Models to investigate the role of anti-Transforming Growth Factor Beta antibodies in lens and corneal wound healing

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Self-induced lens subluxation with avulsion of ciliary processes in Tourette Syndrome

Purpose: To report a case of self-induced eye injury resulting in lens subluxation combined with avulsion of ciliary processes in a patient with Tourette Syndrome. Observation: A 14-year-old male had repeated involuntary trauma to the left side of his face. On exam, left eye lens subluxation combined with ciliary process avulsion were noted. Pars plana vitrectomy and lensectomy were performed. Conclusions and Importance: This report of self-inflicted ciliary processes detachment in Tourette Syndrome is the first of its kind. Ocular injuries reported in the literature include isolated cases of lens luxation, retinal detachment and orbital hemorrhage. Additionally, iatrogenic conjunctival laceration and corneal abrasion have been reported due to involuntary movements during clinical examination. This case provides further evidence that patients with Tourette Syndrome may be at risk of eye injury due to the involuntary jerk movements associated with this condition. Patients with involuntary tics that put their eyes at risk should be advised to wear safety eye wear to avoid eye trauma and its deleterious visual consequences. Keywords: Tourette syndrome, Ocular trauma, Ciliary processes traum

Endothelial keratoplasty for posterior polymorphous corneal dystrophy in a 4-month-old infant

Purpose: To report a case of endothelial keratoplasties (EKs) performed in a 4 month old with a posterior polymorphous corneal dystrophy. Observations: A 4 month old infant underwent Descemet membrane endothelial keratoplasty (DMEK) for posterior polymorphous corneal dystrophy. The graft was found to be dislocated on day 5 post-operatively and an attempt to unfold the DMEK scroll and re-bubble was not successful. The patient was then treated successfully with bilateral Descemet stripping automated endothelial keratoplasty (DSAEK). At 3 years of follow-up, her visual acuity was 20/70 in the right and 20/60 in the left eye with good endothelial cell counts. Conclusions and importance: and Importance: This study reports the youngest case of EKs performed at the age of 4 months in an infant. This is also the first reported case of attempted DMEK highlighting its challenges in infants. DSAEK remains a good treatment option for endothelial dysfunction secondary to posterior polymorphous corneal dystrophy in infants even after failed DMEK

The Cost-Effectiveness of Clinic-Based Chloral Hydrate Sedation versus General Anaesthesia for Paediatric Ophthalmological Procedures

Produced by Technology Assessment at SickKids, Hospital for Sick Children.The primary objective was to determine the incremental cost of paediatric eye examinations carried out in the clinic under sedation using oral chloral hydrate compared to examinations carried out in the OR using general anesthesia (GA) per additional successful procedure gained from a societal perspective. The secondary objective was to conduct a cost-minimization analysis (CMA) under assumptions of equivalent effectiveness between clinic-based sedation and GA.Supported by Brandan's Eye Research Fund

Non-Surgical Consecutive Exotropia following Childhood Esotropia: A Multicentered Study

Purpose: Non-surgical consecutive exotropia (NCX) occurs when an esotropia (ET) spontaneously converts to exotropia (XT) without surgical intervention. Although considered to occur in early onset accommodative esotropia with high hyperopia, consensus on causation is lacking. We report the clinical characteristics of NCX and assess response to conservative management. Design: Retrospective, multi-centered observational case series. Methods: Patients aged 6 months and older with initial diagnosis of esotropia who converted to exotropia without surgical intervention. Sensory strabismus was excluded. Age, visual acuity, cycloplegic refraction, glasses prescriptions, deviation and binocular vision were collected. Results: Forty-nine children were included with a mean age of 3.5±1.6 and 8.4±3.6 years at time of ET and NCX, respectively. Mean refractive error was +4.40±2.13D and +4.05±2.74D at time of ET and NCX, respectively. Accommodative esotropia occurred in 60% of cases, and only 35.7% were high hyperopes. All but one patient presented with their XT at distance. In response to the XT, a mean decrease in hyperopic prescription of 1.55±0.48D was given (N=17); only 1 case reverted to esotropia. Eventually, 43% had exotropia surgery, with similar rates between those who had refractive management and those who did not. Conclusions: NCX occurs in both accommodative and non-accommodative esotropia; high hyperopia is present in only a third of cases. On average, drift to exotropia occurs within 5 years. Refractive management has a modest result. No predictive risk factors were identified. Our findings challenge hyperopia-linked theories of causation. Non-refractive explanations, such as the role of the vergence system, deserve further study. Keywords: accommodation; accommodative esotropia; binocular vision; consecutive exotropia; hyperopia; refractive errors; tonic convergence