bluuebunny/crossref_metadata_2025 huggingface dataset:
Intermediate Uveitis: What is the Natural Course of the Disease and Its Relationship with Other Systemic Diseases?
Authors: Palimeris G. , Marcomichelakis N. , Konstantinidou V. , Trakaniari A. N.
Published: April 2018

This study examined the natural course of intermediate uveitis, to find a possible correlation with systemic diseases and to identify the ocular complications. Patients were classified according to follow-up time in three groups: A (1-5 years) 12 pts, B (6-10 years) 10 pts, C (11-15 years or more) 6 pts for a total of 28 patients (52 eyes). We studied the recurrences, the complications of the disease and the overall prognosis. Eight patients were found to be suffering from systemic diseases: sarcoidosis 2, Adamantiades-Behcet 2, multiple sclerosis 3 and Lyme disease 1. Cataract was found in 21 eyes (40.5%) and macular changes in 20 eyes (38.4%) but chronic cystoid macular edema persisted in only six cases (12.5%). Group C presented more complications than group B. Group A had the fewest. The frequency of recurrences was 1-5 for group A, 1-3 for group B and 1-2 for group C. Four patients received no therapy, 15 received steroids and nine received cyclosporine and steroids.

In this series intermediate uveitis was bilateral in 85.8% of patients and related with systemic diseases in 28.5%. Recurrences appeared mainly during the first five years. The longer the presence of the disease the more frequent were complications and the final visual acuity depended mostly on the severity of the initial attack and the number of exacerbations.
The Role of Serum Calcium in the Development of the Acute Red Eye in Chronic Renal Failure
Authors: Klaassen-Broekema N. , van Bijsterveld O.P.
Published: April 2018

In patients with chronic renal failure treated by longterm dialysis, inflammatory reactions occasionally develop in the bulbar conjunctiva; the episcleral tissue is only rarely involved. Diffuse congestion of both the conjunctiva and episclera was present in 5.3% of our patients and was associated with a sudden, marked rise in serum calcium. Histo-pathological examination suggests that this form of hyperemia, clinically preceded by a marked shedding of calcific precipitates, is the result of a neurogenic-driven inflammatory reaction in which mast cell degranulation is mediated by the axon reflex.

Focal hyperemia associated with elastosis (“pingueculitis”) was present in 6.7% of the patients. This type of hyperemia was observed after an extended period of increasing levels of BUN and seemed independent of both serum calcium and phosphorus. Diffuse hyperemia of the conjunctiva, being clinically distinctly different from the combined diffuse conjunctival and episcleral hyperemia, was also observed in 6.7%. Diffuse conjunctival hyperemia seemed to be associated with low BUN. Here, again, there was no association with serum calcium and phosphorus levels.
Conjunctival Fibrosis after Application of Mitomycin C: An Animal Experimental Study
Authors: Mietz H. , Kirchhof B. , Diestelhorst M. , Krieglstein G.K.
Published: April 2018

Mitomycin C (MMC) is widely used as an antimetabolite to minimize scarring of filtering blebs. Its effectiveness has been demonstrated in several clinical studies. The drug's mechanism of action is attributed to its antiproliferative effect on the subconjunctival cells, reducing the wound healing response. We placed sponges soaked with various concentrations of MMC, from 0.05 to 1.0 mg/ml, under the conjunctiva of 18 rabbits. Four weeks later, there was marked concentration-dependent scarring of the substantia proppria of the conjunctiva. Macrophages were more numerous in treated eyes, as determined by immuno-histochemistry. The reason for MMC-related fibrosis in this animal model is not clear but may be related to the substances toxic effects. Whether it is only present in rabbits remains to be clarified.
Surgical Removal of Subretinal Neovascular Membranes
Authors: Maas S. , Deutman A.F. , Bandhoe F. , Aandekerk A.L.
Published: April 2018

Since 1991 we have been gaining experience in the surgical removal of submacular subretinal membranes in patients with presumed ocular histoplasmosis syndrome (POHS), idiopathic subretinal neovascularisation, myopia and age-related macular degeneration (AMD). Seventeen patients were operated between 1991 and 1993. Significant improvement of vision was achieved in 4 out of 5 patients with POHS, 3 out of 5 with idiopathic neovascularisation, 2 out of 4 with myopia but none of 3 patients with AMD.

The results suggest that subretinal neovascularisation can be succesfully removed in POHS and in some forms of idiopathic neovascularisation and myopia but probably not in AMD.
Ocular Pathology in Light Chain Deposition Disease
Authors: Daicker B.C. , Mihatsch M.J. , Strøm E.H. , Fogazzi G.B.
Published: April 2018

Light-chain deposition disease (LCDD), a rare form of monoclonal gammopa-thy, is characterized by deposits of amorphous light-chain material, mainly in the kidneys but also in various other organs. Here we present the first report of a light-, electron microscopic and immunohistochemical study of the globes of a patient suffering from LCDD secondary to multiple myeloma. Massive deposits of kappa light chains similar to those typically present in the kidneys were found beneath the basement membrane of the ciliary pigment epithelium, on vessels of the ciliary body, within the collagenous zones of Bruch's membrane, and in the innermost part of the choroid. The choriocapillaris in the macular area was partly obstructed by these deposits, and an exudative retinal detachment was present. Whether this detachment was the consequence of disturbed circulation of the choriocapillaris remains speculative.
Lp(a) is not Related to Retinopathy in Diabetic Subjects
Authors: Haffner S.M. , Klein B.E.K. , Moss S. E. , Klein R.
Published: April 2018

Purpose

To examine the association between Lp(a) concentrations and the severity of retinopathy in 22 younger-onset and 48 older-onset diabetic subjects from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR), a population-based study of diabetic retinopathy.

