International Ophthalmology

Khatami, Kiana; Estedlal, AliReza; Vali, Mohebat; Kamalipour, AliReza; Mahmoudinezhad, Golnoush; Nejabat, Mahmood; Nowroozzadeh, Mohammad Hossein; Vardanjani, Hossein Molavi

2023 International Ophthalmology

doi: 10.1007/s10792-023-02872-2

PurposeThe purpose of this study was to investigate the prevalence of cataracts, refractive disorders, age-related macular disease (AMD), and glaucoma, as well as their trends from 1990 to 2019 in Iran, in comparison with high-middle socio-demographic index (HMSDI) countries and the world, using the Global Burden of Disease (GBD) 2019 study.MethodsThe GBD study provided data on the prevalence of blindness and visual impairment (VI), as well as four of their causes including cataracts, refractive disorders, age-related macular disease (AMD), and glaucoma. Using Joinpoint analysis, the annual percent change (APC) was calculated to assess the trend of change in prevalence in each category of diseases from 1990 to 2019, stratified by sex and age, for Iran, HMSDI countries, and the world.ResultsIn 2019, refractive errors and cataracts were the most common causes of blindness and VI for both genders in Iran, HMSDI countries and the world. Iran had a higher age-standardized prevalence in all four categories of ophthalmologic disorders compared to HMSDI countries and the world for both genders in 2019. Additionally, the age-specific prevalence of all four disorders in 2019 was higher in Iran compared to HMSDI countries.However, in terms of trends of prevalence from 1990 to 2019, the rate of reduction for the four ophthalmologic disorders in Iran was higher than in HMSDI and the world for both males and females. Furthermore, Iran had a greater percentage of reduction in prevalence for all age groups in all four disorders compared to HMSDI countries.ConclusionThe prevalence of cataracts, refractive errors, AMD, and glaucoma in Iran was higher compared to HMSDI countries in 2019 for both sexes and all age groups, but the trends of prevalence for all four disorders from 1990 to 2019 in Iran had a higher slope of reduction compared to HMSDI countries for all ages and sexes.

Eldanasoury, Alaa; Bains, Harkaran; Pieger, Stefan

2023 International Ophthalmology

doi: 10.1007/s10792-023-02861-5pmid: 37665494

PurposeTo use spectral-domain optical coherence tomography (SD-OCT) data to develop a new implantable collamer lens (ICL) sizing formula and compare vault outcomes with the Online Calculation and Ordering System™ (OCOS) and the NK2 formula.MethodsConsecutive eyes (n = 237) were evaluated that had undergone ICL/toric ICL implantation. Actual ICL vaults were measured, and a what-if analysis was performed to predict vault values with the NK2 formula using SD-OCT data. To develop a new formula (EPB), multiple regression analysis was performed with different parameters than the NK2 formula. Predicted vaults with NK2 and EPB formulas were compared to the actual vaults.ResultsParameters that were correlated with optimal ICL size were white-to-white, anterior chamber width, lens rise and desired refractive correction. The mean postoperative vault was 489 ± 258 μm. At last visit, 94.5% of eyes were within the manufacturer’s acceptable vault range. Predicted vaults in the acceptable range were 74 and 87% with the NK2 and EPB formulas, respectively. Six percent had a predicted vault less than 100 μm with the EPB formula compared to 1% for actual outcomes. The NK2 formula resulted in a shift toward higher predicted vaults while the EPB formula was similar to the actual postoperative vaults but with slightly more cases with extremely low and high vaults.ConclusionSD-OCT data with OCOS result in good postoperative vaults. Further refinement is required to the NK2 for use with SD-OCT data. Although the EPB formula provides acceptable predicted vaults, further refinement with a larger sample size is needed.

Ruiz-Moreno, José María; Adán, Alfredo; Lafuente, María; Asencio Durán, Mónica; Arias Barquet, Luís; García Layana, Alfredo; Araiz Iribarren, Javier

2023 International Ophthalmology

doi: 10.1007/s10792-023-02864-2pmid: 37697082

ObjectiveTo assess the effectiveness and safety of the intravitreal fluocinolone-acetonide implant (FAc-i) in patients with chronic diabetic macular edema who did not sufficiently respond to other available therapies.MethodsThis was a multicenter, prospective, non-randomized, and phase-IV observational study conducted on patients with recurrent-DME who were insufficient responders to currently available therapies (REACT-Study). The primary end-point was the mean change in best-corrected-visual-acuity from baseline to month-24 values.ResultsThirty-one eyes from 31 patients were included in the study. Mean age was 68.0 ± 7.7 years, and 10 (32.3%) were women. Study patients had received 5.3 ± 7.3 previous DME treatments before starting the study. In the overall study sample, BCVA improved from 56.1 ± 12.3 letters at baseline to 62.4 ± 17.0 letters at month-24 (p = 0.0510). The eyes with a baseline BCVA < 70 ETDRS letters had a significant improvement in BCVA from 53.2 ± 10.2 letters at baseline to 61.5 ± 17.9 letters at month-24 (p = 0.0165). In the overall study population, central-subfoveal-thickness (CST) was significantly reduced from 474.0 ± 135.1 µm at baseline to 333.4 ± 135.6 at month-24 (p < 0.0001). Similarly, macular-volume (MV) was significantly reduced from 10.7 ± 2.7 mm3 at baseline to 9.6 ± 2.9 mm3 (p = 0.0027) at month-24. Among the 31 study eyes, 19 (61.3%) required an additional treatment for DME. Throughout the study, 9 (29.0%) eyes required ocular hypotensive medication for controlling their intraocular-pressure and 5 (16.1%) eyes underwent cataract surgery.ConclusionsIn DME eyes who did not sufficiently respond to previous therapies, the FAc-i was associated with an improvement in visual and anatomic outcomes. There were no unexpected adverse-events.Trial registration numberEudraCT identifier: 2016-001680-37.

