential for improved AMD management. Full article

Background and Clinical Significance: Purtscher-like retinopathy is a rare occlusive microangiopathy that causes sudden vision loss of varying severity. It presents with diverse retinal findings, such as cotton-wool spots, haemorrhages, and optic disc and macular edema, among others. A key characteristic is the absence of trauma. This condition has been observed in patients with acute pancreatitis, renal failure, preeclampsia, HELLP syndrome, childbirth, and other systemic disorders. Case Presentation: A 35-year-old male presented with complaints of seeing spots in front of both eyes, with a duration of ten days following the initiation of treatment for acute alcoholic pancreatitis. On examination, best-corrected visual acuity (BCVA) in both eyes was 5/6. Fundus examination revealed multiple cotton-wool spots and haemorrhages located in the posterior pole and around the optic disc, more pronounced in the left eye, where the optic disc had blurred margins and the macular reflex was absent. Perimetry showed paracentral scotomas, and optical coherence tomography (OCT) revealed thickening and disruption of the inner retinal layers in the papillomacular region of both eyes. Fundus fluorescein angiography demonstrated adequate perfusion of the vascular network, with hypofluorescent areas in the arteriovenous phase, peripapillary and in the papillomacular zone, due to masking by cotton-wool spots and haemorrhages. Treatment included systemic antiplatelet agents, anticoagulants, and vitamins, along with topical non-steroidal anti-inflammatory drugs. Two months after the initial presentation visual acuity improved to 6/6 in both eyes. Follow-up OCT scans showed atrophy of the inner retinal layers corresponding to the previous cotton-wool spot and the areas of reduced light sensitivity on perimetry had decreased in size. Conclusions: Acute pancreatitis is the most common systemic condition associated with the development of Purtscher-like retinopathy. Timely diagnosis and management of the underlying systemic disease are essential for preventing ocular complications. Ophthalmological evaluation is necessary in patients with acute pancreatitis who present with visual symptoms in order to detect this often-overlooked rare condition. Full article

Background/Objectives: We evaluated the clinical features and natural course of treatment-naïve non-exudative macular neovascularization (NE MNV) associated with age-related macular degeneration in Korean patients. Methods: This retrospective longitudinal study of 21 eyes of 21 patients with NE MNV involved a chart review of best corrected visual acuity (BCVA), optical coherence tomography (OCT), and OCT angiography parameters. Results: This study included 13 men (13/21, 61.9%) and 8 women (8/21, 38.1%), with a mean age of 71.5 ± 9.1 years. The average follow-up period was 15.1 ± 11.8 (range 6.0–49.6) months, and 14 eyes (66.7%) demonstrated exudative changes on OCT scans. The baseline BCVA was 0.15 ± 0.18 logMAR. The initial central macular thickness (CMT), subfoveal choroidal thickness, and the outer retinal layer thickness were 265.3 ± 37.1, 245.2 ± 95.2, and 86.6 ± 5.3 μm, respectively. Cox proportional hazards analysis revealed that older age (hazard ratio [HR]: 1.096, 95% confidence interval [CI]: 1.002–1.200; p = 0.045), larger baseline CMT (HR: 1.025, 95% CI: 1.002–1.049; p = 0.035), and larger baseline MNV (HR: 1.618, 95% CI: 1.035–2.529; p = 0.035) were significant risk factors for exudative changes. Conclusions: We observed the clinical features and natural course of NE MNV in Korean patients and identified that significant risk factors for exudative changes in NE MNV included old age, initially thick CMT, and larger MNV size at baseline. For eyes with NE MNV that have risk factors of exudative conversion, more frequent observation is recommended to ensure the appropriate management. Full article

