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Papers in this Session
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Association of Meibomian Gland Dysfunction and Body Mass Index in a Pediatric Population
Authors
Nandini Venkateswaran, MD
Preeya K. Gupta, MD
Jessica Heinke, OD
Sandra S. Stinnett, PhD
Purpose
To determine if meibomian gland architecture in a pediatric population is impacted by body mass index (BMI).
Methods
Prospective evaluation of 175 eyes of 175 pediatric patients from the Duke University Eye Center and Family Eye Care of Woodstock and Lake Geneva clinics. Demographic and clinical information were reviewed. Subjective symptoms of dry eye were assessed with the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Meibography was performed and grading of images was performed by a masked rater using a previously validated 5-point meiboscale (0-4) for gland atrophy and a 3-point meiboscale (0-2) for gland tortuosity.
Results
175 eyes of 175 patients ages 4 to 17 years were imaged. Mean meiboscore was 0.82+ 0.94 (range 0-4) and mean gland tortuosity score was 0.53 + 0.70 (range 0-2). Mean BMI was 20.5 + 4.86 kg/m2 with 39.4% of patients (n=69) above the 85th percentile. Meiboscore was not correlated with BMI percentile (p=0.41) however the difference between gland tortuosity for percentile BMI was statistically significant (p=0.02). BMI percentile was found to be a significant predictor of gland tortuosity (p=0.02) and patients with higher BMI were more likely to have gland tortuosity (odds ratio 3.15, CI 1.17 – 8.48). No significant associations were found between age, race, or sex and meiboscore or tortuosity.
Conclusion
In this pediatric population, there was a significant association between meibomian gland tortuosity and higher percentiles of BMI, suggesting a potential correlation with nutritional status and MGD. Future longitudinal studies are needed to further elucidate the pathogenesis of progressive gland tortuosity, atrophy, and MGD in pediatric patients.
Nandini Venkateswaran, MD
Preeya K. Gupta, MD
Jessica Heinke, OD
Sandra S. Stinnett, PhD
Purpose
To determine if meibomian gland architecture in a pediatric population is impacted by body mass index (BMI).
Methods
Prospective evaluation of 175 eyes of 175 pediatric patients from the Duke University Eye Center and Family Eye Care of Woodstock and Lake Geneva clinics. Demographic and clinical information were reviewed. Subjective symptoms of dry eye were assessed with the Standard Patient Evaluation of Eye Dryness (SPEED) questionnaire. Meibography was performed and grading of images was performed by a masked rater using a previously validated 5-point meiboscale (0-4) for gland atrophy and a 3-point meiboscale (0-2) for gland tortuosity.
Results
175 eyes of 175 patients ages 4 to 17 years were imaged. Mean meiboscore was 0.82+ 0.94 (range 0-4) and mean gland tortuosity score was 0.53 + 0.70 (range 0-2). Mean BMI was 20.5 + 4.86 kg/m2 with 39.4% of patients (n=69) above the 85th percentile. Meiboscore was not correlated with BMI percentile (p=0.41) however the difference between gland tortuosity for percentile BMI was statistically significant (p=0.02). BMI percentile was found to be a significant predictor of gland tortuosity (p=0.02) and patients with higher BMI were more likely to have gland tortuosity (odds ratio 3.15, CI 1.17 – 8.48). No significant associations were found between age, race, or sex and meiboscore or tortuosity.
Conclusion
In this pediatric population, there was a significant association between meibomian gland tortuosity and higher percentiles of BMI, suggesting a potential correlation with nutritional status and MGD. Future longitudinal studies are needed to further elucidate the pathogenesis of progressive gland tortuosity, atrophy, and MGD in pediatric patients.
Outcomes in Pediatric Subluxation of Lens
Authors
Jagat Ram, MS
Surbhi Khurana, MBBS, MS
Parul Chawla Gupta, MS
Bala Murugan Sr., MS
Vijay K. Sharma, MBBS
Savleen Kaur, MS
Purpose
To evaluate the various causes, clinical features and surgical outcomes in children with subluxated lens.
