bluuebunny/crossref_metadata_2025 huggingface dataset:
Penetration of Betaxolol HCL Ionic Suspension 0.25% and Betaxolol HCL Solution 0.50% into the Aqueous Humor
Authors: Yalvac I. Sagdic , Basci N.E. , Dulger B. , Duman S.
Published: January 2018

Purpose.

To determine the intraocular penetration of topical drops of betaxolol HCl 0.25% suspension and betaxolol HCl 0.50% solution into the aqueous humor.

Methods.

Fifteen patients were randomly assigned to receive topical betaxolol HCl 0.25% suspension (n=7) or topical betaxolol HCl 0.50% solution (n=8) the day before cataract surgery. Aqueous samples were collected 2 hours after the administration of the morning dose during cataract surgery. Drug concentrations were determined by high-performance liquid chromatography with fluorescence detection.

Results.

The mean aqueous humor concentration of topical betaxolol HCl 0.25% suspension was 275.1±168.8 μg/mL (range 570–70 μg/mL) and the mean aqueous humor concentration of topical betaxolol HCl 0.50% solution was 195.4±102.4 μg/mL (range 334–50 μg/mL) (p=0.281).

Conclusions.

The mean aqueous humor concentration of betaxolol 0.25% suspension was higher than betaxolol 0.50% solution; however, the difference was not statistically significant. With twofold reduced concentration and similar anterior chamber penetration, betaxolol 0.25% suspension could be first choice for β1 selective blocker therapy when considered for patients with glaucoma.
Optic Nerve Alterations in P27Kip1 Knockout Mice
Authors: Lopez-Sanchez E. , Frances-Muñoz E. , Chaques V. , Sanchez-Benavent M.L. , Menezo J.L.
Published: January 2018

Purpose.

To study the morphologic characteristics of the optic nerve (ON) by using an experimental model of knockout mice for the expression of the P27Kip1 gene, mainly involved in cell cycle arrest, apoptosis control, and retinoblastoma protein phosphorylation.

Methods.

Eyeballs with the retrobulbar ON attached were obtained from 26-week-old mice. By using morphologic and morphometric techniques, light and electron transmission microscopy, the ON characteristics were determined in two groups of mice: 1) wild type mice as the control group (n=15), 2) homozygous knockout mice (-/-) for the P27Kip1 gene as the knockout group (n=15). Glial fibrillary acidic protein (GFAP) and myelin basic protein (MBP) were studied using Western blot and immunoblotting approaches.

Results.

The ON cross-sectional area was significantly larger in the P27Kip1 knockout mice group than in the control group (p<0.001). The axon sizes in knockout animals were much larger than in wild-type mice (p<0.001). Higher number of axons forming the ON, intra-axonal degeneration, myelin sheath, and axoplasm density alterations were found in P27Kip1 knockout mice when compared with control group (p<0.001). Analysis of lysates of optic nerves by Western blot showed less expression of myelin basic protein and GFAP in P27Kip1 knockout mice as compared to wild type mice (p<0.005, p<0.01, respectively).

Conclusions.

The morphologic and morphometric results suggest that homozygous P27Kip1 knockout mice had hypertrophic, hyperplastic, and dystrophic ON.
Biometric Indices Evaluation in Central Retinal Vein Occlusion using Partial Coherence Laser Interferometry
Authors: Moghimi S. , Mirshahi A. , Lasheie A. , Maghsoudipour M. , Beheshtnejaad A.
Published: January 2018

Purpose.

To evaluate the association of axial length and posterior segment length with central retinal vein occlusion (CRVO) using optical coherence interferometry.

Methods.

The study group consisted of 29 patients (13 female and 16 male) with unilateral CRVO who were referred to Farabi Eye Hospital. Patients with macular edema were excluded. The mean keratometry (mean K), axial lengths (AL), anterior chamber depths (ACD), and posterior segment lengths (PSL, defined by AL - ACD) of affected and fellow eyes were measured using optical coherence interferometry.

Results.

Age range was 45 to 74 years (mean 59.2 ± 7.5 years). The mean K of affected eyes was not statistically significantly lower than that of unaffected eyes in the CRVO group. This was also true for ACD. Although affected eyes had shorter axial length (23.26 mm vs 23.33 mm), the difference was not significant. There was a statistically significant difference in PSL affected and unaffected eyes (20.15 mm vs 20.26 mm) (p=0.008).

Conclusions.

Posterior segment length of eyes with CRVO may be shorter than unaffected eyes. This may predispose them to more crowding of central retinal vein and artery in lamina cribrosa, and developing CRVO.
Phakic Intraocular Lenses after Scleral Buckling for Retinal Detachment
Authors: Leccisotti A.
Published: January 2018

Purpose.

To assess efficacy and safety of angle-supported phakic intraocular lenses (PIOL) implanted after scleral buckling for retinal detachment.

Setting.

Private practice in Siena, Italy.

Methods.

Retrospective, noncomparative consecutive case series. Inclusion criteria for retrospective evaluation were previous uncomplicated external retinal detachment surgery (scleral buckling), and a complete follow-up superior to 3 years from PIOL implantation.

Results.

Nine eyes of seven patients were included. Mean time interval between retinal detachment surgery and PIOL implantation was 3.2 years ± 4.5 (range 1 to 15). Mean spherical equivalent (SE) before PIOL implantation was −16.36 D ± 3.98; range: −11.75 to −23. PIOL surgery was uneventful in all cases. Mean SE after PIOL implantation was −0.99±0.51 (95% confidence interval for the mean: −0.59 to −1.39). Mean follow-up after PIOL implantation was 4.2 years ± 0.8 (range 3 to 5). Complications were pupil ovalization (inferior to 1 mm) in two eyes, and worsening of floaters in both eyes of one patient. No recurrences of retinal detachment were observed.

