bluuebunny/crossref_metadata_2025 huggingface dataset:
Course of Intraocular Pressure after Intravitreal Injection of 0.05 mL Ranibizumab (Lucentis®)
Authors: Sharei Vahid , Höhn Fabian , Köhler Thomas , Hattenbach Lars-Olof , Mirshahi Alireza
Published: January 2018

Purpose

This prospective study examines the changes in short-term intraocular pressure (IOP) in patients with wet age-related macular degeneration (AMD) receiving intravitreal injections of 0.05 mL ranibizumab (Lucentis®) in a supine position.

Methods

A total of 45 eyes (45 patients, 16 M, 29 F, mean age: 78 y) received intravitreal ranibizumab injections for treatment of wet AMD (0.05 mL = 0.5 mg). The IOP was measured by Schiötz tonometry immediately preoperatively and postoperatively, and also after 3 and 10 minutes in a supine position. No history of glaucoma was present.

Results

The mean preoperative IOP was 22.4±5.5 mmHg in supine position. Immediately after the injection, IOP increased to 47.9±15.1 (range 23–82, p<0.001), with 32 eyes (71.1%) >40 and 19 eyes (42.2%) >50 mmHg. The mean difference between preoperative IOP and immediately after the injection was +25.5±13.6 mmHg. IOP decreased spontaneously by the first 3 minutes after operation by 12.6±6.0 mmHg and after 10 minutes by 21±9.4 mmHg. The mean difference between preoperative IOP and 10 minutes postoperatively was +4.6±7.0 mmHg (range: −9.3 to +25.9 mmHg, p<0.001). Eyes without a subconjunctival reflux had a higher increase in IOP than eyes with any reflux (p<0.001).

Conclusions

IOP increased significantly in a considerable number of patients after intravitreal ranibizumab injections. A rapid and spontaneous decline was observed in the majority of cases. If there is no subconjunctival reflux after the injection, the increase in IOP is higher than in eyes with any back-flow under the conjunctiva.
Which Choroidal Melanoma Should be Treated with Primary Transpupillary Thermotherapy? Our Experience from 78 Patients
Authors: Yarovoy Andrey A. , Magaramov Dzhavid A. , Bulgakova Evgeniya S.
Published: January 2018

Purpose

To report the outcomes of primary transpupillary thermotherapy (TTT) for choroidal melanomas.

Methods

A total of 78 patients were treated with TTT. Tumor thickness was up to 3.6 mm (mean 2.05 mm), follow-up 2.5–108 months (mean, 32.8 months). The main outcome measures were local control, enucleations, tumor recurrences, complications, and visual acuity. The predictors of treatment failures were analyzed.

Results

A total of 51 tumors regressed completely, and 20 incompletely. Out of 7 patients without response, 2 had enucleation, and 5 had Ru-106 irradiation. Recurrences after primary response were observed in 10 patients in 7–54 months (mean 23.4), 8 of them after incomplete regression. Six recurrences were successfully treated with additional TTT, and 4 with brachytherapy There were no metastases or deaths. Logistic regression showed the main predictive factors for TTT failure to be tumor height (OR=6.85; 95% 01=1.2–38.1; p=0.02), basal diameter (OR=22.85; 95% 01=3.6–144.7; p=0.0003), amelanotic pigmentation (for primary failure, OR=9.18; 95% Cl=1.7–49.2; p=0.008), high maximum systolic velocity (for primary failure, OR=13.6; 95% 01=2.3–81.7; p=0.003), subretinal fluid (OR=11.04; 95% 01=1.2–100.4; p=0.03), and incomplete regression (OR=30.62; 95% 01=6.0–156.4; p=0.00001). Receiver operating characteristic analysis showed the following cutoff levels: for tumor height 3.0 mm, for basal diameter 10.2 mm, for maximum systolic velocity 11.7 cm/s. Kaplan-Meier analysis of negative results was fulfilled in all treated patients and in patients without negative predictors. Mean visual acuity before TTT was 0.65, and after treatment 0.58. A total of 23% of patients had increased visual acuity, 42% had decreased acuity, and there was no change in 35%.

Conclusions

TTT is an investigative treatment for choroidal melanomas. TTT needs careful selection of patients, based on consideration of predictive factors and functional perspectives.
Local Resection versus Combined Local Resection and Plaque Radiotherapy in the Treatment of Choroidal Melanoma
Authors: Querques Giuseppe , Bux Anna V. , Iaculli Chstiana , Delle Noci Nicola
Published: January 2018

Purpose

To evaluate the outcome of local resection versus combined local resection and plaque radiotherapy in the treatment of choroidal melanoma.

Methods

We retrospectively analyzed the records of 60 patients (60 eyes) managed by local resection (group 1, 30 patients, external or internal local resection) or combined local resection and plaque radiotherapy (group 2, 30 patients, both Ruthenium-106 or Cobalt-60), among the 364 melanomas treated at our Department of Ophthalmology, between January 1980 and December 2006. Main outcomes measures were postsurgical complications, visual acuity, local recurrence, reasons for enucleation, and development of metastasis.

Results

The 2 groups of patients were considered sufficiently homogeneous as regards location, cell type, and age. Mean follow-up was 7 years. The median largest basal tumor diameter was 9.8 mm and 10.1, and the median tumor thickness was 7.9 mm and 8, respectively, in groups 1 and 2. No statistically significant differences resulted between group 1 and group 2 as regards postsurgical complications (vitreous hemorrhage, retinal detachment, maculopathy cataract, and optic neuropathy) (p>0.05), visual acuity (p>0.05), local recurrence (p>0.05), reasons for enucleation (p>0.05), or development of metastasis (p>0.05).

