Fundus morphological characteristics assesment in high myopia patients with or without posterior scleral staphyloma by optical coherence tomography.

OBJECTIVE: To observe the morphological characteristics of posterior scleral staphyloma (PSS) with or without macular retinoschisis (MRS) using optical coherence tomography (OCT). Additionally, the incidence and severity of other pathologic myopic maculopathy associated with posterior scleral staphyloma was also evaluated. METHODS: General information and OCT imaging data from 440 patients with posterior scleral staphyloma (PSS) and the PSS curvature > 20×10-3 µm-1 were collected. These patients visited the Department of Ophthalmology at the First Affiliated Hospital of Harbin Medical University from January 2013 to June 2021. The obtained OCT images of PSS were analyzed using the Image J software to measure the curvature along the Bruch's membrane. The measured curvature was divided into four levels using the quartile method. The classification of macular retinoschisis (MRS) was based on the anatomical structure of the retina and the location of macular retinoschisis. Patients with PSS accompanied by MRS were assigned to the MRS group, while PSS patients without MRS were assigned to the non-MRS group. Additionally, typical OCT changes in other pathologic myopic maculopathy diseases, such as myopic choroidal neovascularization (mCNV), myopic traction maculopathy (MTM), and myopic foveoschisis (MF), were recorded and evaluated. RESULTS: A total of 615 eyes (328 right eyes, 287 left eyes) from 440 patients (80 males and 360 females) were recruited in this study. The MRS group consisted of 159 patients (36.1%) with 190 eyes (30.9%), while the non-MRS group consisted of 281 patients (63.9%) with 425 eyes (69.1%). Both groups had a significantly higher proportion of female patients compared to male patients, and the right eye was more commonly affected than the left eye. In the MRS group, the prevalence of MRS increased progressively with the severity of PSS. Among the common posterior pole diseases, epiretinal membrane had the highest prevalence (33.2%), while lamellar macular hole had the lowest prevalence (5.3%). In the non-MRS group, the proportion of PSS in each group decreased progressively (except for an equal prevalence in the third and fourth levels) with increasing severity of PSS. Among the common posterior pole diseases, choroidal neovascularization had the highest prevalence (41.4%), while lamellar macular hole had the lowest prevalence (6.5%). When comparing the two groups, there were no significant differences in age, gender, and eye distribution. The MRS group had a higher prevalence of macular schisis, retinal detachment, and dome-shaped macula (17.9%, 14.2%, 14.8%) compared to the non-MRS group (11.3%, 9.2%, 9.6%). The non-MRS group had a significantly higher prevalence of choroidal neovascularization (41.4%) compared to the MRS group (12.6%), while there were no significant differences in the prevalence of epiretinal membrane and lamellar macular hole between the two groups. CONCLUSION: The prevalence of MRS increased progressively with the severity of PSS, and the MRS occurrence was positively correlated with PSS, which indicated that PSS may lead to MRS, while the proportion of PSS in each group decreases gradually with the severity of PSS in the non-MRS group decreased progressively (except for an equal prevalence in the third and fourth levels). In the MRS group, outer macular retinoschisiss were most relevant to posterior scleral staphyloma, and the prevalence of macular holes and retinal detachments was higher in the MRS group compared to the non-MRS group, indicating that MRS may further turn into complications such as macular holes and retinal detachments, which can significantly affect vision or lead to blindness. The prevalence of choroidal neovascularization (CNV) was significantly higher in the non-MRS group compared to the MRS group, suggesting that PSS with lower severity is more prone to develop into CNV. Dome-shaped macula (DSM) seems to play a protective role in the development of pathologic myopia, and abnormal changes in posterior scleral staphyloma curvature may be an important factor affecting the development and shape of DSM.

Scleral-fixated intraocular lens implantation with "irregular, knotless, zigzag-shaped scleral tunnel suture technique" combined with pars plana vitrectomy or anterior vitrectomy.

