IOBA - Artículos de revista

Aniridia and the ocular surface: Medical and surgical problems and solutions

2026-02-19T20:08:53Z

Congenital aniridia is a multisystemic genetic disease due to a mutation in PAX6 gene which severely affects the development and functionality of the human eyes. In patients affected by the mutation, aside from the absence or defects of iris tissue formation, abnormalities in position or opacities of the crystalline lens, macular hypoplasia, ocular surface disease is the main cause of visual loss and the deterioration of the quality of life of most patients. Limbal stem cell deficiency combined with tear film instability and secondary dry eye cause aniridic keratopathy which, in advanced stages, ends up in corneal opacification. In this paper, the actual knowledge about congenital aniridia keratopathy physiopathology and medical and surgical treatment options and their efficacy are discussed. Indications and results of topical treatments with artificial tears and blood-derivatives in its initial stages, and different surgical techniques as limbal stem cell transplantation, keratoplasty and keratoprostheses are reviewed. Finally, recent advances and results in regenerative medicine techniques with ex vivo stem cell cultivation or other types of cultivated cells are presented.

Efecto de la sobreexpresión de TSG-6 o CXCR4 en la capacidad migratoria, inmunomoduladora y prorregenerativa de células madre mesenquimales en un modelo in vitro de inflamación de epitelio corneal

2026-04-10T06:36:39Z

El síndrome de insuficiencia límbica es una patología de la superficie ocular que provoca ceguera corneal por pérdida de células madre limbares. El trasplante de células madre mesenquimales (MSCs) ha demostrado una eficacia parcial en su tratamiento gracias a su capacidad inmunomoduladora, migratoria y regenerativa. Dicha eficacia se ha tratado de potenciar en este trabajo mediante la modificación genética de MSCs humanas de tejido adiposo con CXCR4 o TSG-6. La transducción de las MSCs no alteró su inmunofenotipo ni su capacidad de diferenciación multilinaje. Ensayos de migración y regeneración epitelial en modelos in vitro de inflamación demostraron la mejora en la capacidad regenerativa y migratoria de las MSCs gracias a la sobreexpresión de TSG-6 o CXCR4. El análisis de sobrenadantes mediante Luminex reveló que IL-6, MCP-1, RANTES y VEGF-A podrían estar implicados en la modulación de la efectividad del tratamiento.

Senile Cataract Formation Does Not Affect Crystalline Lens Thickness

2026-04-10T06:38:59Z

Introduction: Characterizing lens thickness (LT) in patients with cataracts is important for better understanding the lens aging process and for designing new intraocular lens power formulas. This study aimed to analyze the influence of common senile cataract formation on the LT, anterior (ACS) and posterior (PCS) cortex space, and nuclear thickness (NT), controlling for sex, age, and axial length. Methods: A cross-sectional study was performed. A consecutive sample of 603 volunteers (403 women, 200 men) aged 59.1 ± 18.8 years was recruited. The standardized Lens Opacification Classification System (LOCS)-III was used to classify eyes (randomly selected) into cataractous and non-cataractous groups. Also, they were classified according to the cataract location (presence or absence of cortical, nuclear, or posterior subcapsular cataract). Optical biometry was performed to measure LT, ACS, NT, and PCS. Propensity score was used to match participants one-to-one for sex, age, and axial length. Groups were compared using the Student's t test or Yuen's test. Results: The four classifications divided unmatched eyes into: 361 cataractous lenses and 242 non-cataractous, 226 cortical and 377 non-cortical cataractous, 313 nuclear and 290 non-nuclear cataractous and 242 subcapsular and 361 non-subcapsular cataractous. Before matching, cataractous eyes showed significantly higher LT (4.52 ± 0.39 vs. 3.94 ± 0.46 mm, p < 0.001), ACS (0.75 ± 0.20 vs. 0.58 ± 0.23 mm, p < 0.001), NT (3.34 ± 0.23 vs. 3.18 ± 0.25 mm, p < 0.001) and PCS (0.42 ± 0.19 vs. 0.37 ± 0.19 mm, p = 0.003). Matched lens, cortical, nuclear, and subcapsular cataract samples comprised 146, 258, 182, and 226 eyes, respectively. After matching, no significant differences were observed in LT (4.34 ± 0.37 vs. 4.33 ± 0.36 mm, p = 0.94), ACS (0.72 ± 0.20 vs. 0.76 ± 0.19 mm, p = 0.08), NT (3.31 ± 0.22 vs. 3.30 ± 0.23 mm, p = 0.24) and PCS (0.42 ± 0.19 vs. 0.43 ± 0.16 mm, p = 0.79). Conclusions: The presence of senile cortical, nuclear, and posterior subcapsular cataract have no effect on LT, ACS, NT, and PCS. Confounding factors should be controlled for when measuring LT and its main components.

