Cornea Edema Research Articles

Safety, efficacy, and clinical outcomes of transconjunctival intrascleral fixation of an intraocular lens

BackgroundImplantation of intraocular lens in the capsular bag has become the standard of care in aphakic state. However, in the absence of capsular support, several techniques and intraocular lenses are available. Our study aims to report the safety, efficacy, and clinical outcomes of transconjunctival intrascleral intraocular lens fixation with Yamane’s double-needle technique and flanged haptics.MethodsProspective, observational study with some retrospective data collection. The study enrolled 13 patients (16 eyes) who underwent transconjunctival intrascleral fixation of an intraocular lens with Yamane’s technique between June 2017 and April 2019 at Dhahran Eye Specialist Hospital and King Fahd University Hospital. All patients underwent preoperative and postoperative comprehensive evaluation, including uncorrected and best-corrected vision, intraocular pressure, slit-lamp examination, dilated fundus examination, and ultrasound biomicroscopy. We excluded patients with visually significant coexistent pathology such as retinal diseases, glaucoma, follow-up less than three months, and combined surgery such as keratoplasty.ResultsThe mean preoperative uncorrected visual acuity was 1.50 logMAR, and it improved to 0.60 logMAR. The mean preoperative best-corrected visual acuity was 0.70 logMAR, and it improved to 0.40 logMAR. The median safety index was 2.0, and the median efficacy index was 1.58. The postoperative complications included iris capture by the intraocular lens in one eye (7.7%), haptic extrusion in one eye (7.7%), and transient cornea edema in one eye (7.7%). There were no detected reports during the follow-up period of postoperative retinal detachment, choroidal detachment, elevation of the intraocular pressure (> 25 mmHg), hypotony, hyphema, vitreous hemorrhage, or endophthalmitis.ConclusionsThe transconjunctival intrascleral fixation of an intraocular lens is safe and effective with a short learning curve and was not associated with significant intraoperative or postoperative complications.

Comparison of effect and safety of phacoemulsification surgery performed by resident and attending physicians.

The objective of this study is to compare the effect and safety of phacoemulsification surgery performed by resident and attending physicians. This was a retrospective study. Eyes with cataract who underwent phacoemulsification surgery at the First Affiliated Hospital of Ningbo University between January 2021 and December 2023 were reviewed. All the patients were followed up for at least 12 months and were divided into two groups according to the surgery performer. SPSS was used to analyze data, considering p < 0.05 significant. Overall, 316 patients with cataract in group 1 (surgery performed by resident physician, n = 181) and group 2 (surgery performed by attending physician, n = 135) were reviewed. There were no statistically significant differences in patient demographics variables and cataract grade between the groups. The resident surgeon used more cumulative dissipate energy (15.00 ± 7.25 vs. 10.83 ± 6.52, p < 0.001) and operation time (20.46 ± 5.69 vs. 12.59 ± 4.61 min, p < 0.001) to complete the surgery. Also, the ECL in group 1 was higher (14.87 ± 5.00 vs. 10.77 ± 4.46, p < 0.001). The eyes had significant visual improvement in both groups postoperatively (p < 0.05), but at the 12-month follow-up, eyes in group 2 had better best-corrected visual acuity [0.10 (0.00, 0.22) vs. 0.10 (0.10, 0.22) logMAR, p = 0.039]. Except for month 1, the intraocular pressure was no statistical difference in group 1 and group 2 (14.65 ± 2.52 vs. 15.30 ± 2.34 mmHg, p = 0.019). Cases in group 1 were more likely to undergo intraoperative and postoperative complications (37 vs. 14, p = 0.031), including cornea edema (p = 0.025), capsule tear (p = 0.044), and posterior capsular opacification (p = 0.027). The effect of phacoemulsification surgery performed by the resident physician is satisfying, but compared to the attending physician, the higher probability of complications should be paid more attention.

