Iris Adhesions Research Articles

Clinical characteristics and surgical management outcomes of glaucoma secondary to congenital ectropion uveae: a preliminary analysis of penetrating Schlemm's canaloplasty

Objective: To investigate the clinical characteristics and treatment outcomes of glaucoma secondary to congenital ectropion uveae (CEU) using penetrating Schlemm's canaloplasty. Methods: This was a retrospective case series study. Medical records of patients diagnosed with glaucoma secondary to CEU and undergoing penetrating Schlemm's canaloplasty at the Eye Hospital of Wenzhou Medical University between August 2020 and December 2021 were collected. Clinical characteristics including the extent and location of iris ectropion, type of glaucoma, were analyzed. Follow-up visits were conducted at 1, 3, 6 months, and 1 year postoperatively. Visual acuity, intraocular pressure (IOP), anterior segment and fundus condition, filtering bleb morphology, use of IOP-lowering medications, ultrasound biomicroscopy results, and other indicators were analyzed to summarize surgical outcomes. Results: Six cases (6 eyes) of glaucoma secondary to CEU were included, all unilateral, with 3 left eyes and 3 right eyes; median age was 10.0 (5.3, 28.8) years; including 3 males and 3 females. Preoperative IOP was (31.7±10.0) mmHg (1 mmHg=0.133 kPa), and the preoperative number of IOP-lowering medications used was 2.0 (2.0, 3.2). The extent of iris ectropion in the 6 cases ranged from 270 ° to 360 °, with peripheral anterior synechiae corresponding to the location of iris ectropion, and angle closure with the degree of synechiae extending beyond Schwalbe's line. No surgical complications occurred in any of the 6 cases postoperatively. At 1 month postoperatively, the IOP was (16.4±3.2) mmHg, with a median of 0.0 (0.0, 1.5) medications used. At 3 months postoperatively, the IOP was (14.8±6.0) mmHg, with a median of 0.0 (0.0, 2.2) medications used. At 6 months postoperatively, the IOP was (18.1±6.1) mmHg, with a median of 0.0 (0.0, 0.5) medications used. Among them, 5 patients had a follow-up period of 1 year postoperatively, all achieving controlled IOP without the use of IOP-lowering medications, with an average IOP of (15.5±3.1) mmHg. No obvious filtering bleb formation was observed at the surgical site in all patients. Conclusions: Glaucoma secondary to CEU manifests primarily as closed-angle glaucoma, with a correspondence between the closure range of anterior iris adhesions in the angle and the extent of iris ectropion. Penetrating Schlemm's canaloplasty demonstrates favorable and stable efficacy for its treatment.

Traction suture fixation technique using a capsular tension ring fragment for severe lens displacement during cataract surgery in dogs.

To describe the traction suture fixation technique for severely displaced lenses (≥180°) using a capsular tension ring (CTR) fragment during cataract surgery in dogs, and to retrospectively investigate its clinical outcomes. Eight dogs (nine eyes). The medical records of dogs with severe lens displacement (≥180°) due to cataracts that underwent traction suture fixation during cataract surgery using a CTR fragment at the Grand Animal Hospital (Hyogo, Japan) between November 2019 and September 2022 were retrospectively reviewed. The retrieved data included the signalment, type of CTR, and postoperative outcomes. A single CTR fragment was used to fix the capsular bag to the sclera in six eyes, and two CTR fragments were used at two sites in three eyes. The lengths of the CTR fragments used were 1 one-fifth fragment, 3 one-fourth fragments, and 8 one-third fragments. Postoperative complications included uveitis (nine eyes), glaucoma (one eye), posterior iris adhesion (one eye), corneal ulcer (one eye), and intracorneal stromal hemorrhage (one eye). Vision was maintained in all dogs during the follow-up period (2 months to 2 years and 8 months) without recurrent capsular bag displacement. This technique can correct and stabilize capsular bag displacement relatively easily through a small incision during cataract surgery in dogs with severe lens displacement. Intraocular lens implantation was also possible.

Clinical and diagnostic imaging profile of three anterior segment dysgenesis disorders presenting with infantile corneal opacities.

