bluuebunny/crossref_metadata_2025 huggingface dataset:
RECONSTITUTION OF THE CHORIOCAPILLARIS IN ACUTE POSTERIOR MULTIFOCAL PLACOID PIGMENT EPITHELIOPATHY
Authors: Lee Jessica G. , Spaide Richard F.
Published: February 2023

Purpose:

The purpose of this study was to describe findings derived from extensions of optical coherence tomography, including volume rendering and frame-averaged optical coherence tomography angiography (OCT-A), in a case of acute posterior multifocal placoid pigment epitheliopathy (APMPPE).

Methods:

This is a case report of a patient with APMPPE imaged during the acute and convalescent stages.

Results:

A 20-year-old man presented with an acute change in vision. He had multiple yellow–white placoid lesions at the level of the retinal pigment epithelium in the macula and nasal to the optic nerve in both eyes. Within 2 weeks, his visual acuity worsened to 20/80 and 20/400 in the right and left eyes, respectively. Spectral domain OCT showed focal defects in the ellipsoid and retinal pigment epithelium layers. Volume-rendering OCT-A showed inflammatory cells in the outer nuclear layer above the APMPPE lesion. Frame-averaged OCT-A revealed significant loss of capillary flow signal within capillary segments of the choriocapillaris. Ten weeks after presentation, there was resolution of the placoid changes, discontinuance of the inflammatory infiltrate in the outer nuclear layer, and significant reconstitution of flow in the choriocapillaris. The visual acuity was 20/20 in both eyes.

Conclusion:

Novel volume-rendered and frame-averaged OCT-A images in a patient with APMPPE allowed detection of inflammatory cell infiltrate in the outer nuclear layer and reversible capillary segment nonperfusion of associated APMPPE lesions. The findings suggest short-term insults to choriocapillaris function may be reversible and can be tracked with modern imaging techniques.
Rhegmatogenous Retinal Detachment with concurrent Choroidal Detachment and Macular Hole Formation after Uncomplicated Cataract Extraction and Intraocular Lens Implantation – A Case Report and Review of Literature
Authors: Tsui Jonathan C , Brucker Alexander J , Kolomeyer Anton M
Published: February 2023

Purpose:

To describe a case of concurrent rhegmatogenous retinal detachment, choroidal detachment, and macular hole (RRD-CD-MH) formation in a patient after uncomplicated cataract extraction and intraocular lens implantation (CEIOL). In addition, we summarize the previously reported cases of RRD-CD-MH in the literature.

Methods:

Interventional case report and literature review.

Results:

A 71-year-old white man without relevant past medical or ocular history underwent an uncomplicated CEIOL. He presented three weeks later with counting fingers vision and intraocular pressure (IOP) of 5 mmHg. On dilated fundus examination, multiple superior tears and total RRD with a serous CD was evident. Intraoperatively, a full-thickness MH was identified. The patient underwent routine RRD and MH repair, with instillation of 1000 centistoke silicone oil (SiO). The retina successfully re-attached, the CD resolved, and the IOP normalized; however, the MH did not initially close. The SiO was removed ∼4 months later and, while the MH remained open, the patient’s vision improved to 20/80. Approximately three years after the surgical repair, the MH closed spontaneously, and the vision remained at 20/80.

Conclusion:

Our patient developed an RRD-CD-MH post-uncomplicated CEIOL. The MH displayed delayed closure. The vision improved after surgical repair, and remained stable in the long-term.
Efficacy of Maribavir in Valganciclovir-Resistant Cytomegalovirus Retinitis
Authors: Tsui Jonathan C. , Huang Vincent , Kolomeyer Anton M. , Miller Charles G. , Mishkin Aaron , Maguire Albert M.
Published: February 2023

Purpose

To determine whether maribavir is effective at treating ganciclovir-resistant cytomegalovirus retinitis.

Methods

Retrospective case report of a lung transplant patient with bilateral cytomegalovirus retinitis documented with serum and aqueous humor studies and color fundus photographs

Results

A 72-year-old lung transplant patient with active ganciclovir-resistant cytomegalovirus was treated with intravitreal foscarnet therapy in one eye. Retinitis developed in the contralateral eye and was managed with systemic maribavir alone. Active retinitis regressed in both the eye treated with intravitreal foscarnet and the un-injected eye.

Conclusions

This patient’s results suggest that systemic maribavir is an effective treatment for treatment-resistant cytomegalovirus retinitis.
Diffuse posterior scleritis associated with HLA-B14* managed with multimodal imaging: case report and review of the literature
Authors: Raneri Marco , Fossataro Federica , Martines Francesco , Maione Giulio , Pece Alfredo
Published: February 2023

Purpose:

To report a case of posterior scleritis (PS) in an HLA-B*14 positive patient highlighting the crucial role of multimodal imaging and of autoimmune systemic disease screening for the diagnosis.

Methods:

Case Report.

Results:

A 73-year-old woman, complaining of ocular discomfort in right eye (RE), presented conjunctival hyperemia, keratic precipitates involving the anterior segment and four chorioretinal elevations with macular folds at fundus examination. Multimodal imaging and systemic diagnostic work-up were performed. While awaiting results, topical corticosteroid was prescribed. Four days later, worsening of exudative chorioretinal was detected. Except for erythrocyte sedimentation rate, tests were negative, while molecular typing of HLA genes was positive for HLA-B*14. Diagnosis of PS was confirmed by ultrasound examination while diagnosis of ankylosing spondylitis was made by rheumatologist. The patient was given systemic corticosteroid and one month later the posterior segment was unremarkable.

