Expanded Polytetrafluoroethylene Spacer for Nonpenetrating Deep Sclerectomy Combined with Cataract Surgery.

Purpose: To compare the outcomes of nonpenetrating deep sclerectomy (NPDS) with and without an expanded polytetrafluoroethylene (e-PTFE) implant combined with phacoemulsification (PE). Design: Interventional case series with concurrent control group. Materials and methods: Patients with medically uncontrolled glaucoma underwent PE nonpenetrating deep sclerectomy (NPDS) and were consecutively divided into a study group receiving an e-PTFE implant and a control group undergoing PE-NPDS. Intraocular pressure (IOP), corrected distance visual acuity (CDVA), and the number of glaucoma medications at 1 day, 1 week, 1 month, 3 months, and 6 months were recorded. Results: A total of 22 eyes of 16 patients underwent PE-NPDS, including 11 eyes receiving an e-PTFE implant and another 11 eyes with no implant. NPDS with spacer achieved successful results in all patients, including eight (72.7%) complete and three (27.3%) qualified success, 6 months, postoperatively. The corresponding values in the control group were 10 (90.9%) and 1 (9.1%), respectively. In the spacer group, mean IOP was decreased from 19.3 ± 2.8 at baseline to 12.1 ± 2.0 mm Hg at month 6 (p < 0.001). Corresponding values for the control group were 18.6 ± 3.4 and 10.6 ± 1.5 mm Hg, respectively (p < 0.001). Mean IOPs were comparable between the study groups at all time points. Implant exposure occurred in one of the patients in the study group. While the implant was extruded, the IOP was medically controlled. Conclusion: Outcomes of PE-NPDS using an e-PTFE implant were comparable to the same surgery without a spacer in the short term. Larger studies with longer follow-ups are needed to determine the efficacy and safety of this new implant. How to cite this article: Hajizadeh M, Meshksar A, Hassanpour K, et al. Expanded Polytetrafluoroethylene Spacer for Nonpenetrating Deep Sclerectomy Combined with Cataract Surgery. J Curr Glaucoma Pract 2024;18(2):51-56.

Topical erythropoietin for the management of scleral necrosis after ocular chemical burns.

PURPOSE: To evaluate the efficacy of topical erythropoietin for chemical burn induced scleral necrosis. METHODS: This study included 18 eyes of 16 patients with chemical burn induced scleral necrosis who presented within 6 weeks of the injury. In the prospective arm, 11 eyes received topical erythropoietin, 3000 IU/mL every 6 h, along with standard medical treatment. Retrospectively, we included 7 consecutive eyes of 7 patients who were managed with conventional treatment as historical control group. The main outcome measure was healing of avascular scleral lesions. The secondary outcome measure was complete re-epithelization of cornea. RESULTS: Mean patient age was 39.8 ± 16.2 years in the erythropoietin group, and they presented 16.6 ± 15.2 days after acute chemical injury. Scleral necrosis improved in all eyes after 30.7 ± 23.2 days of treatment with topical erythropoietin. Corneal epithelial defects were completely healed in 10 eyes 61.9 ± 50.7 days after the start of the medication. In comparison, standard medical treatment alone did not improve scleral necrosis in the historical control group, necessitating ocular surface reconstruction including conjunctival advancement (1 eye) and tenonplasty (6 eyes). CONCLUSION: The results of our study showed that topical erythropoietin was effective in the management of chemical burn induced scleral necrosis. This treatment could avoid ocular surface reconstruction procedures in inflamed eyes.

Superior Oblique Muscle Extramedullary Plasmacytoma in a Patient with Multiple Myeloma and a Review of Literature.

Introduction: Multiple myeloma (MM), a plasma cell malignancy, is a systemic disease affecting various body organs. Plasmacytoma of bone and extramedullary disease (EMD) are presentations of MM. EMD is usually the sign of a more aggressive form of the disease. Herein, we report a patient with refractory MM presenting with extramedullary plasmacytoma in the superior oblique (SO) muscle. Case Presentation: A 51-year-old female presented complaining of gradual protrusion of the left eye and ocular pain from 20 days prior. She received bone marrow transplantation 1 year prior and was on a chemotherapy regimen for MM for the past 1 year. Ocular examination revealed proptosis of the left eye and mild limitations of adduction and elevation. Orbital magnetic resonance imaging demonstrated remarkable enlargement of the left SO muscle with focal contrast enhancement. The patient underwent a biopsy and mass debulking. The histopathologic exam revealed fibromuscular tissue containing a neoplasm composed of sheets of plasmacytoid cells in a varying degree of differentiation with intervening scantly vascularized stromal components. The plasmacytoid cells were diffusely positive for a cluster of differentiation 138 (CD138), leading to a diagnosis of EMD involving the EOM and soft tissue of the orbit. The patient underwent palliative radiotherapy and a systemic workup. The PET-CT scan revealed involvement of the pelvic bone and left calf. Accordingly, the chemotherapy regimen was upgraded to reflect the aggressive nature of the disease. In the last follow-up, there was no sign of tumor reactivation in the orbital soft tissues. Unfortunately, the patient succumbed to her illness 7 months following her most recent presentation. Conclusion: Early recognition of disease recurrence is lifesaving in MM patients; ophthalmic manifestations should be seriously considered as a sign of MM activity.

