bluuebunny/crossref_metadata_2025 huggingface dataset:
Choroidal Hemangioma Treated with Photodynamic Therapy Using Verteporfin: Report of a Case
Authors: Nicolò M. , Ghiglione D. , Polizzi A. , Calabria G.
Published: January 2018

Purpose

To report the results of treatment of circumscribed choroidal hemangioma with a single application of photodynamic therapy (PDT) with verteporfin according to the Treatment of Age-related Macular Degeneration with Photodynamic Therapy study.

Methods

A 44-year-old man with unilateral decreased vision and macular subretinal fluid secondary to a circumscribed choroidal hemangioma diagnosed by fluorescein and indocyanine green angiography and ultrasonography underwent PDT with verteporfin therapy.

Results

One year after PDT, subretinal fluid was absent and visual acuity improved.

Conclusions

The results obtained in this case are in keeping with previously reported results; however, future randomized studies are necessary to evaluate and standardize different infusion times in order to obtain maximum efficacy of treatment.
Value of Electrodiagnostic Assessment in Nonsyndromic Microcephaly
Authors: Atchaneeyasakul L.-O. , Trinavarat A. , Wanumkarng N. , Samsen P. , Thanasombatsakul N.
Published: January 2018

Purpose

To evaluate the value of electroretinogram (ERG) and visual evoked potentials (VEP) in children with nonsyndromic microcephaly.

Methods

In this observational case series, six children with nonsyndromic microcephaly aged 8.5 to 158 months were examined. Main outcome measures included the amplitude of the flash ERG (photopic, flickering, scotopic, and dark-adapted responses), the amplitude and latency of the VEP (flash or pattern-reversal stimulus), visual acuity, slit-lamp bio-microscopy, and indirect ophthalmoscopy.

Results

Three children demonstrated normal fundus appearances, ERG, and VEP responses: two in this group demonstrated poor vision and brain computed tomography in the third showed schizencephaly. The remaining three children demonstrated abnormal ERG with predominant reduction in photopic amplitudes. Retinal pigmentary granularities were detected in two children in this group, one of whom has poor vision, generalized brain atrophy, and 40% reduction in VEP amplitudes.

Conclusions

Abnormal ERG is not uncommon among children with nonsyndromic microcephaly. Although cone photoreceptors are affected more than rods, this does not anticipate poor vision. It appears that defects in posterior visual pathway or developmental malformations of the brain should be responsible for poor visual function in nonsyndromic microcephaly.
Hemiretinal Vein Occlusion in Wegener's Granulomatosis
Authors: Venkatesh P. , Chawla R. , Tewari H.K.
Published: January 2018

Purpose

To report a case of hemiretinal vein occlusion in a patient with Wegener's granulomatosis.

Method

Case report.

Results

Retinal vein occlusion may occur in patients with Wegener's granulomatosis even in the absence of active inflammation affecting the retinal venules.

Conclusions

Wegener's granulomatosis should be considered in the diagnostic workup of young patients with major retinal vascular occlusion and concurrent history of pulmonary and/or renal disease.
Frosted Branch Angiitis and Late Peripheral Retinochoroidal Scar in a Patient with Acquired Toxoplasmosis
Authors: Díaz-Valle D. , Díaz-Rodríguez E. , Díaz-Valle T. , Benítez Del Castillo J.M. , Toledano N. , Fernández Aceñero M.J.
Published: January 2018

Purpose

To report a case of acute frosted branch angiitis associated with acquired toxoplasmosis in which a late peripheral chorioretinal scar developed.

Method

Case report.

Results

A 32-year-old man without systemic symptoms presented with sudden visual loss in his left eye. Examination demonstrated frosted branch angiitis without necrotizing chorioretinitis. Serologic tests showed elevated Toxoplasma gondii-specific immunoglobulin M antibody titers. Antitoxoplasmic therapy and oral steroids healed the ocular inflammation. In a follow-up visit one year later, a peripheral chorioretinal scar was noted.

Conclusions

Acute frosted branch angiitis without focal necrotizing chorioretinitis can be a manifestation of acquired toxoplasmosis. This could be an important, and sometimes forgotten, sign of the disease.
Distribution of Axial, Corneal, and Combined Ametropia in a Refractive Surgery Unit
Authors: Barcsay Gy. , Nagy Z.Zs. , NÉmeth J.
Published: January 2018

Purpose

To group eyes in our refractive surgery unit on the basis of the origin of their ametropia and to assess the percentage of eyes in the different groups.

Methods

Refractive parameters and the axial eye length (AL) of 131 eyes of 131 persons with different refraction were measured. The eyes were initially classified into five groups on the basis of the grade of their ametropia: hypermetropic (>+0.5 D, n=35), emmetropic (between ±0.5 D, n=24), low myopic (between –0.75 and –4.0 D, n=24), medium myopic (between –4.25 and –8.0 D, n=24), and high myopic (over-8.0 D, n=24). Then a classification scheme was made to group the origin of the ametropia on the basis of AL and corneal refractive power.

Results

In the hypermetropic group pure corneal origin was found in 8.6%, pure axial origin in 62.8%, and combined origin in 28.6% of the eyes. In the low myopic group these values were 20.9%, 29.2%, and 45.8%, respectively In the medium and high myopic groups no pure corneal myopia was found, while axial myopia was found in 16.7% and combined myopia in 83.3% of the eyes.

Conclusions

With the help of the classification scheme, an objective decision could be made as to whether the ametropia of a particular eye had axial, corneal, or mixed origin. The most interesting result was that in 83% of medium and high myopic eyes not only AL but also corneal refractive power contributed to the refractive error instead of the eyes being purely axially myopic.
Improvement of Human Corneal Endothelium in Culture after Prolonged Hypothermic Storage
Authors: Camposampiero D. , Tiso R. , Zanetti E. , Ruzza A. , Bruni A. , Ponzin D.
Published: January 2018

Purpose

To evaluate whether the organ culture method for human cornea preservation may be applied to corneas stored for several days at 4°C.

