OBJECTIVE: To evaluate the efficacy of photodynamic therapy (PDT) in treating cervical low-grade squamous intraepithelial lesions (LSIL) and to identify factors influencing treatment outcomes. METHODS: We conducted a ret...OBJECTIVE: To evaluate the efficacy of photodynamic therapy (PDT) in treating cervical low-grade squamous intraepithelial lesions (LSIL) and to identify factors influencing treatment outcomes. METHODS: We conducted a retrospective study of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) treatment of 93 women diagnosed with cervical LSIL and concurrent high-risk human papillomavirus (HR-HPV) infection. Follow-up assessments of HPV, cytology and colposcope were performed at 6 and 12 months. RESULTS: At the 6-month follow-up, pathological regression was observed in 79.8% (71/89) of patients and HR-HPV in clearance 65.2% (58/89). By 12 months the regression rate increased to 85.9% (73/85) and HR-HPV clearance rate to 78.8% (67/85), while one patient experienced disease progression. Analysis indicated that HPV vaccination history was associated with LSIL reversal and HPV clearance at 6 months (P < 0.05). CONCLUSION: ALA-PDT is effective and well-tolerated for the treatment of LSIL patients with HR-HPV infection, with outcomes influenced by prior HPV vaccination. The combination of vaccination and PDT may yield synergistic therapeutic benefits for cervical lesions.
PURPOSE: Near-infrared photoimmunotherapy has been approved in Japan for unresectable locally advanced or recurrent head and neck cancer. While this therapy theoretically induces selective necrosis of epidermal growth fa...PURPOSE: Near-infrared photoimmunotherapy has been approved in Japan for unresectable locally advanced or recurrent head and neck cancer. While this therapy theoretically induces selective necrosis of epidermal growth factor receptor-expressing tumor cells following administration of cetuximab sarotalocan sodium and irradiation with 690-nm light, residual disease is not uncommon in clinical practice. The mechanisms underlying such persistence remain poorly understood. METHODS: We examined two patients with head and neck squamous cell carcinoma who underwent salvage resection due to residual disease after four cycles of near-infrared photoimmunotherapy. Resected specimens were subjected to histopathological evaluation, including immunohistochemistry for epidermal growth factor receptor, cluster of differentiation 8, programmed cell death protein 1, and forkhead box P3 proteins. RESULTS: In both cases, residual tumor cells were predominantly localized in the superficial mucosal layers, while deeper layers were replaced by fibrosis. All residual tumors retained expression of epidermal growth factor receptor. Lymphocytic infiltration was sparse, with scattered cluster of differentiation 8-positive cells but few programmed cell death protein 1-positive or forkhead box P3-positive lymphocytes. These findings suggest that the tumor microenvironment surrounding residual tumors may have been unfavorable for the induction of robust antitumor immune responses. CONCLUSION: Residual tumors after near-infrared photoimmunotherapy can occur despite adequate laser irradiation and epidermal growth factor receptor expression. Our observations imply that insufficient immune activation within the tumor microenvironment may contribute to treatment resistance. Further characterization of the post-photoimmunotherapy tumor microenvironment will be essential to better understand treatment mechanisms and to optimize therapeutic efficacy.
