VOLUME 89 - ISSUE 1

Mucosal-associated invariant T cells are a distinct subset of immune cells primarily located in mucosal tissues, and their role in ocular disorders has recently garnered increasing attention. This review synthesizes recent research on the roles of mucosal-associated invariant T cells in ophthalmology, focusing on their potential involvement in ocular immune responses, inflammation, and related diseases. By thoroughly analyzing current findings, this paper aims to novel insights that may guide future clinical applications in ophthalmology and address existing knowledge gaps regarding the immunomodulatory roles of mucosal-associated invariant T cells in ocular conditions.

Keywords: Mucosal-associated invariant T cells/immunology; Mucous membrane; Eye diseases/immunology; Immunity, humoral; Autoimmune diseases; Inflammation; Dry eye syndromes/immunology; Eye neoplasms/immunology; Eye infections/immunology; Retinal diseases/immunology

PURPOSE: This study evaluated the proportion of corneas discarded by the Eye Bank of Londrina, Paraná, due to positive serology over a 5-year period and its impact on transplant availability.
METHODS: A cross-sectional study was conducted, analyzing 1,968 corneas from 1,056 donors collected between January 2014 and December 2018 at the Eye Bank of Londrina. Serological tests for hepatitis B (HBsAg and anti-HBc), hepatitis C (anti-HCV), and HIV (anti-HIV 1 and 2) were performed using chemiluminescent microparticle immunoassays. Data were analyzed descriptively and presented in tables and graphs.
RESULTS: Of the 1,968 corneas processed, 897 (45.57%) were discarded. Among these, 333 (37.12%) tested positive for serological markers. Hepatitis B accounted for 34.67% of positive cases (15% of total donations), hepatitis C for 1.11% (0.50% of total), and HIV for 0.89% (0.4% of total). Hepatitis cases remained stable between 2014 and 2016, with a marked decline in 2017 and 2018. Most discarded corneas were positive for anti-HBc (31.88%) and negative for HBsAg; however, the anti-HBs test was not performed to confirm immunity to the hepatitis B virus.
CONCLUSION: The findings highlight the importance of serological testing to identify and eliminate contaminated corneas, thereby preventing the transmission of infectious diseases to recipients. Positive serology for hepatitis, particularly hepatitis B, was the leading cause of corneal disposal.

Keywords: Cornea; Corneal transplantation; Corneal donation; Eye banks; Hepatitis B virus; Hepatitis C virus; HIV infections; Seropositivity; Serologic tests

PURPOSE: To evaluate the effect of using a single iris retractor, affixed to the anterior capsulorhexis at the 12 o'clock position, on the ease of capsular tension ring implantation.
METHODS: This prospective comparative study comprised 37 patients with zonular weakness attributed to pseudoexfoliation syndrome who underwent capsular tension ring implantation during cataract surgery. In Group 1, a single iris retractor was inserted into the anterior capsulorhexis at the 12 o'clock position. Group 2 did not receive this intervention. Zonular weakness was graded on a scale of 1–5, and the subjective difficulty of capsular tension ring implantation was categorized as easy, medium, or difficult.
RESULTS: Group 1 and 2 comprised 20 and 17 patients, respectively. There were no significant differences between the groups in age, sex distribution, and presence of glaucoma (p=0.53, p=0.28, and p=1.00, respectively). The mean zonular weakness score was significantly higher in Group 1 (3.35 ± 0.45) than in Group 2 (2.71 ± 0.59; p=0.02). Capsular tension ring implantation was significantly easier in the iris retractor group (p<0.001).
CONCLUSIONS: Placement of a single iris retractor attached to the anterior capsulorhexis at the 12 o'clock position may facilitate easier capsular tension ring implantation, even in patients with greater zonular weakness. This technique could reduce the risk of capsular tension ring displacement into the iridocorneal angle or ciliary sulcus.

Keywords: Capsular tension ring; Cataract; Iris hook; Pseudoexfoliation syndrome; Zonular weakness; Cataract extraction; Phacoemulsification; Capsulorhexis.