Gu, Zhensheng; Cao, Guofan; Wu, Chunbo; Huang, Yuanshen; Xu, Banglian; Zhuang, Songlin; Li, Baicheng

2023 International Ophthalmology

doi: 10.1007/s10792-023-02878-w

PurposeThis study was conducted to compare the ocular surface temperature in keratoconus eyes with that in normal eyes.MethodsA total of 27 participants were enrolled, with 10 and 17 participants in the keratoconus and control groups, respectively. Participants in the control group underwent an ophthalmic slit lamp examination and ocular thermography, while an additional corneal tomography was performed for those in the keratoconus group.ResultsFor patients with keratoconus, the mean upper eyelid temperature (UET) was 32.36 ± 1.02 °C, inner canthus temperature (ICT) was 34.25 ± 0.83 °C, outer canthus temperature (OCT) was 33.62 ± 0.96 °C, initial central corneal temperature (initial CCT) was 33.04 ± 1.03 °C, sixth-second CCT (6 s-CCT) was 32.67 ± 1.19 °C, and the mean change in CCT measured within 6 s (change in CCT within 6 s) was 0.36 ± 0.26 °C. For controls, the values for UET, ICT, OCT, initial CCT, 6 s-CCT, and change in CCT within 6 s were 32.35 ± 1.13 °C, 34.14 ± 0.91 °C, 33.51 ± 1.02 °C, 33.22 ± 1.01 °C, 32.99 ± 1.01 °C, and 0.22 ± 0.17 °C, respectively. Except for the change in CCT within 6 s (p = 0.022), no significant differences were observed in UET (p = 0.973), ICT (p = 0.659), OCT (p = 0.697), initial CCT (p = 0.556) or 6 s-CCT (p = 0.310) between the two groups.ConclusionThe keratoconus eyes showed faster changes in CCT and evaporation of tear film after opening the eyes. Therefore, the keratoconus eyes had a higher incidence of dry eye conditions.

Wu, Xian; Liu, Xiaomin; Li, Dongfang; Wang, Xiaoyun; Huang, Yusen

2023 International Ophthalmology

doi: 10.1007/s10792-023-02862-4pmid: 37715824

PurposeTo assess the visual quality after implantation of a rotationally asymmetric multifocal intraocular lens (IOL) using a new method according to the angle kappa.SettingQingdao Eye Hospital, Qingdao, China.DesignProspective case series.MethodsPatients with the implantation of SBL-3 IOLs for age-related cataract from September to December 2019 had the distance-horizontal zone of the IOL placed at the center of the optic axis using the Callisto Eye System. Postoperative visual acuities and defocus curves were recorded. Modulation transfer function cutoff frequency, Strehl ratio, and objective scatter index were measured using the Optical Quality Analysis System. The decentration and tilt of IOLs were analyzed by iTrace aberrometry and anterior segment optical coherence tomography. A questionnaire of patient satisfaction was also collected.ResultsThirty patients (60 eyes) were involved, with a balanced sex ratio. Their average age was 56.04 ± 10.83 years. The average angle kappa distance was 0.23 ± 0.121 mm. At 3 months after surgery, the mean uncorrected and corrected distance visual acuities were 0.01 ± 0.07 logMAR and 0.01 ± 0.06 logMAR. The uncorrected intermediate and near visual acuities were 0.09 ± 0.11 logMAR and 0.09 ± 0.11 logMAR. The mean horizontal and vertical tilts of IOLs were 0.67 ± 0.52 degrees and 0.47 ± 0.32 degrees. The mean decentration of IOLs was 0.17 ± 0.08 mm. Most patients were satisfied with their distance, intermediate, and near vision. There was mild glare in 58.3% of the eyes.ConclusionsLocating the center of the optic axis in the distance-horizontal zone during the implantation of SBL-3 IOLs could provide satisfactory visual acuity and quality.

Sun, Xiao; Li, Qingmin; Xu, Guijun

2023 International Ophthalmology

doi: 10.1007/s10792-023-02869-xpmid: 37688652

PurposeThe current study aimed to reveal a novel immune-related signature to evaluate immune infiltration status and the survival outcome for patients with uveal melanoma (UM).MethodsBased on 80 UM samples from the Cancer Genome Atlas, the transcriptome gene expression and clinical characteristics were analyzed to identify immune-related genes that contributed most to prognosis based on LASSO Cox regression. By combining the gene expression level with the corresponding regression coefficient, a risk score was calculated and all patients were divided into high- and low-risk groups. Survival, tumor-infiltrating immune cell abundance, dysregulated signaling pathways, immunophenoscore and tumor mutation burden were compared between two groups. Validation of the risk signature was performed in GSE22138 and GSE44295 cohort. For evaluating the immunotherapy efficacy, 348 advanced urothelial cancer patients treated with immune checkpoint inhibitor (ICI) were used for external validation.ResultsNine immune-related prognostic genes were identified under the LASSO Cox regression in the TCGA cohort; they are ACKR2, AREG, CCL5, CLEC11A, IGKV1-33, IL36B, NROB1, TRAV8-4 and TRBV28. Better prognosis, elevated immune cell infiltration, decreased immune-suppressive cell infiltration, immune response-related pathways and higher immunophenoscore were found in low-risk patients, with better ICI treatment response rate.ConclusionThe identified immune risk signature was demonstrated to be associated with the favorable immune infiltration, prognosis and immunotherapeutic efficacy, which may provide clues for survival evaluation and immune treatment.

