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1
Consejo, Alejandra, Richard Wu, and Ahmed Abass. "Anterior Scleral Regional Variation between Asian and Caucasian Populations." Journal of Clinical Medicine 9, no. 11 (October 25, 2020): 3419. http://dx.doi.org/10.3390/jcm9113419.
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Purpose: To evaluate the anterior scleral shape regional differences between Asian and Caucasian populations. Methods: The study included 250 Asian eyes and 235 Caucasian eyes from participants aged 22 to 67 years (38.5 ± 7.6). Three-dimensional (3D) corneo-scleral maps were acquired using a corneo-scleral topographer (Eye Surface Profiler, Eaglet Eye BV) and used to calculate sagittal height. For each 3D map, the sclera (maximum diameter of 18 mm) and cornea were separated at the limbus using an automated technique. Advanced data processing steps were applied to ensure levelled artefact-free datasets to build an average scleral shape map for each population. Results: Statistically, Asian and Caucasian sclerae are significantly different from each other in sagittal height (overall sclera, p = 0.001). The largest difference in sagittal height between groups was found in the inferior-temporal region (271 ± 203 µm, p = 0.03), whereas the smallest difference was found in the superior-temporal region (84 ± 105 µm, p = 0.17). The difference in sagittal height between Caucasian and Asian sclera increases with the distance from the limbus. Conclusions: Asian anterior sclera was found to be less elevated than Caucasian anterior sclera. However, the nasal area of the sclera is less elevated than the temporal area, independently of race. Gaining knowledge in race-related scleral topography differences could assist contact lens manufacturers in the process of lens design and practitioners during the process of contact lens fitting.
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Perea-García, Juan Olvido, Mariska E. Kret, Antónia Monteiro, and Catherine Hobaiter. "Scleral pigmentation leads to conspicuous, not cryptic, eye morphology in chimpanzees." Proceedings of the National Academy of Sciences 116, no. 39 (September 3, 2019): 19248–50. http://dx.doi.org/10.1073/pnas.1911410116.
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Gaze following has been argued to be uniquely human, facilitated by our depigmented, white sclera [M. Tomasello, B. Hare, H. Lehmann, J. Call, J. Hum. Evol. 52, 314–320 (2007)]—the pale area around the colored iris—and to underpin human-specific behaviors such as language. Today, we know that great apes show diverse patterns of scleral coloration [J. A. Mayhew, J. C. Gómez, Am. J. Primatol. 77, 869–877 (2015); J. O. Perea García, T. Grenzner, G. Hešková, P. Mitkidis, Commun. Integr. Biol. 10, e1264545 (2016)]. We compare scleral coloration and its relative contrast with the iris in bonobos, chimpanzees, and humans. Like humans, bonobos’ sclerae are lighter relative to the color of their irises; chimpanzee sclerae are darker than their irises. The relative contrast between the sclera and iris in all 3 species is comparable, suggesting a perceptual mechanism to explain recent evidence that nonhuman great apes also rely on gaze as a social cue.
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Atta, Ghada, Falk Schroedl, Alexandra Kaser-Eichberger, Gabriel Spitzer, Andreas Traweger, Ludwig M. Heindl, and Herbert Tempfer. "Scleraxis expressing scleral cells respond to inflammatory stimulation." Histochemistry and Cell Biology 156, no. 2 (May 8, 2021): 123–32. http://dx.doi.org/10.1007/s00418-021-01985-y.
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AbstractThe sclera is an ocular tissue rich of collagenous extracellular matrix, which is built up and maintained by relatively few, still poorly characterized fibroblast-like cells. The aims of this study are to add to the characterization of scleral fibroblasts and to examine the reaction of these fibroblasts to inflammatory stimulation in an ex vivo organotypic model. Scleras of scleraxis-GFP (SCX-GFP) mice were analyzed using immunohistochemistry and qRT-PCR for the expression of the tendon cell associated marker genes scleraxis (SCX), mohawk and tenomodulin. In organotypic tissue culture, explanted scleras of adult scleraxis GFP reporter mice were exposed to 10 ng/ml recombinant interleukin 1-ß (IL1-ß) and IL1-ß in combination with dexamethasone. The tissue was then analyzed by immunofluorescence staining of the inflammation- and fibrosis-associated proteins IL6, COX-2, iNOS, connective tissue growth factor, MMP2, MMP3, and MMP13 as well as for collagen fibre degradation using a Collagen Hybridizing Peptide (CHP) binding assay. The mouse sclera displayed a strong expression of scleraxis promoter-driven GFP, indicating a tendon cell-like phenotype, as well as expression of scleraxis, tenomodulin and mohawk mRNA. Upon IL1-ß stimulation, SCX-GFP+ cells significantly upregulated the expression of all proteins analysed. Moreover, IL1-ß stimulation resulted in significant collagen degradation. Adding the corticosteroid dexamethasone significantly reduced the response to IL1-ß stimulation. Collagen degradation was significantly enhanced in the IL1-ß group. Dexamethasone demonstrated a significant rescue effect. This work provides insights into the characteristics of scleral cells and establishes an ex vivo model of scleral inflammation.
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Wang, Guo Hui, and Wei Yi Chen. "Effects of Mechanical Stimulation on MMP-2 and TIMP-2 Expression of Scleral Fibroblasts after Posterior Sclera Reinforcement." Applied Mechanics and Materials 490-491 (January 2014): 867–71. http://dx.doi.org/10.4028/www.scientific.net/amm.490-491.867.
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To understand the effect of mechanical stimulation on posterior sclera reinforcement (PSR), the rabbit scleral fibroblasts after PSR were subjected to stretch in vitro and MMP-2 and TIMP-2 expression of scleral fibroblasts were evaluated. Three-week-old rabbits were monocularly performed by eyelid suturation randomly to prepare experimental myopia eye. After 60 days, the experimental myopia eyes were treated by PSR. After 6 months, the posterior pole scleral fibroblasts (normal sclera - group A, sclera after operation - group B and fusion region of sclera and reinforcing band group C) were isolated and cultured in vitro. The cells were subjected to cyclic stretch regimens (sine wave, 3% and 6% elongation amplitude, 0.1Hz, 48h duration) by FX-4000 Tension System. The MMP-2 and TIMP-2 expression of scleral fibroblasts were evaluated by ELISA method. The results show that after cyclic stretch to the scleral fibroblasts of the normal sclera and the sclera after operation, the MMP-2 expression was significantly reduced and the TIMP-2 expression was significantly increased, the MMP-2 and TIMP-2 expression of the scleral fibroblasts of the fusion region after operation was no changed. It was indicated that the mechanical stimulation could regulate the MMP-2 and TIMP-2 expression of scleral fibroblasts and play an important role in the process of treating high myopia with PSR surgery.
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Fadel, Daddi. "Scleral lenses: considerations on the total diameter." Eye 21, no. 128 (December 2019): 24–27. http://dx.doi.org/10.33791/2222-4408-2019-4-24-27.
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A scleral contact lens (SCL) can be defined as a lens that only rests on the sclera. Raised from the cornea and limbus, the total diameter must be greater than the horizontal visible iris diameter (HVID) and the extension of the limbus. Currently, the most commonly used lenses are scleral lenses with a diameter between 15.0 and 17.0 mm, the so-called mini-scleral lenses. The existing nomenclature of scleral lenses is based only on HVID and total diameter. It is therefore important to further differentiate smaller mini-sclera lenses from lager ones.
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DeNaeyer, Gregory. "Profilometry. Using Corneo-scleral topography for scleral lens fitting." Eye 21, no. 128 (December 2019): 19–22. http://dx.doi.org/10.33791/2222-4408-2019-4-19-22.
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The world-wide use of scleral contact lenses has dramatically increased over the past 10 year and has changed the way that we manage patients with corneal irregularity. Successfully fitting them can be challenging especially for eyes that have significant asymmetries of the cornea or sclera. The future of scleral lens fitting is utilizing corneo-scleral topography to accurately measure the anterior ocular surface and then using software to design lenses that identically match the scleral surface and evenly vault the cornea. This process allows the practitioner to efficiently fit a customized scleral lens that successfully provides the patient with comfortable wear and improved vision.
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Marvasti, Amir H., Jesse Berry, Maria E. Sibug Saber, Jonathan W. Kim, and Alex S. Huang. "Anterior Segment Scleral Fluorescein Angiography in the Evaluation of Ciliary Body Neoplasm: Two Case Reports." Case Reports in Ophthalmology 7, no. 1 (January 8, 2016): 30–38. http://dx.doi.org/10.1159/000443603.
