bluuebunny/crossref_metadata_2025 huggingface dataset:
Bevacizumab-Augmented Retinal Laser Photocoagulation in Proliferative Diabetic Retinopathy: A Randomized Double-Masked Clinical Trial
Authors: Mirshahi A. , Roohipoor R. , Lashay A. , Mohammadi S.-F. , Abdoallahi A. , Faghihi H.
Published: January 2018

Purpose

To evaluate the additional therapeutic effect of single intravitreal bevacizumab injection on standard laser treatment in the management of proliferative diabetic retinopathy.

Methods

A prospective, fellow-eye sham controlled clinical trial was conducted on 80 eyes of 40 high-risk characteristic proliferative diabetic retinopathy type II diabetics. All cases received standard laser treatment according to Early Treatment Diabetic Retinopathy Study protocol. Avastin-assigned eyes received 1.25 mg intravitreal bevacizumab (Genentech Inc., San Francisco, CA) on the first session of their laser treatments. Fluorescein angiography was performed at baseline and at weeks 6 and 16, and proliferative diabetic retinopathy regression was evaluated in a masked fashion.

Results

The median age was 52 years (range: 39–68) and 30% of the participants were male. All patients were followed for 16 weeks. A total of 87.5% of Avastin-injected eyes and 25% of sham group showed complete regression at week 6 of follow-up (pp<0.005). However, at week 16, PDR recurred in a sizable number of the Avastin-treated eyes, and the complete regression rate in the two groups became identical (25%; p=1.000); partial regression rates were 70% vs 65%. In the subgroup of Avastin-treated eyes, multivariate analysis identified hemoglobin A1c as the strongest predictor of proliferative diabetic retinopathy recurrence (p=0.033).

Conclusions

Intravitreal bevacizumab remarkably augmented the short-term response to scatter panretinal laser photocoagulation in high-risk characteristic proliferative diabetic retinopathy but the effect was short-lived, as many of the eyes showed rapid recurrence. Alternative dosing (multiple and/or periodic intravitreal Avastin injections) is recommended for further evaluation.
Short-Term Effect of Topical Brinzolamide on Human Central Corneal Thickness
Authors: Örnek K. , Güllü R. , Oğurel T. , Ergın A.
Published: January 2018

Purpose

To investigate the effect of short-term brinzolamide application on human central corneal thickness (CCT).

Methods

Seventeen eyes of 16 patients who underwent neodymium:YAG laser posterior capsulotomy were included in the study group. Twenty-two subjects served as controls. Brinzolamide twice daily and fluorometholone four times daily were initiated after the procedure. Corneal thickness was evaluated with an ultrasound pachymetry from the central region. CCT measurements were performed before the procedure, at first day, and at the end of first week.

Results

The mean baseline CCT value was 535.1±37.8 μm. In comparison to the control group (546.4±22.2 μm), there was no statistically significant difference (p=0.248). After brinzolamide instillation, the mean CCT values at first day and at first week was measured as 545.1±40.1 μm and 538.8±39.4 μm, respectively. The difference at first day was statistically significant when compared to the baseline values (p=0.00017). When compared to the control group, no statistically significant difference was observed for the mean CCT values of the first day and first week (p=0.906 and p=0.484, respectively). In the fellow eyes, mean CCT values increased following the dorzolamide instillation (529.3±42.6 μm, 534±41.7 μm, and 533±41.9 μm, respectively). No statistically significant difference was observed between the control group and fellow eye group when compared (p=0.162, p=0.247, p=0.270, respectively).

Conclusions

Brinzolamide may cause a short-term increase in the human CCT, particularly on the first day.
Mooren's Ulcer following Extracapsular Cataract Extraction
Authors: Acharya N.R. , Srinivasan M. , Kundu A. , Lietman T.M. , Whitcher J.P. , Cunningham E.T.
Published: January 2018

Purpose

Prior cataract surgery is a recognized risk factor for the development of Mooren's ulcer, but the demographic and clinical features of a large cohort of such patients have not been described.

Methods

The authors performed a retrospective review of demographic and clinical data from 14 eyes in 13 patients who developed Mooren's ulcer following extracapsular cataract extraction at Aravind Eye Hospital in Madurai, South India.

Results

Eight (62%) of the 13 patients were men and 5 (39%) were women. The median age in our population was 65 years, with a range of 45 to 85 years. The median number of months from surgery to the onset of Mooren's ulcer was 19, with a range of 4 to 156 months. Of the 14 eyes with prior cataract surgery, the location of the ulcer was at or contiguous with the wound in 10 eyes (71%), which was 2.5 times more likely than other circumlimbal locations, and only one patient (8%) had bilateral disease.

Conclusions

Mooren's ulcer may occur following extracapsular cataract extraction and when it does it is most likely to be unilateral and contiguous with the wound. These findings support the notion that exposure of normally concealed corneal antigens may contribute to the pathogenesis of Mooren's ulcer in some patients.
Influence of Learning Effect on Blue-On-Yellow Perimetry
Authors: Zhong Y. , Chen L. , Cheng Y. , Huang P.
Published: January 2018

Purpose

Some studies have found that a significant blue-on-yellow perimetry (B/YP) learning effect exists in patients with ocular hypertension (OHT) or open-angle glaucoma who were experienced in standard automated perimetry However, very little is known about the B/YP learning effect in normal subjects and patients without previous white-on-white perimetry (W/WP) experience. Meanwhile, it is unclear whether the B/YP learning effect is influenced by age and refraction.