Deep Learning Versus Corneal Tomography Features to Detect Subclinical Corneal Edema in Fuchs Endothelial Corneal Dystrophy

Purpose: To compare a deep learning model with corneal tomography features for detecting subclinical corneal edema in patients with Fuchs endothelial corneal dystrophy (FECD). Methods: We trained a deep learning model to detect corneal edema on 379 optical coherence tomography B-scans of normal and edematous corneas. 51 eyes of 32 patients with FECD were analyzed and compared with 100 eyes of 50 normal patients. For each eye, the cornea was scanned on the same day using 2 modalities of the same swept-source optical coherence tomography device (Anterion): corneal tomography maps and 6 high-resolution radial B-scans. The 6 radial B-scans were analyzed using our model from which an en face map of edema was reconstructed. The location exhibiting the highest probability of edema was derived from that map. Two corneal surgeons assessed the tomography maps and labeled the location of the supposed highest edema. This location was compared with our model's en face map. Results: According to tomography features, 64.7% of eyes presented subclinical edema. Our model and tomography features agreed in 80% of cases for the presence or absence of subclinical edema. The average distance between the location of maximal edema determined by human experts on tomography maps and that derived from our model's en face map was 1.91 ± 1.15 mm. Our model detected superior peripheral edema in a majority of eyes. Conclusions: Despite being based on different approaches, both methods agreed in the detection of subclinical edema in most cases. The location of detected edema was very similar in both methods. In cases where both methods disagree, our approach provides new objective results that might help the surgeon in making a decision in difficult cases.

Corneal Transplantation in a Patient With Nonperforating Ocular Contusion Caused by a High-Pressure Washer: A Case Report

Purpose: This report details a rare case of a high-pressure washer injury that caused ocular contusion, vitreous hemorrhage, and irreversible corneal edema without perforation necessitating corneal transplantation. Methods: The medical chart of a patient with a high-pressure washer injury at Miyata Eye Hospital (Miyazaki, Japan) was retrospectively reviewed. Results: A 57-year-old man presented to our hospital with a contusion in the left eye caused by a high-pressure washer 1 day prior to the visit. The visual acuity in the left eye was hand motion. Slit-lamp examination of the left eye revealed the presence of corneal epithelial defects, conjunctival lacerations, hyphema, and lacerated iris. Mild clouding of the lens was observed in the anterior chambers, suggestive of cataract. Anterior segment optical coherence tomography revealed the presence of blood in the anterior chamber and a thickened and edematous cornea. Ultrasound examination revealed the presence of vitreous hemorrhage. Therefore, vitreous surgery and traumatic cataract removal were performed under general anesthesia. Postoperatively, the corneal edema and marked opacity persisted, accompanied by glaucoma, and the visual acuity was measured at 0.01. Penetrating keratoplasty was performed 1 year and 2 months after the injury, and scleral fixation of the intraocular lens was performed under local anesthesia 2 years after the injury. The final visual acuity was 0.1 under rigid gas-permeable contact lens usage 3.5 years after sustaining the injury, and the patient required anti-glaucoma drugs. Conclusions: Our patient presented with ocular trauma caused by a high-pressure washer. Corneal transplantation was required although no ocular lacerations were detected. Sufficient instructions must be provided on the usage of heavy machinery to develop a safe working environment.

Mutational Analysis of the SLC4A11 Gene in a (Filipino) Family with Congenital Hereditary Endothelial Dystrophy

