Normal Intraocular Pressure Research Articles

Superior segmental optic nerve hypoplasia with normotensive glaucoma: A case report

We report a 27-year-old woman with a cup disk ratio of 0.75:1, with a focal superior neuroretinal rim loss and corresponding nerve fiber layer defect in both eyes. Intraocular pressure was 10 mm Hg in both eyes with normal anterior segment. Perimetry showed inferior arcuate defects in both eyes. A diagnosis of superior segmental optic nerve hypoplasia (SSOH) was made. On follow-up, there was progression in field defects, which were confirmed by repeat field tests, despite normal intraocular pressures. We concluded that there was coexisting normotensive glaucoma (NTG) in this patient.

Differences and Similarities Between Primary Open Angle Glaucoma and Primary Angle-Closure Glaucoma.

Glaucoma is the leading cause of irreversible blindness worldwide. It is an ocular disease characterized by an increase in intraocular pressure or, in some cases, normal intraocular pressure, which leads to optic nerve damage and progressive constriction of the visual field (VF). Primary Open-Angle Glaucoma (POAG) and Primary Angle-Closure Glaucoma (PACG) represent the predominant forms of glaucoma. Numerous hypotheses have been posited to elucidate the pathogenic mechanisms underlying these conditions. There is an emerging understanding of the distinct pathological processes that differentiate the various types of glaucoma. While some similarities in the mechanisms between PACG and POAG have been suggested, evidence indicates that there are also significant differences between the two. This review synthesizes the similarities and differences in the etiology of optic neuropathy caused by POAG and PACG, considering their respective pathophysiological mechanisms, the morphology of the optic disc and surrounding tissues, genetic characteristics, optical coherence tomography angiography, optical coherence tomography, and structural and functional features from VF examinations. These characteristics may contribute to a deeper comprehension of the underlying pathogenesis of glaucoma and enhance the management of different types of this ocular condition.

Vaccine needle prick-related retinal injury

A 7-year-old male presented with left eye subconjunctival hemorrhage following injury with a 23-G vaccine needle (COVID-19 vaccine) while playing. Examination revealed a best-corrected visual acuity of 20/30 in the left eye with the presence of localized subconjunctival hemorrhage and trace vitreous hemorrhage with normal intraocular pressure. Peripheral fundus examination revealed the presence of a peripheral retinal tear with an adjacent retinal cyst. A laser barrage was done to the retinal tear, and the patient was kept under close follow-up. On follow-up at 3 months, vision improved to 20/20 with the resolution of vitreous hemorrhage and attached retina. Thus, we report a rare case of retinal tear due to an inefficiently disposed vaccine needle, stating the importance of following occupational safety by the vaccinators as well as other health administrators.

Possibilities of physiotherapy in glaucomatous optic neuropathy after glaucoma surgery

The current primary approach to the therapeutic and surgical management of glaucoma is limited to lowering intraocular pressure (IOP). While normalization of IOP stabilizes some functional parameters, there is still potential for further restoration of lost visual function in the post-operative period while maintaining the "therapeutic window". Neuroprotection refers to the modification of retinal ganglion cells and the neuronal microenvironment to promote their survival and function. Numerous studies have identified effective neuroprotective methods for glaucoma; however, their implementation into clinical practice remains a significant challenge. This review presents the most clinically significant treatment strategies, as well as the latest therapeutic advances in physiotherapy.

