Five-year follow-up of corneal endothelial cell density after transscleral ab interno glaucoma gel stent implantation.

PURPOSE: This study investigates the course of the endothelial cell density over a period of 5 years after XEN45 implantation (XEN45µm, Allergan Plc., USA) with or without combined cataract surgery. METHODS: This is a prospective, cross-sectional, monocentric, non-randomized clinical trial with the intention to treat a population of the University Eye Clinic Glaucoma Service Salzburg. One hundred and fifty-five eyes with preoperative central corneal endothelial cell counts were subjected to XEN45 implantation with (combined surgery group) or without (solo surgery group) combined cataract surgery. Endothelial cell density was measured at 3 corneal positions. XEN45 location parameters were determined with anterior segment OCT and gonioscopy. RESULTS: In the combined surgery group, a significant reduction of central endothelial cell count was found at years 2 and 4 when compared to baseline (p = 0.001 and p = 0.02, n = 86), whereas at years 1, 3, and 5, no change was detected (all p > 0.09). The median reduction of endothelial cell count was - 79 (95% CI: - 183 to - 9) and - 93 (95% CI: - 220 to 23) cells at years 2 and 4, respectively. In the solo surgery group (n = 69), no significant change in endothelial cell counts was detected at any time during the 5-year evaluation period (all p > 0.07). Explorative data analyses revealed that XEN45 location parameters did not significantly influence the course of endothelial cell count over time. CONCLUSIONS: Endothelial cell loss after XEN45 implantation seems to be low. The present data suggest no impact on the position of the implant with regard to central endothelial cell counts in this study.

Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation.

PURPOSE: Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population. METHODS: Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP. RESULTS: IOP reductions of -35, -39, -25, -25, -23, -34, and -36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12-0.38]), and the drop persisted during the following 12 months. CONCLUSION: The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.

Femtosecond laser in refractive corneal surgery.

The introduction of the femtosecond (fs) laser has revolutionized ophthalmic surgery. With the worldwide application of fs-lasers, clinical outcomes and safety in corneal procedures have improved significantly and they have become an ideal tool for ultra-precise corneal refractive surgery. Flap creation in laser in situ keratomileusis (LASIK) is the most common use of this laser. It can also be used for other corneal refractive procedures including channel creation for the insertion of intrastromal corneal ring segments (ICRS), performing astigmatic keratotomies (AK), femtosecond lenticule extraction including small incision lenticule extraction (SMILE), and the insertion of corneal inlays. This article summarizes recent advanced applications of fs laser technology in corneal refractive surgery.

Change in visual acuity 12 and 24 months after transscleral ab interno glaucoma gel stent implantation with adjunctive Mitomycin C.

PURPOSE: To analyze changes in best-corrected visual acuity (BCVA) after implantation of the transscleral ab interno glaucoma gel stent (XEN Gel Stent; Allergan, Dublin) in patients with open-angle glaucoma. METHODS: In a single-center, prospective, non-randomized study of 137 eyes with open-angle glaucoma which underwent implantation with XEN, 69 eyes underwent XEN implantation alone (group 1) and 68 eyes underwent XEN implantation and cataract surgery (group 2). BCVA (Bailey-Lovie chart, logMAR scale) was evaluated at baseline, postoperative day 1, weeks 1 and 2, and months 1, 3, 6, 12, and 24. Risk factors for decline in BCVA were analyzed in multivariate models. RESULTS: Baseline BCVA in group 1 was 0.21 ± 031; the group's mean BCVA did not change at any postoperative visit, although a ≥ 2-line loss of BCVA was detected in 15% (95% CI 7-29%) and 4% (95% CI 0-20%) after months 12 and 24, respectively. Baseline BCVA in group 2 was 0.33 ± 031; vision increased significantly at months 3 (0.22 ± 0.29, p = 0.015), 6 (0.20 ± 0.26, p = 0.006), 12 (0.18 ± 0.29, p = 0.001), and 24 (0.18 ± 0.29, p = 0.005). A ≥ 2-line loss of BCVA was reported in 4% (95% CI 1-15%) and 7% (95% CI 1-24%) after months 12 and 24, respectively. CONCLUSIONS: There was no deterioration of BCVA in group 1; those in group 2 had an overall significant increase in BCVA. BCVA decrease was lower than is typically reported in the literature post-trabeculectomy.

