bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Glaucoma Probability Score and Moorfields Regression Analysis to Discriminate Glaucomatous and Healthy Eyes
Authors: Takmaz Tamer , Can İzzet
Published: January 2018

Purpose

To compare sensitivity and specificity values of glaucoma probability score (GPS) and Moorfields regression analysis (MRA) of Heidelberg retina tomograph (HRT) to discriminate between glaucomatous and healthy eyes.

Methods

A total of 160 eyes of 160 individuals (80 glaucoma patients and 80 healthy subjects) were enrolled in this prospective cross-sectional study. Confocal scanning laser ophthalmoscopy was performed with HRT. Performance of GPS and MRA were evaluated by considering borderline (BL) cases as within normal limits (WNL) or as outside normal limits (ONL). For further analysis glaucoma group was divided into two subsets: initial and moderate/severe damage group.

Results

There was no difference between glaucoma patients and normal subjects in terms of gender, disc area, and pachymetry (p>0.05). The GPS was higher, average visual field MD and PSD values were worse, and patients were older in glaucoma group (p=0.001). Sensitivity and specificity values were 72.5% and 93.8% respectively for MRA and 75.0% and 88.8% for GPS when BL cases considered as WNL, and when BL cases considered as ONL these values were 83.8% and 73.8% for MRA and 88.8% and 70.0% for GPS. There was no difference between sensitivity and specificity values of GPS and MRA for either situation (p>0.05). Sensitivity of GPS (76.2%) was higher than of MRA (61.9%) in initial glaucomatous eyes (p=0.317).

Conclusions

Diagnostic performance of GPS was similar to MRA. It was found that GPS might differentiate between glaucomatous and healthy eyes with relatively better sensitivity but worse specificity and represent considerable advantage over MRA in early glaucoma cases.
Episcleral Hemangioma as an Isolated Finding
Authors: Al-Ghadeer Huda , Al-Rajhi Ali A. , Riley Fenwick C.
Published: January 2018

Purpose

To report on a case of episcleral hemangioma in a child.

Methods

A 3-year-old boy presented with a 4-week history of limbal mass in the left eye and had an excision of that mass.

Results

There was an 8 × 7 mm oval lesion, 3–4 mm below the inferior limbus. It was reddish, sharply elevated with smooth surface, and firmly attached to the underlying sclera with two large blood vessels over it. Histopathologic examination demonstrated a cellular lesion containing vascular spaces of various sizes. The solid appearance indicated an increase of cells that appear to be consistent with endothelial cells which formed a nest surrounded by PASpositive strands. Small to moderate size capillaries were evident throughout the solid portion of the lesion. These findings were consistent with episcleral hemangioma of capillary type.

Conclusions

Episcleral hemangioma is a rare tumor and should be included in the differential diagnosis of episcleral tumors. To our knowledge, this is the first reported case of episcleral hemangioma in a child as an isolated finding.
Three-Dimensional Imaging of an Optic Disk Pit Using High Resolution Optical Coherence Tomography
Authors: Schneider Miklos , Geitzenauer Wolfgang , Ahlers Christian , Golbaz Isabelle , Schmidt-Erfurth Ursula
Published: January 2018

Purpose

To clarify the origin of the coexisting fluid in an optic disc pit case by using optical coherence tomography (OCT).

Methods

High resolution OCT (Cirrus™ prototype, Carl Zeiss Meditec) was used for image acquisition; three dimensional segmentation was performed using Food and Drug Administration–approved imaging software (3D-Doctor V4.0, Able software Corp., Lexington, MA) to demonstrate the structural changes of the optic nerve head and the retina.

Results

Using high resolution OCT, the authors demonstrated that this case of optic pit had a possible connection between the subretinal and the intraretinal space.

Conclusions

The authors assume that the intraretinal space is progressively filled with subarachnoidal fluid, leading to a tearing force within the outer neurosensory layers. A connection between the outer nuclear layer and the subretinal space may lead to a serous retinal detachment as a secondary event. Vision loss could consecutively be induced by a serous retinal detachment. High resolution OCT technology is able to visualize discrete changes of the microarchitecture of the optic nerve as well as the retina when combined with appropriate imaging software.
Aspheric Profile versus Wavefront-Guided Ablation Photorefractive Keratectomy for the Correction of Myopia using the Allegretto Eye Q
Authors: Ghoreishi Seyyed Mohammad , Naderibeni Afsaneh , Peyman Alireza , Rismanchian Akram , Eslami Fatemeh
Published: January 2018

Purpose

To compare the results of photorefractive keratectomy (PRK) with Q-factor customized aspheric ablation and wavefront-guided customized ablation for correction of myopia compound with astigmatism.

Methods

Fifty-six patients were enrolled in this prospective controlled study. In each patient, one eye was randomly assigned for treatment with the Q-factor customized PRK (custom-Q study group) and the other eye treated with wavefront-guided customized PRK. Preoperative and 3-month postoperative manifest refraction, contrast sensitivity, visual acuity, aberrometry, and asphericity of the cornea were compared between the two groups. All eyes were treated with the Wavelight Eye-Q 400 Hz excimer laser in a single refractive surgery center by a single surgeon.

Results

Uncorrected visual acuity (UCVA) improved to 20/20 or more and 20/25 or more in 34 eyes (60.7%) and 56 eyes (100%), respectively, in the wavefront-guided ablation group and in 36 eyes (64.2%) and 54 eyes (96.4%) in the custom-Q ablation group. All eyes had UCVA of 20/40 or better. A total of 54 eyes (96.4%) in the wavefront-guided ablation group and 56 (100%) in the custom-Q ablation group had spherical equivalent (SE) within ±0.5 D. One eye in each group (2%) lost ≥ 2 lines of best-corrected visual acuity (BCVA). High order root mean square (RMS) in the wavefront-guided group was 0.3630±0.13 μm preoperatively and 0.427±0.17 at 3 months (p=0.2). In the custom-Q ablation group it was 0.329±0.092 preoperatively and 0.4730±0.181 at 3 months after PRK (p=0.08).

