bluuebunny/crossref_metadata_2025 huggingface dataset:
Refractive lens exchange with the Acri. Twin asymmetric diffractive bifocal intraocular lens system
Authors: Alfonso José F. , Fernández-Vega Luis , Ortí Susana , Montés-Micó Robert
Published: January 2018

Purpose.

To evaluate efficacy, safety, and predictability after refractive lens exchange (RLE) in patients who had implantation of asymmetric Acri. Twin bifocal diffractive intraocular lenses.

Methods.

The study comprised 130 eyes of 65 consecutive patients after RLE who had bilateral implantation of the Acri. Twin system. Eyes were divided into myopic and hyperopic groups. Binocular uncorrected distance visual acuity, best-corrected distance visual acuity (BCVA), uncorrected distance near visual acuity, and best distance-corrected near visual acuity (BCNVA) were recorded preoperatively and 6 months after surgery.

Results.

Efficacy indexes were 0.99 for myopic and 0.93 for hyperopic patients at 6 months postoperatively. No patients lost >2 lines of BCVA. For the myopic group, 6 patients gained 1 line, and 10 patients gained ≥2 lines; for the hyperopic group, 5 patients gained 1 line, and 6 patients gained ≥2 lines. Safety indexes were 1.13 and 1.03 for myopic and hyperopic patients, respectively. No patients lost ≥2 lines of BCNVA; for the myopic group, only 2 patients lost 1; for the hyperopic group there was no change after surgery. Safety indexes at near were 0.99 for myopic and 1.00 for hyperopic patients. Efficacy indexes at near were 1.05 for myopic and 1.07 for hyperopic patients.

Conclusions.

RLE with asymmetric bilateral implantation of the Acri. Twin bifocal IOL is an effective procedure for correcting ametropia and presbyopia. Results obtained were safe and effective at distance and near for both myopic and hyperopic patients.
Anesthesiologist Intervention during Cataract Surgery under Topical or Peribulbar Anesthesia: A Propensity Model Comparison
Authors: Gemma Marco , Gioia Luigi , Dedola Elisa , Basta Benedetta , Blanchi Ingrid , Fasce Francesco , Beretta Luigi
Published: January 2018

Purpose.

To compare the incidence and type of anesthesiologist intervention during cataract surgery under peribulbar (PA) or topical (TA) anesthesia in a day-surgery monitored anesthesia care setting (monitoring provided by nurses with the anesthesiologist available on an on-call basis).

Methods.

From a prospective database of all phacoemulsifications performed in our hospital (January 2008-January 2009), 97 patients submitted to cataract surgery under PA were matched with 97 patients submitted to the same surgery under TA by a propensity model. The resulting groups were homogeneous as to history of antihypertensive therapy administered on the day of surgery and not administered on the day of surgery, cardiologic history, neurologic history, psychiatric history, anxiolytic assumption, and history of diabetes mellitus. We compared the incidence of intervention of the anesthesiologist between groups and the type of adverse event triggering such interventions.

Results.

The anesthesiologist was called in 37 (38.14%) cases in the PA group and in 27 (27.84%) cases in the TA group (37 [38.14%]) (p=0.123). Only the occurrence of agitation differed significantly between groups (9 [9.28%] patients in the TA group vs 24 [24.74%] patients in the PA group; p=0.004).

Conclusions.

Monitored anesthesia care is feasible for cataract surgery both under PA or TA. PA still remains an appealing alternative to TA during cataract surgery for patients incapable of keeping the operating eye in the primary position or with incoercible blinking, photophobia, or phacodonesis. A greater incidence of agitation is to be expected and adequate premedication with anxiolytics should be considered if PA is chosen.
Long-Term Visual Acuity and its Predictors after Cataract Surgery in Patients with Uveitis
Authors: Yoeruek Efdal , Deuter Christoph , Gieselmann Sylvia , Saygili Oguzhan , Spitzer Martin S. , Tatar Olcay , Bartz-Schmidt Karl U. , Szurman Peter
Published: January 2018

Purpose.

To analyze the outcomes of phacoemulsification and posterior intraocular lens (IOL) implantation in patients with uveitis and to determine factors responsible for poor visual outcome.

Methods.

The records of 155 patients (180 eyes) with uveitis who had phacoemulsification and IOL implantation between August 2001 and March 2008 were examined retrospectively. Best-corrected visual acuity (BCVA) was recorded at the immediate preoperative visit and at follow-up examinations every 3 months. At each postoperative visit, a complete ophthalmologic examination was performed. The postoperative visual outcomes and complications were analyzed. Univariate regression analysis was done to determine risk factors for poor visual acuity during follow-up.

Results.

The mean follow-up was 31.4 months (range 3–78 months). An underlying systemic disease was present in 70 (45.2%) patients (82 eyes, 45.6%). The mean preoperative logMAR BCVA was 1.13±0.62 (95% CI: 0.85–1.02) and increased to 0.42±0.57 (95% CI: 0.32–0.59) at last medical visit (p<0.001). A total of 107 eyes (59.4%) had postoperative complications including posterior capsular opacification, newly developed macular edema, recurrence of uveitis, macular epiretinal membrane, and deposits on the IOL surface. Preoperatively observed macular lesions was the factor most strongly associated with poor visual outcome after cataract surgery (odds ratio: 5.43; 95% CI: 3.41–7.34; p<0.001). Anterior segment pathologies, age at surgery, etiology of uveitis (idiopathic, uveitis associated systemic disease), and gender did not influence visual rehabilitation after surgery (p>0.05).

Conclusions.

