Intraocular pressure spikes after gonioscopy-assisted transluminal trabeculotomy (GATT).

PURPOSE: Intraocular pressure (IOP) spikes (IOP > 30 mmHg or > 10 mmHg above baseline IOP) are a common and worrisome complication of gonioscopy-assisted transluminal trabeculotomy (GATT). The purpose of this study is to identify risk factors for IOP spikes and to describe their characteristics, management, and clinical course in a large cohort of patients. METHODS: A retrospective, single-center study which included 217 consecutive eyes of patients that underwent GATT between December 2019 and April 2022 with follow-up of at least 90 days. RESULTS: IOP spikes occurred in 52 of 217 (24%) eyes. Spikes occurred in 15.5% of patients in whom pre-operative IOP-lowering medications were continued after surgery (90 eyes), and in 29.9% in whom IOP-lowering medications were stopped after surgery (127 eyes). Spikes were diagnosed at a mean of 7.7 ± 6.5 days after surgery. All IOP spikes occurred within the first month of surgery. The mean duration of a spike was 4.9 ± 5.4 days. Management of IOP spikes included adding a mean of 3.13 ± 1.7 groups of glaucoma medications. Thirty-seven (72.5%) eyes were treated with oral carbonic anhydrase inhibitor, 11 (21.6%) were treated with IV mannitol, and anterior chamber paracentesis was performed in 16 (31.4%). Six (11.8%) eyes underwent additional glaucoma surgery to control IOP. Patients that continued their pre-operative IOP-lowering medications after surgery were 2.3 times less likely to develop a spike as compared to patients who discontinued their medications (P = 0.016). Spikes were found to be a risk factor for failure of GATT. CONCLUSIONS: IOP spikes are a common occurrence after GATT. They most commonly appear during the first two post-operative weeks and usually resolve with topical and systemic IOP-lowering treatment. The continuation of IOP-lowering medications after GATT is recommended to lower the risk of IOP spikes.

Gonioscopy-assisted transluminal trabeculotomy in patients with advanced glaucoma.

Purpose: To evaluate the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in patients with advanced glaucoma. Methods: Records of 46 patients with advanced glaucoma were reviewed retrospectively in this single-center chart review. The main outcome measure was surgical success; intra-ocular pressure (IOP) and IOP lowering medication use were secondary outcome measures. Success was defined as an IOP of 18 mmHg or lower (criterion A) or 14 mmHg or lower (criterion B) and one of the following: IOP reduction >30% from baseline on the same or fewer medications or IOP ≤ of baseline on fewer medications as compared to baseline. Results: Forty-seven eyes were included in the analysis. The average mean deviation was -17.5 ± 7.2 dB (range -8.0 to -33.0). The average follow-up was 6.8 months (range 3.2-22.3). Success at 6 months was 91% for criterion A and 75% for criterion B (n = 33). Mean IOP was reduced from 19.3 ± 6 mmHg (12-40) on 3.7 ± 1.4 medications to 13.2 ± 5.8 mmHg on 1.6 ± 1.4 medications at the 6th post-operative month (P < 0.001 for both IOP and medications). At the last follow-up visit, 37 patients (78%) had an IOP of 14 mmHg or lower, and ten of these patients were unmedicated. Transient hyphema and IOP spikes were the most prevalent adverse events following surgery. Three eyes required further surgery for IOP control. None of the patients lost vision because of surgery. Conclusions: GATT is a viable surgical option in cases of advanced glaucoma. Careful patient selection and attentive post-operative management are imperative.

A Scleral Buckle Infection Caused by Cutibacterium Acnes (formerly Propionibacterium Acnes) Following An Atypical, Indolent Course.

PURPOSE: To report a case of atypical, indolent presentation of scleral buckle infection, caused by Cutibacterium acnes (formerly known as Propionibacterium acnes). METHODS: Observational case report. RESULTS: A 44-year-old healthy female with a history of scleral buckling procedure for retinal detachment repair sixteen years prior to presentation, was admitted with pain and redness in her left eye for six weeks. Conjunctival hyperemia and vascular congestion were noted over the scleral buckle in a circular manner without signs of exposure. After removal of the scleral buckle, cultures analysis revealed Cutibacterium acne. Systemic Amoxicillin was administrated. Over a 6-months follow-up, the retina remained attached. CONCLUSION: C. acne, known to be associated with chronic postoperative endophthalmitis after cataract surgery, may also lead to scleral buckle infection with an indolent, chronic course.

