Argus II retinal prosthesis for retinitis pigmentosa in the Middle East: The 2015 Pan-American Association of Ophthalmology Gradle Lecture.

BACKGROUND: To describe the outcomes of patients with retinitis pigmentosa (RP) who received the Argus II Retinal Prosthesis System. METHODS: This retrospective, interventional case series evaluated 10 consecutive patients who received the Argus II retinal implant and underwent visual function tests with the system on and system off. The main outcome measures were safety (the number, seriousness, and relatedness of adverse events), and visual function measured by computer-based objective tests, including square localization (SL) and direction of motion (DOM). Secondary measures included functional vision performance, including orientation and mobility (O&M) tasks. RESULTS: There were no intraoperative complications and all prostheses remained implanted at the end of follow up. The mean patient age was 41.3 years; mean duration of the implant in vivo was 2.1 years. One patient had a suture exposure over the coil suture tab and over the inferior case suture tab at 2 years postoperatively, which was managed successfully. One patient developed mild vitreous hemorrhage that resolved spontaneously. One patient developed high intraocular pressure postoperatively due to a tight scleral band (SB) that was managed successfully. Patients performed significantly better with the Argus II system on than off on all tasks. CONCLUSION: Patients who received the Argus II had a safety profile out to 4 years post-implantation that was markedly better than that observed in the pre-approval phase of the Argus II. In this population of RP patients, the Argus II retinal prosthesis provided useful visual function over several years that likely translates into improved quality of life. TRIAL REGISTRATION: clinicaltrials.gov identifier, NCT00407602.

Evaluation of transepithelial stromal riboflavin absorption with enhanced riboflavin solution using spectrophotometry.

PURPOSE: To assess transepithelial stromal riboflavin absorption with an enhanced riboflavin solution (riboflavin 0.1%, 15% dextran T500 with trometamol (Tris-[hydroxymethyl]aminomethane) and sodium ethylenediaminetetraacetic acid by analyzing light-transmission properties of ex vivo rabbit corneas. SETTING: School of Optometry and Vision Sciences, Cardiff, Wales. DESIGN: Experimental study. METHODS: The enhanced riboflavin drops (Ricrolin TE) were applied every 3 minutes for 1 hour to 12 corneas (4 with intact epithelium, 4 with superficial scratches, 4 with 8.0 mm epithelial debridement). As a comparison, riboflavin drops without the enhancers (riboflavin 0.1%, 20% dextran T500) (normal riboflavin group) were applied to 12 corneas (4 with intact epithelium, 4 with superficial scratches, 4 with central epithelial debridement). A control group of 4 corneas with intact epithelium received balanced saline 0.9%. To assess enhanced riboflavin absorption, light-transmission spectra of the corneas were analyzed with a spectrophotometer. RESULTS: The spectra in corneas with intact epithelium in both riboflavin groups and in eyes with superficial scratches treated with normal riboflavin were similar to controls. Those with enhanced riboflavin and superficial scratches showed a homogeneous yellow discoloration of the cornea with a dip in light transmission between 400 and 490 nm, similar to that of the enhanced riboflavin solution. This was also seen, albeit of a greater magnitude, with complete epithelial removal, with eyes receiving enhanced riboflavin having a greater dip in transmission than eyes receiving normal riboflavin. CONCLUSIONS: Administration of enhanced riboflavin and superficial epithelial scratches allowed sufficient riboflavin stromal absorption to homogeneously alter the transmission spectra of rabbit corneas. This did not occur to the same extent with an intact epithelium or normal riboflavin with superficial scratches. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of factors that influence the measurement of corneal hysteresis in vivo and in vitro.

PURPOSE: The purpose of this study was to compare measurements of corneal hysteresis (CH) obtained in vivo, with similar measurements from excised human eyes and from excised human corneas mounted in an artificial anterior chamber. METHODS: Corneal hysteresis was measured using an ocular response analyser (Reichert Ophthalmic Instruments) from three groups: 53 healthy normal corneas of fifty-three patients, six excised eyes and 17 excised corneas. RESULTS: In vivo, it was found that CH was independent of gender, age and mean spherical equivalent, but has a significant inverse relationship with intraocular pressure (IOP(cc)) (r = 0.53; p < 0.0001). However, there was no correlation between CH and IOP(G) (r = 0.10; p = 461). The same inverse relationship with IOP(cc) was recorded in intact, excised eyes (r = 0.74; p < 0.0001), with no significant differences between the behaviour each individual eye. Excised corneas also showed an inverse relationship between CH and trans-corneal pressure (r = 0.72; p < 0.0001), but the measured values of CH were lower than those recorded in vivo and from intact globes. In both excised eyes and excised corneas, we found a significant correlation between CH and central corneal thickness [r = 0.86; p < 0.0001 and r = 0.611; p < 0.0005 (respectively)]. CONCLUSION: The in vitro results indicate that every normal human eye at physiological hydration shows an identical dependence of CH on IOP(cc) , the same dependence as is observed in vivo. This therefore would appear to be an intrinsic response of the tissue to a change in IOP. However, it is possible that the lower values of CH recorded from excised corneas reflect the influence of the artificial chamber replacing the eye globe, so in vivo values of CH may be influenced to some extent by the presence of the other components of the eye.