Among the various fields of ophthalmic surgery, it is arguably corneal transplantation that has undergone the greatest evolution in recent years. The transition to selective replacement of the individual corneal layers is now established principle. What is interesting is that for the most part this transition has been driven by surgical innovation supported by basic instruments only. Endothelial keratoplasty in its various forms requires acquisition of new surgical maneuvers facilitated by inserting devices.
How to cite this article: Moloney G. Moving Beyond Lamellar Keratoplasty - Are We Taking Our First Step? Cli Exp Vis Eye Res J 2018;1(2):1-2
Aim: The aim of this study was to evaluate the feasibility of non-contact manipulation of intraocular lenses (IOLs) using a remote magnetic field.
Materials and Methods: The present experimental ex vivo study was performed at a university medical center. A small neodymium iron boron (NdFeB) ferromagnetic chip was attached to a one-piece polymethylmethacrylate IOL with cyanoacrylate glue. The lens was manipulated using a bar-shaped and toroidal NdFeb magnet outside and inside of an artificial anterior chamber. The lens was then implanted in the capsular bag of a porcine eye that had undergone extracapsular lens extraction. A magnetic field was applied, and attempts to manipulate the lens in various directions were documented.
Results: While in the capsular bag, the IOL was successfully moved and rotated in all directions and axes of movement from a distance of up to 1 cm. The use of a bar-shaped magnet resulted in a more controlled movement than the use of a toroidal magnet. Manipulation of the lens into the ciliary sulcus was also successful. Approaching the magnetic chip with the handheld magnet from a close distance resulted in abrupt and unpredictable movements.
Conclusions: Ferromagnetic IOL can be remotely manipulated by an external magnetic field. The application of this concept may potentially enable non-invasive post-operative adjustment of IOL, particularly toric IOL. The design of devices for this purpose should take into account the non-linear increase in the force exerted by the magnetic field as the distance from the magnet decreases.
Key words: Cataract surgery, magnetic intraocular lens, post-operative manipulation, post-operative refractive error, premium intraocular lenses
How to cite this article: Sternfeld A, Nahum Y. Remote Manipulation of Intraocular Lenses Using a Magnetic Field. Cli Exp Vis Eye Res J 2018;1(2):3-5.
Introduction: Treatment of adults with convergence insufficiency-type (CI-XT) exotropia is challenging as surgery frequently results in distance and lateral gaze esotropia. Recent evidence demonstrates differential compartmental function of extraocular muscle fiber groups. Selective surgery of muscle fiber groups may diminish near-distance disparities (NDD) while maintaining alignment at distance.
Methods: Seven adults with a NDD ≥8 prism diopter (PD) were included in this study. Patients with a NDD <15 PD and a distance deviation of <10 PD were treated with lateral rectus (LR) inferior marginal tenotomy, those with NDD >15 PD and distance deviation of >10 PD were treated with LR slanted recessions, and those with limitation in adduction with negative forced duction testing were treated with medial rectus (MR) inferior fiber plication. Success was defined as <8 PD of XT at distance and near without overcorrection and a NDD ≤8 PD.
Results: Postoperatively, the mean distance deviation was reduced from 7.71 ± 6.87 PD to an overcorrection of 1.43 ± 3.78 PD, and the near deviation from 20.29 ± 9.57 PD to 0.86 ± 1.57 PD. The NDD was reduced from 12.57 ± 3.15 to 2.29 ± 3.73 PD. Six of the 7 (85.7%) patients met criteria for success. One subject was overcorrected at distance and two were slightly undercorrected at near but without diplopia.
Discussion: CI exotropia remains a surgical challenge. Treatment may be optimized when using an individualized approach favoring selective LR and MR procedures when possible.
Conclusions: Preliminary data reveal that selective techniques may eliminate diplopia while collapsing NDD in patients with CI-XT. A focused algorithm will help surgeons select the procedure most likely to benefit each individual patient.
Key words: Convergence insufficiency, convergence insufficiency-type exotropia, intermittent exotropia, medial rectus plication, slanted lateral rectus recession
How to cite this article: Fry MC, Pineles S, Velez FG. Treatment of convergence insufficiency exotropia in adults using a selective muscle fiber surgery algorithm. Cli Exp Vis Eye Res J 2018;1(2):6-10
Purpose: The purpose was to study the expansion of binocular fields in patients of chronic lateral rectus paresis (LR paresis) treated by bilateral medial rectus recession (BMRr) and compare with ipsilateral recession resection.