The effect of combination therapy with intravitreal bevacizumab and topical timolol-dorzolamide eye drops on diabetic macular edema: a double-blind randomized controlled trial.

BACKGROUND: The mainstay of treatment in diabetic macular edema (DME) is intravitreal administration of anti-vascular endothelial growth factors (anti-VEGFs). Aqueous depressants may enhance the effects of anti-VEGF agents by prolonging their clearance via aqueous outflow. PURPOSE: To compare the anatomical and functional outcomes of treatment with intravitreal bevacizumab (IVB) and topical timolol-dorzolamide versus IVB alone. METHOD: In this randomized placebo-controlled clinical trial, patients with center-involving DME (ci-DME) and best corrected visual acuity (BCVA) of 20/30 or less were enrolled and randomly allocated to two treatment arms. One group received three monthly IVB injections and timolol-dorzolamide eye drops twice a day (IVB + TD group); the other group received three monthly IVB injections and artificial tear drops as placebo (IVB group). Patients underwent ophthalmic evaluations and macular optical coherence tomography scans at baseline and 1 month after the third injection. RESULT: Forty-six eyes from 46 patients with ci-DME were recruited. There was no intergroup difference regarding age, gender distribution, diabetic retinopathy stage, glycemic indices, BCVA, central macular thickness (CMT), or intraocular pressure at baseline. BCVA was significantly improved in the IVB + TD group (0.46 ± 0.18 to 0.36 ± 0.18 logarithm of the minimum angle of resolution [logMAR], p = 0.002), in contrast to IVB group (0.40 ± 0.17 to 0.35 ± 0.22 logMAR, p = 0.113). Similarly, the IVB + TD group showed a significant reduction in CMT (p < 0.001), unlike the IVB group (p = 0.086); and the CMT change in the former was greater than in the latter (- 0.57 ± 57.67 vs. - 25.52 ± 68.02 µm, p = 0.033). CONCLUSION: Our findings support the short-term effectiveness of topical timolol-dorzolamide as adjunctive therapy to IVB injections in managing center-involving DME in terms of anatomical and visual outcomes. TRIAL REGISTRATION: Clinicaltrials.gov NCT05083689 (October 19, 2021).

Management of Large Conjunctival Cysts in a Patient with Stevens-Johnson Syndrome: A Case Report and Review of the Literature.

Stevens-Johnson syndrome (SJS) is a life-threatening mucocutaneous disease with various etiologies including drugs, infections, and malignancies. Ocular manifestations of SJS vary from the membrane, symblepharon formation, and epithelial defect in the acute phase to trichiasis, eyelid margin keratinization, and lacrimal duct obstruction in the chronic phase. A 13-year-old boy with a history of drug-induced SJS presented to our clinic complaining of a mass in the nasal side and inferior fornix of the right eye from 1 year ago. The mass-like lesion in the medial side of the right eye was accompanied by ankyloblepharon, symblepharon, and ptosis and limited ocular movement. Orbital imaging showed cystic lesions on the medial side of the right globe and the inferior fornix. Two large cysts were entirely surgically excised. Histopathologic investigation revealed conjunctival tissue with nonkeratinized epithelium and goblet cells. There was no sign of conjunctival cyst recurrence or symblepharon formation on the 6th-month follow-up. The inferior fornix achieved acceptable depth and the ocular movements became normal.

A Modified Formula for Intraocular Lens Power Calculation Based on Aphakic Refraction in a Pediatric Population.

