The justification for obtaining a diagnostic test is presumably to improve patient care. To improve patient care, diagnostic tests must be (1) affordable, (2) convenient, (3) sufficiently safe, (4) able to be validated, and (5) relevant, that is, help the way patients feel and the way they function by providing information needing to be known to accomplish that fundamental goal of caring for patients.

How to cite this article: Spaeth GL. Contrast Sensitivity and Glaucoma. Cli Exp Vis Eye Res J 2019;2(1):1-2.

Received: 05-05-2019

Accepted: 07-05-2019

Introduction: Patients with nystagmus and head turn are traditionally treated by recession and resection of the rectus muscles as described by Kestenbaum and Anderson.

Methods: We present a case series of patients with nystagmus and anomalous head position (AHP) who underwent plication - only surgery of the horizontal rectus muscles from March 1, 2014, to June 1, 2015.

Results: Plication amounts ranged from 5mm to 7.5 mm on the medial rectus and 7-12 mm on the lateral rectus. Average pre-operative horizontal AHP was 22.5° and post-operative AHP 2.5° (paired Student t-test P = 0.034) and only one patient required a second surgery.

Discussion: We found AHP can be effectively treated with plication - only surgery.

Key words: Nystagmus, strabismus surgery, torticollis

How to cite this article: Sauer TC, Velez FG, Pineles SL. Rectus muscle plication in the treatment of anomalous head position associated with nystagmus. Cli Exp Vis Eye Res J 2019;2(1): 3-5.

Received: 13-11-2018;

Accepted: 06-12-2019

Purpose: The purpose of this study was to report the clinical features of seven eyes of seven adolescent patients with spontaneous intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage (IHAPSH).

Design: This was a retrospective case series study.

Participants: A total of seven adolescent patients with IHAPSH were participated.

Methods: All the patients were seen at the Joint Shantou International Eye Centre, between 2006 and 2014. The patient demographics, clinical history, vision, fundoscopy, and results of relevant investigations were collected.

Main Outcome Measures: This was a clinical history and fundoscopic appearance.

Results: All eyes (four males and three females) with IHAPSH had a median age at presentation of 15 years (mean 14.7, range 11-19). Four cases presented in the right eye and three cases in the left eye. All seven patients presented with blurring of vision and floaters upon awakening in the morning. No obvious underlying causes or predisposing factors were present. The presenting visual acuity ranged from 0.12 to 1.00. One eye had no refractive errors and the remaining six eyes had myopia ranging mild to moderate (-0.25 diopters (D)--4.00 D). None had tilted discs. In four eyes, subretinal hemorrhage was <2 disc diameters. There was associated vitreous hemorrhage in five eyes. There were no posterior vitreous detachments in any of the eyes. Visual field test showed an enlarged blind spot in four cases. Optical coherence tomography of the disc revealed optic disc swelling in two cases. Fluorescein angiography demonstrated leakage in the late phase of three eyes. At 2-24 months follow-up, the hemorrhage resolved in all seven cases with vision recovering fully to 20/20. Visual field defect of enlarged blind spots improved with the resolution of intrapapillary and subretinal hemorrhages.

Conclusions: The condition of IHAPSH resolved spontaneously without intervention in all cases. There appeared to be no predisposing factors for the development of this condition. Previously reported risk factors such as myopia, a tilted disc, Valsalva maneuver, and posterior vitreous detachment were not seen in these cases. This is the 1st time a series of young adults have been reported with this condition, all of whom presented in the same manner and had the same clinical outcomes.

Key words: Intrapapillary hemorrhage, subretinal hemorrhage, adolescents

How to cite this article: Yan CL, Brel&#c00E9;n ME, Chen H, Chen W. Spontaneous intrapapillary hemorrhage with adjacent peripapillary subretinal hemorrhage in adolescents. Cli Exp Vis Eye Res J 2019;2(1):6-10.

Received: 30-04-2019;

Accepted: 17-05-2019

Purpose: Subtle irregularities in the corneal flap may affect laser-assisted in situ keratomileusis (LASIK) outcomes. The aim of this study was to evaluate flap protection during ablation in myopic astigmatic patients.

