AvaGen Genetic Testing versus Ocular Screening Assessments Including the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS) in Refractive Surgery Candidates.

Purpose: To determine whether the AvaGen (AG) Genetic Eye Test provided additional information for screening for the presence of keratoconus (KC) and assessing KC risk in refractive surgery candidates, as compared to the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS). Methods: This retrospective study analyzed patients seeking refractive surgery at an eye clinic in the United States between January 2022 and July 2023. The inclusion criteria encompassed those with a family history of KC, positive KC indices, or both. Corneal evaluations and demographic information were recorded and analyzed. KSS and ERSS criteria were utilized to evaluate postoperative KC and ectasia risk, respectively. Patients were categorized on how the AG genetic test compared to KSS and ERSS criteria. Clinicians assessed topographic indices, criteria scoring, and AG testing to deliver a definitive surgical recommendation. Results: Among the 19 patients evaluated for ectasia risk, AG testing showed lower KC risk than ocular screening in three patients (15.8%), equal risk in three patients (15.8%), and higher risk in 13 patients (68.4%). The mean AG scores were 45.7 ± 7.0, 49.0 ± 3.46, and 61 ± 13.0 for these respective categories. The most frequently identified KC risk genes were ADAMTS18, COL2A1, and COL4A1. The AG test modified the physician's recommendation for refractive surgery in nine cases (47.4%). Conclusion: Despite the promising application of AG testing for assessing KC risk, further research and development are needed to enhance its applicability for screening refractive surgery candidates, in addition to standard ocular screening approaches.

Precision in IOL Calculation for Cataract Patients with Prior History of Combined RK and LASIK Histories.

Purpose: This study aimed to evaluate the accuracy of 12 intraocular lens (IOL) power calculation formulae for eyes that have undergone both radial keratotomy (RK) and laser assisted in situ keratomileusis (LASIK) surgery to determine the efficacy of various IOL calculations for this unique patient group. Currently, research on this surgical topic is limited. Methods: In this retrospective study, 11 eyes from 7 individuals with a history of RK and LASIK who underwent cataract surgery at Hoopes Vision were analyzed. Preoperative biometric and corneal topographic measurements were performed. Subjective refraction was obtained postoperatively. Twelve different intraocular lens (IOL) power calculations were used: Barrett True K No History, Barrett True K (prior LASIK, Prior RK history), Barrett Universal 2, Camellin-Calossi-Camellin (3C), Double K-Modified Holladay, Haigis-L, Galilei, OCT, PEARL-DGS, Potvin-Hill, Panacea, and Shammas. Results: The rankings of mean arithmetic error (MAE), from least to greatest, were as follows: 3C (0.088), Haigis-L-L (-0.508), Shammas (-0.516), OCT Average (-0.538), Barrett True K (-0.557), OCT RK (-0.563), Galilei (-0.570), IOL Master (-0.571), OCT LASIK (-0.583), Barrett True K No History (-0.597), Pearl-DGS (-0.606), Potvin-Hill SF (-0.770), Potvin-Hill TNP (-0.778), Panacea (-0.876), and Barrett Universal 2 (-1.522). The 3C formula achieved the greatest percentage of eyes within ±0.25 D of target range (91%), while Haigis-L, Shammas, Galilei, Potvin Hill, Barrett True K, IOL Master, PEARL-DGS, and OCT formulae performed similarly, achieving 45% of eyes within ±0.75D of target refraction. Conclusion: This study demonstrates the accuracy of the lesser known 3C formula in IOL calculation, particularly for patients who have undergone both RK and LASIK. Well-known formulae, such as Haigis-L, Shammas, and Galilei, which are used by the American Society of Cataract and Refractive Surgery (ASCRS), are viable options, although 3C formulae should be considered in this patient population. Furthermore, larger studies can confirm the best IOL power formulas for post-RK and LASIK cataract patients.

Iris atrophy after administration of Dexycu: Additional evidence and possible mechanism for a rare complication.

Purpose: To report the observation of iris atrophy with the use of Dexycu in cataract surgery and describe a possible mechanism for this complication. Observations: Between 2020 and 2021, 2 patients underwent cataract surgery procedures with the use of Dexycu and experienced iris atrophy. The first case of iris atrophy was discovered by 6-month follow-up and the second case by 2-month follow-up. The timing and nature of this complication possibly represent more than steroid-induced hypopigmentation. Conclusions and Importance: This publication adds further evidence of iris atrophy and a proposed mechanism associated with the use of Dexycu. Surgeons should be aware of this complication, especially when operating on eyes with dark irides.

Incidence and severity of asymptomatic ocular injury in adult and pediatric orbital fractures.

