Corneal Incision Research Articles

New epiretinal implant with integrated sensor chips for optical capturing shows a good biocompatibility profile in vitro and in vivo

BackgroundRetinal degenerative diseases, e.g., retinitis pigmentosa, cause a severe decline of the visual function up to blindness. Treatment still remains difficult; however, implantation of retinal prostheses can help restoring vision. In this study, the biocompatibility and surgical feasibility of a newly developed epiretinal stimulator (OPTO-EPIRET) was investigated. The previously developed implant was extended by an integrated circuit-based optical capturing, which will enable the immediate conversion of the visual field into stimulation patterns to stimulate retinal ganglion cells.ResultsThe biocompatibility of the OPTO-EPIRET was investigated in vitro using the two different cell lines L-929 and R28. Direct and indirect contact were analyzed in terms of cell proliferation, cell viability, and gene expression. The surgical feasibility was initially tested by implanting the OPTO-EPIRET in cadaveric rabbit eyes. Afterwards, inactive devices were implanted in six rabbits for feasibility and biocompatibility testings in vivo. In follow-up controls (1–12 weeks post-surgery), the eyes were examined using fundoscopy and optical coherence tomography. After finalization, histological examination was performed to analyze the retinal structure. Regarding the in vitro biocompatibility, no significant influence on cell viability was detected (L929: < 1.3% dead cells; R-28: < 0.8% dead cells). The surgery, which comprised phacoemulsification, vitrectomy, and implantation of the OPTO-EPIRET through a 9–10 mm corneal incision, was successfully established. The implant was fixated with a retinal tack. Vitreal hemorrhage or retinal tearing occurred as main adverse effects. Transitional corneal edema caused difficulties in post-surgical imaging.ConclusionsThe OPTO-EPIRET stimulator showed a good biocompatibility profile in vitro. Furthermore, the implantation surgery was shown to be feasible. However, further design optimization steps are necessary to avoid intra- and postoperative complications. Overall, the OPTO-EPIRET will allow for a wide visual field and good visual acuity due to a high density of electrodes in the central retina.

Corneal Subbasal Plexus in Eyes with Fuchs' Endothelial Corneal Dystrophy after Two Different Endothelial Surgeries.

Purpose To evaluate the morphological features and density of corneal subbasal plexus (SBP) using in vivo corneal confocal microscopy (IVCCM) in patients affected by Fuchs' endothelial corneal dystrophy (FECD) six months after Descemet membrane endothelial keratoplasty (DMEK) and Descemet-stripping automated endothelial keratoplasty (DSAEK). Methods We included patients affected by FECD, requiring corneal endothelial surgery due to corneal oedema occurred from 3 to 6 months. 7 eyes underwent DMEK and 7 eyes DSAEK. All patients performed IVCCM preoperative and in six months postoperative. We analyzed SBP parameters, using CS4 Nerves Tracking Tool, and we studied the differences between the two endothelial keratoplasties. Results Comparing the eyes treated with DMEK with those treated with DSAEK, preoperative corneal thickness, corrected distance visual acuity (CDVA), and age were similar in both groups. SBP was not detectable at preoperative IVCCM in any eye. Postoperatively, the nerve fibers length, the nerve fibers density, the tortuosity, and the number of fibers and of branching did not differ in the eyes that underwent DMEK compared to DSAEK. The corneal beadings density was higher after DMEK than DSAEK, and this difference was statistically significant (P = 0.004). The type of endothelial keratoplasty was not associated with the presence or absence of postoperative corneal SBP (Pearson' chi-square, 0.755). Conclusions Postoperative corneal reinnervation should be easily and noninvasively studied using IVCCM. Morphological postoperative features of SBP did not differ between two different types of endothelial keratoplasty, DMEK and DSAEK, despite the different sizes of the corneal incision. The lower beading density in the DSAEK group should be the consequence of a different distribution of mitochondria along the nerve fibers, as expression of a supposed higher metabolic distress in the DSAEK group.

"IRIS SHELF" TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES.

To describe "iris shelf" technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes. Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision. Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1-8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes). The "iris shelf" technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.

