bluuebunny/crossref_metadata_2025 huggingface dataset:
Atherosclerotic and Thrombophilic Risk Factors in Patients with Recurrent Central Retinal Vein Occlusion
Authors: Sodi A. , Giambene B. , Marcucci R. , Sofi F , Bolli P. , Abbate R. , Prisco D. , Menchini U.
Published: January 2018

Purpose

Atherosclerotic and thrombophilic risk factors may be causes of central retinal vein occlusion (CRVO). The aim of this study was to evaluate the prevalence of the aforesaid risk factors in patients with recurrent CRVOs and patients with a single episode of CRVO.

Methods

Seventeen patients with recurrent CRVO and 30 with a single episode of CRVO were enrolled. The atherosclerotic risk factors investigated were hypertension, diabetes, smoking, and dyslipidemia. Specific laboratory tests for the following thrombophilic markers were performed: homocystinemia (Hcy), lipoprotein (a), factor VIII, factor II G20210A and factor V G1691A polymorphisms, lupus anticoagulant, anticardiolipin antibodies, plasminogen activator inhibitor-1, and deficit of vitamins B6, B12, and folic acid. A multivariate analysis, adjusted for age, gender, traditional and thrombophilic risk factors, was performed. Statistical significance was set at pp≤0.05.

Results

Hypercholesterolemia, hypertriglyceridemia, fasting, and postmethionine hyperhomocysteinemia (HHcy) were more prevalent in recurrent CRVO patients (pp<0.001, pp<0.001, p=0.006, and p=0.005, respectively). At multivariate analysis, hypercholesterolemia (OR: 5.04, 95% CI 1.39–18.17; p=0.025), hypertriglyceridemia (OR: 5.60, 95% CI 1.52–20.61; p=0.017), fasting HHcy (OR: 5.77, 95% CI 1.39–23.89; p=0.028), and postmethionine HHcy (OR: 10.88, 95% CI 2.50–47.42; p=0.002) were found to be significantly associated with recurrent CRVO.

Conclusions

Dyslipidemia and hyperhomocysteinemia are independent risk factors for the occurrence of recurrent CRVO. A complete assessment of atherosclerotic and thrombophilic risk factors is recommended in CRVO patients. In addition, the need for a specific treatment is suggested.
Correlation of Visual Function Impairment and Oct Findings in Patients with Stargardt Disease and Fundus Flavimaculatus
Authors: Querques G. , Prato R. , Iaculli C. , Voigt M. , Delle Noci N. , Coscas G. , Soubrane G. , Souied E.H.
Published: January 2018

Purpose

To investigate the relationship between morphologic lesions of the retina and functional abnormalities in patients with Stargardt disease (STGD) and fundus flavimaculatus (FFM). DESIGN. Case-controlled, prospective, comparative observational study.

Methods

A complete ophthalmologic examination, including best-corrected visual acuity (BCVA) and optical coherence tomography (OCT), was performed in 61 eyes of 32 consecutive patients with STGD/FFM and in 60 eyes of 30 matched healthy control subjects. Furthermore, fundus-related perimetry was performed in 12 of the affected eyes.

Results

The age ranged from 21 to 71 years in STGD/FFM patients and from 21 to 72 years in controls. BCVA ranged from 20/20 to 20/400 and from 20/20 to 20/32, respectively, in STGD/FFM patients and in controls. A foveal thinning was found by OCT Stratus in almost all cases (average 160 μm) compared with controls (average 210 μm) (pp<0.001). BCVA impairment significantly correlated to the degree of foveal thinning (r2=0.16; p=0.0014). Moreover, in STGD/FFM patients the authors observed two types of hyperreflective deposits which were not correlated with BCVA impairment or foveal thinning. In addition, fundus-related perimetry revealed a stable fixation in 8/12 eyes, that was predominantly central in only 4 of these eyes. A smaller degree of foveal thinning correlated to a more stable fixation (p=0.0108), even if not predominantly central (p=0.0218).

Conclusions

In this series, lower visual acuity and unstable fixation correlated with a greater transverse foveal thinning. OCT and fundus-related perimetry may be useful tools in STGD/FFM patients.
Spontaneous Resolution of Vitreomacular Traction following Ranibizumab (Lucentis) Injection
Authors: Rouvas A. , Petrou P. , Ladas I. , Neamonitou G. , Vergados I.
Published: January 2018

Purpose

Spontaneous resolution of vitreomacular traction syndrome in diabetic patients is a rare phenomenon that has been poorly described in the literature.

Methods

Case presentation.

Results

The authors present a case of spontaneous resolution of vitreomacular traction following intravitreal administration of ranibizumab.

Conclusions

In patients with vitreomacular traction syndrome and diabetic macular edema, the combination of the possible vitreous liquefaction and mechanical increase of vitreous volume caused by an intravitreal injection with a degree of reduction in retinal thickness caused by the effect of vascular endothelial growth factor inhibition could play a role in the resolution of vitreomacular traction.
Comparison of Higher-Order Aberrations after Lasik Using Disposable Microkeratome 130 and 90 Micron Heads
Authors: Hosny M. , Awadalla M.A.
Published: January 2018

Purpose

To analyze and compare higher-order aberrations (HOAs) in cases of laser in situ keratomileusis (LASIK) flaps made using the Moria M2 disposable 130-μm head with those made using the 90-μm head.

Methods

Consecutive prospective comparative clinical trial. Ninety-four consecutive eyes of 48 patients were enrolled in this study. They were divided into two equal groups of 47 eyes that underwent wavefront-guided LASIK using VISX CustomVue (VISX, Santa Clara, CA) system. Corneal flap was created using the disposable Moria M2 130 μm in the first group and the 90 μm head in the second one. All patients were followed up for 6 months. Wavefront aberrations were measured at baseline, 1 month, and 6 months after surgery using the WaveScan (VISX Inc.) aberrometer. Root mean square (RMS) of HOAs, coma, and spherical aberration (SA) values were analyzed and compared in the two groups.

