Tenon's Capsule Research Articles

Optical Coherence Tomography of the Orbit Through a Staphyloma: A View of Tenon's Capsule, Orbital Fat, and Inferior Oblique Muscle.

Optical Coherence Tomography of the Orbit Through a Staphyloma: A View of Tenon's Capsule, Orbital Fat, and Inferior Oblique Muscle.

Bleb Morphology Using Anterior-Segment Optical Coherence Tomography after Ahmed Glaucoma Valve Surgery with Tenon Capsule Resection.

Objectives To evaluate the internal morphology of blebs using anterior-segment optical coherence tomography (AS-OCT) and the surgical outcomes of Ahmed glaucoma valve (AGV) surgery with Tenon capsule resection compared to conventional AGV surgery in patients with refractory glaucoma. Patients and Methods. This randomised prospective study included 30 eyes from 30 patients (age range: 42–55 y) with refractory glaucoma from March 2018 to February 2020. The study included two groups: AGV with the Tenon capsule resection group (n = 15) and the conventional AGV surgery group (n = 15). Follow-up continued until 6 months after surgery. The primary outcome was intraocular pressure (IOP) and its association with the number of postoperative glaucoma medications, best corrected visual acuity, visual field, and postoperative complications. The internal morphology of the blebs in both groups was evaluated at 1-day, 1-week, 1-month, 3-month, and 6-month follow-up using AS-OCT in terms of the consequent changes in bleb wall thickness, bleb wall reflectivity, and bleb cavity morphology throughout the 6-month follow-up period. Results A significant reduction in IOP was found in both groups, with a greater reduction in group I, where the mean IOP decreased from 32.73 ± 2.12 mmHg in the preoperative period to 13.33 ± 1.59 mmHg after 6 months, whereas in group II, the mean IOP decreased from 33.2 ± 2.21 mmHg in the preoperative period to 14.27 ± 1.44 mmHg after 6 months (p value <0.05). The difference between the 2 groups in terms of the decrease in IOP was insignificant except at 1 and 3 months, where there was a significant difference (p value = 0.016 and 0.01 at 1 and 3 months, respectively). The bleb analysis revealed a significant reduction in the wall thickness in both groups at 1 and 3 months, which was mostly associated with the hypertensive phase. In group I, the bleb wall thickness decreased from 754.67 ± 53.93 μm in the first postoperative day to 684 ± 81.66 μm and 671.6 ± 69.48 μm at 1 and 3 months, respectively, while in group II, the bleb wall thickness decreased from 707.13 ± 31.7 μm in the first postoperative day to 499.53 ± 99.1 μm and 506 ± 76.91 μm at 1 and 3 months, respectively. There was a significant reduction in AS‐OCT, and bleb reflectivity was insignificant throughout the follow-up period (p value >0.05). Regarding postoperative complications, the hypertensive phase occurred more frequently in group II (6 eyes, 40%) than in group I (2 eyes, 13.3%). Other complications were also reported more frequently in group II such as hypotony, shallow anterior chamber (AC), and tube exposure. Conclusion AS-OCT was beneficial in the analysis of bleb morphology after AGV surgery where there were more diffuse functioning multicystic blebs and less thinning in the bleb wall thickness during the hypertensive phase after resection of the Tenon capsule, which might be related to the less incidence of fibrosis around the surgical site.

Bio-modulation of scaring Glaucoma Filtration Surgery using a novel application of coated magnesium

