Glaucoma and neuroinflammation: An overview

Luciano Quaranta,Carlo Bruttini,Eleonora Micheletti,Diego Sbardella,Giovanni De Angelis,Ivano Riva

doi : 10.1016/j.survophthal.2021.02.003

VOLUME 66, ISSUE 5, P693-713, SEPTEMBER 01, 2021

Glaucoma is an optic neuropathy characterized by well-defined optic disc morphological changes (i.e., cup enlargement, neuroretinal border thinning, and notching, papillary vessel modifications) consequent to retinal ganglion cell loss, axonal degeneration, and lamina cribrosa remodeling. These modifications tend to be progressive and are the main cause of functional damage in glaucoma. Despite the latest findings about the pathophysiology of the disease, the exact trigger mechanisms and the mechanism of degeneration of retinal ganglion cells and their axons have not been completely elucidated. Neuroinflammation may play a role in both the development and the progression of the disease as a result of its effects on retinal environment and retinal ganglion cells. We summarize the latest findings about neuroinflammation in glaucoma and examine the connection between risk factors, neuroinflammation, and retinal ganglion cell degeneration.

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Microinvasive glaucoma surgery: A review of 3476 eyes

Prem Nichani,Marko M. Popovic,Matthew B. Schlenker,Jeff Park,Iqbal Ike K. Ahmed

doi : 10.1016/j.survophthal.2020.09.005

VOLUME 66, ISSUE 5, P714-742, SEPTEMBER 01, 2021

Microinvasive glaucoma surgery (MIGS) is a potentially safer and more efficacious method studied in patients with mild-to-moderate open-angle glaucoma requiring less invasive treatment goals; however, the literature on MIGS must be thoroughly evaluated. We conducted a review of MIGS by searching MEDLINE, EMBASE, and Cochrane CENTRAL. Primary efficacy indicators were reductions in intraocular pressure and topical medication use postoperatively. While all comparative randomized controlled trials assessing MIGS in English peer-reviewed journals were included, only observational studies with a target follow-up of at least one year and a high priority score were analyzed, resulting in a total of 3476 eyes across 20 trials. The mean age was 69.5 ± 2.9 years, 53.7% were female, and 77.4% were Caucasian. One study had last follow-up at less than one year, fifteen studies had follow-up extending 1-2 years, and four had longer than two years of follow-up. A pattern of more significant intraocular pressure and medication reduction was observed in patients who underwent MIGS (n = 2170) relative to control (n = 1306) interventions. iStent had the most literature supporting its efficacy, followed by Hydrus. The most common adverse events after MIGS implantation included stent obstruction, inflammation, and subsequent surgical intervention. Surgical complication rates and efficacy are favorable after MIGS. This review helps to consolidate the high-quality evidence that exists for various MIGS procedures and to identify gaps where further research is needed.

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Pigment dispersion syndrome and its implications for glaucoma

Andres Bustamante-Arias,Raul E. Ruiz-Lozano,J. Carlos Alvarez-Guzman,Sara Gonzalez-Godinez,Alejandro Rodriguez-Garcia

doi : 10.1016/j.survophthal.2021.01.002

VOLUME 66, ISSUE 5, P743-760, SEPTEMBER 01, 2021

Pigment dispersion syndrome (PDS) represents a clinical spectrum of a relatively common and usually underdiagnosed phenomenon produced by spontaneous pigment dispersion from the iris into the anterior segment. PDS is often bilateral, has no gender predisposition, and presents at a young age, particularly in myopes. Although most patients experiencing an episode of pigment dispersion are asymptomatic, extreme photophobia, ocular pain, redness, and blurred vision may occur. Other characteristic signs are iridolenticular contact, concave iris configuration, 360° peripheral iris transillumination, and pigment deposition on the anterior chamber angle or the corneal endothelium (Krukenberg spindle). Early PDS diagnosis is crucial to detect patients with pigment-related ocular hypertension (POHT) that can eventually lead to pigmentary glaucoma (PG). The latter represents a sight-threatening condition in which mechanical, environmental, and genetic factors contribute to optic nerve damage. In this review, we update the pathogenic mechanisms involved in the clinical spectrum of the disease. We describe its clinical presentation, ophthalmologic manifestations, and complications, including the factors influencing the development of POHT and PG. Because PDS has variable clinical presentations that lead to misdiagnoses, we emphasize the differential diagnosis and the actual therapeutic strategies according to disease status.

