bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Posterior Capsular Opacification Removal on Macular Optical Coherence Tomography
Authors: González-Ocampo-Dorta S. , García-Medina J.J. , Feliciano-Sánchez A. , Scalerandi G.
Published: January 2018

Purpose

To evaluate the influence of posterior capsular opacification (PCO) on macular optical coherence tomography (OCT) imaging quality and measurements of macular retinal thickness.

Methods

In this prospective interventional case series, 32 eyes of 23 patients with PCO were recruited. Best-corrected visual acuity (BCVA), a complete ophthalmologic assessment, and macular OCT scans (OCT Stratus 3000) before and after Nd:YAG capsulotomy were performed. Two parameters for image quality (signal strength (SS) and number of tomographic messages) and 10 macular retinal thickness measurements were compared. Spearman correlations between BCVA and SS and macular retinal thickness measurements before and after capsulotomy were also performed.

Results

PCO removal was associated with an increase of best-corrected visual acuity (p<0.0001). The mean SS (n=32) went from 3.34±2.31 to 6.38±1.93 (p<0.0001) after Nd:YAG capsulotomy. The SS improved in 26 of 32 eyes. No significant difference between mean preoperative and postoperative macular retinal thickness measurements was observed (p<0.05) in valuable scans. Before capsulotomy, a correlation existed between BCVA and SS. After capsulotomy this correlation was no longer found.

Conclusions

OCT image quality is influenced by PCO. Nd:YAG capsulotomy results in a measurable improvement in SS and improvement in the number of valuable examinations. Valuable OCT scans in patients with PCO seem to yield reliable measurements of macular retinal thickness even in the presence of severe PCO. The correlation between BCVA and SS before capsulotomy suggests that the SS could be considered an objective indicator of the degree of PCO.
Spontaneous Closure of a Macular Hole Caused by a Ruptured Retinal Arterial Macroaneurysm
Authors: Uemoto R. , Mizuki N.
Published: January 2018

Purpose

To report a spontaneous closure of a macular hole (MH) that was caused by a ruptured retinal arterial macroaneurysm (RAM).

Methods

Observational case report. Clinical examinations and optical coherence tomographic (OCT) evaluations of the retina of a 73-year-old woman who developed a MH secondary to a ruptured RAM.

Results

The first sign of a closure of the MH was the appearance of tissue bridging the MH in the OCT images. Later, OCT images showed a hyperreflective tissue, probably glial cells, that connected the bridging tissue to the RPE. Seven months after the first examination, the hyperreflective tissue was smaller and the shape of the foveal pit had recovered.

Conclusions

A spontaneous closure of a MH caused by a ruptured RAM can occur and surgical intervention was not necessary. The tissue bridging over the MH and the hyperreflective tissue connecting the bridging tissue to the RPE most likely were involved in the spontaneous MH closure.
Intravitreal Bevacizumab in the Management of Choroidal Neovascular Membrane Secondary to Choroidal Osteoma
Authors: Narayanan R. , Shah V.A.
Published: January 2018

Purpose

To describe a patient with choroidal neovascular membrane (CNVM) secondary to choroidal osteoma treated successfully with intravitreal bevacizumab.

Methods

Case report. A 25-year-old healthy woman presented with complaints of sudden painless decrease in vision in the left eye (OS) of 1 month duration. On examination, visual acuity was 20/20 in the right eye (OD) and counting fingers at 1.5 meters OS. Slit lamp examination was unremarkable. Fundus examination OD was normal; OS demonstrated a flat, opaque, yellowish parapapillary choroidal lesion with adjacent subfoveal grayish membrane associated with minimal subretinal fluid suggestive of a CNVM. B-scan ultrasonography revealed findings consistent with a choroidal osteoma. Fundus fluorescein angiography (FFA) of the left eye revealed a relatively well-defined area of hyperfluorescence that increased in size and intensity in the later phases suggestive of active subfoveal CNVM. Optical coherence tomography (OCT) confirmed the subfoveal CNVM with altered foveal contour and distortion of foveal architecture. A diagnosis of subfoveal CNVM associated with choroidal osteoma was made. The patient was treated with intravitreal bevacizumab 1.25 mg in 0.05 mL OS and repeated 6 weeks later.

Results

At the 4-month visit, vision OS improved to 20/125. The FFA and OCT revealed a resolved CNVM.

Conclusions

Intravitreal bevacizumab may be an effective alternative in the management of CNVM secondary to choroidal osteoma. Larger series of such cases need to be studied to further validate our findings.
External Lacrimal Punctum Grading: Reliability and Interobserver Variation
Authors: Kashkouli M.B. , Nilforushan N. , Nojomi M. , Rezaee R.
Published: January 2018

Purpose

To test the reliability and interobserver variation of external lacrimal punctum (ELP) grading.

Methods

In a population-based epidemiologic study, ELP was visually graded based on slit lamp examination (grade 0 to 5), as described previously Grades 0, 1, and 2 are for closed or stenotic ELP and grade 3 is for normal ELP (subjective grades). Grades 4 and 5 are for larger than normal (slit) ELP measured in millimeters by slit lamp beam (objective grades). Upper and lower ELP were graded by an oculoplastic surgeon and a senior ophthalmology resident. Both observers were masked to the reading of the other. Both observers were familiar to the grading system for past few years, although the oculoplastic surgeon had more experience in this regard. Patients with previous periocular surgery, medial lid mass obscuring the ELP, anatomically distorted punctum, and subjects with grade 4 and 5 ELP (objective grades) were excluded. The intraclass correlation coefficient test was used for the statistical analysis.

