bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of Sterile, Postoperative, Anterior Segment Inflammation following Cataract Extraction and Intraocular Lens Implantation
Authors: Bilge A.H. , Aykan Ü. , Akin T. , Ünsal U.
Published: January 2018

Purpose

To evaluate unexpected, acute intraocular anterior segment inflammation following uneventful cataract extraction by phacoemulsification and foldable posterior chamber intraocular lens (PCIOL) implantation.

Methods

This retrospective study evaluated five cases of postoperative inflammation that occurred after cataract extraction with foldable PCIOL implantation. Medical records were reviewed to analyze the unexplained postoperative inflammation.

Results

The five patients who developed inflammatory activity during the postoperative period responded well to corticosteroid treatment. Toxic maculopathy developed in one patient after aggressive antibacterial therapy. Vitrectomy was performed for one patient with prolonged vitreal inflammatory activity.

Conclusions

Noninfectious endophthalmitis developing upon surgery may be caused by a multifactorial process or an interindividual variable response to a common factor as a hypersensitivity reaction. It should be remembered in inflammatory cases after surgery in order to prevent the toxic, irreversible side effects of bacterial endophthalmitis treatment.
Amniotic Membrane Transplantation Associated with Conjunctival Peritomy in the Management of Mooren's Ulcer: A Case Report
Authors: Lambiase A. , Sacchetti M. , Sgrulletta R. , Coassin M. , Bonini S.
Published: January 2018

Purpose

To report the association of conjunctival peritomy with amniotic membrane transplantation (AMT) at the limbus with the exclusion of the central cornea in order to preserve visual function in one case of bilateral Mooren's ulcer.

Methods

A 36-year-old man with bilateral Mooren's ulcer was unresponsive to conventional therapy. Surgical procedure was performed on his right eye, at impending risk of corneal perforation. A 20 × 20 mm piece of amniotic membrane (AM) was prepared by performing a central hole of 7.5 mm diameter with a manual trephine. A 360° conjunctival peritomy was performed and the AM was placed with the epithelium side facing up and the central hole was sutured on the paracentral cornea.

Results

Two weeks after surgery, while the right eye showed improvement of signs and symptoms and unchanged best-corrected visual acuity (BCVA), the left eye showed a peripheral corneal perforation with prolapsed iris that required conjunctival flap. At 7 months of follow-up, the right eye showed no ocular inflammation, a reduction of the lipid-like peripheral corneal infiltrates, an increased stromal thickness, and an unchanged BCVA. The progression of corneal thinning in the left eye led the authors to perform AMT (as described) in the left eye as well. Five months after the AMT in the left eye, neither eye shows signs of disease progression, and neither requires further therapy.

Conclusions

Conjunctival peritomy associated with AMT may be an alternative surgical approach in the management of Mooren's ulcers to control the inflammation and the progression of disease.
Macular Edema and Visual Loss after Macular Pucker Surgery with ICG-Assisted Internal Limiting Membrane Peeling
Authors: Tognetto D. , Haritoglou C. , Kampik A. , Ravalico G.
Published: January 2018

Purpose

To describe the occurrence of massive macular edema and visual loss after indocyanine green-assisted (ICG) macular pucker surgery.

Methods/Results

A 74 years old female presented with a macular pucker and a hypertrophy of the retinal pigment epithelium (RPE) in her left eye. The preoperative visual acuity (VA) was 20/100. Surgery consisted of cataract extraction, lens implantation and standard pars plana vitrectomy with peeling of epiretinal tissue followed by the removal of the internal limiting membrane (ILM) remnants stained using a 0.05% ICG solution. One day after surgery, VA was counting fingers. There was an extensive macular edema and retinal thickening with hyperfluorescence during fluorescein angiography and pronounced autofluorescence using ICG filters. During follow up, the macular edema resolved completely, but VA decreased to 20/800 at six months postoperatively. There was a central scotoma and unstable fixation seen during microperimetry.

Discussion

This case report indicates that ICG might come into contact with bare retina if injected following removal of epiretinal membranes. Whether the observed RPE hypertrophy might have contributed to the pathogenesis of the adverse effect described remains hypothetical.
Comparison between Phaco-Deep Sclerectomy Converted into Phaco-Trabeculectomy and Uneventful Phaco-Deep Sclerectomy
Authors: Rebolleda G. , Muñoz-Negrete F.J.
Published: January 2018

Purpose

To evaluate and compare the results and complications of eyes that underwent a phaco-deep sclerectomy (DS) converted into phaco-trabeculectomy due to an intraoperative macroperforation with eyes undergoing uneventful phaco-DS.

Methods

The authors reviewed 106 eyes having a planned phaco-DS; 10 of them (9.4%) had to be converted into phaco-trabeculectomy because of a large perforation during the nonpenetrating procedure. Intraocular pressure (IOP), visual acuity, glaucoma medication evolution, and complications were evaluated and compared between groups.

Results

Eyes undergoing uneventful phaco-DS (n=96, Group 1) had a significantly higher postoperative IOP compared with those undergoing transformed phaco-trabeculectomy (n=10, Group 2) (p<0.05). One year postoperatively, 81.2% and 100% of the eyes in the Group 1 and 2, respectively, had an IOP ≤ 21 mmHg without treatment (p=0.206). One year postoperatively, eyes that underwent uneventful phaco-DS needed more glaucoma medications than eyes converted into phaco-trabeculectomy (p=0.014). Visual acuity improved more quickly in Group 1 (p<0.05). Hyphema and choroidal detachment rates were significantly higher in Group 2 (p=0.002 and p=0.027, respectively).

