High-grade Myopia Research Articles

An Integrated Stepwise Approach to the Treatment of Graft Disease in a Patient with an Implanted Iris Lens Diaphragm and Concomitant Postkeratoplastic Ametropia (Clinical Case)

The purpose: to analyze the clinical and functional results of the complex staged treatment of graft disease in patient with an implanted iris lens diaphragm and concomitant postkeratoplastic ametropia using descemet’s stripping endothelial keratoplasty using a femtosecond laser (FS-DSEK) and MyoRing implantation into a corneal graft using a femtosecond laser on the example of a clinical case. Methods. Patient M., 51 years old, was admitted with a diagnosis of the left eye: corneal transplant disease, condition after penetrating keratoplasty, iridoartifakia, avitria, optic nerve subatrophy, high myopia. To treat the graft disease, the patient underwent FS-DSEK using a FemtoVisum 1 MHz (Troitsk, Russia). Twelve months after FS-DSEK to correct irregular postkeratoplastic astigmatism and concomitant high-grade myopia detected after restoration of the transparency of the penetrating corneal graft, the MyoRing was implanted into the penetrating corneal graft using a femtosecond laser. Results. After performing FS-DSEK, the transparency of the penetrating corneal graft was completely restored, visometry, refractokeratometry, and keratopachymetric data were stabilized by 6 months after the operation. 12 months after FS-DSEK, uncorrected visual acuity (UCVA) increased from 1.6 to 1.2 LogMAR, best corrected visual acuity (BCVA) increased from 1.6 to 0.8 LogMAR. Loss of endothelial cell density of the posterior layered graft was 27.4 %. MyoRing implantation into a penetrating corneal graft made it possible to significantly increase the UCVA from 1.3 to 0.3 LogMAR and the BCVA from 0.8 to 0.2 LogMAR. The spherical component of refraction decreased from -6.25 to -0.75 D, the cylindrical component of refraction — from -9.25 to -1.25 D, the regularity, sphericity of the corneal graft and its biomechanical properties increased (corneal resistance factor increased from 8.2 to 9.4 mm Hg, corneal hysteresis — from 7.9 to 9.1 mm Hg). Conclusion. A complex staged technique of descemet’s stripping endothelial keratoplasty using a femtosecond laser followed by MyoRing implantation into the corneal graft using a femtosecond laser is an effective and safe method for treating graft disease in a patient with an implanted iris lens diaphragm and concomitant postkeratoplastic ametropia.

Динамика результатов транс-ФРК при коррекции миопии различной степени на аппарате Микроскан Визум

Difficulties in choosing the method of excimer laser correction for high-grade myopia pose to ophthalmologists the task of finding a technique for excimer laser correction of this type of ametropia, combining safety and a good refractive result. The dynamics of the results of correction of myopia of various degrees by the method of transepithelial PRK on the installation of Microscan Visum for up to 6 months was evaluated. Depending on the degree of myopia, 3 groups of patients were formed. Transepithelial PRK has proven to be a safe technique that provides a good refractive result. The results of this study help predict the dynamics of visual functions in the postoperative period in patients with different degrees of myopia. Key words: transepithelial photorefractive keratectomy, myopia, Microscan Visum.

Анализ эффективности экстракции прозрачного хрусталика (ЭПХ) с имплантацией искусственного хрусталика при коррекции миопии высокой степени

The purpose of this work was to study the effectiveness of extraction of a transparent lens in order to correct myopia of medium and high degree. Currently, the correction of high-grade myopia is carried out with the use of phakic intraocular lenses (FIOL), since the correction of LASIK and PRK is not indicated, with a thinned cornea of myopes at a young age. In this paper, the results of cataract phacoemulsification of 20 patients (40 eyes) with moderate and high myopia, with implantation of hydrophobic acrylic IOLS Acrysof (Alcon, USA) in the middle age category (46.6±6.3) were analyzed. with high-grade myopia (M from -7.0D to -19.0D), 14 of them were women and 6 were men. Moderate myopia was detected in 6 patients (12 eyes) and high degree in 14 patients (28 eyes). In the preoperative period, 15 patients (30 eyes) underwent peripheral retinal laser coagulation (30 eyes). Operations were performed on two eyes with an interval of 2-3 weeks, depending on the state of the organ of vision and the general condition of patients. High visual acuity was obtained from 0.6 to 1.0 without correction and averaged =0.83 ±0.05. The accommodative capabilities of the artificial eyes were stopped by the appointment of weak positive lenses. Keywords: phacoemulsification, high degree myopia, IOL implantation, accommodation

