bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between Confocal Scanning Laser Ophthalmoscopy and Scanning Laser Polarimetry in Open Angle Glaucoma
Authors: Sihota R. , Gulati V. , Saxena R. , Agarwal H.C. , Sharma A.K.
Published: January 2018

Purpose

To correlate the findings of confocal scanning laser ophthalmoscopy and scanning laser polarimetry in diagnosed cases of glaucoma with established visual field defects.

Methods

A total of 53 diagnosed cases of primary open angle glaucoma that had at least two recorded of IOP more than 21 mm Hg on Goldmann applanation tonometry, open angles on gonioscopy and glaucomatous visual field defects on automated perimetry, were examined by confocal scanning laser ophthalmoscopy (HRT-II) and scanning laser polarimetry (GDx-NFA), in random order.

Results

The number on GDx advanced analysis had a significant (p<0.05) correlation with the rim area (r=–0.279; p=0.043), cup area (r=0.311;p=0.023) and the vertical cup: disc ratio (r= 0.376; p=0.006). The correlation between HRT-II stereometric parameters and GDx advanced analysis parameters was significant (p<0.05) for more parameters targeting the inferior pole of the disc than the superior pole. Numerically, the worst values of GDx parameters were associated with a worse result on Moorfields regression analysis, but there was poor agreement between the diagnostic labels like within or outside normal limits as obtained on GDx and HRT-II.

Conclusions

Nerve fiber loss as detected on GDx correlates well with topographic optic nerve head changes as measured with the HRT-II. However, automated diagnosis on the two machines showed poor agreement.
Modified Astigmatism Dial Diagram for Locating Eccentric Fixation in Patients with Central Scotoma
Authors: Cohen S.Y. , Beaunoir M-P. , Legargasson J-F. , Martin D. , Tadayoni R. , Gaudric A.
Published: January 2018

Purpose

Patients with central scotoma often develop eccentric fixation on a preferred retinal locus (PRL). Identifying the PRL is one of the first steps in low vision rehabilitation training. We present our evaluation of a simple test designed to locate the eccentric fixation in eyes with central scotoma.

Methods

This was a prospective case series of consecutive patients with age-related macular degeneration and bilateral central scotoma. A numeral was added in the center of an astigmatism dial diagram. After one eye was patched, patients with central scotoma were asked to fixate the dial and describe it, then to look at the 12 o'clock position, and then around the clock. The eccentricity at which the central numeral was best seen was compared with the one determined by scanning laser ophthalmoscopy (SLO). The modified astigmatism dial test and SLO were done independently by two masked investigators. The results of the two methods were expressed in clock hour positions and were considered to be in agreement when they did not differ by more than one hour.

Results

Nine consecutive patients (18 eyes) with severe age-related macular degeneration and bilateral central scotoma were tested. The six women and three men ranged in age from 61 to 86 years (mean 75.8 years). The pattern test correlated with SLO findings in 12 (66%) of the 18 eyes. When considering the best-seeing eye of each patient, results showed agreement in eight (88%) out of nine cases.

Conclusions

The modified astigmatism dial test appears useful for establishing the location of the eccentric fixation in the best-seeing eye of patients with bilateral central scotoma, allowing visual rehabilitation training to be started without delay.
Delay in Migration of the Corneal Epithelium after Incorporation of [3H]-Mannose in Organ Cultures
Authors: Ahmed A. , Ahmed N.
Published: January 2018

Purpose

Corneal epithelial cell surface carbohydrate moieties influence migration during wound healing. The purpose of the present study was to investigate the incorporation of galactose and mannose sugar during corneal epithelial migration and their effect on the rate of wound healing.

Methods

Organ cultures of non-migrating (n=6) and migrating (n=30) corneal epithelia were prepared. The incorporation of [3H]-galactose and [3H]-mannose was followed in the migrating samples after 18, 24, 48 and 72h incubation and at 18h in the non-migrating samples. Wound size was documented at the same intervals and the rate of healing was established.

Results

The migrating corneal epithelium of the galactose and mannose treated samples incorporated more radioactive sugar than the non-migrating samples. Mannose incorporation decreased with time whereas the rate of healing was significantly delayed (41±0.01 μm/h) compared to galactose treated samples (63±0.01 μm/h) and controls (61±0.01 μm/h) during the active healing phase (18–48h). Galactose incorporation increased with time.

Conclusions

Incorporation of mannose sugar has an inhibitory effect on the rate of migration during the linear healing phase of the corneal epithelium.
Ophthalmologic Follow-Up of Premature Twins and Triplets
Authors: Tomazzoli L. , Renzi G. , Mansoldo C.
Published: January 2018

Purpose

To assess the influence of multiple gestation on the visual apparatus and on the general state of health of premature infants and to investigate the condition of the twin or triplet with the lowest birth weight compared to multiple gestation siblings.

Methods

Seventy-seven premature twins or triplets (8 to 54 months of age) were monitored at the Verona University Ophthalmology Department from November 1995 to November 1999. In another 12 subjects (younger than 8 months), only the neonatal disease records were examined; these subjects were excluded from the ophthalmologic follow-up because they were too young to be tested reliably. The study sample was compared with 120 premature singletons monitored from January 1996 to March 1998. Visual acuity, ocular motility, strabismus, refraction defects, dioptric media, and fundus oculi were assessed.

