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Purpose To assess the long-term visual outcomes of children with PCG, irrespective of the type of surgical procedure, and to create visual acuity curves to help in predicting the development of visual function in these patients. The secondary aim is to identify associated factors for visual decline or loss, highlighting differences between neonatal and infantile subgroups. Methods The medical records of pediatric glaucoma patients from 1996 to 2017 at the University Hospital of Verona (Verona, Italy) were retrospectively reviewed. Visual acuities, surgeries, PCG subtype and etiology of vision impairment were recorded. Statistical analyses were performed to detect factors associated with vision decline. Results Sixty-seven eyes (40 patients) were included in the study. Developmental predictive curves of visual acuity showed that children with infantile PCG had a better visual outcome than children with neonatal PCG at each step of follow-up. A good-to-moderate VA (p Conclusions Visual outcomes of PCG significantly correlate with the age at diagnosis. Although a good long-term IOP control can often be achieved in PCG, often the visual acuity remains below the lower limits of the normal range. Poor vision in childhood is related to global developmental problems, and referral to third-level services should not be delayed to prevent vision impairment. In this regard, visual acuity curves can be a useful tool for the consultant ophthalmologist to define the visual development of children affected by PCG.

Purpose To compare the morphological and biomechanical properties of normal cornea and keratoconus at different stages. Methods A total of 408 patients (517 eyes) with keratoconus were included in this study. According to the Topographic Keratoconus (TKC) grading method, keratoconus was divided into stage I (TKC = 1, 130 eyes), stage II (TKC = 1–2, 2, 164 eyes), stage III (TKC = 2–3, 3, 125 eyes) and stage IV (TKC = 3–4, 4, 98 eyes). A total of 158 normal subjects (158 eyes) were recruited as the normal group. The corneal morphological parameters and biomechanical parameters were obtained with Scheimpflug tomography (Pentacam) and corneal visualization Scheimpflug technology (Corvis ST), and the receiver operating characteristic (ROC) curves were drawn. Results Each corneal morphological and most biomechanical parameters of the keratoconic eyes were significantly different from those of the normal eyes in this study (p 0.9), with the Belin-Ambrósio deviation (BAD-D) and Tomographic and Biomechanical Index (TBI) showing higher efficiency. The efficiency of BAD-D and TBI was high in differentiating keratoconus at different stages (AUC > 0.963). The comparison of ROC curves of keratoconus at different stages did not reveal statistically significant differences for TBI. Conclusion BAD-D and TBI can effectively diagnose stage I keratoconus. Moreover, the efficiency of TBI is the same in diagnosing keratoconus at all stages, while the diagnostic efficiency of other parameters increases with the increase in keratoconus stages.

Intraoperative Floppy iris syndrome(IFIS) remains a challenge for surgeons during phacoemulsification. Initially, it was related to the use of tamsulosin, an alpha adrenergic receptor blocker used in benign prostatic hyperplasia. Subsequently, other alpha adrenergic receptor such as alfuzosin, terazosin and doxazosin alongwith different other class of medications and systemic risk factors were identified. Other class of medications includes 5-alpha reductase inhibitor, angiotensin receptor antagonist, benzodiazepines, antipsychotics and antidepressants. Other risk factors include increasing age, male gender, diabetes, hypertension and decreased preoperative pupil diameter. It is very important for surgeons to identify these risk factors preoperatively and take appropriate preoperative and intraoperative measures to tackle the dreaded complications of IFIS. Sometimes, it is important for an ophthalmologist to work in cooperation with physician and urologist to minimize the complications. In conclusion, awareness of the risk factors associated with IFIS, their detailed preoperative assessment and intraoperative measures and surgical intervention is crucial in addressing IFIS. Lack of awareness can turn a routine, uneventful surgery into one with significant visual morbidity.

To investigate the morphological features and surgical outcomes of retinitis pigmentosa (RP)-associated anterior subcapsular cataract (ASC). Consecutive RP-associated ASC cases were reviewed, and one hundred patients (171 eyes) were included. Anterior segment photographed images by slit-lamp microscope were reviewed. Best-corrected visual acuity (BCVA) was recorded. The cases were classified according to preoperative best BCVA, the area (central, midperipheral and peripheral) and the density (Grade 1, vacuolar/bubble-like; Grade 2, plaque-like/translucent; and Grade 3, fibrotic/opaque) of ASC; subgroup analysis of surgical outcomes was then performed. The mean age was 52.1 ± 13.7 years, and the 41–50-year group had the best BCVA. 13.5% of eyes had BCVA better than 20/63, 30.4% were between 20/400 and 20/63, and 56.1% were worse than 20/400. The percentage of ASCs in the central, midperipheral and peripheral areas was 55.0%, 37.4% and 7.6%, respectively. Postoperative BCVA was improved in the central and midperipheral groups (P

Ahmed glaucoma valve (AGV) is an effective treatment method for refractory glaucoma (RG), however, additional surgical interventions may be required over the course of follow-up due to complications. Our aim is to investigate the causes, types, and outcomes of revisional surgical interventions apart from revisions aiming IOP control, following AGV implantation in patients with RG. The pre- and postoperative month 1–3-6–12 and last visit examination findings of the patients who underwent various surgical revisions of AGV between January 2015 and April 2018 in our clinic were recorded, as well as the interval between AGV implantation-revision surgery and the presence of any other complications necessitating additional surgery. The success criteria were defined on the basis of need for additional procedures. Twenty-six eyes of 24 patients were included. The follow-up time and the interval between AGV implantation-surgical revisions were median 12 (6–92) and median 9.7 (1–72) months, respectively. The most common complication requiring revision was tube exposure in 15 (57.7%) followed by tube malposition in 11 (42.3%) eyes. Further interventions were required only in one eye with recurrent exposure. AGV implantation has early and late tube-related complications necessitating revisional surgical interventions; which makes it important to have extended follow-up period for patients with AGV implants. Revisional interventions for AGV implants with tube-related complications are efficient procedures for the majority of patients, but recurrence may occur requiring additional revisions.

To evaluate surgical and refractive outcomes of a new sutured scleral fixation technique in the management of subluxated intraocular lenses (IOLs). Nineteen eyes treated with the new scleral fixation technique were included. The mean corrected distance visual acuity (CDVA), postoperative refraction error, mean endothelial cell count (ECC), and complications were recorded. All patients were evaluated immediately postoperatively, at 1 and 7 days, and then at 1, 3, and 6 months. The mean duration of follow-up of the patients was 10 months (range, 6–15 months). The mean CDVA was 0.41 ± 0.1 logMAR (logarithm of minimum angle of resolution) preoperatively and was 0.08 ± 0.07 logMAR postoperatively. The mean astigmatism was − 2.22 ± 1.86 D preoperative and was − 0.86 ± 0.58 D postoperative. The mean preoperative and postoperative ECC was 2455 ± 288 and 2352 ± 288, respectively. One patient (5.26%) experienced vitreous hemorrhage, and two (10.52%) experienced intraocular pressure elevation. IOL tilt and decentralization, conjunctival erosion, and cystoid macular edema were not observed in any eyes during follow-up. This new IOL repositioning technique can be applied in a short surgical time and provides a stable IOL centration on long-term follow-up.

The aim of this study was to analyze the segmented layers of the macula in patients with obstructive sleep apnea and hypopnea syndrome (OSAS) using spectral domain optical coherence tomography (SD-OCT). This single-center, cross-sectional study included 31 OSAS patients and 31 age- and gender-matched control subjects. SD-OCT and overnight polysomnography were performed on all participants. The OSAS patients were categorized according to disease severity (mild, moderate, severe). The groups were compared in respect of each segmented macular layer through the use of segmentation software on SD-OCT. Total retinal thickness (RT), peripapillary retina nerve fiber layer (pRNFL) thickness, central corneal thickness (CCT) and intraocular pressure (IOP) values were also compared between the groups. Mean CCT (p:0.015) and nasal pRNFL values (p:0.042) were lower and mean IOP was higher (p:0.018) in OSAS patients than in the control group. The statistical analysis revealed significantly thinner total RT, inner retinal layers (IRL), outer retinal layers (ORL), photoreceptor layers (PRL) and ganglion cell layer (GCL) thicknesses in the OSAS groups compared to healthy subjects. No significant differences were found between the three OSAS subgroups in all segmented macular layers and pRNFL measurements. The results of this study showed relatively thinner nasal pRNFL, total RT, IRL, ORL, PRL and GCL layers in OSAS patients compared to healthy subjects. Moreover, this thinning of the segmented layers was unrelated to disease severity.

