bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Factors for Intraoperative and Early Postoperative Complications in Extracapsular Cataract Surgery
Authors: Lumme P. , Laatikainen L.T.
Published: April 2018

The risk factors for intraoperative and early postoperative complications were evaluated in 351 consecutive cataract operations at the Oulu University Hospital in 1990. Bleeding into the anterior chamber during the operation was recorded in 8.6%, zonular rupture in 6.6%, posterior capsular rupture in 5.4% and vitreous loss in 3.2%, On account of the loss of capsular support an anterior chamber intraocular lens was implanted in 3.1%. Of the early postoperative complications, signs of fibrinous reaction were observed in 24.5%, corneal edema in 53.6% and rise of intraocular pressure to 30mmHg or more in 27.6%. There was no difference in the complication rate between men and women or in relation to age. The use of anticoagulant (although discontinued before surgery) or antiplatelet medication increased the risk of intraoperative bleeding but no sight-threatening bleeding occurred. The use of acetylsalicylic acid was also associated with an increased risk of postoperative fibrinous reaction. Other systemic diseases like systemic hypertension, diabetes, asthma, or cardiac or mental disorders, or medications, did not increase the complication rate. Of the various ocular parameters, small pupil and exfoliation syndrome were the most important risk factors for both intra- and early postoperative complications, and the presence of glaucoma increased the risk of vitreous loss, postoperative pressure rise and corneal edema. General anesthesia did not seem to reduce the complications rate.
Serotonin in Human Tears
Authors: Martin X.D. , Brennan M.C.
Published: April 2018

It has been postulated that serotonergic receptors are present in the corneal epithelium and that their activation by serotonin released from subepithelial corneal nerves raises the level of cyclic AMP, which in turn stimulates active Cl-secretion by the corneal epithelium. We looked for serotonin in tears because these bathe the corneal epithelium. Twenty-two normal subjects, 14 women and 8 men between 25 and 60 years of age (average 36.5±9 years), participated in this study. Twenty μl of tears were collected in capillary tubes after trigeminal stimulation (pepper in the nose) and were immediately analysed using high-performance liquid chromatography with electrochemical detection. Serotonin was identified and measured in every subject. Its mean concentration was 2.74±1.99 ng/ml. No difference was found between women and men.

Emotionally evoked tears were obtained from two subjects. The amount of serotonin in these samples was much higher than in the samples obtained by trigeminal stimulation. These results demonstrate for the first time that serotonin is present in human tears. The possible role of this serotonin in chloride transport in the corneal epithelium and the probable difference between “emotional” and stimulated tears warrants further investigation.
Macular Grid Photocoagulation in Persistent Macular Edema Due to Central Retinal Vein Occlusion
Authors: Glacet-Bernard A. , Mahdavi K. Nouri , Coscas G. , Zourdani A. , Fardeau C.
Published: April 2018

Aim

macular edema is still the main cause of poor visual prognosis in central retinal vein occlusion (CRVO). This study was designed to establish whether grid photocoagulation is effective in the management of this disorder.

Methods

the records of 16 patients who had undergone macular grid photocoagulation for persistent macular edema due to CRVO were reviewed retrospectively. Pre-treatment visual acuity ranged from 20/400 to 20/40, and laser treatment was done six months or more after the onset of the disease.

Results

biomicroscopy and fluorescein angiography showed the improvement or disappearance of macular edema in 14/16 patients (87.5%). Improved visual acuity was observed in eight (50%) and no improvement or reduced vision in the other eight (50%). A poorer prognosis was statistically correlated with older age (p < 0.03), macular ischemia (p < 0.001), foveal avascular zone larger than 1/2 disc diameter (p < 0.05) and pigmentary clumps in the foveal area (p < 0.05). Laser treatment was ineffective for most patients with systemic vascular risk factors and pre-treatment visual acuity below 20/200.

Conclusion

macular grid photocoagulation may be effective for drying up, or at least reducing, macular edema due to CRVO and some improvement of vision can be expected in half the cases.
Lens Coloboma and Alport-Like Glomerulonephritis
Authors: Amari F. , Segawa K. , Ando F.
Published: April 2018

An unusual case of bilateral lens coloboma and Alport-like glomerulonephritis is reported. In a 12-year-old boy and in several family members, Alport-like glomerulonephritis was diagnosed without deafness and without ocular signs of Alport syndrome. A bilateral lens coloboma however was observed in the propositus. To our knowledge this is the first reported case of lens coloboma with Alport-like glomerulonephritis.
P53 Protein Overexpression in a Case of Conjunctival Micro-Invasive Carcinoma
Authors: Calzolari A. , Mincione F. , Messerini L. , Parducci V. , Giannelli E. , Mincione G.P.
Published: April 2018

We analysed by immunohistochemistry the expression of p53 protein in a case of micro-invasive carcinoma of the conjunctiva. About 50% of tumor cells showed a strong nuclear positivity for p53. This suggests that p53 gene alterations play a role in the development of this type of tumor.
Indocyanine Green Video-Angiographic Findings in Choroidal Osteoma
Authors: Yuzawa M. , Kawamura A. , Haruyama M. , Matsui M.
Published: April 2018