PURPOSE: To investigate the acute effects of short-term exposure to full-spectrum light on ocular biometric parameters in children with intermittent exotropia (IXT) across different refractive states. METHODS: Children w...PURPOSE: To investigate the acute effects of short-term exposure to full-spectrum light on ocular biometric parameters in children with intermittent exotropia (IXT) across different refractive states. METHODS: Children with IXT were recruited and categorized into myopia, emmetropia, and hyperopia groups based on their baseline refractive status. All participants underwent a single 4-hour session of exposure to full-spectrum light (illuminance: ≈ 500 lux; correlated color temperature: ≈ 4000 K). Axial length (AL), subfoveal choroidal thickness (SFCT), and crystalline lens thickness (LT) were measured before and after the intervention using optical biometry and optical coherence tomography. Changes in ocular parameters were analyzed using linear mixed models and partial correlation analyzes. RESULTS: The ocular response to full-spectrum light exhibited significant refractive-state specificity. The myopia group exhibited significant acute axial shortening (ΔAL = -0.008 ± 0.003 mm; p < 0.05) and a negative correlation between axial length and choroidal thickness changes (p = 0.013), in the absence of significant choroidal thickening at the group level. In contrast, emmetropic eyes showed physiological axial elongation with inferior choroidal thickening, while hyperopic eyes maintained structural stability. CONCLUSIONS: Short-term exposure to full-spectrum light induces distinct, refraction-dependent ocular structural responses in children with IXT. While emmetropic eyes maintain normal circadian growth patterns, myopic eyes exhibit acute axial shortening. The dissociation between axial shortening and choroidal thickening in myopic eyes suggests the involvement of alternative posterior segment regulatory mechanisms. These findings suggest good short-term biocompatibility of full-spectrum lighting and provide insight into refraction-dependent light-eye interactions in children with intermittent exotropia; however, longitudinal studies are needed to determine whether these acute effects translate into sustained ocular changes and to assess potential rebound effects.
The early symptoms of subungual squamous cell carcinoma are often nonspecific, leading to frequent misdiagnosis as conditions such as paronychia or subungual warts. Treatment options for this malignancy remain relatively...The early symptoms of subungual squamous cell carcinoma are often nonspecific, leading to frequent misdiagnosis as conditions such as paronychia or subungual warts. Treatment options for this malignancy remain relatively limited in clinical practice. This study presents the case of a 74-year-old male with subungual squamous cell carcinoma who achieved significant improvement following photodynamic therapy. The patient had experienced pain and exudation of the big toe for over six months. Initially diagnosed with paronychia, he was treated with oral clarithromycin tablets (0.5 g daily) for half a month, which yielded no notable improvement. Subsequent intermittent application of iodophor and mupirocin ointment also resulted in poor clinical outcomes. A pathological biopsy was then performed, leading to a diagnosis of subungual squamous cell carcinoma. The tumor tissues were removed by local resection, followed by three sessions of photodynamic therapy administered at 10-day intervals. All suspected lesions were excised via local resection, with preservation of the nail bed and nail fold. A 20 % 5-aminolevulinic acid (ALA) solution (118 mg, Shanghai Fudan-Zhangjiang Bio-Pharmaceutical Co., Ltd) was topically applied to the entire nail bed and nail fold, occluded with aluminum foil to block light, and incubated for 3 h. After removal of the covering, the area was irradiated with 635-nm red light at 100 mW/cm² and 120 J/cm² for 20 min (Kernel Medical Equipment Co., Ltd). Prior to treatment, the patient took 200 mg ibuprofen orally for analgesia. During the eight-month follow-up period, no recurrence was observed. It is worth noting that due to the patient's history of severe onychomycosis, some residual fungal nail changes remained visible after recovery.
PURPOSE: To compare the safety, efficacy and predictability of ray-tracing-guided with Q-value-adjusted laser-assisted in situ keratomileusis (LASIK) for correcting myopic astigmatism of 2.00 Diopters (D) or greater at 3...PURPOSE: To compare the safety, efficacy and predictability of ray-tracing-guided with Q-value-adjusted laser-assisted in situ keratomileusis (LASIK) for correcting myopic astigmatism of 2.00 Diopters (D) or greater at 3 months postoperatively. METHODS: This retrospective, comparative clinical study included 60 eyes with myopic astigmatism ≥ 2.00 D: 30 eyes in the ray-tracing-guided group (InnovEyes group) and 30 eyes in the Q-value-adjusted group (Custom-Q group). Uncorrected distance visual acuity (UDVA), best-corrected distance visual acuity (CDVA), manifest refraction spherical equivalent (MRSE), sphere and cylinder were evaluated preoperatively and 3-month postoperatively. General estimating equitation was used for inter-group comparison and correlation analyses to account for potential inter-eye correlation within subject. RESULTS: At 3-month postoperatively, CDVA was better in the InnovEyes group (P = 0.005), with 87% of eyes achieving cylinder within ± 0.25 D (vs. 63% in the Custom-Q group). Vector analysis revealed InnovEyes group induced a slight overcorrection (correction index: 1.04 ± 0.02) versus Custom-Q group's undercorrection (correction index: 0.94 ± 0.02) (P = 0.007), with InnovEyes group exhibiting significantly smaller magnitude of error (0.08 ± 0.04 vs. -0.13 ± 0.05, P = 0.002). Correlation analyses revealed that both correction index and magnitude of error were non-significant correlated with target induced astigmatism (TIA) in either group (all P > 0.05). The group × TIA interaction was also non-significant (both P > 0.05). CONCLUSIONS: Ray-tracing-guided LASIK is an effective, safe, and predictable surgical option for eyes with myopic astigmatism ≥ 2.00 D Although a tendency toward mild astigmatism overcorrection was noted, it achieved statistically better postoperative CDVA and small astigmatic errors compared to the Q-value-adjusted group at 3 months postoperatively.
