Macrophages modulate fibrosis during newt lens regeneration.

BACKGROUND: Previous studies have suggested that macrophages are present during lens regeneration in newts, but their role in the process is yet to be elucidated. METHODS: Here we generated a transgenic reporter line using the newt, Pleurodeles waltl, that traces macrophages during lens regeneration. Furthermore, we assessed early changes in gene expression during lens regeneration using two newt species, Notophthalmus viridescens and Pleurodeles waltl. Finally, we used clodronate liposomes to deplete macrophages during lens regeneration in both species and tested the effect of a subsequent secondary injury after macrophage recovery. RESULTS: Macrophage depletion abrogated lens regeneration, induced the formation of scar-like tissue, led to inflammation, decreased iris pigment epithelial cell (iPEC) proliferation, and increased rates of apoptosis in the eye. Some of these phenotypes persisted throughout the last observation period of 100 days and could be attenuated by exogenous FGF2 administration. A distinct transcript profile encoding acute inflammatory effectors was established for the dorsal iris. Reinjury of the newt eye alleviated the effects of macrophage depletion, including the resolution of scar-like tissue, and re-initiated the regeneration process. CONCLUSIONS: Together, our findings highlight the importance of macrophages for facilitating a pro-regenerative environment in the newt eye by regulating fibrotic responses, modulating the overall inflammatory landscape, and maintaining the proper balance of early proliferation and late apoptosis of the iPECs.

[Lens injury as a complication of intravitreal medication injection]. / Linsenverletzungen als Komplikation bei intravitrealer Medikamenteneingabe.

BACKGROUND: Intravitreal medication injections are an efficient and low-risk delivery technique for treating various retinal diseases. Rare serious complications include increased intraocular pressure, vitreous hemorrhage, retinal tears and detachment, intraocular inflammation and endophthalmitis. In the case series presented here, we report iatrogenic lens injuries caused by inadequate performance of intravitreal injections. METHODS: A multicenter data collection of patients treated with intravitreal injections with visible iatrogenic lens defects from 2016 to 2023 was retrospectively performed. RESULTS: Lens trauma after intravitreal injections was identified in six cases (69.3±6.5 years). While five cases were observed after anti-VEGF therapy, we identified lens injury after dexamethasone implantation in one patient. CONCLUSION: Iatrogenic lens injury during intravitreal injection is preventable with the correct injection technique. Knowledge of individual axis length and lens status also helps to avoid this complication.

Diagnosis, management, and outcome of an intralenticular foreign body in a dog: A case report.

Background: Intra-lenticular foreign bodies are rare in veterinary medicine and uncommon in human medicine. Approximately 50% of perforating ocular injuries in canines have lenticular involvement. Treatment choices include conservative management and surgical options. Retained intra-lenticular foreign body with delayed removal has not been reported in animals. Case Description: A 3-year-old male neutered Lurcher presented with right-sided ocular discomfort and a sealed full-thickness corneal perforation. The full ophthalmic examination could not be performed at the initial presentation due to miosis. Recrudescence of anterior uveitis was seen post-drug cessation. Re-evaluation of the eye with a mydriatic pupil revealed an intra-lenticular foreign body. Surgical removal via phacoemulsification was performed 8 weeks after the initial perforating injury. The eye remains visual, comfortable, and normotensive 50 months post-operatively. Conclusion: This is the first report of an encapsulated, retained intra-lenticular foreign body with delayed removal in a dog. Mydriasis and repeat examinations are of crucial importance when evaluating eyes post-perforation.

Use of Yamane technique for secondary intraocular lens implantation following open globe injury.

A woman in her 50s presented with suspected open globe injury (OGI) of the right eye after being hit with a high velocity piece of plastic. Visual acuity at the time of presentation was counting fingers in the affected eye. Slit lamp examination revealed a full thickness laceration of the cornea and a traumatic cataract. Primary corneal repair was performed and the patient was left aphakic after cataract removal. Secondary intraocular lens placement was deferred for 2 years, after which time a scleral-fixated intraocular lens was implanted using the Yamane technique. Postoperative visual acuity of 20/50 was achieved, with the vision limited by persistent diabetic macular oedema. Thus, this case of successful implantation of a secondary lens using the Yamane technique in a patient with prior corneal laceration and traumatic cataract highlights that the Yamane technique can result in visual improvement in patients with prior OGI.

Eye trauma from a cat scratch with retention of the claw in the anterior chamber in a dog.

