bluuebunny/crossref_metadata_2025 huggingface dataset:
Intravitreal and Systemic Foscarnet in the Treatment of Aids-Related Cmv Retinitis
Authors: Tognon M.S. , Turrini B. , Masiero G. , Scaggiante R. , Cadrobbi P. , Baldanti F. , Gerna G. , Secchi A.G.
Published: April 2018

Cytomegalovirus retinitis is the most frequent ocular opportunistic infection in AIDS patients. Untreated, it is always a progressive and destructive disease of the retina that results in blindness. Specific treatment is therefore mandatory to halt the progression of the retinal lesions. The authors report their experience in the treatment of CMV retinitis with foscarnet in 25 AIDS patients; the drug is an analog of pyrophosphate, virostatic against all herpes-class viruses including CMV.

Foscarnet was successful in halting the progression of CMV retinitis during induction treatment (180 mg/kg/day) by either a TID (three times a day) or a BID (twice a day) regimen, and in healing retinal lesions during maintenance (90 mg/kg/day) in 14 out of 19 patients. Five patients had a relapse of retinitis during maintenance. In these patients a brief course of intravitreal foscarnet, in association with the lowest dosage of the drug administered systematically (90 mg/kg/day), was effective in healing the retinal lesions.

The main systemic side effects, such as renal impairment and electrolytic disturbances, were observed only during the induction treatment, and only in one case was it necessary to stop the therapy.
Retinopathy of Prematurity in Denmark. Epidemiological Considerations and Screening Limits
Authors: Fledelius H.C.
Published: April 2018

The epidemiology of retinopathy of prematurity (ROP) in Denmark is analysed based on two sources. Regional experience is presented from 12 years’ prospective ophthalmic control of infants at risk, in a Danish county with population 342,000 and 44,805 liveborns over the period 1982-93. Out of 127 subjects with ROP 101 reached stage 1 or 2 only; 26 progressed to at least stage 3. Seven with blindness due to ROP amounted to 15.6/100,000 liveborns, a high frequency. The trend over the twelve years was towards less serious sequelae. Currently, the national screening limits for ROP have been adjusted under guidance from the compulsory registration of childhood visual impairment; with birth years 1974-94 there were 157 ROP-children in the register. Blindness due to ROP is now seen only in the very immature. It is suggested that gestational age 30 weeks will soon replace the present limits of less than 32 weeks/1750 g.
Evaluation of Amblyopic Scotoma by Electrophysiological Examinations and Computerized Perimetry
Authors: Fioretto M. , Gandolfo E. , Burtolo C. , Orione C. , Fava G.P. , Calabria G. , Zingirian M.
Published: April 2018

To evaluate amblyopic scotoma and the most affected neural cells in suppressive phenomena, eight patients with deep amblyopia from strabismus (visual acuity of the amblyopic eye between 4/50 and 2/10) underwent a pattern electroretinogram (PERG), pattern visual evoked potential (VEP), and event-related potential (ERP) from visual stimuli, and computerized perimetry. The results of stimulation of the amblyopic eye, the leading eye and the leading eye penalized by Ryser filters were compared statistically. Computerized perimetry was used to quantify the depth and amplitude of the amblyopic scotoma.

All electrophysiological potentials were reduced in amplitude and the implicit times of VEP and ERP were longer when stimulating the amblyopic eye compared to the leading eye. Only in PERG the penalization induced major changes.

Our data suggest that the important suppressive phenomena present in the squint amblyopic eye involve not only the occipital cortex, but also the cognitive areas.
Selective Damage to Either the “M” Or “P” Cell Pathway in Human Retinal Disease: Implications for Visual Processing
Authors: Wolf J.E. , Arden G.B. , Plant G.T.
Published: April 2018

Studies in primates have shown there to be 2 main visual afferent pathways (magno and parvo) operating in parallel with different functional roles. Disease state may selectively affect one or other of these, as shown by particular sensory losses. In cases of treated Cuban tropical “neuropathy” (a retinopathy also occurs) visual acuity and achromatic contrast sensitivity are preserved although colour vision is severely affected indicating selective preservation of the “magno” pathway. In Melanoma Associated Retinopathy, red-green colour vision is preserved although achromatic contrast sensitivity for low spatial frequencies, and the detection of motion is damaged suggesting preferential damage to the “magno” pathway. Our studies illuminate two controversial aspects of the P and M systems: the role of type II parvocellular cells in colour vision and the role of M cells in detecting stimuli of low spatial and low temporal frequency.
Ophthalmic and Central Retinal Artery Flow Velocities in Patients with Behçet's Disease
Authors: Seçkin D. , Baysal K. , Erkan D. , Oltulu Y. , Akpolat T. , Turanli A.Y.
Published: April 2018

Vascular involvement is a well known manifestation of Behçet's disease (BD) and may effect systemic and regional circulation in patients with BD. We evaluated ophthalmic and central retinal artery flow velocities in these patients. Mean ophthalmic and central retinal artery flow velocities were lower in patients with BD than in healthy controls, but the cause and significance of these findings remain to be defined.
Botulinum Toxin Treatment of Hertwig-Magendie Sign
Authors: Rebolleda G. , Negrete F.J. Muñoz
Published: April 2018

Hypertropia, not due to the usual causes and associated with a central nervous system disorder, should be suspected as being a skew deviation (Hertwig-Magendie sign). We describe a new case of this supranuclear disorder, presumably related to cocaine-induced stroke. This disorder was treated by botulinum A toxin (Oculinum®) injection into the superior rectus muscle. Follow-up one year later found the vertical deviation resolved.
Compound Myopic Astigmatism Correction using a Mask In-the-Rail Excimer Laser Delivery System. Preliminary Results
Authors: Carones F. , Brancato R. , Morico A. , Venturi E. , Gobbi P.G.
Published: April 2018

Purpose.

