bluuebunny/crossref_metadata_2025 huggingface dataset:
Traumatic Rupture of the Globe Caused by Cow Horns
Authors: Helbig H. , Iseli H.P.
Published: January 2018

Purpose

We investigated the epidemiology, clinical findings and functional outcome of open-globe injuries caused by cow horns over a 50-year period in eastern Switzerland.

Methods

We retrospectively evaluated the files of cases with ruptures of the globe caused by cow horns between 1950 and 1999.

Results

We found 59 cases with ruptures of the globe by cow horns, accounting for 5% of all open-globe injuries. The incidence of these accidents did not change during the observation period. Twenty-two eyes (37%) were enucleated. Only 7 eyes (12%) retained a vision of ≥0.1. Between 1950 and 1989 only 2/43 eyes (5%) reached a vision of ≥0.1. In the 1990's, with the introduction of vitreous surgery 5/16 eyes (31%) had a vision of ≥0.1. Four patients (7%) had blinding eye disease in the partner eye, and three (5%) had a second open-globe trauma.

Conclusions

In rural regions, with cattle breeding, open-globe injuries by cow horns are relatively common and the frequency is still the same as 50 years ago. The visual prognosis of these eyes is still guarded, but functional results have improved with the introduction of vitreous surgery. Patients who have had a rupture of the globe appear to have an increased risk for partner eye trauma. Therefore, all efforts are justified to preserve even limited vision in severely injured eyes.
Pleomorphic Adenocarcinoma of the Ciliary Epithelium: A Clinicopathological, Immunohistochemical, Ultrastructural, Dna-Ploidy and Comparative Genomic Hybridization Analysis of an Unusual Case
Authors: Nicolò M. , Nicolò G. , Zingirian M.
Published: January 2018

Purpose

To describe detailed phenotypic and genotypic analysis of a pleomorphic adenocarcinoma of the ciliary epithelium (CE).

Case Report

An 86-year-old white woman developed an enlarging mass protruding from her previously eviscerated left eye 2 months postoperatively. Based on light and ultrastructural microscopy, the final diagnosis was a pleomorphic adenocarcinoma of the ciliary epithelium (CE).

Discussion

Cell proliferation indices confirmed the unusually rapid growth rate of this tumor; the peridiploid DNA content might explain the relatively low incidence of distant metastases. An imbalance o the chromosome 6 was also found by Comparative Genomic Hybridization (CGH).
Optical Coherence Tomography (OCT) in Retinal Angiomatous Proliferation (RAP)
Authors: Brancato R. , Introini U. , Pierro L. , Setaccioli M. , Forti M. , Bolognesi G. , Tremolada G.
Published: January 2018

Purpose

To verify the utility of optical coherence tomography (OCT) for diagnosing retinal angiomatous proliferations (RAP) in patients with exudative age-related macular degeneration (AMD).

Methods

Multiple cross-sections were taken with OCT from 41 eyes of 39 consecutive patients with AMD and RAP. The presence and the location of the angiomatous complexes had already been documented by fluorescein angiography (FA) and high-speed confocal indocyanine green videoangiography (ICGA).

Results

RAP was detectable by OCT scans in all 41 eyes, appearing as a focal hyper-reflecting area in the neuroretinal layers; it was frequently located close to the inner surface of the retinal pigment epithelium (29 eyes [70.7%]). All eyes had either no or only a low-reflecting OCT signal surrounding the RAP, caused by serous intraretinal edema. Only 13 eyes (31.7%), however, had large serous retinal detachment (SRD). OCT detected pigment epithelium detachment in 31 eyes (75.6%), but none had underlying choroidal neovascularization.

Conclusions

OCT findings confirm the intraretinal localization of the RAP which are always associated with impressive exudative phenomena. OCT is therefore a useful diagnostic tool, adding information to FA and high-speed ICGA.
Retinochoroidal Mass: A Presenting Feature of Metastatic Oat Cell Carcinoma of Lung
Authors: Gupta M. , Puri P. , Jacques R. , Rennie I.G.
Published: January 2018

Purpose

To report retinochoroidal metastasis in small cell carcinoma of the lung.

Methods

Interventional case study. A 46 year old Caucasian male complaining of decreased vision in the left eye wads found to have a retinochoroidal metastasis. He also had developed some subcutaneous nodules and was feeling systemically unwell.

Results

Excisional biopsy of one of the subcutaneous nodules was consistent with small cell carcinoma of the lung. The patient received palliative treatment and died a month later.

Conclusions

Retinochoroidal metastasis can be the presenting sign of small cell carcinoma of the lung
Apoptosis and Lens Vesicle Development
Authors: Mohamed Y. H. , Amemiya T.
Published: January 2018

Purpose

To study the development of the rat lens vesicle in relation to apoptosis.

Materials and Methods

Fetuses of Wistar Kyoto rats were removed by laparotomy on day 10–15 of gestation. Some fetuses were fixed in 2% paraformaldehyde and embedded in paraffin for a TUNEL technique examination of DNA fragmentation. Macrophages were stained immunohistochemically with antibody. Some fetuses were fixed in 4% glutaraldehyde and 1% osmic acid and embedded in Luveak 812, then examined with a transmission electron microscope (TEM).

