Ophthalmology Commons^™

Insight, Volume 3, Issue 1, 2023

inSIGHT

Contents

8 - Age-Related Macular Degeneration and Emerging Treatments
By Charles F. DeYoung

13 - Review of Surgical Management for Closed-Angle Glaucoma
By Scott C. Kozarsky

18 - Exploring the Debate: DMEK and DSEK in Corneal Transplantation
By Christian Raimondo

23 - Room to Wiggle
By Holden Caplan

30 - Ophthalminute Highlight
By Anza Rizvi

34 - Thyroid Eye Disease: Overview and Treatment
By Michelle Omega

38 - Current Barriers to Eye Care
By Annika G. Samuelson

Seeing Eye To Eye: An Overview Of Strabismus And Approach To Treatment, Shreya Swaminathan, Bs

inSIGHT

Strabismus is a heterogenous group of conditions characterized by the misalignment of the eyes. It may manifest as constant or intermittent deviation, meaning the eyes sometimes appear well aligned, or straight, and sometimes appear misaligned. Vision can be normal in some patients, but when associated with amblyopia, may be decreased vision in one eye. There is sometimes diminished binocular vision, with decreased depth perception.

A Look Into Oculoplastics: Repairing Lower Eyelid Defects From Carcinomas, Cameron Haghshenas, Bs

inSIGHT

Eyelids are the thinnest, most sensitive skin we have and can easily be damaged by sun exposure. This is evident given that 5 - 10% of all skin cancers occur on the eyelid, and over half of these occur on the lower eyelid¹. Most of such cases are basal cell carcinomas, which are slow-growing cancers that arise from the basal cell layer, the deepest part of the epidermis. If left untreated or improperly treated, these tumors can extend into adjacent tissues and bone, or recur. Squamous cell carcinomas can also occur on the lower eyelid, although they represent …

Manual Small-Incision Cataract Surgery, Ankur Nahar, Bs

inSIGHT

Of the 49 million people living with blindness worldwide, 15.2 million are blind due to cataracts, making it the leading cause of preventable blindness.^1,2 Furthermore, 65.2 million people experience moderate to severe vision impairment from cataracts, according to the World Report on Vision published by the World Health Organization (WHO).³ While global cataract surgery efforts have been a major success over the past three decades, an aging population has resulted in a rapid rise in cataracts, primarily in low- and middle-income countries (LMICs).^2,4 To address the increasing demand for cataract treatment, countries must perform an equal or …

Gatt: A Micro-Invasive Glaucoma Surgery And A Big Step For Glaucoma Treatment, Mose Im, Bs

inSIGHT

Glaucoma is a group of ocular diseases characterized by damage to the optic nerve that may lead to permanent vision loss. Currently, 76 million people (aged 40-80 years) suffer from glaucoma, and the prevalence is projected to increase to 111.8 million by 2040.¹ The diagnosis of glaucoma can be frightening, particularly because there is no known cure. Fortunately, recent advancements in glaucoma surgery have made more options available for patients presenting with new-onset glaucoma. In particular, patients with mild to moderate glaucoma may be eligible for newer minimally invasive glaucoma surgeries (MIGS). This review is both an overview of …

Origins Of The Wills Eye Manual: Surviving The Test Of Time, Jordan Safran, Bs

inSIGHT

The first copy of the Wills Eye Manual hit the press in late 1989; it featured a black cover page with bold gold lettering and the Wills Eye logo proudly displayed on top. Published in a time before the invention of the world wide web or the advent of digital printing, this 450-page expertly sourced ocular disease reference guide took the ophthalmology world by storm. Since its debut, the manual has served as the go-to guide for trainees and seasoned physicians alike in diagnosing and treating more than 200 ocular diseases. To date, the Wills Eye Manual has published eight …