Results

The incidence of retinopathy of prematurity, refraction defects, or strabismus was not significantly different between premature twins or triplets and premature singletons. The twin or triplet with the lowest birth weight was more frequently affected by eye morbidity and the diseases typical of prematurity. This difference, however, was not statistically significant.

Conclusions

Premature infants are at a disadvantage compared to those born at term, irrespective of multiple birth status; multiple gestation adds no risk beyond that due to prematurity.
Treatment of Keratoconus by Toric Foldable Intraocular Lenses
Authors: Sauder G. , Jonas J.B.
Published: January 2018

Purpose

To report on the correction of marked regular corneal astigmatism due to keratoconus by toric intraocular lenses (IOL).

Setting

University eye hospital.

Methods

A 66-year-old woman presented with cataract and unilateral keratoconus (keratometric readings: 50.2/41.3 diopters [D]). She underwent routine cataract surgery with implantation of a foldable posterior chamber toric IOL (refractive power: +10.0 D sphere/+12.0 D cylinder). A 68-year-old surgically aphakic woman presented with peripheral accentuated keratoconus with regular and stable corneal astigmatism (keratometric readings: 39.75/61.5 D). She underwent secondary implantation of a foldable toric IOL (refractive power: –9.0 D sphere/+30.0 D cylinder) into the ciliary sulcus.

Results

After a follow-up period of 4 months, visual acuity increased to 0.70 with a correction of +0.75 sphere –2.5 cylinder/84° in Patient 1; after a follow-up period of 6 months, visual acuity increased to 0.60 with a correction of +1.0 –2.0/90° in Patient 2.

Conclusions

Foldable toric silicone IOL may be a surgical option in the management of regular marked corneal astigmatism caused by keratoconus.
Multinucleated Giant Cells in Periretinal Silicone Granulomas are Associated with Progressive Proliferative Vitreoretinopathy
Authors: Betis F. , Leguay J.M. , Gastaud P. , Hofman P.
Published: January 2018

Purpose

To determine the histologic features of granulomatous reactions in persilicone periretinal proliferation.

Patients and Methods

This retrospective study included 12 patients with recurrent retinal detachment and persilicone granulomatous proliferation after vitrectomy for proliferative vitreoretinopathy (PVR). All patients underwent reoperation for membrane surgery. Immunohistochemical study of the excised periretinal membranes was performed with cytokeratins, GFAP, vimentin, CD68, CD45, and lysozyme antibodies.

Results

The cellular characteristics of periretinal granulomas allow differentiation of two types of tissue. Spongy tissue (nine cases) showed an accumulation of mature vacuolated macrophages that contained silicone without multinucleated giant cells (MGC). The second type (three cases) consisted of an accumulation of sparsely vacuolated macrophages, epithelioid cells, and MGC. The MGC corresponded to transition forms of foreign body giant cells (FBGC). Spongy tissue was associated with anatomic success (58.3% of cases) and with stabilized PVR (66.7% of cases) at the time of the membrane surgery. MGC were associated with prolonged silicone oil tamponade, recurrent retinal detachment, and progressive PVR.

Conclusions

Intraocular silicone oil can lead to periretinal foreign body granulomas. FBGC are occasionally observed and were associated with progressive PVR.
Analysis of Autoantibody Repertoires in Sera of Patients with Glaucoma
Authors: Joachim S.C. , Grus F.H. , Pfeiffer N.
Published: January 2018

Purpose

Glaucoma is the second cause of blindness worldwide. It is usually considered a neurodegenerative disease. There is evidence that an autoimmune mechanism is involved in the development of glaucoma in some patients. The aim of this study was to analyze the IgG autoantibody repertoires in sera of glaucoma patients and healthy subjects.

Methods

A total of 82 patients were divided into four groups: healthy volunteers without any ocular disorders (CO, n=30), patients with primary open-angle glaucoma (POAG, n=19), ocular hypertension (OHT, n=16), and normal tension glaucoma (NTG, n=17). All groups were matched for age and gender. The sera of these patients were tested against Western blots of retinal antigens. Immunodetection was done using 4-chloro-1-naphthol staining. The autoantibody patterns were digitized and subsequently analyzed by multivariate statistical techniques.

Results

All patients showed different, complex staining patterns of autoantibodies against retinal antigens. There was an increase in the number of peaks in sera of patients with primary open-angle glaucoma (POAG) compared to healthy subjects (CO). Including all peaks the analysis of discriminance revealed a statistically significant difference between the patterns of POAG compared to all other groups (p<0.01). Sera of normal tension glaucoma (NTG) had no statistically different autoantibody pattern compared to those of control subjects.

Conclusions

In this study, we demonstrated a difference in the IgG autoantibody patterns of primary open-angle glaucoma patients compared to healthy subjects. However, the patterns were not significantly different in normal tension glaucoma compared to control subjects.
Retinopathy of Prematurity: Any Difference in Risk Factors between a High and Low Risk Population?
Authors: Allegaert K. , Casteels I. , Cossey V. , Devlieger H.
Published: January 2018

Purpose

To document incidence of and risk factors for development of retinopathy of prematurity (ROP) in a population of low birthweight infants (<1500 g).

