Ocular Surface最新文献

{"title":"Pipeline: Therapeutics – Two views of off-label use","authors":"Gary D. Novack","doi":"10.1016/j.jtos.2025.04.005","DOIUrl":"10.1016/j.jtos.2025.04.005","url":null,"abstract":"","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 216-218"},"PeriodicalIF":5.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143834111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expert consensus on pediatric dry eye: Insights from a European Delphi study","authors":"Edoardo Villani ,&nbsp;Paolo Nucci ,&nbsp;Jose Manuel Benitez-del-Castillo ,&nbsp;Annegret Dahlmann-Noor ,&nbsp;Wolf Alexander Lagrèze ,&nbsp;Dominique Bremond-Gignac ,&nbsp;PeDED Delphi Group","doi":"10.1016/j.jtos.2025.04.004","DOIUrl":"10.1016/j.jtos.2025.04.004","url":null,"abstract":"<div><h3>Context</h3><div>Dry Eye Disease (DED) is a symptomatic multifactorial condition of the ocular surface, primarily characterized by tear film instability, which can lead to ocular surface damage. While traditionally associated with adults, recent studies have shown a significant prevalence of DED in pediatric populations, exacerbated by modern lifestyle changes such as increased screen time and environmental factors. Pediatric DED (PeDED) often goes underdiagnosed due to a lack of tailored diagnostic tools and the misattribution of symptoms to other conditions.</div></div><div><h3>Methods</h3><div>This Delphi study, conducted by a European panel of six ophthalmology experts sought to address expert consensus in pending challenges of PeDED.</div></div><div><h3>Results</h3><div>Over two rounds of surveys, 34 experts reached consensus on 39 of 46 statements, highlighting the need for age-specific diagnostic criteria and treatment protocols. The study identified environmental and lifestyle factors, such as screen time and ocular allergies, as significant risk factors for PeDED. There was strong consensus on the importance of adapting adult DED definitions and treatment approaches to better suit pediatric patients. The study also emphasized the cautious use of treatments like topical steroids or oral macrolides, especially in younger children.</div></div><div><h3>Conclusion</h3><div>The findings underscore the necessity for standardized clinical practices in diagnosing and managing PeDED, with a focus on improving the quality of life for affected children. Further research is required to validate these findings and develop comprehensive guidelines that cater to the unique needs of the pediatric population.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 189-197"},"PeriodicalIF":5.9,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143799779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pard3 promotes corneal epithelial stratification and homeostasis by regulating apical-basal polarity, cytoskeletal organization and tight junction-mediated barrier function","authors":"Mehak Vohra ,&nbsp;Simran Kumar ,&nbsp;Peri Sohnen ,&nbsp;Satinder Kaur ,&nbsp;Sudha Swamynathan ,&nbsp;Tomonori Hirose ,&nbsp;Zbynek Kozmik ,&nbsp;Shivalingappa K. Swamynathan","doi":"10.1016/j.jtos.2025.04.001","DOIUrl":"10.1016/j.jtos.2025.04.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To document the expression of apical-basal polarity (ABP) determinants in the mouse corneal epithelium (CE) and elucidate the functions of Pard3 in establishment and maintenance of ABP, stratification, homeostasis, and barrier function in the CE.</div></div><div><h3>Methods</h3><div><em>Pard3</em>^Δ/ΔC mice (<em>Pard3</em>^{<em>LoxP/LoxP</em>}; <em>Aldh3A1-Cre/+</em>) with cornea-specific <em>Pard3</em> ablation were generated by breeding <em>Aldh3A1-Cre/+</em> with <em>Pard3</em>^{<em>LoxP/LoxP</em>} mice. The control (<em>Aldh3A1-Cre/+</em> or <em>Pard3</em>^{<em>LoxP/LoxP</em>} alone) and <em>Pard3</em>^Δ/ΔC corneal histology, ocular surface properties, barrier function, and actin cytoskeleton were assessed by Haematoxylin and Eosin staining of paraformaldehyde-fixed, paraffin-embedded tissues, scanning electron microscopy, fluorescein staining, and phalloidin staining, respectively. The expression of specific markers of interest was evaluated by qRT-PCR, immunoblots and immunofluorescent staining.