bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of 0.5% Levobupivacaine, 0.5% Bupivacaine, and 2% Lidocaine for Retrobulbar Anesthesia in Vitreoretinal Surgery
Authors: Aksu Recep , Bicer Cihangir , Ozkiris Abdullah , Akin Aynur , Bayram Adnan , Boyaci Adem
Published: January 2018

Purpose

The authors compared the efficacy of local anesthetics levobupivacaine, bupivacaine, and lidocaine for retrobulbar anesthesia in vitreoretinal surgery.

Methods

A total of 135 patients presenting for vitreoretinal surgery under local anesthesia were included in the study. Patients were randomly allocated to one of three groups. Group LB patients received 5 mL of 0.5% levobupivacaine, Group L patients received 5 mL of 2% lidocaine, and Group B patients received 5 mL of 0.5% bupivacaine for retrobulbar anesthesia via inferotemporal injection. Sensory and motor block durations were recorded. Intraoperative and postoperative pain was assessed by using verbal pain scala. Anesthesia efficiency, patient and surgeon satisfaction, and akinesia were assessed by using point scales. Hemodynamic data and adverse events were recorded.

Results

The demographic characteristics of patients, duration of surgery, and hemodynamic data in both groups were similar. The duration of motor and sensory block was longer in levobupivacaine and bupivacaine groups than lidocaine group. Pain on injection was found more frequent in Group L and Group B than Group LB and the difference between the Groups LB and B was significant (p<0.05). Surgeon and patient satisfaction were also higher and intraoperative pain was less in levobupivacaine group than lidocaine and bupivacaine groups.

Conclusions

Levobupivacaine provides longer motor and sensory block duration and higher surgeon and patient satisfaction than lidocaine and bupivacaine when used for retrobulbar anesthesia in vitreoretinal surgery.
Two Cases of Inverse Bell's Phenomenon following Levator Resection: A Contemplation of the Mechanism
Authors: Na Kyung-Sun , Yang Suk-Woo
Published: January 2018

Purpose

The authors observed the unusual complication of inverse Bell's phenomenon of two cases following repeated and extensive levator resection surgery for a blepharoptosis and suggest the possible mechanism of the phenomenon.

Methods

Case report.

Results

The first case was a 22-year-old woman who was diagnosed with a congenital ptosis with good levator function and she underwent levator resection and several reoperations because of asymmetry of lid height. Inverse Bell's phenomenon and resultant exposure keratitis were found in both eyes following the final surgery and they resolved in 1 month. The second case was a 19-year-old man with a right residual congenital ptosis. After a maximal levator resection was performed, he had a satisfactory lid height. Inverse Bell's phenomenon of right eye developed and reverted to normal after 2 weeks. The injury of oculomotor nerves in superior rectus during the repeated and excessive operation would alter a trigemino-oculomotor projection but it is unlikely because the phenomenon resolved without any treatment. Severe edema and hyperemia of the superior fornix following the operation may aggravate the relationship between eyelid and superior rectus movements.

Conclusions

The simultaneous resolution of eyelid edema and inverse Bell's phenomenon supports our hypothesis that the latter may be determined by the edema of the soft tissue secondary to the surgical manipulations rather than the aberrant connections of the nervous system. When the inverse Bell's phenomenon develops postoperatively, copious use of lubricant and close follow-up of corneal complication is required until it resolves.
Escherichia Coli Keratitis Treated with Ultraviolet A/Riboflavin Corneal Cross-Linking: A Case Report
Authors: Ferrari Tommaso Micelli , Leozappa Marco , Lorusso Massimo , Epifani Enrico , Ferrari Luisa Micelli
Published: January 2018

Purpose

To describe a case of keratitis caused by the Gram-negative Escherichia coli, treated with UVA-riboflavin cross linking.

Methods

Case report.

Results

A 78-year-old woman with diabetes presented with a 1-week history of pain, photophobia, foreign body sensation, and lacrimation in the right eye. The patient underwent topical and systemic antimicrobial therapy, without improvement. The authors treated the patient with riboflavin and corneal UVA crosslinking, with the aim to promote healing of the ulceration. One day after the procedure, the corneal ulceration was covered by cicatricial tissue, and the patient reported a significant improvement in symptoms. One month after the treatment, corneal edema was almost completely resolved, corneal ulceration was healed, and the painful symptoms of the patient had disappeared.

Conclusions

UVA-riboflavin crosslinking can be useful for the treatment of corneal ulceration unresponsive to medical treatment.
Flap Amputation with Phototherapeutic Keratectomy (PTK) and Adjuvant Mitomycin C for Severe Post-Lasik Epithelial Ingrowth
Authors: Kymionis George D. , Ide Takeshi , Yoo Sonia H.
Published: January 2018

Purpose

To report a patient with severe post–laser in situ keratomileusis (LASIK) epithelial ingrowth and keratolysis treated with flap amputation and phototherapeutic keratectomy (PTK) with adjuvant intraoperative mitomycin C (MMC).

Methods

Case report.

Results

A 55-year-old woman was referred to our department due to severe post-LASIK epithelial ingrowth with corneal melting 2 years after primary LASIK. The patient had had two previous attempts for epithelial ingrowth treatment (flap lift and epithelial ingrowth manual removal) that were unsuccessful. Slit lamp biomicroscopy and anterior segment optical coherence tomography showed extensive epithelial ingrowth and keratolysis (thinning of the LASIK flap) while the patient had photophobia and could not tolerate contact lenses. Flap amputation with subsequent PTK (in order to smooth out the corneal irregularities caused by the keratolysis and/or variations in flap thickness) and adjuvant intraoperative MMC application for 2 minutes was performed. There were no intra- or postoperative adverse events seen during the follow-up period. Six months after the procedure, uncorrected visual acuity improved to 20/40 compared with 20/50 preoperatively, while best spectacle-corrected visual acuity improved from 20/40 to 20/32. The topographic astigmatism was decreased from 3.24 diopters (D) to 1.00 D.