Advances in corneal preservation using an active storage machine

Since the 1980s, corneal storage has been carried out by eye banks throughout the world, mainly by two methods: short‐term storage at 4°C (America, India), and medium‐to‐long‐term organoculture at 31–34°C (Europe, Australia). In these two techniques, known as passive, the cornea is simply immersed in a storage medium. However, the control of corneal hydration in vivo depends both on the proper functioning of the corneal endothelial cells (responsible for the imbibition pressure IP) and on the presence of a normal intraocular pressure (IOP), both of which are opposed to the stromal swelling pressure (SP): IP = SP‐IOP. By restoring IOP ex vivo in an active storage machine (ASM) that separates an endothelial chamber from an epithelial chamber, corneal hydration is better controlled, thus preventing the formation of deep endothelial folds responsible for endothelial over mortality. The active control of corneal hydration eliminates the need to add macromolecules to deswell the cornea (continuously for cold storage or during the last 48–72 h for organoculture). The toxicity of this forced deswelling has been demonstrated for organ culture.We performed two successive preclinical studies comparing ASM and organoculture with paired human corneas having more than 2000 cells/mm2 at the time of the first endothelial count. The organoculture medium (CorneaMax, Eurobio, les Ulis, France) was identical in both groups. The ASM was an experimental version from our laboratory, including a PEEK (polyetheretherketone) corneal support, a peristaltic pump, an Edwards pressure sensor, a microsolenoid valve and a microcontroller managing the flow rate (2.6 μL/min) and the IOP (21 mmHg). In the first study, for 52 pairs of corneas stored for 4 weeks, the ASM corneas had, at the end of storage, +23% viable endothelial cells compared to passive organoculture. Furthermore, ASM also significantly increased Na+/K+/ATPase protein expression by 3.8 ± 1.4. In the second study, for 12 pairs of corneas stored for 3 months, the ASM corneas had +53% viable endothelial cells at the end of storage compared to passive organoculture. One third of corneas still had 2000 cells/mm2 or more in ASM versus none in organoculture. The ASM significantly increased Na+/K+/ATPase protein expression by 2.9 ± 0.8.The ASM has 2 transparent windows which allow all quality controls to be performed without deconditioning the cornea, and in particular to perform endothelial counting by specular microscopy on a cornea which remains thin. The ASM thus combines the advantages of both methods of storage: long‐term storage without massive oedema and without toxic dextran and a closed system allowing non‐invasive controls. As with the perfusion machines for vascularized organs, the restoration of near‐physiological conditions improves grafts' quality.We have transferred this innovation to THEA laboratories (Clermont‐Ferrand, world specialist in ophthalmology) which is industrializing the ASM via its spin‐off SINCLER. The industrial version will take the form of a single‐use cassette incorporating a flow/pressure regulator, a media reservoir and a waste bin. The cassette will be plugged into a computer‐controlled multi‐place incubator for IOP and media flow management. The ASM could revolutionize eye banking worldwide.

Strategy of Surgical Treatment of Patients with Pigment Dispersion Syndrome and Myopia

Purpose: to conduct a prospective study of the results of surgical treatment of patients with pigment dispersion syndrome and complex myopic astigmatism. Materials and methods. As a result of a comprehensive examination of 10453 adult primary patients with complex myopic astigmatism, the diagnosis of pigment dispersion syndrome was made in 99 patients (0.94 %). The study group consisted of 22 people, 9 men and 13 women, with an average age of 29.4 ± 9.8. In the case of iridosonular contact, according to ultrasound biomicroscopy, laser basal iridectomy was performed at the first stage. In the case of normal intraocular pressure indicators, laser correction of myopia was made in patients of the study group within 6 months after laser basal iridectomy. Results. During biomicroscopy, a Krukenberg spindle was observed in 34 eyes (77.2 %), exogenous pigment was detected in 20 eyes (45.4 %) on the iris and lens, and sectoral illumination of the iris was detected in 5 (11.4 %). After laser basal iridectomy on 24 eyes (54.5 %) in all the studied meridians, we noted a tendency to deepen the posterior chamber, but the increase was statistically significant only at 12 hours (P < 0.05). The achieved decrease in the angle of the anterior chamber was statistically significant (P < 0.05) in the meridians of 3, 9 and 12 hours and ranged from 3.56 to 8.53 degrees in different meridians. Laser correction of complex myopic astigmatism was performed in 11 patients (22 eyes) using ReLEx® SMILE technology and 10 (20 eyes) patients using FemtoLASIK technology. At the end of the observation period after correction, refraction within ±0.5 dptr of the planned one was achieved in 88.1 % of cases (37 eyes), ±1.0 dptr — in 100 % of cases. The efficiency coefficient was 88.46 %, the safety coefficient was 92.8 %. Postoperative values of corneal-compensated IOP were comparable with preoperative indicators (P > 0.05). Conclusions. The analysis of the of surgical treatment results in the patients with pigment dispersion syndrome and myopia showed the absence of negative dynamics in the course, as well as high efficiency, safety and stability of the results achieved after laser correction. The applied algorithm for the management of patients with combined pathology with pigment dispersion syndrome and myopia is pathogenetically justified, safe, promotes the preservation of visual functions of patients and improves their quality of life.

