Medicine and Pharmacology

Abstract: Background/Objectives: To investigate the effect of different sound types on pattern visual evoked potential (VEP) responses among healthy adults. Methods: This prospective cross-sectional trial was conducted at the Retina Clinic, Ophthalmology Department, tertiary Hospital in Riyadh, Saudi Arabia. Healthy adults with no systemic or ocular diseases aged 20-60 years were included. All participants underwent comprehensive visual and ocular assessment including best-corrected visual acuity (BCVA), slit-lamp examination, optical coherence tomography (OCT), screening audiometry, and pattern-reversal visual evoked potential (VEP) test conducted under three auditory conditions: silence, Quran recitation, and music exposure. P100 latency and amplitude were recorded using 1° and 0.25° stimulation sizes. Statistical analysis was performed using non-parametric statistical tests including the Friedman test and Bonferroni-corrected post-hoc comparisons. Results: Significant differences in VEP amplitude responses were observed across auditory conditions, particularly at the 1° stimulation size indicated 95% confidence intervals and exact P value for effects. The Friedman test demonstrated significant amplitude differences at the 1° stimulation size (χ²(2)=16.379, p<0.001), with silence producing significantly higher amplitudes compared with Quran recitation and music exposure (p=0.001). Significant positive correlations were identified between BCVA and P100 amplitude at music exposure (r=0.218, p<0.001) only at the 0.25° stimulation size. Conclusion: Different auditory stimulation significantly influenced VEP responses. Stimulation size could be sensitive in detecting the functional visual pathway in healthy adults, but it could be great sensitive for detecting abnormalities in ocular conditions. Further studies are required to assess the potential value of VEP as a non-invasive test for early neural dysfunction.

Abstract: Background/Objectives: Early corneal changes after phacoemulsification reflect both surgery-related stress and individual tissue susceptibility. The contribution of preoperative corneal hysteresis (CH) to this variability remains uncertain. To test the interaction between preoperative CH and cumulative dissipated energy (CDE) in relation to early postoperative central corneal thickness (CCT), and to characterize postoperative pachymetric and biomechanical changes. Methods: This prospective study included 89 eyes of 80 patients undergoing uncomplicated phacoemulsification. CH and CCT were measured preoperatively, on postoperative day 1, and at 1 month; CDE was recorded intraoperatively. Early change in CCT (ΔCCT) was the primary outcome. Multivariable regression assessed the CH×CDE interaction adjusted for baseline CCT and age, IOPcc and IOPg. Longitudinal and biometric associations were also evaluated. Results: CCT increased by 149.0 ± 112.2 µm and CH decreased by 1.60 ± 1.98 mmHg on postoperative day one. CH significantly modified the CDE–ΔCCT association (β=1.99, 95% CI: 0.08–3.90; p=0.041): higher CH was associated with less predicted thickening at low-to-moderate CDE, with attenuation as CDE increased. CDE was strongly associated with ΔCCT but only weakly with CH reduction. At late follow-up, CCT was no longer significantly different from baseline, whereas CH remained reduced (MD=−0.68 mmHg, 95% CI:−1.30, −0.06; p=0.025). Eyes with ACD ≤2.5 mm showed a greater CCT response to CDE (β=7.70; p=0.028). Conclusions: Preoperative CH showed a moderating effect on the relationship between phacoemulsification energy and early corneal thickening, supporting a contribution of baseline biomechanics to individual corneal susceptibility.

Abstract: Faricimab (Vabysmo, Roche, EU) may improve treatment durability while maintaining functional and anatomical outcomes in neovascular age-related macular degeneration (nAMD). This single-centre retrospective study evaluated 52 eyes of 49 refractory nAMD patients switched from ranibizumab, aflibercept 2 mg, or brolucizumab to faricimab. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), injection intervals, optical coherent tomography (OCT) fluid, and adverse events were assessed at baseline and last follow-up. Mean age was 78.8 years. Before switching, patients had received a mean of 21.85 injections over 996 days, and 77.4% were short responders, with a mean treatment interval of 6.3 weeks. After a mean 466 days of faricimab treatment, BCVA remained stable, changing from 0.389 to 0.378 logMAR (mean change −0.012 logMAR; p = 0.509). BCVA improved in 19.2%, remained stable in 67.3%, and worsened in 13.5% of eyes. CRT decreased significantly from 257.8 to 224.8 μm (mean change −32.9 μm; p = 0.00005). The mean injection interval increased to 8.0 weeks, reaching 8.42 weeks among eyes continuing faricimab. Thirteen eyes (25%) required switching to aflibercept 8 mg because of recurrent fluid or OCT worsening. No endophthalmitis or severe intraocular inflammation occurred. Faricimab maintained vision, improved macular anatomy, and reduced treatment burden, although some refractory eyes required further treatment escalation.

