bluuebunny/crossref_metadata_2025 huggingface dataset:
Switching to Latanoprost Monotherapy for 24 Weeks in Glaucoma Patients
Authors: Takahashi I. , Tanaka M.
Published: January 2018

Purpose

To investigate the intraocular pressure lowering effect in glaucoma patients switched to latanoprost therapy from isopropyl unoprostone given as monotherapy or in combination with a β-blocker.

Methods

Patients with primary open angle glaucoma or normal tension glaucoma treated with 0.12% isopropyl unoprostone as monotherapy or in combination with a β-blocker were eligible for this single-center clinical study. Of the 51 patients (51 eyes) enrolled, 18 were men and 33 were women aged 62.1 ± 12.3 years (mean ± SD). Twenty-two patients had primary open angle glaucoma, and 29 patients had normal tension glaucoma. Intraocular pressure was measured twice within 3 months prior to the switch, and the mean value was taken as the baseline. The patients were then switched to latanoprost (0.005%) monotherapy (once-daily administration), and changes in intraocular pressure were monitored. One physician measured intraocular pressure after 4, 8, 16, and 24 weeks of administration in this 24-week study.

Results

The mean intraocular pressures were 16.0 ± 2.4 mmHg at baseline, 13.7 ± 2.3 mmHg after 4 weeks, 13.1 ± 2.1 mmHg after 8 weeks, 13.6 ± 2.0 mmHg after 16 weeks, and 13.3 ± 2.4 mmHg after 24 weeks. A significant decrease in intraocular pressure was noted at all time points in both groups (paired t-test, p<0.0001), and the intraocular pressure lowering effect persisted through week 24 of administration (analysis of variance, p<0.0001).

Conclusions

Switching to latanoprost monotherapy elicits further reduction in intraocular pressure in patients with primary open angle glaucoma or normal tension glaucoma.
Intraocular Pressure, Safety and Quality of Life in Glaucoma Patients Switching to Latanoprost from Adjunctive and Monotherapy Treatments
Authors: Haverkamp F. , Wuensch S. , Fuchs M , Stewart W. C.
Published: January 2018

Purpose

To evaluate efficacy, safety and quality of life in ocular hypertensive or open-angle glaucoma patients changed to latanoprost from previous therapy.

Methods

A prospective, multicenter, active-controlled design in which qualified patients had their previous therapy substituted for latanoprost and were followed for at least thee months.

Results

In 1068 patients, latanoprost was continued 92% throughout the 36-month observation period. Latanoprost treatment reduced the intraocular pressure (IOP)(p < 0.001) when compared to previous monotherapies including: beta-blockers (-4.0 ± 3.7 mmHg, 42%), alpha-antagonists (-3.9 ± 3.0 mmHg, 14%), miotics (-3.8 ± 3.5 mmHg, 2%), or carbonic anhydrase inhibitors (CAI) (-3.8 ± 3.6 mmHg, n = 16%), and adjunctive therapy including: beta-blocker and CAI (-3.7 ± 3.1 mmHg, n = 12%), alpha-agonist (-3.7 ± 3.4 mmHg, n = 5%), or pilocarpine (-3.4 ± 3.7 mmHg, n = 6%), or CAI and alpha-agonist (-4.6 ± 6.4 mm Hg, n = 2%)(p < 0.0017). The most common adverse event with latanoprost was ocular allergy (1.5% incidence). Patients showed a preference for latanoprost for many systemic and ocular quality of life measures on a non-validated questionnaire (p < 0.05).

Conclusions

In a clinical setting, patients who have their mono- and adjunctive therapy treatment substituted for latanoprost may on average experience reduced IOP, deceased side effects and increased quality of life measures.
Transpupillary Thermotherapy in the Management of Choroidal Metastases
Authors: Kiratli H. , Bilgiç S.
Published: January 2018

Purpose

To report the authors' experience in the use of infrared diode laser transpupillary thermotherapy in the management of selected posterior choroidal metastatic tumors.

Methods

Seven eyes of seven patients were treated using 810 nm infrared diode laser. Spot sizes of 0.5 to 3 mm were selected, each lasting 1 minute. When necessary, the treatment was repeated at 8- to 10-week intervals. Disappearance of the tumor was the main outcome measure.

Results

The primary sites of carcinomas were breast, prostate, and lungs. The largest basal diameters of ocular tumors varied between 5 mm and 10 mm and the thickness ranged between 2 mm and 4.5 mm. A mean power of 612 mW was used in one to four treatment sessions. In six eyes the tumors were reduced into flat scars whereas in one case the tumor continued to grow necessitating external beam radiotherapy. In three eyes the visual acuity decreased and in three eyes the vision became better. In one eye the vision was restored after external beam radiotherapy with the disappearance of extensive subretinal fluid. There were no immediate postoperative complications.

Conclusions

Transpupillary thermotherapy can be a reliable, convenient, and cost-cutting option in the management of small, solitary choroidal metastatic tumors with a thickness of less than 3.5 mm and which have minimal subretinal fluid. Although successful in terms of tumor control, treatment close to the fovea or optic nerve head may cause a permanent decrease in visual acuity.
Deep Lamellar Keratoplasty for Various Corneal Lesions
Authors: Wylęgała E. , Tarnawska D. , Dobrowolski D.
Published: January 2018

Purpose

To evaluate the efficacy and safety of deep lamellar keratoplasty (DLK) as a method for treating various diseases of corneal stroma with unaffected endothelium.