Filtration surgery still plays a mainstream role of treatment for glaucoma. Postoperative scarring is the main cause of surgical failure. This study evaluated the biocompatibility and anti-proliferative properties of pure magnesium with three different coatings, which are hydroxyapatite (HA), dicalcium phosphate dihydrate (DCPD) and DCPD + stearic acid (SA), in a primary culture of human tenon's capsule fibroblasts (HTCFs) and in rabbit Glaucoma Filtration Surgery. Titanium and glass were used as controls in vitro , and trabeculectomy was used as control in vivo . The results show the number and shape of HTCFs seeded on different coatings showed less quantity and poor cell morphology. Each type of coated magnesium demonstrated significantly decreased metabolic activity of HTCFs. DCPD + SA showed higher cytotoxicity than the other coatings. Significant inhibition of proliferation was observed with the DCPD + SA coating. The expression of α-SMA was decreased in the cells when seeded on all of the coated magnesium disks. In vivo , no obvious adverse effects were observed after operation. No significant difference existed for any of the different samples regarding different ion concentrations in the aqueous humor. The inflammatory response in the titanium, DCPD and DCPD + SA treated eyes was more intense than in the trabeculectomy alone and HA groups. Western Blot analysis showed that collagen-1 and α-SMA expression was significantly lower in the titanium, HA, DCPD and DCPD+SA groups compared with the control. Different coatings on magnesium were able to affect the corrosive properties, which in turn, influenced the morphology and function of HTCFs. HA coated magnesium may be considered a very promising biodegradable material for the next generation of glaucoma drainage devices.

The role of primary needle revision after Ahmed glaucoma valve (AGV) implantation.

To evaluate the efficacy and safety of primary needle revision after Ahmed Glaucoma Valve (AGV) implantation in comparison with glaucoma medication use. In this interventional case series, 23 eyes of 23 patients who underwent AGV implantation were enrolled. Needle revision was performed when the intraocular pressure was higher than the target pressure before glaucoma medications. Using a 30-gauge needle, the Tenon's capsule over the plate was incised and the bleb was reformed. Patients were examined on a postoperative day one, weekly (for four weeks), and every 1-3months. Two criteria were used to define cumulative success as a minimum 20% reduction in IOP and 5 <IOP ≤ 21mmHg (Criteria A) or 5 <IOP ≤ 18mmHg (Criteria B) without (Complete success) or with (Qualified success) glaucoma medication. In this pilot study, we enrolled 23 patients with a mean age of 53.8 ± 12.4years (25-78years) who underwent AGV implantation and a one-year follow-up period. The mean number of primary needle revision was 2.2 ± 1.6 (1-6). One year postoperatively, the cumulative success rate was 91.4% and 86.9% based on Criteria A and B, respectively. The average of preoperative IOP was 28.26 ± 8.86mmHg (range 15-46mmHg), reaching 13.78 ± 3.54mmHg (range 8-20) at the end of the one-year follow-up. (P < 0.001) The mean preoperative medication significantly decreased from a median of 4 (range 3-4) at baseline to 2 (range 1-4) after the one-year follow-up (P < 0.001). One patient experienced leakage over the plate, which was successfully treated via conservative management. This pilot study showed that primary needle revision is a safe and effective method for controlling IOP after AGV implantation with a lower need for medication.

Isoliquiritigenin protects against angiotensin II-induced fibrogenesis by inhibiting NF-κB/PPARγ inflammatory pathway in human Tenon's capsule fibroblasts

PurposeTo examine the protective effects of Isoliquiritigenin (ISL) in angiotensin II (ANG II)-induced inflammation and fibrosis on Human Tenon's capsule Fibroblasts (HTFs) and Mouse Peritoneal Macrophages (MPMs). This study also investigated the potential mechanism of action of ISL. MethodMethyl-thiazolyl tetrazolium (MTT) assay was used to test ISL toxicity. An ELISA and an RT-qPCR assay detected the inflammatory cytokines (TNF-α, IL-6, COX-2, and ICAM-1). A Western blot investigated the expression levels of inflammation-related signals [nuclear factor-κB (NF-κB), peroxisome proliferator-activated receptor γ (PPARγ)], and fibrogenesis, including fibronectin and alpha-smooth muscle actin (α-SMA)]. Protein expressions of α-SMA were measured by immunofluorescence. ResultsPre-treatment with ISL (10 or 20 μM) dose-dependently decreased the mRNA levels of TNF-α, IL-6, ICAM-1, and COX-2 induced by ANG II (1 μg/ml) in both MPMs and HTFs. ANG II remarkably increased the amount of P65 in the nuclei and decreased the amount of P65 in the cytoplasm. Additionally, ANG II reduced PPARγ expression levels in a time-dependent manner. Furthermore, these effects which were induced by ISL were remarkably neutralized by ISL pre-treatment. Finally, ANG II markedly elevated the expression of fibronectin and α-SMA. ConclusionISL could alleviate ANG II-induced fibrogenesis by inhibiting the NF-κB/PPARγ inflammatory pathway. In addition, ISL may be a potential agent for the treatment of conjunctival fibrosis. Most importantly, the NF-κB/PPARγ signaling pathway could be an effective therapeutic target for the prevention and treatment of conjunctival fibrosis after glaucoma surgery.