Abstract: Purpose: To investigate the relationship between lipid profile, oxidative stress biomarkers, and dermatochalasis severity and determine the diagnostic and predictive value of these parameters in patients with dermatochalasis.. Methods: This cross-sectional study included 300 participants (150 men, 150 women; mean age: 49.75±6.33 years) divided into four group according to Grade 0 (control, n=120), Grade 1 (n=60), Grade 2 (n=60), and Grade 3 (n=60) dermatochalasis. Lipid parameters [high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), triglyceride (TG), very low-density lipoprotein (VLDL), and total cholesterol (TC)]and oxidative stress biomarkers [total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), oxidized LDL (ox-LDL), paraoxonase-1 (PON1), and apolipoprotein A1 (ApoA1)] were measured. Group comparisons were performed using Mann-Whitney U and Kruskal-Wallis tests with Dunn-Bonferroni posthoc analysis. Correlations were assessed with Spearman’s rho. Binary and ordinal logistic regression analyses were applied to identify independent predictors. Receiver operating characteristic (ROC) curve analysis was performed to evaluate diagnostic performance. Results: OSI values were significantly higher in dermatochalasis patients compared to the control group [median: 2.98 (IQR: 1.72-4.57) vs. 1.18 (0.23-3.19); p< 0.001] with a moderate-to-large effect size (r=0.500). TOS and ApoA1 were also elevated in these patients (p< 0.001 and p=0.013, respectively), while PON1 was decreased (p=0.045). LDL-C was higher in patients (p=0.048) but total cholesterol was lower (p=0.042). Multivariate logistic regression identified OSI (OR: 1.532, 95% CI: 1.315-1.784; p< 0.001), LDL-C (OR: 1.032, 95%: CI 1.016-1.047; p< 0.001), and TC (OR: 0.976, 95% CI: 0.964-0.987; p< 0.001) values as independent predictors of dermatochalasis. Ordinal regression revealed LDL-C as the only independent predictor of severity (OR: 1.007, 95% CI: 1.001-1.014; p=0.030). ROC analysis showed that the OSI had the highest discriminatory power (AUC: 0.750; sensitivity of 91.11% and specificity of 55.00% at cut-off of ≥1.24). Conclusions: Oxidative stress, and particularly elevated OSI, is strongly associated with dermatochalasis presence and demonstrates acceptable diagnostic performance. LDL-C is the only parameter independently associated with both dis-ease presence and severity. These findings suggest that oxidative stress plays a significant role in dermatochalasis development, while lipid metabolism may influence disease progression.

Abstract: Vitreoretinal lymphoma (VRL) is a rare, high-grade intraocular malignancy able to mimic intermediate and/or posterior uveitis. Diagnosis is difficult because lymphomatous cells in ocular samples are scarce, fragile and rapidly degraded, particularly after corticosteroid exposure. This review examines how current knowledge of VRL pathobiology from its clinical, imaging and laboratory features and how these can inform diagnosis. Cytology remains the confirmatory test, while multimodal imaging helps localizing vitreal, intraretinal, subretinal and sub-retinal pigmented epithelium (RPE) involvement guiding ocular sampling. Diagnostic yield depends on appropriate sample collections, handling and timely processing. Cytokine and molecular testing, including interleukin-10 (IL-10)/interleukin-6 (IL-6) assessment and detection of recurrent lymphoma-associated alterations such as MYD88 and CD79B, can provide diagnostic support when morphology is inconclusive. We also examine newer approaches designed to increase the information obtained from small-volume ocular samples through quantitative imaging and high-dimensional molecular profiling. The diagnostic value of each test depends on the anatomical distribution of disease and the characteristics of the specimen and is greatest when complementary findings are interpreted together.