Methods

Twenty healthy subjects, 26 OHT and 14 primary open angle glaucoma (POAG) patients, underwent three full-threshold B/YP tests at intervals of 7 to 21 days. Of the 60 subjects, 38 had no previous W/WP experiences, 22 had previous W/WP experiences for at least two times. The parameters investigated to detect a learning effect were the perimetric indices and the test duration (TD).

Results

Learning effects were demonstrated for mean deviation (MD), pattern standard deviation (PSD), short-term fluctuation (SF), and TD. Significant differences were found between the MD, PSD, SF, and TD of the first test and those of the second and third tests (p<0.05). However, no difference was found between those parameters of the second and third tests. No statistically significant differences were noted in terms of MD1st-2nd, MD1st-3rd, PSD1st-nd, PSD1st-3rd, TD1st-2nd, and TD1st-3rd between the group with W/WP experience and the group without previous W/WP experience (p>0.05). No statistically significant differences were noted in terms of those parameters among the normal subjects and the patients with OHT or POAG (p>0.05). No significant difference was found in the B/YP learning effect among various age groups (p>0.05) and among various refraction groups (p>0.05).

Conclusions

A significant learning effect was observed between the first and the second or third tests and the perimetric indices appeared improved at full-threshold B/YP. The previous W/WP experience and the subject age and refraction did not influence the B/YP learning effect. This above all should be taken into account when considering the clinical use of this test to avoid erroneous diagnostic conclusions.
Posterior Capsule Rupture following Closed Globe Injury: Scheimpflug Imaging, Pathogenesis, and Management
Authors: Grewal D.S. , Jain R. , Brar G.S. , Grewal S.P.S.
Published: January 2018

Purpose

To report the Scheimpflug and clinical findings in a case of pediatric posterior capsule rupture due to blunt ocular trauma.

Methods

Interventional case report. Analysis of Scheimpflug findings and review of literature.

Results

An 11-year-old boy presented 2 days after blunt trauma to the left eye with a slingshot. On examination his best-corrected visual acuity (BCVA) was 20/20 in the right eye and 20/400 in the left. Slitlamp examination (left eye) revealed a Vossius ring, traumatic cataract, and traumatic posterior capsular rupture (TPCR). The contour of the posterior bulge corresponded to the edges of the TPCR. Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany) confirmed traumatic cataract in region of TPCR evidenced by increased lens density at cortex-vitreous interface, absence of vitreous prolapse into the anterior chamber, and the amount of residual nucleus. The extent of the TPCR in the greatest and least dimensions was documented before and after intraocular lens (IOL) implantation. Intraoperatively, TPCR was evident and phacoemulsification with IOL implant was performed. Postoperatively, his BCVA improved to 20/20 in the left eye with a well-centered in-the-bag IOL as found on slit lamp and Scheimpflug images.

Conclusions

This report highlights the use of Scheimpflug imaging in isolated posterior capsule rupture following closed globe injury, to visualize and quantify the size of posterior capsule rupture and its role in management.
Macular Hole following Bartonella Henselae Neuroretinitis
Authors: Donnio A. , Jean-Charles A. , Merle H.
Published: January 2018

Purpose

To report a case of macular hole secondary to Bartonella henselae neuroretinitis.

Methods

Observational case report. An 11 year-old boy presented urgently with a decrease of visual acuity in the left eye. Posterior segment examination revealed neuroretinitis attributed to Bartonella henselae. Treatment was initiated, resulting in the disappearance of symptoms.

Results

Follow-up consultations 7 months later showed a further decline in visual acuity secondary to a macular hole.

Conclusions

Cat scratch disease is a rare pathology and is most often considered benign. Serious complications can nonetheless occur, such as neuroretinitis, choroidal nodules, and disciform keratitis. The authors report a case of sequellar macular hole. They found only one previous report of macular hole caused by B henselae, which, contrary to their case, appeared rapidly 12 days after presentation.
Needle-Shaped Deposits on Retinal Surface in a Case of Ocular Amyloidosis
Authors: Hattori T. , Shimada H. , Yuzawa M. , Kinukawa N. , Fukuda T. , Yasuda N.
Published: January 2018

Purpose

To report a case in which optical coherence tomography (OCT) showed needle-shaped deposits on the retinal surface oriented toward the vitreous cavity and immunohistochemical findings suggested light chain-related amyloidosis.

Methods

A 59-year-old man with no systemic complications had bilateral neovascular glaucoma and vitreous opacities in the right eye. Vitrectomy was conducted on the right eye and the excised vitreous was examined histopathologically.

Results

Glass wool-like opacities were observed during vitrectomy. Postoperative fundus examination of the right eye showed retinal hemorrhage and white deposits around blood vessels and on retinal surface. Fluorescein angiography revealed hyperfluorescence of the optic disc, non-perfusion areas, and vascular focal staining. OCT depicted needle-shaped deposits perpendicular to the retinal surface oriented toward the vitreous. Histologic examination of deposits revealed positive reaction for Congo red stain, and immunohistochemical examination demonstrated positive reactivities for anti-lambda and anti-kappa light chains (precursors of amyloid protein), suggesting a diagnosis of light chain-related amyloidosis.

Conclusions

In this case, OCT showed needle-shaped deposits perpendicular to the retinal surface. Special staining with Congo red revealed the deposit to be amyloid deposition. Immunohistochemical staining suggested light chain-related amyloidosis. Vascular obstructive lesions and neovascular glaucoma secondary to retinal vascular damage in amyloidosis warrant particular attention.
Ultrasound Biomicroscopy and OCT Findings in Posterior Microphthalmos
Authors: Erdöl H. , Kola M. , Türk A. , Akyol N.
Published: January 2018

Purpose

Posterior microphthalmos is a rare ocular abnormality. The authors report two siblings with bilateral posterior microphthalmos.