Antifibrotic role of low-dose mitomycin-c-induced cellular senescence in trabeculectomy models

PurposeWe assessed whether mitomycin-C (MMC) has different antifibrotic mechanisms in trabeculectomy wound healing.MethodsWe identified 2 concentrations of MMC as “low-dose” by using WST-1 assay, Lactic dehydrogenase assay, and fluorescence-activated cell sorting flow cytometry. Senescence-associated β-galactosidase (SA-β-gal) and fibrotic gene expression was examined through immunocytochemistry, flow cytometry, real-time quantitative reverse transcription polymerase chain reaction, Western blotting, zymography, and modified scratch assay in vitro. In vivo, 0.1 mL of MMC or normal saline was injected to Tenon’s capsule before trabeculectomy in a rabbit model. SA-β-gal expression, apoptotic cell death, and collagen deposition in sites treated and not treated with MMC were evaluated using terminal dUTP nick end labeling assay and histochemical staining. Bleb function and intraocular pressure (IOP) levels were examined 3, 7, 14, 21, 28, and 35 days after trabeculectomy.ResultsIn vitro, human Tenon’s fibroblast (HTF) senescence was confirmed by observing cell morphologic change, SA-β-gal accumulation, formation of senescence-associated heterochromatin, increased p16INK4a and p21CIP1/WAF1 expression, lower percentage of Ki-67-positive cells, and decreased COL1A1 release. Increased expression of α-SMA, COL1A1, and Smad2 signaling in TGF-β1-induced stress fibers were passivated in senescent HTFs. In addition, cellular migration enhanced by TGF-β1was inactivated. In vivo, histological examination indicated increased SA-β-gal accumulation, lower apoptosis ratios, and looser collagen deposition in sites treated with 0.2 μM MMC. Low-dose MMC-induced cellular senescence prolonged trabeculectomy bleb survival and reduced IOP levels in a rabbit model.ConclusionLow-dose MMC-induced cellular senescence is involved in the antifibrotic mechanism of trabeculectomy wound healing.

Tenon Capsule Grafting versus Autologous Scleral Graft in Ahmed Glaucoma Valve Surgery.

Objective To compare between the surgical outcomes of Tenon capsule grafting and autologous scleral graft in Ahmed glaucoma valve (AGV) surgery in the management of refractory glaucoma and prevention of tube exposure. Patients and Methods. This prospective randomised study included 30 eyes of 30 patients with refractory glaucoma, who were aged between 46 and 58 years and diagnosed with refractory glaucoma. This study was conducted in Menofia University Hospital between July 2018 and December 2019. Informed patient consent was obtained. The studied eyes were divided into two groups: the first group included 15 eyes for which AGV with Tenon capsule grafting was performed, while the second group included 15 eyes for which AGV with autologous scleral graft was performed. All patients were followed up for one year after the surgery. The outcomes were evaluated according to intraocular pressure (IOP) and the number of postoperative glaucoma medications. Visual acuity, visual field, number of postoperative glaucoma medications, and postoperative complications were followed throughout the 1-year follow-up period. Results There was a significant reduction in IOP in both groups, with more reduction in the Tenon graft group where the mean IOP after one year was 11.66 ± 0.89 mmHg, whereas in the scleral graft group, the mean IOP was 14.20 ± 4.0 mmHg (p value < 0.001). However, the difference between the 2 groups in lowering IOP was insignificant. Regarding postoperative complications, tube exposure was observed in one case in the scleral graft group with associated scleral melting and hypotony, postoperative hypotony was more in the scleral graft group with 3 cases (20%), and in the Tenon graft group, hypotony occurred only in 1 case (6.67%). In addition, less vascular blebs were seen in most cases in the Tenon graft group, while most blebs seen in the scleral graft group were vascular blebs. In addition, both groups showed stability in terms of visual acuity and visual field. Conclusion Tenon capsule grafting and autologous scleral grafting might be effective and safe techniques when applied with AGV in the management of refractory glaucoma. Tenon capsule resection with grafting showed relatively low incidence of tube exposure and hypertensive phase.