Conclusions.

In selected eyes with no anterior chamber abnormalities, the implantation of angle supported PIOL after scleral buckling for retinal detachment is associated with good refractive results and minor complications.
Serum Prolactin Levels and Behçet Disease
Authors: Proença H. , Ferreira C. , Miranda M. , Castanheira-Dinis A. , Monteiro-Grillo M.
Published: January 2018

Purpose.

To evaluate serum prolactin levels in Behçet disease (BD) and correlate with phenotypic expression of the disease.

Methods.

This was a prospective, nonrandomized comparative trial. Twenty-two patients fulfilling BD Research Committee criteria and 21 healthy control subjects were included. Patients were classified in complete-type or incomplete-type BD subgroups according to clinical characteristics such as recurrent oral ulcers, genital ulcers, skin lesions, and ocular disease. Age, sex, HLA phenotyping, and therapy were recorded for comparative analysis between groups. Serum prolactin levels were determined by electrochemiluminescence immunoassay on a Modular Analytics E170 analyzer.

Results.

Prolactinemia was significantly higher (mean=19.34 ng/mL) in BD patients vs controls (mean=9.83 ng/mL) (p=0.009). This value was also statistically higher in complete-type BD subgroup vs controls (p=0.02). Younger patients (<30 y) required corticosteroids plus immunosuppressives more often (75%), suggesting an association between age and disease severity, although not statistically significant.

Conclusions.

Results suggest the role of prolactin in BD pathogenesis and its association with disease expression, especially in complete-type BD.
Triaging and Coding Ophthalmic Emergency - the Rome Eye Scoring System for Urgency and Emergency (RESCUE): A Pilot Study of 1000 Eye-Dedicated Emergency Room Patients
Authors: Rossi T. , Boccassini B. , Iossa M. , Mutolo M.G. , Lesnoni G. , Mutolo P.A.
Published: January 2018

Purpose.

Ophthalmic emergency (OE) triage is essential for prompt recognition of urgent cases. To date, no formal eye-dedicated triaging system has been widely accepted. The purpose of the present study is to propose a fast, accurate, and reproducible coding scale called the Rome Eye System for Scoring Urgency and Emergency (Rescue).

Methods.

Phase 1 of the study is a retrospective analysis of electronic medical records (EMR); phase 2 is a prospective consecutive series. Phase 1 included 160,936 patients. Phase 2 included 1000 consecutive patients referred to the emergency department (ED) of our institution. In phase 1, the authors retrospectively analyzed EMRs of patients presenting to the ED, listing signs and symptoms most frequently associated with hospitalization. Redness, pain, loss of vision, and the risk for an open eye were identified and assigned a score ranging from 0 to 12. Color coding was assigned based on increasing scoring: 0–3 white, 4–7 green, 8–12 yellow code. In phase 2, 1000 consecutive ED patients were enrolled and prospectively coded according to RESCUE. After diagnosis and proper treatment, EMRs were retrospectively reviewed by a masked physician and patients recoded (Retro coding) according to clinical course. Correlation between Rescue and Retro coding was calculated.

Main outcome measures:

Prospective and retrospective ED color coding correlation.

Results.

A total of 160,936 EMR were retrospectively analyzed; 2407 (1.4%) patients required hospitalization. Loss of vision (90%), redness (76%), and pain (47%) were the most frequent complaints. Rescue significantly correlated to Retro coding (p<0.01): 841/1000 patients coded exactly the same color, 45/1000 were overestimated by one color class, none by two, 107/1000 underestimated by one, and 6/1000 by two classes. The 32/1000 hospitalized patients in the prospective cohort had a Rescue score significantly higher than non-admitted patients (p<0.01) and color coding among admitted and dismissed patients was significantly different as well (p<0.01).

Conclusions.

The Rescue system seems promising in terms of usefulness and ease of implementation. The high correlation between Rescue code assigned prospectively and the post-diagnosis coding, as well as the prompt discrimination of cases that eventually required hospitalization, may lead to a wider use of the Rescue system. Further testing on larger samples and different institutions is warranted.
Magnitude and Causes of Unilateral Absolute Blindness in a Region of Oman: A Hospital-Based Study
Authors: Bansal R.K. , Khandekar R. , Nagendra P. , Kurup P.
Published: January 2018

Purpose.

To report the magnitude and causes of unilateral absolute blindness (no light perception) and barriers faced by persons with unilateral blindness in the South Batinah region of Oman.

Methods.

Between January and June 2002, 12,000 patients were evaluated for visual acuity, ocular pressure, anterior ocular biomicroscopic examination, and posterior segment indirect ophthalmoscopy examination by ophthalmologists at Al Rustaq hospital in Oman. Patients having no perception of light in at least one eye were included in the cohort. A closed-ended questionnaire was used to collect data on the personal profile, history of blindness, barriers perceived as the cause of blindness, and participants’ attitude towards eye care and quality of life following visual disability.

Results.

In the 12,000 patients studied, absolute unilateral blindness (no perception of light) was present in 122 persons, a rate of 1.0% in our series. The onset of blindness was gradual in 78 (63.9%) persons and 64 (54.9%) persons had unilateral blindness for more than 10 years. The main causes of blindness were phthisis/absent/disorganized blind eye, which was present in 64 (52.5%) persons; glaucoma, seen in 49 (40.2%) participants; and corneal opacity, seen in 8 (6.5%) persons. Eighty (14.8%) persons had <3/60 vision in the fellow eye. Thirty (24.6%) persons had cataract and 19 (15.6%) persons had glaucoma in the fellow eye. Forty-eight (39.3%) persons had undergone cataract surgeries while 2 (1.6%) persons were operated for glaucoma in the fellow eye. Lack of access to ophthalmic services and use of traditional medicines during the onset of blindness were reported by nearly half of the cohort. The attitude towards blindness was negative in two thirds of subjects.

