Category: 3. Business

Fifty-two-week data show that efficacy was maintained in patients with rheumatoid arthritis (RA) when switching from reference tocilizumab (Actemra; Genentech) to tocilizumab-anoh (Avtozma, CT-P47; Celltrion, Inc.), a biosimilar. Additionally, the data—which were published by study investigators in Clinical Drug Investigation—also demonstrated comparable pharmacokinetics, safety, and immunogenicity between the biosimilar and its reference product.¹

About the Trial

Trial Name: A Study to Compare Efficacy and Safety of CT-P47 and RoActemra in Patients With Rheumatoid Arthritis

ClinicalTrials.gov ID: NCT05489224

Sponsor: Celltrion

Completion Date: November 23, 2023

Tocilizumab is a biologic medication that is FDA-approved to treat adults with moderate to severe RA, giant cell arteritis, interstitial lung disease–complicated systemic sclerosis, juvenile idiopathic arthritis, and other inflammatory-based symptoms. The treatment is administered either as a subcutaneous injection or an intravenous (IV) infusion. When administered as an injection, it can be given every week or every other week either in the abdomen or thigh, whereas the IV infusion is given once every 4 weeks. The American College of Rheumatology notes that tocilizumab may be taken alone or with other medications; however, it is not recommended to be used with other biologic medications.²

Because it is a biosimilar, Avtozma is highly similar and does not have any clinically meaningful differences in efficacy, safety, pharmacokinetics, and immunogenicity compared with its reference product. It is a recombinant humanized monoclonal antibody that acts as an IL-6 receptor antagonist.³ In addition to its previous FDA-approved indications, IV Avtozma was recently approved for the treatment of cytokine release syndrome in both pediatric and adult patients aged 2 years and older.⁴

To further demonstrate IV Avtozma’s efficacy, safety, immunogenicity, and pharmacokinetics in patients with moderate to severe RA, investigators initiated a randomized, double-blind, multicenter, phase 3 clinical trial (NCT05489224).⁵ For this study, 444 patients with RA were randomly assigned to receive Avtozma or Actemra every 4 weeks (8 mg/kg IV) up to week 20. At the 24-week period, patients receiving Avtozma continued maintenance treatment, whereas those on the reference product were randomly assigned again to continue the reference product or switch to its biosimilar as maintenance until week 48 (treatment period 2). Following week 48, patients were followed up until week 52.^1,5

During treatment period 2, 225 patients continued receiving the Avtozma, 109 continued receiving Actemra, and the remaining 110 switched from the reference to the biosimilar. The investigators reported that, during this treatment period, efficacy findings were comparable between the groups. By week 52, the mean changes from baseline in Disease Activity Score in 28 joints-erythrocyte sedimentation rates (DAS28-ESR; the primary end point) were about –4.279, –4.231, and –4.376 in the Avtozma maintenance, Actemra maintenance, and Avtozma switched groups, respectively. Notably, joint damage progression over 1 year was minimal in all 3 groups, and drug serum concentrations were considered relatively consistent throughout the duration of treatment period 2. The safety profile and antidrug antibody-positive conversion rate (less than 5% in each group) were also similar.¹

These findings are consistent with previous 32-week findings, which had also shown efficacy equivalence, comparable pharmacokinetics, safety, and immunogenicity profiles between the biosimilar and its reference product. Similar to the 52-week findings, these data also showed high similarities between the 3 groups.⁶

“DAS28-ESR may not be the most appropriate tool for assessing agents that target the IL-6 pathway, given that these therapies can reduce ESR independently of clinical improvement; however, this is not a significant limitation, as tocilizumab was used in all 3 treatment groups in this study,” the study authors wrote. “With respect to the study design limitations during [treatment period 2], the numbers of patients in the [Actemra] maintenance and [Avtozma] switched groups were lower than in the [Avtozma] maintenance group because of the second randomization. [Treatment period 2] of this study was not designed for statistical comparisons of equivalence between the [Avtozma] and [Actemra] maintenance groups and the [Avtozma] switched group; however, the results from [treatment period 2] in this study provide valuable data on switching from a reference product to a biosimilar.”¹