Bone marrow-versus adipose tissue-derived mesenchymal stem cells for corneal failure in an experimental model of limbal stem cell deficiency

2026-01-13T11:17:31Z

Ocular limbal stem cell deficiency (LSCD) occurs because of corneal epithelial stem cell destruction or dysfunction at the limbal niche. LSCD can cause corneal blindness, and the current therapy based on limbal stem cell transplantation is continuously improving. The aim of this work was to compare the safety and efficacy of human mesenchymal stem cells (hMSCs) derived from bone marrow (hBM-MSCs) and adipose tissue (hAT-MSCs) when transplanted to a rabbit model of LSCD. Both hMSC types expressed the corneal and limbal epithelial cell markers CK3, CK12, ZO-1, and ABCG2 under standard culture conditions. A few hBM-MSCs expressed CK7 and E- cadherin, while hAT-MSCs expressed more CK7 but no E-cadherin. The hMSCs were seeded onto amniotic membranes and transplanted onto the ocular surface of a LSCD rabbit model. Both hMSC types were well tolerated without immunosuppression and were primarily located in the superior limbal stroma eight weeks post- transplantation. The hBM-MSC–treated group showed less superficial neovascularization, while the hAT- MSC–treated group showed less conjunctival invasion and fewer corneal stromal blood vessels. Compared to the untreated LSCD group, both hMSC-treated groups had less corneal opacity, less corneal and limbal stromal inflammation, and more corneal epithelial layers that partially recovered the corneal and limbal epithelial markers CK3, CK15, and p63. Overall, transplantation of hBM-MSCs and hAT-MSCs in a rabbit LSCD model reduced the development of corneal opacity, neovascularization, inflammation, and partially restored corneal and limbal tissue structure and epithelial cell phenotypes. Therefore, both types of hMSCs could become valid alternatives for LSCD treatment.

Human corneal epithelial cells harvested from advanced surface ablation (ASA): An optimized in vitro culture protocol

2025-10-07T19:01:18Z

Purpose: Corneal epithelial cells obtained from advanced surface ablation (ASA) surgery provide a valuable resource for in vitro models of ocular surface diseases. The aim of this study is to enhance culture conditions and characterize the functionality of EpiASA cells in culture, focusing on their ability to keep the distinctive prop- erties of corneal epithelial cells. Methods: EpiASA samples from 51 patients were included in the study. Two different collection media were tested, and their effect on sample preservation and initial viability was evaluated. Then, cells were disaggregated and cultured using different strategies to increase cell viability, which was measured by AlamarBlue assay. Once the optimized conditions were established, cells were cultured and passaged, and structural and functional characterization of native tissue, primary cultures, and first-passage cultures was performed using atomic force microscopy (AFM), qPCR, and immunofluorescence stainings. Results: The addition of trehalose to the basal collection medium increased EpiASA initial viability. Culture surface coating with type I collagen, along with the supplementation of culture medium with hydrocortisone, significantly increased cell viability. On the contrary, co-cultures with different ocular cell lines, or the use of human serum, did not provide a sustained benefit. Further low-concentration trehalose supplementation of EpiASA cultures enhanced monolayer formation and allowed subculturing. AFM and immunofluorescence confirmed that passage 1 EpiASA cells retained corneal epithelial characteristics, including well-organized microvilli and uniform expression of barrier and epithelial markers. Conclusion: This research provides an optimized protocol (EpiKeraMAX) for using EpiASA samples for in vitro studies of human corneal cells