PURPOSE: This cross-sectional study compared best-corrected visual acuity obtained using Cloudscaper symbols, a novel optotype developed according to ETDRS specifications for children's virtual screening, with that obtained using LEA symbols.
METHODS: A total of 560 children aged 3-16 yr underwent visual acuity test with both Cloudscaper symbols and LS. The test application was standardized using the EyeSpy algorithm. Additionally, 147 participants were tested with the standard Snellen E paper chart. Paired t tests were performed to assess the clinical significance of logMAR visual acuity differences.
RESULTS: The mean logMAR visual acuity with LEA symbols was 0.12 (standard deviation [SD]=0.18; range, -0.10 to 0.80), while with Cloudscaper symbols it was 0.18 (SD=0.19; range, -0.10 to 0.80). The mean difference between Cloudscaper symbols and LEA symbols was 0.099 logMAR (approximately 0.5 optotypes; SD=0.08; range, 0.0-0.14; p<0.0001). Cloudscaper symbols slightly underestimated visual acuity compared to LEA symbols. Visual acuity measured by both methods was highly correlated (Spearman's r=0.74, p<0.0001). The mean visual acuity difference between Cloudscaper symbols and the Snellen E chart was 0.0045 (p=0.805; 95% confidence interval [95% CI]), whereas the difference between LEA symbols and Snellen E was 0.0883 (p<0.001; 95% CI).
CONCLUSIONS: Cloudscaper symbols provide a reliable tool for visual screening in children. Although they slightly underestimate visual acuity compared to LEA symbols – a finding also reported when comparing ETDRS letters with LEA symbols – Cloudscaper symbols show strong agreement with Snellen E chart measurements. This suggests that Cloudscaper symbols allow precise visual acuity assessment comparable to the gold standard.

Keywords: Vision screening; Vision tests; Visual acuity; Mobile applications; Eye health; Child health; Diagnostic techniques, Ophthalmological; Child; Preschool child; Adolescent

PURPOSE: To evaluate whether two simplified modifications of flanged intrascleral fixation techniques (Yamane and Canabrava) provide comparable refractive outcomes and complication rates while reducing surgical complexity in trocar-assisted vitrectomy.
METHODS: This retrospective observational study included 88 patients who underwent flanged fixation surgery with vitrectomy. In the modified Yamane technique, a single-path sclerotomy with bilateral symmetry was performed instead of an angled sclerotomy. In the modified Canabrava technique, the intraocular lens was inserted first, followed by the creation of a circular polypropylene loop with 2-mm flange spacing. Postoperative refractive parameters, including intraocular lens astigmatism, and complications such as intraocular lens iris capture were analyzed.
RESULTS: Of the 88 patients, 70 underwent the modified Yamane technique, and 18 underwent the modified Canabrava technique. No significant differences were observed between the two techniques regarding refractive outcomes or postoperative complications, except for surgical duration, which was significantly shorter (p<0.001) in one technique. Mean intraocular lens astigmatism was −0.675 D for Yamane and −0.666 D for Canabrava.
CONCLUSION: Optimizing needle engagement for symmetry in the Yamane technique and narrowing flange spacing while ensuring a circular polypropylene configuration in the Canabrava technique may reduce surgical complexity and improve postoperative outcomes.

Keywords: Polypropylenes; Yamane technique; Vitrectomy; Astigmatism; Lenses, intraocular; Postoperative complications; Suture techniques; Iris.

