We read with interest the results reported by Romano et al. The
authors speculated the reason for lower endothelial failure in larger
grafts (9.5mm) compared to smaller ones is due to the additional
endothelial cells being transplanted.
It has been reported that the host peripheral endothelium in Fuchs
endothelial dystrophy (FED) has some capacity towards restoring corneal
deturgescence in denuded posterior st...
We read with interest the results reported by Romano et al. The
authors speculated the reason for lower endothelial failure in larger
grafts (9.5mm) compared to smaller ones is due to the additional
endothelial cells being transplanted.
It has been reported that the host peripheral endothelium in Fuchs
endothelial dystrophy (FED) has some capacity towards restoring corneal
deturgescence in denuded posterior stroma where the Descemet membrance
endothalial keratoplasty (DMEK) did not attached.(1,2) This observation
was seen in all 7 eyes with FED that had partial graft detachment but not
in any of the 5 eyes with aphakic or pseudophakic bullous keratopathy
(PBK).(1) In an eccentrically positioned DMEK, the area between the edge
of the descemetorhexis and the edge of the graft often showed faster
clearance in a fashion that starts from the recipient endothelium edge
towards the graft.(2) In fact, this gap clears faster than the area over
the attached DMEK.(2)
The above findings suggest the peripheral endothelium in FED may have
migrated to cover the bare posterior stroma. Interestingly, the peripheral
endothelium may have regenerative capacity as the endothelium cell density
(ECD) appeared similar in the repopulated area and in eyes with completed
attached graft.(2)
To accommodate a larger endothelial graft, the surgeon is likely to
perform a larger descemetorhexis, hence removing more of the host's
peripheral endothelium. Should some of latter remains, a large graft is
likely to overlap hence damage the cells. Whether one should always aim to
insert a larger graft in eyes with FED requires more thoughts.
In their study, Romano et al mentioned that graft failure is
associated with ECD and graft size. One wonders whether there is an
association between failure with combined graft size and diagnosis
(PBK/FED).
1) Dirisamer M, Yeh RY, van Dijk K, Ham L, Dapena I, Melles GRJ.
Recipient endothelium may relate to corneal clearance in Descemet membrane
endothelial transfer. Am J Ophthalmol 2012; 154: 290-296.
2) Dirisamer M, Dapena I, Ham L, van Dijk K, Oganes O et al. Patterns of
endothelialization and corneal clearance after Descemet membrane
endothelial keratoplasty for Fuchs endothelial dystrophy. Am J Ophthalmol
2011; 152: 543-555.
Dear Editor;
We read with great interest the article entitled "Prevalence of
canaliculitis after smartplug insertion during long-term follow-up" by
Klein-Theyer et al.(1) I would like to contribute to the article with our
clinical expeience.
Among 11 cases of canaliculitis after lacrimal plug insertion between
2007 and 2013 in a tertiary medical center, seven cases (64%) were noted
to be associated with the us...
Dear Editor;
We read with great interest the article entitled "Prevalence of
canaliculitis after smartplug insertion during long-term follow-up" by
Klein-Theyer et al.(1) I would like to contribute to the article with our
clinical expeience.
Among 11 cases of canaliculitis after lacrimal plug insertion between
2007 and 2013 in a tertiary medical center, seven cases (64%) were noted
to be associated with the use of Smartplug. All these patients were women
with a mean age of 53-year-old. This propensity could be related to
hormonal influence during menopause,(2) use of makeup,(3) or female
predominance of dry eye requiring lacrimal plug insertion. The average
time interval from plug insertion to the onset of symptoms was 4.7 years,
which is in consistent with most published studies.(1) This means that the
prevalence of lacrimal-plug canaliculitis may be underestimated if follow-
up is not really long enough. The most common isolated microorganism in
our study was Pseudomonas aeruginosa(29%), followed by Actinomyces(14%)
and Staphylococcus aureus(14%). All canaliculitis resolved after
canaliculotomy with removal of plug, and there was no recurrence was noted
during a mean post-operative follow-up period of 11 months. In the study
by Klein-Theyer and colleagues, the canaliculitis was resolved by topical
antibiotics and "repeated" lacrimal irrigations, and one of them with
persistent canaliculitis finally required canaliculotomy. Although they
did not find any plug in the lacrimal drainage system by high-resolutional
ultrasound, physicians should always keep in mind that lacrimal irrigation
may cause dislodgement of an inflamed plug into the deep lacrimal drainage
system, inciting infection or permanent blockage of the lacrimal drainage
passages.(4) Canaliculotomy with removal of plug may be an effect and safe
treatment option for these patients.
