Subconjunctival hemorrhage after wet cupping therapy: a case report

Introduction:Cupping therapy is an integrative and complementary medicine therapy that practiced worldwide by several civilizations for thousands of years.Cupping therapy is reported to be a relatively safe practice especially if performed by qualified therapists.Subconjunctival hemorrhage(SCH)is a common cause of eye redness and can be classified into traumatic and spontaneous.Case presentation:This case report discussed an adverse event related to wet cupping therapy.The patient developed SCH one day after performing cupping therapy.He was completely recovered after 2 weeks.This case report should increase the knowledge of cupping therapists regarding increasing safety of patient when performing wet cupping therapy on specific body parts especially,head,neck and cervical areas.Furthermore,it highlighted the importance of conducting research regarding the mechanical and physiological effects of cupping therapy.Conclusion:Adverse events related to cupping therapy should be reported with every patient.Cupping therapists should be aware of this possible mild adverse event.To the best of our knowledge,this is the first published adult case of SCH related to wet cupping therapy session.More studies are critically needed for evaluation of cupping therapy effects and adverse events especially when performed on head and neck.

Subconjunctival conbercept for the treatment of corneal neovascularization

·AIM:To investigate the effectiveness and safety of subconjunctival injection of conbercept in the treatment of corneal neovascularization(CNV).·METHODS:The data on 10 consecutively recruited patients with CNV who received a subconjunctival conbercept(1 mg)once,and measured the area,length,and diameter of neovascularization before and after(1d,1,2wk,and 1mo)treatment as well as the occurrence of systemic and ocular complications after treatment were analyzed.·RESULTS:There was a statistically significant reduction in the area of CNV one day after treatment(mean±SD:38.46±11.36 mm^(2)),compared with before treatment(42.46±12.80 mm^(2),P<0.01).There was also a statistically significant reduction in the length(3.86±1.80 mm vs 4.64±1.77 mm,P<0.01)and diameter(0.044±0.022 vs 0.060±0.026,P<0.05)of CNV,one week after treatment comparing to before treatment.The reduction in all three parameters was maximized at two weeks after treatment(area:29.49±8.83 mm^(2),P<0.001;length:3.50±1.88 mm,P<0.001;and diameter:0.038±0.017 mm,P<0.01).No severe systemic or ocular complication was observed during the study.·CONCLUSION:During the observation period of onemonth,subconjunctival injection of conbercept is an effective and safe method for the reduction of CNV.It may be effective as a preoperative drug for neovascular corneal transplantation.

Comparison of subconjunctivally injected bevacizumab, ranibizumab, and pegaptanib for inhibition of corneal neovascularization in a rat model

AIM: To compare the efficacies of subconjunctival bevacizumab, ranibizumab, and pegaptanib sodium injections for the inhibition of corneal neovascularization in an experimental rat model. METHODS: Sixteen corneas of 16 rats were chemically cauterized and randomized into four groups: bevacizumab group that treated with 0.05mL/1.25mg bevacizumab, ranibizumab group that treated with 0.05mL/0.5mg ranibizumab, pegaptanib group that treated with 0.05mL/0.15mg pegaptanib sodium, and control group that treated with 0.05mL saline solution. Digital photographs of the corneas were taken and analyzed using an image analysis software program. All corneas were excised and examined histologically on the 15 th day. RESULTS: Each treatment group had significantly less neovascularized corneal areas and fewer blood vessels than the control group (all P 【0.05). In addition, bevacizumab group had significantly less neovascu-larized corneal areas and fewer blood vessels than ranibizumab and pegaptanib groups (both P 【0.05). However, there was no significant difference between the ranibizumab and pegaptanib groups regarding percentage of neovascularized corneal areas and number of blood vessels (both P 】0.05). CONCLUSION: Subconjunctival bevacizumab, ranibiz-umab, and pegaptanib sodium were effective with no corneal epitheliopathy for inhibiting corneal neovascularization after corneal burn in rats .Bevacizumab was more effective than ranibizumab and pegaptanib sodium.

Topically administered bevacizumab had longer standing anti-angiogenic effect than subconjunctivally injected bevacizumab in rat corneal neovacularization

AIMTo compare the effect of topically administered and subconjunctivally injected bevacizumab on experimental corneal neovascularization in rats for two weeks after treatment.

A sutureless subconjunctival M-shaped limbus incision for hard cataracts

Dear Editor,Iam Dr.Ping-Hong Lai,from the Jiangxi Eye Center,Jiangxi Provincial People＇s Hospital,Nanchang,Jiangxi Province,China.I would like to present the technique of subconjunctival M-shaped limbus incision for a series of cases with hard cataracts.

