bluuebunny/crossref_metadata_2025 huggingface dataset:
Blood Pressure Effects on Retinal Vessel Diameter and Flicker Response: A 1.5-Year Follow-Up
Authors: Nagel E. , Vilser W. , Fink A. , Riemer T. , Lanzl I.
Published: January 2018

Purpose

The study examined the influence of individual blood pressure changes over time on retinal vessel diameter and the latter's response to flicker light.

Methods

The diameter of a retinal arterial and venous segment was measured continuously online with a Dynamic Vessel Analyzer in 20 patients twice (mean interval between examinations of 24 months). Eleven patients had no cardiovascular disease. Nine patients had arterial hypertension and were untreated at the time of the first measurement; at the time of the second measurement they were undergoing various antihypertensive therapies. Each test consisted of a 50-s baseline plus three 20-s periods of flicker stimulation followed by an 80s period of observation. During the examinations the blood pressure was measured at 1-minute intervals.

Results

In the hypertension group changes in the mean arterial blood pressure (MAP) correlated significantly with changes in the arterial baseline diameter (y=–0.1 - 0.37x, r=0.74, p(increase)<0.03). A comparison of the two measurements showed no such relationship in the group of cardiovascularly healthy subjects. The venous baseline and the arterial and venous flicker response did not change significantly in either group between the two measurements and showed no relationship to blood pressure changes.

Conclusions

In hypertensive subjects, long-term therapy-related changes in blood pressure induced a change in the arterial baseline by approximately +3.7 μm/-10 mmHg MAP. An influence of lowering MAP to the arterial flicker response could not be detected.
Sarcomatoid Carcinoma and Orbital Apex Syndrome
Authors: Sadaba L.M. , García-Layana A. , Garcia-Gomez P.J. , Salinas-Alaman A.
Published: January 2018

Purpose

To report a case of sarcomatoid carcinoma and orbital apex syndrome in a previously healthy adult.

Methods

A previously healthy 45-year-old man presented with exophthalmos of the left eye and a mass visible through his left nostril. A biopsy was performed and immunohistochemistry was used to confirm the diagnosis of the tumor. The patient was treated with chemotherapy and radiotherapy.

Results

After treatment, we observed a substantial reduction in the size of the mass, but side effects of treatment developed. The visual acuity of the left eye was no light perception. Eight months later, the patient presented with bone and liver metastases, and he died 4 months later.

Conclusions

Sarcomatoid carcinoma is an aggressive tumor that can produce compressive symptoms with very poor visual and survival prognoses. A cranio-orbital computed tomography scan should be performed when patients present with symptoms of conjunctivitis and orbital apex syndrome.
Late Leakage of Filtering Bleb in a Patient with Orbital Pseudotumor
Authors: Luk F.O.J. , Leung D.Y.L. , Yuen H.K.L. , Lam D.S.C.
Published: January 2018

Purpose

To report an unusual case of spontaneous late leakage of filtering bleb in a patient with orbital pseudotumor.

Methods

Single case report.

Results

A 53-year-old woman developed spontaneous leakage of bleb in her right eye 23 years after trabeculectomy with application of mitomycin-C (MMC). Two weeks later, her symptoms were blurring of vision, increasing redness, and dull ocular pain in the right eye. The inflammatory signs were suggestive of endophthalmitis, orbital cellulites, or pseudotumor. Absence of ophthalmoplegia, fever, and raised white cell count, together with the computed tomographic scan finding, confirmed the diagnosis of orbital pseudotumor. She responded well to oral steroids.

Conclusions

Orbital pseudotumor may initially present with spontaneous late leakage in a bleb augmented by MMC. Orbital pseudotumor should be added to the list of differential diagnoses when facing a patient with an inflamed, chemotic, proptotic eye in the presence of a late bleb leak.
Allergic Contact Dermatitis Caused by Latanoprost Ophthalmic Solution
Authors: Lai C.-H. , Lai I.-C. , Chi C.-C.
Published: January 2018

Purpose

Latanoprost is a prostaglandin F2α analog that lowers intraocular pressure by increasing uveoscleral outflow. Herein we describe two cases of allergic contact dermatitis (ACD) to latanoprost.

Methods

A 69-year-old man with open-angle glaucoma developed erythematous erosive swelling of bilateral eyelids after 4 months of latanoprost therapy. An 84-year-old man with open-angle glaucoma had pruritic erythematous plaques on the bilateral lower eyelids after latanoprost therapy for 4 months.

Results

In both cases, latanoprost was discontinued and the condition gradually resolved in 1 month. The eyelid lesions recurred in days upon latanoprost rechallenge, but subsided after cessation of rechallenge.

Conclusions

ACD should be suspected if patients on latanoprost therapy have pruritus, erythema, swelling, or erosions on the eyelids even when the symptoms appear after several months of therapy, especially in the elderly.
Anterior Movement of the Crystalline Lens in the Process of Accommodation in Children
Authors: Kaluzny B.J.
Published: January 2018

Purpose

To investigate changes of crystalline lens position during accommodation in children with emmetropia, myopia, and hyperopia.

Methods

A total of 188 children (372 eyes) from 4 to 19 years old (mean age 11.3±4.43) with cycloplegic refractive error within a range +9.00 D to −9.00 D were enrolled. After a general ophthalmic examination, ultrasound biometry was performed, with the eye at a maximal accommodative effort. Cycloplegia was induced by triple installation of 1% tropicamide drops and 30 minutes later the biometric examination was repeated.