Purpose: To investigate and optimize the accuracy of aphakic refraction (AR) techniques for secondary intraocular lens (IOL) power calculation in aphakic children. Methods: Thirty-three aphakic eyes of 18 patients who were candidates for secondary IOL implantation were enrolled in the present study. Axial length (AL) measured by optical biometry was used in the biometric formula (SRK-T, Holladay II, and Hoffer-Q). AR and spherical equivalent (SE) were used in two AR-based formulas (Ianchulev, Leccissotti). True power was calculated based on postoperative SE at three months' follow-up. Results: Regarding the postoperative SE, 13 (40%) eyes were within ± 1.00 diopters (D) and 22 (66%) were within ± 2.00 D. Median absolute error (MedAE) was predicted to be 4.4 and 7.3 D with the use of Ianchulev and Leccissotti formulas, respectively. The corresponding value was 0.8 D with the biometric formula. All eyes were deemed to have myopic refraction when using the AR-based formulas except one eye with the Ianchulev formula. The coefficient of our modified formula was 1.7 instead of 2.01 in the Ianchulev formula. MedAE with the use of new formulae was 0.5 D and was comparable with the true IOL power (P = 0.22). Conclusion: Both Ianchulev and Leccissotti formulas resulted in a significant myopic surprise in aphakic children aged between 4.5 and 14 years. The modified formula proved to determine a more accurate SE that is comparable with biometric formulas.

Indications and outcomes of intraocular Lens Exchange among pseudophakic eyes in a Tertiary Referral Center.

PURPOSE: To determine the indications and surgical outcomes of intraocular lens (IOL) exchange in pseudophakic patients at Labbafinejad Tertiary Referral Center between 2014 and 2019. METHODS: In this retrospective interventional case series, the medical records of 193 patients with a history of IOL exchange were reviewed. Preoperative data, including clinical characteristics, indications of the first and second IOL implantation, intra- and postoperative complications due to IOL exchange, and the pre-and postoperative refractive error and best-corrected visual acuity (BCVA) were considered the outcome measures in this study. All postoperative data were analyzed at least six months after follow-up. RESULTS: The mean age of our participants was 59.13 ± 20.97 years old at the time of the IOL exchange, with a male percentage of 63.2%. The mean follow-up after the IOL exchange was 15.72 ± 16.28 months. The main indications of IOL exchange were IOL decentration (50.3%), corneal decompensation (30.6%), and residual refractive errors (8.3%). 57.10% of patients with the postoperative spherical equivalent at -2.00 diopter (D) to + 2.00D. The mean best-corrected visual acuity was 0.82 ± 0.76 LogMAR before the IOL exchange and was improved to 0.73 ± 0.79 LogMAR after the surgery. Corneal decompensation (6.2%), glaucoma (4.7%), retinal detachment (4.1%), cystoid macular edema (2.1%), and uveitis (1%) were found as the postoperative complications. There was only one case with suprachoroidal hemorrhage during IOL exchange. CONCLUSIONS: IOL decentration followed by corneal decompensation was the most common indication of IOL exchange. After IOL exchange, the most complications during follow-up were corneal decompensation, glaucoma, retinal detachment, and cystoid macular edema.

The Role of Optical Coherence Tomography Angiography in Optic Nerve Head Edema: A Narrative Review.

Optic nerve head (ONH) edema is a clinical manifestation of many ocular and systemic disorders. Ocular and central nervous system imaging has been used to differentiate the underlying cause of ONH edema and monitor the disease course. ONH vessel abnormalities are among the earliest signs of impaired axonal transportation. Optical coherence tomography angiography (OCTA) is a noninvasive method for imaging ONH and peripapillary vessels and has been used extensively for studying vascular changes in ONH disorders, including ONH edema. In this narrative review, we describe OCTA findings of the most common causes of ONH edema and its differential diagnoses including ONH drusen.

Presumably Corneal Graft Rejection after COVID-19 Vaccination.

We report two cases of corneal graft rejection following immunization with COVID-19-inactivated vaccine Sinopharm and describe the practical implications of this phenomenon in the clinical setting. A 36-year-old woman with a history of unilateral repeated PKP received the first dose of inactivated Sinopharm vaccine. Seven days later, she presented with symptoms and signs of unilateral corneal graft rejection on slit-lamp examination. A 54-year-old woman with a history of unilateral PKP secondary to herpes simplex keratitis (HSK) developed signs of unilateral corneal graft rejection just a week after injection of the first dose of the similar vaccine. Rejection in both patients was treated successfully with topical steroids. To the best of our knowledge, this is the first report of corneal graft rejection following the COVID-19-inactivated Sinopharm vaccine which occurred through the short period after the injection. We hypothesized that the rejection is the result of an allogenic reaction and the immunogenic role of aluminum hydroxide as an adjuvant of this type of vaccine. However, as the second case had a history of rejection following the HSK, a reactivation could not be definitely ruled out. Ophthalmologists should consider these types of adverse reactions after COVID-19 immunization and also monitor a close follow-up of graft health postimmunization. Patients should be informed about the signs and symptoms of rejection, urgent referral, and treatment.

