bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peripheral Intravascular Catheter-Assisted Sutureless Scleral Fixation of Three-Piece Intraocular Lenses: A Novel Technique
Authors: Radice Paolo , Carini Elisa , Matteucci Martina , Ranno Stefano , Lucchini Sara , Govetto Andrea 
Published: February 2023

Purpose:
To describe and report the anatomical and functional outcomes of a novel sutureless peripheral intravascular catheter (PIVC)-assisted scleral fixation of three-piece IOL.

Methods:
A retrospective chart review of all patients who underwent scleral fixation surgery performed by a single surgeon was conducted. In all cases, a novel scleral fixation technique of three-piece IOL was performed with the aid of a 24-gauge PIVC cannula. Patients were followed up at postoperative months 1, 3, and 6.

Results:
Thirteen eyes of 12 patients were included in the analysis. Preoperatively, mean best-corrected visual acuity was 1.26 ± 0.82 LogMar (20/364 Snellen Equivalent), and it improved significantly at all follow-up endpoints being of 0.52 ± 0.25 LogMar at 1 month (20/66 Snellen Equivalent, P = 0.02), 0.4 ± 0.22 LogMar at 3 months (20/50 Snellen Equivalent, P = 0.007) and 0.37 ± 0.2 LogMar (20/47 Snellen Equivalent, P = 0.008) at 6 months postoperatively. No serious intraoperative or postoperative complications were registered. Postoperatively, there were no cases of conjunctival erosions. Over the follow-up period, in all the included cases, the IOL remained centered and stable.

Conclusion:
The PIVC-assisted scleral fixation technique may be a safe and reliable surgical option for secondary IOL placement in cases of insufficient capsular support.
MACULAR MORPHOLOGY AFTER MACULAR HOLE SURGERY USING THE INVERTED INTERNAL LIMITING MEMBRANE FLAP TECHNIQUE
Authors: Mizuguchi Tadashi , Horiguchi Masayuki , Kakehi Sayaka , Ito Yasuki 
Published: February 2023

Purpose:
To investigate the influence of an excess inverted internal limiting membrane (ILM) flap that covers the fovea in idiopathic macular hole surgery on postoperative visual acuity and macular morphology.

Methods:
This retrospective study included 66 patients with an idiopathic macular hole who underwent vitrectomy using the inverted ILM flap technique. They were divided into three groups: normal morphology (N), detached ILM (D), or ILM proliferation (P) in the parafoveal area. They were followed up for at least 6 months, and their best-corrected visual acuity, central retinal thickness, and parafoveal retinal thickness were measured.

Results:
There were no significant differences in preoperative or postoperative mean best-corrected visual acuities or postoperative CRTs among the groups. The postoperative inferior parafoveal retinal thicknesses were 319.2 ± 38.0, 377.1 ± 60.6, and 373.1 ± 67.3 µm in the N, D, and P groups, respectively (P vs. D group, P = 0.963; P vs. N group, P = 0.008; N vs. D group, P = 0.004).

Conclusion:
Regardless of the postoperative morphology of the inverted ILM flap, there was no effect on postoperative best-corrected visual acuity or CRT.
Multiple organ dysfunction syndrome and disseminated intravascular coagulation causing extensive multiple Amalric triangular choroidal infarctions
Authors: Lee Ivan J. , Pulido Jose S. , Regillo Carl D. , Leys Monique 
Published: February 2023

Abstract

Purpose:
To present a case of extensive bilateral choroidal infarctions from multiple organ dysfunction syndrome (MODS) and disseminated intravascular coagulation (DIC)

Methods:
A retrospective case report. The medical and imaging records, including fundus photography, optical coherence tomography, fluorescein angiography and visual fields were reviewed.

Patient:
A 49-year-old female presented after a failed suicidal attempt from drug overdose. The patient was subsequently intubated for acute hypoxic respiratory failure with presumed septic shock from aspiration pneumonia while requiring exogenous adrenergic support. Her hospital course was further complicated by development of multiple organ dysfunction syndrome and disseminated intravascular coagulation. The patient complained of blurry vision in both eyes after regaining consciousness.