The outcomes of phacoemulsification and IOL implantation in patients with uveitis were satisfactory. Patients with observed preoperative macular lesions are at risk for poor visual outcome.
Quantitative Assessment of Anterior Chamber Parameters in Pigmentary Glaucoma Using Slit-Lamp Optical Coherence Tomography
Authors: Dine Umut A. , Kulacoglu Destan N. , Oncel Banu , Yalvac Llgaz Sagdic
Published: January 2018

Purpose.

To quantitatively assess the parameters of anterior chamber and angle dimensions by slit-lamp optical coherence tomography (SL-OCT) in eyes with pigmentary glaucoma (PG).

Methods.

A total of 18 eyes of 11 patients with PG and 18 eyes of 11 healthy volunteers were included in the study. Anterior chamber depth (ACD), anterior chamber volume (ACV), spur distance (internal horizontal anterior chamber diameter), central corneal thickness (CCT), angle opening distance at 500 urn from the scleral spur (AOD 500), and trabecular iris space area at 500 μm from the scleral spur (TISA 500) parameters were detected by SL-OCT. The differences of anterior chamber parameters between patients with PG and the control group were analyzed by Mann-Whitney U test.

Results.

Mean ACD and ACV were measured as 3.28±0.38 mm and 191.6±39.7 mm3 respectively in the PG group. Mean AOD 500 and TISA 500 were 0.88±0.47 mm and 0.29±0.15 mm2 at the nasal angle and 1.14±0.67 mm and 0.41 ±0.23 mm2 at the temporal angle, respectively. Nasal and temporal angles were 49.83±11.1° and 53.83±10.46°. In eyes with PG, the midperipheral iris configuration was found to be considerably concave in 15 eyes (83.3%). Except CCT and spur distance, all anterior chamber dimension and angle parameters detected by SL-OCT were found to be significantly higher in the eyes with PG (Mann-Whitney U test, p<0.05).

Conclusions.

SL-OCT provided highly quantitative data on the parameters of anterior chamber and angle dimensions in PG. The evaluation of the anterior segment anatomy using SL-OCT revealed increased anterior chamber dimensions and posterior bowing of the iris consistent with the increase in angle parameters in patients with PG.
A 12-Week, Randomized, Double-Masked Study of Fixed Combination Latanoprost/Timolol versus Latanoprost or Timolol Monotherapy
Authors: Palmberg Paul , Kim Elizabeth E. , Kwok Kenneth K. , Tressler Charles S.
Published: January 2018

Purpose.

To evaluate the efficacy and safety of fixed combination latanoprost/timolol versus latanoprost or timolol monotherapy.

Methods.

This 12-week, randomized, double-masked study was designed to overcome potential shortcomings of previous trials. We enrolled 788 subjects with open-angle glaucoma or ocular hypertension treated with a beta-blocker for ≥4 weeks before screening. After washout, 500 subjects with a baseline mean intraocular pressure (IOP) ≥26 and <37 mmHg were randomized to fixed combination latanoprost-timolol in the evening (n=170), latanoprost monotherapy in the evening (n=165), or timolol monotherapy in the morning (n=165). At weeks 2, 6, and 12, each subject's IOP level was measured in triplicate at 8 AM (predose), 10 AM, and 4 PM in each eye. Adverse events were monitored throughout. The statistical superiority of the fixed combination for the 18 pairwise comparisons with the 2 monotherapies was evaluated (analysis of variance).

Results.

The statistical superiority of the fixed combination was demonstrated at 7/9 time points versus latanoprost and 9/9 time points versus timolol. Mean diurnal IOP levels were similar at baseline but significantly lower with the fixed combination than with either monotherapy at weeks 6 and 12 (each p<0.05). Patients treated with the fixed combination were significantly more likely than those treated with either monotherapy to reach prespecified percent IOP reductions at the upper thresholds and to achieve very low target diurnal IOP levels. All therapies were well tolerated.

Conclusions.

Fixed combination latanoprost/timolol safely reduces IOP levels in patients with glaucoma or ocular hypertension, though only slightly more than does latanoprost monotherapy.
Extrafoveal Vitreous Traction Associated with Branch Retinal Vein Occlusion
Authors: Ophir Avinoam , Trevino Aaron , Martinez Michael R.
Published: January 2018

Purpose.

To present patients with extrafoveal vitreous traction associated with diffuse macular edema secondary to branch retinal vein occlusion (BRVO).

Methods.

A retrospective study on consecutive patients with BRVO using optical coherence tomography (OCT)-2000 is reported. Excluded were patients with eyes with other retinopathies that could affect analysis and eyes following pars plana vitrectomy (PPV). A control group of 30 age-matched patients allowed for normal OCT6-mm macular maps.

Results.

Vitreous traction was detected in 4 of 17 eyes (17 patients, 23.5%). The traction was located extrafoveally in each of the 4 eyes. In one eye there was a simultaneous central macular traction. Only the manually controlled OCT-Line group program, but not the central automatic 6-radial lines program, confirmed vitreous traction in each case. Retinal edema (n=4) and serous retinal detachment (n=2) underlining the traction sites were in continuum with the central macula in 3 eyes, presenting either as diffuse macular edema or combined with serous macular detachment, respectively. In one eye the edema subsided after PPV, and visual acuity stabilized during 7 postoperative months of follow-up. Macular thickness and visual acuity of another eye improved temporarily in repeated conventional treatments after PPV was discarded, but its fovea markedly atrophied 12 months later.

Conclusions.

Extrafoveal vitreous traction maybe apparent following BRVO. Further studies are required to assess whether such traction membranes may play a role in the persistence of diffuse macular edema.
Three-Monthly Intravitreal Bevacizumab Injections for Neovascular Age-Related Macular Degeneration: Short-Term Visual Acuity Results
Authors: Ferraz Daniel , Bressanim Gláucio , Takahashi Beatriz , Pelayes David , Takahashi Walter
Published: January 2018

Purpose.