To describe three anterior segment dysgenesis disorders with infantile corneal opacities, namely, congenital hereditary endothelial dystrophy (CHED), primary congenital glaucoma (PCG), and Peters anomaly (PA) in terms of clinical characteristics, histopathology, genetic association, and diagnostic imaging profiles using imaging modalities such as ultrasound biomicroscopy (UBM) and microscope-integrated intraoperative optical coherence tomography (i-OCT). Seventy-four eyes with 22 eyes of CHED, 28 eyes of PA, and 24 eyes of PCG were clinically evaluated and underwent imaging using UBM and i-OCT. Corneal buttons of 16 operated patients underwent histopathological analysis, while genetic analysis was done in 23 patients using whole-exome sequencing. Corneal diameters (CD) and UBM parameters like anterior chamber depth (ACD), iris thickness (IT), and ciliary body (CB) thickness revealed a statistically significant difference between the three categories. In PA, 9 eyes had a third rare phenotype with only a posterior corneal defect with no iris adhesions. Genetic mutations were seen in all tested patients with CHED, in 83.3% of patients with PCG, and in 80% of patients with the third type of PA. i-OCT helped in the characterization of corneal opacity, identification of posterior corneal defects, iridocorneal adhesions, and contour of Descemet's membrane. Overlapping phenotypes of the above disorders cause a diagnostic dilemma and parameters like CDs, UBM ACD, IT, and CB thickness help differentiate between them. i-OCT can help in classifying the diseases in a high resolution, non-contact manner, and can better delineate corneal characteristics. The rare third type of PA phenotype may have a genetic association.

Ocular toxocariasis presenting as leukocoria

An 8-year-old boy presented to Zhongshan Ophthalmic Center (Guangzhou, China) with a 2-month history of leukocoria (white pupil) in the right eye (figure). His visual acuity was reduced to counting fingers in the right eye and was 20/20 in the left eye. Posterior synechiae (iris adhesions to the lens), total cataract, and tractional retinal detachment were noted in the right eye by slit-lamp microscopy and ultrasound (B-mode). His parents recalled that the patient had a long-term habit of playing with their pet dog, but the dog had never been dewormed. Serological testing for toxocariasis showed Toxocara canis-specific IgG in the serum (74·82 units, reference range 0–9) and aqueous humour (58·53 units, reference range 0–3) of the patient. Embryonated eggs and worms of T canis were found in the faeces of the patient's pet dog by microscopic examination after deworming treatment (video). The patient was diagnosed with ocular toxocariasis presenting as leukocoria. He received cataract surgery and systemic anti-inflammatory therapy with oral prednisone (0·5 mg/kg per day for 30 days), but showed no visual improvement at the 6-month follow-up.

Phenotypic Spectrum of Peters Anomaly: Implications for Management.

The aim of this study was to characterize the wide phenotypic spectrum of Peters anomaly and to suggest a management algorithm based on disease phenotype. The charts of all children diagnosed with Peters anomaly between January 2000 and December 2013 were reviewed retrospectively. Anterior segment color photographs, anterior segment optical coherence tomography, and ultrasound biomicroscopy images were used to phenotype disease severity and to guide management. Disease severity was categorized to Peters anomaly type I and II according to lens involvement. Peters anomaly type I and II were further categorized from mild to severe disease according to the size and location of corneal opacity. Associated systemic findings were also documented. Eighty eyes of 54 patients with Peters anomaly were identified, of which 28 (51.9%) had unilateral disease. Peters anomaly type I was present in 40 patients (57 eyes, 71.2%) and Peters anomaly type II in 14 patients (23 eyes, 28.8%). Nine eyes (11.3%) had phenotypic features that required observation only, 24 eyes (30%) were amenable to pupillary dilation, 43 eyes (53.8%) with large, dense central opacity required penetrating keratoplasty, and 4 eyes (5.0%) had no intervention because of very poor prognostic features. Associated systemic abnormalities occurred frequently in Peters anomaly (n = 20, 37.0%), with congenital heart defect being the most common morbidity (n = 10, 18.5%). Peters anomaly presents with a variable phenotype ranging from minimal peripheral corneal opacity to extensive iris and lens adhesions with dense central corneal opacity detrimental to vision. Management can be standardized and guided by an algorithm based on phenotypic severity. Systemic abnormalities should be ruled out, regardless of the severity of Peters anomaly.

The Results of Pars Plana Vitrectomy in the Treatment of Intraocular Retinoblastoma: A Retrospective Study and Literature Review.

