Journal of Current Ophthalmology
Volume:35 Issue: 1, Jan-Mar 2023

To review current evidence regarding the use of iris‑claw intraocular lens (IOL) in terms of its efficacy and safety in the population of pediatric ectopia lentis.

A comprehensive literature search of six electronic databases (PubMed‑NCBI, Medline‑OVID, Embase, Cochrane, Scopus, and Wiley) and secondary search through reference lists was conducted using keywords selected a priori. All primary studies on the use of iris‑claw in pediatric ectopia lentis that evaluated visual acuity (VA), complications, and endothelial cell density (ECD) were included and critically appraised using the Newcastle–Ottawa Scale.

Ten studies were eligible for inclusion with an overall sample size of 168 eyes of children with ectopia lentis, and the majority of studies evaluated anterior iris‑claw IOL. All studies reported improvement in postoperative VA. The most commonly reported complication across studies was IOL decentration. All studies reported decreasing ECD, and this was observed in both anterior and retropupillary iris‑claw IOL.

Current evidence shows that iris‑claw IOL is effective in terms of improving VA in pediatric ectopia lentis. Due to the lack of long‑term evidence of its safety in children, one must remain cautious regarding potential endothelial cell loss. Further high‑quality, interventional, long‑term studies are needed.

To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management.

This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle‑closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management.

This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned.

Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low‑dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short‑term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

To investigate the agreement between the Oculus and Metrovision perimeters in the visual field evaluation of glaucoma patients.

In this cross‑sectional study, 41 consecutive glaucoma patients were enrolled. After detailed clinical examinations, visual field testing was performed for all patients using the Oculus and Metrovision perimeters. The interval time between the two visual field examinations was 30 min.

A total of 22 participants were male (53.7%) and the mean ± standard deviation (SD) age was 58.6 ± 9.1 years. The absolute average of the mean deviation (MD) in the oculus perimeter (8.24 ± 4.92 dB) was higher compared to the Metrovision perimeter (4.02 ± 4.62; P < 0.001). This difference was also evident in the Bland–Altman graph. The loss variance (pattern SD) values of Oculus perimeter (28.58 ± 16.40) and Metrovision perimeter (28.10 ± 28.45) were not significantly different; although based on the Bland–Altman plots in the lower MDs, the agreement is better and the data dispersion is lower, and in the higher MDs, the agreement is lower. The parameters of four visual field quadrants were also compared and showed poor correlations (P < 0.001).

The Oculus and Metrovision perimeter devices have good agreement in lower MDs; however, they cannot be used interchangeably.

To evaluate the intraocular pressure (IOP)‑lowering effect and safety of selective laser trabeculoplasty (SLT) with same‑day cataract surgery which we named cataract surgery‑assisted selective laser trabeculoplasty (CAST) compared to conventional SLT and cataract surgery as standalone procedures.

Patients with primary open‑angle glaucoma and cataract were included in this prospective interventional study. All patients received either a CAST procedure, standard SLT, or standard cataract surgery. IOP was assessed at baseline and at months 1, 2, 3, and 6. Topical IOP‑lowering medication was canceled during the follow‑up if necessary.

Twenty‑nine, twenty‑seven, and thirty eyes received the CAST procedure, SLT, and standard cataract surgery, respectively. There was no statistically significant difference in age, male‑to‑female ratio, or baseline IOP between groups (P > 0.05). The mean IOP reduction at 6 months after the CAST procedure, SLT, and standard cataract surgery was −7.3 ± 3.8 mmHg, −3.8 ± 3.7 mmHg, and −0.7 ± 3.7 mmHg, respectively (P < 0.001). Eleven out of 29 (37.9%) and 5 out of 27 (18.5%) eyes achieved 30% reduction of IOP after the CAST procedure and SLT, respectively. No eyes achieved 30% reduction of IOP at the end of the follow‑up in cataract surgery group. The median number of IOP‑lowering medications cancelled after the CAST procedure was 1.0 (range, 0–3). No antiglaucoma medication was cancelled after SLT or cataract surgery. No adverse events were registered in patients who received the CAST procedure.

At 6‑month follow‑up, the CAST procedure had a significantly greater IOP‑lowering effect and reduction of topical antiglaucoma medication than SLT or cataract surgery alone.

To evaluate the rate of complications in resident‑performed phacoemulsification and influencing factors.

