bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of Cyclopentolate on Intraocular Pressure and Retrobulbar Hemodynamics in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma
Authors: Taner P. , Unal B. , Demirbaş E. , Ergin A.
Published: January 2018

Purpose

To evaluate the changes of intraocular pressure (IOP) and retrobulbar hemodynamics after cyclopentolate administration in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma.

Methods

Eighteen patients with pseudoexfoliation syndrome and 18 patients with pseudoexfoliation glaucoma were enrolled in the study. After baseline measurements of IOP, the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistivity index (RI) of the ophthalmic, central retinal, and posterior ciliary arteries were investigated by color Doppler imaging. Then, 1% cyclopentolate was instilled in one eye of each subject. After 45 minutes of instillation of the cyclopentolate, the measurements of IOP and retrobulbar blood flow velocities were repeated. The results were compared with those of 20 age-matched normal subjects.

Results

Neither IOP nor retrobulbar blood flow velocities changed significantly in control subjects after cyclopentolate administration. IOP increased significantly after cyclopentolate instillation in pseudoexfoliation syndrome (p=0.004). Retrobulbar blood velocities did not change significantly after the cyclopentolate in this group. In pseudoexfoliation glaucoma group, it was observed that basal mean IOP showed a statistically significant increase after cyclopentolate drop (p=0.002). Although blood flow velocities of ophthalmic artery did not change significantly, PSV and EDV of the central retinal and posterior ciliary arteries decreased significantly (p<0.05) and RI of the posterior ciliary artery increased significantly (p=0.01) after cyclopentolate instillation.

Conclusions

On the basis of our findings, pseudoexfoliation appears to be a predictive factor for an IOP rise after cyclopentolate. In pseudoexfoliation glaucoma patients, an increase of IOP after cyclopentolate could lead to a decreased retrobulbar blood flow. IOP must be rechecked after cyclopentolate administration in these patients to avoid further damage to the ganglion cells.
Intraobserver Reproducibility of Retinal Nerve Fiber Layer Measurements Using Scanning Laser Polarimetry and Optical Coherence Tomography in Normal and Ocular Hypertensive Subjects
Authors: Lleó-Pérez A. , Ortuño-Soto A. , Rahhal M.S. , Martínez-Soriano F. , Sanchis-Gimeno J.A.
Published: January 2018

Purpose

To evaluate quantitatively the intraobserver reproducibility of measurements of the retinal nerve fiber layer (RNFL) in healthy subjects and an ocular hypertensive population using two nerve fiber analyzers.

Methods

Sixty eyes of normal (n=30) and ocular hypertensive subjects (n=30) were consecutively recruited for this study and underwent a complete ophthalmologic examination and achromatic automated perimetry. RNFL were measured using scanning laser polarimeter (GDx-VCC) and optical coherence tomography (OCT Model 3000). Reproducibility of the RNFL measurements obtained with both nerve fiber analyzers were compared using the coefficient of variation.

Results

In both groups the authors found fair correlations between the two methods in all ratio and thickness parameters. The mean coefficient of variation for measurement of the variables ranged from 2.24% to 13.12% for GDx-VCC, and from 5.01% to 9.24% for OCT Model 3000. The authors could not detect any significant differences between healthy and ocular hypertensive eyes, although in normal eyes the correlations improved slightly. Nevertheless, the test–retest correlation was slightly better for GDx-VCC than for OCT Model 3000 (5.55% and 7.11%, respectively).

Conclusions

Retinal mapping software of both nerve fiber analyzers allows reproducible measurement of RNFL in both healthy subjects and ocular hypertensive eyes, and shows fair correlations and good intraobserver reproducibility. However, in our study, GDx showed a better test–retest correlation.
Etiology of Childhood Blindness in Izmir, Turkey
Authors: Cetin E. , Yaman A. , Berk A.T.
Published: January 2018

Purpose

To identify the anatomic sites and the etiology of childhood blindness and to discern treatable and preventable causes.

Methods

The records of 998 patients seen in the authors' pediatric ophthalmology unit between June 1998 and May 2002 were examined retrospectively. A total of 148 patients who had visual impairment and blindness according to World Health Organization criteria were included in the study. They are classified according to the etiology based on time of insult and the anatomic site of visual loss.

Results

The most common anatomic site of visual loss was retina, with a rate of 25.0%. The etiology according to the time of insult was unknown in 45.2% of the patients, of whom 20.2% had cataract. Genetic disorders were responsible in 25.0% of the patients. In 69.6% of the patients, the causes of visual impairment were considered either preventable or treatable, including cataract, retinopathy of prematurity, genetic disorders, and refractive errors.

Conclusions

A high percentage of our patients had avoidable causes of childhood blindness. Genetic counseling services, as well as national screening programs for amblyopia, red fundus reflex, and retinopathy of prematurity, should be established.
Optic Nerve Damage in Highly Myopic Eyes with Chronic Open-Angle Glaucoma
Authors: Jonas J.B. , Budde W.M.
Published: January 2018

Purpose

To compare the amount of optic nerve damage in relation to intraocular pressure in highly myopic eyes with chronic open-angle glaucoma versus non-highly myopic eyes with chronic open-angle glaucoma.

Methods

The comparative clinical observational study included 1841 eyes of 1100 patients with chronic open-angle glaucoma. The highly myopic study group consisted of 25 eyes with a myopic refractive error equal to or higher than −8 diopters. It was subdivided into eyes with an optic disc size larger than 2.7 mm2 and eyes with an optic disc smaller than 2.7 mm2. The control group included the remaining, non-highly myopic eyes (n=1816). For all patients, a morphometric analysis of color stereo optic disc photographs was performed. Main outcome measures were morphometric optic disc measurements and intraocular pressure.

