Scleral sutured aniridia intraocular lens (Morcher®): indications and long-term outcomes.

BACKGROUND/OBJECTIVE: To evaluate the outcomes of trans-scleral sutured posterior chamber black diaphragm intraocular lens (BDIOL) (Morcher®) implantations over 11 years. SUBJECTS/METHODS: Retrospective case-series of patients, who underwent BDIOL implantation, identified from electronic patient records system from 2006 to 2016, Moorfields Eye Hospital. Demographics, pre/post-operative, final best-corrected visual acuity (BCVA), diagnosis, symptomatic improvement, intraoperative and postoperative complications immediate or late were collected and analysed to relate outcomes to surgical indication. RESULTS: Forty eyes of 38 patients (F:M 1:2.8) underwent BDIOL implantation with a mean surgical age of 46.6 years and follow-up of 44.5 months (range of 8-132 months). Indications included 23(57%) ocular trauma, 7(17%) congenital aniridia, 7(17%) iatrogenic lens and/or iris loss, and 3(7%) infectious keratitis. Mean preoperative BCVA was 1.64 logMAR and mean final postoperative BCVA was 0.94 logMAR with an average improvement in BCVA of 0.23 logMAR, equivalent to 1.5 lines of Snellen visual acuity. Visual results varied according to indications. Infectious cause patients had the greatest vision improvement (-0.7 logMAR), followed by trauma (-0.3 logMAR), and 25% of these achieved vision of 0.3 logMAR (6/12 in Snellen acuity) or better. Conversely, the aniridia group had the least improvement (worsened vision of 0.01 logMAR), 17 patients (42%) reported subjective improvement. CONCLUSION: BDIOLs achieve reasonably good visual outcomes in eyes with complex vision threatening pathology. No significant intra-operative complications are documented and most post-operative complications are related to the pre-existing pathology. Post - trauma and iatrogenic aniridia have better outcomes compared to congenital aniridia.

A mathematical determination of foveal attachment in primary rhegmatogenous retinal detachment when obscured by bullous retina.

In primary rhegmatogenous retinal detachment (RRD), the foveal attachment is an important prognostic factors for post-operative vision. When the fovea is obscured by the RRD, its attachment status is considered uncertain. Using a model of the reduced emmetropic and - 10 dioptre myopic eye and the physical properties of the detached retina, we aimed to mathematically ascertain if it is clinically possible for the fovea to be attached while it is obscured by the primary RRD. With the patient upright, a primary RRD due to a 12 o'clock break directly above the fovea was considered. Mathematically, once the trough of the RRD touches the visual axis the edge of the RRD nearest to fovea is [Formula: see text] away from fovea in emmetropic eye and [Formula: see text] in myopic eye. When the RRD reaches the fovea, its trough is [Formula: see text] below the visual axis in emmetropic eye and [Formula: see text] in myopic eye. However, in vivo the RRD makes an acute angle with the retinal pigment epithelium and the corrugation of the retina in RRD shortens the retina. When these in vivo constraints are considered, in both of the above situations the fovea will be detached. If the fovea is obscured by an RRD, the fovea is very likely to be detached. In idiomatic terms, if the fovea cannot be seen, the fovea cannot see. This is an important clinical diagnosis for appropriate triage of the patient.

Heavy silicone oil tamponade: a multicentre experience.

OBJECTIVE: To report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications. METHODS AND ANALYSIS: Patients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil. RESULTS: 134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0-2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes). CONCLUSION: This is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies.

Effect of Face-Down Positioning vs Support-the-Break Positioning After Macula-Involving Retinal Detachment Repair: The PostRD Randomized Clinical Trial.