Jevnikar, Kristina; Počkar, Saša; Umek, Lan; Rothova, Aniki; Valentincic, Natasa Vidovic

2023 International Ophthalmology

doi: 10.1007/s10792-023-02860-6pmid: 37697081

PurposeTo evaluate the long-term visual outcomes of patients with uveitis undergoing cataract surgery and to identify possible factors influencing the visual prognosis and the development of postoperative complications.MethodsRetrospective study of all patients with uveitis who underwent cataract surgery between January 2015 and February 2020 in our tertiary referral center.ResultsA total of 78 eyes from 78 patients were included in the study. The best-corrected visual acuity (BCVA) improved in 86% of patients, and a BCVA of 0.5 or better was achieved in 57 (73%) patients. A significant correlation was shown between the preoperative and postoperative BCVA (Spearman r = 0.521, p < 0.01). Final BCVA differed between diverse anatomical uveitis entities (p = 0.047), and anterior uveitis demonstrated the best outcomes. Chronic uveitis resulted in a worse final BCVA than acute recurrent uveitis (p = 0.001). The presence of CME any time before the surgery and intermediate uveitis were associated with worse visual prognosis, while systemic therapy for uveitis before surgery and iris manipulation during surgery were not related to visual outcomes. Postoperative development of cystoid macular edema (CME) was closely associated with preexisting CME (p < 0.001) and intermediate uveitis (p = 0.01).ConclusionsVisual results of cataract surgery in patients with uveitis were beneficial, but limited visual outcomes were more frequently observed in patients with chronic uveitis and intermediate uveitis with a history of CME. In consequence, prevention, or adequate treatment of CME, especially in patients with intermediate uveitis, might result in better visual results of their cataract surgery.

Moll-Udina, Aina; Hernanz, Inés; Sainz-de-la-Maza, Maite; Pelegrín, Laura; Coelho-Borges, Ana Isabel; Pazos, Marta; Adán, Alfredo; Llorenç, Victor

2023 International Ophthalmology

doi: 10.1007/s10792-023-02828-6pmid: 37698661

PurposeThis study assessed the effectiveness of the 0.19-mg fluocinolone acetonide (FAc) implant by multimodal measurements in patients with non-infectious uveitis (NIU) in a real-world setting in Spain.MethodsA prospective study of patients who had NIU including uveitic macular oedema (UME) with ≥ 12 months follow-up was done. Exclusion criteria include infectious uveitis and uncontrolled glaucoma or ocular hypertension requiring more than 2 medications. Effectiveness was assessed using a multicomponent outcome measure that included nine outcomes. Effectiveness was defined as all components being met at every timepoint. Secondary outcome measures were onset or progression of glaucoma and investigator-reported adverse events.ResultsTwenty-six eyes from 22 patients were included, with 96.2% having an indication including UME. During the 12-month study, the FAc implant was effective in 15 (57.7%) eyes, reaching effectiveness as soon as 2 weeks post-implantation. Mean best-corrected visual acuity and mean central macular thickness (CMT) were significantly improved vs. baseline at all timepoints (all comparisons p < 0.01). During the 12-month study, inflammation markers (anterior chamber cells and vitreous haze) had also significantly declined. Factors predicting effectiveness at month 12 were systemic corticosteroid dose pre-FAc, higher immunomodulatory therapy (IMT) load at baseline and thicker retinal nerve fibre layer (RNFL) at baseline (all p < 0.05). Factors predicting failure were male gender, thinner RNFL at baseline and treatment ineffectiveness at 1 month (all p < 0.05). In parallel, corticosteroid and IMT use also declined significantly. No significant increase in IOP was detected.ConclusionThe FAc implant is safe and effective at treating NIU over 12 months in a real-world setting in Spain.

Prinz, Julia; Hartmann, Kathi; Migliorini, Filippo; Hamesch, Karim; Walter, Peter; Fuest, Matthias; Kuerten, David

2023 International Ophthalmology

doi: 10.1007/s10792-023-02873-1pmid: 37721702

PurposeTo report on the use of allogenous fascia lata (FL) grafts in patients with lower eyelid retraction (LER).MethodsIn this retrospective study, a consecutive series of 27 patients (39 eyes) with LER who underwent lower eyelid elevation with FL was included. Examinations including measurement of the palpebral fissure vertical height (PFVH), the inferior scleral show distance, the margin reflex distance 2 (MRD 2), and the evaluation of conjunctival hyperemia were conducted at baseline and after a mean postoperative time of 25.9 ± 25.5 (5.0–81.0, median 13.0, last follow-up) months in all patients.ResultsAt the last follow-up, a significant reduction of the PFVH (11.3 ± 1.7 versus 12.8 ± 2.1 at baseline, p < 0.001), the inferior scleral show distance (0.7 ± 1.0 mm versus 2.1 ± 1.1 at baseline, p < 0.001), and the MRD 2 (6.4 ± 0.9 versus 7.8 ± 1.3 at baseline, p < 0.001) occurred. The conjunctival hyperemia grading score (McMonnies) was significantly reduced (1.8 ± 0.7) at the last follow-up compared to baseline (2.6 ± 0.6, p < 0.001). No case of ectropion or entropion was observed at the last follow-up visit.ConclusionIn this case series, lower eyelid elevation with FL grafts as a spacer led to a significant reduction of the PFVH, MRD 2, inferior scleral show distance, and conjunctival hyperemia. No severe surgery-related complications occurred.

