Punctal Plugs Research Articles

Simple surgical punctal occlusion with high frequency radiowave electrosurgery

BackgroundTo introduce and evaluate the efficacy of a simple punctal occlusion technique for dry eye patients.MethodsMedical records of 79 eyes from 40 patients refractory to common dry eye conservative treatment who underwent multiple high-frequency radio-wave electro-punctal occlusion were retrospectively reviewed. Pre- and post-procedural ocular surface indices (Schirmer test, tear break-up time (TBUT), and corneal staining grade (Oxford scheme)) and subjective symptom scores (including frequency of artificial tear use, interval between procedures, and total repeat time) were analyzed.ResultsAverage Schirmer test result was significantly (P < 0.05) improved from 4.10 ± 1.39 mm to 8.14 ± 3.13 mm at 6 weeks after the procedure (n = 79). A total of 32 eyes from 16 patients underwent repeated procedure with a mean interval of 8.00 ± 4.86 months, while 24 patients had a single procedure. Twenty-five of 30 patients showed improvement for subjective symptom scores. No complications related to the procedure were observed.ConclusionsA simple, less-invasive punctal occlusion technique using a fine-needle tip with high-frequency radio-wave could significantly relieve subjective symptoms and improve ocular surface indices of patients with aqueous deficient dry eye without causing a major complication. This procedure may play a considerable role in treating dry eye refractory to common practices.

Botulinum Neurotoxin Type a Injection Combined with Absorbable Punctal Plug Insertion: An Effective Therapy for Blepharospasm Patients with Dry Eye.

Blepharospasm patients often have dry eye manifestations. Botulinum neurotoxin type A (BoNT-A) injection has been the main management for blepharospasm and absorbable punctal plug (APP) insertion is shown to be effective in the treatment of dry eye. However, there have been no studies investigating the combined treatment of BoNT-A and APP in blepharospasm patients with dry eye. In this retrospective study, 17 blepharospasm patients with dry eye treated by BoNT-A injection and 12 receiving BoNT-A plus APP treatment were enrolled. The efficacy was evaluated according to the Jankovic rating scale, Ocular Surface Disease Index (OSDI), fluorescein staining (FL), fluorescein tear break-up time (FBUT) and Schirmer I test (SIT). Both BoNT-A and BoNT-A+APP treatment effectively reduced the functional impairment of blepharospasm. At baseline, all the patients had high OSDI scores (BoNT-A group: 82.48 ± 7.37, BoNT-A+APP group: 78.82 ± 4.60, p = 0.112), but relatively low degrees of FL (BoNT-A group: 3.18 ± 1.01, BoNT-A+APP group: 3.50 ± 1.24, p = 0.466), FBUT (BoNT-A group: 1.71 ± 0.77, BoNT-A+APP group: 2.17 ± 0.58, p = 0.077) and SIT (BoNT-A group: 2.53 ± 0.99, BoNT-A+APP group: 3.17 ± 1.23, p = 0.153). After treatment, OSDI, FL, FBUT and SIT were all obviously restored in the two groups. When comparing the changing rates, only OSDI (BoNT-A group: -52.23% ± 15.57%, BoNT-A+APP group: -61.84% ± 9.10%, p = 0.047) and FL (BoNT-A group: -22.55% ± 25.98%, BoNT-A+APP group: -41.94% ± 14.46%, p = 0.016) showed significant differences between the two groups. This study suggests that OSDI is not applicable in the diagnosis of dry eye among blepharospasm patients. For blepharospasm patients with severe dry eye symptoms, especially those with fluorescein staining in the cornea, the combined treatment of BoNT-A and APP is more effective than using BoNT-A alone.

