{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:08:32Z","timestamp":1793214512923,"version":"4.5.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"King Saud University through Vice Deanship of Research Chair, Dr. Nasser Al-Rashid Research Chair in Ophthalmology"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Ophthal Inflamm Infect"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>To investigate the safety and efficacy of rituximab in patients with refractory noninfectious uveitis and scleritis.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A retrospective review of 24 patients (47 eyes) treated with rituximab for refractory noninfectious uveitis and scleritis in the period between January 2018 and December 2024. The diagnosis of these patients included chronic recurrent uveitis associated with Vogt-Koyanagi-Harada disease (<jats:italic>n<\/jats:italic>\u2009=\u200916), idiopathic granulomatous uveitis (<jats:italic>n<\/jats:italic>\u2009=\u20093), multiple sclerosis-associated uveitis (<jats:italic>n<\/jats:italic>\u2009=\u20092), progressive subretinal fibrosis (<jats:italic>n<\/jats:italic>\u2009=\u20091) and scleritis (<jats:italic>n<\/jats:italic>\u2009=\u20092). The primary outcomes were disease quiescence and improvement in best-corrected visual acuity (BCVA). Secondary outcomes included reduction in corticosteroid and immunosuppressive therapy and adverse events.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Rituximab was successful in inducing and maintaining disease quiescence and significantly improved visual acuity in patients presenting with uveitis and scleritis. After starting rituximab therapy, BCVA improved at 1 year from 0.93\u2009\u00b1\u20090.67 logMAR (Snellen: 20\/160) to 0.63\u2009\u00b1\u20090.83 logMAR (Snellen: 20\/80) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Follow-up period ranged from 12 to 80 months (mean 41\u2009\u00b1\u2009SD 20.5). At the last follow-up, BCVA continued to improve to 0.46\u2009\u00b1\u20090.73 logMAR (Snellen: 20\/60) (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Nine of twenty-four patients (37.5%) required more than 3 rituximab doses for disease control. Rituximab successfully reduced corticosteroid use, allowing 87.5% (21\/24) of patients to discontinue steroids completely, with the remaining needing\u2009\u2264\u20097.5\u00a0mg\/day. Mycophenolate mofetil dosage significantly decreased from a mean of 1840\u2009\u00b1\u2009SD 323\u00a0mg to 1045\u2009\u00b1\u2009SD 688\u00a0mg daily (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), with two patients discontinuing all medications. All patients were flare-free at last follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Rituximab is an effective and safe treatment for refractory noninfectious uveitis and scleritis. It offers significant visual improvement, disease quiescence which potentially reduces reliance on corticosteroids and immunomodulatory therapy.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12348-025-00522-5","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:43:27Z","timestamp":1758883407000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Safety and efficacy of rituximab in refractory noninfectious uveitis and scleritis"],"prefix":"10.1186","volume":"15","author":[{"given":"Faris M.","family":"Al Ghulaiga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Alharbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman F.","family":"Albloushi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulsalam M.","family":"Dheyab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan A.","family":"Abouammoh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Abu El-Asrar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"issue":"4","key":"522_CR1","doi-asserted-by":"publisher","first-page":"502","DOI":"10.1001\/archopht.1962.00960030506014","volume":"68","author":"RW Darrell","year":"1962","unstructured":"Darrell RW, Wagenner HP, Kurland LT (1962) Epidemiology of uveitis: incidence and prevalence in a small urban