Purpose: To assess the efficacy and safety of pars plana vitrectomy (PPV) as a treatment for intraocular retinoblastoma (RB) patients. Methods: Twenty-eight RB patients who had PPV were recruited in this retrospective case study, using the digital wide-angle retinal imaging device to record and assess disease condition. Results: The mean value of follow-up time was 79.4 months from diagnosis and 73.1 months from PPV. Up to the end of the follow-up time after PPV, the 5-year survival rate was 96.4%. Ultimately, 35.7% patients underwent enucleation of the eyeball. Among patients with salvaged eyes, 50% had no light perception vision. During the postoperative follow-up time, 14.3% of patients required no further antitumor treatment, and the remaining patients still need to continue to receive systemic or local antitumor treatment, such as chemotherapy, arterial interventional therapy, laser treatment, cryotherapy, and so on. The complication after PPV include cataracts (46.4%), iris adhesion (7.1%), emulsification of the silicone oil (17.9%), band degeneration of the cornea (10.7%), glaucoma (3.6%), and retinal neovascularization (3.6%). Conclusion: According to our observations, we recommend that the utmost care should be taken when considering PPV for the treatment of activated RB. When weighing the risk of tumor recurrence and metastasis, PPV is not suitable for routine treatment. It is necessary to fully grasp the operative indications and strictly observe operation specifications, which includes close postoperative follow-up.

Ten-year safety follow-up and post-explant analysis of an anterior chamber phakic IOL.

To assess endothelial cell loss (ECL) rate and collect safety data in patients with AcrySof L-series Cachet phakic intraocular lens (pIOL) up to 10 years post-implantation. Clinical settings in the United States, European Union, and Canada. Nonrandomized, observational, open-label safety study. Central and peripheral endothelial cell density was evaluated and compared with 6-month post-implantation baseline. Nonlinear analysis was performed to identify factors affecting post-explantation ECL. Additional evaluations included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), adverse device effects (ADEs), and serious adverse events (SAEs). The study included 1123 implanted eyes (mean age, 37.5 years). At 10 years, mean central and peripheral ECL was 16% (1.7% annualized). Explantations were performed in 10% of eyes (n = 136/1323). For eyes with pIOL explantation because of ECL (7%), annualized ECL rate post-explantation was numerically lower compared with the overall rate in eyes that underwent explantation for any reason (annualized rate, -1.65% vs -2.03%, respectively; n = 96) and compared with pre-explantation ECL. Mean ± SD CDVA and UCVA were -0.12 ± 0.11 and 0.03 ± 0.22 logarithm of the minimum angle of resolution, respectively. Common ocular ADEs included ECL (10%), pIOL extraction (9%), iris adhesion (7%), and pupillary deformity (2%). Common SAEs included pIOL extraction (11%), ECL (9%), and iris adhesions (8%). Cachet pIOLs were associated with long-term ECL in some cases. Overall, only 10% of all implanted eyes underwent explantation during 10-year follow-up. In patients requiring explantation because of ECL, the annualized ECL rates decreased post-explantation in some eyes. Continued monitoring of patients regardless of explantation is recommended.

FOXC1 variant in a family with anterior segment dysgenesis and normal-tension glaucoma

Our study describes the glaucoma phenotype in a family with Axenfeld-Rieger syndrome (ARS) and a FOXC1 variant.Included were 20 subjects from a large three generation family of Jewish Indian ancestry. Subjects underwent a comprehensive ophthalmic examination including automated perimetry and optical coherence tomography. Eight subjects were available for molecular analysis which included whole genome sequencing on selected patients and Sanger sequencing for variant screening.Eleven patients demonstrated a wide spectrum of Axenfeld-Rieger anomaly signs and symptoms. These ranged from subtle angle abnormalities to remarkable anterior segment abnormalities such as corectopia, iris adhesions and strands. Among them, six had glaucoma and two were glaucoma suspects. Of the six subjects with glaucoma three had high-tension glaucoma and two had normal-tension glaucoma. Molecular analysis revealed a previously described pathogenic variant in the FOXC1 gene (c.378C > G p.I126M; rs104893958), in six affected patients which was not identified in two healthy siblings. Molecular analysis also revealed a PITX2 missense variant (c.28T > A p.L10M; rs755864040) which did not segregate with clinical findings and was considered likely benign.In conclusion, patients with ARS due to FOXC1 variants may present with glaucomatous optic nerve damage without apparent elevation in IOP. Normal-tension glaucoma is less commonly reported in individuals with ARS and a comprehensive glaucoma assessment may be warranted in these individuals even with normal IOP. These findings raise the possibility that glaucomatous damage associated with FOXC1 is not only due to high IOP.