Methods

The cell density, viability, and morphology of corneal endothelium were examined in 140 human corneas stored at 4°C for the minimal time required for transport to the bank and for the preliminary controls of cornea status (1.6±1.1 days) and in 46 corneas preserved at 4°C for 6.1±1.9 days in Optisol-GS. The evaluation was repeated after 19.7±9.1 days of incubation at 31°C in a culture medium containing 2% newborn calf serum.

Results

After the hypothermic storage the corneal endothelium had a mean density of 2475±159 cells/mm2 without significant difference between the short and the long term incubation. Several corneas of the two groups showed signs of endothelium degeneration and were positive to trypan blue test. After the incubation at 31 °C, the corneas with endothelial degeneration decreased by 52.2% and those positive to trypan blue decreased by 21.7%. Polymorphism (enlarged endothelial cells) increased from 9.6% to 14.5% of the coneas. The remodeling of the endothelium led to a 6.7% decrease in cell density. These results were similar after short-term and long-term storage at 4°C.

Conclusions

Organ culture was effective in improving corneal endothelium when the hypothermic storage was prolonged to the upper temporal limit for this procedure (7–10 days). These results may encourage the possibility of an eye bank to allocate the available conea pool, thus decreasing the risk of discarding precious material.
The Effect of Anterior Chamber Maintainer on Anterior Chamber Contamination
Authors: Baykara M. , Özakin C. , doğru M. , Ertürk H. , Heper Y. , Özçetin H.
Published: January 2018

Purpose

To evaluate the effect of anterior chamber continuous infusion maintainer system on the contamination of anterior chamber in phacoemulsification surgery.

Methods

Clear corneal phacoemulsification surgery was performed in 132 eyes of 132 randomly selected patients with cataract who were divided into two groups of 66 eyes according to the use of an anterior chamber maintainer (ACM) system. The fluid specimens were taken from anterior chamber in the beginning and at the end of the surgery. They were transferred under anaerobic conditions and investigated by culturing onto blood agar and thiogluconate broth media. Differences between the two groups with respect to contamination of the specimens were investigated.

Results

The mean age of the group undergoing surgery without a maintainer system (Group A) was 63±10 years (min = 41, max = 80) versus 59±10 years (min = 33, max = 80) in the other group (Group B) in which the maintainer was used during surgery. In the postoperative specimen, Micrococcus species were isolated from one eye (1.5%) in Group A and S. pyogenes in one eye (1.5%) from Group B. Mean follow-up interval was 12±6 (min = 4, max = 28) months.

Conclusions

The use of ACM system in clear corneal phacoemulsification surgery carries no additional risks as far as contamination is concerned.
Some Current Ideas on the Pathogenesis and the Role of Neuroprotection in Glaucomatous Optic Neuropathy
Authors: Osborne N.N. , Chidlow G. , Wood J. , Casson R.
Published: January 2018

The primary features of glaucomatous optic neuropathy are characteristic changes in the optic nerve head, a decrease in number of surviving ganglion cells and a reduction in vision. It is now generally accepted that a number of factors, including elevated intraocular pressure, could lead to the changes seen in the optic nerve head and to obtain a pharmacological means to treat the causes will vary from patient to patient. In contrast, a cascade of events have been proposed to explain how the changes in the optic nerve head may lead to the slow and differential death of ganglion cells in the disease. It is also proposed that drugs (neuroprotectants) influencing this cascade of events can attenuate ganglion cell death and lead to the treatment of all glaucoma patients.
Brain Changes in Glaucoma
Authors: Gupta N. , Yücel Y.H
Published: January 2018

There is evidence that glaucomatous damage extends from retinal ganglion cells to vision centers in the brain. In the lateral geniculate nucleus (LGN), the major relay center between the eye and the visual cortex, neurons should undergo degenerative and/or neurochemical changes in magno-, parvo-, and koniocellular pathways conveying motion, red-green, and blue-yellow information, respectively. Furthermore, in both the LGN and visual cortex in glaucoma, changes in metabolic activity are observed. The study of brain changes in glaucoma may provide new insights into the pathobiology of glaucomatous damage and disease progression, and may stimulate new detection and therapeutic strategies to prevent blindness.
Glare Disability in Patients with Hydrophilic and Hydrophobic Acrylic Intraocular Lens Implants
Authors: Akman A , Bozbeyoglu S. , Akova Y.A.
Published: January 2018

Purpose

To compare glare disability test results in patients with hydrophilic and hydrophobic acrylic intraocular lenses (IOL).

METHODS

Sixty eyes of 60 patients were studied in three groups of 20. Each eye in Group 1 had a single-piece hydrophilic acrylic (Bioacryl, Biotech, France) IOL implant, and each eye in Group 2 had a three-piece hydrophobic acrylic (AcrySof, Alcon, USA) IOL implant. Group 3 was the control group, and consisted of eyes without cataracts. Glare disability was tested using the Ophthimus glare sensitivity test (Ophthimus, Sweden). For each eye, we determined log contrast sensitivity values without exposure to glare source and with exposure to glare source. The difference between these values was recorded as the threshold contrast increase. An infrared camera was used to measure pupil diameter during glare disability testing, and pupil diameter greater than 4 mm was used as an exclusion criterion to eliminate edge design as a potential contributor to glare disability.