Late sequelae of retinopathy of prematurity in infancy

Retinopathy of prematurity (ROP) is one of the most frequent causes of severe visual impairment or blindness in childhood and can lead to severe late complications in children even after the initial disease has resolved. The present study summarizes possible late effects in childhood after treated and untreated ROP. Aspecial focus is on the development of myopia, retinal detachment, as well as neurological and pulmonary development after anti-vascular endothelial growth factor (VEGF) treatment. This work is based on aselective literature search on late effects in childhood of treated or untreated ROP. Preterm infants have an increased risk of developing high-grade myopia. Interestingly, several studies indicate that the risk of myopia is reduced following anti-VEGF treatment. With anti-VEGF treatment, however, late recurrences after initial response are possible even after several months, making long-term and frequent follow-up examinations essential. Controversy exists regarding the possible negative effects of anti-VEGF treatment on neurological and pulmonary development. After both treated and untreated ROP, rhegmatogenous, tractional or exudative retinal detachment, vitreous hemorrhage, high myopia and strabismus are possible late complications. Children with ahistory of ROP with or without treatment have an increased risk for late ocular sequelae, such as high myopia, retinal detachment, vitreous hemorrhage and strabismus. Aseamless transition from ROP screening to pediatric and ophthalmological follow-up care is therefore essential for timely detection and treatment of possible refractive errors, strabismus, or other amblyogenic changes.

Identification of Rare Variants Involved in High Myopia Unraveled by Whole Genome Sequencing

Myopia (nearsightedness) is a condition in which a refractive error (RE) affects vision. Although common variants explain part of the genetic predisposition (18%), most of the estimated 70% heritability is missing. Here, we investigate the contribution of rare genetic variation because this might explain more of the missing heritability in the more severe forms of myopia. In particular, high myopia can lead to blindness and has a tremendous impact on a patient and at the societal level. The exact molecular mechanisms behind this condition are not yet completely unraveled, but whole genome sequencing (WGS) studies have the potential to identify novel (rare) disease genes, explaining the high heritability. Cross-sectional study performed in the Netherlands. We investigated 159 European patients with high myopia (RE > -10 diopters). We performed WGS using a stepwise filtering approach and burden analysis. The contribution of common variants was calculated as a genetic risk score (GRS). Rare variant burden, GRS. In 25% (n= 40) of these patients, there was a high (> 75th percentile) contribution of common predisposing variants; that is, these participants had higher GRSs. In 7 of the remaining 119 patients (6%), deleterious variants in genes associated with known (ocular) disorders, such as retinal dystrophy disease (prominin 1 [PROM1]) or ocular development (ATP binding cassette subfamily B member 6 [ABCB6], TGFB induced factor homeobox 1 [TGIF1]), were identified. Furthermore, without using a gene panel, we identified a high burden of rare variants in 8 novel genes associated with myopia. The genes heparan sulfate 6-O-sulfotransferase 1 (HS6ST1) (proportion in study population vs. the Genome Aggregation Database (GnomAD) 0.14 vs. 0.03, P= 4.22E-17), RNA binding motif protein 20 (RBM20) (0.15 vs. 0.06, P= 4.98E-05), and MAP7 domain containing 1 (MAP7D1) (0.19 vs. 0.06, P= 1.16E-10) were involved in the Wnt signaling cascade, melatonin degradation, and ocular development and showed most biologically plausible associations. We found different contributions of common and rare variants in low and high grade myopia. Using WGS, we identified some interesting candidate genes that could explain the high myopia phenotype in some patients. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Long-Term Clinical and Functional Results of High-Grade Myopia Correction by Intrastromal Implantation of the MyoRing Ring with Femtolaser Support