Methods

Two siblings (aged 10 and 13) were admitted with a history of low degree of vision. Ophthalmologic examinations, ocular ultrasonography, ultrasonic biomicroscopy (UBM), and optical coherence tomography (OCT) investigations were carried out and the results were evaluated. All results were also compared with their normal sibling.

Results

Two siblings with posterior microphthalmos have normal and near normal anterior segment dimensions, shortened axial lengths (smaller than 17 mm), low vision with high hyperopias, papillomacular folds, and crowded optic discs. OCT investigation showed bilateral papillomacular retinal fold and UBM examination showed that ciliary body moved behind the iris towards the pupilla and the iridocorneal angle anomalies in two siblings. These findings were not observed in the normal sibling.

Conclusions

Posterior microphthalmos can exist in the presence of some ocular anomalies. In this case report, UBM provided new information about the structure of iridocorneal angle and ciliary body.
Systemic Associations and Prevalence of Exfoliation Syndrome in Patients Scheduled for Cataract Surgery
Authors: Sekeroglu M.A. , Bozkurt B. , Irkec M. , Ustunel S. , Orhan M. , Saracbasi O.
Published: January 2018

Purpose

To study the frequency of exfoliation syndrome (XFS) and its association with intraocular pressure (IOP) and systemic diseases in patients with age-related cataract scheduled for surgery.

Methods

All 1480 cataract patients had a comprehensive systemic and eye examination, including slit-lamp biomicroscopy before and after mydriasis, IOP measurement, gonioscopy, and fundus examination.

Results

The percentage of XFS among patients scheduled for cataract surgery was 16.4, with no gender difference (p=0.833). The mean age of XFS patients (74.3±7.0 years) was significantly higher when compared to the ones without XFS (66.5±10.9 years) (p<0.001). XFS was unilateral in 41.3% of the subjects and bilateral in 58.7%. The number of subjects with XFS increased significantly with aging (p<0.001) (OR=1.093, 95% CI=1.073–1.14) (p<0.001). The most common type of cataract was nuclear in the XFS group (33.5%) and 24.6% of patients with mature cataract had XFS. In the XFS group, 11.2% of the subjects had glaucoma, which was statistically higher than the non-XFS group (4.6%) (p<0.001) (OR=2.67, 95% CI=1.65–4.32). Eighty-four patients had glaucoma and 27 of them (32.1%) had exfoliative glaucoma. The only systemic disease that was found to be associated with XFS was coronary heart disease with an OR of 1.49 (95% CI=1.068–2.072) (p=0.019).

Conclusions

XFS is a common problem in the aging cataract population of Turkey and increased IOP, glaucomatous optic neuropathy, and coronary heart disease occur more frequently in patients with XFS compared with subjects without XFS.
Ocular Inflammatory Signs Observed in a Cohort of Spanish Patients with Behçet Disease and Ocular Inflammation
Authors: Sáenz-Francés F , Elías-De-Tejada M. , Martínez-De-La-Casa J.M. , Calvo-González C. , Fernández-Vidal A. , Méndez-Hernández C. , Pato E. , López-Abad C. , Benítez-Del-Castillo J.M. , Garcia-Sanchez J. , Garcia-Feijoo J.
Published: January 2018

Purpose

To study the clinical characteristics of a cohort of Spanish patients diagnosed with Behçet disease and who also presented ocular inflammation.

Methods

Thirty cases of Behçet disease were studied retrospectively. The authors studied age distribution, distribution by sex, clinical course, laterality, type of uveitis, secondary glaucoma, corneal involvement, hypopyon, iris-lens synechiae, secondary cataract, cystoid macular edema (CME), and papillitis (optic neuritis).

Results

Fourteen of the patients were men and 16 were women (ratio 0.875:1). The mean age of the patients was 35.24 years (±10.917; 21–61 years). In 23 patients, the disease course was recurrent. In 9 patients, the disease manifested unilaterally. In 5 patients showing unilateral onset, the contralateral eye became affected. In 2 of the 30 patients, uveitis exclusively affected the anterior segment. In 8 patients, uveitis was solely posterior. There was one case of intermediate uveitis. The remaining 19 patients showed panuveitis. Three had focal chorioretinitis. One had diffuse chorioretinitis. Fifteen showed signs of diffuse vasculitis. Eight patients showed focal vasculitis.

Conclusions

Women were slightly more affected than men, although the authors found no significant correlation between sex and the clinical variables examined. Apart from one unexpected case of intermediate uveitis, the observations are similar to those reported for other patient series.
Characterization of Idiopathic Macular Telangiectasia Type 2 by Fundus Fluorescein Angiography in Indian Population
Authors: Narayanan R. , Majji A.B. , Hussain N. , Hussain A. , Jalali S. , Mathai A. , Shah V.A.
Published: January 2018

Purpose

To characterize the variations in fundus fluorescein angiography (FFA) features in idiopathic macular telangiectasia (IMT) type 2.

Methods

Retrospective observational study. The authors included all the patients with IMT type 2 who underwent FFA during the period from January 2004 to December 2005. The main outcome measures were subretinal neovascularization and number and distance of telangiectasia from the center of the foveal avascular zone.

Results

The mean age of 21 patients included in the study was 53.0±7.7 years. There were 11 women and 10 men. Six of the 21 patients had a history of diabetes mellitus. Subretinal neovascularization (SRN) was observed in 10 (23.8%) eyes. Subretinal plaque of pigment hyperplasia in the macula was found in 7 (21.9%) eyes, and crystalline yellowish deposits on the retinal surface were seen in 19 (59.4%) eyes. Only one eye had visible retinal telangiectasia. Most had more than 10 telangiectatic lesions in the macular area and the temporal macula was most commonly involved. The mean distance from the center of the foveal avascular zone (FAZ) up to which telangiectasia could be observed was 1340±400 μm. The maximum distance from the FAZ at which telangiectasia was identified was 2530 μm.