[Mid- and Longterm Experiences with the Boston-Keratoprosthesis. The Cologne and Salzburg Perspective]. / Mittel- und langfristige Erfahrungen mit der Boston-Keratoprothese. Die Kölner und Salzburger Perspektive.

Background Eyes with severe corneal opacifications and insufficient prognosis for high-risk corneal transplantation can be considered for the implantation of a Boston-keratoprosthesis. Since 2013, this technique of "artificial" corneal replacement is provided to high-risk eyes at the Department of Ophthalmology, University of Cologne and for 9 years at the University of Salzburg. In the meantime, a type I Boston keratoprosthesis (BI-KPro) has been implanted in 24 eyes in Cologne and in 28 eyes in Salzburg. Methods In this article, results and complications according to BI-KPro are discussed, both from the literature in PubMed, as well as from our own experiences. Results Twenty-four eyes of 22 patients had been provided with a BI-KPro since September 2013, of which only one keratoprosthesis could not be obtained thus far, and an increase in visual acuity could be achieved in 23 eyes (96%). On average, 1.5 revisions per eye were required during the postoperative course. Since 2007, a BI-KPro has been implanted in 28 eyes in Salzburg. In 62% (16 of 26 eyes), visual acuity increased postoperatively, with a complication rate of 81% in a longer follow-up period. In both cohorts, the spectrum of complications ranged from retroprosthetic membrane formation, to secondary glaucoma, to infectious keratitis with or without graft melting, to vitritis, to endophthalmitis. Conclusion The range of possible complications according to BI-KPro is broad, but the BI-KPro represents currently the most widely used form of artificial corneal replacement in high-risk eyes and leads to visual improvement in most patients.

Prospective Randomized Intraindividual Comparison of Posterior Capsule Opacification After Implantation of an IOL With and Without Heparin Surface Modification.

PURPOSE: To compare posterior capsule opacification (PCO) of a hydrophobic acrylic heparin surface modified intraocular lens (HSM-IOL) and an uncoated IOL (UC-IOL) 1 year after implantation. METHODS: One hundred two eyes of 51 patients underwent routine phacoemulsification with randomized implantation of a HSM-IOL in one eye (the HSM-IOL group) and a UC-IOL in the fellow eye (the UC-IOL group). Morphologic PCO evaluation was performed comparing digital photographs in retroillumination using the Evaluation of Posterior Capsule Opacification (EPCO) system, grading the density of the opacification from 0 to 4 (0 = none, 1 = minimal, 2 = mild, 3 = moderate, and 4 = severe). Distance visual acuities, subjective manifest refraction, pupil size, straylight measurements, flare in the anterior chamber using a laser flare meter, and contrast sensitivity were also evaluated. RESULTS: The mean total EPCO score was slightly higher in the HSM-IOL group (0.50 ± 0.45) compared to the UC-IOL group (0.45 ± 0.46), but did not reach statistical significance. No statistically significant differences were found in the other main outcome parameters (straylight measurement, distance visual acuities, flare in the anterior chamber, and mesopic and photopic contrast sensitivity) when comparing both IOLs. CONCLUSION: Although the HSM-IOL showed decreased flare 1 day postoperatively, no statistically significant differences regarding PCO were found 1 year postoperatively.

Survey: Preferred practice patterns in the diagnosis of mucous membrane pemphigoid amongst cornea specialists.