The latest development in the erodible mask technology is an excimer laser containing the mask in the laser optical pathway. This paper reports the results of the first human series of consecutive treatments performed for the correction of compound myopic astigmatism.

Methods.

We have treated 83 eyes. Spherical equivalent attempted correction ranged between –1.75 and –11.75 D (mean –7.07 ± 2.45 D), astigmatic attempted correction ranged between –1.00 and –5.00 D (mean –2.42 ± 1.02 D). The sphere correction was made by diaphragm using a multi-zone software with three ablation zones: 100% of the total attempted correction for the central 5.0 mm zone, 70% for the second 6.0 mm zone, 30% for the outer 6.5 mm zone. Cylinder correction was made sequentially after myopic correction using the appropriate mask.

Results.

One month after treatment, mean refractive error was +1.07 ± 1.24 D (range +4.50/–1.75 D) for spherical equivalent, and –0.49 ± 0.57 D (range +0.75/–2.00 D) for astigmatism. Forty-eight eyes (57.8%) had uncorrected visual acuity of 20/40 or better. At six months, mean refractive error was +0.42 ± 0.97 D (range +3.75/–1.00 D) for spherical equivalent, and –0.44 ± 0.51 D (range +0. 25/–3.00 D) for astigmatism. Vector analysis showed that 57 eyes (68.7%) had 5 or less degrees rotation. Seventy-two (86.7%) and 54 eyes (65.1%) had uncorrected visual acuity equal or better than 20/40 and 20/25 respectively. One eye (1.2%) showed a best corrected visual acuity loss of more than one line, but 8 eyes (9.6%) had a gain of more than one line. One-year results on a smaller series (33 eyes) overlap with the six-month results.

Conclusions.

The mask in-the-rail excimer laser delivery system appears to be effective and predictable in the correction of compound myopic astigmatism. We observed no significant regression of the astigmatic correction over time. Longer follow-up on larger series is necessary to draw final conclusions.
3-Hydroxykynurenine Transamination Leads to the Formation of the Fluorescent Substances in Human Lenses
Authors: Malina H.Z. , Martin X.D.
Published: April 2018

The levels of alanine, aspartate and glutamine transaminase increase considerably in some diseases. We measured the activity of these enzymes and of the transaminase of 3-hydroxykynurenine, an aminoacid, which acts as a UV lens filter. Alanine and glutamine transaminases (carboxypeptidase) were not detected in normal and cataractous human lenses, and aspartate transaminase was found only in the cortex of normal lenses. 3-hydroxykynurenine transaminase was not found in lenses from persons below thirty years of age, but was found in lenses at about fifty years of age, and in cataractous lenses. Transamination of 3-hydroxykynurenine leads to the formation of xanthurenic acid and its derivatives. These substances appear to be responsible for the increase of lens fluorescence during cataract development.
Subconjunctival Thc: Yag Laser Sclerostomy under a Partial Thickness Flap
Authors: Luntz M.H. , Fliegler R.D. , Mastrobattista J.
Published: April 2018

Holmium laser sclerostomy is a useful surgical procedure in eyes with refractory glaucoma. The success rate is 60%, comparable to the success rate with a seton, but there is a significantly lower rate of complications compared to a seton.

Furthermore, the conjunctiva is minimally dissected and less surgical trauma is involved with the procedure, an advantage compared to other filtering operations. The use of a corneascleral flap producing a “guarded” Holmium sclerostomy reduces the incidence of complications and there were no flat or shallow anterior chambers in the 47 eyes operated on and reviewed in this study.
Orbital Cyst of Lacrimal Sac Derivation
Authors: Hosal B.M. , Hurwitz J.J. , Howarth D.J.
Published: April 2018

Orbital cyst from lacrimal sac epithelium is rare and thought to originate from diverticulum of the lacrimal sac. The cyst may have direct communication with the sac, or the two structures may be anatomically separate. Since these lesions most commonly present as a medial canthal mass, the differential diagnosis should include other disorders that may cause a mass in this region.

A 42 year old woman presented with a two-year history of a mass in the right medial canthal region. Nasolacrimal system was patent on irrigation. Sophisticated radiological investigation utilizing dacryocystography and computed tomography combined with dacryocystography accurately localized the lesion and demonstrated its relationship to the nasolacrimal system. This tremendously facilitated surgical removal. The lesion was excised completely via anterior orbitotomy and submitted for histopathologic examination.

Haematoxylin-eosin stains revealed a cystic cavity lined by pseudostratified columnar and cuboidal epithelium with interspersed goblet cells consistent with a cyst derived from lacrimal sac epithelium, located separately, but in close proximity to the lacrimal sac.

The Authors present a patient with a mass in the righ medial canthal area histologically diagnosed as an orbital cyst of lacrimal sac epithelium derivation. Sophisticated radiological lacrimal investigation helps in detection, localization and in planning surgery.
Comparative Evaluation of Efficacy and Safety of Ciprofloxacin and Norfloxacin Ophthalmic Solutions
Authors: Adenis J.P. , Brasseur G. , Demailly PH. , Malet F. , Verin PH. , Saint-Blancat P. , Retout A. , Ollé P. , Colin J.
Published: April 2018

The efficacy and safety of ciprofloxacin ophthalmic solution 0.3% and norfloxacin ophthalmic solution 0.3% in the treatment of bacterial conjunctivitis and blepharitis were compared in a double masked randomised study. A total of 131 patients, 65 treated with ciprofloxacin (42 with conjunctivitis and 23 with blepharitis) and 66 treated with norfloxacin (39 with conjunctivitis and 27 with blepharitis) were enrolled in the study at five centres in France.