Conclusions

In IMT type 2, telangiectasia may be seen farther from the parafoveal area.
Assessment of Macular Function by Microperimetry in Intermediate Age-Related Macular Degeneration
Authors: Dinc U.A. , Yenerel M. , Gorgun E. , Oncel M.
Published: January 2018

Purpose

To evaluate retrospectively macular function by microperimetry (MP) in intermediate age-related macular degeneration (AMD).

Methods

Thirty eyes of 30 patients with intermediate AMD and a visual acuity of 20/32 or better were enrolled in the study. Macular function in patients with intermediate AMD and age-matched control group were carried out with MP1 microperimeter. Mean sensitivity (MS), mean defect (MD) parameters, fixation patterns, and localizations were evaluated. Mann-Whitney U test was used for the comparison of macular function parameters between the intermediate AMD group and the control group.

Results

MS was 12.7±2.8 dB and MD was detected as −6.2±2.2 dB in the intermediate AMD group by MP. Fixation patterns were stable in 22 eyes, relatively unstable in 7 eyes, and unstable in 1 eye. Fixation location was predominantly central in 19 eyes, poor central in 5 eyes, and predominantly eccentric in 6 eyes. In the control group MS was 18.0±0.6 dB and MD was −1.9±0.6 dB. When compared with control group, the decrease in MS and the increase in MD were statistically significant in the intermediate AMD group (p=0.001 and p=0.001, respectively).

Conclusions

Assessment of retinal sensitivity with MP1 microperimeter is a rapid, safe and noninvasive diagnostic method. Early macular function loss in intermediate AMD can be precisely detected by MP1 microperimeter before significant visual impairment is established and it is also useful for demonstrating the shift in the localization and the stability of fixation prior to progression of intermediate AMD to advanced and exudative stage.
Oxidative Stress Intensity in Lens and Aqueous Depending on Age-Related Cataract Type and Brunescense
Authors: Zoric L. , Elek-Vlajic S. , Jovanovic M. , Kisic B. , Djokic O. , Canadanovic V. , Cosic V. , Jaksic V.
Published: January 2018

Purpose

Cataract formation represents a serious problem in the elderly, and has a large impact on healthcare budget. The oxidative stress form and intensity might determine the cataract type and pigmentation, making efforts in the cataract prevention challenge more complex.

Methods

This is a retrospective cross-sectional review of 80 samples of aqueous humor and lens corticonuclear blocks. Aqueous samples were analyzed by the method of antioxidant activity estimation (%iMDA), while lipid peroxides (LP) and total sulfhydryl groups (TSH) were determined in lenses.

Results

Mixed and brunescent cataracts have statistically significant lower values of antioxidative %iMDA and TSH (p<0.001 for both parameters) and higher values of lipid peroxidation (p<0.001). No correlation between LP and TSH with maturity of cortical cataract was found, but there was a significant correlation with the %iMDA (p<0.05).

Conclusions

The role of the oxidative stress in cataractogenesis could not be the same for all cataract types. High level of lipid peroxides in pigmented cataracts may point to the different nature of pigment source than proteins solely, whereas lipid peroxidation and SH groups consumption in cortical cataractogenesis might be of less importance.
Amniotic Membrane Transplantation: Indications and Results
Authors: Yildiz E.H. , Nurozler A.B. , Ozkan Aksoy N. , Altiparmak U.E. , Onat M. , Karaguzel H. , Duman S.
Published: January 2018

Purpose

To describe amniotic membrane transplantation indications and results at the authors' institution.

Methods

In this study, chart review of 108 patients who underwent amniotic membrane transplantation between January 2002 and April 2006 was performed. The survival rate of corneal integrity was compared, using Kaplan-Meier survival analysis, as a measure of success rate.

Results

The mean age of the patients was 55.2±20.1 (6–87 years, 75 female, 51 male). The patients underwent amniotic membrane transplantation for six different diagnoses: nontraumatic corneal perforation (32 eyes, Group 1), persistent epithelial defect (29 eyes, Group 2), aphakic/pseudophakic bullous keratopathy (18 eyes, Group 3), infectious ulcer resistant to treatment (14 eyes, Group 4), necrotizing keratitis secondary to endophthalmitis (10 eyes, Group 5), and caustic injury (5 eyes, Group 6). The mean survival of corneal integrity was similar in all groups (p=0.156).

Conclusions

Amniotic membrane transplantation is a successful adjunctive method in achieving corneal epithelization in the study indications.
Penetrating Keratoplasty for Corneal Ectasia after Laser in Situ Keratomileusis
Authors: Kucumen R.B. , Yenerel N.M. , Gorgun E. , Oncel M.
Published: January 2018

Purpose

To improve the visual acuity of patients with progressive keratectasia following laser in situ keratomileusis (LASIK).

Methods

Five eyes of four patients underwent penetrating keratoplasty for ectasia after LASIK. In one patient the second eye was operated on 10 months after the first keratoplasty. The pre- and postoperative refraction, best spectacle-corrected visual acuity, and topographic data were evaluated.

Results

The preoperative refraction was −20.0 diopters (D) with high cylindrical values in all eyes at the time of surgery. After penetrating keratoplasty, mean spherical equivalent was −13.08±3.62 (SD) and mean refractive cylinder was −3.87±1.12 (SD). In one eye Urrets-Zavalia syndrome was noted as an early postoperative complication. In the second operated eye of another patient, there had been graft rejection several times. In this patient, frequent steroid use led to secondary glaucoma and he required filtering surgery.

