bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal Birthweight and Diastolic Blood Pressure: Association with Retinopathy in Severe Preeclampsia
Authors: Kaliaperumal S. , Setia S. , Gupta A. , Rao V.A.
Published: January 2018

Purpose

To find the association of retinopathy in preeclampsia with fetal birthweight and systolic and diastolic blood pressure (BP) in patients with mild and severe preeclampsia.

Methods

Medical records of patients with preeclampsia who delivered at term between January 2002 and December 2006 were included in the study Patients with preterm delivery, eclampsia, intrauterine fetal death, congenital defect in the fetus, and other systemic disorders were excluded. Parameters analyzed were retinopathy, systolic and diastolic BP, and fetal birthweight. Multivariable linear regression was used for statistical analysis. p value ≤0.05 was considered significant.

Results

The patients were divided into two groups: mild preeclampsia (MP) and severe preeclampsia (SP). The MP had 156 patients and SP had 104 patients. The mean systolic BP in MP and SP was 147.2 mmHg and 164.6 mmHg, while the mean diastolic BP in MP and SP was 98.6 mmHg and 112.7 mmHg. Severity of retinopathy was inversely associated with fetal birthweight (p=0.022) in SP, while it was insignificant in the MP (p=0.082). Low birthweight was due to intrauterine growth retardation of the fetus. Diastolic BP in the SP showed significant correlation with retinopathy (p=0.041). The systolic (p=0.55) and diastolic BP (p=0.248) in MP and systolic BP (p=0.803) in SP were insignificantly correlated with the retinopathy.

Conclusions

Retinopathy in preeclampsia may indirectly indicate the level of placental insufficiency and intrauterine growth retardation. The severity of retinopathy is more closely related with diastolic BP rather than systolic BP and the significance of this correlation increases in severe preeclampsia.
Cytomegalovirus Retinitis in the Absence of HIV or Immunosuppression
Authors: Sloan D.J. , Taegtmeyer M. , Pearce I.A. , Hart I.J. , Miller A.R.O. , Beeching N.J.
Published: January 2018

Purpose

Cytomegalovirus (CMV) retinitis classically occurs in advanced human immunodeficiency virus (HIV) infection but is rare in other forms of immunosuppression. The authors report a case of CMV retinitis in an HIV-negative man with idiopathic CD4 lymphocytopenia (ICL). This is the first such case to be confirmed by polymerase chain reaction (PCR) of aqueous humor.

Methods

Case report.

Results

A 69-year-old retired Chinese seaman presented with gradual visual deterioration. He was a diet controlled diabetic on regular steroids for presumed asthma. Examination showed no diabetic eye disease but confirmed acute retinal necrosis (ARN). Anterior chamber tapping of the aqueous humor was PCR positive for CMV. HIV antibody and RNA tests were negative but his full blood count revealed lymphocytopenia, with a low CD4+ subset. He responded to a 3-week course of intravenous ganciclovir therapy followed by suppressive oral valganciclovir.

Conclusions

CMV is associated with sight-threatening retinitis in HIV infection at CD4+ counts below 50 cells/μL and in transplant recipients or heavily immunosuppressed patients. Systemic steroids are a risk factor for clinical disease in these groups. It is extremely rare to report CMV eye disease in previously healthy individuals. This case illustrates that the condition does occur in association with ICL. Corticosteroids may be implicated in disease reactivation. Molecular methods are necessary to confirm the diagnosis.
Angle-Closure Glaucoma after Piggyback Intraocular Lens Implantation
Authors: García-Feijoo J. , Sáenz-Francés F , Martínez-De-La-Casa J.M. , Méndez-Hernández C. , Fernández-Vidal A. , Elías-De-Tejada M. , Reche-Frutos J. , García-Sánchez J.
Published: January 2018

Purpose

To report a case of angle closure glaucoma after piggyback intraocular lens implantation and its treatment.

Methods

The authors present the case of a 75-year-old woman who was seen in the emergency department with angle closure glaucoma. Two years before she had undergone piggyback intraocular lens (IOL) implantation in order to correct a refractive error after cataract surgery. Ultrasound biomicroscopy revealed a closed angle with synechiae in 360° as well as the presence of two IOLs: one in the capsular bag and the other in the ciliary sulcus. Extraction of the anterior IOL was precluded due to the poor endothelial count. Peripheral iridotomy and trabeculectomy were ineffective to lower the intraocular pressure (IOP); the authors decided to implant with an Ahmed valve and to place the valve's tube between the two IOLs to protect the endothelium.

Results

After Ahmed valve implantation, IOP maintains stable around 10–12 mmHg without medical treatment.

Conclusions

Ahmed valve implantation is a good option in angle closure glaucoma due to piggyback. The placement of the valve's tube between the two IOLs is a good option to protect corneal endothelium.
Laser in Situ Keratomileusis for Mixed Astigmatism Using a Modified Formula for Bitoric Ablation
Authors: De Ortueta D. , Haecker C.
Published: January 2018

Purpose

To evaluate the results of treatment of mixed astigmatism with laser in situ keratomileusis (LASIK) by means of a modified Chayet formula for bitoric ablation and personalized nomogram calculations.

Methods

A retrospective study was conducted in 19 consecutive eyes of 13 patients who underwent LASIK treatment of mixed astigmatism with a mean sphere of +1.63±1.23 D and a mean cylinder of −3.55±1.17 D. The authors used the Schwind ESIRIS Laser platform. The ablation was shifted from the pupil center to the vertex normal of the cornea.

