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Purpose: To assess intra‐ (repeatability) and inter‐observer (reproducibility) variability of laser speckle flowgraphy (LSFG) for retinal blood flow (RBF) measurement in 20 eyes of wild type (C57BL/6J) mice and effect of intravitreal Aflibercept on RBF in optic nerve head (ONH) region of 10 eyes of Ins2 (Akita) diabetic mice. Methods: 'Mean blur rate (MBR)' was measured for all quadrants of tissue area (MT), vessel (MV) and total area (MA) of ONH region. Changes in MT were analysed at each timepoint. Repeatability was evaluated by measuring MBR variability without changing mouse head position, and reproducibility after resetting mouse head position by another operator. Coefficient of repeatability (CR) through Bland–Altman plot method coefficient of variation (COV) and Intraclass correlation coefficient (ICC) was calculated. Intravitreal Aflibercept (1 μg) was administered to Akita eyes and intraocular pressure (IOP) was measured using a tonometer at baseline, day 7, 14, 21 and 28 post‐injection. Hurvich and Tsai's criterion was used. Results: Coefficient of repeatability values of repeatability and reproducibility for all quadrants were within limits of agreement. Reliability was excellent (ICC 0.98–0.99) and reproducibility was moderate to excellent (ICC 0.64–0.96). There was a non‐significant IOP increase in all Akita eyes at Day 28 (p > 0.05), and significant increase in MT in all quadrants at Day 21 and superior, inferior and temporal quadrants at Day 28 (p < 0.05). Conclusion: Laser speckle flowgraphy demonstrates excellent repeatability and moderate to excellent reproducibility in measuring RBF. Intravitreal Aflibercept injection results in a significant increase in MT up to 28 days post‐injection without significant increase in IOP. [ABSTRACT FROM AUTHOR]

Purpose: To examine the incidence, clinical findings and management of pellet gun-related ocular injuries that occurred during protests in Kashmir region.Methods: This retrospective study included records from 777 patients diagnosed with pellet gun-related ocular injuries admitted to a tertiary hospital in Srinagar, India, between July and November 2016. By reviewing the clinical records, the following data were collected: demographics, clinical information pertaining to the injury, imaging reports including computer tomography and ultrasonography B-scan, management in the emergency setting, and follow-up treatment.Results: Mean age was 22.3 ± 7.2 years and majority patients were male (97.7%). In terms of laterality, 94.3% and 5.7% of the patients sustained monocular and binocular injuries, respectively. In terms of the nature of injury, 76.3% of the eyes had open globe injury while 23.7% of the eyes had closed eye injury. Emergency surgical exploration was performed in 67.7% of closed globe injuries while emergency primary repair was done in 91.1% of open globe injuries. The vast majority of patients (98.7%) who required surgery underwent surgical intervention on the day of admission or the next day. Final best-corrected visual acuity (BCVA) after treatment was counting fingers or worse in 82.4% of the eyes.Conclusion: Pellet gun-related ocular injuries resulted in significant ocular morbidity, mostly manifesting as open globe injuries. Treatment often required surgical interventions, but despite expeditious management, visual prognosis remained poor for most of the patients. [ABSTRACT FROM AUTHOR]

Minimally invasive glaucoma surgery (MIGS) has grown in popularity over the past decade. This systematic review explores the peri‐operative and intraoperative application of anterior segment imaging to maximize the efficacy and safety of MIGS. A review of the PubMed, EMBASE and CINAHL databases was conducted, with inclusion criteria restricted to MIGS that had received United States Food and Drug Administration (FDA) premarket approval, FDA 510(K) premarket notification, or were listed as a class 1 device exempt from FDA approval or notification. 21 manuscripts from 21 unique studies were identified pertaining to MIGS devices including the XEN Gel Stent, Trabectome, iStent Inject, 1st‐generation iStent and the Kahook Dual Blade (KDB). Anterior segment imaging modalities included anterior segment optical coherence tomography (AS‐OCT), ultrasound biomicroscopy (UBM), aqueous angiography, OCT volumetric scans and in vivo confocal microscopy. Identification and evaluation of aqueous outflow pathways before and after MIGS have potential for improving patient preoperative patient selection and postoperative outcomes. Intraoperative imaging potentially provides the resolution needed for good visualization of angle anatomy and accurate evaluation of surgical endpoints in angle‐based MIGS. Anterior segment imaging has been used to identify procedural complications, provide objective information on implant location in relation to surrounding anatomy, assess the post‐implantation structural impact of MIGS devices and manage bleb failure and scarring. Technical difficulties in incorporating imaging modalities into the surgical microscope, variable quality of images and optical interference from ocular structures or surgical instruments are remaining barriers, which discourage the widespread clinical use of this technology. [ABSTRACT FROM AUTHOR]

