Incidence, Pathophysiology, Complications, and Management of Positive Vitreous Pressure During Penetrating Keratoplasty: A Literature Review.

Positive vitreous pressure (PVP) is common during open anterior segment surgery and penetrating keratoplasty (PKP) has a reported incidence rate of 40-50%. Despite adequate perioperative preventive precautions, positive pressure occurs during surgery and optimum management of PVP is required to avoid serious complications. Many pharmacological and mechanical approaches can be employed either preoperatively or intraoperatively to decrease vitreous pressure. Surgical techniques such as graft-over-host technique, the modified graft-over-host technique, techniques employed mattress sutures and needle, or Vitreous aspiration or vitrectomy can be effectively used to manage intraoperative PVP during PPK. This article reviews the incidence, risk factors, prevention, and different approaches to the management of positive vitreous pressure during PKP to analyze the available evidence in order to improve the safety profile of PKP and prevent sight-threatening complications.

Three-year clinical outcomes of phacoemulsification combined with excisional goniotomy using the kahook dual blade for cataract and open-angle glaucoma in Saudi Arabia.

PURPOSE: The aim of this study was to describe the changes in intraocular pressure (IOP), IOP-reducing drugs, and visual acuity (VA) through up to 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (KDB-phaco) by a single surgeon in Saudi Arabia. METHODS: The health records of 55 eyes of 47 patients undergoing KDB-phaco by a single surgeon were reviewed. Data were extracted from visits occurring preoperatively (n = 55), intraoperatively (n = 55), and 1-day (n = 55), 2 weeks (n = 55), 4-6 weeks (n = 49), 2-3 months (n = 55), and 6 (n = 55), 9 (n = 55), 12 (n = 55), 18 (n = 49), 24 (n = 46), and 36 months (n = 16) postoperatively. Data collection included IOP, IOP-lowering medications, and VA at each time point. Adverse events were also collected. Paired t-tests were used to compare IOP, medications, and VA at each time point to preoperative values. RESULTS: Mean (standard error) baseline IOP was 20.4 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.1 [1.0] months) ranged from 13.6 to 14.1 mmHg; significant reductions (P < 0.0007) of 5.7-7.0 mmHg (23.0%-29.5%) were achieved at every time point. Medications were reduced from 3.2 (0.1) to 0.2-2.0 (reductions of 1.2-3.1 medications [50.0%-94.9%]; P < 0.0001 at every time point). At months 24 and 36, the mean IOP was 13.9 (0.3) and 13.9 (0.5) mmHg and mean medications were 1.4 (0.2) and 2.0 (0.4). Mean logMAR VA improved from 1.0 (0.1) preoperatively to (0.2 [0.0]; P < 0.001) by month 6 and remained stable thereafter through the duration of follow-up. CONCLUSION: KDB-phaco significantly lowered IOP approximately 30% by day 1 with consistency and durability through 3 years. Medication use was reduced by >50% through 36 months. Mean logMAR VA improved from 1.0 to 0.2 (Snellen equivalent 20/200-20/32). This procedure provides meaningful long-term reductions in IOP and the need for IOP-lowering medications without compromising visual rehabilitation in Saudi Arabian eyes with cataract and glaucoma.

Surgical Outcomes of Combined 2nd-Generation Trabecular Microbypass (iStent Inject) and Cataract Surgery for the Treatment of Primary Open-Angle Glaucoma in the Saudi Population.

