Active removal of anterior segment-migrated dexamethasone implant (Ozurdex®)

Background: Ozurdex^® (Allergan plc., Dublin, Ireland) is an intravitreal sustained-release dexamethasone (DEX) implant. The implant has been reported to migrate into the anterior chamber, potentially causing corneal decompensation. Prompt removal or relocation in the vitreous cavity is advised but troublesome due to its fragility. Several techniques exist, but elaborate setup and specialized surgical skills that are required may cause delay in treatment. We report a novel technique that avoids these shortcomings. Case presentation: A 59-year-old woman presented to the emergency department with visual loss due to an anterior chamber-migrated DEX implant and corneal edema. Using an ophthalmic viscosurgical device (OVD) and a bent 19-gauge needle, the implant has promptly been removed in a one-minute procedure under topical anesthesia. Conclusion: Aspirating an anterior chamber-migrated DEX implant using a 19-gauge bent needle is a cost-effective, time-efficient and safe technique, not requiring specialized surgical skills.

Intrinsic and extrinsic risk factors for sagging eyelids

IMPORTANCE

Sagging eyelids, or dermatochalasis, are a frequent concern in older adults. It is considered a feature of skin aging, but risk factors other than aging are largely unknown.

OBJECTIVE

To study nongenetic and genetic risk factors for sagging eyelids.

DESIGN

Upper eyelid sagging was graded in 4 categories of severity using digital photographs. Dermatochalasis was defined as the eyelid hanging over the eyelashes. Age, sex, skin color, tanning ability, hormonal status in women, current smoking, body mass index, and sun protection behavior were analyzed in a multivariable multinomial logistic regression model. Genetic predisposition was assessed using heritability analysis and a genome-wide association study.

SETTING AND PARTICIPANTS

The study was performed in 2 independent population-based cohorts. The Rotterdam Study included older adults from one district in Rotterdam, the Netherlands, and the UK Adult Twin Registry (TwinsUK) included twins from all over the United Kingdom. Participants were 5578 unrelated Dutch Europeans (mean age, 67.1 years; 44.0% male) from the Rotterdam Study and 2186 twins (mean age, 53.1 years; 10.4% male) from the TwinsUK.

MAIN OUTCOMES AND MEASURES

Sagging eyelid severity levels, ranging from 1 (normal control) to 4 (severe sagging).

RESULTS

Among 5578 individuals from the Rotterdam Study, 17.8% showed dermatochalasis (moderate and severe sagging eyelids). Significant and independent risk factors for sagging eyelids included age, male sex, lighter skin color, and higher body mass index. In addition, current smoking was borderline significantly associated. Heritability of sagging eyelids was estimated to be 61% among 1052 twin pairs from the TwinsUK (15.6% showed dermatochalasis). A meta-analysis of genome-wide association study results from 5578 Rotterdam Study and 1053 TwinsUK participants showed a genome-wide significant recessive protective effect of the C allele of rs11876749 (P = 1.7 × 10(-8)). This variant is located close to TGIF1 (an inducer of transforming growth factor β), which is a known gene associated with skin aging.

CONCLUSIONS AND RELEVANCE

This is the first observational study to date demonstrating that other risk factors (male sex, genetic variants, lighter skin color, high body mass index, and possibly current smoking) in addition to aging are involved in the origin of sagging eyelids.

Marked bilateral lower eyelid ectropion in cutis laxa: a paraneoplastic process in multiple myeloma

PURPOSE

To describe a bilateral involutional lower eyelid ectropion in a patient with cutis laxa, a paraneoplastic process in multiple myeloma.

DESIGN

Case report.

RESULTS

A 60-year-old male presented with a marked involutional left lower eyelid ectropion. Systemic history included cutis laxa, a paraneoplastic feature of multiple myeloma. After surgical treatment, the ectropion recurred; furthermore, a right lower eyelid ectropion developed. In addition, a distinct dermatochalasis of both upper eyelids was present.

CONCLUSIONS

This case is the first description of a marked bilateral involutional ectropion in cutis laxa acquisita.

Endothelial cell decay after descemet's stripping automated endothelial keratoplasty and top hat penetrating keratoplasty

PURPOSE

To analyze endothelial cell density (ECD) decay after Descemet's stripping automated endothelial keratoplasty (DSAEK) and top hat keratoplasty (THPK) in patients with Fuchs' endothelial dystrophy (FED) and/or pseudophakic bullous keratopathy (PPBK).

METHODS

Patients underwent either THPK (n = 33) or DSAEK (n = 39) at the Erasmus Medical Center, Rotterdam. For each nonrandomized cohort, a biexponential regression model for ECD decay was fitted. Factors associated with higher ECD decay were evaluated.

