bluuebunny/crossref_metadata_2025 huggingface dataset:
Vitreoretinal Surgery of Retinal Detachment and Macular Hole Associated with Optic Nerve Pit: An Optical Coherence Tomography Study
Authors: Sengün A. , Batioğlu F. , Akbatur H. , Atmaca L.
Published: January 2018

Purpose

To describe the course of a case of macular elevation and a full-thickness macular hole associated with optic nerve pit.

Methods

Case report. A 28-year-old woman who had laser-assisted in situ keratomileusis surgery 2.5 years ago presented with decreased vision, full-thickness macular hole, and macular detachment in association with optic nerve pit. Complete ophthalmic examination was done and optical coherence tomography (OCT) was performed before and after vitreoretinal surgery.

Results

OCT showed that the macular elevation consisted of both separation of the inner and outer retinal layers with neurosensory retinal detachment. There was a full-thickness macular hole. After vitreous surgery and intraocular gas tamponade, the macular elevation completely resolved, and OCT showed the flattening of the outer and inner retinal layers but the macular hole was not closed.

Conclusions

OCT is a reliable technique to study macular elevation with a hole associated with optic nerve pit before and after vitrectomy and gas tamponade.
Results of the Application of Intraoperative Mitomycin C in Dacryocystorhinostomy
Authors: Roozitalab M.H. , Amirahmadi M. , Namazi M.R.
Published: January 2018

Purpose

Dacryocystorhinostomy (DCR) is widely accepted as the procedure of choice for surgical correction of lacrimal drainage system obstruction distal to common canaliculus in adulthood. The success rate of DCR has been reported to be from 63% to 99%. DCR failure has been attributed to membranous occlusion of the rhinostomy site caused by soft tissue scarring. More recently, use of mitomycin C (MMC) has been described in lacrimal drainage surgery. The beneficial effect of MMC as a surgical adjunct is thought to be related to its potent inhibition of fibroblast proliferation.

Methods

To improve the success rate of DCR, the authors used MMC as an adjunct to surgery in 130 patients with nasolacrimal duct obstruction undergoing lacrimal surgery. They were assigned randomly into a MMC DCR group and a regular DCR group (control group).

Results

The mean age of the MMC group was 40 ± 15 years and that of the control group was 42 ± 16 years. The standard surgical techniques of an external DCR were used in all patients of both groups. Patients were followed for 6 months. The authors evaluated the patients with subjective symptoms (improvement in tearing) and objective findings such as the height of tear meniscus, fluorescein dye test, and patency at the time of irrigation. There was no significant difference in the age between the two groups (p=1.00). Six patients in the mitomycin group were symptomatic after 6 months' follow-up; probe and irrigation showed non-patency of lacrimal system. The success rate in the MMC group was therefore 90.5% (59/65), and in the conventional group it was 92.4% (60/65). No significant difference between the two groups was present (p=0.75).

Conclusions

The authors conclude that the use of intraoperative MMC in DCR surgery does not change the success rate of this procedure.
Evaluation of Superior Rectus Muscle Attachment following Hang-Back Recession in Rabbit Eyes
Authors: Wysenbeek Y. , Wygnanski-Jaffe T. , Rosner M. , Spierer A.
Published: January 2018

Purpose

The hang-back suture technique has been advocated to decrease the risk of scleral perforation during strabismus surgery. In this study, we evaluated the muscle insertion site in rabbits 4 weeks after a hang-back recession was performed.

Methods

Twenty-five eyes of 13 rabbits underwent hang-back recessions of between 5 and 8 mm of the superior rectus muscle. Four weeks later, the attachment sites were examined.

Results

Four weeks following the surgery, 14 muscles (n=25, 56%) were anteriorly displaced. In the 5 mm recession group, one muscle was anteriorly displaced (n=7, 14.3%). In the 6 mm recession group, 50% of the muscles recessed were displaced anteriorly (n=8). The 7 mm hang-back recession group demonstrated forward displacement in five muscles operated (n=6, 83%) and in the 8 mm recession group, all four muscles (100%) were anteriorly displaced. The magnitude of displacement was positively correlated to the amount of the hang-back recession performed (Pearson correlation p<0.001).

Conclusions

Anterior displacement of muscles using the hang-back technique in the rabbit eye is unacceptably high and occurred in 56% of the cases. A positive, statistically significant correlation exists between the amount of recession performed and the number of muscles displaced from their new insertion. Therefore, when performing large recessions using the hang-back technique displacement should be anticipated.
Protective Role of Intramuscularly Administered Vitamin E on the Levels of Lipid Peroxidation and the Activities of Antioxidant Enzymes in the Lens of Rats Made Cataractous with Gamma-Irradiation
Authors: Karslioglu Í. , Ertekin M. Vecdi , Koçer Í. , Taysi S. , Sezen O. , Gepdiremen A. , Balci E.
Published: January 2018

Purpose

To determine the antioxidant role of vitamin E (VE) (10 mg/kg/day) against radiation-induced cataract in lens after total-cranium irradiation of rats with a single dose of 5 Gy.

Methods

Sprague-Dawley rats were divided into three groups. Group 1 did not receive VE or irradiation but received both 0.1 ml physiologic saline intraperitoneally and sham irradiation (control group). Group 2 received to total cranium 5 Gy of gamma irradiation as a single dose (RT group) plus 0.1 ml physiologic saline intraperitoneally. Group 3 received irradiation to total cranium plus 10 mg/kg/day VE (RT+VE group). The rats were irradiated using a cobalt-60 teletherapy unit. Chylack's cataract classification (1) was used in this study. At the end of 10 days, the rats were killed and their eyes were enucleated to measure the antioxidant enzymes (the activity of superoxide dismutase [SOD], glutathione peroxidase [GSH-Px]) and lipid peroxidation level (malondialdehyde [MDA]).

