bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnostic Utility of Polymerase Chain Reaction on Intraocular Specimens to Establish the Etiology of Infectious Endophthalmitis
Authors: Sowmya Parameswaran , Madhavan Hajib N.
Published: January 2018

Purpose

To evaluate the utility of polymerase chain reaction (PCR) on intraocular clinical specimens (aqueous humor [AH] and vitreous fluid [VF]) as an etiologic diagnostic tool relative to microbiological culture methods in infectious endophthalmitis.

Methods

Conventional bacterial and mycologic cultures and PCR for eubacterial and panfungal genomes were applied for etiologic diagnosis on pairs of AH and VF obtained from 72 patients with clinically established infectious endophthalmitis.

Results

Based on cultures, an infectious etiology was established in 27 (37.5%) of 72 patients. PCR detected infectious etiology in all 72 patients. PCR increased the clinical sensitivity over culture by 62.5% (p<0.0001, McNemar test). The frequency of culture positivity, single infections, and polymicrobial infection varied significantly among the types of endophthalmitis (p<0.0001, chi-square test). PCR detected an infectious etiology in 48 patients and polymicrobial infection in 24 patients. An etiology was established by PCR on 56 (77.8%) AH and 65 (90.3%) VF of the 72 patients and this difference had no statistical significance.

Conclusions

PCR on intraocular specimens as an etiologic diagnostic tool has been shown to be specific and severalfold more sensitive than cultures and clinically useful. Therefore, PCR may be considered the gold standard to establish the etiology of infectious endophthalmitis. As there is no statistically significant difference in the results of PCR on AH and VF, PCR on AH could be the method of choice considering safety and simplicity of the procedure of its collection (Eur J Ophthalmol 2009; 19: 812–7)
A Rare Case of Peripheral Ulcerative Keratitis in Temporal Arteritis
Authors: Papathanassiou Miltiadis , Elezoglou Antonia , Nikita Eleni , Theodossiadis Panagiotis G. , Vergados Ioannis
Published: January 2018

Purpose

To present a case of peripheral ulcerative keratitis (PUK) that progressed to corneal perforation in the setting of recently diagnosed temporal arteritis.

Methods

A 76-year-old man presented with a 2-week history of red eye and gradual loss of vision in the right eye. His medical history included recently diagnosed temporal arteritis without previous eye involvement. Clinical examination revealed severe peripheral corneal melting leading to corneal perforation.

Results

The patient was treated in the acute phase with topical dexamethasone drops and oral prednisolone. Perforation was sealed with cyanoacrylate glue. Azathioprine was also administered. Inflammation was resolved and his eye remains quiet.

Conclusions

To our knowledge, this is the first reported case of PUK in the background of temporal arteritis. (Eur J Ophthalmol 2009; 19: 866–9)
Refractive Astigmatism in Eyes with Pseudoexfoliation Syndrome
Authors: Örnek Kemal , Güllü Reyhan , Yilmazbas Pelin
Published: January 2018

Purpose

To determine the effect of pseudoexfoliation syndrome on ocular refractive astigmatism.

Methods

One hundred eyes of 100 patients with pseudoexfoliation syndrome and 100 eyes of 100 age- and sex-matched control subjects were included in the study. Refractive astigmatism was measured prior to ocular examination performing cycloplegic autorefractive measures using an autorefractokeratometer (Charops, MRK3100).

Results

All patients in the study and control group had myopic astigmatism. Refractive and ocular residual astigmatism were found to be significantly higher in the pseudoexfoliation syndrome group in comparison to the control group (p<0.05). The mean keratometry reading was significantly steeper in the study group than in the control eyes.

Conclusions

Significant refractive and ocular residual astigmatism were found in pseudoexfoliation syndrome. (Eur J Ophthalmol 2009; 19: 873–5)
Vein of Galen Aneurysmal Malformation Masquerading as Carotid Cavernous Fistula in a Child with Proptosis
Authors: Zafar Sarah , Zafar Saemah N. , Khan Ayesha , Iffat Zafar Saerah
Published: January 2018

Purpose

An infant with proptosis and dilated episcleral vessels was diagnosed with vein of Galen malformation, which is a rare condition presenting initially to an ophthalmologist.

Methods

An 8-month-old child presented with slowly progressive proptosis of the left eye of 5 months' duration. The proptosis was axial, nonpulsatile, with no associated bruit. Dilated corkscrew episcleral vessels were observed. The patient was referred to our center with diagnosis of carotid cavernous fistula. The child had a history of episodes of seizures.

Results

Contrast-enhanced computed tomographic scan of the patient showed dilated vessels, hydrocephalus, and dilated vein of Galen. Vein of Galen aneurysmal malformation was confirmed on magnetic resonance venography.

Conclusions

Occasionally patients with Vein of Galen aneurysmal malformation may first present to the ophthalmologist. Ophthalmologists should therefore be aware of this rare but potentially treatable condition. (Eur J Ophthalmol 2009; 19: 894–6)
Incidence of Conjunctival Exposure following Drainage Device Implantation in Patients with Glaucoma
Authors: Stewart William C. , Kristoffersen Caroline J. , Demos Christina M. , Fsadni Mario G. , Stewart Jeanette A.
Published: January 2018

Purpose

To evaluate prior studies including a glaucoma drainage device and to describe the timing and incidence of conjunctival exposure. A meta-analysis of previously published articles.

Methods

Articles included were prospective, single cohort, or comparative parallel design, with a mean treatment period of at least 3 months and at least 30 patients per treatment arm. We limited our analysis to studies that evaluated the most common devices, including Ahmed, Baerveldt, and Molteno.

