bluuebunny/crossref_metadata_2025 huggingface dataset:
Four Years Later: A Clinical Update on Latanoprost
Authors: Ravinet E. , Mermoud A. , Brignoli R.
Published: January 2018

Purpose

Almost five years have elapsed since the introduction of latanoprost on several markets and considering the large number of publications dealing with it, the authors felt that it was worth re-evaluating the drug.

Methods

The criterion used to select trials for inclusion in the review was: all articles mentioning the drug in common electronic data-bases; these were then screened and considered, on the basis of methodological quality.

Results

Experimental data suggest that latanoprost acts by remodeling the extracellular matrix in the ciliary muscle, thus increasing the flow of aqueous humor through the ciliary muscle bundles of the uveoscleral pathway.

POAG

Latanoprost persistently improves the pulsatile ocular blood flow in primary open angle glaucoma (POAG). Recent trials confirmed the greater IOP-lowering efficacy of latanoprost vs. timolol, dorzolamide, brimonidine and unoprostone. Trials lasting up to 24 months showed that latanoprost is effective in long-term treatment of POAG and ocular hypertension (OH), with no signs of loss of efficacy when compared to timolol or dorzolamide. Latanoprost provides better control of circadian IOP. Non-responders to b-blockers should preferably be switched to latanoprost monotherapy before a combination therapy is started. The possibility of a fixed combination of latanoprost and timolol has been explored, with promising results.

NTG

Latanoprost is effective in normal tension glaucoma (NTG), lowering IOP, improving pulsatile ocular blood flow and increasing ocular perfusion pressure.

Other Glaucomas

Latanoprost may provide effective IOP control in angle-closure glaucoma after iridectomy, in pigmentary glaucoma, glaucoma after cataract extraction and steroid-induced glaucoma. However, latanoprost was effective in only a minority of pediatric cases of glaucoma and is contraindicated in all forms of uveitic glaucoma.

Safety

In the articles reviewed, new or duration-related adverse events were reported.
The Management of Giant Retinal Tears with Silicone Oil
Authors: Ünlü N. , Kocaoğlan H. , Acar M.A. , Sargin M. , Aslan B.S. , Duman S.
Published: January 2018

Purpose

To report the surgical success of vitrectomy with silicone oil tamponade in the treatment of retinal detachment associated with giant retinal tears due to various factors.

Methods

We retrospectively evaluated 21 eyes of 21 patients with retinal tears 90° or greater that underwent vitrectomy, with injection of perfluorocarbon liquids and silicone oil tamponade. Eight eyes (38.1%) had previous ocular surgery (4 aphakia-pseudophakia, 4 pars plana vitrectomy), 4 eyes (19.0%) had a history of trauma (blunt injuries in 2 and penetrating injury in 2), 3 (14.3%) had high myopia. Six eyes (28.6%) had no known condition predisposing to development of giant retinal tear.

Results

Retinal attachment was obtained in 17 (80.5%) of 21 eyes, with a mean follow-up of 12.5 months. Visual acuity improved in 15 eyes (71.4%).

Conclusions

Pars plana vitrectomy with silicone oil tamponade proved highly effective in giant retinal tears in terms of anatomical and functional results.
Management of Free Floating Iris Cysts in the Anterior Chamber: A Case Report
Authors: Öner H.F. , Kaynak S. , Koçak N. , Çingil G.
Published: January 2018

Purpose

To present a case with free iris cysts in the anterior chamber and its management with YAG laser.

Case Report

A 14-year-old boy presenting with the complaint of seeing a small ball-like moving mass in his left eye.

Results

Slit-lamp examination revealed a pair of free-floating iris cysts located inferiorly in the anterior chamber. After YAG laser application both the cysts collapsed.

Conclusions

This is the first report of a case with multiple free iris cysts in the anterior chamber. Considering the possibility of endothelial damage in the long term, it is worth noting the favorable response to YAG laser treatment.
Lens Epithelial Cells Express CD95 and CD95 Ligand Treatment Induces Cell death and DNA Fragmentation in Vitro
Authors: Hueber A. , Eichholtz C.D. , Kociok N. , Esser J.M. , Esser P.J.
Published: January 2018

Purpose

Despite advances in intraocular lens design and material, posterior capsule opacification remains one of the major problems in modern cataract surgery. Therefore, the use of antiproliferative agents has been advocated. CD95 ligand (CD95L, Fas, Apo-1) is a death ligand that triggers apoptosis in susceptible target cells. Apoptosis allows for the safe disposal of cells without damaging the surrounding tissue. The goal of this study was to characterize and evaluate CD95L-induced cell death in cultured lens epithelial cells (LEC).

Methods

Expression of CD95 in untreated porcine LEC was investigated by flow cyto metry. Cell death after CD95L or CD95 agonistic antibody treatment was assessed by crystal violet assay and DNA fragmentation was measured by comet assay.

Results

The presence of CD95 was observed in LEC. CD95L treatment resulted in a time-and concentration-dependent killing of LEC, which was synergistically enhanced by the addition of cyclohexamide. CD95L treatment induced DNA fragmentation.

Conclusions

The present study confirms the use of apoptosis-inducing CD95L in the inhibition of LEC proliferation. Further studies are needed before clinical application of CD95L to inhibit posterior capsule opacification will be feasible.
Primary Vitrectomy for Pseudophakic Retinal Detachment: A Prospective Non-Randomized Study
Authors: Pournaras C.J. , Kapetanios A.D.
Published: January 2018

Purpose

To compare the anatomic and functional results of primary vitrectomy alone or vitrectomy-scleral buckling for pseudophakic retinal detachment (RD). Vitrectomy permits a detailed view of the peripheral retina, so otherwise undetectable holes or additional small lesions can be found which, left untreated, may cause a residual RD.