Results

At 6 months, values of RMS of HOAs, coma, and SA obtained from the 130–μm head group were 0.32±0.10 μm, 0.20±0.11 μm, and 0.18±0.08 μm, respectively. Values of RMS of HOAs, coma, and SA obtained from 90–μm head group were 0.33±0.12 μm, 0.19±0.10 μm, and 0.15±0.08 μm, respectively. Analyzing the data obtained revealed no statistically significant differences between the two groups. In each group, there was a significant decay of higher-order RMS and coma values from 1 month to 6 months.

Conclusions

HOAs following use of Moria M2 disposable 90 μm head are similar to those arising following use of the 130 μm.
Role of BIGH3 R124H Mutation in the Diagnosis of Avellino Corneal Dystrophy
Authors: Huerva V. , Velasco A. , Sánchez M.C. , Matías-Guiu X.
Published: January 2018

Purpose

To report the presence of the R124H mutation in two Spanish families with Avellino corneal dystrophy (ACD).

Methods

Two families with subjects who presented biomicroscopic features of ACD were included in this study They have no relatives of Italian origin. Genomic DNA of the patients was isolated from peripheral blood. DNA was amplified using primer pairs corresponding to exons 4 and 12.

Results

In Family 1, Patients I-1, II-1, and II-3 presented granular deposits in the anterior stroma. In Family 2, Patients I-1 and II-1 presented similar deposits in anterior stroma; Patient I-2 presented biomicroscopic findings similar to granular corneal dystrophy (GCD) and isolated fine lattice deposits. Patient II-2 presented isolated central granular deposits and remarkable lattice deposits in the form of Christmas tree. An identical point mutation in the BIGH3 gene (TGFBI) was observed in all affected members of the two families. The mutation consisted of a substitution of arginine by histidine at amino acid residue 124. It was reflected in the sequence analysis by the presence of a G to A transition at nucleotide 418. The mutation was not found in unaffected family members.

Conclusions

The detection of the R124H BIGH3 mutation confirmed the diagnosis of ACD in the reported families. This is the first study that shows the presence of such mutation in Spain. The authors found the same mutation reported in other countries. In earlier stages, BIGH3 mutation analysis may help to distinguish ACD from GCD, particularly in young patients.
An in Vivo Confocal Microscopy and Impression Cytology Analysis of Preserved and Unpreserved Levobunolol-Induced Conjunctival Changes
Authors: Ciancaglini M. , Carpineto P. , Agnifili L. , Nubile M. , Fasanella V. , Lanzini M. , Calienno R. , Mastropasqua L.
Published: January 2018

Purpose

To provide an in vivo confocal microscopy (IVCM) and impression cytology analysis of preserved- and unpreserved levobunolol-induced changes of conjunctival epithelium.

Methods

27 eyes of 27 patients were consecutively randomized to receive preserved or unpreserved levobunolol; all patients had a recent diagnosis of primary open angle glaucoma (POAG) or ocular hypertension and were not previously treated with topical medications. IVCM and impression cytology were performed before and after six months of therapy. Goblet cells density and a conjunctival epithelium regularity index were considered in the IVCM analysis, whereas impression cytology specimens were graded and scored in accordance with Nelson's method.

Results

After six months of therapy, IVCM and impression cytology parameters showed significant differences with respect to baseline in both groups (p<0.001); significant differences were also found between the two groups (p<0.001). The IVCM analysis showed a goblet cells density reduction (61% and 17% from baseline, respectively in group 1 and 2) (p<0.001) and an higher index of epithelial regularity (p<0.001) in both groups; the impression cytology analysis showed an higher score in both groups (p<0.001).

Conclusions

All the IVCM and impression cytology parameters correlated well with the conjunctival modifications induced by the topical therapy, suggesting the less toxicity of unpreserved drugs
A 5-year, Randomized, Open-Label Safety Study of Latanoprost and Usual Care in Patients with Open-Angle Glaucoma or Ocular Hypertension
Authors: Goldberg I. , Li X.-Y. , Selaru P. , Paggiarino D.
Published: January 2018

Purpose

To investigate the incidence of latanoprost-related adverse events of the cornea, iris, and retina and the occurrence of hyperpigmentation.

Methods

An open-label safety surveillance study was conducted in 14 countries. Patients on intraocular pressure (IOP)-reducing therapy other than latanoprost were eligible if they required a change in therapy Patients were randomly assigned (2:1) to latanoprost administered once daily or to usual care (any other commercially available medication). Patients were examined at baseline and every 6 months for 5 years.

Results

In all, 5854 patients were included (latanoprost, 3936; usual care, 1918). Of those initially randomized to latanoprost, 2707 (68.8%) completed the study, and 4638 (79.2%) patients received at least one dose of latanoprost. Five-year risks were ≤3.17% for new occurrences of corneal erosions, iritis/uveitis, or macular edema in both randomization groups. Serious adverse drug reactions were reported in 17/3936 (0.43%) latanoprost and 9/1918 (0.47%) usual care patients. In all, 87.6% of patients ever treated with latanoprost had no increased iris pigmentation; no serious adverse drug reactions were reported in patients with increased iris pigmentation.