Purpose: Analysis of remote clinical functional results of high myopia correction in patients with thin cornea by method of intrastromal MyoRing implantation with Femtolaser assistance.Materials and methods. 22 eyes of 22 patients were included into investigation, the мean age of patients was 30.20 ± 5.37 (from 24 to 40) years. Mean spherical equivalent (SE) of refraction was –11.52 ± 1.96 D, cylindrical component of refraction was –2.04 ± 1.64 D. Minimal pachymetry index in center was 491.6 ± 20.0 mkm. Corneal hysteresis (CH) was 8.60 ± 1.19 mm Hg. The average pupil diameter in mesopic conditions was 5.60 ± 0.23 mm. All patients had a history of mild amblyopia. Period of control in average 2 years.Results. In 2 years after the surgery uncorrected visual acuity was 0.60 ± 1.22, corrected visual acuity 0.70 ± 0.20. Mean spherical equivalent (SE) of refraction was 0.61 ± 1.43 D, cylindrical component of refraction was –0.13 ± 0.50 D. Predictability of SE within ±0.5 D was 84 %, ±1.0 — 84 %. Index of safety was 1.16, index of efficacy — 1.0. CH was 9.50 ± 0.03 mm Hg. Mean pachymetry at center after the surgery did not change statistically significant in comparison with initial data (p = 1.00).Conclusion. MyoRing implantation is an effective and safe method, it provides: refraction spherical component correction, astigmatism correction and CH increase (p = 0.01).

Глаукома псевдофакичного глаза

Relevance. Currently, there is a steady increase in the age-associated eye diseases worldwide. First of all, this applies to such ocular diseases as age-related maculodegeneration (AMD), glaucoma and cataracts. Despite the development and standardization of surgical techniques, the widespread introduction of cataract phacoemulsification, appearance of many modifications of anti-glaucomatous surgery, and the active use of angiogenesis inhibitors used to treat AMD, these diseases continue to occupy a leading position in the causes of low vision and blindness. Purpose. To reveal the problem of the development of pseudophakic glaucoma in patients who underwent surgical treatment for cataracts. Material and methods.To complete this review, we searched for literature sources on the PubMed and Scopus abstract databases for the period up to 2021 inclusive. In total, 53 articles related to the topic of the review were selected. The beginning of publications on this topic dates back to 1963. Results. At risk are patients with pseudoexfoliative syndrome, high-grade myopia, traumatic, diabetic and uveal cataracts. Pseudophakic glaucoma can also be caused by intraoperative (iris damage, vitreous prolapse, implantation of an intraocular lens outside the capsular bag, incomplete viscoelastic washout) and postoperative complications (inflammatory process, hyphema, dislocation of the artificial lens, pupillary block or Ellingson syndrome). Conclusion. Pseudophakic glaucoma, although rare, is quite formidable, which can reduce result of cataract surgery. Key words: pseudophakic glaucoma, glaucoma, cataract, ophthalmohypertension, complications of phacoemulsification

A rare combination of monogenic connective tissue diseases — Marfan and Stickler syndromes — in one patient

As DNA sequencing techniques have been used more widely in clinical practice, there have been reports of a combination of hereditary diseases in a single patient. Cases of combining diseases with similar clinical symptoms present a particular difficulty for diagnosis. We observe a child who has been identified to have a combination of autosomal dominant diseases associated with connective tissue involvement — Marfan and Stickler type 1 syndromes. Common symptoms of both diseases were as follows: marfanoid habitus, arachnodactyly, kyphoscoliosis, chest deformity, involvement in the process of joints (hypermobile syndrome) and eyes. Marfan syndrome was evidenced by dissociation of mass-growth parameters at birth, tallstature, “Gothic” palate, crowded teeth, aortic dilation at the level of Valsalva sinuses and its ascending part. Type 1 Stickler syndrome was indicated by high-grade myopia, degenerative vitreous changes requiring vitrectomy, flat face, mandibular micrognathia, latent cleft of the soft and hard palate, grade 1 bilateral conductive hearing loss, mild cognitive failure. The diagnosis of both diseases was confirmed by the detection of de novo heterozygous mutations in the FBN1 gene (c.5060_5061 delGCinvAA, p. Cys1687) and COL2A1 gene (c.4074+1G>A). Establishing a final diagnosis is of great importance for predicting the course of the disease and genetic counseling of the proband and their relatives.

Стратегия офтальмолога при оценке возможностей родоразрешения у здоровых беременных женщин с миопической рефракцией

The review highlights aspects of the evolution of the views and opinions of ophthalmologists of different years on ophthalmological and obstetric approaches to the management of pregnancy and childbirth in women with high myopia. According to the literature, prevention of the risk of regmatogenic retinal detachment during childbirth since the early 1980s of the last century has been aimed at identifying peripheral vitreochorioretinal dystrophy during pregnancy as the leading risk factor for regmatogenic retinal detachment during childbirth. The main modern strategies for the management of pregnant women with the presence of peripheral vitreochorioretinal dystrophy during pregnancy and childbirth are considered; indications for natural delivery with high-grade myopia, absolute and relative indications for its implementation in a natural way are presented. This is reflected in the specific selection criteria for natural delivery. Keywords: pregnancy, natural delivery, cesarean section, peripheral vitreochorioretinal dystrophy, regmatogenic retinal detachment, high-grade myopia.