Results

We included 38 studies containing 45 treatment arms (16 Ahmed, 12 Baerveldt, and 17 Molteno). These studies included 3,105 patients and 3,255 eyes with an average follow-up of 26.1±3.3 months. The overall incidence of exposure was 2.0±2.6% (n=64) of eyes with an average exposure/month of 0.09±0.14%. There was no significant correlation between study length and incidence of exposure (p=0.11), although multivariate regression analysis identified length of follow-up as a risk factor for exposure (p=0.001). Among individual drainage devices, there was no significant difference in the incidence of exposure (p=0.22) or percent exposure per month (p=0.18). In addition, no difference existed in the incidence of exposure between sizes for the Baerveldt 250, 350 or 500 mm (p=0.7), number of plates for the Molteno Single or Double (p=0.3), nor between the composition of the Ahmed Silicone or Polypropylene (p=0.7).

Conclusions

This study suggests that tube exposure of glaucoma implants is unusual and the incidence does not differ between the Ahmed, Baerveldt, and Molteno implants. However, exposure appears to occur at any time within the first 5 years following implantation.
Relationship between Optic Nerve Head and Finger Blood Flow
Authors: Mozaffarieh Maneli , Osusky Roman , Schötzau Andreas , Flammer Josef
Published: January 2018

Purpose

To examine the relationship between optic nerve head (ONH) and finger blood flow in subjects with and without a primary vascular dysregulation (PVD).

Methods

ONH blood flow and finger blood flow was measured in 15 subjects with PVD and in 24 subjects without PVD. PVD was defined as being present if it was detected in patient history as well as by nailfold capillaromicroscopy PVD was defined as being absent if the patient history for PVD was negative and the results of nailfold capillaromicroscopy were negative. Scanning laser Doppler flowmetry (LDF) was used to measure ONH and finger blood flow. Finger temperature was measured in all subjects using a contact sensor.

Results

ONH blood flow is significantly related to finger blood flow in subjects with PVD (p<0.01), but not in subjects without a PVD. Subjects with PVD had a significantly lower finger skin temperature in comparison to those without PVD (p<0.01)

Conclusions

The present study indicates a relationship between ONH and finger blood flow in subjects with PVD. This might be an indirect sign of a disturbed autoregulation of ocular blood flow in PVD subjects.
Periorbital Necrotizing Fasciitis: Outcomes Using a CT-Guided Surgical Debridement Approach
Authors: Saldana Manuel , Gupta Deepak , Khandwala Mona , Weir Robert , Beigi Bijan
Published: January 2018

Purpose

The surgical management of necrotizing fasciitis usually involves early radical/wide and aggressive debridement of involved areas. We describe 5 cases of periorbital necrotizing fasciitis (NF), managed using a computed tomographic (CT)-guided approach to surgical debridement.

Methods

Retrospective case series review.

Results

Five patients (4 female, 1 male; age range 39–81) were treated for periorbital NF. The diagnosis was confirmed in all cases with blood cultures and wound swabs. All patients were managed medically by a surviving sepsis regimen. CT scans confirmed suprafascial infection and excluded orbital cellulitis. Four patients had minimal surgical debridement to the surface muscle. All patients survived. Four out of 5 patients underwent delayed reconstruction.

Conclusions

Periorbital NF behaves differently from NF of other areas. CT-guided surgical debridement of the superficial muscle maximizes preservation of healthy tissue and facilitates reconstruction. Delayed reconstruction allows fibrosis to settle and good cosmetic and functional results are possible. However, NF remains potentially lethal and close observation and a flexible management plan are required.
Sustained Regression of Florid Diabetic Retinopathy in a Patient with Donohue Syndrome (Leprechaunism)
Authors: Casati Stefano , Zoppini Giacomo , Muggeo Michele , Marchini Giorgio
Published: January 2018

Purpose

Leprechaunism is a rare congenital syndrome caused by mutations of the insulin receptor gene, transmitted in an autosomal recessive pattern. Insulin growth factor-1 (IGF-1) treatment can be a therapeutic option in this syndrome by its insulin-like effects. Nevertheless, it is of note that IGF-1 has also an angiogenic activity.

Methods

Fundus examination by ophthalmoscopy, fluorangiography and laser treatment were performed.

Results

A 17-year-old girl with leprechaunism, under treatment with high doses of insulin, presented a florid diabetic retinopathy. The large neovascularization of the disk regressed after treatment with argon laser panretinal photocoagulation. Five years after treatment, the patient maintained good vision.

Conclusions

This clinical case is of interest for 2 reasons: 1) the large retinal neovascularization was likely due to the high insulin dosages; 2) this is the first case in which a sustained regression of retinal neovascularization has been observed after laser treatment in leprechaunism.
Proptosis of Eyeball in Children with Medial Rectus Cysticercosis: Report of 2 Cases
Authors: Prasad Rajniti , Bagri Narendra , Mishra Om Prakash , Kumar Singh Mahendra
Published: January 2018

Purpose

To report 2 children with medial rectus cysticercosis presenting as proptosis of eyeball.

Methods

Case report.

Results

In orbital cysticercosis, extraocular muscle cysticercosis is the most common type. Two children, a 12-year-old girl and an 8 year-old boy, presented with proptosis and pain in the left eye. Both were diagnosed with medial rectus cysticercosis based on computed tomographic scan and serologic report and treated with oral albendazole and prednisolone without any residual ocular motility restriction.

Conclusions

We report 2 cases of medial rectus muscle enlargement caused by cysticercosis; describe its clinical importance, diagnosis, and treatment; and present a review of the literature.
Evaluation of Transconjunctival Frontalis Suspension Using Nonabsorbable Suture
Authors: Gawdat Tamer I. , Elsayed Suzan F. , El-Din Yehia M. Salah , Kamel Hesham F.
Published: January 2018

Purpose.

