bluuebunny/crossref_metadata_2025 huggingface dataset:
High-dose (5000-μg) Intravitreal Ganciclovir Combined with Highly Active Antiretroviral Therapy for Cytomegalovirus Retinitis in HIV-Infected Patients in Venezuela
Authors: Arevalo J.F. , Garcia R.A. , Mendoza A.J.
Published: January 2018

Purpose

To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients.

Methods

Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of ≥50 cells/μL to levels over 100 cells/μL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included.

Results

Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%).

Conclusions

High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.
Identification of XLRS1 Gene Mutation (608C>T) in a Portuguese Family with Juvenile Retinoschisis
Authors: Teixeira C. , Rocha-Sousa A. , Trump D. , Brandäo E. , Falcäo-Reis F.
Published: January 2018

Purpose

To characterize electroretinogram (ERG) and molecular genetic findings in a family with XLRS1 mutation. The authors present two cases of a Portuguese family with juvenile retinoschisis with a mutation in exon 6.

Methods

Two brothers and their parents, grandmother, and uncle underwent a full ophthalmic examination. The two brothers with ophthalmic disease were evaluated with color fundus photography, fluorescein angiography, optical coherence tomography (OCT), molecular genetic study (Group VI of Retinoschisis Consortium), pattern visual evoked potential (PVEP), and full field ERG.

Results

Both patients presented funduscopic manifestations of vitreoretinal degeneration. They presented peripheral schisis and retinal detachment. However, foveal schisis had never been observed at funduscopy. A negative ERG was recorded in both. Six months after that, the younger brother showed a typical foveal schisis at fundus examination. A retinoschisis gene (XLRS1) mutation with transition of cytosine by thymine at position 608 (608C>T) had been identified in both.

Conclusions

Negative ERG is the most secure clinical marker to establish the diagnosis of juvenile retinoschisis. XLRS1 gene 608C>T mutation was described for the first time in a Portuguese family.
Cataract Surgery under Systemic Anticoagulant Therapy with Coumarin
Authors: Jonas J.B. , Pakdaman B. , Sauder G.
Published: January 2018

Purpose

To evaluate clinical outcome of cataract surgery under systemic anticoagulant therapy using coumarin.

Methods

This clinical interventional comparative nonrandomized study included 441 patients (441 eyes) consecutively undergoing standard phacoemulsification with clear cornea incision and topical anesthesia. The study group consisted of 21 (4.8%) patients for whom systemic coumarin therapy was continued despite surgery. The control group included 420 patients without anticoagulant coumarin therapy prior to surgery. Study group and control group did not vary significantly in age, preoperative visual acuity, axial length, refractive error, preoperative intraocular pressure, or surgeon.

Results

Frequency of intraoperative or postoperative hemorrhages, intraoperative complications such as posterior capsule rupture, postoperative visual acuity, and intraocular pressure did no vary significantly (p>0.30) between study group and control group.

Conclusions

For patients under systemic coumarin therapy, the rate of surgical complications may not markedly be increased compared to patients without coumarin therapy, when standard phacoemulsification with clear cornea incisions is performed with topical anesthesia. Systemic coumarin therapy does not have to be stopped prior to cataract surgery.
Phacoemulsification in the Vitreous Cavity for Retained Nuclear Lens Fragments
Authors: Ruiz-Moreno J.M. , Barile S. , Montero J.A.
Published: January 2018

Purpose

To evaluate anatomic and functional results after surgery of retained lens fragments in the vitreous cavity after previous phacoemulsification.

Methods

The authors studied retrospectively 18 patients who underwent pars plana vitrectomy (PPV) for retained nuclear lens fragments. Patients having only cortical material in the vitreous cavity were excluded. In all cases the nucleus or nuclear fragments were removed after a complete vitrectomy using perfluorocarbon injection in the vitreous cavity, associated with phacoemulsification in the vitreous cavity. The authors used a conventional phaco probe devoid of the silicone sleeve. Time lapse between cataract surgery and vitrectomy varied between 0 and 24 days (mean 8.2 ± 7.4). Follow-up was 33.9 ± 20.6 months (range 4 to 53).

Results

The mean final best-corrected visual acuity (BCVA) was 20/45 (range 20/400 to 20/20). It was 20/40 or better in 33% of patients, reaching 40% when patients with pevious macular disease were excluded. A total of 61% of patients reached a final BCVA ranging from 20/50 to 20/200. Retinal detachment occurred in one eye and topical medications were necessary to manage intraocular pressure in four cases.

Conclusions

PPV with intravitreous phacoemulsification is the technique of choice for dislocated nuclei or nuclear fragments in the vitreous cavity.
A Comparison of Travoprost, Latanoprost, and the Fixed Combination of Dorzolamide and Timolol in Patients with Pseudoexfoliation Glaucoma
Authors: Parmaksiz S. , Yüksel N. , Karabas V.L. , Özkan B. , Demirci G. , çaglar Y.
Published: January 2018

Purpose

To compare the intraocular pressure (IOP) lowering effect and safety of latanoprost, travoprost given every evening, and the fixed combination dorzolamide + timolol (DTFC) given twice daily in pseudoexfoliation glaucoma (PXG).

Methods

This randomized, prospective, investigator-masked study has been conducted with 50 PXG patients. Patients were assigned to one of three groups: travoprost 0.004%, fixed combination of dorzolamide 2%+timolol 0.5%, or latanoprost 0.005% for 6 months. At baseline and 0.5, 1, 2, 3, 4, 5, and 6 months of therapy, IOP (8 am, 10 am, 4 pm), blood pressures, and pulse rates were measured, and ophthalmologic examination was performed. The side effects were recorded at each visit.