&lt;p&gt;The Pro-Fibrotic Behavior of Human Tenon’s Capsule Fibroblasts in Medically Treated Glaucoma Patients&lt;/p&gt;

PurposeThe aim of this study was to compare human Tenon’s capsule fibroblasts (HTCFs) obtained from patients who received medical therapy for glaucoma (glaucomatous patients) and patients not treated for glaucoma (non-glaucomatous patients) in terms of wound healing and fibrosis.Patients and MethodsBioartificial tissues (BATs) were generated using primary HTCF-populated collagen lattices. Pro-fibrotic gene expression within HTCFs was compared between glaucomatous patients and non-glaucomatous patients after BAT culture. The BATs were also assessed regarding fibroblast–myofibroblast transition, collagen remodeling and collagen contraction using alpha-smooth muscle actin immunohistochemistry, picrosirius red staining and collagen contraction assays, respectively.ResultsPro-fibrotic gene expression in BAT-cultured HTCFs derived from glaucomatous patients was significantly increased compared to non-glaucomatous patients. BATs imbued with HTCFs collected from glaucomatous patients exhibited a greater proportion of myofibroblasts as well as increased collagen contraction/remodeling compared to HTCFs isolated from non-glaucomatous patients.ConclusionHTCFs from glaucomatous and non-glaucomatous patients differ in the expression of genes involved in fibrosis, proportion of fibroblasts undergoing transdifferentiation into myofibroblasts, contractile properties and collagen remodeling. These results suggest that for any number of reasons, at a cellular level, patients who received medical therapy for glaucoma have eyes primed for fibrosis.

Regional Anesthesia for Pediatric Ophthalmic Surgery: A Review of the Literature.

Ophthalmic pediatric regional anesthesia has been widely described, but infrequently used. This review summarizes the available evidence supporting the use of conduction anesthesia in pediatric ophthalmic surgery. Key anatomic differences in axial length, intraocular pressure, and available orbital space between young children and adults impact conduct of ophthalmic regional anesthesia. The eye is near adult size at birth and completes its growth rapidly while the orbit does not. This results in significantly diminished extraocular orbital volumes for local anesthetic deposition. Needle-based blocks are categorized by relation of the needle to the extraocular muscle cone (ie, intraconal or extraconal) and in the cannula-based block, by description of the potential space deep to the Tenon capsule. In children, blocks are placed after induction of anesthesia by a pediatric anesthesiologist or ophthalmologist, via anatomic landmarks or under ultrasonography. Ocular conduction anesthesia confers several advantages for eye surgery including analgesia, akinesia, ablation of the oculocardiac reflex, and reduction of postoperative nausea and vomiting. Short (16 mm), blunt-tip needles are preferred because of altered globe-to-orbit ratios in children. Soft-tip cannulae of varying length have been demonstrated as safe in sub-Tenon blockade. Ultrasound technology facilitates direct, real-time visualization of needle position and local anesthetic spread and reduces inadvertent intraconal needle placement. The developing eye is vulnerable to thermal and mechanical insults, so ocular-rated transducers are mandated. The adjuvant hyaluronidase improves ocular akinesia, decreases local anesthetic dosage requirements, and improves initial block success; meanwhile, dexmedetomidine increases local anesthetic potency and prolongs duration of analgesia without an increase in adverse events. Intraconal blockade is a relative contraindication in neonates and infants, retinoblastoma surgery, and in the presence of posterior staphylomas and buphthalmos. Specific considerations include pertinent pediatric ophthalmologic topics, block placement in the syndromic child, and potential adverse effects associated with each technique. Recommendations based on our experience at a busy academic ophthalmologic tertiary referral center are provided.