To evaluate the change in vision after 3 monthly consecutive intravitreal injections of 1.25 mg of bevacizumab for neovascular age-related macular degeneration (AMD).

Methods.

A retrospective analysis of 35 eyes was performed. Visual acuity (VA) at initial visit and at each follow-up visit was compared. The injection of bevacizumab was performed at 30-day intervals and patients were observed for 5 months after the last injection.

Results.

Of the 35 eyes, 9 had received previous treatment with photodynamic therapy with or without 4 mg of intravitreal triamcinolone. VA was measured in Snellen table and transformed into logMAR for statistical purposes. Mean age was 76.66 years (range, 49–90 years). There were 24 (69%) women and 11 (31%) men. Mean VA at the initial visit was 0.92±0.50. At month 1, mean VA was 0.84±0.51 and at month 2 was 0.74±0.51. At month 3, mean VA remained 0.74±0.49. Six and 8 months after the initial visit, VA was 0.79±0.49 and 0.77±0.50, respectively. The improvement in VA was statistically significant at month 2 and at the end of the follow-up (8 months) compared with the baseline VA.

Conclusions.

Three consecutive monthly injections of intravitreal bevacizumab to treat neovascular AMD is effective in improving VA in the short term. Longer prospective studies should be performed to confirm VA stability after the third injection.
Intravitreal Carboplatin Concentration and area under Concentration versus Time Curve after Intravitreal and Periocular Delivery
Authors: Pochop Pavel , Darsova Denisa , Kukacka Jiri , Tesfaye Hundie , Vajner Ludek , Uhlik Jiri , Kodetová Daniela , Malis Josef , Dotrelova Dagmar
Published: January 2018

Purpose.

To determine platinum (Pt) concentrations and area under the concentration versus time curve (AUC) of the vitreous humor after periocular or transcorneal intravitreal administration of carboplatin in rabbits.

Methods.

Eighteen albino rabbits were included in an in vivo experiment. Each animal received a single dose of either 30 mg of carboplatin by periocular injection (POI30 group: n=6) or 15 mg by periocular injection (POI15 group: n=6), or 0.05 mg by transcorneal intravitreal injection (TII group: n=6), respectively, into the right eye. Vitreous humor from the right eyes and plasma samples were collected post dose at 1, 2, 6, 24, 48, 168, and 336 hours or 448 hours, respectively. Flameless atomic absorption spectroscopy was employed to analyze total platinum concentrations in blood and vitreous humor. AUC was calculated using the trapezoidal rule.

Results.

Pt concentration was mostly <1 mg/L (0–3.15 mg/L) in the vitreous humor samples and ≥2 mg/L (2.33–7.3 mg/L) in the blood samples 1 hour after administration in POI groups. Markedly higher Pt concentrations were found 1 hour after intravitreal (TII) administration (10.285–66.759 mg/L) and decreased below 1 mg/L no less than 168 hours after administration. The mean AUC for Pt in vitreous humor was significantly lower (p=0.0001) after both POI30 and P0I15 administration compared to TII route (8.955 ± 2.464 mg/L/min).

Conclusions.

These findings proved that intravitreal carboplatin delivery enables the achievement of relatively stable concentrations and AUC of platinum in the rabbit vitreous humor. This moreover suggests that transcorneal intravitreal delivery of carboplatin aiming to treat retinoblastoma vitreous seeding is a promising mode of chemotherapy.
Retinopathy of Prematurity: Screening Guidelines Need to be Reevaluated for Developing Countries
Authors: Başmak Hikmet , Niyaz Leyla , şahin Afsun , Erol Nazmiye , Gürsoy Haluk H.
Published: January 2018

Purpose.

Timely screening of premature babies is an important initial step in the management of retinopathy of prematurity (ROP) as earlier treatment results in improved visual prognosis. Screening criteria for ROP currently recommended by the American Academy of Pediatrics may not be applicable in developing countries. The aim of the present study is to find out the incidence of ROP in infants with a gestational age (GA) of ≥32 weeks in Eskisehir, Turkey, to provide information to assist in determining screening criteria.

Methods.

A total of 96 infants with a GA of 32–35 weeks who were referred for ROP between January 1, 2004, and December 31, 2008, were studied. ROP screening, follow-up, and appropriate therapies were applied.

Results.

During ROP screening, there were 42 of 96 (43.8%) infants with no ROP. A total of 54/96 (56.2%) infants were noted to have ROP. Among all infants, 7 (7.3%) had threshold ROP. Two infants with threshold disease were born at the 32nd, 2 at the 33rd, and 3 at the 34th week of gestation. The mean birthweight was 1857.9 (range 1060–3200) grams.

Conclusions.

In our study, it was found that more mature infants may also develop threshold ROP and require early treatment. After more information is gained and widespread screening, screening protocols covering more mature infants can be designed especially for developing countries.
Corneal Chrysiasis: In Vivo Confocal Microscopy Analysis
Authors: Paladini Lacopo , Menchini Ugo , Mencucci Rita
Published: January 2018

Purpose.

To describe the in vivo confocal microscopy corneal findings in a patient treated with gold sodium thiomalate.

Methods.

A woman with rheumatoid arthritis who had been treated with gold sodium thiomalate for 32 years came to our center for an ophthalmologic examination about 5 years ago. Besides visual acuity, the examination included slit-lamp biomicroscopy, intraocular pressure, and funduscopy Confocal microscopy was performed using Confoscan 4 (Nidek Technologies, Padova, Italy) with a 40× lens.

Results.

Every layer of the cornea is affected by gold deposits with high reflectivity, especially in the anterior stroma, where they have a larger dimension.