PURPOSE: To evaluate preferred diagnostic tools and treatment decision-making factors in cases suspicious of mucous membrane pemphigoid (MMP) amongst ophthalmologists and cornea specialists. METHODS: Web-based survey, consisting of 14 multiple choice questions, posted to the Cornea Society Listserv Keranet, the Canadian Ophthalmological Society Cornea Listserv, and the Bowman Club Listserv. RESULTS: One hundred and thirty-eight ophthalmologists participated in the survey. Eighty-six percent (86%) of respondents were cornea trained and practiced in either North America or Europe (83%). Most respondents (72%) routinely perform conjunctival biopsies for all suspicious cases of MMP. For those who do not, fear that biopsy will exacerbate inflammation was the most common reason to defer investigation (47%). Seventy-one percent (71%) performed biopsies from perilesional sites. Ninety-seven percent (97%) ask for direct (DIF) studies and 60% for histopathology in formalin. Most do not recommend biopsy at other non-ocular sites (75%), nor do they perform indirect immunofluorescence for serum autoantibodies (68%). Immune-modulatory therapy is started following positive biopsy results for most (66%), albeit most (62%) would not let a negative DIF influence the choice of starting treatment should there be clinical suspicion of MMP. Differences in practice patterns as they relate to level of experience and geographical location are contrasted to the most up-to-date available guidelines. CONCLUSION: Responses to the survey suggest that there is heterogeneity in certain practice patterns for MMP. Biopsy remains an area of controversy in dictating treatment plans. Identified areas of need should be targeted in future research.

Rapid hair regrowth in an alopecia universalis patient with deucravacitinib: A case report.

Alopecia universalis is a severe, difficult to treat variant of alopecia areata that results in loss of hair on the scalp, eyebrows, eyelashes, and extremities. Deucravacitinib, a selective TYK2 inhibitor, has been recently approved in Canada, opening the door to novel uses of the drug. We present the case of a patient known for psoriasis who developed alopecia universalis resistant to many interventions (topical minoxidil and topical, intralesional, and systemic corticosteroids). We report the first case of successful rapid hair regrowth after starting deucravacitinib, which should prompt further inquiry into the use of TYK2 inhibitors in the management of alopecia areata.

Sustainable Treatment of Oral Traumatic Ulcers with Licorice Containing Hydrogels: Integrating Computational Modeling, Quality by Design, Green Synthesis, and Molecular Biological Evaluation.

The urge to implement innovative approaches that align with eco-friendly practices and hold promise for enhancing oral health while promoting environmental sustainability has been increasing. This current work aims to develop a sustainable treatment for oral traumatic ulcers using licorice-based hydrogels (LHGs) containing hydroxyethyl cellulose (HEC) as the green gelling agent. Licorice root aqueous extract was phytochemically profiled using UPLC-ESI-MS/MS. Forty-three compounds were detected, with Glycyrrhizic acid being the major component of the extract (34.85 ± 2.77%). By implementing a Quality by Design (QbD) approach, the study investigates the effects of different licorice extract and HEC concentrations on key variables such as pH and viscosity of the prepared formulations, ulcer and wound healing scores, and tissue growth factors via a Full Factorial Experimental Design. The LHGs exhibited desirable consistency, spreadability, and clarity. Statistical analysis, employing an ANOVA test, revealed the high significance of the constructed models with the licorice concentration being the key independent factor affecting all dependent outputs. The pH as well as the viscosity of the prepared LHGs were positively influenced by licorice extract concentration, with higher concentrations leading to increased alkalinity and viscosity. Rheological behavior analysis revealed a pseudoplastic flow with demonstrated thixotropy which is advantageous for application and prolongation of residence time. The wound healing process was assessed through ulcer size, traumatic ulcer healing score (UHS), collagen-1 expression (COL-1), growth factors (EGF, VEGF), pro-inflammatory markers (TNF-α), wound healing score (WHS). LHGs prepared using higher levels of both factors, 30% dried licorice root extract and 4% HEC, demonstrated enhanced wound healing, elevated growth factor expression of 66.67% and 23.24%, respectively, and 88% reduced inflammation compared to the control group, indicating their potential in expediting oral ulcer recovery. Overall, these findings highlight the promising role of green licorice-based hydrogels in promoting sustainable oral mucosal healing.