Results

Forty-two of the 50 patients initially enrolled completed this study. Withdrawn patients included one (latanoprost) for lack of efficacy, five (three travoprost, one latanoprost, one DTFC) for adverse events, and two (one latanoprost, one DTFC) for loss of follow-up. Each of the three drugs considerably reduced the IOP in PXG cases throughout the 6 months. Mean IOP reduction at 6 months was –9.3±2.9 mmHg in the travoprost group, -8.2±1.2 mmHg in the latanoprost group, and 11.5±3.3 mmHg in the DTFC group. Comparing the groups, DTFC is more effective than latanoprost and travoprost in lowering IOP (p<0.05). There was no difference between travoprost and latanoprost. The most common treatment-related adverse event was conjunctival hyperemia. Intensity of ocular hyperemia was greater in the travoprost group compared with the latanoprost and DTFC groups (p<0.05). There were no significant effects on systemic safety parameters.

Conclusions

The results demonstrated that DTFC is more effective in reducing IOP than latanoprost and travoprost. Latanoprost and travoprost had similar ocular hypotensive effects in patients with PXG. All three drugs were well tolerated; there were fewer ocular side effects attributable in the latanoprost group.
Intravitreal Triamcinolone Acetonide as Primary Treatment for Diffuse Diabetic Macular Edema: A Prospective Noncomparative Interventional Case Series
Authors: Nicolò M. , Nasciuti F. , Lai S. , Ghiglione D. , Borgia L. , Calabria G.
Published: January 2018

Purpose

To evaluate the efficacy and safety of one intravitreal injection of 25 mg of triamcinolone acetonide as primary treatment for diffuse diabetic macular edema.

Methods

Intravitreal triamcinolone acetonide injection was performed in 30 eyes with previously untreated diabetic macular edema. The main outcome measures were logMAR visual acuity (VA) and central macular thickness (CMT) at 1, 3, and 6 months. A secondary outcome was intraocular pressure progression.

Results

Visual acuity results for 30 eyes that had a follow-up of at least 6 months are presented. Twenty of them were followed up to 10.1 ±2.38 months. Preoperatively, VA was 0.54±0.27. At 1, 3, and 6 months follow-up, VA was 0.44±0.29 (p=0.001), 0.43±0.28 (p=0.001), and 0.45±0.29 (p=0.006), respectively. Preoperatively, CMT was 417.3±143.5 μm. At 1, 3, and 6 months follow-up, CMT was 277.3 +74.0 μm (p<0.0001), 279.6±94.4 μm (p<0.0001), and 297.07±114.87 μm (p=0.002), respectively. For the 20 eyes with a follow-up of 10.1±2.38 months, VA was 0.5±0.25 and 0.50±0.32 at baseline and at the last follow-up visit, respectively (p>0.05). Preoperatively, intraocular pressue (IOP) was 15.13±1.48 mmHg. IOP was 18.26±2.71 mmHg, 20.07±4.27 mmHg, and 20.4±6.18 mmHg, at 1, 3, and 6 months, respectively (p<0.0001). Four eyes underwent uncomplicated filtrating surgery for intractable glaucoma.

Conclusions

Intravitreal triamcinolone as primary treatment effectively increases VA and reduces CMT due to diffuse diabetic macular edema. Longer follow-up and randomized clinical trial are war ranted. Safety results highlight the need to further study the relationship between triamcinolone and intraocular pressure.
Anomalous Vitreoretinal Adhesions in Patients with Exudative Age-Related Macular Degeneration: An OCT Study
Authors: Maftouhi M. Quaranta-El , Mauget-Faÿsse M.
Published: January 2018

Purpose

To analyze the relationship between the retina and the vitreous in patients with exudative age-related macular degeneration (ARMD).

Methods

Consecutive patients with exudative ARMD, proven by fluorescein angiography, were recruited. Fundus biomicroscopic examination, color and red-free fundus photographs, and serial scans of the macular region using optical coherence tomography (OCT3, Carl Zeiss) were performed before and after photo dynamic therapy (PDT) with verteporfin (Visudyne, Novartis Ophthalmics). Vitreoretinal relationships have been described and compared with fundus photographs and data of fundus biomicroscopy examination.

Results

Sixty-six eyes of 52 consecutive patients (33 women, 19 men; mean age 75 years, range 64 to 89 years) with exudative ARMD were studied. Analysis of serial OCT scans showed that 13 eyes (20%) did not present any visible vitreous structures. Two eyes (3%) had the appearance of a complete posterior vitreous detachment (PVD). Fifty-one eyes (77%) exhibited some abnormalities of the vitreoretinal interface including 12 eyes with epiretinal membrane and retinal thickening and distortion. Among the 39 eyes examined before and after PDT with Visudyne, only 3 eyes developed a partial vitreous detachment and 1 eye progressed to a complete PVD.

Conclusions

Eyes with exudative ARMD exhibit a high prevalence of abnormalities of the vitreoretinal interface similar to that observed in many chronic inflammatory diseases. PDT with verteporfin does not modify the observed vitreoretinal adhesions.
Expulsion of a Lacrimal Dacryolith by Sneezing: A Rare Event
Authors: Salam A. , Williams C.P.R. , Manners R.M.
Published: January 2018

Purpose

To describe the case of a man presenting with intermittent epiphora of the right eye and a low grade dacryocystitis due to a dacryolith.

