Quantification of Postoperative Inflammation in Laser and Surgical Procedures for Glaucoma with Laser Flare Photometry: A Review of the Literature.

PURPOSE: To review the application of laser flare photometry (LFP) in the objective quantification of aqueous flare (anterior chamber inflammation) post laser and surgical procedures for glaucoma. METHODS: A search was undertaken using the following: PubMed (all years), the Web of Science (all years), Ovid MEDLINE (R) (1980 to 30 March 2023), Ovid MEDLINE (R) Daily Update 30 March 2023, MEDLINE and MEDLINE non-indexed items, Embase (1980-2021, week 52), Ovid MEDLINE (R) and Epub Ahead of Print, in-Process & Other Non-Indexed Citations and Daily (1980 to 30 March 2023), CENTRAL (including Cochrane Eyes and Vision Trials Register), metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms included "aqueous flare," "anterior chamber inflammation," "tyndallometry," "laser flare photometry" combined with "laser," "iridotomy," "trabeculoplasty," "cataract surgery," "phacoemulsification," "glaucoma surgery," "minimally invasive glaucoma surgery," "trabeculectomy," "aqueous shunt," "glaucoma drainage" and "cyclophotocoagulation." RESULTS: The majority of studies utilizing laser flare photometry in grading flare have been post laser trabeculoplasty. The degree of flare produced varies according to the type of glaucoma laser or surgery performed, with filtration procedures and glaucoma drainage devices having marked and prolonged detectable levels. Aqueous flare in cyclodestructive procedures positively correlated with intraocular pressure (IOP) reduction. CONCLUSION: In comparison to clinician grading, laser flare photometry provides a more objective measure of post-surgical inflammation in eyes that have undergone laser and surgery for glaucoma. Further research is warranted into how this instrument can be utilized to identify eyes at high risk of failure and other adverse outcomes after glaucoma surgery.

The Genetic and Clinical Features of FOXL2-Related Blepharophimosis, Ptosis and Epicanthus Inversus Syndrome.

Blepharophimosis, ptosis, and epicanthus inversus syndrome (BPES) is a craniofacial disorder caused by heterozygous variants of the forkhead box L2 (FOXL2) gene. It shows autosomal dominant inheritance but can also occur sporadically. Depending on the mutation, two phenotypic subtypes have been described, both involving the same craniofacial features: type I, which is associated with premature ovarian failure (POF), and type II, which has no systemic features. The genotype-phenotype correlation is not fully understood, but it has been hypothesised that type I BPES involves more severe loss of function variants spanning the whole gene. Type II BPES has been linked to frameshift mutations that result in elongation of the protein rather than complete loss of function. A mutational hotspot has been identified within the poly-alanine domain, although the exact function of this region is still unknown. However, the BPES subtype cannot be determined genetically, necessitating informed genetic counselling and careful discussion of family planning advice in view of the associated POF particularly as the patient may still be a child. Following puberty, female patients should be referred for ovarian reserve and response assessment. Oculofacial features can be managed with surgical intervention and regular monitoring to prevent amblyopia.

HIGHLIGHTS OF ADVANCES IN MEDICAL RETINA FROM THE VIRTUAL WORLD OPHTHALMOLOGY CONGRESS 2020.

The World Ophthalmology Congress (WOC) is one of the largest international ophthalmology conferences, taking place every two years. The event this year was the first of its kind, held as a virtual summit due to the Covid-19 pandemic. There were over 2000 talks from world experts, a virtual industry exhibition including free papers, e-posters, live symposia and presentations. Medical retina is a subspecialty in which exciting and innovative advances in research were presented. The topics covered included the use of Conbercept for Polypoidal Choroidal Vasculopathy, Faricimab in Diabetic Macular Oedema and neovascular Age Related Macular Degeneration (nAMD), Brolucizumab, Aflibercept and Port Delivery Systems in nAMD, amongst many others. Medical retina continues to be a rapidly advancing field within ophthalmology with new research findings having great implications for treatment burden and service delivery. This report summaries the highlights of advances within the medical retina subspecialty from free papers in WOC 2020.

Does cam osteochondroplasty compromise proximal femur strength?

Little is known about the effect on load bearing ability of cam-type femurs following osteochondroplasty. The aim of this study was to compare the change in deformation undergone by cam-type femoral acetabular impingement femur models after resection of different volumes. Dry-bone replicas (N = 10) of two cam-type femurs (cam A and B) underwent resections of increasing volume (Surgery I, II and III) representing conservative, adequate and radical resections. Deformation under cyclic loading of 700 N for five cycles after each surgery was compared. The 360° alpha angle and the change in head to neck ratio at four equidistant points along the femoral neck were used as measures of surgical efficacy and volume resected. Intact cam A and B replicas had a maximum alpha angle of 88° and 90°, respectively, which were reduced to 55° and 54° post Surgery I. Cam A replicas showed a significant reduction (p < 0.01) in mean axial displacement after Surgery I (up to 10% reduction in neck volume) and an increase after Surgery III (~20%-40% reduction in neck volume) compared to unresected controls (p < 0.01). Surgery II (~10%-15% reduction in neck volume) produced no significant change in mean displacement (p > 0.05). Cam B models exhibited lower mean displacement after Surgery I, II and III (p < 0.01) compared to unresected controls. Conservative surgery appears to improve the axial load bearing ability of dry-bone models. Radical resections may significantly decrease the fracture-resistant properties of bone following osteochondroplasty which should be noted when planning such a procedure.