Paired Opposite 4 mm Clear Corneal Incisions on Steep Meridian during Phacoemulsification.

Purpose:To evaluate the effect of opposite clear corneal incisions (OCCI) with 4 mm incisions on the steep meridian on postoperative astigmatism.Methods:This study was performed on 64 eyes of 55 patients with keratometric astigmatism of ≥ 1 diopter (D) undergoing phacoemulsification. Patients were divided into two groups, with-the-rule (WTR) astigmatism and against-the-rule (ATR) astigmatism. Initial incisions in the WTR group were performed on the temporal side with 3.2 mm keratome and paired stab incisions were performed on the steep meridian. At the end of the surgery, stab incisions were enlarged to 4 mm. Follow-up visits were scheduled at 1, 3, 6, and 12 months postoperatively, which included refraction and keratometry.Results:It was found that the mean preoperative keratometric astigmatism was 2.06 ± 0.86 D. The postoperative mean keratometric astigmatism was 1.3 ± 0.7 D after 1 month and 1.2 ± 0.7 D after 12 months. The mean astigmatism correction between the preoperative measure and that taken at 1 month was statistically significant (P = 0.001), but there was no significant change in the severity of astigmatism afterward. The mean surgically-induced astigmatism was found to be 1.99 ± 0.9 D. The 12-month changes of mean absolute astigmatism were: 1.06 ± 0.7 D in the WTR group, and 0.53 ± 0.7 D in the ATR group. The difference between the two groups was statistically significant (P = 0.02).Conclusion:Based on our findings, we posit that paired OCCI on the steep axis, using 4 mm incisions is an effective technique to correct preoperative astigmatism.

Corneal decompensation following intrastromal hydration of corneal wounds with 0.5% moxifloxacin

Many ophthalmologists have adopted the off-label practice of injecting moxifloxacin intracamerally and into the corneal stroma around the incision at the conclusion of surgery for endophthalmitis prophylaxis. The safety and efficacy of intracameral moxifloxacin for routine cataract surgery has been investigated and endorsed by multiple authors, but to our knowledge, potential complications from intrastromal hydration of clear corneal incisions with 0.5% preservative-free moxifloxacin have not been documented. Two consecutive patients underwent surgery for traumatic ocular injuries. The first patient underwent removal of an intralenticular metallic foreign body with cataract surgery and intraocular lens placement. The second patient underwent repair of an extensive corneoscleral laceration with uveal prolapse. Both patients developed toxic anterior segment syndrome and corneal decompensation within 4 days of intracameral injection and intrastromal hydration of corneal wounds with 0.5% preservative-free topical-formulation moxifloxacin for endophthalmitis prophylaxis following surgery. Surgeons should avoid the use of undiluted 0.5% topical-formulation moxifloxacin drugs for intrastromal hydration of clear corneal incisions following intracameral administration to decrease the risk for corneal decompensation and toxic anterior segment syndrome. We recommend using only 0.1% compounded formulations for both intrastromal and intracameral injections or avoiding intrastromal injection altogether.

Recent Advances in Hydrogels: Ophthalmic Applications in Cell Delivery, Vitreous Substitutes, and Ocular Adhesives.

With the prevalence of eye diseases, such as cataracts, retinal degenerative diseases, and glaucoma, different treatments including lens replacement, vitrectomy, and stem cell transplantation have been developed; however, they are not without their respective shortcomings. For example, current methods to seal corneal incisions induced by cataract surgery, such as suturing and stromal hydration, are less than ideal due to the potential for surgically induced astigmatism or wound leakage. Vitrectomy performed on patients with diabetic retinopathy requires an artificial vitreous substitute, with current offerings having many shortcomings such as retinal toxicity. The use of stem cells has also been investigated in retinal degenerative diseases; however, an optimal delivery system is required for successful transplantation. The incorporation of hydrogels into ocular therapy has been a critical focus in overcoming the limitations of current treatments. Previous reviews have extensively documented the use of hydrogels in drug delivery; thus, the goal of this review is to discuss recent advances in hydrogel technology in surgical applications, including dendrimer and gelatin-based hydrogels for ocular adhesives and a variety of different polymers for vitreous substitutes, as well as recent advances in hydrogel-based retinal pigment epithelium (RPE) and retinal progenitor cell (RPC) delivery to the retina.