Conclusions.

Cataract and glaucoma were important determinants of visual impairment in the fellow eyes of this cohort. These patients are at higher risk of developing bilateral impairment and need special care to prevent/treat visual disabilities in the fellow eyes. Using appropriate services, one can attempt attitudinal changes, rehabilitate them, and create a positive attitude towards life.
Rapid Development of Band Keratopathy of Corneal Graft Associated with Treatment with Intracameral Recombinant Tissue Plasminogen Activator for Postoperative Fibrin Reaction
Authors: Spitzer M.S. , Szurman P. , Aisenbrey S. , Rohrbach J.M.
Published: January 2018

Purpose.

To report a corneal transplant complication associated with intracameral recombinant tissue plasminogen activator (rTPA) treatment of postoperative fibrin reaction.

Methods.

In a 71-year-old patient, a triple procedure was performed for perforated rheumatic ulcer and secondary cataract.

Results.

A dense band keratopathy developed rapidly within 36 hours after the use of intracameral injection of rTPA for the treatment of a dense fibrin clot.

Conclusions.

This is the first report of rapid development of massive band keratopathy in a corneal graft after triple procedure and treatment with intracameral rTPA. Intracameral rTPA should be used with caution in patients with attenuated endothelium.
Ahmed Valve for Elevated Intraocular Pressure Associated with Black Diaphragm Lenses for Aniridia
Authors: Lanzagorta-Aresti A. , Menezo-Rozalen J.L. , Martínez-Costa R. , Cisneros-Lanuza á.
Published: January 2018

Purpose.

To evaluate the Ahmed valve for decrease elevated pressure associated with black diaphragm lenses for aniridia.

Methods.

Drainage devices are useful to obtain good control of intraocular pressure in patients with aniridia and the authors often use them because of the poor results of medical therapy or filtering surgery. However, when the elevated intraocular pressure is associated with black diaphragm lenses for aniridia, most authors decide to carry out a filtering technique. The current authors opted for the implantation of an Ahmed valve in three patients, two with traumatic aniridia and the other with a congenital case. Every patient had a different kind of black diaphragm lens for aniridia.

Results.

The Ahmed valve controlled the intraocular pressure in levels below 20 mmHg for a follow-up year with no complications derived from its application.

Conclusions.

Ahmed valve implantation was the best technique to decrease intraocular pressure in patients with aniridia. The authors have used it successfully for cases with elevated pressure associated with black diaphragm lenses for aniridia.
Actinomyces Neuii Subspecies Anitratus Chronic Endophthalmitis after Cataract Surgery
Authors: Pérez-Santonja J.J. , Campos-Mollo E. , Fuentes-Campos E. , Samper-Giménez J. , Alió J.L.
Published: January 2018

Purpose.

To report a case of unusual chronic endophthalmitis by Actinomyces neuii subspecies anitratus.

Methods.

A 75-year-old man underwent uneventful phacoemulsification with implantation of a foldable posterior chamber intraocular lens in his right eye. Four weeks after surgery, a chronic postoperative endophthalmitis characterized by anterior chamber and vitreous cellular debris developed in this eye. Cultures were positive, and A neuii subspecies anitratus was identified by polymerase chain reaction and subsequent rRNA sequence analysis. Immediate treatment included intravitreal and intensive topical antibiotics along with oral ciprofloxacin.

Results.

The condition improved rapidly, and 6 months after surgery the patient was asymptomatic, the best spectacle-corrected visual acuity was 20/22, and the anterior chamber was quiet.

Conclusions.

A neuii subspecies anitratus should be considered in the differential diagnosis of chronic endophthalmitis after cataract surgery. Polymerase chain reaction and subsequent RNA typing were useful in detecting the causative organism, and intravitreal antibiotics were successful.
Optic Nerve Compartment Syndrome in a Patient with Optic Nerve Sheath Meningioma
Authors: Jaggi G.P. , Mironov A. , Huber A.R. , Killer H.E.
Published: January 2018

Purpose.

To report a patient with optic nerve (ON) sheath meningioma, unilateral optic disc swelling, and inhomogeneous cerebrospinal fluid (CSF) composition between lumbar CSF and CSF from the subarachnoid space (SAS) of the affected ON.

Methods.

A 39-year-old woman presented with unilateral optic disc swelling and slight deterioration of visual function in the left eye. Extensive laboratory workup and magnetic resonance imaging (MRI) of the brain and orbits were performed. As radiotherapy was refused by the patient, ON sheath fenestration (ONSF) was offered and performed in order to stop deterioration. CSF from the SAS of the ON was sampled.

Results.

Laboratory workup was within normal limits. MRI of the left orbit demonstrated enhancement of the dura in the precanalicular portion of the ON and distension of the SAS, most prominent in the bulbar portion of the ON. On lumbar puncture the opening pressure measured 19 (cm H2O). Compared to the lumbar CSF the CSF of the affected ON SAS showed markedly elevated measurements for albumin, IgG, and beta-trace protein. Visual function remained stable over a follow-up time of 18 months.

Conclusions.