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The choroidal rupture: current concepts and insights

Marco Lupidi,Alessio Muzi,Greta Castellucci,Felice Cardillo Piccolino,Jay Chhablani,Carlo Cagini

doi : 10.1016/j.survophthal.2021.01.014

VOLUME 66, ISSUE 5, P761-770, SEPTEMBER 01, 2021

Choroidal rupture is a posterior segment affliction following a traumatic event that results in a break in the retinal pigment epithelium, Bruch membrane, and the underlying choriocapillaris. The visual prognosis may be extremely poor when involving the macular area or in cases with major comorbidities. On funduscopic examination the rupture appears as a whitish/yellowish curvilinear or crescent-shaped lesion with forked or tapered endings. Multimodal imaging including fluorescein angiography, indocyanine green angiography, optical coherence tomography, and optical coherence tomography angiography can provide a detailed assessment of the extent of damage and the onset of complications. Although there is no treatment for choroidal rupture per se, associated complications such as angle-recession glaucoma, retinal detachment, or exudative choroidal neovascularization might need therapeutic interventions. We describe the pathophysiology of choroidal rupture, the recent multimodal imaging findings, and the available treatment options for the management of complications.

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Inverted internal limiting membrane flap technique for myopic macular hole: A meta-analysis

Irini Chatziralli,Genovefa Machairoudia,Dimitrios Kazantzis,George Theodossiadis,Panagiotis Theodossiadis

doi : 10.1016/j.survophthal.2021.02.010

VOLUME 66, ISSUE 5, P771-780, SEPTEMBER 01, 2021

A macular hole (MH) may be a significant complication in patients with high myopia. The recently reported inverted internal limiting membrane (ILM) flap technique is a promising alternative to treat myopic MHs. We performed a meta-analysis of the published anatomical and functional results of the “inverted ILM flap” technique for the treatment of myopic MH with or without retinal detachment (RD). Our results showed that the inverted ILM flap technique, either covering or insertion, is an effective method for treating myopic MH with or without RD and provides high MH closure, ranging from 91.8% to 97.1%. Despite the high MH closure rate, the pooled visual acuity improvement rate was 77.3% and 66.2% in patients with myopic MH without RD, while it was 95% and 80.3% in patients with myopic MHRD, using “covering” and “insertion” ILM flap technique, respectively. Potential complications included reopening or persistence of MH, development of RD, choroidal detachment, ocular hypertension, and chorioretinal atrophy.

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Pharmacologically induced uveitis

Maram E.A. Abdalla Elsayed,Igor Kozak

doi : 10.1016/j.survophthal.2021.01.003

VOLUME 66, ISSUE 5, P781-801, SEPTEMBER 01, 2021

Treatments of numerous systemic and local diseases of different etiologies may be accompanied by an unwanted side effect in the form of uveitis. We inform readers about medications that have the potential to cause uveitis and analyze the strength of association of these medications with uveitis. Subsequently, cessation of medication or appropriate treatment can be individualized for each patient for the purpose of preventing further damage to tissue structure and function. Being aware of these associations, physicians may readily identify medications that may cause uveitis and avoid expensive and unnecessary clinical and laboratory testing.

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Rational laboratory testing in uveitis: A Bayesian analysis

K. Matthew McKay,Lyndell L. Lim,Russell N. Van Gelder

doi : 10.1016/j.survophthal.2021.02.002

VOLUME 66, ISSUE 5, P802-825, SEPTEMBER 01, 2021

Uveitis encompasses a heterogeneous group of clinical entities with the common feature of intraocular inflammation. In addition to patient history and examination, a focused set of laboratory investigations is frequently necessary to establish a specific diagnosis. There is limited consensus among uveitis specialists regarding appropriate laboratory evaluation for many distinct patient presentations. The appropriateness of a laboratory test for a given case of uveitis will depend on patient-specific as well as epidemiologic factors. Bayesian analysis is a widely used framework for the interpretation of laboratory testing, but is seldom adhered to in clinical practice. Bayes theorem states that the predictive value of a particular laboratory test depends on the sensitivity and specificity of that test, as well as the prevalence of disease in the population being tested. In this review we will summarize the performance of commonly-utilized laboratory tests for uveitis, as well as the prevalence of uveitic diagnoses in different geographic practice settings. We will propose a logical framework for effective laboratory testing in uveitic disease through rigorous application of Bayesian analysis. Finally, we will demonstrate that while many highly sensitive laboratory tests offer an effective means to rule out associated systemic disease, limited test specificity and low pretest probability often preclude the diagnosis of systemic disease association with any high degree of certainty, even in the face of positive testing.

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Laser-assisted corneal transplantation surgery

Rashmi Deshmukh,Louis J. Stevenson,Rasik B. Vajpayee

doi : 10.1016/j.survophthal.2021.01.009

VOLUME 66, ISSUE 5, P826-837, SEPTEMBER 01, 2021

Corneal transplant surgeries have a broad range of indications with outcomes largely dependent on surgeon experience. Traditional manual techniques have certain limitations pertaining to the preparation of donor tissue and the recipient bed that might affect the predictability of visual outcomes. Use of lasers for keratoplasty procedures not only improves the repeatability and consistency of the technique, but also enables the surgeon to control the thickness and shape of the transplant tissue tailored to the specific condition. Despite the advantages, cost-effectiveness and technical know-how remain the major challenges. We discuss the various techniques of laser-assisted keratoplasties with respect to their methods, precision, and efficacy in various corneal indications.