Results

The respective mean log contrast sensitivity scores for Groups 1, 2, and 3 in the absence of the glare source were 0.80±0.03, 0.81±0.04, and 0.79±0.08. The corresponding findings with glare source were 0.84±0.07, 0.89±0.07, and 0.84±0.03. The threshold contrast increase in Group 2 (0.070±0.035) was significantly higher than that in both Group 1 (0.043±0.040) and the control group (0.045±0.026) (p<0.05 for both comparisons). There were no significant differences between Group 1 and the control group regarding log contrast sensitivity values with glare source and threshold contrast increase (p>0.05 for both comparisons).

CONCLUSIONS

The eyes with hydrophilic acrylic IOL showed better glare disability results than those with hydrophobic acrylic IOL. The superior performance of the hydrophilic acrylic IOL could be related to their lower refractive index and equi-convex design.
Nonpenetrating Deep Sclerectomy: A 6-Year Retrospective Study
Authors: Lachkar Y. , Neverauskiene J. , Jeanteur-lunel M.-N. , Gracies H. , Berkani M. , Ecoffet M. , Ko pel J. , Kretz G. , Lavat P. , Lehrer M. , Valtot F. , Demailly P.
Published: January 2018

Purpose

Nonpenetrating trabeculectomy, also called nonpenetrating deep sclerectomy (NPDS), is a filtering surgery where the internal wall of Schlemm's canal is excised, allowing sub-conjunctival filtration without actually entering the anterior chamber. This technique was developed to minimize the complications of trabeculectomy. The authors investigated its safety and efficacy in a retrospective noncomparative study.

METHODS

A total of 258 eyes (179 patients, mean age 61.4±11.56 years) with uncontrolled open angle glaucoma with prior medical therapy were treated. NPDS with a biocompatible collagen device (157 eyes) sutured to deep scleral bed or with the use of a 5-fluorouracil sponge (90 eyes) were analyzed. The main outcome measure was postoperative intraocular pressure (IOP) with an average follow-up of 54.4±17.07 months (range 1–85). Efficacy was determined 1 month, 3 months, and every 6 months after the procedure for 6 years.

Results

Mean preoperative IOP was 24.47±5.92 mmHg. Mean postoperative IOP was 14.44±5.31 mmHg (average lowering of the IOP was 38.94±23.81%) at 1 month, 15.16±4.57 mmHg (35.73±21.35%) at 3 months, 15.87±4.24 mmHg (32.45 ±20.52%) at 6 months, 16.32±4.53 mmHg (29.96±23.69%) at 12 months, 17.12±4.45 mmHg (26.51±23.93%) at 18 months, 16.77±4.44 mmHg (28.18±21.73%) at 24 months, 16.43±4.15 mmHg (28.89±23.69%) at 30 months, 16.34±4.12 mmHg (30.05±21.61%) at 36 months, 16.16±4.01 mmHg (30.06±22.55%) at 42 months, 15.71±3.74 mmHg (32.49±19.08%) at 48 months, 15.61±3.48 mmHg (31.26±21.01%) after 5 years, and 15.81 ±3.79 mmHg (33.73±20.9%) after 6 years. YAG goniopuncture was performed in 47.3% of cases with a mean follow-up of 12±13 months. These goniopunctures were effective in lowering IOP after a long-term follow-up (24 months). Additional 5-fluorouracil injections were used in 7% of cases. Visual field (Octopus or Humphrey mean defect and corrected loss variance or loss variance) was not modified (p<0.01). Number of preoperative glaucoma medications was 2.01±0.58 and number of postoperative glaucoma medications was 0.85±0.92. Complications were peroperative microperforations in 27 eyes (10.5%), shallow anterior chamber in 2 eyes, hyphema in 2 eyes (0.8%), cataract in 5 eyes (2%), and dellen in 1 eye (0.4%). No cases of endophthalmitis or choroidal detachment were found. After surgery, 23 eyes (8.9%) required a new filtering surgical procedure, and diode laser cyclophotocoagulation was necessary in 2 eyes (0.8%). The probability success rate, defined as an IOP lower than 21 mmHg, was 66.46% (Kaplan Meier) at 60 months off all glaucoma medications and 80.32% with medical or new surgical treatment.

CONCLUSIONS

NPDS appears to be an effective and safe filtering procedure for lowering IOP and could be an alternative to trabeculectomy in open angle glaucoma with the advantage of having fewer complications.
Air-Guided Manual Deep Lamellar Keratoplasty
Authors: Caporossi A , Simi C. , Licignano R. , Traversi C. , Balestrazzi A.
Published: January 2018

Purpose

To evaluate the efficacy of a new modified technique of deep lamellar keratoplasty (DLK).

METHODS

Nine eyes of eight patients with keratoconus of moderate degree were included. All patients underwent DLK with manual dissection from a limbal side port after an air bubble injection in the anterior chamber. The patients underwent a complete ophthalmologic examinations months after the suture removal, evaluating best-corrected visual acuity, corneal thickness, endothelial cell count, and topographic astigmatism.

Results

One case (11.1%) was converted to penetrating keratoplasty because of micro-perforation. In the eight successful cases, 7 eyes (77.8%) achieved 20/30 or better visual acuity 6 months after suture removal. Mean postoperative pachymetry was 604.76μm (SD 46.76). Specular microscopy 6 months after suture removal revealed average endothelial cell count of 2273/mm2 (SD 229).

CONCLUSIONS

This modified DLK technique is a safe and effective procedure and could facilitate, after a short learning curve, this kind of surgery with a low risk of conversion to penetrating keratoplasty.
Involution of Retinochoroidal Shunt Vessel after Radiotherapy for Optic Nerve Sheath Meningioma
Authors: Mashayekhi A. , Shields J.A. , Shields C.L.
Published: January 2018

Purpose

To illustrate the development and involution of retinochoroidal shunt vessel of the optic disc in a patient with primary optic nerve sheath meningioma.