Methods

DLK was performed in 31 eyes of 31 patients with corneal stroma opacity without endothelial abnormalities. Surgical procedures included deep removal of corneal stroma 7.5 mm in diameter with the use of viscoelastic or 0.02% trypan blue solution, exposing Descemet membrane in the central area of about 5 mm across including the area of pupil, and grafting a corneal lenticule. In three cases of postinflammatory stromal scars with coexisting limbal stem cell deficiency, limbal stem cell grafting was additionally performed. Main outcome measures were best-corrected visual acuity (BCVA) and postoperative astigmatism.

Results

Intraoperative perforation of Descemet membrane with the necessity of converting the procedure into penetrating keratoplasty occurred in five cases (16.1%) and one patient underwent penetrating keratoplasty on the seventh day after DLK due to persistent double anterior chamber. These six patients were excluded from the study. Postoperative BCVA ranged from 0.1 to 1.0 and astigmatism from 1.2 to 4.7 D. Postoperative complications were loose sutures, ocular hypertension, Descemet membrane detachment, and corneal melting.

Conclusions

DLK is an effective procedure for treating various diseases of corneal stroma with unaffected endothelium. This technique as an extraocular procedure seems to be the treatment of choice in mentally retarded patients.
Comparison of Sedation Requirements for Cataract Surgery under Topical Anesthesia or Retrobulbar Block
Authors: Balkan B. Kuvakí , Íyílíkçí L. , Günenç F. , Üzümlü H. , Kara H.C. , Çelik L. , Durak Í. , Gökel E.
Published: January 2018

Purpose

Topical anesthesia is increasingly being used for cataract surgery. However, it is believed that topical anesthesia causes an increased risk of intraoperative complications from unrestricted eye movement and insufficient pain control and more need for sedation. It is difficult to compare pain and anxiety experienced by individual patients; therefore, the authors used the method of patient-controlled sedation to determine whether there is a difference in sedation requirements under topical or retrobulbar anesthesia.

Methods

In this prospective study, patients received either topical anesthesia (n=87) or retrobulbar block (n=104) and self-administered a mixture of midazolam (0.5 mg) and fentanyl (25 μg) in increments using a patient controlled analgesia infuser to achieve sedation. At the end of surgery, patients rated their pain on a 10-point numerical rating scale and their comfort on a 5-point scale. The number of demands and deliveries were noted from the patient controlled analgesia infuser display.

Results

Pain scores were between 0 and 2 in 95.4% in the topical and in 94.2% in the retrobulbar group (p>0.05). Patient comfort was equal in both groups with 2.94 ± 0.92 in the topical group and 2.92 ± 0.99 in the retrobulbar group (p>0.05). Mean sedation requirements were similar in both groups: 26.4% of patients in the topical group and 19.2% in the retrobulbar group did not request any sedation (not significant, p>0.05).

Conclusions

Sedation requirements were similar for cataract surgery under topical and retrobulbar anesthesia.
The Prognostic Value of Post-Treatment Retinopathy after Panretinal Photocoagulation for Proliferative Diabetic Retinopathy in Type 1 Diabetes
Authors: Bek T. , Kjærgaard J.
Published: January 2018

Purpose

To study the prognostic value of post-treatment retinopathy after panretinal laser photocoagulation for proliferative diabetic retinopathy in type 1 diabetes mellitus. Proliferative diabetic retinopathy is treated with panretinal photocoagulation, which significantly reduces the risk of visual loss from this complication. However, no parameters are presently known that can be used to define an optimal control interval after the initial panretinal photocoagulation treatment that ensures enhancement of the treatment in cases where this is needed.

Methods

In this retrospective cohort study, 85 eyes from 56 type 1 diabetic patients were identified who had been subjected to panretinal photocoagulation for proliferative diabetic retinopathy before 1990. The patients were divided into two groups: Group 1 had four or fewer microaneurysms only at the first post-treatment examination whereas Group 2 had more retinopathy.

Results

At the first photographic examination after treatment the eyes in Group 1 had a significantly lower visual acuity (VA) (mean=0.23, range: 0.01–1.00) than the patients in Group 2 (mean=0.48, range: 0.01–1.6). During the follow-up period the VA was further reduced in Group 2 but not in Group 1. Three eyes out of six in Group 1 had improvement of VA from below to above 0.1, whereas 6 eyes out of 12 in Group 2 experienced progression of retinopathy with a consequent worsening of VA to below 0.1 after a mean of 10.8 years (range: 6.8–15.9) after treatment.

Conclusions

The severity of post-treatment retinopathy can be used to assess the need for enhancing photocoagulation of proliferative diabetic retinopathy in type 1 diabetes. The interval between post-treatment examinations can be increased to several years when the initial treatment has reduced retinopathy to a minimal level.
Intravitreal Triamcinolone Acetonide Injection as Primary Treatment for Diabetic Macular Edema
Authors: Özkiris A. , Evereklioglu C. , Erkiliç K. , Tamçelik N. , Mirza E.
Published: January 2018

Purpose

To evaluate the effectiveness of intravitreal triamcinolone injection on the course of diabetic macular edema.

Methods

Forty-eight eyes of 48 diabetic patients were treated with 8 mg of intravitreal triamcinolone injection as the primary therapy for diabetic macular edema. The main outcome measures included best-corrected visual acuity, fundus fluorescein angio- graphy, macular edema map values of Heidelberg Retinal Tomograph II (HRT II), and intraocular pressures before and after intravitreal injection.