In the efficacy population, pathogens were eradicated or reduced in 96% (24/25) of patients in the ciprofloxacin group and 89% (24/27) in the norfloxacin group. There was no difference between treatments with regard to eradication of particular pathogens. In the efficacy population, clinical cure or improvement was seen in 96% of the patients (24/25 in the ciprofloxacin group and 26/27 in the norfloxacin group). There were no significant differences between ciprofloxacin and norfloxacin with respect to improvements in four symptoms or ten clinical signs. No serious treatment-related adverse events were reported and both ciprofloxacin and norfloxacin were well tolerated.
Long-Term Results of Pars Plana Vitrectomy and Silicone Oil for Giant Tears
Authors: Karel I. , Michalickova M. , Soucek P.
Published: April 2018

Purpose

To evaluate the long-term results of pars plana vitrectomy (PPV) and silicone oil implantation (SOI) for giant retinal tears (GT).

Methods

PPV with SOI was performed for GT in 50 eyes of 46 patients. Thirty-one eyes (62%) of 27 patients suffered from idiopathic GT. A direct injury of the eye preceded GT in 19 eyes (38%), a contusion in 14 and perforation of the sclera in five. The patients were followed up for 12 to 96 months, with a mean of 33 months.

Results

At the end of follow-up, anatomical success with a flat macula was achieved in 39 eyes (78%). Functional success with visual acuity 0.02 or better was obtained in 37 eyes (74%). The final functional results did not depend on the size of the GT, and were better in post-traumatic GT (success in 84%) than in idiopathic ones (success in 68%). The functional success rate by life table analysis decreased from 81% after one year and 79% after three years to 55% after five or more years. Silicone oil was removed from 22 eyes (44%). After removal, the retina redetached in seven eyes (30%), and the redetachment caused final failure in two (9%).

Conclusions

PPV with SOI proved highly effective in GT. Proliferative vitreoretinopathy was the main cause of surgical failure and a frequent obstacle to silicone oil removal. The risks of redetachment have to be evaluated especially carefully when dealing with the only eye.
Surgical Treatment of Penetrating Ocular Injuries with Retained Intraocular Foreign Bodies
Authors: Tomic Z. , Pavlovic S. , Latinovic S.
Published: April 2018

A total of 40 cases of retained intraocular foreign bodies (IOFB) presenting to the University Eye Clinic of Novi Sad between January 1988 and December 1994 were evaluated and surgically treated. The group most affected were males with a mean age of 33 years, who had been occupationally injured, presenting with either corneal or scleral single laceration. Thirty-seven injuries (92%) were due to metallic foreign bodies. Two eyes presented with initial clinical signs of endophthalmitis (5%). Five eyes (12.5%) were war-injuries, with tremendous destruction of all ocular structures.

After an average of 12 months follow-up 70% of total eyes achieved postoperative good or useful vision, 50% of these with visual acuity 0.5 or better.
Selection of Suture Material for Scleral Lacerations
Authors: Milenković S. , Jaković N. , Stanković B.
Published: April 2018

With a view to selecting the most suitable suture material for scleral wound management we made histological and tensiometric scar examinations after 7, 21 and 45 days on rabbits’ eyes. Suture materials were also observed under the scanning electron microscope at the same intervals. Three suture materials (virgin silk 8.0, polyglycolic acid 7.0 and Nylon 8.0) were tested. Polyglycolic acid proved the most suitable suture material for this purpose.
Hyperopic Shift after 4-8 Incision Radial Keratotomy: Eight-Year Follow-Up
Authors: Scorolli L. , Scorolli Lg. , Scalinci S.Z. , Savini G. , Meduri R.
Published: April 2018

Purpose.

To evaluate the prevalence, amount and possible factors connected with the hyperopic shift after radial keratotomy.

Basic procedures.

We studied 86 eyes (51 patients) which underwent 4-8 incision radial keratotomy (delayed technique), consecutively performed by the same surgeon between February 1983 and November 1988. The diamond-bladed knife was set at 95% of the smallest paracentral ultrasonic corneal thickness measurement and the clear zone diameter was between 3.0 and 3.5 mm. Preoperative myopia ranged from -2.00 to -7.25 diopters (D). The average follow-up was 97.4 months (range 78 to 122 months).

Main findings.

After eight years of follow-up, the cycloplegic spherical equivalent was satisfactory: 66.2% of the eyes showed a refractive error within 0.5 D, 17.4% were myopic by more than 0.5 D and 16.2% were hyperopic by more than 0.5 D. The mean refractive error was 0.02 D (SD ± 0.75 D). Between six months and eight years after surgery a hyperopic shift of more than 0.5 D was found in 40.6% of the eyes. The mean hyperopic shift was higher (0.78 D) in the eyes which had keratometry less than 36 D six months after surgery. Compared to the eyes with keratometry greater than 36 D (mean hyperopic shift 0.38 D), the difference was statistically significant (p<0.02).

Conclusions.

These results show that keratometry, measured six months postoperatively, plays a fundamental role in the stability of postsurgical refraction, as the risk of hyperopic shift is higher in eyes with keratometry < 36 D.
Calculation of Intraocular Lens Power with the Srk Ii Formula for Axial High Myopia
Authors: Yalvaç I.S. , Nurözler A. , Ünlü N. , Çetinkaya F. , Kasim R. , Duman S.
Published: April 2018

Aim.

