No description available.

No description available.

No description available.

Ocular trauma is common in low-income countries. Groote Schuur Hospital manages large numbers of patients with the manifestations of ocular trauma every year. The lens and its supporting structures, major refractive components of the eye, may be damaged in more than half of cases of severe trauma. Despite this, there is still some doubt as which is the best modality for the most successful rehabilitation of patients who have such severe lens damage as to necessitate its removal along with the capsule in which it is contained. lntraocular lenses sutured to the sclera in the posterior chamber of the eye (SL TC - Sutured lenses for traumatic cataract) - in the natural position of the crystalline lens - is standard practice at Groote Schuur Hospital in selected patients. It is a difficult and intricate procedure, usually only performed by consultants experienced in the technique. The majority of patients who undergo ocular trauma are young, necessitating rapid and effective optical rehabilitation to maximise productivity and quality of life. The use of contact lenses in aphakic, previously traumatised eyes may be the least invasive modality but is not appropriate in all cases. Anterior chamber lenses, especially the older versions with closed loop haptics, have been associated with numerous complications despite being significantly easier to implant'. Numerous other options such as Iris claw fixated lenses, intraocular lenses sutured to the Iris and tissue techniques for the fixation of posterior chamber intraocular lenses have not been used to date at Groote Schuur Hospitar4. Habit and anecdote regarding the dangers of anterior chamber intraocular lenses in patients with presumed co-existing angle trauma has precluded the use of these anterior chamber lenses in patients known to have had trauma. A marker for such trauma, angle recession, may be found in up to 15% of patients in certain parts of the drainage area of our hospital. The selection of patients for SL TC has not been standardized and there may be some difficulty in prognosticating visual outcome in these patients without large series that pertain directly to those eyes that have sustained trauma

No description available.

Objectives. To describe and analyse the effectiveness of using accelerated epithelium-off corneal crosslinking (A-CXL), in a cohort of patients with progressive keratoconus (KC), presenting to Groote Schuur Hospital, South Africa. Methods. A retrospective review of patients who underwent A-CXL, using 6.4 mW/cm2 ultraviolet-A irradiation for 15 min, for progressive KC between 1 May 2017 and 1 June 2018. All patients completed 6 months minimum follow-up (Mean 9months, range 6-15). The diagnosis of keratoconus was based on corneal tomography and its clinical signs. Keratometry values and visual acuities were measured to ascertain if there was improvement in acuity or corneal curvature at 6 months post-procedure. Results. Nineteen eyes of 17 patients were included. The group consisted of 6 (32%) males and 13 (68%) females, with a mean age of 22.17 years (SD = 5.8). Zero eyes showed mild keratoconus, 8(42%) showed moderate keratoconus and 11(58%) showed severe keratoconus. At 6 months follow-up, results revealed that UCDVA improved from logMAR 0.96 to 0.83 (p = 0.068) and BCVA improved from logMAR 0.40 to 0.34 (p = 0.073). The mean UCDVA and BCVA Snellen line gain was 0.43 and 0.94. Overall the change in UCDVA and BCVA trended towards being statistically significant. The median Kmax value decreased from 57.7D to 55.9D. The mean Kmax value decreased from 59.46D to 58.85D (p = 0.137). The mean Kmean anterior increased from 50.26D to 50.86D (p = 0.139), the mean Kmean posterior from -7.48D to -7.67D (p = 0.026). There was a statistically significant change in Kmean post, but not so for Kmean ant and Kmax. Both severity groups showed a decrease in thinnest point corneal pachymetry from mean 445 micrometer(μm) to mean 422 μm (Moderate: p = 0.009; Severe: p = 0.003). KC progression was stopped or stabilised in 13 eyes (68%); 6 eyes (32%) showed progression. No complications were found. Conclusions. Our results show the effectiveness of 15-minute A-CXL (irradiance of 6.4 mW/cm2) in maintaining both corneal stability and visual acuity in our patient population at 6 months follow-up. In future, a larger study with prolonged follow-up would be required to elucidate this finding.

