Journal of Personalized Medicine

Editorial

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4 pages, 209 KiB

Open AccessEditorial

The Challenges and Therapeutic Prospects in Eye Disease

by Chieh-Chih Tsai

J. Pers. Med. 2023, 13(6), 930; https://doi.org/10.3390/jpm13060930 - 31 May 2023

Viewed by 1285

Abstract

A number of key insights into eye disease have been revealed in the past decade, which has resulted in the development of novel, effective, targeted therapies such as teprotumumab for the treatment of thyroid eye disease (also known as Graves’ orbitopathy) [...] Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

Research

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12 pages, 1132 KiB

Open AccessArticle

Morphological and Functional Aspects and Quality of Life in Patients with Achromatopsia

by Caroline Chan, Berthold Seitz and Barbara Käsmann-Kellner

J. Pers. Med. 2023, 13(7), 1106; https://doi.org/10.3390/jpm13071106 - 7 Jul 2023

Viewed by 1463

Abstract

(1) Background: Achromatopsia is a rare disease of which the natural course and impact on life are still unknown to this date. We aimed to assess the morphological, functional characteristics, and quality of life in a large sample size of patients with achromatopsia. [...] Read more.

(1) Background: Achromatopsia is a rare disease of which the natural course and impact on life are still unknown to this date. We aimed to assess the morphological, functional characteristics, and quality of life in a large sample size of patients with achromatopsia. (2) A total of 94 achromats were included in this retrospective cohort study. Sixty-four were patients of the Department of Ophthalmology, Saarland University Medical Centre in Homburg/Saar, Germany, between 2008 and 2021. Thirty further participants with achromatopsia from the national support group were included using an online questionnaire, which is available under ‘Supplementary data’. Statistical analysis was performed using SPSS Version 25; (3) The 94 patients (37 males (39.4%) and 57 females (60.6%)) showed a mean age of 24.23 ± 18.53 years. Visual acuity was stable (SD ± 0.22 logMAR at 1.0 logMAR) over a time of observation from 2008 to 2021. Edge filter glasses were the most used optical aids, while enlarged reading glasses were the most used low vision aids. (4) Conclusions: Our findings give an insight into describing the natural process and the quality of life of achromatopsia. The results demonstrate that achromatopsia is a predominantly stationary disease. The individual prescription of edge filters and low-vision aids is essential following a personalised fitting. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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11 pages, 1584 KiB

Open AccessArticle

Circadian Fluctuation Changes in Intraocular Pressure Measured Using a Contact Lens Sensor in Patients with Glaucoma after the Adjunctive Administration of Ripasudil: A Prospective Study

by Shih-Kung Huang, Mai Ishii, Yuki Mizuki, Tatukata Kawagoe, Masaki Takeuchi, Eiichi Nomura and Nobuhisa Mizuki

J. Pers. Med. 2023, 13(5), 800; https://doi.org/10.3390/jpm13050800 - 6 May 2023

Cited by 4 | Viewed by 1800

Abstract

Nocturnal and circadian intraocular pressure (IOP) fluctuations are important issues in glaucoma treatment. Ripasudil 0.4% eye drops, a new glaucoma medication, lowers IOP by increasing aqueous humor outflow through the trabecular meshwork. We aimed to compare differences between circadian IOP fluctuations measured using [...] Read more.

Nocturnal and circadian intraocular pressure (IOP) fluctuations are important issues in glaucoma treatment. Ripasudil 0.4% eye drops, a new glaucoma medication, lowers IOP by increasing aqueous humor outflow through the trabecular meshwork. We aimed to compare differences between circadian IOP fluctuations measured using a contact lens sensor (CLS) before and after administering 0.4% ripasudil eye drops adjunctively to patients with primary open-angle glaucoma (POAG) and normal tension glaucoma (NTG). Patients with POAG (n = 1) and NTG (n = 5) underwent 24 h IOP monitoring with a CLS before and after administering ripasudil eye drops every 12 h (8 a.m., 8 p.m.) for 2 weeks without discontinuing currently used glaucoma medications. No vision-threatening adverse event occurred. The reduction in IOP fluctuation and the reduction in the SD of IOP in 24 h, awake time and sleep time did not reach statistical significance. The baseline office-hour IOP, which was measured using Goldmann applanation tonometry (GAT), ranged in the low teens, and the reduction in office-hour IOP also did not show a significant difference. Further study is necessary to evaluate whether the low baseline IOP with less IOP reduction relates to attenuated IOP fluctuation reduction. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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10 pages, 253 KiB