Methods/Results

He was treated conservatively and was offered a Dacryocystorhinostomy. A few weeks before surgery, he developed swelling and pain over the right medial canthus followed by violent sneezing with spontaneous extrusion of the dacryolith.

Discussion

The authors propose that the dacryolith fragmented spontaneously and once it reached the nasal cavity, was expelled by violent sneezing to the nostril, a mechanism not previously reported.

Conclusions

Reformation of dacryolith is a likely possibility, and recurrence of symptoms in such cases may ultimately require a Dacryocystorhinostomy.
Conjunctival Deposits as the First Sign of Systemic Sarcoidosis in a Pediatric Patient
Authors: çaça I. , Ünlü K. , Büyükbayram H. , Ari ş.
Published: January 2018

Purpose

Sarcoidosis is an inflammatory disease of unknown cause, characterized by noncaseating granulomas. In this study, the authors present a sarcoidosis patient without systemic signs diagnosed by histopathologic analysis of conjunctival deposits.

Methods

A 10-year-old girl had bilateral, focal, multilobular, multiple pale yellow deposits in bulbar conjunctiva for a year. In the patient's biomicroscopic examination, numerous 0.50-to 2-mm diameter pale yellow deposits were determined in both bulbar conjunctivas. The patient had no other systemic or ocular complaints. A conjunctival biopsy was performed.

Results

The biopsy specimens showed noncaseating granulomas with prominent asteroid bodies. Serum angiotensin-converting enzyme levels were increased in the patient. Conjunctival deposits were the first manifestation of sarcoidosis in the patient and the diagnosis of sarcoidosis was confirmed with a conjunctival biopsy.

Conclusions

To the authors’ knowledge, this is the second study that reports a sarcoidosis patient with non-systemic involvement diagnosed after histopathologic analysis of conjunctival deposits.
Delayed Onset of Pseudotumor Cerebri Syndrome 7 Years after Starting Human Recombinant Growth Hormone Treatment
Authors: Vischi A. , Guerriero S. , Giancipoli G. , Lorusso V. , Sborgia G.
Published: January 2018

Purpose

To report a case of pseudotumor cerebri (PTC) following treatment with human recombinant growth hormone (GH).

Methods

A 42-year-old man who developed pseudotumor cerebri 7 years after starting human recombinant GH treatment is presented.

Results

The patient's medical history was significant for hypophyseal dwarfism with a serious deficit of GH, hypogonadotropic hypogonadism, and hypothyroidism. In 1996 he started taking GH, testosterone, and l-thyroxine. Fundus examination showed disc edema in the left eye. GH was discontinued, and acetazolamide therapy was initiated. At the 3-month follow-up the acuity without correction was patch and the unilateral papilledema had resolved.

Conclusions

Pseudotumor cerebri or idiopathic intracranial hypertension is an uncommon and complex disorder. The diagnosis is possible when important criteria symptoms and signs are met. Several conditions and risk factors are associated with PTC. The most recently recognized risk factor is GH therapy.
Epstein-Barr Positive T-Cell Lymphoma in the Ocular Region
Authors: Sjö L.D. , Juhl B.R. , Buchwald C. , Prause J.U. , Ralfkiaer E. , Sjö N.C. , Heegaard S.
Published: January 2018

Purpose

To present two cases of rapidly growing tumors in the ocular adnexa. Both tumors were Epstein-Barr virus (EBV) positive peripheral T-cell lymphoma.

Methods

Case 1 was a 60-year-old man with a non-tender ulcerating tumor involving the lateral third of both upper and lower right eyelid. Case 2 was a 55-year-old man with a swelling of the left eyelid expanding cranially and dislocating the left eye, resulting in proptosis and diplopia. Both patients underwent incisional biopsy that did not disclose the malignant nature of the tumors. Clinical evaluation resulted in suspicion of malignancy and surgical excision was performed.

Results

The tumors were found to be consistent with EBV-positive peripheral T-cell lymphoma.

Conclusions

Peripheral T-cell lymphoma is uncommon but a diagnosis to be considered in a patient with a tumorous lesion in the eye region. Furthermore, peripheral T-cell lymphoma may be EBV-positive.
Photorefractive Keratectomy in High Myopic Defects with or without Intraoperative Mitomycin C: 1-Year Results
Authors: Bedei A. , Marabotti A. , Giannecchini I. , Ferretti C. , Montagnani M. , Martinucci C. , Barabesi L.
Published: January 2018

Purpose

To study the results of the prophylactic use of mitomycin C (MMC) to reduce haze formation and refractive regression after excimer laser photorefractive keratectomy (PRK) for high myopic defects (>5 diopters).

Methods

Prospective, consecutive, observational study. A total of 124 eyes of 62 patients were divided into two groups of 31 patients, 62 eyes each (Groups A and B). Only Group A was treated with MMC 0.02%. The data of the two groups of eyes, related to the best-corrected visual acuity (BCVA), to the difference of refraction pre- and post-treatment, and to the corneal haze, were analyzed through combined permutation tests by using the NPC Test software.

Results

BCVA of Group A, 1 year after treatment, was better than that of the control Group B (one-sided p value = 0.013): Group A – 3 eyes (4.8%) had a loss of a decimal fraction and no eyes > 1; Group B – 13 eyes (20.9%) had a loss of a decimal fraction and 1 eye (1.6%) of 2. There was a smaller difference between attempted and achieved SE correction in Group A with respect to Group B (one-sided p value = 0.068): Group A – 43 eyes (69.3%) within ± 0.50 D; Group B – 31 eyes (50%) within ± 0.50 D. there was a smaller incidence of corneal haze in the group for which MMC was used (one-sided p value = 0.005).