Conclusions.

Corneal chrysiasis can be evaluated by confocal microscopy, giving information on corneal metabolism and physiology.
Diagnostic Vitrectomy (25-Gauge) in a Case with Intraocular Lymphoma Masquerading as Bilateral Granulomatous Panuveitis
Authors: Kanavi Mozhgan Rezaei , Soheilian Masoud , Bijanzadeh Bijan , Peyman Gholam A.
Published: January 2018

Purpose.

To report a case of intraocular lymphoma, masquerading as bilateral granulomatous panuveitis, and diagnosed after harvesting vitreous specimen with a 25-gauge vitrectomy instrument.

Methods.

A 67-year-old woman presented with bilateral granulomatous uveitis. Visual acuity in both eyes was severely impaired because of severe concurrent cataract and vitreous organization. Sutureless phacoemulsification and posterior chamber intraocular lens implantation combined with 25-gauge diagnostic vitrectomy was performed.

Results.

Cytopathology and immunocytochemistry of the vitreous disclosed a non-Hodgkin B-cell lymphoma despite unremarkable brain MRI, lumbar puncture, bone marrow aspiration, and whole body scan. Visual acuity improved to 20/120 in both eyes.

Conclusions.

Sutureless combined 25-gauge diagnostic vitrectomy, phacoemulsification, and posterior chamber intraocular lens implantation during one-stage surgery was effective in obtaining appropriate vitreous material for cytology in a case of intraocular lymphoma.
Acute Ophthalmoparesis Associated with Human Parvovirus B19 Infection
Authors: Le Scanff Julie , Vighetto Alain , Mekki Yahia , Nguyen Anh Minh , Dufour Jean-François , Broussolle Christiane , Seve Pascal
Published: January 2018

Purpose.

Parvovirus B19 infection (PVB19) has been linked with a broad spectrum of clinical syndromes. In addition to erythema infectiosum and asymptomatic infection, other less common manifestations include transient aplastic crisis in patients with hemoglobinopathies, pure red cell aplasia and pancytopenia in immunocompromised persons, nonimmune hydrops fetalis, chronic arthritis, myocarditis, and hepatitis.

Methods.

Only 19% of patients had peripheral nervous system damage, mainly including brachial plexitis and carpal tunnel syndrome. Two cases of cranial nerves palsies have been described in children in the literature, including one case of peripheral facial nerve palsy and one case of velopalatine hemiparalysis. We report the first case of acute ophthalmoparesis associated with PVB19 infection.

Results.

We present a 40-year-old man with PVB19 with acute sixth cranial nerve palsy, diagnosed on the basis of serology and polymerase chain reaction carried out both on serum and cerebrospinal fluid.

Conclusions.

Clinicians should be aware of this possible clinical presentation.
Comparison of Corneal Endothelial Cell Density Estimated with 2 Noncontact Specular Microscopes
Authors: Goldich Yakov , Marcovich Arie L. , Barkana Yaniv , Hartstein Morris , Morad Yair , Avni Isaac , Zadok David
Published: January 2018

Purpose

To assess the repeatability of endothelial cell density (ECD) measurements by the EM-935 endothelial microscope and their agreement with those of the Konan-Noncon Robo SP 6000 (Noncon Robo) specular microscope.

Methods

We assessed the agreement between automated and semiautomated methods of analysis of the EM-935 and the Noncon Robo by measuring ECD in 40 eyes of 20 healthy subjects and calculating the 95% limits of agreement (LoA) and plotting Bland-Altman graphs. We then evaluated the repeatability of both the methods of the EM-935 by calculating the intraclass correlation coefficients (ICC) and coefficient of variation (CV).

Results

The mean ECD of the 40 eyes was 2531±244 cells/mm2 for Noncon Robo and 2483±159 cells/mm2 for EM-935-Automated. The difference between these 2 methods was not statistically significant. The mean ECD for EM-935-semiautomated was 2635±190 cells/mm2 and was statistically significantly higher than the 2 other methods (p<0.001). The 95% LoA were −435 to 339 cells/mm2 for the Noncon Robo and EM-935-Automated, −230 to 438 cells/mm2 for the Noncon Robo and EM-935-semiautomated, and −347 to 43 cells/mm2 for the EM-935-Automated and EM-935-semiautomated. Repeatability was better for EM-935-semiautomated method compared with automated method as expressed by ICC (95% CI) of 0.80 (0.52–0.95) vs 0.50 (0.09–0.84) and coefficient of variation of 2.43% vs 2.85%, respectively.

Conclusions

The EM-935 specular microscope showed better repeatability for the semiautomated mode compared with the automated mode. Although measurement agreement with the Noncon Robo was somewhat better for the semiautomated mode, agreement was only moderate for both methods. This leads us to recommend that these instruments should not be used interchangeably.
Evaluation of a Recently Developed Noncontact Specular Microscope in Comparison with Conventional Pachymetry Devices
Authors: Módis László , Szalai Eszter , Németh Gábor , Berta András
Published: January 2018

Purpose

The study was conducted to assess the central corneal thickness (CCT) of the healthy cornea with a recently developed noncontact specular microscope (EM-3000; Tomey) and compare the results with those measured with a contact specular microscope and an ultrasound pachymeter. Agreement between measurements taken by 2 investigators was also studied.

Methods

The right eyes of 41 healthy individuals who had negative history of contact lens wear, ophthalmic disease, or ocular surgery were examined. The CCT was determined sequentially with a non-contact specular microscope, a contact specular microscope (EM-1000; Tomey), and an ultrasound pachymeter (AL-2000; Tomey). Each evaluation with the specular microscopes was performed by 2 independent operators.