Importance: A lack of consensus exists with regard to the optimal positioning regimen for patients after macula-involving retinal detachment (RD) repair. Objective: To evaluate the effect of face-down positioning vs support-the-break positioning on retinal displacement and distortion after macula-involving RD repair. Design, Setting, and Participants: A prospective 6-month single-masked randomized clinical trial was conducted at a multicenter tertiary referral setting from May 16, 2016, to May 1, 2018. Inclusion criteria were fovea-involving rhegmatogenous RD; central visual loss within 14 days; patients undergoing primary vitrectomy and gas surgery, under local anesthetic; patients able to give written informed consent; and 18 years old and older. Analysis was conducted following a modified intention-to-treat principle, with patients experiencing a redetachment or failure to attach the macula being excluded from analysis. Interventions: Participants were randomized 1:1 to receive face-down positioning or support-the-break positioning for a 24-hour period postoperatively. Positioning compliance was not monitored. Main Outcomes and Measures: The proportion of patients with retinal displacement on autofluorescence imaging at 6 months postoperatively. Secondary outcomes included proportion of patients with displacement at 2 months; amplitude of displacement at 2 and 6 months; corrected Early Treatment Diabetic Retinopathy Study visual acuity; objective Distortion Scores; and quality of life questionnaire scores at 6 months. Results: Of the 262 randomized patients, 239 were analyzed (171 male [71.5%]; mean [SD] age, 60.8 [9.8] years). At 6 months, retinal displacement was detected in 42 of 100 (42%) in the face-down positioning group vs 58 of 103 (56%) in the support-the-break positioning group (odds ratio, 1.77; 95%CI, 1.01-3.11; P = .04). The degree of displacement was lower in the face-down group. Groups were similar in corrected visual acuity (face-down, 74 letters vs support-the-break, 75 letters), objective D Chart Distortion Scores (range: 0, no distortion to 41.6, severe distortion; with face-down at 4.5 vs support-the-break at 4.2), and quality of life scores (face-down 89.3 vs support-the-break 89.0) at 2 and 6 months. Retinal redetachment rate was similar in both groups (face-down group, 12.2% and support-the-break group, 13.7%). Retinal folds were less common in the face-down positioning group vs the support-the-break positioning group (5.3% vs 13.5%, respectively; odds ratio, 2.8; 95% CI, 1.2-7.4; P = .03). Binocular diplopia was more common in the support-the-break group compared with the face-down positioning group (7.6% vs 1.5%, respectively; odds ratio, 5.3; 95% CI, 1.3-24.6; P = .03). Amplitude of displacement was associated with worse visual acuity (r = -0.5; P < .001) and distortion (r = 0.28; P = .008). Conclusions and Relevance: In this study, findings suggest that face-down positioning was associated with a reduction in the rate and amplitude of postoperative retinal displacement after macula-involving RD repair and with a reduction in binocular diplopia. No association was found with visual acuity or postoperative distortion. Trial Registration: ClinicalTrials.gov Identifier: NCT02748538.

Tamoxifen keratopathy as seen with in-vivo confocal microscopy.

Tamoxifen is a triphenylethylene non-steroidal oestrogen antagonist widely used in oestrogen receptor-positive breast cancer, with well-documented ocular side-effects. Here we report a corneal confocal microscopy finding of a patient on low-dose tamoxifen. We believe that this is the first case report of a patient on low-dose tamoxifen with demonstrable corneal stromal crystalline deposits with confocal microscopy, but clinically asymptomatic with unremarkable corneal findings on cursory slit lamp examination. In summary, confocal microscopy is a useful adjunct in monitoring tamoxifen crystalline keratopathy, and helps detect subclinical deposits not visible/detected on slit lamp examination.

Corneal Endothelium in Brown-McLean syndrome: in-vivo confocal microscopy finding.

When Brown-McLean syndrome (BMS) was first described, there was no confocal microscopy to document corneal endothelial status, and it was understood as a disease entity involving a diseased endothelial layer. In the advent of confocal microscopy demonstrating healthy endothelium in BMS within the affected cornea, it can be inferred that BMS is a spectrum of disease ranging from healthy to decompensated corneal endothelium, rather than just a specific disease entity. Here we report a case of BMS with normal healthy corneal endothelium using corneal confocal microscopy. Any patient with BMS should be followed up to observe for any disease progression and should be educated regarding the signs and symptoms of corneal surface problems. Confocal microscopy documentation is a convenient and informative way and should form part of the follow-up of any BMS patient.

Minocycline induced conjunctival autofluorescence deposition.

Minocycline can cause palpebral conjunctival greyish deposits in which autofluorescence can be readily demonstrated. We believe that this is a first report of the demonstration of in-vivo conjunctival autofluorescence of palpebral conjunctival minocycline deposit. In conclusion, minocycline deposit can be shown clinically without the need of an invasive biopsy procedure in patients with a history of blepharitis on long-term tetracycline group of medication presenting with palpebral conjunctival deposits.

Long term visual outcomes, graft survival and complications of deep anterior lamellar keratoplasty in patients with herpes simplex related corneal scarring.

AIMS: To report long term visual outcomes, complications and graft survival of patients undergoing deep anterior lamellar keratoplasty (DALK) to treat corneal scarring secondary to herpes simplex virus (HSV) keratitis. METHODS: Retrospective, non-comparative case series. 18 patients who underwent DALK for HSV keratitis related corneal scarring between January 2004 and February 2007 were included. DALK was performed by Anwar's big bubble technique. Data collected for analysis included preoperative characteristics, intraoperative complications and postoperative acuity, complications and subsequent operations. RESULTS: Mean best corrected distance visual acuity (LogMAR) improved from 1.51 ± 0.90 preoperatively to 0.82 ± 0.85 at the last follow-up (p=0.05). 27% of patients with more than 4 years follow-up had a best corrected distance visual acuity of 6/12 or better and 64% were 6/24 or better. Six patients (33%) experienced a recurrence of HSV keratitis and 9 (50%) experienced an episode of graft rejection. There were five cases (28%) of graft failure, four of whom had had a previous episode of graft rejection. Logistic regression did not find an association with graft rejection, HSV recurrence, any other observed postoperative host corneal vascularisation and any postoperative complication. The majority of patients underwent a second operation with 50% requiring cataract surgery. CONCLUSIONS: DALK for the treatment of HSV related corneal scarring is associated with a high percentage of postoperative complications. DALK in this context is also associated with a large percentage of secondary operations. Patients should be aware of this when giving informed consent for DALK to treat HSV related corneal scars.