Publications by authors named "Abdelrahman M Elhusseiny"

45 Publications

Lid margin keratinization in Stevens-Johnson syndrome: Review of pathophysiology and histopathology.

Ocul Surf 2021 Apr 3. Epub 2021 Apr 3.

Centre for Ocular Regeneration (CORE), L V Prasad Eye Institute, Hyderabad, Telangana, India; Brien Holden Eye Research Centre (BHERC), L V Prasad Eye Institute, Hyderabad, Telangana, India; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India. Electronic address:

Lid margin keratinization (LMK) is a chronic ocular sequela of Stevens-Johnson syndrome (SJS), which causes lid wiper epitheliopathy and progressive ocular surface damage. The exact etiopathogenesis of LMK, however, remains elusive. This review summarizes the potential pathophysiological mechanisms of LMK and describes its histopathological features. A literature search of articles discussing the pathophysiology of LMK in SJS was performed. The possible pathophysiologic mechanisms contributing to LMK, as identified on the literature review, included loss of the muco-cutaneous junction barrier leading to epidermalization, dyskeratosis involving the meibomian gland orifices, altered lid margin microbiome, and de novo squamous metaplasia of the marginal conjunctival epithelium. Based on these mechanisms, the possible sources of keratinized epithelium at the posterior lid margin in SJS could be the adjacent anterior eyelid skin, hyperkeratinized epithelium from the meibomian gland ductal orifices, or the inflamed marginal conjunctiva. The epithelial, sub-epithelial, and stromal changes seen in keratinized posterior lid margins in SJS patients undergoing mucous membrane grafting were also investigated. The findings revealed keratinizing squamous metaplasia of the posterior lid margin accompanied by subepithelial infiltration of helper T cells predominantly on the conjunctival side. The visible meibomian gland orifices had ductal hyperkeratinization and plugging. These findings support a role for inflammation in the pathogenesis of LMK in SJS. Future research can be directed at delineating the pathways that lead to LMK by studying the changes in the lid margin microbiome, and the molecular mechanisms regulating keratinization in the conjunctiva and the meibomian gland orifices in eyes affected by SJS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtos.2021.03.011DOI Listing
April 2021

Effect of inferior oblique myectomy on primary position when combined with lateral rectus recession for intermittent exotropia.

Eur J Ophthalmol 2021 Mar 15:11206721211002706. Epub 2021 Mar 15.

Department of Ophthalmology, Boston Children's Hospital, Boston, MA, USA.

Purpose: To evaluate the surgical success and need for adjustment due to overcorrection in patients who undergo inferior oblique myectomy (IOM) combined with lateral rectus recession (LRc) for intermittent exotropia in the setting of inferior oblique overaction.

Methods: A retrospective chart review was conducted of patients with intermittent exotropia who underwent LRc using adjustable sutures alone versus LRc combined with IOM between January 2010 and July 2018 at our institution. Binocular alignment was recorded before and within one week of surgery. Evaluation measures noted were surgical success (defined as distance alignment of ⩽10 prism diopters) and need for postoperative adjustment due to overcorrection.

Results: Of 48 patients, 24 underwent LRc alone and 24 underwent LRc combined with IOM; all 48 patients had adjustable sutures. Surgical success was significantly higher in the LRc alone group (91.6%) compared with the LRc with IOM group (62.5%) ( = 0.036). The need for postoperative adjustment due to overcorrection was also significantly higher in the LRc with IOM group (20.8%) compared with the LRc alone group (0%) ( = 0.049).

Conclusions: In this study, more patients needed adjustment for overcorrection after undergoing LRc combined with IOM versus LRc alone. Since the tertiary action of the inferior oblique is abduction it is possible that, in patients with inferior oblique overaction, surgically weakening the inferior oblique causes more esodeviation and overcorrection. Thus, surgical correction of exotropia and inferior oblique overaction using LRc combined with IOM may lead to overcorrection and increased need for postoperative adjustment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/11206721211002706DOI Listing
March 2021

Long-term ophthalmic outcomes in 120 children with unilateral coronal synostosis: a 20-year retrospective analysis.

J AAPOS 2021 Mar 11. Epub 2021 Mar 11.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

Background: Prior studies comparing ophthalmic outcomes after treating unicoronal synostosis (UCS) by early endoscopic strip craniectomy (ESC) versus later fronto-orbital advancement (FOA) are modest in sample size, or lack consistent age adjustment. We report long-term, age-adjusted ophthalmic outcomes for a large cohort after nonrandomized treatment by one of these two options.

