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ObjectivesTo report the spectrum and trends of isolated microorganisms and their antibiotic susceptibility profile in patients with infectious keratitis in a 6-year period at a referral centre in Tehran.MethodsThe microbiology records of all corneal scrapings with a diagnosis of infectious keratitis were reviewed.ResultsA total of 6282 corneal scrapings were performed during the study period, of which 2479 (39.5%) samples were culture positive. Pseudomonas aeruginosa was found to be the most common causative agent in patients with keratitis, although Streptococcus pneumonia was the most prevalently isolated microorganism in patients older than 50 years. Fusarium sp. was the most common responsible pathogen in patients with fungal keratitis. The prevalence of bacterial keratitis due to gram positive microorganisms increased over time, however the number of Pseudomonas keratitis decreased in the second half of the study. Gram negative organisms showed a good sensitivity to levofloxacin, however, 34.1% of S. aureus isolates and 29.7% of coagulase negative staphylococci were resistant to this antibiotic. The odds of ciprofloxacin and levofloxacin resistance increased 1.25 and 1.15 for each 1-year increase in culture date, respectively (P < 0.001, P = 0.004).ConclusionsWe documented an increasing trend in the percentage of gram positive bacteria. Levofloxacin monotherapy might still be a good option in patients with gram negative bacterial keratitis, however owing to increasing resistance of staphylococci to fluoroquinolones, a regimen consisting of a combination of fortified antibiotics may be more effective in staphylococcal keratitis.

[...]it was decided to observe her without additional ophthalmic treatments. A dramatic response to the treatment is evident, characterized by fibrosis and shrinkage of the RHB. Belzutifan, an oral hypoxia-inducible factor-2α (HIF-2α) inhibitor, was approved on August 13, 2021, by the United States Food and Drug Administration (US FDA) for adult VHL patients who need treatment for associated renal cell carcinoma, central nervous system hemangioblastomas, or pancreatic neuroendocrine tumors, when immediate surgery is not indicated.1 Recent findings have also highlighted its efficacy in reducing the size, vascularity, and exudation in certain types of RHB2–5 and in treating giant RHB with extrascleral extension.6 Additionally, it has shown promise in treatment of RHB in a pediatric patient.7 1.

Objective To compare the incidence of falls between patients with visually significant cataracts in both eyes and those who have undergone first-eye cataract surgery. Methods This retrospective case–control study involved patients with a history of cataracts in both eyes who had undergone first-eye cataract surgery within the past 9 to 12 months (pseudophakic group). The control group comprised patients with cataracts in both eyes (cataract group). We assessed best-corrected visual acuity (BCVA), systemic comorbidities and medications (using the Charlson comorbidity index), and independent daily activities (using the Lawton Instrumental Activities of Daily Living scale). The patients were questioned about experiencing two or more falls in the last 6 months. Results Each group comprised 50 patients. Binocular BCVA was significantly better in the pseudophakic group (0.05 ± 0.06 logMAR) than in the cataract group (0.77 ± 0.34 logMAR). Of all participants, 22% reported experiencing two or more falls in the last 6 months. Multivariate analysis demonstrated significantly better BCVA in participants with less than two falls. Conclusions Patients of advanced age with visually significant cataracts in both eyes are at a higher risk of falling. First-eye cataract surgery may mitigate the occurrence of falls by improving binocular BCVA.

Purpose To present a case of presumed limited granulomatosis with polyangiitis (GPA) associated with anterior scleritis and ciliary body inflammatory granuloma which was treated with systemic rituximab (RTX), oral mycophenolate mofetil, and intravitreal (IVT) dexamethasone implant. Observations We report a patient presenting with sectoral scleritis and ciliary body granuloma in the left eye. The patient also had a nasal sinus granuloma which was biopsied three times with negative results for malignancy and fungal infections. The patient underwent a diagnostic vitrectomy, which was also negative for lymphoma, bacterial and fungal infections. Subsequently, intravenous methylprednisolone and oral methotrexate were started, but significant improvement was achieved only following initiation of intravenous RTX, oral mycophenolate mofetil, and IVT dexamethasone implant. Conclusion Therapeutic management of scleritis associated with limited GPA can be very challenging; early diagnosis can help to eliminate potential complications. Our result showed that RTX, mycophenolate mofetil, and IVT dexamethasone implant can be beneficial in treatment-resistant cases.

