Ocular Trauma Caused by Confetti Cannons.

BACKGROUND: Eye trauma is an unfortunate and often preventable cause of vision loss. Confetti cannons are common causes of injury. Awareness of ocular hazards of confetti cannons remains low because of limited reports describing ophthalmic injuries following their use. OBJECTIVES: To describe outcomes of ocular trauma caused by confetti cannons and to increase recognition of their ocular risks. METHODS: A retrospective analysis was conducted of eye injuries caused by confetti cannons presenting to a single medical center between 2016 and 2020. Data collected included age, gender, eye injured, ocular damage, visual outcome, and details of surgeries performed. RESULTS: Overall, six consecutive patients (2 males, mean age 19.5 ± 9.74 years) were identified and studied. In all patients only one eye was injured (3 right eyes) during a private celebration, most commonly (n=5) to a bystander while in the vicinity of a cannon operated by someone else. Most common eye injuries included corneal erosion (n=4), traumatic hyphema (n=4), and retinal edema (n=3). Mean initial logMAR visual acuity in the injured eye was 0.73 ± 0.18, improving to 0.25 ± 0.16 at the final visit (P = 0.125). Two patients underwent eye surgery due to their trauma: one to repair globe penetration and another to undergo intravitreal injection of tissue plasminogen activator and C3F8 for submacular hemorrhage, followed 8 months later by intravitreal bevacizumab injection for choroidal neovascularization. CONCLUSIONS: Confetti cannons pose hazards that can cause severe ocular trauma resulting in permanent vision loss. Increasing awareness of device hazards is necessary to prevent eye injuries.

Characteristics and visual outcome of ocular trauma patients at Queen Elizabeth Central Hospital in Malawi.

BACKGROUND: To describe the epidemiology and visual outcome of patients with ocular trauma treated at Queen Elizabeth Central hospital in Malawi. METHODS: A prospective, observational study was undertaken from September 2017 to December 2017. Data on socio-demographic features, aetiology of trauma, type of ocular injury pre-referral pathway and treatment of ocular trauma was collected as the exposure variables. The main outcome variable was best corrected visual acuity at 8 weeks following initial visit. RESULTS: A total of 102 patients (103 eyes) with ocular trauma were recruited with loss of follow up of 11 participants at 8 weeks following recruitment. The most affected age group were children under 11 years old (35.3%), followed by young adults of age between 21-30 years (22.5%). The male-to-female ratio for ocular injury was 2.8:1. Most participants had closed globe injuries (n = 72, 70.6%), with over half the population injured by blunt objects (n = 62, 60.8%). Furthermore, among the adult population, majority (n = 19 38%) were injured on the road during assaults (n = 24, 48%), while most paediatric injuries (n = 32, 61.5%) occurred at home during play. The incidence of monocular blindness was 25.3% at eight weeks after the first presentation. Factors that were associated with monocular blindness on multivariate analysis were living in rural areas and open globe injuries. CONCLUSION: Ocular trauma led to monocular blindness in a quarter of the study population. There is need for preventive education of ocular injuries at both family and community level.

Long-term outcomes of pediatric traumatic cataracts and retinal detachments due to self-inflicted injuries.

PURPOSE: To report the characteristics and longitudinal visual outcomes of traumatic cataracts and retinal detachments in children with self-inflicted injury. METHODS: A retrospective case series of pediatric patients at a tertiary care center who sustained ocular trauma due to self-inflicted injury between 2000 and 2014. RESULTS: A total of 11 children, all with an intellectual disability and a mean age of 10 ± 4.8 years (range, 2.8-16.2), were identified with traumatic cataract secondary to ocular self-inflicted injury over the study period. Five eyes had a concurrent unilateral retinal detachment. Over the course of follow-up, one additional eye developed a cataract and five eyes developed a retinal detachment. Patients underwent an average of 2.5 ± 2.3 procedures and 17.1 ± 10.7 eye examinations over 11.7 ± 4.2 years of follow-up; 36% required general anesthesia for examination. Visual acuity was improved or preserved in 77% of the eyes that underwent surgical interventions, but was worse in the remaining cases due to development of traumatic retinal detachment. The use of protective helmets, eye shields, and immobilizing orthoses were essential in management of active self-inflicted injury. CONCLUSION: Traumatic cataracts and retinal detachments due to self-inflicted injury may cause severe visual loss. Visual prognosis although poor in children with severe intellectual disabilities may be optimized with risk awareness for early detection and customized interventions.

LONG-TERM VISUAL RECOVERY IN BILATERAL HANDHELD LASER POINTER-INDUCED MACULOPATHY.