Purpose Neovascularization of the optic disk (NVD) is mainly a complication of ischemic retinal disorders and of uveitis with vascular occlusion. Rarely, NVD may develop in patients with uveitis in the absence of retinal ischemia. This report aims to present our long-term experience of treating refractory uveitic NVD (uNVD) with adalimumab in three patients with active non-infectious posterior or panuveitis. Methods Observational case series was collected from institutional tertiary referral center. Patients with chronic refractory uNVD who completed 24 months of follow-up were included. Results uNVD was diagnosed on first presentation in all patients (3 eyes). Mean age at presentation was 29 years (median 20, range 18-49). Mean duration of complaints before presentation was 18.7 weeks (median 24, range 4-28). Uveitis was idiopathic in two patients and secondary to Behcet disease in one. All eyes had concomitant cystoid macular edema. Additional posterior segment signs included optic disk hemorrhage, preretinal hemorrhage and vitreous hemorrhage. All eyes showed retinal vascular leakage and macular leakage with no evidence of capillary non-perfusion. All patients were treated with systemic steroids and steroid-sparing agent. Because of NVD refractoriness, anti-TNF-α therapy was introduced at a mean of 24.7 weeks after first presentation (median 20, range 14-40). Complete regression of NVD was observed at a mean of 34.7 weeks (median 32, range 8-64) following adalimumab institution. Mean follow-up time after starting anti-TNF-α agents was 31.3 months. Conclusions Our results suggest that targeting TNF-α achieves long-term control of uveitic NVD refractory to conventional treatments.

To assess anterior segment anatomic parameters in school-aged children with spontaneously regressed retinopathy of prematurity (sr-ROP) and in children born preterm without ROP history (preT). sr-ROP and preT children were compared with healthy, born at term children (control group). Biometric characteristics were measured with the IOLMaster. Iridocorneal angle structure was evaluated using Visante AS-OCT, and angle opening distance, trabecular iris space area and scleral spur angle were calculated. Best-corrected visual acuity (BCVA) was measured with the ETDRS chart. We examined 22 eyes of 11 children with sr-ROP, 26 eyes of 13 preT children and 24 eyes of 12 healthy controls, with a median age of 8 years. sr-ROP children exhibited worse mean BCVA and reduced AL compared to controls (p = 0.001 and p = 0.007, respectively). A narrower iridocorneal angle was found in sr-ROP compared to the preT and the control groups. Preterm children were found to have similar anterior chamber angle metrics compared to the full-term control group. In this study, school-aged children with a history of sr-ROP had narrower angles compared to preterm- and term-born children. AS-OCT demonstrated structural differences of the iridocorneal angle in sr-ROP, possibly reflecting a mild developmental arrest of the anterior segment.

To investigate the use of collagenase type II for generating a rabbit model of keratoconus and to evaluate the impact of violet light (VL) irradiation on the disease model. Six Japanese White rabbits were used. After epithelial debridement, the collagenase group was treated with a collagenase type II solution for 30 min; the control group was treated with a solution without collagenase. Three rabbits also underwent VL irradiation (375 nm, irradiance 310 μW/cm2) for 3 h daily for 7 days after topical collagenase application. Slit-lamp microscopy, steep keratometry (Ks), corneal astigmatism, central corneal thickness, and axial length were examined before and after the procedure. The corneas were obtained on day 7 for biomechanical evaluation. A significant increase in Ks and corneal astigmatism was observed in the collagenase and VL irradiation groups compared with the control group at day 7. No significant difference was found in the change in corneal thickness between the groups. The elastic modulus at 10% strain but not at 3% and 5% strain in the collagenase group was significantly lower than that in the control group. There was no significant difference in the elastic modulus at each level of strain between the collagenase and VL irradiation groups. The average axial length at day 7 in the collagenase group was significantly longer than that in the control group. Collagenase type II treatment can mimic keratoconus with increased corneal keratometry and astigmatism. There was no significant difference in the observed elastic behaviour of normal and ectatic corneas under physiologically relevant stress levels. VL irradiation did not cause regression of corneal steepening in this model with short-term observation.

To assess the surgical outcomes of reoperations for residual and recurrent esotropia. A retrospective chart review of all patients who underwent surgery during 2000–2017 at a tertiary referral medical center for recurrent or residual esotropia was conducted. Patients who underwent bilateral medial rectus recession as primary surgery and lateral rectus resection as second surgery were included. The success rate of second surgery and its association to various factors were examined. Success of reoperation was defined as mean deviation of

To review the published literature on indications and outcomes of DSAEK/DSEK and DMEK for the treatment of failed penetrating keratoplasty. This is a systematic review and single-arm meta-analysis. Literature searches were conducted in PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews. Prospective and retrospective studies reporting DSAEK/DSEK or DMEK after failed penetrating keratoplasty were included. Primary outcome measures are graft survival and detachment rates, as well as postoperative visual outcomes. A total of 25 studies with 970 patients/989 eyes were included, comprising 735 patients with 746 eyes which underwent DSAEK/DSEK surgery and 235 patients with 243 eyes which underwent DMEK surgery, all of them following a previously failed PK. There were no randomized controlled studies. In all of the DSAEK-PK studies, the graft failure rate was 18% (10%, 26%), the detachment rate was 15% (9%, 22%) and the rejection rate was 7% (3%, 12%) by the time of the last follow-up. And in all of the DMEK-PK studies, the graft failure rate was 14% (4%, 27%), the detachment rate was 42% (28%, 56%) and the rejection rate was 7% (2%, 16%). The mean visual acuity of the DSAEK-PK and DMEK-PK groups is 0.65 ± 0.18 and 0.43 ± 0.23 logMAR, respectively, at 6 months postoperatively. Endothelial keratoplasty for treatment of failed penetrating keratoplasty led to improved vision and graft clarity in most recipients. Though graft survival rates and rejection rates were comparable between the two groups, the DMEK-PK group showed better visual outcomes with higher detachment rate.

In this study, we aimed to determine the alterations in the retina and peripapillary vascular density in patients with vitamin B12 deficiency. The patients were divided into two groups regarding their vitamin B12 levels as the low vitamin B12 group (

The patterns of uveitis in Tokyo have recently changed due to advances in examination tools. We aimed to investigate the changes in the patterns of uveitis between 2004–2015 and 2016–2018. We retrospectively reviewed the data of 732 patients who visited the Uveitis Clinic at the University of Tokyo Hospital between January 2016 and December 2018. Background characteristics, laboratory results, and imaging findings were analysed. We compared the incidences of uveitis in 2016–2018 and 2004–2015 to identify changes in the patterns. The most frequent diagnoses were sarcoidosis (8.9%), herpetic iridocyclitis (6.7%), intraocular lymphoma (5.5%), Vogt–Koyanagi–Harada disease (4.8%), unclassified acute anterior uveitis (4.6%), Behcet’s disease (4.5%), bacterial endophthalmitis (2.9%), and Posner-Schlossman syndrome (2.6%). Suspected sarcoidosis (20.9%) was the most common cause of unclassified uveitis. The incidence of intraocular lymphoma was significantly higher in 2016–2018 than in 2004–2015. Between 2004 and 2018, herpetic iridocyclitis, bacterial endophthalmitis, and juvenile chronic iridocyclitis exhibited an increasing trend, and the incidences of Posner-Schlossman syndrome, unclassified acute anterior uveitis, Behcet’s disease, and Vogt–Koyanagi–Harada disease exhibited a decreasing trend. The changing patterns of uveitis were characterised by increases in the incidence of intraocular lymphoma. This may be attributed to recent advances in examination tools, the changes in the referred patient population, and the aging Japanese population.