Posterior sub-tenon’s injection of triamcinolone acetonide in the treatment of optic disc vasculitis

Objective To evaluate the efficacy of posterior sub-tenon’s injection of triamcinolone acetonide in the treatment of optic disc vasculitis. Methods The clinical data of 60 eyes of 60 patients with optic disc vasculitis from May 2016 to May 2019 in the Seventh People’s Hospital of Zhengzhou were retrospectively analyzed. Triamcinolone acetonide 40 mg/0.5 ml was injected into Tenon’s capsule with a self-made gauge 6 lacrimal irrigation needle, and compound Xueshuantong and energy mixture were infused intravenously, compound anisodine injection was injected subcutaneously beside superficial temporal artery, methylcobalamin, citicoline and compound vitamin B were taken orally. All patients were followed up for 6-18 months. Results All 60 cases were cured within 6 to 18 months after treatment. The visual acuity were improved and the shape of macular fovea were restored, macular edema were alleviated. Conclusion Posterior sub-tenon’s injection of triamcinolone acetonide in the treatment of optic disc vasculitis is safe, effective, simple and inexpensive. Key words: Vasculitis, optic disc; Triamcinolone acetonide, injection, sub-tenon’s posterior; Efficacy, clinical

LINC00028 regulates the development of TGFβ1-treated human tenon capsule fibroblasts by targeting miR-204-5p

Glaucoma is a leading cause of blindness worldwide with complex pathogenesis. The excessive proliferation and fibrosis of human tenon capsule fibroblasts (HTFs) trigger the scar formation after glaucoma filtration surgery. The purpose was to investigate the role of long intergenic non-protein coding RNA 28 (LINC00028) and mechanism in transforming growth factor β1 (TGFβ1)-treated HTFs. The detection of LINC00028 and miR-204-5p expression was conducted using quantitative real-time polymerase chain reaction (qRT-PCR). Cell proliferation was assessed by cell counting kit-8 (CCK-8) assay. Cell migration and invasion were monitored by transwell assay. The expression of Epithelial-mesenchymal transition (EMT)-related markers, including E-cadherin, α-Smooth muscle actin (α-SMA), fibronectin and β-catenin, and autophagy-related markers, including Beclin 1 and light chain 3 (LC3-II and LC3-I) at the protein level was quantified using western blot. The prediction of the relationship between LINC00028 and miR-204-5p was performed by the online tool miRcode, and the verification of the relationship between them was conducted using dual-luciferase reporter assay, RNA immunoprecipitation (RIP) assay and RNA pull-down assay. The expression of LINC00028 was elevated in glaucoma tissues and TGFβ1-treated HTFs. LINC00028 downregulation blocked proliferation, migration, invasion, EMT, fibrosis and autophagy of TGFβ1-treated HTFs. MiR-204-5p was a target of LINC00028, and its reintroduction exerted a similar role of LINC00028 downregulation. The inhibition of miR-204-5p reversed the effects of LINC00028 downregulation in TGFβ1-treated HTFs. LINC00028 regulated proliferation, migration, invasion, EMT, fibrosis and autophagy to induce the development of HTFs by competitively targeting miR-204-5p, and LINC00028 was regarded as a promising biomarker for glaucoma filtration treatment.

Role of the long noncoding RNA H19 in TGF-β1-induced Tenon's capsule fibroblast proliferation and extracellular matrix deposition

