Limbal stem cell deficiency (LSCD) is a very challenging situation and difficult to manage. A great works and ideas were conducted over the past 50 years. Numerous surgical techniques were proposed. We are reporting more than a 20-year follow-up of a case of limbal autograft stem cell transplantation due to LSCD secondary to chemical injury.
Purpose: The purpose of the study was to evaluate the prevalence of various ocular manifestations in diagnosed cases of antiphospholipid syndrome (APS) in Jordan. It will also find the association of these manifestations with primary and secondary APS.
Methods: It was a retrospective cross-sectional study to analyze the ocular manifestations of APS in Jordan. Data of 90 cases were obtained from public hospitals from January 2018 to January 2021. There should have been at least two positive tests with a minimum of 12-week gap between them. The electronic data regarding Schirmer tests, examination of visual acuity (Snellen acuity), neuro-ophthalmic manifestations, dilated fundus examination for posterior eye segment manifestations, and slit-lamp examination for anterior eye segment were also recorded and analyzed. Using SPSS version 25, the frequency and percentages of the categorical data were computed. Pearson's Chi-square test was conducted to find the associations.
Results: Among 90 APS cases, 52 (58%) patients had primary APS and 38 (42%) had secondary APS. At the same time, systemic lupus erythematosus was diagnosed in 31 (34%) patients. Keratoconjunctivitis sicca (dry eyes), decreased vision, and retinal vasculitis were the most common manifestations observed.
Conclusion: The high prevalence of ocular manifestations warrants ophthalmologists to look for APS, as ocular manifestations could be the initial symptoms and/or signs of APS.
Purpose: Toxic anterior segment syndrome (TASS) is a noninfectious anterior chamber reaction caused by ocular surgeries. It usually develops within the first 12-48 h after surgery. In case of clinical suspicion of TASS, endophthalmitis as a devastating disease should always be excluded. However, the fact that TASS and endophthalmitis can look the same, but the treatment for each is different. Therefore, distinguishing between the two conditions is an important factor in coping with both diseases. It was aimed to describe the features and clinical management that are considered when distinguishing the cause of unexpected inflammatory response after cataract surgery.
Methods: A retrospective review of medical records of 13 patients who developed TASS in our clinic at Ege University Ophthalmology Department on three different days between July 2022 and December 2022 were included in this study. Anterior segment photographs of those 13 patients and the records of ophthalmological examinations of those patients, including best-corrected visual acuity (BCVA), ocular pressure, biomicroscopic, and fundoscopic examination, were collected. Medical data were evaluated retrospectively.
Results: The mean time to onset of clinical symptoms was 27.6 h. The main complaint was pain in nine patients. The primary symptom in the remainder of the patients was blurred vision. Severe hypopyon was seen in 5 cases. Despite the presence of pain and hypopyon, patients who were treated with topical steroids were closely followed up (every 2 h) because they were consecutive patients and had relatively acute onset complaints. Inflammation was regressed after an average of 4 h. No factor causing TASS was found. The BCVA was at the minimum level of 8/10 on the 5th day of surgery.
Conclusion: When distinguishing TASS from endophthalmitis, severe pain, relatively late onset, hyperemia, and the presence of severe hypopyon usually lead ophthalmologists to the clinical diagnosis of endophthalmitis. However, in this study, most of the patients diagnosed with TASS had severe pain, a significant portion of them had hypopyon, and the onset of the symptoms was relatively late. Close follow-up immediately after suspicion plays a vital role in clinical diagnosis and management accordingly.
Purpose: The purpose of this study was to evaluate the outcome of patients presenting with mild-to-moderate corneal haze after undergoing corneal collagen cross-linking (CXL) for keratoconus (KCN) and their response to a proposed standardized topical steroid-based treatment.
Methods: This study included 19 eyes of 14 patients presenting with corneal haze after undergoing CXL for KCN. Corrected distance visual acuity, corneal thickness and Kmax values by Pentacam® Scheimpflug tomography, as well as subjective corneal haze changes were evaluated before and after a topical steroid- and cyclosporine-based treatment.
Results: Visual acuity improved after the completion of the treatment by 0.043 logMAR (P = 0.017) and Kmax values decreased by 1.17D (P = 0.0024), while the corneal thinnest pachymetry remained stable. Data collected from the examiner's slit-lamp examination description revealed that seven eyes had a decrease in haze compared to 12 eyes with stable or no changes in the haze.
