Pub Date : 2022-01-01DOI: 10.17925/usor.2022.16.1.17
Amit Biran, A. Loewenstein, D. Mezad-Koursh, Matias Iglicki, Dinah Zur
COVID-19 restrictions have increased the need and use of telemedicine in ophthalmology but this approach requires remote data collection and reliable technologies to ensure accurate and safe examination and diagnosis. This article reviews the existing telemedicine technologies for age-related macular degeneration (AMD), diabetic retinopathy (DR) and paediatric ophthalmology, and discusses their applicability in the COVID-19 era. We conducted a literature search of PubMed using telemedicine keywords for all relevant pathologies (AMD, DR and paediatric ophthalmology) to identify English-language articles published between 2001 and 2021. We assessed whether existing telemedicine technologies would meet the needs of patients under COVID-19 restrictions. Our findings showed that there are reliable existing home-monitoring technologies. However, self-operated home optical coherence tomography is still an investigational technology for AMD monitoring and is not yet available for routine use. Computerized algorithms aimed at identifying DR pathology and or deterioration in relevant parameters under investigation have shown excellent results. In paediatric ophthalmology, parents can conduct basic testing of their child's ophthalmic parameters; improvements in parental testing will require the development of quick and reliable automatic instruments. In conclusion, current technologies lend themselves to remote use for ophthalmic examination by non-professional individuals, which is particularly relevant for ophthalmic care provision in the pandemic setting. Further investigative effort is needed in order to improve home monitoring and computerized data processing.
{"title":"Ophthalmic Telemedicine in the Pandemic–Endemic World: Present and Future Perspectives","authors":"Amit Biran, A. Loewenstein, D. Mezad-Koursh, Matias Iglicki, Dinah Zur","doi":"10.17925/usor.2022.16.1.17","DOIUrl":"https://doi.org/10.17925/usor.2022.16.1.17","url":null,"abstract":"COVID-19 restrictions have increased the need and use of telemedicine in ophthalmology but this approach requires remote data collection and reliable technologies to ensure accurate and safe examination and diagnosis. This article reviews the existing telemedicine technologies for age-related macular degeneration (AMD), diabetic retinopathy (DR) and paediatric ophthalmology, and discusses their applicability in the COVID-19 era. We conducted a literature search of PubMed using telemedicine keywords for all relevant pathologies (AMD, DR and paediatric ophthalmology) to identify English-language articles published between 2001 and 2021. We assessed whether existing telemedicine technologies would meet the needs of patients under COVID-19 restrictions. Our findings showed that there are reliable existing home-monitoring technologies. However, self-operated home optical coherence tomography is still an investigational technology for AMD monitoring and is not yet available for routine use. Computerized algorithms aimed at identifying DR pathology and or deterioration in relevant parameters under investigation have shown excellent results. In paediatric ophthalmology, parents can conduct basic testing of their child's ophthalmic parameters; improvements in parental testing will require the development of quick and reliable automatic instruments. In conclusion, current technologies lend themselves to remote use for ophthalmic examination by non-professional individuals, which is particularly relevant for ophthalmic care provision in the pandemic setting. Further investigative effort is needed in order to improve home monitoring and computerized data processing.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622430","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 : 2022-01-01DOI: 10.17925/usor.2022.16.2.50
N. Alpins, George Stamatelatos
Perfecting the treatment of regular and irregular astigmatism using laser-assisted in situ keratomileusis, photorefractive keratectomy, and small in situ lenticule extraction is possible by reducing and regularizing the asymmetric, non-orthogonal corneal shape while correcting spherical refractive error. Such perfecting treatment may be achieved by conceptually dividing the cornea into two hemidivisions and applying vector planning to optimally customize each half of the cornea to the minimum regular astigmatism possible. This innovative treatment could improve best-corrected visual acuity and minimize aberrations.