Glaucoma filtration surgery (GFS) is a classic surgical method used to treat glaucoma, the second leading cause of blindness. Scar formation caused by excessive Tenon's capsule fibroblast activation leads to surgical failure. However, the mechanism underlying this activation is largely unknown. In this study, we first isolated primary human Tenon's capsule fibroblasts (HTFs) and found that TGF-β promoted the viability, proliferation and extracellular matrix (ECM) deposition of HTFs. Then, we showed that TGF-β promoted the expression of H19 in HTFs and that suppression of H19 inhibited the effect of TGF-β on HTFs. Furthermore, we revealed that H19 exerted its effects by interacting with miR-200a in TGF-β-treated HTFs. Additionally, we showed that β-catenin was a target of miR-200a in TGF-β-treated HTFs. We also demonstrated that H19 acted by modulating the H19/miR-200a/β-catenin regulatory axis in TGF-β-treated HTFs. Ultimately, we found that the components of the H19/miR-200a/β-catenin regulatory axis were aberrantly expressed in a rat model of GFS. Our results show that H19 indeed acts by modulating β-catenin expression via miR-200a in TGF-β-treated HTFs, thus providing a novel rationale for the development of H19-based strategies to attenuate scar formation after GFS.

Inhibitive effect of TAK-242 on Tenon's capsule fibroblasts proliferation in rat eyes.

To study the inhibition effect of TAK-242 on the proliferation of rat eye Tenon's capsule fibroblasts via the toll-like receptor 4 (TLR4) signaling pathway. SD rat Tenon's capsule fibroblasts were extracted and cultured, then the cells were divided into normal control group, lipopolysaccharide (LPS) group (10 g/mL LPS) and TAK-242 group (1 µmol/L TAK-242, and 10 µg/mL LPS after 30min). The expressions of TLR4, transforming growth factor-β1 (TGF-β1) and interleukin-6 (IL-6) in each group were detected by Western blot and reverse transcriptase-polymerase chain reaction (RT-PCR). Cell proliferation was detected by cell counting kit-8 (CCK-8). Double immunofluorescent labeling in the extracted cells showed negative keratin staining and positive vimentin staining. Western blot showed that the LPS group had the highest expression of TLR4 and TGF-β1 (P<0.01). Enzyme linked immunosorbent assay (ELISA) also showed that the secretion of IL-6 was the highest in LPS group (P<0.01). But there was no significant difference in TLR4 and TGF-1, as well as IL-6 expressions between the TAK-242 group and the normal control group (P>0.05). RT-PCR showed that the IL-6 mRNA expression in LPS group was the highest in the three groups (P<0.01). TAK-242 inhibits the proliferation of LPS-induced Tenon's capsule fibroblasts and the release of inflammatory factors by regulating the TLR4 signaling pathway, providing a new idea for reducing the scarring of the filter passage after glaucoma filtration surgery.

Actinomycin D for fibrosis management in ophthalmic implant surgery

Abstract Implants that feature a drug delivery system loaded with antifibrotic active drugs provide a promising approach to address postoperative complications caused by fibrosis. This study is intended to clarify whether Actinomycin D has an impact specifically on components of the extracellular matrix (ECM) and its formation in human primary fibroblasts of the Tenon capsule (hTF). Furthermore, the suitability of this agent in poly(N-vinylpyrrolidone)- poly(methylmethacrylate)(PVP-co-PMMA) as a drug delivery model is evaluated in drug incorporation and release studies. RT-qPCR revealed a significant downregulation of the fibrotic marker genes ACTA2, COL1A1 and FN1 in cells stimulated with TGF- β1 and additionally treated with Actinomycin D. However, these findings could only be confirmed on α- SMA protein level. collagen I and Fibronectin synthesis stayed unaffected. The diffusion based incorporation of Actinomycin D into the polymer model proved to be very effective. The release of the agent was retarded with a slightly prolonged kinetic. These findings make Actinomycin D a promising antifibrotic agent in ophthalmic implant surgery.