Preserve the reserve: The novel way

Abstract Aims: To assess the outcome of a novel approach for thermal punctocanalicular cautery in severe dry eye patients. Materials and Methods: After tear function tests, eligible patients with severe dry eyes recalcitrant to maximal medical therapy underwent permanent punctocanalicular occlusion by thermal punctocanalicular cauterization at a tertiary eye hospital between January 2013 and February 2018. The epithelium of the punctum, the vertical portion and the horizontal portion of the canaliculus was cauterized with long hairline tip of Ellman thermal punctal cautery. Change in Schirmer’s 1, tear film breakup time (TBUT) and fluorescein staining of the corneal epithelium at last follow up were primary outcome measures. Results: Our study included 85 eyes of 47 patients with a mean age of 42.6 ± 17.6 years of which 31 (66%) were women. The average follow up was 68 ± 74 weeks and 85.88% of puncta remained occluded till last follow up. The Schirmer’s 1 improved from 3.2 ± 2.3 mm to 4.3 ± 2.1 mm (P &lt; 0.001), the TBUT improved from 3.3 ± 1.6 s to 4.8 ± 1.5 s (P &lt; 0.001) and average fluorescein stain score reduced from 14.08 ± 2.5 to 7.68 ± 1.71 (P &lt; 0.001). The frequency of using lubricants also reduced significantly from 10 ± 3 times per day to 6.7 ± 2.1 times per day (P &lt; 0.001). No postoperative complication in the form of epiphora or punctal cellulitis were observed. Conclusions: Thermal punctocanalicular cautery is a novel, simple, repeatable, noninvasive and highly effective method for severe dry eye cases. Majority patients showed permanent punctal canalicular occlusion with improvement in tear film function. Frequency of instillation of lubricants needed decreased which can indirectly reduce the economic burden for the patients.

IDose TR Sustained-release Travoprost Implant for the Treatment of Glaucoma

There are several barriers to patient adherence in glaucoma treatment, such as complex dosing regimens, side effects and difficulties with eyedrop administration. This article discusses these challenges, and how they have led to the development of novel sustained-release platforms for glaucoma medications. These platforms include extraocular and intraocular options, such as wearable ocular surface devices, punctal plug systems, subconjunctival injections and intracameral implants. In particular, we focus on the iDose® TR (Glaukos, San Clemente, CA, USA) sustained-release travoprost titanium implant. It is a particularly promising option, which continuously elutes travoprost at therapeutic levels over an extended period. Phase III trial results have shown its efficacy in lowering intraocular pressure. Notably, the implant typically lasts for around 4–5 years and can be safely exchanged with a new one after it finishes its therapeutic effect. This advancement in glaucoma treatment offers a new alternative to traditional treatment modalities. Real-world trials are needed to shed more light on the efficacy and safety profile of iDose TR.

A Protocol for Managing Watery Eyes in Patients with Punctal Stenosis

Purpose • To elucidate all factors resulting in watery eyes in patients with punctal stenosis. • To treat these factors pre-operatively and post-operatively following a horizontal 3-snip punctoplasty to achieve surgical success. Methods: 77 consecutive cases presenting to a tertiary care oculoplastics centre with watery eyes due to punctal stenosis/ occlusion were included. The clinical type of stenois/occlusion was identified. Co-existing factors causing lacrimation and epiphora, besides punctal stenosis, were identified and treated preoperatively. All cases had a rectangular 3-snip punctoplasty followed by repeated punctal dilatation in clinic, weekly for one month, and then 2 monthly for 6 months. The anti-inflammatory therapy was continued post-operatively for 2-4 months. Results: All cases had severe watery eyes (Munk grade 4-5). 69 cases (89.6 %) cases were on steroid-antibiotic topical therapy for recurrent blepharitis, while 12 cases (15.7%) were on anti-glaucoma therapy. 58 cases (75.3%) had previously failed punctoplasty. Ocular surface inflammatory disease (OSD) was present in all 77 cases (100%) causing lacrimation. It was notably severe in cases with pinpoint punctae. Membranous punctal occlusion was more common in the elderly patients with less severe OSD. Repeated punctal dilatation was necessary to maintain punctal patency post-operatively, achieving success rate of 97.4%, and 100% patient satisfaction. Conclusion: Disturbed balance between tear production and its drainage exists in patients with watery eyes. A protocol is suggested to restore that balance in patients with punctal stenosis: • Thorough clinical assessment, identifying factors causing lacrimation and treating them pre-operatively. • Identifying lower lid margin pathology that may be contributing to epiphora besides punctal stenosis and correcting it simultaneously with punctoplasty. • Rectangular 3-snip punctoplasty should be the preferred surgical procedure as it maintains the structure and function of the punctum. • Repeated punctal dilatation post-operatively and continued topical anti-inflammatory therapy to avoid punctal re-stenosis. • Patient education regarding recurrent nature of OSD and its early treatment to prevent punctal re-stenosis

Designing and making an open source, 3D-printed, punctal plug with drug delivery system.