Results

In the highly myopic, large-optic-disc study group compared with the control group, maximal and minimal intraocular pressure readings were significantly (p<0.05) lower and neuroretinal rim area corrected for optic disc size was slightly (p=0.16) smaller. Comparing the total highly myopic study group with a control group adjusted for optic disc area, neuroretinal rim area was significantly (p=0.039) smaller in the study group with no significant difference in intraocular pressure measurements between the groups.

Conclusions

At a given intraocular pressure in chronic open-angle glaucoma, optic nerve damage may be more pronounced in highly myopic eyes with large optic discs than in non-highly myopic eyes. This may suggest a higher susceptibility for glaucomatous optic nerve fiber loss in highly myopic eyes than in non-highly myopic eyes.
Bilateral Complete Avulsion of Ocular Globes in a Le Fort III Maxillofacial Fracture: A Case Report and Review of the Literature
Authors: Unal S. , Argin A. , Arslan E. , Demirkan F. , Aksoy A.
Published: January 2018

Purpose

The purpose of this paper is to demonstrate a case of bilateral complete avulsion of the globes following maxillofacial trauma.

Methods

A 23-year-old man with bilateral complete globe avulsion following a maxillofacial trauma. Both globes were luxated out of the orbit and suspended on the skin of the upper lid below the brows. No direct or indirect light reflexes or any eye movements could be noted. Computerized tomography showed complete lacerations of both optic nerves at a level just anterior to the optic canal. There were also multiple fractures corresponding to Le Fort III fracture with Le Fort II components. The brain parenchyma was normal with an exception of brain edema. As the globes were unsuitable for repositioning, both were enucleated. The maxillofacial fractures were immobilized with plates and screws. Although the patient gained consciousness with normal vital signs in the early postoperative period, he died on the ninth day due to Pseudomonas aeruginosa infection, despite invasive antibiotic treatment.

Discussion

The optic nerve and the globes are very resistant to mild and moderate trauma. The avulsion of the nerve at the canalicular or more posterior level may demonstrate central nervous system complications resulting in life-threatening conditions. The most critical issue in complete globe avulsions with a transected optic nerve is to rescue the vision. In total transected optic nerves the final eyes could only have had cosmetic benefits. In spite of promising experimental research on optic nerve regeneration, there are unknowns, such as the methods to eliminate the risk of anterior segment ischemia and phthisis bulbi.

Conclusions

Globe avulsions with a complete optic nerve cut remain a challenging problem. More research is required to better understand the pathophysiology of optic nerve repair.
Comparing Measurements of Retinal Nerve Fiber Layer Thickness Obtained on Scanning Laser Polarimetry with Fixed and Variable Corneal Compensator
Authors: Da Pozzo S. , Iacono P. , Marchesan R. , Vattovani O. , Ravalico G.
Published: January 2018

Purpose

To compare retinal nerve fiber layer (RNFL) thickness measurements obtained on scanning laser polarimetry (SLP) with commercially available instruments coupled with fixed (FCC) and variable corneal compensator (VCC).

Methods

Forty-two eyes of 42 patients underwent a complete ophthalmologic evaluation and achromatic automated perimetry (24-2 program, SITA standard strategy). Nineteen eyes were healthy (average mean deviation: -0.12 dB ± 2.26) and 23 glaucomatous (average mean deviation: -4.92 dB ± 6.49). All patients underwent SLP with both FCC and VCC. Adequate compensation of corneal birefringence on FCC-SLP was checked acquiring macular retardation map (MRM). RNFL thickness was evaluated considering superior and inferior maximum (SM, IM), average thickness and ellipse average (AT, EA), and superior and inferior average (SA, IA). Mean values (±SD) for each parameter measured by the two polarimeters were compared and linear regression calculated. The ability of each parameter to discriminate between normal and glaucomatous eyes was evaluated on both polarimeters calculating area under ROC curve.

Results

A significant linear correlation for all parameters was noted (r range: 0.65–0.78). VCC produced slightly higher thickness values than FCC, both in normal and glaucomatous eyes. On both polarimeters, area under ROC curve for all parameters discriminated adequately healthy from glaucomatous eyes (range: 0.68–0.81).

Conclusions

In a highly comparable and selected group of normal and glaucomatous eyes, FCC-SLP and VCC-SLP showed considerable concordance in measuring peripapillary RNFL thickness, both for sectorial and global parameters. Proper corneal birefringence compensation provided separation of normal from glaucomatous eyes on both polarimeters.
Iris Atrophy, Serous Detachment of the Ciliary Body, and Ocular Hypotony in Chronic Phase of Vogt-Koyanagi-Harada Disease
Authors: Saari J.M. , Nummelin K.
Published: January 2018

Purpose

To describe iris atrophy, serous detachment of the ciliary body, and ocular hypotony in a patient with chronic phase of Vogt-Koyanagi-Harada (VKH) disease.

Methods

Ocular examination and follow-up including digital infrared transillumination imaging of the iris was done in a 52-year-old woman with chronic phase of VKH disease.

Results

Infrared transillumination imaging showed extensive atrophy of the iris stroma and occasional pigment clumps both in the pupillary and ciliary zones of the iris, and detachment of the ciliary body in both eyes. Conventional transpupillary transillumination using white light showed only minute patchy atrophy of the pigment epithelium in the pupillary zone. Treatment did not normalize bilateral shallow retinal detachment of the posterior pole, serous detachment of the ciliary body, or severe ocular hypotony.