References
1. Klein-Theyer A, Boldin I, Rabensteiner DF, Aminfar H, Horwath-
Winter J. Prevalence of canaliculitis after smartplug insertion during
long-term follow-up. Br J Ophthalmol. 2015 Feb 26. pii: bjophthalmol-2014-
306290. doi: 10.1136/bjophthalmol-2014-306290.
2. Struck HG, H?hne C, Tost M. Diagnosis and therapy of chronic
canaliculitis. Ophthalmologe. 1992; 89: 233-236.
3. Brazier JS. Hall V. Propionibacterium propionicum and infections
of the lacrimal apparatus. Clin Infect Dis. 1993; 17: 892-893.
4. SmartPlug Study Group. Management of complications after insertion
of the SmartPlug punctal plug: a study of 28 patients. Ophthalmology. 2006
Oct;113(10):1859.e1-6.
Vision testing is a very tedious process. If a complete testing
including contrast testing,colour testing,amsler test,glare test,speed of
reading and other tests are undertaken it may take a lot of time.It is a
reality that even today visual acuity testing alone is the deciding factor
for undertaking cataract surgery. It has been noted by some authors that
lack of government-funded routine eye examinations is associated w...
Vision testing is a very tedious process. If a complete testing
including contrast testing,colour testing,amsler test,glare test,speed of
reading and other tests are undertaken it may take a lot of time.It is a
reality that even today visual acuity testing alone is the deciding factor
for undertaking cataract surgery. It has been noted by some authors that
lack of government-funded routine eye examinations is associated with a
reduced incidence of self-reported glaucoma and cataracts, probably due to
reduced detection rates (1) this only means that some method of home
testing may be essential.It is also possible that many kids would not go
blind due to amblyopia if vision was to be tested .So it may be useful to
test vision at home or school, which can be reported to the eye surgeon.
Some authors have envisaged a lay person administered vision test which
may be valid for identifying amblyopia in a controlled environment thus
making a cost-effective and easily accessible vision screening performed
by lay people a reality (2). A school vision screening program involving
only school teachers was found to have resulted in more efficient
screening than a program including professionals with the costs being a
third of what would have been spend and it was found to also improve
compliance with regards to hospital referral (3). Many authors have tried
mobile app based methods for vision and concluded that while the results
are not interchangeable with paper-based charts, mobile app tablet-based
tests of reading speed are reliable and rapid to perform, with the
potential to capture functional visual ability in research studies and
clinical practice(4). Such apps can be easily incorporated into video
glasses routinely used by children in video games.
We used a video glass available for playing video games and projected
vision charts at an appropriate distance into the glass and tested vision
at home. The fact that the glass had covers on the side, nullified the
effect of ambient light. Also some homes in India may be actually cubicles
and so may not have the requisite distance for testing and so in such
cases a mobile app based visual testing with charts projected into the
video glass helps in such situations. Following the ease of testing and
the improved ability of patients or care takers who are now being able to
test vision at home; different aspects of vision are now being tested by
patients or care takers. When this becomes more common even eye surgeons
will begin to do more tests.
References:-
1) Chan CH, Trope GE, Badley EM, Buys YM, Jin YP. The impact of lack
of government-insured routine eye examinations on the incidence of self-
reported glaucoma, cataracts, and vision loss. Invest Ophthalmol Vis Sci.
2014 Dec 9;55(12):8544-9. doi: 10.1167/iovs.14-15361.
2) Longmuir SQ, Pfeifer W, Shah SS, Olson R. Validity of a layperson-
administered Web-based vision screening test. J AAPOS. 2015 Feb;19(1):29-
32. doi:10.1016/j.jaapos.2014.10.021
3) Priya A, Veena K, Thulasiraj R, Fredrick M, Venkatesh R, Sengupta S,
BassettK. Vision screening by teachers in southern Indian schools: testing
a new "all class teacher" model. Ophthalmic Epidemiol. 2015 Feb;22(1):60-
5. doi:10.3109/09286586.2014.988877.