</div></div><div><h3>Results</h3><div>Dynamic changes were observed in the expression and localization of ABP determinants as the CE stratified and matured between post-natal day 5 (PN5) and PN52. Adult <em>Pard3</em>^Δ/ΔC CE contained fewer cell layers with rounded basal cells, and loosely adherent superficial cells lacking microplicae. Adult <em>Pard3</em>^Δ/ΔC CE also displayed impaired barrier function with decreased expression of tight junction, adherens junction, and desmosome components, disrupted actin cytoskeletal organization, increased proliferation, and upregulation of transcription factors that drive epithelial-mesenchymal transition (EMT).</div></div><div><h3>Conclusions</h3><div>Disruption of ABP in <em>Pard3</em>^Δ/ΔC CE, altered expression of cell junction complex components and disorganized actin cytoskeleton, increased cell proliferation, and upregulated EMT transcription factors suggest that the ABP-determinant Pard3 promotes CE features while suppressing mesenchymal cell fate. Collectively, these results elucidate that Pard3-mediated ABP is essential for CE stratification, homeostasis and barrier function.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 201-215"},"PeriodicalIF":5.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143797367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A tribute to Gary N. Foulks, M.D. (1944–2025) and his contributions to the ocular surface","authors":"Michael H. Goldstein ,&nbsp;Deepinder Dhaliwal ,&nbsp;Ed Isbey ,&nbsp;Stephen Pflugfelder ,&nbsp;Mark J. Mannis ,&nbsp;Gary D. Novack","doi":"10.1016/j.jtos.2025.03.009","DOIUrl":"10.1016/j.jtos.2025.03.009","url":null,"abstract":"","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 198-200"},"PeriodicalIF":5.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143789464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal epithelial cells upregulate macropinocytosis to engulf metabolically active axonal mitochondria released by injured axons","authors":"Sonali Pal-Ghosh ,&nbsp;Himani Datta-Majumdar ,&nbsp;Soneha Datta ,&nbsp;Shelly Dimri ,&nbsp;Jordan Hally ,&nbsp;Hugo Wehmeyer ,&nbsp;Zhong Chen ,&nbsp;Mitchell Watsky ,&nbsp;Jian-Xing Ma ,&nbsp;Wentao Liang ,&nbsp;Mary Ann Stepp","doi":"10.1016/j.jtos.2025.03.007","DOIUrl":"10.1016/j.jtos.2025.03.007","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the mechanisms used to internalize mitochondria by corneal epithelial cells after <em>in vivo</em> corneal trephine injury and <em>in vitro</em> in corneal epithelial cells.</div></div><div><h3>Methods</h3><div>Male and female mice were subjected to trephine injury and euthanized immediately, 6, and 24 h after injury. Macropinocytosis was quantified <em>in vivo</em> using 70 kD fluorescent dextran. Mitochondrial content was assessed by immunofluorescence and metabolic activity quantified by Seahorse assay immediately and 6 h after injury. <em>In vitro</em> experiments using human corneal and limbal epithelial (HCLE) cells and isolated mitochondria were performed to assess mitochondrial transfer in the presence of the gap junction inhibitor 18α-glycyrrhetinc acid and the macropincytosis inhibitor ethylisopropylamiloride.</div></div><div><h3>Results</h3><div>Mitochondria accumulate within apical epithelial cell layers within minutes of trephine injury. Macropinocytosis also increases within minutes of trephine injury. Oxygen Consumption Rates increase in the corneal epithelium 6 h after trephine injury in males and females. Inhibiting gap junctions increases mitochondrial engulfment while inhibiting macropinocytosis prevents engulfment of mitochondria by corneal epithelial cells <em>in vitro</em>.</div></div><div><h3>Conclusions</h3><div>Molecules released by injured cells and severed axons induce macropinocytosis in corneal epithelial cells within minutes of trephine injury. An increase in oxygen consumption rate in the corneal epithelium after trephine injury indicates that axonal mitochondria can evade lysosomal degradation for at least 6 h. <em>In vitro</em> studies using isolated labeled and unlabeled mitochondria and control and mechanically stressed human corneal epithelial cells confirm the involvement of macropinocytosis in the engulfment of free and vesicle bound mitochondria by corneal epithelial cells.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 173-188"},"PeriodicalIF":5.