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Introduction: Anterior segment tumors can be difficult to detect until tumor growth is substantial enough to cause local signs or symptoms. Earlier detection may result in improved outcomes, particularly the ability to option for globe-conserving therapy. Multiple diagnostic modalities such as ultrasound or optical coherence tomography exist to aid for earlier detection of ciliary body tumors, but they also have limitations. Here we describe the potential for scleral angiography as an adjunctive modality to assist in evaluating anterior segment ciliary body tumors. Case Presentations: A 61-year-old Caucasian male and a 57-year-old Hispanic female presented for ciliary body tumor evaluation. The Caucasian male notably had abnormal scleral, episcleral, and conjunctival vessels in the affected eye. Scleral angiography was performed in both cases with the abnormal vasculature highlighted in the Caucasian male. The Hispanic female did not demonstrate abnormal scleral angiographic patterns. Notably, the Caucasian male also had regions of abnormal scleral angiography arising in locations of otherwise normal appearing sclera. Both patients had the affected eyes enucleated. Histology of the enucleated eyes demonstrated a ciliary body melanoma in the Caucasian male associated with abnormal vascular and tumor infiltration of the scleral bed. The Hispanic female had a pigmented ciliary body adenoma without involvement of the scleral bed. Conclusion: With limited sample size, scleral angiography has the potential to detect abnormal scleral vascular patterns in otherwise normal appearing sclera in cases of ciliary body tumor with scleral vascular invasion.
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Hannon, Bailey G., Stephen A. Schwaner, Elizabeth M. Boazak, Brandon G. Gerberich, Erin J. Winger, Mark R. Prausnitz, and C. Ross Ethier. "Sustained scleral stiffening in rats after a single genipin treatment." Journal of The Royal Society Interface 16, no. 159 (October 16, 2019): 20190427. http://dx.doi.org/10.1098/rsif.2019.0427.
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Scleral stiffening has been proposed as a therapy for glaucoma and myopia. Previous in vivo studies have evaluated the efficacy of scleral stiffening after multiple treatments with a natural collagen crosslinker, genipin. However, multiple injections limit clinical translatability. Here, we examined whether scleral stiffening was maintained after four weeks following a single genipin treatment. Eyes from brown Norway rats were treated in vivo with a single 15 mM genipin retrobulbar injection, sham retrobulbar injection, or were left naive. Eyes were enucleated either 1 day or four weeks post-injection and underwent whole globe inflation testing. We assessed first principal Lagrange strain of the posterior sclera using digital image correlation as a proxy for scleral stiffness. Four weeks post-injection, genipin treatment resulted in a 58% reduction in scleral strain as compared to controls ( p = 0.005). We conclude that a single in vivo injection of genipin effectively stiffened rat sclera for at least four weeks which motivates further functional studies and possible clinical translation of genipin-induced scleral stiffening.
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Sineok, A. E., A. V. Zolotarev, and G. A. Nikolaeva. "Morphological studies of the cadaveric sclera after nonpenetrating sclerotomy by ND: YAG laser." Russian Ophthalmological Journal 11, no. 4 (December 11, 2018): 64–67. http://dx.doi.org/10.21516/2072-0076-2018-11-4-64-67.
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Purpose: to reveal the changes of the morphological structure of cadaveric human sclera after Nd: YAG laser irradiation.Material and methods. Laser pulses (Nd: YAG) (Lumenis) (power 7.0–7.4 mW, pulse duration 4 ns, wavelength 1064 nm) were applied to the sclera of an isolated eyeball at a distance of 4 to 8 mm from the limbus. Three irradiation types were used: one series of single pulses, a series of triple pulses, and a series of six pulses.Results. Incisions created with single pulses showed insignificant surface defects of the sclera. In triple pulses, the defect of the anterior layers of the sclera capture affected 15 % of the scleral thickness, and in six pulses the defect reached 30 % of the scleral thickness.Conclusions. To achieve a punctate hole in the sclera, a single Nd: YAG pulse is insufficient. To obtain a significant depth of scleral incision at least a triple pulse is needed, which must be taken into account in clinical practice as well as in assessing the results of Nd: YAG laser impact on the rigidity of the sclera.
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Erdinest, Nir, Ortal Palatchi Sabag, Naomi London, and Abraham Solomon. "Quadrant Asymmetric Design Contact Lens for Visual Rehabilitation after Eye Trauma." Case Reports in Ophthalmology 12, no. 2 (May 6, 2021): 330–36. http://dx.doi.org/10.1159/000512505.
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The purpose of this case report is to demonstrate the efficacy of an asymmetric peripheral design scleral contact lens in a case of highly irregular corneal-scleral pattern due to trauma. A 63-year-old patient was involved in a jeep accident which caused a partial-thickness penetrating injury to the peripheral cornea of his left eye. The subsequent corneal irregularity extended beyond the limbus into the sclera which made it difficult to stabilize a contact lens. A quadrant specific peripheral curve (quadrant asymmetric periphery) scleral contact lens successfully resulted in improved comfort and visual acuity. This is the first known published case to use this lens design to correct a post-trauma irregular cornea-scleral relationship. Quadrant asymmetric periphery scleral contact lenses can be effective in cases of severe irregular corneal-scleral patterns.
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Pai, Vijay, Jayaram Shetty, Hrishikesh Amin, and Manu Thomas. "Management of Scleral Thinning : An Alternate Approach." Journal of Health and Allied Sciences NU 06, no. 01 (March 2016): 088–90. http://dx.doi.org/10.1055/s-0040-1708626.
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AbstractA 5 year old child presented with corneo-scleral tear in his left eye following trauma with knife which was repaired immediately. 1 month later there was thinning of the sclera at the sutured site. An alternate approach was proposed for the management of scleral thinning. An autologous scleral patch graft from the same eye was sutured at the area of thinning. This method was found to be more convenient and easy to perform. Since the graft was stable and the donor site was healthy; this method can be used as an alternative approach for the management of scleral thinning.
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Carpineto, P., M. Ciancaglini, S. Scaramucci, M. Nubile, and L. Mastropasqua. "Management of Scleral Rupture during Retinal Detachment Surgery: A Case Report." European Journal of Ophthalmology 12, no. 6 (November 2002): 553–55. http://dx.doi.org/10.1177/112067210201200619.
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Purpose Rupture of the sclera occurring during retinal detachment surgery is generally associated with unfavourable anatomic and visual outcomes. Re-operation after a failed scleral buckle procedure and pre-existing scleral thinning are considered the main risk factors for scleral rupture. Case Report We describe the management and the favourable outcome of a case of scleral rupture in a 71-year-old woman during re-operation for retinal detachment. Conclusions We managed this case of scleral rupture in accordance with current indications concerning the anatomical recovery, by scleral suture and patch graft, restoring IOP by gas tamponade. The positive outcome was partly related to the prompt closure of the retinal hole which led to reattachment, and partly to favourable events such as the moderate intensity of vitreous hemorrhage and the lack of any more serious intraoperative and postoperative complications.
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Bolek, Bartłomiej, Adam Wylęgała, and Edward Wylęgała. "Assessment of Scleral and Conjunctival Thickness of the Eye after Ultrasound Ciliary Plasty." Journal of Ophthalmology 2020 (September 24, 2020): 1–10. http://dx.doi.org/10.1155/2020/9659014.
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Purpose. This study aims to assess scleral and conjunctival thickness using optical coherence tomography after ultrasound ciliary plasty (UCP) procedure with reference to scleral marks appearing in the area where the ultrasound energy was applied. Materials and Methods. Seventy-eight patients with primary and secondary refractory glaucoma participated in this study. Complete ophthalmic examinations including measurements of scleral and conjunctival thickness were performed preoperatively and at 1 week, and 1, 3, 6, 12, 18, and 24 months postoperatively. The parameters were determined using the Swept Source OCT with anterior attachment. Thirty-eight patients (58 scleral marks—23 superior and 35 inferior) fulfilled the inclusion criteria and completed the follow-up period of 24 months. Results. The mean ± SD scleral and conjunctival thickness in superior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 684.57 ± 83.58 μm, 771.78 ± 112.03 μm (p<0.001), 771.74 ± 100.12 μm (p<0.001), 731.38 ± 83.92 μm (p=0.012), 719.52 ± 73.20 μm (p=0.037), 702.91 ± 66.50 μm (p=0.247), 694.13 ± 72.22 μm (p=0.482), and 699.35 ± 70.68 μm (p=0.200), respectively. The mean ± SD scleral and conjunctival thickness in inferior scleral mark before the procedure and at 1 week, and 1, 3, 6, 12, 18, and 24 months after the procedure was 816.86 ± 79.30 μm, 936.37 ± 107.33 μm (p<0.001), 946.00 ± 130.40 μm (p<0.001), 896.63 ± 123.40 μm (p<0.001), 877.69 ± 114.38 μm (p=0.003), 843.03 ± 71.55 μm (p=0.021), 811.86 ± 68.91 μm (p=0.731), and 805.03 ± 69.52 μm (p=0.248), respectively. The transient thickening of the sclera was observed after the procedure; however, after 12 months postoperatively, the parameters returned to the initial value and no significant difference was noted. Conclusion. The sclera thickness increases after UCP. However, with time the thickness reduces to its initial value with no significant difference. Clinical implication of the scleral changes lasts shorter than the measured significant difference in scleral thickness.
