bluuebunny/crossref_metadata_2025 huggingface dataset:
Suspension Made with Amniotic Membrane: Clinical Trial
Authors: Bonci Po. , Bonci Pa. , Lia A.
Published: January 2018

Purpose

To investigate if a suspension made with amniotic membrane could have a beneficial effect on ocular surface diseases.

Methods

In the Imola branch of the Eye Bank of Emilia Romagna, the authors prepared a suspension containing homogenized amniotic membrane previously conserved at −80 degrees Celsius. Subsequently, the authors gave this preparation to 21 patients: 8 had undergone lamellar keratoplasty, 4 had undergone penetrating keratoplasty, 2 had undergone photorefractive keratectomy with a delay of epithelialization, 3 had neurotrophic corneal ulcers, 2 had corneal burning, 1 had torpid corneal ulcer, and 1 had Sjögren syndrome. Each patient had been treated with conventional therapy for at least, 4 months without any clinical improvement. In this sample of eyes the authors evaluated the transparency and integrity of epithelium before and after the therapy by means of a fluorescein staining test, examining the area of epithelial defect as well as the phlogistic situation and the symptoms referred by patients. Nine eyes from this group of patients were studied by impression cytology before and after 3 months of use of suspension. The follow-up was 5 months of once-weekly visits.

Results

In all patients, after 15 to 30 days the corneas became negative to fluorescein staining test and the epithelium seemed more complete and regular, there was an evident decrease of phlogistic situation in the conjunctiva, and an improvement of symptoms was referred by patients. The situation was stable during the whole follow-up. No side effects were noted. The impression cytology repeated 3 months after the treatment showed a significant corneal recovery of the cytologic situation with an important decrease of CK19 + cells on the corneal surface.

Conclusions

This new therapy, which is less traumatic than an implant of amniotic membrane, is safe, and can be repeated for a long period, could help patients with corneal superficial defects.
Frequency of Cataract Surgery after Intravitreal Injection of High-Dosage Triamcinolone Acetonide
Authors: Jonas J.B. , Degenring R. , Vossmerbauemer U. , Kamppeter B.
Published: January 2018

Purpose

To evaluate the frequency of cataract surgery after intravitreal injection of high-dosage triamcinolone acetonide in elderly patients.

Methods

This clinical interventional case series study included 144 phakic eyes that consecutively received an intravitreal injection of about 20 mg triamcinolone acetonide for diffuse diabetic macular edema (n=42 eyes), exudative age-related macular degeneration (n=98), and branch retinal vein occlusion (n=4). Mean age was 72.3±8.9 years. Mean follow-up was 11.0±6.8 months (median, 8.8 months; range, 3 to 35.5 months). Reinjections were carried out in 12 (8.3%) eyes.

Results

Cataract surgery was performed in 20 (13.9%) eyes 17.4±9.1 months (median, 12.7 months; range, 8.0 to 35.5 months) after the first intravitreal injection. Out of the 20 eyes undergoing cataract surgery, 19 (95%) eyes had received one intravitreal injection, and 1 (5%) eye had received two previous injections.

Conclusions

In the elderly population of patients with exudative age-related macular degeneration, diffuse diabetic macular edema, or branch retinal vein occlusion, intravitreal high-dosage injection of triamcinolone acetonide leads to clinically significant cataract with eventual cataract surgery in about 15% to 20% of eyes within about 1 year after the intravitreal injection.
Iatrogenic Horner's Syndrome
Authors: Cavazza S. , Bocciolini C. , Gasparrini E. , Tassinari G.
Published: January 2018

Purpose

To report two cases of Horner's syndrome. One presented after the ablation of a schwannoma of the cervical sympathetic chain, the second after upper thorascopic sympathectomy for primary palmar hyperhidrosis.

Methods

A 42-year-old man underwent excision of a left neck mass found during routine physical examination. A 20-year-old girl with axillary and palmar hyperhidrosis was treated with cervical sympathectomy.

Results

In the early postoperative days, miosis, ptosis, anhidrosis, and enophthalmos were observed.

Conclusions

In the ablation of a schwannoma, postoperative Horner's syndrome is associated with the relationship between nerves and the tumor mass, which makes it impossible to separate them surgically in most cases. In thorascopic sympathectomy, patients should be warned of this complication.
Combined Surgical Ablation and Intravitreal Triamcinolone Acetonide for Retinal Angiomatous Proliferation
Authors: Boscia F. , Furino C. , Prascina F. , Delle Noci N. , Sborgia L. , Sborgia C.
Published: January 2018

Purpose

Neovascular age-related macular degeneration (ARMD) with retinal angiomatous proliferation (RAP) has a poor natural history and the efficacy of any treatment has not yet been established. The authors describe a combined surgical treatment.

Methods

A 76-year-old woman presented with a best-corrected visual acuity (BCVA) of 20/600 in the right eye and macula with stage 3 RAP as identified by fluorescein angiography (FA), indocyanine green angiography (ICGA), and optical coherence tomography (OCT). After a standard three-port pars plana core vitrectomy (PPV), endodiathermy of the arteriolar and venous feeder vessels of each lesion was performed, intraretinal RAP feeder vessels were cut with manual vertical intraocular scissors, and 0.1 mL of triamcinolone acetonide (TAAC) was injected intravitreally At 1 and 4 weeks and at the sixth month, the patient underwent a complete eye examination, FA, ICGA, and OCT to assess outcomes and complications.