Results

In emmetropic eyes in the process of accommodation, the anterior pole of the crystalline lens moved forward by 0.144±0.14 mm (p ≤ 0.001); the position of the posterior pole did not change. In myopic eyes, the anterior pole moved forward by 0.071±0.13 mm (p≤0.001) and the posterior pole moved backward by 0.039±0.10 mm (p=0.003). In hyperopic eyes, the whole lens translocated anteriorly: anterior pole moved forward by 0.242±0.16 mm (p≤ 0.001) and posterior pole moved forward by 0.036±0.09 mm (p≤0.001). Differences among emmetropia, myopia, and hyperopia were statistically significant. Forward movement of the posterior pole correlated with a low axial length of the eye, and also with plus refractive error and with a smaller accommodative increase of lens thickness.

Conclusions

In children, accommodative changes of the crystalline lens position depend on refractive status.
Comparison of Sulcus Implantation of Single-Piece Hydrophilic Foldable Acrylic and Polymethylmethacrylate Intraocular Lenses in Eyes with Posterior Capsule Tear during Phacoemulsification Surgery
Authors: Taskapili M. , Gulkilik G. , Kocabora M.S. , Ozsutcu M. , Yilmazli C. , Kaya G. , Kucuksahin H.
Published: January 2018

Purpose

To compare the results of sulcus implantation of acrylic and poly(methylmethacrylate) (PMMA) intraocular lens (IOL) in eyes with posterior capsule tear during phacoemulsification surgery.

Methods

In all eyes a posterior capsule tear developed during phacoemulsification surgery and an IOL to the ciliary sulcus was implanted primarily. A total of 89 eyes of 88 patients received hydrophilic foldable acrylic IOL (acrylic group). A total of 72 eyes of 72 patients received PMMA IOL (PMMA group). The mean age was 67.1 years and 68.1 years and postoperative follow-up period was 19.2 months and 17.9 months in acrylic and PMMA groups, respectively.

Results

Temporary corneal edema appeared in 33 eyes and 26 eyes, elevation of intraocular pressure in 17 eyes and 12 eyes, anterior chamber inflammatory reaction in 5 eyes and 5 eyes, clinical cystoid macular edema in 7 eyes and 12 eyes, and decentered IOL in 4 eyes and 3 eyes in acrylic and PMMA groups, respectively. Late postoperative endophthalmitis developed in two eyes of the PMMA group. Rhegmatogenous retinal detachment developed in one eye in each group. Final best-corrected visual acuities were 5/10 and above in 73 eyes (82.02%) in the acrylic group and 5/10 and above in 42 eyes (58.33%) in the PMMA group. Postoperative final induced astigmatism was 0.5±0.5 D (SD) in the acrylic group and 1.11±0.65 D (SD) in the PMMA group (p=0.0001) (independent samples t-test).

Conclusions

Increased astigmatism is more frequently seen in the PMMA group. The implantation of foldable acrylic IOL in the sulcus after posterior capsule tear maintains the advantages of small incision surgery.
Intravitreal Bevacizumab (Avastin) as Primary Treatment for Myopic Choroidal Neovascularization
Authors: Mandal S. , Venkatesh P. , Sampangi R. , Garg S.
Published: January 2018

Purpose

To evaluate the short-term efficacy and safety of intravitreal bevacizumab in myopic choroidal neovascularization (mCNV).

Methods

In this noncomparative, consecutive, interventional case series, 12 eyes of 11 patients with mCNV without any previous treatment were included. Patients received intravitreal bevacizumab (1.25 mg/0.05 mL) at baseline and at 4 weeks interval, if optical coherence tomography (OCT) showed presence of intraretinal edema, subretinal fluid, and/or pigment epithelial detachment. Patients were followed up for a minimum of 6 months and changes in best-corrected visual acuity, central macular thickness (CMT) on OCT, angiographic characteristics, and complications were assessed.

Results

The mean refractive error was −11.25 diopters. At 6 months the mean best-corrected visual acuity (BCVA) improved from 20/235 (median 20/235) to 20/71 (median 20/80) (p=0.01). The mean CMT was reduced from 403 μm (median 365 μm) to 229 μm (median 239 μm) (p=0.002). At final visit 9 eyes (75%) had an improvement of BCVA of three lines or more, and only 1 eye (8%) lost two lines. No significant ocular or untoward systemic side effects were observed.

Conclusions

In this small series short-term results suggest that intravitreal bevacizumab (1.25 mg/0.05 mL) is safe, effective, and well tolerated in patients with choroidal neovascularization due to high myopia. Further evaluation in large series with longer follow-up is needed to confirm long-term efficacy and safety in such cases.
Ophthalmologic Findings in Infants after an Apparent Life-Threatening Event
Authors: Altman R.L. , Forman S. , Brand D.A.
Published: January 2018

Purpose

An apparent life-threatening event (ALTE) refers to the sudden occurrence in an infant of a breathing abnormality, color change, or alteration in muscle tone or mental status. The finding of retinal hemorrhage in an infant who has experienced an ALTE strongly suggests the possibility of shaken baby syndrome. Previous ALTE studies have reported the frequency of this specific ocular abnormality but have not reported other ocular findings and their possible diagnostic significance.

Methods

This study reviews ophthalmologic findings from a series of 120 patients with ALTE who underwent eye examinations as part of their inpatient evaluation. Details of the history, physical examination, diagnostic testing, and discharge diagnosis were abstracted from the medical record while the patient was in the hospital.

Results

Ten patients (8.3%) had positive findings, including retinal hemorrhages in four of the six patients with shaken baby syndrome, the only ophthalmologic finding that helped establish the cause of an ALTE.