Results

The visual acuity increased in 41 of 48 eyes (85.4%) during a mean follow-up time of 7.5 months. The mean baseline best-corrected logMAR (logarithm of minimal angle of resolution) value for visual acuities of the patients before intravitreal triamcinolone injection was 1.17±0.20. After treatment, it was 0.85±0.29 at 1 month, 0.73±0.30 at 3 months, and 0.74±0.31 at 6 months, and the differences were significant when compared with baseline values (for each, p<0.001). The mean edema map values significantly decreased by 36% at the 6-month examinations when compared with preinjection values (p<0.001). Average intraocular pressure rose 24.3%, 29.1%, and 11.8% from baseline at the 1-, 3-, and 6-month follow-up intervals. Intraocular pressure elevation exceeding 21 mmHg was observed in 8 of 48 eyes (16.6%), but was controlled with topical antiglaucomatous medications in all eyes.

Conclusions

Intravitreal triamcinolone application provides significant improvement in visual acuity of diabetic patients and clinical course of macular edema, and may therefore be a promising approach in the primary treatment of diabetic macular edema.
In Vitro Effect of Silicone Oil and Liquid Perfluorocarbons on Platelet Aggregation
Authors: Başlar Z. , Aras C. , Unal M. , Kayiran A. , Ustundag S. , Ozkan S.
Published: January 2018

Purpose

To study the in vitro effect of silicone oil of different viscosities and liquid perfluorocarbons on platelet aggregation.

Methods

Silicone oil with a viscosity of 5700 cs and 1000 cs and liquid perfluorocarbons of perfluoroperhydrophenantren and perfluorodecaline were studied to investigate the effect of these agents on platelet aggregation under in vitro conditions. The experiments were performed by using platelet rich plasma with an aggregometer. Aggregation was induced with three different agonists, including 5″-adenosine diphosphate (ADP), epinephrine (EPI), and collagen (Col). The results were obtained as a percentage of maximal aggregation and compared with controls using Kruskal-Wallis one way analysis of variance test.

Results

The tests with ADP as aggregating agent revealed that the percentage of maximal aggregation was a mean of 72.66±3.51% for ADP only, 58.66±3.05% for silicone oil of 1000 cs, 62.66±2.08% for silicone oil of 5700 cs, 56.00±7.00% for perfluoroperhydrophenantren, and 52.3±3.1% for perfluorodecaline. With EPI, aggregation was induced in all control samples with a mean of 76±9.54%. The mean percentage of maximal aggregation was 66.7±3.06 for silicone oil of 1000 cs, 72.33±5.5% for silicone oil of 5700 cs, 71.67±3.79% for perfluoroperhydrophenantren, and 70.33±2.52% for perfluorodecaline. With collagen, it was 86.67±1.53% for controls, 83.67±3.51% for silicone oil of 1000 cs, 85.33±4.51% for silicone oil of 5700 cs, 83.33±4.93% for perfluoroperhydrophenantren, and 81.33±4.16% for perfluorodecaline. Statistical analysis revealed no significant change in the percentage of maximal aggregation for all tested substances in the experiments.

Conclusions

Silicone oil of different viscosities and perfluoroperhydrophenantren and perfluorodecaline have minimal antiaggregating effect on platelets. The level of effect is not statistically significant.
Bioptics by Angle-Supported Phakic Lenses and Photorefractive Keratectomy
Authors: Leccisotti A.
Published: January 2018

Purpose

To assess efficacy and safety of the combination of angle-supported phakic intraocular lenses (IOLs) and photorefractive keratectomy (PRK) for the correction of myopia and astigmatism.

Methods

Prospective, non-randomized single-surgeon study on 48 patients (76 eyes) undergoing angle-supported phakic IOL implantation with surgical peripheral iridectomy, followed 2 to 3 months later by PRK to correct residual refractive error. Twenty-three patients (33 eyes) achieved good uncorrected visual acuity with IOL implantation alone and did not undergo PRK. Thus, the study was completed by 25 patients (43 eyes) with preoperative mean defocus equivalent (DEQ) of 15.73 D (SD 4.67 D) and mean astigmatism of −2.87 D (SD 1.39 D).

Results

Eight months after PRK, mean spherical equivalent was −0.08. Mean DEQ was 0.47 D (SD 0.37); 42/43 eyes (98%) were within ±1 D of DEQ, and 33/43 eyes (77%) within ±0.5 D. Mean uncorrected visual acuity was 0.7 (SD 1.9). Safety index was 1.25; efficacy index 1.11. Best-corrected visual acuity improvement (0.16) was statistically significant (95% CI: 1.1 to 2). Halos were moderate in 6/25 patients (24%); severe in 1/25 patients (4%). Endothelial cell density decreased by −6.6%. Pain after PRK was severe in 3/25 patients (12%) and moderate in 13/25 patients (52%). Complications were recurrent iridocyclitis in one eye, transient ocular hypertension in two eyes, and incomplete iridectomy in one eye.

Conclusions

Angle-supported phakic IOLs followed by adjustment by PRK offer good efficacy, predictability, and safety to manage large refractive myopic errors.
Patient Satisfaction and Vision Improvement after Multiple Surgery for Recurrent Retinal Detachment
Authors: Lesnoni G. , Rossi T. , Gelso A. , Nistri A.
Published: January 2018

Purpose

To assess patient satisfaction and functional status improvement after multiple surgery for recurrent retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C. Main outcome measures included visual acuity (VA), anatomic outcome, and patients' answers to a standardized multiple-choice questionnaire.

Methods

The authors retrospectively reviewed records of patients undergoing pars plana vitrectomy (PPV) for RRD with PVR grade C operated between 1997 and 1999. All included patients underwent a standardized telephone interview aimed at assessing the patients' visual performance and satisfaction. Statistical analysis used Wilcoxon signed-rank test, Mann-Whitney rank sum test, and Spearman rank correlation coefficient. p Values less than 0.05 were considered statistically significant.