CASE REPORT

A 38-year-old woman presented with gradual onset of blurred vision in her right eye. Examination revealed a right relative afferent pupillary defect and mild edema of the right optic disc. Computed tomography (CT) showed changes consistent with a primary optic nerve sheath meningioma affecting the orbital portion of the right optic nerve. Patient was observed without treatment and subsequently developed a retinochoroidal shunt vessel on her right optic disc. With progression of the meningioma towards the optic chiasm, treatment with stereotactic radiosurgery was done. Following treatment, the optic disc gradually became pale and the retinochoroidal shunt vessel decreased in caliber with complete involution three years after radiotherapy.
Indocyanine Green Dye-Enhanced Micropulsed Diode Laser: A Novel Approach to Subthreshold RPE Treatment in a Case of Central Serous Chorioretinopathy
Authors: Ricci F. , Missiroli F. , Cerulli L.
Published: January 2018

Purpose

To present a case of central serous chorioretinopathy (CSC) treated with indocyanine green (ICG) dye-enhanced subthreshold micropulsed diode laser photocoagulation.

METHODS CASE REPORT

A 35-year-old man presenting with recurrent CSC with persistent serous detachment of the sensory retina in his left eye who declined treatment with a 532 nm laser. Subthreshold treatment, with no visible endpoint, was performed with an 810 nm diode laser 15 minutes after the injection of 25 mg ICG in 2 cc of 5% glucose solution. The laser energy was delivered over the active leakage sites with a sequence of repeated 500 ms “envelopes” each containing a train of 250 micropulses with 500 mW peak power at 10% duty cycle (200 μs ON and 1,800 μs OFF) and each separated by 500 ms intra-envelopes relaxation time. Due to the absence of visible laser-induced lesions, post treatment ICG digital angiographic images were taken without further dye injection to verify that the hypofluorescent spots resulting from the subthreshold laser applications coincided with the points of leakage.

Results

After 7 days, the patient presented with a less hyperopic refraction, improved visual acuity, and reduction of serous neuroepithelial detachment. No signs of laser treatment were visible at fluorescein angiography. After 8 weeks, the serous neuroepithelial detachment was almost completely resolved.

CONCLUSIONS

ICG dye-enhanced subthreshold micropulsed diode laser photocoagulation appears to be a safe and effective treatment and tepresents a possible approach for the management of chronic CSC with persistent central serous neuroepithelial detachment. Immediate post treatment ICG angiography, without ICG reinjection, allows documenting the actual number and location of the delivered subthreshold laser applications.
Scleral Fixation of a Posterior Chamber Intraocular Lens in a Patient with Two Dislocated Lens Implants
Authors: Cavallini G.M. , Pagliani L. , Campi L. , Lugli N. , Saccarola P. , Volante V.
Published: January 2018

Purpose

To report the clinical findings and management of a case of two consecutive intraocular lenses (IOLs) dislocated into the vitreous cavity after complicated cataract surgery. METHODS. Review of clinical findings and treatment.

Results

A 69-year-old man sought treatment for posterior chamber IOL dislocation. The patient reported a significant loss of visual acuity in the right eye for 4 months (best-corrected visual acuity (BCVA) 20/200 in the affected eye). In the vitreous cavity two dislocated IOLs were found, complicated by a cystoid macula edema. Surgery was planned and the two IOLs were removed from the vitreous cavity. Aphakia was then corrected by means of a scleral fixated posterior chamber lens. Three months after surgery, BCVA was 20/40.

CONCLUSIONS

In the absence of randomized controlled clinical trials evaluating treatment options, preoperative patient work-up should be as accurate as possible in order to reduce the risk of intraoperative and postoperative complications. In this patient, removing the two IOLs and placing a sutured-fixated posterior chamber IOL allowed resolution of the cystoid macular edema.
The Prevalence of Blindness and Low Vision in Older Onset Diabetes Mellitus and Associated Factors: A Community-Based Study
Authors: Idil A. , Caliskan D. , Ocaktan E.
Published: January 2018

Purpose

This community-based study was conducted to assess the prevalence and related factors of low vision and legal blindness in older onset diabetic patients (diagnosed at age 30 and older).

Methods

All known diabetic patients who live in the four primary health care center region Abidinpaşa Ankara, Turkey (total population: 96,348) were included in this cross-sectional study. The prevalence of known diabetes mellitus is 2.2%, of which 96.6% are older onset and 3.4% are younger onset.

Results

In the older onset diabetes group (1289 cases), 10.8% of the population had low vision and only 2.7% had legal blindness. Diabetic retinopathy (DR) was observed in 23.6% of the patients with low vision (42% proliferative DR) and in 62.9% of the patients with legal blindness (90.1% proliferative DR).

Conclusions

In older onset diabetic patients with low vision, nonproliferative retinopathy was a more frequent cause of impaired vision than proliferative retinopathy. Low vision and legal blindness caused by retinopathy were significantly associated with sex, age at examination, age at diagnosis, duration of diabetes, type of diabetes treatment, and hypertension in univariate analysis. However, in logistic regression analysis, low vision and legal blindness caused by retinopathy were found to be associated with longer duration of diabetes (≥15 years), use of insulin, and hypertension.
Progesterone Administration Fails to Protect Albino Male Rats against Photostress-Induced Retinal Degeneration
Authors: Káldi I. , Berta A.
Published: January 2018

Purpose

Female patients show better recover y after brain injury and lower incidence of vascular diseases before menopause. The aim of this study was to test the protective effect of female sexual hormones against photostress-induced photoreceptor apoptosis.