Methods

The authors registered clinical characteristics (birthweight, gestational age (GA), Clinical Risk Index for Babies (CRIB), Apgar score, respiratory characteristics (intubation, ventilation, respiratory support, supplemental oxygen, oxygenation index), prescription of dopamine, and maximal creatinemia) by retrospective chart review in two consecutive CRIB score-based (

Results

Incidence of ROP was 65/157 (41%; 76% in <851 g and 22% in 851–1350 g). Incidence of stage 3 ROP was 25/46 (54%) in the <851 g and 4/84 (5%) in the 851–1350 g group. Among other risk factors, maximal creatinemia was a risk factor in the 851–1350 g cohort (p<0.03). In a logistic regression model, only GA (OR 0.42) remained significant in the lowest birthweight category; in the 851–1350 g cohort, GA (OR 0.53) and CRIB score (OR 1.7) were independent risk factors for ROP.

Conclusions

In relatively more mature infants (851–1350 g), the risk to develop ROP is based on GA and on neonatal severity of disease (CRIB score); in the tiniest infants, GA is the most important risk factor. Microangiopathy might explain the association of maximal creatinemia and the risk of developing ROP.
Two-Stage Procedure for Management of Large Exposure Defects of Hydroxyapatite Orbital Implant
Authors: Salour H. , Owji N. , Farahi A.
Published: January 2018

Purpose

To report the results of a newly devised two-stage surgical technique for management of large hydroxyapatite exposure defects.

Methods

Eight patients with exposed hydroxyapatite orbital implant were treated in two stages. The exposed hydroxyapatite anterior surface was burred down and the defect was directly closed 3 to 13 months after the primary procedure. Then a mucous membrane or dermis-fat graft was added for socket reconstruction.

Results

Trauma was the primary cause of enucleation in all patients. Hydroxyapatite exposures occurred 1 to 2 weeks after implantation. Mean defect size was 15 mm in the greatest dimension (range 10–21 mm). Socket reconstruction was done in seven patients with mucous membrane graft and in one patient with dermis fat graft 3 to 13 months after direct repair of the defects. All eight patients maintained closure of the defects during a mean follow-up of 13 months (range 9–19 months).

Conclusions

Management of hydroxyapatite exposures, especially those with large defects, can be difficult. Based on our experience, optimal results can be obtained after direct closure of the defect under minimal tension at the expense of foreshortening the fornices after which the socket can be reconstructed with a mucous membrane or dermis fat graft as a secondary procedure.
Bilateral Parry-Romberg Syndrome Associated with Retinal Vasculitis
Authors: Bellusci C. , Liguori R. , Pazzaglia A. , Badiali L. , Schiavi C. , Campos E.C.
Published: January 2018

Purpose

To describe an unusual case of bilateral progressive facial hemiatrophy (Parry-Romberg syndrome (PRS)) associated with retinal vasculitis.

Methods

In a 37-year-old man with bilateral PRS, retinal vasculitis of the right eye was evident on fundus examination and fluorescein angiography. Right temporalis muscle biopsy and needle electromyography of the masseter muscles were performed. The patient underwent immunosuppressive therapy and retinal laser photocoagulation.

Results

Biopsy specimens showed large fibrosis with focal lymphohistiocytic infiltration of the muscle fibers. Electromyographic findings are consistent with a primary muscle disease. Visual acuity improved from 20/25 to 20/20 in the right eye with a follow-up of one year.

Conclusions

The evidence of retinal vasculitis and the histologic findings of facial changes observed in this PRS case could support the pathogenetic model of a chronic inflammatory process as a plausible explanation for progressive facial hemiatrophy.
Hypo-Estrogenemia in Retinal Vasculopathy Due to Primary Antiphospholipid Antibody Syndrome
Authors: Hadid O.H. , Jabir M.
Published: January 2018

Purpose

To report hypo-estrogenemic state in a case of recurrent vitreous hemorrhages due to primary antiphospholipid antibody syndrome.

Methods

Interventional case report. A 40-year-old woman presented with recurrent vitreous hemorrhages. Treated initially with laser photocoagulation followed by hormone replacement therapy.

Results

Cessation of vitreous hemorrhage since starting hormone replacement therapy (twenty months ago).

Conclusions

This is the first documented case of hypo-estrogenemia in lupus anticoagulant retinopathy. The response of this condition to estrogen is worth exploring.
Patient Persistency with Pharmacotherapy in the Management of Glaucoma
Authors: Reardon G. , Schwartz G.F. , Mozaffari E.
Published: January 2018

Purpose

To evaluate persistency with monotherapy in the treatment of glaucoma in patients new to pharmacological management.

Methods

This population-based, retrospective cohort study, using managed care administrative claims data, included patients who were 20 years of age and older and who initiated monotherapy with betaxolol, brimonidine, dorzolamide, latanoprost, or timolol between May 1999 and January 2001. Follow-up continued through January 31, 2001, and prescription refill records for all ocular hypotensive medications were extracted for the full 21-month study period. The primary outcome measures were discontinuation and change (switching/ adding on) of the index ocular hypotensive medication. Rates of discontinuation and discontinuation/change were compared using Cox regression methods; survival curves were generated.

Results

In all, 14,539 patients were prescribed any ocular hypotensive drug during the study period, and 2850 patients met all inclusion criteria. Patients treated with betaxolol, brimonidine, dorzolamide, or timolol were significantly (p<0.05) more likely to discontinue and to discontinue/change the index therapy than were those treated with latanoprost. Results were confirmed in analyses adjusted for age and sex.