Open AccessArticle

Balloon Dacryocystoplasty with Pushed Monocanalicular Intubation as a Primary Management for Primary Acquired Nasolacrimal Duct Obstruction

by Chun-Chieh Lai, Cheng-Ju Yang, Chia-Chen Lin and Yi-Chun Chi

J. Pers. Med. 2023, 13(3), 564; https://doi.org/10.3390/jpm13030564 - 21 Mar 2023

Cited by 2 | Viewed by 1501

Abstract

Given the improvement in the instrument and techniques, novel surgical interventions emerged to avoid the osteotomy from the gold standard dacryocystorhinostomy (DCR) for treating primary acquired nasolacrimal duct obstruction (PANDO). This study’s aim is to compare the surgical outcomes of antegrade balloon dacryocystoplasty [...] Read more.

Given the improvement in the instrument and techniques, novel surgical interventions emerged to avoid the osteotomy from the gold standard dacryocystorhinostomy (DCR) for treating primary acquired nasolacrimal duct obstruction (PANDO). This study’s aim is to compare the surgical outcomes of antegrade balloon dacryocystoplasty (DCP) with pushed monocanalicular intubation (MCI) to balloon DCP alone in patients with complete PANDO. Adult patients with complete PANDO receiving balloon DCP followed by pushed MCI or balloon DCP alone from December 2014 to May 2019 were retrospectively reviewed. A total of 37 eyes of 29 patients were treated with balloon DCP with pushed MCI for 1 month, whereas 35 eyes of 28 patients were treated with balloon DCP alone. The success rates at 1 month, 3 months, and 6 months after operation were 89.2%, 73.0%, and 70.2%, respectively, in balloon DCP with MCI group, and 62.9%, 62.9%, and 60.0%, respectively, in the balloon DCP alone group. The balloon DCP with pushed MCI group had a better success rate but only reached statistical significance at 1 month postoperatively (p < 0.01). Subgroup analysis was performed based on age. The success rate in those under 65 in the combined balloon DCP with MCI group was significantly higher than in balloon DCP alone group (72.7% vs. 9.1%, p = 0.004), whereas there was no significant difference between those aged at least 65 in the combined group and the balloon DCP alone group (69.2% vs. 83.3%, p = 0.2). Conclusively, there was no significant difference in the success rate between antegrade balloon DCP with and without pushed MCI in general. Nevertheless, the former procedure was associated with significantly higher surgical success rate than the latter in younger patients. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

9 pages, 506 KiB

Open AccessArticle

Long-Term Follow-Up in IgG4-Related Ophthalmic Disease: Serum IgG4 Levels and Their Clinical Relevance

by Wei-Yi Chou, Ching-Yao Tsai and Chieh-Chih Tsai

J. Pers. Med. 2022, 12(12), 1963; https://doi.org/10.3390/jpm12121963 - 28 Nov 2022

Cited by 2 | Viewed by 1585

Abstract

(1) Background: To analyze the association between long-term changes in serum IgG4 levels and the clinical course of patients with IgG4-related ophthalmic disease (IgG4-ROD). (2) Methods: Retrospective analysis of 25 patients with IgG4-ROD. (3) Results: Mean age at diagnosis was 60.68 years. Fifty-six [...] Read more.

(1) Background: To analyze the association between long-term changes in serum IgG4 levels and the clinical course of patients with IgG4-related ophthalmic disease (IgG4-ROD). (2) Methods: Retrospective analysis of 25 patients with IgG4-ROD. (3) Results: Mean age at diagnosis was 60.68 years. Fifty-six percent of patients had bilateral ocular involvement and 32% had systemic associations. The ocular structures involved were the lacrimal gland (76%), orbital soft tissue (36%), extraocular muscle (20%) and infraorbital nerve (20%). According to last follow-up, 9 (36%) patients had normalized IgG4 levels, and 16 (64%) patients had elevated IgG4 levels. Patients with normalized IgG4 levels had better response to initial steroid treatment and attained a significantly lower IgG4 level after treatment (p = 0.002). The highest IgG4 levels were at baseline and disease recurrence, and lowest after initial treatment. At final follow-up, IgG4 levels differed in patients with remission (mean 326.25 mg/dL) and stable disease (mean 699.55 mg/dL). Subgroup analysis was performed in patients with remission, categorized according to whether IgG4 levels were normalized (9 patients) or elevated (10 patients) on last follow up. The elevated group had a higher percentage of bilateral disease, lacrimal gland involvement and recurrence. (4) Conclusions: IgG4-ROD patients with a greater response to initial steroid therapy were more inclined to have normalized IgG4 levels in the long term. Some patients remained in remission despite persistently elevated IgG4 levels, and had regular follow-up without treatment. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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10 pages, 2755 KiB