Indocyanine green video-angiography (ICG) was done twice on three patients with choroidal osteoma. Choroidal osteoma consisted of two portions, a yellow-white area and a surrounding orange area. The early phase of ICG angiography showed hypofluorescence due to blockage, corresponding to the osteoma. However, the hypofluorescence was greater in areas corresponding to the orange portions of the lesions than in the yellow-white parts. In the late phase, tumor staining was present, corresponding to the orange area. Although long-standing yellow-white lesions blocked fluorescence in the late phase, some of these showed hyperfluorescence. ICG video-angiography showed areas of blocked fluorescence in the early phase as well as hyperfluorescent areas accompanied by several small hypofluorescent foci in the late phase, corresponding to very slight ophthalmoscopically observed changes in the vicinity of the osteoma. During follow-up observation, fluorescein angiography confirmed the extension of the osteoma into this area. These results confirm that the characteristic findings of choroidal osteoma can be observed with ICG video-angiography. This imaging technique showed the lesions were larger than they appeared with ophthalmoscopy and fluorescein angiography.
Interocular Visual-Field and Intraocular-Pressure Asymmetries in Normal-Tension-Glaucoma
Authors: Orgül S. , Flammer J.
Published: April 2018

To evaluate the role of intraocular-pressure (IOP) in the pathogenesis of glaucomatous damage in normal-tension-glaucoma, we investigated whether the eye with the higher IOP had more severe visual-field damage in 23 normal-tension-glaucoma patients. Twelve patients did have more severe visual-field defects in the eye with the higher IOP, but 11 had more severe defects in the eye with the lower IOP. There was no correlation either between IOP and visual-field damage (r=0.16; p=NS) or between the interocular differences in IOP and in visual-field damage (r=0.21; p=NS). Thus, although intraocular pressure may contribute to glaucomatous damage even in normal-tension-glaucoma patients, other factors must be involved as well.
Stimulation of Penetrating Corneal Wound Healing by Exogenous Fibronectin
Authors: Gundorova R.A. , Brikman I.V. , Ibadova S.I. , Issaeva R.T.
Published: April 2018

The paper describes the effect of exogenous fibronectin administered by instillation on the repair of the rabbit cornea after experimental mechanical injury. The effect was monitored by light microscopy and radioautography. Fibronectin had a beneficial effect on regenerating corneal epithelium, endothelium and keratocytes through a stimulatory effect on cell migration, proliferation and differentiation.
Individual Measurements of Angiotensin II Concentrations in Aqueous Humor of the Eye
Authors: Osusky R. , Nussberger J. , Amstutz C. , Flammer J. , Brunner H.R.
Published: April 2018

The presence of constituents of the renin-angiotensin system (RAS) in ocular tissues and fluids suggests this system is involved in ocular physiology. Angiotensin II (Angll) is the main biological effector of the system, so we measured Angll in plasma and in aqueous humor of the anterior ocular chamber of patients undergoing cataract extraction. Untreated normotensive patients were compared with arterial hypertensive patients taking either diuretics which stimulate the RAS or angiotensin converting enzyme (ACE) inhibitors which reduce the production of Angll. Plasma levels of Angll were higher in patients on diuretics (5.46± 1.04 fmol/ml; mean± SEM) than in untreated cataract patients (2.28± 0.32 fmol/ml, p<0.02), and were very low with ACE inhibitors (0.51±0.18 fmol/ml). In aqueous humor, Angll was measurable in 7 of 11 patients on diuretics (median 1.1 fmol/ml), and in 6 of 16 normotensive patients (median <0.55 fmol/ml), but not in aqueous humor of 4 patients receiving enalapril or captopril. These results demonstrate the presence of Angll in the eye but do not exclude either its sequestration in the eye or local production. The possibility of individual measurements of intraocular Angll will permit more precise determination of its role in future studies.
Sinonasal Undifferentiated Carcinoma Invading the Orbit
Authors: Ascaso F.J. , Adiego M.I. , Garcia J. , Royo J. , Valles H. , Palomar A. , Ramon Y Cajal S.
Published: April 2018

Sinonasal undifferentiated carcinoma (SNUC) is an infrequent tumor described by Frierson et al. in 1986. Since its initial description, fewer than 100 patients have been reported.

We present a case of a SNUC invading the orbit in a 57-year-old woman, for which the findings are documented by CT scan, light and electron microscopy.
Fluorophotometric Study of Lens Autofluorescence and the Blood-Retinal Barrier in 56 Diabetic Patients
Authors: Bordat B. , Arnaud C. , Guirguis I.R. , Laudeho A.
Published: April 2018

We examined lens autofluorescence and the permeability of the blood-retinal barrier in 56 diabetic patients (34 insulin-dependent and 22 non-insulin-dependent), using the Fluorotron Master (R), a commercially available fluorophotometer. Significant relationships were found between age and lens autofluorescence (p<0.01), between duration of diabetes and lens autofluorescence in insulin-dependent diabetics (p<0.01), and between duration of diabetes and blood-retinal barrier permeability in all diabetics (p<0.05). The relationships between lens autofluorescence and duration of diabetes in non-insulin dependent patients (p>0.05), and between lens autofluorescence or the penetration ratio and HBA Ic during the five preceding years (p>0.05) were not significant.

Fluorophotometry provides an objective and reproducible method for in vivo investigation of the ocular complications of diabetes and of the factors influencing them.
Effect of Oral Captopril (SQ 14225) on Intraocular Pressure in Man
Authors: Costagliola C. , Di Benedetto R. , De Caprio L. , Verde R. , Mastropasqua L.
Published: April 2018

The effects of the angiotensin converting enzyme (ACE) inhibitor captopril (SQ 14225) on intraocular pressure (IOP) were studied. Four groups were analyzed: group A, ten control subjects; group B, ten hypertensive patients with normal IOP; group C, ten normotensive patients with primary open angle glaucoma (POAG); and group D, ten hypertensive patients with POAG. Systolic and diastolic blood pressure, heart rate, pupil diameter, IOP and total outflow facility were recorded at baseline and at 1-h intervals up to 3h after an oral dose of 25 mg captopril or placebo, given in a randomized, double-blind cross-over fashion. The alternative treatment was given a week later.

