Aspects of Histopathological and Ultrastructural Retinal Changes in Chronic Exposure to Hydroxychloroquine.

Background and Objective: Hydroxychloroquine sulfate (HCQ) is a lysosomotropic agent administered in systemic lupus erythematosus and rheumatoid arthritis that has fewer toxic effects than chloroquine. However, HCQ may still be responsible for retinal toxicity. In this study, we observed structural changes in the retinas of experimental rats after prolonged exposure to HCQ. Matherials and Methods: We investigated several aspects regarding retinal changes, at both the histopathological and ultrastructural levels. We used 96 male albino Wistar rats distributed into four equal groups (n = 24 per group): the first three groups were treated with different doses of HCQ (50, 100, and 200 mg/kg HCQ, injected intraperitoneally in a single dose daily), and the last group (the control group, n = 24) was treated with saline solution administered in the same way (0.4 mL of saline solution). The treated groups received HCQ daily for 4 months, and every month, six animals from each group were sacrificed to assess retinal changes. The eyes were examined via optical (OM) and electronic microscopy (EM). Statistical analysis was deployed, and results regarding retinal morpho-photometry were acquired. Results: We observed structural retinal changes in both high and low doses of HCQ; while high doses determined a significant thinning of the retina, lower doses caused retinal thickening. Morphological retinal changes upon exposure to HCQ are believed to be caused by accumulated HCQ in lysosomes found in retinal ganglion cells and in the inner nuclear and photoreceptor cell layers. Such changes were most evident in the group receiving HCQ intraperitoneally in doses of 100 mg/kg for a longer period (4 months). Conclusions: The present study highlights histopathological and ultrastructural retinal changes induced by chronic HCQ administration, which were strongly connected to the dosage and period of exposure.

Visual Function Improvement after Plasma Exchange Therapy for Acute Optic Neuritis in Neuromyelitis Optica Spectrum Disorders: Case Series and Review.

OBJECTIVE: Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorder (NMOSD) are autoimmune-mediated central nervous system disorders distinguished by the presence of serum aquaporine-4 IgG antibody (AQP4-Ab). The clinical panel comprises severe optic neuritis (ON) and transverse myelitis, which can result in incomplete recovery and a high risk of recurrence. METHODS: This study aimed to evaluate the visual outcomes of three patients with severe acute ON in NMOSD that was non-responsive to intravenous methylprednisolone (IVMP), who received plasma exchange therapy (PLEX). We included three patients (P1, P2 and P3) with severe acute ON who had no improvement after IVMP treatment and were admitted to the ophthalmology department at the Emergency University Hospital Bucharest from January 2022 to September 2023. All three patients with ON were diagnosed in accordance with the criteria described by the Optic Neuritis Treatment Trial. All the subjects were experiencing their first attack. RESULTS: The mean recruitment age was 35.3 ± 7.71. All patients were seropositive for the AQP4 antibody. All patients were tested for serum myelin oligodendrocyte glycoprotein (MOG) antibody but only one showed a positive test (P3). Lesions visible in orbital MRI indicated the involvement of retrobulbar, canalicular and/or intracranial segments. All three subjects had no response or incomplete remission after an IVMP protocol (5 days of 1000 mg intravenous methylprednisolone in sodium chloride 0.9%). The mean time from onset of optic neuritis to PLEX was 37.6 days. The PLEX treatment protocol comprised five cycles of plasma exchange treatment over 10 days, with a plasma exchange session every other day. An amount of 1 to 1.5 volumes of circulating plasma were dialyzed for 2-4 h. At 1 month after the completion of PLEX therapy, BCVA and VF parameters were improved in all three patients. CONCLUSION: The treatment of ON remains subject to debate and is somewhat controversial. Plasma exchange must be considered as a rescue therapy when IVMP is insufficient for AQP4-ON patients. This study revealed that PLEX treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. This study suggests that PLEX may be associated with improved visual outcomes in NMOSD acute optic neuritis.

A Narrative Review on Neuro-Ophthalmological Manifestations That May Occur during Pregnancy.