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Bikbov, M. M., and M. N. Astrelin. "Experimental substantiation of scleral crosslinking." POINT OF VIEW. EAST – WEST, no. 1 (April 20, 2021): 56–61. http://dx.doi.org/10.25276/2410-1257-2021-1-56-61.
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Purpose. To substantiate the efficacy and safety of scleral collagen cross-linking with riboflavin and ultraviolet radiation. Material and methods. The study was conducted on cadaver porcine eyes and rabbit eyes. Results. It has been experimentally proven that crosslinking with riboflavin / ultraviolet A leads to an increase in the biomechanical strength of the scleral tissue, changing its structure and leading to an increase in the packing density of collagen fibers and an increase in the diameter of collagen fibrils, which confirms the formation of additional cross-links between scleral macromolecules. The absence of any pathological changes in the fibers of the fibrous membrane of the eye was established. The permeability of scleral tissue for ultraviolet radiation of the A range was determined. Based on the data obtained, a formula was proposed for calculating the threshold value of the intensity of ultraviolet radiation during the SCXL procedure. Using the methods of light microscopy, electroretinography and optical coherence tomography, it was revealed that SCXL with riboflavin / ultraviolet A under the studied parameters is safe for the structures of the eye (cornea, retina and optic nerve). A gentle technology for photopolymerization of the sclera with the use of the “UFalink S” device has been developed, the advantage of which is the ability to carry out ultraviolet irradiation in hard-to-reach areas of the eyeball. At the same time, an effective increase in the biomechanical strength characteristics of the scleral tissue was proved and the absence of a damaging effect on the structures of the eye was demonstrated. Conclusion. A clinical study of the scleral crosslinking procedure with riboflavin / ultraviolet A with the proposed parameters: irradiance of 3 mW / cm², irradiation time 30 minutes and preliminary saturation of the sclera with 0.1% aqueous solution of riboflavin for 20 minutes, which in experiments have shown their effectiveness and safety, is recommended. During the procedure, it is recommended to use a water-based photosensitizer riboflavin, without the addition of dextran, which leads to dehydration of the sclera and an increase in its permeability to ultraviolet light, which increases the risk of damage to the inner layers of the eye. Key words: scleral crosslinking, ultraviolet A, riboflavin, experiment, myopia.
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Kokame, Gregg T., Tarin T. Tanji, and Jase N. Omizo. "Long-Term Stability of Sutured Scleral Fixation of a Posterior Chamber Intraocular Lens With 10-0 Polypropylene for More Than 30 Years." Journal of VitreoRetinal Diseases 5, no. 5 (January 8, 2021): 452–54. http://dx.doi.org/10.1177/2474126420978870.
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Purpose: We report the longest follow-up to our knowledge of stable scleral fixation of a posterior chamber intraocular lens (PC IOL) with 10-0 polypropylene sutures. Methods: A retrospective review is presented of a case with more than 30 years’ follow-up after performing sutured scleral fixation with 10-0 polypropylene suture using 2 sutures tied together under a scleral flap. One suture was a cow-hitch looped around the haptic, and the other suture was passed through the sclera to create the scleral fixation. Results: The scleral fixation with 10-0 polypropylene suture knots for both haptics of the PC IOL allowed central optic positioning with excellent vision for more than 30 years without suture breakage. Conclusions: Polypropylene sutures for scleral fixation of PC IOLs remained stable for more than 30 years with central positioning of the PC IOL, without exposure of the fixation suture knots through the conjunctiva, and without suture breakage.
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Zhu, Chengcheng, Qingzhong Chen, Ying Yuan, Min Li, and Bilian Ke. "Endoplasmic Reticulum Stress Regulates Scleral Remodeling in a Guinea Pig Model of Form-Deprivation Myopia." Journal of Ophthalmology 2020 (June 10, 2020): 1–9. http://dx.doi.org/10.1155/2020/3264525.
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Purpose. This study aimed to investigate the role of endoplasmic reticulum (ER) stress in scleral remodeling in a guinea pig model of form-deprivation myopia (FDM). Methods. Guinea pigs were form deprived to induce myopia. ER ultrastructural changes in the sclera were examined by transmission electron microscopy (TEM). The protein levels of ER stress chaperones, including GRP78, CHOP, and calreticulin (CRT), were analyzed by western blotting at 24 hours, 1 week, and 4 weeks of FD. Scleral fibroblasts from guinea pigs were cultured and exposed to the ER stress inducer tunicamycin (TM) or the ER stress inhibitor 4-phenylbutyric acid (4-PBA). CRT was knocked down by lentivirus-mediated CRT shRNA transfection. The expression levels of GRP78, CHOP, TGF-β1, and COL1A1 were analyzed by qRT-PCR or western blotting. Results. The sclera of FDM eyes exhibited swollen and distended ER at 4 weeks, as well as significantly increased protein expression of GRP78 and CRT at 1 week and 4 weeks, compared to the sclera of the control eyes. In vitro, TM induced ER stress in scleral fibroblasts, which was suppressed by 4-PBA. The mRNA expression of TGF-β1 and COL1A1 was upregulated after TM stimulation for 24 hours, but downregulated for 48 hours. Additionally, change of TGF-β1 and COL1A1 transcription induced by TM was suppressed by CRT knockdown. Conclusions. ER stress was an important modulator which could influence the expression of the scleral collagen. CRT might be a new target for the intervention of the FDM scleral remodeling process.
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Singh, Usha, Divya Khosla, Rakesh Kumar Vasishta, and Suresh C. Sharma. "Treatment of Primary Scleral Maltoma: A Technical Challenge for Radiation Oncologist." An International Journal Clinical Rhinology 3, no. 3 (2010): 157–59. http://dx.doi.org/10.5005/jp-journals-10013-1053.
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Abstract We present a case of 53 years old male who developed reddish thickening on sclera and was diagnosed as scleral maltoma after investigations. Primary scleral involvement remains only a theoretical possibility and has never been documented in literature except for one odd case report where orbital lymphoma was misdiagnosed as scleritis but later proved to be of conjunctival origin by histology.1 This case report has been brought up to highlight the technical challenges faced in planning and execution of external radiation therapy in primary scleral lymphoma.
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Ahmed, Faisal, and Nada G. Mohamed. "TAG (Tube and Graft) Sandwich Technique: A Novel Single-Stage Scleral Reinforcement and Aqueous Drainage Tube Implantation." Case Reports in Ophthalmological Medicine 2021 (July 14, 2021): 1–4. http://dx.doi.org/10.1155/2021/6698919.
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Purpose. Refractory glaucoma patients continue to require surgical intervention in the form of trabeculectomy surgery or glaucoma drainage device (GDD). Those patients that require a GDD but have thin sclera or scleromalacia present a challenge. Methods. In this article, we present a novel “TAG sandwich” single surgical procedure in which thinned sclera is reinforced with a pericardial patch graft (“bottom layer of the sandwich”) allowing safe implantation of the GDD (“the tube sandwich filling”) and then placing another patch graft on top of the tube part of the GDD (“top layer of the sandwich”). The surgery was performed on an open-angle glaucoma patient with a generalized thin sclera and uncontrolled intraocular pressure despite maximal topical medication and oral acetazolamide. Results. Reinforcing a compromised sclera with a pericardium patch graft allowed the safe implantation of a glaucoma drainage device. The patient’s intraocular pressure was safely controlled at 7 mmHg almost 1-year postsurgery without intraocular pressure-lowering drops. Conclusions. This scleral strengthening procedure can be considered by readers in other ocular surgeries where there is a risk of scleral perforation, as well as part of a combined surgery where refractory glaucoma patients with thin sclera require scleral reinforcement to allow for safer implantation of a glaucoma drainage device.
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Chaidaroon, Winai, and Sumet Supalaset. "Pseudomonas Scleritis following Pterygium Excision." Case Reports in Ophthalmology 8, no. 2 (July 25, 2017): 401–5. http://dx.doi.org/10.1159/000478721.