Corneal retardation time as an ocular hypertension disease indicator

Objective. A detailed analysis of the corneal retardation time τ as a highly related parameter to the intraocular pressure (IOP), and its plausible role as an indicator of ocular hypertension disease. Approach. A simple theoretical expression for τ is derived within the corneal viscoelastic model of Kelvin-Voigt with 3 elements. This retardation time can be easily calculated from the well-known signal and pressure amplitudes of non-contact tonometers like the Ocular Response Analyzer (ORA). Then, a population-based study was performed where 100 subjects aged from 18 to 30 were analyzed (within this group, about 10% had an elevated IOP with more than 21 mmHg). Main results. A clear relationship between the corneal retardation time and the corneal-compensated intraocular pressure (IOPcc) was found, underlying the risk for ocular hypertensive (OHT) subjects with lower τ values to develop hypertension illnesses (due to the inability of poorly viscoelastic corneas to absorb IOP fluctuations, resulting in probable optic nerve damage). Significance. Our results might provide an useful tool to systematically discern which OHT patients (and even those with normal IOP values) are more likely to suffer glaucoma progression and, consequently, ensure an early diagnosis.

Increased Glaucoma Case-Finding Through Routine Optical Coherence Tomography in Optometry Practice.

Optometrists employing OCT as a routine clinical tool have a higher chance of referring patients for specialist glaucoma management than those without OCT. Timely detection of glaucoma is key to preventing or delaying vision loss. This study aimed to assess whether the routine use of optical coherence tomography (OCT) by optometrists for the detection of glaucomatous changes in the optic nerve and retina increased glaucoma referrals to ophthalmologists. This study was a retrospective review of routinely collected electronic medical records of patients from a chain of 331 optometry practices in Australia. Electronic medical records were reviewed for every patient aged 18-99 years who attended an included practice between January 1 and July 31, 2019. Odds of referral for glaucoma assessment were compared between practices performing OCT routinely on all patients (OCT practices, n=175) and without OCT (non-OCT practices, n=20). A subset of referrals were assessed by ophthalmologists to determine the false positive referral rate. The primary outcome measure of this study was referral to an ophthalmologist for glaucoma assessment. A secondary outcome was the rate of false positive referrals, analyzed in a subset of patients referred for glaucoma assessment. Records from 994,461 patients (59% female) were included, and 10,475 (1.1%) were referred for glaucoma assessment. Most referrals were associated with normal intraocular pressure (non-OCT practices: n=496, 66%; OCT practices: n=6,603, 68%). Referral for glaucoma was higher in OCT practices (n=9,719, 1.1%) compared with non-OCT practices (n=756, 0.8%, age-adjusted, gender-adjusted, and location-adjusted odds ratio 1.39, 95% confidence interval 1.10-1.76). Of 318 referred patients (3%, all from OCT practices) for whom ophthalmologist feedback was available, 68 (21%) were considered not to have glaucoma. The routine use of OCT in optometric practice may lead to more timely glaucoma detection and prevention of avoidable vision loss.

TIE1 and TEK signalling, intraocular pressure, and primary open-angle glaucoma: a Mendelian randomization study

