Amir Hadayer

Twenty-Seven-Gauge Vitrectomy-Assisted Four-Point Scleral Fixation of Intraocular Lens in the Absence of Capsular Support.

Twenty-Seven-Gauge Vitrectomy-Assisted Four-Point Scleral Fixation of Intraocular Lens in the Absence of Capsular Support Numerous innovative techniques have been developed for intraocular lens (IOL) implantation in the absence of capsular support after trauma or after complex cataract surgery. Intraocular lens may be implanted into the anterior chamber (AC), sutured to the iris, clipped to the iris, suture-fixated by transscleral sutures, or fixated by threading the haptics through the sclera. Anterior chamber and iris-sutured IOLs have been associated with a higher risk of postoperative complications such as corneal edema, peripheral anterior synechiae, hyphema, glaucoma, uveitis, and cystoid macular that may result in poor visual outcomes. Scleral fixation of posterior chamber IOLs remains a widely accepted surgical approach in eyes with no capsular support. Slade et al first described a technique where microincision vitrectomy instruments were used for the creation of sclerotomies and suture retrieval without the use of needles. Khan et al modified this method and introduced 23-gauge pars plana vitrectomy instruments for this technique, which can also be performed using 25-gauge vitrectomy instruments. To the best of our knowledge, this is the first report of 27gauge vitrectomy-assisted scleral fixation of PC-IOLs.

Delivery of steroids into the eye for the treatment of macular edema

ABSTRACT Introduction: Steroids have been in extensive use in ophthalmology since their discovery in 1948. Steroids are effective for the treatment of macular edema and may be delivered into the eye either topically, systemically, subconjunctivally, sub-Tenon, intravitreally and through injectable sustained release devices. Various steroid formulations and devices are commercially available. Each carries advantages and disadvantages, which requires the ophthalmologist to exercise careful medical judgment upon treatment selection. Areas covered: This article focuses in steroid delivery into the eye for the treatment of macular edema, and reviews the current and future treatment options, summarizing their clinical efficacy and possible adverse effects. Expert opinion: Steroids have an important role in the treatment of macular edema, regardless of its cause. Steroids are efficacious, low-cost, and much clinical experience has been accumulated regarding their use over the years. Prolonged systemic steroid use may be associated with severe systemic and local side effects, directly proportional to dosage and time. Intravitreal delivery of steroids has gained popularity as the medication is administered close to the target tissue, significantly reducing the possibility of systemic adverse effects. The biggest problem associated with intravitreal steroids still remains unacceptably high risk of glaucoma and cataract formation. Various controlled-release intravitreal delivery devices are currently commercially available, and more are in the pipeline. While they still carry the risk of local side effects, they are efficacious and can control macular edema for months and years after a single administration.

Osseous Metaplasia (Cataracta Ossea) of Lens Remnants in Chronic Uveitis—A Clinicopathologic Report

ABSTRACT Purpose: To describe clinically and pathologically the rare occurrence of calcification and osseous metaplasia in lens remnants in both eyes of a patient with pseudophakic chronic uveitis. Methods: We performed 25-gauge pars plana vitrectomy, removal of dislocated intraocular lens (IOL), and secondary IOL fixation in the left eye. A similar procedure was performed in the right eye with 27-gauge pars plana vitrectomy. Results: The postoperative visual acuities were 20/30 OD and 20/125 OS. Hematoxylin and eosin staining demonstrated an abundance of calcified tissue and rare osteoclasts in lacunae, compatible with osseous metaplasia (cataracta ossea). Conclusion: To our knowledge this is the first clinicopathologic report demonstrating cellular metaplasia that resulted in osseous transformation of the cortical lens remnants into bone in both eyes of a psuedophakic patient with chronic granulomatous pan uveitis of unknown etiology. The surgical technique described in the supplemental videos demonstrates an effective way of managing this complication.