Results

There were 632 eyes from 174 (55.10%) male and 142 (44.90%) female subjects. Subjects' ages ranged from 7 to 87 years (mean ± SD = 54±17.56). The intraclass correlation coeficient test showed a positive and strong correlation between two observers for grading the upper (value=+0.87, 95% CI: 0.84 and 0.88, p=0.000) and lower (value=+0.91, 95% CI: 0.90 and 0.92, p=0.000) ELP. In general, the less experienced observer tended to overestimate both upper and lower ELP grading.

Conclusions

Reliability of the new ELP grading makes it a recommendable option for use in the clinic and comparing reports on ELP pathologies.
Primary Intraocular Lymphoma: Another Great Masquerader
Authors: Gallagher M.J. , Cervantes-Castañeda R.A. , Bhat P. , Yilmaz T. , Foster C.S.
Published: January 2018

Purpose

To describe diverse and atypical presentations of the most common masquerader in neo-plastic masquerade syndromes.

Methods

Retrospective interventional case series. The authors identified three patients who presented with atypical and diagnostically challenging masquerading manifestations. These patients were eventually found to have primary intraocular lymphoma (PIOL). Their case histories, presenting signs and symptoms, diagnostic tests, and treatments are described.

Results

Patient 1 masqueraded as viral retinitis and branch retinal vein occlusion but was resistant to 5 weeks of oral and intravenous acyclovir. Patient 2 presented with choroidal infiltrates and vision loss. This patient had had breast carcinoma for the last 25 years and secondary metastasis was suspected. Patient 3 had chronic uveo-retinitis and a chronic Propionibacterium acnes infection was suspected. All three patients were diagnosed with PIOL.

Conclusions

PIOL is an aggressive masquerader and not only presents clinical diagnostic difficulties but also requires expert tissue handling and analysis, so that early diagnosis can be made and therapy can be instituted.
Diffuse Retinal Pigment Epitheliopathy among the Inhabitants of Brahmaputra Valley of India
Authors: Bujarborua D. , Choudhury A.
Published: January 2018

Purpose

To analyze the patient demography and the various fluorescein angiography (FA) features of diffuse retinal pigment epitheliopathy (DRPE) cases among the inhabitants of the Brahmaputra Valley of India and to see if there is any ethnic variation in its clinical presentation and risk factors.

Methods

This is a retrospective study in a clinical practice setting with study population of Aryan and Mongoloid races. Data analysis of 30 cases (40 eyes) of DRPE of 262 consecutive cases of central serous chorioretinopathy (CSC) was done. The various features of these cases were compared and statistically evaluated with the findings of CSC cases with symptom duration of 6 months or more and cases with recurrent episodes.

Results

A total of 11.45% had DRPE that had average symptom duration of 3.50 years. Logistic regression showed high risk for DRPE if sensory retinal detachment (SRD) persists for more than 18 months. Systemic hypertension was another significant risk factor, whereas multiple RPE leaks appeared to be weakly significant. DRPE was predominant in eyes of patients having first acute episode of CSC in later age and fairly large retinal pigment epithelial detachments (PEDs) contributed to its development. Role of exogenous corticosteroid, retinotoxic drugs, and tobacco consumption could not be assessed properly due to inadequate sample size.

Conclusions

The main factor for the development of DRPE is the persistence of SRD for more than 1.50 years. Fairly large leaking PED and onset of primary CSC in later age appear to contribute towards its development. Except for these, no major variation from Western studies was observed.
Vigabatrin-Induced Visual Dysfunction in Chinese Patients with Refractory Epilepsy
Authors: Hui A.C.F. , Liu D.T.L. , Wong K.K. , Man B.L. , Leung T. , Lam P.T.H. , Lam D.S.C.
Published: January 2018

Purpose

Bilateral visual field constriction has been reported following the use of the antiepileptic drug (AED) vigabatrin. The incidence of retinal toxicity is variable and there are limited data in Asian populations. The authors report the results of ophthalmologic examination in Chinese patients taking this drug.

Methods

The authors identified two groups of patients with refractory epilepsy: one group on vigabatrin and another cohort of patients taking other AEDs. The authors recorded the medical history and performed visual acuity testing, intraocular pressure measurement, slit lamp biomicroscopy, and conventional automated perimetry with Humphrey Visual Field Analyzer II in all patients.

Results

Eighteen patients - 8 men and 10 women - with a mean age of 23.8 years who were taking vigabatrin were reviewed. Length of treatment with this drug ranged from 13 months to 5 years and the mean daily dosage was 1581 mg. None of the patients in either group had a history of coexisting optic nerve diseases or other neurotoxic drug use. Twenty of 36 (55.6%) eyes of the vigabatrin users showed significant bilateral visual field defects with 80% showing a concentric pattern, compared with none in the control group.

Conclusions

The authors confirmed a high prevalence of visual field constriction associated with vigabatrin in Chinese patients. The use of alternative novel techniques such as measurement of the retinal nerve fibre layer thickness and perimetry may detect early retinal damage and result in even higher incidences. Visual field monitoring is recommended in patients who continue to take this drug.
A New Visual Field Test in Empty Sella Syndrome: Rarebit Perimetry
Authors: Yavas G.F. , Küsbeci T. , Eser O. , Ermis S.S. , Coşar M. , Öztürk F.
Published: January 2018

Purpose

Several visual field defects can be seen in empty sella syndrome (ESS). In this study, the authors aimed to evaluate the visual field defects in patients with ESS by rarebit perimetry and to compare the results with Humphrey perimetry.