Mahmoud, Mohamed Salah El-Din; Omar, Ismail Ahmed Nagib; AttaAllah, Heba Radi

2023 International Ophthalmology

doi: 10.1007/s10792-023-02877-xpmid: 37721703

PurposeTo evaluate corneal endothelial cell changes following uncomplicated phacoemulsification in diabetic patients with PEX, compared with diabetic patients and non-diabetic patients with PEX.MethodsThis prospective, comparative, non-randomized cohort study included 61 eyes of 61 patients who were diagnosed as having senile cataract. Patients were divided into three groups: Group (1) included 19 eyes of patients with DM and PEX, group (2) included 22 eyes of diabetic patients, and group (3) included 20 eyes of patients with PEX. All included patients had uncomplicated phacoemulsification with IOL implantation. Patients were examined by non-contact specular microscopy (NIDEK, CEM-530, Japan), preoperatively and postoperatively at regular follow-up periods (one, three, and six months postoperatively) with analysis of the endothelial cell density, percentage of hexagonal cells, CV, and CCT.ResultsBy the end of follow-up period, there was a statistically significant reduction in ECD and HEX with a significant increase in CV and CCT in group one (DM-PEX). In group two (DM), a statistically significant decrease in ECD and HEX with a significant increase in CCT was reported, while in group three (PEX), the only significant difference was found in the form of ECD reduction.ConclusionPatients with DM and PEX had significant changes regarding ECD, CV, HEX, and CCT which were more pronounced than in patients with DM only or PEX only. More attention should be paid while operating on diabetic patients with PEX to save corneal endothelium and decrease postoperative complications.Study registration numberThe study was retrospectively registered (16 July 2021) on ClinicalTrials.gov (NCT04965168).

Ayaz, Yusuf; Erkan Pota, Çisil; Başol, İbrahim; Doğan, Mehmet Erkan; Türkoğlu Şen, Elif Betül; Ünal, Mustafa

2023 International Ophthalmology

doi: 10.1007/s10792-023-02838-4pmid: 37707746

PurposeWe aim to contribute to the literature in terms of treatment safety with our real world data by examining the anterior segment complications and follow-up results of patients who underwent dexamethasone implants in our clinic.MethodsThe records of patients treated with at least one intravitreal dexamethasone implant for various retinal diseases: diabetic macular edema (265 eyes), central retinal vein occlusion (45 eyes), retinal vein branch occlusion (91 eyes), postoperative cystoid macular edema (18 eyes), non-infectious uveitis (37 eyes) and other (14 eyes) between July 2013 and April 2020 were reviewed.ResultsAfter 925 injections were applied to 470 eyes of a total of 383 patients, the eyes were controlled during a mean follow-up of 24 months. No complications were detected in 328 eyes. Intraocular pressure (IOP) above 25 mmHg was detected in 97 eyes (20.6%) that had no previous history of ocular hypertension. Of these 97 eyes, 71 (73.1%) eyes with increased IOP were treated with topical monotherapy, 26 (26.8%) eyes were treated with topical combined therapy and 1 (1.03%) patient had glaucoma surgery. Cataracts requiring surgical intervention developed in 55 (%21.73) of 253 phakic eyes. Three patients have anterior chamber dislocation of dexamethasone, 1 patient was hospitalized with sterile endophthalmitis on the 7th day after the injection, and pars plana vitrectomy was performed.ConclusionThis study is the first long-term follow-up study in our country evaluating the safety of dexamethasone implant injections in various retinal diseases and presenting the first real world data. Cataract progression and increased IOP were found to be the most common side effects. We observed that the patient’s diagnosis did not cause a statistically significant change in the observation of side effects. As a result of our findings, close follow-up of IOP after the injection of dexamethasone implants would be appropriate.

Schoelles, Kristina Joana; Kemper, Katharina; Martin, Gottfried; Boehringer, Daniel; Brinks, Katarzyna; Mittelviefhaus, Hans; Reinhard, Thomas; Auw-Haedrich, Claudia

2023 International Ophthalmology

doi: 10.1007/s10792-023-02855-3pmid: 37684398

PurposeHypoxia-inducible factors (HIFs) are considered to play a significant role in the pathogenesis of pterygium. The aim of this study was to investigate the relative expression or immunoreactivity of HIF1α and HIF2α in the epithelium of primary pterygium, recurrences and healthy conjunctiva.MethodsImmunohistochemical staining was performed with antibodies against HIF1α and HIF2α, respectively, on 55/84 primary pterygium specimens, 6/28 recurrences and 20/20 control tissues (healthy conjunctiva).ResultsImmunohistochemical staining revealed lower epithelial immunoreactivity of HIF1α and HIF2α in both primary pterygium (11% and 38%) and recurrences (18% and 21%) when compared to healthy conjunctival tissue (46% and 66%). Differences between immunoreactivity of HIF1α and of HIF2α in primary pterygium and controls were each highly significant (p < .001). Within the group of primary pterygium, epithelial immunoreactivity of HIF2α (38%) was significantly higher than that of HIF1α (11%). In recurrent pterygium and healthy conjunctiva, immunoreactivity levels of HIF2α were higher than those of HIF1α as well; however, differences between both isoforms were not significant.ConclusionOur study shows evidence that the higher expressed epithelial HIF2α, rather than HIF1α, and the balance between both HIF isoforms might be relevant factors associated with pathogenesis of primary pterygium. Modulation of HIF2α levels and activity may thus offer a new therapeutic approach to the treatment of advancing pterygium where the initial stage with its HIF1-peak has already passed.