INTRODUCTION: To investigate the 24-month efficacy and safety of iStent inject trabecular microbypass system implantation combined with phacoemulsification in subjects with primary open-angle glaucoma (POAG) and concomitant cataract. METHODS: This prospective, uncontrolled, interventional case series included 36 eyes (29 subjects) with POAG of mild to moderate severity and coexisting cataract that underwent combined phacoemulsification and implantation of a second-generation trabecular microbypass stent (iStent inject®). Main outcome measures involved mean intraocular pressure (IOP), number of antiglaucoma medications, and proportional analysis of eyes with IOP ≤ 18 mmHg or ≤ 15 mmHg, or with 0 or ≥ 2 glaucoma medications. Secondary outcome measures involved the cup-to-disc ratio, corrected distance visual acuity (CDVA), and adverse issues. RESULTS: In 36 eyes, the mean IOP at baseline was 18.28 ± 2.87 mmHg, which decreased to 14.24 ± 1.36 (22.1%) and 14.46 ± 1.56 mmHg (20.9%) at 18 and 24 months, respectively (p < 0.001). At the last follow-up, 100% of eyes had an IOP ≤ 18 mmHg (vs. 50% preoperatively), and 75.7% of eyes had an IOP ≤ 15 mmHg (vs. 16.7% preoperatively); 58.3% of eyes achieved ≥ 20% IOP reduction from preoperative status. At baseline, eyes were treated with a mean of 2.35 ± 1.18 medications, which was reduced to 0.80 ± 1.04 (66% reduction) and 0.69 ± 0.95 medications (70.6% reduction) at 18 and 24 months, respectively (p < 0.001). At the last follow-up, 54.1% of eyes were medication-free (vs. 0% preoperatively) and 24.3% of eyes were treated with ≥ 2 medications (vs. 64.9% preoperatively). This combined procedure demonstrated an excellent safety profile with no reported intraoperative complications or adverse events; CDVA was maintained throughout the entire follow-up period. CONCLUSIONS: This real-world series demonstrated that iStent inject device implantation at the time of phacoemulsification is a safe and effective method to decrease IOP and the necessity for antiglaucoma medications in patients with mild-to-moderate POAG and cataract; no associated vision-threatening complications were noted.

Long term outcome of combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade in different subtypes of glaucoma.

To characterize changes in intraocular pressure (IOP) and IOP-lowering medications through up to 2 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma. Prospective, non-comparative, interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Analysis was conducted on open-angle (OAG) and angle-closure (ACG) glaucoma groups separately. Thirty-seven patients with OAG (24 with primary OAG and 13 with pseudoexfoliation glaucoma) and 11 with ACG were enrolled. In OAG eyes, mean (standard error) baseline IOP was 21.1 (0.9) mmHg and through 24 months of follow-up was reduced by 6.4-7.7 mmHg (24.6-32.1%; p ≤ 0.0001 at all time points). In ACG eyes, mean baseline IOP was 20.8 (1.6) mmHg and was reduced by 6.1-8.77 mmHg (23.4-39.0%; p ≤ 0.0353). Mean medications were reduced by 61.9-89.1% (p ≤ 0.0001) in OAG eyes and by 56.3-87.3% (p ≤ 0.0004) in ACG eyes. Phaco-KDB significantly lowered IOP ~ 30% and medications by > 50% through 24 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication and does not adversely affect visual rehabilitation in eyes with cataract and glaucoma.

MicroPulse Transscleral Laser Therapy with Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined with Phacoemulsification for Angle-Closure Glaucoma: A Case Report.

PURPOSE: To report the efficacy and safety of MicroPulse transscleral laser therapy (TLT) and Kahook Dual Blade excisional goniotomy and goniosynechialysis combined with phacoemulsification for chronic angle-closure glaucoma (ACG). PATIENTS AND METHODS: A 39-year-old hyperopic female with a known history of ACG presented with a 2-week history of blurry vision, headache, and photophobia in the right eye (RE) following surgical peripheral iridectomy at another hospital. On examination, her uncorrected visual acuity was 20/50 in the RE, and 20/25 in the left eye (LE). Goldman applanation tonometry revealed an intraocular pressure (IOP) of 51 mmHg in the RE and 12 mmHg in the LE. Ocular examination of the RE revealed conjunctival hyperemia, corneal edema, shallow anterior chamber, posterior synechia, mid-dilated non-reactive pupil, and early cataractous changes. Anterior segment examination findings in the LE were normal except for a shallow anterior chamber. Gonioscopy revealed a closed angle (Schaffer grade 0) with 360° peripheral anterior synechia in the RE and a narrow angle (Schaffer grade 2) in the LE. The cup-to-disc ratios were 0.5 RE and 0.3 LE. The patient underwent MicroPulse TLT with phacoemulsification, Kahook Dual Blade-assisted goniosynechialysis, and excisional goniotomy in the RE. RESULTS: At the 1-year follow-up, her IOP remained stable without the need for antiglaucoma medications. No further optic nerve or visual field deterioration was noted. CONCLUSION: MicroPulse TLT combined with phacoemulsification and Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely reduced IOP and the need for antiglaucoma medications in chronic ACG, avoiding the complications associated with incisional glaucoma surgery.