Background/Objectives: Chronic retinal diseases usually require repetitive local dosing. Depending on factors such as dosing frequency, mode of administration, and associated costs, this can result in poor patient compliance. A better alternative involves using controlled-release drug delivery systems to reduce the frequency of intravitreal dosing and extend drug release. However, reaching the market stage is a time-consuming process. Methods: In this study, we employed two computational approaches to model and estimate the parameters governing the diffusion-controlled drug release from bi-layered microspheres. The case study involved microspheres composed of a chitosan core and a polycaprolactone (PCL) shell. The model drugs were bovine serum albumin and bevacizumab (an agent that slows neovascularization due to retinal disorders). Drug release from the microspheres is described by a mathematical model that was solved numerically using the finite difference and the finite element approaches. The parameter estimation was performed by nonlinear least-squares regression. Results: We used the estimated parameters to simulate the cumulative release under various conditions and optimize the device design to guide future experimental efforts and improve the duration of release beyond a target daily therapeutic release rate from the microspheres. Conclusions: We investigated the effects of polymeric layer sizes on drug release and provided recommendations for optimal sizes. We provide straightforward computational tools for others to reuse in designing bi-layered microspheres for intravitreal drug delivery needs in the treatment of chronic ocular neovascularization. Full article

Background/Objectives: A vasoproliferative retinal tumor (VPT) is a rare, benign, vascular tumor that is found in the peripheral retina. We retrospectively investigated the clinical characteristics and the outcomes of pars plana vitrectomy (PPV) on idiopathic VPTs. Methods: The medical records of 13 eyes of 12 patients who underwent PPV for an idiopathic VPT were reviewed. The chief complaint of the patients, the location and size of the tumor, the presence of concomitant retinal disorders, the treatment procedures, and the best-corrected visual acuity (BCVA) were evaluated. Results: The mean age was 51.2 years, with 4 men and 8 women. The chief complaints at the initial visit were metamorphopsia in 6 eyes, decreased vision in 6 eyes, and blurry vision in 1 eye. A hemangioma was detected in the inferior-temporal quadrant in 11 eyes and in the superior-temporal quadrant in 2 eyes. An epiretinal membrane was present in all 13 eyes with tractional and exudative retinal detachment in 4 eyes, macular hole in 2 eyes, and vitreous hemorrhage in 3 eyes. During the vitrectomy, a posterior vitreous detachment was created in 10 eyes (77%), photocoagulation was performed for the hemangioma in all 13 eyes, cryotherapy in 4 eyes, and direct diathermy in 2 eyes. The visual acuity improved significantly from 0.51 ± 0.66 logMAR units at the baseline to 0.05 ± 0.21 logMAR units at the final examination (p = 0.002). Conclusions: Vitrectomy for idiopathic VPTs is effective in improving the visual acuity. Idiopathic VPTs are often associated with epiretinal membranes, and patients present with various types of visual disorders. Full article

Background/Objectives: Oxidative stress plays a critical role in the development of ocular diseases such as cataracts. Selenium nanoparticles (SeNPs) offer antioxidant benefits with low toxicity. This study aimed to evaluate the antioxidant activity of SeNPs coated with D-α-tocopheryl polyethylene glycol succinate (TPGS) in human lens epithelial (HLE) cells. Methods: SeNPs were synthesised by reducing sodium selenite with ascorbic acid in the presence of TPGS. Physicochemical characterisation was carried out using dynamic light scattering to assess size and surface charge. Antioxidant activity was measured by a 2,2-diphenyl-1-picrylhydrazyl (DPPH) assay. Cytocompatibility was assessed on adult retinal pigment epithelial (ARPE-19) and HLE cells using PrestoBlue. Functional antioxidant performance was determined through enzymatic assays for glutathione peroxidase (GPx), thioredoxin reductase (TrxR), and glutathione (GSH), and lipid peroxidation was assessed using malondialdehyde (MDA) quantification. Catalase mimicry was evaluated under 3-amino-1,2,4-triazole (3-AT)-induced inhibition. Results: The optimal SeNP formulation had an average hydrodynamic diameter of 44 ± 3 nm, low PDI (<0.1), and a surface charge of −15 ± 3 mV. These TPGS-SeNPs demonstrated strong radical scavenging (EC₅₀ ≈ 1.55 µg/mL) and were well tolerated by ARPE-19 cells (IC₅₀ = 524 µg/mL), whereas HLE cells had a narrower biocompatibility window (≤0.4 µg/mL, IC₅₀ = 2.2 µg/mL). Under oxidative stress, SeNPs significantly enhanced GPx and TrxR activity but did not affect GSH or MDA levels. No catalase-mimetic activity was observed. Conclusions: TPGS-SeNPs exhibit potent antioxidant enzyme modulation under stress conditions in HLE cells. Although not affecting all oxidative markers, these nanoparticles show promise for non-invasive strategies targeting lens-associated oxidative damage, including cataract prevention. Full article

