bluuebunny/crossref_metadata_2025 huggingface dataset:
Corneal Topographic Changes after Scleral Buckling
Authors: Karimian F. , Moradian S. , Yazdani S. , Mashayekhy A. , Anisian A. , Kouhestani N.
Published: January 2018

Purpose

To evaluate corneal topographic changes and induced corneal astigmatism after scleral buckling (SB).

Methods

This interventional case series includes all patients who had undergone scleral buckling for rhegmatogenous retinal detachment (RRD) during a 1-year period. Patients were divided into four groups according to type and extent of scleral buckling which depended on the discretion of a retina specialist. Videokeratography was performed for all patients preoperatively and repeated 1 and 3 months after SB.

Results

Thirty-nine eyes of 39 patients (29 male, 74.7%) with mean age of 50.35±20 years (range 13–80) were finally analyzed. There was no statistically significant difference among the groups in terms of preoperative corneal astigmatism, surface regularity index (SRI), surface asymmetry index (SAI), mean keratometry (mean K), and potential visual acuity (P\A). Overall, preoperative mean K was 43.97±1.78 D, which reached 44.2±2.02 D and 43.92±2.16 D 1 and 3 months after the operation. Mean preoperative SRI was 0.58±0.4, which increased to 1.24±1.18 and 1.29±1.13 1 and 3 months after the operation respectively. Mean preoperative SAI was 0.39±0.21, which increased to 0.73±0.37 and 0.75±0.66 1 and 3 months after the procedure. Changes in SAI at 1 and 3 months following SB were significant (p values < 0.001); however, these postoperative values were not significantly different. Mean preoperative PVA was 0.07±0.75 logMAR (equivalent to 20/20) but decreased to 0.24±0.25 (equivalent to 20/30) and 0.27±0.29 (equivalent to 20/40) 1 and 3 months after SB, respectively.

Conclusions

Significant changes in corneal topographic indices including increases in SRI and SAI and a concomitant decrease in PVA may occur after SB procedures. These induced changes must be considered and appropriately addressed postoperatively to provide the best possible corrected vision.
Toxic Keratolysis from Combined use of Nonsteroid Anti-Inflammatory Drugs and Topical Steroids following Vitreoretinal Surgery
Authors: álvarez M.T. , Figueroa M.S. , Teus M.A.
Published: January 2018

Purpose

To evaluate the corneal complications associated with the combined use of nonsteroid anti-inflammatory drugs (NSAIDs) and topical steroids following vitreoretinal surgery.

METHOD.

Description of corneal lesions in three patients after vitrectomy with use of topical ketorolac and prednisolone acetate.

Results

Three eyes of three patients developed an atrophic central corneal ulcer with stromal thinning following a pars plana vitrectomy under local anesthesia. Lesions were asymptomatic and were found during a routine examination 2, 3, and 8 weeks after surgery, respectively. Surgical indications were as follows: a pre-retinal membrane, choroidal neovascularization, and massive uveal effusion following cataract surgery. Topical postoperative treatment was as follows: ketorolac 4 times a day, a combination of prednisolone acetate, polymyxin B, and neomycin 6 times a day, and 1% cyclopentolate 3 times a day. Suspension of ketorolac and ocular occlusion led to the resolution of corneal lesions between 2.5 and 3 months later, yielding a central superficial scarring, which showed no changes after a follow-up of 3 years.

Conclusions

Toxic keratolysis may appear as a secondary effect of the combined use of topical NSAIDs and steroids following vitreoretinal surgery and must be taken into account in the differential diagnosis of postoperative corneal lesions.
Molluscum Contagiosum in a Patient with no Risk Factors
Authors: Aranda R. Luque , Aranda I. Baquero , Hidalgo C. Salido , Garcia-Campos J.
Published: January 2018

Purpose

To report a case of molluscum contagiosum in a patient with no risk factors.

Methods

A 38-year-old patient with a tumor located in the lower eyelid that appeared 5 months previously was seen in the authors’ hospital. The lesion had grown slowly and appeared as a crateriform mass with elevated edges. It was surgically excised and the histopathology study confirmed the diagnosis of molluscum contagiosum. Risk factors were absent.

Results

The histopathologic study confirms the presence of eosinophilic inclusion bodies in the keratinocytes cytoplasm.

Conclusions

External evaluation of the lower lid lesion did not show the morphologic configuration of a molluscum contagiosum. A virus can be suspected if attention is paid to the margin of the eyelid and the patient's age.
Bilateral Cataract following Lightning Injury
Authors: Gupta A. , Kaliaperumal S. , Sengupta S. , Babu R.
Published: January 2018

Purpose

To report a case of bilateral cataract with posterior vitreous detachment induced by lightning injury.

Methods

A case report of 30 year old man injured by lightning.

Results

The patient developed visually significant bilateral cataract after four years of the initial insult on the scalp. The exit wound was noted on the right foot. Fundus evaluation after cataract extraction revealed posterior vitreous detachment.

Conclusions

Lightning can induce various ocular complications. Decrease in vision due to cataract is usually seen years after the initial lightning injury as the initial changes are in the mid-periphery and often missed in the acute setting. Posterior vitreous detachment induced by lightning can rarely lead to retinal tear formation and subsequently retinal detachment. The severity of entry and exit may not give a true picture of the internal organ damage.
Late Effect of External Eye Irradiation on Choroidal Circulation
Authors: Peiretti E. , Slakter J.S. , Wu S. , Iranmanesh R. , Yannuzzi L.A.
Published: January 2018

Purpose

To report two cases of atypical late onset radiation chorioretinopathy occurring 15 and 25 years post exposure and the indocyanine green (ICG) angiographic findings in these patients.

