Abstract: The outcomes of modern ophthalmic surgery, especially cataract surgery, continue to improve and patients now realistically expect an excellent and speedy outcome with good vision and few complications. Social and regulatory demands for greater transparency and accountability in medicine have increased, highlighting a fundamental ethical tension in medical education—balancing the needs of trainees (who have not yet mastered the technique) to gain experience by performing surgery, with patient safety and the needs of the public to be protected from risk. Patient safety and well-being are the paramount considerations in any training program and must be the first consideration in program design. A variety of different educational strategies, each implemented with the aim of improving operative skills assessment and teaching, has recently been described in the literature. Effective use of these educational tools, combined with a structured approach to teaching and providing meaningful feedback, could improve outcomes, decrease complications and improve the quality and efficiency of surgical training in ophthalmology. Supervisors must assess their teaching style and communication, as being a good surgeon does not necessarily make a good trainer. Open disclosure must be given to patients about who will be performing the surgery, and communication during surgery between supervisors and trainees must be clear, respectful and appropriate.
Background: The usage of the light emitting diode (LED) has been increasingly applied in the illumination setting and electronic equipment. However, the effect of LED lights on the retina remains unclear. In this study, we observed and analyzed the impact of white LED lights at different intensities on the function and morphology of rat retinas.
Methods: Thirty-six Sprague-Dawley rats weighing 150–180 g were randomly divided into six groups (n=6 in each group) including a normal control (NC) group, 4 white LED groups at different light intensities (4,000, 6,000, 7,000, and 10,000 lux), and an ultraviolet B (UVB) lighting group (302 nm, 1,000 μw/cm2). After 24 hours of continuous illumination, full-field flash electroretinogram (FERG) and pathological examination were performed in each group.
Results: As revealed by FERG, the impairment of retinal function gradually worsened with the increase of LED light intensity. In contrast, the UVB group had the most severe retinal function impairment. Particularly, the functional damage of rod cells and inner nuclear layer cells was the main FERG finding in each group. In the NC group, the retina had typical morphologies featured by well-defined structures, clearly visible border between the inner and outer segments, and neatly arranged inner and outer nuclear layer cells. After 24 hours of illumination, the inner and outer parts of the retina in the 4,000 lux group were still neatly arranged, along with a clear border; however, the inner and outer nuclear layers were randomly arranged, and some irregular nuclei and cells were lost. The damage of the internal and external retinal segments and the internal and external nuclear layers became more evident in the 6,000 lux group, 7,000 lux group, and 10,000 lux group. The UVB group had a more obviously disordered arrangement of inner and outer nuclear layers and loss of cells.
Conclusions: Continuous exposure to white LED light can cause structural and functional damage to rat retinas, and such damage is related to the intensity of illumination. Therefore, the risk of retinal damage should be considered during LED illumination, and proper LED illumination intensity may help to maintain eye health.
Background: To investigate the effect of sirolimus (SRL) eye drops on acute alkali-burn-induced corneal neovascularization (CNV) and explore its possible mechanism.
Methods: A total of 57 male Sprague-Dawley rats weighing 160–180 g were randomly divided into four groups including a normal control group (NC group, n=12), an untreated alkali-burned model control group (MC group, n=15), a blank eye drop treatment group (BT group, n=15), and an SRL eye drop treatment group (ST group, n=15). Corneal inflammation and CNV were observed and scored under a slit-lamp microscope 3, 7, and 14 days after alkali exposure. Three rats were randomly sacrificed in each group before modeling and 3, 7, 14 days after modeling, and the corneas of right eyes were harvested for Western blotting to compare the expression levels of VEGFR2 and caspase-3.