Results

On day 11 of gestation (E11) before the start of lens invagination, apoptotic changes were noted in the cells between the surface ectoderm and optic vesicle, with the appearance of phagocytic cells. Apoptotic cells were present at the junction of the surface ectoderm and the lens placode, in the ventral and dorsal thirds of the lens placode and in the outer layer of the optic vesicle in the same axes on E12. Apoptotic changes appeared in the lens stalk, surface ectoderm and the anterior lens epithelium on E12.5. The lens vesicle was detached completely from the surface ectoderm by E13 and some cells had the typical characteristics of macrophages in the extracellular space between the surface ectoderm and the anterior lens epithelium. Apoptotic changes were confirmed by the TUNEL method, and macrophages were stained immunohistochemically.

Conclusions

Apoptosis may have a major role during the whole process of lens vesicle development. Apoptosis may eliminate the cells between the surface ectoderm and the optic vesicle, help trigger invagination and facilitate separation from the ectoderm. Apoptosis might aid in the bowing of the optic vesicle during lens invagination.
Indirect Trauma Causing Dislocation of the Crystalline Lens - A Case Report
Authors: Jones LD. , Sampat V. , Hero M.
Published: January 2018

Purpose

To report a case of indirect trauma causing dislocation of the crystalline lens in a patient with no underlying risk factors.

Methods

Case report.

Results

A 76-year-old woman fell injuring her right temple area. She complained of blurring of vision in her right eye. Her vision was reduced to 6/60. Ocular examination revealed right aphakia associated with complete posterior dislocation of the crystalline lens into the vitreous cavity. No predisposing factors as pigment dispersion or pseudoexfoliation material was found on gonioscopy.

Conclusions

Dislocation of the crystalline lens has been reported following direct trauma. It is known to occur spontaneously in mature and hypermature cataracts and in cases of weak zonules. Our case shows that indirect trauma can cause complete dislocation of the crystalline lens in the absence of any predisposing factors.
Uveitis Associated with Granuloma Annulare
Authors: Oz O. , Tursen U. , Yildirim O. , Kaya T.I. , Ikizoglu G.
Published: January 2018

Purpose

To report a case of uveitis associated with granuloma annulare (GA). GA is a benign, usually self-limited dermatosis of unknown origin, causing necrobiotic dermal and subcutaneous papules. So far, ocular involvement has not been reported in GA.

Methods

We describe a case of uveitis with GA. Ocular examination findings were consistent with uveitis. Histopathologic studies on lower extremity lesions revealed features consistent with GA.

Results

The patient was successfully treated with systemic and topical corticosteroids. After two months, however, the skin and eye lesions relapsed. When the same treatment was restarted, her lesions regressed within four weeks.

Conclusions

This case provides an example of concomitant uveitis and GA. To our knowledge, this is the first report of this combination.
Impression Cytology on Conjunctiva and Cornea in Dry Eye Patients Establishes a Correlation between Squamous Metaplasia and Dry Eye Clinical Severity
Authors: Murube J. , Rivas L.
Published: January 2018

Purpose

To obtain deeper knowledge of the cellular transition in squamous metaplasia, and to look for a correlation between the clinical grade of severity of dry eye and the grade of squamous metaplasia of the corneal and conjunctival epithelium, studied by impression cytology.

Methods

A total of 143 patients with dry eye disorders of different grades of clinical severity and 33 control subjects of matched age and sex were studied. Symptoms, clinical tests (including Schirmer test, slit-lamp examination, break-up time, rose Bengal staining, vanishing lacunar sulci, and neovascularization), and tear osmolarity were used to establish the diagnosis of dry eye. The subjects were classified into six clinical grades, grade 0 indicating normal and grades 1 to 5 progressively more severe dry eye. Impression cytology specimens were taken from the central cornea and different areas of the conjunctiva of one eye from all patients. A morphologic and morphometric study of the photographs obtained by light microscopy showed cell size, nuclear size, nuclear-cytoplasmic ratio (N:C) in nonsecretory epithelial cells, and density of goblet cells.

Results

Morphometric and morphologic studies of the ocular surface cells indicated significant differences, mainly in cell sizes, nuclear alterations, and the N:C ratio, in nonsecretory epithelial cells of the conjunctiva and cornea, and in goblet cell densities from the conjunctiva, between the clinically normal eyes and those with the five grades of clinical severity of dry eye, with different degrees of squamous metaplasia.

Conclusions

A morphologic and morphometric analysis of the ocular surface from patients with dry eye obtained by impression cytology led us to draft a new grading system containing one normal level and five levels of squamous metaplasia. This new grading system is based on a significant decrease in the number of goblet cells with less periodic acid-Schiff-hematoxylin-positive staining, an increase in nonsecretory cell size, more marked cell separation, a lower N:C ratio, and an increase in nuclear alterations. The clinical severity of the dry eye correlates with these alterations.
Autogenous versus Allograft Fascia Lata in Frontal Sling Surgery - Long-Term Results
Authors: Gürdal C. , Erdener U. , Orhan M. , Irkeç M.
Published: January 2018

Purpose

Either autogenous or allograft fascia lata frontal sling procedures can be used for the treatment of severe ptosis. We retrospectively evaluated the late outcomes of both approaches.

Methods

Medical records of patients who underwent frontal sling ptosis surgery between 1978 and 2000, with a follow-up of one year or more were included in the study. Success rates and the complications of the surgery for autogenous and allograft fascia lata were recorded. The results were compared statistically.

