Supernumerary lacrimal puncta: case series and review of the literature.

We report a case series of supernumerary puncta-canaliculi, a very rare congenital anomaly, and describe different clinical presentations and new treatment options. This is a retrospective chart review of patients diagnosed with supernumerary lacrimal puncta during the time between June 2015 and December 2021 at the Research Institute of Ophthalmology, Giza, Egypt. Four patients (two females and two males) with a mean presenting age of 54 ± 14 years had unilateral double puncta. Of those four patients, three had double puncta on the right lower eyelid whereas one had double puncta on the left upper and lower eyelid. In one of the three patients, the double puncta anomaly was an incidental finding, and the patient was asymptomatic. The other three patients had associated epiphora. All four patients were found to have patent double puncta with no mechanical obstruction. No surgical interventions were necessary for all four patients as one resolved after discontinuing the topical eye drops. Another patient resolved after the diagnostic probing of the puncta, and the third asymptomatic patient required no interventions. Epiphora in the fourth patient resolved with botulinum toxin injection in the lacrimal gland. Accessory lacrimal puncta can present in patients as an incidental asymptomatic finding or patients may present with epiphora. Patients who present with unilateral epiphora, dry eye, or canaliculitis should be carefully evaluated with a detailed slit-lamp examination using lid eversion to appreciate potentially easily missed supernumerary lacrimal puncta.

Pilot Study of Smartphone Infrared Pupillography and Pupillometry.

PURPOSE: To describe and validate a novel portable smartphone-based infrared pupillographer. MATERIALS AND METHODS: A prototype infrared smartphone pupillographer device was custom designed for this project. Infrared video and photo pupillography were attempted on 12 patients with different clinical pupillary examination findings. Captured pupillography media files were assessed by three masked investigators, and the agreement between their qualitative clinical evaluation was tested against the evaluation of the neuro-ophthalmologist who performed the real-time examination and pupillography. Quantitative measurements of the pupillary diameter were performed by three investigators using a custom designed smartphone application on three different smartphones and on a personal computer. Measurements obtained by the three investigators using the smartphone and the desktop computer were compared. RESULTS: Infrared video pupillography of high quality was successfully captured for light and near pupillary reflexes, and infrared still photographs were obtained in light and dark conditions in 23 eyes of the 12 patients. Examination findings included relative afferent pupillary defect (n = 5), normal pupillary examination (n = 4), anisocoria (n = 2), and relative afferent pupillary reflex by reverse (n = 1). There was 100% agreement in the qualitative pupillary evaluation of the masked investigators compared with real time clinical examination. Quantitative measurements of pupillary size obtained on the smartphone and desktop computer showed excellent agreement among the three investigators with intraclass correlation (ICC) coefficient ranging from 0.982-0.986 (P<0.001) and 0.995 (P<0.001) for the smartphone and the desktop computer groups, respectively. Level of agreement ranged between -0.27 and 0.32. Mean pupil diameter errors were 0.03 ± 0.15 mm between groups (P = 0.248). CONCLUSION: This pilot study demonstrates the feasibility of smartphone-based infrared pupillography for high quality photo and video documentation of pupillary examination at the bedside and in the clinic with accurate and reproducible measurements of the pupillary size in light and dark conditions.

Angle Surgery in Pediatric Glaucoma Following Cataract Surgery.

Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.

The Efficacy and Safety of High-Frequency Deep Sclerotomy in Treatment of Chronic Open-Angle Glaucoma Patients.

PURPOSE: Highlights the high-frequency deep sclerotomy as a competing ab interno surgery in open-angle glaucoma patients and evaluates the efficacy of high-frequency deep sclerotomy in lowering IOP of chronic open-angle glaucoma patients, in addition to the evaluation of the safety of the procedure on the corneal endothelium. DESIGN: A prospective study. It was performed in the Research Institute of Ophthalmology, Cairo. PARTICIPANTS: 43 eyes were enrolled for the study. All eyes were diagnosed with chronic open-angle glaucoma. METHODS: The procedure was performed using the abee® glaucoma tip of Oertli phacoemulsification machine (OS3, Switzerland) and goniolens performing nasal six pockets penetrating 1 mm deep into the trabecular meshwork and Schlemm's canal. Patients were followed up regarding vision and intraocular pressure (IOP) for 9 months. Endothelial cell count and coefficient of variation were calculated using specular microscopy preoperatively and 9 months postoperatively. RESULTS: The mean preoperative IOP was 31.4 ± 4.71 mmHg (range: 22 to 42 mmHg). All patients were followed up for nine months. The mean IOP was 19.06 ± 1.907 mmHg (range: 15 to 26 mmHg) by the end of the study. The reduction across the follow-ups was statistically significant (P < 0.0001). The percentage of total success was 90.7% (39 eyes). Four eyes (9.3%) had IOP > 21 (failed) after surgery and continued on antiglaucoma therapy. CONCLUSION: High-frequency deep sclerotomy is a safe and promising minimally invasive procedure which successfully achieves a lower IOP for chronic open-angle glaucoma patients, but not adequate for advanced glaucoma patients. This trial is registered with PACTR201910823824561.