Current Understanding of Moyamoya Disease (MMD) and Associated Neuropsychiatric Outcomes.

Moyamoya disease (MMD) is a rare cerebrovascular disorder characterized by the progressive narrowing and occlusion of the intracranial internal carotid arteries, leading to the formation of abnormal collateral vessels. MMD primarily affects the cerebrovascular system, and evidence suggests it is associated with various neuropsychiatric outcomes. This manuscript aims to provide an overview of the current understanding of MMD, including its epidemiology, pathophysiology, clinical manifestations, and diagnosis. Furthermore, it explores the emerging research on the neuropsychiatric sequelae of MMD, such as cognitive impairment, psychiatric disorders, and quality of life. The manuscript concludes with the challenges in managing MMD-related neuropsychiatric outcomes and potential avenues for future research.

Comparison of Safety and Efficacy Between Ab Interno and Ab Externo Approaches to XEN Gel Stent Placement.

PURPOSE: To compare the safety and efficacy of two different techniques for implantation of the XEN Gel Stent, a minimally invasive surgical device for the treatment of refractory glaucoma. METHODS: A retrospective chart review of eyes that received ab interno or ab externo XEN Gel Stent placement from February 2017 to October 2019 was conducted. A single surgeon (NMR) performed all operations. Eyes that received the XEN implant concomitant with a glaucoma drainage device insertion or that were lost to 6-month follow-up were excluded. Intraocular pressure (IOP) change, change in glaucoma medications, frequency of slit lamp revision procedures, and frequency of secondary glaucoma surgeries were the primary outcomes compared between groups. RESULTS: Fifty eyes that underwent ab interno placement and 30 eyes that underwent ab externo placement were studied. The ab interno cohort demonstrated a mean IOP reduction of 8.4 ± 1.7 mmHg (28.6% decrease) by 12 months, compared to a mean reduction of 12.8 ± 3.0 mmHg (40.1% decrease) in the ab externo group (p = 0.208). Mean reduction in medication use was 1.81 ± 0.29 medications in the ab interno group and 1.86 ± 0.37 in the ab externo group (p = 0.913). By 12 months, 58% of ab interno eyes had required 5-fluorouracil injection compared to 36.7% of ab externos (p = 0.105). Bleb needling was applied to 42% and 26.7% of the eyes, respectively (p = 0.231). A second glaucoma surgery was necessary for 20% of the ab interno cohort and 10% of the ab externo cohort (p = 0.351). CONCLUSION: There were no differences in outcomes between ab interno and ab externo placement of the XEN Gel Stent. Both approaches are safe and effective for lowering IOP.

The incidence of fungal keratitis and endophthalmitis following penetrating keratoplasty.

PURPOSE: To determine the incidence of postkeratoplasty fungal endophthalmitis and keratitis at the New York Eye and Ear Infirmary. To determine whether there is a relationship between culture-positive corneoscleral donor material and postoperative infection. METHODS: The microbiologic records of corneoscleral donor rims submitted for culture following penetrating keratoplasty at the New York Eye and Ear Infirmary between January 1998 and January 2003 were reviewed. The incidence of rim cultures positive for fungi was tabulated. Clinical outcome measures were recorded for each patient receiving corneal donor tissue. RESULTS: Of 2466 donor corneoscleral rims cultured during the study period, 344 were positive for microbial growth (13%). Of those rims with positive cultures, 28 (8.6%) were positive for fungus. All fungi cultured were Candida species. Four of the 28 recipient eyes (14%) who received contaminated donor material went on to develop postkeratoplasty fungal infections. There were no cases of fungal infection in any postkeratoplasty patients in the absence of contaminated donor rims during the study period. Overall, there was a 0.16% incidence of fungal infection (4/2466) following penetrating keratoplasty. There were 18 positive donor rims identified in the first 4 years of the study, but there were 10 cases in the last 10 months of the study. CONCLUSIONS: The overall incidence of fungal infection following penetrating keratoplasty is low, but all cases in our study were associated with positive rim cultures. Whether prophylactic antifungal therapy would be of any benefit in the presence of a positive corneoscleral rim culture has not yet been determined.

Conservative treatment of meibomian gland dysfunction.

PURPOSE: To evaluate the effectiveness of lid hygiene and preservative-free artificial tears for the treatment of meibomian gland dysfunction (MGD) during a 6-week period. METHODS: Suitable patients with MGD were educated about their disease and instructed to begin a regimen of lid hygiene, which included the application of a heated saline solution and the use of nonpreserved artificial tears. Baseline measurements obtained at the time of enrollment included basic tear secretion test, tear breakup time, a questionnaire grading MGD symptoms (i.e., burning, irritation, itching, sharp pains, foreign body sensation, and hazy vision), and lid margin slitlamp photographs. All measurements except for basic tear secretion were repeated at the 6-week follow-up visit. Photographs were unlabeled, and two cornea specialists graded them in a masked fashion for the presence of lid erythema, irregularity, thickness, meibomian gland capping, and telangiectasis. RESULTS: Thirty-seven patients with a clinical diagnosis of MGD were enrolled, and 26 patients (70%) completed the study. Initial measurement of basic tear secretion averaged 17 mm and was more than 10 mm in 81% of eyes. The tear breakup time was prolonged by an average of 3.4 seconds; in 30% of cases, it was normalized to 10 seconds or more. Symptoms improved in 88% of cases; among those, symptoms were graded mild or less in 83%, and none in 39%. Photographs before and after treatment were not significantly different. CONCLUSIONS: In this noncontrolled case-cohort study of selected patients with MGD, lid hygiene and preservative-free artificial tears significantly improved tear breakup time and relieved symptoms of the condition.

Management of refractory glaucoma in childhood.

Glaucoma in children is characterized by marked intraocular pressure (IOP) elevation with resultant atrophy of the optic nerve and loss of retinal ganglion cells. In very young children, secondary expansion of the globe with damage to anterior segment structures, such as the cornea and zonule, often occurs. Permanent, severe visual dysfunction may result from optic nerve damage as well as from amblyopia arising from anisometropia and corneal opacification. The treatment of childhood glaucoma often involves surgery. Goniotomy and trabeculotomy remain the first line surgical procedures for open-angle glaucoma in children. Trabeculectomy with adjunctive antifibrosis therapy, aqueous shunt surgery, and cyclodestructive procedures are undertaken when angle surgery fails to control the IOP or is unlikely to succeed. The choice of surgical procedure is individualized according to factors such as the age of the patient, the specific type of glaucoma, the number of prior surgical procedures, and the visual potential of the eye. Achieving and maintaining an adequate IOP to prevent progressive optic nerve damage, avoiding complications, and preserving vision are the goals that must be considered in deciding on a surgical plan.