bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effect of Propofol and Alfentanil on the Increase in Intraocular Pressure Due to Succinylcholine and Intubation
Authors: Eti Z. , Yayci A. , Umuroǧlu T. , Göǧüş F.Y. , Bozkurt N.
Published: January 2018

Purpose

The aim of this study was to evaluate the effects of propofol and alfentanil on the increase in intraocular pressure (IOP) due to succinylcholine and intubation, in comparison with thiopental sodium and vecuronium bromide.

Methods

Forty patients aged 20–50 years, scheduled for elective surgery requiring endotracheal intubation, were assigned to four groups of ten. General anesthesia was induced with 2.5 mg/kg propofol in Group I, 2.5 mg/kg propofol and 10 μg/kg alfentanil in Group II and 5 mg/kg thiopental in Groups III and IV; muscle relaxation was obtained with either 1.5 mg/kg succinylcholine (Group I, II and III) or 0.1 mg/kg vecuronium bromide (Group IV). In all patients mean arterial pressure, heart rate, oxygen saturation and IOP were recorded before (baseline) and after induction, after the muscle relaxant and after endotracheal intubation.

Results

Compared with their baseline values in Group I IOP decreased significantly after propofol (p<0.01) and increased significantly after intubation (p<0.01). In Group II IOP decreased significantly after propofol and alfentanyl (p<0.001), remained low after succinylcholine (p<0.01) and did not change after intubation. In Group III IOP decreased significantly after thiopental (p<0.001) and increased significantly after intubation (p<0.001). In Group IV it decreased significantly after thiopental (p<0.001), remained low after vecuronium (p<0.001) and increased significantly after intubation (p<0.05).

Conclusions

In all Groups, IOP did not increase significantly after succinylcholine, but only anesthesia induced with propofol and alfentanil prevented the increase in IOP due to intubation.
Short-Wavelength Automated Perimetry and Neuroretinal Rim Area
Authors: Larrosa J.M. , Polo V. , Pablo L. , Pinilla I. , Fernandez F.J. , Honrubia F.M.
Published: January 2018

Purpose

To determine the correlation between neuroretinal rim area and functional losses detected by short-wavelength automated perimetry (SWAP) in a population of patients with suspected glaucoma.

Methods

Forty-two eyes of 42 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm of Hg and normal conventional visual fields) were studied. A planimetric optic nerve head study was performed, determining the total and sectorized neuroretinal rim areas. SWAP was also done, with a modified Humphrey field analyzer.

Results

There were no significant correlations between the neuroretinal rim areas and the global perimetric parameters. However, the correlations between the inferotemporal neuroretinal rim area and some superonasal visual field regions (areas 3 and 4) were significant.

Conclusions

There is a relation in the topography of some visual field areas assessed by SWAP and the inferotemporal neuroretinal rim area, which may play a role in the diagnosis and follow-up of suspected glaucoma.
Retinal Nerve Fiber Layer Measurements Using Scanning Laser Polarimetry after Photorefractive Keratectomy
Authors: Vetrugno M. , Maino A. , Valenzano E. , Cardia L.
Published: January 2018

Purpose

To assess the effects of corneal depth changes on retinal nerve fiber layer (RNFL) postoperative measurements in myopic patients who had undergone photorefractive keratectomy (PRK).

Methods

A total of 120 myopic patients underwent PRK for myopia (range −2 to −10 diopters) and were divided into three groups according to their myopic correction: lower than 3 diopters (low myopia group), between 3 and 6 diopters (medium myopia group), over 6 diopters (high myopia group). RNFL parameters were evaluated preoperatively and 5 days, 3 months and 6 months after surgery, using a GDx NFA II scanning laser ophthalmoscope.

Results

Significant changes were seen in the symmetry, superior maximum, and average thickness, comparing baseline with six-month measurements (p=0.008, 0.027, 0.015 respectively). Dividing the sample according to attempted myopic correction, it was found that mean postoperative RNFL thickness was significantly lower after PRK only in the high myopia group. Mean RNFL thickness did not change with time (p = 0.884). Ablation depth was correlated with a change in RNFL thickness by the sixth postoperative month for each group. These variables were significantly related only in the high myopia group (p=0.003).

Conclusions

As polarised light penetrates the ablation area, morphological and functional changes might affect Gdx NFA II measurements. It must always be borne in mind that RNFL thickness can decrease either in cases of glaucoma or after PRK for high myopia, so close attention must be paid to interpreting these measurements in patients who have undergone PRK.
Metachronous Tumor Development in Unilateral Retinoblastoma
Authors: Mastrangelo D. , Hadjistilianou T. , Di Pisa F , Capretti M.C. , Frezzotti R.
Published: January 2018

Purpose

A series of 205 retinoblastoma (RB) patients referred to the Department of Ophthalmology at the University of Siena (Italy) was evaluated in order to assess the proportion of unilateral cases later developing tumors in the companion eye (“metachronous” bilateral retinobastoma) (MBRB).

Methods

The total number of unilaterally affected patients developing tumors in the fellow eye was recorded and the risk factors assessed for the development of asynchronous bilateral retinoblastoma, i.e., family history, tumor multifocality and early age at diagnosis.

Results

Only two out of 133 (1.5%) unilateral retinoblastoma patients in our series could be considered affected by MBRB.