Conclusions

Flap amputation with PTK and adjuvant intraoperative MMC is an option for the management of severe post-LASIK epithelial ingrowth with keratolysis.
Argon-Laser Iridoplasty in the Management of Uveitis-Induced Acute Angle-Closure Glaucoma
Authors: Mansouri Kaweh , Ravinet Emilie
Published: January 2018

Purpose

To report the use of argon laser iridoplasty in the management of uveitic acute angle-closure glaucoma.

Methods

Interventional case report.

Results

A 46-year-old man developed uveitic acute angle-closure glaucoma with an intraocular pressure (IOP) of 65 mmHg. After unsuccessful attempts with medical treatment and two laser peripheral iridotomies, iridoplasty allowed to break posterior synechiae, open the angle, and reduce the IOP within a few hours.

Conclusions

Argon laser iridoplasty allowed rapid reduction of IOP and prevented the need for emergency surgery. Therefore, the authors stipulate that it is a viable management option in active uveitic acute angle-closure glaucoma.
Bartonellosis Causing Bilateral Leber Neuroretinitis: A Case Report
Authors: Hernández-Da Mota Sergio E. , Escalante-Razo Felipe A.
Published: January 2018

Purpose

Bartonella henselae is the causal agent of cat scratch disease and one variation in its presentation is Leber neuroretinitis. The unilateral presence of exudation as a macular star and papilledema represent its most common presentation.

Methods

Observational case report. A 7-year-old girl presented a sudden decrease of visual acuity and bilateral macular exudation (macular star) as well as choroiditis.

Results

A complete recovery of visual acuity was seen after a 6-week follow-up. Erythromycin plus deflazacort treatment was given.

Conclusions

The present case represents an unusual variety of cat scratch disease. This represents a challenge in the differential diagnosis of diseases such as Lyme disease and tuberculosis among others.
Effect of Chalazion Excision on Refractive Error and Corneal Topography
Authors: Bagheri Abbas , Hasani Hamid R. , Karimian Farid , Abrishami Mohammad , Yazdani Shahin
Published: January 2018

Purpose

To evaluate refractive and corneal topographic changes following excision of chalazia.

Methods

This prospective noncomparative quasi-experimental clinical trial includes consecutive patients older than 7 years with chalazia of minimum duration of 1 month who underwent excision of the lesions by an internal or external approach.

Results

Overall, 253 lids from 228 eyes of 195 patients including 110 female subjects with mean age of 31±14 years (range 7–71) were studied. Mean duration of presenting symptoms was 4±2.8 months (range 1–24). Lesions were equally distributed in medial, central, and lateral areas of the eyelids. The chalazia were single in 172 (88.2%) and multiple in 23 (11.8%) patients. Mean change in best-corrected visual acuity, spherical equivalent refractive error, and difference of keratometry (corneal astigmatism) were 0.0004±0.007 logMAR (p=0.3), −0.06±0.6 D (p=0.1), and 0.34±0.35 (p<0.0001) after surgery, respectively. Corneal topographic analysis revealed significant changes in surface regularity index (0.13), surface asymmetry index (0.09), and potential visual acuity (0.06±0.1 logMAR) after the procedure (p<0.0001 for all comparisons). Single, central, and firm chalazia were compared with multiple, peripheral, and soft lesions; change in difference of keratometry and spherical equivalent were 0.75±0.42 D versus 0.22±0.15 D (p=0.001) and −0.35±0.19 versus −0.11±0.30 D (p=0.1), respectively, implying more induced astigmatism with the former type of lesions.

Conclusions

Chalazion excision can decrease corneal astigmatism and irregularity, which is more prominent in single, firm, and central upper lid lesions. These findings may have implications in pediatric patients at risk for amblyopia.
Extraocular Muscle Fixation to Porous Polyethylene Orbital Implants Using 2-Octyl-Cyanoacrylate
Authors: Ferraz Lucieni Cristina Barbarini , Schellini Silvana A. , Wludarski Sheila L. , Padovani Carlos R. , Selva Dinesh , Mueller Sergio
Published: January 2018

Purpose

To evaluate the efficacy of bioadhesive in attaching the extraocular muscles to porous polyethylene spheres in rabbit enucleated cavities.

Methods

A prospective, experimental study was performed. Eight adult New Zealand white rabbits underwent right enucleation with insertion of an unwrapped 12 mm porous polyethylene sphere. The superior and inferior rectus muscles were attached to the implant with 2-octyl cyanoacrylate placed to the underside of the muscles and application of pressure for 5 seconds. Ninety days after surgery, the orbits were exenterated and four animals underwent histologic evaluation and the other four animals tensile strength testing of the muscle-sphere attachment.

Results

There were no exposures or infections of the implants and the muscles remained attached in all cases. Histologic examination showed fibrous tissue reaction at the muscle-sphere attachment with minimal inflammation of the surrounding tissues; a pseudocapsule formation around the spheres and full vascularization of the implant was also observed. There was no evidence of residual glue on histologic examination. Tensile strength testing showed that rupture force was similar between bonded muscle and the porous polyethylene sphere.

Conclusions

The 2-octyl-cyanoacrylate did not cause deleterious effects in orbital tissues and provided strong adhesion between muscles and spheres. Bioadhesive may be an option for attaching the extraocular muscles to orbital implants in anophthalmic cavity reconstruction.
Topographically Guided Two-Step LASIK and Standard LASIK in the Correction of Refractive Errors after Penetrating Keratoplasty
Authors: Spadea Leopoldo , Saviano Massimo , Di Gregorio Angela , Di Lodovico Domenico , De Sanctis Fabio
Published: January 2018

Purpose

To evaluate in a long-term period the effectiveness and safety of topographically guided two-step laser in situ keratomileusis (LASIK) and standard LASIK technique in the correction of refractive errors after successful penetrating keratoplasty (PKP) for keratoconus.