AIM: As a medical condition, pregnancy mandates the simultaneous treatment of both the mother and the fetus, making it a distinctive aspect of clinical medicine. MATERIAL AND METHOD: We analyze the physiological changes occurring in the eyes and brain during pregnancy, as well as the neuro-ophthalmological manifestations that can occur during pregnancy. Studies published in both English and other languages, case reports, and reviews from 2011 to 2023 onwards were included. All surveys were acquired by exploring the databases. RESULTS: We found a total of 2135 articles that showcase neuro-ophthalmic changes related to pregnancy: review and research articles (Science Direct 804, Web of Science 923, Scopus 345, and 63 Pub Med). In total, 86 studies were examined after applying the inclusion and exclusion criteria. Bilateral papilledema can be a warning sign for intracranial hypertension or cerebral venous sinus thrombosis. Additionally, when unilateral, it is important to differentially diagnose anterior ischemic optic neuropathy secondary to a hypercoagulant, compressive or inflammatory optic neuropathy, optic neuritis, or even orbital pseudotumor state. Severe eclampsia and preeclampsia can manifest as choroidal infarction, serous retinal detachment, and even cortical blindness. There can also be implications at the level of cranial nerves or transient Horner syndrome. CONCLUSIONS: Evaluating and treating a pregnant woman with neuro-ophthalmological manifestations is challenging. The obstetrician closely follows and has a medical relationship with the pregnant woman; hence he/she might be the first to be informed about the general condition of the pregnant woman or might request an ophthalmologic examination tailored to each specific case.

Leber's Hereditary Optic Neuropathy (LHON): Clinical Experience and Outcomes after Long-Term Idebenone Treatment.

BACKGROUND: Leber's hereditary optic neuropathy (LHON) is a rare disease. Large studies are difficult to conduct; therefore, case reports provide valuable data. Since 2015, patients have been treated with Idebenone. The aim of this paper is to share our experience with diagnosing and managing patients in different stages of LHON. METHODS: We designed a case series study, including four patients undergoing genetic testing and ophthalmologic examination. Criteria for Idebenone administration and follow-up were presented. RESULTS: All patients had mutation 11778G>A in MT-ND4. The first patient, an 82-year-old man, with long history of vision loss, had no indication for Idebenone. Two additional cases emerged within the same family: a 40-year-old brother and a 31-year-old sister. Both received Idebenone, with good outcomes only for the female. After a one-year regimen, they were lost to follow-up. The fourth patient, a 46-year-old man, was diagnosed in the subacute stage. Idebenone administration was deferred, allowing progression of visual field defects. After 17 months of treatment, visual improvement appeared. The treatment was continued for 36 months, with short interruptions, resulting in good outcomes. CONCLUSIONS: Our study demonstrated positive results with long-term Idebenone use. Contrary to medical literature, our female patient had a favorable evolution, despite the delayed diagnosis.

A Narrative Review Discussing the Obstetric Repercussions Due to Alterations of Personalized Bacterial Sites Developed within the Vagina, Cervix, and Endometrium.

BACKGROUND: The reproductive tract microbiota that evolved as an integrative component has been studied intensively in the last decade. As a result, novel research, clinical opportunities, and perspectives have been derived following the close investigation of this microecological environment. This has paved the way for an update to and improvement of the management strategies and therapeutic approaches. However, obscurities, contradictions, and controversies arise regarding the ascension route from the vagina to the endometrium via the cervix, with finality in adverse obstetric outcomes. METHODS: Starting from these considerations, we aimed to gather all existing data and information from four major academic databases (PubMed, ISI Web of Knowledge, Scopus, and ScienceDirect) published in the last 13 years (2010-2023) using a controlled vocabulary and dedicated terminology to enhance the coverage, identification, and sorting of potentially eligible studies. RESULTS: Despite the high number of returned entries (n = 804), only a slight percentage (2.73%) of all manuscripts were deemed eligible following two rounds of evaluation. Cumulatively, a low level of Lactobacillus spp. and of other core microbiota members is mandatory, with a possible eubiosis-to-dysbiosis transition leading to an impairment of metabolic and endocrine network homeostasis. This transposes into a change in the pro-inflammatory landscape and activation of signaling pathways due to activity exerted by the bacterial lipopolysaccharides (LPSs)/endotoxins that further reflect a high risk of miscarriage in various stages. While the presence of some pathogenic entities may be suggestive of an adverse obstetric predisposition, there are still pros and cons of the role of specific strains, as only the vagina and cervix have been targeted as opposed to the endometrium, which recently started to be viewed as the key player in the vagina-cervix-endometrium route. Consequently, based on an individual's profile, diet, and regime, antibiotics and probiotics might be practical or not. CONCLUSIONS: Resident bacteria have a dual facet and are beneficial for women's health, but, at the same time, relaying on the abundance, richness, and evenness that are definitory indexes standing as intermediaries of a miscarriage.