To evaluate the transconjunctival frontalis suspension technique using nonabsorbable suture (4/0 polypropylene) in patients with severe blepharoptosis and poor levator function.

Methods.

A total of 22 patients (33 ptotic eyelids) were included in a prospective interventional case series study. All had severe ptosis with poor levator function. Transconjunctival frontalis suspension using 4/0 polypropylene suture was done in all patients.

Results.

Twelve patients (17 eyelids) had congenital ptosis, 6 patients (12 eyelids) had blepharophimosis, and 4 patients (4 eyelids) had traumatic ptosis. The surgical technique was easy and fast and surgical results in the 3 groups were good functionally and cosmetically. Recurrences in 3 eyelids (9%) happened after 3 years. Follow-up ranged from 1 to 4 years.

Conclusions.

Transconjunctival frontalis suspension technique is simple and time saving for treatment of severe ptosis with poor levator function. It gives good functional and cosmetic results. Healing was normal with no postoperative swelling or infection. 4/0 Polypropylene exhibits satisfactory results and easy manipulation.
Lamellar Keratoplasty with a Novel Anterior Chamber System and Organ Cultured Donor Corneas
Authors: Grueterich Martin , Messmer Elisabeth M. , Lackerbauer Carlo , Kampik Anselm
Published: January 2018

Purpose.

To present a novel artificial anterior chamber system for anterior and posterior lamellar keratoplasty.

Methods.

The artificial anterior chamber system MOZART™ in conjunction with the AMADEUS™ II microkeratome was evaluated for its applicability in anterior and posterior lamellar keratoplasty using organ cultured donor corneas.

Results.

Twelve patients underwent microkeratome-assisted lamellar keratoplasty for corneal opacifications due to either anterior stromal scaring or endothelial decompensation. Eight patients underwent Descemet stripping automated endothelial keratoplasty (DSAEK) and 4 patients underwent anterior lamellar keratoplasty (ALK). A 400-μm and 250-μm cutting head was used for DSAEK and ALK, respectively. In all patients, an 8.5-mm suction ring was applied. For the 250-μm cutting head, a mean anterior lamella thickness of 244±12 μm was found. For the 400-μm cutting head, a mean anterior lamella thickness of 390±18 μm was found. The graft diameter was 8.85±0.5 mm for the 8.5-mm suction ring with both cutting heads. Deswelling of the anterior donor lamella was 11.5% compared to 30% of the posterior lamella transplant after 6 months of follow-up.

Conclusions.

The AMADEUS™ II microkeratome in conjunction with the MOZART™ artificial anterior chamber system proved to be a suitable device for modern lamellar keratoplasty. Swelling and deswelling characteristics of organ cultured corneas need to be further investigated to optimize the deswelling time prior to donor cornea sectioning in lamellar keratoplasty.
Early Bubble Modification of the Big Bubble Technique for Deep Anterior Lamellar Keratoplasty
Authors: Hosny Mohammed H. , Shalaby Ahmad M.M. , El Din Nashwa Badr
Published: January 2018

Purpose.

We modified the deep anterior lamellar keratoplasty big bubble technique to improve safety and ease of performance.

Methods.

We describe a modification of the big bubble technique that involves injecting the air bubble through a peripheral corneal incision 1 mm from the limbus. The incision is made with a limbal relaxing incision knife. This is done before trephination of the recipient cornea, hence the name “early bubble.” The goal of this technique is to reduce the risk of intraoperative corneal perforation and to obtain a large air bubble between Descemet membrane and the corneal stroma. We report outcomes of this technique in 21 eyes.

Results.

At 6 months, 16 eyes showed a best-corrected visual acuity of 20/50; the remaining eyes had a best-corrected visual acuity of 20/80 or better. The postoperative corneal astigmatism was 3.6±0.9 diopters at 3 months and 3.15±0.67 diopters at 6 months. The rate of conversion to penetrating keratoplasty was 14%.

Conclusions.

We found that the “early bubble” technique improved the ease of performance, safety, and predictability of deep anterior lamellar keratoplasty.
Effect of Amniotic Membrane Transplantation on Corneal Healing and Proteoglycan Expression in an Experimental Model of Limbal Deficiency in Rabbits
Authors: Andrade Alexandre L. , Campos Mauro Q. , Gomes José A. P. , Berto Alessandra G. A. , Michelacci Yara M.
Published: January 2018

Purpose.

Amniotic membrane transplantation (AMT) has been used as a graft or as a dressing in ocular surface reconstruction, facilitating epithelization, maintaining normal epithelial phenotype, and reducing inflammation, vascularization, and scarring. The corneal transparency is due, at least in part, to the arrangement in orthogonal lamellae of collagen fibrils, surrounded by proteoglycans (PGs). These PGs regulate fibrilogenesis, the matrix assembly, and ultimately the corneal transparency. The purpose of the present study was to investigate the effects of AMT upon the corneal PGs after severe limbal injury.

Methods.

Experiments were performed on the right corneas of 22 New Zealand female albino rabbits, and their left corneas were used as matched controls. These animals were divided into 3 groups: G1 (n=10): total peritomy and keratolimbectomy followed by application of 0.5 M NaOH; G2 (n=10): submitted to the same trauma as G1, and treated by AMT; G3: no trauma, only AMT (n=2). The right corneas of G2 and G3 were covered by DMSO4 cryopreserved human amniotic membrane, fixed by interrupted 9-0 mononylon sutures, with its stromal face toward the ocular surface. After 7 or 30 days, the corneas were removed and PGs were extracted.

Results.

Normal corneas contained approximately 9 mg of PGs per gram of dry tissue. AMT on intact cornea (G3) did not cause any changes in the concentration of PGs. In contrast, injured corneas contained much less PGs, both on the seventh and on the 30th day posttrauma. The PG concentration was even lower in injured corneas treated by AMT This decrease was due almost exclusively to dermatan sulfate PGs, and the structure of dermatan sulfate was also modified, indicating changes in the biosynthesis patterns.