Conclusions

This 5-year study suggests that latanoprost as prescribed in 14 countries is a safe long-term treatment for patients with glaucoma and ocular hypertension.
Agreement between Slit Lamp Examination and Optical Coherence Tomography in Estimating Cup-Disc Ratios
Authors: Martínez-De-La-Casa J.M. , Sáenz-Francés F , Fernández-Vidal A.M. , Mendez-Hernandez C.D. , Pablo-Júlvez L. , García-Sánchez J. , García-Feijoó J.
Published: January 2018

Purpose

To compare optical coherence tomography (OCT) cup-disc ratio measurements with those estimated by two independent examiners using the slit lamp in an evaluation of the optic nerve head (ONH).

Methods

In 47 eyes each of 47 patients with glaucoma and 47 healthy subjects, the ONH was examined using the slit lamp with a 78 D lens. Two examiners subjectively determined the cup-disc area ratio (A-CDR), the horizontal cup-disc ratio (H-CDR), and the vertical cup-disc ratio (V-CDR). These measurements were compared to objective OCT readings obtained by a third examiner blind to the slit lamp results.

Results

For the three variables determined, correlation indices between the OCT readings and the two sets of slit lamp measurements were significantly higher for the glaucoma group than the control group. In the patients with glaucoma, the OCT tended to underestimate A-CDR and overestimate H-CDR. For both these variables, Bland-Altmann analysis revealed significant differences between the two methods that persisted across the whole range of CDRs examined. In contrast, differences in V-CDR varied with disc size.

Conclusions

The OCT is a diagnostic tool that provides a complete automatic evaluation of the ONH. However, its measurements vary significantly from those obtained in subjective evaluations performed by experienced ophthalmologists.
Effect of Topical Netilmicin on the Reduction of Bacterial Flora on the Human Conjunctiva
Authors: Aslan O. , Teberlk K. , Yucel M. , Gur N. , Karakoc A.E.
Published: January 2018

Purpose

To investigate the effects of topical netilmicin on human conjunctival bacterial flora.

Methods

Fifty-six patients' eyes with cataract were treated three times a day with netilmicin 1 day before the surgery The fellow eyes of the patients were not treated. After 1 day of netilmicin application cultures of the inferior palpebral conjunctiva were performed in both eyes. Bacterial evaluation is qualitative. McNemar test was used for statistical analyses.

Results

The number of eyes with positive culture for coagulase negative staphylococcus (CNS) in untreated eyes was 43 (76.8%) and in treated eyes it was 5 (8.93%) and the difference was statistically significant (p=0.000). In untreated eyes number of negative cultures with no bacterial growth was 8 (14.3%) and it was 47 (83.9%) in the treated eyes. The difference among groups was statistically significant (p=0.000). Netilmicin is found very effective for CNS as the percentage of positive cultures (n=43) in untreated eyes to positive cultures (n=4) in the treated fellow eye was 90.7%. Likewise, all patients with Staphylococcus aureus positive cultures in untreated eyes (n=5) had negative culture for this microorganism in their treated fellow eyes (100%).

Conclusions

The Endophthalmitis Vitrectomy Study demonstrated that the most common causes of postoperative endophthalmitis are coagulase negative microorganisms, S aureus and Streptococcus species. As netilmicin was found effective to reduce the number of positive cultures for these bacteria, it can be used to lower the incidence of postoperative endophthalmitis before surgery.
Bedside Glue Blepharorrhaphy for Recalcitrant Exposure Keratopathy in Immobilized Patients
Authors: Sonmez B. , Özarslan M. , Beden Ü. , Erkan D.
Published: January 2018

Purpose

To report the practical use and the effectiveness of cyanoacrylate glue blepharorrhaphy in immobilized patients with recalcitrant exposure keratopathy.

Methods

Retrospective case series. Temporal two thirds of upper eyelid eyelashes were glued to lower eyelid skin with tissue adhesive n-butyl-2-cyanoacrylate (histoacryl blue) after application of a contact lens. The systemic condition for immobilization; duration of exposure signs in the ocular surface; location, depth, and dimensions of the corneal ulcer; duration of effective blepharorrhaphy; and the time to heal were recorded.

Results

Twelve eyes of nine patients were treated. The reasons for immobilization were coma due to malignancy (3 patients), ischemic encephalopathy (2 patients), subarachnoid hemorrhage (2 patients), head trauma (1 patient), coma and hypotony of unknown cause (1 patient). All of the corneal ulcers healed within 4 to 11 days (mean: 5.5 days). Blepharorrhaphy opened spontaneously in 4 to 21 days (mean: 8.6 days).

Conclusions

Bedside glue blepharorrhaphy with tissue adhesive n-butyl-2-cyanoacrylate is a practical, economic, and effective procedure in the treatment of exposure keratopathy in immobilized patients.
Bilateral Multifocal Retinal Pigment Epithelium Detachments Associated with Systemic Corticosteroids
Authors: Mendrinos E. , Mavrakanas N. , Dang-Burgener N.P. , Pournaras C.J.
Published: January 2018

Purpose

To report an unusual case of central serous chorioretinopathy (CSC), presenting as bilateral and multifocal isolated serous retinal pigment epithelium detachments (RPEDs) following corticosteroid treatment.

Methods

An otherwise healthy 39-year-old man was evaluated for visual loss following blunt trauma of his right eye (RE). The patient underwent complete bilateral ophthalmologic examination, including optical coherence tomography and fluorescein (FA) and indocyanine green angiography (ICGA).