Methods

At least 2 years after PKP and 6 months after removal of all sutures, 15 eyes of 15 patients (Group 1; mean manifest refraction spherical equivalent (MRSE) −7.23 D ± 3.42 SD) were submitted to standard LASIK and 15 eyes of 15 patients (Group 2; mean MRSE −4.37 D ± 1.97 SD) to a topographically guided two-step LASIK procedure (first the flap and at least 2 weeks later the laser ablation). In all cases, a superior hinged corneal flap (160 μm/9.5 mm) was created.

Results

After a follow-up of 36 months, in Group 1 the mean uncorrected visual acuity (UCVA) was 0.51 logarithm of the minimum angle of resolution (logMAR) ± 0.41 SD and the mean best-corrected visual acuity (BCVA) was 0.03 logMAR ± 0.05 SD, with a mean MRSE of −1.57 D ± 2.65 SD. In Group 2, the mean UCVA was 0.28 logMAR ± 0.24 SD and the mean BCVA was 0.01 logMAR ± 0.03 SD, with a mean MRSE of −0.07 D ± 1.00 SD. In both groups, no complications were observed.

Conclusions

After a long follow-up period, both topographically guided two-step LASIK and standard LASIK could be considered effective and safe tools in the correction of refractive errors after successful PKP for keratoconus.
A 12-week Study Evaluating the Efficacy of Bimatoprost 0.03% in Patients with Pseudoexfoliative and Open-Angle Glaucoma
Authors: Ciancaglini Marco , Carpineto Paolo , Agnifili Luca , Nubile Mario , Toto Lisa , Mastropasqua Leonardo
Published: January 2018

Purpose

To evaluate the control of diurnal intraocular pressure (IOP) and the safety profile of bimatoprost in pseudoexfoliative glaucoma (PXG) compared to primary open angle glaucoma (POAG).

Methods

A prospective, observer-masked, nonrandomized study was performed. Seventy consecutive patients with either POAG (35 eyes) or PXG (35 eyes) drug-naive for glaucoma were assigned to receive bimatoprost 0.03% once daily for 12 weeks. Diurnal IOP was measured at baseline and after 12 weeks at three time points (8 AM, noon, and 4 PM). Main outcomes were diurnal IOP control and achievement of target IOP (CIGTS criteria). Mean diurnal IOP, hour-by-hour IOP measurements, and safety, including serious adverse events, were also evaluated.

Results

A significant IOP reduction from baseline was found in both groups (p<0.001). Mean and hour-by-hour IOP differences between groups were not statistically significant (NS). The observed IOP values and percentages of IOP reduction were 17.0 mmHg (31.5%) and 16.4 mmHg (31.9%) in PXG and POAG eyes, respectively; the differences were not statistically significant. Six eyes (1 POAG and 5 PXG, respectively) responded with a <20% IOP reduction (NS). Twenty-seven POAG (77.1%) and 23 PXG (65.7%) eyes achieved target IOP. Consequently, 20 eyes (8 POAG and 12 PXG, respectively) were classified as unable to achieve the IOP target values (NS).

Conclusions

Bimatoprost was effective and safe in lowering IOP both in open angle and pseudoexfoliative glaucoma, achieving target pressure in most patients. However, long-term efficacy in PXG must be evaluated.
Ultrasound Biomicroscopy in Nonperforating Filtering Surgery with Intraoperative 5-fluorouracil and no implant: Long-term Results
Authors: Gutiérrez-Ortiz Consuelo , Vleming Eduardo , Pareja Jesus , Teus Miguel A.
Published: January 2018

Purpose

To evaluate the long-term morphologic changes in the anterior segment structures after nonpenetrating filtering surgery (NPFS) supplemented with 5-fluorouracil (5-FU) and no scleral implant using ultrasound biomicroscopy (UBM).

Methods

Thirteen eyes of 13 consecutive patients who underwent NPFS with intraoperative 5-FU under the conjunctiva and the scleral flap and no implant were evaluated in an observational nonrandomized, consecutive case series study conducted 2 years postoperatively. Patients were assessed for the presence of a subconjunctival filtering bleb, the volume of an intrascleral cavity, and a suprachoroidal hypoechoic area. The intraocular pressure (IOP) was measured preoperatively and postoperatively at the time of UBM.

Results

The IOP decreased significantly (p=0.01) from 24±7.6 mmHg to 13.7±4.1 mmHg. In most patients (69.2%), the postoperative IOP decreased at least 30% from the preoperative value without medications and in 84.6% with medication. UBM showed a subconjunctival empty space in 92.3% of eyes. In 84.6% of patients, an intrascleral cavity was seen, the mean volume of which was 1.68 mm3 (range, 0–4.07). We found a negative correlation between the height, width, and volume of the intrascleral lake and the IOP. In 92.3% of eyes, a hypoechoic area in the suprachoroidal space also was seen.

Conclusions

UBM showed a filtering intrascleral cavity, subconjunctival filtering bleb, and a suprachoroidal space after NPFS supplemented with 5-FU under the conjunctiva and the scleral flap without an implant.
Can an Intraoperative Bevacizumab Injection Prevent Recurrent Postvitrectomy Diabetic Vitreous Hemorrhage?
Authors: Romano Mario R. , Gibran Syed Khurshid , Marticorena Joaquin , Wong David , Heimann Henrich
Published: January 2018

Purpose

To evaluate the recurrence of vitreous hemorrhage (VH) in patients treated with intravitreal bevacizumab (IVB) injection (2.5 mg/0.1 mL) intraoperatively at the end of vitrectomy for treatment of diabetic nonclearing VH.

Methods

A prospective pilot study of 30 eyes of 28 consecutive diabetic patients who underwent pars plana vitrectomy and IVB injection intraoperatively at the end of vitrectomy was performed. The amount of VH was graded with slit lamp biomicroscopy by three masked retinal specialists from grade 0 to grade 3. Main outcome measures were rate of recurrence of the VH, improvement in visual acuity, incidence of cataract formation, and postoperative complications through a follow-up of 6 months.