Aim: The study aims to identify if mutations in the SLC4A11 gene are present in Filipino families affected with congenital hereditary endothelial dystrophy (CHED). Methods: This is a family cohort study that investigated the genetic profile of a selected family in northern Luzon, Philippines, whose members were diagnosed with congenital hereditary endothelial dystrophy (CHED). A patient who was diagnosed with CHED prior to this study served as the proband for this family. A detailed family history was obtained and a complete ophthalmologic examination was performed on each of the family members. A total of six affected members and three unaffected members were included in this study. DNA was isolated from peripheral blood samples of the family members, polymerase chain reaction (PCR) was used to amplify the gene’s entire coding region (19 exons and 2 putative promoter regions), and finally, the amplified regions were analyzed using DNA sequencing. Results: Consanguinity was not present in the family. Corneal haze was reported to have been present since birth or shortly thereafter in all the affected patients. Slit-lamp examination showed edematous corneas. Molecular studies of the SLC4A11 gene revealed four novel homozygous point mutations variably presenting in the six affected members, as well as the three unaffected members. One unaffected family member (I-1) had a novel sense mutation absent in the other family members. All affected siblings showed little phenotypic variability. Conclusions: This is the first report that gives us a genetic profile of a northern Luzon family with members affected by CHED. This study supports earlier findings that mutations in the SLC4A11 gene are not consistently the same among different ethnic groups worldwide, probably due to the disease’s genetic heterogeneity. Our study documented five novel mutations, adding to the growing list of mutations probably responsible for acquiring the CHED phenotype. It is possible that there are more novel mutations waiting to be discovered in this hereditary disease. Screening for these specific mutations in other families may prove useful for genetic counseling, prenatal diagnosis, and the future development of gene therapy.

Optics and quantitative assessment of corneal transparency

While some optical properties of cornea like its stromal birefringence had been known since the early nineteenth century, theories explaining its transparency remained inconclusive until the publication of David Maurice' emblematic paper in 1957 Maurice made a model calculation of light scattering by a single collagen fibril as a “dielectric needle”. The volume density of the fibrils being known, Maurice could demonstrate that in the absence of any order among the fibrils the cornea would be opaque. Maurice postulated the hexagonal structure which since has been confirmed by electron microscopy. In modern terms, the order among the collagen fibrils within a stromal collagen lamella is described by a “structure factor” in the radiative transfer equation. This term corresponds to a description of the structure in reciprocal space and is thus equivalent to the representation of crystalline lattices in the first Brillouin zone used for structural modelling in crystallography.In a recent study we further analysed the collagen structure of healthy and oedematous corneas on a nanometric level observed by transmission electron microscopy (TEM). By automated image analysis we could retrieve the so‐called “pair correlation function” and calculate light attenuation within the corresponding cornea. Our findings show that the 1/e light penetration depth within healthy cornea could be calculated as 7300 ± 800 μm, which explains well the transparency of healthy cornea. However, the photon mean free path of oedematous cornea turned out to be from two to three times that value. In oedematous cornea, the “dilution” effect of the scatters is in fact stronger than the degradation of transparency by the perturbation of the structure. The actual loss of transparency in oedematous cornea may therefore be attributed to scattering processes at the micrometric level induced by the augmented optical contrast at the sites of the keratocytes between the collagen lamellae.Perturbations in corneal transparency do not only hamper vision, they also impact optical imaging methods on cornea. This, in turn, permits to study the transparency properties of the corneal tissue. One of the main research interests of our group is to analyse corneal images recorded by optical coherence tomography (OCT) and to extract quantitative parameters like photon mean path length and the fraction of coherently transmitted light.Our partners could show that in the light scattering regime, a term in the radiation transfer equation may be neglected and the attenuation of the full field OCT signal in the volume of the tissue reduces to a Lambert–Beer law. We developed a data analysis algorithm based on Bayesian inference to extract the attenuation coefficient and used it for the analysis of ex vivo corneal high‐resolution FF‐OCT images.In a second step, we developed an image processing algorithm for clinical OCT images removing typical artefacts and compensating for inhomogeneous illumination and corneal curvature. We presently are able to extract corneal transparency parameters from routine clinical OCT images and to provide post‐op follow‐up after keratoplasty or other surgical interventions.

