Transient Ocular Hypertension Research Articles

Comparing Intracanalicular and Topical Steroid Use in Patients Undergoing Pterygium Surgery.

The study received funding from Ocular Therapeutix, Inc., Bedford, MA.We undertook this study to compare the efficacy of intracanalicular dexamethasone 0.4 mg with topical prednisolone acetate (PA) 1% in controlling postoperative pain and inflammation in patients undergoing pterygium surgery. This was an open-label, prospective, interventional, nonrandomized comparative trial. Thirty patients were assigned to one of the following groups: Group A [intracanalicular insert of 0.4 mg dexamethasone placed into upper and lower puncta during the procedure, followed by at postoperative month 1 visit institution of topical PA 1% twice daily × 2 weeks then once daily × 2 weeks] or Group B [nonintervention group with institution on postoperative day 1 topical PA 1% every 2 hours × 2 weeks then four times per day × 2 weeks then twice daily × 2 weeks then once daily × 2 weeks]. Fifteen cases and 15 controls were enrolled. There was no statistical difference in patient-reported pain or satisfaction between the case and control groups at 1 day; 1 week; and 1, 3, and 6 months postoperatively. There was no significant difference in time to an ocular hyperemia score of 0 between the two groups. There was no difference in the rate of corneal reepithelialization and recurrence rate (two controls). Nine eyes had transient ocular hypertension (seven cases and two controls). Intracanalicular dexamethasone 0.4 mg may reduce the medication burden for patients who need prolonged postoperative steroid therapy as is routine in the setting of pterygium surgery. It is a safe and effective alternative to PA 1% drops alone for postoperative control of pain and inflammation in pterygium surgery.

LONG-TERM OUTCOME OF TRANSSCLERAL FOUR-POINT FIXATION OF AKREOS INTRAOCULAR LENS WITH CLOSED CONTINUOUS-LOOP SUTURE.

To report the long-term clinical outcomes of transscleral four-point fixation of Akreos intraocular lens using a closed continuous-loop suture technique. This was a retrospective, multicenter, interventional case series. Primary outcome measures were best-corrected visual acuity, intraocular pressure, corneal endothelial cell density, and complications with a minimum of 1-year follow-up. One hundred and ninety-two eyes of 177 patients from two surgical hospital sites were identified. The mean best-corrected visual acuity improved from 0.88 ± 0.74 logarithm of the minimum angle of resolution (Snellen 20/152) preoperatively to 0.42 ± 0.52 logarithm of the minimum angle of resolution (Snellen 20/53) postoperatively ( P < 0.001). The mean preoperative intraocular pressure was 17.51 ± 8.67 mmHg, and the mean postoperative intraocular pressure at final follow-up was 15.08 ± 4.18 mmHg ( P = 0.001). The mean corneal endothelial cell density significantly reduced from 2,259 ± 729 cells/mm 2 to 2077 ± 659 cells/mm 2 , representing a cell loss of 5.73% ( P < 0.001). The intraocular lens was fixed well during follow-up. There were no intraoperative complications noted. Postoperative complications included transient ocular hypertension in 15 eyes (7.81%), hypotony in two eyes (1.04%), retinal detachment in one eye (0.52%), and macular edema in one eye (0.52%). The transscleral four-point fixation Akreos intraocular lens using the closed continuous-loop suture technique was effective and safe with satisfactory visual acuity with a minimum of 1-year follow-up.

Self-generating electricity system driven by aqueous humor flow and trabecular meshwork contraction motion activated BCKa for glaucoma intraocular pressure treatment.

Primary open-angle glaucoma (POAG) is the most common form of glaucoma and the leading cause of irreversible vision loss and blindness worldwide. Intraocular pressure (IOP) is the only modifiable risk factor, and prompt treatment to lower IOP can effectively slow the rate of vision loss due to glaucoma. Trabecular meshwork (TM) cells can maintain IOP homeostasis by correcting and adjusting the resistance to aqueous humor outflow in response to sustained pressure changes. TM cells' function is reduced, and membrane ion channels are impaired in POAG. The dysfunction of Large conductance Ca2+-activated K+ (BKCa) plays a central role in the pathogenesis of POAG. In this work, we targeted MXene nanoparticles (MXene-RGD) with piezoelectric response to TM cells in a 3D model of glaucoma in vitro as well as in the rabbit Transient Ocular Hypertension (OHT) Model in vivo. MXene-RGD gives the TM electromechanical transfer properties, while the self-enhancing and self-generated electricity properties of the TM are determined by the aqueous humor flow rate and the size of the deformation of the TM. MXene-RGD is nontoxic, as illustrated by a cell toxicity study and histological examination. In a 3D in vitro model of high-pressure glaucoma, whole-cell patch-clamp confirmed that piezoelectric stimulation turns on BKCa, which reduces the volume of the cell. MXene-RGD was injected into the anterior chamber with minimal trauma, i.e., anterior chamber injection, and specifically targeted to TM cells. The OHT model in vivo confirmed the potential IOP-lowering ability of MXene-RGD. We evaluated the ion channels involved in the reduction of IOP by MXene-RGD by pre-treatment with a BKCa channel blocker (iberiotoxin, IbTX) and a voltage-gated Ca2+channel blocker (nifedipine). Quantitative qPCR analysis showed that MXene-RGD inhibited the upregulation of mRNA expression levels of the myofibroblast marker α-smooth muscle actin (α-SMA) and the inflammatory response marker interleukin-6 (IL-6) induced by IOP. Histology confirmed that MXene-RGD attenuated IOP-induced proliferation and collagen production in the TM. Taken together, we present for the first time a minimally invasive surgical approach for targeting TM cells for POAG by utilizing piezoresponse nanomaterials to target BKCa to repair or awaken the ability of TM cells to regulate IOP homeostasis on their own.

