Glue-Assisted Retinopexy for Retinal Detachments Study Report 2: Fibrin Glue As a Surgical Adjunct in Complex Rhegmatogenous Retinal Detachment.

Purpose: To present the successful application of fibrin glue as a surgical adjunct in the management of complex rhegmatogenous retinal detachment (RRD). Methods: In this retrospective case series, fibrin glue was used as a surgical adjunct in 5 cases of complex RRD. In each case, standard pars plana vitrectomy and laser retinopexy were performed by the same surgeon. Fibrin glue was used intraoperatively as a tamponade to seal the breaks because the isolated use of conventional tamponade agents was not feasible given the variable nature of the complex RRDs, the anatomy of the eye, or an inability to maintain postoperative positioning. Results: In 1 patient previously treated for a large corneoscleral tear, fibrin glue was used to seal a large iatrogenic retinal break caused by a fragmatome-related surge that led to a quadrantic RD. In 2 patients treated for combined RRD, fibrin glue was used with silicone oil to manage recurrent RRD with incompletely drained thick subretinal fluid and blood. In 2 other cases, fibrin glue was applied to manage RRD in congenital aniridia with advanced glaucoma and aphakia. In all cases, retinal attachment without serious adverse effects was attained over a follow-up ranging from 4 to 6 months. Conclusions: Fibrin glue is an effective, safe surgical adjunct in complex RRD. It can be used to transiently seal a retinal break when use of a conventional tamponade agent is not possible or not sufficient alone.

Intraocular Bioadhesives in Vitreoretinal Surgeries: A Systematic Review.

BACKGROUND: Bioadhesion is the ability of materials to adhere to biological surfaces. Bioadhesives are substances which induce or promote bioadhesion. The internal application of bioadhesives is gaining popularity in recent years and is being increasingly utilized in vitreoretinal surgeries. The aim of this review is to discuss the various bioadhesives and their applications in vitreoretinal surgeries. METHODS: PubMed, Google Scholar, ePub and Cochrane library database were used for literature selection. Keywords such as vitreoretinal surgery, bioadhesives, intraocular bioadhesives, glue, fibrin glue, cyanoacrylate glue and transforming growth factor were used individually and in differing combinations to perform a comprehensive systematic literature search. RESULTS: A total of 47 papers were retrieved and included in this review. Cyanoacrylate glue was the first bioadhesive to be utilized for vitreoretinal surgery in human eyes in 1976. The most common indications for the use of bioadhesives were in optic disc pit maculopathy, macular holes and rhegmatogenous retinal detachments. CONCLUSION: The use of intraocular bioadhesives in vitreoretinal surgery represents a significant and evolving area of interest within ophthalmic research. While the pioneering use of cyanoacrylate glue, fibrin glue and transforming growth factor beta demonstrated the possible use of intraocular adhesives, fibrin glue is the most widely used intraocular bioadhesive in vitreoretinal surgery.

Tear Protein Markers for Diabetic Retinopathy and Diabetic Macular Edema - Towards an Early Diagnosis and Better Prognosis.

BACKGROUND: Diabetic eye disease is a highly prevalent and sight-threatening disorder. It is a disease of neuro-vascular unit of the retina, if left untreated can cause blindness. Therapeutic approaches followed for its treatment can only restrict the progression of the disease with highly variable results. There is no known biomarker for an early diagonsis of this disease, therefore by the time it is detected it goes beyond repair. This creates a massive demand for development of such biomarkers that help detect disease in its earlier stages. METHODS: PUBMED (https://pubmed.ncbi.nlm.nih.gov/) was searched for articles relevant to the topic published till November 2023. The search was made using keywords such as Diabetic Retinopathy, inflammation, tear, biomarker, proteomics etc. The studies providing relevant information to prove the importance of biomarker discovery were chosen. After compiling the data, the manuscript writing was planned under relevant headings and sub-headings. RESULTS: The review provides a comprehensive overview of all the tear protein biomarker studies in the field of DR and DME. Briefly, their potential in other diseases is also elucidated. While there are many studies pertaining to DR biomarkers, the identified markers lack validations which has restricted their usage in clinics. In case of DME, there was no such study towards biomarker discovery for its diagnosis and prognosis. CONCLUSIONS: The review highlights major studies and their lacunae in the field of biomarkers discovery for DR and DME.

Suspected Retinal Toxicity After Multiple Intravitreal Ganciclovir Injections in a Patient of CMV Retinitis.

PURPOSE: Intravitreal Ganciclovir has been one of the treatments of choice for cytomegalovirus (CMV) retinitis and has been used extensively for its treatment since 1987. It has not been shown to have any major adverse effects. There are no reports on any retinal toxicity even after multiple, repeated injections. Herein, we report a rare case of retinal toxicity after multiple intravitreal injections in a patient of CMV retinitis. CASE REPORT: A 69-year-old one eyed male, who was on oral corticosteroids and systemic immunosuppression for Granulomatosis with Polyangiitis, presented with CMV retinitis in both eyes. His visual acuity was 20/60 in his right eye and no perception of light in his left eye. He was treated with multiple injections of intravitreal Ganciclovir in his right eye. The left eye was not treated since it had no vision potential. The right eye of the patient which had received multiple injections went on to developed a progressive diffuse atrophy of Retinal Pigment Epithelium (RPE). No such changes were noted in the left eye of the patient. CONCLUSION AND IMPORTANCE: We present a case of progressive diffuse RPE atrophy as a result of toxicity of intravitreal ganciclovir injections. It is important to be aware of this rare potential toxicity of intravitreal Ganciclovir.