PURPOSE: This study evaluated the long-term clinical efficacy of two pro re nata (PRN) anti-vascular endothelial growth factor (VEGF) regimens (3+PRN and 5+PRN) for managing macular edema (ME) secondary to ischemic and n...PURPOSE: This study evaluated the long-term clinical efficacy of two pro re nata (PRN) anti-vascular endothelial growth factor (VEGF) regimens (3+PRN and 5+PRN) for managing macular edema (ME) secondary to ischemic and non-ischemic central retinal vein occlusion (CRVO). METHODS: A retrospective analysis was conducted involving patients diagnosed with CRVO who were managed at the study institution between November 2014 and August 2022, with a minimum follow-up period exceeding 12 months. Changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at 1 month (V1), 6 months (V6), 12 months (V12), and the final observation follow-up visit (Vf). Comparisons were made the 3+PRN and 5+PRN regimens within ischemic and non-ischemic CRVO subgroups. RESULTS: A total of 63 eyes were included in the analysis, including 29 eyes in the 5+PRN group (15 with non-ischemic CRVO and 14 with ischemic CRVO) and 34 eyes in the 3+PRN group (19 with non-ischemic CRVO and 15 with ischemic CRVO). BCVA and CMT improved from baseline at V1, V6, V12, and Vf in both ischemic and non-ischemic cases. No statistically significant differences in BCVA or CMT were observed between the two treatment groups at any follow-up interval. The distribution of outcomes categorized as effective, moderately effective, and ineffective was also comparable between the groups. Although a higher number of injections was administered in the 5+PRN group by month 12, the total number of injections by the final visit did not differ substantially between the two groups. CONCLUSIONS: The 3+PRN anti-VEGF regimen demonstrated clinical outcomes comparable to those of the 5+PRN regimen in patients with CRVO-associated ME, with the benefit of requiring fewer anti-VEGF injections during the first year of treatment. CLINICAL REGISTRATION NUMBER: ChiCTR2000040087.
PURPOSE: To compare the clinical characteristics, multimodal imaging features, and treatment response to half-dose photodynamic therapy (PDT) between patients with chronic central serous chorioretinopathy (cCSC) with and...PURPOSE: To compare the clinical characteristics, multimodal imaging features, and treatment response to half-dose photodynamic therapy (PDT) between patients with chronic central serous chorioretinopathy (cCSC) with and without myopia. METHODS: Sixty-six eyes with cCSC received a single session of half-dose PDT and were followed for at least 6 months. Patients were divided into myopic and non-myopic groups based on spherical equivalent less than -0.5 diopters. Multimodal imaging data, including optical coherence tomography (OCT), OCT angiography, fundus autofluorescence (FAF), and indocyanine green angiography (ICGA), were analyzed. RESULTS: The study included 38 eyes in the myopic group and 28 in the non-myopic group. Among myopic eyes, 65.8% had low myopia, 28.9% moderate, and 5.3% high myopia. The myopic group had significantly less subretinal fluid at baseline (145.1 ± 74.4 µm vs. 193.6 ± 113.1 µm, P = 0.039), but more frequent photoreceptor outer segment (OS) elongation (86.8% vs. 64.3%, P = 0.031) and mottled FAF (55.3% vs. 21.4%, P = 0.010). In contrast, the non-myopic group more often showed hyper or hyper/hypo FAF. Slightly greater BCVA improvement was observed in the non-myopic group (-0.14 ± 0.26 vs. -0.03 ± 0.18, P = 0.031). Multivariate analysis identified OS elongation and mottled FAF as independent predictors of both myopic cCSC (P = 0.049 and P = 0.005, respectively) and more myopic refractive status (P < 0.001 and P = 0.005, respectively). CONCLUSIONS: Myopic cCSC is associated with less subretinal fluid, more photoreceptor outer segment elongations and mottled FAF. Post-treatment BCVA improvement was slightly greater in non-myopic eyes.
