Elevated IOP Research Articles

Macular Edema Ranibizumab v. Intravitreal anti-inflammatory Therapy (MERIT) Trial—24-week Outcomes of Uveitic Macular Edema Retreatment

PurposeEvaluation of longer-term effectiveness of three intravitreal therapies (methotrexate, ranibizumab, or dexamethasone implant) for participants enrolled in the randomized comparative effectiveness trial the Macular Edema Ranibizumab versus Intravitreal anti-inflammatory Therapy (MERIT) Trial followed for24 weeks. DesignMulticenter randomized controlled clinical trial with masked evaluation of retinal thickness and visual acuity. ParticipantsPatients with persistent or recurrent uveitic macular edema. MethodsParticipants from 33 centers were randomized 1:1:1 (stratified by presence or absence of concomitant systemic immunosuppression for uveitis) to receive a sequence of intravitreal treatments with dexamethasone implant, methotrexate or ranibizumab. Participants with bilateral macular edema received the same treatment bilaterally. During 24 weeks’ follow-up, non-assigned treatments were permitted beginning from12 weeks for those meeting retreatment criteria. Main Outcome MeasuresCentral subfield thickness change (CST) from baseline optical coherence tomography (OCT) measurement was the main outcome. Secondary outcomes included change in mean standard letters from baseline best-corrected visual acuity (BCVA). Analyses were conducted according to two principles: 1) “As-Assigned” in which outcomes were analyzed according to their original randomized treatment; and 2) a supplementary “Censored” analysis in which data were excluded after an eye received non-assigned treatment. ResultsAmong 194 enrolled participants (225 eligible eyes), 177 (207 eyes) completed 24 weeks’ follow-up. Eyes assigned to methotrexate (55%) and ranibizumab (37%) more frequently received non-assigned treatments (88% dexamethasone implant or intravitreal corticosteroid injection) compared to dexamethasone (7%). In the As-Assigned analysis, dexamethasone had superior improvement in macular edema compared to ranibizumab (CST: 34% vs 19%, p=0.01) but not compared to methotrexate (CST: 31%, p=0.59) after being superior to both other regimens at 12 weeks. However, in the Censored analysis, only dexamethasone was associated with improvements in macular edema [CST: 34% vs 8% (p<0.001) and 5% (p<0.001)] and BCVA improvement >5 letters compared to methotrexate and ranibizumab, respectively. Dexamethasone more often was associated with IOP elevations ≥ 24 mmHg (32%) and ≥30 mmHg (10%). ConclusionsDexamethasone was more effective that methotrexate and ranibizumab for the treatment of persistent or recurrent uveitic macular edema through 24 weeks, with manageable side effects.

Comparing IOP-Induced Scleral Deformations in the Myopic and Myopic Glaucoma Spectrums.

To compare changes in macular curvature following acute IOP elevation across a range of myopic conditions. We studied 328 eyes from 184 subjects, comprising 32 emmetropic controls (between +2.75 and -2.75 diopters), 50 eyes with high myopia (<-5 diopters; HM), 108 highly myopic with glaucoma (HMG) and 105 pathologic myopia (PM) eyes, and 33 PM with staphyloma (PM+S) eyes. For each eye, we imaged the macula using optical coherence tomography (OCT) under the baseline condition and under acute IOP elevation (to ∼40 mm Hg) achieved through ophthalmodynamometry. We manually aligned the scans (baseline and IOP elevation) using three vascular landmarks in the macula tissue. We then automatically segmented the sclera and the choroid tissues using a deep learning algorithm and extracted the sclera-choroid interface. We calculated the macula curvatures, determined by the radius of curvature of the sclera-choroid interface in the nasal-temporal and superior-inferior direction. Differences in macula curvatures between baseline and elevated IOP scans were calculated at corresponding locations, and the mean curvature difference was reported for each eye. IOP elevation resulted in a significantly higher macula curvature change along the nasal-temporal direction in the PM+S (13.5 ± 8.2 × 10-5µm-1), PM (9.0 ± 7.9 × 10-5µm-1), and HMG (5.2 ± 5.1 × 10-5µm-1) eyes as compared to HM (3.1 ± 2.7 × 10-5µm-1) eyes (all P < 0.05). Interestingly, HM and HMG eyes had the same curvature change in the nasal-temporal direction as emmetropic control eyes (4.2 ± 4.3 × 10-5µm-1). Our findings indicate that the macula in HMG, PM, and PM+S eyes showed greater curvature changes under IOP elevation compared to HM and emmetropic eyes. These preliminary results suggest that HM eyes with conditions such as glaucoma or staphyloma are more sensitive to acute IOP elevation.