Results

At presentation, best-corrected visual acuity (BCVA) was 20/200 in the RE and 200/200 in the left eye (LE). Treatment included topical and oral corticosteroids. Three days later, the patient complained of metamorphopsia and further decrease in the VA of his RE. Fundus examination showed bilateral serous RPEDs. Optical coherence tomography, FA, and ICGA confirmed the diagnosis. Topical and oral corticosteroids were stopped and a follow-up examination 5 days later demonstrated marked resolution of the RPEDs in the RE. Five weeks later, RPEDs regressed in the RE while they persisted in the asymptomatic LE. Visual acuity in the RE further improved to 120/200. Nine months after the first visit, BCVA in the RE was 200/200. At that time, both eyes demonstrated retinal pigment epitheliopathy

Conclusions

Central serous chorioretinopathy is a known complication of corticosteroids. The classic variant of CSC consists of a shallow neuroretinal detachment located at the posterior pole of the fundus. Bilateral and multifocal isolated serous RPEDs represent an atypical form of CSC.
Photorefractive Keratectomy for Myopic Anisometropia: A Retrospective Study on 18 Children
Authors: Magli A. , Iovine A. , Gagliardi V. , Fimiani F , Nucci P.
Published: January 2018

Purpose

To evaluate the safety and efficacy of photorefractive keratectomy (PRK) performed under topical anesthesia in children with myopic anisometropia.

Methods

Medium to high unilateral myopia was corrected in 18 patients by PRK. At the time of surgery patients were between 7 and 17 years of age (mean 10 years). All the surgical procedures were performed under topical anesthesia. Pre- and postoperative data regarding visual acuity, eye alignment, and binocular vision were analyzed.

Results

The mean correction (SE) obtained with excimer laser was −8.21 D (range: −2.25 to −14.50, SD 3.90). The mean preoperative best spectacle-corrected visual acuity (BSCVA) was 20/70, and the postoperative mean BSCVA was 20/50. A significant difference was observed between the arithmetic mean of the preoperative and postoperative BSCVA (p=0.001). Two of 18 patients improved stereopsis; furthermore, surgery variation strabismus was registered in 33.3% of the patients, following PRK. Patients were followed up for a mean of 39 months.

Conclusions

The treatment of medium to high unilateral myopia with PRK under local anesthesia was found effective and safe in pediatric and adolescent patients. This procedure may improve ocular alignment and stereopsis. Further studies are needed to increase the patient experience and extend follow-up time in order to assess the long-term stability of the results.
Full Preoperative Panretinal Photocoagulation Improves the Outcome of Trabeculectomy with Mitomycin C for Neovascular Glaucoma
Authors: Al Obeidan S.A. , Osman E.A. , Al-Amro S.A. , Kangave D. , Abu El-Asrar A.M.
Published: January 2018

Purpose

To investigate the efficacy of full panretinal photocoagulation (PRP) followed by trabeculectomy with mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG).

Methods

This study is based on 30 consecutive eyes of 27 patients with NVG who underwent full PRP followed by trabeculectomy with MMC. NVG was secondary to proliferative diabetic retinopathy (23 eyes) and central retinal vein occlusion (7 eyes). Kaplan-Meier survival analysis of the surgical outcome was performed. Operative success was defined as an intraocular pressure (IOP) of ≤21 mmHg without medical therapy.

Results

Kaplan-Meier cumulative success rates at the 6-, 12-, and 24-month intervals were 86.5%, 74.7%, and 57.6%, respectively. Pseudophakia was the only identified significant risk factor for failure (p=0.0138; Fisher exact test). Additional surgical procedures were performed in 8 (26.6%) eyes. The mean IOP decreased from 41.0±10.2 mmHg to 18.2±9.2 mmHg (p<0.001; Wilcoxon signed rank test). The number of anti-glaucoma medications was reduced from 3.1±0.5 preoperatively to 0.3±0.7 postoperatively (p<0.001; Wilcoxon signed rank test). Twenty-four (80%) eyes were classified as surgical success after a mean follow-up period of 17.3±22.1 months. Twenty-two (73.3%) eyes had improved vision or retained preoperative vision.

Conclusions

Full PRP followed by trabeculectomy with MMC can effectively reduce the elevated IOP associated with NVG. Presence of pseudophakia is a significant negative predictor of surgical outcome.
Post-Trabeculectomy Choroidal Detachment: Not an Adverse Prognostic Sign for Either Visual Acuity or Surgical Success
Authors: Altan C. , Ozturker C. , Bayraktar S. , Eren H. , Ozturker Z.K. , Yilmaz O.F.
Published: January 2018

Purpose

To report the incidence of choroidal detachment (CD) following trabeculectomy and to evaluate its effect on long-term surgical success and best-corrected visual acuity (BCVA).

Methods

A total of 253 eyes of 198 subjects who underwent trabeculectomy between 1993 and 2003 with at least 1 year follow-up were reviewed retrospectively Twenty-eight eyes of 28 subjects which developed CD postoperatively were classified as Group 1 and the remaining 225 eyes of 170 subjects as Group 2. The risk factors for the development of CD and the influence of CD on BCVA and on the success of trabeculectomy were analyzed and compared between the two groups.

Results

In Group 1, preoperative BCVA was significantly lower and cup to disc ratio and the frequency of pseudoexfoliative glaucoma were higher with respect to the control group (p=0.009, p=0.01, p=0.02). The correlations between the development of CD and postoperative findings such as shallowing of the anterior chamber, hypotony hypotonic maculopathy, hyphema, and fibrin reaction in the anterior chamber were statistically significant. CD was not associated with a significant reduction of BCVA. Intraocular pressures at postoperative first day, sixth month, and first year were lower in Group 1. The success of trabeculectomy and the average number of medications used were not significantly different between the two groups.

Conclusions

CD following trabeculectomy occurred in 11% of our patients. CD was not associated with either a significant drop in BCVA or an adverse influence on long-term IOP control.
Intravenous Diclofenac as Prophylactic Treatment for Verteporfin-Associated Low Back Pain
Authors: Theelen T. , Hoyng C.B.
Published: January 2018

Purpose

The authors report on the therapeutic effect of intravenous diclofenac on verteporfin associated low back pain (LBP), which is the most frequent adverse effect of photodynamic therapy (PDT) for macular degeneration.

