Late Recurrence of Anisometropic Amblyopia.

A 15-year-old boy whose anisometropic amblyopia was effectively treated with glasses was examined. Despite years of stability, his visual acuity decreased from 20/20 to 20/60 with poor glasses compliance. Although amblyopia recurrence is well recognized, this case emphasizes potential late recurrence after prolonged success. Fortunately, he improved to 20/20 after improved compliance. [J Pediatr Ophthalmol Strabismus. 2024;61(1):e11-e12.].

Characteristics of Spontaneously Regressed Retinopathy of Prematurity at Termination of Acute Retinal Screening Examinations Using a Novel Grading System.

PURPOSE: To characterize and compare residual retinal changes of spontaneously regressing retinopathy of prematurity (ROP) at termination of acute-phase retinal screening examinations. METHODS: A retrospective chart review of 521 infants screened for ROP from 2016 to 2019 was performed. Data were collected on patients with at least stage 1 ROP, but who were not treated. The primary outcome measure was presence of residual fibrotic retinal tissue at termination of acute ROP screening examinations. Secondary outcomes included: type of residual fibrotic retinal tissue, persistent avascular retina, vitreous hemorrhage, and retinal detachment. A novel grading system was used to categorize findings. Comparisons between groups were made using Fisher exact tests. RESULTS: A total of 255 eyes met inclusion criteria. A total of 206 of 255 eyes (81%) showed persistent avascular retina, whereas 57 of 255 eyes (22%) showed residual fibrotic retinal tissue at termination of acute screening. All eyes with previous stage 3 ROP showed residual fibrotic retinal tissue (8 of 8 eyes, 100%). Eyes whose highest stage of ROP was stage 2 showed more residual fibrotic retinal tissue at termination of acute screening (40 of 73 eyes, 55%) compared to eyes whose highest stage was stage 1 (9 of 174, 5%) (P < .0001). Stage 3 eyes were excluded from this comparison due to the small sample size. One eye had vitreous hemorrhage at post-menstrual age 44 1/7 weeks. No eyes had retinal detachment. CONCLUSIONS: Despite meeting at least one of the criteria for termination of acute ROP screening, residual fibrotic retinal tissue and persistent avascular retina are common after spontaneous regression of ROP. Further investigation into the long-term clinical significance of these residual changes is warranted. [J Pediatr Ophthalmol Strabismus. 2023;60(5):359-364.].

Changes in intraocular pressure control in the first year after secondary intraocular lens implantation in children.

PURPOSE: To compare intraocular pressure (IOP) control before and during the first year after secondary intraocular lens (IOL) implantation in children. METHODS: This was a retrospective chart review of children who received secondary IOL implantation. We analyzed IOP and antiglaucoma medications before and after implantation. The latest exam with IOP measurement found within the 2-15 month period after IOL implantation was used for the postoperative data. Failure to maintain IOP control was defined as either the addition of antiglaucoma medication(s) or a rise in IOP > 4 mm Hg. Statistical analyses were performed to assess risk factors for failure to control IOP after surgery, namely age at IOL implantation, preoperative glaucoma status, and IOL fixation location. RESULTS: A total of 100 eyes were included. The mean duration of follow-up was 7.74 months (SD = 3.11). Twenty-three of one hundred eyes failed to maintain IOP control according to our definition. Eyes with a history of having had a traumatic cataract (n = 3) had a more than threefold increased risk of failure (P = 0.015). Although not statistically significant, very young age at initial cataract surgery (<2 months old) had a twofold increased risk of failure compared to an older age (>12 months old) (P = 0.213). No other risk factors were found to have statistical significance. CONCLUSION: Secondary IOL implantation carries a modest risk of worsening IOP control in the first year after implantation, for which, a history of ocular trauma or young age at initial cataract surgery seems to present the highest risk.

Intermediate term safety and efficacy of transscleral cyclophotocoagulation after tube shunt failure.

PURPOSE: To determine the efficacy and safety of diode transscleral cyclophotocoagulation (TSCPC) after tube shunt failure. PATIENTS AND METHODS: The patient population consisted of 32 eyes of 31 patients with uncontrolled glaucoma. Each eye had a previously implanted aqueous tube shunt and was currently on maximally tolerated medication. Each eye also underwent TSCPC treatment using the Iridex (Mountain View, CA) diode laser with a maximum of 360 degrees of treatment. All 31 charts were reviewed for data pertaining to demographics, treatment, ocular history, and follow-up clinical examinations. Safety was evaluated by complication data. Efficacy was evaluated in terms of TSCPC treatment parameters (number of laser applications, laser power, application duration, and degrees of ciliary body treated), intraocular pressure, number of hypotensive medications, and any further treatment required. RESULTS: With a mean (SD) follow-up of 17.1 (16.3) (median=11.7) months from the last treatment, the mean intraocular pressure decreased from 28.6 (10.2) mm Hg to 16.8 (7.5) mm Hg (35% reduction) at 3 months (n=30, P<0.0001) and to 14.7 (7.9) mm Hg (43% reduction) at 1 year (n=13, P<0.0001). Complications included hypotony (n=4), hyphema (n=2), failed corneal transplant (n=1), and loss of light perception (n=5). CONCLUSIONS: TSCPC has a significant ocular hypotensive effect on glaucoma refractory to both tube shunt and medical therapy. The safety of this intervention remains unclear in this high risk patient population and warrants further study.