Conclusion: Our findings suggest an improvement in visual acuity and possible corneal flattening with decreasing Kmax after the completion of topical steroids with taper course treatment in patients suffering from corneal haze post-CXL. This paper also highlights the importance of postcross-linking anti-inflammatory treatment and close follow-up.
Purpose: The purpose of the study was to evaluate the corneal sensitivity and its quadrature variability in patients with diabetic neuropathy (DN) diagnosed with electromyography and to compare these results with age- and sex-matched healthy individuals.
Methods: The left eyes of 32 patients who applied for refraction or fundus examination and had a diagnosis of DN by electromyography in their medical history were included in this study. Corneal sensitivity was evaluated using the Cochet-Bonnet esthesiometer (Luneau, Paris) in five zones: central, nasal, superior, temporal, and inferior. The measurements of the patients were compared with the measurements of 32 age- and sex-matched healthy volunteers. Furthermore, the measurements of five corneal zones were compared with each other, and the level of correlation was investigated in each group.
Results: The central corneal sensitivity values were measured as 4.12 ± 1.04 (mm) and 5.92 ± 0.14 (mm) (P < 0.001). While the sensitivity values at the superior, inferior, nasal, and temporal quadrants were detected as 5.85 ± 0.21, 5.85 ± 0.26, 5.94 ± 0.13, 5.93 ± 0.13, and 5.92 ± 0.14 (mm) in the control group, it was measured as 3.67 ± 0.66, 3.67 ± 0.62, 3.67 ± 0.62, and 3.89 ± 0.73 (mm) in the DN group, respectively. The corneal sensitivity values were all found to be significantly lower in the DN group (P < 0.001 for all parameters) at all quadrants as well as the central cornea. Furthermore, a moderate positive correlation between all five zones in the control group and a very strong positive correlation in the DN group were found in terms of the corneal quadrature sensitivity.
Conclusion: The current study revealed a significant reduction in corneal sensitivity in patients with DN. In both the control group and DN group, all corneal zones showed positive correlations which show the consistency of the measurement in different quadratures. Evaluating corneal sensitivity with a Cochet-Bonnet esthesiometer might serve as a useful screening tool in detecting neuropathy development. By taking the necessary precautions, further damage can be prevented.
Purpose: The purpose of the study was to evaluate the efficacy and safety of systemic mycophenolate mofetil (MMF) treatment in ocular surface inflammatory diseases.
Methods: For this retrospective study, patients who were treated with systemic MMF for ocular surface inflammatory diseases between March 2020 and March 2022 were evaluated. Apart from demographic data, examination notes including MMF treatment indication and systemic side effect interrogation and routine laboratory examinations during drug treatment were extracted from the patient records. Detailed staging scores were performed according to the diagnosis including Foster and Mondino for ocular mucous membrane pemphigoid (MMP) and limbal stem cell deficiency scoring for limbal transplantation. For thorough evaluation, anterior segment pictures were used.
Results: Fourteen patients were enrolled to the study, with a mean age of 58 ± 12. MMP (6, 42.8%) and limbal allograft transplantation (6, 42.8%) constituted the main indications for the MMF treatment, followed by keratitis-ichthyosis-deafness (KID) syndrome (1, 7.2%) and Mooren's ulcer (1, 7.2%). Five of six patients with MMP regressed according to both staging systems. Only one remained stable which was evaluated as Stage 3. Furthermore, while all limbal transplant groups (6) stabilized and showed regression according to the individualized limbal stem cell deficiency staging system with no rejection during follow-up. Furthermore, patients with Mooren's ulcer and KID syndrome showed control of the inflammation and stabilization after MMF treatment. No significant systemic side effects apart from constipation and nausea (3) were observed in patients whose routine laboratory tests were stable throughout the follow-up.
Conclusion: MMF has the potential to be a valuable and safe systemic agent of first choice in the control of ocular surface inflammatory disorders, especially when topical treatment is not effective. With such studies, it is predicted that MMF may reach wider usage areas with the increase in its effectiveness and safety in its use for ocular surface inflammatory pathologies.
Purpose: Despite the human ocular surface being easily accessible, ocular drug delivery can be challenging. When applied improperly, topical medications, the most popular first-line treatment used to treat glaucoma, can have a very brief contact time with the ocular surface and may not have the desired therapeutic impact. Drug delivery devices are gadgets that can address some of these problems. This study aims to determine patients' opinions on ocular drug delivery devices used in the treatment of primary open-angle glaucoma (POAG).