Results

Six months later, BCVA was stable at 20/300, intraocular pressure was 15 mmHg, anterior segment and vitreous cavity were clear without evidence of TAAC granules, and retina was attached. FA and ICGA showed a complete occlusion of the RAP and absence of leakage or ischemia and OCT demonstrated decreased macular thickness with resolution of both intraretinal edema and pigment epithelium detachment, and the restoration of the normal macular profile. At the end of follow-up, the authors did not observe any ocular or systemic complication.

Conclusions

Surgical approach to RAP stage 3 with intravitreal injection of 4 mg of TAAC was safe and anatomically effective.
Effects of Membrane Adhesion Barriers on Wound Healing Reaction after Glaucoma Filtration Surgery: A Comparative Study with Interceed and Seprafilm
Authors: Akyol N. , Aydogan S. , Akpolat N.
Published: January 2018

Purpose

To evaluate and compare the effectiveness of two adhesion barriers, Interceed and Seprafilm, on wound healing reaction after glaucoma filtration surgery.

Materials and Methods

Full-thickness filtration surgery was carried out on three groups, each containing four rabbits. Interceed and Seprafilm prepared in 3×4 mm dimensions was put on and around scleral opening in Groups 1 and 2, respectively. All groups received tobramycin and dexamethasone drops tid for 14 days. Intraocular pressure (IOP), anterior chamber depth, and bleb appearance were checked on the first, third, seventh, and 14th days. The rabbits were killed on the 14th day and the trabeculectomy area with overlying conjunctiva was excised. The samples were fixed with 10% formalin, buried in paraffin, and stained with hematoxylin and eosin. The surgical site and surrounding subconjunctival area were evaluated histopathologically for cell counts (fibroblast, lymphocyte, eosinophil, and macrophage), presence of edema and foreign body reaction, and potency of the fistula tract.

Results

Mean IOP at the first and third day examinations was significantly different between groups, but there was no statistically significant difference among the groups with respect to IOP, anterior chamber depth, or bleb appearance at the seventh and 14th days. The groups were similar with respect to number of fibroblasts, eosinophils, and neutrophils. Number of macrophages was significantly increased in Groups 1 and 2 and number of vessels was significantly decreased in Group 1.

Conclusions

Neither of these two adhesion-preventing substances seems to suppress wound healing reaction after glaucoma filtration surgery. However, a diminished wound healing reaction was expected with a decreased number of vessels, such as in Group 1. Increased number of macrophages in both groups may result in a decreased level of some inflammatory mediators.
Topical Nonsteroidal Anti-Inflammatory Drugs in Uncomplicated Cataract Surgery: Effect of Sodium Naproxen
Authors: Russo P. , Papa V. , Russo S. , Bella A. Dl , Pabst G. , Milazzo G. , Balestrazzi A. , Caporossi A. ,   Naproxen Study Group, Anselmetti G. , Lorenzi U. , Orsi R. , Faletti P. , Bindella G. , Boccassini G. , Kropp B. , Calabria G. , Campagna P. , Ciurlo C. , Caporossi A. , Tasciotti A.E. , Licignano R. , Balestrazzi A. , Caprioglio G. , Birattari F. , Franch A. , Darondeau J. , Blanluet G. , Ouen Saint , Guerra R. , Saccarola P. , Lenz W. , Schuff O. , Lùpidi G. , Coiràn M. , Checcucci M. , Burattini L. , Foligno  , Mastropasqua L. , Ciancaglini M. , Ciafrè M. , Cerulli A.M. , Moretti G. , Padovano S. , Rotondo San Giovanni , Neuhann T. , Okrafka K.P. , Ratiglia R. , Oldani A. , Reiss H. , Rochefort J.Y. , Coulombe Bois , Sborgia C. , Lorusso V. , Palmisano C. , Moramarco N. , Spinelli D. , Curatola M.R. , Maruccia A. , Vaona P. , Faraldi F. , Villani C.M. , Schiavone M. , Gisoldi R. Colabelli
Published: January 2018

Purpose

To investigate whether topical nonsteroidal anti inflammatory drugs (NSAIDs) are useful, in the absence of concomitant corticosteroid therapy, in limiting postoperative inflammation after uncomplicated cataract surgery.

Methods

A total of 328 patients were enrolled in a prospective, randomized, double-masked, parallel-group, active-controlled study. Anterior chamber inflammation (ACI) was evaluated as the primary efficacy parameter. Only patients with moderate inflammation (ACI score of ≤4) the day after surgery were randomized and treated with NSAIDs. A novel topical formulation containing 0.2% sodium naproxen was compared with 0.1% diclofenac. Both were administered three times a day for 14 consecutive days. Ocular inflammation was measured after 7 and 14 days by using slit-lamp biomicroscopy. Safety parameters were also evaluated at the same time.

Results

Both treatments were equally effective in controlling postsurgical inflammation. No statistically significant differences between treatment groups were observed for the safety variables. No serious adverse events (AEs) occurred during the course of the study. The most frequent AE reported with naproxen was eye redness.

Conclusions

NSAIDs can effectively be used without concurrent administration of corticosteroids to control postoperative inflammation after uncomplicated cataract surgery. In addition, naproxen ophthalmic solution may be considered a suitable alternative to the currently available NSAIDs.
A New, Heavier-Than-Water Silicone Oil: A Solution of Perfluorohexyloctane in Polydimethylsiloxane
Authors: Kim Y. K. , Günther B. , Meinert H.
Published: January 2018

Purpose

To prepare and explore new solutions of semifluorinated alkane in silicone oil, which have a specific gravity slightly higher than silicone oil and vitreous fluid (referred to in the following as heavier-than-water silicone oils (HWSs), and to investigate, in vitro, whether HWSs can be used to plug retina holes, while allowing dehydration of the subretinal space.