community. Arch Ophthalmol 68(4):502\u2013514","journal-title":"Arch Ophthalmol"},{"issue":"3","key":"522_CR2","doi-asserted-by":"publisher","first-page":"173","DOI":"10.4103\/0301-4738.31936","volume":"55","author":"SR Rathinam","year":"2007","unstructured":"Rathinam SR, Namperumalsamy P (2007) Global variation and pattern changes in epidemiology of uveitis. Indian J Ophthalmol 55(3):173\u2013183","journal-title":"Indian J Ophthalmol"},{"issue":"3","key":"522_CR3","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1016\/j.ophtha.2015.10.028","volume":"123","author":"AD Dick","year":"2016","unstructured":"Dick AD, Tundia N, Sorg R, Zhao C, Chao J, Joshi A et al (2016) Risk of ocular complications in patients with noninfectious intermediate uveitis, posterior uveitis, or panuveitis. Ophthalmology 123(3):655\u2013662","journal-title":"Ophthalmology"},{"issue":"1","key":"522_CR4","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1111\/aos.13189","volume":"95","author":"AM Abu El\u2010Asrar","year":"2017","unstructured":"Abu El\u2010Asrar AM, Dosari M, Hemachandran S, Gikandi PW, Al\u2010Muammar A (2017) Mycophenolate mofetil combined with systemic corticosteroids prevents progression to chronic recurrent inflammation and development of \u2018sunset glow fundus\u2019 in initial\u2010onset acute uveitis associated with Vogt\u2013Koyanagi\u2013Harada disease. Acta Ophthalmol 95(1):85\u201390","journal-title":"Acta Ophthalmol"},{"issue":"8","key":"522_CR5","doi-asserted-by":"publisher","first-page":"e603","DOI":"10.1111\/j.1755-3768.2012.02498.x","volume":"90","author":"AM Abu El\u2010Asrar","year":"2012","unstructured":"Abu El\u2010Asrar AM, Hemachandran S, Al\u2010Mezaine HS, Kangave D, Al\u2010Muammar AM (2012) The outcomes of mycophenolate mofetil therapy combined with systemic corticosteroids in acute uveitis associated with Vogt\u2013Koyanagi\u2013Harada disease. Acta Ophthalmol 90(8):e603\u2013e608","journal-title":"Acta Ophthalmol"},{"issue":"5","key":"522_CR6","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1016\/j.it.2020.03.004","volume":"41","author":"G Opdenakker","year":"2020","unstructured":"Opdenakker G, Abu El-Asrar A, Van Damme J (2020) Remnant epitopes generating autoimmunity: from model to useful paradigm. Trends Immunol 41(5):367\u2013378","journal-title":"Trends Immunol"},{"issue":"5","key":"522_CR7","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1136\/annrheumdis-2012-203130","volume":"73","author":"JAB Van Nies","year":"2014","unstructured":"Van Nies JAB, Krabben A, Schoones JW, Huizinga TWJ, Kloppenburg M, Van Helm-Van Mil D AHM (2014) What is the evidence for the presence of a therapeutic window of opportunity in rheumatoid arthritis? A systematic literature review. Ann Rheum Dis 73(5):861\u2013870","journal-title":"Ann Rheum Dis"},{"issue":"6","key":"522_CR8","doi-asserted-by":"publisher","first-page":"864","DOI":"10.1002\/art.22353","volume":"55","author":"A Finckh","year":"2006","unstructured":"Finckh A, Liang MH, van Herckenrode CM, De Pablo P (2006) Long-term impact of early treatment on radiographic progression in rheumatoid arthritis: a meta\u2010analysis. Arthritis Care Res 55(6):864\u2013872","journal-title":"Arthritis Care Res"},{"issue":"2","key":"522_CR9","doi-asserted-by":"publisher","first-page":"e236","DOI":"10.1111\/aos.15254","volume":"101","author":"AM Abu El-Asrar","year":"2023","unstructured":"Abu El-Asrar AM, Rashed FA, Al, AlBloushi AF, Tobaigy MF, Gikandi PW Jr CPH, et al (2023) Therapeutic window of opportunity in the acute uveitic phase of Vogt\u2013Koyanagi\u2013Harada disease: prevention of late autoimmune complications by early intervention. Acta Ophthalmol 101(2):e236\u2013e245","journal-title":"Acta Ophthalmol"},{"issue":"6","key":"522_CR10","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1111\/aos.12127","volume":"91","author":"AM Abu El-Asrar","year":"2013","unstructured":"Abu El-Asrar AM, Al Tamimi M, Hemachandran S, Al-Mezaine HS, Al-Muammar A, Kangave D (2013) Prognostic factors for clinical outcomes in patients with