Results

Three months postoperatively the mean sphere was 0.08±0.24 D and the mean astigmatism −0.45±0.31 D. At 3 months, an uncorrected visual acuity (UCVA) of 20/50 or better could be found in 100% of the eyes, and of 20/25 or better in 59%. All eyes were within ±0.5 D spherical equivalent (SE) at 3, 6, and 12 months. No eye lost more than one line of best spectacle-corrected visual acuity (BSCVA). Postoperatively, the corneal wavefront showed a reduction of spherical aberrations and coma, which were analyzed at 4 and 6 mm pupil diameter. The postoperative higher-order aberrations decreased at 4 mm and increased at 6 mm pupil sizes after surgery.

Conclusions

Modified bitoric treatment with the Schwind ESIRIS laser showed an excellent postoperative UCVA and BSCVA with applying external nomogram adjustments. The method demonstrated good predictability, safety, and effectiveness in the treatment of mixed astigmatism.
Management of Postkeratoplasty Ametropia: Intralasik after Penetrating Keratoplasty
Authors: Kucumen R.B. , Yenerel N.M. , Gorgun E. , Alimgil M.L.
Published: January 2018

Purpose

The authors describe a technique of laser in situ keratomileusis (LASIK) for the management of postkeratoplasty ametropia using a femtosecond laser for flap creation.

Methods

The first step was the placement of a disposable suction fixation ring to ensure that it was well-centered on the graft. The applanation cone was applied; the border of the flap was adjusted according to the edge of the graft. The hinge was at the 12 o'clock position; the mean flap diameter was 7.93 mm and the flap depth was 113.33 μm. The flap creation was made with the IntraLase femtosecond laser in a raster pattern. Twenty minutes after the flap creation, it was lifted and the treatment was completed with the Allegretto Wavelight excimer laser.

Results

Three patients were treated with this technique and no significant intraoperative or postoperative complications were observed.

Conclusions

IntraLASIK is a promising and accurate procedure for the correction of postkeratoplasty ametropia and astigmatism.
Serum Prolactin Levels in Hla-B27-Associated Uveitis
Authors: Proença H. , Ferreira C. , Miranda M. , Castanheira-Dinis A. , Monteiro-Grillo M.
Published: January 2018

Purpose

To evaluate basal serum prolactin levels in patients with HLA-B27-associated uveitis.

Methods

Prospective, nonrandomized comparative trial. Thirty-three patients with HLA-B27-associated uveitis and 30 age- and sex-matched healthy control subjects were included. Age, systemic disease, treatment, and uveitis activity were recorded for comparative analysis between groups. Fourteen out of 23 patients with arthritic disease had ankylosing spondylitis. Basal serum prolactin levels were determined by electrochemiluminescence immunoassay on a Modular Analytics E170 analyzer.

Results

Prolactinemia was significantly higher (mean=15.84 ng/mL) in patients vs controls (mean=11.50 ng/mL) (p=0.026). Subgroup analysis revealed prolactinemia in arthritic disease patients (mean=17.21 ng/mL) significantly higher than controls (mean=11.50 ng/mL) (p=0.009) and in ankylosing spondylitis (mean=17.65 ng/mL) vs controls (mean=11.50 ng/mL) (p=0.006). No correlation was found between prolactinemia and systemic treatment. Prolactinemia did not correlate with disease activity. Autoimmunity features also correlated with higher prolactinemia (mean=17.26 ng/mL) vs controls (mean=11.50 ng/mL) (p=0.015).

Conclusions

These results suggest the role of serum prolactin levels in HLA-B27-associated uveitis pathogenesis and its subgroups. There was no correlation with disease activity.
Optical Coherence Tomography Findings in a Child with Posterior Scleritis
Authors: Erdöl H. , Kola M. , Türk A.
Published: January 2018

Purpose

To present the findings of optical coherence tomography (OCT) in a child with posterior scleritis.

Methods

A 13-year-old boy was admitted to our clinic with symptoms of low degree of vision and ocular pain. Ophthalmologic examination, ocular ultrasonography, magnetic resonance imaging, fundus fluorescein angiography (FFA), and OCT investigations were carried out and the results were evaluated.

Results

Visual acuity was 10/10 in the right eye, and finger counting at 1 meter in the left eye. Anterior segments and vitreous were normal in both eyes. Fundus examination revealed the edema on the macula and the normal disc margins on the left eye, while the right eye was normal. The FFA revealed the leakage on the macula. Posterior scleral thickening, choroidal effusion, and serous retinal detachment were determined in ocular ultrasonography, suggesting posterior scleritis. There were interesting cystic forms underneath the retina and serous macular detachment (SMD) in the first OCT examination. The patient was treated with oral prednisolone for 10 days and then with oral indomethacin for 20 days. Following the systemic treatment the visual acuity of the left eye improved, subjective signs disappeared, and the OCT manifestations returned to normal.

Conclusions

In this case report, OCT provided new information about the retinochoroidal structure in posterior scleritis. These findings may be helpful for the diagnosis of this rare condition, but further studies are needed.
Clinical Complications of Combined Phacoemulsification and Vitrectomy for Eyes with Coexisting Cataract and Vitreoretinal Diseases
Authors: Wensheng L. , Wu R. , Wang X. , Xu M. , Sun G. , Sun C.
Published: January 2018

Purpose

To discuss the intraoperative and postoperative complications of combining phacoemulsification and foldable intraocular lens (IOL) implantation with pars plana vitrectomy in eyes with significant cataract and coexisting vitreoretinal diseases.

Methods

This retrospective study consisted of 186 eyes of 149 patients with various vitreoretinal abnormalities and visually significant cataracts. Vitreoretinal surgery was combined with clear corneal phacoemulsification and foldable IOL implantation. Main outcome measures were the intraoperative and postoperative complications at from 6 to 56 months.