REFERENCES

1. Burmester G, Trefler J, Racewicz, A, et al. Efficacy and Safety of Biosimilar CT-P47 Versus Reference Tocilizumab: 1-Year Results of a Randomised, Active-Controlled, Double-Blind, Phase III Study in Patients with Rheumatoid Arthritis. Clin Drug Investig 45, 551–563 (2025). doi:10.1007/s40261-025-01453-8

2. American College of Rheumatology. Tocilizumab (Actemra). Accessed August 19, 2025. https://rheumatology.org/patients/tocilizumab-actemra

3. Gallagher A. FDA Approves Tocilizumab-Anoh as a Biosimilar to Actemra. Pharmacy Times. January 31, 2025. Accessed August 20, 2025. https://www.pharmacytimes.com/view/fda-approves-tocilizumab-anoh-as-a-biosimilar-to-actemra

4. Ferruggia K. FDA Approves Expanded Indication to Tocilizumab-Anoh IV for CRS. Pharmacy Times. August 6, 2025. August 20, 2025. https://www.pharmacytimes.com/view/fda-approves-expanded-indication-to-tocilizumab-anoh-iv-for-crs

5. A Study to Compare Efficacy and Safety of CT-P47 and RoActemra in Patients With Rheumatoid Arthritis. ClinicalTrials.gov identifier: NCT05489224. Updated October 8, 2024. Accessed August 19, 2025. https://clinicaltrials.gov/study/NCT05489224

6. Smolen JS, Trefler J, Racewicz A, et al. Efficacy and safety of CT-P47 versus reference tocilizumab: 32-week results of a randomised, active-controlled, double-blind, phase III study in patients with rheumatoid arthritis, including 8 weeks of switching data from reference tocilizumab to CT-P47. RMD Open. 2024;10:e004514. doi:10.1136/rmdopen-2024-004514

BBC

Tube workers are to stage a series of strikes next month in a dispute over pay and conditions amid an intensifying dispute with managers.

The Rail, Maritime and Transport union (RMT) said its members would take industrial action for seven days from 5 September amid a dispute over pay and workload, among other things.

In a separate dispute, RMT members on London’s Docklands Light Railway will also be striking in the week beginning 7 September.

London Underground (LU) workers and management have been discussing workers’ demands on pay, fatigue management, shift patterns and a reduced working week. But union leaders have claimed management have refused to engage seriously.

“Our members are doing a fantastic job to keep our capital moving and work strenuous shift patterns to make sure Londoners get to their destinations around the clock,” said the RMT’s general secretary, Eddie Dempsey.

“They are not after a king’s ransom, but fatigue and extreme shift rotations are serious issues impacting on our members’ health and wellbeing – all of which have not been adequately addressed for years by LU management.

“Coupled with the fact there are outstanding issues around staff travel arrangements, an atmosphere of distrust has been created, where our members feel like no one is listening to them.

“RMT will continue to engage LU management with a view to seeking a revised offer in order to reach a negotiated settlement.”

Docklands Light Railway workers have also been in discussions about pay and conditions.

A Transport for London spokesperson said: “We regularly meet with our trade unions to discuss any concerns that they may have, and we recently met with the RMT to discuss some specific points.

“We are committed to ensuring our colleagues are treated fairly and, as well as offering a 3.4% pay increase in our ongoing pay discussions, we have made progress on a number of commitments we have made previously.

“We welcome further engagement with our unions about fatigue and rostering across London Underground, but a reduction in the contractual 35-hour working week is neither practical nor affordable.

“Given the improvements we have recently put in place in response to concerns raised by our unions, we urge the RMT to put our fair, affordable pay offer to their members and to continue to engage with us rather than threaten strike action, which will only disrupt Londoners.”

Originally published by Cognizant

Sydney, Australia, August 21, 2025 – Cognizant (Nasdaq: CTSH) today announced a five-year strategic engagement with Temenos, a global banking technology leader, to develop and market Temenos Country Model Bank in Australia. Temenos Country Model Bank is an extension of its core banking platform designed to accelerate go-live for financial institutions by providing pre-configured, regionalized banking functionality that reduces cost and risk.