PURPOSE: Repeated low-level red-light (RLRL) therapy has emerged as a promising intervention for pediatric myopia control. However, substantial inter-individual variability in treatment response limits its clinical appli...PURPOSE: Repeated low-level red-light (RLRL) therapy has emerged as a promising intervention for pediatric myopia control. However, substantial inter-individual variability in treatment response limits its clinical applicability. Reliable tools for early identification of long-term responders remain limited. This study aimed to develop a prognostic model based on early axial length (AL) dynamics to predict long-term myopia control outcomes in children undergoing RLRL therapy. METHODS: This retrospective cohort study included myopic children treated with RLRL therapy at Xi'an No.1 Hospital between August 2022 and December 2025. Participants were classified into good- and poor-prognosis groups based on yearly AL change (≤ -0.06 vs. > -0.06 mm/year). Demographic characteristics, baseline spherical equivalent (SE), subfoveal choroidal thickness (sChT), and ocular biometric parameters at baseline and at 1 and 3 months post-treatment were collected. Univariable logistic regression was used to screen potential predictors, and nomograms were constructed for prognostic modeling. RESULTS: A total of 69 children were enrolled (35 good-prognosis, 34 poor-prognosis). Significant differences were observed in baseline SE, AL, 1-month AL change, 3-month AL change, and the AL change rate over the first 3 months (all P < 0.05). The nomogram incorporating age, sex, and 3-month AL change showed the highest predictive performance, with an AUC of 0.961. No serious adverse events were observed during follow-up. CONCLUSIONS: RLRL therapy is effective and safe for controlling myopia progression in children. Early AL dynamics, combined with baseline ocular parameters, provide strong predictive power for long-term outcomes, supporting individualized myopia management and risk-stratified clinical decision-making.
OBJECTIVE: To evaluate the change in anterior segment blood supply after horizontal rectus muscle surgery using anterior segment optical coherence tomography angiography (AS-OCTA) and to explore the influencing factors....OBJECTIVE: To evaluate the change in anterior segment blood supply after horizontal rectus muscle surgery using anterior segment optical coherence tomography angiography (AS-OCTA) and to explore the influencing factors. METHODS: This prospective, longitudinal study included patients undergoing horizontal rectus muscle surgery. AS-OCTA images of the iris and episcleral-limbal plexus (ELP) were captured preoperatively and at 1 day, 1 week, 1 month and 3 months. Vessel densities were calculated and compared among different groups. Risk factors were explored using stepwise multivariate linear regression. RESULTS: Sixty patients were enrolled and underwent surgery, 24 for lateral rectus muscle (LR), 11 for medial rectus muscle (MR), and 25 for unilateral medial and lateral rectus muscles (R&R). Vessel densities in the LR group recovered to the preoperative level at postoperative 1 week (ELP: P = 0.052; Iris: P = 0.065), whereas not until 1 month postoperatively in the MR (ELP: P = 0.084; Iris: P = 0.383) and R&R groups (ELP nasal side: P = 0.454; ELP temporal side: P = 0.929; Iris: P = 0.563). The MR and R&R groups experienced greater decreases in iris vessel density (MR: 1.44 ± 1.43 %, P = 0.021; R&R: 1.12 ± 1.42 %, P = 0.021) than the LR group (0.26 ± 0.62 %). Older age (P < 0.001), increased BMI (P = 0.014), and smoking history (P = 0.008) were strong indicators for poorer iris recovery at postoperative 1 month. CONCLUSION: Horizontal rectus muscle surgery induced decreased anterior segment blood supply, which averagely recovered within 1 month. Patients predicted at high risk including those of older age, increased BMI, or a smoking history, may benefit from regular monitoring with AS-OCTA.