Results

While grade 1 cataract development was detectable in seven rats in the RT group, it was detectable only in two rats in the RT+VE group, whereas none of the rats in the control group exhibited any biomicroscopic change in their lenses. MDA level and GSH-Px activity in the rat lens in the RT group was significantly higher than in the control group. SOD activity in the RT group was lower than in the control group. The activity of SOD and GSH-Px enzymes was higher in the RT+VE group, but MDA level was lower in the RT+VE group when compared with the RT group.

Conclusions

Vitamin E has a protective effect on radiation-induced cataract by decreasing oxidative stress.
Ethnic Variability of the Vasculature of the Optic Disc in Normal and in Glaucomatous Eyes
Authors: Nagasubramanian S. , Weale R.A.
Published: January 2018

Purpose

Although disc pallor is associated with glaucoma, the structural macro-anatomy of the disc vasculature has received little attention, and possible ethnic differences have not been considered. Accordingly we studied the distribution of blood vessels crossing the rim of the optic disc.

Methods

Thirty normal controls, and 50 glaucomatous cases with a unilaterally impaired visual field were studied. The sample populations included white Caucasian, and African and Afro/Caribbean volunteers. A b/w photographic method of imaging the blood vessels crossing the rim of the optic disc was used, the illuminant being green. The prints used in the analysis had been masked during their exposure to enhance contrast. The numbers of vessels, grouped into large (~60nm), medium (~30nm), and small (~10nm) lumina, were counted, the disc images being divided radially into eight equal sectors.

Results

While the large vessels crossed the rim mainly along the vertical, the small ones did so mainly in the horizontal. The distribution of the medium vessels was unpolarized but their crossings predominated on the nasal side. The vessel patterns differed significantly between the two ethnic groups as regards both number and distribution along the rim of the disc, the smaller vessels being more numerous in Caucasian eyes (p~0.02). Rim crossings by vessels were smaller in glaucomatous eyes in both ethnic groups. In normal eyes there was a statistically significant age-related decline in the number of small vessels after the age of 20 years.

Conclusions

There exists a statistically significant inverse relation between the number of capillaries crossing the disc rim and the vertical cup/disc ratio. Caucasian rims show the larger number of capillaries crossing.
The Effects of 2% Ibopamine Eye Drops on the Intraocular Pressure and Pupil Motility of Patients with Open-Angle Glaucoma
Authors: Giuffrè I. , Taverniti L. , Di Staso S.
Published: January 2018

Purpose

Ibopamine is a prodrug of N-methyldopamine that has a non-cycloplegic mydriatic action due to its α-adrenergic properties and is able to induce, when topically given, a transient increase of intraocular pressure (IOP) in eyes with hydrodynamic disorders.

Methods

This is a randomized, crossover, open-labeled, two- center study. Forty patients (20 open-angle glaucoma patients and 20 healthy subjects) were treated with ibopamine 2% eye drops and phenylephrine 10% eye drops.

Results

Ibopamine induced a significant increase in IOP only in glaucomatous eyes (p<0.001) without a significant hypertensive effect in normal eyes. Ibopamine and phenylephrine showed a similar mydriatic activity but ibopamine was able to induce an hypertensive effect only in glaucomatous eyes.

Conclusions

The results confirm the use of ibopamine as provocative test in detection of hydrodynamic disorders.
Combined Spatial, Contrast, and Temporal Functions Perimetry in Mild Glaucoma and Ocular Hypertension
Authors: González-Hernández M. , García-Feijoó J. , Mendez M. Sanchez , De La Rosa M. González
Published: January 2018

Purpose

To evaluate the diagnostic ability of a new perimetric procedure in glaucoma.

Methods

Pulsar perimeter shows white circular sinusoidal grating patterns with decreasing amplitude, 5° in diameter, 500 msec in duration in 66 locations. The stimuli scale combines spatial resolution and contrast. The stimuli were shown with centrifugal wave motion at 8 cyl/deg (K6W) or pulse at 30 Hz (T30W). Fifty-six normal eyes and 82 eyes with ocular hypertension and mild glaucoma were included. These 82 cases were classified into four levels of diagnostic certainty, from 0 (ocular hypertension) to 3 (mild glaucoma).

Results

Mean examination time was 3:49 min. Specificity was 96.4% (T30W) and 94.6% (K6W). Sensitivities for levels 0 and 3 were 34.5% to 100% (T30W) and 24.1% to 75% (K6W). The receiver operating characteristic (ROC) curve areas for T30W at levels 1, 2, and 3 were 0.88, 0.94, and 0.99. The ROC areas for K6W were 0.83, 0.91, and 0.97. There was good correlation between both Pulsar perimetries (r=0.88), but it was lower with conventional perimetry (r=0.58 for T30W and r=0.59 for K6W).

Conclusions

The novel Pulsar T30W perimetry may be helpful for the study of mild glaucoma and ocular hypertension.
Choroidal Neovascular Membranes after Photodynamic Therapy: Ultrastructural Analysis of Two Surgically Excised Membranes
Authors: Gremigni E. , Falleni A. , Belting C. , Di Bartolo E. , Rizzo S.
Published: January 2018

Purpose

To report on the ultrastructural electron microscopic findings of two surgically excised subfoveal choroidal neovascular membranes (CNV) that had undergone photodynamic therapy (PDT).