Dynamics of the association between visual and auditory functional changes in glaucoma. Preliminary results.

Glaucoma is a multifactorial degenerative optic neuropathy characterized by the irreversible loss of retinal ganglion cells. Vascular, genetic, anatomical and immune factors are present in etiopathogenic mechanisms. Being the second cause of blindness worldwide after cataract, and with an irreversible character, glaucoma has turned into a disease with a significant impact on public health. Patients with primary open-angle glaucoma (POAG) may have central neurodegenerative changes, such as sensorineural hearing loss and static changes. Aim: The aim of this study was to estimate the connections between visual and auditory functional changes in glaucoma. The subjects were grouped as follows: patients with glaucoma compared with patients without glaucoma, while trying to identify the functional defect of the optic nerve (visual field) and a hearing testing (audiogram). Materials and methods: The prospective, cross-sectional study included 32 eyes of 16 subjects with POAG in a group of study and 24 eyes of 12 healthy subjects in the other group, with a mean age of both groups between 61,64 ± 6,53 years old. Both groups were examined from ophthalmological, audiological and radioimaging perspectives with Pure-tone audiometry (PTA) and magnetic resonance imaging (MRI) for brain. All patients had ophthalmologic assessments according to a standardized protocol. Moreover, auditory functional parameters (audiometry) were recorded. Results: Female cases, over 65 years old, with residency in a city, predominated in the group of study. Compared to the control group, patients in the group of study had average levels of the PTA and modified visual field (VF) parameters. Multivariate analysis demonstrated that the correlation of PTA was indirect, reduced in intensity, both with MD (r = -0.108; p = 0.585), Cal HOV (r = -0.268; p = 0.168) and the slope profile of the right eye. Multivariate analysis demonstrated that there was a correlation of the right PTA, which was indirect, reduced in intensity, both with MD (r = -0.108; p = 0.585), Cal HOV (r = -0.268; p = 0.168) and the slope profile of the right eye. The left ear PTA correlation was indirect, moderate in intensity, statistically significant with both MD (r = -0.584; p = 0.001) and slope profile (r = -0.377; p = 0.048) and reduced as intensity with Cal HOV (r = -0.147; p = 0.456) of the left eye. Conclusions: Patients with POAG showed changes in audiometry in connection with ophthalmological parameters, a fact suggesting that the auditory system might have been affected in POAG. This study highlighted the interdisciplinarity of the medical field with the aim of ensuring the quality of life of glaucoma patients. A good collaboration between the ophthalmologist and the otolaryngologist was very important for our patients. Abbreviations: RE = Right eye, LE = Left Eye, POAG = Primitive Open Angle Glaucoma, PTA = Pure-tone audiometry, VF = visual field, MRI = magnetic resonance imaging, IOP = Intraocular pressure, BVAC = best visual acuity corrected, MD = mean defect, CNS = central nervous system, SAP = standard automated perimetry, CCT = central corneal thickness, ONH = Optic nerve head, CDR = Cup/ Disc ratio, RNFL = Retinal fiber layers.

The Implications of SARS-CoV-2 Infection in a Series of Neuro-Ophthalmological Manifestations-Case Series and Literature Review.

The global pandemic impact of the COVID-19 infection included clinical manifestations that affected several organs and systems, with various neuro-ophthalmological manifestations associated with the infection. These are rare and occur either secondary to the presence of the virus or by an autoimmune mechanism secondary to viral antigens. The manifestations are atypical, being present even in the absence of the systemic symptoms typical of a SARS-CoV-2 infection. In this article, we introduce a series of three clinical cases with neuro-ophthalmological manifestations associated with COVID infection that were shown in Ophthalmology Clinic of St. Spiridon Emergency Hospital. Case 1 is that of a 45-year-old male patient with no personal history of general pathology or ophthalmology, with binocular diplopia, painful red eyes, and lacrimal hypersecretion with a sudden onset of about 4 days. Based on the evaluations, a positive diagnosis of orbital cellulitis in both eyes is made. Case 2 is that of a 52-year-old female patient with general PPA (personal pathological antecedents) of SARS-CoV-2 infection 1 month prior to presentation with decreased visual acuity in the right eye and a positive central scotoma, preceded by photopsia and vertigo with balance disorders. The diagnosis is made at the right eye for retrobulbar optic neuritis and post-SARS-CoV-2 infection status. The last clinical case is that of a 55-year-old male patient known to have high blood pressure (HBP) with a sudden, painless decrease in VARE approximately 3 weeks post-SARS-CoV-2 immunization (Pfizer vaccine first dose). The diagnosis is made after consulting all the RE results for central retinal vein thrombosis. Conclusions: Although the cases were quickly and efficiently investigated and the treatment was administered adequately by a multidisciplinary team (cases 1 and 3), the evolution was not favorable in all three situations. Atypical neuro-ophthalmological manifestations can also be present in the absence of systemic symptoms typical of SARS-CoV-2 infection.