Background: Cat scratches and ocular foreign bodies are frequent reasons for consultation in veterinary ophthalmology. Case Description: We here present an unusual case combining trauma to the cornea and lens by a cat scratch with retention of the claw in the anterior chamber. Management consisted of the removal of the claw, reconstruction of the cornea, and mechanized ablation of the lens by phacoemulsification with implantation of an artificial lens. Conclusion: The progression during the follow-up period was considered satisfactory, with positive responses to visual tests and intraocular pressure within the norms. Only dyscoria and a tear of the endothelium and Descemet membrane, secondary to the trauma, remained.

Management of partially absorbed white soft cataract post penetrating injury to eye.

Background: A measurable burden to the emergency ophthalmology department is represented by ocular trauma in pediatric patients. Traumatic cataracts still result in visual disability despite great advancements in diagnostic and treatment methods. Cataract surgery with intraocular lens (IOL) implantation aids in the improvement of visual acuity in such cases. Duration of trauma is an important prognostic factor for recovery of visual acuity before amblyopia sets in young patients with penetrating ocular injury. Purpose: This video deals with the management of a case of partially absorbed traumatic cataract in a scenario of an old and neglected penetrating injury. This case had a corneal scar, ruptured anterior lens capsule, and posterior synechiae formation between the posterior pigmented epithelium of the iris and the lens capsule. Synopsis: In a case of penetrating ocular injury, one should always suspect violation of posterior lens capsule, weakened or broken zonules and retained intraocular foreign body. In this case, a circular capsulorhexis is difficult to attain. After staining the capsule with trypan blue dye, viscoelastic substance is instilled in the anterior chamber to have good control over the rhexis and to avoid rhexis run out. In case the rhexis runs off to the equator, a pair of Vannas scissors is used to cut the extended flap. The cataract is partially absorbed, white and soft in nature and is easily mobilized from the bag and eaten up via phacoaspiration. Before implantation of posterior chamber intraocular lens (PCIOL) in the sulcus, posterior synechiae are released by swiping a cyclodialysis spatula in the sulcus area. Visual axis is cleared by giving nicks in the posterior capsule to remove the central dense posterior plaque. Automated anterior vitrectomy is done and a three-piece PCIOL is implanted safely in the ciliary sulcus. Retained viscoelastic substance is washed, intracameral antibiotic is instilled, and the anterior chamber is subsequently formed via stromal wound hydration. Highlights: Through this video, we tried to show how one should proceed with phacoaspiration with intraocular lens implantation in a case of traumatic cataract post penetrating injury in a sequential manner. Video Link: https://youtu.be/20DbYUn_Fd8.

Characteristics of pediatric traumatic cataract and factors affecting visual outcomes.

PURPOSE: To evaluate the clinical characteristics, surgical approach and visual results in pediatric traumatic cataract. MATERIAL AND METHODS: Data of pediatric and adult traumatic cataract patients were retrospectively analyzed. Age, gender, cause and zone of trauma, additional clinical findings, initial and final visual acuity (VA) were analyzed and compared between groups. RESULTS: The mean age of 18 patients in the pediatric group was 9.4(SD 5.7); 18 patients in the adult group was 47.8(16.2) years. There was a male predominance in both groups (12/16 male, respectively). The most common cause of trauma was sharp metal objects (50%) in the pediatric group and wooden and traffic accidents (33%) in the adult group. The initial mean VA of the patients were 0.03(0.09), 0.09(0.1) in the pediatric and adult groups, respectively, (p: 0.34). The mean ocular trauma score (OTS) was 51.4(16.4) and 59.6(10.5) in the pediatric and adult groups, respectively (p: 0.09). Simultaneous surgery was performed in 5 (28%) eyes in both groups. Subsequent lens extraction and IOL implantation were performed in 10 of pediatric and 13 of adult patients. The final VA was 0.3(0.7), 0.3(0.4) in the pediatric and adult group, respectively (p: 0.94). Final VA was correlated with OTS in both of the groups and the presence of additional surgery in the pediatric group. CONCLUSION: Traumatic cataract is a major cause of visual loss in children. Lower OTS and presence of additional surgery were the prognostic factors for poor final VA in the pediatric cases. Optimal timing and accurate management of traumatic cataract are important in the pediatric population.

Immune cells in lens injury repair and fibrosis.