With the advancement in the study of keratoconjunctivitis sicca and the scope of its treatment, punctal plugs are being widely used for the therapeutic management of dry eye disease. With the emergence of 3D printing in medicine, 3D printing of punctal plugs that have an inbuilt drug delivery system and also that can be personalized from patient to patient according to their punctum size can be a great therapeutic option. Another benefit of the device is that its printing takes a short period of time and is cost-effective. This study aimed at making an open source design and 3D printing an efficient model of a punctal plug with an inbuilt drug delivery system that can be eventually used for the treatment of various ocular diseases that require frequent drug instillation or blockage of the nasolacrimal pathway. The 3D design for the punctal plug was made using the open source application, FreeCAD, and slicing was done using the application ChituBox. After that, the plugs were printed using the LCD printer Crealty LD-002R. The material used was resin that was compatible with the Crealty LD-002R. Punctal plugs with satisfactory results were printed using the LCD printer. The punctal plugs showed suitable structure and were also easily reproduced in the 3D printer without any complications or setbacks.

Prescription Habits of Scleral Lenses for the Management of Corneal Irregularity and Ocular Surface Disease Among Scleral Lens Practitioners.

To describe prescribing patterns of therapeutic scleral lenses (SLs) in the management of corneal irregularity and ocular surface disease among practitioners who prescribe SLs. Participants ranked treatment options for corneal irregularity and ocular surface disease in the order they would generally consider using them in an electronic survey. Median rank score for each option is reported, along with the percentage of participants assigning first place ranking to each option. The percentage of participants assigning first, second, or third place ranking to each option is also reported. Seven hundred and seventy-eight practitioners participated. Scleral lenses are most frequently considered as the first choice for the management of corneal irregularity based on overall median rank, followed by corneal rigid lenses (rigid gas-permeable [RGPs]). Scleral lenses were the first choice of 42% of participants, followed by RGPs (20%). For ocular surface disease, lubricant drops are most frequently used first, followed by meibomian gland expression, topical cyclosporine or lifitegrast, topical steroids, punctal plugs, and SLs, respectively. Lubricant drops were the first therapeutic option considered for ocular surface disease by 63% of participants and 45% ranked SLs as their sixth, seventh or eighth treatment based on median overall rank. Scleral lenses were identified as the first option for management of corneal irregularity more frequently than RGPs. Scleral lenses are considered for management of ocular surface disease before surgical intervention but after meibomian gland expression, punctal occlusion, and topical medical therapy are attempted.

Age-Related Differences in the Clinical Patterns of Ocular Graft-Versus-Host Disease.

To evaluate age-related differences in clinical patterns of ocular graft-versus-host disease (GVHD). In this cross-sectional study, patients diagnosed with ocular GVHD were evaluated in two groups: Group I included those aged 18 years or younger and Group II included those over 18 years of age. Demographic and clinical information were recorded and compared between the groups. Forty eyes of 20 patients were included (11 patients were in Group I and 9 patients were in Group II). Follow-up was at least 6 months. All patients had burning, dryness, and foreign body sensation. Conjunctival hyperemia, cicatricial conjunctivitis, and limbal stem cell disease (LSCD) was observed more frequently in Group II. In addition to non-preserved artificial tears, cyclosporine A 0.05% (65%) and autologous/allogeneic serum eye drops (80%) were given and silicone plugs were inserted (28%). In Group I, an improvement in GVHD scoring and best corrected visual acuity was observed after 6 months of treatment (p<0.0005). In ocular GVHD, conjunctival cicatrization and limbal stem cell deficiency might be observed more often in adults. Topical cyclosporine, autologous/allogenic serum drops, and punctal plugs are helpful in moderate or more severe cases. With early diagnosis and treatment, an improvement in clinical signs and visual acuity might be observed, particularly in younger patients.

Retrospective Study of a Sustained-Release Intracanalicular Dexamethasone Insert for Treatment of Ocular Inflammation After Cataract and Corneal Surgery.