Results

A significant difference was detected in pachymetry measurements among the 3 instruments (p=0.01; analysis of variance). The mean CCT values were lower measured with the ultrasound pachymeter(537±30 μm) than the contact endothelial microscope (543±37 μm, p=0.17, Student t-test) and the noncontact microscope (549±33 μm, p<0.0001) (operator 1). There was no statistically significant difference in CCT measurements between the 2 endothelial microscopes (p=0.19). We found significant correlations (p<0.0001) in thickness measurements between each pair of instruments (r=0.91, noncontact microscopy and ultrasound pachymetry; r=0.74, noncontact and contact microscopy; r=0.72, contact microscopy and ultrasound pachymetry; Spearman rank correlation).

Conclusions

The strong correlations among the 3 pachymetry devices suggest that the tested instruments provide reliable measurements; however, they cannot be used interchangeably.
Reasons for Not Performing LASIK in Refractive Surgery Candidates in Yemen
Authors: Bamashmus Mahfouth , Saleh Mahmoud Fathi , Abdulrahman Mohamed , Al-Kershy Najeeb
Published: January 2018

Purpose

To determine and analyze the reasons that laser in situ keratomileusis (LASIK) was not performed in patients who requested refractive surgical correction of their refractive errors.

Methods

A retrospective observational study was performed in Yemen Magrabi Hospital between June 2005 and October 2006; the case records of 1596 new consecutive patients who presented for refractive surgery at our refractive surgery unit were reviewed. Data on the ocular status, refractive problems, and investigations performed were analyzed. The reasons for not performing LASIK in the cases that were rejected were recorded and analyzed.

Results

A total of 1191 patients (74.6%) were advised to have LASIK of the 1596 patients examined. LASIK was not advised in 405 patients (25.4%). The most common reasons for rejecting LASIK were suboptimal central corneal thickness (25.9%), high myopia >–11.00 D (17.0%), keratoconus (15.5%), cataract (11.4%), and suspicious corneal topography (forme fruste keratoconus) (9.4%).

Conclusions

Patients who request refractive surgery have a variety of problems and attention must be given to these patients. Suboptimal corneal thickness, high amount of refractive error, and keratoconus were found to be the leading causes of not performing LASIK in Yemeni patients.
Enzymatic Descemetic Lamellar Keratoplasty: Pilot Study
Authors: Bond Paolo , Bond Paola , Malle Vincenzo Delia , Fanini Francesca , Nardi-Pantoli Angela
Published: January 2018

Purpose

This was a pilot study to evaluate the efficacy of a new surgical technique of descemetic anterior lamellar keratoplasty (DALK) with the help of enzymatic hyaluronidase solution.

Methods

We selected 10 patients, 6 male and 4 female, with surgical keratoconus, with a mean age of 45±16 years (range 29–61), with best-corrected visual acuity (BCVA) ≤20/70 logMAR. The study period was from February 1, 2008, to November 3, 2008, at the S. Maria della Scaletta Hospital (Imola, Italy). We evaluated the following parameters preoperatively and postoperatively: BCVA with Snellen card; endothelial density measured by specular microscope (SP 2000P, Topcon, Japan); and mean astigmatism measured by computerized topography (Keratron Scout, Optikon 2000, Rome, Italy). The parameters were evaluated monthly, with a maximum follow-up of 8 months.

Results

There were no perforations and minimal complications (second anterior chamber in 4 eyes) on the first day, which spontaneously resolved after 7 days. Two patients required resuturing because of loose suture on the second postoperative day. The visual recovery was comparable to that obtained by most authors after DALK. The final mean BCVA was 20/25. There was a drop in endothelial cells of approximately 10.1% after 7 months. The mean central astigmatism at the end of the follow-up was 2 diopters (±0.88).

Conclusions

The enzyme application to the recipient cornea makes the stromal dissection easier, but other studies are needed about type and concentration of the enzyme, and the application times.
Multifocal Electroretinogram and Central Visual Field Testing in Central Areolar Choroidal Dystrophy
Authors: Gundogan Fatih Cakir , Dinç Umut Asli , Erdem Uzeyir , Ozge Gokhan , Sobaci Gungor
Published: January 2018

Purpose

To study multifocal electroretinogram (mfERG) and its relation to retinal sensitivity assessed by Humphrey visual field (HVF) analysis in central areolar choroidal dystrophy (CACD).

Methods

Seven eyes of 4 patients with CACD and 15 normal control subjects were examined. mfERG and central 30/2 HVF were tested for each participant. Ring analysis in mfERG was evaluated. HVF results were evaluated in 5 concentric rings in order to compare the results to concentric ring analysis in mfERG. The differences between control subjects and patients were evaluated by Mann-Whitney U test and the correlations were assessed by Spearman test.

Results

Mean Snellen acuity was 0.49±0.10 in patients. HVF revealed central scotoma in 6 of 7 eyes (85.7%), whereas a paracentral scotoma extending to fixation point was detected in 1 eye. The retinal sensitivities in 5 concentric rings in HVF were significantly lower (p<0.001 for ring 1 to ring 4, and p=0.017 in ring 5) in CACD patients. Similarly, CACD patients had lower P1/N1 amplitudes (p<0.05) and delayed P1/N1 implicit times (p<0.05).

Conclusions

In CACD, in the areas of scotoma detected by HVF, mfERG values were depressed. However, both mfERG and HVF abnormalities were found outside the areas of ophthalmoscopically normal retinal areas.
Paraneoplastic Exudative Retinal Detachment Associated with Adenocarcinoma of the Lung
Authors: Burgess Philip I. , Kenawy Nihal , Pearce Ian A.
Published: January 2018

Purpose

To report a case of bilateral paraneoplastic exudative retinal detachment (ERD) associated with asymptomatic adenocarcinoma of the lung.