Conclusions

Severe atrophy of the iris stroma, retinal detachment of the posterior pole, serous detachment of the ciliary body, and ocular hypotony may occur in chronic phase of VKH disease.
Reflex Epiphora in Patients with Dry Eye Symptoms: Role of Variable Time Schirmer-1 Test
Authors: Singh Bhinder G. , Singh Bhinder H.
Published: January 2018

Purpose

To report reflex epiphora in patients with dry eye symptoms and describe the role of variable time Schirmer-1 test.

Methods

The study was conducted in 16 consecutive dry eye patients (32 eyes), nine male and seven female, aged 16 to 73 years (mean 48.56±16.68 years), presenting with reflex epiphora. Each eye was subjected to Schirmer-1 test and the time elapsed in total wetting of the 35 mm strip from its placement into the conjunctiva was noted and test was graded. This was compared with symptomatology, closed chamber infrared thermometry, humidity, fluorescein tear break-up time (FTBUT), fluorescein stain test, and Lissamine green stain.

Results

Schirmer-1 test differentiated reflex epiphora in dry eye patients into groups 0 to 4 based on time it took to wet the 35 mm strip (Group 0 = ≤5 min; Group 1 = ≤2 min; Group 2 = ≤1.5 min; Group 3= ≤1 min; Group 4 = ≤1/2 min). The score was −0.04 in 8 eyes, −0.03 in 10 eyes, −0.02 in 2 eyes, −0.01 in 6 eyes, and 0.00 in 6 eyes in Groups 4, 3, 2, 1, and 0, respectively. Reflex epiphora had a statistically significant correlation to the symptomatology (p<0.001), lissamine green staining (p<0.001), closed chamber humidity difference (p<0.001), and FTBUT score (p=0.001). Fluorescein stain test and difference in infrared thermometry did not show any correlation. A statistically significant correlation existed between severe and mild to moderate reflex epiphora (p=0.002). However, the two groups separately failed to show any statistically significant relationship with the symptomatology (p=0.16), Lissamine green (p=0.69), humidity difference from close to open eye position (p=0.17), and FTBUT (p=0.25). Thermometry and fluorescein stain test showed no relationship.

Conclusions

Schirmer-1 test with variable time quantifies reflex epiphora in dry eye patients, which was significantly related to the other tear function tests.
Discrimination between Normal and Early Glaucomatous Eyes with Scanning Laser Polarimeter with Fixed and Variable Corneal Compensator Settings
Authors: Brusini P. , Salvetat M.L. , Parisi L. , Zeppieri M. , Tosoni C.
Published: January 2018

Purpose

To evaluate the ability of scanning laser polarimetry (SLP) with a fixed corneal polarization compensator (GDx-FCC Nerve Fiber Analyzer) compared to one with a variable one (GDx-VCC) in the discrimination between healthy and early glaucomatous eyes.

Methods

Forty patients with early glaucomatous visual field defects, having a mean deviation of 3.1 ± 1.6 dB and a pattern standard deviation of 3.1 ± 0.9 dB, and 40 controls underwent both GDx-FCC and GDx-VCC. One eye per patient was considered. The cut-off point, taken as the value dividing healthy from glaucomatous eyes with highest probability, was determined for each GDx parameter. Linear discriminant functions (LDFs) were separately developed for GDx-FCC and GDx-VCC parameters. Sensitivity, specificity, and area under the receiver operating characteristic curve (AROC) for discriminating between healthy and glaucomatous eyes were calculated for each GDx parameter, both according to the GDx normative database and after the selection of new cut-off points, and for the LDFs.

Results

All software-provided parameters showed low sensitivity and high specificity. The selection of new cut-off points improved the performance of all GDx parameters: VCC parameters performed better than FCC parameters; the largest AROCs were associated with the superior/nasal ratio for the GDx-FCC (0.86) and with the Number for the GDx-VCC (0.87). The LDFs provided an AROC of 0.89 with both the GDx-FCC and the GDx-VCC parameters.

Conclusions

The GDx-VCC showed a higher ability in the early diagnosis of glaucoma when compared with the GDx-FCC. The individuation of the right cut-off point of selected parameters with both GDx settings performed better than the software-provided parameters, and comparably to the GDx parameters-based LDFs.
Vertical and Torsional Correction in Congenital Superior Oblique Palsy by Inferior Oblique Recession
Authors: Mataftsi A. , Strickler J. , Klainguti G.
Published: January 2018

Purpose

Inferior oblique recession (Fink's technique) is one of various surgical procedures to manage congenital superior oblique muscle palsy. The authors aimed to determine the effectiveness of this operation in reducing vertical deviation and torsional deviation, and to assess the dose-effect relationship.

Methods

Fifty-eight patients presenting with unilateral congenital superior oblique palsy had an inferior oblique recession of 6 mm, 8 mm, or 10 mm (16, 35, and 7 patients, respectively). Vertical deviation and torsional deviation were measured before and after surgery by means of the dark red glass dissociation in front of Harms’ tangent screen and the data were analyzed retrospectively.

Results

A cure rate of 88% was achieved, with no complications, and no overcorrections. For the 34 patients for whom long-term follow-up was possible (mean 2.8 years), final median postoperative vertical deviations and torsional deviations were 0.5° and 0°, respectively both in primary position and in adduction upgaze.