Conclusions

Phaco-DS converted into phaco-trabeculectomy provides better midterm IOP control when compared with uneventful phaco-DS, but has more complications and worse visual acuity in the early postoperative period.
Immunohistochemical Study of Extracellular Matrix Components in Epiretinal Membranes of Vitreoproliferative Retinopathy and Proliferative Diabetic Retinopathy
Authors: Ioachim E. , Stefaniotou M. , Gorezis S. , Tsanou E. , Psilas K. , Agnantis N.J.
Published: January 2018

Purpose

The migration, proliferation, differentiation, and adhesion of cells and other cellular functions are influenced by the surrounding extracellular matrix in normal and wound healing conditions. The formation of epiretinal membranes, a wound healing process, is a serious complication of retinal diseases, the most important being proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR). In the present study, the authors investigated the expression of various extracellular matrix components and in particular tenascin, fibronectin, laminin, collagen IV, and MMP-3 glycoprotein as well as the expression of glial fibrillary acidic protein in each type of epithelial membrane in order to elucidate the role of these molecules in the formation of these two types of membranes.

Methods

The authors performed immunohistochemistry in 14 PVR and 14 PDR membranes, using antibodies against the above mentioned extracellular matrix components. Tenascin and fibronectin were observed as major components in the extracellular matrix, while laminin and collagen type IV were detected as minor components in both types of membranes. A higher fibronectin expression in PVR compared with PDR membranes was found (p=0.0035). A positive relationship of its expression with the proliferative activity (p=0.15) and collagen type IV expression (p<0.0001) was also observed.

Results

Tenascin expression was positively correlated with glial fibrillary acidic protein positive cells in PDR membranes (p=0.04). Collagen type IV localized around vessels was observed with high levels in PDR membranes (p=0.0031).

Conclusions

The results indicated that the extracellular matrix components seem to be involved in PVR and PDR, contributing to tissue remodeling and perhaps by different pathogenetic pathways, which could reflect different stages of development in these two types of membranes.
Evidence-Based Guidelines on the Referral of Visually Impaired Persons to Low Vision Services
Authors: De Boer M.R. , Langelaan M. , Jansonius N.M. , Van Rens G.H.M.B.
Published: January 2018

Purpose

One to two percent of the population in the Western world is visually impaired or blind. For most of these people there is no curative therapy. Therefore, the Dutch Ophthalmic Society has taken the initiative to develop an evidence-based guideline for the referral of visually impaired persons to low vision services.

Methods

A systematic literature search was performed in the Embase (1991–2001) and Medline (1966–2003) databases. Literature was searched for definitions of visual impairment, for physician-patient communication, and for outcome of interventions for visually impaired persons. Results of the articles that were selected were summarized and rated according to the level of evidence. Other considerations such as the current organization of rehabilitation for visually impaired persons in the Netherlands were also taken into account.

Results

The World Health Organization criteria were slightly adapted in order to include all people who experience problems with reading and other daily life activities due to visual impairment. A large number of recommendations were devised. Among these is that the complete diagnosis should be communicated to the patient and that a second appointment should be offered in which the diagnosis and potential treatment options are discussed again. Another recommendation is that in general visually impaired adults eligible for referral should be referred for the provision of low vision aids and that patients with complex problems or extensive rehabilitative demand should be referred to a rehabilitation center.

Conclusions

This article presents a summary of the first European evidence-based guideline for the referral of visually impaired persons.
A Case of Palpebral Dirofilariasis
Authors: Aiello A. , Aiello P. , Aiello F.
Published: January 2018

Purpose

Dirofilaria repens infection is the most frequent and widespread dirofilariasis in the world. In Italy subcutaneous dirofilariasis is present especially in Northern-Central areas.

Methods

A woman with a palpebral lump is presented.

Results

After subcutaneous and muscular décollement, the authors found and removed a parasite. The final diagnosis was subcutaneous parasitosis due toD. repens.

Conclusions

Surgery was both diagnostic and therapeutic.
Long-Term Persistence of Fascia Lata Patch Graft in Glaucoma Drainage Device Surgery
Authors: GutiéRrez-Díaz E. , Montero-Rodríguez M. , Mencía-Gutiérrez E. , Cabello A. , Monescillo J.
Published: January 2018

Purpose

Conjunctival erosion in glaucoma drainage device surgery can be prevented by the use of patch grafts to cover the extraocular portion of the tube. Several materials can be used, among them human preserved fascia lata.

Methods

The authors present a case of a failed Ahmed glaucoma valve due to encapsulation of the bleb, in which the fascia lata patch placed to cover the tube was removed 32 months later, during the implantation of a second glaucoma drainage device.

Results

Histopathologic examination of the fascia lata patch demonstrated its persistence, without degradation or cellular infiltration.

Conclusions

Human preserved fascia lata is a suitable material for tube covering in glaucoma drainage device surgery, with long-term survival.
Intravitreal Triamcinolone in the Treatment of Serous Pigment Epithelial Detachment and Occult Choroidal Neovascularization Secondary to Age-Related Macular Degeneration
Authors: Nicolö M. , Ghiglione D. , Lai S. , Calabria G.
Published: January 2018

Purpose

To report two cases of occult choroidal neovascularization (CNV) and serous pigment epithelial detachment (PED) treated with intravitreal triamcinolone (IVT) injections.

Methods

Interventional case reports.

Results

Both patients showed an increase in visual acuity and a complete flattening of the PED at 10 months (Case 1) and 4 months (Case 2) after IVT injections. No complications or adverse effects are reported.