Descemet&amp;rsquo;s membrane detachment during cataract surgery: a case report

&lt;p&gt;&lt;strong&gt;Background&lt;/strong&gt;: Descemet&amp;rsquo;s membrane detachment is a possible complication after cataract surgery and has been reported to happen in 0.5% of cases after cataract surgery.&lt;br /&gt;&lt;strong&gt;Case Presentation&lt;/strong&gt;: A 77-year-old male patient underwent right eye cataract surgery and presented 2 weeks after surgery with decreased visual acuity (CF) in the operated right eye. There was generalized cornea edema and the Descemet&amp;rsquo;s membrane (DM) was noticed to be detached at 80% of the corneal surface. At 12 days postoperatively, a descemetopexy with intracameral air bubble was performed following the principles of endothelial keratoplasty. On follow-up, the visual acuity in the right eye was 6/7.5 with complete corneal clarity at 2 months.&lt;br /&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;: Early recognition and surgical intervention of a DM detachment at cataract surgery are likely to enable&lt;br /&gt;resolution without the need for a transplant. If suspected or identified at the end of surgery, anterior chamber air insertion is recommended. It is important to note that separated DM can mimic a retained anterior capsule flap. Care must be taken when considering removal of any clear membranes at the end of cataract surgery.&lt;/p&gt;

A Case of Endophthalmitis with Atypical Anterior Symptom by Subconjunctival Dexamethasone Injection after Cataract Surgery

Purpose: To report a case of endophthalmitis with non-specific anterior segment symptom by subconjunctival dexamethasone injection and anterior chamber irrigation for the anterior chamber inflammation resulted in delayed diagnosis after cataract surgery.Case summary: A 74-year-old female patient with visual disturbance and anterior chamber inflammation had subconjunctival dexamethasone injection and anterior chamber irrigation after 5 days of cataract surgery. On the 7th day after surgery, the anterior chamber inflammation had decreased without visual acuity improvement and additional subconjunctival dexamethasone injection was done. The next day, she was referred to our hospital because there were no improvements in her visual symptom. When the patient visit our hospital, visual acuity was hand motion and cornea edema was shown. Because of corneal edema, anterior chamber cells were obscure, but it was assumed as 1+ grade. Severe vitreous opacity and increased vitreous cells were observed, so the fundus was barely visible. With diagnosis of endophthalmitis, vitrectomy and intravitreal antibiotic injection were performed. Seven weeks after surgery, best corrected visual acuity increased to 0.6, and there was no sign of recurrence.Conclusions: When the endophthalmitis after cataract surgery was misdiagnosed as toxic anterior chamber syndrome and subconjunctival dexamethasone injection and anterior chamber irrigation were performed, the diagnosis of endophthalmitis could be delayed because the symptoms of the anterior chamber could be non-specific. Therefore, it is important to take careful use of strong anti-inflammation medications after cataract surgery.

A case of mitomycin C toxicity after XEN gel stent implantation with the XEN air technique in a glaucoma patient

BackgroundTo discuss the first case of mitomycin C (MMC) toxicity after XEN® gel stent implantation in a glaucoma patient, conducted using the XEN “air” technique with an ophthalmic viscosurgical device (OVD).Case presentationA 44-year-old Asian male presented with increased intraocular pressure (IOP; 52 mmHg) accompanied by keratic precipitates and an edematous cornea. He was diagnosed with uveitic glaucoma in the left eye, and the IOP was controlled with a topical anti-glaucoma agent. However, glaucoma progression was revealed by Humphrey visual field (HVF) and optical coherence tomography (OCT) examinations. The patient underwent uneventful XEN gel stent implantation using the XEN air technique and an MMC (0.02%, 0.1 mL) injection, with subconjunctival air and OVD injection provided prior to XEN implantation in the left eye. The patient exhibited a decreased IOP (11 mmHg), elevated bleb, and extensive subconjunctival hemorrhage on postoperative day 1. On postoperative day 18, diffuse conjunctival injection and a large avascular bleb was noticed around the XEN gel stent. The patient complained of severe eye pain and discomfort, suggestive of MMC toxicity, and the IOP was 12 mmHg. The patient was treated with a topical steroid and antibiotics tapered over a 6-month period. Finally, the toxicity was successfully controlled, with the IOP stabilizing at around 15 mmHg.ConclusionsAlthough significantly greater lowering of the IOP can be expected with the use of subconjunctival OVD injection and MMC during XEN gel stent implantation, a cautious approach and a longer monitoring period are required.

