Nikolaos Kopsachilis

Use of accidentally torn descemet membrane to successfully complete descemet membrane endothelial keratoplasty.

Purpose: To describe the use of an accidentally torn Descemet membrane (DM) to successfully complete Descemet membrane endothelial keratoplasty (DMEK) surgery. Methods: Retrospective, observational case series of 3 eyes of 3 patients undergoing DMEK with a DM accidentally torn into 2 pieces during graft preparation. The mean outcome measures included best-corrected visual acuity, endothelial cell density, and central corneal thickness, before and at 1, 3, and 6 months after the DMEK surgery was performed. Results: During graft preparation, immediately before transplantation, a large tear within the 8.0-mm marking line of the DM occurred, resulting in a DM torn into 2 pieces. In all the eyes, both pieces were successfully implanted into the anterior chamber, unfolded and attached to the posterior corneal stroma, one after the other. Six months after the surgery was performed, the best-corrected visual acuity ranged between 20/30 and 20/25. Endothelial cell loss was about 30% (range 28%–32%) 6 months after the surgery. Pachymetry findings showed normal corneal thickness 6 months after the surgery. All corneas remained clear without any signs of graft failure within 6 months of follow-up. Conclusions: DMEK surgery can be successfully completed despite the accidental tearing of donor DMs during the preparation of DMEK grafts by the sequential implantation of both DM pieces.

Time‐dependent morphological alterations and viability of cultured human trabecular cells after exposure to Trypan blue

To determine the time‐dependent toxicity of Trypan blue at 0.06% concentration in cultured human trabecular meshwork cells.

Descemet's membrane substrate from human donor lens anterior capsule.

Background:  To study the potential use of human donor anterior lens capsule as a Descemets membrane substrate.

Severe chronic blepharitis and scarring ectropion associated with discoid lupus erythematosus.

Discoid lupus erythematosus is a common form of chronic cutaneous lupus erythematosus, an autoimmune inflammatory disease that affects most of the human organs, including the skin, kidneys, joints, heart and lungs. We describe a 45‐year‐old Caucasian woman with a 21‐year history of eyelid redness and irritation. She had been treated with antibiotics, steroids and eyelid hygiene, a therapy that resulted to brief periods of relief of symptoms. In the last 12 months, her symptoms seemed to have exacerbated, despite the administration of a local therapy. Following biopsy, a diagnosis of discoid lupus erythematosus was confirmed and the patient was placed on a systemic therapy with hydroxychloroquine. The eyelid inflammation decreased but severe scarring of the marginal eyelids persisted, resulting in cicatricial ectropion.

A novel mechanism of UV-A and riboflavin-mediated corneal cross-linking through induction of tissue transglutaminases.

Purpose: Collagen cross-linking using UV-A irradiation combined with the photosensitizer riboflavin is a new technique for treating progressive keratoconus. The purposes of this study were to examine whether primary human corneal keratocytes (HCKs) are capable of expressing and secreting fibronectin and tissue transglutaminase (tTgase), an enzyme cross-linking extracellular matrix protein, and to examine whether fibronectin and tTgase are increased after the treatment of HCK cells with UV-A irradiation combined with riboflavin (RFUV-A), thus providing another possible physiological mechanism of the cross-linking pathway. Methods: Cell cultures established from HCKs were treated with 0.025% riboflavin solution and UV-A (370 nm) irradiance 3 mW/cm2 for 30 minutes. Induction of fibronectin and tTgase was investigated by immunohistochemistry, real-time polymerase chain reaction, and Western blot analysis. Cell viability was quantified by a microscopic live–dead assay. External tTgase activity was measured by the ability to form polymerized fibronectin and the incorporation of biotinylated cadaverine into fibronectin. Results: Treatment of cultured HCK cells with RFUV-A increased the fibronectin and tTgase messenger RNA and protein levels. This effect was not observed in cells treated with riboflavin or UV-A radiation alone. Incorporation of biotinylated cadaverine was significantly increased when HCK cells were treated with RFUV-A. Conclusions: The enzymes tTgase and fibronectin are expressed by RFUV-A treatment in cultured HCK cells. This mechanism provides more information about the physiology of corneal cross-linking.

