bluuebunny/crossref_metadata_2025 huggingface dataset:
Older Age as Risk Factor for Deviation from Emmetropia in Pseudophakia
Authors: Nuzzi G. , Cantù C. , De Giovanni M.A.
Published: January 2018

Purpose

To find risk factors for deviation from emmetropia after cataract surgery in clinical practice.

Methods

We evaluated the refractive outcome in 106 patients who had underone phacoemulsification and in-the-bag IOL placement 115 ± 10 days after surgery. Postoperative optical correction and refractive error (diopters of spherical equivalent - ED) were related to age and sex, pre-operative axial length and keratometric diopter power, and operative incision technique.

Results

Emmetropia was achieved in 15% of cases; 65% of eyes needed a myopic correction, averaging =0.46±0.91 ED. The refractive error was 0.74 ± 0.61 ED (≤1 ED in 77% of cases, ≤ 2 ED in 97%). Both optical correction and refractive error were correlated to older age at the time of surgery (p=0.002 and p=0.001, respectively). Astigmatism appeared greater in clear-cornea incision than in limbar incision cases (p=0.05).

Conclusions

The higher refractive error in patients aged over 73 years suggests that age may be a risk factor for deviation from emmetropia after cataract surgery.
Color Doppler Imaging of Untreated and Irradiated Choroidal Melanomas
Authors: Regan S. , Egan K.M. , Hart L. , Gragoudas E.S.
Published: January 2018

Purpose

We examined untreated and irradiated choroidal melanomas with color Doppler imaging (CDI), a noninvasive method providing quantitative measures of blood flow, to determine if the tumor vessel damage associated with irradiation can be detected using this technology.

Methods

CDI was performed on 122 untreated and 76 previously irradiated tumors using a Q2000 color Doppler ultrasound unit. Spectral analysis was performed on all detectable vascular regions within the tumor to obtain estimates of the peak systolic and end diastolic flow velocities and resistive index ((syst-diast)/syst).

Results

Vessels were detected in 93% of the untreated tumors and in 63% of the treated tumors (p<0.001, X2), and the median number of vascular regions found was higher among untreated tumors (3 vs 1, p=0.001, Wilcoxon Rank Sum). The effect of treatment status on the detection of tumor vessels was significant (p=0.039), controlling for age, sex, largest tumor pretreatment diameter, and tumor height at CDI in a logistic regression model. Mean resistive index was lower in the untreated tumors (0.53 vs 0.58, p=0.0050), controlling for tumor height and other covariates in an analysis of variance.

Conclusions

On examination with CDI, irradiated tumors had fewer detectable vascular regions and greater resistance to flow than untreated tumors, a pattern consistent with known radiation effects.
Subretinal Fluid Ferning Test in Rhegmatogenous Retinal Detachment
Authors: Parodi M. Battaglia , Saviano S. , Panetta P. , Ravalico G.
Published: January 2018

Purpose

The ferning test involves a process of crystallization achieved simply by removing water and is feasible for all ocular fluids. The ferning test of subretinal fluid (SRF) from patients with rhegmatogenous retinal detachment (RRD) reveals three different patterns: type 1 showing thin crystals, type 2 with larger crystals and type 3 with small, curvilinear structures with no tree-like appearance. The present study was designed to determine whether the SRF ferning test is correlated with the clinical features and the surgical outcome of RRD.

Methods

A series of 65 consecutive patients with RRD at the first onset were considered. Particular attention was paid to duration, extension, and surgical outcome of RRD. SRF samples were collected during scleral buckling surgery. The fluid was dropped onto the slide of a light microscope, left to dry, and examined under the microscope.

Results

There was a significant difference between SRF ferning types 1 and 2 as regards duration and extension (both p < 0.001). There was also a significant difference between SRF ferning types 2 and 3 as regards duration (p<0.001), extension (p<0.001), and surgical outcome (p<0.05).

Conclusions

The ferning test of SRF is quick and simple and can be regarded as a useful tool for obtaining information about clinical features, such as duration or extension of first onset in uncomplicated cases of RRD especially for purposes of forensic medicine.
Sympathetic Ophthalmia after Complicated Cataract Surgery and Intraocular Lens Implantation
Authors: Abu El-Asrar A.M. , Al-Obeidan S.A.
Published: January 2018

Purpose

To report a case of sympathetic ophthalmia (SO) associated with cataract surgery and intraocular lens (IOL) implantation.

Methods

Case report.

Results

A 50-year-old man developed SO two months after complicated cataract surgery and IOL implantation. Adequate and prompt use of immunosuppressive medications and removal of the IOL by pars plana vitrectomy techniques resulted in control of the uveitis with significant visual improvement.

Conclusions

Sympathetic ophthalmia should be included as one of the devastating complications of IOL insertion. A high index of suspicion must be maintained whenever inflammation occurs in the fellow eye of an eye that has undergone intraocular surgery.
The Phenotype of Arg555 Trp Mutation in a Large Turkish Family with Corneal Granular Dystrophy
Authors: Kiratli H. , Irkeç M. , Özgül K. , Öğüş A.
Published: January 2018

Purpose

A large Turkish family with 52 members, 26 of whom had Groenouw type 1 corneal granular dystrophy was evaluated by genetic linkage studies and mutation analyses. Phenotype-genotype correlations were also assessed.

Methods

DNA from peripheral blood lymphocytes of 22 family members was used in establishing linkage to chromosome 5q31. Single-strand conformation polymorphism analysis was done to detect mutations in exons 4 and 12 of the human transforming growth factor ß-induced gene located on chromosome 5q31. Automated sequencing was performed on exon 12 of an affected patient.