A Day In The Life In The Wills Er, Samara Hamou, Ms1

inSIGHT

The Wills Eye Hospital — among the greatest eye hospitals in the country — is a force to be reckoned with. Located in Center City Philadelphia, the eight-story tall brick facility will capture your attention as you stroll down Walnut Street. The entrance to the Wills Eye Emergency Room (ER), however, is less apparent to the average city-goer. Located directly across from the Hospital, the red and blue entrance sign may go unnoticed to the unsuspecting by passer. However, for those who require expert eye care in a timely fashion, the Eye Emergency Room is a signal for the invaluable …

Neuro-Ophthalmology Subspecialty Highlight: With Dr. Sarah Thornton, Wills Eye Hospital, Joseph D. Desimone, Bs

inSIGHT

Neuro-Ophthalmology is a subspecialty within ophthalmology that combines the complexities of nervous system disease with the intricacies of the ocular manifestations of those diseases. Neuro-ophthalmologists work closely with neurologists, neurosurgeons, rheumatologists, and other ophthalmologists in different subspecialties, such as retina and glaucoma, to get to the source of their patients’ problems. Neuro-ophthalmology is typically a 1-year fellowship undertaken after residency training is completed, where physicians will learn the complex ways different diseases can manifest in the eye.

A New Dimension To Offer, Ari August, Bs

inSIGHT

Technological advancements are crafted, fielded, and sold from the vantage point of benefit: How can this make my life better? The origins of three-dimensional (3D) technology are no different. 3D technology targets the mind’s ability to make sense of two different angles of an image, and therefore perceive depth. Earlier models, common in movie theaters and cereal box toys, utilized red and blue lenses to outwit one’s perception of a flat image and project it into 3D images, promising deeper immersive experiences and even “x-ray vision.” More recently, the capacity of 3D technology has expanded, as seen with the recent …

Intraocular Lens Tilt Due To Optic-Haptic Junction Distortion Following Intrascleral Haptic Fixation With The Yamane Technique, Jordan P. Safran, Steven G. Safran

SKMC Student Presentations and Publications

Purpose: To report two patients with a complication of Yamane intrascleral haptic fixation surgery (ISHF) with the Zeiss CT Lucia 602 lens: severely tilted intraocular lens (IOL) leading to significantly decreased vision in the early post-operative period.

Observations: We report two patients presenting with severely tilted IOL implants one day and one month following Yamane ISHF. The first patient is a monocular 81-year-old woman referred for treatment of cornea edema. Initial surgery involved replacement of an anterior chamber lens with a CT Lucia 602 posterior chamber lens using Yamane technique and Descemet's stripping endothelial keratoplasty. The patient returned at one …

Local Ocular Safety Of The Subconjunctival Injection Of Cetuximab In Rabbits, Hossein Aghaei, Ahmad Kheirkhah, Ali Mohammad Alizadeh, Acieh Es'haghi, Roshanak Aliakbar-Navahi, Zahra Keikha, Samira Chaibakhsh

Faculty, Staff and Student Publications

BACKGROUND: To evaluate the safety of different doses of subconjunctival cetuximab in rabbits.

METHODS: After general anesthesia rabbits received a subconjunctival injection of 2.5 mg in 0.5 ml, 5 mg in 1 ml, and 10 mg in 2 ml of cetuximab in their right eyes (two rabbits in each group). A similar volume of normal saline solution was injected subconjunctivally in the left eyes. The histopathologic changes were evaluated after enucleation with the aid of H&E staining.

RESULTS: No significant difference were observed between the treated and control eyes in terms of conjunctival inflammation, goblet cell density, or limbal blood …

Scar Formation In The Presence Of Mitomycin C And The Anti-Fibrotic Antibody In A Rabbit Model Of Glaucoma Microsurgery: A Pilot Study, Aakriti Garg Shukla, Tatyana Milman, Jolanta Fertala, Andrzej Steplewski, Andrzej Fertala

Wills Eye Hospital Papers

Purpose: This study aimed to evaluate the utility of a rationally engineered antibody that directly blocks collagen fibrillogenesis to reduce scar tissue formation associated with subconjunctival glaucoma surgery.