Glioblastoma multiforme (GBM) remains the most aggressive primary brain tumor with median survival of 14.6 months, necessitating novel therapeutic approaches. Here, we report the biogenic synthesis of zinc oxide nanoparticles (ZnO NPs) using Bacillus licheniformis strain TT14s isolated from mining environments and demonstrate their selective anti-glioma efficacy. ZnO NPs exhibited hexagonal wurtzite structure (crystallite size: 15.48 nm) with spherical morphology (19.37 ± 5.28 nm diameter) as confirmed by XRD, HRTEM, and comprehensive physicochemical characterization. Colloidal stability analysis revealed an isoelectric point at pH 7.46, ensuring optimal dispersion in biological media. Cytotoxicity evaluation revealed remarkable selectivity: at 100 μg/mL, ZnO NPs reduced NG-108 glioblastoma cell viability to 36.07 ± 1.89% within 1 h while maintaining 78.9 ± 0.94% viability in primary retinal cells. The selective cytotoxicity was attributed to the interplay of convergent mechanisms acting under dark conditions, including defect-mediated ROS generation supported by photoluminescence analysis revealing a characteristic oxygen vacancy emission at 550 nm, pH-dependent dissolution enhanced in the acidic tumor microenvironment, and preferential cellular uptake by rapidly proliferating cancer cells with compromised antioxidant defenses. Time-course analysis demonstrated concentration-dependent effects with therapeutic windows favoring normal cell preservation. The intrinsic cytotoxic activity under dark laboratory conditions eliminates the need for external activation, providing practical advantages for therapeutic applications. These findings establish ZnO NPs as promising candidates for targeted glioblastoma therapy, warranting further in vivo validation and mechanistic elucidation for clinical translation. Full article

Background: Glaucoma is a progressive optic neuropathy marked by retinal ganglion cells (RGCs), apoptosis, vascular insufficiency, oxidative stress, mitochondrial dysfunction, excitotoxicity, and neuroinflammation. While intraocular pressure (IOP) reduction remains the primary intervention, many patients continue to lose vision despite adequate pressure control. Emerging neuroprotective agents—citicoline, coenzyme Q10 (CoQ10), pyruvate, nicotinamide, pyrroloquinoline quinone (PQQ), homotaurine, berberine, and gamma-aminobutyric acid (GABA)—target complementary pathogenic pathways in experimental and clinical settings. Methods: This literature review synthesizes current evidence on glaucoma neuroprotection, specifically drawing on the most relevant and recent studies identified via PubMed. Results: Citicoline enhances phospholipid synthesis, stabilizes mitochondrial membranes, modulates neurotransmitters, and improves electrophysiological and visual field outcomes. CoQ10 preserves mitochondrial bioenergetics, scavenges reactive oxygen species, and mitigates glutamate-induced excitotoxicity. Pyruvate supports energy metabolism, scavenges reactive oxygen species, and restores metabolic transporter expression. Nicotinamide and its precursor nicotinamide riboside boost NAD⁺ levels, protect against early mitochondrial dysfunction, and enhance photopic negative response amplitudes. PQQ reduces systemic inflammation and enhances mitochondrial metabolites, while homotaurine modulates GABAergic signaling and inhibits β-amyloid aggregation. Berberine attenuates excitotoxicity, inflammation, and apoptosis via the P2X7 and GABA-PKC-α pathways. Preclinical models demonstrate synergy when agents are combined to address multiple targets. Clinical trials of fixed-dose combinations—such as citicoline + CoQ10 ± vitamin B3, citicoline + homotaurine ± vitamin E or PQQ, and nicotinamide + pyruvate—show additive improvements in RGCs’ electrophysiology, visual function, contrast sensitivity, and quality of life without altering IOP. Conclusions: A multi-targeted approach is suitable for glaucoma’s complex neurobiology and may slow progression more effectively than monotherapies. Ongoing randomized controlled trials are essential to establish optimal compound ratios, dosages, long-term safety, and structural outcomes. However, current evidence remains limited by small sample sizes, heterogeneous study designs, and a lack of long-term real-world data. Integrating combination neuroprotection into standard care holds promise for preserving vision and reducing the global burden of irreversible glaucoma-related blindness. Full article