Results

The most common intraoperative complication was iatrogenic retinal hole (5.3%), transient corneal edema (3.2%), and posterior capsule break (2.1%). The most common postoperative complication was posterior capsule opacification (21.5%) and elevated intraocular pressure (9.7%), macular edema (8.1%), fibrinous reaction (6.9%), vitreous hemorrhage (3.7%), posterior synechiae (3.7%), and recurrent retinal detachment (3.2%). Postoperatively, in 162 eyes (87.1%), visual acuity improved by 3 lines or more on the Snellen chart. In 14 eyes (7.5%), vision remained within 3 lines of preoperative levels and in 10 eyes (5.3%), vision had decreased at the last follow-up.

Conclusions

Postoperative complications did not increase significantly in the combined phacoemulsification and vitreoretinal surgery. Combined vitreoretinal surgery and phacoemulsification with foldable IOL implantation is safe and effective in treating vitreoretinal abnormalities coexisting with cataract. Based on extensive experience with the combined procedure, the authors suggest that combined surgery is recommended in select patients having simultaneous vitreoretinal pathologic changes and cataract.
Prevalence of Diabetic Retinopathy among Subjects with Known Diabetes in China: The Beijing Eye Study
Authors: Xie X.W. , Xu L. , Jonas J.B. , Wang Y.X.
Published: January 2018

Purpose

To evaluate the prevalence of diabetic retinopathy and risk factors among patients with self-reported diabetes mellitus in China.

Methods

The Beijing Eye Study, a population-based study on inhabitants aged 40+ years, included 4439 subjects. Fundus photographs of the worse eye from participants with self-reported diabetes were graded.

Results

Fundus photographs ready for evaluation and a filled out questionnaire were available for 4127 (93.0%) subjects. The prevalence of self-reported diabetes was 235/4127 (5.7%). Among the subjects with a self-reported diagnosis of diabetes, diabetic retinopathy was detected on the fundus photographs of 86 (37.1%) subjects, with macular edema in 12 (5.2%) subjects, clinically significant macular edema in 6 (2.6%) subjects, and a vision-threatening stage of the retinopathy in 12 (5.2%) subjects. Diabetic retinopathy was associated with rural region (p=0.004), longer duration of diabetes (p=0.009), use of diabetic medications (p=0.02), and lower education background (p=0.003).

Conclusions

Prevalence of diabetic retinopathy among Chinese patients aged 40+ years with a self-reported diagnosis of diabetes is about 37%, with a vision-threatening stage of the retinopathy detected in 5% of the subjects. About 5.7% of the adult Chinese population report on a known diagnosis of diabetes mellitus, with about 15% of these subjects knowing about the presence of diabetic retinopathy. The frequency of known diabetes mellitus is lower in rural regions than in urban regions, while diabetic retinopathy overall and macular edema among the subjects with known diabetes mellitus were significantly more common in the rural group.
Prognostic Factors after Primary Vitrectomy and Perfluorocarbon Liquids for Bullous Rhegmatogenous Retinal Detachment
Authors: Abu El-Asrar A.M. , Al-Kwikbi H.F. , Kangave D.
Published: January 2018

Purpose

To identify prognostic factors for visual acuity and anatomic outcomes associated with bullous rhegmatogenous retinal detachment (RRD) management using primary pars plana vitrectomy, intraoperative perfluorocarbon liquids (PFCLs), and internal gas tamponade.

Methods

The authors studied a consecutive series of 115 eyes (115 patients) with a bullous RRD not complicated by proliferative vitreoretinopathy (PVR) associated with large, multiple, and/or posterior breaks in 58 (50.4%) eyes. All eyes underwent vitrectomy, injection of PFCL, and gas tamponade as the primary procedure. Encircling scleral bands were placed in all cases. The follow-up period ranged from 3 to 60 months (mean 16.6±14.1 months).

Results

Retinal reattachment was achieved in 92.2% of eyes (106/115) with one operation and in all eyes after a second procedure. PVR was observed in 1 (0.87%) eye and pre-retinal membranes in 3 (2.6%) eyes. Progression of pre-existing cataract and development of new cataract occurred in 45 (58.4%) of the 77 phakic eyes. The presence of inferior retinal breaks was significantly associated with redetachment after the first procedure (p=0.0156). On univariate analysis, better preoperative visual acuity (p<0.001), macular sparing retinal detachment (p<0.001), and fewer quadrants involved by the detachment (p=0.0015) were significant positive prognostic factors for final visual acuity. Logistic regression analysis highlighted that macular sparing retinal detachment and absence of trauma were associated with better final visual acuity.

Conclusions

Redetachment was associated with the presence of inferior retinal breaks. Visual recovery was dependent on preoperative visual acuity, macular involvement, extent of retinal detachment, and trauma.
Induction of Durable Remission in Ocular Inflammatory Diseases
Authors: Cervantes-Castañeda R.A. , Bhat P. , Fortuna E. , Acevedo S. , Foster C.S.
Published: January 2018

Purpose

To describe a paradigm of care for patients with ocular inflammatory diseases aimed at induction of durable remission.

Methods

Retrospective cohort study. The records of 399 patients with ocular inflammatory diseases treated with systemic immunomodulatory therapy (IMT) at the Massachusetts Eye Research and Surgery Institution were reviewed. Durable remission was defined as control of inflammation in the absence of systemic IMT for at least 1 year. Fifty patients met the inclusion criteria.

Results

Mean age was 46±22.5 years (range 18–88). All the patients had corticosteroid therapy and failed this therapy before having IMT. Fifty-two percent of the patients had used methotrexate alone or in combination with other medications. Thirty percent of the patients required at least 2 years of therapy with systemic IMT to obtain durable remission, while 44% required 2 to 5 years of therapy to achieve the same. Twenty percent continued to stay in remission, off immunomodulatory drugs, between 2 and 5 years and 18% were in remission for more than 5 years after therapy discontinuation.

