bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Treatment in Patients with Double Elevator Palsy
Authors: Yurdakul Nazife Sefi , Ugurlu Seyda , Maden Ahmet
Published: January 2018

Purpose

To evaluate the effectiveness of surgical treatment performed in patients with double elevator palsy (DEP).

Methods

Patients diagnosed with congenital DEP between April 2003 and March 2007 were included in the study. The cases with positive traction test had inferior rectus (IR) recession followed by full tendon width muscle transposition Knapp surgery or partial tendon width transposition operation, while those without positive traction test underwent transposition procedure alone. Transposition surgery was combined with recession and resection of horizontal rectus muscles in patients with exotropia according to the amount of horizontal deviation. Eyelid surgery was applied in patients with ptosis following strabismus surgery.

Results

The average age of 13 patients was 14±32.5 years (range, 3–60 years). Five patients (38%) were female and 8 patients (62%) were male. The mean preoperative hypotropia was decreased from 29.2±3.5 prism diopters (PD) (range, 16–45 PD) to 2.6±2.8 PD (range, 0–6 PD) postoperatively. The median amount of horizontal deviation in patients with exotropia (n=4) was 30 PD (range, 25–45 PD) preoperatively; it was reduced to 2 PD (range, 0–8 PD) postoperatively. Mean follow-up period was 14.1±2.8 months (range, 6–31 months). Five patients (38%) underwent eyelid surgery, and all achieved cosmetically satisfactory results.

Conclusions

Transposition surgery alone or combined with IR recession is an effective procedure in treatment of double elevator palsy. In patients with moderate horizontal deviations, recession and resection of horizontal rectus muscles combined with transposition provide correction of the horizontal deviation at the same time. (Eur J Ophthalmol 2009; 19: 697–701)
Prospective Study of Risk Factors for Conjunctival Bacterial Contamination in Patients Undergoing Intraocular Surgery
Authors: De Kaspar Herminia Miño , TA Christopher N. , Froehlich Stephan J. , Schaller Ulrich C. , Engelbert Michael , Klauss Volker , Kampik Anselm
Published: January 2018

Purpose

To determine whether a patient's age, gender, local or systemic risk factors affect the rate of preoperative bacterial contamination.

Methods

Consecutive 1,474 patients undergoing intraocular surgery were enrolled in this prospective masked study. Past medical history was noted and examinations were performed. The patients were divided into four groups: a control group (without local or systemic risk factors), those with local risk factors (chronic use of topical medications, contact lens wear, blepharitis, chronic eyelid or conjunctival inflammation), those with systemic risk factors (immunosuppression, diabetes, autoimmune conditions, and asthma), and those with both. Conjunctival cultures were obtained before surgery.

Results

Among the 1,474 patients, 914 bacteria were isolated from 214 (14.9%) patients. Advanced age was associated with a higher rate of positive conjunctival cultures (p<0.005). No statistical difference was found with regard to gender (p=0.7173). Among the 282 patients in the control group, 14 (5%) had a positive conjunctival culture. Compared to the control group, positive conjunctival cultures were found in 118 out of 503 patients (23.5%) with local risk factors (p<0.0001), 65 out of 545 patients (11.9%) with systemic risk factors (p=0.0019), and 22 out of 144 (15.3%) with both (p=0.0006). Two patients developed postoperative endophthalmitis (0.14%), one with both local risk and systemic factors and the other with a systemic risk factor.

Conclusions

Patients with local or systemic risk factors or advanced age were found to have a higher rate of bacterial conjunctival contamination before intraocular surgery. (Eur J Ophthalmol 2009; 19: 717–22)
Usefulness of Anterior Segment Optical Coherence Tomography in Descemet Membrane Detachment
Authors: Wylęgała E. , Nowińska A.
Published: January 2018

Purpose

To evaluate the usefulness of anterior segment optical coherence tomography (OCT) in diagnosis, choosing the treatment method, and monitoring the treatment outcomes in Descemet membrane detachment (DMD).

Methods

We retrospectively reviewed the clinical data for 14 eyes of 13 patients: 8 eyes with DMD after cataract surgery, 2 eyes after deep anterior lamellar keratoplasty (DALK), 2 eyes of 1 patient with Ehlers-Danlos type VI syndrome, 1 eye after contusion, and 1 eye with spontaneous corneal edema of unknown origin. We used OCT to confirm or make the diagnosis, evaluate the configuration of detachment, and monitor treatment results.

Results

DMD was diagnosed in 12 eyes, based on the slit lamp examination. In 2 eyes, because of a very hazy view due to corneal edema, DMD was diagnosed based on OCT findings. We chose the treatment method based on DMD configuration evaluated by OCT examination. Eight eyes were treated conservatively and 6 eyes underwent intracameral air injection with additional ab externo stab incisions. In 12 eyes, Descemet membrane reattached successfully. In 2 eyes of 1 patient with Ehlers-Danlos syndrome, the detachment remained, but corneal thickness had decreased. After anterior chamber air tamponade, we observed the decrease of corneal thickness within 7 days.

Conclusions

OCT is useful in precise evaluation of DMD configuration and choosing the treatment method, but has a very limited role in diagnosis and monitoring the treatment results, where the clinical examination is the most important indicating factor. (Eur J Ophthalmol 2009; 19: 723–8)
Treatment of Primary Pterygium: Role of Limbal Stem Cells and Conjunctival Autograft Transplantation
Authors: Soliman Mahdy Mohamed A.E. , Bhatia Jagdish
Published: January 2018

Purpose

The limbus and its stem cells are important in the pathogenesis of pterygium. In this study, the usefulness of limbal stem cells and conjunctival autograft transplantation for the treatment of primary pterygium is assessed.

