bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Prognosis after Removal of Silicone Oil
Authors: Lesnoni G. , Rossi T. , Nistri A. , Boccassini B.
Published: January 2018

Purpose

To investigate surgical and functional results six or more months after silicone oil (SiO) removal in patients undergoing pars plana vitrectomy (PPV) and tamponade for various reasons.

Methods

Retrospective chart review. Inclusion criteria were recurrent retinal detachment with PVR grade C (R-RD), primary PVR grade C longer than 9 hours, recurrent vitreous hemorrhage in PDR (PDR-RVH) with traction RD, giant retinal tears (GRT) with PVR grade C and total RD with vitreous hemorrhage and hypotony in penetrating traumas (PT). Indications for removal of SiO included attached retina and intra-ocular pressure (IOP) more than 10 mmHg after 60 days or IOP more than 30 mmHg despite medication.

Results

Of the 212 patients undergoing PPV and SiO tamponade between 1994–1997, 91 met the inclusion criteria, 8 had incomplete charts so 83 eyes were included in the study. The mean interval between PPV and SiO removal was 163.1 ± 111.0 days and follow-up was 351.5 ± 148.6 days. At the time of SiO removal, 30.6% of phakic eyes had cataract, 14.4% keratopathy and 8.4% IOP more than 30 mmHg. At the last visit after SiO removal, 43.5% had cataract, 12.0 keratopathy, 6.0% IOP > 30 mmHg and 3.6% IOP <5 mmHg. After SiO removal, 6.0% eyes developed R-RD. There was no significant difference in SiO duration for patients with and without R-RD. VA was more than 5/200 in 16.8% of eyes preoperatively, 79.5% at the time of SiO removal (p<0.05) and 78.3% at the last visit (n.s.) and better than 20/400 in respectively 2.4%, 51.8% (p<0.05) and 53% (n.s.). There was a tendency for VA to improve after SiO removal (p = 0.011).

Conclusions

SiO is an effective tamponade for complex RD, although its possible benefits must always be weighted carefully against the complications and the need for further intervention. The present series compares favorably with the current literature in terms of complication rates. The optimal timing of SiO removal and precise screening and decision-making guidelines before removal are still the main issues and need careful consideration.
Orbital Kaposi's Sarcoma in Acquired Immunodeficiency Syndrome
Authors: Collaço L. , Gonçalves M. , Gomes L. , Miranda R.
Published: January 2018

A 28-year-old white male with AIDS - C3 staging, presented with an extensive hemorrhagic dark mass localized in the left orbit. No other ophthalmic findings were disclosed. Ultrasonography and computed axial tomographic scans showed orbital involvement. Orbital Kaposi's sarcoma is a rare finding and only a few cases have been reported. Systemic examination revealed other lesions suggestive of disseminated mucocutaneous Kaposi's sarcoma, oral candidiasis, membranous esophagitis and gramulomatous hepatitis. Eyelid incisional biopsy disclosed Kaposi's sarcoma. Despite intensive chemotherapy progression was aggressive with a fatal outcome.
The Role of Ultrasound Biomicroscopy in Predicting the Result of Temporal Artery Biopsy in Temporal Arteritis Patients: A Preliminary Study
Authors: Vianna R.N.G. , Mansour M. , Özdal P.Ç. , Pessoa souza filho J. , Bakalian S. , Saraiva V.S. , Deschênes J. , Burnier M.N.
Published: January 2018

Purpose

Temporal artery biopsy is considered the gold standard for the diagnosis of temporal arteritis (TA). However, complications following this procedure may occur. The goal of this study is to evaluate if ultrasound biomicroscope (UBM) findings are useful in predicting the result (positive or negative) of temporal artery biopsy in patients with TA.

Methods

Twenty-six consecutive patients with clinical diagnosis of TA seen at the Department of Ophthalmology, Royal Victoria Hospital, Montreal, Canada, were involved in this study. All patients were submitted to UBM before temporal artery biopsy. Eight patients presented histopathologic findings consistent with the diagnosis of TA. Thus, UBM findings of these patients were compared with those from 18 patients with negative biopsy. On UBM we searched for the presence of a hypoechoic effect surrounding the walls of the temporal arteries, the so-called halo sign, as well as an intra-arterial middle reflexive filling, the so-called intra-arterial filling.

Results

The halo sign and/or the intra-arterial filling were found in 8 (100%) of 8 patients with biopsy-proven TA. However, 10 (55.5%) of 18 patients with a negative biopsy presented one or both of these two UBM findings. On the other hand, the absence of these two parameters on the UBM of a patient with TA strongly suggests that the temporal artery biopsy will be negative (negative predictive value=100%).

Conclusions

This preliminary work suggests that UBM may play a role in predicting a negative result of the temporal artery biopsy in patients with TA. In the present series approximately 30% of the patients could be spared this surgical procedure and its possible complications.
Comparison of Noncontact Infrared and Remote Sensor Thermometry in Normal and Dry Eye Patients
Authors: Singh G. , Singh bhinder H.
Published: January 2018

Purpose

To evaluate the role of closed chamber infrared and remote sensor thermometry in normal and dry eye patients.

Methods

The study was conducted on 51 dry eye cases (102 eyes), 26 men and 25 women aged 19 to 65 years (35.36±14.36), and 51 normal (102 eyes) age- and sex-matched control subjects. The criteria for dry eye were Schirmer-1 (<10 mm/5 min), FTBUT (<10 sec), and lissamine green score (>2). The remote sensor and infrared thermometry was done in closed chamber around the eye in closed and open eye positions.