Results

Surgeries were performed with 82 autogenous or 43 allograft fascia lata. At last follow-up there were 71 eyes (86.6%) with good, 8 eyes (9.7%) with moderate, 3 eyes (3.7%) with poor results after autogenous fascia lata and 35 (81.4%), 3 (7%) and 5 (11.6%) after the allograft fascia lata frontal sling procedure. There was no significant difference between the two groups. Repeat surgery was carried out on three patients after autogenous and five after allograft fascia lata surgery. Two cases of preseptal cellulitis were observed, one abscess after autogenous and one lagophthalmus after allograft fascia lata sling surgery. All patients had slight edema early after surgery which resolved in a few days. Only one patient developed a hematoma at the site of the leg incision.

Conclusions

Although the long-term success rate with the autogenous fascia lata is slightly higher and this remains the first choice, allograft fascia lata is a good alternative in patients in whom fascia could not be harvested.
Divergent Strabismus Fixus - A Case Report
Authors: Sharma T.K. , Grewal J.S. , MacDonald M.
Published: January 2018

Strabismus fixus is a rare condition and usually is of convergent type in which one or both eyes are anchored in a position of extreme adduction. Convergent type strabismus fixus is considered to be a congenital disorder (1) and a part of congenital extraocular muscle fibrosis syndrome (1). Villasecca (2) and Martinez (4) described an acquired type of strabismus fixus. Hayashi et al (3) reported that progressive esotropia could develop into the acquired type of convergent strabismus fixus. There are very few reports of divergent strabismus fixus in the literature. It may or may not be accompanied by ptosis or generalized extraocular muscle fibrosis. In our report, a case of divergent type strabismus fixus is described and discussed.
Choroidal Neovascularization Secondary to Vitrectomy for Idiopathic Epiretinal Membrane: Report of an Unusual Case
Authors: Micelli Ferrari T. , Dammacco R. , Quaranta G.M. , Cardascia N. , Boscia F. , Sborgia C.
Published: January 2018

Purpose

Epiretinal membranes (ERM) are a common finding in old patients. Pars plana vitrectomy is effective for removing ERM from the macula, but some postoperative complications are relatively frequent. In the present report, we describe a 73-year-old man in whom extrafoveal choroidal neovascularization developed four months after surgery.

Methods

Choroidal neovascularization was treated by argon laser photocoagulation. Results: Six months after treatment, the choroidal neovascularization was obliterated, with no recurrence of ERM.

Conclusions

Choroidal neovascularization can be an unusual complication of ERM surgery, and should be suspected in case of poor visual outcome or recurrence of symptoms.
Optical Biometry before and after Excimer Laser Epithelial Keratomileusis (LASEK) for Myopia
Authors: Winkler Von Mohrenfels C. , Gabler B. , Lohmann C.P.
Published: January 2018

Purpose

In order to select the correct intraocular lens (IOL) for implantation, it is important to measure the eye length (biometry). The IOL Master from Zeiss-Humphry is frequently used for such measurements. Because this instrument employs an optical method, any irregularities on the corneal surface or any disturbances in corneal transparency could lead to mistakes in the measurements. The aim of this study was to determine whether eye length measurements obtained at the University Eye Clinic Regensburg, Germany with the IOL Master before and after excimer laser epithelial keratomileusis (LASEK) show any changes.

Methods

Axial length was measured on 20 myopic eyes (–2.75 to –8.00 diopters) before and one month after LASEK using the IOL Master.

Results

The mean pre-operative eye length was 25.46 mm (SD±1.03) and the postoperative mean length was 25.38 mm (SD±0.99). There was a strong correlation between the pre- and post-operative eye lengths (Pearson correlation coefficient 0.998).

Conclusions

Although LASEK can lead to increased light scattering due to irregularities of the corneal surface and changes in corneal transparency, there is no difference in biometry pre- and post-operatively.
Bilateral Central Anterior Stromal Opacity of the Cornea: Dystrophy or Degeneration?
Authors: Toker E. , Bavbek T.
Published: January 2018

Purpose

To describe a bilateral, central, oval corneal opacity not resembling any known corneal degeneration or dystrophy.

Methods

Ophthalmic examination, corneal topography, and pachymetry.

Results

A 30-year-old woman presented complaining of blurred vision. Biomicroscopic examination revealed bilateral, centrally located, oval, diffuse opacification of the anterior corneal stroma. Corneal topography showed slightly paracentral corneal flattening and irregular astigmatism in both eyes. Pachymetry indicated thinning of the central cornea in the left eye. No evidence of systemic disease was found. Family members had no corneal abnormalities.

Conclusions

This unusual keratopathy closely resembles climatic proteoglycan stromal keratopathy. However, it is not clear whether the condition should be described as a dystrophy or degeneration.
Effects of Ibopamine Eye Drops on Intraocular Pressure and Aqueous Humor Flow in Healthy Volunteers and Patients with Open-Angle Glaucoma
Authors: Azevedo H. , Ciarniello M.G. , Rosignoli M.T. , Dionisio P. , Cunha-Vaz J.
Published: January 2018

Purpose

On the basis of intraocular pressure measurements and fluorophotometry we assessed the effects of 2% ibopamine eye drops on aqueous humor production in normal and glaucomatous eyes.