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Purpose: The aim of this case report was to describe a patient who presented with Pseudomonas scleritis after pterygium excision. The study was conducted at the Department of Ophthalmology, Faculty of Medicine, Chiang Mai University in Chiang Mai, Thailand. Methods: The record of a patient who was diagnosed as Pseudomonas scleritis after pterygium excision was retrospectively reviewed for history, clinical characteristics, laboratory findings, treatments, and outcomes. Results: We described a 66-year-old male patient with a history of pterygium excision in his right eye 10 years ago, he presented with infectious scleritis. Scleral thinning, tissue necrosis, and overlying calcified plaque were found. The culture of scleral scraping revealed Pseudomonas aeruginosa. Topical fortified amikacin (20 mg/mL) and intravenous ceftazidime were started. Urgent surgical debridement of scleral infiltrates and irrigation of necrotic sclera and surrounding conjunctiva with fortified amikacin (20 mg/mL) were performed. After 2 weeks of treatment, scleral thinning and inflammation decreased, and the best-corrected visual acuity improved from 6/24 to 6/9. Fortified amikacin eye drops (20 mg/mL) were continued until the fourth week, with no scleral thinning seen. Conclusions: P. aeruginosa is a virulent organism that causes infectious scleritis complicated by melting and necrotizing of the sclera. This report emphasized that early recognition, intensive antimicrobial treatment, and surgical debridement can prevent morbidity related to this Pseudomonas infection.
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Li, Xuyan, Tianfei Yu, Ming Li, Youqi Wang, Bo Meng, and Yanshuang Mu. "NANOG improves type I collagen expression in human fetal scleral fibroblasts." Archives of Biological Sciences 71, no. 1 (2019): 63–70. http://dx.doi.org/10.2298/abs180711048l.
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Human fetal scleral fibroblasts (HFSFs) are components of the sclera and play important roles in its structure and function. In myopia, scleral remodeling reduces collagen fibers and the sclera begins to thin. NANOG is a key transcription factor essential for pluripotent and self-renewing phenotypes of undifferentiated embryonic stem cells. To determine whether NANOG improves human fetal scleral fibroblast quality and the underlying mechanisms in these cells, we established stable NANOG-overexpressing HFSFs. We studied type I collagen (COL1A 1) and Rho-associated coiled-coil protein kinase 1 (ROCK1) expression in transfected cells. We also investigated POU5F1, SOX2, KLF4, MYC and SALL4 expression in NANOG stably-overexpressed fibroblasts. Our data show that NANOG expression increased proliferation rates in fibroblasts. When compared to controls, expression of COL1A 1 in transfected fibroblasts was increased and the expression of ROCK1 was decreased. Similarly, the expression of POU5F1, SOX2 and KLF4 was downregulated, the expression of MYC was upregulated and there was no significant change in the expression of SALL4 in transfected fibroblasts. Our results suggest that in fibroblasts, NANOG regulates ROCK1 expression and improves COL1A 1 expression to delay scleral remodeling.
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Yarovaya, V. A., A. V. Shatskikh, I. A. Levashov, and A. A. Yarovoy. "Uveal melanoma dissemination within the scleral tract in fine needle aspiration biopsy." Fyodorov journal of ophthalmic surgery, no. 4 (December 29, 2020): 63–66. http://dx.doi.org/10.25276/0235-4160-2020-4-63-66.
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Introduction. Fine needle aspiration biopsy (FNAB) of uveal melanoma (UM) is an invasive procedure. Many authors consider UM FNAB to be safe procedure, however extraocular extension of the tumor through the scleral tracts may occur. Current studies of scleral tracts after FNAB do not compare different biopsy techniques (cannula-assisted and without cannula) in terms of UM cells. Purpose. To assess morphology of scleral tracts for the presence of malignant cells when different biopsy techniques are approached. Material and methods. Forty-four scleral samples were analyzed after transvitreal FNAB performed in 22 enucleated eyes with UM. Cannula-assisted FNAB was performed in 22 cases. In the same eyes FNAB (n=22) was performed without cannula. Results. FNAB material was adequate for cytological examination in all cases. UM was confirmed in 22 eyes pathologically. UM cell implantation was detected in 5 scleral samples after FNAB without cannula. No signs of cell implantation were seen after cannula-assisted FNAB. The risk of scleral tract UM cell implantation was statistically lower in cannula-assisted FNAB technique (p=0.018, Pearson Chi-square test). Conclusions. UM FNAB performed directly through the sclera without cannula is associated with tumor cells implantation in scleral tract. Cannula-assisted FNAB significantly reduces the incidence of UM implantation in scleral tract. Key words: uveal melanoma, fine-needle aspiration biopsy, enucleation, morphology, ophthalmology.
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Wu, Hao, Wei Chen, Fei Zhao, Qingyi Zhou, Peter S. Reinach, Lili Deng, Li Ma, et al. "Scleral hypoxia is a target for myopia control." Proceedings of the National Academy of Sciences 115, no. 30 (July 9, 2018): E7091—E7100. http://dx.doi.org/10.1073/pnas.1721443115.
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Worldwide, myopia is the leading cause of visual impairment. It results from inappropriate extension of the ocular axis and concomitant declines in scleral strength and thickness caused by extracellular matrix (ECM) remodeling. However, the identities of the initiators and signaling pathways that induce scleral ECM remodeling in myopia are unknown. Here, we used single-cell RNA-sequencing to identify pathways activated in the sclera during myopia development. We found that the hypoxia-signaling, the eIF2-signaling, and mTOR-signaling pathways were activated in murine myopic sclera. Consistent with the role of hypoxic pathways in mouse model of myopia, nearly one third of human myopia risk genes from the genome-wide association study and linkage analyses interact with genes in the hypoxia-inducible factor-1α (HIF-1α)–signaling pathway. Furthermore, experimental myopia selectively induced HIF-1α up-regulation in the myopic sclera of both mice and guinea pigs. Additionally, hypoxia exposure (5% O2) promoted myofibroblast transdifferentiation with down-regulation of type I collagen in human scleral fibroblasts. Importantly, the antihypoxia drugs salidroside and formononetin down-regulated HIF-1α expression as well as the phosphorylation levels of eIF2α and mTOR, slowing experimental myopia progression without affecting normal ocular growth in guinea pigs. Furthermore, eIF2α phosphorylation inhibition suppressed experimental myopia, whereas mTOR phosphorylation induced myopia in normal mice. Collectively, these findings defined an essential role of hypoxia in scleral ECM remodeling and myopia development, suggesting a therapeutic approach to control myopia by ameliorating hypoxia.
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Belousova, Elena. "OKVision® Onefit™ Mini-Scleral Lenses Fitting Guide." Eye 127, no. 2019-3 (September 2019): 47–52. http://dx.doi.org/10.33791/2222-4408-2019-3-47-52.
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Corneal topography has been widely used in medical practice over recent years and it has helped to detect keratectasias of various genesis more often and in the earlier stages. The emergence of the new polymer materials with high oxygen permeability made it possible to wear scleral contact lenses safely, that also resulted in their popularization. Scleral gas permeable lenses are an effective method of vision correction not only for various ectasias, but also for ametropia, presbyopia and other refractive pathologies. Scleral contact lenses do not directly touch the cornea and the limbus area, whereas tear firm under the lens physically smoothes out all of the existing defects and irregularities of the corneal surface, thus creating a ”cornea-tear-lens“ unified optical system. As a result, visual acuity increases significantly. In addition, scleral lenses ensure excellent comfort starting from the first minutes of wearing due to a larger diameter, no direct contact with the cornea and relatively low mobility. Scleral lenses ensure high visual functions and comfort owing to their specific self-supporting design, which is rested on the sclera. Selection and fitting of scleral contact lenses is simple and can be mastered by any ophthalmologist
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Stem, Maxwell S., Bozho Todorich, Maria A. Woodward, Jason Hsu, and Jeremy D. Wolfe. "Scleral-Fixated Intraocular Lenses." Journal of VitreoRetinal Diseases 1, no. 2 (March 2017): 144–52. http://dx.doi.org/10.1177/2474126417690650.
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Intraocular lenses (IOLs) can have inadequate support for placement in the capsular bag as a result of ocular trauma, metabolic or inherited conditions such as Marfan syndrome or pseudoexfoliation, or complicated cataract surgery. Surgical options for patients with inadequate capsular support include alternative placement of the IOL in the anterior chamber, fixation to the iris, or fixation to the sclera. The surgical techniques for each of these approaches have improved considerably over the last several decades resulting in improved visual and ocular outcomes. If no capsular or iris support exists, the surgeon can fixate an IOL to the sclera or the patient can remain aphakic. IOLs can be fixated to the sclera using sutures or by tunneling the IOL haptics into the sclera without sutures. This review summarizes the preoperative considerations, surgical techniques, outcomes, and unique complications associated with implantation of scleral-fixated IOLs.