OUTCOMES OF PRIMARY UNCOMPLICATED RHEGMATOGENOUS RETINAL DETACHMENT REPAIR USING SILICONE OIL TAMPONADE IN VITREORETINAL SURGERY

In a prospective observational study, we aimed to determine anatomical and functional outcomes, as well as possible complications, following pars plana vitrectomy (PPV) with silicone oil (SO) tamponade for primary, uncomplicated rhegmatogenous retinal detachments. This study was conducted from August 2023 to November 2023. During the study, 32 patients underwent surgical repair through PPV and SO injection. PPV over scleral buckling was chosen when cataracts or vitreous hemorrhages hindered proper fundus visualization. Patients received comprehensive ocular assessments, including best-corrected visual acuity, anterior segment examination, IOP measurements via applanation, and fundus examinations at different intervals: 1 day, one week, one month, and three months. Intraocular pressure exceeding 21 mmHg was defined as increased IOP. Our study included 32 patients (22 men and ten women) of Asian ethnicity who underwent retinal detachment repair by PPV and SO injection. The patients had an average age of 57.8 ± 10.1 years (34–76 years) at the time of intervention. The follow-up period was three months. An anatomical success rate, defined as retinal reattachment three months after SO removal, was achieved in 29 eyes (90.6%). Final best-corrected visual acuity (BCVA) improved 26 looks (81.2%), with a mean gain of 3 Snellen lines. BCVA remained unchanged in 4 eyes (12.5%) and deteriorated in 2 eyes (6.3%), with a mean loss of 2 Snellen lines. During the 3-month follow-up period, 17 eyes (53.1%) experienced increased intraocular pressure (IOP). Out of these, 15 patients had transient ocular hypertension, requiring topical treatment during the immediate postoperative period (within one month). Only one eye (5.9%) required filtrating drainage surgery for IOP control. Notably, no eyes developed optic neuropathy due to elevated IOP during this short-term follow-up. Pars plana vitrectomy (PPV) combined with silicone oil (SO) injection is a safe and effective surgical approach for treating primary uncomplicated rhegmatogenous retinal detachment. Our series indicates that PPV and SO injection lead to good anatomical and functional outcomes, with high reattachment rates and low rates of proliferative vitreoretinopathy. Although cataract formation and elevated intraocular pressure (IOP) are common complications, they can be successfully controlled.

Which is More Effective and Safer? Comparison of Propensity Score-Matched Microhook Ab Interno Trabeculotomy and iStent Inject.

The purpose of this study was to compare the surgical outcomes between abinterno trabeculotomy (LOT) and iStent injectW implantation (iStent) both combined with cataract surgery, matching the background factors including age, intraocular pressure (IOP), medication score, central corneal thickness (CCT), and axial length. A total of 100 eyes from 75/79 patients with primary open-angle glaucoma were included in the LOT/iStent groups. The background factors were matched between the two groups using the propensity score. There were no significant differences in age, IOP, medication score, CCT, and axial length, preoperatively. The postoperative medication scores were 1.3 ± 1.2 and 1.2 ± 1.2 in the LOT and iStent groups. The postoperative IOPs were 12.8 ± 2.8 and 13.1 ± 2.4mmHg in the LOT and iStent groups, respectively. The changes in the medication score were - 0.64 ± 1.4 and - 0.44 ± 1.6 in the LOT and iStent groups, respectively. The changes in the IOP were - 2.1 ± 3.3 and - 1.5 ± 3.0mmHg in the LOT and iStent groups, respectively. These values were not significantly different between the two groups. The postoperative IOP and changes in the IOP were significantly associated with preoperative IOP and CCT. There was no significant difference in the occurrence of postoperative complications (hyphema, 11.0% and 6.0%, and transient ocular hypertension, 8.0% and 5.0%, in the LOT and iStent groups, respectively). LOT and iStent have similar surgical outcomes with sufficient safety. Postoperative IOP was significantly associated with preoperative IOP and CCT in both groups.

Neuroprotective Effect of a Nutritional Supplement Containing Spearmint Extract, Forskolin, Homotaurine and Group B Vitamins in a Mouse Model of Transient Ocular Hypertension.