Conclusions

Regarding safety and refractive efficacy, custom-Q ablation profiles were clinically equivalent to wavefront-guided profiles in corrections of myopia up to −6.00 D and astigmatism up to 2.50 D.
Topical N-acetylcysteine Reduces Interleukin-1-alpha in Tear Fluid after Laser Subepithelial Keratectomy
Authors: Urgancioglu Berrak , Bilgihan Kamil , Engin Doruk , Cirak Meltem Yalinay , Hondur Ahmet , Hasanreisoglu Berati
Published: January 2018

Purpose

To evaluate the effect of topical N-acetylcysteine (NAC) on interleukin 1-alpha (IL-1α) levels in tear fluid after myopic laser subepithelial keratectomy (LASEK) and its possible role in modulating corneal wound healing.

Methods

Twenty-six eyes of 13 patients who underwent myopic LASEK were divided into 2 groups. Group 1 (n=10 eyes) was used as a control group. All patients received topical lomefloxacin and dexamethasone postoperatively. Additionally, patients in Group 2 received topical NAC for 1 month postoperatively. Tear fluid samples were collected with microcapillary tubes preoperatively, on the first and on the fifth postoperative day, and the release of IL-1α in tear fluid was calculated. Haze grading and confocal microscopic examination were performed at 1 and 3 months postoperatively.

Results

The mean IL-1-α release values were 0.285±0.159 pg/min in Group 1 and 0.235±0.142 pg/min in Group 2 preoperatively. In Group 1, the values were 0.243±0.155 pg/min on day 1 and 0.164±0.125 pg/min on day 5. In Group 2, the mean IL-1α release values were 0.220±0.200 pg/min on day 1 and 0.080±0.079 pg/min on day 5. The difference between the groups was significant only for day 5 (p<0.05). Mean corneal haze score and grey scale value in confocal microscopy were significantly higher (p<0.05) in Group 1 at 1 month. However, at 3 months there was no difference between groups (p>0.05).

Conclusions

NAC seems to have an additive effect to steroids in suppressing IL-1α levels in tear fluid and may be clinically advantageous in modulating corneal wound healing during the early postoperative period after LASEK.
Antioxidant Status Modifications by Topical Administration of Dorzolamide in Primary Open-Angle Glaucoma
Authors: Zanon-Moreno Vicente , Garcia-Medina Jose J. , Gallego-Pinazo Roberto , Vinuesa-Silva Ignacio , Moreno-Nadal Maria A. , Pinazo-Duran Maria D.
Published: January 2018

Purpose

This study deals with the role of the topical administration of dorzolamide eyedrops on the oxidative/antioxidant status of aqueous humor in patients with primary openangle glaucoma (POAG).

Methods

A case-control study including 130 patients distributed into three groups was carried out: 1) patients with POAG without dorzolamide instillation administration (GG; n=34); 2) patients with POAG with dorzolamide (DG; n=36); and 3) subjects with cataracts (comparative group, CG; n=60). Oxidative activity was measured in the aqueous humor by malondialdehyde determination by the thiobarbituric acid reactive substances assay. Antioxidant status was assessed in the aqueous humor samples by measuring the superoxide dismutase activity and the total antioxidant status.

Results

Oxidative activity was significantly higher in both glaucoma groups than in the cataracts group (GG vs CG, p=3.68 E-34; DG vs CG, p=5.11 E-45), and was significantly higher in GG than in DG (p=0.0034). SOD activity was significantly higher in both glaucoma groups than in the cataracts group (GG vs CG, p=1.08 E-14; DG vs CG, p=3.70 E-22), and was significantly higher in GG than in DG (p=0.018). Finally, total antioxidant status was significantly decreased in both glaucoma groups compared with the cataracts group (GG vs CG, p=2.51 E-12; DG vs CG, p=5.06 E-05), and was more significantly decreased in GG than in DG (p=9.23 E-07).

Conclusions

Topical administration of dorzolamide colirium diminishes oxidative stress in patients with glaucoma.
Intravitreal Bevacizumab for Treatment of Chronic Central Serous Chorioretinopathy
Authors: Schaal Karen B. , Hoeh Alexandra E. , Scheuerle Alexander , Schuett Florian , Dithmar Stefan
Published: January 2018

Purpose

To evaluate the short-term safety and efficacy of intravitreal bevacizumab for the treatment of intraretinal or subretinal fluid accumulation secondary to chronic central serous chorioretinopathy (CSC).

Methods

Twelve patients were treated with intravitreal injections of 2.5 mg bevacizumab at 6-to 8-week intervals until intraretinal or subretinal fluid resolved. Observation procedures were Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), ophthalmic examination, and optical coherence tomography (OCT), performed at 6- to 8-week intervals. Fluorescein angiography was performed at baseline visit and thereafter depending on clinical and OCT findings. Multivariate analysis of variance with repeated measures was used to calculate a statistical significance of change in BCVA and mean central retinal thickness, which were the main outcome measures. SAS statistical software was used for analyses.

Results

Patients received 2±1 intravitreal injections of bevacizumab on average during a follow-up of 24±14 weeks. Mean BCVA increased by 2±2 lines; the change in BCVA (log-MAR) was significant (p<0.02). Mean central retinal thickness decreased significantly over follow-up (p<0.05), with 6 patients (50%) showing complete resolution of subretinal fluid.