Conclusions

In this study, the application of MMC 0.02% solution immediately after PRK produced lower haze rates and had better predictability and improved efficacy 1 year after treatment.
Quantitative Corneal Anatomy in Emmetropic Subjects
Authors: Sanchis-Gimeno J.A. , Herrera M. , Lleó-Pérez A. , Alonso L. , Rahhal M.S.
Published: January 2018

Purpose

Currently there is little information available about the corneal thickness values of healthy emmetropic subjects. Therefore, the authors decided to analyze the corneal thickness in healthy emmetropic subjects.

Methods

The authors analyzed the difference in thickness values between the thinnest corneal site and the central and paracentral cornea in 124 eyes of 124 healthy emmetropic white subjects.

Results

The mean difference between the thinnest site of the cornea and the thickness values obtained in the areas analyzed was as follows: 12±6 μm center; 140±19 μm superonasal; 133±23 μm nasal; 117±26 μm inferonasal; 122±19 μm superotemporal; 89±22 μm temporal; and 99±29 μm inferotemporal (p<0.001; one way analysis of variance test).

Conclusions

In healthy emmetropic white subjects the thinnest site of the cornea is statistically lower than the central and paracentral cornea.
Glaucoma Detection using the GDx Nerve Fiber Analyzer and the Retinal Thickness Analyzer (RTA)
Authors: Hoffmann E.M. , Bowd C. , Klein N. , Stemberger K. , Grus F.H. , Pfeiffer N.
Published: January 2018

Purpose

To compare the ability of the nerve fiber analyzer (GDx) and the retinal thickness analyzer (RTA) to discriminate between glaucomatous and healthy eyes.

Methods

Thirty-seven glaucoma patients (early to moderate severity) and 34 healthy controls were included. Glaucoma patients were defined as those with two repeatable abnormal visual fields by automated perimetry within 1 year. All subjects were examined with a GDx scanning laser polarimeter and RTA. Twelve GDx retinal nerve fiber layer parameters and 12 RTA optic disk topography parameters were obtained. GDx and RTA measurements were compared between both experimental groups using t-tests. Areas under the receiver operating characteristic curves (AUROC) for discriminating between healthy and glaucomatous eyes using GDx and RTA parameters were calculated and compared, and sensitivities at ≥80% and≥95% specificity were reported.

Results

Statistically significant differences between glaucomatous and healthy eyes were found for most GDx and RTA parameters. For GDx, the parameter with the largest AUROC for discriminating between healthy and glaucomatous eyes was the number (AUROC = 0.91, sensitivity = 85% at specificity = 84%, sensitivity = 73% at specificity = 95%). For RTA, the parameter with the largest AUROC was mean cup depth (AUROC = 0.79, sensitivity = 61% at specificity = 82%, sensitivity = 33% at specificity = 95%). The AUROC for the GDx number was significantly larger than the AUROC for RTA mean cup depth (p<0.05).

Conclusions

GDX showed better discrimination and better sensitivities at fixed specificities than RTA. The currently available RTA optic disk analysis software likely cannot replace GDx RNFL analysis software for successful glaucoma diagnosis.
Hyperacute Unilateral Gonococcal Endophthalmitis in an HIV-Infected Man without Genital Infection
Authors: Faggian F. , Azzini A. , Lanzafame M. , Bonora A. , Zorzi A. , Concia E. , Vento S.
Published: January 2018

Purpose

To demonstrate the necessity of obtaining an accurate history from patients presenting abnormal evolution of ophthalmologic diseases.

Methods

A 42-year-old patient, denying any previous ocular or systemic morbidity, presented with an unusual severe and hyperacute gonococcal endophthalmitis with corneal abscess but no concurrent genitourinary infection. Only after a further interview did the patient reveal his human immunodeficiency virus status and a previous diagnosis of acquired immunodeficiency syndrome.

Results

Adequate topical and intravenous antibiotic treatment and surgery led to salvage of the eye.

Conclusions

An accurate history should be obtained by patients with an abnormal course of an ophthalmologic disease, focusing on immunologic deficiencies that can cause extremely serious ophthalmologic complications with ensuing risk of visual impairment or ocular loss (bulbar enucleation).
Radial Keratotomy for the Optical Rehabilitation of Mild to Moderate Keratoconus: More than 5 Years’ Experience
Authors: Utine C.A. , Bayraktar S. , Kaya V. , Kucuksumer Y. , Eren H. , Perente I. , Yilmaz ö.F.
Published: January 2018

Purpose

To present the authors’ long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus – central corneal thickness of greater than 400 μm and without apical scarring.

Methods

In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 ± 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated.

Results

In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p<0.0001). Preoperative myopic spherical refraction decreased significantly (p<0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was observed in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p<0.0001). Central corneal thickness did not change significantly (p>0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred.

Conclusions

RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.
Clear Corneal Incision of 2.75 mm for Cataract Surgery Induces Little Change of Astigmatism in Eyes with Low Preoperative Corneal Cylinder
Authors: Giansanti F. , Rapizzi E. , Virgili G. , Mencucci R. , Bini A. , Vannozzi L. , Menchini U.
Published: January 2018

Purpose

To assess the early astigmatic effect induced by 2.75 mm clear cornea incisions with different locations for cataract surgery.