Methods: A pretested interviewer-administered questionnaire was used in a cross-sectional study of 115 POAG patients recruited from outpatient clinics in two Nigerian tertiary health institutions. Participants were asked about their understanding and acceptance of five Ocular drug delivery systems (ODD), namely drug-emitting contact lenses (CL), punctual plugs, subconjunctival injections, intracameral implants, and trabecular meshwork micro-stents, for the treatment of POAG.
Results: Sixty (52.2%) participants, whose average age was 50 ± 9.8 years, were men. Self-pay was used for eye health treatments by 65% of participants. Of the participants, 68.7% admitted to using eye drops on their own. 57% of people were said to take their glaucoma medications consistently. CL and subconjunctival implants were seen to be most acceptable according to 39% and 30% of participants, respectively. Major factors determining the acceptability of ODD for POAG treatment were observed to be cost and effectiveness.
Conclusion: Patients in our cohort who are being treated for POAG have a fairly positive attitude towards ODD. The prospective use of these devices for POAG treatment in Nigeria will depend on their efficacy and cost, as well as how ophthalmologists will weigh ODD options.
Purpose: Knowledge of thyroid eye disease (TED) is based on predominantly Caucasian populations. To date, no studies in the United States examine the presentation in Black and Hispanic patients. The purpose of this study is to introduce the presentation of TED in two previously undescribed populations.
Methods: This is a retrospective, cross-sectional, chart review study of patients with TED at a tertiary center using the Strengthening the Reporting of Observational Studies in Epidemiology checklist. The main outcome measure for severity was the European Group on Graves' Orbitopathy 2016 Severity Scale.
Results: Of the 2905 charts reviewed, 99 met the inclusion criteria. The mean age was 51 (standard deviation 16) years with 78% women. Race was 49.4% Black, 39.1% Hispanic, 9.2% Caucasian, and 2.3% Asian. Smoking rates were 25% current smokers and 14% former smokers. Manifestations were proptosis (94% Hispanic and 91% Black), eyelid retraction (85% Hispanic and 79% Black), extraocular muscle (EOM) restriction (79% Hispanic and 63% Black), eyelid edema (41% Hispanic and 30% Black), chemosis (24% Hispanic and 14% Black), and optic neuropathy (18% Hispanic and 9% Black). Overall, disease severity was 22% mild, 65% moderate to severe, and 13% sight-threatening. Older patients had increased rates of optic neuropathy (P = 0.04). Younger patients had increased rates of proptosis (P = 0.02). Socioeconomic status was not associated with disease severity (P = 0.67).
Conclusion: Hispanic and Black patients with TED presented with higher than previously established rates of proptosis, EOM restriction, and optic neuropathy. Including research of different races broadens understanding of presentation and management, improving patient outcomes.
Purpose: Faculty development for procedural specialists is intended to improve clinical education and surgical/procedural skills. Despite challenging in under-resourced settings, this may be enhanced by developing international collaboration agreements and supported by online learning experiences. The Congolese Society of Ophthalmology and the International Council of Ophthalmology agreed to collaborate on implementing an online educational program to form a community of practice (CoP) of ophthalmologists educators and enhance competence in curriculum design and simulation-based education (SBE) on cataract surgery.
Methods: Ten Congolese ophthalmologists, faculty for the "Centre de Formation Ophthalmologique pour l'Afrique Centrale" (CFOACF), participated in a group-mentored 12-webinar modular program on curriculum design, in 2019. Considering the geo-social-cultural learning environment, we developed a curriculum framework incorporating social constructivism and experiential learning principles to facilitate the implementation of learning. Educational strategies included flipped, practice-based and social learning, group mentoring, and individual and collective reflection opportunities. A CoP was virtually nurtured using WhatsApp. Program evaluation relied on (a) feedback survey per module and 3 months upon conclusion, (b) individual declarative knowledge assessment, and (c) group assignment to test competence improvement.
Results: The CFOACF formed a virtual CoP, commented on an enjoyable opportunity to develop scholar teaching competence, expressed intention in systematically building educational curricula design that includes active learning strategies and effective feedback and showed individual learning and team-competence improvement.
Conclusion: This first iteration of our online faculty development program nurtured the formation of a CoP of ophthalmologists' educators and enabled to practice a scholar teaching approach, especially applied to SBE.
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