Patients and Methods

Twenty-four consecutive pseudophakic eyes with pseudophakic RD were operated by vitrectomy and encircling band (Group I) and 27 additional cases were operated on by vitrectomy alone (Group II). Internal subretinal fluid drainage, using liquid perfluoro-n-octane, endolaser, and/or cryocoagulation and fluid-air exchange with SF6 20%, was applied in all cases. Preoperative findings and intraoperative and postoperative complications as well as final results were analyzed.

Results

Preoperatively undetected retinal holes were identified in 7 of the 51 eyes and additional retinal holes were found in 21. The mean follow-up was 14 months for Group I and 11.5 months for Group II. The retina was successfully reattached with a single operation in 22 of 24 eyes (92%) in Group I. One eye had a recurrence of RD due to an unsuccessfully treated preexisting retinal tear. Proliferative vitreoretinopathy (PVR) was observed in one case with recurrence of RD. In both cases, a second operation achieved retinal reattachment. In Group II, the retinas were attached with a single operation and visual acuity improved by an average of four or more lines in 62.5% of the vitrectomy-buckling group and in 55.5% of the vitrectomy group. The most frequent complication was a transient hypertony, in 21 cases.

Conclusions

Surgical treatment of pseudophakic RD, combining vitrectomy and scleral buckling or vitrectomy alone, achieves very good anatomic and functional results. The advantages include more efficient detection of the peripheral detachment causing retinal lesions, and a lower redetachment rate than after extraocular surgery only.
Tear Function Tests and Conjunctival Impression Cytology before and after Hormone Replacement Therapy in Postmenopausal Women
Authors: Pelit A. , Bağiş T. , Kayaselçuk F. , Dursun D. , Akova Y. , Aydin P.
Published: January 2018

Purpose

To investigate the effect of hormone replacement therapy (HRT) on postmenopausal tear function and the conjunctival epithelium.

Methods

Schirmer I-Jones test, tear film break-up time (BUT), and impression cytology findings were analyzed in 34 eyes of 17 women who were at least two years postmenopausal and not taking HRT. This series of tests was repeated after three months on HRT.

Results

The patients' average age was 53.82 ± 3.6 years, and the mean time postmenopause was 35.29 ± 11.59 months. There was no significant difference in the Schirmer I-Jones test results before and after three months of HRT (p > 0.05). However, the BUT (p<0.05) and impression cytology (p<0.05) findings were significantly affected by HRT.

Conclusions

HRT may alleviate postmenopausal dry eye symptoms by increasing goblet cell density.
Impression Cytology and Ocular Characteristics in Ocular Rosacea
Authors: Koçak-altintas A.G. , Kocak-midillioğlu I. , Gül U. , Bilezikci B. , Isiksaçan O. , Duman S.
Published: January 2018

Purpose

To examine clinical findings and histologic changes on the conjunctival surface in ocular rosacea.

Methods

Thirty-five patients with ocular rosacea and 30 normal subjects underwent dermatologic and ocular examinations. Tear film break-up time, Schirmer tests with and without topical anesthesia, and conjunctival impression cytology were done. Patients were divided into the following groups according to quantity of ocular signs: mild (Group 1), moderate (Group 2), and severe (Group 3). Impression cytology was performed on both upper-bulbar and intrapalpebral inferonasal-bulbar conjunctiva.

Results

Patients had significant cell alteration on the conjunctival surface compared with normal eyes. The most frequent ocular signs and symptoms were feelings of dryness and blepharitis. Average tear break-up times for patients with ocular rosacea were 8.2 seconds in Group 1, 5.69 seconds in Group 2, and 5 seconds in Group 3 (17.2 seconds in normal subjects). Schirmer test results with anesthesia were 11.5 mm, 7.6 mm, and 5.0 mm, and without anesthesia were 14.8 mm, 13.6 mm, and 7.0 mm, in Groups 1, 2, and 3, respectively. These results were 18.7 mm with anesthesia and 24.7 mm without anesthesia in normal controls. Schirmer tests and tear film break-up time were significantly lower in patients with ocular rosacea than in normal controls (p<0.05). Impression cytology showed that both upper bulbar and inferonasal interpalpebral bulbar ocular surface had significant cell alterations compared with those obtained from normal subjects.

Conclusions

Patients with ocular rosacea not only had decreased tear production but also tear instability. Ocular surface epithelium had significant degeneration in patients compared with normal subjects.
Outcome of Temporary Silicone Oil Tamponade in Complex Rhegmatogenous Retinal Detachment
Authors: Abu El-Asrar A.M. , Al-Bishi S.M. , Kangave D.
Published: January 2018

Purpose

To evaluate the anatomic and visual outcomes and complications of temporary silicone oil (SO) retinal tamponade in patients with complex rhegmatogenous retinal detachments (RD).

Methods

The retrospective study included 100 eyes of 93 consecutive patients. Indications for the use of SO were proliferative vitreoretinopathy (PVR) (30 eyes), difficult RD (30 eyes), giant retinal tears (17 eyes), RD after penetrating trauma (14 eyes), and macular holes in highly myopic eyes (9 eyes). Vitrectomy surgery was performed with 5000-centistoke SO as the retinal tamponade. All eyes underwent prophylactic 360° retinopexy at the time of the retinal reattachment operation. The mean duration of SO tamponade was 26.4 weeks, with a mean follow-up of 67.5 weeks after removal of SO.

