A multi-parameter grading system for optimal fitting of scleral contact lenses

Background: While scleral lens practise has improved over the years due to factors such as availability of lenses with better materials and designs as well as experience of practitioners, a lack of objectivity appears to remain in terms of assessment of scleral lens fitting. This prospective observational work aimed to achieve standardization on this front through proposing a grading system for scleral lens fitting. Methods: After application of prosthetic replacement of ocular surface ecosystem (PROSE) devices on the participants’ eyes, four fundamental components for understanding scleral lens fitting such as central and limbal corneal clearance, mid-haptic compression, and alignment of lens edge over anterior sclera were assessed through a series of slit-lamp biomicroscopy imaging as well as with anterior segment optical coherence tomography. FitConnect® was used to modify the device parameters to simulate different grading patterns on the proposed scale. Serial imaging was done for all the different lenses to compose the grading scale. Results: A clinically relevant grading scale was constructed that pictorially demonstrated grades for the different aspect of scleral lens fitting. The grades were conveniently scaled within three categories: “optimal”, “acceptable” and “not acceptable”. Conclusion: The gradation of scleral lens fitting parameters would take a step towards objectifying the assessment patterns in practise. This will also help reducing the gap between a novice and an experienced practitioner in terms of understanding of scleral lens fitting.

A Novel Procedure for the Management of Severe Hyphema after Glaucoma Filtering Surgery: Air–Blood Exchange under a Slit-Lamp Biomicroscopy

Background and Objectives: This study introduces a novel office-based procedure involving air–blood exchange under a slit-lamp microscope for treatment of severe hyphema after filtering surgery. Materials and Methods: This retrospective study enrolled 17 patients (17 eyes) with a diagnosis of primary open-angle glaucoma with severe hyphema (≥4-mm height) after filtering surgery. All patients were treated with air–blood exchange under a slit-lamp using room air (12 patients) or 12% perfluoropropane (C3F8; five patients). Results: The procedures were successful in all 17 patients; they exhibited clear visual axes without complications during follow-up. In the room air group, the mean visual acuity (VA) and hyphema height significantly improved from 1.70 ± 1.07 LogMAR and 5.75 ± 1.14 mm before the procedure to 0.67 ± 0.18 LogMAR and 2.83 ± 0.54 mm after the procedure (p = 0.004; p < 0.001). In the C3F8 group, the mean VA showed a trend, though not significant, for improvement from 1.70 ± 1.10 LogMAR to 0.70 ± 0.19 LogMAR (p = 0.08); the mean hyphema height showed a trend for improvement from 5.40 ± 0.96 mm to 3.30 ± 0.45 mm. Compared with the C3F8 group, the room air group showed the same efficacy with a shorter VA recovery time. Conclusions: “Air–blood exchange under a slit-lamp using room air” is a convenient, rapid, inexpensive, and effective treatment option for severe hyphema after filtering surgery, and may reduce the risk of failure of filtering surgery.

Spectral-domain optical coherence tomography for evaluating palisades of Vogt in ocular surface disorders with limbal involvement

Spectral-domain optical coherence tomography (SD-OCT) has been used to observe the morphology of the palisades of Vogt (POV) with satisfactory resolutions. In this study, we used SD-OCT to examine the microstructure of the POV in ocular surface disorders with limbal involvement. We detect subclinical limbal pathologies based on five parameters, including (1) decreased epithelial thickness, (2) loss of the sharp stromal tip, (3) loss of the smooth epithelial-stromal interface, (4) dilated stromal vessels, and (5) decreased POV density. Eighteen eyes of 10 patients with advancing wavelike epitheliopathy (AWE) and 15 eyes of 9 patients with phlyctenular keratitis/ocular rosacea were recruited. SD-OCT could detect abnormal changes in the POV in 100% of the lesion sites. In presumed-healthy areas of the diseased eyes diagnosed by slit-lamp biomicroscopy, SD-OCT detected abnormal changes in the POV in 100% of the eyes in both groups. In patients with unilateral disease, abnormal changes in the POV were detected by SD-OCT in 50% and 100% of presumed-healthy eyes diagnosed by slit-lamp biomicroscopy in the AWE group and phlyctenular keratitis/ocular rosacea group, respectively. SD-OCT is powerful in detecting POV changes in ocular surface disorders and can provide useful information that cannot be provided by slit-lamp biomicroscopy.

Spectral-Domain Optical Coherence Tomography For Evaluating Palisades of Vogt in Ocular Surface Disorders With Limbal Involvement

Spectral-domain optical coherence tomography (SD-OCT) has been used to observe the morphology and epithelial thickness of the palisades of Vogt (POV) with satisfactory resolutions. In this study, we used SD-OCT to examine the microstructure of the POV in ocular surface disorders with limbal involvement and to detect subclinical limbal pathologies based on five parameters. Eighteen eyes of 10 patients (2 men and 8 women; mean age, 48.7 ± 14.0 years) with advancing wavelike epitheliopathy (AWE) and 15 eyes of 9 patients (2 men and 7 women; mean age, 30.3 ± 18.2 years) with phlyctenular keratitis/ocular rosacea were recruited. SD-OCT could detect abnormal changes in the POV in 100% of the lesion sites. In presumed-healthy areas of the diseased eyes diagnosed by slit-lamp biomicroscopy, SD-OCT detected abnormal changes in the POV in 100% of the eyes in both the AWE and phlyctenular keratitis/ocular rosacea groups. In patients with unilateral disease, abnormal changes in the POV were detected by SD-OCT in 50% and 100% of presumed-healthy eyes diagnosed by slit-lamp biomicroscopy in the AWE and the phlyctenular keratitis/ocular rosacea group, respectively. SD-OCT is powerful in detecting POV changes in ocular surface disorders and can provide useful information that cannot be provided by slit-lamp biomicroscopy.

