Ophthalmological Treatment Research Articles

Stem Cell Ophthalmology Treatment Study (SCOTS): Bone Marrow-Derived Stem Cells in the Treatment of Stargardt Disease.

Background: Stargardt Disease is the most common inherited macular degeneration, typically resulting in progressive central vision loss and legal blindness at an early age. We report regarding 34 eyes with Stargardt Disease treated in the Stem Cell Ophthalmology Treatment Study (SCOTS and SCOTS2). Methods: Autologous bone marrow was processed, separating the stem cell fraction which was provided Arms using retrobulbar, subtenons, intravitreal or subretinal and intravenous. The follow-up period was one year. Results: Of the 34 treated eyes, 21 (61.8%) improved, 8 (23.5%) remained stable, and 5 (14.7%) showed continued progression of their disease. Results were statistically significant with p = 0.0004. The average central vision improvement following treatment was 17.96% (95%CI, 16.39–19.53%) and ranged up to 80.5%. Of 17 patients treated, 13 (76.5%) showed visual acuity improvement in one or both eyes, 3 patients (17.6%) showed no net loss, and 1 worsened as a consequence of disease progression; 94.1% of patients had improved vision or remained stable. There were no adverse events. Conclusions: Patients with Stargardt Disease may potentially benefit from autologous bone marrow-derived stem cells (BMSC) as provided in SCOTS. Improvement or stabilization of vision was found to occur for the vast majority of reported patients and findings were highly statistically significant.

Punctal Stenosis a Rare Complication of Dupilumab Therapy for Atopic Dermatitis: A New Case Report

Background: Dupilumab is the biological drug approved for the treatment of moderate to severe atopic dermatitis (AD) and has demonstrated impressive clinical effect and quality of life-enhancing capacity in clinical trials. The most commonly observed adverse effects of dupilumab therapy included upper respiratory tract infection, headache, nasopharyngitis, injection-site reaction, herpes viral infection, and conjunctivitis. Lacrimal duct obstruction or punctal stenosis is rarely reported side effect of dupilumab therapy and not fully documented. Aim: To document a new case presentation of a young female with a history of AD without previous significant ocular manifestations who developed right eye punctal stenosis while she was on Dupilumab therapy for a one-year duration. Case Report: A 19-year-old female with a long-standing history of AD and on dupilumab therapy for one year duration who developed severe punctal stenosis and continued tearing from her right eye in the last two months not responded to conservative ophthalmological medications but completely improved on discontinuation dupilumab injection over 6 months followed-up. Conclusions: Conjunctivitis is a well-known adverse effect of Dupilumab injection of a patient with AD. However, persistent conjunctivitis and tearing from the eye not improving on ophthalmology treatment might rule out punctal stenosis and discontinuation of dupilumab should be considered.

Trends in Dry Eye Disease Management Worldwide.

Dry eye disease (DED) is a condition frequently encountered in ophthalmology practice worldwide. The purpose of this literature review is to highlight the worldwide trends in DED diagnosis and therapy amongst practitioners and determine if a more uniform approach to manage this multifactorial condition has developed over the past two decades. A manual literature search utilizing PubMed was conducted to obtain papers with survey results relating to ophthalmology and optometry diagnosis and treatment of dry eye from January 2000 to January 2020. This did not include data from clinical trials as we were only interested in community clinical practice trends. The terms “dry eye” and “survey” were searched in combination with one or more of the following words or phrases: prevalence, diagnosis, treatment, therapy, etiology, risk factors, therapy, and quality of life. Papers were selected based on their direct applicability to the subject and were only included if they contained relevant survey data from community practitioners. The available literature suggests common trends worldwide in the diagnosis and treatment of DED. These trends have not modified substantially over the past two decades. Practitioner education on the benefits of measuring tear film homeostasis could increase its use as a diagnostic tool to complement current tools. Of the results found, 75% of the papers were published after 2006 and only one paper after 2017. More recent survey results are required to determine if research into DED pathophysiology is altering the current trend in DED management.