Methods

We used a subset of the WESDR population with standardized protocols and stereoscopic color fundus photography to determine the severity of diabetic retinopathy in relation to Lp(a) concentrations. Lp(a) concentrations were measured by a monoclonal anti-Lp(a) antibody.

Results

Lp(a) levels were not significantly different between younger-onset or older-onset subjects with and without retinopathy.

Conclusion

Our results do not support a link between higher levels of Lp(a) and severe retinopathy in either younger-onset or older-onset diabetic subjects but this needs confirmation in larger prospective studies.
Autofluorescence in a Patient with Adult Vitelliform Degeneration
Authors: Barr D.B. , Beirouty Z.A.Y.
Published: April 2018

The case of an 83 year-old woman is presented in whom bilateral vitelliform macular cysts were observed to fluoresce during the pre-injection phase of intravenous fluorescein angiography. This suggests that the vitelliform response is a non-specific event occurring in retinal pigment epithelial disease in which lipofuscin may or may not be manufactured.
Effect of Flurbiprofen on Acetylcholine-Induced Pupillary Contraction
Authors: Tabandeh H. , Mcalister J. , Thompson G.
Published: April 2018

Preoperative treatment with topical nonsteroidal anti-inflammatory agents such as flurbiprofen (Ocufen) is used to maintain pupil dilatation during cataract surgery. Flurbiprofen maintains pupil dilatation by inhibiting release of prostaglandins and other modulators of surgical miosis. Some reports suggest that these agents may reduce the miotic effect of intra-operative acetylcholine (Miochol). It is hard to explain this effect unless there is a pharmacological interaction between the two drugs. This study aimed to investigate the possibility of a direct interference by flurbiprofen with the action of acetylcholine on the pupil sphincter.

Iris tissue of seven cadaver eyes were isolated and maintained in an organ bath containing Kreb's solution. Pupil contraction force induced by acetylcholine was measured in the presence and absence of flurbiprofen. Acetylcholine produced a mean pupillary contraction force of 52.4 × 10–3 N. When it was added to the organ bath in the presence of flurbiprofen the mean contraction force was 50.6 × 10–3 N (paired t-test P=0.68).

This study does not find any evidence to suggest that flurbiprofen reduces the pupil sphincter contraction that is induced by acetylcholine. It is likely that the apparent reduction in miosis is due to factors other than the mechanism of action of acetylcholine on the sphincter pupillae.
A change in Ocular Involvement in a Patient Suffering from Ankylosing Spondylitis and Behçet's Disease
Authors: Beiran I. , Scharf J. , Dori D. , Miller B.
Published: April 2018

We report a case of a young man suffering from both ankylosing spondylitis and Behçet's disease in whom the character of the ocular involvement changed according to the predominant disease at a given time. When the clinical picture was one of ankylosing spondylitis, only anterior uveitis was observed, while the clinical picture of Behçet's disease occurred with panuveitis and retinal vasculitis. To the best of our knowledge, this is the first report in the English literature of two different patterns of ocular involvement in the same patient with two seronegative arthritides.
Levocabastine Eye Drops do not Affect Accommodative Capacity in Volunteers and Intraocular Pressure in Glaucoma Patients
Authors: Wolf S. , Wohlrab T.-M. , Remky A.
Published: April 2018

Levocabastine is a potent and highly selective H1-receptor antagonist specifically developed for the topical treatment of allergic conjunctivitis. This study assessed the effects of levocabastine eye drops on accommodative capacity in 20 healthy volunteers and on parameters influencing glaucoma in 12 glaucoma patients. A single dose of levocabastine (0.5 mg/ml) did not influence accommodative capacity, pupil diameter, or intraocular pressure (IOP) in volunteers. Similarly, levocabastine (0.5 mg/ml, one drop in each eye twice daily) for two weeks was well tolerated by patients with glaucoma. Measurement of IOP, iridocorneal angle, depth of the anterior chamber, visual acuity and near-point in these patients provided no evidence of exacerbation of glaucoma or interactions with concurrent antiglaucoma medication. Application site reactions (local irritation and ocular pain) were the only adverse effects, with an incidence comparable to placebo-treated controls. In conclusion, ocular levocabastine appears to be well tolerated, with no apparent effects on accommodative capacity or glaucoma.
Bilateral Transient Visual Obscurations with Headaches during Alpha-II Interferon Therapy: A Case Report
Authors: Detry-Morel M. , Boschi A. , Gehenot M. , Geubel A.
Published: April 2018

A 40 year-old woman receiving alpha interferon therapy for chronic active hepatitis C presented transient bilateral visual obscurations with associated visual field defects and headaches, with elevated cryoglobulin levels. These manifestations mimicked the clinical picture of migraine and were associated with worsening of previous moderate Raynaud's syndrome and diffuse paraventricular lesions of the white matter seen in cerebral MRI. Bilateral posterior cerebral transient ischemic episodes rather than an anterior visual pathway lesion were thought to be responsible for the clinical symptoms though the exact role of interferon in these vasospastic-like disorders remains speculative. Their possible relationship with increased cryoglobulinemia is uncertain. We suggest that Raynaud's phenomenon may have a predisposing role for these manifestations.
Excimer Laser Photorefractive Keratectomy (Prk) in Myopic Astigmatism
Authors: Tasindi E. , Talu H. , Ciftci F. , Acar S.
Published: April 2018

To assess the visual and refractive results of excimer laser photorefractive keratectomy (PRK) in myopic astigmatism.