Methods

Left eyes of 13 patients with ESS and left eyes of 15 age-matched normal subjects were included in the study. Visual field testing was performed by Humphrey Visual Field Analyzer II (Fast-pack 30–2 strategy) and rarebit perimetry (regular test). Statistical analysis was performed by independent-samples t-test, Mann-Whitney U test, receiver operating characteristic (ROC) curves, and Pearson correlation test.

Results

Humphrey perimetry mean deviation was −3.67 dB in control group and −6.06 dB in patients with ESS (p=0.12). Mean hit rate calculated by rarebit test was 91.8% in control group and 75.9% in cases with ESS (p=0.005). Area under ROC curve was 0.756 for Humphrey visual field test and 0.827 for rarebit hit rate (p=0.59). There was a significant correlation between rarebit hit rate and Humphrey visual field test mean deviation (r=0.755, p±0.001).

Conclusions

Rarebit perimetry correlates significantly with Humphrey perimeter in detecting visual field defects related with ESS and has a higher sensitivity and specificity.
Bilateral Macular Detachment Caused by Bilateral Optic Nerve Malformation in a Papillorenal Syndrome Due to a New Pax2 Mutation
Authors: Samimi S. , Antignac C. , Combe C. , Lacombe D. , Renaud Rougier M.-B. , Korobelnik J.-F.
Published: January 2018

Purpose

Papillorenal syndrome is an autosomal dominant entity due to PAX2 gene mutation, involving optic nerve and renal malformations.

Methods

The authors report a 19-year-old man with bilateral macular detachment associated with optic nerve pit in one eye and morning glory syndrome in the other eye. The patient underwent three-port pars plana vitrectomy, endolaser photocoagulation, and C3F8 gas tamponade in his best eye. A medical history of vesicoureteric reflux and kidney hypoplasia led to genetic analysis.

Results

Molecular genetic PAX2 analysis revealed a novel nondescribed mutation in exon 3. One year postoperatively, ophthalmologic outcomes were satisfactory with complete flattening of the retina and improvement of the best-corrected visual acuity to 11/10.

Conclusions

PAX2 is involved in the optic vesicles, genital tracts, kidney, and central nervous system embryogenic development. The association of optic nerve and renal malformations should lead to the suspicion of papillorenal syndrome with PAX2 mutation.
Long-Term Progression at Individual Mean Intraocular Pressure Levels in Primary Open-Angle and Exfoliative Glaucoma
Authors: Stewart W.C. , Kolker A.E. , Sharpe E.D. , Day D.G. , Konstas A.G.P. , Holló G. , Astakhov Y.S. , Teus M.A. , Stewart J.A.
Published: January 2018

Purpose

To describe progression and non-progression rates at individual mean intraocular pressure (IOP) levels for patients with primary open-angle and exfoliative glaucoma.

Methods

A meta-analysis of five previously published retrospective studies describing progression and non-progression rates at individual intraocular pressure levels over 5 or more years of follow-up. All patients had primary open-angle (four studies) or exfoliative glaucoma (one study).

Results

This meta-analysis included 822 patients of whom 655 (80%) had primary open-angle glaucoma and 167 (20%) had exfoliative glaucoma. In total, 220 patients progressed (27%), while 602 (73%) remained stable over 5 years. The mean IOP was 20.0 for progressed and 17.1 mmHg for stable patients (p=0.0004). The peak IOP was 29.1 for progressed and 23.6 mmHg for stable patients (p=0.0014). At an IOP level >18 mmHg, 49% of patients remained stable; at 18 mmHg, 78%; between 13 and 17 mmHg, 82%; and <13 mmHg, 96%. Additional factors associated with progression were older age (p=0.0004) and exfoliative glaucoma (p=0.0001). However, multivariant regression analysis identified only mean IOP as a risk factor for progression (p=0.039).

Conclusions

This study suggests that maintaining an IOP well within the normal range over 5 years in patients with primary open-angle or exfoliative glaucoma helps to prevent glaucomatous progression.
Effective Treatment with Topical Cyclosporine of a Child with Steroid-Dependent Interstitial Keratitis
Authors: Miserocchi E. , Modorati G. , Rama P.
Published: January 2018

Purpose

To report a case of steroid-dependent idiopathic interstitial keratitis in a child successfully treated with topical cyclosporine 2% drops.

Methods

Case report.

Results

The authors describe a case of a 6-year-old boy with a history of recurrent idiopathic bilateral interstitial keratitis. The patient had recurrent episodes of corneal inflammation that became more frequent and severe during the follow-up, and caused severe corneal opacities and visual loss. Long-term treatment with topical corticosteroid was required to avoid corneal scarring that eventually caused secondary elevation of intraocular pressure. Topical cyclosporine 2% was therefore introduced as a steroid sparing agent to treat the keratitis. The treatment was continued for 1 year and the patient achieved a complete remission of corneal inflammation with resolution of corneal scarring and normalization of intraocular pressure.

Conclusions

In this child with recurrent episodes of interstitial keratitis, topical cyclosporine 2% has been shown to be a safe and effective alternative for treating corneal inflammation.
Artificial Neural Network-Based Glaucoma Diagnosis Using Retinal Nerve Fiber Layer Analysis
Authors: Grewal D.S. , Jain R. , Grewal S.P.S. , Rihani V.
Published: January 2018

Purpose

To develop, train, and test an artificial neural network (ANN) for differentiating among normal subjects, primary open angle glaucoma (POAG) suspects, and persons with POAG in Asian-Indian eyes using inputs from clinical parameters, optical coherence tomography (OCT), visual fields, and GDx nerve fiber analyzer.