PURPOSE: This study aims to introduce a new suture method and report surgical outcomes of patients who underwent scleral-fixated intraocular lens (SF-IOL) implantation combined with either pars plana vitrectomy (PPV) or anterior vitrectomy (AV). METHODS: Twenty-three eyes performed SF-IOL implantation combined with PPV (Group 1), and 34 eyes performed SF-IOL implantation combined with AV (Group 2) were included in the study prospectively. The SF-IOL, either polymethyl methacrylate or foldable IOL, was sutured into the sclera using PC-9 sutures in an irregular, knotless, and zigzag-shaped manner. The scleral tunnel was approximately 12-15 mm long, with at least four sharp edges. Suture tips were trimmed within the scleral tunnel. Postoperative outcomes and complications were evaluated. RESULTS: Both groups showed no complications such as suture tip expulsion, suture reaction, IOL dislocation, or increased intraocular pressure during postoperative visits. Group 1 exhibited a statistically significant improvement in visual acuity compared to preoperative values (P = 0.036 for the 1st month, <0.001 for the 3rd month). Similarly, Group 2 demonstrated a statistically significant improvement in visual acuity compared to the preoperative period (P = 0.001 for the 1st month, <0.001 for the 3rd month). CONCLUSION: The "irregular, knotless, and zigzag-shaped scleral tunnel suture technique" yielded favorable results in terms of IOL stability and visual acuity. This technique can be safely employed in patients undergoing SF-IOL implantation combined with PPV or AV.

Quality of life and vision assessment with scleral lenses in keratoconus.

PURPOSE: The purpose of the study is to evaluate the visual outcomes and improvement in quality of life (QOL) of patients with keratoconus with scleral lenses. METHODS: In this prospective study, 14 patients (28 eyes) with bilateral keratoconus were fitted with scleral lenses (McAsfeer 16.00 mm) in Pune city, Maharashtra, India. Uncorrected visual acuity (VA), best spectacle-corrected VA, and VA with scleral lenses were evaluated. The patients were given the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25) for judging the QOL, before and after using scleral lenses for 3 months. RESULTS: The mean uncorrected VA of the 14 patients with a mean age of 28.64 ± 6.57 years was 1.18 ± 0.19 logMAR. Best spectacle-corrected high-contrast VA improved from 0.47 ± 0.25 logMAR to 0.03 ± 0.07 logMAR with scleral lenses (P < 0.001). Best spectacle-corrected low-contrast VA improved from 0.68 ± 0.22 logMAR to 00.47 ± 0.10 logMAR with scleral lenses (P < 0.001). Along with the increase in overall median scores on the NEI VFQ-25 from 1735 to 2930 points (P < 0.001), the distance and near activities (P < 0.001), vision-specific mental health (P < 0.002), social functioning (P < 0.004), and driving (P < 0.005) improved after using scleral lenses for 3 months. CONCLUSION: Scleral lenses can be an effective and safe management option for patients with keratoconus leading to an improved vision and QOL.

The effect of lens and fitting characteristics upon scleral lens centration.

PURPOSE: To quantify the impact of varying central fluid reservoir depth, lens thickness/mass and the addition of a peripheral fenestration upon scleral lens centration. METHODS: Ten young, healthy adults participated in a series of repeated-measures experiments involving short-term (90 min) open eye scleral lens wear. Scleral lens parameters (material, back optic zone radius, diameter, back vertex power and landing zone) were controlled across all experiments, and the central fluid reservoir depth (ranging from 144 to 726 µm), lens thickness (ranging from 150 to 1200 µm), lens mass (101-241 mg) and lens design (with or without a single 0.3 mm peripheral fenestration) were altered systematically. Scleral lens decentration was quantified using over-topography maps. RESULTS: On average, scleral lens centration varied by <0.10 mm over 90 min of wear. Medium and high initial fluid reservoir conditions resulted in 0.17 mm more temporal and 0.55 mm more inferior lens decentration, compared to the low fluid reservoir depth (p < 0.001). Changes in lens thickness or the addition of a peripheral fenestration did not cause clinically significant changes in centration (<0.10 mm on average) when controlling for fluid reservoir depth. Central fluid reservoir depth was the best predictor of horizontal and vertical lens decentration, explaining 62-73% of the observed variation, compared to 40-44% for lens thickness and mass. CONCLUSION: Scleral lens decentration remained relatively stable over 90 min of lens wear. A greater initial central fluid reservoir depth resulted in significantly more lens decentration, particularly inferiorly. Large variations in lens thickness, mass or the addition of a single peripheral fenestration did not substantially affect lens centration.

A New Technique with Scleral Grooves for Sutureless Scleral Fixation of the Carlevale Intraocular Lens.