Results

The population study included 62 patients with an average 19 ± 4.1 months follow-up. The average number of operations was 2.9 ± 0.7 with 1.45 ± 0.50 recurrences. At the end of the study, 40/62 eyes had better than 5/400 vision and 14/62 better than 20/200; 2 patients had no light perception and 5 eyes still had RRD. Questionnaire answers yielded the following results: 61% believed their VA was better than before surgery, 13% the same, and 26% worse. Fifty-two percent noticed an improvement in binocular vision versus 35% stable and 13% worse: 84% thought their result had been worth the operation, 15% did not, and 2% did not know. Ninety percent believed the information they received before surgery was accurate. Results exceeded expectations in 35% of cases and matched them in 26%. Increase in binocular visual performance after intervention was significant for clothing, bathing, and home deambulation, climbing steps, watching TV, and reading, but not for car driving. The difference in VA improvement in satisfied and unsatisfied patients was significant. There was no significant correlation between patients' satisfaction and fellow-eye vision.

Conclusions

The sample population showed a high rate of satisfaction and significant subjective improvement on four out of five tested activities, despite multiple surgeries and overall poor outcome, even in patients with a good VA in fellow eye. Many other factors such as visual field and contrast sensitivity improvement, not investigated by the authors, can play an important role in the visual functional status. Correct and extensive patient information remains critical in such settings.
Subcutaneous Tumor of the Lower Eyelid: A Potential Manifestation of a Dirofilaria Repens Infection
Authors: Siepmann K. , Wannke B. , Neumann D. , Rohrbach J.M.
Published: January 2018

Purpose

To report a case of Dirofilaria repens presenting as a subcutaneous tumor of the lower eyelid.

Methods

Interventional case report.

Results

A 29-year-old man of Greek origin without systemic symptoms presented with a 3-week history of a small painless mass localized in the medial part of the lower eyelid. There was no history of a preceding trauma, injury, or visual impairment; however, the patient had recently been on a holiday in Italy. The lesion persisted after systemic antibiotic treatment. Routine blood tests were normal and the efferent tear ducts were patent. Upon surgical intervention a yellowish, pea-sized cyst-like structure was found beneath the orbicularis muscle and removed in toto. Histologic examination revealed the presence of a wormlike structure with the characteristic features of a single adult Dirofilaria repens nematode.

Conclusions

Infection with the nematode Dirofilaria repens has to be considered in the differential diagnosis of malignant and benign tumors of subcutaneous periocular tissues in patients who traveled to endemic areas.
Multiple Bilateral Choroidal Metastatic Tumors from a Small-Cell Neuroendocrine Carcinoma of Unknown Primary Site
Authors: Nicolò M. , Piccolino F.C. , Ghiglione D. , Nicolò G. , Calabria G.
Published: January 2018

Purpose

To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary.

Methods

The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented.

Results

The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identiy the primary site.

Conclusions

Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe thic case together with a review of the literature.
Indocyanine Green Angiography in Congenital Hypertrophy of the Retinal Pigment Epithelium
Authors: Giuffrè G.
Published: January 2018

Purpose

To report a case of congenital hypertrophy of the retinal pigment epithelium followed up for 7 years showing features not previously reported.

Methods

A complete fundus examination including fluorescein angiography was performed at first examination and at follow-up.

Results

The area of congenital hypertrophy of the retinal pigment epithelium presented morphologic changes, showing enlargement of the lesion on one side associated with partial regression on another side. In addition, the indocyanine green angiography findings revealed that this test was more useful than fluorescein angiography to delineate the real boundaries of the lesion and disclosed hypofluorescent areas inside the main lesion that were not appreciated at ophthalmoscopy or fluorescein angiography.

Conclusions

Indocyanine green angiography is an useful test to understand the findings and evolution of congenital hypertrophy of the retinal pigment epithelium.
Balloon Dilatation for Treatment of Congenital Nasolacrimal Duct Obstruction
Authors: Yüksel D. , Ceylan K. , Erden O. , Kiliç R. , Duman S.
Published: January 2018

Purpose

To evaluate the safety and effectiveness of balloon dacryocystoplasty in the treatment of congenital nasolacrimal duct obstructions.

Methods

Balloon dacryocystoplasty was attempted in 25 eyes of 21 patients. The procedure was performed successfully in 24 eyes of 20 patients, age range 21–72 months. Nineteen eyes had no previous procedure. The mean age of this group was 43.9 months (range 36–72 months). Five eyes had failed probing of lacrimal system. The mean age of this group was 22.2 months (range 21–24 months). The authors performed balloon dacryocystoplasty under endoscopic guidance. Clinical success was defined as complete remission of epiphora within follow-up period of 7–34 months (mean 25.2 months).

Results

The authors performed balloon dacryocystoplasty in 24 eyes. The first procedure was successful in 20 of them and the clinic success rate was 83.3%. The technique was repeated in the one eye that recurred and as it ended successfully, the clinic success rate increased to 87.5%. In 17 of the 19 eyes (89.4%) in which balloon dacryocystoplasty was performed primarily, and in 4 of 5 eyes (80%) in which balloon dacryocystoplasty was performed secondarily after unsuccessful probing, the procedure was clinically successful. There was intermittent epiphora in 3 eyes (15%) and these were considered as recurrence.

