bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular Münchausen Syndrome Resulting in Bilateral Blindness
Authors: Salvo M. , Pinna A. , Milia P. , Carta F.
Published: January 2018

Purpose

Münchausen syndrome is a factitious disorder in which patients knowingly harm themselves for subconscious psychological reasons in order to be hospitalized. Recognition of this psychopathology is important, to prevent potentially severe eye damage. Ocular Münchausen syndrome is uncommon. The authors describe an elderly woman with recurrent, probably self-induced, ocular trauma leading to bilateral blindness. The authors are unaware of any previously reported cases of Münchausen syndrome resulting in bilateral blindness and occurring in old age.

CASE REPORT.

A 73-year-old woman was first seen in 1991 with a closed-globe injury to the right eye, apparently following a household fall. Physical examination showed no sign of extraocular trauma. Right visual acuity was 20/30 after 2 months. She was readmitted in May 2003 with left globe rupture, allegedly following a domestic fall. No extraocular trauma was found. She developed ocular phthisis 6 months postoperatively. The patient was admitted again in February 2004 with right globe rupture, following another alleged domestic fall. Physical examination showed no sign of extraocular trauma. Right visual acuity was 20/400 2 months postoperatively. Psychiatric evaluation revealed Münchausen syndrome. Psychotherapy was prescribed, but refused by her family.

Conclusions

Diagnosis of Münchausen syndrome is difficult to make in the ophthalmic department. Münchausen patients have little or no ability to control their self-destructive behavior. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist with experience in factitious disorders. Even with psychotherapy, which is often refused, the prognosis remains poor.
Long-Term Results after Treatment of Basal Cell Carcinoma of the Eyelid in Southwestern Finland
Authors: Paavilainen V. , Tuominen J. , Aho V.V. , Saari K.M.
Published: January 2018

Purpose

Basal cell carcinoma (BCC) is the most common skin cancer of the eyelid, showing an increasing incidence in the white population. The authors studied the clinical characteristics and the treatment results of BCC of the eyelid in southwestern Finland during 1977–1997.

Methods

The authors reviewed the case records of 191 patients with BCC of the eyelids treated at the Turku University Eye Clinic during 1977–1997. The mean follow-up period after the treatment was 8.6±5.2 years.

Results

The 191 patients had altogether 194 BCC tumors of the eyelid with the mean diameter of the tumor being smaller than 10 mm in 77.3% of cases. Of the 194 BCC tumors of the eyelid 16.0% showed recurrence, and the recurrence rate of all surgically treated tumors was 13.7%. In this study 61 patients (31.9%) developed other malignancies than the BCC of the eyelid including 28 patients (14.7 %) with carcinoma in other locations than skin.

Conclusions

Incompletely removed BCCs of the eyelid showed only 18.9% recurrence rate during the follow-up time. On the other hand, BCCs of the eyelid should not be underestimated because of the rather high total recurrence rate. The frequency of 31.9% of other malignancies than BCC of the eyelid is remarkably high and requires special attention from the ophthalmologist taking care of the patient with BCC of the eyelid.
Visual Field Damage and Progression in Glaucomatous Myopic Eyes
Authors: Perdicchi A. , Iester M. , Scuderi G. , Amodeo S. , Medori E.M. , Recupero S.M.
Published: January 2018

Purpose

To make a visual field retrospective analysis on a group of patients with primary open angle glaucoma (POAG) and to evaluate whether different refractive errors could have different progression of the 30° central sensitivity.

Methods

A total of 110 patients with POAG (52 men and 58 women) were included in the study. All the patients were divided into four subgroups based on the refractive error. The visual field of all the included patients was assessed by an Octopus 30° central visual field every 6 months, for a total of 837 visual fields examined. The resulting data were analyzed by PERIDATA for Windows 1.7 TREND function. Mean defect (MD) and loss variance (LV) were considered for the analysis.

Results

At the first examination, 82% of eyes showed a global decrease of differential light sensitivity (MD >2 dB) and in 67% the distribution of the defect was nonhomogeneous (LV >6 dB). The analysis of variance for subgroups showed a more significant decrease of MD in highly myopic patients. A linear regression analysis highlighted a statistically significant change in time of MD in 36% and of LV in 34% of the eyes studied. Highly myopic patients had the highest (p<0.01) percentage of change of MD and LV (46% and 42%, respectively). Among the four subgroups, there was no difference in progression of MD decrease in time.

Conclusions

These results showed that after 5 years of glaucoma, the visual field was altered in most of the eyes examined (82%) and that in 67% of cases, its defect was nonhomogeneous and worsened with the increase of myopia. The regression linear analysis of visual field changes in time showed a progressive increase of MD and LV in approximately one third of all the eyes examined.
Topographic Spatial Summation in Glaucoma
Authors: De La Rosa M. Gonzalez , Gonzalez-Hernandez M. , Lopez V. Lozano , Sanz D. Perera
Published: January 2018

Purpose

Stimulus luminance (L) and area (A) are related by the equation LxAk=constant. The authors evaluated the k value at 66 positions of the central visual field in patients with glaucoma, to modify L and A simultaneously in order to examine advanced glaucomas with a bigger dynamic range.

Methods

The luminance limitation of a computer screen with automatic photometric control was compensated for by increasing the stimulus area in the range between 0 and 17 dB, using the k topographic values previously calculated on normal subjects. Four initial series of 21, 12, 10, and 10 glaucomas were sequentially examined with the Octopus 311 in which the stimulus size cannot be freely changed during the examination, and with the experimental method (Pulsar-SAP) modifying stimulus sizes to equal the results. k Final estimation was verified in 60 new cases.