Open AccessArticle

Personalized Approach in Treatment of Neovascular Age-Related Macular Degeneration

by Radina Kirkova, Snezhana Murgova, Vidin Kirkov and Ivan Tanev

J. Pers. Med. 2022, 12(9), 1456; https://doi.org/10.3390/jpm12091456 - 5 Sep 2022

Cited by 3 | Viewed by 1786

Abstract

Background: Age-related macular degeneration (AMD) is a progressive, degenerative disease of the central retina. AMD is subdivided into “dry” (atrophic), “wet” (exudative), and neovascular (nAMD) forms. In recent years, the concepts about nAMD changed with the development of optical coherence tomography–angiography (OCT-A) and [...] Read more.

Background: Age-related macular degeneration (AMD) is a progressive, degenerative disease of the central retina. AMD is subdivided into “dry” (atrophic), “wet” (exudative), and neovascular (nAMD) forms. In recent years, the concepts about nAMD changed with the development of optical coherence tomography–angiography (OCT-A) and intravitreal anti-VEGF treatment. The aim of this study was to define the morphologic type of the neovascular membrane (NVM) before treatment with OCT-A and to register vascular remodeling after treatment with anti-VEGF. We also analyzed the relationship between NVM and visual acuity. Methods: The study was retrospective and included 119 patients with newly diagnosed, treatment-naïve nAMD. All the patients underwent full ophthalmic examination and also fluoresceine angiography and optical coherence tomography–angiography (OCT-A). Results: Based on the collected data, we found repetitive regularities. Conclusion: The analysis of our results could be used as prognostic markers for the evolution of the disease and as a basis for new treatment strategies, depending on the naïve NVM morphologic type. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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13 pages, 1843 KiB

Open AccessArticle

Increased Orbital Muscle Fraction Diagnosed by Semi-Automatic Volumetry: A Risk Factor for Severe Visual Impairment with Excellent Response to Surgical Decompression in Graves’ Orbitopathy

by Christine Steiert, Sebastian Kuechlin, Waseem Masalha, Juergen Beck, Wolf Alexander Lagrèze and Juergen Grauvogel

J. Pers. Med. 2022, 12(6), 937; https://doi.org/10.3390/jpm12060937 - 6 Jun 2022

Cited by 2 | Viewed by 1849

Abstract

Graves’ orbitopathy (GO) leads to increased orbital tissue and causes symptoms such as exophthalmos, functional complaints, or dysthyroid optic neuropathy. Different GO types with fat and/or muscle enlargement were identified, and increased muscle appears to particularly influence visual status and treatment response. The [...] Read more.

Graves’ orbitopathy (GO) leads to increased orbital tissue and causes symptoms such as exophthalmos, functional complaints, or dysthyroid optic neuropathy. Different GO types with fat and/or muscle enlargement were identified, and increased muscle appears to particularly influence visual status and treatment response. The current study examines visual parameters dependent on orbital muscle volume fraction in a surgically treated GO cohort. After volumetric analysis of the preoperative orbital content, 83 orbits in 47 patients were categorized into predefined groups (increased or not-increased muscle fraction). All cases underwent pterional orbital decompression, and pre- and postoperative visual status was retrospectively analyzed. Forty-one orbits revealed increased and 42 orbits revealed not-increased muscle volume (mean fraction 29.63% versus (vs.) 15.60%). The preoperative visual acuity (VA) was significantly lower in orbits with increased vs. not-increased muscle volume (mean VA 0.30 vs. 0.53, difference 2.5 lines). After surgery, mean VA improved significantly by 1.7 lines in orbits with increased muscle volume. Not preoperative, but postoperative exophthalmos was significantly lower in orbits with not-increased muscle volume. Increased orbital muscle is associated with significantly reduced VA, but can be remarkably improved by pterional orbital decompression. Therefore, surgical therapy should be considered particularly in decreased VA with orbital muscle enlargement. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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8 pages, 3776 KiB

Open AccessArticle

Management of Delayed Complications of Hydrogel Scleral Buckles

by Hsin-Yu Yang, Wei-Kuang Yu and Chieh-Chih Tsai

J. Pers. Med. 2022, 12(4), 629; https://doi.org/10.3390/jpm12040629 - 14 Apr 2022

Cited by 1 | Viewed by 2553

Abstract

(1) Background: hydrogel scleral buckles (HSB)-related complications can happen decades after implantation, although this material has been retrieved for a long time. Due to its fragile texture, ensuring the complete removal of this material and avoiding complications are challenging. Incomplete removal, iatrogenic complication, [...] Read more.