Pathology of 157 human cadaver eyes with round-edged or modern square-edged silicone intraocular lenses: analyses of capsule bag opacification.

PURPOSE: To assess the degree of capsular bag opacification in human cadaver eyes with silicone intraocular lenses (IOLs), specifically comparing the differences between round-edged IOLs and modern square-edged IOLs. SETTING: John A. Moran Eye Center, University of Utah, USA. DESIGN: Experimental study. METHODS: The eyes were immersed in 10% formalin on enucleation. They had anterior segment scanning with a very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess the degree of capsular bag opacification, coverage of the IOL edge by the anterior capsule, and IOL fixation. Selected eyes also had histopathologic examination. RESULTS: Eighty-seven eyes with a 3-piece round-edged IOL, 43 with a 3-piece square-edged IOL, 26 with a 1-piece plate IOL, and 1 with an accommodating IOL design were included in the analyses of capsular bag opacification. Comparison between 3-piece round-edged IOLs and square-edged IOLs showed statistically significant differences in central posterior capsule opacification (PCO) (P=.0001687) and peripheral PCO (P<.0001). In eyes with square-edged IOLs, PCO had a tendency to start in areas without capsulorhexis coverage of the optic. Twenty-one of 26 eyes with a silicone plate IOL had a neodymium:YAG posterior capsulotomy for dense PCO. CONCLUSIONS: This first study using pseudophakic human cadaver eyes that includes a significant number of modern 3-piece silicone IOLs with square optic edges confirmed the role of this design in the prevention of PCO. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Pathology of 219 human cadaver eyes with 1-piece or 3-piece hydrophobic acrylic intraocular lenses: capsular bag opacification and sites of square-edged barrier breach.

PURPOSE: To assess capsular bag opacification and sites of initial posterior capsule opacification (PCO) in human cadaver eyes with square-edged 1-piece or 3-piece hydrophobic acrylic intraocular lenses (IOLs). SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Experimental study. METHODS: Eyes were immersed in 10% formalin after enucleation and had anterior segment scanning with very-high-frequency ultrasound (Artemis). After the eyes were sectioned at the equator, gross examination of the anterior segment was performed from the posterior aspect to assess capsular bag opacification, anterior capsule coverage of the IOL edge, and IOL fixation. Selected eyes had histopathologic examination. RESULTS: One hundred nineteen eyes with 1-piece IOLs and 100 with 3-piece IOLs were included in the analyses of capsular bag opacification. There was no difference in central (P=.29) or peripheral (P=.76) PCO. In 63 of 84 eyes with a 1-piece IOL and peripheral PCO, the optic-haptic junction was the site of initiation. In eyes with a 3-piece IOL, initial peripheral PCO was observed at nearly the same rate whether there was full 360-degree anterior capsulorhexis overlap of the optic or no overlap (P=.13). In the latter, the site of PCO initiation was in areas lacking capsulorhexis coverage in 46% of eyes. CONCLUSIONS: There was no difference in central or peripheral PCO between 1-piece and 3-piece hydrophobic acrylic IOLs. With 1-piece IOLs, PCO tended to start at the optic-haptic junctions. With 3-piece IOLs, full anterior capsule coverage did not produce a statistically significant benefit with respect to PCO prevention.

Long-term pathological follow-up of 2-loop iridocapsular intraocular lens.

We analyzed an enucleated postmortem eye from an 86-year-old donor who had a 2-loop iridocapsular intraocular lens (IOL) that had been implanted at least 30 years earlier. High-frequency ultrasound showed a relatively well-centered iris-supported optic in front of the pupil. Gross and light microscopic analyses of the eye and the IOL showed loop fixation outside the capsular bag remnants, a thickened cornea, mild attenuation of the corneal endothelium, multiple areas of iris trauma secondary to haptic abrasion, fragments of iris tissue attached to the haptics, as well as pigment dispersion within the eye with pigmented epithelial cells attached to the IOL haptics. Histopathological examination of the posterior segment was unremarkable.

Comparison of wound strength with and without a hydrogel liquid ocular bandage in human cadaver eyes.