Conclusions

Anatomic and functional improvement following intravitreal bevacizumab injections suggest that vascular endothelial growth factor (VEGF) may be involved in fluid leakage in patients with chronic CSC. The results suggest a possible role for anti-VEGF agents in the treatment of chronic CSC. Further evaluation of intravitreal bevacizumab for chronic CSC in controlled randomized studies is warranted.
HLA-DQB1 Subtypes Predict Diabetic Retinopathy in Patients with Type I Diabetes Mellitus
Authors: Khazaee Mohammad Hassan , Afshari Jalil Tavakol , Khazaee Bahram , Daneshvar Ramin , Akbarzadeh Javad , Khazaee Ladan , Ganjali Rashin , Raygan Firoozeh
Published: January 2018

Purpose

To investigate if diabetic patients without diabetic retinopathy despite long disease duration have different human leukocyte antigen (HLA) status vs those with an early onset of retinopathy.

Methods

Retrospective, nonrandomized, masked comparative study. Type 1 diabetic patients with a disease onset before age 30 were recruited to the study. The study population consisted of two groups of diabetic patients: those with normal retinopathy course (retinopathy developed during the first 20 years of diabetes onset) (23 patients) and those with postponed retinopathy (no obvious retinopathy in spite of passing 20 years of diabetes) (19 patients). These groups were matched with regard to level of glycemic control, blood pressure, and lipid profile. A group of 23 healthy patients served as controls. HLA-DQB1 typing of blood samples was done using a polymerase chain reaction with sequence-specific primer (PCR-SSP) method.

Results

HLA-DQB1*0201/HLA-DQB1*0501 and HLA-DQB1*0201/HLA-DQB1*0504 haplotypes were more common among type 1 diabetic patients with normal retinopathy course than those with postponed retinopathy (26.1% vs 0.0%; p=0.019). HLA-DQB1*0301 and HLA-DQB1*0304 were less common among those diabetic patients with normal retinopathy course than those with a postponed retinopathy (63.2% vs 34.8%; p=0.067).

Conclusions

Some haplotypes seem to predispose diabetic patients to diabetic retinopathy. HLA typing may be beneficial for predicting the prognosis of diabetic retinopathy in younger diabetic patients.
Aqueous Concentration of Tranexamic Acid after 5% and 10% Eyedrop Administration
Authors: Hosseini Hamid R. Jahadi , Montaseri Hashem , Khalili Mohammad R. , Simakani Shohreh A.
Published: January 2018

Purpose

To determine whether topical tranexamic acid can provide acceptable therapeutic concentration in the aqueous humor.

Methods

A total of 47 patients with cataract as the sole eye disease who have been scheduled for cataract operation received one drop of tranexamic acid 5% solution at various time intervals prior to operation (from 15 minutes to 9 hours). Two patients received 10% solution of the drug. Paracentesis of the anterior chamber was done and the aqueous humor was aspirated in the operation room. The aqueous samples were analyzed using high-performance liquid chromatography method with the limit of quantification around 0.1 μg/mL. Systemic and ocular side effects were evaluated.

Results

Aqueous concentrations of tranexamic acid was higher than 1.5 μg/mL up to 160 minutes after administration of a single drop of 5% solution of the drug and then declined to an average concentration of 1 μg/mL at 300 minutes which persisted up to 9 hours after administration. In two patients for whom a single drop of 10% tranexamic acid solution was used, aqueous concentrations of 2.72 and 2.90 μg/mL were detected 60 minutes after administration. None of the patients experienced ocular or systemic side effects.

Conclusions

Topical administration of tranexamic acid is effective in yielding therapeutic intraocular concentrations of drug without any ocular or systemic toxicity.
Recently Recognized Cases of Ophthalmofilariasis in Hungary
Authors: Fodor Eszter , Fok Éva , Maka Erika , Lukáts Olga , Tóth* Jeanette
Published: January 2018

Purpose

To report four cases of zoonotic ophthalmodirofilariasis infection caused by Dirofilaria repens in Hungary.

Methods

Four cases of ophthalmofilariasis have been treated at our department during the last 14 months. A subconjunctival moving worm was observed by slit lamp biomicroscopy in two cases. In one of these a living filaria was surgically removed, but the other disappeared. Red eye and migrating edema were the presenting signs in two cases. A biopsy taken from the subcutaneous masses disclosed D repens.

Results

Histopathologic or parasitologic examination identified a female D repens in every case. Laboratory alterations were not found. Symptoms subsided after treatment.

Conclusions

The clinical presentation of filariasis is not always straightforward, and a high index of suspicion is necessary in cases presenting with orbital or periorbital inflammation. During the past 10 years the identification of locally acquired infections by D repens has increased in Hungary.
Cardiorespiratory Depression and Hyperglycemia after Unintentional Ingestion of Brimonidine in a Neonate
Authors: Vanhaesebrouck Sophie , Cossey Veerle , Cosaert Katrien , Allegaert Karel , Naulaers Gunnar
Published: January 2018

Purpose

Brimonidine is a third-generation selective alpha-2 adrenergic agonist that lowers intraocular pressure by decreasing aqueous humor production and increasing uveoscleral flow. Its safety profile for children <2 years of age remains unknown.

Methods

We describe a case of ingestion of a single drop of brimonidine 0.2% in a newborn, resulting in sedation, cardiorespiratory depression, and hyperglycemia within minutes.

Conclusions

This report adds to the existing evidence that brimonidine can have serious adverse side effects and should therefore be used with extreme caution in infants <2 years of age. Additionally, safety procedures like double-checking should also include vitamins or oral supplements to improve medication safety in the neonatal intensive care unit.
Laser in Situ Keratomileusis for Treatment of Fully or Partially Refractive Accommodative Esotropia
Authors: Polat Sibel , Can Çigdem , İlhan Bayazit , Mutluay Ayse H. , Zilelioğlu Orhan
Published: January 2018

Purpose

To evaluate the efficacy and safety of laser in situ keratomileusis (LASIK) in partially refractive accommodative esotropia (pRAE) and fully refractive accommodative esotropia (fRAE).

