bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Diagnostic Yield of Vitrectomy Specimen Analysis in Chronic Idiopathic Endogenous Uveitis
Authors: Garweg J.G. , Wanner D. , Sarra G.-M. , Altwegg M. , Loosli H. , Kodjikian L. , Halberstadt M. 
Published: January 2018

Purpose The low diagnostic yield of vitrectomy specimen analysis in chronic idiopathic uveitis (CIU) has been related to the complex nature of the underlying disease and to methodologic and tissue immanent factors in older studies. In an attempt to evaluate the impact of recently acquired analytic methods, the authors assessed the current diagnostic yield in CIU. Methods Retrospective analysis of consecutive vitrectomy specimens from patients with chronic endogenous uveitis (n = 56) in whom extensive systemic workup had not revealed a specific diagnosis (idiopathic) and medical treatment had not resulted in a satisfying clinical situation. Patients with acute postoperative endophthalmitis served a basis for methodologic comparison (Group 2; n = 21). Results In CIU, a specific diagnosis was provided in 17.9% and a specific diagnosis excluded in 21.4%. In 60.7% the laboratory investigations were inconclusive. In postoperative endophthalmitis, microbiological culture established the infectious agent in 47.6%. In six of eight randomly selected cases, eubacterial PCR identified bacterial DNA confirming the culture results in three, remaining negative in two with a positive culture and being positive in three no growth specimens. A double negative result never occurred, suggesting a very high detection rate, when both tests were applied. Conclusions The diagnostic yield of vitrectomy specimen analysis has not been improved by currently routinely applied methods in recent years in contrast to the significantly improved sensitivity of combined standardized culture and PCR analysis in endophthalmitis. Consequently, the low diagnostic yield in CIU has to be attributed to insufficient understanding of the underlying pathophysiologic mechanisms.
A Pilot Study of the use of Objective Structural Clinical Examinations for the Assessment of Ophthalmology Education
Authors: Aydin P. , Gunalp I. , Hasanreisoglu B. , Unal M. , Turacli M. Erol 
Published: January 2018

Purpose A pilot study was carried out to evaluate the practicality, reliability, and validity of an objective structured clinical examination (OSCE) for assessing the clinical skills and abilities of specialists in ophthalmology. Methods Ten unfolded OSCE style, criterion referenced questions were asked to nine candidates to assess their clinical skills and abilities, as opposed to subject knowledge. Candidate and assessor reactions to the examination process were monitored and analyzed using participant observation and questionnaires administered immediately after the event. Relevant statistical techniques were applied to the results. Results A total of 89% of candidates passed the examination, with the pass boundary set at 70%. Candidates revealed themselves more successful in meeting clinical skill criteria (mean 77%) than clinical ability criteria (mean 72%). Candidates, assessors, and observers all expressed the view that the OSCE pilot had been a successful way of assessing clinical skills and abilities. Conclusions OSCE style assessment is an effective and efficient means of assessing skills and abilities in clinical ophthalmology education.
Bilateral Atypical Nodular Posterior Scleritis
Authors: Kranias G. , Tyradellis C. , Krebs T.P. , Augsburger J.J. 
Published: January 2018

Purpose To evaluate ocular features of nodular posterior scleritis simulating choroidal melanoma. Methods A 60-year old woman presented with blurred vision in her right eye of two weeks duration. On examination she had a mild right-globe proptosis with an episcleral nodular mass as well as a large elevated nonpigmented choroidal mass involving the nasal quadrant. Results A and B-scan ultrasonography showed a medium to high-reflective solid choroidal mass. MRI demonstrated a bi-convex mass in the medial aspect of the right globe with signal characteristics compatible with choroidal melanoma. Biopsy of the extra ocular lesion demonstrated chronic inflammatory cell infiltrate suggestive of posterior scleritis. She responded to corticosteroid therapy. On evaluation 41 months later she was noted to have a similar choroidal mass in the left eye. Conclusions The physician should be aware of the clinical manifestations and diagnostic hallmarks of nodular posterior scleritis in order to differentiate this inflammatory process from choroidal melanoma.
Microperimetric Evaluation of Macula in Retinopathy of Membranoproliferative Glomerulonephritis Type II: A Case Report
Authors: Shenoy R. , Mccillvenny S. 
Published: January 2018