Methods

A total of 146 eyes of different patients were studied prospectively. Cataract surgery was performed by three surgeons, two using a temporal approach and one using a superior approach. For both approaches, the site of the 2.75 mm incision was allowed to vary slightly according to the characteristics of the eye and orbit. Computerized videokeratography was used to measure corneal astigmatism before surgery and after 1, 4, and 12 weeks. Corneal astigmatism was recorded as cylinder and axis and it was then converted to 2 power vector. Model based prediction and comparisons were made for the most commonly used corneal incision sites: 12 (both eyes), 2 (left eye), and 8 (right eye) o'clock meridian.

Results

After 3 months the differences in corneal astigmatism (JCC0) between the incisions performed at 12 and 2 o'clock were not statistically significant (-0.08, 95% CI: -0.19, -0.02); the differences in JCC0 between incisions at 12 and 8 o'clock were -0.17 (95% CI: -0.30, -0.05; p<0.01). After 3 months the change in JCC0 for the patients with 0.5 D with-the-rule preoperatively were -0.32 (95% CI: -0.44, 0.21; p<0.01) for incisions at 12; -0.24 (95% CI: -0.36, 0.13; p<0.01) for incisions at 2; and -0.15 (95% CI: -0.27, -0.03; p<0.05) for incisions at 8. After 3 months the changes of JCC0 for the patients with -0.5 D against-the-rule preoperatively were 0.10 (95% CI: 0.04, 0.23) for incision at 12; 0.18 (95% CI: 0.04, 0.32; p<0.05) for incisions at 2; and 0.27 (95% CI: 0.14, 0.40; p<0.01) for incisions at 8 o'clock. The oblique astigmatic vector (JCC45) was very modest in this sample before surgery and underwent minimal and nonsignificant change after it.

Conclusions

This study has shown that a 2.75 mm clear corneal incision causes a small change of corneal cylinder regardless of incision site.
A Comparison of Morning and Evening Instillation of a Combination Travoprost 0.004%/Timolol 0.5% Ophthalmic Solution
Authors: Denis P. , Andrew R. , Wells D. , Friren B.
Published: January 2018

Purpose

To compare the intraocular pressure lowering efficacy and side effect profile of travoprost 0.004%/timolol 0.5% ophthalmic solution dosed in the morning and evening.

Methods

This was a multicenter, prospective, randomized, double-masked, parallel group clinical study of 92 patients with open-angle glaucoma (with or without pseudoexfoliative or pigmentary glaucoma) or ocular hypertension. After a washout of existing glaucoma medications, patients were randomly assigned to receive one drop of travoprost 0.004%/timolol 0.5% in the morning or evening for 6 weeks. The main outcome measures were mean intraocular pressure (IOP) assessed at 9 am, 11 am, and 4 pm, and safety variables.

Results

Travoprost 0.004%/timolol 0.5% ophthalmic solution, dosed in the morning or evening, controlled IOP consistently throughout the day. Mean IOP ranged from 16.5 to 16.7 mmHg in the morning treatment group and from 16.1 to 17.2 mmHg in the evening treatment group. Travoprost 0.004%/timolol 0.5% ophthalmic solution produced statistically significant and clinically relevant reductions in IOP from baseline; mean reductions ranged from approximately 8 to 10 mmHg (32% to 38%). Travoprost 0.004%/timolol 0.5% ophthalmic solution was safe and well tolerated with the most frequently reported adverse event being ocular hyperemia, which occurred in 12.5% of patients in the morning treatment group and 13.6% of patients in the evening treatment group.

Conclusions

Travoprost 0.004%/timolol 0.5% given once daily, either in the morning or evening, is a safe and effective treatment for open-angle glaucoma and ocular hypertension. It may be beneficial for patients judged to be inadequately controlled on a prostaglandin analogue or ophthalmic beta-blocker alone.
External Trabeculectomy with T-Flux Implant
Authors: Jungkim S. , Gibran S.K. , Khan K. , Murray A.
Published: January 2018

Purpose

To evaluate the efficacy and safety of T-Flux implant in nonpenetrating glaucoma surgery.

Methods

This clinical interventional case series study included 35 eyes of 35 patients with medically uncontrolled primary open angle glaucoma. External trabeculectomy with T-Flux (ETTF) is a technique of nonpenetrating glaucoma surgery, in which after removing deep scleral tissue and un-roofing the canal of Schlemn (CS) the external trabecular tissue is peeled off to enhance the aqueous drainage without opening the anterior chamber. A non-absorbable T-Flux implant (IOL TECH Laboratories, France) was sutured in deep intrascleral space to keep it patent. Snellen's best-corrected visual acuity, slit lamp biomicroscopy, intraocular pressure (IOP), gonioscopy, funduscopy, and optic disc assessment were performed preoperatively and postoperatively at 1 day, 1 week, and 1, 3, 6, and 12 months. Visual field testing was performed preoperatively and at 6 and 12 months postoperatively.

Results

For three eyes, surgery was converted to standard trabeculectomy owing to the perforation of trabeculo-Descemet's membrane and iris prolapse and excluded from the study. The results of the remaining 32 eyes were included in the study. Preoperative IOP (mean ± SD) of 32.88 ± 5.7 mmHg decreased to 15.44 ± 1.6 mmHg after 12 months. Ten eyes (28.6%) had microhyphema that resolved spontaneously; 3 eyes (8.6%) had microperforation without iris prolapse so ETTF was proceeded routinely. The preoperative number of antiglaucoma medications per patient reduced from (mean ± SD) 2.74 ± 0.61 to 0.11 ± 0.32 postoperatively at 12 months. Visual acuity and visual fields remained stable.

