Repositioning and scleral fixation of subluxated lenses using a T-shaped capsule stabilization hook.

We describe a T-shaped capsule stabilization hook (modified capsule expander [M-CE]) used for repositioning and scleral fixation of the lens capsule of subluxated lenses. The 5-0 polypropylene device is flexible and attached to a curved needle. The contact portion is bent at 1.25 mm, and the end bifurcates in a T configuration to form a 3.75 mm footpad from which the capsular bag can be suspended. Modified capsule expanders were implanted in 4 eyes of 4 patients with subluxated cataractous lenses and provided excellent support and centration of the intraocular lens (IOL)-capsular bag complex. The IOLs remained well centered and stable. The corrected distance visual acuity improved to at least 20/20 in all patients after surgery. Thus, M-CEs were effective in fixating the lens capsule to the sclera in patients with significant zonular weakness.

Comparison of the outcomes of limbal-based trabeculectomy with and without anchor sutures.

BACKGROUND AND OBJECTIVE: To retrospectively evaluate the efficacy and safety of limbal-based trabeculectomy with anchor sutures compared to standard limbal-based trabeculectomy. Limbal-based trabeculectomy was performed with a new technique using anchor sutures, which involved tying the conjunctiva to the sclera at a deep fornix incision to prevent bleb localization induced by slippage of the conjunctival suture scar toward the scleral flap. PATIENTS AND METHODS: In this retrospective, comparative, interventional case series, 45 eyes that underwent limbal-based trabeculectomy with anchor sutures and 27 eyes that underwent standard limbal-based trabeculectomy were analyzed (primary surgery). RESULTS: At a target intraocular pressure of 15 mm Hg, the 3-year survival rate using Kaplan-Meier analysis was 76.2% in the limbal-based trabeculectomy with anchor sutures group and 55.6% in the standard limbal-based trabeculectomy group. Bleb morphology analysis using the Moorfields Bleb Grading System showed that blebs in the limbal-based trabeculectomy with anchor sutures group were more diffused than those in the standard limbal-based trabeculectomy group. CONCLUSION: Limbal-based trabeculectomy with anchor sutures appears to be an effective method for decreasing intraocular pressure and improving morphology of blebs.

Tlx, an orphan nuclear receptor, regulates cell numbers and astrocyte development in the developing retina.

Tlx belongs to a class of orphan nuclear receptors that underlies many aspects of neural development in the CNS. However, the fundamental roles played by Tlx in the control of eye developmental programs remain elusive. By using Tlx knock-out (KO) mice, we show here that Tlx is expressed by retinal progenitor cells in the neuroblastic layer during the period of retinal layer formation, and it is critical for controlling the generation of appropriate numbers of retinal progenies through the activities of cell cycle-related molecules, cyclin D1 and p27Kip1. Tlx expression is restricted to Müller cells in the mature retina and appears to control their proper development. Furthermore, we show that Tlx is expressed by immature astrocytes that migrate from the optic nerve onto the inner surface of the retina and is required for their generation and maturation, as assessed by honeycomb network formation and expression of R-cadherin, a critical component for vasculogenesis. The impaired astrocyte network formation on the inner retinal surface is accompanied by the loss of vasculogenesis in Tlx KO retinas. Our studies thus indicate that Tlx underlies a fundamental developmental program of retinal organization and controls the generation of the proper numbers of retinal progenies and development of glial cells during the protracted period of retinogenesis.