Outcomes of Surgically Managed Proliferative Diabetic Retinopathy

Purpose: The purpose of this article is to conduct a retrospective chart review of the results of vitrectomy for diabetic vitreous hemorrhage (VH) and diabetic traction retinal detachment (TRD) using small-gauge instruments. Methods: We retrospectively reviewed medical records of all diabetic vitrectomies performed at the University of Louisville from 2012 to 2016 that had at least 6 months of follow-up. Patients included in this study underwent pars plana vitrectomy (PPV) for proliferative diabetic retinopathy complications. We analyzed the preoperative and 6- and 12-month postoperative visual acuities (VAs) in patients who had vitrectomy for their diabetic retinopathy. We also determined the proportion of patients who had best-corrected visual acuity (BCVA) of 20/40 or better and 20/80 or worse. In the patients who had BCVA of 20/80 or worse, we identified the reasons for the decreased VA. We also report intraocular pressure, demographic characteristics, operative techniques, and complications. Results: We identified 93 eyes that underwent diabetic vitrectomy; 81 eyes of 63 patients had at least 6 months’ follow-up. Of those 81 eyes, 40 eyes had VH only; the average duration of vision loss before surgery was 4.7 months. Forty-one eyes had TRDs with average duration of vision loss before surgery of 7 months. The presenting BCVA was 1.14 logMAR (20/300) in the VH-only group and 1.49 logMAR (20/600) in the TRD group (P < .09). Six months after surgery, the BCVA was 0.59 logMAR (20/80) in the VH-only group but still 1.37 logMAR (20/500) in the TRD group (P < .001). By 12 months after surgery (63 eyes), the BCVA was 0.60 logMAR (20/80) vs 1.09 logMAR (20/250), respectively (P < .02). Technical success was achieved in 79 of 81 eyes. At 12 months after surgery, 22 eyes (55%) in the VH-only group and 19 eyes (46%) in the TRD group gained 15 letters or more (doubling the VA) compared with their presenting VA. In the VH-only group 7 eyes (18%) were 23-gauge (G) PPV, 22 (58%) were 25G PPV, and 9 (24%) were 27G PPV, while in the TRD group 15 (38%) were 20G PPV, 11 (27%) were 23G PPV, and 14 (35%) were 25G PPV. There was no difference in outcome with different gauges. Conclusions: While vitrectomy for complications of diabetic retinopathy was technically successful with small-gauge surgery, visual results were disappointing. Further work is needed to clarify the best timing of surgery to improve visual outcomes.

Local S100A8 Levels Correlate With Recurrence of Experimental Autoimmune Uveitis and Promote Pathogenic T Cell Activity

Purpose To investigate the role of damage-associated molecular patterns (DAMPs) in recurrent experimental autoimmune uveitis (EAU). Methods Recurrent EAU was induced in Lewis rats by interphotoreceptor retinoid-binding protein (IRBP) R16-peptide specific T cells (tEAU). Aqueous humor and serum samples were kinetically collected and DAMPs examined by quantitative proteomics, Western blot analysis, and ELISA. tEAU rats were treated with S100 inhibitor paquinimod followed by disease evaluation. The functions of T effector cells and T regulatory cells (Tregs) were compared between treated and nontreated groups. The expression of costimulatory molecules on antigen-presenting cells was examined by flow cytometry. Results S100A8, but not high mobility group box 1 (HMGB1), in the eye was found to be correlated with intraocular inflammatory episodes. Administration of paquinimod significantly protected tEAU rats from recurrence. Treated tEAU rats had fewer R16-specific Th1 and Th17 cells, but increased numbers of Tregs. R16-specific T cells from treated tEAU rats into naïve recipients prevented induction of tEAU by R16-specific T cells from nontreated tEAU rats. Moreover, APCs from treated tEAU rats expressed higher levels of a negative costimulatory molecule, CD200R, and lower levels of CD80, CD86, and MHC class II molecules compared to APCs from nontreated tEAU rats. An opposite pattern of expression of these molecules was observed on APCs incubated in vitro with recombinant S100A8. Conclusions Our data demonstrate a link between local expression of DAMPs and autoimmune responses, and suggest that complete S100A8/A9 blockade may be a new therapeutic target in recurrent autoimmune uveitis.

Disseminated Nocardiosis with retinal abscess in a patient treated for bullous pemphigoid

Purpose To report a case of disseminated Nocardiosis with retinal and intracranial lesions. Observations A 49-year-old woman immunosuppressed because of treatment given for bullous pemphigoid presented with altered mental status and multiple intracranial lesions on imaging. The patient was found to have multiple retinal lesions in both eyes, including a subretinal abscess in the right eye. The patient underwent brain biopsy, confirming Nocardia farcinica histopathologically and in culture. Conclusions and Importance Ocular Nocardiosis is a rare disease with varying prognosis that requires prompt diagnosis to ensure appropriate medical therapy.