Methods

Thirty subjects (15 healthy volunteers and 15 open-angle glaucoma patients with ocular hypertension) were included in a placebo-controlled study with random assignment of treatment from masked containers. All subjects underwent ophthalmologic examinations and intraocular pressure (IOP) measurements. Fluorophotometry was done in both eyes at baseline (without treatment) and during treatment. Each subject was treated with 1 drop of 2% ibopamine in one eye and 1 drop of placebo in the fellow eye 30 minutes before fluorophotometric scans and every hour after the first instillation (for a total of 4 times). Safety was evaluated by recording adverse events and ocular symptoms and signs. Aqueous humor flow data were analyzed using the paired t-test, comparing ibopamine and placebo-treated eyes.

Results

No changes in IOP were detected in normal eyes, whereas glaucomatous eyes showed a mean increase of 4 mmHg (95% CI 3.46–4.51) from baseline. The difference in IOP between healthy eyes and those with glaucoma was significant (p<0.0001). In normal eyes and patients with glaucoma ibopamine led to a significant increase in aqueous humor flow compared with placebo-treated eyes (p<0.01). The safety profile of ibopamine was very good.

Conclusions

The results seem to confirm that ibopamine increases aqueous humor production in normal and glaucomatous eyes, raising IOP only in eyes with glaucoma.
Giant Cell Arteritis Mimicking Idiopathic Orbital Inflammatory Disease
Authors: Islam N. , Asaria R. , Plant G.T. , Hykin P.C.
Published: January 2018

Purpose

To report an unusual presentation of giant cell arteritis, referred from primary care, mimicking orbital apex syndrome.

Case Report

A 72 year old woman was referred with a two week history of pyrexia, dull right eye ache, 2mm of right proptosis, mild conjunctival chemosis and restriction of right eye movements.

Results

An erythrocyte sedimentation rate (ESR) was 90 and fluorescein angiography showed almost complete choroidal non-perfusion suggestive of giant cell arteritis. Temporal artery biopsy confirmed the diagnosis.

Conclusions

Giant cell arteritis (GCA) typically presents with anterior ischemic optic neuropathy (AION), choroidal ischemia, central retinal artery occlusion, infrequently manifesting as an ocular motility problem, but has rarely been known to mimick idiopathic orbital inflammatory disease. Prompt recognition and therapy can minimize the chance of ipsilateral ocular involvement and protect the fellow eye.
Unilateral Purtscher-Like Retinopathy after Weight-Lifting
Authors: Kocak N. , Kaynak S. , Kaynak T. , Oner H.F. , Cingil G.
Published: January 2018

Purpose

To report a case of Purtscher-like retinopathy after weightlifting.

Methods

A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed.

Results

Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography.

Conclusions

The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of Valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinipathy associated with weightlifting.
Visual Performance after Congenital Nystagmus Surgery Using Extended Hang Back Recession of the Four Horizontal Rectus Muscles
Authors: Alió J.L. , Chipont E. , Mulet E. , De La Hoz F.
Published: January 2018

Purpose

To evaluate the results of surgical correction of congenital nystagmus based on the use of extensive recessions of the four horizontal rectus muscles. The outcome of this procedure in terms of visual performance of the patients has been analyzed in follow-ups of at least 1 year.

Methods

Surgery was performed on 42 patients. An extended retroequatorial recession of the four horizontal rectus muscles was performed between 13 and 15 mm from the muscle insertion with hang back sutures in every case. Preoperatively, all cases showed either a horizontal pendular (4 cases) or jerk nystagmus (38 cases).

Results

After surgery, all cases showed full preservation of ductions in all gaze positions. Torticollis decreased in all cases. Binocular best-corrected vision improved in 19 (45.2%) patients and in the remaining 23 (54.8%) it remained unchanged. Consecutive exotropia was observed postoperatively in 7 patients. A second surgical procedure was performed in 9 cases (21.4%) and a botulinum injection in 3 cases (7%). All cases of diplopia resolved. Patient satisfaction was high in 38 cases (96%).

Conclusions

Extended recession of horizontal rectus muscles using hang back sutures offers a good option for the surgical correction of sensorial and neuromuscular nystagmus, providing improvement in binocular best-corrected vision in 45% of the patients (21.4% more than 0.2 logMar units), a high satisfaction rate, and few associated complications. In patients with low vision this can be considered a success that may improve quality of life.
Ablation of Vitreous Tissue with a High Repetition Rate Erbium: YAG Laser
Authors: Krause M.H.J. , D'Amico D.J.
Published: January 2018

Purpose

To quantify erbium (Er):YAG laser ablation of vitreous in relation to different pulse repetition rates ≤ 200 Hz, in order to examine the feasibility of laser for removal of vitreous gel (photovitrectomy) in clinically acceptable times.

Methods

Fresh porcine vitreous samples and saline controls were ablated in air with an Er:YAG laser connected to a sapphire fiber at pulse energies between 1.0 and 21.2 mJ and at pulse repetition rates between 10 and 200 Hz. Net ablation rates were determined by weight measurement.

Results

Reproducible and constant ablation rates were found for given laser parameters. Net ablation rates increased linearly with pulse repetition rate and nonlinearly with pulse energy. Expanded laser parameter domains permitted vitreous ablation rates as low as 1 μg/s to as high as 1031 μg/s. Ablation rates did not differ significantly between vitreous and saline.