Methods

In this prospective noncomparative cohort study, 42 eyes of 42 patients with grade I–III primary pterygium underwent pterygium excision followed by superotemporal limbal stem cells and conjunctival autograft transplantation. Pterygium recurrences and complications within a mean follow-up period of 18.26 months (range, 10–28 months) were assessed.

Results

There were no recurrences of pterygium growth except in 2 cases (4.75%). In addition, no significant complications were noted. No further surgical interventions were needed in any case except for reoperation in the 2 recurrent cases.

Conclusions

Although limbal stem cells and conjunctival autograft transplantation is a time-consuming procedure, it is a safe and effective technique for the treatment of different grades of pterygium. It is useful in prevention of pterygium recurrence, which is a major problem in pterygium surgery. (Eur J Ophthalmol 2009; 19: 729–32)
Refractive and Visual Results after Implantation of the AcrySof ReSTOR IOL in High and Low Hyperopic Eyes
Authors: Alfonso José F. , Fernández-Vega Luis , Ortí Susana , Ferrer-Blasco Teresa , Montés-Micó Robert
Published: January 2018

Purpose

To assess the differences in refractive and visual results obtained in eyes with high and low hyperopia after implantation of a multifocal intraocular lens (IOL).

Methods

A prospective study was performed on 172 hyperopic eyes implanted with the AcrySof ReSTOR Natural (SN60D3) IOL. Two groups were created, high and low hyperopes (86 eyes in both cases). We analyzed monocular visual acuity for distance and near, with and without distance correction. Photopic and mesopic contrast sensitivity (CS) were also assessed. All measurements were performed at 6 months after surgery.

Results

Monocular best distance-corrected visual acuity was 0.01±0.03 logMAR for low hyperopes and 0.04±0.10 logMAR for high hyperopes. Monocular best distance-corrected near visual acuity was 0.02±0.04 and 0.05±0.06 logMAR for low and high hyperopes, respectively. CS for high hyperopic eyes under photopic conditions was lower, primarily at high spatial frequencies, in relation to low hyperopic eyes. Differences between both groups were statistically significant for all spatial frequencies (p<0.004). At the mesopic level, high hyperopic eyes showed lower values compared to low hyperopic eyes for all spatial frequencies. However, these differences were only statistically significant for 1.5, 12, and 18 cpd (p<0.002).

Conclusions

The visual acuity and CS for both distance and near, with and without distance correction, were statistically better in eyes with low hyperopia compared to those obtained in eyes with high levels of hyperopia. (Eur J Ophthalmol 2009; 19: 748–53)
Long-Term Visual Function Outcomes of Congenital Cataract Surgery with Intraocular Lens Implantation in Children under 5 Years of Age
Authors: Hussin Hussin M. , Markham Richard
Published: January 2018

Purpose

To evaluate the long-term visual function outcomes of intraocular lens (IOL) implantation after congenital cataract surgery in children.

Methods

Forty children who had congenital cataract surgery with IOL implantation and at least 5 years follow-up and were 5 years or younger at the time of surgery were included. There were 18 children in the bilateral cataract group (36 pseudophakic eyes) and 22 children in the unilateral cataract group (22 pseudophakic eyes). The examination for the prospective part of this study included the recording of visual acuity, refraction, stereopsis, and intraocular pressures; preoperative, intraoperative, and postoperative details were obtained from the notes.

Results

Mean final best-corrected visual acuity for the bilateral group was 0.57 logMAR (range 0.18– 1.06) and for the unilateral group 0.91 logMAR (range 0.18–1.40). Nystagmus was recorded in 10 children (56%) of the bilateral group and 5 children (23%) of the unilateral group. Strabismus was recorded in 14 children (78%) of the bilateral group and 19 children (86%) of the unilateral group. Glaucoma was diagnosed in one child. There was a significant myopic shift in the unilateral group.

Conclusions

Reasonably good postoperative visual acuity was achieved in the bilateral cataracts group, but relatively poor acuity in the unilateral cataract group. Poor stereopsis was recorded in both groups. One child developed glaucoma. None of the children developed retinal detachment. The expected myopic shift in the unilateral group compared with the bilateral group was demonstrated. Elective primary capsulotomy and elective anterior vitrectomy are mandatory to keep a clear visual axis. (Eur J Ophthalmol 2009; 19: 754–61)
Visual Function, Optic Nerve Structure, and Ocular Blood Flow Parameters after 1 Year of Glaucoma Treatment with Fixed Combinations
Authors: Januleviciene Ingrida , Ehrlich Rita , Siesky Brent , Nedzelskiené Irena , Harris Alon
Published: January 2018

Purpose

To compare the effects of latanoprost/timolol (LTFC) versus dorzolamide/timolol (DTFC) fixed combinations on intraocular pressure (IOP), visual function, and retrobulbar blood flow in patients with open-angle glaucoma (OAG).

Methods

This was a prospective, randomized, double masked, parallel study on 30 patients with OAG. All patients received 4 weeks of timolol treatment prior to randomization to LTFC or DTFC treatment. Measurements after randomization were taken at 1, 6, and 12 months, including arterial blood pressure; IOP; color Doppler imaging of the ophthalmic artery (OA), central retinal artery, and short posterior ciliary artery (SPCA); scanning laser polarimetry; Humphrey visual field examination; and adverse events.

Results

IOP decreased by 5.0 mmHg in the DTFC cohort (p<0.000) and 5.44 mmHg in the LTFC cohort (p=0.0001) after 12 months of treatment. No statistically significant differences in visual field or nerve fiber layer thickness were observed between the treatment groups during 12 months of therapy. Mean increase over 1 year of treatment in ocular perfusion and diastolic perfusion pressures were 10.46% and 10.67% in the DTFC group and 7.47% and 5.61% in the LTFC group, respectively. OA resistive index (RI) and SPCA RI were significantly different at the 12 months visit between the two treatment groups (p=0.05 and p=0.000, respectively): DTFC treatment showed decrease in the RI.