Conclusions

The incidence of MBRB in our series was negligible (1.5% of all unilateral cases) compared to other reports. None of the reported risk factors for the development of tumors in the fellow eye was relevant in the present series. Although close follow-up of some unilateral cases is still recommended, thorough examination of the fellow eye, to search for lesions in the peripheral retina, is essential in all cases of unilateral RB. MBRB may be a distinctive clinical entity with specific clinical, genetic and prognostic features. However, all these aspects need to be better investigated in larger series.
Branch Retinal Vein Occlusion Associated with the 20210 G-to-A Prothrombin Variant
Authors: Martínez C. Peris , Aviñó Martínez J.A. , Díaz-Llopis M. , Gregori E. España , Menezo J.L. , Vayá A.
Published: January 2018

Purpose

To describe a case of branch retinal vein occlusion (BRVO) in a patient who tested positive for the 20210 A allele of the prothrombin (PT) gene.

Methods

A 48-year-old man had visual loss in the right eye secondary to BRVO confirmed by ophthalmoscopy and fluorescein angiography. His medical history was not remarkable for common risk factors for retinal occlusive diseases.

Results

Laboratory tests for hypercoagulability were positive for PT 20210 A variant. The patient's family tested negative for the PT variant.

Conclusions

Laboratory tests for coagulopathy, including the PT 20210 A variant, should be added to the examination of patients with central or BRVO, especially if most common risk factors for thrombosis have been excluded.
Bilateral Non-Arteritic Anterior Ischemic Optic Neuropathy in a Patient with Autoimmune Thrombocytopenia
Authors: Killer H.E. , Huber A. , Portman C. , Forrer A. , Flammer J.
Published: January 2018

Purpose

To describe a patient with bilateral non-arteritic anterior ischemic optic neuropathy (NAION) and idiopathic autoimmune thrombocytopenia (ITP) with an extremely low platelet count.

Method

Case report.

Results

Remarkably good recovery of visual acuity.

Conclusions

Bilateral non-arteritic anterior ischemic optic neuropathy can develop in the presence of a very low platelet count.
A Randomized, Comparative Open-Label Study on the Efficacy of Latanoprost and Timolol in Steroid Induced Ocular Hypertension after Photorefractive Keratectomy
Authors: Vetrugno M. , Maino A. , Quaranta G. M. , Cardia L.
Published: January 2018

Purpose

To evaluate the effect of 0.005% latanoprost and 0.50% timolol for the treatment of steroid-induced ocular hypertension (SIOH) after excimer laser photorefractive keratectomy (PRK).

Methods

In this comparative, open-label study we enrolled 29 patients who received steroid therapy after PRK and developed intraocular pressure (IOP) elevation within 30 days of treatment. Fifteen were randomized to 0.005% latanoprost (group A) and 14 to 0.50% timolol (group B). IOP measurements were scheduled at 1, 3, 7, 15, 30, 60, 90 and 120 days of therapy.

Results

We did not find any real differences between latanoprost and timolol except at the 7-day and 15-day timepoints, when latanoprost reduced IOP significantly more than timolol (p=0.033, 0.035, respectively). After 7 days of therapy two of the 14 timolol-treated patients had high IOP (24 and 26 mmHg) but these promptly returned to normal when latanoprost was added. No significant differences were observed in the ocular side effects considered.

Conclusions

0.005% latanoprost is as safe and effective as 0.50% timolol in the treatment of SIOH after PRK. Both drugs provide a significant and stable IOP reduction in the majority of patients after short-term treatment. These findings are encouraging for the use of latanoprost in the management of SIOH after PRK, although further trials are necessary to consider it as a primary treatment.
Disciforme Keratitis Caused by Bartonella Henselae: An Unusual Ocular Complication in Cat Scratch Disease
Authors: Lohmann C. P. , Gabler B. , Kroher G. , Spiegel D. , Linde H.-J. , Reischl U.
Published: January 2018

Cat scratch disease (CSD) is a common infectious disease, however, its association with disciforme keratitis is a previously unreported ocular complication. With the use of the 16S rDNA-PCR technique with subsequent DANN sequencing on corneal material obtained by corneal scrape we were able to identify Bartonella henselae in an unusual form of disciforme keratitis.
Visual Outcome and Prognostic Factors after Vitrectomy for Posterior Segment Foreign Bodies
Authors: El-Asrar A.M. Abu , Al-Amro S.A. , Khan N.M. , Kangave D.
Published: January 2018

Purpose

To identify the prognostic factors that predict final visual outcome in eyes with posterior segment intraocular foreign body (IOFB) injuries managed by primary pars plana vitrectomy.

Methods

Ninety-six consecutive patients with posterior segment IOFB injuries were retrospectively reviewed. Factors analyzed included initial visual acuity (VA), time between injury and presentation, site of entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, endophthalmitis, location and size of IOFB, use of scleral buckling and/or an encircling band, gas tamponade, lensectomy, number of surgical procedures, and development of retinal detachment. Data were analyzed using univariate and multivariate logistic regression analysis.

Results

After a mean follow-up of 8.6 months, 63 eyes (65.6%) achieved VA of 20/200 or better, and 9 eyes (9.4%) had total retinal detachment complicated by inoperable proliferative vitreoretinopathy. On univariate analysis, predictors of poor vision (hand movements or less) were poor initial VA, corneoscleral entrance wound, uveal prolapse, vitreous prolapse, traumatized iris, and development of retinal detachment. In contrast, predictors of good visual outcome (20/200 or better) were absence of uveal prolapse, no endophthalmitis, and no retinal detachment. Multivariate analysis identified corneoscleral entrance wound, uveal prolapse, and development of retinal detachment as the only factors significantly associated with poor visual outcome. Absence of uveal prolapse was the only factor significantly associated with good visual outcome.