INTRODUCTION: A novel technique is described employing scleral grooves to facilitate sutureless scleral fixation of the Carlevale intraocular lens (CIL). We describe its use in a series of 47 patients with aphakia. METHODS: A retrospective study of all patients with aphakia who underwent CIL implantation with the new technique by a single surgeon during 1 year. The novelty of this technique consists in the creation of two partial-thickness linear sclerotomies (grooves), 180° apart, 2 mm from and parallel to the limbus. In the middle of each groove a full-thickness sclerotomy is performed to facilitate externalization of the CIL anchors. The groove allows the anchor to plug the full-thickness sclerotomy and to rest within the sclera without protrusion. Reported outcomes include pre-operative/post-operative visual acuity, post-operative spherical equivalent and surgical complications. Follow-up was a minimum of 6 months. RESULTS: Forty-eight eyes of 47 patients with aphakia with a mean age of 74 years (range 31-90 years) are included. The commonest causes of aphakia were intraocular lens (IOL) subluxation,with or without exfoliation (54.2%), complicated cataract surgery (29.2%), crystalline lens luxation (6.3%) and trauma (4.1%). All CILs inserted with the new technique stayed successfully in situ during follow-up. Median pre-operative best-corrected visual acuity (0.75 logMAR; range 0.1-2.7) significantly improved to 0.5 logMAR post-operatively (p < 0.001). Moreover, 78% and 65% of the operated cases were within 1.0 and 0.5 diopters, respectively, from intended refraction. The most common complications were transient cystoid macular oedema (8.3%) and transient intraocular pressure rise (8.3%), all of which resolved within 2 months. CONCLUSIONS: The proposed modification of sutureless scleral fixation of the CIL appears safe and effective. In our experience it is less time consuming and easier to perform than previous techniques and may therefore offer a useful future option.

The anterior scleral thickness in primary open-angle glaucoma with high myopia.

Purpose: This study aimed to investigate and compare the anterior scleral thickness (AST) among high myopia (HM), primary open-angle glaucoma (POAG), and POAG with HM (HMPOAG) groups. Methods: Thirty-two HM eyes, 30 POAG eyes, and 31 HMPOAG eyes were included. The Schlemm's canal (SC) area, trabecular meshwork (TM) thickness, scleral spur (SS) length, and AST were measured using swept-source optical coherence tomography. AST was measured at 0 mm (AST0), 1 mm (AST1), 2 mm (AST2), and 3 mm (AST3) from SS. Results: The HMPOAG group had significantly thinner AST, SS length, and TM thickness than the HM and POAG groups (all p < 0.05). In addition, the SC area of the HMPOAG group was also significantly smaller than that of the HM group (p < 0.001). Conclusion: The HMPOAG group had the thinnest AST, shortest SS, thinnest TM, and smallest SC. The thinnest AST might contribute to the shortest SS, and further to the thinnest TM and smallest SC in the HMPOAG group. AST might be a novel clinical indicator in the prediction and evaluation of POAG.

Scleral Lenses for Managing Dry Eye Disease in the Absence of Corneal Irregularities: What Is the Current Evidence?

Scleral lenses (SLs) are large-diameter rigid contact lenses that are a mainstay treatment for eyes with corneal irregularities. In recent years, there has been increased interest in the role of managing dry eye disease (DED) with SLs, as many patients with DED have reported symptomatic relief with SL wear. The role of SLs for DED management when there are associated corneal irregularities is supported by individual case reports and studies. This has prompted practitioners to begin advocating using SLs in DED cases, even in the absence of associated corneal irregularities and other ocular surface diseases (OSDs). There have also been discussions on potentially placing SLs earlier in the treatment hierarchy of DED, where it currently sits at a more advanced level of intervention (Step 3) in the TFOS DEWS II Report. This review will present the currently available, albeit sparse, evidence that supports and suggests this practice, as well as ancillary evidence supporting the purported benefits of SL wear in DED. The advantages of SL wear, such as corneal healing, absence of tear evaporation and contact lens dehydration, and improved visual acuity with associated increased wear comfort, and how this will benefit DED patients will be explored. Conversely, the challenges associated with fitting SLs in DED patients, including increased midday fogging, poor wettability, and subjective patient satisfaction, will also be presented, as well as a discussion on the key considerations for SL fitting in this population. Overall, while more research is needed to support the use of SLs in DED patients without associated corneal irregularities and other forms of OSD, the use of these lenses may prove to have a potentially wider role given their reported ancillary benefits in these populations.