Methods: The following data was retrieved from a retrospective review of the medical records of patients with treated UCS born since 2000: cycloplegic refractions, sensorimotor examinations, and strabismus procedures before craniofacial repair and postoperatively at approximately 18 and 60 months of age. V-pattern strabismus was graded as mild (absent or + 1/-1 oblique dysfunction) versus moderate-to-severe (≥+2/-2 oblique dysfunction or left to right vertical alignment change of ≥20Δ or ocular torticollis >15°).

Results: A total of 120 infants were included: 60 treated by FOA and 60 by ESC. By the late examination, aniso-astigmatism was present in 71.8% of FOA-treated patients and 46% of ESC-treated patients (P < 0.0001). By late examination, the age-adjusted odds ratio of moderate-to-severe V-pattern strabismus after treatment by FOA versus ESC was 2.65 (95% CI, 1.37-6.28; P = 0.02); strabismus surgery was performed in 26 infants treated by FOA compared with 13 treated by ESC (OR = 2.8; P = 0.02). Amblyopia developed in 60% of FOA-treated patients compared with 35% of those treated by ESC (OR 3.0; 95% CI, 1.3-6.7; P = 0.02).

Conclusions: Our age-adjusted ophthalmic results confirm better long-term outcomes after treatment of USC by endoscopic strip craniectomy. Recognition and referral of affected infants by the earliest months of life facilitates the opportunity for endoscopic repair.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.10.013DOI Listing
March 2021

Pseudo-Duane retraction syndrome after orbital myositis.

J AAPOS 2021 Feb 27. Epub 2021 Feb 27.

Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Department of Ophthalmology, Massachusetts Eye & Ear, Boston, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts; Picower Institute for Learning and Memory, Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts. Electronic address:

Orbital myositis is a rare, commonly idiopathic, inflammatory condition that affects one or more extraocular muscles. We present a case of unilateral orbital myositis affecting the lateral rectus muscle presenting with gaze-evoked amaurosis, pain, and diplopia, with restrictive limitation of adduction. With improvement in adduction after initiating treatment, we noted narrowing of the palpebral fissure on attempted adduction, mimicking Duane retraction syndrome (DRS). Reported cases of "pseudo-DRS" are associated with multiple etiologies and are characterized by retraction on attempted abduction rather than adduction, as occurs in true DRS. In this case, pseudo-DRS occurred in the setting of idiopathic orbital inflammatory syndrome (orbital myositis) with a motility pattern more consistent with true DRS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.11.012DOI Listing
February 2021

Angle Surgery in Pediatric Glaucoma Following Cataract Surgery.

Vision (Basel) 2021 Feb 5;5(1). Epub 2021 Feb 5.

Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo 11261, Egypt.

Glaucoma is a common and sight-threatening complication of pediatric cataract surgery Reported incidence varies due to variability in study designs and length of follow-up. Consistent and replicable risk factors for developing glaucoma following cataract surgery (GFCS) are early age at the time of surgery, microcornea, and additional surgical interventions. The exact mechanism for GFCS has yet to be completely elucidated. While medical therapy is the first line for treatment of GFCS, many eyes require surgical intervention, with various surgical modalities each posing a unique host of risks and benefits. Angle surgical techniques include goniotomy and trabeculotomy, with trabeculotomy demonstrating increased success over goniotomy as an initial procedure in pediatric eyes with GFCS given the success demonstrated throughout the literature in reducing IOP and number of IOP-lowering medications required post-operatively. The advent of microcatheter facilitated circumferential trabeculotomies lead to increased success compared to traditional <180° rigid probe trabeculotomy in GFCS. The advent of two-site rigid-probe trabeculotomy indicated that similar results could be attained without the use of the more expensive microcatheter system. Further studies of larger scale, with increased follow-up, and utilizing randomization would be beneficial in determining optimum surgical management of pediatric GFCS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/vision5010009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930951PMC
February 2021

Novel variants in the stem cell niche factor WNT2B define the disease phenotype as a congenital enteropathy with ocular dysgenesis.

Eur J Hum Genet 2021 Feb 1. Epub 2021 Feb 1.

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.