Methods

Excimer laser PRK was performed using an Aesculap Meditec MEL 60 laser in 46 myopic astigmatic eyes. Preoperative corneal astigmatism was –1.50 D. (±0.50) in 7 eyes (15.2%); –2.50 D. (±0.50) in 14 eyes (30.5%); –3.50 D. (±0.50) in 13 eyes (28.3%); –4.50 D. (±0.50) in 8 eyes (17.4%); and –5.50 D. (±0.50) in 4 eyes (8.6%). Mean preoperative cylinder was –3.50 D. (±2.50). Mean preoperative sphere was –4.50 D. (±2.25). Pre and postoperative visual acuity, refraction, keratometer readings, corneal topography, intraocular pressure, and slit lamp findings were recorded.

Results

By one year of follow-up, postoperative cylinder was between +0.50 and –0.50 D. in 31 eyes (67.4%); between –0.50 and –1.50 D. in 11 eyes (23.9%); between –1.50 and –2.50 D. in 4 eyes (8.7%). Mean post-operative cylinder was –1.21 D. (±1.70). Mean postoperative sphere was –1.09 D. (±1.25). Myopic and astigmatic improvement was achieved in each patient (100%). Topography analysis showed 69.4% were within 0.5 mm, 96.8% within 1 mm, 97.8% within 1.5 mm of centration; 55% of the patients achieved uncorrected visual acuity of 10/10 (Snellen). One patient (2.2%) lost one line of best corrected vision due to decentration and change of axis.

Conclusion

These preliminary results of myopic astigmatic excimer laser PRK procedures compare favorably in efficiency and safety with reports of PRK for myopia.
Ocular Penetration Kinetics of Fosfomycin Administered as a One-Hour Infusion
Authors: Forestier F. , Salvanet-Bouccara A. , Leveques D. , Junes P. , Rakotondrainy C. , Dublanchet A. , Jehl F.
Published: April 2018

The penetration of fosfomycin in aqueous humour was studied in 21 patients who were to undergo cataract surgery. All patients received 4 grams of fosfomycin as an infusion lasting one hour. Concentrations of the drug in aqueous humour were measured 1, 2, 4, 6 and 12 hours after the start of infusion. Drug concentrations in aqueous humour and serum were measured by HPCE (High Performance Capillary Electrophoresis).

The aqueous humour concentration at one hour was 11.46 mg/l ± 2.12. Peak concentration was 14.63 mg/l ± 5.54, reached two hours after the infusion. Concentrations were high until 6 hours and remained significant at 12 hours.

These results confirm the excellent diffusion of fosfomycin in aqueous humour, with high levels at 12 hours. They justufy its use in intraocular infections, by infusions repeated every eight hours, to maintain concentrations above the MIC 90 for organisms usually susceptible to the drug.
Ptosis Surgery Using Mersilene Mesh Suspensory Material
Authors: Can I. , Can B. , Yarangümeli A. , Inan Y. , Kural G.
Published: April 2018

Frontalis suspension procedure using a Mersilene mesh sling was performed on 23 ptotic eyelids of 22 patients (age range 3 to 35 years) with poor or absent levator function. The surgical technique used was a modified Fox's method. The mean palpebral fissure height was 3.1 mm preoperatively and increased to 8.0 mm after the operation. No serious complication was seen postoperatively and during an average follow-up of 25 months. In one case with a cosmetically inadequate result, the upper third of the initially implanted Mersilene mesh was removed during reoperation and histological examination of the specimen revealed fibrovascular tissue invasion through the mesh fibres.

Mersilene mesh appears to be an effective and safe alternative sling material for brow suspension surgery, giving good permanent results for cases in which autogenous fascia lata was inappropriate.
Role of Glycation in Human Lens Protein Structure Change
Authors: Ramalho J.S. , Marques C. , Pereira P.C. , Mota M.C.
Published: April 2018

Purpose

Protein glycation may be involved in cataract development, by altering protein structure, particularly amino acid composition, and formation of fluorophores through a Maillard reaction. This study was designed to evaluate major changes in early and advanced (fluorescent) glycation products, with special emphasis on glycation-induced changes in amino acid composition of lens proteins.

Methods

We analyzed 50 human cataractous lenses (25 diabetic and 25 non-diabetic). Glycated proteins were isolated by affinity chromatography. Glycated and non-glycated proteins were separated by molecular sieve chromatography and further analyzed by RP-HPLC to establish the amino acid content. Early glycation levels were determined as furosine content and advanced glycation products were quantified by the characteristic fluorescence.

Results

Specific lens fractions (HMW and LMW) present significant differences in fluorescence levels between glycated and non-glycated proteins, specially in cataractous lenses from diabetic patients in which all proteins analyzed presented higher glycation levels than in non-diabetic patients. The amino and analysis of glycated proteins also revealed some important differences in specific basic residues (namely Lys, Arg and His) compared to the non-glycated fraction.