Results: Corneal inflammation scoring showed that the corneal edema and conjunctival congestion were severe in the MC, BT, and ST groups 1 day after alkali exposure but were alleviated at day 3. The corneal transparency was significantly higher in the ST group than in the MC and BT groups at days 7 (F=9.77, P<0.05) and 14 (F=5.81, P<0.05). At day 1, the corneal limbal vascular network was markedly filled. SNV was obvious at days 3, 7, and 14. The new blood vessels were shorter and sparser in the ST group than in the MC and BT groups, and the CNV scores showed significant differences among these groups (day 3: F=8.60, P<0.05; day 7: F=11.40, P<0.05; and day 14: F=41.59, P<0.01). Western blotting showed that the expressions of VEGFR2 and caspase-3 were low before modeling and showed no significant difference among the different groups (F=0.52, P>0.05; F=0.98, P>0.05). The corneal expression of VEGFR2 became significantly higher in the MC and BT groups than in the ST group 3, 7, and 14 days after alkali exposure, and there were significant differences in relative gray-scale values among these groups (day 3: F=32.16, P<0.01; day 7: F=85.96, P<0.01; day 14: F=57.68, P<0.01). The increase in the corneal expression of caspase-3 was significantly larger in the ST group than in the MC and BT groups at days 3, 7, and 14, and there were significant differences in relative gray-scale values among groups (day 3: F=32.16, P<0.01; day 7: F=53.02, P<0.01; day 14: F=38.67, P<0.01).
Conclusions: SRL eye drops can alleviate acute alkali-burn-induced corneal inflammation and inhibit alkali-burn-induced CNV in rat models. It can reduce VEGFR2 expression and increase caspase-3 expression in the corneal tissue, which may contribute to the inhibition of alkali-burn-induced CNV.
Abstract: The efficacy of selective laser trabeculoplasty (SLT) to treat open-angle glaucoma (OAG) and ocular hypertension (OHT) has been increasingly substantiated lately. Repeated SLT is usually needed to control intraocular pressure (IOP), be it as primary or adjunctive therapy. We review the studies available, in terms of SLT repeatability; and conclude comparable efficacy, with success rate, duration and complications similar to those in initial SLT.
Abstract: To present spectral domain optical coherence tomography (OCT) findings during treatment in a case of acute isolated cilioretinal artery occlusion (CLRAO) reversed with intravenous systemic administration of mannitol and carbogen inhalation. Close monitoring with OCT thickness topographic map and cross section scans, every 12 hours, during treatment and till complete reversal of retinal nerve fiber layer edema. Fundus photography and fluorescein angiography (FFA) were used to illustrate occlusion and recanalization. After 72 hours of therapy, visual acuity improved from counting fingers (CF) to 7/10, Snellen’s chart. Consecutively OCT scans showed that the initial macular edema was gradually restored to typical 72 hours of treatment initiation. FFA performed after treatment confirmed recanalization of the cilioretinal artery. Early intervention with the combined intravenous administration of mannitol and carbogen inhalation can reverse acute onset loss of vision due to CLRAO. The reflectivity of retinal layers differs significantly regarding stages of acute CLRAO. In our case report increased reflectivity of the innermost layers of the retina was illustrated and a corresponding reduction in the outer retina and the retinal pigment epithelium and choriocapillaris layers. Macular thickness follow-up data recorded the course of intracellular edema to normal.
Abstract: Cataract surgery is one of the most commonly performed surgeries among the elderly today. The volume of cataract surgeries has dramatically increased in the past few decades due to technological advancements leading to decreased morbidity, better overall outcomes, and increased expectation for correction of refractive error and spectacle independence after cataract surgery. The number of cataract surgeries is expected to continue to rise with the increase of the elderly population. Thus, accurate predictions of intraocular lens (IOL) power and the ability to correct for any postoperative refractive errors are critical. Despite the improved ability of cataract surgeons to accurately calculate IOL power, postoperative refractive errors still do occur due to various reasons such as imperfect preoperative measurements, toric-lens misalignment, and existing or surgically-induced astigmatism. The aim of this article is to review the various surgical options, including intraocular and corneal refractive surgical approaches, to correct post-operative refractive errors after cataract surgery.
