Phacomorphic Glaucoma as the First Manifestation of the Choroidal Malignant Melanoma

Purpose: To describe a case of choroidal melanoma with phacomorphicglaucoma as the first presentation.Case report: A 63-year-old woman was presented with painfulvisual loss of the left eye. Mature cataract, flat anterior chamber andelevated intraocular pressure were noticed in clinical examination.B mode ultrasonography and CT-Scan showed a large intraocularmass. Enucleation was performed and pathological analysis wascompatible with uveal melanoma.Conclusion: The presence of mature cataract obscures the fundusview in patients with phacomorphic glaucoma. Complete ultrasonographicexamination or other appropriate imaging techniques shouldbe performed to detect potential posterior segment pathologies like amalignant melanoma among these patients.Keywords: Phacomorphic; Glaucoma; Uveal; Melanoma

Genetic Footprints of Human Papilloma Virus in Ocular Surface Squamous Neoplasia

Ocular surface squamous neoplasia (OSSN) after melanoma and lymphoma is the third most common tumor. Including a wide range of ocular malignancy from mild form of epithelial abnormality to invasive squamous cell carcinoma (SCC). Overall, the lesions are different in size but mostly occur in specific tissue called limbus due to the structure of the eye ball, that is the most common area for sunlight exposing. Beside exposure to the sunlight and the UV radiation there are other risk factors and genetic co factors related to the OSSN including immune suppression under the infection to the Human immunodeficiency virus (HIV) or Human papilloma virus (HPV) and also mutation in specific genes regulating cell cycles. However, the exact relation between many of these factors and OSSN has not been revealed and need further researches in this area. In this review we aimed to study OSSN from different views specially risk factors and a glimpse of genetic insights specially related to human viral genome. Later, categorizing the role of them to pave the way in answering different questions related to the OSSN among types of that. On the other hand, although there is no evidence for straight relation between p53 mutations in OSSN, here we tried to mention the separated pathway’s role in p53 malfunction or disabled in different process leading to cancers namely OSSN

Stabilization Time of Refractive Errors and Astigmatism after Cataract Surgery Using Phacoemulsification and Foldable Intraocular Lens Implants

Purpose: To evaluate the stabilization time of astigmatism and refractive errors after cataract surgery using phacoemulsification and foldable lens implantation.Patients and Methods: The present cross-sectional study was carried out with convenience sampling method and included patients who underwent cataract surgery using phacoemulsification and implantation of foldable intraocular lens. The patients were evaluated and their data including age, sex, uncorrected visual acuity, best corrected visual acuity,  corneal cylinder, cylinder axis,  Sim K, and intra ocular pressure were recorded prior to the surgery as well as in days 2, 3, 4, weeks 1, 2, 5 and day 75 post surgery. Results: Eighty one eyes of 77 patients with mean age of 61.39 ± 10.9 years were evaluated. The mean follow up time was 60.5 ± 48.86 days. The mean keratometry before surgery was 44.90 ± 1.85 diopters, while the mean axial length, the mean intraocular pressure and the mean astigmatism were 23.15 ± 1.98 mm, 14.01 ± 2.95 mmHg and 0.99 ± 1.10 diopters, respectively. The mean postoperative keratometry at last visit was 45.34 ± 1.80 diopters, and the mean intraocular pressure and astigmatism were, 12.46 ± 2.87 mmHg and 1.14 ± 0.96 diopters, respectively. The mean time for refraction stabilization was 11.46 ± 11.40 days and the mean stabilization time for astigmatism was 10.18 ± 11.34 days. Conclusion: In the present study the mean stabilization time for refraction and astigmatism after cataract surgery in an Iranian population using phacoemulsification and foldable lens implantation was comparable with previous studies. &nbsp

Choroidal Thickness and Hemoglobin A1c Levels in Patients with Type 2 Diabetes Mellitus

Purpose: The aim of this study was to assess the correlation of hemoglobin A1c (HbA1c) levels with choroidal thickness in patients with type 2 diabetes mellitus (DM) using spectral domain optical coherence tomography (SD-OCT). Methods: In this prospective case series, 180 eyes from 90 patients with type 2 DM were classified into three study groups based on HbA1c values: group 1 included patients with good glycemic control (HbA1c ≤ 7%), group 2 included patients with moderate glycemic control (HbA1c between 7% and 8%), and group 3 included patients with poor glycemic control (HbA1c ≥ 8%). Additionally, 50 eyes from 25 non-diabetic subjects were enrolled to group 4 as a control group. Sub-foveal, nasal, and temporal choroidal thickness were measured and compared. Results: Mean central, nasal, and temporal choroidal thicknesses in diabetic patients (247.80, 238.63, and 239.30 μm) were significantly less than non-diabetic healthy subjects (277.56, 262.92, and 266.32 μm). Additionally, mean central, nasal, and temporal choroidal thickness values in group 4 (277.56, 262.92, and 266.32 μm) were significantly greater than the corresponding values in group 2 (248.34, 237.55, and 236.45 μm) and group 3 (239.81, 234.62, and 233.94 μm), but was not significantly different from corresponding values in group 1 (259.46, 246.12, and 251.00 μm). Conclusion: HbA1c values have a significant correlation with choroidal thickness in diabetic patients, and better glycemic control with HbA1c ≤ 7% may prevent choroidal thinning