PURPOSE: To describe the long-term visual, clinical, and optical coherence tomography (OCT) recovery after 4 years in a patient who incurred severe bilateral handheld laser pointer damage. METHODS: The findings on clinical examination, color fundus photography, and spectral domain OCT at presentation followed by sequential time points over 4 years are presented. RESULTS: A 9-year-old healthy boy presented with bilateral reduced vision to count fingers in each eye with yellow irregular lesions. After extensive evaluation, he admitted to multiple, prolonged episodes of staring at a handheld red laser pointer reflected in a mirror. Initial visual acuity was count fingers bilaterally. Clinical examination revealed bilateral yellow streaks radiating from the fovea without hemorrhages or fluid and retinal pigment epithelium pigmentary mottling. Spectral domain OCT showed disruption of the foveal outer retina extending from the outer plexiform layer to the retinal pigment epithelium spanning 896 µm in the right eye and 564 µm in the left eye. Six months after injury, vision had only minimally improved to 20/200 with resolution of outer plexiform layer and outer nuclear layer opacification on OCT. Over the ensuing 4 years, visual acuity slowly recovered to 20/30 in each eye and the regions of outer retinal disruption progressively reduced in size to 295 µm in the right eye and 115 µm in the left eye. CONCLUSION: This case illustrates gradual vision and anatomical improvement over 4 years despite initial poor vision after severe laser pointer macular damage. Visual recovery may be related to patient and exposure factors as well as initial OCT features where an intact Bruch membrane can provide a scaffold for photoreceptors to recover, thereby reducing the outer retinal defect.

Factors Associated With Increased Risk of Serious Ocular Injury in the Setting of Orbital Fracture.

Importance: Orbital fractures are common in ocular trauma, and there is a need to develop predictive tools to estimate risk of concurrent ocular injury. Objective: To identify clinical and radiographic features that are associated with increased risk of substantial ocular injury in the setting of orbital fracture. Design, Setting, and Participants: Retrospective consecutive case series of patients who sustained orbital fractures between 2012 and 2018. Examinations were done at 1 of 2 level 1 trauma centers in the emergency or inpatient setting. A total of 430 consecutive patients (500 eyes) between 2012 and 2017 met inclusion criteria for the training sample. After building a predictive model, 88 additional consecutive patients (97 eyes) between 2017 and 2018 who met inclusion criteria were collected as a test sample. Main Outcomes and Measures: The primary outcome measure was substantial ocular injury distinct from orbital fracture. Results: The mean age of our patient population was 53.5 years (range, 16-100 years). The overall rate of substantial ocular injury was 20.4%, and the rate of injury requiring immediate ophthalmic attention was 14.4%. Five variables were found to be associated with increased risk of substantial ocular injury: blunt trauma with a foreign object (odds ratio [OR], 19.4; 95% CI, 6.3-64.1; P < .001), inability to count fingers (OR, 10.1; 95% CI, 2.8-41.1; P = .002), roof fracture (OR, 9.1; 95% CI, 2.8-30.0; P = .002), diplopia on primary gaze (OR, 6.7; 95% CI, 1.7-25.1; P = .003), and conjunctival hemorrhage or chemosis (OR, 4.2; 95% CI, 2.2-8.5; P < .001). The results were translated into a bedside tool that was tested in an independent group of eyes (n = 97) and found to be associated with substantial ocular injury with a 95% sensitivity (95% CI, 77.2-99.9), 40% specificity (95% CI, 28.9-52.0), 31.8% positive predictive value (95% CI, 27.5-36.5), and 96.8% negative predictive value (95% CI, 81.3-99.5). Conclusions and Relevance: A minority of patients with an orbital fracture had a substantial ocular injury. Certain radiographic and clinical findings were associated with substantial ocular injury. Testing of the algorithm in prospective longitudinal settings appears warranted.

Lateral Rectus Muscle Injury During Double-Headed Pterygium Surgery: A Rare Complication.

A 43-year-old man developed double vision, esotropia, and abduction limitation after excision of a doubleheaded pterygium. Exploration during strabismus surgery 4 months later revealed a partially severed lateral rectus muscle and extensive conjunctival scarring. Direct injury to the lateral rectus muscle during pterygium surgery is extremely rare. Prevention and management strategies are discussed. [J Pediatr Ophthalmol Strabismus. 2020;57:e96-e99.].

Case Report: Use of Prosthetic Replacement of the Ocular Surface Ecosystem Treatment of Traumatic Lid Ptosis in a Pediatric Patient.