Computer Vision Syndrome: An Ophthalmic Pathology of the Modern Era.

Digital device usage has increased significantly in last decade among all age groups, both for educational and recreational purposes. Computer vision syndrome (CVS), also known as digital eye strain (DES), represents a range of ocular, musculoskeletal, and behavioral conditions caused by prolonged use of devices with digital screens. This paper reviews the principal environmental, ocular, and musculoskeletal causes for this condition. Due to the high prevalence of DES and frequent usage of digital devices, it is important that eye care practitioners be able to provide advice and management options based on quality research evidence.

A Narrative Review Discussing the Efficiency of Personalized Dosing Algorithm of Follitropin Delta for Ovarian Stimulation and the Reproductive and Clinical Outcomes.

Background: Follitropin delta is the third recombinant human follicle-stimulating hormone (r-hFSH) expressed in a host cell line of human fetal retinal origin that currently emphasizes that the actual tendency of administration is a personalized dosing algorithm based on the anti-Müllerian hormone (AMH) and body mass index (BMI) for ovarian stimulation. Methods: In this context, we aimed, in the present manuscript, to gather all available data published between 2018-2022 regarding the co-administration and administration of follitropin delta and the clinical outcomes reported following an in vitro fertilization (IVF). Results: Follitropin delta is non-inferior in contrast to its previously launched agents for ovarian stimulation, enhancing a similar-to-superior response reflected by both the reproductive and pregnancy outcomes in parallel with a low risk of ovarian hyperstimulation syndrome (OHSS), being well tolerated. The body weight and AMH level are factors that may influence the outcome in a patient. Despite controversy and results that refute these arguments on several occasions, follitropin delta exceeds the benefits of conventional dosing with either follitropin alfa or follitropin beta. Thus, all post hoc, derived analyses and subsets of patients that participated in subsequent studies support this statement. Conclusions: Despite the relatively limited spectrum of data in the current literature, most authors brought potent proof, supporting the subsequent use of this drug depending on the patient's profile and overcoming ethnic-related limitations. Although others contradict these observations, this topic and drug possess substantial potential, which is why additional studies are mandatory to fill the existing gaps in our knowledge and expand these experiences at a larger scale supported by the obtained reproductive and clinical outcomes that clearly indicate an overcoming of all limitations.

Classification Algorithms Used in Predicting Glaucoma Progression.

In this paper, various machine learning algorithms were used in order to predict the evolution of open-angle glaucoma (POAG). The datasets were built containing clinical observations and objective measurements made at the Countess of Chester Hospital in the UK and at the "St. Spiridon" Hospital of Iași, Romania. Using these datasets, different classification problems were proposed. The evaluation of glaucoma progression was conducted based on parameters such as VFI (Visual field index), MD (Mean Deviation), PSD (Pattern standard deviation), and RNFL (Retinal Nerve Fiber Layer). As classification tools, the following algorithms were used: Multilayer Perceptron, Random Forest, Random Tree, C4.5, k-Nearest Neighbors, Support Vector Machine, and Non-Nested Generalized Exemplars. The best results, with an accuracy of over 90%, were obtained with Multilayer Perceptron and Random Forest algorithms. The NNGE algorithm also proved very useful in creating a hierarchy of the input values according to their influence (weight) on the considered outputs. On the other hand, the decision tree algorithms gave us insight into the logic used in their classification, which is of practical importance in obtaining additional information regarding the rationale behind a certain rule or decision.

A Mini-Review Regarding the Clinical Outcomes of In Vitro Fertilization (IVF) Following Pre-Implantation Genetic Testing (PGT)-Next Generation Sequencing (NGS) Approach.