Thermal Profile of Pulse Precision Capsulotomy: In vivo and In vitro Infrared Thermography Study.

PurposeThis study aimed to elucidate the thermal safety of precision pulse capsulotomy (PPC) via in vivo and in vitro evaluation of the thermal profile using infrared thermography.MethodsThis prospective observational study enrolled 15 eyes from 15 participants who underwent cataract surgery using the Zepto PPC. All patients underwent temperature measurements of the incision site and the entire cornea using an infrared thermographer during the capsulotomy procedure. To accurately analyze the temperature change of the Zepto PPC, infrared thermography was performed with the Zepto handpiece while exposed to air and then in porcine eyes. Moreover, in each case, the difference in temperature change according to the use of an ophthalmic viscosurgical device (OVD) was also checked to determine the temperature buffering effect.ResultsIn the clinical evaluations, the mean temperature elevation around the corneal incision and time duration from baseline to peak temperature during the Zepto capsulotomy were 4.0°C ± 1.9°C and 4.43 ± 1.26 seconds, respectively, with a mean peak temperature of 32.6°C ± 2.0°C. The mean peak temperature and rise time of the naïve Zepto nitinol ring, as measured from the bottom side, were 109.0°C ± 22.9°C and 43.40 ± 11.06 seconds in the experimental procedures, respectively. In the porcine eyes, the mean elevation of temperature and rise time of the Zepto nitinol ring were 6.2°C ± 1.6°C and 11.67 ± 2.08 seconds with the use of OVDs, and 10.5°C ± 3.3°C and 14.00 ± 3.61 seconds without OVDs, respectively.ConclusionsZepto PPC has the potential to generate extremely high thermal energy, according to an in vitro study. However, the temperature rise of the Zepto capsulotomy can be minimized by using OVDs.

Comparison of magnitude and summated vector mean of surgically induced astigmatism vector according to incision site after phakic intraocular lens implantation

BackgroundTo compare the arithmetic mean (M-SIA) and the summated vector mean of surgically induced astigmatism (SVM-SIA) according to the incision site after phakic intraocular lens (Visian implantable collamer lens (ICL), STAAR Surgical) implantation.MethodsThis study comprised 121 eyes of 121 consecutive patients undergoing ICL surgery through a 3.0-mm temporal or superior clear corneal incision. The magnitude and the axis of corneal astigmatism preoperatively and 3 months postoperatively were measured using an automated keratometer. The M-SIA and the SVM-SIA were determined according to the incision site.ResultsThe magnitude of corneal astigmatism significantly increased from 1.23 ± 0.59 D preoperatively to 1.46 ± 0.72 D postoperatively in the temporal incision group (Wilcoxon signed-rank test, P < 0.001), but it significantly decreased from 1.09 ± 0.36 D preoperatively to 0.86 ± 0.41 D postoperatively in the superior incision group (P < 0.001). The M-SIA was 0.48 ± 0.30 D, and the SVM-SIA was 0.23 ± 0.52 D at a meridian of 82° in the temporal incision group. The M-SIA was 0.57 ± 0.30 D, and the SVM-SIA was 0.47 ± 0.45 D at a meridian of 1° in the superior incision group.ConclusionsICL implantation induces the M-SIA by approximately 0.5 D, but the SVM-SIA decreased to 50% and 80% of the M-SIA in magnitude through temporal and superior incisions, respectively. The direction of the SVM-SIA showed a tendency toward corneal flattening to the incisional site. It should be noted that the M-SIA is somewhat different from the SVM-SIA according to the incision site.Trial registration University Hospital Medical Information Network Clinical Trial Registry (000044269)

Modification of intraocular lens insertion using 4-flanged fixation with a standard cartridge and a 2.4 mm corneal incision in eyes with no capsular support.