Conclusion:

HLA-B*14 may configure as a causal factor so autoimmune systemic disease screening should rule this out in management of PS, which should be diagnosed on the basis of multimodal imaging.
Three cases of acute retinal necrosis with atypical fundus findings
Authors: Chujo Shinichiro , Matsubara Hisashi , Ichio Atsushi , Matsui Yoshitsugu , Sugimoto Masahiko , Kondo Mineo
Published: February 2023

Purpose:

To determine the mechanism for the development of segmental granular lesions along the retinal vessels in eyes with acute retinal necrosis (ARN).

Method:

This was a retrospective analysis of the medical records of 3 eyes of 3 patients who were diagnosed with ARN that had atypical segmental granular lesions aligned along the retinal vessels.

Results:

The segmental granular lesions were present on both the retinal arteries and veins throughout the retina. Optical coherence tomography (OCT) showed that the granular lesions protruded into the vitreous cavity. Histopathological examinations confirmed that the lesions were made up of lymphocytes.

Conclusions:

We suggest that the granular lesions were formed by a mechanism similar to that of HTLV-1-associated uveitis (HAU). We also found that the granular lesions disappeared soon after vitrectomy.
Anatomical and functional outcomes of bevacizumab treatment in pediatric autosomal recessive bestrophinopathy
Authors: Mitchell Jacobs , El-Rashedy May , Fowler Nicholas , Shirkey Belinda , Kitchens John , Maldonado Ramiro S
Published: February 2023

Purpose:

To report functional and anatomical outcomes of anti-VEGF treatment in eyes with autosomal recessive Bestrophinopathy (ARB) presenting in the first decade of life.

Methods:

Case series of four eyes from two siblings with compound heterozygous mutations in the BEST1 gene who were treated with eight monthly intravitreal bevacizumab (IVB) injections. Response to treatment was analyzed using fundus photography (CFP), fundus autofluorescence (FAF), optical coherence tomography (OCT), OCT angiography (OCTA), and Microperimetry (MP).

Results:

Patient-1 (male, age 9 yrs.) with visual acuity of 20/20 OD and 20/50 OS. Patient-2 (female, age 10 yrs.), with visual acuity of 20/25 OD, 20/20 OS. All eyes had multifocal subretinal deposition of lipofuscin, subretinal fluid and three had choroidal neovascularization (CNV). Lipofuscin material reabsorbed in 2/4 eyes, the CNV regressed in 3/3, a bacillary detachment resolved (1/1) but the subretinal fluid did not change. Functional improvement in visual acuity was noted but MP showed scattered areas of reduced retinal sensitivity. No ocular or systemic side effects were detected.

Conclusion:

Anti-VEGF treatment of choroidal neovascularization in eyes with ARB resulted in anatomical changes that were only clinically significant in the eye with decreased visual acuity. The hyporeflective subretinal material remained unchanged suggesting a non-exudative cause. These findings provide new insights into the management of ARB, especially in pediatric subjects with CNV.
Fungal Infection After Descemet Membrane Endothelial Keratoplasty: Incidence and Outcomes
Authors: Wong Brittany M. , Bonnet Clémence , Ghaffari Reza , Houser Kourtney , DeMatteo Jennifer , Lau Nicola , Aldave Anthony J.
Published: February 2023

Purpose:

The aim of the study was to describe the incidence, presentation, management, and outcomes of fungal infection after Descemet membrane endothelial keratoplasty (DMEK).

Methods:

Retrospective case series of culture-proven fungal infections after DMEK reported in the literature, directly by surgeons, and to the Eye Bank Association of America from January 1, 2011, to December 31, 2020.

Results:

The domestic incidence of fungal infections, fungal keratitis, and fungal endophthalmitis after DMEK from 2011 to 2020 was 3.5, 1.3, and 2.2 per 10,000 cases, respectively, with no significant increasing trend. Thirty-four cases were identified, 14 (41.2%) published and 20 (58.8%) unpublished. Donor tissue fungal cultures were performed in 20 of the 34 (58.8%) cases and were positive in 19 of the 20 (95.0%), all but one Candida species. Recipient fungal cultures were performed in 29 of the 34 (85.3%) cases and were positive in 26 of the 29 (89.7%), all but one Candida species. Infection presented a mean of 33 ± 38 days (median 23, range 2–200, outlier 949) after transplantation: 25 (73.5%) with endophthalmitis and 9 (26.5%) with keratitis. Topical, intrastromal, intracameral, intravitreal, or systemic antifungal therapy was used in all 27 eyes with treatment data. Surgical intervention (DMEK explantation or partial removal, repeat endothelial keratoplasty, penetrating keratoplasty, and/or pars plana vitrectomy) was required in 21 of the 27 (77.8%) eyes. The corrected distance visual acuity at the last follow-up was ≥20/40 in 13 of the 27 (48.1%) eyes and counting fingers or worse in 6 of the 27 (22.2%) eyes.

Conclusions:

Fungal infection is a rare but serious complication of DMEK that results in counting fingers or worse corrected distance visual acuity in nearly a quarter of eyes.
Analysis of Various Modalities for Intraocular Pressure Measurement in Relation to Keratoconus Severity in 246 Eyes of the Homburg Keratoconus Center
Authors: Knauf Daniela , Seitz Berthold , Schießl Gesine , Zemova Elena , Flockerzi Elias
Published: February 2023

Purpose:

Intraocular pressure (IOP) measurement may be difficult in keratoconus (KC) due to corneal protrusion and irregular astigmatism. This study aimed to assess which IOP measurement modality is least affected by KC severity.

