bluuebunny/crossref_metadata_2025 huggingface dataset:
Malignant Conjunctival Epibulbar Fibrous Histiocytoma with Orbital Invasion
Authors: Balestrazzi E. , Ventura T. , Noci N. Delle , Blasi M.A. , Spadea L. , Coletti G.
Published: April 2018

The Authors report on a rare case of malignant conjunctival epibulbar fibrous histiocytoma with orbital invasion.

Fibrous histiocytoma is a tumour of mesenchymal origin, which, although among the most common adult age soft tumours, appears very rarely at the conjunctival level. In fact the most frequent site is the orbit. So far only 15 cases concerning conjunctiva have been described in the Literature only 4 of those have been reported as malignant.

We observed a male patient, who 6 years ago, at the age of 53, noticed a neoformation on the temporal portion of the bulbar conjunctiva. In June 1988, after three successive operations, with a histological diagnosis of inflammatory granuloma, he came to our Clinic, where, because of the characteristics of the orbit infiltrations, only a partial excision was carried out for a biopsy.

The histological examination, associated with immunohistochemical techniques, gave the result of malignant fibrous histiocytoma. Consequently in, July 1988, the patient underwent an exenteratio orbitae. To date, the patient enjoys good health without a trace of recurrence. Besides the clinical presentation of the case, histopathological and immunohistochemical findings concerning this type of lesion are presented and discussed, with a comparison of our findings with those reported in the literature.
Manifestations of Graft-Versus-Host Disease following Allogenic Bone Marrow Transplantation
Authors: Arocker-Mettinger E. , Skorpik F. , Grabner G. , Hinterberger W. , Gadner H.
Published: April 2018

Sixty-seven patients undergoing allogenic bone marrow transplantation (BMT) were examined before and at regular intervals for up to 87 months (1-87 months, mean 18) after transplantation. Within a period of 1-39 months, 14 of these patients died (11 male, 3 female; age at BMT 16-46y). Five of these patients died within the first 100 days. They showed no eye involvement; three patients had intraretinal hemorrhage, in one case a squamous blepharitis and filiform keratitis developed during chronic graft-versus-host disease (GVHD).

In contrast, 22 of 53 (41.5%) surviving patients (30 male, 23 female; age at BMT 1-47y) were found to have ocular involvement. Before BMT only two cases of retinal hemorrhage and central chorioretinal scars each were detected.

During the stage of acute GVHD (up to day 100), nine patients were free of ocular manifestations. However, 16 of the 20 patients with chronic GVHD showed ocular involvement; 14 (70%) had reduced tearflow, ten had severe keratoconjunctivitis sicca, four suffered from sterile corneal ulcerations. Bilateral cataracts were detected in 11 patients, nine of whom only had minimal posterior subcapsular opacification, possibly resulting from highdose steroid medication. One additional case presented with bilateral multifocal recurrent chorioretinitis and panuveitis. The fundus lesions appeared some months after BMT (before cyclosporin-A treatment started) and recurred during systemic treatment. All patients undergoing allogenic BMT, especially when treated for severe chronic GVHD, require regular ocular observation to avoid complications such as keratoconjunctivitis sicca at an early stage, as late complications are often severe and hardly amenable to conservative or surgical treatment.
Digital Fluorescein Fundus Angiography with DFC-512 and Imagenet Systems
Authors: Shiraki K. , Harimura Y. , Moriwaki M. , Miki T.
Published: April 2018

Image processing with direct acquisition digital fundus fluorescein angiography using the OIS DFC-512 and Topcon IMAGEnet were assessed. Fundus diseases included central and branch retinal vein occlusion, diabetic retinopathy, age-related macular degeneration, central serous choroidopathy and angioid streaks. Analogue images were taken with Kodak Tri-X 35 mm film as well. Although the resolution of the original image was less than that of 35 mm film, it was improved by image processing, particularly contrast enhancement. One type of contrast enhancement, available in both systems, exaggerated lack of light at the peripheral area of the original image. This drawback was not seen with another type of enhancement processing, available in IMAGEnet. However, the latter produced an artificial hypofluorescent area around an intensely hyperfluorescent lesion and also exaggerated hyper- and hypofluorescent patches of the background. Nevertheless, these processing methods were particularly useful in case of media opacity like cataract, even when the 35 mm film picture is not clear. Other processing techniques like pseudocolor and relief, etc. were used just for different ways of presentation. The two systems are basically equivalent, except for contrast enhancement. There was no problem for diagnosis in both systems, but the artificial effects must be borne in mind when interpreting the image.
Retinal Manifestations in Fibromuscular Dysplasia
Authors: Meire F.M. , De Laey J.J. , Van Thienen M.N. , Schuddinck L.
Published: April 2018

Fibromuscular dysplasia of the arteries (FMD) is a segmental angiopathy which may produce obstruction of the carotid, cerebral, renal, mesenteric, coronary or iliac arteries. Except for lesions related to arterial hypertension, retinal manifestations have not yet been reported. This paper describes the case of a 10-year-old boy with progressive deafness, a history of an unexplained stroke and progressive occlusions of the retinal arterioles in the fundus periphery. This resulted in retinal neovascularization and recurrent retinal and vitreous hemorrhages. Despite repeated photo- and cryocoagulation the eyes progressed to a tractional retinal detachment which was successfully treated by vitrectomy and scleral buckling. The diagnosis of FMD was made on the basis of a histopathological examination of a temporal artery biopsy. The child also presented an asymptomatic but severe aneurysmal dilatation of the aorta and CT scan and MRI showed dilated cerebral arteries.