Conclusions

This experience shows that balloon dilatation is a safe and effective treatment of congenital nasolacrimal duct obstruction as a primary procedure in children over 36 months of age and as a secondary procedure after failure of lacrimal system probing. As a result, balloon dacryocystoplasty can be an alternative treatment in older children and can be preferred to silicone intubation and dacryocystorhinostomy performed after unsuccessful probing.
Corneal Graft Rejection after Penetrating Keratoplasty for Keratoconus in Turner's Syndrome
Authors: Pinna A. , Salvo M. , Dore S. , Carta F.
Published: January 2018

Purpose

To report a patient with Turner's syndrome who developed graft rejection after penetrating keratoplasty (PK) for keratoconus and to review the ophthalmic literature on the association between keratoconus and Turner's syndrome.

Methods

A woman with bilateral keratoconus and Turner's syndrome (45,XO) was referred for progressive visual loss in the right eye. Best-corrected visual acuity was 20/400 in the right eye. Slit-lamp examination revealed corneal thinning with ectatic protrusion of the central cornea and Vogt's striae in the right eye. The patient underwent PK in the right eye in January 2001. She developed graft rejection in April 2003 and visual acuity dropped to hand motion. After treatment with topical and systemic steroids and systemic cyclosporine A, visual acuity recovered to 20/80 in July 2003.

Results

The authors know of only three other reported patients (six eyes) with keratoconus in Turner's syndrome. Five eyes underwent PK with good visual rehabilitation, but one developed immunologic graft rejection 7 years after surgery. On the whole, considering the current report and the other cases described in the literature, graft rejection occurred in 2 out of 6 eyes (33.3%). The graft survival rate was 80% after 2 years and 40% after 7 years.

Conclusions

The results suggest that grafts for keratoconus in patients with Turner's syndrome might have an increased risk of immunologic rejection. Corneal grafts in Turner's syndrome need to be monitored closely. Early detection of graft rejection and aggressive treatment with topical and systemic steroids and systemic cyclosporine A can save the graft and restore useful vision.
The Clinicopathologic Basis of Graves' Ophthalmopathy: A Review
Authors: Kloprogge S. , Kowal L. , Wall J. , Frauman A.G.
Published: January 2018

Purpose

Graves' ophthalmopathy (GO) is a controversial disease, with disagreement within the medical community regarding its pathogenesis, diagnosis, and treatment.

Methods

We reviewed recent literature on clinical and pathological aspects of GO from both the endocrinologist's and ophthalmologist's perspective.

Results

Investigations into the pathogenesis of GO have included possible antigenic targets, orbital cell types, and development of animal models. Diagnosis has been improved recently with new tools and grading systems, but can be complicated by conditions that may simulate one or more of the findings of GO. The new findings of clinical studies also compel practitioners to reassess commonly used GO treatments such as orbital irradiation.

Conclusions

Improved understanding of the pathogenic mechanisms of GO should hopefully lead to new diagnostic and therapeutic approaches to this problematic condition.
Discrimination between Normal and Glaucomatous Eyes with Scanning Laser Polarimetry and Optic Disc Topography: A Preliminary Report
Authors: Magacho L. , Marcondes A.M. , Costa V.P.
Published: January 2018

Purpose

To test the ability of structural parameters (as measured by scanning laser polarimetry (SLP) software 1.0.12 and confocal scanning laser ophthalmoscopy (CSLO) to discriminate between normal and glaucomatous eyes.

Methods

A total of 112 patients with primary open-angle glaucoma and 88 normal individuals were enrolled in the study. All individuals underwent a thorough ophthalmic evaluation, a 24–2 full threshold Humphrey visual field, SLP with the GDx, and CSLO with the TOPSS. Patients with marked cataract or low vision were excluded from the study. Cut-off points were selected and receiver operator characteristic (ROC) curves were created for each individual CSLO and SLP parameter. Finally, multivariate discriminant formulas were developed in order to achieve a better sensitivity (Se)/specificity (Sp) ratio for the diagnosis of glaucoma, initially separately for each device, and then combining parameters from CSLO and SLP.

Results

The mean deviation for the glaucoma group was −10.63 ±7.58 dB. Multivariate discriminant formulas resulted in better sensitivity/specificity ratios than any individual parameter, either for CSLO (Se: 90%; Sp: 81%; accuracy: 86%) or SLP (Se: 87%; Sp: 86%; accuracy: 86%). The multivariate formula combining parameters from both devices resulted in an improvement in the ability to diagnose glaucoma. An area under the ROC curve of 0.97 was obtained, with a sensitivity of 93%, a specificity of 91 %, and an accuracy of 92%.

Conclusions

The combination of structural parameters derived from CSLO and SLP in a multivariate discriminant formula may enhance the ability to diagnose glaucoma. Further studies investigating a random population are needed in order to test the validity of this formula.
Response Time and Safety Profile of Pulsed Oral Methotrexate Therapy in Idiopathic Retinal Periphlebitis
Authors: Bali T. , Saxena S. , Kumar D. , Nath R.
Published: January 2018

Purpose

To evaluate the response time and safety profile of low-dose oral methotrexate pulsed therapy in idiopathic retinal periphlebitis (Eales' disease).

Methods

A tertiary care center-based prospective interventional study, based on visual acuity grading, was undertaken. Twenty-one consecutive patients with idiopathic retinal periphlebitis were administered 12.5 mg methotrexate as a single oral dose, once per week for 12 weeks (cumulative dose = 150 mg). Each patient was assessed for change in visual acuity grades. Time of first therapeutic response was also noted. Drug safety was monitored by laboratory tests that included twice-weekly white blood cells and differential counts, twice-weekly platelet counts, and monthly liver function tests.

Results

Twenty-one eyes were assessed. Mean follow-up period was 6 months. All showed improvement in visual acuity grades. An excel lent visual outcome (6/6 or better) was achieved in 18 (69%) eyes. Time of first therapeutic response varied from 2 to 6 weeks with a majority of eyes (80%) showing response by 4 weeks (median = 3 weeks). All the side effects of methotrexate were mild or moderate in severity and rapidly reversible on dose reduction or discontinuation. No patient had any constitutional symptoms severe enough to necessitate cessation of therapy.