Methods

HWS solutions were prepared with silicone oil 5000 and perfluorohexyloctane (F6H8). The stability was investigated under different conditions. The viscosity was determined by means of a capillary viscometer. The surface and interface tension were measured using the ring method.

Results

HWSS are insoluble in an aqueous medium. Densiron®68 (HWS 1.06) is a transparent homogeneous liquid which is slightly heavier (1.06 g/cm3) than water and has a refractive index close to that of vitreous liquid. Densiron®68 (HWS 1.06) has a low viscosity (1480 mPas) and interface tension (40.82 mN/m), making it an effective tamponade in the surgical treatment of an inferior detached retina. In addition, the interfaces between Densiron®68 and other perfluorocarbon liquids are clearly visible. However, the interface layer between Densiron®68 and water is not clear. Finally, all HWSs are stable over the long term at ambient temperatures, as well as physically and thermally resistant.

Conclusions

Due to its physiochemical properties, Densiron®68 could meet the requirements for a heavier-than-water tamponade.
Accommodative Intraocular Lenses: Short-Term Visual Results of Two Different Lens Types
Authors: Buratto L. , Di Meglio G.
Published: January 2018

Purpose

To compare the ability of two types of accommodative intraocular lenses (IOLs) to provide uncorrected near and distance visual acuity (VA) after cataract surgery.

Methods

A total of 108 eyes of 75 patients underwent cataract surgery by phacoemulsification and IOL implantation either bilaterally or monocularly with one of two types of accommodative IOLs: the AT-45 lens (69 eyes) or the 1-CU lens (39 eyes). Patients were followed for up to 1 year after cataract surgery. Near VA was measured through the distance correction to obtain the true near vision effect of the accommodating IOL.

Results

Uncorrected distance VA of 20/30 or better was achieved by 84.6% of the bilaterally implanted 1-CU patients and 73.6% of the bilaterally implanted AT-45 IOL patients 1 year following surgery. Uncorrected near VA of J1 or better was achieved by 42% of the patients with the bilateral 1-CU implant and 36.8% of the patients with the bilateral AT-45 implant. For J3 or better near acuity, the values were 92.3% for the bilateral 1-CU patients and 84.2% for the bilateral AT-45 patients at 1 year. A total of 54% of the eyes with 1-CU implants underwent a mild myopic shift (<1.0 D), 21% had a mild hyperopic shift, and 45% of the eyes were emmetropic at 1 year.

Conclusions

Both accommodative IOLs provided good near and distance vision postoperatively. The 1-CU IOL appears clinically to provide slightly better uncorrected distance and distance-corrected near VA than the AT-45 lens.
Presentation and Long-Term follow-up of Exfoliation Glaucoma in Greece, Spain, Russia, and Hungary
Authors: Konstas A.G.P. , Hollo G. , Astakhov Y.S. , Teus M.A. , Akopov E.L. , Jenkins J.N. , Stewart W.O.
Published: January 2018

Purpose

To evaluate clinical presentation and long-term follow-up of exfoliation glaucoma in separate European population groups.

Methods

A four-center, retrospective, case series analysis in which 200 charts of patients with exfoliation glaucoma or patients with elevated intraocular pressure (IOP) associated with exfoliation syndrome in at least one eye with at least 5 years of follow-up were consecutively reviewed.

Results

This study found an average follow-up time of 6.0±2.1 years. Patients in Hungary and Spain statistically presented at an older age (79 years) than Greek patients (67 years). Patients with exfoliation glaucoma in Greece and Hungary had more glaucomatous damage, had more severe glaucoma, had a higher untreated IOP (31.8 to 32.1 mmHg), and were more difficult to control, showing a greater number of changes in medicines during the follow-up period, a greater number of medicines at the end of the follow-up period, and more progression. On long-term follow-up, Greek, Russian, and Hungarian patients also had the highest mean IOP (18.8 to 20.8 mmHg) and the greatest incidence of progression (approximately 50%). Spanish patients demonstrated the lowest mean IOP (17.6±3.6 mmHg) and the lowest rate of progression (28%) during the follow-up period and the fewest number of medications per patient (0.7) to control the IOP at the end of the follow-up period.

Conclusions

The severity of exfoliation glaucoma presentation and its course may differ within distinct geographic populations in Europe.
Resource use and Costs for a Glaucoma Screening Program in Austria: An 8-Year Review.: A Cost-Consequence Analysis Based on the Salzburg-Moorfields Collaborative Glaucoma Study
Authors: Hitzl W. , Ortner C. , Hornykewycz K. , Grabner G. , Reitsamer H.A.
Published: January 2018

Purpose

The aim of this study is to report costs, detection rates, and resources needed for detection of primary open angle glaucoma and related diseases in a glaucoma screening program in Salzburg, Austria, over a period of 8 years.

Methods

The Salzburg-Moorfields Collaborative Glaucoma Study performed a complete ophthalmologic examination on a total of 4864 subjects within a study period of approximately 8 years (98 months). The total numbers reported are total number of subjects screened at the initial examination and follow-up examinations; total working hours and estimated working hours per visit for one ophthalmologist and two medical assistants; direct costs per visit; detection rates for subjects; and corresponding costs per true positive case diagnosed with definite primary open angle glaucoma (POAG), early POAG, POAG suspect, ocular hypertension (OHT), and glaucoma artefact.