Conclusions

IMT can be sight saving in patients. It can be tapered and discontinued successfully without the return of ocular inflammation. Durable drug-free remission is an achievable goal, and should be pursued by ocular inflammatory disease specialists.
Low-Fluence Photodynamic Therapy in Longstanding Chronic Central Serous Chorioretinopathy with Foveal and Gravitational Atrophy
Authors: Reibaldi M. , Boscia F. , Avitabile T. , Russo A. , Cannemi V. , Uva M.G. , Reibaldi A.
Published: January 2018

Purpose

To describe anatomic and functional outcomes in two patients with long-standing severe chronic central serous chorioretinopathy (CSC) with foveal and gravitational atrophy treated with low-fluence photodynamic therapy (PDT).

Methods

Two patients with a history of over 10 years of chronic CSC and development of gravitational tracts, with best-corrected visual acuity <20/200, were treated with PDT guided by indocyanine green angiography (ICGA) with a fluence of 25 J/cm2 at an irradiance of 300 mW. Follow-up examinations 1 and 9 months after therapy included measurement of near and far best-corrected visual acuity, fundus biomicroscopy, fluorescein angiography and ICGA, optical coherence tomography, and microperimetry.

Results

At 1 and 9 months after low-fluence PDT, complete resolution of subretinal, intraretinal, and under retinal pigment epithelium fluid was observed in both patients. Far and near visual acuity improved in both eyes. Improvement of sensitivity and fixation stability were demonstrated by microperimetry. No treatment-related side effects were seen.

Conclusions

ICGA-guided low-fluence PDT seems effective and safe for treating long-standing chronic CSC.
Antioxidants Intake and Dry Eye Syndrome: A Crossover, Placebo-Controlled, Randomized Trial
Authors: Drouault-Holowacz Sophie , Bieuvelet SÉVerine , Burckel André , Rigal Danièle , Dubray Claude , Lichon Jean-Louis , Bringer Paul , Pilon François , Chiambaretta François
Published: January 2018

Purpose

To assess whether an orally administered antioxidant dietary supplement could improve the objective clinical signs and alleviate the subjective symptoms of dry eye syndrome.

Methods

Twenty-four subjects diagnosed with dry eye syndrome were randomized in a crossover, double-blind, controlled, randomized study to receive a placebo or an antioxidants combination (Oxybiane®) for 12 weeks. In all subjects, break-up time (BUT) test, Schirmer test, ocular symptoms (sore eyes, burning, itching, sensation of foreign object in the eye, photophobia, sticky eyes, and redness), visual comfort, and general well-being were evaluated weekly.

Results

After 12 weeks of supplementation with Oxybiane®, both the BUT scores (27.3%±8.4% with Oxybiane® versus 3.61%±4.3% with the placebo, p=0.017) and the Schirmer scores (26.9%±14.2% with Oxybiane® versus −4.7%±3.4% with the placebo, p=0.037) were significantly increased. A significantly improvement was also observed considering subjective clinical symptoms such as burning (p=0.031), itching (p=0.027), sensation of foreign body in eye (p=0.030), and redness (p=0.043).

Conclusions

Supplementation with oral antioxidants can improve both tear stability and quantity but also subjective clinical signs.
Bimanual Microincisional Phacoemulsification Combined with Viscocanalostomy plus Deeper Sclerectomy
Authors: Baykara Mehmet , Timucin Ozgur B.
Published: January 2018

Purpose

The aim of the study was to evaluate the safety and effectiveness of a new technique, two-site bimanual microincisional cataract surgery combined with viscocanalostomy plus deeper sclerectomy (two-site bimanual MICS-VC-DS), in patients with cataract and glaucoma.

Methods

Noncomparative, interventional case series. From December 2005 to October 2007, a consecutive series of 12 patients (12 eyes) with uncontrolled primary open angle glaucoma (POAG) and cataract have undergone two-site bimanual MICS-VC-DS. Postoperative evaluation included visual acuity (VA), intraocular pressure (IOP), average retinal nerve fiber layer (RNFL) thickness measurement, and gonioscopic, biomicroscopic, and funduscopic examination. Paired-samples t test was used. A p value of <0.05 was taken as significant.

Results

The mean duration of follow-up was 14.6 months (SD 5.8). At 9 months, mean IOP was 17.0 (SD 4), the mean IOP reduction was 13.2 mmHg (SD 5.86). At 9 months post-surgery, the complete success rate was 75%. Qualified success was achieved in 100% of patients. At 9 months, the mean number of antiglaucoma medications was 0.58 (SD 1.24) (p<0.05). Visual acuity improved by a mean value of 2.8 lines. Average RNFL thickness did not change significantly during the follow-up period (p=0.781).

Conclusions

Two-site bimanual MICS-VC-DS appears to be an effective and safe procedure with quick visual rehabilitation, acceptable mid-term IOP control, and the advantage of having fewer complications.
Coexistent Primary Open-Angle Glaucoma and Cataract: Interim Analysis of a Trabecular Micro-Bypass Stent and Concurrent Cataract Surgery
Authors: Spiegel Detlev , Wetzel Wolfgang , Neuhann Thomas , Stürmer Jorg , Höh Helmut , García-Feijoo Julian , Martínez-De-La-Casa José Maria , García-Sánchez Julian
Published: January 2018

Purpose

To evaluate the safety and efficacy of the iStent Trabecular Micro-bypass Stent in patients undergoing concurrent cataract and glaucoma surgery.

Methods

Prospective, 24-month, uncontrolled, multicenter, multicountry evaluation of 58 patients with uncontrolled primary open-angle glaucoma (including pseudoexfoliation and pigmentary) and cataract. Patients underwent clear cornea phacoemulsification followed by ab interno gonioscopically guided implantation of the iStent. Of the 48 per protocol population, 42 patients completed 12 months of the 24-month study, and their data are included in this interim analysis.