Conclusions

Low dose oral methotrexate pulse therapy (at a dose of 12.5 mg/week) is clinically effective within 4 weeks, and is associated with an acceptable safety profile.
Visual Phenotype of Multiple Sclerosis in the Afro-Caribbean Population and the Influence of Migration to Metropolitan France
Authors: Merle H. , Smadja D. , Merle S. , Olindo S. , Signate A. , Donnio A. , Richer R. , Bonnan M. , Cabre P.
Published: January 2018

Purpose

To describe the visual phenotype of multiple sclerosis (MS) in the Afro-Caribbean population living in Martinique (French West Indies) and to specify the influence of the migration to metropolitan France on ocular impairment.

Design

Prospective consecutive observational case series.

Methods

A complete ophthalmologic examination was performed. Participants. A total of 112 patients of Afro-Caribbean origin with MS satisfying McDonald's diagnostic criteria, divided into 53 cases (47.3%), the non-migrant patients (group NM), who had never left the Caribbean basin, and 59 cases (52.7%), the migrant patients (group M), who had lived in metropolitan France for at least 1 year before age 15.

Results

MS first manifested as an impairment of the optic nerve in 41 cases (36.6%): 25 cases (47.1%) in group NM and 16 cases (27.1%) in group M. Visual function was recovered in 13/25 cases (52%) in group NM compared to 13/16 cases (81%) in group M. Two-thirds of patients presented with a clinical ocular impairment, which was bilateral in 58.5% of cases in group NM. Fourteen cases (12.5%) met the criteria of neuromyelitis optica, nine cases (17%) in group NM and five cases (8.5%) in group M. In group NM, when the initial visual attack did not regress, the visual Expanded Disability Status Scale (EDSS) score was 5±1.5; 75% of patients had monocular blindness and 50% binocular.

Conclusions

In the non-migrants (group NM), MS manifested more frequently with an optical neuropathy, the ocular impairment was more severe, and corresponded to neuromyelitis optica in 17% of the cases; a visual presentation and the absence of complete recovery from the first attack represented a factor of poor prognosis. This series is the largest description of the visual phenotype of MS in patients of African origin. The results confirm the preferential impairment of the optic nerve in the black population in the course of the disease. The migration towards an area of high prevalence of MS influences the visual phenotype in terms of a lower incidence and less severe prognosis of ocular impairment.
Spontaneous Fracture of an Implanted Posterior Chamber Intraocular Lens
Authors: Çaça I. , Ünlü K. , Ari S. , Aksit I.
Published: January 2018

Purpose

Spontaneous fracture of an intraocular lens (IOL) haptic is a rare complication of cataract surgery. The authors report a case of spontaneous fracture of an implanted posterior chamber IOL.

Case

Five years ago, a 12-year-old patient underwent linear lens extraction, posterior capsulotomy, and anterior vitrectomy due to traumatic cataract and received a polymethyl methacrylate (PMMA) biconvex posterior chamber IOL implanted in ciliary sulcus. Five years later, IOL optic was found in anterior chamber with its haptics broken from the optic-haptic junction.

Discussion

The broken haptic was examined with scanning electron microscopy. The fracture site of the haptic was on the optic-haptic junction. The fractured surface had a regular appearance.

Conclusions

To our knowledge, this is the fourth report of spontaneous fracture of an implanted posterior chamber IOL.
Immune Recovery Uveitis and Human Leukocyte Antigen Typing: A Report on Four Patients
Authors: Modorati G. , Miserocchi E. , Brancato R.
Published: January 2018

Purpose

To report the typing of human leukocyte antigen (HLA) in four human immunodeficiency virus-positive (HIV) patients with immune recovery uveitis (IRU).

Methods

The medical history of four consecutive patients who presented at the Ocular Immunology and Uveitis Service (University Hospital San Raffaele, Milan, Italy) with definite diagnosis of IRU is reported. The HLA typing was tested in all patients.

Results

All patients presented the clinical and ophthalmological characteristics of IRU. The HLA typing analysis showed the presence of HLA B 8–18 in all patients.

Conclusions

The data obtained from these patients indicate the presence of the same HLA typing (B 8–18). The clinical relevance of such association needs to be further evaluated.
Long-Term Clinical Results of Selective Laser Trabeculoplasty in the Treatment of Primary Open Angle Glaucoma
Authors: Weinand F.S. , Althen F.
Published: January 2018

Purpose

To investigate the long-term efficacy of selective laser trabeculoplasty (SLT) in primary open-angle glaucoma, the authors performed a non-randomized, prospective, non-comparative clinical case series.

Methods

Fifty-two eyes of 52 patients (19 male, 33 female) with primary open angle glaucoma were treated with SLT. Patients were treated with the Coherent Selecta 7000 (Coherent, Palo Alto, CA, USA) frequency-doubled q-switched Nd:YAG laser (532 nm). A total of approximately 50 non-overlapping spots were placed over 180° of the trabecular meshwork at energy levels ranging from 0.6 to 1.4 mJ per pulse. After surgery, patients were maintained with the drug regimen identical to that before treatment.

Results

After 1 year the average reduction in intraocular pressure (IOP) from the baseline was 24.3% (6.0 mmHg), after 2 years 27.8% (6.12 mmHg), after 3 years 24.5% (5.53 mmHg), and after 4 years 29.3% (6.33 mmHg). A Kaplan-Meier survival analysis revealed a 1-year success rate of 60%, a 2-year success rate of 53%, a 3-year success rate of 44%, and a 4-year success rate of 44%.