Methods

Forty-two eyes of 21 patients who had LASIK for correcting hyperopic refractive error were evaluated. Refractive errors, uncorrected visual acuity (UCVA) and best-corrected visual acuity (BCVA), ocular alignment, and stereopsis were recorded before and after LASIK.

Results

Sixteen patients with fRAE and 5 with pRAE were evaluated. Mean age at the time of surgery was 19.00±3.79 years. Mean follow-up time was 12.19±4.51 months. For the fRAE group, the mean preoperative angle of deviation without spectacle correction was +19.13±5.87 prism diopters (PD); all were orthophoric with spectacles. Postoperatively, all these patients achieved less than 10 PD of deviation without spectacles. For the pRAE group, the mean preoperative angle of deviation was +32.60±9.81 PD and +14.60±6.14 PD without and with spectacles, respectively. Postoperatively, the mean angle of deviation was +13.60±5.72 PD and +12.80±5.40 PD without and with spectacles, respectively. For all 21 patients, the preoperative mean spherical equivalent (SE) with cycloplegia was +4.94±1.43 diopters (D); it was +1.49D±0.70 D postoperatively. Three eyes lost 1 line of BCVA and 3 eyes gained 1 line. No intraoperative complication was recorded.

Conclusions

LASIK is a safe and effective method for treating refractive error and creating orthophoria in fRAE. In pRAE, it eliminates the refractive component of deviation safely and effectively. (Eur J Ophthalmol 2009; 19: 733–7)
Meta-Analysis of Articles Evaluating Routine Intraocular Pressure Control in Monotherapy in the United States and Germany
Authors: Stewart William C. , Pfeiffer Norbert , Mathis Heather M.
Published: January 2018

Purpose

To evaluate routine intraocular pressure (IOP) control in monotherapy patients in the United States and Germany.

Methods

Meta-analysis of published articles. We included articles that were prospective studies of ocular hypotensive therapies that measured an unaltered (visit 1) IOP on monotherapy before enrolling into a clinical trial.

Results

This meta-analysis included 5 studies with 7913 patients, of whom 3245 were from the United States (n=1) and 4668 were from Germany (n=4). In the United States, 2939 patients (91%), and in Germany, 4059 patients (87%), had glaucoma (p<0.0001). Of these, all the US patients (100%) and 2694 (58%) of those from Germany were treated with monotherapy. The mean IOP with individual monotherapies in the United States was 19.6±2.2 and in Germany 20.8±0.8 mmHg (p=0.015). Among individual classes of medicine, patients treated with a prostaglandin demonstrated equal pressures (18.8 mmHg, p=0.60) in both countries, whereas the United States showed a lower pressure (20.2 mmHg) than Germany (21.2 mmHg, p=0.0019) with beta blockers. US physicians less often indicated that IOP was adequately controlled (n=1035, 32%) than in Germany (n=2030 of all patients, 44%, p<0.0001).

Conclusions

This study suggests that patients treated by individual monotherapies in the United States demonstrate a lower pressure, but generally are more often considered uncontrolled, than those in Germany. This finding, if true, indicates a possible variance in treatment goals, or access to treatment, between the United States and Germany in treating patients with elevated pressure. (Eur J Ophthalmol 2009; 19: 769–75)
Intravitreal Injection of Bevacizumab before Vitrectomy for Proliferative Diabetic Retinopathy
Authors: Modarres Mehdi , Nazari Hossein , Ghasemi Falavarjani Khalil , Naseripour Masood , Hashemi Masih , Mehdi Parvaresh Mohammad
Published: January 2018

Purpose

To evaluate the use of preoperative intravitreal bevacizumab (IVB) injection in patients undergoing pars plana vitrectomy for complications of proliferative diabetic retinopathy (PDR).

Methods

In this prospective surgeon-masked randomized clinical trial, 40 eyes of 40 diabetic patients who were candidates for vitrectomy were randomly assigned to receive 2.5 mg IVB 3–5 days before operation (injected group) or no injection before operation (noninjected group). A preoperative complexity score (CS) was recorded. Best-corrected visual acuity, number of endodiathermy applications, backflush needle applications, duration of surgery, and postoperative vitreous hemorrhage were recorded.

Results

Twenty-two patients with a CS of 6±0.95 in the injected group and 18 patients with a CS of 5.7±1.1 in the noninjected group (p=0.3) were studied. Postoperative visual acuities were significantly better than preoperative visual acuities. Preoperative and 3-month postoperative visual acuities were the same for both groups; however, in the last follow-up examinations (mean 7± 3.6 months) the injected group had better visual acuities than the noninjected group (1.1±0.4 and 1.4±0.3 logMAR, respectively, p=0.006). Mean surgical time was 62±57.3 minutes in the injected group vs 95.5±36 minutes in the noninjected group (p=0.03): endodiathermy applications 6.0±4.3 vs 11.0±5.8 (p=0.004), backflush cannula applications 11.0±7.2 vs 18.1±7.8 (p=0.004). In non-silicone-filled eyes, no patient in the injected group developed significant postoperative vitreous hemorrhage obscuring the fundus details, while 7 eyes of noninjected eyes had this complication (p=0.01).

Conclusions

IVB injection before vitrectomy for PDR facilitates the surgery, and may decrease the rate of postoperative vitreous hemorrhage and improve the visual acuity results of the operation. (Eur J Ophthalmol 2009; 19: 848–52)
25-Gauge Sutureless Vitrectomy with Oblique Sclerotomies for the Management of Retinal Detachment in Pseudophakic and Phakic Eyes
Authors: Kapran Ziya , Acar Nur , Altan Tugrul , Unver Yaprak B. , Yurttaser Serap
Published: January 2018

Purpose

To evaluate the anatomic and functional outcomes of 25-gauge sutureless vitrectomy in primary treatment of noncomplex retinal detachments (RD) in pseudophakic and phakic eyes.

