Indian Journal of Ophthalmology最新文献

{"title":"Immunotherapy: Current indications and recommendations in the management of ocular allergy.","authors":"Padukudru Anand Mahesh, Shambo Samrat Samajdar, Sowmya Arudi Nagarajan, Greeshma Mandya Venkatesh Murthy, Saibal Moitra","doi":"10.4103/IJO.IJO_2853_23","DOIUrl":"10.4103/IJO.IJO_2853_23","url":null,"abstract":"<p><p>Allergic diseases, including allergic conjunctivitis (AC), pose a significant health burden, affecting both developed and developing nations. Despite its importance, AC is often underreported, leading to underestimated incidence and prevalence. The coexistence of AC with allergic rhinitis and its comorbidity with asthma underscore its clinical relevance. The prevalence of nasal symptoms with eye symptoms related to eye allergy varies among different age groups and regions worldwide. Climatic factors, aeroallergens, and environmental exposure play significant roles in the prevalence of ocular allergies. Allergen immunotherapy (AIT) represents the only disease-modifying treatment for IgE-mediated allergic diseases. This review provides a comprehensive overview of the history, mechanisms, and evidence of AIT for ocular allergies, with a focus on AC. The primary routes of AIT, subcutaneous immunotherapy (SCIT), and sublingual immunotherapy (SLIT) are discussed in detail. The evidence for AIT in treating AC is extensive and demonstrates its effectiveness in alleviating ocular symptoms, reducing medication usage, and improving the quality of life in patients. Both SCIT and SLIT have shown positive results, with SLIT having a more favorable safety profile. Considerations for initiating and maintaining AIT, including adherence, financial burden, and treatment duration, are highlighted. In summary, AIT is a valuable treatment option for AC, offering long-term symptom relief and potential cost-effectiveness. By understanding the history, mechanisms, and evidence of AIT, healthcare providers can better manage ocular allergies and improve patient outcomes.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":" ","pages":"526-536"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior segment optical coherence tomography in conjunctival ocular surface disorders - A review.","authors":"Rama Rajagopal, Mridula Vijayaraghavan, Janarthanam Jothi Balaji, Karthick Jayavel","doi":"10.4103/IJO.IJO_68_25","DOIUrl":"https://doi.org/10.4103/IJO.IJO_68_25","url":null,"abstract":"<p><p>Ocular surface disorders involving the conjunctiva have a myriad of clinical presentations requiring considerable clinical acumen for an accurate diagnosis. There can also be an overlap in clinical features, resulting in a diagnostic dilemma. Over the last few years, anterior segment optical coherence tomography (AS-OCT), by its ability to provide an optical biopsy of the tissue of interest, has evolved as an important diagnostic device. Besides complimenting clinical diagnosis, it also helps in quantifying the response to topical chemotherapy and aids as a follow-up tool. In this review, we highlight the role of AS-OCT in various ocular surface disorders with relevant literature review.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"543-552"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718852","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biological topicals in ocular surface disorders.","authors":"Sridevi Nair, Murugesan Vanathi, Radhika Tandon","doi":"10.4103/IJO.IJO_482_25","DOIUrl":"https://doi.org/10.4103/IJO.IJO_482_25","url":null,"abstract":"<p><p>Topical biological agents represent a significant advancement in the treatment of ocular surface diseases, offering a regenerative and therapeutic approach beyond conventional therapies. These agents are derived from serum (autologous or allogeneic), platelets, amniotic membrane, and pooled intravenous immunoglobulin. Their efficacy stems from their rich composition of growth factors, cytokines, and anti-inflammatory molecules that promote tissue healing, reduce inflammation, and enhance corneal regeneration. Autologous serum eye drops, closely mimicking natural tears, have been widely utilized for conditions such as dry eye disease, neurotrophic keratopathy, and persistent epithelial defects. Similarly, platelet derivatives, including platelet-rich plasma (PRP) and platelet lysate (PL), have demonstrated accelerated wound healing and nerve regeneration benefits. Amniotic membrane extracts and human amniotic fluid eye drops share the anti-inflammatory and regenerative properties of the human amniotic membrane. Recent advancements have introduced the use of topical IVIG, which modulates immune responses in severe inflammatory dry eye conditions, such as ocular graft-versus-host disease. Despite these promising applications, challenges such as variability in preparation, storage limitations, and cost remain. Nevertheless, the future of topical biological agents is promising, with emerging recombinant therapies and personalized treatment approaches shaping modern ophthalmologic care. As research continues to expand, these agents are poised to become integral components in managing ocular surface disorders, improving patient outcomes, and reducing dependence on traditional therapies.