The Progression of Peripheral Anterior Synechia after Combined Phacoemulsification with Goniosynechialysis Under an Ophthalmic Endoscope: A Three-Year Study

Aim To investigate the long-term changes of peripheral anterior synechia (PAS) after phacoemulsification with goniosynechialysis under an ophthalmic endoscope (Phaco-OE-GSL) in primary angle-closure glaucoma (PACG) assisted with viscoelastics alone or viscoelastics combined with iris repositor (viscoelastics-repositor). Method A retrospective study was conducted. Thirty-nine eyes of 31 PACG patients were included. The follow-up period was 36 months. The main outcomes of the study included the changes of PAS, intraocular pressure (IOP), and the success rate.Results Phaco-OE-GSL was performed assisted with viscoelastics-alone on 20 eyes, and viscoelastics-repositor on 19 eyes. The total recurrence rates of PAS were 62.5% in viscoelastics-alone group and 87.5% in viscoelastics-repositor group. In particular, the recurrence rate of PAS at the same location at which were separated intraoperatively were 37.3% and 75.0% respectively (P=0.033). The recurrence of PAS was observed in 2 eyes in viscoelastics-alone group and 12 eyes in viscoelastics-repositor group within 1-month follow-up (P<0.001). In addition, comparing any two follow-ups 6 months after surgery, there are not significant differences in the extent of re-PAS in total eyes (P>0.05). The extent of postoperative PAS at final follow-up was positively correlated with the range of PAS preoperatively (P=0.036, r=0.356). The complete success rates were 85.0% and 89.5% of viscoelastics-alone group and viscoelastics-repositor group at 36-month follow-up respectively. Both the preoperative and postoperative distribution of PAS are mainly concentrated on the upper (84.6% and 95.8%) and nasal side (74.4% and 62.5%), followed by the inferior side, and the least on the temporal side. Conclusion In summary, although the recurrence rate of PAS was high in early postoperative period, the progression of PAS was rapidly resolved after 6 months postoperatively, and Phaco-OE-GSL is an effective treatment for the long-term control of IOP of PACG patients especially with large range of PAS (> 180°). Both preoperative and postoperative PAS are mainly concentrated on the upper and nasal side. Besides, our results suggested that mechanical separation may be easier to promote the progression of postoperative PAS than viscoelastics-alone separation.

The nose and paranasal sinuses

The external nose is pyramidal and consists of a bony cartilaginous framework. The root/radix is continuous with the forehead an inferiorly terminates at the nasal tip. The dorsum of the nose is formed by two lateral surfaces that converge in the midline. The cartilaginous structure of the nose is formed by paired upper (lateral) cartilages that contribute to the internal nasal valve with the nasal bones, and lower lateral cartilages, combined with additional minor nasal cartilages that surround the ala. The nasal septum relies upon anastomoses from five vessels: two from the ophthalmic, two from the maxillary and one from the facial. Collectively, they form Kieselbach’s plexus. The paranasal sinuses are the frontal, sphenoidal, ethmoidal and maxillary – located within the bones of the same name. They are paired structures lined with mucosa that is continuous with the lateral nasal side wall into which they drain, facilitating clearance of mucus by way of the mucociliary escalator.

Case report: an unusual unilateral pterygium — a secondary pterygium caused by parasitosis in the scleral fistula

Background Ocular parasitosis can cause eye damage, which contribute to eye symptoms such as burning, itching and even blindness. It is uncommon to see the parasitosis lying in the sclera layer, neither it causing pterygium. Here, we present an unusual case of a secondary pterygium caused by intrascleral worm. Case presentation A 52-year-old women complained about discomfort in right eye for 6 years. Slit-lamp examination indicated a thickened triangular layers of conjunctiva extending from the nasal edge to the cornea. The diagnosis was pterygium in the right eye. To our surprise, after scleral of nasal side exposed, we could see a tiny fistula right in the sclera which lied right under the pterygium, with an alive and motile worm inside. An intrascleral fistula was noted. Then the worm was removed by forceps from the fistula, which was creamy white, thread-like and 1 cm long. Discussion and conclusions As far as we known, it is the first case of an intrascleral worm hidden beneath the conjunctiva which caused the secondary pterygium. It is hard to know the etiology of the secondary pterygium which caused by parasitosis in the scleral fistula untill excision surgery. It is hard to imagine the worm was living in the sclera of the patient for a long-time.