Methods

One hundred eyes were classified using optic disc examination and perimetry into normal (n=35), POAG suspects (n=30), and POAG (n=35). EasyNN-plus simulator was used to develop an ANN model with inputs including age, sex, myopia, intraocular pressure (IOP), optic nerve head, and retinal nerve fiber layer (RNFL) parameters on OCT, Octopus 30-2 full threshold visual field, and GDx parameters.

Results

With two outputs (POAG or normal), specificity was 80% and sensitivity was 93.3%. Ninety percent of POAG suspects were labeled as abnormal in this analysis. ANN assigned the highest importance to Smax/Imax RNFL on OCT followed by cup-area (OCT) and other RNFL parameters (OCT) for two outputs. With three outputs (normal, POAG, and POAG suspect), ANN gave an overall classification rate of 65%, specificity of 60%, and sensitivity of 71.4% with a target error rate of the training set at 1%. The parameters for three outputs, in decreasing order of relative importance, were Savg, vertical cup-disc ratio, cup-volume, and cup-area on OCT.

Conclusions

An ANN taking varied diagnostic imaging inputs was able to separate POAG eyes from normal subjects and POAG suspects. The network had reasonable sensitivity with three outputs; however, it had a tendency to mislabel POAG suspects as POAG.
Orbital Metastasis Associated with Primary Breast Carcinoma in a Man Detected during Peribulbar Anesthesia for Cataract Surgery
Authors: Polito E. , Pichierri P. , Occhini R. , Loffredo A. , Moramarco A. , Balestrazzi A.
Published: January 2018

Purpose

A case of orbital infiltration by breast carcinoma in a male patient causing mild enophthalmos and subcutaneous mass detected accidentally during peribulbar anesthesia for cataract surgery is discussed.

Methods

The authors report a case of a 65-year-old man who came to the Ophthalmology Department for cataract surgery. During the presurgery peribulbar injection, a hard palpable mass located under the inferior left eyelid was noted, together with mild enophthalmos. A historical clinical screening revealed that 5 years previously the patient had undergone a right radical mastectomy to treat a ductal carcinoma of the breast.

Results

The patient underwent an incisional biopsy of the orbital mass that confirmed the clinical hypothesis of a metastasis.

Discussion

This case highlights the importance of the collection and screening of detailed clinical information on the patient before every ophthalmic operation including cataract surgery. The occurrence of progressive enophthalmos can represent an unusual symptom of orbital metastasis, commonly presenting with proptosis and diplopia.
Mild Topographic Abnormalities that Become More Suspicious on Scheimpflug Imaging
Authors: Wolf A. , Abdallat W. , Kollias A. , Fröhlich S.J. , Grueterich M. , Lackerbauer CA.
Published: January 2018

Purpose

Although several screening methods exist, postoperative corneal ectasia after refractive surgery is a severe complication. One possibility for this might be the fact that screening methods may fail in detection of preoperative risk factors such as forme fruste keratoconus (FFKC).

Methods

Retrospective evaluation of four cases that showed only mild changes of FFKC on placido-based topography but revealed indicative findings on Scheimpflug imaging (Pentacam®).

Results

While in placido-based topography evaluation of corneal topography did not show a clear FFKC, the evaluation of corneal topography on Scheimpflug imaging together with the data of spatial corneal thickness revealed distinctive FFKC in all cases presented.

Conclusions

Although both methods bear the risk of not detecting pre-existing FFKC, Scheimpflug imaging seems superior to placido-based corneal topography alone.
Two-site Phacotrabeculectomy versus Bimanual Microincision Cataract Surgery Combined with Trabeculectomy
Authors: Bayer A. , Erdem Ü. , Mumcuoglu T. , Akyol M.
Published: January 2018

Purpose

To compare the results of two-site phacotrabeculectomy with microincision cataract surgery (MICS) and trabeculectomy.

Methods

Fifty-eight eyes with coexisting cataract and glaucoma were randomly assigned to have a trabeculectomy in a superior quadrant combined with phacoemulsification and intraocular lens (IOL) implantation through temporal clear corneal incision (two-site phacotrabeculectomy group), or a trabeculectomy in a superior quadrant combined with MICS followed by IOL implantation from the trabeculectomy incision (MICS + trabeculectomy group). The main outcome measures were preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity (BCVA), and complications. Follow-up was period was 12 months.

Results

Twenty-eight two-site phacotrabeculectomies and 30 MICS + trabeculectomies were performed. Mean age of the subjects was 67.4 years. Mean preoperative IOP was 24.6±5.7 mmHg in the two-site phacotrabeculectomy group and 23.7±5.5 mmHg in the MICS + trabeculectomy group (p=0.52). At 12 months postoperatively mean IOP was 14.5±3.0 and 14.3±3.4 mmHg in two-site phacotrabeculectomy and MICS + trabeculectomy groups, respectively (p=0.8). Preoperative and postoperative glaucoma medication numbers were similar and mean number of glaucoma medications decreased in both groups after the surgery (p<0.05). BCVA improved in both groups. Twenty-six of 28 eyes (92%) in the two-site + trabeculectomy group and 27 of 30 (90%) in the MICS + trabeculectomy group had clinically apparent filtering blebs at 12 months (p=0.71). Postoperative complications were comparable.