Assessment of long-term visual outcomes in aphakic children wearing scleral contact lenses.

BACKGROUND: Timely management of aphakic children is critical for the rehabilitation of adequate visual gain. This study aims to evaluate the long-term efficacy of scleral contact lenses in terms of visual outcomes, complications, and compliance in aphakic children. METHODS: Retrospective data review of children with congenital or acquired cataract, or subluxated crystalline lenses, who underwent lensectomy from 2004 to 2018 and who used scleral contact lenses for refractive correction. Collected data from the follow up period included recorded aphakic refraction and visual acuity, complications following scleral contact lens wear documented in the clinic and ophthalmic emergency room and compliance to lens wear according to parental feedback on every visit in the clinic. RESULTS: 76% of cases, with final best corrected visual acuity (BCVA) of 20/40 or better achieved in seventeen eyes (34%). The rate of amblyopia was 50%. Strabismus developed in 56% of children, and those had less favourable visual outcomes (0.43 ± 0.4 LogMAR without strabismus and 0.8 ± 0.5 LogMAR with strabismus, p = 0.015). No corneal infections were documented during the follow up. Main adverse effect on the ocular surface was superficial punctate keratopathy (n = 16). Compliance was good in 48 children (96%)- except for two cases, the scleral lenses were tolerated well by all children. CONCLUSION: Scleral contact lenses are an effective means of visual rehabilitation in aphakic children after lensectomy and may be used long-term with good compliance of wear, excellent visual outcomes, and tolerable adverse events.

Trans-optic suture fixation of malpositioned intraocular lenses.

PURPOSE: To report a technique for fixating posterior chamber intraocular lenses (PCIOLs) to the sclera by passing sutures through the lens material. METHODS: Cases in which PCIOLs were fixated to the sclera using trans-optic sutures were included in this series. Intra and post-operative complications were recorded, and lens position was assessed using slit-lamp examination. RESULTS: Fourteen cases were included in this series. In nine cases, the procedure was performed using 9-0 polypropylene in pseudophakic eyes to correct subluxation, centration, tilt or to replace a broken haptic. In five cases, this technique was used for primary PCIOL fixation using a flanged 6-0 polypropylene suture in aphakic eyes. In all cases, the lenses remained centered and stable at the end of follow-up, and no post-operative complications occurred. CONCLUSION: Trans-optic suturing is a safe and effective alternative method for fixation of IOLs in a variety of pseudophakic and aphakic clinical scenarios.

Second-generation capsular anchor for subluxated lenses: first clinical results.

PURPOSE: To evaluate the use of the second-generation capsular anchor in the treatment of subluxated crystalline and synthetic intraocular lenses. SETTING: Department of Ophthalmology, Meir Medical Center, Kfar Saba, Israel. DESIGN: Prospective interventional study. METHODS: This study evaluated the second-generation capsular anchor, a 3D poly(methyl methacrylate) intraocular implant designed to anchor the lens capsule to the sclera. All surgeries were performed by a single surgeon. Intraoperative and postoperative complications were recorded. Corrected distance visual acuity, lens centration, and lens tilt were assessed at the final follow-up of 3 months. RESULTS: 10 eyes of 10 patients were included in this study. Mean age was 56.2 (22 to 87) years. The reasons for the lack of zonular support were pseudoexfoliation in 3 cases, trauma in 3 cases, and Marfan, ectopia lentis, and pathologic myopia (1 case each). In 1 case, pseudoexfoliation and a history of recent trauma coexisted. 8 of the 10 surgeries were due to subluxation of crystalline lenses and 2 due to subluxation of intraocular lenses. Vision improved in all patients after surgery. Centration of the IOLs was excellent in all patients at the third postoperative month. One patient developed a retinal detachment at the third postoperative week and underwent successful surgery, and 1 patient developed macular edema at the fifth postoperative month, which resolved with topical medication. CONCLUSIONS: The second-generation capsular anchor, designed to provide significant improvements over the first-generation device, is effective in fixating the capsular bag to the scleral wall in cases with inadequate capsular support.