To compare the efficacy of trehalose-HA eye drops versus 0.1% hyaluronic acid for the treatment of dry eye.This prospective, comparative, contralateral eye study included sixty eligible patients (mean age 44.13 ± 14.53 years). Patients having a SPEED questionnaire score of 16 or above, objective scatter index (OSI) 1 and non-invasive tear break up time (NIBUT) of 10 s or less were included in the study. Eyes were randomized to receive 0.1% hyaluronic acid (HA) in one eye and trehalose-HA eye drops in the contralateral eye. At baseline, 1- and 3-month follow-ups, OSI, NIBUT, MG loss, tear meniscus height (TMH) and tear film osmolarity (TFO) were evaluated using non-invasive modalities RESULTS: There was a statistically significant improvement in NIBUT, TMH, OSI, SPEED questionnaire score in the trehalose-HA compared to the 0.1% HA group at both 1- and 3-month visits (p 0.05). In both the study groups, compared to the baseline, the mean values of TFO, MG loss, OSI and SPEED questionnaire score significantly reduced at 3 months (p 0.05). The mean values of NIBUT and tear meniscus height on the other hand showed a significant increase compared to the baseline values (p 0.05). Both drugs were well tolerated by the study participants without any significant ocular side effects.Trehalose-HA was found to be more effective than 0.1% HA eye drops in the management of symptomatic dry eye, as shown by significant reduction in NIBUT, TMH and OSI, when evaluated using non-invasive modalities of dry eye evaluation.

Endophthalmitis is a potentially blinding intraocular infection following intraocular surgery or trauma. Prompt diagnosis and treatment are important in preventing devastating visual complications. Procalcitonin (PCT) is a promising biomarker for diagnosing bacterial infections. The aim of the study was to measure vitreous PCT in infectious endophthalmitis and assess its utility as a biomarker. In this prospective study, vitreous was collected from patients with non-infectious retinal disorders and infectious endophthalmitis. PCT was measured using the Human Procalcitonin ELISA Kit. The diagnostic performance of PCT was calculated via receiver operating characteristic curves. The study included three groups: patients with non-infectious retinal conditions, culture-positive endophthalmitis, and culture-negative endophthalmitis. The average PCT was 75.74 ± 26.8 pg mL−1, 100.24 ± 12.9 pg mL−1, and 126.41 ± 26.47 pg mL−1 in control, culture-negative, and culture-positive endophthalmitis, respectively. There was a significant difference in the vitreous PCT in the study and control groups (p = 0.04), but not between culture-positive and culture-negative endophthalmitis (p = 0.65). The sensitivity (66.7%) and specificity (65%) for PCT with a cut-off of ≤ 54.88 pg mL−1(p = 0.31) implied that its diagnostic accuracy was not significant. But there was a significant difference in gram-negative (68.2 ± 16.5 pg mL−1) and gram-positive (175.09 ± 45 pg mL−1) (p = 0.02) bacterial infections; the sensitivity and specificity were 70%, with a cut-off of ≤ 82.3 pg mL−1. This study showed that vitreous procalcitonin concentration might not be a suitable biomarker for diagnosing culture-negative endophthalmitis though it could help distinguish between gram-positive and gram-negative infections.

To assess the effects of 1,25 dihydroxyvitamin D3 (vitamin D3) either alone or under oxidative damage on human retinal pigment epithelium cell lines. The human retinal pigment epithelial cell lines were pretreated with hydrogen peroxide with different concentrations (100–1000 μM) and durations (4, 12 and 24 h) to determine the appropriate dose. A group of cells were treated with vitamin D3 alone, and another group of cells were co-treated with different concentrations of (10–100 nM) vitamin D3 and hydrogen peroxide. Anti-cytotoxic, anti-apoptotic and anti-genotoxic effects of vitamin D3 on the hydrogen peroxide treated cell line were evaluated. In addition, mitochondrial membrane potentials of treated cell lines were measured. Vitamin D3 showed statistically significant anti-cytotoxic effects and increased cell viability in all concentrations (p

Primary congenital glaucoma (PCG) (OMIM#231,300) can be caused by pathogenic sequence variations in CYP1B1, LTBP2, MYOC and PXDN genes. The purpose of this study was to investigate mutations in the CYP1B1 gene in families affected with primary congenital glaucoma (PCG) using linkage analysis and Sanger sequencing. A total number of four families with nine affected PCG patients during six months were included in this study. The mutations were identified by homozygosity mapping to find the linked loci and then direct sequencing of all coding exons, the exon–intron boundaries and the 5' untranslated region of CYP1B1 using genomic DNA obtained from affected family members and their parents. Moreover, bioinformatic tools were applied to study mutation effect on protein structure and function. A total of four mutations were identified, and three of these were novel. Two were missense mutations: One was truncating mutation, and the other was an in-frame deletion. Mutations in CYP1B1 could fully explain the PCG phenotype in all of the patients. Also, the bioinformatic study of the mutations showed the structure of the protein is affected, and it is well conserved among similar species. In this study, we identified 4 CYP1B1 mutations, 3 of which were novel. In silico analysis of identified mutations confirmed their molecular pathogenicity. A similar analysis will help understand the biological role of CYP1B1 and the effect of mutations on the regulatory and enzymatic functions of CYP1B1 that result in PCG. Not relevant

This study aimed to assess the safety and efficacy of optic nerve sheath fenestration (ONSF) in leukemic children having increased intracranial pressure with severe uncontrolled visual loss on medical treatment and not eligible for venous sinus stenting. In this non-randomized clinical trial, we included patients presenting with severe sight-threatening papilledema due to increased intracranial pressure following leukemia treatment. All included patients were subjected to a complete history taking, assessment of the visual acuity and fundus examination with fundus photography and grading of papilledema using Frisen scale. Patients were evaluated at 2 weeks and 3 months postoperative by recording the best-corrected visual acuity, assessment of the pupillary reaction and fundus examination and fundus photography with grading of papilledema. Among 20 patients included in this study, there was a statistically significant improvement in visual acuity of both eyes in all patients. The mean postoperative visual acuity was 0.28 ± 0.10 two weeks after surgery in the right eye and it was 0.42 ± 0.16 in the left eye. The mean visual acuity in the right eye three months after surgery was 0.78 ± 0.19 and it was 0.87 ± 0.17 in the left eye. Three months postoperatively, papilledema resolved completely in both eyes. There were no recorded ocular complications. In this study, ONSF was sight-saving procedure in all leukemic patients with a significant improvement in the visual acuity, stabilization of the visual function and resolving of the papilledema over follow-up period. There were no recorded intraoperative or postoperative complications. Further well-designed studies are needed to assert upon these results.

To assess the risk factors associated with the development of hypotony after Ahmed glaucoma valve (AGV) implantation. One hundred and ninety-three eyes of 177 patients with various types of glaucoma that were treated with AGV implantation were retrospectively evaluated. Intraocular pressure lower than 6 mmHg related to the surgery is defined as postoperative hypotony. Patients’ demographic characteristics, type of glaucoma, preoperative and postoperative visual acuity, necessity of antiglaucoma treatments, lens status, previous ocular surgeries, intraocular pressure (IOP) measurements before and after surgeries, the need for additional procedures and postoperative complications were recorded from the patients’ charts. Hypotony was seen in 68 of 193 eyes (35.2%) postoperatively. In 45 eyes (23.3%), it has occurred in first postoperative day and in 23 eyes (11.9%) after the first day within the first week. There was no difference in intraocular pressures between two groups in the first year follow-up. Pre- and postoperative best-corrected visual acuities, age and gender were not statistically different between hypotony and no hypotony groups (p > 0.05). Also, lens status, history of previous ocular surgery, type of glaucoma and number of preoperative glaucoma medication usage were not found to be different between groups (p > 0.05). Potential risk factors such as age, sex, lens status, history of previous ocular surgeries, preoperative glaucoma medication usage or glaucoma type are not found to influence upon postoperative hypotony prevalence for AGV surgery. Surgery type and personal ocular factors, which could not be determined beforehand, could be more important than demographic features.