Results

Within the screening period of 98 months, a total of 9427 examinations and second verification checks were performed: 5466 at the initial examination, 404 at the 1-year follow-up, 815 at the 2-year follow-up, 339 at the 3-year follow-up, 225 at the 4-year follow-up, 1059 at the 5-year follow-up, 996 at the 6-year follow-up, 118 at the 7-year follow-up, and 5 at the 8-year follow-up. The total amount of time spent for screening was 23,814 working hours. We estimate the costs per visit at EUR 123 for each initial examination, EUR 28 for each second confirmation check, and EUR 95 per follow-up examination. The following detection rates were observed: definite POAG: 1.7% (95% CI: 1.3–2.2%), early POAG: 2.9% (95% CI: 2.3–3.5%), POAG suspect: 8.5% (95% CI: 7.6–9.4%), OHT: 2.2% (95% CI: 1.7–2.7%), glaucoma artefact or other causes: 5.8% (95% CI: 5.1–6.6%), normal cases: 79% (95% CI: 78–80%).

Conclusions

Direct costs per visit were considerably higher than those reported in the Netherlands or the United Kingdom. If a health care provider decides to perform a glaucoma screening within this setting, the costs for the detection of a new case are EUR 7250 for definite POAG, EUR 4250 for early POAG, EUR 1450 for POAG suspect, EUR 5600 for OHT, EUR 2100 for glaucoma artefact case, and EUR 156 for a normal case.
Apraxia of Eyelid Opening: Clinical Features and Therapy
Authors: Kerty E. , Eidal K.
Published: January 2018

Purpose

Botulinum toxin injection is the treatment of choice in cases of benign essential blepharospasm. However, about 10% of the patients do not get sufficient effect from this treatment, and many of them have concomitant apraxia of lid opening.

Methods

Over a 3-year period we treated 12 patients. Three had pure apraxia of lid opening and in the other nine it was associated with blepharospasm. All patients were initially treated with botulinum toxin injections with poor results. They underwent surgical treatment like blepharoplasty limited myectomy, aponeurosis repair, and/or frontalis suspension. Some of them needed postoperative botulinum toxin injections in the pretarsal part of orbicularis oculi muscles.

Results

This combined therapy gave good functional and aesthetic results.

Conclusions

The specific causes of blepharospasm and apraxia of lid opening are unknown, but these two conditions coexist in some patients and can be difficult to treat. It is important to make a correct diagnosis, and a combined surgical and botulinum toxin treatment can be very effective.
Peribulbar and Retrobulbar Combined Anesthesia for Vitreoretinal Surgery using Ropivacaine
Authors: Seidenari P. , Santin G. , Milani P. , David A.
Published: January 2018

Purpose

To evaluate the efficacy and clinical effects of local retrobulbar anesthesia using ropivacaine in vitreoretinal surgery.

Methods

Prospective study. A total of 919 vitreoretinal operations were followed. The operations were divided into three groups, depending on the degree of anesthesia needed. Group A: Vitrectomies with episcleral procedures (208 vitrectomies for detached retina or perforating trauma). Group B: Episcleral procedures only (410 operations for detached retina without vitrectomy). Group C: Vitrectomies without episcleral surgery (301 operations for macular pucker or hole, proliferative diabetic retinopathy, or silicone oil removal). Anesthesia was administered using a 23-gauge Atkinson-type retrobulbar needle, after topical anesthesia. Six mL of the solution containing 7.5 mg ropivacaine/mL were injected into the peribulbar space, and the other 4 mL deeper, into the retrobulbar space. The degree of infiltration of the palpebral region, the motor block in the extrinsic ocular muscles, and pain felt were checked and rated.

Results

Swelling of lids was seen in 885 patients (96%); in 21 (2%) swelling was partial. In 13 patients (1%) there were no signs of infiltration. The motor block was total in 801 (87%) eyes, while 118 (12%) had reduced ocular movements. The degree of anesthesia was as follows, considering the three groups together: no pain = 855 (93%) patients; moderate pain = 44 (4%) patients; very strong pain = 20 (2%) patients. No adverse events or side effects were observed.

Conclusions

Ropivacaine used for retrobulbar-peribulbar combined anesthesia in vitreoretinal surgery showed excellent clinical efficacy as regards analgesia and muscle akinesia.
Comparison of the Effect of Healon, Healon GV, Healon 5, Viscoat, and OcuCoat on Platelet Aggregation under in vitro Conditions
Authors: Aras C. , Baslar Z. , Unal M. , Horoz H.
Published: January 2018

Purpose

To study the effect of Healon, Healon GV, Healon 5, Viscoat, and OcuCoat on platelet aggregation under in vitro conditions.

Methods

Ocular viscoelastic devices including Healon, Healon GV, Healon 5, Viscoat, and OcuCoat were studied to investigate the effect of these agents on platelet aggregation under in vitro conditions. The experiments were performed by using platelet-rich plasma with an aggregometer. Aggregation was induced with three different agonists including 5”-adenosine diphosphate (ADP), epinephrine (EPI), and collagen (Col). The results were obtained as a percentage of maximal aggregation and compared with controls using one-way analysis of variance (ANOVA) test.