Swept-Source OCT Analysis of the Margin of Choroidal Coloboma: New Insights

To study the retinal architecture and vitreoretinal interface at the edge of choroidal coloboma using swept-source OCT. Prospective observational case series at a tertiary eye care center. Patients with choroidal coloboma treated at an ophthalmology department and fulfilling the inclusion criteria of the study. Swept-source OCT was carried out in 30 eyes of 20 patients with choroidal coloboma. The primary objective was to describe the OCT features at the margin of the coloboma. Swept-source OCT of the coloboma margin revealed new features in addition to the previously described findings. Two types of transition from normal retina into intercalary membrane (ICM) were noted: abrupt (73.33%) and gradual (26.67%). Outer retinal layers (interdigitation zone and ellipsoid zone) terminated at a variable distance before the retinal pigment epithelium in 56.67% of eyes. Cystic spaces in the ICM (46.67%), schisis-like spitting of the ICM (30%), and breaks in the ICM (6.67%) were seen as well. Subclinical retinal detachment (RD) was also noted in 1 eye. The peculiar features noted at the vitreoretinal interface included vitreous attachment at the coloboma margin (23.33%), vitreous condensation (6.67%), and hill like projections of ICM into the vitreous cavity (26.67%). In the region of the coloboma, sclera and Tenon's capsule could also be analyzed as a hyperreflective lamellar structure and an irregularly arranged less hyperreflective structure. Swept-source OCT of the coloboma margin revealed various new features in addition to those described previously. The detection of subclinical RD or early termination of outer retinal layers in selected cases may be helpful in guiding new management protocols.

Practice Patterns in the Management of Primary Pterygium: A Survey Study.

To characterize cornea specialists' current practice preferences in the management of primary pterygium. A 25-item survey regarding indications for surgery, surgical technique, use of adjuvant therapy, type and duration of postoperative therapy, and treatment of early recurrences was designed and sent to members of the Cornea Society through the kera-net listserv. In total, 199 cornea specialists completed the questionnaire. More than 90% considered that surgery should be performed when there is proximity of the pterygium to the visual axis, pain or redness, eye movement restriction, or induction of astigmatism. Cosmesis was considered as an indication by 41.7% of the participants. The most frequent technique for pterygium excision was complete resection including the base and a moderate quantity of Tenon capsule followed by autologous conjunctival or limbal-conjunctival graft. The preferred graft fixation method in this survey was fibrin glue (61.2%). Most respondents reported a recurrence rate of less than 5% and no use of adjuvant agents to prevent recurrence. When early recurrence did occur, the preferred agents were corticosteroids. This study reflects the preferences of cornea experts regarding primary pterygium treatment and may serve as a guide for the management of this pathology.

The clinical features of posterior scleritis with serous retinal detachment: a retrospective clinical analysis.

To summarize the clinical features, systemic associations, risk factors and choroidal thickness (CT) changing in posterior scleritis (PS) with serous retinal detachment. This retrospective study included 23 patients diagnosed PS with retinal detachment from August 2012 to July 2017. All patients' medical history and clinical features were recorded. The examinations included best corrected visual acuity (BCVA), intraocular pressure (IOP), fundus examination, and routine eye examinations. Posterior coats thickness (PCT) was determined by B-scan ultrasound, the CT was measured by enhanced depth imaging spectral-domain optical coherence tomography (EDI-OCT) and clinical data were compiled and analyzed. After application of extensive exclusion criteria, 23 patients with PS remained (13 females, 10 males). The average age at presentation was 29.5±9.24 years old. Ocular pain and blurred vision were the two most common complained symptoms by patients. Anterior scleritis occurred in 12 patients, which was confirmed by ultrasound biomicroscopy (UBM) examination. Despite all patients displaying serous retinal detachment in their macula, no fluorescein leakage was observed in the macular area. Optic disc swelling was documented in 10 of the 23 eyes. From B-scan ultrasound examination, the PCT increased with fluid in Tenon's capsule demonstrated as a typical T-sign. The average PCT was 2.51±0.81 mm in the PS-affected eyes and only 1.09±0.29 mm in the unaffected eye (P<0.0001). The subfoveal CT was 442.61±55.61 µm, which correlated with axis length (r=-0.65, P=0.001) and PCT (r=0.783, P<0.001). The BCVA and IOP did not correlate with either CT or PCT. PS with serous retinal detachment presented a variety of symptoms, such as pain, visual loss, and physical indicators. Typical T-sign detected by B-scan ultrasound is a useful confirmatory sign for PS diagnosis. Pathological increases in CT might be a potential predictive factor for inflammation.

Safety and efficacy of tacrolimus-coated silicone plates as an alternative to mitomycin C in a rabbit model of conjunctival fibrosis.

