Purpose To study the relationship between age and response to surgery in patients with intermittent exotropia and to identify change points in response to surgery. Methods A retrospective analysis was conducted on 311 patients with intermittent exotropia who had bilateral lateral rectus recession using standard tables with minimum follow-up of 6 months. Data were analyzed using the change-point analysis software to identify cutoff points. A prospective pilot study was then performed on 171 consecutive patients with intermittent exotropia with the same clinical characteristics, in whom amount of recession was modified according to the identified cutoff points. In angles with two change points, 1-mm recession was reduced from patients younger than the lower change point and 1.5-mm recession was added to those older than the upper change point. In angles with one change point, 1.5-mm recession was added to those older than the change point. Satisfactory alignment was defined as esophoria/tropia r5D to exophoria/tropia r8D. Results There was a negative correlation (Po0.01) between response to surgery and age at surgery for all angles. In younger patients (o7 years) in whom surgical dose was reduced, there was no significant change in success rate (77%), compared with those who had surgery using standard tables (75%). In older patients (412 years) in whom surgical dose was increased, there was a statistically significant increase in success rate (80% vs 41%). Conclusions Modifying the surgical dose according to age can improve the success in patients with intermittent exotropia.

No author has a financial or proprietary interest in any material or method mentioned.

Background:Lagophthalmos is a condition that results from facial paralysis causing functional as well as esthetic problems. This condition can be treated by a range of techniques, including tarsorrhaphy, facial slings, and canthopexies. Gold plates provide a solution for temporary or permanent lagophthalmos resulting from facial paralysis. This study discusses the use of gold plates in the treatment of lagophthalmos but with the introduction of gold plates in two different positions in the upper lids.Methods:Group 1 (38 eyes) had a low level of placement (2 mm from the lid margin) of gold plates, while Group 2 (23 eyes) had a high level of placement (5 mm from the lid margin).Results:Noticeable bulge was seen in 18.4% of Group 1 eyes compared with 13% in Group 2, and migration of the plate occurred in 2.6% and 0% of eyes in Group 1 and Group 2, respectively, as well as ptosis (7.8% and 4.3%) and conjunctival perforation (0% and 4.3%). The degree of improvement of eyelid closure, keratopathy, and visual acuity were the same for both techniques.Conclusion:Placement of gold plates at a higher level could avoid some of the drawbacks of lower level placement of these plates, such as upper eyelid bulge and ptosis, especially given the thinning of the eyelids and orbicularis muscles that occurs in facial palsy.

Purpose To study the safety and efficacy of 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation in patients with insufficient posterior capsular support. Methods Five aphakic eyes with capsular insufficiency were included in this prospective interventional case series study, at Dar El Oyoun Hospital, Cairo, Egypt. Twenty five-gauge trocar-assisted flanged intrascleral sutureless technique was used for IOL fixation, in which retinal microforceps were used to capture and externalize both haptics through a scleral tunnel. CDVA, IOP measurements and IOL centralization were reported pre- and one day, one & 3 months postoperatively. Any intra- or postoperative complications were recorded. Results The mean LogMAR CDVA had significantly improved one day, 1 & 3 months postoperatively (0.74 ± 0.1, 0.42 ± 0.07 and 0.26 ± 0.08 respectively, p  < 0.001) compared to the preoperative value (1.7 ± 0.17). The mean IOP showed no significant changes along the follow-up period (16.9 ± 0.1; 16.2 ± 1.1; 16.3 ± 0.9 mmHg, p = 0.68, 0.58, 0.89) respectively at 1st day, 1 & 3 months postoperatively) compared to the preoperative measurement (16.4 ± 1.8 mmHg). The IOL was found to be centralized in all cases. No intra- or postoperative complications were encountered. Conclusion 25-gauge trocar-assisted flanged intrascleral sutureless IOL fixation is found to be a reliable and effective technique that overcomes Yamane technique's challenges for IOL fixation in cases with posterior capsular insufficiency.

ABSTRACT.Purpose: To evaluate the efficacy of big-bubble (BB) technique in separating Dua's layer together with the Descemet's membrane endothelial (DE) graft and the effect of 7-day storage of the prepared tissues on the endothelial cells. Method: This is an experimental study in which 21 human corneo-scleral tissues unsuitable for transplantation were used. Grafts were mounted on artificial chamber; epithelial side-up with BB technique was used to detach the DE graft. The resultant tissues were stored in tissue culture medium for 7 days. Dua's layer presence, endothelial cell density (ECD), endothelial cell loss and viability were assessed after the dissection and at 7 days after storage. Results: Complete detachment of DE grafts was achieved in 20 cases (95.24%). Histological analysis revealed Dua's layer presence in 14 cases (70%). The mean ECD for the corneas before dissection was 2375 AE 338 cells/mm 2 with significant reduction to 2200 AE 319 cells/mm 2 (p < 0.00001) with endothelial cell loss of 7.3 AE 3.5% and non-viable cells of 6.5 AE 2.5% at the end of the 7-day storage. On comparing the dissected DE grafts with Dua's layer versus those without at 1 day after dissection and at 7 days after storage, we found no statistically significant changes in endothelial cell loss (p = 0.387; p = 0.836 respectively) and non-viable cells percentage (p = 0.180; p = 0.260, respectively). Conclusion: Big-bubble technique is reproducible in dissecting DE grafts with minimal damage to the endothelial cells. The percentage of endothelial cell loss and non-viable cells is similar in the DE grafts with/without Dua's layer after 7-day storage.