Conclusions

Since the funduscopic examination can help identify child abuse as the cause of an apparent life-threatening event, ophthalmologists play a critical role in the early evaluation of infants who have experienced such an event.
Comparison of BD Multivisc™ with the Soft Shell Technique in Cases with Hard Lens Nucleus and Fuchs Endothelial Dystrophy
Authors: Fasce F. , Spinelli A. , Bolognesi G. , Rossi M. , Gemma M.
Published: January 2018

Purpose

To compare the efficacy of 2.5% sodium hyaluronate (BD Multivisc™) with the soft shell technique in reducing corneal endothelial cell damage during cataract phacoemulsification in patients with hard lens nucleus (3+) and cornea guttata.

Methods

Thirty patients (37 eyes) scheduled for cataract surgery at Department of Ophthalmology and Visual Sciences, University Hospital San Raffaele, Milano, Italy. Thirty-seven eyes (randomly divided into Groups A and B) with hard lens nucleus (grade 3 or higher) and cornea guttata had phacoemulsification using the soft shell technique (Group A) with Biolon® (sodium hyaluronate 1%) and Viscoat® (sodium hyaluronate 3%-chondroitin sulfate 4%) or with BD Multivisc™ alone (Group B). Patients were evaluated preoperatively and after 1, 15, 90, and 180 days, checked for best-corrected visual acuity (BCVA), intraocular pressure (IOP), central corneal thickness, and corneal endothelial density. Stop and chop phacoemulsification technique, with burst mode (Alcon Legacy 20000, Advantec), was performed.

Results

There were no significant differences between the two groups at 3 and 6 months in BCVA, IOP, corneal thickness, or endothelial cell density. The increase of central corneal thickness (preoperative: Group A 584±30 μm, Group B 573±30 μm; postoperative at 90 days: Group A 593±38 μm, Group B 577±25 μm) was not significant. Endothelial cell loss was similar in both groups.

Conclusions

The results suggest that the soft shell technique (Biolon®, Viscoat®) and 2.5% sodium hyaluronate (BD Multivisc™) are both effective in protecting the corneal endothelium in Fuchs dystrophy during phacoemulsification in patients with hard lens nucleus.
One-Year Results of Photodynamic Therapy for Small Predominantly Classic Choroidal Neovascular Membranes Secondary to Age-Related Macular Degeneration
Authors: Doyle E. , Khanwala M. , Shah S.P. , Ong D.G. , Casswell A.G.
Published: January 2018

Purpose

To determine the visual and angiographic outcomes of patients with small predominantly classic choroidal neovascular membranes (CNV) undergoing photodynamic therapy (PDT).

Methods

The subjects were a cohort of patients with age-related predominantly classic CNV with lesion size of greatest linear diameter of 2000 μm or less treated with PDT Lesion size and visual acuity were recorded at baseline and at 3-month intervals. Visual treatment failure was defined as either loss of at least 15 letters or visual acuity less than 35 letters on a modified Early Treatment Diabetic Retinopathy Study chart. Lesion treatment failure was defined as increase in greatest linear diameter (GLD) of at least 500 μm.

Results

Twenty-five eyes of 25 patients were included. Visual treatment failure occurred in 16 and mean visual acuity dropped from 58 letters to 34 letters (p<0.0001). In 11 of these patients this occurred within the first 3 months. Lesion treatment failure occurred in 18 patients. Mean GLD increased from 1331 to 2935 μm (p<0.0001). Early growth of the lesion was associated with poor visual outcome with growth in GLD in the first 3 months of 310 μm in patients without eventual visual treatment failure and 1131 μm in patients with eventual visual failure (p=0.027).

Conclusions

Small predominantly classic lesions commonly cause visual deterioration if treated with PDT alone. In the first year over 50% may lose at least 15 letters or drop below 35 letters, with most visual loss occurring in the first 3 months. Visual loss is associated with early lesion growth.
Depth of Focus: Clinical Manifestation
Authors: Sergienko N.M. , Tutchenko N.N
Published: January 2018

Purpose

To assess depth of focus on the basis of measurements of the point spread function, which involve Stiles and Crawford phenomenon.

Setting

Department of Ophthalmology of National Academy of Postgraduate Education.

Methods

Gullstrand's schematic eye parameters and data of subjective measurement of size of diffusion circles were used for calculation of depth of focus. Data of 1171 eyes with visual acuity 1.0–2.0 were included in the study.

Results

Under condition of visual acuity 1.5 data of the depth of focus were 0.38 D, 0.64 D, and 1.92 D for pupil diameter 5.0 mm, 3.0 mm, and 1.0 mm, respectively. Visual acuity 1.0 is characterized by larger value and visual acuity 2.0 by lesser value of the depth of focus.

Conclusions

Depth of focus and normal levels of visual acuity have a close relation: the higher the visual acuity, the smaller the depth of focus.
Release Hallucinations and Visual Loss as First Manifestations of Postoperative Unilateral Blindness
Authors: Montero J.A. , Ruiz-Moreno J.M. , Galindo A. , Fernandez-Muñoz M.
Published: January 2018

Purpose

Release hallucinations (RH) with insight into the unreality of the hallucination have been reported in association with severe vision loss. Postoperative blindness following nonocular surgery may appear associated with central retinal artery occlusion (CRAO) caused by incorrect head positioning during surgery, intraoperative hypotension, and atherosclerosis. RH may initially mask the loss of vision.

Methods

Case report.

Results

A 27-year-old woman who had undergone lumbar spinal surgery for right L4-L5 discal herniation developed left eye visual loss and complex visual hallucinations immediately after surgery. Her symptoms were initially considered hallucinations related to the anesthesia and not taken into consideration until 4 days later. Ophthalmic examination disclosed CRAO probably caused by ocular compression during surgery. Optic nerve atrophy appeared during the following 6 years.

