bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Multiple Evanescent white Dot Syndrome with Cyclosporine
Authors: Figueroa M.S. , Ciancas E. , Mompean B. , Quereda C.
Published: January 2018

Purpose

To report the seven-year follow-up of a patient with multiple evanescent white-dot syndrome (MEWDS).

Methods

Case report: A 46-year-old woman presented recurrent episodes of bilateral MEWDS.

Results

During the seven-year follow-up there were nine episodes of MEWDS. After four bouts in the first two, cyclosporine therapy was started. During two years of treatment there were no recurrences except when the dose was reduced or discontinued.

Conclusions

The etiology of MEWDS is still unknown but the absence of new episodes during cyclosporine treatment and the recurrence immediately after decreasing or discontinuing the drug suggests an autoimmune origin, with the involvement of cellular immunity in the pathogenic process.
Exudative Retinal Detachment following Grid Laser Photocoagulation in a Patient with Hemiretinal Vein Occlusion
Authors: Ozerdem U. , Freeman W.R.
Published: January 2018

Purpose

To report a patient with unilateral hemiretinal vein occlusion and macular edema who developed exudative macular detachment after grid laser application.

Methods

Clinical examinations, fundus photography and fluorescein angiography.

Results

Severe macular edema and exudation.

Conclusions

This case illustrates a previously unreported complication of grid laser application for macular edema in retinal vein occlusion.
Corneal Topographical Study of the Effect of Lacrimal Punctum Occlusion on Corneal Surface Regularity in Dry Eye Patients
Authors: Özkan Y. , Bozkurt B. , Gedík Ş. , Írkeç M. , Orhan M.
Published: January 2018

Purpose

To compare topographic indices of surface regularity in dry eye patients and in normal subjects (controls) and to investigate the short-term effect of lacrimal punctal plugs on these indices in dry eye patients.

Methods

The surface regularity index (SRI) and surface asymmetry index (SAI) of the TMS-2 corneal topographic modelling system were used to evaluate corneal surface regularity in 20 eyes of 10 dry eye patients before and after the insertion of Herrick silicon lacrimal plugs (Lacrimedics, Rialto, CA, USA) and in 24 eyes of 12 normal subjects as controls.

Results

SRI and SAI were significantly lower in controls than dry eye patients (p=0.00). Median SRI was 1.72 in dry eye patients before punctal occlusion and 0.525 in the control group. Median SAI was 1.305 in dry eye patients and 0.240 in controls. After lacrimal punctal occlusion, Schirmer test results and fluorescein breakup time increased in nine patients and remained the same in one patient. After occlusion, the SRI decreased in 9 eyes, and increased in 11 (p=0.970); SAI decreased in 13 eyes and increased in 7 (p=0.135).

Conclusions

No significant change in topographic indices of corneal surface irregularity could be detected in severe dry eye patients with lacrimal punctal plugs in the short-term follow-up.
Nerve Fiber Layer Assessment with Scanning Laser Polarimetry in Glaucoma Patients and Glaucoma Suspects
Authors: Özdek Ş.C. , Önol M. , Hasanreísoğlu B.
Published: January 2018

Purpose

To investigate whether scanning laser polarimeter can differentiate glaucoma and suspected glaucoma patients from normals.

Methods

Polarimetric measurements were obtained using the nerve fiber analyzer (NFA)-I from 80 eyes of patients with glaucoma with mostly moderate glaucomatous optic nerve damage (37 eyes with primary open angle glaucoma, 21 with normal tension glaucoma, 17 with pseudoexfoliative glaucoma, 3 with angle closure glaucoma, and 2 with juvenile glaucoma), 53 eyes of patients suspected of glaucoma based on disc appearance, and from age-matched healthy volunteers as control groups. Ratios (superior/nasal, inferior/nasal, superior/inferior) were used for assessing nerve fiber layer (NFL) thickness. Student's t-test and linear regression analysis were used for statistical analysis.

Results

Both the glaucoma patients and glaucoma suspects had significantly lower NFL ratios (mean S/N 2.34 ± 0.47, I/N 2.46 ± 0.52, S/I 0.94 ± 0.18) than the control groups (respectively 2.88 ± 0.48, 2.88 ± 0.48, 1.00 ± 0.13) (p<0.05). There was an ample overlap between the patient groups and the normals. The superior and inferior NFL ratios in glaucoma patients gradually decreased as the mean defect in visual field increased (linear regression analysis, p<0.05).

Conclusions

The NFL of glaucomatous eyes and eyes suspected of glaucoma based on disc appearance was significantly less thick than normals. NFA-I detects pathological abnormalities in some patients with glaucomatous optic nerve damage and normal visual fields as measured by conventional achromatic computerized perimetry. NFA-I, however, is unable to distinguish these patients from normals, at least using these parameters, because of the considerable overlap.
Flap Complications in Our Learning Curve of Laser in Situ Keratomileusis Using the Hansatome Microkeratome
Authors: Yildirim R. , Devranoglu K. , Ozdamar A. , Aras C. , Ozkiris A. , Ozkan S.
Published: January 2018

Purpose

To determine the incidence and the type of flap complications in our initial series of eyes undergoing laser in situ keratomileusis and the impact of microkeratome-related complications on best spectacle-corrected visual acuity.

Methods

We reviewed the charts of the 630 consecutive eyes operated in the Refractive Surgery Department of Cerrahpasa Medical School, University of Istanbul, Turkey using the Hansatome microkeratome and the Summit, SVS Apex Plus excimer laser between March 1998 and November 1999. The mean follow-up was 12.6 months.