RESULTS

Median follow-up was 31.2 months (range, 11-91) in the THPK cohort, and 23.4 months (range, 6-61) in the DSAEK group. The early ECD decay was much higher after DSAEK (half time, 2.2 months) than after THPK (half time, 12.8 months). The late ECD decay after DSAEK was less steep (half time, 75.5 months) than after THPK (half time, 62 months). The 1-, 3- and 5-year endothelial cell losses derived from the models after DSAEK were 56%, 66%, and 73%, respectively, and after THPK were 24%, 50%, and 64%, respectively. For the DSAEK cohort, PPBK as an indication for surgery was associated with significantly higher late-phase decay rates. For the top-hat cohort, a significantly lower late-phase decay rate was found in PPBK. FED and same-session cataract surgery were confounding variables in the DSAEK cohort. Regarding DSAEK, postoperative re-bubbling was not found to have significant effects on early or late ECD decay rates. However, the small sample size and other limitations related to the method of evaluation may have influenced these findings.

CONCLUSIONS

After DSAEK, early ECD decay was stronger than after THPK, as opposed to late decay. Late decay was faster for PPBK than for FED after DSAEK.

Not only hard contact lens wear but also soft contact lens wear may be associated with blepharoptosis

OBJECTIVE

The authors attempt to establish an association between prolonged hard and soft contact lens wear and ptosis.

DESIGN

Single-center retrospective consecutive series.

PARTICIPANTS

All patients between 18 and 50 years of age who were diagnosed with unilateral or bilateral ptosis between January 2002 and December 2005 (35 patients).

METHODS

In a retrospective consecutive series, we included all patients between 18 and 50 years of age, with unilateral or bilateral ptosis between January 2002 and December 2005. Patients with congenital ptosis, ophthalmic surgery or disease, trauma, giant papillary conjunctivitis, unknown duration of contact lens wear, or muscular or neurologic disorders were excluded. We compared this study group to a Dutch reference population (the total underlying population from which the ptosis cases derive).

RESULTS

The group included 35 patients: 20 (57%) (ages 18 to 50 years, average 37 years) had been wearing hard contact lenses for, on average, 17.6 years (range 6 to 27 years); 9 (26%) (ages 18 to 45 years, average 30 years) had been wearing soft contact lenses for, on average, 9 years (range 1.5 to 20 years); and 6 (17%) (ages 23 to 39 years, average 33 years) had no history of contact lens wear. The odds ratio for soft contact lenses was 14.7 (4.2 to 50.7; CI = 95) and for hard contact lenses 97.8 (22.5 to 424).

CONCLUSIONS

This study suggests that not only hard contact lens wear but also soft contact lens wear may be associated with ptosis.

Ptosis, extraocular motility disorder, and myopia as features of pompe disease

PURPOSE

The assets of this report are a thorough description of new clinical findings, namely the combination of ptosis, extraocular motility disorder and myopia, in consequence of prolonged survival in classic infantile-onset Pompe disease through enzyme therapy.

DESIGN

Single case description.

RESULTS

This manuscript describes a combination of ptosis, extraocular motility disorder and myopia in a 4.5-year-old patient with classic infantile-onset Pompe disease, who survived through enzyme therapy. This patient was treated with a bilateral frontalis suspension (modified Crawford technique) using prolene 3-0 sutures.

CONCLUSIONS

The combination of ptosis, extraocular motility disorder and myopia, is a new clinical finding in children with classic infantile-onset Pompe disease.

Long-term follow-up of hydrogel intracorneal lenses in 2 aphakic eyes

We report the outcome of hydrogel intracorneal lens implantation in 2 patients. The lenses were implanted at approximately 50% depth in the cornea to correct high hyperopic refractive errors of 10.5 diopters (D) and 14.0 D, respectively. Both patients were contact lens intolerant and not suitable for intraocular lens implantation. Surgery was performed in 1988, and the patients were followed until early 2010. The patients showed good tolerance for the intracorneal lenses, but both developed opacities around the implant, leading to reduced visual acuity in 1 patient. Long-term patient monitoring is essential since corneal opacities can develop after many years. Removing the implant is not necessary as the lens can easily be rinsed by lifting the corneal cap.

The Wies procedure for management of trichiasis or cicatricial entropion of either upper or lower eyelids

AIM

To report the efficacy of the Wies procedure (transverse blepharotomy and marginal rotation) in the management of trichiasis or cicatricial entropion of the upper or lower eyelid.

METHODS

A retrospective chart review was performed of all cases of Wies eyelid rotations supervised or performed by one surgeon for cicatricial entropion or trichiasis of the upper or lower eyelids over a 16-year period to assess the indications, success rate and complications of the procedure. Where follow-up was less than 6 months, telephone interviews were conducted to assess patient satisfaction with the surgery. Patients not meeting these criteria were excluded from the final analysis. Success was defined as no recurrence of the entropion or trichiasis and/or patient satisfaction at least 6 months postoperatively. Statistical analysis was performed using a chi(2) test.