Conclusions

MICS + trabeculectomy provided 1 year IOP control comparable to that with two-site phacotrabeculectomy with similar amount of complications and similar final BCVA.
Assessment of Cup-To-Disc Ratio with Slit-Lamp Funduscopy, Heidelberg Retina Tomography II, and Stereoscopic Photos
Authors: Durmus M. , Karadag R. , Erdurmus M. , Totan Y. , Feyzi Hepsen I.
Published: January 2018

Purpose

To compare optic disc measurements achieved by slit-lamp funduscopy, Heidelberg Retina Tomography II (HRT II), and stereoscopic optic nerve photos (SONP) in glaucomatous, ocular hypertensive, and normal eyes.

Methods

A total of 176 eyes (glaucomatous [n=87], ocular hypertensive [n=40], and normal eyes [n=49]) of 90 participants were studied. Each participant underwent a full ophthalmic examination, including automated perimetry, slit-lamp funduscopy, HRT II, and SONP. To compare the three different methods being investigated, the following measurements were used: vertical cup to disc ratio (VCDR), horizontal cup to disc ratio (HCDR), and cup to disc area ratio (CDR). Slit-lamp funduscopy was evaluated only with respect to VCDR. HRT II and SONP were evaluated with all three measurements (VCDR, HCDR, and CDR).

Results

CDR measurements in ocular hypertensive eyes did not differ significantly according to the measurement methods used (p=0.4). CDR in the other groups of participants, as well as VCDR and HCDR, all differed significantly within each group according to the method used (p<0.05 for all). Mean VCDR measured with funduscopy was smaller than mean VCDR measured with either HRT II or SONP in the glaucoma and ocular hypertension groups (p=0.0001). However, overall, the three methods showed a strong correlation in terms of VCDR, HCDR, and CDR measurements.

Conclusions

Despite the correlation among the three methods, the significant differences between their measurements of optic disc parameters may be too large for these methods to be used interchangeably in clinical situations.
Orthokeratology Associated Microbial Keratitis
Authors: Shehadeh-Masha'Our R. , Segev F. , Barequet I.S. , Ton Y. , Garzozi H.J.
Published: January 2018

Purpose

To report the clinical course, microbiologic findings, treatment, and outcomes of overnight orthokeratology associated microbial keratitis.

Methods

Four cases of overnight orthokeratology associated microbial keratitis are reported.

Results

Four patients aged 14–23 years (mean 18 years) who had central or paracentral corneal ulcers were included. Visual acuity at presentation ranged from 20/30 to hand motion. In all cases Pseudomonas aeruginosa was cultured from corneal scrapings or storage solution. In all patients the infection resolved with intensive topical antimicrobial treatment. Final best-corrected visual acuity ranged from 20/25 to 20/200 according to the location, size, and density of the corneal scar, which complicated all cases.

Conclusions

Infectious keratitis is a significant, visual threatening complication of overnight orthokeratology. Eye care practitioners should be aware of this complication and educate their patients of the importance of lens hygiene and prompt medical care when symptoms or signs of keratitis appear.
Capsule Fixation Device for Cataract Surgery
Authors: Sergienko N.M. , Kondratenko Y.N. , Yakimov A.K.
Published: January 2018

Purpose

The authors present a patient with Marfan syndrome who underwent cataract surgery using a novel device for fixation of capsular bag.

Methods

The capsule fixation device (CFD) is poly(methyl methacrylate) arch with double-armed bent hook that can be introduced into the anterior chamber through the clear corneal incision, placed with a rest on the capsule equator, and sutured to the sclera without injury of the capsular bag. A 16-year-old patient with Marfan syndrome underwent consecutive phacoemulsification with in-the-bag intraocular lens and CFD implantation on both eyes.

Results

During the surgery handling the CFD was technically simple with good visualization. The preoperative best-corrected visual acuity was 0.3 and 0.1 and postoperatively 0.6 and 0.8 in the right and left eyes, respectively. The postoperative follow-up was over 9 months.

Conclusions

Use of the CFD was successful in a case of lens subluxation with no complications observed during the period of follow-up.
Epidemiologic Aspects and Clinical Outcome of Fungal Keratitis in Southeastern Brazil
Authors: Ibrahim Marlon Moraes , Vanini Rafael , Ibrahim Fuad Moraes , Fioriti Livia S. , Furlan Eloisa M.R. , Provinzano Luciana M.A. , De Castro Rosane S. , De Faria Esousa Sidney Julio , Rocha Eduardo Melani
Published: January 2018

Purpose

Fungal keratitis (FK) is a sight-threatening disease, more prevalent in developing regions. The present retrospective study was conducted in order to evaluate the epidemiologic and clinical aspects and the progression of FK in patients treated at two ophthalmologic reference centers in Southeast Brazil.

Methods

The charts of patients with infectious keratitis treated between 2000 and 2004 were reviewed. For the 66 cases of FK confirmed by microbiological analysis, data related to patient, disease, and therapeutic approaches were obtained.

Results

Mean patient age was 40.7±16 years. Fifty-three were men and 13 were women. Ocular trauma occurred in 40% of cases (27). Previous medications taken by the patients were quinolone in 72.5% and antimycotics in 30%. Visual acuity (VA) at presentation was >0.3 in 16% and <0.1 in 74.5%. Penetrant keratoplasty was performed in 38% and evisceration in 15%. The causing agents were Fusarium sp in 67%, Aspergillus sp in 10.5%, and Candida sp in 10%. Medication alone resolved 39% of cases within a mean period of 24.5±12 days. Final VA was >0.3 in 28%, and <0.1 in 63%.