Method: A total of 20 patients of chronic LR paresis were randomly divided into two groups of 10 patients each. In Group A, ipsilateral recession resection was done, while in Group B, BMRr was performed.
Results: In Group A, the mean deviation for distance was 40.10 ± 10.8 prism diopter (PD) and, for Group B, was 41.70 ± 12.2 PD preoperatively. Postoperatively, eight (80%) cases in Group A and nine (90%) cases in Group B achieved acceptable alignment (± 10 PD) in the primary position (P = 0.3). Field of binocular single vision (BSV) increased from a mean value of 70% to 77.7% in Group A and from 68.8% to 79.2% in Group B (P = 0.01)) after 6 months.
Conclusion: BMRr is an equally effective option for chronic unilateral LR paresis and gives a wider field of BSV as compared to ipsilateral recession-resection surgery.
Key words: Chronic lateral rectus paresis, ipsilateral, nerve palsy,
How to cite this article: Kaur S, Kamlesh, Rastogi A, Gupta P, Goyal G, Dash D, Dadeya S. Expansion of binocular fields in the treatment of lateral rectus paresis. Cli Exp Vis Eye Res J 2018;1(2):11-15.
Aim: This study aims to study the effectiveness of laser peripheral iridotomy and other treatment modalities in reducing intraocular pressure (IOP) in patients of pigment dispersion syndrome (PDS), pigmentary ocular hypertension (POH), and pigmentary glaucoma (PG).
Materials and Methods: Retrospective analysis of the records of patients diagnosed with PDS, POH, and PG was done in glaucoma clinic of tertiary eye care center. Patients of PG who underwent laser iridotomy (LI) were separately analyzed. Minimum follow-up was of 6 months.
Results: A total of 86 eyes of 43 patients were analyzed. Patients had a mean follow-up of 49.05 ± 49.68 months. There were 24 males and 19 females. The diagnosis was PDS in 24% (21/86) eyes, POH in 18% (15/86), and PG in 58% (50/86) eyes. Mean age was 51.5 ± 11.58 years, 52.42 ± 13.41 years, and 47.08 ± 17.81 years among PDS, POH, and PG group, respectively. LI was performed in 36.04% (31/86) eyes, of them 70.96% (22/31) eyes had PG. There was a significant difference in IOP before and after LI (P < 0.05) in all the groups. The number of antiglaucoma medicines (AGMs) also dropped significantly after LI (P . 0.05). There was no significant difference in IOP at final follow-up in LI-treated and no LI-treated PG group. Glaucoma surgery was required in 9.3% (8/86) eyes.
Conclusion: LI helps in reducing IOP and number of AGM in PG. Long-term prospective studies are required to evaluate the effectiveness of LI in PDS and PG.
Key words: Laser peripheral iridotomy, pigmentary glaucoma, pigment dispersion syndrome
How to cite this article: Raj S, Joshi G, Kaur M, Thattaruthody F, Kaushik S, Pandav SS. Role of laser peripheral iridotomy and treatment outcomes in patients of pigment dispersion syndrome, pigmentary ocular hypertension, and pigmentary glaucoma in North Indian population. Cli Exp Vis Eye Res J 2018;1(2):16-20.
Purpose: The purpose of this study was to explore the involvement of two known mediators of the apoptotic processes in ganglion cells, the proteins alpha-2-macroglobulin (α2M) and tumor necrosis factor-α (TNF-α), in the pathogenesis of primary open-angle glaucoma (POAG) and pseudoexfoliation (PXF) syndrome.
Methods: Aqueous humor samples were collected at the beginning of cataract surgery. Levels of α2M and TNF-α were measured using western blot analysis and expressed as fold values. Commercially available pure α2M protein and TNF-α were used as controls. For digital quantification, nitrocellulose membranes were scanned and analyzed using Image J software.
