bluuebunny/crossref_metadata_2025 huggingface dataset:
Sympathetic Ophthalmia after successful Retinal Reattachment Surgery with Vitrectomy
Authors: Abu El-Asrar A.M. , Al Kuraya H. , Al-Ghamdi A.
Published: January 2018

Purpose

To report a case of sympathetic ophthalmia (SO) following one successful pars plana vitrectomy (PPV) for rhegmatogenous retinal detachment.

Methods

Case report.

Results

A 50-year-old man developed SO 5 weeks after successful repair of rhegmatogenous retinal detachment with PPV and intraocular gas tamponade. The patient presented with bilateral multifocal exudative retinal detachments and inflamed optic nerve with characteristic changes of SO detected by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. Prompt use of systemic steroids and cyclosporin A resulted in control of the uveitis with significant visual improvement.

Conclusions

PPV should be viewed as a major risk factor for development of SO.
Dry Eye after Lasik for Myopia: Incidence and Risk Factors
Authors: Shoja M.R. , Besharati M.R.
Published: January 2018

Purpose

Patients frequently experience dry eye symptoms after laser-assisted in situ keratomileusis (LASIK). The purpose of this study was to determine the incidence and risk factors of dry eye after myopic LASIK.

Methods

In this retrospective case series 190 eyes that underwent LASIK were examined for a dry eye syndrome. All patents were asymptomatic for dry eyes before surgery. Assessments included subjective complaints of dry eye, tear break-up time (TBUT), corneal staining, corneal sensitivity test, and Schirmer I test. All values were compared before and at 1 week and 1.3 and 6 months after surgery.

Results

For the 190 eyes, chronic dry eye persisting 6 months or more after LASIK was diagnosed in 20 percent of the eyes. Mean patient age was 31 ± 8 years. The risk for chronic dry eye was significantly associated with higher attempted refractive correction, greater ablation depth, and female sex (p=0.001). Subjective score for dryness was increased after LASIK. The greatest change from preoperative levels for all parameters was noted at 1 week. There were obvious decreases in TBUT and Schirmer value at 1, 3, and 6 months postoperatively relative to preoperative level (p<0.05). The Schirmer I test result was higher at 1 day but without statistical significance (p>0.05), but lower at 1 week and 3 and 6 months (p<0.05) after LASIK. Corneal sensitivity was decreased at 1 month and 3 months, and returned to the preoperative level at 6 months after LASIK. There was a statistically significant effect of age, sex, and mean spherical equivalent refraction on corneal sensitivity (p<0.001).

Conclusions

Patients undergoing LASIK for myopia develop dry eye with compromised tear function at least 6 months after surgery. Women and patients requiring higher refractive correction have an increased risk for developing dry eye. (Eur J Ophthalmol 2007; 17: 1–6)
Amniotic Membrane Transplantation for Painful Bullous Keratopathy
Authors: Srinivas S. , Mavrikakis E. , Jenkins C.
Published: January 2018

Purpose

To establish the effectiveness of amniotic membrane transplantation (AMT) in relieving pain and discomfort in patients with painful bullous keratopathy and also its role in improving vision in eyes with visual potential.

Methods

Seven eyes of seven consecutive patients with painful corneal conditions were included in a retrospective interventional noncomparative case series performed at Maidstone General hospital, Maidstone, UK. Amniotic membrane transplantation was performed in seven eyes. Pain relief, epithelial healing, and visual changes were evaluated. Pain relief and freedom from discomfort were considered for the success of the surgery.

Results

The mean follow-up was 26.57 weeks (range 11 to 53 weeks). Pain relief was achieved in all seven (100%) eyes. Associated symptoms including foreign body sensation, photophobia, and tearing subsided significantly in all patients starting soon after the first postoperative day. Vision improved in 5 (71.42%) patients.

Conclusions

AMT is an effective alternative for the management of patients with painful bullous keratopathy. Besides pain relief and reduction of ocular inflammation it remains unclear whether this procedure can also be used to improve vision in eyes with visual potential. (Eur J Ophthalmol 2007; 17: 7–10)
Outcomes of Acute Postoperative Inflammation after Cataract Surgery
Authors: Mohammadpour M. , Jafarinasab M.R. , Javadi M.A.
Published: January 2018

Purpose

To determine characteristics and final visual and surgical outcomes of patients who experienced early onset postoperative inflammation after cataract surgery and their early and late complications.

Methods

This is a prospective case series of 126 patients out of 1500 cases who underwent cataract surgery and experienced early onset postoperative inflammation during the first 2 weeks after cataract surgery. All the patients received complete ocular examinations at onset of signs and symptoms of inflammation. A total of 110 patients with follow-up examinations between 3 and 30 months after recovery of early onset postoperative inflammation (mean follow-up 11.6 months) were enrolled in the next part of the study to evaluate the final visual and surgical outcomes. Background systemic and ocular diseases, type of surgery, type of intraocular lenses and viscoelastic agent, early and late complications, and final best-corrected visual acuity were studied.

Results

Among 1500 patients, 126 cases (8.4%) had early onset postoperative inflammation, 64 cases (50.7%) were male, and 62 cases (49.3%) were female. Early complications were posterior synechia in 9 cases (7.1%), pupillary block in 2 cases (1.5%), and acute rise of intraocular pressure in 6 cases (4.7%). Late complications consisted of posterior capsular opacity in 38 cases (34.5%) and cystoid macular edema in 4 cases (3.2%). Peak of signs and symptoms of inflammation was during 2 weeks after surgery and all patients responded well to topical steroids. Final best-corrected visual acuity (BCVA) was 20/30 and better in 76 cases (69%), between 20/40 and 20/80 in 24 cases (22%), and less than 20/80 in 10 cases (9%). All cases with BCVA less than 20/80 had ocular diseases like choroidal neovascularization scar or age-related macular degeneration, advanced glaucoma, or corneal opacity.