Methods:

Data from 246 corneas of 246 patients with KC were retrospectively analyzed. KC stages were determined using the Topographic KC (TKC) and ABCD KC classifications derived from Pentacam (Oculus, Germany). IOP was measured using Goldmann applanation tonometry (GAT), Ocular Response Analyzer (ORA, Reichert Instruments, USA), and Corvis ST (CST, Oculus, Germany). Cronbach alpha (CA), analysis of variance with Bonferroni correction, Dunnett T3, and Pearson correlation were performed.

Results:

Using CA, the reliability of measurements using various modalities increased to 0.764 to 0.943 when excluding IOP Goldmann overall and in each KC stage (TKC and ABCD). Analysis of variance revealed significant differences between TKC and ABCD stages for almost all IOP modalities. The Bonferroni post hoc test showed significant differences between the measured IOP in earlier and advanced KC stages, except for the biomechanically CST-corrected IOP (bIOP). Pearson correlation analysis showed a significant correlation between IOP and thinnest corneal thickness (TCT) for all IOP modalities except bIOP.

Conclusions:

CST-based bIOP seems to be best suited for IOP measurement in KC because it did not correlate with TCT in contrast to IOP measurements by ORA or GAT. The measurement results from GAT in patients with KC should be interpreted with care and always in view of corneal thickness. As a thumb rule, we suggest to add at least 2 mm Hg to the measured GAT value.
Bacterial Keratitis: Clinical Features, Causative Organisms, and Outcome During a 13-year Study Period
Authors: Almulhim Abdulmohsen , Alkhalifah Muhannad I. , Kalantan Hatem , Alsarhani Waleed K.
Published: February 2023

Purpose:

This study aimed to review clinical features, causative organisms, complications, and outcome of bacterial keratitis cases at a tertiary eye hospital.

Methods:

A retrospective study was conducted on clinically diagnosed bacterial keratitis cases from 2007 to 2019. Poor outcome was flagged if any of the following was identified: final visual acuity (VA) worse than 20/200, decrease in VA (1 line or worse compared with presenting VA), corneal perforation, endophthalmitis, failed graft, or cases requiring enucleation or evisceration.

Results:

The study included 263 cases of bacterial keratitis with 169 cases (64.3%) of culture-positive bacterial keratitis. Gram-positive bacteria were found to be the causative organism in 106 cases (62.8%). The most common types were coagulase-negative staphylococci (23.1%) and Pseudomonas (23.1%). Culture-positive bacterial keratitis was associated with the development of anterior chamber reaction (≥1+) on multivariate analysis [adjusted odds ratio (OR): 3.03, confidence interval (CI): 1.23–7.45, P = 0.016]. The complications that occurred in the current cohort included visually significant scar (64.7%), perforation (10.8%), cataract (8.8%), nonhealing epithelial defects (8.0%), corneal neovascularization (4.9%), endophthalmitis (4.6%), and hypotony (1.5%). On multivariate analysis, diabetes mellitus (adjusted OR: 3.51, CI: 1.59–7.76, P = 0.002), poor presenting best-corrected VA (adjusted OR: 3.95, CI 1.96–7.96, P < 0.001), and positive cultures (adjusted OR: 2.36, CI: 1.11–5.00, P = 0.025) were associated with poor outcome.

Conclusions:

Culture-negative keratitis had less severe infection and better outcomes when compared to culture-positive bacterial keratitis. Factors associated with poor outcome included diabetes, poor presenting VA, and positive cultures.
Video Grading of Descemet Membrane Endothelial Keratoplasty Surgery to Identify Surgeon Risk Factors for Graft Detachment and Rebubbling: A Post Hoc Observational Analysis of the Advanced Visualization In Corneal Surgery Evaluation Trial
Authors: Muijzer Marc B. , Delbeke Heleen , Dickman Mor M. , Nuijts Rudy M. M. A. , Jimale Hanad , van Luijk Chantal M. , Imhof Saskia M. , Wisse Robert P. L.
Published: February 2023

Purpose:

The aim of this study was to explore video-graded intraoperative risk factors for graft detachment (GD) and rebubbling in Descemet membrane endothelial keratoplasty surgery.

Methods:

A post hoc analysis of 65 eyes of 65 pseudophakic subjects with Fuchs endothelial dystrophy that underwent Descemet membrane endothelial keratoplasty surgery as part of the Advanced Visualization In Corneal Surgery Evaluation trial. All surgical recordings were assessed by 2 graders using a structured assessment form. A multinominal regression was performed to estimate the independent effect of video-graded intraoperative factors on the incidence of GD and rebubbling. Secondary outcomes are corrected distance visual acuity and endothelial cell density.

Results:

In total, 33 GDs were recorded, of which 17 required rebubbling. No significant predictors for GD or rebubbling were identified. However, the results revealed 2 clinically relevant patterns. An unfavorable graft configuration (ie, wrinkled, tight scroll, or taco-shaped) and a gas-bubble size smaller than the graft diameter were associated with an increased risk of GD [odds ratio (OR) 2.5 and OR 2.26, respectively] and rebubbling (OR 2.0 and OR 2.60, respectively). Inversely, a larger gas-bubble size was associated with a reduced risk of GD (OR 0.37) and rebubbling (OR 0.36). At 3 and 6 months postoperatively, corrected distance visual acuity was poorer in subjects requiring a rebubbling and endothelial cell density loss was higher in subjects with a partial GD.

Conclusions:

Our analysis revealed that the gas-bubble size and graft shape/geometry seem to be relevant clinical factors for GD and rebubbling, whereas descemetorhexis difficulty, degree of graft manipulation, graft overlap, and surgical iridectomy were not associated with an increased risk.
Effect of Head Trauma–Related Deaths on Corneal Endothelial Cell Loss in Eye Bank Donors
Authors: Oseni Jessinta , Rand Gabriel , Moon Jee Young , Gore Patrick , Edwards Brandon , Livesay Tina , Vizzerra Anthony , Chuck Roy S.
Published: February 2023

Purpose:

The purpose of this study was to examine the effect of head trauma–related deaths on corneal endothelial cell density (ECD) in eye bank donors.