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Boui, Hatim, Yassine Mouzari, Meriem Boui, Fouad Al Asri, Karim Reda, and Abdelbarre Oubaaz. "Scleral Dellen: Early Complication Of Pterygium Surgery And Literature Review." International Journal of Medical Science and Clinical invention 7, no. 06 (June 24, 2020): 4845–47. http://dx.doi.org/10.18535/ijmsci/v7i06.04.
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Introduction :
Severe Scleral Dellen is a rare and early postoperative complication of pterygium surgery.
The various cases reported in the literature are mostly related to this surgical technique; simple excision of the conjunctiva, notably either without adjuvant treatment or using mitomycyine C in preoperative or otherwise beta radiation.
The particularity of our case is that the scleral Dellen is associated with excision and simple suture of the conjunctiva without adjuvant treatment or cauterization of the vessels. The other particularity of this case is that it is to our knowledge the first case of scleral dellen reported in Morocco, and even at the African level.
Case report
This case is a 38-year-old military patient with no medical history
The patient was scheduled for pterygium surgery.
16 days later, the patient came back after noticing the appearance of a blackish brown spot at the nasal side of the right eye associated with mild eye pain.
The slit lamp examination of the involved eye revealed a severe scleral thining, surrounded by an oedematous conjunctiva and the visualization of the ciliary body through the fine sclera. The conjunctival sutures were no longer in place.
After three days and with treatement, we observed a scleral cicatrization, followed by a gradual covering of the sclera by conjunctiva.
Discussion :
In our case as in that described by Garcia-Medina and collaborators, we performed a conjunctival suture with two stitches to cover the sclera. Otherwise, both of the stitches were not found later, which suggests that, like in the Garcia-Medina report; a bad handling by the patient (eye rubbing), loose stitches or even both.
Thus, the sclera would have been exposed in the two cases.
Regarding the treatment of this complication, the graft of a conjunctival flap was performed in two cases with favorable evolution.
In all other cases, only medical treatment has been successfully initiated.
In our case we opted for medical treatment only, including local antibiotic therapy, intensive lubrication with artificial tears (hourly drop) and the occlusion of the eye. The evolution was also favorable under this treatment.
Hence, our case is similar to the Garcias-Medina and collaborators one, concerning the surgical technique, and also the scleral Dellen treatment. Although the difference and the particularity of our case was the absence of cauterization use during the surgical act.
Conclusion:
Scleral Dellen is rare complication of pterygium surgery, which occurs early after the surgical act.
Its exact physiopathology remains unknown, but some factors may be incriminated; first of them is the surgical technique as a simple excision with exposed sclera.
This complication can occur in patients, without any particular medical or ophthalmological history or any underlying pathology. It could also occur for primary pterygium. Medical treatment alone may be appropriate to manage this complication.
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Ismail, Zuhaila, Alistair Fitt, and Colin Please. "The Deformation of Human Eyeball when Undergoing Scleral Buckling." Applied Mechanics and Materials 695 (November 2014): 544–47. http://dx.doi.org/10.4028/www.scientific.net/amm.695.544.
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Scleral buckling is a surgical technique to treat rhegmatogenous retinal detachment (RRD). Vision may be affected by the scleral buckle. Since the buckle is pushed into the sclera towards the detached retina, it may change the shape and the focal length of the eyeball. A paradigm mathematical model of human eyeball is set up to examine how the focal length of the eye is affected under the action of the external force. In particular, this model has been developed using the membrane equations of equilibrium for axisymmetric spherical shells. Using numerical analysis the resulting displacements of the eyeball will be examined. The results of the scleral buckle may prove useful to predict changes in focal length.
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Shin, Yong Un, Mincheol Seong, Hee Yoon Cho, and Min Ho Kang. "Novel Technique to Overcome the Nonavailability of a Long Needle 9-0 Polypropylene Suture for Sutured Scleral Fixation of the Posterior Chamber Intraocular Lens Using a Single Fisherman’s Knot." Journal of Ophthalmology 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/2683415.
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Purpose. To describe a method to overcome the nonavailability of a long needle 9-0 polypropylene suture for sutured scleral fixation of the posterior chamber intraocular lens (PC-IOL) using a single fisherman’s knot (SFK). Methods. First, a 10-0 polypropylene suture was passed from the sclera to the ciliary sulcus using a long needle. A 9-0 suture was tied to the unpassed portion of the 10-0 suture with an SFK. We pulled the 10-0 suture to pass the SFK through the sclera, and then we cut the knot and removed the 10-0 suture. IOL fixation with 9-0 sutures used the conventional techniques used for sutured scleral-fixated IOL. Preoperative and postoperative visual acuity, corneal astigmatism, and endothelial cell count and intraoperative/postoperative complications were evaluated. Results. An SFK joining the two sutures was passed through the sclera without breakage or slippage. A total of 35 eyes from 35 patients who underwent sutured scleral fixation of the IOL. An intraoperative complication (minor intraocular hemorrhage) was recorded in four cases. Knot exposure, IOL dislocation, subluxation, and retinal detachment were not observed. Conclusions. The SFK offers the opportunity to use 9-0 sutures for the long-term safety and may not require the surgeon to learn any new technique.
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DeNaeyer, Gregory, Donald Sanders, Eef Van der Worp, Jason Jedlicka, Langis Michaud, and Sheila Morrison. "Qualitative Assessment of Scleral Shape Patterns Using a New Wide Field Ocular Surface Elevation Topographer." Journal of Contact lens Research and Science 1, no. 1 (November 16, 2017): 12–22. http://dx.doi.org/10.22374/jclrs.v1i1.11.
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Background and Objectives: Objective was to examine new findings regarding conjunctival/scleral shape mapped with a novel wide field elevation topography device and software, to propose a new classification system for scleral shape.
Methods: The Scleral Shape Study Group (SSSG) collaborated on this research. Data was collected from 152 eyes of prospective scleral lens patients utilizing a new topography device and software specifically designed to measure and map the sclera out to as much as 22 mm. Circumferential scleral plots of sagittal height vs. meridian at 14, 15 and 16mm diameters from the corneal center were generated for each eye. Scleral shape patterns were reviewed in all cases and classified according to recurring characteristics.
Results: Twelve eyes were excluded from the analysis due to incomplete data. Of the remaining 140 eyes, 8 (5.7%), of the plots were primarily spherical (Group 1) and 40 (28.6%) were primarily regularly toric, largely conforming to a toric (Sin2) curve with approximately 180° periodicity or interval between elevation to elevation or depression to depression (Group 2). Fifty-seven cases (40.7%) had asymmetric depressions (or steep areas) or asymmetric elevations (or flat areas) which were classified as Group 3. The remaining 35 cases (26%) had a recognizable toric pattern with elevations and depressions but they were irregularly spaced or did not have the customary 180° periodicity (Group 4).
Conclusion: A new classification of conjunctival/scleral shape is presented based upon data now available through wide field elevation topography, which could be helpful in scleral lens fitting and potentially soft lens fitting as the landing zone of these lenses are beyond the corneal borders.
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Brown, Dillon M., Machelle T. Pardue, and C. Ross Ethier. "A biphasic approach for characterizing tensile, compressive and hydraulic properties of the sclera." Journal of The Royal Society Interface 18, no. 174 (January 2021): 20200634. http://dx.doi.org/10.1098/rsif.2020.0634.
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Measuring the biomechanical properties of the mouse sclera is of great interest: altered scleral properties are features of many common ocular pathologies, and the mouse is a powerful tool for studying genetic factors in disease, yet the small size of the mouse eye and its thin sclera make experimental measurements in the mouse difficult. Here, a poroelastic material model is used to analyse data from unconfined compression testing of both pig and mouse sclera, and the tensile modulus, compressive modulus and permeability of the sclera are obtained at three levels of compressive strain. Values for all three properties were comparable to previously reported values measured by tests specific for each property. The repeatability of the approach was evaluated using a test–retest experimental paradigm on pig sclera, and tensile stiffness and permeability measurements were found to be reasonably repeatable. The intrinsic material properties of the mouse sclera were measured for the first time. Tensile stiffness and permeability of the sclera in both species were seen to be dependent on the state of compressive strain. We conclude that unconfined compression testing of sclera, when analysed with poroelastic theory, is a powerful tool to phenotype mouse scleral changes in future genotype–phenotype association studies.