Purpose To report on the microperimetric evaluation of the central visual field in a patient with retinopathy due to membranoproliferative glomerulonephritis. Methods The central 20° visual field was evaluated using fundus-related perimetry with (Nidek MP1) microperimeter in a patient with proven membranoproliferative glomerulonephritis type II, who had multiple drusen-like lesions involving the posterior pole of both eyes, with corresponding window defects on fundus fluorescein angiogram. Results Static threshold perimetry of the central 20° using a 10 dB threshold, Goldmann size II stimulus, with (Nidek-M P1) microperimeter showed reduction in retinal sensitivity in the parafoveal and in the temporal paramacular areas in both the eyes that had drusen-like lesions. Conclusions Early loss of function in retinopathy of membranoproliferative glomerulonephritis type II can probably be detected by fundus-related microperimetry.
Retinal Fibrovascular Proliferation associated with Nocardia Subretinal Abscess
Authors: Rafiei N. , Tabandeh H. , Bhatti M.T. , Monshizadeh R. 
Published: January 2018

Purpose To report the development of extensive fibrovascular proliferation in association with Nocardia subretinal abscess. METHOD. Case report. Results Extensive retinal neovascularization with fractional retinal detachment developed soon after ocular involvement in a 61-year-old patient with systemic nocardiosis. Fundus fluorescein angiography showed extensive area of capillary nonperfusion and severe leakage from the neovascular complex. The Nocardia subretinal abscess responded to systemic antibiotics, and the retinal neovascularization and fractional retinal detachment stabilized after 3 months. Conclusions Retinal ischemia and severe retinal neovascularization may complicate intraocular nocardiosis. The authors propose secondary retinal vasculitis as a contributing factor towards the development of retinal ischemia in this setting.
Ocular Münchausen Syndrome Resulting in Bilateral Blindness
Authors: Salvo M. , Pinna A. , Milia P. , Carta F. 
Published: January 2018

Purpose Münchausen syndrome is a factitious disorder in which patients knowingly harm themselves for subconscious psychological reasons in order to be hospitalized. Recognition of this psychopathology is important, to prevent potentially severe eye damage. Ocular Münchausen syndrome is uncommon. The authors describe an elderly woman with recurrent, probably self-induced, ocular trauma leading to bilateral blindness. The authors are unaware of any previously reported cases of Münchausen syndrome resulting in bilateral blindness and occurring in old age. CASE REPORT. A 73-year-old woman was first seen in 1991 with a closed-globe injury to the right eye, apparently following a household fall. Physical examination showed no sign of extraocular trauma. Right visual acuity was 20/30 after 2 months. She was readmitted in May 2003 with left globe rupture, allegedly following a domestic fall. No extraocular trauma was found. She developed ocular phthisis 6 months postoperatively. The patient was admitted again in February 2004 with right globe rupture, following another alleged domestic fall. Physical examination showed no sign of extraocular trauma. Right visual acuity was 20/400 2 months postoperatively. Psychiatric evaluation revealed Münchausen syndrome. Psychotherapy was prescribed, but refused by her family. Conclusions Diagnosis of Münchausen syndrome is difficult to make in the ophthalmic department. Münchausen patients have little or no ability to control their self-destructive behavior. A sympathetic and supportive approach is therefore required and these patients should be urgently referred to a psychiatrist with experience in factitious disorders. Even with psychotherapy, which is often refused, the prognosis remains poor.
Long-Term Results after Treatment of Basal Cell Carcinoma of the Eyelid in Southwestern Finland
Authors: Paavilainen V. , Tuominen J. , Aho V.V. , Saari K.M. 
Published: January 2018

Purpose Basal cell carcinoma (BCC) is the most common skin cancer of the eyelid, showing an increasing incidence in the white population. The authors studied the clinical characteristics and the treatment results of BCC of the eyelid in southwestern Finland during 1977–1997. Methods The authors reviewed the case records of 191 patients with BCC of the eyelids treated at the Turku University Eye Clinic during 1977–1997. The mean follow-up period after the treatment was 8.6±5.2 years. Results The 191 patients had altogether 194 BCC tumors of the eyelid with the mean diameter of the tumor being smaller than 10 mm in 77.3% of cases. Of the 194 BCC tumors of the eyelid 16.0% showed recurrence, and the recurrence rate of all surgically treated tumors was 13.7%. In this study 61 patients (31.9%) developed other malignancies than the BCC of the eyelid including 28 patients (14.7 %) with carcinoma in other locations than skin. Conclusions Incompletely removed BCCs of the eyelid showed only 18.9% recurrence rate during the follow-up time. On the other hand, BCCs of the eyelid should not be underestimated because of the rather high total recurrence rate. The frequency of 31.9% of other malignancies than BCC of the eyelid is remarkably high and requires special attention from the ophthalmologist taking care of the patient with BCC of the eyelid.
Visual Field Damage and Progression in Glaucomatous Myopic Eyes
Authors: Perdicchi A. , Iester M. , Scuderi G. , Amodeo S. , Medori E.M. , Recupero S.M. 
Published: January 2018