Methods:

This is a retrospective study of 287 corneas from donors with causes of death secondary to motor vehicle accident with sustained head trauma (n = 50), gunshot wound to the head (n = 138), fall with sustained head trauma (n = 2), and non-head–related traumatic causes of death (n = 97). Donors older than age 50 years were excluded due to concern for undiagnosed Fuchs endothelial dystrophy as a potential confounder for the cause of endothelial cell loss. Donor characteristics, ECD, and focal endothelial cell loss on specular microscopy were compared between the groups. Donors in the head trauma and nonhead trauma groups were matched by age; there were 42 age-matched donors in both groups.

Results:

Age and ECD were negatively correlated (Pearson correlation coefficient = −0.57). Death-to-preservation time was not significantly different between the 2 groups (P value = 0.59). The mean ECD in the head trauma group was 2859 ± 370 cells/mm2 and 3041 ± 464 cells/mm2 in the nonhead trauma group. The head trauma group had a lower ECD (178 ± 70 cells/mm2, P value = 0.013). After matching for age, the difference in ECD between the 2 groups was −94 ± 82 cells/mm2 (P value = 0.26). The adjusted odds of having focal endothelial cell loss was not statistically significant (P value = 0.50) between the groups.

Conclusions:

After statistical adjustments, there were no differences between the head trauma and nonhead trauma groups.
Case–Control Study Examining the Composition of the Gut Microbiome in Individuals With and Without Immune-Mediated Dry Eye
Authors: Goodman Courtney F. , Doan Thuy , Mehra Divy , Betz Jason , Locatelli Elyana , Mangwani-Mordani Simran , Kalahasty Karthik , Hernandez Mireya , Hwang Jodi , Galor Anat
Published: February 2023

Purpose:

Gut microbiome alterations have been associated with various autoimmune diseases. There are limited data, however, on relationships between gut dysbiosis and immune-related dry eye (DE). Our aim was to compare the gut microbiome composition of individuals with early and late markers of Sjögren syndrome (SS) with controls without DE.

Methods:

We compared 20 individuals with positive early markers [antisalivary protein 1 (SP1), antiparotid secretory protein (PSP), anticarbonic anhydrase 6 (CA6) IgG, IgA, and IgM, n = 19)], or late markers (anti-Ro/SS-A and anti-La/SS-B, n = 1) of SS with no comorbid autoimmune diagnoses and 20 age-matched and sex-matched controls. Collected stool samples underwent deep RNA sequencing. The main outcomes measured included gut microbiome composition and diversity.

Results:

A total of 20 cases [Dry Eye Questionnaire-5 15.2 ± 3.4, Ocular Surface Disease Index 55.1 ± 22.8, and Schirmer 7.1 ± 5.2 mm] were compared with 20 controls (Dry Eye Questionnaire-5 4.8 ± 3.8, Ocular Surface Disease Index 14.2 ± 12.3, and Schirmer 20.4 ± 9.2 mm). No differences were observed in α-diversity (P = 0.97) or overall community structure (P = 0.62). Between groups, 32 species were differentially abundant (P < 0.01). Among cases, 27 were relatively more abundant, including 10 Lactobacillus and 4 Bifidobacterium species. A relative depletion of 5 species was found in cases compared with controls, notably Fusobacterium varium and Prevotella stercorea.

Conclusions:

Differences in gut microbiome composition were found in individuals with mostly early markers of SS compared with controls. However, their clinical significance to DE manifestations remains unclear. Further studies are needed to elucidate the role of gut dysbiosis on immune dysregulation and disease activity in the various forms of immune-mediated DE.
Prospective In Vitro Comparison of Kerasave and Optisol-GS Corneal Storage Solutions
Authors: Tran Khoa D. , Ellison Mark , Straiko Megan M. W. , Giurgola Laura , Gatto Claudio , Galloway Joshua D. , Ragazzi Eugenio , D’Amato Tothova Jana
Published: February 2023

Purpose:

The aim of this study was to compare the performance of Kerasave and Optisol-GS for hypothermic corneal storage for 14 days.

Methods:

This study was a prospective laboratory investigation. Mate corneas were recovered into Kerasave or Optisol-GS (27 pairs) and stored at 2°C to 8°C for 14 days. Corneas were evaluated by trained eye bank technicians, and study parameters were compared between the initial and final evaluations. Endothelial cell density (ECD), hexagonality (HEX), and coefficient of variation (CV) were evaluated by specular microscopy, and central corneal thickness (CCT) was examined by optical coherence tomography after 1, 3, 7, and 14 days of storage. Corneal transparency was scored using slit lamp examination at days 1 and 14.

Results:

Average ECD, HEX, and CV for the Kerasave (2653 ± 303 cells/mm2, 57 ± 4%, and 36 ± 3%) and Optisol-GS (2623 ± 306 cells/mm2, 57 ± 5%, and 36 ± 4%) groups were not significantly different at day 1. There was also no difference at any other study time points (all P > 0.05). ECD did not significantly change from day 1 to day 14 in either group (P > 0.05), but a statistically significant change in HEX and CV was observed between day 1 and day 14 in both groups (P < 0.01). Average CCT measured at day 1 for corneas stored in Kerasave was 622 ± 49 μm and those stored in Optisol-GS was 580 ± 35 μm (P < 0.01). The difference in CCT measurements was not significantly different at day 14 (Kerasave: 674 ± 46 μm vs. Optisol-GS: 647 ± 58 μm, P > 0.05). Corneal transparency was not significantly different between the 2 groups at day 1 or day 14.