The father of our patient had died at the age of 27 years either from myocardial infarction or rupture of a dissecting aortic aneurysm. He was highly myopic and had lost one eye from retinal detachment. The younger brother of our patient also presents aneurysmal dilatation of the aorta and tortuous cerebral vessels. Ocular examination is still normal. The findings in this family are compatible with an autosomal dominant inheritance with variable expression.
Functional Results after Vitrectomy with Silicone Oil Injection
Authors: Stefer U. , Wiedemann P. , Weber J. , Heimann K.
Published: April 2018

In a prospective study we investigated the visual acuity and differential light sensitivity in 39 patients (40 eyes) with reattached macula. One group, treated with an encircling band (21 eyes), was compared to another, where vitrectomy and silicone oil injection had been necessary (19 eyes). Intraoperatively 9 of the vitrectomized eyes received an infusion of daunomycin (7.5 mg/l for 10 min). On average the vitrectomized eyes had a greater loss of visual acuity and differential light sensitivity. In all groups we found a positive correlation between visual acuity and the differential light sensitivity. At the same visual acuity we did not find any obvious difference in sensitivity between the groups. Correlation and regression line were similar for both groups. The mean relative sensitivity was lower in the fovea than in the rest of the tested field. A selective effect of silicone oil on either spatial resolution or differential light sensitivity could not be verified. The intraoperative application of daunomycin had no influence on the functional results.
A Pilot Study of Glaucoma Visual Field Screening in Diabetes
Authors: Klein B.E.K. , Meuer S.M. , Klein R. , Dalton D.S.
Published: April 2018

Because people with diabetes may be at increased risk of glaucoma, we performed a pilot study using automated visual field testing for screening them. One hundred and seventy-six diabetic persons who had participated in the Wisconsin Epidemiologic Study of Diabetic Retinopathy were tested with the Armaly-Drance screening pattern on the Humphrey Visual Field Analyzer. Individuals with moderate diabetic retinopathy or worse tended to have lower sensitivity of the central visual field and missed more points than those with no or only mild retinopathy. People with a history of glaucoma had slightly less sensitivity and missed more points than controls. These preliminary findings suggest that although people with diabetes and glaucoma may more frequently have visual field defects than people with diabetes but no glaucoma, a larger study is needed. This pilot study shows that such a study would be feasible and should be designed to indicate the sensitivity, specificity, and cost-benefit ratio of a screening program so as to assess the utility of the screening visual field test for finding glaucoma amongst people with diabetes.
Functional Visual Loss in Cambodian Refugees: A Study of Cultural Factors in Ophthalmology
Authors: Drinnan M. J. , Marmor M. F.
Published: April 2018

South East (SE) Asians accounted for a disproportionate percentage of the functional visual loss (FVL) seen in our area between 1983 and 1987. Moreover, 94% of the SE Asian FVL patients were Cambodian, although Cambodians only represented 20-30% of the local SE Asian patient population. Cambodian refugees are, at present, generally from lower socio-economic classes than the Vietnamese, and a much larger percentage of them have a history of camp incarceration and previous trauma. The Cambodians presenting with FVL may have conversion hysteria influenced by their wartime experience and cultural background. This study demonstrates that the SE Asian refugees in California are not a homogenous group with respect to visual problems, and that an awareness of cultural or historical factors can be important to the management of ophthalmic symptoms in our multi-cultural societies.
Endolaser Photocoagulation in Penetrating and Perforating Intraocular Foreign Bodies
Authors: Vine A.K.
Published: April 2018

Ten consecutive eyes that had undergone a pars plana vitrectomy and argon endolaser photocoagulation for penetrating or perforating posterior segment foreign bodies were reviewed. All eyes had undergone a pars plana vitrectomy plus or minus lensectomy, removal of the intraocular foreign body in those eyes with a retained foreign body, endolaser photocoagulation of posterior chorioretinal tears, and peripheral buckle for peripheral retinal pathology. Postoperatively (minimum follow-up, 6 months), all eyes had an attached retina. Eighty percent of the eyes had a visual acuity of 20/40 or better. Advantages of endolaser photocoagulation of posterior breaks include: microscopically controlled sealing of posterior tears, less destructive than posterior cryotherapy, effective when severe choroidal swelling is present, and absence of dispersion of viable retinal pigment epithelial cells which has been documented with external cryotherapy.
Indications for Q-Switched and Mode-Locked Nd: Yag Lasers in Vitreoretinal Pathology
Authors: Tassignon M.J. , Kreissig I. , Stempels N. , Brihaye M.
Published: April 2018

The indications for two types of pulsed Nd: YAG lasers in the treatment of vitreous pathology are reviewed. A series of 94 eyes from 93 patients were treated with the mode-locked system and 72 eyes from 71 patients were treated with the Q-switched system. A classification of vitreous pathology with prognostic value for the efficacy of treatment of both lasers is established.