Glaucoma is one of the most common sight-threatening eye disorders and one of the main causes of irreversible blindness worldwide. The current therapies focusing on reducing intraocular pressure (IOP) are often insufficient to prevent the progression of the disease, so the therapeutic management of glaucoma remains a challenge. The aim of this study was to evaluate the neuroprotective, IOP-lowering independent effects of a nutritional supplement containing forskolin, homotaurine, spearmint extract and vitamins of the B group in a model of acute glaucoma developed in mice. Glaucoma was induced in adult wild-type C57BL/6J mice by transient elevation of IOP. The dietary supplement, branded as Gangliomix® (125 mg/kg/day), was administered by oral gavage for 17 days and ocular hypertension was induced on the 10th day of treatment. A histological analysis of the retinas was performed and RGC survival was evaluated with fluorogold labeling and Brn3a immunostaining on wholemount and retinal sections. Expression of alpha-spectrin, caspase-3, PARP-1 and GFAP was studied with western blotting or immunofluorescence. A significant increase in RGC survival was reported in the retina of mice treated with the dietary supplement as compared to vehicle-treated animals. The observed neuroprotection was associated with a calpain activity decrease, reduction in caspase-3 and PARP-1 activation, and prevention of GFAP upregulation. These effects were independent from the hypotensive effects of the supplement. Altogether, our data suggest that the dietary supplementation with forskolin, homotaurine, spearmint extract and vitamins of the B group supports RGC survival and may offer beneficial effects in glaucoma patients in combination with the currently used IOP-lowering therapy.

27-gauge vitrectomy for posterior segment eye disease: experience at a tertiary care center in Kashmir, India

Background: The aim of this work was to study the clinical outcomes, operative time, and complications of 27-gauge (27G) microincision vitrectomy surgery in posterior segment eye disease (PSED). Material and methods: This prospective observational study was conducted at a tertiary care hospital in Kashmir, India. 27G transconjunctival sutureless vitrectomy was performed on 101 eyes of 101 patients with PSED. Results: Of 101 patients, pars plana vitrectomy was indicated for retinal detachment (RD) (n = 36, 35.7%), vitreous hemorrhage (n = 35, 34.7%), epiretinal membrane (ERM)/vitreomacular traction (VMT) (n = 16, 15.9%), macular hole (n = 7, 6.9%), endophthalmitis (n = 4, 3.9%) and intraocular lens drop (n = 3, 2.9%). We observed significant improvement in mean logMAR visual acuity for all indications (p &lt; 0.05 each). Tamponade agents used were fluid (n = 51, 50.5%), silicone oil (n = 30, 29.7%), SF6 gas (n = 15, 14.85%), C3F8 gas (n = 3, 2.97%) and air (n = 2, 1.98%). The intraocular pressure (IOP) increased significantly in cases where silicone oil and SF6 gas were used as tamponade agents (p &lt; 0.05 each). Mean IOP initially increased on the first postoperative day followed by a gradual decline. Overall, the mean operating time was 37.08 minutes and duration of vitreous removal 22.41 minutes. Intraoperative complications included suprachoroidal hemorrhage (n = 1, 0.99%) and inadvertent retinal breaks (n = 1, 0.99%). Postoperative complications included transient hypotony (n = 2, 1.98%), transient ocular hypertension (n = 12, 11.88%), postoperative vitreous hemorrhage (n = 3, 2.97%), recurrent RD (n = 1, 0.99%) and emulsification of silicone oil (n = 3, 2.97%). Conclusions: The 27G system was safe and effective for treating a broad spectrum of PSED. Minimal complications and good visual outcomes warrant a wider adoption of this technique.

Ocular hypertension and its predictor after a single Ozurdex implant: One-year follow-up in Asian Indian eyes.

To determine the incidence and risk factors for an increase in the intraocular pressure (IOP) after a single dexamethasone intravitreal implant (Ozurdex). Medical records of 41 consecutive eyes who had received a single 0.7 mg Ozurdex implant for the various vitreoretinal pathology, between March 2015 and April 2016 were reviewed retrospectively. Ocular hypertension (OHT) was defined as IOP of >22 mmHg or an increase in the IOP of >6 mmHg from the baseline. Univariate regression analysis was used to measure the predictor of OHT after the implant. Among the 41 eyes, who received a single Ozurdex intravitreal implant, 6/41 (14.6%) of the injected eyes had OHT, with the peak of IOP at 1 month after the injection when compared with the baseline IOP. Eight eyes (19.5%) had preexisting glaucoma or OHT, and 4/8 (50%) of them developed sustained elevation of IOP after the injection. Two eyes had transient OHT, a day after the implant, which did not require any treatment. All the eyes were managed with topical antiglaucoma medications and none required surgery to control the IOP. Preexisting OHT or glaucoma was found to be a significant risk factor for OHT after the Ozurdex injection (P < 0.0001). Patients with preexisting OHT or glaucoma have an increased risk of OHT following the Ozurdex implant and hence needs to be informed of the possible risk. Follow-up at a regular interval is mandatory to monitor and recognize OHT early and treat it appropriately.