Methods

Clinical examination and imaging including fluorescein and ICG angiography were performed.

RESULT.

Fundus examination of the first patient revealed microangiopathy with intraretinal hemorrhages, lipid exudation, telangiectatic and aneurysmal capillary changes. Indocyanine green angiography showed an apparent chorioretinal anastomosis and delayed perfusion of the choriocapillaris. Fundus examination of the second patient revealed a pigment epithelial detachment and retinal pigment epithelial changes. Indocyanine green angiography showed atypical, tortuous, dilated, choroidal vessels as well as areas of hypoperfusion. Both patients had multiple dot-like hyperfluorescent spots in the midphase of the ICG angiogram.

Conclusions

External radiation exposure may lead to both retinal and choroidal alterations which may be independent events and which may manifest after a long period of quiescence. Furthermore, ICG angiography appears to be a useful diagnostic tool to study the alterations of the choroid following external eye irradiation.
Necrotic Uveal Melanoma with Orbital Inflammation
Authors: Blasi M.A. , Giammaria D. , Balestrazzi E.
Published: January 2018

Purpose

Extraocular extension of uveal melanoma can be accompanied by proptosis and signs of orbital inflammation but this clinical presentation is an uncommon feature if the tumor is solely intraocular.

Methods

Case report.

Results

The authors describe a patient with a medium-sized necrotic uveal melanoma, without extraocular spread, presenting with the clinical picture of orbital cellulitis.

Conclusions

The ophthalmologist needs to be aware of this uncommon presentation of uveal melanoma, and not assume the presence of proptosis and orbital inflammation as signs of extraocular extension.
Inaccuracy of Diagnosis in a Cohort of Patients on the Waiting List for Dacryocystorhinostomy When the Diagnosis Was Made by Only Syringing the Lacrimal System
Authors: Beigi B. , Uddin J.M. , McMullan T.F.W. , Linardos E.
Published: January 2018

Purpose

Accurate identification of the factors contributing to epiphora is essential in directing appropriate management and treatment strategies. The authors applied a methodical strategy of assessment for epiphora to patients who were already on the waiting list for dacryocystorhinostomy (DCR). The findings were compared to the original findings.

Methods

Forty-four eyes of 35 patients listed for DCR were re-examined. All canaliculi were examined using four tests: dye disappearance, Jones 1 (dye retrieval), probing using Bowman probes, and syringing of the nasolacrimal duct (NLD) under local anesthesia. Some patients were examined using an endocanalicular mini-endoscope. Patients with NLD obstruction underwent DCR and those with canalicular and NLD stenosis underwent intubation of the lacrimal system-canaliculus, lacrimal sac, and nasolacrimal duct-using silicone stents. The authors refer to this as canaliculodacryocystoplasty (CDCP). The patients were assessed for symptoms of epiphora at 12 months. Forty-four eyes had been listed for DCR. They had been originally diagnosed, by means of lacrimal syringing, as NLD obstruction (24 eyes) or stenosis (12 eyes), and functional blocks (8 eyes).

Results

Four out of the original 44 planned DCR surgeries were performed after re-evaluation. After re-examination, 28 lacrimal systems were found to have canalicular stenosis, 4 NLD stenosis, 4 NLD obstruction, 4 punctal phimosis, 3 ocular surface disease, and 1 patient was asymptomatic. Twenty-eight lacrimal systems underwent CDCP, 4 underwent DCR, 4 had punctoplasty, and 4 had probing alone. Three had treatment for ocular surface disease and one patient required no treatment. After a follow-up of 12 months, 41 (93%) systems had improvement or were free of their epiphora.

Conclusions

Syringing of the lacrimal apparatus may result in a high false positive diagnosis of NLD obstruction. Canalicular pathology is not uncommon in this cohort of patients and may be underdiagnosed.
Role of Central Corneal Thickness on Baseline Parameters and Progression of Visual Fields in Open Angle Glaucoma
Authors: Shah H. , Kniestedt C. , Bostrom A. , Stamper R. , Lin S.
Published: January 2018

Purpose

To evaluate the relationship of central corneal thickness (CCT) to baseline visual field parameters and visual field progression in patients with primary open-angle glaucoma (POAG).

Methods

Charts of consecutive patients with POAG were reviewed to obtain visual field data. Visual field was measured by standard threshold static perimetry. Variables analyzed included mean deviation (MD) and pattern standard deviation (PSD).

Results

A total of 121 eyes examined over 4 years were evaluated. A significant negative relationship between CCT and PSD (correlation coefficient: −0.02, p<0.05) was found. Analyses comparing CCT to change in PSD and MD (visual field progression) were statistically not significant.

Conclusions

Patients with thinner corneas initially present with a greater visual field defect, indicating that thin corneas may contribute to advanced glaucomatous damage at the time of diagnosis. However, CCT does not seem to be a significant risk factor for progression of the disease.
Transscleral Red Laser Cyclophotocoagulation for the Treatment of Therapy-Resistant Inflammatory Glaucoma
Authors: Puska P.M. , Tarkkanen A.H.A.
Published: January 2018

Purpose

To evaluate in a retrospective study the long-term usefulness of red 647 nm krypton and 670 nm diode laser for transscleral contact cyclophotocoagulation (CPC) in the treatment of therapy-resistant inflammatory glaucoma.