Conclusions

Doctors and auxiliary personnel should be aware that visual hallucinations may be a sign of actual vision damage.
Simultaneous Bilateral Retinal Detachment following Coronary Artery Bypass Graft: Case Report
Authors: Ceruti P. , Tosi R. , Marchini G.
Published: January 2018

Purpose

To present an unusual case of simultaneous bilateral retinal detachment (RD) following a coronary artery bypass graft in a patient with acute myocardial infarction (AMI).

Methods

A 78-year-old man was first seen for bilateral sudden visual loss after surgical treatment of AMI. The patient underwent ultrasound biomicroscopy (UBM) and ocular B-scan echographic examination.

Results

The ocular assessment showed a bilateral seclusion of the pupil with bombé of the iris, an anterior chamber without cells or flare, and hypotonia. The evaluation of the visual acuity revealed no light perception in the right eye (RE) and uncertain light perception in the left eye (LE). The UBM analysis of the anterior segment confirmed the presence of bilateral pupillary block due to the seclusion of the pupil and a peripheral serous choroidal detachment involving the RE. The echographic B-scan analysis of the posterior segment showed a bilateral closed funnel-shaped RD and confirmed the presence of the peripheral flat serous choroidal detachment in RE.

Conclusions

The cause for simultaneous bilateral RD remained unclear. It may have been a consequence of a persistent choroidal detachment with multiple swelling and “kissing” of retinal surface. The increased venous pressure caused by congestive heart failure due to AMI could have caused a bilateral uveal effusion. Alternatively, the absence of retinal tears, the presence of a closed funnel-shaped morphology, and seclusion of the pupils allowed us to suspect an exudative pathogenetic mechanism due to a previous unrecognized ocular inflammatory state.
Cyclooxygenase-2 Expression in Primary and Recurrent Pterygium
Authors: Adiguzel U. , Karabacak T. , Sari A. , Oz O. , Cinel L.
Published: January 2018

Purpose

Pterygium is a proliferative, inflammatory, and invasive ocular surface disease associated with excessive ultraviolet radiation exposure and has several tumor-like characteristics. Cyclooxygenase-2 (COX-2) is an inducible enzyme and recently increased expression of the enzyme was found in many cancers and premalign lesions. This study was conducted to identify the COX-2 expression in pterygium tissues.

Methods

Immunohistochemical staining using a primary antibody for COX-2 was performed on 30 specimens with primary pterygium (20 pterygium without recurrence and 10 pterygium which recurred during a 12-month follow-up), 11 specimens with recurrent pterygium, and 8 specimens of conjunctival tumor. As a control we used 10 specimens of normal conjunctiva. Extent and intensity of cytoplasmic and membranous staining in epithelial cells were evaluated.

Results

Higher expression of COX-2 was detected in conjunctival tumor (87.5%) specimens and recurrent pterygium specimens (72.7%) compared to the both normal conjunctiva (30%) and primary pterygium without recurrence (30%). COX-2 expression in primary pterygium tissues with recurrence (60%) was not different from primary pterygium without recurrence (p=0.114) and recurrent pterygium (p=0.537). However, recurrent pterygium tissues were found to express higher COX-2 than primary pterygium without recurrence (p=0.022).

Conclusions

COX-2 expression is increased in recurrent pterygium tissues and COX-2 expression may be a marker for the prediction of recurrence.
Prevalence of Diplopia Related to Cataract Surgery among Cases of Diplopia
Authors: Karagiannis D. , Chatzistefanou K. , Damanakis A.
Published: January 2018

Purpose

To evaluate the prevalence of diplopia in Greece after cataract surgery among diplopia cases.

Methods

The authors retrospectively reviewed the medical records of 571 patients with diplopia over an 8-year period in order to evaluate the prevalence of diplopia related to cataract surgery. The surgical and anesthetic records were also reviewed. All patients had full orthoptic assessment including prisms with cover test in all gaze positions. The chi-square and cross-tabulation statistical tests were used for statistical analysis.

Results

Thirty-nine cases (6.8%) were having persistent diplopia related to cataract surgery. Type of anesthesia was peribulbar. Hyaluronidase was not used. Thirteen patients were men and 26 were women. Left eyes were involved in 22 cases (56.4%), right in 17 cases (43.6%). Mean age was 72.5 years. Patients were divided into four groups. Group 1 consisted of 29 patients related to surgical trauma due to anesthesia. Group 2 consisted of 7 patients related to pre-existing disorders. Group 3 consisted of 2 patients related to aniseikonia or anisometropia. Group 4 with 1 patient related to macular pathology. Vertical diplopia was mostly noted (28 cases). Twenty-nine patients were corrected with prisms, 9 needed strabismus surgery, and 1 needed both surgery and prisms.

Conclusions

Cataract surgery is not a common cause of persistent diplopia. However, this report highlights that prevalence of diplopia related to cataract is high among cases of diplopia in general, with diplopia being mostly vertical (p=0.001), affecting females (p=0.006), and being more common in left eyes, although results did not reach statistical significance (p=0.133).
The Effect of Complement Factor H Y402H Polymorphism on the Outcome of Photodynamic Therapy in Age-related Macular Degeneration
Authors: Seitsonen S.P. , Järvelä I.E. , Meri S. , Tommila P.V. , Ranta P.H. , Immonen I.J.
Published: January 2018

Purpose

Photodynamic therapy (PDT) has been widely used in the treatment of age-related macular degeneration (AMD). The complement cascade has an important role in the tissue reactions occurring after PDT. The Y402H polymorphism of the complement factor H (CFH) gene has been identified as a risk factor for AMD. Since CFH is central in the regulation of the complement system the authors wanted to analyze whether the CFH Y402H polymorphism modifies the PDT outcome in AMD.