Conclusions

The results suggest that protein glycation may be involved in changes in amino acid composition and fluorophore formation. This process may well account for the increased risk factor that diabetes represents for cataract development.
Correlation of Fundus Lesions and Hematologic Findings in Leukemic Retinopathy
Authors: El-Asrar A.M. Abu , Al-Momen A.-K. , Kangave D. , Harakati M.S. , Ajarim D.S.
Published: April 2018

This prospective study evaluated the relationship between the fundus findings in leukemic retinopathy and hematologic parameters. Seventy-four newly diagnosed consecutive patients with acute leukemia were included, 49 with acute myelocytic leukemia (AML), and 25 acute lymphocytic leukemia (ALL). Blood parameters were based on data obtained before starting any therapeutic modalities. Leukemic retinopathy was detected in 32 patients (43%). Patients with ALL and retinal hemorrhages had significantly lower hemoglobin and hematocrit levels than those without hemorrhages (p=0.004 and 0.018 respectively). AML patients with white-centered hemorrhages had a significantly higher leukocyte count than those without (p=0.0002). ALL patients with cotton-wool spots had significantly lower hemoglobin levels and hematocrit than patients without such lesions (p=0.044 and 0.05 respectively). AML patients with cotton woll spots had significantly lower leukocyte and platelet counts than those without (p=0.019 and 0.003 respectively). Our results suggest that anemia is related to the findings of retinal hemorrhage and cotton-wool spots in ALL patients, that high leukocyte count is associated with white centered hemorrhage in AML patients, and that thrombocytopenia is not associated with retinal hemorrhage in this group of patients.
Posterior Empty Spaces during Vitreoretinal Surgery
Authors: Azzolini C. , Brancato R.
Published: April 2018

Purpose

To study during vitreoretinal surgery the intravitreal posterior empty spaces caused by different posterior relationships between the retina, posterior hyaloid and posterior vitreous.

Methods

A total of 151 eyes with different vitreoretinal disorders were considered; 97 eyes with retinal detachment (Group I), 54 eyes without retinal detachment (Group II). Intraoperative anatomy was carefully observed. In Group I, intraoperative observations were made with and without the infusion fluid entering the eyes.

Results

Different intraoperative posterior empty spaces were found: (i) within the posterior vitreous, (ii) between the detached posterior hyaloid and the retina, (iii) above and below the detached posterior “isolated hyaloid”, and (iv) between the more posterior vitreous and the attached posterior hyaloid. The infusion fluid flux may variously change the size and shape of these posterior empty spaces.

Conclusions

Many types of posterior empty spaces were observed intraoperatively. Their correct interpretation was important to well-conducted surgery. Dynamic movements of fluids in the vitreous cavity caused many intraoperative artifacts, making it difficult to understand the empty spaces and the vitreoretinal relationships present before surgery.
Long-Term Cryopreservation of Human Donor Corneas
Authors: Canals M. , Costa J. , Potau J.M. , Merindano M.D. , Pita D. , Ruano D.
Published: April 2018

The purpose of the present study was to develop an optimal freezing method for cryopreservation of human donor corneas for transplantation. Three groups of ten human donor corneas each were cryopreserved using cooling rates of 0.5°C/min, 1 °C/min and 9°C/min. The freezing medium contained 10% fetal calf serum and 7% dimethylsulphoxide. Ten additional human donor corneas were used as controls. Endothelial cell survival after complete thawing was assessed by calculating the mean endothelial cell density and percentage of non-viable endothelial cells from vital staining and scanning electron micrographs. Significant differences in endothelial cell survival between all groups were detected by analysis of variance (p<0.001), but paired contrast found no real differences between corneas frozen at 0.5°C/min or 1°C/min. Nevertheless, 60% of the corneas cryopreserved at 1°C/min but only 10% of those cryopreserved at 0.5°C/min fulfilled both requirements to be considered suitable for transplantation (endothelial cell density > 2000 cells/mm2 and less than 10% dead cells). None of the corneas frozen at 9°C/min fulfilled these requirements. Mean endothelial cell density of corneas frozen at 1°C/min was 2084 cells/mm2 (range 2020 to 2630 cells/mm2). Except for isolated corneas frozen at 0.5°C/min, only corneas cryopreserved at a cooling rate of 1°C/min achieved satisfactory endothelial cell survival for their use in transplantation. However the significant interindividual variability among corneas frozen at 1°C/min (ANOVA: p<0.001) prevents prediction of the condition of the cornea after the complete cryopreservation process. Until this high variability can be drastically reduced, systematic corneal cryopreservation in eye banking remains unattainable.
Granular Dystrophy Associated with Congenital Cataracts
Authors: Brito C. , Pablo L. , Sánchez A. , Ramírez T. , Polo V.
Published: April 2018

Seven members of the same family suffering from Groenow I granular dystrophy and associated congenital cataracts have been studied.

Three patients had corneal dystrophy at various stages and trhee others had a fetal nuclear congenital cataract. A penetrating keratoplasty button was studied under light and electron microscopies. This association has not been described previously. However we must emphasize that there is no general validity for a correlation between granular dystrophy and congenital cataract.
Surgically Induced Astigmatism after Manual Extracapsular Cataract Extraction or after Phacoemulsification Procedure
Authors: Cavallini G.M. , Lugli N. , Campi L. , Lazzerini A. , Longanesi L.
Published: April 2018