Conclusions

Patients initially treated with latanoprost monotherapy are more persistent than those who begin treatment with beta-blockers, brimonidine, or the carbonic anhydrase inhibitor dorzolamide. Greater persistency with an initial ocular hypotensive therapy may improve health outcomes and reduce long-term costs to patients and health plans by limiting the increased resource use associated with discontinuations or changes in therapy.
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri): Descriptive Epidemiology, Clinical Features, and Visual Outcome in Parma, Italy, 1990 to 1999
Authors: Carta A. , Bertuzzi F. , Cologno D. , Giorgi C. , Montanari E. , Tedesc0 S.
Published: January 2018

Purpose

To ascertain the annual incidence rate and the clinical features, other than visual outcome, of idiopathic intracranial hypertension (IIH) in Parma, northern Italy.

METHODS

Neurologic care of people living in the Parma area is entirely provided by one private and two public hospitals. Medical records related to IIH were retrospectively reviewed for all Parma residents from 1990 through 1999.

Results

Ten patients (8 women and 2 men) were identified as having IIH according to modified Dandy criteria. Their age ranged from 16 to 53 years with a mean of 36 years at diagnosis. The annual age-adjusted rate per 100,000 is 0.28 for the total population. For women in reproductive age, the annual incidence rate is 0.65/100,000. For overweight women in reproductive age, the annual incidence rate is 2.7/100,000.

CONCLUSIONS

The incidence rate found in this study is lower than the incidence reported in previous US and Libyan studies. A significant difference in overweight distribution is observed comparing percentage of body weight between US and Parma populations. As overweight and obesity are important factors contributing to IIH development, it is possible that their low percentage in the Parma population may, at least partially, explain the low IIH incidence observed.
Pupil Size in Jewish Theological Seminary Students
Authors: Shemesh G. , Kesler A. , Lazar M. , Rothkoff L.
Published: January 2018

Purpose

To investigate the authors' clinical impression that pupil size among myopic Jewish theological seminary students is different from pupil size of similar secular subjects.

METHODS

This cross-sectional study was conducted on 28 male Jewish theological seminary students and 28 secular students or workers who were matched for age and refraction. All participants were consecutively enrolled. Scotopic and photopic pupil size was measured by means of a Colvard pupillometer. Comparisons of various parameters between the groups were performed using the two-sample t-test, Fisher exact test, a paired-sample t-test, a two-way analysis of variance, and Pearson correlation coefficients as appropriate.

Results

The two groups were statistically matched for age, refraction, and visual acuity. The seminary students were undercorrected by an average of 2.35 diopters (D), while the secular subjects were undercorrected by only 0.65 D (p<0.01). The average pupil size was larger in the religious group under both scotopic and photopic luminance. This difference was maintained when the two groups were compared according to iris color under both conditions, reaching a level of statistical significance (p<0.0001). There was a significant difference in photopic pupil size between dark and light irises (p=0.049), but this difference was not maintained under scotopic conditions.

CONCLUSIONS

The average pupil size of young ultraorthodox seminary students was significantly larger than that of matched secular subjects. Whether this is the result of intensive close-up work or of apparently characteristic undercorrection of the myopia is undetermined.
Adult-Onset Primary Glaucoma and Molecular Genetics: A Review
Authors: Frezzotti R. , Renieri A. , Frezzotti P.
Published: January 2018

Purpose

To evaluate recent molecular genetic studies focused on localizing and identifying the genes involved in adult-onset primary glaucoma, characterizing the gene products, and investigating the molecular mechanisms implicated in the pathophysiology of the disease.

METHODS

Several studies have aimed at understanding gene expression and protein processing and attempting to correlate the mutations identified in the involved genes, particularly the TIGR/MYOC gene, with the overall spectrum of the disease, ranging from juvenile glaucoma to typical late-onset primary open-angle glaucoma. Genetic research lemains essential until highly specific and sensitive tests have been developed (plausible disease-causing sequence variations, polymorphisms).

Results

The most effective method for detecting glaucoma clinically is the study of optic nerve and visual field damage, as well as intraocular pressure. In subjects at high risk, in members of families with a strong history of inherited glaucoma, and in families with a MYOC-positive test, the result may represent a marker to assess presymptomatic diagnosis and may be useful as a prognostic marker.

CONCLUSIONS

OPTN seems to have a role confined to the pathogenesis of normotensive glaucoma with a few exceptions. Presently, the introduction of the expensive and time-consuming OPTN gene test in the current diagnosis of familial glaucoma is not justified.
Regulation of Optic Nerve Head Blood flow in Normal Tension Glaucoma Patients
Authors: Pournaras C.J. , Riva C.E. , Bresson-dumont H. , De gottrau P. , Bechetoille A.
Published: January 2018

Purpose

To investigate the regulation of the optic nerve blood flow (Fonh) in response to an increase of the perfusion pressure (PPm) in normal tension glaucoma (NTG) patients and in age-matched normal volunteers.

METHODS

Measurements were performed in 16 eyes of NTG patients and in 10 eyes of age-matched controls. Laser Doppler flowmetry (LDF) was applied to calculate the relative flux of red blood cells at the temporal rim of the optic nerve head (ONH) in response to increases in PPm. PPm was raised through an increase in systemic blood pressure induced by isometric exercise. Before being tested, all patients had 3 weeks of washout of any local medication.