Methods

Two patients underwent PDT because of subfoveal neovascular membranes (CNV). Due to enlargement of the CNV seen on fluorescein angiography three months after PDT, one patient underwent surgical excision of the membrane; the other patient underwent both surgical membrane excision combined with macular translocation one month after PDT. The membranes were examined under the transmission electron microscope (TEM).

Results

The membranes were composed of a core and a rim, the latter being mainly composed of fibrin and collagen fibrils. The core was preeminently composed of endothelium-lined vascular channels associated with retinal epithelium cells. The endothelial cells of blood vessels appeared well-preserved.

Conclusions

The lack of histological signs of recanalization and vascular thrombosis may indicate that in our cases the enlargement of the CNVs seen on fluorescein angiography three months and one month respectively after PDT may originate mainly from reproliferation of choroidal vessels rather than recanalization of previously occluded vessels.
Macular Hole following Conventional Repair of Bullous Retinal Detachment Using Air Injection (D-ACE Procedure)
Authors: Boscia F. , Recchimurzo N. , Cardascia N. , Sborgia L. , Furino C. , Sborgia C.
Published: January 2018

Purpose

Sequential drainage of subretinal fluid (D), injection of air (A), cryotherapy (C), and application of local explants (E) (D-ACE) sequence was introduced in order to overcome the problems encountered in managing superior bullous detachments from multiple large equatorial breaks. The authors recently observed the occurrence of a full-thickness macular hole in one patient developing the day after he underwent a D-ACE procedure.

Methods

A 61-year-old man presented a bullous retinal detachment in the right eye extending from the 9:30 to the 2 o'clock position, and posteriorly to the vascular arcades two retinal tears were noted, at the equator at 11 o'clock, and anterior to the equator at 12 o'clock. The patient underwent a D-ACE procedure. Subretinal fluid was drained above the lateral rectus muscle at the equator. One and a half milliliters of air were injected 3.5 mm from the limbus midway between the superior and the medial rectus insertions. Cryotherapy was applied to the retinal breaks. A 240 encircling band was used in conjunction with a 276 tyre segment at the level of the tears.

Results

One day after surgery, the retina was flat, but a full-thickness macular hole could be seen with a surrounding cuff of subretinal fluid.

Conclusions

The mechanisms proposed to explain the occurrence of full-thickness macular holes after D-ACE may involve the concurrence of scleral elongation and vitreofoveal traction by means of previous partial posterior vitreous detachment with persistent posterior attachments at the fovea.
Scleroretinal Necrosis after a Subconjunctival Injection of Gentamicin in a Patient with a Surgically Repaired Episcleral Retinal Detachment
Authors: Salati C. , Migliorati G. , Brusini P.
Published: January 2018

Purpose

To describe a case of scleroretinal necrosis after a subconjunctival injection of gentamicin in a patient who had an episcleral retinal detachment that was surgically repaired.

Methods

Case presentation.

Results

Thinning of the sclera due to cryosurgery and the induced localized inflammatory response resulting from the surgical procedure, in addition to the effect of the sponge buckle itself, could have played an important role in accumulation and storage of gentamicin under and adjacent to the buckle after injection. The increasingly higher concentration of the drug under the buckle could have induced a greater penetration of gentamicin through the sclera, which could have been the cause of the scleral-chorio-retinal necrosis observed in this patient.

Conclusions

Attention must be given to avoid side effects from subconjunctival injection of gentamicin.
Intravitreal Triamcinolone in Cystoid Macular Edema Due to Uveitis and Repeated Surgery after a Penetrating Trauma
Authors: Marullo M. , Perilli R. , Balestrazzi E.
Published: January 2018

Purpose

To test the effectiveness of intravitreal triamcinolone acetonide in treating macular edema due to multiple vitreoretinal surgical procedures and uveitis after a penetrating trauma with metallic foreign body retention in a 37-year-old man.

Methods

The patient received two intravitreal injections of triamcinolone acetonide–2 mg/0.05 mL and 4 mg/0.1 ml-1 month apart. The 6-month follow-up included best-corrected visual acuity (BCVA) measurement and optical coherence tomography evaluation.

Results

After the first injection (2 mg) the foveal thickness (685 μm, as compared to a normal value of <165 μm) and the BCVA (20/200) remained unchanged with respect to the preinjection values; 1 week after the second injection (4 mg), the foveal thickness went down to 130 μm and the BCVA improved (20/80). Such results were unchanged at the 6-month control. No complications occurred.

Conclusions

A 2 mg dose of triamcinolone acetonide did not improve the anatomic and functional status of the macula. A 4 mg dose markedly improved BCVA and reduced the macular thickness in this case of macular edema.
Comparison of Keratometric and Topographic Cylinder and Axis Measurements on Normal Corneas with Low Astigmatism
Authors: Karabatsas C.H. , Papaefthymiou I. , Aslanides I.M. , Chatzoulis D.Z.
Published: January 2018

Purpose

To evaluate agreement in measurements of astigmatic axis power and location between keratometry and computer assisted videokeratography (corneal topography) on normal corneas with less than 1.50 D of idiopathic astigmatism.

Methods

Keratometric readings with the 10 SL/O Zeiss ophthalmometer and corneal topographic maps with the TMS-1 were obtained by two independent examiners on 32 normal corneas. Measurement agreement between the two instruments was evaluated in regard to steep and flat meridian power and location, and in astigmatism magnitude (D).

Results

The limits of agreement (d-2 SD to d+2 SD) between the two instruments were found to be broad for clinical purposes in measuring the steep meridian power (-0.16 to −1.20 D), flat meridian power (0.43 to −1.25 D), and astigmatism (0.60 to −1.12 D). A constant bias of the TMS-1 towards the 10 SL/O Zeiss ophthalmometer was found, in measuring steeper both principal meridians and higher amount of astigmatism. Mean location difference was 19° (±19°) for the steep meridian and 17° (±20°) for the flat meridian.