Conclusions

Final visual outcome is greatly determined by the severity of the primary injury. On multivariate analysis, significant predictive factors of final VA were corneoscleral entrance wound, presence or absence of uveal prolapse, and development of retinal detachment.
Magnetic Resonance Imaging in Cavitary Choroidal Melanoma
Authors: Rebolleda G. , Figueroa M. Suárez , Muñoz-Negrete F.J. , Rocamora A.
Published: January 2018

Purpose

To report the development of a cavitary choroidal melanoma in a patient with nevus of Ota and describe its magnetic resonance imaging (MRI) features.

Patient

A 66-year-old man with right oculodermal melanocytosis and an ipsilateral choroidal cavitary melanoma was seen. Diagnosis was suspected on the clinical, ultrasonographic and MRI findings.

Results

T1-weighted image showed a hyperintense solid mass containing hypointense cystic-like spaces delineated by hyperintense septa with respect to the vitreous. The reverse image was observed on T2-weighted images. A choroidal melanoma comprising epithelioid and spindle cells with multilocular cavities was documented histopathologically.

Conclusions

There may be an association between cavitary melanoma and nevus of Ota. Characteristic MRI findings could be helpful in the differential diagnosis of cavitary uveal melanoma.
Birdshot Retinochoroidopathy: Measurement of the Posterior Fundus Spots and Macular Edema Using a Retinal Thickness Analyzer, before and after Treatment
Authors: De Geronimo F. , Glacet-Bernard A. , Coscas G. , Soubrane G.
Published: January 2018

Purpose

To measure the retinal thickness in the macular area and at the typical fundus spots in a patient with birdshot retinochoroidopathy, using the retinal thickness analyzer (RTA), a new image analyzer involving laser-slit biomicroscopy, and to quantify the changes after systemic corticosteroid therapy.

Case Report

A 54-year-old man with posterior uveitis underwent visual acuity measurement, fluorescein and indocyanine green (ICG) angiographies, optical coherence tomography (OCT) and RTA measurements before and after steroid treatment.

Results

The thickness at the birdshot spots measured with RTA remained unchanged after treatment, but the thickness at the fovea decreased in both eyes. Fluorescein and ICG angiographies and OCT showed no change with treatment.

Conclusions

RTA seems a more sensitive method for assessing changes in macula thickness in the course of birdshot retinochoroidopathy and can help document the effect of treatment.
Does Surgical Technique Influence Cataract Surgery Contamination?
Authors: Koç F. , Akçam Z. , Kuruoğlu S. , Öge I. , Günaydin M.
Published: January 2018

Purpose

To compare cataract surgery contamination rates in large-incision extracapsular cataract extraction (ECCE) and phacoemulsification (PE), we studied 65 cases prospectively.

Methods

Thirty-five cases were operated by large-incision ECCE (Group I) and 30 by PE (Group II). Conjunctival swab cultures were taken immediately before surgery and anterior chamber aspirate was taken for culture upon completion of surgery for each case.

Results

Anterior chamber cultures were positive in 22.8% of the cases in group I and 23% in Group II. Frequencies of contamination in each group were no different (x2: 0.22, p>0.05). When the contaminations were evaluated in relation to operating time, prolongation of the operating time raised the contamination rate in Group I (p<0.05) but not in Group II (p>0.05). Silicone and PMMA intraocular lenses (IOL) were tested to see whether they had any additional risk of contamination. The frequencies of contaminated silicone IOL implanted cases (6/26) and contaminated PMMA IOL implanted cases (8/39) were similar (x2: 0.36, p>0.05).

Conclusions

Although the architecture of the incision and irrigation dynamics provided an advantage to the PE technique as the operating time became longer, routine PE was not superior to classical ECCE with respect to contamination when performed in the same circumstances. Prolonging the operating time raised the contamination rate in classical ECCE.
Lipoprotein (a) in Behçet's Disease as an Indicator of Disease Activity and in Thrombotic Complications
Authors: Gürbüz Ö. , Özdemir Y. , Coşar C.B. , Kural G.
Published: January 2018

Purpose

To evaluate the utility of plasma concentrations of lipoprotein (a) (Lp(a)) as an indicator of disease activity in Behçet's disease and to investigate its role in thrombotic complications of this disease.

Methods

30 patients (19 male, 11 female) with Behçet's disease (8 active, 22 inactive) were enrolled in the study group and 30 healthy individuals (16 male, 14 female) in the control group. Seven of the inactive Behçet's disease patients had a history of thrombotic complications. The disease activity was evaluated by clinical manifestations (oral aphthous lesions, genital ulcerations, uveitis and vasculitis) and laboratory investigations (leucocyte count, lipoprotein (a), C-reactive protein (CRP), complement 3 (C3) and complement 4 (C4) concentrations).

Results

Plasma Lp(a) and other acute phase reactant concentrations were significantly higher in the study group than in the controls (p < 0.01). These concentrations were also higher during the active period of the disease than during the inactive phase (p < 0.01). Lp(a) concentrations were significantly correlated with concentrations of other acute phase reactants. There was no difference between the groups with and without thrombotic complications for any of these measurements.

Conclusions

Plasma levels of Lp(a) might be an indicator of disease activity in Behcet's disease. There is no correlation between Lp(a) levels and thrombotic sequela in inactive Behçet's disease. However, further studies are needed on the thrombogenic role of Lp(a) during the active phase of thrombophlebitis, and in larger series.
Keratoconus and Fuchs' Heterochromic Iridocyclitis: A Coincidence or a Defect during Embryogenesis?
Authors: Yagci A. , Uretmen O. , Egrilmez S. , Gunenc U. , Kusbeci T.
Published: January 2018

Purpose

We aimed to discuss the possible role of developmental embryologic factors in neural crest cells in the aetiology of keratoconus and Fuchs' heterochromic iridocyclitis by presenting this case.