Conclusions

Inferior oblique weakening by recession proves to be an efficient and safe procedure for congenital superior oblique palsy, and its effect on vertical deviation can be predicted on the extent of recession. The operation can therefore be adapted to the patient, depending on the degree of the preoperative deviation.
When is Isolated Inferior Oblique Muscle Surgery an Appropriate Treatment for Superior Oblique Palsy?
Authors: Hatz K.B. , Brodsky M.C. , Killer H.E.
Published: January 2018

Purpose

To evaluate the efficacy of isolated inferior oblique muscle weakening in the treatment of superior oblique palsy.

Methods

Forty-seven patients with superior oblique palsy underwent either single-muscle surgery (anteriorization or recession of the inferior oblique muscle) or two-muscle surgery (anteriorization of the inferior oblique muscle combined with recession of the contralateral inferior rectus muscle according to the amount of vertical deviation). In a retrospective non-comparative study the objective surgical effect was calculated as the difference between the deviation at the day before surgery and the deviations 6 weeks and at least 1 year after surgery. Pre- and postoperative sensorimotor status and subjective outcome were evaluated.

Results

In patients who underwent isolated inferior oblique muscle surgery the mean preoperative vertical deviation decreased from 15±9 (distance)/16±10 (near) prism diopters (PD) (anteriorization) and 7±5 (distance)/9±8 (near) PD (recession) to 4±4 (distance)/4±6 (near) PD (anteriorization) and 2±2 (distance)/2±3 (near) PD (recession) at the 1-year follow-up. In patients who underwent two-muscle surgery the mean vertical deviation decreased from 20±11 (distance)/21±10 (near) PD preoperatively and 6±7 (distance)/6±6 (near) PD at 1-year follow-up. Subjective assessment showed excellent scores among the patients treated with single-muscle surgery and slightly lower but also favorable scores among the patients treated with combined techniques. A direct comparison of the different outcome scores was not possible because of the more difficult initial situation in patients who underwent combined surgery.

Conclusions

Isolated inferior oblique muscle weakening is an effective treatment option for superior oblique palsy up to 15 PD of vertical deviation in primary position. Two-muscle surgery should be reserved for patients with larger vertical deviations.
Phacoemulsification in Previously Vitrectomized Patients: An Analysis of the Surgical Results in 100 Eyes as well as the Factors Contributing to the Cataract Formation
Authors: Pardo-Muñoz A. , Muriel-Herrero A. , Abraira V. , Muriel A. , Muñoz-Negrete F.J. , Murube J.
Published: January 2018

Purpose

To evaluate the safety and effectiveness of phacoemulsification with clear corneal incision in previously vitrectomized patients as well as factors affecting the development time and type of cataract occurring after pars plana vitrectomy (PPV).

Methods

The authors conducted a prospective study of 100 consecutive eyes of patients who developed a cataract after PPV. Three groups were established based on the underlying vitreoretinal pathology. The main outcome measurements were intraoperative and postoperative complications and changes in best-corrected visual acuity (BCVA).

Results

The median interval between PPV and phacoemulsification was 11.5 months. Patients with proliferative diabetic retinopathy required phacoemulsification earlier (p=0.018). Posterior subcapsular cataracts developed more frequently in patients <50 years (73.7%, p=0.000) and affected those who underwent vitrectomy primarily for complicated retinal detachment (48.8%, p=0.046). Intraoperative complications included posterior capsular tears (4%), luxated nucleus into vitreous (2%), and zonular dialysis (5%). Postoperative complications were vitreous hemorrhage (6%), retinalredetachment (4%), pupillary synechiae (6%), ocular hypertension (4%), and Seidel phenomenon (3%). Posterior Nd:YAG laser capsulotomy was required in 44% of eyes. BCVA was improved in 85% of cases at the end of follow-up (median, 15.5 months). Twenty-one patients with one functioning eye (61.9%) demonstrated visual improvement compared with 79 patients with bilateral vision (91.1%; p=0.003).

Conclusions

The technique allows stable improvement in BCVA through long follow-ups. It is more risky than in nonvitrectomized eyes. The visual results after phacoemulsification in vitrectomized eyes seem to be limited by retinal comorbidity and surgical complications.
Vogt-Koyanagi-Harada Associated with Diabetes Mellitus and Celiac Disease in a 3-Year-Old Girl
Authors: Al Hemidan A. I. , Tabbara K.F. , Althomali T.
Published: January 2018

Purpose

To present a case of Vogt-Koyanagi-Harada (VKH) associated with type I diabetes mellitus and celiac disease in a 3 year old female.

Methods

We studied a three-year old female who presented with clinical manifestation of VKH and type I Diabetes mellitus and ciliac disease.

Results

Patient was found to have hyperglycemia with type I diabetes mellitus. Duodenal mucosal biopsy specimen confirmed the diagnosis of celiac disease. Patient's ocular inflammation was treated by topical and systemic corticosteroid and immune-suppressive therapy. Her diabetes mellitus was controlled by insulin and her celiac disease was controlled by gluten-free diet.

Conclusions

The association of VKH with two autoimmune diseases (celiac disease and type I diabetes mellitus) is rare. This case is, to our knowledge, the youngest patient reported with VKH.
Zyoptix Wavefront-Guided versus Standard Photorefractive Keratectomy (PRK) in Low and Moderate Myopia: Randomized Controlled 6-Month Study
Authors: Mastropasqua L. , Toto L. , Zuppardi E. , Nubile M. , Carpineto P. , Di Nicola M. , Ballone E.
Published: January 2018

Purpose

To evaluate the refractive and aberrometric outcome of wavefront-guided photorefractive keratectomy (PRK) compared to standard PRK in myopic patients.