Results

k Values increase progressively with defect deepness. Values higher than those of the normal population with equivalent topographic differences were obtained. Correlation between indices was as follows: MD: r=0.94 (p<0.0001); square root of the loss of variance (sLV): r=0.93 (p<0.0001). Frequency of local defects was similar in both procedures. Average topographic differences between thresholds were usually less than 1 dB. The average threshold difference favored Pulsar-SAP by 0.45 dB at those points where the average threshold of both examinations was less than 18 dB and 0.37 dB where such average was higher than or equal to 18 dB.

Conclusions

k Value is higher in patients with glaucoma than in normal subjects, although the topographic features are similar. It is feasible to design a scale combining stimulus luminance and sizes to use screens with relative low brightness as surfaces for visual field examination.
Hydrophilic Acrylic Intraocular Lens Clouding: A Clinicopathological Review
Authors: Taboada-Esteve J.F. , Hurtado-Sarrió M. , Duch-Samper A.M. , Cisneros-Lanuza A. , Menezo-Rozalen J.L.
Published: January 2018

Purpose

An analysis is made of a serious late complication (opacification) of different models of hydrophilic acrylic intraocular lenses (IOLs).

Methods

Seven lenses were explanted from seven patients treated for cataracts with phacoemulsification and implantation of different types of hydrophilic acrylic IOLs (five SC60B-OUV from MDR, one Aquasense from OII, and one H60M Hydroview lens from Bausch & Lomb) who developed important vision impairment in the late postoperative period (1 to 3 years) due to lens opacification. The explanted lenses were subjected to exhaustive study involving photographic analysis, scanning electron microscopy, and energy dispersive X-ray spectroscopy.

Results

Light and scanning electron microscopy revealed diffuse, variable-size granular deposits within the optic of the SC60B-OUV lens, and on the anterior and posterior optic surfaces of the H60M Hydroview lens, though without affecting the haptics in any of the models. Dispersive energy X-ray spectroscopy of the deposits revealed the presence mainly of calcium and phosphorus salts.

Conclusions

Hydrophilic acrylic IOL opacification is a serious late complication of unknown etiology. The condition is more frequent among diabetic patients, and the only management option is IOL explantation and replacement with a lens of some other material. More frequent and longer follow-up is required of those patients wearing lenses for which cases of opacification have been documented, particularly in the presence of predisposing factors (diabetes, uveitis). Caution is required with new lenses, avoiding their generalized use until they have successfully passed the test of time.
Risk Factors for Redetachment and Worse Visual Outcome after Silicone Oil Removal in Eyes with Complicated Retinal Detachment
Authors: Goezinne F. , La Heij E.C. , Berendschot T.T.J.M. , Liem A.T.A. , Hendrikse F.
Published: January 2018

Purpose

The goal of this study was to identify risk factors for redetachment and/or a worse visual outcome after silicone oil removal (SOR) for complicated retinal detachment.

Methods

The authors retrospectively analyzed 287 consecutive eyes with SOR between January 1999 and December 2003.

Results

Anatomic success after SOR was achieved in 81% of the eyes. The overall anatomic success at the end of follow-up was 94%. Postoperative ocular hypertension was found in 8% of the eyes, hypotony in 6% of the eyes, and keratopathy in 29% of the eyes. After SOR 43% of the eyes had an improvement in visual acuity of at least two Snellen lines. After multivariate analysis, male sex, the presence of preoperative rubeosis, and proliferative diabetic retinopathy (PDR) were found to be risk factors for recurrent retinal detachment. Male sex, preoperative visual acuity of <0.1 Snellen lines, PDR, the performance of three more operations, any size of retinectomy, and hypotony were found to be associated with a poor visual outcome of Snellen visual acuity <0.1.

Conclusions

Retinal detachment after SOR in the current unselected series of eyes occurred in approximately 20%, which is comparable to the Silicone Oil Study reports, published approximately 20 years ago. However, preoperative selection was then made, and less than 50% of the silicone oil-filled eyes had SOR. The higher overall anatomic success in the current study may be due to improved vitreoretinal surgical techniques.
ReSTOR® Diffractive versus Array®2 Zonal-progressive Multifocal Intraocular Lens: a Contralateral Comparison
Authors: Renieri G. , Kurz S. , Schneider A. , Eisenmann D.
Published: January 2018

Purpose

To evaluate near and distance visual performance after implantation of a diffractive multifocal intraocular lens (MIOL) (AcrySof ReSTOR®) or a refractive MIOL (Array®2) in bilateral cataract surgery.

Methods

In this prospective, comparative trial, 18 patients with bilateral cataract were selected to have lens surgery with asymmetric MIOL implantation. Eighteen eyes received ReSTOR MIOL and the 18 fellow eyes were implanted with Array 2. Five months after second lens implantation, main postoperative outcomes were uncorrected and distance corrected near visual acuities (VA). Secondary outcomes were distance VA and near acuity with power add, contrast sensitivity with and without glare (Pelly-Robson Contrast Sensitivity Chart, CSV 1000 HGT). Quality of vision was measured by comparing the severity of visual symptoms as referred to a masked interviewer.

