Hajirah N. Saeed

Purpose: To evaluate severe dupilumab-associated ocular surface disease (DAOSD) and identify clinical features, risk factors, and outcomes associated with delayed ophthalmologic referral. Methods: A multicenter retrospective case series of 13 patients (26 eyes) with severe DAOSD presenting to tertiary centers between January 2014 and April 2026 was conducted. Clinical findings were analyzed alongside a focused review of current evidence on pathophysiology, diagnosis, and management. Results: Initial ocular symptoms were frequently mild and nonspecific, most commonly redness and pruritus (13/13, 100%), followed by blurred vision with tearing (3/13, 23.1%), eye pain (2/13, 15.4%), and mucoid discharge (2/13, 15.4%), contributing to delayed referral. Symptom onset ranged from 0 to 37 months after dupilumab initiation (mean 11.7 months). At presentation, advanced disease manifestations included limbitis (3/13, 23.1%), conjunctivalization with corneal neovascularization (3/13, 23.1%), limbal stem cell deficiency (2/13, 15.4%), and cicatricial conjunctivitis (1/13, 7.7%). Preexisting atopic ocular disease was present in 6/13 patients (46.2%). Management included lubrication, topical corticosteroids, calcineurin inhibitors, and scleral lenses. Dupilumab was discontinued in 7/13 patients (53.8%). Clinical stabilization was achieved in 12/13 patients (92.3%) over a mean follow-up of 21.4 ± 20.3 months. Conclusions: Severe DAOSD may be underrecognized, as mild early symptoms can delay referral and allow progression to advanced, vision-threatening complications. Preexisting ocular surface disease identifies a high-risk subgroup. Early ophthalmologic evaluation and timely referral are essential to prevent irreversible ocular surface damage and vision loss.

Vision impairment affects at least 2.2 billion people worldwide, with the burden disproportionately concentrated in low- and middle-income countries (LMICs), where eye care infrastructure remains inadequate and digital health adoption is severely limited. Electronic medical record (EMR) systems designed for ophthalmology are predominantly cloud-dependent, costly, and optimized for large institutional deployments, leaving single-physician practices in resource-constrained settings without viable digital record-keeping solutions. We present a proprietary offline EMR system developed using Claris FileMaker Pro and deployed in a single-physician ophthalmology practice in a small city in Punjab, Pakistan, since 2016. The system is organized around a central HOME page connected to five clinical layouts, underpinned by a relational database schema enabling multi-parameter information retrieval. Key design features include a fully offline, internet-independent architecture; ophthalmology-specific structured data fields covering biometry, keratometry, and OCT reporting; an automated intraocular lens (IOL) inventory subsystem with bidirectional serial number traceability; multi-field patient search; one-click branded prescription and receipt generation; and a dual-file design separating text-based clinical records from an externally linked diagnostic scan repository. Over approximately ten years of continuous deployment the system has accumulated 68,665 patient records and 140,730 clinical encounters, including 133,767 outpatient consultations and 3382 surgical records. Direct evaluation of the deployed database demonstrated indexed query latency of 1 to 17 ms across patient, cohort and device-traceability retrieval classes, complete referential integrity across all encounter records, and structured-field retrieval recall equal or superior to free-text retrieval in all comparisons performed. This paper presents the system architecture, module design, and information retrieval principles as a proof-of-concept model for similar practices, together with an empirical evaluation of its retrieval performance and data quality.

Background: Observational studies examining the relationship between serum lipids and primary open-angle glaucoma (POAG) have yielded inconsistent findings, limiting causal inference. Mendelian randomization (MR) offers a robust approach to evaluate causality by leveraging genetic variants as proxies for modifiable exposures, thereby minimizing confounding and reverse causation. Methods: A two-sample MR study was conducted using GWAS summary statistics for 179 circulating lipid traits (GCST90277238–GCST90277416) as exposures and POAG cases from the FinnGen consortium (Release R12, endpoint H7_GLAUCOMA_POAG) as the outcome. Genetic variants were selected as instrumental variables at p < 1 × 10⁻⁵ and clumped for linkage disequilibrium (R² < 0.001). The inverse variance weighted (IVW) method was the primary analysis. Multiple testing was addressed using both Bonferroni and false discovery rate (FDR) correction. Instrument strength was assessed via F-statistics for all 179 traits. Sensitivity analyses included MR-Egger regression, weighted median, weighted mode, MR-PRESSO, Cochran’s Q, and leave-one-out analysis. Results: Of 179 lipid traits analyzed, one, phosphatidylcholine (16:0/18:1), demonstrated a statistically significant protective association with POAG after FDR correction (β = −0.22, SE = 0.06, OR = 0.80, 95% CI: 0.71–0.90; p = 1.77 × 10⁻⁴, FDR q = 0.032). No other lipid trait survived multiple testing correction. Sensitivity analyses showed no evidence of horizontal pleiotropy or significant heterogeneity. Conclusions: This study provides genetic evidence for a protective association between phosphatidylcholine (16:0/18:1) and POAG risk; however, conditional analyses indicate this association is not fully independent of genetically correlated lipid species, and species-level specificity remains to be formally established. Phosphatidylcholine (16:0/18:1) warrants further investigation as a potential causal factor in glaucoma pathogenesis.

Vaccine-associated anterior uveitis (VAAU) is an uncommon ocular inflammatory phenotype reported after several vaccine platforms. It describes anterior segment inflammation occurring after vaccination when infectious, autoimmune, idiopathic, medication-related, and other possible causes have been reasonably excluded. The current literature indicates that post-vaccination uveitis is rare relative to the scale of immunization, although anterior uveitis is frequently reported among post-vaccination ocular inflammatory events. Evidence remains limited by reliance on case reports, case series, retrospective cohorts, and passive surveillance data, which restricts precise incidence estimation and causal interpretation. Accordingly, the available evidence primarily supports a temporal association rather than a confirmed causal relationship. Proposed mechanisms include innate immune activation, molecular mimicry, adjuvant- or formulation-related immune stimulation, bystander activation, delayed-type hypersensitivity, and host susceptibility related to prior uveitis, autoimmune disease, immune dysregulation, or genetic predisposition. Clinically, VAAU may present with redness, pain, photophobia, blurred vision, anterior chamber cells and flare, keratic precipitates, posterior synechiae, elevated intraocular pressure, vitritis, or cystoid macular edema. Most cases described in the literature are mild to moderate and improve with topical corticosteroids and cycloplegic therapy, whereas recurrent, severe, or treatment-intensive courses have been reported mainly in predisposed individuals. Future work should emphasize active surveillance, standardized phenotype-specific reporting, harmonized case definitions, and mechanistic studies to better define risk, recurrence patterns, and causality. Careful interpretation of suspected cases can support accurate diagnosis, patient counseling, and vaccine-safety monitoring without undermining clinically indicated immunization.