Liquid biopsies and minimal residual disease in lymphoid malignancies.

Minimal residual disease (MRD) assessment using peripheral blood instead of bone marrow aspirate/biopsy specimen or the biopsy of the cancerous infiltrated by lymphoid malignancies is an emerging technique with enormous interest of research and technological innovation at the current time. In some lymphoid malignancies (particularly ALL), Studies have shown that MRD monitoring of the peripheral blood may be an adequate alternative to frequent BM aspirations. However, additional studies investigating the biology of liquid biopsies in ALL and its potential as an MRD marker in larger patient cohorts in treatment protocols are warranted. Despite the promising data, there are still limitations in liquid biopsies in lymphoid malignancies, such as standardization of the sample collection and processing, determination of timing and duration for liquid biopsy analysis, and definition of the biological characteristics and specificity of the techniques evaluated such as flow cytometry, molecular techniques, and next generation sequencies. The use of liquid biopsy for detection of minimal residual disease in T-cell lymphoma is still experimental but it has made significant progress in multiple myeloma for example. Recent attempt to use artificial intelligence may help simplify the algorithm for testing and may help avoid inter-observer variation and operator dependency in these highly technically demanding testing process.

Morphea, Eosinophilic Fasciitis and Cancer: A Scoping Review.

Morphea is an autoimmune fibrotic skin disease. Eosinophilic fasciitis (EF) is considered to belong to the severe spectrum of morphea. We conducted a scoping review assessing the risk of secondary cancer among morphea/EF patients, paraneoplastic morphea/EF and morphea/EF developing secondary to cancer therapy. The search was conducted using MEDLINE, Embase, Cochrane databases for articles published from inception to September 2022 following the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR) guidelines with no language or date restrictions. Two hundred and one studies were included. Of these, 32 studies reported on secondary cancer in morphea/EF patients, 45 on paraneoplastic morphea/EF and 125 on cancer-treatment-induced morphea/EF. While the current evidence remains limited, data suggest an increased risk of secondary cutaneous and possibly pancreatic malignancy in morphea patients, particularly the generalized subtype. There were insufficient data for EF. On the other hand, paraneoplastic morphea was anecdotal, whereas several observational studies suggested that ~10% of EF cases may be paraneoplastic, primarily in the context of hematologic malignancies. Radiotherapy-induced morphea is rare, seen in ~0.2% of treated patients and is usually localized to the treatment site, except in patients with pre-existing autoimmunity. While chemotherapy-induced cases are reported, immunotherapy morphea/EF cases are emerging and are preferentially seen with PD-1 and not CTLA-4 inhibitors. This study is limited by the type of articles included (case reports, case series and observational studies), and hence, additional research on this important topic is needed.

Half-fluence photodynamic therapy in acute central serous chorioretinopathy.

PURPOSE: To evaluate the results of indocyanine green angiography-guided verteporfin (Visudyne; Novartis Pharma AG, Switzerland) photodynamic therapy with half-fluence rate in the treatment of acute symptomatic central serous chorioretinopathy. METHODS: A retrospective review over 12 months was performed of 19 consecutive patients with subfoveal fluid because of acute symptomatic central serous chorioretinopathy proved by spectral-domain optical coherence tomography and fluorescein angiography, treated with indocyanine green angiography-guided verteporfin (6 mg/m) photodynamic therapy with half-fluence rate (25 J/cm). Acute symptomatic central serous chorioretinopathy was defined as first episode of symptoms and duration of symptoms before treatment of ≤12 weeks. RESULTS: Best-corrected visual acuity at baseline was 47 letters (±10; n = 19) according to the Early Treatment Diabetic Retinopathy Study chart. At 12 months after photodynamic therapy, the mean best-corrected visual acuity improved to 56 letters (P = 0.003).Pretreatment central foveal thickness was 406 µm and decreased by a mean of 163 µm at Month 12 control (P < 0.001). At Month 1 after photodynamic therapy, subretinal fluid in spectral-domain optical coherence tomography was completely resolved in all 19 patients. None of the patients developed any recurrence of symptoms over 12 months. No ocular or systemic side effects were observed during 12 months follow-up. CONCLUSION: Indocyanine green angiography-guided half-fluence photodynamic therapy with verteporfin is effective in treating acute symptomatic central serous chorioretinopathy, resulting in visual improvement and complete resolution of exudative macular detachment.