Role of Microscope-Intraoperative Optical Coherence Tomography in Pediatric Keratoplasty: AComparative Study

We evaluate the role of microscope-integrated intraoperative optical coherence tomography (i-OCT) in pediatric keratoplasty. Combined prospective and retrospective, comparative, interventional study conducted at the Dr Rajendra Prasad Center for Ophthalmic Sciences in New Dehli, India. Seventy-five children ≤16 years of age undergoing planned keratoplasty were divided into 2 groups and compared regarding intraoperative course and postoperative outcome. In group 1 (prospective group, n= 56), preoperative anterior segment visualization was performed clinically, with ultrasound biomicroscopy (UBM) and i-OCT and keratoplasty was commenced under i-OCT microscope. In group 2 (retrospective group, n= 19), a conventional microscope was used during keratoplasty. In group 1, i-OCT, UBM, and clinical examination detected retrocorneal membrane in 10%, 7.5%, and 5% (P= .005), iris adhesions in 62.5%, 57.5%, and 20% (P= .02), iris stump in aniridia 15%, 10%, and 0% (P= .001), shallow central anterior chamber in 22.5%, 22.5%, and 7.5% (P= .003), and shallow peripheral anterior chamber in 65%, 60%, and 17.5% (P= .004) of children, respectively. The use of i-OCT affected intraoperative surgeon decision making in 45% and 33% of cases of anterior and posterior lamellar keratoplasty, respectively. During penetrating keratoplasty, concomitant intraoperative procedures were higher in group 1 than in group 2, namely synechiolysis (19/40 vs 2/15; P= .1), pupilloplasty (4/40 vs 0/15; P= .02), lens extraction (4/40 vs 1/15; P= .5), and anterior vitrectomy (2/40 vs 1/15; P= .4). Postoperative secondary interventions were lower (P= .04) in group 1 (48.21% vs 94.74%). Anterior segment imaging with i-OCT and UBM immediately before surgery improves the surgical planning of children with corneal opacities. In addition, the use of i-OCT refines intraoperative steps, thereby optimizing the postoperative outcome of pediatric keratoplasty.

Management of Aphakia with Visual Axis Opacification after Congenital Cataract Surgery Based on UBM Image Features Analysis.

Objective The purpose of this study was to study the imaging features of ultrasound biomicroscopy (UBM) in the aphakia with visual axis opacification (VAO) after congenital cataract surgery. Methods From May 2015 to May 2018, aphakia patients with VAO who underwent congenital cataract surgery were examined by high-resolution bag/balloon UBM technique, and the results of UBM imaging were analyzed. According to UBM imaging features, different types of VAO were classified. Results A total of 38 children (55 eyes) with VAO were included. 17 patients were bilateral, and 21 patients were unilateral. Patients with VAO were classified into 3 groups according to the UBM imaging features: membranous fibrosis VOA (17 cases, 28 eyes), cortical regeneration VOA (15 cases, 20 eyes), and mixed VOA (6 cases, 7 eyes). The patients in the membranous fibrosis group underwent Nd:YAG laser posterior capsulotomy, those in the cortical regeneration group underwent anterior vitrectomy, and those in the mixed type group underwent anterior vitrectomy with RF capsulotomy tip. After surgery, VAO were removed in all patients. During the follow-up period, in the membranous fibrotic VAO group, iris adhesion and pupillary occlusion were found in 2 eyes, and anterior vitrectomy combined with separation of iris adhesion was performed. In cortical regenerative and mixed type VAO groups, anterior vitrectomy was performed without opacity in the axial region. The total recurrence rate of VAO was 3.46%. Conclusion After congenital cataract surgery, the UBM imaging features of aphakia with VAO are helpful to evaluate the condition of VAO before reoperation so as to choose the optimal surgical method to achieve better therapeutic effect.

Expression Profiles of Inflammatory Cytokines in the Aqueous Humor of Children after Congenital Cataract Extraction.