{"title":"Perfecting Laser Treatment for Regular and Irregular Astigmatism","authors":"N. Alpins, George Stamatelatos","doi":"10.17925/usor.2022.16.2.50","DOIUrl":"https://doi.org/10.17925/usor.2022.16.2.50","url":null,"abstract":"Perfecting the treatment of regular and irregular astigmatism using laser-assisted in situ keratomileusis, photorefractive keratectomy, and small in situ lenticule extraction is possible by reducing and regularizing the asymmetric, non-orthogonal corneal shape while correcting spherical refractive error. Such perfecting treatment may be achieved by conceptually dividing the cornea into two hemidivisions and applying vector planning to optimally customize each half of the cornea to the minimum regular astigmatism possible. This innovative treatment could improve best-corrected visual acuity and minimize aberrations.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622181","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 : 2022-01-01DOI: 10.17925/usor.2022.16.1.36
Tyler M Ewing, Hannah Khan, A. L. Wadsworth, Jordyn Vannavong, A. Khanani
Geographic atrophy (GA) secondary to age-related macular degeneration is the leading cause of permanent vision loss in patients over the age of 50 in developed countries. GA is characterized by the atrophy of retinal pigment epithelium and photoreceptors and can lead to central or peripheral vision loss, depending on the location of the atrophy. Currently, there are no US Food and Drug Administration-approved treatments for GA. Avacincaptad pegol (Zimura®; IVERIC Bio Inc, New York, NY, USA) is a C5-specific inhibitor that is being investigated as a potential treatment for GA. C5 is a key protein within the complement system, which maintains retina integrity and health under normal conditions. It is hypothesized that unregulated activation of the complement system (indicated by elevated levels of active proteins such as the membrane attack complex) can exacerbate the progression of GA. This article reviews the latest data regarding avacincaptad pegol as an investigational therapeutic for GA.
继发于年龄相关性黄斑变性的地理萎缩(GA)是发达国家50岁以上患者永久性视力丧失的主要原因。GA的特征是视网膜色素上皮和光感受器的萎缩，并可导致中央或周围视力丧失，这取决于萎缩的位置。目前，美国食品和药物管理局还没有批准治疗GA的药物。Avacincaptad pegol (Zimura®;IVERIC Bio Inc, New York, NY, USA)是一种c5特异性抑制剂，正在研究作为GA的潜在治疗方法。C5是补体系统中的关键蛋白，在正常情况下维持视网膜的完整性和健康。据推测，补体系统不受调节的激活(由活性蛋白如膜攻击复合物水平升高所表明)可加剧GA的进展。本文回顾了关于avacincaptad pegol作为GA的实验性治疗的最新数据。
{"title":"Update on Avacincaptad Pegol for Geographic Atrophy","authors":"Tyler M Ewing, Hannah Khan, A. L. Wadsworth, Jordyn Vannavong, A. Khanani","doi":"10.17925/usor.2022.16.1.36","DOIUrl":"https://doi.org/10.17925/usor.2022.16.1.36","url":null,"abstract":"Geographic atrophy (GA) secondary to age-related macular degeneration is the leading cause of permanent vision loss in patients over the age of 50 in developed countries. GA is characterized by the atrophy of retinal pigment epithelium and photoreceptors and can lead to central or peripheral vision loss, depending on the location of the atrophy. Currently, there are no US Food and Drug Administration-approved treatments for GA. Avacincaptad pegol (Zimura®; IVERIC Bio Inc, New York, NY, USA) is a C5-specific inhibitor that is being investigated as a potential treatment for GA. C5 is a key protein within the complement system, which maintains retina integrity and health under normal conditions. It is hypothesized that unregulated activation of the complement system (indicated by elevated levels of active proteins such as the membrane attack complex) can exacerbate the progression of GA. This article reviews the latest data regarding avacincaptad pegol as an investigational therapeutic for GA.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622568","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 : 2022-01-01DOI: 10.17925/usor.2022.16.2.100
N. Kizor-Akaraiwe, Ifeoma N. Asimadu, N. Uche, S. Okeke, Obinna Shiweobi
Introduction: This study aimed to determine the awareness and uptake of surgery as a treatment option in patients with glaucoma on medical treatment. Methods: A cross-sectional survey was conducted among consenting patients with primary glaucoma who were on medical treatment. The survey was conducted in two eye care facilities (government-owned and private). After responding to a questionnaire, patients had ocular examinations, including visual acuity, anterior/posterior segment examinations, gonioscopy and central visual field testing. Information was obtained on the patients’ awareness of a surgical option, and reasons for non-uptake among those offered surgery were recorded. Logistic regression analysis was used to identify possible predictors of awareness of glaucoma. Results: Across both facilities, 299 patients with glaucoma with a mean age of 63.9 years participated in this study. There were 167 (55.9%) male and 132 (44.1%) female participants. Two hundred and sixty-seven (89.3%) had a formal education, and of the 169 evaluated for visual fields in the worse eye, 129 (76.3%) had severe (advanced) glaucoma. Only 79 (26.4%) of the participants were aware of surgery as a treatment option for glaucoma. The multivariate analysis found that female patients, patients from the private eye care facility and patients with primary angle closure glaucoma patients were more likely to be aware of glaucoma surgery than male patients, patients from the government-owned eye care facility and patients with primary open-angle glaucoma. Patients with primary angle closure glaucoma were more likely to be aware of glaucoma surgery than those with primary open-angle glaucoma. Cost was identified as the major barrier to the uptake of glaucoma surgery when it was recommended, followed by fear of blindness. Age, level of education and severity of disease had no statistical relationship to awareness of glaucoma surgery. Conclusion: Incorporating routine glaucoma education and counselling into glaucoma care protocols will likely improve awareness of glaucoma surgery as a treatment option.