SIGNIFICANCE: This report shares the long-term outcomes of an uncommon use of prosthetic replacement of the ocular surface ecosystem (PROSE) treatment and scleral lenses in the treatment for patients with ptosis who are not surgical candidates. PURPOSE: This study aimed to describe a case of pediatric traumatic lid ptosis and follow-up during an 8-year period with PROSE treatment. CASE REPORT: A 7-year-old Honduran girl presented with a history of severe cranial, facial, and ocular trauma as a result of a motor vehicle accident. Significant ptosis with left-sided facial paralysis and irregular astigmatism significantly reduced the patient's visual function in the left eye. She was evaluated and treated with a scleral prosthetic device in the left eye to improve vision, the ocular surface, and overall function for activities of daily living. After 8 years of PROSE treatment, acuity in the left eye remained stable at 20/25. The corneal health remained stable throughout this period, without complications of corneal neovascularization or corneal edema. CONCLUSIONS: Prosthetic replacement of the ocular surface ecosystem treatment provided support of the ocular surface and mechanical left upper eyelid lift in a traumatic eyelid ptosis, ultimately providing improved visual function during an extensive 8-year period in a pediatric patient. Further studies are needed to evaluate the applicability of this approach in broader ptosis cases.

Eye Emergencies.

Central retinal artery occlusions, chemical injuries, mechanical globe injuries, and retinal detachments are eye emergencies that can result in permanent vision loss if not treated urgently. Family physicians should be able to recognize the signs and symptoms of each condition and be able to perform a basic eye examination. Patients with a central retinal artery occlusion require urgent referral for stroke evaluation and should receive therapy to lower intraocular pressure and vasodilating agents to minimize retinal ischemia. Chemical injuries require immediate irrigation of the eye to neutralize the pH of the ocular surface. A globe laceration or rupture is common in patients with a recent history of trauma from a blunt or penetrating object. Physicians should administer prophylactic oral antibiotics after a globe injury to prevent endophthalmitis. The eye should be covered with a metal shield until evaluation by an ophthalmologist. Patients with symptomatic floaters and flashing lights should be referred to an ophthalmologist for a dilated funduscopic examination to evaluate for a retinal tear or detachment.

Integrative Proteomic and MicroRNA Analysis: Insights Into Mechanisms of Eyestalk Ablation-Induced Ovarian Maturation in the Swimming Crab Portunus trituberculatus.

Eyestalk ablation is the most common method to induce ovarian maturation in decapod crustacean aquaculture, but it jeopardizes broodstock survival and larvae production. It is important to understand the molecular basis underlying the maturation triggered by ablation and thereby develop an alternative measure for maturation manipulation. In this study, we investigate alterations of ovarian proteome and miRNA profile after ablation in a commercially important marine crab Portunus trituberculatus. Quantitative proteomic analysis using iTRAQ reveals that 163 proteins are differentially expressed following ablation, and modulation of methyl farnesoate metabolism and activation of calcium signaling may play important roles in the ovarian maturation induced by ablation. miRNA expression profiling identifies 31 miRNAs that show statistically significant changes. Integration of miRNA and proteome expression data with miRNA target prediction algorithms generates a potential regulatory network consisting of 26 miRNAs and 30 proteins linked by 71 possible functional associations. The miRNA-protein network analysis suggests that miRNAs are involved in promoting ovarian maturation by controlling expression of proteins related to methyl farnesoate synthesis, calcium signals, and energy metabolism. Experimental validation and temporal expression analysis indicate multiple miRNAs can act synergistically to regulate expression of Farnesoic acid O-methyltransferase and Calmodulin. Our findings provide new insights for elucidating the mechanisms underlying eyestalk ablation-induced ovarian maturation and could be useful for devising an alternative technique for manipulating reproduction in P. trituberculatus and other decapods.

Pediatric Ocular Trauma during Eid Festivities in Yemen.

PURPOSE: We sought to elucidate causes of ocular trauma in children younger than 17 years of age during the Eid festivities in Sana'a, Yemen. METHODS: A prospective observational case series study was conducted in two tertiary emergency hospitals (Al-Thawra and Magrabi Hospital). The Eid Al-Fitr festive holidays in 2016 lasted 10 days from July 3 to 12. All children up to 17 years of age presenting with ocular trauma were included in the study. All patients underwent detailed history-taking and examination concerning ocular trauma. RESULTS: One hundred sixty children presented to the two hospitals with ocular injury. All were males (100%). The mean ± standard deviation age was 9.59 ± 4.92 years (range, 4-15 years). The injury involved the right eye in 84 children (52.5%) and the left eye in 76 (47.5%) children. The majority of injuries (n = 152, 95.0%) had occurred in the street, while eight (5.0%) had happened at home. The most frequent cause of injury was toy guns and fireworks, while the most frequent findings were hyphema, corneal laceration, and corneal abrasion. CONCLUSIONS: The causes of ocular injuries are diverse and tend to vary by geographical area. In particular, their incidence can increase during holidays, especially long ones. Usually, eye injuries with toy guns result in significant trauma that requires medical intervention and hospitalization with potential long-term eye complications. Public health workers need to conduct health education program to alert parents and health professionals to the danger of such toys.