BACKGROUND: PGT-based NGS revolutionized the field of reproductive medicine, becoming an integrated component within current assisted reproductive technology (ART) protocols. METHODS: We searched the literature published in the last half a decade in four databases (PubMed/Medline, ISI Web of Knowledge, ScienceDirect, and Scopus) between 2018 and 2022. RESULTS: A total of 1388 articles were filtered, from which 60 met, initially, the eligibility criteria, but only 42 were included (≥100 patients/couples-62,465 patients and 6628 couples in total) in the present mini-review. In total, forty-two (70.0%) reported reproductive outcomes, while eighteen (30.0%) had distinct objectives. Furthermore, n = 1, 1.66% of the studies focused on PGT, n = 1, 1.66% on pre-implantation genetic testing for monogenic disorders (PGT-M), n = 3, 5.0% on pre-implantation genetic testing for structural rearrangements (PGT-SR) and n = 55, 91.66% on pre-implantation genetic testing for aneuploidies (PGT-A). CONCLUSIONS: PGT using NGS proved to be an excellent companion that folds within the current ascending tendency among couples that require specialty care. We strongly encourage future studies to provide a systematic overview expanded at a larger scale on the role of the PGT-NGS.

Phototherapy in dermatological maladies (Review).

Since the introduction of modern phototherapy in 1903 by Nobel Prize-winner Niels Ryberg Finsen, the usage of this therapy in the medical field has grown, techniques have been refined and developed, and it has gained widespread acceptance. Psoriasis vulgaris, parapsoriasis, lichen planus, atopic dermatitis, neonatal jaundice, urticaria, morphea, vitiligo, granuloma annulare and cutaneous T cell lymphoma are only a few dermatological indications that come along with satisfactory results. Most often, it is a 2nd or 3rd line therapy being an alternative in more severe or refractory diseases. Despite the side effects that may occur after phototherapy, which are often minor, the benefits can be significant. Unfortunately, the absolute contraindications limit the use of this type of treatment and implicitly the management of these patients. The current review aimed to combine the recommendations of phototherapy in dermatology, the types of phototherapy that can be suitable for certain dermatological diseases and to emphasize its importance in certain conditions that are associated with significant remission rates.

Mathematical Modeling to Predict COVID-19 Infection and Vaccination Trends.

Background: COVID-19 caused by the Severe Acute Respiratory Syndrome Coronavirus 2 placed the health systems around the entire world in a battle against the clock. While most of the existing studies aimed at forecasting the infections trends, our study focuses on vaccination trend(s). Material and methods: Based on these considerations, we used standard analyses and ARIMA modeling to predict possible scenarios in Romania, the second-lowest country regarding vaccinations from the entire European Union. Results: With approximately 16 million doses of vaccine against COVID-19 administered, 7,791,250 individuals had completed the vaccination scheme. From the total, 5,058,908 choose Pfizer−BioNTech, 399,327 Moderna, 419,037 AstraZeneca, and 1,913,978 Johnson & Johnson. With a cumulative 2147 local and 17,542 general adverse reactions, the most numerous were reported in recipients of Pfizer−BioNTech (1581 vs. 8451), followed by AstraZeneca (138 vs. 6033), Moderna (332 vs. 1936), and Johnson & Johnson (96 vs. 1122). On three distinct occasions have been reported >50,000 individuals who received the first or second dose of a vaccine and >30,000 of a booster dose in a single day. Due to high reactogenicity in case of AZD1222, and time of launching between the Pfizer−BioNTech and Moderna vaccine could be explained differences in terms doses administered. Furthermore, ARIMA(1,1,0), ARIMA(1,1,1), ARIMA(0,2,0), ARIMA(2,1,0), ARIMA(1,2,2), ARI-MA(2,2,2), ARIMA(0,2,2), ARIMA(2,2,2), ARIMA(1,1,2), ARIMA(2,2,2), ARIMA(2,1,1), ARIMA(2,2,1), and ARIMA (2,0,2) for all twelve months and in total fitted the best models. These were regarded according to the lowest MAPE, p-value (p < 0.05, p < 0.01, and p < 0.001) and through the Ljung−Box test (p < 0.05, p < 0.01, and p < 0.001) for autocorrelations. Conclusions: Statistical modeling and mathematical analyses are suitable not only for forecasting the infection trends but the course of a vaccination rate as well.

Update on the etiopathogenesis of psoriasis (Review).