Purpose To make a visual field retrospective analysis on a group of patients with primary open angle glaucoma (POAG) and to evaluate whether different refractive errors could have different progression of the 30° central sensitivity. Methods A total of 110 patients with POAG (52 men and 58 women) were included in the study. All the patients were divided into four subgroups based on the refractive error. The visual field of all the included patients was assessed by an Octopus 30° central visual field every 6 months, for a total of 837 visual fields examined. The resulting data were analyzed by PERIDATA for Windows 1.7 TREND function. Mean defect (MD) and loss variance (LV) were considered for the analysis. Results At the first examination, 82% of eyes showed a global decrease of differential light sensitivity (MD >2 dB) and in 67% the distribution of the defect was nonhomogeneous (LV >6 dB). The analysis of variance for subgroups showed a more significant decrease of MD in highly myopic patients. A linear regression analysis highlighted a statistically significant change in time of MD in 36% and of LV in 34% of the eyes studied. Highly myopic patients had the highest (p<0.01) percentage of change of MD and LV (46% and 42%, respectively). Among the four subgroups, there was no difference in progression of MD decrease in time. Conclusions These results showed that after 5 years of glaucoma, the visual field was altered in most of the eyes examined (82%) and that in 67% of cases, its defect was nonhomogeneous and worsened with the increase of myopia. The regression linear analysis of visual field changes in time showed a progressive increase of MD and LV in approximately one third of all the eyes examined.
Topographic Spatial Summation in Glaucoma
Authors: De La Rosa M. Gonzalez , Gonzalez-Hernandez M. , Lopez V. Lozano , Sanz D. Perera 
Published: January 2018

Purpose Stimulus luminance (L) and area (A) are related by the equation LxAk=constant. The authors evaluated the k value at 66 positions of the central visual field in patients with glaucoma, to modify L and A simultaneously in order to examine advanced glaucomas with a bigger dynamic range. Methods The luminance limitation of a computer screen with automatic photometric control was compensated for by increasing the stimulus area in the range between 0 and 17 dB, using the k topographic values previously calculated on normal subjects. Four initial series of 21, 12, 10, and 10 glaucomas were sequentially examined with the Octopus 311 in which the stimulus size cannot be freely changed during the examination, and with the experimental method (Pulsar-SAP) modifying stimulus sizes to equal the results. k Final estimation was verified in 60 new cases. Results k Values increase progressively with defect deepness. Values higher than those of the normal population with equivalent topographic differences were obtained. Correlation between indices was as follows: MD: r=0.94 (p<0.0001); square root of the loss of variance (sLV): r=0.93 (p<0.0001). Frequency of local defects was similar in both procedures. Average topographic differences between thresholds were usually less than 1 dB. The average threshold difference favored Pulsar-SAP by 0.45 dB at those points where the average threshold of both examinations was less than 18 dB and 0.37 dB where such average was higher than or equal to 18 dB. Conclusions k Value is higher in patients with glaucoma than in normal subjects, although the topographic features are similar. It is feasible to design a scale combining stimulus luminance and sizes to use screens with relative low brightness as surfaces for visual field examination.
Hydrophilic Acrylic Intraocular Lens Clouding: A Clinicopathological Review
Authors: Taboada-Esteve J.F. , Hurtado-Sarrió M. , Duch-Samper A.M. , Cisneros-Lanuza A. , Menezo-Rozalen J.L. 
Published: January 2018