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Kase, Satoru, Takeshi Ohguchi, and Susumu Ishida. "Catastrophic Thermal Corneoscleral Injury Treated with Transplantation of Donor Scleral Graft." Case Reports in Ophthalmology 8, no. 2 (June 6, 2017): 349–52. http://dx.doi.org/10.1159/000477334.
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Background: The aim of this study is to report a patient with senile cataract developing severe thermal corneoscleral injury during phacoemulsification, which was treated with a donor scleral graft. Case: Severe thermal corneoscleral injury occurred during phacoemulsification in the right eye of a 74-year-old male. His medical history was prostate hypertrophy. Visual acuity was hand motion and the intraocular pressure was 3 mm Hg OD. There was heavy corneal stromal opacity with intraocular fluid leakage. The patient underwent transplantation of a donor scleral graft to the burn site. Histologically, the injured sclera showed coagulation necrosis without inflammatory cell infiltration. An intraocular lens was eventually fixed in the ciliary sulcus 7 months later. His visual acuity remains at 2/20 OD. Conclusions: Transplantation of the donor scleral grafts is useful to close the wound in catastrophic thermal injury.
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Murienne, Barbara J., Michelle L. Chen, Harry A. Quigley, and Thao D. Nguyen. "The contribution of glycosaminoglycans to the mechanical behaviour of the posterior human sclera." Journal of The Royal Society Interface 13, no. 119 (June 2016): 20160367. http://dx.doi.org/10.1098/rsif.2016.0367.
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We characterized the structural and mechanical changes after experimental digestion of sulfated glycosaminoglycans (s-GAGs) in the human posterior sclera, using ultrasound thickness measurements and an inflation test with three-dimensional digital image correlation (3D-DIC). Each scleral specimen was first incubated in a buffer solution to return to full hydration, inflation tested, treated in a buffer solution with chondroitinase ABC (ChABC), then inflation tested again. After each test series, the thickness of eight locations was measured. After enzymatic treatment, the average scleral thickness decreased by 13.3% ( p < 0.001) and there was a stiffer overall stress–strain response ( p < 0.05). The stress–strain response showed a statistically significant increase in the low-pressure stiffness, high-pressure stiffness and hysteresis. Thus, s-GAGs play a measurable role in the mechanical behaviour of the posterior human sclera.
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Jahangir, Tehmina, Haroon Tayyab, Muhammad Naeem, Qasim Lateef, and Asad Aslam Khan. "MODIFIED SCLERAL BUCKLING WITH A NON-CONTACT WIDE ANGLE VIEWING SYSTEM AND A 25G CHANDELIER ENDOILLUMINTOR." Annals of King Edward Medical University 21, no. 4 (January 8, 2016): 219. http://dx.doi.org/10.21649/akemu.v21i4.761.
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AbstractPurpose:To evaluate the outcome of scleral buckling surgery using a wide angle non-contact viewing system and chandelier endoillumination for per-operative fundus visualization in patients with non-complex rhegmatogenous retinal detachments.Materials and Methods:This was a prospective, interventional study carried out at the Department of Ophthalmology, Mayo Hospital Lahore over a period of six months. Non-probability convenience sampling technique was employed. Fifteen eyes of fifteen pati-ents underwent modified scleral buckling procedure for rhegmatogenous retinal detachment using a 25G Awh Chandelier (inserted into the sclera through the pars plana) and wide angle viewing system to view the fundus intraoperatively instead of the conventional Indirect Ophthalmoscope.Results:The mean age of the patients in this study group was 41.9 12.4 years. Out of fifteen patients, 13 had flat retinas postoperatively. Two patients had to undergo pars plana vitrectomy with silicone oil tamponade due to development of retinal detachment secon-dary to PVR.Conclusion:Modified scleral buckling with the con-current use of a chandelier light and wide angle viewing system provides an easier and more convenient means of visualizing the fundus under panoramic viewing conditions intraoperatively.Key Words:Wide angle viewing system. Retinal detachment. Scleral buckling. Endoillumination.
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Astrelin, M. N., and V. K. Surkova. "Тhe Safety Assessment of the Ultraviolet Scleral Crosslinking with Riboflavin/UVA in Experiment." Ophthalmology in Russia 16, no. 1S (April 22, 2019): 108–11. http://dx.doi.org/10.18008/1816-5095-2019-1s-108-111.
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The purpose is to evaluate the safety of the scleral crosslinking with riboflavin/ultraviolet A (UVA) in an experiment in vivo. Materials and methods. The study was carried out on 34 Chinchilla rabbits (68 eyes). The right eyes were crosslinked (34 eyes), the left eyes were served as controls (34 eyes). Scleral crosslinking (SCXL) was performed with sclera saturation with a photosensitizer (0.1 % aqueous solution of riboflavin) for 20 minutes and its subsequent irradiation with ultraviolet A (wavelength of 370 ± 5 nm, irradiance — 3 mW/cm2), total exposure time — 30 minutes (6 cycles of 5 minutes). The effect of the procedure on the anatomical and functional state of the eye layers was assessed with high-resolution optical coherent tomography (OCT) and electroretinography (ERG) before crosslinking, a day, 7 and 30 days after it. Results. OCT did not reveal any pathological changes after scleral crosslinking with riboflavin/UVA. The layers of the retina, choroid and sclera were clearly visualized. The performed morphometric analysis has showed the absence of statistically significant changes in the eye layers thickness after ultraviolet crosslinking. The amplitude-time characteristics and the shape of the electroretinogram of the experimental and control rabbits eyes were identical during all periods of observation, had a classic appearance. All waves of ERG were well expressed. It indicates a satisfactory functional state of the retinal neuroreceptor mechanisms. Conclusion. For ultraviolet crosslinking we used UVA with an irradiance of 3 mW/cm2 for 30 minutes and a 0.1 % aqueous solution of riboflavin without dextran and did not reveal any side effects of the procedure. Thus, scleral crosslinking with these parameters is safe for the eye layers in an experiment in vivo.
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Sander, E. A., J. C. Downs, R. T. Hart, C. F. Burgoyne, and E. A. Nauman. "A Cellular Solid Model of the Lamina Cribrosa: Mechanical Dependence on Morphology." Journal of Biomechanical Engineering 128, no. 6 (June 16, 2006): 879–89. http://dx.doi.org/10.1115/1.2354199.
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The biomechanics of the optic nerve head (ONH) may underlie many of the potential mechanisms that initiate the characteristic vision loss associated with primary open angle glaucoma. Therefore, it is important to characterize the physiological levels of stress and strain in the ONH and how they may change in relation to material properties, geometry, and microstructure of the tissue. An idealized, analytical microstructural model of the ONH load bearing tissues was developed based on an octagonal cellular solid that matched the porosity and pore area of morphological data from the lamina cribrosa (LC). A complex variable method for plane stress was applied to relate the geometrically dependent macroscale loads in the sclera to the microstructure of the LC, and the effect of different geometric parameters, including scleral canal eccentricity and laminar and scleral thickness, was examined. The transmission of macroscale load in the LC to the laminar microstructure resulted in stress amplifications between 2.8 and 24.5×IOP. The most important determinants of the LC strain were those properties pertaining to the sclera and included Young’s modulus, thickness, and scleral canal eccentricity. Much larger strains were developed perpendicular to the major axis of an elliptical canal than in a circular canal. Average strain levels as high as 5% were obtained for an increase in IOP from 15to50mm Hg.
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Veronese, Chiara, Chiara Maiolo, Grayson W. Armstrong, Laura Primavera, Carlo Torrazza, Livia Della Mora, and Antonio P. Ciardella. "New surgical approach for sutureless scleral fixation." European Journal of Ophthalmology 30, no. 3 (January 30, 2020): 612–15. http://dx.doi.org/10.1177/1120672120902020.
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Purpose: The aim of this article is to describe a novel surgical technique for sutureless scleral fixation of an intraocular lens using the newly developed FIL SSF Carlevale IOL (Soleko, Italy). Methods: Four eyes of four patients with poor capsular support were recruited to our study, three resulting from intraocular lens subluxation and one case resulting from traumatic cataract. A novel sutureless sclera-fixated intraocular lens was implanted into the posterior chamber of each eye with sclerocorneal plugs fixating the lens to the wall of the eye. Results: Mean age of patients was 52 ± 16 years, ranging from 35 to 70 years. Mean follow-up was 6.50 ± 1.29 months (range: 5–7 months). Mean preoperative best-corrected visual acuity was 0.50 ± 0.33 logMAR (range: 1–0.3 logMAR). Postoperative best-corrected visual acuity improved to 0.08 ± 0.08 logMAR (range: 0.2–0 logMAR). There was no significant change in the mean intraocular pressure and there were no postoperative complications, such as iatrogenic distortion or breakage of the intraocular lens haptic, intraocular lens decentration, endophthalmitis, or retinal detachment. Discussion: To the best of our knowledge, this is the first report of outcomes using the novel sutureless sclera-fixated FIL SSF Carlevale IOL. This new surgical technique offers a simplified and effective approach for sutureless scleral intraocular lens fixation with good refractive outcomes.