Conclusions

Early onset postoperative inflammation causes pain, decreased vision, and patient anxiety in the acute phase but neither decreases final visual acuity nor has any significant or permanent ocular sequels. (Eur J Ophthalmol 2007; 17: 20–8)
Effects of Topical Dorzolamide on IOP after Phacoemulsification with Different Types of Ophthalmic Viscosurgical Devices
Authors: Kocak altintas A.G. , Anayol M.A. , Cakmak H.B. , Simsek S.
Published: January 2018

Purpose

To evaluate the effect of topical dorzolamide on postoperative intraocular pressure (IOP) after routine phacoemulsification surgery with different type of ophthalmic viscosurgical device (OVD).

Methods

Patients who were scheduled for phacoemulsification with intraocular lens (IOL) implantation were evenly divided into four groups. Group I (83 eyes) received one drop of topical dorzolamide immediately after surgery and 1.4% NaHa (BD Visc®) was used as a cohesive OVD during IOL implantation. Group II (83 eyes) did not receive any topical antiglaucoma medication after operation and 1.4% NaHa was used as a cohesive OVD. Group III (83 eyes) received topical dorzolamide and 1% NaHa (Healon®) was used, and Group IV (83 eyes) did not receive any topical and 1% NaHa was used in operation. Mean postoperative IOPs were compared between groups.

Results

Eyes with 1.4% NaHa usage (18.2±9.2 mmHg) had higher mean postoperative IOPs than eyes with 1% NaHa usage (15.5±5.3 mmHg) (p=0.002). Mean postoperative IOPs were lower in eyes with dorzolamide application (15.6±7.2 mmHg) than in eyes without any medication (18.1±8.5 mmHg) both in eyes with 1.4% NaHa and 1% NaHa usage (p=0.003). Dorzolamide application caused an average 2.5 mmHg decrease in mean postoperative IOPs in both groups.

Conclusions

Effects of OVDs on IOP rises after phacoemulsification surgery are closely related to their molecular structure. Increase in viscosity rendered higher postoperative IOP increments. However, topical dorzolamide application effectively reduced postoperative IOP increments in eyes with both Healon® and BD Visc® use. (Eur J Ophthalmol 2007; 17: 38–44)
A Double-Masked, Randomized, Parallel Comparison of a Fixed Combination of Bimatoprost 0.03%/Timolol 0.5% with Non-Fixed Combination use in Patients with Glaucoma or Ocular Hypertension
Authors: Hommer A. ,   Ganfort® Investigators Group I, Boone W. Benton , Branch James D. , Brigatti Luca , Christie William C. , Clifford William S. , Cooke David L. , Corwin Joel , Davitt William F. , Burns Jason , Digby Donald , DiS-clafani Mark , Dorner Martin , Hommer Anton , Katzman Barry , Koch-Schweitzer Hartwig , Krupin Theodore , Latina Mark A. , Lederer Charles , Leopold Martin R. , Lesk Mark , Mansouri Arash , Manusow David , Murphy Paul , Ochsner Katherine , Otto Peter , Pfeiffer Norbert , Piemontesi Roberto , Protzko Eugene , Air Bel , Rubin Rubin , Rybiczka Roman , Scholzel Son-ja , Sonty Sriram , Stewart Robert H. , Tauber Joseph , Walters Thomas R. , Batoosingh Amy L. , Bossowska Izabella , Chou Connie , Ingram Alison , Novack Gary D.
Published: January 2018

Purpose

To compare the safety and efficacy of the fixed combination product with nonfixed combination use of the same active ingredients in separate bottles (bimatoprost oncedaily [qd], and timolol twice-daily [bid]). A bimatoprost 0.03% qd treatment arm was used for validation of the study.

Methods

This was a double-masked, randomized, parallel study in 445 patients with open-angle glaucoma or ocular hypertension. They were randomized in a ratio of 2:2:1 to receive bilateral treatment with the fixed combination, non-fixed combination treatment, or bimatoprost alone.

Results

Comparing the fixed combination and non-fixed combination, the non-inferiority margin of 1.5 mmHg was met at all three timepoints for mean intraocular pressure (IOP), and a margin of 1.0 mmHg for mean diurnal IOP. The incidence of conjunctival hyperemia was statistically significantly lower (p=0.014) in the fixed combination group (8.5%, 15/176) compared with the bimatoprost group (18.9%, 17/90) and the non-fixed combination group (12.5%, 22/176).

Conclusions

The fixed combination of bimatoprost 0.03%/timolol 0.5% administered once daily was comparable in ocular hypotensive efficacy to the non-fixed combination. The lower propensity of the fixed combination to elicit conjunctival hyperemia suggests a superior comparative benefit/risk assessment of the fixed combination in the treatment of elevated IOP. (Eur J Ophthalmol 2007; 17: 53–62)
Long-Term Follow-up of Tacrolimus Treatment in Immune Posterior Uveitis
Authors: Figueroa M.S. , Ciancas E. , Orte L.
Published: January 2018

Purpose

To study the efficacy of tacrolimus in immune posterior uveitis.

Methods

Twenty-one eyes of 11 patients with immune posterior uveitis under tacrolimus treatment were prospectively followed for 1 to 5 years. Tacrolimus dosage was adjusted to maintain blood levels in the range of 7 to 10 ng/mL. Systemic and ophthalmic evaluations were performed at baseline and during follow-up.

Results

After a mean follow-up of 45 months, no treatment other than tacrolimus was necessary to control the inflammation in 6 cases (54.5%). The number of annual recurrences decreased from 3.2 to 1.29 during tacrolimus treatment (p=0.021). In four patients, tacrolimus was suspended after a treatment period of 27±3.5 months and a follow-up period of 12 months free of uveitis relapses. All four were free from relapses following tacrolimus withdrawal. Visual acuity remained unchanged in 16/21 (76%) eyes, deteriorated in 4/21 (19%), and improved in 1/21 (5%). Renal function transiently deteriorated in four patients from basal serum creatinine levels of 0.84, 1.1, 0.88, and 0.78 mg/dL to maximum levels of 1.33, 2.48, 1.38, and 1.39 mg/dL, respectively. This deterioration was directly related with elevated tacrolimus serum levels, returning to normal when doses were reduced. During the overall controlled evolution period, a slight increase of serum creatinine from a basal value of 0.89±0.2 mg/dL to a final of 1±0.19 mg/dL was detected, which was not statistically significant. All secondary effects were mild, transient, and did not require interruption of long-term treatment to be controlled.