Visual outcome of pediatric ocular trauma in a Latin American population

Objective: The aim is to assess associated factors regarding the type of pediatric ocular trauma and final visual acuity (VA) of the patients received ophthalmology service at tertiary care facility between 2013 and 2018. Methods: Retrospective cohort study. The clinical history of patients between 0 and 15 years of age diagnosed with ocular trauma was examined. The exposure variable was the type of ocular trauma (open or closed). Other variables related to ocular trauma were studied. Results: A total of 183 ocular trauma cases were studied. The median age was 9 years (interquartile range: 5–12), most patients were males (65.5%), blunt and sharp objects were the most frequent causes of ocular trauma (41% and 33.3%, respectively). Closed ocular trauma was found in 82.5% of the cases and zone 1 was the most frequently involved (76,5%). Sixty-four percent of cases required surgical management and 26% presented complications at the final follow-up. About 78.7% of the patients had VA equal or higher than 20/40. The risk factors associated with worse visual outcome (worse than 20/40) was found to be open ocular trauma (relative risk [RR] = 5.5; 95%IC: 3.3–9.2), the affected zone (higher risk in zone 3 with RR = 7.62; 95% confidence interval: 7.61–7.63) and time elapsed between the moment of trauma and receiving ophthalmological treatment (RR = 1.01; 95%IC: 1.01–1.01). Conclusion: Most patients that presented with ocular trauma had satisfactory final VA, considering that closed ocular trauma was more frequent. Open ocular trauma, the affected zone, and the time elapsed before starting treatment were associated with worse VA outcomes in our study.

Morphological and Functional Changes of Corneal Nerves and Their Contribution to Peripheral and Central Sensory Abnormalities.

The cornea is the most densely innervated and sensitive tissue in the body. The cornea is exclusively innervated by C- and A-delta fibers, including mechano-nociceptors that are triggered by noxious mechanical stimulation, polymodal nociceptors that are excited by mechanical, chemical, and thermal stimuli, and cold thermoreceptors that are activated by cooling. Noxious stimulations activate corneal nociceptors whose cell bodies are located in the trigeminal ganglion (TG) and project central axons to the trigeminal brainstem sensory complex. Ocular pain, in particular, that driven by corneal nerves, is considered to be a core symptom of inflammatory and traumatic disorders of the ocular surface. Ocular surface injury affecting corneal nerves and leading to inflammatory responses can occur under multiple pathological conditions, such as chemical burn, persistent dry eye, and corneal neuropathic pain as well as after some ophthalmological surgical interventions such as photorefractive surgery. This review depicts the morphological and functional changes of corneal nerve terminals following corneal damage and dry eye disease (DED), both ocular surface conditions leading to sensory abnormalities. In addition, the recent fundamental and clinical findings of the importance of peripheral and central neuroimmune interactions in the development of corneal hypersensitivity are discussed. Next, the cellular and molecular changes of corneal neurons in the TG and central structures that are driven by corneal nerve abnormalities are presented. A better understanding of the corneal nerve abnormalities as well as neuroimmune interactions may contribute to the identification of a novel therapeutic targets for alleviating corneal pain.

Burden of diabetic macular oedema in patients receiving antivascular endothelial growth factor therapy in South Korea: a healthcare resource use and cost analysis

ObjectiveTo examine healthcare resource utilisation (HRU) and direct medical costs for patients with diabetic macular oedema (DME) treated with antivascular endothelial growth factor (anti-VEGF) in Korea by comparing with those...

A prospective study to determine epidemiology, predisposing factors and microbiology of keratitis in north India