Methods

Five week old male albino Sprague-Dawley rats were injected intraperitoneally with progesterone (60 mg/kg body weight) for 4 days. The control group was injected with the vehicle only (benzyl alcohol). Both groups were halved and one was stressed with light (2700 lux for 24 hours) and the other remained under the original dim cyclic light condition. For functional evaluation, baseline electroretinograms (ERGs) were recorded 7 days before light stress, with follow-up ERGs 5 days after the cessation of light exposure. Animals were sacrificed and their eyes enucleated for histology.

Results

Light exposure caused pronounced decrease in the ERG a- and b-wave amplitudes compared to controls. However, in the light-stressed group, the difference in retinal function between progesterone-treated and nontreated animals was not statistically significant. The thickness of the outer nuclear layer and the length of rod outer and inner segments were significantly reduced in the light-stressed group, indicating loss of rod photoreceptor cells. Progesterone had no neuroprotective effect on rod cell structure.

Conclusions

The administration of progesterone did not prove to be protective against excessive light-caused retinal degeneration on male albino rats. The role of other sexual steroids and their interaction need to be clarified.
Choroidal Detachment following Retinal Detachment Surgery: An Analysis and a New Hypothesis to Minimize Its Occurrence in High-Risk Cases
Authors: Verma L. , Venkatesh P. , Chawla R. , Tewari H.K.
Published: January 2018

Purpose

To determine factors predisposing to the development of choroidal detachment following conventional retinal detachment surgery, to evaluate its clinical course, and to identify possible measures to reduce its occurrence.

Methods

Analysis of 25 consecutive cases of choroidal detachment following retinal detachment surgery out of a total of 510 cases undertaken at a tertiary care referral eye center over a period of 15 months.

Results

The incidence of developing choroidal detachment was 4.9%. The mean age was 61 years (range 28 to 76 years) and there was no sex predilection. Hypertension was present in 16% (n=4). A total of 44% (n=11) of patients had myopia and with respect to the lens status, 44% (n=11) were phakic, 36% (n=9) were pseudophakic, and 20% (n=5) were aphakic. Redetachment of the retina was observed in 12% (n=3) of cases. Elevated intraocular pressure developed in 12% (n=3). In one patient with an anterior chamber intraocular lens and “kissing” choroidal detachment, drainage of the choroidals was undertaken to prevent corneo-lenticular touch and corneal decompensation. In two patients with redetachment, anatomic settlement of the retina was achieved only following vitreoretinal surgery.

Conclusions

The following preoperative and intraoperative factors are associated with a significantly increased risk of choroidal detachment following retinal detachment: higher age, myopia, posteriorly placed explants even if its extent is less, anteriorly placed explants whenever its extent is large, drainage of subretinal fluid, and intraoperative hypotony. Choroidal detachment may also occur in patients with only a radial sponge. Designing a notch intraoperatively in the region of the explants overlying the vortex veins may help to reduce the risk of choroidal detachment following conventional retinal detachment surgery.
Intraocular Pressure Lowering Efficacy of Travoprost
Authors: Przydryga J.T. , Egloff C. ,   Swiss Start Study Group
Published: January 2018

Purpose

To assess the intraocular pressure lowering effect of travoprost 0.004% in patients previously treated with another topical medication, and in previously untreated patients.

Methods

This 12-week, open-label trial in 1590 patients was conducted at 219 sites in Switzerland. Primary open-angle glaucoma and ocular hypertension patients discontinued prior medications, and instilled 1 drop of travoprost in each affected eye at 8 pm. Untreated patients were subdivided into 2 groups: baseline IOP of ≥ 21 mmHg, and baseline IOP of ≤ 20 mmHg. Patients returned for follow-up visits at 1 and 3 months. The primary outcome was mean IOP change from baseline to follow-up.

Results

Of 626 patients previously on monotherapy, and 525 previously untreated or newly-diagnosed patients, 479 and 423, respectively, completed 3 months of therapy. The mean changes from baseline at 1 month (mmHg ± SD), by prior treatment group were: beta blocker, −4.9 (±3.6); latanoprost, −2.3 (± 2.8); alpha-agonist, −4.0 (± 3.7); dorzolamide/timolol fixed combination, −3.4 (± 3.9); topical CAI, −4.4 (± 3.1); new IOP ≥ 21 mmHg, −8.6 (± 4.4); new IOP ≤ 20 mmHg, −4.4 (± 3.0). (All changes from baseline were statistically significant (p < 0.0001).

Conclusions

In patients previously treated with a single drug, travoprost decreased IOP to pressures below those achieved on prior therapy. In all groups, travoprost reduced mean IOP below 18 mmHg within 1 month of starting therapy, and control was maintained for at least 3 months. Overall, travoprost was safe and well-tolerated.
Optical Coherence Tomography Imaging of Surgical Resolution of Bilateral Vitreomacular Traction Syndrome Related to Incomplete Posterior Vitreoschisis: A Case Report
Authors: Carpineto P. , Ciancaglini M. , Aharrh-Gnama A. , Cirone D. , Mastropasqua L.
Published: January 2018

Purpose

To report a case of surgical resolution of bilateral vitreomacular traction syndrome related to incomplete posterior vitreoschisis as documented by optical coherence tomography (Stratus OCT, Carl Zeiss Meditec, Dublin, CA).

Case Report

In both eyes of a 72-year-old man with bilateral blurred vision, OCT examination disclosed a relevant increase in mean foveal thickness (right eye = 714 μm; left eye = 757 μm) due to a vitreomacular traction syndrome. At the edges of the most highly elevated area of vitreo-macular traction, OCT scans showed a characteristic splitting of the hyperreflective signal in both eyes, usually identified as posterior vitreous cortex. Both eyes underwent vitrectomy with epiretinal membrane peeling. Postoperative OCT examination showed vitreomacular traction resolution in both eyes with an evident decrease in mean foveal thickness (right eye = 364 μm; left eye = 335 μm). Right visual acuity improved from 20/200 to 20/50; left visual acuity changed from 20/150 to 20/40.