Captopril significantly lowered IOP in all patients, with no effects on heart rate and pupil diameter. Blood pressure changed only in patients with hypertension (groups B and D). Total outflow facility, measured by conventional tonography, increased significantly in all groups. These findings indicate that oral captopril could represent a new antiglaucomatous compound.
Contact Transscleral Cyclophotocoagulation with Diode Laser in Refractory Glaucoma
Authors: Brancato R. , Carassa R. G. , Bettin P. , Fiori M. , Trabucchi G.
Published: April 2018

Objective

To evaluate the clinical effectiveness of contact transscleral cyclophotocoagulation (CTCP) with diode laser.

Design and Patients

Forty-eight seeing eyes and 20 blind and painful eyes of 68 patients suffering from refractory glaucoma were treated using a diode laser (EOS3000, Laser Science) coupled with a 400-μm optic fiber ending in a 3-mm focusing tip. Sixteen to twenty 3.9-J (2.6 W x 1.5 to 2.5 s) laser spots were placed over 360°, 1.5 mm from the corneolimbal junction.

Results

In the seeing-eye group, the follow-up was 20.7 ± 8.14 months, pre- and posttreat-ment lOPs were 37.1 ± 11.27 and 19.5 ± 8.73 mmHg respectively (p < 0.0001), and success (IOP > 2 and < 21 mmHg) was 70.8%. No significant visual acuity change was found in the successful eyes, whereas a significant visual acuity reduction was found in the unsuccessful cases (p=0.03). In the blind-eye group, the follow-up was 20.5 ± 8.54 months, pre- and post-treatment lOPs were 50.7 ± 15.05 and 20.6 ± 13.99 mmHg respectively (p < 0.0001), and success (remission of pain) was 100%. As for complications, one seeing eye developed a spontaneously-resolved vitreous hemorrhage and one seeing and one blind eye became hypotonic, though no phthysis was observed. No conjunctival or lens damage was detected, and no scleral thinning was revealed by ultrasound biomicroscopy. No case of sympathetic ophthalmia was found.

Conclusions

Diode laser can be successfully employed for CTCP in refractory glaucoma.
Factors Predisposing to Postoperative Intraocular Inflammation
Authors: Corbett M.C. , Hingorani M. , Boulton J.E. , Shilling J.S.
Published: April 2018

This prospective study of 123 patients undergoing cataract extraction determined the preoperative and surgical factors predisposing to an exaggerated postoperative inflammatory response. It is important to identify the patients at increased risk of complications requiring additional prophylaxis or more intensive postoperative care, particularly when selecting patients for day case surgery.

Previous intraocular inflammation or surgery was the factor most strongly associated with marked inflammation on the first postoperative day (p < 0.01, compared to uncomplicated patients). As a result, patients stayed in hospital an average of one day longer (p < 0.001) and required significantly more steroid drops (p < 0.001).

Other factors of significance, but reducing importance were: difficult surgery, non-caucasian race and brown irides. Amongst uncomplicated patients, the difficulty of surgery was most significantly related to a high inflammation score (p < 0.01). Non-caucasian patients stayed in hospital significantly longer than their caucasian counterparts (p < 0.05), and required more steroid drops (p < 0.001). Of caucasian patients, those with brown irides were inpatients for significantly longer than those with blue or hazel (p < 0.05). No other factors studied significantly altered postoperative inflammation: neither the presence of diabetes, nor the technique of cataract extraction.
Morphological and Biochemical Assessment of the Cornea in a Gaucher Disease Carrier with Keratoconus
Authors: Salgado-Borges J. , Silva-Araújo A. , Lemos M.M. , Sá-Miranda M.C. , Abreu-Dias P. , Tavares M.A.
Published: April 2018

Ocular abnormalities such as corneal opacities and some specific alterations in ocular movements have been described in the neuropathic forms of Gaucher disease. This study was designed to correlate the clinical, morphological and biochemical findings in the corneal button obtained after keratoplasty in a Gaucher disease carrier with keratoconus.

Morphologically, the cornea showed keratocytes with marked dilatations of the rough endoplasmic reticulum and intracytoplasmic “dark inclusions”; the acidic lipid profiles presented alterations in the cornea of the Gaucher disease carrier when compared with healthy controls and a clear deficiency in ß-glucosidase activity was detected as well.

Our data suggest that the cornea may serve as a good marker of an early target organ in lipid metabolism disorders such as Gaucher's disease.
Systemic Blood Pressure and Capillary Blood-Cell Velocity in Glaucoma Patients: A Preliminary Study
Authors: Orgül S. , Kaiser H.J. , Flammer J. , Gasser P.
Published: April 2018

Systemic hypotension and vasospasm have both been suggested as risk factors for glaucomatous damage. Furthermore, a relationship between the incidence of vasospastic disorders and systemic hypotension has been reported. This preliminary study investigated the relationship between these two risk factors. In 20 glaucoma patients suspected to have vascular risk factors, time of blood-flow standstill was measured under cold provocation in nailfold capillaries and 24-hour blood pressure was monitored. Nine were high-tension glaucoma patients but progressing despite medically well-controlled intraocular pressure, and 11 had normal-tension glaucoma. Thirteen patients were vasospastic, and seven were not. Patients without vasospasm had a significantly lower mean systolic blood pressure during the daytime (113.4± 7.1 mmHg) than vasospastic patients (122.6± 12.8 mmHg), p=0.026. The time of blood-flow standstill in vasospastic patients, however, correlated with the lowest individual systolic blood pressure reading (r=-0.56; p=0.049). These low readings occurred mostly during the night (“deepers”).
PERG and P-VEP after Surgical Trabeculectomy in Primary Open-Angle Glaucoma
Authors: Spadea L. , Giuffrè I. , Bianco G. , Balestrazzi E.
Published: April 2018