Methods
We analyzed children with age less than or equal to 16 years with bilateral subluxated lens at a tertiary eye care centre in India. Patients underwent phacoaspiration assisted with Cionni-ring or Capsular tension segment with/without intraocular lens (IOL) implantation; or lensentomy with trans-scleral fixated IOL (TSFIOL). Preoperative and postoperative best-corrected visual acuity was compared, and causes of subluxation, postoperative complications and secondary procedures were analyzed.
Results
60 eyes of 30 children mean age 8.3 years were included. Causes of subluxation was idiopathic in 19 patients (63.3%), Marfan’s syndrome 8(26.7%), homocystinuria 2(6.7%) and trauma 1(3.3%). Preoperatively, best-corrected visual acuity was ≤20/200 in 60 eyes. Phacoaspiration was assisted with Cionni-ring in 27 eyes (45.8%), CTS in 5 eyes (8.5%). Lensectomy with TSFIOL done in 21 eyes (35.6%). Hydrophobic acrylic IOL was implanted in 32eyes and 6 eyes were left aphakic. Postoperatively, best corrected visual acuity was ≤20/200 in 14 eyes (23.7%), 20/120-≤ 20/40 in 40 eyes (67.8%) and ≥20/40 5 eyes (8.5%). 6 patients required re-surgery in follow up between 6 months to 2 years.
Conclusion
Idiopathic cause was the most common cause of subluxated lens in our study and ocular surgery led to improvement in visual acuity in such cases with very few complications.
Jagat Ram, MS
Surbhi Khurana, MBBS, MS
Parul Chawla Gupta, MS
Bala Murugan Sr., MS
Vijay K. Sharma, MBBS
Savleen Kaur, MS
Purpose
To evaluate the various causes, clinical features and surgical outcomes in children with subluxated lens.
Methods
We analyzed children with age less than or equal to 16 years with bilateral subluxated lens at a tertiary eye care centre in India. Patients underwent phacoaspiration assisted with Cionni-ring or Capsular tension segment with/without intraocular lens (IOL) implantation; or lensentomy with trans-scleral fixated IOL (TSFIOL). Preoperative and postoperative best-corrected visual acuity was compared, and causes of subluxation, postoperative complications and secondary procedures were analyzed.
Results
60 eyes of 30 children mean age 8.3 years were included. Causes of subluxation was idiopathic in 19 patients (63.3%), Marfan’s syndrome 8(26.7%), homocystinuria 2(6.7%) and trauma 1(3.3%). Preoperatively, best-corrected visual acuity was ≤20/200 in 60 eyes. Phacoaspiration was assisted with Cionni-ring in 27 eyes (45.8%), CTS in 5 eyes (8.5%). Lensectomy with TSFIOL done in 21 eyes (35.6%). Hydrophobic acrylic IOL was implanted in 32eyes and 6 eyes were left aphakic. Postoperatively, best corrected visual acuity was ≤20/200 in 14 eyes (23.7%), 20/120-≤ 20/40 in 40 eyes (67.8%) and ≥20/40 5 eyes (8.5%). 6 patients required re-surgery in follow up between 6 months to 2 years.
Conclusion
Idiopathic cause was the most common cause of subluxated lens in our study and ocular surgery led to improvement in visual acuity in such cases with very few complications.