Conclusions

The study documents clinically useful vitreous ablation rates that scale linearly with high repetition rates of Er:YAG laser, and suggests directions for further development of laser technology for enhanced removal of vitreous and other tissues. However, nonlinear effects of pulse energy also exist, indicating need for careful examination of ablation characteristics in various instruments.
A Preliminary Assessment of Macular Function by MF-ERG in Myopic Eyes with CNV with Complete Response to Photodynamic Therapy
Authors: Moschos M.N. , Panayotidis D. , Moschos M.M. , Bouros Chr. , Theodossiadis P.G. , Theodossiadis G.P.
Published: January 2018

Purpose

To evaluate by multifocal electroretinogram (MF-ERG) macular function before and after photodynamic therapy (PDT) in myopic eyes with choroidal neovascularization (CNV).

Patients and Methods

Ten eyes with classic subfoveal CNV due to pathologic myopia were studied with MF-ERG before and after PDT in order to evaluate the results of PDT with verteporfin. The post-treatment follow-up was 6 months. Visual acuity testing, ophthalmic examinations, fluorescein and indocyanine green angiograms, and MF-ERG recordings were used to evaluate the results of PDT with verteporfin. The post-treatment period was 6 months.

Results

Before treatment, the electrical response densities in the foveal and perifoveal areas were apparently decreased in all patients. Six months after treatment, the mean retinal response densities in the same areas were found to be higher than before treatment.

Conclusions

MF-ERG evaluates objectively the macular function in myopic eyes with CNV. After successful PDT, the electrical activity of the foveal and parafoveal areas is higher than before treatment. This finding postulates the efficacy of PDT in the treatment of CNV.
Ex Vivo Expansion of Corneal Limbal Epithelial/Stem Cells for Corneal Surface Reconstruction
Authors: Ramaesh K. , Dhillon B.
Published: January 2018

Purpose

The management of severe ocular surface disease due to limbal stem cell deficiency has changed dramatically. The concept of limbal stem cells, as the source of corneal epithelium revolutionised the therapeutic approach of ocular surface reconstruction. Deficiency of limbal stem cells results in blinding ocular surface diseases. Grafting viable limbal tissue, from either fellow healthy eye or a donor eye, with the resident stem cell population may replenish limbal stem cells and can restore the corneal surface to normality. Transplanting the limbal tissue can be achieved through a variety of procedures that include cadaveric keratolimbal allograft (KLAL), live or living related conjunctival limbal allograft (lr-CLAL) and limbal autograft. Advances in tissue engineering techniques have offered a viable alternative to overcome the limitation of limbal tissue available for transplantation. Epithelial stem cells harvested from a small limbal biopsy can be expanded in vitro on a suitable carrier and then transplanted to the diseased cornea to successfully restore the corneal surface. This article is a chronological review of the important steps that brought ex vivo expanded stem cell transplantation in ocular, particularly corneal surface reconstruction.

Methods

The MEDLINE data base was searched for the years 1966–2002, using key words cornea, cell culture, ex-vivo expansion, limbus, stem cell, ocular surface and transplantation. Several articles that were not found by MEDLINE search were taken from references from other articles. Inclusion or exclusion of article was based on the relevance to the subject.

Conclusions

Corneal epithelial reconstruction with ex vivo expanded limbal cells is a potential tool in ocular surface reconstruction, although the technique is currently investigational. Strategies to achieve conjunctival epithelial restoration and tear film replenishment will allow ophthalmic surgeons to truly reconstruct the ocular surface.
Changes in Tear Protein Pattern after Photorefractive Keratectomy
Authors: Füst Á. , Veres A. , Kiszel P. , Nagy Z.Z. , Cervenak L. , Csákány B. , Maka E. , Süveges I. , Grus F.H.
Published: January 2018

Purpose

Changes in tear protein composition of patients who underwent photorefractive keratectomy (PRK) were analyzed.

Methods

Tear samples were obtained from 23 eyes of 23 patients immediately before PRK and on the fourth postoperative day with glass capillaries. Tear proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Digital image analysis and evaluation of the densitometric data of the electrophoretic separations were done with BioDoc-Analyze.

Results

Analysis of discriminance found a significant difference in the protein patterns (p<0.001). This type of analysis of the electrophoretic densitographs uses all peak information simultaneously. A significant decrease (p<0.005) in three of the main protein peaks – lactoferrin, immunoglobulin A heavy chain, and lysozyme – was also found after PRK.

Conclusions

Excimer laser ablation of the cornea has an acute effect on lacrimal gland protein secretion. Changes in tear composition may lead to feelings of dryness and to a decrease in tear film stability postoperatively.
Peak Pressures: Crossover Study of Timolol and Latanoprost
Authors: Sihota R. , Saxena R. , Agarwal H.C. , Pandey R.M. , Gulati V.
Published: January 2018

Purpose

To compare the diurnal efficacy and action on peak intraocular pressures (IOP) of 0.005% latanoprost and 0.5% timolol as primary therapy in 60 eyes having dark brown irides with primary open angle glaucoma (POAG).

Methods

A prospective, comparative, observer-masked, crossover, interventional trial including the mean of both eyes of 30 patients with POAG who were randomly started on either latanoprost once daily or timolol twice daily. Three months after treatment with one drug, the second drug was substituted. A masked observer carried out diurnal assessments of IOP before the start of therapy and at 3 and 7 months. The fourth month was the washout period for the first drug.