Conclusions.

Although beneficial effects have been observed on clinical observation and concentration of soluble proteins after AMT, the normal PG composition of cornea was not attained, even 30 days postinjury indicating that the normal ocular surface reconstruction, if possible, is a long-term process.
Broader Corneal Characterization with PulseESPI Applied to Elasticity Measurements
Authors: Gualini Muddassir M.S. , Iqbal Salman , Sixt Willibald , Khan Wajid A. , Zulfiqar Khurram
Published: January 2018

Purpose.

A novel application of pulsed electronic speckle pattern interferometry (PulseESPI) techniques in important corneal elasticity measurements is presented in this pilot study. For laser-ablative procedures like laser-assisted in situ keratomileusis, it has been found that elastic properties of the cornea have a role in the outcome of corneal refractive surgery, while for optimal ablative laser power calculations this measurement method may possibly be helpful. It may also help in earlier diagnosis of degenerative corneal disorders such as keratoconus.

Methods.

The approach of this study is to observe dynamic behavior of cornea against stresses as mapped with PulseESPI. For this purpose, strain was induced to the cornea using a fine rod with a mechanical vibrator.

Results.

It was found that cornea has a response pattern to the dynamic stressing. Its surface exhibits a resonance frequency which can be measured with PulseESPI. This information of resonance frequency can be characteristic to the cornea.

Conclusions.

PulseESPI may help in important corneal elasticity measurements used for complication-free optimized ophthalmic surgery. It seems to be a promising method to conduct stress-related investigations on biological samples. To our knowledge, this is the first time that PulseESPI has been used for such ophthalmic measurements.
Quantitative Evaluation of Anterior Chamber Changes after Iridotomy Using Pentacam Anterior Segment Analyzer
Authors: López-Caballero Cristina , Puerto-Hernández Beatriz , Muñoz-Negrete Francisco J. , Rebolleda Gema , Contreras Inés , Cabarga Carmen , Corral Angeles
Published: January 2018

Purpose.

To evaluate changes in anterior chamber morphology with the Pentacam anterior segment analyzer and gonioscopy after laser peripheral iridotomy (LPI) in patients with primary angle closure glaucoma and narrow angle and to compare central corneal thickness measurements performed with Pentacam and ultrasound pachymetry

Methods.

Twenty eyes of 20 patients were enrolled in this prospective interventional study. Before and after LPI, volume, angle, and central and peripheral depth of anterior chamber was quantified with Pentacam. Central corneal thickness was measured with Pentacam and ultrasound pachymetry.

Results.

Mean central corneal thickness as measured with Pentacam pachymetry was slightly lower than the measurements provided by ultrasonic pachymetry (551.9 μm, range 509–659, versus 556.8 μm, range 520–644) (p=0.93) with an intraclass correlation coefficient of 0.92. Anterior chamber angle increased from 20.32 (standard deviation [SD] 4.2) to 22.31 degrees (SD 3.9). Anterior chamber central depth increased significantly from 1.79 mm (SD 0.22) to 1.85 mm (SD 0.21) and volume changed from 72.18 mm (SD 16.82) to 89.12 mm (SD 12.3), p=0.001. Gonioscopy showed that Shaffer angle widened significantly in all quadrants. Mean intraocular pressure changed from 20.8 mmHg to 18.3 mmHg after LPI (p<0.05).

Conclusions.

In patients with primary angle closure glaucoma and narrow angles, anterior chamber volume, angle, and central and peripheral depth, measured with Pentacam, increase significantly after LPI.
Comparison of Burst, Pulse, and Linear Modes Used in Phacoemulsification Surgery
Authors: Özkurt Yelda B. , Evciman Tufan , Sengor Tomris , Haboglu Melih , Bas Gokcen , Kurna Sevda , Aki Suat
Published: January 2018

Purpose.

To compare different ultrasound modes used in phacoemulsification surgery in terms of their efficacy and outcomes during and after surgery.

Methods.

A total of 86 patients with cataract diagnosis who underwent phacoemulsification surgery in Fatih Sultan Mehmet Education and Research Hospital Eye Diseases Clinic between November 2006 and February 2008 were included in the study and were prospectively analyzed. Patients were randomized into 3 groups based on the phacoemulsification mode to be used (burst, pulse, and linear mode).

Results.

Mean phacoemulsification time was 40.32±33.14 seconds, ultrasound time was 19.94±9.10 seconds, and effective ultrasound time was 20.16±16.57 seconds in Group I; mean phaco time was 79.90±65.52 seconds, ultrasound time was 15.30±5.74 seconds, and effective ultrasound time was 39.95±32.76 seconds in Group II; and mean phaco time was 75.75±50.56 seconds, ultrasound time was 11.65±2.91 seconds, and effective ultrasound time was 37.87±22.89 seconds in Group III. Central corneal thickness measurements with pachymetry were 586.61±46.86 μm on day 1,555.54±39.31 μm at week 1,543.29±33.88 μm at month 1, and 543.29±33.88 μm at month 3 in Group I; 549.83±49.18 μm on day 1,530.03±46.42 μm at week 1,524.32±45.76 μm at month 1, and 521.32±45.26 μm at month 3 in Group III; and 572.91±39.12 μm on day 1,545.91±32.67 μm at week 1,537.70±29.77 μm at month 1, and 534.04±28.64 μm at month 3 in Group III.

Conclusions.