The SRK II formula has been widely used for intraocular lens (IOL) power calculations. The predictability of this formula is evaluated in axial myopic patients. Methods. Planned extracapsular cataract extraction and posterior chamber IOL implantation (PECCE+IOL) were performed on 98 eyes of 98 patients with axial length > 24.5 mm. Cases had no preoperative complications and postoperative visual acuity was at least 0.5 (Snellen). Corneal refractive power and axial length were measured preoperatively and emmetropic IOL power calculations were made using the SRK II formula. Long-term (mean 4.7 months) visual acuities and refractions were noted postoperatively.

Results.

The absolute refractive error was < 1.00 Diopters (D) in 57 eyes (58.2%) and < 2.00 D in 83 eyes (84.7%). The mean absolute error of the SRK II formula in axial myopia was 1.16 D ± 0.78 SD.

Conclusions.

The SRK II formula is not very accurate in axial myopic patients.
A Comparative Clinical Trial of Mitomycin C and Cyclosporin a in Trabeculectomy
Authors: Turaçli E. , Gündüz K. , Aktan G. , Tamer C.
Published: April 2018

This prospective, randomized clinical trial assessed the effects of mitomycin C and cyclosporin A used as antimetabolites in trabeculectomy on the post-operative IOP and success rate. Eighty-six consecutive patients were randomly allocated to three treatment groups. There were 30 patients in the mitomycin C group, 28 in the cyclosporin A group and 28 in the control group. The follow-up periods were different for the three groups and ranged from 6 to 30 months. The treatment groups consisted of primary open-angle glaucoma, closed-angle glaucoma, various secondary glaucomas and prior failed trabeculectomy. There were no significant differences pre-operatively with respect to IOP and number of medications used (p>0.05). Postoperative IOP was considered to be successfully reduced when it was reduced by more than 25% from baseline or when it was lower than 20 mmHg. According to these criteria, IOP was under control in 90% of the mitomycin C treated eyes, 85.7% of cyclosporin A treated eyes and 71.4% of the control eyes. Postoperatively there was a significant decrease in IOP (p<0.01) and in the number of medications needed to control IOP (p<0.01) in the mitomycin C and cyclosporin A groups. Post-operative IOP and number of medications in the mitomycin C and cyclosporin A groups were similar. Complications encountered in the three groups were similar. There were no serious complications like hypotonus maculopathy. Our study highlights the utility of mitomycin C as an adjunct in glaucoma filtering surgery and indicates that cyclosporin A may also be used as an antimetabolite.
A Retrospective Study of Ocular Side Effects in Children Undergoing Bone Marrow Transplantation
Authors: De Marco R. , Dassio D.A. , Vittone P.
Published: April 2018

Bone marrow transplantation (BMT) is recognized as a successful treatment for malignant and non-malignant hematological diseases. Thanks to transplantation, the number of long-term survivors has risen and with the improved prognosis a problem of ocular side effects has arisen. We carried out a retrospective study to determine the incidence and etiopathogenesis of ocular complications in a series of young patients undergoing BMT.

One hundred children (62 males and 38 females) with a mean age of 7.12 (±3.3) years at the time of BMT (autologous in 66 cases, allogenic in 34) were followed for a mean of 4.2 years (range 2–9). The conditioning regimens preceding BMT induced cytoreductive chemotherapy alone (47 cases) or associated with total body irradiation (TBI) (53 cases) in three or six fractions for a total dose of 10–12 Gy. We examined every child before BMT and subsequently every six months. We did not include patients with ocular complications due to the primary disease.

Thirty-three children showed several complications after BMT: 17 had subcapsular posterior cataract in both eyes and eight had tear hyposecretion; one had dramatic fungal panuveitis, four had hemorrhagic complications and five optic disk edema. TBI was significantly associated with the development of subcapsular posterior cataract.
Silicone Oil for Complicated Retinal Detachment in the Pediatric Population
Authors: Biedner B. , Rothkoff L. , Klemperer I.
Published: April 2018

We presented our results with silicone oil in vitreoretinal surgery in pediatric patients. The retinas reattached in 58% but corneal opacification occurred in 75% and glaucoma in 25%. Our results indicate that silicone oil should be considered in otherwise hopeless cases of retinal detachment surgery in children.
Lacrimal Sac Dacryolith: A Study with Atomic Absorption Spectrophotometry and Scanning Electron Microscopy
Authors: Orhan M. , Önerci M. , Dayanir V. , Orhan D. , Irkeç T. , Irkeç M.
Published: April 2018

Dacryoliths are uncommon causes of partial or complete obstruction of the nasolacrimal drainage apparatus. We report our findings of a dacryolith that we studied by culture, light microscopy, atomic absorption spectrophotometry, and scanning electron microscopy. Although no fungi were recovered by culturing, hyphae-like structures were observed. No inorganic material was detected by atomic absorption spectrophotometry. Scanning electron microscopy of ultrastructure showed the stone was composed of lobes and lobules built on an amorphous core material.
Influence of the “Fatigue Effect” on the Mean Deviation Measurement in Perimetry
Authors: De La Rosa M. Gonzalez , Pareja A.
Published: April 2018

Purpose.

To quantify the influence of the reduction of the threshold during perimetric study on the mean deviation (MD).

Methods.

One hundred-57 eyes of 94 patients with ocular hypertension and glaucoma and 123 eyes of 62 normal patients were explored using the Humphrey perimeter with a Delphi program specially modified to make 12 consecutive measurements of the MD.

