Pub Date : 2023-09-25DOI: 10.1080/17469899.2023.2263170
Jae-Chiang Wong, Jordan Safran, Shahin Hallaj, Eric Shiuey, Connie Wu, Daniel Lee
ABSTRACTIntroduction Trabeculectomy (TB) with mitomycin C (MMC) is a mainstay of glaucoma surgery for intraocular pressure reduction and visual field preservation, but surgical outcomes are often limited by episcleral and subconjunctival fibrosis leading to intraocular pressure (IOP) spikes.Research Design and Methods Retrospective case series presents seven eyes at a tertiary glaucoma center where open bleb needling was performed in combination with a collagen matrix implant and MMC following failed TB due to excessive fibrosis.Results Seven eyes of seven patients were included. Baseline IOP was 23.9 (±7.4) mmHg with a significant decrease on post-operative (post-op) day 1 to 4.6 mmHg. By post-op month 1, all eyes maintained a non-hypotonus IOP ≥ 5. Notably, four eyes (57%) had at least 1 unsuccessful open bleb needling without a collagen matrix implant prior. All eyes were complication-free by the latest visit without any complication-related visual decline, and six eyes (86%) were glaucoma medication-free at the most-recent post-op follow-up (12.4 ± 11.4 months). All cases were performed by one experienced glaucoma subspecialist (author DL).Conclusions Open bleb needling and MMC in combination with a collagen matrix implant may result in improved and sustained IOP control for encapsulated blebs following failed trabeculectomy, especially in those with prior unsuccessful bleb revisions.KEYWORDS: Ologenglaucomacollagen matrixbleb revisionfailed trabeculectomy Author contributionsAll authors made significant contributions to the research design and to the preparation of the manuscript. J.C. Wong, J. Safran, S. Hallaj and D. Lee were responsible for the execution of the research and data acquisition. J.C. Wong was responsible for the data analysis and interpretation.Declaration of interestD. Lee has received research support from Allergan, Equinox, Glaukos, Mati, Nicox, Olleyes, and Santan, lecture fees from Glaukos, and consulting fees from Quidel Eye Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.
摘要:小梁切除术(TB)联合丝裂霉素C (MMC)是青光眼手术中降低眼压和保护视野的主要方法，但手术结果往往受到导致眼压(IOP)峰值的膜外和结膜下纤维化的限制。研究设计和方法回顾性病例系列介绍了三期青光眼中心的7只眼睛，在由于过度纤维化导致结核病失败后，开放水泡针刺联合胶原基质植入和MMC。结果7例患者共7只眼。基线IOP为23.9(±7.4)mmHg，术后第1天显著下降至4.6 mmHg。术后1个月，所有眼保持非低张力IOP≥5。值得注意的是，有4只眼睛(57%)在没有胶原基质植入的情况下至少有1次不成功的开泡穿刺。术后随访(12.4±11.4个月)6只眼(86%)无青光眼药物治疗。所有病例均由一位经验丰富的青光眼专科医生(作者DL)进行手术。结论开放泡针和MMC联合胶原基质植入可改善小梁切除术失败后包裹性泡的IOP控制，特别是对先前不成功的泡修复患者。关键词:骨胶原青光眼胶原基质;修改;小梁切除术失败;作者贡献所有作者在研究设计和论文准备中都做出了重要贡献。J.C. Wong, J. Safran, S. Hallaj和D. Lee负责研究和数据采集的执行。J.C. Wong负责数据分析和解释。利益申报Lee获得了Allergan、Equinox、Glaukos、Mati、Nicox、Olleyes和Santan的研究支持，Glaukos的讲话费和Quidel Eye Health的咨询费。除了披露的内容外，作者与任何组织或实体没有其他相关关系或财务参与，这些组织或实体与稿件中讨论的主题或材料有经济利益或经济冲突。审稿人披露本文的每位审稿人没有相关的财务或其他关系需要披露。本文未获得资助。
{"title":"Clinical outcomes of collagen matrix as adjuvant to open bleb revision with mitomycin C following failed trabeculectomy","authors":"Jae-Chiang Wong, Jordan Safran, Shahin Hallaj, Eric Shiuey, Connie Wu, Daniel Lee","doi":"10.1080/17469899.2023.2263170","DOIUrl":"https://doi.org/10.1080/17469899.2023.2263170","url":null,"abstract":"ABSTRACTIntroduction Trabeculectomy (TB) with mitomycin C (MMC) is a mainstay of glaucoma surgery for intraocular pressure reduction and visual field preservation, but surgical outcomes are often limited by episcleral and subconjunctival fibrosis leading to intraocular pressure (IOP) spikes.Research Design and Methods Retrospective case series presents seven eyes at a tertiary glaucoma center where open bleb needling was performed in combination with a collagen matrix implant and MMC following failed TB due to excessive fibrosis.Results Seven eyes of seven patients were included. Baseline IOP was 23.9 (±7.4) mmHg with a significant decrease on post-operative (post-op) day 1 to 4.6 mmHg. By post-op month 1, all eyes maintained a non-hypotonus IOP ≥ 5. Notably, four eyes (57%) had at least 1 unsuccessful open bleb needling without a collagen matrix implant prior. All eyes were complication-free by the latest visit without any complication-related visual decline, and six eyes (86%) were glaucoma medication-free at the