Antonio Ballesteros-Sánchez

Objectives: This study aimed to evaluate the short-term effect of a prostaglandin analog–based eyelash serum on the ocular surface. Methods: A prospective interventional study was conducted on 19 healthy women. Participants applied an eyelash serum containing dechloro dihydroxy difluoro ethylcloprostenolamide once daily to the upper eyelid margin for 6 weeks. Tear film parameters, meibomian glands analysis, and ocular surface inflammation and damage were assessed at baseline and posttreatment using the S390L slit lamp (Firefly WDR, MediWorks, Shanghai, China). Results: A significant reduction in tear film stability was observed, with decreases of 3.92±7.45 sec in first noninvasive break-up time ( P =0.003) and 3.97±6.25 sec in average noninvasive break-up time ( P P =0.049) and 0.27±0.66 mm ² in tear meniscus area ( P =0.019). Ocular hyperemia increased, with temporal ciliary hyperemia rising by 1.68±3.45% ( P =0.006) and temporal conjunctival hyperemia by 2.41±4.14% ( P =0.001). No statistically significant changes were observed in meibomian gland morphology or ocular surface staining. Conclusions: Daily application of the prostaglandin analog–based eyelash serum induced tear film instability, reduced tear volume, and increased ocular hyperemia. These findings suggest that even short-term use may disrupt ocular surface homeostasis and cause mild inflammation. Further studies with longer follow-up are needed to assess its safety profile on the ocular surface.

Purpose: To evaluate long-term clinical outcomes after intracorneal ring segment implantation (ICRS) followed by epithelium-off (epi-off) accelerated crosslinking (A-CXL) in pediatric keratoconus (KC). Setting: Centro de Ojos Quilmes, Buenos Aires, Argentina. Design: Longitudinal retrospective study. Methods: 73 eyes from patients with pediatric KC were included. Outcome measures included uncorrected (UDVA) and corrected distance visual acuity (CDVA), spherical refraction, spherical equivalent (SE), mean keratometry (K _m ) with the flattest and steepest (K ₂ ) corneal curvatures, and both refractive and corneal astigmatism. Changes from preoperative were assessed at 12 months, 36 months, 60 months, and 84 months. Astigmatism vector analysis was performed using double-angle plots, reporting centroids and mean absolute values. Results: Throughout the follow-up period, significant improvements were observed in visual and keratometric outcomes compared with preoperative values. At 60 months, UDVA and CDVA improved by 0.29 logMAR ( P < .0001; 95% CI, 0.13-0.45) and 0.15 logMAR ( P < .0001; 95% CI, 0.05-0.27), respectively. K _m decreased by 2.74 diopters (D) at 60 months ( P = .022; 95% CI, 0.24-5.24), whereas K ₂ decreased by 4.01 D at 84 months ( P = .003; 95% CI, 0.96-7.05). Changes in centroids and mean absolute values for both corneal and refractive astigmatism also remained significant during the follow-up. Conclusions: ICRS combined with epi-off A-CXL represents an effective treatment for pediatric KC, providing sustained improvements in visual acuity, keratometry, and both refractive and corneal astigmatism over the follow-up period. These findings support its role as a comprehensive therapeutic approach to halt long-term disease progression and enhance visual function.

Purpose: To analyse the efficacy and safety of eyelid warming therapies in the management of contact lens-related dry eye (CLDE) and their impact on comfortable contact lens (CL) wearing time. Methods: A systematic review with meta-analysis, reporting on the efficacy and/or safety of eyelid warming therapies for CLDE and/or comfortable CL wearing time in three databases, PubMed, Scopus and Web of Science, was performed according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Results: Four randomised controlled trials were included. Analyses revealed significant differences only between eyelid warming therapies and negative controls for ocular surface disease index scores (mean difference (MD): 19.57; 95% CI: 12.51–26.64; I ² = 0%; p < 0.001), with LipiFlow ® and warm compresses showing comparable results ( p = 0.53 ) . Warm compresses did not achieve significant improvements in tear film break-up time (MD: 0.80; 95% CI: −0.29 to 1.88; I ² = 0%; p = 0.15), lipid layer thickness (MD: 4.54; 95% CI: −5.73 to 14.81; I ² = 0%; p = 0.39) or comfortable CL wearing time (MD: −0.06; 95% CI: −1.19 to 1.06; I ² = 0%; p = 0.91) when compared with positive controls, nor in the Schirmer test when compared with negative/positive controls (MD: −0.46; 95% CI: −4.17 to 3.25; I ² = 24%; p = 0.81). Regarding safety, most studies reported no adverse events and demonstrated a satisfactory tolerability profile for eyelid warming therapies. However, a meta-analysis could not be performed. Conclusions: The efficacy of eyelid warming therapies for alleviating CLDE and improving comfortable CL wearing time is limited. Further randomised controlled trials following the consolidated standards of reporting trials (CONSORT) guidelines are needed to confirm these findings.

Introduction This study aimed to analyze the influence of refractive status, residential climate, and exposure to adverse environmental factors in contact lens (CL) dropout. Methods This cross-sectional study involved a face-to-face survey conducted by trained optometrists among former and current CL wearers (CLWs) at General Óptica centers throughout Spain. The survey included questions related to demographic characteristics, refractive status, residential climate, and adverse environmental factors. The chi-square test and a forward stepwise binary logistic regression analysis were performed. Results A total of 1094 surveys were included, comprising 509 former CLWs and 585 current CLWs. Age (B = 0.03; OR 1.03, 95% CI 1.02–1.04) and exposure to chemical (B = 3.51; OR 41.67, 95% CI 12.06–143.95) or dusty environments (B = 1.05; OR 2.93, 95% CI 1.16–7.41) were significantly associated with CL dropout. However, residing in a continental climate was associated with a lower CL dropout compared with a Mediterranean climate (B = − 1.39; OR 0.25, 95% CI 0.15–0.42). Spherical refraction, cylindrical refraction, and near addition power did not show statistically significant associations with CL dropout. Furthermore, the model excluded sex, exposure to high-humidity or dry environments, and the interactions between adverse environmental factors and residential climate as predictive factors. Conclusions Older age, residence in the Mediterranean climate, and exposure to chemical or dusty environments increase the risk of contact lens dropout. However, climate-specific conditions do not appear to significantly influence dropout rates, suggesting that other factors may play a more important role.

