Objectives: The aim of this study was to establish the etiology of uveitis and to examine its relationship with anatomical localization, age, and gender. Methods: A prospective study on patients with uveitis was conducted over a 13-year period at the Department of Ophthalmology, University Hospital “St. George”, Plovdiv, Bulgaria. Each case was diagnosed based on a comprehensive eye examination, a review of the systems, and additional laboratory and specialized examination methods. Patients were categorized into four groups based on the location of inflammation: anterior uveitis, intermediate uveitis, posterior uveitis, and panuveitis. Results: A total of 606 patients with uveitis were included in the study. The mean age of the study group was 46.5 ± 18.6 years. There was no statistically significant difference in gender distribution (p = 0.329). Anterior uveitis was the most dominant anatomical localization (p < 0.001). Cases with clarified etiology were significantly prevalent (p < 0.001). The most frequently identified etiology was HLA B27-associated uveitis (32.5%), followed by viral uveitis (16.8%). A significant correlation between etiology and anatomical localization was found (p < 0.001). The highest proportion (93%) of cases with clarified etiology was associated with posterior uveitis, while the lowest (39.7%) was linked to intermediate uveitis. Conclusions: We found that anterior uveitis was the most common anatomical localization, followed by intermediate uveitis. The disease is rare in childhood, while in elderly patients, there is an increase in idiopathic and viral uveitis cases. Our results provide valuable information about the most common etiologies of uveitis among the Bulgarian population.

Background: Uveitis encompasses a broad group of diseases with infectious and non-infectious etiologies, potentially leading to permanent and irreversible visual impairment. This study aimed to determine whether the etiology and anatomical location of uveitis influence the course and laterality of the disease. Methods: This retrospective observational study included patients with uveitis treated at the University Eye Clinic of “St. George” University Hospital in Plovdiv, Bulgaria, between January 2011 and December 2023. All participants underwent a comprehensive eye examination and minimal laboratory screening, with additional tests and specialist consultations performed when necessary. Uveitis cases were categorized into anterior, intermediate, posterior, and panuveitis according to anatomical location; unilateral or bilateral according to laterality; and acute, chronic, or recurrent based on disease course. Results: The study included 606 patients aged between 3 and 87 years. The etiology and anatomical location of uveitis were significantly associated with the course and laterality of the disease (p < 0.001). Anterior and posterior uveitis were mostly unilateral, with a defined cause and characterized by acute or recurring progression. Intermediate uveitis was mostly idiopathic and chronic, while panuveitis had a more uniform distribution regarding disease progression. Among cases with a determined etiology, HLA-B27-associated uveitis was the most common (32.5%), characterized by sequential involvement of both eyes and a recurrent course. Viral and toxoplasmic uveitis were more frequently unilateral. Conclusions: Our findings indicate that the etiology and anatomical location of uveitis can serve as prognostic factors for contralateral eye involvement and the progression of the inflammatory process. We found that anterior and posterior uveitis were predominantly unilateral and typically presented with an acute or recurrent course, whereas intermediate uveitis and panuveitis were more commonly chronic. In men, uveitis more often had an acute onset, while in women, it tended to follow a chronic course.

This review explores the link between immune interactions and chronic pain, offering new perspectives on treatment. It focuses on Janus kinase (JAK) inhibitors’ potential in pain management. Immune cells’ communication with neurons shapes neuroinflammatory responses, and JAK inhibitors’ effects on pain pathways are discussed, including cytokine suppression and microglial modulation. This review integrates studies from rheumatoid arthritis (RA) pain and central sensitization to highlight connections between immune interactions and pain. Studies on RA joint pain reveal the shift from cytokines to sensitization. Neurobiological investigations into central sensitization uncover shared pathways in chronic pain. Clinical evidence supports JAK inhibitors’ efficacy on pain-related outcomes and their effects on neurons and immune cells. Challenges and future directions are outlined, including interdisciplinary collaboration and dosing optimization. Overall, this review highlights JAK inhibitors’ potential to target immune-mediated pain pathways, underscoring the need for more research on immune–pain connections.