WNT2B is a member of the Wnt family, a group of signal transduction proteins involved in embryologic development and stem cell renewal and maintenance. We recently reported homozygous nonsense variants in WNT2B in three individuals with severe, neonatal-onset diarrhea, and intestinal failure. Here we present a fourth case, from a separate family, with neonatal diarrhea associated with novel compound heterozygous WNT2B variants. One of the two variants was a frameshift variant (c.423del [p.Phe141fs]), while the other was a missense change (c.722 G > A [p.G241D]) that we predict through homology modeling to be deleterious, disrupting post-translational acylation. This patient presented as a neonate with severe diet-induced (osmotic) diarrhea and growth failure resulting in dependence on parenteral nutrition. Her gastrointestinal histology revealed abnormal cellular architecture particularly in the stomach and colon, including oxyntic atrophy, abnormal distribution of enteroendocrine cells, and a paucity of colonic crypt glands. In addition to her gastrointestinal findings, she had bilateral corneal clouding and atypical genital development later identified as a testicular 46,XX difference/disorder of sexual development. Upon review of the previously reported cases, two others also had anterior segment ocular anomalies though none had atypical genital development. This growing case series suggests that variants in WNT2B are associated with an oculo-intestinal (and possibly gonadal) syndrome, due to the protein's putative involvement in multiple developmental and stem cell maintenance pathways.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41431-021-00812-1DOI Listing
February 2021

Amniotic membrane transplantation in a 2-month-old infant with toxic epidermal necrolysis.

Am J Ophthalmol Case Rep 2021 Mar 15;21:101017. Epub 2021 Jan 15.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.

Purpose: To report a case of 2-month-old boy with Stevens-Johnson syndrome (SJS)/Toxic epidermal necrolysis (TEN) and ocular involvement that was successfully treated with cryopreserved amniotic membrane transplantation (AMT).

Observation: A 2-month-old otherwise healthy boy was referred to Boston Children's Hospital with extensive rash and desquamation concerning for SJS/TEN. A skin biopsy was performed which showed full-thickness epidermal necrosis. AMT was performed at the bedside under general anesthesia. A combination of tobramycin and dexamethasone ointment was prescribed four times per day. On reassessment two weeks following AMT, the entire ocular surface had healed with no signs of conjunctival and/or corneal inflammation or ulceration.

Conclusion And Importance: To the best of our knowledge, our case represents the youngest patient with SJS/TEN to be managed by AMT and one of very few cases where acetaminophen is suspected to be the offending agent. This case highlights the efficacy of AMT at such a young age and feasibility of performing the procedure at bedside in these patients It also highlights that SJS/TEN can develop at such young age.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajoc.2021.101017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7820027PMC
March 2021

Kahook Dual Blade Ab-interno Trabeculectomy Compared to Conventional Goniotomy in the Treatment of Primary Congenital Glaucoma: One-year Results.

J Glaucoma 2020 Dec 29;Publish Ahead of Print. Epub 2020 Dec 29.

Department of Ophthalmology, Cairo University Hospitals, Cairo, Egypt.

Introduction: Kahook dual blade (KDB) removes a strip of the trabecular meshwork from the angle, which may make it superior to simple goniotomy in treating the angle anomaly in primary congenital glaucoma (PCG). This prospective study compares KDB ab-interno trabeculectomy to conventional goniotomy in PCG.

Methods: Forty-two eyes of 29 patients with PCG underwent ab-interno trabeculectomy using a KDB or conventional goniotomy using a 25-gauge irrigating needle, targeting 100-120 degrees of the nasal iridocorneal angle. Patients were seen at 1, 3, 6 and 12 months postoperatively. Success was defined as intraocular pressure (IOP) ≤21▒mmHg at 1-year follow-up visit, with no evidence of glaucoma progression.

Results: The KDB group included 21 eyes of patients with a median age of 6 months (IQR: 4-8.5▒mo) and the goniotomy group included 21 eyes of patients with a median age of 5 months (IQR:3-9.5▒mo). There was a significant reduction in IOP in both groups at all follow-up visits. The reduction in the number of glaucoma medications was significant at 1, 3 and 6 months postoperatively in the KDB group, and at 1 month in the goniotomy group.There was no significant difference in IOP or glaucoma medications between both groups at any follow-up visit. Success was achieved in 12 eyes (57.1%) in each group, with no eyes developing any serious complications.

Conclusion: One-year results show that KDB ab-interno trabeculectomy is at least as effective as goniotomy in the treatment of PCG. Eyes with bilateral glaucoma had a tendency to fail both procedures.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001780DOI Listing
December 2020

Ocular involvement in recurrent infectious mucocutaneous eruption (RIME): a variation on a theme.

J AAPOS 2020 Dec 18. Epub 2020 Dec 18.

Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.

We present 2 cases of pediatric patients with reactive infectious mucocutaneous eruption with ophthalmic involvement. In both cases, the disease processes behaved similarly to that seen in patients with Mycoplasma pneumoniae-induced rash and mucositis. Visual outcomes were good.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.10.003DOI Listing
December 2020

Case Series of Perforated Keratomycosis after Laser-Assisted In Situ Keratomileusis.