For the Q-switched laser the range of indications in the posterior pole is larger and fewer sessions are needed; however, complications are more frequent than with the mode-locked laser. This difference is due to the higher energy needed with the Q-switched laser to treat more severe vitreous pathology.
Leukotriene Antagonist S 872419 A for Early-Phase Treatment of Chemical Burn in the Rabbit Eye
Authors: Struck H.G. , Geiser H. , Block H.U. , Mest H.J. , Tost M.
Published: April 2018

S 872419 A, a specific receptor antagonist of peptide leukotrienes, was tested in the early-phase treatment of chemically burned eye (0.25 mol/l sodium hydroxide) of the rabbit. The drug was topically applied 5 times a day in a 1% solution, controls were the untreated opposite eye. Gross and microscopic investigations indicated that S 872419 A inhibits the inflammatory response of the chemically burned anterior eye segment. The parameters of healing considered (epithelial regeneration, corneal clouding and swelling, infiltration with polymorphonuclear leukocytes) suggest inhibition of lipoxygenase-mediated reactions in the tissue. PGF2alpha levels were the same in aqueous humour of treated and untreated eyes. Further experiments with S 872419 A and other nonsteroidal drugs should improve the anti-inflammatory therapy of the chemically burned eye.
Age-Related Macular Degeneration and Vitreous Hemorrhage
Authors: Azzolini C. , Menchini U. , Pece A. , Camesasca F. , Giuliani V.
Published: April 2018

Age-related macular degeneration led to vitreous hemorrhage (VH) in six eyes of four patients. Macular involvement was bilateral in three patients and fluorescein angiography performed before VH showed extensive subretinal hemorrhage in the macular region in all eyes. We examine the possible causal mechanisms of VH resulting from age-related macular degeneration. Local risk factors, as outlined in our series by fluorescein angiography, are discussed and systemic risk factors are considered. Three out of the six eyes underwent pars plana vitrectomy for removal of intravitreal blood, and had severe inflammatory reactions in the postoperative period. In the three non-operated eyes spontaneous reabsorption of VH was observed at the end of follow-up.
Retinal Detachment and Retinal Holes in Retinitis Pigmentosa Sine Pigmento
Authors: Csaky K. , Olk R.J. , Mahl C.F. , Bloom S.M.
Published: April 2018

Retinal detachment and retinal holes in two family members with retinitis pigmentosa sine pigmento are reported. We believe these are the first such cases reported in the literature. We describe the presenting symptoms and management, including cryotherapy, scleral buckling procedure, and sulfur hexafluoride injection (SF6), resulting in stable visual acuity in one case and retinal reattachment and improved visual acuity in the other case.
Eccrine acrospiroma of the eyelid with oncocytic, apocrine and sebaceous differentiation
Authors: Büchi E.R. , Peng Y. , Eng A.M. , Tso M.O.M.
Published: April 2018

A wide variety of sweat gland tumors occur in the eyelids. We used light and electron microscopy to investigate an eccrine acrospiroma showing areas of oncocytic, apocrine and sebaceous differentiation. To our knowledge this is the first report of an oncocytic lesion arising from an eccrine sweat gland, and only the second report of such a lesion arising from the skin. Furthermore, apocrine and sebaceous differentiation are atypical in lesions originating from sweat glands. The wide spectrum of differentiation in this adenoma lends further support to the concept of pluripotentiality of the adnexal glandular epithelia.
Gastric Adenocarcinoma Presenting as an Eyelid and Conjunctival Mass
Authors: Küchle M. , Holbach L. , Schlötzer-Schrehardt U.
Published: April 2018

A 50-year-old white man complained of “inflammation” of his right eyelid since January 1989. In June 1990, he had undergone a gastrectomy for an adenocarcinoma of the stomach. In August 1990, his right eye showed a painless, firm infiltration of the upper and lower lid, ulceration and loss of eyelashes of the upper lid and a reddish, subepithelial thickening of the medial bulbar conjunctiva. Biopsies of the right upper lid and nasal bulbar conjunctiva disclosed a metastatic, poorly differentiated adenocarcinoma of the stomach (signet ring cell carcinoma) both in the lid and conjunctival biopsies. Carcinoembryonic antigen (CEA) was detected in the tumor cells. Electron microscopic examination revealed tumor cells with signs of secretory activity. Although metastases to the eyelids and conjunctiva are rare, they may precede the clinical manifestation of the primary tumor for months or even years. In patients with chronic, recalcitrant lesions of eyelids or conjunctiva, especially if accompanied by loss of eyelashes, a primary or secondary malignancy should be excluded by early biopsies and histopathological examination.
Thrombospondin: A New Attachment Protein in Preretinal Traction Membranes
Authors: Weller M. , Esser P. , Bresgen M. , Heimann K. , Wiedemann P.
Published: April 2018

Thrombospondin (TSP), an adhesive integrin-binding protein of plasma and platelets, was detected in preretinal traction membranes from patients with idiopathic (8/8) and traumatic (7/8) proliferative vitreoretinopathy (PVR) and proliferative diabetic retinopathy (PDR) (6/8). TSP immunoreactivity was compared to the pattern of von Willebrand factor, plasma transglutaminase (blood coagulation factor XIII), fibronectin, and mononuclear phagocytes, using double-label immunoflurorescence microscopy. TSP was partially colocalised with the endothelial cell marker, von Willebrand factor, in PDR. The codistribution of catalytic factor XIII and two cross-linking substrates, fibronectin and TSP, suggests a functional role of the enzyme in the extracellular matrix build-up in PVR and PDR. No significant TSP synthesis by mononuclear phagocytes was observed. Western blotting indicated a plasmin-mediated intravitreal breakdown of presumably plasmatic TSP in PVR and PDR.
Prevalence of Myopia in Open Angle Glaucoma
Authors: Mastropasqua L. , Lobefalo L. , Mancini A. , Ciancaglini M. , Palma S.
Published: April 2018

In this study concerning the prevalence of myopia in patients with open angle glaucoma, its distribution was analyzed within the sample tested in relation to the refraction defect size, compared with a control group of non-glaucomatous myopic subjects.