To evaluate the effectiveness and safety of a sustained-release intracanalicular dexamethasone insert (Dextenza, Ocular Therapeutix, Inc.) as an adjunctive therapy in patients undergoing cataract and corneal surgery. This retrospective case series contains 18 patients undergoing cataract surgery and 6 patients undergoing corneal surgery. All patients received the Dextenza intracanalicular insert. 6/18 of the patients in the cataract surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 11/18 of the patients were on a reduced regimen. 1/18 of the patients was on a drop regimen that deviated from the aforementioned regimens. 2/6 of the patients in the corneal surgery arm were on the standard of care post-surgery topical steroid drop regimen, whereas 3/6 of the patients were on a reduced regimen. 1/6 of the patients were on a drop regimen that deviated from the aforementioned regimens. The primary outcome measures are intraocular pressure (IOP) levels and anterior chamber inflammation levels across the post-operative recovery period. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a clinically significant IOP spike greater than 10 millimeters of mercury (mmHg) above baseline IOP. No patient in either of the study groups had significant inflammation after 1 week post-surgery. 1/18 of the patients in the cataract surgery arm and 1/6 of the patients in the corneal surgery arm experienced a canalicular obstruction. Dextenza with the lower drop protocol showed non-inferiority in terms of inflammation management and safety. As with any steroid delivery mechanism, monitoring IOP is paramount when using Dextenza. One of the patients with a canalicular obstruction had a history of punctal plug implantation, so care should be taken when choosing to implant Dextenza in such a patient.

Evaluation of Lacrimal Punctal Changes by Anterior Segment Optical Coherence Tomography after Punctal Dilation Versus Punctal Plug Insertion in Cases of Inflammatory Punctual Stenosis.

Purpose To compare simple punctal dilation versus punctal dilation augmented by insertion of Punctal Plug Insertion (PPP) with assessing the effect on resolving epiphora and punctum size improvement by an objective method, high-resolution AS-OCT imaging comparing punctal parameters of the patients before and after both techniques. Patients and Methods. It is a prospective, interventional, double-blinded controlled randomized study, which was conducted on two groups of patients, the first epiphora group (EG1 25 eyes), who had acquired punctal stenosis and epiphora and managed by simple punctal dilatation. The second epiphora group (EG2 20 eyes) who managed by punctal dilatation augmented with an application of perforated punctal plugs for two months. Spectral Domain Anterior Segment-OCT Image Acquisition. AS-OCT for lower puncti was performed using RTVue (Optovue Inc., Fermont, CA). OCT images of the width and length of the lower puncti of the participants were captured by the same operator on the same machine. Measuring of punctal size (diameter and length) was performed before treatment, one week, one month, and three months later objectively by using AS-OCT. Results The study included 45 eyes of 50 subjects; the total coverage of epiphora patients fulfilled inclusion criteria and presented to the ophthalmology clinics of Sohag University Hospitals in the period between June 2021 and December 2021. Both groups were comparable regarding mean age (39 ± 11 vs 50 ± 12 years, P value = 0.4) and sex (males were 36% vs 40%, female were 64% vs 60%, P value = 0.5) respectively with no statistically significant difference between both groups. The mean duration of epiphora was measured in both groups before treatment (EG1 = 1.656 ± 0.41 months, EG2 = 1.73 ± 0.32 months) with no statistically significant difference (P value = 0.436). There was marked improvement of the outer punctual diameter and length between outer and inner puncti in EG1 (EG1 391um ± 122 um, EG2 692 ± 226 um (P value < 0.007) and EG1 189 ± 43 um, 380 ± 169 um (P value < 0.0002) during the follow-up period. EG2 showed more improvement than EG1 when compared during the follow-up period in both outer punctual diameter and length between outer and inner puncti with (P value < 0.003 and < 0.0002) in favor of EG2. However; both groups show improvement with the statistically significant difference in both groups by using AS-OCT. Conclusions Punctal dilation augmented by insertion of PPP was an effective method in treating cases of inflammatory punctual stenosis as found by monitoring of punctal parameters changes by AS-OCT. AS-OCT was found a useful method for the evaluation of the lacrimal punctal parameters, especially with different treatment modalities in epiphora cases.

Assessment of knowledge and counselling on ophthalmic preparations among community pharmacists in Ibadan, Nigeria – an intervention study