Results

Patients yonger than 15 years of age had typical linear, granular opacities whereas adults had coarser, deeper granular stromal deposits. These changes were not associated with recurrent erosions or significant visual disabilities. The family was linked to chromosome 5q31 and a DNA shift was observed on exon 12 of affected patients. CGG to TGG transition producing R555W mutation was found.

Conclusions

Segregation of Arg555Trp has been described as causing Groenouw type I corneal dystrophy of variable severity in patients of various ethnic backgrounds. In this large Turkish pedigree, the Arg555Trp mutation was associated with a mild phenotype that became clinically evident at five years of age but which remained asymptomatic in terms of corneal erosions.
Early Hyperbaric Oxygen Therapy for Retinal Artery Occlusion
Authors: Beiran I. , Goldenberg I. , Adir Y. , Tamir A. , Shupak A. , Miller B.
Published: January 2018

Purpose

To assess whether early hyperbaric oxygenation (HBO) treatment has a beneficial effect on visual results after retinal artery occlusion (RAO).

Methods

A comparative retrospective study in which medical records of all HBO-treated RAO patients in our department were reviewed and compared with matched RAO patients not treated by HBO (from a different medical center). Mean visual acuity (VA) at completion of treatment, the presence or absence of improvement in VA between admission and discharge, and the mean change in VA between admission and discharge were noted. All patients treated by HBO had treatment no later than 8 hours after the beginning of visual symptoms.

Results

Mean VA at discharge was 0.2981 (6/20) in the treated group and 0.1308 (6/46) in the control group (p < 0.03). In the treated group, 82.9% had an improvement in VA between admission and discharge, compared with 29.7% of the control group (p < 0.00001). Mean improvement in VA was 0.1957 in the treated group and 0.0457 in the control group (p < 0.01). Differences in outcome measures between treatment and control groups were found to reflect the difference between treated and untreated hypertensive patients. No difference was found between treated and untreated non-hypertensive patients.

Conclusions

Early HBO therapy appears to have a beneficial effect on visual outcome in patients with RAO. Further large-scale prospective controlled studies are needed to confirm this.
Retinal vein Occlusion and Factor V Leiden and Prothrombin 20210 G:A Mutations
Authors: Aras S. , Yilmaz G. , Alpas Í. , Baltaci V. , Tayanç E. , Aydin P.
Published: January 2018

Purpose

The aim of this study was to establish whether the factor V Leiden mutation and the prothrombin 20210 G:A mutation were risk factors for retinal vein occlusion.

Methods

Blood samples were obtained from 40 patients with retinal vein occlusion and from 50 healthy normal volunteers as controls. Polymerase chain reaction assays were done to detect factor V Leiden and prothrombin 20210 G:A mutations, and the two groups were compared.

Results

Two (5%) of 40 patients with retinal vein occlusion and three (6%) of 50 controls were heterozygous for factor V Leiden (p=0.84). None of the individuals in either group had the prothrombin 20210 G:A mutation.

Conclusions

There was no significant association between retinal vein occlusion and the factor V Leiden mutation.
Diode Laser Transscleral Retinopexy in Rhegmatogenous Retinal Detachment Surgery
Authors: Kapran Z. , Uyar O.M. , Bilgin B.A. , Kaya V. , Cilsim S. , Eltutar K.
Published: January 2018

Purpose

To evaluate the safety and efficacy of transscleral diode laser for retinopexy in rhegmatogenous retinal detachment surgery.

Methods

Conventional retinal detachment surgery with transscleral diode laser retinopexy was performed on 52 eyes of 52 patients (22 female, 30 male), aged from 12 to 74 years (mean 51 + 4.1).

Results

Of the 52 eyes 36 (69%) were reattached in a single operation and adequate chorioretinal scars were achieved in 34 of them. Additional transpupillary laser photocoagulation was performed in two cases in the postoperative period. Retinal re-attachment was achieved with exoplant revision and transscleral laser retinopexy in six cases (12%). Ten cases (19%) with severe PVR were reattached with vitreoretinal surgery.

Conclusions

Transscleral diode laser retinopexy was an effective and safe method, with accurate lesion location, concurrent permanent laser marks on the retina, and easy transmission through the extraocular muscles and solid buckling elements. Minor complications were minimized by gaining experience with the technique.
Lincoff Temporary Balloon Buckle in Retinal Detachment Surgery
Authors: Öge I. , Birinci H. , Havuz E. , Kaman A.
Published: January 2018

Purpose

To assess the long-term anatomical and functional results of balloon buckle surgery for rhegmatogenous retinal detachment.

Patients and Methods

Twenty-five selected detachments with a single break or a group of breaks close together were treated with a temporary parabulbar balloon. Adhesion was obtained with transconjunctival cryopexy and argon laser photocoagulation. Retinal detachment was associated with the following risk factors: myopia (15 eyes), aphakia (2 eyes), blunt trauma (1 eye). Twenty-three eyes had a detached macula. The balloon was withdrawn after one week. The patients were kept under observation for at least six months (mean 44.7 months).

Results

Initial retinal attachment was achieved in 29 eyes. After the balloon was removed redetachment occurred in two eyes; thus, complete attachment was attained in 27 eyes. Causes of failure were: undetected break (2 eyes), inadequate buckle (4 eyes), proliferative vitreoretinopathy (2 eyes). Conventional scleral buckling and subretinal fluid drainage was done in all failed cases. Vitrectomy and silicone oil were employed in one patient, and finally retinal attachment was achieved in all patients.

