bluuebunny/crossref_metadata_2025 huggingface dataset:
Monitoring of Photodynamic Therapy Results in Age-Related Macular Degeneration by Means of Preferential Hyperacuity Perimeter
Authors: Wylegala E.A. , Pilat J. , Teper S.J. , Wroblewska-Czajka E. , Bartusek M.
Published: January 2018

Purpose

To describe changes revealed by Zeiss Preferential Hyperacuity Perimeter (PreView PHP) in age-related macular degeneration (AMD), before and after photodynamic therapy (PDT), and determine usefulness of such monitoring.

Methods

Forty patients (40 eyes) with subfoveolar choroidal neovascularization (CNV) and 20 volunteers with cataract (40 eyes) were examined in a prospective study. Control group was screened for false positive results to evaluate reliability of the test. Subfoveolar CNV was confirmed by fluorescein angiography and optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and macular visual field in the PHP (area and intensity of distortion) were assessed 1 day before and 1 week and 4 weeks after PDT.

Results

Four weeks after PDT there was improvement in PHP results in 20 eyes (50%), stabilization in 15 eyes (37.5%) and progression in 5 eyes (12.5%). At this time there was BCVA improvement in 9 eyes (22.5%), stabilization in 28 eyes (70%), and worsening in 3 eyes (7.5%). 1 week after PDT 30 eyes (75%) presented temporary progression in PHP but only 3 patients (7.5%) presented temporary decrease of visual acuity and progression in OCT. Correlation coefficient of BCVA and PHP results was low during whole study. There was no significant change in control group during observation. 17.5% false positive PHP results were obtained at baseline. In the PDT group no false negative results were noted.

Conclusions

Visual outcome after PDT cannot be predicted with use of PreView PHP. Temporary progression of changes in PHP 1 week after PDT can be expected in most cases.
Three-Port Lens-Sparing Vitrectomy for Aggressive Posterior Retinopathy of Prematurity: Early Surgery before Tractional Retinal Detachment Appearance
Authors: Ferrari T. Micelli , Furino C. , Lorusso V.V. , Dammacco R. , Sborgia G. , Sborgia L. , Besozzi G.
Published: January 2018

Purpose

Aggressive posterior retinopathy of prematurity (APROP) may suddenly develop into tractional retinal detachment (TRD), often resulting in poor vision if untreated. The aim of the current study is to examine the anatomic results and complications of lens-sparing vitrectomy (LSV) for stage 3 APROP, before TRD appearance.

Methods

A retrospective, noncomparative, consecutive case series of 13 eyes of 9 patients (mean gestational age 24.1±0.9 weeks [range: 23–25 weeks], mean birthweight of 725.8±107.9 grams [range: 598–897 grams]) with stage 3 APROP was carried out. The eyes did not respond to at least one session of retinal laser photocoagulation, showing signs of disease progression. All eyes underwent 20-gauge LSV before retinal detachment appearance.

Results

All eyes underwent 20-gauge three-port LSV and intraoperative additional laser photocoagulation. At the end of the surgery, five eyes were tamponaded with air; in eight eyes, a balanced salt solution was left in the vitreous cavity. After 13.5±5.3 months of follow-up (range: 4–22), the retina was completely attached in all eyes, without any signs of progression. The authors did not observe any intraoperative or postoperative complications.

Conclusions

Surgical approach to stage 3 APROP refractory to laser photocoagulation could be effective and safe in order to avoid the progression of the disease.
Intravitreal Bevacizumab for the Treatment of Feeder Vessel of Subfoveal Choroidal Neovascularization
Authors: Theodossiadis P.G. , Grigoropoulos V.G. , Emfietzoglou I. , Vergados J. , Chalkiadakis J. , Theodossiadis G.P.
Published: January 2018

Purpose

To report in a single case the effectiveness of bevacizumab in the treatment of feeder vessels (FVs) of subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).

Methods

One patient received intravitreal bevacizumab (Avastin) (1.25 mg) which was repeated 4 weeks after the first intravitreal injection. Fluorescein angiography and optical coherence tomography (OCT) were performed. Visual acuity (VA) was also checked.

Results

Occlusion of the FVs was observed 4 weeks after starting treatment. During the follow-up period and in the final examination 13 months after the first injection, the FVs remained occluded. Complete resolution of macular edema and improvement of the VA were noticed after the second bevacizumab intravitreal injection.

Conclusions

This report documents the successful occlusion of FVs of subfoveal neovascularization after two intravitreal bevacizumab injections in a patient who was followed up for 1 year after the occlusion. Further long-term investigation is warranted given the promising 12-month results.
Combination Products for Glaucoma: An Overview of Treatment Principles
Authors: Traverso C.
Published: January 2018

Glaucoma is a leading cause of blindness and visual impairment. Treatments that lower intraocular pressure (IOP) tend to delay progression of the condition. However, the target IOP cannot be achieved with monotherapy in many patients. If monotherapy adequately controls IOP and is well tolerated, it should not be changed, but if the therapy is only partially effective, a combination may be used. Combination therapy is eventually needed in many cases of glaucoma. Combinations may be given as adjunctive or preferably as fixed therapies. The mechanism of action and contraindications of the constituent agents should be taken into account when prescribing combinations, for optimal safety and efficacy. As treatment choice expands, prescribing patterns are changing worldwide. Fixed combination therapies are increasingly prescribed in Europe in particular for the treatment of glaucoma. They should be administered according to the current evidence-based guidelines.
Fixation Patterns Evaluation by Means of MP-1 Microperimeter in Microstrabismic Children Treated for Unilateral Amblyopia
Authors: Carpineto P. , Ciancaglini M. , Nubile M. , Di Marzio G. , Toto L. , Di Antonio L. , Mastropasqua L.
Published: January 2018

Purpose

The aim of the study was to evaluate the fixation patterns of microstrabismic children previously treated for unilateral amblyopia.