(1) Background: hydrogel scleral buckles (HSB)-related complications can happen decades after implantation, although this material has been retrieved for a long time. Due to its fragile texture, ensuring the complete removal of this material and avoiding complications are challenging. Incomplete removal, iatrogenic complication, recurrent retinal detachment, and infection could occur. (2) Methods: chart review of patients who developed delayed HSB-related complications and received removal of HSB in Taipei Veterans General Hospital from 2004 to 2021. The presenting symptoms, prior diagnosis before referral, clinical findings, image features, surgical technique, operative findings, and outcome were analyzed. Detailed surgical procedure and tips for removal were demonstrated in the study. (3) Results: a total of eleven patients were identified. The presenting symptoms include limitations to extraocular movement (ten eyes, 90.9%), ocular redness (eight eyes, 72.7%), ocular fullness (eight eyes, 72.7%), pain (six eyes, 54.5%), and exposed ocular foreign body (five eyes, 45.5%). Of note, six patients (54.5%) have monocular glaucoma and four of them have intractable high intraocular pressure. All patients underwent surgeries to smoothly remove swollen HSB via transcutaneous or transconjunctival approach. Most symptoms improved after surgery and no cases developed surgical-related complications. (4) Conclusions: although HSB have been off the market for decades, delayed complications are still emerging. Clinicians should remain alert for potential complications for patients with prior HSB surgeries. Early diagnosis and meticulous management can help to safely remove the expanded HSB and reduce the associated complications. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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15 pages, 1553 KiB

Open AccessEditor’s ChoiceArticle

Masticatory Muscle Thickness and Activity Correlates to Eyeball Length, Intraocular Pressure, Retinal and Choroidal Thickness in Healthy Women versus Women with Myopia

by Grzegorz Zieliński, Marcin Wójcicki, Maria Rapa, Anna Matysik-Woźniak, Michał Baszczowski, Michał Ginszt, Monika Litko-Rola, Jacek Szkutnik, Ingrid Różyło-Kalinowska, Robert Rejdak and Piotr Gawda

J. Pers. Med. 2022, 12(4), 626; https://doi.org/10.3390/jpm12040626 - 13 Apr 2022

Cited by 14 | Viewed by 3698

Abstract

This study aims to examine the correlations between masticatory and neck muscle thickness and activity versus eyeball length, retinal thickness, choroidal thickness, and intraocular pressure in healthy women versus women with myopia. The study group consisted of 21 women aged 24 years and [...] Read more.

This study aims to examine the correlations between masticatory and neck muscle thickness and activity versus eyeball length, retinal thickness, choroidal thickness, and intraocular pressure in healthy women versus women with myopia. The study group consisted of 21 women aged 24 years and a control group of 19 women (mean age 23 years). For bioelectrical activity analysis within the temporalis anterior, the superficial part of the masseter muscle, the middle part of the sternocleidomastoid muscle, and the anterior belly of the digastric muscle, an eight-channel BioEMG III electromyograph were used. An M-Turbo ultrasound machine was used to analyze masticatory and neck muscle thickness. The eyeball length was examined by IOL Master 500; choroidal and retinal thickness by Optovue Angiovue; and intraocular pressure by Tono-Pen XL. Refractive errors are related to differences in muscle thickness and electromyographic activity. Bioelectrical activity within the temporalis anterior seems to be associated with ocular length, retinal thickness, and choroidal thickness in women with myopia. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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9 pages, 627 KiB

Open AccessArticle

Change of Optical Coherence Tomography Morphology and Associated Structural Outcome in Diabetic Macular Edema after Ranibizumab Treatment

by Nan-Ni Chen, Chien-Hsiung Lai, Chai-Yi Lee, Chien-Neng Kuo, Ching-Lung Chen, Jou-Chen Huang, Pei-Chen Wu, Pei-Lun Wu and Chau-Yin Chen

J. Pers. Med. 2022, 12(4), 611; https://doi.org/10.3390/jpm12040611 - 11 Apr 2022

Cited by 2 | Viewed by 2133

Abstract

(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after [...] Read more.