BACKGROUND: The incidence of cutaneous malignancies is increasing among older adults. In frail older patients, standard wide excision of mucosal carcinomas often leads to extensive tissue defects, prolonged surgical dura...BACKGROUND: The incidence of cutaneous malignancies is increasing among older adults. In frail older patients, standard wide excision of mucosal carcinomas often leads to extensive tissue defects, prolonged surgical duration, and deeper anesthesia requirements, all of which elevate perioperative risk. At anatomically complex sites, such as the oral cavity or perineal mucosa, surgery is complicated by the dual challenge of achieving clear margins while preserving function. Consequently, local recurrence rates at these sites substantially exceed those of comparable cutaneous malignancies. OBJECTIVE: To evaluate the efficacy and safety of extended local excision guided by intraoperative frozen-section analysis, followed by postoperative photodynamic therapy (PDT), in older patients with mucosal malignancies. RESULTS: Following surgical resection with confirmed clear margins, the patient underwent three sessions of adjuvant PDT. The treated lesion exhibited prompt re-epithelialization with erythema and granulation tissue formation, and no exudate or residual tumor was observed. Serial reflectance confocal microscopy during the 12-month follow-up revealed no atypical cells. The patient's quality of life improved significantly. CONCLUSION: The combined approach of extended resection with adjuvant PDT appears to ensure oncological safety, reduce surgical invasiveness, and preserve mucosal function in high-risk older patients. This combination represents a promising single-stage treatment strategy.
OBJECTIVE: To systematically evaluate the efficacy and safety of photodynamic therapy (PDT) for HPV-infected cervical intraepithelial neoplasia (CIN) based on randomized controlled trials (RCTs). METHODS: A systematic se...OBJECTIVE: To systematically evaluate the efficacy and safety of photodynamic therapy (PDT) for HPV-infected cervical intraepithelial neoplasia (CIN) based on randomized controlled trials (RCTs). METHODS: A systematic search was performed across PubMed, EMBASE, Web of Science, and the Cochrane Library from 2000 to 2025, targeting RCTs that compared PDT with standard conization methods or placebo. The primary outcomes assessed included histopathological response, human papillomavirus (HPV) clearance, and the rate of adverse reactions. The quality of the included RCTs was evaluated using the Cochrane Collaboration's RevMan 5.4.1 tool and meta-analysis was conducted to pool effect sizes. RESULTS: Of 270 retrieved records, 6 eligible RCTs involving 973 patients were included. Meta-analysis showed that PDT significantly improved lesion remission rate (OR = 2.27, 95% CI = [1.66, 3.11], I²=0, P < 0.05) and HPV clearance rate (OR = 1.99, 95% CI = [1.32, 2.99], I²=0, P = 0.05). No statistically significant difference in adverse reaction rate was observed between the two groups (P>0.05). CONCLUSION: Based on the pooled data of 6 RCTs, PDT is an effective and safe therapeutic option for HPV-infected CIN, as it enhances lesion remission and HPV clearance without substantially increasing adverse reactions.
This case report presents a 79-year-old male with scalp Bowen's disease and multiple comorbidities, precluding surgery. An innovative combination of nano-microneedle pretreatment and 5-Aminolevulinic Acid-Photodynamic Th...This case report presents a 79-year-old male with scalp Bowen's disease and multiple comorbidities, precluding surgery. An innovative combination of nano-microneedle pretreatment and 5-Aminolevulinic Acid-Photodynamic Therapy (5-ALA-PDT) was utilized. Following five sessions, complete clinical clearance was achieved, maintained over 18 months of follow-up without recurrence. This synergistic approach enhances drug delivery and light efficacy, overcoming traditional PDT penetration limits. This successful non-surgical treatment for scalp BD using microneedle-assisted PDT, provides a novel therapeutic option for complex, inoperable cases, but rerquires further clinical validation.
