Risk Factors for Senile Corneal Arcus in Patients with Acute Myocardial Infarction

Purpose: To investigate the association between senile corneal arcus and atherosclerosis risk factors in patients with recent acute myocardial infarction. Methods: In this cross sectional study, atherosclerosis risk factors including fasting blood sugar, total cholesterol and triglyceride levels were measured in 165 patients with recent (less than three months′ duration) acute myocardial infarction. Slitlamp examination was performed to detect corneal arcus. Associations between senile corneal arcus and atherosclerosis risk factors were assessed. Results: Overall, 165 patients including 100 male and 65 female subjects with mean age of 62±10.3 years were evaluated. In 122 patients (74%), variable degrees of corneal arcus were observed. The presence of corneal arcus was significantly associated with age (P = 0.03) and high levels of total cholesterol (over 200 mg/dl, P < 0.01). After adjusting for age, arcus was not associated with sex (P = 0.10), hypertriglyceridemia (P = 0.09), fasting blood sugar (P = 0.06), or systemic hypertension (P = 0.08). Conclusion: Our study revealed that corneal arcus is associated with age and hypercholesterolemia in patients with recent acute myocardial infarction. No association was detected with sex, fasting blood sugar, hypertension, and hypertriglyceridemia

Amniotic Membrane Patch Graft in Management of Double Chamber after Deep Anterior Lamellar Keratoplasty

Purpose: To describe a novel technique of amniotic membrane (AM) patch graft in the management of double chamber treatment after big-bubble deep anterior lamellar keratoplasty (DALK). Case Report: A 35-year-old male patient with advanced keratoconus underwent bigbubble DALK. Manual lamellar dissection was done due to failed big-bubble. First-day postoperative double chamber was detected. Air bubbling and SF6 injection were tried without any success. Double chamber resolved by fixation of AM transplantation patch graft (1 × 1 mm) over the Descemet’s membrane perforation with fibrin glue. Conclusion: Amniotic membrane patch graft can be used in the management of double chamber after DALK not responsive to intracameral gas injection

Ophthalmic Workplace Modifications for the Post-COVID Era

The COVID-19 pandemic necessitates implementation of exposure control measures in all facets of the healthcare sector. Healthcare professionals who work in busy ophthalmology clinics and theaters are amidst the highest at-risk of contracting COVID- 19. The authors review the up-to-date scientific evidence of SARS-CoV-2 transmission to demystify and explain the exposure control options available for ophthalmic workplace and offer insights from an industrial hygiene standpoint. As the we enter the post-COVID world, these measures will be critical to enhance workplace safety, and thus protect patients and staff alike

Agreement Between Swept-source Optical Coherence Tomography and Rotating Scheimpflug Camera in Measurement of Corneal Parameters in Normal and Keratoconic Eyes

Purpose: This study aimed to assess the agreement between topographic indices of healthy subjects and keratoconus (KCN) patients using a swept-source optical coherence tomography (SS-OCT CASIA2) versus a Scheimpflug camera (Pentacam). Methods: 40 eyes of 23 patients with KCN and 40 eyes of 20 healthy subjects were included and evaluated with the CASIA2, followed by the Pentacam. Two consecutive modalities were obtained for one eye of each patient. Corneal parameters, including anterior keratometry at steep (Ks) and flat meridians (Kf), anterior astigmatism, anterior and posterior corneal elevation values, thinnest corneal thickness, and apex corneal thickness, were evaluated. Results: CASIA2 and Pentacam showed perfect agreement (95% limits of agreement (LoA): -0.22 to 0.68, 95% LoA: -1.5 to 1.44 D) and good correlation (Intraclass correlation (ICC):0.986, ICC:0.987; to 0.68, 95% LoA: -1.5 to 1.44 D) and good correlation (Intraclass correlation (ICC):0.986, ICC:0.987; P &lt;0.01) for anterior (Ks) in normal and ectatic corneas, respectively. The cylinder amount had moderate agreement and correlation (95% LoA: -0.55 to 0.47D, ICC: 0.797, P &lt;0.01) in normal, and moderate to strong agreement and correlation (95% LoA: -1.57 to 0.87D, ICC=0.911, P &lt;0.01) in Keratoconic eyes. There was a fair agreement for anterior and posterior corneal elevation values in normal subjects (95% LoA: -3.09 to 4.59, 95% LoA: -6.91 to 7.31D). The thinnest corneal thickness amount had an excellent agreement in normal and KCN patients (ICC: 0.983, 0.953; respectively). Conclusions: Although the devices had different mean indices values, they had a good agreement based on the Bland–Altman plots. Since Pentacam is accepted as the standard tool for diagnosing ectatic cornea, pentacam CASIA2 is also helpful for early diagnosis of KCN

The Royal College of Ophthalmologists' National Ophthalmology Database study of cataract surgery: Report 7, immediate sequential bilateral cataract surgery in the UK: Current practice and patient selection.