Customized Scleral Lenses: An Alternative Tool for Severe Dry Eye Disease-A Case Series.

Purpose: Dry eye disease (DED) is a multifactorial condition significantly impacting patients' quality of life (QoL). This study aims to present a case series highlighting the effectiveness of customized scleral lenses in managing severe DED and improving patient outcomes. Methods: This case series includes three patients with severe DED refractory to conventional treatments. Customized scleral lenses were fitted for each patient, and clinical outcomes were evaluated over a period of two months. Assessments included best-corrected visual acuity (BCVA), slit-lamp examination findings, and corneal National Eye Institute (NEI) scores. Results: All three patients demonstrated significant improvements in BCVA, reductions in ocular symptoms, and enhanced ocular surface health. Patient 1, with secondary Sjögren's syndrome and suspected mucous membrane pemphigoid, showed resolution of conjunctival hyperemia and epithelial defects. Patient 2, with graft versus host disease, exhibited resolution of punctate keratitis and the absence of thread mucus. Patient 3, post-oncologic surgery, achieved complete resolution of keratoconjunctivitis sicca and the restoration of vision. Conclusions: Customized scleral lenses are a useful therapeutic option for severe DED, providing significant symptomatic relief and enhancing patients' quality of life. Their use should be considered in refractory cases to optimize ocular surface health and visual outcomes.

Long term surgical results and safety profile of the novel CM T Flex scleral fixated intraocular lens.

PURPOSE: To report the long term visual outcomes and complications with use of the novel CM-T Flex scleral fixated intraocular lens (CMT-SFIOL). MATERIALS AND METHODS: 116 eyes that underwent CMT-SFIOL were reviewed and 57 eyes with CMT-SFIOL that completed a 2-year follow-up were included. Main outcome measures noted were best-corrected visual acuity (BCVA) and complications. Postoperatively, follow-ups were done at 1 week (1w), 1 month (1 m), 1 year (1y) and 2-year (2y) intervals. RESULTS: 40 (70.17%) of 57 eyes received CMT-SFIOL for surgical aphakia. Mean follow up was 39.77 ± 8.44 months. BCVA for distance & near improved from 1.26 ± 0.84 to 0.76 ± 0.77, 0.50 ± 0.72 and 0.51 ± 0.73 & 1.28 ± 0.58 to 0.98 ± 0.49, 0.92 ± 0.44 and 0.89 ± 0.40 at 1 m, 1y and 2y respectively (p < 0.001 for all). At 1w, 10 eyes (17.54%) had corneal edema (CE) and 8 eyes (14.03%) had anterior chamber (AC) reaction. Two eyes (3.50%) had IOP > 30 mm Hg and 1 eye (1.75%) had vitreous hemorrhage (VH). At 1 m, 3 eyes (5.26%) had CE and 5 eyes (8.77%) had AC reaction. Two eyes (3.50%) had IOP > 30 mm Hg and 1 eye (1.75%) had VH. Cystoid macular edema was noted in 3 eyes (5.26%). At 1y and 2y, 2 eyes (3.5%) and 1 eye (1.75%), had CE. No decentration, dislocation, haptic exposure or retinal detachment was noted. No eyes required resurgery. CONCLUSION: CM-T Flex SFIOL is an effective method to correct aphakia, with reliable and safe long-term results.

A Case of Incidental and Uncomplicated Subretinal Triamcinolone Acetonide.

Introduction: Posterior subtenon injection of triamcinolone acetonide (PSTA) is commonly done to treat refractory cases of macular edema. Complications may arise from the procedure as well as from the use of the periocular steroid medications. Side effects include subconjunctival hemorrhage, progression of cataract, scleral perforation (resulting in subretinal, subhyaloid, or intravitreal injection of the drug), retinal detachment, ptosis, orbital fat prolapse, orbital abscess, infectious scleritis, ocular hypertension, and scleral abscess. Here we describe a case of inadvertent subretinal triamcinolone acetonide (TA) deposition from a PSTA procedure without any adverse vision-threatening outcomes. Case Presentation: We report a patient who presented with a history of superior temporal left eye macula-off rhegmatogenous retinal detachment, which was successfully repaired with a scleral buckle (SB), pars plana vitrectomy, and gas placement. Due to persistent diplopia, the SB was removed after 1 year post-operatively. Due to the development of cystoid macular edema, a PSTA was performed after the patient failed topical steroids and NSAIDs. The procedure was halted early due to unexpected resistance during the injection. A dilated fundus exam showed the presence of subretinal triamcinolone acetonide. The patient was observed and found to have no complications with almost complete resolution of the triamcinolone acetonide after 3 months. Conclusion: In previous SB patients, it is important to highlight the risk of globe penetration, subretinal deposition of TA, formation of retinal breaks, or reopening of prior retinal breaks with posterior subtenon injection, which could have adverse effects on the local retina as well as the risk of retinal detachment.