Results

In normal eyes, closed chamber infrared thermometry recorded temperature 34.77±0.37 °C in closed eye position and 35.02±0.39 °C in open eye position as compared to 27.91 ±2.46 °C in closed eye position and 28.01±2.46 °C in open position with remote sensor thermometry. The difference in temperature from closed to open position was 0.25±0.90 °C in infrared thermometry and 0.10±0.00 °C with remote sensor thermometry, which was statistically significant (p<0.0000). In dry eye, the infrared thermometry recorded 35.08±0.61 °C temperature in closed eye position and 35.53±0.63 °C in open eye position as compared to 27.41 ±2.48 °C in open and closed eye position with remote sensor thermometry. The difference in temperature from closed to open eye position was 0.45±0.14 °C (p<0.0000) with infrared thermometry as compared to no change 0.00±0.00 °C with remote sensor thermometry (p<0.0000).

Conclusions

Remote sensor thermometry proved better for diagnosis of dry eye disease as it showed no change in temperature under closed chamber in closed and open position (p=0.0000). Infrared thermometry was better in recording the absolute temperature from any point on the eye.
Corneal Endothelial Cells' Protection against Thermal Injury: Influence of Ophthalmic Viscoelastic Substances in Experimental Study on Rabbits
Authors: Jurowski P. , Goś R. , Owczarek G. , Gralewicz G.Z
Published: January 2018

Purpose

To quantify the maximal level of temperature and the time the maximal temperature is achieved and correlate the temperature parameters to the mean rate of endothelial cell loss after standardized ultrasound delivery assisted with four viscoelastic substances or different temperature of balanced salt solution (BSS).

Methods

Thirty rabbits (60 eyes) were divided into six groups in which different viscoelastic substances or different temperature of BSS were used: Group 1, Viscoat; 2, Proviso; 3, soft shell technique; 4, Celoftal; 5, BSS 22 °C; and 6, BSS 4 °C. The same parameters of ultrasound energy were delivered by standard phaco tip introduced into pupillary plane. Thermocamera was employed for measurements of temperature parameters. Endothelium cell count was measured before surgery and 1 month postoperatively.

Results

Maximal level of temperature was measured as follows: Group 5, 27.85 ± 0.52 °C; Group 2, 27.75 ± 0.54 °C; Group 3, 27.74 ± 0.46 °C; Group 4, 27.25 ± 0.60 °C; Group 6, 26.81 ± 0.34 °C; Group 1, 26.52 ± 0.48 °C (p<0.05). The time the maximal temperature is achieved was statistically shorter in Groups 5 and 6: 4 seconds, 5 seconds, respectively p<0.0001, as compared with Group 2 (30 seconds), Group 3 (40 seconds), Group 1 (45 seconds), and Group 4 (50 seconds). The mean rate of endothelial cell loss was calculated as follows: Group 1, 4.35%±2.55%; Group 2, 8.43%±5.2%; Group 3, 6.25%±4.20%; Group 4, 6.53%±4.65%; Group 5, 14.3%±3.85%; and Group 6, 8.78%±4.45%.

Conclusions

Viscoelastic substances offer different levels of endothelial cell protection against temperature increase during phacoemulsification. The mean rate of endothelial cell loss correlates with the time the maximal temperature is achieved rather than with the value of maximal level of temperature. This implicates that surgical strategy should consider the choice of the most effective viscoelastic substances, particularly in difficult cases, e.g., hard nucleus, shallow anterior chamber, primary endothelial abnormality.
Comparison of the Efficacy and Safety of two Formulations of Diclofenac Sodium 0.1 % Eyedrops in Controlling Postoperative Inflammation after Cataract Surgery
Authors: Bodaghi B. , Weber M.E. , Arnoux Y.V. , Jaulerry S.D. , Le Hoang P. , Colin J.
Published: January 2018

Purpose

To compare the efficacy and safety of diclofenac sodium 0.1% eyedrops packaged in an Abak multidose container without preservative (Dicloabak) with the reference product, sodium merthiolate-preserved diclofenac sodium 0.1% eyedrops, in controlling postoperative inflammation after cataract surgery.

Methods

The multicenter, controlled, randomized, single-masked study included 194 patients (Dicloabak 96, preserved diclofenac 98) scheduled to have cataract surgery by phacoemulsification with foldable intraocular lens. All were evaluated preoperatively and postoperatively after 1, 7, and 28 days. Postoperative inflammation was measured by the total score of anterior chamber cells and flare. Ocular plin, conjunctival hyperemia and ciliary flush were also assessed. Postoperative patient assessments also included visual acuity, objective tolerance by slit-lamp, fluorescein test, and subjective evaluation of local tolerance.

Results

There was no statistically significant difference between the groups in the total score of flare and cells or the degree of conjunctival hyperemia and ciliary flush at any study visit. Dicloabak was demonstrated to be not inferior to preserved diclofenac at all assessment times. The overall assessment of local tolerance was similar for both study medications.

Conclusions

Preservative suppression did not alter diclofenac efficacy. Results support the good safety profile of both formulations when dosed three times daily for 4 weeks in absence of concomitant use of drugs potentially toxic for cornea. Preservative-free formulations like Dicloabak should be preferred to generic diclofenac formulations including other ingredients and may improve the safety profile of this topical nonsteroid anti-inflammatory drug.
Fusidic Acid vs Ofloxacin Prophylaxis before Cataract Surgery
Authors: Lofoco G. , Quercioli P. , Ciucci F. , Bardocci A. , De gaetano C. , Steigerwalt R.
Published: January 2018

Purpose

To evaluate the safety and efficacy of two self-administrated antibiotics in eliminating conjunctival microbial flora.