Proposing a Methodology for Axon-Centric Analysis of IOP-Induced Mechanical Insult.

IOP-induced mechanical insult on retinal ganglion cell axons within the optic nerve head (ONH) is believed to be a key factor in axonal damage and glaucoma. However, most studies focus on tissue-level mechanical deformations, overlooking that axons are long and thin, and that their susceptibility to damage likely depends on the insult's type (e.g. stretch/compression) and orientation (longitudinal/transverse). We propose an axon-centric approach to quantify IOP-induced mechanical insult from an axon perspective. We used optical coherence tomography (OCT) scans from a healthy monkey eye along with histological images of cryosections to reconstruct the axon-occupied volume including detailed lamina cribrosa (LC) pores. Tissue-level strains were determined experimentally using digital volume correlation from OCT scans at baseline and elevated IOPs, then transformed into axonal strains using axon paths estimated by a fluid mechanics simulation. Axons in the LC and post-LC regions predominantly experienced longitudinal compression and transverse stretch, whereas those in the pre-LC and ONH rim mainly suffered longitudinal stretch and transverse compression. No clear patterns were observed for tissue-level strains. Our approach allowed discerning axonal longitudinal and transverse mechanical insults, which are likely associated with different mechanisms of axonal damage. The technique also enabled quantifying insult along individual axon paths, providing a novel link relating the retinal nerve fiber layer and the optic nerve through the LC via individual axons. This is a promising approach to establish a clearer connection between IOP-induced insult and glaucoma. Further studies should evaluate a larger cohort.

Retropupillary sulcus gas migration after retinal detachment repair surgery.

To elucidate etiology and management of retropupillary sulcus migration of intravitreal gas after uneventful retinal detachment repair surgery. 70 year old Caucasian man presented with a temporal macula-off rhegmatogenous retinal detachment. 25-gauge (25G) pars plana vitrectomy was performed with cryopexy to retinal tear and 12% C3F8 gas tamponade under sub-Tenon's anaesthesia. At one week review, there was an elevated IOP of 28mmHg with migration of gas to the retropupillary space. Superiorly, iris was displaced anteriorly causing iridocorneal touch. There was no phacodonesis nor subluxation and retina was attached with a cryopexy scar under a 80% vitreous cavity gas fill. On treatment with topical IOP-lowering agents until two-week review, IOP had normalised to 18mmHg with persistent 50% gas fill in the retropupillary sulcus and superior iridocorneal touch.Retropupillary gas resorbed at week four with normalisation of IOP, a localised superior anterior subcapsular cataract with associated posterior synechiae, and no iridocorneal touch. Best-corrected visual acuity was 6/12 Snellen following resorption of vitreous cavity gas. Medical management may be adequate if there is no complete pupil block and adequate posterior gas fill. With complete pupil block, refractory IOP elevation, or inadequate posterior tamponade resulting in failure of retinal attachment, surgical intervention would be required.

Corneal Endothelial Changes in Chinese Patients with Fuchs’ Uveitis Syndrome

ABSTRACT Purpose To analyze the changes of corneal endothelial cells in Chinese patients with unilateral Fuchs’ uveitis syndrome (FUS) and investigate the factors relevant to these changes. Methods Bilateral specular microscopic examination was performed in 459 Chinese patients with unilateral FUS from April 2008 to April 2023. The affected eyes constituted the study group, while the contralateral eyes served as controls. Results The median values of endothelial cell density (ECD), cell count, total cell size, and hexagonality were significantly lower in the FUS eyes compared to the control eyes (p < 0.001). The median values of average cell size, maximum cell size, SD of cell size, and CV were significantly higher in the FUS eyes compared to the control eyes (p < 0.001). Central ECD showed a negative correlation with age (r = −0.339; p < 0.001), maximum IOP (r = −0.127; p = 0.006), and the interval since symptom onset (r = −0.172; p < 0.001). The ECD was lower in eyes with ocular hypertension compared to those without ocular hypertension (p < 0.001). Eyes with KPs distributed on the central corneal endothelium had a significantly lower ECD than those with KPs distributed diffusely or KPs distributed triangularly on the inferior corneal endothelium (p = 0.006). Conclusion Our findings suggest decreased ECD, increased cell size, and morphological alterations in the affected eyes of Chinese patients with FUS. The reduction in ECD is correlated with age, elevated IOP, the interval since symptom onset, and the distribution of KPs.