The overall myopic rate was 17.2% of the glaucomatous patients; high myopia was more frequent in the subjects with open angle glaucoma (p<0.001) than in the myopic patients, thus appearing as a possible risk factor for the development of glaucoma.
Dark Choroid in Cone-Rod Dystrophy
Authors: Leys A. , Van De Sompel W.
Published: April 2018

An unusual pattern of dark choroid in an eight-year-old girl is described. The ophthalmoscopic, fluorescein angiographic and functional changes were indicative of progressive cone-rod dystrophy.
Simultaneous Bilateral “Malignant Glaucoma” Attack in a Patient with no Antecedent Eye Surgery or Miotics
Authors: Gonzalez F. , Sanchez-Salorio M. , Pacheco P.
Published: April 2018

Malignant glaucoma is a term commonly used to describe a condition characterized by a sudden increase in intraocular pressure, usually occuring after eye surgery. This report describes a case of malignant glaucoma simultaneously presenting in both eyes, with no antecedent eye disease, medication or surgery. As far as we know this is the first report of spontaneous bilateral glaucoma. Both eyes were operated on according to the technique described by Chandler et al. (1), and the condition was solved. We suggest that, despite its rarity in eyes with no antecedent disease or ocular therapy, a surgeon should be aware of this condition.
Chronic Postoperative Endophthalmitis Caused by Propionibacterium Acnes
Authors: Posenauer B. , Funk J.
Published: April 2018

Persistent intraocular inflammation after cataract surgery with intraocular lens implantation is acquiring importance. Frequently, chronic uveitis or the “toxic lens syndrome” have to be differentiated from bacterial infection. This report describes five cases with chronic postoperative endophthalmitis where the anaerobic bacterium Propionibacterium acnes was found to be the causative organism. Adequate anaerobic culture media and proper sampling from the area around the lens haptics are the most important requirements for the detecion of P. acnes.
Randomised Double-Masked Trial of Lodoxamide and Sodium Cromoglycate in Allergic Eye Disease
Authors: Fahy G.T. , Easty D.L. , Collum L.M.T. , Benedict-Smith A. , Hillery M. , Parsons D.G. ,   Study group participants, Fahy G.T. , Easty D.L. , Mackie I. , Collum L.M.T. , Benedict-Smith A. , Hillery M. , Laughrea P. , Jackson B. , Lumbroso P. , Mintsioulis G. , Ober M. , Verin P.
Published: April 2018

135 patients were entered into a 28-day randomized double-masked multicentre study comparing the efficacy and short-term safety of lodoxamide 0.1% ophthalmic solution (Alomide - Alcon Laboratories), a mast cell stabilizer, with sodium cromoglycate 2% ophthalmic solution (Opticrom - Fisons Pharmaceuticals) in the treatment of allergic eye disease. Patients given lodoxamide 0.1% showed a significantly more rapid and greater improvement in their signs and symptoms of allergic eye disease than patients given sodium cromoglycate 2%. Both treatments were found to be safe, and side-effect profiles were comparable between the two treatment groups, although the overall incidence of side-effects in this study was found to be less frequent in the lodoxamide-treated group.
Metastatic Or Dystrophic Conjunctival Calcification in Renal Failure?
Authors: Klaassen-Broekema N. , Landesz M. , Krul B. , Van Bijsterveld O.P.
Published: April 2018

In renal failure the incidence of pingueculae is significantly higher than in a comparable control group but there is no evidence that the calcific precipitation in renal failure is of a dystrophic nature. The lime salts are not located within the area of elastotic degeneration, a prerequisite for dystrophic degeneration. Moreover there is no association between the magnitude of the conjunctival degeneration and the degree of calcification. This makes it likely that the calcium precipitates represent metastatic calcification even though admittedly support for this assumption is tenuous.
Reliability of the Herpes Simplex Virus Immunofluorescent test in Corneal Disease
Authors: Bordin P. , Merlin U. , Pugina P. , Benzi G. , Sichirollo R.
Published: April 2018

Herpetic ocular disease never produces well-identifiable morphological aspects. It is expensive, complicated and slow to culture Herpes simplex virus. The validity of the fluorescent monoclonal antibodies test was investigated using corneal cells with or without a sure herpetic lesion. The tests, on 36 cases without sure herpetic lesions, were always negative, while of the 42 patients with a clinically ascertained herpetic lesion, 38 were positive (90.5%) and 4 negative (9.5%), two of these on account of inadeguate tissue preparations. Thus, this method can prove useful and reliable for diagnostic purposes.
Electrophysiology in Pseudohistoplasmosis and Chronic Idiopathic Retinal Vasculitis
Authors: Pereira-Neves L. , Ribeiro-Da-Silva J.
Published: April 2018

We used computerized electroretinography (E.R.G.) flash to study 12 patients: five pseudohistoplasmosis (P.S.H.) and seven chronic idiopathic retinal vasculitis (C.I.R.V.), compared with 12 healthy controls. We found a moderate correlation in controls between white computer averaged b-wave amplitude and b-wave obtained with other wavelengths (over 600 nm red, over 550 nm orange, and under 500 nm blue), in scotopic (white/orange r = 0.41, P < 0.05; white/red r = 0.45, P < 0.05; white/blue r = 0.48, P < 0.02) and photopic conditions (white/orange r = 0.6, P < 0.01). For P.S.H. there was a highly significant correlation between white and all wavelengths in photopic (white/orange r = 1, white/red r = 0.96, P < 0.0001) and scotopic conditions (white/orange r = 0.97, P < 0.0001; white/red r = 0.96, P < 0.0001; white/blue r = 0.96). In vasculitis, as in controls, we found no white/red correlation and only in vasculitis we could not find a scotopic white/blue correlation. We conclude that these situations are electrophysiologically different. The closer correlation in P.S.H. suggests more efficient phototransduction and in C.I.R.V. there may also be a rod-selective dysfunction.
Transillumination Guided Cyclocryotherapy in the Treatment of Secondary Glaucoma
Authors: Vesti E. , Rong-Guang W. , Raitta C.
Published: April 2018