Results

The average baseline IOP was 23.36 ± 2.14 mm Hg, which was reduced by 8.8 ± 2.2 mmHg with latanoprost (p<0.01) and by 6.75 ± 1.9 mm Hg with timolol (p=0.01). The reduction was greater for latanoprost (p<0.005). The average peak IOP at baseline was 27.6 ± 2.22 mmHg. The effective fall in IOP at the time of new peaks in subsequent diurnal recordings of IOP compared to the baseline diurnal curve was 8.9 mm Hg with latanoprost (p<0.005) and 5.77 mm Hg with timolol (p<0.01). This difference in IOP reduction between the two drugs was statistically significant (p<0.01). Latanoprost had a lower efficacy in peak IOP reduction in eyes with evening peak of IOP than in those with morning peak (p<0.005). The efficacy of timolol was lower overall compared to latanoprost, but was similar in all circadian rhythms. The shift in timing of IOP peak was greater with latanoprost compared to timolol (4.34 hours vs –0.72 hours, p<0.01). A total of 90% of patients on latanoprost and 33.3% on timolol achieved a reduction of >30% in baseline mean IOP. The average of the trough IOP recorded in each of the individual baseline IOP curves was 19.05 ± 2.05 mm Hg.

Conclusions

Greater mean and peak IOP reduction was achieved with latanoprost compared to timolol. Dampening of the circadian rhythm was better with latanoprost. Latanoprost appears to be more effective than timolol at all points in time with greater efficacy in eyes with morning peaks compared to evening peaks.
Positive Tensilon Test and Intracranial Tumor: A Case Report
Authors: Gupta M. , Davis H. , Rennie I.G
Published: January 2018

Purpose

To report a case of intracranial tumor in a patient with positive tensilon test.

Methods

Interventional case report. A 19-year-old male presented with left 6th nerve palsy and had a tensilon test, which was highly positive and was diagnosed as having myasthenia gravis.

Results

The neurologist scanned the patient, which showed an intracranial tumor in the floor of the temporal fossa on the left side. The patient had surgery and a schwannoma was removed. The VIth nerve palsy did not improve upto two years after surgery.

Conclusions

A patient with a positive tensilon test can also have an associated intracranial tumor.
Secondary Intraocular Lens (IOL) Implantation: Anterior Chamber versus Scleral Fixation Long-Term Comparative Evaluation
Authors: Dadeya S. , Kumari Sodhi Kamlesh, P.
Published: January 2018

Purpose

To compare the long-term efficacy of a secondarily implanted flexible angle supported anterior chamber (AC) intraocular lens (IOL) with sclerally fixated IOL as a secondary procedure in patients with aphakia.

Methods

Sixty patients with aphakia were recruited for this study. The patients were randomly divided into two groups: Group I patients underwent secondary implantation with AC IOL (Kelman Z type multiflex Domi classic AC IOL) and Group II patients underwent secondary implantation with scleral fixated IOL (Hanita lens with two eyelets). Postoperatively, the patients were followed up at 1 week, monthly for 6 months, and at twice yearly intervals for 5 years (mean follow-up was 3 years).

Results

Best-corrected visual acuity of 6/18 or better was achieved in 36.6% (11/30) of patients in Group I and 30% (9/30) of patients in Group II after a mean follow-up of 3 years. The complication rate was higher in Group II as compared to Group I. The authors encountered a total of 23 complications in the sclerally fixated group and 11 in the AC IOL group (p=0.004). Uveitis and ciliary tenderness were the most common complications in Groups I and II, respectively.

Conclusions

For secondary implantation of IOL in aphakic patients, Kelman Z type multiflex Domi classic AC IOL is a better rehabilitation modality as compared to the scleral fixated Hanita IOL.
Aprotinin Reduces Ischemia-Reperfusion Injury in the Retina of Guinea Pigs
Authors: Yilmaz T. , Kükner A.Ş. , Aydemir O. , Ozercan H.I. , Naziroğlu M.
Published: January 2018

Purpose

The aim of this study was investigate the role of aprotinin on retinal lipid peroxidation and histopathological changes during ischemia/reperfusion (I/R) of guinea pigs.

Methods

Three groups of seven pigmented guinea pigs each were formed: a control (group 1), ischemia/saline (group 2) and ischemia/aprotinin (group 3). One eye of each animal was selected for histopathological evaluation and the other for biochemical assay. Bilateral pressure-induced retinal ischemia was instigated for 90 min and was followed by 24 hours of reperfusion. Animals in the ischemia/aprotinin and ischemia/saline groups received either 20,000 KIU/kg of aprotinin or saline, repeated four times at 6-hour intervals, with the first dose administered 5 min prior to the ischemic insult. The animals were killed at 24 hours of reperfusion. Retinal malondialdehyde (MDA) levels and the thickness of the inner plexiform layers were measured.

Results

The level of MDA in group 1 was significantly (p<0.001) lower than the other groups. The mean MDA level in group 2 was significantly (p<0.01) higher than in group 3. The inner plexiform layer in group 1 was significantly (p<0.001) thinner than in the other groups. The mean thickness of the inner plexiform layer in group 2 was significantly (p<0.01) higher than in group 3.

Conclusions

These data indicate that intraperitoneally administrated aprotinin has a protective effect against I/R injury in the retina of guinea pig as evidenced by reduced retinal MDA level and retinal thickness.
Assessment of Retinal Nerve Fiber Layer Thickness with NFA-GDx following Successful Scleral Buckling Surgery
Authors: Ozdek S. , Lonneville Y. , Onol M. , Gurelik G. , Hasanreisoglu B.
Published: January 2018

Objective

To assess the effect of retinal detachment (RD) on retinal nerve fiber layer (RNFL) thickness by using a scanning laser polarimeter (NFA-GDx) after successful scleral buckling surgery for the treatment of rhegmatogenous RD.

