In living humans, uveoscleral outflow (Fu) is calculated, not measured. Except in rare tracer studies it is the residual of the modified Goldmann equation, Fu = F - C(IOP - Pev), which treats Fu as pressure-independent and assigns all pressure-dependent outflow to facility (C). Goldmann applanation tonometry (GAT) underestimates manometric IOP by about 4-5 mmHg. Because F, C, and Pev are measured independently of GAT, that low IOP input understates C(IOP - Pev) and overstates the residual reported as pressure-independent uveoscleral outflow. With representative values, GAT 15.5 mmHg yields Fu of about 50% of flow; manometric 20 mmHg yields about 9%, in line with human tracer data. A pressure-dependent uveoscleral component, if present, already sits inside C and cannot be separated by this method. The same bias has likely overstated the pressure-independent effect of prostaglandin analogs.

Gastrointestinal (GI) involvement is among the most common and clinically important manifestations of systemic sclerosis (SSc), affecting up to 90% of patients and substantially contributing to morbidity and reduced quality of life. SSc-related GI disease results from microvascular injury, enteric nervous system dysfunction, and progressive smooth muscle atrophy with fibrosis, producing widespread dysmotility throughout the gastrointestinal tract. Clinical involvement can extend from the oral cavity to the anorectum, with esophageal dysfunction, gastroesophageal reflux disease (GERD), gastroparesis, small intestinal bacterial overgrowth (SIBO), and intestinal pseudo-obstruction among the major manifestations. Recent diagnostic advances, including high-resolution esophageal manometry (HRM), ambulatory pH-impedance monitoring, and improved imaging, have strengthened early detection and characterization of GI involvement. Treatment remains largely supportive and symptom-directed, including acid suppression, prokinetic therapy, nutritional optimization, and endoscopic or surgical management of complications. Growing evidence on the gut microbiome, immune-mediated mechanisms, and the gut-brain axis is expanding understanding of disease pathophysiology and may guide future targeted therapies. This review synthesizes current evidence on the epidemiology, pathophysiology, clinical manifestations, and management of gastrointestinal involvement in systemic sclerosis, emphasizing early recognition and multidisciplinary care. We conclude by outlining persistent management challenges and future directions to improve diagnostic precision, therapeutic development, and patient-centered outcomes.

Glaucoma is a leading cause of irreversible blindness worldwide, with global prevalence projected to rise substantially in the coming decades. Advances in digital health technology have enabled the development of home-based monitoring devices that support patient-centered care. This review provides a comprehensive overview of current and emerging technologies for home glaucoma monitoring, focusing on intraocular pressure (IOP) assessment, optic disc imaging, and visual field testing. Home tonometry includes rebound devices such as the iCare HOME rebound tonometer and Tap Eye tonometer. Continuous IOP monitoring approaches include contact lens sensors (CLSs) such as Triggerfish CLS, miLens microfludic CLS, and implantable telemetric systems including Eyemate-IO and Eyemate-SC, offering insights into diurnal IOP fluctuations. IOP Connect (Injectsense) is a miniature implant that records and wirelessly uploads IOP data, though long-term validation is pending. Q Smart (Qura) is a remotely powered suprachoroidal sensor with frequent measurements, currently supported only by animal data. Smartphone-based optic disc imaging and devices with smartphone adapters provide accessible structural assessment, though image quality and user dependence remain limitations. Home-based perimetry platforms such as Melbourne rapid fields, Peristat, Eyeonic online circular-contrast perimetry, VisuALL, C3 Field Analyzer, Mobile virtual perimetry-Frequency-doubling technology, and Eyecatcher 3.0 show good agreement with standard automated perimetry while enhancing accessibility and testing frequency. Although these technologies show considerable potential to enhance disease surveillance and patient engagement, barriers including cost, regulatory approval, long-term validation, and integration into clinical work flows persist. Large-scale studies and unified digital platforms integrating structural and functional data are required to establish their role in routine glaucoma care.