Zhou, Yu-Fan; Liu, Heng-Wei; Yang, Xu; Li, Chen-Xiang; Chen, Jian-Su; Chen, Zhong-Ping

2023 International Ophthalmology

doi: 10.1007/s10792-023-02859-zpmid: 37688651

PurposeThis study investigated the protective effect of probucol on Müller cells exposed to high glucose conditions and examined potential mechanisms of action.MethodsPrimary human retinal Müller cells were incubated with high glucose (HG, 35 mM) in the present or absence of different concentrations of probucol for 24 h. Cell viability was determined using the CCK-8 method. Mitochondrial membrane potential (MMP) was measured using JC-1 staining and cell cycle by flow cytometry. The expression of nuclear factor E2-related factor 2 (Nrf2), glutamate–cysteine ligase catalytic subunit, and p62 was quantified using quantitative polymerase chain reaction and western blot.ResultsWe found that HG inhibited cell proliferation, arrested cell cycle, and increased MMP in human Müller cells. Probucol activated the Nrf2/p62 pathway and upregulated the anti-apoptotic protein, Bcl2, and attenuated HG-mediated damage in Müller cells.ConclusionsOur results suggest that probucol may protect Müller cells from HG-induced damage through enhancing the Nrf2/p62 signaling pathway.

Wang, Hongmei; Jiang, Xiaodan; Zhang, Pei; Li, Yingyu; Wang, Yiren; Li, Xuemin

2023 International Ophthalmology

doi: 10.1007/s10792-023-02854-4pmid: 37668849

PurposeIn this study, we determined the positive rates of allergen-specific immunoglobulin E (IgE) in the tear fluid of Chinese patients with common allergic conjunctivitis (AC) in autumn and winter, compared systemic and ocular allergen tests, and explored the correlation between the numbers and categories of allergens and clinical AC features.MethodsThis cross-sectional study recruited 44 patients with AC (86 eyes). Specific IgEs for allergens common in China (house dust mite, cat/dog dander, mugwort/ragweed pollen, cottonwood/willow/elm pollen, milk, egg whites, soybeans) were measured in collected tears using kits for allergen-specific IgE antibodies. AC signs and symptoms were graded according to severity.ResultsSpecific IgE in tears was positive in 87.2% of eyes. House dust mite was the most common allergen (86.0%), followed by cat (24.4%) and dog (7.0%) dander; tree and grass pollen accounted for only 4.7% and 2.3%, respectively. Food allergens were not detected. The positive rates of the systemic allergen tests were lower than in tear fluid tests in both eyes, especially for house dust mites (P = 0.000). In patients with more allergens, itching was more severe (P = 0.035), while conjunctival hyperemia was milder (P = 0.002).ConclusionIn autumn and winter, the most common AC allergen in Chinese patients was house dust mites. Compared with systemic allergen tests, measuring specific IgE in tears may be a non-invasive method to diagnose and evaluate AC severity, which may be more suitable to reflect the local conditions of ocular surface inflammation due to its high positive rate and convenience.

Corsi, Andrea; Corsi, Isabella; de Paula, Alessandro

2023 International Ophthalmology

doi: 10.1007/s10792-023-02848-2pmid: 37702840

PurposeTo describe a new and less risky technique for the cleaning of posterior capsule during phacoemulsification called passive cap vac.MethodPassive cap vac consisted in the removal of residual posterior capsule opacities using a disconnected 0.3 mm aspiration cannula. The hole of the aspiration cannula was faced toward posterior capsule and gently rubbed against it to achieve a complete cleaning of posterior capsule. The video of the technique is available online.ResultWith this new technique, the aspiration was ruled by the gravity and by the height of the balanced saline solution (BSS), in addition the Venturi’s effect and the absence of active aspiration beyond the cannula avoided an excessive aspiration of posterior capsule.ConclusionPassive cap vac allowed to clean posterior capsule using softer forces than traditional way, minimizing the risk of capsular tear.

Martínez-Plaza, Elena; López-de la Rosa, Alberto; Ossa-Calderon, Carolina; Blázquez-Arauzo, Francisco; López-Miguel, Alberto; Maldonado, Miguel J.

2023 International Ophthalmology

doi: 10.1007/s10792-023-02871-3pmid: 37697080

PurposeTo evaluate the effect of EVO+ Visian Implantable Collamer Lens (ICL) implantation on the iridocorneal angle pigmentation and structures.MethodsMyopic refractive surgery candidates who underwent posterior chamber EVO+ ICL implantation were evaluated preoperatively and 3 and 6 months postoperatively. High-resolution images of the iridocorneal angle (nasal, superior, temporal and inferior quadrants) were acquired during gonioscopy. A masked observer, blinded to study visits and patients’ information, evaluated the angle width, apparent iris root insertion, iris configuration, and trabecular meshwork pigmentation according to the Spaeth scale in two different occasions. The intra-rater reliability was estimated using the weighted Gwet's Agreement Coefficient (AC2). Differences between visits were analyzed using the Cochran Q test or the Friedman test.ResultsTwenty-one patients (13 females and 8 males) aging 31.3 ± 6.3 years old were recruited. The intra-rater reliability of gonioscopy assessment was excellent for every parameter assessed (AC2 ≥ 0.97). No significant differences were found among the study visits for any quadrant in the angle width (p ≥ 0.74), apparent iris root insertion (p ≥ 0.22), iris configuration (p ≥ 0.21) and trabecular meshwork pigmentation (p ≥ 0.24). Mean pigmentation of trabecular meshwork for the four quadrants did not vary either among visits (p = 0.25).ConclusionsThe EVO+ ICL implantation after uneventful procedures appears not to clinically affect the iridocorneal angle pigmentation and/or structures during a short-medium follow-up using gonioscopy assessment. The intra-rater reliability of glaucoma specialists assessing iridocorneal angle structures using gonioscopy images is very high.