Methods

The authors treated 48 eyes of 38 consecutive patients (mean age 36.8 years, range 6–81 years) with therapy-resistant inflammatory glaucoma secondary to chronic uveitis (45/48), chronic scleritis (1/48), or combined scleritis with keratouveitis (2/48) using transscleral red 647 nm Krypton or 670 nm Diode laser. All eyes had failed maximum tolerated medical therapy and 19/48 (40%) eyes also previous antiglaucoma surgery. Laser power at the scleral surface was 0.35 to 0.45 W and the application time 10 seconds each. The follow-up was 42.8± 40.0 (range 2–145) months.

Results

The mean preoperative intraocular pressure (IOP) of 35.6±8.1 mmHg fell to 6–21 mmHg level in 75% after one or repeated CPC. Among adult patients this was achieved in 85%, among children in 54%. More than one treatment was needed in 52%. No cases of hypotony, phthisis bulbi, or other devastating complications occurred.

Conclusions

Transscleral CPC using red 647 nm krypton or 670 nm diode laser is an effective and well-tolerated procedure for the treatment of therapy-resistant inflammatory glaucoma in adults. CPC can be considered before incisional antiglaucoma surgery with a shunt or antimetabolites is undertaken
Pupil Size Influence on the Intraocular Performance of the Multifocal AMO-Array Intraocular Lens in Elderly Patients
Authors: Salati C. , Salvetat M.L. , Zeppieri M. , Brusini P.
Published: January 2018

Purpose

To study the relationship between pupil size and AMO-Array multifocal intraocular lens (MIOL) performance in a population of elderly patients.

Methods

This prospective trial included 62 patients (mean age 76 years; range 70 to 86) undergoing bilateral cataract phacoemulsification and MIOL (AMO-Array SA-40N, Allergan) implantation. Patients were divided into two groups based on preoperative pupil diameter: small pupil group (pupil size of 2.5–2.9 mm; 45 subjects) and large pupil group (pupil size of 3–5 mm; 17 subjects). The analysis included uncorrected (UC) and best-corrected (BC) near and distance visual acuity (VA), spectacle dependence, and photic phenomena complaints (postoperative follow-up 16.6±6.2 months; range 11–26 months).

Results

Patients in the small pupil group showed postoperatively significantly higher distance UCVA and BCVA, but lower near UCVA compared to those in the large pupil group (Mann-Whitney test, p≤0.02). Patients with small pupils also tended to: be more (not statistically significant) spectacle independent for distance (73.3% versus 47.1%) and spectacle-dependent for near vision (55.6% versus 28.4%); report significantly less photic phenomena complaints (37.8% versus 93.1%, chi-square test, p<0.001); and, more satisfied with the surgery (95.5% versus 76.5%). Posterior capsular opacification (PCO) was observed in 19.4% of the patients.

Conclusions

Bilateral AMO-Array MIOL implantation in elderly patients seems to be an effective and safe surgical procedure that improves distance and near UCVA, providing spectacle independence in many cases. The use of these MIOLs, however, can induce photic phenomena and cause PCO. Patients with small preoperative pupils (<3 mm) presented less photic phenomena complaints and expressed a higher visual outcome satisfaction after surgery.
Phacoemulsification on Previously Vitrectomized Eyes: Results of a 10-Year Period
Authors: Szijártó Z. , Haszonits B. , Biró Z. , Kovács B.
Published: January 2018

Purpose

To provide an overview of intraoperative and postoperative complications during phacoemulsification cataract surgery and to evaluate the visual results in patients having pars plana vitrectomy (PPV) with 10 years of follow-up.

Methods

Retrospective evaluation of intraoperative and postoperative complications and postoperative visual results in 134 consecutive patients who underwent phacoemulsification after PPV. Of 11,498 eyes treated with phacoemulsification, 143 (1.2%) had previous PPV during the 10-year period (January 1, 1995-December 31, 2004). A total of 134 eyes were included in this study.

Results

The phacoemulsification procedure seemed to be difficult where there was a deep or fluctuating anterior chamber (93%) and primary posterior capsule opacification (19%). The most frequent intraoperative complications were posterior capsule rupture (9%) and incomplete capsular rhexis (5%). Postoperative intraocular pressure elevation (7%), retinal detachment (6%), and posterior capsule opacification (8%) occurred most frequently during the mean follow-up period of 18.2 months (1.5–110 months). Best-corrected visual acuity (BCVA) increased two or more Snellen E lines in 55% of the cases or became better than or equal to 0.5 in 10% of the cases.

Conclusions

Despite the well-known difficulties encountered in vitrectomized eyes such as zonular damage, increased mobility of the lens-iris diaphragm, and altered intraocular fluid dynamics, phacoemulsification proved to be a safe procedure in the hands of experienced surgeons.
Causes of Enucleation in Northern India (1995–2005)
Authors: Bal A. , Mohan H. , Chabbra S. , Sood S.
Published: January 2018

Purpose

There are limited data concerning the reasons for surgical removal of eyeball. The present retrospective study was undertaken to evaluate the frequency of diseases requiring surgical removal of eyeball and to study the histopathologic changes in these specimens.

Methods

Forty-eight surgical eyeball specimens received between January 1999 and June 2005 were included in the study. Age, sex, and clinical diagnoses were recorded in each case. Specimens were classified on the basis of surgical procedure. Gross and microscopic findings were noted for all the specimens.

Results

Between January 1995 and June 2005, there were 139,092 outpatients, 6,574 hospital admissions, 12,044 ophthalmic operations, and a total of 48 enucleations in 47 patients. Of these 47 patients, 24 were male and 23 female with almost equal male:female ratio. Right eye was involved in 29 cases while left was involved in 17 cases. Bilateral eye involvement was seen in one case. Surgical specimens included enucleation (28 cases, 58.3%), exenteration (12 cases, 25%), and evisceration (8 cases, 16.6%). On histopathologic examination, the lesions were categorized into two broad groups: neoplastic (8 cases, 16.6%) and non-neoplastic (40 cases, 83.4%). Both groups were further subcategorized and correlated with clinical diagnosis.