PurposeTo report characteristics of microbial keratitis in pediatric patients under five years.MethodsPatients with infectious keratitis under the age of 5 years were included in this retrospective cross-sectional study for ten years. All patients were admitted and corneal scraping was performed in 81 children. Fortified empiric antibiotic eye drops including cefazolin (50 mg/cc) and amikacin (20 mg/cc) were started and the antibiotic regimen was continued or changed according to culture results. In the case of fungal keratitis, topical voriconazole (10 mg/cc) or natamycin (50 mg/cc) and topical chloramphenicol (5 mg/cc) were started. A tectonic procedure was done when corneal thinning or perforation was present.ResultsNinety-Three Patients between 1 to 60 months with a mean age of 33 ± 18 months old with corneal ulcer were included in the study. The most common risk factor was trauma (40.9%) followed by contact lens use (8.6%). Cultures were negative for microbial growth in 28 (30.1%) patients. The most common pathogens were S. epidermidis (10.8%) and P. aeruginosa (10.8%). Fluoroquinolone antibiotics (ciprofloxacin; 93.8% sensitivity) were the most potent antibiotic against bacterial pathogens. Forty-one patients underwent tectonic procedures, which the most common ones were cyanoacrylate glue 18.3% followed by keratoplasty 16.1%.ConclusionThis study emphasizes the role of trauma as the primary cause and S. epidermidis as the most frequent microorganism in pediatric keratitis; according to antibiogram results and poor cooperation of patients under five years, monotherapy with fluoroquinolones could be a good regimen in small non-central lesions without thinning.

This is the studyto investigate the correlation between macular cone density (MCD) and flicker electroretinogram (ERG) response in healthy eyes. In this exploratory study, 23 eyes from 12 healthy subjects were enrolled in this study. The fixed-luminance flicker full-field electroretinogram (ffERG) responses of the retina and MCDs at 24 locations were measured using the Diopsys® NOVA™ system and the rtx1 adaptive optics retinal camera, respectively. Regression analysis was employed to evaluate the correlations. The mean age of the subjects was 30 ± 3 years. The average magnitudes of the flicker response and phase response were 13.44 ± 4.88 μV and 332.63 ± 22.12°, respectively. The MCDs for all 24 locations were 15,043 ± 3511 cones/mm². Among all locations, regression analysis revealed a significant correlation only at one specific location (0, −4°) between cone density and both the mean magnitude and phase of the flicker response, with p-values of 0.005 and 0.004, respectively.In conclusion, we identified a significant correlation between MCD and ffERG responses at a specific retinal locus (0, −4°). This finding may be attributed to the distribution of different cone types throughout the retina and the possibility that various cone types may contribute differently to ERG. Further studies are required to investigate this finding.

Introduction This study aims to apply automated machine learning (AutoML) techniques for the diagnosis of granular corneal dystrophy (GCD), a rare inherited condition characterized by progressive protein deposition in the corneal stroma. Methods Patients diagnosed with GCD who had slit-lamp photographs of the affected eye(s) were enrolled in the study. Individuals with concomitant corneal conditions, ungradable imaging data, or uncertain diagnoses were excluded from the study. Slit-lamp photos depicting the GCD and non-GCD were obtained from the Byers Eye Institute, Stanford University. Image processing included resizing and cropping, focusing solely on the cornea. A deep learning model was subsequently deployed, utilizing Vertex-AI, the AutoML platform developed by Google (Menlo Park, CA). The area under the precision‒recall curve (AUPRC) was plotted, and the sensitivity, specificity, positive predictive value (PPV), accuracy (AC), and F1 score were calculated. Results The model was trained on a dataset comprising 223 images, consisting of 72 GCD and 151 non-GCD images. One hundred seventy six images were used for training, 24 were used for validation, and 23 were used for testing the model. The AUPRC for the model was 0.995 and precision and recall were both 95.70% at a confidence threshold of 0.5. The sensitivity, specificity, PPV, AC, and F1 score of the model were 93.30%, 100%, 100%, 95.70%, and 0.965, respectively. Conclusions A clinician-derived AutoML model successfully identified GCD from slit lamp photographs with high accuracy.