Conclusions

Future studies should be designed to investigate if IVT can effectively influence the clinical and functional outcome of eyes with serous PED and occult CNV secondary to age-related macular degeneration, for which at the moment no treatment has been shown to be effective.
Scanning Laser Polarimetry and Retinal Thickness Analysis before and after Laser in Situ Keratomileusis
Authors: Hoffmann E.M. , Dick H.B. , Grus F.H. , Pfeiffer N.
Published: January 2018

Purpose

To evaluate changes in retinal nerve fiber layer (RNFL) thickness after laserin situ keratomileusis (LASIK) using a scanning laser Polarimeter with fixed corneal compensation (GDx) and the retinal thickness analyzer (RIA).

Methods

Thirty-eight eyes of 19 healthy subjects (10 female and 9 male; mean age 37.0±8.8 years) underwent GDx and RTA measurements before and after LASIK. All subjects revealed mild to high myopia (mean spherical refraction: −4.0±2.75 D). Measurements using GDx were followed by RTA measurements after pupil dilation. All measurements were performed the day before LASIK and 1 week postoperatively.

Results

GDX revealed a decrease in nerve fiber layer thickness measurements after LASIK, but did not reach statistical significance (p>0.05). Using RTA, mean RNFL thickness (MRNFL) and RNFL cross sectional area decreased significantly after LASIK (p=0.03 and p=0.02, respectively).

Conclusions

Scanning laser polarimetry revealed a slight decrease in RNFL thickness measurements after LASIK. MRNFL and RNFL cross section were significantly lower after LASIK using RTA. The changes might be artifacts in a small group of myopic subjects.
Contrast and Glare Sensitivity after Implantation of AcrySof® and Human Optics 1CU® Intraocular Lenses
Authors: Kamppeter B.A. , Sauder G. , Jonas J.B.
Published: January 2018

Purpose

To evaluate contrast and glare sensitivity of a newly developed, potentially accommodative intraocular lens.

Methods

The clinical interventional prospective randomized study included 20 patients (23 eyes) undergoing standard phacoemulsification with clear cornea incision in topical anesthesia. In the study group (10 eyes), the 1CU Human Optics intraocular lens (optics diameter 5.5 mm) was implanted. The control group (13 eyes) received the monofocal AcrySof intraocular lens (optics diameter: 6.0 mm). Using a newly developed contrast measuring device, contrast and glare sensitivity were tested 4 weeks after surgery.

Results

The study group and control group did not vary significantly in contrast (p=0.38) or glare sensitivity (p=0.52).

Conclusions

The results suggest that the newly developed 1CU Human Optics intraocular lens and the standard AcrySof intraocular lens do not vary significantly in glare and contrast sensitivity.
Implantation of Stimulation Electrodes in the Subretinal Space to Demonstrate Cortical Responses in Yucatan Minipig in the Course of Visual Prosthesis Development
Authors: Sachs H.G. , Gekeler F. , Schwahn H. , Jakob W. , Köhler M. , Schulmeyer F. , Marienhagen J. , Brunner U. , Framme C.
Published: January 2018

Purpose

During the course of the development of visual prostheses, subretinal stimulation films were implanted in micropigs in order to prove the feasibility of subretinal electrical stimulation with subsequent cortical response. One aim was to demonstrate that epidural recording of visual evoked potentials is possible in the micropig.

Methods

Film-bound stimulation electrode arrays were placed in the subretinal space of micropigs. This enabled the retina to be stimulated subretinally. Since conventional visual evoked potential (VEP) measuring is virtually impossible in the pig from the neurosurgical point of view, epidural recording electrode arrays were positioned over the visual cortex as permanent electrodes.

Results

The feasibility of temporary implantation of film-bound stimulation electrode arrays was successfully demonstrated in the micropig model. On stimulation with monopolar voltage pulses (1000 to 3000 mV), reproducible epidural VEP measurements (5 to 10 μV) were detected.

Conclusions

The feasibility of subretinal stimulation of the retina was demonstrated in a retinal model that is similar to the human retina. This animal model therefore offers a suitable means of studying the tolerability of stimulation situations in the course of visual prosthesis development.
Immune Recovery Uveitis in a iatrogenically Immunosuppressed Patient
Authors: Miserocchi E. , Modorati G. , Brancato R.
Published: January 2018

Purpose

To report a case of immune recovery uveitis (IRU) in an iatrogenically immunosuppressed human immunodeficiency virus (HIV)-negative patient.

Methods

Interventional case report. One patient was diagnosed with cytomegalovirus retinitis in the left eye while receiving immunosuppressive treatment following renal transplantation. The retinitis resolved completely with systemic ganciclovir. Further reduction of immunosuppressive treatment, causing a rapid increase in CD4–T lymphocyte count, was associated in the same eye with the occurrence of IRU consisting of anterior uveitis, vitritis, and macular edema.

Results

Visual acuity at IRU presentation onset was 20/200 in the left eye. After 6 weeks of follow-up, the uveitis resolved with topical and periocular steroid treatment. Visual acuity restored to 20/40.

Conclusions

IRU can occur in iatrogenically immunosuppressed HIV-negative patients.
Ocular Hypertension and Corneal Thickness: A Long-Term Prospective Study. Results after Two Years
Authors: Brusini P. , Tosoni C. , Parisi L. , Rizzi L.
Published: January 2018

Purpose

To study the importance of the central corneal thickness (CCT) in patients with ocular hypertension in a 2-year follow-up.

