Palpebral lobe of the human lacrimal gland: morphometric analysis in normal versus dry eyes

AimTo study the morphological features of the palpebral lobe of the main lacrimal gland in normal and dry eyes.MethodsThis cross-sectional study included 25 healthy subjects and 83 patients with dry eye disease (DED). The aetiological groups of DED were cicatrising conjunctivitis (CC, n=35), evaporative dry eyes (EDE, n=25) and Sjogren’s syndrome (SS, n=23). The palpebral lobes in both eyes were evaluated using slit-lamp biomicroscopy and photography for size (exposed area in mm2), shape (convex or flat), presence of cicatrisation (scarring and/or symblepharon) and appearance of the overlying conjunctival vessels.ResultsThe palpebral lobes in the normal and EDE group were similar in terms of size (41.5±15.6 mm2 vs 39±12.2 mm2, p=0.203), convex shape (100%) and absence of cicatrisation or vascular engorgement (0%). However, as compared to normal controls, the size of the palpebral lobe was markedly reduced in the SS (27.9±12.3, p<0.0001) and CC (18.1±13.7, p<0.0001) groups. The size of the lobes was asymmetric in the CC group (p<0.0001) and differed significantly from the SS group (p=0.0003). Flat contour (79% vs 50%, p=0.0028), subepithelial scarring with or without symblepharon (52% vs 13%, p<0.0001) and engorged conjunctival vessels (96% vs 63%, p=0.00011) were seen in a significantly higher proportion of lobes in the CC as compared to the SS group.ConclusionThe morphological features of the palpebral lobe of the main lacrimal gland are significantly distorted in aqueous deficient dry eyes due to CC and SS; however, the lobes in patients with EDE are similar to normal eyes.

Ocular COVID-19: Eyes as a reservoir to conceal and spread SARS-CoV-2

: Ocular tissues can serve as a reservoir for the SARS-CoV-2 virus which can not only cause conjunctivitis but also serve as a resource of infection transmission to others. Additionally, the eye and its tear drainage apparatus can track the SARS-CoV-2 from the eye into the respiratory tract of the patient. The potential ocular presence of the SARS-CoV-2 in the eye of a patient can target ACE2 receptors in the endothelium of the conjunctival vessels and use the lacrimal sac a potential space to evade immune detection and clinical isolation. The recently reported case of COVID-19 after the acquisition of SARS-CoV-2 from a COVID-19 patient should alert the healthcare professionals dealing with COIVD-19 patients as wear-ing masks alone cannot guarantee protection against infection transmission. Further studies, like isolation of SARS-CoV-2 from the eyes of patients with COVID-19, needed to identify the eyes as a potential source of SARS-CoV-2 infection trans-mission.

The First Experience of Using a Femtosecond Laser in Pterygium Surgery

Objective: to evaluate the functional results of the surgical treatment of pterygium using a femtosecond laser. Рatients and methods. The study included 115 patients (141 eyes) with a diagnosis of primary and recurrent stage I–III pterygium, of which 17 (19 eyes, 10.6%) had a relapse of the disease. The patients’ age was in average 54 ± 6 years, among them men and women — 56 and 44 % respectively. The same surgeon operated all patients with a femtosecond laser and fibrin glue. Results. The technique is simple to perform, the separation of the autograft from its own conjunctiva does not cause difficulties due to an accurate cut of the femtosecond laser, which helps to obtain optimal functional results in the long-term period. The size of an autograft manufactured using a femtosecond laser averaged 6 × 7 ± 1.0 mm. The edges of the graft in all cases were smooth, its thickness was the same over the entire area and amounted to 80 ± 15 μm, which facilitated the work with it and subsequent fixation. The graft was fixed using fibrin glue, the advantage of which is its hypoallergenicity, the absence of discomfort in patients and the simplicity of its use by the surgeon. Glue resorption is completed from 2 weeks to 1 month. Intra and postoperative complications were not observed in any case. The offset of autograft in the early postoperative period was also not observed in any case. Conclusion. The use of a femtosecond laser in primary and recurrent pterygium I-III surgery allows the formation of an autograft of the required thickness and size with minimal damage to the conjunctival vessels and the absence of scarring of the bulbar conjunctiva in the area of the material intake. The use of fibrin glue for fixing the autograft promotes rapid healing. The absence of relapses during the observation period and obtaining optimal functional results indicate the promise of using femtolaser technologies in pterygium surgery.