Influence of meteorological factors on intraocular pressure variability using a large-scale cohort

The effects of meteorological conditions on IOP using a large-scale health examination cohort were investigated. There were a total of 811,854 measurements from 126,630 eyes of 63,839 subjects in 9 years from a health checkup cohort followed up annually for age, sex, body height, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), and IOP. The effects of these variables and the meteorological data of daily average temperature (TP), daily average local atmospheric pressure (AP), daily average volumetric humidity (VH), and daily amount of rainfall (RF) on the day of IOP measurement on IOP were investigated. Several variables were significantly associated with IOP, including sex, age, body height, BMI, SBP, DBP, average TP, average AP, average VH, RF, white blood cell count, red blood cell count, hemoglobin, aspartate aminotransferase, alanine aminotransferase, guanosine triphosphate, calcium, and HbA1c. This study indicated a correlation between meteorological factors and IOP. Higher AP and RF were associated with elevated IOP, whereas higher TP and VH were associated with decreased IOP.

Meta-Analysis Study for the Best Surgical Techniques for Secondary Intraocular Lens Implantation in Complicated Cataract Surgeries

Abstract Background The most appropriate location to implant intraocular lenses (IOL) is the interior of the capsular bag, but in complicated cataract surgeries, procedures of secondary IOL implantation are associated with insufficiency or absence of this anatomic structure. In these cases, the IOL must be fixated at alternative sites of the eye globe, e.g., the iris or the sclera. Aim of the Work to compare different surgical IOL implantation techniques for best correction of aphakia, postoperative visual acuity, acquired astigmatism and least complications as corneal decompensation, glaucoma and angle support. Methodology This systematic review included a discussion of all available studies meeting the eligible criteria including: well conducted descriptive studies, cohort, articles, accepted manuscripts, clinical trials, analytic studies and the literature of reviews, technical notes. An extensive search of electronic literature located 291 studies; 160 duplicates were removed and 131 of which were eliminated after the title and abstract were reviewed. Results This study demonstrated a statistically significant change in the mean BCVA improvement in all techniques when comparing the baseline to one and three month follow up after operation, though with no statistically difference between the three techniques as A final corrected distance visual acuity of 6/12 or better was achieved in (65%) implanted with an AC-IFIOL, in (44.3%) with anRP-IFIOL, and (18.1%) with an SF-PCIOL(two studies only taken in consideration). At six month follow up all groups showed no significant difference in the BCVA compared to the baseline and along the follow up periods. There is no significant loss in mean ECD in all groups. Regarding IOP elevation it was more in scleral fixated and anterior chamber IOL than that in retropupillary IOL, and glaucoma was the second most common complication in secondary IOL implantation after anterior chamber reaction. Conclusion AC-IFIOL, RP-IFIOL, and SF-IFIOL were similar in visual efficacy and mean corneal endothelial cell loss. Although IOP elevation was significantly higher in the SF- PCIOL group than in the other groups, other rates of complications were similar between the groups.

Analysis of Schlemm's Canal Measurement and Evaluation with Fourier-Domain Optical Coherence Tomography in Primary Open-Angle Glaucoma

The most common cause of permanent vision loss or blindness in the world is glaucoma. Primary Open Angle Glaucoma (POAG) develops when the eye drainage canals clog over time, increasing intraocular pressure and damaging the optic nerve. In POAG, an ophthalmology examination usually shows an open anterior chamber and chronic, irreversible multifactorial optic neuropathy followed by central visual field loss. OCT is specifically employed to investigate the elasticity of tissue, particularly in Schlemm's canal. This study aims to analyzed the morphological parameters of Schlemm's canal among patients with POAG and normal healthy control. In this observational study, we included one hundred patients, among them 50 patients had POAG, and 50 healthy controls, and both eyes were assessed. We measured the study cohort's and the healthy cohort's eyes' elevated IOP and the Schlemm's canal cross-sectional area (CSA). RT-Vue OCT was used to analyze both eyes' temporal, superior, inferior, and nasal regions. The data were analyzed using both univariate and bivariate methods. The characteristics of the morphological measurement of Schlemm's canal results were similar to those of Kagemann et al. There was a significant difference between age and SC measurement, but no correlation was observed between SC measurement and IOP or visual acuity. OCT is a useful way to evaluate the morphological status of Schlemm Canal in glaucoma patients. The eyes with POAG had smaller Schlemm's Canal- CSA than the normal eyes. The Schlemm canal-CSA in Chinese people had no differences from that of peoples of other races.