Conclusions

Despite the differences seen in measurements between the 10 SL/O ophthalmometer and the TMS-1, these differences may be clinically small enough for the methods to be used interchangeably in measuring only the magnitude of astigmatism on normal corneas. However, the disagreement in astigmatism axes is too great to be ignored.
The Effect of Adjunctive Mitomycin C in Ahmed Glaucoma Valve Implantation
Authors: Kurnaz E. , Kubaloglu A. , Yilmaz Y. , Koytak A. , Özertürk Y.
Published: January 2018

Purpose

To evaluate the effectiveness and safety of adjunctive mitomycin C (MMC) in Ahmed glaucoma valve (AGV) implantation for refractory glaucoma.

Methods

Twenty-two eyes of 22 patients who underwent AGV implantation with adjunctive MMC (0.5 mg/ml) for 3 minutes (Group A) were compared to a control group of 26 eyes of 26 patients (Group B) who received AGV implantation without MMC. Nine patients were female and 13 patients were male in Group A and 11 patients were female and 15 patients were male in Group B. The mean age was 56 years ranging from 13 to 77 in Group A and 58 ranging from 14 to 71 years in Group B. Success was defined as an intraocular pressure (IOP) between 4 and 21 mmHg with or without glaucoma medication and with no additional glaucoma surgery, phthisis, or loss of light perception.

Results

The probability of success at 1 year was 86.36% and 80.76% in Group A and Group B, respectively. The number of glaucoma medications decreased from 2.82 to 0.56 in Group A and from 2.65 to 0.73 in Group B. Postoperative hypotony as an early complication was higher in Group A (31.81% in Group A and 15.38% in Group B). As a late postoperative complication, tube exposure developed in 3 patients (13.63%) in Group A and no such complication was seen in Group B. There was no statistically significant difference in success and complication rates between the two groups (p>0.05).

Conclusions

Although adjunctive MMC in AGV implantation is safe and effective, it may not offer a better chance of surgical success compared with AGV implantation without MMC.
Knowledge Base and Preferred Methods of Obtaining Knowledge of Glaucoma Patients
Authors: Hoevenaars J.G.M.M. , Schouten J.S.A.G. , Van Den Borne B. , Beckers H.J.M. , Webers C.A.B.
Published: January 2018

Purpose

To gather information regarding patient's understanding of glaucoma and the manner in which patients wish to learn about the disease with the intent of improving patient education.

Methods

Forty-four of sixty randomly selected ophthalmologists (73%) asked four of their patients consecutively to complete a questionnaire about glaucoma. The selection of questions was based on focus group interviews and suggestions from several experts. Topics included knowledge about glaucoma and its treatment, the need for information, and preferred providers and methods of patient education.

Results

Fifty percent of the patients had 49% or less correct answers to questions about glaucoma or its treatment. Per item the correct answers ranged from 5% to 90%. Lack of knowledge was associated with low level of education, short duration of glaucoma, high age, and no preference for the Internet as method of supplying information. These variables, however, did not identify groups with a considerable lack of knowledge sufficiently accurately to target patient education. A high need for information was observed and included information about the patient's own glaucoma. Almost all patients preferred the ophthalmologist and many also a nurse or a representative of the Glaucoma Patient Society as providers of information. Written material was the preferred method.

Conclusions

Patient education should address all patients. A patient education program should cover a wide range of topics with a focus on general information through written material and information tailored to the individual glaucoma patient's needs. The ophthalmologist is a key- person, but others could play an important role in patient education.
Central Corneal Thickness and Intraocular Pressure Relationship in Eyes with and without Previous LASIK: Comparison of Goldmann Applanation Tonometer with Pneumatonometer
Authors: Bayraktar Ş. , Bayraktar Z.
Published: January 2018

Purpose

To investigate central corneal thickness (CCT) and intraocular pressure (IOP) relationship in eyes with and without previous corneal laser refractive surgery and to compare the estimates of two different tonometers–Goldmann applanation and pneumatonometer.

Methods

The study population included 234 glaucoma suspects who were referred to the glaucoma clinic with cup/disc ratios greater than 0.4, asymmetric cupping, and/or IOP greater than 22 mmHg during routine eye examination. Of those, 84 had previous myopic laser-assisted in situ keratomileusis (LASIK) (Group 1) while 150 of them did not (Group 2). CCT was measured by using optical coherence tomography (OCT) and IOP with both Goldmann applanation tonometer (GAT) and pneumatonometer (PT). In both groups, the difference between IOP estimates of two different tonometers and the relationship between CCT and IOP were analyzed.

Results

In eyes with previous LASIK, GAT measured IOP significantly lower than PT (mean difference of 3.8±1.9 mmHg, p<0.0001). In eyes with virgin corneas, IOP estimates of GAT or PT were not different from each other (19.9±2.8 versus 19.9±2.2 mmHg, respectively, p=0.81). In both groups, there was a significant positive correlation between CCT and IOP estimates of GAT (R=0.29, p=0.007 in eyes with LASIK and R=0.38, p<0.0001 in those without), while no similar relationship was present between CCT with those of PT (R=0.03, p=0.76 in eyes with LASIK and R=0.03, p=0.69 in those without).