Results

The tests with ADP as aggregating agent revealed that the percentages of maximal aggregation were a mean of 75 ± 4.35% for ADP only, 67 ± 4.35% for Healon, 59.33 ± 3.51% for Healon GV, 70 ± 3% for Healon 5, 58 ± 3.46% for Viscoat, and 64 ± 2% for OcuCoat. Kruskal-Wallis one-way ANOVA test revealed no significant decrease in the percentage of maximal aggregation for all tested substances. With EPI, aggregation was induced in all control samples with a mean of 80.66 ± 2.08%. The mean percentage of maximal aggregation was 67 ± 3% for Healon, 77.66 ± 4.04% for Healon GV, 77 ± 4% for Healon 5, 80.6 ± 4.04% for Viscoat, and 65 ± 5% for OcuCoat. Statistical analysis showed no significant difference. With collagen, maximum aggregation was 74 ± 5.29% for controls, 65 ± 4.35% for Healon, 54 ± 2% for Healon GV, 51 ± 2.64% for Healon 5, 59 ± 2% for Viscoat, and 72.66 ± 1.52% for OcuCoat. Kruskal-Wallis one-way ANOVA test revealed no significant change in the percentage of maximal aggregation for all tested substances in the experiments.

Conclusions

Ophthalmic viscosurgical devices like Healon, Healon GV, Healon 5, and Viscoat that contain glycosaminoglycans and OcuCoat that contains hydroxypropylmethylcellulose have inhibitory effects on platelet aggregation but the effect is not statistically significant and there is no difference among the ocular viscoelastic devices in regard to inhibitory effect on platelet aggregation.
Vitrectomy and Silicone Oil Tamponade for Serous Macular Detachment Associated with an Optic Disk Pit
Authors: Fantaguzzi P.M. , Vasco A.
Published: January 2018

Purpose

Description of the results of vitrectomy and silicone oil tamponade to repair serous macular detachment associated with optic disk pit.

DESIGN.

Interventional case report.

Methods

The authors report on a 17-year-old girl with serous macular detachment with a very thin layer near the fovea which clinically simulated a lamellar macular hole and macular schisis associated with an optic disk pit. The patient underwent pars plana vitrectomy with posterior hyaloid removal and silicone oil tamponade.

Results

Good anatomic and functional results were obtained after 1 year of follow-up.

Conclusions

This surgical approach may be a valuable technique for the surgical management of serous macular detachment associated with an optic disk pit.
Retinocytoma Associated with Calcified Vitreous Deposits
Authors: Hadjistilianou T. , De Francesco S. , Martone G. , Malandrini A.
Published: January 2018

Purpose

To report a case of bilateral retinocytoma associated with calcified vitreous deposits.

Methods

Case report.

Results

On routine examination, a 35-year-old asymptomatic father of a child with bilateral retinoblastoma presented bilateral retinocytoma associated with vitreous calcifications, in the vicinity of the retinocytoma in his left eye. Fundus photographic documentation and fluorescein angiography were performed. The patient has been followed up for 10 years.

Conclusions

The lesions in both eyes have remained stable without signs of growth or malignant transformation. Calcified vitreous deposits are a recently described feature of retinocytoma in addition to the three classic features: translucent retinal mass, retinal pigment epithelial alteration, and calcification.
Optic Nerve Alterations in PTEN+/– Mice
Authors: López-Sánchez E. , Francés-Muñoz E. , Menezo J.L. , Pinazo-Durán M.D.
Published: January 2018

Purpose

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

Methods

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

Results

The ON cross-sectional area was significantly higher in the PTEN-G than in the C-G (p<0.001). The axon sizes in mutant animals were much larger than in wild-type mice (p<0.001). No significant differences were noticed between those groups regarding the number of axons forming the ON and the presence of intra-axonal degeneration, myelin sheath alterations, or axoplasm density. No differences were detected in developmental marker protein expression.

Conclusions

The morphologic and morphometric results suggest that heterozygous PTEN knockout mice had hypertrophic ON without ultrastructural alterations.
Sonographic Evaluation of Ocular Trauma in Ilorin, Nigeria
Authors: Nzeh D.A. , Owoeye J.F.A. , Ademola-Popoola D.S. , Uyanne I.
Published: January 2018

Purpose

Ultrasound (US) evaluation of the eye and orbit has become an essential component of clinical ophthalmology. Requests for its use are frequent in the authors’ hospital in spite of the absence of a dedicated eye scanner. The extent to which this has influenced the authors’ patient management, especially for those with orbito-ocular trauma, informed the decision to carry out this study.

Methods

A retrospective review of cases of orbito-ocular trauma with media opacities and/or intraocular hemorrhage sent for ultrasonography over a 5-year period (January 1997–December 2001) at the University of Ilorin Teaching Hospital (UITH), Ilorin, Nigeria, was carried out. The sonographic diagnosis was reviewed with the management outcomes as found in the patients’ records.

Results

A total of 71 patients (45 male, 26 female) were included in the study (M:F=1:1.7). The minimum age was 1½ years and maximum was 70 years. The 11- to 20-year age group was mostly affected by trauma (31%). Retinal detachment (22.5%) was the most common posterior segment lesion diagnosed, followed by vitreous hemorrhage (18.3%) and hyphema (11.3%). Visual acuity improved to between 6/9 and 6/18 in 23 (41.4%) of the 56 injured eyes.

Conclusions

The usefulness of orbito-ocular ultrasonography in ophthalmic trauma management has been demonstrated in this study, especially using nondedicated eye scanners when a dedicated one is unavailable.
Regional Nerve Block of the Upper Eyelid in Oculoplastic Surgery
Authors: Ismail A.R. , Anthony T. , Mordant D.J. , Maclean H.
Published: January 2018

Purpose

To establish the efficacy of a regional nerve block of the upper eyelid and its effect on levator motor function.