Conclusions

Temporary balloon buckling is a simple and curative technique for a selected group of patients with retinal detachments.
Prevalence of Astigmatism among Students in Northern Greece
Authors: Mandalos A.T. , Peios D.K. , Mavracanas T.A. , Golias V.A. , Megalou K.G. , Delidou K.A. , Gregoriadou A.C. , Katsougiannopoulos B.C.
Published: January 2018

Purpose

To assess the prevalence of astigmatism in a sample of 1738 students (15–18 years old) from Northern Greece.

Methods

Collection of the sample was based on a questionnaire method. Statistical analysis included estimation of the prevalence of astigmatism and the distribution of students according to their cylindrical values. We also checked whether heredity or sex affected the occurrence of astigmatism.

Results

The prevalence of astigmatism was 10.2%. It was mostly at low levels, up to 2 D cyl. Females ran a significantly higher risk of astigmatism than males, and heredity seemed to be an important predisposing factor for this refractive error.

Conclusions

There is considerable variability in the prevalence of astigmatism worldwide, as indicated by different studies. However, this refractive error prevails at low levels in the Greek student population, compared with other countries.
Factors Influencing Treatment Results in Pseudophakic Endophthalmitis
Authors: Koç F. , Şen E. , Demirbay P. , Taşkintuna I. , Teke M.Y. , Özdal P. , Ortaç S. , Öz Ö. , Tarkan F. , Firat E.
Published: January 2018

Purpose

To evaluate risk factors, therapeutic approaches and factors associated with the poor visual outcome in pseudophakic endophthalmitis.

Methods

Data related to 28 cases with the diagnosis of endophthalmitis after cataract surgery and IOL implantation were gathered retrospectively.

Results

Preceding surgery was extracapsular cataract extraction (ECCE) in 18, phacoemulsification in 8 and scleral fixated intraocular lens implantation in two cases. Posterior capsule rupture and diabetes mellitus were considered to contribute to the development of endophthalmitis because of their high incidences (50% and 25%) in the study group. Microbiological studies from aqueous and vitreous humour were done in 85% of the cases and 58% were positive. S. Epidermidis was the most common organism, accounting for 50% of the isolates. All cases were given topical and systemic antibiotics. Inflammation was controlled by addition of subconjunctival antibiotics to this regimen in two, intravitreal antibiotic injection in 14, pars plana vitrectomy, total capsular and lens extraction and intravitreal antibiotic injection in three, lens exchange, intracapsular and intravitreal antibiotic injection in three cases. Six (21%) cases eventually needed evisceration. Visual acuity of 20/40 or better was achieved in 25%, and 20/100 or better in 64%.

Conclusions

Treatment delay (p=0.039), capsular rupture complicating cataract surgery, especially with extracapsular cataract extraction (p=0.015), and initial visual acuity worse than hand motion (p=0.003) were strong predictors of poor visual outcome. The risk of endophthalmitis was not different for planned ECCCE (0.26%) and phacoemulsification (0.27%) but the prognosis was better with the latter.
Glaucomatous Damage Patterns by Short-Wavelength Automated Perimetry (SWAP) in Glaucoma Suspects
Authors: Polo V. , Larrosa J.M. , Pinilla I. , Gonzalvo F. , Ferreras A. , Honrubia F.M.
Published: January 2018

Purpose

To determine the glaucomatous visual field damage patterns by short-wavelength automated perimetry (SWAP) in glaucoma suspects, and to compare the frequency of diffuse visual field losses and localized defects.

Methods

157 eyes of 157 ocular hypertensive subjects who met the selection criteria (intraocular pressure greater than 21 mm Hg and normal standard visual fields) were studied. SWAP was done with a modified Humphrey Field Analyzer. Total (TD) and Pattern Deviation (PD) probability maps were calculated for SWAP. The frequency of abnormlities in the TD and PD were determined, analyzing the visual field loss components.

Results

The involvement of the test points was more frequent on the TD plots than on the PD plots for all levels of defects (p< 0.001). The glaucomatous defects also showed certain topographical distribution.

Conclusions

A diffuse sensitivity component of visual field loss was found at all SWAP defect depths in glaucoma suspects.
Correlation of Blood-Glucose Control with Oxidative Metabolites in Plasma and Vitreous Body of Diabetic Patients
Authors: Augustin A.J. , Dick H.B. , Koch F. , Schmidt-Erfurth U.
Published: January 2018

Purpose

In diabetes hyperglycemia and other mechanisms lead to the production of oxidative metabolites that can enhance the production of growth factors, leading to increased proliferative activity. Strict blood-glucose control reduces the progression of retinopathy better than standard control. This study investigated patients with diabetic retinopathy for evidence of oxidative metabolites in plasma and the vitreous body, correlating these values with blood-glucose control.

Methods

The study comprised 136 patients suffering from proliferative diabetic retinopathy. They were grouped according to their mean glycosylated hemoglobin value for the last 9–12 months. Patients with values = 10% (mean 8.7%; n=64) were considered strict glucose control patients, those with values > 10% (mean 12.8%; n=72) were considered standard glucose control patients. Lipid peroxides were determined in blood plasma and the vitreous body by two methods (thiobarbituric acid reactive substances and malondialdehyde-like substances). If present, retinal traction with fibrovascular proliferations (>2 disk areas) was quantified and served as an indicator of proliferative activity.

Results

Patients with strict blood-glucose control had significantly (p < 0.01) lower lipid peroxide values in plasma and the vitreous body than standard glucose control patients. These latter had significantly (p<0.01) higher rate of fibrovascular proliferation (50%) than strict glucose control patients (9.7%).

