Use of Cenegermin in the Presence of Bandage Contact Lenses.

PURPOSE: The aim of this study was to characterize the outcomes of eyes with neurotrophic keratitis (NK) treated with a course of cenegermin-bkbj in the presence of a bandage contact lens (BCL). METHODS: A retrospective chart review of all eyes with a clinical diagnosis of NK treated with cenegermin-bkbj was performed between 2018 and 2020. Inclusion criteria included cenegermin-bkbj treatment with a BCL in place. Demographics, etiology, visual acuity, pretreatment and posttreatment corneal sensation, and treatment outcomes were assessed. RESULTS: There were 18 eyes of 16 patients (69% female) with NK treated with cenegermin-bkbj while having a BCL in place. After cenegermin-bkbj treatment, presence of corneal sensation significantly increased from 7% of eyes to 79% of eyes (P < 0.0001). There was also a significant increase in the number of quadrants with corneal sensation (mean of 0.1 quadrants increased to 1.6 quadrants, P =0.0005). Six of 10 eyes (67%; P = 0.004) with a persistent epithelial defect (PED) experienced complete resolution at the conclusion of treatment, while 3 additional eyes experienced a decrease in the defect size. Despite all 18 eyes necessitating a chronic BCL before cenegermin-bkbj treatment, 4 were able to maintain their epithelium without a BCL after treatment for at least some period. CONCLUSIONS: Cenegermin-bkbj treatment for NK with a BCL in place demonstrated improvement in corneal sensation, epithelial defect size, and fluorescein staining. In eyes demonstrating previous ocular surface decompensation with discontinuation of a BCL, maintenance of BCL use during treatment with cenegermin-bkbj may be considered.

"Basket" mattress suture to manage positive vitreous pressure during penetrating keratoplasty.

OBJECTIVE: To describe a new/modified technique to manage posterior vitreous pressure (PVP) during penetrating keratoplasty (PKP) and report a small series. DESIGN: Retrospective interventional case series and technique description. PARTICIPANTS: PKP eyes necessitating mattress suture placement owing to PVP. METHODS: Retrospective chart review from 2016 to 2019 was undertaken. Placed prophylactically (before trephination) or after trephination, the mattress suture is placed limbus-to-limbus across the anterior chamber. A second mattress suture can be placed in the opposite meridian (perpendicularly) for added support (safety basket configuration). Variations of suture technique are described based on lens status (i.e., phakic, pseudophakic, aphakic) and intraoperative timing. Parameters assessed included demographics, lens status, suture indications, intraoperative technique details, successful PKP completion, and presence of primary failure. RESULTS: There were 6 phakic eyes (5 patients) and 9 pseudophakic/aphakic eyes (8 patients). Indications for the phakic subgroup were obesity (83%), poor scleral rigidity (83%), repeated iris prolapse (67%), dense mature cataract (33%), and planned large-diameter PKP (33%). Indications for pseudophakic/aphakic eyes included intraocular lens/iris prolapse (100%), pre-existing iris defects (67%), and planned large-diameter PKP (33%). Successful PKP was performed in all cases. Whereas one case had residual corneal edema in the setting of a persistent epithelial defect owing to limbal stem cell deficiency, all other cases demonstrated no primary graft failure. CONCLUSIONS: Although increased PVP can present a stressful and challenging situation, it is important to have multiple options for management. This simple mattress suture technique normalizes the lens-iris complex behaviour and appears safe for the donor graft.

Exploratory behavior is associated with plasma carotenoid accumulation in two congeneric species of waterfowl.

Recently, carotenoid pigments have received considerable attention as modulators of animal health and performance. While studies show that elevated carotenoid intake and accumulation can influence activities like parental care and escape-flight performance, little is known of how carotenoid status influences the expression of animal personality traits, which can be energy-demanding and entail survival costs but also rewarding in the context of foraging and mating. We experimentally investigated the effects of carotenoid availability on exploratory behavior and activity level, using adult males and females of two species of waterfowl: mallard (Anas platyrhynchos) and northern pintail (Anas acuta). We assessed behavior using a novel-environment test designed to measure an individual's response to novel objects and a potential predator threat (fox urine scent). We found that carotenoid availability was positively associated with some aspects of exploratory behavior: birds with higher concentrations of circulating carotenoids entered the test arena sooner and approached and entered predator-scented bedding material more frequently than birds with low carotenoid concentrations. These results suggest that the availability of carotenoid resources can influence personality traits in waterfowl, and we discuss putative physiological mechanisms underlying this effect.