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143777254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between personality and dry eye disease: A large cross-sectional study","authors":"Morten S. Magno ,&nbsp;Laura E. Wolpert ,&nbsp;Mathias K. Morthen ,&nbsp;Tor P. Utheim ,&nbsp;Christopher J. Hammond ,&nbsp;Jelle Vehof","doi":"10.1016/j.jtos.2025.03.005","DOIUrl":"10.1016/j.jtos.2025.03.005","url":null,"abstract":"<div><h3>Purpose</h3><div>Personality influences health and wellbeing. The purpose of this large, cross-sectional study was to clarify the association between personality traits and dry eye disease (DED).</div></div><div><h3>Methods</h3><div>78,610 participants from the Lifelines cohort were included. DED was assessed using the Women's Health Study (WHS) dry eye disease questionnaire. Three of the Big Five personality domains (neuroticism, extraversion, conscientiousness) were assessed using an abbreviated NEO Personality Inventory. Logistic regressions including age, sex, BMI, physical activity, smoking, education, income, and 48 medical comorbidities were used to examine the association between personality and DED. The main outcome was WHS-defined DED, with highly symptomatic DED as a secondary outcome. Results are presented as odds ratios per standard deviation increase in personality score.</div></div><div><h3>Results</h3><div>DED was present in 8.7 % of participants. In the fully corrected model including all demographics and comorbidities, higher neuroticism was associated with greater odds of DED (OR 1.10, P &lt; 0.001), while higher conscientiousness was tied to lower odds of DED (OR 0.97, P = 0.014). For highly symptomatic DED, these associations were especially strong: OR 1.23 (P &lt; 0.001) and 0.90 (P &lt; 0.001) for neuroticism and conscientiousness, respectively. Higher extraversion was associated with lower odds of highly symptomatic DED (OR 0.93, P = 0.031), but showed no significant relationship with WHS-defined DED. Additionally, participants diagnosed with DED who had higher neuroticism scores experienced a greater symptom burden.</div></div><div><h3>Conclusions</h3><div>Higher neuroticism and lower conscientiousness are associated with increased odds of DED. These personality traits may contribute to increased subjective symptoms and are important to consider in clinical management and care.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 132-139"},"PeriodicalIF":5.9,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bringing ophthalmology into the scientific world: Novel nanoparticle-based strategies for ocular drug delivery","authors":"Milad Abbasi ,&nbsp;Hossein Aghamollaei ,&nbsp;Ahmad Vaez ,&nbsp;Ali Mohammad Amani ,&nbsp;Hesam Kamyab ,&nbsp;Shreeshivadasan Chelliapan ,&nbsp;Sajad Jamalpour ,&nbsp;Renato Zambrano-Dávila","doi":"10.1016/j.jtos.2025.03.004","DOIUrl":"10.1016/j.jtos.2025.03.004","url":null,"abstract":"<div><div>The distinctive benefits and drawbacks of various drug delivery strategies to supply corneal tissue improvement for sense organs have been the attention of studies worldwide in recent decades. Static and dynamic barriers of ocular tissue prevent foreign chemicals from entering and inhibit the active absorption of therapeutic medicines. The distribution of different medications to ocular tissue is one of the most appealing and demanding tasks for investigators in pharmacology, biomaterials, and ophthalmology, and it is critical for cornea wound healing due to the controlled release rate and increased drug bioavailability. It should be mentioned that the transport of various types of medications into the different sections of the eye, particularly the cornea, is exceedingly challenging because of its distinctive structure and various barriers throughout the eye. Nanoparticles are being studied to improve medicine delivery strategies for ocular disease. Repetitive corneal drug delivery using biodegradable nanocarriers allows a medicine to remain in different parts of the cornea for extended periods of time and thus improve administration route effectiveness. In this review, we discussed eye anatomy, ocular delivery barriers, as well as the emphasis on the biodegradable nanomaterials ranging from organic nanostructures, such as nanomicelles, polymers, liposomes, niosomes, nanowafers, nanoemulsions, nanosuspensions, nanocrystals, cubosomes, olaminosomes, hybridized NPs, dendrimers, bilosomes, solid lipid NPs, nanostructured lipid carriers, and nanofiber to organic nanomaterials like silver, gold, and mesoporous silica nanoparticles. In addition, we describe the nanotechnology-based ophthalmic medications that are presently on the market or in clinical studies. Finally, drawing on current trends and therapeutic approaches, we discuss the challenges that innovative optical drug delivery systems confront and propose future research routes. We hope that this review will serve as a source of motivation and inspiration for developing innovative ophthalmic formulations.