PURPOSE: This study aimed to evaluate the outcomes of strabismus surgical correction in patients with Down syndrome.
METHODS: We conducted a retrospective chart review of patients with Down syndrome who underwent strabismus surgery between January 1997 and May 2024 at an Ophthalmology Outpatient Clinic in São Paulo, Brazil. The data collected included age, sex, medical and ocular history, surgical details, and follow-up outcomes. The patients were categorized by strabismus type into esotropia, fourth nerve palsy, and mixed groups. Surgical success was defined as final alignment within 10^Δ of orthotropia and, where applicable, whether there was resolution of abnormal head posture of ocular origin. Patients with postoperative follow-up <6 months were excluded.
RESULTS: A total of 37 patients (21 females) were included. Of these, 22 (59.5%) were in the esotropia group, 10 (27.0%) in the fourth nerve palsy group, and 5 (13.5%) in the mixed group. The surgical success rate in the esotropia group was 86.4%, with a mean preoperative deviation of 35.2 (± 6.5)^Δ, and mean surgical correction of 30.1 (± 10.4)^Δ. The success rate in the fourth nerve palsy group was 40.0%, with a mean preoperative deviation of 10.4 (± 4.3)^Δ. Overall, success was achieved with a single surgical procedure in 73.0% of the sample. No significant associations were found between surgical success and the clinical and demographic variables, including sex, age at surgery, oblique muscle overaction, pattern strabismus, visual acuity, amblyopia, preoperative deviation, or postoperative follow-up duration (p>0.05).
CONCLUSIONS: When standard surgical tables are applied, strabismus surgery in patients with Down syndrome appears to be safe and effective. We found high success rates, particularly among patients with esotropia. We observed no tendencies toward over- or under-correction. These findings support the use of conventional surgical protocols with this patient population.

Keywords: Down Syndrome/complications; Strabismus/surgery; Esotropia/surgery; Oculomotor nerve diseases/physiopathology; Vision disorders; Humans; Brazil.

PURPOSE: To evaluate the efficacy of different corticosteroid eye drop formulations (prednisolone acetate 1.0%, dexamethasone 1.0%, and loteprednol etabonate 0.5%) administered for different treatment durations (10 vs. 28 days) in controlling postoperative inflammation following uncomplicated cataract surgery.
METHODS: This randomized, masked clinical trial was conducted at the Instituto Cearense de Oftalmologia. Eligible participants were aged ≥50 yr and scheduled for routine cataract surgery. Exclusion criteria included preexisting ocular disease (elevated intraocular pressure, retinopathy, maculopathy, or uveitis) or concurrent medication use that could confound results. Patients were randomized to receive prednisolone acetate (1.0%), dexamethasone (1.0%), or loteprednol etabonate (0.5%) four times daily for 28 days (with tapering) or for 10 days. Medication bottles, prescriptions, and examiners were masked. Postoperative assessments included ocular symptoms, visual acuity, intraocular pressure, anterior chamber cell count and flare, pachymetry, endothelial cell density, and macular thickness over a 30-day follow-up.
RESULTS: A total of 140 eyes from 140 patients were analyzed (29 prednisolone acetate 1.0%, 18 dexamethasone 1.0%, and 21 loteprednol etabonate 0.5% for 28 days; 28 prednisolone acetate 1.0%, 22 dexamethasone 1.0%, and 22 loteprednol etabonate 0.5% for 10 days). No significant differences were found among the six groups during follow-up. However, eyes treated with dexamethasone (1.0%) showed greater intraocular pressure fluctuations, particularly on Days 7 and 30, and a higher incidence of rebound inflammation in the 28-day regimen. Structural cystoid macular edema without visual impact was observed in 5.9% of eyes in the 28-day groups and 14.2% of eyes in the 10-day groups, as detected by optical coherence tomography at 30 days.
CONCLUSION: Equivalent postoperative inflammation control can be achieved using different corticosteroid eye drop formulations at varying treatment durations following cataract surgery. Brazilian Registry of Clinical Trials (ReBEC): RBR-2frpntv

Keywords: Adrenal cortex hormones; Cataract; Cystoid macular edema; Corticosteroids; Inflammation; Loteprednol etabonate; Ophthalmic solutions; Postoperative period; Intraocular pressure; Visual acuity

