This study explores the complication of secondary intraocular pressure (IOP) elevation and consequent glaucoma development in Graves’ orbitopathy (GO), an autoimmune disorder associated with hyperthyroidism. Utilizing Octopus 900 visual field testing and optical coherence tomography (OCT), the research established correlations between functional and structural changes in optic nerve regions in patients with GO and patients with GO with elevated IOP (GO IOP) groups. A comparison with primary open-angle glaucoma (POAG) was conducted in a cohort of 182 subjects. The study identifies optic nerve head parameters that effectively differentiate changes in GO and GO IOP groups. In the GO group, the strongest correlation between structural and functional changes was observed in sector 7, while in the GO IOP group, it was in sectors 1 and 7. For POAG, correlation was found in six sectors. Elevated IOP in GO correlates with structural and functional impairments similarly to early glaucoma. Risk factors for GO-related elevated IOP included older age, longer duration of thyroid disease, and higher anti-thyroglobulin values. The study highlights the significance of regular IOP measurements, visual field assessments, and OCT examinations in GO patients. Early antiglaucoma intervention is warranted when characteristic structural and functional changes and/or risk factors are identified.

The aim of this study is to assess the effectiveness of a 12-week doxycycline treatment for thyroid eye disease (TED), an autoimmune condition associated with thyroid dysfunction. In this randomized controlled clinical trial, 82 patients were randomly assigned at a 1:1 ratio to receive doxycycline (50 mg) or to undergo no treatment. Various metrics, including margin reflex distance (MRD1 and MRD2), eyelid aperture, levator muscle function, lagophthalmos, proptosis, ocular motility, diplopia, and Graves’ ophthalmopathy-specific quality-of-life (GO-QOL) scale scoring were assessed. Exclusion criteria were uncontrolled systemic diseases, tetracycline allergies, pregnancy, lactation, or age below 18. The mean age was 51.6 years (SD), 87.8% of participants were female, and all were Caucasians. By week 12, the doxycycline group exhibited a significant improvement rate based on MRD2 (from 4 to 15 participants with physiological findings), clinical activity score (from 7 to 35 participants with non-active disease), and GO-QOL (from 51.22% to 70.73% of participants with a good life quality). Doxycycline showcased anti-inflammatory and immunomodulatory effects in treating TED, suggesting its potential efficacy for TED and other orbit inflammatory conditions. However, these results warrant further validation through future research involving extended follow-up periods and larger cohorts.

A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021-2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.

Background and Objectives: Corneal cross-linking (CXL) is the standard treatment for progressive keratoconus, but delayed epithelial healing remains a concern, increasing infection risk and patient discomfort. Studies suggest that insulin may promote corneal epithelial cell migration and proliferation, potentially accelerating wound healing. Its benefit has been observed in neurotrophic keratitis and diabetic epithelial defects, and it may offer similar effects post-CXL. Our objective is to evaluate the effect of topical insulin on epithelial healing after CXL in a small case series. Materials and Methods: Eight patients undergoing CXL for keratoconus were divided into two groups (n = 4 each). The insulin group received topical insulin eye drops (1 IU/mL in Systane^®) five times daily, in addition to standard postoperative care. The control group received Systane^® alone with the same regimen. Daily follow-up included slit-lamp exam, anterior segment OCT, and photodocumentation until epithelial defect closure. Results: Baseline parameters (central corneal thickness, keratoconus stage, Schirmer test, tear break up test) were comparable. While not statistically significant, the insulin group showed numerically smaller epithelial defects on day 2, suggesting a possible trend toward faster healing. By day 3, re-epithelialization was complete in all patients. Pain decreased over time in both groups without significant differences. No adverse effects were noted. Conclusions: Topical insulin may modestly accelerate epithelial healing after CXL, as suggested by smaller defects on day 2 in the insulin group. Although results were not statistically significant, the trend warrants further investigation in larger studies.