Pattern-reversal electroretinograms (PERG) and visual evoked potentials (P-VEP) were measured for 10 eyes from 10 rigorously selected patients with bilateral advanced primary open angle glaucoma (POAG), before and after surgical trabeculectomy. The aim was to establish whether electrofunctional examinations improved after major IOP reduction. Only one eye at random was operated, and the fellow eye was used as control. The aim of this study, using electrofunctional examinations, was to clarify whether ganglion cell damage was reversible after marked reduction of IOP by surgery.

The results indicate that glaucomatous damage seems to be irreversible.
Drug Induced Myopia Associated with Treatment for Gynecological Problems
Authors: Grinbaum A. , Ashkenazi I. , Avni I.
Published: April 2018

We present three cases of women who developed acute transient myopia caused by drugs for gynecological problems. One patient was treated with disothiazide for premenstrual edema.

The second had acute cystitis and was treated by sulphonamide and the third developed myopia coincident with metronidazole treatment for trichomonas vaginalis. We followed these patients by A scan ultrasonographic ocular measurements, documenting reduction of the anterior chamber depth combined with lens thickening. The ocular and myopic changes cleared up completely on discontinuation of the causative agent. The possible mechanism is thought to be an allergic reaction to the drug.
Retinal Pigment Epithelium Tear following Toxemia of Pregnancy
Authors: Menchini U. , Lanzetta P. , Virgili G. , Ferrari E.
Published: April 2018

A 28-year-old woman with toxemia during the 34th week of pregnancy complained of visual loss in one eye. Two weeks after abruptio placentae and delivery a retinal pigment epithelium (RPE) tear which presumably followed a RPE detachment (PED) was found in the macular region of the right eye. Visual acuity was 0.8 at the time of diagnosis but was 1.0 in both eyes one year after the delivery. Some authors have described peculiar choroidal lesions associated with central serous chorioretinopathy (CSC) in pregnancy and ischemic exudative choroidal lesions during severe toxemia. However the findings we describe are highly unusual, indicating that the mechanisms of choroidal and RPE pathology are still poorly understood. We also demonstrate that a pathological tear following toxemia of pregnancy is compatible with good acuity in spite of the anatomical damage.
Ophthalmic Screening of School Children in Ankara
Authors: Turaçli M.E. , Aktan S.G. , Dürük K.
Published: April 2018

Ophthalmic screening was done on 23,810 children visited at schools in different regions of Ankara. Children with below normal visual acuity were invited to the outpatient department and had a full routine ocular examination. Thirty-nine nursery and primary schools were selected, ten of them private, eleven average state schools, seven good state schools and eleven village schools. Among the 23,810 children, 3095 (13%) had various pathology; 1516 were girls, 1579 boys. Refractive errors were found in 85% of the children (2630). This equals 11% of the total screened population. Refractive errors were myopia 32%, hypermetropia 21%, astigmatism 47%. Strabismic children were 2.5%, and amblyopia was found in 1.1%. The purpose of the study was to assess the place of an ocular screening program in primary school children and to discuss the differences encountered in different urban areas.
Treatment of Clinically Resistant Cytomegalovirus Retinitis in AIDS Patients: Combination of Intravenous Ganciclovir and Intravitreal Foscarnet
Authors: Pivetti-Pezzi P. , Accorinti M. , Ciapparoni V. , Vullo V.
Published: April 2018

The treatment of clinically resistant cytomegalovirus retinitis in AIDS patients requires a combination of foscarnet and ganciclovir, but the poor clinical condition of some patients may weigh against this intravenous regimen. We treated three patients with high-dose intravitreal foscarnet (2400 μg/0.1 ml; 25 injections; mean follow-up 14.6 weeks)combined with intravenous ganciclovir (5 mg/kg twice daily), and obtained complete control of the retinitis in a mean time of 3.4 weeks with no ocular or systemic side effects and no other eye/organ cytomegalovirus dissemination. This combined therapy seems useful for clinically resistant cytomegalovirus retinitis in AIDS patients.
The Human Corneal Endothelium after Myopic Excimer Laser Photorefractive Keratectomy. Immediate to One-Month Follow-Up
Authors: Carones F. , Brancato R. , Venturi E. , Vigo L.
Published: April 2018

Purpose

To assess whether excimer laser photorefractive keratectomy for myopia (PRK) induced any changes in the human corneal endothelium in the immediate postoperative period and up to one month after surgery.

Methods

No-contact wide-field sp>ecular biomicroscopy of the central corneal endothelium was performed on 56 eyes of 56 patients (age 20-54 years, mean 31.3) who underwent photorefractive keratectomy for the correction of myopia ranging between 1.25 and 12.50 D (5.71 ± 2.96 D, mean ± SD). Images of the endothelium were obtained using the NonCon Robo endothelial biomicroscope (Konan, Hyogo, Japan), and processed to calculate the mean cell density (MCD), the coefficient of variation of cell area (CV), and the percentage of hexagonal cells (Hex%). Eyes were evaluated immediately before (preop) and after surgery (day 0), on the first two postoperative days (days 1 and 2), and after one month.