PurposeTo investigate the change in cytokine microenvironment of the aqueous humor (AH) after surgery in children with congenital or developmental cataracts.MethodsAH samples were obtained from 59 eyes diagnosed with a congenital or developmental cataract. Thirty-three of these eyes were aphakic following previous cataract surgery and were scheduled for secondary intraocular lens (IOL) implantation. Additionally, AH samples from 26 eyes that had not undergone surgery were taken. AH samples were then analyzed for 16 different inflammatory immune mediators using multiplex bead immunoassays and enzyme-linked immunosorbent assay (ELISA).ResultsThe mean interval between secondary IOL implantation and original cataract surgery was 24.85 months (range, 9–60 months). Levels of IL-6, IP-10 (CXCL10), MCP-1 (CCL2), and IL-2 were significantly elevated in the AH of eyes after surgery compared to eyes that did not undergo surgery (P < 0.001, P = 0.047, P = 0.006, P = 0.012, respectively). There was significant correlation between the levels of TGF-β2 and intraocular pressure (IOP) in postsurgical and nonsurgical eyes (r = 0.532, P = 0.006; r = 0.57, P = 0.001). Postsurgical outcomes, such as iris adhesions, capsular fibrosis, and capsular contraction, were found not to be significantly associated with cytokine levels in the AH after surgery; however, IL-6 levels in capsular exposure eyes were significantly higher than those in cortical closure eyes (P = 0.023).ConclusionsTo our knowledge, this is the first study to report significantly increased proinflammatory cytokine levels in the AH after congenital cataract extraction in children. Our study also suggests that this proinflammatory state may be maintained for a prolonged period of time. Overall, these results give us insight into the relationship between the inflammatory cytokine microenvironment of the aqueous humor and potential long-term complications following congenital cataract surgery.Translational RelevanceThe inflammatory cytokine microenvironment of the aqueous humor might help explain potential long-term complications after surgery in patients with congenital or developmental cataracts.

Flubenziamide (Pesticides).

The Food Safety Commission of Japan (FSCJ) conducted a risk assessment of flubendiamide (CAS No. 272451-65-7), an iodophthalimide insecticide for the setting of an acceptable daily intake (ADI) in 2006. FSCJ now has assessed this insecticide for the setting of an acute reference dose (ARfD). Data including fate in animals (rats and mice) and residues in crops (burdock roots, pumpkins and others) were newly submitted. Major adverse effects of flubendiamide include hepatocellular hypertrophy, fatty changes in hepatocytes, follicular epithelial cell hypertrophy in thyroid and ocular enlarged eye in rats. No neurotoxicity, carcinogenicity, reproductive toxicity, teratogenicity, neurodevelopmental toxicity and genotoxicity were observed. The lowest no-observed-adverse-effect level (NOAEL) in the toxicological studies was 1.70 mg/kg body weight/day in a two-year carcinogenicity study in rats. FSCJ confirmed an ADI of 0.017 mg/kg bw/day after applying a safety factor of 100 to the NOAEL. Adverse effects elicited by a single oral administration of flubendiamide would be abnormalities in eyes such as ocular hypertrophy and iris adhesion in offspring, which were obtained in a two-generation reproductive toxicity study, a one-generation reproductive toxicity study and a neurodevelopmental toxicity study in rats. FSCJ judged that these studies may be applicable to set the ARfD for lactating women in relation to the exposure of flubendiamide to offspring after the birth through breast milk. By taking into account the overall evaluations of the two-generation reproductive toxicity study, one-generation reproductive toxicity study and neurodevelopmental toxicity study in rats, FSCJ judged NOAEL of 15.0 mg/kg bw/day as for an overall NOAEL, and consequently specified an ARfD of 0.15 mg/kg bw/day for lactating women by applying a safety factor of 100 to the NOAEL.

Flubenziamide (Pesticides)

The Food Safety Commission of Japan (FSCJ) conducted a risk assessment of flubendiamide (CAS No. 272451-65-7), an iodophthalimide insecticide for the setting of an acceptable daily intake (ADI) in 2006. FSCJ now has assessed this insecticide for the setting of an acute reference dose (ARfD). Data including fate in animals (rats and mice) and residues in crops (burdock roots, pumpkins and others) were newly submitted. Major adverse effects of flubendiamide include hepatocellular hypertrophy, fatty changes in hepatocytes, follicular epithelial cell hypertrophy in thyroid and ocular enlarged eye in rats. No neurotoxicity, carcinogenicity, reproductive toxicity, teratogenicity, neurodevelopmental toxicity and genotoxicity were observed. The lowest no-observed-adverse-effect level (NOAEL) in the toxicological studies was 1.70 mg/kg body weight/day in a two-year carcinogenicity study in rats. FSCJ confirmed an ADI of 0.017 mg/kg bw/day after applying a safety factor of 100 to the NOAEL. Adverse effects elicited by a single oral administration of flubendiamide would be abnormalities in eyes such as ocular hypertrophy and iris adhesion in offspring, which were obtained in a two-generation reproductive toxicity study, a one-generation reproductive toxicity study and a neurodevelopmental toxicity study in rats. FSCJ judged that these studies may be applicable to set the ARfD for lactating women in relation to the exposure of flubendiamide to offspring after the birth through breast milk. By taking into account the overall evaluations of the two-generation reproductive toxicity study, one-generation reproductive toxicity study and neurodevelopmental toxicity study in rats, FSCJ judged NOAEL of 15.0 mg/kg bw/day as for an overall NOAEL, and consequently specified an ARfD of 0.15 mg/kg bw/day for lactating women by applying a safety factor of 100 to the NOAEL.