Conclusions

NO adjunctive benefits from the combined local resection and plaque radiotherapy can be ruled out from our study.
Natural Killer/T-Cell Lymphoma of Nasal Type with Intraocular Involvement: Case Report
Authors: Lee Eun Ji , Wan Kim Tae , Won Heo Jang , Gon Yu Hyeong , Chung Hum
Published: January 2018

Purpose

To report an unusual presentation of disseminated, intraocular, extranodal natural killer/T-cell lymphoma, nasal type (NK/T-cell lymphoma), originating from nasal NK/T-cell lymphoma.

Methods

Case report.

Results

A 63-year-old woman who had been treated with systemic chemotherapy and radiotherapy for NK/T-cell lymphoma in the nasal cavity presented with vitreous haze of the right eye. Despite anti-inflammatory therapy, the right eye showed poor clinical response and received diagnostic vitrectomy. The vitreous opacity resembled a thin sheet, with no sign of subretinal infiltrate or vascular sheathing. The vitreous specimen contained many large, pleomorphic lymphoma cells. The malignant cells were positive for CD3, CD8, and granzyme B. Systemic workups showed no involvement of other organs. A diagnosis of T-cell lymphoma in the vitreous was made; the tumor likely originated from nasal NK/T-cell lymphoma. The patient was treated with intrathecal chemotherapy and intravitreal methotrexate injection. The eye was clinically clear of malignant cells after the injections.

Conclusions

Vitreous infiltration without uveoretinal involvement can be an unusual manifestation of intraocular NK/T-cell lymphoma. Clinician awareness of possible ocular involvement may assist in the diagnosis of disseminated NK/T-cell lymphoma.
Necrotizing Retinopathy Simulating Acute Retinal Necrosis Causing Rhegmatogenous Retinal Detachment in Sarcoidosis: A Case Report
Authors: Shenoy Radha , AI Burwani Badar
Published: January 2018

Purpose

To report on the occurrence of necrotizing type of retinopathy resulting in rhegmatogenous retinal detachment in a patient with asymptomatic sarcoidosis.

Methods

A 38-year-old healthy man presented with poor vision of 0.1 in his left eye of 3 days duration and was found to have panuveitis with occlusive periarteritis and inflammatory infiltrates in the peripheral retina. He was diagnosed with asymptomatic systemic sarcoidosis based on blood investigations and total body gallium scan and was treated with pulse methylprednisolone followed by oral steroids.

Results

Anterior uveitis, vitritis, and retinal infiltrates resolved with pulse methylprednisolone therapy, and there was complete visual recovery. However, deterioration occurred later with development of rhegmatogenous retinal detachment.

Conclusions

Necrotizing retinopathies simulating acute retinal necrosis have not been reported before in patients with sarcoidosis.
Unilateral Optic Atrophy Preceding Coats Disease in a Girl with Parry-Romberg Syndrome
Authors: Nasser Orwa , Greiner Kathrin , Amer Radgonde
Published: January 2018

Purpose

Parry-Romberg syndrome (PRS) is a rare disease of unknown etiology and pathogenesis, characterized by progressive hemifacial atrophy. Diverse ocular manifestations were reported in association with PRS, including enophthalmos, lid retraction, blepharoptosis, restrictive strabismus, ocular motor nerve dysfunction, Horner syndrome, reduced corneal sensitivity, band keratopathy, episcleritis, uveitis, neuroretinitis, and retinal vasculitis.

Methods

Descriptive case report.

Results

We report on the development of unilateral optic atrophy followed by ipsilateral Coats disease (CD) in a girl with PRS. Visual outcome was limited owing to the development of massive subretinal exudation and shallow retinal detachment in the posterior pole and inferior retina.

Conclusions

Optic atrophy was not previously described in association with PRS. We describe the development of unilateral optic atrophy with subsequent CD, 5 years later, in a girl with PRS.
Periorbital Cellulitis Caused by Bacillus Thuringiensis
Authors: Peker Erdal , Cagan Eren , Dogan Murat , Kilic Adil , Caksen Huseyin , Yesilmen Osman
Published: January 2018

Purpose

Periorbital cellulitis is an inflammation of the lids and periorbital tissues without signs of true involvement such as proptosis or limitation of eye movement.

Methods

Bacillus thuringiensis is a Gram-positive, spore-forming soil bacterium with the ability to produce insecticidal crystal proteins. B thuringiensis is an extremely rare causative organism of orbital and periorbital infections. However, it was rarely seen isolated in pediatric cases with preseptal cellulites. Ocular infections of this bacteria quickly progress, within 12–48 hours from inoculation, leading to endophthalmitis or panophthalmitis and irreversible vision loss.

Results

Periorbital cellulitis should be recognized promptly and treated carefully. Hospitalization, prompt systemic antibiotic therapy, and careful monitoring for signs of sepsis and local invasion are critical.

Conclusions

We report a rare presentation of periorbital cellulitis caused by B thuringiensis.
Traditional Arabic Technique of Couching for Cataract Treatment in Yemen
Authors: Bamashmus Mahfouth A.
Published: January 2018

Purpose.

In Yemen, a number of cataract patients still receive sight-restoring surgery using a traditional Arabic couching procedure. In order to evaluate the relative effectiveness and outcomes of the traditional couching procedure, patients attending a teaching center in Sana'a who had the procedure were studied.

Methods.

Fifty-five eyes of 50 patients treated by traditional couching were evaluated. All individuals were checked for best-corrected visual acuity, intraocular pressure, slit-lamp biomicroscopy and fundal examination. All were questioned regarding their clinical history, cost of the surgery, and their satisfaction with the procedure immediately following the operation and presently.

Results.

There were 55 eyes of 50 patients treated by a traditional couching procedure by a local healer. A total of 32 (64%) were men and 18 (36%) were women. The traditional healer was often paid partially in kind and the price paid varied according to patientís ability and was on average $62 USD plus accommodation and meals in the village the healer visited. After aphakic correction of eyes, 1.8% (1/55) had good vision (VA ≥ 6/18), 21.8% (12/55) had low vision (≥3/60), and 76.4% (42/55) were still blind (<3/60). Complications noted were glaucoma (21), corneal opacity (14), uveitis (6), posterior capsule opacity (8), retinal detachment (7), and severe pain (14).