Conclusions

Tacrolimus was well tolerated and useful in controlling posterior immune uveitis. Tacrolimus could be considered a real alternative to cyclosporine, and not only in cases of cyclosporine resistance or toxicity. (Eur J Ophthalmol 2007; 17: 69–74)
Ocular Manifestations in Fetal Alcohol Syndrome
Authors: Ribeiro I.M. , Vale P.J. , Tenedório P.A. , Rodrigues P.A. , Bilhoto M.A. , Pereira H.C.
Published: January 2018

Purpose

To report the prevalence of ocular abnormalities in a group of Portuguese children with a complete fetal alcohol syndrome (FAS).

Methods

Complete ophthalmologic examination in a sample of consecutive children with FAS. Ocular fundus photography was carried out on the cooperative FAS children and on 25 reference children. Ocular fundus anomalies were recorded by the observation of ocular fundus photography. The ratio between the distance of the center of the disc to the fovea and optic disc diameter (DM/DD) was determined. Small optic disc was defined as a DM/DD ratio above mean control group +1 SD.

Results

The authors studied 32 children with FAS (mean age: 9 ± 5 years; 72% boys). The mean corrected visual acuity (VA) was 0.8 ± 0.2. Refraction ranged from −23.00 to +6.50 spherical equivalent. Ocular findings included short horizontal palpebral fissure (81% of children), strabismus (28% of children), epicanthus (27% of eyes), blepharoptosis (16% of eyes), telecanthus (13% of children), nystagmus (1 child), and cataract (1 eye). Ocular fundus photography analysis showed retinal vessel tortuosity in 30% of the eyes and optic disc hypoplasia in 25%. The mean DM/DD for the control and FAS groups was 2.72 ± 0.20 and 2.89 ± 0.25 (p=0.001). Forty percent of the eyes of FAS children had small optic discs.

Conclusions

The most common ocular findings were anomalies of retinal fundus and minor changes in the outer region of the eyes. The authors noted better VA and less severity of disease than others, which might be due to a different selection of patients, different pattern of alcohol consumption, or genetic differences. (Eur J Ophthalmol 2007; 17: 104–9)
Corneal Ulcer as an Atypical Presentation of Ocular Cicatricial Pemphigoid
Authors: Sgrulletta R. , Lambiase A. , Micera A. , Bonini S.
Published: January 2018

Purpose

To describe three patients, each presenting noninfective corneal epithelial damage as first manifestation of ocular cicatricial pemphigoid (OCP).

Methods

Case report.

Results

Patients 1 and 2 were referred to the authors' clinic for corneal ulcer while Patient 3 for relapsed epithelial defects. All patients had negative history for systemic diseases and microbiological tests were negative. Topical steroid treatment induced the complete resolution of corneal damage. During the follow-up period, the onset of mild conjunctival fibrosis in the lower fornix allowed the authors to suspect OCP, confirmed by conjunctival biopsy.

Conclusions

In the three patients corneal damage was an early sign of OCP, in the absence of typical signs of conjunctival fibrosis. The authors thus suggest considering conjunctival biopsy as a useful additional test in the management of idiopathic corneal ulcers. (Eur J Ophthalmol 2007, 17: 121–3)
Photodynamic Therapy Outcomes in a Case of Macular Choroidal Neovascularization Secondary to Candida Endophthalmitis
Authors: Tedeschi M. , Varano M. , Schiano lomoriello D. , Scassa C. , Parisi V.
Published: January 2018

Purpose

To evaluate the effects on visual function and choroidal neovascularization (CNV) progression in a case of subretinal CNV due to Candida endophthalmitis treated with a combination of photodynamic therapy (PDT) and drugs.

Methods

A 28-year-old one-eyed woman with CNV in the right eye came to our observation. The CNV developed as a consequence of Candida endophthalmitis. The CNV was treated with six PDT treatments with verteporfin in association with systemic steroid therapy with prednisone (100 mg/day to reduce) and fluconazole (800 mg/day to reduce). Visual acuity (VA) was assessed in pre-PDT conditions and after six PDT treatments (24 months of follow-up).

Results

Pre-PDT VA was 20/125; after 24 months of follow-up, six PDT re-treatments, and pharmacologic therapy, VA was stabilized at 20/100.

Conclusions

In our case, associated PDT and drug therapies were safe and useful to maintain VA and to arrest CNV progression in the foveal region after 2 years of follow-up. (Eur J Ophthalmol 2007; 17: 124–7)
Complete Resorption of Retinal Hemorrhages in Idiopathic Thrombocytopenic Purpura
Authors: Meyer C.H. , Callizo J. , Mennel S. , Schmidt J.C.
Published: January 2018

Purpose

Idiopathic thrombocytopenic purpura (ITP) is characterized by refractory thrombocytopenia, production of autoantibodies, and persistent predisposition to bleeding affecting virtually all mucocutaneous tissues and various organs.

Methods

A 50-year-old man with chronic ITP and diabetic maculopathy developed massive preretinal, intraretinal, and numerous subretinal hemorrhages accompanied by impaired vision to 20/400. His platelet count was 1100/μL, hemoglobin concentration was 4.6 mg/dL, however his blood clotting and activated partial thromboplastin time (APTT) maintained a normal 26 sec.