Controlled elevation of intraocular pressure in anesthetized mice

Our purpose was to develop a protocol for prolonged anesthesia in mice and evaluate optic nerve axon injury in response to 4 h of controlled elevation of intraocular pressure (CEI). During CEI, C57BL/6 male mice (3–5 months old) were anesthetized with 1.5% isoflurane with 100% oxygen for 4 h and placed on a warm platform, with expired gas and anesthetic actively evacuated. Lactated ringers (0.5 ml) with 5% dextrose was administered subcutaneously at the start and end of CEI. Physiological parameters (oxygen saturation = O2, heart rate = HR, systolic blood pressure = SBP, and temperature) were monitored throughout the 4-h CEI. One eye was cannulated with polyurethane tubing connected to a balanced salt solution reservoir and IOP elevated to 20 (N = 18), 30 (N = 13), 50 (N = 14), and 60 mmHg (N = 16). An additional group of 22 female mice was exposed to CEI of 60 mmHg. Fourteen days after CEI, optic nerves were assessed for axonal injury by masked observers that assigned a grade on a scale from 1 (normal) to 5 (>50% of axons degenerating). CEI optic nerve injury was compared to injury assessed in contralateral optic nerves (N = 84) and naïve optic nerves (N = 18) using a one-way ANOVA followed by Kruskal-Wallis test for multiple comparisons. The relationship between optic nerve injury, physiological parameters, and IOP were assessed by linear regression analyses. Physiologic parameters remained stable throughout CEI (O2 = 95 ± 9%; HR = 450 ± 39; SBP = 102 ± 15 mmHg, and temperature = 38 ± 0.7 °C) and were not statistically different between groups (all comparisons had P > 0.5). Mean optic nerve injury grades (±SD) for naïve optic nerves (1.01 ± 0.02) were not significantly different from fellow/contralateral optic nerves (1.03 ± 0.07, P > 0.99), or from CEI of 20 mmHg (1.04 ± 0.08, P > 0.99) or 30 mmHg (1.05 ± 0.06, P = 0.6). However, animals exposed to CEI of 50 mmHg (2.09 ± 1.43, P = 0.0005) and 60 mmHg (male: 2.86 ± 1.30, P < 0.0001, female: 1.63 ± 1.00, P = 0.0006) developed significant optic nerve injury relative to their fellow/contralateral optic nerves. Axonal injury grades following a CEI of 60 mmHg were not significantly different between male and female mice (P = 0.19). Optic nerve injury positively correlated (P < 0.0001) with IOP and not with physiological parameters, indicating that the optic nerve injury is IOP-related. In conclusion, prolonged anesthesia in mice requires careful attention to animal physiology. With this, a 4-h exposure to elevated IOP can produce significant optic nerve injury with IOPs equal to or greater than 50 mmHg. We provide detailed descriptions of methods and materials for producing prolonged elevations of IOP in mice while maintaining and monitoring their physiology, as well as a unique, cost-effective transducer system for monitoring pressure delivery.

Impact of elevated IOP on lamina cribrosa oxygenation; A combined experimental-computational study on monkeys.