Residents' Perceived Impact of COVID-19 on Saudi Ophthalmology Training Programs-A Survey.

PURPOSE: To evaluate the impact of the current pandemic on ophthalmology residency training in Saudi Arabia, focusing on its effects on clinical education, training, and the mental well-being of the trainees. METHODS: An online self-administered questionnaire was distributed among residents in the Saudi ophthalmology training programs between July 7 and 14, 2020. In this study, we explored residents' opinions regarding training disruption and virtual education. The patient health questionnaire (PHQ-9) was used to assess the COVID-19 pandemic's impact on their mental health. We used descriptive statistics for data analysis. RESULTS: Out of 183 registered ophthalmology residents, 142 participated in this study. Ninety-six participants (35.4%) were rotated at a specialized eye hospital during the COVID-19 pandemic, while 52 (19.2%) had rotations in the ophthalmology department at general hospitals. Those who rotated in both types of hospitals were 123 (45.4%). According to the participants, there was a significant decline in exposure to surgical and office-based procedures compared to emergency eye consultations (Friedman P <0.001). The COVID-19 pandemic's effect on mental health was reported by 100 (70.5%) participants. Eighty-five (55.4%) respondents were satisfied with the virtual method of education. CONCLUSION: COVID-19 pandemic has disrupted residents' clinical and surgical training in the Saudi ophthalmology training programs. Additionally, we believe that COVID-19 may have a negative impact on trainees' mental health. Fortunately, the current pandemic provided an innovative education method that will likely be used even after the pandemic.

Quality of Life After Combined Cataract and Minimally Invasive Glaucoma Surgery in Glaucoma Patients.

PURPOSE: To determine the quality of life (QOL) in glaucoma patients undergoing combined cataract and minimally invasive glaucoma surgery from various perspectives ranging from personal, social, occupational life, and economic status. SETTINGS AND DESIGN: A cross-sectional study design at King Fahd Hospital of the University, Khobar, Saudi Arabia. METHODS: Patients undergoing phacoemulsification in conjunction with various forms of minimally invasive glaucoma surgery (MIGS) for each patient, including either Kahook Dual Blade (KDB) goniotomy, iStent, iStent inject and gonioscopy-assisted transluminal trabeculotomy (GATT), were included in the study between 2018 and 2019. Data were collected through a self-administered questionnaire based on the Visual Function Questionnaire (VFQ-25) for the 25-item National Eye Institute. RESULTS: The study included 93 eyes of 78 patients (40 males and 38 females) who had MIGS: 50 KDB, 13 iStent, 23 iStent inject, and 7 GATT. An overall reduction in the number of anti-glaucoma medications (p<0.001) was statistically significant. In the study, 36.6% of patients had a better social life, but 85.2% had no change in occupational life. Eventually, 86% were satisfied with the operation's outcome, and 79% confirmed that the overall quality of life improved after the procedure. CONCLUSION: Evaluating QOL is a crucial component of glaucoma treatment. More research is needed on MIGS and their relationship to QOL. In the future, MIGS may provide the desired outcomes in controlling glaucoma and improving the QOL.

Combined Gonioscopy-Assisted Transluminal Trabeculotomy (GATT) with Ab Interno Canaloplasty (ABiC) in Conjunction with Phacoemulsification: 12-Month Outcomes.