Conclusions

OCT was a useful tool in identifying an unusual case of bilateral vitreomacular traction syndrome linked to incomplete posterior vitreoschisis and following a favorable course after surgical management.
Impaired Neural Conduction in Crossed Visual Pathways in Patients with Ocular Hypertension
Authors: Parisi V. , Manni G.L. , Olzi D. , Oddone F. , Coppola G. , Bucci M.G.
Published: January 2018

Purpose

To evaluate the neural conduction along crossed and uncrossed visual pathways in patients with ocular hypertension (OHT).

Methods

Fifteen patients (mean age 59.1 ± 6.8 years) with OHT (IOP>22 mmHg, Humphrey 24-2 with mean deviation [MD]> −2 dB) were enrolled. They were compared to 15 age-matched controls. In OHT patients and control subjects, visual evoked potentials (VEPs) were recorded using full-field checkerboard patterns (the check subtended 15' of visual arc; contrast 80%) reversed at 2 Hz. VEP responses were simultaneously recorded in the homolateral visual cortex (HC) and in the contralateral visual cortex (CC), with respect to the stimulated eye.

Results

In OHT patients, VEP P100 implicit times observed in HC and CC were both significantly delayed (analysis of variance, p<0.01) when compared to those of controls, and, in particular, longer in CC than in HC. The interhemispheric differences (ID: P100 implicit time in HC – P100 implicit time in CC) were significantly higher in OHT patients than controls (–3.16±1.80 msec and 1.16 ± 1.04 msec, respectively, p=0.001). In OHT patients we observed an MD hemifield difference (difference between nasal and temporal MD values) higher than in controls (–0.82±0.80 dB and 0.04±1.03 dB, respectively, p<0.01) and significantly correlated with the ID (r: 0.836, p<0.001).

Conclusions

The observed asymmetry in the bioelectrical cortical responses and in the visual hemifield parameters suggests that crossed visual pathways could be impaired earlier than uncrossed visual pathways in OHT patients.
Diurnal Intraocular Pressure Variation in Pseudoexfoliation Syndrome
Authors: Altintaş Ö. , Yüksel N. , Karabaş V.L. , Çaglar Y.
Published: January 2018

Purpose

To describe and compare the diurnal intraocular pressure (IOP) variation in patients with pseudoexfoliation syndrome (PXS) and normal subjects.

Methods

The authors prospectively investigated 19 PXS patients (10 bilateral and 9 unilateral) and 25 age- and sex-matched normal subjects. One eye of each control subject and bilateral PXS patient was selected randomly, and pseudoexfoliative eyes of unilateral cases were enrolled in this study. All patients were admitted to the authors' ophthalmology department and underwent diurnal IOP testing (six measurements over 24 hours).

Results

The mean IOP of PXS patients at all time intervals was significantly higher than the control group (p<0.05). Likewise, a significant difference in the maximum IOP, range of IOP, and minimum IOP, as well as the standard deviation of the pressure at each time point, existed between groups (p<0.05). Normal individuals did not show diurnal variation greater than 5 mmHg. Of patients with PXS, 55.6% showed diurnal variation greater than 5 mm Hg. In addition, in 10% of patients with PXS, the diurnal variations were equal to or higher than 10 mmHg.

Conclusions

Variations in IOP during the daily 24-hour cycle in patients with PXS were higher than control groups. Significant fluctuations in the diurnal curve of IOP in PXS may be an important factor in predicting eyes that may develop pseudoexfoliative glaucoma. IOP fluctuation could influence the diagnostic and prognostic evaluation of PXS.
Unfavorable Effect of Photodynamic Therapy for Late Subretinal Neovascularization with Chorioretinal Anastomoses Associated with Idiopathic Multiple Serous Detachments of the Retinal Pigment Epithelium
Authors: Fossarello M. , Peiretti E. , Zucca I. , Serra A.
Published: January 2018

Purpose

To describe a case of a 46-year-old woman with an asymptomatic history of unilateral multiple serous detachments of the retinal pigment epithelium (PED) in the right eye, treated with photodynamic therapy (PDT) with verteporfin for recent onset of subfoveal choroidal neovascularization (CNV) with chorioretinal anastomoses (CRA).

Methods

Case report.

Results

Fluorescein and indocyanine green (ICG) angiography, performed with a Heidelberg scanning laser ophthalmoscope (SLO), demonstrated a predominantly classic foveal choroidal neovascular membrane associated with a PED and 1 one retinal and 2 two venous chorioretinal anastomoses. The left fundus was normal. PDT therapy was performed according to standard techniques. Three PDT treatments were performed at an interval of 3 months. Three months after the second PDT, visual acuity dropped to 20/200, with an enlargement of the neovascular network. One month after the third treatment, visual acuity deteriorated further and the CRA appeared enlarged, associated with a dense fibrotic reaction in the centere of the lesion.

Conclusions

This clinical observation demonstrates that idiopathic serous detachments of the retinal pigment epithelium may represent predisposing changes to CNV development, and in the case CNV is associated with CRA, PDT may be unsuccessful.
Acute Optic Neuropathy in Behçet Disease
Authors: Yalçindag N. , Yilmaz N. , Tekelí O. , Özdemír Ö.
Published: January 2018

Purpose

To report a patient with Behçet disease presenting with acute optic neuropathy.

Methods

A 47-year-old man was admitted to the authors' clinic owing to sudden visual loss in the left eye. Ophthalmologic and systemic examinations were performed.