Purpose An analysis is made of a serious late complication (opacification) of different models of hydrophilic acrylic intraocular lenses (IOLs). Methods Seven lenses were explanted from seven patients treated for cataracts with phacoemulsification and implantation of different types of hydrophilic acrylic IOLs (five SC60B-OUV from MDR, one Aquasense from OII, and one H60M Hydroview lens from Bausch & Lomb) who developed important vision impairment in the late postoperative period (1 to 3 years) due to lens opacification. The explanted lenses were subjected to exhaustive study involving photographic analysis, scanning electron microscopy, and energy dispersive X-ray spectroscopy. Results Light and scanning electron microscopy revealed diffuse, variable-size granular deposits within the optic of the SC60B-OUV lens, and on the anterior and posterior optic surfaces of the H60M Hydroview lens, though without affecting the haptics in any of the models. Dispersive energy X-ray spectroscopy of the deposits revealed the presence mainly of calcium and phosphorus salts. Conclusions Hydrophilic acrylic IOL opacification is a serious late complication of unknown etiology. The condition is more frequent among diabetic patients, and the only management option is IOL explantation and replacement with a lens of some other material. More frequent and longer follow-up is required of those patients wearing lenses for which cases of opacification have been documented, particularly in the presence of predisposing factors (diabetes, uveitis). Caution is required with new lenses, avoiding their generalized use until they have successfully passed the test of time.
Risk Factors for Redetachment and Worse Visual Outcome after Silicone Oil Removal in Eyes with Complicated Retinal Detachment
Authors: Goezinne F. , La Heij E.C. , Berendschot T.T.J.M. , Liem A.T.A. , Hendrikse F. 
Published: January 2018

Purpose The goal of this study was to identify risk factors for redetachment and/or a worse visual outcome after silicone oil removal (SOR) for complicated retinal detachment. Methods The authors retrospectively analyzed 287 consecutive eyes with SOR between January 1999 and December 2003. Results Anatomic success after SOR was achieved in 81% of the eyes. The overall anatomic success at the end of follow-up was 94%. Postoperative ocular hypertension was found in 8% of the eyes, hypotony in 6% of the eyes, and keratopathy in 29% of the eyes. After SOR 43% of the eyes had an improvement in visual acuity of at least two Snellen lines. After multivariate analysis, male sex, the presence of preoperative rubeosis, and proliferative diabetic retinopathy (PDR) were found to be risk factors for recurrent retinal detachment. Male sex, preoperative visual acuity of <0.1 Snellen lines, PDR, the performance of three more operations, any size of retinectomy, and hypotony were found to be associated with a poor visual outcome of Snellen visual acuity <0.1. Conclusions Retinal detachment after SOR in the current unselected series of eyes occurred in approximately 20%, which is comparable to the Silicone Oil Study reports, published approximately 20 years ago. However, preoperative selection was then made, and less than 50% of the silicone oil-filled eyes had SOR. The higher overall anatomic success in the current study may be due to improved vitreoretinal surgical techniques.
ReSTOR® Diffractive versus Array®2 Zonal-progressive Multifocal Intraocular Lens: a Contralateral Comparison
Authors: Renieri G. , Kurz S. , Schneider A. , Eisenmann D. 
Published: January 2018

Purpose To evaluate near and distance visual performance after implantation of a diffractive multifocal intraocular lens (MIOL) (AcrySof ReSTOR®) or a refractive MIOL (Array®2) in bilateral cataract surgery. Methods In this prospective, comparative trial, 18 patients with bilateral cataract were selected to have lens surgery with asymmetric MIOL implantation. Eighteen eyes received ReSTOR MIOL and the 18 fellow eyes were implanted with Array 2. Five months after second lens implantation, main postoperative outcomes were uncorrected and distance corrected near visual acuities (VA). Secondary outcomes were distance VA and near acuity with power add, contrast sensitivity with and without glare (Pelly-Robson Contrast Sensitivity Chart, CSV 1000 HGT). Quality of vision was measured by comparing the severity of visual symptoms as referred to a masked interviewer. Results Patients reported similar postoperative distance visual acuities for both eyes. ReSTOR-implanted eyes showed better uncorrected and distance corrected near acuity than eyes with Array 2 (p=0.002 and p=0.003, respectively). Intermediate VA with distance correction was slightly higher with the Array 2 MIOL (p=0.058). No important difference was observed in contrast sensitivity, glare disability, and subjective rating of light sensations. Severe photic phenomena were reported only for one Array 2-implanted eye. Conclusions The diffractive MIOL showed better uncorrected and distance corrected near VA. The refractive Array 2 MIOL had a tendency to better value for intermediate distance. Disturbing photic phenomena were observed only in one case with the Array 2 MIOL.
Control of Inflammation and Prophylaxis of Endophthalmitis after Cataract Surgery: A Multicenter Study
Authors: Camesasca F.I. , Bianchi C. , Beltrame G. , Caporossi A. , Piovella M. , Rapisarda A. , Tassinari G. , Zeppa L. ,   For The Italian Betamethasone-Chloramphenicol Vs Dexamethasone-Tobramycin Combination Study Group
Published: January 2018