Methods

Fifty-six eyes of 56 patients were included in the study and were randomly divided into two groups. The study group consisted of 28 eyes with a mean spherical equivalent (SE) of -2.25±0.76 diopters (D) (range: -1.5 to -3.5 D) treated with wavefront-guided PRK using the Zywave ablation profile and the Bausch & Lomb Technolas 217z excimer laser (Zyoptix system) and the control group included 28 eyes with a SE of-2.35±1.01 D (range: -1.5 to -3.5 D) treated with standard PRK (PlanoScan ablation) using the same laser. A Zywave aberrometer was used to analyze and calculate the root-mean-square (RMS) of total high order aberrations (HOA) and Zernike coefficients of third and fourth order before and after (over a 6-month follow-up period) surgery in both groups. Preoperative and postoperative SE, uncorrected visual acuity (UCVA), and best-corrected visual acuity (BCVA) were evaluated in all cases.

Results

There was a high correlation between achieved and intended correction. The differences between the two treatment groups were not statistically significant for UCVA, BCVA, or SE cycloplegic refraction. Postoperatively the RMS value of high order aberrations was raised in both groups. At 6-month control, on average it increased by a factor of 1.17 in the Zyoptix PRK group and 1.54 in the PlanoScan PRK group (p=0.22). In the Zyoptix group there was a decrease of coma aberration, while in the PlanoScan group this third order aberration increased. The difference between postoperative and preoperative values between the two groups was statistically significant for coma aberration (p=0.013). No statistically significant difference was observed for spherical-like aberration between the two groups. In the study group eyes with a low amount of preoperative aberrations (HOA RMS lower than the median value; <0.28 μm) showed an increase of HOA RMS while eyes with RMS higher than 0.28 μm showed a decrease (p<0.05).

Conclusions

Zyoptix wavefront-guided PRK is as safe and efficacious for the correction of myopia and myopic astigmatism as PlanoScan PRK. Moreover this technique induces a smaller increase of third order coma aberration compared to standard PRK. The use of Zyoptix wavefront-guided PRK is particularly indicated in eyes with higher preoperative RMS values.
Central Serous Chorioretinopathy and Helicobacter Pylori
Authors: Cotticelli L. , Borrelli M. , D'alessio A.C. , Menzione M. , Villani A. , Piccolo G. , Montella F. , Iovene M.R. , Romano M.
Published: January 2018

Purpose

This study was designed to evaluate the prevalence of Helicobacter pylori infection in patients with central serous chorioretinopathy (CSC).

Methods

Retrospective observational case series. A group of 23 patients (22 men and 1 woman, age range 34–62 years, median age 47 years) with diagnosis of CSC, confirmed by fluorescein angiogram, and a control group of 23 consecutive patients (22 men and 1 woman, age range 41–69 years, median age 50 years) referred to our Department for retinal disease other than CSC were studied. Each patient provided peripheral venous blood samples and a stool specimen, which were analyzed at the Department of Gastroenterology and Microbiology at the same university. H. pylori infection was determined by measurement of IgG antibodies to H. pylori and by determination of H. pylori antigens in the stool specimens by enzyme-linked immunosorbent assay technique. Patients were defined as H. pylori infected if both tests were positive.

Results

The prevalence of H. pylori infection was 78.2% (95% CI, 56%–92%) in CSC patients and 43.5% (95% CI, 23%–65%) in control subjects (p<0.03 by two-tailed Fisher exact test). The odds ratio for CSC associated with H. pylori infection was 4.6 (95% CI 1.28–16.9).

Conclusions

The results of this study show that the prevalence of H. pylori infection seems to be significantly higher in patients with CSC than in controls. H. pylori infection may represent a risk factor in patients with CSC.
Did the Spectrum of Endophthalmitis Change? A Study Comprising 13 Years Experience with Operative Therapy of Endophthalmitis
Authors: Janknecht P. , Zühlke S. , Hansen L.L.
Published: January 2018

Purpose

The authors wondered whether the spectrum of endophthalmitis and the type of therapy had changed.

Methods

Files of patients who were operated upon for endophthalmitis between 1988 and 2000 were retrospectively analyzed. They were divided into Group 1 (operated upon 1988 to 1994) and Group 2 (1995 to 2000).

Results

Group 1 consisted of 83 patients (43.4% female, mean age 63.9 years), Group 2 of 108 (38.9% female, mean age 64.6 years). Bilateral endophthalmitis occurred in 8.4% of Group 1 patients (3.7% of Group 2 patients). Patients in both groups took on average 1.2 drug types against various internal diseases. The mean interval between first symptoms and presentation in the clinic was 45.7 days in Group 1 (19 days in Group 2; difference statistically significant). There were 63% (Group 1) (70% [Group 2]) cases of postoperative endophthalmitis, among them 58% (Group 1) (63% [Group 2]) after cataract extraction, 6% (Group 1) (5% [Group 2]) after glaucoma surgery, 20% (Group 1) (17% [Group 2]) endogenous and 17% (Group 1) (13% [Group 2]) posttraumatic. In Group 2 slightly more Gram-negative bacteria were found. As an initial procedure the following were performed: vitrectomy (70% [Group 1], 88% [Group 2]), removal of crystalline lens (11% [Group 1], 10% [Group 2]), removal of pseudophakos (2% [Group 1], 12% [Group 2]), opening of posterior capsule (1% [Group 1], 9% [Group 2]), and anterior chamber irrigation (36% [Group 1], 43% [Group 2]), often combining procedures. There were significantly more vitrectomies and openings of the posterior capsule in Group 2. Neither the spectrum of secondary and tertiary procedures nor the reasons for such surgery differed in both groups. Neither visual acuity at initial presentation (0.1) nor at final follow-up (0.3) differed between the two groups. The rate of enucleation was less in Group 2 (6% versus 11%) although not statistically significantly.