Results:
Fundus photography showed bilateral dot-blot hemorrhages and cotton wool spots followed by multiple areas of triangular granular pigmentation, consistent with choroidal infarcts. Fluorescein angiography revealed delayed patchy filling, followed by late staining. Optical coherence tomography showed diffuse thinning of the choroid with overlying retina pigment epithelium atrophy. Goldmann visual field displayed discrete areas of visual field deficits. At the most recent visit, the best corrected final visual acuity remained 20/100 OD and 20/30 OS.

Conclusion:
DIC has been associated with choroidal infarcts. We present a case of extensive bilateral choroidal infarction in a patient with combined DIC and MODS consistent with Amalric choroidal triangular sign.
Two cases of von Hippel-Lindau syndrome-associated retinal hemangioblastoma treated with belzutifan
Authors: Grimes Joseph M , Gershkovich Alexandera , Bogomolny Dmitry , Marr Brian P 
Published: February 2023

Abstract:

Purpose:
To describe two cases of retinal hemangioblastoma (RH) regression following treatment with belzutifan in patients with von Hippel-Lindau (VHL) syndrome.

Methods:
Clinical information was extracted from the charts and tumor imaging of two patients with VHL-associated RH.

Results:
In case 1, a 40-year-old man was treated with belzutifan for spine hemangioblastomas after diagnosis of a 2.0x2.0x1.3 mm left eye RH temporal to the macula associated with intraretinal edema, subretinal fluid, and mild retinal traction. In case 2, a 66-year-old woman presented with a right eye 2.0x1.5x1.3 mm juxtapapillary lesion with subretinal fluid, intraretinal fluid, and nasal traction, and a 4.0x3.5x1.1 mm inferior mid-periphery lesion with subretinal fluid, intraretinal fluid, and active exudation. She was treated for 2.5 years with belzutifan for renal cell carcinoma on the National Institutes of Health trial. The patient in case 1 demonstrated a 10% reduction in largest tumor diameter and 8% reduction in thickness, along with improving subretinal fluid, intraretinal edema, and retinal traction, after 4 weeks of treatment. After 2.5 years of treatment, the patient in case 2 demonstrated similar margins of her now fibrotic-appearing juxtapapillary lesion with a 45% reduction in thickness, along with resolved subretinal fluid and greatly improved intraretinal fluid and traction. The inferior lesion demonstrated 12.5% reduction in largest diameter, 36% reduction in thickness, and was without active subretinal fluid or exudation. Neither patient demonstrated new lesions while on-treatment.

Conclusion:
Belzutifan is a promising treatment for RH with the potential for both rapid and sustained tumor regression.
Comparison of Ocular Wavefront Aberration Measurements Obtained Using Two Hartmann–Shack Wavefront Aberrometers
Authors: Koh Shizuka , Inoue Ryota , Iwamoto Yuuri , Mihashi Toshifumi , Soma Takeshi , Maeda Naoyuki , Nishida Kohji 
Published: February 2023

Objectives:
To assess agreement between measurements of ocular wavefront aberrations obtained using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) (Aberrometer A) and KR-1W (Topcon Corp) (Aberrometer B), both of which are based on the Hartmann–Shack principle.

Methods:
In this prospective case–control study, ocular wavefront aberrations measurements were obtained using both aberrometers in patients with keratoconus (KC) and control participants. Ocular wavefront aberrations were measured through the natural pupil without dilation using both devices in a dark room. For both aberrometers, accommodation was inhibited by automatically adding fogging. The individual Zernike coefficients from the second to fourth order were compared between the two aberrometers for a 4-mm pupil diameter.

Results:
Twenty-six KC and 29 control eyes were assessed. Statistically significant correlations (P<0.05) were observed for all Zernike coefficients, except for Z4
−2 in the control group. Bland–Altman analysis indicated good agreement between aberrometers and no statistically significant differences in the control group. However, in the KC group, patterns of proportional error were observed in vertical coma Z3
−1 (r=0.338, P=0.008), trefoil Z4
−4 (r=0.701, P=0.003), secondary astigmatism Z4
−2 (r=0.348, P=0.025), and spherical aberrations Z4
0 (r=0.407, P=0.012).