BACKGROUND: Primary open angle glaucoma (POAG) is the second-leading cause of blindness in the U.S. It is caused by a buildup of aqueous humor resulting from abnormally increased resistance to outflow in the trabecular drainage pathway, which leads to an increase in intraocular pressure (IOP) in the eye. Elevated IOP is the primary risk factor for development and progression of POAG. Higher IOP compresses and damages the optic nerve, causing visual field loss, and ultimately leading to blindness. Reducing the IOP slows the progression of glaucoma. Netarsudil, sold under the brand name “Rhopressa,” is a rho-kinase/NE transporter inhibitor that lowers elevated IOP in patients with open-angle glaucoma or ocular hypertension. A previous study showed that netarsudil uses a number of mechanisms to increase the outflow facility of aqueous humor in human eyes (Gong & Swain 2020). However, netarsudil’s effects on the endothelial cells of Schlemm’s canal (SC) have yet to be investigated. AIM: The goal of this study was to determine the effects of netarsudil-treatment on cell dimensions, volumes, and GVs of the inner wall endothelial cells of SC in comparison to those of non-treated control eyes using serial block-face scanning electron microscopy (SBF-SEM) and 3D reconstruction. METHODS: The two pairs of eyes were perfused with green fluorescent tracer to determine the correct outflow pattern (either high-flow or non-flow) before administering either 0.3 µM netarsudil or vehicle solution at constant pressure of 15 mmHg for 3 hours. Afterwards, the eyes were perfused with red fluorescent tracer to determine the outflow pattern post-treatment followed by perfusion fixation. Global imaging was performed for the eyes to visualize these high- and non-flow areas in the trabecular meshwork (TM) and ESV’s. A SBF-SEM was used to image the inner wall cells of SC in high- and non-flow areas of each eye. This study analyzed a total of 9,257 images and 3D reconstructed 16 inner wall endothelial cells of SC (4 cells in each group) to compare the cell dimensions, cell volume, nuclear volume, giant vacuole (GV) volume, and multi-cell GV (mcGV) volume, as well as GV types between cells from high- or non-flow regions of netarsudil-treated and un-treated control eyes. RESULTS: The mean cell length appears to be greater in the non-flow regions of netarsudil-treated eyes compared to that in the control group. The mean cell width in both nuclear and non-nuclear regions did not differ much among the control and treatment groups in both high-flow and non-flow regions. The mean cell thickness in both nuclear and non-nuclear regions appeared to be greater in high-flow regions of the treated eyes than that of control eyes. Netarsudil treatment increased the mean cellular volume and the mean nuclear volume in areas of high-flow. The number of GVs associated with endothelial cells from both high- and non-flow regions increased after netarsudil treatment. When treated with netarsudil, cells from high-flow regions appear to have increased mean mcGV volume. Type II GVs appear to be the most common type of GV, and no type III GVs were observed. The treated cells had a greater percentage of type I GVs, while the control cells had a greater percentage of type II GVs. There was no apparent difference between the treatment and control groups in the percentage of type IV GVs. CONCLUSIONS: SBF-SEM and 3D reconstruction provided a reliable method to evaluate cellular changes after netarsudil treatment. Preliminary data shows that, when treated with netarsudil, inner wall endothelial cells of SC appear to have increased cellular thickness, nuclear, cell and GV volumes (including mcGVs). Previous studies indicated that size of GVs plays a role in pore formation. A large number of cells will need to be studied to determine whether increased GV size leads to increased pore or type IV GV formations, contributing to netarsudil-induced increase in aqueous outflow.