Results

At baseline, mean (±SD) intraocular pressure (IOP) was 21.7±3.98 mmHg. At 12 months, mean IOP was reduced to 17.4±2.99 mmHg, a mean IOP reduction of 4.4±4.54 mmHg (p<0.001, 18.3%). At baseline, patients were taking a mean 1.6±0.8 medications. By 12 months, the mean number of medications was reduced to 0.4±0.62 (p<0.001). Half the patients achieved an IOP ≤18 mmHg and were able to discontinue hypotensive medication by the 12-month visit. The most commonly reported device-related adverse events were the appearance of stent lumen obstruction (7 eyes) and stent malposition (6 eyes). None of the adverse events were deemed serious.

Conclusions

In patients undergoing concurrent cataract and glaucoma surgery, the iStent was safe and efficacious for the reduction of IOP and medication therapy.
Optical Coherence Tomography for Diagnosis of Posterior Vitreous Detachment at the Macular Region
Authors: Höhn Fabian , Mirshahi Alireza , Hattenbach Lars-Olof
Published: January 2018

Purpose

To assess optical coherence tomography (OCT) for diagnosing posterior vitreous detachment (PVD) at the macular region compared to kinetic B-scan ultrasonography.

Methods

In the present study, the authors prospectively investigated the frequency of PVD at the posterior pole utilizing ocular kinetic B-mode sonography in 315 eyes of 188 patients (113 female, 75 male; mean age, 72.8 years; range, 39–94) prior to cataract surgery. In addition, OCT scans of the macular region were performed in all subjects for detection of PVD at the macula.

Results

A total of 130 eyes (41.3%) had no sonographic signs of PVD. In this subset of patients in 36 eyes (27.7%), OCT revealed a flat PVD at the macular region with the distance between the posterior hyaloid and retinal surface being less than 400 μm (mean distance, 234 ± 112 μm, range, 24–398). When combining both methods, the diagnosis of PVD at the posterior pole was made in 221 of 315 eyes (70.2%).

Conclusions

OCT is a valuable tool for detecting PVD at the macular region, particularly in cases with small distances between the retinal surface and posterior hyaloid. Proof of attachment of the posterior hyaloid can be established only by combining kinetic ultrasonography and OCT.
Perfluorocarbon Liquid Vitreous Delamination and Wide-Angle Viewing System in the Management of Complicated Diabetic Retinal Detachment
Authors: Yadarola Maria B. , Gramajo Ana L. , Arrambide Maria P. , Colombres Gustavo A. , Juárez Claudio P. , Luna José D.
Published: January 2018

Purpose

The authors used perfluorocarbon liquid (PFCL) and a wide-angle viewing system (WAVS) to evaluate their efficacy on tractional and combined tractional/rhegmatogenous retinal detachment (RD) secondary to proliferative diabetic retinopathy (PDR).

Methods

In a prospective, noncomparative, interventional study, 76 consecutive cases of severe PDR with tractional and combined tractional/rhegmatogenous RD were submitted to vitrectomy en bloc excision technique using a WAVS and delamination with PFCL between July 1999 and December 2003. None of the patients had had previous retinal photocoagulation treatment. Preoperative characteristics, intraoperative findings, and procedures as well as postoperative results were recorded. Main outcome measures included visual acuity (VA) and rates of retinal reattachment and complications.

Results

After 1 to 4 years of follow-up (mean 34.3 months), the number of patients changed from 3 (3.95%) to 11 patients (14.47%) in the ≥ 20/40 VA range, from 12 (15.79%) to 7 (9.21%) in the 20/50 to 20/200 group, and from 61 (80.26%) to 58 (76.31%) in the ≤ 20/400 group, preoperatively and postoperatively, respectively. The mean final VA improved from 1.2 logMAR before surgery to 0.89 after vitrectomy (p=0.001). This modified technique resulted in less bleeding during surgery, a better identification of intraocular structures, faster retinal reattachment, subretinal fluid reabsorption, and easier dissection of fibrovascular membranes, among other benefits.

Conclusions

PFCL and WAVS appear to reduce intraoperative complication rates in the management of complicated cases of tractional and combined tractional/rhegmatogenous RD secondary to PDR. Retinal reattachment and functional vision rates improved after this technique.
Risk Factors in Central Retinal Vein Occlusion and Activated Protein C Resistance
Authors: Güven D. , Sayinalp N. , Kalayci D. , Dündar S. , Hasiripi H.
Published: January 2018

Introduction

Central retinal vein occlusion (CRVO) tends to be a disease of older individuals, with some known major risk factors, and activated protein C resistance seems to be one of the causes in younger patients. In this study, we reviewed risk factors including activated protein C resistance in a series of patients with CRVO.

Methods

Twenty-four patients with a diagnosis of CRVO presenting either acutely or for a follow-up visit during the study period, were enrolled. Ages ranged between 31 and 83 years (mean 59.7). The risk factors, presence of ischemia, the results of biochemical serological and hematological tests, especially activated protein C resistance (APC-R), were analysed.

Results

In 17 patients (71%) one or more of the following risk factors existed: hypertension, diabetes, oral contraceptive usage, family history of thrombosis, and previous operation. In 40% of the eyes, there were ischemic changes. Serum triglycerides were high in 4 of 21 patients (19%) and cholesterol and urea were high in 10 of 21 patients (19%). APC-R was found in 6 out of 24 patients (25%).

Conclusions

Besides known predisposing factors like hypertension, diabetes, glaucoma and hyperlipidemia, APC-R seems to be a risk factor for CRVO at all ages.
Listeria Monocytogenes-Induced Endogenous Endophthalmitis in an Otherwise Healthy Individual: Rapid PCR-Diagnosis as the Basis for Effective Treatment
Authors: Lohmann C.P. , Gabel V.P. , Heep M. , Linde H. J. , Reischl U.
Published: January 2018

Purpose

Listeria monocytogenes is a rare cause of endogenous endophthalmitis. To date 15 cases have been published in the literature. All eyes showed similar clinical features and profound visual loss mainly due to delayed diagnosis.