Vogt-Koyanagi-Harada disease treated with high-dose corticosteroids. Acta Ophthalmol 91(6):486\u2013493","journal-title":"Acta Ophthalmol"},{"issue":"2","key":"522_CR11","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1136\/bjo.2007.128967","volume":"92","author":"W Fang","year":"2008","unstructured":"Fang W, Zhou H, Yang P, Huang X, Wang L, Kijlstra A (2008) Longitudinal quantification of aqueous flare and cells in Vogt-Koyanagi-Harada disease. Br J Ophthalmol 92(2):182\u2013185","journal-title":"Br J Ophthalmol"},{"issue":"sup1","key":"522_CR12","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3109\/02713689008999417","volume":"9","author":"H Inomata","year":"1990","unstructured":"Inomata H, Sakamoto T (1990) Immunohistochemical studies of Vogt-Koyanagi-Harada disease with sunset sky fundus. Curr Eye Res 9(sup1):35\u201340","journal-title":"Curr Eye Res"},{"issue":"6","key":"522_CR13","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1016\/0002-9394(88)90052-9","volume":"105","author":"CC Chan","year":"1988","unstructured":"Chan CC, Palestine AG, Kuwabara T, Nussenblatt RB (1988) Immunopathologic study of Vogt-Koyanagi-Harada syndrome. Am J Ophthalmol 105(6):607\u2013611","journal-title":"Am J Ophthalmol"},{"issue":"5","key":"522_CR14","doi-asserted-by":"publisher","first-page":"649","DOI":"10.1038\/sj.eye.6702342","volume":"21","author":"AM Abu El-Asrar","year":"2007","unstructured":"Abu El-Asrar AM, Struyf S, Van den Broeck C, Van Damme J, Opdenakker G, Geboes K et al (2007) Expression of chemokines and gelatinase B in sympathetic ophthalmia. Eye 21(5):649\u2013657","journal-title":"Eye"},{"issue":"3","key":"522_CR15","doi-asserted-by":"publisher","first-page":"255","DOI":"10.3109\/09273949309085026","volume":"1","author":"DN Shah","year":"1993","unstructured":"Shah DN, Piacentini MA, Burnier MN, McLean IW, Nussenblatt RB, Chan CC (1993) Inflammatory cellular kinetics in sympathetic ophthalmia a study of 29 traumatized (exciting) eyes. Ocul Immunol Inflamm 1(3):255\u2013262","journal-title":"Ocul Immunol Inflamm"},{"issue":"8","key":"522_CR16","doi-asserted-by":"publisher","first-page":"1696","DOI":"10.1097\/IAE.0000000000000506","volume":"35","author":"HA Aziz","year":"2015","unstructured":"Aziz HA, Flynn HW Jr, Young RC, Davis JL, Dubovy SR (2015) Sympathetic ophthalmia: clinicopathologic correlation in a consecutive case series. Retina 35(8):1696\u20131703","journal-title":"Retina"},{"issue":"6","key":"522_CR17","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/archopht.116.6.801","volume":"116","author":"AAS Dunlop","year":"1998","unstructured":"Dunlop AAS, Cree IA, Hague S, Luthert PJ, Lightman S (1998) Multifocal choroiditis: clinicopathologic correlation. Arch Ophthalmol 116(6):801\u2013803","journal-title":"Arch Ophthalmol"},{"issue":"3","key":"522_CR18","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.ajo.2004.04.013","volume":"138","author":"WK Lim","year":"2004","unstructured":"Lim WK, Chee SP, Sng I, Nussenblatt RB, Chan CC (2004) Immunopathology of progressive subretinal fibrosis: a variant of sympathetic ophthalmia. Am J Ophthalmol 138(3):475\u2013477","journal-title":"Am J Ophthalmol"},{"issue":"11","key":"522_CR19","doi-asserted-by":"publisher","first-page":"4606","DOI":"10.1167\/iovs.16-19758","volume":"57","author":"AM Abu El-Asrar","year":"2016","unstructured":"Abu El-Asrar AM, Berghmans N, Al-Obeidan SA, Mousa A, Opdenakker G, Van Damme J et al (2016) The cytokine interleukin-6 and the chemokines CCL20 and CXCL13 are novel biomarkers of specific endogenous uveitic entities. Invest Ophthalmol Vis Sci 57(11):4606\u20134613","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"6","key":"522_CR20","doi-asserted-by":"publisher","first-page":"2222","DOI":"10.1167\/iovs.17-23225","volume":"59","author":"AM Abu El-Asrar","year":"2018","unstructured":"Abu El-Asrar AM, Berghmans N, Al-Obeidan SA, Gikandi PW, Opdenakker G, Van Damme J et al (2018) Differential CXC and CX3C chemokine expression profiles in aqueous humor of patients with specific endogenous uveitic