4) Kingsnorth A, Wolffsohn JS. Mobile app reading speed test. Br J
Ophthalmol.2014 Oct 29. pii: bjophthalmol-2014-305818.
doi:10.1136/bjophthalmol-2014-305818.
Indirect ophthalmoscopy has advanced since its inception. We now
recognize the importance of video imaging of the retina. Authors deviced
various slit lamp adaptors to capture retinal image(1) Many authors have
used smartphones coupled with indirect ophthalmoscopy and some even
identified an iPhone application that can control the flash and reduce the
intensity to levels that do not damage the retina.(2,3,4,5)
Indirect ophthalmoscopy has advanced since its inception. We now
recognize the importance of video imaging of the retina. Authors deviced
various slit lamp adaptors to capture retinal image(1) Many authors have
used smartphones coupled with indirect ophthalmoscopy and some even
identified an iPhone application that can control the flash and reduce the
intensity to levels that do not damage the retina.(2,3,4,5)
Some authors described a lightweight, compact, user-friendly, 3D
printed attachment which enabled high quality fundus photos achieved by
coupling smartphones to indirect ophthalmoscopy lens. (6)
In January 2013, the FDA approved the iExaminer (Welch Allyn), the
first smartphone-based imaging adaptor system that attaches an iPhone 4
(Apple Inc, Cupertino, CA) to Welch Allyn's Panoptic Ophthalmoscope to
capture images of the retina in combination with the iExaminer App.(7)
But all of the methods with adapters and iPhones are expensive or
bulky and impossible to use in ICCU setting.
We used a blackberry Z 3 mobile phone to capture serial video
recordings of cases in ICCU setting in patients on ventilator support and
recorded various cases like Terson's syndrome and papillodema and other
retinal conditions that need serial follow up. The smartphone allowed us
to use 1080 p HD recording and the autofocus and ambient light sensors in
recent cameras as well as the other features allow better evaluation of
the retina.
The audio video combine recording allows for simultaneous commentary
too which is important for Medical records and to save time in ICCU
setting. The audio and video format supported are 3GP, 3GP2, M4A, M4V,
MOV, MP4, MKV, MPEG-4, AVI, ASF, WMV, WMA, MP3, MKA, AAC, AMR, F4V, WAV,
AWB, OGG, FLAC and these allow viewing in any setting,transfer over any
media and storage and editing with ease so as to create a time compressed
view of the condition for patient education and counselling.
The blackberry at a cost of Indian currency of 13,000 rupees is a
very cheap piton for such video recording of the retina. It was very easy
to train ICU residents and the ability to transfer data through encrypted
messengers like Telegram allows for excellent management of such patients
in the follow up period especially in ICCU setting in rural areas where
Superspeciality may not be available round the clock in a country like
India. The ease with which even residents and non ophthalmologists can
acquire images and transfer the images ,makes smart phones replace
indirect ophthalmoscopes in these settings. Besides the use of these
methods by those screening for diabetic retinopathy in rural outreach
settings makes it all the more exciting.The ability to see the video in
slow motion allows for better screening as well as in better assessment in
telepath alkaloid from rural areas as has been our experience.
Considering all these developments the traditional indirect
ophthalmoscope may need to be modified and made less expensive and less
bulkier and easier to use and learn even in emergency rooms and ICCU
settings to withstand the competition from smart phones.
References:-
1) Chakrabarti D. Application of mobile technology in ophthalmology to
meet the demands of low-resource settings. Journal of Mobile Technology in
Medicine 2012;1(4S):1-3.
2) Lord RK, Shah VA, San Filippo AN, Krishna R. Novel uses of smartphones
in ophthalmology. Ophthalmology 2010;117(6):1274. e3
3) Chakrabarti D. Application of mobile technology in ophthalmology to
meet the demands of low-resource settings. Journal of Mobile Technology in
Medicine 2012;1(4S):1-3.