Composition of CSF is considered to be homogenous throughout all CSF spaces. In this patient the authors found a marked concentration-gradient of albumin, IgG, and beta-trace protein between the CSF in the spinal canal and the CSF in the SAS of the affected ON. Based on the radiologic features of the left ON and the dissociated beta-trace protein concentrations in the CSF of the SAS of the ON and the lumbar CSF, the diagnosis of an ON sheath compartment syndrome due to an ON sheath meningioma was made.
Trabeculectomy and Phaco-Trabeculectomy with and without Peripheral Iridectomy
Authors: Kaplan-Messas Audrey , Cohen Yuval , Blumenthal Eytan Z. , Avni Isaac
Published: January 2018

Purpose

To compare the 1-year outcome of trabeculectomy and combined phaco-trabeculectomy that were performed with or without a peripheral iridectomy (PI).

Methods

In a large tertiary glaucoma clinic, with a single surgeon performing all surgeries, 47 patients scheduled to undergo either a primary trabeculectomy or phaco-trabeculectomy were prospectively randomized to surgery with or without peripheral iridectomy. Other than the inclusion (PI group) or omission (no PI group) of a PI, surgical technique and postoperative care were identical for the two groups. The two groups were compared for intraocular pressure (IOP), success rates, visual acuity (VA), and complication rates. Complete and qualified success rates were defined as IOP 18 mmHg or less with or without medications, respectively.

Results

The 1-year complete and qualified success rates were comparable for both groups. Complete success was observed in 70% of cases, and qualified success in more than 90%. One patient (4.3%) from the no-PI group developed an iris incarceration into the internal sclerectomy site on postoperative day 1, requiring surgical intervention. No other significant complications (blebitis, endophthalmitis, or choroidal hemorrhage) were encountered in any of the study patients.

Conclusions

This randomized prospective small scale study explored the possibility of sparing the need to perform a routine PI in trabeculectomy and phaco-trabeculectomy. These preliminary results suggest that the outcomes in the two groups are comparable, paving the way to a larger scale study evaluating the need for PI in modern trabeculectomy surgery.
Prognostic Factors that Determine Visual Outcome following Cataract Surgery Complicated by Vitreous Loss
Authors: Konstantopoulos Aristides , Yadegarfar Ghasem , Madhusudhana Khrishnapa , Canning Chris R. , Luff Andrew J. , Anderson David F. , Hossain Parwez N.
Published: January 2018

Purpose

To identify prognostic factors that determine visual outcome following phacoemulsification cataract surgery complicated by vitreous loss.

Methods

A retrospective cohort study. All cases of vitreous loss during phacoemulsification surgery at a university hospital, between June 2000 and December 2005, were identified from the hospital computer database. By reviewing the medical notes, preoperative, intraoperative, and postoperative data were collected. Outcome of interest was presence of poor visual outcome (best-corrected visual acuity [BCVA] <6/12). Chi-square and Mann-Whitney U tests were used to compare groups of poor and good visual outcome.

Results

A total of 230 consecutive cases (eyes) were identified; medical notes were available for 228. Mean patient age was 78.4 years (SD 11); median follow-up 13.4 weeks (range 1–203). In multivariable logistic regression analysis poor visual outcome was independently associated with poor preoperative vision (BCVA <6/12) (OR 3.78, 95% CI 1.76–8.11), age-related macular degeneration (OR 3.04, 95% CI 1.16–8.00), cystoid macular edema (OR 3.85, 95% CI 1.29–11.51), and secondary pars plana vitrectomy (PPV) for nuclear fragment loss (OR 4.42, 95% CI 1.03–19.02). Primary PPV for nuclear fragment loss, age >70, ocular comorbidity, axial length, vitreous loss during irrigation/aspiration, or lens implantation, anterior chamber lens, and secondary lens implantation were not significant associations (p≥ 0.05). In 33 (14.5%) eyes BCVA was reduced by at least one Snellen line compared to before surgery.

Conclusions

Poor visual outcome was associated with poor preoperative vision, age-related macular degeneration, cystoid macular edema, and secondary PPV following nuclear fragment loss. Primary PPV for nuclear fragment loss was not a significant association.
Bimanual Technique in Proliferative Diabetic Retinopathy Using an Optical Fiber-Free Intravitreal Surgery System: A Case Control Study
Authors: Shen Li-Jun , Wang Zhao-Yang , Qu Jia , Wang Qin-Mei
Published: January 2018

Purpose

To evaluate the results of bimanual membrane peeling technique with an optical fiber-free intravitreal surgery system (OFFISS) in eyes with fibrovascular proliferation due to diabetic retinopathy.

Methods

Fifteen eyes of 14 consecutive patients with severe fibrovascular proliferation due to diabetic retinopathy who underwent bimanual vitrectomy using the OFFISS and 15 eyes of 15 nonconsecutive patients with similar fundus condition who underwent vitrectomy using a conventional microscope system were compared in a retrospective, consecutive case-control series.

Results

Reattachment rates at 3 months following surgery for the cases and controls were 93% and 100%, respectively, and final reattachment rates for both were 100%. The best-corrected visual acuity improved by two lines or more in 100% of the cases as compared to 87% of the controls (p=0.48). The mean VA (logMAR) improved 1.08 in the cases and 0.93 in the controls at final examination (p=0.46). Surgical complications were rare in both groups (p>0.05). The mean duration of membrane peeling of the cases was significantly lower than the controls (p=0.01).

Conclusions

For complicated surgical manipulations such as membrane peeling in diabetic vitrectomy for severe fibrovascular proliferation, bimanual vitrectomy using the OFFISS is a more effective and safer alternative to the conventional vitrectomy method.
A Case of Subperiosteal Abscess of the Orbit with Central Retinal Artery Occlusion
Authors: Okamoto Yoshifumi , Hiraoka Takahiro , Okamoto Fumiki , Oshika Tetsuro
Published: January 2018

Purpose

To report a rare case of orbital subperiosteal abscess with central retinal artery occlusion that resulted in blindness.