Methods

Thirty-three children (mean age 7.3±1.5 years) were included in the study. Visual acuity (VA) was measured using the Early Treatment of Diabetic Retinopathy Study charts. Fixation was assessed by MP-1 microperimeter. Differences in position and stability of fixation between the fellow and the microstrabismic eyes were calculated by using the percentage of the preferred fixation points within central fixation and the percentage of the fixation points within target fixation, respectively. For statistical analysis Mann-Whitney test was used. To evaluate the influence of age and duration of anti-amblyopic treatment on microstrabismic eyes fixation, linear regression analysis was performed.

Results

In the microstrabismic eyes VA was significantly reduced when compared to the fellow eyes (0.1236±0.0204 vs 0.0042±0.0032 logMAR; p<0.001). Position and stability of fixation were significantly better in the fellow eyes (93.21±0.65% vs 70.91±4.80%; p=0.002, and 89.88±0.94% vs 71.73±2.94%; p<0.001, respectively). A significant correlation was found between fixation stability and both the duration of anti-amblyopic treatment and pretreatment VA (p=0.024 and p=0.009, respectively) and between fixation centrality and pretreatment VA (p<0.001).

Conclusions

VA, centrality, and stability of fixation were significantly impaired in the microstrabismic eyes. Pretreatment VA was a risk factor for fixation impairment. The severity of fixation stability impairment was linked to the duration of anti-amblyopic treatment.
Ocular Manifestations of Chronic Graft-Versus-Host Disease in Patients Treated with Extracorporeal Photochemotherapy
Authors: Motolese E. , Rubegni P. , Poggiali S. , Motolese P.A. , Marotta G. , Russo L. , D'ascenzo G. , Carcagnì M.R. , Fruschelli M. , Motolese I. , Fimiani M.
Published: January 2018

Purpose

Eye involvement has long been appreciated in patients with chronic graft versus host disease (cGVHD). In particular, ocular complications are frequent and can be potentially severe in patients with steroid-refractory cGVHD, and therefore necessitate close monitoring. This prospective study was designed to describe eye manifestations of cGVHD in a large series of patients monitoring them before and after 1 year of extracorporeal photochemotherapy (ECP). ECP is a relatively new therapeutic approach based on the biological effects of psoralen 8-methoxypsoralen (8-MOP) and ultraviolet A light (UVA) on mononuclear cells collected by apheresis, and reinfused into the patient.

Methods

Only patients with steroid-refractory cGVHD under treatment with ECP, who developed cGVHD-related eye symptoms, were selected for the study. Ophthalmologic examination was repeated every 3 months. Only patients with complete recovery of the ocular manifestations and symptoms were considered responsive.

Results

In our study we observed eye alterations in 24 out of 140 patients (17%) with cGVHD. After 12 months of ECP, 10 out of 21 patients (48%) completely responded to the therapy. In all these cases the contribution of ECP was also essential in all the other organs subject to cGVHD.

Conclusions

Further studies are necessary to clarify the role of ECP in patients with cGVHD, especially in associated eye manifestations. Although our experience is limited, it suggests that ECP could be a safe and effective therapy for steroid-refractory eye manifestations of cGVHD.
Systemic Bevacizumab for Retinal Angiomatous Proliferation Associated with Retinal Pigment Epithelial Detachment
Authors: Abi-Ayad N. , Mauget-Faÿsse M. , Amara-Allieu S. , Ardisson P.
Published: January 2018

Purpose

To report the off-label use of systemic bevacizumab in a patient with stage 3 retinal angiomatous proliferation (RAP) associated with a vascularized pigmented epithelium detachment (PED).

Methods

Interventional case report.

Results

The patient was treated with systemic bevacizumab after obtaining fully informed consent. At 3 months post-treatment, the authors observed an improvement of one line (seven letters) in visual acuity and total regression of the PED on ocular coherence tomography. No adverse effects were observed.

Conclusions

Systemic bevacizumab therapy appears to be safe and effective in the treatment of RAP associated with PED during this short follow-up period of 3 months. The authors recommend a large trial with long-term follow-up to confirm the promising results and evaluate the occurrence of adverse effects associated with systemic bevacizumab.
The Costs of Treating Glaucoma with Combinations of Topical Drugs in Spain
Authors: Neymark N. , Buchholz P. , Honrubia F. , Kobelt G.
Published: January 2018

Purpose

This study describes the treatment in ordinary clinical practice in Spain of patients with glaucoma with a two-drug combination therapy. The authors present the treatment outcome as end-of-period intraocular pressure (IOP) and the calculated direct medical costs over a 2-year period.

Methods

Data were extracted retrospectively from patient charts recording the use of all medical resources related to glaucoma. Costs were estimated using unit costs from public sources (2005). Descriptive cost analysis according to combination treatment at baseline was performed.

Results

The study included 216 patients from 21 centers. Around half of the patients were started on a β-blocker/prostaglandin analogue combination, while the rest received various other combinations containing either an α2-agonist or a carbonic anhydrase inhibitor. Across the seven groups considered, there was a statistically significant difference in the costs of the least and the two most costly groups, while the confidence intervals were overlapping in all other pairwise comparisons. The least costly drug combination was brimonidine/timolol. Assessing IOP at the end of follow-up, all the groups were equally effective (overlapping confidence intervals). In a multivariate regression analysis, the drug combination did not have an independent, significant impact on total direct medical costs, drug costs, or end-of-period IOP. Significant determinants of these variables were surgical interventions and one or more changes of drug combination during the follow-up.