Effect on Corneal Endothelium Following Intra Vitreal Injection of Ranibizumab in Age Related Macular Degeneration
Authors
Dr.Bibhuti Kashyap, MD, DNB
Nidhi Gadkar, MS, DNB
Bharti Kashyap, MS
Purpose
Studies have shown the expression of VEGF & its receptors in cornea esp at epithelium & endothelial layer.These were found to have increased in inflamed & vascularized cornea. to evaluate the effect of possible changes of endothelium & central corneal thickness after intra vitreal injection of Ranibizumab in age related macular degeneration
Methods
82 eyes of 80 patients (78 unilateral, 2 bilateral) aged between 55 years to 72 years were included in this study. All patients received monthly intra vitreal injection of (0.05ml, 0.5mg) ranibizumab for 3 consecutive months. The endothelial cell densities were measured by Non Contact specular microscopy performed before injection and at 7 day and 6 months after first intra vitreal injections. The central corneal thickness was measured compared and analyzed preoperatively, at 7th day and 6th month by Alcon, Acuscan Machine to measure Pachymetry
Results
This study group included 48 male and 32 female. Out of 82 eyes, 29 eyes (35.4 %) were phakic and 53 eyes (64.6 %) were pseudophakic. There was no significant difference in the CCT measurements before injections and at 7 days post intra vitreal injection (t=1.157, p= 0.287) & between central corneal thickness before injections and at 6 months post first intravitreal injection (t=1.41, p=0.198). The Pre operative Corneal Endothelial count was found to be similar with no statistical significant difference between the post IV injection at 7 days (t=1.198, p=.234) and post 6 months (t= 1.094, p=0.311) respectively.
Conclusion
Repeated dose of intra vitreal injection of ranibizumab (0.5mg) has no statistically significant effect on corneal endothelium and central corneal thickness at 6 months.
Dr.Bibhuti Kashyap, MD, DNB
Nidhi Gadkar, MS, DNB
Bharti Kashyap, MS
Purpose
Studies have shown the expression of VEGF & its receptors in cornea esp at epithelium & endothelial layer.These were found to have increased in inflamed & vascularized cornea. to evaluate the effect of possible changes of endothelium & central corneal thickness after intra vitreal injection of Ranibizumab in age related macular degeneration
Methods
82 eyes of 80 patients (78 unilateral, 2 bilateral) aged between 55 years to 72 years were included in this study. All patients received monthly intra vitreal injection of (0.05ml, 0.5mg) ranibizumab for 3 consecutive months. The endothelial cell densities were measured by Non Contact specular microscopy performed before injection and at 7 day and 6 months after first intra vitreal injections. The central corneal thickness was measured compared and analyzed preoperatively, at 7th day and 6th month by Alcon, Acuscan Machine to measure Pachymetry
Results
This study group included 48 male and 32 female. Out of 82 eyes, 29 eyes (35.4 %) were phakic and 53 eyes (64.6 %) were pseudophakic. There was no significant difference in the CCT measurements before injections and at 7 days post intra vitreal injection (t=1.157, p= 0.287) & between central corneal thickness before injections and at 6 months post first intravitreal injection (t=1.41, p=0.198). The Pre operative Corneal Endothelial count was found to be similar with no statistical significant difference between the post IV injection at 7 days (t=1.198, p=.234) and post 6 months (t= 1.094, p=0.311) respectively.
Conclusion
Repeated dose of intra vitreal injection of ranibizumab (0.5mg) has no statistically significant effect on corneal endothelium and central corneal thickness at 6 months.
Microscope Integrated OCT Guided Intralenticular Lens Aspiration in Anterior Dislocation of Lens with Lenticulo-Corneal Adhesion and Edema
Authors
Prafulla K. Maharana, MD, DNB
Pranita Sahay, MD, DNB
Purpose
To describe the usefulness of microscope integrated optical coherence tomography (MIOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of lens with lenticulo corneal adhesion and corneal edema.
Methods
MIOCT guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal oedema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MIOCT.
Results
In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication such as Descemet tear or worsening in corneal oedema. Improvement in visual acuity was noted in all cases (median 6/9) with resolution in corneal edema by two weeks. There was no significant vitreous loss. There was no lens matter drop. No significant endothelial damage was noted in any of the case.
Conclusion
MIOCT guided ILLA ensures complete and safe lens aspiration in cases of anterior dislocation of lens with lenticulo-corneal adhesion and corneal edema without any significant vitreous loss and endothelial damage.