Technique of re-enclavation of post-traumatic disenclaved haptic of posterior iris claw lens in a vitrectomised eye

A 58-year-old woman presented to us with sudden onset diminution of vision for 10 days following trauma while using mobile phone. Patient had a history of posterior iris claw implantation 3 years ago. On examination, the patient was aphakic and intraocular lens (IOL) was seen enclaved on nasal side and disenclaved on temporal side on ultrasound biomicroscopy. Patient underwent surgery for re-enclavation of temporal haptic by lifting the IOL using 23-gauge pars plana trocar. Patient had a postoperative uncorrected visual acuity of 6/9 and best-corrected visual acuity of 6/6 with refraction. Re-enclavation of partially disenclaved posterior iris claw lens is a minimally invasive technique to restore visual acuity in such cases.

Some aspects of diagnosis and treatment of a сircumscribed form of choroidal hemangioma complicated by macular edema

Introduction. The interest are rare cases of a сircumscribed choroidal hemangioma located juxtapapillary (JP) on the nasal side of the optic nerve disc (OND) and complicated by macular edema. Purpose. Studying the possibility of timely diagnosis and evaluating the effectiveness of treatment of a сircumscribed choroidal hemangioma complicated by macular edema. Material and methods. A retrospective analysis of the diagnostics and treatment results of 5 patients (5 eyes) with JP сircumscribed choroidal hemangioma, localized on the nasal side of the optic disc, complicated by macular edema, was carried out. Results. As a result, in all patients, already 1 month after the session of selective laser transpupillary thermotherapy (TTT), an increase in visual acuity and quality was observed, which was accompanied by pronounced resorption of intraretinal cysts and / or subretinal fluid in the macula. Conclusion. The purposeful use of modern diagnostic methods and the use of a sparing method of laser TTT makes it possible to identify and cure patients with CPCH complicated by macular edema without loss of visual functions. Key words: сircumscribed choroidal hemangioma, selective transpupillary thermotherapy, cystic macular edema.

The closure of the macular holes with the use of autoplasty ILM: a comparative analysis of functional and morphological parameters

Actual. Peeling the internal limiting membrane when closing the macular tear is a fundamental procedure. However, recently, additional microtraumatization of the layers of neuroretinal tissue during peeling and changes in morphofunctional parameters have been proven. Purpose. The aim of this study was to propose a technique with autoplasty of the ILM and preservation of the papillomacular bundle in the area and to assess the dynamics of morphofunctional parameters after surgery for a macular hole. Materials and methods. Morphofunctional data of 200 patients (100 eyes) were studied.) Patients of group 1 (100 eyes) were operated on using the introverted flap technique Patients of group 2 (100 eyes) were operated on using the original method with the preservation of ILM in the foveolar zone. All patients underwent a standard ophthalmological examination before and after surgery. The assessment of morphometric data was carried out on the basis of the ACT-study. Statistical processing of the results was carried out using the IBM SPSS Statistics 23 program. Results. According to the results of surgical treatment on the 7th day and on the 30th day after the operation, higher indicators of functional parameters of the retina were revealed in patients of the 2nd group. In comparison with the data before surgery, BCVA increased 2.55 times in group 1, and 4.46 times in group 2. There was a significant decrease in MH height-n in patients of group 1 in comparison with data before surgery and group 2 in comparison with data before surgery by 1.68 and 2.12 times, respectively. This is due to the lack of additional microtraumatization of neuroretinal tissue (no peeling) on the nasal side of the macular hole. Keyword: macular hole, ILM peeling, vitrectomy.