Case Rep Ophthalmol Med 2020 15;2020:7237903. Epub 2020 Sep 15.

Department of Ophthalmology, Faculty of Medicine, Benha University, Egypt.

Background: Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty.

Aim: To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). . Hospital-based prospective interventional case series.

Methods: Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA).

Results: The mean age of patients was 22 ± 1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8 ± 1 day, and the mean interval between symptom onset and referral was 14 ± 1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud's medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4 ± 1.2 days of antifungals. In all cases, complete resolution of infection was seen 26 ± 1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14 ± 1.1 months.

Conclusion: MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2020/7237903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7512097PMC
September 2020

Adjustable graded augmentation of superior rectus transposition for treatment of abducens nerve palsy and Duane syndrome.

J AAPOS 2020 10 22;24(5):268.e1-268.e7. Epub 2020 Sep 22.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Purpose: To report the results of adjustable graded augmentation of superior rectus transposition, a novel modification of superior rectus transposition (SRT) designed to reduce postoperative vertical or torsional diplopia.

Methods: The medical records of patients who underwent adjustable graded augmentation of SRT with or without adjustable medial rectus recession (MRc) from February 2017 to December 2019 were reviewed retrospectively. A Mendez ring was used to monitor torsional change after transposition of the superior rectus muscle to the lateral rectus muscle and after sequential placement of 2 or 3 augmentation sutures by superior rectus-lateral rectus loop myopexy. If excessive mechanical intorsion was induced, the responsible augmentation suture was severed intraoperatively. If torsional or vertical diplopia was noted after recovery, the distal-most augmentation suture was cut. Exotropia was managed by severing the distal-most augmentation suture or by medial rectus adjustment.

Results: A total of 8 patients who underwent adjustable graded augmentation of SRT were included (6 using the 3-suture technique): 3 for esotropic Duane syndrome, 2 for abducens nerve palsy, 1 for Moebius syndrome, and 2 for combined trochlear and abducens nerve palsies. Of the 8 patients, 4 had prior strabismus surgery, and 1 patient had previously undergone treatment with botulinum toxin. Severing one augmentation suture in 3 cases resolved vertical (n = 2) or torsional (n = 1) diplopia and consecutive exotropia (n = 2), resulting in excellent alignment and reduction of torticollis to ≤4° in 7 cases. The technique proved insufficient in 1 patient, who had undergone 3 prior strabismus procedures.

Conclusions: In this study cohort, adjustable graded augmentation of SRT effectively managed the risk of postoperative vertical or torsional diplopia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.05.013DOI Listing
October 2020

Changes in Intraocular Pressure and Anterior Chamber Angle After Congenital Cataract Extraction.

J Glaucoma 2021 Jan;30(1):61-64

Cairo University Faculty of Medicine, Cairo, Egypt.

Precis: Anterior chamber angle (ACA) narrowing continues to occur for at least 2 years after congenital cataract surgery. Risk factors for intraocular pressure (IOP) elevation after congenital cataract surgery were higher central corneal thickness (CCT) and surgery at <2 months.

Purpose: The purpose of this study was to study the changes in IOP and in the ACA during the first 2 years after pediatric cataract surgery and to determine risk factors for such changes.

Patients And Methods: A retrospective observational study was done on infants who underwent pediatric cataract surgery in Cairo University Hospitals and completed a 1-year follow-up. Demographic and clinical characteristics were recorded including age at surgery, sex, corneal diameter, CCT pupil diameter, IOP, gonioscopic findings, presence of persistent hyperplastic primary vitreous, surgical approach, primary intraocular lens implantation, and perioperative subconjunctival steroid injection. Changes in IOP and in the ACA were recorded, and the risk factors for such changes were analyzed.

Results: Postoperative IOP elevation >18 mm Hg occurred in 23 eyes of 206 eyes (11%), who completed Year 1 and in 9 (13%) of 86 eyes who completed Year 2. Risk factors for IOP elevation were larger preoperative CCT (P=0.01) in Year 1, and younger age at surgery (P=0.01), and aphakia (P=0.05) in Year 2. In multivariate analysis only younger age at surgery was a risk factor for IOP elevation in Year 2. ACA narrowing occurred in 49% and in 21% of the examined eyes in Years 1 and 2, respectively. Aphakia was not a significant risk factor of angle narrowing in Years 1 and 2 (P=0.17 and 0.42, respectively).

Conclusions: Higher preoperative CCT was a risk factor for early-onset IOP elevation. Surgery at >2 months was associated with lower susceptibility to late-onset IOP elevation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/IJG.0000000000001681DOI Listing
January 2021

Self-grading effect of inferior oblique myectomy and recession.