Spontaneous resolution of corneal decompensation after big-bubble deep anterior lamellar keratoplasty with intraoperative Descemet's membrane perforation.

lesion’s superior aspect. Grossly, the cyst was lobular, thin-walled and measured 22 ¥ 20 ¥ 13 mm. It was filled with clear and non-viscous fluid. Histopathology showed fibrofatty tissue with a cyst lined by stratified cuboidal epithelium, resembling most closely a lacrimal duct epithelium. There was a small focus of stratified squamous epithelium on one edge, representing part of the dermolipoma. No goblet cells were seen to account for the possibility of a conjunctival inclusion cyst. The histological diagnosis was a simple cyst associated with a dermolipoma. Dermolipomas are pinkish yellow, ill-defined lesions typically situated in the supero-temporal fornix.They may be closely associated with the lateral rectus muscle, lacrimal gland or superior rectus tendon or sheath. Cases of intractable diplopia, ptosis and dry eye have been reported, following attempted removal; thus, their excision biopsy is often advised against. Cosmesis or ocular irritation is common indication for debulking. Our case underwent surgery because of unusual cystic change and rapid growth over a span of 6 months. A lack of history of injury or surgical intervention and absence of goblet cells on pathology made the diagnosis of conjunctival inclusion cyst unlikely. Ectopic lacrimal gland within dermolipoma has been reported in the past: although without any cystic change. Close proximity to lacrimal gland ductules makes it probable that a lacrimal cyst was associated with the dermolipoma. But in this case, it was difficult to label the cyst with stratified cuboidal epithelium lining as purely related to the lacrimal gland ductules or conjunctiva, as the cyst lining was not specific for a particular tissue. This case however, with cystic changes in a dermolipoma has not been reported earlier and may be another indication for surgical intervention. Dermolipomas may develop cystic change, which can be an indication for surgical debulking.

Bilateral intracavernous carotid artery aneurysms presenting as diplopia in a young patient.

Introduction. Bilateral intracavernous carotid artery aneurysms (ICAAs) are extremely rare and difficult to treat. Case Report. A 26-year-old female presented in our clinic with acute diplopia due to oculomotor nerve palsy on the left side. Magnetic resonance imaging of the brain showed two heterogeneously enhanced masses indicating bilateral ICAA. An endovascular coil embolization was performed on the left side successfully, resulting in resolution of her symptoms. Conclusion. Thorough systemic evaluation in young patients with diplopia can reveal life-threatening underlying pathology and prevent major complications.

Phacoemulsification using 8 flexible iris hooks in a patient with a short eye, small pupil, and phacodonesis

UNLABELLED We describe a technique that uses flexible iris hooks to dilate and stabilize the capsular bag in a patient with a very deep set and small eye, narrow palpebral fissure, shallow anterior chamber, and very small pupil, who was scheduled for routine phacoemulsification for a white cataract. At the time of iris hook placement, the capsular bag was noted to be markedly unstable. The patient was managed successfully with phacoemulsification of the lens using 4 iris hooks to dilate the pupil and 4 iris hooks to stabilize the capsular bag during surgery. A foldable posterior chamber 3-piece intraocular lens was fixated in the ciliary sulcus. FINANCIAL DISCLOSURE Neither author has a financial or proprietary interest in any material or method mentioned.

Alpha-1 Adrenergic Agonists for the Prevention of Floppy Iris Syndrome

Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Ontario, Canada; Ophthalmic Pathology Laboratory, University of Toronto, St. Michael’s Hospital, Toronto, Ontario, Canada; Keenan Research Centre at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada; Glaucoma Unit, St. Michael’s Hospital, Toronto, Ontario, Canada; Dalla Lana School of Public Health, Faculty of Medicine, University of Toronto, Ontario, Canada

Giant Cell Arteritis Presenting as Choroidal Infarction

Background. Giant cell arteritis (GCA) is a systemic granulomatous vasculitis that affects large- and medium-sized arteries of the head and neck. Ocular manifestations of GCA usually are anterior ischaemic optic neuropathy (AION) or retinal vessel occlusion. Case Report. We report an interesting case of a 70-year-old man who presented with sudden vision loss and choroidal infarction in his left eye. Thorough clinical and paraclinical evaluation revealed an underlying GCA, the treatment of which prevented further vision loss and systemic complications. Conclusion. This is an unusual presentation of choroidal infarction associated with CGA and emphasizes the need of thorough systemic evaluation in patients with choroidal infarction.