Efficacy Evaluation of Comprehensive Preformed Physical Factors Application against Retinal Complications in the Early Postoperative Period after Cataract Surgery on Eyes with High Myopia

Currently, modern high-tech methods of cataract surgery do not always guarantee high visual acuity after surgery, and are not always insured against the development of early postoperative complications in the eyes with concomitant ocular pathology. Aim. Development and analysis of the preformed physical factors comprehensive application efficacy against retinal complications in the early postoperative period after cataract surgery in patients with high myopia. Material and methods. The study involved 75 patients (75 eyes) with high myopia, aged 58 to 79 years with developing macular edema on the second day after cataract surgery. Patients from the first group (25 people) received standard medical treatment, the second group (25 people) additionally received low-frequency magnetotherapy course, and the third group received extended standard treatment with combined application of low-frequency magnetotherapy and endonasal electrophoresis with pentoxifylline. Assessment of treatment efficacy was performed according to visual acuity data and morphometric parameters of the central retinal zone using optical coherence tomography. The results of Statistica 12.0 (StatSoft, USA) program was used for statistical analysis. Results and discussion. Immediate results of treatment and long-term results up to one month in all groups were objectively confirmed by the morphometric parameters of the central retinal zone. Macular edema reduction in height and area of distribution was significantly different in the third group compared with the first and second groups immediately after treatment and with the continuation of positive dynamics after a month. In the third group, high clinical results were objectively confirmed by the restoration of normal parameters of the central retinal zone after one month of observation. In the first and second groups, lower treatment results were confirmed by the preservation of morphometric signs of edema in the macular region, that required the continuation in the patients’ rehabilitation. Conclusion. Combination of complex application of preformed physical factors with standard medical therapy of exudative processes in the macula after cataract surgery reliably increases functional (visual) result of treatment and reduces rehabilitation period in the majority of patients with high-grade myopia. Thus, the expediency of physiotherapeutic support in relief of retinal edema in the early postoperative period of cataract surgery on eyes with high degree myopia has been substantiated.

Retrospective analysis of functional and anatomical changes, the level of intraocular pressure in patients with glaucoma and highgrade myopia during surgical treatment of cataracts

Purpose of the study. To conduct a retrospective analysis of functional, morphometric changes, the level of intraocular pressure after phacoemulsification of cataracts in the early and late postoperative period in patients with glaucoma and highgrade myopia.
 Materials and methods. A retrospective analysis of lens morphometric parameters, baseline IOP in patients with PVKG and MIA, IOP in the early and late postoperative period (12 months) in 60 patients who underwent surgical treatment of cataracts by phacoemulsification. There were 2 groups: 1 group consisted of 20 patients with glaucoma, including men – 11, women – 9, the average age of patients in this group was 73,42 ± 6,8 years, the second group consisted of 20 patients with MIA, including men – 8, women – 12, the average age was 71,46 ± 8,25 years. The control group included 20 patients with cataracts (36 eyes), of whom there were 10 men, 10 women, the average age of patients was 70,82 ± 10,25 years.
 Patients in all groups were homogeneous and comparable in sex and age. Patients of the 1st observation group were in a state of compensation for the level of IOP on the background of the use of antiglaucoma drugs. All patients underwent standard ophthalmological examination, including visometry, perimetry, tonometers, biomicroscopy, ophthalmoscope, echobiometry, keratorefractometry.
 Results. A retrospective analysis of functional and anatomical changes in patients with glaucoma and highgrade myopia during surgical treatment of cataracts indicates the effect of FEC + IOL on the condition of ophthalmotonus and functional parameters of the eyes in both early and late postoperative period.
 Conclusion. Analysis of examination of patients with primary openangle glaucoma and high grade myopia revealed differences in functional, morphometric parameters and the level of intraocular pressure after phacoemulsification of cataracts. Maximum corrected visual acuity (MCG) after phacoemulsification of cataracts was significantly increased in all observation groups. The frequency of thick lenses in the control group was 25%, in the group with PVKG – 35%, and in patients with MIA the incidence was minimal, «respectively – 10%. In the remote period 1 year after FEC there is a decrease in IOP in the control group and in glaucoma patients by 0,8 and 1,1 mm Hg, respectively, while in the group of patients in the Ministry of Internal Affairs there is an increase in ophthalmotonus by 0,7 mm Hg (P  0,05). The frequency of reduction of IOP 1 year after FEC is 70% in patients of the control group, 55% in patients with glaucoma and 10% in patients with high myopia.