Scleral Fixation of Akreos AO60 Intraocular Lens Using Gore-Tex Suture: An Eye on Visual Outcomes and Postoperative Complications.

Purpose “In-the-bag” placement of an IOL is the Holy Grail for any cataract surgeon. However, in the absence of capsular integrity, alternative surgical options to place the IOL must be sought. We aim to report the clinical outcomes and safety profile of scleral-fixated Akreos AO60 intraocular lens implantation using Gore-Tex suture, combined with pars plana vitrectomy. Methods This is a single-center, retrospective case series descriptive study. Electronic clinical records of all patients subjected to scleral fixation of a Bausch and Lomb Akreos AO60 IOL combined with pars plana vitrectomy, between April 1, 2017, and August 1, 2021, were reviewed. Data concerning age, sex, laterality, past ophthalmological history, pre- and postoperative best-available visual acuity, surgical indication, and intra- and postoperative complications were collected. Measured outcomes were the differences in best-available visual acuity and frequency of postoperative complications. Results A total of 37 eyes (20 right eyes and 17 left eyes) from 36 patients (16 females and 20 males) were included in the statistical analysis. The mean age at time of surgery was 72.0 ± 12.4 years. The mean follow-up period was 548.9 days (range 39–1564 days). Globally, the mean best-available logMAR visual acuity improved from 1.61 preoperatively (0.025 decimal equivalent) to 0.57 postoperatively (0.3 decimal equivalent), this difference being statistically significant (P < 0.001). Indications for surgery included aphakia due to complicated cataract surgery (24.3%; n = 9); subluxated IOL due to closed trauma (21.6%; n = 8); PEX-related subluxated IOL (16.2%; n = 6); non-traumatic, non-PEX-related subluxated IOL (18.9%; n = 7); subluxated crystalline lens due to closed trauma (8.1%; n = 3); aphakia due to open-globe injury (5.4%; n = 2); silicone-induced IOL opacification (2.7%; n = 1); and aphakia post-endophthalmitis (2.7%; n = 1). Postoperative complications included transient ocular hypertension (27.0%; n = 10), transient corneal edema (18.9%; n = 7), cystoid macular edema (18.9%, n = 7), self-limited hypotension (5.4%, n = 2), self-limited vitreous hemorrhage (2.7%, n = 1), central retinal vein occlusion (2.7%, n = 1), late retinal detachment (2.7%, n = 1), and Akreos IOL opacification (2.7%, n = 1). No suture-related complications were observed. Conclusion There was a statistically significant improvement in visual acuity after scleral fixation of Akreos AO60 intraocular lens using Gore-Tex suture, with no suture-related problems recorded. This procedure seems to be a valuable alternative for posterior chamber IOL placement when secondary IOL implantation is required.

A 27 - Gauge Microincision Vitrectomy Surgery for Posterior Segment Diseases in a Tertiary Centre, Nepal

Introduction: Transconjunctival micro incision vitrectomy surgery (MIVS) with 23 or 25 gauge instrumentation is more advantageous than traditional 20 gauge surgery. We intended to evaluate the visual outcome, complications and indication of various vitreoretinal diseases using 27 Gauge vitrectomy systems. &#x0D; Methods: This study was a prospective, interventional, non-comparative study conducted in Nepal Eye Hospital from June 2017 to July 2018. Fifty-two patients with various vitreoretinal diseases were recruited. The main outcome measures included corrected distance visual acuity (CDVA) preoperative and postoperative, intraocular pressure (IOP) preoperative and postoperative, indication for vitreoretinal surgery, intraoperative complications, and postoperative complications.&#x0D; Results: Fifty two eyes of 52 patients (26 men and 26 women; mean age, 59 years) underwent 27-gauge pars planavitrectomy. Surgical indications included epiretinal membrane (n = 11), full-thickness macular hole (n = 11), rhegmatogenous retinal detachment [n = 14 (12 vitrectomy only and two vitrectomy with scleral buckle)], vitreous haemorrhage (n = 3), vitreous opacities (n = 3), silicon oil removal (n = 3), proliferative diabetic retinopathy [n = 6 (5 vitreous haemorrhage and one tractional retinal detachment)], posterior IOL dislocation (n = 1). Postoperative complications included transient ocular hypertension in eight eyes (15.39%), transient hypotony in five eyes (9.62%) and vitreous haemorrhage in five eyes (9.62%). No cases of postoperative endophthalmitis, sclerotomy - related tears, or choroidal detachments were encountered in the follow-up period. Mean corrected distance visual acuity improved from 20 / 796 (logarithm of the minimum angle of resolution, 1.60 ± 0.64) preoperatively to 20 / 49 (logarithm of the minimum angle of resolution, 0.42 ± 0.26) postoperatively (p = 0.000,) at final follow up.&#x0D; Conclusions: 27-gauge micro-incision vitrectomy surgery was found to be a safe and effective suture-less surgery with favourable outcomes, in terms of vision.