Background/Objectives: Glaucoma is the primary cause of irreversible blindness worldwide, with enormous impact on quality of life and activities of daily living. Since one pathogenic mechanism of glaucoma is mitochondrial dysfunction at the retinal ganglion cell level, niacin has been proposed as an adjuvant treatment, with encouraging results. The objective of this prospective, non-randomized, single-arm clinical trial was to investigate the effect of oral supplementation with niacin on the quality of life of a cohort of glaucoma patients in Romania. Methods: Fifty-eight patients diagnosed with primary open angle glaucoma, under topical hypotensive treatment, were evaluated before and after a 6-month period of daily administration of 500 mg of oral niacinamide. Evaluation involved a complete ophthalmological exam and QoL quantification using the Glaucoma Quality of Life-15 (GQL-15) Questionnaire. Results: We found strong evidence that niacin supplementation for 6 months led to a statistically significant improvement in QoL scores among glaucoma patients (mean difference = −2.10, 95% CI: [−2.89, −1.32], p < 0.0001), including central and near vision (mean difference = −2.16, 95% CI: [−3.91, −0.4], p = 0.017), peripheral vision (mean difference = −2.66, 95% CI: [−0.23, −0.08], p < 0.001), and the glare and dark adaptation (mean difference = −5.24, 95% CI: [−0.33, −0.14], p < 0.001). In addition, B3 treatment resulted in a significant reduction in intraocular pressure in both eyes over 6 months (mean difference = 0.53, 95% CI: [0.21, 0.86] in the left eye and mean difference = 0.36, 95% CI: [0.04, 0.68] in the right eye), indicating potential clinical benefits. Conclusions: The observed GQL-15 score reductions suggest that B3 may be of benefit in glaucoma management. Further research with larger sample sizes and placebo-controlled designs is needed to confirm B3 potential impact on disease progression and quality of life. Trial Registration at clinicaltrials.gov: NCT07007260. Full article