PURPOSE: To report the surgical outcomes of combined gonioscopy-assisted transluminal trabeculotomy (GATT) with ab interno canaloplasty (ABiC) in conjunction with phacoemulsification for primary open-angle glaucoma (POAG). PATIENTS AND METHODS: This prospective, interventional, non-comparative case series included POAG patients who underwent combined GATT and ABiC in conjunction with phacoemulsification performed between January 2018 and August 2018. Main outcome measures include surgical success rate, changes in intraocular pressure (IOP), number of antiglaucoma medications, corrected distance visual acuity (CDVA), and complications. RESULTS: We enrolled twenty eyes of 19 patients in our study. The mean age was 61.2 ± 6 years, and all the patients completed a 12-month follow-up. The overall success rate was 100%. The mean baseline IOP was 19.75 ± 4.68 mmHg, and at 12 months, the mean IOP was 13.30 ± 1.30 mmHg (IOP reduction of 32.7%). The baseline number of antiglaucoma medications was 3.4 ± 0.6 (range: 2 to 4 medications), and after 12 months follow-up, the number was reduced to 1.1 ± 1.0 (range: 0 to 2 medications). The CDVA for all 20 eyes was 0.85±0.58 LogMAR at baseline, and 0.16±0.30 LogMAR at 12-month follow-up. Only six eyes developed hyphaema, which had cleared by the first postoperative month, and three eyes needed medical treatment for postoperative IOP spikes. CONCLUSION: The 12-month results of our study suggest that combined GATT with ABiC in conjunction with phacoemulsification is a safe and effective alternative in decreasing the IOP and number of antiglaucoma medications in POAG patients.

Episcleritis as a possible presenting sign of the novel coronavirus disease: A case report.

PURPOSE: In this report, we describe a case of episcleritis that appeared to be the first sign of the novel coronavirus disease (COVID-19). OBSERVATIONS: A 29-year-old man with no prior medical condition presented with a complaint of redness and foreign body sensation in his left eye, which started two days before his consultation. He had no history of decreased vision, pain, photophobia, discharge, ocular surgery, or trauma. He had no symptoms in his fellow eye nor did he have any systemic symptoms. External examination of his left eye revealed a sectoral nasal conjunctival and episcleral injection and a clear cornea. There was no scleral edema. A diagnosis of episcleritis was made based on clinical grounds and topical fluorometholone 0.1%. was started. Three days later, the patient presented with headache, shortness of breath, cough, and fever (39.2 °C). Real-time fluorescence polymerase chain reaction test of his nasopharyngeal swab returned a positive result for COVID-19. The patient was then admitted for observation and supportive therapy. After five days, fever, respiratory and ocular symptoms were markedly improved and the patient was discharged and advised to isolate at home for 14 days. CONCLUSIONS AND IMPORTANCE: This is the first report that describes episcleritis as a possible presenting sign of COVID-19. Understanding the association between ocular signs/symptoms and COVID-19 can aid in the diagnosis of the viral infection and can help in limiting its transmission.

Outcomes of Combined iStent Trabecular Micro-Bypass and Cataract Surgery for the Treatment of Open-Angle Glaucoma in a Saudi Population.

PURPOSE: To assess the effectiveness and safety of a single iStent trabecular micro-bypass stent implantation in combination with cataract surgery in lowering the intra ocular pressure (IOP) and number of anti-glaucoma medications in Saudi patients with open-angle glaucoma (OAG). SETTING: King Fahad Hospital of the University, Al Khobar, Saudi Arabia. DESIGN: Prospective, non-comparative, uncontrolled, non-randomized interventional case series. METHODS: One iStent was implanted during phacoemulsification cataract surgery for adult patients with OAG by a single surgeon over a period of 3 years. Main outcome measures include number of anti-glaucoma medications, IOP, corrected distance visual acuity (CDVA) and complications. RESULTS: Thirty-six eyes of 33 patients with OAG underwent the surgery. The pre-operative mean IOP and mean anti-glaucoma medications were 17.47 ± 5.44 mmHg and 2.69 ± 0.92, respectively. At 1 year of follow-up mean, IOP decreased to 13.44 ± 1.99 (23.1% reduction) (P<0.001) and mean anti-glaucoma medications decreased to 1.47±1.13 (45.4% reduction) (P<0.001). CONCLUSION: After 12-month follow-up, phacoemulsification with the implantation of a single iStent seems to be an effective and safe procedure to lower IOP and the number of anti-glaucoma medications, and to overcome the problems associated with medication nonadherence in OAG patients with cataracts.