Background: Corneal opacification due to keratitis is a leading cause of blindness, with fungal pathogens being important causative agents. Thus, a prospective study was designed to identify the etiological agents; and assess the epidemiological features and risk factors for infective keratitis in India with particular reference to fungal keratitis.Methods: Corneal scrapings were collected from 151 patients and subjected to direct microscopic examination by gram’s stain, KOH wet mount, followed by fungal culture in sabouraud’s dextrose agar and bacterial culture in MacConkey’s agar and blood agar. Identification of fungal growth was done by colony morphology, slide culture and lacto phenol cotton blue wet mount preparation.Results: Out of the 151 cases of keratitis, 65 (43.0%) showed fungal elements on KOH smear. By culture methods, microbial etiology (fungal/ bacterial) was established in 68 (45.0%) patients. Aspergillus spp. (57.7%) was the most frequently isolated fungus, followed by Fusarium (15.4%), Penicillium (7.7%), Curvularia (9.6%), Alternaria (5.8%) and Candida albicans (1.9%). History of trauma with vegetative and non-vegetative material and prior ophthalmologic intervention were the major identifiable risk factors.Conclusions: Thus, aspergillus spp. is the most common cause for fungal keratitis in India, with A. fumigatus and A. flavus being the most familiar species, followed by Fusarium. Bacterial isolates were responsible for considerably fewer cases of keratitis.

A retrospective study of pediatric thyroid eye disease: the Asian experience

ABSTRACT Aim To study the clinical presentation, disease characteristics, and management approach for children with thyroid eye disease (TED) over a 10 year period in a multidisciplinary Paediatric Thyroid Eye Disease Clinic at a tertiary care referral center. Methods Retrospective case series of patients with TED at Kandang Kerbau Women’s and Children’s Hospital (KKWCH) Singapore between August 2006 to June 2015. The diagnosis of TED was clinical based on the Bartley criteria. Ophthalmic examination findings, systemic thyroid function and ophthalmological intervention were recorded. Results Nineteen subjects with pediatric TED were studied. The median age at diagnosis was 12.5 years (range 6–17). The onset of TED was at the same time as their thyroid disease in half of these patients (52.6%) of which all were hyperthyroid except one. The most common signs at TED diagnosis were proptosis (84.2%), lid retraction (63.2%), acquired epiblepharon (63.2%). All patients were inactive and none had evidence of compressive optic neuropathy. TED remained stable in all patients except for one who developed worsening proptosis with exposure keratopathy. No patients were prescribed steroids (oral or intravenous) or had orbital decompression surgery. The most debilitating morbidity was acquired epiblepharon of which out of 12 patients, one had everting sutures and three were offered surgical correction. Conclusions Paediatric TED subjects exhibit milder clinical manifestations compared to adults. Acquired epiblepharon causes most significant visual morbidity by compromising the corneal surface. Being cognizant of the subtleties of pediatric TED will permit the discerning clinician to effectively manage such cases accordingly.

The Impact of Race on Short-term Treatment Response to Bevacizumab in Diabetic Macular Edema

To determine the impact of race and ethnicity on efficacy of intravitreal bevacizumab for diabetic macular edema in anti-vascular endothelial growth factor (VEGF) treatment-naive patients. Retrospective cohort study. Setting: Urban-based academic institution with affiliated private offices. Intravitreal anti-VEGF naïve patients seen between 2010 and 2019 of White (W) race, Black (B) race, or Hispanic (H) ethnicity aged 18 years and older with diabetic macular edema who received intravitreal injections of bevacizumab. Exclusion criteria were prior intravitreal anti-VEGF treatment, invasive ophthalmologic interventions, and laser treatments within 3months prior to first injection through the duration of the study. Exposures: Intravitreal bevacizumab. Percentage of patients with visual acuity (VA) improvement and mean percentage reduction in central macular thickness (CMT). Percentage with VA improvement was 27% vs 39% vs 50% after 1 injection (n= 314), and 34% vs 55% vs 59% after 3 injections (n= 150) for B, H, and W cohorts, respectively. Black patients experienced lower odds of VA improvement compared with White and Hispanic patients after 1 injection (odds of 0.480, CI 0.284-0.814, P= .006) and 3 injections (odds of 0.342, CI 0.149-0.782, P= .008) while controlling for age, sex, baseline glycated hemoglobin (HbA1c), baseline CMT, baseline VA, laser history, injection time course, and follow-up delay. Black patients had a significantly lower likelihood of visual acuity improvement following intravitreal bevacizumab treatment compared with White and Hispanic patients. Further research is warranted to understand the effect of race and ethnicity on anti-VEGF efficacy to ensure optimal treatment for each individual.