Prospective evaluation of CO2 laser-assisted sclerectomy surgery (CLASS) with Mitomycin C.

Our purpose was to evaluate the clinical safety and efficacy of CO2 laser-assisted sclerectomy surgery (CLASS) with Mitomycin C (MMC) in open angle glaucoma (OAG). This was a prospective, uncontrolled, interventional case series. All subjects underwent CLASS procedure by a single surgeon. After the dissection of a partial thickness scleral flap, topical MMC 0.2mg/ml was applied to the sclera and the conjunctiva for 3min. The CO2 laser with a beam-manipulating system was used to ablate the scleral tissue and expose the Schlemm's canal area. Primary outcomes: intraocular pressure (IOP) change, number of IOP-lowering medicaments change. Adverse events were evaluated as secondary outcomes. Twenty-one eyes of 21 patients underwent the CLASS procedure. Thirteen were primary OAG (62%), two normal pressure glaucoma (10%), three exfoliative glaucoma (14%) and three others secondary OAG. With a mean (SD) follow-up of 15.3 (5.9) months, the IOP changed from 25.4 (6.7) mmHg at baseline to 10.9 (3.4) mmHg al the last visit. Mean reduction of IOP was -14.5mmHg (95% CI, -17.7 to -11.2, P < 0.001). The median (IQR) number of IOP-lowering medication decreased from 3 (3-3) at baseline to 1 (0-1) at the last visit (P < 0.001). Visual acuity did not change significantly. Adverse events: five eyes (24%) developed iris adhesion to the filtration area that was successfully managed with office-based procedures. In one case (5%), CLASS was converted to trabeculectomy due to intraoperative perforation of the ablated area. There was one case of hypotony maculopathy successfully treated with placement of additional transconjunctival scleral flap sutures. The CLASS procedure with MMC is clinically safe and effective maintaining a large reduction in IOP and in the number of IOP-lowering medications with a mean follow-up of 15months. Iris adhesion at the filtrating area warrants further evaluation and possibly reflects the surgeon's learning curve.

Long-term safety follow-up of an anterior chamber angle-supported phakic intraocular lens

To report adverse device effects and annualized endothelial cell loss rate for up to 10years after implantation of the Acrysof L-series Cachet phakic intraocular lens (pIOL). Clinical centers in the United States, European Union, and Canada. Nonrandomized clinical trial. After implantation of the pIOL, the endothelial cell density (ECD) at follow-up evaluations was compared with the 6-month postoperative baseline. Adverse device effects were assessed. This study assessed 638 patients (1087 eyes) from previous clinical trials. The mean central ECD change from baseline was -9.6%±8.3% (SD) (-1.7% annualized; 623 eyes) and -11.0%±9.9% (-1.7% annualized; 703 eyes) at 6years and 7years, respectively. The mean peripheral ECD change from baseline was -10.8%±8.7% (-2.0% annualized; 615 eyes) and -11.9%±10.0% (-1.8% annualized; 680 eyes), respectively. Endothelial cell loss greater than 30% from the preoperative baseline at any time after implantation affected 8.0% of all eyes. An ECD of 1500cells/mm2 or less at any time after implantation affected 2.7% of all eyes. The most common adverse device effects were peripheral iris adhesions (57 eyes [5.2%]), corneal endothelial cell loss (42 eyes [3.9%]), and pIOL explantation (37 eyes [3.4%]). Long-term evaluation of the pIOL showed a persistent ECD decrease in some eyes that was numerically larger than the annual rate expected with aging. Endothelial cell loss resulted in explantation in 3.1% of all eyes with the pIOL. Patients had no permanent vision loss. The manufacturer recommends that patients continue to be monitored and their corneal endothelium evaluated semiannually.