Methods

A total of 110 subjects with ocular hypertension (intraocular pressure [IOP] >21 mmHg and normal automated visual field test) were admitted to the study. All patients periodically underwent the following tests: 1) circadian IOP curve; 2) standard automated perimetry (SAP, Humphrey 30–2 SITA test); 3) short wavelength automated perimetry (SWAP); 4) frequency doubling technology perimetry (FDT, N-30 threshold test); 5) nerve fiber layer analysis with GDx; 6) ibopamine test; 7) ultrasonic pachymetry. Patients were divided into three groups, based on corneal thickness. The frequency of abnormal tests within these groups was evaluated with the Pearson's χ2 test. Baseline IOP was corrected using the Doughty and Zaman formula. CCT was also considered as a continuous variable. A control group of 48 normal subjects was also considered.

Results

The mean CCT was 562.8 um ± 37.7. The difference with respect to normal subjects was statistically significant (p<0.01). Using the correction formula, 43 eyes (39.1%) had an IOP <21 mmHg. Abnormal test results were more frequently found with FDT. The percentage of abnormal results was found to be inversely proportional to CCT. The other tests gave inconsistent or conflicting results. Using the values of CCT as a continuous variable, no significant association was found with the GDx number and the visual field indices.

Conclusions

The results of our 2-year study confirm the importance of CCT measurement in the evaluation of the risk of developing glaucomatous damage.
12-Week Study Comparing the Fixed Combination of Brimonidine and Timolol with Concomitant Use of the Individual Components in Patients with Glaucoma and Ocular Hypertension
Authors: Goñi F.J. ,   Brimonidine/Timolol Fixed Combination Study Group, de Groot Veva , El-Rifai Mohamed , Khalifa Ali Ahmed , Labib Taha , Sabry Nabil , Saif Sayid , de Jong Leo , Tjia Khiun Fi , Vaandrager Willem , Cernica Ozana , Chiselita Dorin , Vasinca Dumitru Ioan , Goñi Francisco Javier , Larena-Gomez Concepcio , Teus-Guezala Miguel , Urcelay-Segura Jose Luis , Calel Bertil , Chen Enping , Andac Kutay , Izgi Belgin , Ocakoglu Ozcan , Turacli M. Erol , Bossowska Izabella J. , Ingram Alison M.
Published: January 2018

Purpose

To evaluate the efficacy and safety of fixed-combination brimonidine tartrate 0.2%/timolol 0.5% ophthalmic solution dosed BID and demonstrate non-inferiority to concomitant use of brimonidine tartrate 0.2% BID and timolol 0.5% BID in glaucoma and ocular hypertension patients with intraocular pressure (IOP) uncontrolled on monotherapy.

Methods

Randomized, multicenter, double-masked, parallel-group study involving 371 patients with inadequate IOP control (IOP from 22 to 34 mmHg) after ≥3 weeks of run-in on any monotherapy. Patients were treated with fixed-combination brimonidine/timolol BID (fixed-combination group, n=188) or concomitant brimonidine BID and timolol BID (concomitant group, n=183). IOP was assessed pre-dose and 2 hours after morning dosing at weeks 2, 6, and 12.

Results

A total of 355 patients (96%) completed the study. Patient demographics, run-in monotherapy, and baseline mean IOP on monotherapy were comparable between treatment groups. During follow-up, the mean reduction from baseline IOP was significant (p<0.001) at all time points and ranged from 4.4 to 5.3 mmHg in each group. Brimonidine/timolol fixed combination was as effective as concomitant therapy with respect to mean IOP and mean change from baseline IOP at all time points and visits. Between-group differences were <0.35 mmHg for mean IOP and <0.30 mmHg for mean change from baseline IOP; none were significant. No unexpected side effects were associated with the fixed combination. Both treatments were well tolerated with no difference in adverse events between groups.

Conclusions

Brimonidine/timolol fixed-combination therapy is as safe and effective as concomitant treatment with the individual components. Its simplified dosing regimen has the potential to improve compliance.
Optic Disc Drusen in Tilted Disc
Authors: Giuffrè G.
Published: January 2018

Purpose

To investigate if a congenital anomaly of the head of the optic nerve like such as tilted disc can be a risk factor for the development of optic disc drusen.

Methods

The study was performed retrospectively on the files of 47 patients with optic disc drusen. The diagnosis was confirmed by fluorescein angiography and B-scan ultrasonography. The authors examined the fundus photographs and the fluorescein angiographies of these patients looking for the presence of tilted discs.

Results

Two of the 47 patients with optic nerve drusen had tilted discs as well, about twice the expected rate. Both cases presented a parapapillary hemorrhage.

Conclusions

The concomitant presence of tilted disc and optic disc drusen can have a cause-effect relationship. The axonal crowding in a scleral canal of reduced size, as seen in tilted disc, can compress the nerve fibers against the stiff lamina cribrosa, producing a chronic optic neuropathy leading to drusen.
Upregulation of ICAM-1 Expression in the Conjunctiva of Patients with Chronic Graft-Versus-Host Disease
Authors: Aronni S. , Cortes M. , Sacchetti M. , Lambiase A. , Micera A. , Sgrulletta R. , Bonini S.
Published: January 2018

Purpose

To correlate conjunctival intercellular adhesion molecule 1 (ICAM-1) expression with cytologic and clinical findings of chronic graft-versus-host disease (GVHD).