Results

In the NTG group, mean ophthalmic arterial blood pressure increased during isometric exercise from 73 to 89 mmHg (22%), resulting in a 29% increase of the PPm. This increase did not induce any significant change in mean Fonh. For the control group, the 28% increase of PPm also did not significantly affect Fonh. There was a trend for a greater increase in vascular resistance during isometric exercise in the NTG than in the normal control group (47% versus 25%).

CONCLUSIONS

The LDF parameters, measured in the ONH, did not indicate an abnormal Fonh regulation in response to an increase of the PPm in either normal subjects or NTG patients. The maintenance of constant blood flow is achieved by an increase in local vascular resistance. Our data show a greater percent increase in vascular resistance in the NTG patients compared to the normal subjects for a similar percent increase in PPm in both groups during squatting. This suggests some alteration of the vessel tone regulatory mechanisms in NTG patients.
Clinical Evaluation of Corneal Epithelialization after Photorefractive Keratectomy in Patients Treated with Polydeoxyribonucleotide (PDRN) Eye Drops: A Randomized, Double-blind, Placebo-controlled Trial
Authors: Lazzarotto M. , Tomasello E.M. , Caporossi A.
Published: January 2018

Purpose

The effect of polydeoxyribonucleotide (PDRN) eye drops vs placebo on corneal epithelial healing after photorefractive keratectomy (PRK) for correction of myopic and myopic-astigmatic defects was evaluated in a randomized, double-blind clinical trial. Primary endpoint for efficacy was the evolution of corneal re-epithelialization. Secondary endpoint was the evaluation of PDRN eye drops tolerability.

Methods

Sixty eyes were enrolled in the study, randomly allocated into standard therapy plus placebo eye drops (30 eyes), or standard therapy plus PDRN eye drops (30 eyes). Checks were carried out preoperatively and at days 1, 2, 3, and 7 of the follow-up. Six eyes dropped out (four in PDRN group, two in placebo group) for reasons unrelated to the study.

Results

On day 2, the disepithelialized area was 8.4 mm2 ± 9.2 (mean ± SD) in controls and 6.0 mm2 ± 6.8 in PDRN group. On day 3 a complete corneal re-epithelialization was found in 20 out of 26 (77%) eyes of PDRN group and in 17 out of 28 (61%) eyes of placebo group (p<0.05 in percentage terms). On day 7 of follow-up, all eyes appeared to be completely re-epithelialized. The mean score of corneal evaluation on day 3 was 2.9 in PDRN group and 3.75 in control group (p<0.05 between groups). No adverse events occurred during the study.

Conclusions

The data of the study have shown that after PRK, PDRN stimulates corneal epithelium regeneration. PDRN eye drops administration four times a day is well tolerated by patients during the re-epithelialization stage. A much larger clinical study should be performed in order to prove the results obtained in this pilot study.
Medial Rectus Muscle Incarceration in Pediatric Medial Orbital Wall Trapdoor Fractures
Authors: McCulley T.J. , Yip C.C. , Kersten R.C. , Kulwin D.R.
Published: January 2018

Purpose

We describe two cases of orbital trapdoor fractures with medial rectus muscle incarceration.

Methods

Small interventional case series.

Results

This is a retrospective university based report of two healthy males (11 and 14 years old) who developed diplopia following blunt orbital trauma. Both patients had decreased horizontal ocular motility of the involved eye with minimal additional evidence of trauma. Computed tomography (CT) demonstrated no significant bony displacement; however, the left medial rectus muscle was located within the ethmoid sinus in the first and had an abnormal size and shape in the second case. In both cases, during urgent surgical repair, the incarcerated medial rectus muscle was gently released from linear non-displaced medial wall fractures and ocular motility normalized postoperatively.

Conclusions

In pediatric patients sustaining blunt orbital trauma, medial rectus incarceration should be considered and managed accordingly.
Congenital Retinal Macrovessel Causes Reduced Retinal Sensitivity at the Macula
Authors: Shah V.A. , Chalam K.V.
Published: January 2018

Purpose

To report a case of reduced macular sensitivity at the macula due to congenital retinal macrovessel as measured by liquid crystal display (LCD) microperimetry.

Methods

Case report.

Results

We present a patient with normal visual acuity OU, with fundus OS revealing a congenital retinal macrovessel. LCD microperimetry of the macular area OS revealed reduced sensitivity of the superior retina (median sensitivity, 13.0 dB) compared to the inferior retina (median sensitivity, 15.0 dB) based on numerical values of the sensitivity. Such a difference of sensitivity was not found in OD which had a normal fundus ezamination.

Conclusions

The patient's congenital macrovessel may be causing a relative angioscotoma with reduced retinal sensitivity in the superior half of the macula as compared to the inferior half.
Spontaneous Resolution of Vitreomacular Traction Associated with Diabetic Macular Edema
Authors: Lecleire-Collet A. , Muraine M. , Siahmed K. , Brasseur G.
Published: January 2018

Purpose

Little information is available about the natural history of vitreomacular traction (VMT) associated with diabetic macular edema. A few cases of spontaneous resolution of VMT associated with diabetic macular edema have been described, but have not been documented by optical coherence tomography (OCT). The authors report the spontaneous resolution of VMT associated with diabetic macular edema 1 month after the end of panretinal photocoagulation therapy (PRP).

Methods

Case report: A 66-year-old woman presented with complicated proliferative diabetic retinopathy and diabetic macular edema associated with VMT, documented by OCT, in the right eye. Left eye examination showed complete PRP and ischemic maculopathy. PRP was immediately realized in the right eye in regard to the presence of complicated proliferative diabetic retinopathy.