PURPOSE: To evaluate the incidence of severe ocular injury requiring emergent ophthalmic evaluation in visually asymptomatic patients presenting with orbital fractures. METHODS: We performed a retrospective chart review of all adult and pediatric orbital fractures between 2012-2022 at a level 1 trauma center. Ocular injuries were categorized into severe, moderate, and mild. We evaluated symptoms, mechanism of injury, visual acuity (VA), and severity of injuries using the Cochran-Armitage and linear-by-linear tests. RESULTS: Of the 2495 cases, 1534 had ophthalmology evaluation. The mean ± standard deviation age was 40.4 ± 20.4 years. Most patients were male (73.1%) and Caucasian (75.9%). The mean time to evaluation was 0.6 ± 2.5 days. 486 (31.7%) were visually symptomatic, 760 (49.5%) were asymptomatic, and 288 (18.8%) were unknown. Of the symptomatic, 135 (27.8%) had severe injuries, 108 (22.2%) had moderate injuries, 216 (44.4%) had mild injuries, and 27 (5.6%) had no injuries. Of the asymptomatic, 67 (8.8%) had severe injuries, 183 (24.1%) had moderate injuries, 468 (61.6%) had mild injuries, and 42 (5.5%) had no injuries. Symptoms correlated with injury severity (p-value <.001). The most common mechanism of injury were falls (24.0%), assaults (22.2%), and motor vehicle accidents (14.8%). CONCLUSIONS: Visually asymptomatic orbital fractures were less likely to have severe ocular injuries; however, many patients were unable to express symptoms. Emergent ophthalmology evaluation should be considered in all patients presenting with orbital fractures, especially patients with visual symptoms or are unable to report symptoms.

Vitamin B12 does not increase cell viability after hydrogen peroxide induced damage in mouse kidney proximal tubular cells and brain endothelial cells.

Vitamin B12 (B12) is an essential co-factor for two enzymes in mammalian metabolism and can also act as a mimetic of superoxide dismutase (SOD) converting superoxide (O2 •‒) to hydrogen peroxide (H2O2). High oral dose B12 decreases renal O2 •‒ and post-ischemia/reperfusion injury in mice and protects against damage induced by hypoxia/reperfusion in mouse kidney proximal tubular cells (BU.MPT). O2 •‒ is unstable and rapidly converted to H2O2. H2O2 mediates oxidative stress associated with O2 •‒. Whether B12 protects against damage induced by H2O2 is unknown. Both BU.MPT cells and mouse brain endothelial cells (bEdn.3) were applied to test the effects of B12 on H2O2-induced cytotoxicity. Both types of cells were treated with different doses of H2O2 with or without different doses of B12. Cell viability was analyzed 24 h later. H2O2 caused cell death only at a very high dose, and high pharmacological dose of B12 did not prevent this detrimental effect in either cell type. In bEnd.3 cells, transcriptional levels of heme oxygenase-1 (HO-1) increased, while nuclear factor erythroid 2-related factor 2 (Nrf2) decreased by H2O2. The levels of transcripts were not affected by the B12 treatment. We conclude that the cytotoxic effects of exogenous H2O2 in BU.MPT and bEdn.3 cells are not prevented by B12.

Oral high dose vitamin B12 decreases renal superoxide and post-ischemia/reperfusion injury in mice.

Renal ischemia/reperfusion injury (IRI) is a leading cause of acute kidney injury (AKI), a potentially fatal syndrome characterized by a rapid decline in kidney function. Excess production of superoxide contributes to the injury. We hypothesized that oral administration of a high dose of vitamin B12 (B12 - cyanocobalamin), which possesses a superoxide scavenging function, would protect kidneys against IRI and provide a safe means of treatment. Following unilateral renal IR surgery, C57BL/6J wild type (WT) mice were administered B12 via drinking water at a dose of 50 mg/L. After 5 days of the treatment, plasma B12 levels increased by 1.2-1.5x, and kidney B12 levels increased by 7-8x. IRI mice treated with B12 showed near normal renal function and morphology. Further, IRI-induced changes in RNA and protein markers of inflammation, fibrosis, apoptosis, and DNA damage response (DDR) were significantly attenuated by at least 50% compared to those in untreated mice. Moreover, the presence of B12 at 0.3 µM in the culture medium of mouse proximal tubular cells subjected to 3 hr of hypoxia followed by 1 hr of reperfusion in vitro showed similar protective effects, including increased cell viability and decreased reactive oxygen species (ROS) level. We conclude that a high dose of B12 protects against perfusion injury both in vivo and in vitro without observable adverse effects in mice and suggest that B12 merits evaluation as a treatment for I/R-mediated AKI in humans.