Conclusions

Despite a declining success rate, SLT is an effective method to lower IOP over an extended period of time.
Hereditary Hyperferritinemia Cataract Syndrome: Ocular, Genetic, and Biochemical Findings
Authors: Ismail A.R. , Lachlan K.L. , Mumford A.D. , Temple I.K. , Hodgkins P.R.
Published: January 2018

Purpose

To describe the cataract morphology and genetic and biochemical findings in a four-generation family with hereditary hyperferritinemia cataract syndrome (HHCS).

Methods

Family members of the proband with HHCS were investigated. DNA sequencing was carried out to identify the iron responsive element (IRE) of the L-ferritin gene in affected and non-affected family members. Molecular modeling allowed prediction of the structure of the mutant IRE in affected cases. Serum ferritin and transferrin saturation were determined using standard methods. All family members underwent slit lamp examination by an ophthalmologist to document presence of cataract or lens status. Cataract morphology was documented where present.

Results

This family with HHCS had the genetic heterozygous mutation G32C in the IRE of the L-ferritin mRNA. Lens opacities were detectable in young members of the family, and morphology of cataracts was consistent with previous reports. Biochemical testing demonstrated high serum ferritin levels in affected individuals.

Conclusions

The morphology of cataracts in HHCS seems to be similar in all cases. In the heterozygous G32C mutation, the age at onset of cataracts is very early. Greater awaeness of this condition among ophthalmologists will lead to effective family counseling of those affected, by genetic testing or simple biochemical tests. Serum ferritin levels can be effectively used to screen for this condition in suspected families.
Sympathetic Ophthalmia in VATER Association Combined with Persisting Hyperplastic Primary Vitreous after Cyclodestructive Procedure
Authors: Jonas J.B. , Back W. , Sauder G. , Jünemann U. , Harder B. , Spandau U.H.
Published: January 2018

Purpose

To report on the occurrence of histology-proven sympathetic ophthalmia in a patient with VATER association and persisting hyperplastic primary vitreous (PHPV) after a cyclodestructive procedure was performed to treat secondary angle-closure glaucoma.

Methods

The left eye of a 13-year-old boy with VATER association was microphthalmic from birth and had been diagnosed with PHPV at age 1 year. It developed iris neovascularization and secondary angle-closure glaucoma, which was treated by combined cyclocryocoagulation and cyclophotocoagulation. Six weeks later, a bilateral fibrinous iritis developed. Despite intensive topical and systemic steroid treatment, the iritis persisted so that the left blind eye was enucleated.

Results

Histology of the enucleated eye showed a marked intraocular inflammation with lymphocytes, epithelioid cells, and multinuclear giant cells grouped around remnants of melanin-bearing cells.

Conclusions

Sympathetic ophthalmia may occur in patients with VATER association and PHPV after a secondary angle-closure glaucoma is treated by a combined cyclocryocoagulation and cyclophotocoagulation.
Burkitt's Lymphoma Presenting as Oculomotor Palsy in an HIV-Positive Patient
Authors: Levy J. , Kratz A. , Lifshitz T.
Published: January 2018

Purpose

To report a case of Burkitt's lymphoma (BL) in an HIV-positive patient presenting as complete third nerve palsy.

Methods

Interventional case report. A 34-year-old man presented with headache, left eye pain, diplopia, and complete ptosis of several hours’ duration. Left eye examination disclosed complete third nerve palsy with pupillary involvement. Significant hepatomegalia was noted at physical examination and computed tomography (CT) scan of the abdomen showed multiple solid lesions.

Results

Liver biopsy was consistent with Burkitt's lymphoma. Bone marrow biopsy was normal. Brain imaging was normal. Work-up also revealed positivity for human immunodeficiency virus. Chemotherapy treatment was started. Two months later, ocular motility examination was normal.

Conclusions

Although BL affects the central nervous system very rarely, BL should be considered in any immunosuppressed patient presenting with diplopia or ophthalmoparesis.
Mikulicz's Disease: A New Perspective and Literature Review
Authors: Lee S. , Tsirbas A. , Mccann J.D. , Goldberg R.A.
Published: January 2018

Purpose

To report the clinical and pathophysiologic features of two patients with Mikulicz's disease and to further characterize recommendations for diagnosis and management with a review of the literature.

Methods

Retrospective nonrandomized consecutive case series, Jules Stein Eye Institute, David Geffen School of Medicine at UCLA.

Results

Mikulicz's disease is characterized by symmetric lacrimal, parotid, and submandibular gland enlargement with associated lymphocytic infiltrations. The authors noted two cases of Mikulicz's disease. The diagnosis of Mikulicz's disease was based on the following criteria: 1) symmetric and persistent swelling of the lacrimal glands and either or both of the major salivary glands (parotid and submandibular); and 2) the exclusion of other diseases that may mimic this presentation, such as sarcoidosis, viral infection, or lymphoproliferative disorders.

Conclusions

Mikulicz's disease is a condition in which there is bilateral lacrimal and salivary gland swelling that is not associated with other systemic conditions. The condition is self-limiting and most often, the diagnosis is a clinical one. Previously, Mikulicz's disease was often considered as a subtype of Sjögren's syndrome (SS). Clinical and immunologic differences between Mikulicz's disease and SS may warrant further consideration of Mikulicz's disease as a specific autoimmune phenomenon separate from SS, and Mikulicz's disease may be amenable to different treatment modalities than those employed in patients with SS.
The Comparison of Eyelash Lengthening Effect of Latanoprost Therapy in Adults and Children
Authors: Elgin U. , Batman A. , Berker N. , Ilhan B.
Published: January 2018

Purpose

To compare the eyelash lengthening effect of latanoprost in adults and children with glaucoma.