Ophthalmic emergency-room visits during the Covid-19 pandemic - a comparative study.

BACKGROUND: The goal of this study is to compare ophthalmic emergency room (OER) visits during the Coronavirus disease-19 (Covid-19) pandemic to those during a control period. METHODS: We compared all visits to the OER to Meir Medical Center in Israel, from March 15th to April 15th, 2020, during the Covid-19 pandemic and government mandated quarantine, to the same period in 2019. Factors analyzed were patient demographics, chief complaints, referral patterns, exam findings, treatments given, hospitalizations and surgical interventions. RESULTS: We included in this study 1311 visits of 1158 patients, 477 during the 2020 Covid-19 pandemic and 834 during the same period in 2019. The demographic distribution (age, gender, and ethnicity) was similar between the two periods. LogMAR visual acuity at presentation was worse during the Covid-19 pandemic (0.42 ± 0.6 and 0.34 ± 0.5 in 2020 and 2019 respectively; p = 0.025) and the number of emergent surgeries was higher (3.7% in 2020 vs 1.8% in 2019, p = 0.026). In 2019 there was a higher likelihood of involvement of both segments of the eye (4.82% versus 1.2%, p < 0.01) and more diagnoses were given to each patient (1 ± 0.5 versus 0.93 ± 0.35, p = 0.001; During the Covid - 19 pandemic medications (both topical and systemic) were prescribed more often (1.22 ± 0.95 in 2020 and 0.84 ± 0.67 in 2019, p < 0.001). CONCLUSIONS: OER visits were less frequent during the Covid - 19 pandemic as compared to 2019, though the demographics of the patients remained unchanged. Visits during the pandemic tended to be for more severe ocular conditions, with worse visual acuity at presentation and required more medical and surgical treatment which imply higher necessity of ocular evaluation. This analysis can aid healthcare resource management in similar scenarios in the future.

Evaluation of Accuracy and Agreement of Optical Coherence Tomography Angiography Interpretation of Common Retinal Findings and Diagnoses.

PURPOSE: To evaluate the accuracy and agreement of optical coherence tomography angiography (OCTA) interpretation in cases of common retinal findings and diagnoses, and to evaluate the effect of OCT B-scans on OCTA interpretations. METHODS: This is a case series consisting of a questionnaire with 8 cases demonstrating common retinal conditions of normal, age-related macular degeneration (AMD) and diabetic retinopathy (DR). Each case included OCTA images, and 58 participants were asked to identify retinal findings and provide a diagnosis. Following OCTA interpretation, the corresponding OCT B-scans were revealed and the participants were asked again to identify retinal findings and provide a diagnosis. The rates of accuracy and agreement for each condition were analyzed. RESULTS: Overall the rates of accurate diagnosis and identification of retinal findings were 37.4 and 61.6%, respectively. Following addition of the OCT B-scans, the rates increased to 61.6 and 79.4%, respectively (p < 0.001 for both). A significant improvement in correct interpretation occurred in the normal and AMD cases, but not in the DR cases. There was no correlation with length of experience or self-reported familiarity with OCTA. DISCUSSION: Considerable variability exists in OCTA interpretation, with mediocre rates of accuracy and agreement between clinicians. Increased familiarity as well as future automation advances will be needed to improve OCTA interpretation accuracy and uniformity.

Late spontaneous posterior capsule rupture after hydrophilic intraocular lens implantation.