Results

After a splenectomy the patient was placed on high-dose oral corticosteroids (40 mg/day), immunoglobulin, and CellCept. The platelet count was restored to 25,000/μL within months. Four months later the unaffected retina received a panretinal photocoagulation and intravitreal triamcinolone injection (25 mg). Two years after the thrombolytic event the hemorrhages resolved completely and the patient's vision recovered to 20/100.

Conclusions

Repetitive treatments with immunoglobulins and high-dose corticosteroids may increase the platelet count, inducing a complete resorption of the retinal hemorrhages and visual recovery during a long-term follow-up. (Eur J Ophthalmol 2007; 17: 128–9)
Isolated Optic Neuritis from an Identified Gnathostoma Spinigerum
Authors: Chuenkongkaew W. , Chirapapaisan N. , Hongyok T. , Yoolek A.
Published: January 2018

Purpose

To describe a patient with isolated monocular optic neuritis caused by an identified Gnathostoma spinigerum infestation.

Case report

A 21-year-old man developed a swollen eyelid and painful monocular visual loss of his left eye which did not improve after treatment by intravenous steroid and albendazole. A remarkable eosinophilia in his peripheral blood count was demonstrated. The patient subsequently found a live parasite emerged from his lower eyelid and it was successfully removed by himself. Gross and histopathology examinations of the obtained parasite was undertaken. The parasite was identified as Gnathostoma spinigerum. His blood test for Gnathostoma antibody was positive.

Discussion

The etiology of isolated optic neuritis in this patient was Gnathostoma spinigerum which was confirmed by the histopathology of the obtained parasite and the positive serologic test.

Conclusions

We could identify the exact parasite that was proven to cause an isolated optic neuritis. The immediate removal of a causative parasite may not result in an improvement of the injured tissue but is beneficial in preventing further destruction as well as future complications. (Eur J Ophthalmol 2007; 17: 130–2)
Lateral Canthal Dynamics, Correlation with Periorbital Anthropometric Measurements, and Effect of Age and Sleep Preference Side on Eyelid Metrics and Lateral Canthal Tendon
Authors: Beden Ü. , Yalaz M. , Güngör I. , Süllü Y. , Erkan D.
Published: January 2018

Purpose

To evaluate dynamic and static properties of lateral canthal tendon and involutional periorbital anthropometric and lateral canthal changes with any possible effect of sleep preference side on these changes.

Methods

Ninety-two healthy adult subjects with a mean age of 43.5 years were enrolled in the study. Lateral canthal tendon lengths (LCT), canthal movement amplitudes, and other periorbital anthropometric parameters were measured. Any effects of age and sleep preference side on anthropometric and particularly lateral canthal tendon measurements were evaluated. Pearson correlation analysis, one-way analysis of variance, and t-test for paired samples were used for statistical evaluation.

Results

LCT length was weakly correlated with age, lower lid tractability, horizontal palpebral fissure length, and interpupillary distance and also inversely correlated with margin reflex distance, but not with other measurements. Age was also correlated with lower lid tractability, and with the ratio of LCT to the horizontal palpebral fissure length (LCT/HPFL). No correlation between age and horizontal palpebral fissure length was detected. Age was weakly and inversely correlated with canthal height but not with canthal movement amplitudes. No effect of sleep preference side on LCT length, canthal height, or lower lid tractability was detected.

Conclusions

Lateral canthus has a dynamic structure that is not correlated with any other periorbital anthropometric measurements. LCT length is correlated with lower lid tractability, and increases with age, unlike horizontal palpebral fissure that stays constant with increasing LCT/HPFL ratio. Sleep preference side has no effect on the eyelid metrics and LCT. (Eur J Ophthalmol 2007; 17: 143–50)
Different Conjunctival Adaptive Response in Patients with Aqueous-Deficient and with Mucous-Deficient Dry Eyes
Authors: Rivas L. , López-garcía J.S. , Murube J. , García-lozano I.
Published: January 2018

Purpose

To describe the different cellular adaptive patterns found in the conjunctival epithelium from patients with aqueous-deficient and mucous-deficient dry eyes.

Methods

The authors studied different conjunctival areas, by impression cytology and by biopsy, 50 eyes with facial nerve paralysis (FNP), 50 eyes with ocular cicatricial pemphigoid (OCP), and 50 eyes from patients with primarily Sjögren syndrome (1SS).

Results

Eyes with FNP from the first clinical grade showed a progressive alteration of the nonsecretory cells, with a significant decrease in density goblet cells, generally with a PAS-positive staining. Eyes with OCP, during clinical grades 1 and 2, showed a slow deterioration of the nonsecretory cells; but from clinical grade 3, there was a significant increase of the cellular size and the thickness of the conjunctiva. Goblet cells showed a significant decrease in density from clinical grade 1, generally with a PAS-negative staining. Eyes with 1SS during clinical grades 1 and 2 showed a progressive alteration of the nonsecretory cells, with a significant decrease in density goblet cells, and a PAS-positive staining. From clinical grade 3 appeared a significant increase of nonsecretory cellular size and thickness of conjunctiva, with a significant decrease in goblet cell counts, and a PAS-negative staining.

Conclusions

Patients with FNP (a primarily aqueous-deficient alteration) follow completely the squamous metaplasia process. Patients with OCP (a primarily mucous-deficient syndrome) have a hypertrophy and hyperplasia process along the ocular surface. Patients with 1SS (a primarily aqueous-deficient and mucin-deficient alteration) have a squamous metaplasia process, but from clinical grade 3 also appears a hypertrophy and hyperplasia process. (Eur J Ophthalmol 2007; 17: 160–70)
Safety and Efficacy of Two Ocular Anesthetic Methods for Phacoemulsification: Topical Anesthesia and Viscoanesthesia (Visthesia™)
Authors: Perone J.-M. , Popovici A. , Ouled-moussa R. , Herasymyuk O. , Reynders S.
Published: January 2018

Purpose

VisThesia™ is a new ophthalmic viscosurgical device (OVD) which has 1% lidocaine combined with 1.5% sodium hyaluronate. This is a prospective evaluation of the safety and efficacy of VisThesia™ used in association with phacoemulsification.

