Posterior vitreous detachment rates post-uncomplicated phacoemulsification surgery: a systematic review.

PURPOSE: It is commonly accepted that phacoemulsification surgery is a risk factor for the development of posterior vitreous detachment (PVD) and may accelerate the process. This is an important consideration particularly in cases involving young patients who pre-operatively have no PVD, given the increased risk of retinal tears and detachments. METHODS: A comprehensive literature search was conducted to identify studies reporting incidence of PVD post-uncomplicated phacoemulsification surgery. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was used for search strategy. Of 3071 titles, 7 studies met the inclusion criteria; The outcomes measured were PVD occurrence by (1) time, (2) type, (3) age, (4) gender and (5) axial length, with all statistical analysis performed using Review Manager. RESULTS: A total of 2034 eyes were included for analysis with a mean follow-up time of 28.3 months. 33.3% of patients developed a PVD, either partial or complete, with rates increasing in a time dependent manner. No significant difference was noted in sub-group analysis by age, gender or axial length. CONCLUSIONS: The results from our systematic review show that uncomplicated phacoemulsification accelerates the physiological process of PVD development. Pre-operative evaluation of the vitreoretinal interface should be performed with careful post-operative follow-up advised in those without a pre-existing PVD.

Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK)-a systematic review and meta-analysis.

BACKGROUND/OBJECTIVES: Endothelial keratoplasty (EK) is a commonly performed transplant procedure used in the treatment of corneal endothelial dysfunction. The aim of this systematic review and meta-analysis is to evaluate the differences in visual acuity outcomes, endothelial cell density (ECD) and complications between two forms of EK, ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS: A literature search of MEDLINE, Embase and Cochrane Library was conducted to identify studies reporting comparative results of UT-DSAEK versus DMEK. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for search strategy. Of 141 titles, 7 studies met the inclusion criteria; best corrected visual acuity (BCVA) (LogMAR), ECD (cells/mm2), and complications were compared, with all statistical analysis performed using Review Manager. RESULTS: A total of 362 eyes were included for analysis. DMEK resulted in significantly better BCVA at 3 months (0.14 vs 0.22, p = 0.003), 6 months (0.08 vs 0.18, p = 0.005) and 1 year post-op (0.07 vs 0.14, p = 0.0005). UT-DSAEK resulted in significantly lower total complications (25.2% vs 57.3%, p = 0.0001) and rates of re-bubbling (11.0% vs 33.7%, p = 0.004). No differences were found in ECD between the two procedures (1541 vs 1605, p = 0.77). CONCLUSIONS: DMEK results in superior visual acuity rates with quicker recovery. However, UT-DSAEK has a more favourable complication profile, particularly regarding lower rates of re-bubbling. Both are valuable options in the treatment of corneal endothelial disease and choice of procedure may depend on surgical expertise.

Changing trends in corneal transplantation: a national review of current practices in the Republic of Ireland.

BACKGROUND: First Irish National Corneal Transplant Registry report. AIM: To report about current corneal transplantation practices in Ireland including patient demographics, indications and types of transplant performed and to compare the findings with other developed countries. METHODS: Nationwide retrospective review of the corneal transplants performed in Ireland between 2016 and 2019. RESULTS: Overall, 536 keratoplasties were carried out: 256 (47.8%) Penetrating Keratoplasties (PK), 212 (39.6%) Descemet Stripping Automated Endothelial Keratoplasties (DSAEK), 30 (5.6%) Descemet Membrane Endothelial Keratoplasties (DMEK), and 25 (4.7%) Deep Anterior Lamellar Keratoplasties (DALK). The most common indication was Keratoconus (KC, 19%), followed by Fuchs endothelial dystrophy (FED, 18.8%), and Pseudophakic bullous keratopathy (PBK, 17%). KC (34%) and re-grafting (17%) were the leading indications for PK, whereas FED and PBK were the major indications for DSAEK (38% and 33%) and DMEK (67% and 20%), respectively. During the period studied, the number of transplants increased from 11.3 to 14 grafts per month. The number of PKs remained stable, whereas Endothelial Keratoplasties, DSAEK and DMEK, increased (3.8 to 5.6 and 0.2 to 1.6 per month, respectively), becoming the most commonly performed grafts since 2018. Only a small number of DALK were performed. CONCLUSIONS: Corneal transplantation in Ireland is following international trends as endothelial procedures have become the most common approach since 2018. However, a low overall number of transplants is performed in Ireland compared with other countries suggesting that care pathways should be implemented to improve access to corneal transplantation.