Methods

An additional case of an otherwise healthy 73 year-old male, who was referred to our hospital because of acute iridocyclitis with secondary glaucoma, is reported. Within a few days the severity of the intraocular infection increased dramatically, resulting in the clinical picture of acute endophthalmitis.

Results

In contrast to most published cases, early identification of the causative pathogen in the aqueous humor after anterior chamber puncture using polymerase chain reaction (PCR) and the initiation of a specific, systemic antibiotic medication, resulted in complete recovery of visual acuity.

Conclusions

PCR is very useful for the identification of the pathogen in intraocular infections.
Diffuse Unilateral Subacute Neuroretinitis in Europe
Authors: Harto M.A. , Rodriguez-Salvador V. , Aviñó J.A. , Duch-Samper A. M. , Menezo J.L.
Published: January 2018

Background

Diffuse unilateral subacute neuroretinitis is thought to be caused by a solitary helminth migrating within the subretinal space. Laser photocoagulation of the located worm is the preferred mode of therapy.

Methods

We describe the clinical and electrophysiological features of a case of a 15-year-old Caucasian male with a longstanding diffuse unilateral subacute neuroretinitis (DUSN), in whom two worms were seen in the fundus examination. Focal photocoagulation of the worms was applied as treatment.

Results

No signs of inflammation could be seen after treatment. Three months later, the patient was doing well. Follow-up examination 4 years later revealed an unchanged fundus appearance in the affected eye, with no evidence of progression of the syndrome.

Conclusions

If a worm is identified in DUSN, focal laser treatment of the located area is the treatment of choice, regardless of whether fundus changes suggest late stages of the disease. However, the eye of the patient should be thoroughly examined to rule out the presence of more than one worm that might cause the failure of therapy.
Pretarsal and Marginal Orbicularis Oculi Muscle Fiber Changes in Trachomatous Cicatricial Entropion: Histopathological Evaluation
Authors: Guzey M. , Basar E. , Ermis S.S. , Bitiren M. , Ozardali I. , Mirzatas C.
Published: January 2018

Purpose

To evaluate the histopathological changes of pretarsal and orbicularis muscle fibers in trachomatous cicatricial entropion.

Methods

Orbicularis muscle tissue specimens were histopathologically evaluated in 17 eyes of 11 cases in which anterior lamellar reposition and/or wedge-shaped tarsal resection or Wies procedure were performed.

Results

Degeneration of orbicularis muscle fibers, atrophy, connective tissue increase between muscle fibers and edema were observed in 13 tissue specimens. Muscle fiber changes were more commonly observed in cases with severe entropion, in which Wies procedure was performed.

Conclusions

These histopathological changes, which may develop secondary to other structural changes that can cause entropion in the eyelid and weaken the orbicularis muscle, may be a co-factor influencing the severity of entropion more than causing entropion alone.
Results of Trabeculotomy and Guarded Filtration Procedure for Glaucoma Associated with Sturge-Weber Syndrome
Authors: Irkeç M. , Kiratli H. , Bilgiç S.
Published: January 2018

Purpose

To assess the efficacy of trabeculotomy and guarded filtration procedure in the management of glaucoma associated with the Sturge-Weber syndrome.

Methods

Six patients (seven eyes) with Sturge-Weber syndrome who underwent glaucoma surgery were retrospectively reviewed. One patient had bilateral glaucoma. Age at the time of operation ranged between 23 days and 9 years. The mean preoperative intraocular pressure was 30.6 mmHg (range 25–38 mmHg). Trabeculotomy and guarded filtration procedure were performed in three eyes each and both techniques were used in one eye.

Results

The mean follow-up was 6.3 (range 2–11) years. A single procedure lowered the intraocular pressure and arrested the progression of the disease in five eyes. Two patients required topical antiglaucoma medication. No patient needed reoperation. Two eyes suffered intra- and post-operative temporary choroidal effusions.

Conclusions

Trabeculotomy in infancy and guarded filtration procedure in older children effectively stabilized the eyes and prevented further glaucomatous damage in our patients with Sturge-Weber syndrome.
Bacteriological Profile of Ophthalmic Infections in an Israeli Hospital
Authors: Mezer E. , Gelfand Y.A. , Lotan R. , Tamir A. , Miller B.
Published: January 2018

Aim

To find the optimal antibiotic treatment for ophthalmic infections in an Israeli hospital.

Methods

In a retrospective study from our laboratory, which serves as both a primary and secondary referral center, we analyzed the bacteriological profile and the antibiotic sensitivity of ophthalmic infections using the computerized laboratory reports of 331 consecutive ophthlamic bacteriological cultures from patients with various ophthalmic infections.

Results

Microbiological growth was obtained in 113 samples (34.1%). The most commonly isolated organism was coagulase-negative staphylococcus (19.5%), followed by coagulase-positive staphylococcus (16.8%), Enterobacteriaceae (14.2%), Pseudomonas aeruginosa (13.3%), and streptococcal species (8.9%). Pseudomonas species were the most common isolates from the lacrimal pathways (20.0%). Streptococci were the most common isolates cultured from the conjunctiva (27.3%). Coagulase-positive staphylococcus was the most common isolate from corneal ulcers (33.3%), and coagulase-negative staphylococcus from the vitreous (30.8%). The overall antibiotic sensitivity of common ophthalmic pathogens was similar to that reported from other parts of the world.