Results.

Hypertension and glaucoma population: during the test, which lasted 13.88 ± 1.25 minutes, the estimated MD showed a tendency to decrease by 2.9 dB on average from the beginning to the end of the exploration. This diminution was more important in patients with deeper defects, in whom the average was near 6 dB (Normal population: 13.26 ± 2.91 minutes; mean decrease 2.22 dB). It was found that, in fact, this reduction is related to age (p<0.01) and not to the level of the glaucomatous defect.

Conclusions.

Age, through a “fatigue effect”, influences the measured depth of the glaucomatous defect. Since in a conventional exploration the thresholds of the points are obtained from the whole test, we can estimate that the “fatigue effect” influences the MD to the extent of approximately half (1.45-1.11 dB), with respect to the numbers indicated above.
Clinical Evaluation of the Effect of Mitomycin-C in Re-Operation for Primary Open Angle Glaucoma
Authors: Andreanos D. , Georgopoulos G.T. , Vergados J. , Papaconstantinou D. , Liokis N. , Theodossiadis P.
Published: April 2018

The aim of the study was to evaluate the effect of mitomycin-C (MMC) in a second antiglaucoma operation after failure of the first operation. We assessed 46 patients (26 male, 20 female, mean age 64.2 years) with high intraocular pressure (IOP) (mean 32.4 ± 5.2 mmHg) despite previous trabeculectomy (Tr-Ec) one to three years earlier and topical or systemic medical treatment. All patients underwent a second Tr-Ec and were randomly divided into two groups: group A, 24 patients, underwent a second Tr-Ec with MMC and group B, 22 patients, also underwent a second Tr-Ec but without MMC.

Postoperative complications included: shallow anterior chamber (duration >1 week), group A 29.2%, group B 13.6%; chroidal effusion, group A 8.3%, group B 0%; cystic degeneration of conjunctiva, group A 16.6%, group B 4.5%; transient maculopathy, group A 12.5%, group B 0%. IOP control (≤ 20 mmHg after 18 months) was: group A 20 patients (83.3%) with mean 12.5 ± 3.2 mmHg and group B 13 patients (63.6%) with mean 19.6 ± 6.1 mmHg.

In conclusion, the use of MMC in re-operation for primary open-angle glaucoma is associated with a higher rate of and more severe postoperative complications than Tr-Ec alone. However, it achieves significantly lower IOP in a larger number of patients.
Diode Laser Photocoagulation in Retinopathy of Prematurity
Authors: González I. , Ferrer C. , Pueyo M. , Melcon B. , Ferrer E. , Honrubia F.M.
Published: April 2018

We used diode laser photocoagulation to treat 22 eyes of 12 patients with retinopathy of prematurity. Three infants were followed for at least six months and nine for at least one year. We treated 14 eyes with threshold disease and 8 eyes with prethreshold disease. The treatment was administered within 72 hours of diagnosis and topical anesthesia and sedation were used. No evidence of lesions of the anterior segment of preretinal or vitreous hemorrhages was found after the treatment. External inflammatory signs were neglibible. Systemic complications occurred only in three treatment sessions. Eight of the 14 eyes with threshold disease (57%) and all eight eyes with prethreshold disease had favorable outcomes. In total 73% with ROP had favorable outcomes. Treatment with the diode laser is easily performed, effective essentially in cases of prethreshold disease but in threshold disease too, with minimal ocular or systemic complications
Cranial Nerve II–VII Injuries in Fatal Closed Head Trauma
Authors: Mariak Zo. , Mariak Ze. , Stankiewicz A.
Published: April 2018

Purpose.

To study the distribution and mechanism of traumatic injuries to the nerves supplying the eye and muscles protecting the visual apparatus.

Methods.

Brain autopsy was carried out in 12 consecutive patients who died within three days after closed head injury. A segment of the brainstem with the entire intracranial portion of nerves II – VII was dissected out in each case and fixed in formalin. The specimens were stripped of the leptomeninges and inspected thoroughly under magnification.

Results.

Injuries to the nerves were seen in nine subjects. The oculomotor nerve was completely torn off from the midbrain unilaterally in three and bilaterally in two cases. In one patient only a portion of the superficial fibres on the medial aspect of the nerve was ripped out from the brainstem. In two patients the fourth nerve was ruptured. The root of the fifth cranial nerve was contused and the fibres between the brainstem and Gasserian ganglion crushed and separated in one case. Bilateral avulsion of the root of the sixth nerve from the brainstem was found in two cases. The initial segment of the facial nerve was crushed in two subjects. No visible injury to the optic nerves was found.

Conclusions.

Cranial nerves related to the visual system are subject to serious injury in a large proportion of cases of severe head trauma resulting from automobile accidents. In the majority of cases damage results from ripping the roots of these nerves out of the brainstem.
Vitreous Management in Massive Suprachoroidal Hemorrhage
Authors: Quiroz-Mercado H. , Garza-Karren C.D. , Roigmelo E.A. , Jimenez-Sierra J.M. , Dalma-Weiszhausz J.
Published: April 2018

Purpose.

To establish whether total vitrectomy with posterior hyaloid removal and choroidal hemorrhage drainage posterior sclerotomies improved the outcome of eyes with massive postoperative suprachoroidal hemorrhage (kissing choroidals).

Methods.

We reviewed the medical records of five patients with massive suprachoroidal hemorrhage (MSCH) who had received the same medical and surgical management.

Results.