Introduction To compare the safety of 0.05% and 0.1% water-free cyclosporine formulation (CyclASol) with vehicle and 0.05% cyclosporine (CsA) in patients with dry eye disease (DED). Methods A systematic review with meta-analysis, reporting on the safety of CyclASol in patients with DED in three databases (PubMed, Scopus, and Web of Science until 4 April 2025), was performed according to the PRISMA statement. Results Four randomized controlled trials (RCTs) were included, encompassing 1575 eyes from 1575 patients. The meta-analysis revealed no significant difference in the likelihood of experiencing treatment-emergent adverse events (TEAEs) between CyclASol and control groups (risk ratio [RR]: 0.98; 95% confidence interval [CI] 0.85–1.12; P = 0.72; I² = 43%) (rate CyclASol: 30.3% [240 eyes]; rate controls: 30.9% [243 eyes]; rate difference: –0.6%). Similar results were observed for ocular TEAEs (RR: 1.00; 95% CI 0.78–1.30; P = 0.97; I² = 0%) (rate CyclASol: 3.6% [95 eyes]; rate controls: 3.7% [93 eyes]; rate difference: –0.1%). Regarding sensitivity analyses, no significant difference in the likelihood of TEAEs was observed between CyclASol and vehicle groups (RR: 1.02; 95% CI 0.88–1.18; P = 0.83; I² = 44%) (rate CyclASol: 32.5% [240 eyes]; rate vehicle: 30.3% [222 eyes]; rate difference: 2.2%). Comparable results were found for ocular TEAEs (RR: 1.07; 95% CI 0.81–1.41; P = 0.65; I² = 0%) (rate CyclASol: 4.1% [95 eyes]; rate vehicle: 3.6% [85 eyes]; rate difference: 0.5%). Similarly, no statistically significant differences in TEAEs were observed when comparing CyclASol with 0.05% CsA (RR: 0.74; 95% CI 0.51–1.09; P = 0.13; I² = 5%) (rate CyclASol: 29.4% [30 eyes]; rate CsA: 39.6% [21 eyes]; rate difference: –10.2%). Ocular TEAEs also remained comparable between groups (RR: 0.67; 95% CI 0.32–1.41; P = 0.29; I² = 0%) (rate CyclASol: 2.8% [10 eyes]; rate CsA: 3.7% [8 eyes]; rate difference: –0.9%). Conclusions Based on the data presented in the meta-analysis, CyclASol is a safe treatment for patients with DED. However, the comparable likelihood of experiencing TEAEs and ocular TEAEs between CyclASol and 0.05% CsA suggests that there is not sufficient evidence to indicate a superior safety profile of CyclASol over commercially available CsA.

To compare the efficacy of punctal occlusion and artificial tears combined with lid hygiene in the treatment of dry anophthalmic socket syndrome (DASS). A prospective, randomized, parallel group-controlled trial enrolled 40 patients with DASS. Patients were randomized to receive punctal occlusion (group A) or artificial tears and eyelid wipes (group B). Standard Patient Evaluation of Eye Dryness (SPEED) score, tear meniscus height (TMH) and Schirmer I test (ST) were assessed at baseline visit and follow-up visit at 3 months. At the 3-month evaluation, mean SPEED, TMH and ST showed significant improvement from baseline in group A (p < .001 for all comparisons) and group B (p < .001 for all comparisons). Comparing both groups, the results were in favor punctal occlusion group in TMH (p = .012), and ST (p = .005). No statistically significant differences were found comparing SPEED score between both groups (p = .055). Both punctal occlusion and the combination of lubricant artificial tears with eyelid wipes may help in the treatment of DASS.

Introduction This study aimed to investigate the efficacy and safety of quantum molecular resonance (QMR) electrotherapy in patients with dry eye disease (DED). Methods A systematic review with meta-analysis, reporting the effects of QMR electrotherapy in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement with a search period ending on December 24, 2024. Results Seven studies, including four open-label, non-comparative trials and three randomized controlled studies (RCTs), were included. Although all studies reported significant improvements in most outcome measures after QMR electrotherapy, the meta-analysis indicated that overall efficacy did not significantly favor either group when comparing QMR electrotherapy to controls (SMD 0.40; 95% CI − 0.06 to 0.86; P = 0.09; I² = 85%). However, only the change in DED symptoms was significantly favorable for QMR electrotherapy compared to controls (SMD 0.69; 95% CI 0.30–1.08; P = 0.0005; I² = 28%). In sensitivity analyses, overall efficacy remained non-significant when comparing QMR electrotherapy to placebo QMR electrotherapy (SMD 0.14; 95% CI − 0.24 to 0.52; P = 0.46; I² = 65%). Additionally, changes in DED symptoms, TBUT, ST, and CFS also showed no statistically significant differences between both groups. Regarding safety, most studies reported no AEs, with a satisfactory tolerability profile for QMR electrotherapy. However, a meta-analysis could not be performed. Conclusions With the current scientific literature available to date, QMR electrotherapy seems to show some evidence of alleviating DED symptoms. However, evidence supporting its efficacy in improving DED signs and safety remains limited. Therefore, further RCTs with robust designs are needed to confirm these findings.