Conclusions

Fungal keratitis presented as a disease with severe complications, predominantly among young males, and was mostly caused by filamentous fungi. The present information permits the establishment of preventive strategies. Reducing the time between onset and treatment and using more accessible specific medication would reverse the negative prognosis.
The Effect of Different Doses of Intracameral Bevacizumab on Surgical Outcomes of Trabeculectomy for Neovascular Glaucoma
Authors: Gupta Viney , Jha Randhir , Rao Aparna , Kong George , Sihota Ramanjit
Published: January 2018

Purpose

To prospectively evaluate the effect of 1.25 mg and 2.5 mg intracameral bevacizumab on surgical outcomes of trabeculectomy for neovascular glaucoma (NVG), with primary outcome measures being the regression of neovascularization of iris (NVI) and reduction of intraocular pressure (IOP).

Methods

Consecutive patients with neovascular glaucoma from December 2006 to March 2007 were randomized into two cohorts assigned to receive 1.25 mg (Group 1) or 2.5 mg (Group 2) intracameral bevacizumab prior to undergoing mitomycin C (MMC) trabeculectomy. Surgical outcome measures were evaluated following initial injection and during follow-up post-surgery.

Results

The most common causes for iris neovascularization were central retinal vein occlusion (47.3%) and proliferative diabetic retinopathy (36.8%). Following intracameral bevacizumab, there was a reduction in IOP compared to baseline in both treatment groups (Group 1, n=9: −10.4±4.5 mmHg, p=0.57; Group 2, n=10: −12.1±5.5 mmHg, p=0.1). The reduction in IOP was not statistically significant between the two groups (p=0.55). None of the eyes underwent further retinal ablation post trabeculectomy. Reappearance of NVI was seen in three eyes (Group 1, n=2; Group 2, n=1) after 3 months. There was no statistically significant difference in regression of NVI grade between the treatment groups (p=0.1).

Conclusions

The efficacy of an intracameral dose of 2.5 mg of bevacizumab prior to trabeculectomy for eyes with NVG is not significantly different from a 1.25 mg dose. Intracameral bevacizumab followed by trabeculectomy results in good surgical outcomes. Longer follow-up would be needed to evaluate differences in recurrence rates of iris neovascularization using different dosages.
Reactive Keratoma of the Central Corneal Epithelium
Authors: Finger Paul T. , Chin Kimberly J. , Wong Jeffrey J. , Iacob Codrin E.
Published: January 2018

Purpose

The authors present a unique corneal tumor.

Methods

A 75-year-old gardener presented with a 1-year history of a slowly growing central corneal lesion with progressive visual loss. We performed an ophthalmic examination, slit lamp photography, high-frequency ultrasonography, and culture with sensitivity (followed by therapeutic scrape biopsy).

Results

Clinical examination revealed a gray-white central corneal tumor without extension to the limbus. No significant tumor neovascularization or intraocular inflammation was noted. High frequency ultrasound revealed no penetration of the corneal stroma. The tumor was removed with a platinum spatula. Histopathology revealed simple hyperkeratosis characterized by stratified hyperkeratotic corneal epithelium with metaplastic granular layer characteristic of epidermis. Few and focal clusters of passenger bacteria were found (as seen in cutaneous leukoplakia). Cultures revealed a few Gram-positive cocci and no fungus. A human papilloma virus wide-screen spectrum assay (in situ hybridization) was negative.

Conclusions

The authors present a benign keratoma of the central corneal epithelium. High frequency ultrasound and scrape biopsy histopathologic techniques were used to diagnose and treat this keratoleukoma caused by a reactive keratoma as well as improve his vision.
Sjögren's Syndrome: Pathogenesis
Authors: Tabbara K. , Sharara N.
Published: January 2018

Sjögren's syndrome is a chronic inflammatory disease of the lacrimal and salivary gland with subsequent keratoconjunctivitis sicca and xerostomia. Histopathologic findings include damaged acini of the lacrimal and salivary glands with mononuclear cell infiltrates of lymphocytic and plasma cell type. The cause of the damage is cell-mediated cytotoxicity. The pathogenesis of Sjögren's syndrome is still unknown. The role of viral infections failed to show a causative effect. On the other hand, tissue destruction was shown to be mediated by activated T cells of CD4+ type that home into the lacrimal gland. This process is signal-mediated through the T-cell receptor that interacts with class II antigen on the epithelial cells of exocrine glands. This, in turn, induces the expression of Fas/APO-1 and Fas-mediated apoptosis of acinar cells. Granzyme A and perforin are cytolytic enzymes secreted by activated T lymphocytes that seem to participate in acinar cell destruction.
Origin and Types of Emotional Tearing
Authors: Murube J. , Murube L. , Murube A.
Published: January 2018

Objective

To understand why a wide range of states of mind are expressed by spilling tears.

Methods

465 different episodes of crying with tears were analyzed and their motivation interpreted in the search for a common factor.

Results

The only common factor in all tear-spilling episodes was a relationship with help: either requesting help or offering help. This leads us to speculate on the biological origins of emotional tearing.