{"title":"Cross-sectional Survey to Determine the Awareness and Uptake of Glaucoma Surgery","authors":"N. Kizor-Akaraiwe, Ifeoma N. Asimadu, N. Uche, S. Okeke, Obinna Shiweobi","doi":"10.17925/usor.2022.16.2.100","DOIUrl":"https://doi.org/10.17925/usor.2022.16.2.100","url":null,"abstract":"Introduction: This study aimed to determine the awareness and uptake of surgery as a treatment option in patients with glaucoma on medical treatment. Methods: A cross-sectional survey was conducted among consenting patients with primary glaucoma who were on medical treatment. The survey was conducted in two eye care facilities (government-owned and private). After responding to a questionnaire, patients had ocular examinations, including visual acuity, anterior/posterior segment examinations, gonioscopy and central visual field testing. Information was obtained on the patients’ awareness of a surgical option, and reasons for non-uptake among those offered surgery were recorded. Logistic regression analysis was used to identify possible predictors of awareness of glaucoma. Results: Across both facilities, 299 patients with glaucoma with a mean age of 63.9 years participated in this study. There were 167 (55.9%) male and 132 (44.1%) female participants. Two hundred and sixty-seven (89.3%) had a formal education, and of the 169 evaluated for visual fields in the worse eye, 129 (76.3%) had severe (advanced) glaucoma. Only 79 (26.4%) of the participants were aware of surgery as a treatment option for glaucoma. The multivariate analysis found that female patients, patients from the private eye care facility and patients with primary angle closure glaucoma patients were more likely to be aware of glaucoma surgery than male patients, patients from the government-owned eye care facility and patients with primary open-angle glaucoma. Patients with primary angle closure glaucoma were more likely to be aware of glaucoma surgery than those with primary open-angle glaucoma. Cost was identified as the major barrier to the uptake of glaucoma surgery when it was recommended, followed by fear of blindness. Age, level of education and severity of disease had no statistical relationship to awareness of glaucoma surgery. Conclusion: Incorporating routine glaucoma education and counselling into glaucoma care protocols will likely improve awareness of glaucoma surgery as a treatment option.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622169","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 : 2022-01-01DOI: 10.17925/usor.2022.16.2.67
Nicole Weber Duncan, Kourtney H. Houser, Sumitra S. Khandelwal
Impairment in trigeminal nerve function causes a loss of corneal sensation and can lead to neurotrophic keratitis (NK). This gradual deterioration in the surface integrity of the cornea predisposes to the development of ulcers and may even progress to perforation, posing a risk for profound vision loss. Many common ophthalmic and systemic conditions, such as herpetic infections, ocular surgeries, neurosurgical procedures, multiple sclerosis and diabetes, can elicit NK by injuring the trigeminal nerve. Disease progression can occur rapidly and without symptoms, therefore, detecting NK early is critical. Management aims to halt continuing corneal damage and promote epithelial cell healing and nerve fibre regeneration. Novel treatment options show promise in restoring corneal sensitivity by re-establishing innervation, targeting the fundamental source of NK.