Results

Visual acuity was 4/10 in the left eye. Fundus examination demonstrated swollen optic disc with blurred margins. There was relative afferent pupil defect in the same eye. Mega-dose corticosteroid treatment was started with the diagnosis of acute optic neuropathy. Ocular findings resolved within 2 weeks.

Conclusions

Behçet disease rarely presents with acute optic neuropathy.
Infectious Keratitis in South Australia: Emerging Resistance to Cephazolin
Authors: Leibovitch I. , Lai T.F. , Senarath L. , Hsuan J. , Selva D.
Published: January 2018

Purpose

To analyze the microbiologic spectrum and patterns of resistance of infectious keratitis in patients treated at a tertiary hospital in South Australia.

Methods

Retrospective review of microbiology laboratory records of all patients with infectious keratitis who had corneal scrapings, from 1998 to 2003. All records were subsequently reviewed for Gram staining and culture results, as well as antibiotic sensitivity and resistance.

Results

Positive corneal cultures were obtained in 134 out of 211 patients who had corneal scrapings (63.5%). Coagulase negative Staphylococcus was the commonest pathogen identified (29.8% of positive cultures), followed by Staphylococcus aureus (18.7%), Pseudomonas aeruginosa (12.7%), Moraxella (6.7%), Streptococcus pneumonia (6.0%), and fungal keratitis (5.2%). In 43.3% of culture positive cases, the organisms were also identified in Gram stain, and in all these cases there was a full correlation between the two methods. In vitro sensitivities were highest for gentamicin. Fourteen cases (35%) of coagulase negative Staphylococcus were found to be resistant to cephazolin. No ciprofloxacin resistance was identified in all Pseudomonas isolates tested.

Conclusions

Staphylococcus species continue to be the commonest causative organism for infectious keratitis; however, there is an emerging resistance to cephazolin, which is commonly used as the first-line antibiotic for Gram-positive cocci.
Ocular Blood Flow Evaluation in Injured and Healthy Fellow Eyes
Authors: Martini E. , Guiducci M. , Campi L. , Cavallini G.M.
Published: January 2018

Purpose

To assess if injured eyes develop ocular blood flow disturbances that may contribute to development of traumatic glaucoma.

Methods

Twenty-five eyes of 25 patients hospitalized from January 1997 to July 1999 for blunt (15) or penetrating (10) eye injury and elevated intraocular pressure (IOP) (>23 mm Hg) were controlled at least 24 months after the trauma and underwent visual field examination, pulsatile ocular blood flow (pOBF), and color Doppler imaging (CDI) analysis of ophthalmic artery, central retinal artery, nasal and temporal short posterior ciliary arteries. Uninjured healthy eye was used as control.

Results

IOP was significantly higher in injured eyes (15.1±3.3 vs 13.0±2.7 mmHg; p<0.01), but only 2 eyes (8%) were under medical treatment. pOBF values were significantly lower in injured eyes: 11.25±6.56 μL/sec in the trauma eyes and 15.40±7.29 in fellow eyes (p=0.002). Resistivity index of all investigated retrobulbar vessels was very significantly higher in injured eyes than in fellow eyes (p<0.0001). There is no significant correlation between IOP and ocular blood flow disturbance.

Conclusions

Long-term follow-up (mean 39±12 months) of injured eyes shows, besides a slight but significant increase of IOP, a very significant impairment of ocular blood supply to injured eyes compared to healthy fellow eyes with reduction of pulsatile ocular blood flow and marked increase of resistance to flow in all retrobulbar vessels. These anomalies may be considered an independent risk factor to develop traumatic glaucoma.
Myogenic Response Reduction by High Blood Glucose Levels in Human Retinal Arterioles
Authors: Blum M. , Brändel C. , Müller U.A.
Published: January 2018

Purpose

The effect of elevated blood glucose level on the myogenic response of human retinal arterioles to acute increases in blood pressure is investigated.

Methods

The vascular response to raised blood pressure (Bayliss effect) was measured in 12 healthy volunteers by use of the retinal vessel analyzer (RVA). For a 9-minute period an on-line measurement of the diameter of a retinal branch arteriole was performed. After the first 3 minutes (baseline measurement) a second phase with 3 minutes of isometric exercise caused an acute rise in blood pressure, followed by 3 minutes of recovery (phase III). After the first session 100 g glucose were administered per os. After 30 minutes blood glucose was measured again and an identical second session was performed with higher blood glucose levels. The Wilcoxon test was used for statistical analysis.

Results

During the first session a rise in mean arterial pressure of 22.8 (±8.4) mmHg was followed by an arterial vasoconstriction of −6.6 (±1.7) %. The administration of 100 g glucose resulted in a significant rise in blood glucose levels within 30 minutes between the two sessions (4.35 mmol/L vs 7.46 mmol/L) (p=0.002). The blood pressure rise of 25.7 (±7.3) mm Hg in the second session was associated with a significant loss in arterial vasoconstriction of −2.3 (±1.4) % (session I vs session II p=0.002).

Conclusions

The myogenic response of the arterial wall in human retinal arterioles was significantly reduced during acute rise of blood glucose levels.
The Efficacy of Intravitreal Triamcinolone Acetonide on Macular Edema in Branch Retinal Vein Occlusion
Authors: Özkiris A. , Evereklioglu C. , Erkiliç K. , Ilhan Ö.
Published: January 2018

Purpose

To evaluate the effectiveness of intravitreal triamcinolone acetonide as primary treatment of macular edema in branch retinal vein occlusion.

Methods

Fifteen eyes of 15 patients with macular edema due to branch retinal vein occlusion (Group 1) who received 8 mg/0.2 ml of intravitreal triamcinolone injection as primary treatment were retrospectively evaluated. The control group (Group 2) consisted of 19 eyes of 19 patients who had received laser treatment for macular edema. The main outcome measures included best-corrected visual acuity, intraocular pressure, and macular edema map values of Heidelberg Retinal Tomograph II.