Methods

In this interventional clinical case series, 23 pseudophakic and 13 phakic eyes with total RDs with proliferative vitreoretinopathy grade A/B underwent primary 25-gauge sutureless vitrectomy with oblique sclerotomies and gas endotamponade. Eyes with minimum follow-up of 6 months were evaluated. Main outcome measures were single surgery and final reattachment rates, complications, and changes in visual acuity (VA).

Results

Mean duration of visual loss was 14.65±12.57 and 22.46±18.95 days in pseudophakic and phakic eyes, respectively. Eighteen (78.26%) pseudophakic eyes and 12 (92.30%) phakic eyes had macular detachment. In all eyes, 25-gauge sutureless vitrectomy was completed without complication. Mean follow-up period was 11.00±6.63 months. Single surgery and final retinal attachment rates were 91.30% and 95.65% in pseudophakic eyes and 61.53% and 84.61% in phakic eyes, respectively (p=0.073, p=0.539). In both groups, mean VA increased significantly at postoperative month 1 (p<0.05) and at the last visit (p<0.001). Transient hypotony was detected in 2 pseudophakic and 3 phakic eyes with spontaneous resolution. Two (15.38%) phakic eyes had cataractous changes.

Conclusions

In this study, 25-gauge sutureless vitrectomy resulted in higher single surgery and final anatomic success rates in primary treatment of noncomplex RDs in pseudophakic versus phakic eyes, with commensurate increase in VA. (Eur J Ophthalmol 2009; 19: 853–60)
The Influencing Factors and Characteristics of Corneal Graft Endothelial Decompensation after Penetrating Keratoplasty
Authors: Xiao Xuan , Xie Lixin
Published: January 2018

Purpose

To investigate the influencing factors and characteristics of endothelial decompensation after penetrating keratoplasty (PK).

Methods

We investigated the indications for PK, the onset times of postoperative endothelial decompensation, and the prevalence of risk factors in 151 eyes from 3031 eyes treated with PK in our center from 1993 to 2007.

Results

Ocular trauma (22%), repeated PKs (17%), and chemical and thermal burns (10%) were the most common PK indications with the occurrence of endothelial decompensation. Although herpes simplex keratitis (HSK) accounted for 13% in the PK indications with endothelial decompensation, its incidence was actually statistically low (p=0.040) due to the high percentage of HSK in the cases treated with PK (20%). Most endothelial decompensation occurred within 2 years (66%), which may be related to early rejection (p=0.038). Endothelial decompensation occurred within 2 years in all patients due to congenital corneal endothelial dystrophy and iridocorneal endothelial syndrome; more than 70% due to ocular trauma and chemical and thermal burn occurred within 2 years; most cases due to mycotic corneal ulcer (100%) and bullous keratopathy (93%) occurred within 5 years. In the HSK group, endothelial decompensation occurred most at 10.5 and 126 months (median time). The prevalence of risk factors depended on the indicator for PK (p=0.027), and rejection was the highest (41%) among all factors.

Conclusions

Patients with different indicators for PK had different incidences and onset times for endothelial decompensation, which could help clinicians to follow-up and treat patients with PK reasonably and improve the basic research of pathogenesis of endothelial decompensation.
Imaging Quality of Bifocal Piggyback Intraocular Lens versus ReSTOR and TECNIS Multifocal Lenses
Authors: Artigas José M. , Felipe Adelina , Díaz-Llopis Manuel , García-Delpech Salvador , Navea Amparo
Published: January 2018

Purpose

The imaging quality provided by a piggyback integrated by a monofocal intraocular lens (IOL) + a bifocal IOL of zero power and +3.75 diopters of addition is compared with the optics quality of a simple multifocal IOL of the same power and addition.

Methods

The imaging quality was evaluated by determining the modulation transfer function (MTF), using an artificial eye simulating in vivo conditions of the anterior chamber, including an artificial cornea and a wet cell containing physiologic solution where the IOL was positioned. The MTFs of the bifocal piggyback for near and distance vision were measured, with pupil diameters of 3 and 5 mm, and compared with the MTFs of an equivalent power of ReSTOR and TECNIS multifocal IOLs measured under the same conditions.

Results

The MTFs for distance and near focus of the bifocal piggyback are similar to the MTFs of the ReSTOR and TECNIS multifocal IOLs with the two diameters of pupil. A more accurate comparison, values of average modulation, and Strehl ratio show a greater similitude with ReSTOR than with TECNIS.

Conclusions

The bifocal piggyback system provides a similar imaging quality to that obtained with a ReSTOR multifocal IOL and, like the ReSTOR, provides better performance in distance vision than in near vision, whereas the TECNIS multifocal IOL provides the best performance.
Bevacizumab in Central Retinal Vein Occlusion: A Retrospective Analysis after 2 Years of Treatment
Authors: Stahl Andreas , Struebin Isabell , Hansen Lutz L. , Agostini Hansjürgen T. , Feltgen Nicolas
Published: January 2018

Purpose

Bevacizumab (Avastin®) was first used clinically in 2005. Reports on the treatment of more than 600 patients with central retinal vein occlusion (CRVO) have been published to date. However, there are limited data on the long-term effects of bevacizumab in patients with CRVO.

Methods

We retrospectively re-evaluated 10 patients with CRVO who were initially part of one of the first published case series on the short-term effects of bevacizumab (1). The patients were invited for a follow-up visit 2 years after their initial bevacizumab injection. Study endpoints were changes in visual acuity (VA) and central macular edema (CME) compared to 1) baseline values and 2) short-term values after the initial injection.