PurposeTo find safer and more effective drugs than mitomycin C to prevent conjunctival fibrosis in a rabbit model.MethodsTwenty-four rabbits were involved and randomly divided into four groups. Limbus-based peritomy was performed at the superior cornea, and normal saline (NS group), mitomycin C (MMC group), SR (SR group), or TC (TC group)-coated silicone plate was inserted at the sub-Tenon’s space in each group. Conjunctival congestion was evaluated at 1 and 4 weeks postoperatively. At 4 weeks, the numbers of inflammatory cells, fibroblasts, myofibroblasts, blood vessels, and goblet cells were counted in the conjunctiva and Tenon’s capsule around the silicone plate.ResultsAt 4 weeks, conjunctival congestion was significantly less than that observed at 1 week in the SR and TC groups (p < 0.05), whereas the number of myofibroblasts was significantly lower in the MMC and TC groups (p < 0.05). The conjunctiva was significantly less congested in the TC group versus the other groups at 1 week and 4 weeks (p < 0.05). The TC group had the lowest number of inflammatory cells and MMC group had the lowest number of goblet cells among all groups (p < 0.05).ConclusionsThe TC-coated silicone plate was more effective in inhibiting inflammation and fibrosis versus the MMC-coated silicone plate and was associated with fewer adverse effects in the rabbit model.

Robot-Assisted Simulated Strabismus Surgery.

PurposeThis study aims to investigate the feasibility of robot-assisted simulated strabismus surgery using the new da Vinci Xi Surgical System and to report what we believe is the first use of a surgical robot in experimental eye muscle surgery.MethodsRobot-assisted strabismus surgeries were performed on a strabismus eye model using the robotic da Vinci Xi Surgical System. On the lateral rectus of each eye, we performed a procedure including, successively, a 4-mm plication followed by a 4-mm recession of the muscle to end with a 4-mm resection. Operative time from conjunctival opening to closing and successful completion of the different steps with or without complications or unexpected events were assessed.ResultsRobot-assisted strabismus procedures were successfully performed on six eyes. The feasibility of robot-assisted simulated strabismus surgery is confirmed. The da Vinci Xi system provided the appropriate dexterity and operative field visualization necessary to perform conjunctival and Tenon's capsule opening and closing, muscle identification, suturing, desinsertion, sectioning, and resuturing. The mean duration to complete the whole procedure was 27 minutes (range, 22–35). There were no complications or unexpected intraoperative events.ConclusionsExperimental robot-assisted strabismus surgery is technically feasible using the new robotic da Vinci Xi Surgical System. This is, to our knowledge, the first use of a surgical robot in ocular muscle surgery.Translational RelevanceFurther experimentation will allow the advantages of robot-assisted microsurgery to be identified while underlining the improvements and innovations necessary for clinical use.

Peritomy-sparing scleral buckle

AbstracPurposeTo introduce a modified technique for encircling circumferential scleral buckling without peritomy thorough a small conjunctival opening for the repair of uncomplicated rhegmatogenous retinal detachment (RD).MethodsThis technique was performed in 10 eyes of 10 patients with primary rhegmatogenous RD who underwent encircling circumferential scleral buckling without peritomy. Transconjunctival traction sutures were placed in four rectus muscles. After transconjunctival location of the retinal break, a 5- to 6-mm radial conjunctival incision was performed in 4 quadrants without cutting the limbal conjunctiva–Tenon's capsule. A 240-silicone band in scleral belt loops was used for an encircling circumferential buckle. After drainage and cryopexy, SF6 was used for tamponade. The incision was closed via layered closure only ocassionally.ResultsPrimary attachment success of 100% was achieved by single procedure. The intraoperative and postoperative complications observed included subconjunctival hemorrhage observed in 5 (50%) of eyes. These disappeared in the postoperative period.ConclusionsMinimal conjunctival incision in scleral buckle without peritomy can achieve excellent anatomical success in patients with rhegmatogenous RD without distorting ocular surface anatomy. This is the first description of technique preserving corneal limbus anatomy that could convert buckling surgery to more attractive option for retina surgeons.