In this retrospective cohort study, the outcomes of cataract surgeries performed by 18 ophthalmology residents were analyzed. The outcome of first 80 phacoemulsification cataract surgeries (1440 cataract surgeries) performed by each resident were analyzed. Outcome measures included the rate of intraoperative capsular rupture requiring anterior vitrectomy, nucleus drop, and incomplete attempts at uncomplicated procedures. Changes in the rate of complications over the surgical training course were also assessed.

The most common surgical complications were capsular rupture (7.5%), followed by incomplete attempt(s) (5.9%), and nucleus drop (1.1%). Comparing the first 40 and second 40 surgeries, the rate of complications decreased as a function of surgeon experience in all resident cohorts. Greater theoretical skills and younger surgeon age were associated with a lower rate of intraoperative capsular rupture (hazard ratios = 1.421 and 1.481, respectively; P = 0.047 and P = 0.041, respectively). The use of antianxiety drugs and number of surgeries in the first 6 months demonstrated no predictive value for a lower rate of intraoperative complications (hazard ratios = 0.929 and 1.002; P = 0.711 and P = 0.745, respectively).

The use of antianxiety medication and more surgeries in the first 6 months did not decrease the rate of intraoperative complications of phacoemulsification, while improvement of theoretical skills may have increased the safety of resident‑performed cataract surgery.

To investigate the choroidal structure in keratoconic patients with different severity using the choroidal vascularity index (CVI) derived from image binarization on enhanced depth imaging optical coherence tomography scans (EDI‑OCT).

Sixty‑eight eyes from 34 keratoconus (KCN) patients and 72 eyes from 36 healthy subjects were recruited in this prospective, noninterventional, comparative cross‑sectional study. EDI‑OCT was employed to measure choroidal parameters, including choroidal thickness (CT), total choroidal area (TCA), luminal area, stromal area, and CVI.

Subfoveal CT was 354.6 ± 66.8 μm in the control group and 371 ± 64.5 μm in the KCN group (P = 0.86). There was no significant difference between control and KCN groups in terms of TCA (0.66 ± 0.14 mm2 vs. 0.7 ± 0.12 mm2; P = 0.70), luminal area (0.49 ± 0.10 mm2 vs. 0.53 ± 0.08 mm2; P = 0.67), and stromal area (0.16 ± 0.05 mm2 vs. 0.17 ± 0.05 mm2; P = 0.84). CVI was also comparable in the control group (75.4% ±3.4%) and the KCN group (75.6% ±4.5%; P = 0.43). There was also no significant correlation between other choroidal parameters and KCN severity indices.

It seems that CVI as well as other choroidal biomarkers were not significantly different between patients with KCN and healthy subjects.

To compare the intraocular lens (IOLs) power calculated with Haigis, Hoffer Q, Holladay 1, and SRK/T formulas between the IOLs Master 500 and Pentacam AXL according to the lens status.

In this cross‑sectional study, sampling was done in subjects above 60 years living in Tehran using multi‑stage cluster sampling. All participants underwent optometric examinations including the measurement of visual acuity and refraction as well as slit‑lamp biomicroscopy to determine the lens status. Biometric measurements and IOLs power calculation were done using the IOL Master 500 and Pentacam AXL. The order of imaging modalities was random in subjects. IOL power calculation was done according to optimized ULIB constants for the Alcon SA60AT lens. The IOL power was calculated according to a target refraction of emmetropia in all subjects.

After applying the exclusion criteria, 1865 right eyes were analyzed. The mean IOL difference between the two devices was −0.33 ± 0.35, −0.38 ± 0.39, −0.41 ± 0.43, and −0.51 ± 0.43 according to the SRK/T, Holladay, Hoffer Q, and Haigis formulas, respectively. The Pentacam calculated larger IOL power values in all cases. The 95% limits of agreement (LoA) between the two devices for the above formulas were −1.01 to 0.35, −1.14 to 0.39, −1.25 to 0.43, and −1.35 to 0.33, respectively. The best LoA were observed in normal lenses for all formulas. The difference in the calculated IOL power between the two devices using the four formulas had a significant correlation with axial length, mean keratometry reading, and anterior chamber depth. According to the results of the four formulas, mean keratometry reading had the highest standardized regression coefficient in all formulas.