DISCUSSION

Strict blood-glucose control leads to reduced oxidative tissue damage both systemically and locally in the eye, and reduced proliferative activity. Oxidative metabolites can stimulate proliferation by increasing the amounts of different growth factors an cytokines such as vascular endothelial growth factor. Thus, it can be speculated that in hyperglycemia the relative increase of oxidative metabolites contributes both to damage of retinal vessels and to more pronounced proliferative activity in diabetic retinopathy.
Original Three-Point Fixation Technique for Sutured Posterior Chamber Intraocular Lens
Authors: Beltrame G. , Driussi G.B. , Salvetat M.L. , Chizzolini M. , Scuderi B.
Published: January 2018

Purpose and Methods

In order to avoid the complications associated with posterior chamber intraocular lens (IOL) scleral fixation, the authors have developed an original surgical technique by which the IOL is secured at the ciliary sulcus by suturing the haptics to the sclera in three points (at the 3, 5 and 9 o'clock positions). This technique was utilized for secondary IOL implantation in 21 aphakic eyes. The mean follow-up was 18 months, range 6–28 months.

Results

All eyes that underwent secondary implants had equal or better visual acuity postoperatively; none developed serious intra- or postoperative complications. No tilt or decentration of the IOL was observed postoperatively.

Discussion

The technique described appeared easy to perform and produced good visual outcomes with stable transscleral fixation of the IOL.
Metastatic Cutaneous Melanoma to the Vitreous Cavity Masquerading as Intermediate Uveitis
Authors: Soheilian M. , Mirbabai F. , Shahsavari M. , Parvin M. , Manieei F.
Published: January 2018

Purpose

To report a patient with metastatic cutaneous melanoma (MCM) presenting as intermediate uveitis.

Methods

We examined a 49-year-old man with malignant cutaneous melanoma and central nervous system (CNS) metastasis who was initially treated for bilateral intermediate uveitis. Biomicroscopic examination disclosed a normal anterior segment and vitreous organization with red blood cells (RBC) and some non-pigmented cells in both eyes. Funduscopy disclosed a retinal metastasis in the right eye, but vitreous organization precluded visualization of the retina in the left eye.

Results

The first diagnostic vitrectomy was negative for malignant cells in the left eye. However, progressive worsening of the condition persuaded us to repeat vitrectomy in the left eye and to do it in the right eye too. Vitreous samples were positive for malignant melanoma cells in both eyes.

Conclusions

Metastatic cutaneous melanoma to the vitreous cavity is exceedingly rare and may masquerade as intermediate uveitis. It should be considered in the differential diagnosis of unusual uveitis and masquerade syndromes.
Central Retinal Artery Occlusion Associated with Ocular Behçet's Disease
Authors: Özdal P. Ç. , Ortaç S. , Taskintuna I. , Teke M.Y. , Firat E.
Published: January 2018

Purpose

To report a case of central retinal artery occlusion associated with ocular Behçet's disease (BD) and briefly discuss retinal vasculitis due to BD.

Case Report

A 52-year-old man, diagnosed as BD 22 years ago and followed up with ocular involvement for six years presented with sudden loss of vision. The clinical diagnosis was central retinal artery occlusion.

Results

No other associated systemic diseases were found and the case was classified as a complication of retinal vasculitis due to BD.

Conclusions

Although the arteries are rarely affected in retinal vasculitis due to BD, it has to be considered in the differential diagnosis of retinal arterial occlusions especially in countries where the disease is prevalent. To our knowledge, this is the first reported case of ocular BD complicated with central retinal artery occlusion.
Topical Allopurinol or Corticosteroids and Acetylcysteine in the Early Treatment of Experimental Corneal Alkali Burns: A Pilot Study
Authors: Sekundo W. , Augustin A.J. , Strempel I.
Published: January 2018

Purpose

To investigate the effect of topical allopurinol on experimental corneal burns and to compare this to established treatment modalities such as topical prednisolone and acetylcysteine.

Methods

Twenty Wistar rats were randomly assigned to four groups (n=5 each). The groups were controls (normal saline), allopurinol 0.4% eye drops, prednisolone acetate 1% eye drops and acetylcysteine 8% eyedrops. Corneal burn was induced using a 3 mm paper disc soaked in 1N NaOH for 60 seconds. Drops were instilled 6 times per day. In addition, one drop/day ofloxacine was given to prevent secondary infections. Eyes were enucleated 50 hours later and fixed in 4.5% formaldehyde. Three histological levels of each globe were stained with hematoxylin-eosin and examined by two independent masked investigators using a 0 to 4+ inflammatory score. All pair-wise multiple comparison procedures (Student-Newman-Keuls method) were applied for statistical work-up.

Results

All three substances significantly reduced the number of histologically visible inflammatory cells compared to the control group (p<0,05).

Conclusions

In the present study, topical allopurinol was as effective as established drugs, namely steroids and acetylcysteine, in the early treatment of experimental alkali corneal burns.
Electro-Oculographic Abnormality in Eyes with Uveal Melanoma
Authors: Spadea L. , Bianco G. , Magni R. , Rinaldi G. , Ponte F. , Brancato R. , Ravalico G. , Balestrazzi E.
Published: January 2018

Purpose

To seek out correlations between preoperative electro-oculogram (EOG) recordings with different types of uveal melanomas, after surgery.