Clinical outcomes of posterior scleral reinforcement in Chinese high myopia children.

We aim to observe the posterior scleral reinforcement (PSR) clinical outcomes of children with high myopia and analyze the retinal vessel alteration before and after PSR by using angiography optical coherence tomography (angio-OCT). Fifty-six pediatric participants (112 eyes) clinically diagnosed high myopia were recruited and were treated by PSR in Shanghai Children's Hospital from June 1, 2021 to May 1, 2023. The average age ranged from 5.42 to 14.83 years (mean 8.83 years) and mean follow up duration was 8.7 months (3-24 months). The axial length (AL) was significantly shortened after PSR (p < 0.05). The spherical equivalent (SE) and the best-corrected visual acuity (BCVA) were also improved without severe rejection in the follow-up. Compared with baseline, angio-OCT parafoveal vessel indices including vascular area density (VAD) and vascular skeleton density (VSD) on the superficial capillary plexus layer (SCPL), as well as VAD and vessel perimeter index (VPI) on the deep capillary plexus layer (DCPL), were significantly increased after PSR surgery (p < 0.05). VPI on the SCPL, vascular diameter index (VDI) and VSD on the DCPL were also improved without statistical difference after PSR. The VSD on SCPL, VAD on DCPL of the right eyes and the VPI on SCPL of the left eyes were significantly increased after PSR (p < 0.05). PSR surgery can shorten the AL and can stable BCVA and SE in high myopia children. The angio-OCT parameters indicated that the retinal microcirculation supply was significantly improved after PSR.

Rhegmatogenous Retinal Detachment in Anterior Scleritis With Ulcerative Colitis.

Rhegmatogenous retinal detachment (RRD) is an ocular emergency as it is sight-threatening and requires urgent surgical intervention. Ulcerative colitis (UC) is an immune-mediated inflammatory bowel disease that can present with ocular manifestations. The objective of this case report is to share the rare presentation of RRD associated with UC leading to diagnosis and management dilemmas. A 35-year-old man with active UC presented with a right chronic red eye for two months. The best corrected visual acuity (BCVA) was 6/6 in both eyes (OU). On examination, sectoral inferotemporal anterior scleritis (AS) with subclinical inferior RRD with peripheral holes in the lattice at the 6 o'clock position was noted. There was no posterior vitreous detachment. Optical coherence tomography (OCT) delineated the RRD objectively and was non-progressive for nine months. Barricade laser was given, in addition to intravenous methylprednisolone (IVMP), followed by a tapering dose of oral prednisolone and topical dexamethasone 0.1% over three months. Over a year, the scleritis resolved. However, six months later, while still on immunomodulating agents, the inferior RRD progressed on OCT. Segmental scleral buckle, indirect laser retinopexy, and subtenon triamcinolone injection were performed. IVMP 1 g per day was given for three days prior to surgery. Two months later, his BCVA was 6/6, with signs of fluid resorption and normal intraocular pressure. No recurrent AS was seen. Treatment of non-progressive, subclinical RRD patients with UC and active AS can be delayed with regular follow-up. When RRD progressed and there was no AS activity, it was the window of opportunity for the success of scleral buckle and perioperative steroids.

[Comparative evaluation of transscleral laser exposure in anatomical experiment]. / Sravnitel'naya otsenka lazernogo transskleral'nogo vozdeistviya v usloviyakh anatomicheskogo eksperimenta.