PURPOSE: This study aimed to evaluate disparities in the distribution of ophthalmologists and the volume of cataract surgeries across Brazil, considering public and private health sectors and the country's federative units.
METHODS: Data on ophthalmologists were obtained from the National Medical Residency Commission and the Associação Múdica Brasileira. Information on cataract surgeries performed through the Unified Health System was collected from the DATASUS database, while data on procedures covered by private health plans were retrieved from the National Supplementary Health Agency. Population estimates from the 2024 Demographic Census of the Brazilian Institute of Geography and Statistics were used to calculate physician density and surgery rates per 100,000 inhabitants. Associations between the number of ophthalmologists and cataract surgery volume were analyzed using Spearman's correlation coefficient.
RESULTS: Brazil has 16,784 ophthalmologists, representing 8.96 specialists per 100,000 inhabitants. Marked disparities were observed: large cities (>500,000 inhabitants) had 18.75 ophthalmologists per 100,000 residents, whereas municipalities with <50,000 inhabitants had fewer than one. Across federative units, physician density ranged from 19.18 per 100,000 in the Federal District to 4.22 in Maranhão. In 2024, cataract surgery rates varied widely, from 1,012.61 per 100,000 inhabitants in the Southeast to 435.00 in the North. Nationally, Unified Health System performed 736.30 surgeries per 100,000 inhabitants, compared with 1,276.79 in the private sector. On average, each ophthalmologist performed 96.92 cataract surgeries annually.
CONCLUSION: Significant inequalities persist in the geographic distribution of ophthalmologists and in cataract surgery provision, with higher surgical volumes concentrated in the private sector. Targeted policies are required to address regional disparities and improve the equity and efficiency of cataract care delivery in Brazil.

Keywords: Ophthalmologists/supply & distribution; Ophthalmologists/statistics & numerical data; Cataract extraction; Health services accessibility/statistics & numerical data; Healthcare disparities; Health policy; Public health systems; Insurance, Heal

PURPOSE: Diabetic retinopathy screening in low- and middle-income countries is limited by restricted access to specialized care. Portable retinal cameras offer a practical alternative; however, image quality – affected by mydriasis – directly influences the performance of artificial intelligence models. This study evaluated the effect of mydriasis on image gradability and AI-based diabetic retinopathy detection in real-world, resource-limited settings.
METHODS: The proportions of gradable images were compared between mydriatic and non-mydriatic groups. Generalized estimating equations were used to identify factors associated with image gradability, including age, sex, race, diabetes duration, and systemic hypertension. A ResNet-200d model was trained on the mobile Brazilian Ophthalmological dataset and externally validated on both mydriatic and non-mydriatic images. Model performance was evaluated using accuracy, F1 score, area under the curve, and confusion matrix metrics. Sensitivity differences were assessed using the McNemar test, and area under the curves were compared using DeLong's test. The Youden index was used to determine optimal classification thresholds. Agreement between macula- and disc-centered images was analyzed using Cohen's κ.
RESULTS: The mydriatic group demonstrated a higher proportion of gradable images compared with the non-mydriatic group (82.1% vs. 55.6%; p<0.001). In non-mydriatic images, lower gradability was associated with systemic hypertension, older age, male sex, and longer diabetes duration. The AI model achieved better performance in mydriatic images (accuracy, 85.15%; area under the curve, 0.94) than in non-mydriatic images (accuracy, 79.68%; area under the curve, 0.93). The McNemar test showed a significant difference in sensitivity (p=0.0001), whereas DeLong's test revealed no significant difference in area under the curve (p=0.4666). The Youden index indicated that optimal classification thresholds differed based on mydriasis status. Agreement between image fields was moderate to substantial and improved with mydriasis.
CONCLUSION: Mydriasis significantly improves image gradability and enhances AI performance in diabetic retinopathy screening. Nonetheless, in low- and middle-income countries where pharmacologic dilation may be impractical, optimizing model calibration and thresholding for non-mydriatic images is essential to ensure effective AI implementation in real-world clinical environments.

Keywords: Artificial intelligence; Bias; Diabetic retinopathy; Portable camera; Retina

Glaucoma is a progressive optic neuropathy that can cause irreversible blindness, though it rarely affects women of reproductive age. Its management during pregnancy and lactation is particularly challenging because of the potential impact of intraocular pressure fluctuations on disease progression and the risks of treatment to both the mother and fetus. Physiological changes in pregnancy, such as decreased intraocular pressure and hormonal alterations, may influence disease activity but do not guarantee disease stability. Preconception counseling plays a key role in mitigating risks and tailoring treatment strategies. Many glaucoma medications carry teratogenic risks, with brimonidine being the only US Food and Drug Administration Category B drug. Surgical interventions – including laser trabeculoplasty and minimally invasive glaucoma surgeries – offer alternative options but require careful timing and consideration of fetal safety. Multidisciplinary collaboration is essential to optimize maternal and neonatal outcomes. This review summarizes evidence-based approaches for glaucoma management during pregnancy and lactation, highlighting clinical considerations, therapeutic strategies, and patient-centered care.