Results

One month after the end of PRP, right eye visual acuity improved. OCT examination showed complete release of foveal posterior hyaloid traction, and significant reduction in foveal thickness. The follow-up was 1 year. At the end of follow-up, visual acuity slightly improved again; only a small residual foveal retinal thickening remained.

Conclusions

The authors report spontaneous resolution of VMT associated with diabetic macular edema, probably facilitated by PRP, with concurrent reduction of macular thickness and visual improvement. As spontaneous resolution may occur in some eyes with diabetic macular edema associated with VMT, a period of observation after the end of the PRP may be considered prior to vitrectomy.
Bilateral Cnv Associated with Optic Nerve Drusen Treated with Photodynamic Therapy with Verteporfin
Authors: Silva R. , Torrent T. , Loureiro R. , Travassos A. , De Abreu J. Rui Faria
Published: January 2018

Purpose

To report a case of bilateral choroidal neovascularization (CNV) associated with optic nerve drusen (OND) treated with photodynamic therapy (PDT) with verteporfin.

Methods

A 10-year-old girl with juxtapapillary CNV in the right eye and juxtapapillary and juxtafoveal CNV in the left eye associated with OND underwent PDT with verteporfin in both eyes.

Results

Visual acuity increased from 20/160 to 20/25 in the right eye and from 20/1000 to 20/25 in the left eye after two sessions of PDT and 2 years of follow-up. CNV showed no leakage after two PDT sessions in both eyes and no recurrence was observed.

Conclusions

Subfoveal CNV is an uncommon complication of OND and excellent anatomic and functional results can be obtained with PDT.
Late Onset Posttraumatic Propionibacterium Acnes Endophthalmitis
Authors: Abu El-Asrar A.M. , Al-Obeidan S.A. , Yeboah E.A.
Published: January 2018

Purpose

To report a case of late onset posttraumatic endophthalmitis secondary to Propionibacterium acnes infection.

Methods

Interventional case report.

Results

A 28-year-old man developed endophthalmitis 6 months after a penetrating trauma. The patient underwent pars plana lensectomy and vitrectomy along with injection of intravitreal antibiotics. Anaerobic cultures of the vitreous yielded P. acnes. Seven months after surgery, the eye was quiet with a best-corrected visual acuity of 20/60.

Conclusions

This case emphasizes the importance of considering P. acnes when treating patients with late onset posttraumatic endophthalmitis.
Limitations of Color Doppler Sonography in the Imaging of Ocular Vessels
Authors: Ustymowicz A. , Obuchowska I. , Krejza J. , Mariak Z.
Published: January 2018

Purpose

To describe a case where detection of blood flow in the central retinal artery and the central retinal vein was limited by an artifact evoked by the optic disc drusen.

Methods

Case report.

Results

During color Doppler sonography, examination of optic disc drusen may generate an artifact – the so-called twinkling artifact – which can simulate blood flow and make evaluation of the central retinal vessels impossible.

Conclusions

Twinkling artifact does not allow evaluation of color Doppler sonography in the imaging of ocular vessels.
Epithelial Cell, Keratocyte, and Endothelial Cell Apoptosis in Fuchs' Dystrophy and in Pseudophakic Bullous Keratopathy
Authors: Szentmáry N. , Szende B. , Süveges I.
Published: January 2018

Purpose

To elucidate the pathomechanism of Fuchs' dystrophy and pseudophakic bullous keratopathy (PBK) by examining cell apoptosis in different corneal layers.

Methods

The authors studied corneal buttons obtained from 21 eyes following central penetrating keratoplasty: 14 corneal buttons (13 patients, age 70.8 ± 10.0 years) with Fuchs' dystrophy, and 7 buttons (7 patients, age 69.6 ± 10.2 years) with PBK. Four buttons from enucleated eyes with choroidal melanoma served as controls. Histologic changes were examined using light microscopy with hematoxylin-eosin (HE) staining. The average numbers of apoptotic cells per field of view (125x magnification) in separate samples of the epithelial, stromal, and endothelial layers were determined using the TUNEL (terminal deoxyri-bonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling) assay.

Results

In 11 of the Fuchs' dystrophy corneas and 2 of the PBK corneas, apoptotic activity was detected. In the control corneas no apoptotic activity was found. Compared to the controls there was a statistically significant difference in the mean (normalized) apoptotic cell numbers for all three layers (p=0.01 in each case) in the Fuchs' dystrophy corneas, and for the stromal layer (p<0.01) in PBK corneas. The apoptotic cell numbers for the epithelial and endothelial layers of the latter were higher, but the difference was not statistically significant (p=0.07, 0.07).

Conclusions

Apoptosis may play a role in the pathomechanism of Fuchs' dystrophy and in keratocyte death in corneas with PBK.
Prevalence of Blindness and Visual Impairment among Jordanian Diabetics
Authors: Al-Till M.I. , Al-Bdour M.D. , Ajlouni K.M.
Published: January 2018

Purpose

To investigate the prevalence of blindness and visual impairment among a population of Jordanian diabetics.

Methods

A total of 986 diabetic patients were fully assessed, including complete history, examination, and laboratory tests. All patients underwent detailed eye examination, which included visual acuity, slit-lamp examination, tonometry, funduscopy, and fundus fluorescein angiography (FFA).