To investigate the associations of Single Nucleotide Polymorphisms (SNPs) in the SNTB1 gene with high myopia in a Han Chinese population. Based on previous studies, four SNPs from the SNTB1 gene were chosen for genotyping. This is a case-control genetic association study comprising 193 high myopia participants and 135 normal emmetropic controls from a Han Chinese population. Allelic frequencies of the SNPs and haplotypes were compared to assess the associations of the SNPs with high myopia and axial length (AL). The SNPs rs7839488 (effect allele: A; OR = 0.685), rs4395927 (effect allele: T; OR = 0.692), and rs6469937 (effect allele: A; OR = 0.683) displayed significant associations with high myopia initially (P =.044, 0.049, and 0.035, respectively), but did not withstand permutation testing (all Ppermutation>0.05). rs6469937 displayed associations with high myopia in the dominant model (AG+AA: OR = 0.609) against GG (reference). rs6469937 was also associated with AL in the dominant model (AG+AA: Beta = −0.58) against GG (reference). The haplotype analysis demonstrated ATGA as the protective haplotype against high myopia, which remained statistically significant in permutation testing (Ppermutation = 0.045). Our findings are suggestive that SNTB1 is associated with high myopia in a Han Chinese population. [ABSTRACT FROM AUTHOR]

Purpose: To report two cases of young immunocompetent males with herpes simplex acute retinal necrosis (HSV ARN) with initial diagnosis of unilateral disc swelling.Methods: Retrospective case series.Results: Two young immunocompetent males who were diagnosed to have unilateral disc swelling were treated as presumed optic neuritis and started on systemic steroids. On dilated fundal examination, unilateral retinitis and vasculitis was found after 2-3 days of systemic steroids and the diagnosis of ARN was made. Tetraplex vitreous tap subsequently returned as HSV-2 and HSV for the first and second patient, respectively. Both patients had no significant systemic medical history and tested negative for human immunodeficiency virus (HIV). Despite aggressive treatment, both patients developed profound visual morbidity.Conclusions: Close monitoring of patients with unilateral disc swelling and dilated fundus evaluation is critical, particularly upon initiation of systemic steroid therapy, even if immunocompetent, as misdiagnoses can result in potentially devastating consequences. [ABSTRACT FROM AUTHOR]