Methods

The authors studied 818 patients who received PDT with verteporfin for choroidal neovascularization. Systemic blood pressures were recorded in all study participants half an hour before PDT treatment. All patients who experienced LBP during verteporfin infusion were asked to grade their pain as mild (1), moderate (2), severe (3), or unbearable (4).

Results

Thirty-three patients had LBP during their first verteporfin infusion. Of these, 11 subjects (1.34% of all) reported increased pain scores (level 2 to 4) and received intravenous diclofenac ahead of their next PDT. Patients with LBP during verteporfin infusion had significantly higher systolic blood pressures than uncomplicated cases (180 mmHg vs 155 mmHg, p=0.01). Treatment with intravenous diclofenac short before PDT significantly reduced the patients' mean pain score by 1.8 levels (p=0.0001).

Conclusions

In this study, intravenous application of diclofenac short before verteporfin infusion effectively prevented verteporfin associated LBP in patients with systemic hypertension.
Shaken Baby Syndrome: Intending to Harm or Attempting to Help?
Authors: Felekis T. , Asproudis I. , Gorezis S. , Kritikou E. , Siamopoulou A. , Peschos D. , Aspiotis M.
Published: January 2018

Purpose

To describe the role of ophthalmologists in shaken baby syndrome evaluation.

Methods

Case report.

Results

A 3.5-month-old girl was admitted to the Pediatrics Clinic with lethargy. The mother, who brought in the baby, claimed that the baby had fallen from her cradle 6 hours ago. Clinical examination showed signs of head injury. Ophthalmologic examination was requested and revealed extensive retinal hemorrhages bilaterally covering the whole fundus, and retro-hyaloid hematoma in the right eye. Computerized tomography neuroimaging documented large subdural hematomas exerting force on the brain parenchyma. The sum of the results of the clinical and neuroimaging examination-retinal hemorrhages and subdural hematomas-was indicative of violent shaking of the baby. Coronal evaluation was unable to determine whether the baby was abused by her parents or whether she was accidentally hurt.

Conclusions

Ophthalmologic examination is necessary to document shaken baby syndrome since it reveals the retinal hemorrhages which together with the neuroimaging findings are almost always present in such cases. However, even when all the signs of shaken baby syndrome are present, it is difficult and sometimes destructive for a parent to be falsely accused of abusing his or her own child.
Different Presentations of Ophthalmic Aspergillosis
Authors: Willermain F. , Bradstreet C. , Kampouridis S. , Libert J. , Koch P. , Dediste A. , Saussez S. , Caspers L.
Published: January 2018

Purpose

Aspergillus species is found worldwide and does not normally cause disease. However, when the immune system is compromised, it can invade many organs and be responsible for severe disease. The authors present cases with both classical and atypical features of ophthalmic aspergillosis.

Methods

Case series of three patients.

Results

All patients were female and had a long history of methylprednisolone use. The first two presented with endogenous endophthalmitis. One case was unilateral with a classical presentation of endophthalmitis. The other presented with a very severe bilateral acute retinal necrosis like syndrome. General work-up revealed disseminated disease in both cases. The diagnosis was made by serum immunologic testing in one case and after direct examination and culture from vitrectomy in the other. Despite intense antimycotic therapy, both patients died. The third patient presented with a unilateral progressive painful orbital apex syndrome. An orbital lesion was demonstrated by computed tomography scan and was unresponsive to methylprednisolone. Diagnosis of sino-orbital syndrome was made on biopsy. The lesion responded poorly to different antimycotic therapies, invaded the chiasma, and the patient lost all visual acuity.

Conclusions

This case series illustrates that ophthalmic aspergillosis can present acutely with a devastating intraocular inflammation or more indolently in the setting of sino-orbital aspergillosis. Both forms have a poor visual prognosis and the systemic form is frequently associated with a fatal outcome.
Spectral Domain OCT Documented Resolution of Recalcitrant Macular Edema after Intravitreal Bevacizumab in Branch Retinal Vein Occlusion
Authors: Chalam K.V. , Keshavamurthy R. , Brar V.S.
Published: January 2018

Purpose

Cystoid macular edema is one of the important causes of visual loss in branch retinal vein occlusion. Proximity of the cyst to the external limiting membrane and disruption of the layer on time domain optical coherence tomography is associated with poor final visual outcomes. The authors describe pre- and post-intravitreal bevacizumab spectral domain optical coherence tomography features in a case of cystoid macular edema associated with branch retinal vein occlusion that was resolved after treatment with intravitreal bevacizumab.

Methods

A 50-year-old woman was diagnosed with cystoid macular edema due to branch retinal vein occlusion and underwent intravitreal injection with bevacizumab after the primary treatment with laser photocoagulation failed.

Results

The patient's visual acuity recovered from 20/40 to 20/20. Spectral domain optical coherence tomography documented complete resolution of a large foveal cyst (150 μm by 280 μm) and recovery of the discontinuity of the external limiting membrane 1 week after treatment.

Conclusions

Spectral domain optical coherence tomography is a useful tool in identifying the ultrastructural changes associated with cystoid macular edema associated with branch retinal vein occlusion and identifying the possible factors involved in prognosticating visual outcome after effective treatment.
Conjunctival Displacement to the Corneal Side for Oblique-Parallel Insertion in 25-Gauge Vitrectomy
Authors: Shimada H. , Nakashizuka H. , Hattori T. , Mori R. , Mizutani Y. , Yuzawa M.
Published: January 2018

Purpose

To assess the usefulness of the method of oblique-parallel trocar insertion with conjunctival displacement to the corneal side in 25-gauge (G) transconjunctival vitrectomy.