Methods

Case report.

Results

A 47-year-old man presented with bilateral ERD accompanied by anterior and posterior segment inflammation. Extensive investigations for local and systemic causes of ERD were unrewarding. Only when computed tomography scanning of the thorax was performed were enlarged thorax lymph nodes demonstrated and revealed biopsy-proven adenocarcinoma.

Conclusions

Paraneoplastic phenomena should be considered in patients presenting with ERD. Ocular paraneoplastic pathologies may be the initial manifestation of an underlying malignancy.
Choroidal Lymphoma Masquerading as Anterior Ischemic Optic Neuropathy
Authors: Tavallali Ali , Shields Carol L. , Bianciotto Carlos , Shields Jerry A.
Published: January 2018

Purpose

To report a patient with presumed nonarteritic anterior ischemic optic neuropathy (NAION) found on our evaluation to have bilateral uveal lymphoma.

Methods

The clinical history and physical examination, Humphrey visual field testing, ultrasonography, magnetic resonance imaging (MRI), and fine needle aspiration biopsy specimen of a 60-year-old man with presumed NAION were evaluated.

Results

The patient initially presented with painless blurred vision OD and foreign body sensation OS. Upon examination, he was found to have optic nerve edema OD suspicious for NAION and oral steroids were employed with no improvement. Later, an abnormality in the left eye raised suspicion for choroidal metastasis. By ultrasound, the tumor in the left choroid was acoustically hollow. MRI of the orbits revealed a choroidal infiltrative process OU. Fine needle aspiration biopsy of OS confirmed atypical lymphocytes, predominantly small to intermediate sized, without necrosis. The patient was treated with external beam radiation therapy to both eyes.

Conclusions

Choroidal lymphoma may present with clinical features of anterior ischemic optic neuropathy or choroidal metastasis.
Investigation of Corneal Topography after Deep Lamellar Endothelial Keratoplasty
Authors: Lombardo Marco , Terry Mark A. , Lombardo Giuseppe , Serrao Sebastiano , Ducoli Pietro
Published: January 2018

Purpose

To analyze the 6-month anterior and posterior topographic changes of the cornea after deep lamellar endothelial keratoplasty.

Methods

Orbscan topographies of 22 eyes from 21 patients with corneal decompensation were retrospectively analyzed: 11 eyes received a 9-mm scleral access incision (large-incision group) and 11 eyes received a 5-mm scleral access incision (small-incision group). All the preoperative and postoperative corneal raw data were imported into custom software which computed the average composite corneal maps and difference maps for both study groups in order to evaluate the corneal response to the surgery. The software delineated 2 concentric zones of the cornea to characterize the regional response following the surgery: the central and peripheral regions.

Results

There were no significant differences (analysis of variance, <0.35 D, p>0.05) between 6-month postoperative and preoperative average anterior central corneal topographies in either group. At the end of follow-up, the average posterior curvature tangential map did not significantly differ from before surgery in either group (<0.35 D, p>0.05). However, a significant increase (>0.60 D, p<0.01) in the average posterior central astigmatic power of the cornea was found in both groups.

Conclusions

Deep lamellar endothelial keratoplasty effectively preserves the preoperative keratometric corneal topography, minimizing changes in curvature and astigmatism of the cornea. The great predictability of corneal topography following deep lamellar endothelial keratoplasty is likely to be attributed to the minimal changes that occur in the anterior stroma, the portion of the cornea that appears to be mainly responsible for maintenance of corneal shape.
Meta-analysis of Timolol on Diurnal and Nighttime Intraocular Pressure and Blood Pressure
Authors: Lee Princeton Wen-Yuan , Doyle Aoife , Stewart Jeanette A. , Kristoffersen Caroline J. , Stewart William C.
Published: January 2018

Purpose

To evaluate the nighttime intraocular pressure (IOP) and blood pressure (BP) response to timolol treatment in patients with ocular hypertension or primary open-angle glaucoma.

Methods

This was a meta-analysis of previously published studies that must have been randomized, prospective, crossover or parallel, single or double-masked trials. The treatment period must have been ≥2 weeks with ≥19 patients per treatment arm for a crossover, and ≥50 patients for a parallel designed trial. Studies must have included both baseline and treated 24-hour curves.

Results

For the IOP analysis, we included 8 articles with 340 patients. A reduction from baseline was observed for timolol at each time point and for the 24-hour curve (p≤0.009). When 2 studies, in which timolol was used adjunctively were removed, a similar difference was observed as above at each time point and for the 24-hour curve (p≤0.003). In 2 studies, there were small reductions from baseline for the mean diastolic and systolic BPs at most time points and for the 24-hour curve (3.9 and 4.2 mmHg, respectively) with timolol treatment. The ocular perfusion pressure did not show any difference between baseline and timolol treatment at any time point or for the 24-hour curve (p>0.05).

Conclusions

This meta-analysis suggests that topical timolol therapy provides an ocular hypotensive effect over the 24-hour curve, including the nighttime hours, and while small reductions in the systolic and diastolic pressures occur, the ocular perfusion pressure is not altered over 24 hours.
Fine Needle Aspiration Biopsy with Liquid-Based Cytology and Adjunct Immunohistochemistry in Intraocular Melanocytic Tumors
Authors: Pelayes David E. , Zárate Jorge O.
Published: January 2018

Purpose

To determine the efficacy of liquid-based cytology (LBC) and immunohistochemistry in the evaluation of fine needle aspiration biopsy (FNAB) of intraocular melanocytic tumors.