Retinal toxicity after facial laser epilation.

A 39-year-old man presented to the ophthalmology emergency room complaining of decreased visual acuity and metamorphopsia on his left eye after undergoing Nd:YAG facial hair epilation without wearing proper eye protection. Fluorescein angiography showed a foveal staining initially, with an increase in foveal leakage over late phases. On optical coherence tomography, a subfoveal retinal pigment epithelial detachment with associated subretinal fluid and no signs of choroidal neovascularization or cystoid macular edema was observed. Observation with monthly follow-ups was adopted. By the fourth month, the subretinal fluid had already disappeared and visual acuity had returned to 20/20. Over one-year follow-up, the retinal pigment epithelial detachment experienced a decrease in its size. Conservative management may be a valid option in assessing accidental foveal photocoagulation when choroidal neovascularization or cystoid macular edema is absent. The use of wavelength specific goggles is mandatory for the patient and the aesthetician operating the cosmetic laser, especially when operating on the face or around the eyes. Abbreviations: Nd:YAG = neodymium-doped yttrium aluminium garnet, OCT = optical coherence tomography, PED = pigment epithelial detachment, CME = cystoid macular edema.

Corneal Sensitivity and Tear Function in Recurrent Corneal Erosion Syndrome.

Purpose: To determine the association of corneal sensitivity and tear functions on the prognosis of eyes after posttraumatic recurrent corneal erosion syndrome (RCES). Methods: Patients were enrolled retrospectively and had unilateral RCES and a history of ocular surface trauma. A corneal sensitivity test and tear function test (tear break-up time and Schirmer test) were performed at three time points (month 1 to month 3, month 3 to month 6, and month 6 to month 12). Depending on the number of recurrences during the follow-up, patients were divided into group A (n > 2) or group B (n = 2). A comparison between diseased and normal fellow eyes in each patient was performed. Results: A total of 31 patients were enrolled and divided into group A (n = 14) and group B (n = 17). The mean age was 40.3 ± 12.2 years, whereas the mean follow-up was 28.0 ± 3.6 months. During the study period, corneal sensitivity, tear break-up time, and the Schirmer test results were all lower in diseased eyes than in normal fellow eyes in both groups. Compared to the first time point, recovery of corneal sensitivity and the Schirmer test values were observed in diseased eyes in group B at the second and third time points. Conclusions: Poor corneal sensitivity and tear function are associated with posttraumatic RCES. Recovery of corneal sensitivity and tear function may be associated with a reduction of recurrence in eyes with posttraumatic RCES.

Ocular trauma score como predictor de agudeza visual en pacientes con trauma ocular grave: predictor de pronóstico visual en urgencia oftalmológica / Ocular trauma score as a predictor of visual acuity in patients with severe ocular trauma: visual prognosis in ophthalmological urgency

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.

This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.

The ABCs of Ocular Trauma: Adapting a Familiar Mnemonic for Rapid Eye Exam in the Pre-Ophthalmic Zone of Care.

Evaluation and management of eye trauma is daunting to many practitioners. For general medical emergencies, the familiar ABCs mnemonic serves to both recompose the provider as well as provide a logical order for evaluation and action. We recently adapted an ABCs mnemonic to provide non-ophthalmologists with a familiar method for systematically evaluating and managing eye trauma. A = ACUITY. Visual acuity is the most importance piece of information in eye trauma. B = BEST exam of BOTH eyes. Starting with acuity, examination proceeds from the front to the rear of the eye. Examine the uninjured eye first. C = CONTIGUOUS STRUCTURES and CONTACT LENSES. Examine structures contiguous to the apparent injury. Inspect for contact lens wear. D = DRUGS, DIAGNOSTIC IMAGING, and the DON'TS. Start antibiotics, antiemetics, and analgesics. Administer tetanus. Obtain computerized tomography if available. Do not attempt ocular ultrasound or magnetic resonance imaging. Do not apply pressure to the eye. Do not patch the eye or apply any medication. E = EYE SHIELD and EVACUATE. Shield and ship to ophthalmology. The mnemonic was adapted to reflect current Joint Trauma Services and Tactical Combat Casualty Care practice guidelines. We believe this familiar mnemonic will serve as a useful tool in allowing non-ophthalmologists to comfortably and safely evaluate an eye for trauma.