Conclusions

Although essentially similar to previous series, this report from the Middle East differs as follows. Firstly, Pseudomonas species were the most common isolates from the lacrimal pathways. Secondly, the overall rate of streptococcal isolates was lower than in previous reports. Thirdly, streptococcal species were rarely isolated from corneal samples. Although other studies from the region have described the causative organisms of ocular infections in specific ocular sites, this is the first study from the Middle East to summarize the full bacteriological profile of ocular infections in one medical center.
Tc-99m Labeled Red Blood Cells Scintigraphy: A Diagnostic Method for Orbital Cavernous Hemangioma
Authors: Gdal-On M. , Gelfand Y.A. , Israel O.
Published: January 2018

Purpose

To evaluate Tc-99m labeled red blood cells scintigraphy (Tc-99m RBC scintigraphy) as a diagnostic method for orbital cavernous hemangioma.

Patients and Methods

Retrospective analysis of the medical records of all patients who were diagnosed as suffering from orbital cavernous hemangioma over the last 16 years.

Results

Medical records of 12 patients with orbital cavernous hemangioma were identified. In all twelve patients, the tentative diagnosis of orbital cavernous hemangioma was made by CT scan. In all of them, the diagnosis was established by Tc-99m RBC scintigraphy, demonstrating a typical picture of “perfusion blood- pool mismatch” (This is normal radionuclide angiography, followed by a variable radionuclide uptake during the early blood-pool study and an intensive radionuclide uptake during the delayed blood-pool study). The tumor was surgically removed in all 12 patients. This diagnostic method was found to be reliable as no single case was recorded in which the preoperative diagnosis was not confirmed pathologically after surgical removal of the tumor.

Conclusions

Tc-99m RBC scintigraphy is a reliable method for diagnosing orbital cavernous hemangioma. It should be included in our arsenal of diagnostic techniques, particularly for cases which are otherwise difficult to diagnose.
Electric Cataract: A Case Report and Review of the Literature
Authors: Reddy S.C.
Published: January 2018

A case of electrically induced cataract in both eyes in a 12-year-old boy, after a high-voltage electric shock, is reported. He sustained skin burns on the neck, chest, abdomen, and inner left arm. The cataract developed first in the left eye and later on in the right eye. The child regained normal vision in both eyes after cataract extraction and aphakic correction with spectacles. The need for awareness of the possibility of this complication and screening of all cases of electrical injuries is stressed. The majority of cases respond well to surgery, but final visual acuity will depend on the other ocular damage due to electrical current. The clinical features and pathogenesis of this condition are briefly reviewed.
Retinal Vein Occlusion in Armenia
Authors: Malayan A. S. , Shakhsuvaryan M. L. , Grigoryan G.L. , Melkonyan A.K.
Published: January 2018

Purpose

To determine the demographic characteristics, associated ophthalmic and systemic conditions of retinal vein occlusion (RVO) and associations of central retinal vein occlusion among Armenian patients.

Methods

A retrospective study of 460 patients aged 30 years and older with a clinical diagnosis of RVO who were seen in the five-year period between January 1, 1993, and December 31, 1997 at the Eye Hospital.

Results

Signs of central RVO were found in 297 eyes (64.5%), branch RVO in 163 eyes (35.5%). Among the 460 patients occlusion was hemispheric in 4 eyes (2.4%), hemicentral in 5 eyes (3%). CRVO was more common among the younger patients (odds ratio [OR] = 2.42, 95% confidence interval [CI]: 1.06–5.65). Hypercoagulability was noted in the majority of RVO cases. Glaucoma was an associated condition (12.6%). Systemic hypertension was the most frequent association. In CRVO a significant association was found with hypertension (OR= 1.89, 95% CI: 1.23–2.70).

Conclusions

Our results suggest RVO is associated with glaucoma and hypertension. RVO was more closely associated with hypertension than BRVO. There were no differences in the distribution for the site of occlusion with regard to sex in patients with CRVO and BRVO. No seasonal pattern was found in the onset of any type of RVO. Hypercoagulability may be a contributing factor in the pathogenesis. The findings reinforce recommendations to carefully evaluate patients with RVO for open-angle glaucoma, and to diagnose and treat systemic hypertension.
Retinitis Pigmentosa, Coats Disease and Uveitis
Authors: Solomon A. , Banin E. , Anteby I. , Benezra D.
Published: January 2018

Purpose

To study the anamnestic immune response to retinal specific antigens of two patients suffering from a rare triad of retinitis pigmentosa, Coats disease and uveitis.

Patients

17-year-old girl presented with an acute episode of panuveitis, and her 19-year-old brother suffered from chronic uveitis. On examination, both patients showed retinal vascular changes and subretinal exudations typical of Coats disease, with bone-spicule pigmentary changes as observed in retinitis pigmentosa.

Results

All routine examinations were unrevealing. However, the peripheral lymphocytes from these two siblings gave a specific anamnestic response to retinal antigens in vitro. A stimulation index of 4.6 was obtained when the sister's lymphocytes were stimulated with interphotoreceptor binding protein. IRBP-during the acute stage of the uveitis. The brother's lymphocytes showed a stimulation index of 2.7 towards S-Ag during the chronic phase of his uveitic condition.

Conclusions

These results indicate that autoimmunity towards retinal antigens may play some role in specific types of retinitis pigmentosa. Whether these autoimmune reactions are a primary pathological mechanism or are secondary to the extensive destruction of the photoreceptor layer resulting from the retinitis pigmentosa remains debatable
Morphological Evaluation of Full-Thickness Idiopathic Macular Holes by Optical Coherence Tomography
Authors: Ripandelli G. , Coppé A.M. , Bonini S. , Giannini R. , Curci S. , Costi E. , Stirpe M.
Published: January 2018

Purpose

To assess the efficacy of optical coherence tomography (OCT) for the morphological evaluation of idiopathic full-thickness macular holes and for detecting any morphological changes with time.