Background: The ratio of patients to ophthalmologists is rather high, affffording inadequate time for&nbsp;patient interaction, especially on the use of ophthalmic preparations. An assessment of community&nbsp;pharmacists' knowledge and counselling on ophthalmic preparations is vital to maintaining quality of&nbsp;care received by patients.&nbsp; Methods: A cross-sectional study was carried out among consented community pharmacists&nbsp;practicing in Ibadan metropolis in southwest Nigeria, who were randomized into control and&nbsp;intervention arms. Baseline assessment of their knowledge and counselling on ophthalmic&nbsp;preparations was done. An educational intervention was then carried out among the intervention&nbsp;pharmacists. Postintervention assessment was carried out to evaluate the effffect of the intervention.&nbsp;Data was summarized with descriptive and inferential statistics.&nbsp; Results: A total of 115 (control arm-62; intervention arm-53) community pharmacists participated in&nbsp;the study. Percentage of community pharmacists who understood punctal occlusion (control vs&nbsp;intervention) increased from 21.0% vs 22.6% at baseline to 45.4% vs 83.0% postintervention.&nbsp;Preintervention (control vs intervention), 83.9% vs 81.1% knew that eye drop bottle tip should not&nbsp;touch the eyes during application. This improved postintervention to 82.3% vs 100%. A signifificant&nbsp;difffference in participants' knowledge and counselling on ophthalmic preparations was observed&nbsp;postintervention. Participants' knowledge comparison (control vs intervention) was 7.79 ± 1.79 vs&nbsp;7.60 ± 1.65 (p = 0.565) and 8.89 ± 1.73 vs 10.83 ± 1.63 (p &lt; 0.001) at baseline and postintervention,&nbsp;respectively. The counselling comparison (control vs intervention) was 2.82 ± 1.93 vs 2.57 ± 1.91 (p =&nbsp;0.476) at baseline, and 2.97 ± 2.48 vs 5.98 ± 1.69 (p &lt; 0.001) postintervention. Conclusion: The educational intervention, which addressed the knowledge and counselling gaps&nbsp;discovered at baseline, improved the community pharmacists' knowledge and counselling on&nbsp;ophthalmic preparations.

Perioperative nuances of cataract surgery in ocular surface disorders.

Ocular surface disorders (OSDs) constitute a varied spectrum of conditions that could be associated with dryness, compromised limbal status, varying grades of forniceal obliteration, corneal scars, and a possible underlying immune etiology. These associations adversely impact surgical outcomes in the eye. One of the treatable causes of decreased vision in these eyes is cataracts which could be secondary to the disease, its treatment, or age-related. The compromised ocular surface status can interfere with decision-making regarding the technique of cataract surgery, preoperative biometry for intraocular lens (IOL) power calculation, and intraoperative visibility, increasing the possibility of complications and compromising the final visual outcome. The postoperative course can be affected by complications, including melt and infection. Stabilization of the ocular surface by medical or surgical means, and appropriate management of underlying immune etiology, if any, helps improve and maintain a healthy ocular surface, optimizing cataract outcomes. With the help of pre, intra, and postoperative tools and means, such as punctal occlusion, ocular surface reconstruction, systemic immunosuppression, illuminators, capsule staining dyes, optical iridectomy, prosthetic replacement of the ocular surface ecosystem (PROSE) lenses, and others, the visual outcome post-cataract surgery in these eyes can be maximized. This article highlights the nuances of performing cataract surgery in various OSDs and the need to have a comprehensive stepwise approach is emphasized.

Current approaches for the regeneration and reconstruction of ocular surface in dry eye.

Significant research revealed the preocular tear film composition and regulations that remain vital for maintaining Ocular surface functional integrity. Inflammation triggered by many factors is the hallmark of Ocular surface disorders or dry eyes syndrome (DES). The tear deficiencies may lead to ocular surface desiccation, corneal ulceration and/or perforation, higher rates of infectious disease, and the risk of severe visual impairment and blindness. Clinical management remains largely supportive, palliative, and frequent, lifelong use of different lubricating agents. However, few advancements such as punctal plugs, non-steroidal anti-inflammatory drugs, and salivary gland autografts are of limited use. Cell-based therapies, tissue engineering, and regenerative medicine, have recently evolved as long-term cures for many diseases, including ophthalmic diseases. The present article focuses on the different regenerative medicine and reconstruction/bioengineered lacrimal gland formation strategies reported so far, along with their limiting factors and feasibility as an effective cure in future.

Ophthalmic Complications and Managements of Sulfur Mustard Exposure: A Narrative Review.