Although the difference in the calculated IOL power between IOL Master 500 and Pentacam AXL is not significant clinically, the results of these two devices are not interchangeable due to the wide LoA, especially for the Haigis formula; therefore, it is necessary to optimize lens constants for the Pentacam.

To evaluate the short‑term microvasculature changes of the macula and optic disc following coronavirus disease 2019 (COVID‑19).

This study included 150 eyes (50 eyes of healthy controls and 100 eyes of patients) during the 1st month following COVID‑19 recovery, as evidenced by two negative polymerase chain reactions. A complete ophthalmic examination and optical coherence tomography angiography were performed to detect the deep and superficial macular vessel density (VD). In addition, the VD of the optic disc was evaluated.

Deep VD (DVD) showed a statistically significant decrease in post‑COVID‑19 patients, particularly those with severe COVID‑19. This reduction occurred in the whole image, parafoveal, and perifoveal VD (P = 0.002, P = 0.002, and P < 0.001, respectively). Concerning the superficial VD (SVD), only the superior hemisphere of the whole image density was statistically significantly reduced (P = 0.037). There was no statistically significant difference in foveal VD (both deep and superficial vessel) among the study groups (P = 0.148 and P = 0.322, respectively). Regarding the foveal avascular zone (FAZ), there was no statistically significant among groups (P = 0.548). Regarding the optic disc, the whole image VD and redial peripapillary capillary VD demonstrated a highly significant decrease, particularly in cases of severe COVID‑19. Conversely, inside disc VD showed a nonsignificant change among the study groups.

According to the findings of the current study, retinal microvasculature was affected in the 1st month following recovery from COVID‑19. DVD was significantly reduced more than SVD. In addition, peripapillary VD decreased, whereas the FAZ was unaffected.

To evaluate the incidence of unplanned return to the operating room following vitreoretinal surgery and assess the reasons.

In this retrospective case series, medical records of all patients who underwent vitreoretinal surgery were reviewed to determine the incidence and reasons of early (<30 days postoperatively) and late (≥30 days postoperatively) unplanned reoperations after the surgery.

A total of 488 eyes of 468 patients with a mean age of 55.84 ± 18.23 years were included. Fourteen percent (68/488) of eyes required one or more unplanned reoperation following their primary surgery. These include 3.9% (19/488) for the early and 10.0% (49/488) for the late reoperation. The most common primary reason for baseline surgery was rhegmatogenous retinal detachment (RRD) without proliferative vitreoretinopathy (PVR, 38.2%), followed by RD with PVR (23.5%), and tractional RD (TRD, 19.1%). Unplanned reoperations were most common in RD with PVR (19.3%), RRD without PVR (17.2%), and TRD (14.4%). Overall, the most common reasons of the first unplanned reoperation were repeated RD with PVR (27.9%), repeated RD (19.1%), and the presence of silicone oil (SO) in the anterior chamber (AC) (10.3%). For early unplanned reoperations, SO in AC, postoperative endophthalmitis, and persistent hyphema were the most common causes. Repeated RD with PVR was the most prevalent cause of late unplanned reoperations (34.7%). In the multivariate analysis, preoperative best‑corrected visual acuity (BCVA) was significantly lower in eyes with unplanned reoperation than in eyes without (P = 0.011).

Unplanned reoperation following vitreoretinal surgery is not very common, and occurs mostly in the setting of PVR, RRD, and TRD. Lower preoperative BCVA may indicate an increased chance of future unplanned reoperation(s).

To evaluate the clinical and demographic aspects of off‑label drug use applications for age‑related macular degeneration (AMD) in Turkey.

Applications for off‑label drug use in the treatment of AMD to the Turkish Medicines and Medical Devices Agency (TITCK) in 2018 were retrospectively analyzed. Demographic characteristics, requested drugs, previous treatment regimens, and reasons for applications were evaluated.

The mean age of the patients (n = 209) was 64.9 ± 15.7 years, of which 48.8% were male and 51.2% were female. Ranibizumab (n = 113) comprised 54.1% and aflibercept (n = 96) 45.9% of off‑label use applications. No application was made for bevacizumab. The most frequent reasons for application were switchback (49.3%), nonreimbursement of indicated drugs in cases under 50 years of age (24.4%), and failure to complete the loading dose (14.4%).