Psoriasis is one of the most common immune-mediated chronic inflammatory skin disorders, involving hyperproliferative keratinocytes and infiltration of T cells, dendritic cells, macrophages, and neutrophils. Multiple factors appear to play important roles in the pathogenesis of psoriasis. These environmental (e.g., infectious agents and trauma), genetic, and immunologic factors are reviewed in this article. Although the pathogenesis of psoriasis remains to be established, data suggesting immune cell dysregulation in the skin are available. The involvement of the immune system, particularly T cells, in the etiopathogenesis of psoriasis is discussed in this review, indicating a potential justification for innovative treatment intervention. Besides describing pathogenic T cells, the aim of the review was to assess the function of newly identified antimicrobial peptides (AMPs), interleukin (IL)-23, IL-17, and tissue resident memory cells (TRMs), and their role in psoriasis. Furthermore, new insights were presented regarding TRMs, a recently identified subset of memory T cells, and the role they play in the local memory of disease, making them a potential new therapeutic target in psoriasis. Finally, current developments in T-cell research and cytokine-targeted therapy for psoriasis treatment are reviewed.

The Learning Curve of Surgery of Diabetic Tractional Retinal Detachment-A Retrospective, Comparative Study.

Background and Objectives: There are few data in the literature concerning the learning curve of tractional retinal detachment (TRD) surgery. We have analyzed the experience gained by a vitreoretinal surgeon over 10 years. Materials and Methods: A retrospective, comparative study of 34 TRD cases operated using 20G instruments between 2008 and 2011 (group A) and 94 cases operated using 23G instruments between 2015 and 2019 (group B). The preoperative characteristics, the type of endotamponade, and the anatomical and functional success were reviewed. Results: The group A patients had a significantly higher rate of concomitant vitreous hemorrhage (VH) at presentation (64.7% vs. 37.2%) and of non-macular retinal detachments (52.9% vs. 39.3%). The rate of silicone oil endotamponade was high in both groups (76.4% vs. 68.1%), but in group B 25.5% were left without a tamponade (vs. none in group A). A postoperative anatomical success was obtained in 76.5% of eyes in group A and 84.04% of eyes in group B (where it was improved to 89.3% by reinterventions). The presenting visual acuity (VA) was very low in both groups (0.01 and 0.05, respectively). The proportion of eyes with improved or stabilized VA was 85.3% in group A and 79.8% in group B (statistically non-significant difference). Conclusions: The anatomical success rate improves quite slowly with increasing surgeon experience and can be further improved by reinterventions. Visual improvement does not match the rate of anatomical improvement. With increasing experience and self-confidence, the surgeon will approach more difficult cases, a fact that may slow down the increase in surgical success rates.

Comprehensive Review on the Use of Artificial Intelligence in Ophthalmology and Future Research Directions.

BACKGROUND: Having several applications in medicine, and in ophthalmology in particular, artificial intelligence (AI) tools have been used to detect visual function deficits, thus playing a key role in diagnosing eye diseases and in predicting the evolution of these common and disabling diseases. AI tools, i.e., artificial neural networks (ANNs), are progressively involved in detecting and customized control of ophthalmic diseases. The studies that refer to the efficiency of AI in medicine and especially in ophthalmology were analyzed in this review. MATERIALS AND METHODS: We conducted a comprehensive review in order to collect all accounts published between 2015 and 2022 that refer to these applications of AI in medicine and especially in ophthalmology. Neural networks have a major role in establishing the demand to initiate preliminary anti-glaucoma therapy to stop the advance of the disease. RESULTS: Different surveys in the literature review show the remarkable benefit of these AI tools in ophthalmology in evaluating the visual field, optic nerve, and retinal nerve fiber layer, thus ensuring a higher precision in detecting advances in glaucoma and retinal shifts in diabetes. We thus identified 1762 applications of artificial intelligence in ophthalmology: review articles and research articles (301 pub med, 144 scopus, 445 web of science, 872 science direct). Of these, we analyzed 70 articles and review papers (diabetic retinopathy (N = 24), glaucoma (N = 24), DMLV (N = 15), other pathologies (N = 7)) after applying the inclusion and exclusion criteria. CONCLUSION: In medicine, AI tools are used in surgery, radiology, gynecology, oncology, etc., in making a diagnosis, predicting the evolution of a disease, and assessing the prognosis in patients with oncological pathologies. In ophthalmology, AI potentially increases the patient's access to screening/clinical diagnosis and decreases healthcare costs, mainly when there is a high risk of disease or communities face financial shortages. AI/DL (deep learning) algorithms using both OCT and FO images will change image analysis techniques and methodologies. Optimizing these (combined) technologies will accelerate progress in this area.

