Introduction: Brimonidine tartrate is a commonly used eyedrop for short- and long-term lowering of intraocular pressure. Its use has been popularized due to its effects on aqueous suppression and u...

Brimonidine tartrate for the treatment of glaucoma.

Purpose To summarize available literature on physiologic and pathologic ocular changes during pregnancy. Methods Narrative review of literature. Results Ocular changes occur commonly during pregnancy. Although most of these are benign physiologic responses to the metabolic, hormonal, and immunologic modifications to adopt the gestational product, there is some serious pathology that may develop, exacerbate, or even resolve over the course of pregnancy which requires prompt diagnosis and management. The pathological eye conditions can be classified into preexisting pathologies and emerging ocular diseases. Regardless of the different mechanisms by which these ocular changes occur, the key point is the establishment of an effective perinatal screening program to monitor the new development or successive progression of these ocular abnormalities. Irrespective of the visual health status of the pregnant women, regular perinatal eye examination should be scheduled in order to assure continuous surveillance of healthy eyes. Treatment of pathologic ocular conditions or functionally disturbing benign changes relies on an appropriate patient selection. Conclusions Discriminating pathological eye disease from physiologic ocular changes is important in order to establish an individualized treatment or preventive plan and constitutes the mainstay of obstetric ophthalmology. This individualized approach should always weigh the ocular benefits of treatment to the mother against the potential harms to the fetus.

Ocular changes during pregnancy

Introduction: Brimonidine tartrate and brinzolamide eye drops are often used as third and fourth line treatment options to reduce intraocular pressure (IOP) in the management of glaucoma and ocular hypertension. Better tolerated, more effective topical agents requiring once daily instillation including prostaglandin analogues and beta-blockers usually are preferred as initial therapy, unless there are contraindications. Brimonidine and brinzolamide are often required owing to progressive glaucoma or intolerances to or ineffectiveness of front-line agents.Areas covered: We review the safety of formulations containing brimonidine tartrate and/or brinzolamide. Safety considerations for these agents in higher risk populations are highlighted.Expert opinion: Each class of ocular hypotensive eye drop has a unique set of possible side effects. Brimonidine might have neuro-protective capabilities and offer reasonable IOP control, but its use is limited by a relatively high rate of ocular allergy, hyperemi...

Brimonidine and brinzolamide for treating glaucoma and ocular hypertension; a safety evaluation.

To compare the cumulative dissipated energy (CDE), aspiration time and estimated aspiration fluid utilized during phacoemulsification cataract surgery using two phacoemulsification systems . A total of 164 consecutive eyes of 164 patients undergoing cataract surgery, 82 in the active-fluidics group and 82 in the gravity-fluidics group were enrolled in this study. Cataracts graded NII to NIII using LOCS II were included. Each subject was randomly assigned to one of the two platforms with a specific configuration: the active-fluidics Centurion ® phacoemulsification system or the gravity-fluidics Infiniti ® Vision System. CDE, aspiration time (AT) and the mean estimated aspiration fluid (EAF) were registered and compared. A mean age of 68.3 ± 9.8 years was found (range 57–92 years), and no significant difference was evident between both groups. A positive correlation between the CDE values obtained by both platforms was verified (r = 0.271, R
 2 = 0.073, P = 0.013). Similarly, a significant correlation was evidenced for the EAF (r = 0.334, R
 2 = 0.112, P = 0.046) and AT values (r = 0.156, R
 2 = 0.024, P = 0.161). A statistically significantly lower CDE count, aspiration time and estimated fluid were obtained using the active-fluidics configuration when compared to the gravity-fluidics configuration by 19.29, 12.10 and 9.29%, respectively (P = 0.001, P < 0.0001 and P = 0.001). The active-fluidics Centurion ® phacoemulsification system achieved higher surgical efficiency than the gravity-fluidics Infiniti ® IP system for NII and NIII cataracts.

Comparison of cumulative dissipated energy delivered by active-fluidic pressure control phacoemulsification system versus gravity-fluidics

Background: Anemia is the most common hematological disorder. The purpose of this study was to establish and validate a deep-learning model to predict Hgb concentrations and screen anemia using ultra-wide-field (UWF) fundus images. Methods: The study was conducted at Peking Union Medical College Hospital. Optos color images taken between January 2017 and June 2021 were screened for building the dataset. ASModel_UWF using UWF images was developed. Mean absolute error (MAE) and area under the receiver operating characteristics curve (AUC) were used to evaluate its performance. Saliency maps were generated to make the visual explanation of the model. Results: ASModel_UWF acquired the MAE of the prediction task of 0.83 g/dl (95%CI: 0.81–0.85 g/dl) and the AUC of the screening task of 0.93 (95%CI: 0.92–0.95). Compared with other screening approaches, it achieved the best performance of AUC and sensitivity when the test dataset size was larger than 1000. The model tended to focus on the area around the optic disc, retinal vessels, and some regions located at the peripheral area of the retina, which were undetected by non-UWF imaging. Conclusion: The deep-learning model ASModel_UWF could both predict Hgb concentration and screen anemia in a non-invasive and accurate way with high efficiency.