Purpose To compare two different postcataract surgery antibiotic/steroid therapeutic combinations, for clinical results as well as patient satisfaction. Methods Prospective randomized clinical trial of patients with bilateral operative cataract. Postoperatively, for 15 days one eye was randomly assigned to therapy with the combination chloramphenicol 0.25%-betamethasone 0.13% gel three times a day (Group 1) and the other to the combination tobramycin 0.3%-dexamethasone 0.1% eyedrops four times a day (Group 2). Results A total of 142 patients (284 eyes) completed the study. The authors could not detect any significant difference between Group 1 and Group 2 concerning preoperative evaluation, surgical procedure, and complications. Pertaining to the two therapeutic regimens, efficacy, side effects, and clinical findings such as uncorrected visual acuity, intraocular pressure, edema or hyperemia of eyelids and/or conjunctiva, conjunctival and/or ciliary vessels congestion, decreased corneal transparency, corneal edema, Descemet folds, anterior chamber Tyndall and depth, and posterior synechiae were also comparable. Postoperative subjective pain and dry eye sensation were comparable between the two groups, while the gel preparation elicited a significantly more pleasant sensation in the patients (p=0.04). Conclusions The motivation for use of a gel is to prolong the permanence of associated drugs on the ocular surface, increasing potency and decreasing concentration of the drug and rate of administration. This in order to improve compliance and decrease potential side effects. Chloramphenicol 0.25%-betamethasone 0.13% gel combination proved to have comparable efficacy, tolerance, and better acceptance by the patients than an aqueous tobramycin 0.3%-dexamethasone 0.1% preparation.
Efficacy of Anterior Chamber Paracentesis after Intravitreal Triamcinolone Injection
Authors: Chang W. , Chung M. 
Published: January 2018

Purpose To investigate the efficacy of anterior chamber paracentesis for intravitreal triamcinolone acetonide injection (IVTA). Methods A prospective, randomized clinical trial was conducted on 30 eyes from 30 patients scheduled for IVTA (4 mg/0.1 mL). Eyes were randomly divided into two groups: eyes that had undergone anterior chamber paracentesis (Group 1, 15 eyes) and eyes that did not have anterior chamber paracentesis (Group 2, 15 eyes). Intraocular pressure (IOP) was measured by Goldmann applanation tonometry at a baseline of 2, 15, 30, and 60 minutes at 1 day and 1 week after the injection. The authors analyzed the short-term postoperative changes of the IOP in each group. Results For Group 1, the mean preoperative IOP was 15.33±1.72 mmHg, and the postoperative IOP at 2 and 15 minutes were 7.80±1.47 and 11.73±1.67 mmHg, respectively. For Group 2, there was a significant elevation of IOP (46.73±8.26 mmHg) 2 minutes after the injection, which decreased to the normal range (16.13±2.61 mmHg) by 15 minutes after the injection. There were no significant differences between the two groups in IOP at 15 minutes postsurgery compared with the distinct difference in IOP at 2 minutes post surgery (Student t-test, p=0.01). Conclusions The findings suggest that routine anterior chamber paracentesis is inappropriate due to the brief immediate postoperative IOP elevation with IVTA.
Epidural Empyema Secondary to Orbital Cellulitis: A Case Report
Authors: Meena M.K. Brijlal , Sharma P. 
Published: January 2018

Purpose To report a case of epidural empyema, a rare complication of orbital cellulitis, underlining the importance of early diagnosis and appropriate therapy to avoid severe complications often associated with this disease. Methods The treatment was initiated with extended spectrum antibiotics such as third generation cephalosporins along with aminoglycoside or metronidazole for anaerobes. Results The patient responded well and was asymptomatic after 15 days. Radiologic investigations (computed tomography/magnetic resonance imaging) should be done on an emergency basis. Treatment should be aggressive with parenteral use of extended spectrum antibiotics. The role of steroid is when proptosis is causing lagophthalmos with exposure keratitis and/or optic nerve compression. Judicious surgical intervention can be life saving in this emergency. Peribulbar antibiotic injection has no role in the therapy. Conclusions The authors present a unique case of epidural empyema secondary to orbital cellulitis associated with an episode of epileptic seizure.