Conclusions:

The corneal quality and clinically relevant parameters including ECD, endothelial morphometry, and corneal transparency were not different in corneas stored in Kerasave or Optisol-GS for 14 days. The initial difference in CCT between the 2 groups decreased at day 14. These results demonstrated that Kerasave corneal storage solution preserves the corneal endothelium similarly to Optisol-GS.
Use of Ethylenediaminetetraacetic Acid in Chronic Calcium-Based Chemical Injury
Authors: Arora Anchal , Sahu Srikant Kumar , Muni Ipsita , Sharma Aakash
Published: February 2023

Purpose:

This study presents the successful management of a patient with chronic chemical-based injury using ethylenediaminetetraacetic acid (EDTA) chelation.

Methods:

This is a case report of a 59-year-old man who presented to us 2 months after a bilateral, accidental, ocular injury with lime particles at his workplace.

Results:

The patient was initially managed with extensive debridement and amniotic membrane grafting for both eyes. At 4-month follow-up, the left eye appeared to have extensive calcium-based plaques. 0.02N EDTA chelation was performed for his left eye. Postchelation, the visual acuity improved to 20/800. At 1-week follow-up, a repeat EDTA chelation was performed. The corneal clarity improved further, and the patient recovered a visual acuity of 20/200.

Conclusions:

EDTA chelation in the setting of calcium deposition in the chronic phase of chemical injuries can be reasonably effective.
Corneal Plana-Like Phenotype With Peripheral Scleralization Associated With a Pathogenic Variant of PITX2: A Case Report
Authors: Franco Elena , Scanga Hannah L. , Nischal Ken K.
Published: February 2023

Purpose:

The aim of this study was to report a case of corneal plana-like phenotype with bilateral peripheral scleralization associated with a PITX2 pathogenic variant.

Methods:

Clinical findings were obtained by ophthalmologic examination. Molecular diagnosis was performed by whole-exome sequencing in the patient and his parents.

Results:

A 12-month-old male patient present with bilateral peripheral corneal scleralization, corneal plana-like phenotype, and iris hypoplasia. The genetic analysis revealed a de novo PITX2 pathogenic variant (c.323G>A, p.R108H).

Conclusions:

PITX2 c.323G>A (p.R108H) can be associated with a unique corneal plana-like phenotype with peripheral scleralization, and thus, PITX2 should be targeted in genetic testing of this specific phenotype.
Posterior Segment Air Injection–Assisted Descemet Membrane Endothelial Keratoplasty in Pseudophakic and Vitrectomized Eyes
Authors: Li Shaowei , Miao Yuan , Liang Weiyan , Liu Chang , Li Ling
Published: February 2023

Purpose:

This study aimed to present a novel technique for Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic and vitrectomized eyes.

Methods:

The sterile air was injected into the posterior eye segment (anterior vitreous cavity) as a barrier to prevent the fluid of the vitreous cavity flowing into the anterior chamber, levitating the iris–lens diaphragm to flatten the anterior chamber during the surgery. This approach assists in the unfolding of the donor endothelial graft, helping to perform DMEK surgery on patients with a posterior intraocular lens (IOL) and vitrectomy.

Results:

Four cases presented with corneal endothelial decompensation (pseudophakic bullous keratopathy) with previous IOL implantation and vitrectomy underwent DMEK with this technique. The Descemet endothelial graft unfolding time after air injection was 68.75 ± 8.96 seconds. No graft displacement occurred during the surgery. The uncorrected and corrected distance visual acuities were improved in 3 of 4 patients. The corneas were transparent, and there was no graft detachment observed postoperatively in all 4 patients.

Conclusions:

The posterior eye segment air injection can reduce the difficulty of unfolding the DMEK graft in patients after IOL implantation and vitrectomy and the potential intraoperative and postoperative complications, allowing for easy performance of DMEK surgery on pseudophakic and vitrectomized eyes for corneal endothelial dysfunction.
Clinical Outcomes of Transscleral-Sutured Intraocular Lens Combined With Descemet Membrane Endothelial Keratoplasty
Authors: Gouvea Larissa , Din Nizar , AlShaker Sara , Gendler Shai , Weill Yishay , Chan Clara C. , Rootman David S.
Published: February 2023

Purpose:

The aim of the study was to report clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK) combined with transscleral-sutured intraocular lens (IOL) compared with DMEK combined with phacoemulsification and posterior chamber IOL (Phaco-DMEK).

Methods:

A retrospective chart review of all patients who underwent DMEK combined with transscleral-sutured intraocular lens fixation or combined with phacoemulsification for Fuchs endothelial corneal dystrophy from 2016 to 2021 at the Toronto Western Hospital or the Kensington Eye Institute (Toronto, ON, Canada) and had at least 18 months of follow-up was performed. Main outcomes were postoperative distance-corrected visual acuity, rebubbling rate, graft survival rate, and complications.

Results:

Twenty-one cases of DMEK combined with transscleral-sutured IOL (DMEK-TSS-IOL) and 44 cases of Phaco-DMEK were evaluated. Twelve eyes (57.15%) had a foldable acrylic 3-piece IOL (AR40E) and 9 (42.85%) had a single-piece polymethylmethacrylate (PMMA) IOL (CZ70BD). LogMAR distance-corrected visual acuity improved significantly from 1.48 ± 0.62 (SD) to 0.86 ± 0.82 (P = 0.01) 12 months after DMEK-TSS-IOL and from 0.41 ± 0.29 logMAR to 0.11 ± 0.11 logMAR (P < 0.0001) after Phaco-DMEK. No statistically significant differences were observed in donor (P = 0.97) or 1-year postoperative endothelial cell density (P = 0.11) between the groups. Rebubbling was necessary in 33.33% of eyes in DMEK-TSS-IOL compared with 25% of Phaco-DMEK eyes (P = 0.55). Graft survival rate was 76.19% in the DMEK-TSS-IOL group compared with 90.90% in the Phaco-DMEK group (P = 0.13).