(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after the initial IVIR, while the data of ophthalmic examination, optical coherence tomography (OCT) image, and systemic diseases were collected. The study population was categorized into different subgroups according to the existence of OCT morphologic change and the initial OCT morphologic pattern, including diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). The primary outcomes were the baseline best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a two-year study period. The distribution of OCT morphologic change and its relation to primary outcome were analyzed. (3) Results: Comparing the 42 eyes (18.4%) with OCT morphological changes to another 186 eyes (81.6%) without such alteration, the former showed a poorer baseline BCVA (0.84 ± 0.39 vs. 0.71 ± 0.36, p = 0.035), worse final BCVA (0.99 ± 0.44 vs. 0.67 ± 0.30, p = 0.001), and thicker final CMT (354.21 ± 89.02 vs. 305.33 ± 83.05, p = 0.001). Moreover, the VMIA developed in 14.9% of all DME patients presenting the most common morphologic change among DRT, CME, and SRD. Besides, the presence of stroke was independently correlated to the morphologic change (adjusted odds ratio [aOR]: 6.381, 95% confidence interval (CI): 1.112–36.623, p = 0.038). (4) Conclusions: The change of OCT morphology in DME patients receiving IVIR was correlated to worse structural and visual outcome while the formation of VMIA most commonly occurred after initial treatment. Full article

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9 pages, 6542 KiB

Open AccessArticle

An Outperforming Artificial Intelligence Model to Identify Referable Blepharoptosis for General Practitioners

by Ju-Yi Hung, Ke-Wei Chen, Chandrashan Perera, Hsu-Kuang Chiu, Cherng-Ru Hsu, David Myung, An-Chun Luo, Chiou-Shann Fuh, Shu-Lang Liao and Andrea Lora Kossler

J. Pers. Med. 2022, 12(2), 283; https://doi.org/10.3390/jpm12020283 - 15 Feb 2022

Cited by 10 | Viewed by 5804

Abstract

The aim of this study is to develop an AI model that accurately identifies referable blepharoptosis automatically and to compare the AI model’s performance to a group of non-ophthalmic physicians. In total, 1000 retrospective single-eye images from tertiary oculoplastic clinics were labeled by [...] Read more.

The aim of this study is to develop an AI model that accurately identifies referable blepharoptosis automatically and to compare the AI model’s performance to a group of non-ophthalmic physicians. In total, 1000 retrospective single-eye images from tertiary oculoplastic clinics were labeled by three oculoplastic surgeons as having either ptosis, including true and pseudoptosis, or a healthy eyelid. A convolutional neural network (CNN) was trained for binary classification. The same dataset was used in testing three non-ophthalmic physicians. The CNN model achieved a sensitivity of 92% and a specificity of 88%, compared with the non-ophthalmic physician group, which achieved a mean sensitivity of 72% and a mean specificity of 82.67%. The AI model showed better performance than the non-ophthalmic physician group in identifying referable blepharoptosis, including true and pseudoptosis, correctly. Therefore, artificial intelligence-aided tools have the potential to assist in the diagnosis and referral of blepharoptosis for general practitioners. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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9 pages, 241 KiB

Open AccessArticle

Factors Predicting the Success of Combined Orbital Decompression and Strabismus Surgery in Thyroid-Associated Orbitopathy

by Meng-Wei Hsieh, Chih-Kang Hsu, Pao-Cheng Kuo, Hsu-Chieh Chang, Yi-Hao Chen and Ke-Hung Chien

J. Pers. Med. 2022, 12(2), 186; https://doi.org/10.3390/jpm12020186 - 31 Jan 2022

Cited by 3 | Viewed by 2560

Abstract

To evaluate the safety and efficacy of orbital decompression combined with strabismus surgery in thyroid-associated orbitopathy (TAO) and identify factors leading to surgical success. A retrospective comparative case series was conducted on 52 patients who were treated with combined orbital decompression and strabismus [...] Read more.

