Intravitreal Fluocinolone Acetonide (ILUVIEN) Implant for the Treatment of Refractory Cystoid Macular Oedema After Retinal Detachment Repair

Cystoid macular oedema (CMO) is one of the most frequent postoperative macular complications to cause partial visual recovery after successful retinal detachment (RD) repair. Refractory CMO is difficult to treat and many strategies have been employed with varying degrees of success. We report for the first time the use of ILUVIEN implant to treat refractory CMO after successful RD repair. A 65-year-old female presented with right eye full-thickness macular hole and underwent pars plana vitrectomy, internal limiting membrane peeling and cryotherapy with gas tamponade with 12% C3F8. She subsequently developed right eye macula-on RD and proliferative vitreoretinopathy and required multiple procedures for successful retinal reattachment. Later, she developed CMO that responded to intravitreal triamcinolone injections and intravitreal dexamethasone 0.7-mg implants but recurrence of CMO continued to be a problem. After receiving ILUVIEN intravitreal implant, her visual acuity improved and CMO resolved without recurrence for 13 months. Refractory CMO after RD repair is difficult to treat and in a quarter of cases will not improve without treatment. Our case shows that a single ILUVIEN implant maintained anatomical dry fovea and improved vision. This also demonstrates that ILUVIEN is an effective management strategy to reduce the need for repeated treatments

Binocular visual field in adults with horizontal strabismus and driving requirements.

ObjectiveTo determine the horizontal extent of the binocular visual field (BVF) in subjects with horizontal strabismus and whether the BVF falls below the driving standard.Methods and analysisAdults with congenital esotropia and infantile exotropia ≤45 Prism Dioptres (PD), and subjects with orthotropia were recruited. The manifest angle of deviation was measured using a simultaneous prism cover test. Monocular Visual Field (MVF) and BVF were measured using the Esterman visual field test. Subjects with diplopia or a manifest angle of strabismus that varied by>8PD or the present of a vertical tropia >8PD were excluded.ResultsForty-nine subjects were included: 10 with orthotropia, 20 with exotropia and 19 with esotropia. The horizontal extent of BVF (degrees) was significantly smaller in esotropes (122.8 ± 18.8) than in orthotropes (141 ± 6.6) or exotropes (138.3 ± 8.3) (p ConclusionThe horizontal extent of BVF is significantly smaller and more variable in adults with congenital esotropia and may fall below the driving standard.Strengths and limitationsLargest study on visual fields in subjects with horizontal strabismus including an orthotropic control group who do not have diplopia and who would otherwise meet the driving standard. Visual field quality was high but limitation is that visual field repeatability was not undertaken.How this study might affect research, practice, or policyThe findings of this study would suggest that people with an esotropia should be offered the opportunity to have a binocular visual field test before applying for a driving license. The DVLA may want to consider requesting people with an esotropia to have a binocular visual field test as is a requirement with other ophthalmic conditions such as glaucoma

OP-1 Analysis and reporting of surgically induced keratometric effect (SIKE).

*Correspondence, Fadi Alfaqawi: [email protected] PURPOSE: To investigate the surgically induced keratometric effect (SIKE) associated with cataract surgery.MethodsConsecutive patients undergoing cataract operation by four surgeons were prospectively included. Two surgeons made an incision at 110 with one side port at 50 (location 1). Two surgeons made a temporal incision at 200 and 20 for right eyes and left eyes respectively, with two side ports (location 2). Biometry was acquired preoperatively and at 6-weeks postoperatively using an IOL Master 500 (Carl Zeiss Meditec, Jena, Germany) on the operated and unoperated fellow eye. Keratometric change was analysed after being transformed into Long's formalism. Coupling was defined as a change between the mean pre to post K that was less than the change in the unoperated eye.ResultsTwo hundred patients were included, (132 in location 1 and 68 in location 2). There were significant differences in pre- to postoperative keratometry: location 1: preoperative and postoperative mean K were 43.65 (95%CI:40.27 to 47.04), 43.64 (95%CI:40.20 to 47.09) respectively, mean absolute difference 0.19 (SD0.19;pConclusionThe SIKE is relatively predictable for incision location and was surgeon independent. Coupling occurs in less than 50% of cases with a change in the mean keratometry

Endothelial Migration and Regeneration after Penetrating Trauma Injury in a Deep Anterior Lamellar Keratoplasty Graft: Case Presentation and Literature Overview

Background: Traumatic injuries in eyes previously treated with Deep Anterior Lamellar Keratoplasty (DALK) can lead to ruptures in the Descemet Membrane (DM) and damage to the corneal endothelium, a crucial layer for maintaining corneal clarity. Due to cell cycle constraints, the human corneal endothelium cannot proliferate; instead, it compensates for injury through cell enlargement and migration from adjacent areas. Methods: This study examines a notable case of corneal endothelial cell migration following a penetrating eye injury in a patient previously treated with DALK for keratoconus, supplemented by a review of relevant literature to contextualize the regenerative response. Results: A 39-year-old male with a history of DALK suffered a traumatic eye injury, resulting in damage to the Descemet Membrane and loss of the crystalline lens. After primary repair and considerations for further surgery, the patient’s cornea cleared remarkably, with an improved visual acuity. This demonstrates the DM’s potential for self-repair through endothelial cell migration. Conclusions: The outcomes suggest that delaying corneal transplant surgery for up to 3 months following Descemet Membrane injury due to ocular trauma could be advantageous. Allowing time for natural healing processes might eliminate the need for further invasive surgeries, thereby improving patient recovery outcomes