Methods

Seven patients with chronic GVHD-related keratoconjunctivitis and five age-matched normal controls were recruited for the study. Clinical examination included medical history, visual acuity, evaluation of ocular signs and symptoms (scored from 0 to 3), corneal fluorescein staining (scored from 0 to 5 on the basis of the number of corneal sectors involved), Schirmer test type I, and break-up time (BUT). Impression cytology samples were collected from the nasal and inferior bulbar conjunctiva of patients and controls. Goblet cells were counted in three randomly selected fields and averaged. Immunofluorescent staining for ICAM-1 was carried out and the percentage of cells expressing the marker was evaluated.

Results

All patients showed signs and symptoms of keratoconjunctivitis sicca. Schirmer test type I and BUT were reduced (4.8±6.7 mm/5 min and 3.9±2.7 seconds, respectively). Goblet cells were significantly reduced in GVHD eyes with respect to normal eyes (65±30.5 and 192±16.9 cells/field respectively; p<0.001). Goblet cell number was directly related to Schirmer test values (p<0.01, rho=0.817) and inversely related to total sign score (p<0.01, rho=-0.939). ICAM-1 expression was increased in GVHD eyes with respect to normal controls, in which no staining was observed. ICAM-1 expression showed an inverse relation to goblet cell number (p<0.01, rho=-0.852) and Schirmer test values (p<0.01, rho=-0.926), and was directly correlated to total sign score (p<0.01, rho=0.982).

Conclusions

Conjunctival ICAM-1 expression is increased in GVHD patients. The severity of the disease is associated with tear parameters, goblet cell decrease, and inflammatory markers, such as ICAM-1.
Corneal Topography Parameters after Superior Clear Corneal Incision Cataract Surgery in Arcus Lipoides
Authors: Resch M.D. , Bausz M. , Nagy Z.Z. , Suveges Í.
Published: January 2018

Purpose

To compare changes in corneal topographic parameters after cataract surgery in eyes with different severities of arcus lipoides.

Methods

Fourty eyes of 40 patients (23 women, 17 men, age 71.3±20.4 years, range 40 to 89 years) were studied prospectively in a consecutive, non-interventional, comparative series of cases. Eyes were classed in three groups (0 to 2) according to the assessed grade of arcus lipoides (none, <180°, >180°). Corneal topography (Tomey TMS-2) was performed preoperatively and at 1 and 10 days and 1 and 3 months following cataract surgery (superior 4.0 mm clear corneal incision, no suture). Keratometric astigmatism (Dcyl), surface regularity index (SRI), surface asymmetry index (SAI), and potential visual acuity (PVA) were evaluated for the different groups and time-points, using the Kruskal-Wallis, Wilcoxon, and Mann-Whitney statistical tests.

Results

No significant preoperative difference was found in mean Dcyl, SRI, or PVA; preoperative SAI was lower in Group 1. Postoperatively Dcyl was increased at day 1 in Groups 1 and 2, and remained higher in Group 2 until month 1. At month 3 significant differences among Groups 0, 1, and 2 disappeared.

Conclusions

The 4.0 mm superior clear corneal incision is a safe method for cataract surgery in the presence of arcus lipoides. This procedure induces greater corneal astigmatism, surface irregularity, and lower PVA in the early postoperative period in cases with arcus lipoides than in normal corneas. Concerning final results, wound healing was not affected by greater severity of arcus lipoides, although stabilization of the corneal surface tended to be slower.
Effects of Latanoprost and GLC756, a Novel Dopamine D2 Agonist and D1 Antagonist, on Cultured Normal Human Dermal Fibroblasts
Authors: Laengle U.W. , Markstein R. , Pralet D. , Greiner B. , Roman D.
Published: January 2018

Purpose

Proliferation of subconjunctival fibroblasts plays a critical role in scarring and failure of glaucoma filtering surgery. Long-term topical glaucoma medications appear to increase fibroblast proliferation. In this study, the effects of topical antiglaucoma drugs latanoprost and GLC756, a novel dopamine D2 agonist and D1 antagonist, on cultured normal human dermal fibroblasts (NHDF) were examined.

Methods

The NHDF cell line was incubated with latanoprost, prostaglandinF2α (PGF2α), GLC756, or 5-fluorouracil as a positive control at concentrations of 3 and 30 μM for 6, 18, and 24 hours. Fibroblast growth was measured by 5-bromodeoxyuridine (BrdU) uptake using laser scanning cytometry.

Results

Latanoprost and PGF2α had a biphasic response on the number of cultured NHDF positively stained with BrdU. A stimulating effect on proliferation occurred early, 6 hours after incubation, and an inhibitory effect 18 to 24 hours after incubation. GLC756, in contrast, revealed only inhibitory effects on BrdU uptake 18 to 24 hours after incubation. The pattern of GLC756 was similar to that of the positive control 5-fluorouracil.

Conclusions

Latanoprost seemed to have a biphasic response on the proliferation of cultured NHDF. First there was a stimulating thereafter a secondary negative modulating effect. GLC756 had a fully antiproliferative effect on the NHDF, indicating an additional potential of novel dopamine compounds for topical glaucoma medication.
Hypericin-Enhanced Argon Laser Photocoagulation for Subfoveal Choroidal Neovascular Membrane in Age-Related Macular Degeneration: A Pilot Study
Authors: Sobaci G. , Bayraktar M.Z. , Karslioğlu Y. , Durukan A.H. , Hurmeriç V. , Aykaş S.
Published: January 2018

Purpose

To evaluate the efficacy and safety of hypericin-enhanced argon laser photocoagulation (H-ALP) in the treatment of subfoveal choroidal neovascular membrane (CNM) secondary to age-related macular degeneration (ARMD).