Three eyes had MSCH secondary to surgery of the anterior segment and two after ocular trauma. All had hemorrhagic choroidal detachment with retinal apposition, producing vitreous changes and adherence of the “kissing” retina. Surgery was delayed one to three weeks to allow liquefaction of the blood clot. All eyes had complete ocular evaluation including ultrasound, and were treated with steroids before surgical treatment. The procedure consisted of anterior chamber fluid infusion, posterior drainage sclerotomies, and primary total pars plana vitrectomy with posterior hyaloid removal. Mean follow-up was 9.4 months. Visual acuity after surgery improved in all eyes from light perception to 20/60. One patient without light perception improved to 20/200.

Conclusions.

Total vitrectomy may be indicated in selected cases with MSCH. The successful outcome of these patients comes from the combination of vitrectomy and external drainage.
Merkel Cell Carcinoma of the Eyelid
Authors: Dini M. , Lo Russo G.
Published: April 2018

A case of Merkel cell carcinoma of the eyelid of an 85-year-old woman is presented. We define the essential morphological features of this much-debated neuroendocrine cutaneous tumor and its clinical and morphobiological peculiarities, with particular reference to its location in the palpebral region.
Prevention of Amblyopia and the Concept of Cure
Authors: Sjöstrand J. , Abrahamsson M.
Published: April 2018

Amblyopia is used as a comprehensive term for unexplained reduction of visual acuity, usually unilateral. As long as the visual deficit is monocular the visual loss is more of a potential problem than an actual handicap. Amblyopia is one of the most common causes of visual deficit in childhood, and since it is treatable, at least in children, considerable efforts have been made to detect it as early in life as possible. Screening programmes for amblyopia among preschool and school children have been widely organized throughout the world, although questions remain about their utility. This study evaluated amblyopia screening, focussing on some essential points that need thorough consideration before a screening programme is started. We also try to demonstrate some of the pros and cons of a screening system.
A Comparison of two Ophthalmic Steroid-Antibiotic Combinations after Cataract Surgery
Authors: Van Endt J.J. , Veraart H.G.N. , Kramer R. , Janssen A.G.W. , Raj P. Sunder
Published: April 2018

We performed this prospective, randomised, investigator-masked, parallelgroup study to compare Fluorometholone-Gentamicin eye drops with Maxitrol® (dexamethasone, neomycin, polymyxin B) eye drops in the reduction of ocular bacterial flora and control of ocular inflammation after cataract surgery. One hundred and twelve (FML-Genta 54, Maxitrol® 58) patients of both sexes undergoing cataract and posterior chamber lens implant surgery for visually disabling cataract were enrolled in the study and examined preoperatively and post-operatively on days 1, 6–8 and 24–34. The baseline parameters were similar in the two study groups. The conjunctival bacterial colony count on day 6–8 post-operatively was significantly less on FML-Genta compared with Maxitrol® (p = 0.033).

There was no statistically significant difference between the two treatments in the degree of intra-ocular inflammation as assessed by flare and cells in the anterior chamber. Both treatments were judged to be equal in the global assessment of the success of therapy and local tolerance by the study patients and doctors. Fluorometholone-gentamicin eye drops were more effective than Maxitrol® eye drops in the reduction of ocular bacterial flora while being as well-tolerated and as effective as Maxitrol® in the control of ocular inflammation after cataract surgery.
Boxing and the Eyes: Morphological Aspects of the Ocular System in Boxers
Authors: Vadalà G. , Mollo M. , Roberto S. , Fea A.
Published: April 2018

Among all sports, the so-called “contact sports” are those in which the athlete's eye is particularly at risk. In boxing, where the face is the main target, the eye is clearly one of the most exposed parts.

To assess the eye risks in this sport a study was carried out between 1992 and 1994 at the Ophthalmological Clinic of the university of Turin, Italy, involving 75 active and ex-boxers (amateurs and professionals) aged 15 to 70 years.

Biomicroscopic examinations, refraction and acuity tests, tonometry, exophthalmometry, gonioscopy, ocular fundus examination with Goldmann three-mirror lens) were done.

The results of the survey confirm the existence of alterations, generally asymptomatic, both in amateur and professional boxers. The eye examination showed alterations of structures such as the orbital arch, conjunctiva, iris, lens, retina. Four boxers had retinal detachment, three of them due to boxing.

The ophthalmologist has an important part to play in preventing serious damage to the eye and in checking alterations which might be an expression of subtle neural damage (pupillary alterations).
Is Tear Calcium An Indicator of Ocular Calcification in Patients with Chronic Renal Failure?
Authors: Oto S. , Aydin P. , Haberal A. , Dursun D. , Yilmaz A.
Published: April 2018

Background.

In patients with chronic renal failure (CRF) on regular dialysis treatment, limboconjunctival degeneration and calcifications are common. The mechanisms of ectopic conjunctival and corneal calcification remain largely speculative. The aim of the present work was to study tear calcium levels in patients with chronic renal failure, which could alter calcium excretion patterns, and to examine whether the calcium level in tear fluid is of more diagnostic importance than static calcium levels in blood.

Methods.

Tear calcium levels were measured in 25 patients with chronic renal failure, compared with 14 normal subjects. Conjunctival and corneal calcium deposits were graded by the Porter and Crombie classification.

Results.

While 11 of the 25 patients had no clinically apparent calcium deposits, six had Grade 1 or 2, and eight had Grade 3 and over limboconjunctival calcification. Mean tear calcium levels were 1.436±0.165 mg/dl in the patients and 1.307±0.155 mg/dl in the normal group. The difference was not significant (P=0.572). No correlation was found between the grade of the calcium deposits and tear calcium levels.

Conclusions.