A modification of intraocular lens (IOL) implantation, using the 4-flanged IOL fixation technique, through a 2.4 mm corneal incision using a standard cartridge and injector, is presented. An IOL with 4 eyelets is used, through which a 6-0 polypropylene suture is threaded on one side and then loaded into a provided cartridge and inserted to the anterior chamber through a 2.4 mm corneal incision. Using the handshake technique, the suture ends are eventually threaded through the eyelets and secured outside the eye with the creation of 4 flanges. This technique was used in 6 eyes of 5 consecutive patients with the absence of capsular support. During all follow-up visits, the IOLs were well centered and stable, and the flanges were buried in the sclera and covered with the conjunctiva. No complications were recorded. This modification simplifies the technique and reduces the well-known complications of large corneal incisions.

Effect of Opposite Clear Corneal Incision (CCI) on Corneal Higher-Order Aberrations after Phacoemulsification

Abstract Background: Nowadays, care of a cataractous patient greatly exceeds surgical removal of the opacified lens. In a step foreword to welfare of the elderly, phacoemulsification can perform as a refractive tool, addressing both spherical and astigmatic refractive errors. Aim of Study: The aim of that work was to evaluate safety and effectiveness of OCCIs, as an innovative procedure for correction of corneal astigmatism, during phacoemulsification. Patients and Methods: The study assessed 64 patients, who underwent phacoemulsification. Pre-operative and post-operative corneal topography was done, documented and statistically analyzed for each patient. Results: The study revealed a decrease of pre-operative corneal astigmatism from a pre-operative mean of –1.78D to a post-operative mean of 1.09D in OCCI group and a decrease of pre-operative corneal astigmatism from a pre-operative mean of –1.71D to a postoperative mean of 1.29D in single incision group. Conclusion: The present study revealed that OCCIs with appropriate pre-operative corneal topography represent a real advance in the applications of refractive lenticular surgery. OCCIs provide an innovative technique for managing pre-operative, regular, corneal astigmatism. This is simple, easy to learn technique, with no extra instrumentation. The OCCIs in this study was safe, with no wound related complications. However, OCCIs require careful early post-operative care, due to their penetrating nature. Once the wounds are sealed, risk of further complications approaches zero. Further studies on that technique, employing different incision architecture are required to help development of nomograms correlating the incision length, width, age of the patient, and the amount of pre-operative corneal astigmatism to be corrected.

Correlation between keratometry and corneal incision before and after phaco surgery.

Cataract is a common cause of vision loss and blindness in humans. After surgical management of cataract, all efforts should be focused on reducing postoperative astigmatism thus providing an excellent vision to patients. To determine the relationship between corneal incision and refraction changes before and after phacoemulsification surgery in 300 patients undergoing cataract surgery in Khatam hospital in Mashhad, Iran from January 2017 to April 2018. Three hundred patients (144 women and 156 men) with cataract undergoing phacoemulsification surgery were recruited in this cross-sectional study. Refraction, keratometry and visual acuity measurement were performed before surgery. Then, a steep-based incision in the cornea was made without stitches. A 3.2 mm corneal incision was made at two supratemporal and temporal sites. The patients were followed-up for one and six months, and one year after surgery monitoring their vision and refraction, and performing keratometric measurements. The mean age of the patients was 65.7±9.54 years (age range, 42-84 years). No major complications were observed. The greatest mean of changes in corneal power was in the supratemporal incision (1.28±0.6). Keratometry had a significant relation with the incision (p.

Scleral Lens-Induced Corneal Edema After Radial Keratotomy.

This case series examines the magnitude and regional variation in scleral lens-induced corneal edema in postradial keratotomy (RK) eyes. Scheimpflug imaging was used to measure corneal thickness across the central 6 mm before and after scleral lens wear in nine post-RK eyes (median age 64 years). Variations in corneal edema were examined as a function of distance from the corneal center (six 0.5-mm annuli) and from 0° to 360°. The median central corneal edema was 2.19% (interquartile range 1.03%-3.18%; P=0.02) and increased in magnitude and variability further from the central cornea (from 1.30% in the central 0-0.5 mm to 3.12% in the 2.5-3.0 mm midperiphery) (P=0.02). Scleral lens-induced corneal edema in post-RK eyes was greater in magnitude further from the corneal center and at the approximate location of corneal incisions.

Initial experience with three-dimensional heads-up display system for cataract surgery - A comparative study.