Conclusions.

In Yemen, cataract-blind persons are still treated by traditional healers. This study suggests that the couching method used is relatively expensive, ineffective, and dangerous, and most patients are not satisfied with the results.
Bacterial Contamination Rate of the Anterior Chamber during Cataract Surgery using Conventional Culture and Eubacterial PCR
Authors: Cornut Pierre-Loïc , Vandenesch François , Lina Gerard , Benito Yvonne , Etienne Jerome , Piras Carolina , Kodjikian Laurent , Denis Philippe , Burillon Carole
Published: January 2018

Purpose.

To evaluate the incidence of anterior chamber bacterial contamination during phacoemulsification cataract surgery using eubacterial polymerase chain reaction and conventional cultures.

Methods.

This prospective study included 30 eyes of 24 patients who had phacoemulsification with implantation of a foldable acrylic posterior chamber intraocular lens through a 3.2-mm clear corneal incision. Topical aminosid was administered 3 days before surgery. After povidone-iodine antisepsis, 2 intraoperative anterior chamber aspirates were obtained from each patient, the first taken upon entering the anterior chamber and the second at the conclusion of surgery after the suture. Broad-range eubacterial polymerase chain reaction amplification and conventional cultures were used to verify that aqueous humor did not contain any detectable bacteria at the beginning of the surgery and to evaluate the bacterial contamination rate of the anterior chamber at the end of it. No oral antibiotic prophylaxis was used.

Results and Conclusions

No specimens (0%) aspirated on entry into the anterior chamber or obtained at the conclusion of surgery were positive for microorganisms on culture or eubacterial polymerase chain reaction. None of the eyes developed acute endophthalmitis. The incidence of anterior chamber bacterial contamination during phacoemulsification recovered in this study using eubacterial polymerase chain reaction and conventional culture was null (0%).
Macular Thickness Changes after Phacoemulsification Combined with Primary Posterior Curvilinear Capsulorhexis
Authors: Yazici Ahmet Taylan , Bozkurt Ercument , Altan Çi Dem , Albayrak Sinan , Çakir Mehmet , Alagoz Nese , Yilmaz Ömer Faruk
Published: January 2018

Purpose.

To evaluate the changes in central macular thickness measured with optical coherence tomography (OCT) after cataract surgery combined with primary posterior continuous curvilinear capsulorhexis (PCCC).

Methods.

Forty-six eyes of 40 consecutive patients who had uneventful phacoemulsification and in-the-bag intraocular lens implantation surgery with primary PCCC, taking place between August 2005 and January 2006 in Beyoğlu Eye Training and Research Hospital, were enrolled. Patients with a history of previous ocular surgery, eye trauma, uveitis, or glaucoma, or any systemic disease such as diabetes mellitus, were excluded from the study. None of the cases had macular pathology before surgery. OCT was performed in all patients preoperatively and postoperatively on the first day, first week, and first, third, and sixth months.

Results.

Significant quantitative changes from the preoperative examination were observed in the postoperative first week, first month, and third month (p<0.05). The difference between the mean preoperative and postoperative sixth month central macular thickness was not statistically significant (p=0.20). The greatest change in mean macular thickness was noted in the first month visit. No patient developed cystoid macular edema.

Conclusions.

Because primary PCCC does not have an adverse effect on macular integrity, this procedure may be preferred especially in patients with a high risk of posterior capsular opacification.
Effects of Physical Effort on Neuroretinal Function in Athletes and Non-Athletes: An Electroretinographic Study
Authors: Zwierko Teresa , Czepita Damian M. , Lubiński Wojciech , Lubkowska Anna
Published: January 2018

Purpose.

Physical exertion may disturb retinal function. We wondered whether different levels of physical performance could affect the plot of neuroretinal activity after dynamic exercise in healthy subjects. The aim of our study was to estimate the effect of increasing intensity physical exercise on retinal activity in 2 groups: athletes (n=10) and non-athletes (n=10).

Methods.

We analyzed the amplitude and implicit time of b-wave electroretinogram (ERG) responses for a photopic white 30-Hz flicker stimulus. Using a cycloergometer, 3 10-minute effort tests with increasing intensity were performed. Each participant was attributed an individual workload value (W) below his lactate threshold (40% VO2max), at his lactate threshold (65%-75% VO2max), and above his lactate threshold (80% VO2max). Five ERG recordings were taken: before the efforts (first), immediately after the 3 consecutive efforts (second to fourth), and 1 hour after the last effort (fifth).

Results.

After the first effort, in both groups we observed a statistically significant increase in b-wave amplitude (p<0.05), and in non-athletes a decrease in implicit time of b-wave (p<0.05). After the last effort, we observed a decreased b-wave amplitude in non-athletes, whereas in athletes the amplitude remained at a high level.

Conclusions.

Physical effort significantly differentiated the plot of b-wave amplitude changes between athletes and non-athletes. These findings suggest that strenuous physical effort may disturb signal transfer in the inner retinal layer in non-athletic subjects. The ERGs may be used as a neurophysiologic indicator in defining the cardiovascular training status of an athlete.
Comparison of Normal and Amblyopic Retinas by Optical Coherence Tomography in Children
Authors: Aguirre Fernando , Mengual Encarnación , Hueso José Ramón , Moya Manuel
Published: January 2018

Purpose.

To measure retinal thickness in eyes of children with regular visual development and in amblyopic eyes (distinguishing between mild and severe) by optical coherence tomography (OCT), establishing significant differences between them.

Methods.