Methods

Forty-one patients underwent surgery on 54 upper eyelids by one surgeon, after administration of a regional nerve block at the supraorbital notch. The amount of pain experienced by patients due to the local anesthetic injection and surgery was determined by using visual analogue scores. The effect of the local anesthetic injection on levator function was determined by comparing the measured levator function prior to and following administration. Any complications attributable to the regional sensory nerve block were recorded.

Results

Ninety-two percent of patients found the injection painless, and the rest reported negligible pain. The mean pain score for the injection was 2 (SD 1.3, range 0–6). The mean pain score for the surgery was 0.3 (SD 0.6, range 0–3). No significant difference was found in levator function prior to and following the injection (pre-function: 14.4 mm, post-function: 13.4 mm, p=0.01). One patient had hematoma formation at the site of injection.

Conclusions

A regional nerve block of the upper eyelid achieves effective sensory anesthesia, without compromising motor function. This helps in an accurate assessment of intraoperative height during upper lid surgery.
Inferior Turbinate Fracture and Congenital Nasolacrimal Duct Obstruction
Authors: Attarzadeh Ab. , Sajjadi M. , Owji N. , Talebnejad M. Reza , Farvardin M. , Attarzadeh Ad.
Published: January 2018

Purpose

To evaluate the success rate of probing combined with inferior turbinate fracture in comparison with simple probing as a first attempt in the treatment of congenital nasolacrimal duct obstruction in children.

Methods

In a prospective interventional case-control study, 86 eyes from 61 children older than 6 months with congenital nasolacrimal duct obstruction underwent surgical intervention. Forty-two eyes of 33 patients underwent probing combined with infracturing of the inferior turbinate and 44 eyes of 28 patients underwent simple probing. The outcome evaluation included a standard ophthalmologic examination plus a dye disappearance test 2 months after the surgical intervention.

Results

In the case group (probing + infracture of the inferior turbinate), the results were good in 22 (66.7%) patients, fair in 8 (24.2%), and poor in 3 (9.1%). In the control group (simple probing), the results were good in 20 (71.4%) patients, fair in 3 (10.7%), and poor in 5 (17.9%) (p=0.9). Success rates were 91% and 82% in the case and control groups, respectively (p=0.4).

Conclusions

Based on the results of this study, infracturing of the inferior turbinate does not increase the success rate of simple probing as a first attempt.
First Day Review after Uncomplicated Phacoemulsification: Is it Necessary?
Authors: Alwitry A , Rotchford A. , Gardner I.
Published: January 2018

Purpose

To determine whether first day follow-up is necessary after routine uncomplicated phacoemulsification cataract surgery.

Methods

Data collected prospectively at day 1 postoperative review.

Results

In 510 consecutive cases, serious complications occurred in 8 (1.6%) (wound leak [4], corneal abrasion [2], iris prolapse [1], hyphema [1]). Intraocular ptessure (IOP) >30 mmHg was found in 26 (5.1%) and was strongly associated with a diagnosis of pre-existing glaucoma or ocular hypertension (odds ratio [OR] 7.7). Symptoms of headache or ocular discomfort occurred in 40 (7.8%), mostly in association with raised IOP, and were also associated with pre-existing glaucoma or ocular hypertension (OR 4.7). Central corneal edema was found in 61 (12.0%). In the absence of corneal edema, IOP was >30 mmHg in only two cases (0.39%).

Conclusions

Few sight-threatening complications were detected on the morning after an uncomplicated procedure. First day follow-up may be safely omitted if adequate patient counseling is undertaken and there is provision of adequate access to eye services. Review prior to discharge on the day of surgery would provide an opportunity to detect these few surgical complications and for counseling. A diagnosis of glaucoma or ocular hypertension is a risk factor for significantly raised next day IOP and these patients are more likely to experience postoperative discomfort. They may benefit from prophylactic treatment.
A Case of Diabetic Retinopathy with both Retinal Neovascularization and Complete Posterior Vitreous Detachment
Authors: Shiraya T. , Kato S. , Fukushima H. , Tanabe T.
Published: January 2018

Purpose

Report of a case with retinal neovascularization developing in the setting of diabetic retinopathy despite complete posterior vitreous detachment (PVD).

CASE REPORT.

A 76-year-old man had had type II diabetes mellitus for more than 30 years. Weiss’ ring was detected by direct and indirect ophthalmoscopy. PVD was thus considered to be complete. On the other hand, fluorescein angiography showed two areas of hyper-fluorescence at the margin of the retinal nonperfusion area.

Conclusions

The present case underscores the importance of periodic follow-up using fluorescein angiography, given the probability of retinal neovascularization development and proliferative changes for many years even in diabetic retinopathy associated with complete PVD.
Changes in Medical and Surgical Treatments of Glaucoma between 1997 and 2003 in France
Authors: Kenigsberg P.-A.
Published: January 2018

Purpose

To analyze quantitative changes in glaucoma treatment strategies between 1997 and 2003 in France.

Methods

Numbers of ab externo trabeculectomies and other glaucoma surgeries were extracted from the national database of the French Diagnosis Related Group system, which includes data for both public and private hospitals. Numbers of patients treated per year were estimated from drug unit sales using defined daily doses for each drug.