Das, Anthony Vipin; Satyashree, Gagan; Joseph, Joveeta; Bagga, Bhupesh

2023 International Ophthalmology

doi: 10.1007/s10792-023-02866-0pmid: 37668848

ObjectiveTo describe the demographics and clinical profile of Herpes Simplex Virus (HSV) Keratitis in patients presenting to a multi-tier ophthalmology hospital network in South India.MethodsWe have reviewed the medical records of all patients having a clinical diagnosis of any form of HSV keratitis, seen between May 2012 and August 2020 across the L V Prasad Eye Institute network. All the further analyses of the groups were performed using the keywords used for making the diagnosis of HSV keratitis and the data were collected from the electronic medical record system.ResultsThere were a total of 8308 (N = 8897 eyes) patients. Male: female ratio was 5368 (64.61%):2940 (35.39%). Unilateral involvement was in 7719 (92.91%) patients. The most common age group affected was between the third to fifth decades of life with 1544 (18.58%). 3708 (1.68%) eyes had mild visual impairment (< 20/70) while the rest of them had moderate to severe visual impairment as observed mainly (p ≤ 0.01) in Necrotizing stromal keratitis. 7314 (82.21%) eyes had normal intraocular pressure (10–21 mm Hg) while raised most commonly in keratouveitis (P ≤ 0.01). Epithelial Keratitis, Immune Stromal Keratitis, Endotheliitis, Neurotrophic keratopathy and Keratouveitis were observed in 1875 (17.22%) eyes, 5430 (61.03%) eyes, in 129(1.45%) eyes, 1188 (13.35%) eyes, 148 (1.66%) eyes and 256 (2.88%) eyes respectively.ConclusionBased on our institute-based data, the most common type of HSV keratitis is Immune stromal keratitis followed by epithelial keratitis. Although not representative of the general population, this data provide useful insights related to HSV keratitis from India.

Tharwat, Ehab; Ahmed, Riad Elzaher Hassan; Eltantawy, Basheer; Ezzeldin, Ezzeldin Ramadan; Elgazzar, Akram Fekry

2023 International Ophthalmology

doi: 10.1007/s10792-023-02856-2pmid: 37698662

PurposeThis study aims to compare posterior subtenon triamcinolone acetonide injection either formulated or alone versus suprachoroidal triamcinolone in the management of diabetic macular edema.MethodsThis study is a prospective interventional study that included 75 patients, divided into three groups, each group with 25 patients. Group I received a combination of triamcinolone acetonide (TA) (40 mg) and VISCOAT, which is a combination of sodium chondroitin sulfate (20 mg) and sodium hyaluronate (15 mg). The injection was done in the posterior subtenon space using the NAGATA cannula. Group II received TA (40 mg) in the posterior subtenon space. Group III underwent an injection of 4 mg/100µl of TA in the supra choroidal space.ResultsWe found a statistically significant difference between the three studied groups regarding BCVA (P = 0.001) and CMT at six months postoperative (P = 0.001) with the highest median BCVA and lowest median CMT observed in the formulated TA group.ConclusionWe concluded that early treatment of DME by formulated TA is better than TA alone, and suprachoroidal TA in the form of increasing the BCVA and decreasing the CMT without any elevation of IOP.Trial registration number NCT05464953.Date of registration 17/7/2022 (retrospectively registered).

Liu, Jiannan; Wang, Hao; Gu, Wei; Zhao, Tingting; Fan, Wenxue; Peng, Shaomin

2023 International Ophthalmology

doi: 10.1007/s10792-023-02858-0pmid: 37665493

PurposeTo evaluate the safety of yttrium–aluminum-garnet (YAG) laser vitreolysis for intraocular tissues.MethodsThirty-six New Zealand rabbits were divided as follows: Group 1000 (n = 12) treated with YAG laser of 1000 mJ (5 mJ × 200 shots), Group 2000 (n = 12) treated with YAG laser of 2000 mJ (5 mJ × 400 shots), Group 3000 (n = 12) treated with YAG laser of 3000 mJ (5 mJ × 600 shots). Either a single eye was chosen as the study eye in study groups while the other was untreated as the control group. Intraocular pressure (IOP), slit-lamp, optical coherence tomography (OCT), transmission electron microscopy (TEM), and inflammatory cytokines of aqueous humor (interleukin-1α (IL-1α), interleukin-1β (IL-1β), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α)) were performed to examine the rabbits.ResultsThere were no abnormalities in the study groups of IOP, slit-lamp, and OCT examinations. Group 3000 of TEM showed: neutrophils and mitochondrial swelling on day 1, and fibroblasts and neocollagen on day 14. No abnormalities were observed in Group 1000 and 2000 of TEM. Levels of IL-1α and TNF-α increased at 12 h and decreased to baseline on day 3. Levels of IL-1β increased at 12 h and decreased to baseline on day 7. Levels of IL-8 increased on day 1 and decreased to baseline on day 3.ConclusionYAG laser vitreolysis is safe when the distance is more than 2 mm from ablation point to the lens and the retina, and the total energy is less than 2000 mJ for one treatment procedure.