Following our previous study, 192 eyes of children from 4 to 10 years old were examined: 68 with regular vision and 124 with ametropic amblyopia at the time of diagnosis (66 mild and 58 severe). The outside macular ring was analyzed by OCT, divided into 4 areas (superior, inferior, temporal and nasal). Effect of sex, age and refraction in retinal thickness obtained were studied.

Results.

All retinal areas in the various groups showed a high correlation between them, with rates ranging between 0.652 and 0.718 (all p <0.001). According to results, all retinal areas are thicker in amblyopic eyes than in normal ones (p <0.05 in the upper and nasal), especially in slight amblyopia, which is up to 4.5% thicker than in normal eyes (maximum 11 μm in the nasal area, p <0.001). Differences were greater in females (up to 5.9% thicker). The inferior area in hyperopic eyes proved to be thicker, with no differences according to age.

Conclusions.

Retinas of eyes with ametropic amblyopia have a more considerable retinal thickness than in a normal eye, at least in some areas. The severity of amblyopia and gender are factors of interaction, not of confounding.
Effect of Oral Prednisolone on Visual Outcomes and Complications after Scleral Buckling
Authors: Dehghan Mohammad H. , Ahmadieh Hamid , Soheilian Masoud , Azarmina Mohsen , Moradian Siamak , Ramezani Ali R. , Tavallali Ali , Naghibozakerin Jalil
Published: January 2018

Purpose.

To evaluate the effect of oral prednisolone on visual outcomes and complications of scleral buckling (SB) in phakic eyes with acute rhegmatogenous retinal detachment (RRD).

Methods.

In a randomized double-blind placebo-controlled trial, patients with acute RRD underwent SB. The treatment group received 1 mg/kg oral prednisolone for 10 days while the control group received placebo. Outcome measures included visual acuity (VA), retinal redetachment (re-RD), cystoid macular edema (CME), proliferative vitreoretinopathy (PVR), and other possible postoperative complications. Outcome measures were compared between groups with McNemar test.

Results.

Overall, 52 eyes of 52 subjects were enrolled into the study, which included 25 and 27 eyes in the treatment and placebo groups, respectively. Preoperatively, the extent and location of RD and rate of hypotony was comparable between the study groups. VA improvement (logMAR) was 0.75±0.61 overall: 0.85±0.62 in the treatment group versus 0.65±0.61 in the placebo group (p=0.36). Postoperative complications in the treatment and placebo groups included choroidal detachment, 3 versus 4 eyes (p=0.45), significant PVR, 1 versus 3 (p=0.33), and CME, 3 versus 5 eyes (p=0.39), respectively.

Conclusions.

Postoperative oral prednisolone does not seem to improve the visual outcomes and complications of scleral buckling in simple phakic RRD.
Prevalence and Causes of Bilateral Blindness and Visual Impairment among Institutionalized Elderly People in Pamplona, Spain
Authors: Sainz-Gómez Carmen , Fernández-Robredo Patricia , Salinas-Alamán Ángel , Montañés Javier Moreno , Berasategui José Maria Escudero , Guillén-Grima Francisco , Ruiz-Moreno José María , Garcia-Layana Alfredo
Published: January 2018

Purpose.

To estimate the prevalence and causes of bilateral blindness and visual impairment in an urban institutionalized population aged 65 years and older.

Methods.

A total of 392 nursing home residents completed a standardized eye examination, including measurement of visual acuity (VA), intraocular pressure, lens opacity grading, indirect ophthalmoscopy, and photography of the macular area. The major causes of vision loss identified for all participants were blindness and visual impairment.

Results.

The average subject age was 82 years (65–97); women outnumbered men 263 to 129. The prevalence of bilateral blindness (VA ≥1.0 logarithm of the minimum angle of resolution [logMAR]) was 14.9% (43/288); the prevalence of visual impairment (VA ≥0.5 and 1.0 logMAR) was 31.9% (92/288). Blindness and visual impairment increased significantly with age (p<0.05), odds ratio (OR) 1.047 and 1.088, respectively. Cataract was the most common cause of bilateral blindness and visual impairment (27.9% and 44.6%, respectively) followed by pathologic myopia (23.3%) and age-related macular degeneration (AMD) (20.9%) for blindness, and by AMD (27.2%) and pathologic myopia (12%) for visual impairment. Fifty percent of subjects with visual loss had the potential for improved vision with medical or surgical intervention.

Conclusions.

Although the prevalences were high, these data are important since it is difficult for epidemiologic studies to include aged, institutionalized individuals, although their numbers are increasing. Recognition of the predominant causes of visual loss dependent on age is fundamental for early diagnosis and treatment of ocular diseases. Many cases of low vision can be treated with appropriate ophthalmologic care.
Recurrent Cytomegalovirus Corneal Endotheliitis after Penetrating Keratoplasty
Authors: Wang Shih-Chien , Tsai I-Lun , Lin Hsiao-Cheng , Kuo Li-Lin , Tsai Ching-Yao , Liou Shiow-Wen
Published: January 2018

Purpose.

To report a case of recurrent cytomegalovirus (CMV) corneal endotheliitis after penetrating keratoplasty.

Methods.

Penetrating keratoplasty (PK) was performed in a 49-year-old man with bullous keratopathy. Pigmented keratic precipitates (KPs) were found in the corneal endothelium of the graft 13 days after surgery, with the subsequent appearance of coin-shaped lesions. Confocal microscopy was performed on the corneal endothelium. Aqueous humor was analyzed for viral DNA by polymerase chain reaction (PCR).

Results.

CMV DNA was detected from the excised corneal button, and aqueous humor revealed positive results for CMV and HSV1 by PCR. Confocal microscopy showed large corneal endothelial cells, consistent with the typical owl's eye morphology of CMV endotheliitis. After systemic ganciclovir was administered, the pigmented KPs and coin-shaped lesions gradually decreased.