Ocular surface squamous neoplasia (OSSN) is a low-grade malignancy arising from the squamous epithelium of the ocular surface To describe the clinical presentation, histological diagnoses, treatment, and outcome of treatment in patients with OSSN managed at a tertiary health facility. Medical records of all patients with OSSN managed using a standardized treatment protocol over a 10-year period were reviewed. Eighty-six patients comprising 44 (51.2%) males and mean age of 48.2 ± 15.8 years were studied. The most common presentation was a fleshy growth in the eye in all patients, and 43 (50.0%) patients tested positive to human immunodeficiency virus. The right eye was affected in 44 (51.2%) patients with no bilateral tumors, and the medial limbus was involved in 28 (32.6%) patients. Morphologically, 40 (46.5%) patients had gelatinous growth, 24 (27.9%) patients were in Tis category while 30 (34.9%) patients were in T4 category. Twenty-eight (32.6%) patients received complete course of adjuvant topical mitomycin C (0.04%) while nine (10.5%) patients completed adjuvant systemic chemotherapy and external beam radiation. Overall, 61 (70.9%) patients had no tumor recurrence, seven (8.1%) patients had recurrent tumor, while the status of 18 (20.9%) patients was not known. OSSN occurs more commonly in younger age group in our studied population and is strongly associated with HIV seropositivity. Intraoperative cryotherapy in patients with carcinoma in situ and intraoperative cryotherapy with adjuvant topical mitomycin C in those with invasive SCC that is limited to the ocular surface are associated with low tumor recurrence.

Retinal nerve fiber/ganglion cell layer (RNFL/GCL) thickness measured using optical coherence tomography has been proposed as an ocular biomarker for children with attention-deficit/hyperactivity disorder (ADHD), but findings varied in different studies. This study aims to determine the association between RNFL/GCL thickness and ADHD in children by systematic review and meta-analysis. We performed a literature search in Embase, PubMed, Medline, Web of Science, and PsycINFO for relevant articles published up to February 29, 2020. All studies with original data comparing RNFL/GCL thickness in ADHD and healthy children were included. The Newcastle Ottawa Scale was used to assess bias risk and quality of evidence. Pooled estimates of the differences in thickness of RNFL or GCL between ADHD and healthy subjects were generated using meta-analysis with a random-effect model due to significant inter-study heterogeneity. Sensitivity analysis was also performed. We identified four eligible studies involving a total of 164 ADHD and 150 control subjects. Meta-analysis revealed that ADHD in children was associated with a reduction in global RNFL thickness (SMD, − 0.23; 95% CI − 0.46, − 0.01; p = 0.04). The global GCL thickness was examined in two studies with 89 ADHD and 75 control subjects, but the pooled difference in global GCL thickness between ADHD children and controls was not statistically significant (SMD, − 0.34; 95% CI − 1.25, 0.58; p = 0.47). Existing evidence suggests a possible association between ADHD and RNFL thinning in children. In view of the limited number of reports, further studies in large cohorts should be warranted.

The aim of this study was to analyse the safety profile and efficacy of ab interno viscocanaloplasty (ABiC) through to 12 months post-operatively. In this retrospective study, the medical records of all patients who underwent ABiC between September 2015 and December 2019 were analysed. Complete success was defined as a 12-month reduction in intraocular pressure (IOP) ≥ 20% from baseline with no concomitant medications. Qualified success criteria were identical, with no more medications than at baseline. In all, 54 eyes of 41 patients were analysed. Mean IOP decreased from 23.6 ± 7.4 mmHg preoperatively to 14.2 ± 2.9 mmHg (-39.8%; p

The aim of the study is to study the safety and efficacy of three cyclodestructive treatments; high-intensity focused ultrasound (HIFU) cyclocoagulation versus micropulse cyclophotocoagulation (MP-CPC) versus transscleral continuous-wave cyclophotocoagulation (CW-CPC) for treatment of non-refractory glaucoma. This is a prospective comparative single-center study. Thirty non-refractory, medically uncontrolled, primary open-angle glaucoma patients with good vision were randomized to a single session of HIFU, MP-CPC or CW-CPC. Intraocular pressure (IOP) reduction, number of medications, success rate, visual acuity and complications were compared between the three groups. Success was defined as an IOP reduction of 30% and IOP between 6 and 21 mmHg with or without medications, in the absence of vision-threatening complications. Thirty patients were enrolled in our study: 10 patients received HIFU, 10 patients received MP-CPC and 10 patients received CW-CPC. At 6 months, IOP was reduced by 31.5%, 23.9% and 19.4% (P = 0.4) achieving a success rate of 50%, 60% and 50% (P = 0.8) for continuous, micropulse and HFU groups, respectively, with reduction in the number of drops and stop of oral acetazolamide. Although the difference in the rate of complications between groups was not significant, CW-CPC group had more complications. Cyclophotocoagulation could be an option in the treatment of non-refractory glaucoma even in patients with good visual acuity, with similar outcomes between the three types of cyclodestruction.

To asses the course of intraocular pressure (IOP) restoration and visual acuity (VA) recovery in eyes with hypotony after trabeculectomy.Medical charts of patients undergoing trabeculectomy between January 2017 and June 2019 were reviewed. Cases with hypotony (IOP 5 mmHg) due to over-filtration in the early postoperative period were assessed retrospectively. Primary outcome measures included change in IOP and VA in the postoperative period and percentage of eyes with hypotony on each follow-up.Thirty-five eyes of 31 patients (23 male, 8 female) were included. The mean follow-up was 18.3 ± 6.9 months. The mean IOP was 3.0 ± 3.2, 9.2 ± 6.2, 9.4 ± 5.6, 9.4 ± 4.0, 10.9 ± 3.6 and 10.2 ± 3.3 mmHg at week 1, months 1, 3, 6, 12 and last follow-up, respectively. Out of 35 hypotonic eyes, 8 (22.8%) had prolonged hypotony at month 1, 4 (11.4%) at month 3, 1 (2.9%) at month 6. The decrease in VA continued to be significant at months 1 and 3 (p = 0.015, p = 0.036, respectively) and returned to baseline after the sixth month (p 0.524).In eyes with early hypotony after trabeculectomy while low IOP recovers at first month, it takes longer for the visual restoration. The postoperative month 1 appears to be decisive for recovery of hypotony.

Many reports have shown that Wnt/β-Catenin pathway is associated with a variety of diseases, but its role in the pathogenesis of myopia is still unknown. In order to clarify the role of Wnt/β-catenin pathway in the development of form deprivation myopia (FDM), this study investigated the expression of scleral Wls, β-catenin and TCF4 in mice model of form deprivation (FD) myopia. Three parallel experimental groups, including FD, monocular exposure (SC) and binocular exposure (NC) group, were designed to investigate the effects of Wnt/β-Catenin pathway on scleral remodeling mouse during form deprivation in three-week-old C57BL/6 mice. Diopters and axial lengths (AL) in each sample were measured with an infrared eccentric refractometer or spectral-domain optical coherence tomography. The expression of scleral Wls, β-catenin and TCF4 were detected with Western blot. Morphological changes of posterior sclera were observed with a transmission electron microscope (TEM). The above characterization and analysis were performed on the 0th, 7th, 14th, 21st and 28th days, respectively. The difference of diopter and AL between the three groups (SC, NC and FD group) gradually increased with the prolongation of FD time (except AL between SC and NC groups). The changes of diopter and AL gradually increased with the prolongation of FD time. Especially, the diopter and AL will increase sharply after FD lasts for a long time, such as the measurement on the 21st for diopter and 28th days for AL. Most notably, the AL of FD eyes significantly increased after 28 days of deprivation. Thinning and disordered arrangement of collagen fibers and a decrease of extracellular matrix were observed with TEM. The expression of scleral Wls, β-catenin and TCF4 increased with age in the NC and SC group. In FD group, they increased significantly on the 7th, 14th and 21st days but decreased on the 28th day. The expression of Wls, β-Catenin and TCF4 to FD were more sensitive indicators than that of diopter and AL. Within the first 7 days of FD, the expression of Wls, β-Catenin and TCF4 in sclera increased sharply. With the extension of FD duration, it gradually decreased. It is suggested that the Wnt/β-catenin pathway might be involved in the scleral remodeling induced in FDM mice.