Epidemiology and Outcomes Following Open Globe Injury in Agricultural Region, an 11-Year Experience.

PURPOSE: To determine the characteristics and epidemiology of open globe injury (OGI) in a third referral centre over 11 years. METHODS: The study was a retrospective observational study. The medical records of 978 OGI cases (a total of 998 eyes), admitted to Chiang Mai University Hospital, Thailand from January 2006 to December 2016, were reviewed. RESULTS: The mean age (SD) of patients was 39.1 (17.5) years. Patients were predominantly male (867, 88.7%). The age with the highest incidence of injury ranged from 41 to 60 years, in both genders. Most injuries happened at the workplace (64.8%), with flying objects from electric grass trimmers (23.9%) being the major injury-related mechanism. Penetration injuries were found in 479 eyes (48.0%). In elderly group (aged >60 years), a higher proportion of a globe rupture injuries were observed (13.3%). In general, intraocular foreign body group presented with better initial visual acuity (VA) compared to other injury types (p< 0.001). In all types of injury, final VA was significantly improved after treatment. However, rupture and perforation globe injuries had significantly worse final VA outcomes, compared to penetration and intraocular foreign body injuries (p< 0.001). With multivariable regression analysis, poor initial VA (p< 0.001), type of injury (p= 0.028), positive relative afferent pupillary defect (RAPD) (p< 0.001), and endophthalmitis (p< 0.001) were associated with poor visual outcomes. CONCLUSIONS: Work-related eye injury is a major cause of OGI. Poor initial VA, endophthalmitis, presence of RAPD, and rupture were the predictors for poor final visual outcomes.

Pupil cerclage technique for treatment of traumatic mydriasis.

AIM: The aim of this study is to evaluate the efficacy of pupil cerclage and a new variant of sliding knot technique for repairing traumatic mydriasis. DESIGN: This is a observational case series study. SETTING/METHODS: A series of consecutive patients affected by traumatic permanent mydriasis who underwent pupil cerclage were recruited at the Department of Ophthalmology of the University of Padova, Italy. Best-corrected visual acuity, measured in logarithm of minimum angle of resolution (logMAR), and intraocular pressure at 1, 3, 6, and 12 months were monitored. Postoperative pupil size and anterior chamber angle were measured. Postoperative cystoid macular edema (CME) and glaucoma were evaluated. RESULTS: Twelve patients were recruited. Phakic patients (7) underwent cataract surgery combined with pupil cerclage. Vitrectomy was performed in nine patients. Best-corrected visual acuity improved from 2.9 ± 1.1 logMAR at baseline to 0.3 ± 0.8 logMAR at 12th month. No significant difference between the preoperative and postoperative intraocular pressure was demonstrated. Mean pupil size at 12th month was 2.82 ± 0.5 mm with round shape. Anterior chamber angle mean was 47° ± 4.5°. Six patients developed a CME, and two patients a glaucoma. CONCLUSION: Pupil cerclage technique reestablishes the pupil with a precise regulation of the pupil size without distortion of its natural round shape. New sliding knot allows surgeon to reduce the risk of iatrogenic iris damage and to make a security permanent knot.

Development of a rabbit model of persistent hypotony without ciliary body injury.

In order to study the pathophysiological alterations of the ciliary body (CB) during persistent hypotony, it is necessary to develop an animal model without CB injury. In this study, we successfully established a modified model of persistent hypotony without CB injury in New Zealand rabbits. A 23-gauge pars plana vitrectomy (PPV) was performed and a trocar-formed fistula was allowed to remain in situ, to produce a continuous outflow of intraocular fluid. Both eyes underwent PPV with normal intraocular pressure (IOP); eyes with no surgical intervention were used as controls. The IOP was monitored and used to evaluate the reliability of the model. Secondary changes of hypotony were evaluated by slit-lamp biomicroscopy and B scans while morphological changes of the CB were observed by haematoxylin and eosin staining. The mean IOP in the hypotony groups were consistently lower than 6 mmHg. Furthermore, there were no significant differences in IOP between the PPV control group and normal eyes. Collectively, our data indicate that this model successfully simulates the secondary changes of hypotony, including a reduction in corneal size, corneal oedema, anterior chamber inflammation, morphological alterations of the CB, cataract, retinal detachment, and choroidal detachment. The morphological structure of the CB tissue changed dramatically after persistent hypotony, indicating that normal IOP may be required in order to maintain normal function in the CB. This model of persistent hypotony potentially represents a valuable tool for future studies aiming to investigate the pathophysiological mechanisms underlying CB dysfunction and other secondary changes that occur during hypotony.