Conclusions

1) The classical division of emotional tearing as either negative or positive is based on accidental characteristics and does not answer most of the questions. All kinds of emotional tearing are related to help, and can be classified as requring-help and offering-help. 2) Why do we spill tears when we are asking for help? When children need help because of hunger, fear or pain, they add tearing to sound and body language to symbolise their suffering. Accordingly, tearing was chosen as a symbol of suffering because the reaction was already present as a reflex response to physical pain when ocular trauma and inflammation occurred, as they did very frequently in mankind's past. Moreover, this sign is seen on the face, the most conspicuous part of the body. 3) Why do we spill tears when we are offering help? As humanity evolved and needed to express empathy and sympathy, i.e. an emotion diametrically opposed to requesting help, the same core symbol was used, though the facial and body language are different.
Central Serous Retinopathy Associated with Weber-Christian Disease
Authors: Dinakaran S. , Desai S.P.
Published: January 2018

Purpose

To report an association between central serous retinopathy and Weber-Christian disease.

Methods

A case report.

Results

Central serous retinopathy was noticed in a patient with Weber-Christian disease possibly secondary to vasculitis involving the choriocapillaris.

Conclusions

Central serous retinopathy may be associated with an uncommon systemic condition like Weber-Christian disease.
Central Retinal Vein Occlusion: Report of Two Familial Cases
Authors: Bhagat N. , Goldberg M.F. , Gascon P. , Bell W. , Haberman J. , Zarbin M.A.
Published: January 2018

The authors report a 46-year-old father and 17-year-old son who each presented with unilateral central retinal vein occlusion (CRVO) and bilateral abnormalities of retinal vascular perfusion. The son presented with a nonperfused CRVO in the left eye, developed traction-rhegmatogenous retinal detachment treated with vitreous surgery, and developed prolonged arteriovenous filling in the retina of the fellow eye. The father presented with progressive CRVO in the right eye, developed choroido-vitreal neovascularization following laser treatment to create a chorioretinal anastomosis, underwent vitrectomy for retinal detachment and vitreous hemorrhage in that eye, and developed prolonged arm-eye and retinal arteriovenous circulation times in the fellow eye. An extensive evaluation (including hematological studies and imaging of the major vessels of the neck) failed to reveal a predisposing cause in either patient although echocardiography disclosed a mitral valve thrombus in the father. After institution of coumadin therapy, the circulatory parameters in the fellow eye of each patient improved.
Dacryoliths in Chronic Dacryocystitis and Their Composition (Spectrophotometric Analysis)
Authors: Iliadelis E. , Karabatakis V. , Sofoniou M.
Published: January 2018

Purpose

To present the findings from histological and chemical analysis of large dacryoliths and correlate them with previous reports.

Materials and Methods

Dacryoliths were found in 8% of 216 dacryocystorhinostomy operations. In two cases with mild chronic dacryocystitis, large dacryoliths were extracted. The first case was a 42-year-old male with three dacryoliths in a lacrimal sac, presenting diverticulum-like formations, the second was a 22-year-old woman with one dacryolith at the entrance of the nasolacrimal duct. Chemical analysis was based on atomic absorption spectrophotometry (F.AAS) and on atomic emission spectrometry (AES). Light histological examination was also done.

Results/Conclusions

The findings were the same in both cases. Histological examination revealed amorphous organic material, and limited areas with the characteristics of calcium salt depositions. Chemical analysis showed mainly organic material with only minimal inorganic material. Explanations are offered about the formation of these dacryoliths.
Posterior Chamber Silicone Intraocular Lens for the Correction of Myopia: An Experimental Study in Rabbits
Authors: Menezo J.L. , Salinas E. , Aviño J.A. , Navea A. , Cisneros A.
Published: January 2018

Purpose

To establish whether ocular lesions arise after implantation of posterior chamber silicone intraocular lenses (IOL) for the correction of high myopia.

Methods

Twenty-three posterior chamber silicone IOL were implanted in 23 eyes of the same number of pigmented rabbits. After different follow-up time (from one week to one year) the eyes were enucleated and processed for histopathological study after determining the protein concentration in the acqueous humor. The IOL were removed for staining and examination, and adhered cells were counted. Ten eyes analogous to those operated upon were used as controls.

Results

Intense inflammation was observed in the early postoperative period in all cases. Protein concentration in the acqueous humor was initially high and decreased over time, though without reaching normal values at one year. Mono- and multinucleated cells were seen adhering to the IOL, though they decreased in number over time and were practically absent after one year. Friction between the posterior surface of the iris and the IOL had no clinical repercussions. The only pigment accumulations were in the iris and in the peritrabecular zone. There were no siginificant differences in the accumulation of granules in relation to IOL diameter or power. Excluding three cataracts morphologically similar to traumatic cataracts, five lens opacifications were observed: two were anterior subcapsular cataracts, and the other three were only precapsular deposits. The IOL had no synechiae to the ocular tissues.

Conclusions

Opacification of the lens is the main concern with implantated posterior chamber silicone IOL. Larger series of eyes must be analysed to establish the true incidence and reversibility of these opacities.
Orbital Emphysema and Diplopia following Thoracotomy
Authors: Fox R.J. , Teener J.W. , Liu G.T.
Published: January 2018

Purpose

To describe the clinical and radiological findings in a patient with diplopia and orbital emphysema following thoracotomy.

Methods

Reported is a 71-year-old woman who presented with diplopia several days following thoracotomy.

Results

Physical examination revealed diffuse subcutaneous emphysema and a right hypertropia. Head computed tomography revealed facial and palpebral subcutaneous emphysema extending into the infratemporal fossa and orbits bilaterally. A chest tube was replaced and her diplopia resolved.