Сравнительные клинико-функциональные результаты имплантации «реверсной-М» и «реверсной-М1» ИОЛ у пациентов с миопией высокой степени в отдаленном послеоперационном периоде

The formation of secondary cataracts in patients with high-grade myopia remains the main cause of vision loss in the long-term postoperative period. Taking this into account, a soft model of posterior chamber «reverse» IOL was developed in the Fyodorov Eye Microsurgery Federal State Institution, Moscow, which allows reducing the development of secondary cataracts. Purpose. Comparative analysis the clinical and functional results of implantation of «reverse M and M1» IOL in patients with high myopia in the long-term follow-up. Materials and methods. Clinical studies were conducted on 140 eyes of 97 patients with high-grade myopia aged from 42 to 83 years (on average, 64.24±0.79 years) after phacoemulsification cataract (FEC) with IOL implantation in high-grade myopia. The main group consisted of 57 eyes of 40 patients who were implanted with «reverse-M1» IOL, the control group-83 eyes of 57 patients who were implanted with «reverse-M» IOL. Visual acuity before surgery without correction in any patient did not exceed 0.01, and with the maximum correction was no more than 0.2 (80%). The follow-up period was up to 5 years. Results. Visual functions in the majority of patients increased and remained stable throughout the postoperative period, amounting to 0.55+0.04 in the main group, and 0.54+0.03 in the control group. In the late postoperative period, dissection of the posterior lens capsule with «reverse-M» IOL was performed in 11 eyes of 13 patients (13.2%), in the main group, YAG laser dissection of the posterior capsule was required in 2 patients with 3 eyes (5.3%). Conclusions. Implantation of a «reverse-M1» IOL is safe, predictable and allows you getting less PCO formation compare with «reverse-M» IOL in the long-term follow-up in patients with high myopia. Keywords: phacoemulsification cataract, implantation of «reverse» IOL, high myopia.

Congenital myopia complicating pregnancy: A rare case and mini-review of the literature

A highly myopic 35-year-old female patient (P0, G1) with reduced visual acuity R 3/10 l 3/10 due to bilateral choroidal neovascularization (CNV) admitted at our Department. The patient had atomic history of congenital myopia firstly diagnosed at the age of 2-y-old. The initial diagnosis established a refractive error over 8 diopters (high grade myopia) progressively increased. During third trimester of gestation her vision was acutely diminished. The fundoscopic examination depicted elevated intraocular pressure and deterioration of myopia to -30D bilaterally. (Fruoresceinangiography revealed active CNV). Patient underwent selected caesarean section due to increased risk of macular hemorrhage. She discharged from hospital the 4th pod in good clinical condition. Assiduous ocular and obstetrical monitoring appeared mandatory in order to insure optimal therapeutic mapping. Objective of our study remains proper diagnosis and treatment of such a rare case.

Comparative evaluation of pre-infusion at caesar section performed under spinal anesthesia. Results of multicenter trial

Abstact. Study of the effect of preinfusion, various infusion solutions on the state of hemodynamics, in patients undergoing a cesarean section performed under spinal anesthesia with 0.5 % solution of Longocain Heavy (0.5 % hyperbaric bupivacaine).Materials and methods. Spinal anesthesia (SAN) was performed in 2 190 women, aged 21 to 39 years, with a gestational age of 39 to 40 weeks. The structure of extragenital pathology was dominated by chronic anemia of varying severity – 1 650 (75.3 %), urinary tract infections – 756 (34.5 %), mild preeclampsia – 245 (11.2 %), chronic nonspecific lung diseases – 125 (5.7 %). 1 786 (81.5 %) patients underwent surgery in a planned manner, according to emergency indications – 404 (18.4 %). A combination of the two pathologies was observed in 852 (38.9 %) women. Indications for surgery were: disease of the operated uterus, insolvency of the scar on the uterus, clinically narrow pelvis, high-grade myopia, secondary labor weakness. The duration of surgery is ranged from 40 to 52 minutes.Results. In group I, the expressed hypotension, requiring sympathomimetic support with mezaton was observed in 192 (34.8 %) patients. In group II, severe hypotension requiring sympathomimetic support with mezaton was observed in 114 (20.8 %) patients. And in group III, hypotension requiring sympathomimetic support with mezaton was observed in 127 (23.2 %) patients. At that time, in patients of group IV severe hypotension, requiring sympathomimetic support with mezaton was observed in only 91 (18 %) cases.Conclusions. Neuraxial anesthesia is accompanied by the development of hypotension, which can be prevented by preinfusion with crystalloid solutions. Aggressive preinfusion of large volumes of isoosmolar crystalloids at a dose of 10–14 ml/kg was associated with an increase in the frequency of hemodynamic instability requiring sympathomimetic support.