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Mitochondrial DNA A3243G variant-associated retinopathy: Current perspectives and clinical implications

Razek Georges Coussa,Sumit Parikh,Elias I. Traboulsi

doi : 10.1016/j.survophthal.2021.02.008

VOLUME 66, ISSUE 5, P838-855, SEPTEMBER 01, 2021

Cellular function and survival are critically dependent on the proper functionality of the mitochondrion. Neurodegenerative cellular processes including cellular adenosine triphosphate production, intermediary metabolism control, and apoptosis regulation are all mitochondrially mediated.

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Orbital exenteration: an updated review with perspectives

Arnaud Martel,Stephanie Baillif,Sacha Nahon-Esteve,Jacques Lagier,Mehrad Hamedani,Gilles Poissonnet

doi : 10.1016/j.survophthal.2021.01.008

VOLUME 66, ISSUE 5, P856-876, SEPTEMBER 01, 2021

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Neurodevelopmental outcomes in preterm infants with retinopathy of prematurity

Hao Tan,Patricia Blasco,Tamorah Lewis,Susan Ostmo,Michael F Chiang,John Peter Campbell

doi : 10.1016/j.survophthal.2021.02.012

VOLUME 66, ISSUE 5, P877-891, SEPTEMBER 01, 2021

Over the past decade there has been a paradigm shift in the treatment of retinopathy of prematurity (ROP) with the introduction of antivascular endothelial growth factor (anti-VEGF) treatments. Anti-VEGF agents have the advantages of being easier to administer, requiring less anesthesia, having the potential for improved peripheral vision, and producing less refractive error than laser treatment. On the other hand, it is known that intravitreal administration of anti-VEGF agents lowers VEGF levels in the blood and raises the theoretical concern of intraocular anti-VEGF causing deleterious effects in other organ systems, including the brain. As a result, there has been increased attention recently on neurodevelopmental outcomes in infants treated with anti-VEGF agents. These studies should be put into context with what is known about systemic comorbidities, socioeconomic influences, and the effects of extreme prematurity itself on neurodevelopmental outcomes. We summarize what is known about neurodevelopmental outcomes in extremely preterm infants with ROP, discuss the implications for determining the neurodevelopmental status using neurodevelopmental testing as well as other indicators, and review the existing literature relating to neurodevelopmental outcomes in babies treated for ROP.

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What did he eat?

Sara Rodrigo-Rey,Consuelo Gutiérrez-Ortiz,Silvia Mu?oz,Jes?s Vicente Ortiz-Castillo,R. Michael Siatkowski

doi : 10.1016/j.survophthal.2020.09.007

VOLUME 66, ISSUE 5, P892-896, SEPTEMBER 01, 2021

A 13-year-old boy reported acute horizontal binocular diplopia and headache. Ten days before these symptoms he suffered from a gastrointestinal infection. Ophthalmological examination revealed bilateral ophthalmoparesis and diffuse hyporeflexia. Magnetic resonance imaging of the brain was normal. Lumbar puncture revealed albumin-cytological dissociation. There were no anti-GQ1b antibodies, but serum anti-GM1 antibodies were detected. He received intravenous immunoglobulins and had fully recovered two weeks later. Miller Fisher syndrome and its atypical variants are uncommon in childhood; nevertheless, they should be considered in the differential diagnosis of bilateral acute ophthalmoparesis.

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Comments on: Chronopoulos and colleaguesPneumatic retinopexy--a critical re-appraisal

Francesco Pellegrini,Erika Mandarà

doi : 10.1016/j.survophthal.2021.01.012

VOLUME 66, ISSUE 5, P897-899, SEPTEMBER 01, 2021

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Authors’ Response to correspondence: Pneumatic retinopexy–a critical reappraisal

Argyrios Chronopoulos,Lars-Olof Hattenbach,James S. Schutz

doi : 10.1016/j.survophthal.2021.01.010

VOLUME 66, ISSUE 5, P900-901, SEPTEMBER 01, 2021

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Comments On: Grzybowski et al: Commonly used intracameral antibiotics for endophthalmitis prophylaxis: A literature review

Saban Gonul,Serhat Eker

doi : 10.1016/j.survophthal.2021.02.006

VOLUME 66, ISSUE 5, P902-904, SEPTEMBER 01, 2021

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Authors’ Response to Letter to the Editor

Andrzej Grzybowski,Piotr Brona,Luis Zeman,Michael W. Stewart

doi : 10.1016/j.survophthal.2021.02.015

VOLUME 66, ISSUE 5, P905-906, SEPTEMBER 01, 2021

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Table of Contents

doi : 10.1016/S0039-6257(21)00116-8

VOLUME 66, ISSUE 5, PA2-A4, SEPTEMBER 01, 2021

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