Results

Patients reported similar postoperative distance visual acuities for both eyes. ReSTOR-implanted eyes showed better uncorrected and distance corrected near acuity than eyes with Array 2 (p=0.002 and p=0.003, respectively). Intermediate VA with distance correction was slightly higher with the Array 2 MIOL (p=0.058). No important difference was observed in contrast sensitivity, glare disability, and subjective rating of light sensations. Severe photic phenomena were reported only for one Array 2-implanted eye.

Conclusions

The diffractive MIOL showed better uncorrected and distance corrected near VA. The refractive Array 2 MIOL had a tendency to better value for intermediate distance. Disturbing photic phenomena were observed only in one case with the Array 2 MIOL.
Control of Inflammation and Prophylaxis of Endophthalmitis after Cataract Surgery: A Multicenter Study
Authors: Camesasca F.I. , Bianchi C. , Beltrame G. , Caporossi A. , Piovella M. , Rapisarda A. , Tassinari G. , Zeppa L. ,   For The Italian Betamethasone-Chloramphenicol Vs Dexamethasone-Tobramycin Combination Study Group
Published: January 2018

Purpose

To compare two different postcataract surgery antibiotic/steroid therapeutic combinations, for clinical results as well as patient satisfaction.

Methods

Prospective randomized clinical trial of patients with bilateral operative cataract. Postoperatively, for 15 days one eye was randomly assigned to therapy with the combination chloramphenicol 0.25%-betamethasone 0.13% gel three times a day (Group 1) and the other to the combination tobramycin 0.3%-dexamethasone 0.1% eyedrops four times a day (Group 2).

Results

A total of 142 patients (284 eyes) completed the study. The authors could not detect any significant difference between Group 1 and Group 2 concerning preoperative evaluation, surgical procedure, and complications. Pertaining to the two therapeutic regimens, efficacy, side effects, and clinical findings such as uncorrected visual acuity, intraocular pressure, edema or hyperemia of eyelids and/or conjunctiva, conjunctival and/or ciliary vessels congestion, decreased corneal transparency, corneal edema, Descemet folds, anterior chamber Tyndall and depth, and posterior synechiae were also comparable. Postoperative subjective pain and dry eye sensation were comparable between the two groups, while the gel preparation elicited a significantly more pleasant sensation in the patients (p=0.04).

Conclusions

The motivation for use of a gel is to prolong the permanence of associated drugs on the ocular surface, increasing potency and decreasing concentration of the drug and rate of administration. This in order to improve compliance and decrease potential side effects. Chloramphenicol 0.25%-betamethasone 0.13% gel combination proved to have comparable efficacy, tolerance, and better acceptance by the patients than an aqueous tobramycin 0.3%-dexamethasone 0.1% preparation.
Efficacy of Anterior Chamber Paracentesis after Intravitreal Triamcinolone Injection
Authors: Chang W. , Chung M.
Published: January 2018

Purpose

To investigate the efficacy of anterior chamber paracentesis for intravitreal triamcinolone acetonide injection (IVTA).

Methods

A prospective, randomized clinical trial was conducted on 30 eyes from 30 patients scheduled for IVTA (4 mg/0.1 mL). Eyes were randomly divided into two groups: eyes that had undergone anterior chamber paracentesis (Group 1, 15 eyes) and eyes that did not have anterior chamber paracentesis (Group 2, 15 eyes). Intraocular pressure (IOP) was measured by Goldmann applanation tonometry at a baseline of 2, 15, 30, and 60 minutes at 1 day and 1 week after the injection. The authors analyzed the short-term postoperative changes of the IOP in each group.

Results

For Group 1, the mean preoperative IOP was 15.33±1.72 mmHg, and the postoperative IOP at 2 and 15 minutes were 7.80±1.47 and 11.73±1.67 mmHg, respectively. For Group 2, there was a significant elevation of IOP (46.73±8.26 mmHg) 2 minutes after the injection, which decreased to the normal range (16.13±2.61 mmHg) by 15 minutes after the injection. There were no significant differences between the two groups in IOP at 15 minutes postsurgery compared with the distinct difference in IOP at 2 minutes post surgery (Student t-test, p=0.01).

Conclusions

The findings suggest that routine anterior chamber paracentesis is inappropriate due to the brief immediate postoperative IOP elevation with IVTA.
Epidural Empyema Secondary to Orbital Cellulitis: A Case Report
Authors: Meena M.K. Brijlal , Sharma P.
Published: January 2018

Purpose

To report a case of epidural empyema, a rare complication of orbital cellulitis, underlining the importance of early diagnosis and appropriate therapy to avoid severe complications often associated with this disease.

Methods

The treatment was initiated with extended spectrum antibiotics such as third generation cephalosporins along with aminoglycoside or metronidazole for anaerobes.

Results

The patient responded well and was asymptomatic after 15 days. Radiologic investigations (computed tomography/magnetic resonance imaging) should be done on an emergency basis. Treatment should be aggressive with parenteral use of extended spectrum antibiotics. The role of steroid is when proptosis is causing lagophthalmos with exposure keratitis and/or optic nerve compression. Judicious surgical intervention can be life saving in this emergency. Peribulbar antibiotic injection has no role in the therapy.

Conclusions

The authors present a unique case of epidural empyema secondary to orbital cellulitis associated with an episode of epileptic seizure.
Combination Products in Clinical Practice: Canadian Experience
Authors: Gouws P.
Published: January 2018

Purpose.

Data are provided from the Combigan Early Experience Data (CEED) study, which evaluated patients’ clinical experience of using Combigan® in a real-life setting.

Methods.