Methods

A total of 88 patients having been treated with PDT and without further scheduled PDT sessions were analyzed. Depending on the situation at their final PDT session the patients were classified retrospectively as PDT-responders or PDT-nonresponders. All patients were genotyped for the CFH Y402H polymorphism.

Results

The proportion of PDT-responders was 18/26 (69.2%) in patients homozygous for the CFH Y402H risk allele, 34/50 (68.0%) in heterozygous, and 7/12 (58.3%) in patients with the normal genotype (p=0.520). The median number of PDT treatments of the PDT-responders was three for all the genotypes.

Conclusions

The dysfunction of the CFH related to the risk of AMD and caused by the Y402H polymorphism does not modify the outcome of PDT. Genotyping for CFH Y402H cannot be used to select patients for this treatment.
Phenotypic Intrafamilial Variability Associated with S212G Mutation in the RDS/Peripherin Gene
Authors: Passerini I. , Sodi A. , Giambene B. , Menchini U. , Torricelli F.
Published: January 2018

Purpose

To describe an Italian family in which two separate phenotypes (retinitis pigmentosa and adult onset vitelliform macular dystrophy) are associated with an identical mutation (S212G) in the peripherin/RDS gene. This mutation has already been reported in patients with retinitis pigmentosa, but it has never been previously detected in association with adult onset vitelliform macular dystrophy.

Methods

A 38-year-old woman complained of bilateral mild metamorphopsias and on ophthalmologic examination she showed the clinical phenotype of adult onset vitelliform macular dystrophy. Her 62-year-old mother was clinically diagnosed with a retinitis pigmentosa, with a severe clinical course.

Results

In both patients, molecular genetic analysis revealed a 874A→G transition in the exon 2 of the RDS gene leading to the amino acid change of S212G.

Conclusions

Peripherin/RDS S212G mutation may have damaging effects on the formation and stability of the photoreceptors' disk structure and may be associated with different clinical phenotypes, even in the same family. Intrafamilial phenotypic variability has been reported for other RDS mutations; this supports the possible influence of modifier genes or environmental factors in the clinical expression of RDS gene variants. Moreover, it suggests that in patients with retinal degeneration and peripherin/RDS mutation, caution should be taken both in using molecular genetic results to predict the clinical course of the disease and in offering genetic counseling.
Minimally Invasive Pterygium Surgery: A New Approach for Prevention of Recurrence
Authors: Bozkir N. , Yilmaz S. , Maden A.
Published: January 2018

Purpose

To introduce a novel approach for pterygium excision, to report recurrence rates, and to compare with conjunctival autografting. DESIGN. A comparative, prospective clinical case series design was used.

Methods

The study population consisted of 155 patients with unilateral primary or recurrent pterygia. All patients underwent pterygium excision, either by conventional conjunctival autografting (Group A) or by the minimally invasive pterygium excision (MIPE) technique (Group B). The new technique involves making a limbal incision of the conjunctiva through the body of pterygium, removing the head of the pterygium by blunt dissection, keeping the adjacent Tenon capsule intact, and performing a small conjunctival autograft to cover the epithelial defect. The recurrence rate of each technique was compared statistically.

Results

There were 84 patients in Group A and 71 patients in Group B. The recurrence rates were 18% at 1 year after surgery in the conjunctival autografting technique and 4.2% in the MIPE technique. The MIPE technique had significantly lower recurrence rates compared with conjunctival autografting technique (p<0.0001).

Conclusions

The MIPE technique had lower recurrence rate and fewer postoperative complications than the conjunctival autografting technique. Preserving the Tenon capsule and minimizing conjunctival excision in pterygium surgery does not appear to increase the recurrence rate in the 1-year period. However, the effectiveness of this technique in preventing recurrences needs to be proven with more than 1-year results, which we plan to report in the future.
Early and Late Endophthalmitis following Trabeculectomy in a Chinese Population
Authors: Kuang T.-M. , Lin Y.-C. , Jui-Ling Liu C. , Hsu W.-M. , Chou C.-K.
Published: January 2018

Purpose

To investigate the rate of bleb-related endophthalmitis over 5 years in a Chinese population.

Methods

Retrospective chart review.

Results

Of 988 trabeculectomies performed over 5 years, one case (0.1%) developed early endophthalmitis caused by Morganella morganii, which was rarely reported in the literature. Six cases (0.6%) developed late-onset endophthalmitis. Mitomycin C significantly increased the risk of late-onset endophthalmitis (p=0.0002).

Conclusions

Physicians should weigh the benefits against the risks of mitomycin C application in performing trabeculectomies.
Combined Treatment with Laser Photocoagulation and Cryotherapy for Threshold Retinopathy of Prematurity
Authors: Autrata R. , Šenková K. , Holoušová M. , Helmanová I. , Pyrochtová S.
Published: January 2018

Purpose

To report the structural, functional, and refractive outcome, safety, and effectiveness of combined cryotherapy and diode laser indirect photocoagulation in the treatment of threshold retinopathy of prematurity (ROP).

Methods

Medical records of patients developing threshold ROP between 1995 and 2003 were reviewed to identify those with combined treatment and followed up for at least 4 years postoperatively. A total of 94 patients (172 eyes) received combined treatment. Data consisted of grade of ROP pre- and postoperatively, most recent fundus examination, birthweight, visual acuity, complications, and refraction. Diode laser was used to ablate posterior avascular retina, and cryotherapy was used for anterior retina.