Trends in primary retinal detachment surgery: results of a Bicenter study.

PURPOSE: To assess trends and outcomes in retinal detachment (RD) surgery based on a retrospective, interventional, bicenter study. METHODS: Baseline demographic data, surgical procedures, and outcomes from 230 patients with a diagnosis of primary rhegmatogenous RD, who underwent surgery between January 2007 and December 2008 at the Rudolf Foundation Clinic, Vienna (Center 1) and the Weill Cornell Medical College, New York, (Center 2) were analyzed using a regression model. RESULTS: Besides the baseline parameters, lens status (P = 0.01), refraction (P = 0.01), retinal tears (P < 0.02), proliferative vitreoretinopathy (P = 0.02), and previous treatment (P < 0.02), the primary RD procedure (P < 0.0001) was significantly different between the 2 centers. In Center 1, scleral buckling was the most common primary RD procedure (66.19%) compared with vitrectomy (82.42%) in Center 2. Primary retinal reattachment (88.49% Center 1 vs. 84.62% Center 2, P = 0.43) and best-corrected visual acuity at the final follow-up (best-corrected visual acuity ≥ 0.3 logarithm of minimum angle of resolution 48.92% Center 1 vs. 47.25% Center 2, P = 0.78) were not significantly different between the 2 centers. CONCLUSION: Although there is a trend toward primary vitrectomy, scleral buckling was preferred in the center in Vienna and primary vitrectomy in the center in New York. Despite the different primary RD procedures, anatomical and visual outcomes were comparable.

Cirrus OCT versus Spectralis OCT: differences in segmentation in fibrovascular pigment epithelial detachment.

BACKGROUND: Automatically measurements of retinal thickness by optical coherence tomography (OCT) facilitate the assessment of various retinal diseases.The aim of this retrospective study was to report macular thickness measurements in eyes with vascular pigment epithelial detachment (PED) due to age-related macular degeneration (AMD) by using two different commercially available spectral domain (SD) OCT instruments and to consequently point out differences in their algorithm software.systems. METHODS: OCT images of patients with vascular PED due to AMD, obtained with Cirrus and Spectralis OCT, were retrospectively analyzed. Main objectives were to observe differences in central retinal thickness (CRT) values and failures in automated threshold delineation, as well as central point thickness values obtained after manual correction of threshold lines. Scanning with the Cirrus HD OCT was performed with the 512 × 128 scan pattern; scans performed with the Spectralis OCT were 20 × 15 degree raster scans consisting of 19 high-speed line scans. RESULTS: OCT images of 34 eyes of 28 patients with a mean age of 71 years and a mean distance visual acuity (VA) of 0.70 ETDRS were analyzed. Mean central retinal thickness (CRT) was 262.38 µm ± 133.18 (176-507 µm) in Cirrus and 337.82 µm ± 137.75 (277-790 µm) in Spectralis scans,mainly caused by different software approaches in positioning the posterior threshold line, following the PED in Cirrus OCT whereas remaining unelevated in Spectralis OCT. There were failures in positioning the outer retinal boundary line in 50% of Cirrus scans and in 73.52% of Spectralis scans. We obtained the mean value of central point neurosensory retinal thickness of each central single scan after manual delineation, and found a significant correlation (r = 0.819, p < 0.001). CONCLUSIONS: Our study indicates that there are significant differences in CRT values in patients with vascular PED, due to different segmentation algorithms and a high error rate in automatically set threshold lines. When planning and conducting multicenter studies, one has to be especially aware of the differences in delineating threshold algorithm lines by different SD OCT devices.

