Surgical Preferences in the Management of Primary Pterygium among Anterior Segment Specialists

Purpose: The purpose of this study is to reflect anterior segment specialists’ current practice pattern regarding the management of primary pterygium. Methods: A 24-item survey regarding indications for surgery, different surgical techniques, use of adjuvant pharmacological therapy, type of intraoperative and postoperative pharmacological therapy, and the preferred treatment of early recurrences was sent to members of the Saudi Ophthalmological Society (SOS) and practicing cornea experts including consultants, specialists, and fellows in Saudi Arabia. Results: A total of 61 cornea specialists completed the questionnaire (response rate 49%). More than 95% considered the proximity of the pterygium to the visual axis an indication for excision. The most frequent technique for pterygium excision was extensive head and conjunctival resection, including the base (69%) and intermediate resection of the Tenon's capsule (53%). For conjunctival replacement, conjunctival autograft was preferred by 79%, amniotic membrane (54%), and simple conjunctival closure (46%). Interrupted vicryl sutures, fibrin glue, and combined sutures and tissue adhesive were the preferred graft fixation conveyed by 85%, 46%, and 34% of our experts, respectively. An estimated recurrence rate of 1-5% was stated by 29% of respondents and 46% reported recurrence within 6 to 12 months. Half of the respondents specified using mitomycin C intraoperatively to prevent early pterygium recurrences. When recurrence occurred, corticosteroid was the agent of choice. Conclusion: This study set out to reflect the practice pattern of anterior segment specialists regarding the management of primary pterygium, and it may serve as an insight for further studies to define the optimal management of pterygium.

Necrotizing Anterior Scleritis in a Woman with Terrien’s Marginal Degeneration: A Case Report

Purpose: The aim of the study was to report the first case of a patient with Terrien’s Marginal Degeneration (TMD) who developed necrotizing anterior scleritis without systemic disease association, requiring systemic immunosuppressive treatment. Case Report: A 32-year-old female consulted for bilateral ocular burning and hyperemia. Initially, she was diagnosed with conjunctivitis and treated with topical antibiotics and corticosteroids, with mild transitory improvement but the progression of the disease. Years later, she attended the ocular immunology consultation for a second opinion where TMD with ocular inflammatory component OU was diagnosed. Seven months later, she presented with severe pain, decreased visual acuity, and photophobia in OS. At the slit-lamp examination, necrotizing anterior scleritis with a high risk of perforation in OS was observed. The patient was referred to the rheumatologist and started treatment with systemic corticosteroids and cyclophosphamide, exhibiting a clinical improvement. The patient did not meet the criteria for any systemic illness associated with scleritis, such as autoimmune diseases or vasculitis. Thus, scleritis was related to the adjacent inflammatory process associated with TMD, as an atypical presentation of this disease. Conclusion: Although an inflammatory type of TMD has been proposed, it is essential to follow up closely these patients and consider necrotizing anterior scleritis, a severe ocular disease that requires prompt immunosuppressive management, as a possible atypical associated presentation of this disease.

Evaluation of Pollen Adhesion to Verofilcon-A Soft Contact Lenses

Purpose: A new 1-day disposable soft contact lens (SCL), verofilcon-A, constructed of silicone hydrogel material, has recently become available in Japan. This SCL has a very smooth surface produced by using the SMARTSURFACE ® Technology, and it was expected that pollen particles and protein components would not adhere easily to its surface. We examined the degree of pollen adhesion to the surface of the verofilcon-A material SCL and compared the results with those of other 1-day disposable SCLs (1DSCL). Methods: To determine the number of pollen grains attached to the surface of different types of SCLs, 0.01 mg/ml of cedar pollen solution was dropped onto the surface of 13 types of 1DSCL. After 24 h, each 1DSCL was rinsed in a shaker and washed five times with saline (n = 10 for each 1DSCL type). The number of pollen particles adhered to the 1DSCL and the percentage of surface area occupied by pollen was determined. Results: The number of pollen particles on the 1DSCLs ranged from 0 to 185 in the 200 × 200 µm area. The number of particles was lowest in the delefilcon-A and verofilcon-A SCLs with 0 particles, and the number was higher in the other 11 1DSCLs. The number of pollen particles was negatively correlated with the water content (r = −0.48), oxygen permeability (Dk; r = −0.43), oxygen transmissibility (r = −0.42), and center thickness (r = −0.33) of the 1DSCLs. The pollen adhesion area ranged from 0.0% to 3.1% and was lowest in the delefilcon-A and verofilcon-A 1DSCLs. There were significant differences in the pollen adhesion area between colored 1DSCLs (2.73 ± 1.97%) and clear 1DSCLs (1.03 ± 1.01%, P<0.001) and between hydroxyethyl methacrylate-based 1DSCLs (1.84 ± 1.45%) and silicone hydrogel-based 1DSCLs (0.05 ± 0.16%, P<0.001). Conclusion: These findings indicate that the verofilcon-A 1DSCL processed with SMARTSURFACE™ Technology is an excellent option for SCL users with allergic conjunctivitis during the high pollen season.

