Background: Depression and anxiety are highly prevalent among medical students and may adversely affect academic functioning and professional development. Early identification of these symptoms and their associated factors is therefore essential. Religiosity has been suggested as a potential modifier of mental health outcomes, although existing evidence remains inconsistent. This study aimed to assess symptoms of depression and anxiety, levels of religiosity, and their associations among medical students. Methods: This cross-sectional study was conducted among medical students at the University of Osijek, Croatia, from 29 September to 5 October 2025. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, depressive symptoms using the Patient Health Questionnaire-9 (PHQ-9), and religiosity using the Duke University Religion Index (DUREL). Results: A total of 260 students (197 females, 63 males) completed the survey. At least mild depressive and anxiety symptoms were reported by 54.2% and 58.1%, respectively; 9.2% had moderately severe or severe depression, and 25% reported moderate to severe anxiety. Suicidal or self-harm ideation in the past two weeks occurred in 12.8%. Female students had higher median depression (p = 0.01) and anxiety scores (p = 0.005) than male students; however, these differences did not remain statistically significant after Bonferroni correction. Religiosity was not associated with PHQ-9 or GAD-7 scores after correction; however, categorical analyses indicated that students with moderate to high religiosity more frequently reported moderate to severe depressive symptoms (p = 0.037). Conclusions: The high prevalence of depression, anxiety, and suicidal ideation underscores the need for continuous mental health screening, early identification of risk factors, and implementation of preventive programs among the student population, particularly medical students as future healthcare professionals.

Rationale: Herpes simplex virus 1 establishes a latent infection in trigeminal ganglia. Reactivation causes cold sores, as well as viral keratitis. The purpose of this study was to report potential benefits of using active vitamin D receptor ligands (VDR-agonists) as adjunctive therapies for the treatment of infectious corneal perforations, and prevention of HSV recurrence. Patient concerns: A 57-year-old female with a past history of episodic, poorly-healing, corneal erosions, recurring orolabial herpetic lesions, as well as PCR-confirmed recurrences of herpes simplex keratitis presented with a burning sensation and slight pain in the right eye. Examination indicated HSV keratitis. Topical antibiotic and oral antiviral treatments were prescribed. Despite these standard-of-care treatments, a perforated corneal ulcer ensued. Diagnoses: Corneal perforation associated with HSV-1 keratitis recurrence, later confirmed by PCR analysis of corneal scrapings. Interventions: Corneal perforation was treated with a human fibrin glue, fortified with multilayered amniotic membrane transplant, as well as a therapeutical contact lens. Following surgery, calcifediol and paricalcitol were started as oral adjunctive therapies in an attempt to boost tissue regeneration and innate-immunity within the slow-healing cornea. Anterior segment optical-coherence tomography was used to measure corneal thickness. Frequent follow-ups with various specialists allowed for comprehensive patient evaluation, and meticulous screening for any signs indicating potential HSV-1 recurrence. Outcomes: Following calcifediol-paricalcitol therapy corneal thickening, and re-epithelization ensued. During combined calcifediol-paricalcitol therapy, the patient has had no recurrence of herpes simplex keratitis, or orolabial herpes lesions. Lessons: Corneal stabilization avoided a high-risk, full-thickness corneal transplantation, facilitating future cataract surgery, and allowing for some degree of visual recovery in this eye. Export

Aim: To define the clinical profile of patients with unilateral optic neuritis (ON) presented to our clinic and to identify baseline clinical features and demographic data associated with one-month visual acuity (VA) outcome. Methods: Patients with suspected ON referred to our clinic were consecutively assessed for inclusion between February 2017 and November 2019. VA was measured using Snellen charts. Clinical and demographic, baseline and after one-month follow-up data were analyzed in a multivariate model. Results: Overall, 71 patients were included, of which six were considered lost to follow-up. The median age was 50 years old (interquartile range 37-57 years old) and the female to male ratio was 3:1. 14.1 % had a severe attack and 83.1 % recovered completely one month after the diagnosis. Multivariate analysis of data from 65 patients showed that baseline VA of the affected eye (P=0.011) and fellow eye (P=0.015) were factors associated with VA of the affected eye at follow up. Conclusion: Our cohort was older, had a higher female to male ratio and on average, a less severe ON clinical presentation compared to reports from other countries. Baseline VA of both the affected and fellow eye are predictors of one-month VA recovery

Background/Objectives: Chronic topical antiglaucoma therapy may affect the ocular surface. We assessed documented dry eye disease (DED) and its associations with active-ingredient burden, treatment duration, and preservative exposure. Methods: This retrospective cross-sectional study included 357 adults receiving topical antiglaucoma therapy at a tertiary center who had complete treatment and ocular-surface data. Ocular-surface testing was prompted by symptoms or clinical judgment. The first eligible visit identified during chronological record review was analyzed for each patient. DED was based on the treating ophthalmologist’s documented diagnosis. Logistic regression evaluated treatment-related factors. Results: DED was documented in 171/357 patients within this selected sample (47.9%; 95% CI 42.8–53.1%). Prevalence was higher with at least two versus one active IOP-lowering ingredient (60.6% vs. 23.1%; p < 0.001). Each additional ingredient was associated with higher DED odds after adjustment for age, sex, and glaucoma subtype (adjusted odds ratio [aOR] 2.65, 95% confidence interval [CI] 1.88–3.74). Longer treatment duration was also associated with higher odds (aOR 1.12 per 12 months, 95% CI 1.05–1.20). In the linear extended model, active-ingredient count was not associated with documented DED (aOR 1.02, 95% CI 0.69–1.51), whereas an exclusively preservative-free regimen was associated with lower odds (aOR 0.011, 95% CI 0.001–0.084) and fixed-combination therapy with higher odds (aOR 3.23, 95% CI 1.74–5.98). However, categorical modeling of ingredient count significantly improved extended-model fit (likelihood-ratio p < 0.001), indicating sensitivity to functional form. Documented DED occurred in 1/91 (1.1%) exclusively preservative-free patients versus 170/266 (63.9%) preserved-exposure patients, with sparse PF events limiting interpretation. Conclusions: Documented DED was common in this selected cohort undergoing ocular-surface assessment. Active-ingredient count was associated with DED in the primary adjusted model, but its interpretation in the extended model depended on the functional form used. The marked inverse association with an exclusively preservative-free regimen requires prospective confirmation because sparse data, limited overlap between treatment groups, treatment selection, and residual confounding preclude causal inference.