Clinical Characteristics of Visual Dysfunction in Carbon Monoxide Poisoning Patients.

Purpose The aim of the present study was to analyze the clinical characteristics of visual dysfunction in patients with carbon monoxide (CO) poisoning. Methods A total of 436 patients with CO poisoning were enrolled in our hospital from October 2012 to December 2018, including 193 patients with moderate poisoning (MP group), 165 with severe poisoning (SP group), and 78 with delayed encephalopathy (DE group). The clinical characteristics of visual dysfunction in patients with CO poisoning were analyzed through the collection of medical history, regular physical examination, brain magnetic resonance imaging (MRI), ophthalmological examination, the National Eye Institute Visual Function Questionnaire (NEI-VFQ), and its influencing factors. Results Some patients in the three groups had visual dysfunction. The main ocular symptoms were local pain, eye movement disorder, and visual field defect. The key pathological factors were keratopathy, retinal nerve cell damage, optic nerve damage, retinal vascular disease, macular disease, and occipital visual center damage. The clinical symptoms of visual dysfunction after CO poisoning lasted for a long time (>12 months) and were not completely consistent with the positive results of the ophthalmological examination. A few sequelae of ophthalmology were still left after the help of medicine. Conclusion The incidence of visual dysfunction in patients with CO poisoning was high, the clinical symptoms were rich and diverse, the duration of disease was long, and the prognosis was poor. Thus, the relevant ophthalmological examination and intervention treatment should be perfected as soon as possible.

Cooperation between the department of ophthalmology at the University of Düsseldorf (Germany) and the Fundación Visión in Asunción (Paraguay) as an example of the German hospital partnerships programm

HintergrundSeit 2014 besteht auf der Basis eines Memorandum of Understanding eine Partnerschaft zwischen der Universitätsaugenklinik Düsseldorf (UAK Düsseldorf) und der Fundación Visión (FV) in Asunción, die eine führende Rolle in der augenärztlichen Behandlung sowie der Prävention von Erblindung in Paraguay einnimmt. Seit 2016 existiert ein Programm zur Förderung internationaler Klinikpartnerschaften der Bundesregierung.Material und MethodenDie Klinikpartnerschaft Düsseldorf–Asunción wird nach schriftlichem Antrag im Jahr 2016 durch das Ministerium für wirtschaftliche Zusammenarbeit gefördert. Im Rahmen der Projektlaufzeit sollen mithilfe mehrerer Aktivitäten in einem definierten Zeitplan moderne, minimal-invasive Hornhauttransplantationstechniken, die eine schnellere postoperative Rehabilitation und weniger Nachsorge erfordern, in Paraguay etabliert werden. Zusätzlich sollen erste Prävalenzdaten von Augenerkrankungen erhoben und die Basis für moderne Hornhautbanktechniken geschaffen werden.ErgebnisseZunächst erfolgte die Ausbildung eines paraguayischen Operateurs in der Durchführung von DMEK-Transplantationen in Deutschland. Zeitgleich wurden die instrumentellen Voraussetzungen für die Etablierung der DMEK-Technik in der FV geschaffen. Im September 2018 wurden unter Supervision eines erfahrenen OP-Teams aus Düsseldorf die ersten lamellären Hornhauttransplantationen durch das Team der FV erfolgreich in Paraguay durchgeführt. In der Folge wurden in Asunción auch die Verwendung einer Spenderhornhaut für je ein Transplantat für eine hintere und eine vordere lamelläre Keratoplastik (DMEK und DALK) umgesetzt. Im November 2019 erfolgte eine epidemiologische Datenerhebung zu Augenerkrankungen im Rahmen einer Feldkampagne der Fundación in einer ländlichen Region Paraguays. In deren Zug erlernte der datenerhebende Mitarbeiter der Universitätsaugenklinik Düsseldorf die Technik der manuellen Kleinschnittkataraktchirurgie. Im März 2019 wurde ein Mitarbeiter der FV in Düsseldorf in den Techniken der Hornhautgewebekultur und der Herstellung von Amnionmembrantransplantaten in der Lions-Hornhautbank NRW geschult.SchlussfolgerungMithilfe einer geförderten Klinikpartnerschaft können moderne minimal-invasive Hornhauttransplantationstechnik erfolgreich in die Augenklinik eines Schwellenlandes transferiert und im Gegenzug chirurgische Fertigkeiten für in Ausbildung befindliche Operateure aus Deutschland vermittelt werden. Damit stellt eine effiziente Klinikpartnerschaft die Grundlage für einen wechselseitigen Austausch dar und ist keine reine Einbahnstraße.