AIMS: to investigate the influence of contemporary remineralizing agents, i.e., sodium fluoride (naf), casein phosphopeptide-amorphous calcium phosphate (cpp-acp), diode laser (dl), and theobromine on the microhardness (...AIMS: to investigate the influence of contemporary remineralizing agents, i.e., sodium fluoride (naf), casein phosphopeptide-amorphous calcium phosphate (cpp-acp), diode laser (dl), and theobromine on the microhardness (mh) and shear bond strength (sbs) of one-step self-etch (se) adhesive to the caries-affected primary molars. MATERIALS AND METHODS: 100 extracted primary mandibular molars with carious lesions in dentin, classified as level 5, according to the international caries detection and assessment system, were considered. the teeth were disinfected, followed by the removal of infected dentin. all teeth were allocated into five groups based on the remineralization technique (n = 20). group 1 (untreated cad), group 2 (naf), group 3 (cpp-acp), group 4 (dl), and group 5 (theobromine). a digital vickers hardness tester was used to assess mh (n = 10). the composite was built on cad, and the samples were thermocycled (n = 10). sbs and failure mode testing were performed using a universal testing machine and a stereomicroscope, respectively. one-way anova and post hoc tukey determined significant differences in mh and sbs between the investigated groups (p˂0.05). RESULTS: cpp-acp-pretreated cad samples displayed the highest mh (195.11±20.13) and sbs (9.27± 0.23 mpa). untreated samples exhibited the lowest mh (164.26±11.02) and sbs (7.77± 0.22 mpa). there was no significant difference in the mh and sbs of cad treated with naf, cpp-acp, and theobromine (p˃0.05). CONCLUSION: Applying remineralizing agents such as sodium fluoride, casein phosphopeptide-amorphous calcium phosphate, or theobromine to caries-affected dentin in primary molars enhances shear bond strength and microhardness before restoration with a self-etch adhesive.
AIM: The photodynamic diagnostic agent oral 5-aminolevulinic acid (5-ALA) promotes the selective accumulation of protoporphyrin IX in tumor cells and is used for intraoperative visualization of tumor tissue in the diagno...AIM: The photodynamic diagnostic agent oral 5-aminolevulinic acid (5-ALA) promotes the selective accumulation of protoporphyrin IX in tumor cells and is used for intraoperative visualization of tumor tissue in the diagnosis and treatment of non-invasive bladder cancer confined to the muscle. However, the use of oral 5-ALA in photodynamic diagnosis has been reported to cause intraoperative hypotension during urologic surgery. Therefore, this meta-analysis was conducted to identify risk factors for intraoperative hypotension associated with oral 5-ALA use during transurethral resection of bladder tumors (TURBT) performed for non-invasive bladder cancer in the muscle layer. METHOD: This meta-analysis was conducted on studies investigating risk factors for intraoperative hypotension during TURBT using oral 5-ALA. Relevant studies published in PubMed, Scopus, Cochrane Library, and Ichu-shi databases through June 14, 2024, were selected. A meta-analysis was performed on risk factors evaluated in at least four studies. RESULT: We found that age (mean difference: 3.55; 95% confidence interval [CI]: 1.76-5.35), female sex (odds ratio [OR]: 1.60; 95% CI: 1.16-2.24), a comorbidity of hypertension (OR: 1.57; 95% CI: 1.18-2.07), Renin-Angiotensin System inhibitors (OR: 1.67; 95% CI: 1.25-2.22), and use of general anesthesia (OR: 6.08; 95% CI: 3.17-11.63) were significantly associated with the risk of intraoperative hypotension. CONCLUSIONS: This meta-analysis elucidated the risk factors for severe hypotension during TURBT. Consequently, when oral 5-ALA is used in TURBT, the patient background should be assessed, and modifiable risk factors should be addressed to prevent the development of severe hypotension.