Results

The incidence of total flap complications was 19.8 %. Flap folds (5%) were the most common complication. The incidence of epithelial ingrowth was 3.3%. Diffuse lamellar keratitis was encountered in 20 cases (3.17%). Displaced flaps were seen shortly after the procedure in 8 eyes (1.26%) and repositioned immediately. Improper keratectomy occurred in 14 eyes (2.2%) and incomplete keratectomy in four procedures (0.63%). The presence of interface debris and hemorrhage was each 1.9%. We observed one interface abscess, which was culture-negative and cured with fortified antibiotics, and one free flap.

Conclusions

Although the LASIK procedure with the Hansatome had an easy learning curve without any of the serious complications that frequently occur in this phase, we still observed flap related complications that affected visual outcome
Von Willebrand Factor in Subretinal Fluid
Authors: Malukiewicz-Wiśniewska G. , Kotschy M.
Published: January 2018

Purpose

To measure the vWF antigen concentration (vWF Ag) in subretinal fluid (SRF) and blood plasma.

Methods

Prospective study of 30 patients, aged from 15 to 78 years (mean 52.7 years), undergoing retinal detachment surgery. Excluded were patients with venous or arterial disease or any other factors that could affect the parameters evaluated. Subretinal samples were obtained at the time of routine drainage during retinal detachment surgery. Venous blood samples were taken from the cubital vein into sodium citrate solution (9:1) immediately after induction of anesthesia but before surgery. VWF in plasma and in SRF and its relation to patients' age, sex, the duration and extent of retinal detachment, number of retinal tears, and cryopexy application were evaluated.

Results

The median level of vWF Ag in 30 samples of SRF was 6.3%. The median level of vWF Ag in blood plasma was 70.34%. The levels of vWF Ag in SRF were significantly lower than in blood plasma (p<0.00001). We found no correlation between the vWF Ag concentration in plasma or in SRF and sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and the use of cryopexy.

Conclusions

Determination of vWF Ag showed that this factor in SRF is unrelated to patients', sex, the degree of myopia, the duration and extent of retinal detachment, number of retinal tears and use of cryopexy.
Local Anaesthesia for Vitreoretinal Surgery: An Audit of Patient and Surgical Experience
Authors: Knight H.M.L. , Newsom R.B. , Canning C.R. , Luff A.J. , Wainwright A.C.
Published: January 2018

Purpose

Local anaesthesia for vitreoretinal surgery is little used as these procedures are deemed to be too long and uncomfortable for patients to tolerate. In this unit anterior intraconal local anaesthesia is used for most routine surgery. We undertook an audit to ensure that surgical standards and patient acceptability were not compromised.

Methods

A prospective observational audit was performed. Audit data included: Grade of anaesthetist and surgeon; details of anaesthetic and operation; compliance of patient; operating conditions and pain scores. Anaesthesia was provided with a combined peribulbar and intraconal anaesthetic, using bicarbonate buffered lignocaine and bupivacaine 50:50 mixture.

Results

135 (76%) had local anaesthesia alone, 13 (7%) had local anaesthesia with sedation and 29 (16%) had general anaesthesia. 96.4% of patients were compliant and 98.8% of operating conditions were good or excellent. The mean perioperative pain score was 0.1 (range of 0–1), 97% said they would choose local anaesthesia again.

Conclusions

LA for vitreoretinal surgery is a useful and flexible method of anaesthesia, which has been shown to have excellent patient tolerance.
Eyelid Hypertrichosis Associated with Latanoprost is Reversible
Authors: O'Toole L. , Cahill M. , O'Brien C.
Published: January 2018

A 56-year-old woman with primary open-angle glaucoma in an only eye presented with hypertrichosis after using Latanoprost to lower IOP. After trabeculectomy with adjunctive Mitomycin C, IOP was well controlled and antiglaucoma medications could be discontinued. At eight-month follow-up the abnormal eyelashes had disappeared.
Electrophysiological Approaches for Early Detection of Glaucoma
Authors: Bach M.
Published: January 2018

Purpose

While elevated intraocular pressure (IOP) is a major risk factor for glaucoma, only about 1% of patients with 25 mmHg develop the condition each year. Since a sizeable proportion of the ganglion cells are already lost when the visual field losses are apparent, the aim is to identify patients with elevated IOP in whom glaucoma damage is incipient before visual field changes occur.

Methods

This report concerns early diagnosis of glaucoma with electrophysiological techniques, rather than with monitoring the disease using various available psychophysical and morphological methods. Visual electrophysiology offers a wide range of tools to assess function layer-by-layer along the visual pathway. Their clinical value for early detection of glaucoma will be discussed. The pattern electroretinogram (PERG), a direct functional indicator of retinal ganglion cell function, is markedly affected by glaucoma, and in longitudinal studies the PERG correctly indicated eyes at risk before manifest glaucoma occurred.

Conclusions

Consequently, this report will concentrate on the PERG. Less proven, but promising measures like the “photopic negative response”, the motion visually evoked potential (VEP) and the multifocal VEP will also be touched upon.
Evaluation of Glaucomatous Visual Field Loss with Locally Condensed Grids Using Fundus-Oriented Perimetry (FOP)
Authors: Schiefer U. , Malsam A. , Flad M. , Stumpp F. , Dietrich T. J. , Paetzold J. , Vonthein R. , Knorr M. , Denk P.O.
Published: January 2018

Purpose

We compared detection rates of glaucomatous visual field defects (VFDs) between a conventional rectangular stimulus grid and locally condensed test point arrangements in morphologically suspicious regions.

Methods

Humphrey Field Analyzer model 630 (HFA I, program 30-2 with a rectangular 6° × 6° grid) was used as the conventional perimetric method. Individual local test-point condensation was realized by fundus-oriented perimetry (FOP) on the Tuebingen Computer Campimeter (TCC).

Results

Of a total of 66 glaucoma patients, or suspected sufferers, 23 showed normal findings and 27 showed pathological findings with both methods. In 15 cases we found normal visual fields in HFA 30-2, whereas FOP revealed early glaucomatous functional damage. Only one case showed pathological HFA results, while FOP was normal. Detection rates of VFDs significantly differed between the two methods (p < 0.001; sign test).