To evaluate the severity of primary open angle glaucoma (POAG) at presentation using visual field analysis and its relationship to demographic and ocular factors in patients presenting to a tertiary eye care centre. Cross-sectional study. Newly diagnosed POAG patients were classified as early, moderate, or severe stage in the worse eye based on the Humphrey visual field testing using Hodapp–Parrish–Andersons criteria. The groups were compared for differences in demographics and ocular characteristics. Statistical analysis was done using STATA 14.1 (Texas, USA). The average age of 71 eligible patients was 60.04 ± 9.53 years, and the cohort had 29.5% females. Among the subjects, 19 (26.7%) had early, 24 (33.3%) had moderate and 28 (38.89%) had severe POAG at presentation. There was no statistically significant difference among different stages of glaucoma with respect to age and sex groups. No statistical association was found with education, occupation status, presenting complaints, family history of glaucoma, or systemic diseases between the different stages of severity. 5.6% with severe disease presented with a relative afferent pupillary defect (RAPD). The mean intraocular pressure (IOP) in the severe stage was 22.54 ± 5.27 mmHg, which was not statistically higher than the other groups (P = 0.726). Newly diagnosed POAG patients predominantly present at moderate or severe stage of disease, reflecting either the asymptomatic nature of the disease or a lack of access to vision care services. Existing screening programmes need to be improved, with special attention to women and individuals less than 50 years of age.

To investigate the changes and evaluate the diagnosis value of circumpapillary vessel density (VD) in cases of acute primary angle closure (APAC).Case-control study.APAC patients with a history of unilateral acute attack were enrolled. The eyes with acute episode constituted the case group while the contralateral eyes without attack consisted of the control group. Ophthalmic examinations including slit-lamp examination, best-corrected visual acuity, intraocular pressure and visual field were carried out. Retinal nerve fiber layer (RNFL), macular ganglion cell complex (GCC) were measured by spectral-domain optical coherence tomography, while VD was assessed by optical coherence tomography angiography.The whole en face image vessel density (wiVD), circumpapillary vessel density (cpVD) and inside disk VD for both all vessels and capillary were all significantly lower in the APAC eyes compared to the fellow eyes (P 0.01 for all). In APAC eyes, the wiVD, inside disk VD and cpVD both for all vessels and capillary were all positively correlated with RNFL and GCC thicknesses but negatively correlated with the mean deviation (MD), pattern standard deviation (PSD) and the duration of acute attack (all P 0.01). From the ROC curve, the cpVDIn APAC eyes, circumpapillary VD decreased significantly compared with the fellow unaffected eyes. They were significantly correlated with thicknesses of RNFL and GCC, and visual field MD and PSD in the APAC eyes. The patients with longer duration of acute attack were more likely to have lower cpVD. For APAC, the diagnostic ability of wiVD and cpVD was similar with RNFL, GCC and MD and was higher than inside disk VD.

Purpose To evaluate the use of the two-hole technique in augmenting the efficiency of surgeons-in-training when performing the phaco-chop technique. We hypothesized that drilling two holes in opposite angles to each other adjacent to the capsulorhexis would mimic a new lens equator. The phaco-tip and the chopper can be inserted into these holes at appropriate depths and may sandwich and fracture the lens more easily than conventional methods. Methods The two-hole technique described above was performed by three first-year surgeons before they performed the standard phaco-chop technique. We collected data of their first 8 cases and analyzed a total of 64 cases: 16, divide-and-conquer; 24, two-hole method; 24, phaco-chop. The main outcome measures included the cumulative dissipated energy (CDE) and case ultrasound time (UST) with different phacoemulsification techniques. Results The young practicing surgeons eventually performed the standard phaco-chop more safely after repeated practice using the two-hole method. The drilling of holes enabled deep and effortless impaling of the nucleus. Although there was no significant difference in the CDE among the techniques, there was a significant difference in the UST (P Conclusion The two-hole method enabled surgeons-in-training to acquire standard phaco-chop skills more efficiently. However, further studies with higher statistical power will be needed to validate these findings. Additionally, a variation of this technique, the four-hole method, is applicable even for experienced surgeons in cases of a hardened nucleus.

Purpose In this retrospective case series multicentric study, we assessed the efficiency and safety of micropulse transscleral cyclophotocoagulation (MP-TSCPC) among several types of advanced uncontrolled glaucoma cases. This study was intended to be a real-life study. Methods We treated 55 eyes with the Iridex Cyclo G6 device with the MP3 handpiece (IRIDEX Laser Systems) using a standardized protocol. Patients were followed up for a period of one year with an intention-to-treat protocol. Observation points are day 1, week 1, month 1, month 3, month 6, month 9 and year 1 after treatment. The primary outcome is a significant decrease in intra-ocular pressure (IOP) with a threshold of 20% reduction. The secondary outcomes are a reduction in the number of topical molecules needed to control glaucoma progression and the discontinuation of oral acetazolamide. Results We observed a significant IOP reduction at every observation point with a mean preoperative IOP of 24.19 mmHg (SEM: 0.96) and mean IOP at final follow-up was 19.50 mmHg (SEM: 1.20). At least 50% of patients reached the significant threshold of 20% IOP reduction at every observation point except for month 6 follow-up. No significant reduction was achieved in the number of topical medications necessary to control glaucoma progression. Mean number of topical medications used at final follow-up is 3.00 (SEM: 0.134). Mean number of topical molecules preoperatively was 3.08 (SEM: 0.138). The discontinuation of oral acetazolamide was obtained with a statistically significant difference (p = 0.003). Conclusion Thanks to the design of this study, we add some proofs about the efficiency and the safety of MP-TSCPC for the treatment of uncontrolled advanced glaucoma cases in a real-life practice.

Purpose To evaluate choroidal thickness (CTh) in children with chronic heart failure (CHF) secondary to dilated cardiomyopathy (DCM) using spectral domain optical coherence tomography (SD-OCT) and to compare their values to those of healthy children. Methods Sixty eyes of thirty children (mean age 9.9 ± 3.57 years) with chronic heart failure (left ventricular ejection fraction, LVEF ≤ 55%) due to DCM lasting for over 6 months were prospectively enrolled. The control group consisted of 30 age- (mean age 10.16 ± 3.42 years) and sex-matched healthy children. All participants underwent transthoracic echocardiography with LVEF measured using the Simpson method and had the blood serum level of N-terminal-pro-brain natriuretic peptide marker (NT-proBNP) determined. All children underwent SD-OCT and had subfoveal choroidal thickness (SFCTh) and CTh measured at 1500 µm (μm) nasally, temporally, superiorly and inferiorly from the fovea in both eyes by two investigators. Results CTh at all locations was statistically significantly lower in children with DCM compared to the control group. Mean CTh in the group with CHF compared to the control group were (304.03 vs. 369.72 μm, p p p p p p p Conclusion Patients with CHF due to DCM had a thinner CTh at all measured locations. The results of our research indicate that CHF affects CTh and this parameter may be very helpful in monitoring the clinical course of the disease in children with DCM.

To quantitatively analyze α-zone and β-zone peripapillary atrophy (PPA) in patients having early primary open-angle glaucoma (POAG) using fundus autofluorescence (FAF) in conjunction with spectral domain optical coherence tomography, colored photography and perimetry. This is an observational cross-sectional case–control study. This study included 100 eyes (54 patients) of early to moderate POAG and 100 normal eyes (50 subjects). Ophthalmological examination, OCT for the optic nerve and FAF were performed. The extent of α-PPA and β-PPA was measured. The extent of α-PPA and β-PPA as measured by FAF had higher values in POAG group as compared to control group (p values 0.003 and ≤ 0.001 for the total nasal and temporal extents, respectively). However, the nasal alpha and temporal beta zones showed more values in POAG patients as compared to normal controls (p values 0.002 and 0.024). The difference between the total extents of either zones alone was not significant. B-scan OCT was able to positively detect both zones. Detecting the alpha zone was significantly higher in the control group, while beta zone detection was significantly higher in the POAG group (p values ≤ 0.001). The sensitivity of alpha zone detection was equal using colored photographs, FAF and B-scan OCT. FAF showed superior results in estimating the beta zone extent although OCT was more accurate in the anatomical delineation of Bruch’s membrane and RPE termination. The nasal alpha and temporal beta zone extents could be taken as early indices for evaluating early glaucomatous optic neuropathy.