Case Report

We diagnosed bilateral keratoconus and unilateral Fuchs' heterochromic iridocyclitis in a 19 year old women complaining of progressively blurring vision in her left eye. We also examined most of her first and second degree relatives. One niece had FHI in addition to a choroidal nevus in the inferior temporal quadrant of her left eye.

Discussion

Regarding the common embryological origins of iris stroma, uveal melanocytes and corneal stroma, it might be worth considering that the combination of FHI and keratoconus is not coincidental. A role of embryologic factors in neural crest cells in the etiology of both diseases cannot be excluded.
Interactions between Ocular Surface Fluid and Cornea Related to Contact Lenses
Authors: Reim M. , Schrage N.F. , Becker J.
Published: January 2018

Purpose

To improve the quantification of damage to the ocular surface, metabolite levels, electrolyte concentrations, and enzyme activities were assayed in corneal epithelium, stroma and tears.

Methods

In rabbits, rinsing or contact lenses were used to induce microtrauma. For more severe trauma, experimental injuries were induced with 1 N NaOH. Human accidents included epithelial lesions and mild chemical burns. Enzymatic test systems and electron dispersive X-ray analyses (EDXA) were employed. Corneal hydration was assessed by wet and dry weights. Interleukins were analysed with ELISA.

Results

In contrast to normal eyes, in ocular surface trauma the interaction between tear fluid and cornea played an important part. After wearing contact lenses or rinsing, glucose and lactate levels in the cornea and in tears increased, and ATP and glycogen in the cornea decreased. After epithelial lesions, N-acetylglucose aminidase (NAcGA, E.C.3.2.1.50) was released into the tears. Epithelial defects alone and – much more – rinsing the denuded stromal surface produced an increase of lactate and glucose in tears and a dramatic fall in Na, Cl, and S levels in the stroma. Rinsing with phosphate induced corneal calcification. IL-1 and IL-6 were increased in human corneal buttons from patients with trauma and inflammation.

Conclusions

Biochemical analyses may be useful to quantify trauma to the ocular surface.
Susac Syndrome: A Vasospastic Disorder?
Authors: Flammer J. , Kaiser H. , Haufschild T.
Published: January 2018

Purpose

The Susac syndrome is a microangiopathy that leads to visual symptoms, hearing loss and neurological symptoms.

Case Report

We report on a young woman suffering from this syndrome who also presented the following signs and symptoms typical of a vasospastic syndrome; 1) a history of cold hands, low blood pressure and migraine; 2) a typical alteration of conjunctival vessels; 3) prolonged flow arrest time after cooling in nailfold capillaromicroscopy; 4) increased resistivity in the orbital vessels measured by color Doppler imaging; and 5) an increased plasma level of endothelin-1.

Conclusions

We postulate that the Susac syndrome is a manifestation of the vasospastic syndrome.
Multilayer Amniotic Membrane Transplantation in Severe Ocular Graft versus Host Disease
Authors: Peris-Martínez C. , Menezo J.L. , Díaz-Llopis M. , Aviñó-Martínez J.A. , Navea-Tejerina A. , Risueño-Reguillo P.
Published: January 2018

Purpose

To clarify the usefulness of multilayer amniotic membrane transplantation in an unusual case of calcareous corneal degeneration in a patient with graft-versus-host disease.

Methods

A 20-year-old Caucasian woman had bilateral calcareous corneal degeneration of one year of evolution, secondary to graft-versus-host disease. Treatment for both eyes with topical steroids and antibiotic ointment was not successful. Right eye had a spontaneous corneal perforation, and a three-layer circle amniotic membrane graft was applied to the whole cornea.

Results

During a follow-up period of 20 months we observed stability of the corneal epithelium and stroma. The amniotic membrane-covered area showed rapid epithelization, reduced inflammation and suppressed fibrosis formation.

Conclusions

Multilayer amniotic membrane transplantation may be considered an alterantive for reconstructing the ocular surface in a patient with severe dry eyes and calcareous corneal degeneration, even with little perforation.
Aerosol Keratopathy: A Revised Maclean Classification
Authors: Al-Abdulla N.A. , Kim M.C.
Published: January 2018

Case Report

Chemical keratopathy has been linked to many household aerosols. We present a dramatic case of aerosol keratopathy. The finding of an unexplained epithelial or superficial stromal keratopathy must alert the physician to inquire about the use of household aerosols near the patient's face. We also propose a revised classification system based on the work of MacLean.
Retinal Vessel Reaction to Short-Term IOP Elevation in Ocular Hypertensive and Glaucoma Patients
Authors: Nagel E. , Vilser W. , Lanzi I.M.
Published: January 2018

Purpose

Regulation of ocular blood flow might be impaired in glaucoma patients. We compared the reaction of retinal vessels to a short-term increase of intraocular pressure (IOP), using a retinal vessel analyzer (RVA), in normal volunteers, ocular hypertensive patients (OH) and primary open angle glaucoma patients (POAG).

Methods

Ten healthy subjects (56 ± 8 years, IOP 13.7 ± 1.6 mmHg), 10 OH patients (55 ± 12 years, IOD 23.4 ± 4.1 mmHg) and 11 POAG patients (60 ± 11 years, IOP 23.3 ± 1.95 mmHg) were evaluated. Arterial and venous retinal vessel diameter was measured continuously before, during and after raising IOP to suprasystolic values by the suction cup method, described as ocular oscillo-dynamography.

