Effect of SMILE-derived decellularized lenticules as an adhesion barrier in a rabbit model of glaucoma filtration surgery

Background To investigate the effects of small incision lenticule extraction (SMILE)-derived decellularized lenticules on intraocular pressure (IOP) and conjunctival scarring in a rabbit model of glaucoma filtration surgery. Methods Trabeculectomy was performed on both eyes of New Zealand rabbits. A decellularized lenticule was placed in the subconjunctival space in one eye of the rabbits (the decellularized lenticule group), and no adjunctive treatment was performed in the fellow eye (the control group). The filtering bleb features and IOP were evaluated 0, 3, 7, 14, 21, and 28 days after surgery, and histopathologic examination was performed 28 days after surgery. Results Decellularized lenticules significantly increased bleb survival and decreased IOP postoperatively in the rabbit model with no adverse side effects. The histopathologic results showed a larger subconjunctival space and less subconjunctival fibrosis in the decellularized lenticule group. Conclusions Decellularized lenticules can prevent postoperative conjunctiva-sclera adhesion and fibrosis, and they may represent a novel antifibrotic agent for trabeculectomy.

Effects Of SMILE-Derived Decellularized Lenticule As An Adhesion Barrier In A Rabbit Model of Glaucoma Filtration Surgery

Background: To investigate the effects of small incision lenticule extraction (SMILE)-derived decellularized lenticule on intraocular pressure (IOP) and conjunctival scarring in a rabbit model of glaucoma filtration surgery. Methods: Trabeculectomy was performed on both eyes of New Zealand rabbits. Decellularized lenticule was placed in the subconjunctival space in one eye of the rabbits (decellularized lenticule group), and no adjunctive treatment was performed in the fellow eye (control group). The filtering bleb features and IOP were evaluated 0, 3, 7, 14, 21, and 28 days after surgery, and histopathologic examination was performed 28 days after surgery. Results: Decellularized lenticule significantly increased bleb survival and decreased IOP postoperatively in the rabbit model with no adverse side effects. Histopathologic results showed a larger subconjunctival space and less subconjunctival fibrosis in the decellularized lenticule group. Conclusions: Decellularized lenticule can prevent postoperative conjunctiva-sclera adhesion and fibrosis, and it may represent a novel antifibrotic agent for trabeculectomy.

Anatomy of the Aqueous Outflow Drainage Pathways

Lowering intraocular pressure (IOP) has been central to glaucoma care for over a century. Minimally invasive glaucoma surgical (MIGS) devices are able to exploit different aspects of aqueous outflow to reduce IOP. Increasing aqueous humour outflow may be achieved either through facilitating the existing pathways of Schlemm’s canal and the suprachoroidal space or to bypass the normal angle anatomy to create a full thickness fistula into the subconjunctival space. A complete understanding of angle anatomy and outflow pathways is important to develop new treatment strategies, improve current ones and better target the right operation for particular glaucoma subtypes.

CLINICAL-RADIOLOGICAL CORRELATION OF ORBITAL CYSTICERCOSIS

Background: Orbital cysticercosis is an infectious cause of preventable blindness not uncommon in India. It is a parasitic infestation caused by Cysticercus cellulosae, which is the larval form of Taenia solium. The aim of our study was to evaluate the role of the ultrasonography and CT scan in detecting ocular and adnexal cysticercosis. Materials and methods: This hospital based retrospective study was conducted in the department of Ophthalmology and Radio-diagnosis of GMC Hospital Jammu from July 2017 to January 2020. A total of 12 patients with suspected diagnosis of ocular and adnexal cysticercosis were studied with the help of ophthalmic examination, serology profile, ultrasonography and CT imaging. Results: Our study included 12 patients with male to female ratio 2:1. Majority of the patients had unilateral presentation with only two having bilateral eye involvement. The most common site of lodgement of orbital cysts was seen in the subconjunctival space in 4 patients (33%), followed by 2(16%) in eyelid, 2(16%) in extraocular muscles, 2(16%) in posterior segment, 1(8%) in optic nerve and 1(8%) retro-orbital space. Indirect ophthalmoscopy in one case showed a free floating cyst in the vitreous cavity while in two other patients a translucent cyst with an intracystic whitish spot suggestive of scolex was demonstrated. Conclusion: On the basis of present study, it can be concluded that the diagnosis of orbital cysticercosis is usually accomplished by high degree of clinical suspicion, ophthalamoscopic demonstration of the larval worm and the characteristic features on imaging studies. CT scan can be helpful in assessing extraocular cysticercosis, neurocysticercosis and ancillary findings, if any.