Australian financial institutions face increasing regulatory complexities and legacy system inefficiencies that limit agility. By leveraging Temenos’ cloud-native banking solutions and Cognizant’s implementation and market expertise, the Temenos Country Model Bank provides pre-configured frameworks designed to accelerate modernization while reducing costs and operational friction. As the preferred upgrade partner for Australia, Cognizant aims to further develop the regionalized functionality of the Country Model Bank, tailoring the core banking platform to meet the needs of Australian financial institutions.

“We are delighted to collaborate with Cognizant, strengthening our commitment to delivering agile and future-ready banking solutions in Australia,” said Will Dale, Managing Director – APAC, Temenos. “Together, we are driving digital transformation that enhances efficiency and scalability for financial institutions.”

Key highlights of strategic engagement:

• Cloud-Native Banking Modernization: Cloud migration designed to enhance security, scalability, and performance for Australian banks. Near seamless platform updates reduce downtime and improve banking reliability.
• Comprehensive Temenos Software Delivery: Cognizant delivers end-to-end implementations, providing consulting, integration, upgrades, maintenance, and support. Leveraging its deep expertise across Temenos Core, Digital, Payments, Financial Crime Management, and Wealth Management solutions, Cognizant aims to drive efficient transformation.
• Market-Ready Core Banking Solutions: Pre-configured framework helps support banks to meet Australian financial industry requirements, reducing complexity. Cost-effective, streamlined banking modernization solutions help minimize operational burdens while enhancing financial accuracy.

Archana Ramanakumar, Global Head of Industry Solutions at Cognizant, emphasized the strategic significance of this initiative, reinforcing over 15 years of global partnership with Temenos. She said, “We are thrilled to expand our collaboration with Temenos to advance our shared commitment to this very strategic market. Together, Cognizant and Temenos will bring decades of global expertise, insights from leading core modernization programs, and industry-proven methodology to the Australian financial services sector, helping enable financial institutions to achieve their target digital operating model. This will be a true game-changer for Australian financial institutions that are on their digital transformation journey, delivering a pre-integrated, market-ready solution that aims to significantly reduce risk in core modernization initiatives.”

“The expansion of our strategic engagement with Temenos is set to accelerate banking innovation in Australia, integrating emerging technologies into core banking operations,” said Rob Marchiori, Australia Country Manager at Cognizant. “Not only will this relationship add value for existing Temenos clients through product innovation and engineering, it is also expected to create new opportunities aligning with our strategic priority of building our banking solutions and portfolio in Australia.”

About Cognizant:
Cognizant (Nasdaq: CTSH) engineers modern businesses. We help our clients modernize technology, reimagine processes, and transform experiences so they can stay ahead in our fast-changing world. Together, we’re improving everyday life. See how at  or @cognizant.

About Temenos:
Temenos (SIX: TEMN) is a global leader in banking technology. Through our market-leading core banking suite and best-in-class modular solutions, we are modernizing the banking industry. Banks of all sizes utilize our adaptable technology – on-premises, in the cloud, or as SaaS – to deliver next-generation services and AI-enhanced experiences that elevate banking for their customers. Our mission is to create a world where people can live their best financial lives.

Getty Images

AFP via Getty Images

The UK’s third-largest steelworks has been placed under government control, creating an uncertain future for nearly 1,500 workers in Rotherham and Sheffield.

Insolvency courts granted a compulsory winding up order sought by creditors owed hundreds of millions of pounds by Speciality Steels UK (SSUK) – part of the Liberty Steel metals empire of controversial tycoon Sanjeev Gupta.

The company will now be placed in the hands of the Official Receiver and special managers from consultancy firm Teneo, which has been appointed to run it on behalf of the liquidator.

The government has agreed to cover the ongoing wages and costs of the plant while a buyer for is sought.

Liberty Steel said the decision to put the firm into compulsory liquidation was “irrational”.

Chief transformation officer Jeffrey Kabel said the move would “impose prolonged uncertainty and significant costs on UK taxpayers for settlements and related expenses, despite the availability of a commercial solution”.

Lawyers for Mr Gupta had applied for a four-week adjournment to allow time to place the company in a “pre-pack administration”, which allows an insolvent company to sell its assets to a bidder.

He wanted funding from investment giant BlackRock and Fidera, which invests in distressed companies, to buy back the business.

Winding up the company, his lawyers argued, could place the business in “free fall” and incur significant disruption, cost and risk to a nationally important steel company and its 1,500 workers.