Astigmatic changes in three series of cataract surgical procedures were compared. The first two series comprised eyes having a manual extracapsular cataract extraction (ECCE) through a 12.0 mm or 8.0 mm incision and implant of a PMMA posterior chamber lens. The third series comprised eyes having phacoemulsification through a scleral pocket and implant of a PMMA posterior chamber lens. Preoperative keratometry measurements and corneal topography maps were compared with those obtained two days, one week, one, three and six months postoperatively. The keratometry measurements, obtained with computerized videokeratography, revealed: on day 2, 4.89 D (1st series), 3.95 D (2nd series), 2.66 D (3rd series); one week, respectively 4.46 D, 3.51 D and 2.14 D; one month, 0.65 D, 0.53 D and 0.05; three months, 1.44 D, 0.35 D and 0.36 D; six months, 1.36 D, 0.42 D and 0.48 D. The surgically-induced cylinder at three months was four times greater in the manual ECCE 12.0 mm incision series than in the phacoemulsification series. However, by six months all differences were markedly reduced. The results add to the growing evidence that the phacoemulsification procedure produces less astigmatism and more rapid visual rehabilitation than the manual ECCE procedure. Topographic analysis showed much less corneal steepening after phacoemulsification than after manual ECCE. However, all three surgical procedures offered satisfactory clinical results.
Simultaneous 24-Hour Monitoring of Intraocular Pressure and Arterial Blood Pressure in Patients with Progressive and Non-Progressive Primary Open-Angle Glaucoma
Authors: Detry M. , Boschi A. , Ellinghaus G. , De Plaen JF.
Published: April 2018

We measured and compared diurnal and nocturnal blood pressure (BP) with the Space Labs Holter in progressive and non-progressive glaucomatous patients with a satisfactory diurnal control of IOP in order to identify any link between a progressive worsening of their visual field (VF) defects and the characteristics of their nocturnal BP “dip”. Ambulatory 24-hour BP monitoring and inpatient IOP curves were done on two consecutive days on 36 patients (17 women, 19 men, mean age 67.44 ± 8.06 years) with moderate to severe POAG and good diurnal therapeutic control of IOP (daytime IOP ≤ 21 mm Hg). Depending on the stability or progression of their VF defects during the last two years, the patients were classified in two groups: the progressive group comprised 24 patients (14 women, 10 men) and the stable group 12 patients (9 men, 3 women). We compared local and systemic risk factors for POAG, mean and maximum daytime and nighttime IOP in each group. The mean systolic and diastolic daytime BP, mean systolic and diastolic nighttime BP and the nocturnal systolic and diastolic BP dip were calculated for each patient. The distribution of these parameters was then statistically compared with normal reference values and for the two groups. The groups were closely comparable as regards their IOP 24-hour profile. The overall mean daytime, nighttime, and nocturnal dips fell within the normal range of the reference population.

We found a significanty smaller systolic and diastolic BP dip in the progressive group and a broader distribution of the lower values both for systolic and diastolyc BP in the progressive group. A broader distribution of the lower values for systolic and diastolic BP dip was also noticed when progressive patients were compared with the reference population.

The relative absence of a nocturnal BP dip may be interpreted as another disturbing factor in the self-regulatory mechanisms of the optic nerve head in glaucoma.
Uveitis in Children
Authors: Pivetti-Pezzi P.
Published: April 2018

Uveitis is diagnosed more often in adults than in children but in children the prevalence of chronic inflammation and the difficulty of an early diagnosis may worsen the visual prognosis. The different incidence of the presumed or defined etiologies in the various ages is probably responsible for the better classification of uveitis in childhood (71% versus 55% in adult patients). Juvenile rheumatoid arthritis is the most common identifiable etiology of pediatric anterior uveitis (28%). However, its long-term prognosis is not satisfactory and ophthalmic surveillance protocols are necessary especially for ANA and HLA DR11 positive girls with the pauci articular form of the disease. Intermediate uveitis is idiopathic in 98% of the cases and accounts for 20-26% of all pediatric uveitis; cystoid macular edema in these patients is the leading cause of visual impairment. Toxoplasmosis is the most frequent cause of posterior uveitis (43%) and of uveitis in childhood (12%); involvement is bilateral in 50-60% of cases. Diffuse uveitis forms are uncommon in children, but their course is particularly severe. They may either be the natural evolution of a posterior uveitis or the presenting sign of a systemic disease typical of the third decade of life, such as sarcoidosis, Behçet's disease, Vogt-Koyanagi-Harada's disease. Masquerade syndromes including retinoblastoma, leukemia and lymphoma, intraocular foreign body, retinitis pigmentosa may contribute to confusion in the differential diagnosis of inflammatory disease of the uveal tract in childhood.
Indocyanine Green Angiography in Serpiginous Choroidopathy
Authors: Giovannini A. , Ripa E. , Scassellati-Sforzolini B. , Ciardella A. , Tom D. , Yannuzzi L.
Published: April 2018

Background.

Manifestations of serpiginous choroidopathy have been well described, but very little is known about its true pathogenesis. By virtue of the enhanced imaging of the choroidal circulation, indocyanine green angiography may offer information on the causative factors of the disorder.

Methods.

Indocyanine Green (ICG) videoangiography was carried out in 17 patients with serpiginous choroidopathy. A full ophthalmological examination and intravenous fluorescein angiography were simultaneously done as well. The patients were studied at 3 different stages of the disease as follows: 1) with acute manifestations; 2) with subacute lesions; 3) in the inactive or healed state.

Results.

Acute Lesions: Indocyanine angiography showed active choroidal involvement in the acute stage beyond the limits delineated by corresponding fluorescein studies. Subacute Lesions: ICG angiography showed resolution of choroidal involvement in advance of clinical and fluorescein angiographic changes in some eyes. Healed Lesions: ICG angiography showed better delineation of the atrophic choroid with clearer definitions than corresponding fluorescein studies. Late staining of fibrovascular tissue within atrophic zones was similar to fluorescein findings. Two patients in the healed state showed multifocal hypofluorescence (one patient) and hyperfluorescent choroidal lesions (one patient) with no clinical or fluorescein counterparts, possibly representing occult lesions.