Methods

After preliminary studies for definition of parameters, argon-green laser was administered 4 hours after single dose of oral 1800 mg hypericin (Saint-John's wort tablets, 0.3%, 300 mg) with a subthreshold light fluence, 24 J/cm2 in 34 eyes (20 with subfoveal classical and 14 with subfoveal occult CNM). Additionally, histopathologic examination was done in two eyes destined for enucleation and exenteration. Maintenance therapy (one tablet, twice a day) was performed for the following 6 months. Anatomic (complete closure of CNM) and functional success (improvement of final visual acuity in three or more Snellen lines) were analyzed with minimum 6-month follow-ups.

Results

Histopathologic examinations revealed photothrombosed choriocapillaries together with minimal retinal pigment epithelial disruption in H-ALP exposed areas. One to four (mean 1.88±0.91) treatment sessions were applied in 6 to 29 months (mean 12.2±5.1 months) follow-up period. Twenty-three (67.6%) eyes had 12 months follow-up. Two eyes in each group had functional success (20% in subfoveal classical and 14.3% in subfoveal occult CNM), which had a minimum 12-month follow-up. Anatomic success was achieved in 16 of 20 (80%) eyes with subfoveal classical and 10 of 14 (71.4%) eyes with subfoveal occult CNM. Severe gastric irritation was noted in 1 (2.9%) and pigment epithelial rupture in 2 (5.9%) patients.

Conclusions

H-ALP is a novel and low-cost treatment for subfoveal CNM secondary to ARMD. It seems its efficacy depends on the photodynamic and antiproliferative properties of hypericin. Comparative studies are required to apply this new technique in ophthalmic practice.
25-Gauge Transconjunctival Sutureless Pars Plana Vitrectomy
Authors: Yanyali A. , Celik E. , Horozoglu F. , Oner S. , Nohutcu A.F.
Published: January 2018

Purpose

To evaluate the effectiveness, feasibility, and safety of the transconjunctival sutureless vitrectomy (TSV) system for a variety of vitreoretinal diseases.

Methods

In this retrospective study, the authors evaluated 71 eyes of 63 patients who underwent pars plana vitrectomy (PPV) with the 25-gauge TSV system. The indications for surgical intervention were diabetic vitreous hemorrhage (29 eyes), diabetic macular edema (14 eyes), macular epiretinal membrane (13 eyes), endophthalmitis (5 eyes), vitreous opacities secondary to Behçet's disease (4 eyes), vitreous hemorrhage secondary to branch retinal vein occlusion (4 eyes), and vitreous hemorrhage secondary to age-related macular degeneration (2 eyes). Epiretinal membrane and internal limiting membrane removal, endolaser photocoagulation, and air-fluid exchange were performed when required.

Results

Mean follow-up was 3.6 months (range 1–8 months). Mean overall visual acuity (VA) was counting fingers (range light perception to 0.4) preoperatively and 0.2 (range 0.1 to 0.8) postoperatively (p=0.000). Statistically significant VA improvement was observed in eyes with vitreous hemorrhage, diabetic macular edema, and macular epiretinal membrane. VA improved postoperatively in all eyes with endophthalmitis and vitreous opacities secondary to Behçet's disease. The surgery was completed without conjunctival and scleral suturing in all eyes. Mean intraocular pressure (IOP) was 17.2 mmHg (range 10–26 mmHg) preoperatively, 12.4 mmHg (range 6–24 mmHg) on the first postoperative day, 16.6 mmHg (range 10–33 mmHg) at 1 week, and 15.4 mmHg (range 10–20 mmHg) at 1 month postoperatively. On the first postoperative day, IOP was below 10 mmHg (between 6 and 9 mmHg) in 12 eyes (16.9%). In these eyes, IOP was normalized within 1 week without affecting the visual outcome. Five eyes (7%) had transient increase of IOP controlled by topical antiglaucomatous medications. Vitreous washout using 25-gauge TSV system was performed in two eyes, in which vitreous hemorrhage recurred.

Conclusions

The TSV system was observed to be feasible, effective, and safe for a variety of vitreoretinal diseases. This minimally invasive and completely sutureless (transconjunctival) technique appears to decrease the convalescence period, operating time, and postoperative inflammatory response, and improve patient comfort.
Nocardia Keratitis: A Case Report
Authors: Matuska S. , Rama P. , Cavallero A. , Paganoni G. , Spinelli A. , Brancato R.
Published: January 2018

Purpose

To describe a case of Nocardia keratitis resistant to 2% amikacin, with a toxic-allergic reaction to fortified topical 5% amikacin, and recurrence of the infection with topical corticosteroids.

Methods

Nocardia was diagnosed from a smear and positive culture and identified as Nocardia asteroides by gas chromatography and quantitative fatty acid analysis using the Microbial Identification System. Treatment was started with topical 2% amikacin, which was subsequently raised to 5% because of clinical resistance.

Results

A toxic-allergic reaction was observed after 5% amikacin so the drug was discontinued and commercially available drugs combining 1% chloramphenicol, 0.5% tetracycline, and 18 mil IU colistin with 0.3% ofloxacin were given. These were well tolerated and the infection improved quickly. After 1 month the antibiotics were discontinued and topical 0.1% clobetasone was given to reduce scar formation. The infection recurred after 1 week but responded to 3 months of the previous antibiotic combination and its sensitivity was checked with the Epsilometer test.