RESULTS

126 eyelids (77 upper lids, 49 lower lids) were identified in 89 patients (53 single eyelid, 33 multiple eyelids) who underwent a Wies procedure with a minimum follow-up period of 6 months. The mean follow-up period was 67 months (range 6-188 months). The overall success rate was 85%. 13 eyelids (10%) developed complications. 18 eyelids (14%) developed recurrences that required a second procedure. 10 of these second procedures were repeat Wies procedures, one of which was followed by electrolysis. All of these second Wies procedures were successful.

CONCLUSIONS

The Wies procedure (transverse blepharotomy and marginal rotation) is reasonably successful in managing trichiasis and cicatricial entropion of either upper or lower eyelids.

Acute angle closure glaucoma after oculoplastic surgery

PURPOSE

To describe two patients with acute angle closure glaucoma after oculoplastic surgery.

DESIGN

Interventional case reports.

METHODS

Review of clinical findings and treatment.

RESULTS

A 61-year-old female developed a painful eye with decreased visual acuity a few days after bilateral blepharoplasty. A 69-year-old male developed a painful red eye with decreased visual acuity a few days after ptosis correction. In both cases the intraocular pressure increased to more than 50 mmHg. Both patients were diagnosed with acute angle closure glaucoma and treated appropriately.

CONCLUSIONS

Acute angle closure glaucoma is a possible complication of oculoplastic surgery.

Bicanalicular silicone intubation in acquired partial nasolacrimal duct obstruction

PURPOSE

To assess the effectiveness of bicanalicular silicone intubation (SI) in acquired partial nasolacrimal duct (NLD) obstruction.

DESIGN

Retrospective nonrandomized case series

METHODS

72 tear ducts from 53 patients with severe epiphora due to acquired partial NLD obstruction underwent bicanalicular SI. Mean age at intubation was 55.9 years. The silicone tubes were removed after, on average, 10.4 weeks. Mean follow up period was 29.3 months (range 6 to 66 months). The results were assessed using the Munk score: 0-1: complete success, 2: partial success and 3-4: failure.

RESULTS

Complete success was reported in 47% (31/66). Partial success was reported in 3% (2/66), and no improvement in 50% (33/66). 12% (8/66) was subsequently treated with dacryocystorhinostomy (DCR).

CONCLUSION

In patients with acquired partial NLD obstruction, we noted a low success-rate for bicanalicular SI. Although it may be considered in patients who refuse DCR surgery, the relatively poor outcome compared to DCR does not justify its systematic use for this indication.

Silicone intubation with or without balloon dacryocystoplasty in acquired partial nasolacrimal duct obstruction

PURPOSE

To examine if the addition of (antegrade) balloon dacryocystoplasty to bicanalicular silicone intubation affects the success rate in adults with incomplete nasolacrimal duct (NLD) obstruction.

DESIGN

Prospective, randomized trial.

METHODS

Seventy eyes of 70 patients with incomplete NLD obstruction and severe epiphora (Munk score grade 3 or 4) were treated randomly with dacryocystoplasty (Lacricath) and silicone intubation (Ritleng; n = 35, group 1; mean age, 54.4 years; standard deviation [SD], 11.8 years) or silicone intubation alone (n = 35, group 2; mean age, 53.5 years; SD, 13.1 years; P > .05). The silicone tubes were removed after, on average, three months. At the visit, we assessed the grade of epiphora using the Munk score. Complete success was defined as Munk score of 0 or 1, partial success was defined as Munk score of 2, and failure was defined as Munk score of 3 or 4. Long-term Munk scores were obtained through a telephone survey nine to 76 months after surgery (mean, 43.4 in group 1 and 34.9 in group 2; P > .05).

RESULTS

Complete success was reported by 18 patients (52%) in group 1 and by 20 patients (57%) in group 2. Partial success was reported by one patient in group 1 and by one patient in group 2. No improvement was reported by 15 patients (44%) in group 1 and by 14 patients (40%) in group 2. Differences between the two groups proved to be not significant (P = .8, exact Chi-square trend test).

CONCLUSIONS

In our patients with acquired partial NLD obstruction, treatment with a combination of antegrade dacryocystoplasty and silicone intubation was not associated with a higher success rate compared with treatment with silicone intubation alone.

Newborn with bilateral hazy corneas

In this case report we present a preterm born baby with bilateral hazy corneas and initially normal intraocular pressures. After birth, the corneal opacification increased and a progressive buphthalmos became evident in the right eye. A trabeculectomy was performed in the right eye. Our final diagnosis was sclerocornea in combination with Peters' anomaly.