Results

In 6 of 100 eyes (6%), the retina redetached after removal of SO. Including the successfully reoperated eyes, the final anatomic success rate was 96%. Other complications were cataract (61%), increased intraocular pressure (13%), hypotony (4%), keratopathy (4%), intravitreal hemorrhage (1%), and suprachoroidal hemorrhage (1%). Corespondence analysis demonstrated that redetatchment and hypotony were associated with PVR and trauma. Overall, good visual outcome (20/200 or better) was achieved in 51% of the whole study group, and in 70.6% of eyes with giant tears, 62.1% of eyes with difficult RD, 44.8% of eyes with PVR, 33.3% of eyes with macular holes, and 28.6% of eyes with trauma (p=0.0382). Logistic regression analysis identified initial visual acuity of 20/200 or better as a factor associated with good visual outcome and occurrence of retinal redetachment/hypotony and old age (≥50 years) as factors negatively associated with good visual outcome.

Conclusions

The low redetachment rate might be due to prophylactic 360° retinopexy. Giant tears had the best visual outcome. Redetachment/hypotony had a negative impact on achievement of good visual outcome and were associated with PVR and trauma.
Intravitreal Triamcinolone Acetonide as Treatment of Ischemic Ophthalmopathy
Authors: Jonas J.B. , Kreissig I. , Degenring R.F.
Published: January 2018

Purpose

To describe the clinical course of a patient receiving repeated intravitreal injections of triamcinolone acetonide (25 mg) as treatment of ischemic ophthalmopathy.

Methods

A 70-year-old patient with Waldenström disease presented with progressive iris neovascularization, vitreous hemorrhage, and ocular hypotony due to ischemic ophthalmopathy. Visual acuity was 0.05. Within 2.5 years, he received three intravitreal injections of 25 mg of triamcinolone acetonide. Additionally, penetrating keratoplasty and synechiolysis were performed during the follow-up.

Results

After each intravitreal injection, visual acuity and intraocular pressure increased, iris neovascularization regressed, and vitreous haze cleared up.

Conclusions

Intravitreal triamcinolone acetonide may induce regression of iris neovascularization, increase intraocular pressure, and improve visual acuity in eyes presenting with ocular hypotony, vitreous hemorrhage, and progressive intraocular neovascularization due to ischemic ophthalmopathy.
Filamentary Keratopathy: A Non-Contact Photomicrographic in Vivo Study in the Human Cornea
Authors: Tabery H.M.
Published: January 2018

Purpose

To investigate in vivo morphology of corneal filaments.

Materials and Methods

Over a 12-year period, 19 patients with corneal filaments (7 with keratoconjunctivitis sicca and 12 with other surface diseases) were examined with the slit lamp and photographed by non-contact photomicrography.

Results

The filaments appeared as variously long and thick threads, attached at one or both ends to the surface and carrying various amounts of granular and amorphous material. The attachment points and their surroundings showed abnormal cells and diffusion of tear fluid stained green with fluorescein sodium. The underlying stroma appeared normal. The remaining epithelium often showed abnormal surface cells and/or edematous or cystic changes.

Conclusions

The in vivo morphology of filamentary keratopathy is consistent with aggregations of mucus and cell debris adhering to the corneal surface. The underlying diseases seem to have in common corneal epithelial edema. The nature of additional factors, or their combination, precipitating mucus adherence to the surface is not clear.
Tumor Necrosis Factor-Alpha (TNF-α) in Seasonal Allergic Conjunctivitis and Vernal Keratoconjunctivitis
Authors: Leonardi A. , Brun P. , Tavolato M. , Plebani M. , Abatangelo G. , Secchi A.G.
Published: January 2018

Purpose

To quantify the presence of the proinflammatory cytokine tumor necrosis factor-alpha (TNF-α) in allergic conjunctivitis.

Materials and Methods

Tears and peripheral blood samples were collected from patients with seasonal allergic conjunctivitis (SAC, n=6), vernal keratoconjunctivitis (VKC, n=12), and normal subjects (CT, n=12). From an additional six nonactive allergic patients, tears were collected before and after specific conjunctival allergen challenge (CAC). Upper tarsal conjunctival biopsies were obtained from five CT and five VKC patients. TNF-α in tears was measured by enzyme-linked immunoassay and identified in tissues by immunohistochemistry.

Results

Tear TNF-α levels in VKC patients were significantly increased compared to CT (p=0.03), and were significantly correlated with the severity of the disease. No differences were found between SAC and CT tear samples. TNF-α serum levels were higher in VKC than CT; however, this difference was not statistically significant. After CAC, tear TNF-a levels were found increased in only one of six patients. In VKC tissues, TNF-α positive cells were significantly increased compared to CT (p=0.03).

Conclusions

TNF-α may have a significant role in severe forms of allergic conjunctivitis.
Herpes Simplex Virus Acute Retinal Necrosis during Pregnancy
Authors: Chiquet C. , Thuret G. , Poitevin-Later F. , Gain P. , Najioullah F. , Denis P.
Published: January 2018

Purpose

As pregnancy is liable to modify immune response, the authors explored the immune functions of a pregnant patient with acute retinal necrosis (ARN) to ascertain whether pregnancy may promote the onset of infection.

Methods

Polymerase chain reaction (PCR) was used for the detection of herpes simplex virus (HSV) DNA in ocular, uterus cervix, and cerebrospinal fluid samples. Peripheral blood mononuclear cells were cultured for 72 hours with mitogens and cellular proliferation was assessed using (methyl-3H) thymidine incorporation. Flow cytometry was performed for T, B, and NK cell count using CD2, CD3, CD4, CD8 (T cells), CD19, CD20 (B cells), and a combination of CD3–CD16 and CD56 monoclonal antibodies (NK cells).

Results

Unilateral ARN, with a confluent peripheral necrotizing retinitis extending throughout the entire retina, was diagnosed clinically. The herpetic infection (herpes simplex virus 1) was confirmed using PCR of aqueous humor specimen. The immunologic study performed during and after pregnancy showed that T and B lymphocytes were quantitatively normal and responses to concanavalin A, phytohemagglutinin, and pokeweed mitogens were weaker during pregnancy.