CEED was a Canadian open-label, prospective 2-month surveillance trial involving 47 investigators and 453 patients. Primary outcomes were intraocular pressure (IOP) reduction and patient satisfaction. Adverse events and doctor satisfaction were secondary outcomes. Most patients were aged over 50, with 82% white, and nearly 90% had open-angle glaucoma. Combigan was used either as a replacement of, or an addition to, the patients’ existing therapy.

Results.

Switching to, or adding, Combigan to existing glaucoma therapy led to an additional reduction in IOP of 3.8 mmHg, and 70% of patients achieved IOP ≤18. mmHg compared with 31% at baseline. There was an additional reduction in IOP of almost 3 mmHg in patients switched from Cosopt to Combigan and the proportion of eyes achieving an IOP ≤18 mmHg more than doubled in these patients. Altogether, 92% of patients who switched from Cosopt alone to Combigan alone rated Combigan as more comfortable; 98% of doctors rated Combigan as good or excellent compared with other IOP-lowering medications.

Conclusions.

Combigan effectively lowered IOP over the 2-month trial, and the findings suggest that it is as effective as, or more effective than, Cosopt.
Meeting Summary
Authors: Migdal C.
Published: January 2018

Several fixed combination products are now available in glaucoma management. Considerations when selecting combination therapy include safety, finding the best combination of mechanisms of action. Combigan® is one such product that has been shown to be more effective than either of its constituent agents, brimonidine or timolol, used alone. It has at least a similar intraocular pressure (IOP)-lowering effect as the concomitant use of its two constituents, and it produces a significant additional lowering of IOP in patients who switch from other therapies, including Cosopt®. Combigan has high patient satisfaction ratings.
Dry Eye Syndrome in Diabetic Children
Authors: Akinci A. , Cetinkaya E. , Aycan Z.
Published: January 2018

Purpose

To compare the symptoms, signs, and results of objective tests for dry eye syndrome (DES) in type 1 diabetes mellitus (T1DM) patients and controls.

Methods

A total of 104 children with T1DM and 104 age- and sex-matched controls were compared in terms of the symptoms, signs, and results of objective tests for DES. Duration of T1DM, presence of diabetic retinopathy, mean hemoglobin A1c level, pubertal status, and a history of accompanying autoimmune disease were noted in T1DM group. Analysis of variance, multivariate regression analysis, Student t, Mann-Whitney U, and chi-square tests were used for statistical analysis.

Results

A total of 15.4% of diabetic children complained of dry eye symptoms, versus 1.9% of the controls (p=0.029). Dry eye signs were detected in 7.7% of diabetic children, versus 0.96% of controls (p=0.034). Tear break-up time (TBUT) and Schirmer test results were significantly lower in T1DM group than controls (p=0.018, p=0.024, respectively). A total of 7.7% of diabetic children had definite and 0.96% had probable diagnosis of DES, versus none of the controls (p=0.03). TBUT and Schirmer test results were significantly lower in patients with more than 10 years duration of T1DM (p<0.001 for both).

Conclusions

The prevalence of symptoms, signs, and definite diagnosis of DES are higher and basal tear secretion and tear film stability are lower in diabetic children than controls. Duration of T1DM is the only disease-related variable which is associated with basal tear secretion and tear film stability.
Behaviour of the Phakic Iris-claw Intraocular Lens (Artisan®/Verisyse®) during Accommodation: an Optical Coherence Biometry Study
Authors: Sekundo W. , Bissmann W. , Tietjen A.
Published: January 2018

Purpose

To evaluate variations in the position of the phakic iris claw lens (Artisan®, Verisyse®) and the natural crystalline lens during the accommodation process.

Methods

We measured changes in position of the iris claw lens and the crystalline lens during the accommodation using optical coherence biometry (AC Master®/Carl Zeiss Meditec, Germany) in 17 patients (28 eyes) with a phakic iris claw lens implanted for high myopia and/or myopic astigmatism. Accommodative effort was obtained using an internal optical target within the measuring device.

Results

There was a forward shift of the phakic iris claw lens with a mean of 70 μm (8–178 μm) of the optical path length (OPL). At the same time the anterior pole of the natural lens showed a forward mean movement of 85 μm (4- 260 μm).

Conclusions

An anterior displacement of the iris-claw phakic lens was shown in a series of eyes during the accommodation process. As this displacement goes along with the forward displacement of the anterior pole of the crystalline lens, the preoperative measurement of the latter might provide some additional information about the position of the iris claw lens in the accommodative state after implantation.
Protein S Deficiency and Retinal Arteriolar Occlusion in Pregnancy
Authors: Vela J.I. , Díaz-Cascajosa J. , Crespí J. , Mariages T. , Buil J.A.
Published: January 2018

Purpose

To report two cases of retinal arteriolar occlusion in pregnant women with transient protein S (PS) deficiency.

Methods

Observational case reports.

Results

Two pregnant women in their 30s presented with a paracentral scotoma in their right and left eye, respectively. In both cases the only risk factor for vascular occlusion was pregnancy. Systemic diseases were excluded. Free and functional PS activity was physiologically reduced in both patients. In Case 1, free PS was 47% and functional PS was 22%. In Case 2, free PS was 43% and functional PS was 25%. These levels of PS seem to be lower than those published for normal pregnancy.