Introduction Nearly 6.8 million people in India have vision less than 6/60 in at least one eye due to corneal diseases; of these, about a million had bilateral involvement. Purpose To identify the challenges faced; the trends in collection, storage and utilisation of corneal tissues in an eye bank in north India. Materials and methods The past records of Eye Bank linked to a tertiary hospital in northern India were analysed from November’1999 to October’2015 with respect to number of eye donations per year, donor demographics and utilisation of corneal tissues. Results The number of donations during the first 6 years were 100, 279 in the next 5 years and 473 in the last 5 years. The mean donor age was 63.2 ± 19.5 years. The percentage of donors less than 30, 31–60 and more than 60 years was 10%, 28% and 62%. Forty-two percent donations were from the hospital. The average time between the death and enucleation was 4.74 ± 5.31 hours. The percentage of corneas used in the donor age groups less than 30, 31–60 and above 60 years was 61.9%, 61.6% and 53.8%, respectively. The usability rate of the corneas from home and hospital was 63.7% and 55.3%, respectively. Conclusions The eye bank had a lukewarm response in the beginning, but gained momentum with time. The myths and beliefs prevalent in our society deter people from donating eyes freely. Each eye bank needs to individualise its problems and find solutions for adequate procurement and utilisation of tissue.

To evaluate the efficacy and safety of ultrasound cycloplasty procedures (UCP) in patients with uncontrolled glaucoma. Prospective longitudinal study with UCP was performed by EyeOP1© probe with 8 s duration on 6 or 8 sectors, according to baseline intraocular pressure (IOP). Complete ophthalmic examination was performed pre- and post-operatively at 1st day, 1st week, 1st, 3rd, 6th, 9th and 12th months. UCP was repeated beyond 3rd month if IOP was > 21 mmHg, under maximum therapy, without major complications. Primary outcomes were complete (IOP reduction ≥ 20% or reduction in number of antiglaucomatous drugs and IOP ≥ 5 mmHg without occurrence of major complications) and qualified (IOP reduction ≥ 20% or reduction in number of antiglaucomatous drugs and IOP ≥ 5 mmHg) surgical success rates at 12 months. Secondary outcomes were mean IOP reduction, mean number of drugs reduction, rates of failure, number of repeated procedures, mean time to failure and occurrence of complications. Fourteen eyes of 13 patients (11 male) with advanced glaucoma (Hoddap classification) were included. Six were surgically naive. Mean age was 68.29 ± 10.66 years. Four eyes were treated in 8 sectors (28.5%). Patients were followed for 12 months after first UCP procedure. Overall surgical success was achieved in 92.9% at 6 months and in 100% of cases at 12 months. Mean IOP significantly reduced from 28.50 ± 7.61 mmHg to 13.79 ± 6.97 at 1 month, 17.36 ± 8.58 at 3 months, 17.79 ± 6.29 at 6 months, 16.3 ± 4.6 at 9 months and to 15.23 ± 5.09 at 12 months (p

The aim of this paper was to study the correlation and agreement between the intraocular pressure (IOP) peak value and fluctuations detected with the modified diurnal tension curve (mDTC) and the water drinking test (WDT) in pseudoexfoliation glaucoma (XFG) patients. This prospective observational study enrolled 42 eyes of 42 XFG patients. The IOPs were measured at 2-h intervals from 8 am to 4 pm with a Goldmann applanation tonometer by a single observer to establish the mDTC. The WDT was then performed between 4 and 5 pm on the same day and the IOP was measured 4 times at 15-min intervals after water ingestion. The IOPpeak, IOPmean, IO min, and IOPfluctuation were measured with both the mDTC and WDT. The paired sample t test, Spearman's correlation coefficient and Bland–Altman plots were used for statistical analysis. The mean age of the 42 patients consisting of 24 females and 18 males was 66.9 ± 6.8 years, and the mean central corneal thickness was 517.7 ± 29.1 µm. The mean values with the mDTC and WDT measurements were 15.05 ± 2.75 mmHg and 17.17 ± 3.25 mmHg (p ≤ 0.0001, r = 0.884) for IOPmean, 16.76 ± 3.45 mmHg and 18.92 ± 3.94 mmHg (p ≤ 0.0001, r=0.787) for IOPpeak, and 13.61 ± 2.56 mmHg and 15.11 ± 2.84 mmHg (p ≤ 0.0001, r=0.824) for IOPmin, respectively, and a positive correlation was present between these values. There was a positive correlation between the peak, minimum, and mean IOP values determined using the mDTC and WDT in treated XFG patients. WDT can be used as an alternative in the assessment of the IOP in these patients as a more practical method.

To investigate refractive and visual outcomes as well as rotational stability following implantation of Eyecryl phakic toric intraocular lens (pIOL) for moderate-to-high myopic astigmatism. The efficacy, safety, predictability, stability, and adverse events of Eyecryl toric pIOL were evaluated in patients with spherical refraction from − 4.50 to − 18.50 diopters (D) and cylindrical refraction from − 0.50 to − 5.50 D. This study included 60 eyes of 31 patients. The mean manifest refraction spherical equivalent (MRSE) dropped from − 10.45 ± 2.74 D preoperatively to − 0.34 ± 0.51 D and − 0.40 ± 0.56 D at 6 and 12 months postoperatively, respectively. There was an 81% decrease in astigmatism after surgery. The safety and efficacy of indices were 1.36 ± 0.43 and 1.20 ± 0 .32. At the final follow-up, the rate of eyes within ± 1.00 D and ± 0.50 D of the desired MRSE were 85% and 68.33%, respectively. Vision-threatening complications were not observed during the follow-up. The implantation of pIOL was effective, safe, and predictable in patients with moderate-to-high myopic astigmatism during 1-year follow-up.

To investigate the effect of corneal shape parameters on corneal deformation responses measured with a Scheimpflug camera. A total of 241 eyes of 241 participants were enrolled in this study. The anterior and posterior corneal curvature radii (CCR), anterior and posterior corneal Q-values, and corneal diameters of the participants were measured using the Pentacam HR. A total of 17 corneal deformation parameters including time, velocity, deflection amplitude, length, and area during ingoing applanation, highest concavity, and outgoing applanation were recorded by corneal visualization using Scheimpflug technology (Corvis ST). The effect of corneal shape parameters on corneal deformation responses was evaluated using multivariate regression models. Multivariate regression analyses showed that six, five, four, and three corneal deformation parameters were significantly correlated with anterior CCR, posterior CCR, anterior Q-value, and posterior Q-value, respectively. Steeper anterior corneal curvature was associated with faster velocity during ingoing applanation and greater deformation during outgoing applanation. Steeper posterior corneal curvature was correlated with faster velocity during outgoing applanation and greater deformation during ingoing applanation. Eyes that had steeper corneal curvatures were associated with less stiff corneas. More negative anterior Q-value corresponded with faster velocity and greater deformation during ingoing applanation. Eyes that had more prolate posterior corneal surfaces showed more resistance to corneal deformation at the highest concavity. However, corneal diameter was not selected in any corneal deformation parameters models. Corneal deformation response is significantly influenced by anterior and posterior corneal curvature and corneal asphericity, but not corneal diameter.

To investigate the impact of oxygen delivery on the clinical outcomes of accelerated transepithelial corneal cross-linking (A-TE CXL). Fifty-seven eyes of 44 progressive keratoconus (KCN) patients were randomly separated into two age–sex-matched groups. Twenty-nine eyes of 23 KCN patients that underwent oxygen-supplemented A-TE CXL formed the study group and 28 eyes of 21 patients treated with the same procedure but under room air conditions formed the control group. All patients were examined preoperatively, one, six and twelve months after the procedure. The logMAR spectacle-corrected distance visual acuity (CDVA), maximum keratometry (Kmax), mean keratometry, apical posterior keratometry, cylindrical power, minimum central corneal thickness, keratoconus vertex front and back, ocular aberrations, endothelial cell density (ECD), demarcation line depth (DLD) and proportion measures were recorded for statistical analysis. The preoperative, 1st, 6th and 12th months mean Kmax values of the study group were 55.14 ± 3.99D, 54.85 ± 3.82D, 54.37 ± 3.84D and 54.40 ± 3.86, respectively, and 54.47 ± 3.17D, 54.52 ± 2.97D, 54.25 ± 2.95D and 54.20 ± 2.97 in the control group. The mean Kmax value was decreased significantly more in the oxygen-supplemented group after 12 months compared to the control group (p = 0.019). The mean DLD was also significantly deeper in the study group (320 ± 17 µm) compared to the control group (269 ± 19 µm). There was no significant difference between the two groups in terms of ECD alterations at any of the time intervals (p > 0.05). Keratoconus progression was significantly halted in both groups 12 months after the treatment. In addition, oxygen supplementation during A-TE CXL further significantly increased clinical outcomes compared to room air conditions without any significant change in ECD measures.