Results

Short-term VA gain had been 2.9 lines 3 weeks after the first bevacizumab injection. Two years later, mean VA gain vs baseline was 1.6 lines. Low baseline VA and good response to the first injection correlated positively with higher long-term VA gains (Pearson correlation of r = 0.50 and r = 0.66). There was no correlation for injection number, occlusion time, or CME changes with long-term VA gain.

Conclusions

The initial short-term VA gain after bevacizumab treatment was not always maintained over a 2-year period despite repeated injections. Patients with low baseline VA and good response to the first injection seemed to benefit most from repeated bevacizumab injections.
Risk Factors for Culture-Positive Endophthalmitis after Repair of Open Globe Injuries
Authors: Al-Mezaine Hani S. , Osman Essam A. , Kangave Dustan , Abu El-Asrar Ahmed M.
Published: January 2018

Purpose

To identify risk factors for the development of culture-positive endophthalmitis after repair of open globe injuries.

Methods

We retrospectively reviewed the medical records of 629 consecutive patients with open globe injuries admitted to King Abdulaziz University Hospital between May 1996 and January 2008.

Results

Endophthalmitis developed in 12 (1.9%) patients. The following factors were significantly associated with endophthalmitis by univariate analysis: delayed presentation (>24 hours) (p=0.008), rural address (p=0.013), and dirty wound (p=0.012). Logistic regression analysis identified dirty wound to be associated with the development of endophthalmitis (odds ratio = 11.6; 95% confidence interval [CI] = 2.67–50.6). On logistic regression analysis, presence of retained intraocular foreign body (IOFB) in association with rural address (odds ratio = 11.0; 95% CI = 1.44–83.3) or dirty wound (odds ratio = 9.2; 95% CI = 1.22–69.1) was associated with development of endophthalmitis. Endophthalmitis was a significant negative predictor for final good visual outcome (p=0.00261) and was significantly associated with hypotony (p=0.033).

Conclusions

Delayed presentation, rural address, and dirty wound were associated with development of endophthalmitis. Retained IOFB in association with rural address or dirty wound was associated with a particularly high risk of endophthalmitis.
Allergic Conjunctivitis: A National Cross-Sectional Study of Clinical Characteristics and Quality of Life
Authors: Palmares Jorge , Delgado Luis , Cidade Manuela , Quadrado Maria J. , Filipe Helena P.
Published: January 2018

Purpose.

Ocular allergy is one of the most common ocular problems in clinical practice and, although easily identified and frequently a mild to moderate condition, it has relevant direct and indirect costs. To characterize clinical and demographic aspects of allergic conjunctivitis in Portugal, using a structured questionnaire. As a secondary outcome, patient's initial therapeutic and health care options, self-perception of health, and work/school absenteeism were also evaluated.

Methods.

A cross-sectional study, in 16 ophthalmology departments of central or regional hospitals, in patients diagnosed with allergic conjunctivitis during the spring of 2006.

Results.

A total of 220 patients were enrolled (mean age of 31.4±18.5 years). A quarter of these patients had >5 episodes of ocular allergy in the past year, 59.3% all year-round episodes, and most presented associated comorbidities (allergic rhinitis 45.9%, asthma 15.5%). They had significant impairment of their overall quality of life during an acute episode (45.6% ≥6 in a 10-point severity scale). Only 19.4% had an appointment with an ophthalmologist as a first action and most (56.1%) started with self treatment measures. Only 37.2% had a previous allergy diagnostic evaluation.

Conclusions.

In this cross-sectional study of allergic conjunctivitis patients seen in ophthalmology departments, we found a significant impairment of self-rated health status during an ocular allergy episode. Moreover, most patients had year-round episodes and started ocular allergy management with self treatment measures.
Refractive surgery in patients with retinitis pigmentosa
Authors: Vingolo Enzo Maria , Grenga Pier Luigi , Meduri Alessandro , Lupo Stefano , Grenga Roberto
Published: January 2018

Purpose.

To evaluate the refractive outcomes and safety of laser refractive surgery in a group of myopic patients with retinitis pigmentosa (RP).

Methods.

This was a multicenter, retrospective, noncomparative, interventional case series. A total of 32 eyes of 16 patients with RP with at least 18 months of follow-up were treated with laser refractive surgery (photorefractive keratectomy [PRK], laser subepithelial keratectomy [LASEK]). Refractive outcomes, complete eye examination, corneal topography, and retinal sensitivities were evaluated during follow-up. Mean follow-up was 28.3 months (minimum 18, maximum 50). Mean patient age was 29.6 years (range 24–54). Mean best-corrected visual acuity (BCVA) was 0.75 preoperatively

Results.

Eighteen months after surgery, mean uncorrected visual acuity (UCVA) was 0.8±1 line (p=0.02); mean BCVA was 0.85±1 line (p<0.0005) with mean spherical equivalent of −0.16 D. Corneal complications were not detected during follow-up; corneal topography did not show corneal ectasia in any patient after surgery. During follow-up visits, no development or progress of macular edema was noted in any eye. Retinal sensitivities increased after surgery; there were no significant changes in electroretinogram amplitude.

Conclusions.

Mean UCVA and BCVA 18 months after surgery were higher than preoperative BCVA. All patients were safely treated without any significant complications. Our results support the safety of performing PRK and LASEK in patients with tapetoretinal degeneration.
In Vitro Susceptibility of Bacterial Keratitis Isolates to Fourth-Generation Fluoroquinolones
Authors: Chawla Bhavna , Agarwal Prakashchand , Tandon Radhika , Titiyal Jeewan S. , Sharma Namrata , Agarwal Tushar , Nayak Niranjan , Satpathy Gita
Published: January 2018

Purpose.

