A study of the dose-response relationship for transscleral cyclophotocoagulation in refractory glaucoma

Background To research the efficiency of transscleral cyclophotocoagulation (TCP) in refractory glaucoma and to evaluate the dose-response relationship. Methods A retrospective analysis of the cases of 31 eyes of 31 consecutive patients with uncontrolled glaucoma who underwent TCP. Six to thirty-six months were reviewed. The main outcome measure is intraocular pressure (IOP) reduction combined with the best corrected visual acuity and complications. Calculations were performed to determine possible predictive factors that would help establish optimal treatment parameters. Results All the 31 patients felt a relieved ocular pain after TCP. Corneas of 30 eyes recovered transparent one week after TCP, except one eye with corneal epithelialization. The IOP of all patients decreased to 5mmHg-38mmHg（average is 17.93±8.00mmHg）at the end of follow-up. The main earlier complications include conjunctival burns, hyphema and mild inflammation of the anterior chamber, and the late complications were phthisis bulbi and corneal staphyloma. Final IOP was moderately negative related to the number of spots, r=-0.41(t=2.05, P<0.05), and the linear regression equation is y=27.53-0.62x (independent variable x represents the number of spots, dependent variable y represents the final IOP). To a medium extent, the final IOP was negatively correlated with the number of the audible spots, r=-0.58(t=3.75, P<0.01), and the linear regression equation is y=28.39-1.26x. Conclusion Cyclophotocoagulation is a convenient, safe and effective procedure in refractory glaucoma. The recommended parameter is about 14 spots or 8 audible spots.

Using ultraviolet corneal crosslinking for the treatment of corneal ulcers and other corneal pathologies in animals

Purpose. To study the effects of corneal collagen cross-linking (CCL) using ultraviolet-A (UVA) irradiation with riboflavin on the eye’s anterior segment structures in corneal ulcers and other keratopathies in animals.Material and methods. The study involved 26 animals (39 eyes) — 10 cats, 10 dogs, and 6 horses with ulcers, corneal staphyloma, dry and autoimmune keratoconjunctivitis. Examination included slit-lamp biomicroscopy, ophthalmoscopy (in cases of transparent cornea), tear production test, and staining the eye surface with vital dyes. CCL was performed using UVA radiation of LEDs with a fiber optic output (wavelength 370 nm, radiation power 3 mW/cm2) combined with 0.1 % riboflavin instillation according to the protocol we developed, which specifies various numbers and durations depending on the diagnosis and therapeutic effect desired.Results. Restoration of the shape and transparency of the cornea, relief of anterior eye inflammation, and normalization of tear production occurred much sooner than using traditional treatment. The restoration of vision occurred 2 to 3 months earlier in eyes with corneal staphyloma; more than 4 to 5 months earlier in eyes with keratoconjunctivitis; no relapses were noted in eyes with ulcerative processes, and the restoration of the function of stratified squamous epithelium was achieved within 2 or 3 weeks.Conclusions. The inclusion of modified UFA-based CCL in the treatment scheme of corneal ulcers and staphylomas as well as dry and autoimmune keratoconjunctivitis enables a high therapeutic effect of anterior eye structure restoration. In future, the results obtained could serve as basis for using the developed technology in the treatment of similar eye pathologies in humans.

Post-Ocular Trauma Corneal Staphyloma in a Child Living in an Underdeveloped Region of Eastern Indonesia

Ocular trauma occurring in children often leads to visual impairment or blindness when it is not properly managed. This often occurs in underdeveloped regions with difficult access to professional care at local health facilities. We report a case of post-trauma corneal staphyloma in an underdeveloped region of eastern Indonesia to illustrate the importance of proper management of ocular trauma in areas lacking such expertise and where patients have difficulty accessing even basic health care. During a community health outreach in Southwest Sumba, eastern Indonesia in May 2017, a 7-year-old boy presented with white protrusion of the left eye of 3 years’ duration following an event of sharp trauma. The patient lived in an inaccessible and impoverished area. Upon contemporary examination, visual acuity of the left eye was 1/300 while that of the right eye was 6/6. Anterior examination revealed corneal staphyloma of the left eye, and its posterior segment could not be evaluated. The patient was transported to an eye care center in Jakarta, receiving a stock prosthesis implant while awaiting a corneal evisceration procedure with dermofat graft. Ocular trauma is one of the most common causes of visual impairment in children. This case illustrates the consequences of inadequate post-trauma management and the importance of prevention of infection.

George Critchett (1817-1882) and His Son George Anderson Critchett (1845-1925)

George Critchett (1817-1882) and his son George Anderson Critchett (1845-1925) have influenced the development of ophthalmology and ocular surgery for about a century. They presented new ocular operations such as Critchett’s advancement operation, Critchett’s corneal staphyloma operation, and Critchett’s keratoconus operation, and they invented new surgical instruments such as Critchett’s cataract knife, Critchett’s scissors, and Critchett’s fixation forceps. Both were delicate ocular surgeons managing complex and difficult surgeries.

Histopathological Features in a Case of Peters' Anomaly with Acquired Corneal Staphyloma

We report a case of corneal staphyloma histologically diagnosed as caused by Peters' anomaly. A 62-year-old male had a protruding opaque vascularized cornea that began to bulge from six months ago in the right eye. Since his right eye was blind and he wanted us to remove the eyeball for cosmetic improvement, we enucleated the affected eye. The enucleated tissue was fixed in formalin and embedded in paraffin for histological examination. Hematoxylin and eosin staining showed that the cornea lacked the posterior part of the corneal stroma and Descemet's membrane in the central region and the entire corneal endothelium. The corneal epithelium was keratinized. Collagen type I was strongly positive in peripheral cornea and weakly in protruding stroma. The cells labeled by antibodies againstαSMA were scattered in the entire corneal stroma. As judged by the histological findings, the eye with the central corneal staphyloma was diagnosed as Peters' anomaly.