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SABRI, K., and S. A. VERNON. "Scleral perforation following trans-scleral cyclodiode." British Journal of Ophthalmology 83, no. 4 (April 1, 1999): 501c. http://dx.doi.org/10.1136/bjo.83.4.501c.
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Baykara, Mehmet. "Scleral fixation technique with scleral cleft." Journal of Cataract & Refractive Surgery 34, no. 1 (January 2008): 6. http://dx.doi.org/10.1016/j.jcrs.2007.08.018.
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Muth, Daniel Rudolf, Armin Wolf, Thomas Kreutzer, Mehdi Shajari, Efstathios Vounotrypidis, Siegfried Priglinger, and Wolfgang J. Mayer. "Safety and Efficacy of Current Sclera Fixation Methods for Intraocular Lenses and Literature Overview." Klinische Monatsblätter für Augenheilkunde 238, no. 08 (April 14, 2021): 868–74. http://dx.doi.org/10.1055/a-1333-3199.
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Abstract Background Evaluation of the three currently most common techniques for intraocular lens (IOL) sclera fixation: (1) Prolene suture with Hoffman sclera pocket (2) four-point GoreTex suture technique (3) sutureless flanged intrascleral IOL fixation with double-needle (“Yamane”) technique. Material and Methods Retrospective, clinical case series (chart review) at the Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany. Enrolled in the study were 51 patients with 55 eyes. Best-corrected visual acuity (BCVA); manifest refraction (OR); corneal tomography (central corneal thickness, CCT); biometry; central macular thickness (CMT) by optical coherence tomography (OCT); intraocular pressure (IOP); and IOL type and IOL power were recorded and compared prior to and 3 – 12 months post IOL sclera fixation surgery. Pre- and postsurgery difference analysis was performed by Wilcoxon rank sum testing (z). Results Intrascleral fixation by GoreTex suture was performed in 14 (25.5%) eyes, by Prolene suture in 19 (34.5%,) and by Yamane technique in 22 (40.0%) eyes. Within the 3 – 12 months follow-up post scleral fixation, a total of 2 (14.3%) eyes from the GoreTex, 3 (15.8%) from the Prolene and 1 (4.5%) eye from the Yamane group required refixation. Pre- and post-surgery analysis revealed a statistically significant difference in the total patient population BCVA (exact Wilcoxon test: z = − 3.202; p = 0.001; n = 55) and the Yamane subgroup (exact Wilcoxon test: z = − 2.068; p = 0.001; n = 22). The GoreTex (n = 14) and Prolene (n = 19) subgroups revealed no statistically significant differences versus preoperative baseline. Across groups, there was no statistically significant difference in IOP, CMT, and CCT. No retinal complications were observed, neither intraoperatively nor during follow-up. Conclusion The volume of IOL revision surgery is increasing. Often, the only option left for visual rehabilitation is scleral IOL fixation. All three scleral fixation techniques studied demonstrated a good safety profile with no statistically significant impact on IOP, CMT, CCT, but with a notable revision rate. Visual rehabilitation to preoperative baseline levels (GoreTex [n = 14] and Prolene [n = 19]) and a statistically significant increase in visual acuity (total cohort [n = 55] and Yamane [n = 22]) seems possible. Unlike iris fixation, scleral fixation is surgically more complex and the surgeon must master a steeper learning curve.
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Lobbes, Hervé, Julien Dehos, Bruno Pereira, Guillaume Le Guenno, Laurent Sarry, and Marc Ruivard. "Computed and Subjective Blue Scleral Color Analysis as a Diagnostic Tool for Iron Deficiency: A Pilot Study." Journal of Clinical Medicine 8, no. 11 (November 5, 2019): 1876. http://dx.doi.org/10.3390/jcm8111876.
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Iron deficiency (ID) is the most common nutritional deficiency. ID diagnosis requires ferritin measurement because clinical findings are poor and nonspecific. We studied the diagnostic value of blue sclera, which was scarcely reported as a specific and sensitive sign of ID. We enrolled 74 patients suspected of having ID. Pictures of their eyes were taken using a smartphone under similar daylight conditions. Three independent physicians graded the scleral color, and a computer analysis yielded the blue percentile of the sclera image. Final analysis included 67 patients (mean age 59.9 ± 20.1 years). Fifty-one had ID. Subjective blue scleral color was associated with ID for physician 1 (64.5% vs. 86.1%, p = 0.03). Sensitivity was 60.8% (CI95: 46.1%; 74.2%), specificity 68.8% (CI95: 41.3%; 89%), and positive predictive value 86.1% (CI95: 70.5%; 95.3%). A marginal difference was observed for other physicians (p = 0.05). Computer analysis showed higher blue in the ID group (p = 0.04). The area under the receiver operating characteristic (ROC) curve was 0.7 (0.54; 0.85). Sensitivity was 78.4% (CI95: 63.7%; 88.7%), specificity was 50% (CI95: 24.7%; 75.3%). Assessment of blue sclera was not influenced by iris color, sex, or anemia. We showed that blue sclera has good positive predictive value for ID diagnosis, and computer analysis was correlated to clinical assessment. Improvement of this innovative, non-invasive method could provide an easy handling and inexpensive diagnosis tool for ID.
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Iomdina, E. N., E. P. Tarutta, G. A. Markosian, and J. I. Gavrilova. "Current assessment results of the efficacy and safety of scleroplasty in progressive myopia." Russian Ophthalmological Journal 14, no. 1 (March 20, 2021): 96–103. http://dx.doi.org/10.21516/2072-0076-2021-14-1-96-103.
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The purpose of the review is to analyze the data of recent studies (performed in the last two decades) of the efficacy and safety of sclera reinforcement surgeries for progressive myopia in children and adults. Short-term and long-term observation results are presented, indicating the impact of the initial degree of myopia, the patient's age, surgical technique and the choice of plastic material on the outcome of the intervention and the further course of the myopic process. The advantages of a biologically active synthetic graft are described, which makes it possible to deposit drugs that stimulate scleral crosslinking and have a biomechanical, trophic and hemodynamic effect. Crosslinking of scleral collagen is a promising approach to the treatment of myopia.
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Lam, Carol P. S., Jason C. S. Yam, Flora H. S. Lau, Dorothy S. P. Fan, C. Y. Wong, Christopher B. O. Yu, and Winnie W. Y. Lau. "SR and LR Union Suture for the Treatment of Myopic Strabismus Fixus: Is Scleral Fixation Necessary?" BioMed Research International 2015 (2015): 1–5. http://dx.doi.org/10.1155/2015/470473.
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Purpose. To evaluate and compare the effectiveness of scleral fixation SR and LR union suture and nonscleral fixation union suture for the treatment of myopic strabismus fixus.Methods. Retrospective review of 32 eyes of 22 patients with myopic strabismus fixus who had undergone union suture of superior rectus (SR) and lateral rectus (LR) with or without scleral fixation, and follow-up longer than 6 months at Hong Kong Eye Hospital from 2006 to 2013. Surgical techniques and outcomes in terms of ocular alignment are analyzed.Results. There is significant overall improvement both in postoperative angle of esodeviation (P<0.01) and postoperative range of movement (P=0.042). Comparing between the sclera fixation group (11 eyes) versus nonscleral fixation group (21 eyes), the postoperative horizontal deviation, the postoperative vertical deviation, successful outcome, and the change in horizontal deviation were not significantly different (P>0.05).Conclusions. Union suture of SR and LR is an effective procedure in correcting myopic strabismus fixus. Fixation of the union suture to the sclera does not improve surgical outcome.
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Norn, Mogens. "Topography of scleral emissaries and sclera-perforating blood vessels." Acta Ophthalmologica 63, no. 3 (May 27, 2009): 320–22. http://dx.doi.org/10.1111/j.1755-3768.1985.tb06813.x.
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STERNBERG, PAUL, JAMES TIEDEMAN, and JAY G. PRENSKY. "SUTURELESS SCLERAL BUCKLE FOR RETINAL DETACHMENT WITH THIN SCLERA." Retina 8, no. 4 (1988): 247–49. http://dx.doi.org/10.1097/00006982-198808040-00005.
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Makino, Shinji, and Yukihiro Sato. "A Case of Extrusion of a Solid Silicone Tire Migrating through the Superior Rectus Muscle withAeromonas hydrophilaInfection following a Scleral Buckling Procedure." Case Reports in Ophthalmological Medicine 2012 (2012): 1–3. http://dx.doi.org/10.1155/2012/167164.