A consecutive series of 38 eyes of 35 glaucoma patients treated with transillumination guided cyclocryotherapy (CCT) either to obtain pain relief or to achieve IOP control was studied at Helsinki University Eye Hospital. Transillumination was used to guide the applications to the correct site. The follow-up range was 1 - 43 months (mean 9 months). Pretreatment IOP was 39 ± 13 mm Hg and postoperative 26 ± 16 mm Hg (mean ± SD). Twenty-three eyes underwent one and 15 eyes 2 - 5 procedures. IOP control (IOP 9 - 23 mm Hg) was achieved in 50%. The response was more favorable in eyes without iris neovascularisation (59% achieved IOP control) than in eyes with neovascular glaucoma (38% achieved IOP control). The best response was achieved in eyes with chronic uveitis (5/7 eyes achieved IOP control). Repeated procedures improved the IOP control rate. Hypotony (IOP < 9 mm Hg) without clinical signs of phthisis occurred in three eyes (8%). Thirteen eyes needed primarily pain relief and 92% achieved it. Postoperatively vision was better in 8%, unchanged in 37% and worse in 55%. Visual acuity was 0.05 or better in nine eyes pretreatment and in eight eyes after treatment.
Two Different Genetic Markers for High and Low Myopia
Authors: Olmedo M.V. , Muñoz J.I. , Rodriguez-Cid M.J. , Carracedo A. , Gomez-Ulla F.J. , Salorio M.S.
Published: April 2018

In myopia patients, Rh and acid phosphatase were typed in two groups: group 1 consisted of 214 patients with low myopia (−6 D or less); group 2 of 124 patients with high myopia (more than −6 D). Statistical analysis of the markers showed a good Hardy-Weinberg equilibrium for both groups. In the Rh system there was a significant difference between group 1 and the control population (p < 0.05), but not between group 2 and control (p > 0.1). In the case of ACP there was a significant difference between group 2 and the control population (p < 0.05), but not between group 1 and control (p > 0.25). We conclude that the observed association between myopia and Rh system (chromosome 1) involves low myopia, while the association between myopia and acid phosphatase (chromosome 2) involves high myopia. Further DNA researche will lead to more specific results.
A Case Report of Both Duane's Syndrome and Rieger's Anomaly in a Single Patient
Authors: Gregg F.M.
Published: April 2018

A young patient manifesting both Duane's syndrome and Rieger's anomaly is presented. This is believed to be the first known report of such an association. Although there is no obvious genetic correlation, the clinical implications of this finding are discussed.
Presumed Intraocular Lymphoma in a 60-Year-Old Man with AIDS
Authors: Baarsma G. Seerp , Smit L.M.J. Roland
Published: April 2018

A 60-year-old man with AIDS and active pulmonary tubercolosis presented with a rapidly growing chorioretinal tumor. Tuberculostatics had no effect on the tumor but radiation resulted in a quick decrease in its size. It is therefore believed to be a lymphoma. No biopsy was performed. An intraocular lymphoma in a patient with AIDS has not yet been described.
Visual Field Indices for the Nasal Step: Different Calculation Procedures and Their Correlation with the Clinical Classification of Visual Field Defects
Authors: Damms T. , Dannheim F. , Dannheim D.
Published: April 2018

We calculated normal values for the normal population of the Octopus G1 program (n=836) and values for defective fields due to glaucoma and other diseases (n=147) to determine indices for a nasal step in the interpretation of glaucomatous visual fields. We used different calculation procedures and correlated the results with the clinical evaluation of the visual field. All indices tested were able to detect and quantify nasal steps in defective fields and to separate them from normal findings (area under curve of Receiver Operating Characteristic curves 0.963 to 0.999). Indices calculated excluding sensitivity values of positions with the greatest distance from the horizontal meridian or weighting of sensitivity values according to their closeness to the horizontal meridian showed the best results (auc=0.999). We can thus conclude that the calculation of an index for nasal step is a simple and effective adjunct to any interpretation system for visual fields.
Sagittal Magnetic Resonance Imaging of Dysthyroid Ophthalmopathy
Authors: Inoue Y. , Higashide T. , Yoshikawa K. , Inoue T.
Published: April 2018