Agreement between rhinomanometry and computed tomography-based computational fluid dynamics

Purpose Active anterior rhinomanometry (AAR) and computed tomography (CT) are standardized methods for the evaluation of nasal obstruction. Recent attempts to correlate AAR with CT-based computational fluid dynamics (CFD) have been controversial. We aimed to investigate this correlation and agreement based on an in-house developed procedure. Methods In a pilot study, we retrospectively examined five subjects scheduled for septoplasty, along with preoperative digital volume tomography and AAR. The simulation was performed with Sailfish CFD, a lattice Boltzmann code. We examined the correlation and agreement of pressure derived from AAR (RhinoPress) and simulation (SimPress) and these of resistance during inspiration by 150 Pa pressure drop derived from AAR (RhinoRes150) and simulation (SimRes150). For investigation of correlation between pressures and between resistances, a univariate analysis of variance and a Pearson’s correlation were performed, respectively. For investigation of agreement, the Bland–Altman method was used. Results The correlation coefficient between RhinoPress and SimPress was r = 0.93 (p < 0.001). RhinoPress was similar to SimPress in the less obstructed nasal side and two times greater than SimPress in the more obstructed nasal side. A moderate correlation was found between RhinoRes150 and SimRes150 (r = 0.65; p = 0.041). Conclusion The simulation of rhinomanometry pressure by CT-based CFD seems more feasible with the lattice Boltzmann code in the less obstructed nasal side. In the more obstructed nasal side, error rates of up to 100% were encountered. Our results imply that the pressure and resistance derived from CT-based CFD and AAR were similar, yet not same.

Outcome of Primary Pterygium Surgery Using the Inferior Conjunctival Autograft

INTRODUCTION Pterygium is a common ocular condition with prevalence varying from 0.7-39% in different population and particularly high in the tropics. Various surgical techniques including inferior conjunctival autograft are available for the treatment of pterygium. This study was done to determine the clinical profile and outcome of primary pterygium surgery using inferior conjunctival autograft. MATERIAL AND METHODS This was a prospective, non-comparative interventional study conducted over a period of one year from January to December 2019 in patients with primary pterygium who presented at cornea department of Lumbini Eye Institute and Research Center, Bhairahawa, Nepal. All the patients with primary pterygium, a detail clinical history and examination were done. Pterygium was excised using inferior conjunctival autografting and followed regularly over a period of 3 months. RESULTS We analysed 626 eyes in 619 patients with primary pterygium in which mean age was 44.63 ± 13.84 years. There were 363 (58.64%) females. Majority of our patients were housewife 350 (56.54%) and farmer 170 (27.46%). Mean duration of presentation was 3.59 ± 2.87 year. Pterygium was found mostly on nasal side 614 (98.08%). Depending on the size, maximum patients had type 2 pterygium (73.80%) followed by type 3 pterygium (18.69%). The commonest post operative complication was raised intraocular pressure which was seen in 43 (6.87%) eyes and recurrence rate was 0.64%. CONCLUSION Primary pterygium was seen more commonly in adults in their 4th -5th decade of life with female predominance. Primary pterygium surgery using inferior conjunctival autograft is a safe and effective with very few complication and recurrence.

Papilledema in Space Flight: Pathogenesis, Diagnostics and Monitoring

Some Russian cosmonauts in space flight have revealed swelling of the optic nerve head of varying severity. Four clinical cases presented in this article. A quantitative method for the analysis of OCT images of the optic nerve head and the retina has been developed for the diagnosis and monitoring of the optic nerve’s state. This method is quite informative, regardless of the opinion of each specific medical consultant; diagnosis of optic nerve head edema can be performed according to the generally accepted Frisen’s grading, and thus objectify its diagnostic capabilities. In cases when changes in the optic nerve head are not visualized during ophthalmoscopy, quantitative analysis of OCT images allows one to quantify the presence of optic nerve head edema at the subclinical stage. This objective diagnostic method allows us to establish and quantify the amount of industrial activity, which, with edema of the optic nerve because of intracranial hypertension, mostly pronounced on the nasal side of the nerve disc. Determining the thickness of the retina and head of the optic nerve in the nasal side are paramount for monitoring changes in papilledema in dynamics, especially in the subclinical and 0 stage according to Frisen. Quantitative measurements of the optic nerve head in the temporal side are necessary for the diagnosis, developed papilledema and differential diagnosis of 1-2 stages on the Frisen scale. The use of this diagnostic method has the great importance in assessing the influence of various factors of the space flight on the optic nerve head.