Current Issue : July-September Volume : 2026 Issue Number : 3 Articles : 5 Articles
Background: Cultivated oral mucosal epithelial transplantation (COMET/CAOMECS) is an autologous, immunosuppression-sparing option for ocular surface reconstruction in limbal stem cell deficiency (LSCD). After two decades, indications, platforms and outcome definitions vary, and COMET’s position relative to limbal-derived epithelium remains uncertain. Methods: We conducted a PRISMA-ScR scoping review of human clinical studies (PubMed, 2000–30 December 2025) with hand-searching and regulatory sources. Eligible reports included COMET/CAOMECS series and comparative cohorts (CLET/ACLET, SLET, KLAL/CLAL). The primary outcome was anatomical success (stable epithelialised cornea without recurrent persistent epithelial defect, progressive conjunctivalisation or uncontrolled neovascularisation at last assessment). Given heterogeneity in definitions and analytic frames (fixed-time vs. Kaplan–Meier [KM]), results were synthesised narratively by indication and platform. Results: Twenty-five reports (893 eyes; 821 patients) were included. Aetiologies were predominantly burns and SJS/TEN. Across amniotic membrane-based mixed-aetiology series, 12-month anatomical success clustered around 55–70%. Aggregated descriptively across COMET eyes, 211/467 (45%) had a stable surface at last follow-up. Epithelialisation was generally rapid in quiet AM-based reconstructions and slower with severe adnexal disease or carrier-free platforms. Mean BCVA improved from 1.8 ± 0.7 to 1.4 ± 0.7 logMAR (471 eyes); ≥2-line gains occurred in 308/471 (65.4%). A matched comparison suggested better 12-month survival, less neovascularisation and better BCVA with substrate-free versus AM-carried COMET; a biomaterial-/feeder-free platform reconstructed most eyes but failed more often with four-quadrant symblepharon. Observational comparative cohorts suggested higher surface survival and average visual gain with limbal-derived epithelium, at the cost of systemic immunosuppression. Conclusions: In appropriately selected bilateral LSCD, COMET offers immunosuppression-sparing reconstruction with moderate, durable surface stability and clinically meaningful visual gains when performed on a quiet, optimised surface. Platform refinements—particularly substrate-free constructs—and prospective, indication-defined comparative studies with harmonised outcomes are needed to define COMET’s role relative to limbal-derived epithelium....
Background and Objectives: To evaluate the occurrence of retinal displacement using bluefundus autofluorescence (BFAF) imaging in eyes treated for primary rhegmatogenous retinal detachment (RRD) and its associations with clinical factors, including macular status, detachment extent, baseline visual acuity, high myopia, postoperative visual recovery, and metamorphopsia. Materials and Methods: This retrospective observational study included 98 patients who underwent surgery for primary RRD at a single center. Surgical approaches included pars plana vitrectomy (PPV), phacovitrectomy, or scleral buckling, with tamponade agents such as SF6 gas (20%), silicone oil (≈1300 cSt), or air. Postoperative BFAF imaging assessed retinal displacement. Demographic and clinical data were recorded. Results: Macula-off detachments occurred in 56.1% of cases, while 43.9% were macula-on detachments. Phacovitrectomy was performed in 41.8%, simple vitrectomy in 33.7%, and scleral buckling in 24.5%. SF6 gas was the most used tamponade, while silicone oil was used in 13.3%. Retinal displacement was detected in 16.3% of cases, predominantly downward (81.25%) and less commonly upward (18.75%). Macula-off detachments were significantly associated with displacement (81.2% vs. 51.2%, p = 0.027). No significant associations were found with other parameters. Metamorphopsia was reported in 12.5% of patients with displacement and 4.9% without, though the difference was not statistically significant. Conclusions: Retinal displacement can occur after primary RRD repair, irrespective of tamponade, though it tended to be less frequent with silicone oil and in macula-on detachments. It is significantly more common in macula-off cases, even with immediate postoperative prone positioning. These findings emphasize the need to refine postoperative positioning protocols to reduce displacement and its sequelae. Further studies should explore the impact of retinal displacement on visual function, particularly metamorphopsia, in patients with preserved best-corrected visual acuity....