Purpose:To compare the complication rates, surgical time and learning curve using the 3-D Heads up display system in comparison with the conventional microscope for routine cataract surgery.Methods:Consecutive consenting adults with uncomplicated cataract were offered phacoemulsification using the 3-D Heads up display system (ARTEVO 800 Carl Zeiss Meditec) or the conventional microscope (Zeiss Lumera 700) by two experienced surgeons. Surgical time, measured from start of corneal incision to removal of microscope from the surgical field and complication rates were compared between the groups.Results:Of the 343 eyes enrolled, 100 (29%) underwent surgery using the 3-D Heads up display system. The surgical time for 3-D Heads up display system was significantly higher in the 3-D group (8.4 ± 2.1 vs. 6.5 ± 1.8 minutes, P < 0.001). There were no group differences in surgical complications (2% in 3-D vs. 2.5% in conventional microscope, P = 0.28). Comparing across 4 quartiles within the 3-D group, the mean surgical time was slightly higher during the 1st quartile (n = 25, 9.1 ± 1.9 minutes) compared to the last quartile (n = 25, 8.2 ± 1.9 minutes) (p = 0.17). Complications in the 3-D group occurred only in the initial 50% of cases. Seven (7%) cases in the 3-D group were converted to conventional binocular microscope of which 3 each were due to difficulty in depth perception and low illumination while one was due to intraoperative pupillary constriction.Conclusion:Phacoemulsification with the 3-D Heads up display system takes longer time but offers excellent visualization, ergonomics and safety compared to conventional microscopes. Experienced surgeons should be able to adapt easily after their first 50 surgeries.

Incisional correction of corneal astigmatism during ‎phacoemulsification – a randomized trial

Background: Phacoemulsification is regarded as a type of refractive surgery by which it is possible to ‎reduce pre-existing corneal stigmatism.‎ This study aimed to evaluate the efficacy and safety of on-axis corneal incision with or without opposite clear corneal incisions (OCCI) to correct preoperative corneal astigmatism during uncomplicated phacoemulsification ‎surgeries.‎ Methods: A randomized, prospective, parallel two-arm interventional study, which included a ‎total 40 eyes from 40 patients, was conducted.‎ Patients were divided into two groups: 20 patients as controls underwent phacoemulsification with on-axis incision (CCI group), and 20 patients underwent phacoemulsification with OCCI (OCCI group). Results: Mean astigmatic correction was significantly higher in the OCCI group (0.665 vs 0.265 diopters, p-value &lt;0.001), compared to the CCI group. Most of the parameters (surgical induced astigmatism, magnitude of error, and correction index) were significantly higher in the OCCI group compared to the CCI group (p-value &lt;0.01). There were no ‎incision-related complications. Conclusions: Both incisional methods are useful methods for correction of preoperative corneal ‎astigmatism but OCCIs correct a higher amount of astigmatism than the on-axis clear ‎corneal incision.‎ Registration: ClinicalTrials.gov NCT04418986 (05/06/2020).

Long-term outcomes of \u201copen iridectomy\u201d for secondary anterior chamber epithelial iris cysts

Epithelial cysts run a high risk of recurrence and conversion to sheet-like ingrowth after surgical intervention. In this retrospective study, we introduced a modified iridectomy for treatment of secondary epithelial iris cysts (EICs) in the anterior chamber. Twenty-nine patients (29 eyes) aged 2–61 years received “open iridectomy” for EICs between April 1995 and July 2019. After viscodissection, most of the cyst wall was cut using a 20-gauge aspiration cutter via a 2.5-mm clear corneal incision. The residue closely adhering to the iris stroma was remained to avoid photophobia and diplopia. At 3 months, best corrected visual acuity was ≥ 20/100 in 55.5% (15/27, except two pediatric patients with poor cooperation) of patients. Among the eight patients suffering partial corneal edema preoperatively, six patients received surgery treatment at 3–6.5 months, and the cornea in the other two patients became transparent after medication. In a mean follow-up of 47.4 months, recurrence occurred in 3 patients at 7, 37, and 118 months, respectively. The percentage of treatment success was 96%, 87%, and 65% at 1, 5, and 10 years, respectively. “Open iridectomy” was effective for EICs, with a minimal invasion, less damage to the corneal endothelium, and a low recurrence rate.