most-recent post-op follow-up (12.4 ± 11.4 months). All cases were performed by one experienced glaucoma subspecialist (author DL).Conclusions Open bleb needling and MMC in combination with a collagen matrix implant may result in improved and sustained IOP control for encapsulated blebs following failed trabeculectomy, especially in those with prior unsuccessful bleb revisions.KEYWORDS: Ologenglaucomacollagen matrixbleb revisionfailed trabeculectomy Author contributionsAll authors made significant contributions to the research design and to the preparation of the manuscript. J.C. Wong, J. Safran, S. Hallaj and D. Lee were responsible for the execution of the research and data acquisition. J.C. Wong was responsible for the data analysis and interpretation.Declaration of interestD. Lee has received research support from Allergan, Equinox, Glaukos, Mati, Nicox, Olleyes, and Santan, lecture fees from Glaukos, and consulting fees from Quidel Eye Health. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Additional informationFundingThis paper was not funded.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135816186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-22DOI: 10.1080/17469899.2023.2262766
Alex Hui
{"title":"Antibiotic releasing contact lenses: the future of treatment for corneal infection and injury?","authors":"Alex Hui","doi":"10.1080/17469899.2023.2262766","DOIUrl":"https://doi.org/10.1080/17469899.2023.2262766","url":null,"abstract":"","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136060807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.1080/17469899.2023.2259613
Charles W McMonnies
ABSTRACTIntroduction Dryness symptoms in soft contact lens (SCL) wearers are common, especially at the end of the day, and are the most common reason for discontinuing wear.Areas covered With references to mechanisms for dry eye syndromes in non-SCL wearers, this review examines mechanisms whereby dryness symptoms are generated during SCL wear, including the significance of endogenous tear dysfunctions, pre-lens tear film instability, post-lens tear film volumes and stagnation, tear hyperosmolarity, blink inefficiency, SCL material dehydration, and front surface biocompatibility and wetness.Expert opinion Numerous efforts have been made to reduce dryness symptoms by improving SCL materials and surfaces, but the prevalence of dryness symptoms remains stubbornly high. It is possible that symptoms might be due to neuropathy and associated increases in corneal and/or lid wiper sensitivity that develops during SCL wear. For example, over time sensory thresholds for SCL awareness may be lowered and/or conditions that increase their perception sharpened. There are several mechanisms for contributions to thinner pre-lens tear films and reduced SCL biocompatibility. Dryness symptoms may occur with bandage SCL, perhaps especially in a previous wearer of SCL.KEYWORDS: Dry eyecontact lensOcular surfaceCorneaTearssymptomsDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestsThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Article highlightsEvidence does not support the expectation that the division of the pre-corneal tear film into two layers by a SCL is a contributor to subsequent quantitative or qualitative aqueous, lipid or mucus deficiency and the risk of lens dehydration.Any SCL-related reduction in aqueous production, combined with increased rates of aqueous loss by evaporation (shorter TBUT), could explain lower tear meniscus heights during SCL wear.Insulation of the cornea from normal atmospheric blink stimuli by a SCL may contribute to aqueous production deficiency and/or blink inefficiency, with associated increased lens drying. For example, corneal insulation from blink stimuli such as exposure to air movement, dust and po