Retro-pupillary iris fixated intraocular lens: A boon to aphakia

To evaluate post operative visual outcomes and complications of retro-pupillary iris fixated Intracoular lens (IOL) in aphakia. This is a prospective interventional case study conducted at our tertiary eye care centre from March 2018 to February 2019. All monocular aphakias secondary to any cause with no capsular support, good iris diaphragm support and BCVA of better than 6/60 were included. Patients who required combined procedures like trabeculectomy and retinal procedure were excluded. Patients with poor endothelial count/ corneal decompensation, any posterior segment pathologies, pre existing glaucoma and any form of uveitis were also excluded from the study. Pre operative visual acuity, slit lamp examination and fundus examination were carried out. Anterior vitrectomy and retropupillary fixation of iris claw lens were done. The primary outcome was to assess the post operative visual acuity and secondary outcome was to analyse post operative complications at various intervals up to 6 months after surgery. Our study comprised of thirty eyes of 30 aphakic patients. Retropupillary Iris fixated IOL was inserted as primary intraocular lens in 18 patients (60%) and secondary intraocular lens in 12 patients (40%). Baseline best corrected visual acuity was 0.831±0.66 logMAR. Four patients had light perception at baseline. The mean best corrected visual acuity was 0.77±0.35 logMAR at month 1, 0.64±0.36logMAR at month 3 and 0.53±0.33logMAR at month 6. Mean intraocular pressure at baseline was 16mmHg. Mean intraocular pressure at month 1, 3 and 6 were 17mmHg, 16mmHg, and 16mmHg respectively. Among the complications, twelve eyes (40%) had significant ovalisation of pupil at post operative month 1 which persisted at month 6, two eyes(6.66%) had transient ocular hypertension (OHT), and none of the eyes progressed to glaucoma. Choroidal detachment was noted in 2 eyes (6.66%), CME in 3 eyes (9.99%), 1 eye (3.33%) had retinal detachment and 2 eyes (6.66%) had one haptic disenclavation. Among the complications, ovalisation of pupil was the most common observed one. Retro-pupillary Iris fixated IOL is an effective, safe and simple procedure for management of aphakia in eyes with no posterior capsular support.

Scleral Buckle Removal: Indications, Timing, Complications, and Long-Term Outcomes

To report indications, timing, complications, and outcomes of scleral buckle (SB) removal surgery. Retrospective observational case series. Eyes that underwent SB removal between 2010 and 2016 with greater than 1 year of follow-up were included. Main outcome measures were post-SB removal complications and best-corrected visual acuity (BCVA). Fifty eyes that underwent SB removal met the inclusion criteria. Indications include exposed SB (54%), infection (26%), diplopia (16%), and recurrent retinal detachment (4%). Mean and median intervals between SB placement and removal were 65 months and 30 months. Complications include recurrent retinal detachment (12%), transient ocular hypertension (6%), and persistent diplopia (4%). There was no significant change in mean BCVA after SB removal (P = .979). Exposed SB, infection, and diplopia are the most common indications for SB removal. The single-surgery success rate is high and the risk for complications is relatively low. [Ophthalmic Surg Lasers Imaging Retina. 2021;52:138-144.].

Sutureless Scleral Fixated IOL: The "Catcher Pole" Technique.

PurposeTo describe a new surgical technique for sutureless intrascleral intraocular lens (IOL) fixation with an adapted retinal scraper used as an instrument “the Catcher Pole” to retrieve the IOL haptic through a scleral tunnel.SettingPublic Eye Hospital, Roma, Italy.DesignRetrospective case series.MethodsTwenty-one eyes from 19 patients who underwent sutureless intrascleral IOL fixation were studied. A standard three-piece posterior chamber IOL (PCIOL) was implanted in aphakia or rescued and fixated in cases of dislocated PCIOL. A 23 to 25 G retinal loop scraper (the “Catcher Pole“) was inserted through a 1.5 mm long tunneled sclerotomy performed on the horizontal meridian, to capture, hold and externalize the tip of the haptic of the IOL. A flange created with an handheld cautery on the externalized haptic tip prevents IOL slippage. The best-corrected visual acuity (BCVA), central corneal pachymetry (CCP), IOL tilt and complications were assessed.ResultsIn twenty-one eyes of 19 patients, the mean preoperative BCVA was 0.61 logMAR units ±0.05 SD, and the mean postoperative BCVA improved significantly to 0.18 logMAR units at three months ±0.05 SD (P=0.002). The mean preoperative CCP was 610 µ ±17 SD and the mean postoperative CCP 623 µ ±16 SD, (P=0.73). In the subgroup that underwent IOL tilt evaluation, mean IOL tilt was 3.19±2.01. The postoperative complications included iris capture of the IOL in one eye (4,7%) and transient ocular hypertension in two eyes (9,4%).ConclusionsThe “Catcher Pole” sutureless intrascleral IOL fixation technique is easy to perform with reduced anterior chamber manipulations and achieves both anatomical and optical stability.