Liposomal dexamethasone–moxifloxacin nanoparticle combinations with collagen/gelatin/alginate hydrogel for corneal infection treatment and wound healing

Infectious keratitis is still one of the major causes of visual impairment and blindness, often affecting developing countries. Eye-drop therapy to reduce disease progression is the first line of treatment for infectious keratitis. The current limitations in controlling ophthalmic infections include rapid precorneal drug loss and the inability to provide long-term extraocular drug delivery. The aim of the present study was to develop a novel ophthalmic formulation to treat corneal infection. The formulation was prepared by constructing moxifloxacin (MFX) and dexamethasone (DEX)-loaded nanostructured lipid carriers (Lipo-MFX/DEX) mixed with a collagen/gelatin/alginate (CGA) biodegradable material (CGA-Lipo-MFX/DEX) for prolonged ocular application. The characteristics of the prepared Lipo-MFX/DEX nanoparticles were as follows: average size, 132.1 ± 73.58 nm; zeta potential, −6.27 ± 4.95 mV; entrapment efficiency, 91.5 ± 3.5%; drug content, 18.1 ± 1.7%. Our results indicated that CGA-Lipo-MFX/DEX could release an effective working concentration in 60 min and sustain the drug release for at least 12 h. CGA-Lipo-MFX/DEX did not produce significant toxicities, but it increased cell numbers when co-cultured with ocular epithelial cells. An animal study also confirmed that CGA-Lipo-MFX/DEX could inhibit pathogen microorganism growth and improve corneal wound healing. Our results suggest that CGA-Lipo-MFX/DEX could be a useful anti-inflammatory formulation for ophthalmological disease treatment.

Ophthalmological features and treatments in five cases of Waardenburg syndrome.

The present study aimed to investigate the ocular characteristics and treatment of Waardenburg syndrome (WS). A total of five patients with Waardenburg syndrome from our hospital, aged between 1 and 8 years, were included in the present study. The clinical data of these patients were analyzed, and the ocular manifestations and treatments were described. The general manifestations included hearing loss (1/5), broad high nasal root (2/5) and hypoplasia of alae nasi (2/5). Ophthalmological evaluations revealed ptosis (1/5), strabismus 1 (1/5), synophrys (2/5), telecanthus (5/5), iris hypopigmentation (5/5), high intraocular pressure (1/5) and choroidal hypopigmentation (1/5). For patients with characteristic external eye abnormalities, including ptosis, ocular plastic surgery was performed. For patients with only symptoms of iris heterochromia, no special treatment was required. The findings from the present study suggest that patients with WS may have several characteristic ocular manifestations. Abnormalities in the eyelid can be corrected by ocular plastic surgery, which is beneficial to children's physical and mental development.

Sequential restoration of external limiting membrane and ellipsoid zone after intravitreal anti-VEGF therapy in diabetic macular oedema.