{"title":"Neurotrophic Keratitis: A Review","authors":"Nicole Weber Duncan, Kourtney H. Houser, Sumitra S. Khandelwal","doi":"10.17925/usor.2022.16.2.67","DOIUrl":"https://doi.org/10.17925/usor.2022.16.2.67","url":null,"abstract":"Impairment in trigeminal nerve function causes a loss of corneal sensation and can lead to neurotrophic keratitis (NK). This gradual deterioration in the surface integrity of the cornea predisposes to the development of ulcers and may even progress to perforation, posing a risk for profound vision loss. Many common ophthalmic and systemic conditions, such as herpetic infections, ocular surgeries, neurosurgical procedures, multiple sclerosis and diabetes, can elicit NK by injuring the trigeminal nerve. Disease progression can occur rapidly and without symptoms, therefore, detecting NK early is critical. Management aims to halt continuing corneal damage and promote epithelial cell healing and nerve fibre regeneration. Novel treatment options show promise in restoring corneal sensitivity by re-establishing innervation, targeting the fundamental source of NK.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622276","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 : 2022-01-01DOI: 10.17925/usor.2022.16.2.80
Sruthi Arepalli
Multiple disorders, such as neovascular age-related macular degeneration, diabetic macular oedema and myopic choroidal neovascularization require anti-vascular endothelial growth factor treatments to preserve and improve vision. In the last few decades, a multitude of options has arisen allowing for the best possible results. While the success of these drugs has been indisputable, the expiration or pending expiration of their patents creates an avenue for biosimilar medications to enter the market. These biosimilars can be produced at a discount compared with the original medications, with the possibility of a lower economic burden. However, they do not undergo as rigorous an approval process as innovator medications, leaving concerns about the heterogeneity of their clinical profile or side effects. This review will focus on the available biosimilar treatments, as well as the clinical trials evaluating them.
{"title":"Ranibizumab Biosimilars for Neovascular Age-related Macular Degeneration, Macular Oedema with Retinal Vein Occlusion and Myopic Choroidal Neovascularization","authors":"Sruthi Arepalli","doi":"10.17925/usor.2022.16.2.80","DOIUrl":"https://doi.org/10.17925/usor.2022.16.2.80","url":null,"abstract":"Multiple disorders, such as neovascular age-related macular degeneration, diabetic macular oedema and myopic choroidal neovascularization require anti-vascular endothelial growth factor treatments to preserve and improve vision. In the last few decades, a multitude of options has arisen allowing for the best possible results. While the success of these drugs has been indisputable, the expiration or pending expiration of their patents creates an avenue for biosimilar medications to enter the market. These biosimilars can be produced at a discount compared with the original medications, with the possibility of a lower economic burden. However, they do not undergo as rigorous an approval process as innovator medications, leaving concerns about the heterogeneity of their clinical profile or side effects. This review will focus on the available biosimilar treatments, as well as the clinical trials evaluating them.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622333","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 : 2022-01-01DOI: 10.17925/usor.2022.16.1.42
C. C. Kwan, Christopher R. Dermarkarian, Sanja G Cypen, J. Kennedy, J. Tao
Blepharoptosis in acquired anophthalmia is common, yet the best treatment methods remain uncertain. We review the literature for descriptions of pathophysiology or management of blepharoptosis in acquired anophthalmic sockets and describe a technique and results of using a template prosthesis to facilitate intraoperative adjustment during external levator resection ptosis repair. The PubMed database was searched in October 2021 to identify all studies in English describing the pathophysiology or treatment of anophthalmic blepharoptosis. Seventy-one articles were identified; 13 met inclusion criteria and were reviewed. We also reviewed the charts of 12 adult patients with acquired anophthalmia undergoing external levator resection using a limbal templated, non-detailed, customshaped prosthesis. We assessed results (margin to reflex distance 1 [MRD1] and symmetry), as well as the number of eye prosthesis modifications. According to the literature, levator pathophysiology and orbital volume loss are important variables in anophthalmic ptosis. Prosthesis augmentation may be useful to treat ptosis in many instances, but may be limited by decreased motility and a poorer overall prosthesis fit. A variety of blepharoptosis repair surgical techniques have been described with reported success rates of 88–100%. The use of a template prosthesis to facilitate intraoperative lid positioning in ptosis repair was effective in 12 patients. All patients had MRD1 within 1 mm of target and with good facial symmetry. There were no complications or need for revision ptosis repair or redundancy in prosthesis fabrication at 3 years (mean; minimum 6-month) follow-up.