Methods

Cytologic diagnosis was necessary in 25 patients with intraocular melanocytic tumors to deliver a therapeutic course of treatment. The patients’ clinical, cytologic, and histologic diagnoses were correlated. All samples were stained with hematoxylin and eosin, and studied through standardized monolayer techniques, with a mean cellular concentration of 60,000 cells/mm2. Immunohistochemistry was performed using Vimentin, S 100, HMB 45, Melan A, cytokeratin, and as prognostic factors, B and T lymphocyte, CD68 (macrophage), and antibody Ki 67 (growth factor).

Results

The positive predictive value was 100%; the negative predictive value was 80%. Sensitivity and specificity of LBC for detecting malignancy were 95.2% and 100%, respectively. The FNAB LBC with immunohistochemistry findings resulted in a revision of treatment in 32% of patients. There was no evidence of local tumor dissemination or a recurrence associated with biopsy in any patient.

Conclusions

Fine needle aspiration biopsy (LBC and immunohistochemistry) is a safe, sensitive, and specific method of establishing tissue diagnosis in a subset of patients with intraocular melanocytic tumors, particularly in cases where sample material is scarce. The routine use of immunohistochemical stain increases the diagnostic utility, and prognosis factor determination may change clinical management.
Efficacy of Brimonidine in Preventing Intraocular Pressure Spikes following Phacoemulsification in Glaucoma Patients
Authors: Kandarakis Artemios , Soumplis Vasileios , Karampelas Michalis , Panos Christos , Kyriakos Nikolaos , Baxevanakis Anastasios , Karagiannis Dimitrios
Published: January 2018

Purpose

To measure intraocular pressure (IOP) elevation 6 and 24 hours after phacoemulsification in patients with glaucoma and to investigate the efficacy of brimonidine tartrate 0.2% in preventing IOP rise on the first postoperative day following cataract surgery.

Methods

In this prospective randomized single-masked study, 86 eyes of 78 patients with well-con-trolled open-angle glaucoma were scheduled for phacoemulsification surgery. Patients were randomly assigned into 2 groups. Group A received 1 drop of brimonidine tartrate 0.2% and group B, which served as a control group, received 1 drop of artificial tears. Intraocular pressure was measured at baseline, before surgery, and 6 and 24 hours postoperatively.

Results

Within each group, we found a statistically significant difference in IOP between baseline and 6 hours postoperatively (p<0.01) and between 6 and 24 hours (p<0.01). There was no statistically significant difference between baseline IOP and 24-hour values. Comparing the 2 groups, there was no statistically significant difference in preoperative and 24-hour postoperative IOP. Six hours after surgery, the mean IOP in the brimonidine group was 18.52±4.58 mmHg, compared with 20.86±3.79 mmHg in the control group. Treatment with brimonidine tartrate 0.2% significantly reduced postoperative IOP elevation 6 hours following cataract extraction (p=0.009).

Conclusions

Patients with medically well-controlled glaucoma may experience a substantial increase in IOP shortly after phacoemulsification surgery. Instillation of brimonidine tartrate 0.2%, although it significantly reduced IOP elevation following cataract operation, did not completely prevent IOP spikes.
Prevalence of Exfoliation Syndrome in Estonia
Authors: Kaljurand Kuldar , Teesalu Pait
Published: January 2018

Purpose

To estimate the prevalence of exfoliation syndrome (XFS) in Estonia.

Methods

A total of 766 residents, representing the demographics of Tartu, Estonia, were chosen by random sampling from the Estonian Population Database, and invited to participate in this study. Each patient underwent careful slit-lamp examination including applanation tonometry before and after pupil dilatation. Presence of XFS was confirmed after mydriasis as typical white-gray fluffy material on the anterior lens surface, and on the pupillary border as well on the corneal endothelium.

Results

A total of 424 subjects, 277 female and 147 male, participated in this study. The median age was 70 years (70 years in women and 71 years in men). The overall prevalence of XFS among the study participants in 1 or both eyes was 25.5% (25.2% in men and 25.6% in women). Intraocular pressure measured before and after dilatation was significantly higher in the XFS group. Glaucoma was significantly more frequent in the XFS group than the non-XFS group; 35.7% and 11.3%, respectively. Fifty percent of all patients with glaucoma had exfoliative glaucoma. Cataract was detected in 57.0% of cases in the XFS group compared to 39.5% in the non-XFS group (p=0.002). We found similar prevalence of systemic diseases in both groups for both genders. There was no difference between the 2 groups in visual acuity.

Conclusions

In this population-based cross-section study, XFS was found to be a frequent finding in Estonia. Exfoliation syndrome is a risk factor for glaucoma and cataract formation.
Correlation between Optical Coherence Tomography Results and the Scoring Tool for Assessing Risk (STAR) Score in Patients with Ocular Hypertension
Authors: Yalvac Ilgaz Sagdic , Kulacoglu Destan N. , Satana Banu , Eksioglu Umit , Duman Sunay , Sokak Sakir Kesebir
Published: January 2018

Purpose

To correlate retinal nerve fiber layer thickness (RNFL) and optic nerve head (ONH) parameters measured with optical coherence tomography (OCT) with the Scoring Tool for Assessing Risk (STAR) threshold in patients with ocular hypertension (OH).

Methods

The study included 92 patients with OH. They were divided into low-risk (n=32), moderate-risk (n=36), and high-risk (n=24) groups according to STAR criteria. RNFL and ONH OCT protocols were used to evaluate all study participants. Major parameters for RNFL analysis were average RNFL thickness, superior quadrant, nasal quadrant, inferior quadrant, temporal quadrant, and segmental thickness per 12 o'clock hour position. ONH parameters were vertical integrated rim area (VIRA), horizontal integrated rim width (HIRW), disc diameter, disc area, cup area, rim area, cup-to-disc (CID) area ratio, horizontal CID ratio, and vertical CID ratio.