Surgical Outcomes of Microcatheter-assisted Trabeculotomy as a Secondary Procedure in Patients with Primary Congenital Glaucoma.

PURPOSE: To investigate the efficacy and safety of illuminated microcatheter-assisted trabeculotomy as a secondary procedure in patients with primary congenital glaucoma (PCG). METHODS: This retrospective case series included patients with PCG who underwent trabeculotomy using an illuminated microcatheter with the intent of catheterizing the full circumference of Schlemm's canal in a single procedure. Success was defined as intraocular pressure (IOP) ≤21 mmHg, with or without the use of glaucoma medications. Clinical examination data were collected for up to 36 months postoperatively. RESULTS: Surgery was performed on 16 eyes of 16 patients. The mean patient age was 75.1 ± 69.4 months (range: 4.0-216.0 months). Complete catheterization was achieved in 11 of the 16 eyes (69%), whereas partial catheterization was achieved in five of the 16 eyes (31%). All eyes had previously undergone surgery for PCG. The mean follow-up duration was 20.3 ± 9.0 months (range, 12.0-36.0 months). IOP was reduced from a mean of 31.8 ± 6.6 mmHg preoperatively to 15.6 ± 3.7 mmHg at the final follow-up (P < 0.001). The mean preoperative number of glaucoma medications was 3.9 ± 0.5, which was reduced to 1.1 ± 1.6 at the final follow-up (P = 0.001). Ten (62.5%) of the 16 eyes did not require glaucoma medication by the final follow-up. Early transient postoperative hyphema occurred in six eyes (37.5%). No other complications were noted. All corneas were clear at the final follow-up. CONCLUSION: Ab externo circumferential trabeculotomy using an illuminated microcatheter may be safe and effective as a secondary surgical option for children with PCG after unsuccessful glaucoma surgery.

Outcome Of MicroPulse® Transscleral Photocoagulation In Different Types Of Glaucoma.

PURPOSE: To evaluate the safety and efficacy of MicroPulse® transscleral cyclophotocoagulation (µP-TSCPC) up to 24-months follow-up using a standardized fixed protocol in patients with various types of glaucoma. METHODS: Prospective, nonrandomized, non-comparative interventional case series of µP-TSCPC performed by a single glaucoma surgeon at tertiary hospitals between May 2017 and May 2019. RESULTS: A total of 71 eyes of 68 patients (39 males, 29 females) aged 60.0 years (13-89 years) were treated with µP-TSCPC. The most common diagnosis was neovascular glaucoma. The safety index of corrected distance visual acuity (CDVA) was 1.0, i.e. there was no significant change in CDVA postoperatively compared to baseline CDVA. The median baseline IOP was 35.0 mmHg (21.0-70.0 mmHg), which was reduced to 16 mmHg (8-32 mmHg) at 12 months/last follow-up postoperatively (p<0.001, Wilcoxon signed-rank test). The median reduction in IOP was 52% (0.0-89%) at 12 months/last follow-up postoperatively compared to baseline. The median number of medications was 5 (3-5) at baseline compared to 4 (2-4) at 12 months/last follow-up postoperatively (p<0.001, Wilcoxon signed-rank test). The percent of eyes treated with systemic glaucoma medication was 62% (44) at baseline compared to 0% (0) at 12 months/last follow-up postoperatively. The postoperative surgical success of 90%, 91.4%, and 95.7% at 2 weeks, 3 months, and 6 months respectively then remains unchanged. No significant adverse events or complications were observed. CONCLUSION: µP-TSCPC demonstrated good efficacy and safety profiles with minimal vision-threatening complications in treating a variety of glaucoma types.