Methods

Serial sagittal tomographs through the macula were taken by OCT in a consecutive series of 34 eyes of 34 patients with diagnosis of idiopathic full-thickness macular hole. The patients were divided into two groups on the basis of “recent” (group 1, 25 patients) or “not-recent” (group 2, 9 patients) onset of symptoms related to the macular hole. Fourteen of the 25 patients in group 1 and all nine in group 2 underwent vitrectomy. The 11 in group 1 who refused surgery were observed by OCT examination with follow-up from 6 to 13 months.

Results

In most eyes OCT scans revealed two different anatomical features of macular holes depending on the time of onset of symptoms. Eleven of the 14 “recent-onset” holes that underwent surgery showed “sharp”, undermining edges at preoperative OCT; the other three had “rounded” edges. Seven of the nine eyes operated for long-standing full-thickness macular holes had preoperative “rounded” edges, while the edges in the remaining two eyes were “sharp”. OCT of eight of the 11 non-operated eyes in group 1 showed a morphological evolution of the macular hole edges from a “sharp” to a “rounded” contour and an increase in the diameter of the hole.

Conclusions

OCT can help in the morphological evaluation of idiopathic full-thickness macular holes and in the detection of morphological changes with time.
Long-Term Outcome of RPE Allografts in Non-Immunosuppressed Patients with AMD
Authors: Algvere P. V. , Gouras P. , Dafgård Kopp E.
Published: January 2018

Purpose

To determine the long-term outcome of human retinal pigment epithelium (RPE) transplants in patients with advanced age-related macular degeneration (AMD).

Methods

Using pars plana microsurgical techniques, RPE allografts were transplanted subretinally to four groups of AMD patients: five patients received organized patch transplants after removal of choroidal neovascular membranes, four got small patch transplants in dry AMD; suspensions of RPE cells were transplanted in five cases with dry AMD, and two patients with RPE tears. None received immunosuppression. Transplants were followed for 24–38 months by biomicroscopy, fundus photography, SLO microperimetry, and fluorescein angiography. Rejection was defined as loss of visual function over the transplant, development of an exudative response (subretinal fluid with or without neovascularization), fluorescein leakage, and disruption, depigmentation, or encapsulation of the transplant.

Results

Four of 16 transplants (25%) presented no clinical signs of rejection. Three of the four small patch transplants remained pigmented and essentially unchanged after 30–32 months. Clinical signs of graft rejection appeared within three months in all cases of neovascular AMD (disrupted blood-retinal barrier, BRB), but after 6 - 20 months in five of nine eyes with non-exudative AMD (intact BRB).

Conclusions

Subretinal human RPE allografts present a high rejection rate (75%) without immunosuppression. However, small extrafoveal transplants remained unchanged in shape, size and color for more than two years in non-exudative AMD. A disrupted BRB is likely to enhance graft rejection, which occurs earlier in exudative than in non-exudative AMD.
Bilateral Medial Rectus Recession in Convergence Excess Esotropia, with and without Distance Orthophoria
Authors: Damanakis A.G. , Arvanitis P.G. , Kalitsis A. , Ladas I.D.
Published: January 2018

Purpose

To evaluate the effectivity and safety of bilateral medial rectus recession for the correction of acquired convergence excess esotropia, with and without distance orthophoria.

Methods

Thirty-five pediatric patients with acquired convergence excess esotropia were operated with bilateral medial rectus recessions based on the near angle measured through the distance correction. Preoperatively, in 26 patients, full hypermetropic correction did not fully correct the distance angle; these patients were operated for the residual angle for distance and near. In nine patients full hypermetropic correction produced distance orthophoria and these cases also had near orthophoria through a near add; these patients could have used bifocals, but surgery was chosen instead.

Results

Postoperatively, 19 of the 26 patients with distance esotropia (73%) and 6 of the 9 with distance orthophoria (66.6%) were successfully aligned. Consecutive exotropia developed in two patients (7.6%) in the distance esotropia group and one (11.1%) in the distance orthophoria group.

Conclusions

These results suggest that bilateral recession of the medial recti based on the near deviation is effective in eliminating the near angle in convergence excess esotropia. In patients with distance orthophoria this operation can be used as an initial treatment instead of bifocals. Although the risk of consecutive exotropia was low in this series, a larger number of patients would determine its actual rate more accurately.
Magnetic resonance imaging changes following natalizumab discontinuation in multiple sclerosis patients with progressive multifocal leukoencephalopathy
Authors: Hodel Jérôme , Bapst Blanche , Outteryck Olivier , Verclytte Sébastien , Deramecourt Vincent , Benadjaoud Mohamed Amine , Pruvo Jean-Pierre , Vermersch Patrick , Leclerc Xavier
Published: January 2018

Background:

Detecting early progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome (PML-IRIS) is clinically relevant.

Objective:

Evaluating magnetic resonance imaging (MRI) changes following natalizumab (NTZ) discontinuation and preceding PML-IRIS.

Methods:

MRIs (including diffusion-weighted imaging (DWI), T2-weighted fluid-attenuated inversion recovery (T2-FLAIR), post-contrast T1-weighted sequences) were performed every week following PML diagnosis in 11 consecutive NTZ-PML patients. PML expansion, punctate lesions, contrast-enhancement, and mass-effect/edema were evaluated on each MRI sequence, following NTZ discontinuation.

Results:

PML-IRIS occurred from 26 to 89 days after NTZ discontinuation. MRI changes prior to early PML-IRIS appeared significantly more pronounced using DWI compared to T2-FLAIR imaging ( p < 0.003). Two DWI features (marked PML expansion, punctate lesions) systematically preceded contrast-enhancement.

Conclusion:

Subtle changes may occur on DWI preceding contrast-enhancement.