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 140-172"},"PeriodicalIF":5.9,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoplasmic reticulum stress contributes to the development of ocular graft-vs-host disease in the eyelids and the ocular surface","authors":"Shinri Sato ,&nbsp;Yoko Ogawa ,&nbsp;Eisuke Shimizu ,&nbsp;Kazuki Asai ,&nbsp;Kazuno Negishi ,&nbsp;Kazuo Tsubota ,&nbsp;Masatoshi Hirayama","doi":"10.1016/j.jtos.2025.03.003","DOIUrl":"10.1016/j.jtos.2025.03.003","url":null,"abstract":"<div><h3>Background</h3><div>While endoplasmic reticulum (ER) stress has been implicated in various aspects of graft-versus-host disease (GVHD), its effects on the eyelids and ocular surface in patients with chronic GVHD (cGVHD) remains poorly understood. We aimed to investigate the relationship between ER stress and ocular GVHD using the ER stress suppressor, 4-phenylbutyric acid (PBA).</div></div><div><h3>Methods</h3><div>The study used allogeneic bone marrow transplantation (BMT) and syngeneic BMT to establish a cGVHD mouse model. cGVHD mice were treated with either intraperitoneal administration of PBA or 2 % PBA eye drops following BMT.</div></div><div><h3>Results</h3><div>The Intraperitoneal PBA-treated (PBAip) group retained a larger meibomian gland (MG) area and corneal epithelial damage and inflammatory and fibrotic cell infiltration in the ocular surface was attenuated compared to vehicle-treated cGVHD mice. The expression of unfolded protein response markers was significantly elevated in the vehicle group compared to the syngeneic control and the PBAip group. Electron microscopy and immunohistochemistry revealed that fibroblasts and macrophages infiltrated the eyelids and ocular surface of cGVHD mice under ER stress. The corneal fluorescein staining score was significantly lower in the PBA eye drop-treated group than in the vehicle-treated group. The numbers of leukocyte marker CD45-, T cell marker CD4-, and macrophage marker F4/80-positive cells were significantly reduced in the PBA eye drop-treated group compared to the vehicle group.</div></div><div><h3>Conclusions</h3><div>The study suggests that the ER stress response, which is triggered by cGVHD in ocular surface tissues, can be suppressed by PBA, an ER stress suppressor, potentially offering therapeutic benefits in ocular GVHD.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 115-131"},"PeriodicalIF":5.9,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143701430","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Smoking negatively impacts ocular surface health and corneal nerve metrics","authors":"Ansa Anam ,&nbsp;Mingyi Yu ,&nbsp;Chang Liu ,&nbsp;Isabelle Xin Yu Lee ,&nbsp;Juanita Yang ,&nbsp;A.V. Shanmathi ,&nbsp;Ching-Yu Cheng ,&nbsp;Yu-Chi Liu","doi":"10.1016/j.jtos.2025.03.002","DOIUrl":"10.1016/j.jtos.2025.03.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effects of smoking on ocular surface through comprehensive analysis of corneal nerves, corneal epithelium, dendritic cells (DCs), and clinical assessments.</div></div><div><h3>Methods</h3><div>This cross-sectional study included 250 healthy smokers and 272 healthy non-smokers. Patients’ smoking status and duration were recorded. In vivo confocal microscopy was performed to assess 7 quantitative corneal nerves parameters, 3 corneal neuroma parameters, 3 DCs parameters, and 3 epithelial parameters. Ocular surface evaluations included tear break-up time (TBUT), ocular surface and corneal staining, corneal sensitivity, and Schirmer test. Ocular Surface Disease Index questionnaire was used for symptom assessment.