Purpose To study the indications and clinical outcomes, in a real-word setting, of amniotic membrane extract eye drops (AMEED) use for ocular surface disease (OSD). Methods A retrospective study of patients treated with topical AMEED between January 2018 and January 2020 was conducted. Patients were classified in two groups according to specific OSD-dry eye disease (DED) and wound healing delay (WHD) groups. Demographics, comorbidities, treatment duration and clinical outcomes were analysed. Results A total of 50 eyes of 36 patients with or without previous treatments were included. Patients in the DED group presented more systemic comorbidities (83 vs 22%; p < 0.001) and spent more mean time under AMEED treatment (10 vs 7.2 months average) than the WHD group (p = 0.0104). In four patients, long-term treatment (more than 24 months) was reported. Global similar symptomatic improvement was reported for both groups (DED 88.9% vs WHD 100%; p = 0.486), with the WHD group especially consisting in general relief (78%) and the DED group reporting more pain improvement (44%) (p = 0.011). Regarding patients with autologous serum as a previous treatment, no statistical differences were found in subjective or objective improvement. An overall success was achieved in 94.4% of the cases and no adverse events were found. Conclusion AMEED administration is a promising mean to treat OSD such as dry eye, persistent epithelial defect and corneal ulcers. Although AMEED may be effective in the treatment of severe DED and persistent epithelial defect or corneal ulcers, conclusions are limited owing to the absence of controlled clinical trials.

To compare the visual and refractive outcomes of bifocal toric and trifocal toric intraocular lenses (IOL) in patients with moderate to high myopia at 12 months after implantation. This is a prospective and comparative study. In 120 eyes with moderate to high myopia and astigmatism, bifocal toric IOLs (n = 60 eyes) or trifocal toric IOLs (n = 60 eyes) were implanted. Eyes with axial lengths from 24.0 to 26.5 mm were included. Postoperative examinations measured near, intermediate, and distance visual acuity (VA), along with refractive measurements, binocular defocus curves, and patient satisfaction with the National Eye Institute Visual Function Questionnaire. For uncorrected- and corrected distance intermediate VA, the trifocal group showed significantly better VA at 1, 3, 6, and 12 months than the bifocal group. Driving subscale scores from the questionnaire were significantly better in the trifocal than the bifocal group. Concerning the binocular defocus curve, uncorrected distance VA was significantly higher in the trifocal than bifocal group at test distances of -1.5 D. Both trifocal and bifocal toric IOLs effectively corrected the near, intermediate, and distance vision in patients with moderate to high myopia and astigmatism. However, intermediate vision was significantly better in eyes with trifocal than bifocal toric IOLs.

To investigate the safety and efficacy of femtosecond laser-assisted penetrating keratoplasty (FLAK) versus conventional penetrating keratoplasty (CPK). A literature search of PubMed, Cochrane, Embase, Web of Science, and Clinicaltrials.gov was conducted for comparative studies published from January 2007 to October 2019. Studies that involved both FLAK and CPK groups and reported on the relevant efficacy and/or safety parameters were included. The Newcastle–Ottawa quality assessment scale was used to analyse the methodological quality of these studies. Further, weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. From the screened articles, a total of 1991 eyes from nine comparative studies were included. FLAK was not statistically superior for twelve-month postoperative best corrected visual acuity (WMD = − 0.06; 95% CI [− 0.16, 0.04]; P = 0.22), corneal astigmatism (WMD = − 0.81; 95% CI [− 1.63, 0.01]; P = 0.05) or six-month postoperative uncorrected visual acuity (WMD = − 0.11; 95% CI [− 0.27, 0.06]; P = 0.21). There were no significant differences in corneal graft rejection rate and the graft failure between FLAK and CPK at twelve months postoperative. However, best-corrected visual acuity (BCVA) and corneal astigmatism corrected with FLAK were better than those with CPK six months postoperative after elimination of data heterogeneity. Visual outcomes improvement in FLAK was better than that in CPK at six months postoperative, but not twelve months postoperative. This review recommends selecting a technique based on patients’ work demands and economic burdens.

To develop an automatic algorithm to analyze dystrophic lesions on photographic images of corneal dystrophy. The dataset included 32 images of corneal dystrophy. The dystrophic area was manually segmented twice. Manually labeled dystrophy areas were compared with automatically segmented images. First, we manually removed the light reflex from the image of the cornea. Using an automatic approach, we extracted the brown color of the iris. Then, the program detected the circular region of the pupil and the corneal surface. A whitish dystrophy area was defined based on the image intensity on the iris and the pupil. The sliding square kernel was applied to clearly define the dystrophic region. For the manual analysis and the twice automatic approach, the Dice similarity was 0.804 and 0.801, respectively. The Pearson correlation coefficient was 0.807 and 0.806, respectively. The total number of distinct dystrophic areas showed no significant difference between the manual and automatic approaches according to the Wilcoxon signed-rank test (p

To analyze intraocular pressure (IOP) and glaucoma-associated factors in children. A total of 4438 children aged 7–16 years (2321 boys and 2117 girls) were included in this study. Various ophthalmologic [IOP, central corneal thickness (CCT), etc.] and demographic (body mass index, etc.) parameters were evaluated. IOP increased between the ages of 7 and 9 years, peaking at 9 years. IOP increased after reaching a trough at 11 years and subsequently stabilized after 14 years. Girls exhibited thinner CCT (534.28 ± 30.84 µm vs. 537.04 ± 31.33 µm, P = 0.003), thicker lens thickness (3.56 ± 0.21 mm vs. 3.54 ± 0.20 mm, P = 0.001), shorter axial length (22.91 ± 0.93 mm vs. 23.32 ± 0.89 mm, P

This study describes presenting clinical features and surgical techniques associated with successful repair of pediatric rhegmatogenous retinal detachment (RRD). This is a retrospective case series which involved 242 cases younger than 18 years with new-onset RRD with descriptive statistics for the full group. Further exclusion established 168 cases that underwent surgery with minimum 3-month follow-up. Comparison of features associated with successful outcomes was analyzed using Chi-squared tests, logistic regression and univariate generalized equation models. We measured proportion of patients with BCVA ≤ 1.0 logMAR and/or an increase in final BCVA of 0.3 logMAR with respect to baseline and complete reattachment at final visit; 104 eyes (62%) achieved total reattachment, and 91 eyes (54%) achieved visual success. Absence of macular involvement, subtotal RRD and older age group (13–18) were associated with both success measures. There were higher visual and anatomic success rates with primary scleral buckling (SB, 66% and 79%; OR 9.26 and 11.09) and combined SB plus pars plana vitrectomy (PPV, 54% and 58%; OR 5.67 and 3.94) compared with PPV alone (26% and 17%). A majority of patients achieved anatomical success with repair. Trauma and myopia were the most common etiologic associations, with myopic cases having better outcomes. Success was more likely in patients with subtotal RRD or uninvolved macula at presentation; previous intraocular surgery was a risk factor for failure. Younger patients had a higher likelihood of worse outcomes. Initial PPV showed a lower rate of success than either SB or combined SB/PPV.