Conclusions

A reduced response to mitogens, with postdelivery normalization, was noted in a pregnant woman with an ARN syndrome. Further studies are needed to explore the antigen-specific immune deviation in pregnant patients with ARN.
Sequential Combined Therapy for Treatment of Choroidal Neovascularization in Age-Related Macular Degeneration: Photodynamic Therapy and Thermal Laser Photocoagulation
Authors: Ruiz-Moreno J.M. , Montero J.A.
Published: January 2018

Purpose

To analyze the results achieved after treating extrafoveal choroidal neovascularization (CNV) recurrences with thermal laser photocoagulation (TLP) in patients who had previously undergone photodynamic therapy (PDT).

Patients and Methods

Seven eyes (seven patients: four women and three men) that had been initially treated by PDT for CNV associated with age-related macular degeneration (ARMD) and then developed extrafoveal recurrences were treated with green argon TLP. All patients underwent a complete ophthalmologic evaluation and fluorescein angiography. Mean age was 74.4±4.4 years (range, 69 to 81 years). Five right eyes and two left eyes were treated. Mean follow-up after the beginning of the treatment with PDT was 18.0±3.5 months (range, 11 to 22 months). Follow-up after TLP was 6.8±1.0 months (range, 6 to 8 months).

Results

Mean best-corrected visual acuity (BCVA) before treatment was 20/150 (range 20/400 to 20/40). After PDT it was 20/281 (range, 20/400 to 20/80), with a mean of 3.1±0.8 treatments (range, 2 to 4). After TLP, BCVA was 20/233 (range, 20/400 to 20/80), with no statistically significant difference from BCVA after PDT (p=0.06, Student's t-test paired data). In all cases total closure of CNV was achieved after only one session of TLP.

Conclusions

TLP could be helpful in association with multiple sessions of PDT in order to achieve a complete closure of subfoveal CNV secondary to ARMD. Further studies are required to confirm our findings.
Short-Term Reaction of Choroidal Neovascularization and Choriocapillaris to Photodynamic Therapy in Age-Related Macular Degeneration
Authors: Eter N. , Vogel A. , Inhetvin-Hutter C. , Spitznas M.
Published: January 2018

Purpose

To identify the number of primary angiographic nonresponders to photodynamic therapy (PDT) with verteporfin, to determine the rate and speed of reperfusion of choroidal neovascularization (CNV) within a short observation period of only 5 weeks, and to examine the reaction of the underlying choroidal vessels.

Methods

PDT according to the TAP regimen was carried out in 36 eyes with subfoveal classic CNV secondary to age-related macular degeneration. The response to PDT was examined 1 (T1) and 5 (T2) weeks following treatment. At all visits distant visual acuity was measured and both fluorescein and indocyanine green angiography was carried out.

Results

One week after treatment (T1), complete closure of classic CNV had not been achieved in 17% of eyes (primary angiographic nonresponders). At T2, 91% of eyes showed reperfusion of the CNV. In 83% of the primary angiographic nonresponders the CNV size was larger than before treatment. Choroidal shadowing was present in 82% at T1 and in 48% at T2.

Conclusions

Primary angiographic PDT nonresponders are relatively rare; however, in contrast to former reports, they exist and can be identified by follow-up examination 1 week after PDT. Recurrence of leakage occurred earlier than expected and may require closer follow-up and earlier retreatment than recommended by the TAP trial.
Management of Vitreous Loss during Cataract Surgery under Topical Anesthesia with Transconjunctival Vitrectomy System
Authors: Shah V.A. , Gupta S.K. , Chalam K.V.
Published: January 2018

Purpose

A new technique to manage posterior capsular rupture with vitreous prolapse into the anterior chamber during phacoemulsification under topical anesthesia using the sutureless self-sealing 25-gauge transconjuctival vitrectomy system.

Method

In the event of vitreous prolapse into the anterior chamber, the corneal wound is sutured and cleared of vitreous. A trans conjunctival 25-gauge sclerotomy through the pars plana is made. The high speed 25-guage trans-conjunctival vitrectomy system (TVS-25) under topical anesthesia is introduced and vitrectomy is performed to clear the anterior chamber of vitreous. An anterior vitrectomy is also done. A foldable intraocular lens is subsequently inserted.

Results

The vitrectomy is performed in a closed chamber maintaining normal intraocular pressure. The high-speed cutter exerts minimal traction on the vitreous. The accessibility to vitreous improves through the pars plana route ensuring more complete removal of the vitreous and restoration of normal anatomy. Topical anesthesia avoids the risks of globe perforation, retrobulbar hemorrhage, and prolonged postoperative akinesia of the eye.

Conclusions

The 25-gauge pars plana incision is small and self-sealing. This makes the procedure fast, effective, painless and safe.
Unilateral Giant Coloboma of the Upper Eyelid Associated with Other Congenital Anomalies (33 Years Follow-Up of Surgical Repair)
Authors: Scassellati-Sforzolini G. , Scassellati-Sforzolini B.
Published: January 2018

Purpose

To describe a case of congenital unilateral giant coloboma and its successful surgical repair with 33 years of follow-up.

Case Report

A 6-year-old boy presented with a congenital unilateral giant coloboma of the right upper eyelid associated with madarosis of the eyebrows, microphthalmos, dystopia of the hair, and coloboma of the apex of the nose. The patient underwent surgical repair of the multiple anomalies in different steps.