Conclusions

FOP, using individually condensed test grids, significantly increases detection rates of glaucomatous VFDs in morphologically suspicuous areas compared with a conventional HFA 30-2 technique using equidistant rectangular (6° × 6°) test point arrangements.
Brimonidine (Alphagan®): A Clinical Profile Four Years after Launch
Authors: David R.
Published: January 2018

The early information on the clinical efficacy, safety, and tolerability of brimonidine 0.2% were obtained from studies that compared brimonidine monotherapy with timolol and betaxolol. These studies showed its intra-ocular pressure lowering efficacy to be comparable with timolol and superior to betaxolol. The data from the timolol studies showed consistent results after four years. These findings have been confirmed by additional studies in the clinical setting.

More recently, several clinical trials have been completed investigating the role of brimonidine as adjunctive medication to beta-blockers and as replacement therapy to other intraocular pressure lowering compounds. When added to beta-blockers, brimonidine is superior to dorzolamide, similar in efficacy but better tolerated than pilocarpine, and more predictable than latanoprost.

Data from replacement studies have indicated that there may be advantages in replacing rather than adding medications in the treatment of glaucoma.
Corneal Thickness in Trachomatous Dry Eye
Authors: Guzey M. , Satici A. , Karadede S.
Published: January 2018

Purpose

To investigate the effect of severe desiccation on corneal thickness in scarring trachoma by comparing the thickness of normal and trachomatous dry eye corneas.

Methods

Ultrasonic pachymetry was used to measure the corneal thickness at nine points in the central and peripheral cornea (superior, superonasal, nasal, inferonasal, inferior, inferotemporal, temporal, superotemporal) in 45 eyes of 27 patients with trachomatous dry eye and 54 eyes of 31 normal subjects.

Results

The average thickness of the nine sites in the central and midperipheral cornea was significantly less in trachomatous dry eyes than normal eyes. The superior cornea was the thickest area in both groups, measuring 574.03 ± 31.62 μm in trachomatous dry eyes and 611.33 ± 34.99 μm in normal eyes (p<0.001). The centre of the cornea was the thinnest, measuring 510.43 ± 32.12 μm in trachomatous dry eyes and 546.27 ± 36.20 μm in normal eyes (p<0.001).

Conclusions

The thickness of the central and midperipheral cornea was significantly reduced in patients with trachomatous dry eye. The chronic state of severe desiccation, tear film instability and increased immune activation in trachomatous dry eye may contribute to this thinning.(Eur J Ophthalmol 2002; 12: 18–23)
Outcome of Abducens Nerve Paralysis in Patients with Nasopharyngeal Carcinoma
Authors: Ílhan Ö. , Şener E.C. , Özyar E.
Published: January 2018

Purpose

The objective of this study was to investigate the incidence, management and outcome of patients with nasopharyngeal carcinoma (NPC) who developed VIth nerve palsy.

Methods

Between December 1993 and December 1999, we investigated retrospectively the charts of 166 patients with NPC.

Results

Twenty-eight of 166 patients (16.8%) had cranial nerve involvement at the time of the diagnosis of NPC. Sixteen (57.2%) were identified as having abducens nerve palsy. In 25% abducens nerve palsy was the presenting symptom. Three patients were able to compensate for their diplopia after prism correction or botulinum toxin-A injection, and six (50%) completely recovered from abducens nerve palsy after either radiotherapy or chemotherapy.

Conclusions

Abducens is the most common cranial nerve involved in NPC, radiotherapy and or chemotherapy relieves the paralysis in half the patients. Prism correction or botulinum toxin-A injection are effective non-invasive procedures for patients with significant diplopia.
Vitreous Hemorrhage following Phakic Anterior Chamber Intraocular Lens Implantation in Severe Myopia
Authors: Nuzzi G. , Cantù C.
Published: January 2018

Purpose

To describe two cases of vitreous hemorrhage following phakic anterior chamber lens (AC-IOL) implantation in high myopia.

Case Report

In case 1, hemorrhage developed one month after surgery, without retinal involvement, and visual acuity (VA) resulted 20/200 after pars-plana vitrectomy (PPV). In Case 2, vitreous hemorrhage was complicated by retinal detachment (RD). PPV and silicone oil injection were performed, with AC-IOL removal and cristalline lens extraction. After 2 years the retina was attached and VA was 20/80.

Discussion

Only few cases of RD, posterior uveitis and endophthalmitis are reported following phakic AC-IOL implant. Vitreous hemorrhage could represent an additional posterior segment complication. Intraoperative manoeuvres, hypotony-induced posterior vitreous detachment and/or peripheral retina traction could play a role in engendering this complication in highly myopic eyes.
Effects of Melatonin, Vitamin E and Octreotide on Lipid Peroxidation during Ischemia-Reperfusion in the Guinea Pig Retina
Authors: Çelebi S. , Dilsiz N. , Yilmaz T. , Kükner A. Sahap
Published: January 2018

Purpose

The purpose of this study is to provide evidence that free radical damage is a component of retinal ischemia-reperfusion (I/R) injury, and to determine whether melatonin, vitamin E and octreotide can protect the retina from this injury.

Methods

The right eyes of 50 male guinea pigs weighing 500–600 g were used. The animals were randomly assigned to group 1 (control), group 2 (I/R), group 3 (melatonin + I/R), group 4 (vitamin E + I/R) and group 5 (octreotide + I/R). Groups 3, 4 and 5 received four subcutaneous injections with a 6-h interval for a total daily dose of 10 mg/kg melatonin, 150 mg/kg vitamin E and 22 μg/kg octreotide. The first dose of each substance was administered 5 minutes before retinal ischemia, which was induced for 1.5 hours, followed by reperfusion for 24 hours. All three substances were repeated for 6, 12 and 18 hours during reperfusion. The animals were killed at 24 hours of reperfusion. Retinas were isolated and processed for the quantification of malondialdehyde (MDA).