Sulfur mustard (SM) is a lethal chemical agent that affects many organs, particularly the eyes, respiratory system and skin. Even asymptomatic patients with documented SM vapor exposure may develop organ disorder many years later. Patients with even minor signs in the acute stage may experience late complications that necessitate surgery. Early decontamination and conservative measures could help the patients and decrease the complications. Despite decades of research, there is still no effective treatment for either acute or long-term SM-induced ocular complications. Even after multiple medications and surgical procedures, the majority of patients continue to have symptoms. For dry eye, punctual occlusion, autologous eye drops, and aggressive lubrication are used; for persistent epithelial defects (PED), tarsorrhaphy, amniotic membrane transplant, and stem cell transplantation are used; for total limbal stem cell deficiency (LSCD), living-related conjunctivolimbal allograft and keratolimbal allograft are used; for corneal vascularization, steroids, non-steroidal anti-inflammatory drugs, and anti-vascular endothelial growth factor prescribed; and for corneal opacities, corneal transplantation is done. Platelet rich plasma and topical drops containing stem cell transplantation for LSCD, photodynamic therapy paired with subconjunctival or topical anti-vascular endothelial growth factors for corneal vascularization, topical curcumin and topical ciclosporin-A for dry eye, and orbital fat-derived stem cells for PED are all alternative treatments that can be suggested. Despite the experimental and clinical research on the complications of SM exposure over the past decades, there is still no effective treatment for eye complications. However, supportive medical and surgical management has been applied with relatively good outcome.

Incidence of ocular manifestations in patients with graft versus host disease after allogeneic stem cell transplant in Riyadh, Saudi Arabia.

To evaluate the incidence and severity of ocular graft versus host disease (oGVHD) in patients who underwent allogeneic stem cell transplant (SCT) in King Abdul-Aziz Medical City, Saudi Arabia. This is a retrospective cohort study conducted in King Abdul Aziz Medical City on patients who underwent allogeneic hematopoietic cell transplant (allo-HCT) from 2010 to 2017. The ocular examination findings including visual acuity, meibomian gland dysfunction, corneal and conjunctival staining with severity, corneal scarring, tear film meniscus and breakup time, anterior and posterior segment examination findings, intraocular pressure, treatment given, punctual plugs used or not, and follow up response were collected. The five years cumulative incidence of oGVHD among post-transplant patients was 56.98% (95%CI 38.6%-71.7%). The potential risk factors assessed for developing ocular manifestation were age, gender, donor's age, donor gender mismatch CD3 and CD34 infusion, while none of the correlates were identified as statistically significant risk factors of developing ocular manifestation. However, the incidence was statistically significantly different between patients diagnosed with acute myelocytic leukemia and acute lymphocytic leukemia (P=0.038). The mean latent period to develop ocular symptoms was 20.5mo. All patients had variable degree of dry eyes. None of the patients developed any posterior segment complication. The incidence of oGVHD is low in King Abdul-Aziz Medical City. This can be attributed to the preconditioning and immunosuppressive regime.

Neurotrophic Keratopathy in the United States: An Intelligent Research in Sight Registry Analysis

To describe the characteristics of neurotrophic keratopathy (NK) in the United States. Retrospective database study. Thirty-one thousand nine hundred fifteen eyes of 27 483 patients with a diagnosis of NK. Retrospective analysis of visits associated with a diagnosis of NK between 2013 and 2018 using the American Academy of Ophthalmology Intelligent Research in Sight (IRIS®) Registry. Demographic information, prevalence, visual acuity (VA), concomitant diagnosis and procedure codes, and risk factors impacting VA most closely after NK onset date. Mean ± standard deviation (SD) age at initial diagnosis of NK was 68.0 ± 16.0 years, and 58.91% of patients were women (P &lt; 0.0001). Presentation was unilateral in 58.14%, bilateral in 16.13%, and unspecified in 25.73%. Average 6-year prevalence of NK in the IRIS Registry was 21.34 cases per 100 000 patients. Mean ± SD VA was 0.60 ± 0.79 logMAR before diagnosis and 0.88 ± 0.94 logMAR after diagnosis (P &lt; 0.0001). Most common concomitant diagnoses included herpetic keratitis (33.70%), diabetes (31.59%), and corneal dystrophy (14.28%). Common procedures for NK management included the use of amniotic membrane (29.90%), punctal plugs (29.65%), and bandage contact lenses (22.67%). Age, male sex, Black race, Hispanic or Latino ethnicity, unilateral involvement, concomitant diagnoses of diabetes, corneal transplantation, and herpetic keratitis were associated significantly with worse VA. Based on the IRIS Registry, the prevalence of NK is 21.34 cases per 100 000 patients. Visual acuity was significantly worse after NK diagnosis compared with other time points. Neurotrophic keratopathy was associated most commonly with herpetic keratitis and diabetes. Worse VA in patients with NK was associated with several demographic characteristics, history of diabetes, corneal transplantation, and herpetic keratitis.