J AAPOS 2020 08 2;24(4):218.e1-218.e6. Epub 2020 Sep 2.

Boston Children's Hospital Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts. Electronic address:

Purpose: To evaluate the outcomes of inferior oblique (IO) weakening surgery, whether recession or myectomy, and to assess the dose-response relationship and correlation with angle of preoperative hypertropia.

Methods: The medical records of all patients with vertical deviation in primary gaze who underwent unilateral IO-weakening surgery, either recession or myectomy, at Boston Children's Hospital over an 8-year period with a minimum postoperative follow-up of 1 month were reviewed retrospectively. Outcome measures were effect of IO weakening surgery on vertical deviation in primary gaze and its correlation with the preoperative angle of hyperdeviation. Secondary outcomes included resolution of abnormal head posture, reduction of ocular torsion, and postoperative under- and overcorrection.

Results: A total of 94 patients were identified (mean age at surgery, 29.3 ± 19.8 years; range, 1-69). The mean postoperative follow-up period was 17.2 ± 15 months. IO recession was performed in 30 patients; IO myectomy, in 64. Surgical success in primary position was achieved in 72 patients (77%), with resolution of anomalous preoperative head posture in 93%. The mean effect on alignment in primary position was 11.3 ± 6.8. The response to IO-weakening surgery was strongly correlated with the preoperative hyperdeviation for both recession (R = 0.53) and myectomy (R = 0.87).

Conclusions: As with other types of strabismus surgery, IO weakening has a "self-grading" contribution, in which the surgical effect strongly correlates with the magnitude of preoperative deviation. A large range of vertical misalignment can be corrected with the same surgical approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.04.014DOI Listing
August 2020

One-year results of two-site trabeculotomy in paediatric glaucoma following cataract surgery.

Eye (Lond) 2020 Aug 21. Epub 2020 Aug 21.

Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt.

Purpose: The management of glaucoma following cataract surgery (GFCS) in children is challenging. This study looks at the results of two-site trabeculotomy in paediatric aphakic/pseudophakic glaucoma, 1-year post operatively.

Methods: This prospective, institutional study was performed on 33 eyes with GFCS in patients aged ≤14 years. Patients underwent two-site trabeculotomy using the rigid-probe trabeculotome, through a superonasal and an inferotemporal scleral flap. Intraocular pressure (IOP), medications, complications and success rates at 1 year were reported. Success was defined as IOP < 23 mmHg or 30% IOP reduction, on the same or fewer number of medications at 1 year, without the need for another glaucoma procedure.

Results: Trabeculotomy was performed on average 3.5 years after the cataract surgery. Patients were aged 5.73 ± 1.79 years. We excluded four eyes in which >180° incision could not be achieved. A 360° incision was achieved in 14 eyes (48%). There was a significant reduction in IOP and medications at 1, 3, 6 and 12 months (p < 0.001). At 1 year, mean IOP reduction was 48.2 ± 31.5%. Success was achieved in 26 eyes (89.6%), of which 15 were controlled without medications. There was no significant difference in IOP, medications or success between aphakic and pseudophakic eyes nor between eyes that had 360° trabeculotomy and eyes that had a 180-270° incision. Three eyes (10.3%) required another glaucoma procedure. One eye required core vitrectomy for vitreous haemorrhage.

Conclusions: Two-site trabeculotomy can be used as an effective and safe first-line procedure in paediatric GFCS eyes that do not have extensive peripheral anterior synechiae.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1038/s41433-020-01138-wDOI Listing
August 2020

Acute, severe dystonia after strabismus surgery in a patient on propofol, ondansetron, and bupropion.

J AAPOS 2020 10 18;24(5):312-314. Epub 2020 Jul 18.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

Acute, severe dystonia is a frightening and potentially life-threatening surgical complication. We describe the case of a 41-year-old woman who experienced postoperative drug-induced dystonia after elective strabismus surgery. In this case, the medications likely responsible were propofol, ondansetron, and, possibly, bupropion.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.05.006DOI Listing
October 2020

Severe bilateral ankyloblepharon filiforme adnatum.

J AAPOS 2020 08 2;24(4):251-252. Epub 2020 Jul 2.

Department of Ophthalmology, Research Institute of Ophthalmology, Cairo University, Egypt.

We present a case of bilateral ankyloblepharon filiforme adnatum in 1-day-old girl and describe our surgical approach. The bands connecting the upper and lower eyelids of both eyes were severed using blunt scissors. Point bleeding at the cut bands stopped in 1-2 minutes, without the need for cauterization or compression. The patient was able to open her eyes shortly after the procedure, as she woke up from anesthesia. Examination under general anesthesia showed normal eye examination appropriate for age. Postoperatively, the patient maintained open palpebral fissures. Visual development over 3 years' follow-up was normal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.04.002DOI Listing
August 2020

Mycoplasma Pneumoniae-Induced Rash and Mucositis: A Longitudinal Perspective and Proposed Management Criteria.