Conclusions:
The Zernike coefficient values measured by the two aberrometers were well correlated in the control and KC groups. However, in eyes with KC, Aberrometer B tended to present greater values in several Zernike coefficients than Aberrometer A, suggesting that wavefront measurements obtained using the two aberrometers are not interchangeable in patients with KC.
Conjunctival Autografts for Ocular Surface Reconstruction after Conjunctival Nevus Excision
Authors: Ucar Fikret 
Published: February 2023

Purpose:
The aim of this study was to evaluate the clinical and therapeutic outcomes of the cases where we used conjunctival autografts with and without the Tenon fascia for ocular surface reconstruction after conjunctival nevus excision.

Methods:
This study included 63 eyes of 63 patients who underwent conjunctival nevus excision between January 2013 and December 2020. Although a Tenon-free conjunctival autograft was used in 32 eyes of 32 patients in group 1, a Tenon-containing conjunctival autograft was used in 31 eyes of 31 patients in group 2. The clinical and histopathological characteristics of the nevus, complete graft epithelization, cosmetic outcomes, and postoperative complications were evaluated.

Results:
Conjunctival autografts were harvested from the contralateral eye in 3 eyes (9.3%) in group 1 and 2 eyes (6.4%) in group 2 (P = 0.66). Postoperatively, the mean defect size at the harvest site was 5.3 ± 1.4 mm in group 1 and 5.5 ± 1.5 mm in group 2 (P = 0.47). Graft edema was observed in only 1 case (3.1%) in group 1 and 6 cases (19.3%) in group 2 (P = 0.04). Although a complete graft epithelization was observed in all eyes in group 1, fluorescein staining was present in 2 eyes (6.4%) in group 2 (P = 0.14). Cosmetically, retracting and shrinking grafts were absent in group 1, whereas group 2 had in 4 eyes (12.9%) (P = 0.03). Neither group had conjunctival scarring, symblepharon, eyelid cicatrization, dysmotility, or pannus at the donor site.

Conclusions:
Ocular surface reconstruction with a Tenon-free conjunctival autograft after conjunctival nevus excision provides excellent cosmetic and functional results without significant complications.
Influence of Descemet Membrane Endothelial Keratoplasty Graft Preparation Patterns on Postoperative Clinical Outcome
Authors: Schrittenlocher Silvia , Matthaei Mario , Rokohl Alexander C. , Franklin Jeremy , Bachmann Björn , Cursiefen Claus 
Published: February 2023

Purpose:
The aim of this study was to quantify preparation difficulties and complications during DMEK graft preparation and their influence on clinical outcome.

Methods:
A retrospective evaluation of 214 consecutive DMEK surgeries from the prospective Cologne DMEK database was performed between July 2018 and December 2019. Preparation conditions (such as central and peripheral adherences, tissue fragility, and Descemet membrane splitting) were quantified and divided into 3 groups: easy, difficult, and very difficult preparation. At follow-up (3, 6, and 12 months after DMEK), best spectacle-corrected visual acuity, endothelial cell count (ECC), and rebubbling rates were evaluated and compared between groups.

Results:
An easy preparation was possible in 41.6% of cases (group 1, n = 89), a difficult preparation of the DMEK graft occurred in 30.8% (group 2, n = 66), and a very difficult preparation occurred in 27.6% (group 3, n = 59). There was no difference between groups for best spectacle-corrected visual acuity at 3, 6, and 12 months (P = 0.179, P = 0.325, and P = 0.682, respectively) or for ECC at 3 and 6 months (P = 0.537 and P = 0.606, respectively). Only at 12 months, the ECC was slightly significant between groups (P = 0.045). Regarding the rebubbling rate, there was no difference (P = 0.585). 17.9% of eyes from group 1, 25.7% of eyes from group 2, and 23.7% of eyes from group 3 received at least 1 rebubbling.