4) Haddock LJ, Kim DY, Mukai S. Simple, Inexpensive Technique for High-
Quality Smartphone Fundus Photography in Human and Animal Eyes. Journal of
Ophthalmology 2013;2013. http://dx.doi.org/10.1155/2013/518479
5) Chhablani J, Kaja S, Shah VA. Smartphones in ophthalmology. Indian J
Ophthalmol 2012;60(2):127
6) David Myung, Alexandre Jais, Lingmin He.Mark S. Blumenkranz, Robert
T. Chang, 3D Printed Smartphone Indirect Lens Adapter for Rapid, High
Quality Retinal Imaging. Journal MTM 3:1:9-15, 2014
7) Teichman JC, Sher JH, Ahmed IIK. From iPhone to eyePhone: A technique
for photodocumentation. Canadian Journal of Ophthalmology/Journal Canadien
d'Ophtalmologie 2011;46(3):284-6.
Endoscopic suturing of lacrimal sac flap to the nasal mucosa flap in
Dacryocystorhinostomy ( DCR) was described by us as early as 2004 and a
video of the procedure was published in textbook of oculoplasty (1) The
audits done showed that the short term results were excellent and the only
concern was the time taken to do the surgery. Three years later another
paper described excellent results with suturing of the flaps an...
Endoscopic suturing of lacrimal sac flap to the nasal mucosa flap in
Dacryocystorhinostomy ( DCR) was described by us as early as 2004 and a
video of the procedure was published in textbook of oculoplasty (1) The
audits done showed that the short term results were excellent and the only
concern was the time taken to do the surgery. Three years later another
paper described excellent results with suturing of the flaps and it was
reported to have a primary success rate of 96 percent and ultimate success
rate of 100 percent and the authors contemplated replacement of external
DCR with endonasal DCR (2) Traumatic Dacryocystitis has been treated
often by external DCR and some authors have suggested external DCR with
stenting in such cases (3) We have noted in our audits that doing an
endonasal DCR with suturing of the flaps and stenting both leads to 100
percent results even in cases with trauma where in there is Dacryocystitis
with coexisting orbital fracture too. The endoscopy procedure does not
disturb the lacrimal pump and the suturing of the flap causes healing by
primary intention and makes the procedure 100 percent successful
especially when combined with stents.
Reference
1) Sunil Moreker, Sneha K, Kirtane MV, Mankekar G. Endoscopic
Dacrocystorhinostomy :Recent advances. Oculoplasty and reconstructive
surgery , Jaypee publications 2010, page 286
2) Kirtane MV, Lall A, Chavan K, Satwalekar D. Endoscopic
dacryocystorhinostomy with flap suturing. Indian J Otolaryngol Head Neck
Surg. 2013 Aug;65(Suppl):236-41. doi: 10.1007/s12070-011-0354-z.
3) Rizvi SA, Sharma SC, Tripathy S, Sharma S. Management of traumatic
Dacryocystitis and failed dacryocystorhinostomy using silicone lacrimal
intubation set. Indian J Otolaryngol Head Neck Surg. 2011 Jul;63(3):264-8.
doi:10.1007/s12070-011-0230-x.
Dear Editor;
I have read the article entitled "Intrastromal voriconazole for deep
recalcitrant fungal keratitis: a case series" by Kalaiselvi et al. with
interest.1 The authors investigated the efficacy of intrastromal
voriconazole injection in the management of deep recalcitrant fungal
keratitis and found it safe and effective. I would like to contribute to
the article in terms of clinical practice.
Dear Editor;
I have read the article entitled "Intrastromal voriconazole for deep
recalcitrant fungal keratitis: a case series" by Kalaiselvi et al. with
interest.1 The authors investigated the efficacy of intrastromal
voriconazole injection in the management of deep recalcitrant fungal
keratitis and found it safe and effective. I would like to contribute to
the article in terms of clinical practice.
The authors' choice was voriconazole as an antifungal agent, and it
seems reasonable because of its' safety and potency on various fungal
species especially aspergillus spp. On the other hand, itraconazole could
also be studied due to a distinct characteristic of it. Goktas et al.
revealed that itraconazole can reduce corneal neovascularization.2
Recalcitrant corneal infections usually result in corneal scars and
sometimes corneal neovascularizations. Therefore; intrastromal
administration of itraconazole would be more beneficial in which cases the
infectious agents are found sensitive to itraconazole.
Zeng et al. have recently reported that amniotic membrane covering
(AMC) may enhance cornea epithelial regeneration after debridement of
fungal keratitis.3 I suppose that AMC could be helpful alone or in
combination with intrastromal administration of antifungal agents. It will
promote wound healing, support corneal integrity and decrease the risk of
perforation due to such persistent fungal infections.