Results

The change in vessel diameter after the IOP rise differed in its temporal sequence and in absolute values depending on the group examined. In the retinal branch veins the reduction of vessel diameter during the IOP rise was significantly different in POAG (0% ± 6.7) and volunteers (-6.7% ± 8.5; p = 0.06) and in POAG and OH (-6.7% ± 7.0; p = 0.04). At 70–130 sec after IOP increase a dilatation occurred, again differing significantly in POAG (+5.8% ± 3.9) and volunteers (+9.7% ± 4.3; p = 0.03). Systemic blood pressure did not show any significant differences between groups or during the course of the examination.

Discussion

At short-term rise in IOP leads to less retinal vessel reaction in POAG patients than in volunteers and OH. This might be due to impaired autoregulation to ocular perfusion changes in POAG patients.
Animal and Culture Models of Glaucoma for Studying Neuroprotection
Authors: Levin L.A.
Published: January 2018

Purpose

Neuroprotection aims to treat nervous system disease by maintaining the health and function of neurons. The final proof of the neuroprotective strategy relies on randomized, controlled clinical trials, but the choice of which agents to study for these trials depends on studies in the laboratory using culture and animal models. Most culture models for studying ocular neuroprotection use retinal cells, and a range of mechanisms can be studied in culture, e.g. axotomy and serum or growth factor deprivation.

Methods

A variety of animal models are available for studying neuroprotection as possible therapy for glaucomatous optic neuropathy. Those most closely related to glaucoma are probably associated with moderate elevation of the intraocular pressure to levels similar to those seen in patients with untreated glaucomatous optic neuropathy.

Conclusions

Care should be taken when applying the results of these models to humans, and there is no single criterion for deciding which culture or animal model is most relevant to the clinical situation. The most important feature is whether the model's results correlate with clinical results, and this information will only become available over time, as randomized clinical trials are completed.
Influence of Topical Brimonidine on Visual Field in Glaucoma
Authors: Lapuente C. Ruiz , Lapuente A. Ruiz , Link B.
Published: January 2018

Purpose

We evaluated the efficacy of topical brimonidine in visual field preser vation and/or improvement in eyes undergoing controlled glaucoma.

Methods

Seventy eyes of patients were trained with two different visual field test strategies: The Octopus Tendency Oriented Perimetry (TOP) G1 and the Frequency Doubling Technology (FDT) 30°. Following 2–4 months of brimonidine treatment, there were significant improvements in visual field, as assessed using the TOP G1 strategy (p = 0.003). The FDT 30° test revealed no statistically significant differences.

Conclusions

These data support the results of other studies, which indicate that brimonidine may increase mean sensitivity in visual field tests. Since it is known that the control of intraocular pressure does not fully protect glaucomatous eyes from visual field loss, it is possible that the neuroprotective qualities of brimonidine may contribute to visual field preservation in glaucomatous eyes.
Indolent Corneal Ulcers in a Patient with Congenital Insensitivity to Pain with Anhidrosis: A Case Report and Literature Review
Authors: Jarade E.F. , El-Sheikh H.F. , Tabbara K.F.
Published: January 2018

Purpose

To report a case of bilateral corneal neurotrophic ulcer in patient with congenital insensitivity to pain with anhidrosis (CIPA) and review the literature.

Case Report

A 6 year-old boy presented with bilateral central corneal sterile ulcer, decreased corneal sensitivity, moderately altered corneal reflex and normal tearing response. History taken, systemic evaluation and medical chart review were undertaken.

Discussion

Fifty-two cases of CIPA have been reported worldwide. Fourteen cases had corneal involvement. The clinical picture of our patient is characteristic of CIPA.

Conclusions

Congenital insensitivity to pain with anhidrosis may present as neurotrophic corneal ulcer. We report herewith, this vision threatening corneal congenital abnormality. Early diagnosis and prompt treatment are mandatory to prevent corneal complications such as scarring and perforation.
Ophthalmologic Findings in Fifteen Patients with Wolfram Syndrome
Authors: Al-Till M. , Jarrah N.S. , Ajlouni K.M.
Published: January 2018

Purpose

To look for ophthalmologic abnormalities in 15 patients with Wolfram syndrome, also known as DIDMOAD syndrome (diabetes insipidus, diabetes mellitus, optic atrophy and deafness).

Methods

Fifteen patients from four inbred families diagnosed as having Wolfram syndrome at the National Center for Diabetes, Endocrinology and Genetics, in Amman, Jordan, were evaluated ophthalmologically. Their examination included best-corrected visual acuity, color vision testing, pupillary light reflexes, slit-lamp biomicroscopy and fundus examination. Fundus fluorescein angiography was done in all patients.

Results

The prevalence of optic atrophy was (93.3%), color defect (92.9%), cataract (66.6%), pigmentary retinopathy (30%) and diabetic retinopathy (20%). Abnormal pupillary light reflexes and nystagmus were also reported.

Conclusions

Although our group of patients was genetically heterogeneous, the ophthalmic findings are consistent with those reported in other series, except for cataract which was highly prevalent but mild and did not contribute significantly to loss of vision. (Eur J Ophthalmol 2002; 12: 84–8)
Retinal Thickness in Healthy and Diabetic Subjects Measured Using Optical Coherence Tomography Mapping Software
Authors: Massin P. , Erginay A. , Haouchine B. , Mehidi A. Ben , Paques M. , Gaudric A.
Published: January 2018

Purpose

To define the normal retinal thickness in healthy subjects using optical coherence tomography (OCT) mapping software and to assess the ability of OCT to detect early macular thickening in diabetic patients.

Methods

Six radial scans centered on the fixation point were done on 60 healthy eyes and 70 eyes of 35 diabetic patients without macular edema on biomicroscopy. Retinal thickness was measured automatically with OCT mapping software. Mean retinal thickness was compared in subgroups of healthy patients based on age, sex, and eye, and in the eyes of diabetic patients and healthy subjects. Thickening was diagnosed if mean retinal thickness of an area was greater than the mean thickness + 2SD in the corresponding area in healthy subjects; or if the difference between right and left eye exceeded the mean difference + 2 SD in a given area in healthy subjects.