Results

The percentage of severe recurrent VH with no fundus details (grade 3) was 7%, 13%, 27%, and 30%, respectively, at 7 days and 1-, 3-, and 6-month follow-up. At 6-month follow-up, the best-corrected visual acuity improved from 1.00 to 0.4 logMAR (p=0.01) in 21 out of 30 eyes (70%). Nine out 20 (40%) phakic patients developed cataract during the follow-up period, and 7 (31%) of them underwent cataract surgery.

Conclusions

The study suggests that intravitreal bevacizumab injection cannot prevent rebleeding in eyes undergoing pars plana vitrectomy for treatment of diabetic vitreous hemorrhage.
Intravitreal Bevacizumab in Refractory Uveitic Macular Edema: One-year Follow-up
Authors: Cervantes-Castañeda Rene A. , Giuliari Gian Paolo , Gallagher Michael J. , Yilmaz Taygan , Macdonell Rebecca E. , Quinones Karina , Foster Charles S.
Published: January 2018

Purpose

Uveitis is a major cause of ocular morbidity in developed countries. It has been demonstrated that macular edema is a significant cause of decreased visual acuity and macular edema in these patients. In this article, we evaluate the long-term outcome of intravitreal bevacizumab in the treatment of refractory uveitic macular edema.

Methods

In this retrospective, noncomparative, interventional case series, uveitic patients with macular edema who were refractory to conventional therapy and who were treated with intravitreal bevacizumab were identified and assessed. Best-corrected visual acuity and optical coherence tomography central macular thickness measurements were collected and analyzed with correlative statistical analysis, including the use of Student paired t-test, Kaplan-Meier, and linear regression analysis.

Results

Twenty-nine eyes of 27 patients with diverse uveitic etiologies were analyzed and followed up at 1 year. Thirteen patients received a single intravitreal bevacizumab injection. Six patients required a second intravitreal bevacizumab injection, while 10 patients received combination therapy of intravitreal bevacizumab and triamcinolone acetonide. Baseline mean logMAR visual acuity was −0.59. At 1 year, the mean logMAR visual acuity was −0.42± 0.36 (p=0.0045). Baseline mean central macular thickness was 383.66 μm. At 1 year, the mean thickness was 294.32±110.87 (p=0.0007).

Conclusions

Intravitreal bevacizumab is a useful and therapeutically beneficial agent in the treatment of refractory uveitic macular edema. Some patients will require adjunctive intravitreal bevacizumab injections or the use of combination therapy with intravitreal triamcinolone acetonide.
Long-term Choroidal Vascular Changes after Iodine Brachytherapy versus Transpupillary Thermotherapy for Choroidal Melanoma
Authors: Pilotto Elisabetta , Vujosevic Stela , De Belvis Valentina , Parrozzani Raffaele , Boccassini Barbara , Midena Edoardo
Published: January 2018

Purpose

To compare long-term choroidal vascular changes after iodine-125 brachytherapy (IBT) versus transpupillary thermotherapy (TTT) used as primary treatment of small choroidal melanoma.

Methods

Ninety-five small choroidal melanomas were randomized: 49 eyes with TTT and 46 eyes with IBT alone. Fluorescein and indocyanine green angiography (ICGA) were performed at 3-month intervals during the first year, and every 6 months thereafter.

Results

Mean follow-up was 56.2 months (range, 24–118 months; SD, 22.6). Tumor regressed in 45 (92%) TTT-treated vs 45 (98%) IBT-treated eyes (p=0.397). Four TTT-treated and one IBT-treated tumor recurred. Occlusion of choriocapillaris was present in all TTT and IBT cases. Closure of medium and large choroidal vessels was observed in 17 (35%) TTT-treated vs 44 (96%) IBT-treated eyes (p<0.001). Choroidal vascular remodeling was detected in 20 (41%) TTT-treated and 16 (35%) IBT-treated eyes (p=0.693). Retinochoroidal anastomosis was present in 4 of the 37 (11%) TTT-treated eyes with patency of medium and large choroidal vessels, but never observed in the IBT-treated eyes, and was associated with tumor recurrence. Among IBT-treated eyes, segments of choroidal vascular wall ICG staining and choroidal aneurysmal changes were detected in 30 (65%) and 7 (15%), respectively. These changes were never detected in TTT-treated cases (p<0.0001 and p=0.015, respectively).

Conclusions

The pattern of tumor choroidal vascular changes following IBT and TTT differs. TTT is less effective in closing all tumor vasculature. The role of long-term choroidal vascular remodeling observed after these two treatments needs longer follow-up.
KIF21A variant R954W in Familial or Sporadic Cases of CFEOM1
Authors: Rudolph Guenther , Nentwich Michael , Hellebrand Heide , Pollack Katharina , Gordes Roswitha , Bau Viktoria , Kampik Anselm , Meindl Alfons
Published: January 2018

Purpose

To demonstrate the clinical characteristics and determine mutations in the KIF21A gene, encoding a kinesin motor protein in patients with congenital fibrosis of the extraocular muscles (CFEOM) type 1.

Methods

Patients of five families with congenital fibrosis syndrome and two simplex patients with CFEOM underwent ophthalmologic examination and mutation analysis in the KIF21A gene.

Results

Clinical examination and passive motility testing prior to surgery met criteria for CFEOM. All patients had congenital restrictive ophthalmoplegia primarily affecting muscles innervated by the oculomotor nerve. Complete mutation screening in the KIF21A gene revealed the presence of the known and most common recurrent variant R954W in three families and in two simplex cases. Two families demonstrated linkage to chromosome 16.