To study the mechanism of restoration of retinal photoreceptor ellipsoid zone (EZ), after intravitreal bevacizumab (IVB) therapy, in diabetic macular oedema (DMO). Forty-four consecutive patients aged 40-65 years having type 2 diabetes mellitus (DM) with DMO were prospectively recruited for IVB therapy. It comprised of three doses (1.25 mg in 0.05 ml) of IVB at monthly intervals. Patients with other ocular and systemic diseases affecting retinal vessels and earlier ophthalmological interventions were excluded. Visual acuity (logMAR VA) was recorded. Spectral domain optical coherence tomography (SD-OCT) was performed pre and post intervention. Central sub-foveal thickness (CST) and grades of disorganization of retinal inner layers (DRIL), external limiting membrane (ELM) and EZ were assessed. Data were statistically analysed on SPSS software. Clinical trials registry: CTRI/2019/03/018135. Mean logMAR VA decreased after IVB therapy from 1.78 ± 0.07 pre-intervention to 0.42 ± 0.05 post intervention (p < 0.001). Similarly, CST reduced from 354.23 ± 15.0 µm pre-intervention to 233.18 ± 7.88 µm post intervention (p < 0.001). Among qualitative variables, DRIL decreased from 93.2% pre-intervention to 13.6% post intervention. Likewise, global ELM disruption reduced from 81.8 to 9.1% and global EZ disruption reduced from 79.5 to 11.4%. ELM restoration preceded EZ restoration. Anti-VEGF therapy restores the barrier effect of ELM. It causes ELM to restore first followed by EZ restoration in DMO.

Standard precaution measurements during ophthalmology practice in the pandemic stage of COVID-19.

To take specific precautions and keep a safe practice during providing ophthalmology health services without compromising the patient's safety as well as the team workers and the community in the pandemic stage of corona virus disease 2019 (COVID-19). Applying patient circulation scheme implemented in our ophthalmology centers with the guidance of ministry of health infection control guidelines started from the moment that we receive a call or WhatsApp message or Facebook inquiry from patients until 21d after patients first visit if any. Four directions were taken. First, community awareness of the disease and the ophthalmology related advices in how eye can transfers the infection and how to protect our eyes not to be infected through videos interviews of our consultants and distribution in social media like Instagram, Facebook, WhatsApp pages radio and TV interviews as well as leaflet health awareness for distribution for public. Second, scheduling of patients' appointments to prevent overcrowdings and cross infection. Third, protective measurements tools in the center to detect and prevent any exposure of the patients to patients and to protect medical staff, COVID-19 scoring system was set up to identify patients with fever, respiratory symptoms, acute conjunctivitis or recent travel to outbreak areas and to encourage these individuals to postpone their appointments for at least 21d. Proper use of personal protective equipment was implemented. Stopping all the elective surgeries keeping only the emergency types advised by fourth: how to deal with our patients if they need an urgent ophthalmological intervention and how to deal with suspected cases of corona if any cases detected. Our measures helped our colleagues to try to keep providing ophthalmology health services without increasing the incidence of infection for COVID-19 until this pandemic is over. In our practice, ophthalmologists should work with new aura of social media to facilitate the non-direct communication with the patients through maximizing the use of communication technology to keep contact with their patients and deal safely with COVID-19 cases.

Ophthalmological care of SARS-CoV-2 positive patients in intensive care units

Eine frühe augenärztliche Mitbetreuung von intensivpflichtigen Patienten mit SARS-CoV-2 (Severe-Acute-Respiratory-Syndrom-Corona-Virus-2) Infektion ist sehr aufwendig, aber sinnvoll, um ophthalmologische Krankheitsbilder, wie z. B. den Lagophthalmus, zu verhindern. Die ophthalmologische Behandlung unterscheidet sich dabei nicht bei SARS-CoV-2-positiven und anderen intensivpflichtigen Patienten. Aufgrund der geringen Fallzahl unserer Beobachtungsstudie lassen sich bis dato keine spezifischen ophthalmologischen Krankheitsbilder in Zusammenhang mit der SARS-CoV-2-Infektion ablesen. Nennenswert ist jedoch das gehäufte Auftreten von Hyposphagmata bei intensivpflichtigen SARS-CoV-2-Patienten. Unklar bleiben weiterhin der Zusammenhang von okulären Symptomen bei SARS-CoV-2-Infektionen sowie das Auftreten in verschiedenen Krankheitsstadien. Daher sind weitere Studien für repräsentative Aussagen notwendig.

Adherence to ophthalmology referral, treatment and follow-up after diabetic retinopathy screening in the primary care setting

IntroductionTelemedicine-based diabetic retinopathy screening (DRS) in primary care settings has increased the screening rates of patients with diabetes. However, blindness from vision-threatening diabetic retinopathy (VTDR) is a persistent problem. This...