Contrast sensitivity after intravitreal antivascular endothelial growth factor therapy for myopic choroidal neovascularization.

BACKGROUND: To evaluate contrast sensitivity (CS) using Pelli-Robson charts after intravitreal ranibizumab (IVR) (Lucentis, Novartis, Basel, Switzerland) or bevacizumab (IVB) (Avastin, Genentech, South San Francisco, California, USA) in eyes with myopic choroidal neovascularization (mCNV). METHODS: A retrospective review was performed of 17 consecutive patients treated with IVR (n = 10; 0.5 mg) or IVB (n = 7; 1.25 mg) for mCNV from July, 2006 with follow-ups through September, 2009. Re-treatment was performed at monthly or longer intervals if there was fluorescein leakage in fluorescein angiogram (FAG) and or apparent subretinal fluid in optical coherence tomography (OCT) persisted. RESULTS: CS improved by a mean of one letter at 1 month (n = 17; p = 0.32), four letters at 3 months (n = 17; p = 0.02), four letters at 6 months (n = 15; p = 0.01), five letters at 9 months (n = 14; p = 0.04) and six letters at 12 months (n = 13; p = 0.03). The mean number of IVR/IVB was 1.6/1.6, 2.6/2.3, 3.1/3.2, 4.1/4.2 and 4.5/4.6 at 1 month, 3 months, 6 months, 9 months, and 12 months, respectively. CONCLUSIONS: Improvements in Pelli-Robson CS scores were observed during the first year after IVR/IVB in eyes with mCNV.

Longitudinal bleb morphology in anterior segment OCT after minimally invasive transscleral ab interno Glaucoma Gel Microstent implantation.

PURPOSE: Like the classic trabeculectomy, the minimally invasive, ab interno XEN Glaucoma Gel Microstent (XEN-GGM) creates a filtration bleb in the conjunctiva. The goal of this study was to investigate internal bleb morphology over time with anterior segment optical coherence tomography (AS-OCT) after XEN-GGM implantation. METHODS: In a prospective, single-centre, single-armed cohort study, blebs were characterized using AS-OCT in 78 eyes of 60 patients at day 1, at weeks 1 and 2 and at months 1, 3, 6, 9 and 12 after XEN-GGM implantation in patients with open-angle glaucoma. Morphological bleb characteristics were correlated with IOP and surgical success. RESULTS: Anterior segment optical coherence tomography data indicate early and late bleb changes in the course of 12 months. Uniform blebs in AS-OCTs showed higher IOPs at all examinations between week 1 (17.7 ± 4.8 mmHg versus 11.3 ± 7.1 mmHg, p = 0.001) and month 3 (16.4 ± 6.1 versus 13.4 ± 6.1, p = 0.04). Subconjunctival tissue separation bleb morphology was associated with lower mean IOPs during the course of 12 months (r = -0.75, p = 0.031). Predictors for surgical failure at month 12 were microcystic multiform bleb morphology in AS-OCT at month 3 (60% versus 15%, relative risk 4.0, p = 0.043) and uniform bleb morphology at month 9 (33% versus 23%, relative risk 1.4, p = 0.015). CONCLUSION: Bleb appearance after XEN surgery seems to be different to classic trabeculectomy literature. The present data suggest correlation of IOP and surgical long-term success with bleb morphology in AS-OCT. Prevalence of small diffuse cysts is directly associated with lower IOPs, while cystic encapsulation at 3 months predicts higher surgical failure.