Results

MCD was 2645 ± 344 cells/mm2 at preop, 2609 ± 293 cells/mm2 on day 0, 2681 ± 320 cells/mm2 on day 1, 2629 ± 305 cells/mm2 on day 2, and 2709 ± 308 cells/mm2 at one month; a significant difference was found only comparing preoperative to one month data (p= 0.009). CV was 31.6 ± 4.7 at preop, 39 ± 7.1 on day 0 (p= 0.000001), 37.1 ± 7.8 on day 1 (p= 0.00005), 43.4 ± 13.1 on day 2 (p= 0.000001), and 34.7 ± 5.8 on one month (p=0.0006). Hex% was 61.9 ± 7.1 at preop, 58 ± 7.3 on day 0 (p= 0.002), 58.5 ± 8.5 on day 1 (p= 0.015), 57.1 ± 8.5 on day 2 (p= 0.00004), and 59.3 ± 7.5 at one month (p= 0.002). No correlations were found between ablation depth and endothelial changes.

Conclusions

Endothelial cell density was not reduced by PRK in the immediate postoperative period. Changes in morphological indices like CV and Hex% indicate that the photoablation causes some kind of damage to the endothelial cells.
Chemical and Physical Stability of Perfluorocarbons with Laser Treatment
Authors: Meinert H. , Mader J. , Röhlke W. , Geister U. , Lang G.E. , Lang G.K. , Kreiner C.F.
Published: April 2018

Physical and toxicological aspects of different perfluorocarbons and semifluorinated compounds are discussed. The urgent need for ultrapurification of perfluorocarbons is demonstrated. In vitro laser treatment simulating physiological conditions of two ultrapur-ified perfluorocarbons used for temporary tamponade and mechanical fixation of unfolded retina in case of giant tears, and one semifluorinated diether resulted in no detectable chemical alteration. Cytotoxic examinations of both laser treated and untreated probes showed no difference in cell proliferation.
Screening for Tamoxifen Ocular Toxicity: A Prospective Study
Authors: Therssen R. , Jansen E. , Leys A. , Rutten J. , Meyskens J.
Published: April 2018

Specific ocular complications, namely retinopathy, keratopathy and optic neuritis, have been described in women being treated with tamoxifen for metastatic breast cancer or taking this drug as an adjuvant postoperative therapy. We examined 61 patients who had been using tamoxifen for at least one year, in order to detect the incidence of ocular complications. Two patients had retinopathy after having taken high cumulative doses of tamoxifen. Another had corneal deposits and a fourth had optic neuritis.

It thus appears that systematic screening of all symptom-free patients using this drug for metastatic breast cancer is superfluous. However, an ophthalmological assessment every two years or earlier in case of visual complaints for patients taking tamoxifen as an adjuvant therapy remains useful, because the oncological therapy can be adjusted if serious ocular complications arise.
Fluorescence Histochemical Demonstration of Adrenergic Terminations in the Human Choroid
Authors: Nuzzi R. , Guglielmone R. , Grignolo F.M.
Published: April 2018

With the existing literature on the aspects of anatomic and physiological ocular choroid membrane variables in mind, the authors verify the possibility of applying the methods of Axelsson et al and of Lindvall and Bjorklund, as simplified by Furness and Costa for fluorescent microscopy, to the study of human choroid nerve topographic distribution. The material for the study was obtained from three human eyeballs, two enucleated because of malignant melanoma of the choroid and one because of neoplasia of the ciliary body. A binocular dissecting microscope was used. A fluorescent microscope was used to observe the histological specimens and photographs were taken.

The following results are presented and discussed: 1) the fluorescent paravascular nervous fibres and periarterial nervous plexuses divided into preterminal and terminal fibres; 2) in the suprachoroidal layer, there were small groups of polygonal nervous branches with or without this connection; 3) the most intervasal plexus development was in the posterior part of the vascular layer with preterminal and terminal fibres, 4) in the intervascular space, melanocytes and free adrenergic nervous terminations were observed; 5) adrenergic fibres were not observed in the choriocapillaris of the choroid membrane; 6) there were adrenergic neurons in the vascular layer.
Ocular Blood Flow Velocities in Patients with Proliferative Diabetic Retinopathy before and after Scatter Photocoagulation: A Prospective Study
Authors: Mendívil A. , Cuartero V. , Mendívil M.P.
Published: April 2018

Introduction

Color Doppler imaging allows for simultaneous two-dimensional anatomical imaging and Doppler measurement of blood flow velocity. Chemicals are released during the development of a thermal lesion caused by photocoagulation.

Methods

A prospective study compared ocular blood flow velocities (ophthalmic artery, posterior ciliary arteries, central retinal artery, central retinal vein and vortex veins) before and 30 minutes after the first episode of scatter photocoagulation (650, 0.1 s, 500 micron argon laser) in 25 patients with proliferative diabetic retinopathy, using a color Doppler imaging unit (Toshiba Sonolayer SSA-270 A with a 5.0 MHz PLF-503 ST phased-array scanning head).

Results

Systolic, diastolic and mean arterial blood flow velocities were higher after photocoagulation than before. There was a significant difference in the ophthalmic artery; diastolic (P<0.01), mean velocity (P<0.05), posterior ciliary arteries; systolic (P<0.01), diastolic (P<0.001), mean velocity (P<0.05), central retinal artery; mean velocity (P<0.05), central retinal vein; systolic (P<0.001) and vortex veins; systolic (P<0.01), diastolic (P<0.01). Ophthalmic artery systolic and end-diastolic velocities declined with age in diabetic patients before scatter photocoagulation; these changes were not significant (systolic: r= −0.33, diastolic: r= −0.30).