Evaluation of Corneal Endothelium after Myopic Laser-Assisted In Situ Keratomileusis (LASIK) with Accelerated Cross-Linking (CXL) in Diabetic Patients

Purpose: To study the effect of LASIK with accelerated CXL on corneal endothelium in myopic diabetic patients. Methods: A prospective comparative interventional case series study on 120 eyes of 60 myopic patients treated with LASIK with accelerated CXL. They were divided into two groups; group A included 60 eyes of diabetic patients, group B included 60 eyes of non-diabetic patients. Corneal endothelium was evaluated by specular microscope preoperatively and after 3 and 6 months postoperatively. Results: The endothelial cells density (ECD) showed statistically significant changes after 3 and 6 months postoperatively (p-value <0.001) in group A while group B showed statistically significant changes after 3 months without significant change after 6 months (p-value= 0.103), both groups had improved to near preoperative levels, with no significant differences between them at the end of 6 months follow-up (p-value = 0.219). Regarding pleomorphism, there was a significant change in group A during 6 months follow-up (p-value <0.001) with no significant change in group B (p-value= 0.884), and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value <0.001). Regarding polymegathism, there was a significant change in group A during 6 months follow-up (p-value <0.001) with no significant change in group B after 3 (p-value= 0.178) and 6 (p-value= 0.866) months follow-up, and in comparing both groups, there was a significant change at the end of 6 months follow-up (p-value <0.001). Conclusion: LASIK with accelerated CXL is safe on corneal endothelium in diabetic myopic patients but needs to follow up for a long period.

Identification of a PROM1 mutation in a Spanish family with inherited retinal dystrophies

Background: We report a Spanish family, comprising an affected mother and daughter, respectively diagnosed with retinitis pigmentosa and Stargardt-like macular dystrophy, in whom we identified a PROM1 mutation. Methods: A custom gene panel consisting of 119 inherited retinal dystrophies (IRD)-genes was applied in the two affected individuals of this family and sequenced using the Illumina´s NextSeq500 platform. Results: The analysis of the resulting data allowed us to identify the pathogenic PROM1 mutation c.1117C>T (p.Arg373Cys) as the primary cause of the disease in both patients. No additional variants contributing to the extent of retinal dysfunction were detected. Conclusion: The variable expressivity of the detected PROM1 mutation is the most likely responsible for the intrafamilial phenotypic variability observed in this family. Screening of this mutation should be considered in patients with compatible clinical manifestations, especially when accompanied by an autosomal dominant family history.

The Effect of Optical Defocus on the Choroidal Thickness: A Review

The choroid is a heavily vascularized tissue located between the retina and sclera and plays a primary role in ocular metabolism. It has recently been suggested that the choroid has the ability to change its thickness and secretion of growth factors. This may play an important role during visual development by adjusting retinal position during growth to support emmetropisation; however, the mechanism by which changes in choroidal thickness (ChT) occur is unclear. This relationship becomes an interesting topic in the clinical field, although conflicting evidence found that these changes in the choroidal thickness may not be associated with the development of refractive errors. Many reports have investigated the changes in the choroid and related factors that affect the ChT. Thus, this review will summarize the current literature related to choroidal thickness in different refractive error groups, determine the factors that influence the thickness of the choroid, and discuss in detail the relationship between the changes in the ChT and ocular elongation, and therefore, the effect of optical defocus on ChT and the development of the refractive error.

Azzopardi Phenomenon in a Non-neoplastic Phthisical Eye: A Case Report

Objective: The Azzopardi phenomenon, known as the deoxyribonucleic acid deposition on various structures due to cellular necrosis, has never been reported in non-neoplastic eyes. Methods: We report a case of a 48-year-old man who had congenital nystagmus with poor vision in both eyes, presented with decreased vision and photophobia in his left eye. An exudative retinal detachment was found, which did not respond to systemic steroid treatment. Glaucoma due to occlusio pupillae was later developed. Laser iridotomy and anti-glaucoma medications decreased intraocular pressure to an acceptable level. Vision in the left eye gradually deteriorated during the 10-year clinical course. Evisceration was finally performed due to persistent dull aching ocular pain along with signs of ocular hypotony Results: Histopathological examination showed phthisis bulbi and focal nodular retinal gliosis. The Azzopardi phenomenon was found at the retinal vessel walls, within the retinal layers and along the internal limiting membrane. There was neither evidence of intraocular tumors nor foreign bodies. Conclusion: This case demonstrated that the Azzopardi phenomenon could be present in a non-neoplastic eye with a longstanding disease that proceeds to phthisis bulbi.