This cross-sectional study investigated vestibular function outcomes after cochlear implantation in patients with inner-ear anomalies. Twenty-two patients with bilateral symmetric inner-ear anomalies and 28 patients with normal inner ears were included. All were congenitally or progressively deaf persons implanted unilaterally during the previous 15 years. Vestibular system function was assessed by vestibular-evoked myogenic potential and bithermal caloric tests. The vestibular-evoked myogenic potential abnormality rate in implanted ears with an inner-ear anomaly was 81.8 per cent, compared with 39.3 per cent in implanted ears with normal anatomy. In the non-implanted sides, the rate was 45.5 per cent (10 out of 22 cases) in the inner-ear anomaly patients compared with 17.9 per cent in patients with normal inner-ear structure. The respective abnormal caloric test rates in inner-ear anomaly versus normal anatomy patients were 81.8 per cent and 17.9 per cent (implanted ears), 77.3 per cent and 14.3 per cent (non-implanted sides). Inner-ear anomaly and implantation were both associated with more vestibular-evoked myogenic potential abnormalities; when occurring together, these factors showed a synergistic effect. Caloric test abnormality is mainly dependent on the presence of an inner-ear anomaly, but implantation is not associated with caloric abnormality.

To assess the efficacy of sclerotherapy with sodium tetradecyl sulfate (STS; Fibrovein 1%) in superficial periocular venous and lymphatic malformations. Eleven patients with low-flow venous and lymphatic malformations with extension predominantly to the eyelids, conjunctiva, and anterior orbit were selected. Sclerotherapy with STS was undertaken as an office-based procedure without any radiological guidance. Injections were repeated every 4 weeks until desired response occurred. Therapeutic effect was assessed objectively by change in the size of the lesions in serial photography. The lesions completely resolved in 4 cases with small eyelid and fornix lesions. In other 7 cases there was partial resolution to less than half of primary size. We did not have any significant complications. Sclerotherapy with STS is an easy and effective modality for treatment of venous-lymphatic malformations and can be undertaken as an office-based procedure in lesions which are limited to eyelids and anterior orbit.

Background Adalimumab is a monoclonal antibody approved for the treatment of autoimmune diseases and non-infectious uveitis (NIU). It targets tumor necrosis factor alpha, a key mediator in inflammation. However, the development of anti-adalimumab antibodies (AAA) can reduce therapeutic efficacy and prompt treatment modifications. This study aimed to describe the clinical characteristics of patients with transient AAA and compare them to patients with persistent AAA, testing whether serum antibody and drug levels differ between groups. Main body We conducted a retrospective cohort study using the Stanford Research Repository (STARR) to identify patients treated with adalimumab for autoimmune conditions between June 2006 and May 2024 who developed AAA. Patients whose AAA became undetectable on follow-up testing were compared to an age-, sex-, and disease-matched cohort with persistent AAA. Demographics, diagnoses, treatment details, serum adalimumab and AAA levels, and concomitant immunomodulatory therapy (IMT) were analyzed. Among 190 AAA-positive patients, 18 (9.47%) demonstrated antibody resolution over a median follow-up of 6.5 months. These patients had lower median AAA levels (39.55 ng/mL vs. 92.35 ng/mL, p =0.020) and higher adalimumab levels (6.25 μg/mL vs. 1.55 μg/mL, p =0.018) than controls. AAA resolution was negatively correlated with AAA levels ( p =0.018) and positively correlated with adalimumab levels ( p =0.016). Conclusions Therapeutic monitoring of AAA and drug levels may help guide personalized therapeutic strategies and support continued treatment in selected patients. Key points I. Therapeutic drug monitoring enables individualized management by identifying patients with low AAA and adequate drug levels who may safely continue adalimumab. II. Detection of AAA should not lead to automatic discontinuation; Therapeutic drug monitoring can guide personalized decisions to maintain effective treatment.