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"496-507"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative evaluation of aqueous solution and oil emulsion formulations of 0.05% cyclosporine eye drops in dry eye disease - A randomized clinical trial.","authors":"Ayesha A Salam, Seema Sen, Neiwete Lomi, Noopur Gupta, Murugesan Vanathi, Radhika Tandon","doi":"10.4103/IJO.IJO_1850_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1850_24","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical response of patients with moderate-to-severe dry eye disease to treatment with 0.05% cyclosporine eye drops as an aqueous solution or oil emulsion.</p><p><strong>Study design: </strong>Prospective randomized clinical trial.</p><p><strong>Methods: </strong>An institutional study where 88 patients with moderate-to-severe dry eye was enrolled after written informed consent and randomized to receive either aqueous solution (Group 1) or oil emulsion (Group 2) 0.05% cyclosporine eye drops in twice daily dosing in addition to lubricant eyedrop 0.5% carboxymethylcellulose six times/day in both eyes. Comprehensive eye examination and baseline parameters were recorded, and clinical assessment was repeated at 4, 8, and 12 weeks. Parameters evaluated included ocular surface disease index score (OSDI), Schirmer test, tear break-up time (TBUT), corneal fluorescein staining - National Eye Institute (NEI) scoring, lipid layer thickness (LLT), tear meniscus height (TMH), non-invasive tear break-up time (NIBUT), percentage loss of meibomian glands, and impression cytology (number of goblet cells/hpf).</p><p><strong>Results: </strong>The mean age was 39 ± 15.6 years and 42 ± 17.7 years, and the M:F ratio was 26:19 and 20:24 in Groups 1 and 2, respectively. Both the groups showed comparable values at baseline. After treatment, there was statistically significant improvement over baseline values in both groups at 4, 8, and 12 weeks. At 12 weeks for the following parameters, there was no significant difference between the groups, though there was an improvement over baseline in Groups 1 and 2, respectively, as follows: OSDI score - 30.89, 33.28 (P < 0.001), Schirmer test - 5 mm, 4 mm (P < 0.001), TBUT - 2.65 sec, 3.07 sec (P < 0.001), NEI score - 2, 2 (P < 0.001) and the number of goblet cells/hpf - 1.5,9 (P = 0016, P = 0.001). A higher number of patients, by a value of 9, in Group 2 showed an increase in the number of goblet cells/hpf. The NIBUT value showed statistically significant improvement in Group 2 compared to Group 1 (P = 0.011). Group 2 also showed statistically significant improvement in TMH by the 8th week (P = 0.015) and in LLT by the 12th week (P < 0.001). Group 1 comparatively showed earlier improvement in LLT by the 4th week (P = 0.027).</p><p><strong>Conclusion: </strong>Both aqueous solution and oil emulsion 0.05% cyclosporine formulations appear to be equally effective in the management of dry eye disease with a comparatively better response with oil emulsion formulations.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"577-581"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emerging approaches for ocular surface and corneal stromal regeneration: Recent advances and future perspectives.","authors":"Rashmi Deshmukh, Vineet Joshi, Vivek Singh, Sayan Basu","doi":"10.4103/IJO.IJO_1974_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1974_24","url":null,"abstract":"<p><p>Corneal blindness affects millions worldwide, with a particularly high burden in developing regions, especially in Asia and Africa. In India, the scarcity of donor corneal tissue and challenges in post-transplant care complicate efforts to address this issue. While enhancing the eye banking network and increasing surgical training remain important, corneal transplantation alone cannot address the problem, particularly for high-risk cases such as trauma, infections, and degenerative diseases, which often have poor long-term outcomes. Advances in regenerative medicine and bioengineering offer promising alternatives. Cell-based therapies, including cultivated limbal epithelial and mesenchymal stem cell treatments, aim to restore corneal function through the modulation of native cell behavior. Additionally, cell-free therapies, such as exosomes, decorin, and extracellular matrix derivatives, provide innovative, donor-independent options to reduce scarring and promote healing. Bioengineered corneas and hydrogel scaffolds further reduce dependence on donor tissue, expanding treatment possibilities and alleviating donor shortages. The successful integration of these therapies into clinical practice requires collaboration between research institutions and industry, along with localized manufacturing to ensure affordability and accessibility. To support these advancements, eye banks may need to evolve into comprehensive cell and tissue facilities, ultimately expanding care options for patients with corneal blindness in resource-limited settings.