We have shown previously that the acute administration of 0.5 mg/h of Pluronic L-81 (L-81), a non-ionic hydrophobic surfactant, markedly reduced the lymphatic lipid transport by the rat small intestine. This inhibition is quickly reversible. By studying two other Pluronic surfactants, 25R1 and P84, we assessed the importance of the positioning of the hydrophilic moiety relative to the hydrophobic chain and also the hydrophilic-to-hydrophobic ratio in the action of L-81. In 25R1 the hydrophilic moiety is at the center and the hydrophobic chain is at both ends; in L-81 the reverse is true. P84 has four times more hydrophilic moiety by weight than L-81. Four groups of intestinal lymph fistula rats were infused intraduodenally for 8 h with [3H]triolein, egg lecithin, sodium taurocholate, and 1 mg/h of either L-81, 25R1, or P84. The control group did not have a surfactant added. Both the absorption of lipid by the small intestine and the intestinal transport of the lipid into the lymph were measured. Similar to previous findings, infusion of 1 mg/h of L-81 produced a dramatic reduction in lipid transport by the small bowel. Although infusion of 1 mg/h of either 25R1 or P84 reduced significantly the intestinal lipid transport, both surfactants were markedly less effective than L-81. In conclusion, both the positioning of the hydrophilic moiety and the hydrophilic-to-hydrophobic ratio of L-81 are important for its action.

The authors reviewed the charts of 22 patients with Peters' anomaly. Various surgical procedures were performed on 30 eyes of 18 patients (mean number of procedures = 3.3 per eye). Follow-up averaged six years. Visual acuity varied widely, with six eyes having an acuity of 20/400 or better, and 11 eyes with no light perception. Concomitant or secondary glaucoma required a greater number of surgical procedures (4.1 vs 3.4) per eye and was associated with a poorer visual outcome. No eyes with glaucoma had visual acuity better than 20/400. In bilaterally operated patients, visual results in one eye were independent of the outcome of the fellow eye. The range of visual acuity in bilaterally operated patients was similar to the vision in those operated unilaterally. Visual outcome in patients with Peters' anomaly remains guarded. With modern surgical techniques and aggressive attempts at visual rehabilitation, many patients may benefit from surgery. Some patients may have moderately good visual acuity for months or years before vision is lost. In the interim they may learn tasks they may not have otherwise acquired.

Introduction: This study sought to assess ocular surface disease changes following cataract surgery combined with trabecular micro-bypass stent(s) implantation (iStent or iStent inject). Methods: This prospective interventional single-arm clinical trial enrolled 47 eyes with mildto-moderate open-angle glaucoma (OAG) on 1-4 glaucoma medications who underwent phacoemulsification and trabecular micro-bypass stent(s) implantation. Key glaucoma and ocular surface data through 3 months postoperatively included the Ocular Surface Disease Index score (OSDI), corneal/conjunctival staining (Oxford Schema), fluorescein tear break-up time (FTBUT), conjunctival hyperemia (Efron Scale), glaucoma medications, and intraocular pressure (IOP). Results: Mean OSDI scores improved from 40.1 ± 21.6 (severe) preoperatively to 17.5 ± 15.3 (mild) at 3 months (p \ 0.0001). While 73% of eyes had moderate or severe OSDI scores preoperatively, 29% had such scores at 3 months, and the OSDI score was normal in 57% of eyes versus 9% preoperatively. Mean FTBUT increased from 4.3 ± 2.4 s preoperatively to 6.4 ± 2.5 s at 3 months (p \ 0.0001); mean Oxford corneal/conjunctival staining reduced from 1.4 ± 1.0 preoperatively to 0.4 ± 0.6 at 3 months (p \ 0.0001); mean Efron conjunctival hyperemia score reduced from 1.4 ± 0.7 preoperatively to 1.2 ± 0.6 at 3 months (p = 0.118). The number of glaucoma medications decreased from 1.5 ± 0.9 to 0.6 ± 0.8 mean medications (60% reduction, p \ 0.0001), with all eyes maintaining or reducing medications versus preoperatively and 55% of eyes becoming medication-free (versus 0% preoperatively). Mean IOP reduced from 17.4 ± 4.2 mmHg to 14.5 ± 3.2 mmHg (p \ 0.0001). The safety profile was excellent. Conclusion: Implantation of trabecular microbypass stent(s) (iStent or iStent inject) with cataract surgery produced significant improvements in ocular surface health, alongside significant reductions in IOP and medications. Trial registration: ClinicalTrials.gov identifier, NCT04452279.

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