Abstract: Optical coherence tomography angiography (OCTA) has evolved from a novel method for non-invasive vascular visualization into an increasingly quantitative component of multimodal imaging in uveitis. Its distinctive value lies not in replacing fluorescein angiography (FA) or indocyanine green angiography (ICGA), but in providing depth-resolved visualization of the retinal and choroidal microvasculature without obscuration by dye leakage, while enabling quantitative assessment of vascular alterations. This review examines the current role of OCTA in uveitis, with particular emphasis on retinal vasculitis, macular microvascular injury, choriocapillaris involvement, inflammatory choroidal neovascularization, widefield imaging, and quantitative vascular biomarkers. Particular attention is given to the interpretation of OCTA abnormalities in the context of active inflammation, potentially reversible flow impairment, and irreversible vascular damage, as these processes may produce overlapping OCTA appearances yet have different clinical and prognostic implications. We also address acquisition, projection and segmentation artifacts; cross-device and algorithmic variability; the importance of multimodal interpretation; and emerging applications of automated image analysis and artificial intelligence. The most promising future role of OCTA may lie in longitudinal monitoring rather than stand-alone diagnosis, providing reproducible quantitative biomarkers of microvascular injury and treatment response. Realization of this potential will require prospective multicentre validation, standardized acquisition and reporting protocols, robust inter-device harmonization, and clinically meaningful thresholds for longitudinal change.

Abstract: Alzheimer’s disease (AD) pathology is increasingly recognized to manifest in the retina, offering a non-invasive window for early biomarker discovery. This proof-of-concept study investigated whether multimodal retinal imaging—hyperspectral imaging (HSI), optical coherence tomography (OCT), and color fundus photography (CFP)—can differentiate individuals with and without cerebral amyloid-beta (Aβ) pathology in 40 participants with PET-confirmed Aβ status (17 Aβ+, cognitively normal or with mild cognitive impairment; 23 Aβ− cognitively normal controls). HSI-derived gray-level co-occurrence matrix (GLCM) texture, OCT-derived ganglion cell–inner plexiform layer (GC-IPL) thickness, and CFP-derived vascular biomarkers (VBMs) were extracted, and logistic regression with leave-one-out cross-validation assessed classification performance per modality, alone and combined; the cohort was supplemented with AD dementia patients for exploratory trajectory analyses. HSI showed significantly lower GLCM correlation at 466 nm in Aβ+ participants, most pronounced in the inferior macula (p = 0.01, AUC = 0.72), and GC-IPL thickness confirmed an “inferior vulnerability zone.” Combining HSI and GC-IPL features yielded the best performance (AUC = 0.84; sensitivity = 0.82; specificity = 0.78), whereas vascular biomarkers contributed minimally. HSI features followed a non-monotonic trajectory across the AD continuum, decreasing in early Aβ+ stages and rising again in dementia. These findings demonstrate synergy between HSI and OCT for detecting retinal biomarkers of early-stage AD, supporting multimodal retinal imaging as a scalable screening approach warranting validation in larger, longitudinal cohorts.

Abstract: This was an interventional consecutive case series including 63 patients (70 eyes) who underwent enhancement of uveoscleral outflow by rerouting aqueous humor (AH) flow from the anterior chamber (AC) to the suprachoroidal space (SCS) without detaching the ciliary body from the scleral spur. Long-term outcomes were evaluated retrospectively. Inclusion required a minimum follow-up of 6 months, with data collected longitudinally for up to 36 months after baseline. In addition to evaluating the safety and efficacy of the applied technique, the role of the scleral, episcleral and conjunctival lymphatic vessels (CLVs) in suprachoroidal drainage was assessed clinically and using optical coherence tomography (OCT) technologies. The primary outcome was the proportion of eyes with a final IOP < 18 mm Hg and a > 20% reduction in IOP with the same or fewer medications compared to baseline. This outcome was achieved in 90.1, 88.3, 90.4, 93.5, 96.2 and 100% of cases at months 6, 12, 18, 24, 30 and 36, respectively. No bleb formation occurred after surgery in any of the cases. Intra- and postoperative complications were rare and easily manageable. Transparent CLVs arising directly from the sclera and far from the surgical site were visible on biomicroscopy in the superior bulbar conjunctiva in 52.9% of eyes (37/70). Long-lasting CLVs were related to higher values of intraocular pressure (IOP). In comparison to the preoperative evaluation, when no CLVs were identified on OCT, they were identified in 94.6% of eyes after surgery. Long-term CLV’s identification on OCT was related to a long-term decrease in IOP and less additional hypotensive medication. The technique was safe and effective in achieving a long-term reduction in IOP and decreasing the medication burden. A novel SCS–scleral–episcleral–CLV outflow route was identified for suprachoroidal drainage.