Структура оперативных вмешательств в офтальмологической практике Центра амбулаторной хирургии КГБУЗ «КДЦ «Вивея»

Структура оперативных вмешательств в офтальмологической практике Центра амбулаторной хирургии КГБУЗ «КДЦ «Вивея»

Stem Cell Ophthalmology Treatment Study (SCOTS): Bone Marrow-Derived Stem Cells in the Treatment of Age-Related Macular Degeneration.

Background: Dry age-related macular degeneration (AMD) is one of the leading causes of vision loss in older patients. The macula accumulates drusen with loss of retinal pigment epithelial cells and photoreceptors. Abnormal subretinal neovascularization is absent. There is no effective drug therapy for dry AMD and a large proportion of patients progress to legal blindness from macular atrophy. The Stem Cell Ophthalmology Treatment Study (SCOTS) was conducted to assess the effect of bone marrow-derived stem cells (BMSCs) on dry AMD and other retinal and optic nerve diseases. Methods: Thirty-two eyes were treated with BMSC per the protocols in SCOTS. Provision of BMSCs in Arm 1 was via retrobulbar (RB), sub-tenons (ST) and intravenous (IV); Arm 2 via intravitreal, RB, ST and IV; Arm 3 via subretinal and IV. Patient age averaged 78 years old and ranged from 69 to 90. Visual acuity preoperatively ranged from counting fingers to 20/50-2 with an average preoperative LogMAR of 1.125. Results: Following treatment, 20 of 32 (63%) of eyes experienced improvement in visual acuity averaging 27.6% on LogMAR and ranging from 2.5% to 44.6%. The mean improvement in LogMAR was 0.963 with a standard deviation (SD) of 0.42. The visual acuity remained stable in 34% of treated eyes. One eye continued to worsen as a consequence of disease progression. The results showed high statistical significance with p ≤ 0.001. The procedures were conducted safely, and no complications were observed. Conclusions: Treatment of dry AMD with BMSC using the protocols developed in the SCOTS clinical trial has shown statistically significant clinical benefit improving visual acuity and potentially delaying visual loss in the disease.

Peters anomaly: A 5-year experience.

Peters anomaly is a rare, congenital eye malformation characterized by an opaque cornea and blurred vision. Central corneal opacification can lead to delayed progression of visual development caused by defects in Descemet membrane and the posterior stroma. These children require several anesthetics for multiple eye examinations under anesthesia and corneal transplantation. We sought to review the anesthetic management of patients with Peters anomaly for ophthalmologic procedures at Westchester Medical Center, a major referral center for Peters anomaly. A retrospective chart review was completed which included pediatric patients who underwent ophthalmologic procedures related to Peters anomaly from 2013-2018. The charts of 35 patients with Peters anomaly were reviewed: 14 patients with Peters anomaly Type I, 10 patients with Peters anomaly Type II, and 11 patients with Peters plus syndrome. Thirty patients required three procedures on average, two examinations under anesthesia pre- and post-transplant, and anesthesia for the corneal transplant itself. The youngest patient encountered for examination under anesthesia was 39-week postconceptual age. Anesthetic time for examination under anesthesia averaged 31minutes using a laryngeal mask airway while corneal transplant averaged 104minutes utilizing endotracheal intubation. Postanesthesia care unit stay averaged 51minutes following examination under anesthesia and 65minutes after corneal transplant. All examinations under anesthesia were successfully completed without adverse events with the use of a laryngeal mask airway. This case series includes two patients with Goldenhar syndrome and Al-Gazali syndrome accompanying Peters anomaly. Although limited by its retrospective nature, this case series describes the cardiac and systemic implications of patients undergoing anesthesia with Peters anomaly. Our experience indicates that general anesthesia and airway manipulation are tolerated with minor postoperative concerns in these infants. Pediatric patients with Peters anomaly require multiple anesthetics for repeated ophthalmologic interventions. The laryngeal mask airway can be routinely utilized in infants less than 3months of age for an eye examination under anesthesia with no airway complications noted.Perioperative providers should be aware of the multisystemic implications in patients with Peters plus syndrome.