Conclusions

In eyes with previous LASIK, GAT measured IOP significantly lower than PT. Because IOP estimates of PT were found to be independent from CCT in all of the study eyes, this device was considered to be a more reliable method of IOP estimation than GAT in eyes with and without previous LASIK.
Macula off Retinal Detachments. how Long Can They Wait before it is Too Late
Authors: Mowatt L. , Shun-Shin G.A. , Arora S. , Price N.
Published: January 2018

Purpose

To determine the association between the duration of macula off detachment and the visual outcome following corrective surgery.

Methods

Retrospective review of the medical records of patients who underwent surgery for macula off detachment over a 5 year period (April 1994– March 1999).

Results

There were 104 patients in the study. Patients with macula off detachments wait a mean of 2.6 weeks (±0.3 SE mean) before presentation and 1.8 weeks (±0.2 SE of mean) thereafter before surgery. The mean duration of detachment prior to surgical repair was 4.2 weeks (±0.3 SE mean). 78% of patients achieved a postoperative improvement in visual acuity. 36.5% achieved functional visual success of 6/12 at 3 months, which increased to 51% at final discharge. There was no significant difference in visual outcomes for patient undergoing internal vs external procedures (p=0.188). The preoperative visual acuity was the most significant predictor of post operative visual acuity (p<0.0005). Less than 40% of macula off detachments of =6 weeks duration will achieve a vision of 6/12 or better compared with 68.2% of patients with macula off detachments of ≤1 week.

Conclusions

The best mean postoperative vision (LogMAR 0.35) was seen in patients with detachment of <1 week duration. Patients <60 years are more likely to achieve visual improvement despite the duration of the detachment. Macula off detachments of >6 weeks duration have a significantly poor postoperative visual prognosis. Awareness of this visual prognosis can assist in planning the timing of surgery to ensure an acceptable result.
Rhodotorula Rubra Keratitis and Melting after Repeated Penetrating Keratoplasty
Authors: Lifshitz T. , Levy J.
Published: January 2018

Purpose

To describe a rare case of Rhodotorula rubra keratitis in a corneal graft, and to discuss the management of this unusual pathogen.

Methods

A 78-year-old debilitated man was treated for corneal abscess and descemetocele in his right eye. Urgent penetrating keratoplasty (PKP) with old donor material was performed. The patient underwent a new PKP when appropriate donor cornea was available. The graft was clear after the operation. Corneal cultures were negative.

Results

One month after the second PKP procedure, deep stromal infiltrate with hypopyon appeared. Cultures grew R. rubra. A third PKP operation was performed. Systemic and topical amphotericin B treatment was started. Six months after the last operation the graft remains clear.

Conclusions

Rhodotorula keratitis is an extremely rare infection that should be considered in debilitated patients with persistent and progressive corneal infection despite adequate antibiotic therapy.
Ocular Manifestations in Patients with Microscopic Polyangiitis
Authors: Mihara M. , Hayasaka S. , Watanabe K. , Kitagawa K. , Hayasaka Y.
Published: January 2018

Purpose

To describe ocular manifestations in patients with microscopic polyangiitis.

Methods

Two patients with microscopic polyangiitis complained of ocular symptoms and underwent ophthalmologic examinations.

Results

An 83-year-old woman (Case 1) was diagnosed with microscopic polyangiitis, according to the general clinical findings and the presence of perinuclear pattern of antineutrophil cytoplasmic antibodies (P-ANCA). She had hypopyon iridocyclitis in the right eye and retinal cotton-wool spots in the left eye. The patient was treated with oral prednisolone and subconjunctival betamethasone. The hypopyon iridocyclitis and retinal cotton-wool spots responded. A 79-year-old man (Case 2) had bilateral scleritis. The diagnosis of microscopic polyangiitis was made based on general clinical findings and the presence of P-ANCA. Scleritis was reduced after corticosteroid treatment.

Conclusions

Ophthalmologists should be aware that hypopyon iridocyclitis, cotton-wool spot, and scleritis could occur in patients with microscopic polyangiitis.
Optical Coherence Tomography and Fundus Microperimetry Imaging of Spontaneous Closure of Traumatic Macular Hole: A Case Report
Authors: Carpineto P. , Ciancaglini M. , Aharrh-Gnama A. , Agnifili L. , Cerulli A.M. , Cirone D. , Mastropasqua L.
Published: January 2018

Purpose

To report a case of spontaneous closure of traumatic macular hole in a young patient followed using optical coherence tomography (OCT) and fundus microperimetry.

Methods/Results

In the right eye of a 10-year-old child, a traumatic macular hole was observed to spontaneously resolve 18 weeks after blunt trauma. Initially, visual acuity in the right eye was 20/200 and OCT examination showed a 200üm-diameter full-thickness macular hole with perifoveal edema. Fundus microperimetry examination showed an evident decrease in retinal sensitivity within the macular hole and in the upper macular region where an area of commotio retinae was clearly visible. During follow-up OCT demonstrated the appearance of a band of tissue linking the inferior edge of the hole to the foveal retinal pigment epithelium and at the bottom of the hole the presence of hyperreflective (glial) material. Eighteen weeks after trauma right eye visual acuity had improved to 20/25, OCT examination showed a restored foveal depression, and fundus microperimetry demonstrated an increase in foveal sensitivity.

Conclusions

Both OCT and fundus microperimetry were useful tools for following the favorable course in a case of spontaneous closure of traumatic macular hole in a young patient. During follow-up OCT examinations were able to demonstrate the course of macular hole closure.
Viscocanalostomy with Mitomycin-C: A Preliminary Study
Authors: Yarangümeli A. , Köz ö. Gürbüz , Alp M.N. , Elhan A.H. , Kural G.
Published: January 2018

Purpose

To compare the results of viscocanalostomy with and without mitomycin-C (MMC).