The judge found the company was “hopelessly insolvent” with £600,000 in the bank, a monthly wage bill of £3.7m, supported by a parent group that has 15 entities in insolvency proceedings across nine jurisdictions.

Introduction

Glaucoma is a leading cause of irreversible blindness worldwide, and is characterized by optic neuropathy with associated visual field damage.^1,2 Intraocular pressure (IOP) control is the gold-standard method of slowing the progression of glaucoma, which can be achieved through various means, including pharmacotherapy, laser, and surgery.³ Transscleral cyclophotocoagulation (TCP) and endoscopic cyclophotocoagulation (ECP) are two laser-based cycloablative techniques that are commonly used to treat mild to end-stage glaucomatous disease.^4–7

TCP is a laser-based procedure designed to reduce IOP by indirectly targeting the ciliary processes.⁴ Accurate targeting in TCP is critical, as deviations can lead to suboptimal results and damage to surrounding ocular tissues. Complications of TCP include prolonged inflammation, pain, hyphema, and hypotony.⁵ While evolutions in TCP have led to improved safety, this technique still lacks the ability to treat with a targeted approach. ECP is a relatively newer technique, offering a more targeted and controlled method of cycloablation.⁶ Previous literature has demonstrated that ECP effectively reduces IOP with lower risk of collateral damage to surrounding tissue.^7,8 Unlike TCP, ECP involves direct visualization of the ciliary processes via an endoscope.

Previous histological and acute structural analyses have demonstrated clear differences in tissue effects between TCP and ECP.^7,9 TCP induces widespread disruption of the ciliary body, including coagulative necrosis of the stroma often with extension into adjacent structures like the pars plana. In contrast, ECP produces more localized alterations, primarily affecting the ciliary epithelium. These differences can be observed under both light and scanning electron microscopy (SEM), further validating that ECP is a more tissue-sparing approach.

A newly developed ECP system (Leos™ BVI Medical Waltham, MA, USA) features enhanced imaging capabilities through a high-resolution camera and customized LED illumination, offering over twice the pixel density of traditional systems (40,000 vs 17,000 pixels). Using a single-use 19-gauge endoscope, laser delivery is integrated with real-time projections of intraocular images onto a large display allowing for a more detailed view. During treatment, a red aiming beam ensures precise targeting of the ciliary processes, much like standard ECP. Unlike standard ECP setups that require manual adjustment by an assistant, the Leos system automates parameters such as image focus, illumination, and orientation. The introduction of this system—with enhanced resolution and automated imaging capabilities—may further refine the precision of ECP.

This study aims to extend prior findings by comparing the acute structural changes induced by standard ECP, Leos ECP, and TCP on the ciliary body and surrounding structures in human cadaveric eyes.

Materials and Methods

No living human subjects or identifiable private information were involved in this study. As such, this study was exempted for IRB review by the Colorado Multiple Institutional Review Board under institutional policy.

This study was designed to compare acute structural changes induced by standard ECP, the investigational Leos ECP system, and TCP using SEM on three human cadaveric eyes. Human eyes were obtained within 24 hours of death from the Lions World Vision Institute (Tampa, Florida). Eyes had no prior history of glaucoma, intraocular surgery (excluding lens implantation), or laser intervention. Institutional review board waiver was obtained for this tissue-based laboratory analysis, and this study was performed in accordance with the latest declaration of Helsinki.

Each globe was inflated to physiologic intraocular pressure using balanced salt solution injected via a 25-gauge needle through the optic nerve. This facilitated optimal internal tension and consistent external placement of the TCP probe. Two eyes were divided into three 120° sections—one untreated segment served as a control, while the remaining two-thirds received Leos ECP (0.25W) and either the standard ECP (0.25W) or TCP (2.5W, 2–4 seconds), respectively. In a third eye, the globe was hemisected; one half was treated with Leos ECP (0.25W) and the other half with TCP (2.5W, 2–4 seconds). Treated areas were demarcated with permanent ink to help with subsequent sectioning and orientation.