Diagnostic age- and sex-adjusted reference intervals of Meibomian gland morphological features

2025-12-02T11:49:29Z

Purpose: To establish reference intervals of Meibomian gland (MG) characteristics in healthy participants, and to classify meibography images of evaporative type dry eye disease (DED) subjects according to the determined reference intervals. Methods: Prospective study including healthy and evaporative type DED subjects. Upper eyelid meibography images were analyzed to evaluate: MG length, minimal distance between endpoints, tortuosity, width, MG shortening area, deviation from a vertical orientation, number of linear segments, MG global area, and number of MGs. Reference intervals for MG characteristics were determined using generalized additive models for location, scale, and shape (GAMLSS). Participants with evaporative type DED were classified as normal or non-normal based on the reference intervals. Clinical features were compared between groups using Student’s t test or Mann–Whitney U test. Results: Participants were 156 healthy individuals (50.6 % males; mean age 44 years) and 39 individuals with evaporative type DED (74.4 % women; mean age 62 years). MG length, minimal distance between endpoints, tortuosity, and width, depended on age but not on sex. MG shortening area depended on age and sex. Neither age nor sex affected the deviation from a vertical orientation, number of linear segments, MG global area, and number of MGs. Furthermore, 66.7 % of the participants in the evaporative type DED group were classified as normal (all the MG characteristics fell within the corresponding reference intervals). A significantly higher value was observed in the non-normal group in OSDI (P = 0.034) and meibum expressibility (P = 0.041, indicative of poor expressibility). Conclusions: Reference intervals values may be useful in classifying meibography images as normal or non- normal, thus aiding in the objective diagnosis of morphological alterations of MGs.

The relationship between the eyelid status and contact lens discomfort

2025-07-08T19:04:13Z

Purpose: To study the relationship between eyelid alterations and the presence of contact lens discomfort (CLD) in soft contact lens (CL) wearers. Methods: One hundred thirty-seven CL wearers were included in this cross-sectional study. CLD symptoms were quantified by the Contact Lens Dry Eye Questionnaire (CLDEQ)-8. Participants were also classified considering the CLD effect on wearing time. Non-invasive tear break-up time was measured with the EasyTear® VIEW + Tearscope, tear film lipid layer thickness was assessed with the LipiView II interferometer, and lid margin pa- rameters, Meibomian gland morphology and function, and lid wiper epitheliopathy were evaluated using slit- lamp biomicroscopy (SL-D7, Topcon corp.). Correlations between symptoms and signs were analysed, and multivariable regression models were performed. Results: Lid margin thickness (p = 0.07), Meibomian gland secretion quality (p = 0.02) and expressibility (p = 0.09) showed a significant (p ≤ 0.1) simple association with the CLD effect classification, but only lid margin thickness reached statistical significance in the multivariable regression model [odds ratio (95 % confidence interval): 0.52 (0.30/0.87); p = 0.015]. No significant (p ≤ 0.05) simple linear association was found between the CLDEQ-8 and any of the ocular parameters. Conclusions: The presence of mild CLD symptoms in soft CL wearers was not consistently associated with any eyelid alteration, except for lid margin thickness. Future studies assessing the impact of lid margin thickness on CLD would be valuable.