Results

New medical treatments of glaucoma and ocular hypertension, introduced in France between 1997 and 2003, allowed treatment of 557,000 patients. In 2003, 63% of patients treated with these new medicines were receiving prostaglandins (39% latanoprost, 9% travoprost, 8% the fixed combination of latanoprost + timolol, and 7% bimatoprost), 13% brinzolamide, 13% the fixed combination of dorzolamide + timolol, and 11% brimonidine. During the same period, trabeculectomies declined by 38% (-48% in public hospitals and −32% in private clinics), while the total number of glaucoma surgeries declined by 22% (−34% in public hospitals and −14% in private clinics). Hospital days related to open-angle glaucoma surgery declined by 51%. There is a strong correlation (r2=-0.97) between the reduction of glaucoma surgery and the increase in the number of patients treated with prostaglandins during the study period.

Conclusions

Between 1997 and 2003, new glaucoma drugs, primarily prostaglandins, improved intraocular pressure control and delayed surgery, reducing glaucoma surgery by 22%.
Surgical Outcome following Breach Rhexis
Authors: Olali C.A. , Ahmed S. , Gupta M.
Published: January 2018

Purpose

Phacoemulsification cataract surgery is the gold standard for lens removal and continuous curvilinear capsulorhexis is one of the important first steps during the procedure. It is also one of the most difficult steps to master and so has a learning curve and capsulorhexis breach is therefore common among trainees. Once there is capsulorhexis breach, the surgeon could continue with the procedure or convert to extracapsular extraction, with each having its advantages and disadvantages. In our unit, the phacoemulsification procedure is usually continued with some modifications, and the results over a specified period are presented. To report the incidence of breach rhexis during phacoemulsification over a specific period, deduce reasons for the breach, as well as the surgical outcome including other intraoperative and postoperative complications directly resulting from the capsular tear. Interventional case series.

Methods

All patients who developed breach rhexis during routine phacoemulsification had all information regarding the procedure entered into a predesigned ProForma. These ranged from the instruments used for the capsulorhexis to subsequent surgical modification to reduce risk of further complications to the final surgical outcome.

Results

In the study period March 12, 2004, to March 30, 2005, the team carried out 358 phacoemulsifications, of which 20 (0.56%) had breach rhexis. The end of the breach was visible in 70% of cases and equatorial in the rest. None extended to the posterior capsule and so there was no vitreous loss in any of these cases. In most of the cases, the cause of the breach was attributed to inexperience or error of judgment (60%). However, modification of the surgery including the transfer of the procedure to a more experienced surgeon helped to reduce the rate of further complications. Eighty-five percent of the patients achieved a corrected visual acuity of 6/12 or better and those with worse vision had comorbidity.

Conclusions

In this study, the authors showed that, when properly managed, capsular breach during phacoemulsification has little or no effect on the final surgical outcome.
A Survey of Intraocular Lens Explantation: A Retrospective Analysis of 23 IOLs Explanted during 2005
Authors: Jirásková N. , Rozsíval P. , Kohout A.
Published: January 2018

Purpose

To evaluate the indications, lens styles, perioperative findings, and results of intraocular lens (IOL) explantation or exchange performed in the authors department in 2005.

Methods

The retrospective analysis comprised 22 patients (23 eyes). Twenty-one eyes had previous phacoemulsification and IOL implantation, one eye secondary aphakic IOL, and one eye phakic IOL implantation. The indications for IOL explantation/exchange and perioperative complications were evaluated. The best-corrected visual acuity (BCVA) before and after surgery was compared.

Results

Time from initial surgery to explantation/exchange varied from 1 to 121 months, median value was 46 months. The IOLs were explanted using local anesthesia and in 21 eyes replaced with new lens. Indications for IOL removal were opacification of the IOL in 12 eyes, malposition of the IOL in 5 eyes, postoperative refractive error in 2 eyes, recurrent toxic anterior segment syndrome in 1 eye, pseudophakic dysphotopsia in 1 eye, endothelial cell loss in phakic anterior chamber IOL in 1 eye, and visual discomfort with intraocular telescopic lens in 1 eye. The mean BCVA (decimal scale) before and after IOL explantation/exchange was 0.562±0.279 and 0.627±0.276, respectively. There was no significant difference in visual acuity before and after IOL exchange (Wilcoxon test).

Conclusions

The most frequent indications for IOL explantation/exchange were opacification of the IOL and IOL malposition. Surgeries were uneventful in most cases. Final visual results have been largely good. Long-term follow-up of patients with various types of IOLs should be maintained.
Risk Factors for Post-Traumatic Endophthalmitis in Patients with Positive Intraocular Cultures
Authors: Gupta A. , Srinivasan R. , Gulnar D. , Sankar K. , Mahalakshmi T.
Published: January 2018

Purpose

To determine the risk factors for post-traumatic endophthalmitis in patients with positive intraocular culture.

Methods

An institutional-based prospective nonrandomized interventional study of patients older than 15 years who presented for primary repair of open globe injury between June 2003 and April 2005 was undertaken. The main outcomes measured were initial and final visual acuity, type of injury, presence of uveal and vitreous prolapse, time interval between injury and primary repair of the globe, length of wound, location of wound, and virulence of organism. Statistical analysis tests used were Student t-test, Fisher exact test, and chi-square test.

Results

Fifty patients were included in the study. They were divided into two groups: Group 1 (n=19) patients, who developed clinically significant endophthalmitis; and Group 2 (n=31) patients, who did not develop clinically significant endophthalmitis. Delay in primary repair more than 36 hours (p=0.042), length of wound more than 8 mm (p=0.050), and isolation of organisms like fungus (p=0.006, OR=14), Bacillus cereus (p=0.01, OR=11.25), and Pseudomonas aeruginosa (p=0.05–0.10, OR=11.3) significantly increased the risk of endophthalmitis. Mean initial and final visual acuity was better in Group 2 but was not statistically significant (p=0.21).