We read with interest and congratulate Lee et al1 on publishing the
largest study to date on visual outcomes reported upto 36 months, with
intravitreal ranibizumab treatment for neovascular age related macular
degeneration (AMD). However we do not agree with their conclusion that
this is the first publication to focus on the visual outcomes on this
subgroup of patients, excluded from treatment by the NICE UK criteria.
O...
We read with interest and congratulate Lee et al1 on publishing the
largest study to date on visual outcomes reported upto 36 months, with
intravitreal ranibizumab treatment for neovascular age related macular
degeneration (AMD). However we do not agree with their conclusion that
this is the first publication to focus on the visual outcomes on this
subgroup of patients, excluded from treatment by the NICE UK criteria.
Our group2 was the first to publish, in this journal, the 12-month
treatment outcomes in a retrospective small case series of fourteen
patients. Subsequently, Williams and Blyth3 reported the outcomes from
Wales, UK. Other investigators have published good treatment outcomes with
earlier treatments at good baseline visual acuity 4,5. Surprisingly, none
of these investigators seem to have been acknowledged or referenced in the
discussion section by Lee et al1.
We agree with the authors that earlier treatment in neovascular age
related macular degeneration has the potential to maintain good visual
function for longer duration and await the cost effectiveness analysis the
authors wish to publish in future. Clinical experience and logic does
dictate that once there is clinical and/or OCT based imaging evidence of
disease activity in neovascular age related macular degeneration,
commencing treatment earlier rather than waiting for visual acuity to
deteriorate to 6/12 and below, is the best course of action.
REFERENCES
1. Lee AY, Lee CS, Butt T , et al. UK AMD EMR USERS GROUP REPORT V :
benefits of initiating therapy for neovascular AMD in eyes with vision
better than 6/12. Br J Ophthalmol. 2015 Feb 13. Pii:bjophthalmol-2014-
306229. Doi: 10.1136/bjophthalmol-2014-306229. Epub ahead of print.
2. Raja MS, Saldana M, Goldsmith C, Burton BJ: Ranibizumab
treatment for neovascular age- related macular degeneration in patients
with good baseline visual acuity (better than 6/12): 12-month outcomes. Br
J Ophthalmol 2010; 94:1543-1545.
3. Williams TA, Blyth CP: Outcome of ranibizumab treatment in
neovascular age related macular degeneration in eyes with baseline visual
acuity better than 6/12. Eye (Lond) 2011;25:1617-1621.
4. Saito M, Iida T, Kano M: Intravitreal ranibizumab for exudative
age-related macular de- generation with good baseline visual acuity.
Retina 2012;32:1250-1259.
5. Kato A, Yasukawa T, Suga K, et al. Intravitreal ranibizumab for
patients with neovascular age related macular degeneration with good
baseline visual acuity. Ophthalmologica . 2015;233(1):27-34.
In the recently published study by Klein-Theyer and colleagues, the
authors conducted a retrospective case series study to evaluate the number
of eyes (and patients) that develop canaliculitis over time after having
SmartPlugs inserted into the eye for underlying dry eye syndrome. The
authors described the measure of disease occurrence as prevalence;
however, this is incorrect. Prevalence is the proportion of the
popul...
In the recently published study by Klein-Theyer and colleagues, the
authors conducted a retrospective case series study to evaluate the number
of eyes (and patients) that develop canaliculitis over time after having
SmartPlugs inserted into the eye for underlying dry eye syndrome. The
authors described the measure of disease occurrence as prevalence;
however, this is incorrect. Prevalence is the proportion of the
population that has the disease at a particular time. In this study,
disease-free eyes were followed over time to determine the occurrence of
new cases of canaliculitus during the observation period. This describes
a measure of incidence, not prevalence. This error has implications for
the appropriate interpretation of the observed results. The authors
reported a cumulative probability of the event during the observation
period; however, this assumes none of the patients had been lost to follow
-up. Patients were followed for a median of 7.9 years, which means some
of the patients were censored and their limited participation must be
accounted for in the denominator. Therefore, an incidence rate based on
person-time should have been calculated. Authors are strongly encouraged
to conduct a reanalysis of their study data and provide readers with the
appropriate measure of incidence, amending their interpretation as
warranted.