Suggested Drugs for Human Strabismic Extraocular Muscle

Background: Misalignment of the eyes is called strabismus that is one of the most common disorders in ophthalmology. This disorder must be rapidly diagnosed because late diagnosis increases the probability for surgery. Genetic and environmental risk factors are involved in the prevalence of strabismus. This study aimed to investigate differentially expressed genes in patients with the extraocular muscles (EOMs) and heathy individuals, and also elucidating suggestive drugs for the treatment of the disease. Methods: The data were collected from Gene Expression Omnibus, comprising series of GSE38780. To detect hub genes with dysregulated expression, microarray data were used. Statistical methods extract differentially expressed genes and network analyses were used to detect potential biomarkers of EOMs. Then drugs were suggested based on potential biomarkers. Results: 2009 DEGs were identified by help of adjusted  P value and log fold change. DEGs were mapped on PPI data obtained from STRING database and PPI network was extracted after considering interactions. Centrality of nodes in network was calculated and 10 nodes with highest centrality as marker genes were identified. Ten potential biomarker including CYCS, NDUFV1, COX5A, NDUFB9, SDHA, NDUFS2, UQCR10, UQCR11, MDH2 and UQCRC1 were identified and Six candidate drugs based on them were suggested including NV-128, ME-344, Metformin Hydrochloride, Famoxadone, Albumin Human and Cisplatin. Conclusion: This work was conducted to identify potential biomarker for strabismus and seeking the candidate drugs for it. The marker genes are the most important genes based on statistical and network analysis. By use of potential biomarkers, six drugs were suggested

COVID-19: Preliminary Clinical Guidelines for Ophthalmology Practices

The zoonotic Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and its resultant human coronavirus disease (COVID-19) recently appeared as a global health threat that can cause severe respiratory infection and terminal respiratory distress. By the first week of April, more than 1.3 million people had been globally infected and more than 70,000 had lost their lives to this contagious virus. Clinical manifestations occur shortly after exposure, or a few days later. There is controversy regarding the transmission of the virus through the tear and conjunctiva; however, there are reports that the ocular surface might be a potential target for COVID-19. The ease of transmission of this virus at close proximity presents a risk to eyecare workers. Several recommendations have been issued by local and national organizations to address the issue of safe ophthalmic practice during the ongoing COVID-19 pandemic. These guidelines have numerous similarities; however, subtle differences exist. The purpose of this paper was to discuss measures, with a specific focus on standard precautions, to prevent further dissemination of COVID-19 at Eye Clinics. We have proposed procedures to triage suspected cases of COVID-19, considering emergency conditions.Photo Courtesy of Majid Moshirfar, MD FACS

Buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction

Abstract Background To evaluate the outcomes of a surgical technique using buccal mucosal membrane graft for correction of cicatricial lower eyelid retraction. Methods Twelve patients with unilateral cicatricial lower eyelid retraction were enrolled in the study. All patients underwent a four-step surgical technique consisted of release of scars, midface lift, transfer of buccal mucosal membrane to posterior lamella as spacer graft, and canthal tightening. All patients were followed for at least 12 months. Results Mean preoperative Margin-to-Reflex-Distance 2 (MRD2) was 7.73 ± 1.10 mm, compared to mean postoperative MRD2 of 5.04 ± 0.49 mm (P < 0.0001). The mean improvement in retraction was 2.69 mm. Postoperative scleral show was present in only one case and no major complications were observed. Conclusion The four-step procedure (scar release, midface lift, buccal mucosal graft and canthal tightening) was an effective procedure to correct cicatricial lower eyelid retractions with acceptable outcomes and a low morbidity rate

Visual outcomes of successful versus failed big-bubble deep anterior lamellar keratoplasty for keratoconus