Conclusions

Penetrating keratoplasty is effective and successful in treating iatrogenic keratectasia after LASIK, but these patients need a close and lifelong follow-up to treat late-term complications such as graft rejection and secondary glaucoma.
Stability of Silicone Band Frontalis Suspension for the Treatment of Severe Unilateral Upper Eyelid Ptosis in Infants
Authors: Fogagnolo P. , Serafino M. , Nucci P.
Published: January 2018

Purpose

To address the efficacy, safety, and stability of frontalis suspension of the upper eyelid with a silicone band for the treatment of severe congenital ptosis in infants.

Methods

Data from 22 pediatric patients undergoing unilateral frontalis suspension with silicone band were retrospectively reviewed with a follow-up ranging from 18 to 30 months. The margin-reflex distance (MRD) and the corneal staining had been evaluated at each pre- and postoperative visit. Data were analyzed by analysis of variance and t test for paired data.

Results

MRD was absent before surgery in all cases: it ranged from −1 mm to −4 mm (-2.4±0.8 mm). Immediately after surgery, it increased to 2.9±0.3 mm, and then progressively reduced by 0.6 mm within the first 3 months (p=0.001); a further reduction of 0.2 mm, occurring between 3 and 12 months after surgery, was not statistically significant. After the 12-month visit, no changes in MRD were found at follow-up for any patient. Corneal staining, which was present in five patients over the first 2 postoperative weeks, recovered without sequelae. Complications occurred in three eyes: overcorrection and corneal ulcer in one case requiring removal of the silicone band, one granuloma, and one extrusion of the silicone band from the upper frontal incision.

Conclusions

During the study period, the frontalis suspension with a silicone band was an effective and safe procedure. MRD values were stable between month 3 and the end of follow-up, although this series does not preclude the possible occurrence of blepharoptosis at longer time intervals.
A European Perspective on Costs and Cost Effectiveness of Ophthalmic Combinations in the Treatment of Open-Angle Glaucoma
Authors: Hommer A. , Thygesen J. , Ferreras A. , Wickstrøm J. , Friis M.M. , Buchholz P. , Walt J.G.
Published: January 2018

Purpose

Efficacy, safety, and cost implications are important considerations when choosing an ophthalmic treatment. Fixed-combination glaucoma medications containing brimonidine 0.2% and timolol 0.5%, or dorzolamide 2% and timolol 0.5%, were compared with brimonidine 0.2% and dorzolamide 2% that were used as adjunctive therapy to timolol 0.5%.

Methods

A literature review was conducted to determine the outcome parameters of intraocular pressure reduction and tolerability after 3 months of use of brimonidine or dorzolamide, each together with timolol as a fixed-combination or in concomitant therapy. Modelled cost-minimization and cost-effectiveness analyses were performed to investigate the economic consequences of ophthalmic therapy with brimonidine, dorzolamide, and timolol from a societal perspective.

Results

The literature review found that brimonidine and dorzolamide used as fixed combinations with timolol as well as in adjunctive therapy to timolol were equally effective and safe. Furthermore, in the European countries studied, the fixed combination of brimonidine/timolol represented a less costly option when compared to the fixed combination of dorzolamide/timolol evaluated over both a 3-month and a 12-month horizon.

Conclusions

Brimonidine used as a fixed-combination therapy with timolol provided better cost value than dorzolamide/timolol in all the countries studied. For most countries, the fixed combination of brimonidine and timolol also provided better cost value than adjunctive therapy with brimonidine, which was more cost effective than adjunctive therapy with dorzolamide.
The Role of Advanced Oxidation Protein Products and Total Thiols in Diabetic Retinopathy
Authors: Baskol G. , Gumus K. , Oner A. , Arda H. , Karakucuk S.
Published: January 2018

Purpose

This study aimed to investigate the role of protein peroxidation by detecting the serum levels of advanced oxidation protein products (AOPP), a novel marker for the degree of oxidative damage to proteins, and total thiol as a marker of antioxidant status in diabetic patients with or without diabetic retinopathy (DR) and to compare the results with those of control subjects.

Methods

The study groups consisted of two separate subgroups: 1) 37 patients (14 male, 23 female) with noninsulin-dependent diabetes mellitus (NIDDM) showing diabetic retinopathy (DR) and 2) 20 patients with NIDDM and without any signs of DR (9 male, 11 female); 26 healthy non-diabetic control subjects (15 male, 11 female) were selected from the patients attending our department for refractive disorders. Venous blood samples of all participants were collected in the morning after an overnight fast, and serum samples stored at −70°C until assay for AOPP, and total thiol.

Results

AOPP levels were significantly higher in diabetic patients with (210.9±73.0 μmol/L) or without DR (222.7±94.4 μmol/L) when compared to those of controls (152.4±72.04 μmol/L) (p=0.004). Even though the difference was not statistically significant (p=0.095), total thiol levels in cases with DR (278.7±139.1 μmol/L) were lower than those without DR (334.0±129.4 μmol/L) and controls (353.2±145.6 μmol/L). Correlation tests did not reveal any association between these parameters and age, sex, or duration of DM.

Conclusions

The present study suggests that increased protein oxidation may contribute to the pathogenesis of DR.
OCT-Guided Photodynamic Therapy for Angiographic Occult CNV in Pathologic Myopia
Authors: Milani P. , Pierro L. , Scialdone A.
Published: January 2018

Purpose

Pathologic myopia (PM) is frequently complicated by choroidal neovascularization (CNV). Diagnosis is mainly clinical and angiographic but in recent years optical coherence tomography (OCT) has been noted to add important information. The authors report on the successfully OCT-guided photodynamic therapy (PDT) of an angiographic occult CNV complicating PM.