A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes.

Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed.

Performance of the Prototype NovioSense Noninvasive Biosensor for Tear Glucose in Type 1 Diabetes.

INTRODUCTION: We recently published the results of a pilot study measuring glucose in tear fluid. We now show the results of an additional 24 patients. METHODS: Twenty-four subjects were recruited from Haaglanden Diabetes Centre. The patients reported in a fasting state and were given a meal with half the usual dose of insulin during the test. The device was applied under the lower eyelid. Glucose levels from capillary blood and interstitial fluid with a flash glucose measurement device were recorded every 15 minutes; the current from the tear glucose sensor was recorded continuously. The eye surface and tolerability were regularly checked. A calibration algorithm to convert tear glucose to blood values was built using a neural network regression model and validated. RESULTS: No adverse events were attributed to the sensor coil placed under the lower eyelid. The mean absolute relative difference for the 24-patient subset was 16.7 (after 6 hours total time in the eye). The median absolute relative difference was 13.3. Compared to published data from Abbott (15.7 on day 1), the present device is comparable to Libre, considering that the device was allowed only one hour of equilibration time before the measurements were made. CONCLUSION: The NovioSense Tear glucose sensor measures blood glucose values with an acceptable accuracy and may become a good alternative to invasive devices.

Endogenous Endophthalmitis: A Review of Case Series Published between 2011 and 2020.

This is a literature review of 31 case series of endogenous endophthalmitis (EE) published in the last ten years, identified from a literature search of several databases (PubMed, EMBASE, and the Cochrane Library). While diabetes mellitus and malignancies remain the most frequently associated medical conditions, intravenous drug use is a significant risk factor (especially in the last years, in studies from Western countries). Ophthalmologic screening is recommended for candidaemia, but not in patients with sepsis of other aetiologies (however, the physician treating patients with sepsis must be well aware of EE). The most frequent Gram-positive microorganisms that cause EE are Staphylococcus and Streptococcus; the most frequent Gram-negative organism is Pseudomonas, and yeasts, probably Candida, usually cause fungal infections. In all-cause EE, prognostic factors of better visual outcomes are initial VA better than counting fingers, performing a pars plana vitrectomy (PPV), performing an intravitreal injection within the first 24 hours after clinical diagnosis, and the presence of a focal type of EE. In endogenous fungal endophthalmitis, more than 1/4 of patients have bilateral involvement. Blood samples have a low rate of positivity. Yeasts remain the most prevalent cause. Many authors report using azoles and echinocandins for systemic therapy (and voriconazole for intravitreal injections). Although PPV was performed in small proportions of eyes, the anatomical success rate is quite high. Klebsiella pneumoniae is an important cause of EE in Southeast Asia (and probably an emergent etiology in other regions), which is frequently associated with diabetes. There is a robust association with pyogenic liver abscess (PLA) (but in up to half of the cases, the diagnosis of EE precedes that of PLA). Blood cultures have a high diagnostic yield, while vitreous samples have a low yield. K. pneumoniae may carry antibiotic resistance. Anatomical and functional success rates are small, but they may be improved with PPV.

Clinical Evidence for Use of a Noninvasive Biosensor for Tear Glucose as an Alternative to Painful Finger-Prick for Diabetes Management Utilizing a Biopolymer Coating.

Diabetes is a metabolic condition that is exponentially increasing worldwide. Current monitoring methods for diabetes are invasive, painful, and expensive. Herein, we present the first multipatient clinical trial that demonstrates clearly that tear fluid may be a valuable marker for systemic glucose measurements. The NovioSense Glucose Sensor, worn under the lower eye lid (inferior conjunctival fornix), is reported to continuously measure glucose levels in the basal tear fluid with good correlation to blood glucose values, showing clear clinical feasibility in both animals and humans. Furthermore, the polysaccharide coated device previously reported by our laboratory when worn, does not induce pain or irritation. In a phase II clinical trial, six patients with type 1 Diabetes Mellitus were enrolled and the capability of the device to measure glucose in the tear fluid was evaluated. The NovioSense Glucose Sensor gives a stable signal and the results correlate well to blood glucose values obtained from finger-prick measurements determined by consensus error grid analysis.