Intracorneal Hematoma After Ahmed Glaucoma Valve Implant Surgery.

Intracorneal hematoma or hemorrhagic descemet detachment is a rare phenomenon. It has been previously described after nonpenetrating glaucoma surgeries such as canaloplasty, viscocanalostomy, and deep sclerectomy. In this report, we describe a rare case of intracorneal hematoma as a yet nondocumented complication after Ahmed glaucoma valve implant surgery.

Outcomes of Scleral-fixated Intraocular-lens in Children with Idiopathic Ectopia Lentis.

PURPOSE: The purpose of the study was to review the safety and stability of scleral-fixated intraocular lens (IOL) 2 years after implantation in children with idiopathic ectopia lentis (EL). METHODS: This retrospective case series enrolled children with EL managed between 2011 and 2015 at a tertiary eye hospital in the eastern of Saudi Arabia. Data were collected on age, gender, vision, isolated or syndromic pathology, intraoperative and postoperative complications, spherical equivalent refraction, and final best-corrected visual acuity (BCVA). RESULTS: The series included 18 eyes of 11 children with EL (6 males and 5 females). There were 7 bilateral and 4 unilateral cases. The median age was 3.5 years (25% quartile 1 year; range: 1-8 years). Preoperatively, fixation was absent in 3 eyes, 8 eyes were fixating but vision could not be recorded. In the remaining seven eyes, median distant visual acuity was 0.1 (25% quartile: 0.08). The median postoperative follow-up was 24 months (25% quartile, 7 months). Complications included two eyes with iris capture and one eye with lens subluxation requiring re-implantation. Postoperative BCVA was better than 20/60 in 15 (83%) eyes. At last follow-up, 6 eyes required myopic correction, 1 eye was emmetropic, and 11 eyes were hypermetropic. One eye with glaucoma was managed medically. CONCLUSION: Scleral fixated IOL in eyes of young children with EL had good visual outcomes and high stability. However, there is a high incidence of residual refractive error.

Secondary implantation of implantable collamer lens (ICL) for correction of anisometropic hyperopia in a 3-year-old pseudophakic child.

We report the first case of secondary implantation of implantable collamer lens (ICL) for correction of anisometropic hyperopia in a 3-year-old pseudophakic child. The ICL implantation was considered in our patient due to parental noncompliance for contact lens and spectacles use for one year. In terms of efficacy, the preoperative refractive error of +7.00-1.75 diopter (D) reduced to +1.00-1.75 D. The uncorrected distance visual acuity (UDVA) significantly improved from 20/400 (preoperatively) to 20/50 (postoperatively). In terms of safety, after an uneventful implantation surgery, the ICL was well tolerated, and remained well centered, with no serious postoperative complications encountered over a 22-month follow-up.

Tuberculous Conjunctivitis in an Anophthalmic Socket.

Tuberculous (TB) conjunctivitis was not an uncommon condition before the early 20(th) century but is currently a rare occurrence, especially in the developed countries. We report a 27-year-old Saudi female who underwent enucleation of the right eye at the age of 20 following a penetrating eye injury. She had a history of miliary TB that was treated at the age of 22. She was presented with chronic purulent discharge from her right an anophthalmic socket for 2 months. Cultures for bacteria and fungi were sterile. There was no response to empirical topical antibiotics and steroids. Direct microscopic examination of conjunctival scrapings with the Ziehl-Neelsen staining revealed no microorganisms. Histopathological examination revealed epithelioid granulomas. Polymerase chain reaction was negative for Mycobacterium tuberculosis DNA. TB conjunctivitis was suspected from the history of miliary TB and presence of epithelioid granulomas. The definitive diagnosis was made after prompt resolution of the ocular signs with no recurrence only after systemic anti-TB therapy.

Implantation of spherical and toric copolymer phackic intraocular lens to manage amblyopia due to anisometropic hyperopia and myopia in pediatric patients.