entities. Invest Ophthalmol Vis Sci 59(6):2222\u20132228","journal-title":"Invest Ophthalmol Vis Sci"},{"issue":"3","key":"522_CR21","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1080\/09273948.2019.1604974","volume":"28","author":"AM Abu El-Asrar","year":"2020","unstructured":"Abu El-Asrar AM, Berghmans N, Al-Obeidan SA, Gikandi PW, Opdenakker G, Van Damme J et al (2020) Local cytokine expression profiling in patients with specific autoimmune uveitic entities. Ocul Immunol Inflamm 28(3):453\u2013462","journal-title":"Ocul Immunol Inflamm"},{"key":"522_CR22","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.coi.2016.09.003","volume":"43","author":"SE Franks","year":"2015","unstructured":"Franks SE, Getahun A, Hogarth PM, Cambier JC (2015) Targeting B cells in treatment of autoimmunity. Curr Opin Immunol 43:39\u201345","journal-title":"Curr Opin Immunol"},{"key":"522_CR23","doi-asserted-by":"publisher","first-page":"835","DOI":"10.3389\/fimmu.2018.00835","volume":"9","author":"K Hofmann","year":"2018","unstructured":"Hofmann K, Clauder AK, Manz RA (2018) Targeting B cells and plasma cells in autoimmune diseases. Front Immunol 9:835","journal-title":"Front Immunol"},{"key":"522_CR24","doi-asserted-by":"publisher","first-page":"622","DOI":"10.3389\/fimmu.2018.00622","volume":"9","author":"P Musette","year":"2018","unstructured":"Musette P, Bouaziz JD (2018) B cell modulation strategies in autoimmune diseases: new concepts. Front Immunol 9:622","journal-title":"Front Immunol"},{"key":"522_CR25","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1016\/j.coi.2016.09.003","volume":"43","author":"SE Franks","year":"2016","unstructured":"Franks SE, Getahun A, Hogarth PM, Cambier JC (2016) Targeting B cells in treatment of autoimmunity. Curr Opin Immunol 43:39\u201345","journal-title":"Curr Opin Immunol"},{"issue":"6","key":"522_CR26","doi-asserted-by":"publisher","first-page":"782","DOI":"10.1136\/bjophthalmol-2015-306790","volume":"100","author":"E Miserocchi","year":"2016","unstructured":"Miserocchi E, Modorati G, Berchicci L, Pontikaki I, Meroni P, Gerloni V (2016) Long-term treatment with rituximab in severe juvenile idiopathic arthritis-associated uveitis. Br J Ophthalmol 100(6):782\u2013786","journal-title":"Br J Ophthalmol"},{"issue":"8","key":"522_CR27","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1093\/rheumatology\/ker107","volume":"50","author":"A Heiligenhaus","year":"2011","unstructured":"Heiligenhaus A, Miserocchi E, Heinz C, Gerloni V, Kotaniemi K (2011) Treatment of severe uveitis associated with juvenile idiopathic arthritis with anti-CD20 monoclonal antibody (rituximab). Rheumatology 50(8):1390\u20131394","journal-title":"Rheumatology"},{"issue":"2","key":"522_CR28","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1097\/IAE.0000000000001563","volume":"38","author":"AF Lasave","year":"2018","unstructured":"Lasave AF, You C, Ma L, Abusamra K, Lamba N, Navarro MV et al (2018) Long-term outcomes of rituximab therapy in patients with noninfectious posterior uveitis refractory to conventional immunosuppressive therapy. Retina 38(2):395\u2013402","journal-title":"Retina"},{"issue":"8","key":"522_CR29","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1080\/09273948.2017.1327602","volume":"26","author":"C You","year":"2018","unstructured":"You C, Ma L, Lasave AF, Foster CS (2018) Rituximab induction and maintenance treatment in patients with scleritis and granulomatosis with polyangiitis (Wegener\u2019s). Ocul Immunol Inflamm 26(8):1166\u20131173","journal-title":"Ocul Immunol Inflamm"},{"key":"522_CR30","doi-asserted-by":"publisher","first-page":"177","DOI":"10.1007\/s12348-011-0027-9","volume":"1","author":"R Dolz-Marco","year":"2011","unstructured":"Dolz-Marco R, Gallego-Pinazo R, D\u00edaz-Llopis M (2011) Rituximab in refractory Vogt-Koyanagi-Harada disease. J Ophthalmic Inflamm Infect 1:177\u2013180","journal-title":"J Ophthalmic Inflamm Infect"},{"issue":"1","key":"522_CR31","doi-asserted-by":"publisher","first-page":"197","DOI":"10.3109\/14397595.2015.1071234","volume":"28","author":"RMR