Results

Of all patients examined, 53.2% were male and 46.8% were female. The mean age and duration of diabetes were 55.3 and 11.9 years. Of all patients, 93.3% had type 2 while 6.7% had type 1 diabetes mellitus (DM). Over half (50.3%) were on oral hypoglycemic agents, 34% on insulin, and 14.5% on both types of treatment, whereas only 1.2% were on diet alone. The mean value for HbA1c was 7.7%. The prevalence of blindness among participants was found to be 7.4%, while 10.1% were visually impaired. Diabetic retinopathy (DR) was present in 64.1%, 37.8% had cataract, and 8.7% had undergone cataract surgery. Using multivariate logistic regression analysis, visual impairment was significantly associated with age, treatment of diabetes, and DR, while only age and retinopathy were significantly related to blindness.

Conclusions

DM is a common disease in Jordan and DR is highly prevalent among Jordanian diabetics. National screening and educational programs are highly needed to reduce the risk of blindness and visual impairment among diabetic patients.
Clinical Outcome and Subjective Quality of Life after Photodynamic Therapy in Patients with Age-Related Macular Degeneration
Authors: Krummenauer F. , Braun M. , Dick H.B.
Published: January 2018

Purpose

Whereas the efficacy of photodynamic therapy (PDT) in preventing the progression of age-related macular degeneration (ARMD) is established, its effect on quality of life is under discussion.

Methods

All patients who underwent PDT during 2000 and 2001 at the University Eye Hospital of Mainz were interviewed using a standardized 82-item questionnaire on quality of life and patient satisfaction in ophthalmologic patients. Information was assessed in terms of 82 questions; global scores ranging from 1.0 (optimum self-estimated quality of life) to 4.0 (worst) were derived. Cataract patients' scores were used to characterize the ARMD patients' subjective outcome; the latter were then related to clinical outcome parameters via logistic regressions.

Results

A total of 84 patients (50% female, median age 77 years) were interviewed, who underwent a median of three PDT interventions. During the period of PDT treatment, their median decrease in visual acuity was 3 lines from 0.125 to 0.063. Patients who reported a subjective increase in visual function during this period showed a median private flexibility score of 1.86; patients with the subjective impression of visual function decrease, a median score of 2.71; the median scores for mobility were 2.00 versus 3.00, for flexibility in reading 1.91 versus 3.64, for psychological stress 1.56 versus 2.25, and for communicational flexibility 1.72 versus 2.25. The difference in reading flexibility was statistically significant (p=0.001) after correction for clinical cofactors.

Conclusions

The established clinical benefit of PDT treatment concerning its efficacy in ARMD progression prevention coincides with an at least slight subjective benefit in quality of life and patient satisfaction. However, the latter is associated with the patients' subjective impression of visual acuity progression rather than with clinically validated outcome after PDT treatment.
Intravitreal Triamcinolone Acetonide in Refractory Pseudophakic Cystoid Macular Edema: Functional and Anatomic Results
Authors: Boscia F. , Furino C. , Dammacco R. , Ferreri P. , Sborgia L. , Sborgia C.
Published: January 2018

Purpose

To evaluate safety and efficacy of intravitreal triamcinolone acetonide (TAAC) injections in the treatment of refractory pseudophakic cystoid macular edema (CME).

Methods

Seven eyes of six patients (age range: 50–74) with pseudophakic CME resistant to standard treatment received intravitreal injections of 4 mg of TAAC with all vehicle. Mean preinjection duration of CME was 18.3 months. A mean of 2.1±1.2 (range 1 to 4) treatments were performed in four eyes (57.1%) when visual acuity deteriorated towards baseline levels. Visual acuity assessment, optical coherence tomography (OCT), and fluorescein angiography (FFA) were performed pre- and postoperatively to evaluate results of TAAC injections. Intraocular pressure (IOP) and complications related to treatment were assessed.

Results

After 11.1±3.9 months, mean best-corrected visual acuity (BCVA) increased (p=0.019) from 20/132 to a best value of 20/38. Mean macular thickness decreased from 517.29±146.98 mm to a best value of 263.71±83.13 mm (p=0.0018). Area of fluorescein leakage decreased (p<0.0001) from 11.84±0.93 mm2 at baseline to a minimal value of 3.86±0.98 mm2. The anatomic and functional improvement appeared after 1 month from the intravitreal injection and persisted through at least 3 months of follow-up. At the end of follow-up BCVA, macular thickness, and area of fluorescein leakage did not differ from baseline. Four eyes (57.1%) developed IOP values higher than 21 mmHg, controlled by topical treatment. Two patients developed an endophthalmitis-like reaction.

Conclusions

Intravitr eal TAAC was relatively safe and effective in resistant cases of pseudophakic CME with a temporary beneficial effect on visual acuity and macular edema.
Congenital Dacryocystocele with Intranasal Extension
Authors: Teixeira C.C. , Dias R.J. , Falcão-Reis F.M. , Santos M.
Published: January 2018

Purpose

Congenital dacryocystocele is a rare anomaly in the newborn child. The swelling of lachrymal sac is observed by birth and it is associated with obstruction of lachrymal system either above or below lachrymal sac.

Methods

Diagnosis was made by clinical observation. Some ancillary examinations, such as ultrasonography, tomography, and rhinoscopy, were useful.

