Objectives Macular edema after cataract surgery is known as pseudophakic cystoid macular edema or Irvine-Gass syndrome. The aim of this study was to determine the incidence and time to onset of cystoid macular edema after uncomplicated cataract surgery. Methods A retrospective review was conducted of 1,325 consecutive cataract surgeries performed by a single surgeon at a single institution over four years, from January 2022 to December 2025. Results Among 1,325 eyes, one or more macular cysts were detected by optical coherence tomography in 27 eyes (2.0%) of 22 patients who complained of blurred vision or decreased visual acuity after having no symptoms immediately after surgery. The 22 patients (27 eyes: 12 right and 15 left) comprised 12 men and 10 women. Their ages at the time of surgery ranged from 57 to 82 years, with a median of 75.5 years. Of the 27 eyes that developed macular cysts, 13 eyes with no preoperative or intraoperative risk factors for inflammation received topical 0.1% bromfenac twice daily as the only postoperative anti-inflammatory treatment, together with topical antibacterial 0.5% moxifloxacin four times daily. In contrast, the remaining 14 eyes, which had risk factors for inflammation, such as exfoliation, floppy iris, poor mydriasis, extracapsular cataract extraction, or diabetes mellitus, received topical bromfenac twice daily and 0.1% betamethasone (or 0.1% fluorometholone in two eyes) four times daily, as well as topical moxifloxacin. The time from surgery to the diagnosis of macular cysts ranged from one week to eight months, with a median of two weeks, in the 13 eyes treated with topical bromfenac only. In the 14 eyes treated with the combination of topical bromfenac and betamethasone, the time to diagnosis ranged from two weeks to 13 months, with a median of two months. In 26 of the 27 eyes, the macular cysts disappeared and visual acuity returned to normal without residual symptoms within two weeks to seven months, with a median of one month, after topical betamethasone four times daily was initiated or resumed. Conclusions Pseudophakic macular cysts developed during the postoperative course in eyes with no preoperative or intraoperative risk factors that received topical bromfenac alone. They also developed later in the postoperative course after the combination of topical bromfenac and betamethasone was discontinued in eyes with risk factors for inflammation. The macular cysts disappeared following the initiation or resumption of topical betamethasone, accompanied by recovery of visual acuity and resolution of symptoms.

Drug-induced uveitis is a rare and often under-recognised entity. We present a rare case series of bilateral anterior uveitis associated with Mediclore, a thermosensitive anti-adhesion agent composed of gelatine, chitosan, and poloxamer, used in obstetric and gynaecologic surgery. Nine female patients aged 30-51 were included; five had Caesarean sections, and four had total abdominal hysterectomy with bilateral salpingo-oophorectomy (one patient also had an appendectomy). Ocular symptoms started on the first/second postoperative day. Initial visual acuity (VA) was between 0.5 and 1.0; intraocular pressure was normal; and inflammation was mild, anterior, and frequently bilateral. Topical corticosteroids (dexamethasone, prednisolone acetate, or fluorometholone) and mydriatics were prescribed. Active infection screening was ruled out. All patients demonstrated remission with a VA of 1.0 and no persistent inflammation. Even though topical medication gave favourable results, clinicians should be aware of this potential association, ensure appropriate screening to exclude mimickers, and counsel patients accordingly.

Transplantation of human mesenchymal stem cells (hMSCs) has demonstrated safety and efficacy in the treatment of the inflamed and damaged ocular surface in patients with limbal stem cell deficiency (LSCD). However, this strategy alone is often insufficient to fully resolve clinical signs such as corneal opacity, neovascularization, ulceration, chronic inflammation, vision loss, and pain. The aim of this work was to nano-engineer hMSCs with fluorometholone-loaded nanostructured lipid carriers (FML-NLCs) to develop a combined cell-based drug delivery strategy capable of achieving sustained drug release, enhanced in situ anti-inflammatory activity, and promoting corneal repair. FML-NLCs were characterized in terms of particle size, polydispersity index, zeta potential, morphology, encapsulation efficiency, and drug release profile. The impact of hMSC nano-engineering with FML-NLCs on cell functionality was evaluated, including viability, nanoparticle uptake, immunophenotype, differentiation potential, migration capacity, extracellular drug release profile, and anti-inflammatory activity in vitro. The results demonstrated that nano-engineered hMSCs remained viable and preserved their characteristic immunophenotype and multilineage differentiation potential. Although a modest reduction in migratory capacity was observed, FML-NLC-loaded hMSCs provided sustained extracellular drug release and exerted a potent anti-inflammatory effect on inflamed corneal epithelium. Overall, these findings demonstrate that nano-engineered hMSCs with FML-NLCs act as an effective intermediate pharmacokinetic compartment that generates a biologically regulated extracellular drug release profile and represent a promising platform for the targeted treatment of inflammatory ocular surface diseases. These findings provide the basis for future in vivo proof-of-concept studies and support the subsequent clinical translation of this strategy for the treatment of LSCD.