PURPOSE: This study comparatively analyzed the morphology of eye tissues after laser exposure using the latest generation of transscleral laser techniques - micropulse transscleral cyclophotocoagulation (MP-TSCPC) and laser activation of scleral hydropermeability (LASH) - in an anatomical experiment. MATERIAL AND METHODS: The study used pulsed-periodic radiation of an Er-glass fiber laser (λ=1.56 µm) and radiation of a diode laser (λ=0.81 µm) in the micropulse mode. A comparative morphological evaluation of histological preparations of target scleral and ciliary body (CB) tissues was performed with the study of laser-induced changes occurring after LASH and MP-TSCPC. RESULTS: The study of histological preparations obtained after MP-TSCPC and LASH did not reveal any noticeable signs of an inflammatory reaction or significant destructive changes. There were no signs of pronounced coagulative changes in the form of disorganization of connective and muscle tissue in the exposure area. At the same time, MP-TSCPC was accompanied by thinning and discontinuity of the CB pigment epithelium in the projection of its flat part and expansion of the gaps between the anterior connective tissue fibers fixing the CB to the sclera, which is likely a factor contributing to uveoscleral outflow. After LASH, in the irradiated areas at the level of the outer layers of the sclera (¾ of its thickness) located in the projection of the flat part of the ciliary body, multiple slit-like cavities and enlargements (stretching) of interfiber spaces were revealed with simultaneous compaction of the inner part of the sclera (» of its thickness). CONCLUSION: The identified morphological changes may indicate certain differences in the mechanisms of intraocular pressure (IOP) reduction after MP-TSCPC and LASH. The results of this study suggest that the enhancement of uveoscleral outflow of intraocular fluid and the hypotensive effect after MP-TSCPC may be associated with laser-induced expansion of the interspaces between the anterior connective tissue fibers of the CB in the suprachoroidal space. With LASH, the possible mechanism of lowering IOP may be related rather to an increase in transscleral filtration due to the appearance of slit-like interfiber spaces in the sclera, caused by local contraction of scleral fibers in the area of laser exposure. The absence of pronounced destructive changes at the histological level indicates the gentle nature of both laser techniques and the possibility of expanding the indications for the use of LASH in the treatment of glaucoma, including at its earlier stages.

Clinical features of retinal detachment treated with segmental scleral buckling.

PURPOSE: Our study aims to evaluate the surgical outcomes and clinical features of retinal detachment (RD) cases treated with segmental scleral buckling (SB), elucidating the role of segmental SB as a vital option in specific situations during the current era. METHODS: We retrospectively reviewed 128 eyes with primary rhegmatogenous RD that underwent segmental scleral buckling between November 2008 and December 2020. Clinical features and success rates were recorded and analyzed. RESULTS: A total of 128 eyes were included. The patient's ages ranged from 12 to 72 years, with a median age of 45. Most of the eyes were phakic (97%). Regarding the type of break, 47% were holes, and flap tears were found in 68 cases (53%). The break locations were superior-temporal (54%), inferior-temporal (31%), superior-nasal (9.5%), and inferior-nasal (5.5%). The length of the SB applied ranged from 3.5 to 8.0 clock hours, with a median of 6.0. Primary success was achieved in 121 eyes, and recurrence occurred in 7 eyes. All recurrent RD cases reattached after undergoing secondary VT. The causes of failure included 2 break reopens, 1 missed break, and 4 eyes with proliferative vitreoretinopathy. The single-surgery anatomic success (SSAS) rate for segmental SB was 94.5%. The final success rate was 100%. CONCLUSIONS: For phakic, low complexity retinal detachment in our study, segmental scleral buckling emerges as a surgical option with a high primary success rate and a lower incidence of complications.

Unusual orbital, scleral and choroidal findings in Erdheim-Chester disease: a case report.

This case report highlights a unique presentation of Erdheim-Chester Disease (ECD) with bilateral scleral lesions, choroidal infiltration, and extensive sinus involvement. It is the first case report where the diagnosis was confirmed through a scleral biopsy after an initial presentation of a unilateral nodular scleritis. There was a gradual disease progression and ocular examination later revealed bilateral subconjunctival hyperemic lesions and mild exophthalmos, ophthalmoplegia, and extensive choroidal infiltration. Infiltration of the frontal and maxillary sinus was present and extended into the nasal cavity and both orbits. The diagnostic work-up is described in detail. Current treatment options are analyzed. It is emphasized that the ophthalmologist can play a crucial role in the diagnosis of ECD, given the substantial prevalence of orbital and ocular symptoms. The overall prognosis for ECD remains unfavorable, particularly in cases with orbital involvement. This case underscores the complexity and importance of a multidisciplinary approach in managing ECD.

Changes in bulbar conjunctival microcirculation and microvasculature during short-term scleral lens wearing and their associated factors.