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"537-542"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal breakdown in thyroid eye disease: Presentation and outcomes over a decade.","authors":"Prasansha Narnoli, Suryasnata Rath, Devjyoti Tripathy, Samir Mohapatra, Smruti R Priyadarshini, Sujata Das, Md Hasnat Ali","doi":"10.4103/IJO.IJO_1067_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1067_24","url":null,"abstract":"<p><strong>Purpose: </strong>Corneal breakdown in thyroid eye disease (TED) is an ocular emergency. This study aimed to assess the outcome of multimodal management for corneal breakdown in TED.</p><p><strong>Methods: </strong>This retrospective audit included all consecutive corneal breakdowns in TED patients between November 2011 and May 2023. The primary outcome measure was the best corrected visual acuity (BCVA), and secondary outcome measures included proptosis, clinical activity score (CAS), and proportion of globe salvage.</p><p><strong>Results: </strong>In all, 35 TED patients (50 eyes; 15 bilateral) were included in this study. The mean age was 50.6 + 16 years (range 17-83), and 23 were male. Median TED duration was 5 months (range 1-108). Seven patients (nine eyes) developed corneal breakdown ≥2 years after disease onset. Corneal breakdown was graded as superficial punctate keratopathy in 18, microbial keratitis in 14, and microbial keratitis with thinning and/or perforation in 18 eyes. At median follow-up of 17 months (range 2-72), in the orbital decompression group, overall mean BCVA before and after orbital decompression showed improvement from 1.2 to 0.7, mean proptosis from 25.4 ± 3.5 to 20.7 ± 2.1 mm, and median CAS from 4.2 ± 1.3 to 0.3 ± 0.6. In the medical management group, the mean BCVA changed from 1.7 to 1.5, mean proptosis from 22.5 ± 2.5 to 22.3 ± 2.4 mm, and CAS from 3.0 ± 1.4 to 1.1 ± 1.4 before and after treatment, respectively. At the final follow-up, 44 eyes (88%) achieved globe salvage, while six eyes were eviscerated.</p><p><strong>Conclusion: </strong>Corneal breakdown necessitates expeditious and intensive multimodal management - topical medications, systemic medications, eyelid surgery, and orbital decompression surgery. In severe corneal breakdown with microbial keratitis with thinning and perforation, multimodal management helps achieve a high percentage of vision and globe salvage.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"567-576"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limbal stem cell deficiency approaches and limbal niche restoration.","authors":"Zahra Bibak-Bejandi, Zohre Arabpour, Alireza Razavi, Amirhossein Moghtader, Sumaiya Shahjahan, Ahmad Alzein, Jeonghyun Esther Kwon, Reyhaneh Bibak-Bejandi, Nuran Aly, Ali Djalilian","doi":"10.4103/IJO.IJO_464_25","DOIUrl":"https://doi.org/10.4103/IJO.IJO_464_25","url":null,"abstract":"<p><p>Approaches to limbal stem cell deficiency remain challenging, especially in bilateral cases, where healthy limbal stem cells are not accessible. While living-related allogeneic and allogeneic limbal stem cell sources have been utilized, their dependence on immunosuppression and its associated side effects pose significant limitations. Mucosal and mesenchymal stem cells have shown potential for differentiation into limbal stem cells and promoting corneal healing, primarily when cultured on the amniotic membrane or fibrin. However, none can fully replicate the original limbus. Innovations in surgical techniques, such as simple oral mucosal transplantation and subconjunctival or intrastromal mesenchymal stem cell injections, are emerging approaches. For successful limbal regeneration, both appropriate cells and suitable scaffolds are essential. Recent studies on decellularized and acellularized limbus models have demonstrated the potential to provide a three-dimensional native structure for cell seeding, retention, and differentiation. Creating a thin, evenly decellularized scaffold is a critical step in ensuring proper corneo-limbal slope formation, facilitating cell migration to the ocular surface. Harvesting the limbus, decellularization, and cell seeding are the three main steps in limbal reconstruction. Recent studies focus on microkeratome-assisted limbal harvesting to create a thin, even, and 360-degree limbal graft. This technique helps form an attached corneo-limbal interface, facilitating limbal stem cell migration. In the second step, acellularization is performed to preserve the extracellular matrix as much as possible, maintaining hemostasis and supporting paracrine interactions. The final steps involve recellularization and transplantation onto the eye. We summarize various limbal decellularization methods, their outcomes, and their potential in limbal reconstruction. More clinical studies are needed to validate this phase of limbal deficiency treatment.