Clinical presentation of acute primary angle closure during the COVID-19 epidemic lockdown.

Purpose: This study aimed to investigate the clinical presentation of acute primary angle closure (APAC) during the COVID-19 epidemic lockdown in Wuhan. Methods: Consecutive patients seeking APAC treatment at the Wuhan Aier Eye Hospital during the 76 days (January 23-April 8, 2020) when the lockdown policy was implemented due to the COVID-19 pandemic were compared to those during the same period the following year (January 23-April 8, 2021), when the lockdown policy was not implemented. The cohorts were compared to assess demographic variables and clinical presentations. Results: A total of 54 patients (64 eyes) were included in the 2020, compared with 46 patients (51 eyes) in the 2021. Demographic factors were similar between the groups. Significantly more patients developed blindness in the 2020 cohort (21.87%) than in the 2021 cohort (7.84%). Patients in the 2020 showed a longer time from symptom to treatment (241.84 ± 211.95 h in 2020 vs. 121.53 ± 96.12 h in 2021; P = 0.001), higher intraocular pressure at presentation (52.63 ± 12.45 mmHg in 2020 vs. 45.16 ± 9.79 mmHg in 2021; P = 0.001), larger pupil diameter (5.47 ± 1.62 mm in 2020 vs. 4.33 ± 1.27 mm in 2021; P = 0.001), and more glaucomatous optic neuropathy diagnoses [20/64 eyes (31.25%) in 2020 vs. 7/51 eyes (13.73%) in 2021; P = 0.03]. Conclusion: The time between the onset of APAC symptoms and its treatment during the COVID-19 epidemic lockdown was significantly prolonged, which increased the blindness rate of APAC patients.

Controlled release of triamcinolone from an episcleral micro film delivery system for open-globe eye injuries and proliferative vitreoretinopathy.

Open globe trauma is the major cause for single eye blindness that stem from subsequent proliferative vitreoretinopathy (PVR). Though biomaterials and tissue engineering have significantly advanced drug delivery and management of human diseases, currently there is no effective drug formulation or device to pharmacologically mitigate PVR formation after open-globe eye trauma. This highlighted the challenge we are facing to bring the technology from bench to bedside. The current study reported an engineered episcleral drug film using biodegradable material, Poly(L-lactide)-co-poly(ɛ-caprolactone), and triamcinolone acetonide (TA) as a model drug. The film can be conveniently sized into any shape to fit the configuration of the eye globe trauma and easily installed onto the ruptured sclera during primary trauma repair surgery. The film allows therapeutic TA to slow release for at least 6 months without toxicity and demonstrated a significant benefit to reduce the odds of developing severe PVR by 5.7 times when compared with a no-drug film control on a rabbit trauma PVR model. Our results suggested this micro episcleral drug film as promising drug delivery carrier for the targeted treatment of various unwanted retinal proliferation diseases.

Hydrophobic drug adsorption loss to syringe filters from a perspective of drug delivery.

Filtering with a syringe filter is a common operation in pharmaceutical analysis. Ophthalmic research often has a limited amount of sample and low amount of drug which is vulnerable to filtering membrane adsorption loss but not well recognized in the research community. Current study investigated drug adsorption by 11 types of syringe filters for 4 hydrophobic compounds commonly encountered in transscleral drug delivery. Among the 11 types of syringe filters surveyed, polytetrafluoroethylene - NBA, polytetrafluoroethylene - NLA, and polypropylene filters caused the least adsorptive drug loss for these four drugs studied. The magnitude of drug adsorption was filter- and drug-specific. Polytetrafluoroethylene-NLA caused the least adsorptive loss (1%) for triamcinolone acetonide, polytetrafluoroethylene-NBA caused the least adsorptive loss (5.4%) for diclofenac, and polypropylene caused the least adsorptive loss for cyclosporine A, 16.8% on average. Tacrolimus had the least adsorptive loss to the filters of polytetrafluoroethylene - NLA and polypropylene; however, the percentage of adsorptive loss from filtration was the highest (32% loss in average) among the four drugs surveyed. CONCLUSION: Low drug concentrations as seen in samples from ophthalmic researches are vulnerable to filtration drug loss. Selecting the right filter via validation is critical to avoid underestimating the drug level and distorting the resultant distribution/clearance profile in the ocular pharmacokinetic analysis.

Genipin-Crosslinked Donor Sclera for Posterior Scleral Contraction/Reinforcement to Fight Progressive Myopia.

Purpose: Myopia has become a global public health problem, particularly in East Asia where myopic retinopathy has become one of the leading causes of blindness and visual impairment in the elderly population. The purpose of this study was to evaluate the efficacy of posterior scleral contraction/reinforcement (PSCR) surgery on controlling the progressive elongation of axial length of highly myopic eyes in young patients. Methods: This is a prospective self-controlled interventional case series. Forty young patients (<18-years old) with progressive high myopia received PSCR with a genipin-crosslinked donor scleral strip for one eye and the fellow eye served as concurrent control without surgery. The main outcome measurement was the change of axial length over 2 to 3 years of follow-up. Results: Immediately after the surgery, axial length was shortened and subsequently increased by 0.32 mm over the follow-up period. In contrast, axial length of the fellow eyes increased by 0.82 mm over the same period (P < 0.001, paired t-test). PSCR delayed axial elongation in eyes with or without staphyloma. No significant change of visual acuity, cornea refractive power, or retina thickness was noted between the surgery and fellow eyes. None of the patients lost visual acuity compared with the baseline. The procedure was well tolerated with only temporary corneal refractive axis shifts that recovered by the 6-month postsurgical visit. Conclusions: PSCR with genipin-crosslinked sclera is safe and effective to restrain eye globe elongation in young patients within a 2- to 3-year follow-up period.