Corneal sensory changes and nerve plexus abnormalities in chronic neuropathic ocular pain and dry eye postrefractive surgery

2025-06-19T19:04:57Z

Purpose Chronic neuropathic ocular pain (NOP) can develop alongside chronic dry eye (DE) post–laser-assisted in-situ keratomileusis (LASIK), yet its specific characteristics remain poorly understood. This study aims to compare the clinical characteristics of patients who developed both DE and NOP after LASIK to those with only DE and to asymptomatic LASIK patients, to facilitate the diagnosis of NOP. Methods Prospective, cross-sectional “case-control” comparison study. An 89-subject post-LASIK study comprised 3 groups: 34 patients developing NOP and DE (NOP-DE group), 25 patients developing only DE (DE group), and 30 asymptomatic subjects (control group). Assessments included clinical history and symptom questionnaires (OSDI, mSIDEQ, NRS, WFPRS), anxiety and depression evaluation (HADS), tear film stability (osmolarity and TBUT) and production (Schirmer), and ocular surface integrity. Corneal mechanical and thermal sensitivity thresholds were measured using Belmonte's noncontact esthesiometer, whereas tactile sensitivity threshold was assessed pre-/post-topical anesthesia using the Cochet-Bonnet esthesiometer. In vivo confocal microscopy (IVCM) was used to evaluate the sub-basal nerve plexus characteristics and dendritic cell density in the central cornea. Group comparisons and correlations were conducted. Results Compared with DE group, patients in the NOP-DE group exhibited significantly more DE symptoms with mSIDEQ (P = .019) higher level of pain with NRS and WFPRS, increased use of ocular lubrication (P = .003), greater frequency of patients with pathological results on anxiety and depression questionnaires (P < .001), and a higher prevalence of central sensitization syndromes (P < .001). Additionally, NOP-DE patients demonstrated higher tactile corneal sensitivity post-topical anesthesia (P = .002). IVCM revealed lower nerve density (P = .049) and higher microneuroma density (P = .008) in the sub-basal nerve plexus of NOP-DE patients compared to DE patients without NOP (P = .008). Most nerve metrics correlated moderately to strongly with clinical parameters. Conclusions Persistent high corneal tactile sensitivity postanesthesia, reduced nerve density, and increased microneuroma density in the central cornea may serve as diagnostic indicators for confirming NOP in patients experiencing chronic DE post-LASIK. These findings underscore the potential utility of incorporating these measures into clinical assessments to improve diagnostic accuracy and guide management strategies in this patient population.

A comparison of stem cell-related gene expression in the progenitor-rich limbal epithelium and the differentiating central corneal epithelium

2024-12-16T07:47:33Z

Corneal epithelium is maintained by a population of stem cells (SCs) that have not been identified by specific molecular markers. The objective of this study was to find new putative markers for these SCs and to identify associated molecular pathways.

Reduction in the risk of peripheral neuropathy and lower decrease in kidney function with metformin, linagliptin or their fixed-dose combination compared to placebo in prediabetes: a randomized controlled trial

2024-07-30T19:01:42Z

Objective: To compare the effect of glucose-lowering drugs on peripheral nerve and kidney function in prediabetes. Methods: Multicenter, randomized, placebo-controlled trial in 658 adults with prediabetes treated for 1 year with metformin, linagliptin, their combination or placebo. Endpoints are small fiber peripheral neuropathy (SFPN) risk estimated by foot electrochemical skin conductance (FESC < 70 μSiemens) and estimated glomerular filtration rate (eGFR). Results: Compared to the placebo, the proportion of SFPN was reduced by 25.1% (95% CI:16.3–33.9) with metformin alone, by 17.3% (95% CI 7.4–27.2) with linagliptin alone, and by 19.5% (95% CI 10.1–29.0) with the combination linagliptin/metformin (p < 0.0001 for all comparisons). eGFR remained +3.3 mL/min (95% CI: 0.38–6.22) higher with the combination linagliptin/metformin than with the placebo (p = 0.03). Fasting plasma glucose (FPG) decreased more with metformin monotherapy −0.3 mmol/L (95%CI: −0.48; 0.12, p = 0.0009) and with the combination metformin/linagliptin −0.2 mmol/L (95% CI: −0.37; −0.03) than with the placebo (p = 0.0219). Body weight (BW) decreased by −2.0 kg (95% CI: −5.65; −1.65, p = 0.0006) with metformin monotherapy, and by −1.9 kg (95% CI: −3.02; −0.97) with the combination metformin/linagliptin as compared to the placebo (p = 0.0002). Conclusions: in people with prediabetes, a 1 year treatment with metformin and linagliptin, combined or in monotherapy, was associated with a lower risk of SFPN, and with a lower decrease in eGFR, than treatment with placebo.