Prafulla K. Maharana, MD, DNB
Pranita Sahay, MD, DNB
Purpose
To describe the usefulness of microscope integrated optical coherence tomography (MIOCT) guided removal of lenticulo-corneal adhesion and intralenticular lens aspiration (ILLA) in cases with anterior dislocation of lens with lenticulo corneal adhesion and corneal edema.
Methods
MIOCT guided ILLA was performed in three eyes of two cases of homocystinuria with spontaneous anterior dislocation of lens and corneal oedema. Lenticulo-corneal adhesion was noted intraoperatively, which was not apparent pre-operatively. The lenticulo-corneal adhesion could be successfully peeled using intravitreal forceps and viscodissection with visco-dispersive viscoelastic under the guidance of MIOCT.
Results
In all cases, the lenticulo-corneal adhesion could be successfully removed without any complication such as Descemet tear or worsening in corneal oedema. Improvement in visual acuity was noted in all cases (median 6/9) with resolution in corneal edema by two weeks. There was no significant vitreous loss. There was no lens matter drop. No significant endothelial damage was noted in any of the case.
Conclusion
MIOCT guided ILLA ensures complete and safe lens aspiration in cases of anterior dislocation of lens with lenticulo-corneal adhesion and corneal edema without any significant vitreous loss and endothelial damage.
Combining Retina and Optical Performance to Predict Viability of Trifocal IOLs
Author
Samir I. Sayegh, MD, PhD, FACS, ABO
Purpose
To present results of our quantitative model of evolution of contrast sensitivity in patients at risk for retinopathy and suggest an evidence based foundation for the consent process in particular for implantation of trifocal intraocular lenses at the time of cataract surgery.
Methods
We summarize the effect of retinopathies on contrast sensitivity and review the effect of trifocal IOLs and their Modulation Transfer Functions. The evolution of the contrast sensitivity throughout the remaining life of the patient is modeled based on real data.
Results
It is demonstrated based on experimental evidence and Schade’s equivalent resolution, that a patient at risk for retinopathy reaches a suboptimal level of contrast sensitivity earlier in their life if implanted with a trifocal IOL as opposed to a monofocal IOL. Similar results apply to multifocals. Depending on time of surgical intervention and patient’s life expectancy, the difference may be significant. Cases of specific retinopathies, including macular degeneration and diabetic retinopathy, are discussed.
Conclusion
Suboptimal quality of vision in patients at risk for retinopathies despite early satisfaction with trifocals can be estimated . Given their mean age and the heightened desire of the younger segment to be spectacle free, coupled with a high life expectancy, it is paramount that this specific aspect be discussed and included in the informed consent.
Samir I. Sayegh, MD, PhD, FACS, ABO
Purpose
To present results of our quantitative model of evolution of contrast sensitivity in patients at risk for retinopathy and suggest an evidence based foundation for the consent process in particular for implantation of trifocal intraocular lenses at the time of cataract surgery.
Methods
We summarize the effect of retinopathies on contrast sensitivity and review the effect of trifocal IOLs and their Modulation Transfer Functions. The evolution of the contrast sensitivity throughout the remaining life of the patient is modeled based on real data.
Results
It is demonstrated based on experimental evidence and Schade’s equivalent resolution, that a patient at risk for retinopathy reaches a suboptimal level of contrast sensitivity earlier in their life if implanted with a trifocal IOL as opposed to a monofocal IOL. Similar results apply to multifocals. Depending on time of surgical intervention and patient’s life expectancy, the difference may be significant. Cases of specific retinopathies, including macular degeneration and diabetic retinopathy, are discussed.
Conclusion
Suboptimal quality of vision in patients at risk for retinopathies despite early satisfaction with trifocals can be estimated . Given their mean age and the heightened desire of the younger segment to be spectacle free, coupled with a high life expectancy, it is paramount that this specific aspect be discussed and included in the informed consent.