Impact of Microplastics on the Ocular Surface.

Plastics are synthetic materials made from organic polymers that are ubiquitous in daily living and are especially important in the healthcare setting. However, recent advances have revealed the pervasive nature of microplastics, which are formed by degradation of existing plastic products. Although the impact on human health has yet to be fully characterised, there is increasing evidence that microplastics can trigger inflammatory damage, microbial dysbiosis, and oxidative stress in humans. Although there are limited studies investigating their effect on the ocular surface, studies of microplastics on other organs provide some insights. The prevalence of plastic waste has also triggered public outcry, culminating in the development of legislation aimed at reducing microplastics in commercial products. We present a review outlining the possible sources of microplastics leading to ocular exposure, and analyse the possible mechanisms of ocular surface damage. Finally, we examine the utility and consequences of current legislation surrounding microplastic regulation.

Glaucoma drainage implant exposure: A review of aetiology, risks and repair considerations.

In recent years, there has been a paradigm shift in glaucoma surgical procedures. Glaucoma drainage implant (GDI) surgeries are being performed much more commonly. Thus, it is important for surgeons to be cognisant of potential complications and their management. Exposure of a GDI is a well-known complication, and prompt recognition and treatment are required to prevent endophthalmitis, a potentially blinding condition. In this review, we discuss the mechanisms and risk factors for GDI exposure, highlight important considerations for repair, and discuss repair techniques, with the aim of improving patient outcomes and minimising the risk of re-exposure.

The Management of Ocular Surface Squamous Neoplasia (OSSN).

The rise of primary topical monotherapy with chemotherapeutic drugs and immunomodulatory agents represents an increasing recognition of the medical management of ocular surface squamous neoplasia (OSSN), which may replace surgery as the standard of care in the future. Currently, there is no consensus regarding the best way to manage OSSN with no existing guidelines to date. This paper seeks to evaluate evidence surrounding available treatment modalities and proposes an approach to management. The approach will guide ophthalmologists in selecting the most appropriate treatment regime based on patient and disease factors to minimize treatment related morbidity and improve OSSN control. Further work can be done to validate this algorithm and to develop formal guidelines to direct the management of OSSN.

Polymicrobial versus monomicrobial keratitis: a retrospective comparative study.

OBJECTIVES: To compare the risk factors, clinical characteristics, microbiological profile, and treatment outcomes of polymicrobial versus monomicrobial keratitis. METHODS: In this retrospective comparative case series, eyes with polymicrobial and monomicrobial keratitis were identified from microbiological records at a tertiary academic referral center, from January 2002 to December 2010. Only culture positive cases were included. Eyes with infectious keratitis involving two or more pathogens were included in the polymicrobial group, whereas eyes infected solely by Pseudomonas aeruginosa were included in the monomicrobial group. Various parameters including demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed. RESULTS: Twenty-one eyes each with polymicrobial and monomicrobial keratitis were included in this study. The mean age of polymicrobial patients was significantly higher than monomicrobials. Use of contact lens was the commonest predisposing factor in both groups. Systemic (23.8%) and multiple (33.3%) risk factors were involved in eyes with polymicrobial keratitis only. The mean size of corneal infiltrates and mean duration for resolvement of infection were significantly greater in the polymicrobial group. Medical treatment was successful only in 80.9% eyes with polymicrobial keratitis, whereas all monomicrobial keratitis patients responded to it. A total of 44 organisms belonging to 18 species (bacteria = 13, fungi = 5) were isolated from the polymicrobial group. P. aeruginosa and Candida albicans were the most frequently isolated bacteria (n = 12) and fungi (n = 5), respectively. In the polymicrobial group, gram-negative organisms were most sensitive to gentamicin (87.8%), followed by ciprofloxacin (78.7%), whereas gram-positive organisms were 100% sensitive to ciprofloxacin and cefazolin. CONCLUSIONS: A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Contact lens usage was the most common risk factor in both groups. Size of corneal infiltrate is a fairly reliable indicator for suspecting polymicrobial keratitis. Prolonged course of the disease and decreased antibiotic sensitivity were the other notable features of polymicrobial keratitis.

Dupilumab-associated ocular manifestations: A review of clinical presentations and management.

Dupilumab is a first-in-class biologic approved by the European Medicines Agency and the US Food and Drug Administration for the treatment of multiple atopic diseases, including atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyposis. Since gaining traction as an effective treatment modality, multiple reports have highlighted the many ocular side effects associated with dupilumab usage. These range from mild diseases, such as conjunctivitis, dry eyes, and blepharitis, to more severe manifestations such as intraocular inflammation and cicatrizing conjunctivitis. The pathogenesis behind these manifestations remains controversial, but are likely multi-factorial. We review the current evidence surrounding ocular manifestations of dupilumab-associated disease and proposed treatments to provide an overview of this unique disease entity. With increasing usage of dupilumab, formal recommendations regarding the treatment of dupilumab-associated ocular disease are warranted to provide standardized clinical guidance. Furthermore, it is important for health care practitioners to remain abreast with existing literature to counsel and empower patients with the knowledge surrounding contemporary treatments for atopic diseases and their associated sideeffects.

Efficacy and Safety of Repeated Micropulse Transscleral Diode Cyclophotocoagulation in Advanced Glaucoma.

PRECIS: Repeat micropulse transscleral cyclophotocoagulation (MPTCP) has some benefit in lowering intraocular pressure (IOP). There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. AIM: This study aimed to determine the efficacy and safety of repeated MPTCP for an Asian population with refractory glaucoma. METHODS: This is a retrospective case series of 43 eyes (43 patients) with severe glaucoma which underwent repeated MPTCP. Baseline parameters were taken from the visit just before the second MPTCP session. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, without further glaucoma reoperation, and ≤3 total MPTCP episodes. The IOP, number of IOP-lowering medications, and best-corrected visual acuity were documented preoperatively and postoperatively. Postoperative complications were also analyzed. RESULTS: The mean age±SD was 57.4±18.2 years with a mean follow-up duration of 28.9±27.5 months. Neovascular glaucoma was the most common type of glaucoma [18 eyes (41.9%)]. The success rates at postoperative years 1, 2, and 3, and the latest follow-up were 36.4%, 42.9%, 32.0%, and 39.5%, respectively. The median survival time of repeat MPTCP was 4.6 months. Compared with the preoperative mean IOP (35.2±11.0 mm Hg), the mean IOP at postoperative years 1, 2, and 3, and latest follow-up, was 27.8±13.7 mm Hg (P=0.004), 27.4±12.4 (P=0.003), 31.8±13.2 (P=0.35), and 27.1±13.8 mm Hg (P=0.002), respectively. The mean number of IOP-lowering medications was reduced from 3.3±0.9 preoperatively to 2.8±1.3 at the final follow-up (P=0.007). Postoperative complications included prolonged hypotony [3 eyes (7.0%)] and phthisis bulbi [2 eyes (4.7%)]. CONCLUSION: Repeated MPTCP is at best moderately effective in lowering IOP for eyes with advanced glaucoma.

Clinical Efficacy and Safety Outcomes of Micropulse Transscleral Diode Cyclophotocoagulation in Patients With Advanced Glaucoma.

PRECIS: Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. AIM: The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma. METHODS: This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed. RESULTS: The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)]. CONCLUSION: Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.