Conclusions

In Group 2 there were slightly more Gram-negative bacteria and the time interval between initial symptoms and presentation in the clinic had decreased. This can be interpreted as an increase in the severity of the endophthalmitis cases. The final visual acuity was identical in both groups, the enucleation rate improved.
Choroidopathy with Serous Retinal Detachment in a Patient with Polymyositis
Authors: Hotta K.
Published: January 2018

Purpose

The authors report a unique case of multifocal choroidopathy in association with polymyositis.

Methods

The clinical presentation, laser treatment, and subsequent changes in ocular findings are described.

Results

A 65-year-old Japanese man with polymyositis experienced mild acute vision impairment in both eyes during systemic corticosteroid treatment for interstitial pneumonia. Fundus examination revealed a gray-white subretinal exudate with serous retinal detachment. Angiographic examination disclosed partial dilatation of the choroidal vein at the posterior pole and dye leakage points in the retinal pigment epithelium. The patient's left eye developed bullous retinal detachment and multifocal choroidal nodules at the posterior pole during the period of tapering of oral corticosteroid administration. Retinal burns were applied to the dye leakage points in the right eye using an argon laser. Vision in the right eye showed rapid recovery due to regression of the serous retinal detachment. However, in the left eye without retinal burns visual acuity decreased to light perception only even after regression of the bullous retinal detachment and choroidopathy.

Conclusions

In serous retinal detachment with choroidopathy associated with polymyositis, laser photocoagulation at leakage points may be useful for rapid restoration of vision and for the prevention of permanent severe vision loss.
Photodynamic Therapy in Retinal Angiomatous Proliferation Stage I
Authors: Panagiotidis D. , Karagiannis D.A. , Baltatzis S.
Published: January 2018

Purpose

To report a case of photodynamic therapy (PDT) treatment in an 85-year-old patient with retinal angiomatous proliferation (RAP) stage I.

Methods

According to Treatment of Age-Related Macular Degeneration with Photodynamic Therapy and Verteporfin in Photodynamic Therapy study guidelines, two sessions of PDT with verteporfin were performed, which was activated by a diode laser light at 690 nm.

Results

The left eye was treated with PDT because of RAP stage I. Even in the early stage of RAP, PDT treatment did not alter the natural course of the disease. In particular, the lesion evolved towards stage III, being initially in stage I, with the final result of development of retinal pigment epithelial (RPE) tear after the second session of PDT treatment.

Conclusions

Even in the early stage of RAP, PDT treatment did not alter the natural course of the disease, with the final result of RPE tear after the second session of PDT treatment.
Nd:YAG Laser Membranotomy Treatment of Premacular Hemorrhage in two Children with Hematologic Disease
Authors: Hlozanek M. , Dotrelova D. , Vrabcova T.L. , Osmera J.
Published: January 2018

Purpose

Nd:YAG laser membranotomy is considered a safe treatment of premacular hemorrhage (PMH) in adult patients, enabling rapid enhancement of visual functions. For children, however, pars plana vitrectomy (PPV) performed under general anesthesia has been the accepted treatment. In this report, the authors describe Nd:YAG laser membranotomy (LM) in two children with PMH complicated by hematologic disease.

Methods

Size of lesions was measured in optic disc diameters (DD). The authors performed three openings in the anterior surface of PMH with immediate intravitreal drainage of blood in both patients.

Results

Rapid enhancement of visual functions was followed. The authors observed no complications in 1 year of follow-up.

Conclusions

LM may be a safe method of treatment of PMH in children in selected cases.
Intravitreal Triamcinolone Acetonide in Vogt-Koyanagi-Harada Syndrome
Authors: Karacorlu M. , Karacorlu S. Arf , Ozdemir H.
Published: January 2018

Purpose

To report the results of intravitreal triamcinolone acetonide in two eyes of a patient with Vogt-Koyanagi-Harada syndrome.

Methods

A 24-year-old woman with Vogt-Koyanagi-Harada syndrome was treated with a single 4-mg dose of intravitreal injection of triamcinolone acetonide in both eyes.

Results

On the seventh day after injection, visual acuity improved from 20/50 to 20/20 in the right eye and from 20/100 to 20/32 in the left. One month after injection, visual acuity was 20/20 in the right eye and 20/32 in the left, and fluorescein angiography showed that serous detachment had almost completely resorbed. The ocular examination remained stable during the 8-month follow-up period.

Conclusions

In this study, a prompt improvement in the clinical picture of a patient with Vogt-Koyanagi-Harada syndrome after intravitreal triamcinolone acetonide injection was described. The results suggest that intravitreal triamcinolone acetonide injection may be an additional tool in the treatment of Vogt-Koyanagi-Harada syndrome.
Unilateral Recurrent Acute Retinal Necrosis Syndrome Caused by Cytomegalovirus in an Immune-Competent Adult
Authors: Voros G.M. , Pandit R. , Snow M. , Griffiths P.G.
Published: January 2018

Purpose

To report an immune-competent patient with unilateral recurrent acute retinal necrosis syndrome caused by cytomegalovirus, and to highlight the importance of diagnostic vitreous biopsy and specific antiviral therapy in this condition.