</div></div><div><h3>Results</h3><div>Compared to non-smokers, smokers exhibited significantly lower corneal nerve fiber density (CNFD), nerve branch density, nerve fiber length, nerve total branch density, corneal nerve fiber area (CNFA), and corneal nerve fractal dimension (CFracDim; all p &lt; 0.001). Smokers also presented with a significantly swollen corneal nerve fiber (p &lt; 0.001). Longer smoking duration was significantly associated with lower CNFD (β = −0.04, P = 0.010), lower CNFA (β = −0.00002, P = 0.033), and lower CFracDim (β = −0.0008, P = 0.016). Additionally, a significantly larger neuroma total area (p = 0.040), size (p &lt; 0.001) and perimeter (p &lt; 0.001), as well as a significantly higher DCs density (p &lt; 0.001), DCs count (p = 0.003), and lower DCs elongation which suggested higher DCs maturity (p &lt; 0.001), were observed in the smoking group. Smokers demonstrated significantly higher ocular surface staining scores (p &lt; 0.001) and reduced TBUT (p = 0.001). Corneal epithelial circularity was borderline higher in the smoking subjects (p = 0.059).</div></div><div><h3>Conclusions</h3><div>Smoking is associated with significant alterations in corneal nerve morphology and quantity, increased immunological cells, and compromised ocular surface integrity.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 105-114"},"PeriodicalIF":5.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143635049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A masked study to differentiate in vivo confocal microscopic features of Pythium insidiosum and fungal filaments","authors":"Bhupesh Bagga ,&nbsp;Md Hasnat Ali ,&nbsp;K Shreeya Jain ,&nbsp;Tanmay Gokhale ,&nbsp;Joveeta Joseph ,&nbsp;Pabitra Duwal ,&nbsp;Amrita Mohanty ,&nbsp;Lakshminarayanan Gowtham ,&nbsp;Savitri Sharma","doi":"10.1016/j.jtos.2025.03.001","DOIUrl":"10.1016/j.jtos.2025.03.001","url":null,"abstract":"<div><h3>Purpose</h3><div>To describe <em>in vivo</em> confocal microscopic features of <em>Pythium insidiosum</em> in patients with <em>Pythium</em> keratitis and compare with those observed in fungal keratitis.</div></div><div><h3>Method</h3><div>We collected <em>in vivo</em> confocal images of the cornea from patients with microbiologically confirmed <em>Pythium</em> and fungal keratitis, analysing five putative distinguishing features: filament width (broad or thin), granularity within the filament (present or absent), filament continuity or traceability, the presence or absence of loops, and the double track sign. Three masked observers were shown images with concealed identities and tasked with detecting <em>Pythium</em> filaments<em>.</em> After initial assessment and training, their detection rates were calculated and compared before and after training. We did perform imageJ (Open Source software project Fiji) analysis of all the images for objectively assessment.</div></div><div><h3>Results</h3><div>Sixty confocal images of <em>Pythium</em> (n = 32,15 patients) and fungal (n = 28,12 patients) keratitis were analysed. The continuity of filaments and the presence of loops emerged as strong predictors of <em>Pythium</em>, with adjusted odds ratios (OR) of 18.1 and 19.29, respectively, based on multivariate logistic regression and decision tree splits. Pre-training accuracy was 0.51, 0.52, and 0.56, but post-training (95 % CI) improved to 0.75 (0.62–0.85), 0.80 (0.67–0.89), and 0.86 (0.75–0.94). Correct identification rates for <em>Pythium</em> were 27, 28, and 29 (84–89 %) out of 32, and for fungus were 16, 21, and 24 (57.4–85.7 %) out of 28 images with sensitivity and specificity ranging from 70.7 to 87.5 % and 80–85 % respectively. ImageJ analysis revealed a significant difference between <em>Pythium</em> and fungal filaments in both width (9.30 ± 1.21 μ vs. 6.20 ± 0.88 μ, <em>p</em> &lt; 0.001) and branching angle (83.92 ± 13.57° vs. 55.10 ± 6.03°, <em>p</em> &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Based on our analysis, these features may be indicative of <em>Pythium</em> and could serve as a helpful reference for future prospective studies. However, further large scale studies and validation are needed to strengthen these observations.</div></div>","PeriodicalId":54691,"journal":{"name":"Ocular Surface","volume":"37 ","pages":"Pages 99-104"},"PeriodicalIF":5.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}