Conclusions

Costs are determined by the response to treatment. Inadequate response triggers treatment changes and sometimes eventually surgical interventions, thereby increasing costs significantly.
Octreotide Acetate in Dominant Cystoid Macular Dystrophy
Authors: Hogewind B.F. , Pieters G. , Hoyng C.B.
Published: January 2018

Purpose

Dominant cystoid macular degeneration (DCMD) is an autosomal dominant trait of cystoid macular edema with poor visual prognosis. Until now, no efficient treatments for DCMD have been reported. The authors evaluated a somatostatin-analogue (octreotide acetate) as treatment for DCMD.

Methods

The authors treated four patients with early DCMD by intramuscular longacting octreotide acetate, 20 mg every 4 weeks for 1 year. In addition to general ophthalmologic examination the authors performed fluorescein angiography (FA) before and after treatment.

Results

Seven out of eight eyes showed improvement on FA and stabilization of visual acuity.

Conclusions

Somatostatin-analogues may reduce cystoid edema in DCMD and may thus prevent disease-related visual loss.
Necrotizing Fasciitis of Eyelid Secondary to Parotitis
Authors: Akcay E.K. , Cagil N. , Yulek F. , Anayol M.A. , Cetin H. , Cag Y. , Altintas A.G.K. , Simsek S.
Published: January 2018

Purpose

Evaluation of a patient with necrotizing fasciitis of the eyelid spreading from parotid gland. DESIGN. Interventional case report.

Methods

The patient admitted with rapidly progressive swelling, redness, and pain of four eyelids, and whole face. Pathogenic microorganism was searched, laboratory tests were evaluated. Intensive medical treatment and necrotic wound debridement was performed.

Results

The patient had been receiving oral cephalosporin at the time she was referred to our hospital, but her infection had spread rapidly under this treatment. In addition to her eyelid necrosis, septic shock developed within 24 hours. No pathogenic microorganism was detected in cultures. The patient responded to intravenous sulbactam ampicillin, surgical debridement of necrotic wound and supportive medical care. Moderate ptosis was the only complication observed in this patient. Reconstructive surgery was not needed.

Conclusions

With prompt antibiotic treatment and surgical debridement, cosmetic and functional success may be obtained in necrotizing fasciitis cases rarely seen with parotid gland origin.
Exophthalmometry Values of Turkish Adult Population and the Effect of Age, Sex, Refractive Status, and Hertel Base Values on Hertel Readings
Authors: Beden Ü. , Özarslan Y. , Öztürk H.E. , Sönmez B. , Erkan D. , Öge İ.
Published: January 2018

Purpose

To establish normal exophthalmometry values in the adult Turkish population, and the impact of age, gender, interpupillary distance, Hertel base selection, and refractive status on globe position.

Methods

Exophthalmometry measurements and refractive status of 2477 subjects were conducted in one tertiary and five primary health care centers. Change of globe position by age, intersex differences in terms of globe position, correlations of Hertel base with exophthalmometry results, and interpupillary distance (IPD) were evaluated. Multiple linear regression analysis was performed to test determination effect of each variable on final Hertel reading.

Results

Median Hertel reading was 13 mm, and 95% of the population had an upper limit of 17 mm for both eyes. There was a negative correlation between spherical equivalent of refractive status and exophthalmometry results and a weak positive correlation between IPD and exophthalmometry result. Mean Hertel value was found to decrease significantly after the third decade. Hertel base value was found to have moderate linear correlation with Hertel results. A weak correlation was detected with Hertel base/IPD ratio with final Hertel results. Multiple linear regression analysis was performed and only 13% and 20% of change in Hertel values bilaterally were found to be determined by other variables (age, IPD, refractive status, and Hertel base value) for females and males.

Conclusions

Normative dataset for exophthalmometry results of the Turkish population is established to be used in clinical practice and research. Only 13% to 20% of change in Hertel values was detected to be determined by age, IPD and Hertel base values.
Intracameral Avastin Dramatically Resolves Iris Neovascularization and Reverses Neovascular Glaucoma
Authors: Chalam K.V. , Gupta S.K. , Grover S. , Brar V.S. , Agarwal S.
Published: January 2018

Purpose

To report the biologic effect of intracameral bevacizumab in patients with iris neovascularization secondary to proliferative retinal vasculopathies.

Methods

Sixteen eyes of 15 patients with iris neovascularization associated with or without neovascular glaucoma secondary to proliferative retinal vasculopathies received intracameral bevacizumab (1.25 mg). Ophthalmic evaluations included Snellen visual acuity (VA), complete ophthalmic examination, fluorescein iris angiography, and slit lamp photography Main outcome measure was change in degree of iris neovascularization. Secondary outcomes included fluorescein iris angiographic leakage, control of intraocular pressure, and changes in VA.

Results

All patients with neovascularization demonstrated by slit lamp photography and fluorescein angiography (16/16 eyes) had complete (or at least partial) reduction in leakage of the neovascularization within 3 weeks after the injection. Leakage from iris neovascularization resolved in 12 of 16 (75%) eyes. In two cases recurrent leakage was seen as early as 4 weeks necessitating repeat injection. Intraocular pressure was controlled with maximum medical therapy in eight of nine eyes reducing the need for glaucoma surgery. Visual acuity improved from a median of hand motions to 20/200.