Methods

A total of 114 eyes were divided into two groups. Fifty-nine eyes were treated with tetracaine + oxybuprocaine topical anesthesia and DuoVisc® OVD and 55 eyes were treated with VisThesia™, for use as both topical anesthetic and OVD. Endothelial cell counts were measured at 30 days postoperatively and compared to preoperative baseline values. Pain and discomfort was subjectively evaluated by patients using a visual analog pain scale (0–10).

Results

All surgeries were uneventful with no intraoperative or immediate postoperative complications. Patients receiving topical anesthesia had a mean pain score of 1.1±6.8 compared to a mean score of 1.3±4.6 for patients receiving VisThesia™ (p=0.59). Postoperatively, endothelial cell loss at 1 month was greater for patients receiving VisThesia™ (20.32%±43.75) than for those receiving the topical anesthetic (8.8%±59.6; p<0.0001).

Conclusions

The results from the visual analog pain scale were comparable between groups, showing that VisThesia™ provides similar pain relief to topical anesthesia. Specular microscopy performed at 30 days postoperatively showed a significantly greater loss of endothelial cells with the use of VisThesia™, suggesting that the 1% lidocaine concentration used in VisThesia™ may be toxic to corneal endothelial cells. (Eur J Ophthalmol 2007; 17: 171–7)
Is Pulse Synchronized Pneumotonometry More Reproducible than Routine Pneumotonometry and More in Agreement with Goldmann Applanation Tonometry?
Authors: Lafaut A.-S. , Van malderen L. , Zeyen T.
Published: January 2018

Purpose

This study compared the variability of intraocular pressure (IOP) measurements taken with pulse synchronized pneumotonometry (PNT) and with routine PNT (without pulse synchronization) and evaluated the agreement between PNT and Goldmann applanation tonometry (GAT).

Methods

In this prospective study, 148 eyes from 78 patients were enrolled. Patients were randomized into two groups. In the first group (A), the sequence of measurements was pulse synchronized PNT, routine PNT, and GAT. In the second group (B), the sequence of measurements was routine PNT, pulse synchronized PNT, and GAT. The mean of three measurements was averaged for PNT and GAT. All the measurements were performed by the same investigator, who was masked to GAT measurements. The mean IOP measurements and intrapatient standard deviations among the three tonometers were compared using analysis of variance measurement. Bland & Altman plots were used to assess the agreement between PNT and GAT.

Results

The variability of IOP measurements taken with pulse synchronized PNT was significantly lower than with routine PNT in both groups (1.2±0.7 vs 1.3±0.7 mmHg in group A and 1.1±0.9 vs 1.3±1.0 mmHg in group B [p<0.001], respectively). PNT measurements with and without pulse synchronization were on average ±2 mmHg higher than GAT measurements in both groups (p<0.001). The 95% limits of agreement between PNT and GAT varied between −3.8 and 8.5 mmHg.

Conclusions

Pulse synchronized PNT gives more reproducible measurements than routine PNT. The agreement between PNT and GAT is poor. (Eur J Ophthalmol 2007; 17: 178–82)
Test-Retest Variability in Visual Field Testing Using Frequency Doubling Technology
Authors: Horani A. , Frenkel S. , Blumenthal E.Z.
Published: January 2018

Purpose

To quantify the magnitude of test-retest variability (TRV) for normal subjects in serial visual fields (VF) using the frequency doubling technology (FDT) instrument.

Methods

Twenty-one healthy adults, aged 23 to 60 years, underwent four serial FDT VF tests, using the full-threshold C-20 program of the Zeiss-Humphrey FDT analyzer, on one randomly chosen eye. The VF tests were spaced 2 to 4 days apart. All subjects performed two preliminary FDT tests in order to minimize any learning effect. Test-retest variability was calculated as the standard deviation of each location's sensitivity value across the four VF tests.

Results

Mean TRV (±SD) for the entire field was 2.44±1.32 dB. Mean TRV (±SD) for the superior, inferior, nasal, and temporal hemifields were 2.48±1.3, 2.40±1.4, 2.40±1.3, and 2.48±1.3 dB, respectively. Mean TRV (±SD) for the foveal location, the 4 central, and the 12 peripheral locations were 2.49±1.4, 2.16±1.2, and 2.54±1.4 dB, respectively.

Conclusions

TRV was found to be rather uniform across the visual field of the commercially available FDT device, with only a mild, clinically insignificant, effect of both eccentricity and age on TRV. Variability in the FDT VF, for normal subjects, was found to be more uniform than that of both standard and short wavelength automated perimetry. In addition, a strong inverse correlation was found, in normal subjects, between the mean sensitivity and TRV. (Eur J Ophthalmol 2007; 17: 203–7)
Combined Phacoemulsification and Nonpenetrating Deep Sclerectomy in the Treatment of Chronic Angle-Closure Glaucoma with Cataract
Authors: Yuen N.S.Y. , Chan O.C.C. , Hui S.P. , Ching R.H.Y.
Published: January 2018

Purpose

To review the result of nonpenetrating deep sclerectomy (NPDS) combined with phacoemulsification in the treatment of chronic angle-closure glaucoma (CACG) with coexisting cataract.

Methods

This is a retrospective review of 29 eyes of 26 patients who had undergone combined non-penetrating deep sclerectomy and phacoemulsification for cataract and chronic angle-closure glaucoma between January 2001 and June 2003. The visual acuity, intraocular pressure (IOP) and complications were analyzed.