Conclusions

One year of treatment with LTFC or DTFC resulted in similar IOP lowering effects as well as stable visual function and structure. The DTFC group showed lower vascular resistance in retrobulbar vessels compared to the LTFC group. (Eur J Ophthalmol 2009; 19: 790–7)
Incidence, Clinical Features, Causative Organisms, and Visual Outcomes of Delayed-Onset Pseudophakic Endophthalmitis
Authors: Al-Mezaine Hani S. , Al-Assiri Abdullah , Al-Rajhi Ali A.
Published: January 2018

Purpose

To report the incidence, clinical features, causative organisms, and visual outcomes associated with delayed-onset pseudophakic endophthalmitis.

Methods

We retrospectively reviewed the clinical records and microbiology files of all patients with culture-proven endophthalmitis that was present 6 weeks or more after cataract extraction and posterior chamber intraocular lens (IOL) implantation who were treated at King Khaled Eye Specialist Hospital (KKESH) during a 10-year period.

Results

From January 1997 through December 2006, 17 patients with culture-proven, delayed-onset pseudophakic endophthalmitis were treated at KKESH. Of the 17 cases, only 5 cases developed delayed-onset endophthalmitis, among 29,509 cataract surgeries performed at KKESH, indicating an incidence rate of 0.017% (5/29,509). The mean time between cataract surgery and diagnosis of endophthalmitis was 5±2.48 months. The culture isolates revealed Propionibacterium acnes in 7 (41.2%) eyes, polymicrobial (mixed) infections in 3 (17.6%) eyes, Staphylococcus species in 3 (17.6 %) eyes, fungal infections in 3 (17.6%) eyes, and Alcaligenes xylosoxidans in 1 (5.9%) eye. The mean follow-up period was 29.8 months. The final visual outcomes were as follows: 7 eyes (41.2%) achieved a final best-corrected visual acuity of ≥ 20/60; 6 eyes (35.3%) achieved a best-corrected visual acuity of <20/60 to ≥ count fingers; 2 eyes (11.8%) had hand motion to light perception vision; and 2 eyes (11.8%) were enucleated.

Conclusions

In this study, infection by P acnes was the most common cause of delayed-onset pseudophakic endophthalmitis and had the most favorable visual outcome, whereas fungal endophthalmitis had the worst visual prognosis. (Eur J Ophthalmol 2009; 19: 804–11)
Optical Coherence Tomography in Neovascular Age-Related Macular Degeneration Compared to Fluorescein Angiography and Visual Acuity
Authors: Henschel Andreas , Spital Georg , Lommatzsch Albrecht , Pauleikhoff Daniel
Published: January 2018

Purpose

To assess the sensitivity and specificity of optical coherence tomography (OCT) for monitoring patients with choroidal neovascularization (CNV) after photodynamic therapy (PDT) in comparison to fluorescein angiography (FA).

Methods

Prospective study of 14 patients with CNV secondary to age-related macular degeneration receiving PDT. Best-corrected visual acuity (BCVA), fluorescein angiography, and OCT (Zeiss Stratus OCT3) were performed before and at 2, 6, 12, and 24 weeks after treatment. FA images were assessed for leakage and presence of subretinal or intraretinal fluid was assessed on OCT images. Retinal thickness was measured automatically. OCT sensitivity and specificity levels for detecting leaking CNV were calculated. Retinal thickness was correlated with visual acuity.

Results

Mean follow-up time was 14.1 weeks. Sixty-one OCT/FA examinations were analyzed. Thirty-one examinations presented leakage (51%). OCT showed intraretinal fluid in 46 (75%) and subretinal fluid in 30 cases (49%). In 49 cases (80%), either intraretinal or subretinal fluid was present. Sensitivity for detecting intraretinal fluid in OCT was 90% (specificity 40%) and 71% (specificity 73%) for subretinal fluid. Combined sensitivity for intraretinal or subretinal fluid was 97% (specificity 37%). Increased central foveal thickness correlated with decreased BCVA. Correlations were significant (p<0.05).

Conclusions

OCT showed good sensitivity in detecting active CNV. Specificity was only moderate. Central foveal thickness correlated negatively with visual acuity. Owing to different aspects of active CNV shown by FA and OCT, OCT should be combined with other examinations, and may not substitute FA for indication/reindication of PDT but can be a valuable addition in difficult cases. (Eur J Ophthalmol 2009; 19: 831–5)
Macular Pigment Optical Density Relates to Foveal Thickness
Authors: Van Der Veen Rob L.P. , Ostendorf Saskia , Hendrikse Fred , Berendschot Tos T.J.M.
Published: January 2018

Purpose

Macular pigment is composed of 2 dietary carotenoids, lutein and zeaxanthin, and is mainly present at the nerve fiber layers and ganglion cell layers of the retina, with peak concentrations in the fovea. It is thought to function as a blue-light filter and antioxidant, and therefore protect the retina from damaging influences that are thought to play a role in the pathogenesis of age-related macular degeneration. This study was performed to investigate the suggested positive relationship between foveal macular pigment optical density (MPOD) and foveal retinal thickness.

Methods

We determined MPOD and foveal thickness in the right eyes of 40 healthy Caucasian subjects (5 men, 35 women) recruited at the University of Maastricht, The Netherlands. Their mean age was 24.4±8.7 years. MPOD was determined by using a novel method of heterochromatic flicker photometry (HFP), where subjects have to detect flicker instead of conventionally minimizing a present flicker motion. Foveal thickness parameters were obtained using optical coherence tomography (OCT 3).

