ABSTRACT.Purpose: To investigate the expression of proteases, proteolytic activity and cytokines in the tear film of people with keratoconus. Methods: Basal tears from people with keratoconus, from individuals who had undergone corneal collagen cross-linking for the treatment of keratoconus, and from normal controls were collected using a capillary tube. Corneal curvature of each subject was mapped. The total protein in tears was estimated. Levels and activity of proteases in the tears were analysed using specific antibody arrays and activity assays. Results: The total tear protein level was significantly reduced in keratoconus (4.1 ± 0.9 mg ⁄ ml) compared with normals (6.7 ± 1.4 mg ⁄ ml) (p < 0.0001) or subjects who had undergone corneal collagen cross-linking (5.7 ± 2.3 mg ⁄ ml) (p < 0.005). Significantly (p < 0.05) increased tear expression of matrix metalloproteinases (MMP) -1, -3, -7, -13, interleukins (IL) -4, -5, -6, -8 and tumour necrosis factor (TNF) -a, -b were evident in keratoconus. Tear IL-6 was the only cytokine significantly (p < 0.05) increased in tears of keratoconus subjects compared with the collagen cross-linked group. No significant difference in tear proteases were observed between the normal and the cross-linked groups, although the expression of TNF-a was significantly (p < 0.05) increased in the cross-linked group compared with the controls. Elevated gelatinolytic (87.5 ± 33.6 versus 45.8 ± 24.6 FIU, p < 0.0001) and collagenolytic (6.1 ± 3.2 versus 3.6 ± 2.0 FIU, p < 0.05) activities were observed in tears from keratoconus compared with normal subjects. The activity of tear gelatinases (69.6 ± 22.2 FIU) and collagenases (5.7 ± 3.3 FIU) in the collagen cross-linked group was not significantly different compared with either keratoconus or normals. Conclusion: Tears of people with keratoconus had 1.9 times higher levels of proteolytic activity and over expression of several MMPs and cytokines compared with tears from controls. Further investigations are required to study the possible implications of these changes and whether they can be used to monitor disease progression or determine the success of corneal collagen cross-linking.

Recently proposed deep learning (DL) algorithms for the segmentation of optical coherence tomography (OCT) images to quantify the morphological changes to the optic nerve head (ONH) tissues during glaucoma have limited clinical adoption due to their device specific nature and the difficulty in preparing manual segmentations (training data). We propose a DL-based 3D segmentation framework that is easily translatable across OCT devices in a label-free manner (i.e. without the need to manually re-segment data for each device). Specifically, we developed 2 sets of DL networks: the ‘enhancer’ (enhance OCT image quality and harmonize image characteristics from 3 devices) and the ‘ONH-Net’ (3D segmentation of 6 ONH tissues). We found that only when the ‘enhancer’ was used to preprocess the OCT images, the ‘ONH-Net’ trained on any of the 3 devices successfully segmented ONH tissues from the other two unseen devices with high performance (Dice coefficients > 0.92). We demonstrate that is possible to automatically segment OCT images from new devices without ever needing manual segmentation data from them.

Aim:The aim of this study is to analyze the postoperative visual outcomes of fibrin glue-assisted, suture-less posterior chamber (PC) intraocular lens (IOL) implantation technique in eyes with inadequate capsule support at a tertiary eye care hospital in South India.Setting and Design:This is a retrospective, nonrandomized case series.Patients and Methods:This study analyzes 94 eyes which underwent PC-IOL implantation by fibrin glue-assisted, suture-less technique. All patients who had IOL implants by the fibrin glue-assisted PC-IOL technique from August 2009 to January 2014 were included in the study. Intra- and post-operative complications were analyzed. The postoperative best spectacle-corrected visual acuity (BSCVA) was evaluated and recorded at the end of 6 months.Statistical Analysis:The data were analyzed using SPSS version 16.1 (SPSS Inc., Chicago, Illinois, USA) using two sample paired t-test and independent t-test.Results:A total of 94 eyes of 92 patients that underwent glued IOL implantation over a period of 5 years were analyzed. Out of 94 eyes, 77 eyes (84.6%) maintained or improved on their preoperative BSCVA (P = 0.012).Conclusion:We conclude that glued IOL implantation is a feasible option in rehabilitating patients with aphakia without adequate capsular support.

Purpose To evaluate the efficacy and safety of micro-pulse trans-scleral diode laser cyclophotocoagulation (MP-TSCPC) in Indian eyes with refractory glaucoma. Methods A prospective interventional short-term study was carried out with relatively small sample size of 55 eyes with refractory glaucoma. All eyes had visual acuity (VA) and intraocular pressure (IOP) measurements at baseline, 1 week (1w), 1 month (1 m) and 3 months (3 m). A single surgeon treated all eyes with recommended MP-TSCPC treatment settings. Surgical success was defined as achieving an IOP between 8–21 mmHg or achieving > 20% IOP reduction. Results The age of participants was 56.98 ± 15.74 years. Our study had more number of males. VA (in logMAR) at baseline was 1.38 ± 0.99. VA was 1.43 ± 0.93 at 1w, 1.47 ± 0.94 at 1 m and 1.47 ± 0.96 at 3 m (p > 0.05 for all). IOP (in mmHg) at baseline was 30.38 ± 10.70. IOP was 15.72 ± 6.85 at 1w, 16.98 ± 8.72 at 1 m and 17.60 ± 8.40 at 3 m (p < 0.001 for all). At 3 m, 49 (89.1%) eyes had surgical success. Surgical success was lesser in primary open angle glaucoma (p = 0.03). IOP at baseline showed significant correlation with percentage reduction in IOP at each review (p < 0.05). Use of glaucoma medication reduced from 2.94 ± 0.98 to 2.01 ± 1.16 at 3 m (p < 0.001). At 3 m, hypotony was noted in 4 (7.3%) eyes and reduction in visual acuity was seen in 15 (27.3%) eyes. Conclusion Initial experience in Indian eyes has shown that MP-TSCPC is safe and effective for refractory glaucoma. Patients can expect significant IOP lowering along with reduction in number of topical medications required for control of IOP.

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