Twelve-month follow-up of the Artiflex toric phakic intraocular lens.

PURPOSE: To evaluate the efficacy, safety, refractive predictability, and complications 12 months following the implantation of a foldable toric phakic intraocular lens (PIOL) for the correction of myopic astigmatism. METHODS: Uncorrected visual acuity (UCVA) and best-corrected distance visual acuity (CDVA), subjective and objective manifest refraction, endothelial cell count (ECC), intraocular pressure, biomicroscopy findings, and patient-reported symptoms were the main parameters recorded pre and post the implantation of an Artiflex toric PIOL. RESULTS: Twenty-eight eyes of 19 patients with preoperative myopia ranging from -1.00 D to -12.00 D and with astigmatism ranging from -1.00 D to -5.50 D had the Artiflex toric PIOL inserted to correct refractive error. Postoperatively, all eyes had UCVA of at least 6/12, 94% of at least 6/9, and 58% of at least 6/6. The CDVA improved in 38% of eyes and vision deteriorated by one line in one eye. Postoperative mean refractive spherical equivalent was -0.25 D (range -1.25 D to 0.00 D) with mean astigmatism being -0.60 D (range -1.50 D to 0.00 D). The ECC decreased by a mean of 6.17% (SD 5.63%) at 12 months when compared with the preoperative baseline. CONCLUSION: The Artiflex toric PIOL is an efficacious, predictable, and safe method of treating moderate to high refractive error with astigmatism.

Excimer laser photorefractive keratectomy for low to moderate myopia using a 5.0 mm treatment zone and no transitional zone: 16-year follow-up.

PURPOSE: To evaluate the safety and efficacy of photorefractive keratectomy (PRK) 16 years postoperatively. SETTING: Refractive Laser Suite, Mater Private Hospital, Dublin, Ireland. DESIGN: Cohort study. METHODS: Myopic PRK was performed using the UV200 excimer laser with a 5.0 mm ablation zone. The following were evaluated in patients returning 16 years postoperatively: refractive stability, refractive predictability, corrected visual acuity, corneal haze, and subjective patient symptoms (eg, glare, halos). RESULTS: Most of the 120 eyes (80 patients) were followed for 2 years or more; 23 patients (39 eyes) were followed for 16 years. Preoperatively, the spherical equivalent (SE) ranged from -1.75 to -7.25 diopters (D) and astigmatism from 0.00 to 1.50 D. At 2 years, the mean SE was -0.25 D and at 16 years, -0.58 D. Overall, 31 eyes (79.5%) were within ± 1.00 D of emmetropia, with 6 eyes (15.4%) between 1.00 D and 2.00 D and 2 eyes (5.1%) between 2.00 D and 3.00 D. The final uncorrected distance visual acuity was 20/20 or better in 27 eyes (69.2%) and 20/30 or better in 36 eyes (92.3%). Eight eyes (20.5%) lost 1 line of corrected distance visual acuity. Four eyes (10.3%) had visible haze and 7 eyes (17.9%) had hemosiderin. All patients stated they would have the procedure again. CONCLUSION: Photorefractive keratectomy was safe and effective in the treatment of myopia up to -7.00 D, and all patients reported being satisfied. There appeared to be slight regression over the follow-up period. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Age-dependent rat retinal ganglion cell susceptibility to apoptotic stimuli: implications for glaucoma.