Keywords: Pregnancy complications; Glaucoma; Lactation; Parturition; Intraocular pressure

PURPOSE: To analyze the association between corneal tomography patterns and atopic conditions in children and adolescents, and to investigate the relationship between corneal tomography findings, sleeping position, and dominant hand.
METHODS: Patients aged 8–16 yr underwent ocular and immunological examinations, including biomicroscopy, corneal tomography, the International Study of Asthma and Allergies in Childhood questionnaire, and an allergy skin test. Based on immunological results, participants were assigned to either the Control Group or the Atopic Group. Tomographic indices were analyzed alongside information on ocular itching, sleeping position, and dominant hand.
RESULTS: A total of 158 patients (mean age: 10.72 ± 2.13 yr) were evaluated, including 34 (21.52%) in the Control Group and 124 (78.48%) in the Atopic Group. Abnormal tomography was observed in 25 patients (15.82%), while 133 (84.18%) had normal results. Comparison between the Control and Atopic Groups regarding ocular itching episodes revealed a statistically significant difference (p≤0.05). Dominant hand and sleeping position showed no statistically significant associations with group classification, tomography results, or ocular itching.
CONCLUSION: Systemic allergies are strongly associated with biomechanical and structural corneal changes, which may or may not progress to different keratoconus patterns. No association was found between eye rubbing and any tomographic parameter, nor between sleeping position or hand dominance and tomography findings.

Keywords: Adolescent; Child; Hypersensitivity; Hypersensitivity, immediate; Cornea; Skin tests; Sleep; Tomography.

PURPOSE: To evaluate the preferred surgical practice patterns for glaucoma among members of the Latin American Glaucoma Society.
METHODS: A cross-sectional study was conducted using an electronic survey distributed in July 2023 via email to members of the Latin American Glaucoma Society. The questionnaire comprised four sections addressing the specialists' profiles, preferred surgical procedures for open-angle glaucoma, and choices in 10 different clinical scenarios, including congenital glaucoma.
RESULTS: Of the 63 members, 49 physicians (77.7%) responded – 13 women and 36 men – from nine Latin American countries. Thirty-one respondents (63.26%) had more than 20 yr of professional experience. For the surgical management of open-angle glaucoma, trabeculectomy was the most preferred procedure (48 physicians), followed closely by glaucoma drainage devices (47 physicians) and minimally invasive glaucoma surgery (29 physicians). Across the 10 clinical scenarios, glaucoma drainage devices were selected most frequently (203 preferences), followed by trabeculectomy (118), ciliary body laser procedures (107), and minimally invasive glaucoma surgery (40). However, minimally invasive glaucoma surgery was the preferred option for primary open-angle glaucoma with mild-to-moderate cataracts.
CONCLUSION: Among specialists of the Latin American Glaucoma Society, trabeculectomy and glaucoma drainage devices remain the most commonly performed surgical procedures. Minimally invasive glaucoma surgery is primarily used in combination with cataract surgery, while ciliary body laser procedures are generally reserved for cases of previous glaucoma drainage device failure or as an initial option for newly diagnosed glaucoma cases.

Keywords: Glaucoma; Ophthalmologic surgical procedures; Latin America; Practice patterns, physicians; Surveys and questionnaires