Presbyopia is a ubiquitous age-related condition characterized by reduced near focusing ability due to lenticular stiffening. Pharmacologic agents such as pilocarpine have re-emerged as a less-invasive treatment option by inducing miosis and thereby enhancing depth of focus. However, the optimal pharmacologically induced pupil size that balances improved near vision with sufficient retinal illuminance remains undetermined. In this work, we present for the first time a direct integration of advanced theoretical modeling with a systematic synthesis of clinical trial outcomes to define the optimal target pupil size for pharmacologic presbyopia correction. We modeled visual performance using the Visual Strehl Ratio of the Optical Transfer Function (VSOTF) and convolved images of optotypes across a range of pupil diameters from 1.5 mm to 3.5 mm. This combined optical–clinical approach allowed us to quantitatively compare modeled image quality and depth of focus predictions with real-world clinical efficacy data from pilocarpine-based interventions. Simulations showed that smaller pupil sizes (1.5–2.5 mm) significantly extended depth of focus compared to standard multifocal optics while maintaining image quality within acceptable limits. These findings align with clinical trials of pilocarpine formulations, which commonly achieve post-treatment pupil diameters in the 2.0–2.5 mm range and are associated with clinically meaningful gains in near vision. Our analysis uniquely demonstrates that these clinically achieved pupil sizes closely match the theoretically optimal 2.0–3.0 mm range identified in our modeling, strengthening the evidence base for drug design and patient selection. These results reinforce the role of pharmacologically controlled pupil size as a central target in presbyopia management. By explicitly linking predictive optical modeling with aggregated clinical outcomes, we introduce a novel framework to guide future pharmacologic development strategies and refine clinical counseling in the emerging era of presbyopia therapeutics. Full article

Optical coherence tomography (OCT) acquisitions often reduce lateral sampling density to shorten scan time and suppress motion artifacts, but this strategy degrades the signal-to-noise ratio and obscures fine retinal microstructures. To recover these details without hardware modifications, we propose MGFormer, a lightweight Transformer for OCT super-resolution (SR) that integrates a multi-granularity attention mechanism with tensor distillation. A feature-enhancing convolution first sharpens edges; stacked multi-granularity attention blocks then fuse coarse-to-fine context, while a row-wise top-k operator retains the most informative tokens and preserves their positional order. We trained and evaluated MGFormer on B-scans from the Duke SD-OCT dataset at $2\times$, $4\times$, and $8\times$ scaling factors. Relative to seven recent CNN- and Transformer-based SR models, MGFormer achieves the highest quantitative fidelity; at $4\times$ it reaches 34.39 dB PSNR and 0.8399 SSIM, surpassing SwinIR by +0.52 dB and +0.026 SSIM, and reduces LPIPS by 21.4%. Compared with the same backbone without tensor distillation, FLOPs drop from 289G to 233G (−19.4%), and per-B-scan latency at $4\times$ falls from 166.43 ms to 98.17 ms (−41.01%); the model size remains compact (105.68 MB). A blinded reader study shows higher scores for boundary sharpness (4.2 ± 0.3), pathology discernibility (4.1 ± 0.3), and diagnostic confidence (4.3 ± 0.2), exceeding SwinIR by 0.3–0.5 points. These results suggest that MGFormer can provide fast, high-fidelity OCT SR suitable for routine clinical workflows. Full article

Diabetic retinopathy (DR), a critical ocular disease that can lead to blindness, demands early and accurate diagnosis to prevent vision loss. Current automated DR diagnosis methods face two core challenges: first, subtle early lesions such as microaneurysms are often missed due to insufficient feature extraction; second, there is a persistent trade-off between model accuracy and efficiency—lightweight architectures often sacrifice precision for real-time performance, while high-accuracy models are computationally expensive and difficult to deploy on resource-constrained edge devices. To address these issues, this study presents a novel deep learning framework integrating depthwise separable convolution and a multi-view attention mechanism (MVAM) for efficient DR diagnosis using retinal images. The framework employs multi-scale feature fusion via parallel 3 × 3 and 5 × 5 convolutions to capture lesions of varying sizes and incorporates Gabor filters to enhance vascular texture and directional lesion modeling, improving sensitivity to early structural abnormalities while reducing computational costs. Experimental results on both the diabetic retinopathy (DR) dataset and ocular disease (OD) dataset demonstrate the superiority of the proposed method: it achieves a high accuracy of 0.9697 on the DR dataset and 0.9669 on the OD dataset, outperforming traditional methods such as CNN_eye, VGG, and UNet by more than 1 percentage point. Moreover, its training time is only half that of U-Net (on DR dataset) and VGG (on OD dataset), highlighting its potential for clinical DR screening. Full article