Results

The compounds had the following relationships: melatonin more than vitamin E more than octreotide in preventing retinal damage by ischemia-reperfusion. All three gave significant protection against the formation of MDA (10.4±2.3, 12.4±2.4, 13.9±1.5 nmol/100 mg tissue wet weight, respectively) compared to the control (3.7±1.3 nmol/100 mg tissue wet weight) and I/R groups (22.7±6.2 nmol/100 mg tissue wet weight).

Conclusions

This study demonstrates the inhibitory effect of melatonin, vitamin E and octreotide on MDA levels during retinal ischemia-reperfusion injury.
Long-Term Visual Acuity after Argon Green Laser Photocoagulation of Juxtafoveal Choroidal Neovascularization in Highly Myopic Eyes
Authors: Ruiz-Moreno J.M. , Montero J.A.
Published: January 2018

Purpose

To evaluate visual outcomes in patients with high myopia after juxtafoveal choroidal neovascularization (CNV) treated with argon green laser photocoagulation.

Patients and Methods

We retrospectively analyzed 23 eyes of 21 patients with high myopia (>6.0 diopters and/or axial length >26 mm) with juxta foveal CNV treated with direct Argon green laser photocoagulation. Mean age at diagnosis was 49.08±12.20 years (range, 29 to 71). Mean follow-up was 54.26±26.18 months (range 18 to 96).

Results

Best corrected visual acuity (BCVA) before treatment was 0.09±0.10 (range, 0.01 to 0.40). Two months after treatment it was 0.14±0.12 (0.01 to 0.6), significant difference (p=0.02, Student's t-test for paired data) and after six months 0.19±0.14 (0.01 to 0.5) (p=0.0002). Mean BCVA decreased with follow-up, to 0.19±0.15 (0.01 to 0.4) after two years, 0.16±0.15 (0.01 to 0.5) after three years and 0.16±0.19 (0.01 to 0.7) after four years, with no significant improvement after the third year (p=0.04). In two cases CNV reappeared.

Conclusions

Direct argon green laser photocoagulation in high-myopia juxtafoveal CNV can improve BCVA initially for between two and 24 months. The improvement fades with time, and is no longer significant after the third year.
Multifocal Choroiditis after Allogenic Bone Marrow Transplantation
Authors: Alvarez M.T. , Hernáez J.M. , Ciancas E. , Figueroa M.S.
Published: January 2018

Purpose

To describe the clinical manifestations of multifocal choroiditis presumed to be secondary to allogenic bone marrow transplantation after development of self-tolerance to chronic graft-versus-host disease (GVHD).

Methods

Case report. A 17-year-old male who received an allogenic bone marrow transplant (BMT) from his HLA-identical sister.

Results

One year after BMT, grade II chronic GVHD developed. Two years later, vision deteriorated to 20/50 R.E. and 20/400 L.E. Ophthalmoscopic examination showed multiple chorioretinal punched-out scars throughout the posterior pole and mid-periphery of both eyes. Fluorescein angiography showed four choroidal neovascular membranes (CNVMs) in the right eye that were surgically removed, and a subfoveal disciform scar in the left eye.

Conclusions

Multifocal choroiditis is a possible complication related to allogenic BMT. It should be included as a late cause of BMT-associated choroidopathy. Surgical removal of vision-threatening CNVMs is a reasonable approach.
Phacofragmentation without Perfluorocarbon Liquid for Dislocated Crystalline Lenses or Lens Fragments after Phacoemulsification
Authors: Yao K. , Shentu X. , Jiang J. , Du X.
Published: January 2018

Purpose

To evaluate the clinical outcome of vitrectomy with phacofragmentation without perfluorocarbon liquid (PFCL) in the management of dislocation of the crystalline lens, caused by trauma, hereditary disorders, or hypermature cataracts, and lens fragments due to phacoemulsification.

Methods

A prospective study was conducted to evaluate 30 eyes of 29 patients who had undergone standard pars plana vitrectomy with phacofragmentation without PFCL in the vitreous cavity, for the removal of dislocated crystalline lenses or lens fragments, from January 1998 to July 2000. All cases were followed for more than six months.

Results

Final best corrected visual acuity of 0.5 or better increased from 0% preoperatively to 36.7% postoperatively, and 0.2 or better rose to 76.7%. The mean IOP was significant reduced, from 26.35 mmHg to 12.75 mmHg. No intraoperative complications occurred. Although two eyes (6.7%) developed retinal detachment, one (3.3%) had cystoid macular edema (CME) and one (3.3%) had a transient intraocular pressure increase (to 25 mmHg) postoperatively, all others had a favorable outcome.

Conclusions

Standard pars plana vitrectomy with phacofragmentation without PFCL in the vitreous cavity is a safe, simple, and effective method for removing a dislocated crystalline lens or lens fragments, with good visual outcome.
Comparison of Emedastine 0.05% or Nedocromil Sodium 2% Eye Drops and Placebo in Controlling Local Reactions in Subjects with Allergic Conjunctivitis
Authors: Orfeo V. , Vardaro A. , Lena P. , Mensitieri I. , Tracey M. , De Marco R.
Published: January 2018

Purpose

To assess the efficacy of nedocromil sodium 2% eye drops and emedastine difumarate 0.05% eye drops in controlling the ocular allergic reaction induced by conjunctival allergen challenge (CAC).