Discussion

During and after thermal lesion caused by photocoagulation, there is a dynamic inflammatory and an autoregulatory response of the retinal circulation, causing changes in the ocular circulation.
A Case of Paradoxical Worsening of Dural-Sinus Arteriovenous Malformation Syndrome after Neurosurgery
Authors: Nagy Z.Z. , Németh J. , Süveges I. , Lanyi F.
Published: April 2018

The authors present a case of a patient with the syndrome of paradoxical worsening of dural-sinus cavernous arteriovenous malformation which was a iatrogenic consequence of embolization of the basal branches of a dural shunt with Yvalon. It is presumed that the thrombogenous Yvalon reached the basal branches of the medial meningeal artery to the superior ophthalmic vein, where it caused complete thrombosis. The impaired ocular and orbital venous outflow caused a dramatic worsening of the ocular congestive symptoms: venous stasis retinopathy with dilated veins, flame - and dot - shaped hemorrhages and a secondary increase in intraocular pressure. The diagnosis of thrombosis of the entire superior ophthalmic vein was confirmed by color Doppler imaging. The mechanism is discussed. Although the ocular pathology is usually self-limiting following the establishment of collateral venous outflow channels, in view of the patient's serious congestive ocular symptoms argon laser photocoagulation and conservative antiglaucomatous local therapy were applied. Once orbital collateral venous drainage was established, the ocular symptoms improved. In the one-year follow-up there was no other complication.
Syphilitic Interstitial Keratitis with Bilateral Funnel-Shaped Iridocorneal Adhesions a Case Report
Authors: Ruusuvaara P. , Setälä K. , Kivelä T.
Published: April 2018

We present the clinical and light microscopic ophthalmological findings in a 60-year-old woman with bilateral, symmetrical, paracentral anterior synechia formation and healed, old, inactive interstitial keratitis, probably secondary to congenital syphilis.

The patient underwent ECCE and IOL implantation in the left eye and a triple procedure (corneal transplantation, ECCE and IOL) in the right eye. Gonioscopy, fluorescein angiography and light microscopy of a specimen from the triple procedure revealed a fibrovascular connection between the iris and cornea. The etiology of the funnel-shaped bilateral iridocorneal synechiae is discussed.
Erythropoietin-Induced Iritis-Like Reaction
Authors: Beiran I. , Krasnitz I. , Mezer E. , Meyer E. , Miller B.
Published: April 2018

The present report describes an iritis-like reaction found in 13 patients treated with recombinant human erythropoietin (Eprex), a drug given to hemodialysis patients for their chronic anemia. Among 120 patients being treated by hemodialysis in two centers affiliated with our medical center, ten out of 30 Eprex-treated patients but none of 90 not being treated with Eprex developed this reaction. The observations described support a causal relation between Eprex treatment and the iritis-like reaction. Further investigative effort is needed to establish the mechanism.
Preclinical Safety Profile of Brimonidine
Authors: Angelov O.V. , Wiese A.G. , Tang-Liu D.D. , Acheampong A.A. , Ismail I.M. , Brar B.S.
Published: April 2018

Brimonidine is a selective α2-adrenergic agonist developed for lowering intraocular pressure in glaucoma patients. Since brimonidine will be used in long-term theraphy, the safety of this drug is an important feature for its clinical success. Brimonidine has been evaluated in a number of safety studies using doses much greater than those in humans. In this paper chronic and carcinogenicity studies are presented. The results of the 6-month ocular/systemic study in rabbits and the 1-year ocular/systemic study in monkeys with 0.2, 0.5, and 0.8% brimonidine ophthalmic formulations showed no ocular or organ toxicity. The highest concentration of 0.8% used in rabbits and monkeys resulted in plasma drug concentrations of 95 (Cmax) and 10 (C2hr) times, respectively, higher than those seen in humans following topical dosing. Dose-related transient exaggerated pharmacologic effects of sedation were observed in the 1-year oral study in monkeys without any organ toxicity. The dose that elicited an apparent pharmacologic effect produced a plasma drug concentration that was approximately 115 times higher than that in humans. In 2-year carcinogenicity studies in mice and rats using doses that produced plasma concentrations 77 and 118 times, respectively, higher than those seen in humans, no oncogenic effect was observed. Based on the extensive safety research on brimonidine, it was concluded that this drug has an excellent safety profile.
Computer Assisted Image Analysis Using the Subtraction Method in Indocyanine Green Angiography
Authors: Miki T. , Shiraki K. , Kohno T. , Moriwaki M. , Obana A.
Published: April 2018

The choroidal vessels are three dimensionally distributed and very complex in their patterns. They often appear to be overlaid in indocyanine green (ICG) angiograms so it is harder to analyze ICG angiography than fluorescein angiography. When an earlier frame is subtracted from a later frame in a sequence of angiograms, the fluorescence which has increased during the time between the two frames can theoretically be demonstrated.

We applied computer-assisted image subtraction methods in selected clinical cases of directly acquired digital ICG angiography to demonstrate how this method works. We used software already installed in an IMAGEnet computer system (Topcon) for image subtraction. We applied the subtraction technique in 18 cases with various diseases. When two images with a time difference of several seconds were subtracted, filling of the choriocapillaris, the neovascularization or the pathological vessels could be observed. When the images had a time difference of several minutes, intrachoroidal dye leakage could be seen more clearly. This method is very helpful for analyzing pathological changes in ICG angiography in clinical cases, when two images are selected appropriately.
Vitreous Changes and Retinal Detachment in Highly Myopic Eyes
Authors: Stirpe M. , Heimann K.
Published: April 2018

This report on 496 highly myopic eyes that underwent transcleral or vitreoretinal surgery for retinal detachment (RD) focuses particularly on how changes in the vitreous gel and the resulting modifications of the vitreoretinal interface produce typical characteristics and complications.