Conclusions

The patients included in the study had marked restriction of movement bilaterally with nearly complete loss of vertical ocular motility, graded reduction of horizontal motility, ptosis, and compensatory chin elevation. The phenotype was variable in patients carrying the same mutation. In one family, all patients were diagnosed with mental retardation, indicating that this syndrome might not only affect the development of cranial nerves, but can also be responsible for general neurologic dysfunction. The screening data suggest frequent and exclusive appearance of the R454W variant in sporadic and familial cases of CFEOM1 in Germany.
Expression of Alpha-Crystallins in Human Sebaceous Carcinoma of the Eyelid
Authors: Rigas Panayota K. , Kase Satoru , Rao Narsing A.
Published: January 2018

Purpose

α-Crystallins are molecular chaperones that protect various cells from apoptosis. This study used immunohistochemistry to examine the expression of αA-crystallin and αB-crystallin in human sebaceous carcinoma tissues.

Methods

Nine patients with sebaceous carcinoma of the eyelid underwent excision of the eyelid or orbital exenteration. Formalin-fixed, paraffin-embedded tissue sections were submitted for hematoxylin-eosin staining and immunohistochemistry with anti-αA- and αB-crystallin antibodies.

Results

In the noncancerous eyelid, α-crystallins were weakly and homogeneously expressed in the Meibomian gland lobules. In eyelids with sebaceous carcinoma, αA-crystallin and αB-crystallin were highly expressed in 4 cases, where the cytoplasmic immunoreactivity was heterogeneously detected in the tumor cells. Three and 2 cases were shown to express low levels of αA-crystallin and αB-crystallin, respectively. A statistically significant correlation was observed between expression levels of αA-crystallin and αB-crystallin in sebaceous carcinomas (p=0.012). All sebaceous carcinoma tissues contained mitotic tumor cells, which showed predominantly perinuclear immunoreactivity of αB-crystallin. The mitotic rate of tumor cells was 5.85±1.76 and 10.72±1.64 in high and moderate/low αB-crystallin-expressing cases, respectively. The number of mitotic cells was significantly higher in moderate/low αB-crystallin-positive than in high-positive cases (p<0.01).

Conclusions

α-Crystallins are expressed in human sebaceous carcinomas including mitotic cells. Expression of αB-crystallin correlated with low number of mitotic tumor cells, suggesting that αB-crystallin may play a potential role in the regulation of tumor cell proliferation. (Eur J Ophthalmol 2009; 19: 702–7)
Mitomycin C Aqueous Humor Concentration after Photorefractive Keratectomy: An Experimental Study
Authors: Kymionis George D. , Diakonis Vasilios F. , Panagopoulou Sophia I. , Grentzelos Michael A. , Kazakos Dimitris C. , Tzatzarakis Manolis N. , Tsatsakis Aristidis M. , Pallikaris Aristophanis I.
Published: January 2018

Purpose

To evaluate mitomycin C (MMC) aqueous humor concentration after photorefractive keratectomy (PRK).

Methods

In this experimental study, twenty-four eyes of 12 male pigmented rabbits were divided into 4 groups and studied at the Institute of Vision and Optics, Department of Medicine, University of Crete, Greece. Eyes in groups 1 and 2 underwent PRK to correct –5 diopters (D) in a 6-mm optical zone, while sponges soaked with 0.02% MMC were applied on the exposed corneal stroma for 60 and 120 seconds, respectively. Similarly, eyes in groups 3 and 4 underwent PRK to correct –10 D in a 6-mm optical zone, while sponges soaked with 0.02% MMC were applied on the exposed corneal stroma for 60 and 120 seconds, respectively. Aqueous humor was extracted from all rabbit eyes 10 minutes after MMC application and high-performance liquid chromatography was performed immediately to detect and quantify MMC levels.

Results

The mean aqueous humor concentration of MMC was 0.23±0.03 μg/mL, 0.39±0.05 μg/mL, 0.28±0.04 μg/mL, and 0.52±0.16 μg/mL in groups 1, 2, 3, and 4, respectively. The effect of application time and correction on aqueous humor MMC concentration was significant (p<0.0001 and p=0.019), while the exposure time had a greater impact on aqueous humor MMC concentration when compared with the attempted correction.

Conclusions

Both exposure time of MMC on the corneal stroma and the attempted correction was correlated with MMC aqueous humor concentrations. (Eur J Ophthalmol 2009; 19: 738–42)
Customizing the Amadeus® II Microkeratome: Evaluation of Cut Quality with Various Settings Using Electron Microscopy
Authors: Lackerbauer Carl-Arnold , Grueterich Martin , Kojetinsky Corina , Ulbig Michael , Kollias Aris
Published: January 2018

Purpose

To evaluate the cut quality of keratectomy specimens created with the new Amadeus® II microkeratome (SIS, Ziemer Ophthalmic, Port, Switzerland) using scanning electron microscopy (SEM).

Methods

Corneal cuts were performed in 24 freshly enucleated porcine eyes using the Amadeus® II microkeratome with combinations of cutting-head depth, oscillation rate, head-advance speed, and reuse of the blade. For the cutting trials, a 140-μm and 160-μm cutting head with three oscillation rates of 8,000, 10,000, and 13,000 rpm and two head-advance speed rates of 1.5 and 3.5 mm/s were chosen. In each setting, the blade was reused for a second time. All eyes were included, resulting in 4 groups with 6 eyes for each configuration. The surface and edge of the corneal cut was examined using SEM.

Results

At fixed oscillation rates, an increase in head-advance speed led to lower quality cuts, higher surface roughness, and irregular cut edges for both cutting heads (140 μm/160 μm), especially when using the blade for a second time. At fixed head-advance speeds an increase in oscillation rates improved the cut quality for both cutting heads (140 μm/160 μm). This results in smoother surface characteristics and more regular cut edges, especially when using the blade for the first time.