Methods

Twenty eyes of 13 men and 7 women (mean age: 54.9, range 42–69 years) with primary open-angle glaucoma and 20 eyes of 9 boys and 11 girls (mean age: 10.7, range 6–16 years) with glaucoma were included in this prospective study. In 19 children, juvenile glaucoma and in one, pseudophakic glaucoma had been detected. A single eyelash was pulled from the center of the upper eyelid before latanoprost therapy and at the sixth month of therapy, and measured.

Results

In adult cases, the mean eyelash length was 5.79±0.18 mm (5.5–6.1 mm) at baseline and 6.45±0.21 mm (6.2–6.8 mm) at the sixth month. In children, the mean length was 5.66±0.22 mm (5.3–6.0 mm) at baseline and 6.39±0.37 mm (5.9–6.9 mm) at the sixth month. The mean difference in eyelash lengths at baseline and the sixth month was 0.67±0.09 mm (0.5–0.7 mm) in adults and 0.75±0.25 mm (0.4–1.2 mm) in children.

Conclusions

The differences in mean eyelash lengths at baseline and at the sixth month of latanoprost therapy were statistically significant in both adults and children (p=0.000). The mean of the difference of the eyelash length in children was higher than in adults but the result was not statistically significant (p=0.678).
Reproducibility of Keratometric Measurements Decreases with Time after Blinking
Authors: Erdélyi B. , Csákány B. , Németh J.
Published: January 2018

Purpose

The reproducibility of keratometry measurements was investigated in relation to the elapsed time after blinking.

Methods

Thirty ophthalmologically healthy subjects were examined, using a standard corneal topographic instrument (17 women, 13 men, age 25.7±5.6 years). Photographs were taken in series of four: at 5, 15, 30, and 60 seconds after a complete blink. The series was repeated three times in each individual. The main outcome measures were the mean values, the standard deviation, and the reproducibility error of the simulated keratometric values (K1, K2), the surface regularity index (SRI), and the surface asymmetry index (SAI).

Results

The mean of K1 and K2 values did not change (p=0.684 and p=0.982); however, the measurement error increased significantly for K1 (p=0.007) and for K2 (p=0.038). The mean values of SRI changed significantly (p=0.034) during the 1-minute pause in blinking together with a non-significant change in the standard deviation (p=0.106), without elevation of the measurement error (p=0.619). The elevation of SAI with time was not significant (p=0.093).

Conclusions

The break-up phenomenon of the tear film at the ocular surface induces significant deterioration of the reliability of keratometric measurements on prolonged gaze without blinking. The created error can exceed 0.6 D, which is unacceptably high in practice. Therefore care should be taken to avoid such circumstances during the examination.
Prophylaxis against Infection in Cataract Surgery: A Survey of Routine Practice
Authors: Ang G.S. , Barras C.W.
Published: January 2018

Purpose

To survey the routine practice of consultant ophthalmic surgeons in the United Kingdom in preventing postoperative endophthalmitis following cataract surgery.

Methods

This is a cross-sectional questionnaire-based study. A questionnaire was sent to consultant ophthalmic surgeons in university teaching hospital ophthalmology departments in the United Kingdom.

Results

Questionnaires were sent to 391 consultant ophthalmic surgeons in 36 ophthalmology departments. The response rate was 55.0% (215 responses). Eleven (5.1%) did not perform cataract surgery routinely. Of the remaining 204 respondents, all performed phacoemulsification as routine. A total of 28 (13.7%) reported a 0% rate of postoperative infective endophthalmitis. Preoperative topical antibiotics were routinely prescribed by 12 respondents (5.9%). The most common immediately preoperative measure was the usage of povidone iodine (203 respondents, 99.5%). A total of 19 (9.3%) used an antibiotic infusion during surgery. Postoperative subconjunctival antibiotics were given by 138 (67.6%), most commonly cefuroxime. A total of 33 (16.2%) administered postoperative intracameral antibiotics. A total of 141 (69.1%) prescribed topical antibiotics after surgery, most commonly neomycin. None gave systemic antibiotics routinely pre-or postoperatively.

Conclusions

The results show a wide variation of prophylactic measures used in the United Kingdom. The routine practices adopted reflect personal preferences, and were not necessarily evidence-based. Further prospective studies are required to provide evidence for the efficacy of these prophylaxis techniques.
Evolution of Retinal Pigment Epithelium Detachment after Photodynamic Therapy for Choroidal Neovascularization in Age-Related Macular Degeneration
Authors: Theodossiadis G.P. , Grigoropoulos V.G. , Emfietzoglou I. , Nikolaidis P. , Panagiotidis D. , Vergados I. , Theodossiadis P.G.
Published: January 2018

Purpose

To report a case of pigment epithelium detachment (PED) which appeared after photodynamic therapy (PDT) and was followed up for 50 months.

Methods

Case report.

Results

A 71-year-old woman with occult choroidal neovascular membrane due to age-related macular degeneration (ARMD) developed PED 48 hours after PDT. The patient was studied with fluorescein angiography (FA) and optical coherence tomography (OCT). Fluorescein angiographic evidence of PED remained essentially unchanged during the follow-up period of 50 months. Although OCT initially gave clear evidence of PED, in the last 12 months of follow-up the PED appears to have resolved.

Conclusions

Photodynamic treatment could be involved in the occurrence of PED in occult choroidal neovascular membrane due to ARMD. In this particular case OCT could be considered since it offers useful information in the pretreatment and the post-treatment follow-up period.