BackgroundIn primary open-angle glaucoma (POAG), lowering intraocular pressure (IOP) is the only proven way of slowing vision loss. Schlemm’s canal (SC) is a hybrid vascular and lymphatic vessel that mediates aqueous humour drainage from the anterior ocular chamber. Animal studies support the importance of SC endothelial angiopoietin-TEK signalling, and more recently TIE1 signalling, in maintaining normal IOP. However, human genetic support for a causal role of TIE1 and TEK signalling in lowering IOP is currently lacking.MethodsGWAS summary statistics were obtained for plasma soluble TIE1 (sTIE1) protein levels (N = 35,559), soluble TEK (sTEK) protein levels (N = 35,559), IOP (N = 139,555) and POAG (Ncases = 16,677, Ncontrols = 199,580). Mendelian randomization (MR) was performed to estimate the association of genetically proxied TIE1 and TEK protein levels with IOP and POAG liability. Where significant MR estimates were obtained, genetic colocalization was performed to assess the probability of a shared causal variant (PPshared) versus distinct (PPdistinct) causal variants underlying TIE1/TEK signalling and the outcome. Publicly available single-nucleus RNA-sequencing data were leveraged to investigate differential expression of TIE1 and TEK in the human ocular anterior segment.ResultsIncreased genetically proxied TIE1 signalling and TEK signalling associated with a reduction in IOP (− 0.21 mmHg per SD increase in sTIE1, 95% CI = − 0.09 to − 0.33 mmHg, P = 6.57 × 10–4, and − 0.14 mmHg per SD decrease in sTEK, 95% CI = − 0.03 to − 0.25 mmHg, P = 0.011), but not with POAG liability. Colocalization analysis found that the probability of a shared causal variant was greater for TIE1 and IOP than for TEK and IOP (PPshared/(PPdistinct + PPshared) = 0.98 for TIE1 and 0.30 for TEK). In the anterior segment, TIE1 and TEK were preferentially expressed in SC, lymphatic, and vascular endothelium.ConclusionsThis study provides novel human genetic support for a causal role of both TIE1 and TEK signalling in regulating IOP. Here, combined evidence from cis-MR and colocalization analyses provide stronger support for TIE1 than TEK as a potential IOP-lowering therapeutic target.

Comparisons of the clinical outcomes of Centurion® active fluidics system with a low IOP setting and gravity fluidics system with a normal IOP setting for cataract patients with low corneal endothelial cell density

BackgroundDuring cataract phacoemulsification surgery, the Alcon Centurion with Active Sentry can achieve a more stable anterior chamber, which allows a lower intraocular pressure (IOP) setting than the gravity fluidics system. In this randomized controlled trial, we compared these two systems’ damage to the cornea under different IOP settings.MethodsSeventy-eight eyes of 53 patients with corneal endothelial cell density (ECD) of 500∼1500/mm2 were enrolled and randomly divided into the active fluidics system (AFS) group using an Active Sentry handpiece with 30 mmHg IOP setting (40 eyes) and the gravity fluidics system (GFS) group using an Ozil handpiece with 80 cmH2O IOP setting (38 eyes). Intraoperative parameters, visual acuity, corneal edema ratio, central corneal thickness (CCT) changes as well as loss rate of ECD were analyzed.ResultsWe observed no significant differences in best corrected visual acuity (BCVA), cumulative dissipated energy (CDE), total case time, estimated fluidics usage (EFU) and ophthalmic viscoelastic devices (OVDs) usage between the two groups. The enrolled eyes were further divided into soft nucleus (27 eyes) and hard nucleus (51 eyes) subgroups. And we found less pain complaint during surgeries, lower corneal edema ratio at 1-day and 1-week visit, smaller CCT changes at 1-day visit and lower ECD loss rate at 1-month visit (p < 0.05) in both subgroups of the AFS group than in the GFS group, implying higher intraoperative comfort levels and less corneal damage of the AFS group with a low IOP setting.ConclusionOwing to a lower IOP setting, Centurion® Vision System with Active Sentry handpiece causes less corneal damage and pain perception during phacoemulsification for patients with low pre-operative ECD.Clinical Trial Registrationhttps://www.chictr.org.cn, identifier ChiCTR2300077865.

Study on maintenance of eyeball morphology by foldable capsular vitreous body in severe ocular trauma