To study the microbiological profile of bacterial keratitis in Northern India and to determine the antibiotic sensitivity pattern of bacterial keratitis isolates to fourth-generation fluoroquinolones.

Methods.

Laboratory records of all consecutive cases of clinically suspected bacterial corneal ulcers were retrospectively reviewed. Data noted included microorganism isolated and antibiotic culture sensitivity to cefazolin, tobramycin, gatifloxacin, and moxifloxacin. In vitro susceptibility toward individual antibiotics was determined and compared with the potential in vitro susceptibilities to cefazolin-tobramycin, cefazolin-gatifloxacin, and cefazolin-moxifloxacin combinations.

Results.

A total of 292 bacterial isolates were identified. Of these, 255 (87.3%) were Gram-positive and 37 (12.7%) were Gram-negative. Staphylococcus epidermidis (n=227, 77.7%) was the most common organism. Overall susceptibility of isolates was 95.52% to gatifloxacin, 92.83% to moxifloxacin, 90.07% to tobramycin, and 83.56% to cefazolin (p<0.000). Organisms which showed resistance to fourth-generation fluoroquinolones included Staphylococcus epidermidis, Pseudomonas aeruginosa, viridans streptococci, Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli. Susceptibilities to gatifloxacin and moxifloxacin were comparable with each other (p=0.312) and with potential susceptibilities to cefazolin-tobramycin (p=0.479), gatifloxacin-cefazolin (p=0.134), and moxifloxacin-cefazolin (p=0.412) combinations.

Conclusions.

Monotherapy with moxifloxacin or gatifloxacin can be an effective alternative to cefazolin-tobramycin combination as a first-line empirical therapy for bacterial keratitis. The addition of cefazolin to a fourth-generation fluoroquinolone is of limited value.
Long-Term Benefit of Reduced Intraocular Pressure in Primary Open-Angle Glaucoma Patients in Ethiopia
Authors: Alemu Abiye M. , Kristoffersen Caroline J. , Kristoffersen Michael S. , Stewart Jeanette A. , Stewart William C.
Published: January 2018

Purpose.

To determine the incidence of progression of primary open-angle glaucoma at individual levels of mean intraocular pressure (IOP) in patients in Ethiopia.

Methods.

A retrospective, multicenter, cohort analysis of patient records with at least 5 years of potential follow-up were evaluated for risk factors associated with progressive optic disc and visual field loss.

Results.

There were 300 patients with the potential of 5 years of follow-up. In total, 166 patients progressed before 5 years and 134 remained stable for the full 5-year follow-up period. Of the total sample, 84% of patients with IOPs ≤19 (n=117/139), 53% of patients with IOPs of 20 (n=9/17), 14% of patients with IOPs of 21–24 (n=9/63), and 0% of the patients with IOPs of ≥25 mmHg (n=0/79) remained stable over at least 5 years. The mean IOP was 17.4±2.1 in the stable group and 25.0±5.9 mmHg in the progressed group (p<0.0001). The highest average peak IOP was 24.5±4.5 in the stable group and 29.0±6.1 mmHg in the progressed group (p<0.0001). A multivariant regression analysis to determine risk factors for progression was positive for mean IOP (p=0.0097).

Conclusions.

This study suggests that IOP reduction in a developing country, despite potential limitations in diagnostic techniques, follow-up, and compliance, can be effective in reducing the risk of glaucomatous progression over long-term follow-up.
Comparison of 2 Surgical Techniques in Phacotrabeculectomy: 1 Site versus 2 Sites
Authors: Nassiri Nader , Nassiri Nariman , Mohammadi Babak , Rahmani Laleh
Published: January 2018

Purpose.

To compare 1-site and 2-site phacotrabeculectomies with regard to visual acuity, intraocular pressure (IOP) control, antiglaucoma medication requirements, and postoperative complications.

Methods.

In a randomized controlled trial, 169 eyes with coexisting visually significant cataract and glaucoma were randomly allocated into 2 groups: eyes that had a trabeculectomy in a superior quadrant combined with phacoemulsification through the same incision (1-site group; n=85) or those with a separate, temporal, clear corneal incision for phacoemulsification (2-site group; n=84). Postoperative evaluation, including visual acuity, intraocular pressure (IOP), glaucoma medication requirements, and surgical complications, was for up to 18 months.

Results.

After 18 months, there was no significant difference between the 2 groups with respect to visual acuity and antiglaucoma medication requirements. There was a 0.6 to 1.4 mmHg difference in mean IOP, with the 2-site technique demonstrating statistically significant advantage over the 1-site technique in some follow-up visits with nonparametric analysis; however, the difference cannot be clinically significant. Success rates (IOP<21 mmHg with the maximum use of medication) of 1-site and 2-site groups were 85.9% and 92.8%, respectively, which was not statistically significant (p=0.153). Nevertheless, the incidence of failure in the 1-site group was almost twice that of the 2-site group (12 vs 6). Postoperative complications were comparable in both groups.

Conclusions.

Results for 18-month follow-ups of 1-site and 2-site phacotrabeculectomies were comparable in terms of visual acuity, antiglaucoma medication requirements, and postoperative complications. While lowering of IOP was more pronounced in the 2-site group, this was not clinically significant.
Differences in Visual Performance of Acrysof ReSTOR IOL in High and Low Myopic Eyes
Authors: Alfonso José F. , Fernández-Vega Luis , Ortí Susana , Ferrer-Blasco Teresa , Montés-Micó Robert
Published: January 2018

Purpose.

To determine the differences in refractive and visual results obtained in eyes with high and low myopia after multifocal intraocular lens (IOL) implantation.

Methods.