A 2.4 mm corneal incision was made and the anterior chamber and ciliary sulcus were deepened with viscoelastic (Healon, Advanced Medical Optics, Santa Ana, CA, USA) to visualize the ciliary processes. Endoscopic treatments were delivered using either a reusable 19-gauge laser microendoscope (EndoOptiks^®, BVI Medical Waltham, MA) or a single-use 19-gauge Leos ECP device (BVI Medical, Waltham, MA), both of which delivered continuous-wave 810 nm diode laser energy with a 640 nm red aiming beam. ECP was applied until visible whitening and shrinkage of the processes was observed.

For TCP, a G-probe was connected to an Iridex 810nm diode laser (Mountain Vew, CA, SLx diode laser photocoagulation system). The probe was positioned 1.2 mm posterior to the limbus and aligned perpendicularly to the limbus externally on the sclera. Energy was delivered in pulses of ~2.5W for 2 to 4-second duration, targeting the pars plicata region. Laser treatment was titrated as needed to minimize audible “pops” which indicated tissue over-treatment.

Following treatment, all eyes were sectioned at the level of the pars plana and divided into control and treatment segments. Each section was fixed in 10% Neutral buffered formalin (Sigma-Aldrich, St. Louis, MO, USA) and stored on wet ice for transfer to the electron microscopy facility.

The tissues designated for acute structural evaluation were initially fixed in 2.5% glutaraldehyde at 4°C for 24 hours. The samples were then rinsed in 0.1 M phosphate-buffered saline, followed by secondary soaking in 1% osmium tetroxide. Subsequently, the specimens underwent graded ethanol dehydration and were kept in acetone. They were then critical point dried, ion coated, and then imaged using SEM to assess microarchitectural changes in the ciliary body and adjacent ocular structures.

All SEM images were analyzed by a single observer with extensive experience (MYK). Particular focus was paid to the ciliary processes and changes to the ciliary epithelium after treatment. Further observations were made on any tissue disorganization and extension of damage into the pars plana and iris stroma. The observer was not masked to the treatment modality. Statistical methods were not applicable due to the qualitative nature of SEM image comparisons.

Results

Electron microscopic analysis revealed distinct acute structural alterations among the different treatment modalities. In untreated control samples, the ciliary processes exhibited well-preserved architecture with intact epithelial surfaces and regularly arranged longitudinal ridges (Figure 1A). Tissues treated with the standard ECP and Leos ECP method demonstrated moderate ciliary epithelial disruption, including blunting and partial flattening of the ciliary processes (Figure 1B and C). There was minimal damage to the pars plana. TCP treated tissues displayed extensive tissue disorganization, including destruction of ciliary processes that extended into the iris and pars plana (Figure 1D). These acute structural patterns were consistently observed across all treated sections from each eye. None of the laser treatment modalities resulted in detectable damage to the adjacent scleral tissue in any of the specimens.

Figure 1 (A) Scanning electron microscopy of normal ciliary processes (arrows) with adjacent pars plana (asterisk) and iris stroma (I). (B) Scanning electron microscopy of standard endoscopic cyclophotocoagulation-treated ciliary processes showing shrinking of the processes with blunting of their tips (arrows). The adjacent pars plana (asterisk) and iris stroma (I) are unaffected. (C) Scanning electron microscopy of the LEOS endoscopic cyclophotocoagulation-treated ciliary processes showing shrinking of the processes with blunting of their tips (arrows). The adjacent pars plana (asterisk) and iris stroma (I) are unaffected. (D) Scanning electron microscopy of transscleral cyclophotocoagulation-treated ciliary processes showing extensive architectural destruction (straight arrows).

Discussion

This study provides new insights into the acute structural impact of different cyclophotocoagulation modalities on the ciliary processes. Both the novel Leos ECP and standard ECP demonstrated more targeted tissue destruction without the collateral tissue damage seen with TCP. These findings further validate results from previous literature by confirming SEM patterns and by introducing comparable histologic outcomes with a novel ECP platform.^7–11

The significance of minimizing collateral damage during cyclophotocoagulation rests in its clinical implications. Namely, excessive destruction of the ciliary body, stroma, and adjacent iris tissue has been associated with complications such as phthisis, hypotony, and prolonged inflammation.⁵

SEM has been used in prior studies to assess structural changes^7,8,10,12 and laser-induced injury patterns¹³ with exquisite resolution, making it a valuable tool for evaluating the effects of glaucoma and laser treatment. These views offer insights into laser-induced cellular disruption, stromal damage, and epithelial integrity beyond what is visible with light microscopy. Incorporation of electron microscopic analysis in the current study allows for a more refined analysis of tissue alterations across different cycloablation modalities.