Methods

Observational case report. Fluorescein angiography with a confocal SLO (HRA, Heidelberg Engineering, Germany) and OCT Stratus (Carl Zeiss Meditec, Inc.) imaging were used for diagnosis and monitoring of the CNV. Standard PDT was performed.

Results

A highly myopic 17-year-old girl complained of a drop in visual acuity (VA) in left eye (LE), dating back a few weeks. Her best-corrected (BC) VA was 20/40 in the LE, with some metamorphopsia. No hemorrhage or evident signs of CNV were visible either at fundus or at dynamic fluorescein angiography. OCT scans indicated a slight elevation of the RPE-choriocapillary complex with rarefaction of neuroretinal tissue that has been interpreted as CNV. PDT was then performed. LE BCVA had improved to 20/25, metamorphopsias disappeared, and at OCT examination no retinal morphologic modification was evident. Nine months later, BCVA and ophthalmoscopy are still stable.

Conclusions

In this case, OCT was the fundamental tool for the correct diagnosis and post-therapy monitoring of CNV-complicated PM. The CNV, not clearly detectable using angiographic imaging, was treated with PDT, and results in terms of VA and anatomic resolution were good.
Modifying the Position of Cataract Incisions in Triple Procedure
Authors: Baykara M. , Uçan G.
Published: January 2018

Purpose

The authors present a surgical technique for enhancing the visualization of the lens capsule by lamellar corneal dissection and performing phacoemulsification through the partially trephined recipient bed in eyes undergoing penetrating keratoplasty combined with cataract surgery.

Methods

First, the cornea was thinned by lamellar dissection in 11 patients undergoing triple procedure (penetrating keratoplasty phacoemulsification, and intraocular lens implantation). After continuous curvilinear capsulorhexis (CCC) was performed in the closed system, phacoemulsification was carried out through the incisions that were created on the partially trephined recipient bed. The trephination was completed by excising the remaining corneal tissue and intraocular lens was implanted. At the end of the surgery, donor cornea was sutured into the recipient bed.

Results

The cataract surgery was performed in a closed system and the cataract incision places were removed at the end of the surgery; therefore both CCC and phacoemulsification could be completed easily without any intraoperative complication in 11 eyes of 11 patients.

Conclusions

Phacoemulsification, through the recipient bed that is thinned by lamellar dissection, could be safely performed in a short time, under good view of the lens.
Congenital Cataract Extraction with Primary Aphakia and Secondary Intraocular Lens Implantation in the Posterior Chamber
Authors: Magli A. , Fimiani F. , Bruzzese D. , Carelli R. , Giani U. , Iovine A.
Published: January 2018

Purpose

To evaluate visual outcomes, eye movement abnormalities, and postoperative complications after secondary posterior chamber intraocular lens (IOL) implantation in aphakic children who had initial LAC correction.

Methods

A retrospective study was carried out on 53 patients (94 eyes). Following aphakic surgery and LAC correction the patients received secondary IOL implantation in the posterior chamber. Special attention was paid to factors that may have influenced their visual outcomes, such as eye movement abnormalities, cataract unilaterality, and cataract density.

Results

No association was found between age at surgery and the onset of strabismus (p=0.611) or with visual acuity (p=0.086). However, unilaterality and total cataract density were found to have a negative association with poor vision (p<0.001). Strabismus and nystagmus were found to have a statistically significant negative association with visual acuity (p=0.002). Posterior capsule opacification occurred in six eyes of five patients following cataract extraction; IOL dislocation occurred in four eyes after IOL intraocular implantation, and secondary glaucoma occurred in one eye.

Conclusions

IOL implantation before 12 months of age may be useful in unilateral cataract; in bilateral cataract, simultaneous surgical aphakia, LAC correction, and then IOL implantation at 2.5–3 years of age, together with anti-amblyopic therapy when strabismus or asymmetric cataract density occur, are efficient methods to obtain visual recovery. Extraocular muscle surgery may be required to correct strabismus.
Age-Related Maculopathy and Diabetes
Authors: Borrone R. , Saravia M. , Bar D.
Published: January 2018

Purpose

To compare the prevalence of age-related maculopathy (ARM) in a sample of diabetic patients with the general population.

Methods

Binocular indirect ophthalmoscopy, biomicroscopy, and fluorescein angiography. Retrospective prevalence study; descriptive-observational case-control type. Two different groups were analyzed from a sample of 1000 consecutive files of diabetic patients: 1) 65 to 74 years old (n = 263) and 2) 75 years and older (n = 199). Prevalence was compared to that of the general population in a control group and the following epidemiologic studies: Beaver Dam Eye Study, Framingham Eye Study, Blue Mountains Study, and Rotterdam Eye Study.

Results

In diabetic patients aged 75 or older, prevalence of ARM was as follows: early lesions 2.51% (5/199), late lesions (ARMD) 2.51% (5/199). In comparison, the risk in patients 75 or older is as follows: control group (ARMD): OR 4.79, 95% CI 1.778–12.033, p (Fisher) 0.0005; Beaver Dam Eye Study (ARMD): OR 2.93, 95% CI 1.152–7.450, p (Fisher): 0; Blue Mountains Eye Study (ARMD): OR 3.06, 95% CI 1.208–7.754, p (Fisher): 0; Framingham Eye Study (ARM): OR 6.73, 95% CI 3.041–14.880, p (Fisher): 0; Rotterdam Eye Study: p (Fisher) 0.133.