Am J Ophthalmol 2020 11 20;219:351-356. Epub 2020 Jun 20.

Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.

Purpose: To evaluate the natural history and ophthalmologic morbidity of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and propose a treatment algorithm.

Design: Retrospective, interventional case series.

Methods: Retrospective chart review of all MIRM patients examined by the department of ophthalmology at a tertiary children's hospital. Diagnosis was established clinically concomitant with either positive Mycoplasma pneumoniae IgM or PCR testing from January 1, 2010, until December 31, 2019. The main outcome measures were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention.

Results: There were 15 patients (10 male and 5 female) aged 10.9 ± 4.2 years who had primary episodes of MIRM; of those, 4 had multiple episodes. All patients required topical steroid treatment, 3 required amniotic membrane transplantation, and 1 patient underwent placement of a sutureless biologic corneal badage device. There were no patients who suffered visual loss, but 1 was left with mild symblephara near the lateral canthus in each eye and 2 others had scarring of the eyelid margins and blepharitis.

Conclusions: The ocular morbidity is significantly less in MIRM than in other closely related syndromes such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. However, these patients still require close observation and a low threshold for intervention to avoid permanent ophthalmic sequelae and possible blindness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ajo.2020.06.010DOI Listing
November 2020

Outcomes of Glaucoma Drainage Devices in Childhood Glaucoma.

Semin Ophthalmol 2020 Apr 20;35(3):194-204. Epub 2020 Jun 20.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School , Boston, MA, USA.

Purpose: Angle surgery is the gold standard for the management of many types of childhood glaucoma, yet glaucoma drainage devices (GDD) are effective tools for refractory advanced cases or secondary childhood glaucomas. The purpose of this article is to review recently published literature focused on the use of GDDs for pediatric glaucoma, including GDD general principles and surgical outcomes.

Methods: Literature review of various electronic databases was performed.

Results: 71 papers were reviewed for outcomes of GDD in childhood glaucomas. Success rates were usually defined by intraocular pressure (IOP) of 5-22 mmHg, with or without medications. Success rates were typically higher for non-valved GDDs but varied by length of follow-up. Non-valved GDDs afford lower and longer-lasting IOP control in pediatric eyes than valved GDD, however, no randomized controlled trials exist in childhood glaucoma.

Conclusion: Various designs of GDDs are available for management of childhood glaucoma with good short-term success rates; individual patient factors should be taken into consideration when selecting a specific device.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08820538.2020.1781906DOI Listing
April 2020

Surgical management of uveitis-glaucoma-hyphema syndrome.

Int J Ophthalmol 2020 18;13(6):935-940. Epub 2020 Jun 18.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA.

Aim: To report outcomes of patients after intraocular lens (IOL) repositioning or exchange for the version of the uveitis-glaucoma-hyphema (UGH) syndrome that does not include closed loop anterior chamber IOL (nUGH).

Methods: Chart review of patients with nUGH who underwent IOL repositioning or exchange by one surgeon were reviewed. The main outcome measures were best corrected visual acuity (BCVA) as a decimal fraction preoperatively and postoperatively after IOL repositioning or exchange. Clinical findings evaluated included the presence of uveitis, hyphema, elevated intraocular pressure (IOP), and other complications such as pigment dispersion or vitreous hemorrhage. The number of anti-inflammatory and glaucoma medications were assessed before and after IOL repositioning or exchange.

Results: The study included 14 pseudophakic eyes. The median time at the onset of contemporary UGH after cataract extraction and IOL implantation (CE/IOL) was 7.5y. IOL repositioning or exchange was performed at a mean duration of 8.1±4.7mo (median: 4mo) after onset of UGH. The mean BCVA was improved from 0.45±0.26 preoperatively after onset of UGH syndrome to 0.76±0.22 (=0.016) after IOL repositioning or exchange. Among the 14 eyes, uveitis, elevated IOP, and hyphema were present preoperatively in 13, 13, and 6 eyes, respectively. Uveitis and hyphema resolved in all cases after IOL surgery. The mean IOP was reduced from 26.4±4.5 mm Hg preoperatively to 14.7±4.9 postoperatively (=0.01). The mean number of glaucoma medications used was reduced from 1.7±1.1 medications preoperatively to 0.8±1.08 (=0.04) postoperatively.