OBJECTIVE: To explore the changes in microcirculation and microvasculature of the bulbar conjunctiva during the short-term wearing of the scleral lenses (ScCL). And investigate the factors affecting the microcirculation and microvasculature of the bulbar conjunctiva. METHODS: In this prospective cross-sectional study, functional slit lamp biomicroscopy (FSLB) was used to image the ocular surface microcirculation and microvascular images at two different sites (under the area of ScCL and outside of the area of ScCL) before (baseline) and during the wearing of ScCL at 0 h, 1 h, 2 h and 3 h. Anterior segment optical coherence tomography (AS-OCT) (RTVue, Optovue Inc, USA) was also used to image central post-lens tear film (PoLTF) and the morphology changes of the conjunctiva under the landing zone at the same time period. The semi-automatic quantification of microcirculation and microvasculature including vessel density (Dbox), vessel diameter (D), axial blood flow velocity (Va) and blood flow volume (Q). And the morphological changes of conjunctiva and PoLTF fogging grading were evaluated manually. The changes in the microcirculation and microvasculature of the ocular surface, PoLTF fogging grade and conjunctival morphology were compared before and during the ScCL wearing at different time periods, and the relationship between them was analyzed. RESULTS: Nineteen eyes (11 right eyes, 8 left eyes) were analyzed in this study. Outside of the area of ScCL, the Dbox before wearing lenses was less than that at 0 h (P = 0.041). The Q at baseline was greater than that after 1 h ScCL wearing (P = 0.026). Under the area of the ScCL, the Q at 1 h was less than that at baseline and 3 h. During the ScCL wearing, statistically significant conjunctival morphology changes were found among different time stages (baseline (0 µm), 0 h (113.18 µm), 2 h (138.97 µm), 3 h (143.83 µm) (all P ＜0.05). Outside the area of the ScCL, the morphology changes of the conjunctiva were negatively correlated with the changes of Va (P＜0.001,r = -0.471) and Q (P = 0.003,r = -0.348),but positively correlated with the Dbox (P = 0.001,r = 0.386). Under the area of ScCL, the morphology changes of the conjunctiva were negatively correlated with the Q (P = 0.012, r = -0.291). The fogging grade was positively correlated with the Q under the area of the ScCL (P = 0.005, r = 0.331). CONCLUSIONS: The microcirculation and microvasculature of the ocular surface and conjunctival morphology were changed after wearing ScCL in wearers, which indicated that the microvascular responses happened in the ScCL wearers and the severity of microvascular responses of the ocular surface related to the morphology changes of the conjunctiva. The quantification methods and findings in this study provide clues for the safety of ScCL wearing and may supervise the health of the wearer's ocular surface.

Clinical features of primary and compound forms of wide macular posterior staphyloma in high myopia.

BACKGROUND: To compare the ocular features of highly myopic eyes with posterior staphyloma of wide macular type according to its morphological complexity. METHODS: In this cross-sectional study, wide macular posterior staphyloma (WMPS) was classified into the primary (Curtin type I) and the compound (Curtin types VI to X) forms based on the configuration within the staphyloma. The grades of myopic maculopathy and the thicknesses of choroid and sclera were compared between the primary and compound forms of WMPS. RESULTS: A total of 154 eyes (103 patients) with primary WMPS and 65 eyes (49 patients) with compound WMPS were included. Eyes with compound WMPS had worse visual acuity (P = 0.001) and greater axial length (P < 0.001) than those with primary WMPS. Compared to primary WMPS, compound WMPS had a higher grade of myopic macular degeneration (P < 0.001) and a higher frequency of lamellar or full-thickness macular hole associated with myopic traction (21.5% vs. 10.4%; P = 0.028) and active or scarred myopic choroidal neovascularization (33.8% vs. 20.1%; P = 0.030). On swept-source optical coherence tomography, eyes with compound WMPS had significantly thinner choroid and sclera. CONCLUSIONS: The compound form of WMPS had more severe myopic macular changes and worse visual prognosis compared to the primary form of WMPS, and these were associated with more structural deformation in the posterior eyeball. Compound WMPS should be considered as an advanced form of staphyloma.

A Divergent Sequela of Scleral Buckle Removal.