Methods

Thirty subjects with a personal history of allergic conjunctivitis were enrolled (first visit). At the second visit each subject randomly received emedastine 0.05% or nedocromil 2% in one eye and placebo in the other eye. Five minutes after the medication the offending allergen was instilled in both eyes. Ocular redness and itching were evaluated according to a standardized scoring system at 3, 10 and 20-minute intervals after instillation of the allergen. After one week (third visit) the whole procedure was repeated using the placebo in the eye used as control during second visit and one of the trial drug that was not used at second visit in the other eye (either emedastine or nedocromil).

Results

Emedastine 0.05% and nedocromil 2% eye drops were more effective than placebo in controlling ocular redness and itching (p<0.01). Emedastine was more effective (p<0.01) than nedocromil in alleviating redness and itching 3 and 10 minutes after application of the allergen.

Conclusions

Emedastine 0.05% appeared superior to nedocromil 2% in producing immediate relief when subjects with allergic conjunctivitis were exposed to the offending allergen.
Risk Factors for Anatomical Success and Visual Outcome in Patients Undergoing Silicone Oil Removal
Authors: Jiang F. , Krause M. , Ruprecht K. W. , Hille K.
Published: January 2018

Purpose

To define risk factors for anatomical success and visual outcome in patients undergoing removal of silicone oil.

Methods

This retrospective study included patients who had silicone oil removed at this hospital between 1996 and 2000. All were followed for at least six months. Patients with recurrent retinal detachment after silicone oil removal were compared with patients without this complication. We also compared patients whose vision improved or stabilized with patients whose vision deteriorated. Risk factors for anatomical success and visual outcome were identified.

Results

We analysed 94 eyes of 92 patients with silicone oil removal. Nineteen eyes (20%) had recurrent retinal detachment, and in 30 eyes (32%), the vision deteriorated after removal of the oil. Initial vision less than ambulatory vision, initial pathology of giant retinal tears and recurrent retinal detachment, postoperative hypotony and postoperative epiretinal membrane occurred more frequently in eyes with than without recurrent retinal detachment. Pre- and postoperative hypotony, postoperative epiretinal membranes and postoperative recurrent retinal detachment were also more frequent in eyes with deteriorated vision.

Conclusions

When treating giant retinal tears or recurrent retinal detachments with silicone oil tamponade, surgeons and their patients need to be aware of the higher possibility of unfavorable results, particularly when the initial vision is less than ambulatory vision. The presence of risk factors before and after silicone oil removal should remind surgeons of the higher risk profile of this particular surgery.
Exposure Keratopathy following Phacoemulsification under Local Anaesthesia
Authors: Dinakaran S.
Published: January 2018

Purpose

Report a series of patients with exposure keratopathy following phacoemulsification under local anaesthesia.

Methods

A case series.

Results

Four patients were found to have exposure keratopathy within hours after surgery resulting in a visit to the casualty on the day of surgery.

Conclusions

One should anticipate the possibility of lagophthalmos and assess the blink reflex at the end of surgery. If the reflex is poor, patching the eye or taping the lids should be undertaken to prevent this complication.
Intraoperative Capsular Block Syndrome Masquerading as Expulsive Hemorrhage
Authors: Yip C.-C. , Au Eong K.-G. , Yong V.S.H.
Published: January 2018

Purpose

To describe the clinical features of two cases of intraoperative capsular block syndrome (CBS) mimicking expulsive hemorrhage.

Setting

The Eye Institute at Tan Tock Seng Hospital, National Healthcare Group, Singapore.

Methods

Two case reports.

Results

Two patients underwent phacoemulsification under retrobulbar anesthesia and developed severe globe hardening, shallow anterior chamber (AC) and uveal prolapse intra-operatively after hydrodissection. The AC spontaneously deepened in one patient and the operation was converted to extracapsular cataract surgery on suspicion of CBS with posterior capsule rupture, which was confirmed after nucleus expression; anterior vitrectomy was done and an anterior chamber lens implanted. At the eight post-operative month, his best-corrected visual acuity was 6/24 secondary to an epiretinal membrane in the macula. CBS, however, was not recognized in the other patient and caused posterior lens dislocation during attempted phacoemulsification. This patient underwent vitrectomy, removal of the lens nucleus and insertion of a posterior chamber intraocular lens in the sulcus the next day. His best-corrected visual acuity was 6/9 at the tenth postoperative month.

Conclusions

Intraoperative CBS may mimic expulsive hemorrhage. Early diagnosis of this condition and proper management optimizes the visual outcome.
Ultrasound Measurement of the Horizontal External Eye Muscles in Patients with Thyroid Disease. is Orbital Involvement Associated with Thyroid Autoantibodies?
Authors: Zimmermann-Belsing T. , Feldt-Rasmussen U. , Fledelius H.
Published: January 2018

Purpose

To describe ophthalmic findings with emphasis on exophthalmometry and ultrasonic assessment of extraocular eye muscle diameter in a consecutive group of females with Graves' disease (GD), compared with healthy controls and patients with other thyroid diseases. We also investigated the relationship with biochemical markers of thyroid autoimmunity such as TSH receptor antibodies (TRAb) and anti-thyroid peroxidase antibodies (anti-TPO).

Methods

Seventy adult women (age 26–74 years) with various types of thyroid disease consecutively entered the study at a tertiary referral center for thyroid-associated ophthalmopathy (TAO). Twenty-three had long-standing GD with TAO. Clinically, TAO was mainly absent in 22 with newly diagnosed GD and in seven with relapse of GD. Nine with Hashimoto's thyroiditis and nine with multinodular goiter were included for comparison and 18 healthy females served as controls. A full ophthalmic status included B-scan ultrasonic assessment of the four horizontal rectus muscle thicknesses, and a clinical NOSPECS score was attempted for each.