Methods

We analysed the EOG recordings of 120 patients with uveal melanomas, histologically verified, 100 in the choroid and 20 in the iris and ciliary body. The EOG data were correlated with the site, size and histological type of the tumor.

Results

In 100 eyes with choroidal melanoma the Arden Index (AI) was less than in fellow eyes (mean 126.6, SD ± 23.8 and 202.9, SD ± 47.0; p=0.01). The EOG values were not different with respect to the histological type, site and size of tumor. In cases with iris and ciliary body melanomas the AI were not significantly different from the fellow eyes (mean 180.6, SD ± 23.6 and 203.2, SD ± 38.7; p=0.07).

Conclusions

Since the EOG is abnormal in eyes with choroidal melanoma, it can be considered a powerful auxiliary for diagnosing these tumors.
Conjunctival Ulcer - Mucocutaneous or Ocular Manifestation of Behçet's Disease? a Case Report
Authors: Shenoy R.
Published: January 2018

Purpose

To report the rare occurrence of conjunctival ulceration in a patient with Behcet's disease.

Methods

Case report. A 35 year old “Behçet's suspect” on azathioprine presented to the ophthalmic emergency room with a painful ulceration involving the inferior palpebral conjunctiva of her left eye.

Results

The ulcer responded to treatment with topical steroids and healed without scarring.

Conclusions

Conjunctival ulceration is not a common manifestation of Behcet's disease. Its occurrence during maintenance therapy with azathioprine in a patient with Behcets could be either incidental or indicate inadequate immunosuppression.
Self-Inflicted Repetitive Optic Nerve Injury: A Case Report
Authors: Detry-Morel M. , Philippart P. , Boschi A. , Luts A.
Published: January 2018

Purpose

To describe an obsessive-compulsive patient who developed blindness after self-inflicted repetitive optic nerve injury.

Methods

Case report.

Results

A myopic 46-year-old male became blind as a result of intermittent rubbing of his eyes, causing stretching of the optic nerves. Extensive ocular, neurologic and systemic work-ups were negative. Cerebral and orbital MR studies showed severe bilateral optic nerve atrophy. Psychiatric evaluation confirmed obsessive-compulsive personality.

Conclusions

Self-inflicted optic nerve injury should be included in the differential diagnosis of progressive optic neuropathy in a young adult.
Evaluating the Management of Diabetic Retinopathy in a Teaching Center
Authors: Pharmakakis N.M. , Petropoulos I.K. , Peristeropoulos P.A. , Vantzou C.V. , Koliopoulos J.X.
Published: January 2018

Purpose

To evaluate the efficacy of the management of diabetic retinopathy (DR) in the teaching center of the University Eye Clinic of Patras in Greece.

Methods

From 1989 to 1999, 302 patients with type I (5.3%) and type II (94.7%) diabetes mellitus (DM) were examined. Standard examination and treatment protocols were employed. Examinations and laser treatment were done by trainee specialists, under the supervision of the head physician (N.Ph), during their rotation in the retina and vitreous disorders outpatient department.

Results

At baseline examination, 17.9% of the eyes had no DR, 71.7% had nonproliferative DR, and 10.4% had proliferative DR. In 34.4%, no laser treatment followed. The other 65.6% underwent focal and/or grid laser and/or panretinal photocoagulation and/or vitrectomy. At the final examination, DR was still the same in 63.1% of the eyes, progression had occurred in 34.1%, and regression in 2.8%. Type I DM patients' eyes had a higher prevalence of proliferative DR at the final examination than type II DM eyes. There was also a significant correlation between progression of DR and duration of DM, insulin treatment for DM, and elevated glycosylated hemoglobin (HbA1c).

Conclusions

Having applied standard examination and treatment protocols, the efficacy of the management of our diabetic patients was consistent with international standards, even though patients were treated mostly by doctors in training.
Hyperhomocysteinemia and Retinal Vascular Occlusive Disease
Authors: Abu El-Asrar A.M. , Abdel Gader A.G.M. , Al-Amro S.A. , Al-Attas O.S.
Published: January 2018

Purpose

Elevated plasma homocysteine is an independent risk factor for thrombosis and vascular disease. This prospective study compared plasma total homocysteine levels in patients with retinal vascular occlusive disease and in matched healthy controls.

Methods

We measured plasma total homocysteine in 56 consecutive patients with recently diagnosed retinal vascular occlusive disease: 36 had central retinal vein occlusion, 12 branch retinal vein occlusion, and 8 retinal artery occlusion, and compared them with 59 age- and sex-matched healthy controls. Homocysteine levels were determined by high-performance liquid chromatography with electrochemical detection. Hyperhomocysteinemia was defined as a plasma homocysteine level above the 95th percentile in the control group (13.6 μmol/L).

Results

Mean plasma total homocysteine levels were significantly higher in patients than controls (16.1 ± 8.3 vs. 8.96 ± 5.6 μmol/L p<0.001). Mean homocysteine levels were significantly higher in the retinal vein occlusion and retinal artery occlusion groups than the control group (15.3 ± 8.2 and 20.95 ± 6.9 vs 8.96 ± 5.6 μmol/L, p<0.001). Estimates of the relative risk indicated that the risk of hyperhomocysteinemia was significantly higher in patients with retinal vascular occlusive disease than controls. Hyperhomocysteinemia was present in 37 (66.1%) of the 56 patients with retinal vascular occlusive disease but only 2 (3.4%) controls (odds ratio [OR] 47.5, 95% confidence interval [CI] 9.8 - 149.9). Hyperhomocysteinemia was present in 29 (60.4%) of the patients with retinal vein occlusion (OR 43.5, 95% CI 8.77 - 141.93) and in 6 (75%) patients with retinal artery occlusion (OR 85.5, 95% CI 7.49 - 1173.1).