Methods

A 60-year-old previously healthy woman was referred to the hospital with 4-day history of orbital cellulitis, progressive left eye pain, eyelid swelling, and 1-day history of visual impairment. The patient was diagnosed with subperiosteal abscess of the orbit on diagnostic imaging.

Results

An emergent surgical intervention was performed due to prominent visual impairment. One day after surgery, ophthalmoscopic examination revealed cherry-red spot of the left fundus and central retinal artery occlusion. The final vision of the left eye was no light perception.

Conclusions

Central retinal artery occlusion, which is a therapeutic emergency, can be associated with acute progression of space-occupying lesion in the orbit such as subperiosteal abscess.
Late Onset of Deep Corneal Vascularization: A Rare Complication of Intrastromal Corneal Ring Segments for Keratoconus
Authors: Cosar Cemile Banu , Sridhar M.S. , Sener Bozkurt
Published: January 2018

Purpose

To report deep corneal vascularization noted 3 years after intrastromal corneal ring segments (Intacs) implantation for the treatment of keratoconus.

Methods

A 33-year-old male keratoconus patient intolerant to rigid gas permeable contact lens in the right eye underwent Intacs implantation. At 2 years postoperatively, slit-lamp examination of the right eye revealed superficial corneal vascularization inferotemporally, extending 1.5 mm from the limbus. At 3 years postoperatively, the slit-lamp examination of the right eye revealed deep stromal vascularization extending to and arborizing along the temporal segment. Also, superficial vascularization was noted along the nasal segment inferiorly. The Intacs segments were then explanted.

Results

On post-explantation day 10, the deep vessels regressed to ghost vessels with topical corticosteroid therapy.

Conclusions

The authors present a rare case where deep corneal vascularization was noticed 3 years following Intacs implantation for keratoconus. All patients having superficial vascularization away from the incision site need to be followed for this rare complication.
Frosted Branch Angiitis with Undiagnosed Hodgkin Lymphoma
Authors: Hua Minh-Tri , Blaise Pierre , De Leval Laurence , Rakic Jean-Marie
Published: January 2018

Purpose

To report the case of a patient with bilateral frosted branch angiitis and undiagnosed Hodgkin lymphoma.

Methods

Review of clinical history, laboratory findings, histology of supraclavicular lymph node biopsy, and follow-up.

Results

A 22-year-old man presented with a sudden, bilateral visual loss. Fundus examination and fluorescein angiography disclosed a bilateral frosted branch angiitis that was dramatically responsive to systemic corticosteroid therapy. Laboratory tests were unremarkable but radiologic studies showed extensive mediastinal and supraclavicular lymphadenopathy. A supraclavicular lymph node biopsy led to the diagnosis of nodular sclerosis Hodgkin lymphoma.

Conclusions

The occurrence of frosted branch angiitis in combination with classical Hodgkin lymphoma, although possibly coincidental, raises the possibility of a paraneoplastic syndrome. Thus, we suggest that, for patients with frosted branch angiitis, Hodgkin lymphoma should be considered in the diagnostic workup.
Branch Retinal Vein Occlusion Followed by Central Retinal Artery Occlusion in Churg-Strauss Syndrome: Unusual Ocular Manifestations in Allergic Granulomatous Angiitis
Authors: De Salvo Gabriella , Calzi Concetta Li , Anastasi Mario , Lodato Gaetano
Published: January 2018

Purpose

To describe a rare branch retinal vein occlusion (BRVO) followed by central retinal artery occlusion (CRAO) in a patient with Churg-Strauss syndrome (CSS).

Methods

A 55-year-old man with a not yet diagnosed CSS developed a BRVO in the left eye and 1 year later a CRAO with painless and acute vision loss in the same eye. Medical history included bronchial asthma, history of allergy, eosinophilic pneumonia, bilateral pleuric and pericardial effusion, hypereosinophilia, and purpuric vasculitis.

Results

CRAO in the left eye was diagnosed by retinal whitening and a cherry red spot with coexisting old BRVO evidenced by previous laser photocoagulation. Corticosteroids and cyclophosphamide therapy improved his general condition but no visual recovery occurred.

Conclusions

BRVO and CRAO can occur in the same eye in CSS. In the presence of systemic signs or symptoms, it is important to rule out systemic vasculitis in order to start appropriate immune-modulatory treatment thereby avoiding unnecessary mortality.
Visual Disturbance as Initial Presentation of Hairy Cell Leukemia
Authors: Charalel Resmi A. , Jain Atul K. , Rachakonda Leelanand P. , Gaynon Michael W.
Published: January 2018

Purpose

Hairy cell leukemia (HCL) is a rare disorder that occasionally has visual symptoms after diagnosis. The authors present a case of HCL in which bilateral visual symptoms led to the initial diagnosis.

Methods

Observational case report.

Results

Bilateral decreased vision to 20/30 in the right eye and 20/40 in the left due to intraretinal and pre-retinal hemorrhages with no other systemic signs or symptoms prompted a hematologic evaluation in which HCL was found to be the causative disorder in a previously healthy 41-year-old man.

Conclusions

The authors present a rare case in which bilateral visual complaints led to the diagnosis of HCL. Thus, though uncommon, HCL should be considered in the differential diagnosis of otherwise unexplained retinal hemorrhages.
Optic Disc Pit Maculopathy Treated with Vitrectomy, Internal Limiting Membrane Peeling, and Gas Tamponade: A Report of Two Cases
Authors: Georgalas Ilias , Petrou Petros , Koutsandrea Chrysanthi , Papaconstadinou Dimitris , Ladas Ioannis , Gotzaridis Eustratios
Published: January 2018

Purpose

Two cases with optic disc pit associated maculopathy, treated with vitrectomy surgery, internal limiting membrane peeling (ILM) and gas tamponade, are presented.