Results and Conclusions

Besides higher NOSPECS scores, the TAO subgroup had higher exophthalmometry and muscle thickness. The GD groups without significant TAO also scored higher in these ratings compared to controls. Hertel recordings, NOSPECS and muscle thicknesses were all correlated in GD but showed no correlation to thyroid antibodies (TRAb and anti-TPO). Thus, the muscle thickness did not correlate with thyroid autoimmune activity. Nevertheless, we found extraocular muscle assessment useful since a) thicker muscles were usually found in patients with GD, with or without evidence of TAO, and b) other space-occupying orbital lesions could be excluded, thereby reducing the need for the more elaborate imaging techniques (CT, MRI, etc.).
Refractive Lens Exchange for Correction of High Myopia
Authors: Gabrić N. , Dekaris I. , Karaman Ž.
Published: January 2018

Purpose

To evaluate the efficiency and safety of refractive lens exchange for the correction of high myopia.

Methods

We made a prospective study of the results of refractive lens exchange in 72 eyes that had undergone this surgical procedure between January 1996 and January 2001. Lens extraction by phacoemulsification was done by one surgeon on 34 patients. Follow-up was five months to five years (mean 48 months). The postoperative refractive target was emmetropia or a low degree of myopia. We compared pre- and postoperative uncorrected visual acuity, and preoperative best-corrected visual acuity with postoperative uncorrected visual acuity. Intra- and postoperative complications were recorded.

Results

In 72.2% of the eyes best-corrected visual acuity (BCVA) was ≥ 0.5 before surgery. Four years after refractive lens exchange, uncorrected visual acuity (UCVA) was ≥ 0.5 in 58.3% of eyes, and the proportion of eyes with BCVA ≥ 0.5 increased to 83.3%. The sphere was fully corrected in 70.8% of cases, remained within 1.0 D of emmetropia in 87.5% and within 2.0 D of emmetropia in 95.8%. Posterior capsule opacification developed in 22 eyes (30.5%)and was treated with neodymium:YAG (Nd:YAG) laser capsulotomy Cystoid macular edema with retinal detachment occurred in one eye. No wound leakage or eye infections were observed during five years' follow-up.

Conclusions

Refractive lens exchange seems to be an effective alternative for the correction of high myopia, helping people over 40 years of age regain their distant vision.
A Comparison of Endophthalmitis after Phacoemulsification or Extracapsular Cataract Extraction in a Socio-Economically Deprived Environment: A Retrospective Analysis of 2446 Patients
Authors: Kalpadakis P. , Tsinopoulos I. , Rudolph G. , Schebitz K. , Froehlich S.J.
Published: January 2018

Purpose

To assess which cataract operation technique involves least risk of postoperative endophthalmitis, when performed in a population living in poor hygiene conditions.

Methods

This retrospective clinical study evaluated 2446 cases at the Eye Clinic of the Komotini General Hospital, Greece, between January 1998 and January 2001.

Results

Endophthalmitis arose in 12/1055 patients (1.13%) after extracapsular cataract extraction (ECCE) and in 8/1391 after phacoemulsification (0.57%). The mean time to onset of endophthalmitis was 23 and 73 days respectively after phacoemulsification and ECCE. This difference was statistically significant.

Conclusions

Endophthalmitis develops considerably later after ECCE than phacoemulsification. Thus it would appear that hygiene conditions have a stronger effect in patients operated with the ECCE technique. In order to reduce the risk of endophthalmitis after cataract extraction in patients living in substandard conditions, phacoemulsification is proposed as preferable to ECCE.
Perfluorohexyloctane Endotamponade for Treatment of Subfoveal Hemorrhage
Authors: Jonas J.B. , Jäger M.
Published: January 2018

Purpose

To report on the use of perfluorohexyloctane as a heavy liquid to temporarily tamponade the fovea for the prevention of recurrent massive subfoveal hemorrhage in patients with exudative age-related macular degeneration (ARMD).

Methods

The case series comprised seven patients with acute massive subfoveal hemorrhage due to exudative ARMD. The patients underwent pars plana vitrectomy, drainage of the subretinal blood, and foveal endotamponade with perfluorohexyloctane. The perfluorohexyloctane was removed 80.4 ± 38.1 days (median 98 days; range 22–118 days) after the primary surgery in a second pars plana intervention.

Results

In six patients (85.7%) the subretinal hemorrhage removed during the first pars plana vitrectomy did not recur after removal of perfluorohexyloctane. In the seventh, however, a subretinal hemorrhage re-developed five days after release of perfluorohexyloctane. No large epiretinal membranes were observed. In six eyes (85.7%), the retina remained attached after removal of perfluorohexyloctane but in one eye proliferative vitreoretinopathy developed, with central retinal detachment. After the first pars plana vitrectomy, visual acuity increased slightly but not significantly (p=0.25), from 0.03 ± 0.03 to 0.05 ± 0.07. Intraocular pressure rose from 15.0 ± 1.9 mm Hg to 24.9 ± 16.9 mm Hg. After a follow-up of 69.7 ± 121.0 days after removal of the perfluorohexyloctane, final visual acuity was 0.02 ± 0.04.

Conclusions

Perfluorohexyloctane may be a useful additional tool for preventing the recurrence of subfoveal re-bleeding in exudative ARMD.
Multicenter Evaluation of Tendency-Oriented Perimetry (TOP) Using the G1 Grid
Authors: Gonzáles de la Rosa M. , Morales J. , Dannheim F. , Papst E. , Papst N. , Seiler T. , Matsumoto C. , Lachkar Y. , Mermoud A. , Prünte C.
Published: January 2018

Purpose

The G1-TOP program is a short automated perimetric strategy which sub-divides the G1 grid of 59 points into four sub-grids. Each point is tested only once, but each patient's response is used to modify that particular point and the surrounding ones from the remaining sub-grids. This study compared the results of the G1-TOP program with the Standard Bracketing strategy.