Conclusions

Using the Amadeus® II microkeratome for laser in situ keratomileusis procedures, the optimum oscillation rate, the optimum head-advance speed, and a single use of the blade will produce a very smooth and regular surface and cut edge for safe, comfortable, and improved customized refractive surgery. (Eur J Ophthalmol 2009; 19: 743–7)
Novel 3D Computer-Automated Threshold Amsler Grid Visual Field Testing of Scotomas in Patients with Glaucoma
Authors: Nguyen Dieuthu T. , Fahimi Ali , Fink Wolfgang , Nazemi Paul P. , Kim Janet K. , Sadun Alfredo A.
Published: January 2018

Purpose

Three-dimensional (3D) computer-automated threshold Amsler grid testing was used to identify and characterize scotomas typical of glaucoma.

Methods

The 3D test exhibits a grid on a computer screen at a preselected grayscale and angular resolution, and allows patients to trace those areas on the grid that are missing in their visual field using a touch screen. Eleven eyes in patients with an established diagnosis of glaucoma were examined according to the above protocol. A total of 23 eyes from normal subjects were used as controls. The 5-minute test required that patients repeatedly outline scotomas on a touch screen with varied displays of contrast while maintaining their gaze on a central fixation marker. A 3D depiction of the visual field defects was then obtained that was further characterized by the location, shape, extent, depth, and slope of the scotomas.

Results

In this pilot study, the 3D depiction of visual field loss demonstrated paracentral, superior and inferior altitudinal, and nasal step defects consistent with glaucomatous damage. The 3D depiction showed a shape, extent, depth, and slope that are consistent with the severity of damage.

Conclusions

The 3D test identified and characterized scotomas typical of glaucoma. The test provides several advantages over conventional perimetry including additional information through 3D depiction of scotomas with the addition of contrast sensitivity and a higher angular/spatial resolution. Improved patient compliance and reliability through shorter testing time and potential interactive accessibility and distribution over the Internet further characterize the test. (Eur J Ophthalmol 2009; 19: 776–82)
Comparison of ICare, Dynamic Contour Tonometer, and Ocular Response Analyzer with Goldmann Applanation Tonometer in Patients with Glaucoma
Authors: Vandewalle Evelien , Vandenbroeck Sofie , Stalmans Ingeborg , Zeyen Thierry
Published: January 2018

Purpose

To compare the intraocular pressure (IOP) readings taken by ICare, Pascal dynamic contour tonometer (DCT), and ocular response analyzer (ORA) with those taken by Goldmann applanation tonometer (GAT). We sought to evaluate the influence of central corneal thickness (CCT) on IOP measurements and to compare patients' preferences for the four tonometers.

Methods

In this prospective study, 93 eyes from 93 patients were examined. Patients were randomly divided into 4 groups to vary the order in which the tonometers were applied. CCT was measured with an ultrasound pachymeter.

Results

The average CCT was 558±47.4 μm. The mean ± standard deviation IOP for GAT, ICare, DCT, and ORA (Goldmann-correlated IOP) (ORAgc) were 15.1±4.8, 15.7±5.7, 18.3±5.1, and 18.3±6.6 mmHg, respectively. There was no significant difference between the mean IOP obtained with GAT and ICare (p=0.14). There was also no difference in IOP levels between the mean IOP obtained with DCT and ORA (p=0.26). There was no correlation between IOP measurements and CCT for the four instruments. Bland-Altman graphs showed disagreement between the measurements taken by GAT and the other instruments. There was no significant difference in patients' preference among the 4 instruments (p=0.48).

Conclusions

IOP readings from ICare were consistent with those from GAT, whereas DCT readings correspond well to ORAgc measurements. DCT and ORA readings both overestimated the GAT readings. There was no correlation between the IOP measurements and the CCT for the 4 instruments. There was no significant difference in patients' preference among the 4 instruments. (Eur J Ophthalmol 2009; 19: 783–9)
Diurnal Variation of Corneal Biomechanics and Intraocular Pressure in Normal Subjects
Authors: Oncel Banu , Dinc Umut Asli , Gorgun Ebru , Ilgaz Yalvaç Belkis
Published: January 2018

Purpose

To assess and investigate the relationship between diurnal variations in intraocular pressure (IOP) and biomechanical properties of cornea.

Methods

Sixty-two healthy volunteers were recruited. Corneal compensated IOP (IOPcc), Goldmann-correlated IOP (IOPg), corneal resistance factor (CRF), and corneal hysteresis (CH) parameters were recorded by the Ocular Response Analyzer (ORA). Central corneal thickness (CCT) was measured using an ultrasonic pachymeter. Three consecutive measurements of IOPcc, IOPg, CRF, CH, and CCT were recorded at 8:00 AM, 11:00 AM, 2:00 PM, and 5:00 PM. One-way analysis of variance and Pearson correlation tests were used for statistical analysis. Intra device repeatability was evaluated using Scheffe multiple comparison.

Results

IOPcc, IOPg, CRF, CH, and CCT measurements displayed a stable profile during daytime acquisitions and no statistically significant variation was noted (p>0.05). All measurements of IOPcc, IOPg, CRF, and CH recorded by ORA at 8:00 AM, 11:00 AM, 2:00 PM, and 5:00 PM were all found to be highly repeatable (p>0.05). There was a statistically significant and inverse correlation between IOPcc and CH (p=0.001), and a positive correlation was detected between IOPcc and CRF (p=0.001). CRF and CH were both found to be positively correlated to CCT (p=0.001).

Conclusions

IOPcc readings and recordings of corneal biomechanics were constant throughout the day in healthy eyes. CRF and CH seem to exert different effects on IOPcc as diverse correlations were detected between CRF, CH, and IOPcc. Assessment of IOP and corneal biomechanics using ORA was found to be a highly repeatable. (Eur J Ophthalmol 2009; 19: 798–803)
Intravitreal Infliximab in Experimental Endotoxin-Induced Uveitis
Authors: Hosseini Hamid , Safaei Akbar , Khalili Mohammad R. , Nowroozizadeh Behdokht , Eghtedari Masoometh , Farvardin Mohsen , Nowroozizadeh Sarah , Tolide-Ie Hamid R.
Published: January 2018

Purpose

Tumor necrosis factor-α (TNF-α) plays a central role in the pathogenesis of ocular inflammation and the level of TNF-α is increased in ocular fluids of patients with uveitis. Intravenous infliximab, a monoclonal antibody against TNF-α, has been used for the treatment of uveitis with promising preliminary results. The aim of this study was to evaluate the effect of intravitreal injection of infliximab on experimental uveitis.