Methods

A total of 133 patients operated for cataract surgery were divided into three groups. The first group (A), 55 patients, received fusidic acid drops (1%) two times per day during the 3 days before the surgery; a second group (B), 55 patients, received ofloxacin (0.3%) four times per day during the 3 days before the surgery; and the third group (C), 23 patients, did not receive any topical antibiotic before the surgery. On the day of the surgery, cultures were taken from the lower fornix.

Results

In Group A, 28 cultures (50.9%) were sterile, and 27 (49.1%) were positive for the presence of microbial agents. In Group B, 25 cultures (45.4%) were sterile, and 30 (54.5%) were positive for the presence of microbial agents. In Group C, 5 cultures (21.7%) were sterile, and 18 (78.2%) were not. Staphylococcus epidermidis was the most common micro-organism isolated in all the groups. Statistical analysis does not reveal a significant difference between Groups A and B for the sterile cultures (p=0.7) (chi-square test), but a statistically significant difference is present between the treated and not treated patients (p= 0.05) (chi- square test).

Conclusions

A preoperative antibiotic prophylaxis is useful in eliminating conjunctival micro-organism, and both antibiotics (fusidic acid and ofloxacin) are efficient.
Continuous Light Increment Perimetry Compared to full Threshold Strategy in Glaucoma
Authors: Wabbels B.K. , Diehm S. , Kolling G.
Published: January 2018

Purpose

Continuous light increment perimetry (CLIP) is an improved testing strategy for automated static perimetry designed to save test time and enhance patient compliance. CLIP uses a modified ramp stimulus where stimulus intensity is continuously increased according to patient reaction time, starting from a subthreshold intensity until recognition. The test is constantly modified according to patient performance. As CLIP showed good results in normal subjects in previous studies, the authors now compared CLIP to the standard 4/2-full threshold (4/2) strategy in glaucoma patients.

Methods

Fifty-two patients with glaucomatous visual field defects (mean sensitivities 2.9 to 18.4 dB), all with perimetric experience, were tested with CLIP (three times) and 4/2 in a randomized fashion. Tests were performed at 55 test locations within the central 30° visual field (24-2 area) using the Twinfield perimeter.

Results

Average mean sensitivity was significantly higher for CLIP than for 4/2 (t test, p<0.0001). Absolute scotomas and extension of scotomas were comparable for both strategies, whereas CLIP found less deep relative scotomas in some cases. Mean test time was significantly shorter for CLIP (5.6 min) compared to 4/2 (8.9 min) (Wilcoxon signed rank test, p<0.0001). Patient acceptance was better for CLIP than for 4/2.

Conclusions

CLIP showed comparable results to 4/2 with excellent patient acceptance. Mean sensitivities are 1.8 dB higher than for 4/2; similar results were found previously in normal subjects. CLIP was able to save a mean 38% of test time compared to full threshold strategy with good reproducibility.
Magnification Requirement after Photodynamic Therapy with Verteporfin for Subfoveal Predominantly Classic Choroidal Neovascularization due to Age-Related Macular Degeneration
Authors: Thoelen A.M. , Bernasconi P.P. , Buser F. , Fierz A.B. , Messmer E.P.
Published: January 2018

Purpose

To prospectively assess the magnification requirement after repeat photodynamic therapy (PDT) with verteporfin in patients with predominantly classic subfoveal choroidal neovascularization (CNV) due to age-related macular degeneration (AMD).

Methods

A total of 103 patients were treated for the first time with PDT between November 1999 and September 2002. These patients were followed up at 3-month intervals for a minimum of 12 months. In addition to the usual investigations undertaken during PDT therapy, the magnification requirement was determined, under standardized conditions, using the SZB test developed by the Swiss Central Association for Blindness.

Results

A stable lesion with a stable magnification requirement was achieved in 86 (83.5%) patients; these patients were followed up for 24.8 months (range 12 to 36 months). At the time of the last follow-up examination, the magnification requirement compared with baseline was <3 log units higher in 46 patients (53.5%) and ≥3 log units higher in the remaining 40 patients (46.5%). Seventy-four (86%) of these 86 patients had a magnification requirement of ≤8x. Stability was not achieved in 17 (16.5%) patients; up to the last examination these patients had been followed up for 12 to 30 months (mean 20.8). At the time of the most recent examination, 7 (41.2%) patients had a higher magnification requirement of <3 log units while 10 (58.8%) had changed by ≥3 log units. Sixteen patients (94%) had a magnification requirement of ≤8x.

Conclusions

PDT with verteporfin helps achieve stability without severe impairment in reading ability in most patients with predominantly classic subfoveal CNV due to AMD.
Efficacy of Autologous Plasmin for Idiopathic Macular Hole Surgery
Authors: Sakuma T. , Tanaka M. , Inoue J. , Mizota A. , Souri M. , Ichinose A.
Published: January 2018

Purpose

To determine whether a single intravitreal injection of autologous plasmin or a combination of plasmin and intraocular gas without peeling the internal limiting membrane (ILM) will close idiopathic macular holes.

Methods

Eight eyes of seven patients with an idiopathic macular hole were studied. The degree of posterior vitreous detachment (PVD), vitreal liquefaction, closure of the macular hole, visual acuity, and complications following intravitreal plasmin or plasmin with gas were investigated. The removed ILM was examined by electron microscopy.

Results

A PVD was created in seven out of eight eyes exposed to plasmin or plasmin with gas, however, the macular hole was not closed by either. Closure occurred in two eyes using conventional vitrectomy after the plasmin with gas injection, but peeling the ILM was required in the remaining six eyes. Vitreal fibers and glial cells were not observed on the vitreal surface of the extracted ILM.