Conclusions

ETTF appears to provide significant control of IOP and have low incidence of complications.
Outcomes of Vitreoretinal Surgery for Retinal Detachment after LASIK for Myopia
Authors: Salazar P.F. , Rodriguez F.J. , Medina D.M. , Infante R. , Rodriguez A.
Published: January 2018

Purpose

To report and compare outcomes of vitreoretinal surgery for repair of retinal detachment in myopic patients with and without previous laser-assisted in situ keratomileusis (LASIK).

Methods

This is a descriptive retrospective observational study with a control group for comparison that consisted of the analysis of clinical and surgical charts of patients who underwent vitreoretinal procedures for retinal detachment at the Fundación Oftalmológica Nacional between January 1995 and December 2002. The authors identified those myopic patients who had previous history of LASIK and an age- and myopia-matched control group without refractive surgery.

Results

The sample contains 24 myopic eyes of 22 patients with previous LASIK and 23 myopic eyes without previous LASIK in the control group, matched by age and myopia. Mean refractive error was -9.4 D before LASIK for the cases group and -11.2 for the control group. Poor preoperative best-corrected visual acuity was present in 71% of cases and 61% of controls (p=0.489). Macula off retinal detachment was found in 17 eyes in both groups. Five eyes required at least two procedures, achieving 91% (20 eyes) reattachments at the end of follow-up in each group. Final best-corrected visual acuity was better than 20/100 in 15 eyes (62.5%) in the LASIK group and 17 eyes (74 %) in the control group (p=0.659).

Conclusions

Retinal detachment in patients with previous myopic LASIK has similar characteristics as in myopic patients without refractive surgery. Current vitreoretinal surgery is of good prognosis as the retina was successfully reattached in most cases in both groups.
Phthisis Bulbi and Buphthalmos as Presenting Signs of Retinoblastoma: A Report of Two Cases and Literature Review
Authors: Hadjistilianou T. , De Francesco S. , Marconcini S. , Mastrangelo D. , Galluzzi P. , Toti P.
Published: January 2018

Purpose

To report two cases of bilateral retinoblastoma (RB) with unusual presentations.

Methods

The medical records of 321 patients from the Retinoblastoma Referral Center in Siena were reviewed. A total of 111 patients had bilateral RB, 2 of them presenting with phthisis bulbi and buphthalmos. Both patients underwent bilateral enucleation. Clinical features, imaging studies, and histopathology were reviewed.

Results

These 2 cases represent 0.62% (2/321) in our series. Histopathology did not reveal viable tumor cells in the phthisical eyes; in both buphthalmic eyes the tumor was active, infiltrating the choroid and optic nerve.

Conclusions

Phthisis bulbi and buphthalmos are unusual presenting signs of RB. This very rare combination of these two signs in different eyes of the same patient is probably due to a delay in diagnosis.
Conjunctival Papilloma and Human Papillomavirus: Identification of HPV Types by PCR
Authors: Minchiotti S. , Masucci L. , Santos M. Serapiao Dos , Perrella E. , Graffeo R. , Lambiase A. , Bonini S.
Published: January 2018

Purpose

To report the identification of human papillomavirus types in four cases of conjunctival papillomas and to review the literature regarding human conjunctival papillomavirus (HPV).

Methods

Specimens from conjunctival papillomas of four patients were analyzed for the presence of HPV by polymerase chain reaction and subsequent filter hybridization. HPV types 6, 11, 16, 18, 31, and 33 were investigated. Histologic sections were analyzed for the presence of koilocytosis.

Results

Histologic examination confirmed HPV infection in all cases. HPV type 11 was detected in all specimens.

Conclusions

HPV is frequently implicated in the pathogenesis of proliferative squamous lesions. HPV type 11 was the most frequently found in benign conjunctival lesion in this study.
Bilateral Disc Edema and Unilateral Macular Hole in a Patient with Retinitis Pigmentosa
Authors: Ozdek S. , Ozdogan S. , Sezgin T. , Gürelik G.
Published: January 2018

Purpose

A unique case of retinitis pigmentosa (RP) associated with bilateral disc edema and unilateral macular hole is presented.

Methods

A 49-year-old woman, a known RP patient, was found to have bilateral disc edema and a macular hole in the left eye during routine clinical examination. Fluorescein angiography revealed hyperfluorescent leakage of the optic nerve head significantly OD and minimally OS. There was staining in the macular regions which was consistent with retinal pigment epithelium atrophy OD and cystoid macular edema (CME) OS. Cerebrospinal fluid pressure and examination by lumbar puncture was normal. Disc edema spontaneously decreased bilaterally during follow-up.

Discussion

Bilateral disc edema was thought to be secondary to inflammation caused by rapid degeneration of photoreceptors and retinal pigment epithelium and macular hole was secondary to CME.

Conclusions

Inflammatory response in the course of retinitis pigmentosa may result in disc edema and cystoid macular edema, which may further progresses to macular hole.
A Regression Model for Correcting Intraocular Lens Power after Refractive Surgery Independent of Preoperative Data
Authors: Razmjoo H. , Peyman A. , Kashfi A. , Peyman M. , Dehghani A.
Published: January 2018

Purpose

To find a method of calculating intraocular lens (IOL) power that may be independent of preoperative data in eyes that have previously undergone myopic laser in situ keratomileusis (LASIK).