Immune cells, both tissue resident immune cells and those immune cells recruited in response to wounding or degenerative conditions, are essential to both the maintenance and restoration of homeostasis in most tissues. These cells are typically provided to tissues by their closely associated vasculatures. However, the lens, like many of the tissues in the eye, are considered immune privileged sites because they have no associated vasculature. Such absence of immune cells was thought to protect the lens from inflammatory responses that would bring with them the danger of causing vision impairing opacities. However, it has now been shown, as occurs in other immune privileged sites in the eye, that novel pathways exist by which immune cells come to associate with the lens to protect it, maintain its homeostasis, and function in its regenerative repair. Here we review the discoveries that have revealed there are both innate and adaptive immune system responses to lens, and that, like most other tissues, the lens harbors a population of resident immune cells, which are the sentinels of danger or injury to a tissue. While resident and recruited immune cells are essential elements of lens homeostasis and repair, they also become the agents of disease, particularly as progenitors of pro-fibrogenic myofibroblasts. There still remains much to learn about the function of lens-associated immune cells in protection, repair and disease, the knowledge of which will provide new tools for maintaining the core functions of the lens in the visual system.

Circular RNA circZNF292 regulates H2 O2 -induced injury in human lens epithelial HLE-B3 cells depending on the regulation of the miR-222-3p/E2F3 axis.

Circular RNAs (circRNAs) play important roles in the pathogenesis of age-related cataract (ARC). CircRNA zinc finger protein 292 (circZNF292, hsa_circ_0004058) is downregulated in ARC lens capsules. Here, we focused on its precise roles in oxidative stress underlying the pathogenesis of ARC. CircZNF292, microRNA (miR)-222-3p, and E2F transcription factor 3 (E2F3) were quantified by quantitative real-time polymerase chain reaction or western blot. Cell viability was assessed by the cell counting kit-8 assay. Cell cycle distribution and apoptosis were detected by flow cytometry. The activities of superoxide dismutase, catalase, and malondialdehyde were measured using the corresponding assay kit. Targeted correlations among circZNF292, miR-222-3p, and E2F3 were verified by the dual-luciferase reporter, RNA immunoprecipitation and RNA pull-down assays. Our data showed that circZNF292 was downregulated in ARC tissues and H2 O2 -treated human lens epithelial B3 (HLE-B3) cells. Increased expression of circZNF292 alleviated H2 O2 -induced cell viability suppression, apoptosis promotion, and oxidative stress enhancement. Mechanistically, circZNF292 directly targeted miR-222-3p, and circZNF292 regulated E2F3 expression through miR-222-3p. MiR-222-3p was a functional mediator of circZNF292 in modulating H2 O2 -induced injury in HLE-B3 cells. Furthermore, reduced level of miR-222-3p ameliorated H2 O2 -induced HLE-B3 cell damage by upregulating E2F3. Our present study demonstrated that increased expression of circZNF292 ameliorated H2 O2 -induced injury in HLE-B3 cells at least in part through the miR-222-3p/E2F3 axis, highlighting a novel insight into the involvement of circRNAs in the pathogenesis of ARC.

"IRIS SHELF" TECHNIQUE FOR MANAGEMENT OF POSTERIOR SEGMENT INTRAOCULAR FOREIGN BODIES.

PURPOSE: To describe "iris shelf" technique for removal of posterior segment intraocular foreign bodies (IOFBs) through a corneal incision combined with phacovitrectomy and to report its outcomes. METHODS: Medical records of patients with posterior segment metallic IOFBs who had combined phacovitrectomy were collected and analyzed. In all patients, the IOFB was placed on the iris surface after forming the anterior chamber with viscoelastic to be extracted through a corneal phacoemulsification incision. RESULTS: Thirty-three eyes of 33 male patients with a mean age of 31.6 ± 8.3 years were included in the study. The mechanism of injury was hammering in 24 eyes (72.7%) and gunshot in 9 eyes (27.3%). The mean interval between injury and IOFB removal was 14.76 ± 6 days. The mean IOFB volume was 8.5 ± 5.5 mm3, and its longest dimension was 3.45 mm (range, 1-8 mm). The mean preoperative corrected distance visual acuity changed from 20/1,500 (1.79 logarithm of the minimum angle of resolution) to 20/94 (0.67 logarithm of the minimum angle of resolution), postoperatively (P < 0.001). Postoperative complications included retinal detachment (two eyes), proliferative vitreoretinopathy (one eye), epiretinal membrane (one eye), and posterior synechiae (three eyes). CONCLUSION: The "iris shelf" technique with phacovitrectomy is a safe and reproducible approach for posterior segment IOFB extraction through a corneal incision with favorable visual and anatomical outcomes.

Long-term outcomes of pediatric traumatic cataracts and retinal detachments due to self-inflicted injuries.