Phacoemulsification power should be kept at minimum in order to induce minimal trauma and to achieve early rehabilitation.
Optical Coherence Tomography Findings in Pseudoxanthoma Elasticum
Authors: Yaylali Sevil Ari , Akcakaya Aylin Ardagil , Erbil Hasan Hasbi , Salar Senem , Karakurt Yücel
Published: January 2018

Purpose

To describe optical coherence tomography (OCT) findings of ocular lesions in pseudoxanthoma elasticum (PXE).

Methods.

Sixteen eyes of 8 patients with PXE and 20 eyes of 10 age-matched healthy volunteers were included in the study. All patients in the study and control group underwent a complete ophthalmologic examination and OCT. Fluorescein angiography was performed on the patients with PXE.

Results.

In the areas of peau de orange mottling, OCT demonstrated increased reflectivity on the level of retinal pigment epithelium (RPE), Bruch membrane, and choriocapillaris complex. OCT scans of crystalline body showed a hyperreflective shell and an isoreflective or hyporeflective core. OCT scans of the angioid streaks demonstrated thinning in RPE-Bruch membrane-choriocapillaris complex.

Conclusions.

Disturbances on the level of RPE, choroid, and Bruch membrane may be responsible for the ocular lesions in PXE. OCT may give clues to the pathophysiology of the retinal lesions. Spectral domain OCT could provide more details and information. Further studies using this new technology should be performed.
Torsional Diplopia after Orbital Decompression and Strabismus Surgery
Authors: Serafino Massimiliano , Fogagnolo Paolo , Trivedi Rupal H. , Saunders Richard A. , Nucci Paolo
Published: January 2018

Purpose.

To investigate diplopia after orbital decompression in patients with thyroid-related orbitopathy.

Methods.

We retrospectively analyzed medical records of 45 consecutive patients who had undergone orbital decompression surgery (DS) and a subgroup of 10/45 patients who underwent disinsertion of the inferior oblique (IO) muscle during DS. Diplopia was assessed before DS and 1 and 3 months after DS. Residual strabismus defects were treated surgically approximately 3 months after DS with follow-up visits 1 week, 3 months, and 6 months postoperatively. Patients with horizontal or vertical diplopia were evaluated using the alternate prism-and-cover test and torsional diplopia (TD) using a double Maddox rod test to quantitate their strabismus.

Results.

Strabismus surgery was effective in treating the horizontal and vertical diplopia (13/40 cases with residual deviations required prism glasses), but did not resolve the TD. None of the patients with IO disinsertion during DS complained of TD before strabismus surgery. However, after strabismus surgery, TD occurred in all IO patients with IO disinsertion vs 8/30 patients without IO disinsertion (p<0.001, Fisher exact test). Overall, TD was induced in 18/45 (40%) of the DS cohort.

Conclusions.

Patients with IO disinsertion during DS may be at increased risk of developing TD postoperatively. We recommend sparing or reattaching the IO muscle during DS when possible to reduce the risk of developing untreatable TD.
Epidemiology of Open-Globe Trauma in the Southeast of Spain
Authors: Larque-Daza Ana Belen , Peralta-Calvo Jesus , Lopez-Andrade Jesus
Published: January 2018

Purpose.

To describe epidemiologic and clinical findings of open-globe trauma (OGT) in the southeast area of Spain.

Methods.

A retrospective descriptive study of 94 eyes with OGT evaluated between 1999 and 2007, in a primary referral hospital.

Results.

The incidence of OGT in our area was 6.76 per 100,000 inhabitants/year. The majority of patients were male (89%) and young (80% of patients < 50 years old), with an average age of 37 ± 20 years (mean ± SD). The most common causes and location of injury were wire-induced trauma (50%) and accidents at work (56%), respectively. The types of injury encountered were ruptures, intraocular foreign bodies, perforating injury, penetrating injury, and mixed injury. Sixty-six percent of these injuries were penetrating in zone I (55%). The injuries found were vitreous hemorrhage (33%), cataracts (47%), vitreous prolapse (30%), retinal detachment (8%), endophthalmitis (2%), and associated with a facial trauma (7%). Eighty percent of surgery was carried out under general anesthesia. Fifty-one percent of the eyes underwent one operation only (5% were enucleated). Sixty-one percent of the eyes resulted in visual acuity of less than 50%.

Conclusions.

The incidence of OGT in the southeast of Spain is very high, being in most cases produced by accidents while using wire in greenhouses. This provokes severe monocular visual loss among the young population.
Spectral OCT Analysis in Bietti Crystalline Dystrophy
Authors: Gaucher David , Saleh Maher , Sauer Arnaud , Bourcier Tristan , Speeg-Schatz Claude
Published: January 2018

Purpose.

To report the analysis of the cornea and the macular retina using both time domain (TD-OCT) and Fourier domain optical coherence tomography (FD-OCT) in a case of Bietti crystalline dystrophy (BCD).

Methods.

This is a case study of a 32-year-old woman who presented with moderate visual loss in both eyes with nyctalopia. She had a complete ophthalmologic examination including fundus examination. She also underwent fluoroangiography Goldmann perimetry, electroretinography/electrooculography and both TD-OCT and FD-OCT examinations.

Results.

Large atrophy of retinal pigment epithelium and choroidal sclerosis were observed on both funduscopy and angiography. Microcrystals deposits were observed in the cornea and in the retina. Visual fields were constricted and electrophysiology was greatly impaired. BCD was diagnosed. TD-OCT examination was normal whereas FD-OCT revealed modifications of the outer retina and the presence of numerous lesions corresponding to microcrystals deposits in all retinal layers. The diameter of the deposits was comprised between 18 and 100 μm.

Conclusions.

FD-OCT was superior to TD-OCT in detecting and localizing microcrystals in BCD. FD-OCT might be useful in the understanding and the follow-up of this rare disease.
Clinical evaluation of the Canon TX-10 noncontact tonometer in healthy eyes
Authors: García-Resúa Carlos , Fernández María Jesús Giráldez , Yebra-Pimentel Eva , García-Montero Silvia
Published: January 2018

Purpose.