Conclusions

In summary, intracameral bevacizumab was effective in reversing iris neovascularization in the majority of patients. It also facilitated intraocular pressure control in patients with associated glaucoma.
Endothelial Function, Intima-Media Thickness, and Ankle-Brachial Index in Patients with Cataract and Age-Related Macular Degeneration
Authors: Zaliuniene D. , Jasinskas V. , Jurkevicius R. , Gustiene O. , Zaliunas R.
Published: January 2018

Purpose

To evaluate the association between cardiovascular risk factors, including endothelial dysfunction, increased intima-media thickness (IMT) of the carotid arteries, ankle-brachial index (ABI), and age-related macular degeneration (AMD), and cataract.

Methods

Forty-seven patients with AMD and cataract, 35 with cataract only, and 49 with AMD were included. Carotid ultrasound, ischemia-induced brachial artery reactivity test, and ABI in conjunction with investigation of conventional cardiovascular risk factors were performed.

Results

Increased levels (more than 1.23 mg/L) of high-sensitivity C-reactive protein (hsCRP) and IMT (more than 0.97 mm) increased prevalence odds for AMD and cataract 3.1 and 3.9 times, respectively.

Conclusions

Elevated hsCRP or increased IMT of the carotid arteries are associated with comorbid cataract and AMD, whereas there were no reliable differences between groups in respect to endothelial function and ABI.
Five-Year Results of Viscocanalostomy
Authors: David V.P. , Kutty K.G. , Somasundaram N. , Varghese A.M.
Published: January 2018

Purpose

To prospectively study the success rates and complications of viscocanalostomy.

Methods

Prospective nonrandomized case series of 46 eyes (46 patients) with medically uncon-trolled primary and secondary open angle glaucoma. All patients in the study underwent viscocanalostomy. Control of intraocular pressure was used to measure success. Pre and postoperative glaucoma medications, visual acuity, complications, and adjunctive procedures were recorded.

Results

At 60 months, qualified success (intraocular pressure below 21 mmHg with glaucoma medication) was achieved in 37 (82%) patients and complete success (intraocular pressure below 21 mmHg without medication) in 25 (54%) patients. Nd:YAG laser goniopuncture was performed in 33 (72%) patients with significant post laser reduction of intraocular pressure. No sight threatening complications were observed in this series. Visual acuity remained unchanged in 33 patients (72%).

Conclusions

Viscocanalostomy appears to be a safe and effective intraocular pressure lowering procedure in eyes with primary open angle glaucoma and certain types of secondary open angle glaucoma.
Intravitreal Triamcinolone for the Treatment of Refractory Macular Edema in Idiopathic Intermediate or Posterior Uveitis
Authors: Hogewind B.F.T. , Zijlstra C. , Klevering B.J. , Hoyng C.B.
Published: January 2018

Purpose

Cystoid macular edema (CME) is the most significant cause of visual loss associated with idiopathic uveitis. The authors report on the use of intravitreal triamcinolone acetonide (IVTA) in a group of patients with macular edema due to idiopathic intermediate and posterior uveitis.

Methods

Retrospective, noncomparative, interventional case series. Thirty-three eyes were included with uveitic CME that was refractory to topical steroids, oral prednisone, or a combination thereof. Previous steroid treatment did not result in elevated intraocular pressure (IOP). The eyes received an intravitreal injection with 10 mg triamcinolone acetonide, after best-corrected visual acuity (BCVA) and fluorescein angiography (FA) were assessed. Ophthalmologic examination including FA was regularly performed during a 1-year follow-up period.

Results

Within 12 weeks after injection of IVTA, 50% of the eyes responded with an improvement in vision of more than two lines and 30% of the eyes reached an IOP of ≥21 mmHg (p<0.01). All eyes with an elevated IOP responded well on topical antiglaucoma medication. After 12 months follow-up 40% of the eyes responded with an improvement in vision of more than two lines and 28% of the affected eyes underwent phacoemulsification during the follow-up. No other complications occurred within a year after the treatment.

Conclusions

In macular edema due to idiopathic intermediate or posterior uveitis IVTA improves the visual acuity within the first 3 months. However, thereafter the visual acuity decreases again. Cataract and elevated IOP are common side effects.
Ophthalmologic Abnormalities in Long-Chain 3-Hydroxyacyl-Coa Dehydrogenase Deficiency: Presentation of a Long-Term Survivor
Authors: Sturm V.
Published: January 2018

Purpose

Long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD) deficiency is one of the recently discovered defects of mitochondrial fatty acid beta-oxidation surprisingly associated with ophthalmologic abnormalities. The presentation of a long-term survivor may enlarge the clinical spectrum associated with this disorder.

Methods

A 12-year retrospective review of the clinical course of a 19-year-old long-term survivor was performed. The author concentrated on characteristic ophthalmologic measures: visual acuity, refraction, ophthalmoscopy, visual fields, and electroretinography

Results

The author found a milder course than described in the literature, although very few case reports of long-term survivors have been published. The patient developed slower circumscribed atrophy of the choroid, retinal pigment epithelium, and retina.

Conclusions

Because of therapeutic and prenatal diagnostic opportunities in LCHAD deficiency, it is important to recognize this severe disorder early in its course. This may lead to a milder course and better prognosis due to early dietary therapy.
Comparison of Daytime Efficacy and Safety of Dorzolamide/Timolol Maleate Fixed Combination versus Latanoprost
Authors: Mulaney J. , Sonty S. , Ahmad A. , Stewart J.A. , Stewart W.C.
Published: January 2018

Purpose

To compare the 12-hour efficacy and safety of dorzolamide/timolol fixed combination (DTFC) dosed twice daily versus latanoprost dosed every evening following a timolol run-in in primary open-angle glaucoma patients.