Methods

25-G vitrectomy was performed in 77 consecutive eyes. Before making oblique-parallel trocar insertions, the conjunctiva was conventionally displaced superiorly in 35 eyes, but was displaced toward the corneal side in 42 eyes. After surgery, the distance between the scleral and conjunctival wounds was measured with calipers. The frequency of scleral wound exposure was assessed.

Results

After cannula removal at the end of surgery, inferior repositioning of the superiorly displaced conjunctiva was observed, while marked posterior repositioning of the corneal side caused displacement of the conjunctiva due to gravity. The superior displacement distances between the sclera and conjunctival wounds were 2.4±0.3 mm at the infusion port, 2.0±0.4 mm at the superior temporal port, and 1.9±0.4 mm at the superior nasal port, while the corresponding distances for corneal side displacement were 3.6±0.5, 3.5±0.5, and 2.5±0.5 mm, and were all significantly (p<0.0001) greater with corneal side displacement. The frequency of scleral wound exposure due to conjunctival damage around the cannula (infusion port) was significantly (p=0.0164) lower for corneal side displacement (0/42; 16.7%) than superior displacement (5/35; 14.3%). There was no postoperative endophthalmitis in all 77 patients studied.

Conclusions

In 25-G transconjunctival vitrectomy, using oblique-parallel trocar insertions with the conjunctiva displaced toward the corneal side results in marked posterior repositioning of the conjunctiva after cannula extraction. Corneal side conjunctival displacement is technically easy and completely covers the scleral wound. This method is expected to be effective in preventing endophthalmitis.
Comparison of Mersilene Mesh and Autogenous Fascia Lata in Correction of Congenital Blepharoptosis: A Randomized Clinical Trial
Authors: Salour H. , Aletaha M. , Bagheri A.
Published: January 2018

Purpose

To asses the functional results and complications of Mersilene mesh as an alternative to autogenous fascia lata in the management of low function ptosis.

Methods

In a randomized clinical trial, 31 eyelids with poor levator function were operated on. In 16 eyelids Mersilene mesh (Group A) and in 15 eyelids autogenous fascia lata were used for frontalis suspension procedure (Group B).

Results

Nine patients with congenital unilateral and 11 patients with bilateral ptosis underwent sling procedure. There were no differences between the two groups with regards to functional (lid fissure height stability) and cosmetic (lid margin contour) results. Eyelid fissure increase was 4.00±1.46 mm in Group A and 3.13±1.72 mm in Group B. Change in eyelid fissure in both groups was significant (p=0.00, paired t-test), but intergroup difference was not significant (p=0.141, independent sample t-test). Follow-up for Group A was 14.2 (range 6–26) months and for Group B was 15.1 (range 9–29) months. Dermatochalasis was seen more in Group B (B/A = 10/2) and extrusion of Mersilene mesh was seen in two cases of Group A and none of Group B. Early complications such as corneal epithelial defects and entropion and late complications such as undercorrection were comparable in the two groups.

Conclusions

Mersilene mesh with long-term functional results and low rate of complications is a suitable alternative to autogenous fascia lata as a suspensory material in ptosis surgery.
The Ultima© Foldable Scleral Fixation Intraocular Lens: A 2-year Follow-Up
Authors: Migliorati G. , Brusini P.
Published: January 2018

Purpose

To describe a new scleral fixation foldable intraocular lens (IOL): the Ultima©.

Methods

The novel IOL is a new scleral fixation acrylic hydrophilic foldable lens that offers a 360° sulcus support due to its round geometry. It can be folded and inserted through a 4 mm clear cornea incision. Twenty-five eyes implanted with the Ultima© lens were followed for 2 years.

Results

Twenty-two eyes showed visual improvement, two eyes had no functional improvement, and one eye had visual deterioration. The IOL remained well centered and showed no signs of tilting in all patients during the entire follow-up.

Conclusions

The main advantages of the Ultima© IOL include the lack of tilting and the minimum postoperative astigmatism. It also allows a clear retinal examination and provides an excellent barrier for silicone oil between vitreous cavity and anterior chamber.
Influence of IOP Measurement through the Wrong Eyepiece of the Slit Lamp on Goldmann Applanation Tonometry
Authors: Kubota T. , Nagata T. , Tawara A. , Okada H. , Ishibashi S. , Yamashita M. , Harada Y. , Yanase M.
Published: January 2018

Purpose

This study examined whether intraocular pressure (IOP) measurements through the wrong eyepiece of the slit lamp may be a source of error.

Methods

Seven skilled observers measured the IOP from seven healthy subjects. The observers used a Haag-Streit Goldmann applanation tonometer with two types of slit lamps (Haag-Streit and Rodenstock). In the Haag-Streit slit lamp the prism of the tonometer is aligned with the right part of the slit lamp optics. Conversely in the Rodenstock slit lamp, the prism is aligned with the left. Each observer measured the IOP of each subject through the right eyepiece, through the left eyepiece, and under binocular vision.

Results

The IOP measured with the left eyepiece of the Haag-Streit slit lamp was significantly higher than that measured with the right eyepiece and binocular vision. The IOP measured with the right eyepiece of the Rodenstock slit lamp was significantly higher than that measured with the left eyepiece and binocular vision.

Conclusions

IOP measurement through the wrong eyepiece of the slit lamp may be a source of error.
Intravitreal Bevacizumab versus Combined Bevacizumab-Triamcinolone versus Macular Laser Photocoagulation in Diabetic Macular Edema
Authors: Faghihi H. , Roohipoor R. , Mohammadi S.-F. , Hojat-Jalali K. , Mirshahi A. , Lashay A. , Piri N. , Faghihi Sh.
Published: January 2018

Purpose

To evaluate the additive effect of triamcinolone to bevacizumab in comparison to standard macular laser photocoagulation versus bevacizumab in the management of diabetic macular edema (DME).