Conclusions.

ICG angiography may be useful in understanding certain clinical features of the entity, such as a clearer documentation of the extent and nature of the choroidal damage and possible sites at risk for future recurrences. However, it adds little to our current management of the disorder.
Laser Photocoagulation of Soft Drusen in Early Age-Related Maculopathy (Arm). the One-Year Results of a Prospective, Randomised Trial
Authors: Frennesson I.C. , Nilsson S.E.G.
Published: April 2018

In this prospective, randomised trial, 19 patients (mean age 72.2±6.6 years) with soft drusen maculopathy and good visual acuity (0.93+0.1) were treated with argon green laser photocoagulation. Fundus colour photography and fluorescein angiography were performed at study entry and after 3, 6 and 12 months. Nineteen patients (mean age 68.5±6.2 years) with visual acuity 0.95±0.1 and similar fundus changes served as a control group. The area occupied by drusen within a circular zone was calculated in the fundus colour photographs (radius 2500 μm) and in the angiograms (radius 1250 μm). Mean drusen area of the treatment group did not differ from that of the control group at study entry (p>0.5-0.7). In the treatment group, mean drusen area had decreased significantly from 7.87% to 2.93% (p=0.00013) and from 19.22% to 7.15% (p<0.0001) at 12 months respectively in the colour photographs and in the angiograms. Visual acuity and colour contrast sensitivity did not change. No complications were seen in the treated group. In the control group, mean drusen area increased from 8.33% to 10.69% and from 17.41% to 22.05%, respectively. These differences did not reach statistical significance. When comparing the 12-month change in drusen area in the two groups, significant differences were found both in fundus colour photographs and angiograms (p<0.001). In the control group, mean visual acuity decreased to 0.89±0.1 (p=0.008) and mean colour contrast threshold for the tritan axis increased significantly (p=0.044), indicating impairments of retinal function. Three patients in the control group advanced to an exudative stage of the disease.
Comparative Evaluation of the Short-Term Bactericidal Potential of a Steroid-Antibiotic Combination versus Steroid in the Treatment of Chronic Bacterial Blepharitis and Conjunctivitis
Authors: Shulman D.G. , Sargent J.B. , Stewart R.H. , Mester U.
Published: April 2018

The effects of four days’ treatment with topical Maxitrol® (neomycin sulphate 3500 lU/mL, polymyxin-B sulphate 6000 lU/mL with dexamethasone 0.1%) were compared with those of Maxidex® (dexamethasone 0.1% alone) in a double-masked study in 111 patients with bacterial blepharitis or conjunctivitis, 95 of whom were evaluable for efficacy. The majority of patients (N=80) had chronic blepharitis. Maxitrol treatment resulted in a significantly greater reduction (90%) in bacterial counts and bacterial eradication (50%) compared with Maxidex (34% and 17% respectively). Maxitrol treatment also produced a significantly greater reduction in conjunctival discharge than did Maxidex, while the treatments were equally effective in alleviating other ocular signs and symptoms. It was concluded that use of a fixed dose combination steroid-antibiotic product was more effective for bacterial control and therapeutic efficacy in the treatment of chronic blepharitis and conjunctivitis patients than treatment with steroid alone. However, in the long-term treatment of chronic blepharitis the well-known toxic problems of neomycin sulphate have to be taken into account.
Sulcus Fixated Posterior Chamber Lenses with and without Suture in Cases Lacking Capsular Support
Authors: Hennekes R.
Published: April 2018

In a prospective study ten commercially available anterior chamber lenses with S-shaped haptics and multipoint support were implanted into the posterior chamber in cases of secondary lens implantation after intracapsular cataract operation. The lenses were trans-sclerally fixed by two sutures through the ciliary sulcus. They showed more immediate stability than ten C-loop posterior chamber lenses of a control group and remained firmly fixed without complications during a follow-up of up to 54 months. To overcome the disadvantages of suture fixation a sutureless sulcus self-fixating PCL was developed and implanted into six eyes with special indications. After more than one year of follow-up no late adverse reaction was noted.
Management of Delayed Massive Suprachoroidal Hemorrhage: A Clinical Retrospective Study
Authors: Becquet F. , Caputo G. , Mashhour B. , Chauvaud D. , Pouliquen Y.
Published: April 2018

Suprachoroidal hemorrhages, both expulsive and delayed non-expulsive, are among the most devastating complications of intraocular surgery. We reviewed the charts of 13 patients with a delayed non-expulsive suprachoroidal hemorrhage (DNSCH) after cataract extraction (3 patients), glaucoma filtering surgery (6 patients), penetrating keratoplasty (3 patients), or vitrectomy (1 patient). All had large hemorrhagic choroidal detachments with nine eyes presenting kissing choroidal detachment, five eyes with associated retinal detachment, and one eye with intravitreous hemorrhage. All patients were treated with systemic corticosteroids before surgery. Eleven eyes underwent anterior drainage sclerotomy, followed by SF6 gas injection in eight eyes, and pars plana vitrectomy with silicon oil tamponade in three eyes. Mean follow-up was 22 months. These procedures gave good anatomical results in eleven cases and good visual results in nine. The results suggest that not all DNSCH need to be drained surgically but that, when surgical drainage is indicated, the use of gas to maintain internal tamponade appears to be beneficial.
Clinical use of a New Method for Visual Field Damage Classification in Glaucoma
Authors: Brusini P.
Published: April 2018

This new method, based on the use of MD and CPSD (or CL V) visual field indices, can instantly classify not only the stage of glaucomatous visual field damage, but also the type of defect (localized, generalized or mixed). This system was used to study glaucomatous visual field defects in 500 automated tests, performed with either Humphrey 30-2 or Octopus G1 threshold tests. The most common defects found were mixed, and purely local defects were very unusual, especially in advanced glaucoma.
Ocular Abnormalities in Transgenic Mice Harboring Mutations in the Type Ii Collagen Gene
Authors: Ihanamäki T. , Metsäranta M. , Rintala M. , Vuorio E. , Sandberg-Lall M.
Published: April 2018

Purpose.