Review of Risk Factors and Complications of Anterior Migration of Ozurdex Implant: Lessons Learnt from the Previous Reports.

Purpose: Ozurdex had shown promising anatomical and functional outcomes in managing refractory Irvine-Gass syndrome over the years. Burgeoning usage of Ozurdex has prompted the study of its related complications, particularly the anterior chamber migration of the implant. Methods: Literature reviews on the anterior chamber migration of the Ozurdex via PubMed, EBSCO, and TRIP databases were searched from 2012 to 2020. The predisposing factors, outcomes, and management of such cases were evaluated. Results: A total of 54 articles consisting of 105 cases of anterior migration of Ozurdex were included in this analysis. The vitrectomized eye and compromised posterior capsule were highly associated with this complication. About 81.9% of the cases had cornea edema upon presentation, with 31.4% of them ending up with cornea decompensation despite intervention. Although there was high intraocular pressure reported initially in 22 cases, only 2 cases required glaucoma filtration surgeries in which they had preexisting glaucoma. Numerous techniques of repositioning or surgical removal of the implant were described but they were challenging and the outcomes varied. Conclusions: A noninvasive method of manipulating the Ozurdex into the vitreous cavity via the "Trendelenburg position, external pressure with head positioning" maneuvers is safe yet achieves a favorable outcome. Precaution must be taken whenever offering Ozurdex to the high-risk eyes. Prompt repositioning or removal of the implant is crucial to deter cornea decompensation. Clinical Trial Registration number: NMRR-22-02092-S9X (from the Medical Research and Ethics Committee (MREC), Ministry of Health, Malaysia).

Pupillary Block Glaucoma after Nd: YAG Capsulotomy

A 65-year-old-woman presented following neodymium: YAG capsulotomy for posterior capsular opacification with acute glaucoma. Cataract surgery had been done with good outcomes. Cornea edema obscured detail of the anterior chamber, but the edge of the lens could be seen clearly within the pupillary space and the acute angle-closure glaucoma was due to vitreous prolapse in the anterior chamber. We believe this case demonstrates the possible complications of the Nd: YAG capsulotomy even if it is an effective tool to treat an opacified posterior capsule after cataract surgery.

The study of ability to integrate with the recipient cornea of xenomaterial “Corneoplast” for keratoplasty in the animal experiment

Currently, there is a significant shortage of donor materials for replacing corneal tissue that is why it is relevant to create xenomaterials, which are able to replace a donor cornea with various types of keratoplasty. “Corneoplast” is a new medical device, which is a devitalized, fixed by the method of double crosslinking (dehydrothermic + UV), pork cornea.Purpose: to assess the biocompatibility and ability to integrate with the recipient cornea of implants based on the xenomaterial “Corneoplast”.Materials and methods. The experiment was based on biomicroscopy examination, high-resolution optical coherence tomography and histological examination of the experimental rabbits’ corneas (group I–IV: total of 8 eyes were examined), where keratoplasty was performed with the “Corneoplast” material.Results. High biocompatibility and ability to integrate with the recipient’s cornea were observed in all types of keratoplasty: penetrating, superficial lamellar and intralamellar keratoplasty. On the next day, the implant was transparent with slight swelling of the recipient’s corneal stroma. A week later, the slight swelling of implant was recorded without cornea edema. Its transparency decreased. The recipient’s cornea was reactive. A month later, the moderate neovascularization was noted towards the sutures. After 6 months, the recipient’s cornea was clear, transparent. The implant was translucent and neovascularization was absent. The entire surface of cornea and implant was epithelialized. On the series of optical coherent tomograms, a normal thickness of the epithelium continuous layer was determined in 6 months after the surgery. The complete integration of material with the recipient’s cornea was noted. The layered structure characteristic of corneal tissue was preserved. The cornea retained a layered structure and the endothelium was preserved. On histological examination, there were no differences in the intact cornea and implanted material.Conclusion. The “Corneoplast” material is sufficiently biocompatible and capable of integration with the recipient’s cornea in an animal experiment. This allows, at a certain stage of preclinical trials completion, to use it for replacing corneal tissue in penetrating keratoplasty, intralamellar and superficial anterior layer-by-layer implantations and to cover purulent corneal ulcers of various depths.