Conclusions

In our setting, non-neoplastic lesions are the main cause of eyeball surgery, as compared to the West, where trauma followed by neoplasms constitute important causes. Pathologic examination of eyeballs is a must for proper postoperative management of the patient.
Contraceptives, Cerebral Vein Thrombosis, and Choked Discs
Authors: Reddy A.R. , Backhouse O.C.
Published: January 2018

Purpose

To raise awareness of the importance of prompt and appropriate imaging in patients presenting with signs and symptoms suggestive of idiopathic intracranial hypertension.

Methods

Case report with diagnostic tests and discussion of management options.

Results

A 15-year-old girl presenting with bilateral optic disc swelling was noted to have extensive thrombosis of intracerebral venous sinuses with the clot extending along the internal jugular vein as inferior as the root of the neck demonstrable on magnetic resonance venography.

Conclusions

Ophthalmologists should be vigilant in obtaining appropriate imaging in cases of optic disc swelling.
An Unusual Cause of Central Retinal Artery Occlusion: Acquired Immunodeficiency Syndrome
Authors: Erdol H. , Turk A. , Caylan R.
Published: January 2018

Purpose

In patients with acquired immunodeficiency syndrome (AIDS), disturbances in the circulation of retinal vessels are mostly encountered at the microvascular level. Rarely observed large retinal vessel occlusions frequently affect retinal veins.

Methods

A 32-year-old woman was admitted to the authors' clinic with sudden loss of vision. Her clinical and ophthalmologic examinations and laboratory tests were carried out and the results were evaluated.

Results

The patient's history revealed a diagnosis of AIDS established 5 years ago. Her corrected visual acuity was limited to light perception in the right eye and 20/60 in the left eye. There was afferent pupillary defect in the right eye. Posterior segment examination demonstrated central retinal artery occlusion in the right eye and cotton-wool spots in the left eye. The clinical examination and laboratory test results did not reveal any comorbid disease state that can contribute to this presentation.

Conclusions

As thrombi may develop in patients with human immunodeficiency virus infection, they should be closely followed up for the development of vasoocclusive disease.
Prospective Randomized Comparison of 1-Day versus 3-Day Application of Topical Levofloxacin in Eliminating Conjunctival Flora
Authors: Ta C.N. , Sinnar S. , He L. , Myung D. , De Kaspar H. Miño
Published: January 2018

Purpose

To compare efficacy of a 1-day versus 3-day application of topical levofloxacin in reducing ocular surface bacteria.

Methods

In this prospective randomized controlled trial, 100 volunteer patients (50 per group) were assigned to receive topical 0.5% levofloxacin four times daily for 1 day or 3 days. Conjunctival cultures were obtained prior to (T0) and after the application of antibiotics (T1). Additionally, all patients received topical levofloxacin at 5-minute intervals for three applications (T2), followed by two drops of topical 5% povidone-iodine (T3). Conjunctival cultures were obtained at timepoints T2 and T3.

Results

A 1-day application of topical levofloxacin significantly reduced (p = 0.0004) the number of eyes with positive conjunctival cultures from 41 eyes (82%) to 23 eyes (46%). Similarly, a 3-day application significantly reduced (p = 0.0001) the positive culture rate from 37 eyes (74%) to 17 eyes (34%). Two drops of povidone-iodine further reduced the positive culture rate for both groups to 20% (10 eyes for each group). There was no significant difference in positive culture rate between the 1-day and 3-day groups at T0 (p = 0.4689), T1 (p = 0.3074), T2 (p = 0.6706), or T3 (p = 1.000).

Conclusions

The application of topical 0.5% levofloxacin for 1 or 3 days significantly reduced the number of eyes with positive conjunctival cultures. The addition of 5% povidone-iodine further eliminated bacteria from the conjunctiva. The application of levofloxacin for 1 day appears to be as effective as a 3-day application.
Methotrexate for Uveitis Associated with Juvenile Idiopathic Arthritis: Value and Requirement for Additional Anti-Inflammatory Medication
Authors: Heiligenhaus A. , Mingels A. , Heinz C. , Ganser G.
Published: January 2018

Purpose

To study the value of methotrexate (MTX) and the requirement for additional anti-inflammatory drugs for the treatment of severe chronic iridocyclitis associated with juvenile idiopathic arthritis (JIA).

Methods

Institutional study of 35 consecutive patients with JIA started on MTX as the single systemic immunosuppressive drug for the treatment of associated iridocyclitis. The clinical epidemiologic data, course of visual acuity (VA), development of complications, and the need for additional anti-inflammatory drugs were analyzed.

Results

Mean follow-up with MTX treatment was 27.6 months. Uveitic complications were present in 31 patients before MTX treatment. With MTX, quiescence of uveitis was obtained with (n=21) or without (n=4) additional topical steroids. Additional systemic immunosuppressive drugs were required in another 7 patients: cyclosporine A (n=4), azathioprine (n=1), infliximab (n=1), or etanercept (n=1). Three patients had active uveitis at the end of the follow-up period. During MTX therapy, uveitis first developed in the unaffected fellow eyes in 2 patients, and secondary glaucoma or ocular hypertension occurred in 7 patients. The VA deteriorated in 6, improved in 13, and was stable in the remaining eyes.