BACKGROUND: Cataract extraction is the most frequently performed surgical intervention in the world and demand is rising due to an ageing demography. One option to address this challenge is to offer selected patients immediate sequential bilateral cataract surgery (ISBCS). This study aims to investigate patient and operative characteristics for ISBCS and delayed bilateral cataract surgery (DSCS) in the UK. METHODS: Data were analysed from the Royal College of Ophthalmologists' National Ophthalmology Database Audit (NOD) of cataract surgery. Eligible patients were those undergoing bilateral cataract extraction from centres with a record of at least one ISBCS operation between 01/04/2010 and 31/08/2018. Variable frequency comparison was undertaken with chi-square tests. RESULTS: During the study period, 1073 patients had ISBCS and 248,341 DSCS from 73 centres. A higher proportion of ISBCS patients were unable to lie flat (11.3% vs. 1.8%; p < 0.001), unable to cooperate (9.7% vs. 2.7%; p < 0.001); underwent general anaesthesia (58.7% vs. 6.6% (p < 0.001)); had brunescent/white/mature cataracts (odds ratio (OR) 5.118); no fundal view/vitreous opacities (OR 8.381); had worse pre-operative acuity 0.60 LogMAR ISBCS vs. 0.50 (first) and 0.40 (second eye) DSCS and were younger (mean ages, 71.5 vs. 75.6 years; p < 0.001). Posterior capsular rupture (PCR) rates adjusted for case complexity were comparable (0.98% ISBCS and 0.78% DSCS). CONCLUSIONS: ISBCS was performed on younger patients, with difficulty cooperating and lying flat, worse pre-operative vision, higher rates of known PCR risk factors and more frequent use of general anaesthesia than DSCS in centres recorded on NOD

A Technique to Salvage Big-Bubble Deep Anterior Lamellar Keratoplasty after Inadvertent Full-Thickness Trephination

Herein we describe a technique for management of large inadvertent full-thickness trephination during deep anterior lamellar keratoplasty using the big-bubble technique without converting to penetrating keratoplasty. First, the anterior chamber is formed with an ophthalmic viscosurgical device (OVD). Then, the full-thickness wound is secured with one X-type 10-0 nylon suture. A 27-gauge needle is attached to a 2 ml air-filled syringe and inserted into the corneal stroma in the meridian opposite to the site of full-thickness trephination. Air is gently injected to produce a limited area of "big-bubble" detaching Descemet′s membrane (DM) from the corneal stroma. The "big bubble" is slowly expanded with injection of OVD. Finally, the recipient stroma is removed, the donor lenticule is placed and the DM tear is secured with one full thickness 10-0 nylon suture

Lens densitometry after corneal cross-linking in patients with keratoconus using a Scheimpflug camera

Purpose: To evaluate changes in crystalline lens densitometry following corneal cross-linking (CXL) in keratoconic patients. Methods: In a quasi-experimental study, three-dimensional lens densitometry was performed using the Pentacam Scheimpflug camera (Oculus Optikgerate GmbH, Wetzlar, Germany) at baseline and six months after CXL. Densitometry was performed in a fixed area of 2 inch × 1 inch of the anterior capsule and anterior lens cortex. The subject group included patients with progressive keratoconus who underwent CXL (n = 40) and the control group was comprised of aged-matched patients with non-progressive keratoconus (n = 36). Results: Mean age of the case and control groups was 25.8 ± 4.0 and 25.0 ± 4.1 years, respectively (P = 0.392). Mean lens density in the CXL group was 6.68% ± 0.58% at baseline and 6.77% ± 0.53% at the last visit (P = 0.352). Corresponding figures in the control group were 6.53% ± 0.27% and 6.39% ± 0.31%, respectively (P = 0.213). There was no significant difference between the study groups at baseline or six months later (P = 0.96). Conclusion: In this short term study with six months' follow-up, we observed no significant impact on lens density following exposure of the crystalline lens to ultraviolet A and riboflavin free radicals in the CXL procedure

Identification of a Non-Stop Mutation in PAX6 Causing a Unique Presentation of Aniridia in an Iranian Family Trial

Non-syndromic aniridia (iris hypoplasia) as an autosomal dominant eye disorder results from the chromosomal abnormalities and mutations within the paired box gene 6 (PAX6). The aim of this study was to investigate on the clinical and the underlying genetic alteration in PAX6 gene in a large pedigree with five generations of Iranian family with an autosomal dominant aniridia. Here, we reported unique clinical features in terms of presenting nystagmus, ptosis, minimal iris abnormality, foveal hypoplasia and late-onset clinical limbal stem cell deficiency. Genomic DNA was extracted from the affected members and polymerase chain reaction (PCR) was conducted using specific primers to amplify coding sequence of PAX6. Then, PCR products were subjected to bidirectional dye terminator sequencing. A heterozygous transversion mutation A→T (c.1268A>T, p.*423Lext*15) in exon 13 of PAX6 was identified in all affected individuals, but not in the healthy members. This is the first report of non-stop mutation in PAX6 gene in an Iranian family accompanied with an isolated form of unusual congenital aniridia running within this family