Results

The mean follow-up period was 33.8 months (range 23.3 to 54.0 months). Postoperative visual acuity improved in 21 eyes (72%) and remained the same in 6 eyes (21%). The IOP was reduced significantly from 20.3±3.9 mmHg (mean ± SD) preoperatively to 15.9±3.1 mmHg postoperatively at last follow-up visit (p<0.001). The number of antiglaucoma medications was also reduced significantly from 2.9±0.8 (mean ± SD) preoperatively to 1.0±1.2 at last follow-up (p<0.001). Fifteen eyes (52%) achieved complete success with IOP ≤ 21 mmHg without antiglaucoma medications and 25 eyes (86%) achieved qualified success with IOP ≤ 21 mmHg with or without medications at the last follow-up visit. Of the 25 eyes achieving qualified success, 24 (96%) had a reduction in the number of medications. There were 4 failures, defined as uncontrolled IOP requiring further filtering operation or oral drug treatment. Intraoperative complications included one accidental anterior chamber puncture and one iris plug intraoperatively. Postoperative complications included one choroidal effusion, three wound leaks requiring repair, and two punctate epithelial erosions. There was no shallowing of the anterior chamber, hyphema, hypotony, or infection encountered.

Conclusions

Combined NPDS and phacoemulsification could be a safe and effective surgical option for the management of CACG with cataract. (Eur J Ophthalmol 2007; 17: 208–15)
Diagnostic Accuracy of the Moorfields Regression Analysis Using the Heidelberg Retina Tomograph in Glaucoma Patients with Visual Field Defects
Authors: Medved N. , Cvenkel B.
Published: January 2018

Purpose

This study was designed to determine the specificity and sensitivity of the Heidelberg Retina Tomograph I (HRT) using the Moorfields Regression Analysis (MRA) in differentiating healthy from glaucomatous eyes.

Methods

In this cross-sectional study, 74 eyes of 37 healthy subjects and 87 eyes of 47 glaucoma patients were examined with Octopus standard automated perimetry and HRT. Only one eye per patient was used for statistical analysis. According to visual field index mean defect (MD) glaucoma patients were divided into three groups with early (MD <6 dB), moderate (6 dB < MD <12 dB), and advanced visual field loss (MD >12 dB). The sensitivity and specificity of optic nerve head examinations using the MRA of HRT were evaluated by two criteria (criteria 1, as diseased if classified by MRA as outside normal limits; criteria 2, as diseased if classified by MRA as borderline). The correlations between the topographic parameters and visual field index MD were measured by correlation coefficient and presented by scatter plot.

Results

The specificity and sensitivity of HRT-MRA examination were, respectively, 100% and 68.1% when borderline cases were considered normal (criteria 1) and 97.3% and 85.1% when borderline cases were considered glaucomatous (criteria 2). The sensitivity of the MRA in eyes with different stages of visual field loss was 59.1% for early, 54.5% for moderate, and 92.8% for advanced visual field loss with criteria 1; the figures were, respectively, 81.8%, 72.7%, and 100% with criteria 2. The statistically significant correlations with moderate strength of association (r=0.40–0.59) were found for rim area, rim volume, cup to disc area ratio, mean retinal nerve fiber layer (RNFL) thickness, and RNFL cross-sectional area.

Conclusions

The MRA showed an excellent specificity and good sensitivity using criteria 2 including as glaucomatous optic discs those classified by MRA as borderline. Although correlations of moderate strength were found between rim area, rim volume, mean RNFL thickness, RNFL cross-sectional area, and visual field index MD, great interindividual variation limits the prediction of one parameter from the other. Therefore, in clinical practice both structural and functional examinations should be performed in order to characterize glaucomatous damage. (Eur J Ophthalmol 2007; 17: 216–22)
Dominant Optic Atrophy in a Japanese Family with Opa1 Frameshift Mutation (V942fsX966)
Authors: Hayashi T. , Takeuchi T. , Gekka T. , Kitahara K.
Published: January 2018

Purpose

The authors report the ophthalmic characteristics of a male proband in a Japanese family with autosomal dominant optic atrophy (DOA) harboring a frameshift mutation in the OPA1 gene.

Methods

Conventional ophthalmologic examinations including static automated perimetry were performed, as well as assessment of the three-generation family history. The peripapillary retinal nerve fiber layer (RNFL) was evaluated using scanning laser polarimetry. Mutation screening of the OPA1 gene was performed with polymerase chain reaction amplification and direct sequencing.

Results

A frameshift mutation (p.V942fsX966) was identified in the proband and his mother. In comparison with the adolescent onset of visual loss in the proband and his maternal grandfather, the mother presented with only subtle temporal disc pallor and has never been aware of any visual disturbances. Symmetric thinned peripapillary RNFL was detected in the proband, whose visual field abnormalities were limited to central scotomas and were without mean deviation worsening between 11 to 17 years of age in both eyes. The proband's logMAR visual acuity (0.52 to 0.7) has remained almost unchanged for more than 10 years since initial evaluation at age 10.

Conclusions

The OPA1 mutation may be correlated with slow progression of DOA, and with phenotypic variations within the family. Further study is necessary to determine whether symmetric thinned peripapillary RNFL represents a feature of DOA. (Eur J Ophthalmol 2007; 17: 253–8)
Development of Early Choroidal Neovascular Membrane in a Young Myope after Lasik
Authors: Al-dhibi H. , Chaudhry I.A. , Al-assiri A. , Shamsi F.A.
Published: January 2018

Purpose

To describe development of early choroidal neovascular membrane (CNVM) after laser-assisted in situ keratomileusis (LASIK) in a young myopic patient with initial differential diagnosis of central serous chorioretinopathy (CSCR) that was successfully managed by photodynamic therapy (PDT).

Methods

A retrospective interventional case report.

Results

A 20-year-old woman with myopic astigmatism underwent an uneventful LASIK surgery resulting in best-corrected visual acuity (BCVA) of 20/20 bilaterally. One week later, the patient presented with decreased VA in the right eye and was diagnosed initially by her referring ophthalmologist with CSCR, and was treated by systemic corticosteroids without any improvement. Two weeks following LASIK, the patient's VA was found to be 20/200 and clinical evidence of early CNVM was confirmed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography (OCT). PDT resulted in regression of her CNVM with improvement in her VA and OCT findings.