Abstract: Airborne particulate matter (PM₂.₅) contributes to oxidative damage of the ocular surface, particularly under dry eye-related hyperosmolar conditions. We evaluated the protective effects of a soluble extract derived from lyophilized human amniotic membrane patches (hAM-Te) in human corneal and conjunctival epithelial cells and THP-1 macrophages exposed to hyperosmolarity, industrial PM₂.₅, or both. Cell viability, migration, reactive oxygen species, nitrite production, total antioxidant capacity, and antioxidant enzyme activities were assessed. Combined hyperosmolarity and PM₂.₅ markedly impaired cell viability and migration while increasing oxidative and nitrosative stress. hAM-Te significantly improved cell viability and wound closure, reduced reactive oxygen species and nitrite levels, restored antioxidant capacity, and modulated endogenous antioxidant defenses. These findings demonstrate that hAM-Te attenuates redox imbalance and cellular injury induced by combined environmental and hyperosmolar stress, supporting its potential as a protective strategy against pollution-associated ocular surface damage.

Abstract: There is a dearth of research on the readiness of the multiple stakeholder groups needing to adopt competency-based education (CBE) reform in a single optometry program context. This study assessed and compared readiness for transition to CBE across four stakeholder groups—students, educators, regulators, and employers—in Nigerian optometry training on six domains: knowledge, skills, institutional/system readiness, regulatory alignment, workforce relevance, and change readiness. A structured questionnaire (36 items, three-point format) was administered to students (n = 656), educators (n = 26), regulators (n = 3), and employers (n = 16). Scores were computed as a Readiness Index (0–100%), with group differences tested using Kruskal-Wallis and Mann-Whitney U tests. All four groups scored above the scale midpoint. Educators reported significantly higher readiness than students (86.9% vs. 77.3%; H = 14.03, p = 0.003); differences between students and regulators (87.5%) or employers (84.9%) were not significant after Bonferroni correction. The lowest-scoring domain across all groups was institutional/system readiness, particularly among students (mean = 2.20/3.00), and student readiness varied significantly by training institution. Nigerian optometry stakeholders broadly support CBE adoption in principle, but institutional and system-level preparedness lags behind attitudinal support, indicating that reform will require deliberate investment in institutional infrastructure.

Abstract: Purpose: To evaluate the ability of computer vision models to detect myopia from standard colour fundus photographs and to compare their diagnostic performance with that of experienced ophthalmologists. Methods: A total of 324 retinal fundus images were labelled as myopic or non-myopic using cycloplegic subjective refraction. Images were acquired with a non-mydriatic 45° fundus camera and split into training, internal validation (80 images), and independent testing sets (50 images). YOLOv8 and YOLOv11 variants were trained for binary classification. Performance was evaluated using standard diagnostic metrics, with bootstrap confidence intervals and Holm–Bonferroni correction. Five ophthalmologists independently classified the test set, and their consensus was compared with model predictions using DeLong and McNemar tests. Results: On internal validation, YOLOv8-xl achieved the highest sensitivity (0.983) and MCC (0.646). YOLOv11 models showed greater variability, with the extra-large variant displaying degenerate behaviour. On the independent test set, YOLOv8-n achieved an AUC of 0.860 versus 0.753 for YOLOv11-s, with no significant difference (p = 0.174). Clinical consensus reached an AUC of 0.832 and did not differ from YOLOv8-n (p = 0.725). McNemar testing showed no difference between YOLOv8-n and clinicians (p = 1.000), while YOLOv11-s differed significantly (p &lt; 0.001). Limitations include the small, class-imbalanced dataset and the limited number of ophthalmologists. Conclusions: YOLOv8 models can detect myopia from standard fundus photographs with performance comparable to experienced ophthalmologists, supporting their potential as complementary screening tools.