To assess the accuracy and repeatability of intraocular pressure (IOP) measurements obtained with the Canon TX-10™ noncontact tonometer (NCT), using the Goldmann applanation tonometer (GAT) as the gold standard.

Methods.

Seventy-three young healthy subjects were enrolled in the study. Central corneal thickness (CCT) was obtained with Orbscan™ Topography System and then repeated IOP measurements were obtained with both tonometers. Canon TX-10™ NCT was performed first, followed by GAT. Another study sample of 32 young healthy subjects was used to test the repeatability with both tonometers. Two sets of data were acquired separated by 1 week. Plotting the difference between the methods against the mean was done to compare the tonometers and the intersession variability. The hypothesis of zero bias was examined by a paired t test. The 95% limits of agreement (LoA) were also calculated.

Results.

NO statistically significant differences were found when comparing the Canon TX-10™ NCT with GAT, displaying close level of agreement with GAT as seen by the 95% LoA (-4.78 mmHg to +4.00 mmHg). CCT ranged from 419 νm to 585 μm and no relationship was found between CCT and IOP measurements. The coefficients of repeatability were 3.70 mmHg and 3.41 mmHg for GAT and TX-10 tonometers, respectively.

Conclusions.

There was a good agreement between Canon TX-10™ and GAT in healthy subjects. From the results obtained here, CCT appears to not affect IOP measurements when CCT is thinner than 570 μm.
Comparing the Measurement of Diurnal Fluctuations in Intraocular Pressure in the Same Day versus over Different Days in Glaucoma
Authors: Magacho Leopoldo , Toscano Daniela A. , Freire Gislene , Shetty Rajesh K. , Ávila Marcos P.
Published: January 2018

Purpose.

To compare the measurement of diurnal fluctuations in intraocular pressure (IOP) in the same day versus over different days in primary open-angle glaucoma.

Methods.

Twenty-five eyes from 25 patients with primary open-angle glaucoma were submitted to a diurnal curve on the same day, 5 measurements, 2.5 hours apart, from 8:00 AM to 6:00 PM. For the measurements on different days, we randomly selected one time point from the diurnal curve for each patient. All patients were then instructed to return every 3–7 days to complete all 5 measurements. The maximum, minimum, and IOP fluctuation were compared between the 2 methods.

Results.

The IOP fluctuation (maximum-minimum) was similar when we measured the IOP on different days (5.0±2.6 mmHg vs 4.0±1.2 mmHg, p=0.08). There was no difference regarding the minimum or maximum IOP assessed in the diurnal curve or over different days. There was a high correlation for the maximum IOP (r=0.863, p<0.001) and the minimum IOP (r=0.708, p<0.001) by either method of measuring during the same day or different days, as well as for all measurements (8:00 AM: r=0.718, p<0.001; 10:30 AM: r=0.479, p=0.01; 1:00 PM: r=0.628, p=0.001; 3:30 PM: r=0.757, p<0.001; and 6:00 PM: r=0.910, p<0.001).

Conclusions.

IOP fluctuation in primary open-angle glaucoma can be assessed using IOP measures on different days, at different time points, which strongly correlate to a diurnal curve.
Adjustable Superior Oblique Tendon Spacer with Application of Nonabsorbable Suture for Treatment of Isolated Inferior Oblique Paresis
Authors: Fard Masoud A. , Ameri Ahmad , Anvari Faramaz , Jafari Alireza K. , Yazdian Ziaeddin
Published: January 2018

Purpose

To evaluate and report the outcomes of a superior oblique tendon spacer procedure using nonabsorbable adjustable sutures in patients with inferior oblique (IO) paresis.

Methods

This interventional case series included 6 eyes of 6 patients with IO paresis. All met Bielschowsky/Parks Three-step Test criteria to identify an isolated IO paresis. In all patients, the superior oblique tendon was exposed; 2 nonabsorbable polyester sutures were placed 3 mm apart, and the tendon was cut. With the use of a slipknot, the cut ends of the tendon were separated 5 to 7 mm. Tendon separation was adjusted intraoperatively according to the fundus torsion and exaggerated traction test.

Results

The mean duration of follow-up was 8.1 months (range, 5-12 months). Four patients had congenital IO paresis and 2 had iatrogenic IO paresis following denervation/myectomy of IO. Mean primary position hypotropia improved from 15.2 prism diopters (PD) before surgery to 2.7 PD in congenital IO paresis and from 11.5 PD to 2.5 PD in iatrogenic IO paresis. In congenital IO paresis, mean preoperative superior oblique overaction and IO underaction was +2 and −2, which decreased to 0 and −1.25 respectively; fundus incyclotorsion resolved in all patients. Superior oblique overaction and IO underaction improved in iatrogenic IO paresis as well. In no patient did an overcorrection develop.

Conclusions

The adjustable superior oblique tendon suture spacer procedure is an effective and safe option for correcting IO paresis without developing iatrogenic superior oblique paresis.
Evaluation of the Effect of Topical Cyclosporine a with Impression Cytology in Dry Eye Patients
Authors: Yüksel Bora , Bozdağ Berkant , Acar Memed , TopaloğLu Engin
Published: January 2018

Purpose.

This study evaluated the efficacy of topical cyclosporine A 0.05% treatment with impression cytology in dry eye patients.

Methods.

Forty eyes of 40 patients with dry eye were included. Schirmer, tear break-up time, and Ocular Surface Disease Index (OSDI) scores and goblet cell densities were noted before and after 6 months of topical cyclosporine A treatment. Patients were graded clinically and biomicroscopically as follows: grade 1, 12 patients; grade 2, 18; and grade 3, 10 patients.