Results

We found a positively significant correlation between MPOD and central foveal thickness (r=0.359, p=0.027). In addition, we found a negatively significant correlation between foveal thickness and foveal width (r=–0.558, p<0.001).

Conclusions

Our data confirm the previously suggested positively significant correlation between MPOD and central foveal thickness. The observed negative relationship between foveal thickness and foveal width may be explained by eccentric scans on the OCT. (Eur J Ophthalmol 2009; 19: 836–41)
Anti-Vascular Endothelial Growth Factor Activity in the Bevacizumab and Triamcinolone Acetonide Combination for Intravitreal Use
Authors: Giammaria Daniele , Cinque Benedetta , Di Lodovico Domenico , Cristina Savastano Maria , Grazia Cifone Maria , Spadea Leopoldo
Published: January 2018

Purpose

To find out if the combination for intravitreal use of the antibody bevacizumab (AvastinTM; Genentech, Inc., San Francisco, CA) and triamcinolone acetonide (TA) (Kenacort®; Bristol-Myers Squibb, Anagni, Italy) could affect over time the anti–vascular endothelial growth factor (VEGF) activity of bevacizumab.

Methods

Two different combined preparations were obtained, drawing up together 1.25 mg/0.05 mL of bevacizumab and 2 mg/0.05 mL (B+TA2mg) or 4 mg/0.05 mL (B+TA4mg) of TA into insulin syringes with 29-G needle. Control preparations were obtained with bevacizumab and an injectable solution (B). The syringes were stored refrigerated at 4°C. The bevacizumab concentration was measured, through its binding to VEGF-165 isoform, at 48 hours and at 1 week.

Results

No preparations showed statistically significant changes in bevacizumab concentration with time (p=0.74 for B+T2mg, p=0.92 for B+T4mg, p=0.57 for B). The B+TA2mg preparations showed a larger percentage of degradation of bevacizumab than the B+TA4mg preparations (28.4% versus 17.6% at 48 hours; 26.4% versus 18% at 1 week). The B control preparations showed the lowest drug degradation: 9.6% at 48 hours and 14.8% at 1 week.

Conclusions

After storage at 4°C for 48 hours and 1 week, the combined preparations showed a larger reduction in bevacizumab concentration than the control preparations. No significant change was observed with the length of storage. The preparations obtained mixing 4 mg/0.05 mL of TA and 1.25 mg/0.05 mL of bevacizumab maintained the highest anti-VEGF activity over time. (Eur J Ophthalmol 2009; 19: 842–7)
Topical Bevacizumab for Corneal Neovascularization after Penetrating Keratoplasty
Authors: Saxena Sandeep , Kishore Poonam , Pandey Sukant , Khattri Mohit , Kumar Dipak
Published: January 2018

Purpose

To evaluate the efficacy of topical bevacizumab for corneal neovascularization in graft rejection.

Methods

A 55-year-old man presented with corneal neovascularization and graft rejection 6 months following penetrating keratoplasty (triple procedure) in the left eye. His best-corrected visual acuity (BCVA) was counting fingers at 1 meter. He was administered topical bevacizumab (4 mg/4 mL) in a dose of one drop twice a day for 15 days. No adjunct therapy was given during bevacizumab administration.

Results

After 1 month, his BCVA improved to 20/120. Corneal vascularization and stromal haze regressed. After 6 months, his BCVA improved to 20/60 with further regression in corneal vascularization and stromal haze. At 9-month follow-up, he maintained BCVA of 20/60.

Conclusions

Short-term topical bevacizumab therapy may potentially offer a safer and more effective alternative in treating graft rejection after penetrating keratoplasty. (Eur J Ophthalmol 2009; 19: 870–2)
T-Shaped Pigmentary Changes in Tilted Disk Syndrome
Authors: Yves Cohen Salomon , Dubois Lise , Ayrault Sandrine , Quentel Gabriel
Published: January 2018

Purpose

Many complications associated with tilted disk syndrome may occur in the area bordering on the inferior staphyloma, including macular pigmentary changes, choroidal neovascularization, macular serous retinal detachment, polypoidal choroidal vascular anomalies, and radially orientated chorioretinal folds. The purpose of the present article is to describe an additional complication, Tshaped pigmentary changes, orientated radially from the border of the inferior staphyloma, in eyes with tilted disk syndrome..

Methods

Retrospective series of 6 eyes of 6 patients (3 men and 3 women) aged from 35 to 67 years. All eyes were studied by fluorescein angiography.

Results

All 6 eyes exhibited pigmentary changes located along the border of the staphyloma, and also radially to it, giving a particular T-shaped pattern of pigmentary changes. These changes were visible as either a linear strip or a triangular or oval-shaped area. Three eyes had a documented history of subretinal leakage that mimicked central serous chorioretinopathy, a well-known complication of tilted disk syndrome.

Conclusions

T-shaped pigmentary changes may develop in the course of tilted disk syndrome, and should be added to the list of this syndrome's possible retinal complications. These changes may indicate the presence of chronic leakage in the area around the superior border of the inferior staphyloma (Eur J Ophthalmol 2009; 19: 876–9).
Foveal Geographic Atrophy following Intravitreal Pegaptanib Sodium (Macugen) for Drusenoid Pigment Epithelium Detachment
Authors: Querques Giuseppe , Bux Anna V. , Delle Noci Nicola
Published: January 2018

Purpose

To describe a patient with nonexudative age-related macular degeneration (AMD) who underwent intravitreal pegaptanib sodium injection for drusenoid pigment epithelium detachment (PED).

Methods

A 66-year-old woman, who underwent intravitreal pegaptanib sodium injection in her right eye (RE) for chronic serous drusenoid PED, was submitted to a complete ophthalmologic examination, including fundus biomicroscopy, fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT-3, Humphrey-Zeiss, San Leandro, CA), 3 days and 1 month after the treatment.