Conclusions.

Stress from surgery and corticosteroid usage can revitalize CMV activity. PCR and confocal microscopy are valuable for the diagnosis of CMV corneal endotheliitis.
Cefuroxime Dilution Error
Authors: Sakarya Yasar , Sakarya Rabia
Published: January 2018

Purpose.

To present clinical findings of a cluster of cases of inadvertent high-dose intracameral cefuroxime injection after uneventful phacoemulsification cataract surgery.

Methods.

Six eyes of 6 patients (mean age 68.33 years, range 61–75, 4 male, 2 female) were operated on the same day by the same surgeon. At the end of surgery, 3 mg in 0.1 mL cefuroxime (30 mg/mL, Zinnat, GlaxoSmithKline) was erroneously injected into anterior chamber of 6 eyes. Incorrect dilution of cefuroxime was noticed at the end of operation day.

Results.

The 6 patients were followed up very closely every day during the first week. No adverse reaction or inflammation was observed at postoperative examination. All patients achieved 20/20 or better vision at the end of the first week.

Conclusions.

Inadvertent intracameral (3 mg in 0.1 mL) cefuroxime injection did not cause any detectable adverse effect on ocular tissues.
Chronic Macular Edema Medical Treatment in Irvine-Gass Syndrome: Case Report
Authors: Randazzo Alessandro , Vinciguerra Paolo
Published: January 2018

Purpose.

The advent of intravitreal pharmacologic therapies opened a new perspective in the treatment of Irvine-Gass syndrome with potential side effects. In this case report we evaluated the efficacy of steroid sub-Tenon injection treatment in chronic macular edema.

Methods.

Five sub-Tenon injections, each of 0.8 cc of 4 mg betamethasone, were performed at 1-week intervals, followed by a second cycle of 5 sub-Tenon injections with the same cadency injections 4 months after the first cycle in a 52-year-old Caucasian woman with post-cataract surgery macular edema (Irvine-Gass syndrome).

Results.

At first examination, the patient showed a best spectacle-corrected visual acuity (BSCVA) of 0.52 (logMAR). Optical coherence tomography (OCT) showed a foveal thickness of 893±4 μm and total macular volume of 15.41 mm3. Eleven months after starting treatment, BSCVA was 0.39 (logMAR) with reduction in metamorphopsia and better color sensitivity. OCT showed a foveal thickness of 217 μm and total macular volume of 8.05 mm3. Differential map between the first and the last OCTs showed a foveal thickness reduction of 660 μm.

Conclusions.

The significant improvement observed in this case of postsurgical macular edema showed how sub-Tenon steroidal injections proved to be useful as a first-step therapy.
Type II Idiopathic Macular Telangiectasia and Soft Confluent Drusen
Authors: Querques Giuseppe , Coscas Gabriel , Soubrane Gisèle , Souied Eric H.
Published: January 2018

Purpose.

To describe the simultaneous presentation of soft confluent drusen and type 2 idiopathic macular telangiectasia (IMT) in both eyes of one patient.

Methods.

A 79-year-old man with bilateral metamorphopsia and gradual reduction of central vision underwent a complete ophthalmologic examination.

Results.

In this patient, fundus biomicroscopy revealed soft confluent drusen and a cystic appearance within the fovea, and fluorescein angiography (FA) showed late dye leakage. Interestingly, indocyanine green angiography (ICGA) showed absence of late hypercyanescence, and spectral domain optical coherence tomography (Spectralis SD-OCT) clearly revealed the presence of bilateral foveal cysts with thinning and loss of the normal architecture of the outer retina, as well as absence of retinal thickening within the parafoveolar area showing discrete late dye leakage on FA. Based on these findings, the patient was diagnosed with nonexudative age-related macular degeneration with foveal soft confluent drusen, and coincident nonproliferative type 2 IMT.

Conclusions.

To our knowledge, there is no previously reported case of simultaneous presentation of soft confluent drusen and type 2 IMT. This report highlights the importance of ICGA and OCT in the correct diagnosis of such cases.
Full-Thickness Macular Hole after Intravitreal Injection of Ranibizumab in a Patient with Retinal Pigment Epithelium Detachment and Tear
Authors: Grigoropoulos Vlassis , Emfietzoglou John , Nikolaidis Pantelis , Theodossiadis George , Theodossiadis Panagiotis
Published: January 2018

Purpose.

To report a case of full-thickness macular hole (FTMH) after intravitreal injection of ranibizumab in a patient with retinal pigment epithelium detachment (PED) and tear.

Methods.

A 67-year-old woman with PED and retinal pigment epithelium (RPE) tear due to age-related macular degeneration was studied by biomicroscopy, fluorescein and indocyanine green angiography, and optical coherence tomography and was treated with intravitreal ranibizumab.

Results.

The patient developed a FTMH that was observed 1 month after the ranibizumab injection.

Conclusions.

Intravitreal ranibizumab may create focal sites of fractional forces on the retinal surface while contraction of the choroidal neovascular membrane may also place forces on the RPE and outer retina. Both actions may have as a result contraction and tearing of the retina leading to the formation of a FTMH.
Intraocular Gas Treatment for Myopic Foveoschisis
Authors: Gili Pablo , Yangüela Julio , Martín José Carlos
Published: January 2018

Purpose.

To report a case of symptomatic myopic retinoschisis with foveolar detachment and lamellar macular hole, treated with expansible gas.

Methods.

Interventional case report. A myopic patient presented with a history of decreased vision and metamorphopsia in his right eye. Optical coherence tomography (OCT) revealed an increased macular thickness, thinning and separation of the inner and external retina (retinoschisis or foveoschisis), foveolar detachment, lamellar hole, and foveolar vitreous traction. We treated the patient with a single dose of 0.2 mL of perfluoroethane (C2F6), performed under retrobulbar anesthesia, followed by prone posturing for 15 days.