Tear calcium level has no diagnostic importance for the development of ocular calcification in chronic renal failure.
Eyelid Hyperlaxity and Obstructive Sleep Apnea (O.S.A.) Syndrome
Authors: Robert P.Y. , Adenis J.P. , Tapie P. , Melloni B.
Published: April 2018

Purpose.

An association between the floppy eyelid syndrome and the obstructive sleep apnea syndrome (O.S.A.) has been reported. We studied eyelid tissue elasticity and other ophthalmologic findings in a large number of patients with sleep disorders.

Material and Methods.

Sixty-nine patients with sleep disorders were evaluated. Two thirds were found to have O.S.A., and one third was treated at night by nasal continuous positive airway pressure (nasal C.P.A.P.). Slit lamp examination, eyelid measurements and Schirmer test were performed.

Results.

Eyelid hyperlaxity was increased in patients with O.S.A. The floppy eyelid syndrome (associated papillary conjunctivitis), however, was rare. Associated corneal lesions were rare, and most patients were asymptomatic. In some cases, ocular irritation was due to air leaks from nasal C.P.A.P. A significant proportion of patients required treatment for primary open angle glaucoma.

Conclusions.

Our study of 69 patients found an association between O.S.A. and eyelid hyperlaxity.
Causes of Enucleation: A Clinicopathological Study
Authors: Günalp I. , Gündüz K. , Özkan M.
Published: April 2018

Background.

Enucleation is an approach used for unresponsive end-stage ocular disease often resulting in blind, painful or cosmetically unacceptable eyes.

Methods.

We reviewed the clinicopathological data on 3506 enucleations performed over a 50-year period, 1945-1995. Histopathological data were divided into eight groups according to the causes leading to enucleation: trauma, phthisis, corneal disease, inflammation, vitreoretinal disease, glaucoma, tumors and infections.

Results.

The study considered 3506 enucleated eyes of 3482 patients, 2467 (70.8%) males and 1011 (29.1%) females (4 sex unspecified). The z-test showed there were significantly more enucleations in males for phthisis (p<5.05), infections (p<0.01), trauma (p<0.01) and inflammation (p<0.01) and more enucleations for tumors in females (p<0.01). There were no differences between males and females with regard to enucleations for glaucoma, vitreoretinal and corneal diseases (p>0.05). The 0–9 years age group was most frequently affected, accounting for 29.7% of the cases. Patients aged less than 30 years constituted 53.6% of all enucleations. The primary or underlying causes leading to enucleation were tumors (1185 eyes, 33.8%), phthisis (587 eyes, 16.7), glaucoma (561 eyes, 16.0%), vitreoretinal diseases (320 eyes, 9.1%), infections (259 eyes, 7.4%), corneal disease (229 eyes, 6.5%), trauma (209 eyes, 6.0%) and inflammation (156 eyes, 4.4%). Time trends in enucleating eyes with different causes showed the number of enucleations for phthisis, infections, corneal diseases, trauma and inflammations had dropped during the ten-year period 1986–1995 compared to 1976–1985 (z-test, p<0.01). There were no real changes in enucleations for glaucoma and vitreoretinal diseases and there was an increase in the number of enucleations for tumors (p<0.01).

Conclusions.

Improved diagnostic and therapeutic methods, widespread use of photocoagulation in vascular disorders and vitreoretinal surgery in traumas, effective antimicrobial treatment, increasing use of corticosteroids and immunosuppressants, have contributed to the decreasing frequency of enucleation. Tumor patients generally presented late with advanced tumors totally filling the eye, not salvageable by other non-invasive treatment methods. Prompt diagnosis of intraocular malignant tumors (retinoblastoma and malignant melanoma) may reduce the need for enucleation.
Electrophysiological Assessment of Visual Pathways in Glaucoma
Authors: Parisi V. , Pernini C. , Guinetti C. , Neuschuler R. , Bucci M.G.
Published: April 2018

Purpose.

To assess nerve conduction in visual pathways in patients with open-angle glaucoma.

Methods.

Pattern-electroretinograms (PERG) and visual-evoked potentials (VEP) were simultaneously recorded in 16 patients with open-angle glaucoma (POAG) and 15 age-matched controls. The visual stimuli were checker-board patterns (the check edges subtend 15’; the contrast was 70% and reversed at the rate of 2 reversals/s).

Results.

POAG patients showed significantly higher PERG and VEP latencies (ANOVA: P<0.01) and significantly lower amplitudes than controls; the retinocortical time (RCT: difference between VEP P100 latency and PERG P50 latency) was longer (P<0.01) in POAG than controls and the longer RCT was correlated with the reduced PERG amplitude (r:0.798, P<0.01).

Conclusions.

This suggests that POAG patients have an involvement of the innermost retinal layers and impaired nerve conduction in their visual pathways.
Color Doppler Ultrasound in Ocular Behçet's Disease
Authors: Uçakhan O. , Salih M. , Altan S. , Özdemir O.
Published: April 2018

The purpose of this study was to evaluate the hemodynamic changes occurring in the ophthalmic vasculature of eyes with Behçet's disease in a controlled clinical trial.

Both eyes of patients with retinal involvement due to Behçet's disease were consecutively evaluated and were established as having mild or severe retinal vasculitis according to the ophthalmoscopic and fundus fluorescein angiographic findings. One eye from each patient was randomly selected and 25 eyes with mild to moderate and 25 eyes with severe vasculitis were identified. Color Doppler imaging (CDI) was used to quantitate blood flow velocities and vascular resistance in the ophthalmic artery (OA), central retinal artery (CRA) and central retinal vein (CRV) of these patients and those of 25 healthy volunteers. All three groups were age- and sex-matched.