Background Limbal stem cells(LSCs) are crucial for the regeneration of the corneal epithelium in patients with limbal stem cell deficiency (LSCD). Thus, LSCs during cultivation in vitro should be in highly homogeneous amounts, while potency and expression of stemness without tumorigenesis would be desirable. Therefore, further characterization and safety evaluation of engineered limbal grafts is required to provide safe and high-quality therapeutic applications. Methods After in vitro expansion, LSCs undergo laboratory characterization in a single-cell suspension, cell culture, and in limbal grafts before transplantation. Through a clinically applicable protocol,the collected data on LSCs at passage 1 were summarized: identity (cell size, morphology); potency (yield, viability, population doubling time, colony-forming efficiency were analyzed by trypan blue staining); expression of putative stem cell markers by flow cytometry, immunofluorescence and immunohistochemistry. Then, mitotic chromosome stability and normal mitotic outcomes were explored by using live-cell imaging. Finally, impurities, bacterial endotoxins and sterility were determined. Results Expression of the stemness marker p63 in single-cell suspension and in cell culture showed high values by different methods. Limbal grafts showed p63-positive cells (78.7 ± 9.4%), Ki67 proliferation (41.7 ± 15.9%), while CK3 was negative. Impurity with 3T3 feeder cells and endotoxins was minimized. We presented mitotic spindles with a length of 11.40 ± 0.54 m and a spindle width of 8.05 ± 0.55 m as new characterization in LSC culture. Additionally, live-cell imaging of LSCs (n=873) was performed, and only a small fraction <2.5% of aberrant interphase cells was observed; 2.12 ± 2.10% of mitotic spindles exhibited a multipolar phenotype during metaphase, and 3.84 ± 3.77% of anaphase cells had a DNA signal present within the spindle midzone, indicating a chromosome bridge or lagging chromosome phenotype. Conclusion This manuscript provides, for the first time, detailed characterization of the parameters of fidelity of the mitotic process and mitotic spindle morphologies of LSCs used in a direct clinical application. Our data show that p63-positive CK3-negative LSCs grown in vitro for clinical purposes undergo mitotic processes with extremely high fidelity, suggesting high karyotype stability. This finding confirms LSCs as a high-quality and safe therapy for eye regeneration in humans.

Dirofilaria ist eine zoonotische Wurmerkrankung, die durch einen Parasiten der Gattung Dirofilaria verursacht wird [1]. Dirofilaria sind in mediterranen Ländern, wie Italien, Frankreich, Griechenland und Kroatien, einheimisch. Zu den Betroffenen zählen meist Hunde, Wölfe, Füchse oder andere nicht menschliche Säugetiere, Menschen sind nur selten betroffen. Die Ansteckung des Menschen erfolgt durch Anthropoden, deren Zwischenwirt und Überträger Mücken sind. Im Unterhautgewebe paaren sich ausgewachsene Würmer und bilden Mikrofilarien, die sich im peripheren Blut befallener Tiere befinden. Diese werden durch Stechmücken aufgenommen und entwickeln sich dort zu infektiösen Larven. Diese sog. Drittlarven werden während des Saugaktes auf den Menschen übertragen. Die ausgewachsenen Würmer können hier nicht das Stadium sexueller Reife erreichen, weshalb sich Mikrofilarien nicht im Menschen entwickeln. Dirofilaria immitis hat eine weltweite Ausbreitung, wohingegen Dirofilaria repens derzeit nur in Europa, Asien und Afrika vorkommt [2]. Der Befall des Menschen zeigt sich für gewöhnlich durch ein punktuelles Knötchen (der ausgewachsene Fadenwurm ist durch das Immunsystem eingekapselt) in der Nähe des infizierten Mückenstichs. Klinische Formen sind okular, subkutan und manchmal sogar pulmonal. Von 6 der 40 verschiedenen Arten der Dirofilaria (D. immitis, D. repens, D. straita, D. tenuis, D. ursi und D. spectans) ist bekannt, dass sie Krankheiten beim Menschen verursachen können [1]. Dabei handelt es sich um unilaterale Infektionen, die meist subkonjunktival sind und eine orbitale Dirofilaria/Dirofilaria des Augenlides zur Folge haben. Es können aber auch intravitreale oder orbitale Fälle sein [3]. Patienten haben eine tastbare Masse. Die meisten dokumentierten Fälle dieser Art beim Menschen können der Dirofilaria repens zugeordnet werden [4]. Bei der Differenzialdiagnose von Tumoren subkutanen periokularen Gewebes muss ein Befall, wie er durch Dirofilaria repens verursacht wird, in Betracht gezogen werden.