Our goal is to evaluate how lamina cribrosa (LC) oxygenation is affected by the tissue distortions resulting from elevated IOP. Experimental study on monkeys. Four healthy monkey eyes with OCT scans with IOP of 10 to 50 mmHg, and then with histological sections of LC. Since in-vivo LC oxygenation measurement is not yet possible, we used 3D eye-specific numerical models of the LC vasculature which we subjected to experimentally-derived tissue deformations. We reconstructed 3D models of the LC vessel networks of 4 healthy monkey eyes from histological sections. We also obtained in-vivo IOP-induced tissue deformations from a healthy monkey using OCT images and digital volume correlation analysis techniques. The extent that LC vessels distort under a given OCT-derived tissue strain remains unknown. We biomechanics-based mapping techniques: cross-sectional and isotropic. The hemodynamics and oxygenations of the four vessel networks were simulated for deformations at several IOPs up to 60mmHg. The results were used to determine the effects of IOP on LC oxygen supply, assorting the extent of tissue mild and severe hypoxia. IOP-induced deformation, vasculature structure, blood supply, and oxygen supply for LC region. IOP-induced deformations reduced LC oxygenation significantly. More than 20% of LC tissue suffered from mild hypoxia when IOP reached 30 mmHg. Extreme IOP(>50mmHg) led to large severe hypoxia regions (>30%) in the isotropic mapping cases. Our models predicted that moderately elevated IOP can lead to mild hypoxia in a substantial part of the LC, which, if sustained chronically, may contribute to neural tissue damage. For extreme IOP elevations, severe hypoxia was predicted, which would potentially cause more immediate damage. Our findings suggest that despite the remarkable LC vascular robustness, IOP-induced distortions can potentially contribute to glaucomatous neuropathy.

Surgical Outcomes, Ocular Safety and Tolerability of Bio-Interventional Cyclodialysis with Allograft Scleral Reinforcement: Clinical Experience of More than 240 Cases.

Background: To report the surgical safety of reinforced bio-interventional cyclodialysis with scleral allograft reinforcement. Methods: This was a consecutive case series of 243 eyes with open-angle glaucoma who underwent a bio-scaffolded cyclodialysis (BSC) procedure for uveoscleral outflow enhancement using allogeneic bio-spacers to maintain patency of the internal filtration conduit. Results: 79% of the eyes underwent concomitant phacoemulsification cataract surgery prior to BSC intervention, while the remaining eyes underwent stand-alone BSC surgery. All patients had a postoperative surgical safety period of at least 30 days. There were no sight-threatening or serious ocular adverse events. There was one case of prolonged iritis beyond 30 days, which resolved with topical treatment. Two cases (0.8%) of intraoperative and five (2%) of postoperative non-sight-threatening hyphema were without clinical sequelae, which resolved with conservative management. There were 11 cases of IOP elevation and one case of numeric hypotony without maculopathy, which resolved within the study period. The rate of secondary surgical intervention for IOP control was low, and overall, IOP for the cohort improved in the postoperative period, with 78.6% of eyes achieving IOP ≤ 18 mmHg without an increase in medications. Conclusions: Allogeneic biotissue for cyclodialysis intervention demonstrates a biocompatible ocular profile as an implantable material for internal scleral reinforcement during uveoscleral outflow enhancement surgery.

CO2 laser-assisted sclerectomy surgery for secondary open-angle glaucoma after vitrectomy.

To explore the efficiency and safety of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with glaucoma secondary to vitrectomy. This retrospective study consisted of 16 eyes from 16 patients with glaucoma secondary to vitrectomy who underwent CLASS and were followed up for 12 months. Main outcome measures included preoperative and postoperative intraocular pressure, best corrected visual acuity (BCVA), number of anti-glaucoma medications, and postoperative surgical success rate and complications. The postoperative IOP and number of anti-glaucoma medications used at all follow-up time point were significantly lower than those preoperatively. The difference in BCVA was not significant before and after surgery. The main complicatios were peripheral anterior synechiae (PAS) and scleral reservoir reduction, which were controlled after neodymium-doped yttrium aluminum garnet (Nd:YAG) laser, 2 (12.50%) patients underwent re-operation. The complete and total success rates at 12 months were 68.75% and 87.50%, respectively. CLASS is a safe and effective procedure for Chinese patients with glaucoma secondary to vitrectomy. PAS and scleral reservoir reduction is a major contributor to postoperative IOP elevation, and trabecular minimally invasive perforation with the Nd:YAG laser is effective in lowering IOP and increasing scleral cistern volume.

PATHOPHYSIOLOGICAL FACTORS THAT PREDISPOSE PEOPLE TO GLAUCOMA AND MEASURES OF PREVENTION OF GLAUCOMA AMONG THE PATIENTS RECEIVING EYE CARE SERVICES IN THE EYE CLINIC AT JINJA REGIONAL REFERRAL HOSPITAL. A CROSS-SECTIONAL STUDY.