To characterize the morphological changes in the eyes of transgenic mice harboring different mutations in type II collagen gene to elucidate the function of this collagen in the eye, and to find out whether these animals could function as models for the human arthro-ophthalmopathies of the Kniest, Stickler and Wagner types.

Methods.

Three genetically engineered mouse lines representing two types of mutations in the triple-helical domain of type II collagen and their nontransgenic littermates used as controls were analyzed on day 18.5 of embryonic development. After genotyping by polymerase chain reaction (PCR) and Southern hybridization the embryos were prepared for routine histology. Polarization microscopy was done on hyaluronidase-treated sections.

Results.

Histological analysis revealed several genotype-dependent abnormalities in the eyes of the transgenic mice. Most striking changes were observed in the vitreous architecture; in one line of mice the vitreous was tightly packed in the posterior region of the vitreous space with thick fibrils, empty cavities and dense membrane-like material. The other mutation resulted in reduced filament density of the vitreous. In the most severely affected phenotype the internal limiting membrane was detached from the retinal layers and was markedly thickened, and the posterior lens capsule was thickened. The anterior chamber was shallow or absent in all transgenic lines but was well formed in the normal animals. Changes were also observed in the lens, corneal and scleral structures.

Conclusions.

The ocular changes observed in transgenic mice harboring mutations in type II collagen gene show similarities to the human ocular findings in Kniest dysplasia, and in Stickler and Wagner syndromes. We therefore propose that these animals could serve as models for systematic analysis of vitreoretinal degeneration and other abnormalities, as seen in these syndromes.
Intraocular Foreign Bodies: Myths and Truths
Authors: Kuhn F. , Halda T. , Witherspoon C.D. , Morris R. , Mester V.
Published: April 2018

Over the centuries, the management of eyes with intraocular foreign bodies (IOFB) has posed a special challenge to the physician, and the anxiety created by such injuries has never abated. During the past few decades, several new diagnostic tests, IOFB removal techniques, and methods to treat the complications of the injury have been introduced. Nevertheless, old habits die hard: many of the management options that used to be standard are not appropriate any more but have proved difficult to change. This article reviews over forty of these die-hard myths and confronts them with factual statements published in the peer-review international literature.
Spontaneous and Pharmacologically-Modulated Wound Healing after Nd: Yag Laser Sclerostomy Ab Interno in Rabbits
Authors: Iliev M.E. , Van Der Zypen E. , Fankhauser F. , England C.
Published: April 2018

The course of tissue repair evoked by Nd:YAG laser sclerostomy ab interno and the effect of mitomycin-C on same were investigated ultrastructurally in 15 rabbits. In ten of them, the dynamics of the spontaneous postoperative healing response (i.e. in the absence of medication) was analyzed at two-day intervals by light- and electron microscopy. In two, fibroblast activity was assessed autoradiographically. In the last three rabbits, the sclerostomy site was exposed transconjunctivally to mitomycin-C (0.5 mg/ml; 5 minutes) before surgery, and morphological analysis was done on postoperative days 6 and 12.

Results.

In the spontaneously healing group, blebs disappeared within five days of surgery. This corresponded to a massive invasion of macrophages and fibroblasts from the episclera and iris root. The sheath of coagulated tissue around the fistula appeared to act as a barrier to cell migration from the sclera itself at this stage. By days 8 to 12, the canal had become occluded by a network of cells and capillaries, and collagen fibrils in the coagulation sheath had undergone repolymerization. In the mitomycin-C group, large filtering blebs and patent, cell-free fistulas were observed over the entire period. Although applied transconjunctivally, the drug penetrated the whole scleral depth, as the iris root and ciliary body cell reaction was inhibited. Repolymerization of heat-damaged collagen was also hindered. The overall findings provide information on the sequence of repair events following laser sclerostomy. Local, non-invasive application of mitomycin-C delays the onset of this process, not only by inhibition of cell proliferation but also by suppressing the collagen recovery.
Luminance and Color Contrast Sensitivity and Vep Latency in Subjects with Normal and Defective Binocularity
Authors: Johansson B. , Jakobsson P.
Published: April 2018

Luminance contrast sinusoidal gratings (spatial frequencies 1, 2 and 4 cycles/degree) were compared with the corresponding color contrasting patterns (along the protan, deutan and tritan axes) to see whether they demonstrated normal binocular function in humans, and distinguished between normals and persons with defective binocularity. Contrast sensitivity and transient pattern VEP latency (on-responses) were measured in normals (n=11, median age 36, range 12–46 years) and subjects with no stereopsis (n=6, median age 13, range 8–38 years). The normal group had significantly higher contrast sensitivity with binocular stimulation for all patterns except tritan contrast gratings of 2 and 4 c/deg. The stereo-deficient group showed no higher binocular contrast sensitivity for any pattern. Differences between groups were significant with all gratings of 4 c/deg, and also with protan and deutan contrast gratings of 2 c/deg. In the normal group, binocular VEP latency was significantly shorter than the monocular with protan contrast gratings of 2 c/deg and tritan contrast gratings of 1 and 2 c/deg. Differences between the normal and the stereo-deficient groups were significant for all color contrast patterns of 2 c/deg, and tritan contrast gratings. of 1 c/deg. We conclude that color contrast sensitivity and VEP measurements are potentially useful for demonstrating binocular function, and for separating normals from stereo-blind subjects. Color contrast patterns however are less effective than the corresponding luminance contrast patterns in evoking cortical potentials.
Gorlin's Syndrome. Case Report
Authors: Salati C. , Virgili G. , Menchini U. , Frattasio A. , Patrone G.
Published: April 2018