Conclusions

Subcutaneous emphysema can lead to diplopia and orbital emphysema in the absence of orbital trauma. Contrary to previously suggested mechanisms of orbital emphysema associated with subcutaneous emphysema, computed tomography imaging suggested that air entry into the orbit in this case was through the inferior orbital fissure.
Experimental study of friction coefficient of rocks in high pressure and tight gas reservoirs in Sichuan
Authors: Chen Yong , Yu Hao , Shu Qiugui , Fang Fang
Published: January 2018

The calculation of torque and drag in horizontal wells and extended reach wells is an important element in drilling operations, but determining the value of the friction factor is difficult in the calculation of friction. Sichuan Basin constitutes a special gas reservoir system with high pressure and tight formations. They are favorable for gas production which can be accomplished economically only with horizontal drilling and hydraulic fracturing, and Xujiahe Formation is the focus of the exploration and development. In order to determine the reasonable friction factor for directional well and horizontal well in Xujiahe Formation and complete comprehensive evaluation method, both theoretical study on friction mechanism and experimental investigation on friction factor need to be carried out. A series of experiments are conducted for different lithology (sandstone, sand-mudstone, and mudstone), steel, and lubricants (mud systems). The test results are as follows: lubricants have the most obvious influence on the friction coefficient; the friction-reducing effect of the same lubricant on different friction pairs varies; and lubricants have very different effects on the same friction pair. Under the condition of lubrication with clear water, the friction coefficient of rock increases slightly as the normal load rises. Under lubrication with mud, the change range of the friction coefficient of rock with the increase of normal load is low. Rotation speed has limited impact on the friction coefficient. Under the same test condition, the friction coefficient of sandstone is a little higher in the three kinds of rocks. Through a large number of experimental studies, the value range of the friction coefficient of different kinds of rock in the fifth member in Xujiahe Formation is obtained, providing a scientific basis for the drilling design and the calculation of torque and drag in high pressure and tight formations in Sichuan.
Andro-privilege, raunch culture, and stripping
Authors: Barton Bernadette , Mabry Hannah
Published: January 2018

This study notes a rising number of female customers at heterosexual strip bars and explores the reasons for this change. Drawing methodologically on audio-taped interviews with strip club employees and 150 hours of observation in strip bars, we explore the dynamics of raunch culture—a hypersexualized climate—and andro-privilege, a new concept in feminist theory that we originate here. Patriarchal cultures condition members to preference practices associated with hegemonic masculinity, and uphold masculinism, the ideology that justifies male domination. Andro-privilege is a new Western cultural practice that cloaks masculinism in a discursive mantle of gender progress. That andro-privilege exists at all is a sign of growth. It demonstrates that progressive ideas about gender equality have affected people, and created, at least among some, a misalignment with unfairness. Andro-privilege resolves this discomfort by temporarily allowing some girls and women to be “one of the guys” while allowing no parallel for boys and men to benefit from being “one of the girls.” We argue that andro-privilege thrives in raunch culture because it permits a woman or girl to resist objectification and position herself as a subject—a lad or bro—rather than a sex doll.
Diagnosing sex: Intersex surgery and ‘sex change’ in Britain 1930–1955
Authors: Griffiths David Andrew
Published: January 2018

The medical ‘management’ of individuals with atypical sex characteristics, or intersex variations, has been under scrutiny since the beginnings of intersex activism in the 1990s. This article explores a history of intersex surgeries in Britain and the interaction with medical and popular discourses around ‘sex-change’ between 1930 and 1955. A focus on this period in Britain helps to critically elaborate on debates in intersex scholarship; provides historical context for the introduction of approaches and protocols based on John Money and colleagues’ work in the USA in the mid-century; and analyses a long history of tension and intersection between trans and intersex experiences, treatments, politics and popular representations that continue into the present.
Intimate attunements: Everyday affect in Sydney’s drag king scene
Authors: Drysdale Kerryn
Published: January 2018

For over a decade, attending events featuring drag king performances—a subcultural phenomenon where women consciously perform masculinity—proved a popular pastime in Sydney, Australia. Established within a broader tradition of live performance culture but also part of a wider urban night-time economy catering to lesbian patrons, Sydney’s drag king scene sustained a range of activities and interactions that took place in the vicinity of the performances on stage. In this article, I draw on data collated from a series of group discussions with scene participants, alongside my own immersive form of participation over a sustained five-year period, to review the role of affect within the drag king scene. Combining Lauren Berlant’s account of queer intimacies with Kathleen Stewart’s rendering of atmospheric attunement, I consider how the act of being together engenders an intimate attunement of the everyday potentialities of the scene.
Global south approaches to bilingual and early childhood teacher education: Disrupting global north neoliberalism
Authors: Saavedra Cinthya M , Pérez Michelle Salazar
Published: January 2018

Global south onto-epistemologies are rarely part of bilingual and early childhood teacher education programs. Most university courses, even those that are critically oriented, remain embedded in global north conceptualizations of theory and practice. In this paper, we offer critical examinations of how global north colonialism and its latest reiteration, neoliberalism, have produced hegemonic discourses which have shaped the education of teachers in the fields of bilingual and early childhood education. We then share our pláticas about our global south approaches to teacher education. In doing so, we offer ways in which to make sense of our role as teacher educators in challenging and navigating dynamic, and often all-encompassing neoliberal systems of oppression within bilingual and early childhood teacher/education.