Results

The authors describe the clinical case of a newborn with a unilateral congenital dacryocystocele. This anomaly was successfully treated with probing and marsupialization of the nasal cyst.

Conclusions

Treatment of this congenital anomaly is by light compressive massage, probing with silicone intubation of lachrymal system to assure prolonged permeability of the system, or with marsupialization of the nasal cyst. In some cases with intranasal extension of dacryocystocele, collaboration with an otolaryngologist may be necessary.
Cytomegalovirus Retinitis in a Patient with Non-Hodgkin's Lymphoma: A Diagnostic Dilemma
Authors: Chawla R. , Venkatesh P. , Garg S.P. , Mandal S. , Tewari H.K.
Published: January 2018

Purpose

Patients with lymphoma can rarely develop cytomegalovirus (CMV) retinitis. Clinically it is difficult to distinguish from intraocular lymphoma. Also, in such cases the CD4+ count may be high. The authors report a rare case of bilateral CMV retinitis in a patient with non-Hodgkin's lymphoma with high CD4+ counts.

Methods

Observational case report with review of literature.

Results

CMV retinitis was clinically suspected due to the presence of large areas of retinal necrosis and hemorrhages in one eye and a demarcation line with white mottled retina in the other eye. Other differential diagnoses considered were intraocular lymphomatous infiltration and acute retinal necrosis due to herpes group of viruses. The diagnosis of CMV retinitis was confirmed by polymerase chain reaction performed on vitreous sample.

Conclusions

CMV retinitis can develop in cases of lymphoma despite high CD4+ counts. An early diagnosis can be established by performing PCR on vitreous biopsy.
Delayed Atrophy of the Retinal Pigment Epithelium after Submacular Surgery
Authors: Maclaren R.E. , Aylward G.W.
Published: January 2018

Purpose

We report a case of delayed atrophy of the retinal pigment epithelium (RPE) eighteen months after apparently successful excision of submacular choroidal new vessels (CNV) in a patient with age-related macular degeneration (AMD).

Methods

Case report.

Results

Submacular surgery for CNV was achieved without visible disturbance of the underlying RPE in an 83 year old man diagnosed with AMD. At the time of surgery the CNV displayed clinical features consistent with lying internal to Bruch's membrane (Type 2 configuration). There was no visible RPE defect at the fovea and vision improved during the subsequent 12 months follow-up. Eighteen months later, however, an atrophic central RPE defect appeared, with a similar shape to the CNV originally excised.

Conclusions

This case demonstrates that submacular CNV with Type 2 configuration can occur in AMD and lead to an initially favourable outcome following submacular surgery. Atrophy of the RPE nevertheless did eventually occur and in a pattern consistent with damage during the original operation. It is important to consider results of longer term follow-up when interpreting success rates for surgery in AMD.
Uncomplicated Phacoemulsification and First-Day Review: The Patient's Perspective
Authors: Kumar A. , Hugkulstone C. E.
Published: January 2018

Purpose

To evaluate patients’ opinions regarding first-day review following uncomplicated phacoemulsification.

Methods

A prospective questionnaire-based survey was conducted on consecutive patients at the time of listing for day-case phacoemulsification. Data collected included demographic details, proposed anaesthetic technique, first or second eye surgery and postcode. Statistical analysis was undertaken with the unpaired t-test, the χ2-test with Yates’ correction for small numbers or Fisher's exact test, and Kendal's rank correlation, as appropriate.

Results

100 patients (59% female; mean age 74.2 (12.6) years) were recruited. 87% preferred to return to hospital for their first-day review. This result was not significantly affected by sex, proposed anaesthetic technique, first eye surgery or postcode area. Only patients

Conclusions

In this population, patients preferred to return for first-day review following uncomplicated phacoemulsification. There may be some variance in the opinions of surgeons and patients regarding this issue, and the patient's preferences should be taken into account to provide optimum quality of care.
Therapeutic Effects of Laser Photocoagulation and/or Vitrectomy in Eales' Disease
Authors: Dehghan M.H. , Ahmadieh H. , Soheilian M. , Azarmina M. , Mashayekhi A. , Naghibozakerin J.
Published: January 2018

Purpose

To determine visual outcomes and regression of retinal neovascularization following laser photocoagulation and/or vitrectomy in eyes with Eales' disease.

Methods

In a retrospective noncomparative study, the authors reviewed the existing data of 67 eyes of 54 patients with a diagnosis of Eales' disease who had undergone laser photocoagulation and/or vitrectomy based on their clinical presentations. Main outcome measures were visual acuity changes and regression of retinal neovascularization of the eyes following treatment.

Results

Both laser therapy and vitrectomy improved visual acuity and induced egression of retinal neovascularization. Forty-three eyes had undergone laser therapy; their rate of visual acuity ≥20/30 improved from 53% before treatment to 60% after treatment. Twenty-four eyes had undergone vitrectomy; rate of visual acuity ≥20/30 improved from 13% before surgery to 38% after surgery. In eyes that had undergone laser therapy, additional laser therapy controlled recurrent neovascularization in 47% of the eyes, but ultimately, 12% of them required vitrectomy. In the primary vitrectomized group, additional required treatment was repeat vitrectomy in 21 %, and/or laser therapy in 29% of the eyes.

Conclusions

Although laser photocoagulation should be the first line of treatment in Eales' disease, it cannot always induce regression of retinal neovascularization. In such cases vitrectomy may further enhance therapeutic success.