Conclusions

A PVD was created safely and reliably although closure of the macular hole did not occur with either plasmin or with plasmin and gas injection. However, vitreous surgery became easier, and it required a shorter time to close the macular hole with intravitreal plasmin.
First Genetic Analysis of Lattice Corneal Dystrophy Type I in a Family from Bulgaria
Authors: Capoluongo E. , De benedetti G. , Concolino P. , Sepe M. , Ambu R. , Faa G. , Sciandra F. , Santonocito C. , D'alberto A. , Caselli M. , Brancaccio A.
Published: January 2018

Purpose

To report a new family belonging to a previously non-investigated geographic area with a rare form of lattice corneal dystrophy (LCD).

Methods

Detailed ophthalmologic analysis was carried out on a Bulgarian woman, enrolled for perforating keratoplasty. In order to obtain a final diagnosis both histology and genetic analysis were performed.

Results

Upon transplantation, histologic analysis of the dystrophic cornea revealed the typical staining pattern and amyloid deposits of lattice corneal dystrophies. Genetic analysis of the subject and her daughter confirmed the presence of an autosomal dominant R124C mutation within exon 4 of the BIGH3 gene, encoding for keratoepithelin, while showing no abnormalities in her son.

Conclusions

The identification of this mutation allows the unambiguous classification of this corneal dystrophy as LCD type I. A first case of LCD I in a family from Eastern Europe could help to better clarify the molecular epidemiology of the disease.
Branch Retinal Artery Occlusion Combined with Branch Retinal Vein Occlusion in a patient with Hepatitis C Treated with Interferon and Ribavirin
Authors: Nicolò M. , Artioli S. , La mattina G.C. , Ghiglione D. , Calabria G.
Published: January 2018

Purpose

To report a case of a combined branch retinal artery and vein occlusion in a patient with hepatitis C treated with interferon and ribavirin.

Methods

A 29-year-old man with a 1-week history of sudden visual field defect and decrease of central visual acuity was examined.

Results

Ophthalmoscopy and fluorescein angiography demonstrated an ischemic whitening of the inferior hemi-retina involving part of the macular region, numerous intraretinal hemorrhages, and a significant delay in arterial and vein filling of the dye.

Conclusions

The findings of a retinopathy associated with interferon and ribavirin treatment of hepatitis C are important. The symptomatic permanent visual field defect and decrease of central visual acuity developing following a branch retinal artery and vein occlusion event emphasizes the need for careful and regular ocular monitoring of patients receiving interferon for hepatitis C.
Photodynamic Therapy with Verteporfin in the Treatment of Exudative Idiopathic Polypoidal Choroidal Vasculopathy
Authors: Mauget-Faÿsse M. , Maftouhi M. Quaranta-El , De La Marnièrre E. , Leys A.
Published: January 2018

Purpose

To determine the safety and efficacy of photodynamic therapy with verteporfin (V-PDT) in the treatment of exudative idiopathic polypoidal choroidal vasculopathy (IPCV) lesions that were not suitable for laser photocoagulation.

Methods

This was a prospective, open label study in two centers involving 30 consecutive patients (31 eyes) diagnosed with exudative IPCV using fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). All patients underwent complete ophthalmologic examination including best-corrected visual acuity (VA) measurement, contrast sensitivity (CS) testing, FA, ICGA, and OCT. OCT was used to assess the stage of the polypoidal dilations (active or scarred) and the evolution of the signs associated with exudation. Study patients were treated with V-PDT and followed up at 6 weeks and 3, 6, and 12 months. Re-treatment was applied, at an interval of 3 months, until there was an absence of leakage on FA and hyperfluorescence on ICGA.

Results

Thirty eyes (29 patients) completed the 12 months post-treatment visit and were retained for further analysis. The mean number of V-PDT treatments was 2.5 (SD 1.1). At 12 months post-treatment, the mean foveal thickness had significantly (p<0.03) decreased to 224 (SD 104) μm from the baseline 292 (SD 124) μm while the mean VA had significantly (p<0.02) improved to 0.50 (SD 0.38) from the baseline 0.38 (SD 0.24). Serous detachment of the macula completely resolved in 83.3% of the eyes while 73.3% of the polypoidal dilations were occluded at 12 months.

Conclusions

The results suggest that V-PDT is effective and relatively safe in treating exudative IPCV.
Diabetic Blindness Significantly Reduced in the Warmia and Mazury Region of Poland: Saint Vincent Declaration Targets Achieved
Authors: Bandurska-Stankiewicz E. , Wiatr D.
Published: January 2018

Purpose

The authors’ aim was to verify if the targets of the Saint Vincent Declaration concerning the reduction of diabetes-related blindness in the Warmia and Mazury Region, Poland, had been achieved.

Methods

A register of World Health Organization-defined blindness due to diabetes was conducted in the Warmia and Mazury Region between 1989 and 2004. The incidence rate of blindness as the number of new cases/100,000 diabetic population/year and 100,000 total population/year was estimated for three subperiods differing in political-economic system and diabetologic care delivery: 1989–1994, 1995–1999, and 2000–2004.

Results

The major cause of blindness among diabetic patients was diabetic eye disease (97%). Out of 70 patients with Type 1 diabetes, 53% lost vision due to proliferative diabetologic vitreoretinopathy 20% due to neovascularization with glaucoma, while clinically significant macula edema and cataract associated with proliferative diabetologic vitreoretinopathy or clinically significant macula edema predominated in 210 patients with Type 2 diabetes. The incidence rate of blindness due to diabetes in the diabetic population ranged from 102.4/100,000 (confidence interval [CI]: 65.7–139.0) to 13.3/100,000 (3.8–24.9). The incidence rate of blindness due to Type 1 diabetes ranged from 1.3/100,000 (CI: 0.5–2.2) to 0.1/100,000 (CI: −0.1–0.4). The incidence rate of blindness due to Type 2 diabetes was variable in the first subperiod, and it next decreased by 19% each year from 3.9/100,000 (CI: 2.5–5.3) to 0.7/100,000 (CI: 0.1–1.2); p<0.001.