Methods

Eleven participating institutions provided data from 213 patients (406 eyes). The main group consisted of 284 glaucomas and 55 glaucoma suspects. Other groups included 31 eyes with neurological disorders, 20 with chorioretinal lesions and 16 normal eyes. Mean age was 62.7 ± 15.4 (range 14–88) years. All subjects had previous perimetric experience and visual acuity better than 0.5. Examination included G1-Standard Bracketing and G1-TOP testing, in interchangeable order, with the Octopus 1-2-3 perimeter.

Results

The correlation coefficient for mean defect (MD) was 0.95. Standard error (YX) for MD, square root of loss variance (LV) and individual thresholds were 1.86 dB, 1.29 dB, and 4.72 dB, respectively. Mean sensitivity values were similar (difference 0.04 ± 1.87 dB) (p>0.05). Mean duration for G1-TOP was 2.19 ± 0.26 min, while G1-Standard Bracketing took 11.51 ± 1.52 min (ratio 1/5.1, or a net reduction of 80.4%). The sensitivity of G1-TOP versus G1-Standard Bracketing was: glaucoma 77.1/78.5, glaucoma suspects 38.2/47.3, neurological disorders 87.1/87.1 and chorioretinal lesions 80.0/85.0.

Conclusions

The G1-TOP program gave very similar results to G1-Standard Bracketing in only 20% of the time required by the standard strategy.
Implantation of a Black Diaphragm Intraocular Lens in Ten Cases of Post-Traumatic Aniridia
Authors: Beltrame G. , Salvetat M.L. , Chizzolini M. , Driussi G.B. , Busatto P. , Di Giorgio G. , Barosco F. , Scuderi B.
Published: January 2018

Purpose

To retrospectively review the safety and efficacy of black-diaphragm intraocular lenses (IOL) implanted for the treatment of post-traumatic aniridia.

Methods

Ten patients (mean age 48 years, range 21–75) were implanted with a black-diaphragm posterior chamber IOL (Morcher GmbH, model 67F) for correction of post-traumatic aniridia associated with cataract or aphakia. This IOL, in poly(methylmethacrylate), consists of an opaque diaphragm surrounding the transparent optic, and was inserted through a 10-mm scleral tunnel (seven eyes) or through the corneal trephination in cases of simultaneous penetrating keratoplasty (three eyes), and in-the-sulcus implanted, transsclerally sutured (six eyes) or on capsular support (four eyes). Mean follow-up was 33.4 months (range 12–52).

Results

Best-corrected visual acuity (BCVA) improved in eight eyes and remained unchanged in two. Glare and photophobia decreased in all patients. Intraoperatively, ciliary sulcus bleeding occurred in two cases and haptic rupture during lens insertion in one. Postoperatively, persistent intraocular inflammation was seen in four eyes, secondary glaucoma in four eyes, transient hyphema and/or hemovitreous in four, IOL decentration in two, and post-traumatic haptic detachment in one eye.

Conclusions

Although in our experience the haptics still seem weak and the diaphragm diameter too large, implantation of the black-diaphragm IOL type 67 F appeared sufficiently safe and provided satisfactory functional results for correction of post-traumatic aniridia combined with cataract or aphakia, improving BCVA and reducing glare and photophobia in most patients, though clearly more cases and longer follow-up are needed to assess its clinical performance properly.
Corneal Neovascularization Possibly Associated with Latanoprost Therapy
Authors: Orhan M. , Kerimoğlu H. , Irkeç M.
Published: January 2018

Purpose

To report a case of corneal neovascularization possibly associated with latanoprost therapy.

Methods

Case report: A 67-year-old man developed a progressive stromal corneal neovascularization in his right eye within eight months of a corneal trauma. At admission, he was receiving latanoprost 0.005% therapy. His topical medications were rearranged: latanoprost was replaced with carteolol hydrochloride 1% twice daily bilaterally and prednisolone acetate 1% was added twice daily in the right eye.

Results

One month later, he presented regression of the corneal neovascularization and an increase in visual acuity.

Conclusions

Latanoprost, an arachidonic acid derivative, could have directly or indirectly stimulated the corneal neovascularization in this patient with a history of nonpenetrating corneal trauma.
Herpes Simplex Virus Type 2 Acute Retinal Necrosis in an Immunocompetent Patient
Authors: Miserocchi E. , Modorati G. , Azzolini C. , Foster C.S. , Brancato R.
Published: January 2018

Purpose

To report a case of acute retinal necrosis caused by herpes simplex virus 2 in an otherwise healthy patient.

Case Report

A 45-year-old man presented with one month's history of decreased vision in the right eye. He had previously received a course of intravenous gancyclovir because of a clinical suspicion of cytomegalovirus retinitis. The patient's ocular history was remarkable for a similar episode in the left eye thirty years earlier, resulting in important visual impairment. System and laboratory investigations were unremarkable. Ocular examination showed severe anterior granulomatous uveitis, vitreous haze, areas of necrosis and retinal exudates. The anterior chamber tap disclosed the presence of HSV type 2, and oral steroids and acyclovir were instituted. Two weeks after the patient had been discharged, a retinal detachment occurred in the right eye, necessitating surgical repair. The presence of HSV type 2 was confirmed in the vitreous. Visual acuity recovered completely after surgery and the patient was placed on a maintenance dose of oral acyclovir.

Conclusions

HSV type 2 is a rare cause of acute retinal necrosis in healthy patients. Bilateral involvement can occur in the fellow eye, even with a long delay. Acute retinal necrosis is a severe ocular inflammatory syndrome associated with a very poor visual outcome. It is caused by VZV, HSV type 1 and, less commonly, by HSV type 2. The disease can affect healthy patients and cause bilateral involvement in the fellow eye, even with a long delay..
Perfluorohexyloctane Endotamponade for Treatment of Persisting Macular Hole
Authors: Jonas J.B. , Jäger M.
Published: January 2018

Purpose

To report the use of perfluorohexyloctane to endotamponade a persisting macular hole.