Methods

Thirty-three white New Zealand rabbits were divided randomly into three groups. Group 1 (n=5) received intravitreal injection of 1 mg/0.1 cc infliximab plus 0.1 cc normal saline, group 2 (n=14) received intravitreal injection of 2 μg Salmonella typhimurium endotoxin plus 1 mg/0.1 cc infliximab, and group 3 (n=14) animals received intravitreal endotoxin 2 μg/0.1 cc plus normal saline 0.1 cc. Inflammation was evaluated by clinical examinations on days 1, 3, 5, and 7 after the injections; measuring the protein concentration and inflammatory cell content of the aqueous humor; and histopathologic examination.

Results

No inflammation occurred in group 1 animals. There was a statistically significant difference between group 2 and 3 animals with regard to clinical examination on the third, fifth, and seventh postinjection days. The differences between groups 2 and 3 were significant with regard to aqueous cell counts and protein content at day 7 (p=0.02 and p=0.001, respectively). Histopathologic examination results showed less inflammation in group 2 animals compared to group 3 animals (p=0.009).

Conclusions

The results provide evidence that intravitreal injection of infliximab suppresses ocular inflammation in a rabbit model of severe endotoxin-induced uveitis. (Eur J Ophthalmol 2009; 19: 818–23)
Toxoplasmic Retinochoroiditis in an Italian Referral Center
Authors: Accorinti Massimo , Bruscolini Alice , Pia Pirraglia Maria , Liverani Marco , Caggiano Claudio
Published: January 2018

Purpose

To evaluate the clinical features of ocular toxoplasmosis (OT).

Methods

Retrospective review of 3080 new patients with uveitis was performed to identify patients with active OT. The main outcome measures were ocular features and ocular complications.

Results

Active OT was diagnosed in 88 patients (2.85% of all uveitis), 39 male (44.3%) and 49 female (55.7%), at an average age of 20.4±14.6 years, lower than in other types of uveitis (p<0.0001). Acquired OT diagnosis was possible in 4 cases (4.5%), while in the others a differentiation between acquired or congenital OT was impossible. Unilateral OT occurred in 76 patients (86.36%), with lesions located inside the vascular arcade in 64 of them (84.2%). Among bilateral cases (12 patients, 13.63%), at least one lesion was central in 9 (75%). Isolated peripheral lesions were observed in 12 out of 88 patients (13.6%). During an average follow-up of 70±73.5 months, OT recurrences appeared in 70 patients (79.54%). Mean interval between diagnosis and first relapse was 43.57±48.46 months, while it shortened between subsequent relapses (24.44±26.5 months; p=0.001).

Conclusions

Ocular toxoplasmosis is a highly recurrent disease, mainly unilateral, with an average age at onset lower than those observed in other types of uveitis. Time between relapses shortens significantly over time. (Eur J Ophthalmol 2009; 19: 824–30)
Determining Size and Characteristics of Metal Intraocular Foreign Bodies Using Helical CT Scan
Authors: Briscoe Daniel , Geffen Noa , Assia Ehud I. , Yaffe Daniel
Published: January 2018

Purpose

To carry out a pilot study comparing the size of various types of metallic intraocular foreign bodies as imaged on computed tomographic (CT) scan to their actual size, and to determine the features of different types of metals on CT scan.

Methods

Metallic foreign bodies of predetermined standardized sizes were prepared from iron, silver, copper, aluminium, and lead. The metallic pieces/shards were each inserted into the vitreous of a cow's eye and helical CT scan (MX twin, Picker) was performed to image the intraocular foreign bodies, using soft tissue and bone window settings. Slice section thickness was 1.3 mm, with intervals of 0.6 mm. Milliampere per second was 265 and pitch 0.7.

Results

The size of all types of metals as measured on CT was larger than the actual size. Iron was enlarged by a factor of 2.29, silver 1.77, copper 1.26, and aluminum 1.17. All metals had features including central core, ring density, and artifacts which varied for each type of metal, giving each one a characteristic appearance

Conclusions

Helical CT scan could be useful in estimating the type and size of an intraocular metal foreign body made from iron, silver, copper, aluminium, or lead. (Eur J Ophthalmol 2009; 19: 861–5)
An Unusual Case of Cocaine-Induced Maculopathy
Authors: Ascaso Francisco J. , Cruz Nancy , Del Buey María A. , Cristóbal José A.
Published: January 2018

Purpose

Cocaine is one of the most common substances of abuse. When used intranasally, cocaine is cut with a variety of agents, which may increase local and systemic toxic reactions.

Methods

We examined a 34-year-old man who complained of color disturbance. The patient reported a 10-year history of daily intranasal cocaine use, but denied use during the last year. Color vision testing showed a dysregulation of blue–yellow color vision. Electroretinogram revealed significantly reduced blue cone responses. Dilated fundus examination of both eyes revealed a bilateral maculopathy. Fluorescein angiography disclosed an early hyperfluorescence in both foveal areas which maintained in late phase. Optical coherence tomography was normal in both eyes. The patient was diagnosed with an unusual maculopathy related to a long-term intranasal cocaine use.

Results

All 6 eyes exhibited pigmentary changes located along the border of the staphyloma, and also radially to it, giving a particular T-shaped pattern of pigmentary changes. These changes were visible as either a linear strip or a triangular or oval-shaped area. Three eyes had a documented history of subretinal leakage that mimicked central serous chorioretinopathy, a well-known complication of tilted disk syndrome.