Background Glaucoma is a group of disorders characterized by progressive optic neuropathy resulting in a characteristic appearance of the optic disc and a specific pattern of irreversible visual field defects. The study aims to assess the pathophysiological factors that predispose people to glaucoma and measures of prevention of glaucoma. Methodology A cross-sectional quantitative study was conducted because data was collected at one point in time. A non-probability convenient sampling process was used since a specific group of patients with glaucoma was required among patients above 40 years of age receiving eye health services at JRRH. Results Most of the respondents 78% were above 40 years, 10% were 0 to 19 years with a percentage of 10%, 8.33% were 30 to 39 years and 3.33% were 20 to 29 years. Raised IOP contributed the highest percentage of 58% followed by systemic hypertension with a percentage of 16% then genetics and family history with a percentage of 12% followed medication-related IOP elevation with a percentage of 8% and finally myopia, systemic hypotension, and pseudoexfoliation syndrome all contributing to a percentage of 2% respectively. Early eye checkups turned out to be the most effective means for preventing glaucoma with the highest percentage of 34% followed by drug adherence with a percentage of 28% then reduction on steroid medication with a percentage of 12%. Conclusion Raised IOP and systemic hypertension were the significant factors in glaucoma while early checkups drug adherence and reduction of steroid medications were the significant prevention measures for glaucoma. Recommendation The Ministry of Health should equip all hospitals and health centers with the necessary equipment to enable eye health workers to diagnose glaucoma.

Anterior segment optical coherence tomography for the detection of silicone oil emulsification on the iris surface

BackgroundTo investigate the presence of silicone oil (SO)-emulsification on the anterior iris surface with anterior segment optical coherence tomography (AS-OCT).MethodsIn this single-center cross-sectional study, vitrectomized eyes with SO tamponade that underwent AS-OCT imaging and gonioscopy examination during the postoperative follow-up visits, were reviewed.Results45 eyes of 42 consecutive patients were included. In 35.6% of the eyes (n = 16) emulsified SO droplets were detected in the anterior chamber (AC) angle by gonioscopy and in 55.6% (n = 25) on the anterior iris surface by AS-OCT imaging. The presence of SO emulsifications in the AC-angle correlated with the presence of SO emulsifications on the anterior iris surface (OR = 13.4, 95% CI [2.179–82.130]; p = 0.005). The accuracy of the AS-OCT predicting the presence of SO in the AC-angle was 71.0% and the sensitivity was 87.5%. No significant association between SO droplets in the AC and other clinical parameters including endotamponade-duration or type of silicone oil were found. The presence of emulsified SO droplets on the anterior iris surface detected by AS-OCT was significantly correlated to postoperative IOP rise (p = 0.027).ConclusionAS-OCT is a suitable method for the detection of SO on the anterior iris surface. SO droplets on the iris surface correlate with elevated postoperative IOP and with the presence of SO in the AC detected by gonioscopy, therefore AS-OCT might be used as a screening method for the detection of SO migration into the AC.Trial registration numberInstitutional Review Board of the Hamburg Medical Chamber (Ethik-Kommission der Ärztekammer Hamburg): 2023-300372-WF.

The FLuorometholone as Adjunctive MEdical Therapy for Trachomatous Trichiasis Surgery (FLAME) Trial: Study Design.

To report the design of FL uorometholone as A djunctive ME dical Therapy for TT Surgery (FLAME) Trial. Parallel design, double-masked, placebo-controlled clinical trial with 1:1 randomization to fluorometholone 0.1% eyedrops twice daily or placebo twice daily for four weeks in eyes undergoing trachomatous trichiasis (TT) surgery; assessing the efficacy, safety, and cost-effectiveness of fluorometholone 0.1% in preventing recurrent postoperative trichiasis. Up to 2500 eligible persons with trachomatous trichiasis (TT) undergoing lid rotation surgery will be enrolled in Jimma zone, Ethiopia. Participants, surgeons, study field staff, and study supervisors leading operational aspects of the trial are masked to treatment assignment. Randomization is stratified by surgeon, which simultaneously stratifies by the district. The study visits are at baseline/enrollment, at four-week post-enrollment, six months, and one year (study exit). The primary outcome is cumulative one-year postoperative TT (PTT) incidence, defined as: ≥1 lashes touching the globe, evidence of epilation, and/or repeat TT surgery. Secondary postoperative outcomes include number of trichiatic lashes, location thereof (touching the cornea or not), evidence of post-operative epilation, entropion, changes in corneal opacity, IOP elevation, need for cataract surgery, visual acuity change from baseline, eyelid contour abnormality, granuloma, eyelid closure defect, and occurrence of adverse events. Health economic analyses center on calculating the incremental cost per case of PTT avoided by fluorometholone treatment. The FLAME Trial is designed to provide evidence of the efficacy, safety, and cost-effectiveness of adjunctive topical peri-/postoperative fluorometholone 0.1% therapy with trichiasis surgery, which is hypothesized to reduce the risk of recurrent trichiasis while being acceptably safe. Trial Registration: ClinicalTrials.gov # NCT04149210.