Methods

A 62-year-old patient presented with persisting stage IV macular hole, after uncomplicated, but unsuccessful, pars plana vitrectomy with peeling of the inner limiting membrane of the retina for treatment of the disorder. A second pars plana vitrectomy was performed in combination with cataract surgery, using perfluorohexyloctane as a new heavyweight ocular endotamponading agent. No additional membrane peeling was done.

Results

Four weeks later, marked emulsification of the perfluorohexyloctane and pronounced opacification of the posterior lens capsule were observed. After removal of the perfluorohexyloctane ten weeks after instillation, the macular hole was closed, and visual acuity increased from 0.1 to 0.3. The whole retinal surface was covered with a whitish amorphous membranous layer, that could partially be sucked off. After another four weeks, the membrane had mostly disappeared, and visual acuity increased to 0.5.

Conclusions

Perfluorohexyloctane merits further evaluation for ocular endotamponade in patients with persisting macular holes. Formation of epiretinal membranes needs to be thoroughly investigated.
Factors Influencing Visual Outcome after Penetrating Keratoplasty Combined with Intraocular Lens Implantation
Authors: Jonas J.B. , Rank R.M. , Budde W.M. , Sauder G.
Published: January 2018

Purpose

To establish which factors influence visual outcome after penetrating keratoplasty combined with intraocular lens implantation.

Methods

This retrospective noncomparative clinical interventional case series study included 135 consecutive patients (mean age 70.2 ± 13.6 years) who underwent central penetrating allogenic keratoplasty combined with intraocular lens (IOL) implantation, all operated by the same surgeon. There were 79 triple procedures, 33 keratoplasties combined with an exchange of IOL, and 23 penetrating keratoplasties combined with a secondary implantation of a posterior chamber lens. Mean follow-up was 28.3 ± 18.7 months (range 3.3–112 months). Reasons for keratoplasty were herpetic or traumatic corneal scars or defects (46), Fuchs corneal endothelial dystrophy (22), pseudophakic or aphakic bullous keratopathy (49), corneal endothelial decompensation due to other reasons (15), and keratoconus (3). Main outcome measures were postoperative visual acuity and gain in visual acuity.

Results

Mean postoperative visual acuity and mean gain in visual acuity were 0.33 ± 0.21 (median 0.30) and 0.25 ± 0.20 (median 0.20), respectively. Compared with the preoperative measurements, mean visual acuity increased in 129 patients (129/135, 95.6%). Factors influencing postoperative visual outcome and gain in visual acuity were preoperative visual acuity (p<0.005), reason for keratoplasty (p<0.005), and diameter of the graft (p = 0.046). Postoperative visual outcome was independent of age, sex, right or left eye, presence of diabetes mellitus, preoperative refractive error, length of follow-up, duration of surgery, and preoperative intraocular pressure.

Conclusions

The most important factors influencing visual outcome after central penetrating allogenic keratoplasty combined with IOL surgery are preoperative visual acuity, graft size, and reason for keratoplasty. Other factors such as age, sex, diabetes mellitus, and preoperative refractive error do not substantially influence postoperative visual outcome.
The Effects of Some Antibiotics on Sheep Lens Glucose 6-Phosphate Dehydrogenase in Vitro
Authors: Beydemir Ş. , Kulaçoğlu D.N. , Çiftçi M. , Küfrevioğlu Ö.I.
Published: January 2018

Purpose

To investigate the in vitro effects of gentamicin sulfate, vancomycin hydrochloride, sodium cefazolin and ceftriaxone on glucose 6-phosphate dehydrogenase enzyme (G6PD) purified from sheep lenses.

Methods

G6PD was purified from sheep lenses with a yield of 66.8% and a specific activity of 7.8 U/mg proteins, and 10,400-fold using ammonium sulfate fractionation and 2′,5′-ADP Sepharose 4B affinity gel. The enzyme activity was determined by Beutler's method.

Results

Gentamicin sulfate and vancomycin hydrochloride strongly inhibited the enzyme in vitro. The concentrations causing 50% inhibition (IC50) were 15.34, and 8.0 mM, respectively. Conversely, cefazolin sodium strongly activated this enzyme, and ceftriaxone caused milder activation.

Conclusions

If a patient with G6PD deficiency requires gentamicin sulfate or vancomycin hydrochloride, routine ophthalmic did not inhibit this enzyme. Postmortem studies are now needed to investigate the activity of G6PD and how it is affected by these antibiotics.
Cystoid Macular Edema Associated with Latanoprost Therapy in a Pseudophakic Vitrectomized Patient after Removal of Silicone Oil Endotamponade
Authors: Jäger M. , Jonas J.B.
Published: January 2018

Purpose

To describe the occurrence of cystoid macular edema in a pseudophakic vitrectomized patient following use of latanoprost (0.005%).

Methods

A 58-year-old patient underwent routine cataract surgery with posterior chamber lens implantation complicated by rhegmatogenous retinal detachment three months later. A pars plana vitrectomy was performed with silicone oil endotamponade which was removed six months later. Five months after oil removal, the patient presented with secondary open-angle glaucoma treated with latanoprost 0.005% eye drops once daily.

Results

Two weeks after initiation of latanoprost treatment, visual acuity dropped from 0.8 to 0.3 due to cystoid macular edema confirmed by fluorescein angiography. After discontinuing latanoprost therapy and with topical corticosteroid treatment, cystoid macular edema slowly resolved, and within 6 months, visual acuity improved to 0.8.

Conclusions

Despite its marked ocular hypotensive effect, latanoprost should be carefully used in patients after uncomplicated cataract surgery if the vitreous body was removed by pars piana vitrectomy.