Laser-Activated Corneal Adhesive: Retinal Safety in Rabbit Model.

PurposeThe purpose of this study was to investigate whether laser irradiation, used to activate an adhesive for sealing penetrating corneal incisions, causes any ophthalmoscopically or histologically visible retinal changes.MethodsBaseline fundus assessment was conducted prior to laser irradiation of eyes of pigmented Dutch Belted rabbits. Treatment group was 18 eyes with the corneal adhesive activated in situ by a near infrared laser (125 mW for 45 seconds). The positive control group was 18 eyes, each irradiated for 60 seconds at 375, 500, 625, and 750 mW at different retinal locations. Unexposed regions of the retina were used as negative internal control. Ophthalmoscopic assessment was conducted immediately after laser exposure and prior to euthanasia. Retinas were histologically assessed at 0, 3, 72, and 168 hours after treatment.ResultsNo ophthalmoscopically or histologically visible retinal changes were observed in the treatment group immediately, nor up to 168 hours after laser irradiation. In the positive control group, the incidences of ophthalmoscopically visible retinal lesions increased with irradiation power: 5.6% at 375 mW, 16.7% at 500 mW, 44.4% at 625 mW, and 50% at 750 mW. Histologically, retinal damage was observed as coagulative necrosis to all layers of the neural retina, including the retinal pigment epithelium.ConclusionsThe laser irradiation process used in the corneal adhesive technology did not cause any ophthalmoscopically or histologically visible retinal changes in the in vivo pigmented rabbit model. Prolonged exposure with this laser and at higher power can cause coagulative necrosis to the retina.Translational RelevanceThe corneal adhesive can be applied in humans without causing laser retinal damage.

Injection time related to intraocular pressure using a CO2 driven preloaded injector: An experimental laboratory study.

PurposeExperimental study to measure the intraocular lens (IOL) injection time and injection speed at different intraocular pressure (IOP) settings when using the AutonoMe® injector.MethodsIn this experimental study, following phacoemulsification in porcine cadaver eyes, a trocar was inserted at pars plana with a connected infusion and IOPs of 20, 50 and 80 mmHg were generated by altering the infusion height. Twelve CO2 gas-driven injectors were used to implant an IOL via a corneal incision of 2.2 mm. For each IOP setting, the duration of the IOL injection and the injection speed was measured by analyzing a video recording of the procedure.ResultsThe mean ±SD injection time (seconds) was 4.47±0.50 at 20 mmHg, 4.98±0.55 at 50 mmHg and 5.47±0.20 at 80 mmHg. The mean ±SD injection speed (millimeters per seconds) was 1.36±0.15 at 20 mmHg, 1.22±0.14 at 50 mmHg and 1.10±0.04 at 80 mmHg.There was a significant (p<0.05) difference between the 20 and 80 mmHg groups in mean injection duration and injection speed.ConclusionThe CO2 gas driven injector allows a safe IOL injection even at elevated IOP. Although the implantation time is slightly extended at higher IOPs, this does not seem to be clinically relevant. No IOL damage was observed at these pressure settings.

New thin-film adhesive for sealing full-thickness corneal incisions in rabbits.

To compare the repair of penetrating corneal incisions in an in vivo rabbit model using a laser-activated thin-film adhesive, sutures, or self-seal. The University of Sydney, Camperdown, Australia. Animal studies. Under an operating microscope, 2.0 mm penetrating incisions were created in 162 right eyes. Incisions in one group were repaired with the adhesive, the second group received a single 10-0 nylon suture, and the third group was left to self-seal. Rabbits were killed humanely at predetermined timepoints over 2 weeks, and wound healing was assessed using burst pressure and immunohistological studies. A modified McDonald-Shadduck scoring was used to assess eyes. The mean burst pressure of the adhesive group was significantly higher than the sutured or self-sealed groups at all timepoints within the first 72 hours. At 0 hour, the burst pressure was 98.0 (±17.0) mm Hg, 30.6 (±2.1) mm Hg, and 3.8 (±0.6) mm Hg (P < .00001) for adhesive-treated (n = 5), sutured (n = 5), and self-sealed wounds (n = 5), respectively. These increased to 229.0 (±53.7) mm Hg, 12.4 (±2.9) mm Hg, and 27.3 (±4.0) mm Hg (P = .0011) at 72 hours. The modified McDonald-Shadduck score was significantly higher for eyes repaired using the adhesive than those sutured or left to self-seal for the first 72 hours. On histology and immunofluorescence, adhesive treatment demonstrated better wound approximation and higher myofibroblastic activation than the other groups. The adhesive was efficacious in sealing penetrating corneal incisions and tolerated higher burst pressures than sutures or self-seal. The adhesive was biocompatible in rabbits, and incisions demonstrated a rapid gain in wound strength that sustained over the study period.