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To our knowledge, there are no reports ofAeromonas hydrophilainfection after a scleral buckling procedure. Also, migration of a silicone explant element through the rectus muscles is extremely rare. Herein, we describe a case experiencing extrusion of a solid silicone tire migrating through the superior rectus muscle withAeromonas hydrophilainfection following a scleral buckling procedure. A 42-year-old man was referred to our hospital complaining of ocular pain and purulent discharge in his left eye which has persisted for several months. He had a history of bilateral rhegmatogenous retinal detachment which had been treated with scleral buckling. The left eye showed extrusion of the solid silicone buckle which had migrated through the superior rectus muscle and an infection in the upper quadrant of the sclera. The buckle was removed, and the patient was treated with antibiotics. After the removal of the buckle, the symptoms showed rapid amelioration and there was no recurrence of retinal detachment.Aeromonas hydrophilawas isolated from the discharge and the removed explant. He used well water in daily life. In this case, theAeromonas hydrophilainfection of the extruded buckle might have originated from contaminated well water.
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Geffen, Noa, Yokrat Ton, Gonzalo Muñoz, Cesare Mariotti, and Ehud I. Assia. "CO2 Laser-assisted Sclerectomy Surgery for Open-angle Glaucoma." European Ophthalmic Review 06, no. 01 (2012): 12. http://dx.doi.org/10.17925/eor.2012.06.01.12.
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Purpose:To evaluate the safety and performance of CO2 laser-assisted sclerectomy surgery (CLASS).Materials and Methods:CLASS using the IOPtiMate system was performed in experimental models and in patients with primary and pseudoexfoliative open-angle glaucoma. CO2 laser was used to achieve deep scleral ablation. Percolation and perforation rates were recorded. Histopathological analysis was performed on laboratory models, complications were recorded and postoperative intraocular pressure (IOP) was measured.Results:Deep scleral ablation and aqueous percolation were repeatedly achieved. Histology disclosed deep scleral craters with a thin intact sclero-corneal tissue at the ablation area with mild, transient and limited thermal damage. Thirty of 37 patients with glaucoma completed 12 months of follow-up. The baseline IOP of 26.3 ± 7.8 mmHg (mean ± SD) dropped to 14.4 ± 3.4 mmHg and 14.3 ± 3.1 mmHg at six and 12 months, respectively (p<0.001). Complications were mild and transitory with no sequelae.Conclusions:CLASS using the IOPtiMate system is a safe and efficacious procedure for achieving effective fluid percolation.
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Monteiro, Manuel. "Reply: Scleral fixation technique with scleral cleft." Journal of Cataract & Refractive Surgery 34, no. 1 (January 2008): 6. http://dx.doi.org/10.1016/j.jcrs.2007.08.019.
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Mansour, Ahmad M., Bachir Abiad, Fouad I. Boulos, Ramzi Alameddine, Fadi C. Maalouf, Alaa Bu Ghannam, and Rola N. Hamam. "Adult Ocular Toxocariasis Mimicking Ciliary Body Malignancy." Case Reports in Medicine 2014 (2014): 1–5. http://dx.doi.org/10.1155/2014/368907.
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Purpose. To discuss an unusual presentation of ocular toxocariasis.Methods. Case report.Results. A 40-year-old woman presented with decreased vision in the left eye with a long history of recurrent red eye from uveitis. Eosinophilia and positive ELISA titers forToxocara canisfavored the diagnosis of ocular toxocariasis. Over 3 months, an anterior scleral mass had a rapid growth raising the possibility of medulloepithelioma, which rarely can mimic uveitic syndromes. Surgical plan changed from local excision to enucleation. Histopathology demonstrated a large homogeneous mass of chronic inflammatory cells with inflammation of the overlying thinned out sclera, medial rectus insertion, and limbal cornea. The triad of peripheral granuloma, eosinophilia, and positive blood serology established the diagnosis of ocular toxocariasis.Conclusions. Ocular toxocariasis can mimic ocular malignancy such as medulloepithelioma in adults and rarely presents as an anterior scleral mass.
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Talieri, Ivia Carmem, José Luiz Laus, Joaquim Coutinho-Netto, Maria Cecília Rui Luvizotto, and Meiby Carneiro de Paula. "Natural latex graft in lamellar and penetrating sclerectomies in rabbits." Ciência Rural 39, no. 6 (September 2009): 1815–22. http://dx.doi.org/10.1590/s0103-84782009000600027.
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The objective of study was to investigate the effects of natural latex with 0.1% of polylysine on lamellar and penetrating scleroctomies in rabbits. Two groups of twelve rabbits each (lamellar GI and penetrating GII) were studied. Scleral square incisions near the limbus were performed on the left eye of each animal. The latex biomembrane was fixed to the recipient sclera and it covered with a conjunctival flap. The clinical evaluations were followed for 60 days. Aplannation tonometry, binocular indirect ophthalmoscopy and slit-lamp biomicroscopy were performed during evaluation. Bright field microscopy and polarization microscopy were employed. Blepharospasm, graft infection, mucoid ocular discharge and chemosis were not observed in either treatment group. The conjunctival hyperemia varied from moderate to hardly noticeable. The postoperative IOP was not statiscally significant, comparing to the preoperative IOP, for GI and GII. The histopathology by polarization microscopy showed that the neoformed tissue was primarily dependent on adjacent vascularized tissues and was constituted by collagen type III. Both groups presented optimum graft adhesion to the receiving sclera. The natural latex biomembrane with 0.1% polylysine constitutes a new alternative for scleral reconstruction. Furthermore, this is a durable material, easy to obtain and manipulate.
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Misawa, Norihiko, Mizuki Tagami, Atsushi Sakai, Takeya Kohno, and Shigeru Honda. "Rapid Regression of Scleral Melting Associated with Tumor Necrosis Factor-α in a Case of Surgically Induced Necrotizing Scleritis." Case Reports in Ophthalmology 11, no. 2 (August 6, 2020): 418–22. http://dx.doi.org/10.1159/000509260.
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Purpose: To report a case with rapid regression of scleral melting associated with tumor necrosis factor-α (TNF-α) in a surgically induced necrotizing scleritis (SINS) patient treated with local steroid therapy. Case Presentation: An 85-year-old male patient presented with conjunctival tumor in his right eye. Complete resection of the tumor lesion and conjunctival re-construction were performed. Local steroid drops were administered until 1 month after surgery, and a good clinical course was achieved. However, after stopping the local steroid, scleral melting to the uvea occurred on the center of the tumor-resected sclera. After diagnosing SINS, we immediately restarted his local steroid. After 2 weeks, there was a complete and rapid regression of the scleral melting. Following this episode, only local steroid therapy was continued for the treatment of SINS, with no recurrence observed after 6 months. Histopathological analysis revealed the infiltration of inflammatory cells during the acute phase, with TNF-α immune reactivity observed in the center of the melting site near the resected conjunctiva. Conclusion: We speculate that the observed changes were associated with the TNF-α that was present during the pathological state of SINS. Local steroid therapy may play a key role in the local immune balance in SINS.
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Hu, Xin, Bo Zhao, and Haiying Jin. "Intraocular Suture Looping Technique for Flapless Four-Point Refixation of Dislocated Intraocular Lenses." Journal of Ophthalmology 2021 (February 8, 2021): 1–5. http://dx.doi.org/10.1155/2021/6648777.
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Purpose. To describe a flapless/grooveless technique for four-point refixation of a dislocated intraocular lens (IOL) with four fenestrated haptics. Methods. An intraocular suture looping technique was performed with the assistance of two 27-gauge needles. A looping needle was passed into the eye through paracentesis and was used to loop both fenestrated haptics on the same side with an 8–0 polypropylene thread. A guiding needle was used to guide the looping needle out of the eye at the scleral fixation sites. After looping each pair of fenestrated haptics on nasal/temporal sides with 8–0 polypropylene sutures, the IOL was refixated by definitive knotting. The exterior suture ends were buried into the sclera without the creation of scleral flaps/grooves. Results. The technique was employed in four eyes (three patients). The mean postoperative follow-up period was 13.8 ± 2.2 months. Postoperatively, the IOLs of all the eyes remained well positioned and stable. The postoperative visual acuities of all the eyes were improved. No suture erosion, hypotony, scleral atrophy, chronic inflammation, retinal tears, and/or detachments were observed within the follow-up period. Conclusion. The present technique provides minimal surgical invasion for the transscleral refixation of a dislocated IOL with four fenestrated haptics.