Invasive Orbital Squamous Cell Carcinoma in a Patient with Multiple Myeloma.

Background: Orbital squamous cell carcinoma (SCC) is a rare entity. It is often a result of local invasion of SCC originating from the skin, nasopharynx, nasal cavity, paranasal sinuses, conjunctiva, lacrimal glands, or sac or less commonly occurs through hematogenous metastasis. Herein, we report a patient with orbital SCC with a history of multiple myeloma (MM). Case presentation. A 45-year-old woman with a history of MM in the past two years presented to our clinic complaining of gradual right eye proptosis for six months. The relative afferent pupillary defect was detected in the right eye on her examination. Ocular movements of the right eye were limited in all directions. Orbital magnetic resonance imaging demonstrated an infiltrative mass in the right orbit extended from the anterior to the orbital apex and the optic canal. The patient underwent debulking, and a histopathology examination revealed SCC results. No other secondary site was found to be the origin of the tumor. Result: The patient underwent chemotherapy and subsequent radiotherapy. To our knowledge, this is the first report of concomitant MM and primary orbital SCC.

The Influence of Near Vision Tasks on Intraocular Pressure in Normal Subjects and Glaucoma Patients.

Purpose: To investigate the effect of static accommodative tasks on intraocular pressure (IOP) of glaucomatous and normal eyes. Methods: Four groups of subjects categorized as primary open-angle glaucoma (POAG), primary angle-closure suspects (PACS), normal age-matched controls, and normal young adults (NYA; age < 40 years) were enrolled. The baseline IOPs were measured after the subjects were looking at a distant target for 15 min. Static accommodation was obtained by execution of near vision tasks (reading at 33 cm in daylight [300 lux] for 60 min). IOPs were measured at 15, 30, 45, and 60 min intervals while accommodating and then measured again after 15 min of relaxing accommodation while looking at a distant target. Results: One-hundred and eighteen eyes of 98 subjects were recruited. The study groups consisted of the following categories: 25 POAG (46 eyes), 24 PACS (47 eyes), 25 matched controls (50 eyes), and 24 NYA (48 eyes). Within all groups, the mean IOP decreased throughout the accommodation period at all time points. Maximum IOP reduction after accommodation was detected at the 30-min time among the POAG subjects, at the 45-min time in the PACS and matched control groups, and at 15 min after the relaxation of accommodation in the NYA group. IOP reduction levels showed no statistically significant difference among POAG, PACS, and the normal matched groups in their response to accommodation. However, NYA had significantly lower IOP and greater IOP reduction after the resting period (relaxation of accommodation). Conclusion: Static accommodative tasks can significantly reduce IOP in normal, POAG, and PACS individuals. Encouraging glaucoma patients to practice periodical near vision tasks could be viewed as an adjunctive measure for glaucoma management.

Comparison of the clinical phenotype of systemic sclerosis patients in Iran and France in two university centers.

Objectives: Systemic sclerosis is a severe and rare chronic auto-immune multisystem disorder characterized by vasculopathy and skin stiffness. Ethnic and geographical origin can influence the outcomes. In this study, we compared the phenotypic characteristics of Iranian and French patients. Methods: This cross-sectional study was performed on 200 Iranian and 268 French systemic sclerosis patients. Iranian patients collected from the Iranian systemic sclerosis cohort of the Rheumatology Research Center, Shariati hospital, Tehran University of Medical Sciences. The French population was monocentric, and it was constituted by the patients included locally in the EUSTAR database in December 2016. Results: The mean age at onset was significantly lower in Iranian patients (35.58 ± 11.68 vs 47.06 ± 13.54, p-value < 0.001). The female-to-male ratio was approximately 5.2:1 and was not different in the two populations. The prevalence of diffuse cutaneous systemic sclerosis was significantly higher in Iranian patients (60.2% vs 42.85%, p-value < 0.001). Calcinosis cutis and joint synovitis were more prevalent in French patients (p-value = 0.013, <0.001). The positivity of anti-topoisomerase antibody was higher in Iranian patients, whereas the anti-centromere antibody predominated in French cases (p-value < 0.001). Restrictive pattern of pulmonary function test was more common in Iranian patients (p-value < 0.001), while estimated pulmonary arterial pressure by echocardiography was higher in French patients (p-value < 0.001). Conclusion: It seems that systemic sclerosis occurred in younger ages among Iranian female with the predominance of diffuse cutaneous subtype. In addition, lung interstitial disease appeared to be more prevalent and severe in Iranians than French patients.