A Comparative Study between Air Bubble Tamponade Alone versus Air Bubble Tamponade with Internal Fluid Aspiration for Nonplanar Descemet's Membrane Detachment after Phacoemulsification.

Purpose To compare the efficacy of air bubble tamponade alone versus air bubble tamponade with internal fluid aspiration for nonplanar Descemet's membrane detachment after clear corneal incision phacoemulsification. Methods This study is a prospective, intervention, comparative randomised clinical trial, conducted at a private eye centre, Ismailia, Egypt, from March 2019 to March 2020. It contained 30 eyes of 24 patients who had postphacoemulsification nonplanar Descemet's membrane detachment involving the periphery and the central area of the cornea (>50% of the cornea) with corneal oedema. The patients were divided into two groups: group A: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade only and group B: patients with nonplanar DMD affecting the central cornea treated by air bubble tamponade augmented by internal fluid aspiration. Trial Registration: This trial was registered at www.pactr.org and the identification number for the registry is PACTR202006612296119. Results During the 12-month study period, this study included 30 eyes (24 patients) out of 1356 phaco surgeries with postphacoemulsification nonplanar Descemet's membrane detachment. Six patients had DMD in both eyes, eight patients had DMD in the right eye, and ten patients had DMD in the left eye. All patients have successful surgeries without complications. The calculated incidence rate for visually significant DMD was 2.2% per year. The mean ± SD time interval from cataract surgery to the primary intervention was 4.2 ± 1.1 days. Descemet's membrane was attached in 56.25% of patients in group A (9 out of 16 eyes) and 92.6% of patients in group B (13 out of 14 eyes) with a minimum of one-month follow-up. Conclusion Air descemetopexy combined with the internal fluid aspiration demonstrated to be more efficient than air descemetopexy only to treat Descemet's membrane detachment following phacoemulsification. It should be tried before planning other major surgeries in patients with severe Descemet's membrane detachment.

Comparative Analysis of Safety and Feasibility of Suture Versus Sutureless Pediatric Cataract Surgery.

To compare the safety, feasibility, and outcomes of clear corneal cataract surgery with or without sutures in children (2 to 8 years old) with congenital or developmental cataracts. One hundred seventy consecutive eligible eyes with pediatric cataracts were randomized into treatment groups depending on closure of clear corneal incisions: suture group and sutureless hydroclosure group (sutureless group). Patients were evaluated on days 1, 7, 30, and 90 postoperatively, with an emphasis on wound leakage from incisions and complications. Wound leakage from any corneal incisions was not observed in both groups. Shallow anterior chamber on the first postoperative day was observed in 2 and 3 eyes in the suture and sutureless groups, respectively (P = .48). Hypotony was not observed in any patients. Intraocular pressure measurements were comparable on follow-up visits (P > .05). Mean cylindrical error was significantly greater (P = .03) in the suture group than the sutureless group (1.01 and 0.74 diopters, respectively) after 1 month. One patient developed endophthalmitis after suture removal in the suture group. Sutureless hydroclosure of incisions is not inferior compared to suturing in pediatric cataracts. This avoids suture-related complications while reducing the astigmatic error and is thus potentially less amblyogenic. However, sutures must be used whenever the incision architecture is compromised. [J Pediatr Ophthalmol Strabismus. 2021;58(4):246-253.].