{"title":"Mechanisms for the symptoms of dryness in soft contact lens wearers","authors":"Charles W McMonnies","doi":"10.1080/17469899.2023.2259613","DOIUrl":"https://doi.org/10.1080/17469899.2023.2259613","url":null,"abstract":"ABSTRACTIntroduction Dryness symptoms in soft contact lens (SCL) wearers are common, especially at the end of the day, and are the most common reason for discontinuing wear.Areas covered With references to mechanisms for dry eye syndromes in non-SCL wearers, this review examines mechanisms whereby dryness symptoms are generated during SCL wear, including the significance of endogenous tear dysfunctions, pre-lens tear film instability, post-lens tear film volumes and stagnation, tear hyperosmolarity, blink inefficiency, SCL material dehydration, and front surface biocompatibility and wetness.Expert opinion Numerous efforts have been made to reduce dryness symptoms by improving SCL materials and surfaces, but the prevalence of dryness symptoms remains stubbornly high. It is possible that symptoms might be due to neuropathy and associated increases in corneal and/or lid wiper sensitivity that develops during SCL wear. For example, over time sensory thresholds for SCL awareness may be lowered and/or conditions that increase their perception sharpened. There are several mechanisms for contributions to thinner pre-lens tear films and reduced SCL biocompatibility. Dryness symptoms may occur with bandage SCL, perhaps especially in a previous wearer of SCL.KEYWORDS: Dry eyecontact lensOcular surfaceCorneaTearssymptomsDisclaimerAs a service to authors and researchers we are providing this version of an accepted manuscript (AM). Copyediting, typesetting, and review of the resulting proofs will be undertaken on this manuscript before final publication of the Version of Record (VoR). During production and pre-press, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal relate to these versions also. Declaration of interestsThe author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.Reviewer disclosuresPeer reviewers on this manuscript have no relevant financial or other relationships to disclose.Article highlightsEvidence does not support the expectation that the division of the pre-corneal tear film into two layers by a SCL is a contributor to subsequent quantitative or qualitative aqueous, lipid or mucus deficiency and the risk of lens dehydration.Any SCL-related reduction in aqueous production, combined with increased rates of aqueous loss by evaporation (shorter TBUT), could explain lower tear meniscus heights during SCL wear.Insulation of the cornea from normal atmospheric blink stimuli by a SCL may contribute to aqueous production deficiency and/or blink inefficiency, with associated increased lens drying. For example, corneal insulation from blink stimuli such as exposure to air movement, dust and po","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134970228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-03DOI: 10.1080/17469899.2023.2267757
Steffani Krista Someda, Yasuhiro Takahashi
{"title":"Applications of three-dimensional printing technology in Oculoplastic and Orbital Surgery: updates and trends","authors":"Steffani Krista Someda, Yasuhiro Takahashi","doi":"10.1080/17469899.2023.2267757","DOIUrl":"https://doi.org/10.1080/17469899.2023.2267757","url":null,"abstract":"","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134949742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/17469899.2023.2255746
S. Handa, Hind Amin, Atul Arora, R. Agrawal, Vishali Gupta
ABSTRACT Introduction Ocular tuberculosis (OTB) is a significant cause of visual morbidity and can have varied clinical manifestations. Recent advances in imaging and molecular diagnostic methods have greatly improved our understanding of the disease process. We conducted a search of published articles related to the diagnosis of ocular tuberculosis as of December 2021. Keywords were used to search the databases. Databases that were searched included PubMed and Scopus. Areas covered This review highlights the role of novel imaging modalities including ultra-widefield fundus photography, widefield fluorescein angiography, widefield indocyanine green angiography, swept-source optical coherence tomography, and optical coherence tomography angiography in the diagnosis of OTB. Radiological, immunological, and molecular diagnostic methods and their role in diagnosis of OTB have been discussed as well. Expert opinion With recent advancements in imaging, radiological, immunological, and molecular diagnostic methods, it is now possible to diagnose and treat ocular tuberculosis with greater accuracy, resulting in better treatment outcomes.