PURPOSE: To determine whether a hydrogel liquid ocular bandage improves wound strength. SETTING: John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA. DESIGN: Laboratory investigation. METHODS: The wound strength of 2.8 mm clear corneal incisions and 23-gauge scleral incisions was tested in cadaver eyes by raising the intraocular pressure (IOP) until leakage occurred. The pressure at the first sign of incision leakage with the liquid bandage and without the liquid bandage was determined. RESULTS: Four corneal incisions and 4 scleral incisions were made in 5 cadaver eyes. The mean pressure at the first sign of corneal incision leakage was 59.5 mm Hg ± 21.0 (SD) without the liquid bandage and 198.1 ± 57.6 mm Hg with the liquid bandage (P<.0001). The mean pressure at the first sign of scleral incision leakage was 47.9 ± 21.4 mm Hg and 209.0 ± 42.9 mm Hg, respectively (P<.0001). Eight corneal incisions and 8 scleral incisions did not leak at the maximum pressure of 246 mm Hg. With both incision types, the difference in leakage with a liquid bandage in place and with no liquid bandage was statistically significant (P = .002). CONCLUSION: With application of a hydrogel liquid ocular bandage, incisions withstood significantly higher IOP before leakage occurred than when no liquid bandage was used.

An anterior chamber toxicity study evaluating Besivance, AzaSite, and Ciprofloxacin.

PURPOSE: We determined whether Besivance (Bausch & Lomb), AzaSite (Inspire Pharmaceuticals, Inc; both with DuraSite bioadhesive [InSite Vision, Inc]) and ciprofloxacin are toxic inside the anterior chamber. DESIGN: Randomized, masked, placebo-controlled animal study. METHODS: Twenty New Zealand white rabbits (40 eyes) were randomized to 1 of 4 study groups: Besivance, AzaSite, ciprofloxacin, and balanced salt solution. Each eye was injected with 0.1 mL of the study medication. Clinical slit-lamp examinations were conducted at 24 and 48 hours after injection. All rabbits then were killed and all eyes were enucleated. We randomized eyes to either corneal vital staining or histopathologic examination. The main outcome measures were clinical and pathologic signs of toxicity. RESULTS: The 2 DuraSite-based study groups (Besivance and AzaSite) showed clinically and pathologically significant differences when compared with the ciprofloxacin and balanced salt solution groups. Besivance and AzaSite eyes exhibited significantly similar and severe clinical damage, including severe corneal edema. Ciprofloxacin and balanced salt solution eyes appeared very similar and had only mild conjunctival injection and limbal vascularity. Vital staining and histopathologic evaluation revealed glaucomatous and toxic damage in eyes given DuraSite-based medications, whereas non-DuraSite groups showed minimal changes. CONCLUSIONS: DuraSite blocks the trabecular meshwork and may be additionally toxic when introduced as a large bolus. Until the safety of these medications is established with further studies using smaller injected volumes, we recommend placement of a suture over a clear corneal wound if DuraSite-based medications are used.

Bench-top evaluation of air flow through a valved peelable introducer sheath.

PURPOSE: Air embolism is a rare but potentially fatal complication that may occur during the insertion of a central venous catheter. A valved peelable introducer sheath was developed to reduce the likelihood of an air embolus. This study was performed to determine the rate of air flow through this valved introducer sheath under different conditions that may be encountered in a clinical setting. MATERIALS AND METHODS: A 16-F-diameter valved peelable introducer sheath was used for all experiments. A bench-top testing system was constructed that consisted of a vacuum source, a mass flow meter, and a digital vacuum gauge. A coupling device with a pneumatic O-ring was used to seal and connect the distal end of the introducer sheath to the testing system. A vacuum of -5 mm Hg was applied to the sealed distal end of the sheath to simulate physiologic conditions. The rate of air flow through the valved sheath was measured under three different conditions; (i) valve open, (ii) valve closed, and (iii) valve open but with the sheath manually pinched. Thirty air flow measurements were performed for each of the three test conditions. RESULTS: When the valve was in the open position, the mean rate of air flow through the introducer sheath was 417.2 mL/sec (range, 415.5-419.7 mL/sec). When the valve was in the closed position, the mean rate of air flow was 0.004 mL/sec (range, 0.000-0.067 mL/sec). When the valve was open but the sheath was manually pinched, the mean rate of air flow through the sheath was 31.7 mL/sec (range, 23.0-38.8 mL/sec). During the 90 testing procedures, the mean vacuum was -5.10 mm Hg (range, -5.00 to -5.45 mm Hg). CONCLUSIONS: This bench-top study revealed that a massive amount of air flowed through the open 16-F introducer sheath when it was subjected to a vacuum of -5 mm Hg, a situation that may occur under normal physiologic conditions. The rate of air flow could be decreased by aggressively pinching the sheath but the rate of air flow was still substantial. This study demonstrated that the addition of a sophisticated valve mechanism can essentially eliminate air flow through a peelable introducer sheath.