Material and methods: Fourteen eyes of 7 adult rabbits underwent glaucoma filtering surgery using XEN 45 Gel Stent. The rabbits’ eyes were divided randomly into three treatment groups: (i) treated with the antibody, (ii) treated with mitomycin C, and (iii) treated with the antibody and mitomycin C. Following surgeries, the intraocular pressure and bleb appearance were evaluated in vivo. The rabbits were sacrificed 8 weeks after the surgery, and their eyes were …

Identification Of The Vibrational Optical Coherence Tomography Corneal Cellular Peak, Nathalie D. Daher, Ahmed Saeed Saad, Hiram J. Jimenez, Tatyana Milman, Orlando G. Gonzalez-Martinez, Tanmay S. Deshmukh, Jose S. Pulido, Frederick H. Silver, Dominick A. Benedetto, Christopher J. Rapuano, Zeba A. Syed

Wills Eye Hospital Papers

Purpose: Our team previously identified the presence of five corneal resonant frequency (RF) peaks in healthy volunteers using vibrational optical coherence tomography (VOCT). Prior studies have suggested that the ≤100 Hz RF peak represents the cellular element of tissue. The aim of this study was to confirm that this peak reflects the human corneal cellular component using VOCT and histological analysis.

Methods: Two human research globes were obtained from the same donor, and VOCT measurements were collected from the full-thickness corneas. A microkeratome was then used to create serial-free corneal caps from each cornea, with VOCT performed on the residual …

Induction Of Innate Inflammatory Pathways In The Corneal Epithelium In The Desiccating Stress Dry Eye Model, Zhiyuan Yu, Ghasem Yazdanpanah, Jehan Alam, Cintia S De Paiva, Stephen Pflugfelder

Faculty, Staff and Students Publications

PURPOSE: To determine whether 24-hour exposure to the desiccating stress (DS) dry eye model induces NF-kB and NLRP3 inflammasome pathways in the mouse cornea epithelium.

METHODS: Six- to 8-week-old C57BL/6J mice were housed under normal humidity (nonstressed) or subjected to DS from a drafty, low-humidity environment combined with subcutaneous scopolamine four times/day for one day to suppress tear production (DS1). Cornea whole mounts were prepared for immunofluorescent staining, or the corneal epithelium was scraped for NF-kB p-p65 ELISA, Western blot, or real-time PCR to detect NF-kB and inflammasome pathway proteins and gene transcripts, respectively.

RESULTS: NF-kB phospho-p65 protein, nuclear NF-kB …

Light Responses And Amacrine Cell Modulation Of Morphologically-Identified Retinal Ganglion Cells In The Mouse Retina, Ji-Jie Pang, Fan Gao, Samuel M Wu

Faculty, Staff and Students Publications

By analyzing light-evoked spike responses, cation currents (ΔIC) and chloride currents (ΔICl) of over 100 morphologically-identified retinal ganglion cells (GCs) in dark-adapted mouse retina, we found there are at least 14 functionally- and morphologically-distinct types of RGCs. These cells can be divided into 5 groups based on their patterns of spike response to whole field light steps (SRWFLS), a GC identification scheme commonly used in studies with extracellular recording techniques. We also found that all GCs in the mouse retina express strychnine-sensitive glycine receptors, and receive light-elicited chloride current (ΔICl) accompanied by a conductance increase from narrow-field, glycinergic amacrine cells. …

The Circadian E3 Ligase Fbxl21 Regulates Myoblast Differentiation And Sarcomere Architecture Via Myoz1 Ubiquitination And Nfat Signaling, Bo Hu, Jian-Xing Ma, Adam S Duerfeldt