Clinical exome analysis and targeted gene repair of the c.1354dupT variant in iPSC lines from patients with PROM1-related retinopathies exhibiting diverse phenotypes

2025-09-04T07:59:20Z

ABSTRACT. BACKGROUND: Inherited retinal dystrophies (IRD) are one of the main causes of incurable blindness worldwide. IRD are caused by mutations in genes that encode essential proteins for the retina, leading to photoreceptor degeneration and loss of visual function. IRD generates an enormous global financial burden due to the lack of understanding of a significant part of its pathophysiology, molecular diagnosis, and the near absence of non-palliative treatment options. Patient-derived induced pluripotent stem cells (iPSC) for IRD seem to be an excellent option for addressing these questions, serving as exceptional tools for in-depth studies of IRD pathophysiology and testing new therapeutic approaches. METHODS: From a cohort of 8 patients with PROM1-related IRD, we identified 3 patients carrying the same variant (c.1354dupT) but expressing three different IRD phenotypes: Cone and rod dystrophy (CORD), Retinitis pigmentosa (RP), and Stargardt disease type 4 (STGD4). These three target patients, along with one healthy relative from each, underwent comprehensive ophthalmic examinations and their genetic panel study was expanded through clinical exome sequencing (CES). Subsequently, non-integrative patient-derived iPSC were generated and fully characterized. Correction of the c.1354dupT mutation was performed using CRISPR/Cas9, and the genetic restoration of the PROM1 gene was confirmed through flow cytometry and western blotting in the patient-derived iPSC lines. RESULTS: CES revealed that 2 target patients with the c.1354dupT mutation presented monoallelic variants in genes associated with the complement system or photoreceptor differentiation and peroxisome biogenesis disorders, respectively. The pluripotency and functionality of the patient-derived iPSC lines were confirmed, and the correction of the target mutation fully restored the capability of encoding Prominin-1 (CD133) in the genetically repaired patient-derived iPSC lines. CONCLUSIONS: The c.1354dupT mutation in the PROM1 gene is associated to three distinct AR phenotypes of IRD. This pleotropic effect might be related to the influence of monoallelic variants in other genes associated with retinal dystrophies. However, further evidence needs to be provided. Future experiments should include gene-edited patient-derived iPSC due to its potential as disease modelling tools to elucidate this matter in question.

Clinical and genetic characterization of patients with eye diseases included in the Spanish Rare Diseases Patient Registry

2025-09-10T13:08:33Z

ABSTRACT: BACKGROUND: The low prevalence of rare diseases poses a significant challenge in advancing their understanding. This study aims to delineate the clinical and genetic characteristics of patients with rare eye diseases (RED) enrolled in the Spanish Rare Diseases Patient Registry. METHODS: A total of 864 patients from the registry database were included. Diseases were categorized into inherited retinal dystrophies (n=688); anterior segment diseases (n=48); congenital malformations (n=27); and syndromic diseases with ocular involvement including muscular (n=46), neurological (n=34), or metabolic (n=13); inflammatory diseases (n=4); and tumors (n=4). Data on visual acuity (VA) and/or visual field (VF), symptoms and signs, concurrent diseases in syndromic cases, age of onset and at diagnosis, affected genes, disability rating, inability to work and dependency grade recognition were collected. RESULTS: A mean diagnostic delay of 7 years from symptom onset was observed. Commonly reported symptoms included photophobia, night blindness, and progressive vision loss (≥57% of patients). Cataract was the most prevalent secondary disease (46%), with pseudophakia being the most common ocular surgery (26%). Hearing loss and cardiovascular diseases were the most prevalent concurrent systemic diseases (≥13%). Certificates of disability, incapacity for work, and dependency were held by 87%, 42%, and 19% of patients, respectively. Among the 719 patients with available VA data, 193 (27%) were blind, and 188 (26%) had moderate to severe visual impairment. Over half of the patients (54%) exhibited VF defects, and 216 (25%) had concentric contraction ≤5° or abolished VF. Most had genetic diseases with autosomal recessive (55%), autosomal dominant (30%), X-linked (9%), and mitochondrial (6%) patterns. One patient had mutations in both recessive USH2A and dominant RHO genes simultaneously. Of the 656 patients (75.7%) who underwent genetic testing, only 461 (70.3%) received a positive result (pathogenic or likely pathogenic mutations explaining the phenotype). We found 62 new gene variants related to RED not previously reported in databases of genetic variants related to specific phenotypes. CONCLUSIONS: This study delineates the clinical and genotypic profiles of RED in Spain. Genetic diseases, particularly retinal disorders, predominate, but a significant proportion of affected patients remain genetically undiagnosed, hindering potential gene therapy endeavors. Despite notable improvements in reducing diagnosis delays, it is still remarkable. RED frequently lead to disability and blindness among young populations.