Conclusions

There might be a special relationship between PS deficiency and the development of arterial occlusion in pregnant women. A direct effect may be possible. Although the prevalence and incidence of vasoocclusive disease in these patients are low, PS deficiency should be considered as another risk factor. Further studies are necessary to evaluate changes in PS and to assess its relationship with thromboembolic events during pregnancy.
Comparison of Preoperative and Postoperative Anterior Segment Measurements with Pentacam in Horizontal Muscle Surgery
Authors: Emre S. , Çankaya C. , Demirel S. , Doganay S.
Published: January 2018

Purpose

To evaluate the effect of horizontal muscle surgery (recession or recession plus resection) on the anterior chamber parameters in patients after strabismus surgery. Patients and Methods. The Scheimpflug of 18 eyes of 12 patients with horizontal deviations were recorded just before surgery and 1 month after surgery. The power of anterior surface of cornea in horizontal and vertical axis, thinnest corneal thickness, anterior chamber depth, anterior chamber volume, and cornea volume were analyzed. The clinical characteristics of patients, the size of the deviations, the surgical doses, and observed responses to surgery were reviewed.

Results

There were six male and six female patients with an average age of 11.4 years (range, 4 to 22 years). Mean preoperative deviation was 47.91 PD (range, 20 to 75 PD), eight patients had esotropia with 57.5 PD average deviation (range, 40 to 75 PD), and four patients had exotropia with 28.75 PD average deviation (range, 20 to 35 PD). Of these 18 eyes, 12 eyes had horizontal muscle recession and 6 eyes had recession plus resection surgery. At the end of 1 month, three patients were orthophoric and eight patients had residual deviations varying between 16 and 35 PD. Preoperative and postoperative comparison of the whole study group documented insignificant changes in anterior chamber parameters and in keratometer readings. However, after dividing patients into two groups–recession or recession plus resection group–only one parameter, anterior chamber volume, was significantly reduced in recession plus resection group.

Conclusions

Patients with strabismus who undergo recession plus resection procedure are prone to change in anterior chamber volume. Study with larger groups and long follow-up is necessary for clearer documentation of alterations at anterior chamber parameters.
Comparison of Intraocular Pressure Lowering Effect of Once Daily Morning vs Evening Dosing of Latanoprost/Timolol Maleate Combination
Authors: Takmaz T. , Aşik Ş. , Kürkçüoğlu P. , Gürdal C. , Can İ.
Published: January 2018

Purpose

To compare intraocular pressure (IOP) reduction profiles of latanoprost-timolol maleate fixed combination (LTFC) administered in the morning or evening in primary open angle glaucoma (POAG).

Methods

A prospective, randomized study including 60 eyes of 30 patients with POAG was carried out. Patients were randomized to treatment with LTFC at 8 PM (Group 1) or at 8 AM (Group 2). After therapy of 4 weeks, IOP was measured at 2 AM, 6 AM, 10 AM, 2 PM, 6 PM, and 10 PM and compared with baseline values and latanoprost therapy alone.

Results

Mean diurnal baseline IOPs and IOPs after treatment with latanoprost and LTFC were 23.6±2.6, 16.7±2.3, and 15.5±2.2 mmHg in Group 1 and 23.1±2.6, 16.9±2.4, and 15.7±2.4 mmHg in Group 2. LTFC lowered IOP more than latanoprost at all time points in both groups (p<0.001) (except 6 AM in Group 2). The mean IOP range after LTFC therapy was lower than the baseline in Group 1 whereas it was not different in Group 2. IOP at 10 AM was significantly higher than the other time points at baseline measurements in both groups (p<0.01) but after treatment there was no difference (p>0.05). According to IOP reduction from baseline, there was a statistically significant difference between groups in favor of Group 1 at 6 AM, 10 AM, and mean diurnal measurement (p<0.01).

Conclusions

Both morning and evening dosing of LTFC were effective in lowering diurnal IOP in patients with POAG. However, evening dosing of LTFC seemed to be more effective in controlling IOP especially in the morning and avoiding the fluctuations with lower range of IOP
Urinary 8-Hydroxydeoxyguanosine Levels in Diabetic Retinopathy Patients
Authors: Dong Q.Y. , Cui Y. , Chen L. , Song J. , Sun L.
Published: January 2018

Purpose

Involvement of oxidative stress in the pathogenesis of diabetic microvascular complications has been proposed. Recently, 8-hydroxy-2′-deoxyguanosine (8-OHdG) has been reported to serve as a new sensitive biomarker of the oxidative DNA damage in vivo. This study was undertaken to investigate whether the urinary levels of 8-OHdG are altered in patients with type 2 diabetes. The authors also attempted to analyze the relationship between 8-OHdG levels and other clinical parameters of patients with diabetes, especially the relationship between oxidative DNA damage and the severity of the retinal lesions in patients with diabetic retinopathy.

Methods

The authors studied 60 patients with type 2 diabetes and compared them with 35 nondiabetic control subjects. Urinary 8-OHdG concentrations were assayed using competitive enzyme-linked immunosorbent assay.

Results

The patients with type 2 diabetes had significantly higher concentrations of 8-OHdG in their urine than the control subjects (19.6±6.7 vs 11.9±4.9 ng/mgCr; p<0.05). The authors could not find any correlation between urinary 8-OHdG levels and age, duration of diabetes, or serum lipids. However, HbA1c values were significantly correlated with 8-OHdG values. Among the patients with diabetes, those with proliferative retinopathy had significantly higher 8-OHdG levels than those with nonproliferative retinopathy or without retinopathy.