Clinical characteristic and management of Peters anomaly

Background Peters anomaly is a rare eye disease.Understanding the clinical features of Peters anomaly is helpful for us to correctly manage this disease. Objective This study was to investigate the clinical characteristics and treatment methods of Peters anomaly and provide available basis for the diagnosis and individualized treatment of Peters abnormal. Methods A descriptive study was performed.The clinical data from 8 eyes of 4 patients with Peters anomaly who were diagnosed and treated in Beijing Children's Hospital from January 1, 2014 to March 30, 2016 were retrospectively analyzed.The clinical manifestations of the anterior ocular segment were examined by handheld slit-lamp microscope, and corneal curvature, corneal thickness, axial length and intraocular pressure were measured.The therapy and outcomes of the patients were evaluated. Results Peters anomaly was classified into type Ⅰ, type Ⅱ and Peters plus syndrome based on the findings and literature' criteria.Regarding to the clinical findings, the adhesion of peripheral angle with cornea, shallow or disappeared anterior chamber were found in all the eyes, and these manifestations were type Ⅰ Peters anomaly and occurred in 2 eyes of 2 patients.The opacity and adhesion of the central lens capsula to corneal endothelium was seen in 6 eyes which belonged to type Ⅱ Peters anomaly.The mean corneal thickness was (680±127)μm in 4 measured eyes, which was thicker than normal eyes; the mean corneal curvature was (37.40±1.79)D in 4 measured eyes; the mean axial length was (21.06±0.19)mm and the mean diameter of cornea was (9.4±0.5)mm in 4 measured eyes.Iridocoloboma was found in 4 eyes and congenital aniridia was in 4 eyes.In addition, esotropia appeared in 1 patient, and nystagmus occurred in 3 patients.The 3 patients of type Ⅱ in this study were found to have the disorders associated with systemic neurogenic developmental abnormalities and diagnosed as Peters plus syndrome.Trabeculectomy with anterior vitrectomy was performed in 2 eyes with the intraocular pressure >30 mmHg(1 mmHg=0.133k Pa) and the introcular pressure reduced to below 21 mmHg after operation.Penetrating corneal transplantation was carried out on 1 eye with central opacity.However, rejection of graft occurred at 1 month and became complete cloudy at 3 months after surgery.Cataract extraction surgery was performed on 4 eyes with lens opacity and intraocular lens were implanted in 2 eyes or iridectomy was carried out in another 2 eyes, and the visual quality was evidently improved after operation. Conclusions The clinical characteristics of Peters anomaly include leukoma, shallow anterior chamber, peripheral iris adhesion with cornea and lens opacity due to adhesion of lens anterior capsule to corneal endothelium.Personalized operative regimen should be determined based on the clinical findings of the eyes with Peters anomaly. Key words: Congenital diseases; Children; Peters anomaly; Ocular diseases; Clinical feature; Therapy/methods; Descriptive study

Long-Term Corneal Endothelial Cell Counts After Penetrating Keratoplasty in Infants.

To report long-term endothelial cell counts after penetrating keratoplasty (PKP) in infants. The charts of all children who have undergone PKP in their first year of life between 1998 and 2013 at the Hospital for Sick Children, Toronto, Canada, were reviewed retrospectively. Patients who had a single successful transplant with a valid endothelial cell density (ECD) analysis postsurgery were included in the study. Donor ECDs were provided by a local eye bank. Specular microscopy images were taken at a variable interval after surgery using a noncontact specular microscope (ROBO, Konan; Konan Medical) and endothelial cell loss was calculated. In young children images were taken in the lateral decubitus position under general anesthesia. Twenty-one eyes of 16 patients were included in the study. Median patient age at the time of surgery was 2.0 months [mode, 2.0; interquartile range (IQR), 1.6-2.6 months] and median follow-up time was 49.0 months (IQR, 33.0-99.5 months). The most common indication for surgery was Peters anomaly, in 16 eyes (76.2%). Ten eyes had additional intraocular surgeries posttransplant. The median ECDs prekeratoplasty and at last follow-up were 2958 cells per square millimeter (IQR, 2807-3205 cells/mm) and 1307 cells per square millimeter (IQR, 946-1613 cells/mm) respectively, reflecting a median endothelial cell loss of 59.2% (IQR, 44.3%-68.8%). Iris adhesions to the graft-host junction were strongly associated with low final ECD (P = 0.01). Despite technical challenges and difficult postoperative care, pediatric keratoplasty is associated with a lower endothelial cell loss over time compared with that reported in adults after PKP.