Results

In Group 1, mean visual acuity improved significantly from a mean logMAR (logarithm of minimal angle of resolution) value of 0.98±0.19 at baseline to a maximum of 0.24±0.24 during a mean follow-up time of 6.3 months. In the control group, the mean baseline logMAR visual acuity before laser treatment was 1.02±0.22, and it was 0.50±0.28 at 6-month examinations. Mean improvement in visual acuity at 1–, 3–, and 6-month examinations was significantly higher in Group 1 when compared with the control group (for each, p<0.001). The mean edema map value of Group 1 significantly decreased by 40% at 6-month examinations when compared with preinjection value (p<0.001). In Group 1, mean increase in intraocular pressure elevation was 19.8% at the 1-month, 26.9% at 3-month, and 5.7% at 6-month visits, but intraocular pressures were under control with topical antiglaucomatous medications.

Conclusions

Intravitreal triamcinolone acetonide injection may be a new and promising approach as initial therapy for macular edema due to branch retinal vein occlusion.
Optical Coherence Tomography Findings in a Case of Acute Multifocal Posterior Placoid Pigment Epitheliopathy (AMPPPE)
Authors: Lofoco G. , Ciucci F. , Bardocci A. , Quercioli P. , Steigerwalt R.D. , De Gaetano C.
Published: January 2018

Purpose

To report the optical coherence tomography (OCT) findings in a case of acute multifocal posterior placoid pigment epitheliopathy (AMPPPE).

Design

Case report.

Methods

A 26-year-old woman was seen for a mild loss of visual acuity in both eyes. The fundus examination revealed yellow-white placoid lesions in the posterior pole suggesting AMPPPE. Fluorescein and indocyanine green (ICG) angiography and optical coherence tomography (OCT) were performed 2 days, 9 days, and 1 month after the first examination.

Results

In the acute phases the OCT revealed a mild hyperreflective area above the retinal pigmented epithelium (RPE) in the photoreceptor layer. In the later phases the OCT scan revealed a nodular hyperreflective lesion on the plane of the RPE with mild underlying backscattering.

Conclusions

In AMPPPE, the OCT demonstrates hyperreflective lesions that may indicate inflammatory tissue and inflammatory cells or the presence of ischemic edema in the outer retinal layers.
Corneal Thickness and Functional Damage in Patients with Ocular Hypertension
Authors: Zeppieri M. , Brusini P. , Miglior S.
Published: January 2018

Purpose

To correlate functional damage over time detected by standard automated perimetry (SAP) and frequency doubling technology (FDT) with central corneal thickness (CCT) in patients with ocular hypertension (OHT).

Methods

Seventy-eight OHT patients underwent CCT measurements, SAP, and FDT (the latter two also after 12 and 18 months). Patients were divided into three equally sized groups of 26 patients each: thin (<540 üm), normal (540–580 üm), and thick cornea (>580 üm). The frequency of abnormal FDT and SAP results was analyzed over time (Pearson χ2 test).

Results

Six of 26 patients with thin corneas (23.1%) presented an abnormal FDT test at baseline, compared to 1 of 26 (3.8%) in the normal thickness cornea group and 1 of 26 (3.8%) in the thick cornea group. After 12 months, the abnormal FDT tests were as follows, respectively: 9 of 26 (34.6%), 2 of 26 (7.7%), and 2 of 26 (7.7%). For SAP the abnormal results were as follows, respectively: 8 (30.1%), 5 (19.2%), and 2 (7.7%). After 18 months, the abnormal FDT tests were as follows, respectively: 16 (61.5%), 5 (19.2%), and 5 (19.2%). For SAP, the abnormal results were as follows, respectively: 10 (38.5%), 5 (19.2%), and 2 (7.7%).

Conclusions

OHT patients with thinner corneas have a greater risk of developing functional damage over time.
Lens Epithelial Apoptosis and Cell Proliferation in Human Age-Related Cortical Cataract
Authors: Charakidas A. , Kalogeraki A. , Tsilimbaris M. , Koukoulomatis P. , Brouzas D. , Delides G.
Published: January 2018

Purpose

To probe the presence of apoptosis in the epithelium of human lenses with age-related cortical cataract as well as to assess cell proliferation, a predicted consequence of apoptotic cell death, in this specific cell population.

Methods

DNA fragmentation was assessed using terminal digoxigenin-labeled dUTP nick end labeling (TUNEL) in capsulotomy specimens obtained from patients who underwent either extracapsular cataract extraction for the removal of adult-onset cortical cataract (n=27) or clear lens extraction for the correction of high myopia (n=25). Cell proliferation was assayed in 23 epithelia of cataractous lenses, and 20 epithelia of non-cataractous lenses with the proliferation marker MIB1, a monoclonal antibody against the nuclear antigen Ki-67 that is detected throughout the cell cycle but is absent in the resting (G0) cell.

Results

TUNEL staining was observed in 25 (92.6%) specimens of cataractous lenses, whereas cells undergoing apoptosis were identified in 2 (8%) of the epithelia from non-catarac-tous lenses. Only two MIB1-positive samples were detected, one of which was a capsule obtained during intracapsular cataract extraction.

Conclusions

The epithelium of human lenses with cortical cataract undergoes low rate apoptotic death. This limited epithelial apoptosis is unlikely to result in any significant cell density decrease since epithelial gaps are likely to be replaced by cell proliferation at the germinative zone of the anterior lens capsule. Nevertheless, the accumulation of small-scale epithelial losses during lifetime may induce alterations in lens fiber formation and homeostasis and result in loss of lens transparency.