Intraocular Pressure Changes after Intravitreal Bevacizumab or Ranibizumab Injection: A Retrospective Study.

Purpose:To determine intraocular pressure (IOP) changes after intravitreal bevacizumab or ranibizumab injection administered for various retinal disorders.Methods:A retrospective chart review of 796 eyes of 574 patients receiving intravitreal ranibizumab (0.5 mg) and/or bevacizumab (1.25 mg) injection for different retinal diseases from March 2009 to December 2016 was performed. Ocular hypertension (OHT) was defined as IOP >21 mmHg or an increase in IOP of >5 mmHg from the baseline. IOP at the baseline and at various time periods after the injection was evaluated in the injected eyes and fellow control eyes.Results:One hundred and thirty-one eyes received either a single dose of bevacizumab or ranibizumab intravitreal injection unilaterally, 222 patients received single injection in both the eyes (n = 444 eyes), and 221 eyes received multiple doses of the injection. OHT was noted in 11 eyes (1.38%), of which 3 eyes (0.38%) had transient OHT and 8 eyes (1%) had delayed and sustained OHT and among them, 3 eyes (0.4%) progressed to glaucoma. Preinjection IOP was significantly higher in the treated eyes when compared to the control untreated eyes (P = 0.006).Conclusions:Incidence of delayed and sustained OHT is low after a single or multiple intravitreal bevacizumab and ranibizumab injections. Clinicians should be aware of possibility of OHT or glaucoma after the procedure.

Modified Intraocular Lens Intrascleral Fixation Technique Using Two Vitrectomy Ports as Lens Haptic Fixation Sites.

IntroductionWe developed a new technique that uses two of the vitrectomy ports as intraocular lens (IOL) haptic fixation sites and compared that with a conventional T-fixation method.MethodsA total of 33 eyes were retrospectively divided into the port-fixation (n=21) and conventional (n=12) groups. For the port-fixation group, supranasal and inferotemporal trocars (25-gauge) were placed in the center of a T-shaped lamellar scleral incision 2 mm from the corneal limbus and a supratemporal trocar at 3.5 mm. Following a vitrectomy, along with lens or IOL extraction as needed, the infusion cannula was changed from an inferotemporal to supratemporal trocar. The first IOL haptic and trocar were then simultaneously withdrawn from the eye by grasping with vitreoretinal forceps, with the same performed for the second IOL haptic and trocar, after which the infusion cannula was removed. In the conventional group, 2 T-shaped scleral incisions and three trocars were separately placed.ResultsPostoperatively, transient ocular hypotension and hypertension were observed in a few eyes in both groups. At 6 months after surgery, astigmatism was 1.71±1.13 D in the port-fixation group and 2.21±1.78 D in the conventional group (p=0.40, t-test).ConclusionThis new technique may be effective because of the lower number of scleral wounds.

Surgical Outcomes of Retropupillary-Fixated Iris-Claw Intraocular Lens

Purpose:To assess the visual outcome and complications following retropupillary-fixated iris-claw intraocular lens (IOL) implantation.Methods:For this retrospective, non-comparative study, chart review of patients who underwent retropupillary iris-claw IOL implantation for the correction of aphakia from July 2014 to October 2018 and had a minimum postoperative follow-up of 2 months was carried out. Postoperative corrected distance visual acuity (CDVA), intraocular pressure (IOP), and complications were noted.Results:One hundred and twenty-two eyes of 122 patients (mean follow-up: 7.48 ± 5.2 months, range, 2 months-3.5 years) were enrolled in the study. The mean logMAR CDVA improved from 1.36 ± 0.52 preoperatively to 0.5 ± 0.42 postoperatively, at the last follow-up visit (P < 0.0001). The final CDVA improved in 110 eyes (90.2%), remained unchanged in 8 eyes (6.6%), and worsened in 4 eyes (3.3%). In cases of pre-existing cystoid macular edema (CME) or excessive intraoperative manipulations, 0.05 ml of 4 mg intravitreal triamcinolone acetonide (IVTA) was injected at the end of the surgery. Twenty eyes (16.4%) had transient ocular hypertension (OHT), 6 eyes (4.9%) had persistent OHT, and 2 eyes (1.6%) progressed to glaucoma. Choroidal detachment was noted in 2 eyes (1.6%), CME in 6 eyes (4.9%), 2 eyes (1.6%) had retinal detachment, 20 eyes (16.4%) had significant ovalization of pupil, 8 eyes (6.6%) had one haptic disenclavation, 1 eye (0.8%) had corneal decompensation, and 1 eye (0.8%) had endophthalmitis.Conclusions:Retropupillary iris-claw IOL provides good visual rehabilitation with a few complications. Its ease of insertion and short surgical time makes it a good option to correct aphakia in patients with an inadequate capsular support.