Conclusions

The Saint Vincent Declaration target of reducing diabetes-related blindness by one third appears to have been achieved in the Warmia and Mazury Region.
Changing Patterns of Ocular Manifestations in HIV Seropositive Patients Treated with HAART
Authors: Accorinti M. , Pirraglia M.P. , Corradi R. , Corsi C. , Fabiani C. , Pivetti-Pezzi P.
Published: January 2018

Purpose

To report the changing patterns of ocular manifestations in human immunodeficiency virus (HIV) seropositive patients treated with highly active antiretroviral therapy (HAART).

Methods

The clinical charts of HIV seropositive patients, 735 examined from 1997 to 2003 and treated with HAART for at least 2 months (Group 1), and 838 untreated examined from 1988 to 1995 (Group 2), were reviewed to assess the frequency of ocular manifestations.

Results

HIV- related retinal microangiopathy and opportunistic retinal infections (cytomegalovirus retinitis and toxoplasmic retinochoroiditis) were significantly higher in Group 2 than 1 (p<0.0001), while in patients treated with HAART a statistically significant increase in the frequency of chalazion (p<0.0001), diabetic and hypertensive retinopathy (p<0.0001), lipid arc of the cornea (p<0.0001), cataract and glaucoma (p<0.0001), and uveitis (p=0.026) was observed.

Conclusions

HAART therapy has induced a dramatic decrease in the incidence of HIV-related microangiopathy and opportunistic retinal infection and the occurrence of new lesions related both to the metabolic alterations induced by HAART and to immune reconstitution, such as uveitis.
Spontaneous Separation in Idiopathic Vitreomacular Traction Syndrome Associated with Contralateral Full-Thickness Macular Hole
Authors: Rodríguez A. , Infante R. , Rodríguez F.J. , Valencia M.
Published: January 2018

Purpose

Vitreomacular traction syndrome (VMTS) and full-thickness macular hole are two different well-known entities that on follow-up may be subjected to clinical modifications. Precisely, a spontaneous separation of idiopathic VMTS occurred in three eyes of three patients relieving in addition traction of the posterior hyaloid that had led also to a focal macular pigment epithelium detachment (RPE). An association to a full-thickness macular hole was observed in the contralateral eye of one of the patients.

Methods

This is a retrospective study of three patients evaluated with fluorescein angiography and documented with optical coherence tomography using the Stratus (OCT) model 3000, with scans analysis and protocols analysis, measuring the size and shape of vitreomacular adhesions, macular thickness changes before and after the spontaneous separation of the fractional posterior hyaloid adhesion. In addition, the vitreous was evaluated with contact lens slit lamp biomicroscopy and ultrasound. The associated contralateral macular hole in one of the patients was surgically treated.

Results

Two of the three eyes with spontaneous separation of the VMTS recovered 20/25 central visual acuity; the other eye maintained the initial 20/50 visual acuity. The treated macular hole recovered 20/100 corrected visual acuity.

Conclusions

Spontaneous separation of posterior hyaloid is a possible outcome during follow-up of idiopathic VMTS that can be well evaluated and documented with OCT while macular fluorescein angiography may be silent in cases like these presently reported. Central vision recovery can be excellent following the spontaneous separation, which releases anterior-posterior traction including on the retinal pigment epithelium and decreases macular thickness as measured with OCT. Therefore, regarding management, the indication for vitrectomy should be delayed awaiting the spontaneous release of vitreomacular traction in 4 to 6 months. The association between idiopathic VMTS in one eye and full-thickness macular hole in the opposite eye of one patient is an important pathophysiologic consideration.
Keratoconus Associated with Corneal Macular Dystrophy: In vivo Confocal Microscopic Evaluation
Authors: Balestrazzi A. , Martone G. , Traversi C. , Haka G. , Toti P. , Caporossi A.
Published: January 2018

Purpose

The authors present a case, studied through in vivo confocal microscopy, of concomitant keratoconus and macular corneal dystrophy (MCD).

Methods

A 29-year-old man underwent a penetrating keratoplasty in the right eye in May 2005. Confocal microscopy was performed to examine the cornea of the right eye.

Results

A diagnosis of concomitant keratoconus and MCD was suspected, due to the simultaneous findings of corneal ectasia and stromal opacities.

Conclusions

In this case, using in vivo confocal microscopy, morphologic changes were detected in many corneal layers and compared with the histopathologic findings. The morphologic alterations were found mainly in the area of the cornea apex.
Sequential Descemet's Membrane Detachments and Intraocular Lens Haze Secondary to SF6 or C3F8
Authors: Saeed M.U. , Singh A.J. , Morrell A.J.
Published: January 2018

Purpose

To report an unusual complication of treatment in the case of a Descemet's membrane detachment.

Methods

Observational case report.

Results

A 79-year-old woman presented for elective cataract surgery. Ocular risk factors identified preoperatively included moderately shallow anterior chambers bilaterally, previously treated with bilateral YAG peripheral iridotomies. After a clear corneal section during phacoemulsification, large Descemet's tears on introducing the micro finger and phaco probe were noticed. Conversion to an extracapsular technique was necessary because of poor view. Similar peroperative Descemet's detachments were noticed in the contralateral eye during phacoemulsification by a senior surgeon a year later. Postoperatively, the Descemet's detachments were managed by intracameral SF6 and later C3F8 gas. A few weeks later, a fine haze was noticed under the anterior surface of the intraocular lens (IOL). Corneal edema persisted and corneal decompensation ensued. Both eyes needed penetrating keratoplasties. The right eye needed an IOL exchange due to IOL haze.