Conclusions

The authors' findings show that measuring urinary 8-OHdG is a novel convenient method for evaluating oxidative DNA damage in patients with diabetes, and it is also suggested that 8-OHdG could be a sensitive biomarker and may be helpful for the early diagnosis and treatment of patients with diabetic retinopathy.
Trends in Blind and Low Vision Registrations in Taipei City
Authors: Tsai I.-L. , Woung L.-C. , Tsai C.-Y. , Kuo L.-L. , Liu S.-W. , Lin S. , Wang I.-J.
Published: January 2018

Purpose

To determine the overall reported incidence and causes of registrable blindness and low vision in Taipei, Taiwan, that have occurred in the previous 10 years.

Methods

Study data were obtained from disability identification registration forms completed between January 1995 and December 2004. Definitions of low vision and blindness were defined by WHO criteria: low vision included visual acuity worse than 6/18 (20/60) to a lower limit of 3/60 (20/400). Blindness was defined as visual acuity worse than 3/60 (20/400) in the better eye with best possible correction.

Results

There were 3151 registrations for visual impairment during the study period. A total of 239 registrations were excluded due to insufficient data. Of the remaining 2912 (1518 males and 1394 females), 640 males and 647 females were legally blind (44.20%). A total of 878 males and 747 females were partially sighted. The six leading causes of low vision and blindness, in decreasing frequency, were glaucoma, optic neuropathy, diabetic retinopathy, retinitis pigmentosa, age-related macular degeneration, and myopic macular degeneration.

Conclusions

The proportions of new registrations owing to glaucoma, diabetic retinopathy, age-related macular degeneration, and myopic macular degeneration have changed significantly since 2000; the proportion due to diabetic retinopathy has increased.
Superficial Keratectomy and Amniotic Membrane Patch in the Treatment of Corneal Plaque of Vernal Keratoconjunctivitis
Authors: Pelegrin L. , Gris O. , AdáN A. , Plazas A.
Published: January 2018

Purpose

To report the importance of early surgical treatment of corneal ulcers associated with vernal keratoconjunctivitis (VKC) which may potentially produce severe lesions and permanent visual sequelae.

Methods

The authors present the case of a child with corneal ulcer in plaque who did not respond to medical treatment and had a good response to surgical treatment.

Results

A superficial keratectomy with an amniotic membrane patch was performed. A rapid postoperative epithelialization with a final good visual acuity was achieved.

Conclusions

Although amniotic membrane grafts following keratectomy have been described as a successful treatment in deep ulcers, in cases with slight stromal thinning, the amniotic membrane patch may be enough to achieve epithelialization. This procedure avoids the presence of the remains of membrane under the epithelium, which may affect postoperative corneal transparency.
Effect of Pterygium Surgery on Corneal Topography
Authors: Errais K. , Bouden J. , Mili-Boussen I. , Anane R. , Beltaif O. , Meddeb Ouertani A.
Published: January 2018

Purpose

To evaluate the effect of successful pterygium surgery on corneal topography.

Methods

Computerized corneal topography was performed on 20 eyes with pterygium before and 3 months after successful excision and limbo-conjunctival autograft surgery. Corneal shape, corneal spherical power, simulated keratometric astigmatism, surface regularity index (SRI), and surface asymmetry index (SAI) were assessed before and after surgery. Pre- and postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and manifest refraction spherical equivalent (MRSE) were also evaluated.

Results

Changes in corneal shape were mainly a decrease in midline corneal flattening. Corneal spherical power was 41.65±3.29 diopters (D) (mean ± SD) preoperatively and 44.58±1.55 D postoperatively (p=0.04). Simulated keratometric astigmatism was 5.47±3.45 D preoperatively and 1.79±1.52 D postoperatively (p=0.0005). SRI was 1.39±0.93 preoperatively and 1.10±0.57 postoperatively (p=0.03). SAI was 1.17±1.09 preoperatively and 0.75±0.73 postoperatively (p=0.02). UCVA was 0.31±0.33 preoperatively and 0.52±0.32 postoperatively (p=0.04). BSCVA was 0.73±0.20 preoperatively and 0.89±0. 16 postoperatively (p=0.008). MRSE was −0.54±3.29 D preoperatively and −1.30±3.05 D postoperatively (p=0.45).

Conclusions

Corneal topographic changes caused by the pterygium are almost reversible after surgical treatment. Successful pterygium surgery significantly reduces topographic astigmatism, SRI, SAI, and corneal flattening. However, precise prediction of these refractive changes is not always accurate.
Cataract Surgery in Exudative Uveitis: Effectiveness of Total Lens Removal, Anterior Vitrectomy, and Scleral Fixation of PC Iols
Authors: Secchi A.G.
Published: January 2018

Purpose

Cataract surgery in exudative uveitis is often followed by severe complications (pupillary seclusion/occlusion, dense posterior capsule/anterior vitreous opacification, cystoid macular edema following repeat YAG laser procedures) which often drastically limit functional recovery Total removal of cataract, anterior vitrectomy, and scleral fixation of a posterior chamber (PC) intraocular lens (IOL) has been tried as a surgical alternative, searching for lessened postsurgical complications and a better outcome.

Methods

Group A was a cohort of 12 patients with cataract after exudative (mostly sarcoidosis and Vogt-Koyanagi-Harada) uveitis, subjected to intracapsular cataract extraction, anterior vitrectomy, and scleral fixation of PC IOLs. Group B was the control group, including 12 patients with a similar clinical condition subjected to phacoemulsification or extracapsular cataract extraction plus in-the-bag or in-the-sulcus IOL implantation. Follow-up time for both groups was at least 7 years.