Methods

Following a 6-week timolol run-in patients were randomized to either DTFC or latanoprost for 6 weeks and then changed to the opposite treatment for 6 weeks. At the end of the run-in, and the end of each treatment period, the intraocular pressure (IOP) was measured every 2 hours between 8:00 AM and 8:00 PM.

Results

Thirty-one patients completed at least one time point in both treatment periods. Both treatments reduced the IOP for the diurnal curve, and at each time point, from the timolol run-in baseline (p<0.0001). The 12-hour IOP on timolol was 22.1±2.8 mmHg, whereas on DTFC it was 18.1±2.8 and latanoprost 18.3±3.1 mmHg (p=0.4). Further, there was no statistical difference in IOP between treatments at any time point (p≤0.1). There was no statistical difference for any individual adverse event between treatments (p>0.05).

Conclusions

This study suggests that following a timolol run-in both DTFC and latanoprost provide comparable daytime efficacy and safety.
Four Years Incidence of Diabetic Retinopathy and Effective Factors on its Progression in Type II Diabetes
Authors: Manaviat M.R. , Rashidi M. , Afkhami-Ardekani M.
Published: January 2018

Purpose

To study the 4 years incidence of diabetic retinopathy in patients with type II diabetes and effective factors on its progression.

Methods

Among diabetic patients referred to Yazd Diabetes Research Center, 120 patients with type II diabetes without diabetic retinopathy were selected. After complete ophthalmic examination, fasting blood sugar (FBS), postprandial blood sugar, triglyceride, and cholesterol were measured and height, weight, and blood pressure (BP) were recorded. Then patients were followed with eye examination yearly for 4 years.

Results

Four-year cumulative incidence of diabetic retinopathy was 47.5% (95% CI: 38.6–56.4). The retinopathy was mild nonproliferative diabetic retinopathy (NPDR) in 43 (35.8%) whereas 10 (8.3%) patients had moderate NPDR, 3 (2.5%) patients had severe NPDR, and only one patient had proliferative diabetic retinopathy. The incidence of diabetic retinopathy was 5.8% in first year, 20.3% in the second year, 24.4% in the third year, and 7.4% in the fourth year. Duration of diabetes, FBS, and systolic BP had statistically significant relation with grades of diabetic retinopathy. However, there was no significant association between age, sex, body mass index, triglyceride, cholesterol, method of treatment, smoking, and diastolic BP with grades of diabetic retinopathy.

Conclusions

These data provide 4-year cumulative incidence of diabetic retinopathy in defined type 2 diabetic patients. The present study shows that duration of diabetes, hyperglycemia, and systolic BP appear to be the major factors associated with the development of any level of retinopathy in type 2 diabetic patients.
Can Intravitreal Tissue Plasminogen Activator and SF6 Gas Facilitate Management of Macular Degeneration with Photodynamic Therapy?
Authors: Muqit M.M.K. , Ghanchi F.D.
Published: January 2018

Purpose

To describe the safety and efficacy of intravitreal tissue plasminogen activator (tPA) and sulfur hexafluoride (SF6) gas with sequential photodynamic therapy (PDT) in the management of submacular hemorrhage (SMH) associated with macular degeneration (MD).

Methods

Consecutive case series of five patients presenting with acute SMH from neovascular MD between May 2004 and January 2006 in a UK Eye Centre. Duration of visual loss was less than 7 weeks. Treatment involved intravitreal injections of tPA, SF6 gas to achieve pneumatic displacement of SMH, and 24 hours prone posturing. Displacement of SMH was assessed by digital photography, and choroidal neovascularization (CNV) was reclassified using angiography. PDT was applied when indicated within 1 to 12 days postoperatively.

Results

Adequate displacement of SMH allowed visualization of CNV within 24 hours in three of five patients. One patient with large SMH of 7 weeks duration had partial displacement of SMH. Three patients were reclassified with classic CNV after tPA-SF6 injection, and successfully underwent PDT.

Conclusions

Intravitreal tPA and SF6 assisted pneumatic displacement of SMH is a safe and effective intervention. This technique facilitates more accurate angiographic classification of CNV. PDT may be sequentially and rapidly applied as early as 1 day after injections. The technique may be offered to patients with neovascular MD presenting with acute SMH.
Orbital and Ocular Manifestations of Acute Childhood Leukemia: Clinical and Statistical Analysis of 180 Patients
Authors: Russo V. , Scott I.U. , Querques G. , Stella A. , Barone A. , Delle Noci N.
Published: January 2018

Purpose

To investigate the association between presence of orbital or ocular lesions and type and stage of leukemia and to investigate whether orbital and ocular lesions are significant in predicting leukemia prognosis.

Methods

The authors evaluated 180 patients with acute childhood leukemia. Lesions associated with leukemia may be classified as specific (due to leukemic infiltration of various ocular tissues), nonspecific (due to one of the secondary complications), or iatrogenic manifestations caused by chemotherapy. Risk-based treatment assignment is based on clinical and laboratory features at diagnosis. Children with presenting white blood cell count below 50,000 mm3 are considered at standard risk for treatment failure, while all others are considered at high risk for treatment failure.

Results

Specific lesions were noted in 66% of patients with acute myeloid leukemia (AML) and 11.5% patients with acute lymphocytic leukemia (ALL) (p±0.05), and were more severe in patients with high risk leukemia than in patients with standard risk leukemia. Orbital or ocular lesions were noted more commonly in patients with AML (66.6%) compared to patients with ALL (15.1%). In both the AML and ALL groups, there was a higher frequency of leukemic relapses in the bone marrow and/or central nervous system in patients with specific lesions (63.1%) compared to patients with nonspecific lesions (42%), and in patients without orbital or ocular lesions (29.2%) (p±0.05).