Lekskul, Manapon; Thaiwat, Supitchaya; Lekvijittada, Jiraporn

2023 International Ophthalmology

doi: 10.1007/s10792-023-02868-ypmid: 37688653

PurposeThis study aimed to evaluate the recovery time of tear film function and ocular surface after discontinuing systemic isotretinoin treatment.MethodsThis was a prospective, cross-sectional study. 34 eyes of 17 patients treated with low- dose oral isotretinoin (< 0.5 mg/kg/day) were enrolled. The modified OSDI score, tear break-up time, Schirmer test, and corneal staining were performed in all patients at baseline, during the course of treatment and after withdrawing treatment every two weeks until the result returned to baseline.ResultsTear breakup time appeared to be the most sensitive and changed significantly at 2 weeks after starting treatment (p < 0.001) and returned to baseline at 4 weeks after withdrawal from treatment (p < 0.001). The Schirmer test results significantly decreased at 6 weeks and returned to baseline at 4 weeks after withdrawal from treatment (p < 0.001). OSDI scores were significantly changed at 6 weeks after treatment (81.8%) and returned to baseline at 2 weeks (54.5%) after withdrawal from treatment. No significant change was found in the MGD. Corneal staining was significantly positive 90.9% 6 weeks after starting treatment and returned to baseline 6 weeks after withdrawal from treatment (p < 0.001).ConclusionDry eye disease can return to baseline levels after treatment withdrawal. At least 6 weeks later, they could wear contact lenses again, and it was useful to prepare all patients requiring further ocular surgery.

Stoynova, Mariya Asenova; Shinkov, Alexander Dimitrov; Dimitrova, Inna Dimitrova; Yankova, Inna Angelova; Kovatcheva, Roussanka Dimitrova

2023 International Ophthalmology

doi: 10.1007/s10792-023-02875-zpmid: 37698660

PurposeIntravenous glucocorticoids (GCs) are the mainstay of treatment for severe forms of Graves’ orbitopathy (GO). Our aim was to assess the effectiveness and safety of a modified monthly regimen (mMR) and to compare them with those of the established weekly regimen (WR).MethodsThis was a prospective non-randomized single-center study involving 62 patients, divided into two therapeutic groups depending on their referral time. Thirty-one subjects, admitted in the period 2017–2018, were treated with mMR, total dose—5.5 g, with intake of oral GCs after completion of intravenous infusions. Thirty subjects, who were referred in the period 2019–2020, were treated with WR, total dose—4.5 g One patient refused to be part of the WR group and was treated with mMR. Eye status and therapeutic response were evaluated on the 1st, 3rd and 6th months, quality of life—at 3rd and 6th month.ResultsAt 1st month and 3rd month, there was no significant difference in the therapeutic response between the two groups. At 3rd month, the proportion of patients with improvement in soft tissue manifestations and subjective complaints was significantly higher in mMR group (65.6% vs. 40% and 81.3% vs. 46.7%, respectively) and the same manifestations were of significantly milder degree.At 3rd month, significant improvement in quality of life was found without significant difference between the two groups.At 6th month, worsening of GO occurred in 3 patients from WR group, while in 5 patients from mMR group further improvement was found.ConclusionsThe two GC regimens have comparable efficacy with small differences in the time of onset of the effect and its duration, as well as in the effectiveness on some ocular manifestations.Trial registration number NCT05793359/29.03.2023, retrospectively registered..

Caporossi, Tomaso; Gambini, Gloria; Baldascino, Antonio; Scampoli, Alessandra; Carlà, Matteo Mario; Rizzo, Stanislao

2023 International Ophthalmology

doi: 10.1007/s10792-023-02867-z

PurposeTo describe and evaluate the effectiveness of the Kaminari Kagura technique as a posterior hyaloid detachment treatment.Study designThis was a prospective, consecutive, randomized interventional study.MethodsThis study examined 30 eyes from 30 patients divided into two groups: (1) a Kaminari Kagura group (15 eyes) and (2) a control group (15 eyes) scheduled for vitrectomy with an optical coherence tomography (OCT)-based diagnosis of adherent posterior hyaloid.ResultsThe mean time for posterior vitreous detachment (PVD) induction in the Kaminari Kagura group was 58 ± 6.6 s, and that in the control group was 69 ± 9 s (p < 0.005). No intra- or post-operative complications were reported.ConclusionsThe Kaminari Kagura technique results in effective posterior hyaloid detachment in less time than that required for posterior vitreous cortex engagement.

Huang, Yue; Yu, Mengting; Liu, Xiaobao; Li, Qiong; Ke, Xiaozheng; Cai, Yajing; Wu, Wenjie