Sagittal magnetic resonance imaging (MRI) scans of the eye and orbit were made of 30 eyes in 15 cases of dysthyroid ophthalmopathy (DO). On the basis of these scans, we sought to elucidate relationships between the morphological condition of the levator palpebrae muscle, fatty tissue in the upper eyelid and the superior, inferior recti muscles and the occurrence of such symptoms as lid retraction, lid swelling and vertical disturbance of eye movement. The levator palpebrae muscle was enlarged in all 15 DO eyes (100%) with upper eyelid retraction. In 16 (88.9%) of 18 eyes with apparent lid swelling, enlargement of the preaponeurotic fat or submuscular fat pad was clearly evident. In the control eyes, no such enlargement was seen in either the levator palpebrae muscle or orbital fatty tissue. The clear space between the superior recti and the levator palpebrae muscles that was seen in control eyes was absent in all five eyes that presented a disturbance in infraduction. In 8 (80%) of 10 eyes with a disturbance in supraduction, the inferior rectus muscle was enlarged and muscle extension was impaired. Sagittal MRI seemed to be a useful means of obtaining a better clinical understanding of a variety of eye symptoms associated with DO.
The Fate of Eyes with Anterior Chamber Intra-Ocular Lenses
Authors: David R. , Yagev R. , Shneck M. , Briscoe D. , Gilad E. , Yassur Y.
Published: April 2018

A total of 143 anterior chamber (AC) intra-ocular lenses (IOL) of various designs were implanted in a five-year period and followed for 18 to 76 months. The lenses were inserted as a secondary implant after extracapsular cataract extraction (ECCE) complicated by vitrectomy, or after primary intra-capsular extraction. The complications (corneal edema, uveitis/glaucoma, extrusion/imbedding, cystoid macular edema), the final visual acuity and the need for removal of the IOL were analyzed. Only small differences were found between the different lenses but some association was found between complicated surgery (ECCE + vitrectomy) and a higher rate of complication, poorer visual outcome and more frequent need for IOL removal. Cystoid macular edema was encountered only in cases with complicated ECCE. A high percentage of other ocular pathologies was found among the cases, possibly implying that diseased eyes are more prone to surgical complications. An alternative to the AC-IOL in cases with a ruptured posterior capsule is the suture-supported posterior chamber IOL, but the flexible-loop AC-IOL may not yet be obsolete.
Granular Cell Tumor of the Eye (Myoblastoma): Ultrastructural and Immunohistochemical Studies
Authors: Rodríguez-Ares T. , Varela-Durán J. , Sánchez-Salorio M. , Varela-Nuñez R. , Capeans-Tomé C. , Urdiales-Viedma M.
Published: April 2018

The clinical and pathological characteristics of a myoblastoma of the orbital are described. The tumor presented as a painless hard mass in the left orbit of a 56-year-old caucasian male, causing diplopia and hypertrophy of the left eye in the primary visual position. Light microscopy studies revealed a typical granular cell tumor with PAS-positive intracytoplasmic granules. Immunoperoxidase studies showed positivity for S-100 protein and desmin. Electron microscopy studies showed numerous intracellular myelin degenerative bodies. The patient developed an epidermoid cyst at the site of initial surgery, but has no signs of local or distant disease two years after initial treatment.
Full-Thickness Macular Hole and Retinal Detachment Complicating Best's Disease
Authors: Glacet-Bernard A. , Coscas G.
Published: April 2018

The unusual association of Best's vitelliform macular dystrophy and a full-thickness macular hole causing retinal detachment is reported. Successful reattachment was achieved with pneumatic retinopexy and postoperative laser photocoagulation. The mechanisms underlying the combination of full-thickness macular hole and retinal detachment in Best's disease remain to be elucidated.
An Anatomic Index for the Severity of Ocular Injuries
Authors: Klein B.E.K. , Karlson T.A. , Rose J.
Published: April 2018

Ocular injuries are a frequent cause of monocular blindness and cause disfigurement and discomfort. We developed a measure of severity for eye injuries using a multi-attribute utility (MAU) model. The severity index scoring was applied to eye injuries that presented at hospitals in Wisconsin, U.S.A. The resulting distribution of severities was compatible with that seen by general eye care physicians. A severity scale provides a means of comparing the severity of injuries from a wide variety of traumatic sources (e.g. automobile crashes, combat injuries, occupational accidents, etc.) and is useful in evaluating preventive and public health measurements.
Corneal Sensitivity after Penetrating Keratoplasty
Authors: Tutkun I. Tuğal , Akarçay K. , Bilgin L. Közer , Sansoy N. , Urgancioğlu M.
Published: April 2018

In order to determine corneal sensitivity after penetrating keratoplasty, 71 corneal transplants and their recipient beds were tested using the Cochet-Bonnet esthesiometer. The periods from surgery to examination were two weeks to 15 years. When the test results were divided into six groups according to the postoperative period, correlation analysis revealed a progressive improvement of sensitivity in the central and peripheral graft as well as in the recipient cornea. Only one graft had normal central sensitivity at 24 months; 36 grafts were completely anesthetic while 35 grafts had some level of sensitivity at the time of last clinical testing. Age, preoperative diagnosis or graft size were not correlated with the recovery of sensitivity. The extent and time of reinnervation in corneal grafts varied in individual patients.
Dopamine and Its Metabolites in Human Tears
Authors: Martin X.D. , Brennan M.C.
Published: April 2018

Dopamine is known to stimulate ion transport in the corneal epithelium. Since epithelium is in contact with tears, we searched for dopamine and its metabolites in tears. Twenty normal subjects participated in this study. Twenty μl of tears were collected in capillary tubes after trigeminal stimulation and immediately analyzed using high-performance liquid chromatography with electrochemical detection. Dopamine and two of its metabolites, 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), were identified and measured. The mean concentration of dopamine was 8.9 ±5.1 ng/ml; DOPAC, 2.2 ± 1.6 ng/ml; and HVA, 0.55 ± 0.4 ng/ml. These results permit us to suggest that dopamine is deaminated by monoamine oxidase, then methylated by catechol-O-methyltransferase and that catabolism occurs in the lacrimal gland and perhaps in corneal epithelium. Finally, part of the dopamine involved in ion transport may come from tears.
Immunological and Viral Markers of Hiv Infection and Retinal Microangiopathy
Authors: Pivetti-Pezzi P. , Tamburi S. , Accorinti M. , Mezzaroma I. , Vullo V. , Sorice F. , Aiuti F.
Published: April 2018