Scleral buckle (SB) removal is done for a variety of reasons following treatment of rhegmatogenous retinal detachments (RRD), such as buckle exposure, migration, and infection. The most worrying complication of SB removal is retinal redetachment. We report a unique case of a patient developing strabismus about one month after scleral buckle removal for anterior migration and exposure of the scleral buckle. We also share a successful strabismus surgery which had a main aim of relieving diplopia in the patient's primary gaze.

Clinical Outcomes in Scleral Fixation Secondary Intraocular Lens with Yamane versus Suture Techniques: A Systematic Review and Meta-Analysis.

Background: The purpose of the study is to compare the visual outcomes and complications of sutured scleral fixation (SSF), a traditional and conservative surgical approach, and the newer and faster Yamane technique for secondary intraocular lens placement. Methods: A literature search was performed on PubMed, Embase, and Scopus on studies published between 1 July 2017 to 29 September 2023. Outcomes analyzed included the final best corrected visual acuity (BCVA) between 3 and 12 months to assess the effectiveness of the procedure, post-operative month (POM) 1 BCVA to assess the speed of visual recovery, endothelial cell count (ECC), absolute refractive error, surgical duration, and complication rates. Additional subgroup analyses were performed based on surgeon experience with the technique. Single-surgeon studies had an average of 26 procedures performed, whereas multiple-surgeon studies averaged only 9 procedures performed; these were then used to delineate surgeon experience. A sample-size weighted mean difference (MD) meta-analysis was performed across all variables using RevMan 5.4.1; p < 0.05 was considered statistically significant. Results: Thirteen studies with 737 eyes were included: 406 eyes were included in the SSF group, and 331 eyes were included in the Yamane group. There was no significant difference in the final BCVA between groups in both the single-surgeon versus multiple-surgeon studies (MD = -0.01, 95% CI: [-0.06, 0.04], p = 0.73). In the single-surgeon studies, the BCVA at POM1 was significantly improved in the Yamane group compared to SSF (MD = -0.10, 95% CI: [-0.16, -0.04], p = 0.002). In the multiple-surgeon studies, there was no significant difference in BCVA at POM1 (MD = -0.06, 95% CI: [-0.16, 0.04], p = 0.23). The Yamane group had a shorter surgical duration than SSF in both single-surgeon and multiple-surgeon studies (MD = -24.68, 95% CI: [-35.90, -13.46], p < 0.0001). The ECC, refractive error, and complication rates did not significantly differ amongst all groups. Conclusions: The Yamane technique demonstrated similar long-term visual outcomes and complication rates to the traditional SSF. Visual recovery was significantly faster in the Yamane group in the single-surgeon studies. The operative times were shorter across all Yamane groups. Based on these findings, it is advisable to consider the Yamane technique as a viable, and perhaps preferable, option for patients requiring secondary IOL placement, alongside traditional SSF methods.

Current Evidence for a New Surgical Technique for Scleral Fixation: The Implantation of a Carlevale Lens, a Systematic Review.

Background: The Carlevale lens (FIL SSF, Soleko IOL Division, Italy) is a new lens for suture-less scleral fixation. This paper aimed to systematically review articles on this lens, the surgical techniques used for its implantation, complications and outcomes. Methods: This systematic review was performed following the PRISMA guidelines. The search string used was "Carlevale" AND "scleral fixation" from inception until March 2024. For completeness, either case-control studies, case reports or case series written in English were included. The authors used the Newcastle-Ottawa scale for the case-control studies and the JBI Critical Appraisal Checklist for case reports and case series. Results: Twenty-nine articles were included. Scleral fixation with Carlevale lens can be performed by creating scleral flaps or, alternatively, by using scleral pockets. The two sclerotomies must be diametrically opposed, and are preferably created by 25-gauge trocars. A pars plana vitrectomy should be performed every time, and the design of the lens should be suitable for self-anchoring to the sclera; the most accredited strategy to achieve this is to avoid scleral sutures. There were only a few intraoperative and postoperative complications reported; vitreous hemorrhages were the most frequent intraoperative events, while the most relevant postoperative complications were vitreous hemorrhages, cystoid macular oedema and transient variations in the intraocular pressure. Excellent results have been obtained in terms of BCVA, IOL centration and stability, mean intraocular pressure, postoperative spherical equivalent, separation between anterior and posterior chamber and the distance of the IOL from anterior chamber structures. Conclusions: The foldable hydrophilic design of the Carlevale lens has shown good effectiveness, IOL stability and few intra and post-operative complications.