Protocolo de tratamiento del edema macular quístico asociado a retinosis pigmentaria y otras distrofias hereditarias de la retina

2025-09-11T06:48:49Z

Inherited retinal dystrophies (IRD) are the leading cause of legal blindness in the wor-king population. Cystic macular edema (CME) is one of the treatable causes of visual loss,affecting up to 50% of the patients.A bibliographic review has been carried out combining “inherited retinal dystrophy”, “reti-nitis pigmentosa”, “macular edema” and a diagnostic-therapeutic protocol according to thelevels of evidence and recommendations of the “US Agency for Healthcare Research andQuality”.This protocol has been discussed in the monthly meetings of the XAREA DHR group withthe participation of more than 25 experts, creating a consensus document.The etiology of CME is multifactorial: dysfunction of the blood-retinal barrier, retinal pig-ment epithelium, and Müller cells, inflammation, and vitreous traction.OCT is the test of choice for the diagnosis and follow-up of CME associated with IRD.The drugs with the highest degree of scientific evidence are carbonic anhydrase inhibitors(IAC). Intravitreal corticosteroids, anti-VEGF, and vitrectomy with peeling of the internallimiting membrane do not have sufficient evidence.A treatment scheme is proposed for the CME in IRD in adults, another for pediatric patientsand an another for IRD and cataract surgery.Oral and topical IACs are effective in the treatment of CME secondary to IRD. Treatment withcorticosteroids, anti-VEGF, and vitrectomy are second-line options. Randomized clinicaltrials are required to establish the therapeutic scale in these patients.

Intravitreal allogeneic mesenchymal stem cells: a non-randomized phase II clinical trial for acute non-arteritic optic neuropathy