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"468-482"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferred practice guidelines and narrative review on infectious keratitis in ocular surface diseases.","authors":"Aafreen Bari, Sushma Nandyala, Jyothi Balakrishnan, Tushar Agarwal, Tanuj Dada, Rohit Saxena, Namrata Sharma","doi":"10.4103/IJO.IJO_1917_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_1917_24","url":null,"abstract":"<p><p>Ocular surface disease (OSD) encompasses a variety of additional factors in the natural history of infectious keratitis like disruption of the normal tear film, altered ocular microbiome, adnexal inflammation, de-epithelization of the cornea due to anatomical factors like trichiasis, lid margin keratinization, presence of limbal stem cell deficiency, and other lid related problems. These cases need special attention with respect to lower threshold for inpatient admission and care along with examination and careful corneal scraping to avoid any perforation. The preferable practice patterns in these include documenting epithelial defects using fluorescein stain in the presence of cobalt blue filter, use of preservative-free monotherapy drops in mild to moderate corneal ulcers, quantification of corneal thinning and depth of infiltrate using anterior segment optical coherence tomography, and early tapering of epithelia-toxic drugs with judicious addition of lubricants and steroids. The changes in surgical management involve adopting a lower threshold for procedures that can enhance healing, such as amniotic membrane grafting, electrolysis of trichiasis, and punctal occlusion for severe dry eye disease. Conversely, a higher threshold for therapeutic keratoplasty is preferable as postoperative healing is a major challenge in eyes with OSD. A closer follow-up is vital as healing is slower and risk of reinfection is higher. The long-term management of corneal opacity in OSD is also complex as first-stage ocular surface stabilization is essential prior to keratoplasty.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"508-515"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Collaboration in ocular surface diseases: Bridging specialties for better care.","authors":"Shweta Agarwal","doi":"10.4103/IJO.IJO_539_25","DOIUrl":"https://doi.org/10.4103/IJO.IJO_539_25","url":null,"abstract":"","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"465"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could ocular demodicosis be a risk factor for punctal stenosis, dry eye, and blepharitis?","authors":"Ibrahim Basol, Hatice Yazisiz, Hatice Deniz Ilhan, Ozlem Koyuncu Ozyurt, Betil Ozhak","doi":"10.4103/IJO.IJO_2187_24","DOIUrl":"https://doi.org/10.4103/IJO.IJO_2187_24","url":null,"abstract":"<p><strong>Purpose: </strong>Demodex, an ectoparasite, can threaten eye health by settling into different eyelash bases. It is particularly suggested to cause dysfunction in the Meibomian glands. This cross-sectional study aimed to investigate the relationships between ocular demodicosis, punctal stenosis, dry eye, and blepharitis.</p><p><strong>Methods: </strong>A total of 144 patients who presented to the Ophthalmology Clinic and volunteered to participate in the study were included. The demographic characteristics of the patients, presence of blepharitis, tear breakup time, eye-watering according to Munk's epiphora scoring, and punctal structures according to Kashkouli classification were recorded. Eyelash epilation was performed while preserving the root structure, and the eyelashes were examined under a light microscope. The relationship between Demodex presence and severity with punctal structure, dry eye status, and blepharitis was evaluated.</p><p><strong>Results: </strong>No significant relationship was found between punctal stenosis and Demodexspp. infestation in both eyes (P > 0.05). Overall, there was a statistical relationship between the presence of Demodexspp. settled in the eyelashes (right lower and upper, left upper eyelid lashes) and dry eye (P < 0.05), but there was no relationship with Demodex density (>3/eyelid). In eyes with blepharitis, especially in patients with anterior blepharitis, the presence and density of Demodexspp. were higher than in patients without blepharitis (P < 0.001 for the right upper, left lower, and upper eyelids, P = 0.001 for the right lower eyelid).</p><p><strong>Conclusion: </strong>Demodex infestations may be associated with blepharitis and dryness of eyes, but there is no association with punctal stenosis.</p>","PeriodicalId":13329,"journal":{"name":"Indian Journal of Ophthalmology","volume":"73 4","pages":"603-609"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}