Methods

Case report.

Results

A 75-year-old man with good general health had two episodes of acute retinal necrosis syndrome affecting his left eye. Vitreous biopsy was performed in each episode, and polymerase chain reaction analysis on the vitreous specimen was positive for cytomegalovirus and negative for varicella zoster virus and herpes simplex virus 1 and 2. On each occasion, investigations indicated past cytomegalovirus infection but no evidence of a systemic reactivation. No indication of immunodeficiency was found over a 2-year follow-up period. His management, which included systemic and intravitreal antiviral therapy, is discussed.

Conclusions

To the authors’ knowledge, only two other cases of acute retinal necrosis syndrome caused by cytomegalovirus have been reported previously in immune-competent patients. This case illustrates the importance of vitreous biopsy for viral polymerase chain reaction studies in cases of acute retinal necrosis syndrome, in order to direct appropriate antiviral treatment. It also illustrates the role of an intravitreal antiviral drug that is effective against all three herpetic viruses.
Follow-Up after Intravitreal Triamcinolone Acetonide for Diabetic Macular Edema
Authors: Jonas J.B. , Spandau U.H. , Kamppeter B.A. , Vossmerbaeumer U. , Harder B.
Published: January 2018

Purpose

To report on the follow-up of patients who received an intravitreal high-dosage injection of triamcinolone acetonide (IVTA) as treatment of diffuse diabetic macular edema.

Methods

The clinical interventional case-series study included 109 eyes (90 patients) with diffuse diabetic macular edema who consecutively received an IVTA of about 20 mg. Mean follow-up was 11.2 ± 6.2 months.

Results

Visual acuity improved significantly (p<0.001) from 0.89 ± 0.33 logMAR to a best minimum of 0.65 ± 0.35 logMAR. An increase in best visual acuity by at least 1 Snellen line, 2 lines, and 3 lines was found in 91 (83%) eyes, 68 (62%) eyes, and 45 (41%) eyes, espectively Differences in visual acuity between baseline and follow-up examinations were significant for measurements performed at 1 month (p<0.001), 2 months (p<0.001), 3 months (p<0.001), and at 6 months (p=0.001) after the injection. At 9 months after the injection, mean visual acuity regressed significantly so that visual acuity at 9 months (p=0.83) and at 12 months after the injection (p=0.58) compared with baseline values did not differ significantly. Forty-seven (43%) eyes developed a rise in intraocular pressure (pressure >21 mmHg) for 6 to 8 months after the injection. No other severe complications were detected.

Conclusions

The duration of a visual acuity increase and intraocular pressure rise after high-dosage IVTA in diffuse diabetic macular edema is about 6 to 8 months. Compared with data in the literature, the high-dosage IVTA may not have a markedly higher profile of side effects than low-dosage IVTA.
Pars Plana Vitrectomy and Removal of the Internal Limiting Membrane in Diabetic Macular Edema Unresponsive to Grid Laser Photocoagulation
Authors: Yanyali A , Horozoglu F. , Celik E. , Ercalik Y. , Nohutcu A.F.
Published: January 2018

Purpose

To evaluate the effectiveness of pars plana vitrectomy (PPV) with removal of the internal limiting membrane (ILM) in diabetic patients with macular edema unresponsive to grid laser photocoagulation.

Methods

In this randomized controlled study, 20 eyes of 10 patients with diabetic macular edema unresponsive to grid laser photocoagulation were evaluated. PPV with ILM removal was performed randomly in one eye each of 10 patients and taken as the study group; the untreated fellow eyes were taken as the control group. Main outcome measures were foveal thickness changes measured with optical coherence tomography and preoperative and postoperative visual acuity. Mann-Whitney U, Wilcoxon, and chi-square tests were used in statistical analysis.

Results

The mean age of the patients was 61.5±6 years (range 51 to 71). All patients were followed up for 12 months. In the study group, mean foveal thickness was 391.3±91.6 μm preoperatively and 225.5±49.4 μm postoperatively (p=0.009). In the control group, mean foveal thickness was 356.2±140 μm at baseline and 318.4±111.1 μm at 12-month follow-up (p=0.138). Mean decrease in foveal thickness was 165.8±114.8 μm in the study group and 37.8±71.2 μm in the control group (p=0.016). In the study group, best-corrected logMAR visual acuity was 0.71 ±0.43 preoperatively and 0.54±0.45 postoperatively (p=0.125). In the control group, best-corrected logMAR visual acuity was 0.43±0.44 at baseline and 0.59±0.55 at 12-month follow-up (p=0.235). In the study group, visual acuity improved by two or more lines in 4 eyes (40%) and remained stable in 6 eyes (60%). In the control group, visual acuity improved by two or more lines in 1 eye (10%) and decreased by two or more lines in 3 eyes (30%).

Conclusions

PPV with ILM removal appears to be an effective procedure for reducing diabetic macular edema unresponsive to grid laser photocoagulation. A further study with a large number of patients is required to assess the effectiveness and safety of this procedure.
The Diagnostic Yield of Vitrectomy Specimen Analysis in Chronic Idiopathic Endogenous Uveitis
Authors: Garweg J.G. , Wanner D. , Sarra G.-M. , Altwegg M. , Loosli H. , Kodjikian L. , Halberstadt M.
Published: January 2018

Purpose

The low diagnostic yield of vitrectomy specimen analysis in chronic idiopathic uveitis (CIU) has been related to the complex nature of the underlying disease and to methodologic and tissue immanent factors in older studies. In an attempt to evaluate the impact of recently acquired analytic methods, the authors assessed the current diagnostic yield in CIU.