The relationship between retinal microangiopathy and some features of human immunodeficiency virus (HIV) infection such as HIV antigenemia, antibodies to the viral proteins, T lymphocyte subsets, were studied in 71 patients with acquired immunodeficiency syndrome (AIDS). The absence of antibodies to the HIV p24 protein was significantly related to retinal microangiopathy (p = 0.0051) and more closely to retinal cotton-wool spots (p = 0.0007); the combination of positive antigenemia with the absence of antibodies to p24, which is typical of the later phases of HIV infection, was found in a larger percentage of patients with cotton-wool spots (p = 0.0013) than in subjects with every sign of microangiopathy (p = 0.0546). T-helper (CD4+) cells count below 200 cells/mm3 was also detected in a higher percentage of patients with HIV-related retinal microangiopathy (p = 0.009). These findings suggest that retinal microangiopathy and especially retinal cotton-wool spots are related to the progression of immunodeficiency.
Localised Wegener's Granulomatosis Presenting as an Orbital Pseudotumour with Extension into the Posterior Cranial Fossa
Authors: Diamond J.P. , Bloom P.A. , Ragge N. , Easty D.L. , Laszlo G.
Published: April 2018

Pseudotumour has rarely been reported to invade the intracranial cavity. We present a case of pseudotumour which extended intra-cranially into the posterior cranial fossa. The patient had circulating antineutrophil cytoplasmic antibodies in titres diagnostic for Wegener's granulomatosis. In the absence of clinical renal or respiratory tract disease, the case may represent a newly recognized sub-type of “localised” Wegener's granulomatosis.
Retinal Detachment after Cataract Surgery: Retrospective Study of 57 Cases
Authors: Frau E. , Sam H. , Korobelnik J.F. , Chauvaud D.
Published: April 2018

The Authors studied the characteristics and the surgical results of 57 pseudophakic patients operated on between January 1989 and June 1991 for primary retinal detachment at the Department of Ophthalmology of the “Hotel Dieu de Paris Hospital”, with a postoperative follow-up of at least six months. The series included 23 eyes with posterior chamber IOL, 33 eyes with anterior chamber IOL. The ECCE with PC IOL group and the ICCE with AC IOL group had the same anatomical and visual prognosis.
Diabetic Retinopathy and Metabolic Control
Authors: Porta M.
Published: April 2018

Retinopathy is probably the first long-term complication of diabetes mellitus to become clinically evident, possibly because the retina is the only microvascular bed that can be observed directly and repeatedly. This makes it a good model for studying the pathogenesis and natural history of diabetic microangiopathy. Most of the proposals to account for its pathogenesis invoke mechanisms that depend directly on the circulating and tissue levels of glucose: protein glycosylation, activation of the “polyol pathway”, abnormalities of vascular endothelium, altered capillary blood flow. Several population studies and clinical trials suggest that the degree of metabolic control maintained over the years influences the rates of appearance and progression of retinopathy. However, on an individual basis, factors independent of control may intervene, making some patients more or less prone to this complication. Animal models also suggest that the progression of retinopathy may become irreversible from its very early stages. From a clinical point of view, it is difficult to establish a satisfactory definition of “good” control and approaching it may increase the risk of dangerous hypoglycemia and weight gain. Diabetes and eye specialists are thus left to strive for the best possible, sensible, metabolic control but must also rely on early diagnosis and treatment for the sight-threatening complications of diabetes.
Topical Ciprofloxacin in the Treatment of Blepharitis and Blepharoconjunctivitis
Authors: Bloom P.A. , Leeming J.P. , Power W. , Laidlaw D.A.H. , Collum L.M.T. , Easty D.L.
Published: April 2018

An international multicentre study assessed the clinical and antibacterial efficacy of a new topical ophthalmic formulation of the quinolone antimicrobial agent ciprofloxacin and compared it with that of tobramycin ophthalmic solution in patients with blepharitis and blepharoconjunctivitis. The study consisted of a randomised double-masked between-group evaluation of 464 patients, 230 of whom were treated with ciprofloxacin and 234 with tobramycin. There was qualitative and quantitative bacteriology, and clinical assessment of ocular symptoms and signs before and after a seven-day course of treatment. Bacteriological cultures demonstrated eradication or reduction of potentially pathogenic bacteria in 93.7% of eyes (ciprofloxacin) versus 88.9% of eyes (tobramycin), seven days after starting treatment. Clinically more than 80% of patients in both treatment groups were cured or improved after seven days. No statistically significant differences were observed between the two treatment groups. No serious side-effects were observed after use of either antimicrobial agent. Ciprofloxacin ophthalmic solution appears safe and effective. The spectrum of activity and clinical efficacy of this new formulation are discussed in comparison with currently used antimicrobial agents.
Night Vision after Excimer Laser Photorefractive Keratectomy: Haze and Halos
Authors: O'Brart D.P.S. , Lohmann C.P. , Fitzke F.W. , Smith S.E. , Kerr-Muir M.G. , Marshall J.
Published: April 2018