Conclusions

LASIK-induced early CNVM may be misdiagnosed as CSCR. PDT may be effective in the resolution of LASIK-induced early CNVM. (Eur J Ophthalmol 2007; 17: 262–5)
Surgical Anatomy of the Deep Lateral Orbital Wall
Authors: Beden U. , Edizer M. , Elmali M. , Icten N. , Gungor I. , Sullu Y. , Erkan D.
Published: January 2018

Purpose.

To determine the exact anatomic location and volume of the thickest section of the greater wing of the sphenoid bone (trigone), which is removed during deep lateral orbital wall decompression.

Methods.

Eighteen dried skulls were used to determine the exact anatomic location and computed tomography (CT) images of 20 patients (10 male, 10 female) were used for volumetric calculations.

Results.

Mean values were 14.5 mm for the orbital rim to inferior orbital fissure distance, 23.3 mm for rim to trigone distance, 13.0 mm for width of the trigone base, 5.8 mm for trigone to orbital apex distance, and 12.3 mm for trigone height. The width of the narrowest section of the trigone was 5.2 mm. The trigone was found to have a lower segment (0.92 cc) neighboring the inferior orbital fissure, and an upper segment (0.32 cc) adjoining the thick substance of frontal bone. The narrowest part between these two segments was located just at the superior border of the lateral rectus muscle.

Conclusions.

The authors recommend avoiding the thin rectangular portion located in the interfissural area adjacent to the superior orbital fissure. A high intersubject variability underscores the need for individualized preoperative analysis by imaging studies
Optimal Dosage of Cyclopentolate 1% for Complete Cycloplegia: A Randomized Clinical Trial
Authors: Bagheri A. , Givrad S. , Yazdani S. , Mohebbi M. Reza
Published: January 2018

Purpose.

To determine the optimal dosage of cyclopentolate for adequate cycloplegia with minimal side effects.

Methods.

A prospective randomized clinical trial of patients 3.5 to 20 years of age referred to a strabismus clinic during a 1-year period. Eligible patients were randomly divided into three groups. In Group 1, the cycloplegic effect of one drop of cyclopentolate was compared with two drops; in Group 2, the effect of two drops was compared with three drops; and in Group 3, the effect of one drop was compared with three drops.

Results.

This study includes 192 eyes of 96 patients with a mean age of 11.0±5.7 years. Strabismus was present in 43 patients (44.8%). A total of 146 patients (76%) were hyperopic, 33 (17.2%) were myopic, and 13 (6.8%) were slightly hyperopic or myopic at the two stages of the study. Overall, only 16 eyes, including 9 eyes in Group 1 (16.4%), 2 eyes in Group 2 (3.2%), and 5 eyes in Group 3 (8.6%), had ≥0.5 D difference in spherical equivalent refractive error at two stages of the study; however, intergroup differences were not statistically significant (p=0.16, chi-square test). Within each group, the percentage of eyes with <0.5 D difference was significantly greater than those with ≥0.5 D difference (p<0.001 in all three groups, binomial test). Side effects were more prevalent using more frequent drops.

Conclusions.

A single drop of cyclopentolate 1% suffices for cycloplegic refraction. There were less frequent side effects using one drop of cyclopentolate, compared to two or three drops.
Factors Affecting Changes in Astigmatism before and after Suture Removal following Penetrating Keratoplasty
Authors: Yilmaz S. , Ozdil M. Ali , Maden A.
Published: January 2018

Purpose.

To analyze the factors related to changes in astigmatism before and after suture removal in patients who underwent penetrating keratoplasty (PK).

Methods.

The study group consisted of 171 consecutive PKs in 171 patients. Keratometric astigmatism was measured before and after suture removal in all patients. The vectorial difference for each eye was calculated between the examination before suture removal and the first year after suture removal. The vectorial difference values were compared with the possible factors affecting astigmatic change such as age of the patient, donor-recipient trephine diameter difference, preoperative diagnosis, and time of suture removal. All sutures were removed completely in one session. The vectorial difference values of all groups were compared with each other statistically.

Results.

Before suture removal, the mean cylinder was 4.40±3.24 D; it was 3.96±2.19 D at 1 year after suture removal. The net difference of astigmatism was −0.27±3.50. The mean value of vectorial difference for all patients was 4.93±4.02 D. There was a statistically significant negative correlation between the trephine diameter difference and the vectorial difference (r=-0.582, p<0.01). There was a significant change in vectorial difference values in patients with high pre-suture removal astigmatism. Patients with keratoconus had a positive correlation between the pre-suture removal astigmatism and the vectorial difference (r=0.615, p=0.038).

Conclusions.

After suture removal following PK, unexpected high levels of astigmatic change could be encountered due to donor-recipient trephine diameter difference and underlying primary diagnosis such as keratoconus. In particular, high level astigmatism before suture removal has a greater risk of increased astigmatic change after suture removal.
Comparison of Divide and Conquer and Phaco-Chop Techniques during Fluid-Based Phacoemulsification
Authors: Tsorbatzoglou A. , Módis L. , Kertész K. , Németh G. , Berta A.
Published: January 2018

Purpose.

To determine whether, similar to ultrasound phacoemulsification, applied energy and surgery time decrease using phaco-chop nucleus fragmentation method compared to divide and conquer technique using the fluid-based system.

Methods.

This prospective, comparative, randomized clinical study included patients with cataract who were randomly assigned to use either standard divide and conquer technique (25 eyes of 25 patients, Group 1) or Nagahara phaco-chop maneuver (25 eyes of 25 patients, Group 2) during fluid-based phacoemulsification. Surgical parameters were recorded and patients were examined 1 day, 10 days, and 1 month after surgery. Statistical analyses were performed using the paired test of Wilcoxon.

Results.