Results.

OCT showed reattachment of the foveolar retina, disappearance of the retinoschisis, and visual acuity improvement.

Conclusions.

Intraocular expansible gas and prone posturing, without vitrectomy, could be an alternative treatment in selected cases of symptomatic macular foveoschisis with foveolar detachment, in the absence of dense epiretinal membranes.
Partial Regression of Degenerative Retinoschisis Associated with Epiretinal Membrane after Vitrectomy
Authors: Stopa Marcin , Rogalińska Izabela , Kociçcki Jarosław
Published: January 2018

Purpose.

To report a new and atypical pathology of epiretinal membrane formation on the top of the retinoschisis (schisis-membrane).

Methods.

We describe a patient with recent visual acuity and visual field deterioration due to a rapid progression of retinoschisis in the macular area resulting from shrinking membrane on the top of the schisis. The patient underwent vitrectomy with membrane removal.

Results.

Partial regression of the schisis was observed and visual acuity improved from 5/12 to 5/5. Perimetry demonstrated that the corresponding visual field deterioration partially regressed.

Conclusions.

Release of traction exerted by a shrinking membrane is a surgical option to promote regression of retinoschisis and improvement in visual field and vision in schisis-membrane cases.
Cytomegalovirus Retinitis Associated with Good's Syndrome
Authors: Mateo-Montoya Aranzazu , Stanescu Dinu , Wolff Benjamin , Sahel José-Alain , Bonnel Sébastien
Published: January 2018

Purpose.

To report a case of cytomegalovirus (CMV) retinitis associated with Good's syndrome.

Methods.

A 57-year-old man presented to our ophthalmology clinic with complaints of visual loss in the left eye for 2 weeks. His medical anamnesis revealed myasthenia gravis, thymoma resection, multiple chest infections, and Campylobacter septicemia. Left eye examination revealed mild anterior uveitis, moderate vitritis, and superotemporal active retinitis.

Results.

Polymerase chain reaction of both aqueous humor and vitreous tap were positive for CMV DNA, which suggested CMV retinitis. The patient was treated with systemic treatment of acyclovir and ganciclovir combined with weekly intravitreal injections of ganciclovir and foscarnet. Retinitis resolved within 3 weeks and visual acuity improved.

Conclusions.

CMV retinitis can be associated with Good's syndrome.
Traumatic Neuroma of the Infraorbital Nerve Subsequent to Inferomedial Orbital Decompression for Graves’ Orbitopathy
Authors: Baldeschi Lelio , Saeed Peerooz , Regensburg Noortje I. , Zacharopoulos Ioannis , Wiersinga Wilmar M.
Published: January 2018

Purpose.

To present and discuss the occurrence of a traumatic neuroma subsequent to inferomedial orbital decompression surgery in Graves’ orbitopathy.

Methods.

Case report.

Results.

Approximately 1 month after surgery, a patient who underwent bilateral rehabilitative inferomedial orbital decompression developed a mass with clinical and radiologic characteristics compatible with a traumatic neuroma of the left infraorbital nerve. The lesion, which was thought to be the result of unnoticed nerve trauma at the time of surgical dissection of the infraorbital canal, remained stable in shape and other imaging characteristics during the 39-month follow-up period. Symptoms of trigeminal neuralgia could be only partially controlled with medical therapy (oral pregabalin 75 mg 3 times daily).

Conclusions.

The second branch of the trigeminal nerve may be damaged in the course of orbital floor removal decompression for Graves’ orbitopathy. This may potentially induce the formation of traumatic or amputation neuromas. Such lesions should be included in the potential complications of decompressions when counseling patients about to undergo this type of surgery, as they are difficult to treat and may cause persistent and disabling pain.
Sutureless Human Sclera Donor Patch Graft for Ahmed Glaucoma Valve
Authors: Zeppa Lucio , Romano Mario R. , Capasso Luigi , Tortori Achille , Majorana Mara A. , Costagliola Ciro
Published: January 2018

Purpose.

To report the safety and effectiveness of a sutureless human sclera donor patch graft covering the subconjunctival portion of glaucoma drainage implant tube to prevent its erosion throughout the overlying conjunctiva.

Methods.

This was a prospective pilot study. Fifteen eyes of 15 consecutive patients not responsive to medical and to not-implant surgical glaucoma treatment underwent Ahmed glaucoma valve (AGV) implant surgery with sutureless human sclera donor patch graft. The surgical procedure included AVG implant placed 8 mm behind the corneal limbus and fixed to the sclera with two 9–0 black nylon sutures. The tube was passed through the scleral tunnel, parallel to the corneal limbus, and shortened at the desired length. The anterior part of the tube was covered with human donor scleral graft and kept in place with fibrin glue (Tissue Coll®) under the conjunctiva. Examinations were scheduled at baseline and then at 1 week and 1, 3, 6, and 12 months after surgery.

Results.

At 12-month follow-up, the best-corrected visual acuity did not significantly improve from baseline 0.78±1.2 logMAR, whereas mean intraocular pressure significantly decreased from preoperative values of 29.8 (SD 8.4) mmHg. In all cases, the scleral patch was found in place at each check during the follow-up period. No conjunctival erosion over the AGV tube nor sign of endophthalmitis was recorded at any time during the follow-up period.

Conclusions.

AVG implant surgery with sutureless human sclera donor patch graft represents an effective and relatively safe surgical procedure for complicated glaucomas, avoiding conjunctival erosions over the AGV tube.
Ocular Morbidity of Traumatic Hyphema in a Jamaican Hospital
Authors: Mowatt Lizette , Chambers Celeste
Published: January 2018

Purpose.

To determine the outcome of patients with hyphema secondary to ocular contusion.

Methods.