Revue de la Littérature Traitement actuel du glaucome pseudo-exfoliatif et options thérapeutiques

Pseudoexfoliation glaucoma (PXFG) is known as the most common secondary open angle glaucoma. Accumulation of exfoliative debris in the angle and subsequent IOP elevations is thought to help make PXFG more recalcitrant to topical/medical therapy than primary open angle glaucoma. Laser therapy treatment in the form of selective laser trabeculoplasty for open angle PXFG is therefore discussed. Attention is also called however to the risk of an angle closure component in PXFG eyes and several possible mechanisms behind this. A literature-based discussion on the risks and benefits of laser peripheral iridotomy or cataract surgery to open the angle follows. Literature on the many microinvasive glaucoma surgery options (MIGS) available for PXFG is also reviewed. We provide an overview of MIGS subtypes and summarize study data on several of the better studied options for PXFG. The efficacy and risks of filtering procedures including trabeculectomy and tube shunts for PXFG is also examined.

Symptomatic pigment dispersion with intraocular pressure elevation attributed to intracameral moxifloxacin after open-globe injury

Background: Intracameral moxifloxacin is commonly used following intraocular surgery to prevent endophthalmitis. Pigment dispersion is a rare complication of moxifloxacin use that has mainly been reported following systemic administration. Case presentation: We report a case of unilateral pigment dispersion three weeks after open-globe repair with intracameral moxifloxacin presenting with pain, redness, photophobia, elevated intraocular pressure, marked pigment liberation, new iris transillumination defects and pigment deposits on the anterior iris surface. Conclusion: Symptomatic unilateral pigment dispersion with IOP elevation following intracameral moxifloxacin is a rare entity, but it is a crucial complication for clinicians to be aware of as intracameral antibiotic use following intraocular surgery becomes more frequent.

Retinal microglial cells increase expression and release of IL-1β when exposed to ATP.

Cytokine IL-1β is an early component of inflammatory cascades, with both priming and activation steps required before IL-1β release. Here, the P2X7 receptor (P2X7R) for ATP was shown to both prime and release IL-1β from retinal microglial cells. Isolated retinal microglial cells increased expression of Il1b when stimulated with endogenous receptor agonist extracellular ATP; ATP also rapidly downregulated expression of microglial markers Tmem119 and Cd206. Changes to all three genes were reduced by specific P2X7R antagonist A839977, implicating the P2X7R. Microglial cells expressed the P2X7R on ramifications and responded to receptor agonist BzATP with robust and rapid rises in intracellular Ca 2+ . BzATP increased expression of IL-1β protein colocalizing with CX3CR1-GFP in retinal wholemounts consistent with microglial cells. ATP also triggered release of IL-1β from isolated retinal microglia into the bath; release was inhibited by A839977 and induced by BzATP, supporting a role for the P2X7R in release as well as priming. The IL-1β release triggered by ATP was substantially greater from microglial cells compared to astrocytes from the optic nerve head region. Il1b expression was increased by a transient rise in intraocular pressure and Il1b levels remained elevated 10 days after a single IOP elevation. In summary, this study suggests the P2X7 receptor can both prime IL-1β levels in microglial cells and trigger its release. The P2Y12R was previously identified as a chemoattractant for retinal microglia, suggesting the recruitment of the cells towards the source of released extracellular ATP could position microglia for P2X7R receptor, enabling both priming and release of IL-1β.

Fluorescent identification of axons, dendrites and soma of neuronal retinal ganglion cells with a genetic marker as a tool for facilitating the study of neurodegeneration.