Conclusions

Nocardia keratitis may not respond to 2% topical amikacin and fortified topical 5% amikacin may cause a strong toxic-allergic reaction. A commercially available combination of chloramphenicol, tetracycline, and colistin, with ofloxacin, may be effective but the treatment must be continued for several months. Topical steroids should only be used with considerable caution since they can lead to relapse of the infection.
Visual Outcome after Excimer Laser Refractive Surgery in Adult Patients with Amblyopia
Authors: Roszkowska A.M. , Biondi S. , Chisari G. , Messina A. , Ferreri F.M.B. , Meduri A.
Published: January 2018

Purpose

To evaluate the visual and refractive outcome in adult patients with refractive and anisometropic amblyopia treated with photorefractive keratectomy.

Methods

An interventional non-comparative study was performed on 50 consecutive patients with amblyopia treated with photorefractive keratectomy. Sixty-eight eyes of 18 participants with bilateral refractive amblyopia and 32 participants with unilateral anisometropic amblyopia were studied. The photorefractive keratectomy was performed with MEL 70 G-Scan excimer laser. Follow-up was 1, 3, 6, and 12 months after the treatment. The mean outcome measures were uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), refraction, and corneal transparency.

Results

In 64.7% of eyes, the UCVA at 12 months after the treatment was better than or equal to their preoperative BCVA. A total of 82.4% of eyes improved their BCVA one or more lines. No eye lost lines of BCVA, 17.6% remained unvaried, 50% gained one line, 20.6 % gained two lines, and 11.8% gained three lines of BCVA. The number of lines gained correlated strongly with diopters of anisometropia between eyes (p<0.01). The mean sphere changed from –5.62±3.37D to –0.47±1 D, mean cylinder varied from -2.36±1.57 to –0.18±0.41 D, and the spherical equivalent varied from –6.82±3.1 to –0.45±1.08 D. No clinically significant haze was observed.

Conclusions

Excimer laser refractive surgery appears to be a safe and efficient procedure in the treatment of ametropic and anisometropic amblyopia in adults. Adult patients with anisometropic and refractive amblyopia could benefit from the refractive treatment with significant improvement of the visual acuity.
Pseudoexfoliation Syndrome and its Antioxidative Protection Deficiency as Risk Factors for Age-Related Cataract
Authors: Zoric L. , Miric D. , Milenkovic S. , Jovanovic P. , Trajkovic G.
Published: January 2018

Purpose

Pseudoexfoliation syndrome (PES) seems to be a systemic condition. However, to an ophthalmologist it represents a continual challenge, due to unclear etiology and pathogenesis, and because of a potential for development of an aggressive glaucoma, and cataract surgery complications. According to some findings, PES could be a factor of hastened aging, which means that it could be considered as a secondary aging factor.

Methods

Frequencies of secondary aging diseases (non-insulin dependent diabetes mellitus, atherosclerotic myocardiopathy chronic obstructive lung diseases, arterial hypertension, and PES) were investigated in 162 patients with age-related cataract and 55 age- and sex-matched control subjects, and analyzed by a logistic regression. The authors also determined elements of antioxidative protection in a group of sera from patients with cataract and PES, and compared them to those obtained from patients with cataract without PES (activity of catalase and peroxidase, glutathione, vitamins C and E), and total antioxidative protection (%iMDA). Antioxidant defense of aqueous humors, expressed as a rate of induced malondialdehyde (%iMDA), and total thiol groups in the lens corticonuclear blocks (TSH) were estimated in samples of 17 patients with PES and cataract and 55 patients with cataract only.

Results

Logistic regression showed the highest odds ratio for PES (OR=4.516; p<0.05). Catalytic activity of serum catalase had significantly lower values in patients with PES (p<0.05). Antioxidative defense of aqueous humor and lens had lower values in patients with PES.

Conclusions

The results indicate that PES might be a significant factor for cataractogenesis. At least a part of pathogenesis alterations in an eye with PES could be the result of higher intensity of oxidative stress.
Preoperative Factors Influencing Visual Outcome following Surgical Excision of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration
Authors: Shimada H. , Fujita K. , Matsumoto Y. , Mori R. , Yuzawa M.
Published: January 2018

Purpose

To evaluate long-term visual acuity outcomes and the influences of various preoperative factors on visual outcome in patients undergoing surgical removal of choroidal neovascular neovascularization (CNV) caused by age-related macular degeneration (ARMD).

Methods

The authors studied 146 eyes of 146 patients who were followed for at least 1 year after surgical excision of CNV associated with ARMD. Surgical indications included subfoveal active CNV localized mainly above the retinal pigment epithelium (RPE) and a standard Japanese decimal visual acuity of 0.3 or worse. CNV above the RPE was diagnosed by fluorescein angiography, indocyanine green angiography, and optical coherence tomography. CNVs were divided into completely classic CNV or mainly classic CNV. The relationships of the postoperative logarithm of the minimum angle of resolution (logMAR) visual acuity with preoperative logMAR visual acuity, the shortest distance from the center of the foveal avascular zone to the CNV margin, CNV size, and age were analyzed.

RESULTS

Final logMAR visual acuity was improved (defined as a logMAR visual acuity increase of 0.2 or more) in 78 eyes (54%), stable in 47 (32%), and worsened in 21 (14%). Stepwise regression identified CNV size as a significant factor influencing final logMAR visual acuity (R2 = 0.213, p<0.0001), while preoperative logMAR visual acuity, shortest distance from the center of the foveal avascular zone to the CNV margin, and age showed no significant correlation with final logMAR visual acuity. Surgical complications included retinal detachment in six eyes (4%), subretinal hematoma in four eyes (2%), macular hole in three (2%), and proliferative vitreoretinopa thy in two (1%). CNV recurred postoperatively in 18 eyes (12%). In 92 eyes with completely classic CNV, visual acuity was improved in 57 (62%), stable in 27 (29%), and worsened in 8 (9%). In 54 eyes with mainly classic CNy visual acuity was improved in 21(39%), stable in 20 (37%), and worsened in 13 (24%).