Cyclophotocoagulation is the only surgical modality that targets aqueous production; ECP is the only micro-invasive surgery to do so.^14–16 Therefore, both surgical techniques are important parts of a glaucoma surgeon’s armamentarium. Compared to TCP, the safety profile of ECP has been demonstrated to be more favorable in both prospective and retrospective studies.^16,17 Though conventional ECP outcomes are good, improvements in device design may further reduce clinical variability and ensure safety. Importantly, the consistency in histologic findings between the two ECP modalities evaluated here suggest the Leos system is similar in tissue impact. However, the Leos system may offer the additional benefit of simpler and more consistent operation through its enhanced imaging capabilities, more detailed view, its larger, more ergonomic screen and standardized settings, which limit risk of human error in manual setting adjustments.

Attempts have also been made to modify TCP to mitigate complications with MicroPulse CPC, which cycles laser energy off/on to allow cooling of tissue during transscleral laser therapy.^18,19 With MicroPulse there is still extensive histological and structural damage, through a recent meta-analysis found a more favorable side-effect profile versus traditional TCP.²⁰ MicroPulse, like TCP, lacks direct visualization of ciliary tissue and variations in anatomy.²¹

Limitations

Despite these promising results, there are limitations inherent to this study. First, the analysis was performed by a single, unmasked observer, which introduces the potential for interpretation bias. Human cadaveric eyes cannot replicate the dynamic biological processes of live tissue, such as inflammation, wound healing, and aqueous humor flow. Thus, it is unclear how these findings will translate into clinical outcomes. Additionally, the number of eyes studied was small with only three cadaveric globes evaluated. This limited size restricts generalizability. As such, findings should be interpreted as preliminary rather than conclusive. Further research could be aimed at correlating these structural findings with functional data such as aqueous production rates. Future studies are also needed to validate these results using multiple, masked observers, a rigorous quantitative scoring system, and a larger sample size. It would also be valuable to investigate whether the other advances in the Leos ECP system lead to improved surgeon and surgical staff satisfaction, ergonomics, shortened learning curve for new surgeons and improved operative efficiency all of which are incredibly important in our current climate.

Conclusions

In this study, we demonstrate that both standard ECP and the novel Leos ECP produce significantly less acute structural disruption to the ciliary body compared to TCP. While the Leos ECP system yielded tissue effects similar to standard ECP, its enhanced imaging and automated features may translate into greater clinical consistency and usability across operators. However, this remains a hypothesis and requires confirmation through clinical trials. These findings also further validate the more targeted approach that ECP offers compared to TCP.

Acknowledgment

BVI sponsored the study through an unrestricted research grant.

Disclosure

Malik Y. Kahook: Consultant to FCI, New World Medical, and SpyGlass Pharma, Ownership of SpyGlass Pharma, Patent Royalties from Alcon, New World Medical, FCI, and SpyGlass Pharma. Leonard Seibold: Consultant to New World Medical, Thea, and Abbvie/Allergan. The authors report no other conflicts of interest in this work.

References

1. Jonas JB, Aung T, Bourne RR, Bron AM, Ritch R, Panda-Jonas S. Glaucoma. Lancet. 2017;390(10108):2183–2193. doi:10.1016/S0140-6736(17)31469-1

2. Zhang N, Wang J, Li Y, Jiang B. Prevalence of primary open angle glaucoma in the last 20 years: a meta-analysis and systematic review. Sci Rep. 2021;11(1):13762. doi:10.1038/s41598-021-92971-w

3. Schwartz K, Budenz D. Current management of glaucoma. Curr Opin Ophthalmol. 2004;15(2):119–126. doi:10.1097/00055735-200404000-00011

4. Brancato R, Giovanni L, Trabucchi G, Pietroni C. Contact transscleral cyclophotocoagulation with Nd:YAG laser in uncontrolled glaucoma. Ophthalmic Surg. 1989;20(8):547–551.