Conclusions

1) A lower prevalence of ARM was found in the sample of diabetic patients aged 75 or older than in the general population (with the exception of the Rotterdam study). 2) Prevalence of ARM was even lower in diabetic patients presenting diabetic retinopathy, whether or not they had been treated with photocoagulation. 3) In diabetic patients, the exudative form was more frequent than the atrophic form, in an inverse ratio to that of the general population.
Verteporfin Photodynamic Therapy for Subfoveal Choroidal Neovascularization in Pathologic Myopia: A 12-Month Retrospective Review
Authors: Costagliola C. , Campa C. , Incorvaia C. , Parmeggiani F. , Menzione M. , Della Corte M. , Rinaldi M. , Romano M. , Semeraro F.
Published: January 2018

Purpose

To evaluate the visual outcome of patients with subfoveal choroidal neovascularization (CNV) secondary to pathologic myopia treated with verteporfin photodynamic therapy (PDT-V) and to verify the predictive role of visual and angiographic parameters.

Methods

This is a retrospective, interventional, consecutive case series study of subjects with subfoveal CNV secondary to pathologic myopia. All patients received PDT-V according to VIP guidelines. A complete ophthalmologic evaluation was performed on all patients and included best-corrected visual acuity (BCVA), fundus examination, and fluorescein angiography (FA, IMAGEnet System, Topcon Corp., Japan). CNV size (mm2) was directly measured on the early phase of the angiogram using the software included with the IMAGEnet package. All checks were scheduled at 3-month intervals for a period of 1 year. A review of medical and angiographic records was performed and assessed throughout a 12-month follow-up period.

Results

A total of 62 patients (62 eyes) were examined. Best-corrected visual acuity (BCVA) moderately decreased without reaching a statistically noticeable level throughout the follow-up; reduction in lesion size reached a significant level at the second checkup. A significant correlation between higher baseline BCVA and better final visual outcome was detected.

Conclusions

Standardized PDT-V minimizes central vision deterioration in patients with CNV secondary to pathologic myopia. Better BCVA at presentation represents a good predictive sign.
Causes of Blindness at Nkhoma Eye Hospital, Malawi
Authors: Sherwin J.C. , Dean W.H. , Metcalfe N.H.
Published: January 2018

Purpose

The majority of blindness in Sub-Saharan Africa is treatable. This hospital-based study was undertaken in order to investigate the etiology of blindness at Nkhoma Eye Hospital, Malawi.

Methods

One ophthalmologist examined 2082 consecutive new patients who presented to the outpatient department at Nkhoma Eye Hospital, Malawi in 2006. Data recorded included age, sex, visual acuity and diagnosis. Patients were classified as blind if their best corrected visual acuity was <3/60 in one eye (unilateral) or two eyes (bilateral).

Results

The most common diagnosis in new outpatients was cataract (52.8%), followed by glaucoma (8.1%), corneal pathology (7.2%), uveitis (4.5%) and maculopathy (3.2%). There were 742 (35.6%) patients with unilateral blindness and 331 (15.9%) patients with bilateral blindness. Unilateral blindness was present in 37.4% of males and 26.5% of females. The most common causes of unilateral blindness were lens pathology (57.8%), followed by glaucoma (12.1%), corneal pathology (10.0%) and uveitis (6.1%). Bilateral blindness was present in 12.5% of males and 16.8% of females respectively. The most common causes of bilateral blindness were lens pathology (54.4%), followed by glaucoma (19.9%), retinopathy (3.6%), maculopathy (3.6%), uveitis (3.6%) and corneal pathology (3.3%).

Conclusions

Cataract is the most common cause of blindness in Nkhoma. Resultantly cataract management is preferentially targeted in the Nkhoma VISION2020 Programme. Training of auxiliary eye personnel in cataract diagnosis and surgery may assist in this approach.
Changes of Vascular Endothelial Growth Factor after Vitrectomy for Macular Edema Secondary to Retinal Vein Occlusion
Authors: Noma H. , Funatsu H. , Mimura T. , Hori S.
Published: January 2018

Purpose

To examine whether vitrectomy combined with retinal photocoagulation reduces the vitreous level of vascular endothelial growth factor (VEGF) in patients with macular edema associated with retinal vein occlusion (RVO).

Methods

The authors measured VEGF levels in vitreous samples from four eyes of four patients with RVO during vitrectomy and fluid samples obtained during revitrectomy 3 to 9 months postoperatively for complications: an epiretinal membrane in two patients, macular holes in one patient, and vitreous hemorrhage in one patient. During vitrectomy, retinal photocoagulation was performed on the ischemic region of the retina in all cases (mean of 510 shots).

Results

In four eyes with RVO, there was a difference in the vitreous VEGF levels between the vitreous samples obtained during vitrectomy (mean of 2692 pg/mL, range of 15.6–9040 pg/mL) and the fluid samples obtained at the time of revitrectomy (mean of 947 pg/mL, range of 15.6–3430 pg/mL).

Conclusions

The results suggest that the vitreous levels of VEGF may be reduced by vitrectomy combined with retinal photocoagulation for macular edema with RVO. It may be important to reduce the vitreous levels of VEGF by vitrectomy and retinal photocoagulation for ischemic retina in macular edema with RVO.
Early Results of Modified Nonpenetrating Deep Sclerectomy and Phacoemulsification in the Treatment of Open Angle Glaucoma and Cataract
Authors: Yuen N.S.Y.
Published: January 2018

Purpose

To study the outcome and control of intraocular pressure (IOP) of a combined modified nonpenetrating deep sclerectomy (NPDS) without use of implants and phacoemulsification in patients with primary open angle glaucoma (POAG) and cataract.