Methods

Interventional case reports.

Results

Two patients with serous macular detachment associated with a congenital optic pit underwent vitrectomy surgery, induction of posterior vitreous detachment, peeling of the ILM, and gas tamponade. In both cases, complete resolution of intraretinal and subretinal fluid was observed within a few months after surgery. The retina remained attached during a follow-up of 12 months and the visual acuity of both patients improved.

Conclusions

Vitrectomy with ILM peeling and gas tamponade without any additional laser photocoagulation seems to be sufficient for the treatment of optic disc pit maculopathy. Further studies are required to evaluate the above findings, although the implementation of large-series studies remains a challenge due to the rarity of cases with optic disc maculopathy.
A New Stereotest for Strabismologists: The Covered two Pencil Test
Authors: Mojon Daniel S.
Published: January 2018

Purpose

The two pencil test (TPT) checks the ability to perform a simple visual-motor task. The test is only partially based on intact stereopsis, since monocular depth perception clues are involved. To overcome this shortcoming, a new test variant has been developed and tested.

Methods

By covering the tip of the examiner's rod, monocular cues should be drastically reduced. Twenty normal subjects performed the TPT and the covered two pencil test (CTPT) under monocular and binocular conditions. Each test condition was repeated 15 times. Four subjects were retested by three different examiners in order to determine the observer variation. Differences between the accuracy and observer variation of the two test variants under monocular and binocular condition were compared using the paired t test.

Results

The average difference between monocular and binocular accuracy was for the TPT 1.26 cm and for the CTPT 2.37 cm (p<0.0005). The average coefficients of variation of both test variants were similar, for the TPT 0.28 and for the CTPT 0.33 (p>0.1).

Conclusions

This study demonstrates that covering the tip of the examiner's rod approximately doubles the differences between monocular and binocular accuracy. Therefore, covering seems to reduce monocular cues and increase the stereoscopic value of the TPT.
The Efficacy of 5% Povidone-Iodine for 3 Minutes Prior to Cataract Surgery
Authors: Carrim Zia I. , Mackie Gordon , Gallacher Grace , Wykes William N.
Published: January 2018

Purpose

To evaluate the efficacy of 3 minutes of 5% povidone-iodine for skin and conjunctival antisepsis prior to cataract surgery as recommended by the European Society of Cataract and Refractive Surgeons.

Methods

A prospective controlled study of 54 patients undergoing unilateral cataract surgery by phacoemulsification was undertaken. The eye undergoing surgery was prepared with 5% povidone-iodine for 3 minutes. The other eye served as control. Swabs were taken from both eyes prior to application of 5% povidone-iodine and 3 minutes after. Proportion of culture-positive swabs, mean number of species, and growth of isolates on culture were compared at different times and between the two groups.

Results

Coagulase-negative Staphylococcus (CoNS) was the main species isolated from culture-positive swabs. Use of 5% povidone-iodine for 3 minutes resulted in a statistically significant reduction in proportion of culture-positive swabs (87% vs 30%, p<0.001), mean number of species (0.96±0.47 vs 0.30±0.46, p<0.001), and growth of CoNS (heavy: 30% vs 0%, moderate: 23% vs 6%, light: 47% vs 94%, p=0.004). No such changes were observed in the control group.

Conclusions

Use of 5% povidone-iodine for 3 minutes prior to cataract surgery achieves a significant reduction in organisms such as CoNS from lid and conjunctival flora.
Dry Eye Syndrome-Related Quality of Life in Glaucoma Patients
Authors: Rossi Gemma Caterina Maria , Tinelli Carmine , Pasinetti Gian Maria , Milano Giovanni , Bianchi Paolo Emilio
Published: January 2018

Purpose

To verify the presence of dry eye syndrome (DES) in treated patients with glaucoma and to analyze DES's impact on the patients' quality of life (QOL) versus the control group.

Methods

In this observational cross-sectional study, 61 patients were enrolled at a clinical practice. Patients were divided into three groups by number of glaucoma drops instilled per day (G1=1 drop/day, G2=2 drops/day, G3=3 drops/day). A control group of 20 subjects was also selected (G0). All subjects were submitted to a complete ocular examination (including tear function and ocular surface status) and completed the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ), Glaucoma Symptom Scale (GSS) questionnaire, and Ocular Surface Disease Index (OSDI). DES was defined as presence of punctate keratitis and decreased break-up time. Statistical analysis was performed applying the Kruskal-Wallis analysis of variance and Mann-Whitney U tests (to compare median values between groups) as well as the χ2 and Fisher test (to verify significant differences).

Results

A total of 40% of G3 and 39% of G2 patients presented DES versus 11% of G1 and 5% of G0 (p=0.01). QOL was significantly influenced and altered (NEI-VFQ 25 total mean and GSS total mean and symptoms average: p=0.0085, p=0.006, and p=0.03, respectively). OSDI pointed out differences by group: 26% of G2 and 15% of G3 presented moderate OSDI and 15% of G3 and 8.7% of G2 severe OSDI (p>0.05).

Conclusions

Patients with topically treated glaucoma present DES more often than a similar control group (p=0.01). The presence of DES negatively influences the patient's QOL. The patients with glaucoma's ocular surface status should be evaluated regularly to ensure the timely detection and treatment of pathologic signs on the ocular surface.
Color Doppler Imaging and Ocular Pulse Amplitude in Glaucomatous and Healthy Eyes
Authors: Stalmans Ingeborg , Harris Alon , Fieuws Steffen , Zeyen Thierry , Vanbellinghen Veerle , McCranor Lynne , Siesky Brent
Published: January 2018

Purpose

To determine factors influencing color Doppler imaging (CDI) measurements, to compare retrobulbar flow velocities between patients with glaucoma and healthy controls, and to describe the correlation between CDI and ocular pulse amplitude (OPA).