Results

In healthy subjects, mean retinal thickness in the central macular area 1000 μm in diameter was 170±18 μm. There was no significant difference according to age, or left or right eye, but central macular thickness was significantly greater in men than women (p=0.0139). No difference was observed between the eyes of healthy subjects and diabetic patients without macular edema on biomicroscopy, but OCT detected early macular thickening in 12 diabetic eyes.

Conclusions

In this study average retinal thickness and mean local variations in a normal population were defined using a commercially available mapping software. OCT seems a sensitive tool for detecting early retinal thickening.
Comparison of the Effects of Argon and Neodymium: YAG Laser Iridotomy on Cytokines in the Rabbit Aqueous Humor
Authors: Er H. , Doganay S. , Evereklioglu C. , Turkoz Y. , Gündüz A. , Borazan M. , Ozyalin F.
Published: January 2018

Purpose

We compared the effects in rabbits of iridotomy using the argon or Nd:YAG laser on cytokines such as interleukin 1–beta (IL-1β), interleukin 6 (IL-6), interleukin 8 (IL-8), and tumor necrosis factor-alpha (TNF-α).

Methods

Twenty pigmented rabbits (20 eyes) underwent argon and Nd:YAG iridotomy under general and topical anesthesia. Group 1 (10 right eyes) was treated with the argon laser and group 2 (10 right eyes) with the Nd:YAG laser, using an equal number of shots and the same laser parameters for each group. Left eyes in both groups were evaluated as controls. Aqueous humor specimens were collected from each eye preoperatively and 1 and 3 days postoperatively.

Results

Aqueous IL-6 and TNF-α levels rose more on day 1 in the Nd:YAG group than the argon group. IL-6 and TNF-α levels were significantly higher on days 1 and 3 than the preoperative and control levels (p<0.05). TNF-α levels on day 1 were significantly lower in the Nd:YAG than the argon group. There were no significant differences between the two laser groups for IL-6 on days 1 and 3. IL-1β and IL-8 did not change

Conclusions

Our findings suggest that cytokines, particularly IL-6 and TNF-α, may be inflammatory mediators in the early inflammation following argon and Nd:YAG laser iridotomies. These results also indicate that cytokines contribute to the acute effects of Nd:YAG and argon laser applications on inflammation.
Dacryoadenitis as the Earliest Presenting Manifestation of Systemic Wegener's Granulomatosis
Authors: Soheilian M. , Bagheri A. , Aletaha M.
Published: January 2018

Purpose

To report a case presenting with dacryoadenitis as the earliest manifestation of systemic Wegener's granulomatosis (WG).

Design

Observational case report.

Methods

A 41-year-old woman initially presented symptoms of bilateral dacryoadenitis. She subsequently developed upper and lower respiratory tract involvement, scleritis and keratitis.

Results

Cytoplasmic antineutrophil antibody (c-ANCA) titer was positive. The lacrimal gland and lung biopsies were consistent with WG. The patient responded well to cyclophosphamide and prednisolone.

Conclusions

Dacryoadenitis may be the earliest presenting manifestation of WG and prompt immunosuppressive chemotherapy may control it preventing the limited disease from progressing to a complete form and reducing its morbidity and mortality
Macular Phototrauma after Cataract Extraction and Multifocal Lens Implantation: Case Report
Authors: Menezo J.L. , Peris-Martínez C. , Taboada Esteve J.
Published: January 2018

Purpose

To report a patient who developed photic injury after cataract surgery and multifocal MF4 lens implantation

Methods

A 41-year-old caucasian woman without antecedents of interest was subjected to left catarct surgery involving phacoemulsification with capsular sac implantation of a new type of multifocal lens. A coaxial light microscope was used for surgery. The operation was filmed and anterior pole photographs were obtained.

Results

Two days after the operation, the patient noted a paracentral scotoma and hand movement visual acuity in the left eye. Indirect ophthalmoscopy revealed an oval, hyper-pigmented macular lesion compatible with phototoxic maculopathy.

Conclusions

Phototoxic injury to the macula may occur after cataract extraction. Implantation of an intraocular lens is an important factor in the producion of maculopathy, on account of its light-focusing effect on the retina. This effect was probably increased in our patient by the use of a new autofocus multifocal lens.
Clinical, Genetic and Histopathologic Findings in Two Siblings with Muscle-Eye-Brain Disease
Authors: Zervos A. , Hunt K.E. , Tong H.-Q. , Avallone J. , Morales J. , Friedman N. , Cohen B.H. , Clark B. , Guo S. , Gazda H. , Beggs A.H. , Traboulsi E.I.
Published: January 2018

Purpose

We present the clinical, genetic and histopathologic findings in two siblings with Muscle-Eye-Brain Disease (MEB-D), an autosomal recessive disease characterized by mental retardation, muscular dystrophy, retinal hypoplasia and brain abnormalities.

Methods

Clinical, histopathologic and gene mapping studies of a family with two normal and two children with MEB-D.

Results

Two siblings presented in the first few months of life with developmental delay, hypotonia, and strabismus. MRI of the brain showed colpocephaly, pontine and cerebellar atrophy, and diffuse white matter disease. Both patients were blind and had high myopia, strabismus, and retinal and optic nerve abnormalities. The older boy had glaucoma. Both children died from uncontrolled seizures. There was retinal, choroidal and RPE atrophy and optic nerve hypoplasia on ocular histopathology. Both patients shared the same parental haplotypes at the MEB locus on chromosome 1p, while an unaffected sibling did not, indicating possible linkage to the MEB locus.