PURPOSE: To report the characteristics and longitudinal visual outcomes of traumatic cataracts and retinal detachments in children with self-inflicted injury. METHODS: A retrospective case series of pediatric patients at a tertiary care center who sustained ocular trauma due to self-inflicted injury between 2000 and 2014. RESULTS: A total of 11 children, all with an intellectual disability and a mean age of 10 ± 4.8 years (range, 2.8-16.2), were identified with traumatic cataract secondary to ocular self-inflicted injury over the study period. Five eyes had a concurrent unilateral retinal detachment. Over the course of follow-up, one additional eye developed a cataract and five eyes developed a retinal detachment. Patients underwent an average of 2.5 ± 2.3 procedures and 17.1 ± 10.7 eye examinations over 11.7 ± 4.2 years of follow-up; 36% required general anesthesia for examination. Visual acuity was improved or preserved in 77% of the eyes that underwent surgical interventions, but was worse in the remaining cases due to development of traumatic retinal detachment. The use of protective helmets, eye shields, and immobilizing orthoses were essential in management of active self-inflicted injury. CONCLUSION: Traumatic cataracts and retinal detachments due to self-inflicted injury may cause severe visual loss. Visual prognosis although poor in children with severe intellectual disabilities may be optimized with risk awareness for early detection and customized interventions.

Lamellar Dissection Technique for Traumatic Cataract With Corneal Incarceration.

PURPOSE: To describe a technique for traumatic cataract management for cases in which part of the anterior capsule has been incarcerated into a healed corneal laceration. METHODS: This is a single-center retrospective chart review of 3 patients with capsular/corneal incarceration after penetrating injury. Each patient underwent primary globe repair, followed by subsequent cataract surgery with intraocular lens (IOL) and iris prosthesis placement. The main outcome measure was corrected distance visual acuity. RESULTS: At a mean of 19-month postoperative follow-up (range 12-26 mo), corrected distance visual acuity ranged from 20/25 to 20/80 and all patients had improved vision compared with before cataract surgery. At the final follow-up, all IOLs and iris prostheses were in stable position and no eyes required corneal transplantation. CONCLUSIONS: Traumatic cataracts may be complicated by incarceration of the anterior capsule into the cornea. Incorporating the posterior aspect of the cornea into the anterior capsulotomy enables cataract removal and IOL placement in a stable capsular bag complex.

Spontaneous resolution of a traumatic cataract in a patient with an open-globe ocular injury: a case report.

BACKGROUND: We report a case of spontaneous resolution of a traumatic cataract in a patient with an open-globe ocular injury. This case highlights the importance of conservative management in these types of cases, as excellent visual outcome is possible without invasive surgical intervention. CASE PRESENTATION: A 13-year-old boy presented with a corneal laceration in the left eye caused by a neuter pen. He underwent emergency repair of the corneal laceration under general anesthesia, and at 3 days post-op, a dense posterior cortical cataract was observed. Based on the patient's age and normal visual development, in addition to preserving accommodative potential, the patient received conservative management and follow-up. Interestingly, the cataract spontaneously resolved over the following 9 months and the corrected distance visual acuity in the injured eye was restored from finger counting at 50 cm, to 20/25 + 3. CONCLUSIONS: To optimize treatment in pediatric traumatic cataract, several critical factors such as age, visual development and the preservation of accommodative potential, need to be comprehensively considered. Conservative management with lens preservation is important to consider in young, traumatic cataract patients where invasive surgical intervention may not be required.

Lead Intraocular Foreign Body Injury Following Ejection.

BACKGROUND: Ejection injuries involving the eyes have become uncommon due to effective protection by helmets and visors. We report a unique case of intraocular lead foreign body injury occurring after ejection from a Hawk aircraft in a pilot who had his helmet and visor on.CASE REPORT: A 40-yr-old male pilot sustained facial injuries after ejection from a Hawk aircraft. He had multiple foreign bodies embedded in the skin around his jaw, corneal foreign bodies, and self-sealed corneal and lens entry in left eye, with one foreign body lodged within the lens and two in the vitreous behind the lens. The foreign bodies showed low reflectivity on CT scan suggestive of plastic. However, spectroscopic and electron microscopic analysis of pieces removed from the cornea confirmed the material to be predominantly lead, which came from the miniature detonator cord (MDC). An electroretinogram (ERG) showed reduction of scotopic b wave amplitude in the affected eye. The pilot underwent intravitreal foreign body removal successfully through pars plana vitrectomy. Post-removal vision recovered from 20/60 to 20/20 with ERG also showing recovery of scotopic b wave amplitude from 100 µV to 180 µV.DISCUSSION: Though systemic toxicity due to high blood levels of lead are well known, this case is unique in demonstrating direct retinal toxicity because of intravitreal lead foreign body. It also raises aeromedical concerns about the hazards of MDC splatter despite full protection with helmet and visor.Khan MA, Gaur D, Murthy PC, Pandey A. Lead intraocular foreign body injury following ejection. Aerosp Med Hum Perform. 2020; 91(8):673-677.