Methods: Medical files and corneal topographies of consecutive patients with myopic astigmatism (>2.5 D) that underwent LASIK were retrospectively reviewed. The visual and refractive outcomes with and without flap protection during the procedure were compared. We calculated and compared safety index, efficacy index, index of success (Alpins vector analysis) and ratio between nasal and temporal ablation.

Results: We included 57 subjects that fulfilled inclusion criteria. Patients in the flap guarding group were similar to patients in the no-guarding group, in terms of pre-operative parameters and similar treatment zones were used in both groups. Post-operatively, the flap guarding group had a better efficacy index (1.08 ± 0.17 vs. 0.96 ± 0.24, P = 0.04) and index of success (0.16 ± 0.07 vs. 0.23 ± 0.17, P = 0.04). The proportion of subjects with more than double nasal over-ablation ratio (>200%) was significantly lower in the guarding group compared to the no-guarding group (04.2% [1/23] vs. 32.3% [11/34], P = 0.02). No significant differences were found between groups in terms of post-operative safety index, uncorrected visual acuity, best-corrected visual acuity, sphere, cylinder and keratometry.

Conclusion: Guarding the flap during high myopic astigmatic LASIK was associated with better visual and refractive outcomes.

Keywords: Efficacy, flap, high myopic astigmatic, laser-assisted in situ keratomileusis

How to cite this article: Duvdevan N, Mimouni M, Dominitz Y, Sela Y, Munzer G, Achiron A, Kaiserman I. Flap protection during laser-assisted in situ keratomileusis improves refractive outcomes in high myopicastigmatism. Cli Exp Vis Eye Res J 2019;2(1):11-17.

Received: 17-05-2019;

Accepted: 29-05-2019

Purpose: The purpose of this study was to evaluate the efficacy and outcome of viscosealing of incisions made during pediatric cataract surgery.

Design: This was a prospective case series.

Participants: A total of 96 eyes of 65 patients aged <10 years were included.

Methods: Analysis of all children with congenital cataract who underwent cataract surgery with intraocular lens implantation and sealing of the side port with 1.45% sodium hyaluronate was done at a tertiary care center. In all the patients’, phacoaspiration with primary posterior capsulorhexis and anterior vitrectomy was done.

Results: Mean age at surgery was 42.76 months (3.5 years ± 3.1 years). Complications encountered were irregular pupil in 6 eyes (6.25%), iridolenticular adhesions in 8 eyes (8.3%), and shallow anterior chamber in 6 eyes (6.25%) postoperatively. Most of these complications were seen in children <6 months of age (65.3%). At 3 months postoperatively, the mean spherical equivalent was 1.34 DS ± 2.86 D and mean astigmatism -0.05 ± 1.55 D.

Conclusion: Viscosealing is an effective way to close side ports in children above 6 months of age. It does away with suture-related problems and need for the 2nd time general anesthesia

Key words: Incision closure, pediatric cataract, wound stability

How to cite this article: Kaur S, Sukhija J, Jugran D, Ram J. Viscosealing: A novel technique for port closure in pediatric cataract surgery. Cli Exp Vis Eye Res J 2019;2(1):18-21.

Received: 17-04-2019;

Accepted: 11-05-2019

Glaucoma is a leading cause of blindness worldwide. Treatment typically consists of the chronic administration of topical eye drops. However, fluctuations in intraocular pressure, local and systemic side effects, and low patient compliance have prompted the development of various sustained drug delivery platforms, both extraocular and intraocular, over the last decade. Some are currently undergoing advanced clinical trials. Extraocular platforms include wearable ocular surface devices (such as ocular insert rings, topical ocular drug delivery devices, gel-forming eye drops, collagen shields, and contact lenses), punctal plugs (such as the OTX-TP and Latanoprost punctal plug delivery system), and subconjunctival injections (such as the Eye-D VS-101, POLAT-001, GB-6249-103, IBI-60089, and dorzolamide-loaded polymer microparticles). Intraocular platforms include mainly intracameral implants (such as the Bimatoprost SR, ENV515 Travoprost XR, iDose, OTX-TIC, PA5108, and DE-117-loaded PLC), although other devices are drawing attention as potential treatment alternatives (such as intravitreal nanosponges and supraciliary implants). The purpose of this review is to describe these emerging sustained drug delivery systems for the treatment of glaucoma and ocular hypertension.