Conclusions:

Transscleral-sutured IOL combined with DMEK is an option for the management of endothelial diseases in aphakic eyes or those which require IOL exchange for the experienced surgeon. However, when compared with routine Phaco-DMEK, there are higher complication and lower survival rates at 18 months.
Introducing a Revised Tissue Saving Protocol for Combined Topography-Guided Photorefractive Keratectomy and Cross-Linking in Keratoconic Corneas
Authors: Yousif Mohamed Omar , Elkitkat Rania Serag , Edrees Eman Samir , Alaarag Noha Abdelsadek
Published: February 2023

Purpose:

The aim of this study was to introduce a revised tissue-saving technique for combined topography-guided photorefractive keratectomy (PRK) and cross-linking for keratoconus (KC) treatment and to evaluate its efficacy, safety, and stability.

Methods:

This retrospective, noncontrolled study was performed at Maadi Eye Subspecialty Center and Eye Care Center, Cairo, Egypt. The technique was performed on virgin keratoconic corneas with 3 different morphological patterns of ectasia. It involves performing topography-guided PRK before epithelial removal, followed by customized phototherapeutic keratectomy (PTK) that is tailored to each cornea after studying the treatment profile on the laser treatment screen. The electronic medical records were explored for preoperative and postoperative data, including subjective refraction and topographic data (using Sirius topographer).

Results:

The study was conducted on 123 eyes of 93 patients with a mean age of 27.98 years ±6.06. The follow-up ranged from 6 to 36 months (mean ± SD of 16.2 months ±10.4). The results showed statistically nonsignificant differences among the 3 ectasia subgroups in treatment spherical equivalent, treatment maximum depth, thickness of removed epithelium, and thinnest residual stromal bed. There were statistically significant differences in almost all values between the preoperative and postoperative data, with significant postoperative patients' improvement (P value <0.001). The subgroups' results were almost the same as the whole cohort's results. The safety and efficacy indices of the performed procedure showed remarkably high values (1.48 ± 0.21 and 0.87 ± 0.40, respectively).

Conclusions:

This revised protocol for KC management maximally preserves stromal tissue with proven efficacy, safety, and stability.
Cornea Classic: Stern, Beuerman, Fox, Gao, Mircheff, and Pflugfelder, “The Pathology of Dry Eye: The Interaction Between the Ocular Surface and Lacrimal Glands” (1998)
Authors: Shtein Roni M.
Published: February 2023

In one of the most frequently cited articles from Cornea, Stern et al's “The pathology of dry eye: the interaction between the ocular surface and lacrimal glands” (1998) revolutionized our current understanding of the pathophysiology of dry eye disease.
Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation
Authors: Chaudhary Simmy , Kate Anahita , Chappidi Kiranmayi , Basu Sayan , Shanbhag Swapna S.
Published: February 2023

Purpose:

The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD).

Methods:

This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs.

Results:

The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4–17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 (P < 0.001) after SLET and to logMAR 0.6 (P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit.

Conclusions:

CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.
Validity of Algorithms to Identify Patients With Glaucoma Using the Japanese Claims Data
Authors: Fujita Asahi , Aoyama Yurika , Yamana Hayato , Konishi Takaaki , Hashimoto Yohei , Aihara Makoto , Yasunaga Hideo
Published: February 2023

Précis:

Diagnostic or antiglaucoma drug records in the Japanese claims data showed a high validity in identifying glaucoma patients. Specific subtypes were identified with high specificity and negative predictive values but low sensitivity and positive predictive values.

Purpose:

Despite the widespread use of administrative claims data in epidemiological research on glaucoma, only a few studies have investigated the validity of the methods in defining patients with glaucoma using diagnoses and drug records. We aimed to evaluate the validity of these algorithms in identifying patients with glaucoma using the Japanese claims data.

Methods:

Two ophthalmologists independently reviewed the medical charts and administrative claims data of 500 randomly selected patients who visited the Department of Ophthalmology of an academic hospital in 2019. We constructed 12 algorithms to identify patients with any type and specific subtypes of glaucoma using the claims records of diagnosis, antiglaucoma drugs, and visual field tests. We regarded the diagnosis of glaucoma based on the medical charts as the reference standard and calculated the sensitivity, specificity, and positive and negative predictive values of each algorithm based on the claims data.

Results:

The algorithms of ≥1 diagnostic record per year and ≥1 antiglaucoma drug record per year exhibited sensitivities of 94.6% and 89.2%, respectively, and specificities of 88.9% and 98.3%, respectively. An increase in the frequency of records resulted in a decreased sensitivity and slightly increased specificity. The addition of visual field tests did not improve the validity. The algorithms for specific subtypes of glaucoma exhibited high specificity and relatively low sensitivity.

Conclusion:

Diagnostic or antiglaucoma drug records in the Japanese claims data were useful for identifying patients with glaucoma. Researchers should select identification algorithms based on the study design.
Quantification of Hypotony Maculopathy Using Spectral-Domain Optical Coherence Tomography
Authors: Dumas Rémy , Lacourse Magaly , Kassem Rabea , Lesk Mark R. , Costantino Santiago
Published: February 2023

Précis:

We provide a free-to-use, open-source algorithm to quantify macular hypotony based on optical coherence tomography (OCT) images. This numerical approach calculates a metric that measures the deviations of Bruch’s membrane from a smooth ideal retinal layer.