{"title":"Blepharoptosis in the Setting of an Ocular Prosthesis: A Literature Review and Description of the Novel Use of a Template Prosthesis","authors":"C. C. Kwan, Christopher R. Dermarkarian, Sanja G Cypen, J. Kennedy, J. Tao","doi":"10.17925/usor.2022.16.1.42","DOIUrl":"https://doi.org/10.17925/usor.2022.16.1.42","url":null,"abstract":"Blepharoptosis in acquired anophthalmia is common, yet the best treatment methods remain uncertain. We review the literature for descriptions of pathophysiology or management of blepharoptosis in acquired anophthalmic sockets and describe a technique and results of using a template prosthesis to facilitate intraoperative adjustment during external levator resection ptosis repair. The PubMed database was searched in October 2021 to identify all studies in English describing the pathophysiology or treatment of anophthalmic blepharoptosis. Seventy-one articles were identified; 13 met inclusion criteria and were reviewed. We also reviewed the charts of 12 adult patients with acquired anophthalmia undergoing external levator resection using a limbal templated, non-detailed, customshaped prosthesis. We assessed results (margin to reflex distance 1 [MRD1] and symmetry), as well as the number of eye prosthesis modifications. According to the literature, levator pathophysiology and orbital volume loss are important variables in anophthalmic ptosis. Prosthesis augmentation may be useful to treat ptosis in many instances, but may be limited by decreased motility and a poorer overall prosthesis fit. A variety of blepharoptosis repair surgical techniques have been described with reported success rates of 88–100%. The use of a template prosthesis to facilitate intraoperative lid positioning in ptosis repair was effective in 12 patients. All patients had MRD1 within 1 mm of target and with good facial symmetry. There were no complications or need for revision ptosis repair or redundancy in prosthesis fabrication at 3 years (mean; minimum 6-month) follow-up.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622586","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 : 2022-01-01DOI: 10.17925/usor.2022.16.1.46
Matthew J. McSoley, T. C. Chang, S. Wellik
We describe two cases of Descemet membrane detachment (DMD) as a complication of gonioscopy-assisted transluminal trabeculotomy (GATT). The two patients had a history of retinal vein occlusions, subsequent intravitreal anti-vascular endothelial growth factor injections and uncontrolled intraocular pressures. They underwent ab-interno canaloplasty with 360-degree GATT without any intraoperative complications. In each case, DMD was noted on post-operative day 1. Both detachments were observed for several weeks before reattachment occurred. These cases illustrate that DMD is a potential sight-threatening complication of GATT, although the exact mechanisms involved remain uncertain. We hypothesize that the DMD may occur during the viscodilation of the Schlemm canal or due to the cleavage plane being anterior to the trabecular meshwork.
{"title":"Descemet Membrane Detachment Following Ab-interno Canaloplasty with 360-degree Gonioscopy-assisted Transluminal Trabeculotomy: A Case Report","authors":"Matthew J. McSoley, T. C. Chang, S. Wellik","doi":"10.17925/usor.2022.16.1.46","DOIUrl":"https://doi.org/10.17925/usor.2022.16.1.46","url":null,"abstract":"We describe two cases of Descemet membrane detachment (DMD) as a complication of gonioscopy-assisted transluminal trabeculotomy (GATT). The two patients had a history of retinal vein occlusions, subsequent intravitreal anti-vascular endothelial growth factor injections and uncontrolled intraocular pressures. They underwent ab-interno canaloplasty with 360-degree GATT without any intraoperative complications. In each case, DMD was noted on post-operative day 1. Both detachments were observed for several weeks before reattachment occurred. These cases illustrate that DMD is a potential sight-threatening complication of GATT, although the exact mechanisms involved remain uncertain. We hypothesize that the DMD may occur during the viscodilation of the Schlemm canal or due to the cleavage plane being anterior to the trabecular meshwork.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622624","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 : 2022-01-01DOI: 10.17925/usor.2022.16.1.13
F. Hafezi, M. Hillen, L. Kollros, Nikki L. Hafezi, E. A. Torres-Netto
Corneal cross-linking (CXL) can halt ectasia progression and involves saturating the stroma with riboflavin, followed by ultraviolet-A (UV-A) light irradiation. This generates reactive oxygen species that covalently cross-link together stromal molecules, strengthening the cornea. The ‘Dresden protocol’ left a 70 µm uncross-linked region at the base of the stroma to protect the corneal endothelium from UV damage; however, this limited CXL to corneas ≥400 µm. Approaches made to overcome this limitation involved artificial corneal thickening to ≥400 μm through swelling the stroma with hypo-osmolaric riboflavin, applying riboflavin-soaked contact lenses during UV irradiation or leaving ‘epithelial islands’ over the thinnest corneal regions. The drawbacks to these three approaches are unpredictable swelling, suboptimal stiffening and unpredictable cross-linking effects, respectively. Newer approaches adapt the irradiation protocol to the cornea to deliver CXL that maintains the 70 μm uncross-linked stroma safety margin. The sub400 protocol employs an algorithm that models the interactions between UV-A energy, riboflavin, oxygen diffusion and stromal thickness. It requires only corneal pachymetry measurements at the thinnest point and the selection of the appropriate UV irradiation time from a look-up table to cross-link corneas as thin as 200 µm safely and effectively.