Methods

Prospective series of 14 eyes in 14 patients with medically uncontrolled POAG and cataract with significant visual impairment undergoing a modified NPDS and phacoemulsification. The surgery was designed to utilize all four mechanisms of outflow track of aqueous of NPDS without the use of scleral implant and a standardized postoperative management and early Nd:YAG laser goniopuncture at 4 weeks. All patients underwent clinical assessment before and after surgery at day 1, day 7, weeks 2, 3, and 4, and then at 2, 3, and 6 months postoperation. Surgical outcome was assessed in terms of IOP, visual acuity, and the incidence of complications.

Results

IOP decreased significantly from a preoperative value of 21.71±3.81 mmHg (mean ± SD) to a postoperative value of 13.14±3.73 mmHg (mean ± SD) (p<0.05, paired t test) at 6 months. The number of antiglaucoma eyedrops needed for control of IOP decreased from 3.28±0.91 to zero after operation at 6 months follow-up. The change in IOP pre and post laser goniopuncture was noted with no complication or fluctuation in anterior chamber depth. Visual acuity ranged from finger counting to 6/18 with Snellen chart at 6 meters preoperatively to 6/36 to 6/9 postoperatively. There were no intraoperative complications. There was one recessed conjunctival wound at 1 week. No other postoperative complication was noted.

Conclusions

Modified NPDS without scleral implant with early Nd:YAG laser goniopuncture and phacoemulsification for treatment of patients with POAG and cataract is a safe and effective procedure with complete success at 6 months.
Oxidative DNA Damage in Retinopathy of Prematurity
Authors: Ates O. , Alp H.H. , Caner I. , Yildirim A. , Tastekin A. , Kocer I. , Baykal O.
Published: January 2018

Purpose

This study examines the levels of oxidative damage in patients with retinopathy of prematurity (ROP).

Methods

Fifty patients were recruited with a birthweight below 1500 g or gestational age below 32 weeks. The cases were classified into those who developed ROP (n=25) and those without ROP (n=25). The authors obtained blood and urine samples from each infant, for measuring 8-hydroxy 2-deoxyguanosine (8-OHdG) and malondialdehyde (MDA) levels, at the time of the first examination at 4–6 postnatal weeks.

Results

A significant difference was observed in leukocyte and urine 8-OHdG levels in patients with ROP compared to those without ROP (p<0.001 for both). Similarly, a significant difference was observed in plasma and urine MDA levels in patients with ROP compared to those without ROP (p<0.001 for both). In addition, significant correlations were found between levels of 8-OHdG in leukocyte DNA and plasma MDA (r=0.859, p<0.001), and between levels of urine 8-OHdG excretion and urine MDA (r=0.563, p<0.001).

Conclusions

8-OHdG in leukocyte DNA and urine levels in premature infants can be useful as an indicator for ROP screening.
Hypoxia Tolerance and Retinal Vein Occlusion: A Pilot Evaluation
Authors: Mauget-Faÿsse M. , Germain-Pastene M.
Published: January 2018

Purpose

To determine if hypoxia tolerance in patients with retinal vein occlusion (RVO) following exposure to transient hypoxia is different from the hypoxia tolerance of healthy patients without retinal vein occlusion.

Methods

Consecutive patients presenting with RVO following exposure to transient hypoxia (Group I) were compared with healthy subjects (Group II). In addition to cardiovascular and plasma tests, functional respiratory evaluation was performed at rest and during exercise at both normal oxygen levels (21% O2) and in hypoxia (11.6% O2). We used the Wilcoxon test for statistical analysis.

Results

Both groups of eight males had similar mean ages: Group I, 47.5 years and Group II, 53 years. In Group I, three patients had glucose or lipid abnormalities, one had hypertension, and one minor thalassanemia. In Group II, one patient had hypertension. At rest in hypoxia, the oxyhemoglobinic desaturation was significantly different (p=0.03) in Group I in comparison with Group II (-13.8 versus −9.3). At exercise in hypoxia, the oxyhemoglobinic desaturation was similar in both groups but there was a statistically significant increase in both systolic (189 versus 155 mmHg; p=0.01) and diastolic (94 versus 77 mmHg; p=0.03) blood pressure in Group I. Ventilation rate and increased heart rate during hypoxia were higher in Group I compared with Group II but were not statistically significant.

Conclusions

In our pilot study, patients with RVO following exposure to transient hypoxia demonstrated intolerance to hypoxia and were significantly different from healthy subjects in their response to hypoxia. A larger study is required to confirm these preliminary results.
Nonpenetrating Glaucoma Surgery with Goniosynechiolysis ab Interno: A Surgical Technique
Authors: Mirshahi A. , Scharioth G.B.
Published: January 2018

Purpose

To present a surgical technique for treatment of peripheral anterior synechiae (PAS or goniosynechiae) at the operative field during nonpenetrating glaucoma surgery.

Methods

After usual preparation of a superficial and a deep scleral flap with externalization of the Schlemm's canal and peeling the juxtacanalicular trabecular meshwork, the goniosynechia is transected by a spatula introduced to the anterior chamber through a paracentesis. A Descemet's window provides full visual control at the peripheral cornea at the basis of the superficial scleral flap.

Results

With this surgical technique, selective treatment of goniosynechiae is possible exactly at the area where creation of low outflow resistance is intended by the surgeon during nonpenetrating glaucoma surgery.

Conclusions

This technique enables the surgeon to perform nonpenetrating glaucoma surgery even in the presence of peripheral anterior synechiae.