2025-02-20T09:23:58Z

BACKGROUND: An effective treatment for acute non-arteritic ischemic optic neuropathy (NA-AION) has not been known or proven yet. Previous studies have suggested a neuroprotective effect of allogeneic bone marrow-derived mesenchymal stem cells. This study aims to report the results of a clinical trial on patients with acute non-arteritic optic neuropathy (NA-AION) treated with an intravitreal injection of allogeneic bone marrow-derived mesenchymal stem cells (BM-MSCs) (MSV®). METHODS: We conducted a prospective, non-randomized, clinical phase-II study (Eudra CT number 2016-003029-40; ClinicalTrials.gov Registry NCT03173638) that included 5 patients with acute unilateral NA-AION diagnosed within 2 weeks after symptom onset and who received an intravitreal injection of allogeneic BM-MSCs (0.05 ml; cell concentration: 1.5 × 106cells/mL). The patients underwent regular ophthalmological examinations and were followed for one year. RESULTS: In this trial, allogeneic BM-MSCs appeared to be safe as no patients developed signs of acute nor chronic intraocular inflammation or a significant change in intraocular pressure, although an epiretinal membrane was developed in one patient. A retrolental aggregate formed shortly after the injection spontaneously disappeared within a few weeks in another phakic patient, leaving a subcapsular cataract. Visual improvement was noted in 4 patients, and amplitudes of P100 on the visually evoked potentials recordings increased in three patients. The retinal nerve fiber layer and macular ganglion cell layer thicknesses significantly decreased during the follow-up. CONCLUSIONS Besides the development of an epiretinal membrane in one patient, the intravitreal application of allogeneic BM-MSCs appeared to be intraocularly well tolerated. Consequently, not only NA-AION but also BM-MSCs deserve more clinical investigational resources and a larger randomized multicenter trial that would provide stronger evidence both about safety and the potential therapeutic efficacy of intravitreally injected allogeneic BM-MSCsin acute NA-AION. TRIAL REGISTRATION: Safety Assessment of Intravitreal Mesenchymal Stem Cells for Acute Non-Arteritic Anterior Ischemic Optic Neuropathy (NEUROSTEM). NCT03173638. Registered June 02, 2017 https:// clini caltr ials. gov/ ct2/ show/ NCT03173638.

Evaluación de signos tomográficos no exudativos en casos de degeneración macular asociada a la edad de tipo exudativo

2025-09-11T06:23:55Z

ABSTRACT. OBJECTIVE: To analyze the prevalence of non-exudative tomographic signs (onion sign, pseudoswelling, external retinal tubulation, pseudocysts, subretinal clefts and macular atrophy) in patients with neovascular age-related macular degeneration. MATERIAL AND METHODS: A total of 174 eyes of patients with neovascular age-related macular degeneration who had not received previous treatment were included in the study. Visual acuity, neovascularization activity, and the appearance or not of the different signs under study were assessed at times 0 (initial visit), 4 months, one year, year and a half, and at 2 and 3 years of follow-up. The following were also evaluated: age, sex, affected eye and type of neovascularization (1, 2, 3, polypoid or mixed). The analysis were performed using the statistical software R (version 3.3.2) and the glmmADMB package (version 0.8.3.3). RESULTS: The presence of pseudocysts and external retinal tubulation increases throughout the follow-up. The onion sign begins with an ascending frequency up to 12 months, then decreases at 18 months and increases again at 24 months. Regarding pseudowelling, it maintains an increase until 18 months to finally decrease. Subretinal clefts is the rarest sign, presenting in 1.1% on the first visit. Finally, macular atrophy, present in 12.6% of the eyes initially, is found in 25% after 2 years. CONCLUSION: Pseudocysts, external retinal tubulation and macular atrophy were the most prevalent signs, while subretinal clefts were the most infrequent.

Intraocular emulsion of silicone oil (ITEMS) grading system

2025-09-11T06:40:04Z

ABSTRACT. PURPOSE: To propose the InTraocular EMulsion of Silicone oil (ITEMS) grading system for the assessment of silicone oil (SiO) emulsion, applicable in a routine clinical setting and validated through an expert-led consensus procedure. METHODS: Seven experts on intraocular liquid tamponades, led by a facilitator, performed a literature review on the detection of SiO emulsion. Based on the proposed ideas, a questionnaire was developed and submitted to the experts on the methods to detect SiO emulsion and the items to grade. After two rounds of individual ranking using a nine-point scale and related discussion, the final grading system was developed including items that reached consensus (score ≥7 from ≥75% of members). RESULTS: The agreed ITEMS grading system includes the quantification of SiO microbubbles and large SiO bubbles through slit lamp biomicroscopy, gonioscopy, fundus examination under mydriasis or ultra-widefield fundus photography. Moreover, macular and disc OCT are used to detect SiO-associated hyperreflective dots. CONCLUSION: An evidence-based expert-led consensus was conducted to develop grading system of SiO emulsion, allowing, for the first time, homogenous collection of data on SiO emulsion. This has the potential to improve our understanding of the role and clinical relevance of SiO emulsion allowing comparisons between different studies.