{"title":"Corneal Cross-linking in Thin Corneas: From Origins to State of the Art","authors":"F. Hafezi, M. Hillen, L. Kollros, Nikki L. Hafezi, E. A. Torres-Netto","doi":"10.17925/usor.2022.16.1.13","DOIUrl":"https://doi.org/10.17925/usor.2022.16.1.13","url":null,"abstract":"Corneal cross-linking (CXL) can halt ectasia progression and involves saturating the stroma with riboflavin, followed by ultraviolet-A (UV-A) light irradiation. This generates reactive oxygen species that covalently cross-link together stromal molecules, strengthening the cornea. The ‘Dresden protocol’ left a 70 µm uncross-linked region at the base of the stroma to protect the corneal endothelium from UV damage; however, this limited CXL to corneas ≥400 µm. Approaches made to overcome this limitation involved artificial corneal thickening to ≥400 μm through swelling the stroma with hypo-osmolaric riboflavin, applying riboflavin-soaked contact lenses during UV irradiation or leaving ‘epithelial islands’ over the thinnest corneal regions. The drawbacks to these three approaches are unpredictable swelling, suboptimal stiffening and unpredictable cross-linking effects, respectively. Newer approaches adapt the irradiation protocol to the cornea to deliver CXL that maintains the 70 μm uncross-linked stroma safety margin. The sub400 protocol employs an algorithm that models the interactions between UV-A energy, riboflavin, oxygen diffusion and stromal thickness. It requires only corneal pachymetry measurements at the thinnest point and the selection of the appropriate UV irradiation time from a look-up table to cross-link corneas as thin as 200 µm safely and effectively.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622374","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 : 2022-01-01DOI: 10.17925/usor.2022.16.1.22
S. Ahmad, Syed Mohammed Bilal, Anam Tariq, Aliya Rashid
Glaucoma is a multifactorial disorder caused by risk factors dependent on, as well as those independent of, intraocular pressure. Currently, the treatment of this condition is primarily lowering of intraocular pressure. However, despite achieving the apparent target pressure, some patients continue to deteriorate. As a result, other modalities such as complementary and alternative medicine are being increasingly used to manage patients with glaucoma. These approaches include modifications or supplementations in diet and lifestyle changes, such as exercise and cessation of smoking. The objective of this review is to assess how different diets can be useful or detrimental to the visual health of patients with glaucoma. It also aims to shed light on the effect of dietary intervention on the epidemiology of glaucoma.
{"title":"Dietary Intervention in Glaucoma","authors":"S. Ahmad, Syed Mohammed Bilal, Anam Tariq, Aliya Rashid","doi":"10.17925/usor.2022.16.1.22","DOIUrl":"https://doi.org/10.17925/usor.2022.16.1.22","url":null,"abstract":"Glaucoma is a multifactorial disorder caused by risk factors dependent on, as well as those independent of, intraocular pressure. Currently, the treatment of this condition is primarily lowering of intraocular pressure. However, despite achieving the apparent target pressure, some patients continue to deteriorate. As a result, other modalities such as complementary and alternative medicine are being increasingly used to manage patients with glaucoma. These approaches include modifications or supplementations in diet and lifestyle changes, such as exercise and cessation of smoking. The objective of this review is to assess how different diets can be useful or detrimental to the visual health of patients with glaucoma. It also aims to shed light on the effect of dietary intervention on the epidemiology of glaucoma.","PeriodicalId":90077,"journal":{"name":"US ophthalmic review","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67622511","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：