A retrospective review of the ophthalmic records of 44 consecutive patients with traumatic hyphema secondary to ocular trauma presenting to the Eye Clinic of the University Hospital of the West Indies between May 2004 and November 2007.

Results.

The mean age was 21 years (95% confidence interval [CI] 16.4–25.5 years). Follow-up ranged from 2 weeks to 22 months. The most common mechanism of injury was impact by a missile and 41% occurred at home. The mean visual acuity at presentation was logMAR 1.85 (95% CI 1.4–2.3) and at 3 months improved to logMAR 0.63 (95% CI 0.3–1.0). The presenting intraocular pressure (IOP) ranged from 7–64 mmHg with 45.4% (20/44) having IOP of greater than 21 mmHg; 18% had the sickle cell trait. A total of 72.7% of patients presented with a grade I hyphema. Surgical intervention was indicated in 20.5% (9/44), which included anterior chamber paracentesis/washout and trabeculectomy. The most frequent complications were secondary glaucoma (32.4%), angle recession (23.5%), cataract (20.6%), and commotio retinae (20.6%). In the sickle cell group, 80% presented with elevated IOP (29–64 mmHg) and 70% had complications. A total of 94.7% of patients had an IOP <21 mmHg at 3 months.

Conclusions.

Traumatic hyphema is a recognized cause of significant visual disability. Improved visual acuity was attained after 3 months. The presenting visual acuity correlated with the visual prognosis. Patients with posterior segment complications tended to have poorer visual outcomes. The presence of the sickle cell gene increased the risk of secondary glaucoma.
Comparison of the Clinical Presentation and Visual Outcome in Open Globe Injuries in Adults and Children over 30 Months
Authors: Gupta Arvind , Srinivasan Renuka , Babu K. Ramesh , Setia Sajita
Published: January 2018

Purpose.

To compare the clinical presentation and final visual outcome of open globe injuries in children and adults in a referral hospital over a 30-month period.

Methods.

This is an institutional-based prospective study of open globe injuries cases presenting in the emergency department between July 2003 and December 2005. Patients were divided in 2 groups: group 1, children (2–15 years), and group 2, adults (>15 years). All the patients were admitted and emergency surgical interventions were undertaken. The clinical features at presentation and the final visual acuity are compared. Chi-square and Fisher exact tests were used for statistical analysis.

Results.

Ninety and 84 patients were included in group 1 and group 2, respectively. The most common places of injuries were home or while playing outdoor games in group 1 (67%) and workplace in group 2 (53.5%). The presenting features were significantly more grave in group 2. These included poor presenting visual acuity (p=0.012), vitreous prolapse (p=0.002), presence of relative afferent pupillary defect (p=0.001), and incidence of endophthalmitis (p=0.004). Time interval between injury and surgical intervention (p=0.018) was better in group 2. Other features, such as presence of hyphema, uveal tissue prolapse, cataract, intraocular foreign body, and length or location of laceration were similar in both groups. The final visual outcome was similar in the groups (p = 0.21), with approximately half of the patients achieving vision of 20/60 or better in each group.

Conclusions.

The majority of injuries in children and adults occurred in their homes or workplaces, respectively. Although the clinical presentations of open globe injuries were significantly more grave in adults than in children, the final visual outcomes were similar.
Screening for Ophthalmic Disorders and Visual Impairment in a Nigerian School for the Deaf
Authors: Onakpoya Oluwatoyin Helen , Omotoye Olusola J.
Published: January 2018

Purpose.

To detect the presence of ophthalmic abnormalities and visual impairment in deaf students.

Methods.

A cross-sectional survey of all students in the school for the deaf was conducted following ethical clearance from the Ministry of Health. Age, sex, and previous eye examination was recorded for each student as well as visual acuity, penlight eye examination, intraocular pressure, dilated funduscopy and refraction (when applicable). Data were analyzed with SPSS version 11 and statistical significance inferred at p<0.05.

Results.

The 156 (100%) students at the school for the deaf with age range 6–25 years, mean ± standard deviation of 15.6±3.3 years, and modal age of 14 years were studied. A total of 110 (70.5%) had no previous eye examination, 2 (1.3%) students were blind, 5 (3.2%) were visually impaired, 4 (2.6%) had unilateral visual impairment, and 4 (2.6%) had unilateral blindness. Blindness was caused by Usher syndrome in 1 (50%) and bilateral pigmented macular scar in 1 (50%) patient. Uncorrected refractive errors were the leading cause of unilateral visual impairment (75%), visual impairment (60%), and unilateral blindness (50%). Ocular abnormality was present in 53 (34%) students while uncorrected refractive error (18.6%), retina changes (7%), and allergic conjunctivitis (3.8%) were the leading disorders. Previous eye examination was more common among primary school students (p<0.0001) and students with ocular abnormalities (p=0.046).

Conclusions.

Institutions for deaf children should be aware of the high prevalence of ophthalmic disorders and the importance of vision to development of a deaf child, and conduct an initial and periodic eye examination for every intake.
Spontaneous Dislocation of a Verisyse Phakic Intraocular Lens with Severe Corneal Endothelial Cell Loss
Authors: Wang Kai-Jie , Zhu Si-Quan
Published: January 2018

Purpose.

To report a case of spontaneous dislocation of a Verisyse phakic intraocular lens (PIOL) with severe corneal endothelial cell loss.

Methods.

A 29-year-old woman with no history of trauma presented with complaint of blurred vision in the right eye of 5 months’ duration. History included uneventful implantation of a PIOL bilaterally to correct high myopia in January 2007.

Results.

Visual acuity was 20/100, central endothelial cell density had decreased to 592/mm2 central corneal pachymetry was 634 μm. The PIOL dislocated temporally and was removed without any lens implanted again. Three months postoperatively, her best-corrected visual acuity was 20/60.

Conclusions.