A series of 85 patients with myopia, up to −6.00D, was treated by photorefractive keratectomy (PRK), using a 5 mm diameter ablation zone. At six months, 38 patients (45%) reported slight disturbances of night vision, nine (11%) of whom had significant problems. Perturbations of night vision after PRK are seen as starbursts and halos around lights. Corneal haze produces the starbursts, which are usually transient. In contrast, halos are myopic blur circles and may be persistent. Using a computer program, halos after PRK were found to be significantly larger than those in emmetropes and myopes corrected with spectacles (p < 0.01). The halos were diminished by using either artificial pupils or negative lens over-correction. In patients with identical bilateral PRK corrections, except for the ablation zone size, the magnitude of the halo was less with 5 mm than 4 mm zones (p < 0.01). Patients treated with 5 mm reported fewer problems attributable to halo than with the 4 mm ablation diameters (p < 0.01). Halos and pupil diameters were measured in nine patients with significant impairment of night vision haze. Those with starbursts had small hyperopic shifts, minimal halos and high haze and light scatter measurements, whilst patients with halos had large hyperopic shifts, little haze and large pupil diameters. Patients with persistent halo problems benefited from either negative lens over-correction or miotics at night.
Conjunctivalization of Meibomian Glands following Cryosurgery for Basal Cell Carcinoma of the Eyelid
Authors: Daicker B. , Büchner S. , Kraus M.
Published: April 2018

Cryosurgery on the eyelids destroys the cellular elements in the frozen region, but preserves the collagenous supporting structures. Cells from the neighborhood colonize this framework during wound healing. The Authors describe a peculiar change in the Meibomian glands, which obviously developed by this mechanism in a lid treated by cryotherapy for a basal cell carcinoma. The collagenous lodges of the Meibomian glands, denuded of their sebaceous cells by the therapy, were epithelialized by ingrown conjunctival epithelium. This situation seems to promote the spread of and maintain acute and chronic exogenous inflammation in the tarsal plate.
Reliability of Preoperative Ultrasonography Evaluation for Vitreoretinal Surgery
Authors: Azzolini C. , Pierro L. , Candino M. , Brancato R.
Published: April 2018

To evaluate the present level of reliability of common ultrasonography prior to vitreoretinal surgery, we carried out a prospective study to compare preoperative ultrasonography data with direct intraoperative findings. A total of 228 eyes with different vitreoretinal disorders and opaque or clear media were studied. In the group of 187 eyes with fractional retinal detachment (group I), the percentage of agreement between the ultrasonography data and the surgical fingings ranged from 77.1% to 92.2%, depending on the pathology. In the group of 41 eyes without retinal detachment (group II), agreement ranged from 90.4% to 100%. The most frequent causes of failure of preoperative ultrasonography were incorrect prediction of macular detachment, partial posterior vitreous detachment, posterior vitreoschisis and vitreoretinal adhesions. The main cause of failure was the presence of multiple complicated echos in group I, particularly in fractional diabetic retinal detachment. To achieve maximum benefits from ordinary preoperative ultrasonography, the vitreoretinal surgeon must be fully aware of its present level of reliability and general limitations.
Levocabastine Eye Drops: A New Approach for the Treatment of Acute Allergic Conjunctivitis
Authors: Abelson M.B. , Weintraub D.
Published: April 2018

Acute allergic conjunctivitis (AAC) is a common ocular allergic disorder and incident rates as high as 20% have been reported. Although a wide range of therapeutic agents are available for the treatment of AAC, the ideal treatment seems to have remained elusive. Levocabastine, a highly potent specific H1-receptor, appears to offer a promising alternative as a topical single-agent therapy. Levocabastine eye drops have been found to be well tolerated with an adverse-effect profile comparable to placebo and sodium cromoglycate. In addition, ocular levocabastine has been shown to have a rapid onset and long duration of action. The efficacy of levocabastine has been extensively investigated in conjunctival provocation tests and environmental studies. The available data suggest that ocular levocabastine is an effective therapeutic agent. Statistically significant differences in favour of levocabastine have been observed in comparisons with sodium cromoglycate, antazoline/naphazoline and oral terfenadine.
Rapid Progression of Band-Shaped Keratopathy with Early Central Localisation in a Patient on Chronic Dialytic Treatment
Authors: Klaassen-Broekema N. , Van Bijsterveld O.P.
Published: April 2018

This clinical study reports on an unusual start of a band-shaped keratopathy in a patient with diabetic nephropathy on dialytic treatment. The earliest corneal manifestations were centrally located small greyish-white disc-shaped lesions evenly distributed in the interpalpebral area in the left eye. Later a typical peripheral band-shaped keratopathy developed. In the course of the observation period the peripheral keratopathy rapidly spread towards the centre, finally resulting in a complete band-shaped keratopathy in which only the most central original disc-shaped lesions could be identified. Serum calcium and phosphorus concentrations were markedly elevated at the time of the progression of the band-shaped keratopathy but no tertiary hyperparathyroidism was present.
Ethical Dimensions of the Care of Patients with Glaucoma
Authors: Spaeth G.L
Published: April 2018

The thesis of this report is that ethical considerations frequently take precedence over other considerations in the care of patients with glaucoma. This relates at least partially to the still incomplete knowledge regarding the diagnosis and management of patients with glaucoma. The surest way to avoid damaging patients on the basis of incorrect information is to make certain that we recall the fallibility of our knowledge and that we listen to the patient with all our attention, so that we can truly hear who he or she is and what it is that he or she needs or wants. In so doing not only do we have the best chance to respect the patient's autonomy, but to avoid doing harm and to be active in helping. These are ethical, not technical considerations.