Background: Ocular Surface Squamous Neoplasia (OSSN) is the most common non-melanocytic ocular surface tumor. Treatment options include surgery and topical or injectable therapies, with interferon alpha-2b (IFNα-2b) being a well-tolerated immunomodulatory agent. This case report aims to explore the use of topical IFNα-2b in a patient with multiple OSSN recurrences. Case Description: A 65-year-old woman with a history of recurrent conjunctival papilloma, confirmed as OSSN, was treated with excision and cryotherapy, followed by subconjunctival IFNα-2b injections and eventually topical IFNα-2b (3 million international units-MIU/mL, four times daily for 12 weeks) after further recurrence. Initial discomfort and redness were reported shortly after starting topical therapy, but significant lesion regression was observed. After eight weeks, complete clinical remission was achieved. Despite premature discontinuation due to drug unavailability, no relapse was observed during a 3-year follow-up. Conclusions: This case underscores the clinical effectiveness and favorable tolerability of topical interferon alpha-2b in the management of recurrent ocular surface squamous neoplasia. The achievement of durable remission after a shortened treatment course highlights its potential as a flexible therapeutic option, with meaningful implications for clinical practice, particularly in settings with limited access to biologic therapies.

Cytomegalovirus (CMV) has recently emerged as a significant cause of anterior uveitis (AU) with intraocular pressure (IOP) elevation and corneal endothelial damage. The purpose of this study is to investigate the long-term prognostic factors for glaucoma surgery in patients with CMV-AU. In this retrospective cohort study, immunocompetent patients with CMV-AU were included from one academic institution and a uveitis-specialized private clinic between May 2015 and Mar 2024. Upon confirmation of polymerase-chain-reaction results, patients received anti-viral therapy (oral valganciclovir or 2% topical ganciclovir). When intraocular pressure was not controlled, glaucoma surgery (glaucoma filtering surgery or glaucoma drainage device) were performed. Indicators of glaucoma surgery were analyzed using Kaplan-Meir survival analyses and Cox-proportional hazard model. A total of 149 consecutive patients with CMV-AU included with a mean age of 44.5 ± 16.5 years; 65.1% being male. The baseline corneal endothelial cell (EC) density in affected eyes was 2088 ± 695 cells/mm[2]. During follow-up, glaucoma surgery was performed in 24 patients (16.1%), of whom 75% underwent glaucoma filtering surgery and 25% underwent drainage device implantation. The median survival time from the first onset of the disease to glaucoma surgery was 73.0 ± 11.6 months. In the univariate Cox-regression analyses for receiving glaucoma surgery, baseline EC < 1000 cells/mm[2] (Exp(B) = 4.142, p = 0.013), baseline BCVA < 0.3 (Exp(B) = 2.733, p = 0.029), and number of anti-glaucoma medications at quiescent phase ≥ 2 (Exp(B) = 2.645, p = 0.024) were significantly associated with the future requirement for glaucoma surgery. In the multivariate analyses, baseline EC < 1000 cells/mm[2] was the only significant factor for predicting glaucoma surgery (Exp(B) = 3.960, p = 0.022). In conclusion, baseline corneal endothelial cell density can serve as a useful indicator for future requirement of glaucoma surgery in CMV-AU.

Cytomegalovirus (CMV) infection of the anterior segment is increasingly recognized as an important cause of corneal endotheliitis and secondary glaucoma, even in immunocompetent individuals. CMV corneal endotheliitis typically presents with coin-shaped or linear keratic precipitates (KPs), corneal edema, mild anterior chamber inflammation, and recurrent intraocular pressure (IOP) elevation; persistent or episodic ocular hypertension may progress to glaucomatous optic neuropathy if inadequately treated. Definitive diagnosis relies on aqueous humor polymerase chain reaction (PCR) testing for CMV DNA, supported by adjunctive imaging including specular microscopy, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM). Management requires a comprehensive strategy integrating antiviral therapy, anti-inflammatory treatment, and appropriate IOP control. Topical or systemic ganciclovir remains the cornerstone, while refractory disease may necessitate surgical intervention. Older age and male sex, host immune status, prolonged or recurrent CMV infection, and pre-existing ocular conditions are major risk factors for progression and poor outcomes. The pathogenesis of secondary glaucoma is thought to involve both direct viral cytopathic effects and inflammation-mediated damage to the trabecular meshwork (TM), resulting in impaired aqueous outflow. Therefore, early recognition, accurate diagnosis, and effective treatment are essential to prevent corneal decompensation and permanent vision loss.