Ocular Dirofilariasis after Clinically Manifested Subcutaneous Migration of the Parasite: A Case Report

Dirofilaria repens is the causative agent of human subcutaneous or, less often, ocular dirofilariasis. The work presents a rare case of ocular dirofilariasis manifested by previous subcutaneous migration accompanied by severe headache symptoms. In February 2017, a 58-yr-old man from Trnava region, western Slovakia, noticed red and itchy stripes on his left leg. Inflamed but painless stripes disappeared and showed up again every 5–7 days, migrating gradually towards the head. Approximately one month after the first skin´s alterations, strong pain in the left temple, with the swelling of the left face and the enlargement of mandibular lymph nodes appeared. Several days later, the patient felt excruciating pain of the right eyeball accompanied by strong nausea and subsequent vomiting. Ocular examination revealed the presence of a live worm in the subconjunctival space and morphological and molecular analyses of extracted helminth confirmed D. repens as etiological agent of the infection. According to clinical manifestation of the infection, it could be supposed that ocular form of the disease was the result of the migration of a parasite through the subcutaneous tissues. Moreover, a rare phenomenon of lymphadenitis of underlying lymph nodes and the swelling of left face accompanied the migration.

A rare mechanism of subconjunctival dislocation of anterior chamber intraocular lens after blunt ocular trauma

Introduction. Dislocation of intraocular lens (IOL) after ocular trauma is an emergency situation requiring prompt surgery. Dislocation of IOL into the subconjunctival space or pseudophacocoele is a rare event after blunt ocular trauma. Case outline. We report a case of a pseudophakic patient with a dislocation of the anterior chamber IOL (ACIOL) into subconjunctival space following blunt trauma to the right eye. A 76-year-old man presented with ACIOL dislocation into subconjunctival space, adapted old scleral wound and preserved corneal integrity. Fifteen years previously he suffered right eye globe rupture after blunt trauma, which was surgically closed and ACIOL was inserted. Conclusion. This case highlights a rare mechanism of ACIOL dislocation into subconjunctival space following blunt ocular trauma with preserved corneal integrity and adapted old scleral wound. In cases of post-traumatic aphakia, IOL dislocation into the subconjunctival space should be suspected.

XEN® stent complications: a case series

Background XEN® gel stent (Allergan, Dublin/Republic of Ireland) is a relatively new microinvasive glaucoma device providing an ab-interno approach to the subconjunctival space for aqueous drainage and reduction of intraocular pressure. It is thought to be less invasive, reduce surgical time and post-operative infection rates compared with traditional glaucoma procedures. Little information however, has been published regarding complications and subsequent management. Case presentation The authors highlight five complicated cases of XEN® stent insertion, how they were managed and key learning points. Cases include: entire stent found at the bottom of the anterior chamber several months after uncomplicated insertion, stent broke into multiple pieces during manipulation within subconjunctiva, XEN45 stent migrated into the anterior chamber 7 months post-operatively and a case of limbal-based conjunctival dissection during open revision which lead to additional scarring around the stent and subsequent raised intraocular pressure. Conclusions We present some new and interesting complications of XEN implant as well as potential management options. This can assist clinical decision-making and enable better pre-operative discussions with patients regarding risks of surgery.

Eyelash in lacrimal punctum: demonstrating a negative pressure in the lacrimal sac

Eyelashes are normally arranged in two or three rows on the upper and lower eyelids. They are more numerous on the upper eyelid, with approximately 150 eyelashes being present on the upper and 75 on the lower eyelid. Eyelashes, like body hair, are shed regularly every 100 to 150 days. Usually, the shed eyelashes do not cause any symptoms. However, the cilia may sometimes get misplaced and end up in the lacrimal puncta, meibomian gland orifice, subconjunctival space, and corneal stroma. An eyelash that gets misplaced into the punctum has the potential to cause additional problems. Once the eyelash enters the punctum, the barbs on the hair prevent it from being expelled.

Submacular cysticercosis

Ocular cysticercosis could involve subconjunctival space, anterior chamber, extraocular muscle, subretinal space, or vitreous. The presence of intraocular live cyst is a potential threat to visual acuity. The removal of the cyst in-toto is thus of importance to prevent inflammatory reaction and ocular damage. The presence of cysticercosis underneath the macula makes the management challenging. Herein, we describe the management of a submacular live cysticercus cyst with a good postoperative gain in visual acuity. Also, the swept-source optical coherence tomography changes are described.