Key words: Compliance, delayed-action preparations, drug delivery systems, glaucoma, intraocular pressure

How to cite this article: Shouchane-Blum K, Geffen N, Zahavi A. Sustained drug delivery platforms - A new era for glaucoma treatment. Cli Exp Vis Eye Res J 2019;2(1):22-29.

Received: 21-05-2019;

Accepted: 17-06-2019

Over the last decade, several new surgical devices and treatment options have been developed for the management of glaucoma. Together, known as micro-invasive glaucoma surgery, they aim to provide a safer approach to glaucoma surgery. Although the early devices were used to either stent or ablate a segment of the trabecular meshwork, newer devices such as the XEN gel stent (Allergan Inc., Dublin, Ireland), offer the possibility of creating a safer, more predictable filtering bleb. Since its FDA approval in 2016, several retrospective case series and prospective studies have highlighted the efficacy of the XEN gel stent with regards IOP lowering and reduction in the need for glaucoma medications. The XEN gel stent has also been shown to have a favorable safety profile in terms of intraoperative and post-operative complications. The major concern is the need for bleb intervention in the form of needling and injection of anti-fibrotic agents. This review focuses to summarize the current knowledge on the XEN gel stent for treatment of various subtypes of glaucoma.

Key words: Glaucoma surgery, micro-invasive glaucoma surgery, XEN gel stent

How to cite this article: Dangda S, Castanos MV, Do A, Panarelli JF. XEN gel stent: A review. Cli Exp Vis Eye Res J 2019;2(1):30-37.

Accepted: 07-05-2019

Received: 27-05-2019

To report a case of gentamicin-induced macular toxicity following subconjunctival injection of gentamicin after flanged intraocular lens (IOL) fixation. A 54-year-old female presented with poor post-operative visual gain following uncomplicated pars plana vitrectomy with dropped nucleus removal and flanged IOL fixation. Clinical examination revealed a patch of retinal opacification at the posterior pole with surrounding cotton-wool spots. Fluorescein angiography demonstrated a sharply demarcated area of retinal ischemia with pruning of the surrounding retinal vessels. The findings were suggestive of gentamicin-induced macular toxicity. A short course of systemic corticosteroids failed to bring about significant improvement and the patient developed retinal atrophy in the area. Subconjunctival antibiotics can gain access into the eye in cases with sutureless transconjunctival flanged IOL fixation. Drugs with known intraocular toxicity such as gentamicin should be avoided in such cases.

Key words: Aminoglycoside toxicity, drug toxicity, flanged intraocular lens fixation, gentamicin toxicity, trans-scleral-fixated intraocular lens

How to cite this article: Singh SR, Dogra M, Chandra K, Dogra MR. Gentamicin-induced macular toxicity following flanged intraocular lens fixation. Cli Exp Vis Eye Res J 2019;2(1):38-40.

Received: 11-03-2019

Accepted: 17-04-2019

Posterior chamber pseudophakic pupillary block (PPB) due to anterior optic capture is a rare condition with possible grave consequences. It can lead to extremely elevated intraocular pressure (IOP) and absence of anterior chamber space which may preclude the use of standard treatment methods. We describe a novel technique for its alleviation. An 80-year-old woman presented to a tertiary medical center with the left pupillary block 3 months after implantation of an intraocular lens (IOL) in the ciliary sulcus and 3 days after routine evaluation for age-related macular degeneration with tropicamide 0.5%. By exerting manual pressure on the corneal surface, the inferior half of the IOL optic was reduced into the posterior chamber, creating sufficient space for immediate Neodymium:Yttrium-Aluminum-Garnet (Nd:YAG) peripheral iridotomy. After IOP dropped to 20 mmHg, the upper half of the IOL optic was reduced into the posterior chamber using a Sinskey hook inserted through a single limbal paracentesis, and the anterior chamber was filled with an ophthalmic viscoelastic device. The device was subsequently aspirated and 1% acetylcholine was injected to constrict the pupil above the IOL optic. There were no operative complications. The corneal edema resolved, with normal cupping of the optic nerve head. At 3 months, the IOP was stable at 14-18 mmHg. The maneuver described to allow for laser treatment of PPB is technically simple and non-invasive and was highly successful in an 80-year-old patient. Repositioning the pseudophakic IOL optic may be planned as a subsequent, non-urgent procedure.