2023 International Ophthalmology

doi: 10.1007/s10792-023-02876-y

PurposeTo evaluate the effect of primary posterior continuous curvilinear capsulorrhexis (PPCCC) on the positional stability of IOLs.MethodsThis study is a prospective intra-individual comparative randomized controlled trial including 31 patients (62 eyes). Eyes of the same patient were randomly assigned to the PPCCC group (18 right eyes and 13 left eyes) or group without PPCCC (NPCCC group). Eyes in both groups were implanted with a one-piece foldable hydrophobic acrylic IOL via routine cataract surgery. Patients in the PPCCC group underwent additional manual PPCCC before IOL implantation. Examinations were performed 1 day, 1 week, 1 month and 3 months postoperatively. IOL tilt (x, y), decentration (x, y), anterior chamber depth (z) and refractive prediction error data were collected and analyzed with Pentacam.ResultsPostoperatively, the range of IOL position change over 3 months in PPCCC group was comparable to NPCCC group, which indicated smaller value in every tilt and decentration index. PPCCC eyes showed comparable tilt and decentration with NPCCC eyes in this study endpoint: mean tilt (x, y), decentration (x, y) and anterior chamber depth (ACD) were 1.04 ± 0.56°, 0.90 ± 0.64°, 0.239 ± 0.140 mm, 0.233 ± 0.133 mm and 4.01 ± 0.32 mm, respectively, in the PPCCC group vs. 1.09 ± 0.76°, 1.10 ± 0.82°, 0.252 ± 0.153 mm, 0.244 ± 0.155 mm and 4.01 ± 0.38 mm, respectively, in the NPCCC group. Refractive prediction error in the PPCCC group demonstrated a mild hyperopic shift vs. the NPCCC group (0.13 ± 0.50 vs. 0.05 ± 0.39; p = 0.208), and corrected distance visual acuity (CDVA) did not differ between the two groups (0.027 ± 0.014 vs. 0.059 ± 0.185; p = 0.377).ConclusionsComparable IOL tilt, decentration, ACD and refractive prediction error were observed in PPCCC eyes with that underwent routine cataract surgery. Little IOL position fluctuation and good visual acuity were shown in PPCCC group over time. Trail registration: The study was registered at the Chinese Clinical Trial Register Center on May 27th, 2020 (protocol code ChiCTR2000033304, 27/05/2020).

DeYoung, Charles; Asahi, Masumi G.; Rosenberg, Sedona; Pakhchanian, Haig; Liu, Ivan Z.; Bellur, Sunil; Raiker, Rahul; Dalal, Monica

2023 International Ophthalmology

doi: 10.1007/s10792-023-02865-1

PurposeTo evaluate the relationship between the COVID-19 pandemic and ophthalmic procedural volume.MethodsA retrospective cohort study using TriNetX, a federated electronic health record's research network was done. Monthly Current Procedural Terminology-specific volumes per healthcare organization were clustered chronologically to calculate average volumes into 3-month seasons to calculate average procedural volumes. An aggregate of the total pandemic period (March 2020–August 2021) was compared to corresponding figures in pre-pandemic timeframes.ResultsIntravitreal injections were the most prevalent procedure in this time period with 320,106 occurrences. Phacoemulsification cataract surgery was the second most prevalent (N = 176,095) procedure. From March 2020 to August 2021, a mean pandemic volume of 266.7 (SD = 15) was observed, a 5% decrease (p < 0.05) in procedures compared to the pre-pandemic mean of 280.8 (SD = 26.1).Spring 2020 exhibited the sharpest seasonal decrease in procedural volume (− 88%). The largest count of statistically significant increases in procedure volume was in Spring 2021 (+ 18%). The aggregate mean volume per HCO showed significant decreases for 11 out of 17 procedures in the 12 month March 2020–February 2021 timeframe and significant decreases for 10 out of 17 procedures over the 18-month March 2020–August 2021 pandemic period.ConclusionsThis study highlights the relative inverse relationship between COVID-19 cases and ophthalmic procedure volume in America. Quantifying ophthalmic procedure trends is important in retrospectively assessing surgical disruptions and prospectively accommodating delayed surgeries. Furthermore, awareness of these trends could help ophthalmologists prepare should similar disruptions occur in the setting of future pandemics or national disasters.

Müller, Michael; Pavlovic, Ana; Niermann, Theresa; Pavlovic, Ivana; Priglinger, Siegfried; Kohnen, Thomas; Shajari, Mehdi; Mackert, Marc

2023 International Ophthalmology

doi: 10.1007/s10792-023-02823-xpmid: 37658170

PurposeTo evaluate the impact of the iridocorneal angle size (ICAS) on the diurnal intraocular pressure (IOP) in patients with suspected glaucoma (SG).MethodPatients with any eye-pressure lowering medication or previous ocular surgery were excluded. In a retrospective study set, diurnal IOP profiles of 120 patients (205 eyes) within a 48-h period were analysed by regression analysis. Of those eyes, 44 were diagnosed to have glaucoma. The remaining eyes were used as healthy control group (HCG).ResultsThe overall mean IOP was 15.63 mmHg ± 2.72 mmHg and mean ICAS was 23.92° ± 4.74°. In the glaucoma cohort, mean IOP was 18.77 ± 1.86 mmHg and mean ICAS was 25.02° ± 4.96°. In the HCG, mean IOP was 14.77 ± 2.25 mmHg and mean ICAS was 23.62° ± 4.64°. In the total cohort, as well as in the subgroups (HCG or glaucoma), regression analysis showed no significant impact even of the minimum ICAS, which was larger than 10°, on average (P = 0.89), maximum (P = 0.88), and range of IOP (P = 0.49) within 48 h. The difference between glaucoma cohort and HCG cohort was significant in terms of IOP (P < 0.001), but not for minimum ICAS (P = 0.07). Chi-square test showed no increase in prevalence of IOP peaks of  > 21 mmHg within 48 h in eyes with an angle between 10° and 20° (P = 0.18).ConclusionAn ICAS of larger than 10° in HCG or glaucoma patients with an open-angle does not influence the minimum, average, maximum or range of IOP. Additionally, an angle size larger than 10° does not allow the prediction of IOP changes in these two cohorts.