Conclusions

Patients with MEB-D have severe visual impairment from retinal and optic nerve hypoplasia. High myopia appears to be a consistent finding. The ocular manifestations of MEB-D appear to be distinct from those of patients with Walker-Warburg syndrome.
Corneal Epithelial Keratitis in Herpes Zoster Ophthalmicus: “Delayed” and “Sine Herpete”. a Non-contact Photomicrographic in Vivo Study in the Human Cornea
Authors: Tabery H.M.
Published: January 2018

Purpose

To investigate the origin of corneal epithelial keratitis occurring without accompanying herpes zoster ophthalmicus (HZO) cutaneous rash.

Methods

Corneal epithelial lesions in seven patients (four with a history of classical HZO with cutaneous rash, one of herpes zoster oticus, and two with no history of herpes zoster, were examined with the slit lamp and photographed by non-contact in vivo photomicrography. The findings were compared with lesions in classical acute HZO. Polymerase chain reaction (PCR) was done in three patients.

Results

Slit lamp appearance, morphology at higher magnification, and kinetics of the lesions were indistinguishable from classical acute HZO. PCR was positive for varicell-azoster virus DNA in all three samples.

Conclusions

The findings strongly suggest that HZO typical corneal epithelial lesions occurring in the absence of cutaneous rash are in fact recurrent episodes of virus shedding.
Pulsatile Ocular Blood Flow during Pregnancy
Authors: Centofanti M. , Migliardi R. , Bonini S. , Manni G. , Bucci M.G. , Pesavento C.B. , Amin C.S. , Harris A.
Published: January 2018

Purpose

To study pulsatile ocular blood flow (POBF) throughout pregnancy.

Methods

We enrolled twenty-seven healthy women in the first trimester of gestation, only ten of which were followed through the second trimester, and fourteen non pregnant healthy women. In each subject we measured POBF with the POBF pneumotonometer (OBF Ltd. UK), IOP, blood pressure (BP) and heart rate (HR). An unpaired Student t-test was used to compare pregnant women with non-pregnant women, and a two-tailed paired Student t-test was used to compare the same women in the first and second trimester of pregnancy. p <0.05 is considered statistically significant.

Results

Results are presented as means ± SD. In the first trimester of pregnancy the age was 32 ± 6, POBF 1516.4 ± 382 ml/min, IOP 13 ± 3 mmHg, BP 92 ± 6 mmHg, and HR 86 ± 14 beats/min. In the second trimester POBF was 1629.11±352.4 ml/min, intraocular pressure (IOP) 12 ± 3 mmHg, BP 96 ± 3 mmHg, and HR 93 ± 10 beats/min. In the control group the age was 27 ± 9, POBF 972.23 ± 329.3 ml/min, BP 88 ± 4.3 mmHg, and HR 80 ± 14 beats/min. POBF increases during the first trimester (p = 0.00008). In the second trimester POBF was higher compared to the first trimester (p = 0.0008). Non significant differences were observed for the other parameters.

Conclusions

The POBF increases throughout gestation. During pregnancy there is an increase in estrogen which induces endothelial-dependent vasodilatation in several tissues. The estrogen changes may influence POBF.
Effects of L-NAME and Timolol on Aqueous IL-1β, IL-6, IL-8, TNF-α and NO Levels after Nd:YAG Laser Iridotomy in Rabbits
Authors: Er H. , Doganay S. , Evereklioglu C. , Cekmen M. , Daglioglu M.C. , Isci N.
Published: January 2018

Purpose

Pro-inflammatory cytokines are produced by tissues and play a vital role in the host inflammatory response and uveitis. Nitric oxide (NO) can be produced in large amounts as a response to experimentally-induced uveitis or cytokines. In this study, we measured the levels of pro-inflammatory cytokines such as interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor (TNF)-α and free-radical in aqueous humor after Nd:YAG laser iridotomy in rabbits, and investigated whether timolol maleate an anti-glaucoma drug, or a NO synthase inhibitor, NG-nitro-L-arginine methyl esther (L-NAME) had an inhibitory effect on these molecules, since L-NAME is a known anti-inflammatory agent in rabbits.

Methods

Bilateral experimental Nd:YAG laser iridotomy (power 7.5 mJ, mode single burst, aiming beam 4) was performed on 18 rabbits under general plus topical anesthesia. Aqueous humor samples were taken by clear corneal paracentesis preoperatively, and 1 and 24h postoperatively. Six rabbits (12 eyes) were given bilateral topical timolol maleate 0.5% (Tim-optic®) drop b.i.d (group 1), six rabbits (12 eyes) received bilateral 0.1 ml subconjuntival injections of L-NAME (150 mg/kg) (group 2), and six rabbits (12 eyes) were treated with topical balanced salt solution (BSS) b.i.d. (control).

Results

Preoperative cytokine and NO levels were comparable in the three groups, with no significant differences. In addition, there was no significant difference in baseline cytokine levels between the right and left eyes. In all groups, pre- and postoperative mean IL-1β levels were below the detection limit of the assay (<5.0 pg/ml). In the control group, postoperative mean IL-6, IL-8 and NO levels were significantly higher after Nd: YAG laser iridotomy than before (for each, p < 0.01). Timolol and L-NAME both inhibited the rise in IL-8 and TNF-α levels. Timolol also inhibited the rise in IL-6 but not NO. L-NAME had an inhibitory effect against NO, but not IL-6.