ObjectivesTo explore the feasibility and safety of using a foldable capsular vitreous body (FCVB) in managing severe ocular trauma and silicone oil-dependent eyes.MethodologyThis is a retrospective study of 61 ocular trauma patients (61 eyes) who presented to the Department of Eye Emergency, Hebei Eye Hospital from May 1, 2018, to May 31, 2019, including 51 male patients (51 eyes) and 10 female patients (10 eyes) with an average age of 44.98 ± 14.60 years old. The oldest patient was 75 years old, and the youngest was 8 years old. These cases represented 51 eyes with severe eyeball rupture and 10 eyes with severe, complicated ocular trauma, which became silicone oil-dependent after the operation. These patients received FCVB implants, and data regarding their visual acuity, intraocular pressure, changes in eye axis, cornea, retina, and FCVB state were recorded after the operation.ResultsIn all patients, the FCVB was properly positioned and well supported with the retina. All 61 patients cleared a follow-up window of 1–36 months with no reports of important changes in their visual acuity. Among the patients, 91.8% reported normal intraocular pressure, the retinal reattachment rate reached 100%, and the eyeball atrophy control rate reached 100%. There was no report of rupture of the FCVB, allergies to silicone, intraocular infection, intraocular hemorrhage, silicone oil emulsification, or sympathetic ophthalmia.ConclusionsFoldable capsular vitreous bodies (FCVBs) designed to mimic natural vitreous bodies are suitable as long-term ocular implants that can provide sustained support for the retina without the need for any special postoperative postures. Their barrier function may effectively prolong the retention time of the tamponade and prevent various complications caused by direct contact of the eye tissues with the tamponade.

Corneal characteristics and OCT-angiography findings in pediatric glaucoma and glaucoma suspects

To analyze corneal biomechanics, specular microscopy, and optical coherence tomography-angiography findings in children with glaucoma. Pediatric patients (<18 years of age) with glaucoma (n = 38), increased cup:disk ratio and normal intraocular pressure (IOP) glaucoma suspects (n = 36), and controls (n = 67) were prospectively enrolled. Patients underwent testing with Ocular Response Analyzer, CellChek Specular Microscope, and Heidelberg OCT-A. Average age of participants was 12.4 ± 3.5 years, with no difference between groups (P = 0.71). Glaucoma patients had undergone more intraocular surgeries (P < 0.0001) and showed worse logMAR visual acuity (P < 0.0001) than suspects or controls. Central corneal thickness (CCT) was greater in glaucoma patients (642.8 ± 85.9 μm [P < 0.0001]) and suspects (588 ± 43.7 μm [P = 0.003]) compared with controls (561 ± 39.9 μm). Corneal hysteresis (CH) was decreased in eyes with glaucoma (10.4 ± 3.0) compared with controls (11.7 ± 1.5 [P = 0.006]), but not suspects (11.3 ± 2.0 [P = 0.1]). Glaucoma patients had lower endothelial cell density (2028.4 ± 862.7 [P < 0.0001]) and greater average cell area (547.2 ± 332.4 [P < 0.0005]) compared with suspects (2919.3 ± 319.1, 347.5 ± 46.2) and controls (2913.7 ± 399.2, 350.8 ± 57.7), but there was no difference in polymegathism (P = 0.12) or pleomorphism (P = 0.85). No differences in vessel density or vessel skeletal density in the retinal vascular complex (P = 0.3077, P = 0.6471) or choroidal vascular complex (P = 0.3816, P = 0.7306) were detected. Children with glaucoma showed thicker corneas with lower endothelial cell density and greater cell area, but no difference in retinal/choroidal vascular densities compared with suspects and controls.

Measurement of vitreous humor pressure in vivo using an optic fiber pressure sensor

We conducted a study to assess the pressure difference between the aqueous and vitreous humors in rabbit eyes using a direct intraocular pressure (IOP) measurement method. A micro-optic-fiber pressure sensor was utilized for this purpose. Preliminary experiments with enucleated porcine eyes confirmed the sensor's accuracy in measuring both aqueous and vitreous humor pressure. The main study involved six healthy albino rabbits, where the sensor measured the pressure in the anterior chamber (aIOP) and posterior vitreous-cavity (pIOP). These measurements were compared to aIOP values obtained through rebound tonometry. Additionally, pre- and postoperative pressure comparisons were made after performing a vitrectomy. Results revealed a significant disparity between aqueous and vitreous humor pressures. Prior to vitrectomy, pIOP was 22.8 mmHg, over twice as high as aIOP (11.0 mmHg), but decreased to a similar level following the procedure. Comparison between the sensor measurements and rebound tonometry showed agreement in aIOP values. In conclusion, our study demonstrates that vitreous humor pressure is consistently higher than aqueous humor pressure, reaching the upper limit of normal IOP. Furthermore, vitrectomy effectively reduces pIOP, aligning it with aIOP. These findings contribute valuable insights into intraocular pressure dynamics and have implications for clinical interventions targeting ocular pressure regulation.