According to the pattern of vitreous modifications the 496 eyes were divided into five groups:

1) eyes with uniform PVD (108 eyes)

2) eyes with PVD spreading towards the upper quadrants (231 eyes)

3) eyes with extensive vitreous liquefaction (EVL) and condensations of the vitreous base (51 eyes)

4) eyes with posterior vitreous lacuna (PVL, 87 eyes)

5) eyes with very limited PVD (19 eyes).

Age, degree of myopia, surgical procedures and final results are reported for each group. A strong correlation was observed between vitreous changes and clinical picture of RD especially in the group of PVL and EVL. In the PVL group a higher degree of myopia was found and more pronounced posterior staphyloma. Frequently the posterior hyaloid, in the form of a thin, extremely smooth membrane, was hard to separate from the inner posterior retina during surgery. Posterior retinal breaks, including macular holes, were found in 56% of eyes.

The presence of EVL with condensation of the vitreous base was correlated with giant retinal tear (GRT) in 70% of cases (36 of 51 eyes). Sixteen GRT were also found in the group of uniform PVD, but these were less extensive and located more posteriorly than in the EVL group. In the former group there were better surgical results because of a lower incidence of PVR. In 46% of the eyes of our series (group 2), PVD extended mostly in the upper quadrants with no vitreous detachment inferiorly. In these cases there was a clinical appearance of inferior vitreous collapse. These eyes had 92% of peripheral superior retinal breaks. Relapses of RD in this group almost invariably occurred in the inferior quadrants.
Homonymous Bilateral Hemianopsia: Electrophysiological Study of a Case
Authors: Magni R. , Reni G. , Rinaldi G. , Ravalico G. , Brancato R.
Published: April 2018

Described is a case of bilateral homonymous hemianopsia with macular sparing, resulting from head trauma. The case presented lesions of the occipital visual areas which involved entirely the left hemisphere and only partially the right hemisphere. VEP were obtainable only from electrodes placed on the right hemisphere with both right eye and left eye stimulation. VEP mapping showed that each eye projects macular fibres towards functional areas of the right occipital hemisphere.

Electrophysiological examination confirmed objectively and for the first time in man the theory of “double cortical macular representation”.

Clinical implications of this finding are discussed.
Simultaneous Bilateral Primary Choroidal Melanoma
Authors: Ascaso F.J. , Cascante J.M. , Castillo J.M. , Arraiza A. , Palomar A.
Published: April 2018

A case of bilateral primary choroidal melanoma is described. To our knowledge, this is the first reported case in Spain. On admission of a 70-year-old man for a choroidal melanoma in the right eye, an asymptomatic tumor was detected in the periphery of his left eye. A-scan ultrasonography, fluorescein angiography and diascleral transillumination supported the diagnosis of choroidal melanoma in both eyes. The right eye was enucleated. Histology confirmed a choroidal melanoma of the mixed type. The left eye was treated with laser photocoagulation and an episcleral plaque of ruthenium-106. Careful systemic evaluation produced no evidence of a primary tumor or metastatic disease elsewhere in the body. Because of the impossibility, in most cases, of obtaining histological confirmation in both eyes, and the tendency of choroidal melanomas to metastatize late, we suggest that the criteria of independent origin (two separate cell types and tumors separated in time) are not necessary in cases of presumed bilateral choroidal melanoma.
Transvaginal Sonographic Diagnosis of Cataract in a Fetus
Authors: Rosner M. , Bronshtein M. , Leikomovitz P. , Berkenstat M. , Barkai G. , Barishak R. Y.
Published: April 2018

Transvaginal ultrasonography is a relatively new technique for visualizing the orbits in a fetus of 4 to 5 cm. At fifteen weeks of gestation it is possible to recognize the lenses and the hyaloid arteries in the eyes, to diagnose structural malformations such as anophthalmos, microphthalmos, buphthalmos and moderate to severe cataract. In most cases cataracts were associated with intracranial defects. We describe a case where the sonographic diagnosis of fetal cataract was confirmed by histopathological examination. A 27-year-old woman had a routine transvaginal sonography at 15 weeks’ normal gestation. Microphthalmos without a hyaloid artery and disorganization of the anterior chamber and lens consistent with cataract were demonstrated in the fetal left eye. In accordance with the parents’ decision, the pregnancy was terminated a week later. Autopsy of the fetus was done and serial sections of the left eye were studied by light microscopy. Histopathological examination verified the sonographic diagnosis of fetal cataract in a microphthalmic eye. Associated findings included malformation of the anterior segment and retinal dysplasia.
Tear Histamine and Histaminase during the Early (Epr) and Late (Lpr) Phases of the Allergic Reaction and the Effects of Lodoxamide
Authors: Leonardi A.A. , Smith L.M. , Fregona I.A. , Salmaso M. , Secchi A.G.
Published: April 2018