Longitudinal Study on Ocular Manifestations in a Cohort of Patients with Fabry Disease

ABSTRACTPurposeThis study aims to assess the evolution of ocular manifestations in a cohort of Fabry patients.METHODSThis is a prospective observational study conducted from 2013 to 2017 (5 consecutive exams). All subjects underwent a comprehensive ocular examination including oriented case history, refraction, corneal topography, biomechanical corneal properties and pachometry assessments, aberrometry, anterior segment evaluation, double-frequency visual field (FDT), intra-ocular pressure, and ocular fundus. At baseline, 41 subjects enrolled but 9 dropped-out and 4 files were not kept for analysis (missing data). Remaining 28 subjects were classified into: Group 1 -hemizygotes (HMZ), all on enzyme replacement therapy (ERT) (N=10); Group 2 -heterozygotes (HTZ) actively ERT-treated (N=8), and Group 3 -HTZ not treated (N=10).RESULTSThere is a high intra and inter-subjects variability. At baseline, prevalence of the ocular manifestations found is similar to published data: cornea verticillata (89.2%), conjunctival vessels tortuosity (85.7%), corneal haze (67.8%), retinal vessels tortuosity (64.2%), anterior cataract (39.2%) and posterior cataract (28.5%). Prevalence for new elements are found: upper lid vessels toricity (96.4%) and micro-aneurysms (42.8%). At the end, micro-aneurysms (+82%), posterior cataract (+75%) corneal haze (+21%) anterior cataract (+17%) and retinal vessels tortuosities (+4%) evolved in prevalence and severity despite the fact that 68% of the patients were on ERT. Treated heterozygotes evolved more than other groups (p>0.05)CONCLUSIONERT does not halt the clinical evolution of several ocular manifestations. Longer observational time may be required to fully confirm these findings.

Anterior Segment Scleral Fluorescein Angiography in the Evaluation of Ciliary Body Neoplasm: Two Case Reports

Introduction: Anterior segment tumors can be difficult to detect until tumor growth is substantial enough to cause local signs or symptoms. Earlier detection may result in improved outcomes, particularly the ability to option for globe-conserving therapy. Multiple diagnostic modalities such as ultrasound or optical coherence tomography exist to aid for earlier detection of ciliary body tumors, but they also have limitations. Here we describe the potential for scleral angiography as an adjunctive modality to assist in evaluating anterior segment ciliary body tumors. Case Presentations: A 61-year-old Caucasian male and a 57-year-old Hispanic female presented for ciliary body tumor evaluation. The Caucasian male notably had abnormal scleral, episcleral, and conjunctival vessels in the affected eye. Scleral angiography was performed in both cases with the abnormal vasculature highlighted in the Caucasian male. The Hispanic female did not demonstrate abnormal scleral angiographic patterns. Notably, the Caucasian male also had regions of abnormal scleral angiography arising in locations of otherwise normal appearing sclera. Both patients had the affected eyes enucleated. Histology of the enucleated eyes demonstrated a ciliary body melanoma in the Caucasian male associated with abnormal vascular and tumor infiltration of the scleral bed. The Hispanic female had a pigmented ciliary body adenoma without involvement of the scleral bed. Conclusion: With limited sample size, scleral angiography has the potential to detect abnormal scleral vascular patterns in otherwise normal appearing sclera in cases of ciliary body tumor with scleral vascular invasion.

Elevated Intraocular Pressure due to Arteriovenous Fistula between External Carotid Artery and Facial Vein

Aqueous outflow via the conventional outflow pathway is dependent on the pressure gradient between intraocular pressure (IOP) and episcleral venous pressure (EVP). Elevated IOP resulting from increased EVP is a well-known complication of arteriovenous fistulas, which are usually between the carotid artery and the cavernous sinus. Arteriovenous malformations usually occur spontaneously, after a trauma or from iatrogenic causes, and they manifest with findings of chemosis, dilatation of the conjunctival vessels, exophthalmos, and extraocular motility limitation. In this study, we present a case of elevated IOP due to facial arteriovenous malformations following a functional neck dissection surgery that caused intraocular pressure elevation.