Bilateral Corneal Perforation in a Patient with Chronic Ocular Graft-Versus-Host Disease: A Case Report and Literature Review

Graft-versus-host disease (GVHD) is a serious complication that may occur in patients receiving allogeneic hematopoietic stem cell transplant (HSCT). GVHD occurs because of the immunological reaction between the donor’s T cells and the recipient’s antigens; GVHD may develop in different tissues, including the eye. Corneal perforation is an uncommon but vision-threatening manifestation of GVHD. We reported the case of a 65-year-old male patient who developed corneal perforation sequentially in both eyes 3 years after receiving HSCT. Conservative treatment with topical steroids and lubricants, bandage contact lens, and lacrimal punctal occlusion surgery resulted in the successful resolution of the corneal perforation with satisfactory visual recovery in the right eye. Therefore, corneal perforation can occur as the presenting manifestation of ocular GVHD. Regular ophthalmological examinations are recommended after HSCT to enable the early diagnosis of ocular GVHD and prompt treatment initiation.

Опыт радиохирургического блокирования слезоотведения при недостатке слезопродукции

The purpose of the study was the effective assessment and safety of the lacrimal ducts obturation by using radio wave energy in patient with “dry eye” syndrome with sagnificant damage of the ocular surface. Materials and methods. A retrospective analysis of data as patients radiosurgical blocking of tear flow was performed was carried out. Occlusion of the lacrimal ducts was carried out according to the own method using “Surgitron™” devices. The radio wave low-temperature event leads to persistent closure of the lumen of the lacrimal ducts and blockage of the passage of the lacrimal fluid. Results and discussion. The study included 49 patients (79 eyes), of different age groups, with severe manifestations of the “dry eye” syndrome. All patients after the procedure observd an improvement in their condition, an objective examination showed an increase in tear production, tear test values and visual acuity compared to the initial state. Over the entire period of observation, spontaneous recanalization of the lacrimal ducts occurred only in 2 patients (4 %) (3 eyes), which is significantly less in detection with other surgical methods of occlusion of the lacrimal ducts. Conclusion. Radiosurgical lacrimal blockage is an alternative method of surgical treatment of patients with “dry eye” syndrome wich allows to achieve a good functional result. It is supposed to be clinically atraumatic, bloodless and aesthetic. A small percentage of spontaneous recanalization of open tracts of high efficiency and preservation of the result after radiosurgical blocking of lacrimal drainage. Keywords: “dry eye” syndrome, punctal occlusion surgery, radiosurgical occlusion of lacrimal passage, lacrimal punctum plug.

Newer advances in medical management of glaucoma.

The burden of irreversible vision loss from Glaucoma continues to rise. While the disease pathogenesis is not well understood, intraocular pressure (IOP) is the only modifiable risk factor identified to prevent glaucomatous vision loss. Medical management remains the first-line of treatment in most adult glaucomas and the evolution of medical therapy for glaucoma has followed an exponential curve. This review tracks the rapid development of new medications and drug delivery systems in the recent years. Introduction of Rho kinase inhibitors with an entirely new mechanism of action from that of the currently used anti glaucoma medications has been a significant milestone. Latanoprostene Bunod is a novel, single molecule which provides two active metabolites that work through two different pathways for reducing intra ocular pressure. Bimatoprost implants and travoprost punctum plugs attempt to ease chronic medication use in glaucoma patients. Nanotechnology is an evolving route of drug delivery. Role of cannabinoids in medical management of glaucoma remain equivocal. The relatively short term effect on IOP, the risks of developing tolerance and side effects impacting patients’ neurocognitive health greatly outweigh the potential benefit. Research on Latrunculin B, Adenosine receptor agonists, Specific gene silencing and Stem cell therapy are poised to make an impact on glaucoma treatment. While there is some evidence to support the role of Brimonidine in neuroprotection, further research is needed to clarify the role of Memantine and Neurotrophins. Evidence for benefit from dietary supplementation with Alpha lipoic acid, Forskolin , and Ginko Biloba is limited

Outcomes of scleral lenses for dry eye disease in chronic ocular graft-versus-host disease

Ocular graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem cell transplantation, seen in approximately 40% of patients [1]. Dry eye symptoms in ocular GVHD can be debilitating [2,3]. Despite initial measures such as frequent preservative-free lubrication, autologous serum drops, punctal occlusion, and topical steroids, symptoms can be refractory [4].