To evaluate the safety and efficacy of orbital decompression combined with strabismus surgery in thyroid-associated orbitopathy (TAO) and identify factors leading to surgical success. A retrospective comparative case series was conducted on 52 patients who were treated with combined orbital decompression and strabismus surgery. Outcome measurements included perioperative Hertel exophthalmometry and strabismus measurements. Surgical success was defined as binocular single vision (BSV) in the primary and reading positions within 5 prism diopters (PDs). As a result, the average reduction in proptosis was 3.23 mm, with a mean preoperative Hertel measurement of 22.64 mm. Forty-four patients (84.6%) achieved the success criterion and composed the success group. In addition to sex and underlying hyperthyroidism, symmetry of orbitopathy, interocular exophthalmos difference of more than 2 mm, predominant esotropia type, mixed type strabismus, baseline horizontal deviations, baseline vertical deviations, and combination with one-wall decompression surgery were significantly different between the success and failure groups. All complications were mild and temporary. Orbital decompression combined with strabismus surgery produced satisfactory outcomes in selected patients with efficacy and safety. Symmetry between the two eyes with relatively simple strabismus and proptosis ensured surgical success. With experienced surgeons, advanced techniques, and selected patients, this method can serve as an alternative treatment option to minimize the number of surgeries, medical costs and recovery period. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

Review

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15 pages, 474 KiB

Open AccessReview

Photoactivated Chromophore Corneal Collagen Cross-Linking for Infectious Keratitis (PACK-CXL)—A Comprehensive Review of Diagnostic and Prognostic Factors Involved in Therapeutic Indications and Contraindications

by Ileana Ramona Barac, Andrada-Raluca Artamonov, George Baltă, Valentin Dinu, Claudia Mehedințu, Anca Bobircă, Florian Baltă and Diana Andreea Barac

J. Pers. Med. 2022, 12(11), 1907; https://doi.org/10.3390/jpm12111907 - 16 Nov 2022

Cited by 4 | Viewed by 1986

Abstract

Infectious keratitis is a severe infection of the eye, which requires urgent care in order to prevent permanent complications. Typical cases are usually diagnosed clinically, whereas severe cases also require additional tools, such as direct microscopy, corneal cultures, molecular techniques, or ophthalmic imaging. [...] Read more.

Infectious keratitis is a severe infection of the eye, which requires urgent care in order to prevent permanent complications. Typical cases are usually diagnosed clinically, whereas severe cases also require additional tools, such as direct microscopy, corneal cultures, molecular techniques, or ophthalmic imaging. The initial treatment is empirical, based on the suspected etiology, and is later adjusted as needed. It ranges from topical administration of active substances to oral drugs, or to complex surgeries in advanced situations. A novel alternative is represented by Photoactivated Chromophore Corneal Collagen Cross-Linking (PACK-CXL), which is widely known as a minimally invasive therapy for corneal degenerations. The purpose of this review is to identify the main diagnostic and prognostic factors which further outline the indications and contraindications of PACK-CXL in infectious keratitis. Given the predominantly positive outcomes in the medical literature, we ponder whether this is a promising treatment modality, which should be further evaluated in a systematic, evidence-based manner in order to develop a clear treatment protocol for successful future results, especially in carefully selected cases. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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14 pages, 808 KiB

Open AccessReview

Neuroprotection in Glaucoma: Basic Aspects and Clinical Relevance

by Che-Yuan Kuo and Catherine Jui-Ling Liu

J. Pers. Med. 2022, 12(11), 1884; https://doi.org/10.3390/jpm12111884 - 10 Nov 2022

Cited by 13 | Viewed by 4437

Abstract

Glaucoma is a neurodegenerative disease that affects primarily the retinal ganglion cells (RGCs). Increased intraocular pressure (IOP) is one of the major risk factors for glaucoma. The mainstay of current glaucoma therapy is limited to lowering IOP; however, controlling IOP in certain patients [...] Read more.

Glaucoma is a neurodegenerative disease that affects primarily the retinal ganglion cells (RGCs). Increased intraocular pressure (IOP) is one of the major risk factors for glaucoma. The mainstay of current glaucoma therapy is limited to lowering IOP; however, controlling IOP in certain patients can be futile in slowing disease progression. The understanding of potential biomolecular processes that occur in glaucomatous degeneration allows for the development of glaucoma treatments that modulate the death of RGCs. Neuroprotection is the modification of RGCs and the microenvironment of neurons to promote neuron survival and function. Numerous studies have revealed effective neuroprotection modalities in animal models of glaucoma; nevertheless, clinical translation remains a major challenge. In this review, we select the most clinically relevant treatment strategies, summarize preclinical and clinical data as well as recent therapeutic advances in IOP-independent neuroprotection research, and discuss the feasibility and hurdles of each therapeutic approach based on possible pathogenic mechanisms. We also summarize the potential therapeutic mechanisms of various agents in neuroprotection related to glutamate excitotoxicity. Full article

(This article belongs to the Special Issue The Challenges and Therapeutic Prospects in Eye Disease)

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