In the OA, peak systolic, end diastolic and average flow velocities were significantly higher in patients with Behçet's disease than in the control group (p<0.05). CRA blood flow velocities of patients with severe retinal involvement were significantly lower than those with mild to moderate vasculitis and control groups and the average vascular resistance was significantly higher than in the control group (p<0.05). Additionally, the average blood flow velocities in the CRV of patients with severe vasculitis were significantly lower than in mild to moderate vasculitis and control patients.

Marked circulatory changes were seen in the ophthalmic vasculature of eyes with Behçet's disease. Although larger studies are required to define the true sensitivity and specificity of this technique, these initial results suggest that CDI could play a major part in the assessment of patients with ocular Behçet's disease.
Acquired Bilateral Superior Oblique Palsy: A Localising Sign in the Dorsal Midbrain
Authors: Barr D.B. , Mcfadzean R.M. , Hadley D. , Ramsay A. , Houston C.A. , Russell D.
Published: April 2018

Bilateral superior oblique palsy is an uncommon ocular motility problem, the commonest cause being closed head trauma. Two cases, both adults, are presented in whom bilateral superior oblique palsy occurred as a result of neoplastic infiltration of the dorsal midbrain in the region of the anterior medullary velum. In the absence of a history of head trauma, the presence of an acquired bilateral superior oblique palsy is a definite sign of a single lesion in the region of the decussation of the trochlear nerves and appropriate imaging is indicated.
1-Octadecene as a Solvent for Ferrofluids for Intraocular use
Authors: Tejada P. , Méndez M.J. , Madero S. , Cava C. , Barcelo A. , Castellano V.
Published: April 2018

Purpose.

1-Octadecene is a hydrocarbon with one double bond in its structure that could serve as a solvent for ferrofluids. The aim of this pilot study was to obtain preliminary information on intraocular tolerance to 1-octadecene.

Methods.

Vitreous compression with perfluoropropane gas was achieved in 20 eyes of albino rabbits. Four days after gas injection a fluid-gas exchange was undertaken. Sixteen eyes received 1-octadecene. Four eyes received balanced salt solution. Eyes were obtained at 3, 7, 14 and 30 days. The samples were fixed in 10% buffered formalin, processed in paraffin and sections were stained with hematoxylin and eosin.

Results.

Emulsification of the oil bubble was observed in 31.25% of the cases by the fifth day; light microscopy showed normal retinal architecture in all the eyes and epiretinal and vitreous macrophages in 50% of the eyes.

Conclusions.

1-Octadecene does not appear to have any retinal cytotoxic effect but elicits an inflammatory response in the vitreous activity.
Evaluation of the Brusini Glaucoma Staging System for Follow-Up in Glaucoma
Authors: Koçak I. , Zulauf M. , Hendrickson P. , Stümpfig D.
Published: April 2018

Background

Brusini developed a new interpretation system for Octopus and Humphrey automated perimeters that is based on mean defect (MD) and corrected loss variance (CLV) or corrected pattern standard deviation (CPSD). This study tested the performance of Brusini's glaucoma staging system (GSS) in staging and follow-up.

Methods

Retrospectively, 610 visual fields of 64 eyes of open-angle glaucoma patients were analyzed with Brusini GSS and compared with Aulhorn-Karmeyer stages and by PeriData 7.0 trend analysis.

Results

Follow-up was comparable to PeriData 7.0 trend analysis in 97%. Change was observed in 41% of eyes, i.e., initial improvement (19% eyes), deterioration (16%), and after an initial improvement, either deterioration (11%) or a stable period (5%). No change was seen in 59% of the eyes, of which 30% showed small and 19% high long-term fluctuation (LF) due to fatigue effect, poor cooperation of patient, impaired reliability, or short-term fluctuation (SF) greater than 1.7 dB. However, for 8% of the eyes there was no apparent reason for high LF.

Conclusions

Brusini GSS is useful for staging and recommended for follow-up evaluation of visual fields in glaucoma.
Comparison of Two Fixed Beta-Blocker-Pilocarpine Combinations
Authors:   The Carteolol-Pilocarpine Study Group, Bron A. M. , Garcher C. P. , Sirbat D. , Allaire C. M. , Lablache-Combier M. J. , Trinquand C. J. M.
Published: April 2018

Purpose

To compare the efficacy and safety of a newly developed ophthalmic solution containing carteolol 2% and pilocarpine (2% (CBS341A) with a timolol 0.5% and pilocarpine 2% fixed combination.

Patients and Methods.

A randomized, double-masked, multicenter study was conducted in 209 patients with primary open-angle glaucoma or ocular hypertension, whose intraocular pressure (IOP) was higher than 21 mm Hg on bet-blocker twice a day alone. The test medications were administered twice daily for 4 months. IOP was measured at 9 and 11 a.m. at the beginning of the study (with beta-blocker alone) and after one and four months of treatment. Adverse effects were recorded.

Results

Both combinations caused a similar, statistically significant decrease in IOP. At four months, in the CBS341A group a 2.4 mm Hg (9%) reduction in IOP was achieved at 9 a.m. and 4.1 mm Hg (17.3%) at 11 a.m. compared with respectively 3 mm Hg (11%) and 4.5 mm Hg (19.5%) in the timolol-pilocarpine group. No statistical difference was observed between the two groups in safety and efficacy.

Conclusions

The carteolol-pilocarpine combination appears as safe and as effective as the timolol-pilocarpine combination in the medical treatment of primary open-angle glaucoma or ocular hypertension.