Longitudinal Change of Cup to Disc Ratio in Premature Infants with Enlarged Cup to Disc Ratio and Normal Intraocular Pressure

ABSTRACT Purpose To evaluate the longitudinal change of cup to disc ratio (CDR) in premature infants with enlarged CDR and normal intraocular pressure (IOP). Methods This retrospective, observational study included 283 eyes of 283 premature infants at single center. Infants were divided into enlarged CDR and control groups. Data on demographics, gestational age (GA), birth weight (BW), vertical cup to disc ratio (vCDR), IOP, and corneal diameter were analyzed. Results Of the 283 patients, 38 (13.4%) and 245 (86.6%) were in the enlarged CDR and control groups, respectively. In the enlarged CDR group, the vCDR and baseline IOP was 0.63 ± 0.12 and 12.7 ± 2.2 mmHg, respectively. In the control group, the vCDR and baseline IOP was 0.18 ± 0.05 and 10.9 ± 1.7 mmHg, respectively. The IOP at a GA of 40 weeks and at 1 and 2 years of age were significantly lower than that at baseline. The differences in vCDR between baseline and each follow-up visit were not significant. vCDR was negatively correlated with GA and BW; however, these correlations were not significant. Conclusions The vCDR did not significantly change up to age of 2 years of age in premature infants with enlarged CDR and normal IOP. However, close follow-up is needed until other reliable glaucoma examinations, such as optical coherence tomography and visual fields, can be possible.

Factors associated with visual field or structure progression occurring first in a prospective study on patients with untreated open-angle glaucoma with normal intraocular pressure

Background/ObjectivesTo identify factors associated with disc/retina deterioration in stereo fundus photographs preceding that of the visual field (VF), as determined with a Humphrey Field Analyzer (HFA) (Structure First deterioration) and factors associated with the latter preceding the former (Field First deterioration) in open-angle glaucoma (OAG) with lower normal intraocular pressure (IOP).Subjects/MethodsProspective cohort study. Ninety eyes of 90 patients with OAG and a baseline IOP < 15 mmHg participated in a 5-year prospective study without treatment. IOP measurements and HFA 24-2 Swedish Interactive Test Algorithm Standard tests were performed every 3 months, and fundus photographs were obtained every 6 months. VF deterioration was determined by Guided Progression Analysis and deterioration of disc/retina was determined on stereophotographs by an independent committee. A multivariable Cox proportional hazard model was used to identify factors associated with Structure First deterioration, and with Field First deterioration.ResultsThe average baseline age and mean deviation were 53.9 ± 9.8 years and −2.8 ± 2.8 dB, respectively. During the 5-year follow-up, the probability of Field First deterioration was 49% ± 6.6% (standard error) and that of Structure First deterioration was 33% ± 6.4% (P = 0.062, log-rank test). Disc hemorrhage (DH) prior to the event (P = 0.006) was associated with Structure First deterioration, and older age was associated with Field First deterioration (P = 0.040).ConclusionsIn OAG eyes with lower normal IOP, DH was significantly associated with Structure First deterioration, and age was significantly associated with Field First deterioration.

THU444 A Case Of Zoledronic-Acid Induced Acute Anterior Uveitis, Episcleritis, And Synovitis