Reticular Epithelial Edema in a Postkeratoplasty Eye Due to Ripasudil.

A 34-year-old female underwent phacoemulsification with Descemet stripping endothelial keratoplasty (Supplementary Digital Content, Fig. 1A, B, http://links.lww.com/APJO/ A132) under a failed previous therapeutic penetrating keratoplasty. The visual acuity was restored to 20/50. At 2 years postoperative period, she developed raised intraocular pressure of 30 mm Hg despite being on 2 antiglaucoma medications, and hence ripasudil was initiated as an additional antiglaucoma medication. The endothelial cell density was 920 cells/mm.1Figure 1: Slitlamp image (A) and anterior segment optical coherence tomography (B) illustrating reticular edema in superficial cornea after 4 months of ripasudil use.Her intraocular pressure at 1 month of starting ripasudil was 12 mm Hg. Subsequently, 3 months later, she presented with counting finger vision, honeycomb edema in the superficial cornea (Fig. 1). Ripasudil was discontinued and 1 month later, although the epithelial net-like pattern disappeared, the graft was diffusely edematous and failed to recover the clarity until a follow-up of 3 months (Supplementary Digital Content, Fig. 1C, D, http://links.lww.com/APJO/A132) when repeat endothe-lial keratoplasty was planned. Rho kinase inhibitors have gained popularity in the management of glaucoma and corneal endothelial diseases.2 Ripasudil and netarsudil are Rho kinase inhibitors approved for clinical use. Reticular bullous epithelial edema has been reported with the use of 0.02% netarsudil, which improves in some eyes after the medication is discontinued.1 In our patient, similar pattern of edema was noted with 0.4% ripasudil after 4 months of treatment, which failed to resolve on discontinuing ripasudil. The reticular epithelial edema during ripasudil treatment should be distinguished from graft rejection. The medication should be stopped promptly if cornea edema is noted. The likelihood of nonclearance of edema should be explained to the patients.

Perspiratio Insensibilis of the Cornea

Introduction: The deswelling of the cornea via the natural pathways of perspiratio insensibilis and endothelial pump has been known for a long time. However, reliable data on the amount of perspiratio insensibilis, especially in edematous corneas, have been lacking until now. Material and Methods: In the Ex Vivo Eye Irritation Test (EVEIT), corneas can be observed purely physically under defined and stable biochemical conditions. The thickness and temperature of the corneas is measured by infrared thermography and Optical Coherence Tomography (OCT). Three corneas in stable MEM EVEIT culture and three corneas with induced and reversible edema in an EVEIT osmolar deficiency culture were placed in at 20°C and 60% humidity while tracking thickness and temperature for 30 minutes. Results: Over a period of 30 minutes, the temperature of both, healthy and edematous EVEIT corneas decreased from an initial 28°C to 21°C. The corneal thickness decreased by 51 ±12 μm in the healthy corneas and by 131 ±16 μm in the edematouscorneas. Conclusion: The considerable thickness differences between healthy and swollen corneas might give a physical and physiological explanation of some observable clinical effects in Fuchs’s endothelial dystrophy. The clinically observed effect of clearing of the cornea during the waking period. Furthermore, some phenomena of Dry Eye Syndrome (DES) can be explained by this difference of increased water release from the eye.

Real-world efficacy of the intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma: a 1-year retrospective study.