PURPOSE: Refractory diabetic macular edema (DME) remains a therapeutic challenge despite anti-vascular endothelial growth factor (anti-VEGF) treatment. This study compares the efficacy and safety of intravitreal dexameth...PURPOSE: Refractory diabetic macular edema (DME) remains a therapeutic challenge despite anti-vascular endothelial growth factor (anti-VEGF) treatment. This study compares the efficacy and safety of intravitreal dexamethasone (DEX) implants and conbercept in patients with refractory DME. METHODS: This retrospective cohort study included 317 eyes from 317 patients with refractory DME who had received at least three prior anti-VEGF injections. Patients were divided into two groups based on the treatment they received: the DEX group (n = 125) and the conbercept group (n = 192). Best-corrected visual acuity (BCVA) was recorded in logarithm of the Minimum Angle of Resolution (logMAR) units. Central macular thickness (CMT), intraocular pressure (IOP), and adverse events were assessed at baseline and 3, 6, and 12 months after treatment. RESULTS: Both groups showed significant improvements in BCVA and reductions in CMT. The DEX group achieved greater BCVA gains at 3 and 6 months (P < 0.05), but differences were not significant at 12 months (P = 0.229). CMT reduction was more pronounced in the DEX group at 3 and 12 months (P < 0.05), with no significant difference observed at 6 months (P > 0.05). IOP increased significantly in the DEX group at each follow-up visit (all P < 0.001), with a higher incidence of ocular hypertension (21.6% vs. 3.6%, P < 0.001). Cataract surgery was more common in the DEX group (8.8% vs. 2.6%, P = 0.014). CONCLUSIONS: DEX implants provide better short-term efficacy but with higher risks, while conbercept offers safer outcomes for refractory DME.
BACKGROUND: Hemoporfin-mediated photodynamic therapy (HMME-PDT) is an established treatment for port-wine stains (PWS), but hypertrophic or nodular lesions often respond poorly, and the molecular mechanisms that govern t...BACKGROUND: Hemoporfin-mediated photodynamic therapy (HMME-PDT) is an established treatment for port-wine stains (PWS), but hypertrophic or nodular lesions often respond poorly, and the molecular mechanisms that govern treatment sensitivity remain unclear. The Ataxia Telangiectasia Mutated (ATM)-Seryl-tRNA synthetase (SerRS)-Vascular endothelial growth factor A (VEGFA) pathway has recently been implicated in hypoxia- and DNA damage-driven angiogenesis. METHODS: Human umbilical vein endothelial cells (HUVECs) were treated with HMME-PDT and/or all-trans retinoic acid (tRA). Cell viability was assessed by CCK-8 assay, angiogenic activity by tube formation assay, and mRNA expression of ATM, SerRS and VEGFA by quantitative real-time PCR. Protein levels of ATM, phosphorylated ATM (p-ATM), SerRS and VEGFA were evaluated by Western blotting. RESULTS: HMME-PDT significantly inhibited HUVEC viability and tube formation in a concentration- and light dose-dependent manner. HMME-PDT decreased total ATM and, more prominently, p-ATM, while upregulating SerRS and downregulating VEGFA at both mRNA and protein levels. tRA alone dose- and time-dependently reduced HUVEC proliferation, increased SerRS expression and suppressed VEGFA expression. Combined treatment with tRA and HMME-PDT produced the greatest inhibition of tube formation and the strongest induction of SerRS together with the most pronounced reduction in VEGFA, whereas changes in ATM and p-ATM were mainly driven by HMME-PDT. CONCLUSIONS: HMME-PDT exerts anti-angiogenic effects at least in part by modulating the ATM-SerRS-VEGFA axis in endothelial cells. Pharmacologic upregulation of SerRS by tRA further enhances VEGFA suppression and inhibition of angiogenesis, indicating a synergistic interaction between tRA and HMME-PDT. These findings provide a mechanistic rationale for tRA-augmented HMME-PDT as a potential strategy to improve outcomes in refractory PWS.