Results

The highest area under receiver operating characteristics curves for distinguishing the high-risk group from the other groups were vertical CID ratio (0.88), CID area (0.88), VIRA (0.87), and HIRW (0.81) for ONH parameters, and inferior (0.82) and 6 o'clock hour position (0.77) for peripapillary RNFL thickness measurements.

Conclusions

Inferior average, 6 o'clock hour position analyses for RNFL measurement, and VIRA, HIRW, CID area, and vertical CID ratio for ONH measurement were the best parameters for STAR staging in patients with OH.
Alternative Bearing Surfaces: Crosslinked Polyethylenes for Total Hip Replacement. A Review
Authors: Harris W.H.
Published: January 2018

Highly crosslinked polyethylene has three major advantages as an alternative bearing surface that are in common with ceramic on ceramic and metal on metal. They are 1) prior long-term in vivo human use, 2) low wear and lysis rates and 3) being a relatively inert material. In addition they have several other advantages not shared by the hard on hard alternatives. They include lower cost, less difficulty from impingement and less difficulty with accelerated wear if the acetabular component is placed in a high degree of abduction. It does not have the brittleness of ceramic nor the metallosis that can accompany the metal on metal bearings. Polyethylene is familiar, without a learning curve. It is more adaptable, with extended lip liners, offset liners and constrained liners. For certain of the crosslinked polyethylenes wear is independent of head diameter. Thus, there appear to be several valuable advantages for considering highly crosslinked polyethylene as the preferred alternative bearing.
Occlusion and Stability of Two Different Femoral Canal Plugs in Cemented Hip Arthroplasty. A Prospective and Randomized Study, with a Two Year Follow-Up
Authors: Freund K.G. , Houshian S. , Riegels-Nielsen P.
Published: January 2018

The aim of this prospective and randomised study was to test the ability of two different femoral plugs to seal off the femoral canal to prevent cement leakage, displacement of the restrictor and early aseptic loosening. Seventy patients, 35 in each of two groups, were included. There were 31 men and 39 women. The average age was 70 years; the follow-up was two years. In group 1 (the Exeter plug) there were four cases with cement leakage and in group 2 there were three (the DePuy plug). There were four cases with failures in group 1, due to technical failure peroperatively, and none in group 2. Two cases with early mechanical loosening were found in group 1 and none in group 2. Both restrictors were found equivalent in their ability to occlude the femoral canal but peroperatively there seem to be technical difficulties with the Exeter restrictor.
The mechanical behaviour of a pre-formed hip spacer
Authors: Baleani M. , Traina F. , Toni A.
Published: January 2018

This study investigated the mechanical behaviour under dynamic load of a preformed hip spacer made of antibiotic impregnated bone cement (Spacer G 60, Tecres SpA, Sommacampagna VR, Italy) used in two-stage treatment of infected hip prostheses. In the experimental protocol the spacer was assumed as a temporary hip hemiarthroplasty so was liable to the same level of load stresses. Therefore, the cycling loading procedure was defined following the recommendation of the ISO 7206/4:1989 standard for determination of fatigue performance of hip stems. Three spacers were subjected to a 4 Hz cyclic load ranging between 300 and 2300 N until specimen failure or for 0.5 million cycles. This loading condition was chosen to simulate six months of patient use without any restriction in moving or loading the operated hip, which should represent the worst load history conditions for the device. One out of the three spacers completed the test. The remaining two spacers failed at 0.40 and 0.45 million cycles. These results demonstrated that the investigated spacer has finite fatigue strength when subjected to the described loading conditions but failure occurs only at the end of a very extreme loading history, hardly ever reproduced in standard clinical practice. Since decreasing the load level increases the fatigue life, the surgeons can safely implant the spacer if the patient is allowed partial weightbearing, as it is in standard clinical practice.
Long-term quality of life evaluation of patients with total hip arthroplasty
Authors: Knahr K. , Jagsch R. , Kryspin-Exner I.
Published: January 2018

The aim of the study was to evaluate the clinical and psychological situation of total hip arthroplasty (THA) patients before and one year and five years after surgery. Data of 101 patients were available for the one-year and of 69 patients for the five-year follow-up. Quality of Life (QoL) data were collected using the Nottingham Health Profile (NHP), functional capacity comprised patient's self-assessment (Functional Outcome Questionnaire Hannover, FFbH) and surgeon's assessment (Harris Hip Score, HHS).

While all dimensions of QoL and functional capacity except social isolation showed significant improvement at the one-year follow-up, only pain scores showed further improvement at the five-year evaluation. Implantation of THA is accompanied by significant increases in QoL and functional capacity. Stabilised scores were found at the five-year evaluation while significant increases could be observed after one year.
Pigmented villonodular synovitis associated with congenital dislocation of the hip
Authors: Atilla B. , Üzümcügil A. , Aydingöz Ü. , Gedikoglu G.
Published: January 2018

Hip involvement in pigmented villonodular synovitis (PVNS), itself a rare disease, is not uncommon. However, no association of PVNS with congenital dislocation of the hip has been reported in the literature. Here we describe the case of a middle-aged woman with such a condition.
Variations in the anterolateral approach to the hip
Authors: Fletcher M.D.A. , Spencer R.F.
Published: January 2018

A pictorial questionnaire distributed to 56 hip surgeons who use an anterolateral approach to the hip revealed that only 46% use an approach which conforms closely to the original eponymous description. This is important because problems associated with anterolateral approaches such as the bare trochanter, bursitis, gluteal detachment, persistent limp and superior gluteal nerve palsy may be associated with particular variants. We suggest a classification to append to eponymous descriptions which may assist in proper evaluation of these approaches in future, as well as being helpful to any surgeon required to carry out revisions on such cases.