To characterize the imaging features in eyes with vitreoretinal lymphoma (VRL) using ultra-widefield fundus photography (UWF-FP), swept-source optical coherence tomography (SSOCT) and fundus autofluorescence (FAF) that are correlated to ongoing treatment with intravitreal Rituximab(IVR).Retrospective observational imaging-based study of 15 treatment-naive eyes with VRL treated with IVR. All patients with primary VRL underwent vitreous biopsy using 23/25G microincision vitrectomy system for confirmation of diagnosis. All eyes received monthly IVR (1 mg/0.1 mL) injections till disease remission. Baseline clinical characteristics, treatment details, outcomes, and sequential imaging features on UWF-FP, FAF, and SSOCT were analyzed.Baseline features and changes in UWF-FP, FAF patterns, and SSOCT features in response to treatment RESULTS: Clinically, patients presented with sub-RPE deposits (n = 15), superficial retinal hemorrhages (n = 2), 'giant' RPE (retinal pigment epithelium) holes (n = 2), and anterior segment reaction (n = 1). Eyes were treated with mean 5.7 IVR injections (median: 5; range 1-13) over a mean 7.2 ± 4.9 months. During the course of treatment, two eyes developed superficial retinal hemorrhages with spontaneous resolution, 2 eyes developed CME, and 4 eyes developed characteristic 'leopard skin' pigmentation. Hyper-autofluorescence corresponding to areas of active lesions decreased with each treatment cycle and was finally replaced by hypo-autofluorescence. Serial OCTs showed regression of sub-RPE/subretinal deposits (n = 15), ellipsoid zone disruption (n = 9), and its resolution with treatment (n = 3), epiretinal membrane (ERM; n = 6), choroidal hyperreflective foci (HRF; n = 4), disorganization of retinal inner layers (DRIL; n = 3), RPE-rip (n = 2), cystoid macular edema (CME; n = 2), and hyperreflective lesions in the choroid (n = 1). Complete resolution was observed in all eyes with extensive hypo-AF. The central foveal thickness decreased from 237 ± 113 μ to 182 ± 114 μ (p = 0.1) and subfoveal choroidal thickness decreased from 258 ± 66 μ to 220 ± 64 μ (p = 0.12) at final follow-up. The mean baseline BCVA was logMAR 0.9 ± 0.9 that deteriorated to mean logMAR 1 ± 1 final visit (p = 0.7). The mean recurrence-free follow-up was 5.9 ± 5.1 months CONCLUSION: Multimodal imaging provides novel insights into features of VRL, a better understanding of regression patterns, and prognostication of outcomes when treated with intravitreal rituximab. Larger, multicentric studies with longer follow-up will help unravel imaging biomarkers to understand these aspects better.

To study frequency and characteristics of ocular manifestations in Indian patients with collagen vascular disorders. The medical records of 73 patients (Males: Females 16:57) aged between 22 and 78 years (mean ± SD = 43.5 ± 12.9 years) with collagen vascular diseases were analyzed retrospectively for demography, subtypes of collagen vascular disease, and findings of complete ophthalmic examination. Lupus erythematosus (LE) in 39(53.4%, (SLE 18, DLE 21), systemic sclerosis in 27(37%), dermatomyositis in 5(6.8%), and primary Sjogren's syndrome in 2(2.7%) patients, respectively, were observed. Only 35(47.9%) patients had ocular manifestations. In LE keratoconjunctivitis sicca (n = 6), keratitis (n = 5), severe blepharitis (n = 3), retinopathy (n = 2), and optic neuritis in one patient, respectively, were major ocular manifestations. Major abnormalities occurring in systemic sclerosis included restricted eyelid mobility of variable severity (n = 8), eyelid telangiectasia (n = 5), keratoconjunctivitis sicca (n = 6), cataract (n = 5), shallow fornices (n = 4), conjunctival surface disease (n = 4), and uveitis, keratitis, episcleritis in one patient each, respectively. One patient with dermatomyositis had heliotrope rash. Two patients with primary Sjogren's syndrome had keratoconjunctivitis sicca. The study shows that LE frequently presented with keratoconjunctivitis sicca, retinopathy, and optic neuritis. Systemic sclerosis commonly develops eyelid immobility, blepharitis and telangiectasia, ocular surface disease and keratoconjunctivitis sicca, corneal abnormalities, and uveitis. A comprehensive ocular evaluation is imperative for early detection and management particularly of ocular surface disease, uveitis, and retinopathy to prevent potential sight-threatening complications. Limitations include retrospective study design and small number of patients for stratification.

To study the impact of prophylactic intracameral (IC) moxifloxacin on the incidence, clinical profile and outcomes in eyes developing post-cataract surgery endophthalmitis (PCE). This was a single-centre, retrospective, comparative, observational study in which all eyes with PCE between June 2013 and May 2014 without IC moxifloxacin prophylaxis (group A) and June 2015–May 2016 with IC moxifloxacin prophylaxis (group B) were analysed. A total of 101,815 cataract surgeries were performed in group A and 112,967 in group B. PCE was diagnosed in 179 eyes (0.18%) in group A and 92 eyes (0.08%) in group B (p

Abnormal accommodative convergence per diopter of accommodative response (AC/A ratio) ratio is an important factor leading to myopia. This study aimed to examine the effect of refractive correction on the gradient of AC/A ratio with low-to-moderate myopia in children and adolescents. Children and adolescents aged 8-18 years, with low and moderate myopia, were divided into groups of myopia with no refractive correction and myopic continuous refractive correction of more than half a year. Then, in accordance with the myopia gradient, they were further divided into 0.00 to - 1.50, - 1.75 to - 3.00, - 3.25 to - 4.50, and - 4.75 to - 6.00 groups. Results showed that the AC/A ratio of the myopic group without refractive correction history was significantly higher than that with refractive correction history for more than half a year. The AC/A ratio increased with the deepening of myopia in the group without refractive history of myopia. However, it decreased significantly in the group with refractive history of myopia for more than half a year. Therefore, the AC/A ratio is related to the degree of uncorrected myopia, and it increases with the degree of uncorrected myopia.

To evaluate whether the anterior segment topographic measurements, meibomian gland (MG), and non-invasive tear film break-up time (NITFBUT) differ between healthy children and children with isolated growth hormone deficiency (GHD). A total of 74 eyes of 37 children with GHD and 84 eyes of 42 age- and sex-matched healthy children were included in the study. The spherical equivalence (SE), mean keratometry (Km), corneal thickness, corneal volume (CV), anterior chamber depth (ACD), topographic NITFBUT, qualitative and quantitative MG measurements, corneal endothelial cell density (CD), and proportion of hexagonal cells (HG) were analysed. The mean SE level of GHD group was similar between groups (p = 0.017). Back Km values were insignificantly steep in children with GHD (p = 0.004, with Bonferroni correction). Specular microscopy analysis was not different between groups. MG loss of GHD group were higher than control group (p 0.05). Our results showed that the growth hormone (GH) may have an important role on the anterior segment parameters; however, it is not clear that this misregulation leads to a clinical scenario in childhood. Future studies investigating GHD and/or GH therapy on the ocular surface system are required to clearly demonstrate basic mechanism of GH action.

To evaluate the incidence of non-glaucomatous ocular disease in patients with asymmetric optic disc cupping. A retrospective case series, including consecutive patients with cup-to-disc ratio (CDR) asymmetry greater than 0.2. All patients underwent a complete neuro-ophthalmological examination, automated perimetry with the Humphrey 24-2 visual fields program. Retinal nerve fibre layer thickness was measured by optical coherence tomography (OCT). The results of neuroimaging, macular OCT and blood tests were recorded as well. Patients were assigned a diagnosis of glaucomatous optic neuropathy (GON) or non-glaucomatous disease (NGD). The main outcome measure was the rate of non-glaucomatous ocular disease. A total of 120 (67 males) patients with a mean age of 71.1 ± 12.5 years met the inclusion criteria and were included in this study. The mean asymmetry in CDR between the eyes was 0.3 ± 0.13 (range, 0.2–0.9). Twenty patients (16.6%) had a visual field defect not typical for glaucoma and positive relative afferent pupillary defect was found in 24 patients (20%). Six patients were found to have newly diagnosed non-glaucomatous ocular disease: maculopathy in three patients, retinopathy in one patient and traumatic optic neuropathy in two patients. Patients with NGD were significantly younger than the patients with GON (59.8 ± 23.3 vs. 71.3 ± 11.5 years, P = 0.001). Optic disc pallor was found in 4/93 patients with glaucoma compared to 3/6 with newly diagnosed non-glaucomatous disease (4.7% vs. 50.0%, P = 0.03). Asymmetric optic disc cupping can be associated with non-glaucomatous disease and may warrant neuro-ophthalmological evaluation, especially in younger patients or those with optic disc pallor.