Methods

Retrospective results of 15 standard viscocanalostomy (VCO) operations (Group 1) were compared with the prospective results of 15 VCO operations performed with intraoperative adjunctive MMC (Group 2). MMC (0.2 mg/mL) was applied over and under the superficial scleral flap for 3 minutes in Group 2 before the deep flap was prepared. Each patient was followed up for at least 1 year, and results of examinations in the first 12 months were used in the statistical comparison of the two groups. Surgical success was defined as intraocular pressure (IOP) ≤ 18 mmHg.

Results

Pr eoperative mean intraocular pressures (IOP) in Group 1 and Group 2 wer e 35.3±11.0 and 39.1±8.9, respectively. Mean IOP levels at the 12th month were 14.4±2.6 and 11.9±4.0, respectively, showing a significant decrease in both groups (p<0.001). Postoperative IOP course appeared to be lower in the MMC group, however, the difference was not statistically significant (p=0.554). Complete success rates without medications were 40% in Group 1 and 67% in Group 2. No significant difference was found between the two groups in terms of early and late postoperative complications, pre- and postoperative number of antiglaucoma medications, and surgical success rates at the end of the study period (p>0.05 for all). A significant difference was verified between the two groups of eyes considering the conjunctival bleb types, as low-lying, localized blebs were the most frequent type in Group 1 and thin-walled, avascular blebs were more predominant in the MMC group (p=0.004).

Conclusions

Intraoperative adjunctive MMC use might improve the long-term results of viscocanalostomy by facilitating subconjunctival filtration and might widen the indication range of the technique.
Effect of Prophylactic Brimonidine on Bleeding Complications after Cataract Surgery
Authors: Desco M C. , Navea A. , Ferrer E. , Menezo J.L.
Published: January 2018

Purpose

To evaluate the effect of prophylactic brimonidine on bleeding complications after cataract surgery.

Methods

The authors performed a prospective, double-masked, two-surgeon study of 137 patients (137 eyes) who underwent phacoemulsification and intraocular lens implantation with or without prophylactic brimonidine before cataract surgery. The authors also compared the effect of brimonidine among patients with systemic diseases such as diabetes mellitus (types I and II), hypertension, and anticoagulant or antiplatelet treatment.

Results

Subconjunctival hemorrhage was observed in 73.70% of the patients not treated with brimonidine before surgery and in only 23.75% of the patients who were given prophylactic brimonidine (p<0.001, χ2). The grade of hemorrhage was also statistically significant (p<0.001, Mann-Whitney). No statistically significant difference with regard to the presence of hemorrhage in diabetic patients or in the anticoagulant or antiplatelet treatment group was observed. However, a statistically significant difference (p<0.027, χ2) was found between hypertensive patients treated and not treated with prophylactic brimonidine before cataract surgery.

Conclusions

This study suggests that brimonidine administered before cataract surgery may significantly reduce subconjunctival hemorrhage in the general population. It has been shown to be beneficial in hypertensive patients. A strong statistical trend, but not significance has been found in diabetic patients or in patients treated with antiplatelet or anticoagulant drugs, but further studies are needed to reach conclusive results.
A Short Duration Transient Ischemia Induces Apoptosis in Retinal Layers: An Experimental Study in Rabbits
Authors: Öz Ö. , Gürelik G. , Akyürek N. , Cinel L. , Hondur A.
Published: January 2018

Purpose

To investigate retinal cell apoptosis in an experimental transient, short duration ocular ischemia model.

Methods

An experimental ischemia model, which simulates creating temporary high intraocular pressure to control intraocular bleeding during pars plana vitrectomy, was set up. Rabbits were randomly divided into three groups. Group 1 was the control group. In Group 2, intraocular pressure was increased to 97 mmHg for 5 minutes. In Group 3, intraocular pressure was increased to 97 mmHg for 10 minutes. After 24 hours, terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labeling assay was used to detect retinal apoptosis in rabbit eyes. Only nuclear staining in retinal cells was counted.

Results

Groups with 5 minutes and 10 minutes of ischemia showed significantly higher amount of ganglion cell layer apoptosis when compared with the control group (p<0.05). Light microscopy and standard hematoxylin-eosin did not show any significant damage in the retina cells.

Conclusions

Apoptotic cell death in the retinal cell layers occurs in temporary ischemia-reperfusion as early as 5 and 10 minutes duration.
Retinal Nerve Fiber Layer Measured by Heidelberg Retina Tomograph and Nerve Fiber Analyzer
Authors: Iester M. , Mermoud A.
Published: January 2018

Purpose

To compare retinal nerve fiber layer (RNFL) thickness measured by Heidelberg retina tomograph (HRT) and nerve fiber analyzer (GDx).

Methods

Twenty eyes of 20 consecutive healthy subjects were recruited for this study. Each subject had a normal visual field and a normal optic nerve head, which was assessed by slit-lamp biomicroscopy using a 90° lens. Using the HRT and GDx, RNFL measurement was calculated as for software vs 2.01 and vs 1.0.14, respectively. Retinal nerve fiber layer thickness was evaluated for the entire annulus surface every 5° degrees. RNFL was assessed by HRT and GDx. HRT RNFL measurement was calculated at 0 üm from the edge, while GDx RNFL measurement at 1.75 disc diameter as for software. The difference between the highest points and the deepest points was calculated and compared. Furthermore, because of the possibility of different scales in the two systems, the following ratio was calculated: superior/inferior, superior/temporal, superior/nasal, inferior/temporal, and inferior/nasal.