Conclusions

High plasma homocysteine is a risk factor for retinal vascular occlusive disease so it may be useful to measure homocysteine in the management of these patients. A randomized, controlled trial is required to study the effect of lowering with homocysteine folic acid and other B vitamins on the risk of recurrent vascular occlusion in the same eye or its development in the fellow eye.
Anesthesia through a Novel Retrobulbar Catheter Provides Perioperative Pain Control for 24 h after Pars Plana Vitrectomy
Authors: Jonas J.B. , Jäger M. , Hemmerling T.M.
Published: January 2018

Purpose

The purpose of this study was to assess the retrobulbar catheter technique for perioperative pain control in pars plana vitrectomy.

Methods

One hundred consecutive pars plana vitrectomies (duration 20–220 minutes) in 88 patients (age range 37–88 years) were performed by the same surgeon under retrobulbar anesthesia using a commercially available retrobulbar needle. Initially, 7 ml of mepivacaine 2% were injected, a 28-gauge flexible catheter was introduced into the retrobulbar space and the needle was withdrawn. The catheter was removed 24 h after surgery. Intra-operatively and postoperatively, the patients were asked to rate pain using a numerical scale from 0 to 10. When pain was more than grade 3, 2 ml of a local anesthetic were re-injected through the catheter.

Results

A first re-injection was given intraoperatively 53.0 ± 34.6 minutes after the start of surgery during 35/100 procedures, and second and third injections were needed during 12/100 and 4/100 procedures, respectively. The first postoperative re-injection was given 3.9 ± 1.5 hours after the start of surgery in 54 procedures, and second and third injections were carried out in 35/100 and 10/100 procedures respectively.

Conclusions

The results suggest that a temporary indwelling retrobulbar catheter allows long-lasting titratable local anesthesia during pars plana vitrectomy and titratable postoperative analgesia.
Determination of Optic Cup Depth by Confocal Scanning Laser Tomography
Authors: Budde W.M. , Jonas J.B. , Hayler J.K. , Mardin C.Y.
Published: January 2018

Purpose

To assess whether confocal scanning laser tomography of the optic disc and clinical ophthalmoscopy using stereoscopic optic disc photographs, agree in the evaluation of the deepest part of the optic cup.

Patients and Methods

The study included 33 eyes of patients with focal normal-pressure glaucoma. Using 15° color stereoscopic optic disc photographs and dividing the optic disc into an upper and a lower half, two trained observers independently established the location of the deepest part of the cup. By selection, the two observers had made congruent judgements for all eyes in the study. All patients also underwent confocal scanning laser tomography of the optic disc using the Heidelberg Retina Tomograph (HRT). The location of the deepest “mean cup depth” was noted.

Results

The deepest optic cup region based on stereoscopic evaluation of photographs and on scanning laser tomography did not correlate significantly with each other (p=0.18; chi-square test, linear-by-linear association). According to the scanning laser tomography data, the maximal optic cup depths were not correlated with the corresponding locations of maximal visual field defect (p=0.80). Using the stereo photographic data, the locations of maximal optic cup depth and maximal visual field defect were correlated (p=0.006).

Conclusions

In some glaucomatous eyes, confocal scanning laser tomographic assessment of the location of the deepest optic cup region does not agree with clinical judgement and, in contrast to clinical examination, does not correlate with the location of the maximal visual field defect.
Topical Aminocaproic Acid to Prevent Rebleeding in Cases of Traumatic Hyphema
Authors: Karkhaneh R. , Naeeni M. , Chams H. , Abdollahi M. , Mansouri M.R.
Published: January 2018

Purpose

To determine the effect of topical aminocaproic acid on the incidence of rebleeding after traumatic hyphema.

Patients and Methods

This randomized double blind clinical trial investigated 132 consecutive cases of traumatic hyphema referred to the emergency room of Farabi Eye Hospital in 1998–1999. The patients were randomly divided into three groups: Group 1 received cycloplegic drops only. Group 2 received cycloplegic drops and 2% carboxy polymethylene (CPM) gel as placebo. Group 3 was treated with cycloplegic drops and 25% aminocaproic acid (ACA) in CPM gel (supplied by Messrs. Sina Darou). All patients were treated for five days on an outpatient basis, with a two-week follow-up. The incidence of rebleeding, time needed for clot absorption, and complications of hyphema were recorded and analyzed using the chi-square and Student's t-tests and logistic regression modeling.

Results

Rebleeding occurred in 8 eyes of 52 patients in group 1 (15.4%), 7 eyes of the 39 patients in group 2 (17.9%) and 5 eyes of the 41 patients in group 3 (12.2%). This difference was not significant. The time needed for clot absorption in groups 1, 2 and 3 was respectively 9.5±3.9, 9.3±4.2 and 11.15±4.7 days, the difference between group 3 and the other two groups being statistically significant (p<0.04).

Conclusions

Topical 25% ACA is not effective in reducing the incidence of rebleeding and lengthens the time needed for clot absorption.
Spontaneous Visual Improvement in Pituitary Metastasis
Authors: Berney C. , Borruat F.-X. , De Tribolet N.
Published: January 2018

Purpose

To report spontaneous visual improvement in a patient with unilateral optic neuropathy due to pituitary metastasis.

Methods

Report of a case.