5. Sheheitli H, Persad PJ, Feuer WJ, Sayed MS, Lee RK. Treatment outcomes of primary transscleral cyclophotocoagulation. Ophthalmol Glaucoma. 2021;4(5):472–481. doi:10.1016/j.ogla.2020.12.014

6. Pastor SA, Singh K, Lee DA, et al. Cyclophotocoagulation: a report by the American academy of ophthalmology. Ophthalmology. 2001;108(11):2130–2138. doi:10.1016/s0161-6420(01)00889-2

7. Pantcheva MB, Kahook MY, Schuman JS, Noecker RJ. Comparison of acute structural and histopathological changes in human autopsy eyes after endoscopic cyclophotocoagulation and trans-scleral cyclophotocoagulation. Br J Ophthalmol. 2007;91(2):248–252. doi:10.1136/bjo.2006.103580

8. Pantcheva MB, Kahook MY, Schuman JS, Rubin MW, Noecker RJ. Comparison of acute structural and histopathological changes of the porcine ciliary processes after endoscopic cyclophotocoagulation and transscleral cyclophotocoagulation. Clin Exp Ophthalmol. 2007;35(3):270–274. doi:10.1111/j.1442-9071.2006.01415.x

9. Beardsley R, Law SK, Caprioli J, et al. Comparison of outcomes between endoscopic and transcleral cyclophotocoagulation. Vision. 2017;1(4). doi:10.3390/vision1040024

10. Smith RS, Boyle E, Rudt LA. Cyclocryotherapy: a light and electron microscopic study. Arch Ophthalmol. 1977;95(2):285–288. doi:10.1001/archopht.1977.04450020085015

11. Lanzagorta-Aresti A, Montolío-Marzo S, Davó-Cabrera JM, Piá-Ludeña JV. Transscleral versus endoscopic cyclophotocoagulation outcomes for refractory glaucoma. Eur J Ophthalmol. 2021;31(3):1107–1112. doi:10.1177/1120672120914230

12. Sihota R, Goyal A, Kaur J, Gupta V, Nag TC. Scanning electron microscopy of the trabecular meshwork: understanding the pathogenesis of primary angle closure glaucoma. Indian J Ophthalmol. 2012;60(3):183–188. doi:10.4103/0301-4738.95868

13. Basu PK. Application of the scanning electron microscopy in ophthalmic research. Indian J Ophthalmol. 1983;31(5):476–485.

14. Kirk S, Kirk C, Barnes R, Kirk T. Minimally invasive glaucoma surgeries, is two better than one? Invest Ophthalmol Visual Sci. 2020;61(7):976.

15. Klug E, Chachanidze M, Nirappel A, et al. Outcomes of phacoemulsification and endoscopic cyclophotocoagulation performed with dual blade ab interno trabeculectomy or trabecular micro-bypass stent insertion. Eye. 2022;36(2):424–432. doi:10.1038/s41433-021-01475-4

16. Francis BA, Flowers B, Dastiridou A, Yelenskiy A, Chopra V, Alvarado JA. Endoscopic cyclophotocoagulation and other cyclodestructive methods: histopathologic comparison of in vivo treatment in humans and monkeys. Ophthalmol Glaucoma. 2019;2(6):413–421. doi:10.1016/j.ogla.2019.08.008

17. Francis BA, Berke SJ, Dustin L, Noecker R. Endoscopic cyclophotocoagulation combined with phacoemulsification versus phacoemulsification alone in medically controlled glaucoma. J Cataract Refract Surg. 2014;40(8):1313–1321. doi:10.1016/j.jcrs.2014.06.021

18. Moussa K, Feinstein M, Pekmezci M, et al. Histologic changes following continuous wave and micropulse transscleral cyclophotocoagulation: a randomized comparative study. Trans Vision Sci Technol. 2020;9(5):22. doi:10.1167/tvst.9.5.22

19. Hwang YH, Lee S, Kim M, Choi J. Comparison of treatment outcomes between slow coagulation transscleral cyclophotocoagulation and micropulse transscleral laser treatment. Sci Rep. 2024;14(1):23944. doi:10.1038/s41598-024-75246-y