Conclusions

In both the AML and ALL groups, the presence of specific orbital or ocular lesions was associated with a higher frequency of bone marrow relapses and CNS involvement (p±0.05), leading to a lower survival rate.
Ocular Manifestations in a Case of Childhood Cicatricial Pemphigoid
Authors: Iovine A. , Fimiani F , Vassallo P. , Alessio M. , Magli A.
Published: January 2018

Purpose

Cicatricial pemphigoid is a rare chronic autoimmune disease, characterized by progressive alterations on the skin and mucous membranes. Ocular lesions consists of chronic conjunctivitis, progressive subepithelial fibrosis on the conjunctival fornix together with symblepharon formation, obstruction of the Meibomian ducts, sicca syndrome, and occasionally, entropion associated with consequent trichiasis and corneal ulcers.

Methods

A 9-year-old patient with cicatricial pemphigoid with severe eye involvement came to our observation. A complete anamnesis, ophthalmologic examination, and systemic evaluation, including serum antibody levels evaluation and biopsies of mouth, vulva, parotid, and intestine mucosa, were performed.

Results

Ocular examination showed blepharospasm, conjunctival hyperemia, symblepharon, total cicatricial corneal leucoma, severe dryness, trichiasis, and eyelid edema. The results of medical and surgical treatment are reported.

Conclusions

Given the serious clinical picture, possibly due to a late diagnosis, it was not possible to avoid relapse and appearance of new cicatricial adherences for which we considered wait and see the most appropriate approach, protecting the anterior segment of both eyes, sacrificing their function. Further follow-up was not possible as the patient died. An early diagnosis would have had a significant influence on the clinical course and on the response to therapy.
Burn during a Routine Pterygium Excision Operation
Authors: Naftali M. , Jabaly-Habib H. , Mukari A.
Published: January 2018

Purpose

To report a patient who sustained a spark fire burn during a routine pterygium operation.

Methods

A 40-year-old woman was referred for pterygium excision in her left eye. During the operation a low temperature cautery caused a spark fire that resulted in left eye corneal burn, upper and lower eyelid burns, and melting of eyelashes and eyebrows bilaterally.

Results

Topical antibiotics and vitamin C followed by topical corticosteroids were given. After 1 week the corneal epithelium healed but a paracentral corneal opacity developed. Two months later on last follow-up visit, a mild diffuse corneal opacity was still seen. The combination of three elements found in most routine (ophthalmologic) surgical fields-an enriched oxygen environment with the high temperature transmitted by the electrocautery in the vicinity of hair-might explain the event.

Conclusions

Surgeons should try to separate these three elements or eliminate any of them, in order to minimize or prevent such events.
Automatized Large Diameter Lamellar Keratoplasty and Stem Cell Transplantation for the Treatment of Ocular Surface Diseases with Limbal Insufficiency
Authors: Mendicute J. , Bidaguren A. , Martínez-Soroa I. , Gibelalde A.
Published: January 2018

Purpose

To report a new surgical procedure for the treatment of ocular surface diseases associated with severe limbal insufficiency.

Methods

A retrospective review of four patients with severe ocular surface disease who required stem cell transplantation and keratoplasty for the correction of limbal insufficiencies. They underwent large diameter lamellar keratoplasty with microkeratome. When limbal dysfunction was associated with limited alteration of the ocular surface and transparent deep corneal stroma only the anterior corneal stroma was transplanted. When the entire corneal thickness was compromised, both anterior and deep donor buttons were transplanted.

Results

Patients remained stable and improved their visual acuity after surgery. Best-corrected visual acuity ranged from 20/200 to 20/30. No corneal graft rejections were found. The main complication found in one of our patients was a central stromal opacity which required a secondary penetrating keratoplasty.

Conclusions

Automatized large diameter lamellar keratoplasty provides a safe and successful alternative to limbal transplantation for limbal insufficiency associated with corneal opacity. This technique enables a single-stage surgical procedure and the use of a single donor which reduces the risk of rejection. In addition, better refractive results are achieved due to the quality of the interface and the absence of corneal sutures.
Silicone Oil in the Surgical Treatment of Traumatic Endophthalmitis
Authors: Yan H. , Lu Y , Yu J. , Han J. , Zhang J. , Chen S. , Xu Y
Published: January 2018

Purpose

To explore the effects of vitrectomy combined with silicone oil injection in the treatment of traumatic endophthalmitis without retinal detachment, and analyze the relative factors.

Methods

Eighteen eyes of 18 patients with traumatic endophthalmitis and without retinal detachment received the treatment of vitrectomy combined with silicone oil filling. Silicone oil removal combined with intraocular lens implantations were performed in all eyes 6 months postoperatively. The visual acuity was measured by logMAR values. Preoperative visual acuity ranged from light perception to 0.1. The mean preoperative intraocular pressure was 9 mmHg with a range from 5 to 25 mmHg. Follow-up ranged from 6 to 43 months with a mean of 18 months.

Results

The postoperative visual acuity ranged from light perception to 0.8 at the last follow-up examination. The visual acuity increased in 15 eyes (83%), and was stable in 3 eyes (17%). The mean postoperative intraocular pressure was 17 mmHg with a range from 10 to 20 mmHg, and was significantly higher than preoperatively (p<0.05). There was no retinal detachment or ocular atrophy. Postoperative complications mainly included fibrosis exudates in the anterior chamber (18 eyes) and temporary intraocular pressure elevation (3 eyes).