Ranibizumab was the most requested off‑label drug for AMD. There was no application for off‑label bevacizumab since its use does not require approval from TITCK. In Turkey, new rules were established for the reimbursement of intravitreal drugs for AMD in 2019. Three doses of intravitreal bevacizumab were required initially for aflibercept and ranibizumab to be covered for reimbursement. There is not enough data in the English literature regarding the off‑label use of ranibizumab and aflibercept for AMD. This study provides information about drug regulations and the off‑label treatment options preferred by physicians for AMD in Turkey.

To evaluate the vision‑related quality of life (VRQoL) of patients receiving hemodialysis through the assessment of the impact of vision impairment (IVI) questionnaire and ocular parameters, including best‑corrected visual acuity (BCVA), intraocular pressure (IOP), and refraction as calculated by spherical equivalent (SE) of each eye.

Fifty‑one patients with end‑stage renal disease undergoing hemodialysis at a single center were recruited, and a total of 77 eyes were evaluated. BCVA, IOP, and SE were evaluated before and after hemodialysis (within 30 min).

Of the 51 patients recruited, 13 (25%) were female, 37 (73%) were male, and one (2%) chose not to specify gender. The mean age was 61.85 ± 32 years. The mobility IVI score was correlated significantly with the presence of hypertension (P = 0.01), eye drop usage (P = 0.04), and gender (P = 0.04). Emotional IVI scores were correlated significantly with diabetes (P = 0.03) and hypertension (P < 0.01). IOP significantly correlated with the IVI overall score (P = 0.02), including the reading IVI subscale and the emotional IVI subscale. Several factors were associated with posthemodialysis ocular parameters, including predialysis ocular parameters, age, and hypertension (P < 0.05 for all).

IOP significantly correlated with VRQoL in hemodialysis patients. Demographic variables such as diabetes status, hypertension, eye drop usage, and gender also significantly correlated with subsections of the IVI questionnaire. This study investigated the relationship between ocular parameters and VRQoL in hemodialysis patients, and future longitudinal research is needed to further elucidate the mechanisms.

To identify the causative mutations of autosomal dominant (AD) congenital cataracts in a large Iranian family.

The complete and accurate family history and clinical information of participants were collected. A total of 51 family members, including 22 affected and 29 unaffected individuals, were recruited in this study. We performed whole exome sequencing to reveal pathogenic mutation. We used amplification refractory mutation system polymerase chain reaction and Sanger sequencing techniques to confirm segregation in patients and also to rule it out in the healthy participants.

A known missense mutation, c.827C>T (S276F), in GJA8 was identified. This mutation was confirmed in all patients. Neither all healthy family members nor 100 healthy individuals who served as controls from general population had this mutation.

The missense mutation c. 827C>T in the GJA8 gene is associated with AD congenital lamellar cataract with complete penetrance in a six‑generation Iranian family.

To determine the prevalence of different types of ocular trauma and their relationship with some factors in the elderly population.

The present population‑based cross‑sectional study was conducted on the elderly population aged 60 years and above in Tehran, Iran, using multi‑stage stratified random cluster sampling in 2019. After selecting the samples and their participation in the study, demographic information and history of ocular trauma were obtained through an interview. Psychological evaluation was performed using the Goldberg’s 28‑question General Health Questionnaire. All study participants underwent optometric and ophthalmological examinations.

Three thousand three hundred and ten people participated in the study (response rate: 87.3%). Of these, 1912 individuals (57.8%) were female and the mean age of individuals was 68.25 ± 6.55 (from 60 to 97) years. 7.46% (95% confidence interval [CI]: 6.51–8.41) of the study participants reported a history of ocular trauma. Blunt and chemical traumas were the most and the least common types of ocular trauma, respectively (5.72% and 0.16%). 3.93% of cases visited an ophthalmologist for ocular trauma, 1.67% reported a history of hospitalization, and 1.47% underwent surgery. The prevalence of visual impairment in individuals with a history of ocular trauma was 12.53%. Visual impairment was more prevalent in people with a history of ocular trauma than those without a history of ocular trauma (P < 0.05). History of ocular trauma was only significantly related to low education level (odds ratio = 0.63, 95% CI = 0.40–0.99). Participants with a history of ocular trauma had more anxiety and higher mean psychological distress score than those without a history of ocular trauma (P = 0.035).

