Corneal Refractive Surgery in the Right Patient at The Right Time.

BACKGROUND: Despite their proven level of safety and patient satisfaction, laser-assisted in situ keratomileusis (LASIK) and other corneal refractive surgeries have faced scrutiny in the media recently as they have been linked to suicides following poor outcomes. Between 1998 and 2006, the Food and Drug Administration (FDA) received 140 official complaints linked to LASIK surgery, spurring the development of a Patient-Reported Outcomes With LASIK (PROWL) questionnaire to measure quality of life-related outcomes after LASIK. Dry eye symptoms are the most common complication after LASIK, but the overall patient satisfaction rate after surgery remains around 95 percent with around 1 million surgeries performed in the U.S. each year. Three cases involving completed or attempted suicide after corneal refractive surgery are discussed. Considerations and recommendations including preoperative screening and counseling to help prevent similar outcomes in the future are provided. OBJECTIVE: We seek to discuss the facts surrounding LASIK surgery, and the factors that may contribute to a purported connection between corneal refractive surgery and mental illness. CONCLUSION: Patients will continue to pursue refractive surgery with high expectations. Prevention by proper screening and setting of realistic expectations paired with early recognition and treatment may help minimize the effect of complications. Less-than-perfect cases must be reported to build a more robust body of literature on the topic. This will help highlight the procedures' safety and efficacy while improving management when complications occur. Performed for the right patient, at the right time, refractive surgery has the potential for consistently transformative results.

Bilateral Tarsal Conjunctival Pigmentation After Eight Months of Minocycline Therapy.

A 71-year-old female presented to the ophthalmology clinic with bilateral brown to black pigmentary cysts in the lower palpebral conjunctiva following eight months of 100 mg twice daily oral minocycline therapy for long- standing pyoderma gangrenosum. Minocycline-induced pigmentation has been reported in skin, nails, teeth, mucosa, thyroid, bones, and sclera. To our knowledge, since 1981, only eight cases of minocycline-induced conjunctival pigmentation have been reported, all of which occurred after longer usage and higher cumulative doses of minocycline. The diagnosis could be verified by cobalt blue filter autofluorescence. Too few cases of this benign condition exist to establish management guidelines, risk stratification of minocycline dosage/length of therapy, or other contributing patient-demographic factors. In this case, minocycline discontinuation was recommended, and a two-month follow-up ophthalmologic exam revealed unchanged pigmentation.

Conservative Management of Traumatic Optic Neuropathy Secondary to Lateral Orbital Wall Fracture.

PURPOSE: To inform rural healthcare providers about the early identification and management of traumatic optic neuropathy (TON). Specifically, we seek to legitimize expectant management as a viable approach to such cases. OBSERVATIONS: A 27-year-old female with direct posterior compressive TON with associated visual field and visual acuity deficit was managed expectantly without steroids or surgical intervention. In four months, her visual acuity improved from 20/400 to 20/50. CONCLUSTION AND IMPORTANCE: Although steroids and surgery have been common practice for treatment of TON, there is insufficient evidence to support their use in all cases. Existing research supports expectant management as a viable option. This could prove especially useful in rural settings where resources and surgical subspecialists are limited.

Unilateral Abducens Nerve Palsy Following Perinatal Stroke of the Middle Cerebral Artery.

The authors describe a case of unilateral abducens nerve palsy following perinatal stroke of the middle cerebral artery. A 1-year-old boy presented with left eye esotropia but no other ocular abnormalities. The patient's history, examination, and diagnostic tests were consistent with abducens nerve palsy. He underwent left medial rectus recession of 5.5 mm and left lateral rectus resection of 7 mm followed by patching. At 15 months after surgery, primary gaze by prism alternate cover testing revealed a 4 prism diopter (PD) esophoria (small angle in left gaze with essentially no action of lateral rectus) and 2 PD right hyperphoria. Ophthalmologic management of abducens nerve palsy entails addressing neurological sequelae in a timely manner, treating the esotropia and strabismic amblyopia to optimize visual system development. [J Pediatr Ophthalmol Strabismus. 2020;57:e30-e33.].

Short-Term Steady-State Pattern Electroretinography Changes Using a Multi-Pressure Dial in Ocular Hypertensive, Glaucoma Suspect, and Mild Open-Angle Glaucoma Patients: A Randomized, Controlled, Prospective, Pilot Study.

INTRODUCTION: This study evaluates the effects of the multi-pressure dial (MPD) on steady-state pattern electroretinography (ss-pERG) parameters. The study is a randomized, controlled, prospective, pilot trial in a private practice setting with ocular hypertensive (OHT), glaucoma suspect, and open-angle glaucoma (OAG) subjects. METHODS: This study included nine patients (64 ± 9.0 years, nine female) with OHT, glaucoma suspect, or mild OAG. One eye of each subject was randomized to receive negative periocular pressure, while the contralateral eye served as the intrasubject control through the goggle without negative pressure. The Diopsys High Contrast Sensitivity ss-pERG protocol was conducted on both eyes of each subject while wearing the MPD device. Application of negative periocular pressure was set at 50% of baseline intraocular pressure for each study eye. RESULTS: Following 2 h of negative periocular pressure application, the difference in MagnitudeD (MagD) from baseline for eyes randomized to receive negative periocular pressure (+ 0.17 versus - 0.26) was statistically significant (p = 0.023). Over the same period, the change in MagD/Magnitude (MagD/Mag ratio) from baseline for eyes randomized to receive negative periocular pressure was also higher (+ 0.14 versus - 0.16), compared to the control eyes, approached significance (p = 0.059). CONCLUSIONS: Following 2 h of MPD wear, the measured MagD and MagD/Mag ratio improved compared to control, suggesting that negative periocular pressure application to the anterior globe can lead to short-term improvement in one measure of retinal ganglion cell function.

Gene-based vaccines and immunotherapeutic strategies against neurodegenerative diseases: Potential utility and limitations.

There has been a recent expansion of vaccination and immunotherapeutic strategies from controlling infectious diseases to the targeting of non-infectious conditions including neurodegenerative disorders. In addition to conventional vaccine and immunotherapeutic modalities, gene-based methods that express antigens for presentation to the immune system by either live viral vectors or non-viral naked DNA plasmids have been developed and evaluated. This mini-review/commentary summarizes the advantages and disadvantages, as well as the research findings to date, of both of these gene-based vaccination approaches in terms of how they can be targeted against appropriate antigens within the Alzheimer and Parkinson disease pathogenesis processes as well as potentially against targets in other neurodegenerative diseases. Most recently, the novel utilization of these viral vector and naked DNA gene-based technologies includes the delivery of immunoglobulin genes from established biologically active monoclonal antibodies. This modified passive immunotherapeutic strategy has recently been applied to deliver passive antibody immunotherapy against the pathologically relevant amyloid ß protein in Alzheimer disease. The advantages and disadvantages of this technological application of gene-based immune interventions, as well as research findings to date are also summarized. In sum, it is suggested that further evaluation of gene based vaccines and immunotherapies against neurodegenerative diseases are warranted to determine their potential clinical utility.