Postoperative corneal haze, driven by aberrant TGF-β1-mediated fibrosis, remains a formidable clinical challenge following refractive surgery. Current steroid therapies are compromised by severe side effects, including steroid-induced glaucoma. Herein, we report a nanoparticle (CCB@TET) comprising a tetrandrine-loaded bovine serum albumin core and a 3-carboxyphenylboronic acid-modified chitosan shell for corneal haze prevention. The optimized nanoplatform (202 nm, +35 mV) exhibited high drug loading (39.25%) and sustained release. The shell coating endowed dual transport mechanisms: mucoadhesion via electrostatic interaction and reversible tight junction opening via occludin downregulation, facilitating enhanced transcorneal permeation. In vitro, CCB@TET suppressed human corneal stromal cell migration and myofibroblast transdifferentiation without compromising epithelial wound healing. In a rabbit transepithelial photorefractive keratectomy haze model, topical CCB@TET outperformed free tetrandrine and clinical fluorometholone, while avoiding steroid-induced intraocular pressure elevation. Mechanistically, CCB@TET was found to suppress the TGF-β1/Smad signaling cascade through ITGB6 downregulation, as revealed by transcriptomic screening and biochemical validation. This study presents a rationally designed nanoplatform for safe and effective prevention of postoperative corneal haze.

Quantitative NMR (qNMR) provides a direct approach for determining the absolute purity of pharmaceutical substances. In this study, 19F- and 1H-qNMR measurement conditions were systematically optimized and validated for three fluorinated pharmaceuticals listed in the Japanese Pharmacopoeia-fluorometholone (FM), flurbiprofen (FP), and flutamide (FT)-using interlaboratory data. Building on our prior experience with 31P-qNMR, careful selection of solvents and reference standards was emphasized. The aprotic solvent dimethyl sulfoxide-d6 (DMSO-d6) was employed to suppress proton-deuterium exchange, and the International System of Units (SI)-traceable certified reference material 3,5-bis(trifluoromethyl)benzoic acid (3,5-BTFMBA) was used as the reference standard for both 19F- and 1H-qNMR. For 1H-qNMR of FT, sodium 4,4-dimethyl-4-silapentanesulfonate-d6 (DSS-d6) was used as an alternative reference standard to avoid spectral overlap. Key qNMR parameters, including relaxation delay, spectral width, and pulse offset, were optimized. We then validated 19F-qNMR against the more established 1H-qNMR technique across multiple laboratories (n = 6-10). The average purity values determined by 19F-qNMR were 98.79 ± 0.62% (n = 7) or 98.62 ± 0.34% (n = 6) for FM, 99.84 ± 0.40% (n = 9) for FP, and 99.84 ± 0.48% (n = 9) for FT; these values were in good agreement with those determined by 1H-qNMR (99.23 ± 0.41% (n = 9), 100.04 ± 0.34% (n = 10), and 99.67 ± 0.38% (n = 10), respectively). Collectively, these results indicate that 19F-qNMR is a reliable and reproducible technique for absolute quantification of fluorinated pharmaceuticals, supporting its application in pharmaceutical quality control and regulatory assessment.

We describe bilateral Encephalitozoon hellem keratoconjunctivitis in a 39-year-old immunocompetent woman with two years of daily close contact with a pet parrot. She presented with a three-week history of bilateral ocular redness, itching, foreign-body sensation, and blurred vision that had not improved with topical fluorometholone, lubricants, and levofloxacin prescribed for presumed dry eye disease. Slit-lamp examination showed bilateral conjunctival inflammation and diffuse superficial punctate corneal infiltrates. Giemsa staining of a left-eye corneal scraping demonstrated oval spore-like structures, while bacterial and fungal cultures were negative. Metagenomic next-generation sequencing (mNGS) of the same specimen detected 9,684 reads assigned to E. hellem, with a relative abundance of approximately 98% and genome coverage of 63%, supporting the diagnosis. Fluorescence microscopy of a fecal specimen from the pet parrot revealed a small number of spore-like structures morphologically compatible with microsporidia, but no molecular typing was performed. The symptoms and corneal lesions resolved over six weeks during treatment with topical 0.02% polyhexamethylene biguanide, topical 0.5% gatifloxacin administered as post-scraping antibacterial prophylaxis, and a short course of oral albendazole, with no recurrence during four months of follow-up. This case highlights the diagnostic value of combining corneal-scraping microscopy with mNGS in treatment-refractory keratoconjunctivitis and the importance of obtaining a detailed avian-exposure history. It also illustrates that microscopic findings in avian feces alone cannot establish zoonotic transmission.