Results: Levels of α2M level were measured in 61 samples, which included 18 with PXF, 15 with POAG, and 28 controls. Mean levels of α2M in the aqueous humor of patients with PXF without glaucoma were comparable to control levels and lower than for patients with POAG (0.63 ± 0.1; 0.6 ± 0.05; and 0.92 ± 0.1, respectively, P = 0.05). TNF-α levels were measured in 25 aqueous humor samples including eight with PXF, seven with POAG, and 10 controls. TNF-α protein fold level values were higher in patients with glaucoma, with and without PXF, and compared to control values (0.77 ± 0.1 and 0.5 ± 0.4 compared to 0.06 ± 0.01, respectively, P = 0.05 post-log conversion).
Conclusion: This work further documents the role of α2M protein in the apoptotic process in ganglion cells related to increased IOP but marks its absence in PXF material accumulation without glaucoma. Our findings regarding TNF-α levels may still suggest a role for this protein in PXF syndrome alone.
Key words: alpha-2-macroglobulin, tumor necrosis factor-α, pseudoexfoliative syndrome, glaucoma
How to cite this article: Barcelona PF, Schaap-Fogler M, Garcia MDAG, Eiger-Moscovich M, Mimouni K, Saragovi HU, Kramer M. Variable expression of alpha-2-macroglobulin and tumor necrosis factor-α in the aqueous humor of patients with pseudoexfoliative syndrome with and without glaucoma. Cli Exp Vis Eye Res J 2018;1(2):21-25.
The introduction of topical beta-blockers in 1978 was a major breakthrough in the treatment of ocular hypertension and glaucoma, and although no longer first-line, beta-blockers remain a commonly prescribed and important intraocular pressure (IOP) lowering medication. On the 40th anniversary of their introduction we critique the current role of topical beta-blockers, with particular regard to their efficacy, side effects, and role in fixed-dose combinations. While beta-blockers are effective at lowering IOP during the day, sleep laboratory studies have shown that they have minimal effect overnight, likely due to the physiological nocturnal reduction in aqueous production. Cardiac and respiratory side effects are especially important to consider in elderly patients with multiple comorbidities or in those using multiple systemic medications, which may affect beta-blocker metabolism. The increasing number of alternative medical and minimally invasive surgical options for glaucoma treatment is likely to see a reduction in beta-blocker prescribing.
Key words: Timolol, beta-blocker, glaucoma, ocular hypertension, side effects, asthma, hypotension, polypharmacy
How to cite this article: Lee YY, Tatham AJ. 40 years of topical beta-blockers for glaucoma. Cli Exp Vis Eye Res J 2018;1(2):26-31.
Aim: To report the case of a patient with Marfan syndrome that presented with an heterozygous change from thymine (T) to cytosine (C) at nucleotide 3538, resulting in a missense change from cysteine to arginine at codon 1180 in exon 28 (3538 T>C; cys1180arg) of the FBN1 gene, causing a severe phenotype of the disease with early-onset bilateral lens subluxation with nasal displacement of the lens and absent zonules.
Background: Ectopia lentis (EL) is a major criterion to diagnose MFS, a connective tissue disorder caused by a mutation in the FBN1 gene.
Case Description: An 11-year-old boy with a history of MFS causing severe aortic root dilatation with increasing dimension and no evidence of dissection. Refraction revealed bilateral myopia with astigmatism and deprivation amblyopia in the left eye. Slit-lamp examination evidenced iridodonesis with flat iris in both eyes, and nasal displacement of the lens that was mild in the right eye and moderate in the left eye with absent temporal zonular ligaments.
Conclusion: MFS typically presents with EL with superotemporal displacement of the lens secondary to zonular laxity. Our patient has bilateral lens subluxation with nasal displacement of the lens and absent zonules, due to a missense change from cysteine to arginine at codon 1180 in exon 28 (3538 T>C; cys1180arg) of the FBN1 gene, resulting in a severe phenotype of the disease.
Clinical Significance: This mutation can be the cause of an aggressive phenotype with complete zonular weakness at a young age.
Key words: Marfan syndrome, ectopia lentis, fibrillin, mutation, missense
How to cite this article: Velez FG. Thymine > cytosine missense mutation at nucleotide 3538 in fibrillin-1 gene in Marfan syndrome: A case report of an aggressive phenotype. Cli Exp Vis Eye Res J 2018;1(2):32-34.