Conclusions

In this case the SF6 or C3F8 gas may have produced the unexpected effect of an anterior IOL haze. The mechanism of this phenomenon is unknown. To the knowledge of the authors, this effect has not been observed previously with SF6 or C3F8 gas. This haze was visually significant and required an IOL exchange. To the knowledge of the authors this is the first report of this nature. The authors advise caution when using intracameral SF6 or C3F8 gas for repair of Descemet's membrane detachment with this type of IOL.
Bilateral Ischemic Maculopathy in a Patient with Aids
Authors: Romano M.R. , Valldeperas X. , Romano F.
Published: January 2018

Purpose

To describe ischemic maculopathy as a cause of sudden bilateral decreased vision in a patient with human immunodeficiency virus (HIV) infection.

Methods

A 44-year-old HIV-positive woman presented with bilateral decreased vision and normal examination, except for pale maculae and retinal vascular tortuosity. Fluorescein angiography showed bilateral enlargement of the foveal avascular zone with perifoveal dye leakage.

Conclusions

Ischemic maculopathy is a potential cause of decreased vision in patients with acquired immunodeficiency syndrome, even in patients with immune sustained recovery. This condition can be almost totally reversible, in the absence of other concomitant ocular pathologies.
Fundus Autofluorescence Imaging Findings in Retinal Pigment Epithelial Tear
Authors: Karadimas P. , Paleokastritis G.P. , Bouzas E.A.
Published: January 2018

Purpose

Retinal pigment epithelial (RPE) tear is a clinical and angiographic entity, which usually occurs in association with pigment epithelial detachments (PED), in the context of neovascular age-related macular degeneration (ARMD). The recording of fundus autofluorescence (FAF) has been introduced as a technique of retinal imaging, allowing the in vivo assessment of the integrity of RPE. The authors describe the FAF imaging findings in a patient with RPE tear.

Methods

Observational case report.

Results

A 70-year-old woman developed RPE tear after the application of photodynamic therapy for choroidal neovascularization associated with PED. The diagnosis of the RPE tear was confirmed by fluorescein angiography (FA) and indocyanine green angiography (ICGA). FAF imaging revealed absence of autofluorescence at the area which was denuded of RPE, while at the area where the RPE was rolled, a heterogeneous signal of FAF was recorded. The intensity of the signal in that area was, on average, not different from the normal background FAF signal expected in an unaffected RPE/photoreceptor complex.

Conclusion

The authors report the FAF imaging findings in a patient with RPE tear. These findings can be interpreted from the ability of FAF imaging to access in vivo the integrity of RPE, and correlate well with the histopathology of this clinical entity. FAF imaging, as a fast and noninvasive technique, may be a useful modality, alternative to FA and ICGA, in the diagnosis and evaluation of such cases. Moreover, it may contribute to a more detailed phenotyping of the various clinical pictures associated with neovascular ARMD.
Retinal Pigment Epithelial Tear following Intravitreal Injection of Bevacizumab (Avastin)
Authors: Nicolò M. , Ghiglione D. , Calabria G.
Published: January 2018

Purpose

To report one case of retinal pigment epithelium tear following intravitreal bevacizumab injection for neovascular age-related macular degeneration.

Methods

A 59-year-old patient presented with occult choroidal neovascularization associated with a serous pigment epithelial detachment secondary to age-related macular degeneration. The patient was treated with an intravitreal injection of bevacizumab.

Results

The patient developed a retinal pigment epithelium tear 60 days following the intravitreal injection.

Conclusions

This report describes the development of retinal pigment epithelium tear after intravitreal bevacizumab injection. Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this potential devastating visual complication.
Successful Management of Melanocytoma-Associated Choroidal Neovascularization with Photodynamic Therapy
Authors: Chalam K.V. , Gupta S.K. , Shah G.Y. , Agarwal S.
Published: January 2018

Purpose

To report the efficacy of photodynamic therapy in treatment of choroidal neovascular membrane (CNV) associated with melanocytoma of the optic disc.

Methods

A middle-aged man with visual acuity of 20/200 in right eye was treated with photodynamic therapy for juxtafoveal classic CNV overlying the papillomacular bundle. CNV was secondary to ocular melanocytoma, a rare event.

Results

At the 6-month follow-up, a scarred CNV with final visual acuity of 20/30 was noted clinically and angiographically Tomography revealed high reflective scar tissue with flat macula and microperimetry showed restoration of retinal sensitivity over the papillomacular bundle.

Conclusions

Photodynamic therapy effectively resolved CNV that involved papillomacular bundle (secondary to melanocytoma) and restored retinal function in papillomacular bundle.
The Effects of Artificial Tear Application on Contrast Sensitivity in Dry and Normal Eyes
Authors: Akin T. , Karadayi K. , Aykan U. , Certel I. , Bilge A. Hamdi
Published: January 2018

Purpose

To investigate the effects of artificial tear application on contrast sensitivity in dry and normal eyes.

Methods

A total of 55 patients with normal (10/10) corrected or uncorrected visual acuity referring to GATA Gulhane Military Medical Academy Haydarpasa Ophthalmology Outpatient Clinic were evaluated in regard to dry eye diagnostic criteria, and assigned into the dry eye group (Group 1; 35 patients) and the control group (Group 2; 20 patients). All patients were given a contrast sensitivity testing at low and high spatial frequencies using the gradual contrast sensitivity chart before and at 5 minutes after application of artificial tears, and the two groups were compared. Wilcoxon test was used in statistical analysis, accepting a p value of <0.05 as significant.