Macular Hole Surgery Using Gas Tamponade-An Outcome from the Oslo Retrospective Cross-Sectional Study.

Purpose: The study aims to determine the anatomical success and functional outcome of pars plana vitrectomy (PPV) for macular holes (MH) performed at a single study center using a consistent procedure of internal limiting membrane (ILM) peeling, SF6 tamponade and 3 days face-down positioning. Methods: A retrospective cross-sectional study involving eyes with MHs which underwent 23- or 25-gauge PPV with or without phacoemulsification and all undergoing a 20% SF6 gas tamponade, follow-up to 6 months postoperatively were included at the Department of Ophthalmology, Oslo University Hospital and University of Oslo, Oslo, Norway (12-month study period between 1 January and 31 December 2015) Pre- and post-operative Best-Corrected Visual Acuity (BCVA) assessment, comprehensive eye examination and intraocular pressure (IOP) measurement. as well as Optical Coherence Tomography to determine the diameter of the MH and its closure were all carried out. Results: 198 consecutive eyes operated for MH (age: 69.4 ± 7.6 years; 1.6:1 female:male ratio) were included; 35.7%/48.6% had symptoms from 3–6/6–48 months; 5.1% had high-grade myopia, 21.5% focal VMT <1500 µm with or without epiretinal membrane (ERM), and 74.0%/26.0% had phakic/pseudophakic status. Primary closure of the MH occurred in 93.3% of the patients. Lens status and length of symptoms showed no significant correlation with closure of the MH. The pre-operative logMAR visual acuity: 0.8 ± 0.3 (median: 0.7; interquartile range (IQR): 0.5–0.8; range: 0.3–1.7), improved significantly post-operatively: 0.4 ± 0.3 (median: 0.3; interquartile range (IQR): 0.1–0.5; range: −0.02–1.2). BCVA improvement of <0.2, 0.2–0.4 and >0.4 was present in 28.3%, 27.3% and 44.4% of the treated patients. No significant median differences could be detected between the duration of the pre-operative symptoms and the pre-/post-operative visual acuity. Increased IOP was measured in 2.6% of the cases day after surgery. Conclusions: Our study found visual outcome not to be dependent upon the length of symptoms in MH patients treated by PPV all undergoing ILM peeling, SF6 tamponade and face-down positioning. The large diameter MH was not a limiting factor to achieve improved post-operative BCVA.

Z-LASIK and Trans-PRK for correction of high-grade myopia: safety, efficacy, predictability and clinical outcomes.

The aim of the study was to examine the outcomes of transepithelial photorefractive keratectomy (Trans-PRK) and Femtosecond Laser-assisted in situ keratomileusis (Z-LASIK) for the correction of high myopia. A retrospective cohort study design was used. The study group included 792 eyes with high-grade myopia (-6.0 diopters or higher) or high-grade myopia with astigmatism that were treated with Z-LASIK or Trans-PRK in 2013 through 2014 in an optical outpatient clinic of a large private medical service. The Trans-PRK group comprised of 674 eyes with a spherical equivalent (SE) of -7.87±1.46 and the Z-LASIK group comprised of 118 eyes with a SE of -7.19±0.81 (P<0.001). The mean postoperative SE in the Trans-PRK group was -0.06 and -0.02 in the Z-LASIK group (P=0.545). Efficacy index values were 0.92 in the Trans-PRK group and 0.95 in the Z-LASIK group (P=0.083), and corresponding safety index values were 0.95 and 0.97 (P=0.056). An UCVA of 20/40 or better was achieved in 94.20% of eyes in the Trans-PRK group, and 98.31% in the Z-LASIK group (P=0.063). The majority of eyes in both the Trans-PRK and Z-LASIK groups were within±0.5D of attempted correction: 59.35 and 64.71%, respectively (P=0.271). Both Trans-PRK and Z-LASIK demonstrated excellent efficacy, safety and predictability profiles, with results comparable and in some cases superior to the current literature. Results of Z-LASIK were slightly better than those of Trans-PRK, though the preoperative SE of the latter was higher.