Results

Three days after the intravitreal pegaptanib sodium injection, best-corrected visual acuity (BCVA) was 20/32 in the RE. One month later, the patient's BCVA dropped to 20/200 in the RE. Interestingly, fundus biomicroscopy, FA, OCT, and ICGA revealed the development of foveal geographic atrophy. Fundus-related perimetry (MP-1 Micro Perimeter, Nidek Technologies, Padova, Italy) revealed an eccentric and unstable fixation within 2° with central absolute scotoma and pericentral diffuse reduction of sensitivity.

Conclusions

The rapid development of foveal geographic atrophy in our patient may be related to the antivascular endothelial growth factor treatment, in part because of the reduced neuroprotective effect, and in part because of the adjunctive decreased blood flow in an already imbalanced foveal choroidal circulation due to AMD complicated by chronic serous drusenoid PED. (Eur J Ophthalmol 2009; 19: 890–3)
Hans Goldmann (1899–1991)
Authors: Gloor Balder R.P.
Published: January 2018

Hans Goldmann (1899–1991), born in Komotau in Bohemia, studied medicine in Prague. He was trained in physiology by A.V. Tchermak-Seysenegg and in ophthalmology by A. Elschnig in Prague and by A. Siegrist in Berne. He succeeded Siegrist as chairman of the Department of Ophthalmology in Berne in 1935. He was granted Swiss citizenship in 1936. For almost 70 years, Hans Goldmann has influenced, and continues to influence, the daily practice of ophthalmology. In 1933, he and W. Haag and H. Papritz produced the Haag-Streit-Slitlamp 320. This instrument, together with contact lenses that he developed, enabled the whole eye from the surface of the cornea to the fundus to be examined with the patient in the seated position. In 1945, the Goldmann Cupola-Perimeter followed, which allowed the standardization of background and target luminance. The applanation tonometer was introduced in 1954 and, in 1958, the Haag-Streit Slitlamp 900. The presentation of every new instrument was accompanied by a clinical article demonstrating its value. Goldmann's research culminated in the understanding of the production and outflow of the aqueous. He determined the volume of the anterior chamber in 1941, detected the aqueous veins in 1945, proved that these contain aqueous in 1949, measured aqueous production by fluorescein dilution curves in 1950, and coined the formula that determines outflow facility. This article is to remind the current generation of ophthalmologists of an outstanding man who developed our understanding of disease and who created the many of the instruments that still determine the daily practice of ophthalmology worldwide.
Corneal Higher-Order Aberrations in Amblyopia
Authors: Plech Agata R. , Piñero David P. , Laria Carlos , Alesón Alicia , Alió Jorge L.
Published: January 2018

Purpose

To investigate the amount, type, and role of corneal higher order aberrations in both isotropic and anisometropic amblyopic adult patients.

Methods

A total of 125 eyes of 78 patients with age ranging from 18 to 67 years (30 patients with unilateral amblyopia, 17 with bilateral amblyopia, and 31 normal eyes considered as the control group) were included. All eyes received a comprehensive ophthalmologic examination that included corneal topographic and aberrometric analysis with the CSO system. The aberrometric study was performed for a 6-mm pupil using different root mean square (RMS) parameters. Additionally, the ocular residual astigmatism (ORA) was also calculated and analyzed. A comparative analysis of the refractive and aberrometric data between groups was performed.

Results

In the unilateral amblyopia group, statistically significant differences between the amblyopic and non-amblyopic eye were found in cylinder (p=0.003), best-corrected visual acuity (BCVA) (p<0.001), total RMS (p=0.015), and astigmatic RMS (p=0.019). Statistically significant differences between the bilateral amblyopia and control groups were observed in sphere (p=0.025), cylinder (p=0.005), and BCVA (p <0.001). When comparing isometropic and anisometropic bilateral amblyopic eyes, significant differences in total (p=0.025) and astigmatic RMS (p=0.013) were detected. Higher but nonsignificant amounts of primary coma were found in isometropic eyes (0.25 μm anisometropic vs 0.43 μm isometropic, p=0.09). Regarding the ORA, no significant differences between groups were found (p≥0.224).

Conclusions

In unilateral and bilateral amblyopia, lower order aberrations are the main refractive factors leading to amblyopia. Higher order aberrations could have a bilateral amblyogenic effect in those cases where isometropia is present.
Effect of Recipient Corneal Pathology on Pascal Tonometer and Goldmann Tonometer Readings in Eyes after Penetrating Keratoplasty
Authors: Papastergiou Georgios I. , Kozobolis Vasilios , Siganos Dimithos S.
Published: January 2018

Purpose

To assess the influence of recipient corneal pathology on the performance of the Pascal dynamic contour tonometer (PDCT) (Swiss Microtechnology AG) by comparing it to Goldmann applanation tonometry (GAT) in post-penetrating keratoplasty (PKP) eyes.

Methods

Intraocular pressure (IOP) was measured in 40 post-PKP eyes of 40 patients using PDCT and GAT. The study patients were divided into two groups. Group A included patients who had undergone PKP for ectatic corneal disorders (keratoconus, n=20) and group B included patients who had undergone PKP for other non-ectatic corneal disorders (Fuchs, post-corneal ulcer, post-chemical burn, post-trauma, n=20). Keratometric measurements were obtained in all eyes using Orbscan II (Bausch & Lomb) and central corneal thickness (CCT) was measured using Corneo-Gaze Plus (Sonogaze).

Results

In group B, a correlation between PDCT and GAT IOP measurements was observed. In group A, GAT IOP measurements were significantly lower than PDCT measurements (3.7±1.8 mmHg, p<0.001). Additionally, CCT affected GAT IOP measurements much more than PDCT measurements, while corneal curvature did not significantly affect IOP measurements of any instrument in either group.