Faculty, Staff and Student Publications

Diabetic retinopathy and age-related macular degeneration are common retinal diseases with shared pathophysiology, including oxidative stress-induced inflammation. Cellular mechanisms responsible for converting oxidative stress into retinal damage are ill-defined but have begun to clarify. One common outcome of retinal oxidative stress is mitochondrial damage and subsequent release of mitochondrial DNA into the cytosol. This leads to activation of the cGAS-STING pathway, resulting in interferon release and disease-amplifying inflammation. This review summarizes the evolving link between aberrant cGAS-STING signaling and inflammation in common retinal diseases and provides prospective for targeting this system in diabetic retinopathy and age-related macular degeneration. Further defining …

Pamam- Cyclodextrin Conjugate Upregulates Brain-Derived Neurotropic Factor In Arpe-19 Cells, Gopika Ashokan

USF Tampa Graduate Theses and Dissertations

Background: Traumatic Brain Injury (TBI) is a major contributor to death and disability due to motorvehicle accidents, sports, physical abuse, and battlefield injuries. The primary insult to the brain leads to inflammation, vascular dysfunction, and oxidative stress in the brain as well as in the eye. This leads to loss of Retinal Ganglion Cells (RGCs) and downregulation of Brain derived Neurotopic Factor (BDNF). BDNF is a neurotrophic factor that binds to Tropomyosin Receptor Kinase B (TrkB) receptor to promote cell growth, survival, and differentiation. Current treatment strategies do not promote neuronal regeneration. Therefore, novel treatments are needed to restore vision …

Intratumoral Bacteria In Uveal Melanoma: A Case Report, Katherine Vega Escobar, Paola Ordonez Armijos, Tatyana Milman, Carol L. Shields, Ralph C. Eagle Jr.

Wills Eye Hospital Papers

Purpose Intratumoral bacteria and their potential application to cancer immunotherapy have been a topic of interest in recent studies. To our knowledge, bacteria in uveal melanoma have not been previously reported.

Observations We describe a patient with a large choroidal melanoma, measuring 18 × 16 mm in basal dimension and 15 mm in ultrasonographic thickness, managed by plaque brachytherapy. At the time of plaque removal, a prophylactic scleral patch graft was placed to protect from anticipated scleral necrosis. Progressive ocular ischemia led to a blind and painful eye. The enucleated eye demonstrated an extensively necrotic and heavily pigmented mushroom-shaped regressed …

Topical Anesthetic Gel Interferes With Antibacterial Efficacy Of Povidone-Iodine Both In Vitro And In Vivo, Cecilly Kelleher Bs, Jacob Im Md, Linda Kang Bs, Aleksey Mishulin Md, Sukhvinder Singh Phd, Ashok Kumar Phd

Medical Student Research Symposium

Purpose: To evaluate the effects of viscous lidocaine gel on the antimicrobial efficacy of povidone-iodine (PI) and their order of application in both in vitro and in vivo models.

Methods: In vitro antibacterial effects were tested against Staphylococcus aureus (S. aureus) with disc diffusion methods for application of lidocaine alone, PI alone, PI before lidocaine, and lidocaine before PI. Zones of inhibition were measured after incubation at 37°C overnight. Mouse eyes were colonized with S. aureus for in vivo study to which PI and/or lidocaine were applied in various combinations. Eyes were then rinsed with saline, and …

Assessment Of The Nanodropper Eye Drop Adaptor For Glaucoma Medications, Nicholas Pryde, Parker J. Williams, Faisal Ridha Al-Timimi, John Michael Guest

Medical Student Research Symposium

Assessment of the Nanodropper Eye Drop Adaptor for Glaucoma Medications

Nicholas Pryde, BS¹; Parker J. Williams, DO ¹; John-Michael Guest, MD¹; Bret A. Hughes, MD¹; Faisal Ridha MD¹

¹Kresge Eye Institute and Wayne State University Department of Ophthalmology, Detroit, MI, USA

Purpose: To determine the dispensed volume change for seven medications with and without the Nanodropper adaptor.

Methods: Sequentially, 100 µL of each medication was dispensed by micropipette into a 1.5 mL Eppendorf tube, and mass without the tube was determined with a precision balance (Practum, Germany). The mean mass was …