Gorlin's syndrome (GS) is a hereditary dominant autosomal disease linked to a gene which has a strong discerning and an extremely variable expressiveness. It is an ecto-mesodermic polydysplasia generally characterized by multiple nevoid basal-cell carcinomas, palmo-plantar pits, cysts of cutis and long bones, intracranial ectopic calcification; less frequently it is accompanied by tumors of other organs such as the ovaries, and by brain, neurological and ocular defects. Chalazions and squinting are the most typical ocular complications.

We describe a patient with GS detected at an ophthalmology consultancy during which by chance we found multiple peripheral retinal breaks with a partial retinal detachment and retinoschisis.
Macular Hole in a Case of Choroidal Melanoma
Authors: Uffer S. , Zografos L.
Published: April 2018

Background.

Rhegmatogenous retinal detachment associated with intraocular tumors has been described in a small number of cases. We describe a patient with choroidal melanoma associated with a rhegmatogenous retinal detachment and a macular hole.

Methods.

A 71-year-old man underwent enucleation for a bulky pigmented tumor overying the macula.

Results.

Hystopathological examination revealed moderate cystoid macular edema with a full-thickness macular hole and a mixed-cell type choroidal melanoma.

Conclusions.

The relationships between choroidal melanoma, macular hole and rhegmatogenous retinal detachment are discussed.
Cataract Surgery in Fuchs’ Heterochromic Iridocyclitis
Authors: Avramides S. , Sakkias G. , Traianidis P.
Published: April 2018

Purpose.

To assess the particularities of extracapsular cataract extraction and posterior chamber intraocular lens implantation in patients with Fuchs’ heterochromic iridocyclitis.

Methods.

Retrospective analysis of 24 extracapsular cataract operations performed from September 1991 to June 1994. Our technique - a slight modification of Blumenthal's technique - included a triplanar watertight small scleral incision, an envelope capsulotomy, nucleus hydrodissection and hydroexpression, anterior chamber maintainer use, thorough residual cortex removal through a side-port corneal incision and “in the bag” posterior chamber intraocular lens implantation.

Results.

Mydriasis was slightly larger than 5 mm in 79.16% of the total group. Posterior capsule rupture with vitreous loss occurred in one and without in two patients. A transient rise in intraocular pressure was seen in seven patients and a mild anterior chamber reaction in almost all patients. No bleeding occurred during anterior chamber opening, or postoperative I.O. L. decentration or glaucoma. Best corrected postoperative visual acuity ranged from 5-10/10 in 21 patients (87.50%).

Conclusions.

Extracapsular cataract extraction in patients with Fuchs’ heterochromic iridocyclitis does not currently present any difficulties compared with normal senile cataract. No major complications occurred and the final visual acuity was satisfactory.
Correlation between Ocular Hypertension Induced by Ibopamine and Perimetric Defect in Primary Open-Angle Glaucoma
Authors: De Gregorio F. , Pecori-Giraldi J. , De Stefano C. , Virno M.
Published: April 2018

In 35 patients with bilateral primary open-angle glaucoma (POAG), with asymmetrical evolution of the neuropticopathy between the two eyes, we compared within each patient, the response to ibopamine and the perimetric defect. In 88% of cases (31/35 patients) the eye with the most severe perimetric defect had high intraocular pressure or a larger IOP increase after ibopamine. This result was highly significant at the sign test (P<0.001). IOP and its increase after ibopamine significantly differed in the most and least affected eye, being higher in the eye with the most impaired visual field. Since ibopamine can be used to quantify the hydrodynamic impairment, which is thus presumably correlated to the perimetric defect. This study further confirms its importance in the development of glaucomatous damage.
Exploration of Vogt-Koyanagi-Harada Syndrome by Infrared Choroidal Angiography with Indocyanine Green
Authors: Harada T. , Kanbara Y. , Takeuchi T. , Niwa T. , Majima T.
Published: April 2018

The choroid affected by the Vogt-Koyanagi-Harada syndrome (VKH) has seldom been explored by indocyanine green choroidal angiography. Five patients with definite diagnosis of VKH underwent this investigation. The first case had the most marked leakage, very similar to that on fluorescein angiography. The right eye of case 2 showed fewer leakage points on ICG than on fluorescein angiography, compared with case 1. The left eye of case 2 did not show any leakage. Cases 3, 4 and 5 yielded segmental hyperfluorescence, distant from the posterior pole, which could not be identified by fluorescein angiography. This might indicate segmental choroiditis.

There were two types of hypofluorescent lesions; all the cases except case 2 showed early hypofluorescence. Hypofluorescent areas corresponding to overlying retinal detachment were seen in the right eye of case 4. Multiple spots, late hypofluorescence, about 200 to 500 urn in size appeared throughout the posterior pole in four eyes out of ten.

In conclusion, indocyanine green choroidal angiography provides a wider variety of pictures than fluorescein angiography.