Conclusions

Surgical excision of CNV for ARMD was effective for completely classic CNV, and better postoperative visual acuity was achieved in cases of small CNV. Given the fact that photodynamic therapy (PDT) has only been used in Japan since 2004, future study should compare PDT and surgical excision in Japanese subjects for relative merits against surgical risk and postoperative complications, to define indications for PDT and surgical excision.
Severe Orbitopalpebral Emphysema after Nose blowing Requiring Emergency Decompression
Authors: García-Medina J.J. , García-Medina M. , Pinazo-Durán M.D.
Published: January 2018

Purpose

Orbital emphysema is a frequent condition associated with medial wall fractures after blunt trauma. It is usually a benign, self-limited phenomenon. The authors are unaware of previous reports of severe orbital emphysema needing emergency decompression with no evidence of any previous significant trauma such as the case presented herein.

Methods/Results

A 51-year-old woman had painful swelling of the left orbital region that prevented her from opening her eyelids. She complained of a coincident cold with abundant mucous rhinorrhea. She had blown her nose vigorously several times. A computed tomography scan revealed a left proptosis, an extensive orbitopalpebral emphysema, and a blowout fracture of the medial wall of the left orbit. A complete ophthalmic examination was only possible after a needle decompression. No significant ocular damage was observed, so outpatient treatment was provided. Twenty-eight hours later, the swelling had almost disappeared, and the ocular assessment was normal.

Conclusions

A forceful expiratory effort raising intranasal pressure may cause a medial wall orbital fracture. If the airway hyperpressure episodes are repeated, a severe orbitopalpebral emphysema may develop. Should there be any suspicion of vascular compression, it must be drained to allow the assessment of visual function and theoretically prevent a potentially irreversible ischemic visual loss.
Endogenous Endophthalmitis by Propionibacterium Acnes associated with Leflunomide and Adalimumab Therapy
Authors: Montero J.A. , Ruiz-Moreno J.M. , Rodríguez A.E. , Ferrer C. , Sanchis E. , Alio J.L.
Published: January 2018

Purpose

To report a case of unusual endogenous endophthalmitis associated with the use of leflunomide and adalimumab.

Methods

A 48-year-old woman on treatment with leflunomide and a dalimumab for rheumatoid arthritis developed an endogenous endophthalmitis caused by Propionibacterium acnes. Diagnosis was confirmed by polymerase chain reaction and positive cultures. The patient underwent surgical treatment and intravitreal vancomycin, but the eye developed retinal fibrosis and untreatable retinal detachment.

Results

This report of endogenous endophthalmitis associated with the use of anti-tumor necrosis factor alpha (anti-TNF-α) drugs is consistent with those in the literature. P. acnes may induce pathologic reactions in compromised patients and cause endophthalmitis, but only after ocular surgery or in intravenous drug users. The Naranjo probability scale indicated a probable relationship between the drugs and the infection.

Conclusions

Awareness of atypical infectious conditions in patients on anti-TNF-α drugs is critical for early diagnosis and good outcome.
The Efficiency of Limbal Conjunctival Autografting in Pterygium Surgery
Authors: Kilic A. , Gurler B.
Published: January 2018

Purpose

To investigate the efficiency of limbal conjunctival autografting technique in pterygium surgery.

Methods

Eighty-four eyes of 68 patients with pterygium were treated by simple excision technique and 29 eyes of 24 patients with pterygium were treated by limbal conjunctival autografting technique. The definition of recurrence was fibrovascular tissue over the limbus onto the cornea in the area of previous pterygium excision.

Results

The ages of the patients were between 25 and 88. The follow-up periods ranged from 6 to 25 months. The patients treated by simple excision technique were followed up for 6 to 25 (average 15±6) months and the patients treated by limbal conjunctival autografting technique were followed up for 7 to 24 (average 17±5) months. The recurrence rates were 27% (23 eyes) and 7% (2 eyes), respectively. There was a statistically significant difference in the recurrence rate between the patients who underwent simple excision and those who underwent limbal conjunctival autografting (p=0.016).

Conclusions

Limbal conjunctival autografting is an effective surgical technique for the treatment of pterygium. It has a low recurrence rate when compared with the simple excision technique.
A Sphenoid en Plaque Meningioma Aggravates Exophthalmos in a Patient with Thyroid Ophthalmopathy
Authors: Asproudis I.C. , Petsanas A.P. , Nikas A.N. , Vranos G.H. , Kalogeropoulos C.D. , Polyzoidis K.S.
Published: January 2018

Purpose

To describe the rare case of a patient with thyroid ophthalmopathy whose unilateral aggravated exophthalmos was caused by the development of an ipsilateral sphenoid wing en plaque meningioma.

Methods

Case report.

Results

The ophthalmologic examination included visual acuity assessment, anterior segment examination, funduscopy, ocular motility examination, and exophthalmometry. Magnetic resonance imaging (MRI) of the brain and orbit revealed the existence of a sphenoid meningioma. Removal of the tumor through a pterional craniotomy was performed. The histologic examination showed that it was an en plaque meningioma. There were no postoperative complications and no recurrence of the tumor was revealed 24 months after the operation.

Conclusions

Detailed ophthalmologic examination and MRI of the brain and orbit are necessary in every patient with deterioration of the exophthalmos even if the suggestive cause seems obvious.