In routine keratoplasties, HLA matching and systemic
immunosuppressive drugs are not employed, yet 90% of the uncomplicated
transplants survive. (1) But allografts of stem cells may need to be taken
from live HLA matched donors as cadaver stem cells have been reported to
fail in the long term inspite of continued immunosuppressive treatment
with cyclosporine A,steroids, FK 506 and mycophenolate mofetil.Also the
success o...
In routine keratoplasties, HLA matching and systemic
immunosuppressive drugs are not employed, yet 90% of the uncomplicated
transplants survive. (1) But allografts of stem cells may need to be taken
from live HLA matched donors as cadaver stem cells have been reported to
fail in the long term inspite of continued immunosuppressive treatment
with cyclosporine A,steroids, FK 506 and mycophenolate mofetil.Also the
success of the said procedure as described by Sangwan et al (2) needs to
be tested as an allograft in cases of immune damage to stem cells too. We
did an allograft SLET on a 29 year old patient's eye with vision of hand
movements upto one feet ; by taking the stem cell from the patient's
sister in the same manner as described by Sangwan et al but modified it
and did a sandwich technique placing the stem cell on tissue glue between
two layers of amniotic membrane and covered it with a bandage contact
lens. The patient had bilateral Limbal stem cell deficiency due to a host
graft rejection phenomena after a bone marrow transplant at the age of six
with poor vision in both eyes. Post operatively he was maintained on
immunosupression with steroids systemically and locally. The final visual
acuity at two months post operatively was 6/36. There have been cases
reports (3) of success with stem cell allografts but this probably needs
to be further evaluated especially in cases which are bilateral like our
case. Allograft stem cell has been used successfully in Limbal stem cell
deficiency due to chemical burns (4). It has also been described for
Steven Johnson syndrome (5) and authors have described that HLA nonmatched
live relative donor's stem cell fail to reconstitute the corneal surface.
But the efficacy of such a procedure when done as an allograft in Limbal
stem cell deficiency after host graft rejection process due to bone marrow
transplant in childhood needs to be further evaluated. We attempted to do
the same and achieved reasonable success in the short term. Long term
follow up should provide us with more information. In the meantime any
advice would be welcome.
References
1. Niederkorn JY, Kaplan HJ (eds): Immune Response and the Eye. Chem
Immunol Allergy. Basel, Karger, 2007, vol 92, pp 290-299 .
2. Sangwan et al. Simple limbal epithelial transplantation (SLET): a novel
surgical technique for the treatment of unilateral limbal stem cell
deficiency. Br J Ophthalmol 2012 96:931-934; doi:10.1136/bjophthalmol-
2011-301164
3. Gardu?o -Vieyra L. * Gonzalez C.R. * Hernandez-Da Mota S.E.
Limbal Stem Cell Allografts and Corneal Transplant in a Patient with
Severe Corneal Perforation due to Thermokeratoplasty andCross-Linking
Treatment Burn
Case Rep Ophthalmol 2012;3:364-369
4. Huang T, Wang Y, Zhang H, Gao N, Hu A. Limbal allografting from living-
related donors to treat partial limbal deficiency secondary to ocular
chemical burns.Arch Ophthalmol. 2011 Oct;129(10):1267-73. doi:
10.1001/archophthalmol.2011.251.
5. Rao SK, Rajagopal R, Sitalakshmi G, Padmanabhan P. Limbal allografting
fromrelated live donors for corneal surface reconstruction. Ophthalmology.
1999 Apr;106(4):822-
Dear Editor
We read with great interest the article entitled "Outcomes of posterior-
approach 'levatorpexy' in congenital ptosis repair" by Al-Abbadi Z et
al.(1) In their article, the authors described posterior-approach
levatorpexy surgical technique for management of congenital ptosis. In
this technique, the first suture was passed through the levator
aponeurosis- levator muscle junction or above according to levator
f...
Dear Editor
We read with great interest the article entitled "Outcomes of posterior-
approach 'levatorpexy' in congenital ptosis repair" by Al-Abbadi Z et
al.(1) In their article, the authors described posterior-approach
levatorpexy surgical technique for management of congenital ptosis. In
this technique, the first suture was passed through the levator
aponeurosis- levator muscle junction or above according to levator
function. The second suture was passed 2 mm medial to first suture. (1)
However, in their previous article the authors used the second suture 2 mm
lateral to first suture for management of involutional aponeurotic ptosis.