Severe Bilateral Ocular Chemical injury after use of Traditional Medicines: Result of Malpractice in Indian Villages

Case History A 24 year old farmer presented with bilateral decreased vision of three days duration. There was a history of snake bite on his left arm after which he was taken to a snake charmer at his village for treatment. A traditional eye medicine in the form of a whitish flaky powder was instilled into both his eyes by the snake charmer to keep him “awake”. Two days later he developed pain, redness and reduced vision in both eyes. He was referred to a tertiary care hospital. At presentation the visual acuity in both the eyes was perception of light. There was lid edema and conjunctival necrosis with 360 degree limbal involvement in both eyes. Examination of the right eye revealed the presence of corneal melt with iris prolapse and adhesions at multiple sites between bulbar and palpebral conjunctiva (Figure 1A). The left eye cornea was edematous with large epithelial defect (Figure 1 B). Blood coagulation profile, renal and liver function tests were normal. Prothrombin time was 11 seconds, Partial thromboplastin time 40 seconds,blood urea 24 mg%, creatinine 0.6 mg%, total bilirubin 0.9 mg%, SGOT 10 units/ litre, SGPT 13 units/litre. Topical 5% cefazolin and 0.5% carboxymethyl cellulose (CMC) eye drops were started at hourly intervals. Homatropine hydrobromide 2% and autologous serum 20% eye drops were started four times a day for both eyes. The patient underwent large diameter tectonic keratoplasty in the right eye (Figure 2a & b) with bilateral amniotic membrane transplantation (Figure 3a & b). Postoperatively the patient was advised topical 0.5% CMC and 0.3% gatifloxacin for both eyes. Subsequently,he was started on 0.5% loteprednol and a permanent tarsorrhaphy was performed in the right eye to salvage the graft. At 12 weeks follow up the patient had visual acuity of 6/24 with partially opaque cornea in the left eye (Figure 4 a). Right eye had visual acuity of light perception only with opaque corneal graft (Figure 4 b). Chemical analysis of the powder obtained from the snake charmer revealed it to be potassium nitrite. Figure 1 (a): Right eye on presentation: corneal melt with iris prolapse

Upside-down Lens Syndrome: Ocular Complications Secondary to Inverted Implantation of the Kelman Multiflex Anterior Chamber Intraocular Lens

To describe ocular complications resulting from inverted insertion of a Kelman Multiflex anterior chamber intraocular lens (ACIOL). Retrospective observational case series. We describe the outcomes of 4 cases of complicated cataract surgery in which a flexible open-loop polymethylmethacrylate (PMMA) ACIOL (Kelman Multiflex type) was placed in an inverted configuration, all of which were referred to a single institution. In all 4 cases, the placement of an inverted ACIOL resulted in ocular complications including chronic iritis, cystoid macular edema, pupil capture, iris adhesions, and corneal decompensation. Inadvertent inverted placement of the Kelman Multiflex anterior chamber intraocular lenses can lead to a constellation of severe ocular complications. When inserting such lenses, the surgeon should ensure that the lens is correctly oriented such that the optic vaults anteriorly and not posteriorly.

Clinical study on the treatment of primary angle-closure glaucoma with cataract by phacoemulsification combined with goniosynechialysis

Objective To investigate the clinical effect of phacoemulsification combined with goniosynechialysis on primary angle-closure glaucoma with cataract. Methods It was a retrospective study.There were 20 cases (22 eyes) diagnosed primary angle-closure glaucoma (PACG) with cataract in our hospital from 2007 to 2009. Male, 12 cases (14 eyes) and female, 8 cases (8 eyes). Their age were from 64to 85 years old, mean age is 76.8 gears old. 22 eyes:18 with PACG, 4 with CPACG, were undergone phacoemulsification and IOL implantation, combined with goniosynechialysis. The intraocular pressure (IOP)before and after operation, best corrected visual acuity ( BCVA), peripheral anterior chamber (PAC) and the change of anterior chamber angle were all observed and reported. The time of following up was 3 to 12months. Results preoperative IOP were from 7.8 mmHg to 30 mmHg and mean IOP is 18. 91 + 5.48mmHg. Meanwhile the postoperative IOP were 11.81+2.9 mmHg. The IOP were obviously decreased after operation. The IOP were obviously decreased after operation. There were 7 eyes (31.8%) whose preoperational BCVA were less than 0.1. There were 12 eyes (54.5%) whose postoperative BCVA were more than 0. 5, There were 18 eyes whose preoperative PAC depth were less than 1/2 CT. There were 22 eyes whose postoperative PAC depth were more than one CT. They have smooth iris and disappeared peripheral bulges.The angle-closure can be partly opened and the range of goniosynechia can be decreased after operation. Two cases had anterior chameber angle exudative and iris adhesion. Only one case had posterior capsular rupture.No case had corneal decompensation. Conclusion The treatment of primary angle-closure glaucoma with cataract by phacoemulsification combined with goniosynechialysis phacoemulsification combined with goniosynechialysis is safe and effective. Key words: phacoemulsification; goniosynechialysis; primary angle-closure glaucoma; cataract