Suprachoroidal surgery can lower intraocular pressure and medication use. There is currently no commercial suprachoroidal product on the market. Here, we report our 1 year results of a novel ciliary sulcus suprachoroidal microtube technique. To determine the real-world efficacy of intrascleral ciliary sulcus suprachoroidal microtube technique in Black and Afro-Latinx patients with glaucoma refractory to topical ocular hypertensive medications. A retrospective non-comparative single center study of 36 Black and Afro-Latinx patients with glaucoma and pseudophakia who underwent intrascleral ciliary sulcus suprachoroidal microtube surgery for glaucoma as a stand-alone procedure at a single practice. Investigated parameters were number of medications, visual acuity (VA), intraocular pressure (IOP), mean deviation on visual field (VF) test. Success was defined as (a) IOP ⩽ 15 mmHg and or ⩾ 20% reduction in IOP and (b) a reduction in number of medications. We used paired t-test to compare baseline and follow-up parameters. We reviewed a total of 36 patients who had undergone the procedure. Twenty had success with 12-month follow-up in the study. The mean number of medications decreased significantly from 4.2 ± 1.0 preoperatively to 2.4 ± 1.7 in 12 months (p = 0.021) with five patients being medication free. In addition, the IOP decreased significantly from 21 ± 8.2 to 13.5 ± 4.4 mmHg (p = 0.032). In the 20 patients who had 12-month follow-up, the VA remained stable from Log Mar 0.62 ± 0.6-0.46 ± 0.6 (p = 0.052). VF in patients with successful procedure (no further interventions) remained stable from baseline mean deviation of -16.53 ± 10.04 to -16.82 ± 9.80 dB at 6-12 months. Adverse effects were transient and included IOP spike, hypotony, hyphema, and cornea edema that were treated and resolved. This 12-month retrospective study demonstrated that intrascleral ciliary sulcus suprachoroidal microtube surgery can reduce IOP and medication burden in pseudophakic patients with glaucoma. However, despite several successes, surveillance should take place for IOP spikes, possible tube obstruction, and need for additional glaucoma surgery.

Effectiveness of full-thickness corneal compressive suture in acute hydrops: Two cases

Aim:The aim of this study was to demonstrate the effectiveness of compressive sutures for rapid resolution ofacute hydrops in keratoconus cases. Case reports:Two young adult patients having keratoconus presented with sudden painful marked dimness ofvision associated with watering and photophobia in their left eyes for about 2 weeks. Visual acuity was countingfinger-to-hand movement. The examination showed a markedly opaque edematous cornea without any visibilityof the pupil, lens, and posterior segment. Patients were diagnosed with acute hydrops. Patients underwent full-thickness corneal compressing sutures under peribulbar anesthesia. Patients were post-operatively treated withtopical corticosteroid, antibiotic, cycloplegic, and hypertonic saline. On days 48 and 32, respectively, the totalresolution of corneal edema with the central scar was seen in both of the patients. Vision improved to 3/60 and6/60, respectively, and symptoms decreased. Both patients were advised for penetrating keratoplasty for furtherimprovement of vision. Conclusion:Full-thickness corneal compressive sutures quickly resolve acute hydrops of keratoconus.

Management of an intrastromal corneal foreign body

A 27-year-old male presented with complaints of irritation and watering in the left eye following injury by a shrub. These symptoms subsided on rubbing the eyes and an eyewash. Slit-lamp bio-microscopy revealed an edematous cornea with vegetative foreign bodies embedded in the stroma, which were confirmed by anterior-segment optical coherence tomography. Antimicrobial therapy and immediate foreign body removal was undertaken. The patient was discharged the next day, with regular follow-ups. Foreign bodies either get embedded on the corneal surface or penetrate into the anterior chamber; it is rare for them to be retained intracorneally. The patient made a full and uneventful recovery following surgery.

Deep Learning Model for the Detection of Corneal Edema Before Descemet Membrane Endothelial Keratoplasty on Optical Coherence Tomography Images.