Results

Postoperative inflammatory signs were substantially less in Group A patients, from 2 days up to >7 years postsurgery Group A patients showed no cells/exudates adhering to the IOL surfaces, no synechiae, minimal (as compared to Group B) vitreous opacifications, and significantly higher visual acuity (p=0.024 at the seventh year control). Group A patients reported less frequent relapses of uveitis postsurgery, but the relevant clinical data did not allow statistical evaluations.

Conclusions

Total removal of cataract in highly exudative uveitic eyes, plus anterior vitrectomy and scleral fixation of PC IOLs, although technically a more demanding surgical procedure, proved to be safe and more effective than classical procedures.
Hess Lancaster Screen Test with the Head Tilted: A Useful Test in the Diagnosis of Bilateral Fourth Nerve Palsies
Authors: Armesto A. , Ugrin M.C. , Travelletti E. , Schlaen A. , Piantanida N.
Published: January 2018

Purpose

To introduce Hess Lancaster screen test performed with the head tilted as a new ancillary test to help in the diagnosis of bilateral superior oblique (SO) nerve paresis.

Methods

Three patients with clinical diagnosis of acquired bilateral fourth nerve paresis, three with clinical diagnosis of acquired unilateral fourth nerve paresis, and three normal subjects were tested with Hess Lancaster test in the nine positions of gaze with their heads straight and with their heads tilted to each side. Test results were compared and data were analyzed.

Results

Hess Lancaster test of all patients with bilateral SO palsy performed with their heads straight showed unilateral SO underaction, but when the test was carried out with the head tilted to each side findings were positive for ipsilateral SO underaction and ipsilateral hypertropia for both sides. In those patients with unilateral SO palsy, Lancaster test was positive for SO underaction when the head was in straight position and when it was tilted to the side of the paretic muscle, but it was almost normal with the head tilted to the opposite side. Normal subjects did not show any abnormality regardless of the head position.

Conclusions

Bilateral SO palsies are sometimes difficult to diagnose for they might be masked. Hess Lancaster test carried out with the head tilted to both sides could help in the diagnosis of bilateral SO palsies.
Mycobacterium Chelonae Keratitis in a Patient with SjöGren's Syndrome
Authors: Van Der Beek M.T. , Bernards A.T. , Lapid-Gortzak R.
Published: January 2018

Purpose

In this report a case of Mycobacterium chelonae keratitis in a patient without any previously described risk factors is described. The only risk factor found was a rheumatoid arthritis related Sjögren's syndrome.

Methods

Case report.

Results

A 60-year-old woman was referred to the hospital with an infectious keratitis of the left eye of 3 months duration, unresponsive to empirical therapy with ofloxacin and tobramycin drops. Her medical history included a longstanding rheumatoid arthritis and a secondary ocular surface syndrome. Upon arrival the left eye showed diffuse corneal edema and centrally several large infiltrates with fluffy edges, surrounded by several smaller satellite infiltrates. The cornea was scraped for culture and grew M chelonae and sensitivity testing showed sensitivity to ciprofloxacin, clofazimine, and clarithromycin. Systemically ciprofloxacin 750 mg and clarithromycin 500 mg twice daily were prescribed orally. Topical therapy consisted of topical erythromycin 10 mg/mL and ofloxacin 3 mg/mL every 2 hours. Treatment was continued for a total of 10 months during which the infiltrates cleared completely, but the central cornea remained scarred.

Conclusions

M chelonae can be a cause of infectious keratitis in patients without known risk factors for rapidly growing mycobacterium keratitis. Especially in the case of ocular infections that show no response to regular antibacterial treatment, mycobacterial infection should be considered. Good communication between the ophthalmologist and the microbiologist is crucial for a rapid diagnosis.
Single-Session Photodynamic Therapy Combined with Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration
Authors: Ahmadieh H. , Taei R. , Soheilian M. , Riazi-Esfahani M. , Ahadi H.
Published: January 2018

Purpose

To evaluate the efficacy of combined single-session photodynamic therapy (PDT) and intravitreal bevacizumab (IVB) for treatment of neovascular age-related macular degeneration (AMD).

Methods

In a prospective interventional case series, patients with subfoveal choroidal neovascularization (CNV) underwent PDT followed by 1.25 mg IVB injection. Best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) measurements were repeated at 6-week intervals and fluorescein angiography was performed after 12 weeks and when considered necessary thereafter. Repeat injections of IVB were performed based on fluorescein angiographic evidence of CNV leakage.

Results

Fourteen eyes were included in this study. Mean follow-up was 52.4±15.2 weeks (range: 26–74 weeks). Initially, mean BCVA was 0.80±0.42 logMAR and mean central macular thickness (CMT) was 308±88 μm. At week 12, BCVA improved to 0.62±0.47 logMAR (p=0.006) and CMT reduced to 186±53 μm (p=0.003). Corresponding results were 0.53±0.52 logMAR (p=0.02) and 193±78 μm (p=0.002) after 24 weeks. A second IVB injection was performed in 13 eyes with a mean interval of 16.3±5.9 weeks.

Conclusions

Combination therapy with single-session PDT and IVB can improve vision and reduce CMT in neovascular AMD. Repeat IVB injections may maintain the visual gain from the initial combination therapy.
Vitreoretinal Surgery for Retinal Detachment in Retinochoroidal Colobomata
Authors: Teoh S.C.B. , Mayer E.J. , Haynes R.J. , Grey R.H.B. , Dick A.D. , Markham R.H.C.
Published: January 2018

Purpose

To report the management and outcome of retinal reattachment surgery in retinochoroidal coloboma.