Conclusion: IOL repositioning or exchange is an effective treatment in many cases for medically resistant contemporary UGH syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18240/ijo.2020.06.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270258PMC
June 2020

Ocular injury via epinephrine auto-injector.

J AAPOS 2020 06 2;24(3):179-181. Epub 2020 Jun 2.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.

Intraocular injury by epinephrine auto-injector has been rarely reported. Toxic risk to the intraocular structures is suspected, but the evidence is inconclusive. We present the case of a 2-year-old girl who sustained an injury to her right eye by inadvertent epinephrine injection. Cataract surgery was performed to treat an increasingly opaque lens, and an intraocular lens was implanted. The visual outcome was good, with no retinal damage.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2020.02.008DOI Listing
June 2020

Trochleitis presenting with double vision in a patient with juvenile idiopathic arthritis.

Orbit 2020 Jun 5:1-2. Epub 2020 Jun 5.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School , Boston, Massachusetts, USA.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/01676830.2020.1772317DOI Listing
June 2020

Collector Channels: Role and Evaluation in Schlemm's Canal Surgery.

Curr Eye Res 2020 10 1;45(10):1181-1187. Epub 2020 Jun 1.

Department of Ophthalmology, Kasr Al-Ainy, Cairo University , Giza, Egypt.

Objectives: 1) To elucidate the role of collector channels in the aqueous humor outflow pathway 2) To suggest anatomic and functional methods of imaging collector channels in-vitro and in-vivo and 3) To discuss the role of such imaging modalities in the surgical management of glaucoma.

Methods: A thorough literature search was conducted on databases for studies published in English regarding the available methods to determine the role of collecting channels in normal and glaucomatous patients and to assess their patency.

Results: Intraocular pressure (IOP) exists as a balance between aqueous humor production and aqueous humor outflow. Collector channels are an essential anatomical constituent of the distal portion of the conventional aqueous humor outflow pathway. There are different surgical options for glaucoma management and with the recent advances in Schlemm's canal-based surgeries, collector channel's patency became a key factor in determining the optimum management for the glaucomatous eye. The advent of anatomic imaging methods has improved the ability to visualize collector channel morphology in-vitro, including swept-source optical coherence tomography (SS-OCT), spectral domain optical coherence tomography (SD-OCT), micro-computed tomography (micro CT), new immunohistochemistry techniques and scanning electron microscopy. The recent advent of real-time assessment of collector channel patency (including evaluation of episcleral venous outflow, observation of episcleral venous fluid wave, and tracer studies utilizing fluorescein, indocyanine green, and trypan blue) has been validated by the aforementioned anatomic imaging modalities.

Conclusions: New modalities of in-vitro and in-vivo studies of collector channels provide promise to aid in the assessment of collector channel patency and individualization of surgical management for glaucoma patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/02713683.2020.1773866DOI Listing
October 2020

Long-Term Outcomes After Idiopathic Epiretinal Membrane Surgery.

Clin Ophthalmol 2020 31;14:995-1002. Epub 2020 Mar 31.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.

Purpose: To report anatomic and logMAR best-corrected visual acuity (BCVA) outcomes with long-term follow-up after pars-plana vitrectomy and epiretinal membrane peeling (PPV-MP).

Design: A retrospective case-series.

Participants: Patients with epiretinal membrane (ERM) who underwent PPV-MP performed by one surgeon.

Methods: Best-corrected visual acuity (BCVA) was recorded as a logMAR preoperatively and, when available, at 1, 2, 3, 5, 8, 10 years after surgery. The integrity of outer retinal layers was evaluated using spectral domain optical coherence tomography (SD-OCT).

Main Outcome Measures: Postoperative BCVA at different follow-up visits and its correlation with different OCT parameters.

Results: Fifty-five eyes of 49 patients were followed postoperatively with a mean of 8.6± 2.6 years (median: 9 years, range 5-16 years). The mean BCVA improved from 0.56±0.29 (20/72) preoperatively to 0.33±0.25 (20/42) at 1 year, 0.29±0.27 (20/38) at 2 years, 0.25±0.28 (20/35) at 3 years, 0.29±0.32 (20/38) at 5 years, 0.28±0.31 (20/38) at 8 years, and 0.28±0.25 (20/38) at 10 years (p<0.001). The BCVA improved at each of the first 3 years postoperatively and remained stable at 5, 8, and 10 years. Postoperative improvement in the integrity of ELM, and EZ, on SD-OCT correlated with improved BCVA.

Conclusion: BCVA continues to improve after PPV-MP during the first 3 years postoperatively and remains stable. Improved anatomic integrity of outer retinal layers correlated with improved BCVA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/OPTH.S242681DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7127775PMC
March 2020

REPLY.