Methods

Patients with normal tension (n=28) or primary open angle glaucoma (n=19) and healthy controls (n=22) underwent CDI and OPA measurements. Intraocular pressure, corneal thickness, blood pressure, and heart rate were also measured. Spearman correlations were used to explore relations among these variables. A regression model for repeated measures was applied to compare between diagnostic groups the flow velocity indices in the retrobulbar vessels.

Results

Retrobulbar diastolic blood flow velocities correlated with diastolic blood pressure and perfusion pressure (range of Spearman rho [ρ] coefficients=0.25–0.28; P=0.044–0.013 for the different vessels). Corneal thickness showed a positive correlation with systolic and diastolic flow velocities in the central retinal artery (ρ=0.29 and 0.31; P=0.017 and 0.011 for peak systolic and end diastolic velocity, respectively). Systolic and diastolic blood flow velocities were reduced in the retrobulbar vessels of patients with normal tension glaucoma (P=0.0004) as well as primary open angle glaucoma (P=0.003) compared to healthy controls. A correlation was found between OPA and the resistive index in the retrobulbar vessels of the healthy controls (range ρ=0.42–0.53; P=0.059–0.014).

Conclusions

Retrobulbar blood flow velocities are reduced in patients with primary open angle glaucoma and normal tension glaucoma. Blood pressure and corneal thickness may influence CDI measurements. OPA correlates with the resistive index in CDI.
Ophthalmologist Attitudes regarding Fixed Combination Treatment for Glaucoma in the European Union
Authors: Stewart William C. , Kruft Bonnie , Nelson Lindsay A. , Stewart Jeanette A.
Published: January 2018

Purpose

To survey ophthalmologists in the European Union to determine their fixed combination (FC) preferences.

Methods

A multiple-choice survey was sent to randomly chosen ophthalmologists throughout the European Union and bordering countries by electronic mail delivery. Ophthalmologists were resent the survey on two more occasions if no response was obtained.

Results

In total, 50 surveys were received from 530 distributed (9.4% response) from 16 countries. More ophthalmologists prescribed an FC as second (80%) or third choice (64%) therapy than first choice (30%, p=0.0036). As first (p<0.0001) and third choice (p=0.011), the dorzolamide/timolol FC was most commonly prescribed, while as second choice the latanoprost/timolol FC (p<0.0001) was most popular. Overall, 98% (49/50) of doctors believed FC therapy improved patient care most often by better compliance (n=49) and quality of life (n=48, p<0.0001). Most ophthalmologists believed that there was a difference in efficacy between the FC products (32/50, 64%) with the most effective being the bimatoprost/timolol FC (n=12, 24%, p=0.029). However, fewer ophthalmologists perceived safety differences between the products (34/50, 68%). For prostaglandins, dosing time was suggested in the morning by 18 (36%) ophthalmologists and in the evening by 24 (48%) (p=0.35).

Conclusions

FCs in the European Union are a potentially popular method to reduce intraocular pressure, being prescribed most commonly as second or third choice therapy. The perceived advantages to FC therapy are greater compliance to the medicine and improved patient quality of life.
Efficacy of Intravitreal Triamcinolone after or Concomitant with Laser Photocoagulation in Nonproliferative Diabetic Retinopathy with Macular Edema
Authors: Aydin Erdinc , Demir Helin Deniz , Yardim Huseyin , Erkorkmaz Unal
Published: January 2018

Purpose

To investigate the clinical effects and outcomes of intravitreal injection of 4 mg of triamcinolone acetonide (IVTA) after or concomitant with macular laser photocoagulation (MP) for clinically significant macular edema (CSME).

Methods

Forty-nine eyes of 49 patients with nonproliferative diabetic retinopathy and CSME were randomized into three groups. The eyes in the laser group (n=17), group 1, were subjected to MP 3 weeks after IVTA; the eyes in the IVTA group (n=13), group 2, were subjected to MP, concomitant with IVTA; the eyes in the control group (n=19), group 3, underwent only IVTA application. Visual acuity (VA), fundus fluorescein angiography, and photography were performed in each group.

Results

In the first group, the mean VA improved from 0.17±0.09 at baseline to 0.28±0.15 (p=0.114) and in the second group, deteriorated from 0.19±0.08 at baseline to 0.14±0.08 at the sixth month (p=0.141), respectively. In Group 3, the mean VA improved from 0.16±0.08 at baseline to 0.28±0.18 (p=0.118) at the end of the follow-up. When VA was compared between the control and study groups, significant difference was detected at the sixth month (p=0.038).

Conclusions

MP after IVTA improved VA, rather than MP concomitant with IVTA, and only IVTA application for CSME. MP after IVTA may reduce the recurrence of CSME and needs further investigations in a longer period.
Proton Beam Radiotherapy of Uveal Melanoma: Italian Patients Treated in Nice, France
Authors: Mosci Carlo , Mosci Sofia , Barla Annalisa , Squarcia Sandro , Chauvel Pierre , Iborra Nicole
Published: January 2018

Purpose

To evaluate the results of 15 years of experience with proton beam radiotherapy in the treatment of intraocular melanoma, and to determine univariate and multivariate risk factors for local failure, eye retention, and survival.

Methods

A total of 368 cases of intraocular melanoma were treated with proton beam radiotherapy at Centre Lacassagne Cyclotron Biomedical of Nice, France, between 1991 and 2006. Actuarial methods were used to evaluate rate of local tumor control, eye retention, and survival after proton beam radiotherapy. Cox regression models were extracted to evaluate univariate risk factors, while regularized least squares algorithm was used to have a multivariate classification model to better discriminate risk factors.