Monocular visual acuity for distance and near, with and without distance correction, and photopic and mesopic contrast sensitivity were measured at 6 months after surgery in 152 myopic eyes implanted with the AcrySof ReSTOR Natural (SN60D3) IOL. Two groups were created: high and low myopia (76 eyes in each).

Results.

Monocular best distance-corrected visual acuity was 0.02±0.06 logMAR for low myopes and 0.05±0.09 logMAR for high myopes. Monocular best distance-corrected near visual acuity was 0.04±0.05 and 0.07±0.08 logMAR for low and high myopes, respectively. Contrast sensitivity for high myopic eyes under photopic conditions was lower, primarily at high spatial frequencies, in relation to low hyperopic. Differences between both groups were statistically significant for 6 and 18 cycles per degree (cpd) spatial frequencies (p<0.006). At mesopic level, high myopic eyes showed lower values compared to low myopic eyes for all spatial frequencies. However, these differences were only statistically significant for 3, 6, and 12 cpd (p<0.003).

Conclusions.

The AcrySof ReSTOR IOL provided good visual acuity and contrast sensitivity for both distance and near, with and without distance correction; however, better results were found in low myopic eyes compared to those obtained in eyes with high levels of myopia.
The Combination of Diffractive and Refractive Multifocal Intraocular Lenses to Provide Full Visual Function after Cataract Surgery
Authors: Hütz Werner W. , Bahner Katarzyna , Röhrig Bernd , Hengerer Fritz
Published: January 2018

Purpose.

To investigate if implantation of a far dominant refractive multifocal intraocular lens (IOL) in one eye and a near dominant diffractive multifocal IOL in the fellow eye improves range of vision following cataract surgery.

Methods.

This was a prospective, nonrandomized, case-control study involving 20 patients (40 eyes) scheduled for cataract surgery. Inclusion criteria were bilateral cataracts, minimum age 50 years, availability for follow-up visits, and informed consent. All patients received a far dominant refractive multifocal IOL (ReZoom, Abbott Medical Optics) in their dominant eye and a near dominant diffractive multifocal IOL (Tecnis ZM900, AMO) in their nondominant eye. Preoperative and postoperative measurements (3 months) included refraction, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), reading acuity, and reading speed.

Results.

All patients completed the study. We present results of the 3-month postoperative visit. The patient group comprised 14 females and 6 males, with mean age 72 years (SD 6.1 years). Postoperatively, the mean sphere was 0.05 ± 0.31 D and the cylinder −0.31 ± 0.37 D. At the 3-month visit, mean binocular distance UCVA was 0.080 logMAR (SD 0.070) and BCVA was 0.030 logMAR (SD 0.066). The mean binocular near visual acuity was 0.140 logMAR (SD 0.068), mean binocular best-corrected, near visual acuity 0.060 logMAR (SD 0.060).

Conclusions.

The combination of a far dominant refractive multifocal IOL (with better distance performance) with a near dominant diffractive multifocal IOL (with better near vision) proved to be very suitable to help meet cataract patients’ visual needs.
Visual Neuropraxia and Progressive Vision Loss from Thyroid-Associated Stretch Optic Neuropathy
Authors: Soni Chetan R. , Johnson LenWorth N.
Published: January 2018

Purpose.

Animal models have provided information on the tensile strength of the optic nerve, but to our knowledge no in vivo study of the tensile strength of the human optic nerve has been reported. Accordingly, we present 3 cases of stretch optic neuropathy, an often unrecognized cause of vision loss from thyroid eye disease.

Methods.

Observational study of thyroid-associated stretch optic neuropathy.

Results.

Three cases of stretch optic neuropathy were identified. Visual acuity was better than 20/40. Two patients had arcuate scotoma. Moderate to severe proptosis of 25 to 33 mm was present, without evidence of apical orbital compression. Two patients had retinal hemorrhages suggesting venous stasis retinopathy; the venous stasis retinopathy resolved after orbital decompression. Orbital decompression resulted in improvement of visual function. The rate of decibel sensitivity loss on automated perimetry was estimated at −0.042 dB/da in one case, with complete blindness projected to occur within 785 days from the onset of visual symptoms.

Conclusions.

Stretch optic neuropathy presents initially as neuropraxia with temporary visual loss. Orbital decompression should be considered for treatment before permanent and irreversible visual loss ensues.
Pneumatic Displacement of Acute Submacular Hemorrhage with and without the use of Tissue Plasminogen Activator
Authors: Çakir Mehmet , Çekiç Osman , Yilmaz Ömer F.
Published: January 2018

Purpose.

To evaluate the efficacy of C3F8 gas-assisted pneumatic displacement in the treatment of massive submacular hemorrhage, with and without the use of tissue plasminogen activator (tPA).

Methods.

Twenty-one eyes of 21 patients with recently developed (up to 10 days) dense submacular hemorrhage underwent intravitreal injection of pure C3F8 gas (0.4–0.5 mL) followed by face-down positioning for pneumatic displacement. Seven of them received additional intravitreal injection of 25–50 μg tPA. The primary etiology of submacular hemorrhage was age-related macular degeneration (n=16), myopic choroidal neovascularization (n=2), retinal arterial macroaneurysm (n=2), and trauma (n=1). Visual acuity and displacement of hemorrhage were the main outcome measures.

Results.

Follow-up period was 6–12 months. Effective displacement of hemorrhage was obtained in 20 of 21 patients within 7 days. Final median Snellen visual acuity (0.18) was found significantly improved compared to baseline (0.03) (p<0.001). Visual acuity improvement was similar in both groups (p=0–72).

Conclusions.

Intravitreal injection of C3F8 effectively displaced thick submacular hemorrhage and improved visual acuity independently from primary cause. Additional tPA use in this study had no impact on the final outcomes.