Autologous Retinal Transplant for Macular Hole

We aim to review scientific literature concerning published studies on autologous retinal transplantation to treat macular hole patients. The following databases were searched: Medline and Medline Non-Indexed Items, Embase (1990–2020), Ovid Medline® (1990 to November 2020), Embase (1990 to November 2020), Ovid Medline® and Epub Ahead of Print, in-Process and Web of Science (all years). Search keywords included “autologous”, “retinal transplant”, “autologous neurosensory retinal free flap” “transplantation”, “macular hole”, and “macular hole surgery”. Eighteen case series and single case reports were reviewed. Preoperative and final best-corrected visual acuity, microperimetry and multifocal electroretinogram findings, macular hole closure rate, preoperative and postoperative ellipsoid zone, and external limiting membrane defects were obtained and analyzed. Indications of autologous retinal transplantation for macular hole surgery included refractory macular holes, conventional techniques, and large macular holes. The number of cases included in the different case series ranged from 2 to 130 cases, and prior macular hole surgeries of the patients ranged from 0 to 3. Overall, the published case series of autologous retinal transplants have reported a macular hole closure rate of 66.7 to 100%, as well as a significant improvement in best-corrected visual acuity. The most frequently reported complications included considerable intraoperative bleeding and postoperative dislocation of the graft. The presence of functionality in the graft area has also been documented by microperimetry and multifocal electroretinogram. In conclusion, the autologous retinal transplantation technique for macular hole patients has emerged as another surgical option, with a high macular hole closure rate and visual improvement.

Assessment of the Efficiency of HP-Guar and hyaluronic Acid Tear Supplements to Control Tear Film Evaporation Rate in Dry Eye Subjects

Background: The most common factor that could lead to dryness is the accelerated tear evaporation rate. Controlling the tear evaporation rate is increasingly used as a method to control dry eye complications. The present study explores the effects of different tear supplements formulations on tear film evaporation rate. Objective: This study aimed to evaluate the short-term effects of Systane ULTRA and Artelac Advanced eye drops on the tear film evaporation rate. Methods: Fifteen male dry eye subjects were enrolled in the current study. Tear film parameters were observed at several time points post installation (10, 20, 30, and 60 min). The tear film parameters observed in the current study were tear evaporation rate, noninvasive breakup time (NITBUT) and tear meniscus height (TMH). Two visits were required to conduct this study. One visit was conducted to assess the physiological tear film parameters with the use of Systane® ULTRA eye drop. The other visit was conducted to assess tear film parameters with the use of Artelac Advanced eye drop. Results: The mean tear evaporation rate at baseline was 52.58 ± 23.24 g/m2 h. A box plot of tear evaporation showed a reduction in tear film evaporation rate after instillation of Systane eye drop. A drop in tear film evaporation rate of 14% was observed at 20 and 60 min time point after instillation of Systane ULTRA eye drop. A significant increase in NITBUT was found after instillation of Systane ULTRA (P = 0.01) and Artelac Advanced (P = 0.02). Conclusion: The current study indicates a significant improvement in the tear film parameters using both HP-Guar and hyaluronic acid formulations. However, it was apparent that the use of HP-Guar was superior to hyaluronic acid in controlling the tear evaporation rate in dry eye subjects.

The Prevalence and Risk Factors for Symptomatic Dry Eye in Adults in Riyadh, Saudi Arabia

Objectives: The objective of this study is to estimate the prevalence of symptomatic suspected dry eye, diagnosed dry eye syndrome (DES), and associated risk factors; in Riyadh, Saudi Arabia. Methods: A cross-sectional study of 654 participants was employed using a self-administered semi-structured questionnaire that included demographic characteristics like age, gender, and risk factors (smoking, using contact lenses, chronic comorbidities, etc.). Results: There were 266 (40.7%) previously diagnosed DES participants and 388 (59.3%) non-diagnosed DES, of which 497 were female and 157 were male. Females had a significantly higher rate of diagnosed DES than males (p<0.001), with a significant increase in the rate of DES diagnosis with age (p<0.001). There was also a significant increase in DES in participants with diabetes mellitus, allergic eye, thyroid eye, and skin diseases, as well as having undergone laser surgery or using contact lenses. There was no significant increase in DES in cases of smoking, daily use of electronic devices, or duration of sleep. Conclusion: The prevalence of dry eye among adults in Riyadh was 46.6%, with the most important risk factors being female gender, increasing age, Lasik refractive surgery, skin disease around the eye, and thyroid eye disease.