Results

Tumor relapse occurred in 8.4% of the eyes, with a median recurrence time of 46 months. Enucleation was performed on 11.7% of the eyes after a median time of 49 months following proton beam; out of these, 29 eyes were enucleated due to relapse and 16 due to other causes. The univariate regression analysis identified tumor height and diameter as primary risk factors for enucleation. Regularized least squares analysis demonstrated the higher effectiveness of a multivariate model of five risk factors (macula distance, optic disc distance, tumor height, maximum diameter, and age) in discriminating relapsed vs nonrelapsed patients.

Conclusions

This data set, which is the largest in Italy with relatively long-term follow-up, demonstrates that a high rate of tumor control, survival, and eye retention were achieved after proton beam irradiation, as in other series.
Acute Presentation of Nasal-Type Natural Killer/T-cell Lymphoma of the Orbit
Authors: Qin Wei , Yin Zhengqin , Madge Simon N.
Published: January 2018

Purpose

An unusual case of nasal-type natural killer/T-cell lymphoma (NKTL) of the orbit is reported.

Methods

The clinical history, computed tomography, magnetic resonance imaging, and biopsy specimen of a 29-year-old man with a right orbital lymphoma were evaluated.

Results

The patient initially presented with conjunctival injection and had flu-like symptoms before developing right proptosis and reduced vision; imaging showed a diffuse infiltrative process throughout the orbit. Orbital biopsy revealed angiodestruction with prominent necrosis, and angiocentric lymphoma growth and lymphoma cells were positively stained for CD3, CD20, CD45RO, CD56, cytotoxic molecules (granzyme B and T-cell intracellular antigen-1), and Epstein-Barr virus.

Conclusions

NKTL is rare and may present acutely; the imaging findings presented serve to highlight the radiologic features of the disease.
Palpebro-orbital Myiasis in a Patient with Basal Cell Carcinoma
Authors: Abalo-Lojo Jose M. , López-Valladares Maria J. , Llovo J. , Garcia Abel , Gonzalez Francisco
Published: January 2018

Purpose

We report a patient with basal cell carcinoma presenting with severe myiasis in a large ulcer involving the upper and lower eyelid.

Methods

Myiasis is an infestation of vertebrate animals by larvae of certain fly species. About 70 larvae were removed manually. A biopsy of the tissue underneath demonstrated a basal cell carcinoma. The myiasis was produced by the fly Lucilia sericata, currently used for treating chronic nonhealing ulcers. Because of the stage of the carcinoma, an orbital exenteration was carried out.

Results

The patient died 2 days later because of cardiopulmonary failure not related to the myiasis.

Conclusions

We present a case of a severe orbital myiasis focusing on its management and life-threatening nature.
Iris Color: Validation of a new Classification and Distribution in a Spanish Population-Based Sample
Authors: Díaz Yerena Muiños , Saornil Maria A. , Almaraz Ana , Muñoz-Moreno Mari F. , García Ciro , Sanz Ruperto
Published: January 2018

Purpose

To design and validate a standard, simple, and reliable iris color classification and to study its distribution in a Spanish population. Iris color has a geographic distribution and has been correlated with different ocular diseases. However, there is no standard and validated iris color classification allowing comparison among different studies.

Methods

Classification was made in three grades (blue-gray, hazel-green, brown) and was validated by 3 independent readers. Initially, a preliminary study was made in 50 iris photographs to detect technical hitches. Afterwards, based on this procedure, 221 iris photographs were graded

Results

Measures of interobserver reliability were 0.786 by kappa index with an agreement of 89.6%. Iris color distribution in the Spanish cohort was blue-grey 16.29%, hazel-green 55.2%, and brown 28.5%.

Conclusions

This classification is simple, reliable, and easy to use in clinical research and by ophthalmologists or generalists in practice. The Spanish cohort from this study shows a different iris color distribution from those previously published in other countries.
Leber miliary aneurysms and multiple sclerosis
Authors: Querques Giuseppe , Bux Anna V.
Published: January 2018

Purpose

To describe a patient with Leber miliary aneurysms who fulfilled the criteria for clinically definite multiple sclerosis (MS) in remission.

Methods

Case report.

Results

We performed a complete ophthalmologic examination in a 45-year-old woman who was referred to our department for retinal vascular abnormalities in her left eye. Twenty-eight years previously, the patient had been diagnosed with MS. Following a complete ophthalmologic examination, the patient was diagnosed with Leber miliary aneurysms and coincident MS in remission. To our knowledge, there are no previous reports describing association between Leber miliary aneurysms and MS.

Conclusions

Leber miliary aneurysms have been found in association with multiple ocular and systemic syndromes. In this report, we suggest another possible systemic association (MS) with Leber miliary aneurysms
Treatment of Serous Pigment Epithelium Detachment with Subthreshold Micropulse Diode Laser Photocoagulation: A Case Report
Authors: Battaglia-parodi Maurizio , Sheth Saumil , Papayannis Alessandro , Bandello Francesco
Published: January 2018

Purpose

To propose a possible treatment for symptomatic serous pigment epithelium detachment (SPED) in the setting of dry age-related macular degeneration.

Methods

A 60-year-old woman presented with a SPED, subfoveal in location, enlarging in size and with gradually worsening vision over 1 year of follow-up, without any evidence of choroidal neovascular membrane or neurosensory detachment until it was treated with subthreshold micropulse laser.

Results

The last follow-up showed complete resolution of the SPED with restoration of visual function.

Conclusions

Subthreshold micropulse laser could serve as a useful therapeutic modality for the treatment of symptomatic SPED. (Eur J Ophthalmol 2009; 19: 887–9)