Purpose:

Hypotony maculopathy is a recurrent complication of glaucoma surgical interventions in which extremely low intraocular pressure triggers changes in the shape of retinal layers. Abnormal folds can often be observed in the retina using standard fundoscopy, but OCT is particularly important to appreciate the severity of symptoms at different depths. Despite the need for metrics that could be used for the informed clinical decision to evaluate the progression and resolution of macular hypotony, algorithms that quantify the retinal folds are not available in the literature or included in clinical imaging equipment. The purpose of this work is to introduce a simple algorithm that can be used to assess hypotony maculopathy from OCT B-Scans and volumes and a free, open-source implementation.

Methods:

The pipeline we present is based on a straightforward segmentation of Bruch’s membrane complex. The principal idea of quantification is to compute a smoothed version of this complex and analyze the deviations from an ideal interface. Such deviations are then measured and added to create a metric that characterizes each OCT B-Scan. A full OCT volume reconstruction is thus characterized by the average metric obtained from all planes.

Results:

We tested the metric we proposed against the assessment of 3 experts and obtained a very good correspondence, with Pearson correlation coefficients higher than 0.8. Furthermore, agreement with automatic analysis seemed better than between experts. We describe the pipeline in detail and illustrate the results with a group of patients, comparing baseline images, severe hypotony maculopathy, and a variety of outcomes.

Conclusion:

The tool we introduce and openly provide fills a clinical gap to quantitatively grade hypotony maculopathy. It offers a metric of relatively simple interpretation that can be used to help clinicians in cases where the regression of symptoms is not obvious to the naked eye. Our pilot study demonstrates reliable results, and an open-source implementation facilitates easy improvements to our algorithm.
Influence of 0.002% Omidenepag Isopropyl on Intraocular Pressure and the Cornea in Normal Tension Glaucoma
Authors: Lee Seung Hyeun , Lee Won Jun , Kim Kyoung Woo , Jeong Jae Hoon , Park In Ki , Chun Yeoun Sook
Published: February 2023

Précis:

Although Omidenepag isopropyl drops elicited stable intraocular pressure reductions in NTG patients, transient changes in refraction and corneal endothelial cells, significant increase of central corneal thickness, and corneal erosion should be considered.

Purpose:

To analyze the efficacy and safety of 0.002% omidenepag Isopropyl (OMDI) eye drops in patients with normal tension glaucoma (NTG).

Methods:

Medical records for 62 eyes treated with OMDI for ≥6 months were analyzed. Intraocular pressure (IOP), refraction, keratometry, central corneal thickness (CCT), endothelial cell count, coefficient of variation of endothelial cell area (CV), corneal erosion, and central retinal thickness were compared at baseline and 1, 3, and 6 months.

Results:

IOP significantly decreased from 13.4±3.8 to 11.9±3.0, 11.7±2.9, and 12.2±3.3 mm Hg at each follow-up (P<0.001). Endothelial cell count did not change, but CV transiently increased from 12.6 to 17.0 at 1 month, CCT increased from 531.5 to 538.4 μm, myopia changed from −1.5 to −1.9 D, and keratometry changed from 44.5 to 44.7 D. CV, myopia, and keratometry recovered to baseline at 6 months; however, CCT remained high. Significant corneal erosion was observed at 6 months. Central retinal thickness changes were not observed. There were improvements in prostaglandin-associated skin pigmentation (86.7%), eyelash elongation (40.0%), and deepening of the upper eyelid sulcus and ptosis (~30%) at 3 months after exchange to OMDI. Adverse reactions were corneal erosion (27.4%), corneal thickening (21.0%), conjunctival hyperemia (11.3%), photophobia (5.7%), blurred vision (5.7%), and anterior chamber cells (4.8%).

Conclusions:

OMDI eye drops elicited significant and stable IOP reductions after 6 months in NTG patients with low IOP. However, transient myopic and corneal endothelial cell changes, development of corneal thickening, and corneal erosion should be considered when using OMDI.
Acute and Postacute Clinical Characteristics of Coronavirus Disease 2019 in Children in Japan
Authors: Katsuta Tomohiro , Aizawa Yuta , Shoji Kensuke , Shimizu Naoki , Okada Kenji , Nakano Takashi , Kamiya Hajime , Amo Kiyoko , Ishiwada Naruhiko , Iwata Satoshi , Oshiro Makoto , Okabe Nobuhiko , Korematsu Seigo , Suga Shigeru , Tsugawa Takeshi , Nishimura Naoko , Hishiki Haruka , Fujioka Masashi , Hosoya Mitsuaki , Mizuno Yumi , Miyairi Isao , Miyazaki Chiaki , Morishima Tsuneo , Yoshikawa Tetsushi , Wada Taizo , Ouchi Kazunobu , Moriuchi Hiroyuki , Tanaka-Taya Keiko , Saitoh Akihiko
Published: February 2023

Background:

The clinical features of coronavirus disease 2019 (COVID-19) in children have been changing because of the emergence and rapid spread of variants of concern (VOC). The increase in cases infected with VOC has brought concern with persistent symptoms after COVID-19 in children. This survey aimed to analyze the clinical manifestations and persistent symptoms of pediatric COVID-19 cases in Japan.

Methods:

We analyzed the clinical manifestations of pediatric COVID-19 cases reported between February 2020 and April 2022 in Japan, using a dedicated database updated voluntarily by the members of the Japan Pediatric Society. Using the same database, we also analyzed persistent symptoms after COVID-19 in children who were diagnosed between February 2020 and November 2021.