A Case of Sporadic Bilateral Polythelia with High-Grade Myopia

A Case of Sporadic Bilateral Polythelia with High-Grade Myopia

Association of Insulin-Like Growth Factor-1 Gene Polymorphisms with Different Types of Myopia in Egyptian Patients.

To investigate the effect of the insulin-like growth factor-1 (IGF-1) gene's rs6214 and rs5742632 polymorphisms on IGF-1 expression levels and their association with different types of myopia in Egyptian patients. A case-control format was used that included 272 patients with myopia and 136 controls. The IGF-1 gene rs6214 and rs5742632 polymorphisms were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analyses. IGF-1 levels were measured by an enzyme-linked immunosorbent assay. In patients with high-grade myopia, the frequencies of the IGF-1 rs6214 GA and AA genotypes, and the A allele were significantly increased compared to the control group: 41.9% vs. 33.8%, 17.7% vs. 8.9%, and 38.9% vs. 25.7%, respectively. Subjects with the GA and AA genotypes and carriers of A allele were significantly more likely to have high-grade myopia: odds ratios (OR) = 1.75, 95% confidence interval (CI) = 1.03-2.9, and p = 0.03; OR = 2.8, 95% CI = 1.3-6.0, and p = 0.003; and OR = 1.8, 95% CI = 1.25-2.61, and p = 0.001, respectively. A nonsignificant association of the IGF-1 gene rs5742632 polymorphism with the two myopia groups was also observed. The IGF-1 levels were significantly increased in patients with high-grade myopia and simple myopia compared to the control group (p < 0.05). In addition, our results showed a nonsignificant association of the IGF-1 (rs6214-rs5742632) haplotype with either simple myopia or high-grade myopia. We found a significant association of the IGF-1 gene rs6214 polymorphism in Egyptian patients with simple myopia and high-grade myopia. IGF-1 levels were significantly increased in relation to the IGF-1 rs6214 genotypes, while a nonsignificant association was found between IGF-1 level and the IGF-1 (rs5742632) genotypes.

Optical coherence tomography and pathological myopia: an update of the literature.

The purpose of this paper is to give an updated review of the last clinical entities in pathological myopia proposed by means of new generation optical coherence tomography (OCT), including enhanced depth imaging (EDI-OCT) and swept source OCT (SS-OCT). PubMed and Google engine search were carried out using the terms "pathological myopia" associated with "coherence tomography," "enhanced depth imaging," and "swept source OCT." Latest publications up to Jan 2015 about myopia-related complications, including open-angle chronic glaucoma, peripapillary retinal changes, acquired macular diseases, and choroidal neovascularization, have been reviewed. New OCT technologies have led to a greater insight in pathophysiology of high-grade myopia. However, further investigation is needed in order to prevent irreversible visual loss and optic nerve damage.

Variable expression pattern in Donnai-Barrow syndrome: Report of two novel LRP2 mutations and review of the literature

Donnai-Barrow syndrome (DBS; MIM 222448) is characterized by typical craniofacial anomalies (major hypertelorism with bulging eyes), high grade myopia, deafness and low molecular weight proteinuria. The disorder results from mutations in the low density lipoprotein receptor-related protein 2 gene LRP2 that maps to chromosome 2q31.1. LRP2 encodes megalin, a multi-ligand endocytic receptor. Herein, we describe the clinical presentation of 4 patients from 2 unrelated Saudi families. Two novel LRP2 mutations, a homozygous nonsense mutation (c.4968C>G; p.Tyr1656*) and a missense mutation (c.12062G>A; p.Cys4021Tyr), were detected in the first and second family respectively. Interestingly, intrafamilial phenotypic variability was observed in one family, while DBS features were atypical in the second family. Differential diagnosis of DBS includes several syndromes associating hypertelorism with high grade myopia, and several syndromal forms of CDH, which are briefly summarized in this study.