A correct fixation with sufficient folded iris inside the claw and long-term follow-up are important for patients with implanted PIOL, and the long-term effects on endothelial cell density in this patient remain to be seen.
Epidemiology and Etiologic Diagnosis of Infectious Keratitis in Uberlandia, Brazil
Authors: Furlanetto Rafael Lacerda , Andreo Eduardo G. V. , Finotti Loná G.A. , Arcieri Enyr S. , Ferreira Magno A. , Rocha Flavio J.
Published: January 2018

Purpose.

To study risk factors, microbiological characteristics, and clinical course of nonviral infectious keratitis diagnosed in a referral service of ophthalmology.

Methods.

A total of 65 charts of patients with microbial keratitis were retrospectively reviewed at the Clinical Hospital of Federal University of Uberlandia, Brazil, from July 2001 through August 2004. All cases were submitted to microbiological tests and treated according to local protocol. Risk factors, clinical course, therapeutic keratoplasty, and visual outcomes were analyzed.

Results.

The mean age of patients was 45.9 years (2–83 years) and male to female ratio 2.6:1. Symptoms at presentation ranged from 1–3 days in 16 patients out of 65 (24.61%), 4–7 days in 19 cases (19/65; 29.23%), and more than 7 days in 27 patients (27/65; 41.53%). The major risk factor was trauma (28/65; 40%), predominantly by organic material. A total of 32 eyes out of 65 (49.23%) were culture positive. Fungi were the most common isolates (18/32; 56.25%), being headed by Fusarium sp (11/65; 16.92%), and the most common bacteria was Streptococcus pneumoniae (7/65; 10.77%). Final visual acuity was equal to or better than 20/60 in 20 patients out of 65 (30.77%), between 20/60 and 20/400 in 7 patients (7/65; 10.77%), and worse than 20/400 in 35 patients out of 65 (53.85%). A total of 48 eyes out of 65 (73.84%) presented corneal scar, 12 eyes (12/65; 18.46%) needed therapeutic penetrating keratoplasty, and 2 eyes (2/65; 3.08%) were eviscerated.

Conclusions.

The high incidence of fungal keratitis in the studied population shows their vulnerability to such infections, which may result in devastating visual outcomes.
Acute Postoperative Endophthalmitis Caused by Gemella Morbillorum
Authors: Ascaso Francisco J. , Cardeñosa Eugenia , Cascante José M. , Lario Bianca , Pérez Diana , Cristóbal José A.
Published: January 2018

Purpose.

We present a case of Gemella morbillorum endophthalmitis after uneventful cataract surgery.

Methods.

A 78-year-old woman developed progressive blurring of vision, hypopyon, and vitritis in the precocious postoperatory following cataract surgery. Pars plana vitrectomy and intraocular lens explantation were performed followed by intravitreal injection of vancomycin and ceftazidime. Postoperatively, the patient was given hourly topical fortified vancomycin according to antimicrobial susceptibility testing. At the final follow-up visit 6 months after the initial procedure, visual acuity was 20/50 and no signs or symptoms of endophthalmitis were observed.

Results.

The undiluted vitreous samples and explanted lens were analyzed. Cultures revealed the growth of G morbillorum, an infrequent opportunistic pathogen.

Conclusions.

To date, this is the second reported case of postoperative endophthalmitis by this species. Although endophthalmitis is rare, ophthalmologists should be alert to the possibility of patients having endophthalmitis caused by G morbillorum. Especially, it is necessary to be cautious with surgery in patients with recent infections. A review of the medical literature of this rare ocular infection is presented.
Vitreous and Retinal Metastasis from Gastric Cancer
Authors: Kim Chang Yeom , Ha Chang Won , Lee Sung Chul
Published: January 2018

Purpose.

Intraocular metastasis from gastric cancer is not common and metastatic carcinoma to the vitreous or retina is exceedingly rare. We describe a case of gastric cancer metastatic to the vitreous and retina.

Methods.

Retrospective, single-center case report.

Results.

A 64-year-old woman with advanced gastric cancer with multiorgan metastatic disease presented with decreased visual acuity. Ophthalmoscopy revealed extensive overlying vitreous seeds and macular infiltrations in both eyes. Fine-needle aspiration cytology from the vitreous confirmed the diagnosis of metastatic carcinoma.

Conclusions.

We report an extremely rare case of vitreous and retinal metastasis from gastric cancer. Ophthalmologists and oncologists should be aware that gastrointestinal cancer can cause intraocular metastasis in the form of vitreous seeds and retinal infiltration.
Retinal Mass in a Case of Pediatric Myelodysplastic Syndrome (Refractory Anemia with Excess of Blasts)
Authors: Basu Biswanath
Published: January 2018

Purpose.

Myelodysplastic syndrome is a rare childhood clonal hematologic disorder characterized by dysplastic hematopoiesis and progression to leukemia.

Methods.

Case report.

Results.

An 8-year-old boy with low-grade fever, easy fatigability, and pallor of 3 months duration showed pancytopenia with 9% circulating blast cells. The bone marrow aspirate revealed striking trilineage dysplasia with 13% of blast cells. Cytogenetic analysis revealed 46, XY, del (20) (q11;q13). The findings were diagnostic of myelodysplastic syndrome with refractory anemia with excess of blasts in accordance with the World Health Organization criteria modified for pediatric age group. Fundus examination revealed a sickle-shaped hanging retinal mass of right eye. Biopsy/aspiration cytology of the retinal mass was not done in this case owing to risk of severe bleeding, a common feature in any hematologic malignancy. The child had been included in pediatric acute myeloid leukemia trials as the parents were not ready for stem cell transplantation, but he died after 3 months due to overwhelming infection.

Conclusions.

Myelodysplastic syndrome of childhood may present with retinal mass along with other hematologic features. Biopsy/aspiration cytology of the mass should not be attempted as it may cause intraocular hemorrhage.