Conclusions

The data suggest that MTX is very effective in controlling inflammation of uveitis in patients with JIA. However, additional topical steroids or systemic immunosuppressive drugs are often required.
Alterations in Central Retinal Sensitivity after Intravitreal Triamcinolone Injection for Diffuse Diabetic Macular Edema
Authors: Bardak Y. , Çekiç O. , Tiğ U. Şahin , Bardak H.
Published: January 2018

Purpose

To evaluate alterations in central retinal sensitivity following intravitreal triamcinolone injection in patients with diffuse diabetic macular edema that persisted after laser treatment.

Methods

Fourteen eyes of 14 patients that received 4 mg 0.1 cc intravitreal triamcinolone underwent macular threshold test using computerized visual field analyzer before and after 1, 2, 3, and 5 months of triamcinolone injection. Pre- and postinjection values of total defect depth, total threshold, and best-corrected visual acuity were compared and correlated.

Results

At the last follow-up, compared to baseline, visual acuity improved from 1.4±0.4 (logMAR, mean ± standard deviation) to 1.0±0.4 (p=0.01). Total defect depth tended to recover from 148±64 dB to 121±48 dB (p=0.12), and total threshold tended to increase from 241±87 dB to 271±68 dB (p=0.16), but these values did not reach significance. There was a significant correlation between baseline and 5 months postinjection values of total defect depth (rho=0.60, p=0.02), and of total threshold of light sensitivity (rho=0.55, p=0.04).

Conclusions

Best-corrected visual acuity was found improved in patients with diabetic macular edema 5 months after triamcinolone injection. Improvement in central retinal sensitivity did not reach significant level at the last follow-up. Macular threshold test may be a valuable tool in the follow-up of patients with diffuse diabetic macular edema after intravitreal triamcinolone injection.
Radiologic Findings in Infected and Noninfected Scleral Buckles
Authors: Mansour A.M. , Han D.P. , Kim J.E. , Uwaydat S.H. , Sibai A. , Medawar W.A. , Li H.K.-F. , Rjeily J.A. , Salti H.I. , Bashshur Z. , Hourani M.
Published: January 2018

Purpose

To present the radiologic findings in scleral buckle infections and in the early postoperative period after scleral buckling.

Methods

Retrospective multicenter orbital computed tomography (CT) study of 14 patients and brain magnetic resonance (MR) in one patient with scleral buckle infections, some with the referring diagnosis of endophthalmitis, proliferative vitreoretinopathy, orbital cellulitis, or unilateral headache. The control population consisted of early postoperative prospective CT study of 38 consecutive patients with scleral buckle without clinical infection.

Results

Diffuse scleral thickening and preseptal soft tissue swelling were noted in acute scleral buckle infections. Scleral thickening decreased radiologically following prompt antibiotic therapy in five patients with acute infections. Silicone sponge had low attenuation without infection and high attenuation with infection. In chronically infected scleral buckle, the sclera was thickened around the buckle, with scleral melt under the buckle. MR showed increased signal intensity in the preseptal region in one patient with chronic fungal infection. In the controls, two had thickening of the sclera without soft tissue swelling.

Conclusions

CT or MR can assist in the early diagnosis and management of scleral buckle infections.
Vogt-Koyanagi-Harada Disease after Head Trauma
Authors: Accorinti M. , Pirraglia M.P. , Corsi C. , Caggiano C.
Published: January 2018

Purpose

To report two cases of Vogt-Koyanagi-Harada disease after closed head trauma.

Methods

Case report.

Results

Two patients, one male and one female, developed headache, dysacusis, vertigo, tinnitus, and hair hypersensitivity shortly after a closed head trauma and, 10 and 18 days later, a bilateral uveitis with papillitis and exudative retinal detachment in one and a bilateral mild uveitis with macular exudative detachment in the other. The ocular lesions resolved with intravenous high-dose steroid therapy, but recurred after reduction of the dosages, requiring further steroid therapy. The course of the disease in both patients, with the appearance of fundus depigmentation and pigment clumping, and the occurrence of a concomitant ocular and auditory relapse in one, were typical of Vogt-Koyanagi-Harada disease.

Conclusions

Vogt-Koyanagi-Harada disease may appear after a closed head trauma suggesting that even an indirect trauma in melanocyte-containing tissue may induce an inflammatory response within the eye.
Air-Guided Manual Deep Anterior Lamellar Keratoplasty: Long-Term Results and Confocal Microscopic Findings
Authors: Balestrazzi A. , Malandrini A. , Traversi C. , Martone G. , Caporossi A.
Published: January 2018

Purpose

To evaluate the long-term results of air-guided manual deep anterior lamellar keratoplasty (DALK) and to perform confocal microscopy on postoperative DALK corneas.

Methods

Seven postoperative consecutive DALK corneas were evaluated 1 year after suture removal. All patients underwent a complete ophthalmologic examination evaluating visual acuity, astigmatism, corneal thickness, and endothelial cell count. Confocal microscopy was performed to examine the corneas of the seven eyes and to obtain the measured interface depth.

Results

Eighteen months after surgery, the mean postoperative uncorrected visual acuity was 20/38 and the mean best-corrected visual acuity was 20/23. Postoperative mean value of residual recipient stroma thickness was 65.57 μm ± 28.74.

Conclusions

Maximum depth DALK can lead to significant advantages for quality of vision when compared to other types of anterior lamellar keratoplasty. Still, it remains a challenging procedure. These results show that a deep dissection without baring Descemet membrane makes good visual results possible, preventing corneal perforation and conversion to penetrating graft.
Glaucoma Drainage Implants in the Treatment of Refractory Glaucoma in Pediatric Patients
Authors: Autrata R. , Helmanova I. , Oslejskova H. , Vondracek P. , Rehurek J.
Published: January 2018

Purpose

The aim of this study is to report the clinical course, effectiveness, and safety of glaucoma drainage implants (Molteno and Baerveldt devices) in primary and secondary childhood glaucomas refractory to conventional surgical treatments and medical therapy.

