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The cornea was the first human solid tissue to be transplanted successfully, and is now a common procedure in ophthalmic surgery. The grafts come from deceased donors. Corneal therapies are now being developed that rely on tissue from living-related donors. This presents new ethical challenges for ophthalmic surgeons, who have hitherto been somewhat insulated from debates in transplantation and donation ethics. This paper provides the first overview of the ethical considerations generated by ocular tissue donation from living donors and suggests how these might be addressed in practice. These are discussed in the context of a novel treatment for corneal limbal stem cell deficiency. This involves limbal cell grafts which are transplanted, either directly or after ex vivo expansion, onto recipient stem cell-deficient eyes. Where only one eye is diseased, the unaffected eye can be used as a source of graft tissue. Bilateral disease requires an allogenic donation, preferably from a genetically related living donor. While numerous papers have dealt with the theory, surgical approaches and clinical outcomes of limbal stem cell therapies, none has addressed the ethical dimensions of this form of tissue donation.

PURPOSE:To describe the outcome of a novel capsular or sulcular device to support the bag-in-the-lens (BIL) implant in cases of capsular or zonular instability. Bean-shaped ring segments or ‘beans’ (Morcher GmbH, Stuttgart, Germany) are designed to fit the groove of the BIL and may be placed in either the capsule or the ciliary sulcus in cataract cases with loose zonules or unstable capsule.METHODS:This was a retrospective single center observational study of all consecutive cases of bean implantation between May 2011 and April 2015.RESULTS:Sixty-four eyes of 57 patients were included in this study. Beans were used to support the BIL implant in all cases. Surgical technique, positioning, visual outcomes, refractive outcomes, and complications were evaluated in all cases. The beans were implanted in 23 eyes after IOL exchange, 14 eyes with crystalline lens dislocation, 12 eyes presenting with traumatic cataract, 8 eyes presenting with unstable capsules, and 7 eyes with postoperative visual complaints due to an unstable BIL implant. The mean increase in visual acuity was 0.35 decimal Snellen for the total cohort. Visual gain was highest in the crystalline lens dislocation (0.43 decimal Snellen) and traumatic cataract (0.41 decimal Snellen) groups. Best refractive outcomes were achieved in the traumatic cataract and intraocular lens exchange groups (0.73 and 0.80 diopters mean deviation from target refraction, respectively).CONCLUSIONS:Bean-shaped ring segments are a useful tool to augment the stability of the capsule/zonular complex, expanding the indications of patients who can be treated with the BIL implant.[[J Refract Surg.2017;33(7):454–459.]

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The aim of the study was to present a novel technique for the assessment of postoperative centration and bending in phakic intraocular lens (PIOL), illustrated through 4 patient examples.

Purpose To report the case of an atypical sino-orbital inflammatory myofibroblastic tumor.Methods Case report.Results A 71-year-old man presented slowly progressive painless diplopia followed by unilateral proptosis of the left eye with slight edema of the upper eyelid. Visual acuity was 0.4 with a relative afferent pupillary defect (RAPD). Abduction and depression of the left eye were limited. Imaging showed a left sino-orbital tumor with mass effect on the medial rectus muscle resulting in proptosis. The lesion showed intracranial extension through the superior orbital fissure with bone erosion and sclerotic bone reaction. Endoscopic ethmoidal, maxillary, and orbital biopsies revealed an inflammatory myofibroblastic tumor. Full blood count showed an eosinophilia while antineutrophil cytoplasmic antibodies and C-reactive protein were negative. To date, 7 cases of orbital myofibroblastic tumor have been described, though none of the prior studies have described bone invasion.Conclusions This erosive sino-orbital inflammatory myofibroblastic tumor is a novel finding mimicking a malignant tumor.

The cornea is an important barrier to consider when developing ophthalmic formulations, but proper modeling of this multilayered tissue remains a challenge. This is due to the varying properties associated with each layer in addition to the dynamics of the tear film. Hence, the most representative models to date rely on animals. Animal models, however, differ from humans in several aspects and are subject to ethical limitations. Consequently, in vitroapproaches are being developed to address these issues. This review focuses on the barrier properties of the cornea and evaluates the most advanced three-dimensional cultures of human corneal equivalents in literature. Their application potential is subsequently assessed and discussed in the context of preclinical testing along with our perspective toward the future.Impact statementMost ocular drugs are applied topically, with the transcorneal pathway as the main administration route. Animal corneas are currently the only advanced models available, contributing to the drug attrition rate. Anatomical and physiological interspecies differences might account for a poor translatability of preclinical results to clinical trials, urging researchers to devise better corneal equivalents. This review elaborates on the emerging generation of three-dimensional in vitromodels, which comprises spheroids, organoids, and organs-on-chips, which can serve as a stepping stone for advancements in this field.