{"title":"Advances in the diagnosis of ocular tuberculosis","authors":"S. Handa, Hind Amin, Atul Arora, R. Agrawal, Vishali Gupta","doi":"10.1080/17469899.2023.2255746","DOIUrl":"https://doi.org/10.1080/17469899.2023.2255746","url":null,"abstract":"ABSTRACT Introduction Ocular tuberculosis (OTB) is a significant cause of visual morbidity and can have varied clinical manifestations. Recent advances in imaging and molecular diagnostic methods have greatly improved our understanding of the disease process. We conducted a search of published articles related to the diagnosis of ocular tuberculosis as of December 2021. Keywords were used to search the databases. Databases that were searched included PubMed and Scopus. Areas covered This review highlights the role of novel imaging modalities including ultra-widefield fundus photography, widefield fluorescein angiography, widefield indocyanine green angiography, swept-source optical coherence tomography, and optical coherence tomography angiography in the diagnosis of OTB. Radiological, immunological, and molecular diagnostic methods and their role in diagnosis of OTB have been discussed as well. Expert opinion With recent advancements in imaging, radiological, immunological, and molecular diagnostic methods, it is now possible to diagnose and treat ocular tuberculosis with greater accuracy, resulting in better treatment outcomes.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41406189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/17469899.2023.2248393
R. Hess, B. Thompson
We live in an ever-increasing digital world, digital applications and diagnostics are part and parcel of everyday clinical practice, particularly in Ophthalmology. All previous digital applications have been directed to improving our diagnostic capabilities but now, for the first time there is a digital pill. This is not a digitally activated/tracked pharmaceutical [1], this is a digital treatment per se, one designed to recover visual function in later life that had been lost in childhood. The neural substrate for this is residual neural plasticity present after the early critical period for visual development. There appear to be two pathways, a bottom-up one that is reliant on the appropriate dichoptic stimulation [2] while the other is a top-down one from higher brain areas that involves attention [3–5]. Treatment efficacy depends on activation of both pathways and there is an important role for AI in ensuring that attention is fully engaged for the duration of the bottom-up stimulation which is administered on a videogaming platform suitable for engaging young children.
{"title":"Can artificial intelligence be used to improve the quality of vision in patients with amblyopia? The first digital pill in medicine administered under AI","authors":"R. Hess, B. Thompson","doi":"10.1080/17469899.2023.2248393","DOIUrl":"https://doi.org/10.1080/17469899.2023.2248393","url":null,"abstract":"We live in an ever-increasing digital world, digital applications and diagnostics are part and parcel of everyday clinical practice, particularly in Ophthalmology. All previous digital applications have been directed to improving our diagnostic capabilities but now, for the first time there is a digital pill. This is not a digitally activated/tracked pharmaceutical [1], this is a digital treatment per se, one designed to recover visual function in later life that had been lost in childhood. The neural substrate for this is residual neural plasticity present after the early critical period for visual development. There appear to be two pathways, a bottom-up one that is reliant on the appropriate dichoptic stimulation [2] while the other is a top-down one from higher brain areas that involves attention [3–5]. Treatment efficacy depends on activation of both pathways and there is an important role for AI in ensuring that attention is fully engaged for the duration of the bottom-up stimulation which is administered on a videogaming platform suitable for engaging young children.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49067560","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/17469899.2023.2258285
J. Aquavella, Esteban Santiago, J. Zavislan
The ‘Dry Eye’ definition has matured and evolved over time motivated by advances in technology, knowledge, and understanding of the disease. When TFOS DEWS first presented a definition in 2007, it was defined as a ‘multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface.’ In 2017, the same group added to the definition the concept of ‘loss of homeostasis of the tear film,’ ‘hyperosmolarity,’ ‘inflammation,’ and ‘neurosensory abnormalities.’ All these made a more complete definition of this complex and multifactorial condition [1]. In 2017, the Asia Dry Eye Society (ADES) describes and emphasizes the concept of ‘unstable tear film’ in their definition of dry eye creating a simpler classification oriented to creating a simpler diagnosis and management of these patients [2]. Nowadays, thanks to proliferative research and hard work of different societies to try to bring clarity to a disorder with a high level of complexity, the multifactorial characteristic of Dry Eye Disease is better understood, as is the concept of the lacrimal functional unit (LFU) and its role in the production and maintenance of a healthy ocular surface tear film [3,4].