Inflammatory Myofibroblastoma Tumor of Intraocular Ciliary Body: A Case Report and Literature Review

Background: IMTs are extremely rare in eyes. This is the first report of a IMT of the ciliary body.Case presentation: A ciliary body tumor was found under slit lamp biomicroscopy in a 55-year-old male first diagnosed with cataract. Then this patient underwent trans-sclera resection via partial lamellar sclerouvectomy and par plans vitrectomy to remove the mass. Hematoxylin and eosin (HE) staining and immunohistochemistry findings showed that the characteristics of the tumor were consistent with inflammatory myofibroblastoma tumor (IMT).Conclusions: we reported a rare case of intraocular IMT, which is confirmed by H&E staining, and IHC positive staining for Vimentin, Desmin and ALK, while negative staining for SMA, S-100, ki-67, CK, CD68, and calponin.

CORTICAL SPOKES CATARACT

A 40 years old man presented with bilateral mild dimness of vision and mild glare. Diffuse and focal illumination on slit lamp biomicroscopy did not reveal any pathology. Retro-illumination on slit lamp showed faint bilateral spokes like cortical lens opacities. Retro-illumination mode on Auto-Ref/Keratometer (HRK 7000A, Huvitz, Anyang-si, Gyeonggi-do, Republic of Korea) prominently revealed these insignificant bilateral spokes like cortical opacities (cataracts). Visual acuity was 6/9 in both eyes. No intervention was advisable and the patient was reassured.

Retinal involvement in type 1 diabetics, an experience from a specialized diabetes care unit of Karachi, Pakistan.

Objectives: To evaluate frequency of retinopathy in type 1 diabetics. Study design: Retrospective Study. Setting: Diabetes Unit (BIDE) of Baqai Medical University (BMU) Hospital of Karachi, Pakistan. January 2017 to September 2018. Material & Methods: Convenience sampling was done to collect clinical, biochemical, demographic and anthropometric measurements. Ophthalmic screening was performed by funduscopy at a slit lamp biomicroscopy with the help 90 D fundus lens. Modified Early Treatment Diabetic Retinopathy Disease Severity Scale (ETDRS) was used for the categorization. Results: Overall retinopathy was observed in around seven percent (7%) participants. On further examination by the ophthalmologist, 2 (5.1%) and 1 (2.3%) cases were grouped into STDR group and1 (2.6%) into NSTDR group. The frequency of mild to moderate and moderate to severe non proliferative diabetic retinopathy (NPDR) was found in 2.5% cases each. Whereas, tractional retinal detachment TRD and CSME were found in 2.6% cases each. Conclusion: This study highlights the importance of screening of retinopathy in type 1 diabetics to avoid insult on.

Pupillary Membrane Persistence in a Feline

Background:Pupillary membrane persistence (PMP) is a congenital abnormality, which is not usually reported in felines. It is characterized by remnants of the fetal membrane that persist as filamentous tissue across the pupil. In general, this change does not cause any clinical symptoms. However, the filaments may either attach to the cornea and cause small opacities in it or attach to the lens and cause cataracts. In most cases, there is no visual impairment, so treatment is not prescribed. This report aims to describe a case of PMP in a domestic cat diagnosed at the Veterinary Hospital of the State University of Santa Cruz (HV-UESC). Case: A two-and-a-half-year-old mixed-breed castrated male cat was brought to the HV-UESC with dermatological complaints. Upon physical examination, the animal was alert with a body temperature, heart, and respiratory rate within the normal parameters for the feline species. The lymph nodes were non-reactive, and the coloration of the oral mucosa was normal. There was no ophthalmic complaint from the owner, nor any loss of visual acuity. In addition, the animal had moderate pruritus, redness, and alopecia in the region of the ears, head, neck, chest, and back. Bristle samples were collected for an optical microscope analysis and an infestation with lice (Felicola subrostratus) was confirmed. An endectocide containing selamectin (15 mg; single application every 30 days) was prescribed. During physical examination, filamentous tissue crossing from iris to iris through pupil was observed in both eyes. The eyelid, corneal, and pupillary reflexes were within normal ranges. An ophthalmic evaluation did not identify conjunctival hyperemia or episcleral vessel congestion, and the eyelid, corneal, and pupillary reflexes were determined to be within the normal range. A slit-lamp biomicroscopy did not detect any anterior chamber alteration besides the filamentous tissue previously mentioned. An examination of the fundus of the eye by direct ophthalmoscopy revealed that the crystalline lens, retina, optic nerve, and retinal vessels all looked normal with no other ophthalmic alteration. Thus, the diagnosis was PMP, and because of the absence of visual impairment or any other ophthalmic abnormality, no treatment was initiated. Discussion: Feline PMP is a rare condition. Since the present case, a few studies about this alterations in cats were found in the literature about. As in cats, this ophthalmopathy is uncommon in horses and cattle. The present report describes a case of PMP, a poorly described alteration in veterinary medicine, which was diagnosed by ophthalmic examination and slit-lamp biomicroscopy. As reported previously, PMP was an incidental finding during physical examination, since most animals with this alteration present little impairment of visual acuity. However, in some cases, membranous filaments may attach to the cornea and/or lens causing opacities and/or cataracts that may result in vision defects. This did not occur in the present case. In previous studies too, other ophthalmic alterations beyond PMP were not observed, thus corroborating the findings of our case. In the present case, as there were no other ophthalmic changes, it was not necessary to initiate any type of treatment. In conclusion, the lack of information regarding the epidemiology of PMP in cats warrants further studies of this alteration. Although infrequent in cats, this condition can easily be diagnosed in the routine examinations of this species.