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To assess whether transcutaneous retrobulbar amphotericin B injections (TRAMB) reduce exenteration rate without increasing mortality in rhino-orbital-cerebral mucormycosis (ROCM). In this retrospective case–control study, 46 patients (51 eyes) with biopsy-proven ROCM were evaluated at 9 tertiary care institutions from 1998 to 2021. Patients were stratified by radiographic evidence of local orbital versus extensive involvement at presentation. Extensive involvement was defined by MRI or CT evidence of abnormal or loss of contrast enhancement of the orbital apex with or without cavernous sinus, bilateral orbital, or intracranial extension. Cases (+TRAMB) received TRAMB as adjunctive therapy while controls (−TRAMB) did not. Patient survival, globe survival, and vision/motility loss were compared between +TRAMB and -TRAMB groups. A generalized linear mixed effects model including demographic and clinical covariates was used to evaluate the impact of TRAMB on orbital exenteration and disease-specific mortality. Among eyes with local orbital involvement, exenteration was significantly lower in the +TRAMB group (1/8) versus -TRAMB (8/14) (p = 0.04). No significant difference in mortality was observed between the ±TRAMB groups. Among eyes with extensive involvement, there was no significant difference in exenteration or mortality rates between the ±TRAMB groups. Across all eyes, the number of TRAMB injections correlated with a statistically significant decreased rate of exenteration (p = 0.048); there was no correlation with mortality. Patients with ROCM with local orbital involvement treated with adjunctive TRAMB demonstrated a lower exenteration rate and no increased risk of mortality. For extensive involvement, adjunctive TRAMB does not improve or worsen these outcomes. [ABSTRACT FROM AUTHOR]

Myopia prevention and anti-myopia treatment is of great importance in South East Asia. To evaluate the prevalence and related factors of myopic retinopathy in Vietnam. A cross-sectional study was conducted on 168 eyes of 88 patients with high myopia presenting to the Refraction Department of Vietnam National Eye Hospital. Inclusion criteria were high myopia (≤−6.00D with cycloplegic retinoscopy). Consecutive presenting patients recruited between January 2020 and August 2020 consented to participate. Participant age range was 12–47 years. Peripapillary atrophy was present in 70.2% of participants, most commonly atrophy of one-quarter of the disc (38.7%). Central retinal changes were present in 66.1% of participants, subclassified as tessellated fundus in 60.7%, diffuse chorioretinal atrophy in 4.2% and patchy chorioretinal atrophy in 1.2%. Peripheral retinal lesions were present in 43.5% of participants, consisting of white-without-pressure in 32.1%, lattice degeneration in 16.1%, snail track degeneration in 4.2% and microcystoid degeneration in 1.2%. Myopia ≤−8.00D and axial length ≥26.5 mm were associated with additional risk of posterior ocular complications. Furthermore, age ≥19 years increased risk of central myopic retinopathy and ≥10 years since initial myopia diagnosis increased the risk of peripapillary atrophy and central retinal changes. Other factors such as the age of onset of myopia and family myopia history did not appear to alter the risk of peripheral retina damage. Retinal disorders were common in Vietnamese people with high myopia. Within the current cohort with high myopia, myopia ≤−8.00D and axial length ≥26.5 mm were associated with a significant further elevation of risk. [ABSTRACT FROM AUTHOR]

Following effective treatment with systemic antifungal therapy, eyelid lesions from blastomycosis infection may be replaced by disfiguring fibrosis and scarring, which may be surgically challenging to correct. A 68-year-old man with biopsy-proven eyelid blastomycosis was treated with 6 months of oral voriconazole, but resolution of the lesion was complicated by cicatricial changes causing complete lower eyelid defect, epicanthal web, cicatricial mechanical ptosis, and skin plaques. Although repair adhered to the fundamentals of eyelid reconstruction, cicatricial changes associated with blastomycosis infection necessitated a modified approach and attachment sites. A tarsoconjunctival flap (Hughes flap) with modified flap connections utilizing cicatrix and remaining viable tissue was employed to reconstruct the lower eyelid defect and combined with tissue advancement using a Mustardé four-flap epicanthoplasty and post-auricular full-thickness skin graft. Satisfactory cosmetic outcome was achieved at last follow-up of 3.5 months postoperatively. This case demonstrates a feasible technique for reconstruction of significant eyelid defects following robust cicatricial changes such as those after blastomycosis. This report also presents the first description of reconstruction of lower eyelid defect and of posterior lamellar loss after blastomycosis infection. [ABSTRACT FROM AUTHOR]

