Weekly review in ophthalmology: April 9-April 15

An end-of-week review of what happened in ophthalmology from April 9-April 15.

This week in ophthalmology, we saw breaking news regarding the first MINIject surgery completed in the UK, updates on 'Focus on Child Eye Health' from the International Agency for the Prevention of Blindness (IABP), a first-hand account of how to use an anterior segment camera during a slit lamp exam and so much more.

First MINIject surgery completed in the UK

iSTAR Medical, a medtech company delivering breakthrough eye care solutions to patients today, recently announced it has further expanded its commercial rollout for MINIject® to the UK.

According to a press release, MINIject® is iSTAR Medical’s minimally-invasive glaucoma surgery (MIGS) implant, and is currently the only commercially available supraciliary MIGS device. It is designed to enhance natural fluid outflow, reduce intraocular pressure (IOP) and the need for medication, while bio-integrating with surrounding tissue, limiting inflammation, fibrosis and subsequent complications.

This expansion allows patients in the UK living with open angle glaucoma the benefit of the implant, which has demonstrated “meaningful and sustained performance, combined with a favourable safety profile,” the release states.

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A portable solution for high definition slit-lamp imaging

Learning how to use the slit lamp is not easy. I think as ophthalmologists we take this skill for granted and forget the journey we undertook to master basic examination techniques. I vividly remember sitting in the clinic during my ophthalmology rotations as a medical student and wishing that I could see what the consultant was seeing.

I had a revelation at the beginning of my ophthalmology residency some years ago when I witnessed the use of an anterior segment camera. Why not use this camera to teach people how to use slit lamps?

My consultants at the time seemed indifferent to this suggestion but one of my seniors agreed with me. So, when the camera was not in use (the vast majority of the time), we used it in the clinic. It helped me to develop my clinical skills—I found it particularly useful for learning how to examine the cornea and recognise a huge variety of pathologies.

With the consent of the patients that we saw, I made a video library, which I attached my notes to. Feeling vindicated as well as passionate about the benefit of slit lamp cameras for ophthalmic education, I fought for a grant for teaching slit lamps after securing a loan device for a few months.

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High performance microscopy for non-invasive conjunctival goblet cell examination examined by study

A team of investigators from Pohang University of Science and Technology has found that conjunctival goblet cell examination is important for the precise diagnosis and effective treatment of ocular surface diseases; however, CGC examination has not been possible until now due to lack of non-invasive devices.

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'Focus on Child Eye Health' initiative introduced by IAPB

The International Agency for the Prevention of Blindness (IAPB) recently announced an expansion of their ‘Focus on Glaucoma’ and ‘Focus on Diabetes’ series with their new ‘Focus on Child Eye Health’ series in partnership with CooperVision.

Traditionally, these series have concentrated knowledge over the course of a single week; however, this time, this year, IAPB is undertaking a new format.

“The topic will be revisited from January through December — a major commitment corresponding with the importance of the issue,” a press release from IAPB said. “By doing this, IAPB will engage more members than ever before and shine a brighter light on efforts that advance child eye health awareness and advocacy across the vision sector and beyond.”

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Corneal haze after corneal cross-linking associated with mitomycin C

Rather than preventing the development of corneal haze after corneal cross-linking (CXL) procedures, the application of the cytotoxic agent mitomycin C (MMC) contributes to its development, according to Dr Shady T. Awwad, professor of clinical ophthalmology at the American University of Beirut Medical Center, in Lebanon.

The rationale for applying MMC after CXL is that it inhibits incoming keratocytes following the procedure. However, abundant cytokine release from a surge in apoptosis due to the combination of CXL and MMC seems to be responsible for the development of more haze.

Dr Awwad and colleagues reached this conclusion based on the results of a retrospective, single-centre study of 72 patients (87 eyes with keratoconus) who underwent CXL from June 2013 to January 2015 at the American University of Beirut Medical Center. The same surgeon performed all CXL procedures using the Dresden protocol. MMC was applied at the end of each CXL procedure as part of the routine protocol from February 2015 to December 2015.

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Identifying patients at high risk for endophthalmitis post-cataract surgery

The risk factors for development of endophthalmitis after cataract surgery have been identified as complex cataract procedures, the performance of simultaneous vitreous procedures, a history of diabetic macular oedema or proliferative diabetic retinopathy, male sex and certain cataract types.

A large retrospective analysis using the IRIS (Intelligence Research in Sight) Registry showed that these factors are associated with significantly higher rates of the rare but potentially vision-threatening infection, according to Dr Michael H. Goldstein, president and chief medical officer of Ocular Therapeutix. Incidence rates range from 0.5 to 3.0 cases per 1,000 cataract surgeries. Dr Goldstein pointed out that the incidence rate between 2013 and 2017 was 0.42 cases per 1,000 surgeries, based on IRIS Registry data.

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