Background/Objectives: To describe the presentation, diagnostic evaluation, management, and clinical outcome of unilateral corneal ulcer in an otherwise healthy infant without identifiable predisposing factors. Methods: We report a case of a 2-month-old infant who presented with a visible white corneal lesion. Initial examination revealed a 2 × 1 mm fluorescein-positive corneal ulcer with a surrounding stromal infiltrate. There was mild conjunctival injection without ocular discharge. The anterior chamber was deep, without cells or flare. Corneal scraping was deferred because specimen collection would have required sedation or general anesthesia. Consequently, the microbial etiology remained unconfirmed, and empirical antimicrobial treatment was initiated. Results: The patient was treated with topical azithromycin, tobramycin, moxifloxacin, and aciclovir, as well as liposomal ozonized oil eye drops. During empirical treatment and close clinical monitoring, the corneal epithelial defect resolved within seven days, and the surrounding stromal infiltrate progressively decreased in size and opacity. At the one-month follow-up, a small residual stromal scar remained outside the visual axis. Conclusions: This case illustrates the diagnostic and therapeutic challenges of managing corneal ulcer in early infancy when microbiological confirmation is unavailable. The favorable clinical course observed during empirical treatment and close monitoring does not establish an infectious etiology or demonstrate a causal effect of antimicrobial therapy.

Background and Objectives: Iris-based biometric identification is among the most accurate personal recognition technologies in routine use today. Cataract remains the leading cause of blindness worldwide, and surgical removal of the opacified lens is the most frequently performed ophthalmic operation globally, inevitably involving mechanical and thermal manipulation of the anterior segment, where the iris resides. The aims of this study were: (1) to compare the effect of ultrasound phacoemulsification (PHACO) and conventional extracapsular cataract extraction (ECCE) on iris-based identification; (2) to determine whether the vital dye trypan blue, used during phacoemulsification of mature cataracts, independently impairs biometric accuracy; and (3) to quantify associations between key intraoperative parameters and post-operative recognition performance. Materials and Methods: This prospective, non-randomised comparative cohort study enrolled 120 participants assigned to four parallel cohorts (n = 30 each) (clinically allocated by surgical indication rather than randomised; group comparability with respect to age, cataract severity and case complexity was not guaranteed, and findings should therefore be interpreted as observational associations rather than causal effects) according to clinical indication: PHACO (uncomplicated phacoemulsification), PHACO-DYE (phacoemulsification with trypan blue 0.6 mg/mL for mature cataracts), ECCE (conventional extracapsular extraction for complex cataracts), and a healthy Control group. Standardised iris photographs were acquired on the day before the surgery and one month after surgery using a semi-professional digital camera under controlled lighting. Images were processed by a custom Java-based iris recognition platform that performed boundary detection, polar normalisation into 65 discrete iris sectors, and sector-by-sector comparison using a dual-threshold matching rule: sectors with 100% identity, or with a residual difference below 2%, were scored as direct matches; all others were scored as indirect, non-matching elements. The primary outcome was the percentage of correspondence (match %) between pre- and post-operative templates. Intraoperative parameters, cumulative dissipated energy (CDE), phaco time, and estimated fluid used, were recorded for all phacoemulsification cases. Results: All three surgical groups showed significantly lower match percentages than controls (median 91.0%, IQR 86–96; Mann–Whitney U test, all p < 0.001). Median match % was 85.0% (IQR 71–89) for PHACO, 78.5% (68–85) for PHACO-DYE, and 44.0% (29–61) for ECCE. ECCE differed significantly from both phacoemulsification groups (Mann–Whitney U test, p < 0.001 each); no significant difference was found between PHACO and PHACO-DYE (Mann–Whitney U test, p = 0.210, not statistically significant). Only CDE differed significantly between PHACO and PHACO-DYE (Mann–Whitney U test, p = 0.026, statistically significant). All three intraoperative parameters showed significant negative correlations with match % (Pearson correlation coefficient), with estimated fluid used showing the strongest association (PHACO: r = −0.88; PHACO-DYE: r = −0.71; both p < 0.001). Conclusions: In this non-randomised cohort, surgical group was associated with postoperative match reduction, with ECCE showing markedly greater reduction than phacoemulsification; however, residual confounding by cataract severity, case complexity and baseline age differences limits causal interpretation. No significant unadjusted difference in match % was found between PHACO and PHACO-DYE, indicating that this study could not demonstrate an independent effect of trypan blue, though it also cannot exclude one, since dye use was itself linked to more complex, mature cataracts. Estimated intraoperative fluid use showed the strongest unadjusted negative correlation with match %; whether it is an independent predictor requires multivariable analysis that this study, as designed, was not powered to perform. These preliminary, hypothesis-generating findings support considering postoperative biometric re-enrolment after cataract surgery and further, adequately powered and adjusted studies before firm clinical or algorithmic recommendations can be made.