AbstractThis study characterizes a fluorescentSlc17a6-tdTomato neuronal reporter mouse line offering strong labeling in axons throughout the optic nerve, dendrites and soma in 99% of retinal ganglion cells (RGCs). The model facilitates neuronal assessmentex vivowith wholemounts quantified to show neurodegeneration following optic nerve crush or elevated IOP as related to glaucoma,in vitrowith robust Ca2+responses to P2X7 receptor stimulation in neuronal cultures, andin vivousing a confocal scanning laser ophthalmoscope (cSLO). While the tdTomato signal showed strong overlap with RGC markers, BRN3A and RBPMS, there was no cross-labeling of displaced amacrine cells in the ganglion cell layer. Controls indicated no impact ofSlc17a6-tdTomato expression on light-dependent neuronal function, as determined with a microelectrode array (MEA), or on structure, as measured with optical coherence tomography (OCT). In summary, this novel neuronal reporter mouse model offers an effective means to increase the efficiency for real-time, specific visualization of retinal ganglion cells. It holds substantial promise for enhancing our understanding of RGC pathology in glaucoma and other diseases of the optic nerve, and could facilitate the screening of targeted therapeutic interventions for neurodegeneration.Abstract FigureGraphical abstract.Fluorescent identification of axons, dendrites and soma of neuronal retinal ganglion cells with a genetic marker as a tool for facilitating the study of neurodegeneration. Puttipong Sripinun, Wennan Lu, Sergei Nikonov, Suhani Patel, Sarah Hennessy, Claire H. Mitchell*. This study delves into a new mouse model, featuring a fluorescentSlc17a6-tdTomato neuronal reporter. This model effectively labels axons in the optic nerve, as well as dendrites and soma in 99% of retinal ganglion cells (RGCs). This allows for bothin vitroandin vivoassessment of neurodegeneration, offering a practical tool for real-time, precise visualization of RGCs, with potential applications in various fields of neuroscience and neurology. Created byBiorender.com.

Comparing ranibizumab, dexamethasone implant, and combined therapy for macular edema secondary to branch retinal vein occlusion: a clinical trial.

Macular edema (ME) is a common complication following branch retinal vein occlusion (BRVO) and is also the main reason for visual impairment. This study aimed to compare the efficacy and safety of intravitreal ranibizumab (IVR) or dexamethasone implant (IDI) monotherapy, as well as the combination of IVR and IDI injections, in patients with ME secondary to branch retinal vein occlusion (BRVO). This multicenter, prospective, and comparative study included 292 patients with unilateral ME involvement (total of 292 eyes) secondary to BRVO. The patients were randomly assigned to three groups and followed up for 12months. Patients in group 1 (n = 96) were treated with 3-dose loading IVR injections followed by a pro re nata (PRN) regimen. Patients in group 2 (n = 98) received IVR combined with IDI injection, followed by IVR PRN regimen. Patients in group 3 (n = 98) were treated with IDI injection, followed by repeated IDI injection based on clinical necessity. Best corrected visual acuity (BCVA), central retinal thickness (CRT), complications, and frequency of injections were recorded and compared between the three groups. At baseline, the three groups did not differ in age, gender, duration of ME, BCVA, IOP, and CRT (P > 0.05). Mean number of total injections per eye within 12months were 7.1 ± 2.3 (range 4-9) in group 1, 3.7 ± 1.5 (range 2-6) in group 2, and 1.8 ± 0.4 (range 1-3) in group 3. There was a statistical difference in the number of injections between group 1 and group 2 (P = 0.037). Eyes in group 3 received fewer injections than those in group 2, but the difference was not statistically significant (P = 0.052). BCVA improvement and CRT reduction were achieved in all groups and there was no significant difference between the three groups at the end of the 12th month. However, IOP elevation and cataract progression were more frequent in group 3, especially in those patients who received repeated IDI injections. Three therapeutic regimens had comparable efficacy in treating ME secondary to BRVO. Combination therapy had an advantage in maintaining good effect with fewer re-injections and complications. The study complied with the principles of the Declaration of Helsinki and was approved by Xi'an Aier Ancient City Eye Hospital, Xi'an Aier Eye Hospital, and Xianyang Aier Eye Hospital ethics committees (2022SF-367).