Histamine-Induced Conjunctivitis and Breakdown of Blood-Tear Barrier in Dogs: A Model for Ocular Pharmacology and Therapeutics.

Conjunctival inflammation disturbs the blood–tear barrier and thus affects the tear film stability and composition. We aimed to develop a non-invasive and reliable method to induce conjunctivitis in dogs, a large animal model for translational work on ocular surface disease in humans. Six beagle dogs underwent a randomized, vehicle-controlled, balanced crossover trial—on six separate days, one eye received topical artificial tears (vehicle), while the other eye received one of six concentrations of histamine solution (0.005–500 mg/ml). At sequential times after eyedrop administration, a conjunctivitis score was given to each eye based on the degree of palpebral and bulbar conjunctival hyperemia and chemosis, ocular pruritus, and discharge. Total protein content (TPC) and serum albumin were quantified in tear fluid at baseline and 20 min. Additionally, 13 dogs presenting for various ophthalmic diseases with associated conjunctivitis were examined. Experimentally induced conjunctivitis developed rapidly (<1 min) following topical histamine administration and lasted for 1–3 h (four lowest doses) to 6–8 h (two highest doses). The severity of conjunctivitis was dose-dependent. Histamine was overall well tolerated, although transient blepharitis, aqueous flare, and ocular hypertension occurred in a few dogs receiving histamine ≥375 mg/ml. TPC and serum albumin levels increased in tears of eyes receiving histamine ≥1.0 mg/ml, being significantly higher than vehicle and baseline in eyes receiving histamine ≥375 mg/ml. Lacrimal albumin levels were also increased in 13 dogs with naturally acquired conjunctivitis, up 2.7–14.9 fold compared to contralateral healthy eyes. Histamine-induced conjunctivitis represents a robust model for translational work on the ocular surface given the low cost, non-invasiveness, self-resolving nature, ability to adjust the duration and severity of the disease, and shared features with naturally occurring ocular diseases. Histamine solutions of 1, 10, and 375 mg/ml induce mild, moderate, and severe conjunctivitis in dogs, respectively. Leakage of serum albumin in tear fluid of eyes with conjunctivitis suggests a breakdown of the blood–tear barrier.

Efficacy and safety of dexamethasone intravitreal implant in patients with retinal vein occlusion resistant to anti-VEGF therapy: a 12-month prospective study

Purpose: To evaluate the safety and efficacy of repeated intravitreal dexamethasone implant (Ozurdex) injections administrated on an “as-needed” protocol for retinal vein occlusion patients with macular oedema, previously subjected to at least five anti-vascular endothelial growth factor (VEGF) injections with poor or no response.Methods: Prospective interventional case series of 13 branch retinal vein occlusion (BRVO) and 10 central retinal vein occlusion (CRVO) patients with persistent macular oedema (>250 μm) after at least five anti-VEGF injections. Exclusion criteria included: baseline visual acuity worse than 1.5 logMAR, previous intravitreal implant, history of vitreoretinal surgery, manifest glaucoma or ocular hypertension, epiretinal membrane, retinal neovascularization, massive retinal or macular ischaemia, vitreous haemorrhage or severe lens opacity, previous laser photocoagulation treatment. Each patient received an initial intraocular dexamethasone implant and the procedure was repeated at 6 months “as needed.” Patients were followed up at months 2, 4, 6, 8, 10 and 12 with spectral domain optical coherence tomography and best corrected visual acuity measurements. Exclusion criteria included: baseline visual acuity worse than 1.5 logMAR, previous intravitreal implant, history of vitreoretinal surgery, manifest glaucoma or ocular hypertension, epiretinal membrane, retinal neovascularization, retinal or macular ischaemia, vitreous haemorrhage or severe lens opacity, previous laser photocoagulation treatment. Patients on topical or systemic corticosteroid therapy (during the last 3 months), and known steroid responders as well as diabetic patients were also excluded.Results: In the BRVO group, the mean central retinal thickness (CRT) and best corrected visual acuity (BCVA) significantly improved from 482.92 ± 139.99 μm (0.55 ± 0.12 logMAR) at baseline, to 369.31 ± 119.72 μm (0.43 ± 0.18 logMAR) at 6 months (p = 0.011/p = 0.019). At 12 months CRT was 295.82 ± 135.48 μm (p = 0.026) and BCVA 0.29 ± 0.17 logMAR (p = 0.002). Minimum CRT values were achieved at 3.45 months after the first injection, and 2.46 months after the second injection (197.00 ± 84.27 and 180.00 ± 76.89 μm, respectively). Best BCVA values were achieved at a mean of 4 ± 0.853 months after the first injection, and 4 months after the second injection (0.219 ± 0.129 and 0.222 ± 0.078 logMAR, respectively). In the CRVO group, neither the mean CRT nor BCVA improved significantly at 6 months: from 669.70 ± 203.20 μm (0.80 ± 0.231 logMAR) at baseline, to 586.20 ± 237.63 μm (0.740 ± 0.268 logMAR) at 6 months (p = 0.131/p = 0.333). At 12 months CRT was significantly improved: 549.90 ± 191.26 μm (p = 0.047), but BCVA lacked significant improvement: 0.690 ± 0.285 logMAR (p = 0.072). Minimum CRT values were achieved at a mean of 2 months after the first injection, and also 2 months after the second injection (261.60 ± 121.31 and 280.00 ± 177.43 μm, respectively). Best BCVA values were achieved at a mean of 2 months after the first injection, and 2 months after the second injection and were 0.390 ± 0.173 and 0.385 ± 0.233 logMAR, respectively. Cataract progression was a rare event (2/23 eyes), while transient steroid-induced ocular hypertension (5/23 eyes) was managed successfully with IOP-lowering medicationConclusion: Dexamethasone implant should be considered as an effective and safe alternative in patients with BRVO and CRVO who have failed anti-VEGF therapy. Shortening the re-injection interval especially for CRVO cases should be considered.