Methods

Retrospective analysis of consecutive vitrectomy specimens from patients with chronic endogenous uveitis (n = 56) in whom extensive systemic workup had not revealed a specific diagnosis (idiopathic) and medical treatment had not resulted in a satisfying clinical situation. Patients with acute postoperative endophthalmitis served a basis for methodologic comparison (Group 2; n = 21).

Results

In CIU, a specific diagnosis was provided in 17.9% and a specific diagnosis excluded in 21.4%. In 60.7% the laboratory investigations were inconclusive. In postoperative endophthalmitis, microbiological culture established the infectious agent in 47.6%. In six of eight randomly selected cases, eubacterial PCR identified bacterial DNA confirming the culture results in three, remaining negative in two with a positive culture and being positive in three no growth specimens. A double negative result never occurred, suggesting a very high detection rate, when both tests were applied.

Conclusions

The diagnostic yield of vitrectomy specimen analysis has not been improved by currently routinely applied methods in recent years in contrast to the significantly improved sensitivity of combined standardized culture and PCR analysis in endophthalmitis. Consequently, the low diagnostic yield in CIU has to be attributed to insufficient understanding of the underlying pathophysiologic mechanisms.
A Pilot Study of the use of Objective Structural Clinical Examinations for the Assessment of Ophthalmology Education
Authors: Aydin P. , Gunalp I. , Hasanreisoglu B. , Unal M. , Turacli M. Erol
Published: January 2018

Purpose

A pilot study was carried out to evaluate the practicality, reliability, and validity of an objective structured clinical examination (OSCE) for assessing the clinical skills and abilities of specialists in ophthalmology.

Methods

Ten unfolded OSCE style, criterion referenced questions were asked to nine candidates to assess their clinical skills and abilities, as opposed to subject knowledge. Candidate and assessor reactions to the examination process were monitored and analyzed using participant observation and questionnaires administered immediately after the event. Relevant statistical techniques were applied to the results.

Results

A total of 89% of candidates passed the examination, with the pass boundary set at 70%. Candidates revealed themselves more successful in meeting clinical skill criteria (mean 77%) than clinical ability criteria (mean 72%). Candidates, assessors, and observers all expressed the view that the OSCE pilot had been a successful way of assessing clinical skills and abilities.

Conclusions

OSCE style assessment is an effective and efficient means of assessing skills and abilities in clinical ophthalmology education.
Bilateral Atypical Nodular Posterior Scleritis
Authors: Kranias G. , Tyradellis C. , Krebs T.P. , Augsburger J.J.
Published: January 2018

Purpose

To evaluate ocular features of nodular posterior scleritis simulating choroidal melanoma.

Methods

A 60-year old woman presented with blurred vision in her right eye of two weeks duration. On examination she had a mild right-globe proptosis with an episcleral nodular mass as well as a large elevated nonpigmented choroidal mass involving the nasal quadrant.

Results

A and B-scan ultrasonography showed a medium to high-reflective solid choroidal mass. MRI demonstrated a bi-convex mass in the medial aspect of the right globe with signal characteristics compatible with choroidal melanoma. Biopsy of the extra ocular lesion demonstrated chronic inflammatory cell infiltrate suggestive of posterior scleritis. She responded to corticosteroid therapy. On evaluation 41 months later she was noted to have a similar choroidal mass in the left eye.

Conclusions

The physician should be aware of the clinical manifestations and diagnostic hallmarks of nodular posterior scleritis in order to differentiate this inflammatory process from choroidal melanoma.
Microperimetric Evaluation of Macula in Retinopathy of Membranoproliferative Glomerulonephritis Type II: A Case Report
Authors: Shenoy R. , Mccillvenny S.
Published: January 2018

Purpose

To report on the microperimetric evaluation of the central visual field in a patient with retinopathy due to membranoproliferative glomerulonephritis.

Methods

The central 20° visual field was evaluated using fundus-related perimetry with (Nidek MP1) microperimeter in a patient with proven membranoproliferative glomerulonephritis type II, who had multiple drusen-like lesions involving the posterior pole of both eyes, with corresponding window defects on fundus fluorescein angiogram.

Results

Static threshold perimetry of the central 20° using a 10 dB threshold, Goldmann size II stimulus, with (Nidek-M P1) microperimeter showed reduction in retinal sensitivity in the parafoveal and in the temporal paramacular areas in both the eyes that had drusen-like lesions.

Conclusions

Early loss of function in retinopathy of membranoproliferative glomerulonephritis type II can probably be detected by fundus-related microperimetry.
Retinal Fibrovascular Proliferation associated with Nocardia Subretinal Abscess
Authors: Rafiei N. , Tabandeh H. , Bhatti M.T. , Monshizadeh R.
Published: January 2018

Purpose

To report the development of extensive fibrovascular proliferation in association with Nocardia subretinal abscess. METHOD. Case report.

Results

Extensive retinal neovascularization with fractional retinal detachment developed soon after ocular involvement in a 61-year-old patient with systemic nocardiosis. Fundus fluorescein angiography showed extensive area of capillary nonperfusion and severe leakage from the neovascular complex. The Nocardia subretinal abscess responded to systemic antibiotics, and the retinal neovascularization and fractional retinal detachment stabilized after 3 months.

Conclusions

Retinal ischemia and severe retinal neovascularization may complicate intraocular nocardiosis. The authors propose secondary retinal vasculitis as a contributing factor towards the development of retinal ischemia in this setting.