Conclusions

Under treatment with systemic antibiotics, vitrectomy combined with silicone oil filling may be a reasonable alternative to standard endophthalmitis treatment using intravitreal antibiotics.
Intermediate Visual Acuity without Spectacles following Bilateral ReSTOR® Implantation
Authors: Cuq C. , Spera C. , Laurendeau C. , Lafuma A. , Berdeaux G.
Published: January 2018

Purpose

This survey determined uncorrected visual acuity (VA) at near, intermediate, and far distances in cataract patients implanted with ReSTOR®, and assessed patient satisfaction.

Methods

Consecutive cataract patients implanted bilaterally with ReSTOR® were followed up at least 4 months. The Early Treatment Diabetic Retinopathy Study scale was used to measure VA for near (40 cm), intermediate (50, 60, and 70 cm), and distance vision, with VAs expressed in logMAR and adjusted for distance using Bennett's (1993) formula. Satisfaction was self-rated on a visual analogue scale ranging from 0 (poor) to 10 (high).

Results

Twenty-four consecutive patients (mean age 67.6 years) were operated upon by a single surgeon and followed up for a mean of 336.5 days after second eye surgery. Average postoperative VAs for uncorrected distance were 0.06 logMAR and intermediate VAs were 0.21 logMAR at both 50 cm and 60 cm and 0.22 logMAR at 70 cm. These levels of uncorrected intermediate VA would allow patients to read Word® computer text in Times New Roman font 8 zoomed to 100%, at 70 cm from the monitor screen. The authors found that 23/24 patients (96%) no longer wore spectacles. The remaining patient required correction for astigmatism as this refraction error is not yet correctable by ReSTOR®. Average self-rated satisfaction was 8.54.

Conclusions

In an everyday surgical practice, none of the studied bilateral ReSTOR® cataract patients without astigmatism required spectacles when followed up 6 months or later. Intermediate VA was compatible with reading and led to high patient satisfaction.
Correlation of Disc Damage Likelihood Scale, Visual Field, and Heidelberg Retina Tomograph II in Patients with Glaucoma
Authors: Hornová J. , Kuntz Navarro J.B.V. , Prasad A. , Freitas D.G.J. , Nunes C.M.
Published: January 2018

Purpose

To correlate the analysis of the optic nerve head (ONH) obtained with Disc Damage Likelihood Scale (DDLS), Heidelberg Retina Tomograph II (HRT II), and visual field (VF) parameters (Aulhorn scale, mean deviation [MD], and pattern standard deviation [PSD]) in patients with glaucoma.

Methods

Sixty-five eyes were evaluated using the DDLS classification. Fifty-seven eyes had stable primary open-angle glaucoma (POAG) and eight eyes were normal (control group). Classification of the ONH was performed using the HRT II, with Moorfields Regression Analysis (MRA) and Cup Shape Measure (CSM) indexes. The VF was examined by Full Threshold test (30–2) using the Humphrey Field Analyzer (HFA) perimeter and evaluated by three methods: Aulhorn's scale of 0 to 6, and two global indices, MD and PSD.

Results

The amount of ONH damage as estimated by the DDLS correlated well with topographic damage determined by HRT II (r=0.923 with MRA and r=0.807 with CSM) and with visual field loss as measured by the MD (r=-0.792) and PSD (r=0.718) of the HFA and Aulhorn field staging system (r=0.849).

Conclusions

This study shows that evaluation of the ONH using the DDLS provides information that correlates well with VF and with data obtained from HRT II.
Nonpenetrating Deep Sclerectomy with Reticulated Hyaluronic Acid Implant versus Punch Trabeculectomy: A Prospective Clinical Trial
Authors: Russo V. , Scott I.U. , Stella A. , Balducci F. , Cosma A. , Barone A. , Delle Noci N.
Published: January 2018

Purpose

To compare the intraocular pressure (IOP)-lowering effect and complication rate of nonpenetrating deep sclerectomy (NPDS) with reticulated hyaluronic acid (SK-GEL®) scleral implant versus traditional punch trabeculectomy (PT) in the management of primary open angle glaucoma (POAG).

Methods

Prospective, randomized comparative study including 93 patients with uncontrolled POAG. Group 1 (43 eyes) underwent NPDS with SK-GEL® scleral implant; Group 2 (50 eyes) underwent PT Mitomycin C (0.2 mg/mL) was applied intraoperatively in both techniques. Study follow-up evaluations were conducted at 36 and 48 months. Complete success indicated the achievement of the target IOP without antiglaucoma medications, while qualified success indicated the same goal with medications. These categories were assessed at two target IOP levels, <21 mmHg and <18 mmHg.

Results

At 36 months for complete and qualified success with a <21 and <18 mmHg target IOP, no significant differences were noted between the two groups. At 48 months postprocedure when a <21 mmHg IOP target was considered, the rate of eyes that achieved complete success was 51.1% in the NPDS group versus 72% in the PT group (p<0.05). As for the <18 mmHg IOP target, the rate of eyes that achieved complete success was 32.5% in the NPDS group versus 44% in the PT group (p<0.05). Complications occurred significantly more frequently after PT than after NPDS.