Results.

Mean age was 57.1±11.8 (23.0–80.0) years. A total of 36 (90%) of the patients were female and 4 (10%) were male. Mean Schirmer test value was 3.2±1.6 (0.0–8.0) mm in the beginning and was 8.4±4.3 (1.0–19.0) mm after 6 months of cyclosporine A topical treatment (p=0.00). At the first visit, mean tear break-up time was 4.4±1.8 (2.0–8.0) seconds. It increased to 11.8±4.8 (2.0–20.0) seconds at the end of the sixth month (p=0.00). Mean clinical grading was 1.9±0.8 (1.0–3.0) and this value regressed to 0.8±1.2 (0.0–3.0) after the treatment (p=0.00). Mean OSDI score was 30.0±11.7 (9.0–50.0) before the treatment and 21.3±11.0 (4.0–47.0) after the treatment (p=0.00). Mean goblet cell density of all cases was 12.3±8.7 before the treatment (2.0–28.0). It increased to 33.0±25.4 (6–70) after the treatment (p=0.04).

Conclusions.

Topical cyclosporine A treatment is effective in grade 1 and grade 2 dry eye patients but results are poor in grade 3 patients.
Serum Lycopene Levels in Patients with Diabetic Retinopathy
Authors: Li Zhen-Zuo , Lu Xiu-Zhen , Ma Chi-Cheng , Chen Li
Published: January 2018

Purpose.

Accumulating evidence indicates that oxidative stress may play an important role in the pathogenesis of type 2 diabetes and its complications. Lycopene, a very potent antioxidant of carotenoids, has received considerable scientific interest in recent years for its potential role in the prevention of oxidative stress-related chronic diseases. This study was undertaken to investigate whether the serum levels of lycopene are altered between type 2 diabetic patients with and without diabetic retinopathy.

Methods.

A total of 71 patients with type 2 diabetes were analyzed and compared with 23 nondiabetic healthy controls. Serum lycopene concentrations were assayed using high-performance liquid chromatography.

Results.

Lycopene level was found to be significantly lower in diabetic patients than in controls (p=0.021). In the diabetic group, subjects with proliferative diabetic retinopathy had significantly lower lycopene levels than subjects without diabetic retinopathy or with nonproliferative diabetic retinopathy. In the analysis of correlations, hemoglobin A1c were negatively correlated with lycopene (r=–0.345, p=0.007) after multivariate adjustment. A stepwise linear multiple regression model revealed that age and hemoglobin A1c were significant determinants of lycopene.

Conclusions.

Our findings show that measuring serum lycopene is a novel convenient method for evaluating oxidative damage. Diabetic patients, especially those with advanced diabetic retinopathy, had significantly lower serum lycopene levels; this suggests that lycopene may be helpful for the diagnosis, severity, and therapeutic evaluation of diabetic retinopathy.
Keratitis after Implantation of Intrastromal Corneal Ring Segments (Intacs) Aided by Femtosecond Laser for Keratoconus Correction: Case Report and Description of the Literature
Authors: Levy Jaime , Lifshitz Tova
Published: January 2018

Purpose.

The majority of reported cases of infectious keratitis after intrastromal corneal ring segment implantation have been described after mechanical implantation of the segments. We present a case of keratitis after implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser for keratoconus correction and review the relevant literature.

Methods.

A 31-year-old woman with keratoconus underwent uneventful sequential implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser performed 6 weeks apart. Two months after surgery in the second eye, she complained of red eye, pain, and decreased vision of 2 days’ duration. Left eye visual acuity was 20/100.

Results.

Slit-lamp examination of the left eye revealed a stromal infiltrate at the lower segment near the incision site. The infiltrate progressed despite topical treatment of vancomycin and ceftazidime. Cultures were negative. The inferior segment was removed and the inferior channel irrigated with antibiotics. One day later, significant fibrin and 1-mm hypopyon were detected in the anterior chamber. Significant improvement was observed after adding topical amikacin and amphotericin B. Six months later, a small stromal scar is present at the inferior incision site and best-corrected visual acuity is 20/25.

Conclusions.

To our knowledge, this is the second reported case of keratitis after implantation of intrastromal corneal ring segments (Intacs) aided by femtosecond laser for keratoconus correction. Prompt and adequate treatment is essential to prevent irreversible reduction of visual acuity.
Fundus Autofluorescence and Spectral Domain Optical Coherence Tomography in Early Detection of Plaquenil Maculopathy
Authors: Kelmenson Amy T. , Brar Vikram S. , Murthy Ravi K. , Chalam Kakarla V.
Published: January 2018

Purpose.

To report fundus auto fluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT) findings in a patient with early hydroxychloroquine maculopathy.

Methods.

A 50-year-old man presented with complaints of ring-like shadows in front of his eyes. He had been on hydroxychloroquine (Plaquenil) 400 mg orally twice daily for 10 years (5.14 mg/kg/day). Fundus examination revealed granular hypopigmentation in an arcuate pattern in the inferior parafoveal area bilaterally. The patient underwent further evaluation with SD-OCT and FAF imaging. Functional changes were assessed by microperimetry

Results.

Hypopigmented lesions on the fundus were autofluorescent and SD-OCT corresponding to this area revealed loss of inner segment-outer segment, suggesting loss of photoreceptor layer in the affected area with underling dysfunctional retinal pigment epithelium.

Conclusions.

Findings on SD-OCT and FAF imaging support the histopathologic findings described in cases of hydroxychloroquine maculopathy.
Intravitreal Ranibizumab for Choroidal Neovascularization Associated with Retinal Astrocytic Hamartoma
Authors: Querques Giuseppe , Kerrate Houda , Leveziel Nicolas , Coscas Gabriel , Soubrane Gisele , Souied Eric H.
Published: January 2018

Purpose.