VKH disease in the elderly: Variations in clinical course as compared to VKH disease in adults.

PURPOSE: To describe disease characteristics and outcomes of Vogt-Koyanagi-Harada (VKH) disease in elderly patients. METHODS: Retrospective analysis of patients older than 50 years with VKH disease at two referral centers in India. Demographics, extraocular and ocular involvement, treatment, complications, and visual acuity outcomes were noted. RESULTS: In total, 69 patients (mean age at presentation: 56.4 ± 4.7 years) were analyzed; 6/69 patients had diabetes mellitus at presentation, and 10/69 had hypertension. Clinical signs included anterior chamber cells >2+ (29%), granulomatous keratic precipitates (23%), disc hyperemia (26%), neurosensory retinal detachment (34.7%), and "sunset-glow" fundus (52.1%). Patients were classified as probable (n = 50, 72.4%), incomplete (n = 18, 26%), and complete VKH (n = 1, 1.4%). The mean follow-up period was 20.2 ± 19.4 months. Improvement in mean BCVA of (0.63 LogMAR, 6 Snellen lines) was noted on the last follow-up. Patients receiving systemic steroids with immunosuppressants ( P < 0.0001) had better visual outcomes at final follow-up compared to steroids alone ( P = 0.103). Eight patients (11.6%) had complications due to systemic immunosuppressants, and 17 patients (24.6%) developed diabetes mellitus or had worsening of diabetes while on systemic corticosteroids. CONCLUSION: Few patients presented with systemic manifestations in our cohort. Those treated with steroids and concurrent immunosuppressants had better outcomes. However, therapy with immunosuppressants was encountered with major dose-limiting complications in a significant number of elderly patients with VKH syndrome.

Ten-year results of scleral-fixated intraocular lens implantation: outcomes of ab externo scleral fixation with 10-0 polypropylene suture.

PURPOSE: To describe long-term visual and anatomical outcomes of sutured scleral-fixated intraocular lens (SF IOL) implantation. SETTING: Tertiary eyecare hospital in India. DESIGN: Retrospective interventional noncomparative study. METHODS: Postoperative change in corrected distance visual acuity (CDVA) and occurrence of complications were assessed from the patient medical records. Long-term SF IOL survival rates and factors affecting the occurrence of postoperative IOL-related complications were assessed. Patients with postoperative follow-up less than 10 years or incomplete medical records were excluded. RESULTS: 64 eyes of 53 patients were included. Follow-up duration was 11.4 ± 1.2 years. Mean preoperative CDVA was 0.71 ± 0.43 logMAR (Snellen equivalent: 6/30), and mean CDVA at the final visit was 0.52 ± 0.49 logMAR (Snellen equivalent: 6/18) (P < .01). 48% cases had CDVA of 6/12 or better at the last follow-up. 58% cases had coexistent ocular pathology affecting the final visual outcome. IOL and suture-related complications were the commonest and included IOL decentration (17% cases), IOL drop (14%), and suture exposure (6%). The probability of IOL survival (postoperative period without IOL-related complications) was 90.6% at 8 years and 81.2% at 10 years (Kaplan-Meier analysis). Occurrence of postoperative IOL-related complications was unaffected by patient sex, age, indication for surgery (trauma or other), previous intraocular surgery, or technique of scleral fixation (2-point or 4-point) (multivariate regression analysis). CONCLUSIONS: Although sutured SF IOL implantation is viable with favorable long-term visual outcomes, there is a risk of postoperative IOL-related complications. Occurrence of postoperative IOL-related complications is unaffected by patient and ocular factors.

Microbiological Landscape and Epidemiology of Endophthalmitis in Children and Adolescents in a Multi-Tier Ophthalmology Network in India: An Electronic Medical Record-Driven Analytics Report.

PURPOSE: To study the epidemiology and microbiological landscape in patients (≤21 yrs) diagnosed with endophthalmitis across a multi-tier ophthalmology network in India. METHODS: This cross-sectional hospital-based study included 1,041 patients (≤21 yrs) diagnosed with endophthalmitis, between April 2012 and May 2022. The data were collected using an electronic medical record system. RESULTS: Bacteria (24%) was the most common etiology followed by fungus (2%). The majority of the patients were male (66%) with a mean age of 8.37 ± 5.99 years. The most common age group was middle childhood (6-11 years) with 365 (35.06%) patients. The patients were more commonly from the lower socio-economic status (60.81%) and urban geography (49%). The common cause of endophthalmitis was trauma (59.33%) and amongst the 279 culture positive eyes, the predominant bacteria isolated was Streptococcus pneumoniae followed by Bacillus species and fungus included predominantly Aspergillus and Candida species. The most common surgical intervention performed was intraocular antibiotics (74%) followed by pars plana vitrectomy (52%). CONCLUSION: The most common etiology of endophthalmitis in children is bacterial and traumatic in nature and presented from the lower socio-economic status. A half of the eyes warranted a vitreo-retinal surgical intervention. .

A cross-sectional study on the microbiological landscape in pediatric endophthalmitis showed that the most common cause of endophthalmitis was trauma and the predominant bacteria isolated was Streptococcus spp. and Bacillus spp. Additionally, majority of the patients were from the lower socio-economic status and urban geography and the most common surgical intervention performed was injection of intraocular antibiotics.