(2) The authors did not discuss the reason why they moved the second
suture from lateral to medial.
REFERENCES
1. Al-Abbadi Z, Sagili S, Malhotra R. Outcomes of posterior-approach
'levatorpexy' in congenital ptosis repair. Br J Ophthalmol. 2014
Dec;98(12):1686-90.
2. Patel V, Salam A, Malhotra R. Posterior approach white line advancement
ptosis repair: the evolving posterior approach to ptosis surgery. Br J
Ophthalmol. 2010 Nov;94(11):1513-8.
We read with interest the results reported by Romano et al. The authors speculated the reason for lower endothelial failure in larger grafts (9.5mm) compared to smaller ones is due to the additional endothelial cells being transplanted.
It has been reported that the host peripheral endothelium in Fuchs endothelial dystrophy (FED) has some capacity towards restoring corneal deturgescence in denuded posterior st...
Dear Editor; We read with great interest the article entitled "Prevalence of canaliculitis after smartplug insertion during long-term follow-up" by Klein-Theyer et al.(1) I would like to contribute to the article with our clinical expeience.
Among 11 cases of canaliculitis after lacrimal plug insertion between 2007 and 2013 in a tertiary medical center, seven cases (64%) were noted to be associated with the us...
Vision testing is a very tedious process. If a complete testing including contrast testing,colour testing,amsler test,glare test,speed of reading and other tests are undertaken it may take a lot of time.It is a reality that even today visual acuity testing alone is the deciding factor for undertaking cataract surgery. It has been noted by some authors that lack of government-funded routine eye examinations is associated w...
Indirect ophthalmoscopy has advanced since its inception. We now recognize the importance of video imaging of the retina. Authors deviced various slit lamp adaptors to capture retinal image(1) Many authors have used smartphones coupled with indirect ophthalmoscopy and some even identified an iPhone application that can control the flash and reduce the intensity to levels that do not damage the retina.(2,3,4,5)
...
Endoscopic suturing of lacrimal sac flap to the nasal mucosa flap in Dacryocystorhinostomy ( DCR) was described by us as early as 2004 and a video of the procedure was published in textbook of oculoplasty (1) The audits done showed that the short term results were excellent and the only concern was the time taken to do the surgery. Three years later another paper described excellent results with suturing of the flaps an...
Dear Editor; I have read the article entitled "Intrastromal voriconazole for deep recalcitrant fungal keratitis: a case series" by Kalaiselvi et al. with interest.1 The authors investigated the efficacy of intrastromal voriconazole injection in the management of deep recalcitrant fungal keratitis and found it safe and effective. I would like to contribute to the article in terms of clinical practice.
The author...
We read with interest and congratulate Lee et al1 on publishing the largest study to date on visual outcomes reported upto 36 months, with intravitreal ranibizumab treatment for neovascular age related macular degeneration (AMD). However we do not agree with their conclusion that this is the first publication to focus on the visual outcomes on this subgroup of patients, excluded from treatment by the NICE UK criteria. O...
In the recently published study by Klein-Theyer and colleagues, the authors conducted a retrospective case series study to evaluate the number of eyes (and patients) that develop canaliculitis over time after having SmartPlugs inserted into the eye for underlying dry eye syndrome. The authors described the measure of disease occurrence as prevalence; however, this is incorrect. Prevalence is the proportion of the popul...
In routine keratoplasties, HLA matching and systemic immunosuppressive drugs are not employed, yet 90% of the uncomplicated transplants survive. (1) But allografts of stem cells may need to be taken from live HLA matched donors as cadaver stem cells have been reported to fail in the long term inspite of continued immunosuppressive treatment with cyclosporine A,steroids, FK 506 and mycophenolate mofetil.Also the success o...
Dear Editor We read with great interest the article entitled "Outcomes of posterior- approach 'levatorpexy' in congenital ptosis repair" by Al-Abbadi Z et al.(1) In their article, the authors described posterior-approach levatorpexy surgical technique for management of congenital ptosis. In this technique, the first suture was passed through the levator aponeurosis- levator muscle junction or above according to levator f...
Pages