Conclusions

Final visual outcome in the presence of positive intraocular culture is poor. Isolation of virulent organisms, longer length of laceration, and delayed primary repair of open globe injuries have high risk of developing endophthalmitis. Prophylactic intraocular antibiotics should be considered in cases with longer length of wound and delayed primary closure.
Domestic Ocular Injuries: A Case Series
Authors: Mansouri M. Reza , Mirshahi A. , Hosseini M.
Published: January 2018

Purpose

To determine the nature and types of domestic eye injuries.

Methods

The authors prospectively analyzed data of 100 consecutive patients with domestic eye injury (104 eyes) referred to the emergency room of Farabi Hospital during October 2003. Standardized international classification of ocular trauma (Birmingham Eye Trauma Terminology) was used for eye injury classification.

Results

Domestic ocular trauma represented 4.85% of all ocular emergencies (2061 patients) referred to the emergency room during that period. Male to female ratio was 1.13 and mean age of patients was 26±18 years (range, 1–73). Cornea was involved in 50.0% and sclera, lens, and retina each was involved in 4.8%. There was severe visual loss (best-corrected distance visual acuity <20/200 due to trauma) in 4% of the patients. The most frequent domestic ocular injury was globe injury (93.7%) including mechanical (72.1% closed and 4.8% open), chemical (14.4%), and thermal (1.9%) injuries.

Conclusions

Closed mechanical injuries were the most common type of domestic ocular injury in our series. Considering the high rate of domestic eye trauma among ocular emergency cases, more preventive measures should be taken at home.
Long-Term Follow-Up in Bietti Crystalline Dystrophy
Authors: Mansour A.M. , Uwaydat S.H. , Chan C.-C.
Published: January 2018

Purpose

To present a long-term follow-up of Bietti crystalline dystrophy.

Methods

Two brothers are presented including the clinical findings, fluorescein angiography, electrophysiology (electroretinography [ERG], electrooculography [EOG], adaptometry), optical coherence tomography (OCT), and transmission electron microscopy of bulbar conjunctiva and peripheral blood lymphocytes. The clinical findings were documented over a period of 25 years in one brother and 5 years in the other.

Results

The most striking features were deposits in the retina that were formed de novo with old ones replaced by choroidal atrophy in advanced stage of the disease. The light rise (EOG), rod- and cone-driven responses (ERG), and visual fields were affected progressively during the course. These changes of the retinal pigment epithelium and choriocapillaris were observed in the second decade and worsened gradually. OCT demonstrated preferential crystal accumulation in the inner retina. Cytoplasmic lipid crystalline inclusions were found in lymphocytes and conjunctival fibroblasts by transmission electron microscopy.

Conclusions

Bietti crystalline retinopathy is a progressive retinal disease characterized by retinal crystals gradually replaced by atrophy of the retinal pigment epithelium and gradual constriction of visual fields.
Single-action Implantation of SA60AT with Monarch II®
Authors: Iwase T. , Saeki A. , Sugiyama K.
Published: January 2018

Purpose

The authors have invented a method to implant the AcrySof® model SA60AT intraocular lens (IOL) with a single action to avoid complications in the recommended method.

Methods

After inversely inserting the SA60AT into the Monarch II® cartridge, the optic of the SA60AT is held with IOL forceps and rotated 90° counterclockwise. At this point, the haptics of the SA60AT are placed on the upper side of the optic within the cartridge. Next, the cartridge is inserted into the anterior chamber, and the main body of the Monarch II® injector rotated by 180° prior to pushing the plunger gradually. Once the front area of the SA60AT is inserted into the capsular bag, the remainder of the SA60AT can be slowly injected into the capsular bag. Aspiration of viscoelastic substances enables the haptics to expand in the capsular bag. The authors examined the complications in the invented method.

Results

The authors successfully implanted the SA60AT into the capsular bag in 226 consecutive patients (170 patients with cataract surgery alone and 56 patients with combined vitreous surgery) using the single-action method without any complications.

Conclusions

The method is simple and useful for the implantation of SA60AT with Monarch II® injector.
Molecular Scanning of the ABCA4 Gene in Spanish Patients with Retinitis Pigmentosa and Stargardt Disease: Identification of Novel Mutations
Authors: Stenirri S. , Battistella S. , Soriani N. , Bernal S. , Baiget M. , Ferrari M. , Cremonesi L.
Published: January 2018

Purpose

Among the 500 ABCA4 mutations identified so far in the retina-specific ABC transporter (ABCA4) gene, only 20 have been described in patients with autosomal recessive retinitis pigmentosa (arRP). In this study the gene was screened for mutations in a cohort of 25 patients of Spanish origin, to further assess ABCA4 involvement in retinal dystrophies.

Methods

The 50 exons of the ABCA4 gene have been analyzed through denaturing high performance liquid chromatography (DHPLC) and direct sequencing of samples displaying altered elution profiles.

Results

Four new and five known mutations were identified in our patients; except for one new deletion detected in a patient with Stargardt disease, all the remaining variations are single nucleotide substitutions resulting in missense mutations.

Conclusions

The results further underline the genetic heterogeneity of retinal disorders, suggesting that more than one gene could differentially contribute to at least some forms of retinal degeneration. Finding a high proportion of novel mutations merits the use of scanning methodologies to analyze the whole coding region of the ABCA4 gene.