PURPOSE: To describe and discuss the presentation and management of 4 cases of late (17 to 20 years) postoperative spontaneous posterior capsule rupture (PCR) and intraocular lens (IOL) subluxation in eyes implanted with the same hydrophilic 1-piece IOL. SETTING: Center for Applied Eye Research, Meir Medical Center and the Ein-Tal Eye Center, Israel. DESIGN: Case series. METHODS: Four patients presented with spontaneous rupture and posterior dislocation of the same design IOL (B-Lens) 17 to 20 years after implantation. No trauma or any other direct causative factor was identified in any of the cases. RESULTS: Of the 4 cases reported, the IOLs were successfully repositioned to the ciliary sulcus and sutured to the scleral wall (1 case) or the iris (2 cases), and the IOL was stable in the sulcus without the need for further sutured fixation in 1 case, with effective vision restored in all cases. CONCLUSIONS: Spontaneous PCR is a rare postoperative complication and has not been reported, to the authors' knowledge, in cases without predisposing factors. A mechanism of late capsular tear was not confirmed, but the specific design of the IOL might have been a contributing factor.

Massive Orbital Myiasis Caused by Sarcophaga argyrostoma Complicating Eyelid Malignancy.

Purpose. To report a case of massive orbital myiasis caused by the larvae of Sarcophaga argyrostoma, complicating eyelid malignancy. Observations. A 98-year-old man first presented to our clinic noted to have a fast-growing lesion on his right upper and lower eyelids. Squamous cell carcinoma of the eyelids was highly suspected, and surgical excision was advised, but the patient refused any surgical or nonsurgical intervention. For the next eight months, the patient's family members continued to observe a high rate of tumor growth accompanied by deterioration of the general condition. During this whole period, the patient rejected admission to the hospital and was observed by nursing home staff. He was admitted to the emergency room in cachexic, unresponsive condition with fetid discharge and multiple live maggots crawling out from a large necrotic mass over the right orbit. On examination, no eyelids, eyeball, or other ocular tissue could be seen, while an extension of necrotic mass to forehead and midcheek was noted. Manual removal of larvae was performed. The patient passed away eight hours after his admission and larval removal. The maggots were identified as the third-instar larvae of Sarcophaga argyrostoma. Conclusions and Importance. This is the first reported case of home-acquired, massive orbital myiasis by S. argyrostoma. This case illustrates the crucial role of fly control as part of medical and home care in immobile patients. Moreover, it shows the importance of awareness by nursing home staff, paramedical, and medical personnel of possible myiasis, especially in bed-bound patients with skin malignancies and open wounds.

Does Bariatric Surgery Affect Intraocular Pressure?

PURPOSE: The effect of body mass index (BMI) reduction following bariatric surgery on intraocular pressure (IOP) is not well established. We evaluated association between BMI reduction and IOP measurements and other ocular and metabolic parameters 1 year after bariatric surgery. MATERIALS AND METHODS: A retrospective study with over 1-year follow-up on patients who underwent weight reduction bariatric surgery between January 2016 and December 2016 at Wolfson Medical Center, Israel. Patient data was extracted from outpatient's bariatric and ocular clinic records. Metabolic, ocular, and clinical parameters were assessed including BMI changes, IOP, central corneal and retinal nerve fiber layer thickness, optical coherence tomography, and biometry results. RESULTS: Of 22 bariatric surgery patients, 15 underwent laparoscopic sleeve gastrectomy (LSG) and 7 laparoscopic mini gastric bypass (MGB). All were followed up for over 1 year after surgery. Average BMI decreased from 41.9 ± 7.3 to 25.5 ± 5.7 kg/m2 at 1-year follow-up (p < 0.001). Mean IOP decreased significantly by 21% after 1 year (p < 0.001). Decrease in IOP 1 year after surgery was correlated with decrease in IOP at 3-month follow-up (r = 0.677, p = 0.001), preoperative IOP (r = 0.837, p < 0.001), and corneal thickness (r = 0.589, p = 0.006), with no correlation between reduction in IOP and baseline weight, BMI, or the reduction in either (p > 0.05). Central corneal thickness and retinal nerve fiber layer thickness were also significantly decreased (p = 0.038) and (p = 0.018), respectively. CONCLUSION: BMI reduction achieved by bariatric surgery was associated with significant and continued decline in IOP beyond 1 year after surgery. Clinical implications highlight the importance of considering bariatric surgery in patients with ocular hypertension.