{"title":"Advances in dry eye","authors":"J. Aquavella, Esteban Santiago, J. Zavislan","doi":"10.1080/17469899.2023.2258285","DOIUrl":"https://doi.org/10.1080/17469899.2023.2258285","url":null,"abstract":"The ‘Dry Eye’ definition has matured and evolved over time motivated by advances in technology, knowledge, and understanding of the disease. When TFOS DEWS first presented a definition in 2007, it was defined as a ‘multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance and tear film instability with potential damage to the ocular surface.’ In 2017, the same group added to the definition the concept of ‘loss of homeostasis of the tear film,’ ‘hyperosmolarity,’ ‘inflammation,’ and ‘neurosensory abnormalities.’ All these made a more complete definition of this complex and multifactorial condition [1]. In 2017, the Asia Dry Eye Society (ADES) describes and emphasizes the concept of ‘unstable tear film’ in their definition of dry eye creating a simpler classification oriented to creating a simpler diagnosis and management of these patients [2]. Nowadays, thanks to proliferative research and hard work of different societies to try to bring clarity to a disorder with a high level of complexity, the multifactorial characteristic of Dry Eye Disease is better understood, as is the concept of the lacrimal functional unit (LFU) and its role in the production and maintenance of a healthy ocular surface tear film [3,4].","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/17469899.2023.2258284
D. Shukla, Jay Kalliath, A. Dhawan
ABSTRACT Introduction Although we have been familiar with optic disc pits for a long time, the diagnosis and management of maculopathy remain unclear. Better imaging has improved the diagnosis of this subtle pathology. A recent update on the natural history of optic pit maculopathy marks a paradigm shift in the understanding and management of this condition. There is renewed scope for non-surgical management and less urgency for vitrectomy, which remains the definitive treatment. Areas covered This perspective highlights and critiques the updates on diagnostic imaging, natural history, indications and prognosis for surgery, non-surgical alternatives, and surgical adjuncts. We searched the Medline database using the keywords optic pit AND maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the salient articles. Expert commentary There has been no major change in the surgical options and outcomes for optic pit maculopathy in recent times, except a greater clarity on the role of vitrectomy without any adjuvants as the primary surgical procedure. The key updates are on better imaging for diagnosis and prognosis, and less urgency for surgery in view of the favorable natural history.