Role of Histamine H₃ Receptor Antagonists on Intraocular Pressure Reduction in Rabbit Models of Transient Ocular Hypertension and Glaucoma.

Intraocular pressure (IOP) has a tendency to fluctuate throughout the day, reaching its peak in the early morning in healthy subjects or glaucoma patients. Likewise, histamine tone also fluctuates over time, being lower at nighttime. Numerous studies have demonstrated a correlation between short-term IOP fluctuation and glaucoma progression; however, it has not yet been determined whether histamine plays a role in IOP fluctuations. The aim of this research was to establish the distribution of the histamine receptor proteins and respective mRNAs in the eye by western blot, immunohistochemistry and RT-PCR in New Zealand rabbits. Furthermore, we used a transient ocular hypertension (OHT) model induced by injection of 50 µL of 5% hypertonic saline into the vitreous and a stable OHT model (100 µL 0.1% carbomer in the anterior chamber) to address the potential IOP-lowering ability of H3 receptor (H3R) antagonists (ciproxifan, DL76 and GSK189254). IOPs were performed with a Tono-Pen at baseline and 60, 120 and 240 min post treatment after transient OHT induction and, every day for 12 days in the stable OHT model. All histamine receptor subtypes were localized in the rabbit retina and ciliary body/trabecular meshwork. All the treatments lowered IOP in a dose-dependent fashion between 0.3% and 1%. More specifically, the effects were maximal with ciproxifan at 60 min post-dose (IOP60 change = −18.84 ± 4.85 mmHg, at 1%), remained stable until 120 min (IOP120 change = −16.38 ± 3.8 mmHg, at 1%) and decayed thereafter to reach baseline values at 240 min. These effects were highly specific and dependent on histamine release as pre-treatment with imetit (H3R agonist, 1%) or pyrilamine (H1R antagonist, 1%) largely blocked ciproxifan-mediated effects. Color Doppler ultrasound examination was performed to evaluate changes in ophtalmic artery resistivity index (RI) before and after repeated dosing with DL 76, GSK189254, ciproxifan and timolol. Chronic treatments with H3R antagonists and timolol improved the vascular performance of ophthalmic arteries and reduced retinal ganglion cell death. Oxidative stress was also reduced and measured 8-Hydroxy-2′-deoxyguanosine (8OHdG) expression, and by dihidroethydium (DHE) staining. These results demonstrated that the histamine system participates in IOP regulation and that H3R antagonists could represent a future promising therapy for glaucoma. Further studies should be focused on the long-term IOP circadian fluctuations.

Bimanual irrigation-aspiration for ectopia lentis and use of a small incision for 4-point scleral-sutured foldable intraocular lens and anterior vitrectomy in patients with Marfan syndrome.

Purpose:This study evaluated bimanual intracapsular irrigation-aspiration for ectopia lentis with use of a small incision for 4-point scleral fixation of a foldable posterior-chamber intraocular lens (IOL) and anterior vitrectomy in patients with Marfan syndrome.Methods:We performed a retrospective study of 18 eyes from 10 patients with Marfan syndrome who underwent surgical intervention for ectopia lentis at our clinic between July 2012 and September 2018. In this study, intraoperative and postoperative complications, uncorrected visual acuity, best-corrected visual acuity, spherical equivalent, intraocular pressure, and endothelial cell density were evaluated.Results:No intraoperative complications were reported. In all cases, early postoperative evaluation revealed a clear cornea, round pupil, and well-centered IOL. Mean logMAR uncorrected visual acuity improved from 1.09 preoperatively to 0.56 postoperatively (P < 0.05). Mean logMAR best-corrected visual acuity improved from 0.45 preoperatively to 0.17 postoperatively (P < 0.05). Aside from transient ocular hypertension, no postoperative complications were reported.Conclusion:The combined surgical technique presented above yields excellent visual outcomes with an extremely low incidence of complications. This approach is simple, safe, and effective in the treatment of ectopia lentis in patients with Marfan syndrome.