Results

A total of 149 (87%) eyes responded to combined treatment and they had favorable anatomic outcome at last examination. In 131 eyes (76%), functional outcome was favorable (visual acuity better than 20/200) at last examination. Perioperative complications included hemorrhages in 26% of eyes, which resorbed spontaneously. Mean duration of treatment was 31 minutes/eye. At final visit (4 to 12 years), 115 eyes (66.8%) refracted were myopic, of which 26 (22.5%) had high myopia over −6 diopters.

Conclusions

Combined cryotherapy and diode laser photocoagulation for ROP in our patients resulted in regression of threshold ROP with relatively successful structural and functional outcomes. Combined therapy may be faster and useful for eyes with very posterior ROP. This may decrease the number of complications occurring when excessive cryotherapy or laser photoablation must be used in zone 1 ROP.
Surgical Management of Optic Disc Pit Associated Maculopathy
Authors: Ghosh Y.K. , Banerjee S. , Konstantinidis A. , Athanasiadis I. , Kirkby G.R. , Tyagi A.K.
Published: January 2018

Purpose

To report the surgical outcome in seven cases of optic disc pit associated maculopathy.

Methods

This was a retrospective case-note analysis of presenting features, pre- and postoperative visual acuities, surgical procedures, complications, and follow-up. The principal treatment in all the cases was pars plana vitrectomy, posterior hyaloid peel, endolaser to the papillomacular bundle temporal to the disc, and internal tamponade with gas or silicone oil.

Results

Of the four male and three female patients, two were children. All the patients had posterior hyaloid peeling during the vitrectomy and endolaser. Six patients had intraocular gas tamponade and one had silicone oil. Four patients needed a second surgical procedure to obtain a satisfactory anatomic and visual outcome. Postoperatively, four patients had an improvement of 2 or more Snellen lines. One patient with a history of multiple surgeries developed high intraocular pressure postoperatively and cataract. The mean follow-up period was 9.1 months.

Conclusions

Serous retinopathy associated with optic disc pit responds well to early vitrectomy, endolaser, and internal tamponade. Silicone oil was effective in one refractory case. Cumulative data are required to define the management of this condition.
Optical Coherence Tomography Findings of Incomplete Posterior Vitreoschisis with Vitreomacular Traction Syndrome and Impending Macular Hole: A Case Report
Authors: Figus M. , Carpineto P. , Romagnoli M. , Ferretti C. , Di Antonio L. , Nardi M.
Published: January 2018

Purpose

Vitreomacular traction syndrome is a clinical entity characterized by partial posterior vitreous detachment in combination with persistent macular adherence. Recently, optical coherence tomography (OCT) allowed visualization of incomplete posterior vitreoschisis leading to vitreomacular traction.

Methods

The authors report on a 57-year-old woman with blurred vision in her left eye.

Results

OCT scan showed incomplete posterior vitreoschisis with vitreomacular traction syndrome and impending macular hole in her left eye.

Conclusions

The intraoperative findings together with the evidence that the internal limiting membrane (ILM) thickness is thinner than the axial resolution of the Stratus OCT (8 μm) and a spontaneous ILM detachment has never been demonstrated are likely to support the hypothesis that posterior vitreoschisis exists and can be associated with vitreomacular traction syndrome.
Suprasellar Germinoma and Late Perioptic Seeding
Authors: Pereira L.S. , Green A.J. , Hwang T.N. , McCulley T.J.
Published: January 2018

Purpose

To report an unusual case of optic nerve seeding 12 years following treatment of a suprasellar germinoma.

Methods

Observational case report.

Results

A 34-year-old woman presented with a 3-week history of subjective right eye visual loss. She had been diagnosed with a suprasellar germinoma at 22 years of age, which had been partially excised and radiated (5400 cGy). The tumor had shown complete radiographic regression without neurologic sequelae. Pertinent findings on current examination included right eye visual acuity of 20/150, right relative afferent papillary defect, and optic nerve pallor in the right eye. In addition, partial left facial paralysis was noted. Examination was otherwise unremarkable including 20/20 acuity in the left eye. Magnetic resonance imaging demonstrated abnormal enhancement and thickening of both optic nerves and along the course of the left V and VII cranial nerves. Serum levels of α-fetoprotein and β-HCG were abnormal, consistent with metastatic germinoma. Following two cycles of chemotherapy (VIP–etoposide, ifosfamide, and cisplatin), visual acuity returned to 20/20 bilaterally, with corresponding radiographic improvement and normal cerebrospinal fluid cytology.

Conclusions

Perioptic subarachnoid seeding may occur over a decade after presumed successful treatment of germinomas, suggesting the importance of lifelong observation.
Evaluation of Threshold Estimation and Learning Effect of two Perimetric Strategies, Sita Fast and Clip, in Damaged Visual Fields
Authors: Capris P. , Autuori S. , Capris E. , Papadia M.
Published: January 2018

Purpose

The threshold estimation, learning effect, and between-algorithm differences of the Fast Swedish Interactive Thresholding Algorithm (SITA Fast), of the Humphrey Field Analyzer (HFA), and the Continuous Light Increment Perimetry (CLIP) strategy of the Oculus Twinfield perimeter were evaluated in damaged visual fields.

Methods

Twenty-one glaucomatous patients with damaged visual fields (MD worse than −8 dB) underwent Oculus Full Threshold (FT), Humphrey FT, SITA Fast, and CLIP 30–2 perimetric examinations. All the tests were repeated in a second session at least 3 days later. The point-wise differences in absolute sensitivity and of the total deviation plot values between FT and fast algorithms, between fast algorithms and the learning effect were evaluated (Wilcoxon test and Bland-Altman analysis).