PURPOSE: To evaluate the safety and efficacy of implantation of the Visian Implantable Collamer Lens phakic intraocular lens (pIOL) (spherical and toric models) for management of amblyopia due to anisometropic hyperopia and myopia in children. DESIGN: Retrospective case series. SETTING: Tertiary care eye specialty hospital, Dhahran, Saudi Arabia. METHODS: Eyes of patients who underwent the implantation of the pIOL for refractory anisometropic amblyopia were identified. None of the patients were compliant with spectacle/contact lens correction. Preoperative and postoperative clinical evaluation included visual acuity, cycloplegic refraction, slitlamp microscopy, intraocular pressure, orthoptic evaluation, anterior chamber depth, and ICL vault. RESULTS: A total of 11 eyes (9 myopic, 2 hyperopic) of 11 patients aged 5 to 15 years were identified. Of the 9 myopic eyes, 6 eyes received spherical ICLs and 3 received toric ICLs. Both hyperopic eyes received spherical ICLs. Preoperatively, the mean cycloplegic refractive spherical equivalent (CRSE) was -11.07 D (range -7.75 to -21.88 D) in myopic eyes, and +8.75 D (range +8.63 to +8.87 D) in hyperopic eyes. The mean corrected distance visual acuity (CDVA) was 20/171 (range 20/40 to 20/400) in myopic eyes, and 20/130 (range 20/60 to 20/200) in hyperopic eyes. At a mean follow-up of 16.8 months (in myopic eyes), the mean CRSE was -1.40 D (range 0 to -2.25 D), and mean CDVA was 20/51 (range 20/20 to 20/100). In hyperopic eyes, at a mean follow-up of 15 months, the mean CRSE was +1.82 D (range +1.75 to +1.88 D) and the CDVA had improved to 20/25 in both eyes. Although complications occurred in the 2 hyperopic eyes, the complications were either temporary or visually insignificant and did not necessitate reoperation or ICL explantation. CONCLUSION: ICL implantation may be considered a safe and effective treatment option for refractory amblyopia due to anisometropic hyperopia or myopia in children who are noncompliant with conventional therapy. FINANCIAL DISCLOSURE: The authors have no financial or proprietary interest in a product, method, or material described herein.

A review of the efficacy of mitomycin C in glaucoma filtration surgery.

The success of trabeculectomy, which is considered the gold standard in the surgical treatment of glaucoma, depends on the wound healing response. The introduction of antiproliferative agents such as mitomycin C (MMC) has increased the success rates of trabeculectomy. However, complications due to these agents can be challenging to manage. Hence, it is important to determine the most efficacious dose and duration of exposure. Multiple studies suggest that many factors, including but not limited to MMC preparation, different concentrations, different exposure times, and method of application may affect success rate, and these factors were reviewed in this article. We concluded that lower concentrations of MMC that are prepared and applied in a standardized fashion, such as that using the Mitosol(®) kit (for 2-3 minutes) during trabeculectomy, could potentially provide trabeculectomy success rates similar to that reported with off-label preparations, and that such a treatment regime could result in in lower complication rates than higher doses of MMC.

Idiopathic Peripapillary Subretinal Neovascular Membrane in a Young Woman with Recurrence of the Lesion during Pregnancy after Treatment with Intravitreal Bevacizumab.

We report a 27-year-old woman who was diagnosed with idiopathic peripapillary subretinal neovascular membrane (PSRNVM) in her left eye with best-corrected visual acuity (BCVA) of 20/160. She had been treated by three monthly doses of intravitreal bevacizumab (1.25 mg/0.05 ml) at 4-week intervals, which showed a favorable response. The treatment led to regression of the choroidal neovascular membrane (CNVM) with complete resorption of subretinal fluid and improvement of BCVA to 20/25. Subsequently, recurrence of the CNVM was observed during pregnancy (28 months after treatment). To the best of our knowledge, this is the first report of recurrence of idiopathic PSRNVM during pregnancy.