Conclusions

Ocular complications from topical cocaine abuse are rare. Impaired color vision, as in our patient, has been reported in cocaine-withdrawn patients. To our knowledge, this is the first described case of a bilateral and symmetric maculopathy associated with long-term intranasal cocaine use. To avoid a delay of treatment, ophthalmologists should be aware that a maculopathy with small defects in color vision may be related to adulterants added to cocaine when it is used intranasally. (Eur J Ophthalmol 2009; 19: 880–2)
Massive Spontaneous Choroidal Hemorrhage in a Patient with Chronic Renal Failure and Coronary Artery Disease Treated with Plavix
Authors: De Marco Rocco , Aurilia Pasquale , Mele Alessandro
Published: January 2018

Purpose

To report a case of massive spontaneous choroidal hemorrhage in a patient with chronic renal failure and coronary artery disease treated with clopidogrel bisulfate (Plavix).

Methods

Case report.

Results

A 75-year-old man presented with pain and loss of vision in the left eye for 1 week. His medical history was remarkable for systemic hypertension, chronic renal failure, and artery coronary disease. For 6 months, he had been taking 75 mg/day of Plavix after coronary angioplasty. Ocular examination revealed the patient to be in angle closure. Ultrasonography and computed tomography scan revealed a massive choroidal hemorrhage pushing the iris-lens diaphragm forward. Pain and intraocular pressure were treated successfully with evacuative sclerotomies, but the final exitus after 6 months was bulbar phthisis.

Conclusions

Massive spontaneous choroidal hemorrhage is an extremely rare event that usually has been described in older patients (65–87 years old) receiving anticoagulants or thrombolytic agents. Systemic hypertension, generalized atherosclerosis, and age-related macular degeneration are additional risk factors. In the present case, massive choroidal hemorrhage was associated with use of clopidogrel bisulfate (Plavix) in a patient with chronic renal failure. Our report indicates that Plavix should be administered with caution in patients with chronic renal failure owing to the risk of serious choroidal bleeding. Chronic renal failure should be also included in the list of risk factors for massive spontaneous choroidal hemorrhage. Evacuative sclerotomies may have value in the relief of pain and elevated intraocular pressure but has not been shown to be beneficial in visual and anatomic outcomes. (Eur J Ophthalmol 2009; 19: 883–6)
Amadeus® II Microkeratome: Optimizing Microkeratome Settings for High Flap Accuracy Using Optical Low Coherence Reflectometry
Authors: Lackerbauer Carl-Arnold , Kollias Aris , Kreutzer Thomas C. , Ulbig Michael , Kampik Anselm , Grueterich Martin
Published: January 2018

Purpose

To investigate the impact of various experimental microkeratome settings and blade reuse on the accuracy of the flap thickness created with the new Amadeus® II microkeratome (SIS, Ziemer Ophthalmic, Port, Switzerland).

Methods

In this prospective study, 120 porcine eyes were used to create corneal flaps with the Amadeus® II using 2 different cutting heads (140 μm, 160 μm) with the Surepass® blade. Using each blade twice, a head advance speed of 1.5 mm/s and 3.5 mm/s and oscillation rates of 8000 rpm, 10,000 rpm, and 13,000 rpm were used. Flap thickness was measured by optical low coherence reflectometry (OLCR). Descriptive statistical analysis was based on means, medians, and quartiles, with graphical representation on box plot. Pearson correlation test and Mann-Whitney U-test for unpaired samples were employed to identify the impact of different settings.

Results

Using the 140 μm cutting head, highest precision of the flap thickness was achieved with a head advance rate of 1.5 mm/s and an oscillation rate of 10,000 rpm (mean 132.1±10.0 μm; range 120.2–147.2 μm). Reusing the blade, highest accuracy (mean 130±6.9 μm; range 118.5–135 μm) was achieved with 8000 rpm. Using the 160 μm cutting head, an optimum flap thickness was reached with a head advance rate of 3.5 mm/s and an oscillation rate of 13,000 rpm (mean 162.4±7.7 μm; range 151.9–169.8 μm). Reusing the blade with the 160 μm cutting head, an adjustment to 3.5 mm/s and 10,000 rpm was necessary (mean 157.4±7.7 μm; range 153.7–161.8 μm).

Conclusions

Optimized microkeratome settings lead to minimized deviation from the intended flap thickness and are mandatory to improve flap accuracy. OLCR is an ideal method to proof individualized settings.
Induction of Controlled Wound Healing with PMMA Segments in the Deep Stroma in Corneas of Hens
Authors: Merayo-Lloves Jesus , Blanco-Mezquita Tomas , Ibares-Frías Lucia , Fabiani Larisa , Alvarez-Barcia Angel , Martinez-García Carmen
Published: January 2018

Purpose

Polymethylmethacrylate (PMMA) segments are normally used in additive surgery to treat both corneal ectasia post laser-assisted in situ keratomileusis and keratoconus. The aim of this work was to develop an experimental animal model to induce wound healing in the deep stroma in corneas of hens.

Methods

PMMA segments were implanted in the right eyes of 40 adult hens without suture in the wound incision. Animals were randomized for 5 time points to histopathology study (1, 3, 15, 30, and 90 days) being clinically evaluated during the experiment.

Results

Thirty-four eyes (85%) had a successful clinical outcome and intraoperative mistakes occurred in 6 eyes (15%), including anterior chamber perforation resulting in abscess (1), excess of lamellar dissection with segment migration (3), and peripheral incisions evolving with neovascularization (2). At 24 hours, all the epithelial injuries were completed in integrity, but a persistent stromal incision, with a fish mouth form, was observed until day 15. Corneal edema disappeared at the fifth day. Haze, keratocyte cell death, keratocyte proliferation, myofibroblast differentiation, and new matrix production were observed in length around the segment.

Conclusions

Wound healing was induced in the deep corneal stroma by means of PMMA segment implantation in a new animal model developed in hens.