Abstract Disclosure: X. Au: None. R.I. Dorin: None. L.E. Aguirre: None. Introduction: IV zoledronic acid infusion (ZAI) may result in acute phase reaction associated with self-limited symptoms of pyrexia, myalgia, headache, arthralgia, and pain in extremities. Eye inflammation and joint swelling are less common manifestations of post-ZAI acute phase reaction, but are important to recognize and treat owing to the potential for long-term sequelae. Clinical Case: A 66-year-old female was diagnosed with osteoporosis by DXA. She received her first ZAI (5 mg) and within 24 hours noted onset of moderate-to-severe diffuse musculoskeletal pain and fever up to 102°F. Two days later, the patient noted swelling of her left wrist and bilateral knee and ankle joints. Clinical assessment led to a diagnosis of post-ZAI synovitis, which improved somewhat with IV ketorolac followed and outpatient po acetaminophen and ibuprofen. Six days after ZAI she developed left eye (OS) redness. Ophthalmologic evaluation identified acute episcleritis and acute anterior uveitis with normal visual acuity and intraocular pressures. The patient was managed with a transient (5 day) course of prednisone (40 mg daily) and a 14-day course of topical prednisone, cyclosporine, and lubrication. Posterior synechiae of OS resolved on follow-up exam and topical medications were successfully tapered over three weeks with resolution of visual complaints. Discussion: Acute phase reaction is a common side effect of ZAI, with an incidence of fever (17.2%) and diffuse musculoskeletal pain (15.7%) reported in one study [1]. Eye inflammation and joint swelling have also been reported after ZAI, but at a lower incidence (0.4% each) [1]. Patients with acute episcleritis and uveitis may require systemic steroids. While the prognosis of appropriately treated acute anterior uveitis is good, it may be associated with concomitant orbital inflammation that could lead to permanent vision loss. Risk factors for development of severe acute-phase reactions after ZA infusion have not been identified, though acute phase reactions are more commonly observed after the first dose of ZAI [2]. Conclusion: Physicians should be aware of rare ophthalmic complications of ZAI, as their prompt recognition and treatment may be important in prevention of long-term ocular sequelae.

Incidence of cataract and glaucoma in children with nephrotic syndrome undergoing steroid treatment

Background Nephrotic syndrome (NS) is by far, the most common glomerular disease in childhood period and is considered as one of the main aetiologies of child exposure to systemic steroids. High-dose corticosteroids for NS, are usually prescribed by pediatrians for a long period. Posterior subcapsular cataract (PSC) and increased intraocular pressure (IOP) are the two most common ocular complications associated with steroid treatment. The exact incidence, prevalence, severity, and time of cataract and glaucoma onset in those childrens have not yet been thoroughly investigated. Aim Evaluating the incidence of cataract and glaucoma in children with NS receiving steroid treatment during and after treatment cessation. Patients and methods This cohort prospective study was done at the Pediatric Nephrology Clinic at Zagazig University Children’s Hospital in co-operation with the Department of Ophthalmology, Zagazig University, for detailed eye examination. Totally 48 children with primary NS who received corticosteroids either as a single treatment or with other treatment modalities for more than 3 months were included in our study. Clinical features plus laboratory tests confirmed by renal biopsy were the main parameters used in the diagnosis of NS. Results Posterior subcapsular cataracts (PSC) were observed in 14 patients (29.2%). All studied patients had normal intraocular pressure ranging between 10 and 20 mmHg in both eyes during the follow-up period with no glaucomatous optic disc changes observed. Conclusion A significant number of children with NS treated with steroids are liable to develop cataracts and glaucoma that may progress and need surgery to preserve vision, so they have to be well diagnosed and followed-up.

Transvenous embolization via the facial vein for intraorbital dural arteriovenous fistula: illustrative case.

Intraorbital arteriovenous fistula (IOAVF) is a rare type of intracranial fistula that presents with ocular signs similar to those of cavernous sinus dural arteriovenous fistula. The treatment of IOAVF is based on the vascular architecture of each case due to its infrequent occurrence. The authors report the case of an IOAVF that was successfully treated with embolization via the facial vein, with good outcomes. A 78-year-old woman presented with left eyelid swelling, pulsatile ocular protrusion, and left ocular conjunctival hyperemia. Ophthalmological evaluation revealed elevated intraocular pressure; time-of-flight magnetic resonance angiography revealed a dilated left superior ophthalmic vein. Digital subtraction angiography showed an arteriovenous shunt in the left superior orbital fissure, which was treated using transvenous coil embolization. The patient experienced immediate improvement in left ocular protrusion and conjunctival hyperemia. Ophthalmological evaluation 1 month after treatment showed normal intraocular pressure in the left eye. No neurological symptoms were observed, and there was no recurrence of the arteriovenous shunt 3 months postoperatively. The authors report a rare case of IOAVF treated with embolization via the facial vein with a good outcome. A thorough understanding of the vascular architecture using three-dimensional images is useful for determining endovascular access and procedures.