The objectives of this study were two-fold: to identify tear histamine content and its relationship to changes in tear histaminase activity during the early (EPR) and late phases (LPR) of the allergic reaction induced by a conjunctival provocation test (CPT) and to evaluate the effects of lodoxamide on histamine release and allergic signs and symptoms during EPR and LPR. A baseline CPT was administered to 20 allergic patients with no baseline signs or symptoms of allergy. Clinical signs and symptoms were evaluated after 20 minutes and 6 hours. Tear samples were taken after 5-10 minutes and after 6 hours for subsequent analyses of cytology and histamine content (ELISA). Patients were then randomly assigned to receive lodoxamide or placebo four times daily for one week in a double-masked fashion. A second CPT was done after this therapy and the same parameters were re-evaluated. During EPR, tear histamine increased significantly with respect to baseline values (p<0.05). During LPR, tear histamine increased significantly (p<0.05) only in histamine inactivated samples. Histaminase enzymes were also significantly less active during the EPR (5.5±0.7) than the LPR (9.9±2.3) and at baseline. Histamine levels significantly correlated with allergic signs and symptoms (p<0.05) only during the EPR. Lodoxamide significantly reduced histamine release during EPR (p<0.05), allergic signs and symptoms during both EPR (p<0.001) and LPR (p<0.005), and tear cytology counts during LPR. In conclusion, greater histaminase activity may account for the smaller amount of tear histamine generally found during LPR, while these enzymes seem to play less of a role during the surge of histamine release and activity in the EPR. Lodoxamide was shown to ideally inhibit various aspects of the allergic reaction: clinical signs and symptoms in both the early and late phases, the primarily EPR-related peak of histamine release, and the primarily LPR-related changes in tear cytology.
One Quadrant Sub-Tenon's Capsule Anesthesia in Anterior Segment Surgery
Authors: Kapran Z. , Uyar M. , Eltutar K. , Dinçer N.
Published: April 2018

Reports of complications associated with local anesthesia in ophthalmic surgery have increased conspicuously in recent years. Sub-Tenon's capsule anesthesia for anterior segment surgery avoids the risks of retrobulbar and peribulbar injections. This study compared sub-Tenon's and retrobulbar anesthesia. Patients undergoing various anterior segment surgery were randomly assigned to sub-Tenon's or retrobulbar anesthesia; 300 were operated with 1-quadrant sub-Tenon's anesthesia (1-QST) and the results were compared with 270 patients operated with retrobulbar anesthesia.

Retrobulbar anesthesia consisted of a 2.5 ml injection of a 1: 1 mixture of 2% lidocaine without epinephrine and 0.5% bupivacaine. Sub-Tenon's anesthesia involved direct transconjunctival infiltration of the same local anesthetic directly into the sub-Tenon's space, in the inferior-nasal quadrant, using a blunt 23-gauge cannula. Patients undergoing various anterior segment surgery procedures were randomly assigned to 1-QST or retrobulbar anesthesia; 300 patients were operated with 1-QST and the results were compared with 270 patients operated with retrobulbar anesthesia.

Preinjection mean (±SD) IOP were 12.9±3.7 mmHg in the retrobulbar and 13.4±3.2 mmHg in the 1-QST patients. Preoperative intraocular pressures were 8.7±3.0 mmHg in the retrobulbar and 9.2±3.2 mmHg in 1-QST patients. Pre- and postinjection IOP for retrobulbar and 1-QST patients were similar.

Pain scores for delivery of the anesthetic, using a numerical rating scale, produced a median score of 1 for 1-QST and 2 for the retrobulbar technique. For the subsequent operative procedure, the median score was 1 for 1-QST and 2 for the retrobulbar patients. Complete akinesia was achieved in 41% with 1-QST and in 69% of retrobulbar patients. 1-QST patients with incomplete akinesia most often had lateral muscle function which did not interfere with the operation.

We found the use of a blunt cannula to deliver anesthetic into the sub-Tenon's space as a simple, safe and effective alternative approach to traditional retrobulbar anesthesia in anterior segment surgery.
Reopening of Failed Trabeculectomies with Ab Interno Nd: Yag Laser
Authors: Kandarakis A. , Mitropoulos P. , Angelou M. , Dikidou M. , Amariotakis A.
Published: April 2018

Purpose

To test the efficacy of ab interno Nd:YAG laser in reopening closed trabeculectomies and to specify the factors influencing the success or failure of the revision.

Methods

27 patients underwent ab interno revision of their failed trabeculectomies with a Q switched, single-shot Cooper Vision 2500 Nd:YAG laser. The cause of obstruction was iris in 12 patients, transparent membrane in sclerectomy in 8 and fibrosis of the scleral flap in the remaining 7. The pre-laser IOP ranged from 28 to 40 mmHg, the patients’ ages from 42 to 75 years and the time between the trabeculectomy failure and the revision from 3 to 17 months. The total energy given to each eye per session, using a gonioscope, ranged from 30 to 1185 mj.

Results

Post-laser follow-up ranged from 6 to 32 months. IOP was controlled in 20 of 27 cases.

Conclusions

We believe that factors influencing the success of the revision are the patient's age, the kind and location of the obstacle and the time elapsed between the failure of the trabeculectomy and the Nd:YAG revision.
Morbidity of Malignant Tumours with Ocular Location in the Bulgarian District of Plovdiv
Authors: Atanassova-Chilova B.K.
Published: April 2018

Purpose

To study the actual and standardized morbidity of malignant tumours with ocular location (per 100,000 inhabitants) over a period of ten years.

Methods

Retrospective evaluation of the registers of the Plovdiv District Oncology Centre and the Department of Ophthalmology in the Medical University. It includes 698 patients grouped according to the International Classification of Diseases. We used the method of standardization (world standard).

Results

The highest is the actual and standardized morbidity of carcinoma of the eyelid, followed by eyeball tumours and the lowest is malignant melanoma of the eyelids. The standardized morbidity of eyelid carcinoma is significantly higher for males and the rural population. There is no significant difference between epi- and intrabulbar morbidity (from the group of the tumours affecting the eyeball). The rural population suffers more from epibulbar and the urban population from intrabulbar malignant tumours.

Conclusions

The morbidity of malignant tumours of the eyes is relatively low but it has clinical importance because these tumors may lead to blindness and death.