INTRODUCTION AND AIM: Primary Open-Angle Glaucoma (POAG) is a leading cause of blindness worldwide. The pathology is characterized by elevated resistance to aqueous humor (AH) outflow which leads to an increased intra-ocular pressure (IOP). Elevated IOP is a risk factor for the development and progression of POAG because increased IOP can cause visual impairments or blindness by damaging the optic nerve. Previous studies indicated that Thrombospondin-1 (TSP-1) expression is higher in glaucomatous eyes and TSP1-deficient mice exhibit lowered IOP, suggesting TSP-1 plays a role in regulating IOP. A preliminary study in the Gong Lab has showed that TSP-1 decreased outflow facility in porcine eyes. This study aims to explore morphologic changes in the trabecular meshwork and episcleral veins (ESVs) in porcine eyes that were previously treated with either TSP-1 or phosphate-buffered saline containing 5.5 mM D-glucose (GPBS). METHODS: Nine fresh porcine eyes were used in this study. All eyes were perfused with GPBS for 30 minutes to establish a stable baseline outflow facility. TSP-1 (0.8μg/mL) was then exchanged and perfused to one eye of each pair for 3 hours, while GPBS was exchanged and perfused to the contralateral eyes (N=5) as the control group. All perfusion was performed at a consistent pressure of 15mmHg, and the outflow facility was recorded. After perfusion, all eyes were perfused with a fluorescent tracer to label the outflow pattern, and then they were perfusion-fixed. The tissue of the anterior chamber angle of each eye was dissected and processed for light microscopy. One TSP-1 treated eye was excluded for morphologic study due to damage of the tissue. Three wedges from each eye were used for data collection and analysis. Semi-thin sections of each sample were cut and stained with 0.1% Toluidine Blue. The morphology of trabecular meshwork was evaluated. Numbers of episcleral veins (ESVs) were counted and their sizes (cross-sectional areas) were measured using ImageJ (NIH). This study was masked and decoded after all the measurements were done. Statistical significance between control and TSP-1 treated was analyzed. RESULTS: Outflow facility was significantly decreased in the TSP-1 treated group compared to the control group (performed by other members in Gong lab). The average cross-sectional area of ESVs (797.0 ± 30.1 μm2) in the TSP-1 treated group was significantly smaller than the area of ESVs (1628.2 ± 191.3 μm2) in the control group (P<0.05). No significant morphologic differences were found in the TM of TSP-1 treated eyes when compared to the control. CONCLUSIONS: TSP-1 reduced the size (cross-sectional area) of ESVs, which may contribute to decreased outflow. The findings of this study suggest that blocking TSP1- induced vasoconstriction in the ESVs could be a potential target to increase outflow facility or lower IOP for glaucoma treatment.

Alpha-Melanocyte Stimulating Hormone (α-MSH) is an anti-inflammatory neuropeptide that is produced by the Retinal Pigment Epithelium (RPE). This neuropeptide has been found to reduce inflammation and severity of Experimental Autoimmune Uveitis (EAU) mice and inflammation in other ocular pathologies. In many of these inflammatory diseases, there are mechanisms, which may demonstrate the existence of innate immune memory. Innate immune memory is associated with an epigenetic gene modification that regulates cytokine production in subsequent restimulation of the innate immune cells. In trained innate immunity, the restimulated innate immune cell suppressed pro-inflammatory cytokine production while producing anti-inflammatory cytokines. When the macrophage cell line RAW 264.7 was treated with lipopolysaccharide (LPS), it stimulates an immune response with the production of Nitric Oxide (NO•), and interleukins such as IL-1β and IL-10. The results showed statistically significant differences in the production of NO• between RAW 264.7 cells treated with α-MSH and the untreated cells. The results of IL-1β were not statistically different between the amounts produced between the untreated and the α-MSH treated cells. For IL-10, there were statistically significant and suggested that α-MSH may have a role in creating greater amounts of IL-10 upon restimulation in the presence of α-MSH and LPS, leading to enhancement of anti-inflammatory mechanisms, demonstrating innate immune memory.

No description available.