Results:

A total of 5411 and 1697 pediatric COVID-19 cases were included for analyzing clinical manifestations and persistent symptoms, respectively. During the Omicron variant predominant period, the percentage of patients with seizures increased to 13.4% and 7.4% in patient groups 1–4 and 5–11 years of age, respectively, compared with the pre-Delta (1.3%, 0.4%) or Delta period (3.1%, 0.0%). Persistent and present symptoms after 28 days of COVID-19 onset were reported in 55 (3.2%).

Conclusions:

Our survey showed that the rate of symptomatic pediatric COVID-19 cases increased gradually, especially during the Omicron variant predominant period, and a certain percentage of pediatric cases had persistent symptoms. Certain percentages of pediatric COVID-19 patients had severe complications or prolonged symptoms. Further studies are needed to follow such patients.
Neonatal Early-Onset Sepsis Due to Haemophilus Influenzae in Utah
Authors: Varghese Alyssa , Blaschke Anne J. , Korgenski Ernest. Kent , Crandall Hillary
Published: February 2023

Haemophilus influenzae causes serious invasive disease in children and is described as an infrequent cause of neonatal early-onset sepsis (EOS). Here we present the clinical and microbiologic features of 10 cases of EOS due to H. influenzae in Utah.
Multiple MIS-C Readmissions and Giant Coronary Aneurysm After COVID-19 Illness and Vaccination: A Case Report
Authors: Haq Khadija , Anyalechi E. Gloria , Schlaudecker Elizabeth P. , McKay Rachel , Kamidani Satoshi , Manos Cynthia K. , Oster Matthew E.
Published: February 2023

Background:

Multisystem inflammatory syndrome in children (MIS-C) rarely involves delayed giant coronary aneurysms, multiple readmissions or occurrence after COVID-19 vaccination.

Methods:

We describe a child with all 3 of these unusual features. We discuss his clinical presentation, medical management, review of the current literature and CDC guidance recommendations regarding further vaccinations.

Results:

A 5-year-old boy had onset of MIS-C symptoms 55 days after COVID-19 illness and 15 days after receiving his first BNT162b2 COVID-19 vaccination. He was admitted 3 times for MIS-C, and twice after his steroid dose was tapered. On his initial admission, he was given intravenous immunoglobulin and steroids. During his second admission, new, moderate coronary dilation was noted, and he was treated with intravenous immunoglobulin and steroids. At his last admission, worsening coronary dilation was noted, and he was treated with infliximab and steroids. During follow-up, he had improvement in his coronary artery dilatation. However, his inflammatory markers increased after steroid wean, and his steroid taper was further extended, after which time his inflammatory markers improved. This is the only such reported case of a patient who was admitted 3 times for MIS-C complications after COVID-19 vaccination.

Conclusion:

MIS-C rarely involves delayed giant coronary aneurysms, multiple readmissions, or occurrence after COVID-19 vaccination. Whether our patient’s COVID-19 vaccine 6 weeks after COVID-19 illness contributed to his MIS-C is unknown. After consultation with the CDC-funded Clinical Immunization Safety Assessment Project, the patient’s care team decided against further COVID-19 vaccination until at least 3 months post normalization of inflammatory markers.
Routine Immunization Coverage and Immunization Card Retention in Pakistan: Results From a Cross-sectional National Survey
Authors: Hussain Imtiaz , Khan Ahmad , Rhoda Dale A. , Ahmed Imran , Umer Muhammad , Ansari Uzair , Shah Muhammad Akram , Yunus Soofia , Brustrom Jennifer , Oelrichs Robert , Soofi Sajid Bashir , Bhutta Zulfiqar A
Published: February 2023

Background:

Immunization is one of the most successful public health interventions available, saving millions of lives from death and disability each year. Therefore, improving immunization coverage is a high priority for the Government of Pakistan and essential to progress toward universal health coverage. This survey reports the national and provincial/regional coverage and determinants of fully, partially, and not-vaccinated children 12–23 months of age, antigen-wise coverage, percentage of home-based vaccination records (HBR) retention, and reasons for nonretention; dropout, timeliness, and prevalence of missed opportunities for simultaneous vaccination (MOSV).

Methods:

The survey was a descriptive cross-sectional national household survey carried out across Pakistan. The survey included 110,790 children 12–23 months old and their caregivers. A World Health Organization (WHO)—Expanded Program on Immunization (EPI) Survey questionnaire was adapted to collect information. Data were analyzed using the WHO Vaccination Coverage Quality Indicators (VCQI) software and Stata version 17.

Results:

Nationally excluding Azad Jammu and Kashmir (AJK) and Gilgit Baltistan (GB), the coverage of fully vaccinated children was 76.5%. The likelihood of being fully vaccinated was higher among children of educated parents who belonged to higher wealth quintiles and resided in any province/region other than Balochistan. The main reasons for unimmunization were no faith in immunization, rumors about vaccines, and distance to the facility. About two-thirds (66.2%) of the children had their HBR available, and the main reasons for not having a card were never visiting a health facility and having no awareness about the importance of a card. Dropout was discernible for later doses of vaccines compared with earlier ones. Higher proportions of children received the last doses late by more than two months. Of the 218,002 vaccination visits documented on HBR in the provinces, MOSVs occurred in 17.6% of the visits.

Conclusion:

The immunization coverage rates provide a direction to strategize the progress to improve the vaccination rates in Pakistan. The country needs to outline the immediate and long-term actions to combat vaccine-preventable diseases, such as escalating integrated immunization campaigns and outreach activities, provision of mobility support, and deploying behavioral interventions as a cross-cutting strategy to improve awareness and reduce misconceptions.