Conclusions

In post-PKP eyes, PDCT appears to be less influenced than GAT by CCT and pre-existing recipient corneal pathology. Therefore, PDCT may be better suited for monitoring IOP in post-PKP eyes.
VEGF TrapR1R2 Suppresses Experimental Corneal Angiogenesis
Authors: Oliveira Hailton B. , Sakimoto Tohru , Javier Joel A.D. , Azar Dimitri T. , Wiegand Stanley J. , Jain Sandeep , Chang Jin-Hong
Published: January 2018

Purpose

To determine the effect of vascular endothelial growth factor (VEGF) TrapR1R2 on bFGF-induced experimental corneal neovascularization (NV).

Methods

Control pellets or pellets containing 80 ng bFGF were surgically implanted into wild-type C57BL/6 and VEGF-LacZ mouse corneas. The corneas were photographed, harvested, and the percentage of corneal NV was calculated. The harvested corneas were evaluated for VEGF expression. VEGF-LacZ mice received tail vein injections of an endothelial-specific lectin after pellet implantation to determine the temporal and spatial relationship between VEGF expression and corneal NV. Intraperitoneal injections of VEGF TrapR1R2 or a human IgG Fc domain control protein were administered, and bFGF pellet-induced corneal NV was evaluated.

Results

NV of the corneal stroma began on day 4 and was sustained through day 21 following bFGF pellet implantation. Progression of vascular endothelial cells correlated with increased VEGF-LacZ expression. Western blot analysis showed increased VEGF expression in the corneal NV zone. Following bFGF pellet implantation, the area of corneal NV in untreated controls was 1.05±0.12 mm2 and 1.53±0.27 mm2 at days 4 and 7, respectively. This was significantly greater than that of mice treated with VEGF Trap (0.24±0.11 mm2 and 0.35±0.16 mm2 at days 4 and 7, respectively; p<0.05).

Conclusions

Corneal keratocytes express VEGF after bFGF stimulation and bFGF-induced corneal NV is blocked by intraperitoneal VEGF TrapR1R2 administration. Systemic administration of VEGF TrapR1R2 may have potential therapeutic applications in the management of corneal NV.
EpiLASIK with Mitomycin C
Authors: Von Mohrenfels Christoph Winkler , Khoramnia Ramin , Maier Mathias , Lohmann Chris P.
Published: January 2018

Purpose

Mitomycin C after photorefractive keratectomy (PRK) is used to reduce the development of haze and regression in higher intended corrections. The aim of this study was to investigate the safety, stability, and efficacy of EpiLASIK with mitomycin C.

Methods

Fifty eyes of 29 patients underwent EpiLASIK with the Gebauer EpiLift microkeratome. The mean preoperative spherical equivalent was −6.89 D (SD ±0.63, range −6.0 to −8.0 D). After the laser ablation, mitomycin C 0.02% was applied for 30 seconds on a sterile filter paper. Preoperatively and 1, 3, 6, and 12 months after surgery, a full ophthalmic examination was performed.

Results

In 42 of 50 eyes, the bandage contact lens was removed at day 3. Twelve months after surgery, 96% of all eyes were within ±1.0 D and 82% were within ±0.5 D of intended correction. Five percent of all patients lost 1 line of best-corrected Snellen visual acuity, 42% were stable, and 56% gained 1 or more lines. In most patients, the cornea was clear during the whole follow-up, and in 10% only trace haze was visible. The uncorrected visual acuity was at least 1.0 in 86% of all patients, and all patients reached 0.5.

Conclusions

EpiLASIK with mitomycin C with higher intended corrections seems to be an effective and safe procedure. With the application of mitomycin C, only minimal haze appears.
Comparison of Internal Anterior Chamber Diameter Measured with Ultrabiomicroscopy with White-to-White Distance Measured Using Digital Photography in Aphakic Eyes
Authors: Wilczynski Michal , Bartela Joanna , Synder Aleksandra , Omulecki Wojciech
Published: January 2018

Purpose

Measuring the anterior chamber diameter (AC) is important both for diagnostics and before ocular surgery. In clinical practice, horizontal AC diameter is usually estimated on the basis of measurements of corneal diameter (so-called white-to-white [WTW] distance). The usual method for selecting an appropriate size for an AC lens is to add 1 mm to WTW measurement. The purpose of this study was to compare AC diameter measured using ultrasound biomicroscopy (UBM) with WTW distance measured using digital photography in aphakic eyes.

Methods

The data were gathered prospectively from a nonrandomized consecutive series of aphakic patients. The examined group consisted of 23 eyes of 23 adult patients, mean age 71.17 years. WTW diameter was measured in the 3 o'clock and 9 o'clock meridian on a digital photograph. Internal horizontal AC diameter measurements were performed in the 3 o'clock and 9 o'clock meridian with the Sonomed Ultrabiomicroscopy device with a 50-MHz probe.

Results

Mean horizontal WTW diameter measured using digital photographs was 11.65±0.38 mm and mean horizontal internal AC diameter measured using UBM was 13.53±0.83 mm. A significant difference in mean WTW diameter measured using digital photography and UBM was found (Mann-Whitney U test, p<0.05). There was a significant correlation between these values (Spearman=0.70, p<0.001).

Conclusions

In order to obtain good and precise measurements of internal AC diameter, a method of direct visualization of the intraocular structures should be used. Despite the limits of a small case series, our results support the use of UBM technique for preoperative evaluation of the internal AC diameter and AC intraocular lens sizing in aphakic eyes.
Bilateral Implantation of the Acri.LISA Bifocal Intraocular Lens in Myopic Eyes
Authors: Fernández-Vega Luis , Madrid-Costa David , Alfonso José F. , Poo-López Arancha , Montés-Micó Robert
Published: January 2018

Purpose

To asses visual quality after bilateral implantation of the Acri.LISA 366D intraocular lens (IOL) (Carl Zeiss Meditec) in patients with high and low–moderate myopia.