Methods

In 148 eyes of 75 patients, before and 6 months after LASIK, IOL power was calculated with SRK/T formula utilizing the spherical equivalent as the desired target refraction. Assuming that LASIK does not alter the crystalline lens refractive properties, IOL calculation error (CER) was estimated with this formula: CER = [pre-LASIK IOL power]/[post-LASIK IOL power]. Then the authors used postoperative biometry and Orbscan II corneal topography data in multiple regression models to find the best variables to predict the CER. Predicted amount of error which is calculated independent of preoperative data could be used to correct the post-LASIK calculated IOL: [corrected post-LASIK IOL power] = CER x [post-LASIK IOL power].

Results

A regression model with these predictors was found: axial length in millimeters (L), radius of the anterior corneal surface best fitted sphere in millimeters divided by radius of the posterior corneal surface best fitted sphere in millimeters (AntBFS/PostBFS), corneal central 5 millimeters mean power in diopters divided by corneal central 3 millimeters mean power in diopters (mean 5 mm/mean 3 mm), the post-LASIK IOL power, and the post-LASIK simulated K reading. The model R square was 0.88.

Conclusions

There is correlation between post-LASIK biometry values and IOL power correction factor. This study presents a new model for further investigation.
Conservative Treatment of Keratoconus by Riboflavin-UVA-Induced Cross-Linking of Corneal Collagen: Qualitative Investigation of Corneal Epithelium and Subepithelial Nerve Plexus Regeneration by in vivo HRT II System Confocal Microscopy in Humans
Authors: Mazzotta C. , Traversi C. , Baiocchi S. , Sergio P. , Caporossi T. , Caporossi A.
Published: January 2018

Purpose

To assess corneal tissue modifications after riboflavin-UVA-induced cross-linking of corneal collagen in patients with progressive keratoconus as well as regeneration of epithelium and subepithelial nerve plexus by in vivo HRT II system confocal microscopy in humans.

Methods

Ten patients with progressive keratoconus were treated by riboflavin-UVA-induced cross-linking of corneal collagen, involving assessment of ultrastructural modifications of the corneal epithelium and subepithelial nerve plexus by HRT II system confocal microscopy. Treatment included instillation of 0.1% riboflavin-20% dextrane solution 5 minutes before UVA irradiation and every 5 minutes for a total of 30 minutes. Radiant energy was 3 mW/cm2 or 5.4 Joule/cm2 and the source was dual UVA (370 nm) light-emitting led. The protocol included the operation followed by antibiotic medication and eye dressing with a soft therapeutic contact lens. Changes in epithelium and subepithelial and stromal nerve plexus were assessed by HRT II system confocal microscopy in vivo.

Results

After 5 days of soft contact lens wearing corneal epithelium has a regular morphology and density. Disappearance of subepithelial stromal nerve fibers was observed in the central irradiated area where, 1 month after the operation, initial reinnervation was microscopically observed. No changes in nerve fibers were observed in the peripheral untreated with a clear lateral transition between the two areas. Six months after the operation, the anterior subepithelial stroma was recolonized by nerve fibers with restoration of corneal sensitivity.

Conclusions

HRT II system confocal microscopy confirms corneal epithelium restore and reinnervation after riboflavin-UVA-induced collagen cross-linking directly in vivo in humans.
Band Keratopathy: A Modified Treatment
Authors: De Ortueta D. , Schreyger F. , Baatz H.
Published: January 2018

Purpose

The surgical treatment of band keratopathy usually consists of abrasion of the corneal epithelium followed by removal of the subepithelial calcium deposits by means of an ethylenediamine-tetraacetic acid (EDTA) solution. In order to reduce the discomfort and pain that occur after corneal abrasion, the authors developed a modified technique that avoids the abrasion of the epithelium.

Methods

In three patients (four eyes) with long-standing band keratopathy, the epithelium was detached with a 19% ethanol solution and placed gently toward the limbus, a method also used in laser-assisted subepithelial keratectomy (LASER). After clearing the anterior stroma with EDTA solution, the epithelial flap is unrolled and a bandage contact lens applied.

Results

Postoperative pain was greatly reduced and after removal of the contact lens no pain was reported.

Conclusions

This modified epithelium-sparing treatment of band keratopathy shows good results while reducing postoperative pain.
Adenoma of the Nonpigmented Ciliary Epithelium
Authors: Elizalde J. , Ubia S. , Barraquer R.I.
Published: January 2018

Purpose

To report the clinicopathologic features of an adenoma of the nonpigmented ciliary epithelium.

DESIGN.

Single interventional case report.

Methods

A nonpigmented iris and ciliary body tumor was diagnosed in a 66-year-old woman who complained of blurred vision related to a unilateral cataract. A combined cataract surgery and partial lamellar sclerouvectomy was performed.

Results

Histopathologic findings disclosed an adenoma of the nonpigmented ciliary epithelium.

Conclusions

Unilateral cataract in an adult patient can be rarely related to a tumor growing from the ciliary epithelium. Adenoma of the non pigmented ciliary epithelium may mimic an amelanotic melanoma. Partial lamellar sclerouvectomy is an effective method to manage this condition and to confirm the diagnosis.
Long-Term Results of Closed Nasolacrimal Intubation in Adults
Authors: Shah A. , Tekriwal A.K. , Drummond P.M. , Woodruff G.
Published: January 2018

Purpose

Dacryocystorhinostomy (DCR) is the standard surgical treatment for adult nasolacrimal duct obstruction. There have been relatively few studies of closed nasolacrimal duct intubation in adults. The aim of this study was to determine rates of anatomic patency following this procedure.