Discussion

A multiple-step, two-layer technique for the reconstruction of the right upper eyelid was performed in a 6-year-old boy with congenital unilateral giant coloboma associated with multiple ocular and facial anomalies. After 33 years of follow-up, the cosmetic results are excellent, although it has not been possible to preserve the visual function of the right eye, which had to be enucleated.
Open-Sky Capsulorrhexis in Triple Procedure: With or without Trypan Blue?
Authors: Özkiriş A. , Arslan O. , Cicik E. , KÖylüoglu N. , Evereklioglu C.
Published: January 2018

Purpose

To establish the beneficial effects of trypan blue 0.1% capsule staining in open-sky capsulorrhexis during triple procedure.

Methods

Patients who underwent penetrating keratoplasty (PK) with phacoemulsification and intraocular lens (IOL) implantation were divided into two groups. Group 1 consisted of 31 eyes of 26 patients with a mean age 64.4 ± 6.9 years and anterior lens capsule was stained with trypan blue 0.1% to perform open-sky capsulorrhexis. In Group 2, capsulorhexis was performed without staining of the anterior capsule in 19 eyes of 17 patients with a mean age 60.6 ± 5.3 years. The rates of complete capsulorrhexis and intra- and postoperative capsule-related complications were compared between the groups.

Results

The most common diagnosis before PK was corneal opacification in both groups. Open-sky capsulorrhexis was not completed in 3 eyes (9.6%) in Group 1 and in 9 eyes (47.3%) in Group 2. The rates of incomplete capsulorrhexis, posterior capsule tear, and transscleral fixation IOL implantation were higher in Group 2 (for each, p<0.05). The diameters of capsulorrhexis were smaller than 4.5 mm in one eye in Group 1 and in two eyes in Group 2, and larger than 6.5 mm in two eyes in Group 1 and in three eyes in Group 2. Malposition of IOL, zonular dialysis, retinal detachment, and pupil capture were only observed in eyes in Group 2. In the follow-up period, there were no adverse reactions due to application of trypan blue in Group 1.

Conclusions

Trypan blue staining of the anterior capsule during triple procedure helps the surgeon perform open-sky capsulorrhexis more easily and safely and in proper dimensions, provides positive effects on the other steps of the surgery, and decreases the rate of posterior capsule tear formation.
Clonazepam Associated Retinopathy
Authors: Gatzonis Sta. , Karadimas P. , Gatzonis Sty. , Bouzas E.A.
Published: January 2018

Purpose

To report a case of retinopathy associated with the longterm intake of the antiepileptic drug clonazepam.

Methods

Case report.

Results

A 36-year-old woman, with a history of long-term use of the antiepileptic drug clonazepam developed subtle visual disturbances. Funduscopy revealed areas of mild depigmentation of the retinal pigment epithelium throughout the posterior pole bilaterally corresponding to transmission hyperfluorescence on fluorescein angiography. There was no history of any inherited retinal degenerative disease and no other known agent responsible for retinal toxicity had been used.

Conclusions

The longstanding intake of the antiepileptic drug clonazepam may be associated with the development of toxic retinopathy.
Acute Commotio Retinae Determined by Cross-Sectional Optical Coherence Tomography
Authors: Meyer C.H. , Rodrigues E.B. , Mennel S.
Published: January 2018

Purpose

To demostrate the cross-sectional anatomy in acute commotio retinae.

Methods

A 27-year-old male with unilateral decreased vision after acute blunt ocular trauma, was examined by optical coherence tomography (OCT).

Results

Visual acuity was 20/20 OD and 20/50 OS. Fundus examination OS demostrated a mild edema in the papillomacular and foveal area. OCT confirmed a separation of the neurosensory retina and the retinal pigment epithelium (RPE). The thickness of the retina was normal and the contour of the foveola intact. The uncommon hyperreflective band at the outer retina may present the traumatic disruption of photoreceptors.

Conclusions

In vivo investigations by OCT confirmed previous histological studies, a commotio retinae consists a disruption and fragmentation at the level of the foveal photoreceptor segments and RPE.
Introduction to Apoptosis in Ophthalmology
Authors: Carella G.
Published: January 2018

Apoptosis represents a mode of cellular death genetically programmed to maintain homeostasis of tissues. In specific pathologic circumstances, the death program may be activated by various environmental factors such as exposure to toxic substances or bacteria or deprivation of nutrients. From this point of view, apoptosis is considered the final event in several pathologies. In ophthalmology, experimental evidence has confirmed that apoptosis is a type of cellular death involved in various pathologic processes including glaucoma, retinitis pigmentosa, ischemic retinopathy, corneal reparative processes, cataract, and retinoblastoma. The aim of this article is to review the most recent results published in this field and to describe some of the molecular mechanisms responsible for the activation of the apoptotic program in some important ocular disorders. The understanding of such mechanisms could outline new therapeutic strategies for the prevention of cellular death in ophthalmology.
The Mechanisms of Apoptosis in Biology and Medicine: A New Focus for Ophthalmology
Authors: Tempestini A. , Schiavone N. , Papucci L. , Witort E. , Lapucci A. , Cutrì M. , Donnini M. , Capaccioli S.
Published: January 2018