PURPOSE: Glaucoma is one of the leading causes of irreversible blindness worldwide. When topical hypotensive agents or laser trabeculoplasty fail to adequately control the disease, escalation of therapy becomes necessary, with transscleral cyclophotocoagulation being one of the available options. Several variations of transscleral cyclophotocoagulation exist, including traditional continuous wave, MicroPulse, and slow-coagulation techniques. We propose a novel variation – custom slow-coagulation transscleral cyclophotocoagulation – which combines elements of both continuous wave and slow-coagulation approaches. This study aimed to evaluate the outcomes of this technique in patients with refractory glaucoma.
METHODS: This retrospective, interventional study included 104 eyes of 83 patients with refractory glaucoma who underwent custom slow-coagulation transscleral cyclophotocoagulation. Changes in intraocular pressure, visual acuity, the number of glaucoma medications, and postoperative complications were analyzed. A paired t test was used to compare changes in intraocular pressure and visual acuity, while the Wilcoxon signed-rank test was applied to categorical variables. Success rates following custom slow-coagulation transscleral cyclophotocoagulation were estimated using Kaplan–Meier survival analysis.
RESULTS: Mean intraocular pressure decreased significantly from 38.9 ± 15.8 mmHg at baseline to 16.3 ± 9.9 mmHg at Month 12 (p<0.001). The mean number of glaucoma medications also decreased significantly from 3.6 ± 0.6 to 1.8 ± 1.4 (p<0.001). No significant reduction in mean visual acuity was observed during follow-up.
CONCLUSIONS: Custom slow-coagulation transscleral cyclophotocoagulation effectively reduced baseline intraocular pressure and the number of glaucoma medications, with a low rate of complications and no decline in visual acuity over a 12-month follow-up period. This novel technique demonstrated a high safety profile in a Hispanic population and represents a low-cost, minimally invasive procedure with rapid recovery and promising efficacy in intraocular pressure control.

Keywords: Glaucoma/surgery; Sclera; Filtering surgery; Laser coagulation/methods; Lasers, semiconductor/therapeutic use; Intraocular pressure; Blindness/prevention & control; Vision, low/epidemiology; Visual acuity

PURPOSE: Glaucoma is a chronic and progressive disease that requires long-term treatment and continuous monitoring. The Kahook Dual Blade, a device used to perform goniotomy in adults, is designed to improve intraocular pressure control in patients with glaucoma. This study aimed to evaluate the long-term efficacy and safety of kahook dual blade goniotomy in glaucoma patients undergoing cataract surgery over a 36-month follow-up.
METHODS: This was a retrospective case series including 56 eyes from 56 patients with mild-to-moderate primary open-angle glaucoma who underwent phacoemulsification combined with kahook dual blade goniotomy. Mean intraocular pressure values, number of preoperative and postoperative hypotensive eye drops, procedure survival, and complications were evaluated over 36 months. Surgical success was defined as either a reduction in intraocular pressure of ≥20% with intraocular pressure between 6 and 18 mmHg without additional medication or a reduction of ≥1 eye drop with intraocular pressure between 6 and 18 mmHg.
RESULTS: The mean preoperative intraocular pressure decreased from 15.96 ± 2,83) mmHg to 13.14 ± 2,11) mmHg at 36 months, representing a 14.9% reduction (p<0.001). The mean number of eye drops decreased from 1.91 ± 0,75) to 1.34 ± 0,92), a 29.8% reduction (p<0.001). The overall success rate was 69.6% at 36 months.
CONCLUSION: Kahook dual blade goniotomy combined with cataract surgery significantly reduced intraocular pressure and the number of hypotensive eye drops required in patients with mild-to-moderate primary open-angle glaucoma, with a favorable success rate maintained at 36 months.

Keywords: Glaucoma, open-angle/surgery; Gonioscopy/methods; Intraocular pressure/physiology; Lens implantation, intraocular; Phacoemulsification/methods; Trabeculectomy/instrumentation; Treatment outcome

PURPOSE: To evaluate the relationships between retinal changes identified by optical coherence tomography in patients with migraine with aura or migraine without aura and the duration and severity of the disease, as measured by the questionnaire.
METHODS: In this cross-sectional study, 16 patients with migraine with aura and 15 patients with migraine without aura were compared with 16 age- and sex-matched controls without migraine. Retinal parameters were assessed using optical coherence tomography, and disease severity was evaluated using scores.
RESULTS: Foveal choroidal thickness was significantly reduced in migraine patients to controls (p=0.040). Negative correlations were observed between disease duration and total macular thickness (p=0.037), ganglion cell complex thickness (p=0.017), and choroidal thickness (p=0.039) in the migraine without aura Group. Additionally, scores showed an inverse correlation with peripapillary retinal nerve fiber layer thickness (p=0.027) in the migraine without aura Group.
CONCLUSION: Individuals with migraine exhibited significant choroidal thinning compared with controls. Longer disease duration was associated with reduced total macular, ganglion cell complex, and choroidal thickness, while greater migraine-related disability correlated with thinner peripapillary retinal nerve fiber layers.