To report on a patient with retinal astrocytic hamartoma, who developed a choroidal neovascularization (CNV), effectively treated by intravitreal ranibizumab injections.

Methods.

A 74-year-old woman who, 12 years before, had been diagnosed with a yellow-gray lesion in the left eye (OS) presented in our department for OS decreased vision of recent onset.

Results.

Upon a complete ophthalmologic examination including ultrasonography, fluorescein angiography (FA), and spectral domain optical coherence tomography (SD-OCT), the patient was diagnosed with retinal astrocytic hamartoma and coincident CNV on its foveal border. Six months after 3 monthly intravitreal ranibizumab injections, FA and OCT revealed the CNV closure and absence of intraretinal and subretinal fluid on the foveal border of the retinal astrocytic hamartoma.

Conclusions.

Associations between retinal astrocytic hamartoma and CNV have not been previously reported. Intravitreal ranibizumab injection appears an attractive therapeutic option for patients showing such an unusual association.
Unilateral Retinal Hemorrhages with Subarachnoid Hemorrhage in a 5-Week-Old Infant: Is This Nonaccidental Injury?
Authors: Reddy Aravind R. , Clarke Michael , Long Vernon W.
Published: January 2018

Purpose.

Retinal hemorrhages are an important sign in the setting of nonaccidental injury (NAI) (abusive head injury) in young infants and form a very important part of the evidence in support of the diagnosis. The diagnosis of NAI has serious social and legal implications. Other causes of retinal hemorrhages in an infant, such as birth trauma, accidental head injury, subarachnoid hemorrhage, other less common disorders of clotting, leukemia, and infections such as endocarditis, need to be considered and ruled out in making a diagnosis of NAI.

Methods.

Descriptive case report.

Results.

A 5-week-old child presented with rapid onset of symptoms of drowsiness and hypotonia, unilateral retinal hemorrhages, and an intracranial hemorrhage in the posterior fossa. NAI was high on the list of differential diagnosis, which caused considerable anxiety in the parents. The cause of the intracranial hemorrhage only became apparent at repeat neuroimaging several weeks later.

Conclusions.

The case is presented to point out arteriovenous malformation as a possible cause of retinal hemorrhages in this age group where an early diagnosis of the etiology is often not possible. A diagnosis of NAI, commonly associated with a similar clinical presentation, can have serious social and legal implications.
Clinical Results with the Use of a Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery
Authors: Khouri Albert S. , Vaccaro Anzhelica , Zarbin Marco A. , Chu David S.
Published: January 2018

Purpose

To evaluate surgical outcomes using a temporary intraoperative keratoprosthesis (KP) in patients undergoing combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP).

Methods

From January 2001 to August 2008, medical records of 23 patients undergoing combined KP/PPV/PKP for traumatic and nontraumatic corneal and retinal pathologies were studied. Only patients with ≥6 months follow-up were included. Patient characteristics, diagnoses, visual acuity, intraocular pressure, and status of the retina and cornea at baseline, and postoperatively on day 1, months 1 and 6, and yearly until the last follow-up, were collected. Functional (best-corrected visual acuity: improved, stable, worsened) and anatomic outcomes (clear corneal graft, retinal reattachment) were defined prior to review.

Results

Twenty-four eyes underwent combined KP/PPV/PKP (mean follow-up 36 months). At final follow-up, best-corrected visual acuity improved in 8 (40%) eyes, remained stable in 8 (40%), and worsened in 4 (20%). Corneal graft was clear in 18(79%) eyes; 5(21%) had graft failure. Retinal reattachment occurred in 22 (92%) eyes; 2 (8%) developed a localized traction retinal detachment not warranting additional surgery. Derangement in intraocular pressure was common (13 [54%] eyes). Three eyes (13%) showed signs of phthisis preoperatively that resolved with reestablishment of normal intraocular pressure postoperatively.

Conclusions

Temporary KP during PPV/PKP surgery allowed surgical intervention in eyes with complex anterior and posterior segment disease. Corneal graft clarity and successful retinal reattachment was possible in the majority of eyes.
Anatomic Evaluation of Macular Holes with Silicone Oil Tamponades in Highly Myopic Eyes Using Optical Coherence Tomography
Authors: Qian Jing , Jiang Yan-Rong
Published: January 2018

Purpose

To observe the postoperative status of the macula after vitrectomy with silicone oil tamponade for macular hole-related retinal detachment in highly myopic eyes by optical coherence tomography (OCT), to analyze the factors associated with anatomic success, and to evaluate the possibility of successful silicone oil removal.

Methods

OCT was used to follow the postoperative changes in the macular area of 51 highly myopic eyes, and other information was obtained from patient records.

Results

OCT confirmed that successful retinal reattachment was achieved in 41 eyes (80.4%) after the initial surgery, and all of them underwent silicone oil removal postoperatively. The macular holes were closed in 20 eyes (20/41), all of which remained retina attached after silicone oil removal. In 21 (21/41) macular hole nonclosed eyes, recurrent retinal detachment (RRD) occurred in 8 eyes (8/21) after silicone oil removal. There were statistically significant association between posterior staphyloma and the presence of macular hole (p<0.001). Macular hole closure significantly increased the chances of successful silicone oil removal (p=0.003). Improved postoperative best-corrected visual acuity was significantly associated with macular hole closure (p=0.012).

Conclusions

OCT helps predict anatomic and functional outcomes of highly myopic eyes with macular hole-related retinal detachment. Posterior staphyloma may prevent macular hole closure. Silicone oil removal can be performed when macular hole closure was confirmed by OCT, while in eyes with nonclosed macular holes, silicone oil removal may lead to RRD.