{"title":"Current advances in the management of optic disc pit maculopathy","authors":"D. Shukla, Jay Kalliath, A. Dhawan","doi":"10.1080/17469899.2023.2258284","DOIUrl":"https://doi.org/10.1080/17469899.2023.2258284","url":null,"abstract":"ABSTRACT Introduction Although we have been familiar with optic disc pits for a long time, the diagnosis and management of maculopathy remain unclear. Better imaging has improved the diagnosis of this subtle pathology. A recent update on the natural history of optic pit maculopathy marks a paradigm shift in the understanding and management of this condition. There is renewed scope for non-surgical management and less urgency for vitrectomy, which remains the definitive treatment. Areas covered This perspective highlights and critiques the updates on diagnostic imaging, natural history, indications and prognosis for surgery, non-surgical alternatives, and surgical adjuncts. We searched the Medline database using the keywords optic pit AND maculopathy, optic pit AND macular schisis, optic pit AND macular detachment; optic pit AND vitrectomy, optic pit AND laser photocoagulation, and included the salient articles. Expert commentary There has been no major change in the surgical options and outcomes for optic pit maculopathy in recent times, except a greater clarity on the role of vitrectomy without any adjuvants as the primary surgical procedure. The key updates are on better imaging for diagnosis and prognosis, and less urgency for surgery in view of the favorable natural history.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/17469899.2023.2258279
Giulia Coco, A. Taloni, V. Scorcia, G. Giannaccare
ABSTRACT Introduction Dry eye disease (DED) is a very common ocular condition with a considerable socioeconomic impact affecting patient’s visual function and quality of life. Currently, thanks to the better knowledge on DED pathophysiology, therapeutical approaches are focused on the primary core mechanisms of DED. Furthermore, new drugs and compounds are being explored in the light of recent findings concerning unique disease-related pathways. The purpose of this review is to stress DED pathogenesis, addressing its vicious cycle, and highlighting the cutting-edge drug therapy approaches under development. Areas covered A literature search on the PubMed and Scopus databases was carried out. The database search strategy was formulated around the term ‘dry eye disease’ and other terms regarding its pathophysiology and therapeutic strategy. Additional search was conducted on ClinicalTrials.gov for unpublished results and ongoing clinical trials. Expert opinion The primary approaches used for DED include lifestyle, environmental changes, tears supplementation, and control of the eyelids and ocular surface inflammation. In selected cases, medical therapy could benefit by technological device-based management. Due to the complexity of DED and the continuous growth of disease prevalence and patients’ unmet needs, new therapeutic approaches focused on its pathogenesis are currently under investigation, while others are pending approval.
{"title":"The vicious cycle of dry eye disease: a look into promising novel drug therapies","authors":"Giulia Coco, A. Taloni, V. Scorcia, G. Giannaccare","doi":"10.1080/17469899.2023.2258279","DOIUrl":"https://doi.org/10.1080/17469899.2023.2258279","url":null,"abstract":"ABSTRACT Introduction Dry eye disease (DED) is a very common ocular condition with a considerable socioeconomic impact affecting patient’s visual function and quality of life. Currently, thanks to the better knowledge on DED pathophysiology, therapeutical approaches are focused on the primary core mechanisms of DED. Furthermore, new drugs and compounds are being explored in the light of recent findings concerning unique disease-related pathways. The purpose of this review is to stress DED pathogenesis, addressing its vicious cycle, and highlighting the cutting-edge drug therapy approaches under development. Areas covered A literature search on the PubMed and Scopus databases was carried out. The database search strategy was formulated around the term ‘dry eye disease’ and other terms regarding its pathophysiology and therapeutic strategy. Additional search was conducted on ClinicalTrials.gov for unpublished results and ongoing clinical trials. Expert opinion The primary approaches used for DED include lifestyle, environmental changes, tears supplementation, and control of the eyelids and ocular surface inflammation. In selected cases, medical therapy could benefit by technological device-based management. Due to the complexity of DED and the continuous growth of disease prevalence and patients’ unmet needs, new therapeutic approaches focused on its pathogenesis are currently under investigation, while others are pending approval.","PeriodicalId":39989,"journal":{"name":"Expert Review of Ophthalmology","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139363080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-07-04DOI: 10.1080/17469899.2023.2258283
S. A. Schellini
The congenital absence or the acquired loss of an eye or its content causes a functional deficit and facial deformity that is also associated with poor psychological outcomes. The main goal of the treatment is to restore the appearance, and for that, it is mandatory to replace the volume of the lost eye, usually by a combination of orbital implants (OI) and external ocular prostheses (EOP) Figure 1. Symmetry, satisfactory eyelid and eyelid closure, adequate orbital volume, and motility of the EOP are the main issues to be addressed [1]. This is a complex topic that requires an understanding of the anatomy of the eyelids, fornices, and orbit as well as a thorough understanding of the associated surgical techniques and disposable OIs. Optimal collaboration between ophthalmologists and ocularists using customized EOP, patient/parental motivation, and long-term follow-up adherence are the keys to achieving success.
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