Defects in apoptosis (programmed cell death) have recently emerged as being closely involved in the pathogenesis of most ocular diseases and, therefore, apoptosis is now a topic of exponential interest in ophthalmology. This review summarizes recent works on mechanisms of apoptosis, from its initiation and modulation to the switching-on of its execution machinery. Interactions of cell death with cell division programs to orchestrate ontogenesis, aging, and adult life and their alterations in human diseases are pointed out. Two main apoptotic signaling pathways are identified: a death receptor-dependent (extrinsic) pathway and a mitochondrion-dependent (intrinsic) pathway. Mitochondrion harbors both anti-apoptotic (Bcl-2, Bcl-XL) and apoptotic factors (Smac/Diablo, Apaf-1, cytochrome c). Its permeability transition pore (mPTP) is the main trigger of cell suicide. The process of mPTP opening, in association with extrusion to cytoplasm of a variety of apoptotic factors, is shown. Cytochrome c is one of these apoptotic factors. When expelled to cytoplasm, this double-faced respiratory chain component assembles with two other modules, Apaf-1 and procaspase 9, to form a protein complex – the apoptosome – that starts apoptosis execution. Another respiratory chain component, the CoQ10, is believed to counteract mPTP opening. What makes apoptosis particularly exciting for medicine is that its dysfunctions play a central role in the pathogenesis of several human diseases. For instance, excesses of apoptosis lead to cell loss that accompanies neurodegenerative diseases, whereas genetically determined defects of apoptosis lead to the deregulated cell proliferation typical of cancer. A variety of ophthalmologic diseases, such as post-keratectomy haze, corneal lesions, cataract, glaucoma, senile maculopathies, and genetic ocular pathologies, that underlie apoptosis dysfunctions are treated in detail in the other reviews of this issue.
Small Incision Clear Lens Extraction for Correction of High Myopia
Authors: Kubaloğlu A , Yazicioğlu T. , Tacer S.
Published: January 2018

Purpose

To evaluate the effectiveness, predictability, and safety of clear lens extraction in the correction of high myopia.

SETTING

Kartal Education and Research Hospital, Istanbul, Turkey.

METHODS

This retrospective study comprised 56 eyes of 30 patients who had clear lens extraction to correct myopia of 12.00 diopters (D) or more. Small incision clear lens extraction using an anterior chamber maintainer was performed and low-power posterior chamber intraocular lens (IOL) was implanted. The mean postoperative follow-up was 40.2±11.9 months.

Results

Uncorrected visual acuity improved in 94.6% of eyes. Best-corrected visual acuity (BCVA) improved in 37 eyes (66 %); 27 (48.2 %) gained two or more lines. The percentage of eyes achieving a BCVA of 20/40 or better increased from 26.7% preoperatively to 58.9% postoperatively. Of the eyes, 38 (67.8%) were within ±1.00 D of targeted refractive error and 52 (92.8%) were within ±2.00 D. Posterior capsule tear with vitreous loss occurred in one eye (1.7%). During the follow-up, retinal detachment (RD) occurred in 2 eyes (3.5%).

CONCLUSIONS

Clear lens extraction and IOL implantation was effective and had an acceptable predictability and a low morbidity in correcting high myopia. Regular retinal examination is necessary to prevent postoperative RD.
Optic Disc Pit Maculopathy after Blunt Ocular Trauma
Authors: Meyer C.H. , Rodrigues E.B.
Published: January 2018

Purpose

To present a symptomatic optic pit 3 months after a blunt ocular trauma.

METHODS

A 16-year-old male with unilateral decreased vision was examined with multiple cross-sectional scans using optical coherence tomography (OCT) and kinetic ultrasound at the optic disc and macula.

Results

Visual acuity was 20/30 OD and 20/20 OS. Fundus examination OD demonstrated an optic pit with a corresponding serous macular detachment. OCT disclosed a schisis-like separation of the inner retinal layer emanating from the optic disc and an outer layer detachment of the retina. B-scan ultrasound disclosed attached Choquet's canal at the optic pit.

CONCLUSIONS

Patients with optic pit and firm adherent posterior vitreous may develop schisis-like retinal detachments after blunt ocular trauma.
Refractive Outcome of Single Running Suture Adjustment in Penetrating Keratoplasty
Authors: Küçükerdönmez C. , Akova Y.A. , Dursun D.
Published: January 2018

Purpose

To evaluate the effectiveness of single running suture adjustment in reducing postoperative astigmatism and improving visual acuity in patients who have undergone penetrating keratoplasty.

METHODS

Eighteen eyes of 18 patients who underwent penetrating keratoplasty at the Department of Ophthalmology, Başkent University between May 1997 and December 2000 and who had an astigmatism over 2 diopters (D) at the fourth postoperative week were included. All eyes underwent suture adjustment at the fourth week and eight eyes with residual astigmatism above 3 D underwent a second adjustment at the eighth week. Final astigmatism and visual acuity findings were evaluated 28 weeks postoperatively.

Results

The mean postoperative keratometric and refractive astigmatism were 5.76±0.88 D (range=4.50–7.76) and 5.22±0.78 D (range=4.0–7.0) at the fourth week, which were decreased to 2.82±0.99 D (range=1.25–4.62, p=0.0001) and 2.61 ± 1.01 D (range=1.0–4.5, p=0.0001) after suture adjustment, respectively. In eight eyes at the eighth week, a second suture adjustment reduced the average keratometric and refractive astigmatism from 3.86±0.65 D (range=2.75–4.62) and 3.81±0.44 D (range=3.25–4.50) to 2.33±0.91 D (range=0.87–3.50, p=0.012) and 2.06±0.68 D (range=1.0–2.75, p=0.011), respectively. At the 28th week, the average keratometric and refractive astigmatism levels for the entire cohort, which were 2.39±1.06 D (range=1.0–3.50) and 2.25±0.96 D (range=1.0–3.25), respectively, showed a statistically significant decrease when compared with the levels before the first suture adjustment (p=0.0001 for both data). The mean best-corrected visual acuity was 20/25 on the Snellen chart at the 28th week.

CONCLUSIONS

Postoperative adjustment of single running suture is a safe and effective way of reducing postkeratoplasty astigmatism.
Nitric Oxide Levels of Aqueous Humor after Photorefractive Keratectomy
Authors: Adiguzel U. , Bilgihan K. , Ozdek S.C. , Sancak B. , Hasanreisoglu B.
Published: January 2018

Purpose

To measure the nitric oxide (NO) levels of aqueous humor in rabbits after photorefractive keratectomy (PRK) and to evaluate the alterations of NO levels according to the PRK surgery steps, ablation depth, and time.