The development of preventive programs against the occurrence of ocular trauma can play an important role in reducing the psychological damage of affected patients while reducing visual disorders. These interventions should be especially considered in groups with a lower education level.

To report the clinical course and optical coherence tomography (OCT) findings of ocular angiostrongyliasis.

A 36‑year‑old female with a history of ingesting regular raw freshwater shrimp and other raw food presented with acute unilateral painless visual loss in the right eye. Her right eye’s best‑corrected visual acuity (BCVA) was 1 ft of the count finger. Fundus examination showed vitritis, generalized retinal pigment epithelial alteration, and a moving roundworm in the vitreous at the 6 o’clock position. Macular OCT of her right eye showed thinning of the retina, loss of the external limiting membrane and ellipsoid zone, subretinal hyper‑reflective material clumping, and hyper‑reflective foci at the superficial choroidal layer.

The patient was administered oral and topical prednisolone. The roundworm, identified as Angiostrongylus cantonensis, was wholly extracted from the vitreous using a 23G sclerotomy port and pars plana vitrectomy. The final BCVA was 1 ft of the count finger.

This case report describes an infrequent presentation and illustrates the clinical course and OCT findings of ocular angiostrongyliasis.

To describe a case of combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) with peculiar optical coherence tomography (OCT) findings.

Case report.

A 7‑year‑old girl with a history of decreased visual acuity in the left eye since early childhood presented with pigmented epiretinal membrane in favor of CHRRPE based on clinical and paraclinical findings. In OCT images, an area of retinal defect was noted, and the retina doubled up on itself near the defect (double retina sign).

Careful examination of OCT images in patients with CHRRPE can reveal new findings.

To report surgical repair of a rare case of Tessier number 9 craniofacial cleft.

Case report.

Tessier number 9 craniofacial cleft is the rarest cleft anomaly. This article reports a congenital eyelid coloboma in a 21‑year‑old woman that involved the lateral third of the left upper eyelid and extended to the lateral canthus, consistent with number 9 craniofacial cleft Tessier classification. The additional findings included a fibrotic band between the globe and the remnant of the upper lid, which caused a small‑angle exotropia. There were also skin appendages in the preauricular area and the inner surface of the nasal columella consistent with Goldenhar syndrome. The eyelid coloboma was repaired by releasing the adhesions and using a composite graft of the hard palate to repair the posterior lamella. The anterior lamella was repaired by creating a skin advancement flap. The esthetic and functional outcomes were acceptable in the 2‑year postoperative follow‑up period.

The composite hard palate graft can be used to repair posterior lamella defect in the case of Tessier number 9 craniofacial cleft.

To report two rare cases of orbital cholesterol granuloma (CG) presenting with ptosis and proptosis.

The first case was a 31‑year‑old male presented with progressive ptosis of the left eye (LE) during the past year and the second case was a 35‑year‑old male presented with proptosis of the right eye (RE) for 5 months ago. Orbital computed tomography revealed a cystic well‑demarcated lesion in the superotemporal orbit with adjacent bone erosion in the LE of the first case and the RE of the second case.

In both cases, the tumor was excised completely through an anterolateral orbitotomy approach. Histopathological evaluation showed fibroconnective tissue with cholesterol clefts surrounded by granulomatous inflammation consistent with the diagnosis of CG. The symptoms of patients were resolved after surgery.

CG of the orbit is a rare lesion that commonly occurred in the superotemporal area. Erosive bone expansion is the characteristic finding of this lesion that can be mistaken with lacrimal gland malignancies. Hence, it is essential to keep CG in mind in the differential diagnosis of lacrimal gland masses.

To report a case with an unusual giant mass in the eyelid which was diagnosed as peripheral T‑cell lymphoma, not otherwise specified (PTCL‑NOS).

A 40‑year‑old woman was referred with a 1‑year history of rapidly and constantly growing eyelid mass.

The patient underwent an incisional biopsy and histopathological examination revealed a PTCL‑NOS. After achieving regression by the combination of cyclophosphamide, hydroxydoxorubicin, vincristine (oncovin), etoposide, and prednisolone therapy, the remaining crusts were debrided, the eyelids were separated, and the wound was left to heal by secondary intention. Cicatricial ectropion of the lower eyelid occurred during follow‑up and it was corrected with a free skin graft successfully.

PTCL‑NOS is uncommon but it may reach massive dimensions in the eyelid region.