BACKGROUND Varicella zoster virus (VZV) infection can involve various ocular structures with atypical manifestations. Distinguishing VZV interstitial keratitis from corneal intraepithelial neoplasia (CIN) is important to avoid unnecessary interventions. This report aims to demonstrate an unusual clinical presentation of VZV interstitial keratitis and present the value of various diagnostic tools in excluding CIN. CASE REPORT We describe the case of a 26-year-old woman with a right-eye corneal finding thought to be CIN. She had a history of unilateral headache, alopecia, loss of eyelashes, and redness on the right side over the past 5 years. Upon examination, she had normal vision, with a sectoral conjunctival injection and anterior stromal opacity. Anterior segment optical coherence tomography (AS-OCT) and epithelial mapping aided in the diagnosis of VZV interstitial keratitis. Treatment with oral valacyclovir and topical corticosteroids resulted in resolution of active keratitis within 1 month, with residual scarring. CONCLUSIONS This case report highlights the importance of considering infectious etiologies, including VZV, in atypical corneal lesions, and demonstrates the diagnostic value of AS-OCT in differentiating CIN. It also highlights the primary role of AS-OCT and epithelial mapping in providing diagnostic clues that can distinguish OSSN from other mimickers. Timely recognition of viral keratitis mimicking neoplasia prevents unnecessary surgical interventions and enables targeted antiviral therapy.

Cataract is a leading cause of vision impairment worldwide and are primarily caused by oxidative stress that damages and aggregates lens proteins, leading to lens opacification. However, the eye's anatomical barriers limit the penetration and bioavailability of antioxidant therapies. To address this challenge, a dendrimer-based nanogel with a built-in reactive oxygen species (ROS)-scavenging capability developed by us was employed to deliver the antioxidant N-acetylcysteine (NAC) to the lens. NAC was loaded into a generation-5 PEGylated poly(amidoamine) dendrimer (G5-PEG-TK, termed the GPT) nanogel. The resulting NAC-GPT was characterized for its ROS-scavenging activity, bioavailability, and corneal permeability. The efficacy of NAC-GPT was evaluated ex vivo and in vivo using a sodium selenite (Na2SeO3)-induced cataract model. Both ex vivo and in vivo results demonstrated that NAC-GPT significantly increased the level of NAC accumulation in the lens. Furthermore, the in vivo study shows that NAC-GPT significantly increased the ratio of reduced glutathione (GSH) to oxidized glutathione (GSSG), an indicator of redox balance restoration. In particular, the GSH/GSSG ratio in NAC-GPT-treated lenses was nearly 2-fold higher than that of the untreated cataract control. These findings indicate that the GPT nanogel platform can effectively deliver antioxidants to the eye and is a promising noninvasive antioxidant delivery strategy with the ability to restore redox balance in cataract.

Ocular complications of Mpox are relatively rare but can be devastating, particularly in immunocompromised individuals. We report a case of severe keratitis resulting in significant visual impairment in a 26-year-old male living with advanced HIV. The patient presented with a 2-month history of disseminated ulcerative lesions and a 1-month history of progressive vision loss in the right eye. He was newly diagnosed with HIV, and laboratory testing revealed a positive Mpox virus polymerase chain reaction (PCR) result alongside severe immunosuppression (CD4 + T-lymphocyte count: 35 cells/μL). Ophthalmologic examination revealed corneal opacity, stromal edema, and neovascularization. Despite systemic antiviral and topical antibiotic/anti-inflammatory treatment, visual acuity remained poor due to permanent corneal scarring. This case highlights the potential for sight-threatening ocular complications in individuals with Mpox and severe immunodeficiency, underscoring the critical importance of early ophthalmologic assessment in this vulnerable population.