Key words: Non-invasive maneuver, optic capture, pseudophakic pupillary block

How to cite this article: Shilova N, Sternfeld A, Bahar I, Livny E. Novel maneuver for the alleviation of pseudophakic optic capture and consequent pupillary block: A case report and technique. Cli Exp Vis Eye Res J 2019;2(1):41-44.

Received: 12-05-2019;

Accepted: 26-05-2019

Dental implants are often used in maxillofacial surgery. Extraocular muscle (EOM) laceration is a rare complication of the mandibular-zygomatic drilling accidentally penetrating the orbital space. In a single previous report of a lost lacerated lateral rectus muscle post-dental implantation, the muscle was not found, and transposition of the vertical muscles was performed to restore ocular motility partially. Here we present a case of traumatic laceration of the lateral rectus muscle and a successful reconstruction six weeks after injury. Our case demonstrates the EOM laceration was missed on initial radiological assessment, which led to a delayed surgical exploration. Fortunately, the lacerated muscle was re-attached. Botulinum toxin was injected to the antagonist medial rectus muscle in order to improve surgical outcome. Radiological assessment may not be sufficiently sensitive to detect EOM cut. Therefore, surgical exploration should be performed according to clinical suspicion. Even if the surgical procedure is delayed due to hematoma or edema, there is a potential for complete functional recovery.

Key words: Dental implant, extraocular muscle, diplopia, strabismus, reconstruction

How to cite this article:Vardizer Y, Shamaly S, Raveh D, Shamir D, Borisovsky N, Man-Peles I, Goldenberg-Cohen N. Dental implant causing lateral rectus muscle traumatic laceration. Cli Exp Vis Eye Res J 2019;2(1):45-48.

Received: 20-05-2019

Accepted: 07-06-2019

Presentation of bilateral simultaneous angle closure in a patient must alert one to look beyond the common “knee-jerk” diagnosis of acute primary angle closure (APAC). We describe a case with bilateral simultaneous acute angle closure with signs of anterior chamber inflammation with intraocular pressure of 60 mmHg. Based on the clinical details and ultrasonic findings of peripapillary choroidal thickening and supraciliary fluid, a diagnosis of Vogt-Koyanagi-Harada (VKH) disease was made. Our case highlights that every angle closure is not a primary angle closure requiring laser peripheral iridotomy. Detailed clinical examination with appropriate investigations could prevent misdiagnosis of APAC in VKH.

Key words: Glaucoma, Angle closure, Imaging

How to cite this article: Singh S, Kaushik S, Kaur S, Singh R, Pandav SS. Vogt-Koyanagi-Harada syndrome presenting as bilateral simultaneous acute angle closure. Cli Exp Vis Eye Res J 2019;2(1):49-51.

Received: 16-02-2019;

Accepted: 03-03-2019

Background: Tuberous sclerosis is characterized by hamartomas in multiple organs including retinal hamartomas. Everolimus is a novel treatment for tuberous sclerosis-related lesions. We present a case where everolimus led to lesion shrinkage, the skin tuberomas, as well as the retinal hamartomas, indicating that its effect can be detected, measured, and monitored with an ocular examination.

Case Report: We describe a 24-year-old female diagnosed with tuberous sclerosis since birth, with multiorgan involvement. The patients had multiorgan involvement, with angiolipomas of the kidney resistant to treatment. She also underwent subependymal giant cell astrocytoma brain tumor resection. The patient was treated with everolimus after recurrent embolization failed to shrink the renal angiolipomas. The tumors responded well to treatment.

Conclusions: Skin lesions disappeared, and fundus photos and repeat retinal optical coherence tomography measurements documented shrinkage of the retinal hamartomas during the 24 months of treatment. We conclude that a simple eye examination can monitor treatment effectiveness.

Key words: Tuberous sclerosis, retinal hamartomas, everolimus, mammalian target of rapamycin inhibitor, subependymal giant cell astrocytoma

How to cite this article: Herscu K, Cohen R, Man-Peles I, Michowiz S, Goldenberg-Cohen N. Retinal hamartomas respond to everolimus treatment for tuberous sclerosis: A case report. Cli Exp Vis Eye Res J 2019;2(1):52-54.

Received: 12-05-2019

Accepted: 19-05-2019