Lid-sharing approaches are often advocated for repair of large full thickness lower eyelid defects, however result in temporary visual obstruction and the need for a second-stage procedure. The authors describe and report outcomes using a one-stage technique utilizing a free tarsoconjunctival graft (TCG) and musculocutaneous transposition flap (MCT) to repair defects up to 90% of the lower eyelid. A retrospective chart review on patients that had undergone full thickness lower eyelid reconstruction using a TCG and MCT between the dates of 1/1/2015 to 3/1/2020 was performed. Demographic and clinical information including indication for repair, size of defect, post-operative complications, and outcomes were recorded and analyzed. Six cases of lower eyelid reconstruction using this technique were identified. Fifty percent were male, average age was 61.3 years (range 36–91, SD = 18.9), and follow up was 36.7 weeks (range 3–129, SD = 48.1). All defects were due to malignancy (4/6 for basal cell carcinoma, 1/6 each for sebaceous cell carcinoma and merkel cell carcinoma). Average horizontal defect size was 80% of lower eyelid width (range 57%-90%, SD = 12.3), while average vertical defect size was 8 mm (range 5–10 mm, SD = 1.7). There were no instances of post-operative infection, lid malposition, or dehiscence. A pyogenic granuloma was noted in one case and was managed with excision. A single-stage procedure using a TCG and MCT can be used to repair laterally based full-thickness lower eyelid defects up to 90% with satisfactory outcomes and few complications. [ABSTRACT FROM AUTHOR]

PurposeMethodsResultsConclusionTo assess the trigeminal blink reflex in chronic orbital pain and its modification by orbital anesthetic injections using a novel blink reflexometer.The EyeStat (Generation 3, Blinktbi, Inc. Charleston, SC) is a device that triggers and analyzes the carbon dioxide puff-evoked trigeminal blink response. In this prospective study, CO2 puffs were delivered to each eye of 6 patients with unilateral, chronic orbital pain at baseline and 30 minutes after unilateral orbital anesthetic injections consisting of lidocaine and bupivacaine. Ten healthy subjects underwent the testing once without injections. Main outcome measures were comparison of the average of the right and left eyelid responses to stimuli given to the right or left eye (to assess afferent response in the right vs left eye) and comparison of the right eyelid to left eyelid responses to both the right and left stimuli (to assess efferent response in the right vs left eye).In 10 healthy patients, direct blink response of the stimulated eyelid exceeded the consensual response of the opposite eyelid (latency p = .001, excursion p = .04, time to close p = .03). Among the 6 pain patients, eyelid kinematics for afferent trigeminal input were similar between the affected eye and the fellow eye. However, after injection, the afferent latency of the affected eye was significantly prolonged relative to the unaffected eye (p = .006). Efferent blink responses were similar between the two eyelids at all time points.Peribulbar anesthetic injections modulate mechanical afferent input to the trigeminal blink reflex. [ABSTRACT FROM AUTHOR]

We investigated operative course and post-operative findings of patients undergoing primary enucleation for uveal melanoma versus those requiring secondary enucleation after brachytherapy. A retrospective chart review was performed with IRB approval on patients receiving treatment for uveal melanoma. Patients with enucleation as initial treatment and patients enucleated after plaque brachytherapy were analyzed for demographic data, operative course, and post-enucleation outcome. Further cause analysis for secondary enucleations was investigated. No significant difference was seen in age, laterality, or gender between the primarily enucleated (n= 54) and secondarily enucleated (n= 34) groups. Greater difficulty with surgery was noted in 28/32 (87.5%) of secondary enucleations compared to 1/54 (1.8%) of primary enucleations (p< 0.0001). Operative time was >2 hours in 3/51 (6%) of primary enucleations (vs. 8 of 32, 25%,p= 0.02). Average implant size was similar in the 2 groups (20.6 mm), however 2/34 (6%) of secondary enucleations required dermis fat grafting. Post-enucleation anophthalmic ptosis occurred after 8/49 (16%) of primary cases (vs. 13/30, 43%,p= 0.02) and prosthetic enophthalmos after none (0%) of primary cases (vs. 5/30, 17%,p= 0.006). Class 2 gene expression profile was found in 6/8 (60%) of eyes enucleated for treatment failure. Secondary enucleation performed after plaque brachytherapy was technically more difficult, and had more anophthalmic socket and eyelid complications compared to primary enucleation for uveal melanoma. Primary enucleation may avoid additional surgery and morbidity in a subset of patients with contraindications to plaque brachytherapy. [ABSTRACT FROM AUTHOR]

The concentrations of polycyclic aromatic hydrocarbons (PAHs) and nitropolycyclic aromatic hydrocarbons (NPAHs) in total suspended particulates (TSP) and soil were measured at a traffic site in Hanoi, a typical motorcycle city of Vietnam. TSP was collected using high-volume air sampler on Pallflex 2500QAT-UP membrane filters. PAHs and NPAHs were analyzed by high-performance liquid chromatography (HPLC) using fluorescence and chemiluminescence detectors, respectively. The average concentrations of total 10 PAHs and 10 NPAHs in soil varied from 3.4–43.7 ng g−1and from 112–780 pg g−1dry weight, respectively, which were much lower than those in TSP. The results showed that large part of the higher molecular weight PAHs in soil, especially benzo[ghi]perylene and benzo[b]fluoranthene came from the atmosphere. However, NPAHs profile showed a different pattern. 3-nitroperylene and 6-nitrochrysene were the most abundant NPAHs in soil, followed by 1-nitropyrene and 6-nitrobenzo[a]pyrene. The fate of NPAHs in soil varied depending on soil properties and chemical structure of NPAHs. The finding that the [NPAH]/[PAH] concentration ratios in soil were different from those in TSP could be due to bio-degradation and/or secondary formation of NPAHs in soil, depending on NPAHs properties. [ABSTRACT FROM AUTHOR]