Results

The average point-wise sensitivity difference between SITA Fast and HFA FT strategy (0.84 dB) was significantly lower than that found between CLIP and Oculus FT strategy (1.71 dB). Between-algorithm point-wise differences of the total deviation plot values of the fast strategies were not significantly different. Learning effect for SITA Fast (0.67 dB) was higher than that found for CLIP (0.39 dB). Test time for SITA (367±71 sec) and CLIP (453±98 sec) were about 55% and 35%, respectively, shorter (pp<0.001) than those found with FT algorithms. The acceptance for fast algorithms and particularly for CLIP was significantly better.

Conclusions

The two fast strategies, even though using very different algorithms, showed good threshold estimation compared to FT strategies with a consistent time saving in damaged visual fields.
Combined Phacoemulsification and Ahmed Valve Glaucoma Drainage Implant: A Retrospective Case Series
Authors: Nassiri N. , Nassiri N. , Yarandi S. Sadeghi , Mohammadi B. , Rahmani L.
Published: January 2018

Purpose

To report on the efficacy and safety of combined phacoemulsification and an Ahmed valve glaucoma drainage implant with respect to visual acuity improvement, intraocular pressure (IOP) control, and requirement for antiglaucoma medication.

Methods

A retrospective chart review was conducted of 41 eyes (31 patients) with coexisting visually significant cataracts and uncontrolled glaucoma who had combined phacoemulsification and Ahmed valve implantation. The outcome measures were: visual acuity, IOP, antiglaucoma medication requirements, and intra- and post-operative complications. Success was categorized as absolute (IOPp<21 mmHg without the need for antiglaucoma medication) and relative (IOPp<21 mmHg with one or more antiglaucoma medications). Failure was considered to be an IOPp<6 mmHg or IOP>21 mmHg on maximally tolerated medications or any devastating complication.

Results

The mean patient age was 67.3±5.9 years old. The mean visual acuity improved from 0.73±0.5 to 0.16±0.16 (p=0.000). The mean IOP decreased from 28.2±3.1 to 16.8±2.1 (p=0.000, 40.4%), while the number of antiglaucoma medication decreased from 2.6±0.66 to 1.2±1.4 (p=0.000). The absolute and relative success rates were 56.1% and 31.7%, respectively; 5 eyes (12.2%) were considered failures. There were no intraoperative complications; postoperative complications occurred in 8 eyes (19.5%). A hypertensive phase was detected in 12 (29.3%) eyes.

Conclusions

Combined phacoemulsification and Ahmed valve glaucoma drainage implantation is a safe and effective alternative to phacotrabeculectomy in patients with coexisting cataract and refractory glaucoma.
Retinal Photocoagulation for Proliferative Sickle Cell Retinopathy: A Prospective Clinical Trial with New Sea Fan Classification
Authors: Sayag D. , Binaghi M. , Souied E.H. , Querques G. , Galacteros F. , Coscas G. , Soubrane G.
Published: January 2018

Purpose

To compare the clinical outcome of stage III proliferative sickle cell retinopathy (PSR) treated by peripheral retinal scatter photocoagulation to natural course disease.

Methods

Long-term follow-up of 101 patients enrolled in a prospective trial of photocoagulation for PSR has been completed. Among 202 eyes of 101 patients enrolled at the University Eye Clinic of Créteil, 73 eyes showed a stage III PSR, which the authors further divided into five new grades (A, B, C, D, E) considering size, hemorrhage, fibrosis, and visible vessels. Grading was based on a three-mirror fundus examination, 360° color photographs, and fluorescein angiography. Mean follow-up was 4 years.

Results

Thirty-eight treated eyes and 35 untreated eyes were included in this study. The evolution was not statistically significant between treated and untreated groups concerning flat sea fan p<1 MPS disc area (grade A) or elevated sea fan with partial fibrosis (grade C). Progression and regression were compared between the two groups for grade B, resulting statistically significant (pp<0.05). Nine complications (13%) were observed, which only occurred in untreated patients with elevated sea fan and hemorrhage (grade B) or complete fibrosed sea fan with well defined vessels (grade E) (pp<0.05).

Conclusions

These data suggest that patients with grade A or C new sea fan classification should not be initially treated but observed.
Congenital Ocular Motor Apraxia
Authors: Gonçalves Carrasquinho S. , Teixeira S. , Cadete A. , Bernardo M. , Pêgo P. , Prieto I.
Published: January 2018

Purpose

Congenital ocular motor apraxia is a rare disease characterized by defective or absent voluntary and optically induced horizontal saccadic movements. Jerky head movements or thrusts on attempted lateral gaze are a compensatory sign. Most affected children have delayed motor and speech development. Cases associated with systemic diseases, neurologic maldevelopment, metabolic deficits, and chromosomal abnormalities have been described.

Methods

Case report and review of the scientific literature.

Results

The authors describe the ophthalmologic, pediatric, and neurologic evaluations and follow-up of a child with impaired horizontal saccades, jerky head movements, and delayed motor and speech development.

Conclusions

Congenital ocular motor apraxia is an uncommon disorder of ocular motility. Even so, ophthalmologists should be aware of the developmental delay and the other associated conditions, in order to grant the patients the multidisciplinary assistance they often require.
Hepatitis C Virus Presumably Associated Bilateral Consecutive Anterior Ischemic Optic Neuropathy
Authors: Fodor M. , Nagy V. , Berta A. , Tornai I. , Pfliegler G.
Published: January 2018

Purpose

To report a case of bilateral nonarteritic anterior ischemic optic neuropathy (NAION) in a hepatitis C (HCV) infected patient and demonstrate the relationship between HCV and the development of NAION.

Methods

Case report.