Conclusions:
These data suggest that difficult preparation conditions do not lead to any worsening of visual acuity or rebubbling rate in the 1-year outcome after DMEK. The endothelial cell density at 12 months showed slightly poorer results in the cases of very difficult preparation.
Healing of Chemical Injury–Related Persistent Corneal Epithelial Defects With Topical Insulin
Authors: Balal Shafi , Din Nizar , Ashton Christopher , Ahmad Sajjad 
Published: February 2023

Purpose:
The purpose of this study was to evaluate the effectiveness of insulin eye drops for treating refractory persistent epithelial defects (PEDs).

Methods:
A prospective, single-center, case series was performed from March 2020 to September 2021. All patients were prescribed insulin eye drops for refractory PEDs that failed on maximum standard medical treatment (including serum eye drops). The drops were used 4 times/day. Patients were followed up at 2 weekly intervals with full slitlamp examination and serial anterior segment photography. The primary end point was resolution of the epithelial defect.

Results:
Eleven eyes of 10 patients were treated with insulin eye drops. The mean age of the cohort was 45.4 + 25 years with a mean follow-up of 195.7 + 114.3 days after re-epithelization. The most common causative condition was chemical injury (n = 5, 60%). Mean baseline PED defect was 41.3 + 55.2 mm2. Nine of 11 eyes (82%) fully re-epithelized within a mean time of 62.3 + 34.6 days (range 14–112). In 2 patients who did not achieve re-epithelization, one had a reduction in size from 12.25 mm2 to 4.5 mm2 and the other had no response. No recurrence in defect was observed in the group that had fully re-epithelized.

Conclusions:
This study showed that the use of topical insulin eye drops led to a successful resolution of PED in 9 of 11 cases. We demonstrate the use of insulin for closure of PEDs in chemical eye injury. Larger controlled studies are required to further evaluate this novel therapy.
Novel Map Biopsy Technique to Define the Extent of Infection Before Penetrating Keratoplasty for Acanthamoeba Keratitis
Authors: Simpson Alasdair , Sarode Deep , Lockington David , Ramaesh Kanna 
Published: February 2023

Purpose:
The purpose of this study was to report a novel approach of prepenetrating keratoplasty (PKP) corneal map biopsies to define the extent of Acanthamoeba cyst infiltration in recalcitrant Acanthamoeba keratitis.

Methods:
Corneal map biopsies were performed 1 week before PKP. Four biopsies, 1 from each peripheral corneal quadrant, were obtained to delineate the extent of microscopic infection. Histological results of these map biopsies were used to determine the size and location of the subsequent PKP.

Results:
In our first case, map biopsies revealed Acanthamoeba cysts in 2 of the 4 biopsies. This led to an inferotemporally eccentric 8.5-mm PKP. The final histology report indicated that the closest resection margin was 0.08 mm. In our second case, the peripheral map biopsies were clear and an inferiorly eccentric 8.25-mm PKP was performed. The final histology report indicated that the closest resection margin was 2.3 mm. Both grafts have remained clear at 6 months postoperatively.

Conclusions:
Map biopsies of the cornea can achieve total removal of the corneal tissues infested with Acanthamoeba cysts and prevent reinfection of the donor graft.
Keratoplasty in the United States: Trends and Indications From 2015 to 2020
Authors: Xiao Grace , Tsou Brittany C. , Soiberman Uri S. , Prescott Christina R. , Srikumaran Divya , Woreta Fasika A. 
Published: February 2023

Purpose:
The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020.

Methods:
This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran–Armitage test.

Results:
The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160–15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%–27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%–33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%–1.2%, P < 0.001).
From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%–11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively.

Conclusions:
From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.
Paraproteinemic Keratopathy in a Patient With Previous LASIK Procedure Mimicking Lattice Corneal Dystrophy
Authors: Guerrero-Becerril Jesus , Vigderovich-Cielak Itamar , Neme-Yunes Yvette , Pérez Alejandro Navas , Miranda Arturo Ramírez , Zenteno-Ruiz Juan Carlos , Terrazas-Marín Ricardo , Graue-Hernández Enrique O. 
Published: February 2023

Purpose:
The aim of this study was to report a unique clinical presentation of paraproteinemic keratopathy after a myopic uneventful laser in situ keratomileusis (LASIK) procedure that led to the diagnosis of gammopathy of undetermined significance.