Methods

Consecutive patients who had successful scleral buckling surgery in one eye were assessed for RNFL thickness by using NFA-GDx prospectively. Fellow healthy eyes of the patients formed the control group. Eyes with RD surgery were compared with the control group with respect to three variables (superior average, inferior average, and average thickness) of NFA-GDx by using two-sampled t-test. Additionally, a possible effect of duration of RD on RNFL thickness was assessed with a correlation test.

Results

The study group consisted of 16 patients with a mean age of 49.8 years. The mean duration of RD was 28 days. Although the retardation values in operated eyes were less than that of the control eyes, the difference was not statistically significant (p>0.05). However, these three values were seen to increase with increased duration of detachment and this correlation was statistically significant (R>0.5, p<0.03).

Conclusion

RD seemed to cause minimal or no change in RNFL thickness as determined by GDx variables. The positive correlation between RNFL thickness and duration of RD, however, may be because of the proliferated Müller cells in eyes with RD, which may be responsible for some of the retardation measurements, which may be even more prominent in longstanding RD cases. This needs to be supported by further studies in larger patient groups with longer duration of RD and with histopathologic studies.
Lacquer Crack Formation after Photodynamic Therapy
Authors: Ladas I.D. , Moschos M.M. , Rouvas A.A. , Karagiannis D.A. , Kokolakis S.N.
Published: January 2018

Purpose

To report the occurrence of a lacquer crack after photodynamic therapy (PDT) of choroidal neovascularization (CNV) in a patient with pathologic myopia.

Design

Interventional case report.

Methods

PDT was performed with verteporfin, which was activated by a diode laser light at 690 nm.

Results

The left eye of a 42-year-old woman was treated with PDT because of juxtafoveal CNV caused by pathologic myopia. No lacquer crack was present in the macula on either fluorescein or indocyanine green angiography before treatment. The CNV subsided after treatment. However, a large lacquer crack underlying a subretinal hemorrhage was formatted in the macula of the treated eye soon after PDT.

Conclusions

Although the chorioretinal damage produced by PDT is minimal, it is enough to create, directly or indirectly, the basis for the formation of a lacquer crack in an eye with pathologic myopia.
Apoptosis in the Mechanisms of Neuronal Plasticity in the Developing Visual System
Authors: Nucci C. , Piccirilli S. , Nisticò R. , Morrone L.A. , Cerulli L. , Bagetta G.
Published: January 2018

Visual experience during early postnatal life is essential for normal development of synaptic connections in the visual system. In fact, altered visual experiences such as monocular deprivation (MD) or abnormal visual stimulation (e.g. strabismus, anisometropia) during this period disrupt the physiologic organization of the visual pathway, leading to loss of visual responses in cortical neurons and reduction in visual acuity of the affected eye, so that it becomes amblyopic. The authors review the main functional and morphologic changes induced by altered visual experiences in the developing visual system and focus on the recent discovery that MD induces apoptotic cell death in the lateral geniculate nucleus of newborn rats. Particular attention is given to the authors' studies documenting that, during development, MD leads retinal terminals to release excessive glutamate in the lateral geniculate nucleus where it elevates nitric oxide and causes DNA fragmentation. The latter event is known to activate poly-(ADP-ribose) polymerase, which in turn may trigger apoptosis. Better understanding of the mechanisms underlying the morphologic changes induced by altered visual experiences during development may open new venues for studying novel neuroprotective strategies for amblyopia and, more generally, for the treatment of ophthalmic diseases associated with neuronal apoptosis.
Naturalistic, Prospective Study of Glaucoma and Ocular Hypertension Treatment in France: Strategies, Clinical Outcomes, and Costs at 1 Year
Authors: Rouland J-F. , Le Pen C. ,   The Ophthalmologists of the Glaucoma Study
Published: January 2018

Purpose

To prospectively observe second-line treatment strategies, their clinical outcomes, and treatment costs in patients with glaucoma or ocular hypertension (OH) in France.

Methods

Patients were recruited between 1998 and 2000 in 37 centers and were followed for up to 2 years. Outcomes were numbers of and reasons for treatment changes, changes in clinical parameters (intraocular pressure [IOP] levels, visual field defects, and optic nerve excavation), and direct medical costs associated with glaucoma management in patients receiving monotherapy or combination therapy. This article reports results of an interim analysis of 1-year follow-up data for patients having at least two contacts with a study ophthalmologist.

Results

Data were analyzed for 283 patients and 549 treated eyes. Ocular hypotensive monotherapy was used as first-line therapy in 92.0% of eyes. Second-line treatment was initiated an average of 3.4 ± 0.5 years after diagnosis, primarily due to insufficient IOP control (62.8%). Mean IOP reductions after 1 year of second-line therapy were 3.0 mmHg in eyes treated with latanoprost monotherapy versus 2.1 mmHg in those receiving beta-blocker monotherapy (p=0.02) and 5.4 mmHg in eyes treated with the latanoprost + timolol combination versus 4.1 mmHg in those receiving combination therapies that did not include latanoprost (p=0.01). Although second-line treatment with latanoprost was more costly than treatment with beta blockers, the average daily cost for latanoprost monotherapy was similar to that for patients who failed beta-blocker monotherapy, and latanoprost + timolol was less costly than therapeutic combinations without latanoprost.