Results

In the dry eye group, there was a statistically significant increase in contrast sensitivity scores both at low and high frequencies after application of artificial tears (p<0.05). In the control group, although there was a significant increase in low frequency scores after artificial tear application (p< 0.05), there was not a significant change in high frequency scores (p>0.05).

Conclusions

The decreased contrast sensitivity in dry eyes improves with application of artificial tears. Therefore, the impeded quality of vision seen in dry eye patients could be restored closer to normal with artificial tear therapy. Besides, contrast sensitivity testing could be used in the follow-up of artificial tear therapy.
Rheumatoid Keratolysis: A Series of 40 Eyes
Authors: Malik R. , Culinane A.B. , Tole D.M. , Cook S.D.
Published: January 2018

Purpose

Rheumatoid keratolysis (RK) is a rare but a serious cause of ocular morbidity in rheumatoid patients. The aim of this study was to analyze the presenting features, the subsequent treatment, and the outcome of patients with RK in the authors’ department.

Methods

A retrospective study was undertaken of all patients with a diagnosis of RK at Bristol Eye Hospital between January 1987 and June 2002.

Results

Forty eyes of 38 patients were identified in total. The mean age at presentation was 70 years. The mean duration of rheumatoid arthritis at presentation was 15 years. Most (22, 55%) ulcers were peripheral. Three patients (8%) developed RK within a month of cataract surgery. Out of the 19 patients who did not have a further RK, 11 were immunosuppressed. A total of 37 grafts were performed on 26 eyes. Twenty-two grafts (59%) failed. Immunosuppression increased the chance of anatomical success following penetrating keratoplasty. Infection was identified as a cause of graft failure for immunosuppressed patients in the postoperative period. Nine patients had reversible side effects from immunosuppressant treatment. Four eyes (10%) had to be surgically removed and a further 10 (25%) had severe visual loss (visual acuity less than 6/60). Eleven of the 38 patients subsequently died (29% mortality).

Conclusions

Although the visual prognosis is often poor, surgical preservation of the eye can be achieved by penetrating keratoplasty and systemic immunosuppression. With careful observation and regular monitoring, immunosuppressive medication appears to be safely tolerated in this group of patients.
Evaluation of Early Corneal Endothelial Cell Loss in Bimanual Microincision Cataract Surgery (MICS) in Comparison with Standard Phacoemulsification
Authors: Wilczynski M. , Drobniewski I. , Synder A. , Omulecki W.
Published: January 2018

Purpose

To analyze early corneal endothelial cell loss due to microincision cataract surgery (MICS) in comparison with standard phacoemulsification through the temporal clear corneal incision.

Methods

The examined group consisted of a nonrandomized, consecutive prospective series of 20 eyes of 20 patients who underwent uneventful microincision cataract surgery. Twenty eyes of 20 patients who underwent standard phacoemulsification with foldable intraocular lens (IOL) implantation served as a reference group. Patients with corneal disorders, contact lens wear, previous intraocular surgery, and a history of ocular trauma were excluded from the study. Patients were examined preoperatively and 10 days postoperatively. The following items were evaluated in this study: corneal endothelial cell density, intraoperative phaco power, effective phaco time, as well as pre- and postoperative visual acuity. Corneal endothelial cell counts were done in the central part of the cornea using a non-contact Topcon SP 2000P specular microscope before and 10 days after the surgery. The measurements were performed in a semiautomated, masked manner. Statistical analysis was done using nonparametric tests (Wilcoxon signed-ranks test and Mann-Whitney U test).

Results

All patients in the study underwent uneventful surgery. Best-corrected visual acuity (BCVA) examined 10 days postoperatively in the MICS group was 0.94±0.094, whereas in the standard phacoemulsification group it was 0.90±0.094. There was no significant difference between BCVA in the two groups (Mann Whitney U two-tailed test: p>0.05). In both groups there was a significant decrease in postoperative endothelial cell densities (ECDs) when compared to preoperative values. Mean postoperative ECDs were 2235±418 cells/mm2 in the MICS group and 2079±399 cells/mm2 in the standard phacoemulsification group; the difference was not statistically significant (Mann-Whitney U test: p>0.05). Patients in the MICS group lost an average of 9.5% of cells, whereas patients after standard phacoemulsification lost about 7.6% of cells. This difference was statistically insignificant.

Conclusions

Microincision cataract surgery induced corneal endothelial cell loss similar to a standard phacoemulsification and allowed excellent visual results in this series of patients. These results support the use of MICS technique for cataract surgery.
The Efficacy and Safety of Timolol Maleate versus Brinzolamide Each Given Twice Daily Added to Travoprost in Patients with Ocular Hypertension or Primary Open-Angle Glaucoma
Authors: Holló G. , Chiselita D. , Petkova N. , Cvenkel B. , Liehneova I. , Izgi B. , Berta A. , Szaflik J. , Turacli E. , Stewart W.C.
Published: January 2018

Purpose

To compare the efficacy and safety of timolol maleate 0.5% versus brinzolamide 1% when added to travoprost 0.004% in patients with ocular hypertension or primary open-angle glaucoma.

Design

A prospective, double-masked, randomized, active-controlled, parallel comparison.

Methods

Qualified patients at Visit 1 were placed on travoprost dosed every evening for 4 weeks and then were randomized at baseline (Visit 2) to the addition of timolol maleate or brinzolamide each given twice daily. Patients returned to clinic at Week 4 (Visit 3) for a safety visit and Week 12 (Visit 4) for an efficacy visit. At Visits 2 and 4 the intraocular pressure (IOP) was measured at 08:00, 12:00, and 16:00 hours.