Methods

This retrospective study included 76 children (76 eyes) younger than 18 years who underwent glaucoma drainage device (GDD) implantation in our clinic between 1990 and 2004. The mean age at time of surgery was 6.9±5.3 years (range: 4 months to 17.5 years). Intraocular pressure (IOP), visual acuity, corneal diameter, axial length, intraoperative and postoperative complications, and number of glaucoma medications were evaluated. Criteria for success were defined as IOP between 7 and 22 mmHg with or without glaucoma medications, no further glaucoma surgery, the absence of visually threatening complications, and no loss of light perception. Results were compared for children with primary and secondary glaucomas. The mean follow-up was 7.1±6.5 years (range: 1.6 to 15.2 years).

Results

Mean preoperative and postoperative IOP was 33.6±11.4 mmHg and 17.1±6.5 mmHg (p<0.001), respectively. Kaplan-Meier survival analysis showed cumulative probability of success: 93% at 6 months, 91% at 1 year, 82% at 2 years, 76% at 3 years, 71% at 4 years, 67% at 5 years, and 65% at 6 years. There was no difference between patients with primary (n=31 eyes) and secondary glaucoma (n=45 eyes) in terms of cumulative success (p=0.186), final IOP, number of medications, or length of follow-up. On average, the GDI surgery was successful for a mean period of 6.7 years. Fourteen eyes of 76 (18.4%) failed: 10 eyes with uncontrolled IOP, 2 eyes with retinal detachment, and 2 eyes with no light perception. Statistical regression model did not show influence of gender and previous surgery. Lower age at the time of surgery was found to be associated with higher probability of treatment failure.

Conclusions

Molteno and Baerveldt glaucoma drainage implants surgery seems to be safe and effective treatment for primary and secondary pediatric glaucoma refractory to the initial surgical procedure and medical therapy.
Unilateral Vernal Keratoconjunctivitis: A Case Report
Authors: Keklikci U. , Soker S.I. , Cakmak S. Soker , Ozkul S. , Sakalar Y.B. , Unlu K.
Published: January 2018

Purpose

A rare case of unilateral vernal keratoconjunctivitis is presented.

Methods

A 5-year-old boy had itching, foreign body sensation, redness, and ptosis in his left eye. Impression cytology specimens were taken from both upper eyelid tarsal conjunctiva.

Results

On slit-lamp biomicroscopy, unilateral cobblestone papillae and a shield ulcer were found in the left eye. On impression cytology examination, there was a significant increase in inflammation, presence of a honeycomb pattern, plasma cells, and mucus strands in the upper tarsal conjunctiva of the specimens.

Conclusions

Giant papillary conjunctivitis must be considered in differential diagnosis of unilateral vernal conjunctivitis. Impression cytology method may be combined with the clinical findings in vernal keratoconjunctivitis diagnosis.
Peribulbar Tramadol, Clonidine, and Ropivacaine in Blind and Seeing Painful Eyes
Authors: Tarantini A. , Lanzetta P. , Cugini U.
Published: January 2018

Purpose

To report on the treatment of painful eyes by peribulbar injection of tramadol, clonidine, and ropivacaine.

Methods

The authors treated a 72-year-old woman with chronic prephthisical pain in the left eye secondary to graft rejection after penetrating keratoplasty and an 81-year-old woman with severe ocular pain in her left eye for neovascular glaucoma secondary to an ischemic central vein occlusion. They were treated with a medial canthus injection of tramadol (100 mg/2 mL ampules), clonidine (0.15 mg/1 mL ampules), and 1% ropivacaine.

Results

Both injections were very well tolerated and neither transient nor lasting complications were reported. Complete pain relief was obtained in both patients within 1 day and was maintained throughout the follow-up (11 months and 7 months).

Conclusions

Peribulbar tramadol, clonidine, and ropivacaine injection may represent a safe and effective treatment modality in the management of chronic ocular pain.
The Removal of 10/0 Polyester (Mersilene) Sutures after Small Incision Congenital Cataract Surgery
Authors: Bar-Sela S.M. , Spierer O. , Spierer A.
Published: January 2018

Purpose

To evaluate the use of 10/0 polyester (Mersilene) sutures for closure of small corneal incision after congenital cataract surgery.

Methods

The authors retrospectively reviewed the medical records of 58 cases (42 patients) who underwent congenital cataract extraction and intraocular lens implantation between 1999 and 2004, using Mersilene sutures. An examination looking for suture-related complications and retinoscopy was done 1 week after surgery and then every month for 6 months. The sutures were removed in cases of local tissue reaction, but not due to high postoperative astigmatism. Paired t-test was used to compare patients' age and astigmatism level in those cases who had suture removal (Group 1) as opposed to those who did not (Group 2).

Results

In 10 cases (17%) corneal vascularization, necessitating suture removal, was found during 6-month follow-up period, without the trigger of loose suture. Patient age was 3.5±3.3 years and 4.4±3.3 years in Groups 1 and 2, respectively. At 1 week postoperatively the astigmatism value was 1.7±1.7 diopter (D) and 2.3±2.2 D in Groups 1 and 2, respectively, and it reduced to 0.9±0.8 in both groups at 6 months postoperatively. One case of endophthalmitis was encountered 2 days after suture removal.