Keywords: Migraine with aura; Migraine without aura; Nerve fibers; Retina; Macula; Optic disc; Choroid; Tomography, optical coherence; Surveys and questionnaires.

PURPOSE: To evaluate the effects of a propylene glycol–hydroxypropyl guar nanoemulsion on symptoms and ocular surface parameters in patients with evaporative dry eye.
METHODS: This prospective, single-center, interventional study included patients aged 18–50 years with evaporative dry eye who received a propylene glycol–hydroxypropyl guar nanoemulsion. Participants were instructed to instill the nanoemulsion three times daily for 90 days. Evaluations included the Ocular Surface Disease Index, tear osmolarity, tear meniscus height, lipid layer thickness, noninvasive tear break-up time, fluorescein tear break-up time, corneal fluorescein staining (National Eye Institute Scale), Schirmer’s test I, and meibum quality.
RESULTS: Thirty-three participants were enrolled, and 30 completed the study. The mean age was 36 ± 10 yr, and 73.3% were women. The mean Ocular Surface Disease Index score significantly decreased from 43.1 ± 20 at baseline to 25.2 ± 17 at 3 months (p=0.009). Median corneal fluorescein staining decreased from 2 (IQ range=1–3) to 1 (IQ range 25–75 = 0–1) at the final follow-up (p=0.002). The mean fluorescein tear break-up time increased significantly increased from 3.8 ± 2.1 at baseline to 5.8 ± 2.2 at 3 months (p=0.002). Tear osmolarity decreased significantly (p=0.01) and lipid layer thickness improved markedly (p<0.001). No significant changes were observed in tear meniscus height or noninvasive tear break-up time (p>0.05).
CONCLUSIONS: Treatment with a propylene glycol–hydroxypropyl guar nanoemulsion significantly improved dry-eye symptoms, corneal staining, tear film stability, and lipid layer quality in patients with evaporative dry eye. No adverse events were reported, supporting the safety and efficacy of this formulation.

Keywords: Dry eye syndromes/drug therapy; Meibomian gand dysfunction/drug Dry Eye therapy; Tears; Emulsions; Lubricant eye drops; Nanoparticles; Propylene glycol/therapeutic use; Polysaccharides/ therapeutic use

PURPOSE: To investigate choroidal structural and vascular changes in patients with mild autonomous cortisol secretion using enhanced depth imaging optical coherence tomography and optical coherence tomography angiography.
METHODS: This cross-sectional study included 60 eyes of 30 patients with mild autonomous cortisol secretion and 60 eyes of 30 subjects with nonfunctional adenoma (controls) between February 2023 and January 2024. Subfoveal choroidal thickness, pachychoroid spectrum disease and choroidal vascularity index were evaluated using spectral-domain optical coherence tomography. Group comparisons were performed, and correlations between subfoveal choroidal thickness and clinical features were analyzed.
RESULTS: Pachyvessels were more common in patients with mild autonomous cortisol secretion than in controls (71.4% vs. 42.9%, p=0.002). The frequency of pachychoroidal spectrum disease was significantly higher in the mild autonomous cortisol secretion Group (68.3% vs. 31.7%; p<0.001). Median subfoveal choroidal thickness was 355 μm (range, 150–535) in the mild autonomous cortisol secretion Group and 297 μm (range, 162–597) in controls (p=0.014). Choroidal vascularity index was comparable between groups (p=0.072). Subfoveal choroidal thickness correlated significantly with axial length, spherical equivalent, post-1-mg dexamethasone suppression test cortisol level, and disease duration.
CONCLUSION: Patients with mild autonomous cortisol secretion exhibited greater subfoveal choroidal thickness and a higher frequency of pachychoroidal spectrum disease compared with controls, whereas stromal and vascular structural alterations were proportionally similar between groups.

Keywords: Adrenal gland neoplasms; Central serous chorioretinopathy; Choroid; Cushing syndrome; Hydrocortisone; Optical coherence tomography