Prcis: This study reports 12-month outcomes of combined phacoemulsification and Hydrus Microstent implantation in Asian eyes with moderate-to-severe normal tension glaucoma (NTG), demonstrating a significant reduction in glaucoma medications with an excellent intra and postoperative safety profile., Objective: To evaluate the 12-month safety and efficacy outcomes of combined phacoemulsification and Hydrus Microstent (Ivantis Inc.) implantation in Asian eyes with moderate to severe NTG., Methods: Retrospective study of consecutive surgeries performed from August 2019 to August 2021 in a single tertiary eye centre in Singapore. Outcome measures included a reduction in intraocular pressure (IOP), number of glaucoma medications, and intra and postoperative complications., Results: Data from 21 eyes of 21 subjects were analyzed. All subjects were ethnic Chinese, and the majority were males (14, 66.7%). At baseline, the mean IOP was 13.3 (2.3) mm Hg, all eyes had a Humphrey visual field mean deviation of ≥-6 dB [mean: -13.9 (4.3) dB], and all eyes were on at least one glaucoma medication. There was no statistically significant reduction in IOP at all time points compared with baseline (all P > 0.05). However, the median number of medications was reduced from 2 to 0 at all time points, up to postoperative month (POM) 12 (all P < 0.001). There were no intraoperative complications. No eyes underwent secondary glaucoma procedures nor lost any Snellen line of visual acuity by POM12. One (4.8%) eye experienced numerical hypotony at postoperative day 1, which resolved conservatively. Two (9.5%) eyes underwent laser iridoplasty for stent occlusion by iris. There was no deterioration in Humphrey visual field mean deviation at POM12 compared with baseline (n = 20, P > 0.05)., Conclusion: Combined phacoemulsification and Hydrus Microstent implantation were effective in reducing medication burden in Asian eyes with moderate to severe NTG, up to 12 months postoperatively., Competing Interests: Disclosure: B.C.H.A. has received speaker's honoraria from Alcon, Inc. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To compare the safety and effectiveness of standalone Kahook Dual Blade (KDB) excisional goniotomy to standalone ab-interno Xen gel stent implantation in eyes with moderate-to-severe open-angle glaucoma (OAG)., Methods: A single-center, retrospective study including eyes with moderate-to-severe OAG undergoing standalone KDB goniotomy or Xen gel stent implantation was conducted. Intraocular pressure (IOP), the number of antiglaucoma medications taken daily, and best-corrected visual acuity (BCVA) were recorded at baseline and for up to 36-months. Primary outcomes assessed included changes from baseline in IOP and the number of antiglaucoma medications taken. Intergroup comparisons were conducted using independent-samples Student's  t -tests. The incidence of intraoperative and postoperative adverse events and the need for glaucoma surgical re-interventions were also recorded., Results: Eyes receiving standalone KDB (n=26) or Xen gel stent (n=45) surgery were analyzed. The baseline mean IOP and number of antiglaucoma medications in both groups were as follows: KDB: 23.2 ± 6.0 mmHg, 2.2 ± 1.4 medications; Xen: 22.7 ± 8.8 mmHg, 3.0 ± 1.0 medications. At 36 months, IOP was reduced to 16.6 ± 5.4 mmHg in KDB eyes (n=23, -23.5%; p=0.0004) and 15.3 ± 5.6 mmHg in Xen gel stent eyes (n=15, -22.1%; p=0.006), while number of antiglaucoma medications was reduced to 1.1 ± 0.7 (-30.8%; p=0.0005) and 2.2 ± 1.4 (-25.6%; p=0.01), respectively. Three eyes (11.5%) in the KDB group and 19 eyes (42.2%) in the Xen gel stent group required additional surgery before month 36 due to refractory high IOP., Conclusion: Both KDB goniotomy and Xen gel stent implantation significantly lowered the IOP and antiglaucoma medication burden in patients with moderate-to-severe OAG. While the Xen gel stent is frequently used to treat moderate-to-severe OAG patients with uncontrolled IOP, standalone KDB goniotomy may be equally effective as a long-term intervention, reducing the need for subsequent glaucoma surgery., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Boopathiraj et al.)

Purpose: To compare the outcomes of combined phacoemulsification-trabeculectomy surgery with intraoperative sponge-applied versus subconjunctival injection of mitomycin-C (MMC) in Asian eyes., Methods: This was a retrospective review of 95 eyes that consecutively underwent combined phacoemulsification-trabeculectomy surgery in a tertiary eye center in Singapore from January 2013 to June 2014. Data collected included intraocular pressure (IOP), best corrected visual acuity, and number of glaucoma medications. Outcome measures included postoperative IOP and complications at various timepoints up to 12 months after surgery., Results: Twenty eyes (21.1%) received 0.2 mg/ml subconjunctival MMC injection ("Group 1") and 75 (78.9%) received 0.4 mg/ml sponge-applied MMC ("Group 2"). There was no difference between groups in demographics, IOP, and number of glaucoma medications preoperatively. There was a reduction in IOP at postoperative month (POM) 1, 6, and 12 in both the groups (POM12: Group 1, -2.8 ± 5.36 mmHg, P < 0.001; Group 2, -5.8 ± 6.29 mmHg, P = 0.054). At POM1, Group 2 showed a trend toward greater IOP reduction (-5.89 ± 7.67 mmHg vs. -1.55 ± 5.68 mmHg, P = 0.061). However, at both POM6 and POM12, there was no statistically significant difference in IOP reduction between the two groups. At POM12, complete success, defined as achieving an IOP of between 6 and 15 mmHg without the use of antiglaucoma medications, was achieved in 11 (55%) eyes in Group 1 and 48 (64%) in Group 2 ( P = 0.9). There was a lower rate of postoperative hypotony in the Group 1 (0%) compared to Group 2 (8%) ( P = 0.34)., Conclusion: Combined phacoemulsification-trabeculectomy with subconjunctival MMC injection has comparable outcomes to that with sponge-applied MMC, with a similar reduction in IOP at 1, 6, and 12 months postoperatively and a lower postoperative complication rate., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Current Ophthalmology.)