Outcome and safety of secondary pars plana capsulotomy in patients with posterior capsular opacity following extracapsular cataract extraction

Objectives: Posterior capsular opacity is a major delayed complication seen in patients following cataract extraction. Neodymium-doped Yttrium Aluminium Garnet laser capsulotomy is the standard procedure for capsulotomy; however, its high cost and unavailability in the developing countries makes it important for us to find an alternative, effective and safe method that will help reduce the burden of severe visual impairment and blindness in individuals who have had cataract extraction. The aim of the study was to showcase the effectiveness, outcome and safety of pars plana capsulotomy in reducing the burden of visual impairment and blindness occurring after cataract extraction due to posterior capsular opacity amongst patients. Materials and Methods: This is a hospital-based retrospective study, where the clinic, ward and theatre registers of patients who had secondary pars plana capsulotomy in the past 3 years (2019–2022) due to posterior capsular opacity were reviewed. Patient’s folders who had pars plana capsulotomy with incomplete records were excluded as well as patients who had diabetes, glaucoma, corneal opacity and age-related macular degenerations. The frequency, age distribution, duration from cataract extraction to presentation with posterior capsule opacification (PCO), the grading and morphology of PCO were all noted. The pre- and post-operative visual acuity (VA) was also recorded alongside the pre- and post-operative intraocular pressure (IOP). We also documented intra- and post-operative complications that were seen in these patients. Data were analysed using SPSS package version 23 (SPSS Inc. Illinois, Chicago), and values were expressed as simple frequencies and proportions. Paired t-test was used to test the statistical significance with P &lt; 0.05. Results: A total of 36 patients records were reviewed; capsulotomy was performed in all age groups with the majority done in individuals 60–69 years – 11 eyes (26.8%). A total of 41 eyes of 36 patients had undergone secondary pars plana capsulotomy. Five (13.9%) patients had bilateral pars plana capsulotomy on different occasions. The mean age was 45.3 ± 26.9 years. There were 22 (53.7%) females and 19 (46.3%) males. Female-to-male ratio was 1.2:1. About 75.6% presented between 1 and 5 years after cataract surgery; mean duration for presentation with posterior capsular opacity after cataract extraction was 2.0 years ± 1.6 months. The majority 31 (75.6%) had their pars plana capsulotomy done under topical anaesthesia. VA at presentation was found to be below 3/60 in 17 (41.5%) eyes. After pars plana capsulotomy, VA improvement was seen – 6/6–6/12 in 23 (56.1%) eyes. Grade of PCO revealed that 15 (36.6%) eyes had Grade 2 PCO and the Elschnig pearls were the most common morphological form seen in 30 (73.2%) eyes. Most eyes had normal IOP post-operatively 38 (92.7%); there was a transient increase in IOP in 3 (7.3%) eyes. There were no complications recorded in most eyes 27 (66%). The most common of the few complications seen was subconjunctival haemorrhages in 6 (14.6%) eyes which resolved within a week of follow-up. Conclusion: Pars plana capsulotomy is a safe, easy and effective alternative for posterior capsulotomy and will be useful in resource-poor settings.

Management of Primary Open Angle Glaucoma (POAG): Ayurvedic and Modern Approaches

Primary open-angle glaucoma (POAG) is a chronic disease characterized by elevated intraocular pressure (IOP), optic nerve damage, and visual field loss. This review explores the management of glaucoma from both Ayurvedic and modern medical perspectives, discussing their similarities, differences, and potential benefits. Modern therapeutic approaches include medication, laser therapy, and surgery to lower IOP and prevent visual field damage. However, glaucoma progression and optic nerve damage can occur even with normal IOP levels. Ayurveda views POAG as a manifestation of Adhimantha, primarily involving Pitta and Rakta doshas. Ayurvedic treatments focus on improving ocular health through various therapies, herbal formulations, and lifestyle modifications. Integrating Ayurvedic and modern approaches may provide a comprehensive approach to glaucoma management, enhancing patient outcomes.