Results

When the entire RNFL thickness was considered, a significant (p<0.001) difference was found between the HRT and GDx measurements. A difference of 200 üm was found between the highest and the deepest HRT points while a difference of 40 üm was found between the highest and the deepest GDx points.

Conclusions

HRT and GDx RNFL measurements were statistically different in each sector. However, ratio parameters showed no difference between the obtained values except for superior/temporal ratio and inferior/temporal ratio.
Early Age-Related Maculopathy and Risk Factors of Cardiovascular Disease in Middle-Aged Lithuanian Urban Population
Authors: Paunksnis A. , Cimbalas A. , Cerniauskiene L.R. , Luksiene D.I. , Margeviciene L. , Domarkiene S. , Tamosiunas A. , Norkus A.
Published: January 2018

Purpose

To assess the prevalence of age-related maculopathy (ARM) in a middle-aged urban population and the relationship between ARM and the main risk factors of cardiovascular disease (CVD).

Methods

The survey according to the WHO MONICA study protocol was carried out in Kaunas city, Lithuania, from 2001 to 2002. A total of 1403 persons aged 35 to 64 years were screened (626 men and 777 women: response rate 62.4%). Ophthalmologic investigation was performed for 1337 respondents (594 men and 743 women). Analysis of the relationship between ARM and risk factors of CVD was performed in case-control subdivision matching for sex, age, and education level.

Results

Early ARM was diagnosed in 7.4% of men and 5.4% of women. Rate of current smoking in case and control groups did not differ in men but in case group of women it was greater than in control group. Mean systolic and diastolic blood pressure and body mass index (BMI) in male case group and mean fasting blood glucose concentration in female case group were higher than in corresponding control groups. Frequency of diastolic hypertension (diastolic blood pressure ≥90 mmHg) and obesity (BMI ≥30 kg/m2) in male case group was higher than in control group. ARM was not associated with cholesterol and triglyceride levels in men and women.

Conclusions

Early ARM in middle-aged Lithuanian urban population was associated with current smoking in women but not in men; it was associated with diastolic blood pressure and BMI in men and with fasting glucose level in women.
Idiopathic Sclerosing Inflammation of the Orbit: A Case of Steroid-Responsive Disease in a Patient with Autoimmune Hemolytic Anemia
Authors: Billing K.J. , Hsuan J.D. , Selva D.
Published: January 2018

Purpose

Idiopathic sclerosing orbital inflammation (ISOI) has been categorized by some authors as a unique clinicopathologic entity, separate from the heterogenous group of disorders known collectively as nonspecific orbital inflammation. Histologic similarity and clinical association with other fibrosclerosing conditions has been shown. The authors present a case of ISOI in conjunction with autoimmune hemolytic anemia.

Methods

A 59-year-old woman with a history of hemolytic anemia had left upper lid swelling, periocular pain, proptosis, and restriction of ocular motility. Magnetic resonance imaging (MRI) showed a homogenously enhancing lateral orbital mass. Biopsy revealed dense fibrous connective tissue with a paucicellular infiltrate, consistent with ISOI, and treatment with prednisolone 60 mg/day was instituted.

Results

At 4-week review, the proptosis had settled and the patient regained full range of extraocular movements. At 14 months, the response was sustained and repeat MRI showed a 70% reduction in size of the mass.

Conclusions

The first known case of ISOI and hemolytic anemia is presented. Despite dense fibrosis histologically, steroid responsiveness can be encountered in cases of ISOI. An early, aggressive approach to management is recommended, and corticosteroids should be considered as a treatment option.
Acute Retinal Necrosis Presenting as Central Retinal Artery Occlusion with Cilioretinal Sparing
Authors: Shah S.P. , Hadid O.H. , Graham E.M. , Stanford M.R.
Published: January 2018

Purpose

To report a case of acute retinal necrosis presenting as central retinal artery occlusion with cilioretinal sparing.

Methods

Single inter ventional case report. The findings of the ophthalmic examination, MRI, blood parameters, biopsy results and clinical course are reported.

Results

A forty two year old gentleman reporting sudden loss of sight, ophthalmic examination revealing uveitis, central retinal artery occlusion with cilioretinal sparing and peripheral necrotizing retinitis.

Conclusions

Central retinal artery occlusion can be an early feature of acute retinal necrosis (ARN).
Central Corneal Thickness in Primary Open Angle Glaucoma, Pseudoexfoliative Glaucoma, Ocular Hypertension, and Normal Population
Authors: Yagci R. , Eksioglu U. , Midillioglu I. , Yalvac I. , Altiparmak E. , Duman S.
Published: January 2018

Purpose

This study was designed to determine the relationship between central corneal thickness (CCT) and intraocular pressure (IOP) measured by applanation tonometer in glaucomatous, ocular hypertensive, and normal eyes.

Methods

A total of 125 subjects were included in the study. Twenty-six had primary open angle glaucoma (POAG), 25 had pseudoexfoliative glaucoma (PXG), 24 had ocular hypertension (OHT), and 50 of them were normal. IOP values were measured by Goldmann applanation tonometer whereas CCT values were measured by ultrasonic pachymeter.

Results

CCT values in the OHT group (595.75±22.52 μm) were greater than the CCT values of the POAG group (539.92±21.50 μm), the PXG group (526.28±31.73 μm), and the normal group (533.96±29.25 μm) (p<0.05). Eight patients who were diagnosed with OHT showed IOP values of 21 mm Hg or lower with corrected IOP values according to CCT.