Abstract: Age-related macular degeneration (nAMD) is a significant cause of visual impairment globally.1 This single-centre retrospective study evaluated real-world outcomes of faricimab in patients with neovascular age-related macular degeneration (nAMD) who responded suboptimally to other anti-VEGF treatment. Patients with nAMD who were switched to faricimab between September and December 2022 with a minimum of 12 months’ follow-up were included. Main outcomes were best-corrected visual acuity (BCVA), central subfield thickness (CST), and treatment intervals at 12 and 18 months. A total of 136 eyes received at least one intravitreal faricimab injection, of which 71 eyes (62 patients) with sufficient follow-up data were included in the analysis. Median BCVA changed from 68 ETDRS letters (IQR 57-74) to 66 (55-75, p=0.119) at 12 months and 67 (56-73, p=0.009) at 18 months. Median CST changed from 296 µm (IQR 270-339) at baseline to 273 µm (245-313, p=0.0001) at 12 months and 263 µm (240-300, p<0.000) at 18 months. 5.6% of eyes had a dry macula at baseline, compared to 26.8% (p=0.002) and 31.7% (p=0.001) at 12 and 18 months, respectively. Mean treatment interval changed from 5.2 ± 1.6 weeks at baseline, to 7.4 ± 2.8 weeks (p<0.0000) at 12 months, and 7.5 ± 3.1 weeks (p<0.0000) at 18 months. Adverse events included one case of hypertensive anterior uveitis and one post-injection hypotony. Switching to faricimab for nAMD achieved stable vision, improved anatomical outcomes and extended treatment intervals over 18 months.

Abstract: Despite a growing range of effective monotherapies for childhood myopia control, a subset of children continues to show suboptimal control, prompting interest in combination therapy. This narrative mini-review summarises recent evidence on combining pharmacological, optical, and device-based treatments to slow myopia progression, with emphasis on axial length (AL) as the benchmark of efficacy. The most studied combination is low-dose atropine plus orthokeratology (OK), with multiple studies and meta-analyses reporting greater slowing of AL elongation than OK alone, particularly in younger children and faster progressors. Emerging evidence supports combining low-dose atropine with other refractive interventions, such as Defocus-incorporated multisegment (DIMS) and highly aspherical lenslets (HAL), and dual-focus soft contact lenses, although findings vary by study design, atropine dose, and cohort characteristics. Repeated low-level red light (RLRL) therapy combined with OK or DIMS spectacles has also shown improved AL outcomes in some studies, but retinal safety signals and rebound after cessation require careful monitoring. Combination therapy may be most appropriate for fast progressors, notably those with greater than 0.2 mm over 12 months or for inadequate responders to monotherapy, with stepwise escalation guided by AL response, safety, and adherence. Further long-term, randomised trials with standardised endpoints and responder definitions are needed.

Abstract: Retinal degeneration is associated with mitochondrial dysfunction, oxidative stress, and disruption of metal homeostasis within the retinal pigment epithelium (RPE). Dysregulation of redox-active metals has been implicated in age-related macular degeneration (AMD), but whether targeted intracellular metal modulation preserves retinal structure and function remains unclear. This study explores the effect of metal ion modulation on retinal structure and visual function. Telomir-Zn, a first-in-class intracellular metal modulator, depletes labile Fe²⁺, potently inhibits multiple JmjC KDMs, and induces epigenetic reprogramming. In a zebrafish model combining impaired DNA repair and mitochondrial dysfunction (Sen57^wrn−/−ND6^−/+), Telomir-Zn reduced oxidative stress, preserved retinal architecture, improved visual behaviors, and partially normalized telomeric content and CpG methylation patterns. Complementary studies in human ARPE-19 RPE cells showed attenuation of iron/copper-induced ROS and calcium dysregulation, with reciprocal zinc accumulation and labile Fe²⁺ depletion. These findings establish targeted metal modulation and multi-KDM inhibition as a novel strategy to mitigate oxidative-epigenetic stress and preserve retinal structure/function in degenerative disease, supporting further development for AMD.

Abstract: Purpose: To report a child with severe treatment resistant juvenile idiopathic arthritis associated uveitis (JIAU), a condition that typically presents as chronic anterior uveitis, although severe panuveitis with retinal vasculitis may rarely occur.Methods: We describe the clinical course, treatment response, and challenge, dechallenge, and rechallenge sequence in a child with severe refractory JIAU treated with combined infliximab and tofacitinib therapy.Results: The patient showed marked improvement in ocular inflammation, macular edema, and visual acuity following addition of tofacitinib to ongoing infliximab therapy. Inflammation recurred after holding infliximab despite continuation of tofacitinib and improved again following reintroduction of infliximab.Conclusion: This challenge, dechallenge, and rechallenge sequence suggests that neither infliximab nor tofacitinib alone provided adequate disease control, whereas their combination was associated with sustained suppression of ocular inflammation. Combined tumor necrosis factor alpha and Janus kinase inhibition may represent a rescue therapeutic option for carefully selected patients with severe refractory JIAU, although its long term safety and efficacy require further evaluation.