Methods

A total of 304 eyes of 152 patients had bilateral implantation of the Acri.LISA 366D IOL. The patients were divided into 2 groups: low–moderate myopia (IOL power from 15 to 20.5 D) and high myopia (IOL power from 0 to 14.5 D). Monocular and binocular best-corrected distance visual acuity (BCVA) and best distance-corrected near visual acuity (BCNVA), binocular best distance-corrected intermediate visual acuity (BCIVA), and distance contrast sensitivity (OS) under photopic (85 cd/m2) and mesopic (5 cd/m2) conditions were determined.

Results

At the 6-month postoperative visit, there were no statistically significant differences in monocular and binocular BCVA (p=0.13 and p=0.22, respectively). Monocular and binocular BCNVA was comparable between the groups (p=0.26 and p=0.09, respectively). The mean binocular BCIVA changed significantly as a function of the distance of the test (p<0.01) in both groups, and there were no statistically significant differences between groups at any distance. Monocular and binocular CS under photopic and mesopic conditions was similar between both groups (p>0.01).

Conclusions

Bilateral implantation of the Acri.LISA 366D in high myopic eyes provides a satisfactory full range of vision comparable to that obtained in low–moderate myopic eyes.
Visual Acuity and Contrast Sensitivity Function after Accommodative and Multifocal Intraocular Lens Implantation
Authors: Mesci Cem , Erbil Hasan , Özdöker Levent , Karakurt Yücel , Bilge Ayse Dolar
Published: January 2018

Purpose

To evaluate visual acuities and contrast sensitivities (CS) after accommodative, refractive, and diffractive multifocal intraocular lens (IOL) implantations.

Methods

After cataract extractions, in 20 eyes accommodative IOL (group 1), in 30 eyes refractive IOL (group 2), and in 20 eyes diffractive multifocal IOL (group 3) implantations were performed. CS were measured with the stereo optical functional acuity contrast test. Uncorrected distance (UCDVA) and distance corrected near visual acuities (DCNVA) and refractive values were determined.

Results

The mean UCDVA (0.99±0.03) and DCNVA (0.98±0.04) of group 3 were significantly better than the other IOL groups. The mean DCNVA of group 2 (0.71±0.14) was significantly better than group 1 (0.5±0.08). One month after the operations CS, values of group 2 were significantly lower than the 2 other IOL groups. Photopic CS values of group 1 at 12 and 18 cycles per degree (cpd) were significantly higher than group 3. Three months after the operations, CS values of group 1 and 3 were significantly higher than that of group 2 at 3, 6, 12, and 18 cpd and in all spatial frequencies respectively. There was no difference between groups 1 and 3 with respect to photopic CS values. Mesopic CS values of group 3 were significantly higher than that of group 1 at 1.5, 3, and 6 cpd. At the 6th and 12th month, CS values of group 3 were similar or better compared to the values of the 3rd month.

Conclusions

The diffractive multifocal IOL resulted in more favorable visual acuities and higher CS values than accommodative and refractive multifocal IOL.
Why is Cataract Surgery Canceled? A Retrospective Evaluation
Authors: Bamashmus Mahfouth , Haider Talal , Al-Kershy Reem
Published: January 2018

Purpose

We performed this retrospective study to evaluate and report the reasons for cancellation of elective cataract surgeries in our tertiary care hospital, Kuwait University Hospital, from January 2001 until December 2003. Proportion of elective cataract surgeries canceled on the day of surgery was obtained from the operating theater list and reasons for cancellations were recorded.

Methods

The selected patients for the surgery had gone through preoperative investigations including complete blood count, random blood sugar, coagulation profile, urea and electrolytes, viral serology (hepatitis B, hepatitis C, and human immunodeficiency virus), intraocular lens calculation, and medical condition assessed for chronic diseases.

Results

A total of 1952 patients were scheduled for elective cataract surgery. A total of 234 cases (12%) were canceled due to different reasons on the day of surgery. Main reasons for cancellation were poor control of systemic hypertension (77), canceled by patient (46), improper control of diabetes (20), patients did not bring the intraocular lens (18), chest infection or influenza in children (17), local eye infection (13), cardiac problems (11), high intraocular pressure after local anesthesia (8), and uncooperative patients (7).

Conclusions

Postponing elective cataract surgery for patients scheduled for surgery is a stressful situation for the patients and their relatives. Most reasons (80%) for canceling the surgery were avoidable and efforts to reduce the number of postponed cases should be increased. Medical fitness should be done properly to avoid unexpected rise in blood pressure and blood sugar on the day of surgery.
Toxic Anterior Segment Syndrome after Uncomplicated Cataract Surgery
Authors: Ozcelik N. Demet , Eltutar Kadir , Bilgin Burak
Published: January 2018

Purpose

To evaluate the anterior segment examination findings and the response to medical therapy of patients who had toxic anterior segment syndrome (TASS) after uncomplicated cataract surgery.

Methods

Fourteen eyes of 14 patients were enrolled in the study. Visual acuity, biomicroscopic anterior segment examination, intraocular pressure measurement, and fundus examination were performed to assess TASS occurring during postoperative 12–48 hours after uncomplicated phaco surgery. The visual impairment, corneal edema, tyndallization, fibrin formation, hypopyon, vitritis, and response to steroid therapy were evaluated prospectively.