Results

A 54-year-old woman with a history of breast carcinoma lost vision in her right eye to 20/70 without any other symptoms. Six days later, vision spontaneously improved to 20/30. A pituitary mass compressing the right intracranial optic nerve was found on magnetic resonance imaging and the diagnosis of metastatic breast carcinoma was confirmed by biopsy.

Conclusions

Spontaneous visual improvement can occur in the setting of compressive optic neuropathy by a solid mass.
Biopsy of the Conjunctiva in Dry Eye Patients Establishes a Correlation between Squamous Metaplasia and Dry Eye Clinical Severity
Authors: Murube J. , Rivas L.
Published: January 2018

Purpose

The aim of this work was to evaluate the different grades of squamous metaplasia of the conjunctiva during the clinical course of dry eye syndrome, detecting the most characteristic morphological and morphometric changes by biopsy in order to provide a diagnostic classification.

Methods

The conjunctiva was studied under light microscopy by conventional histological methods and by morphometric analysis in 165 patients and in 33 controls. Patients were classified according to the Schirmer 1 test, break-up time, rose Bengal staining, osmolarity and impression cytology. The epithelium and connective tissue, with their different cells and other structures, were studied.

Results

The conjunctiva in dry eye patients showed progressive stratification, hyperplasia, hypertrophy and cellular flattening, with loss of goblet cell density and mucous layer. We found five pathological grades of squamous metaplasia and one normal grade. Clear nuclear alterations (indentation and binucleation) were found in the early grades of dry eye syndrome, but pyknotic nuclei and anucleated cells were only seen in the most severe grades. The smallest epithelial cells were found in the control group and their size increased with the severity of the dry eye syndrome From the earliest stages to the most severe cases, increases in cellular separation were observed. There was also an increase in the number of inflammatory cells. Blood and lymphatic vessels showed alterations only in the most severe cases.

Conclusions

This is the first grading system proposed for biopsy evaluation of the ocular surface in dry eye patients. These morphological and morphometric studies alone were able, even in the earliest phases of dry eye, to detect the squamous metaplasia that progresses from the surface of the epithelium to the connective tissue. This degenerative or adaptative cellular process was characterized mainly by marked increases in the stratification, epithelial cellular size and a general loss of goblet cells.
Changes in Blood Antioxidants and Several Lipid Peroxidation Products in Women with Age-Related Macular Degeneration
Authors: Nowak M. , Świȩtochowska E. , Wielkoszyński T. , Marek B. , Karpe J. , Górski J. , Głogowska-szelαg J. , Kos-kudła B. , Ostrowska Z.
Published: January 2018

Purpose

The aim of this study was to evaluate the ferric reducing ability of plasma (FRAP), selected enzymatic and non-enzymatic components of the antioxidative system, and the intensity of peroxidative processes in the blood of patients with age-related macular degeneration (AMD).

Methods

In the peripheral blood, we evaluated FRAP; concentrations of vitamins C, A, and E; and of thiols. We assayed the activity of enzymatic components of the antioxidative system-superoxide dismutase, catalase, ceruloplasmin and the concentration of reduced glutathione as an indicator of glutathione peroxidase activity. In order to determine the intensity of lipid peroxidation, we measured the concentrations of malondialdehyde and hydroxyalkenales (MDA-HNA) and conjugated diens (CD).

Results

We found a significant increase in FRAP in patients with AMD compared with the control group. The average concentrations of vitamins A and C were low and vitamins E and GSH were significantly higher in AMD than in the control group. The activity of almost all the antioxidative enzymes was high. We found a significant increase in MDA-HNA but no difference in CD.

Conclusions

The significantly higher concentration of lipid peroxidation products in patients with AMD indicates an important pathogenic role of oxido-reduction disturbance. The high FRAP concentration may be one of the protective mechanisms in oxidation stress. The adaptive increase of the antioxidant barrier mostly involves the enzymatic components.
Intravitreal Triamcinolone Acetonide Injection in Blind Painful Eyes
Authors: Rodriguez M.L. , Juarez C.P. , Luna J.D.
Published: January 2018

Purpose

Phthisis bulbi results from different ocular conditions. We evaluated intravitreal triamcinolone acetonide as a treatment option in blind painful eyes.

Methods

Thirty-one patients with unilateral phthisis were randomly divided into two groups. Group A received 0.3 ml (12.5 mg) triamcinolone acetonide intravitreally and Group B 0.3 ml balanced salt solution after retrobulbar anesthesia. Treatment success was assessed by subjective response to pain and clinically by biomicroscopic evaluation of conjunctival congestion. Tonometry was done before and after treatment. Follow-ups were at 24 hours, 3 weeks, 3 and 6 months, and 1 and 2 years.

Results

Throughout the two-year follow-up, only two patients in Group A reported pain after the procedure and were retreated, one at week 4 and the other at week 7. Conjunctival congestion was significantly lower in Group A. Two patients with hypotony before treatment had normal tension after triamcinolone. All Group B patients were reinjected with triamcinolone because pain continued after balanced salt solution injection. No severe complications were found.

Conclusions

Intravitreal triamcinolone acetonide may be effective and safe for treating blind painful eyes.
Goldmann-Favre Vitreoretinal Degeneration
Authors: Batioğ lu F.
Published: January 2018

Purpose

To describe a case of Goldmann-Favre vitreoretinal degeneration with typical clinical findings.

Methods

The case report of a healthy 47-year-old woman with typical clinical findings of Goldmann-Favre vitreoretinal degeneration is presented. She had complaints of reduced visual acuity and night blindness. Her parents were first cousins.