Abstract: Background/Objectives: Diabetic retinopathy (DR) is a leading cause of visual im-pairment in United States adults. Artificial intelligence (AI) screening systems using non-dilated fundus photography in primary care settings offer a convenient alternative to dilated screening, but image quality remains a critical limitation. No studies have as-sessed how primary care photographer experience affects gradability of non-dilated images in AI-assisted screening. We hypothesized that medical assistant (MA) photog-raphers’ gradability rates (GR) would improve with experience. Methods: We retrospectively reviewed 1354 DR screenings performed from 05/12/2021-12/28/2022 across 10 Temple Primary Care Clinics using the Canon CR-2 AF camera and EyeNuk’s EyeArt system. 30 MA photographers captured images; MAs with < 10 screenings were excluded. GR were calculated for each photographer. Linear and polynomial regression analyses assessed associations between number of photographs and GR. For MA photographers with >90 screenings, GR was further evaluated over time in blocks of ten consecutive screenings. Results: Eleven MA photographers met inclusion criteria. Linear regression showed no significant association between number of photographs and percentage of gradable images (F = 0.259, p = 0.7784). Three MAs conducted at least 91 screenings. Linear re-gression analysis of successive screenings showed no significant association with average GR (F = 0.684, p = 0.4323). Conclusions: Image gradability did not improve with increasing MA photographer experience. Repeated practice alone appears insufficient to achieve high GR. Standard-ized competency-based training, refresher sessions, or robotic fundus photography may be needed to optimize image quality in AI-assisted DR screening programs in a primary care setting.

Abstract: Purpose:To model treat and extend (TREX) therapy as a threshold-search problem and compare common extension and shortening rules using durability distributions derived from published studies. Design: Computational modelling study using Monte Carlo (MC) simulation and Pareto multi-objective optimisation analysis of TREX rules. Subjects: 10,000 simulated eyes per durability distribution. Methods: Each simulated eye was assumed to have a fixed maximum dry interval (T_max), defined as the longest injection interval maintaining disease stability. Four TREX search rules were evaluated: +2/−2, +4/−4 with midpoint refinement, +4/−2, and a midpoint bracketing strategy. Deterministic pathways were enumerated for each T_max from 4 to 16 weeks. Durability priors were derived from published maintenance interval data from TENAYA/LUCERNE, the FARIT study, and a real-world aflibercept 2 mg cohort, with intermediate weekly survival values interpolated using a piecewise constant hazard interpolation. Monte Carlo simulation of 10,000 eyes was used to estimate visits to maintenance interval, cumulative overshoot, and maximum single overshoot. Pareto analysis identified dominated and non-dominated strategies. Main outcome measures: Number of visits to find maintenance interval, cumulative and maximum overshoot beyond a disease-controlling interval. Results: Under TENAYA/LUCERNE priors, +4/−2 required the fewest visits to maintenance, while +2/−2 had the lowest overshoot. The midpoint strategy achieved similar efficiency to +4/−2 with lower overshoot. Across all three durability distributions, +4/−4 was consistently dominated. The Pareto-optimal set varied by durability prior: midpoint performed favourably under longer-durability distributions but carried greater overshoot risk under shorter-durability priors. Conclusion: TREX rule choice involves explicit trade-offs between search efficiency and overshoot. Pareto analysis provides a structured framework for comparing extension strategies and tailoring rule choice to expected durability and clinical risk tolerance.