Conclusions

Increased CCT may lead to falsely high values of IOP measured with Goldmann applanation tonometer. In this study, when IOP values of the OHT group were redefined according to the formulae regarding the CCT, the authors noted that one third of them were normal. Determination of the CCT in OHT cases is crucial since it has great impact on IOP values, measured with applanation tonometer, which is the main parameter in the diagnosis and follow-up of glaucoma.
Safety and Efficacy of Bimatoprost 0.03% versus Timolol Maleate 0.5%/Dorzolamide 2% Fixed Combination
Authors: Day D.G. , Sharpe E.D. , Beischel C.J. , Jenkins J.N. , Stewart J.A. , Stewart W.C.
Published: January 2018

Purpose

To determine the efficacy and safety of bimatoprost given every evening versus the dorzolamide/timolol fixed combination (DTFC) given twice daily in open-angle glaucoma and ocular hypertensive patients.

Methods

A double-masked, three-center, prospective, randomized, crossover comparison with two 8-week treatment periods following a 4-week medicine free washout period. Diurnal curve intraocular pressures (lOPs) were taken at 08:00 (trough) and 10:00 and 16:00 hours.

Results

A total of 35 patients were enrolled and 32 completed all evaluations. The diurnal untreated baseline intraocular pressures was 24.8 ± 2.4 mmHg. On the last day of treatment the mean diurnal intraocular pressures was 17.4 ± 2.9 for bimatoprost and 18.1 ± 2.8 mmHg for DTFC (p = 0.35). The individual time points for intraocular pressures were not statistically different between groups. Both groups statistically reduced the intraocular pressures from baseline for each time point and for the diurnal curve (p < 0.05). Regarding ocular safety and tolerability, there was more conjunctival hyperemia with bimatoprost (n = 15) than with DTFC (n = 7, p = 0.013) and more burning and stinging with DTFC (n = 12) than with bimatoprost (n = 0, p = 0.0005). Few systemic adverse events were recorded and there was no statistical difference between groups for any individual event (p > 0.05).

Conclusions

This study indicates that the intraocular pressures are lowered to a statistically similar amount with DTFC compared to bimatoprost in open-angle glaucoma and ocular hypertensive patients.
Bilateral Lens Subluxation Associated with Atopic Eczema
Authors: Peter N.M. , Nath R. , Tranos P.G. , Teimory M.
Published: January 2018

Purpose

Ectopia lentis remains a therapeutic challenge for ophthalmologists. It classically presents with a preceding history of blunt or penetrating ocular trauma, or it may be associated with other ocular disorders such as congenital glaucoma and aniridia, or concomitant hereditary systemic diseases such as Marfan syndrome and homocystinuria.

Methods

Case report.

Results

The authors describe a previously unreported mechanism of ocular trauma associated with continuous eye rubbing, resulting in bilateral recurrent subluxation of both intraocular lens and crystalline lens.

Conclusions

It is useful for the ophthalmologist to be aware of this uncommon cause of ectopia lentis, since early advice and appropriate medical or surgical intervention may prevent more severe, sight-threatening complications.
Reconstruction of Conjunctiva with Amniotic Membrane after Excision of Large Conjunctival Melanoma: A Long-Term Study
Authors: Dalla Pozza G. , Ghirlando A. , Busato F. , Midena E.
Published: January 2018

Purpose

To evaluate, on a long- term basis, the role of amniotic membrane in the reconstruction of large conjunctival defects after excision of large conjunctival melanoma.

Methods

Four consecutive patients with diffuse conjunctival melanoma involving both bulbar and palpebral conjunctiva were studied. Conjunctival melanoma was completely excised (with wide clinically disease-free margins) and amniotic membrane immediately sutured to the surrounding conjunctiva and sclera to cover the conjunctival defect. Minimum follow-up was 48 months.

Results

Successful conjunctival surface reconstruction and physiologic fornical depth were achieved in all patients within 6 weeks. No recurrence of primary melanoma was observed during long-term follow-up.

Conclusions

Amniotic membrane transplantation is an effective alternative in ocular surface repairing surgery after removal of large conjunctival tumors.
Implantation of Iris Devices in Congenital and Traumatic Aniridias: Surgery Solutions and Complications
Authors: Menezo J.L. , Martínez-Costa R. , Cisneros A. , Desco M.C.
Published: January 2018

Purpose

To show surgical solutions in patients with traumatic and congenital aniridia, to evaluate the clinical improvement of these patients when iris prosthesis are implanted, and to examine safety and complications of these implants in a long-term follow-up.

Methods

Eight patients were included in this retrospective noncomparative case series. Nine eyes had an artificial iris implantation for traumatic or congenital aniridia. Three eyes received a black diaphragm intraocular lens (IOL) in capsular bag after phacoemulsification. An aniridia prosthesis, sulcus sutured, in front of a previous IOL was implanted in two eyes. A black diaphragm IOL, sulcus sutured, in two eyes; two iris diaphragm rings, in front of the previous IOL, in one eye; and a sector iris prosthesis in front of an IOL in the last eye were implanted. Mean follow-up was 22.5 months (range 16 to 44 months).

Results

All patients had improved visual acuity (VA) and visual comfort after surgery. The glare disability was subjectively better in all cases. Two patients developed new ocular hypertension after surgery; one of them was controlled by medical treatment and the other needed cyclodiode. Two of the patients with glaucoma preoperatively also needed cyclodiode procedure and one of them an Ahmed valve.

Conclusions

Several kinds of artificial iris implants are available. In all our patients with aniridia, iris artificial prostheses improved VA and diminished visual discomfort. Glaucoma is the most important complication after artificial iris implant. It is possible to implant the iris prosthesis in the capsular bag, but this requires a large capsulorrhexis and presents a surgical challenge.