Results

Ninety-seven patients on brinzolamide had a baseline diurnal IOP of 21.5±2.2 mmHg and 95 on timolol maleate had 21.3±2.5 mmHg, each added to travoprost. The diurnal mean IOP at Week 12 was 18.1±2.7 mmHg for brinzolamide and 18.1±3.0 mmHg for timolol maleate (p=0.96). There was no statistical difference found between treatment groups in the absolute level of pressure, or in the reduction in IOP from baseline, at each time point or for the diurnal curve (p>0.05). There was no significant difference for any adverse event between groups (p>0.05), with the most common side effect being conjunctival hyperemia in 15/97 (16%) brinzolamide and 6/95 (6%) timolol treated patients (p=0.06).

Conclusions

This study showed that brinzolamide provides similar safety and efficacy compared to timolol maleate when added to travoprost.
Quality of Vision: A Consensus Building Initiative for a New Ophthalmologic Concept
Authors: Piermarocchi S. , Sartore M. , Bandello F. , Lanzetta P. , Brancato R. , Garattini L. , Lumbroso B. , Rispoli M. , Pece A. , Isola V. , Pulazzini A. , Menchini U. , Virgili G. , Tedeschi M. , Varano M.
Published: January 2018

Purpose

Many studies have addressed the quantification of visual acuity, and the conventional method of measuring it has so far demonstrated serious limitations. Vision testing requires new methods that can more precisely express the quality of vision as perceived by the patient.

Methods

This study employed the Delphi method of consensus building. Concepts associated with quality of vision (QoV) were identified by a board of experts and proposed to participating specialists in two subsequent questionnaires. Upon receipt of the completed questionnaires, the replies were classified to determine the building blocks of a consensus.

Results

By analyzing the replies to the two questionnaires, the authors determined the key elements of QoV on which a consensus was found among the respondents.

Conclusions

A consensus was reached on the opinion that the quantification of visual acuity by traditional means is inadequate for investigating QoV. Although visual acuity is still a basic element for testing, the experts believe that contrast sensitivity, reading speed, and microperimetry are additional parameters necessary for quantifying QoV. The use of a psychometric questionnaire on visual function could allow a better interpretation of visual impairment.
Controlling Blepharospasm Effect during Applanation Tonometry using the Volk SuperField Lid Lens Adapter
Authors: Mohammed B.R. , Perry S.R.
Published: January 2018

Purpose

To describe a practical clinical technique that can be used to control the effect of blepharospasm during applanation tonometry.

Methods

The Volk Superfield NC Lid Lens Adapter is used to keep the eye open and prevent the squeezing effect of orbicularis oculi in blepharospasm.

Results

This helpful tool can be used when blepharospasm becomes a problem that interferes with accurate intraocular pressure measurement.

Conclusions

The technique is potentially useful and relatively easy to perform.
Limbal Stem Cell Deficiency in the Context of Autoimmune Polyendocrinopathy
Authors: Mohammadpour M. , Javadi M.-A. , Karimian F.
Published: January 2018

Purpose

To report two sisters with bilateral progressive visual loss and photophobia secondary to stem cell deficiency due to multiple endocrine deficiency.

Methods

Case reports and review of medical literature.

Results

The younger sister had severe photophobia and decreased visual acuity since May 2000. Despite multiple outpatient visits no definite cause was found and conservative treatments failed. On slit lamp examination severe meibomian gland dysfunction, loss of eyelashes, decreased tear meniscus, diffuse corneal vascularization, and delayed punctate fluorescein staining of corneal epithelium were detected. She also had episodes of hypotension, oral candidiasis, and seizures. Her systemic workup revealed multiple endocrine deficiency (Addison's disease and hypoparathyroidism). Hormone replacement therapy with fludrocortisone and oral calcium accompanied by punctual occlusion led to significant clinical recovery. The older sister showed a similar pattern but interestingly the onset was later and the signs and symptoms were milder.

Conclusions

In the pediatric age group with diffuse corneal vascularization and no definite cause, systemic workup should be done to rule out multiple endocrine deficiencies. The therapy consists of hormone replacement therapy and management of dry eye.
Bilateral Primary Choroidal Melanoma Treated with Bilateral Plaque Radiotherapy: A Report of Three Cases
Authors: Shields L. , Furuta M. , Uysal Y. , Shields J.A.
Published: January 2018

Purpose

To report three cases of bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy.

Methods

Retrospective, single-center case series.

Results

Case 1: In 1981, a 50-year-old man was diagnosed with a 5-mm-thick choroidal melanoma in the right eye (OD) and treated with plaque radiotherapy. In 1994, a 6.8-mm-thick choroidal melanoma in the left eye (OS) was treated with plaque radiotherapy. Final visual acuity was light perception OD and 20/20 OS at 24 years follow-up. Case 2: In 1983, a 53-year-old woman was diagnosed with a 3.5-mm-thick choroidal melanoma OS and treated with plaque radiotherapy. In 2001, an enlarging 2.5-mm-thick choroidal melanoma OD was treated with plaque radiotherapy. Final visual acuity was 20/30 OD and 20/20 OS at 22 years follow-up. Case 3: In 2001, a 92-year-old man was diagnosed with a 7.9-mm-thick choroidal melanoma OD treated with plaque radiotherapy. In 2003, an enlarging 2.8-mm-thick juxtapapillary choroidal melanoma was treated with plaque radiotherapy. Final visual acuity was 20/70 OD and 20/60 OS at 2.5 years follow-up. No patient showed ocular melanocytosis. Stable tumor regression was achieved in all six eyes. Metastatic disease did not develop in any case over 16 years of follow-up.

Conclusions

Monitoring of both eyes of patients with uveal melanoma is important for the remote possibility of melanoma in the second eye. In these three patients, plaque radiotherapy allowed for preservation of the globes and some vision.