/pdf/deep-learning-based-hemoglobin-concentration-prediction-and-123q0r8h.pdf

Deep-Learning-Based Hemoglobin Concentration Prediction and Anemia Screening Using Ultra-Wide Field Fundus Images

Pterygium is a common ocular surface disorder with a wing shaped fibrovascular overgrowth of bulbar conjunctiva onto the cornea and it is often triangular in shape and consists of a head, i.e., the part which rests on the cornea, a neck, and a body.[1] It is a common conjunctival degenerative condition, which is characterized by elastotic degeneration of collagen and fibrovascular proliferation. Pterygium affects 0.3–29% of the population worldwide and it is reported to occur in males twice as frequently as in females. Patients older than 40 years have the highest prevalence of pterygia while patients aged 20–40 years are reported to have the highest incidence of pterygia.[2,3] Pterygium occurs as a result of breakdown of the corneoscleral limbal barrier results in subsequent conjunctivalization of the cornea,[4] as the scattered light might follow alternative optical paths when entering the eye, thus hitting limbal stem cells from their inner surface.[5]

A number of treatment methods have been described which includes adjunctive medical methods (mitomycin c, 5-flurouracil, daunorubicin, thiotepa drops, and cyclosporine drops instillation), beta irradiation and surgical methods (conjunctival autograft, amniotic membrane grafts, conjunctival flaps, bare sclera technique, and excision with lamellar keratoplasty).[6]

It has been well-established that pterygia are composed of proliferating fibrovascular tissue and the pterygium formation, and progression require neovascularization, many molecules regulate angiogenesis have been identified, suggesting that the vascular endothelial growth factor (VEGF) may be involved directly or indirectly in the pathogenesis of pterygia.[7]

Various studies have shown that recurrence is high from 30% to 88% after simple excision in pterygium and in excision with bare sclera it may be 32%.[8] VEGF has been detected in increased amounts in pterygium epithelium, compared with normal conjunctiva by studies employing immunohistochemistry.[9]

Bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA, USA) is a recombinant, humanized anti-VEGF antibody that binds all VEGF isoforms and exerts a neutralizing effect by inhibiting the VEGF-receptor interaction. It has been suggested as a possible adjunctive therapy for pterygium excision that decreases the vascularity of newly formed blood vessels, hence decreasing the recurrence rate and appears to have a role in prevention of recurrence.[10]

This study aimed to evaluate the effect of subconjunctival injection of bevacizumab in a single dose followed by surgical excision of pterygium with conjunctival autograft after 1 week.

A randomized controlled prospective study to assess the role of subconjunctival bevacizumab in primary pterygium surgery in Indian patients

The treatment of glaucoma in and around pregnancy offers the unique challenge of balancing the risk of vision loss to the mother as against the potential harm to the fetus or newborn. Most anti-glaucoma drugs (i.e. beta-blockers, prostaglandin analogues, carbonic anhydrase inhibitors topical and systemic, cholinergics, anticholinesterases, and apraclonidine) are considered category C agents and ophthalmologists are usually limited to treating patients with the category B drugs of brimonidine and dipivefrin. Brimonidine is generally the preferred first-line drug in the first, second and early third trimester. Late in the third trimester, brimonidine should be discontinued because it can induce central nervous system depression in newborns wherein topical carbonic anhydrase inhibitors may be the optimal choice. Glaucoma surgery can be performed with caution in second and third trimester if the patients have a strong indication for the procedure. However, anesthetics, sedative agents, and antimetabolites still have potential risk for the fetus. Argon laser trabeculoplasty (ALT) or selective laser trabeculoplasty (SLT) is an alternative treatment that can be performed in all trimesters. Carbonic anhydrase inhibitors and β-blockers are certified by the American Academy of Pediatrics for use during nursing. However, low doses of these medications should be considered when used in the breast feeding period. Optimum treatment for glaucoma in pregnancy must not be withheld so as to prevent any further deterioration in progressive vision loss and quality of life.

Management of glaucoma in pregnancy: risks or choices, a dilemma?

A 15‐year‐old female presented with insidious onset, gradually progressive, and painless diminution of vision. Relevant ophthalmic, systemic, and family history was negative. Best Corrected Visual Accuity (BCVA) on Snellens chart was 6/12. Slitlamp examination showed fine birefringent deposits in the corneal stroma. Ref. Figs. 1‐3. Rest ocular examination was unremarkable. There was no evidence of pedal edema or pericoular edema or oliguria ruling out renal dysfunction. Urine examination did not reveal any crystals. Renal function tests were well within normal limits. Leucocyte assay revealed elevated levels of Cysteine. A diagnosis of Ocular Cystinosis was made and the patient is now on follow‐up.

Ocular cystinosis: Rarity redefined

To compare the intraoperative efficiency and postoperative visual outcome of coaxial phacoemulsification using 2.2- and 2.8-mm clear corneal incision coaxial phacoemulsification. The study was conducted at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi which is a tertiary health care centre. This is a prospective, randomized, comparative interventional study. A total of 140 eyes of patients undergoing cataract surgery were enrolled according to the inclusion–exclusion criteria and randomly divided in two groups of 70 such that Group I—Patients underwent phacoemulsification through 2.8-mm clear corneal incision. Group II—Patients underwent phacoemulsification through 2.2-mm clear corneal incision.Postoperative assessment was done at 1 day, 1 and 6 weeks to note best-corrected visual acuity (BCVA), ophthalmic examination, corneal topography, central corneal thickness and corneal endothelial cell count. 1. Quantitative variables were compared using Mann–Whitney test and Wilcoxon ranked-sum test. 2. Qualitative variables were compared using Fisher’s exact test. p value of <0.05 was considered statistically significant. There is steady trend in decrease in postoperative astigmatism with time, more so in 2.8 mm group; however, differences were not found to be statistically significant. 2.2 mm group had larger increase in CCT and ECC compared to 2.8 mm group which was not statistically significant (p = 0.296). Reducing the incision size from 2.8 to 2.2 mm does not result in any significant reduction in the amount of surgically induced astigmatism. Also, both the incision sizes have similar intraoperative efficacy when compared in terms of postoperative decrease in corneal endothelial cell count and increase in central corneal thickness.

Comparative analysis of coaxial phacoemulsification with 2.2- and 2.8-mm clear corneal incisions.

Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Temporal iridofundal coloboma with persistent pupillary membranes with persistent fetal vasculature.

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