Methods

In a prospective, randomized clinical trial, 130 eyes of 110 patients with type 2 diabetes with DME were included. Eligible eyes were randomly assigned to 1.25 mg intravitreal bevacizumab (42 eyes) (IVB group) or combination of 1.25 mg bevacizumab and 2 mg triamcinolone acetonide (41 eyes) (IVB+IVT group) or macular laser photocoagulation (47 eyes) (MPC). Central macular thickness (CMT) and visual acuity changes at week 6 and 16 were assessed.

Results

The mean age of the patients was 57 ±7 years. Patients were followed 16 weeks. At week 6, all the three groups showed significant reduction in CMT but the reductions for IVB and IVB+IVT were significantly more than MPC (p<0.001). At week 16, the response was not stable for IVB (p<0.001), but IVB+IVT maintained its superior status to MPC (p<0.001). At week 16, visual acuities were essentially unchanged for the two groups of MPC and IVB and improvement for IVB+IVT was marginal and at most was 0.1 log MAR. No patient developed uveitis, endophthalmitis, or thromboembolic event.

Conclusions

Single intravitreal bevacizumab or triamcinolone plus bevacizumab injection brought about significantly greater macular thickness reduction in diabetic patients in comparison to standard laser treatment. However, the response for bevacizumab alone was short-lived. Reduction in macular thickness was only marginally associated with visual acuity improvement in the triamcinolone plus bevacizumab injection group.
Frequency, Characteristics, and Risk Factors of Late Recurrence of Retinal Detachment
Authors: Zhioua R. , Ammous I. , Errais K. , Zbiba W. , Ben Younes N. , Lahdhiri I. , Meddeb Ouertani A.
Published: January 2018

Purpose

To evaluate the frequency, characteristics, causes, and risk factors of late recurrent retinal detachments (LRRD).

Methods

The authors retrospectively analyzed 445 eyes operated consecutively for rhegmatogenous retinal detachment between 1990 and 2003 by the same surgeon. Only eyes with complete reattachment after a minimum follow-up of 6 months were included. The authors defined LRRD as detachment occurring at least 6 months after a complete retinal reattachment.

Results

Nine eyes had a LRRD (2.02%). Mean age was 52.55 years. Six eyes had scleral buckle procedure and three eyes had vitrectomy silicone oil injection then silicone oil removal. LRRD occurred after an average period of 54 months. During follow-up two patients had a removal of extrusion of scleral buckling material. New or reopened breaks were associated with LRRD in all eyes. Endo-ocular surgery was carried out in seven eyes. The retinal reattachment was achieved in the seven eyes. Final visual acuity ranged from 20/400 to 20/60 after an average follow-up of 37.8 months. Relation between aphakic eyes (and more generally nonphakic eyes) and LRRD was close to significant value (p=0.05). LRRD was statistically independent (p>0.05) of myopia, preoperative pseudophakia, vitrectomy for initial detachment, scleral buckle removal, and cataract surgery after reattachment.

Conclusions

LRRD were rare. Most of them were due to a retinal break. This break can be a new break, or reopened break especially after removal of scleral buckle material. Vitreous traction, at the vitreous base, seemed to be the cause of these breaks.
Evolution of Idiopathic Epiretinal Membrane Studied by Optical Coherence Tomography
Authors: Theodossiadis P.G. , Grigoropoulos V.G. , Kyriaki T. , Emfietzoglou J. , Vergados J. , Nikolaidis P. , Theodossiadis G.P.
Published: January 2018

Purpose

To study the evolution of idiopathic epiretinal membrane (IERM) as examined by optical coherence tomography (OCT) in the 1-mm-diameter circle centered on the fovea.

Methods

In a case series study 71 subjects (71 eyes) with idiopathic epiretinal membrane and macular thickness greater than 220±10 μm were evaluated by OCT. The fellow healthy eye of 52 patients was used as the control group. The mean follow-up was 36 months. Measurements of macular thickness at baseline and at the final examination were performed. Best-corrected visual acuity was expressed as the number of letters read on the Early Treatment Diabetic Retinopathy Study chart.

Results

Within the inner macular central circle of 1 mm diameter the thickness of the fovea increased by an average of 12.29% (p<0.001) during follow-up in the study group while in the control group the foveal thickness decreased by −0.44% (p=0.43). The mean increase of the fovea thickness was accompanied by a modest decrease of best-corrected visual acuity from a mean 43.26 letters at baseline to a mean 39.20 letters at the last examination (p<0.001).

Conclusions

In the study group the macular thickness increased during a mean follow-up period of 36 months. The average increase between the baseline and the final examination at the inner central circle of 1 mm diameter was 12.29%. Decrease of the macular thickness was not observed in any of the studied cases. The mean decrease of visual acuity was 9.4%. OCT also depicted with accuracy the changing morphology of the affected macula during the study period.
Sutureless Amniotic Membrane Fixation with Fibrin Glue in Symptomatic Bullous Keratopathy with Poor Visual Potential
Authors: Chawla B. , Tandon R.
Published: January 2018

Purpose

To report a sutureless method of amniotic membrane fixation using fibrin glue in two cases of symptomatic bullous keratopathy with poor visual potential.

Methods

Under topical anesthesia, the loose epithelium was debrided up to 1.0 mm from the limbus and fibrin glue was applied uniformly and thinly onto the corneal surface. Cryopreserved amniotic membrane was evenly placed over the cornea and once a firm and uniform adhesion was achieved, excess membrane was trimmed off. A bandage contact lens was applied.

Results

In both the cases, complete relief from symptoms was obtained and 3 weeks later, the ocular surface had completely re-epithelialized. At 6 months follow-up, both patients were symptom free without the need for any medication. No complications were observed.