Ophthalmol Retina 2020 03;4(3):e4

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.oret.2019.12.006DOI Listing
March 2020

Advanced spheroidal degeneration.

Digit J Ophthalmol 2019 Apr 22;25(4):68-71. Epub 2019 Dec 22.

Department of Ophthalmology, Kasr Al-Ainy Hospitals, Cairo University, Giza, Egypt.

Spheroidal degeneration, involving the cornea and/or the conjunctiva, is characterized by amber-colored homogeneous, translucent spherules in the corneal stroma, Bowman's membrane, and subepithelium. The condition has a higher prevalence in areas with extreme temperatures, low humidity, high wind, and presence of sand. We report the case of a 46-year-old man with a 10-year history of gradual progressive diminution of vision, severe blepharospasm, and photophobia. Examination revealed bilateral plaques of amber-colored nodules covering about half of the cornea. Superficial keratectomy was performed for the lesions in both eyes, leaving an epithelial defect overlying a plane of opaque cornea. Histopathology showed amorphous protein in the anterior stroma, confirming the clinical diagnosis of advanced grade 4 spheroidal degeneration. Visual acuity and other symptoms dramatically improved, and the patient was scheduled for keratoplasty.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5693/djo.02.2019.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7001646PMC
April 2019

Role of Matrix Metalloproteinase 9 in Ocular Surface Disorders.

Eye Contact Lens 2020 Mar;46 Suppl 2:S57-S63

Department of Ophthalmology (E.C.J.), Columbia University Medical Center, New York, NY; Bascom Palmer Eye Institute (A.M.E., T.K.E.), University of Miami Miller School of Medicine, Miami, FL; Department of Ophthalmology (A.M.E., R.H.E., Y.M.E.S.), Kasr Al-Ainy, Cairo University, Giza, Egypt; and Department of Ophthalmology (T.K.E.), Faculty of Medicine, Benha University, Benha, Egypt.

Objectives: (1) To explore the role and significance of Matrix Metalloproteinase 9 (MMP-9), a proteolytic enzyme, in various ocular surface diseases of inflammatory, infectious, and traumatic etiology (2), to further elucidate the molecular mechanisms responsible for its overexpression in ocular surface disease states, and (3) to discuss possible targets of therapeutic intervention.

Methods: A literature review was conducted of primary sources from 1995 onward using search results populated from the US National Library of Medicine search database.

Results: MMP-9 overexpression has been found in in vitro and in vivo models of dry eye disease (DED), corneal ulceration, microbial keratitis, corneal neovascularization, ultraviolet light-induced radiation, and a host of additional surface pathologies. MMP-9 is involved in an intricate signal transduction cascade that includes induction by many proinflammatory molecules including interleukin-1 (IL-1), tumor necrosis factor alpha (TNF-a), nuclear factor kappa light chain enhancer of activated B cells (NF-kB), platelet-activating factor, activator protein 1 (AP-1), and transforming growth factor beta (TGF-B). MMP-9 expression is blunted by a diverse array of molecular factors, such as tissue inhibitors of metalloproteinases, cyclosporine A (CyA), PES_103, epigalloccatechin-3-gallate (EGCG), N-acetylcysteine (NaC), ascorbate, tetracyclines, and corticosteroids. Inhibition of MMP-9 frequently led to improvement of ocular surface disease.

Conclusions: Novel insights into the mechanistic action of MMP-9 provide potential for new therapeutic modulations of ocular surface diseases mediated by its overexpression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/ICL.0000000000000668DOI Listing
March 2020

Corrigendum to "A gut connection in mucous membrane pemphigoid: Insights into the role of the microbiome" [Ocul Surf 17 (4) (2019) 615-616].

Ocul Surf 2020 04 13;18(2):349. Epub 2020 Feb 13.

Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL, United States. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jtos.2020.02.002DOI Listing
April 2020

Severe reverse amblyopia with atropine penalization.

J AAPOS 2020 04 15;24(2):106-108. Epub 2020 Jan 15.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:

We report 2 cases of refractory reverse amblyopia that developed after instillation of 1-4 drops of atropine. Risk factors appear to include age <4, large-angle esotropia, and lack of adherence to spectacle wear.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jaapos.2019.12.001DOI Listing
April 2020

Carboplatin- and/or paclitaxel-induced ischemic retinopathy.

Can J Ophthalmol 2020 06 23;55(3):e95-e98. Epub 2019 Dec 23.

University of Miami Miller School of Medicine, Miami, FL. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2019.09.004DOI Listing
June 2020