Introduction: Filtration surgery is the most effective method of lowering intraocular pressure (IOP) in patients with insufficient medical control. It consists in facilitating the drainage of the intraocular fluid (IOF) from the anterior chamber to the subconjunctival space and subsequent lowering of IOP. The formation of filtration blebs (FB) and the processes of scarring occurring in the conjunctiva are of particular importance in glaucoma surgery. In many cases, the appearance of FB does not match the IOP values, and what causes the failure after trabeculectomy often remains unclear. Often, over time, there is a change in the structure of the FB, as fibrous tissue grows, which prevents the IOF drainage. Laser scanning in vivo confocal microscopy is a non-invasive study allowing the production of layered images at the microstructural level with high resolution of both the cornea and other structures of the anterior ocular surface. Aim: To evaluate the morphological structure and function of filtering blebs after trabeculectomy using in vivo confocal microscopy taking into account the type of implant and when the surgery was performed. Materials and methods: The study included 33 patients, 46 eyes with glaucoma. Twenty-six of the eyes had primary open-angle glaucoma (POAG), 18 eyes had pseudoexfoliative glaucoma and 2 eyes had juvenile glaucoma. All patients underwent trabeculectomy with fornix-based flap, and three of the eyes underwent retrabeculectomy. Mitomicyn C (MMC) was administered intraoperatively to all patients. The study of the filtering bleb was performed by in vivo confocal microscopy (CFM) (Heidelberg Retina Tomograph II (HRT II) /Rostock Cornea Module/ (Heidelberg Engineering GmbH, Heidelberg, Germany), the period from trabeculectomy and examination being from 1 year to 22 years. An Express implant was placed in 14 eyes, Ologen implant in 7 eyes, and 25 eyes had no implant placed. In the analysis of the morphological structure of the filtering blebs, three indicators were evaluated: the type of epithelium, the type of stroma, and blood vessels. Results: Statistical significance was established with regard to the function and morphological structure of the filtering bleb (p=0.009). Blebs with fine collagen mesh and dense collagen mesh demonstrate good function. In the case of blebs with insufficient function, those with a dense collagen network and hyper-reflective tissue predominated and there were no blebs with a fine collagen network, and in non-functioning blebs most common were those with a pronounced collagen network and hyper-reflective tissue. With regard to vascularization, we found that the functioning blebs in the shortest postoperative period were dominated by those with one blood vessel (stage 1) and there was no stage 3, with weak tortuosity, while in non-functioning blebs in the late postoperative period, there was moderate to severe vascularization and tortuosity (p=0.037), (p=0.043), (p=0.047), (p=0.021). The type of implant affects the tortuosity of the blood vessels of the filtering bleb (p=0.026). The blebs with Express implants show a slight tortuosity, followed by the blebs with Ologen implants. The highest percentage of highly kinked blood vessels occurred in blebs without an implant. Conclusions: In vivo confocal microscopy is an innovative method which allows visualization of the internal structure of the filtering blebs at a cellular level, giving us a new insight into the ongoing healing processes, premising the function of the filtering blebs after glaucoma surgery.

Background and Clinical Significance: Purtscher-like retinopathy is a rare occlusive microangiopathy that causes sudden vision loss of varying severity. It presents with diverse retinal findings, such as cotton-wool spots, haemorrhages, and optic disc and macular edema, among others. A key characteristic is the absence of trauma. This condition has been observed in patients with acute pancreatitis, renal failure, preeclampsia, HELLP syndrome, childbirth, and other systemic disorders. Case Presentation: A 35-year-old male presented with complaints of seeing spots in front of both eyes, with a duration of ten days following the initiation of treatment for acute alcoholic pancreatitis. On examination, best-corrected visual acuity (BCVA) in both eyes was 5/6. Fundus examination revealed multiple cotton-wool spots and haemorrhages located in the posterior pole and around the optic disc, more pronounced in the left eye, where the optic disc had blurred margins and the macular reflex was absent. Perimetry showed paracentral scotomas, and optical coherence tomography (OCT) revealed thickening and disruption of the inner retinal layers in the papillomacular region of both eyes. Fundus fluorescein angiography demonstrated adequate perfusion of the vascular network, with hypofluorescent areas in the arteriovenous phase, peripapillary and in the papillomacular zone, due to masking by cotton-wool spots and haemorrhages. Treatment included systemic antiplatelet agents, anticoagulants, and vitamins, along with topical non-steroidal anti-inflammatory drugs. Two months after the initial presentation visual acuity improved to 6/6 in both eyes. Follow-up OCT scans showed atrophy of the inner retinal layers corresponding to the previous cotton-wool spot and the areas of reduced light sensitivity on perimetry had decreased in size. Conclusions: Acute pancreatitis is the most common systemic condition associated with the development of Purtscher-like retinopathy. Timely diagnosis and management of the underlying systemic disease are essential for preventing ocular complications. Ophthalmological evaluation is necessary in patients with acute pancreatitis who present with visual symptoms in order to detect this often-overlooked rare condition.

Objectives: The purpose of the current research is to examine and analyze the attitudes of healthcare service users towards the integration of remote medical services into ophthalmology in Bulgaria, including teleglaucoma. Methods: A cross-sectional survey study was conducted among 902 healthcare users during the period from May 2023 until December 2024. Descriptive statistics, parametric, and non-parametric tests for hypothesis testing were used. Results: The present study outlined predominantly positive attitudes towards the use of telemedicine services in ophthalmology, with 69.6% of respondents reporting a positive overall opinion in the final assessment. The greatest support was observed during remote consultations with a familiar doctor (77.4%) and during continuous follow-up of eye conditions (55.2%). Willingness to use such services was lower in emergencies or when contacting an unfamiliar specialist. A significant correlation was established between socio-demographic characteristics and attitudes—respondents with greater education levels (p = 0.006), men, and younger participants were more positive towards telemedicine (p < 0.05). The high level of awareness about glaucoma, particularly among those with university-level education, served as a positive prerequisite for the implementation of teleophthalmology services related to its monitoring. Mobile applications and digital solutions were evaluated as beneficial means of facilitating communication and increasing adherence to treatment. Regarding the use of artificial intelligence, certain skepticism and insufficient awareness levels were observed, which required additional efforts to increase trust and digital literacy among users. Conclusions: The implementation of telemedicine services into ophthalmology has potential but outlines the necessity of considering the individual attitudes of applying coherent quality and safety standards and of directed awareness campaigns, especially towards the groups of lower technological and healthcare literacy.