Interleukin-6 (IL-6) is a highly promising therapeutic target across numerous pathological conditions. This cytokine mediates two distinct downstream signaling cascades: classic signaling, which primarily regulates regenerative and anti-inflammatory processes; and trans-signaling, which drives pathological and pro-inflammatory processes. Non-selective IL-6 inhibition affects both pathways, carrying significant risk of severe clinical adverse effects. Soluble glycoprotein 130 (Sgp130) enables pathway-specific blockade of IL-6 trans-signaling only, making it a compelling candidate for treating disorders driven by this signaling axis. However, its therapeutic potential in ocular diseases remains poorly defined. We investigated the ability of recombinant tag-free Sgp130 (rSgp130) to alleviate corneal inflammation and angiogenesis induced by alkali burn, a common cause of visual impairment. In human umbilical vein endothelial cells (HUVECs), rSgp130 reduced IL-6 trans-signaling-activated phosphorylation of STAT3, ERK and AKT. Functional assays of rSgp130 demonstrated suppression of IL-6 trans-signaling-induced angiogenic activities, including cell migration and tubular formation. In a mouse model of corneal alkali burn, topical administration of 1.5 mg/mL rSgp130 diminished inflammatory cell infiltration and neovascularization, exhibiting comparable efficacy to fluorometholone, a standard ocular corticosteroid. Notably, rSgp130 outperformed fluorometholone in reducing vascular remodeling area, highlighting its superior anti-angiogenic activity. Consistent with these findings, rSgp130 attenuated alkali burn-induced phosphorylation of STAT3, ERK and AKT in corneal tissue. Pharmacokinetic analysis revealed rapid corneal penetration, with increased intracellular levels at 5 min and sustained tissue presence beyond 2 h. Safety evaluation confirmed favorable toxicity profiles in major organs. Collectively, these findings validate rSgp130 as a promising topical therapeutic for corneal pathologies linked to IL-6 trans-signaling.

Corticosteroid-antibiotic combinations are commonly used in veterinary ophthalmic practice, yet the potential for corticosteroids to modulate antimicrobial susceptibility remains incompletely characterized. This study evaluated the in vitro effects of fluorometholone (FML) on the antimicrobial susceptibility of three major canine ocular pathogens-Staphylococcus pseudintermedius, Streptococcus canis, and Pseudomonas aeruginosa-and compared its interaction profile with that of dexamethasone.

The treatment of complex inflammatory diseases like dry eye disease (DED) is hampered by the intertwined pathologies of inflammation and oxidative stress, which form a self-amplifying vicious cycle. Here, we report an intelligent nanoplatform (CFMPDA) designed to actively navigate and disrupt this cycle through sequential, pathology-responsive targeting. CFMPDA is constructed by encapsulating the anti-inflammatory agent Fuziline within a mesoporous polydopamine (MPDA) nanoscavenger and conjugating CCL2-targeting antibodies on its surface. This design enables a two-stage therapeutic strategy: first, CCL2-mediated anchoring to the inflamed cornea, providing disease severity-dependent retention that overcomes rapid ocular clearance; second, subsequent mitochondrial targeting to deliver combined anti-inflammatory and antioxidant therapy directly to the organelle generating pathogenic ROS. In vivo, CFMPDA demonstrated potent, synergistic efficacy in a DED mouse model, simultaneously suppressing the inflammatory cascade (IL-1β, IL-6, TNF-α, MMP9, T cell infiltration) and quenching oxidative stress, leading to comprehensive tissue repair and functional recovery that surpassed the clinical standard-Fluorometholone. This work establishes a versatile nanotechnology blueprint-responsive bio-interfacing coupled with programmed subcellular delivery-for the synergistic treatment of inflammatory disorders characterized by chemokine upregulation and mitochondrial dysfunction.

Immune-mediated ocular surface disorders represent a group of diseases associated with hypersensitivity reactions. Most of these conditions have a chronic progressive course, which can lead to severe consequences, including loss of visual function. In addition to necessary systemic therapy that depends on the underlying condition, the basic approach to the treatment of immune-mediated ocular surface diseases consists of immunosuppressants and artificial tears. In the acute stage or during exacerbations of severe immune-mediated lesions, the drug of choice is the glucocorticosteroid (GCS) dexamethasone. Fluorometholone and loteprednol considered to be "soft", i.e., low-potency GCSs. Although the use of cyclosporine A, including in the form of a cationic emulsion (Ikervis), is considered ineffective for most forms of dry eye disease, it may be used in a selected group of patients with moderate immune keratoconjunctivitis. In more severe cases, the use of the more potent agent tacrolimus is advisable. As for mandatory tear substitution therapy in this patient population, combined formulations containing hyaluronic acid and the reparative agent dexpanthenol appear promising. The composition of Stillavit Intensive provides reliable hydration of ocular surface tissues due to sodium hyaluronate 1.8 mg, additional anti-inflammatory effects mediated by sodium chondroitin sulfate, and regeneration of the conjunctival and corneal epithelium through D-panthenol 50.0 mg.