Results

A 43-year-old woman with chronic HCV infection and long-term euthyroid autoimmune thyroiditis suddenly lost vision in her right eye, and 6 months later in her left eye, due to NAION. Slightly elevated levels of aminotransferases suggested liver infection activity. Anti-HCV antibody was detected; the genotype of the virus was 1b and the viral RNA level was 1.8 × 106 IU/mL. Liver biopsy proved chronic active hepatitis (Ishak score grading: 7, staging: 2). Except for the elevated levels of antithyroid antibodies and a weak antinuclear factor, the detailed laboratory examinations (thrombophilia, cryoglobulin, anticardiolipin antibodies, co-infections) revealed no other abnormalities; a causative relationship between the underlying chronic hepatitis C and bilateral NAION therefore seems probable. The patient was treated with pegylated interferon and ribavirin for 1 year and a sustained viral remission could be achieved. Her vision has neither improved nor deteriorated further.

Conclusions

This appears to be the first reported case of bilateral NAION presumably caused by HCV infection.
Optociliary Shunt Vessels in Compressive Optic Neuropathy by the Intracranial Internal Carotid Artery
Authors: Rebolleda G. , Corcóstegui J. , Arruabarrena C. , Martínez San Millán J. , Muñoz-Negrete F.J.
Published: January 2018

Purpose

To report a clinical case of optic nerve compression by supraclinoidal internal carotid artery associated with optociliary shunt vessels.

Methods

A 78-year-old woman with the clinical triad of left visual loss, ipsilateral optic disc pallor, and retinochoroidal (optociliary) shunt vessels is reported. She complained of loss of vision in the left eye of 2 years' duration.

Results

A diffuse depression of the visual field was found in the affected eye. Magnetic resonance imaging revealed left optic nerve compression by the supraclinoidal internal carotid artery.

Conclusions

The occurrence of optociliary shunt vessels, visual loss, and optic atrophy is a non-specific sign of chronic optic nerve compression and in some instances may be falsely localized.
Favorable Long-Term Results of Primary Pterygium Removal by Bare Sclera Extirpation Followed by a Single 90Strontium Application
Authors: Mourits M.P. , Wyrdeman H.K. , Jürgenliemk-Schulz I.M. , Bidlot E.
Published: January 2018

Purpose

To describe and compare long-term (≥36 months) effects of patients with 86 primary pterygia treated with bare sclera extirpation (BSE) followed by β-RT or by sham irradiation.

Methods

Prospective, multicenter, randomized, double-blind study After BSE of their pterygium, patients were randomized to either β-RT or sham irradiation. In the case of β-RT, within 24 hours after the operation, a 90Sr eye applicator was used to deliver 2500 cGy to the sclera surface at a dose rate of between 200 and 250 cGy/min. Sham irradiation was given using the same type of applicator without the 90Sr layer. After treatment, both a masked ophthalmologist and a radiation oncologist performed follow-up examinations. These were continued until either a relapse occurred or at least 36 months had elapsed.

Results

Adequate follow-up was available of 86 pterygia in 81 patients, treated between February 1998 and September 2002. Fifty-two (60%) patients were male. The mean age of the patients was 50 years (range: 24–77). After a follow-up of at least 36 months (mean: 40 months, SD:13.9 months), 5 out of 44 eyes (11%) treated with β-RT showed a recurrence versus 32 out of 42 eyes (76%) treated with sham-RT (after a mean follow-up of 22 months) (p<0.001). In the β-RT group, 80% were satisfied with the cosmetic result, whereas in the sham group this percentage was 41% (p<0.001). In the β-RT group, no scar or a white scar could be detected in 86% of the treated eyes, versus in 24% of the sham irradiated eyes (p<0.001). A change of keratometry (Javal) was seen in 5 patients (12%) following β-RT compared to 16 (38%) after sham irradiation (p=0.002). Complications were few: a granuloma was seen in three patients after sham irradiation, mild limitation of abduction in two β-RT patients versus in five after sham irradiation, and mild scleromalacia in one β-RT patient.

Conclusions

Bare sclera extirpation of a pterygium without adjuvant treatment has an unacceptably high recurrence rate and therefore should be considered obsolete. Bare sclera extirpation of a primary pterygium followed by a single-dose β-RT is a simple, effective, and safe treatment with lasting results and very few complications.
Patient Comfort and Surgeon Satisfaction during Cataract Surgery Using Topical Anesthesia with or without Dexmedetomidine Sedation
Authors: Erdurmus M. , Aydin B. , Usta B. , Yağcı R. , Gozdemir M. , Totan Y
Published: January 2018

Purpose

To determine the safety and efficacy of perioperative dexmedetomidine (Dex) sedation on patient comfort and surgeon satisfaction during cataract surgery under topical anesthesia.

Methods

Forty-four patients having routine clear corneal phacoemulsification surgery under topical anesthesia were included in the study Patients were randomly divided into two groups: Dex group (n=22) and control group (n=22). Patients in the Dex group were to receive intravenous Dex using an infusion pump and those in the control group were to receive 0.9% saline infusion. Primary outcome measures were patient comfort, surgeon satisfaction, and patient pain perception.

Results

There was no significant difference between the groups in terms of baseline characteristics including age, sex, eye side, pupil diameter, and vital signs (p>0.05 for all). Patient comfort and surgeon satisfaction in Dex group was better than in control group (p=0.042 and p=0.003, respectively). The mean pain perception score was lesser in the Dex group (1.23±1.72) than control group (3.64±1.43), (p<0.001). The mean surgical time and intraoperative complications were similar in both groups (p>0.05). There was no significant effect of the Dex sedation on vital signs perioperatively (p>0.05 for all).

Conclusions

Dex sedation improved patient and surgeon satisfaction and decreased patients' pain perception while undergoing cataract surgery under topical anesthesia. It appears to be a safe and suitable choice of sedation for cataract surgery.