Conclusions

L-NAME has an inhibitory effect on IL-8, TNF-α and NO, but not on IL-6. Timolol had inhibitory effects on IL-6, IL-8 and TNF-α, but not on NO. These preliminary experimental resutls might help in assssing the effect of Nd: YAG laser iridotomy in aqueous humor, and to understand the inhibitory effects of timolol and L-NAME against these molecles.
Intraocular Pressure Response of Capsular Glaucoma and Primary Open-Angle Glaucoma to Selective Nd:Yag Laser Trabeculoplasty: A Prospective, Comparative Clinical Trial
Authors: Gračner T.
Published: January 2018

Purpose

To compare the intraocular pressure (IOP) response of uncontrolled capsular glaucoma (CG) and primary open-angle glaucoma (POAG) to selective laser trabeculoplasty (SLT) in a prospective clinical trial.

Methods

Ten eyes of ten patients suffering from uncontrolled CG (CG Group) and ten eyes of ten patients with uncontrolled POAG (POAG Group) were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The baseline characteristics were similar in both groups. IOP was measured before and 1 day, 1 week, 1 month and 3, 6, 9, 12, 15 and 18 months after treatment. Success was defined as IOP more than 20% lower than before treatment. Any change of hypotensive medication led to the subjects' exclusion from the study. The two groups were compared using the independent-sample t test for continuous variables and the log-rank test for survival analysis. A value of p<0.05 was considered significant.

Results

The mean follow-up was 12.0 months (SD 5.5) for the CG group and 13.5 months (SD 4.3) for POAG (n.s.). No significant difference was found between the two groups for mean pretreatment IOP (23.6 mmHg ± 5.70 in the CG group and 22.8 mmHg ± 2.44 in the POAG group) or for mean IOP and mean IOP reductions during the follow-up. At all follow-up visits, IOP was reduced less in the CG group than in the POAG group (24.8% ± 11.15 vs. 27.7% ± 9.91 at 6 months, 22.0% ± 6.66 vs. 30.6% ± 6.35 at 12 months, and 31.4% ± 5.55 vs. 35.1% ± 1.75 at 18 months), but the difference was significant only at 12 months. Kaplan-Meier survival analysis gave an 18-month success rate of 64% in the CG group and 78% in the POAG group, with no significant differences between the groups.

Conclusions

SLT is an effective procedure for lowering IOP in CG and POAG eyes, although the effect seems to last less in CG eyes.
Low-Dose Intravenous Methylprednisolone or Conservative Treatment in the Management of Traumatic Optic Neuropathy
Authors: Yip C.-C. , Chng N.-W. , Au Eong K.-G. , Heng W.-J. , Lim T.-H. , Lim W.-K.
Published: January 2018

Purpose

To compare the efficacy of low-dose intravenous methylprednisolone or conservative treatment in the management of traumatic optic neuropathy.

Methods

A non-randomized retrospective study of 21 patients (21 eyes) with traumatic optic neuropathy treated between October 95 and November 97 in a tertiary ophthalmology unit. Traumatic optic neuropathy was defined as traumatic visual loss with afferent pupillary defect in the absence of direct injury to the globe or optic nerve. The median follow-up period was one year. Nine patients were treated with 125–250 mg methylprednisolone 6-hourly intravenously for a mean of 3.3 days (range 2–5 days) and 12 patients were treated conservatively. Visual acuity (VA) was measured with a Snellen chart before and after treatment at each follow-up visit. Visual recovery was defined as an improvement of 2 or more Snellen lines one week post-injury or later.

Results

The patients' mean age was 37.1 years (range 12–65 years). There were more males (90.5%) than females (9.5%). Traumatic optic neuropathy was in 12 right eyes and 9 left eyes. The cause of injury included traffic accidents (52.4%), falls (28.6%), assault (14.2%) and others (4.8%). The mean interval between the injury and steroid therapy was 3.6 days (range 1–11 days). Visual recovery was observed in 44.4% of eyes treated with methylprednisolone and in 33.3% treated conservatively (p = 0.673, Fisher's exact test).

Conclusions

Intravenous methylprednisolone at the dosage and duration used in this retrospective study did not significantly improve the visual recovery of eyes with traumatic optic neuropathy compared to conservative treatment. However, this small sample may not be sensitive enough to detect a small difference in visual recovery rates, and further studies with larger samples may be warranted.
Corneal Complications following Abuse of Topical Anesthetics
Authors: Pharmakakis N.M. , Katsimpris J.M. , Melachrinou M.P. , Koliopoulos J.X.
Published: January 2018

Purpose

To describe corneal complications in three patients following abuse of topical anesthetics.

Materials and Methods

We describe one case with bilateral corneal perforation, another with unilateral corneal perforation and a third case of chronic keratitis following excessive use of topical anesthetics.

Results

Two patients continued to instill topical anesthetic drops despite all recommendations to stop. The result was a bilateral corneal perforation in the first case and a large unilateral descemetocele in the second. The third patient who had chronic toxic keratitis discontinued the anesthetic drops and after the appropriate treatment the cornea returned to normal. Corneal grafting and conjunctival flaps were used to seal the corneal perforation but the long-term anatomical and functional results were very poor.

Conclusions

The initial presentation of this rare clinical entity creates difficulties in reaching a correct diagnosis. A presumed acanthamoeba keratitis is the first choice among many similar conditions. Thus abuse of topical ocular anesthetic drops should be included in the differential diagnosis of cases of chronic keratitis as it may masquerade as acanthamoeba keratitis. A current or past history of psychiatric and mental disorders or psychoactive substance abuse is important in the diagnosis. Functional and anatomical results after appropriate treatment are usually poor. Psychiatric counselling is extremely helpful and is in fact mandatory in the management of these patients.