Methods:
This was an interventional case report. A 55-year-old woman present with bilateral branching opacities limited to the optical zone of myopic LASIK. The patient's medical history was unremarkable.

Results:
After ruling out a mutation in TGF-β1, a systemic workup was performed, revealing an IgG level of 12.8 mg/dL, lambda-free light chain of 12.8 mg/dL, and M-spike of 0.6 g/dL. Bone marrow aspiration was slightly hypercellular, without evidence of neoplastic infiltration by plasma cells. The patient underwent 3 cycles of systemic chemotherapy, with improvement in best-corrected visual acuity.

Conclusions:
Paraproteinemic keratopathy is a rare clinical presentation that may lead to a systemic diagnosis of hematologic malignancy. To the best of our knowledge, this is the first reported case of paraproteinemic keratopathy after LASIK.
Leukocyte Immunoglobulin-like Receptor A5 Deletion Aggravates the Pathogenesis of Pseudomonas aeruginosa Keratitis by Promoting Proinflammatory Cytokines
Authors: Shang Yuqi , Liu Xi , Wei Liwen , Liang Siping , Zou Zhengyu , Wu Minhao , Xia Jinyu 
Published: February 2023

Purpose:
The purpose of this study was to assess the role of leukocyte immunoglobulin-like receptor A5 (LILRA5) in regulating bacterial infection and corneal inflammation.

Methods:
The human corneal tissue microarray data set GSE58291 from Gene Expression Omnibus was downloaded. Then, the differentially expressed genes, Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, Gene Set Enrichment Analysis, and the immune infiltration analysis were conducted. We constructed the Pseudomonas aeruginosa (P. aeruginosa) keratitis mice model using wild-type and LILRA5-deficient mice. The results of the bioinformatics analysis were verified by the cell in vitro and animal in vivo experiments.

Results:
This study revealed that LILRA5 is substantially expressed in human keratitis and regulates the immune response negatively. Neutrophils were identified as the core fraction of immune cells in keratitis. After P. aeruginosa infection, neutrophils lacking LILRA5 induced elevated levels of proinflammatory cytokines and toll-like receptor 4. LILRA5 deficiency exacerbated the severity of the infection and the production of proinflammatory cytokines in mice.

Conclusions:
LILRA5 was discovered as an immunosuppressive regulator in P. aeruginosa keratitis, highlighting its significance in activated immune responses.
Types of Descemet Membrane Detachment After Ocular Surface Burns: The Factor Long Been Ignored
Authors: Li Yuan-Ting , Wu Wen-Yu , Li Jing-Yi , Chan Szy-Yann , Ang Marcus , Feng Yun 
Published: February 2023

Purpose:
The aim of this study was to explore types of Descemet membrane detachment (DMD) after ocular surface burns by anterior segment optical coherence tomography.

Methods:
This is a pilot, case series, observational study. Patients with DMD after ocular surface burns were enrolled. Ophthalmologic examinations were performed in all patients including slit-lamp photography and anterior segment optical coherence tomography.

Results:
Three types of DMDs in 9 eyes of 9 patients with ocular surface burns were identified depending on the detachment components involved with the pre-Descemet layer (PDL). Type A was referred as a taut chord that the PDL and Descemet membrane (DM) detached simultaneously but were remained attached to each other, while type B was identified as a wavy line separated from the stroma by a dark slit that demonstrated the detachment of DM from the PDL and stroma. Type C was defined as the DM detached with or without PDL but they were separated from each other. We found that DM and PDL were detached simultaneously in most condition, with type A in 4 cases, type C in 5 cases, and type B in only 1 case.

Conclusions:
Our study demonstrated 3 types of DMDs after ocular surface burns and revealed that the limbal involvement and retrocorneal exudations may give clues to DMD in the corresponding areas. DMDs may be neglected for long in patients with extensive limbal involvement in early stages and also play an important role in unstable ocular surface condition until the late stages of conjunctivalization after ocular surface burns.