Umran","year":"2018","unstructured":"Umran RMR, Shukur ZYH (2018) Rituximab for sight-threatening refractory pediatric Vogt\u2013Koyanagi\u2013Harada disease. Mod Rheumatol 28(1):197\u2013199","journal-title":"Mod Rheumatol"},{"issue":"6","key":"522_CR32","doi-asserted-by":"publisher","first-page":"1303","DOI":"10.1080\/09273948.2021.1880604","volume":"30","author":"E Bolletta","year":"2022","unstructured":"Bolletta E, Gozzi F, Mastrofilippo V, Pipitone N, Simone L, De, Croci S et al (2022) Efficacy of rituximab treatment in Vogt-Koyanagi-Harada disease poorly controlled by traditional immunosuppressive treatment. Ocul Immunol Inflamm 30(6):1303\u20131308","journal-title":"Ocul Immunol Inflamm"},{"issue":"3","key":"522_CR33","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1080\/09273948.2020.1820531","volume":"30","author":"AM Abu El-Asrar","year":"2022","unstructured":"Abu El-Asrar AM, Dheyab A, Khatib D, Struyf S, Van Damme J, Opdenakker G (2022) Efficacy of B cell depletion therapy with rituximab in refractory chronic recurrent uveitis associated with Vogt-Koyanagi-Harada disease. Ocul Immunol Inflamm 30(3):750\u2013757","journal-title":"Ocul Immunol Inflamm"},{"key":"522_CR34","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.705796","volume":"8","author":"AM Abu El-Asrar","year":"2021","unstructured":"Abu El-Asrar AM, Van Damme J, Struyf S, Opdenakker G (2021) New perspectives on the immunopathogenesis and treatment of uveitis associated with Vogt-Koyanagi-Harada disease. Front Med 8:705796","journal-title":"Front Med"},{"key":"522_CR35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/ar1739","volume":"7","author":"A Mohrbacher","year":"2005","unstructured":"Mohrbacher A (2005) B cell non-Hodgkin\u2019s lymphoma: rituximab safety experience. Arthritis Res Ther 7:1\u20137","journal-title":"Arthritis Res Ther"},{"key":"522_CR36","doi-asserted-by":"crossref","unstructured":"Khraishi M Comparative overview of safety of the biologics in rheumatoid arthritis. J RheumatolSuppl . 2009;82:25\u201332.","DOI":"10.3899\/jrheum.090128"},{"issue":"10","key":"522_CR37","doi-asserted-by":"publisher","first-page":"1761","DOI":"10.3899\/jrheum.150051","volume":"42","author":"RF van Vollenhoven","year":"2015","unstructured":"van Vollenhoven RF, Fleischmann RM, Furst DE, Lacey S, Lehane PB (2015) Longterm safety of rituximab: final report of the rheumatoid arthritis global clinical trial program over 11 years. J Rheumatol 42(10):1761\u20131766","journal-title":"J Rheumatol"}],"container-title":["Journal of Ophthalmic Inflammation and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-025-00522-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12348-025-00522-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12348-025-00522-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:43:28Z","timestamp":1758883408000},"score":1,"resource":{"primary":{"URL":"https:\/\/joii-journal.springeropen.com\/articles\/10.1186\/s12348-025-00522-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["522"],"URL":"https:\/\/doi.org\/10.1186\/s12348-025-00522-5","relation":{},"ISSN":["1869-5760"],"issn-type":[{"value":"1869-5760","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]},"assertion":[{"value":"28 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 September 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in adherence with the tenets of the Declaration of Helsinki for research involving human subjects. All study subjects or legal guardians in the case of patients under 16 years old signed an informed consent for treatment. The study was evaluated by the Institutional Review Board of King Abdulaziz University Hospital. Due to the retrospective nature of the study, ethical approval was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"An informed consent was obtained from the patients or legal guardians in the case of patients under 16 years old for the anonymous use and publication of data and images.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"70"}}