Objective To assess potential methods of reducing visible aerosol generation during clear corneal phacoemulsification surgery in the era of Covid-19. Methods Aerosol generation during phacoemulsification was assessed using a model comprising a human cadaveric corneoscleral rim mounted on an artificial anterior chamber. Typical phacoemulsification settings were used and visible aerosol production was recorded using high-speed 4K camera. Aerosolisation was evaluated under various experimental settings: Two different phacoemulsification tip sizes (2.2, 2.75 mm), varying levels of corneal moisture, the use of suction and blowing air in the surgical field, the use of hydroxypropyl methylcellulose (HPMC) coating of the cornea with a static and moving tip. Results This model demonstrates visible aerosol generation during phacoemulsification with a 2.75-mm phacoemulsification tip. No visible aerosol was noted with a 2.2-mm tip. The presence of visible aerosol was unrelated to corneal wetting. Suction in close proximity to the aerosol plume did not impact on its dispersion. Blowing air redirected the aerosol plume toward the ocular surface. Visible aerosol production was abolished when HPMC was used to coat the cornea. This effect lasted for an average of 67 ± 8 s in the static model. Visible aerosol generation was discerned during movement of the 2.2mm tip toward the corneal wound. Conclusions We demonstrate visible aerosol production in the setting of a model of clear corneal phacoemulsification. Visible aerosol can be reduced using a 2.2-mm phacoemulsification tip and reapplying HPMC every minute during phacoemulsification.

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Precis: Chronic hypotony is not uncommon following deep sclerectomy (DS), but only a minor proportion of patients develop hypotony-associated complications. Numerical hypotony does not affect the visual outcomes. This study identifies factors associated with hypotony.Purpose: To investigate the incidence and risk factors of hypotony and hypotony-associated complications after DS.Methods: Retrospective cohort study of 1765 eyes (1385 patients) undergoing DS with or without cataract extraction between 2001 and 2020 in 2 UK centers. Chronic hypotony was defined as intraocular pressure (IOP) ≤ 5 mm Hg in ≥ 2 consecutive visits lasting > 90 days or as any IOP ≤ 5 mm Hg associated with hypotony-related complications or requiring surgical intervention. Clinical hypotony was defined as the presence of: serous or hemorrhagic choroidal detachment, hypotony maculopathy, flat anterior chamber requiring reformation, decompression retinopathy. The incidence of hypotony was calculated with Kaplan-Meier statistics, and Cox regression was used to identify risk factors. Results:The median (interquartile range) age and follow-up were 76 (67 to 82) years and 45.4 (20.9 to 79.8) months, respectively. The incidence (95% confidence interval) of chronic and clinical hypotony at 5 years was 13.4% (11.5%-15.3%) and 5.6% (4.3%-6.9%), respectively. Sixteen eyes (15.7%) with hypotony-associated complications had IOP > 5 mm Hg. Male sex (hazard ratio [HR]: 1.89,

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(1) Background: Eye drops are the most common route of administration for ophthalmic medications. Administering drops can be a major hurdle for patients, potentially resulting in noncompliance and treatment failure. The purpose of this study is to compare the efficacy and safety of two different aids and the conventional bottle for eye drop instillation; (2) Methods: An interventional crossover study involving standard eye drop bottle, Opticare aid and Autodrop aid. The study included healthy subjects without a history of regular eye drop use; (3) Results: Twenty-six subjects were enrolled. Of those subjects, 96% and 92% were able to assemble the eye drop bottle into the Autodrop and the Opticare aids, respectively. Subjective assessment indicated that Autodrop was significantly easier to assemble than Opticare (95% CI: −1.6802 to −0.1659, p = 0.02). When using either aid, there was no contamination of the bottle tip, which occurred in 46% of subjects when no aid was used (p = 0.0005). Fewer drops were expelled when using the conventional bottle as compared to the aids (p = 0.05 compared to Autodrop, p = 0.1 compared to Opticare); (4) Conclusions: Autodrop and Opticare can assist patients with eye drop placement. These aids completely prevented bottle tip contamination, which was frequently observed when the conventional bottle was used alone.

Glaucoma is the leading cause of irreversible blindness and the aim of all glaucoma treatments is to lower intraocular pressure (IOP), the only modifiable risk factor. This article summarises the identification and management of open‐angle and closed‐angle glaucoma, including medical, laser and surgical treatment options.

Objective: To assess potential methods of reducing visible aerosol generation during clear corneal phacoemulsification surgery in the era of Covid-19. Methods: Aerosol generation during phacoemulsification was assessed using a model comprising a human cadaveric corneoscleral rim mounted on an artificial anterior chamber. Typical phacoemulsification settings were used and visible aerosol production was recorded using high speed 4K camera. Aerosolisation was evaluated under various experimental settings: Two different phacoemulsification tip sizes (2.2mm, 2.75mm), varying levels of corneal moisture, the use of suction and blowing air in the surgical field, the use of hydroxypropyl methylcellulose (HPMC) coating of the cornea with a static and moving tip. Results: This model demonstrates visible aerosol generation during phacoemulsification with a 2.75mm phacoemulsification tip. No visible aerosol was noted with a 2.2mm tip. The presence of visible aerosol is unrelated to corneal wetting. Suction in close proximity to the aerosol plume did not impact on its dispersion. Blowing air redirected the aerosol plume towards the ocular surface. Visible aerosol production was abolished when HPMC was used to coat the cornea. This effect lasted for an average of 67±8 seconds in the static model. Visible aerosol generation was discerned during movement of the 2.2mm tip towards the corneal wound. Conclusions: We demonstrate visible aerosol production in the setting of a model of a clear cornea phacoemulsification. Visible aerosol can be reduced using a 2.2mm phacoemulsification tip and reapplying HPMC every minute during phacoemulsification.

AimsTo report the incidence, risk factors and long-term outcomes of laser goniopuncture (LGP) in patients with previous deep sclerectomy (DS).MethodsRetrospective cohort study of 1765 eyes (1385 patients) undergoing DS with or without cataract surgery between 2001 and 2020 in two UK institutions. Kaplan-Meier was used to estimate LGP incidence. DS success after LGP was calculated for criteria A, B, and C defined as intraocular pressure (IOP) of ≤18, ≤15 and ≤12 mm Hg with 20%, 25% and 30% reduction, respectively. Cox regression was used to investigate factors associated with the risk of failure.ResultsLGP had an estimated incidence of 33.3% (30.9%–35.6%), 56.3% (53.5%–58.9%) and 62.8% (59.7%–65.6%) at 1, 3, 5 years, respectively. Mean (±SD) IOP significantly (p<0.001) decreased from 21.2 (±6.0) mm Hg pre-LGP to 13.8 (±5.2) mm Hg and 12.9 (±4.7) mm Hg at 3 and 5 years post-LGP, respectively. Success rates at 3 and 5 years were, respectively, 40.9% (37.5%–44.6%) and 33.7% (30.3%–37.6%) for criterion A; 27.1% (24.0%–30.5%) and 22.3% (19.3%–25.7%) for criterion B and 13.9% (11.6%–16.7%) and 11.6% (9.5%–14.3%) for criterion C. In all models, higher pre-LGP IOP (p<0.001) and higher pre-LGP medication number (p<0.001) were associated with increased failure, while male gender (p≤0.004), intraoperative mitomycin C (p≤0.031), longer interval between DS and LGP (p≤0.01) with reduced failure.ConclusionMost patients undergoing DS will eventually require LGP. LGP is effective at rescuing eyes with a failing DS. This study identifies several factors associated with LGP outcomes, knowledge of which may help clinicians predict LGP success.