Conclusions

Insufficient IOP control is the main reason for changing first-line treatment in patients with glaucoma or OH. After 1 year, second-line treatment with latanoprost, as monotherapy or combined with timolol, provides superior IOP control at an acceptable cost.
Pregnancy-Related Papillophlebitis
Authors: McLoone E.M. , Best R.M.
Published: January 2018

Purpose

To report a case of pregnancy-related papillophlebitis in a woman with an uncomplicated pregnancy and no identifiable coagulation defect.

METHODS

Clinical evaluation and fundus photography.

Results

Spontaneous recovery occurred post-delivery without treatment.

CONCLUSIONS

Venous thromboembolic events of the eye are a rare complication of pregnancy unless associated with toxemia. This case report of a pregnant patient with papillophlebitis indicates that the natural clinical course of this condition is one of spontaneous resolution and treatment is there fore unnecessary.
Lidocaine-Assisted Xylocaine Jelly Anesthesia versus one Quadrant Sub-Tenon Infiltration for Self-Sealing Sclerocorneal Incision Routine Phacoemulsification
Authors: Sekundo W. , Dick H.B. , Schmidt J.C.
Published: January 2018

Purpose

To compare the effect of Xylocaine jelly and intracameral lidocaine with one quadrant instant sub-Tenon infiltration for self-sealing sclerocorneal phacoemulsification.

METHODS

One hundred patients were enrolled into a prospective randomized study, receiving either a combination of topical 2% Xylocaine jelly and 0.5 ml of intracameral 1% lidocaine or sub-Tenon infiltration with 2 ml of 2% Xylocaine on the operating table. All patients underwent a standard divide and conquer phacoemulsification procedure through a superior sclerocorneal frown incision followed by implantation of a polymethylmethacrylate intraocular lens. Intraoperative pain was indicated by the patient by squeezing the bedside nurse's hand, who allocated it to particular stages of surgery on a chart. After surgery, patients assessed the pain experienced using a 10-unit visual analogue scale.

Results

Pain was indicated on 31 occasions during the operation in the sub-Tenon group (mainly the injection itself) and 67 times in the topical group. The median overall subjective pain score was 3 in the jelly group and 0 in the sub-Tenon. Five eyes (10%) had to be converted to sub-Tenon during the surgery because of intolerable pain.

CONCLUSIONS

Whereas lidocaine supported Xylocaine jelly anesthesia provided acceptable analgesia for 90% of patients operated, sub-Tenon anesthesia proved to deliver better intraoperative comfort in all patients receiving sclerocorneal incision cataract surgery.
A Simple way to Prevent Indocyanine Green from Entering the Subretinal Space during Vitrectomy for Retinal Detachment Due to Myopic Macular Hole
Authors: Facino M. , Mochi B. , Lai S. , Terrile R.
Published: January 2018

Purpose

To present a safe and simple method of preventing indocyanine green (ICG) from entering the subretinal space in patients undergoing vitrectomy for retinal detachment caused by myopic macular hole.

PATIENTS AND METHODS

Four consecutive highly myopic eyes (three phakic, one Pseudophakic) with retinal detachment due to myopic macular hole were operated on by pars plana vitrectomy. The ICG-assisted peeling of the internal limiting membrane was performed after temporarily closing the macular hole by means of a small bubble of perfluorocarbon liquid (PFCL) in order to prevent ICG from entering the subretinal space.

Results

Retinal reattachment was successful in all patients, and anatomic closure of the macular hole occurred during the follow-up period (range 3 to 10 months).

CONCLUSIONS

A small bubble of PFCL prevents ICG dye from entering the subretinal space during vitrectomy for retinal detachment due to macular hole in highly myopic eyes.
The Effects of Three-Piece or Single-Piece Acrylic Intraocular Lens Implantation on Posterior Capsule Opacification
Authors: Bílge A.H. , Aykan Ü. , Akin T. , Ünsal U.
Published: January 2018

Purpose

To evaluate the development of posterior capsule opacification (PCO) in patients implanted with 5.5 mm optics, single-piece or three-piece acrylic intraocular lens (IOL) in cataract surgery prospectively.

Methods

This study was carried out on 267 eyes of 249 patients implanted with three-piece, 5.5 mm optics, acrylic IOL and 252 eyes of 244 patients implanted with single-piece, 5.5 mm optics, acrylic IOL by phacoemulsification technique between September 2001 and February 2003. A total of 519 eyes of 493 patients were prospectively evaluated for PCO development during the 25-month period. All the patients were analyzed periodically with anterior segment retroillumination photography. The data provided were analyzed with chi-square method.

Results

The results between the two groups for PCO development were not statistically significant. However, there was a prominent opacification of the posterior capsule where the optic and haptic junction of IOL was positioned in some patients implanted with single-piece IOL. During the follow-up period, no patients implanted with either three-piece or single-piece acrylic IOL required Nd:YAG laser capsulotomy.

Conclusions

Biocompatibility and reduced rate of PCO development are among the leading features of new generation IOLs. The intracapsular implantation of 5.5 mm optics acrylic IOLs resulted in decreased incidence of PCO and therefore greater patient satisfaction. Further studies investigating the effects of IOL optics, haptic structure and length, capsulorrhexis size, and IOL material and design features on PCO development will clarify the subject.