Results

Fundus examination revealed annular pigmentary degenerative changes, macular edema, and peripheral retinoschisis in both eyes. Electroretinography results were abnormal. Optical coherence tomography scans revealed hyporeflective spaces in the macular area and irregularities of the chorioretinal complex in the degenerative pigmentary areas.

Conclusions

Typical fundus findings combined with night blindness and electroretinogram abnormalities permited the diagnosis of Goldmann-Favre vitreoretinal degeneration.
Bilateral Acanthamoeba Keratitis with Late Recurrence of the Infection in a Corneal Graft: A Case Report
Authors: Rama P. , Matuska S. , Viganò M. , Spinelli A. , Paganoni G. , Brancato R.
Published: January 2018

Purpose

To report a case of bilateral Acanthamoeba keratitis with late, atypical recurrence after penetrating keratoplasty à chaud.

Methods

A 23-year-old contact lens wearer was treated for bilateral Acanthamoeba keratitis and underwent penetrating keratoplasty in the right eye for descemetocele with impending risk of perforation. The postoperative course was uneventful and topical steroids were combined with neomycin and propamidine. Two months after the operation in the right eye the patient presented with active infection in the left eye. One month later recurrence appeared in the right eye, as a central corneal infiltrate in the graft.

Results

Recurrences in both eyes were successfully treated with a combination of hexamidine and neomycin, and with polyhexamethylene biguanide respectively. The right eye was regrafted three months after the recurrence and penetrating keratoplasty was done two years later in the left eye. Both grafts were successful and remained clear. There has been no further recurrence in the long-term follow-up.

Conclusions

Recurrence of Acanthamoeba keratitis after penetrating keratoplasty à chaud may occur even several months after the operation and the manifestation may be atypical. Current antiamoebal therapy was effective and regrafting in the quiet eye was successful.
Transient Third Nerve Palsy in a Young Patient with Intracranial Arteriovenous Malformation
Authors: Wu G. , Agrawal A. , Ghanchi F.D.
Published: January 2018

Purpose

To describe a patient with transient third nerve palsy as the possible presenting sign of intracranial arteriovenous malformation.

Method

Case report.

Result

A 24-year-old female presented to ophthalmic casualty with sudden onset binocular diplopia and was diagnosed to have right sided partial third nerve palsy. Within 30 hours the third nerve palsy had recovered completely. A MRI scan and subsequent carotid angiogram revealed a large, high flow, trans-cortical Spetzler-Martin grade 4 arteriovenous malformation. The feeder vessel of the AVM originated from the right middle cerebral artery. Superficial venous drainage was via the superficial middle cerebral vein to the right transverse sinus. The deep venous drainage was via thalamostriate veins into markedly dilated internal cerebral vein and vein of Galen (Great cerebral vein). Venous reflux was noted around the midbrain from the vein of Galen.

Conclusions

Transient third nerve palsy may rarely occur secondary to intracranial arteriovenous malformation. Ophthalmologists should consider neuroimaging in the investigations for transient cases of III nerve palsy in young patients.
Treatment of Blepharospasm with Botulinum Neurotoxin Type A: Long-Term Results
Authors: Calace P. , Cortese G. , Piscopo R. , Della Volpe G. , Gagliardi V. , Magli A. , De Berardinis T.
Published: January 2018

Purpose

To describe the long-term efficacy and side effects of treatment of blepharospasm with botulinum neurotoxin type A (Botox).

Methods

A total of 178 patients with blepharospasm were treated by injections of botulinum toxin in the Eye Clinic of the University of Naples from 1980 to 2001. The severity of spasm for each patient was graded on a four-point scale. Duration of improvement was assessed and reported in months.

Results

Of 178 cases, 10 were lost to follow-up; of the remaining patients, 93% reported improvement after treatments. The mean duration of improvement was 3.6 months. Twelve patients (76%) who underwent more than 14 treatments maintained stable relief. Three patients (1.7%) had a total remission of spasms. Side-effects were local; none of the 168 patients experienced any systemic or toxic reaction.

Conclusions

Botulinum toxin therapy for blepharospasm can provide long-lasting relief and reduction of spasms in the majority of patients. This therapy has the advantages of being safe, simple, and repeatable.
Iris Transillumination Defects in Patients with Primary Open Angle Glaucoma
Authors: Christen R. , Pache M. , Teuchner B. , Meyer P. , Prünte C. , Flammer J.
Published: January 2018

Purpose

To examine the incidence and pattern of iris transillumination defects in patients with primary open angle glaucoma (POAG) with and without vascular dysregulation, in comparison to controls.

Methods

We prospectively examined 24 patients with POAG (M/F 10:14; mean age 59 ± 14, range 21–76 years) and 23 controls (M/F 10:13; mean age 52 ± 15, range 25–86 years). Vascular dysregulation was presumed if patients had a typical medical history of vasospasm and a pathological result in nailfold capillaroscopy. Iris transillumination defects were visualized by video-taped, digitized diaphanoscopy and assessed by two blinded observers.

Results

We found significantly more iris transillumination defects in POAG than in controls (54.2% vs. 8.7%; χ2 = 8.85; df = 1; p = 0.002). The defects in POAG showed a characteristic radially-streaked pattern different from those described, for instance, in pigment dispersion syndrome, pseudoexfoliation syndrome, and acute glaucoma. Glaucoma patients with vascular dysregulation had a tendency to a higher incidence of transillumination defects than non-vasospastic patients, though this finding was not significant.

Conclusions

Patients with POAG have a higher incidence of iris transillumination defects than controls. The underlying mechanisms are not yet clear and call for further investigation.