The Indian Diabetic Retinopathy Image Dataset (IDRiD) has been widely adopted for DR lesion segmentation research. However, it contains annotation gaps for proliferative DR lesions and labeling errors that limit its utility for comprehensive automated screening systems. We present Refined IDRiD, an enhanced version that addresses these limitations through (1) expert ophthalmologist validation and correction of labeling errors in original annotations for four non-proliferative lesions (microaneurysms, hemorrhages, hard exudates, cotton-wool spots), (2) the addition of three critical proliferative DR lesion annotations (neovascularization, vitreous hemorrhage, intraretinal microvascular abnormalities), and (3) the integration of comprehensive anatomical context (optic disc, fovea, blood vessels, retinal region). A team of three ophthalmologists (one senior specialist with >10 years’ experience, two expert fundus image annotators) conducted systematic annotation refinement, achieving an inter-rater agreement F1-score of 0.9012. The enhanced dataset comprises 81 high-resolution fundus images with pixel-level annotations for seven DR lesion types and four anatomical structures. All images were cropped to the retinal region of interest and resized to 1024 × 1024 pixels, with annotations stored as unified grayscale masks containing 12 classes enabling efficient multi-task learning. Refined IDRiD enables training of comprehensive DR screening systems capable of detecting both nonproliferative and proliferative stages while reducing false positives through anatomical context awareness....
Ophthalmic diseases, including inherited retinal dystrophies, age-related macular degeneration (AMD), and glaucomatous neuropathies, are often driven by the expression of pathogenic proteins or dysfunctional non-coding RNAs that are currently considered ‘undruggable’ with conventional small-molecule therapeutics. The emerging strategy of Ribonuclease-Targeting Chimeras (RIBOTACs) offers a revolutionary approach to address this therapeutic gap. RIBOTACs are heterobifunctional small molecules designed to bind a specific target RNA with one moiety and recruit a latent endogenous ribonuclease, such as RNase L, with the other, thereby catalyzing the RNA’s degradation. This targeted degradation can potentially halt the production of mutant proteins, eliminate toxic gain-of-function RNAs, or modulate key regulatory pathways involved in angiogenesis, inflammation, and apoptosis—core processes in many blinding diseases. This review explores the immense potential of applying RIBOTAC technology to ophthalmology, discussing prospective targets such as mutant alleles in retinitis pigmentosa, VEGF transcripts in neovascular AMD, and inflammatory mediators in uveitis. We will also address the unique challenges and opportunities for RIBOTAC development in the eye, including delivery strategies to overcome ocular barriers, the need for high specificity to avoid off-target RNA degradation, and the optimization of pharmacokinetic properties for intraocular administration. With continued innovation, RIBOTACs are poised to evolve into a robust therapeutic platform, expanding the druggable genome and enabling precise, durable treatments for a range of currently intractable ophthalmic conditions....
Background: Evidence on long-term visual field progression in childhood glaucoma compared with open-angle glaucoma (OAG) is limited. We compared the rate and timing of visual field progression and identified predictors of final visual field status. Methods: Single-center, retrospective, observational study including childhood glaucoma and OAG, with ≥3 reliable visual field tests and ≥2 years of follow-up. Visual fields were obtained with Octopus perimeter (Haag-Streit Diagnostics, Köniz, Switzerland) with the G grid and TOP strategy. Visual field progression was evaluated using the rate of change in mean defect (MD, dB/year). Rates were compared with the Mann–Whitney U test. Timing was evaluated with Kaplan–Meier and restricted mean survival time (RMST). Cox models assessed risk of progression. Secondary analysis used multiple linear regression to identify predictors of final MD. The mean follow-up duration was 5.7 ± 2.6 years. Results: 171 eyes (87 childhood glaucoma, 84 OAG) were analyzed. Childhood glaucoma had worse baseline MD (10.7 ± 7.5 dB) than OAG (5.1 ± 6.5 dB, p < 0.001), and underwent more surgeries, while OAG used more medications. The median MD progression rate was −2.3 dB/year [IQR: −5.6 to 0.1] in childhood glaucoma vs. 0.0 dB/year [IQR: −1.2 to 1.3] in OAG (p < 0.001), a value consistent with functional stability under treatment, with some eyes showing negative slopes indicating relative improvement. In Octopus perimetry, MD is expressed on a positive scale, so a negative slope reflects absence of visual field worsening, suggesting comparatively greater deterioration in OAG. Kaplan–Meier curves showed similar progression-free survival between groups (Log-Rank p = 0.284). RMST at 12 years was 10.93 years in childhood glaucoma and 10.56 years in OAG (difference ≈ 4.4 months, not clinically relevant). These survival results should be interpreted cautiously due to the low number of progression events and the high censoring rate. In regression, baseline MD was the strongest predictor of final MD; a higher number of medications was associated with worse final MD; number of surgeries and follow-up duration were not significant predictors. Conclusions: MD slopes suggested faster deterioration in OAG than in childhood glaucoma, whereas the timing to first progression was similar between groups. Baseline differences and treatment patterns were consistent with functional stability in childhood glaucoma under current management strategies. These findings support individualized follow-up and timely intervention, especially in pediatric patients....
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