Methods

The authors carried out a survey of all patients undergoing closed nasolacrimal duct intubation as a primary procedure over a period of 3 years and 4 months. There were 32 eligible patients of whom 20 attended for review.

Results

A total of 75% of these cases had patent drainage after follow-up of between 6 months and 3 years. The proportion of patients with persistent patency after intubation was the same regardless of length of follow-up.

Conclusions

The minimally invasive procedure of lacrimal intubation may have a role in some adults with nasolacrimal duct obstruction.
Changes in Higher Order Aberrations after Wavefront-Guided Prk for Correction of Low to Moderate Myopia and Myopic Astigmatism: Two-Year Follow-Up
Authors: Wygledowska-Promienska D. , Zawojska I.
Published: January 2018

Purpose

To assess efficacy, safety, and changes in higher order aberrations after wavefront-guided photorefractive keratectomy (PRK) in comparison with conventional PRK for low to moderate myopia with myopic astigmatism using a WASCA Workstation with the MEL 70 G-Scan excimer laser.

Methods

A total of 126 myopic or myopic-astigmatic eyes of 112 patients were included in this retrospective study. Patients were divided into two groups: Group 1, the study group; and Group 2, the control group. Group 1 consisted of 78 eyes treated with wavefront-guided PRK. Group 2 consisted of 48 eyes treated with spherocylindrical conventional PRK.

Results

Two years postoperatively, in Group 1, 5% of eyes achieved an uncorrected visual acuity (UCVA) of 0.05; 69% achieved a UCVA of 0.00; 18% of eyes experienced enhanced visual acuity of −0.18 and 8% of −0.30. In Group 2, 8% of eyes achieved a UCVA of 0.1; 25% achieved a UCVA of 0.05; and 67% achieved a UCVA of 0.00 according to logMAR calculation method. Total higher-order root-mean square increased by a factor 1.18 for Group 1 and 1.6 for Group 2. There was a significant increase of coma by a factor 1.74 in Group 2 and spherical aberration by a factor 2.09 in Group 1 and 3.56 in Group 2.

Conclusions

The data support the safety and effectiveness of the wavefront-guided PRK using a WASCA Workstation for correction of low to moderate refractive errors. This method reduced the number of higher order aberrations induced by excimer laser surgery and improved uncorrected and spectacle-corrected visual acuity when compared to conventional PRK.
Resolution of Juvenile Idiopathic Arthritis-Associated Uveitis after Development of Common Variable Immunodeficiency
Authors: Amer R. , Bamonte G. , Forrester J.V.
Published: January 2018

Purpose

To describe the occurrence of common variable immunodeficiency (CVID) in a patient with juvenile idiopathic arthritis (JIA) and JIA-associated uveitis.

Methods/Results

Case report. A 29-year-old woman was followed-up since the age of 10 years because of right eye JIA-associated recurrent anterior uveitis. She was treated with steroids and immunosuppressants with good control of uveitis and arthritis. At the age of 17 years, she did not experience any further relapse of uveitis or arthritis and both diseases were considered to be in remission. Concomitantly, she started to have recurrent infections and later she underwent splenectomy because of autoimmune hemolytic anemia and thrombocytopenia. Liver biopsy disclosed granulomatous hepatitis. She was ultimately diagnosed with CVID at the age of 23 years when her blood tests revealed neutropenia and severe panhypogammaglobulinemia. She has been treated since then with intravenous immunoglobulins with good control of the disease. Since the development of CVID, she has had no relapses of uveitis or arthritis during a follow-up period of 12 years.

Conclusions

Common variable immunodeficiency (CVID) is the most common primary immunodeficiency where defective antibody formation is the most common feature with B-cell differentiation failure. Ocular complications have been rarely documented and included bacterial conjunctivitis, retinal vasculitis and multifocal choroiditis. We herein report on the occurrence of JIA-associated uveitis as a comorbid manifestation of CVID. We speculate a role for B cells in the pathogenesis of JIA and JIA-associated uveitis here, as this patient had total remission of both conditions with the onset of CVID.
Retinal Pigment Epithelial Tear after Ranibizumab Therapy for Subfoveal Fibrovascular Pigment Epithelial Detachment
Authors: Chan C.K. , Lin S.G.
Published: January 2018

Purpose

To describe the unusual complication of retinal pigment epithelial (RPE) tear after intravitreal ranibizumab (Lucentis®) for subfoveal fibrovascular pigment epithelial detachment (PED) and its effective management.

Methods

Chart review for case report of RPE tear after ranibizumab.

Results

An inferior RPE tear was documented by fluorescein angiography, fundus photography, and optical coherence tomography (OCT) 1 month after receiving repeat ranibizumab injection in the right eye of a patient with bilateral subfoveal fibrovascular PED. He had undergone multiple bevacizumab followed by ranibizumab injections for neovascular age-related macular degeneration (AMD) in both eyes, starting 6 months previously. Subsequent antivascular endothelial growth factor (VEGF) therapy improved vision of right eye from 20/200 to 20/40, despite RPE tear.

Conclusions

RPE tear may form after anti-VEGF therapy, including ranibizumab injection. Further anti-VEGF therapy may preserve or improve vision. To the authors' knowledge, this is first case report of effective suppression of neovascular activity with bevacizumab after an RPE tear following ranibizumab therapy.