Safety & efficacy of single subconjunctival triamcinolone 5 mg depot vs topical loteprednol post cataract surgery: less drop cataract surgery

AIM: To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide(SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. METHODS: A total of 400 patients were randomized into 2 groups; Group A(200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine(0.5%) with ofloxacin(0.3%) combination for 3 wk. Group B(200 patients) received tapering topical loteprednol etabonate(0.5%) along with ofloxacin(0.3%) and ketorolac tromethamine(0.5%) for 3 wk. Outcomes evaluated were intraocular pressure(IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12 wk.RESULTS: Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A(P=0.82) and Group B(P=0.61) and postoperative IOP values in between both groups(P=0.14) at 1 wk. Incidence of cells/flare postoperative was statistically not significant(P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. CONCLUSION: SCTA appears to be an effective alternative to prolong postoperative topical steroid use.

Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema

AIM:To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide(TA)injections for treating uveitic macular edema(UME).METHODS:This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6 mo.The main outcome measure was central macular thickness(CMT).The secondary outcome measures included best-corrected visual acuity(BCVA),recurrence rate and intraocular pressure(IOP).RESULTS:In total,65 patients(80 eyes),mainly including idiopathic uveitis in 33 patients(50.77%)and VogtKoyanagi-Harada(VKH)syndrome in 19 patients(29.23%),were enrolled in this study.The mean CMT decreased from 457.6±173.0μm at baseline to 325.9±176.8,302.7±148.2,332.2±177.3 and 270.6±121.6μm at 1-,2-,3-and 6-months postinjection,respectively(all P<0.001).BCVA increased from log MAR 0.5±0.3 at baseline to log MAR 0.4±0.3,0.4±0.3,0.4±0.4 and 0.4±0.3 at the 1-,2-,3-and 6-months postinjection visits,respectively(all P<0.001).Twenty-one(21/80,26.25%)eyes underwent relapse of UME within 6 mo.A total of 20/80(25%)eyes exhibited elevated IOPs,of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit.CONCLUSION:Subconjunctival TA injections appear to be safe and effective for UME.

Subconjunctival Ocular Filariasis—Case Report

Purpose: We report a case of ocular worm diagnosed clinically and treated surgically. Methods: A 68-year-old man presented to the ophthalmology clinic, complaining of redness, foreign body sensation and lacrimation in the left eye since 1 week. Slit-lamp examination disclosed a subconjunctival whitish cord like structure with movement. Presentation, clinical, surgery removal, and treatment are described. Results: At the time of surgery, an alive and still intact worm was extracted through conjunctiva incision. Conclusions: As a not yet known endemic region, we would like to emphasize the importance of this zoonosis with its ocular manifestation, knowing previously the diagnostic difficulties. From this perspective, we conclude that the incidence of ocular dirofilariasis may be much higher than that is reported in our region.

Semaphorin 3A controls allergic and inflammatory responses in experimental allergic conjunctivitis

AIM: To assess the efficacy of topical Semaphorin 3A(SEMA3A) in the treatment of allergic conjunctivitis.METHODS: Experimental allergic conjunctivitis(EAC)mice model induced by short ragweed pollen(SRW) in 4-week-old of BALB/c mice, mice were evaluated using haematoxylin and eosin(H&E) staining, immunofluor-escence and light microscope photographs. Early phase took the samples in 24 h after instillation and late phase took the samples between 4 to 14 d after the start of treatment. The study use of topical SEMA3A(10 U, 100 U,1000 U) eye drops and subconjunctival injection of SEMA3 A with same concentration. For comparison, five types of allergy eyedrops were quantified using clinical characteristics.· RESULTS: Clinical score of composite ocular symptoms of the mice treated with SEMA3 A were significantly decreased both in the immediate phase and the late phase compared to those treated with commercial ophthalmic formulations and non-treatment mice. SEMA3 A treatment attenuates infiltration of eosinophils entering into conjunctiva in EAC mice. The score of eosinophil infiltration in the conjunctiva of SEMA3 A 1000 U-treated group were significantly lower than low-concentration of SEMA3 A treated groups and non-treated group. SEMA3 A treatment also suppressed T-cell proliferation in vitro and decreased serum total Ig E levels in EAC mice. Moreover, treatment of SEMA3 A suppressed Th2-related cytokines(IL-5, IL-13 and IL-4)and pro-inflammatory cytokines(IFN-γ, IL-17 and TNF-α)release, but increased regulatory cytokine IL-10 concentration in the conjunctiva of EAC mice.CONCLUSION: SEMA3 A as a biological agent, showed the beneficial activity in ocular allergic processes with the less damage to the intraocular tissue. It is expected that SEMA3 A may be contributed in patients with a more severe spectrum of refractory ocular allergic diseases including allergic conjunctivitis in the near future.