Conclusions

Removal of Mersilene sutures after congenital cataract surgery is required in cases of corneal vascularization, occurring during the first months postoperatively. Owing to the risk of general anesthesia and infection, suture removal should be considered with caution in cases of postoperative astigmatism.
Hyperthyroidism and Severity of Orbital Disease do not Change the Central Corneal Thickness in Graves' Ophthalmopathy
Authors: Konuk O. , Aktas Z. , Aksoy S. , Onol M. , Unal M.
Published: January 2018

Purpose

To investigate whether the central corneal thickness (CCT) shows alterations in Graves disease and Graves ophthalmopathy (GO) cases according to the disease severity and hormonal status of the patients.

Methods

A total of 150 patients (62 male, 88 female) with Graves disease and 32 control subjects (11 male, 21 female) were included in the study. The patients were divided into six groups according to the severity of orbital involvement and thyroid hormone status. Best-corrected visual acuity, pupillary responses, color vision, biomicroscopy, CCT, intraocular pressure, and funduscopy were performed, and proptosis was measured with Hertel exophthalmometry in all patients.

Results

CCT values of patients with Graves disease and patients with GO with hyperthyroid or euthyroid hormonal status showed no statistical difference among themselves and versus control subjects (p>0.05).

Conclusions

Hyperthyroidism or severity of orbital disease does not affect the CCT.
Unusual Coexistence of Bilateral Keratoconus and Optic Disc Pit: A Case Report
Authors: Fasciani R. , Mosca L. , Giannico M.I. , Legrottaglie E.F. , Balestrazzi E.
Published: January 2018

Purpose

To report the unknown coexistence of bilateral optic disc pit and keratoconus.

Methods

A 23-year-old man with bilateral keratoconus underwent complete ophthalmology screening, with an unexpected detection of undiagnosed optic disc pit in both eyes. Computerized corneal topography (CT), Orbscan, corneal pachometry, endothelial microscopy, and optical coherence tomography (OCT) examination were performed.

Results

The corneal CT showed a keratoconus pattern in both eyes, evolved in the right eye with a minimum corneal pachometry of 336 μm in the right eye and 405 μm in the left eye. Mean endothelial cell density was 1937 cells/mm2 in the right eye and 1912 cells/mm2 in the left eye. The OCT scans showed the presence of the disc pit in both eyes with a normal macular thickness and profile in the right eye, and in the left eye an augmented retinal thickness in the nasal macular zone due to retinal oedema and schisis, with an initial detachment of the neuroepithelium in the parapapillary area starting from the optic pit.

Conclusions

This is the first clinical report of bilateral optic disc pit and keratoconus. Further investigations will be necessary to assess if there is a possible pathogenetic correlation between these two ocular pathologies or if this is an unusual coexistence of separate entities.
Analysis of Progressive Ophthalmic Lesion in a Patient with Subacute Sclerosing Panencephalitis
Authors: Zako M. , Kataoka T. , Ohno-Jinno A. , Inoue Y. , Kondo M. , Iwaki M.
Published: January 2018

Purpose

To evaluate the progressive lesions affecting the visual system in a patient with subacute sclerosing panencephalitis (SSPE).

Methods

The authors observed a 15-year-old boy with SSPE. Since the diagnosis was made before the appearance of ocular manifestations, the authors recorded the progressive ocular lesions using various ophthalmic examinations.

Results

The patient showed no ophthalmic abnormalities until he developed a left homonymous hemianopia with sudden bilateral disturbed visual acuity. Severe progressive macular lesions including a pigment epithelial window defect by fluorescein angiography, a marked decrease in foveal thickness by optical coherence tomography, and an extensive disorder mainly specific to cone cells in the central retina by electroretinography were demonstrated. Novel findings such as a transient relative afferent pupillary defect and an anterior uveitis were also observed.

Conclusions

Analyses over a long period of time showed progressive ophthalmic findings in a patient with SSPE.
Color Doppler Imaging of Retrobulbar Hemodynamics in Sturge-Weber Syndrome-Associated Glaucoma
Authors: Neely D. , Harris A. , Siesky B. , McCranor L. , McNulty L. , Hynes E. , Benzion I.
Published: January 2018

Purpose

Sturge-Weber syndrome (SWS) is frequently associated with early onset glaucoma in the eye on the same side as the facial angioma. The exact cause of glaucoma in SWS is poorly understood and difficult to treat. The purpose of this study is to investigate the ocular hemodynamics of children with SWS-associated glaucoma using color Doppler imaging techniques.

Methods

This is a prospective study of 10 pediatric patients with unilateral SWS-associated glaucoma. Color Doppler imaging was used to measure the peak systolic velocity and the end diastolic velocity of both the ophthalmic and central retinal arteries in the glaucomatous eye compared to the fellow healthy eye.

Results

Twenty eyes of 10 children with SWS (6 boys) with unilateral glaucoma were included in the prospective study. The mean age of the 10 participants was 5.5 years. When compared to their contralateral normal eyes, the glaucomatous eyes had greater CDR (p<0.001) and a myopic shift (p=0.04). No significant differences were found in the measurements of ocular blood flow velocities of the ophthalmic and central retinal arteries.

Conclusions

Vascular pathology has been proposed to play a role in SWS glaucoma etiology. The authors did not find arterial retrobulbar blood flow differences between the glaucomatous and the fellow normal eye. Since the primary vascular anomaly in patients with SWS is in the venous plexus, a bigger prospective trial is warranted in order to better understand and treat children with SWS glaucoma.
Rarebit Perimetry and Frequency Doubling Technology in Patients with Ocular Hypertension
Authors: Corallo G. , Iester M. , Scotto R. , Calabria G. , Traverso C.E.
Published: January 2018

Purpose

To test the capability of rarebit perimetry (RP), a recent non-conventional perimetric technique, in detecting early functional damage in subjects with ocular hypertension (OHT) and to compare RP findings with those obtained by frequency-doubling technology (FDT) perimetry.