Purpose: To compare the visual outcomes of deep anterior lamellar keratoplasty (DALK) for keratoconus with and without successful big-bubble formation. Methods: In this retrospective comparative study, a total of 289 consecutive eyes from 257 patients underwent DALK using the big-bubble technique. In cases where the big bubble could not be accomplished, manual stromal dissection down to Descemeton membrane (DM) was performed using a crescent knife. Visual acuity and refractive outcomes were compared between the bare DM group (Group 1) and manual dissection group (Group 2). Results: A bare DM was successfully achieved in 229 (79.2%) eyes and manual dissection was performed in 60 (20.8%) eyes. The study groups were comparable in terms of age (P = 0.79), preoperative best-spectacle corrected visual acuity (BSCVA) (P = 0.15), and follow-up duration (P = 0.73). Postoperative BSCVA was significantly better in Group 1 than in Group 2 throughout follow-up (P < 0.05). In Group 2, BSCVA was significantly lower in eyes with advanced keratoconus as compared to those with moderate keratoconus (P = 0.007). At final follow-up, BSCVA ≤ 0.30 logarithm of minimum angle of resolution (logMAR) was achieved in 82.1% of eyes in Group 1 versus 54.5% of eyes in Group 2 (P < 0.001). Groups 1 and 2 were comparable in terms of postoperative spherical equivalent refractive error (P = 0.61) and keratometric astigmatism (P = 0.39). Conclusion: Retention of the posterior corneal stroma which occurs with manual dissection during failed big bubble formation in DALK is associated with lower visual acuity as compared to achieving a bare DM

Comparison of the MyoRing implantation depth by mechanical dissection using PocketMaker microkeratome versus Melles hook via AS-OCT

Abstract Background This paper seeks to evaluate the depth and outcomes of MyoRing implantation using two mechanical dissection procedures including: PocketMaker microkeratome in opposition to the Melles hook method. Methods This retrospective study was carried out on 39 eyes of 38 keratoconus patients (28 male and 10 female) with the mean age of 28.97+.10.37 $$28.97\frac{+}{.}10.37$$ years and had undergone MyoRing implantation by the two mentioned methods. The MyoRing was inserted into the corneal pocket which was made manually in 18 eyes (Melles hook group) or with PocketMaker microkeratome in 21 eyes (PocketMaker group). The mean follow up time was 9.81+.3.7 $$9.81\frac{+}{.}3.7$$ months with pre-operative and post-operative ophthalmic examination including uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), keratometry readings and central corneal thickness measurement. AS-OCT (Casia, SS-1000, Tomey, Nagoya, Japan) imaging was used to measure MyoRing insertion depth, exactly. Results Pre-operative and post-operative UCVA (LogMAR) mean change for the PocketMaker and Melles hook groups were recorded at 0.75 ± 0.32 and 0.78 ± 0.33, respectively. Similarly, BCVA (LogMAR) mean change were 0.27 ± 0.22 and 0.23 ± 0.22. Mean keratometry (Kmean) change were 6.06 ± 4.18 and 6.56 ± 3.55 respectively. UCVA change (P = 0.767), BCVA change (P = 0.77) and Kmean change (P = 0.693) showed that there was no statistically significant difference between both groups for any parameter. Depth measurements achieved from AS-OCT images showed that there was no statistically significant difference in pocket depth between two methods of MyoRing implantation (P = 0.413). Conclusions The results of Myoring implantation outcomes using mechanical dissection via PocketMaker microkeratome as against Melles hook are comparable

Biomimetic amniotic/silicone-based bilayer membrane for corneal tissue engineering

Amniotic membrane (AM) is an effective and widely used dressing in ocular injuries to reconstruct the cornea. Due to its low mechanical strength, high biodegradation rate, and difficult handling, its usage in medical interventions remains challenging. In this study, decellularized AM was covered with an ultrathin layer of Polydimethylsiloxane (PDMS) through a spinning method, which in turn resulted in an ultrathin (less than 80 µm in thickness) bilayer corneal wound dressing membrane with improved mechanical behavior and transparency. The biomechanical, biological, and antibacterial properties of the bilayer membranes were measured both in vitro and in vivo. The optimized microsized membrane was applied on a corneal defect wound created in a rabbit model to evaluate the corneal healing. The results demonstrated a significant decrease in degradation rate, improved mechanical properties, and AM/PDMS transparency compared with AM. The corneal transparency improved until 21 days post-surgery in AM/PDMS group. Histological evaluations revealed that AM/PDMS had better epithelial delaminated cell morphology. The results of the RT-PCR showed a significant increase in MMP9, a significant decrease in Col1A1, TGF-β1, TNF-α and IL-6 in both AM and AM/PDMS compared with control wounds. This study suggessts AM/PDMS membrane as an excellent corneal wound dressing