Purpose. To evaluate gel microstent (XEN, Aquesys, Inc) for treatment of primary open angle glaucoma (POAG). Methods. In this prospective interventional study, 13 eyes with POAG underwent XEN implantation with subconjunctival mitomycin-C. Of those eyes, 3 were pseudophakic and 10 underwent simultaneous phacoemulsification and XEN. Patients had uncontrolled IOP, had intolerance to therapy, or had maximal therapy but undergoing cataract extraction. Follow-up visits included IOP, number of medications, vision, and complications and lasted for 1 year. Complete success was defined as IOP reduction ≥20% from preoperative baseline at 1 year without any glaucoma medications while partial success as IOP reduction of ≥20% at 1 year with medications. Results. IOP dropped from 16 ± 4 mmHg pre-op to 9 ± 5, 11 ± 6, 12 ± 5, 12 ± 4, and 12 ± 3 mmHg at 1 week, 1, 3, 6, and 12 months (p = 0.004, 0.026, 0.034, 0.01, and 0.01, Wilcoxon Signed Ranks) consecutively. BCVA (LogMAR) was 0.33 ± 0.34 and improved to 0.13 ± 0.11 at 1 year. Mean number of medications dropped from 1.9 ± 1 preoperatively to 0.3 ± 0.49 (p = 0.003) at 1 year. 42% of eyes achieved complete success and 66% qualified success. Complications included choroidal detachment in 2 eyes, and implant extrusion in 1 eye, and 2 eyes underwent trabeculectomy. Conclusion. XEN implant is an effective surgical treatment for POAG, with significant reduction in IOP and glaucoma medications at 1 year follow-up.

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.

This study describes a modification of deep sclerectomy, making it completely sutureless, with a 6-month follow-up period. This was a prospective pilot phase that included 24 eyes of 16 patients, 13 male individuals and 3 female individuals, with medically uncontrolled open-angle glaucomas despite maximally tolerated medical therapy. After excising the deep flap, no sutures are added to the superficial scleral flap or to the conjunctiva. A statistically significant reduction of the intraocular pressure was reported during all the follow-up visits without serious complications.

Background. Orbital epidermoids form a rare pathological entity that is separate from dermoid cysts. They have variable clinical and radiological presentations and they should be considered in the differential diagnosis of orbital cystic lesions. This work describes the various clinical and radiological presentations of 17 cases of epidermoid cysts and the surgical outcome. Method. A prospective interventional study was conducted on 17 patients diagnosed with epidermoid cysts. Patients' symptoms and signs were recorded; CT scan was done for all patients. All lesions were removed through anterior orbitotomy and histopathological diagnosis confirmed. Results. Mean age of patients was 16.3 years ±  10.54. Main complaints were lid swelling, masses, ocular dissimilarity, chronic pain, and ocular protrusion. Clinical signs varied from lid swelling and masses in all cases to proptosis, globe displacement, limitation of ocular motility, and scars. Radiological findings ranged from homogenous hypodense masses (58.8%) to homogenous radiolucent (17.6%) and heterogenous masses (23.5%). No recurrences following surgeries were reported throughout the follow-up (mean 18.8 months ±  0.72). Conclusion. Deep orbital epidemoid cysts are a separate entity that can behave like deep orbital epidermoid; however, they usually present at a relatively older age. They can be associated with increased orbital volume but not necessarily related to bony sutures.

Purpose: To evaluate retinal sensitivity in children who are on hydroxychloroquine (HCQ) for systemic lupus erythematosus using microperimetry and compare the results with those of the Humphrey visual field (HVF) 10-2 and spectral-domain optical coherence tomography (SD-OCT). Procedure: A case-control cross-sectional study including 19 patients (less than 18 years old) on HCQ for at least 5 years. Controls were 21 normal children. Participants underwent a complete ophthalmic examination, then were investigated using HVF 10-2, SD-OCT, and microperimetry. Results: Ocular examination revealed no abnormalities. The overall mean microperimetry sensitivity of the patients (15.75 dB) was not significantly different from that of the controls (16.35 dB). The HVF 10-2 showed a significant difference in the mean deviation of the patients. Conclusions and Message: Microperimetry was not more revealing than HVF 10-2 and SD-OCT. Larger studies are required to compare the diagnostic accuracy of screening modalities of retinal toxicity in children on HCQ.