Conclusions

The IOP-lowering effects of the two procedures were comparable at 36 months. At 48 months PT showed a significantly higher rate of complete success compared with NPDS. Complications were more frequent after PT than after NPDS.
Serum Haptoglobin Levels in Ocular Behçet Disease and Acute Phase Proteins in the Course of Behçet Disease
Authors: Yalçindağ F.N. , YalçIndağ A. , Çağlayan O. , Özdemir Ö.
Published: January 2018

Purpose

Changes in concentrations of acute phase proteins in the serum of patients might be significant in the pathogenesis of Behçet disease. This report investigates the association between ocular disease activity and serum haptoglobin levels in patients with Behçet disease, and summarizes the current understanding of the correlation between acute phase proteins and Behçet disease based on both personal studies and data from the literature.

Methods

Thirty patients with Behçet disease with ocular involvement and 15 healthy subjects were included in the study. Of the 30 patients, 14 had acute uveitis and 16 had inactive ocular involvement at the time of enrollment.

Results

There was a significant difference in haptoglobin levels between the patients with active ocular disease and controls (p=0.0005). There was also a significant difference in haptoglobin levels between the patients with inactive ocular disease and control subjects (p<0.0001). However, no significant difference was observed among patients with active versus inactive uveitis with regard to serum haptoglobin levels.

Conclusions

Higher serum haptoglobin levels in patients with Behçet disease compared to control subjects were obtained. However, elevated serum haptoglobin levels do not seem to be a risk factor for uveitis activity. Behçet disease is generally diagnosed by physical examinations and no laboratory marker has been widely accepted for follow-up of disease activity.
Retinal Nerve Fiber Layer Thickness in Congenital Color Vision Deficiency
Authors: Yilmazbas Taner P. , Onaran Z. , Ornek K. , Gullu R.
Published: January 2018

Purpose

To evaluate the thickness of the retinal nerve fiber layer (RNFL) in subjects with congenital red-green color vision deficiency (CVD).

Methods

This study included 20 healthy subjects with congenital red-green CVD and 22 healthy subjects with normal color vision. After Ishihara test and examinations visual field by automated perimetry, all individuals underwent scanning laser polarimetry to measure the thickness of the RNFL.

Results

All scanning laser polarimetry parameters related to RNFL thickness were found to be similar in subjects with congenital CVD and normal color vision (p>0.05).

Conclusions

This is the first report suggesting normal thickness of the RNFL in subjects with congenital red-green CVD.
Microbiologic Efficacy of 3-day Treatment with Azithromycin 1.5% Eyedrops for Purulent Bacterial Conjunctivitis
Authors: Denis F. , Chaumeil C. , Goldschmidt P. , Delval L. , Pouliquen P. , Cochereau I. , Chainier D. , De Barbeyrac B.
Published: January 2018

Purpose

Antibacterial efficacy of topically applied azithromycin 1.5% was compared with tobramycin 0.3% in a multicenter, randomized, investigator-masked study for the treatment of purulent bacterial conjunctivitis.

Methods

A total of 1043 adults and children received either azithromycin twice daily for 3 days (n=524) or tobramycin every 2 hours while awake for 2 days, then four times daily for 5 days (n=519). Conjunctival swabbing was taken at days 0, 3, and 9, using alginate swabs resuspended in a dissolution-transport medium, providing rapid and reproducible results. Cagle's criteria were used to define the pathogenicity level for each isolated bacterium.

Results

In the per-protocol set, the rate of bacteriologic resolution was 85.2% for azithromycin versus 83.8% for tobramycin on day 3, and 92.8% for azithromycin versus 94.6% for tobramycin on day 9. Azithromycin was demonstrated to be noninferior to tobramycin according to the 10% noninferiority margin. Although some bacteria were categorized as resistant to tested antibiotics, eradication was observed (for azithromycin: Acinetobacter, Enterobacteriaceae, Pseudomonas), highlighting the specific pharmacokinetics/pharmacodynamics of the ocular route.

Conclusions

In total, topical therapy with azithromycin 1.5% administered only twice daily for 3 days effectively eradicates most pathogenic bacteria associated with bacterial conjunctivitis. These microbiologic results are in accordance with the observed clinical outcome. This new anti-infective product has the advantage of a short treatment course which could lead to an improvement in patient compliance.
Limbal Stem Cells Transplantation in the Reconstruction of the Ocular Surface: 6 Years Experience
Authors: Wylegala E. , Dobrowolski D. , Tarnawska D. , Janiszewska D. , Gabryel B. , Małecki A. , Siekiera U.
Published: January 2018

Purpose

To analyze the graft survival rate and stability of the corneal surface in patients who underwent limbal stem cell transplantation. Three surgical techniques were performed based on the origin of the ocular surface lesion: conjunctival limbal autograft (CLAU), living-related conjunctival limbal autograft (lr-CLAL), and keratolimbal allograft (KLAL) transplantations.

Methods

Nonrandomized consecutive comparative case series study. Eighty-four patients (90 eyes; 31 women and 53 men; age range: 11–78 years) were included in the study. Mean follow-up was 31.2 months (range: 6–72 months). Patients were divided into three groups: CLAU, lr-CLAL, and KLAL, comprising 21, 26, and 43 eyes, respectively. Graft survival rate and clinical success of the stem cell transplantation was confirmed by impression cytology. The Kaplan Meier survival curve and generalized Peto tests were used for the analyses.

Results

Graft survival rate and the regularity of the corneal surface differed significantly between the allo- and autografts. The 3-year and 6-year graft survival rates were 76.1% and 61.9%, respectively, for the autologous transplantation group, and 59.4% and 46.3%, respectively, for the allogeneic transplantation group. Corneal surface restoration correlated with positive staining for corneal epithelial cells in impression cytology.

Conclusions

Significantly better long-term outcomes were achieved with autotransplantation of the limbus compared with allogeneic limbal grafts from living-related and cadaveric donors.