20. Chavez MP, Guedes GB, Pasqualotto E, et al. Micropulse transscleral laser treatment vs. continuous wave transscleral cyclophotocoagulation for the treatment of glaucoma or ocular hypertension: a meta-analysis. J Glaucoma. 2025;34(8):575–584. doi:10.1097/ijg.0000000000002583

21. Feldman RM, el-Harazi SM, LoRusso FJ, McCash C, Lloyd WC, Warner PA. Histopathologic findings following contact transscleral semiconductor diode laser cyclophotocoagulation in a human eye. J Glaucoma. 1997;6(2):139–140. doi:10.1097/00061198-199704000-00011

The delay in Pakistan’s 5G spectrum auction has cost the exchequer billions in potential revenue. An Auditor General audit flagged indecision and weak coordination between PTA and MoITT.

The main reason for the delay is uncertainty over the proposed PTCL–Telenor Pakistan merger. The Competition Commission of Pakistan (CCP) is yet to decide, citing incomplete documentation from PTCL.

Minister for IT and Telecommunication Shaza Fatima Khawaja said the ministry cannot influence the CCP. She stressed that the body is independent and must complete its review.

The 5G Spectrum Auction Advisory Committee, led by the finance minister, will act only after the CCP delivers its verdict.

A senior IT Ministry official said the auction design depends on the number of operators post-merger. He explained that the terms vary if there are four or three players.

Pakistan currently has four telecom operators. Jazz holds a 37% share, Zong 26%, Telenor 22%, and Ufone—PTCL’s subsidiary—13%.

Officials added that PTCL’s submissions were unclear and required further clarification. This has further prolonged the CCP’s decision-making process.

Concerns remain due to Ufone’s consistent financial losses, unlike the profitable performance of Jazz, Zong, and Telenor.

A PTCL-Ufone spokesperson did not respond to media queries despite repeated requests.

 

Today’s world runs on critical minerals. The elements are the building blocks of batteries, electronics, and a slew of other technologies and are often key to the economic and national security of a nation. In the US, most of these elements are imported, and researchers have been working for years to find domestic sources of these minerals to avoid supply chain disruptions.

At the American Chemical Society Fall 2025 meeting, Pacific Northwest National Laboratory (PNNL) scientist Chinmayee Subban explained how she and her team extract critical minerals using the waste from a technology capable of tweaking ocean chemistry, to lower the costs of both processes.

Critical mineral recovery processes almost always use acid-base chemistry; it’s precipitation chemistry at scale, Subban said. But industrial acids and bases can be expensive to manufacture and store, so “it’s always valuable if you can find low-grade waste chemicals that you could use for the extraction,” she said.

Electrochemical ocean alkalinity enhancement, or OAE—a process wherein scientists increase the pH of seawater to draw carbon dioxide from the air and counter ocean acidification—offers one such source of acid. Through a public-private partnership with Ebb Carbon, PNNL scientists have deployed an OAE system developed by the company. The system uses electricity and a specialized membrane to separate ocean water into streams of acidic, basic (alkaline), and partially deionized water. But “the benefits of the ocean alkalinity are limited to the alkaline stream,” Subban said. “There’s a lot of acid that’s generated.”

That waste acid can be used to extract minerals from another waste stream: the salty brine left over from desalination, which is the first step of the electrochemical OAE system. “Think of it as Lego blocks,” Subban said. If the steps are in the correct order, scientists can generate a couple of mineral coproducts depending on the starting feed water and local industrial ecology, she explained.

So far, Subban’s team has demonstrated that waste acid can pull lithium from the salty brine produced during desalination. Her team has also pulled uranium from the water, and her future work will focus on extracting strontium, she said.

They’ve also shown that waste acid can extract nickel from locally sourced olivine minerals, flipping the economics of domestic nickel extraction. The scientists showed that, even without accounting for any revenue from CO₂ removal credits, “we were able to get sufficient net positive benefits” on the dollar per ton, she said. In fact, the waste acid digests the olivine faster than a commercial equivalent, Subban said, likely because the low grade acid contains a small amount of salt.

To “take something that is a waste and [use it] to improve aspects of the lithium and nickel extraction will be incredibly beneficial down the road,” said Tyler Bridges, a graduate researcher at Virginia Tech and attendee of the presentation. “There’s a lot of exciting work that’s being done in that field right now,” he added.