Incidence of endophthalmitis after phacoemulsification cataract surgery:a Meta-analysis

AIM:To evaluate the overall endophthalmitis incidence and the effectiveness of potential prophylaxis measures following phacoemulsification cataract surgery(PCS).METHODS:The Pub Med and Web of Science databases were searched from inception to April 30^(th),2021.We included studies that reported on the incidence of endophthalmitis following PCS.The quality of the included studies was critically evaluated with the Newcastle-Ottawa quality assessment scale.The random effect or the fixed-effects model was used to evaluated the pooled incidence based on the heterogeneity.The publication bias was assessed by Egger’s linear regression and Begg’s rank correlation tests.RESULTS:A total of 39 studies containing 5 878 114 eyes were included and critically appraised in the Meta-analysis.For overall incidence of endophthalmitis after PCS,the Meta-analysis yielded a pooled estimate of 0.092%(95%CI:0.083%-0.101%).The incidence appeared to decrease with time(before 2000:0.097%,95%CI:0.060%-0.135%;2000 to 2010:0.089%,95%CI:0.076%-0.101%;after 2010:0.063%,95%CI:0.050%-0.077%).Compared with typical povidone-iodine solution(0.178%,95%CI:0.071%-0.285%) and antibiotics subconjunctival injections(0.047%,95%CI:0.001%-0.095%),the use of intracameral antibiotics significantly reduced the incidence of endophthalmitis after PCS(0.045%,95%CI:0.034%-0.055%,RR:7.942,95%CI:4.510-13.985).CONCLUSION:Due to the advancement of phacoemulsification technology and the widespread use of intracameral antibiotics,the incidence of endophthalmitis following PCS shows a decreasing trend over time.The use of intracameral antibiotics administration will significantly reduce the risk of endophthalmitis.

Ocular injuries by durian fruit

·AIM:To report various ocular injuries caused by durian fruit. ·METHODS:Three cases of ocular injuries were described in young patients, due to accidental fall of durian fruit on the forehead and face, while they were taking rest/sleeping /playing under the durian tree. ·RESULTS:The ocular injuries observed were lacerating injury of cornea with iris incarceration, hyphema, superficial penetrating injury of sclera and angle recession glaucoma in the right eye of first patient; lacerating injury of cornea with iris prolapse in the left eye of second patient; subconjunctival haemorrhage, traumatic mydriasis and superficial penetrating injury of sclera, commotion retinopathy and macular edema in the left eye of third patient. Vision improved to normal in all the eyes following surgical/ medical/optical treatment. ·CONCLUSION:Evidence of penetrating injury (because of thorns) and blunt injury (because of weight) can be seen in the eyes when durian fruit falls on the face. Vision can be recovered fully with immediate and appropriate treatment in these cases. The ocular injuries can be prevented by educating the public to wear protective metal frame wide goggles and not to sleep/take rest under the durian tree.

Safety and efficacy outcomes of the Xen45 Gel Stent use for refractory glaucoma:a surgery series from surgeon trainees at a tertiary teaching hospital

Background:To study the effect of an ab interno gelatin stent(XEN45 Gel Stent,Allergan Inc.,Irvine,California,USA)on intraocular pressure(IOP)as placed by glaucoma fellowship trainees in eyes with refractory glaucoma.Methods:A prospective noncomparative study at a tertiary training center on 28 unique eyes undergoing ab interno gelatin stent implantation by glaucoma fellowship trainees.Data was collected at baseline and postoperatively at day 1,week 1,and months 1,3,5,and 12.Primary outcome was mean IOP change.Secondary outcomes included change in number of glaucoma medication classes and visual acuity.Safety outcomes included needling rates.Surgical success was defined by achieving≥20%reduction in IOP with the same or fewer classes of antiglaucoma medications from baseline without the need for secondary surgical intervention and/or stent removal.Results:At baseline,28.6%(8/28)of the subjects had prior failed incisional glaucoma surgery in a study population that was 54%African-American,with 78%with severe glaucoma(average mean deviation of−14.58 dB).Thirteen subjects terminated their clinic visits before their 12-month postoperative visit,leaving 15 subjects for end point analysis.Average IOP went from 21.6 mmHg(range 12.0–31.0,SD 6.6)at baseline to 12.5 mmHg(range 7.0–19.0,SD 3.6),a 42.1%reduction(p<0.007).All subjects decreased the number of medication classes they were taking with an average reduction of 3.8(range 2–5,SD 0.9)to 1.3(range 0–3,SD 1.0)classes,or a 65.8%decrease(p<0.006).Crude surgical success was 80.0%for the 15 subjects that followed up at 12 months.The Kaplan-Meier cumulative probability of success for all 28 subjects at 12 months was 70.4%(95%CI:44.7–85.8%).Regardless of the length of follow-up,21.4%(6/28)met failure criteria:3 subjects failed because they required secondary surgical intervention,and the other 3 did not have adequate IOP reduction.Initial bleb needling rate was 28.6%(8/28)and repeat was 17.9%(5/28).Conclusions:Compared to the reported literature with experienced ocular surgeons,ab interno gel stent placements by glaucoma fellowship trainees have similar mean IOP,topical medication reduction,surgical success,and needling rates at 12-month follow-up.