Results

After topical steroid therapy lasting for 1 week, visual acuity improved in 11 eyes. No significant visual improvement occurred in 3 eyes. Significant corneal edema was found in 4 and mild corneal edema was observed in the other 10 eyes. Fibrin reaction occurred in 5 and tyndallization in various degrees was positive in all eyes. There was a 1-mm hypopyon in 1 patient. There was no sign of vitritis and steroid therapy was effective in all of the patients. In addition to topical treatment with steroid and antibiotic drops; systemic and subconjunctival steroids were used in 3 patients who had fibrin formation and in one patient who had hypopyon.

Conclusions

After uncomplicated cataract surgery, toxic anterior segment may occur in the early postoperative period, which is treated successfully with steroids. More studies are needed to understand the multifactorial risk factors affecting the etiopathogenesis of this syndrome.
Intravitreal Phacoemulsification with Pars Plana Vitrectomy for Management of Posteriorly Dislocated Nucleus or Lens Fragments
Authors: Soliman-Mahdy Mohamed Abdel-Monem E. , Zakaria Eid Mohamed , Shalaby Khalid Abdel-Gelil , Hegazy Hasan Mohamed
Published: January 2018

Purpose

Dislocation of crystalline lens nucleus/fragments into the vitreous cavity during phacoemulsification is a potentially serious, sight-threatening, uncommon complication of cataract surgery. It is associated with significant intraocular inflammation and can lead to poor visual outcome. The current study assesses the outcome of immediate intravitreal phacoemulsification with pars plana vitrectomy in management of posteriorly dislocated nucleus/lens fragments.

Methods

In this retrospective case series, records of 23 patients who underwent immediate pars plana vitrectomy and intravitreal phacoemulsification for removal of dislocated nucleus/lens fragments at the same sitting of phacoemulsification were reviewed. Data including patients’ preoperative and postoperative vision and intraoperative and postoperative complications were recorded.

Results

The mean follow-up period was 16.5 months (range, 5–31 months). Preoperative visual acuity ranged from 0.05 to 0.5. The final postoperative visual acuity ranged between HM and 1.0. Fifty-two percent of eyes (12 eyes) had a final postoperative visual acuity of 0.5 or better. Complications included 2 cases of cystoid macular edema and 2 cases of retinal detachment.

Conclusions

Immediate vitrectomy and intravitreal phacoemulsification is a surgical option in the management of posteriorly dislocated nucleus/lens fragments without much risk of retinal damage. It is relatively safe and most patients achieved a good visual outcome. The risk of postoperative complications including uveitis, secondary glaucoma, and cystoid macular edema could be minimized.
Efficacy of 2% Ibopamine on the Dilation of Patients with Pseudoexfoliation Syndrome
Authors: Luca Scuderi Gian , Regine Federico , Perdicchi Andrea , Turtoro Angela , Teresa Contestabile Maria
Published: January 2018

Purpose

To compare the mydriatic effects of 2% ibopamine and collyrium containing 10% phenylephrine + 0.5% tropicamide and to study the associated drug in patients with ocular pseudoexfoliation (PEX) syndrome.

Methods

This was a prospective, comparative, interventional clinical study. The study group consisted of 20 patients with ocular PEX syndrome. Intervention procedures included administration of 10% phenylephrine-0.5% tropicamide versus 2% ibopamine versus 2% ibopamine followed by the combination drug. Main outcome measurement was mydriatic efficacy measured in terms of mean pupil diameter. Adverse effects on intraocular pressure (IOP) were measured with a Goldmann applanation tonometer. Mean premedication pupil diameters in all patients were less than 3.5 mm.

Results

Instillation of 10% phenylephrine-0.5% tropicamide caused significantly greater mydriasis than 2% ibopamine (pupil diameters: 6.17 mm, SD=1.14 versus 5.33 mm, SD=1.34; p<0.001). Combined use of both collyria significantly increased mydriasis (7.19 mm; SD=0.69) compared with that induced by either of the products alone (p<0.001). Inadequate mydriasis (pupil diameters < 5.5 mm) was observed in 2 patients after administration of 10% phenylephrine-0.5% tropicamide and in 10 following instillation of 2% ibopamine, but the addition of 10% phenylephrine-0.5% tropicamide to ibopamine-treated eyes resulted in adequate dilation in all cases. IOP increases of 4 mmHg over baseline values were observed in 12 (60%) patients after 2% ibopamine.

Conclusions

In patients with ocular PEX, instillation of 2% ibopamine exerts a significant additive effect on mydriasis induced with 10% phenylephrine-0.5% tropicamide with only minimal increases in IOP
Progressive Changes in the Retinal Nerve Fiber Layer in Patients with Multiple Sclerosis
Authors: García-Martín Elena , Pueyo Victoria , Martin Jesus , Almarcegui Carmen , Ara Jose R. , Dolz Isabel , Honrubia Francisco M. , Fernández Francisco J.
Published: January 2018

Purpose

To quantify changes in the retinal nerve fiber layer (RNFL) of patients with multiple sclerosis (MS) over a 1-year time period and to compare the ability of noninvasive diagnostic imaging devices and visual evoked potentials (VEP) to detect axonal loss in these patients.

Methods

Eighty-one patients with MS underwent a complete ophthalmic examination that included assessment of visual acuity and color vision, refractive evaluation, visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (GDx), and measurement of VEP. All the patients were re-evaluated after a period of 12 months in order to quantify any change in the RNFL. Only one randomly chosen eye from each patient was included in the study.

Results

Statistically significant differences between the 2 examinations were recorded for the overall mean and inferior RNFL thickness and the macular volume, as assessed by OCT, as well as for the temporal-superior-nasal-inferior-temporal average standard deviation provided by GDx. The greatest differences were obtained for the mean RNFL thickness (90.46 μm vs 85.96 μm). Changes in the optic nerve were detected by structural measurements but not by functional assessments.

Conclusions

Axonal loss in the optic nerve of patients with MS is greater than that expected in healthy subjects, regardless of the presence of a previous optic neuritis.