BACKGROUND: This paper seeks to investigate differences between the neonatal and adult retinal ganglion cell populations to apoptotic death stimuli. DESIGN AND SAMPLES: In vitro and ex vivo paradigms involving P6 and P60 Sprague-Dawley rat retinal explants and retinal ganglion cells were employed. METHODS: Postnatal day 6 (P6) and 60 (P60) Sprague-Dawley retinal ganglion cells and retinal explants were either serum starved or subjected to excitotoxicity using calcium ionophore A23187. MAIN OUTCOME MEASURES: Apoptosis was detected in both models using terminal dUTP nick end labelling. Expression of Apaf-1, active caspases-3 and 9 in P6 and P60 retinas, and in the ganglion cell layer was examined using Western blotting. RESULTS: In both the dissociated retinal ganglion cell and retinal explant models, P60 retinal ganglion cells were significantly less susceptible to excitoxicity and serum starvation than their P6 counterparts. Western blotting indicated that active caspase-3 and Apaf-1 are downregulated in the Sprague-Dawley rat retina at P60 compared with P6. CONCLUSIONS: We demonstrate that neonatal Sprague-Dawley retinal ganglion cells are more susceptible to glaucoma-related death stimuli than their adult counterparts in dissociated retinal ganglion cells and axotomized retinal explant models. It is apparent that these different retinal ganglion cell populations are inherently designed to react differently to death stimuli. Thus caution should be exercised when noting the high susceptibility of neonatal retinal ganglion cells to glaucomatous death stimuli.

Surgical management of heavy eye phenomenon.

Heavy eye phenomenon can be cosmetically unaccepted due to significant pseudoproptosis and hypotropia. We highlight the salient features of this condition, and report successful cosmetic outcome following a staged procedure comprising orbital decompression and horizontal recti surgery.

Worldwide geographical distribution of ophthalmology publications.

International peer-reviewed publications form the basis of evidence-based medicine and are one of the main indicators of ophthalmology research activity. This paper examines the origins of such articles in relation to geographical location, population demographics and economic research profiles. Publications from five ophthalmology journals over 5 years were analysed using the Medline/Pubmed search engine. Country of origin was ascertained based on the address of the corresponding author. Worldwide ophthalmology research output was analysed in relation to population demographics and research expenditure. In total, 7,754 articles from 67 countries from 2002 to 2006 were analysed. The overall number of articles published increased by over 29% during this period. The United States (US) produced the greatest number of articles. Singapore produced the most publications per 10(6) population. There was a relationship between gross domestic product (GDP) greater than $20,000 and population-adjusted output. The US followed by the United Kingdom and Japan were the greatest gross contributors. Population-adjusted figures revealed that Singapore, Iceland and Australia were the most prolific nations. There was a relationship between GDP and the top-ranked population-adjusted countries. The top 10 most productive population-adjusted countries spend relatively more on research and development than the top 10 gross contributors.

A key role for calpains in retinal ganglion cell death.

PURPOSE: The purpose of this study was to examine the importance of calpains in retinal ganglion cell (RGC) apoptosis and the protection afforded by calpain inhibitors against cell death. METHODS: Two different models of RGC apoptosis were used, namely the RGC-5 cell line after either intracellular calcium influx or serum withdrawal and retinal explant culture involving optic nerve axotomy. Flow cytometry analysis with Annexin V/PI staining was used to identify RGC-5 cells undergoing apoptosis after treatment. TdT-mediated dUTP nick end labeling (TUNEL) was used to identify cells undergoing apoptosis in retinal explant sections under various conditions. Serial sectioning was used to isolate the cell population of the ganglion cell layer (GCL). Western blotting was used to demonstrate calpain cleavage and activity by detecting cleaved substrates. RESULTS: In the RGC-5 cell line, the authors reported the activation of mu-calpain and m-calpain after serum starvation and calcium ionophore treatment, with concurrent cleavage of known calpain substrates. They found that the inhibition of calpains leads to the protection of cells from apoptosis. In the second model, after a serial sectioning method to isolate the cells of the ganglion cell layer (GCL) on a retinal explant paradigm, protein analysis indicated the activation of calpains after axotomy, with concomitant cleavage of calpain substrates. The authors found that inhibition of calpains significantly protected cells in the GCL from cell death. CONCLUSIONS: These results suggest that calpains are crucial for apoptosis in RGCs after calcium influx, serum starvation, and optic nerve injury.