Methods

Four patients with retinochoroidal colobomata presented to the Bristol Eye Hospital (a UK tertiary referral center for vitreoretinal surgery) with retinal detachment. INTERVENTION. All were type II colobomatous detachments (three patients with type IIB, one patient with type IID). All eyes underwent vitrectomy with endolaser and/or cryotherapy and three eyes underwent scleral buckling. Two eyes had internal tamponade with gas (SF6, C3F8) while the other two had silicone oil. Endolaser was applied over healthy retinal pigment epithelium.

Results

At last follow-up, all (100%) remained attached, with no recurrences. Three patients achieved visual acuity of 6/120 or better and were able to perform satisfactory near work with appropriate magnifiers. The last patient began with hand movement vision and retained similar vision but subjectively felt more navigational.

Conclusions

Good anatomic and functional outcomes can be achieved in this patient group with combined vitrectomy with or without scleral buckling surgery. Endolaser retinopexy is effective over healthy RPE at the margin of the coloboma combined with either gas or oil internal tamponade.
Preparation of Donor Corneas: A Study of the Endothelial Population
Authors: Bonci P. , Bonci P. , Della Valle V. , Lia A.
Published: January 2018

Purpose

To quantify the endothelial damage in corneal rim excisions prepared in different ways.

Methods

From the Imola branch of Eye Bank of Emilia Romagna, 24 corneal rim excisions which belonged to 12 pairs of enucleated eye globes were selected. The endothelial mortality was quantified by Trypan blue staining and counting the endothelial cells in a central area of about 5 mm2 of each cornea. The mate corneas of each pair were prepared in two different ways: one with an epithelium-endothelium cut using a Hanna trephine with an artificial chamber and the other with an endothelium-epithelium cut using a Hanna trephine with punch. After the cut the endothelium was studied again in the same way as described above.

Results

The cell mortality in the corneas before and after the epithelium-endothelium cut using the artificial chamber was increased by 0.9% and the percentage of endothelial loss was increased by 3.9±6.8%. In the corneas prepared with endothelium-epithelium cut using a punch the mortality before and after the cut increased by 8.8% and the percentage of endothelial loss was 20.7±10.9%.

Conclusions

The authors found that in terms of endothelial mortality and endothelial cell density there is less damage to the endothelial population using the epithelium-endothelium cut as compared to the endothelium-epithelium cut.
Topical Anesthesia versus Sub-Tenon Block for Cataract Surgery: Surgical Conditions and Patient Satisfaction
Authors: Rodrigues P.A. , Vale P.J. , Cruz L.M. , Carvalho R.P. , Ribeiro I.M. , Martins J.L.
Published: January 2018

Purpose

To compare the surgical conditions and complications and patient and surgeon satisfaction in cataract surgery by phacoemulsification under topical anesthesia (TA) versus sub-Tenon block (STB).

Methods

Prospective randomized comparative blind study, without placebo control. Patient satisfaction evaluated by the Iowa Satisfaction with Anesthesia Scale (ISAS).

Results

The authors prospectively enrolled 59 patients (61% female) in the study, who were randomized into groups: 26 in the TA group and 33 in the STB. There was no statistically significant difference between the groups in terms of age, sex, waiting time for surgery, ASA (American Society of Anesthesiologists) state, eye laterality, cataract density, pupillary dilation, or surgery duration, but patient collaboration was better in the STB group. We found a mean 2.2 mmHg post-anesthetic rise in intraocular pressure in the STB group, with normalization at 24 hours, and no rise in the TA group. Subconjunctival hemorrhage and chemosis were more prevalent in the STB group, and the improvement of visual acuity was similar in both groups. Subjective satisfaction with the anesthetic technique, both for the surgeon and for the patient, was more elevated in the STB group. The final ISAS scores were 1.87 in the TA group and 2.71 in the STB (p<0.005).

Conclusions

The data indicate that more significant anesthesia and analgesia was achieved with the STB, leading to more favorable surgical conditions and enhanced patient and surgeon satisfaction.
Postoperative Refraction Changes in Phacoemulsification Cataract Surgery with Implantation of Different Types of Intraocular Lens
Authors: Iwase T. , Tanaka N. , Sugiyama K.
Published: January 2018

Purpose

To examine postoperative refraction changes following phacoemulsification cataract surgery and to assess their influential factors, including intraocular lens (IOL) materials and anterior chamber depth (ACD) of the implanted IOL.

Methods

In this prospective study, 339 eyes were randomly assigned to receive a rigid polymethylmethacrylate (PMMA) IOL (811C or 824C), an acrylic IOL (MA60BM), or a silicone IOL (AQ110NV). All patients were followed for 48 weeks after surgery. Postoperative spherical equivalent refraction and ACD were measured by a refractometer and by an anterior eye segment image analyzer, respectively.

Results

In the silicone IOL group, statistically significant myopic shift was observed at 8 weeks after the surgery and continued throughout the follow-up period. Mean myopic shift at the end (48 weeks) was −0.53 D. Concomitantly shortened ACD was also confirmed at 12 weeks after the surgery. In the other groups, postoperative refraction and IOL position did not change after surgery.

Conclusions

The eyes with silicone IOL caused postoperative myopic shift due to the anterior IOL movement. It is important to be aware of the characteristics of each IOL and to take myopic shift into consideration when silicone IOL is implanted. Preferably the A-constant for silicone IOL should be reconsidered to obtain rather accurate postoperative refraction.