Abstract: Background: To investigate the effects of biologic and targeted synthetic therapies on retinal microvascular parameters assessed by optical coherence tomography angiography (OCTA) in patients with axial spondyloarthritis (axSpA). Methods: This cross-sectional study included 159 eyes of 82 patients with radiographic or non-radiographic axSpA receiving tumor necrosis factor inhibitors (TNFi), interleukin-17 inhibitors (IL-17i), or Janus kinase inhibitors (JAKi) for at least one year. All patients had low disease activity at the time of examination (BASDAI < 3). Comprehensive ophthalmic evaluation and swept-source OCTA imaging were performed. The superficial capillary plexus vessel density and foveal avascular zone (FAZ) areas in both the superficial (SCP) and deep capillary plexus (DCP) were assessed. Statistical analyses were adjusted for age, sex, smoking status, history of uveitis, treatment duration, and ocular variables. Results: Significant differences were observed among treatment groups in the deep foveal avascular zone (DCP-FAZ) area (P = 0.0060). Post-hoc analyses revealed larger DCP-FAZ values in patients treated with TNFi compared with IL-17i (P = 0.0010), and in those treated with IL-17i compared with JAKi (P = 0.0151). No significant differences were found in superficial FAZ area or superficial capillary plexus vessel density between treatment groups. Patients receiving JAKi were older and had shorter treatment duration compared with the other groups. Smoking status was associated with a significantly smaller deep FAZ area (P = 0.0019), whereas superficial FAZ measurements remained unaffected. A weak positive correlation was observed between intraocular pressure and deep FAZ area (r = 0.18, P = 0.0237), and treatment duration was positively correlated with deep FAZ size (rho = 0.16, P = 0.0454). Conclusions: Different classes of biologic and targeted synthetic therapies are associated with distinct retinal microvascular characteristics in patients with axSpA. The observed differences in deep FAZ measurements suggest that treatment-specific effects on retinal microcirculation may persist despite low systemic disease activity. OCTA may serve as a valuable non-invasive tool for detecting subclinical vascular alterations and monitoring ocular microvascular involvement in axSpA. Further longitudinal studies are required to clarify the clinical significance and long-term implications of these findings.

Abstract: The goal of study was to identify bacterial species isolated from canine non-healing ulcers and evaluate temporal changes in resistance patterns. Corneal microbiology samples were collected from 228 non-healing ulcers of 221 dogs between January 2019 and February 2023. Samples were cultured aerobically and isolates were identified using MALDI-ToF mass spectrometry. Antibiotic susceptibility testing was performed using Kirby-Bauer disc diffusion according to current CLSI guidelines. Acquired resistance patterns were compared between 2019–2020 and 2021–2023, and multidrug-resistant (MDR) and possible extensively drug-resistant (XDR) isolates were characterized. Bacterial growth was observed in 71% (163/228) of samples, yielding 170 isolates. The most frequently isolated species were Staphylococcus epidermidis (21%), Staphylococcus pseudintermedius (18%), Staphylococcus capitis (15%), and other coagulase-negative staphylococci (14%). Overall susceptibility was highest to combinations involving neomycin-polymyxin-bacitracin (neopolybac). A statistically significant increase in overall bacterial resistance (P = 0.000008) and acquired resistance (P = 0.000504) was observed from 2019–2020 to 2021–2023. Methicillin-resistant Staphylococcus spp. comprised 61% of staphylococcal isolates, with an increase from 47% (2019–2020) to 70% (2021–2023). Over half the isolates (53%) were multidrug-resistant. Topical antibiotic regimens containing neomycin-polymyxin-bacitracin provided the broadest coverage. Increasing resistance, particularly methicillin resistance in staphylococci, highlights the concern about the development of highly resistant bacteria which can potentially increase crossover infections between humans and dogs.

Abstract: Background: The rabbit (Oryctolagus cuniculus) is a currently indispensable pre-clinical model for fundamental discovery and translational research in glaucoma surgery. While not fully representative of the human eye, the rabbit often serves as the first robust assessment of a new chemical entity in an anatomically and physiologically relevant setting. In later stages of development, the rabbit is also a critical model for regulatory-facing Good Laboratory Practice (GLP) graded pre-clinical safety studies. However, while guidelines exist for human glaucoma surgeries in terms of patient profile vs surgery type and success criteria, there is limited collated information available on how rabbit glaucoma filtration surgeries are designed, use and mode of administration of anti-metabolite Mitomycin C (MMC) and post-operative antibiotic and anti-inflammatory dosing regime. These disparities limit cross-comparability in studies and encourage sub-optimal study design and incomplete reporting. Methods: This review investigated and collated current procedural and reporting practices based on 100 peer-reviewed rabbit glaucoma filtration surgery publications from the years 2011-2025. Publications meeting acceptance criteria were segmented into pre-operative design (ethical approval, rabbit characteristics, study duration), intra-operative (surgery type, surgical approach, use of MMC) and post-operative follow up (antibiotics, anti-inflammatories, analysis and adverse events). Results: It was found that there were clear preferences in animal model selection, study design and intra-/post-operative anti-fibrotic/inflammatory treatment regimes. Additionally, there were several areas identified where reporting was ambiguous or omitted. E.g. rabbit age, post-operative treatments, adverse events. The levels of omission were 16-30% and represent areas for improvement and highlight the need for ongoing review in pre-clinical research.