Conclusions

This technique of amniotic membrane fixation is a simple, effective, and safe procedure whereby a stable and secure adherence of the amniotic membrane with the corneal surface is achieved avoiding the use of sutures.
Pseudophakic Macular Edema and Oral Acetazolamide: An Optical Coherence Tomography Measurable, Dose-Related Response
Authors: Ismail R.A. , Sallam A. , Zambarakji H.J.
Published: January 2018

Purpose

Although uncommon after phacoemulsification surgery, cystoid macular edema (CME) is an important cause of postoperative reduction of vision after cataract surgery. To demonstrate an optical coherence tomography (OCT) measurable, dose-related response to orally administered acetazolamide in a patient presenting with pseudophakic CME.

Methods

A 76-year-old woman with reduced vision in right eye due to cataract had uneventful phacoemulsification. Surgery was complicated by early onset endophthalmitis that was treated with intravitreal antibiotics with good visual recovery. At 6 months follow-up, she presented with further reduction of vision (0.5 LogMAR) due to CME and a central foveal thickness (CFT) of 587 μm.

Results

Acetazolamide treatment was started in combination with topical ketorolac. At a daily dose of 500 mg, CFT and visual acuity were 262 μm and 0.34 LogMAR, respectively. Dose reduction of acetazolamide to 250 mg/day was associated with worsening of the CFT to 335 μm. CFT was subsequently measured at 230 μm on increasing the acetazolamide dose to 500 mg/day and measured 353 μm when acetazolamide dose was halved. CFT was 478 μm when acetazolamide was ceased.

Conclusions

In this report, the authors have shown a dose-related response of pseudophakic CME to oral acetazolamide. This would suggest that the clinical response to oral acetazolamide may be titrated to the extent of CME and monitored by OCT.
Development of Full-Thickness Macular Hole despite Previous Posterior Vitreous Detachment and Vitrectomy for Retinal Detachment: Two Cases
Authors: Sheth H.G. , Bainbridge J.
Published: January 2018

Purpose

To report the delayed development of idiopathic full-thickness macular hole in eyes with previously documented complete posterior vitreous detachment that were vitrectomized during surgery for rhegmatogenous retinal detachment.

Methods

Two interventional case reports with serial color fundus photographs and optical coherence tomography scans.

Results

Case 1: A 62-year-old man underwent vitrectomy cryoretinopexy and intraocular gas tamponade for rhegmatogenous retinal detachment associated with a complete posterior vitreous detachment. Three years later, he developed a full-thickness macular hole in the same eye. Peeling of the inner limiting membrane and gas tamponade resulted in complete closure of the macular hole with improvement in visual acuity. Case 2: A 70-year-old man presented with a macula-off inferior retinal detachment and counting fingers vision. Vitrectomy cryoretinopexy to a single tear, and gas tamponade was successful and acuity improved to 6/9. He subsequently developed retinal redetachment associated with a new retinal tear and was treated by further vitrectomy and gas. He developed a full-thickness macular hole in the same eye 2 years later with acuity dropping to 1/60.

Conclusions

Macular hole formation may occur in the context of vitrectomized eyes. These observations support the hypothesis that anteroposterior vitreomacular traction, while traditionally implicated, is not always essential for the development of macular holes.
Triamcinolone-Assisted Vitreous Imaging Using B-Scan Ultrasonography
Authors: Mourtzoukos S. , Mangouritsas G. , Feretis E.
Published: January 2018

Purpose

To evaluate the echographic vitreoretinal patterns before and after intravitreal injection of triamcinolone (IVTA) in eyes with opaque media and several pathologies.

Methods

One eye with pseudophakic cystoid macular edema and two eyes with postoperative endophthalmitis and opaque media were examined using B-scan ultrasonography before and after 0.1 mL ITVA (4 mg Kenacort). The obtained images were compared and the two eyes with endophthalmitis underwent pars plana vitrectomy (PPV) the same day. The relationship between intraoperative and echographic findings was evaluated.

Results

Vitreous was relatively anechoic in all three cases before ITVA. Postinjection examination improved visualization of vitreous and posterior hyaloid face (PHF) and revealed vitreoretinal adhesions. The echographic findings confirmed intraoperatively in the two vitrectomized eyes.

Conclusions

Triamcinolone-assisted ultrasonography enhances imaging of the PHF. This method might be useful in cases with opaque media regarding PPV planning and prognosis. It is suggested to be applied in selected cases taking into account the beneficial diagnosis information versus the risks to IVTA application.
Phakic Iris-Claw IOL Implantation, with Bursa Technique, through a Self-Sealing Scleral Tunnel and without Iridotomy or Iridectomy
Authors: Ozcetin H. , Baykara M. , Ozmen A.T. , Yalcinbayir O.
Published: January 2018

Purpose

To present a novel technique for the implantation of phakic iris-claw intraocular lenses (IOL) in highly myopic cases.

Methods

Twelve cases, under the age of 40, with high myopia were included in this retrospective study. The mean follow-up span was 14.4±5.8 months. Phakic iris-claw IOL implantation was performed, through a 5.5 or 6.5 mm self sealing scleral tunnel with Bursa technique. No suturing and opening a peripheral iridectomy or iridotomy was required in our study. Pre- and postoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best-corrected visual acuity (BCVA), induced astigmatism, and intraocular pressure (IOP) assessments.

Results

All eyes gained one to nine lines of BCVA of the Snellen chart. The vector analysis revealed an induced astigmatism of 0.63 D. No significant IOP change was detected throughout the follow-up.

Conclusions

The data suggest that nonfoldable iris fixated phakic IOL implantation, through a self-sealing incision with Bursa technique, is safe and requires no iridectomy or iridotomy in cases with deep anterior chambers.