Achalasia is a primary esophageal motility disorder defined by impaired lower esophageal sphincter relaxation and absent peristalsis. Late-stage disease can lead to megaesophagus, a severe dilation and tortuosity of the esophageal body. While most cases are idiopathic, secondary achalasia can be caused by Chagas disease (Trypanosoma cruzi infection), an important consideration in patients from endemic regions of Central and South America. Our case highlights a 51-year-old female from Nicaragua who presented to the emergency department with an acute onset of shortness of breath. A computed tomography angiogram (CTA) ruled out a pulmonary embolism but revealed a severely distended esophagus impacted with food contents. A chest radiograph demonstrated cardiac silhouette enlargement and left-base atelectasis. Gastroenterology was consulted, and the patient was admitted. A barium esophagogram revealed a markedly dilated, tortuous esophagus with an abrupt transition point with narrowing of the distal esophagus at the gastroesophageal junction (GEJ), resulting in the characteristic "bird's beak" appearance. High-resolution esophageal manometry confirmed an elevated median integrated relaxation pressure (IRP) and absent contractility, establishing a diagnosis of achalasia. Because the patient emigrated from a Chagas-endemic region, T. cruzi IgG antibody testing was performed twice and returned negative. The patient underwent a successful upper endoscopy with pneumatic balloon dilation of the GEJ. Her respiratory and dysphagia symptoms resolved; she tolerated a regular diet, and she was safely discharged. This case highlights a unique presentation of end-stage achalasia with megaesophagus initially manifesting as acute dyspnea. It underscores the diagnostic imperative to screen for secondary infectious etiologies like Chagas disease in endemic populations, while recognizing the limitations of single-assay serology. Ultimately, idiopathic achalasia remains the most probable diagnosis once pseudoachalasia and mechanical obstructions are excluded via high-resolution esophageal manometry and endoscopy.

ObjectiveBladder sensation plays a pivotal role in the physiological regulation of urine storage and micturition and is essential for maintaining normal lower urinary tract function. This systematic review aimed to comprehensively summarize current methods for assessing and detecting bladder sensation, compare their characteristics, and discuss their potential clinical applications.MethodsThis systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was prospectively registered in PROSPERO (CRD42024625435). Eight electronic databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, Wanfang Database, VIP Database, and SinoMed) were searched from database inception to October 2024. Eligible studies investigating methods for the assessment or detection of bladder sensation were identified through predefined inclusion and exclusion criteria. Data regarding study characteristics, assessment methods, and principal findings were extracted and qualitatively synthesized.ResultsA total of 83 studies were included in this review. The published studies spanned from 1984 to 2023 and investigated a broad range of bladder sensation assessment methods. These included equipment-based techniques, such as urodynamic testing, sympathetic skin reaction, positron emission tomography, functional magnetic resonance imaging, bladder manometry, and bladder ultrasonography, as well as non-equipment-based approaches including bladder diaries, visual analogue scales, Patient Perception of Bladder Condition, frequency-volume charts, and forced diuresis tests. Each method demonstrated distinct strengths, limitations, and potential clinical applications.ConclusionsCurrent methods for assessing bladder sensation vary considerably in their underlying principles, invasiveness, clinical feasibility, and diagnostic utility. Understanding the characteristics, advantages, and limitations of different assessment approaches may facilitate more comprehensive evaluation of bladder sensory function and support individualized clinical decision-making. Further studies are warranted to establish standardized, objective, and clinically applicable methods for bladder sensation assessment.

Fournier's gangrene (FG) often requires repeated aggressive debridement. Its long-term effects on continence, anal sphincter integrity, and quality of life remain insufficiently defined. Among 188 patients treated for FG between 2000 and 2021 and assessed for eligibility, 21 survivors who had perianal debridement within 5 cm of the anal verge, healed without permanent stoma, and completed the study protocol were included. Participants underwent standardized physical examination, anorectal manometry, endoanal ultrasonography, and questionnaire-based assessment of fecal incontinence and quality of life. Majority of patients were male (66.7%) with a median age of 59 years (39-74). The median follow-up time was 83 months (27-211). On anorectal examination, 3 patients had anal fistula, 1 had anal fissure, 1 had external rectal prolapse, and 11 had decreased anal tone on digital examination. Endoanal ultrasonography demonstrated isolated external sphincter defects in 2 patients and combined external and internal sphincter defects in 2. Anorectal manometry showed decreased resting pressure in 2 patients and decreased squeeze pressure in 11. Questionnaire-based assessment demonstrated that fecal incontinence and reduced quality of life were common among long-term survivors. Long-term survivors of Fournier's gangrene frequently report fecal incontinence and reduced quality of life, although overt sphincter defects are uncommon.