Fluid-based time, mean fluid-based magnitude, effective fluid-based time, and the number of pulses were significantly less using phaco-chop technique compared to divide and conquer method (p<0.001). Surgery time was similar using the two nucleofractis techniques (p=0.97). Visual acuities showed no statistical differences between the two groups (p>0.05).

Conclusions.

Nuclear fragmentation can be performed with Nagahara phaco-chop technique using the fluid-based system as well. The applied fluid-based energy decreases compared to divide and conquer method. However, surgery time is not reduced due to the difficulties reaching the full occlusion necessary to hold the nucleus during the chop maneuver
A Comparison of Higher Order Aberrations in Eyes Implanted with AcrySof IQ SN60WF and AcrySof SN60AT Intraocular Lenses
Authors: Awwad S.T. , Lehmann J.D. , Mcculley J.P. , Bowman R.W.
Published: January 2018

Purpose.

To evaluate the efficacy of AcrySof SN60WF aspheric intraocular lens (IOL) in decreasing spherical aberration and total higher order aberrations (HOAs) after cataract surgery compared to the spherical SN60AT lens.

Methods.

Wavefront analysis was conducted on 28 eyes of 28 patients that underwent uncomplicated phacoemulsification with implantation of either SN60WF (15 eyes) or SN60AT lenses (13 eyes). Eyes with a history of uveitis, retinal diseases, and previous surgery were excluded.

Results.

SN60WF eyes had less mean absolute spherical aberration than SN60AT eyes both at 4 mm (0.04±0.03 vs 0.11±0.03 RMS, p<0.0001) and 6 mm pupils (0.09±0.04 vs 0.43±0.12 RMS, p<0.0001). Mean total HOAs was lower in the SN60WF group at 6 mm pupils (0.44±0.14 vs 0.56±0.13 RMS, p=0.0274), while no difference was seen at 4 mm pupils (0.20±0.10 vs 0.25±0.08 RMS, p=0.160). There were no clinically significant differences between the SN60WF and SN60AT IOLs both at 4 and 6 mm pupils in terms of coma (0.16±0.07 vs 0.18±0.09 RMS, p=0.514 and 0.25±0.12 vs 0.23±0.12 RMS, p=0.664) and trefoil (0.14±0.09 vs 0.10±0.05 RMS, p=0.167 and 0.28±0.12 vs 0.23±0.07 RMS, p=0.199). There were no differences between groups in mean age, axial length, postoperative spherical equivalent, IOL power, or corneal curvature.

Conclusions.

An aspheric posterior optic IOL design with thinner center effectively reduces the positive ocular spherical aberration observed in the pseudophakic and elderly eyes, especially at larger pupillary diameters (6 mm), with no notable increase in coma. However, reduction in total ocular HOAs was only significant at 6 mm pupils.
Comparison of Anterior Chamber Depth Measurements using Orbscan II and IOLMaster
Authors: Frisch I.B. , Rabsilber T. M. , Becker K.A. , Reuland A.J. , Auffarth G.U.
Published: January 2018

Purpose.

To To evaluate and compare anterior chamber depth (ACD) measurements using Orbscan II (Bausch & Lomb, Rochester, NY) and IOLMaster (Carl Zeiss Meditec AG, Jena, Germany).

Methods.

In this prospective clinical study, the authors measured ACD of 145 phakic eyes of 30 healthy volunteers and 115 patients using Orbscan II and IOLMaster. Average patient age was 52.9±19.4 (range 16 to 87) years. ACD was evaluated from corneal epithelium to anterior lens surface. Additionally, axial length (AL) was measured using the Zeiss IOLMaster to calculate the regression coefficient between AL and ACD.

Results.

Mean ACD was 3.35±0.43 mm (range 2.01 mm to 4.37 mm) using Orbscan II and 3.36±0.41 mm (range 2.09 mm to 4.24 mm) using IOLMaster. Mean total axial length was 24.04 mm ± 2.1 mm (range 20.7 mm to 31.41 mm). The linear regression coefficient of ACD between both methods was R=0.95. ACD and AL correlated only slightly (R=0.57). The Spearman coefficients of rank correlation were 0.94 and 0.61, respectively. A p value less than 0.01 (paired Wilcoxon test) was considered statistically significant. However, a significant difference was not calculated comparing ACD measurements using both systems and the Bland-Altman-Plot showed 95% of the differences ranging between 0.25 and −0.27 mm.

Conclusions.

Regarding clinical application, both systems seem to be equally good and interchangeable in clinical practice in terms of ACD evaluation.
Impact of Intraocular Pressure after Filtration Surgery on Visual Field Progression in Primary Open-Angle Glaucoma
Authors: Lazaro C. , Garcia-Feijoo J. , Castillo A. , Perea J. , Martinez-Casa J.M. , Garcia-Sanchez J.
Published: January 2018

Purpose.

To compare visual field progression after trabeculectomy in eyes showing a postoperative intraocular pressure (IOP) less than or equal to 16 mmHg and eyes with an IOP of 17 to 21 mmHg.

Methods.

A retrospective cohort study design was used. A total of 101 eyes of 101 consecutive patients undergoing trabeculectomy for primary open-angle glaucoma (POAG) with a postoperative IOP less than or equal to 21 mmHg were divided into two groups: Group 1 included eyes showing a postoperative IOP less than or equal to 16 mmHg at all visits and Group 2 included eyes with a postoperative IOP between 17 and 21mmHg. In turn, each of these groups was divided into two subgroups according to whether treatment was required for IOP control. Glaucomatous visual field control during follow-up was compared between the subject groups.

Results.

Kaplan-Meier analysis revealed glaucomatous visual field control in 98.53% of the eyes in Group 1 and 89.06% of those in Group 2 at 5 years, the difference between the groups being significant.

Conclusions.

Glaucomatous disease progression is less frequent when IOP is less than or equal to 16 mmHg in all the follow-up visits after trabeculectomy. The results indicate a definite benefit of low IOP in visual field control.