Descemet membrane endothelial keratoplasty (DMEK) is the preferred method for treating corneal endothelial dysfunction, such as Fuchs endothelial corneal dystrophy (FECD). The surgical indication is based on the patients' symptoms and the presence of corneal edema. We developed an automated tool based on deep learning to detect edema in corneal optical coherence tomography images. This study aimed to evaluate this approach in edema detection before Descemet membrane endothelial keratoplasty surgery, for patients with or without FECD. We used our previously described model allowing to classify each pixel in the corneal optical coherence tomography images as "normal" or "edema." We included 1992 images of normal and preoperative edematous corneas. We calculated the edema fraction (EF), defined as the ratio between the number of pixels labeled as "edema," and those representing the cornea for each patient. Differential central corneal thickness (DCCT), defined as the difference in central corneal thickness before and 6 months after surgery, was used to quantify preoperative edema. AUC of EF for the edema detection was calculated for Several DCCT thresholds and a value of 20 µm was selected to define significant edema as it provided the highest area under the curve value. The area under the curve of the receiver operating characteristic curve for EF for the detection of 20 µm of DCCT was 0.97 for all patients, 0.96 for Fuchs and normal only and 0.99 for non-FECD and normal patients. The optimal EF threshold was 0.143 for all patients and patients with FECD. Our model is capable of objectively detecting minimal corneal edema before Descemet membrane endothelial keratoplasty surgery. Deep learning can help to interpret optical coherence tomography scans and aid the surgeon in decision-making.

Use of Decellularized SMILE (Small-Incision Lenticule Extraction) Lenticules for Engineering the Corneal Endothelial Layer: A Proof-of-Concept

PurposeTo demonstrate the suitability of using decellularized SMILE (Small-incision Lenticule Extraction) lenticules for culturing and transplanting the corneal endothelium (CE).MethodsThe SMILE lenticules, obtained during refractive surgery, were decellularized by incubating in CE culture medium and fetal bovine serum. Decellularization was confirmed by hematoxylin and eosin staining, DAPI staining, and gel electrophoresis. The amount of DNA per milligram of dry tissue weight was calculated to quantify the residual nuclear content. The transparency of the decellularized lenticules was determined by calculating the modulation transfer function. Immunostaining for stromal collagens and glycosaminoglycan was performed using specific antibodies. Engineered tissue was constructed by culturing the CE cells on lenticules and staining for ZO-1, Na/K ATPase, and N-cadherin. The functionality of the engineered tissues was assessed by transplanting them onto edematous human donor corneas and perfusing for 10 days ex-vivo.ResultsThe residual DNA per milligram of dry tissue weight was found to be significantly reduced (p < 0.0001) in serum (0.255 µg/mg) and Opti-MEM (0.140 µg/mg) when compared to fresh lenticules (3.9 µg/mg). Decellularization did not alter the arrangement of the collagen fibers or the transparency of the lenticules. CE cells attached and matured to express ZO-1, Na/K ATPase, and N-cadherin at two weeks after seeding. The engineered tissue upon transplantation significantly reduced the corneal edema (p < 0.05) and the transplanted cells remained intact on the SMILE lenticule post-transplantation.ConclusionThis study demonstrates the suitability of using SMILE lenticules decellularized using a simple, chemical-free method for engineering the corneal endothelium for transplantation.

Phacoemulsification combined with goniosynechialysis under a gonioscope in the treatment of angle-closure glaucoma: the effect of reopening the synechial anterior chamber angle

A total of 170 consecutive patients (181 eyes) who were diagnosed with primary angle-closure glaucoma (PACG) and underwent phacoemulsification and intraocular lens implantation (PEI) combined with goniosynechialysis (GSL) with an instrument under a gonioscope in the Eye Hospital, Wenzhou Medical University from January 1, 2017 to December 31, 2019 were observed. Anterior chamber angle synechiae of 0 (0, 2) clock hour were released after PEI, while after combined goniosynechialysis, synechiae of 6 (3, 8) clock hours were further released. No matter in chronic PACG and acute PACG with cornea edema, the extent of anterior chamber angle synechiae was different before surgery and after PEI, and so was it in post-PEI and PEI-GSL prospectively (all P<0.01). Phacoemulsification alone can reopen the synechial anterior chamber angle in both chronic PACG and acute PACG in part, but not sufficiently. Combined goniosynechialysis under a gonioscope with an instrument is essential and effective.