Methods

Thirty patients with OHT were matched with 30 healthy subjects. All were tested with RP and FDT. Frequency-doubling technology mean deviation (MD) and pattern standard deviation (PSD), as well as RP mean hit rate (MHR), of the two groups were analyzed. The agreement between the two techniques was tested by Kappa analysis.

Results

In the OHT group the mean (SD) FDT MD was 0.5 (2.1), the mean (SD) FDT PSD was 4.2 (1.6), and the mean (SD) RP MHR was 81.4 (6.7). In the control group, corresponding values were mean (SD) FDT MD 1.1 (1.4), mean (SD) FDT PSD 3.0 (0.3), mean (SD) RP MHR 96.2 (2.0). The differences between the two groups were not significant for the studied indexes. Eleven (36.6%) out of the 30 OHT eyes had abnormal RP results; 12 (40.0%) eyes had abnormal FDT results. Five (16.6%) eyes had abnormal RP and FDT findings. Only 1 eye (3.3%) in the control group had abnormal RP results and 3 eyes (10.0%) had abnormal FDT results. RP and FDT showed a moderate agreement (Kappa = 0.43; 95% CI: 0.42 to 0.51).

Conclusions

RP and FDT showed VF defects not shown in standard automated perimetry in the OHT group. This may be indicative of an increased risk in developing glaucoma, even if a gold standard for detecting subtle defects is not currently available. RP has the additional advantage of not requiring any expensive device to be used. The poor agreement between these techniques in identifying eyes with early damage warrants further investigations. Large longitudinal studies are needed before defining the role of RP in early glaucoma diagnosis.
Results of Combined Phacoemulsification and Viscocanalostomy in Patients with Cataract and Pseudoexfoliative Glaucoma
Authors: Hassan K.M. , Awadalla M.A.
Published: January 2018

Purpose

Coexisting pseudoexfoliation glaucoma (PEXG) and cataract represents a special challenge. Although phacotrabeculectomy is an effective procedure, it combines the risks of phacoemulsification and trabeculectomy. This study evaluates phacoviscocanalostomy to manage eyes with PEXG and cataract.

Methods

We conducted a prospective noncomparative study that included 30 consecutive eyes of 22 patients with uncontrolled PEXG and cataract. Phacoviscocanalostomy was performed in all. Success rate based on postoperative intraocular pressure (IOP) reduction and requirement for topical antiglaucoma medication was evaluated as the main outcome measure. Visual acuity and complication rates were secondary outcomes.

Results

The mean follow-up was 18.6 months ± 6.2 (SD) (range 12 to 36 months). There was statistically significant decrease in mean IOP from 25.3 ± 5.2 mmHg preoperatively to 13.5 ± 6.0 mmHg 1 day after surgery (pp< .05), 12.3 ± 3.1 mmHg at the final follow-up (pp< .05), and at all evaluations to the last postoperative visit. Only three eyes (10%) required a single antiglaucoma medication to achieve the target IOP A complete surgical success (IOP p< 21 mmHg without medication) was achieved in 90%, while a qualified success (IOP p< 21 mmHg with or without glaucoma medication) was achieved in 100% of cases. Complications included Descemet membrane microperforations (13.3%), macroperforation (3.3%), zonular dehiscence (6.6%), and transient postoperative IOP spike (3.3%).

Conclusions

Phacoviscocanalostomy achieved excellent IOP control and visual acuity improvement in pseudoexfoliation patients with coexisting cataract and glaucoma. Complication rate was low and did not affect the surgical outcome.
Association of Plasma Homocysteine and Macular Edema in Type 2 Diabetes Mellitus
Authors: Aydin E. , Demir H.D. , Ozyurt H. , Etikan I.
Published: January 2018

Purpose

The aim of this study was to assess the association of macular edema (ME) with plasma homocysteine, vitamin B6, vitamin B12, and folic acid levels in patients with Type 2 diabetes.

Methods

Sixty-five diabetic subjects with no retinopathy and nonproliferative diabetic retinopathy (NPDR) (no DR, without ME, with ME: 16, 25, 24, respectively), 28 with proliferative diabetic retinopathy (PDR) (with and without ME: 14, 14, respectively), and 19 healthy subjects as control were recruited in this cross-sectional study Plasma homocysteine, vitamin B12, vitamin B6, and folate levels were determined after 8-hour of fasting for all subjects. The levels of serum homocysteine and vitamin B6 were measured using high performance liquid chromatography (HPLC) with fluorescence detection, and the levels of serum vitamin B12 and folic acid were measured by electrochemiluminescence immunoassay.

Results

When diabetic groups with ME were compared with diabetic groups without ME for homocysteine, vitamin B12, vitamin B6, and folic acid, the only significant difference was detected in homocysteine levels (p=0.001). There was no significant difference between NPDR with ME group compared with NPDR without ME group and no DR group for plasma homocysteine, vitamin B12, vitamin B6, and folic acid (p=0.200, p=0.660; p=0.999, p=0.678; p=1.0, p=0.248; p=1.0, p=0.982, respectively). On the other hand, when PDR with ME group was compared with PDR without ME group, there was only significant difference in homocysteine levels (p=0.023).

Conclusions

Mild to moderate elevation of homocysteine may explain the role of vascular dysregulation and endothelial dysfunction in patients with DR. The present study suggests hyperhomocysteinemia may be one of the crucial risk factors for development of ME.