METHODS

Fifty eyes of 25 New Zealand white rabbits were included in the study. One eye was later randomly excluded from the study in order to equalize the number of eyes in groups. Eyes were divided into seven groups, each comprising seven eyes: unwounded control (Group 1), epithelial scrape (Group 2; aqueous humor samples taken at the 4th hour), superficial PRK (Group 3; samples taken at the 4th hour), deep PRK (Group 4; samples taken at the 4th hour), epithelial scrape (Group 5; samples taken at the 24th hour), superficial PRK (Group 6; samples taken at the 24th hour), and deep PRK (Group 7; samples taken at the 24th hour). The corneal epithelium was mechanically removed in surgical groups. The authors performed superficial corneal ablation (59 μm) in Groups 3 and 6 and deep corneal ablation (99 μm) in Groups 4 and 7. Aqueous humor samples were taken at the 4th hour (Groups 2–4) or 24th hour (Groups 5–7) after corneal surgeries. NO measurements were performed indirectly by using the Griess reaction with a spectrophotometer.

Results

Aqueous humor NO levels 4 hours after corneal surgery were statistically significantly lower than the control group (p<0.05). However, there was no difference among the surgical groups at the 4th hour (p>0.05). At the 24th hour, the deep PRK group had significantly lower NO levels than both the control group and Groups 5 and 6 (p<0.05). NO levels were normalized at the 24th hour in epithelial scrape and superficial PRK groups (p>0.05) but remained stable at lower levels in deep PRK groups (p<0.05).

CONCLUSIONS

Corneal surgery caused low NO levels in aqueous humor 4 hours after surgery. However, 24 hours after surgery, NO levels normalized following epithelial scrape and superficial PRK and were stable at lower levels in the deep PRK group. Complications of deep PRK application are possibly induced by low NO existence in the aqueous humor.
Effect of Cataract Surgery and Foldable Intraocular Lens Implantation on Retinal Nerve Fiber Layer as Measured by Scanning Laser Polarimetry with Variable Corneal Compensator
Authors: Vetrugno M. , Trabucco T. , Sisto D. , Sborgia C.
Published: January 2018

Purpose

Scanning laser polarimetry (SLP) enables the measurement of retinal nerve fiber layer (RNFL) thickness in vivo. As SLP measurements can be influenced by several conditions such as corneal birefringence, the new version GDx Access is implemented by the variable corneal compensator (VCC). The aim of this study was to evaluate the influence of cataract extraction and foldable intraocular lens (IOL) implantation on SLP parameters measured by GDx Access.

METHODS

Sixty-eight eyes of 68 patients undergoing phacoemulsification with foldable IOL implantation (silicone and acrylic) were examined by SLP before and after surgery. SLP was performed using GDx Access (with VCC). Mean values for SLP parameters were compaied before and after 30 days from surgery with paired two-tailed Student's t-test.

Results

No statistically significant differences were found between SLP parameters before and after cataract surgery, and regardless of the type of IOL implanted.

CONCLUSIONS

Phacoemulsification and foldable IOL implantation do not influence RNFL parameters, as measured by GDx Access.
Subretinal Choroidal Neovascularization Associated with Choroidal Nevus
Authors: Zografos L. , Mantel I. , Schalenbourg A.
Published: January 2018

Purpose

Evaluation of a large series of choroidal nevi inducing the formation of a neovascular membrane in order to more clearly define the clinical presentation and to evaluate the efficacy of various treatment options.

METHOD

Retrospective study of 22 clinical cases.

Results

All nevi were situated in the posterior choroid. They had a mean diameter of 3.8 mm and a mean thickness of 1.4 mm. Neovascular membranes were classic in all cases, extrafoveal in 13 cases (59%), and subfoveal in 9 cases (41%). A serous retinal detachment was present in every case, hemorrhages were present in 13 cases (59%), and lipid deposits were present in 16 cases (73%). All extrafoveal neovascular membranes were successfully treated by thermal laser photocoagulation. Initial visual acuity was 0.1 in three cases, 0.2–0.4 in five cases, 0.5–0.8 in four cases, and 1.0 or more in two cases. Final visual acuity was 0.1 in one case, 0.2–0.4 in one case, 0.5–0.8 in four cases, and 1.0 or more in seven cases. Five subfoveal neovascular membranes were treated either by thermal laser, photodynamic therapy, or irradiation. No treatment was applied in four cases and in one of these cases, spontaneous resolution of the neovascular membrane was observed. No growth of the pigmented tumor was observed with a mean follow-up of 4.8 years.

CONCLUSIONS

Proliferation of a neovascular membrane on the surface of a pigmented choroidal tumor is a rare complication and is considered to be a relative indicator of a benign nature of the lesion. In the authors' experience, neovascular membranes are extrafoveal in more than half of cases and are accessible to laser photocoagulation. In contrast, the various modalities used to treat subfoveal neovascular membrane were ineffective and functional prognosis was unfavorable in these cases.
Choroidal Effusion and Hypotony Caused by Severe Anterior Lens Capsule Contraction following Cataract Surgery
Authors: Musa F. , Aralikatti A. K.V. , Prasad S.
Published: January 2018

Purpose

To describe a case of severe anterior capsular contraction associated with choroidal effusion in a 81 year old female with primary open angle glaucoma undergoing routine phacoemulsification cataract surgery.

CASE REPORT

Eight weeks following surgery the anterior capsule opening had reduced to 3 mm in size. Intraocular pressure was found to be 4 mmHg and B scan ultrasound revealed a large choroidal effusion. Anterior capsulotomy with Nd:YAG laser was performed. At review, two weeks later, the choroidal effusion had resolved and visual acuity had recovered.

CONCLUSIONS

The Nd:YAG laser radial relaxing capsulotomies helped relieve the capsular contraction and associated traction on the ciliary body.
Repeated Probing Results in the Treatment of Congenital Nasolacrimal Duct Obstruction
Authors: Singh Bhinder G. , Singh Bhinder H.
Published: January 2018

Purpose

To assess the results of our protocol of repeated probing for the treatment of congenital nasolacrimal duct obstruction in various presentations.

METHODS

A total of 1600 patients (1748 eyes) with congenital dacryocystitis (850 boys, 750 girls; age range, 1 month to 48 months [mean 16.54 ± 12.21 months]) were included. Diagnosis was confirmed by history of tearing, crusting of lids, and a boggy swelling over inner canthal region, which on pressure ejected mucopurulent discharge through punctum. Antibiotic eye drops were instilled five times a day for a week in affected eyes after the mother pressed the sac area and cleaned the discharge. The cases that were not relieved were subjected to sequential probing dilating with an increasing diameter probe repeated in failed cases second and third times at 1-week interval.

Results

Medical treatment was effective in only 60 eyes (3.43%). Probing and syringing achieved successful results in 790 eyes (100%) aged 1 month to 12 months; 330 eyes (99.40%) aged 12 months to 18 months; 200 eyes (98%) aged 18 months to 24 months; 150 eyes (95.24%) aged 24 months to 36 months; and 158 eyes (89.87%) aged 36 months to 48 months. The cure rate with first probing was 98.10%, second probing was 99.64%, and third probing was 100%.

CONCLUSIONS

Our protocol of medical regime and early probing repeated two to three times was very effective in the treatment of nasolacrimal duct obstruction at all ages. A second and third probing was recommended after 1 week of the first probing with successful results if first probing failed.
Disease-Specific Assessment of Quality of Life after Decompression Surgery for Graves' Ophthalmopathy
Authors: Tehrani M. , Krummenauer F. , Mann W.J. , Pitz S. , Dick H.B. , Kahaly G.J.
Published: January 2018

Purpose

Graves' ophthalmopathy (GO) is an organ-specific autoimmune disease. Hydrophily of accumulated acidic mucopolysaccharides into bulbar adipose tissue leads to swelling of the eye muscles. Orbital surgical decompression is performed in severe cases of compressive optic neuropathy and severe corneal exposure or failure of steroid therapy. The study was designed to evaluate decompression surgery with respect to the clinical benefit and the patient's satisfaction by means of a disease-specific questionnaire.

METHODS

The 90-item study questionnaire was distributed to 105 patients with GO who underwent orbital decompression surgery at the authors' institution.

Results

A total of 88% of patients stated that decompression had helped them, 80% of the interviewees would undergo decompression again, 78% were content with their eye symptoms, and 71% were satisfied with the cosmetic result of decompression. Furthermore, analysis showed a clinically relevant increase in quality of life after surgery. The correlation between the clinical endpoint proptosis at last examination and the quality of life score proved to be significant (p=0.05).

CONCLUSIONS

The large majority of interviewees were satisfied with the result of the orbital decompression. These results confirmed that disfiguring proptosis is an important indication for decompression surgery.
Giant Chalazia in the Hyperimmunoglobulinemia E (Hyper-Ige) Syndrome
Authors: Crama N. , Toolens A.P.M. , Van der meer J.W.M. , Cruysberg J.R.M.
Published: January 2018

Purpose

To report the occurrence of recurrent multiple giant chalazia in the hyperimmunoglobulin E syndrome (hyper-IgE syndrome or Job syndrome).

METHODS

Two patients with hyperimmunoglobulinemia E (>500 IU/ml) had ophthalmologic examination and surgical treatment for chalazia of the eyelids.

Results

The hyper-IgE syndrome is a rare immunodeficiency and multisystem disorder characterized by recurrent skin and pulmonary abscesses, connective tissue abnormalities, and elevated levels of serum IgE. In two patients with the hyper-IgE syndrome, multiple giant chalazia were seen in upper and lower eyelids. Despite surgical incision new giant chalazia arose.

CONCLUSIONS

Recurrent multiple giant chalazia may occur as an ophthalmic feature of the hyper-IgE syndrome.
Polypoidal Choroidal Vasculopathy Associated with Doyne'S Familial Choroiditis: Treatment with Thermal Laser
Authors: Ladas I.D. , Karagiannis D.A. , Georgalas I. , Rouvas A.A. , Moschos M.M. , Apostolopoulos M.
Published: January 2018

Purpose

To report the unusual occurrence of polypoidal choroidal vasculopathy (PCV) in a patient with Doyne's familial honeycomb choroiditis (DFHC) and its course after laser treatment.

DESIGN

Interventional case report.

METHODS

Indocyanine green (ICG) angiography guided laser was performed on active polypoidal lesions.

Results

A 45-year-old man with a 15-year history of bilateral DFCH and a scarred macular choroidal neovascularization in the right eye (RE) was referred to us with exudative maculopathy in the left eye (LE). His best-corrected visual acuity (BCVA) was 20/800 in the RE and 20/40 in the LE. ICG angiography revealed a picture that was characteristic for PCV in both eyes. ICG guided argon green laser was performed on the active parapapillary and perifoveal polypoidal lesions of the LE. Eight months after the laser photocoagulation treatment, the macular exudative lesions had subsided and the BCVA improved to 20/20. The favorable anatomic and functional results have remained stable over 3 years.

CONCLUSIONS

This is, to our knowledge, the first case of a PCV that occurred secondary to DFHC.